MRCS - April 3/52 Flashcards
1
Q
first step in investigating prostate tumor after radiological finding?
A
biopsy > gleason scoring
2
Q
options in mx of prostate cancer
A
conservative - active surveilance for low gleason score
hormonal therapy
external or internal RT
robot prostatectomy
3
Q
benign cause for nipple bloody discharge in young female
A
intraductal papilloma
4
Q
what nerve lies between lateral and medial head of tricep
A
radial nerve
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)
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
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
8
Q
what does foramen spinosum contain and which bone is it on?
A
middle meningeal artery
meningeal branch of mandibular artery
sphenoid
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
10
Q
which cranial foramen does the Facial nerve pass thru
A
stylomastoid foramen
11
Q
which cranial foramen does the abducent nerve travel thru
A
superior orbital fissure
12
Q
which foramen does the vagus nerve go thru
A
jugular foramen
13
Q
which foramen does Nerve V2 pass thru?
A
foramen rotundum
14
Q
what is clear cell mets assoc w
A
renal cell carcinoma
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
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
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
18
Q
what nerve innervates the middle ear?
A
glossopharyngeal nerve (CN IX)
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
20
Q
where does superior adrenal artery originate from
A
inferior phrenic artery which comes from aorta
21
Q
what is the biochemical picture for pagets disease of the bone
A
raised ALP, but normal calcium
22
Q
what is the order of bone affected in pagets disease of the bone
A
spine skull pelvis femur
23
Q
what is the xray appearance of pagets dz of the bone
A
abnormally thickened sclerotic changes
24
Q
parts of urethra from bladder to glans
A
pre-prostatic urethra prostatic urethra membranous urethra bulbar urethra penile urethra
25
in perineal trauma injuries, which part of urethra most prone to damage?
bulbar urethra rupture
26
in pelvic fracture associated trauma, which part of urethra is most prone to injury?
membranous urethra
27
what other signs is a membranous urethra damage associated with?
pelvic fracture
inability to feel prostate on DRE due to displaced prostate
perineal oedema/haematoma
28
how to investigate suspected urethral injury?
ascending urethrogram
29
how to mx urethral injuries?
suprapubic catheters
30
how does bulbar urethra rupture present?
perineal injury
blood at meatus in 50% of cases
urinary retention
perineal haematoma
31
features of paediatric pyloric stenosis
```
Males > females
presents 2-4 weeks in life
NBNB vomiting 30 mins after feeds
palpable mass in abdomen
hypochloraemic hypokalaemic metabolic alkalosis
```
32
what kind of blood pH abnormality do u get with persistent vomiting ?
hypochloraemic, hypokalaemic metabolic alkalosis
33
3 major blood supply of the breast
internal thoracic artery (medial side)
pectoral branch of thoraco acromial artery
lateral thoracic artery
34
innervation of pect minor
medial pectoral nerve
35
nerve supply of pect major
medial and lateral pectoral nerve
36
origin and insertion of pect minor
coracoid process -> costal cartilage of 3rd to 4th rib
37
which finger has no palmar interossei attachment?
middle finger
38
structures superficial to extensor retinaculum of the dorsum of wrist
basilic vein
superficial branch radial nerve
cephalic vein
dorsal cutaneous branch of ulnar nerve
39
what major organ lies just ventral to the origin of the SMA?
pancreas
40
where is the coelic trunk in relation to the pancreas?
coelic trunk lies above the pancreas
41
difference between anterior resection and low anterior resection?
more of the rectum is taken out in LAR
42
structure at highest risk of damage in low anterior resection?
left ureter
43
what is the pattern of edema seen in lyphoedema
initially pitting, then non pitting as tissues fibrose
44
conservative management of lymphoedema
exclude other causes
treat infection if present
raise legs
compression bandage or pneumatic compression devices
45
surgical options of lymphoedema
must have good distal lymphatics
debulking surgery with or without graft
lymphatic anastamosis
46
causes of 2ndary lymphodema
```
groin or axillary surgery
post radiotherapy
infection by wuchera bancrofti
malignancy
lymph surgery
```
47
what type of surgery of anal verge cancer?
abdomino-perineal excision of colon and rectum
48
what surgery for transverse colon tumors?
extended right hemicolectomy
49
what size of adrenal incidentaloma should always be excised?
>4cm
50
how to investigate for a functioning adrenal incidentoloma?
```
midnight/morning cortisol
dex suppression test
24h urine catecholamines
24h urine cortisol
serum K, Aldos, renin
```
51
what coag tests are abnormal in von willebrands disease?
prolonged APTT and bleeding time
| normal PT and platelets
52
what bleeding disorder can cause increased PT?
Vit K def
53
what is the coag abnormality seen in haemophilia?
prolonged APTT, normal PT and bleeding time
54
where is dietary iron most absorbed?
duodenum and prox jjm
55
how does erythromycin increase gastric emptying?
acts on motilin receptors on the gut
56
which structure do the thebesian veins of the heart drain into?
into the heart atria/ventricles directly
57
how to calculate MAP?
diastolic pressure + 0.33(SP-DP)
58
which type of hypersensitivity reaction is seen in TB? which cell mediates it?
type 4, T cell mediated
59
what parasite is associated with consumption of watercress?
fasciola hepatica
60
management of fistulo in ano - high vs low fistulas
high fistulas should be treated with setons
| low fistulas can be laid open (less risk of incontinence)
61
what cranial nerves go thru the jugular foramen?
9 10 11
62
which part of the lower GIT does UC spare?
anal canal and anal transitional zone
63
what nerve in involved in nerve entrapment causing neuropathic pain following inguinal hernia surgery?
ilioinguinal nerve
64
what hormone stimulates prolactin release? and what inhibits it?
Thyrotropin releasing hormone stimulates, dopamine inhibits
65
contents of the jugular foramen
anterior: inferior petrosal sinus
middle: CN 9 10 11
post: sigmoid sinus
66
what is the precursor to the Internal jugular vein?
sigmoid sinus
67
insertion of brachialis?
ulnar
68
what senses pass thru the spinothalamic tract?
pain and temperature
69
what spinal tract passes motor signals
anterior corticospinal tract
70
what does vestibulospinal tract convey
motor signal relating to posture
71
what conveys fine touch, pressure and proprioception
cuneate fasciculus
72
what tracts convey proprioceptive signals?
posterior spinocerebellar tract
| cuneate fasciculus
73
what approach and technique can be used in adult hydrocele repair? - what approach in children?
lords repair or jamboulay repair, via scrotal approach. in children, inguinal approach is used
74
3 types of rectal prolapse?
complete
incomplete
concealed
75
describe a complete rectal prolapse
contains 2 layers of rectum, peritoneum, sometimes bowel loops
76
describe incomplete rectal prolapse
involves only the mucosa, a/w haemorrhoids
77
what causes incomplete and complete rectal prolapses
incomplete: usually children, a/w straining
complete: adults, a/w weak pelvic floor attachments and anal musculature, floppy redundant sigmoid colon
78
presentation of incomplete and complete rectal prolapses
incomplete: a/w straining
complete: defecation, when worse, standing/laughing/sneezing
79
management of rectal prolapse
incomplete: as per haemorrhoids: sclerotherapy, banding, haemorrhoidectomy
complete: laxatives for conservative mx, surgically can do laparoscopic abdominal rectopexy
80
Which muscle relaxant is an agent that is degraded by hydrolysis and may produce histamine release?
atracurium
81
what blood vessels are within the posterior triangle of the neck
external jugular vein
| subclavian artery
82
what is the bainbridge reflex?
increase in CVP causing stretch in atria muscles causing increased heart rate
83
contents of the cavernous sinus
```
oculomotor (3)
trochlear (4)
opthalmic (v1)
maxillary (v2)
Carotid (int)
abducent (6)
t
```
84
where does the cavernous sinus drain into?
IJV via superior and inferior petrosal sinus
85
what muscles in the hand innervated by Median nerve
Lateral 2 lumbricals
Opponens pollicis
Abductor policis brevis
Flexor pollicis brevis
86
what are signs of damage to anterior interosseous nerve? what nerve is it a branch of?
median nerve
loss of pronation of forearm
weak long flexor of thumb and index finger
87
what parotid tumour is more associated with facial nerve invasion?
adenoid cystic carcinoma
88
what common benign parotid neoplasm?
benign pleomorphic adenoma
89
in colorectal TNM staging, whats the difference between T2 and T2 disease?
T2 has invaded into muscularis propria
| T3 has invaded through the muscularis propria
90
in colorectal TNM staging, whats the difference between N1 and N2 disease?
N1 is up to 4 nodes involvement, N2 is more than 4
91
which organ transplant is most at risk of HLA-mismatch rejection?
renal
92
what type of thyroid tumour is associated with papillary projections and pale empty nuclei?
papillary carcinoma
93
what is given in massive transfusion protocl
1:1:1 ratio if platletes plasma and rbc
94
most common early lymphatic metastasis of ovarian tumours? what other primary tumors commonly metastasise here early?
para-aortic nodes, testis, uterine fundus
95
how to manage local anaesthetic toxicity?
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
presentation of prilocaine toxicity? how to manage?
methaemoglobinaemia - sudden cyanosis and desaturation - give methylene blue
97
safe dose of neat systemic local anaesthetic agents?
lignocaine - 3mg/kg
bupivicaine 2mg/kg
prilocaine 6mg/kg
98
safe dose of systemic local anaesthetic agents with adrenaline?
lignocaine - 7mg/kg
bupivicaine 2mg/kg
prilocaine 9mg/kg
99
presentation of systemic LA toxicity?
palpitations, cardiac arrythmias, perioral numbness, tinnitus, GCS drop and coma
100
what kind of raised bilirubin is found physiological (benign) neonatal jaundice? conjugated or unconjugated
unconjugated bilirubin is found in benign jaundice
| conjugated bilirubin is found in pathological e.g. obstructive liver disease
101
management of traumatic haemothorax?
large bore chest drain insertion, if massive bleeding >1.5L or >200mls/hour after 24hrs, for thoracotomy
102
management for diaphragmatic injuries
direct surgical repair
103
features of sub acute thyroiditis AKA de quervains
```
follows viral infection
painful goitre
hyperthyroidism
raised ESR
reduced uptake on iodine 131 scan
```
104
management of sub acute thyroiditis
self limiting, KIV steroids if severe, analgesia
105
pathophysiology of hashimotos thyroiditis?
autoimmune disorder involving anti-thyroglobulin, Anti-TPO and anti-TSH-Receptors
106
which antibody is markedly raised initially in hashimotos?
anti thyroglobulin
107
features of hashimotos?
goitre, progressive hypothyroidism
108
what lies inferomedially to the deep inguinal ring?
inferior epigastric artery
109
what artery lies anteriorly to the submandibular gland?
facial artery
110
where does the lingual artery lie in relation to the submandibular gland
posteriorly (Deep)
111
what artery and nerve supplies the submandibular gland?
facial artery
sympathetic innervation from superior cervical ganglion
parasympathetic innervation from submandibular ganglion via lingual nerve
112
first structured to be approached in a posterior right nephrectomy?
right ureter
113
contents of popliteal fossa from medial to lateral
popilteal artery
popliteal vein
tibial nerve
common peroneal nerve
114
what is an example of a tyrosine kinase inhibitor, what uses does it commonly have
imatinib - for GISTs and chronic myeloid leukaemia
115
what is Trastuzumab?
AKA herceptin, HER receptor targetted biologic - breast cancer
116
what is Bevacizumab
Anti VEGF biologic agent -
117
what is the target of Adalimumab
Infliximab
Etanercept
anti TNF alpha
118
what is involved in open fracture gustillo anderson Type 3A/B/C fractures?
3A - large open# with adequate soft tissue damange
3B - inadequate soft tissue coverage
3C - associated arterial injury
119
what type of thyroid cancer is hashimotos associated with?
lymphoma of the thyroid
120
MOA of tranaxemic acid?
inhibition of plasmin
121
where in the GI tract is calcium most absorbed
small bowel
122
what is the histological appearance of tertiary hyperparathyroidism
hyperplasia
123
BP levels that kidney can accomodate to maintain gfr
80-180
124
which lvl does the common carotid bifurcate?
c4
125
what lies between subclavian artery and vein?
scalenus anterior
126
borders of anatomical snuffboxx
medially - extensor pollicis longus
| laterally - abductor pollicis longus and extensor pollicis brevis
127
which type of lung cancer is most a/w early dissemination? which part of the lung is commonly found in
small cell lung ca , large airways
