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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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295
Q

HLA types asx with mismatch

A

A B C DR

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296
Q

septic arthritis most common causative organism

A

staph aureus

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297
Q

basilic vein

medial or lateral?
superficial or deep?

A

medial
superficial until mid upper arm

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298
Q

middle meningeal artery exits through which cranial foramen

A

foramen spinosum

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299
Q

basilic vein + ____ vein > _____ vein

A

medial brachial vein
axillary vein

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300
Q

potent vasodilators in acute inflammation

A

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

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301
Q

serotonin - vasodilator or vasoconstrictor?

A

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

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302
Q

malignancy histology

A

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

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303
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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304
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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305
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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306
Q

indications for lymphoedema surgery

A

marked disability and/or deformity
incompetent proximal lymphatics

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307
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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308
Q

stored blood has more or less affinity for oxygen

A

more affinity
less 2,3-DPG

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309
Q

haldane effect of haemoglobin

A

LEFT SHIFT
haem has greater affinity for oxygen

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310
Q

what causes haldane effect

A

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

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311
Q

bohr effect of haemoglobin

A

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

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312
Q

what causes bohr effect

A

acidosis
high co2
high temperature
high 2,3-DPG

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313
Q

suxamethonium features

A

depolarising muscular blocker
rapid onset
produces muscular contractions before paralysis

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314
Q

side effects of suxamethonium

A

hyperkalaemia
malignant hyperthermis

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315
Q

atracurium reversing agent

A

neostigmine

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316
Q

diagnostic OGD prep

A

NBM >6hrs

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317
Q

flexi sigmoidoscopy prep

A

phosphate enema 30 mins before

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318
Q

femoral triangle borders

A

medial - adductor longus
lateral - sartorius
superior - inguinal ligament

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319
Q

brachial embolectomy can damage which nerve

A

median @ ACF

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320
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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321
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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322
Q

propofol features

A

rapid onset
pain on injection
anti-emetic properties

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323
Q

sodium thiopentane features

A

very rapid onset
marked myocardial depression

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324
Q

etomidate

A

can cause adrenal suppression

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325
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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326
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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327
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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328
Q

sympathetic effect on ventricles

A

increase contracrility via increase of intracellular calcium

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329
Q

what increases functional residudal capacity

A

standing up right
asthma
emphysema

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330
Q

what decreases FRC

A

abdo swelling
pulmonary oedema
decreased diaphragm tone

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331
Q

cavernous sinus lateral wall contents

A

oculomotor
trochlear
ophthalmic
maxillary

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332
Q

cavernous sinus contents

A

ICA (medially)
abducens (laterally)

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333
Q

insulinoma ix and tx

A

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

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334
Q

superficial back muscles

A

lats
traps
rhomboid minor
rhomboid major
levator scapula

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335
Q

traps:

origin and insertion
innervation

A

origin: skull + spinous process C7-T12

insertion: clavicle, acromion, scapula spine

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336
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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337
Q

function of lats

A

extends, adducts and medially rotates upper arm

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338
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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339
Q

function of levator scapula

A

elevate scapula

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340
Q

rhomboid major:

origin and insertion
innervation

A

spinous process of T2-T5
medial border of scapula

dorsal scapular nerve

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341
Q

rhomboid minor

origin and insertion
innervation

A

spinour process of C7-T1
medial border of scapula

dorsal scapular nerve

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342
Q

intermediate muscles of the back

A

serratus posterior superior

serratus posterior inferior

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343
Q

serratus posterior superior

origin and insertion
innervation

A

C7-T3 to anterior ribs 2-5

intercostal nerve

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344
Q

serratus posterior superior action

A

elevate the ribs 2-5

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345
Q

superficial muscles of the deep back muscles

A

the SPINOTRANSVERSALIS muscles

splenius capitis
splenius cervicis

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346
Q

splenic capitis innervation

A

posterior rami of c3-c4

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347
Q

splenic capitis funciton

A

rotate + extend head

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348
Q

intermediate muscles of the deep back muscles

A

erector spinae muscles

longissimus
iliocostalis
spinalis

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349
Q

function of erector spinae muscles

A

unilateral contraction = lateral flex
bilateral contraction = extension

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350
Q

innervation of erector spinae muscles

A

posterior rami of the spinal nerves

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351
Q

deep muscles of the deep back

A

transversospinales muscle group

semispinalis - extends head
multifidius
rotatores

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352
Q

conus medullaris

A

tapering of spinal cord @ L1/L2

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353
Q

spinal cord enlarges where

A

cervical and lumbosacral regions

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354
Q

2 depressions of spinal cord

A

anterior median fissure
posterior median sulcus

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355
Q

filum terminales

A

meninges ending at bottom of spinal cord

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356
Q

epineurium

A

dura mater surrounding the peripheral nerves when they leave spinal cord

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357
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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358
Q

artery of Adamkiewicz

A

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

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359
Q

venous drainage of spinal cord

A

3x anterior spinal veins
3x posterior spinal veins

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360
Q

where does subscapularis attach on scapula

A

subscapular fossa on costal surface of scapula

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361
Q

where do supraspinatus and infraspinatus originate

A

posterior side of scapula

supraspinatus fossa
infraspinatus fossa

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362
Q

where does long head of biceps brachii attach

A

supraglenoid tubercle

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363
Q

where does long head of triceps brachii attach

A

infraglenoid tubercle

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364
Q

most common part of clavicel that is fractured

A

middle

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365
Q

muscles inserting onto greater tuberosity of humerus

A

supraspinatus
infraspinatus
teres minor

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366
Q

muscles inserting onto lesser tuberosity of humerus

A

subscapularis

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367
Q

muscles attaching onto intertubercular sulcus of humerus

A

lats
pec major
teres major

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368
Q

what tendon runs along intertubercular sulcus

A

long head of biceps brachii

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369
Q

what neurovascular vessels are related to surgical neck of humerus

A

axillary nerve
circumflex humeral vessels

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370
Q

axillary nerve injury paralyses which muscle

A

deltoid
teres minor

ABDCUTORS

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371
Q

what muscles attach onto humeral shaft

A

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

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372
Q

mid shaft humeral fracture affects which nerves

A

radial nerve - wrist drop

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373
Q

lateral epicondyle is associated with which attachment site of humerus

A

trochlea

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374
Q

medial epicondyle is associated with which attachment site of humerus

A

capitulum

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375
Q

what makes up trochlear notch of ulnar

A

olecranon + coronoid fossa

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376
Q

which artery is at risk in supracondylar humeral fractures

A

brachial artery

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377
Q

volkmann’s contracture

A

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

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378
Q

how do you test function of anterior interosseoss nerve

A

OK sign

assessing flexor pollicis longus

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379
Q

ulnar shaft shape

A

triangular shape

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380
Q

monteggia fracture

A

proximal ulnar fracture with radial head dislocation at elbow

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381
Q

galeazzi fracture

A

distal radial fracture with distal RUJ dislocation

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382
Q

what muscle inserts on to radial tuberosity

A

biceps brachii

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383
Q

proximal carpal bones (lateral to medial)

A

scaphoid,lunate, triquetrum, pisiform

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384
Q

distal carpal bones (lateral to medial)

A

trapezium, trapezioid, capitate, hamate

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385
Q

bennetts fracture

A

base of 1st metacarpal fracture

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386
Q

tx of fibroadenoma

A

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

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387
Q

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

A

chemotherapy - 5FU + oxaliplatin combination

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388
Q

rectal cancer: anterior resection or APER?

A

APER is sphincters involved or lower tumours (anal verge)

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389
Q

difference between tx of rectal cancers and colon cancers

A

rectum is retroperitoneal therefore neoadjuvant radiotherapy can be used

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390
Q

which colon cancers need chemotherapy

A

high risk recurrence
lymph node involvement

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391
Q

transverse colon cancer tx

A

extended RHC + ileocolic anastomosis

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392
Q

left colon cancer tx

A

LHC + colon-colon anastomosis

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393
Q

sigmoid cancer tx

A

high anterior resection with colo-rectal anastomosis

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394
Q

upper rectum tx

A

anterior resection (TME) with colo-rectal anastomosis

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395
Q

low rectum tx

A

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

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396
Q

why do rectal cancers usually need defunctioning stoma

A

to reduce the risk of anastomotic leakage and reoperation rates

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397
Q

most common type of rotator cuff tear

A

supraspinatus

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398
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

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399
Q

investigation for suspected lymphoma presenting with lymphadenopathy

A

excision biopsy

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400
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

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401
Q

how does cholestatic jaundice cause vit k deficiency

A

less bile into circulation

vit K cannot be absorbed as well

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402
Q

what muscle flexes DIP joints

A

flexor digitorum profundus

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403
Q

TPN SEs

A

phlebitic

can cause deranged LFTs long term

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404
Q

testicular cancer tx

A

orchidectomy via inguinal approach

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405
Q

gardners syndrome facts

A

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

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406
Q

cervical ribs usually arise from which vertebra

A

C7

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407
Q

layers of spermatic cord

A

inner - transversalis fascia
outer - external oblique

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408
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

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409
Q

which cancer surgeries need bowel prep

A

left sided colon

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410
Q

in surgeries with radiated tissue - how do you close wounds

A

using flaps

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411
Q

which heparin for bypass

A

unfractioned - shorter HL, more controllable

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412
Q

c fibres trasmit …

A

mechanicothermal stimuli

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413
Q

A beta fibres transmit

A

touch and pressure stimuli

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414
Q

B fibres transmit

A

autonomic stimuli

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415
Q

CSF contains ???

A

no RBC
less glucose than plasma

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416
Q

hyatid cysts associated with which infection

A

echnicoccus infection

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417
Q

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

A

hyatid cysts

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418
Q

how does pagets disease cause high output heart failure

A

angiogenesis

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419
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

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420
Q

trunks of brachial plexus relationship to SCA

A

brachial plexus passes posterior to SCA at 1st rib

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421
Q

3 types of nerve injury

A

neuropraxia
axonotmesis
neurotmesis

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422
Q

neuropraxia features

A

nerve intact
problem with conduction

wallerian degeneration not present

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423
Q

axonotmesis features

A

axon damaged but connective tissue intact

wallerian degeneration occurs

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424
Q

wallerian degeneration

A

distal axonal injury

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425
Q

neurotmesis features

A

degeneration of axon and myeline sheath

wallerian degeneration occurs

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426
Q

ulnar nerve path in forearm

A

medial forearm

passes inferiorly to flexor carpi ulnaris

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427
Q

scrotal cancer drains into which lymph nodes

A

inguinal LNs

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428
Q

access point for right middle lobe

A

6th ICS in mid axillary line

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429
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

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430
Q

quadrangular space contents

A

axillary nerve
posterior circumflex humeral artery

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431
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

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432
Q

triangular space contents

A

circumflex scapular artery

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433
Q

triangular interval borders

A

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

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434
Q

triangular interval contents

A

radial nerve
profunda brachii artery

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435
Q

axilla borders

A

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

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436
Q

what affects axilla size

A

arm abduction - decreases it

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437
Q

apex of the axilla

A

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

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438
Q

contents of axilla

A

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

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439
Q

cubital fossa borders

A

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

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440
Q

cubital fossa contents (5)

A

radial nerve
median nerve
brachial artery
biceps tendon
median cubital vein

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441
Q

carpal tunnel contents

A

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

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442
Q

median nerve branches

A

splits in carpal tunnel

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

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443
Q

anatomical snuffbox contents (3)

A

radial artery
superficial branch of radial nerve
cephalic vein

444
Q

anatomical snuffbox borders

A

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

445
Q

extensor compartment 1 of wrist contents

A

Extensor pollicis breivs
abductor pollicis longus

446
Q

extensor compartment 2 of wrist contents

A

extensor carpi radialis longus
extensor carpi radialis brevis

447
Q

extensor compartment 3 of wrist contents

A

extensor policis longus

448
Q

what seperates extensory compartment 2 and 3 of the wrist

A

Lister’s tubercle of radius

449
Q

ulnar’s canal contents

A

ulnar nerve
ulnar artery
venae comitantes of ulnar artery
lymphatic vessels

450
Q

dysphagia lusoria is dysphagia caused by what

A

oesophageal compression from vascular abnormality

451
Q

dysphagia lusoria dx ix

A

CT angio

452
Q

sural nerve supplies sensation to which area

A

lateral aspect of foot

453
Q

dorsum of foot sensation nerve

A

superficial peroneal nerve

454
Q

1st web space of foot sensation nerve

A

deep peroneal nerve

455
Q

cell saver devices
what is it
contraindications

A

collect patient blood during surgery and reinfuse

CI: malignancy and infection

456
Q

Lynch disease cancer associations

A

colorectal
endometrial

457
Q

Lynch disease gene

A

mismatch repair gene mutation

458
Q

ESWL contraindications

A

pregnancy
patients with severe calcification of vessels

459
Q

uteroscopy method

A

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

460
Q

RENAL stone tx

A

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

461
Q

URETERIC stone tx

A

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

462
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

463
Q

ivor lewis incisions

A

laparotomy + RHS thoractomy

(Mckeowan = + neck incision)

464
Q

how can delayed gastric emptying be avoided in oesophagectomies

A

pyloroplasty - widening of canal

465
Q

anal fissures associations

A

STDs
IBD
leukaemia
TB
previous surgery

466
Q

catecholamines derived from ….

A

tyrosine (–> dopamine –> NA –>A)

467
Q

which clotting factors are most sensitive to temperature

A

FACTOR 5 AND 8

this is why FFP needs to be frozen ASAP

468
Q

gluteus maximus innervation

A

inferior gluteal nerve

469
Q

bartons fracture

A

distal radial fracture + radiocarpal dislocation

470
Q

holstein lewis fracture

A

distal 1/3 humerus fracture causing entrapped radial nerve

471
Q

varicose veins tx

A
  1. endothermal ablation
  2. foam sclerotherapy
  3. trendelnberg surgery
472
Q

cowden disease

what is it
mutation ?

A

PTEN mutation

harmatomal growths of colon
also associated with breast cancer

473
Q

boerhaave syndrome ix

A

CT contrast

474
Q

boerhaave syndrome tx

A

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

475
Q

positive iontropes

A

adrenaline/noradrenaline
dopamine
glucagon
dobutamine
theophylline

476
Q

alpha 1 receptors MOA

A

vasoconstriction

477
Q

alpha 2 receptors MOA

A

vasoconstriction

478
Q

beta 1 receptors MOA

A

increase heart rate and contractility

479
Q

beta 2 receptors MOA

A

vasodilation

480
Q

adrenaline MOA

A

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

481
Q

noradrenaline MOA

A

alpha 1 stimulation

482
Q

dobutamine MOA

A

beta 1 stim (increase contractility + heart rate)

483
Q

omphalitis definition, organism + tx

A

infection of umbilicius
staph aureus
topical + systemic abx

484
Q

umbilical granuloma

A

cherry red lesions

485
Q

patent urachus - definition and symptoms

A

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

486
Q

biers block

A

double torniquet applied
prilocaine injected into vein

487
Q

which local anaesthetic is very cardiotoxic

A

bupivicaine

488
Q

why is adrenaline sometimes added to local anaesthetic

A

potentiates duration of action

489
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
490
Q

ulnar nerve and artery association

A

nerve lies on ulnar side of artery

491
Q

2 nerves involved in voice production

A

superior laryngeal nerve
recurrent laryngeal nerve

492
Q

superior laryngeal nerve innervates … ?

A

cricothyroid muscle - tenses vocal cords

493
Q

paralysis of superior laryngeal nerve causes

A

pitch abnormalities

494
Q

specificity =

A

true negative / true negative + false positives

495
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

496
Q

laryngeal muscles supplied by

A

laryngeal arteries

branch of superior/inferior thyroid arteries

branch of ECA

497
Q

cranial nerve for external ear sensation

A

auriculotemporal nerve
branch of mandibular nerve

498
Q

which nerve runs next to middle meningeal artery

A

auriculotemporal nerve

499
Q

allograft

A

same species

500
Q

pec majo function

A

adduct and medially rotate upper arm

501
Q

pec major innervation

A

medial and lateral pectoral nerves

502
Q

what is the added function of clavicular head of pec major

A

flex upper limb

503
Q

pec major insertions

A

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

both attach on intertubercular sulcus of the humerus

504
Q

pec minor function

A

stabilise scapula

505
Q

pec minor innervation

A

medial pectoral nerve

506
Q

pec minor insertions

A

ribs 3-5 onto coracoid process of scapula

507
Q

serratus anterior function

A

rotates scapula allowing for shoulder flexing >90 degrees

508
Q

serratus anterior insertions

A

lateral aspect of ribs 1-8 and insert onto scapula

509
Q

subclavius

action
innervation

A

depress clavicle

nerve to subclavius

510
Q

biceps brachii origin and insertion

A

long head - supraglenoid tubercle
short head - coracoid process

insert onto radial tuberosity

511
Q

what artery supplies anterior compartment of upper arm

A

brachial artery

512
Q

coracobrachialis insertions

A

coracoid process to medial shaft humerus

513
Q

coracobrachialis function

A

shoulder flexion

514
Q

brachialis insertions

A

humeral shaft to unlar tuberosity

515
Q

triceps supplied by which blood vessel

A

profunda brachii

516
Q

where do triceps insert onto

A

olecranon

517
Q

deltoid insertions

A

lateral 1/3 clavicle onto deltoid tuberosity

518
Q

front delt function

A

flexion and internal rotation

519
Q

rear delt fx

A

extension and external rotation

520
Q

teres major function

A

adduct and axternally rotate shoulder

521
Q

teres major innervation

A

lower subscapular nerve

522
Q

supraspinatus fx

A

0-15degrees abduction

523
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

524
Q

nerve supply to rotator cuffs

A

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

525
Q

subscapularis fx

A

internal rotation

526
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

527
Q

superficial muscles of the anterior forearm all originate from

A

medial epicondyle

528
Q

flexor carpi ulnaris

A
529
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

530
Q

FCU:

fx
insertion

A

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

531
Q

palmaris longus:

fx
insertion

A

flex wrist
inserts onto flexor retinaculum

532
Q

flexor carpi radialis:

fx
insertion

A

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

533
Q

pronator teres:

originS
insertion
fx

A

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

fx - pronation

534
Q

FDS

what lies between 2 heads?

A

ulnar artery and median nerve

535
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

536
Q

FDP action

A

flex Distal IPJ and MCPJ and wrist

537
Q

FPL fx

A

flex all joints of thumb

538
Q

FPL insertions

A

attach onto base of distal phalanx of thumb

539
Q

pronator quadratus insertions

A

anterior ulnar to anterior radius

540
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

541
Q

superficial muscles of posterior forearm

A

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

542
Q

deep muscles of posterior forearm

A

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

543
Q

muscles in posterior forearm innervated by?

A

radial nerve

544
Q

what is special about brachoradialis

A

paradoxical muscle

origin and innervation suggest extensor, but is a flexor

545
Q

brachoradialis

origin, insertion, fx

A

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

546
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

547
Q

extensor carpi radialis fx

A

extend and abduct wrist

548
Q

extensor digitorum communis

fx
insertions

A

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

549
Q

extensor digiti minimi

insertions and fx

A

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

550
Q

extensor carpi ulnaris

fx and insertions

A

extend and adduct wrist
lateral epicondyle to MC V

551
Q

aconeus fx

A

extend and stablise elbow

552
Q

supinator makes up what part of cubital fossa

A

floor

553
Q

deep muscles of the posterior forearm are innervated by?

A

posterior interosseous branch of radial nerve

554
Q

difference in fx between EPL and EPB

A

longus extends all thumb joints INCLUDING IPJ

brevis only extends MCPJ and CMCJ

555
Q

thenar muscles are innervated by

A

recurrent branch of median nerve

556
Q

opponens policis insertions and fx

A

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

557
Q

abductor policis brevis insertions

A

tubercle of scaphoid and trapezium onto lateral side of proximal phalanx

558
Q

opponens digit minimi origin

A

hook of hamate

559
Q

abductor digiti minimi origin

A

pisiform

560
Q

flexor digiti minimi brevis origin

A

hook of hamate

561
Q

lumbricals fx

A

flex and MCPJ and extend at IPJ

562
Q

palmaris brevis fx and innervation

A

wrinkles skin in hypothenar region and ulnar n

563
Q

adductor policis innervation

A

ulnar n

564
Q

cranial nerves carrying parasympathetic fibres

A

3, 7, 9, 10

565
Q

fasciola hepatica definition

A

common liver fluke from parasitic infection by trematode

566
Q

fasciola hepatica symptoms

A

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

567
Q

dx of fasciola hepatica

A

stool sample +/- serology

568
Q

tx of fasciola hepatica

A

triclabendazole +/- ERCP

569
Q

inflammatory breast carcinomas risk factors

A

pregnancy
lactation

570
Q

branchial cyst excision - nerves at risk of injury

A

mandibular nerve
greater auricular nerve
accessory nerve

571
Q

cryptochidism causes

A

idiopathic
patent processus vaginalis
cerebral palsy
wilms tumour
developmental delay

572
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

573
Q

reasons to correct cryptochidism

A

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

574
Q

cryptochidism tx

A

orchidopexy at 6m-18m

if identified later - orchidectomy (sertoli cells already degraded)

575
Q

episiotomy usually requires which nerve block

A

pudendal nerve

576
Q

pudendal nerve innervates

A

anal sphincters and external urethral sphincters

577
Q

acute inflammation general phases

A
  1. vascular phase
  2. cellular phase
578
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
579
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
580
Q

neutrophil role in acute inflammation

A
  1. margination
  2. rolling
  3. adhesion
  4. emigration - into blood vessel wall
581
Q

sign of chronic infection

A

granuloma formation

582
Q

AA vs AL amyloidosis

A

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

583
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

584
Q

vascular cx of renal transplant

A

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

585
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

586
Q

brachial plexus definition

A

anterior rami of c5-t1

587
Q

brachial plexus 5 parts

A

roots
trunks
division
cords
branches

588
Q

brachial plexus roots relationship to scalene muscles

A

pass between anterior and medial scalene muscles

589
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
590
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)

591
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

592
Q

which nerves are posterior to axillary artery

A

axillary nerve
radial nerve

593
Q

ulnar nerve in relation to axillary artery

A

medial to axillary artery

594
Q

musculocutaneous nerve in relation to axillary artery

A

lateral to axillary artery

595
Q

axillary nerve sensory branch

A

superior lateral cutaneous nerve

596
Q

median nerve roots

A

c6-t1 (c5 in some individuals)

597
Q

radial nerve roots

A

c5-t1

598
Q

axillary nerve roots

A

c5,c6

599
Q

ulnar nerve roots

A

c8-t1

600
Q

musculocutaneous nerve roots

A

c5-c7

601
Q

sensory branches of median nerve

A

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

602
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

603
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)

604
Q

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

A

brachial artery

605
Q

how does radial nerve enter forearm

A

anteriorly to lateral epicondyle

606
Q

radial nerve branches in ACF:

A
  1. deep - motor of posterior forearm
  2. superficial - sensory
607
Q

axillary nerve passes ____ to surgical neck of humerus

A

medial

608
Q

3 branches of axillary nerve

A

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

609
Q

median nerve descends down humerus, ____ to brachial artery

A

laterally then crosses medially halfway down humerus

610
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

611
Q

why is there preserved lateral palm sensation in carpal tunnel syndrome

A

palmar cutaneous nerve does not pass through carpal tunnel

612
Q

supracondylar fractures damage which nerve

A

initially - anterior interosseous nerve (median) most common

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

613
Q

hand branches of ulnar nerve

A

deep branch - supplies hypothenar
superficial branch - medial 1.5 fingers

614
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

615
Q

ulnar nerve entering forearm

A

passes posterior to medial epicondyle

616
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

617
Q

froment’s sign tests which muscle

A

adductor policis

618
Q

hypochonium of nail

A

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

619
Q

eponychium

A

stratum corneum layer at base of nail

620
Q

germinal matrix of nail

A

cells that become keratinized to become nail plate

621
Q

3 possible outcomes of peripancreatic fluid collection post-pancreatitis

A
  1. resolution
  2. pseudocyst
  3. abscess
622
Q

psuedocyst of pancreas features

A

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

623
Q

tx of pseudocyst

A

endoscopic or surgical cystogastrostomy or aspiration

624
Q

father can consent if….

A
  1. married to biological mother OR
  2. on birth certificate
625
Q

renal cell carcinoma tx

A

t1 = partial nephrectomy
t2 = radical nephrectomy

no need for neoadjuvant chemo if resection is complete

626
Q

nerve repair growth rate

A

1mm/day

627
Q

lobular carcinoma in situ - distinct features

A

low malignancy risk
can observe
need MRI

628
Q

risk factor for lobular carcinoma in situ

A

previous contralateral breast cancer

629
Q

risks of aortic aneurysm over 5 years

A

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

630
Q

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

A

5 cm

631
Q

CEA also high in

A

colitis (IBD)
cirrhosis

632
Q

osteomyelitis of spine predilects to which part of spine

A

cervical

633
Q

TB of spine predilects to which part of spine

A

thoracic

634
Q

carcinoid ix

A

24hr urine collection of 5-hydroxindoleacetic acid
CT

635
Q

carcinoid tx

A

if <1.2cm and limited to appendix - DISCHARGE

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

octreotide often given

636
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

637
Q

what nervous system predominates post-op

A

sympathetic

638
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
639
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

640
Q

groshong vs hickmanns

A

groshong has 3 way valve

641
Q

omphacele vs gastroschisis

A

omphacele - abdominal contents covered in peritoneum

gastroschisis - abdominal contents not covered by peritoneum

642
Q

ligament anterior to spleen

A

gastrosplenic ligament (part of greater ommentum)

643
Q

ligament posterior to spleen

A

leinosplenal ligament

644
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

645
Q

ITU patient feeding

A

continuous enteral feeding 16-24 hours

646
Q

enteral feeding options

A

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

647
Q

PEG can be used when after insertion

A

after 4 hours post-insertion

648
Q

best sterilising method for tubercle bacili

A

autoclaving

649
Q

what is autoclaving

A

air removed & high pressure steam used

650
Q

pulmonary artery occlusion pressure is an indirect monitor of

A

left atrial pressure / filling of left side of heart

651
Q

PAOP interpretation

A

normal = 8-12

low <5 = hypovolaemia

low w/ pulmonary oedema <5 = ARDS

high >18 overload

652
Q

what can be damaged in anterior resection

A

left ureter
(near upper rectum/sigmoid)

653
Q

dorsalis pedis is a branch of

A

anterior tibial artery

654
Q

what structures can be damaged in caecum operations

A

right ureter + gonadal arteries

655
Q

which adenoma in colon has highest malignancy risk

A

villous adenoma

656
Q

colorectal cancer follow up after resection

A

colonoscopy 1year post op

657
Q

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

A

3 year colonoscopy

658
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

659
Q

diagnosis of transitional cell carcinoma

A

CT IVU

660
Q

most renal tumours are what colour?

A

yellow or brown

661
Q

pathology - colour of TCC

A

pink fleshy

662
Q

nephroblastoma tx

A

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

663
Q

neuroblastoma definition

A

nerve cell cancer

664
Q

neuroblastoma tx

A

surgical resection, radiotherapy and chemotherapy

665
Q

most common extracranial tumour of childhood

A

neuroblastoma

666
Q

angiomyolipoma associated neurological condition

A

tuberous sclerosis

667
Q

radial head fracture

A

proximal forearm tenderness
pain on pronation and supination

668
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.

669
Q

non surgical treatment of keloid scars

A

triamcinolone

670
Q

giant cell tumour of the bone (osteoclastoma) xray appearance

A

soap bubble appearance
- multiple lytic and lucent appearances

671
Q

bones usually affected by osteoid osteoma

A

femur and tibia

672
Q

commonest benign tumour of the bone

A

osteoid osteoma

673
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

674
Q

Boerhaaves syndrome
definition

A

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

675
Q

where is the rupture typically located in boerhaave’s syndrome

A

left sided and distal

676
Q

why do you ventilate head injured patients

A

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

677
Q

tranexemic acid MOA

A

prevents plasminogen to plasmin

prevents clot from being broken down

678
Q

pseudomyxoma peritonei:

definition
where do they arise

A

rare mucinous tumour

most commonly arising from appendix but also bladder and ovaries

679
Q
A
680
Q

risk factors for pseudogout

A

hyperPTH
hypothyroidism
haemochromatosis

681
Q

why is haemochromatosis a RF for pseudogout

A

iron causes overstimulation of osteoclasts

682
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

683
Q

lymphatic drainage from inferior to dentate line

A

inguinal nodes

684
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

685
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
686
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

687
Q

common organisms causing maxillary sinusitis

A

haemophilus influenzae
strep pneumoniae

688
Q

malignancies of the nose and paranasal sinuses

A

adenoid cystic carcinoma
squamous cell carcinoma
adenocarcinoma

689
Q

adenocarcinoma of the paranasal sinus and nasopharynx linked to what exposure

A

hard wood dust

690
Q

ameloblastomas definition

A

rare tumours of odontogenic epithelium

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

691
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%

692
Q

what stimulates prolactin release

A

TRH (dopamine inhibits)

693
Q

superficial partial thickness burns characteristics:

A
  • form vesicles and bullae
  • preservation of hair follicles
  • healing by re-epithelialisation
694
Q

plasma typically accounts for what percentage of body weight

A

4-6%

695
Q

what % of body water is intracellular

A

65%

696
Q

what % of body weight is intracellular

A

40%

697
Q

which dermatome requires blockade in local anaethetic open inguinal hernia repair

A

T12

698
Q

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

A

lingual nerve

699
Q

flail chest with sats<90% mx

A

intubation and ventilation

700
Q

full spine immobilisation if:

A

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

701
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

702
Q

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

A

facial nerve - impaired innervation to stapedius

trigeminal nerve - increased tensor tympani innervation

703
Q

porta hepatis transmits what structures

A

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

704
Q

papillary thyroid spread

A

lymphatic

705
Q

follicular thyroid cancer spread

A

haematogenous

706
Q

berrys sign

A

absence of carotid pulse due to malignant thyromegaly

707
Q

friebergs disease

A

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

708
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

709
Q

fissure in ano tx

A

stool softerners + topical diltiazem or GTN

if topical fail -> botulinum toxin injection

if botulinum toxin fails –> sphincterotomy

710
Q
A
711
Q

osteopetrosis definition

A

osteoclast function problem

bones become overly dense –> brittle –> fracture

712
Q

rectal cancer staging

A

MRI rectum + CT CAP

713
Q

colon cancer staging

A

CT CAP

714
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

715
Q

urethral injury triad of sx

A

urinary retention
perineal haematoma
blood at the meatus

716
Q

dieulafoy lesion

A

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

717
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

718
Q

septic shock precise meaning

A

refers to refractory systemic arterial hypotension in spite of fluid resuscitation

719
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

720
Q

phrenic nerve - which triangle of the neck

A

posterior

721
Q

Rectal cancers with threatened resection margins management

A

radiotherapy and chemotherapy

722
Q

frank haematuria + high RBC?

A

renal cell carcinoma (not bladder)
because RCC cause polycythaemia

723
Q

angiotensinogen to angiotensin 1. which enzyme

A

renin

724
Q

cerebral perfusion pressure =

A

mean arterial pressure - ICP

725
Q

mean arterial pressure =

A

diastolic +0.33(SBP - DBP)

726
Q

phases of wound healing

A
  1. haemostasis
  2. inflammation - neutrophils, fibroblasts and macrophages
  3. regeneration - fibroblasts, endothelial cells and macrophages
  4. myofibroblasts
727
Q

tracheomalacia

A

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

can occur after removal of very large thyroids/goitre

728
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

729
Q

what muscles do femoral nerve innervate

A

pectineus
sartorius
quadriceps muscles

730
Q

branches of the femoral nerve

A

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

731
Q

which gut hormone is dependent of vagal stimuli

A

gastrin

732
Q

what autosomal dominant neurological condition causes discrepancies in limb length

A

neurofibromatosis type 1

733
Q

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

A

superficial inguinal nodes

734
Q

superior aspect of the vagina lymph node drainage

A

internal and external iliac nodes

735
Q

which muscles attach onto greater trochanter

A

piriformis
obturator internus
gemelli
obturator externus

736
Q

anal cancer tx

A

chemoradiotherapy
(different from rectal cancer)

737
Q

medications causing pseudohaematuria

A

rifampicin
phenytoin
levodopa
methyldopa
quinine

738
Q

DIC dx

A

fibrin degredation products are raised

739
Q

DIC definition

A

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

740
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)

741
Q

stable bleeding peptic ulcer tx

A

adrenaline injection + endoscopic clipping/heat therapy

742
Q

cushings triad

A

HYPERTENSION
bradycardia
respiratory depression

743
Q

pancreatic cancer with mets tx

A

ERCP and stent and palliation

744
Q

head of pancreas cancer tx

A

Whipple’s + adjuvent chemo

newer techqiues include pylorus preservation and SMA/SMV resection

745
Q

carcinoma of pancreas body and tail

A

distal pancreatectomy + adjuvant chemo

746
Q

vertebral level of left main bronchus

A

T6

747
Q

inferior border of both lungs

A

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

748
Q

popliteal fossa contents (medial to lateral)

A

popilteal artery
popliteal vein
tibial nerve
common peroneal nerve

749
Q

thoracic aorta rupture CXR

A

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

750
Q

DALM lesions tx

A

seen in longstanding ulcerative colitis

panproctocolectomy

751
Q

homonymous hemianopia with macula sparing lesion location

A

occipital cortex

752
Q

which finger has no attachment of the palmar interosseous

A

middle finger

753
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

754
Q

adrenaline receptor preference

A

alpha agonist at lower doses

beta agonist at higher doses

755
Q

tranexamic acid MOA

A

competitively inhibits conversion of plasminogen to plasmin

756
Q

unilateral isolated cleft lip cause

A

incomplete fusion of the nasolabial muscle rings

757
Q

Contents of carotid sheath:

A

Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve

758
Q

post-transplant viral complications

A

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

759
Q

most gastric malignancies are….

A

adenocarcinoma

760
Q

the tunica vaginalis is derived from —–

A

peritoneum

761
Q

vein mapping investigation

A

venous duplex > venous doppler

762
Q

coarctation of aorta tx

A

angioplasty

763
Q

tumours of the posterior tongue metastasize to

A

bilateral deep cervical nodes

764
Q

lymphatic drainage from the tip of the tongue

A

submental nodes

765
Q

lymphatics from the medial mid portion of the tongue drain into

A

submandibular nodes?
bilateral deep cervical nodes

766
Q

lymphatics from the lateral mid portion of the tongue drain into

A

ipsilateral deep cervical nodes

767
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
768
Q

which thyroid cancer linked to non-therapeutic irradiation

A

papillary thyroid

769
Q

main pancreatic duct embryological origin

A

ventral outgrowth of the duodenum

770
Q

which bacteria implicated in cholangitis infections

A

e.coli

771
Q

Paneth cells - what are they and where are they located

A

Secretory cells that contribute to the gut micobiome

Crypt of lieberkuhn

772
Q

where do the 3 adrenal arteries arise from

A

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

773
Q

femoral canal borders

A

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

774
Q

how is tamoxifen a RF for endometrial cancer

A

is an ER antagonist in breast BUT agonist in endometrial tissue

775
Q

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

A

Liver MRI

776
Q

saphena varix O/E

A

blue discolaration
enlarge during coughing
disappear on lying down

777
Q

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

A

recurrent laryngeal nerve

778
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

779
Q

vagus nerve leaves cranium via

A

jugular foraemne

780
Q

right vagus nerve anatomical course in the neck

A

passes anterior to the subclavian artery

781
Q

left vagus nerve anatomical course in the neck

A

passes between the left common carotid and left subclavian artery

782
Q

hyperplasia vs hypertrophy

A

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

783
Q

what happens when catheter enters prostatic urethra

A

resistance decreases (as it is much wider)

784
Q

arterial supply of prostate

A

inferior vesical artery (branch of internal iliac)

785
Q

prostate lymph drainage

A

internal iliac

786
Q

prostate innervation

A

inferior hypogastric plexus

787
Q

where do most prostate cancers occur in prostate

A

peripheral zones

788
Q

what causes high amylase

A

acute pancreatitis
acute cholecystitis
DKA
mesenteric infarct

789
Q

what hormones are decreased in stress response

A

insulin
testosterone
oestrogen
thyroxine

790
Q

hormonal affects on pancreatic secretions

A

SECRETIN - causes secretion of water and electrolytes

CCK - causes enzyme secretion

Somatostatin - decreases volume of secretion

791
Q

loop diuretic MOA

A

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

reduces absorption of NaCl

792
Q

Thiazide site of action

A

distal tubule

793
Q

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

A

CT colonography

794
Q

stridor after thyroid surgery management

A

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

795
Q

drugs that can cause parotid enlargement

A

high oestrogen dose contraceptives
thiouracil
isoprenaline

796
Q

permanent sutures

A

polypropylene
polyester

797
Q

when should clopidegrel be stopped before surgery

A

5-7d before

reduces ADP induced platelet aggregation for 120hours after final dose

798
Q

heterotropia

A

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

799
Q

most common extra-colonic lesion in FAP?

A

duodenal polyps

800
Q

external jugular vein relation to sternocleidomastoid

A

lateral / superficial

801
Q

right recurrent laryngeal nerve anatomical course

A

branches off right vagus nerve more proximal than T4

it arches posteriorly around the subclavian artery

802
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

803
Q

differences in procedure of splenectomy in emergency vs elective

A

most elective are laparoscopic

804
Q

cx of splenectomy

A

haemorrhage
pancreatic fistula
thrombocytosis
encapsulated bacteria infection

805
Q

CKK effects on rate of gastric emptying

A

reduce rate

806
Q

factors increasing gastric acid production

A

vagal nerve stimulation
gastrin release
histamine release

807
Q

factors decreasing gastric acid production

A

somatostatin
CKK
secretin

808
Q

dercums disease

A

multiple lipomas + generalized obesity

809
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)

810
Q

normal statistical power desired

A

0.8

811
Q

type 1 error

A

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

it equates to the significance of a test

812
Q

type 2 error

A

a test fails to reject a false null hypothesis

related to statistical power

813
Q

components needed for power calculations

A

size of effect
significance level
sample size
desired power

814
Q

where do vertebral arteries unite to form basilar artery

A

base of the pons

815
Q

branches of the vertebral arteries

A

PICA
anterior spinal artery
posterior spinal artery

816
Q

basilar artery branches

A

pontine arterie
AICA
superior cerebellar artery
posterior cerebral artery

817
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

818
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

819
Q

adrenal masses of what size need to be removed

A

> 4cm

820
Q

most significant event to contribute to wound healing immediately following injury

A

platelet degranulation

821
Q

fistula in ano cell type

A

squamous

822
Q

respiratory centres

A
  1. medulla respiratory centre
  2. apneustic centre
  3. pneumotaxic centre
823
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

824
Q

where are respiratory chemoreceptors

A

central - medulla
peripheral - carotid and arch of aorta

825
Q

central chemoreceptors in medulla respond to

A

H+ in brain interstital fluid

826
Q

obstructing renal cancer stoma

A

loop colostomy - to defuntion distal segment of colon

827
Q

loop ileostomy indications

A

defunction distal bowel in low anterior resection

828
Q

spongy urethra and glans penis lymphatic drainage

A

deep inguinal nodes

829
Q

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

A

rifampicin
macrolides
tetracyclines

830
Q

bone mets that are hypervascular primary source?

A

renal cancer

831
Q

prilocaine antidote

A

methylene blue

reverts ferric type to ferrous type Hb

832
Q

scrotal sensation

A

ilioinguinal nerve - anterior
pudendal - posterior skin

833
Q

SOMATOSTATIN FUNCTIONS

A
  1. inhibit GH
  2. delays gastric emptying
  3. reduces gastric acid production
  4. reduces pancreatic exocrine secretions
834
Q

suspicious melanoma lesions should undergo which ix

A

excision biopsy

835
Q

long head of biceps femoris innervation

A

tibial division of sciatic nerve

836
Q

short head of biceps femoris innervation

A

common peroneal nerve

837
Q

hydrocele tx

A

children - transinguinal ligation of the patent processus vaginalis

adults - Lords of Jabouley procedure

838
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

839
Q

comedo vs cribiform DCIS

A

comedo - microcalficications
cribiform - multifocal

840
Q

hyoid vertebral level

A

C3

841
Q

notch of the thyroid cartilage vertebral level

A

c4

842
Q

cricoid cartilage vertebral level

A

c6

843
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

844
Q

open fractures >6 hours ago mx

A

amputation

845
Q

hartmans procedure risk of wound infection

A

35%

846
Q

preparation for endoscopy

A

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

847
Q

where does apneuorsis end

A

below arcuate line

848
Q

high output fistula management

A

octreotide - limit pancreatic secretions
nutritional complications

nutritional support is common - TPN

849
Q

perianal fistulae secondary to Chrons mx

A

seton

850
Q

nephroblastoma vs neuroblastoma

A

nephroblastoma are non-calcified
neuroblastoma are usually calcified

851
Q

drug causing goitre

A

lithium

852
Q

when do callus become visible on radiographs after fracture

A

3 weeks

853
Q

which cell type relies on Cori cycle alone for energy needs

A

erythrocytes - lack mitochondria

854
Q

parenteral nutrition - what needs to be monitored

A

zinc
folate
b12
copper
iron
ferritin
magnesium
vitamin d
bone density

855
Q

intra-op arterial bleeding mx

A

ligation

856
Q

proximal humerus fractures mx

A

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

857
Q

drugs reducing renin secretion

A

beta blockers
NSAIDs

858
Q

which scaphoid fractures need surgery

A
  1. displaced
  2. all proximal pole fractures
859
Q

splenic vein thrombosis:
dx
cx
tx

A

dx - CT angio
cx - varices
tx - splenectomy

860
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

861
Q

gritti stokes amputation

A

remove part of femur. connect remaining femur to patella

862
Q

skew flaps benefits

A

less bulky
easier to attach prosthesis to

863
Q

late sign of compartment

A

lossof pulses

864
Q

pelvic fracture and lwoer abdominal peritonism ….?

A

bladder rupture

865
Q

large bowel obstruction with visible fluid level cause

A

sigmoid volvulus

866
Q

what aspect of RAAS causes vasoconstriction

A

angiotensin II

867
Q

burns + bad ventilation in patient who already intubated

A

escharotomy

868
Q

colonic pseudoobstruction mx

A

supportive - electrolyte replacement

sometimes neostigmine required to stimulate peristalsis

869
Q

suture for securing drains

A

2/0 silk

870
Q

what type of smooth muscle propels food through the oesophagus

A

longitudinal smooth muscle

871
Q

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

A

9 seconds (primary peristalsis)

872
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
873
Q

discitis organisms in children

A

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

874
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

875
Q

what ligament seperates vertebral column vs spinal cord

A

posterior longitudinal ligament

876
Q

what blood vessel is divided in lateral approach for hip arthroplasty

A

transverse branch of the lateral circumflex artery

877
Q

brisk haematuria in pregnancy

A

placenta PERCRETA - invades mymometrium and can extend into bladder

878
Q

hashimoto’s can lead to which cancer

A

thyroid lymphoma (MALT)

879
Q

most posterior structure at the hilum of the kidney

A

ureter

880
Q

body of uterus drains into which lymph node

A

iliac lymph nodes

881
Q

ovaries drain into which lymph node

A

para-aortic lymph nodes

882
Q

MEN IIB

A

medullary thyroid
phaeochromocytoma
mucosal neruroma
marfanoid features

883
Q

MEN I

A

pancreatic/ZES
parathyroid
pituitary

884
Q

MEN IIA

A

Phaeochromocytoma
Medullary thyroid
HyperPTH

885
Q

difficult viewing during cholecystectomy - how to manage

A

cholecystostomy - drainage of gall bladder

886
Q

sarcomas spread how? and where commonly

A

haematogenous
lung common site

887
Q

parotid gland secretions account for what percentage of secretions to saliva

A

25%

888
Q

PTH half life

A

10 mins

889
Q

which parasitic infection affects gut and lungs

A

ascariasis

890
Q

duct ectasia tx

A

multiple ducts = hadfields procedure
single duct = microdochectomy

891
Q

stroke volume range

A

55-100ml

892
Q

coronary arteries have which adrenergic receptors

A

Beta2

893
Q

most common cause of bacterial infective diarrhoea

A

campylobacter jej

894
Q

causes of hyperuricaemia

A

severe psoriasis
lesch-nyhan syndrome
DKA
alcohol

895
Q

which 2 arteries run near SFJ

A

deep external pudendal artery
superficial external pudendal artery

896
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

897
Q

hypokalaemia is associated to which pH imbalance

A

alkalosis

898
Q

posterior urethral valve tx

A

endoscopic valvotomy

899
Q

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

A

acetyl choline

900
Q

worm infection of anus most common

A

enterobius vermicularis

901
Q

5 FU MOA

A

antimetabolite

902
Q

doxorubicin MOA

A

Anthracycline - inhibit DNA and RNA synthesis by intercalating base pairs

903
Q

cisplatin MOA

A

crosslinks DNA to induce apoptosis

904
Q

cyclophosphomide MOA

A

alkylating agent

905
Q

actinomycosis

A

chornic progressive granulomatosis disease caused by filamentous gram positive anaerobic bacteria

906
Q

proximal SCC oesophageal cancer tx

A

chemoradiotherapy

907
Q

lateral medullary syndrome sx

A

ipsilateral ataxia
ipsilateral nystagmus
ipsilateral facial nerve
dysphagia
contralateral hemisensory loss

908
Q

saphenous nerve is related to which vein

A

long saphenous vein below the knee

909
Q

long saphenous vein course

A

travels anterior to medial malleolus
at the knee runs over the posterior border of the medial epicondyle of the femur bone

910
Q

short saphenous vein course

A

posterior to the lateral malleolus
passes between the heads of the gastrocnemius muscle

911
Q

CNS tumour with sigificant necrosis

A

glioblastomas

912
Q

most common paediatric CNS tumours

A

astrocytomas

913
Q

cranial venous sinuses eventually drain into…

A

internal jugular vein

914
Q

what is the single most important prognostic factor in breast cancer

A

nodal disease

915
Q

Kocher criteria

A

WIFE

WCC >12
Inability to weight bear
Fever
ESR . 40

916
Q

lacunar infarct presentation

A

isolated hemiparesis
isolated hemisensory
or hemiparesis with limb ataxia

917
Q

lesion affecting lobule in ear - drain into…

A

superficial cervical LNs

918
Q

sartorius nerve supply

A

femoral nerve

919
Q

the foramen marking the termination of the adductor canal is located in …?

A

adductor magnus

920
Q

papillary thyroid cancer tx

A

total thyroidectomy and central compartment nodal dissection

921
Q

GIT surgery - what surgeries have lower rates of anastomotic leak

A

small intestine

oesophageal and rectal have highest

922
Q

follicular thyroid cancer tx

A

total thyroidectomy

923
Q

anaplastic thyroid cancer tx

A

palliative radiotherapy

924
Q

medullary thyroid cancer tx

A

total thyroidectomy

925
Q

Which of the following nerves is responsible for the cremasteric reflex?

A

genitofemoral nerve

926
Q

dupuytrens contracture tx

A

fasiectomy

927
Q

what is the pathological size of the caecum

A

9+cm

928
Q

drugs inhibiting secretion of insulin

A

alpha adrenergic drugs
beta blockers
sympathetic nerves

929
Q
A
930
Q

where are oxyphil cells found

A

parathyroid glands and follicular thyroid

931
Q

GIST derived from

A

cells of Cajal

932
Q

what nerve innervates perineum

A

pudendal n

933
Q

CSF: lateral ventricles to 3rd ventricle foramen

A

foramen of Munro

934
Q

CSF: 3rd to 4th ventricle foramen

A

aqueduct of sylvius

935
Q

neurological signs + acute abdo =

A

acute intermittent porphyria or lead posioning

936
Q

the activation of which clotting factor is when both intrinsic and extrinsic factors meet

A

factor 10

937
Q

heparin inhibits which clotting factors

A

2,9,10,11

938
Q

which is the main pathway of coagulation

A

extrinsinc

939
Q

what starts extrinsic pathway

A

tissue factor

940
Q

which structure is at risk of injury following a fracture dislocation of femoral epicondyles

A

popliteal artery

941
Q

symptom difference between maxillary and ethmoidal sinusitis

A

altered sense of smell a feature of maxillary sinusitis

942
Q

what causes a risk in TLCO

A

asthma
haemorrhage
LtoR shunts
polycythaemia

943
Q

parotid gland PSNS fibres originate from

A

Otic ganglion

944
Q

saliva secretion by parotid gland nerve involvement

A

PREGANGLIONIC: tympanic nerve (branch of CN IX) to lessor petrosal nerve to OTIC GANGLION

POSTGANGLIONIC fibres travel as part of auriculotemporal nerve (branch ofV3)

945
Q

The parasympathetic fibres to the lacrimal apparatus transit via which ganglion

A

pterygopalatine

946
Q

which ligament keeps radial head connected to radial notch of ulnar

A

annular ligament

947
Q

Which of the following nerves is most often permanently damaged during a superficial parotidectomy

A

GREATER AURICULAR

948
Q

Which structures pass through both greater and lesser sciatic foramina

A

pudendal nerve
internal pudendal artery
nerve to obturator internus

949
Q

cholangitis tx

A

ERCP and stent

950
Q

where is most iron absorbed?

A

duodenum

951
Q

ileitis common organism

A

yersinia enterocolitica

952
Q

external urethral sphincter nerve roots

A

s2-s4 (pudendal)

953
Q

COCP linked to what liver disease

A

liver cell adenoma

954
Q

which of the following would still be digested normally in a patient with pancreatic insufficiency?

  1. Fat
  2. Protein
  3. Folic Acid
  4. Vitamin B12
A
  1. Folic Acid
  2. Vitamin B12
955
Q

during a splenectomy - what needs to be divided

A

short gastric vessels within the gastrosplenic ligament

956
Q

WARTHIN TUMOUR CHARACTERISTICS

A

male elderly smokers
bilateral in 10%

957
Q

younger patient with PROXIMAL lymphoedema management ?

A
  1. lymphovenous anastomosis
958
Q

clinical differences between FAP and Lynch

A

FAP - usually 100s of polyps
Lynch associated with more RHS cancers

959
Q

axillary artery branches

A

FIRST SEGMENT of the axillary artery:
1. superior thoracic artery

SECOND SEGMENT of the axillary artery:
1. thoracoacromial
2. lateral thoracic artery

THIRD SEGMENT of the axillary artery:
1. subscapular artery
2. anterior circumflex humeral artery
3. posterior circumflex humeral artery

960
Q

Which of the following laboratory tests would most accurately identify whether CSF is present or not?

A

beta-2 transferrin assay

961
Q

Which structures are linked by the ductus arteriosus?

A

PA and (descending) aorta

962
Q

persistent PDA tx

A

NSAIDs

963
Q

ductus venosus connects what 2 structures

A

umbilical vein to IVC
(to bypass the liver)

964
Q

burns affect on potassium levels

A

HYPERKALAEMIA

965
Q

JVP waveform detailing

A

A wave - right atria contracts

X descent - RELAXATION of the right atrium causing drop in pressure

C wave - tricuspid wave closes and right ventricle contract causing bulging of TV which transiently increases pressure in RA therefore JVP

X descent - complete RV contraction allowing atria to expand - pressure drops

V wave - atrial filling with bloods (against a closed tricuspid valve)

Y wave - tricuspid valve opens again (JVP pressure drops)

966
Q

tricuspid regurgitation affevct on JVP

A

large V waves

967
Q

first radiological change in Perthes disease

A

stage II Caterall disease: Sclerosis of femoral head

968
Q

secondary haemorrhage after tonsillectomy usual time frame

A

5-10 days

(anything over 24hours is technically secondary haemorrhage however)

969
Q

autonomic vs voluntary control of bladder function

A

autonomic - hypogastric plexuses

voluntary control of urethral sphincter - pudendal nerve

970
Q

desmoid tumours:

what are they? and where do they tend to arise?

A

fibrous neoplasms

usually arise from musculoaponeurotic structures

971
Q

INDUCTION AGENT (SEDATIVE) BEFORE PARALYTIC AGENTS (RELAXANTS)

A

.

972
Q

GOODSALLS rule

A

anterior fistula - tract straight

posterior fistula - curvature traction

only applies to fistulae within 3cm radius of anus

973
Q

what skin rash is associated to necrolytic migratory erythema

A

glucagonoma

974
Q

What type of epithelium is present on the external aspect of the tympanic membrane?

A

stratified squamous

975
Q

adductor longus innervation

A

anterior division of obturator nerve (L2-L4

976
Q

Which substance is commonly used to sterilize endoscopic and laparoscopic equipment?

A

glutaraldehyde

977
Q

abdo + neurological symptoms niche cosiderations

A

think acute intermittent porphyrias
think lead posioning

978
Q

most radioopaque kidney stone

A

calcium phosphate

979
Q

sensory innervation of axilla

A

intercostobrachial plexus

980
Q

laboratory features of dehydration

A

rising haemotocrit
hypernatraemia
metabolic acidosis
rising lactate
urinary sodium<20

981
Q

posteriorn digastric innervation

A

facial nerve

982
Q

posterior approach hip replacement - which artery is at risk

A

inferior gluteal artery

983
Q

popcorn cells seen in …

A

nodular lymphocyte predominant HL

984
Q

beta-napthalamine is associated with which cancer

A

bladder cancer

985
Q

important structures posterior to right colon

A

gonadal vessels
right ureter

986
Q

distal third clavicle fracture - which artery at risk of injury

A

thoracoacromial artery

987
Q

squamous cell carcinoma of skin excision margins

A

lesions <20mm need 4mm margin excision

lesions >20mm need 6mm margin excisions

988
Q

metastatic bone fractures - which cancers are more likely to have bone mets that fracture

A

breast cancer bone mets are usually lytic (prostate cancers are sclerotic)

989
Q
A
990
Q

which bone mets site is at greatest risk of fracture

A

peritrochanteric fracture

991
Q

typical GFR

A

125ml

992
Q

left sided SVC congenital abnormality - how does blood enter right atrium

A

enlarged coronary sinus

993
Q

somatostatin effects

A

decrease acid and pepsin secretion

decrease gastrin secretion

decreases pancreatic enzyme secretion

decreases insulin and glucagon secretion

994
Q

waldeyer’s fascia

A

posterior ano-rectum

995
Q

sibsons fascia

A

apex of lung

996
Q

bucks fascia

A

base of penis

997
Q

gerotas fascia

A

surrounding kidney

998
Q

denonvilliers fascia

A

between rectum and prostate

999
Q

discitis in children organisms

A

<6m = staph aureus
6m-4y = kigella kingae

1000
Q

which enzyme deficiency causes steatorrhoea

A

lipase

1001
Q

why is tranfusion with platelets most likely to cause gram +ve infection out of all transfusion types

A

platelets stored at room temperature

1002
Q

hypovolaemic shock features

A

decreased CO
decreased BO
increased HR
increased SVR

1003
Q

parathyroid embryological origin

A

superior parathyroids - fourth pharyngeal pouch

inferior parathyroids - inferior pharyngeal pouch

1004
Q

parathyroid relation to thyroid

A

parathyroid is POSTERIOR

1005
Q

epiploic foramen contents

A

portal vein
hepatic artery
common bile duct

1006
Q

how is the pituitary gland attached to the hypothalamus

A

by the infundibulum

1007
Q

what can cause high 5-HIAA

A

drugs: naproxen and MAOi
food: spinach, cheese, wine, caffeine, tomatoes

1008
Q

hassall’s corpuscles found in …

A

medulla of the thyroid

1009
Q

middle ear innervated by ….

A

glossopharyngeal nerve

1010
Q

aptt is a measure of

A

intrinsic pathway

1011
Q

instrinsic patheay of coagulation

A

F12> F11>F9>F10

1012
Q

PT measure of

A

extrinsic pathway (TF+F7)

1013
Q

tip of tongue lymphatic drainage

A

submental nodes (then to deep cervical nodes)

1014
Q

mid portion of tongue lymphatic drainage

A

submandibular drainage

or if lateral then ipsilateral deep cervical nodes

1015
Q

what muscles do ansa cervicalis innervate

A

sternohyoid
sternothyroid
omohyoid

1016
Q

From which embryological structure is the ureter derived?

A

mesonephric duct

1017
Q

metallic heart valve patient needs operation - when to stop heparin

A

6 hours pre-op

1018
Q

mid inguinal point

A

midway between the ASIS and the pubic symphysis

1019
Q

stoma earliest complication vs most common

A

earliest = necrosis
most common = dermatitis

1020
Q

electrical burns fluid resus

A

4ml hartmanns x kg x %TBSA

1021
Q

flame burns fluid resus

A

2ml hartmanns x kg x %TBSA

1022
Q

scrotal layers

A
  1. skin
  2. dartos fascia and muscle
  3. external spermatic fascia
  4. cremasteric muscle and fascia
  5. internal speramtic fasscia
  6. parietal layer of the tunica vaginalis
1023
Q

physiologyical insulin after surgery

A

reduced
(so is testosterone and oestrogen)

1024
Q

nerve most closely related to bladder

A

obturator bladder

1025
Q

hormones increased after surgery

A

GH
cortisol
renin
ACTH
aldosterone
prolactin
ADH
glucagon

1026
Q

where does neonate spinal cord end

A

L3

1027
Q

What increases physiological dead space

A

PE
COPD
hypotension

1028
Q

ileo-ileal intususcception mx

A

rarer subtype

requires laparotomy

1029
Q

DMSA vs MAG 3 uses

A

DMSA best for scarring (not necessary if CT-proven)

MAG-3 best for assessment of renal function in damaged kidneys

1030
Q

renal vein in relation to renal hilum

A

vein is anterior

1031
Q

ureter in relation to renal hilum

A

posterior to hilum

1032
Q

transported kidney anastomised to which blood supply

A

external iliac artery

1033
Q

haemangioma on ultrasound

A

hyperechoic

1034
Q

pancreatic secretions volume a day

A

1L-1.5L

1035
Q

What is the lymphatic drainage of the female urethra?

A

internal iliac nodes

1036
Q

what type of suture is prolene

A

permanent monofilament

1037
Q

vicryl type of suture

A

braided absorbable

1038
Q

what type of suture is polyester

A

braided permanent

1039
Q

PDS type of suture

A

monofilament

1040
Q

high output stoma causes acidosis or alkalosis

A

acidosis

1041
Q

superior adrenal artery is a branch of

A

inferior phrenic artery

1042
Q

suxamethonium can lead to which electrolyte imbalance

A

hyperkalaemia

1043
Q

structures passing through the parotid gland

A

facial nerve and branches
external carotid artery
retromanidbular vein
auriculotemporal nerve

1044
Q

which artery runs under the long saphenous vein

A

deep external pudendal artery

1045
Q

what does inferior mesenteric vein drain into

A

splenic vein

1046
Q

which steroid doesnt affect cortisol levels

A

dexamethasone

1047
Q

incision for malrotation

A

transvere supra umbilical abdominal incision

1048
Q

rectal prolapse surgery types

A

perineal
1. Delormes
2. Altmeirs - more effective but carries higher risk of anastomotic leak

abdominal
1. rectopexy - low recurrrence rates

1049
Q

atracurium produces what on hydrolysis

A

histamine

1050
Q

What is the most important urinary acid base buffer?

A

phosphate

1051
Q

toxic megacolon mx

A

sub total colectomy and end ileostomy

1052
Q

brocas area is supplied. by

A

middle cerebral artery

1053
Q

posterior belly of diagastric muscle supplied by

A

facial nerve

1054
Q

which vessels most likely to bleed in tonsils removal

A

external palatine vein

1055
Q

asteroid bodies found in which condition

A

sarcoidosis

1056
Q

Administration of which of the following may facilitate the identification of parathyroid glands intra operatively?

A

methylene blue

1057
Q
A
1058
Q

median nerve course relative to the brachial artery

A

lateral>anterior>medial

1059
Q

adductor longus innervation

A

obturator nerve

1060
Q
A
1060
Q

which thyroid cancer spreads haematogenously and commonly mets to bones

A

follicular

1061
Q

incision for whipples procedure

A

rooftopv

1062
Q

lateral to medial: foramina of skull

A

spinosum > ovale > rotundum

SOR

1063
Q

hydrocele mx

A

children - ligation of patent processus vaginalis via inguinal approach

adult - jabuloay or lords via scrotal approach

1064
Q

exposure of which fascia exposes the ansa cervicales

A

pretracheal fascia

1065
Q

ansa cervicales lies _____ to carotid sheath

A

anterior

1066
Q

obstructing splenic flexure cancer tx

A

EXTENDED RIGHT HEMICOLECTOMY

IF NOT OBSTRUCTING THEN LEFT HEMICOLECTOMY

1067
Q

MIDDLE MENINGEAL ARTERY IS A BRANCH OF….

A

maxillary artery

1068
Q

What is the most important structure involved in supporting the uterus?

A

central perineal tendon

1069
Q

which coagulation factor likely to be normal in liver failure

A

factor 8

1070
Q

What is the level of the hyoid bone?

A

c3

1071
Q

What is the commonest type of fistula in ano?

A

intersphincteric

1072
Q

parasympathetic nerve supply to bladder does what

A

contraction of detrusor muscles

1073
Q

What is the main component of colloid in the thyroid gland?

A

thyroglobulin

1074
Q

anterior vs posterior duodenal ulcers

A

anterior - more likely to perforate causing peritonitis

posterior - more likely to bleed

1075
Q

Sudden onset of abdominal pain followed by forceful evacuation of bowels - think of…

A

acute mesenteric infarction

1076
Q
A
1077
Q

which breast cancer patients need post-op chemo

A

patients with grade 3 lesions or axillary node disease

1078
Q

tenia coli converge where?

A

base of appendix

1079
Q

diaphragm disease:
1. what is it
2. what causes it

A

rare condition that causes multiple strictures in the small bowel

caused by NSAID overuse

1080
Q

Infection with which of the following micro-organisms may result in a clinical picture resembling achalasia of the oesphagus?

A

TRYPANOSOMA CRUZI (Chagas)

1081
Q

upper pole of kidney corresponds with which rib

A

11th

1082
Q

colonic villous adenomas can cause which electrolyte disturbance

A

hypokalaemia

1083
Q

what blood product most cocmmonly causes urticaria

A

FFP

1084
Q

how can you confirm enterocutaneous fistula as appose to wound infection?

A

methylene blue found in the drain = fistula

1085
Q

DIC consumes which clotting factors first

A

5&8
then platelets

1086
Q

what cell type responsible for contractile nature of scar

A

myofibroblasts

1087
Q

which hormone will secreted in decreased quantities after distal gastrectomy

A

gastrin - released from gastric antrum

1088
Q

structures that pass posterior to lateral malleolus

A

peroneus brevis tendon
peroneus longus tendon
short saphenous vein
sural nerve

1089
Q
A
1089
Q

What is the half life of insulin in the circulation of a normal healthy adult?

A

less than 30 mins

1090
Q

parasympathetic affect on HR

A

tachycardia

atropine (antiPSNS causes brady)

1091
Q

What is the anatomical level of the transpyloric plane?

A

L1

1092
Q

A 34 year old lady is due to undergo a laparoscopic cholecystectomy. Which of the following intrabdominal pressures should typically be set on the gas insufflation system?

A

10mmhg

1092
Q

what proportion of fissures are anterior

A

10%

1093
Q

Into which of these veins does the middle thyroid vein drain?

A

internal jugular vein

1094
Q

thyroid arterial supply

A

superior thyroid - ECA

inferior thyroid - branch of thyrocervical - branch of subclavian

thyroidea ima

1095
Q

thyroid venous drainage

A

superior and middle thyroid veins - drain into IJV

inferior thyroid vein - into brachiocephalic

1096
Q

sigmoid sinus drains into…

A

internal jugular vein

1097
Q

radial nerve position to humerus at distal third

A

anterolateral

1098
Q

one RCT is which level of evidence

A

II

1099
Q

dura terminates at which spinal level

A

S2

1100
Q

JUGULAR FORAEMEN PART OF WHICH BONE

A

temporal

1101
Q

foramen magnum part of which bone

A

occipital bone

1102
Q

suspected breast implant complication - which imaging

A

MRI

MRCS A (1 decks)

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