MRCS april 4/52 Flashcards
1
Q
which lymph nodes would a tumor of the inferior auricle and lobule drain into
A
superficial cervical nodes
2
Q
which lymph nodes would a tumor of the lateral auricle and upper half of ear drain into
A
superficial parotid nodes
3
Q
which lymph nodes would a tumor of the cranial surface of superior half of the ear drain into
A
deep cervical and mastoid nodes
4
Q
compartments of lower leg
A
anterior, fibular, deep posterior superficial posterior
5
Q
innervation of anterior compartment of leg?
A
deep peroneal nerve
6
Q
innervation of peroneal compartment of leg ?
A
superficial peroneal nerve
7
Q
innervation of superficial posterior compartment of leg?
A
tibial nerve
8
Q
innervation of deep posterior compartment of leg?
A
tibial nerve
9
Q
what structures pass thru the parotid gland
A
facial nerve
external carotid
retromandibular vein
auriculotemporal nerve
10
Q
lymph drainage if parotid gland
A
deep cervical nodes
11
Q
invasion of what breast structure causes retraction and dimpling?
A
breast ligament and duct
12
Q
nerve root supply of breast
A
t4-t6
13
Q
arterial supply of breast
A
internal and external mammary arteries
thoraco acromial artery
14
Q
lymph drainage of rectum
A
mesorectal nodes (superior dentate line) inguinal nodes (infe dentate line)
15
Q
how can u tell the diff between sigmoid colon and rectum
A
rectum does not have taenia coli
16
Q
what are the important fascial layers anterior and posterior to the rectum?
A
anteriorly: fascia of Denonvilliers
posterior: waldeyers
17
Q
how does spironolactone cause gynaecomastia ?
A
anti androgenic effects
18
Q
common complication in chemotherapy extravasation?
A
ulceration
19
Q
what to do in event of doxorubicin extravasation
A
stop infusion, elevate, cold compress
20
Q
what drugs/compounds would indicate warm compress in extravasation events
A
vinc alkaloids,
21
Q
when to give hyaluronidase in extravasation events
A
tpn, contrast media
22
Q
does phrenic nerve pass anterior or posterior to scalenus anterior ?
A
anterior
23
Q
insertion of psoas muscle ?
A
lesser trochanter of femur
24
Q
what nerve innervates the adrenal medulla, what neurotransmitter does it release and what is its effect ?
A
splanchnic nerves -> acetyl coline -> release of adrenaline and norad
25
what type of dressing/compound/solution to use for exuberant granulation tissue on healing wound
topical silver nitrate
26
characteristics of osteoid osteoma - who gets it, how does it present, where is it found most often, how does it look on xray?
younger 10-25 YO
pain that responds to nsaids
usually in cortex of femur or tibia
<1cm lesions with lucent core and sclerotic edges
27
antbx are use prior to mayo repair of para umbilical hernia repair. t or f
false, no mash
28
what are the margins required for excision of skin SCC and what determines it ?
>20mm is 6mm marginn
| <20mm is 4mm margin
29
which part of the face would radiotherapy be unsafe for skin cancer
prone to radionecrosis eg nose
30
most common cardiac emergency in pregnant women
mitral stenosis
31
what are the superficial veins of the lower leg?
short saphenous vein
| long saphenous vein
32
name all the veins of the lower limb up till iliac vein
(anterior tibial vein + posterior tibial vein + peroneal vein) + (gastrocnemius vein + soleal vein) + (short saphenous vein) -> popliteal vein -> superficial femoral vein + great saphenous vein + femoral profunda veins -SFJ---> iliac vein
33
course of SFV and GSV?
SFV is on lateral side, over lateral malleolus, joins at popliteal vein
GSV goes over medial malleollus and joins at SFJ
34
how many points of communication are there between superficial and deep vein system in lower limb?
6
35
why is it important to differentiate primary vs secondary cause of varicose veins
in secondary varicose veins, surgical stripping is not an option as patient will not have viable deep venous system for return of venous blood
36
what are symptoms of varicose veins
cosmetic, itching, aching, bleeding
thrombophlebitis, engorgement, ankle swelling
haemosiderin deposition, venous stasis eczema, lipodermatosclerosis
venous ulcers
37
risk factors for varicose veins
```
age 50-60s
female
pregnancy
obese
prev DVT
prolonged standing occupation
pelvic malignancy
```
38
investigation of varicose veins
hand held doppler, duplex us, venography
39
options in mx of varicose veins
conservative - compression bandage, stockings
| surgical - sclerotherapy, endoluminal RF ablation or laser, surgical stripping
40
indications for splenectomy post trauma?
hilar injuries
major haemorrhage
large associated injuries
41
what kind of incision is used for traumatic splenectomy?
midline incision
42
what post-op antibiotics should be given post splenectomy?
Pen V and pneumococcal vaccine
43
what kind of spleen injury can be managed conservatively?
small subscapular haematoma
minor intra abdominal blood
no hilar disruption
44
production of which clotting agents are inhibited by Warfarin?
factor 10 9 7 2 and protein C
45
which rib level is the spleen at
9 10 11th
46
what are the ant/post/inf/sup/hilar relations of the spleen
```
anteriorly, the stomach
post, left kidney
inferior, splenic flexure of colon
super: diaphragm
hilum: tail of pancreas
```
47
blood supply of spleen
coeliac trunk -> splenic artery -> short gastric arteries supply fundus of stomach, splenic artery goes into hilum of spleen, gastroeomental artery supplies body of stomach
48
what nerve supplies the platysma
cervical branch of facial nerve
49
where does the facial nerve divide into 5 branches?
parotid
50
what lies within the carotid sheath at C7?
common carotid, IJV, vagus nerve
51
what are the deep cervical layers in the neck? at C7
investing sheath - surrounds everything under the subcutaneous layer
prevertebral sheath
carotid sheath
pretracheal sheath
52
what is within the pretracheal sheath at C7?
esophagus, trachea and thyroid gland
53
At C7, what muscles lie between investing sheath and pretracheal sheath
sternohyoid and omohyoid
54
describe the blood supply of the thyroid gland?
superiorly: superior thyroid artery < ECA
inferiorly: inferior thyroid artery < thyrocervical artery < subclavian
55
where does the superior thyroid artery branch of from?
ext carotid artery right after the bifurcation of the common carotid
56
what connects the left and right lobe of the thyroid gland?
isthmus
57
which cord does the musculocutaenous nerve branch off from the brachial plexus?
lateral cord
58
what nerves come off the posterior cord of the brachial plexus?
subscap (upper and lower)
thoracodorsal
axillary
radial
59
what are the names of the branches of brachial plexus from root to nerve
root -> trunks -> division -> cords
60
what are the trunks of the brachial plexus
superior, middle and inferior trunk
61
what are the divisions of the brachial plexus
```
anterior division of superior trunk
posterior division of superior trunk
anterior division of middle trunk
posterior division middle trunk
posterior division of inferior trunk
```
62
what forms the posterior cord of the brachial plexus?
the posterior division of superior, middle and inferior trunks
63
what forms the lateral cord of the brachial plexus?
anterior division of superior trunk
| anterior division of middle Itrunk
64
what forms the medial cord of the brachial plexus?
anterior div of inferior trunk
65
which cord supply the median nerve?
lateral cord and medial cord
66
which cord does the radial nerve come off?
posterior cord
67
which cord does the ulnar nerve come off?
medial cord
68
where does the cephalic vein usually drain into
axillary vein
69
what is the vein that crosses the anatomical snuffbox?
cephalic vein
70
what is a potts fracture and how is it sustained?
forced foot eversion
| bimalleolar ankle fracture
71
what is a barton's fracture and it's key feature?
fall onto extended and pronated wrist
fracture of distal radius with radiocarpal dislocation
involvement of joint is key feature
72
difference between pri hyperparathyroidism and famlial hypocalciuria hypercalcaemia
FHH has mildly high calcium, normal PTH and low 24hr urine calcium excretion
73
what is the likely primary for a hypervascular boney metastasis?
renal cancer
74
5 common cancers that spread to bone?
```
breast
bronchus
prostate
renal
thyroid
```
75
mechanism of action of doxorubicin and epirubicin?
inhibition of DNA/RNA formation by intercalation of base pairs
76
e.g of chemotherapy agent that works by inhibiting topoisomerase II?
etoposide
77
how do platinum based chemotherapy agents work?
crosslinks DNA molecules distorting shape, induces apoptosis
78
e.g. of an akylating chemotherapy agent
cyclophosphamide
79
how does an alkylating chemotherapy agent work?
forms DNA cross links and induces apoptosis
80
how does tamoxifen work?
selective estrogen receptor inhibitor
| inhibits breast ER, but induces peripheral ER
81
what increased cancer risks does tamoxifen bring about? why?
increased endometrial cancer due to peripheral ER stimulating effects
82
what cancer is EBV associated with
burkitt's lymphoma
hodgkin's lymphoma
post transplant lymphoma
nasopharyngeal carcinoma
83
describe brown seqard syndrome
hemisection of spinal cord causing
ipsilateral loss of proprioception, motor and vibratory sense
and contralateral loss of pain and temperature sensation
84
where does the spinothalamic tract decussate?
at the level of the spinal cord
85
where does the dorsal column tract decussate?
medulla
86
which spinal tract carries fine touch, vibration and proprioception?
dorsal column medial lemniscus pathway
87
which spinal tract carries pain and temperature sensation?
lateral spinothalamic tract
88
what does the anterior spinothalamic tract carry?
crude touch
89
what holds the spinal cord within the dural sheath
denticulate ligaments
90
difference in presentation between a breast fibroadenoma and a breast cyst
fibroadenoma usually younger premenopausal females, firm mobile mass, non tender, non fluctuant
breast cyst usually in perimenopausal females, soft, fluctuant
91
boundaries of hesselbachs triangle
medially rectus abdominis
laterally inferior epigastric arteries
inferiorly inguinal ligament
92
hernia within hesselbachs triangle is direct or indirect?
direct
93
what type of paediatric hernias have to be repaired immediately?
premature neonates with hernias at birth - highest risk of strangulation
94
herniotomy VS herniorapphy vs hernioplasty
herniotomy: sac ligated and excised
herniorapphy: herniotomy + posterior wall repair
hernioplasty: herniorapphy + reinforcement with mesh
95
what type of hernia repair is commonly done in children?
herniotomy
96
relations of the subclavian vein
inferiorly: 1st rib
posteriorly: scalenius anterior
anteriorly: middle 3rd of clavicle
97
what separates the subclavian artery and the subclavian vein
scalenus anterior
98
which is more anterior, subclavian artery or vein?
vein
99
what muscle lies posterior to external jugular vein?
inferior belly of omohyoid
100
conservative management options for female urinary bladder incontinence: stress vs urge ?
urge: bladder drill training for 6 weeks
stress: pelvic floor exercises for 3 months
101
when should urodynamic studies be done?
if etiology not evident from history
| or prior to surgery
102
management options for female urge incontinence?
bladder training for 6 weeks
oxybutinin (antimuscarinic drug)
sacral nerve stimulation
103
when is a urethral sling type operation done?
in female stress incontinence after failure of conservative measures
104
what attaches periosteum to bone?
sharpey's fibres
105
describe schatzkers classification for tibea plataeu fractures
1) split in lateral condyle
2) depression in lateral plataeu
3) split and depression in lateral condyle and plataeu
4) split of medial tibia plataeu
5) both medial and lateral condyle fracture
6) condylar, subcondylar highly comminuted fracture dissociation of metaphysis
106
how does 5 FU work?
mimics uracil, and incorporates itself into RNA
107
what is the common histology for anal cancer
squamous cell carcinoma
108
what accompanies the aorta as it passes thru the diaphragm and at what leve?
T12, thoracic duct
109
which structure does the vagus nerve travel with and what level does it go through the diaphragm?
oesophagus - T10
110
what does the right phrenic nerve go with when it traverses the diaphragm and at hwat level?
T8, Inf Vena cava
111
how does the left phrenic nerve enter the thorax
pierces the diaphragm on its own on the left side
