new part A 2020 Flashcards
Surface marking of the femoral artery?
Mid-inguinal point
Content of the adductor canal in order?
from lateral to medial: a continuation of the apex of the femoral triangle.
Laterally: Lateral cutaneous nerve of the thigh, femoral nerve, Femoral artery, femoral vein.
Discuss Femoral triangle
It is medially bound by the adductor longus, laterally sartorius, superiorly inguinal ligament, floor is pectinus.
Content L to M: Nerve, artery, vein, lacunar ligament.
Femoral sheathe contains all the above except the lacunar ligament because it is medial. in the female contains Cloquet’s node (also Rosenmuller’s node)
Mid inguinal point Vs mid point of inguinal ligament?
Mid inguinal point is from ASIS to the pubic symphsis, this gives the landmark inferiorly to the femoral artery.
Mid point of inguinal ligament is lateral compared to the former(ASIS to pubic tubercle). this represents inferiorly the landmark of the femoral nerve and the deep inguinal ring.
Conn’s syndrome Vs Addison disease?
Addisons: Adrenal insufficiency
Conns: Hyperaldosteronism.
Adrenal insuficieny / Addison:
Not enough cortisol, glucocorticoids, mineralcorticoids, not enough aldosterone -> Hyponat, Hyperkal, Increased ACTH due to lack of adrenal activity, hence increased melanin. Low BP, low mood, Hypercalcaemia from Reduced GFR due to lower volume.
Conns/ Hyperaldosteronism: Opposite of Addisons. Hypernat, hypokal, hypocal, hypomag. Not too much aldo, high BP.
Papillary thyroid Ca. What do you know about it?
80-85% of all thyroid Ca.
Spread via Lymphatics
Psamomma bodies.
Orphan anni cells.
Tell me about otitis media.
Common in paeds.
Strep pneumo, strep pyogens, staph aureus, H. Influenzae.
Dural venous thrombophlebitis posterior to the ear of the mastoid air cells.
Mastoid air cells are part of the temporal bone.
When tX, first line is Abx, exploratory is reserved is resistant.
Tell me the 12 CN Nerves.
CN I: Olfactory nerve
CN II: Optic nerve
CN III: Oculomotor nerve
CN IV: Trochlear nerve
CN V: Trigeminal nerve (First ph. pouch) V1 opthalmic, V2 Max, V3 Mand
CN VI: Abducens nerve
CN VII: Facial nerve (2nd Ph. pouch)
CN VIII: Vestibulocochlear n.
CN IX: Glossopharyngeal n. (3rd Ph. pouch)
CN X: Vagus Nerve (4th Ph. pouch)
CN XI: Accessory Nerve
CN XII: Hypoglossal Nerve
Foramen rotundum contents and which bone
Max nerve, V2
opening in the greater wing Sphenoidal bone.
Anterio-medial to foraman ovale.
it connects the middle cranial fossa to the pterygopalatine fossa.
Foraman ovale content
Mandibular nerve
motor root of the trigeminal nerve
accessory meningeal artery
lesser petrosal nerve
emissary vein
Foraman spinosum content
Middle meningeal artery
Middle meningeal vein
Maybe also nervus spinosus
Posterior lateral to ovale.
Hypoglossal nerve. Tell me what you know
Hypoglossal nerve.
Innervates the intrinsic muscles of the tongue.
Lesions cause ipsilateral deviations
Runs through the hypoglossal canal located in the occipital bone medially and superiorly to the occipital condyles.
CN X. Tell me about it.
Vagus nerve.
From the 4th Ph. Pouch.
Innervates the palate. Ipsilateral deviations to the site of lesion.
Travels through the jugular foramen.
Hassall’s corpuscles
Anterior mediastinum, also called thymic corpuscles found in thymus.
What muscle opens the jaw?
Lateral Ptreygoid
Muscles of mastication
Masster, temporalis, medial and lateral pterygoid
Buccinator muscle function?
Tightens the cheeks and presses them against the teeth while chewing.
List common organisms causes necrotising fasciitis
Psudomonas aerugoniosa _____G-ve, rod, sweet/grape smell
Clostridium perf. ____G+ve rod
E.coli ____G-ve rod
MRSA ____G+ve rod
Post splenectomy vaccines?
H.influenza type B
N. meningiditis
Strep pneumoniae
(ALL encapsulated)
which H.Influenza is encapsulated?
H. influenza B is encapsulated, A is not
Deep peroneal nerve root
L4-S2
Cholecystokinin (CKK) function?
Relaxes sphincter of Oddi.
Contracts gall bladder
Constricts pyloric sphincter
Inhibits appetite by acting on hypothalamus
Lynch syndrome
Autosomal dominant due to mismatch repair gene defect/ Part of the HNPCC. Associated with Endometrial, ovarian, colorectal. and other genitourinary tumors
Histologically likely to be mucinous and likely to be right sided.
strong genetic history
Hodgkins lymphoma
Reed sternberg cells (Bi-lobed nucleated B lymphocytes).
subMandibular node swelling.
Night sweats.
Fever
AML
Auer rod
Sarcoidosis histology
Non-caseating granuloma
TB histology
Caesating granuloma with central necrosis
Respiratory accessory muscles
Scalene muscles and sternocleidomastoid
Celiac trunk arises at which level
T12
Paired bilateral aortic arteries branches
T12- inferior phrenic arteries, middle suprarenal arteries
L1/L2: RENAL ARTERIES
L2: gonadal arteries
4 Parasympathetic cranial ganglion
Ciliary, Otic, submandibular and pterygopalatine. stellate is sympathetic
Kaposi sarcoma associated with which disease
HHV-8, common with HIV, appears as a purple lesion on the mucosa or skin or internally.
Urachus dervied from ?
Allantois
Lumbar cistern anatomical level?
L1/L2 extending to S2
Midgut to hindgut transition point?
Proximal two thirds to distal third of the transverse colon
foregut to midgut transition point
Half way boundary at D2
First aortic arch?
Maxillary artery
second aortic arch
pharyngeal artery and stapedial artery
third aortic arch
common carotid and internal carotid
4th aortic arch
R subclavian on the R side and aortic arch on the L
6TH AORTIC ARCH
R & L pulmonary arteries
Medullary thyroid carcinoma
Amyloid deposition in 80%
Part of MEN 2
cancer of the parafollicular cells
raised calcitonin levels
antecubital fossa anatomy
Medially: lateral border of pronator teres
Laterally: medial border of brachioradialis
Floor is proximally brachialis and distally by supinator.
Roof is skin and fascia of bicipital aponeurosis which arises from biceps brachii.
Biceps brachii tendon is the most lateral border and medially is the brachial artery and median nerve.
Medial cubital vein is above the aponeurosis and below the skin
Hodgkins vs non-Hodgkins features?
NHL is systemic lymphadenopathy, HL is localized lymph nodes
Medial arch of the foot anatomy
Made from the tibilias posterior inserts into the navicular tuberosity and base of the medial cuneiform. Travels through the tarsal tunnel
Tarsal tunnel anatomy
Anterior to posterior: Post. tibial tendn, flexor digitorum longus, post tibial artery, vein, nerve and flexor hallucis longus tendon.
Flexor retinaculum.
Tarsal tunnel is posterior to medial mall. and anterior to it is the great saphenous vein.
features of pulmonary sarcoidosis
Bilateral hilar lymphadenopathy
raised ACE levels
SOB
How does Gastrin work?
Binds to enterochromaffin cells by binding to CCK but does not bind directly to histamine cells
NICE guidelines for CT within 8 hrs for head injuries criteria?
Age of 65 years or older
history of bleeding disorder
>30 minutes of retrograde amnesia
dangerous mechanism of injury
Post op infection time
After 72 hrs
where is potassium excreted in the nephron
Collecting ducts
most common location for urinary calculi to impact
VUJ
cat scratch disease ?
Bartonella henselae from cat saliva
Lyme disease
B.BURGDORFERI. EXODUS TIC
ERYTHEMA MIGRANS
BULLS EYE LESION
Causes heart block
VACTERL
vertebral defect, anal atresia, cardiac defect, tracheo-oesophageal fistula, renal anomaly and limb anomalies
Solitary nucleus function and location
Antero medial on the medulla oblongata
Purely sensory:
Taste sensation from the tongue via chorda tympani of CN7
sensory info from the middle ear
chemoreceptors in the carotid body
baroreceptors in the aortic body.
Embryonic structure that forms nucleus pulposus
Notochord
Carotid sheath anatomy ?
medial: common carotid artery, internal carotid artery, Vagus nerve, internal jugular vein.
at C3-C4 the common carotid bifurcates to the external carotid.
Oesophagus is medial to the carotid sheath
Vagus nerve is posterior lateral to the common carotid artery.
Lobes of the thyroid are anterior to the sheath
Fluid maintenance in children
100ml/kg/24hr for the first 10kgs of the body weight
50 ml/kg/24hr for the next 10kgs of the body weight
20 ml/kg//24hr for the remainder weight
which foramen does the facial nerve leave the skull
Stylomastoid foramen
Aspirate in gout
Negative birefringent needle shaped crystals
Which vessels originates from the right ventricle and drains into the right atrium
Anterior cardiac vein
Which vein drains the inferior surface of the heart and drains into the coronary sinus?
Middle cardiac vein
Where does the hypoglossal nerve exit the skull?
Superior and medial to each occipital condyle
Hip extensor muscles?
Gluteus maximus
Hamstrings ( Semitendinosus, semimembranosus and biceps femoris)
Adductor magnus
Function of the gluteus medius?
Primary abductor of hip. Posterior portion causes hip extension and external rotation
Classify Salmonella, and give relation to orthopaedics
Encapsulated Gram negative rod. common cause of osteomyelitis in patients with sickle cell anaemia because of serial splenic infarct causing splenic dysfunction
On bimanual examination what is felt anteriorly to the vagina?
Base of the bladder
what is the level of luschka joint
C3 to T1
Which organism appears on Ziehl-Neelsen and Lowenstein-Jensen?
Mycobacterium TB
what is the most influential factor on prognosis of breast cancer?
Nodal involvement, the more nodes involved the lesser the prognosis
Duration of analgesia of lidocaine?
90 mins
Antagonist of benzodiazepines and GABA agonist
Flumazenil
Duration of bupivacaine?
6-8 hours
Diabetic develops swelling and abscess after tooth extraction. Pus is oozing from the affected gum. Swab shows anaerobic Gram positive bacterium?
Actinomyces israelii, produces yellow sulfur granules.
DM causes immunodeficiency
Which of the following structures forms from the second pharyngeal arch?
Muscles of facial expression
Expected ECG findings in isolated obstruction of the circumflex coronary artery?
I and V5-V6
patient with traumatic brain injury, CT shows isolated contusion in a deep brain region. BP is 88/56 mmHg, HR 100bpm, temperature is 40.5 degrees. Plasma sodium is 121. What area of the brain is most likely affected?
Hypothalamus
Deep posterior compartment of leg content?
Popliteus, tibialis posterior, flexor hallucis longus and flexor digitorium longus.
innervated by tibial nerve
Superficial posterior compartment of leg content?
Gastrocnemius, soleus and plantaris, innervated by tibial nerve
Lateral compartment of leg?
Peroneus longus and brevis, innervated superficial peroneal nerve
Anterior compartment content of leg?
tibialis anterior, extensor hallucis longus, extensor digitorum and peroneus tertius. innervated by deep peroneal nerve
