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MRCS A > Miscellaneous stuff I get wrong p1 > Flashcards

Miscellaneous stuff I get wrong p1 Flashcards

1
Q

What structures suspend the spinal cord within the dural sheath?

A

denticulate ligaments

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2
Q

What is tidal volume

A

volume of air inspired and expired in a normal breath
500 males
350 female s

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3
Q

what is the inspiratory reserve volume

A

maximum volume per inspiration
c. 3000mls

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4
Q

what is the expiratory reserve volume

A

maximum volume per expiration
c. 1000mls

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5
Q

what is the reserve volume

A

volume in lungs after a max expiration
c 1500mls

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6
Q

what is the FRC lungs

A

volume in lungs at the end of a normal expiration
= RV + ERV

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7
Q

what is the vital capacity

A

maximum volume of air that can be forcibly exhaled after a maximum inhale
c 4000mls male
c 3500mls female

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8
Q

what is the TLC (total lung capacity)

A

volume of air in lungs after max insp
FRC + TV + IRV
c. 6000mls

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9
Q

what is lung compliance

A

change in lung volume per unit change in air pressure

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10
Q

what increases lung compliance? (2)

A

age
emphysema

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11
Q

what decreases lung compliance (4)

A

pulmonary oedema
pulmonary fibrosis
pneumonectomy
kyphosis

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12
Q

management of transection of a nerve - <1cm gap

A

primary surgical repair

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13
Q

management of transection of a nerve - >2.5cm gap

A

autologous nerve grafting

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14
Q

management of median nerve injury in distal 1/3 forearm

A

fascicular repair

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15
Q

management of closed tibial shaft fracture

A

manage conservatively

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16
Q

management of transphincteric fistula

A

seton

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17
Q

how does hypovolaemia lead to AKI

A

hypovolaemia –> decreased renal blood flow –> hypoxic injury –> ATN

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18
Q

pre-operative management if comes back as MRSA +ve

A

mupirocin nasal ointment
chlorhexidine mouth wash

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19
Q

when to use full thickness over partial thickness skin grafts

A

very small area of burn/skin needing fraft

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20
Q

how to urgently reverse warfarin pre-operatively

A

prothrombin complex

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21
Q

pre-operatively - if patient is anaemic Mx

A

2 weeks of oral iron pre-surgery

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22
Q

who to avoid O+ blood transfusions in

A

women of childbearing age

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23
Q

lidocaine dose adults

A

3mg/kg without adrenaline
7mg/kg with adrenaline

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24
Q

thyroid tumour >4cm Mx

A

total thryoidectomy
+ RAI to reduce risk recurrence

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25
Q

tension pneumothorax 1st step Mx

A

needle decompression 5th ICS Mid axillary line
then after can do chest drain

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26
Q

Bohr curve - which states shift to the LEFT

A

increased pH (hence decrease CO2)
decreased DPG
decreased temp

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27
Q

Bohr curve - which states shift to the RIGHT

A

decreased pH (hence increase CO2)
increased temp
increase DPG

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28
Q

ABx which act on the cell wall (2)

A

penicillins
cephalosporins ee.g. ceftraixone

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29
Q

ABx which inhibit protein synthesis (5)

A

fusidic acid
aminoglycosides (misread MRNA)
chloramphenicol
macrolides (50s subunit ribosomes)
tetracyclines

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30
Q

ABx which inhibit DNA synthesis (4)

A

quinolone (ciprofloxacin - inhibit topoisomerases)
metronidazole
sulphonamides
trimethoprim (bacterial folate synthesis inhibition)

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31
Q

which ABx inhibits RNA synthesis

A

rifampicin

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32
Q

how does cutting mode on monopolar diathermy work

A

pressure is applied to the tissues to vaporise the water content

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33
Q

how does coagulation mode on the monopolar diathermy power

A

pressure is applied, lower than cutting mode so coagulum is form instead of vapor

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34
Q

blend mode monopolar diathermy

A

alternates between cutting and coagulation mode
for procedures e.g. polypectomy

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35
Q

how does bipolar diathermy work

A

electric current flows from one electrode to the other, both contained within the same device e.g. a pair of forceps

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36
Q

e.g.s of USS based devices surgery

A

CUSA
Harmonic scalpel

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37
Q

how do CUSA/Harmonic scalpels work

A

high frequency oscillations to seal and coagulate tissues
different energy settings allow them to dissect + seal vessels simultaneously

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38
Q

hazards of diathermy (2)

A

patient burn
explosion/fire

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39
Q

which week of embryogenesis do dermatomes arise from

A

3rd week

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40
Q

embryogenesis of dermatomes

A

3rd week
31 somites –> 31 spinal nn
split into dorsal + ventral
ventral = sclerotome (ribs/VC)
dorsal = dermomyotomes

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41
Q

myotomes - UL - C5

A

abduction shoulder

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42
Q

myotomes - UL - C6

A

elbow flexion

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43
Q

myotomes - UL - C7

A

elbow extension

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44
Q

myotomes - UL - C8

A

finger flexion

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45
Q

myotomes - UL - T1

A

finger abduciton

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46
Q

myotomes - LL - L2

A

hip flexion

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47
Q

myotomes - LL - L 3

A

knee exptension

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48
Q

myotomes - LL - L4

A

ankle dorsiflexion

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49
Q

myotomes - LL - L5

A

hallux extension

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50
Q

myotomes - LL - S1

A

ankle plantarflexion

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51
Q

conditions associated with oslers nodes (4)

A

SLE
gonorrhoea
typhoid
haemolytic anaemia
endocarditis

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52
Q

bouchards are found at

A

PIPJ

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53
Q

heberdens are found at

A

DIPJ

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54
Q

liver injury grade 1

A

<10% SA haematoma
laceration <1cm

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55
Q

liver injury grade 2

A

haematoma 10-50% SA or intraparenchyma <10cm
laceration - capsular tear 1-3cm in depth

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56
Q

liver injury grade 3

A

haematoma >50% SA or intraparenchymal >10cm
laceration - capsular tear >3cm depth
vascular injury within parenchyma

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57
Q

liver injury grade 4

A

laceration - involving 25-75% hepatic lobe or 1-3 segments
vascular injury breaching parenchyma into peritoneum

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58
Q

liver injury grade 5

A

> 75% hepatic lobe
juxtahepatic vessel injury

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59
Q

which cells produce gastric acid

A

parietal cells

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60
Q

what are the 3 phases of gastric acid secretion

A

1) cephalic phase - smell/taste food - 30% acid prod
- vagal stim –> HCL + gastrin release
2) gastric phase - distension stomach - 60% acid prod
stomach distends + low H+ + peptides –> gastrin release
3) intestinal phase - 10% gastric acid prod
- decr pH/distention/hypertonic solution in the duodenum inhibs gastric acid prod via CCK + secretin + neural reflexes

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61
Q

factors that increase gastric acid production (3)

A

CN X
gastrin
histamine release

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62
Q

which cells release histamine in the GIT

A

enterochromaffin cells

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63
Q

factors that decrease gastric acid production (3)

A

somatostatin
cholecystokinin
secretin

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64
Q

which cells produce gastrin

A

G cells in atrum

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65
Q

role of gastrin

A

increase HCL, peptin + IF secretion
increase gastric motility

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66
Q

here is cholecystokinin produced

A

I cells of the upper SI

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67
Q

what stimulates CCK

A

proteins/TG

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68
Q

role of CCK

A

increases secretion of enzymes from the pancreas
contracts GB
decreases gastric emptying
induces satiety

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69
Q

where is secretin produced

A

S cells of the upper SI

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70
Q

what stimulates secretin

A

acidic chyme + fatty acids

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71
Q

role of secretin

A

increased secretion of HCO3 fluid from liver/pancreas
decreases gastric acid secretion

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72
Q

where is VIP produced

A

SI + pancreas

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73
Q

role of VIP

A

stimulates secretion by pancreas + intestines
inhibits gastric acid + pepsinogen secretion

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74
Q

where is somatostatin secreted from

A

D cells pancreas + stomach

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75
Q

what stimulates somatostatin

A

fat, bile salts, glucose

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76
Q

role of somatostatin

A

dectreases acid production, pepsin + gaastric secretions
decreases pancreatic enzyme, insulin +glucagon secretion
stimulates gastric mucus production

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77
Q

Allograft transplant

A

tissue from genetically non identical donor of same species

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78
Q

Isograft transplant

A

tissue from genetically identical donor

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79
Q

Autograft transplant

A

transplant from same individual - from one organ/site to another

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80
Q

Xenograft transplant

A

transplant from a different species

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81
Q

hyperacute organ transplant rejection is due to

A

presence of preformed antibodies e.g. ABO incompatibility

82
Q

when does hyperacute organ transplant rejection occur

A

immediately

83
Q

when does acute organ transplant rejection occur

A

during first 6 months

84
Q

acute organ transplant rejection is due to

A

T cell mediated

85
Q

when does chronic organ transplant rejection occur

A

after 6 months

86
Q

what type of transplant is most vulnerable to hyperacute rejection?

87
Q

what type of transplant is least vulnerable to hyperacute rejection

88
Q

cell type dominating in acute transplant rejection

A

mononuclear cell infiltrates

89
Q

process of chronic transplant rejection

A

Vascular changes are most prominent with myointimal proliferation leading to organ ischaemia.

90
Q

head of pancreas tumour surgical Mx

91
Q

carcinoma of body/tail pancreas surgical Mx

A

distal pancreatectomy

92
Q

embryological origin of the pancreas

A

ventral and dorsal entodermal outgrowth from the duodenum
ventral remanent will ultimately become the pancreatic duct

93
Q

FEV1:FVC obstructive diseases

94
Q

pathway of impulses of baroceptors

A

increase BP stimulates baroceptors
relayed to tractus solitarius -> vasomotor centre of brain

95
Q

what is the name of the most important ligament supporting the uterus?

A

cardinal ligament

96
Q

which pathogens are patients with Sickle Cell at risk from? (3)

A

Strep pneumonia
H influenza
N meningitis

97
Q

What is Stills disease

A

autoimmune syndrome
PS with high fever, bright pink rash, arthralgia, HSmegaly, abnormal LFTs
mistaken for EBV

98
Q

Mx of trimalleolar fracture post reduction

A

elevate, then delayed ORIF

99
Q

where would be tender on bimanual palp in ovarian torsion?

A

lateral fornices

100
Q

spread of mastoiditis to the brain

A

mastoiditis –> mastoid air cells –> temporal bone –> epidural space

101
Q

effect of coning of brain on Urine output and why

A

high UO, low osmolality
due to pituitary ischaemia –> diabetes insipidis

102
Q

Adelta fibres transmit which pain

A

sharp pain

103
Q

Abeta fibres transmit which pain

A

light pain

104
Q

C fibres transmit which pain

A

dull/diffuse pain
(note these fibres are smallest and unmyelinated)

105
Q

which immunoglobulin can cross the placenta to fetus

A

igG (i Got it from my mumma!)

106
Q

what makes up the posterior wall of tthe inguinal canal laterally and medially

A

lateral 2/3 = transversalis fascia
medial 1/3 = conjoint tendon

107
Q

hip pain - ext rotation + shortened =

108
Q

hip pain - int rotation + shortened =

A

posterior dislocation

109
Q

how much maintenance fluid does an adult need/day

A

25-30ml/kg/day

110
Q

which type of lung cancer is the most likely to cavitate ?

A

squamous cell carcinoma

111
Q

T1 or T2RF - PE

112
Q

which tumour marker is most sensitive for testicular teratoma?

113
Q

layers pierced during a lumbar puncture

A

skin, fascia, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater, subarachnoid space

114
Q

if you see cortical bone thickening on an xray what condition should you think of? (+ unsual fracture)

115
Q

Where in the body would you find Hassal’s corpusles (+fct)

A

Thymus gland
function unknown

116
Q

Pseudomonas aerguniosa

A

sweet smell (like grapes)
gram negative rod

117
Q

urachus originates from

A

allantosis

118
Q

what does the umbilical aa become after birth

A

medial umbilical ligament

119
Q

what does the umbilical vein become after birth

A

round ligament of liver (1 week after birth)

120
Q

when does the vitelline duct usually disappear

A

by 6 weeks after embryogenesis

121
Q

lower limit lumbar cistern

A

S2 (runs from L2- S2)

122
Q

levels of research pyramid (draw please)

123
Q

which thyroid cancers are calcitonin and amyloid levels greatly raised in?

A

medullary thyroid carcinoma

124
Q

mutation medullary thyroid carcinoma

A

RET proto-oncogene

125
Q

hodgkins vs non hodgkins lymphoma - contingous LN involvement

A

Hodgkins - contingous LN involvement
NHL - non-contingous LN involvement (ie LN are not next to e/o)

126
Q

ACE - which autoimmune condition is this markedly high in?

A

sarcoidosis

127
Q

how does Zollin-Ellinger syndrome incr gastric acid

A

incr gastrin binds to CCK-b receptors (on enterochromaffin cells)–> incr histamine –> incr gastric acid secretion

128
Q

mode of action furosemide

A

binds to Na-K-Cl channels in thick ascending loop Henle
–> inhibition of Na/K/Cl –> H2O diffuses out

129
Q

efferent Angiotensin II on glomerulus

A

constriction of efferent arterioles
–> increased glomerular pressure

130
Q

effect of ACEi on aquaporin insertion in the nephron

A

decreases aquaporin insertion hence less water is reabsorbed (due to less ADH)

131
Q

effect of vomiting on the kidneys

A

hypovolaemia 2’ to vomiting –> Na reabsorption in kidneys –> K+ secretion from collecting duct 2’ to RAAS

132
Q

most common site for kidney stone obstruction

133
Q

where are the central chemoreceptors located?

A

ventrolateral medulla, between the exits of CN IX + X

134
Q

embryology - notochord forms

A

anterior parts of VB + nucleus propolsus of IVD

135
Q

embryology - neural tube forms

A

spinal cord

136
Q

embryology - neural crest forms

A

pia mater
spinal symp ganglia
adrenal medulla

137
Q

embryology - sclerotome forms

A

post parts of VB
annulus fibrosus IVD

138
Q

where does Aldosterone act in the kidney?

A

intercalated cells of the collecting duct to increase Na (+ hence H2O) uptake

139
Q

examples of secondary cartilaginous joints

A

= 2 bones joined by fibrocartilage + always found in midline
pubic symphysis
xiphisternal
manubriosternal
intervertebral joints between VB

140
Q

examples of primary cartilaginous joints

A

two bones joined by hyaline - no movement
growing bones betw epiphysis + diaphysis
1st costosternal joint
all costochondral joints

141
Q

Klippel-Trenaunay-Weber (KTW) syndrome

A

portwine stains
varicose veins
bony/soft tissue hypertrophy –> gigantism of a limb

142
Q

Tx axillary vein thrombosis

A

catheter directed TPA

143
Q

heaped/raised borders on an ulcer raises supsicion of…

A

marjolin ulcer

144
Q

extensive iliac aa occlusion + significant co-morbidities Mx

A

femoro-femoral cross over graft

145
Q

what is a cervical rib?

A

elongation of the TP of the 7th cervical vertebra

146
Q

extensive bilateral iliac aa occlusion in a young patient Mx

A

aorto-bifemoral bypass

147
Q

Skew/Burgess flaps are used in

A

below knee amputation

148
Q

what is a Gritti-Stokes amputation

A

through knee amputation

149
Q

what is a Syme’s amputation

A

through ankle amputation

150
Q

what is the most common cyanotic Congen heart disease at birth?

151
Q

Ix of choice for upper airway compression

A

flow volume loop

152
Q

which cell is the majority of tumour necrosis factor secreted by

A

macrophages

153
Q

intracellular fluid makes up what % of total volume body

154
Q

extracellular fluid makes up what % of total volume body

155
Q

plasma makes up what % of total volume of the body

156
Q

drugs causing SIADH (4)

A

carbamazepine
Sulfonylureas
SSRIs
TCAs

157
Q

red pulp of spleen is resposnbile for

A

maintainence of quality of erythrocytes

158
Q

white pulp of spleen is responsible for

A

reticuloendothelial system + Ab production

159
Q

zona fasciulata adrenals produce

160
Q

zona glomerulosa adrenals produce

A

aldosterone (think of it acting on the kidneys!)

161
Q

where in the GIT is most water reabsorped

162
Q

which Amino acid are catecholamines primarily derived from?

163
Q

what is measured to obtain renail plasma flow

A

PAH
= amount of PAH in urine per unit time / difference in PAH concentration in renal aa/vv

164
Q

normal PAH value

165
Q

PTH half life

A

10 minutes

166
Q

what % of salivary gland secretions are from the parotid gland

167
Q

which substance is released from the sympathetic nn system to stimulate the adrenal medulla

A

acetylcholine

168
Q

ventricular tachycardia - which rate limiting drug is contra-indicated

169
Q

which intracranial lesion tends to show more marked necrosis and oedema

A

glioblastoma

170
Q

how to do LN biopsy for suspected hodgkins lymphoma

A

excison LN biopsy

171
Q

which oesophageal carcinoma are you more likely to get with Barretts

A

adenocarcinoma

172
Q

with carcinoid tumours, what is necessary for the diagnosis of carcinoid syndrome

A

liver mets

173
Q

Sarcomas in which Lymphatic Metastasis is seen?

A

‘RACE For MS’

R: Rhabdomyosarcoma
A: Angiosarcoma
C: Clear cell sarcoma
E: Epithelial cell sarcoma

For: Fibrosarcoma

M: Malignant fibrous histiocytoma
S: Synovial cell sarcoma

174
Q

what are popcorn cells and where are they seen

A

small cells with hyper-lobulated nucleus and small nucleoli
seen in Nodular lymphocyte predominant Hodgkin’s lymphoma

175
Q

what are desmoid tumours

A

fibrous neoplasms arising from musculoaponeurotic structures. They typically contain clonal proliferations of myofibroblasts.

176
Q

what are psamomma bodies in papillary cell thyroid carcinomas

A

clusters of calcification

177
Q

what is the dominant necrosis pattern in the CNS

A

colliquative necrosis

178
Q

what is the dominant necrosis pattern in TB

A

caseous necrosis

179
Q

what is the dominant necrosis pattern in the body

A

coagulative necrtosis

180
Q

what is the dominant necrosis pattern in arterioles of hypertensive patients

A

fibrinoid necrosis

181
Q

what is a Hadfield’s procedure

A

total duct excision
for ductal ectasia

182
Q

risk of AAA 5-6cm rupturing over 5y

183
Q

risk of AAA 6-7cm rupturing over 5y

184
Q

risk of AAA >7cm rupturing over 5y

185
Q

what is Ormond’s disease

A

proliferation of fibrous tissue in the retroperitoneum
present with lower back pain, kidney failure, hypertension, deep vein thrombosis
Tx = steroids, +/- surg +/- ureteric stent

186
Q

which clotting factors are liable to dysfunction 2’ to liver disease

A

1,2,5,7,9,10,11

187
Q

which clotting factors does heparin effect

188
Q

which clottting factors are affected by DIC

A

1,2,5,8,11

189
Q

Haemophilia - APTT, PT + bleeding time

A

APTT Increased
PT Normal
bleeding time Normal

190
Q

vwD - APTT, PT + bleeding time

A

APTT Increased
PT Normal
bleeding time Increased

191
Q

vit K deficiency - APTT, PT + bleeding time

A

APTT Increased
PT Increased
bleeding time Normal

192
Q

which thyroid cancer usually presents as a single thyroid nodule

A

follicular carcinoma

193
Q

way to remember hypersensitivity type reactions

A

ACID
EGGT
Anaphylaxsis - IgE
Cytotoxic - IgG
Immune complent mediated - IgG
Delayed - T cells

194
Q

what is the most common extra-colonic lesion in FAP

A

duodenal polyps

195
Q

what is diaphragm disease + what is its cause

A

lumen of the small bowel is divided into short compartments by circular membranes of mucosa and sub-mucosa; these membranes have a pinhole lumen leading to frequent bouts of intestinal obstruction.
cuased by L term NSAID use

196
Q

what is the most common adverse affect of a packed red cells transfusion

197
Q

what is the most common adverse affect of a FFP transfusion

198
Q

soap bubble appearance XR femur

A

osteoclastoma

199
Q

what is the most common child brain tumour

A

astrocytoma

200
Q

Von Hippel-Lindau syndrome features

A

cerebellar haemangiomas
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic
endolymphatic sac tumours

MRCS A (36 decks)

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