Part B Flashcards
(336 cards)
1
Q
Issues with diathermy
A
Burns from touching the skin, or from incorrect placement of the patient electrode
Interferes with pacemakers
Ignites volatile gases or liquids
2
Q
Pacemakers in theatre
A
Recent review
Determine degree of pacemaker dependency
Make sure temporary pacing available
Monitor ECG throughout
Limit monopolar and bipolar
Keep patient electrode far away from pacemaker site
3
Q
Biploar
A
Current goes between the two metal tips of the forceps
Better for pacemakers
4
Q
Monopolar current
A
Current moves from the tip of the instrument through the tissues to the patient electrode
5
Q
Cleaning vs disinfection vs sterilisation
A
Cleaning - removes visible dirt from an area
Disinfection - cleaning products denature bacteria and viruses present, reducing the number of transmissable microbes (inanimate surface)
Antiseptic - agent applied to living tissue, kill/ inhibit or reduce number of microbes
Sterilisation - uses heat and steam to denature cells, killing microorganisms including fungi and spores
6
Q
How do you sterilise theatre instruments?
A
Moist heat and a steam autoclave
7
Q
How to sterilise endoscopes
A
Irradiation or ethylene oxide
8
Q
Stopping warfarin
A
Advise of haematology
High or low risk?
- low risk stop 5 days before
- high risk bridge with LMWH and stop 12 hrs pre-op, restart 6 hrs post op, then gradual titration of warfarin back in
9
Q
C diff abx
A
Cephalosporins
Co-amoxiclav
Ciprofloxacin
Clindamycin
PPIs as well
10
Q
Chlorhexadine
A
potent against gram +ve and -ve
some activity against viruses
effective for >4hrs
poor action against spores and fungi
bacteriostatic and bacteriocidal
disrupts the cell membrane
11
Q
Betadine
A
Iodine based
potent against bacteria, fungi and viruses including TB
effective <4hrs
some activity against spores (best option)
bacteriocidal
12
Q
Isopropyl alcohol
A
Broad spectrum bacteria, viruses, fungi, TB
No activity against spores
Fast acting
13
Q
Principles of draping
A
Seperates clean and dirty
Clean barrier preventing microbe spread
Covers equipment
Controls fluid to keep patient clean and dry
14
Q
Drape properties
A
Durable
Water resistant
Resist penetration of microbes
Flexible
Non-toxic
Electrostatic
Breathable
Non-flammable
15
Q
In all procedures
A
Wash hands
Check patient details
Obtain consent
Do procedure
Wash hands
Document procedure
Tell a grown up
16
Q
Risks of chest drain
A
pain, failure, drain can become blocked, drain can fall out and need to be replaced
Can cause infection at the wound or inside the chest
Damage to blood vessels and bleeding
Are they anticoagulated??
17
Q
Prior to giving any local anaesthetic
A
Any allergies?
18
Q
Borders for chest drain
A
Anterior - lateral border pec major
Lateral - edge of lat dorsi
Superior - base of axilla
Inferior - 5th intercostal space
19
Q
Direction for chest drain
A
Up in pneumo
Down in haemo
20
Q
Reason for chest drain
A
Traumatic, tension, large spontaneous pneumothorax not resolving after decompression, large secondary pneumothorax
21
Q
When to call cardiothoracics following chest drain
A
More than one pneumothorax on the same side, a pneumothorax on both sides (at once or previously), spontaneous haemothorax, persistent air leak/ failure to expand, in pregnancy, pneumothorax in divers/pilots
22
Q
Local with adrenaline dose
A
1% lidocaine with 1:80,000 adrenaline
1% is 1mg lidocaine in 10ml
23
Q
Suture removal time by body part
A
Face - 5 days
Scalp 7 days
Trunk + limb 10-14 days
24
Q
Monocryl lasts
A
3 months
Wound support 20 days
25
Vicryl lasts
8-10 weeks
wound support 10-30 deays
26
PDS lasts
6 months
wound support 60 days
27
LA toxicity
Tongue numbness, fasiculations, seizure, apnoea, hypertension, tachy, cardiac arrest (late)
28
What is diathermy
high frequency alternating current
localised heat that coagulates or cuts tissue
29
Risk of further MI with surgery
30% before 30 days
10-20% between 1-3 months
6% 3-6 months
30
Cardiac patient investigations
Bloods including BNP
ECG
CXR
ECHO
?dobutamine stress test/exercise ecg/angio
31
Mechanism antiplatelets
irreversibly binds ADP to platelet receptor. Stops platelet aggregation
32
Mechanism aspirin
COX-1 inhibitor, prevents the synthesis of thromboxane which is required for platelet aggregation
33
When to stop clopidogrel
7-14 days prior to surgery
34
How to bridge warfarin
Stop 5/7 before
Start enoxaparin after INR sub-theraputic only
INR on morning of procedure
35
Warfarin reversal
Time
Vitamin K (PO takes 12-24 hrs)
Prothrombin complex (or FFP if PCC not available) - ask haematology
36
Peri-op measures for COPD patient
regional anaesthesia, lower abdominal wound, use laprascopic
37
Metformin causing lactic acidosis
Metformin blocks pyruvate carboxylase, the first step of gluconeogenesis, which converts pyruvate to oxaloacetate. This leads to a buildup of lactic acid.
38
Types of sterilisation
Steam (120-130 for 30 mins) - surgical instruments
Cold/chemical (hydrogen peroxide)- plastics, endoscopes
Gas (ethylene oxide) - sutures, electrical equipment
Ionising radiation (gamma) - catheters/ syringes
39
ASA mortality
1 - 0.05%
2 - 0.5%
3 - 5%
4 - 25%
5 - 50%
40
define laparotomy
an incision that enters the peritoneal cavity
41
laparotomy layers
skin
subcutaneous fat
scarpa's fascia
linea alba
transversalis fascia
extra-peritoneal fat
peritoneum
42
Open cholecystectomy incision
Kocher's
43
Off centre abdominal incision
Paramedian - access spleen
44
Open appendix incision
Lanz
45
Classify wounds
Mechanism
Contamination (clean, clean-contaminated, contaminnated, dirty)
Depth
46
Patient factors affecting wound healing
poor skin condition, smoking, obesity, malnutrition, immunosuppression (DM, steroids, chemo), renal failure, liver failure, hypoxia
47
Cutting mode diathermy
highest heat, continuous current
vaporises cell water and cell explodes
up to 1000 celsius
48
Coag mode diathermy
pulsing current, less head
protein denaturation and cell dehydration
spray - coag over a wide area
49
wound packing name
alginate dressing highly absorbable and haemostatic
50
VITAMIN C
Vascular
Infective
Traumatic
Autoimmune
Metabolic
Iatrogenic
Neoplastic
Congenital
51
Excision margin skin lesion
2mm benign
4mm suspecting SCC
52
Contraindication to IO
Can't find the site
Long bone fracture
Vascular injury to that extremity
Previous surgery on that area
Overlying infection
53
Definition of a stoma
Artificial connection between two epithelial surgaces in hollow organs
54
Stoma complications
Early - ischaemia/necrosis, high output, retraction obstruction
Late - obstruction, prolapse, retraction, stenosis, hernia, granuloma, mucocutaneous separation, fistula formation
55
What is a branchial cyst?
Congeniital lesion from the incomplete involution of branchial cleft structures during embryonic development - usually cleft 2
56
CN 7
temporal - raise eyebrows
zygomatic - scrubch eyes
buccal - puff cheeks
mandibular - smile
cervical - grimace
57
Nerve supply anterior 2/3 tongue
Taste - facial nerve via chorda tympani
Sensation - lingual nerve (mantibular branch trigeminal)
58
How does UMN lesion spare the forehead?
Frontalis muscle has dual innervation from both hemispheres
59
Path of CNXI
upper spinal cord
enters cranium trough foramen magnum
exits cranium through jugular foramen
descends along carotid artery
60
Which muscle is NOT supplied by hypoglossal
palatoglossal (CN X)
61
What does ROmberg's test look for
Sensory ataxia - NOT cerebellar defect
62
Critical limb ischaema
Ischaemic pain and rest, gangrene/ulcers, ABPI < 0.4
63
Causes of varicose veins
Valvular insufficiency causing elevated superficial venous pressure
DVT
Pregnancy due to hormonal changes
64
Define RA
symmetrical inflammatory poly-arthropathy with systemic manifestations
65
Extra-articular features of RA
nodules, lymphadenopathy, vasculitis, atherosclerosis, pleural effusion, fibrosing alveolitis, splenomegaly, Feltys (splenomegaly, RA, neutropaenia), scleritis/episcleritis
66
What are RA nodules
collagen with central necrosis and surrounding fibroblasts and mpgs
67
RA on XR
Loss of joint space
Juxta-articular osteopaenia
Bone erosion
Soft tissue swelling
(NO osteophytes)
68
Bankart lesion
injury to anterior labrum, capsule and ligaments from recurrent dislocation
69
Hill-Sachs lesion
Indentation on posterolateral humeral head from impacting against the anteroinferior glenoid rim
70
Test cervical radiculopathy
Spurling's test
ear to shoulder, look up ,axial loading
71
Test for AS back movement
Schober's test >5cm is normal
mark 10cm above and 5cm below L3/4
72
Bicarb < 24
Metabolic acidosis
73
Causes of normal anion gap metabolic acidosis
loss of bicarb
diarrhoea, renal tubular acidosis
74
Causes of raised anion gap metabolic acidosis
added acid
arsenic, lactate, DKA, uraemia, aspirin, iron, metformin
75
Causes metabolic alkalosis
loss of H+
hypokalaemia (drives H+ into cells), vomiting, renal abnormalities
76
Causes respiratory acidosis
CO2 retention
COPD, sleep apnoea
opioids, NM disorders
77
Causes respiratory alkalosis
CO2 loss
hyperventilation
head injury, interstitial lung disease
78
Base excess
The amount of strong acid required to be added to 1L of blood to return the pH to 7.4
79
Stages of dermal wound healing
Inflammation, proliferation, maturation
80
Describe inflammation stage of dermal wound healing
Early - bleeding, plt activation, clot formation
Late - erythema, oedema, creates exudate encouraging mpg/neut growth, autolysis of tissue
81
Describe proliferation stage of dermal wound healing
increase in connective tissue - collagen 3
granulation, contraction, epithelialisation of tissue
82
Describe maturation stage of dermal wound healing
20 days - 1yr
collagen 3 replaced with 1
tissue vascularity redeuces
83
3 pops of LP
supraspinous ligament, interspinous ligament, ligamentum flavum
84
how long dues bupivicaine last?
6hrs
85
how does LA work?
reversibly blocks voltage gated sodium channels
86
burn - erythematous and painful
1
87
burn - moist and painful
2 - superficial
88
burn - dry, mild pain, red
2 - deep
89
burn - leathery/white/painless
3
90
re-warming of frostbite
acidosis, hyperkalaemia, swelling
91
measure NP
nose to tragus
92
measure OP
incosor to angle of jaw
93
massive transfusion
>4 units in 1 hr
>10 units in 24 hrs
94
grading liver injuries
1-5
3 - contained vascular injury
5 - major vessels/ >75% laceration
95
grading splenic injuries
1-5
4 - includes vascular injury
5 - shattered spleen
96
temporal herniation sign
oculomotor nerve
97
central cord syndrome
upper limbs worse
98
anterior cord affected
paraplegia, loss of pain and temperature
99
nurve injury elbow
ulnar
100
nerve injury wrist#/disloc
median
101
nerve injury supracondylar #
anterior interosseous
102
nerve injury anterior shoulder dislocation
musculocutaneous
103
humeral shaft # nerve injury
radial nerve
104
proximal humeral # nerve injury
axillary nerve
105
lethal triad
acidosis, hypothermia, coagulopathy
106
Cardiac output =
SV x HR
107
optic canal
Optic nerve, opthalmic artery
sympathetic nerve fibres
108
superior orbital fissure
oculomotor, trochlear, abducens, opthalmic division trigeminal nerve (3, 4, 5a, 6)
opthalmic vein
branches of MMA and lacrimal arteries
109
foramen rotundum
maxillary division trigeminal nerve
110
foramen spinosum
middle meningeal artery
111
foramen lacerum
greater petrosal nerve + carotid
112
foramen cecum
emissary veins
113
foramen ovale
Otic ganglion
mandibular division trigeminal nerve
accessory meningeal artery
lesser petrosal nerve
emissary veins
114
internal acoustic meatus
facial nerve, vestibulocochlear nerve
115
hypoglossal canal
hypoglossal nerve
116
jugular foramen
glossopharyngeal, vagus, accessory (CN9, 10,11)
Internal jugular vein
117
foramen magnum
ascending spinal accessory nerve, vertebral arteries, brainstem
apical ligament of the dens
118
cribiform plate
olfactory
119
Adrenal cortex
glomerulosa - aldosterone
fasiculata - cortisol
retucularis - sex hormones
remember ACS/GFR
120
where is renin released from
juxtaglomerular cells
121
what is renin?
an enzyme that breaks angiotensinogen into angiotensin
122
what does ACE do?
produced in lungs
converts angiotension 1 to angiotensin 2
123
what does angiotensin 2 do?
vasoconstriction
increases sodium resorbtin
increased noradrenaline
increases ADH
stimulates aldosterone
124
what does aldosterone do?
acts on collecting ducts
increases water retention, decreases K+, increases Na and Cl
125
when is RAAS activated?
decreased renal perfusion, hyponatraemia
126
Define ARDS
diffuse inflammatory lung injury, bilateral
NOT due to cardiac cause
causes leaky capillaries which decerase gas exchange, lungs become stiff (reduced compliance) and pulmonary htn
127
Risk factors for ARDS
aspiration, sepsis, trauma, drowning, fat embolism, pancreatitis
128
Where does the brachail plexus originate?
C5-T2
129
Which vessel does it run with?
Subclavian artery
Passes between anterior and middle scalenes
130
Posterior cord brachal plexus
ULTRA (C5-T1)
Upper subscap
Lower subscap
Thoracodorsal
Radial
Axillary
131
Lateral cord brachial plexus
LML (C5, C6, C7)
Lateral pectoral
Lateral median
Musculocutaneous
132
Medial cord brachial plexus
4MU (C8-T1)
Medial brachial cuteneous
Medial antebrachial cutaneous
Medial pectoral
Medial root of median
Ulnar
133
Function musculocutaneous nerve
Motor:
biceps, brachialis, and coracobrachialis
Sensory:
lateral forearm (lateral cutaneous nerve)
134
Function axillary nerve
Motor:
deltoid + teres minor
Sensory:
regimental patch
135
which ear for TM?
the way the cone of light is shining - the cone of light gets it right
136
external carotid branches
some anatomists like freaking out poor medical students
Superior thyroid
ascending pharyngeal
lingual
facial
occipital
posterior auricular
maxillary
superficial temporal
137
carotid sinus
baroreceptor - internal carotid
CN IX
138
carotid body
glomus cells are chemoreceptors
CN IX
139
what does the facial nerve do?
face, ear, taste, tear
facial expression, stapedius (loud sounds), anterior 2/3 taste, lacrimal and salivary glands
140
chorda tympani does...
taste
141
geniculate ganglion
greater petrosal nerve, comes out of foramen lacerum
lacrimation and taste
142
what branch of the facial nerve is after the stylomastoid foramen?
posterior auricular nerve - sensation to mastoid
143
extra-cranial branches of the facial nerve
temporal
zygomatic
buccal
marginal mandibular
cervical
144
What muscles does the facial nerve innervate?
Facial expression
platysma
stylohyoid
posteior belly of digastric
145
where does spinthalamic tract decussate?
a few levels above in the spinal cord
146
where does the corticospinal tract decussate?
medulla
147
Describe Brown-Sequard syndrome
Ipsilateral hemiplegia + loss of fine touch
Contralateral loss of pain and temperature a few spinal levels below
148
Where is a branchial cyst found?
Anterior triangle of the neck
149
What is a dermoid cyst and where is it normally found?
Like a teratoma
Occur during embryonic development
Will be found in the midline, suprahyoid
150
What is a cystic hygroma and where is it found?
Posterior triangle
Congenital lymphangioma - when lymph glands do not develop properly in embryonic development
151
What is fibrmonatosis colli?
Fibromatosis in the SCM
Soft tissue tumour made of fibroblasts, cause muscle stiffness
152
How to tell between cystic hygroma and branchial cyst?
Branchial cyst should be anterior triangle and will be black on USS
Cystic hygroma is posterior triangle and should transilluminate
153
Differentials for salivary duct cancers
Mets, benign, TB, glandular fever, first branchial cleft cyst
154
Most common malignant salivary gland cancer
Mucoepidermoid carcinoma
155
Most common parotid tumour
benign pleomorphic ademona
156
Bilateral parotid tumour
Warthin tumour
157
Salivery gland tumour, bilateral, involving facial gland
sarcoid
158
complications of full thickness burns
compartment syndrome, renal damaeg from myoglobinaemia, ,protein loss
159
mgx full thickness burn
debridement, IVI, analgesia, antibiotics, warm and humid environment
160
the three tissue zones of burns
coagulation, ischaemia, hyperaemia
161
ca15-3
breast ca
162
liver cancer marker
AFP
163
ovarian cancer markers
AFP, BRCA, Ca-125
164
Germ cell tumour markers
AFP, bHCG
165
what does the long thoracic nerve innervate
serratus anterior - causes winging of the scapula
166
pec minor innervated by
median and lateral pectoral nerves
167
dorsal scapular nerve
rhomboids and levator scapulae
168
Define carcinoma
Tumour of epithelial cells
169
Define sarcoma
Tumour of connective tissue cells
170
Petrosal nerves
Lesser petrosal nerve - from glossopharngeal nerve, salivation
Greater petrosal nerve - taste and lacrimation
171
Levels of the neck
1a. submental
1b. sumbandibular
2-4: internal jugular upper, mid and lower (deep cervical)
5a+b. posterior triangle
6. central anterior compartment
172
Where do the vocal cords attach?
from aretynoid cartilage to thyroid cartilage
173
Which nerves innervate the larynx?
Inferior laryngeal - all muscles except cricothyroid (which is superior laryngeal)
inferior laryngeal comes from recurrent larangeal
174
function cricothyroid
lengthens and stretches vocal cords - high pitch
175
function thyroaretynoid
shortens and relaxes cords - deep pitch
176
Anterior interosseous nerve innervates
Motor
Deep muscles of the anterior forearm – flexor pollicis longus, lateral half of flexor digitorum profundus and pronator quadratus.
177
SIRS and MODs
Systemic inflammatory response syndrome
Multi organ dysfunction syndrome
178
Define sepsis
SIRS resulting from a documented infection
179
Define severe sepsis
associated with endo organ dysfunction, hypoperfusion/hypotension
180
Define septic shock
Severe sepsis with refractory hypotension
181
what helps produce heat in hypothermia?
shivering
noradrenaline causing fat breakdown from brown fat causing heat production
182
stages of hypothermia
35-37 - cold stress
32-35 - mild
28-32 - moderate
< 28 - severe
183
How does hypothermia cause arrhythmias?
slows action potentials, disperses action potentials and makes re-entry more likely
184
Bacteria nec fasc
Staph aureas, strep, polymicrobial with gram negatives and anaerobes
185
Risk factors nec fasc
DM, alcohol/ liver cirrhosis
186
describe c.diff bacteria
gram +ve anaerobic rod
187
describe pseudomembranous colitis
inflammation and ulceration of musosa, sloughing of the mucosa
188
describe toxic megacolon
thinning of mucosal walls, ulceration, necrosis and granulation tissue
189
Rx c diff
metronidazole, PO vancomycin
190
Risk factor diverticular disease
Connective tissue disorders, western diet, low fibre, obesity
191
How many people have diverticular disease, and how many are symptomatic?
60% by age 60
5-15% will get diverticulitis
192
Define diverticular disease
false diverticulae, herniation of mucosa and submucosa through the muscularis layer, covered by serosa
193
Who gets treatment for diverticular disease?
systemically unwell, immunosuppressed, significant comorbidities
194
What is the classification and stages for Divreticulitis?
Hinchey
0 - colonic thickening
1 - pericolic change +- pericolic abscess
2- distant abscess
3 - purulent peritonitis
4 - faecal peritonitis
195
cerebral blood flow with incresed CO2
vasodilation
196
cerebral bloodflow with increased O2
constriction
increased if PaO2 < 8
197
rise in blood pressure causes what reaction in the brain
vasoconstriction
198
Causes of non-cyclical mastalgia
medication, contraception, antidepressants, antipsychotics
199
Define an abscess
collection of pus surrounded by granulation or fibrous tissue
200
causes of gynaecomastia
Physiological - puberty, old age
Pathological - lack of testosterone (Kleinfelter's, androgen insensitivity), increased oestrogen (liver disease, tumours), medication (spironolactone, digoxin, metronidazole, chemo, antipsychotics, steroids), idiopathic
201
thoracodorsal nerve
latissimus dorsi
202
Hormone treatments for breast cancer
Tamoxifen - selective oestrogen receptor modulator
Anastrazole - aromatase inhibitor, blocking peripheral conversion of testosterone to oestrogen
203
What is herceptin?
MAB
HER-2 is an epidermal growth factor
204
Sensory innervation to the breast
Anterior and lateral cutaneous branches of 4th-6th intercostal nerves
205
describe fibroadenoma
biphasic - proliferation of epithelial and stromal tissues of duct lobules
206
describe phylloides tumour
biphasic - overgrowth of stromal cells
207
describe breast cyst
fluid filled involuted lobules
208
peri-ductal mastitis is
non lactational mastitis - inflammation of subareolar ducts
209
what is Mondor's disease
sclerosing thrombophlebitis
210
Axillary LNs and levels
1. inferolateral to pec minor
2. posterior to pec minor
3. superomedial to pec minor
211
LN drainage of breast
axilla, parasternal(internal thoracic), posterior intercostal
212
What is Cooper's ligament
fibrous septae from pectoral fascia separating breast lobules
213
bloody nipple discharge causes
duct ectasia, intra-ductal papilloma, epithelial hyperplasia, pregnancy
214
Blood supply to breast tissue
Internal thoracic (from subclavian)
Lateral thoracic and thoraco-acromial (from axillary)
215
Define naevus
Benign proliferation of the normal constituent of cells of the skin
216
Cytological features of malignancy
increased or abnormal mitoses, hyperchromatism (+DNA) pleomorphism, increased nuclear:cytoplasmic ratio
217
Histological features of malignancy
Loss of architecture, invasion of BM, neovascularisation, necrosis and haemorrhage
218
melanoma excision margin
< 1mm 10mm
>1mm 20mm
219
Immunohistochemistry for melanoma
S100 - a protein in melanoma signalling
220
Surgery where you take a small margin and reassess
Mohs microsurgery
221
What is Breslow thickness
from top granular epidermal layer to deepest invasion
222
Describe BCC
slow growing pearly nodule, rolled boarders, telangectasia, bleeding and crusting
223
Describe SCC
scaly/crusty lump which may ulcerate, ben painful or bleed
224
Rx BCC
excise or topical 5-FU
225
Rx SCC
excise, Mphs microsurgery, radiotherapy if inoperable
226
How to classify any cancer/growth
Benign or malignant, primary or secondary or congenital
227
Most common benign thyroid pathology
thyroid adenoma
228
papillary thyroid cancer histology
psammoma bodies - microcalcification
orphan Annie eyes
229
how does follicular thyroid cancer spread?
haematogonous
230
describe medullary thyroid cancer cells
oxyphill cells from parafollicular c cells that make calcitonin
231
Men 1 cancers
Pituitary, Parathyroid, Pancreas
232
Men 2a cancers
Parathyroid, Phaeochromocytoma, Medullary thyroid
233
Men 2b cancers
Phaeochromocytoma, Medullary thyroid, Mucosal neuromas, marfanoid
234
What is Riedel thyroiditis?
thyroid replaced by fibrous tissue - hard painless goitre
235
medial cutaneous neve root origin
medial cord of brachial plexus C8+T1
236
lower brachial plexus injury - mechanism and features
shouder dystocia - abduction traction
Klumpke's palsy
237
upper brachial plexus injury - mechanism and features
Motorcyclist RTA, falling onto shoulder
Waiter's tip
238
describe Klumpke palsy
intrinsic hand muscles
claw hand from unopposed action of long flexors/extensors
wrist extension, flexed IP joints, hyperextension MCP
239
Describe Erb's palsy/ waiters tip
adducted arm, internally rotated, forearm extended and pronated
240
Quadrangular space
sup. - teres minor
inf. - teres major
med. - triceps
lat. - humerus
241
What is important about the quadrangular space
where the axillary nerve, posterior circumflex artery and vein pass
242
Branches of axillary artery (and parts)
Screw the lawyers, save a patient
1) Superior thoracic
2) Thoracoacromial
2) Lateral thoracic
3) Subscapular
3) Anterior humeral circumflex
3) Posterior humeral circumflex
Runs from 1st rib to teres major
243
What splits up the branches of the axillary artery?
pec minor - medial, behind, lateral
244
Ulnar muscles
flexor carpi ulnaris
ulnar half of flexor digitorum profundus
intrinsic hand muscles
245
Pope's blessing
clawing 4+5th digit from ulnar nerve damage
(worse the more distal the injury)
246
Pain transmission in appendicitis
Lesser splanchnic nerve
247
Scoring system for appendicitis
Alvarado score - based on signs, symptoms and blood tests
248
Define sinus
blind ended track lined with granulation tissue
249
Define fistula
abnormal communication between two epithelial surfaces
250
Define stoma
Surgical opening into a hollow viscus
251
Define aneurysm
abnormal, permanent, localised dilatation of a blood vessl to 1.5 times normal size
252
What is the difference between a thrombus and a clot?
clot - formed in stationary blood
thrombus - formed in flowing blood
253
Define polyp
Mass of tissue arising from an epithelial surface
254
Define neoplasm
uncoordinated growth that exceeds that of the normal tissue and continues to grow despite removal of original stimulus
255
Hyperplasia
increase in size due to increase in number of cells
256
Hypertrophy
increase in size due to increase in size of cells
257
Define harmatoma
tumour-like malformation - disorganised arrangement of different amounts of tissue normally found at that site
258
Define dysplasia
disordered cell development with increased mitosis and pleomorphism
259
sensitivity
how many people with that disease get a positive result
260
specificity
how many people without the disease get a negative test result
261
bcg type of vaccine
live attenuated
262
ghon focus
TB - granuloma in lung lymph nodes
263
dgx TB
IGRA - interferon gamma release assay
Mantoux test
264
nosocomial
disease originating in a hospital
265
Features of Crohn's
cobblestone, skip lesions, fistulae, strictuers, rosethron (fissuring) ulcers, non-caseating granulomas, transmural inflammation
266
Features UC
pseudopolyps, crypt abscesses, mucosal layers only
267
PSC
primary sclerosing cholangitis - in UC
268
Extra-articular features IBD
anterior uveiitis
liver cirrhosis
renal calculi
arthropathy
skin - erythema nodosum, pyoderma gangrenosum
anaemia
DVT
269
Low anterior resection
rectum with anal sparing to top of sigmoid
270
sub total colectomy
leaves sigmoid and below
271
total colectomy
leaves the rectum in place
272
causes of large bowel obsutrction
tumour, adhesions, stricture from diverticular disease, volvulus
273
layers of the GI tract
mucosa, submucosa, muscularis propria, serosa
274
define adenocarcinoma
malignant tumour glandular cells
275
Malignant asciities
Exudative, with high protein content
276
Autodigestion in pancreatitis caused by
Tripsinogen to trypsin conversion
277
Autodigestion enzymes pancreatitis
Proteases - digest parenchyma
Lipases - digest fat and causes fat necrosis
Elastases - particularly vessel walls leading to haemorrhage
Amylase
278
Glasgow score pancreas
PO2 <8
Age >55yrs
Neutrophilia WC >15
Ca <2
Renal function Urea >16
Enzymes AST >200, LDH >600
Albumin < 32
Sugar BM >10
279
Complications pancreatitis
Early - shock, ARDS, DIC, renal failure, hypocalcaemia, hyperglycaemia, ileus
Late - necrosis, pseudocyst, abscess, haemorrhage, thrombosis of splenic artery, fistulae, chronic pancreatitis
280
why does pancreatitis cause hypocalcaemia?
digestion of fats lead ro saponification of calcium
281
what causes high amylase?
pancreatitis, intestinal perforation, trauma, burns, tumours, medications
282
define ulcer
abnormal discontinuation of a mucous membrane
283
Testicular layers
Worried about scrotum? SDEC ITT
Skin
Dartos fascia+muscle
External spermatic fascia
Cremasteric muscle
Internal sprematic fascia
Tunica vaginalis
Tunica albuginea
284
Femoral artery
inferior to inguinal ligament mid-inguinal point halfway between pubic symphesis and ASIS
285
Define shock
Acute circulatory failure associated with inadequate oxygen utilisation by cells
Can't deliver sufficient oxygen
286
Monroe-Kelly doctrine
Cranium is rigid - brain, blood and CSF must balance the pressure maintaining ICP
Eventually there will be a point of ICP decompensation reducing CPP
287
Cushing reflex
Response to raised ICP
HTN, bradycardia, irregular breathing
288
CPP definition
the pressure gradient that drives oxygen delivery to the brain
289
Regulation of cerebral blood flow
Myogenic reflex - vessel stretch causes constriction
Hypercarbia and hypoxia cause vasodilation
290
define wound healing
tissue restoring structure and function
291
process of seconday wound healing
phagocytes remove cell debris, granulation tissue and myofibroblasts contact wound and deposit collagen
292
Tumour markers seminoma
Placental alkaline phosphatase, B-hCG
293
CA 15-3
Metastatic breast cancer
294
Miliary TB
Lung, liver, spleen, pancreas
295
Define granuloma
Organised collection macrophages surrounded by lymphocytes/ epithelialised macrophages
296
define atherosclerosis
artery wall thickening from accumulation of fats like cholesterol
297
How does valve calcification occur?
Lipid accumulation, inflammation, calcification
298
Peripheral signs of Aortic stenosis
slow rising pulse, narrow pulse pressure, left sided heart failure
299
Abx cover with valve replacements
GI or GU procedures where there is suspected infection, then make sure to cover with an abx that works for infective endocarditis
300
Type 1 hypersensitivity cells
B cells, Th cells prime IgE and bind to mast cells
301
Graft vs host disease
DONOR T cells react against host HLA antigens
302
Staging vs grading
staging - extent of tumour on size and spread
grading - differentiation of the tumour (Gleason score prostate ca.)
303
Duke's staging colorectal ca. + 5yr survival
A (in situ) 95-100%
B (local) 65-75%
C - (LN mets) 30-40%
D - (distant mets) - 5-10%
304
Define hypersensitivity
Exaggerated response of the host immune system to a particular stimulus
305
e.g. type 2 hypersensitivity
transfusino reaction, autoimmune haemolytic anaemia, Goodpastures
306
e.g. type 3 hypersensitivity
SLE/ lupus, rheumatoid arthritis, extrinsic allergic alveolitis
307
e.g. type 4 hypersensitivity reaction
contact dermatitis, Hashimoto's, Mantoux test
308
Which chemical mediators are released in inflammation?
histamine, prostaglandins, cytokines, plasmin, bradykinin
309
Describe the complement cascade
Innate immune system
Formation of membrane attack complex
Destroys bacteria and recruits other cells
Osmotic lysis of cells
310
Define chronic inflammation
Inflammation, tissue injury and healing are occuring at the same time
311
Three things contributing to surgical infection
Infective agent
Susceptibility of hist
Poorly perfused/ closed space
312
Four most common bugs for wound infection
Staph aureas, strep pyogenes, enterococci, pseudomonas
313
qSOFA score
likelihood of sepsis in infection
GCS < 15
RR >22
BP <100
314
Exudative ascites
Peritonitis
Post-irradiation
Peritoneal mets
Pancreatitis
315
Transudative ascites
Increased portal pressure - cirrhosis, right HF, constrictive pericarditis
Hypoalbuminaemia - liver failure, starvation, nephritic/nephrotic syndrome
316
Sebaceous cyst
Epidermoid cyst or hair follicle containing keratin
Attached to the skin, so do not move freely
317
Ludwig's angina
cellulitis soft tissues of the neck and floor of mouth
Leads to airway obstruction as it pushes the tingue backwards
Caused by teeth
318
Bacteria causing OPSI (overwhelming post splenectomy infection)
Strep pneumoniae
H flu
N.meningitidis
E.Coli
319
Post splenectomy vaccines
Pneumococcal, H flu, Meningococcal, Flu vaccine
320
Blood film post splenectomy
Increased platelets
Howell-Jolly bodies (remnant nucleus in RBCs)
Pappenheimer bodies (contain iron)
Target cells
321
Causes of splenomegaly
Infections
Increased portal pressure
Haem disorder - sickle cell, leukaemia, lymphoma
Systemic - amyloid, sarcoid, RA
322
Indications for renal filtration
Acidaemia
Oedema
Hyperkalaemia
Ureamic complications
CKD 5
Acute poisoning
323
Types and examples of hyperplasia
Physiological - breast tissue during puberty, thyroid during pregnancy
Pathological - BPH, Adrenals in Cushings
324
Types and examples of hypertrophy
Phys - muscle, uterus in pregnancy
Path - cardiomyopathy, Thyroid in Graves
325
Carcinoma spread
Lymph
326
Sarcoma spread
Haem
327
What is rheumatic fever?
Systemic disease following untreated pharyngeal infection with b haemolytic strep
328
Frey's syndrome
is a rare neurological condition that causes you to sweat excessively while eating or thinking about food
329
4Hs + 4 Ts
Thrombosis, Tamponade, Tension pmeumothorax, Toxins
Hypothermia, Hypokalaemia, Hypovolaemia, Hypoxia
330
Subclavian branches
VIT C+D
Vertebral
Internal thoracic
Thyrocervical
Costocervical (supplies 1+2 intercostal spaces)
Dorsal scpular
331
Porto-systemic anastamosis
BURP L
Bare area of liver
Upper anal canal
Retroperitoneal space
Periumbilical
Lower end oesophagus
332
Retroperitoneal organs
SAD PUCKER
Suprarenal glands
Aorta
Duodenum 2+3
Pancreas
Ureters
Ccolon (ascending+descending)
Kidneys
Esophagus
Rectum
333
spigalian hernia
through abdominal muscles, between internal and external oblique
334
Richters hernia
Wall of small bowel stuck
335
Monteggia
proximal 1/3 ulna fracture with an associated radial head dislocation
336
