MRCS May 2/52

Question 1

Muscles supplied by deep branch of ulnar nerve

Answer 1

Hypothenar muscles
All interossei muscles
Ulnar 2 lumbricals
Adductor pollicis 
medial head of flexor pollicis brevis

Question 2

Describe the ulnar paradox

Answer 2

Flexion of LF and RF at MCPJ but not at DIPJ (less clawing) due to more proximal ulnar injury causing dysfunction of ulnar half of FDP (FDS still functional)

Question 3

Claw hand VS hand of benediction

Answer 3

Claw hand is a sign during attempted extension, indicating distal ulnar injury due to loss of ulnar 2 lumbricals

Hand of benediction is an active sign seen on flexion of fingers with a proximal median nerve injury due to loss of FDS and radial half of FDP, but functional ulnar half of FDP

Question 4

What is ape hand?

Answer 4

Sign at rest, due to median nerve injury, thumb will be extended at rest

Question 5

Which level of sympathetic ganglia are responsible for sweating in the arms

Answer 5

T2 T3 make the hand sweat free

Question 6

Which C spine level is the hyoid, thyroid cartilage prominence and cricoid cartilage?

Answer 6

Hyoid - C3
Thyroid artilage - C4
Cricoid inferior edge - c6

Question 7

Where does the trachea begin and at what lvl?

Answer 7

At the inf edge of cricoid cartilage at c6

Question 8

What does obturator nerve supply

Answer 8

Medial compartment of thigh

External obturator, Adductor longus, adductor brevis, medial part of adductor magnus, gracilis

Question 9

where is the azygos vein in relation to the bronchus

Answer 9

lies superior to right main bronchus

Question 10

origin and course of azygos vein

Answer 10

right common iliac vein -> right ascending lumbar vein -> azygos vein (posterior mediastinum) arches over right bronchus and enters SVC

Question 11

origin and course of inferior mesenteric vein

Answer 11

anorectal vein -> IMV -> splenic vein -> hepatic portal vein

Question 12

what are top two most common histology found in gallbladder cancer?

Answer 12

adenocarcinoma ~90%

squamous cell carcinoma ~10%

Question 13

what is the MOA of heparin?

Answer 13

binds to antithrombin III and enhances it’s effect

Question 14

which thyroid hormone is most active peripherally

Answer 14

T3

Question 15

what kind of gait is seen in common peroneal nerve injury?

Answer 15

high shuffling gait - patient lifts foot higher to clear the dropped foot

Question 16

what electrolyte abnormality can be seen in heparin use? why?

Answer 16

hyperkalaemia due to aldosterone inhibition

Question 17

what is thrombophlebitis migrans associated with? what is the sign called?

Answer 17

visceral cancer - pancreas, lung, stomach, GU tract - AKA trosseau’s sign of malignancy, due to hypercoagulable state caused by cancer

Question 18

which sinus most commonly causes osteomyelitis as a complication?

Answer 18

frontal

Question 19

what is codman’s triangle and what is it a sign of

Answer 19

radiological appearance of new bone forming under periosteum causing elevation of periosteum. a/w osteosarcomas or ewings sarcoma

Question 20

what type of antibodies are responsible for hyperacute rejection reactions

Answer 20

IgG

Question 21

which HLA class rejection is worst of all?

Answer 21

HLA class 1 rejection

Question 22

what is beck’s triad?

Answer 22

hypotension
quiet heart sound
raised JVP

Question 23

which type of colonic polyps have the highest risk of malignant transformation

Answer 23

Villous adenomas

Question 24

which part of the urethra does semen enter?

Answer 24

prostatic urethra

Question 25

describe the production of semen

Answer 25

sperm move from testes towards ejaculatory duct where seminal vesicles add fluid to it, then goes through prostatic duct where prostate adds fluid to it, finally the bulbourethral gland adds fluid to it

Question 26

what is the function of protein c

Answer 26

inactives factor Va and VIIIa

Question 27

which thyroid artery is closely related to the external laryngeal nerve?

Answer 27

superior thyroid artery

Question 28

which structure does the ayzgous vein travel with as it passes through the diaphragm? what lvl?

Answer 28

aorta and thoracic duct at T12

Question 29

in men, which structures arise from the embryological mesonephric ducts?

Answer 29

the genitourinary system: collecting tubules, renal pelvis, calyces, ureter, vas deferens, epididymis, seminal vesicle

Question 30

what is the goldstandard investigation for DVT

Answer 30

venography, but venous duplex is more commonly used

Question 31

where is secretin produced in the GIT?

Answer 31

duodenum

Question 32

what is the role of secretin

Answer 32

stimulate pancreatic enzyme release

Question 33

what stimulates release of secretin

Answer 33

acid gastric chyme in ddnm

Question 34

which syndrome is the amsterdam criteria useful for?

Answer 34

lynch syndrome

Question 35

what is the amsterdamn criteria

Answer 35

3 colorectal cancers 2 generations apart 1 < 50 y/o

Question 36

what does PEEP and IPPV do to intracranial pressure?

Answer 36

increases

Question 37

how does IPPV affect cardiac output and BP

Answer 37

decreases cardiac output, reduces blood pressure due to increases intrathoracic pressure

Question 38

what forms the medial border of the hasselbach triangle

Answer 38

linea semilunaris - lateral aponeurosis of rectus sheath

Question 39

what is a spigelian hernia?

Answer 39

hernia through linea semilunaris

Question 40

where does the inferior epigastric vessels perforate the rectus abdominis?

Answer 40

arcuate line

Question 41

where are spiegellian hernias commonly seen

Answer 41

at the intersection of linea semilunaris and the arcuate line

Question 42

which artery supplies the lateral nasal wall and nasal septum?

Answer 42

sphenopalatine artery

Question 43

describe the blood supply of the nose

Answer 43

1) ICA branches -> opthalmic artery -> anterior and posterior ethmoid arteries 2) ECA branches -> sphenopalatine, greater palatine, sup. labial and angular arteries

Question 44

what supplies the superior portion of the nose

Answer 44

anterior and posterial ethmoid arteries

Question 45

what is the kiesselbach plexus?

Answer 45

point of anatamoses of 3 main blood supplies to the nose -> sphenopalatine, anterior, posterior ethmoid art.

Question 46

what veins does the superior sagittal sinus receive blood from

Answer 46

superior cerebral veins

Question 47

where does the superior sagittal sinus drain into

Answer 47

confluence of sinus

Question 48

what drains into the cavernous sinuses

Answer 48

sup. & inf. opthalmic veins, sphenoparietal sinus, superficial middle cerebral vein

Question 49

where do the cranial nerves 1 to 12 exit the skull?

Answer 49

``` CN 1 - cribiform plate CN 2 - optic canal CN 3, 4, V1, 6 - SOF CN V2 - foramen rotundum CN v3 - foramen ovale C7 - internal acoustic meatus - stylomastoid foramen CN 8 - internal acoustic meatus CN 9 - jugular foramen CN 10 - jugular foramen CN 11 - jugular foramen CN 12 - hypoglossal canal ```

Question 50

what investigation required to diagnose hereditary haemochromatosis?

Answer 50

liver biopsy

Question 51

where does iron sequester in the liver between hereditary haemochromatosis VS 2ndary iron overload?

Answer 51

in HH - parenchymal cells | in 2ndary causes - kuppfer cells

Question 52

in suspicion of DDH in newborns, when should the US scan be scheduled for?

Answer 52

4-6 weeks to allow some to resolve by themselves

Question 53

when is a single or double pneumatic cuff used?

Answer 53

single cuff - e.g. knee arthroscopy | double cuff - biers block

Question 54

what is linitis plastica?

Answer 54

a type of gastric adenocarcinoma

Question 55

in what form is most of CO2 transported to the lungs?

Answer 55

form of bicarbonate ions

Question 56

which nerve supplies taste to the posterior 1/3 of the tongue

Answer 56

glosspharyngeal (CN IX)

Question 57

which nerve supplies taste to the anterior 2/3 of the tongue

Answer 57

chorda tympani

Question 58

which nerve supplies general sensation to the anterior 2/3 of the tongue

Answer 58

V3 via lingual nerve

Question 59

which nerve supplies general sensation to posterior 1/3 of the tongue?

Answer 59

glosspharyngeal CN IX

Question 60

what facia lies posterior to the ascending colon?

Answer 60

gerota's fascia AKA anterior renal fascia

Question 61

what is the posterior renal fascia also called

Answer 61

zuckerkandl's fascia

Question 62

what does the APC gene do? what type of gene is it?

Answer 62

controls cell growth and reproduction, tumour supression gene

Question 63

which peritoneal structure is attached to the pancreas

Answer 63

transverse mesocolon

Question 64

what plane is the pancreas on

Answer 64

transpyloric plane at L1

Question 65

what is the relation between the pancreas and the two kidneys

Answer 65

head of pancreas lies next to the hilum of right kidney | but the tail of the pancreas is anterior to the left kidney

Question 66

which part of the pancreas does the SMV pass behind of

Answer 66

the body of the pancreas

Question 67

which cell receptor is associated with HIV entry into cells

Answer 67

CCR-5

Question 68

what do barlow's and ortolani's test test for

Answer 68

barlows check if the hip is dislocatable | ortolani check if it's dislocated and relocatable

Question 69

what is the MOA of rapamycin? what is it AKA? what is it used as?

Answer 69

inhibits interleukin 2, AKA sirolimus, used as immunosuppressant in organ transplants

Question 70

what is the narrowest and widest part of the male urethra?

Answer 70

membranous is narrowest, prostatic is widest

Question 71

Dystrophic calcification vs metastatic calcification

Answer 71

Dystrophic Calc - in damaged/necrotic tissues, happens in normal range serum calcium e.g. atherosclerosis, TB, more localised Metastatic calc - in high serum calcium, diffused calcification in multiple areas of the body

Question 72

which complement is polymerised to from MAC

Answer 72

C9

Question 73

what is the final product of the classical, alternative and lethicin pathway in complement system

Answer 73

c3 convertase

Question 74

what is C3b involved in

Answer 74

1) activation and formation of MAC | 2) opsonisation of pathogens to induce phagocytosis

Question 75

what is c3a and c5a involved in

Answer 75

recruitment of phagocytes and stimulators of inflammation

Question 76

what are the complements involved in MAC formation

Answer 76

c3b -> c5b c6 c7 c8 [c9]

Question 77

what is the origin of the sural nerve

Answer 77

tibial nerve

Question 78

what nerve supplies cutaneous sensation to the medial posterior lower limb (calf) and its origin

Answer 78

saphenous nerve

Question 79

what nerve supplies sensation to the skin over the head of the fibular

Answer 79

lateral sural nerve

Question 80

what is the alcock canal AKA? what is inside? what is it formed by

Answer 80

aka pudendal canal, contains internal pudendal artery and veins, and pudendal nerve, formed by fascia of obturator internus

Question 81

what can pulmonary wedge pressure be used to help diagnose

Answer 81

a raised PWP can be used to diagnosed pulmonary edema due to left heart failure

Question 82

what does pulmonary wedge pressure measure?

Answer 82

pressure in left atrium

Question 83

which veins would oseophageal varices be found in? which part of the oseophagus do they drain and where do they drain into?

Answer 83

superficial oesophageal veins, drains lower 1/3 of oseophagus, drains into left gastric vein and then portal vein

Question 84

what is the arterial blood supply of the oseophagus?

Answer 84

upper 1/3 - branches from inf thyroid artery middle 1/3 - branches from thoracic aorta lower 1/3 - oseophageal branches from left gastric art

Question 85

where does the eustachian tube drain into?

Answer 85

nasopharynx

Question 86

enlargement if what tonsils can cause glue ear ?

Answer 86

adenoids

Question 87

what muscle attaches to the eustachian tube ?

Answer 87

tensor vili palitini

Question 88

what happens to eustachian tube during swallowing

Answer 88

closes

Question 89

what are the muscles innervated by trigeminal

Answer 89

v3 innervates tensor tympani tensor vili palitini mylohyoid anterior belly of digastric

Question 90

what does anterior branch of v3 innervate

Answer 90

ipsilateral inner cheek mucosa

Question 91

what does gluteus medius and minimus attach to?

Answer 91

lateral surface of greater trochanter of the hip

Question 92

what does gluteus maximus attach to?

Answer 92

gluteal tuberosity of femur

Question 93

where do the external rotators of the hip attach to?

Answer 93

medial, posterior and superior surface of greater trochanter of the hip

Question 94

which bone is the carotid canal on

Answer 94

temporal bone

Question 95

common cancers that mets to bone

Answer 95

particular tumours like killing bone | prostate thyroid lung kidney breast

Question 96

according to ATLAS 2018 formula, how much fluids should be given in burn patients in the first 24h?

Answer 96

2mls X weight X TBSA %

Question 97

what L-spine level is the transpyloric plane found?

Answer 97

L1 lower border

Question 98

what can be found at the transpyloric plane

Answer 98

1st part of duodenum, pylorus of stomach, fundus of gallbladder, origin of hepatic portal vein, transverse mesocolon, splenic hilum

Question 99

injury to which nerve causes numbness of medial upper arm in axillary node clearance?

Answer 99

intercostobrachial nerve < lateral cutaneous branch < 2nd intercostal nerve (T2)

Question 100

what forms the medial, super, infe, lat, ant, post and floor of the axilla?

Answer 100

medial: serratus anterior, ribs 1-4 superior: first rib, clavicle, superior scapula infe: skin, subcut tissue and axillary fascia lat: bicipital groove ant: pect major and minor post: lats dorsi, teres maj, subscap, humerus, scapula floor: axillary fascia