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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
Q

cut off for USS with Ix Perthe’s

A

3 months

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26
Q

Imagine for developmental dysplasia of the hip if missed on XR

A

MRI

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27
Q

Greenstick fracture vs Buckle fracture

A

Greenstick: unilateral cortical disruption + haematoma
Buckle: periosteal haematoma only

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28
Q

Ladd’s procedure

A

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

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29
Q

midgut volvulus in paeds what happens

A

bowel undergoes a 720’ twist, the bowel viability depends upon a narrow mesentery containing the superior mesenteric artery

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30
Q

Ix midgut volvulus (+ positive results)

A

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

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31
Q

what is osteogenesis imperfecta + PS

A

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

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32
Q

Bronchogenic cyst cause

A

anomalous development of the ventral foregut

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33
Q

Hirschprung’s first line Mx

A

enemas of either dilute gastrograffin or N-acetyl cysteine
(C/I if suspect perforation)

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34
Q

Hypospadias most common location

A

distal ventral side of penis

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35
Q

Kocher’s criteria septic arthritis

A

Kocher’s ‘WIFE’ is:

WCC >12
Inability to weight bear
Fever
ESR >40
= >90% chance of septic arthritis

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36
Q

Biliary atresia surgical Mx

A

Roux-en-Y portojejunostomy

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37
Q

which bacteria tends to colonic plastic devices e.g. breast implant

A

staph epidermidis

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38
Q

most common causative organism septic arthritsi

A

staph aureus

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39
Q

which bacterial gastroenteritis are birds associated with

A

Campylobacter jejuni

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40
Q

grey membrane in soft palate/oropharynx indicates which infection

A

diphtheria

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41
Q

which bacteria is associated with Ca colon?

A

strep bovis

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42
Q

What drain should be used to prevent seroma post breast surgery

A

use a Redivac type system that is made of polypropylene.
= a closed suction drain

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43
Q

what % of iron in the body is found in haemoglobin

A

70%

44
Q

use of culposuspension

A

stress incontinence

45
Q

Ependymoma - where in the brain and who gets it

A

33% of paeds tumours <3
arises from 4th ventricle and can grow through the foramina of Luschka and Magendie

46
Q

what’s Berrys sign

A

Absence of carotid pulse due to malignant thyromegaly.

47
Q

noradrenaline effect

A

alpha agonist
vasopressor action
minimal effect on CO

48
Q

adrenaline effect

A

alpha + beta agonist
incr CO + PVR

49
Q

dopamine effect

A

beta 1 agonist
incr contractility + rate

50
Q

dobutamine effect

A

beta 1 +2 agonist
incr CO
decr SVR

51
Q

milrinone effect

A

PDE inhibitor
incr cAMP levels –> improves mm contractility
short half life

52
Q

where do the tinea coli converge

A

base of the appendix

53
Q

which nn is the main responsible for the tonsillar fossa?

A

glossopharyngeal nn

54
Q

transenamic acid - mechanism of action

A

plasmin inhibitor

55
Q

important urinary base buffer?

A

phosphate

56
Q

Ix of choice pre-operatively for localising a pituitary adenoma

A

Sestamibi scan

57
Q

adhesive capsulitis vs rotator cuff tear - ROM

A

AC - both active and passive reduced
RTT - active reduced only - near normal passive ROM

58
Q

Ix of choice to rule out urethral injury

A

retrograde urethrogam

59
Q

patient on steroids pre-op - how to change regime

A

increase for 3 days to mimic HPA axis

60
Q

acetabular fracture - which nn is affected

A

peroneal branch of sciatic nn

61
Q

Hirschprungs vs small bowel atresia

A

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
Q

stroke location - contralateral lower limb weakness and loss of sensation

A

ACA

63
Q

where is the largest amount of pectinae musculae found in the heart?

A

RA

64
Q

relation of sympathetic trunk to lung pleura

A

posterior to the parietal pleura

65
Q

8 branches of the ECA - which are anterior, posterior medial + terminal branches

A

anterior - sup thyroid, facial + lingual
medial - pharyngeal aa
posterior - post auricular, occipital
terminal - maxillary, superficial temporal

66
Q

relation to chorda tympani to the pars ear

A

runs medially to the pars flaccida

67
Q

what are the 4 collateral venous return systems if the SVC is obstructed

A

Azygos venous system
Internal mammary venous pathway
Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)

68
Q

IVC tributaries (+ mnenomic)

A

I Like To Rise So High
Iliacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein

69
Q

which membrane does the cephalic vv pierce to terminate into the axillary vv (+ what is it a continuation of)

A

corocoid membrane
continuation of clavicopectoral fascia)

70
Q

DRE - what would you feel anteriorly

A

Seminal Vesicle-

71
Q

DRE - what would you feel posteriorly

A

Sacrospinous Ligament

72
Q

DRE - what would you feel posterolaterally

A

Puborectalis

73
Q

causes of raised TLCO (carbon monoxide transfer factor) (4)

A

asthma,
haemorrhage,
left-to-right shunts,
polycythaemia

74
Q

what hormone stimulates prolactin release

A

TRH
Thyrotropin releasing hormone

75
Q

which clotting factors are temperature sensitive

A

V
VIII

76
Q

medical Tx carcinoid syndrome

A

octreotide (because it is the synthetic alternative to somatostatin)

77
Q

ductal vs lobular carcinoma of the breast - which is more likely to mets to the contralateral breast?

A

lobular

78
Q

Hurthle cell tumours prominent features

A

prominent oxyphil cells
scanty thyroid colloid
aka a subtype of follicular thyroid carcinoma

79
Q

which type of biliary disease is HIV associated with

A

primary sclerosing cholangitis

80
Q

Hyperhydrosis spinal level mnemonic

A

T2 & T3 Make the hands sweat-free

81
Q

ECA, facial nn retromandibular vv over parotid - which is most sup + which is deepest

A

facial nn = most sup
retromandibular = middle
ECA = most deep

82
Q

mm inn by ANSA CERVICALIS mnemonic

A

GHost THought SOmeone STupid SHot Izzy

GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid

83
Q

structures crosses anterior and posteriorly - carotid sheath

A

anteriorly - hypoglossal nn + ansa cervicalis
posteriorly - cervical sympathetic chain

84
Q

in what week do the pharyngeal arches develop

A

week 4 of embryonic growth
= series of mesodermal outpouchings of the pharynx which fuse in the ventral line

85
Q

pharyngeal arch 1 - muscles

A

mm mastication
ant belly digastric
mylohyoid
tensor tympani
tensor veli palatini

86
Q

pharyngeal arch 1 - skeletal structures

A

maxilla
meckels
incus/malleus

87
Q

pharyngeal arch 1 - arteries

A

maxillary
ECA

88
Q

pharyngeal arch 1 - nerves

A

mandibular nerve (CN V)

89
Q

pharyngeal arch 2 - muscles

A

buccinator
platysma
mm facial expression
stylohoid
post belly digastric

90
Q

pharyngeal arch 2 - skeletal structures

A

stapes
styloid process
lesser horn + upper body of hyoid

91
Q

pharyngeal arch 2 - aa

A

stapedial aa
sup thyroid aa

92
Q

pharyngeal arch 2 - nn

A

facial CN VII

93
Q

pharyngeal arch 3 - muscles

A

stylopharyngeus

94
Q

pharyngeal arch 3 - skeletal structures

A

greater horn + lower part hyoid

95
Q

pharyngeal arch 3 - endocrine

A

thymus
inf parathyroid

96
Q

pharyngeal arch 3 - aa

A

ICA
CCA

97
Q

pharyngeal arch 3 - nn

A

CN IX

98
Q

pharyngeal arch 4 - muscles

A

cricothyroid
intrinsic mm soft palate

99
Q

pharyngeal arch 4 - skeletal structures

A

thyroid
epiglottic

100
Q

pharyngeal arch 4 - endocrine

A

sup parathyroid

101
Q

pharyngeal arch 4 - aa

A

R SCA
Aortic arch (L)

102
Q

pharyngeal arch 4 - nn

A

CNX + sup laryngeal nn

103
Q

pharyngeal arch 6 - muscles

A

all intrinsic mm of the larynx except cricothyroid

104
Q

pharyngeal arch 6 - skeletal structures

A

cricoid
arytenoid
corniculate

105
Q

pharyngeal arch 6 -aa

A

R pulm aa
L pulm aa
DA

106
Q

pharyngeal arch 6 - nn

A

CNX. + rec laryngeal nn

MRCS A (36 decks)

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