MRCS Clinical Conditions Flashcards
What is the most common tumour of anterior mediastinum?
Thymoma
Investigation of choice for achiles tendon rupture?
US or MRI
What test is diagnostic of Achilles tendon rupture? What is it
Thompson test - squeeze posterior calf, doesn’t plantarflex = positive result
Mammogram shows coarse linear branching calcification. Dx?
Comedo type DCIS
Which 2 kidney stones are radiopaque?
Calcium oxalate
Calcium phosphate
Which 2 kidney stones are radiolucent?
Uric acid
Indinavir
Which kidney stone is partially radiolucent?
Cystine
What are the 2 types of cartilagenous joints? Examples of each?
Primary- 2 bones joined by hyaline cartilage e.g. growing bones or in costochondral joints and first chondrosternal joint
Secondary - 2 bones joined by fibrocartilage **midline e.g. manubriosternal, pubic symphysis, xiphisternum, interverterbal joints
Which type of cartilagenous joints are found in midline? What are they?
Secondary cartilagenous- 2 bones joined by fibrocartilage
Twisting injury, immediate pain, delayed swelling and knee locking. Dx?
Meniscus injury
Greasy surface plus keratin plugs. Diagnosis?
Seb K
Most common parotid tumour? Features
Benign pleomorphic adenoma
Slow growing, can recur, needs excising
Can become malignant
What is Warthins tumour otherwise known as?
Benign papillary cystadenoma
What is the most common bilateral parotid tumour?
Warthins
Which common parotid tumour can become malignant?
Pleomorphic adenoma
What is most common parotid tumour in kids?
Haemangioma
Which malignant parotid cancer is associated most with perineural spread?
Adenoid cystic carcinoma
Management of benign vs malignant parotid tumours?
Benign - superficial parotidectomy
Malignant- radical excision
What is the most common type of renal stone? Main RF?
Calcium oxalate
High calcium
Which renal stone precipitates in acidic urine? Main RF for these?
Uric acid stones
High uric acid - e.g. cancer
Which is the main radio lucent renal stonse?
Uric acid
Xanthine
Which renal stones are semi opaque? Ground glass. What do they contain
Cysteine stones
Contain sulfur
Which renal stone is formed in alkali urine and seen in RTA 1 and 3?
Calcium phosphate
What is the most radio dense renal stone?
Calcium phosphate
What is the treatment of choice for staghorn calculi or renal stones over 2cm?
PCNL
Which stones are suitable for ESWL?
5-10mm ureteric or renal stones, some larger renal stones
Characteristics of superficial epidermal burns?
Red, moist skin, blanches
Characteristics of superficial epidermal burns?
Red, moist skin, blanches
Characteristics of superficial partial thickness burns?
Pale and dry, blistery, blanches
Characteristics of deep partial thickness burns?
Red mottled and non blanching skin
What depth of burn must be at least if skin non blanching?
Deep partial thickness
Characteristics of full thickness burns?
Dry leathery hard skin that doesn’t blanch
What is the most accurate way of measuring SA burns in kids?
Lund Bronder chart
Describe Wallaces rule of 9s?
Arm = 4.5% front and back (x2)
Leg = 9% front and back (x2)
Trunk = 9% x 4
Head = 4.5% front and back
Perineum is 1%
Palm is roughly 0.8%
Parkland formula for first and next 24 hours?
2 x SA x weight over first 24, 1/2 in fjrst 8 hours
Then 1.5 x SA x weight over next 24
In adults and kids what is cut off for needing fluid as per parkland?
15% SA in adults, 10% in kids
At least partial thickness
How is fluid formula different for electrical burns?
4 x SA x kg rather than 2
What is adequate UO for adults vs kids in burns?
At least 0.5 ml per kg per hour in adults
1 in kids
Which thyroid Ca commonly metastases via lymph?
Papillary
What cells characterise medullary thyroid Ca?
Parafollicular c cells of neural crest origin
Which thyroid Ca is notoriously not radio iodine sensitive?
Medullary
Which thyroid Ca doesn’t usually need resection?
Lymphoma
Which thyroid Ca usually metastasises via blood?
Follicular
What scans can be used to localise parathyroid adenomas?
US in combo with sestamibi (MIBI radionucleotide)
What infarction causes AV node ischaemia - be specific and also where it arises?
RCA - posterior IV artery, AV nodal branch. Arises in ant coronary sinus
What bit of adrenal hypertrophies in Cushings?
Zona fasciculata
What is piriformis syndrome?
Entrapment neuropathy of sciatic nerve causing radicular pain and paraesthesia
From which muscle does sciatic nerve emerge under? Entrapment syndrome?
Piriformis
Piriformis syndrome
Which nerve emerge over piriformis? Innervated muscles?
Superior gluteal nerve
Gluteus medius and minimus
Nerve roots of superior gluteal nerve?
L4-S1
Inferior gluteal nerve innervates?
Gluteus maximus
Once thawed, when does FFP have to be used within? What about overall fridgd ztorage time?
24 hours
36 months total
Most common pathogen causing bacterial flexor tenosynovitis?
S aureus
Ewings sarcoma is diagnosed based on what? Radiology and biopsy
Lytic destruction with onion skin appearance, usually diaphyseal in LLs of teenagers
Small round blue cells on biopsy
What condition is suggested by onion skin appearance lytic lesion and pain swelling in teenage lower limb long bone?
Ewings sarcoma
What is a chondroblastoma?
Benign epiphyseal tumour
What do you do if DDH suspected in newborn? Why?
US at 4 to 6 weeks to reduce inappropriate splinting, as many lax capsules tighten by then
Why does radial nerve injury in spiral groove of humerus leave elbow extension ok?
Triceps branch originates higher up
What is the emegency treatment of hereditsry angiodema?
FFP to replace C1 esterase inhibitor
Why is ferrous sulphate better than ferric?
Dissolves better in water
Where is most body iron stored?
Hb
How are displaced intracapsular fractures in young people managed?
Fixation - emergency e.g. Dhs
MUST fracture?
Monteggia- proximal ulna fracture with superior/prox radial head dislocation
GRIP fracture?
Galeazzi- radial fracture with inferior radio ulnar dislocation
CD arm fractjre?
Colles - dorsal angulation, fall on outstretched hand
Smiths fracture?
Reverse colles - fall on flexed hand, volar angulation of segment
Barton fracture? BC
Distal radial fracture with radioCarpal joint dislocation
Main MALT gastric lymphoma association and therefore first treatment measure for local disease?
H pylori therefore eradicate
Minimal size for aystmpomtatic AAA intervention?
Over 5.5 cm
What is PEEP useful for? Specific example?
Diffuse processes to keep Airways open - e.g. ARDS
Best method of investigating microcalcification on mammography?
Core biospy
Majority of hip dislocations are what? How do they look? Nerve at risk?
Posteiror due to trauma
Sciatic nerve palsy
Shortened adducted and internally rotated
Diagnosis of Hirschprungs is confirmed by?
Absence of ganglia in submuvosa of rectum
What acid base disturbance can be caused by over administration of NaCL?
Hyperchkoraemic metabolic acidosis
Haemophilia A causes prologned what?
APTT
Management of pregnancy associated CTS?
Conservative initially e.g. wrist splint as most resolve after pregnancy
What investigation is best breast imaging in women under 35?
US
Incision for open appendicectomy?
Lanz
VWD is what inheritance?
AD
Lichen planus is a RF for what?
Oral cancer
Which is more common in trauma - intra or extraperitoneal bladder rupture? How are these repaired
Extra
2 layer technique, absorbable sutures
MEN2a? 2b?
Medullary thyroid Ca
Phaeochromocytoma
Parathyroid hyperplasia
2b is this but with marfans and neuromas, no parathyroid
Men1?
Pituitary tumour
Parathyroid hyperplasia
Pancreatic - insulinoma/ZES
What neck swelling classically gets big/painful after URTI?
Branchial cyst
How does PTH increase Ca?
Increases hydroxylatkon of 25 hydroxy vit D to 1 25 dehydr vit D
In turn increases intestinal absortpion of Ca
What cells release PTH?
Chief cells of parathyroid
What investigation is most sensitive for heart transplant rejection?
Heart biopsy
A central lumbar disc herniation at a given spinal level e.g. L3/4 will affect which nerve?
One below - transiting
E.g. L4
A lateral disc prolapse will get which nerve?
Exiting nerve e.g. at L3/4 would be L3 nerve
