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
2
Q
FACT
A
All the medullary cranial nerves arise from anterior medulla, nothing from post
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
4
Q
Where is the chemoreceptors found
A
Retro-trapezoid nucleus of the medulla, Respons to H+ entering the CSF due to increased CO2
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.
6
Q
What is the first ste of haematopoesis
A
Yolk sack
7
Q
FACT
A
Approximately 80% of patients that have a myelomeningocele also have hydrocephalus
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
9
Q
VC
A
IRV + ERV + TV
10
Q
What is the most common site of VSD
A
Pre-membranous
11
Q
Hypothermia
A
32-35: Use warm IV and warm blanket
<32: Intraperitoneal fluid lavage
12
Q
Which cells secrete mucus to protect the gastric mucosa
A
Foveolar cells
13
Q
Spinal anaesthesia line
A
Supracrestal line
14
Q
Wher is EPO made
A
Interstitial cells of the peritubular capillaries
15
Q
Cardiac AP
A
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
17
Q
T3 half life
A
1 day
18
Q
Which renal cancer is most likely to respond to cytokine therapy
A
Clear cell
19
Q
Blood supply of the temporal lobe
A
Posterior and middle cerebral arteries
20
Q
Felon
A
DIP pulp joint infection
21
Q
Bleeding during an LP
A
Vertebral venous plexus
22
Q
Lymphatics from the body of the uterus and the cervix
A
Obturator nodes
23
Q
FACT
A
Chronic irritation from renal stones can cause SCC of the bladder
24
Q
What is the treatment for malignancy-associated hypercalcemia
A
Zoledronic acid
25
What to give to priapism
Phenylephrine
26
Tensor tympani vs tensor veli palatini
Main action of tensor tympani is acoustic reflex and the other one is opening the ET when swallowing and contributes the most to this.
27
FACT
Billiary obstruction is essential for bacterial cholangitis to develop
28
FACT
Axillary lymphadenopathy is not associated with DCIS
29
FACT
Hypothyroidism can lead to hypercholesterolaemia
30
What happens to CO in septic shock
It increases in sympathetic response to the
31
Paraphimosis vs phimosis
phimosis is only the thing that makes the skin tight, paraphimosis is the actual event
32
How can you reconstruct large facial defects?
Skin flaps due to the good vascula supply of the face
33
Which part of the heart is most commonly affected in penetrating trauma
RV due to it's anterior relation
34
Pseudoaneurysm management
If small then US and surveillance, if big and/or non resolving then compression
35
What is the most important marker for Multiple myeloma
Monoclonal gammopathy
36
Tibial fractures
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
37
Female with a 6-month history of on and off discharge and a history of nipple piercing
Mammary fistula
38
What is the mechanism of action of tranexamic acid
Plasmin inhibition
39
Ig that does not cross the placental barrier
IgM
40
FACT
Tacrolimus may cause increased level of post transplant ALP.
41
Aortic disruption after RTA
Descending part is the most common
42
Difference between non-union and malunion of a fracture
Non-union is painful but malunion is painless as the healing process is complete but the bones have just healed in the wrong position
43
When to stop apixaban pre-op
12 hours
44
FACT
Is IIV is posterior to the IIA
45
Type of amyloid in the heart
ATTR
46
Child post lung surgery can't push himself from crawling to standing position due to right arm
weakness, injury to which nerve has occurred?
Long thoracic nerve
47
Iatrogenic bowel perforation management
48
Rules of tourniquet
Exsanguination before inflation of the tourniquet improves the quality of the bloodless field and
minimizes pain associated with tourniquet use.
49
After oesophagectomy, blood supply of upper oesophagus
Inferior thyroid
50
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 ?
Presence of oestrogen
51
What did two Lateral ligaments passing from umbilicus carry during fetal Period
Deoxygenated blood from the fetus to the placenta
52
9 years old patient. Testicular cancer with high Beta-HCG, this one is also associated with cryptorchadism
Seminomas
53
Most dangerous valvular disease in intra op period
AS
54
Renal pigmented stone types
55
Girl goes skiing, crashed into soft snow. Sudden swelling knee with positive patellar tap. Difficulty extending knee. Knee aspiration showed hemarthrosis. What happened?
Meniscal damage
56
Knee trauma, swollen and tense, no sign of any damage, definitive diagnosis
Knee arthroscopy
57
What is the Reciprocal of absolute risk reduction?
Number needed to treat
58
Patient with refractory hypertension and diagnosed of Conn's what you think the cause of hypertension?
Increased plasma volume
59
AV septal defect. Defect in which?
Endocardial cushion
60
How does Frey's syndrome work
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
61
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?
Pleuroperitoneal membrane defect
62
What does a CD20 in thyroid profile most likely indicate
Lymphoma
63
Follow up in medullary thyroid cancer following thyroidectomy (Calcitonin not in option)
CEA, More
than 50% of patients with MTC have a mild elevation of CEA
64
What is the deepest structure in the posterior compartment of the leg
Tibial nerve
65
In how many weeks does intestine go back into the abdominal cavity in a fetus
12 weeks
66
180 cm tall man FVC
4x FEV1
67
How does stellate ganglion form
C7T1
68
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
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.
69
In hypotension, which receptors would respond first
* 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
70
Prostate position in a trauma setting
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)
71
How does preoperative carbohydrate loading p to improve the outcome of surgery?
it improves nitrogen balance and reduce insulin resistance
72
FACTS about anaemia
Reticulocytosis in 7 days
Erythropoises take 2-3 weeks after iron is started
73
About antithrombin
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
74
What are the types of ectopic tissues in meckles diverticulum
Gastric and pancreatic
75
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?
Schistosoma haematobium
76
The cells of the stomach
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.
77
Cardiac tamponade scenario and then arrest due to?
Reduced LV diastole
78
What part of the kidney produces EPO
interstitial fibroblasts
79
Where are the vertebral end plates
Between discs and the vert bodies
80
What is a tracheo-innonimate fistula origin vessel
BCA
81
How many secondary ossification centres between C3 and L5
5
82
Where is the pulp of the finger initially directed during a PR
Posteriorly
83
How does cleft lip develop
The medial nasal prominence fails to fuse with the maxillary prominence
84
STSG infection
Most common organism is Pseudomonas and hence meropenem should be used
85
FACT
No abnormal bone marrow cells are found in aplastic anaemia
86
What ganglion is associated with loss in taste sensation in the anterior 2/3rd of the tongue
Geniculate ganglion (CN7)
87
Most common bacteria for dental abscess
Bacteroides and actinomyces
88
Pfennelstein incision
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
Which blood vessel supplies extra oxygenated blood to the fetus when the umbilical cord is clamped
Umbilical vein
90
First line for nausea as a result of raise ICP
Cyclizine. Dex can also be added later if needed
91
Cardioplegic shock is delivered in which vein
Left marginal vein
92
What is the sagging rope sign
Thin sclerotic line at the neck of the femur consistent with Perthes disease
93
What line is interrupted in DDH
The Shenton line
94
Flaps based on thirds of legs
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
Postcholecystectomy syndrome
As the name suggest, when the symptoms do not resolve
96
When is the fundus of the uterus cross the pelvic brim in pregnancy?
12th week
97
What is the surgical approach for hemiarthroplasty in trauma?
Anterolateral approach or Hardinge approach
98
What is the most appropriate investigation to guide stoma reversal?
Water soluble contrast enema
99
FACT
THR for health and fit and mobile old ppl above the age of 85. Otherwise DHS
100
FACT
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
When there is testicular damage as well as tunica albuginea disruption
Testicular rupture
102
What is the use of dex in liver mets
Mitigates the pain caused by stretching of the liver capsule due to cancer
103
What is the minimum urine output?
0.5ml/kg/hr
104
What contributes to the arc of riolan
Middle colic and left colic arteries
105
Where will blood from a perforated duodenal ulcer track down
Right paracolic gutter
106
What are the different degrees if haemarroids
Goligher classifications
1: Confined to the anal canal
2: Prolapse but reduce spnt
3: Need to be digitally reduced
4: Irreducibly prolapsed and thrombosed
107
Intraductal papilloma vs DCIS
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
The SMA lies anterior to which part of the pancreas
Uncinate process
109
Which structure is responsible for co-ordination of contraction of the purkenje fibres
Moderator bands
110
Which artery is involved in coronary dominance
Posterior descending artery
111
Which lobe is responsible for speech production
Brocas area and this is in the frontal lobe
112
Thymus lesion associated with myasthenia
Benign thymoma as most thymus cancers tend to be benign
113
What organism most commonly causes Fournier's
Group A strep
114
Which artery is the MCA in direct contact with
ACA
115
TCC vs SCC
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
Patient plays Bball, wakes up and finds a swollen knee, why?
Medial meniscus injury as this is shock absorbing, Lateral meniscus can also present this way but is far less common
117
What scan to do in prostate cancer and you are worried about bone mets
Bone scan
118
IN an RTA what type of aortic dissection is more common
Descending
119
Median nerve injury and the nerves are in close contact
Fascicular repair
120
How many days of LMWH do you need after THR
28 days
121
Drug that causes gynaecomastia
aMLODIPINE
122
Patient presented with a hoarse voice after burn
Intubate
123
What bacteria causes a sweet smell in nec fasc for example
P.Aureginosa
124
What intestinal abnormality is associated with cystic fibrosis
Meconium ileus
125
When to do total vs hemithyroidectomy
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
What is the attachment of the tibialis posterior?
Navicular tuberosity
127
FACT
Sarcoidosis increase ACE levels
128
Which receptors due gastrin bind on
Cholecystokinin B receptors and this releases histamine and the histamine causes the parietal cells to secrete acid
129
What is the dermatome responsible for that groin pain in a ureteric calculus
L1
130
Torniquets
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
How is IV fluid spread out
2/3rds remains in and 1/3rd remains extra cellular
Off the extracellular, 20% is intravascular
132
What part of the bladder can be felt on bimanual vaginal examination
Base of the bladder
133
FACT
Muscles of mastication is the first pharyngeal arch and muscles of facial expression is the second
134
Where does a thyroglossal cyst arise from
Foramen cecum
135
What is the first step in tx of MALT lymphoma?
eradication of the H Pylori
136
FACT
Until the age of 2, infants are obligate nasal breathers
137
FACT
In an insulinoma, all parameters such as insulin, C peptide and proinsulin will all be raised
138
In ARDS
Give PEEP and raise FIO2
139
What is the earliest sign of Volkman's ischemic contracture
Pain
140
What is the initial conservative management of Carpal tunnel syndrome
Wrist splint
141
Name an absolute contraindication to spinal anaesthesia
Hypovolemia
142
DVT in preg
Compression stocks + LMWH
143
Bladder ruptures
More extraperitoneal than intraperitoneal, absorbable sutures are used to repair as non absorbable will cause stone formation in the future
144
When does a burst abdomen actually occur
Post day 6
145
Ewing's sarcoma
Image-guided core biopsy
146
What is the most important mediator for blood flow after a tourniquet is released
NO
147
What is a late sign of compartment Syndrome?
Numbness as this indicated neurovascular compromise
148
When breast lump is felt
Do breast US. If BRCA then do MRI as this has better sensitivity
149
Palm on the table and unable to extend the thumb. 6 months post distal radial injury
EPL tendonitis
150
What pigment will gall stones be after ileal resection
Black
151
FACT
Tension pneumothorax is an obstructive type of shock
152
Total vs lobe thyroidectomy
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
HIV infection from HIV infected needlestick injury
0.3%
0.001% from mucocutaneous exposure
154
Hep C risk of transmission from infected needle
1.8%
155
Risk of Hep B infection from infected needle
30%
156
What is one of the major concern in renal transplant evaluation
Hypertension
157
Layers of a pfannelstein incision
Skin, superficial fascia, anterior rectus sheath, rectus abdominis, transversalis fascia,
158
What is the hallmark histological finding of AAA
Disruption of the elastic lamellae
159
Which transporter is stimulated by PTH to reabsorb calcium from the kidneys
TRPV 5
160
What can bleed during an LP
Dura mater
161
What vessel is encountered first during a parotidectomy
Ext Jug vein
162
Chronic pancreatitis and there is still pain
Consider surgery for removal of strictures
163
Where is EPO secreted from
Peritubular cells
164
The volar aspect of the wrist
Essentially the front of the forearm close to the wrist.
165
What is located lateral to the second part of the duodenum?
Hepatic flexure of the transverse colon
166
HALF life
During each half-life, the concentration of the drug decreases by half
167
What causes the bradycardia in the Cushing reflex
Vagal stimulation due to increase in BP from baroreceptors
168
Where does the femoral nerve terminate
In the femoral triangle
169
What lies lateral to the brachial artery in the cubital fossa
Biceps Brachii tendon, The bicipital aponeurosis forms the roof and is hence superficial
170
Which muscle does the ulnar paradox involve
Flex dig long
171
Which layer of the scalp is most commonly involved in avulsion injury
Loose areolar tissue
172
What is the diagnostic test for PSC
MRCP
173
RSI in patients with head injury
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
Hyperkalemia waves
Loss of P waves, tenting T waves and widening QRS complex and this makes patients prone to having arrhythmias
175
FACT
Info from the baroreceptors goes to the tractus solitaris
176
Conn syndrome
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
Posterior wall difference of the inguinal canal
Laterally it is the transversalis fascia and medially it is the conjoint tendon. These are the places where the mesh is fixed
178
What is the first line of investigation in a foreign object stuck inside the throat while swallowing
Flexible nasendoscopy
179
Main blood supply of the femoral head
Median and lateral circumflex of the profunda
180
Glucose absorbtion in the PCT
NA and K active transported maintain the concentration gradient
181
Mastoiditis
If left untreated can spread to the epidural space. NOT THE MIDDLE EAR
182
MRSA tx
Rifampicin can be used
183
Where are salivary stones most common
Submandibular gland
184
Which structure is the most important in regulation of the autonomic nervous system
Hypothalamus
185
What is the most common type of lunch cancer to cavitate
186
Insulinoma
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
What is a late complication of HPB surgery?
Retained stone
188
MONDOR's disease
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
What is the shelf life of platelets stored at 22C
5 days
190
Diarrhoea in farmers
Can be caused by Whipple's disease
191
Congenital heart diseases
Congenital heart disease
Cyanotic: TGA most common at birth, Fallot's most common overall
Acyanotic: VSD most common cause
192
