Past paper 2017 POS Flashcards
Operative management for 6 week old infant with pyloric stenosis
Ramstedt Pyloromyotomy
Lymphatic drainage of breast and sentinel lymph node mapping
Left breast drains into the thoracic duct and from there into the left suibclavian.
Conversely, the right breast drains into right jugulo subclaving junction.
Crawford classification
Thoracoabdominal aneurysms
Type I involves most of the descending thoracic aorta from the origin of the left subclavian to the suprarenal abdominal aorta. Type II is the most extensive, extending from the subclavian to the aortoiliac bifurcation. Type III involves the distal thoracic aorta to the aortoiliac bifurcation. Type IV TAAAs are limited to the abdominal aorta below the diaphragm. Safi’s group modified this scheme by adding Type V, which extends from the distal thoracic aorta including the celiac and superior mesenteric origins but not the renal arteries
Tumours that commonly metastasise to bone
P - Prostate T - Thyroid L - Lung K - Kidney B - Breast (Particular tumours love killing bone)
Blastic metastases (Sclerotic)
5 Bs Lick Pollen Brain Bronchus Breast Bowel Bladder Lymphoma Prostate
Calcifying metastases (Lytic)
BOTTOM
Breast Osteosarcoma Testicular Thyroid Ovary Mucinous cystadenocarcinoma of the GI tract
Basal cell Carcinoma
Most common skin cancer
Sun exposure
Slow growing, low metastatic potential
Standard surgical excision, topical chemo + radio
Punch biopsy at least if not going to be excised
Primary hyperaldosteronism
Commonly due to an adrenal adenoma (Conn’s)
Secreting too much aldosterone (from adrenal cortex)
(Zona glomerosa)
Patients with Conn’s present with
Hypertension, antihypertensive agents, symptoms relating to hypokalaemia (ileus, abdominal distention, muscle cramps and weakness, headaches, cardiac arrhythmias).
Can also present with complications of hypertension sucha as a stroke, proteinuria, renal disease, cardiac failure.
Investigations (ABCD)
Adrenal scintigraphy (Differentiates conns and bilateral adrenal hyperplasia)
Bloods (Plasma aldosterone raised)
CT/ MRI
Diurnal and postural measurements of aldosterone and renin
What is the action of aldosterone
Mineralocorticoid hormone secreted by the zona glomerulosa of the adrenal cortex.
It acts on the mineralocorticoid receptor in the distal convoluted tubule of the kidney to promote sodium reabsorption and potassium excretion
This is why patients with primary hyperaldosteronism present with Hypernatraemia and hypokalaemia
Aldosterone is the end product of RAAS. Leads tto an increase in BP. Given the high levels of circulating aldosterone, high BP, low renin (negative feedback)
When is it not appropriate to use tourniquet
Debridement of a traumatic dirty injury to the limb
In open limb injuries, it is necessary to make an assessment of the devascularised zone of injury.
If under tourniquet, may lead to incomplete debridement
Doses of LA
Lidocaine - 3mg/kg
Lidocaine + Ad = 7mg/kg
1ml of 1% = 10mg
First line test for bony pain
Serum ALP
Indirect reflection of bone destruction as it reflects osteoblastic response
Arterial supply of posterior scalp
Occipital artery
What is the Allis technique?
Used to reduce posterior hip dislocations.
Appearance of posteriorly disloated hip
Shortened flexed, adducted and internally rotated
