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MRCS A > Miscellaneous stuff I get wrong - part 2 > Flashcards

Miscellaneous stuff I get wrong - part 2 Flashcards

1
Q

Define mild traumatic brain injury

A

brief LOC <30 mins
headache
amnesia lasting <24 hours
GCS 13-15
CT normally NAD

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2
Q

Define moderate traumatic brain injury

A

LOC >30 mins <24 hours
amnesia <7 days
GCS 9-12
potential Sx: severe headache, repeated eps vom, convulsions, pupil dilatations, loss coordination
+/- CT scan changes

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3
Q

Define severe traumatic brain injury

A

LOC >24 hours
post traumatic amnesia >7 days
GCS 3-8

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4
Q

familial hypocalciuric hypercalcaemia

A

affects ca sensing receptors in parathyroid glands + kidneys
mildly elevated Ca
normal/mildly elevated PTH
Ca not excreted in urine
rarely symptomatic, does not usually req Tx

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5
Q

encapsulated thyroid carcinoma with brain mets?

A

follicular thyroid carcinoma

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6
Q

Mx arterial bleed from laceration

A

torniquet application above systolic BP
after venous draining

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7
Q

Mx venous bleed from laceration

A

pressure dressing of wound

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8
Q

immediate Mx for all patiets GCS 8 or <

A

intubate

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9
Q

pulse oximetry 95% or less in pre operative clinic –>

A

ABG

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10
Q

pre-operative neck cirucmference of >60cm –>

A

35% difficult intubation

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11
Q

pre-operative - bicarb >25 in obese people

A

likely 2’ to sleep apnoea/ obesity hypoventilation syndrome
–> hence sleep studies indicated

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12
Q

necrotising fascitis Mx regime:

A

surgical debride
ampicillin 2g IV 4’
clindamycin IV
ciprofloxacin

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13
Q

fracture with reduced blood flow - 1st step

A

reduce fracture to attempt revascularisation before surgical Mx

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14
Q

shoulder pain after FOOSH + lateral tenderness with normal ROM?

A

acromioclavicular joint sprain

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15
Q

Mx complex regional pain syndrome type 1

A

sympathetic nn block around paravertebral sympathetic ganglia
physio

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16
Q

Mx complex regional pain syndrome type 2

A

surgical mx e.g. if in wrist - carpal tunnel release as are 2’ to nerve injury

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17
Q

FOOSH + wrist/hand pain + median Nn symtpoms?

A

lunate dislocation

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18
Q

hamate fracture vs hook of hamate fracture Sx

A

both ps with ulnar nn symptoms
hook of hamate tends to be delayed Sx

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19
Q

gastrocnemius vs soleus vs sural flap

A

gastrocnemius - good for proximal 1/3 leg injury
soleus - good for middle 1/3 leg injury
sural - good for distal 1/3 leg injury

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20
Q

typical torniquet pressure for upper arm operation

A

250mmHg

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21
Q

typical torniquet pressure for thigh operation

A

300mgHg

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22
Q

APLS lifelong Tx

A

low dose aspirin

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23
Q

Gastoschisis

A

Isolated abnormality, bowel lies outside abdominal wall through defect located to right of umbilicus

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24
Q

Omphaleocele

A

Liver and gut remain covered with membranous sac connected to umbilical cord. It is associated with other developmental defects.

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25
cut off for USS with Ix Perthe's
3 months
26
Imagine for developmental dysplasia of the hip if missed on XR
MRI
27
Greenstick fracture vs Buckle fracture
Greenstick: unilateral cortical disruption + haematoma Buckle: periosteal haematoma only
28
Ladd's procedure
paediatric surgical procedure for intestinal malrotation = laparotomy + division of adhesional bands bowel returned to abdo in non-rotated fashion ie caecum on left, small bowel on right usually + an appendicectomy to avoid confusion in future
29
midgut volvulus in paeds what happens
bowel undergoes a 720' twist, the bowel viability depends upon a narrow mesentery containing the superior mesenteric artery
30
Ix midgut volvulus (+ positive results)
abdominal ultrasound scan - determine the relationship between the superior mesenteric artery and vein (normally SMA lies to the left of the SMV). + upper GI contrast series - establish that the DJ flexure is correctly sited to the left of the vertebral bodies. SMA + DJ flexure should be LEFT to SMV + VB respectively
31
what is osteogenesis imperfecta + PS
congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine. --> failure of maturation of collagen in all the connective tissues PS: translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) trefoil pelvis
32
Bronchogenic cyst cause
anomalous development of the ventral foregut
33
Hirschprung's first line Mx
enemas of either dilute gastrograffin or N-acetyl cysteine (C/I if suspect perforation)
34
Hypospadias most common location
distal ventral side of penis
35
Kocher's criteria septic arthritis
Kocher's 'WIFE' is: WCC >12 Inability to weight bear Fever ESR >40 = >90% chance of septic arthritis
36
Biliary atresia surgical Mx
Roux-en-Y portojejunostomy
37
which bacteria tends to colonic plastic devices e.g. breast implant
staph epidermidis
38
most common causative organism septic arthritsi
staph aureus
39
which bacterial gastroenteritis are birds associated with
Campylobacter jejuni
40
grey membrane in soft palate/oropharynx indicates which infection
diphtheria
41
which bacteria is associated with Ca colon?
strep bovis
42
What drain should be used to prevent seroma post breast surgery
use a Redivac type system that is made of polypropylene. = a closed suction drain
43
what % of iron in the body is found in haemoglobin
70%
44
use of culposuspension
stress incontinence
45
Ependymoma - where in the brain and who gets it
33% of paeds tumours <3 arises from 4th ventricle and can grow through the foramina of Luschka and Magendie
46
what's Berrys sign
Absence of carotid pulse due to malignant thyromegaly.
47
noradrenaline effect
alpha agonist vasopressor action minimal effect on CO
48
adrenaline effect
alpha + beta agonist incr CO + PVR
49
dopamine effect
beta 1 agonist incr contractility + rate
50
dobutamine effect
beta 1 +2 agonist incr CO decr SVR
51
milrinone effect
PDE inhibitor incr cAMP levels --> improves mm contractility short half life
52
where do the tinea coli converge
base of the appendix
53
which nn is the main responsible for the tonsillar fossa?
glossopharyngeal nn
54
transenamic acid - mechanism of action
plasmin inhibitor
55
important urinary base buffer?
phosphate
56
Ix of choice pre-operatively for localising a pituitary adenoma
Sestamibi scan
57
adhesive capsulitis vs rotator cuff tear - ROM
AC - both active and passive reduced RTT - active reduced only - near normal passive ROM
58
Ix of choice to rule out urethral injury
retrograde urethrogam
59
patient on steroids pre-op - how to change regime
increase for 3 days to mimic HPA axis
60
acetabular fracture - which nn is affected
peroneal branch of sciatic nn
61
Hirschprungs vs small bowel atresia
Hirschprungs - failure to pass meconium in 48 hours small bowel atresia - bilous vom, abdo distention, failure to pass further stools after meconium, distended loops w/ fluid level
62
stroke location - contralateral lower limb weakness and loss of sensation
ACA
63
where is the largest amount of pectinae musculae found in the heart?
RA
64
relation of sympathetic trunk to lung pleura
posterior to the parietal pleura
65
8 branches of the ECA - which are anterior, posterior medial + terminal branches
anterior - sup thyroid, facial + lingual medial - pharyngeal aa posterior - post auricular, occipital terminal - maxillary, superficial temporal
66
relation to chorda tympani to the pars ear
runs medially to the pars flaccida
67
what are the 4 collateral venous return systems if the SVC is obstructed
Azygos venous system Internal mammary venous pathway Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
68
IVC tributaries (+ mnenomic)
I Like To Rise So High Iliacs Lumbar Testicular Renal Suprarenal Hepatic vein
69
which membrane does the cephalic vv pierce to terminate into the axillary vv (+ what is it a continuation of)
corocoid membrane continuation of clavicopectoral fascia)
70
DRE - what would you feel anteriorly
Seminal Vesicle-
71
DRE - what would you feel posteriorly
Sacrospinous Ligament
72
DRE - what would you feel posterolaterally
Puborectalis
73
causes of raised TLCO (carbon monoxide transfer factor) (4)
asthma, haemorrhage, left-to-right shunts, polycythaemia
74
what hormone stimulates prolactin release
TRH Thyrotropin releasing hormone
75
which clotting factors are temperature sensitive
V VIII
76
medical Tx carcinoid syndrome
octreotide (because it is the synthetic alternative to somatostatin)
77
ductal vs lobular carcinoma of the breast - which is more likely to mets to the contralateral breast?
lobular
78
Hurthle cell tumours prominent features
prominent oxyphil cells scanty thyroid colloid aka a subtype of follicular thyroid carcinoma
79
which type of biliary disease is HIV associated with
primary sclerosing cholangitis
80
Hyperhydrosis spinal level mnemonic
T2 & T3 Make the hands sweat-free
81
ECA, facial nn retromandibular vv over parotid - which is most sup + which is deepest
facial nn = most sup retromandibular = middle ECA = most deep
82
mm inn by ANSA CERVICALIS mnemonic
GHost THought SOmeone STupid SHot Izzy GenioHyoid ThyroidHyoid Superior Omohyoid SternoThyroid SternoHyoid Inferior Omohyoid
83
structures crosses anterior and posteriorly - carotid sheath
anteriorly - hypoglossal nn + ansa cervicalis posteriorly - cervical sympathetic chain
84
in what week do the pharyngeal arches develop
week 4 of embryonic growth = series of mesodermal outpouchings of the pharynx which fuse in the ventral line
85
pharyngeal arch 1 - muscles
mm mastication ant belly digastric mylohyoid tensor tympani tensor veli palatini
86
pharyngeal arch 1 - skeletal structures
maxilla meckels incus/malleus
87
pharyngeal arch 1 - arteries
maxillary ECA
88
pharyngeal arch 1 - nerves
mandibular nerve (CN V)
89
pharyngeal arch 2 - muscles
buccinator platysma mm facial expression stylohoid post belly digastric
90
pharyngeal arch 2 - skeletal structures
stapes styloid process lesser horn + upper body of hyoid
91
pharyngeal arch 2 - aa
stapedial aa sup thyroid aa
92
pharyngeal arch 2 - nn
facial CN VII
93
pharyngeal arch 3 - muscles
stylopharyngeus
94
pharyngeal arch 3 - skeletal structures
greater horn + lower part hyoid
95
pharyngeal arch 3 - endocrine
thymus inf parathyroid
96
pharyngeal arch 3 - aa
ICA CCA
97
pharyngeal arch 3 - nn
CN IX
98
pharyngeal arch 4 - muscles
cricothyroid intrinsic mm soft palate
99
pharyngeal arch 4 - skeletal structures
thyroid epiglottic
100
pharyngeal arch 4 - endocrine
sup parathyroid
101
pharyngeal arch 4 - aa
R SCA Aortic arch (L)
102
pharyngeal arch 4 - nn
CNX + sup laryngeal nn
103
pharyngeal arch 6 - muscles
all intrinsic mm of the larynx except cricothyroid
104
pharyngeal arch 6 - skeletal structures
cricoid arytenoid corniculate
105
pharyngeal arch 6 -aa
R pulm aa L pulm aa DA
106
pharyngeal arch 6 - nn
CNX. + rec laryngeal nn

MRCS A (36 decks)

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