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mrcs study > MRCS - April 3/52 > Flashcards

MRCS - April 3/52 Flashcards

1
Q

first step in investigating prostate tumor after radiological finding?

A

biopsy > gleason scoring

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2
Q

options in mx of prostate cancer

A

conservative - active surveilance for low gleason score

hormonal therapy

external or internal RT

robot prostatectomy

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3
Q

benign cause for nipple bloody discharge in young female

A

intraductal papilloma

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4
Q

what nerve lies between lateral and medial head of tricep

A

radial nerve

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5
Q

what kind of cells can you expect to see on a blood film post splenectomy?

A

holly jowell
erythrocytes containing siderotic granules
poikilocytes (target cells)

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6
Q

what is a holly jowell cells

A

rbc that still contains dna material

usually removed by spleen.

presence on PBF can indicate aplenism or hyposplenism

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7
Q

what nerves innervate lacrimal gland, where does the preganglionic fibres come from

A

sensory innervation is via lacrimal nerve which comes from V1 (opthalmic)

secretory innervation is via parasympathetic fibres that come from VII via greater petrosal nerve -> pterygopalatine ganglion -> zygomatic nerve -> communicating branch to lacrimal nerve

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8
Q

what does foramen spinosum contain and which bone is it on?

A

middle meningeal artery
meningeal branch of mandibular artery
sphenoid

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9
Q

what does foramen ovale contain and which bone is it on?

A 
Otic ganglion
V3 (mandibular nerve)
Accessory meningeal artery
Lesser petrosal nerve
Emissary veins
sphenoid
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10
Q

which cranial foramen does the Facial nerve pass thru

A

stylomastoid foramen

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11
Q

which cranial foramen does the abducent nerve travel thru

A

superior orbital fissure

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12
Q

which foramen does the vagus nerve go thru

A

jugular foramen

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13
Q

which foramen does Nerve V2 pass thru?

A

foramen rotundum

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14
Q

what is clear cell mets assoc w

A

renal cell carcinoma

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15
Q

cause and treatment of infected sinuses post appendicectomy with GP organisms and sulphur granules?

A

actinomycosis - treat w long term penicillin kiv surgical debridement

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16
Q

what groin mass is a/w varicose veins, +ve cough impulse - what other features are there and how to ix ?

A

saphenous varix - varicose vein at SFJ

bluish tinge, disappears on lying down, hum on auscultation,

ix with US

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17
Q

a man collapses and is hypotensive due to ruptured AAA - fast bolus of 1L fluids is indicated, true or false ?

A

false. 1L over 4H is better as fast fluids might dislodge a protective haematoma

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18
Q

what nerve innervates the middle ear?

A

glossopharyngeal nerve (CN IX)

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19
Q

what is the venous drainage of left and right adrenal glands?

A

right side via right adrenal vein into IVC

left side via left adrenal vein > left renal vein > IVC

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20
Q

where does superior adrenal artery originate from

A

inferior phrenic artery which comes from aorta

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21
Q

what is the biochemical picture for pagets disease of the bone

A

raised ALP, but normal calcium

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22
Q

what is the order of bone affected in pagets disease of the bone

A

spine skull pelvis femur

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23
Q

what is the xray appearance of pagets dz of the bone

A

abnormally thickened sclerotic changes

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24
Q

parts of urethra from bladder to glans

A 
pre-prostatic urethra
prostatic urethra
membranous urethra
bulbar urethra
penile urethra
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25
Q

in perineal trauma injuries, which part of urethra most prone to damage?

A

bulbar urethra rupture

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26
Q

in pelvic fracture associated trauma, which part of urethra is most prone to injury?

A

membranous urethra

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27
Q

what other signs is a membranous urethra damage associated with?

A

pelvic fracture
inability to feel prostate on DRE due to displaced prostate
perineal oedema/haematoma

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28
Q

how to investigate suspected urethral injury?

A

ascending urethrogram

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29
Q

how to mx urethral injuries?

A

suprapubic catheters

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30
Q

how does bulbar urethra rupture present?

A

perineal injury
blood at meatus in 50% of cases
urinary retention
perineal haematoma

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31
Q

features of paediatric pyloric stenosis

A 
Males > females
presents 2-4 weeks in life
NBNB vomiting 30 mins after feeds
palpable mass in abdomen
hypochloraemic hypokalaemic metabolic alkalosis
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32
Q

what kind of blood pH abnormality do u get with persistent vomiting ?

A

hypochloraemic, hypokalaemic metabolic alkalosis

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33
Q

3 major blood supply of the breast

A

internal thoracic artery (medial side)
pectoral branch of thoraco acromial artery
lateral thoracic artery

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34
Q

innervation of pect minor

A

medial pectoral nerve

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35
Q

nerve supply of pect major

A

medial and lateral pectoral nerve

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36
Q

origin and insertion of pect minor

A

coracoid process -> costal cartilage of 3rd to 4th rib

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37
Q

which finger has no palmar interossei attachment?

A

middle finger

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38
Q

structures superficial to extensor retinaculum of the dorsum of wrist

A

basilic vein
superficial branch radial nerve
cephalic vein
dorsal cutaneous branch of ulnar nerve

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39
Q

what major organ lies just ventral to the origin of the SMA?

A

pancreas

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40
Q

where is the coelic trunk in relation to the pancreas?

A

coelic trunk lies above the pancreas

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41
Q

difference between anterior resection and low anterior resection?

A

more of the rectum is taken out in LAR

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42
Q

structure at highest risk of damage in low anterior resection?

A

left ureter

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43
Q

what is the pattern of edema seen in lyphoedema

A

initially pitting, then non pitting as tissues fibrose

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44
Q

conservative management of lymphoedema

A

exclude other causes
treat infection if present
raise legs
compression bandage or pneumatic compression devices

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45
Q

surgical options of lymphoedema

A

must have good distal lymphatics
debulking surgery with or without graft
lymphatic anastamosis

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46
Q

causes of 2ndary lymphodema

A 
groin or axillary surgery
post radiotherapy
infection by wuchera bancrofti 
malignancy
lymph surgery
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47
Q

what type of surgery of anal verge cancer?

A

abdomino-perineal excision of colon and rectum

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48
Q

what surgery for transverse colon tumors?

A

extended right hemicolectomy

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49
Q

what size of adrenal incidentaloma should always be excised?

A

> 4cm

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50
Q

how to investigate for a functioning adrenal incidentoloma?

A 
midnight/morning cortisol 
dex suppression test
24h urine catecholamines
24h urine cortisol 
serum K, Aldos, renin
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51
Q

what coag tests are abnormal in von willebrands disease?

A

prolonged APTT and bleeding time

normal PT and platelets

52
Q

what bleeding disorder can cause increased PT?

A

Vit K def

53
Q

what is the coag abnormality seen in haemophilia?

A

prolonged APTT, normal PT and bleeding time

54
Q

where is dietary iron most absorbed?

A

duodenum and prox jjm

55
Q

how does erythromycin increase gastric emptying?

A

acts on motilin receptors on the gut

56
Q

which structure do the thebesian veins of the heart drain into?

A

into the heart atria/ventricles directly

57
Q

how to calculate MAP?

A

diastolic pressure + 0.33(SP-DP)

58
Q

which type of hypersensitivity reaction is seen in TB? which cell mediates it?

A

type 4, T cell mediated

59
Q

what parasite is associated with consumption of watercress?

A

fasciola hepatica

60
Q

management of fistulo in ano - high vs low fistulas

A

high fistulas should be treated with setons

low fistulas can be laid open (less risk of incontinence)

61
Q

what cranial nerves go thru the jugular foramen?

A

9 10 11

62
Q

which part of the lower GIT does UC spare?

A

anal canal and anal transitional zone

63
Q

what nerve in involved in nerve entrapment causing neuropathic pain following inguinal hernia surgery?

A

ilioinguinal nerve

64
Q

what hormone stimulates prolactin release? and what inhibits it?

A

Thyrotropin releasing hormone stimulates, dopamine inhibits

65
Q

contents of the jugular foramen

A

anterior: inferior petrosal sinus
middle: CN 9 10 11
post: sigmoid sinus

66
Q

what is the precursor to the Internal jugular vein?

A

sigmoid sinus

67
Q

insertion of brachialis?

A

ulnar

68
Q

what senses pass thru the spinothalamic tract?

A

pain and temperature

69
Q

what spinal tract passes motor signals

A

anterior corticospinal tract

70
Q

what does vestibulospinal tract convey

A

motor signal relating to posture

71
Q

what conveys fine touch, pressure and proprioception

A

cuneate fasciculus

72
Q

what tracts convey proprioceptive signals?

A

posterior spinocerebellar tract

cuneate fasciculus

73
Q

what approach and technique can be used in adult hydrocele repair? - what approach in children?

A

lords repair or jamboulay repair, via scrotal approach. in children, inguinal approach is used

74
Q

3 types of rectal prolapse?

A

complete
incomplete
concealed

75
Q

describe a complete rectal prolapse

A

contains 2 layers of rectum, peritoneum, sometimes bowel loops

76
Q

describe incomplete rectal prolapse

A

involves only the mucosa, a/w haemorrhoids

77
Q

what causes incomplete and complete rectal prolapses

A

incomplete: usually children, a/w straining
complete: adults, a/w weak pelvic floor attachments and anal musculature, floppy redundant sigmoid colon

78
Q

presentation of incomplete and complete rectal prolapses

A

incomplete: a/w straining
complete: defecation, when worse, standing/laughing/sneezing

79
Q

management of rectal prolapse

A

incomplete: as per haemorrhoids: sclerotherapy, banding, haemorrhoidectomy
complete: laxatives for conservative mx, surgically can do laparoscopic abdominal rectopexy

80
Q

Which muscle relaxant is an agent that is degraded by hydrolysis and may produce histamine release?

A

atracurium

81
Q

what blood vessels are within the posterior triangle of the neck

A

external jugular vein

subclavian artery

82
Q

what is the bainbridge reflex?

A

increase in CVP causing stretch in atria muscles causing increased heart rate

83
Q

contents of the cavernous sinus

A 
oculomotor (3)
trochlear (4)
opthalmic (v1)
maxillary (v2)
Carotid (int)
abducent (6)
t
84
Q

where does the cavernous sinus drain into?

A

IJV via superior and inferior petrosal sinus

85
Q

what muscles in the hand innervated by Median nerve

A

Lateral 2 lumbricals
Opponens pollicis
Abductor policis brevis
Flexor pollicis brevis

86
Q

what are signs of damage to anterior interosseous nerve? what nerve is it a branch of?

A

median nerve
loss of pronation of forearm
weak long flexor of thumb and index finger

87
Q

what parotid tumour is more associated with facial nerve invasion?

A

adenoid cystic carcinoma

88
Q

what common benign parotid neoplasm?

A

benign pleomorphic adenoma

89
Q

in colorectal TNM staging, whats the difference between T2 and T2 disease?

A

T2 has invaded into muscularis propria

T3 has invaded through the muscularis propria

90
Q

in colorectal TNM staging, whats the difference between N1 and N2 disease?

A

N1 is up to 4 nodes involvement, N2 is more than 4

91
Q

which organ transplant is most at risk of HLA-mismatch rejection?

A

renal

92
Q

what type of thyroid tumour is associated with papillary projections and pale empty nuclei?

A

papillary carcinoma

93
Q

what is given in massive transfusion protocl

A

1:1:1 ratio if platletes plasma and rbc

94
Q

most common early lymphatic metastasis of ovarian tumours? what other primary tumors commonly metastasise here early?

A

para-aortic nodes, testis, uterine fundus

95
Q

how to manage local anaesthetic toxicity?

A

stop injection of agent
100% high flow oxygen
ECG lead monitoring
administer lipid emulsion bolus (intralipid 20%) at 1.5ml/kg over 1 minute as bolus
KIV lipid emulsion infuion at 0.25ml/kg/minute

96
Q

presentation of prilocaine toxicity? how to manage?

A

methaemoglobinaemia - sudden cyanosis and desaturation - give methylene blue

97
Q

safe dose of neat systemic local anaesthetic agents?

A

lignocaine - 3mg/kg
bupivicaine 2mg/kg
prilocaine 6mg/kg

98
Q

safe dose of systemic local anaesthetic agents with adrenaline?

A

lignocaine - 7mg/kg
bupivicaine 2mg/kg
prilocaine 9mg/kg

99
Q

presentation of systemic LA toxicity?

A

palpitations, cardiac arrythmias, perioral numbness, tinnitus, GCS drop and coma

100
Q

what kind of raised bilirubin is found physiological (benign) neonatal jaundice? conjugated or unconjugated

A

unconjugated bilirubin is found in benign jaundice

conjugated bilirubin is found in pathological e.g. obstructive liver disease

101
Q

management of traumatic haemothorax?

A

large bore chest drain insertion, if massive bleeding >1.5L or >200mls/hour after 24hrs, for thoracotomy

102
Q

management for diaphragmatic injuries

A

direct surgical repair

103
Q

features of sub acute thyroiditis AKA de quervains

A 
follows viral infection
painful goitre
hyperthyroidism
raised ESR
reduced uptake on iodine 131 scan
104
Q

management of sub acute thyroiditis

A

self limiting, KIV steroids if severe, analgesia

105
Q

pathophysiology of hashimotos thyroiditis?

A

autoimmune disorder involving anti-thyroglobulin, Anti-TPO and anti-TSH-Receptors

106
Q

which antibody is markedly raised initially in hashimotos?

A

anti thyroglobulin

107
Q

features of hashimotos?

A

goitre, progressive hypothyroidism

108
Q

what lies inferomedially to the deep inguinal ring?

A

inferior epigastric artery

109
Q

what artery lies anteriorly to the submandibular gland?

A

facial artery

110
Q

where does the lingual artery lie in relation to the submandibular gland

A

posteriorly (Deep)

111
Q

what artery and nerve supplies the submandibular gland?

A

facial artery
sympathetic innervation from superior cervical ganglion
parasympathetic innervation from submandibular ganglion via lingual nerve

112
Q

first structured to be approached in a posterior right nephrectomy?

A

right ureter

113
Q

contents of popliteal fossa from medial to lateral

A

popilteal artery
popliteal vein
tibial nerve
common peroneal nerve

114
Q

what is an example of a tyrosine kinase inhibitor, what uses does it commonly have

A

imatinib - for GISTs and chronic myeloid leukaemia

115
Q

what is Trastuzumab?

A

AKA herceptin, HER receptor targetted biologic - breast cancer

116
Q

what is Bevacizumab

A

Anti VEGF biologic agent -

117
Q

what is the target of Adalimumab
Infliximab
Etanercept

A

anti TNF alpha

118
Q

what is involved in open fracture gustillo anderson Type 3A/B/C fractures?

A

3A - large open# with adequate soft tissue damange
3B - inadequate soft tissue coverage
3C - associated arterial injury

119
Q

what type of thyroid cancer is hashimotos associated with?

A

lymphoma of the thyroid

120
Q

MOA of tranaxemic acid?

A

inhibition of plasmin

121
Q

where in the GI tract is calcium most absorbed

A

small bowel

122
Q

what is the histological appearance of tertiary hyperparathyroidism

A

hyperplasia

123
Q

BP levels that kidney can accomodate to maintain gfr

A

80-180

124
Q

which lvl does the common carotid bifurcate?

A

c4

125
Q

what lies between subclavian artery and vein?

A

scalenus anterior

126
Q

borders of anatomical snuffboxx

A

medially - extensor pollicis longus

laterally - abductor pollicis longus and extensor pollicis brevis

127
Q

which type of lung cancer is most a/w early dissemination? which part of the lung is commonly found in

A

small cell lung ca , large airways

mrcs study (9 decks)

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