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MRCS > MRCS A > Flashcards

MRCS A Flashcards

1
Q

Nerve commonly injured during inguinal hernia surgery?

A

Ilioinguinal nerve

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2
Q

Nerve commonly injured during posterior triangle LN biopsy?

A

Accessory nerve

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3
Q

Nerve commonly injured when using Lloyd-Davies stirrups?

A

Common perineal nerve

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4
Q

Nerve commonly damaged during thyroidectomy?

A

Recurrent laryngeal

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5
Q

Nerve commonly damaged during anterior resection of rectum?

A

Hyogastric autonomic nerves (arise from pelvic splanchnic nerves)

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6
Q

Nerves that could be damaged during axillary LN clearance?

A

Thoracodorsal - innervates lat dorsi
Long thoracic - innervates serrates anterior (winging of scapula)
Intercostobrachial - cutaneous sensation axilla and medial aspect upper arm

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7
Q

Nerves commonly injured during varicose vein surgery?

A

Sural nerve (related to short saphenous vein) - lateral aspect of foot/calf
Saphenous nerve (related to long saphenous vein) - medial calf

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8
Q

Nerve commonly injured during posterior approach to hip?

A

Sciatic nerve

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9
Q

Nerve commonly injured during carotid endarterectomy?

A

Hypoglossal nerve

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10
Q

Bochdalek hernia

A

Typically congenital diaphragmatic hernia
85% cases are located in the left hemi diaphragm
Associated with lung hypoplasia on the affected side
More common in males
Associated with other birth defects
May contain stomach
May be treated by direct anatomical apposition or placement of mesh. In infants that have severe respiratory compromise mechanical ventilation may be needed and mortality rate is high

Bochdalek hernia is a diseases of 3 P’s and 3 B’s
1- Birth defect (congenital)
2- Posterior located
3- Big
4- Bad Prognosis
5- Pulmonary hyPoPlais is common
6- Placement of mesh may be needed to treat

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11
Q

Morgagni Hernia

A

Rare type of diaphragmatic hernia (approx 2% cases)
Herniation through foramen of Morgagni
Usually located on the right and tend to be less symptomatic
More advanced cases may contain transverse colon
As defects are small pulmonary hypoplasia is less common
Direct anatomical repair is performed

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12
Q

Scrotum is drained by which LNs?

A

Inguinal

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13
Q

Testis drained by which LNs?

A

Lumbar and para-aortic

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14
Q

Cremasteric artery arises from…

A

Inferior epigastric artery

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15
Q

Artery of vas deferens arises from…

A

inferior vesical artery

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16
Q

Layers of spermatic cord/scrotum

A

Some Damned Examiner Called It The Testes -
Skin, Dartos, External fascia (external oblique), Cremaster (internal oblique), Internal fascia (transversalis), Tunica vaginalis, Testes

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17
Q

Vit K dependent factors

A

2, 7, 9, 10 (mnemonic 1972)
Measured using PT

NB. warfarin also affects Protein C synthesis

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18
Q

APTT factors

A

8, 9, 11, 12

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19
Q

Femoral hernia position?

A

Infero-lateral to pubic tubercle

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20
Q

Inguinal hernia position?

A

Supero-medial to pubic tubercle

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21
Q

Which blood product can cause iatrogenic gram positive organism infection?

A

Platelets (because stored at room temp)

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22
Q

Which blood product can cause iatrogenic gram negative organism infection?

A

Packed red cells (because stored at 4c)

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23
Q

Organisms in Fournier’s gangrene?

A

Bacteroides and e. coli

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24
Q

Nec fasc most common organism?

A

Streptococcus

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25
Q

Risks of abdominal aortic aneurysm rupture (over 5 years)?

A

5-5.9cm = 25%
6-6.9cm= 35%
7cm and over = 75%

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26
Q

MEN 1

A

3 Ps:
- Pituitary adenoma
- Parathyroid hyperplasia
- Pancreas

MENIN gene - chromosome 11

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27
Q

MEN 2a

A

2Ps + 1M:
- Parathyroid
- Phaeochromocytoma
- Medullary thyroid ca.

RET oncogene - chromosome 10

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28
Q

Men 2b

A

1P + 2Ms:
- Phaeochromocytoma
- Medullar thyroid ca.
- Marfanoid habitus / mucosal neuroma

RET oncogene - chromosome 10

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29
Q

Erb’s palsy - which roots affected? How does it present?

A

C5/6

Waiter’s tip position
Loss of shoulder abduction (deltoid and supraspinatus paralysis)
Loss of external rotation of the shoulder (paralysis of infraspinatus)
Loss of elbow flexion (paralysis of biceps, brachialis and brachioradialis)
Loss of forearm supination (paralysis of Biceps)

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30
Q

Branches of posterior cord of brachial plexus?

A

S - subscapular (upper and lower)
T - thoracodorsal
A - axillary
R - radial

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31
Q

Lateral hip rotators?

A

Superior to inferior: P - GO - GO - Q

Piriformis
Gemellis superior
Obturator internus
Gemelis inferior
Obturator externus
Quadratus femoris

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32
Q

Types of transplant

A

Isograft - identical twin/same DNA
Allograft - non-related donor
Autograft - self
Xenograft - non-human

33
Q

Popcorn cells - which lymphoma?

A

Nodular lymphocyte predominant Hodgkins lymphoma

34
Q

Hodgkins with best prognosis?

A

Nodular sclerosing

35
Q

Hodgkins with worst prognosis?

A

Lymphocyte depleted

36
Q

Von Hippel Landau syndrome?

A

Autosomal dominant

Haemangiomas (cerebellar and retinal)
Phaeo
Renal or extra-renal cysts
Endolymphatic sac tumours

37
Q

Structures posterior to medial malleolus?

A

Anterior to posterior:
posterior Tibialis
flexor Digitorum longus
tibial Artery
tibial Nerve
flexor Hallucis longus

(Tom Dick And Nervous Harry)

38
Q

Structures passing through greater and less sciatic foramen?

A

PIN (medial to lateral):
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus

39
Q

Scrotal sensation nerve supply?

A

Anterior skin - ilioinguinal
Posterior/perineum - pudendal

40
Q

Arterial supply to adrenals?

A

Superior adrenal (branch of inferior phrenic artery)
Middle (from aorta)
Inferior adrenal (from renal artery)

41
Q

Venous drainage of adrenals?

A

Left –> renal vein
Right –> IVC

42
Q

Which factors consumed in DIC?

A

5 and 8 plus platelets

43
Q

Branches of subclavian artery?

A

VIT CD
- Vertebral
- Internal thoracic
- Thyrocervical trunk
- Costocervical trunk
- Dorsal scapular

44
Q

Femoral nerve innervates….?

A

Q SIP (queen sips tea):
Quads (3x vastus + rectus femoris)
Sartorius
Iliacus
Pectineus

or

MIS VQ Scan for PE
Medial cutaneous nerve of thigh
Intermediate cutaneous nerve of thigh
Saphenous nerve

Vastus
Quadriceps femoris

Sartorius
PEctineus

45
Q

3 sigma rule in stats?

A

68 - 95 - 99
68% of values lie within 1 SD of mean
95% within 2 SD
99% within 3 SD

46
Q

Which nerve related to origin of middle meningeal artery?

A

Auriculotemporal nerve - supplies sensation to the external ear and outermost part of the tympanic membrane

47
Q

Fascia that separates prostate from rectum?

A

Denonvilliers

48
Q

Fascia that separates rectum from sacrum?

A

Waldeyers

49
Q

Salter-Harris classification?

A

SALTR
Straight across/slipped
Above
Lower
Through
Rammed

50
Q

Porta hepatis contents?

A

VAD (posterior to anterior)
portal Vein
hepatic Artery
hepatic Duct

51
Q

Level of hyoid?

A

C3

52
Q

Level of thyroid cartilage notch?

A

C4

53
Q

Level of cricoid?

A

C6

Also;
Junction of larynx with trachea
Junction of pharynx with oesophagus
Level at which the inferior thyroid artery enters the thyroid gland
The level at which the vertebral artery enters the transverse foramen in the 6th cervical vertebra
Level at which the superior belly of omohyoid crosses the carotid sheath
The level of the middle cervical sympathetic ganglion
The level at which the carotid artery can be compressed against the transverse process of C6 (carotid tubercle).

54
Q

Lymph drainage of superior vagina?

A

Iliac nodes

55
Q

Lymph drainage of inferior vagina?

A

Superficial inguinal

56
Q

Branches of axillary artery?

A

Screw The Lawyer, Save A Patient

Superior thoracic

Thoracoacromial
Lateral thoracic artery

Subscapular
Anterior circumflex humeral
Posterior circumflex humeral

1 from 1st part, 2 from 2nd part, 3 from 3rd part

57
Q

Papillary thyroid ca. route of spread?

A

Lymphatic

58
Q

Follicular thyroid ca. route of spread?

A

Haematogenous

59
Q

During dissection of saphenofemoral junction, which structure could be injured?

A

Deep external pudendal artery (lies deep to junction)

60
Q

Layers during LP?

A

Skin –> Subcutaneous tissue –> Supraspinous ligament –> Interspinous ligament –> Ligamentum flavum –> Epidural space –> Dura –> Arachnoid –> Subarachnoid space

3S ILEDAS

61
Q

Branches of external carotid artery?

A

Some angry lady figured out PMS

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal

62
Q

Muscles innervated by the musculocutaneous nerve?

A

Biceps brachii
Brachialis
Coracobrachialis

(BBC)

63
Q

Structures passing through foramen ovale?

A

O - otic ganglion
V3 - mandibular
A - accessory meningeal artery
L - lesser petrosal nerve
E - emissary veins

64
Q

Nerves passing through supraorbital fissure?

A

Live Frankly To See Absolutely No Insult

Lacrimal
Frontal
Trochlear
Superior division of oculomotor
Abducens
Nasociliary
Inferior division of oculomotor

3,4, 5-1, 6

65
Q

Which foramina does trigeminal nerve exit?

A

Standing Room Only

V1 - superior orbital fissure
V2 - rotundum
V3 - ovale

66
Q

Level of IMA?

A

L3

67
Q

Level of SMA?

A

L1

68
Q

Fluid resus burns?

A

2ml x TBSA % x kg
Half in first 8 hours

69
Q

Cranial nerve exits?

A

2244

2 cerebrum (I, II)
2 midbrain (III, IV)
4 pons (V, VI, VII, VIII)
4 medulla (IX, X, XI, XII)

Cerebellopontine angle mass affects VII and VIII (7 and 8)

70
Q

Most common parotid malignancy?

A

Mucoepidermoid, followed by adenoid cystic (latter characterised by perineurial invasion)

71
Q

Branches of ICA?

A

Ophthalmic
Posterior communicating
Choroidal
Anterior cerebral
Middle cerebral

Only Press Carotid Arteries Momentarily

72
Q

Diaphragmatic apertures and structures?

A

T8 = IVC + Right Pherenic nerve
T10 = esophagus + Both Vagii
T12 = Aorta + azygous + thoracic duct

I 8, 10Eggs, At12

73
Q

Ureteric stones composition?

A

most common = calcium oxalate
most radio dense = calcium phsphate
cystiene = familial
struvite = proteus mirabilis = stag horn = alkaline urine

74
Q

Parasympathetics CNs?

A

1973

75
Q

Most common thyroid ca.?

A

Papillary
Lymphatic spread predominates

76
Q

Second most common thyroid ca.?

A

Follicular
Vascular spread predominates

77
Q

Nerve damaged during urological or gynae surgery?

A

Obturator
Supplied medial thighs and adductor muscles

78
Q

Renal transplant pt viruses

A

< 6/12 since transplant = CMV
> 6/12 since transplant = EBV

MRCS (2 decks)

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