MRCS A Flashcards
Nerve commonly injured during inguinal hernia surgery?
Ilioinguinal nerve
Nerve commonly injured during posterior triangle LN biopsy?
Accessory nerve
Nerve commonly injured when using Lloyd-Davies stirrups?
Common perineal nerve
Nerve commonly damaged during thyroidectomy?
Recurrent laryngeal
Nerve commonly damaged during anterior resection of rectum?
Hyogastric autonomic nerves (arise from pelvic splanchnic nerves)
Nerves that could be damaged during axillary LN clearance?
Thoracodorsal - innervates lat dorsi
Long thoracic - innervates serrates anterior (winging of scapula)
Intercostobrachial - cutaneous sensation axilla and medial aspect upper arm
Nerves commonly injured during varicose vein surgery?
Sural nerve (related to short saphenous vein) - lateral aspect of foot/calf
Saphenous nerve (related to long saphenous vein) - medial calf
Nerve commonly injured during posterior approach to hip?
Sciatic nerve
Nerve commonly injured during carotid endarterectomy?
Hypoglossal nerve
Bochdalek hernia
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
Morgagni Hernia
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
Scrotum is drained by which LNs?
Inguinal
Testis drained by which LNs?
Lumbar and para-aortic
Cremasteric artery arises from…
Inferior epigastric artery
Artery of vas deferens arises from…
inferior vesical artery
Layers of spermatic cord/scrotum
Some Damned Examiner Called It The Testes -
Skin, Dartos, External fascia (external oblique), Cremaster (internal oblique), Internal fascia (transversalis), Tunica vaginalis, Testes
Vit K dependent factors
2, 7, 9, 10 (mnemonic 1972)
Measured using PT
NB. warfarin also affects Protein C synthesis
APTT factors
8, 9, 11, 12
Femoral hernia position?
Infero-lateral to pubic tubercle
Inguinal hernia position?
Supero-medial to pubic tubercle
Which blood product can cause iatrogenic gram positive organism infection?
Platelets (because stored at room temp)
Which blood product can cause iatrogenic gram negative organism infection?
Packed red cells (because stored at 4c)
Organisms in Fournier’s gangrene?
Bacteroides and e. coli
Nec fasc most common organism?
Streptococcus
Risks of abdominal aortic aneurysm rupture (over 5 years)?
5-5.9cm = 25%
6-6.9cm= 35%
7cm and over = 75%
MEN 1
3 Ps:
- Pituitary adenoma
- Parathyroid hyperplasia
- Pancreas
MENIN gene - chromosome 11
MEN 2a
2Ps + 1M:
- Parathyroid
- Phaeochromocytoma
- Medullary thyroid ca.
RET oncogene - chromosome 10
Men 2b
1P + 2Ms:
- Phaeochromocytoma
- Medullar thyroid ca.
- Marfanoid habitus / mucosal neuroma
RET oncogene - chromosome 10
Erb’s palsy - which roots affected? How does it present?
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)
Branches of posterior cord of brachial plexus?
S - subscapular (upper and lower)
T - thoracodorsal
A - axillary
R - radial
Lateral hip rotators?
Superior to inferior: P - GO - GO - Q
Piriformis
Gemellis superior
Obturator internus
Gemelis inferior
Obturator externus
Quadratus femoris
Types of transplant
Isograft - identical twin/same DNA
Allograft - non-related donor
Autograft - self
Xenograft - non-human
Popcorn cells - which lymphoma?
Nodular lymphocyte predominant Hodgkins lymphoma
Hodgkins with best prognosis?
Nodular sclerosing
Hodgkins with worst prognosis?
Lymphocyte depleted
Von Hippel Landau syndrome?
Autosomal dominant
Haemangiomas (cerebellar and retinal)
Phaeo
Renal or extra-renal cysts
Endolymphatic sac tumours
Structures posterior to medial malleolus?
Anterior to posterior:
posterior Tibialis
flexor Digitorum longus
tibial Artery
tibial Nerve
flexor Hallucis longus
(Tom Dick And Nervous Harry)
Structures passing through greater and less sciatic foramen?
PIN (medial to lateral):
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
Scrotal sensation nerve supply?
Anterior skin - ilioinguinal
Posterior/perineum - pudendal
Arterial supply to adrenals?
Superior adrenal (branch of inferior phrenic artery)
Middle (from aorta)
Inferior adrenal (from renal artery)
Venous drainage of adrenals?
Left –> renal vein
Right –> IVC
Which factors consumed in DIC?
5 and 8 plus platelets
Branches of subclavian artery?
VIT CD
- Vertebral
- Internal thoracic
- Thyrocervical trunk
- Costocervical trunk
- Dorsal scapular
Femoral nerve innervates….?
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
3 sigma rule in stats?
68 - 95 - 99
68% of values lie within 1 SD of mean
95% within 2 SD
99% within 3 SD
Which nerve related to origin of middle meningeal artery?
Auriculotemporal nerve - supplies sensation to the external ear and outermost part of the tympanic membrane
Fascia that separates prostate from rectum?
Denonvilliers
Fascia that separates rectum from sacrum?
Waldeyers
Salter-Harris classification?
SALTR
Straight across/slipped
Above
Lower
Through
Rammed
Porta hepatis contents?
VAD (posterior to anterior)
portal Vein
hepatic Artery
hepatic Duct
Level of hyoid?
C3
Level of thyroid cartilage notch?
C4
Level of cricoid?
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).
Lymph drainage of superior vagina?
Iliac nodes
Lymph drainage of inferior vagina?
Superficial inguinal
Branches of axillary artery?
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
Papillary thyroid ca. route of spread?
Lymphatic
Follicular thyroid ca. route of spread?
Haematogenous
During dissection of saphenofemoral junction, which structure could be injured?
Deep external pudendal artery (lies deep to junction)
Layers during LP?
Skin –> Subcutaneous tissue –> Supraspinous ligament –> Interspinous ligament –> Ligamentum flavum –> Epidural space –> Dura –> Arachnoid –> Subarachnoid space
3S ILEDAS
Branches of external carotid artery?
Some angry lady figured out PMS
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
Muscles innervated by the musculocutaneous nerve?
Biceps brachii
Brachialis
Coracobrachialis
(BBC)
Structures passing through foramen ovale?
O - otic ganglion
V3 - mandibular
A - accessory meningeal artery
L - lesser petrosal nerve
E - emissary veins
Nerves passing through supraorbital fissure?
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
Which foramina does trigeminal nerve exit?
Standing Room Only
V1 - superior orbital fissure
V2 - rotundum
V3 - ovale
Level of IMA?
L3
Level of SMA?
L1
Fluid resus burns?
2ml x TBSA % x kg
Half in first 8 hours
Cranial nerve exits?
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)
Most common parotid malignancy?
Mucoepidermoid, followed by adenoid cystic (latter characterised by perineurial invasion)
Branches of ICA?
Ophthalmic
Posterior communicating
Choroidal
Anterior cerebral
Middle cerebral
Only Press Carotid Arteries Momentarily
Diaphragmatic apertures and structures?
T8 = IVC + Right Pherenic nerve
T10 = esophagus + Both Vagii
T12 = Aorta + azygous + thoracic duct
I 8, 10Eggs, At12
Ureteric stones composition?
most common = calcium oxalate
most radio dense = calcium phsphate
cystiene = familial
struvite = proteus mirabilis = stag horn = alkaline urine
Parasympathetics CNs?
1973
Most common thyroid ca.?
Papillary
Lymphatic spread predominates
Second most common thyroid ca.?
Follicular
Vascular spread predominates
Nerve damaged during urological or gynae surgery?
Obturator
Supplied medial thighs and adductor muscles
Renal transplant pt viruses
< 6/12 since transplant = CMV
> 6/12 since transplant = EBV
