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MRCS Sciences deck > PAST PAPER WRONG > Flashcards

PAST PAPER WRONG Flashcards

1
Q

Where does the renal artery lie in relation to surrounding structures

A

Post to the IVC and sup to the renal vein

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2
Q

FACT

A

All the medullary cranial nerves arise from anterior medulla, nothing from post

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3
Q

Respiratory centres of the pons

A

Ventral - Exp
Dorsal - Insp
Pneumotaxic - Limits insp and controls tidal vol and RR
Apneustic - Prolongs insp
Pre-bortzinger complex generates rythm of respiration

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4
Q

Where is the chemoreceptors found

A

Retro-trapezoid nucleus of the medulla, Respons to H+ entering the CSF due to increased CO2

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5
Q

What is the hering-bruer inflation reflex

A

Stretch in bronchus and bronchioles due to over inflation triggers vagus nerve to reduce insp.

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6
Q

What is the first ste of haematopoesis

A

Yolk sack

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7
Q

FACT

A

Approximately 80% of patients that have a myelomeningocele also have hydrocephalus

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8
Q

Point of entry for lap port insertions

A

Palmers point. Lee Huang point is used as a secondary umbilical port point if it has been used in the past or if adhesions are suspected

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9
Q

VC

A

IRV + ERV + TV

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10
Q

What is the most common site of VSD

A

Pre-membranous

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11
Q

Hypothermia

A

32-35: Use warm IV and warm blanket
<32: Intraperitoneal fluid lavage

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12
Q

Which cells secrete mucus to protect the gastric mucosa

A

Foveolar cells

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13
Q

Spinal anaesthesia line

A

Supracrestal line

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14
Q

Wher is EPO made

A

Interstitial cells of the peritubular capillaries

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15
Q

Cardiac AP

A
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16
Q

Which nerve is most important in allowing the passage of urine during micturation

A

Pelvic splanchnic nerves, Allows detrusor muscles to contract and internal urethral sphincter to relax

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17
Q

T3 half life

A

1 day

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18
Q

Which renal cancer is most likely to respond to cytokine therapy

A

Clear cell

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19
Q

Blood supply of the temporal lobe

A

Posterior and middle cerebral arteries

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20
Q

Felon

A

DIP pulp joint infection

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21
Q

Bleeding during an LP

A

Vertebral venous plexus

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22
Q

Lymphatics from the body of the uterus and the cervix

A

Obturator nodes

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23
Q

FACT

A

Chronic irritation from renal stones can cause SCC of the bladder

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24
Q

What is the treatment for malignancy-associated hypercalcemia

A

Zoledronic acid

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25
Q

What to give to priapism

A

Phenylephrine

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26
Q

Tensor tympani vs tensor veli palatini

A

Main action of tensor tympani is acoustic reflex and the other one is opening the ET when swallowing and contributes the most to this.

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27
Q

FACT

A

Billiary obstruction is essential for bacterial cholangitis to develop

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28
Q

FACT

A

Axillary lymphadenopathy is not associated with DCIS

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29
Q

FACT

A

Hypothyroidism can lead to hypercholesterolaemia

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30
Q

What happens to CO in septic shock

A

It increases in sympathetic response to the

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31
Q

Paraphimosis vs phimosis

A

phimosis is only the thing that makes the skin tight, paraphimosis is the actual event

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32
Q

How can you reconstruct large facial defects?

A

Skin flaps due to the good vascula supply of the face

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33
Q

Which part of the heart is most commonly affected in penetrating trauma

A

RV due to it’s anterior relation

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34
Q

Pseudoaneurysm management

A

If small then US and surveillance, if big and/or non resolving then compression

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35
Q

What is the most important marker for Multiple myeloma

A

Monoclonal gammopathy

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36
Q

Tibial fractures

A

Non-complicated ones are put in a cast, complex ones have intramedullary nails put in and toddlers frac are treated with back slab.
External fixation if there are multiple injuries but patient is not safe to go for surgery

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37
Q

Female with a 6-month history of on and off discharge and a history of nipple piercing

A

Mammary fistula

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38
Q

What is the mechanism of action of tranexamic acid

A

Plasmin inhibition

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39
Q

Ig that does not cross the placental barrier

A

IgM

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40
Q

FACT

A

Tacrolimus may cause increased level of post transplant ALP.

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41
Q

Aortic disruption after RTA

A

Descending part is the most common

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42
Q

Difference between non-union and malunion of a fracture

A

Non-union is painful but malunion is painless as the healing process is complete but the bones have just healed in the wrong position

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43
Q

When to stop apixaban pre-op

A

12 hours

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44
Q

FACT

A

Is IIV is posterior to the IIA

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45
Q

Type of amyloid in the heart

A

ATTR

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46
Q

Child post lung surgery can’t push himself from crawling to standing position due to right arm
weakness, injury to which nerve has occurred?

A

Long thoracic nerve

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47
Q

Iatrogenic bowel perforation management

A
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48
Q

Rules of tourniquet

A

Exsanguination before inflation of the tourniquet improves the quality of the bloodless field and
minimizes pain associated with tourniquet use.

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49
Q

After oesophagectomy, blood supply of upper oesophagus

A

Inferior thyroid

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50
Q

A 62-Year Old Woman Presents With A Firm Irregular Mass In The Upper Outer Quadrant Of The
Right Breast. This Is Shown To Be Malignant On Mammography And Fine Needle Aspiration
Cytology. She Is Treated With Wide Local Excision And Axillary Clearance. Which Of The Following
Histopathological Findings Would Imply A Better Prognosis ?

A

Presence of oestrogen

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51
Q

What did two Lateral ligaments passing from umbilicus carry during fetal Period

A

Deoxygenated blood from the fetus to the placenta

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52
Q

9 years old patient. Testicular cancer with high Beta-HCG, this one is also associated with cryptorchadism

A

Seminomas

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53
Q

Most dangerous valvular disease in intra op period

A

AS

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54
Q

Renal pigmented stone types

A
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55
Q

Girl goes skiing, crashed into soft snow. Sudden swelling knee with positive patellar tap. Difficulty extending knee. Knee aspiration showed hemarthrosis. What happened?

A

Meniscal damage

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56
Q

Knee trauma, swollen and tense, no sign of any damage, definitive diagnosis

A

Knee arthroscopy

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57
Q

What is the Reciprocal of absolute risk reduction?

A

Number needed to treat

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58
Q

Patient with refractory hypertension and diagnosed of Conn’s what you think the cause of hypertension?

A

Increased plasma volume

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59
Q

AV septal defect. Defect in which?

A

Endocardial cushion

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60
Q

How does Frey’s syndrome work

A

The synkinetic mechanism for Frey syndrome is aberrant reinnervation of postganglionic
parasympathetic neurons to nearby denervated sweat glands and cutaneous blood vessels

Regeneration of the parasympathetic fibers of auriculotemporal nerve into sympathetic

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61
Q

A 1 day old infant is born with severe respiratory compromise. On examination, he has a
scaphoid abdomen, stomach is in abdomen and an absent apex beat. Which of the following
anomalies is most likely?

A

Pleuroperitoneal membrane defect

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62
Q

What does a CD20 in thyroid profile most likely indicate

A

Lymphoma

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63
Q

Follow up in medullary thyroid cancer following thyroidectomy (Calcitonin not in option)

A

CEA, More
than 50% of patients with MTC have a mild elevation of CEA

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64
Q

What is the deepest structure in the posterior compartment of the leg

A

Tibial nerve

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65
Q

In how many weeks does intestine go back into the abdominal cavity in a fetus

A

12 weeks

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66
Q

180 cm tall man FVC

A

4x FEV1

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67
Q

How does stellate ganglion form

A

C7T1

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68
Q

Patient with urinary bladder cancer and made an operation for resection of urinary bladder
and then new bladder is formed from small intestine mainly ileum, creatinine is high. What is the
electrolyte disturbance

A

The mechanism of the development of hyperchloremic acidosis occurs due to ammonium
absorption. Ammonium ions dissociate into ammonia and hydrogen. The ammonia then
dissociates into cells and the hydrogen ion is actively absorbed in exchange for sodium. The
ammonium itself may be absorbed as a substitute for potassium through the potassium channels.
This causes the ammonium to enter the ileal or colonic luminal cell, and this is further balanced by
the absorption of chloride. Hence, the ammonium and chloride are absorbed and cause a
hyperchloremic acidosis and bicarbonate loss.

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69
Q

In hypotension, which receptors would respond first

A
  • Carotid sinus baroreceptors respond to increase and decrease in blood pressure.
  • Aortic sinus baroreceptors respond to decrease in blood pressure.
  • Firing from baroreceptors is directly
    proportional to parasympathetic supply to heart
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70
Q

Prostate position in a trauma setting

A

i.Bulbar rupture
- most common
- straddle type injury e.g. bicycles
- triad signs: urinary retention, perineal haematoma, blood at the meatus
ii. Membranous rupture
- can be extra or intraperitoneal
- commonly due to pelvic fracture
- Penile or perineal oedema/ hematoma
- PR: prostate displaced upwards (beware co-existing retroperitoneal haematomas as they may
make examination difficult)

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71
Q

How does preoperative carbohydrate loading p to improve the outcome of surgery?

A

it improves nitrogen balance and reduce insulin resistance

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72
Q

FACTS about anaemia

A

 Reticulocytosis in 7 days
 Erythropoises take 2-3 weeks after iron is started

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73
Q

About antithrombin

A

 Antithrombin inactivates thrombin and factor XII a, XIa, IXa and Xa
 Rare defect, inherited in autosomal dominant fashion
 10x increase in risk of thrombotic events
 Heparin may be ineffective because it works via antithrombin

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74
Q

What are the types of ectopic tissues in meckles diverticulum

A

Gastric and pancreatic

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75
Q

A 49-year-old Egyptian man on holiday in the United Kingdom presents wit haematuria. He gives a history of bladder irritative symptoms for seven months. He has lived in a rural community for his whole life. What is the possible organism?

A

Schistosoma haematobium

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76
Q

The cells of the stomach

A

Mucus Cells (Foveolar Cells) : mucus-producing cells that primarily line the gastric mucosa. They secrete mucus that acts as a barrier to the corrosive nature of the gastric acid.

Oxyntic Cells (Parietal Cell): Epithelial cells which are located in gastric glands found in the lining of the fundus and in the body of the stomach. They secrete hydrochloric acid and intrinsic factor.

Chief cells: Responsible for secreting pepsinogen. They have basally located nuclei and a basophilic cytoplasm with abundant rough endoplasmic reticulum and many secretory granules that contain pepsinogen. These are secreted into the lumen of the gastric gland.

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77
Q

Cardiac tamponade scenario and then arrest due to?

A

Reduced LV diastole

78
Q

What part of the kidney produces EPO

A

interstitial fibroblasts

79
Q

Where are the vertebral end plates

A

Between discs and the vert bodies

80
Q

What is a tracheo-innonimate fistula origin vessel

A

BCA

81
Q

How many secondary ossification centres between C3 and L5

A

5

82
Q

Where is the pulp of the finger initially directed during a PR

A

Posteriorly

83
Q

How does cleft lip develop

A

The medial nasal prominence fails to fuse with the maxillary prominence

84
Q

STSG infection

A

Most common organism is Pseudomonas and hence meropenem should be used

85
Q

FACT

A

No abnormal bone marrow cells are found in aplastic anaemia

86
Q

What ganglion is associated with loss in taste sensation in the anterior 2/3rd of the tongue

A

Geniculate ganglion (CN7)

87
Q

Most common bacteria for dental abscess

A

Bacteroides and actinomyces

88
Q

Pfennelstein incision

A

Skin, Subcut fat and fascia, ant rect sheath, rect muscle, transversalis fascia, extraperitoneal fat and peritoneum

Internal and transverse abdominal muscles are commonly split rather than divided to improve integrity of the rectus sheath

89
Q

Which blood vessel supplies extra oxygenated blood to the fetus when the umbilical cord is clamped

A

Umbilical vein

90
Q

First line for nausea as a result of raise ICP

A

Cyclizine. Dex can also be added later if needed

91
Q

Cardioplegic shock is delivered in which vein

A

Left marginal vein

92
Q

What is the sagging rope sign

A

Thin sclerotic line at the neck of the femur consistent with Perthes disease

93
Q

What line is interrupted in DDH

A

The Shenton line

94
Q

Flaps based on thirds of legs

A

Sural is for distal
Gastroc is for proximal and
Soleus is for medial

Free flaps from other areas are only used where there is no local sckin to graft with

95
Q

Postcholecystectomy syndrome

A

As the name suggest, when the symptoms do not resolve

96
Q

When is the fundus of the uterus cross the pelvic brim in pregnancy?

A

12th week

97
Q

What is the surgical approach for hemiarthroplasty in trauma?

A

Anterolateral approach or Hardinge approach

98
Q

What is the most appropriate investigation to guide stoma reversal?

A

Water soluble contrast enema

99
Q

FACT

A

THR for health and fit and mobile old ppl above the age of 85. Otherwise DHS

100
Q

FACT

A

Full-thickness skin grafts are the only viable option if there is very good blood supply and/or the area of defect is 1cm or less in diameter

101
Q

When there is testicular damage as well as tunica albuginea disruption

A

Testicular rupture

102
Q

What is the use of dex in liver mets

A

Mitigates the pain caused by stretching of the liver capsule due to cancer

103
Q

What is the minimum urine output?

A

0.5ml/kg/hr

104
Q

What contributes to the arc of riolan

A

Middle colic and left colic arteries

105
Q

Where will blood from a perforated duodenal ulcer track down

A

Right paracolic gutter

106
Q

What are the different degrees if haemarroids
Goligher classifications

A

1: Confined to the anal canal
2: Prolapse but reduce spnt
3: Need to be digitally reduced
4: Irreducibly prolapsed and thrombosed

107
Q

Intraductal papilloma vs DCIS

A

DCIS is Malignant but not yet invaded the basement membrane, There are usually no symptoms and it is found on imaging.

IDP: Affects on duct and can have bloody discharge. It affects only one duct and hence tx is usually microducotomy

108
Q

The SMA lies anterior to which part of the pancreas

A

Uncinate process

109
Q

Which structure is responsible for co-ordination of contraction of the purkenje fibres

A

Moderator bands

110
Q

Which artery is involved in coronary dominance

A

Posterior descending artery

111
Q

Which lobe is responsible for speech production

A

Brocas area and this is in the frontal lobe

112
Q

Thymus lesion associated with myasthenia

A

Benign thymoma as most thymus cancers tend to be benign

113
Q

What organism most commonly causes Fournier’s

A

Group A strep

114
Q

Which artery is the MCA in direct contact with

A

ACA

115
Q

TCC vs SCC

A

SCC of the bladder is more common when there is chronic inflammation, infection, or repeated injury and/or chronic catheter use. TCC is the most common histological type

116
Q

Patient plays Bball, wakes up and finds a swollen knee, why?

A

Medial meniscus injury as this is shock absorbing, Lateral meniscus can also present this way but is far less common

117
Q

What scan to do in prostate cancer and you are worried about bone mets

A

Bone scan

118
Q

IN an RTA what type of aortic dissection is more common

A

Descending

119
Q

Median nerve injury and the nerves are in close contact

A

Fascicular repair

120
Q

How many days of LMWH do you need after THR

A

28 days

121
Q

Drug that causes gynaecomastia

A

aMLODIPINE

122
Q

Patient presented with a hoarse voice after burn

A

Intubate

123
Q

What bacteria causes a sweet smell in nec fasc for example

A

P.Aureginosa

124
Q

What intestinal abnormality is associated with cystic fibrosis

A

Meconium ileus

125
Q

When to do total vs hemithyroidectomy

A

If the lesion is less than 4cm and there are no risk factors. The RF include age >45, Multifocal, Invasive, nodal involvement, mets etc

126
Q

What is the attachment of the tibialis posterior?

A

Navicular tuberosity

127
Q

FACT

A

Sarcoidosis increase ACE levels

128
Q

Which receptors due gastrin bind on

A

Cholecystokinin B receptors and this releases histamine and the histamine causes the parietal cells to secrete acid

129
Q

What is the dermatome responsible for that groin pain in a ureteric calculus

A

L1

130
Q

Torniquets

A

Increase both systolic and diastolic BP and an increase in HR due to sympathetic response of pain on inflation of the cuff. SVR will also increase and the the circulating volume has effectively increased

131
Q

How is IV fluid spread out

A

2/3rds remains in and 1/3rd remains extra cellular
Off the extracellular, 20% is intravascular

132
Q

What part of the bladder can be felt on bimanual vaginal examination

A

Base of the bladder

133
Q

FACT

A

Muscles of mastication is the first pharyngeal arch and muscles of facial expression is the second

134
Q

Where does a thyroglossal cyst arise from

A

Foramen cecum

135
Q

What is the first step in tx of MALT lymphoma?

A

eradication of the H Pylori

136
Q

FACT

A

Until the age of 2, infants are obligate nasal breathers

137
Q

FACT

A

In an insulinoma, all parameters such as insulin, C peptide and proinsulin will all be raised

138
Q

In ARDS

A

Give PEEP and raise FIO2

139
Q

What is the earliest sign of Volkman’s ischemic contracture

A

Pain

140
Q

What is the initial conservative management of Carpal tunnel syndrome

A

Wrist splint

141
Q

Name an absolute contraindication to spinal anaesthesia

A

Hypovolemia

142
Q

DVT in preg

A

Compression stocks + LMWH

143
Q

Bladder ruptures

A

More extraperitoneal than intraperitoneal, absorbable sutures are used to repair as non absorbable will cause stone formation in the future

144
Q

When does a burst abdomen actually occur

A

Post day 6

145
Q

Ewing’s sarcoma

A

Image-guided core biopsy

146
Q

What is the most important mediator for blood flow after a tourniquet is released

A

NO

147
Q

What is a late sign of compartment Syndrome?

A

Numbness as this indicated neurovascular compromise

148
Q

When breast lump is felt

A

Do breast US. If BRCA then do MRI as this has better sensitivity

149
Q

Palm on the table and unable to extend the thumb. 6 months post distal radial injury

A

EPL tendonitis

150
Q

What pigment will gall stones be after ileal resection

A

Black

151
Q

FACT

A

Tension pneumothorax is an obstructive type of shock

152
Q

Total vs lobe thyroidectomy

A

1-4 cm with no distant mets and no signs of invasion can undergo hemi thyroidectomy but the patient must understand that this may be converted to total depending on intraoperative findings

153
Q

HIV infection from HIV infected needlestick injury

A

0.3%
0.001% from mucocutaneous exposure

154
Q

Hep C risk of transmission from infected needle

A

1.8%

155
Q

Risk of Hep B infection from infected needle

A

30%

156
Q

What is one of the major concern in renal transplant evaluation

A

Hypertension

157
Q

Layers of a pfannelstein incision

A

Skin, superficial fascia, anterior rectus sheath, rectus abdominis, transversalis fascia,

158
Q

What is the hallmark histological finding of AAA

A

Disruption of the elastic lamellae

159
Q

Which transporter is stimulated by PTH to reabsorb calcium from the kidneys

A

TRPV 5

160
Q

What can bleed during an LP

A

Dura mater

161
Q

What vessel is encountered first during a parotidectomy

A

Ext Jug vein

162
Q

Chronic pancreatitis and there is still pain

A

Consider surgery for removal of strictures

163
Q

Where is EPO secreted from

A

Peritubular cells

164
Q

The volar aspect of the wrist

A

Essentially the front of the forearm close to the wrist.

165
Q

What is located lateral to the second part of the duodenum?

A

Hepatic flexure of the transverse colon

166
Q

HALF life

A

During each half-life, the concentration of the drug decreases by half

167
Q

What causes the bradycardia in the Cushing reflex

A

Vagal stimulation due to increase in BP from baroreceptors

168
Q

Where does the femoral nerve terminate

A

In the femoral triangle

169
Q

What lies lateral to the brachial artery in the cubital fossa

A

Biceps Brachii tendon, The bicipital aponeurosis forms the roof and is hence superficial

170
Q

Which muscle does the ulnar paradox involve

A

Flex dig long

171
Q

Which layer of the scalp is most commonly involved in avulsion injury

A

Loose areolar tissue

172
Q

What is the diagnostic test for PSC

A

MRCP

173
Q

RSI in patients with head injury

A

Etomidate as Ketamine causes in increase in ICP. Ketamine has a very good cardiovascular profile and hence should be given when CV instability is not present.

174
Q

Hyperkalemia waves

A

Loss of P waves, tenting T waves and widening QRS complex and this makes patients prone to having arrhythmias

175
Q

FACT

A

Info from the baroreceptors goes to the tractus solitaris

176
Q

Conn syndrome

A

It causes severe hypernatraemia, Hypokalaemia and hypocalcaemia. This also results in a positive trousseau sign which is painful clawing of the hand when a blood pressure cuff is applied

177
Q

Posterior wall difference of the inguinal canal

A

Laterally it is the transversalis fascia and medially it is the conjoint tendon. These are the places where the mesh is fixed

178
Q

What is the first line of investigation in a foreign object stuck inside the throat while swallowing

A

Flexible nasendoscopy

179
Q

Main blood supply of the femoral head

A

Median and lateral circumflex of the profunda

180
Q

Glucose absorbtion in the PCT

A

NA and K active transported maintain the concentration gradient

181
Q

Mastoiditis

A

If left untreated can spread to the epidural space. NOT THE MIDDLE EAR

182
Q

MRSA tx

A

Rifampicin can be used

183
Q

Where are salivary stones most common

A

Submandibular gland

184
Q

Which structure is the most important in regulation of the autonomic nervous system

A

Hypothalamus

185
Q

What is the most common type of lunch cancer to cavitate

A
186
Q

Insulinoma

A

Gold standard biochemical marker tests for diagnosis are C peptide, insulin, blood glucose and pro insuline BUT AFTER 72H FAST.

Generally clinicians will visualise an insulinoma via CT scan

187
Q

What is a late complication of HPB surgery?

A

Retained stone

188
Q

MONDOR’s disease

A

Thrombophlebitis of the chest wall and can feel like a line on the chest. This can happen by very light trauma such as a tight bra or cancer

189
Q

What is the shelf life of platelets stored at 22C

A

5 days

190
Q

Diarrhoea in farmers

A

Can be caused by Whipple’s disease

191
Q

Congenital heart diseases

A

Congenital heart disease
Cyanotic: TGA most common at birth, Fallot’s most common overall
Acyanotic: VSD most common cause

192
Q
A

MRCS Sciences deck (16 decks)

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