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MRCS A > Neurovascular anatomy > Flashcards

Neurovascular anatomy Flashcards

1
Q

oesophagus arterial supply

A

upper third - inferior thyroid artery
middle third - oesophageal branch of descending aorta
lower third - left gastric artery

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2
Q

oesophagus venous drainage

A

upper third - inferior thyroid
middle third - azygous
lower third - left gastric (portal) and azygous (systemic)

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3
Q

oesophagus LN

A

upper third - deep cervical
middle third - mediastinal
lower third - left gastric + celiac

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4
Q

oesophagus innervation

A

upper half - recurrent laryngeal
lower half - oesophageal plexus

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5
Q

stomach arterial supply

A

generally:

right gastric - branch of proper hepatic artery - branch of CHA
left gastric - branch of coeliac trunk
right gastro-omental - branch of gastroduodenal - branch of CHA
left gastro omental - branch of splenic - branch of coeliac trunk

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6
Q

branches of CHA

A

gastroduodenal artery
proper hepatic artery

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7
Q

arterial supply of lesser curvature

A

right and left gastric artery

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8
Q

arterial supply of greater curvature

A

right and left gastro-omental
short gastric arteries

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9
Q

stomach innervation

A

parasympathetic
sympathetic t6-t9

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10
Q

stomach lymphatic drainage

A

gastric LNs
gastro-omental LNs

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11
Q

L.O.S in rolling hiatus hernia

A

in place
requires surgery more than sliding HH

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12
Q

duodenum arterial supply

A

proximal to major duodenal papilla - gastroduodenal artery (celiac branch)
distal to major duodenal papilla - inferior pancreaticoduodenal artery (SMA)

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13
Q

duodenum lymph drainage

A

pancreaticoduodenal and superior mesenteric LNs

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14
Q

jejunoileal arterial supply

A

supermesenteric arteries - vasa recta

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15
Q

jejunoileal venous drainage

A

SMV

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16
Q

caecum:

arterial supply
venous drainage
innervation
LNs

A

A - ileocolic artery
V - ileocolic vein
N - superior mesenteric plexus
LNs - ileocolic LNs

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17
Q

jejunoileal lymph drainage

A

SM LNs

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18
Q

ascending colon:

arterial supply
venous drainage
innervation
LNs

A

A - ileocolic + right colic arteries
V - ileocolic + right colic arteries
lymph nodes: superior mesenteric LNs
N: superior mesenteric plexus

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19
Q

appendix:

arterial supply
venous drainage
innervation
LNs

A

A - appendicular artery
V - appendicular vein
N - superior mesenteric plexus
LNs - ileocolic LNs

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20
Q

ascending colon innervation

A

superior mesenteric plexus

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21
Q

midgut innervation

A

superior mesenteric plexus

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22
Q

hindgut innervation

A

inferior mesenteric plexus

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23
Q

inferior mesenteric plexus innervation

A

parasympathetic = pelvic splanchnic nerves
sympathetic = lumbar splanchnic nerves

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24
Q

transverse colon:

arterial supply
venous drainage
innervation
LNs

A

arterial supply: right, middle and left colic arteries
venous drainage: middle colic vein
innervation: proximal 2/3 = SMP, distal 1/3 = IMP
LNs: superior mesenteric

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25
Q

descending colon:

arterial supply
venous drainage
innervation
LNs

A

A - left colic
V - left colic
Innervation - IMP
LNs - Inferior mesenteric

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26
Q

SM + IM drain into….

A

cisterna chyla which drain into thoracic duct

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27
Q

seperator of right atria smooth vs rough walls

A

crista terminalis

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28
Q

what seperates conus arteriosus from inflow portion of RV

A

supraventricular crest

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29
Q

parietal pleura:

innervation
arterial supply

A

innervation: phrenic + intercostal nerves
arterial supply - intercostal arteries

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30
Q

visceral pleura:

innervation
arterial supply

A

innervation - pulmonary plexus
arterial supply - bronchial arteries

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31
Q

calot’s triangle borders

A

superior - inferior border of liver
medial - common hepatic duct
lateral - cystic duct

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32
Q

what connects greater and lesser sacs

A

epiploic foramen (of Winslow)

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33
Q

cludocentesis

A

fluid from pouch of douglas
for draining pelvic abcesses

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34
Q

trachea start and end point

A

c6 - t4/5

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35
Q

name the pleural recesses

A

costodiaphragmatic
costomediastinal

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36
Q

parasympathetic effect on lungs (3)

A

bronchoconstriction
vasodilation
stimulate bronchial secretions

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37
Q

central tendon of diaphragm derived from ___?

A

septum transversum

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38
Q

each lung root contains…

A

bronchus
bronchial vessels
pulmonary artery
pulmonary veins x2
pulmonary plexus
lymphatic vessels

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39
Q

cx of fasciotomy

A

rhabdomyolysis

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40
Q

electrolyte disturbances causing digitalis toxicity

A

low magnesium
low potassium
high calcium

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41
Q

causes of low magnesium

A

diuretics
TPN
diarrhoea
hypokalaemia
hypocalcaemia
alcohol

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42
Q

factors that decrease gastric acid production

A

secretin
cholecystokinin
somatostatin

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43
Q

phases of gastric secretion

A
  1. cephalic - 30%
  2. gastric - 60%
  3. intestinal - 10%
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44
Q

trotter’s triad

A

unilateral conductive HL
ipsilateral facial pain and otalgia
ipsilateral paralysis of soft palate

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45
Q

g cells produce

A

gastrin

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46
Q

what cells produce gastric acid

A

parietal cells

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47
Q

chief cells produce

A

pepsinogen

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48
Q

LP:

  • needle into?
  • where in spine?
A

into subarachnoid space
around L3/L4

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49
Q

csf path

A

lateral ventricles
3rd ventricle
cerebral aqueduct
4th ventricles
SAS

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50
Q

Ormond’s disease

A

fibrous proliferation of retroperitoneal structures
pushes ureters medially
causes HTN, kidney failure, lower back pain, DVT

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51
Q

case-control study good for…

A

rarer disease
done when following group WITH outcome e.g. disease
odds ratio

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52
Q

ix for assessing bladder reflex

A

MCUG

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53
Q

causes of raised anion gap

A

MUDPILES

methanol
uraemia
dka
paraldehyde
iron
lactic acidosis
ethylene glycol
salicylates

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54
Q

lacrimal gland innervation

A

opthalmic branch - lacrimal nerve
greater petrosal nerve - secretomotor function

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55
Q

where are pectinate muscles in heart

A

RA

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56
Q

femoral canal borders

A

lateral - femoral vein
medial - lacunar ligament
anterior - inguinal ligament
posterior - pectineal ligament

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57
Q

klippel-trenauney syndrome

A

port wine stains
gigantism features
varicosa veins
spares saphenous veins

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58
Q

heart venous drainage

A

anterior cardiac veins - drain into RA

coronary sinus:
1. great cardiac vein - along anterior interventricular groove
2. middle cardiac vein - along posterior interventricular groove
3. small cardiac vein - with marginal artery

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59
Q

IVC origin

A

L5

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60
Q

EARLY repolarisation of heart: ion responsible

A

potassium efflux

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61
Q

thymus:

arterial supply
venous drainage

A

A - anterior intercostal + branches of internal thoracic
V - left brachiocephalic vein

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62
Q

breast:

arterial supply
venous drainage
innervation

A

A: medial - internal thoracic. Lateral = mammary + lateral mammary (branches of AIC and PIC respectively)

V: axillary + internal thoracic

I: anterior + lateral cutaneous branches of the 4th-6th intercostal nerves

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63
Q

trachea

A
V
N

A

A - inferior thyroid
V - brachiocephalic, azygous, acessory hemizaygous
N = recurrent laryngeal nerve

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64
Q

diaphragm

A
N

A

A = inferior phrenic
N = phrenic n.

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65
Q

SVC tributaries

A

Brachiocephalic
Azygous
Mediastinal
Pericardial
Oesophageal

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66
Q

IVC tributaries

A

Hepatic
Renal
Lumbar
Phrenic
Gonadal

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67
Q

bronchi nerve supply

A

pulmonary branches of CN X

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68
Q

bronchioles specific cells

A

club cells - produce surfactant

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69
Q

alveoli cell lining

A

simple squamous

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70
Q

where do coronary arteries originate

A

aortic sinus

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71
Q

3 main causes of AS

A
  1. age related calcification
  2. congenital defects
  3. RhF
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72
Q

what seperates arterial and venous vessels of heart

A

transverse pericardial sinus

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73
Q

4 functions of pericardium

A
  1. fixes the heart
  2. lubricartion
  3. prevents overfilling
  4. protection from infection
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74
Q

parasympathetic effect on heart

A

decrease HR

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75
Q

pericardium innervation

A

somatic innervation by phrenic nerve

causes referred shoulder pain in pericarditis

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76
Q

tetralogy of fallot 4x

A

pulmonary stenosis (ESM)
RVH
VSD
overriding aorta

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77
Q

2 parts of RA

A

sinus venosum (posterior)
atria proper (anterior) - rough walled

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78
Q

level of pulmonary trunk bifurcation

A

t5/t6

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79
Q

bile leak post-cholecystectomy tx

A

ERCP+ sphincterotomy + CBD stent

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80
Q

cx after bypass

A
  1. post-perfusion syndrome
  2. MI
  3. stroke
  4. AKI
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81
Q

barret’s oesophagus causes which cancer

A

adenocarcinoma of lower 1/3 oesophagus

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82
Q

zollinger ellison MEN subtype

A

type 1

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83
Q

graft for CABG

A

internal mammary artery

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84
Q

contents of popliteal fossa

A

popliteal artery
popilteal vein
common peroneal nerve
tibial nerve
small saph vein

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85
Q

hypertrophic vs keloid scar

A

keloid scar goes beyond original wound margins

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86
Q

osteomalacia bone profile

A

low calcium AND phosphate
high ALP

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87
Q

hernia surgery differences in adults vs kids

A

adults - herniorrhhapy - fix abdomen weakness
children - herniotomy

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88
Q

thoracic aorta origin and end

A

t4-t12

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89
Q

whats anterior to thoracic aorta

A

oesophagus
left lung root
pericardium

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90
Q

branches of thoracic aorta

A

bronchial
posterior intercostal
mediastinal
oesophageal

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91
Q

brown-sequard syndrome sx

A

ipsilateral loss of proprioception + UMN signs
contralateral loss of pain + temp sensation

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92
Q

verterbral lesions below ___ cause LMN sign

A

L1

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93
Q

what articulates with tubercle of ribs

A

tranverse process of vertebra

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94
Q

features of 1st rib

A

short and wider
grooves due to subclavain vessels
only 1 articular facet

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95
Q

what muscle has a relationship with 2nd rib

A

serratus anterior

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96
Q

what level do diaphragam crura arise

A

L1/L2

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97
Q

caval hiatus contents

A

IVC
terminal branches of right phrenic nerve

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98
Q

oesophageal hiatus contents

A

oesophagus
vagus nerve
oesophageal branches of left gastric artery

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99
Q

aortic hiatus contents

A

thoracic aorta
azygous vein
thoracic duct

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100
Q

peripheral attachments of diaphragm

A
  1. lumbar vertebrae
  2. costal cartilages 7-10
  3. xiphoid process
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101
Q

posterior diaphragm posterior border

A

t5-t12

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102
Q

phrenic nerve in relation to heart +hilum of lungs

A

anterior

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103
Q

right vagus nerve travel

A

runs parallel to trachea
posterior to SVC and bronchus

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104
Q

left vagus nerve travel

A

anterior to aortic arch
posterior to bronchus

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105
Q

SAAG>1.1

A

portal HTN

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106
Q

function of greater omentum

A

immunity - stops spread of infection

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107
Q

function of lesser omentum

A

holds organs together

hepatogastric ligament
hepatoduodenal ligament

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108
Q

embryology of peritoneum

A

parietal - somatic mesoderm
visceral - splanchnic mesoderm

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109
Q

peritoneum cell type

A

simple squamous (mesothelium)

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110
Q

gubernaculum

A

fibrous cord attached to inferior portion of gonad and guides descent into scrotum or labia

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111
Q

why does appendix pain start umbilical

A

visceral peritoneal pain - poorly localised. midgut structure therefore pain in umbilical region

once inflammation so great it reaches parietal layer - RIF localisation

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112
Q

mid inguinal point

A

halfway between PS + ASIS
femoral pulse palpable here

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113
Q

inguinal canal borders

A

anterior -apneurosis of external obliques + reinforced by internal obliques
floor - inguinal ligament + lacunar ligament medially
roof - internal oblique + transversus abdominis + transversalis fascia
posterior - tranversalis fascia

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114
Q

superficial ring:

location
formed by

A

superior to PT
formed by external oblique invagination

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115
Q

contents of inguinal canal

A

spermatic cord OR round ligament
ilioinguinal nerve
genital branch of genitofemoral nerve

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116
Q

deep inguinal ring location

A

midpoint of the inguinal ligament
ring created by tranversalis fascia

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117
Q

lumbar vertebra features

A

largest vertebral body
VB is kidney shaped
foramen is triangular
spinous processes are short and broad
transvers processes are long and thin

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118
Q

superficial fascia below skin in abdomen

A

above umbilicus - 1 layer

below umbilicus - 2 layers
superior - campers
inferior - scarpas

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119
Q

external oblique muscles

origin and insertion

action

innervation

A

iliac crest + PT to ribs 5-12

contralateral rotation of torso

thoracoabdominal nerve (t7-11), subcostal nerve (t12)

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120
Q

internal oblique muscles

origin and insertion

action

innervation

A

iliac crest + inguinal ligament to ribs 10-12

ipsilateral rotation of torso

thoracoabdominal nerve (t7-11), subcostal nerve (t12), branches of lumbar plexus

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121
Q

transversus abdominis

origin and insertion

action

innervation

A

xiphoid + linea alba + costal cartilage 7-12 to inguinal ligament

compression of abdominal wall

thoracoabdominal nerve (t7-11), subcostal nerve (t12), branches of lumbar plexus

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122
Q

rectus abdominis

origin and insertion

action

innervation

A

innervation = TAN

pubic crest to xiphoid and 5th-7th costal cartilages

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123
Q

pyramidalis innervation

A

SCN

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124
Q

pyramidalis insertion and origin

A

xiphoid/CC 5-7 to pubic crest

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125
Q

transpyloric plane

A

L1
halfway between jugular notch and pubic symphysis

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126
Q

quadratus lumborum

origin and insertion

action

innervation

A

transverse process of L1-L4 to iliac crest

extension and lateral flexion of verterbal column + fixing of 12th rib during inspiration

innervation T12-l4

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127
Q

psoas major

origin and insertion

action

innervation

A

vetebral bodies of T12-l5
inserts onton lesser trochanter of femur

hip flexion

anterior rami of L1-L3

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128
Q

psoas minor

origin and insertion

action

innervation

A

only 60% have a psoas minor

vertebral bodies of T12-L1 onto pectineal line

hip flexion

anterior rami of L1

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129
Q

Iliacus

origin and insertion

action

innervation

A

iliac fossa to LToF

flexion of hip

femoral nerve (L2-L4)

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130
Q

why is psoas sign +ve in appendicitis

A

contracting iliopsoas comes into contact with inflammed appenidx

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131
Q

lower leg anterior compartment:

muscles

actions of muscles

nerve supply

A

extensor hallucis longus + extensor of toes

anterior tibialis - dorsiflexor

peroneus tertius - dorsiflexor

extensor digitorum longus - dorsiflexor + extensor of toes

deep peroneal nerve

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132
Q

lower leg peroneal compartment:

muscles

actions of muscles

nerve supply

A

peroneus longus - everts foot + plantarflexor

peroneus brevis - plantarflexor

superficial peroneal nerve

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133
Q

lower leg posterior superficial compartment:

muscles

actions of muscles

nerve supply

A

gastrocnemius - plantar flexor + may also flex the knee

soleus - plantarflexor

tibial nerve

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134
Q

lower leg posterior deep compartment:

muscles

actions of muscles

nerve supply

A

flexor hallucis longus - flex toes
flexor digitorum longus - flex toes
tibialis posterior - plantarflexor + foot inverter

tibial nerve

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135
Q

palmar interossei function

A

adductors of fingers

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136
Q

dorsal interossei function

A

abduction of fingers

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137
Q

lumbricals function

A

flex @ MCPJ
extend @ IPJ

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138
Q

lumbricals innervation

A

1+2 = median
3+4 = ulnar

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139
Q

thenar eminence muscles

A

opponens policis
abductor policis brevis
flexor policis brevis

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140
Q

hypothenar eminence muscles

A

opponens digiti minimi
flexor digiti minimi
abductor digiti minimi

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141
Q

most common organism of Nec Fasc

A

streptococcus

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142
Q

most common causative organism for fourniers gangrene

A

e.coli + bacteriodes

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143
Q

extravasation injuries = tx

A

doxorubicin - cold compress
TPN - hyaluronidase

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144
Q

fissure in ano 1st line tx

A

gtn or diltiazem cream

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145
Q

internal haemorrhoids 1st line tx

A

ligation > sclerotherapy

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146
Q

ankle joint ligaments

A

medial - deltoid ligaments

lateral - anterior talofibular, posterior talofibular, calcaneofibular

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147
Q

ankle fracture mx based on weber

A

A - boot
B - boot or surgery - depends on talar shift
C - fixation

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148
Q

lauge-hansen classification

A

supination adduction
supination external rotation
pronation abduction
pronation external rotation

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149
Q

syndesmosis made of

A

interosseus membrane
anterior tibiofibular ligament
posterior tibiofibular ligament
transverse tibiofibular ligament

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150
Q

heparin affects which clotting factors

A

2,7,9, 10, 11

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151
Q

bevacuzimab has a role in which cancers

A

colorectal
renal
glioblastoma

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152
Q

undisplaced intracapsular fracture tx

A

internal fixation
hemiarthroplasty if unfit

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153
Q

stable intertrochanteric fracture tx

A

DHS

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154
Q

abdominal aorta branches

A

inferior phrenic t12
coeliac trunk t12
superior mesenteric l1
suprarenal l1
renal l1
testicular l2
lumbar l1-l2
inferior mesenteric l3
medial sacral l4

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155
Q

le fort 2 vs le fort 3 difference

A

more likely csf leak in le fort 3

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156
Q

ileum resection cx

A

diarrhoea
risk of gallstones

due to malabsorption of bile salts

tx with oral cholestyramine

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157
Q

klumpke features

A

claw hand - mcpj extension, iph flexion

horners

loss of sensation over medial forearm and hand

loss of wrist flexors

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158
Q

oesophagus constricts at 4 points

A

aortic arch
left main bronchus
cricoid cartilage
diaphragmatic hiatus

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159
Q

layers of oesophagus

A

adventitia
muscle layer
submucosa
mucosa

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160
Q

oesophagus vertebral level start and end

A

c6 to t11

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161
Q

difference between upper oesophageal and lower oesophageal sphincter

A

upper is muscular - cricopharyngeus muscle

lower is physiological

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162
Q

organs anterior to stomach

A

liver
gall bladder

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163
Q

superior duodenum level

A

L1

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164
Q

descending duodenum level

A

L1-L3

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165
Q

inferior duodenum level

A

lateralises left
L3

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166
Q

ascending duodenum level

A

L3-L2

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167
Q

superior duodenum special facts (3)

A
  1. connected to liver by hepatoduodenal ligament
  2. most common site of duodenal ulceration
  3. only intraperitoneal portion of duodenum
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168
Q

causes of appendicitis

A

<30 years old - lymphatic tissue
>30 years old - faecolith

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169
Q

features of large colon

A

taenia coli
omental appendices
wider than small intestine

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170
Q

rectum begins at which vertebral level

A

s3

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171
Q

2 main flexures in rectum

A

sacral flecure
anorectal flexure - formed by puborectalis muscle

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172
Q

site in rectum that temporarily stores faeces

A

ampulla

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173
Q

is the rectum covered by peritoneum

A

partially

upper third is
middle third is covered anteriorly
lower third is not

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174
Q

rectal arterial supply

A

superior rectal artery - inferior mesenteric artery
middle rectal artery - internal iliac artery
inferior rectal artery - internal pudenal artery

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175
Q

rectal veins

A

superior rectal vein - into portal circulation

middle and inferior rectal veins - into systemic circulation

anastomosis in wall of anal canal between both circulations

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176
Q

rectal innervation

A

sympathetic
1. lumbar splanchnic n
2. superior hypogastric plexus
3. inferior hypogastric plexus

parasympathetic
1. s2-s4 via pelvic splanchnic n

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177
Q

rectal lymph node drainage

A

upper rectum - pararectal LNs
lower rectum - internal iliac LNs

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178
Q

anal canal sphincters

A

internal sphincter - surrounds upper 2/3
involuntary smooth muscle

external sphincter - surrounds lower 2/3
voluntary

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179
Q

junction between rectum and anal canal

A

anorectal ring

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180
Q

anorectal ring formed of

A

fusion between internal and external anal sphincters and puborectalis muscle

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181
Q

dentate line formed by

A

anal canals

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182
Q

cell differences above and below dentate

A

above - columnar
below - non-keratinised stratified squamous

once at the intersphincteric groove - becomes keratinised stratified squamous

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183
Q

above dentate line

arterial supply
venous drainage
innervation
lymph

A

A - superior rectal artery + branches of middle rectal artery

V: superior rectal vein (portal)

N: inferior hypogastric

lymph: internal iliac nodes

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184
Q

below dentate line

arterial supply
venous drainage
innervation
lymph

A

A: inferior rectal artery + branches of middle rectal

V: inferior rectal vein

N: inferior rectal nerve

LN: superficial inguinal

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185
Q

shape of each adrenal gland

A

right - pyramidal
left - semilunar

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186
Q

adrenal arterial supply

A
  1. superior adrenal - branch of internal phrenic
  2. middle adrenal
  3. inferior adrenal - branch of renal arteries
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187
Q

adrenal venous drainage

A

right adrenal vein drains straight into IVC
left adrenal vein drains into left renal vein then into IVC

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188
Q

adrenal innervation

A

coeliac plexus
greater splanchnic nerves

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189
Q

adrenal lymphatic drainage

A

lumbar LNs

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190
Q

parotid tumours only affect facial nerve if

A

malignant

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191
Q

most common bilateral tumour of parotids

A

warthins

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192
Q

cord of brachial plexus related to

A

axillary artery

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193
Q

dose of protamine before vascular bypass surgeries

A

around 3000 U given 3-5 mins before clamping of vessel

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194
Q

dose of protamine before cardiac bypass surgeries

A

30000 U

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195
Q

macrolide MOA

A

inhibit protein synthesis by binding to 50S

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196
Q

aminoglycoside MOA

A

inhibit protein synthesis

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197
Q

most common biliary disease in HIV patients

A

sclerosing cholangitis

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198
Q

where is ampulla of vater

A

medial aspect in the 2nd part of duodenum

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199
Q

ligament of treitz significance

A

AKA suspensory muscle of duodenum

differentiates Upper vs Lower GI bleed

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200
Q

ejection systolic murmur causes

A

AS
Aortic sclerosis
pulmonary stenosis
ToF
HOCM
ASD

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201
Q

mid diastolic murmur causes

A

mitral stenosis
austin flint (severe AR)

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202
Q

late systolic murmur causes

A

mitral valve prolapse
coarctation of aorta

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203
Q

decreased global uptake on technetium scan

A

Subacute thyroiditis

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204
Q

trigeminal nerve originates from ___

A

pons

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205
Q

muscles innervated by mandibular nerve

A

maasseter
temporalis
tensor tympani
mylohyoid
pterygoid
anterior belly of digastric

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206
Q

gingiva innervated by which nerve

A

lingual nerve

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207
Q

periosteum layers

A

outer fibrous layer
inner cambium layer - contains progenitor cells

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208
Q

pharyngeal arches:

1st

A

external carotid
mandibular n

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209
Q

pharyngeal arches:

2nd

A

facial nerve

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210
Q

pharyngeal arches:

3rd

A

common carotid
internal carotid
glossopharyngeal
inferior parathyroids
thymus

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211
Q

pharyngeal arches:

4th

A

right subclavian
aortic arch
vagus
superior parathyroid

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212
Q

pharyngeal arches

6th

A

pulmonary arteries
vagus + RLN
ductus arteriosus

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213
Q

hashimotos histology

A

lymphocytic infiltration + fibrosis

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214
Q

penile fractures pathophysiology

A

break in the tunica albunginea

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215
Q

ansa cervicalis nerve roots

A

c1-c3

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216
Q

thoracic cord lesion symptoms

A

ACUTE: spinal shock causes arreflexia + flaccid paralysis

AFTER WEEKS:
- spastic paralysis
- sensory ataxia
- urinary incontinence
- hyperreflexia
- extensor plantars

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217
Q

forearm flexor muscles

A

flexor carpi radialis - median nerve

flexor carpi ulnaris - ulnar

palmaris longus - median

flexor digitorum superificialis - median

flexor digitorum profundus - ulnar (medial) + anterior interosseus (lateral)

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218
Q

flexor carpi radialis functions

A

wrist flexor
carpal abductor
part flexor of elbow
part pronater of forearm

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219
Q

flexto carpi ulnaris functions

A

wrist flexor
carpal adductor

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220
Q

breast surgery cx

A

intercostobrachial nerve injury - paraesthesia of armpit
long thoracic nerve injury
serosa

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221
Q

kidneys anatomical position wrt vertebra

A

T12-L3

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222
Q

order of encapsulating layers of kidneys

A

outer to inner

pararenal fat
renal fascia
perirenal fat
renal capsule

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223
Q

function of calyx in kidneys

A

store urine

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224
Q

what can be used to show differing arterial supply to parts of kidney

A

Line of Brodel

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225
Q

describe pathway:

renal artery to efferent arterioles

A

renal artery TO
anterior or posterior renal artery TO
5x segmental arteries each TO
interlobar arteries TO
arcuate arteries TO
interlobular arteries TO
afferent arterioles TO
glomerulus TO
efferent arterioles

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226
Q

what type of vessels make up glomerulus

A

capillaries

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227
Q

kidney lymphatic drainage

A

para-aortic nodes

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228
Q

horseshoe kidney

A

fusing of both kidneys
fuse at the isthmus (lower pole)

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229
Q

why can renal cancers often be treated with partial nephrectomies

A

segmental blood supply

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230
Q

how is spleen connected to other organs

A

greater ommentum

gastrosplenic ligament
splenorenal ligament

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231
Q

spleen anterior to…

A

left ribs
left diaphragm
left lung

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232
Q

spleen arterial supply

A

splenic artery

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233
Q

spleen venous drainage: portal or systemic?

A

splenic vein > SMA > hepatic portal vein

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234
Q

spleen innervation

A

coeliac plexus

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235
Q

spleen LN

A

pancreaticosplenic LNs

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236
Q

vertebral level of pancreas

A

L1

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237
Q

pancreas relationship to duodenum

A

2nd part of duodenum wraps around pancreatic head

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238
Q

what is posterior to head of pancreas

A

aorta
IVC

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239
Q

which part of the pancreas is intraperitoneal

A

tail - in the splenorenal ligament

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240
Q

pancreas blood supply

A

pancreatic branches of splenic artery

pancreatic head: + superior pancreaticoduodenal artery (coeliac)+ inferior pancreaticoduodenal artery (SMA)

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241
Q

pancreas LN

A

pancreaticoduodenal LN

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242
Q

pancreas venous drainage

A

head - SMV
rest - pancreatic veins of splenic vein

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243
Q

pancreatitis causes

A

GET SMASHED

gallstones
ethanol
trauma

scorpion
mumps
autoimmune
steriods
high calcium, high triglycerides, high PTH
ERCP
drugs e.g. sodium valproate, azathioprine

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244
Q

what stimulates relase of bile from gall bladder

A

cholecystokinin

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245
Q

Hartmann’s pouch

A

mucosal folds at neck of the gall bladder - commonest entrapment of gallstones

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246
Q

common hepatic duct runs ____ in relation to pancreas head + 1st part of duodenum

A

posterior

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247
Q

cystic artery is a branch of

A

right hepatic artery

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248
Q

gall bladder venous drainage

A

neck - into cystic vein
body + fundus - directly into hepatic sinusoids

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249
Q

gall bladder innervation

A

sympathetic - coeliac plexus
parasympathetic - vagus

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250
Q

parasympathetic innervation effect on gall bladder

A

stimulate contractions

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251
Q

lymph nodes of gall bladder

A

hepatic lymph nodes

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252
Q

where do hepatic lymph nodes drain into

A

coeliac lymph nodes

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253
Q

ligaments of liver

A
  1. falciform ligament - straps liver to anterior abdomen wall
  2. ligamentum teres - in free edge of falciform ligament
  3. coronary ligament - attach bare edge of liver to diaphragm
  4. triangular ligament - liver to diaphragm

+ LESSER OMENTUM (hepatogastric + hepatoduodenal ligaments)

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254
Q

Morison’s pouch:
1. what is it
2. clinical relevancee

A
  1. potential space between liver and right kidney. deepest part of peritoneal cavity when lying flat
  2. ascites more likely to accumulate here in bed-ridden patient
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255
Q

liver is covered by a fibrous layer named?

A

Glisson’s capsule

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256
Q

lobes of liver

A

right
left
caudate
quadrate

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257
Q

what seperates caudate and quadrate lobes of liver

A

porta hepatis

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258
Q

portal triad

A

hepatic artery
portal vein
hepatic bile duct

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259
Q

liver blood supply

A

hepatic artery proper - 25%
portal vein - 75%

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260
Q

liver innervation

A

sympathetic - hepatic plexus
parasympathetic - vagus

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261
Q

liver lymph drainage

A

anterior - hepatic LNs
posterior - phrenic + posterior mediastinal LNs

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262
Q

thoracic aorta branches UPDATED

A

bronchial
mediastinal
pericardial
oesophageal
intercostal
superior phrenic

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263
Q

how can aortic aneurysm affect voice

A

irritates recurrent laryngeal nerve causing hoarse voice

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264
Q

watershed zone

A

splenic flexure

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265
Q

coeliac trunk compression by

A

median arcuate ligament

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266
Q

most common type of visceral aneurysm

A

splenic aneurysm

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267
Q

disc herniation pathophysiology

A

jelly nucleus pulposus herniates through annulus fibrosus

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268
Q

cervical vertebrae features

A

7x
bifid spinous processes
triangular vertebral foramine
have transverse foramina

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269
Q

thoracic verterbrae features

A

12x
circular foramine
vertebral bodies have 2x demifacets
transverse processes have costal facets
spinous processes are inferiorly orientated

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270
Q

lumbar vertebra features

A

5x
largest vertebral bodies
kidney shaped VB
triangular vertebral foramina
SP short and wide
TP long and thin

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271
Q

sacrum features

A

5x fused vertebrae
inverted triangle shaped
have lateral facets for ilium

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272
Q

coccyx features

A

4x fused verterbrae
no vertebral arches

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273
Q

lumbarisation

A

S1 seperation from sacrum

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274
Q

sacralisation

A

L5 fused to sacrum

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275
Q

trochlear nerve supplies this ocular muscle

A

superior oblique

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276
Q

corneal reflex innervation

A

afferent - nasociliary branch of ophthalmic (V1)
efferent - facial nerve via oribicularis oculi muscle

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277
Q

where does trigeminal nerve originate

A

pons

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278
Q

where does facial nerve originate

A

between pons and medulla

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279
Q

where does vestibulocochlear nerve originate

A

pons

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280
Q

where does glossopharyngeal nerve originate

A

pons

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281
Q

where does vagus nerve originate

A

medulla

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282
Q

where does hypoglossal nerve originate

A

medulla

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283
Q

which tongue muscle does hypoglossal nerve not innervate

A

palatoglossus

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284
Q

course of facial nerve

A

leave between pons and medulla

passes temporal bone and enters internal auditory meatus

then passes through facial canal and exits at the stylomastoid foramen

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285
Q

what cranial nerve supplies parotid

A

glossopharyngeal

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286
Q

richter’s hernia

A

wall of small bowel (usually anti-mesenteric layer) is strangulated - but as luminal patency maintained there is no obstruction

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287
Q

bochdalek hernia

A

congenital hernia
nearly always associated with left hemidiaphragm
causes lung hypoplasia
more common in males

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288
Q

jenkins rule

A

aim to minimis incisional hernias in midline laparotomy incisions

suture length 4x incision length
sutures at 1cm intervals
sutures 1cm from wound edge

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289
Q

morgagni hernia

A

rare diaphgramatic hernia
hernia through foramen of morgagni

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290
Q

umbilicus hernia tx

A

surgery after 3rd birthday

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291
Q

paraumbilical hernias more common in ?

A

adult females

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292
Q

technique for paraumbilical hernia repair

A

mayo’s repair
- overlapping vertical edges

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293
Q

spigelian hernias

A

lateral to rectus abdominis
where arcuate line meets semilunaris line

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294
Q

middle meningeal artery is a branch of

A

maxillary artery
which is a branch of external carotid artery

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294
Q

HLA types asx with mismatch

A

A B C DR

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295
Q

septic arthritis most common causative organism

A

staph aureus

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296
Q

basilic vein

medial or lateral?
superficial or deep?

A

medial
superficial until mid upper arm

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296
Q

middle meningeal artery exits through which cranial foramen

A

foramen spinosum

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297
Q

basilic vein + ____ vein > _____ vein

A

medial brachial vein
axillary vein

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298
Q

potent vasodilators in acute inflammation

A

prostaglandins
nitric oxide
histamine
complement 5a and 3a
lysosomal compounds

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299
Q

serotonin - vasodilator or vasoconstrictor?

A

depends on vessel state - in healthy vessels it is a vessel dilator

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300
Q

malignancy histology

A

angiogenesis
increased mitoses
de-differentiation
invasion of basement membrane - this differentiates it to in situ tumours

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301
Q

types of gastritis

A

type A - autoimmune
type B - antral (infective
erosive - NSAIDs and alcohol
stress - mucosal ischaemia
reflux - bile refluxes into stomach. prokinetics can help

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302
Q

type A gastritis pathophysiology

A

autoimmune

antibodies to parietal cells causing decrease HCl and decreased intrinsic factor

decrease in HCl also stimulates gastrin release and stimulates enterochromaffin cells leading to adenoma production

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303
Q

causes of lymphodema

A

primary
- congenital
- milroys

secondary
- infection e.g. filariasis
- DVT
- thrombophlebitis
- radiation to LNs
- LN clearance
- lymphatic malignancy

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304
Q

indications for lymphoedema surgery

A

marked disability and/or deformity
incompetent proximal lymphatics

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305
Q

lymphoedema procedures

A

Homans - reduction procedure with preservation of overlying skin

Charles - all skin and subcutaneous tissue removed + split skin grafts placed over surgical sites

lymphovenous anastomosis - when proximal lymph obstruction with normal distal lymphatics

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306
Q

stored blood has more or less affinity for oxygen

A

more affinity
less 2,3-DPG

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307
Q

haldane effect of haemoglobin

A

LEFT SHIFT
haem has greater affinity for oxygen

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308
Q

what causes haldane effect

A

low co2
low 2,3-DPG
HbF
carboxyhaemoglobin
low temperature

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309
Q

bohr effect of haemoglobin

A

RIGHT SHIFT
haem has lower affinity for oxygen
oxygen more readily available/deliverable

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310
Q

what causes bohr effect

A

acidosis
high co2
high temperature
high 2,3-DPG

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311
Q

suxamethonium features

A

depolarising muscular blocker
rapid onset
produces muscular contractions before paralysis

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312
Q

side effects of suxamethonium

A

hyperkalaemia
malignant hyperthermis

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313
Q

atracurium reversing agent

A

neostigmine

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314
Q

diagnostic OGD prep

A

NBM >6hrs

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315
Q

flexi sigmoidoscopy prep

A

phosphate enema 30 mins before

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316
Q

femoral triangle borders

A

medial - adductor longus
lateral - sartorius
superior - inguinal ligament

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317
Q

brachial embolectomy can damage which nerve

A

median @ ACF

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318
Q

malignant mesothelioma rough tx

A

receptive to combination chemotherapy - usually cisplatin based

relatively resistant to radiotherapy - best given pre-operatively

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319
Q

fem-pop surgery

A

for proximal occlusions

use own vein if sufficient

if not, can use PTFE + Miller cuff e.g. in varicose veins

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320
Q

propofol features

A

rapid onset
pain on injection
anti-emetic properties

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321
Q

sodium thiopentane features

A

very rapid onset
marked myocardial depression

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322
Q

etomidate

A

can cause adrenal suppression

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323
Q

Laplace law

A

wall tension proportional to pressure x radius

  • explains why its harder to blow up a balloon at the start
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324
Q

how does Laplace law explain why aneurysms don’t ordinarily explode

A

pressure is inversely proportional to radius

as balloon inflates, pressure decreases

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325
Q

bainbridge reflex

A

reflexive increase in heart rate when baroreceptors in atria are stimulated

this decreases SVC pressure, creating a pressure gradient between venous system and right atria - meaning no pooling of blood in venous system

can occur in rapid blood transfusions

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326
Q

sympathetic effect on ventricles

A

increase contracrility via increase of intracellular calcium

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327
Q

what increases functional residudal capacity

A

standing up right
asthma
emphysema

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328
Q

what decreases FRC

A

abdo swelling
pulmonary oedema
decreased diaphragm tone

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329
Q

cavernous sinus lateral wall contents

A

oculomotor
trochlear
ophthalmic
maxillary

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330
Q

cavernous sinus contents

A

ICA (medially)
abducens (laterally)

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331
Q

insulinoma ix and tx

A

ix - endoscopic USS
tx - benign = enucleation, malignant = whipples

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332
Q

superficial back muscles

A

lats
traps
rhomboid minor
rhomboid major
levator scapula

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333
Q

traps:

origin and insertion
innervation

A

origin: skull + spinous process C7-T12

insertion: clavicle, acromion, scapula spine

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334
Q

lats:

origin and insertion
innervation

A

origin: spinous process of T6-T12
insertion: intertubercular sulcus of humerus

innervation: thoracodorsal nerve

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335
Q

function of lats

A

extends, adducts and medially rotates upper arm

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336
Q

levator scapula:

origin and insertion
innervation

A

transverse process of C1-C4
insertion: medial border of scapula

dorsal scapular nerve

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337
Q

function of levator scapula

A

elevate scapula

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338
Q

rhomboid major:

origin and insertion
innervation

A

spinous process of T2-T5
medial border of scapula

dorsal scapular nerve

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339
Q

rhomboid minor

origin and insertion
innervation

A

spinour process of C7-T1
medial border of scapula

dorsal scapular nerve

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340
Q

intermediate muscles of the back

A

serratus posterior superior

serratus posterior inferior

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341
Q

serratus posterior superior

origin and insertion
innervation

A

C7-T3 to anterior ribs 2-5

intercostal nerve

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342
Q

serratus posterior superior action

A

elevate the ribs 2-5

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343
Q

superficial muscles of the deep back muscles

A

the SPINOTRANSVERSALIS muscles

splenius capitis
splenius cervicis

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344
Q

splenic capitis innervation

A

posterior rami of c3-c4

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345
Q

splenic capitis funciton

A

rotate + extend head

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346
Q

intermediate muscles of the deep back muscles

A

erector spinae muscles

longissimus
iliocostalis
spinalis

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347
Q

function of erector spinae muscles

A

unilateral contraction = lateral flex
bilateral contraction = extension

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348
Q

innervation of erector spinae muscles

A

posterior rami of the spinal nerves

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349
Q

deep muscles of the deep back

A

transversospinales muscle group

semispinalis - extends head
multifidius
rotatores

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350
Q

conus medullaris

A

tapering of spinal cord @ L1/L2

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351
Q

spinal cord enlarges where

A

cervical and lumbosacral regions

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352
Q

2 depressions of spinal cord

A

anterior median fissure
posterior median sulcus

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353
Q

filum terminales

A

meninges ending at bottom of spinal cord

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354
Q

epineurium

A

dura mater surrounding the peripheral nerves when they leave spinal cord

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355
Q

spinal cord vasculature

A

anterior spinal artery - branch of vertebral arteries
posterior spinal artery - branch of vertebral artery or PICA

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356
Q

artery of Adamkiewicz

A

main artery that supplies blood to the lower third of the spinal cord

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357
Q

venous drainage of spinal cord

A

3x anterior spinal veins
3x posterior spinal veins

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358
Q

where does subscapularis attach on scapula

A

subscapular fossa on costal surface of scapula

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359
Q

where do supraspinatus and infraspinatus originate

A

posterior side of scapula

supraspinatus fossa
infraspinatus fossa

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360
Q

where does long head of biceps brachii attach

A

supraglenoid tubercle

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361
Q

where does long head of triceps brachii attach

A

infraglenoid tubercle

362
Q

most common part of clavicel that is fractured

A

middle

363
Q

muscles inserting onto greater tuberosity of humerus

A

supraspinatus
infraspinatus
teres minor

364
Q

muscles inserting onto lesser tuberosity of humerus

A

subscapularis

365
Q

muscles attaching onto intertubercular sulcus of humerus

A

lats
pec major
teres major

366
Q

what tendon runs along intertubercular sulcus

A

long head of biceps brachii

367
Q

what neurovascular vessels are related to surgical neck of humerus

A

axillary nerve
circumflex humeral vessels

368
Q

axillary nerve injury paralyses which muscle

A

deltoid
teres minor

ABDCUTORS

369
Q

what muscles attach onto humeral shaft

A

coracobrachialis
deltoid (tuberosity)
brachialis
brachoradialis
medial and lateral tricep heads

370
Q

mid shaft humeral fracture affects which nerves

A

radial nerve - wrist drop

371
Q

lateral epicondyle is associated with which attachment site of humerus

A

trochlea

372
Q

medial epicondyle is associated with which attachment site of humerus

A

capitulum

373
Q

what makes up trochlear notch of ulnar

A

olecranon + coronoid fossa

374
Q

which artery is at risk in supracondylar humeral fractures

A

brachial artery

375
Q

volkmann’s contracture

A

ischaemic contracture as a result of brachial artery damage causing fibrosis and shortening of flexors of hand and wrist

376
Q

how do you test function of anterior interosseoss nerve

A

OK sign

assessing flexor pollicis longus

377
Q

ulnar shaft shape

A

triangular shape

378
Q

monteggia fracture

A

proximal ulnar fracture with radial head dislocation at elbow

379
Q

galeazzi fracture

A

distal radial fracture with distal RUJ dislocation

380
Q

what muscle inserts on to radial tuberosity

A

biceps brachii

381
Q

proximal carpal bones (lateral to medial)

A

scaphoid,lunate, triquetrum, pisiform

382
Q

distal carpal bones (lateral to medial)

A

trapezium, trapezioid, capitate, hamate

383
Q

bennetts fracture

A

base of 1st metacarpal fracture

384
Q

tx of fibroadenoma

A

<3cm - observation
>4xm - cone biopsy to exclude phyllodes

385
Q

as well as resection, what are colon cancer patients with high chance of recurrence offered

A

chemotherapy - 5FU + oxaliplatin combination

386
Q

rectal cancer: anterior resection or APER?

A

APER is sphincters involved or lower tumours (anal verge)

387
Q

difference between tx of rectal cancers and colon cancers

A

rectum is retroperitoneal therefore neoadjuvant radiotherapy can be used

388
Q

which colon cancers need chemotherapy

A

high risk recurrence
lymph node involvement

389
Q

transverse colon cancer tx

A

extended RHC + ileocolic anastomosis

390
Q

left colon cancer tx

A

LHC + colon-colon anastomosis

391
Q

sigmoid cancer tx

A

high anterior resection with colo-rectal anastomosis

392
Q

upper rectum tx

A

anterior resection (TME) with colo-rectal anastomosis

393
Q

low rectum tx

A

anterior resection (low TME) with colo-rectal anastomosis +/- defunctioning stoma

394
Q

why do rectal cancers usually need defunctioning stoma

A

to reduce the risk of anastomotic leakage and reoperation rates

395
Q

most common type of rotator cuff tear

A

supraspinatus

396
Q

gastric cancer tx

A

if >5-10cm from GOJ = subtotal resection

if <5cm from GOJ = total gastrectomy + Roux en Y bypass

will need lymphadenectomy and most patients get pre- or post-op chemo

397
Q

investigation for suspected lymphoma presenting with lymphadenopathy

A

excision biopsy

398
Q

axillary artery branches

A

Highest thoracic
Thoraco-abdominal
Lateral thoracic
Subscapular - circumflex scapula artery is a branch of this
Posterior circumflex humeral artery
Anterior circumflex humeral artery

he took love so pain awaits

399
Q

how does cholestatic jaundice cause vit k deficiency

A

less bile into circulation

vit K cannot be absorbed as well

400
Q

what muscle flexes DIP joints

A

flexor digitorum profundus

401
Q

TPN SEs

A

phlebitic

can cause deranged LFTs long term

402
Q

testicular cancer tx

A

orchidectomy via inguinal approach

403
Q

gardners syndrome facts

A

Autosomal dominant
can cause malignant tumours of colon
APC gene
association to desmoid tumours

404
Q

cervical ribs usually arise from which vertebra

A

C7

405
Q

layers of spermatic cord

A

inner - transversalis fascia
outer - external oblique

406
Q

contents of spermatic cord

A

vas deferens
vas deferens artery
testicular artery
genital branch of genitofemoral nerve
cremasteric artery
pampiniform plexus
SNS fibres
lymphatic vessels

407
Q

which cancer surgeries need bowel prep

A

left sided colon

408
Q

in surgeries with radiated tissue - how do you close wounds

A

using flaps

409
Q

which heparin for bypass

A

unfractioned - shorter HL, more controllable

410
Q

c fibres trasmit …

A

mechanicothermal stimuli

411
Q

A beta fibres transmit

A

touch and pressure stimuli

412
Q

B fibres transmit

A

autonomic stimuli

413
Q

CSF contains ???

A

no RBC
less glucose than plasma

414
Q

hyatid cysts associated with which infection

A

echnicoccus infection

415
Q

USS shows daughter cysts with septa and thick walls in liver??

A

hyatid cysts

416
Q

how does pagets disease cause high output heart failure

A

angiogenesis

417
Q

path of subclavian artery and vein

A

both pass OVER (anterior) 1st rib but POSTERIOR to clavicle

SCA passes posterior to scalenus anterior
SCV passes anterior to scalenus anterior

418
Q

trunks of brachial plexus relationship to SCA

A

brachial plexus passes posterior to SCA at 1st rib

419
Q

3 types of nerve injury

A

neuropraxia
axonotmesis
neurotmesis

420
Q

neuropraxia features

A

nerve intact
problem with conduction

wallerian degeneration not present

421
Q

axonotmesis features

A

axon damaged but connective tissue intact

wallerian degeneration occurs

422
Q

wallerian degeneration

A

distal axonal injury

423
Q

neurotmesis features

A

degeneration of axon and myeline sheath

wallerian degeneration occurs

424
Q

ulnar nerve path in forearm

A

medial forearm

passes inferiorly to flexor carpi ulnaris

425
Q

scrotal cancer drains into which lymph nodes

A

inguinal LNs

426
Q

access point for right middle lobe

A

6th ICS in mid axillary line

427
Q

quadrangular space borders

A

superior - inferior border of teres minor
inferior - superior border of teres major
medial - lateral border of triceps brachii
lateral - surgical neck of humerus

428
Q

quadrangular space contents

A

axillary nerve
posterior circumflex humeral artery

429
Q

triangular space borders

A

superior - inferior border of teres minor
inferior - superior aspect of teres major
lateral - medial margin of long head of triceps brachii

430
Q

triangular space contents

A

circumflex scapular artery

431
Q

triangular interval borders

A

superior border - inferior border of teres major
lateral - lateral head of triceps
medial - long head of triceps trachi

432
Q

triangular interval contents

A

radial nerve
profunda brachii artery

433
Q

axilla borders

A

anterior - pec major + minor
posterior - scapula, teres major, + lats
medial - serratus anterior + thoracic wall
lateral - intertubercular sulcus

434
Q

what affects axilla size

A

arm abduction - decreases it

435
Q

apex of the axilla

A

lateral border of 1st rib
posterior border of clavicle
superior border of scapula

436
Q

contents of axilla

A

axillary artery
axillary vein
brachial plexus
axillary lymph nodes
biceps brachii short head

437
Q

cubital fossa borders

A

superior - epicondylar line
medial - lateral border of pronator teres
lateral - medial border of brachoradialis

438
Q

cubital fossa contents (5)

A

radial nerve
median nerve
brachial artery
biceps tendon
median cubital vein

439
Q

carpal tunnel contents

A

median nerve
1x flexor pollicis longus tendon
4x flexor digitorum supericialis
4x flexor digitorum profundus

440
Q

median nerve branches

A

splits in carpal tunnel

recurrent branch - thenar muscles
palmar digital nerve - innervates lateral lumbricals + sensation

441
Q

anatomical snuffbox contents (3)

A

radial artery
superficial branch of radial nerve
cephalic vein

442
Q

anatomical snuffbox borders

A

medial - extensor hallucis longus
lateral - extensor pollicis brevis
proximal border = styloid process of radius

443
Q

extensor compartment 1 of wrist contents

A

Extensor pollicis breivs
abductor pollicis longus

444
Q

extensor compartment 2 of wrist contents

A

extensor carpi radialis longus
extensor carpi radialis brevis

445
Q

extensor compartment 3 of wrist contents

A

extensor policis longus

446
Q

what seperates extensory compartment 2 and 3 of the wrist

A

Lister’s tubercle of radius

447
Q

ulnar’s canal contents

A

ulnar nerve
ulnar artery
venae comitantes of ulnar artery
lymphatic vessels

448
Q

dysphagia lusoria is dysphagia caused by what

A

oesophageal compression from vascular abnormality

449
Q

dysphagia lusoria dx ix

A

CT angio

450
Q

sural nerve supplies sensation to which area

A

lateral aspect of foot

451
Q

dorsum of foot sensation nerve

A

superficial peroneal nerve

452
Q

1st web space of foot sensation nerve

A

deep peroneal nerve

453
Q

cell saver devices
what is it
contraindications

A

collect patient blood during surgery and reinfuse

CI: malignancy and infection

454
Q

Lynch disease cancer associations

A

colorectal
endometrial

455
Q

Lynch disease gene

A

mismatch repair gene mutation

456
Q

ESWL contraindications

A

pregnancy
patients with severe calcification of vessels

457
Q

uteroscopy method

A

scope through urethra and bladder
into ureters
laser of pneumatic fragmentation
a stent can be left in situ

458
Q

RENAL stone tx

A

0-5mm + asx = observation
<10 = ESWL
10-20 = ESWL or ureteroscopy
>20 = PC NL

459
Q

URETERIC stone tx

A

0-5mm = observation
5-10mm = ESWL
10-20mm = ureteroscopy

460
Q

oesophageal cancer tx

A

largely resction based
no resection if patient has mets or N2+ disease

lower or middle third - Ivor lewis oesophagectomy

upper third - Mckeowans (total)

very distal tumours - can have transhiatal procedures

461
Q

ivor lewis incisions

A

laparotomy + RHS thoractomy

(Mckeowan = + neck incision)

462
Q

how can delayed gastric emptying be avoided in oesophagectomies

A

pyloroplasty - widening of canal

463
Q

anal fissures associations

A

STDs
IBD
leukaemia
TB
previous surgery

464
Q

catecholamines derived from ….

A

tyrosine (–> dopamine –> NA –>A)

465
Q

which clotting factors are most sensitive to temperature

A

FACTOR 5 AND 8

this is why FFP needs to be frozen ASAP

466
Q

gluteus maximus innervation

A

inferior gluteal nerve

467
Q

bartons fracture

A

distal radial fracture + radiocarpal dislocation

468
Q

holstein lewis fracture

A

distal 1/3 humerus fracture causing entrapped radial nerve

469
Q

varicose veins tx

A
  1. endothermal ablation
  2. foam sclerotherapy
  3. trendelnberg surgery
470
Q

cowden disease

what is it
mutation ?

A

PTEN mutation

harmatomal growths of colon
also associated with breast cancer

471
Q

boerhaave syndrome ix

A

CT contrast

472
Q

boerhaave syndrome tx

A

<12hours since sx onset = surgery
>12 hours = controlled fistula with T tube

473
Q

positive iontropes

A

adrenaline/noradrenaline
dopamine
glucagon
dobutamine
theophylline

474
Q

alpha 1 receptors MOA

A

vasoconstriction

475
Q

alpha 2 receptors MOA

A

vasoconstriction

476
Q

beta 1 receptors MOA

A

increase heart rate and contractility

477
Q

beta 2 receptors MOA

A

vasodilation

478
Q

adrenaline MOA

A

alpha 1, alpha 2, beta 1, beta 2 stimulation

479
Q

noradrenaline MOA

A

alpha 1 stimulation

480
Q

dobutamine MOA

A

beta 1 stim (increase contractility + heart rate)

481
Q

omphalitis definition, organism + tx

A

infection of umbilicius
staph aureus
topical + systemic abx

482
Q

umbilical granuloma

A

cherry red lesions

483
Q

patent urachus - definition and symptoms

A

patent connection between umbilicus and bladder
sx - urine leaks through umbilicus

484
Q

biers block

A

double torniquet applied
prilocaine injected into vein

485
Q

which local anaesthetic is very cardiotoxic

A

bupivicaine

486
Q

why is adrenaline sometimes added to local anaesthetic

A

potentiates duration of action

487
Q

penile erection physiology

A
  1. autonomic innervation:
    - SNS from T11-L2 and PSNS from S2-S4
    - PSNS - causes erection
    - SNS - causes ejaculation
  2. somatic
    - dorsal penile nerve
    - pudendal nerve
488
Q

ulnar nerve and artery association

A

nerve lies on ulnar side of artery

489
Q

2 nerves involved in voice production

A

superior laryngeal nerve
recurrent laryngeal nerve

490
Q

superior laryngeal nerve innervates … ?

A

cricothyroid muscle - tenses vocal cords

491
Q

paralysis of superior laryngeal nerve causes

A

pitch abnormalities

492
Q

specificity =

A

true negative / true negative + false positives

493
Q

laryngeal muscles and their function (4)

A

posterior cricoarytenoid - abduct vocal folds
lateral cricoartyenoid - adduct vocal folds
thyroarytenoid - relaxes vocal cords
vocalis - relaxes posterior fold, tenses anterior folds

494
Q

laryngeal muscles supplied by

A

laryngeal arteries

branch of superior/inferior thyroid arteries

branch of ECA

495
Q

cranial nerve for external ear sensation

A

auriculotemporal nerve
branch of mandibular nerve

496
Q

which nerve runs next to middle meningeal artery

A

auriculotemporal nerve

497
Q

allograft

A

same species

498
Q

pec majo function

A

adduct and medially rotate upper arm

499
Q

pec major innervation

A

medial and lateral pectoral nerves

500
Q

what is the added function of clavicular head of pec major

A

flex upper limb

501
Q

pec major insertions

A

clavicular head: medial clavicle
sternal head: sternum + 1-6th CC

both attach on intertubercular sulcus of the humerus

502
Q

pec minor function

A

stabilise scapula

503
Q

pec minor innervation

A

medial pectoral nerve

504
Q

pec minor insertions

A

ribs 3-5 onto coracoid process of scapula

505
Q

serratus anterior function

A

rotates scapula allowing for shoulder flexing >90 degrees

506
Q

serratus anterior insertions

A

lateral aspect of ribs 1-8 and insert onto scapula

507
Q

subclavius

action
innervation

A

depress clavicle

nerve to subclavius

508
Q

biceps brachii origin and insertion

A

long head - supraglenoid tubercle
short head - coracoid process

insert onto radial tuberosity

509
Q

what artery supplies anterior compartment of upper arm

A

brachial artery

510
Q

coracobrachialis insertions

A

coracoid process to medial shaft humerus

511
Q

coracobrachialis function

A

shoulder flexion

512
Q

brachialis insertions

A

humeral shaft to unlar tuberosity

513
Q

triceps supplied by which blood vessel

A

profunda brachii

514
Q

where do triceps insert onto

A

olecranon

515
Q

deltoid insertions

A

lateral 1/3 clavicle onto deltoid tuberosity

516
Q

front delt function

A

flexion and internal rotation

517
Q

rear delt fx

A

extension and external rotation

518
Q

teres major function

A

adduct and axternally rotate shoulder

519
Q

teres major innervation

A

lower subscapular nerve

520
Q

supraspinatus fx

A

0-15degrees abduction

521
Q

where do rotator cuffs insert

A

supraspinatus, infraspinatus and teres minor - insert onto greater tubercle of humerus

subscapularis inserts onto lesser tubercle of humerus

522
Q

nerve supply to rotator cuffs

A

supraspinatus - suprascapular nerve
infraspinatus - suprascapular nerve
subscapularis - upper and lower subscapular nerve
teres minor - axillary nerve

523
Q

subscapularis fx

A

internal rotation

524
Q

anterior forearm ALL muscles

A

superior:
flexor carpi radialis
flexor carpi ulnaris
palmaris longus
pronator teres

intermediate:
flexor digitorum superficialis

deep:
flexor digitorum profundus
pronator quadratus
flexor pollicis longus

525
Q

superficial muscles of the anterior forearm all originate from

A

medial epicondyle

526
Q

flexor carpi ulnaris

A
527
Q

muscles of the anterior forearm all innervated by? expect for?

A

median nerve

not FCU - ulnar n
medial half of FDP - ulnar n

deep muscles innervated by anterior interrosseous branch of median nerve

528
Q

FCU:

fx
insertion

A

flex and adduct wrist
inserts onto pisiform, HoH and base of 5th metacarpal

529
Q

palmaris longus:

fx
insertion

A

flex wrist
inserts onto flexor retinaculum

530
Q

flexor carpi radialis:

fx
insertion

A

flex and abduct wrist
inserts onto 2nd and 3rd metacarpal

531
Q

pronator teres:

originS
insertion
fx

A

head 1 - medial epicondyle
head 2 - coronoid process of ulnar
insert onto midshaft radius

fx - pronation

532
Q

FDS

what lies between 2 heads?

A

ulnar artery and median nerve

533
Q

FDS

origins
insertion
fx

A

medial epicondyle and radius –> 4 tendons at wrist which attach to base of middle phalanx

flex wrist, flex MCPJ and proximal IPJ

534
Q

FDP action

A

flex Distal IPJ and MCPJ and wrist

535
Q

FPL fx

A

flex all joints of thumb

536
Q

FPL insertions

A

attach onto base of distal phalanx of thumb

537
Q

pronator quadratus insertions

A

anterior ulnar to anterior radius

538
Q

muscles in posterior forearm

A

superficial

brachoradialis
extensor carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris
extensor digitorum communis
extensor digit minimi
aconeus

deep
supinator
extensor pollucis longus
extensor pollicis brevis
abductor pollicis longus
extensor indicis propius

539
Q

superficial muscles of posterior forearm

A

brachoradialis
extensor carpi radialis longus + brevis
extensor carpi ulnaris
extensor digitorum communis
extensor digit minimi
aconeus

540
Q

deep muscles of posterior forearm

A

extensor pollicis longus
extensor policis brevis
abductor poliicis longus
extensor indicis propius
supinator

541
Q

muscles in posterior forearm innervated by?

A

radial nerve

542
Q

what is special about brachoradialis

A

paradoxical muscle

origin and innervation suggest extensor, but is a flexor

543
Q

brachoradialis

origin, insertion, fx

A

lateral humerus onto distal radius
flex at elbow and supination at proximal RUJ

544
Q

extensor carpi radialis longus and brevis insertions

A

longus: supracondylar ridge to MC II and III
brevis: lateral epicondyle to MC II and III

545
Q

extensor carpi radialis fx

A

extend and abduct wrist

546
Q

extensor digitorum communis

fx
insertions

A

main flexor of fingers
lateral epicondyle –> extensor hood of each fingers

547
Q

extensor digiti minimi

insertions and fx

A

lateral epicondyle to extensor hood of 5th finger
fx - extend all little finger joints

548
Q

extensor carpi ulnaris

fx and insertions

A

extend and adduct wrist
lateral epicondyle to MC V

549
Q

aconeus fx

A

extend and stablise elbow

550
Q

supinator makes up what part of cubital fossa

A

floor

551
Q

deep muscles of the posterior forearm are innervated by?

A

posterior interosseous branch of radial nerve

552
Q

difference in fx between EPL and EPB

A

longus extends all thumb joints INCLUDING IPJ

brevis only extends MCPJ and CMCJ

553
Q

thenar muscles are innervated by

A

recurrent branch of median nerve

554
Q

opponens policis insertions and fx

A

tubercle of trapezium onto lateral margin of MC I
fx - medial rotation and flexion at CMCJ

555
Q

abductor policis brevis insertions

A

tubercle of scaphoid and trapezium onto lateral side of proximal phalanx

556
Q

opponens digit minimi origin

A

hook of hamate

557
Q

abductor digiti minimi origin

A

pisiform

558
Q

flexor digiti minimi brevis origin

A

hook of hamate

559
Q

lumbricals fx

A

flex and MCPJ and extend at IPJ

560
Q

palmaris brevis fx and innervation

A

wrinkles skin in hypothenar region and ulnar n

561
Q

adductor policis innervation

A

ulnar n

562
Q

cranial nerves carrying parasympathetic fibres

A

3, 7, 9, 10

563
Q

fasciola hepatica definition

A

common liver fluke from parasitic infection by trematode

564
Q

fasciola hepatica symptoms

A

acute - abdo pain, fever
chronic - bile duct infection - jaundice

565
Q

dx of fasciola hepatica

A

stool sample +/- serology

566
Q

tx of fasciola hepatica

A

triclabendazole +/- ERCP

567
Q

inflammatory breast carcinomas risk factors

A

pregnancy
lactation

568
Q

branchial cyst excision - nerves at risk of injury

A

mandibular nerve
greater auricular nerve
accessory nerve

569
Q

cryptochidism causes

A

idiopathic
patent processus vaginalis
cerebral palsy
wilms tumour
developmental delay

570
Q

differentials for cryptochidism

A

could be retractile testes
could be absent testes

ix - try to locate testes and move into scrotum. if it stays immediately after –> probably retractile

571
Q

reasons to correct cryptochidism

A

infertility
increased risk of seminoma (40x)
risk of torsion
cosmetic

572
Q

cryptochidism tx

A

orchidopexy at 6m-18m

if identified later - orchidectomy (sertoli cells already degraded)

573
Q

episiotomy usually requires which nerve block

A

pudendal nerve

574
Q

pudendal nerve innervates

A

anal sphincters and external urethral sphincters

575
Q

acute inflammation general phases

A
  1. vascular phase
  2. cellular phase
576
Q

vascular phase of inflammation

A
  1. vasodilation of arterioles and capillaries which increases blood flow to area (calor and rubor)
  2. increased vascular permeability
  3. this allows protein, cells and fluids to leave the blood vessel to form exudate
577
Q

exudate formation

A

made by starling forces

  1. hydrostatic forces - force exerted by fluid which forces fluid out
  2. oncotic pressure - force exerted by colloids to draw fluid in
578
Q

neutrophil role in acute inflammation

A
  1. margination
  2. rolling
  3. adhesion
  4. emigration - into blood vessel wall
579
Q

sign of chronic infection

A

granuloma formation

580
Q

AA vs AL amyloidosis

A

AA secondary to chronic inflammatory conditions e.g. IBD or RhA

581
Q

complications of renal transplantation

A

common - blocked catheter or hypovolaemia

vascular - renal artery thrombosis SUDDEN UO CESSATION or renal artery stenosis

immunological - graft rejection

urological -obsturction

582
Q

vascular cx of renal transplant

A

<1%
typically results in graft loss
usually due to technical problem
sudden cessation of UO

583
Q

salter harris types

A

SALTER

S straight (T1) through GP
A above (T2) through GP and into metaphysis
L lower (T3) through GP and into epiphysis
T through (T4) through GP, epiphysis and metaphysis
E everything (T5) - crush

T2 MOST COMMON

584
Q

brachial plexus definition

A

anterior rami of c5-t1

585
Q

brachial plexus 5 parts

A

roots
trunks
division
cords
branches

586
Q

brachial plexus roots relationship to scalene muscles

A

pass between anterior and medial scalene muscles

587
Q

roots to trunks brachial plexus

A

roots converge to form 3 trunks at base of neck:

  1. superior trunk - c5+c6
  2. middle trunk - c7
  3. inferior trunk - c8 +t1
588
Q

trunks to divisions brachial plexus

A

each trunk forms an anterior and posterior division

leaves 3x anterior and 3x posterior divisions (anterior superior trunk division, posterior superior trunk division etc)

589
Q

divisions to cords brachial plexus

A

3 cords named accordingly to position to axillary artery

lateral cord - anterior division of superior trunk and middle trunk

posterior cord - all posterior divisions (superior, middle and inferior)

medial cord - anterior division of inferior trunk

590
Q

which nerves are posterior to axillary artery

A

axillary nerve
radial nerve

591
Q

ulnar nerve in relation to axillary artery

A

medial to axillary artery

592
Q

musculocutaneous nerve in relation to axillary artery

A

lateral to axillary artery

593
Q

axillary nerve sensory branch

A

superior lateral cutaneous nerve

594
Q

median nerve roots

A

c6-t1 (c5 in some individuals)

595
Q

radial nerve roots

A

c5-t1

596
Q

axillary nerve roots

A

c5,c6

597
Q

ulnar nerve roots

A

c8-t1

598
Q

musculocutaneous nerve roots

A

c5-c7

599
Q

sensory branches of median nerve

A

palmar cutaneous branch - lateral palm sensation
digital cutaneous branch - lateral 3.5 fingers

600
Q

minor branches of brachial plexus

A

roots - dorsal scapular nerve, long thoracic nerve
trunks - suprascapular nerve & nerve to subclavius
lateral cord - lateral pectoral nerve
medial cord - medial pectoral nerve
posterior cord - upper and lower subscapular nerve

601
Q

MCN anatomical course

A

pierces coracobrachialis
passes deep to bicep
passes superior to brachialis
emergees lateral to biceps tendon where it gives off lateral cutaneous branch (sensation of lateral forearm)

602
Q

radial nerve - as it passes down humerus, accompanied by which artery

A

brachial artery

603
Q

how does radial nerve enter forearm

A

anteriorly to lateral epicondyle

604
Q

radial nerve branches in ACF:

A
  1. deep - motor of posterior forearm
  2. superficial - sensory
605
Q

axillary nerve passes ____ to surgical neck of humerus

A

medial

606
Q

3 branches of axillary nerve

A

posterior terminal branch - teres minor + rear delt
anterior terminal branch - supply front delt
articular branch - supply GHJ

607
Q

median nerve descends down humerus, ____ to brachial artery

A

laterally then crosses medially halfway down humerus

608
Q

branches of median nerve

A

in forearm:
1. anterior interosseous –> deep anterior forearm muscles
2. palmar cutaneous nerve –> lateral palm sensation

in carpal tunnel:
1. recurrent –> thenar
2. palmar digital nerves –> lateral lumbrical (motor) and lateral finger sensation

609
Q

why is there preserved lateral palm sensation in carpal tunnel syndrome

A

palmar cutaneous nerve does not pass through carpal tunnel

610
Q

supracondylar fractures damage which nerve

A

initially - anterior interosseous nerve (median) most common

post-op - ulnar nerve is most common (by k-wire)

611
Q

hand branches of ulnar nerve

A

deep branch - supplies hypothenar
superficial branch - medial 1.5 fingers

612
Q

ulnar nerve in relation to axillary artery and vein

A

ulnar nerve is medial to axillary artery
ulnar nerve is lateral to axillary vein

613
Q

ulnar nerve entering forearm

A

passes posterior to medial epicondyle

614
Q

froment’s sign

A

ulnar nerve palsy test
tests adductor policis
hold paper between thumb and index finger
lack of thumb adduction and compensation by flexing IPJ is positive

615
Q

froment’s sign tests which muscle

A

adductor policis

616
Q

hypochonium of nail

A

area distal to nail bed, under the free edge of nail plate

617
Q

eponychium

A

stratum corneum layer at base of nail

618
Q

germinal matrix of nail

A

cells that become keratinized to become nail plate

619
Q

3 possible outcomes of peripancreatic fluid collection post-pancreatitis

A
  1. resolution
  2. pseudocyst
  3. abscess
620
Q

psuedocyst of pancreas features

A

high amylase in 75%
most are retrogastric
PRESENT >4 WEEKS AFTER ACUTE PANCREATITIS

621
Q

tx of pseudocyst

A

endoscopic or surgical cystogastrostomy or aspiration

622
Q

father can consent if….

A
  1. married to biological mother OR
  2. on birth certificate
623
Q

renal cell carcinoma tx

A

t1 = partial nephrectomy
t2 = radical nephrectomy

no need for neoadjuvant chemo if resection is complete

624
Q

nerve repair growth rate

A

1mm/day

625
Q

lobular carcinoma in situ - distinct features

A

low malignancy risk
can observe
need MRI

626
Q

risk factor for lobular carcinoma in situ

A

previous contralateral breast cancer

627
Q

risks of aortic aneurysm over 5 years

A

5-5.9 cm = 25%
6-6.9 cm = 35%
>7.0 cm = 75%

628
Q

anything over ____ cm on USS for aortic aneurysm needs a CT scan

A

5 cm

629
Q

CEA also high in

A

colitis (IBD)
cirrhosis

630
Q

osteomyelitis of spine predilects to which part of spine

A

cervical

631
Q

TB of spine predilects to which part of spine

A

thoracic

632
Q

carcinoid ix

A

24hr urine collection of 5-hydroxindoleacetic acid
CT

633
Q

carcinoid tx

A

if <1.2cm and limited to appendix - DISCHARGE

if >2cm need isotope scan –> if mets –> right hemicolectomy

octreotide often given

634
Q

charcot foot definition

A

occurs in patients with peripheral neuropathy where trauma occurs to neuropathic extremities leading to bone and soft tissue/joint damage

635
Q

what nervous system predominates post-op

A

sympathetic

636
Q

body responses to surgery (4)

A
  1. NA and A facilitated sympathetic drive resulting in bronchodilation, increased glucagon, decreased cortisol, increased HR, increased contractility
  2. increased APP
  3. increased nitric oxide from vessels
  4. endocrine –> increased cortisol
637
Q

tunnelled vs non-tunnelled lines

A

tunnelled lines have a different exit point (not same as entry point)
- they are inserted under skin
- have a cuff to anchor to skin
- are for longer term infusions e.g. dialysis and chemotherapy

examples include groshong and hickmans

638
Q

groshong vs hickmanns

A

groshong has 3 way valve

639
Q

omphacele vs gastroschisis

A

omphacele - abdominal contents covered in peritoneum

gastroschisis - abdominal contents not covered by peritoneum

640
Q

ligament anterior to spleen

A

gastrosplenic ligament (part of greater ommentum)

641
Q

ligament posterior to spleen

A

leinosplenal ligament

642
Q

indications for pre-operative enteral feeding

A

patients having major abdominal surgery who are:

malnourised, have an unsafe swallow or inadequate oral intake but have functional GIT

643
Q

ITU patient feeding

A

continuous enteral feeding 16-24 hours

644
Q

enteral feeding options

A

gastric feeding unless upper GI problem - then duodenal or jejunal feeding

645
Q

PEG can be used when after insertion

A

after 4 hours post-insertion

646
Q

best sterilising method for tubercle bacili

A

autoclaving

647
Q

what is autoclaving

A

air removed & high pressure steam used

648
Q

pulmonary artery occlusion pressure is an indirect monitor of

A

left atrial pressure / filling of left side of heart

649
Q

PAOP interpretation

A

normal = 8-12

low <5 = hypovolaemia

low w/ pulmonary oedema <5 = ARDS

high >18 overload

650
Q

what can be damaged in anterior resection

A

left ureter
(near upper rectum/sigmoid)

651
Q

dorsalis pedis is a branch of

A

anterior tibial artery

652
Q

what structures can be damaged in caecum operations

A

right ureter + gonadal arteries

653
Q

which adenoma in colon has highest malignancy risk

A

villous adenoma

654
Q

colorectal cancer follow up after resection

A

colonoscopy 1year post op

655
Q

high risk features found on baseline colonsocopy - how to follow up

A

3 year colonoscopy

656
Q

branches of facial nerve

A

when it passes through IAM - has 3 branches:
1. greater petrosal nerve
2. nerve to stapedius
3. chorda tympani

then passes through SMF and has 2 branches:
1. posterior auricular
2. branch of posterior digastric belly

then passes through parotid and has 5 branches:
Temporal nerve
Zygomatic nerve
Buccal nerve
Marginal Mandibular
Cervical nerve

657
Q

diagnosis of transitional cell carcinoma

A

CT IVU

658
Q

most renal tumours are what colour?

A

yellow or brown

659
Q

pathology - colour of TCC

A

pink fleshy

660
Q

nephroblastoma tx

A

surgical resection combined with chemotherapy (usually vincristine, actinomycin D and doxorubicin)

661
Q

neuroblastoma definition

A

nerve cell cancer

662
Q

neuroblastoma tx

A

surgical resection, radiotherapy and chemotherapy

663
Q

most common extracranial tumour of childhood

A

neuroblastoma

664
Q

angiomyolipoma associated neurological condition

A

tuberous sclerosis

665
Q

radial head fracture

A

proximal forearm tenderness
pain on pronation and supination

666
Q

An upper GI endoscopy is performed and an ulcer is seen at the greater curvature of the stomach that is actively bleeding. What vessel is most likely to be involved?

A

gastroepiploic artery.

667
Q

non surgical treatment of keloid scars

A

triamcinolone

668
Q

giant cell tumour of the bone (osteoclastoma) xray appearance

A

soap bubble appearance
- multiple lytic and lucent appearances

669
Q

bones usually affected by osteoid osteoma

A

femur and tibia

670
Q

commonest benign tumour of the bone

A

osteoid osteoma

671
Q

Mirel Scoring system use

A

stratify the risk of spontaneous fracture for bone metastasis of varying types and thus identify those that need prophylactic fixation

672
Q

Boerhaaves syndrome
definition

A

spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting

673
Q

where is the rupture typically located in boerhaave’s syndrome

A

left sided and distal

674
Q

why do you ventilate head injured patients

A

prevents hypercapnia
prevents vasodilation, reducing blood flow to brain and therefore ICP

675
Q

tranexemic acid MOA

A

prevents plasminogen to plasmin

prevents clot from being broken down

676
Q

pseudomyxoma peritonei:

definition
where do they arise

A

rare mucinous tumour

most commonly arising from appendix but also bladder and ovaries

677
Q
A
678
Q

risk factors for pseudogout

A

hyperPTH
hypothyroidism
haemochromatosis

679
Q

why is haemochromatosis a RF for pseudogout

A

iron causes overstimulation of osteoclasts

680
Q

causes of hydronephrosis

A

UNILATERAL: PACT
Pelvic-ureteric obstruction
Aberrant blood vessels
Calculi
Tumours

BILATERAL: SUPER
Stenosis of urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

681
Q

lymphatic drainage from inferior to dentate line

A

inguinal nodes

682
Q

why can hypocalcaemia occur in hyperventilation

A

hyperventilation –> respiratory ALKALOSIS –> bound hydrogen ions dissociate from albumin leaving more albumin to bine to ionized calcium

683
Q

prostate cancer tx

A
  1. if old, multiple co-morbidities or low gleason score - WATCH AND WAIT
  2. external beam radiotherapy - both palliative and curative therapy possible. radiation proctitis and rectal malignancy are later problems
  3. radical prostatectomy - for localised disease or young patients. Erectile dysfunction common SE
  4. Hormonal therapy - anti androgen or LHRH analgoues. Testosterone stimulates prostate tissue
684
Q

A 35 year old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?

A

subclavian vein

685
Q

common organisms causing maxillary sinusitis

A

haemophilus influenzae
strep pneumoniae

686
Q

malignancies of the nose and paranasal sinuses

A

adenoid cystic carcinoma
squamous cell carcinoma
adenocarcinoma

687
Q

adenocarcinoma of the paranasal sinus and nasopharynx linked to what exposure

A

hard wood dust

688
Q

ameloblastomas definition

A

rare tumours of odontogenic epithelium

they have a rim of periosteum that when palpated gives rise to crepitus

689
Q

in normal distribution data - what percentage of values lies between:
1 SD of mean
2 SD of mean
3 SD of mean

A

68.27%
95.54%
99.73%

690
Q

what stimulates prolactin release

A

TRH (dopamine inhibits)

691
Q

superficial partial thickness burns characteristics:

A
  • form vesicles and bullae
  • preservation of hair follicles
  • healing by re-epithelialisation
692
Q

plasma typically accounts for what percentage of body weight

A

4-6%

693
Q

what % of body water is intracellular

A

65%

694
Q

what % of body weight is intracellular

A

40%

695
Q

which dermatome requires blockade in local anaethetic open inguinal hernia repair

A

T12

696
Q

Which nerve wraps around Wharton’s duct (submandibular duct)

A

lingual nerve

697
Q

flail chest with sats<90% mx

A

intubation and ventilation

698
Q

full spine immobilisation if:

A

GCS<15
neck pain/tenderness
paraesthesia extremities
focal neurological deficit
suspected c-spine injury

699
Q

cspine injury: Xray or CT

A

CT if:
- intubated
- GCS <13
- normal Xray
- any focal neurology
- a CT head is being performed
- Xray is abnormal

700
Q

what 2 cranial nerves may be non-functioning in hyperacusis?

A

facial nerve - impaired innervation to stapedius

trigeminal nerve - increased tensor tympani innervation

701
Q

porta hepatis transmits what structures

A

common hepatic duct
hepatic artery
portal vein
SNS and PSNS fibres
lymphatic drainage of the liver

702
Q

papillary thyroid spread

A

lymphatic

703
Q

follicular thyroid cancer spread

A

haematogenous

704
Q

berrys sign

A

absence of carotid pulse due to malignant thyromegaly

705
Q

friebergs disease

A

anterior metatarsalgia affecting the head of the second metatarsal usually associated to pubertal growth spurt

706
Q

use of alginate dressing

A

for abscess or highly exudating wounds

used after incision and drainage

alginate is a calcium compound acting as a haemostat

707
Q

fissure in ano tx

A

stool softerners + topical diltiazem or GTN

if topical fail -> botulinum toxin injection

if botulinum toxin fails –> sphincterotomy

708
Q
A
709
Q

osteopetrosis definition

A

osteoclast function problem

bones become overly dense –> brittle –> fracture

710
Q

rectal cancer staging

A

MRI rectum + CT CAP

711
Q

colon cancer staging

A

CT CAP

712
Q

which menisci is usually affected in injury? and why do most sympatomatic tears need treatment?

A

medial

menisci have no nerve or blood supply to heal poorly

713
Q

urethral injury triad of sx

A

urinary retention
perineal haematoma
blood at the meatus

714
Q

dieulafoy lesion

A

large tortuous artery most commonly in the stomach wall that erodes and bleeds

715
Q

A 23 year old man is readmitted following a difficult appendicectomy. His wound is erythematous and, on incision, foul smelling pus is drained. Which of the organisms listed below is responsible?

A

bacteroides fragilis

716
Q

septic shock precise meaning

A

refers to refractory systemic arterial hypotension in spite of fluid resuscitation

717
Q

vasopressors vs ionotropes

A

vasopressors increase blood pressure by constricting blood vessels which increases the amount of blood that can flow to organs

ionotropes increase the heart’s ability to contract, which imrpoves cardiac output and help maintain BP

718
Q

phrenic nerve - which triangle of the neck

A

posterior

719
Q

Rectal cancers with threatened resection margins management

A

radiotherapy and chemotherapy

720
Q

frank haematuria + high RBC?

A

renal cell carcinoma (not bladder)
because RCC cause polycythaemia

721
Q

angiotensinogen to angiotensin 1. which enzyme

A

renin

722
Q

cerebral perfusion pressure =

A

mean arterial pressure - ICP

723
Q

mean arterial pressure =

A

diastolic +0.33(SBP - DBP)

724
Q

phases of wound healing

A
  1. haemostasis
  2. inflammation - neutrophils, fibroblasts and macrophages
  3. regeneration - fibroblasts, endothelial cells and macrophages
  4. myofibroblasts
725
Q

tracheomalacia

A

collapse of airway due to cartilage degeneration (collapses in expiration)

can occur after removal of very large thyroids/goitre

726
Q

femoral nerve (L2-L4) palsy sx

A

weak hip flexion
weak knee extension
impaired quadriceps reflex
sensory deficit in anteromedial aspect of the thigh

727
Q

what muscles do femoral nerve innervate

A

pectineus
sartorius
quadriceps muscles

728
Q

branches of the femoral nerve

A

medial cutaneous nerve of thigh
saphenous nerve
intermediate cutaneous nerve of thigh

729
Q

which gut hormone is dependent of vagal stimuli

A

gastrin

730
Q

what autosomal dominant neurological condition causes discrepancies in limb length

A

neurofibromatosis type 1

731
Q

The inferior aspect of the vagina drains to which of the following lymph node groups?

A

superficial inguinal nodes

732
Q

superior aspect of the vagina lymph node drainage

A

internal and external iliac nodes

733
Q

which muscles attach onto greater trochanter

A

piriformis
obturator internus
gemelli
obturator externus

734
Q

anal cancer tx

A

chemoradiotherapy
(different from rectal cancer)

735
Q

medications causing pseudohaematuria

A

rifampicin
phenytoin
levodopa
methyldopa
quinine

736
Q

DIC dx

A

fibrin degredation products are raised

737
Q

DIC definition

A

dyregulation between coagulation and fibrinolysis - mediated by the abnormal exposure of TF in the circulation

738
Q

Via which structure does cerebrospinal fluid enter the subarachnoid space?

A

Laterally:
foramen of Luschka (from 4th ventricle)

Medially: foramen of Magendie (from 4th ventricle)

739
Q

stable bleeding peptic ulcer tx

A

adrenaline injection + endoscopic clipping/heat therapy

740
Q

cushings triad

A

HYPERTENSION
bradycardia
respiratory depression

741
Q

pancreatic cancer with mets tx

A

ERCP and stent and palliation

742
Q

head of pancreas cancer tx

A

Whipple’s + adjuvent chemo

newer techqiues include pylorus preservation and SMA/SMV resection

743
Q

carcinoma of pancreas body and tail

A

distal pancreatectomy + adjuvant chemo

744
Q

vertebral level of left main bronchus

A

T6

745
Q

inferior border of both lungs

A

6th rib MCL
8th rib MAL
10th rib posteriorly

746
Q

popliteal fossa contents (medial to lateral)

A

popilteal artery
popliteal vein
tibial nerve
common peroneal nerve

747
Q

thoracic aorta rupture CXR

A

widened mediastinum
trachea/oesophagus to right
depression of left main stem bronchus
widened paraspinal interfaces

748
Q

DALM lesions tx

A

seen in longstanding ulcerative colitis

panproctocolectomy

749
Q

homonymous hemianopia with macula sparing lesion location

A

occipital cortex

750
Q

which finger has no attachment of the palmar interosseous

A

middle finger

751
Q

how do catecholamines work as ionotropes

A

increase cAMP levels by adenylate cyclase stimulation

this increases intracellular calcium ion mobilisation and thus the force of contraction

752
Q

adrenaline receptor preference

A

alpha agonist at lower doses

beta agonist at higher doses

753
Q

tranexamic acid MOA

A

competitively inhibits conversion of plasminogen to plasmin

754
Q

unilateral isolated cleft lip cause

A

incomplete fusion of the nasolabial muscle rings

755
Q

Contents of carotid sheath:

A

Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve

756
Q

post-transplant viral complications

A

CMV - 4weeks-6m
EBV >6m (post-transplant lymphoproliferative disorder)

757
Q

most gastric malignancies are….

A

adenocarcinoma

758
Q

the tunica vaginalis is derived from —–

A

peritoneum

759
Q

vein mapping investigation

A

venous duplex > venous doppler

760
Q

coarctation of aorta tx

A

angioplasty

761
Q

tumours of the posterior tongue metastasize to

A

bilateral deep cervical nodes

762
Q

lymphatic drainage from the tip of the tongue

A

submental nodes

763
Q

lymphatics from the medial mid portion of the tongue drain into

A

submandibular nodes?
bilateral deep cervical nodes

764
Q

lymphatics from the lateral mid portion of the tongue drain into

A

ipsilateral deep cervical nodes

765
Q

rome IV criteria for IBS

A

recurrent abdo pain or discomfort at 3 days/ month for >3months associated with:

  1. improvement with defecation
  2. onset associated with a change in the frequency of stool
  3. onset associated with a change in the form of the stool
766
Q

which thyroid cancer linked to non-therapeutic irradiation

A

papillary thyroid

767
Q

main pancreatic duct embryological origin

A

ventral outgrowth of the duodenum

768
Q

which bacteria implicated in cholangitis infections

A

e.coli

769
Q

Paneth cells - what are they and where are they located

A

Secretory cells that contribute to the gut micobiome

Crypt of lieberkuhn

770
Q

where do the 3 adrenal arteries arise from

A

superior - inferior phrenic
middle - aorta
lower adrenal vessels - renal vessels

771
Q

femoral canal borders

A

lateral - femoral vein
medial - lacunar ligament
anteriorly - inguinal ligament
posteriorly - pectineal ligament

772
Q

how is tamoxifen a RF for endometrial cancer

A

is an ER antagonist in breast BUT agonist in endometrial tissue

773
Q

Patients being monitored for HCC: if they have rise in AFP + USS show nodule -> diagnostic scan?

A

Liver MRI

774
Q

saphena varix O/E

A

blue discolaration
enlarge during coughing
disappear on lying down

775
Q

what nerve lies medially to lobes of thyroid and is betewen thr oesophagus and trachea

A

recurrent laryngeal nerve

776
Q

phrenic nerve: does it pass anteriorly or posteriorly to the following structure:

Subclavian vein
Subclavian artery
Lung roots

A

SCV - travels posterior to SCV
SCA - travels anterior to SCA
lung roots - travels anteriorly to lung roots

777
Q

vagus nerve leaves cranium via

A

jugular foraemne

778
Q

right vagus nerve anatomical course in the neck

A

passes anterior to the subclavian artery

779
Q

left vagus nerve anatomical course in the neck

A

passes between the left common carotid and left subclavian artery

780
Q

hyperplasia vs hypertrophy

A

hyperplasia - increase in number of cells
hypertrophy - increase in size of cells

781
Q

what happens when catheter enters prostatic urethra

A

resistance decreases (as it is much wider)

782
Q

arterial supply of prostate

A

inferior vesical artery (branch of internal iliac)

783
Q

prostate lymph drainage

A

internal iliac

784
Q

prostate innervation

A

inferior hypogastric plexus

785
Q

where do most prostate cancers occur in prostate

A

peripheral zones

786
Q

what causes high amylase

A

acute pancreatitis
acute cholecystitis
DKA
mesenteric infarct

787
Q

what hormones are decreased in stress response

A

insulin
testosterone
oestrogen
thyroxine

788
Q

hormonal affects on pancreatic secretions

A

SECRETIN - causes secretion of water and electrolytes

CCK - causes enzyme secretion

Somatostatin - decreases volume of secretion

789
Q

loop diuretic MOA

A

inhibit Na/K/Cl transporter in ascending limb of Henle

reduces absorption of NaCl

790
Q

Thiazide site of action

A

distal tubule

791
Q

if colonoscopy is indicated but cannot be tolerated - which scan is next

A

CT colonography

792
Q

stridor after thyroid surgery management

A

re-open neck wound by removal of skin clips ON THE WARD

793
Q

drugs that can cause parotid enlargement

A

high oestrogen dose contraceptives
thiouracil
isoprenaline

794
Q

permanent sutures

A

polypropylene
polyester

795
Q

when should clopidegrel be stopped before surgery

A

5-7d before

reduces ADP induced platelet aggregation for 120hours after final dose

796
Q

heterotropia

A

tissue found in abnormal location that is present from birth e.g. Meckels (gastric mucosa)

797
Q

most common extra-colonic lesion in FAP?

A

duodenal polyps

798
Q

external jugular vein relation to sternocleidomastoid

A

lateral / superficial

799
Q

right recurrent laryngeal nerve anatomical course

A

branches off right vagus nerve more proximal than T4

it arches posteriorly around the subclavian artery

800
Q

lady having splenectomy for ITP - when to give platelet transfusion?

A

AFTER ligation of the splenic artery

before surgery - platelets would be sequestered by spleen

801
Q

differences in procedure of splenectomy in emergency vs elective

A

most elective are laparoscopic

802
Q

cx of splenectomy

A

haemorrhage
pancreatic fistula
thrombocytosis
encapsulated bacteria infection

803
Q

CKK effects on rate of gastric emptying

A

reduce rate

804
Q

factors increasing gastric acid production

A

vagal nerve stimulation
gastrin release
histamine release

805
Q

factors decreasing gastric acid production

A

somatostatin
CKK
secretin

806
Q

dercums disease

A

multiple lipomas + generalized obesity

807
Q

statistical power definition

A

probability of a test that it will reject the null hypothesis when it is false (thereby avoiding type 2 error)

808
Q

normal statistical power desired

A

0.8

809
Q

type 1 error

A

a test rejects a TRUE null hypothesis (false positive).

it equates to the significance of a test

810
Q

type 2 error

A

a test fails to reject a false null hypothesis

related to statistical power

811
Q

components needed for power calculations

A

size of effect
significance level
sample size
desired power

812
Q

where do vertebral arteries unite to form basilar artery

A

base of the pons

813
Q

branches of the vertebral arteries

A

PICA
anterior spinal artery
posterior spinal artery

814
Q

basilar artery branches

A

pontine arterie
AICA
superior cerebellar artery
posterior cerebral artery

815
Q

what passes posterior to the medial malleolus

A

tibialis posterior tendon
flexor hallucis longus tendon
flexor digitorum longus tendon
tibial nerve
posterior tibial artery

816
Q

locations of accessory spleens (8)

A

tail of pancreas
splenic vessels
gastrosplenic ligament
splenrenal ligament
walls of the stomach and intestines
greater omentum
mesentery
gonads

817
Q

adrenal masses of what size need to be removed

A

> 4cm

818
Q

most significant event to contribute to wound healing immediately following injury

A

platelet degranulation

819
Q

fistula in ano cell type

A

squamous

820
Q

respiratory centres

A
  1. medulla respiratory centre
  2. apneustic centre
  3. pneumotaxic centre
821
Q

apneustic vs pneumotaxic centre

A

pneumotaxic centre in upper pons
apneustic centre in lower pons

pneumotaxic centre overrides apneustic cntre and can inhibit inspiration

822
Q

where are respiratory chemoreceptors

A

central - medulla
peripheral - carotid and arch of aorta

823
Q

central chemoreceptors in medulla respond to

A

H+ in brain interstital fluid

824
Q

obstructing renal cancer stoma

A

loop colostomy - to defuntion distal segment of colon

825
Q

loop ileostomy indications

A

defunction distal bowel in low anterior resection

826
Q

spongy urethra and glans penis lymphatic drainage

A

deep inguinal nodes

827
Q

additional antibiotics to consider for MRSA (in addition to glycopeptide)

A

rifampicin
macrolides
tetracyclines

828
Q

bone mets that are hypervascular primary source?

A

renal cancer

829
Q

prilocaine antidote

A

methylene blue

reverts ferric type to ferrous type Hb

830
Q

scrotal sensation

A

ilioinguinal nerve - anterior
pudendal - posterior skin

831
Q

SOMATOSTATIN FUNCTIONS

A
  1. inhibit GH
  2. delays gastric emptying
  3. reduces gastric acid production
  4. reduces pancreatic exocrine secretions
832
Q

suspicious melanoma lesions should undergo which ix

A

excision biopsy

833
Q

long head of biceps femoris innervation

A

tibial division of sciatic nerve

834
Q

short head of biceps femoris innervation

A

common peroneal nerve

835
Q

hydrocele tx

A

children - transinguinal ligation of the patent processus vaginalis

adults - Lords of Jabouley procedure

836
Q

lord vs jabouley procedure of hydrocele

A

Lord - plication of sac

Jabouley - sac drained, everted and sutured behind testes

Jabouley for larger hydrocele; lower risk of recurrence but higher risk of haematoma

837
Q

comedo vs cribiform DCIS

A

comedo - microcalficications
cribiform - multifocal

838
Q

hyoid vertebral level

A

C3

839
Q

notch of the thyroid cartilage vertebral level

A

c4

840
Q

cricoid cartilage vertebral level

A

c6

841
Q

what landmarks are at C6

A

junction of larynx with trachea
junction of pharynx with oesophagus
inferior thyroid artery enters thyroid
middle cervical ganglion level

842
Q

open fractures >6 hours ago mx

A

amputation

843
Q

hartmans procedure risk of wound infection

A

35%

844
Q

preparation for endoscopy

A

colonoscopy = oral purgatives day before
sigmoidoscopy = eneme 30 mins before
OGD = NBM for 6 hours

845
Q

where does apneuorsis end

A

below arcuate line

846
Q

high output fistula management

A

octreotide - limit pancreatic secretions
nutritional complications

nutritional support is common - TPN

847
Q

perianal fistulae secondary to Chrons mx

A

seton

848
Q

nephroblastoma vs neuroblastoma

A

nephroblastoma are non-calcified
neuroblastoma are usually calcified

849
Q

drug causing goitre

A

lithium

850
Q

when do callus become visible on radiographs after fracture

A

3 weeks

851
Q

which cell type relies on Cori cycle alone for energy needs

A

erythrocytes - lack mitochondria

852
Q

parenteral nutrition - what needs to be monitored

A

zinc
folate
b12
copper
iron
ferritin
magnesium
vitamin d
bone density

853
Q

intra-op arterial bleeding mx

A

ligation

854
Q

proximal humerus fractures mx

A

impacted fractures - collar and cuff for 3 weeks
displaced - ORIF

855
Q

drugs reducing renin secretion

A

beta blockers
NSAIDs

856
Q

which scaphoid fractures need surgery

A
  1. displaced
  2. all proximal pole fractures
857
Q

splenic vein thrombosis:
dx
cx
tx

A

dx - CT angio
cx - varices
tx - splenectomy

858
Q

During an Ivor Lewis Oesophagectomy for carcinoma of the lower third of the oesophagus which structure is divided to allow mobilisation of the oesophagus?

A

azygous vein

859
Q

gritti stokes amputation

A

remove part of femur. connect remaining femur to patella

860
Q

skew flaps benefits

A

less bulky
easier to attach prosthesis to

861
Q

late sign of compartment

A

lossof pulses

862
Q

pelvic fracture and lwoer abdominal peritonism ….?

A

bladder rupture

863
Q

large bowel obstruction with visible fluid level cause

A

sigmoid volvulus

864
Q

what aspect of RAAS causes vasoconstriction

A

angiotensin II

865
Q

burns + bad ventilation in patient who already intubated

A

escharotomy

866
Q

colonic pseudoobstruction mx

A

supportive - electrolyte replacement

sometimes neostigmine required to stimulate peristalsis

867
Q

suture for securing drains

A

2/0 silk

868
Q

what type of smooth muscle propels food through the oesophagus

A

longitudinal smooth muscle

869
Q

how long does it take food to get from oesophagus into the stomach

A

9 seconds (primary peristalsis)

870
Q

three main types of peristaltic activity in the colon

A
  1. segmentation contractions - localised contractions in which the bolus is subjected to local forces to maximise mucosal absorption
  2. anti-peristaltic contractions - reverse peristaltic waves to slow entry into colon and maximise absorption
  3. mass movements
871
Q

discitis organisms in children

A

0-6m = staph aureus
6m-4y = kingella kingae

872
Q

cluster RCT vs normal RCTs

A

randomize GROUPS vs individuals

more prone to error
they require increased recruitment to achieve the same level of statistical power

873
Q

what ligament seperates vertebral column vs spinal cord

A

posterior longitudinal ligament

874
Q

what blood vessel is divided in lateral approach for hip arthroplasty

A

transverse branch of the lateral circumflex artery

875
Q

brisk haematuria in pregnancy

A

placenta PERCRETA - invades mymometrium and can extend into bladder

876
Q

hashimoto’s can lead to which cancer

A

thyroid lymphoma (MALT)

877
Q

most posterior structure at the hilum of the kidney

A

ureter

878
Q

body of uterus drains into which lymph node

A

iliac lymph nodes

879
Q

ovaries drain into which lymph node

A

para-aortic lymph nodes

880
Q

MEN IIB

A

medullary thyroid
phaeochromocytoma
mucosal neruroma
marfanoid features

881
Q

MEN I

A

pancreatic/ZES
parathyroid
pituitary

882
Q

MEN IIA

A

Phaeochromocytoma
Medullary thyroid
HyperPTH

883
Q

difficult viewing during cholecystectomy - how to manage

A

cholecystostomy - drainage of gall bladder

884
Q

sarcomas spread how? and where commonly

A

haematogenous
lung common site

885
Q

parotid gland secretions account for what percentage of secretions to saliva

A

25%

886
Q

PTH half life

A

10 mins

887
Q

which parasitic infection affects gut and lungs

A

ascariasis

888
Q

duct ectasia tx

A

multiple ducts = hadfields procedure
single duct = microdochectomy

889
Q

stroke volume range

A

55-100ml

890
Q

coronary arteries have which adrenergic receptors

A

Beta2

891
Q

most common cause of bacterial infective diarrhoea

A

campylobacter jej

892
Q

causes of hyperuricaemia

A

severe psoriasis
lesch-nyhan syndrome
DKA
alcohol

893
Q

which 2 arteries run near SFJ

A

deep external pudendal artery
superficial external pudendal artery

894
Q

contents of greater sciatic foramen

A

sciatic nerve
pudendal nerve
superior and inferior gluteal nerves
nerve to quadratus femoris
nerve to obturator internus

superior gluteal artery and vein
inferior gluteal artery and vein
internal pudendal artery and vein

895
Q

hypokalaemia is associated to which pH imbalance

A

alkalosis

896
Q

posterior urethral valve tx

A

endoscopic valvotomy

896
Q

Which substance is released from the sympathetic nervous system to stimulate the adrenal medulla?

A

acetyl choline

897
Q

worm infection of anus most common

A

enterobius vermicularis

898
Q

5 FU MOA

A

antimetabolite

899
Q

doxorubicin MOA

A

Anthracycline - inhibit DNA and RNA synthesis by intercalating base pairs

900
Q

cisplatin MOA

A

crosslinks DNA to induce apoptosis

901
Q

cyclophosphomide MOA

A

alkylating agent

902
Q

actinomycosis

A

chornic progressive granulomatosis disease caused by filamentous gram positive anaerobic bacteria

903
Q

proximal SCC oesophageal cancer tx

A

chemoradiotherapy

904
Q
A

MRCS A (1 decks)

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