PasTest Flashcards
Where are most of the ganglia for the sympathetic nervous system found?
Paraspinally, Bilaterally
Compare the mechanism of action of Vincristine and 5-fluorourcil?
Vincristine = interferes with microtubule function during mitosis, causing cell apoptosis
5-FU - an antimetabolite - it is a pyrimidine analogue and inhibits formation of essential nucleic acids
Compare the routes that the posterior interosseous nerve (branch of radial nerve) and radial nerve exit the antecubital fossa?
Posterior interosseous nerve - between 2 heads of supinator muscle
Radial nerve - between brachioradialis and brachalis
Which artery must be identified and ligated in a right hemicolectomy?
The right colic artery
It is a branch of the superior mesenteric artery and supplies the ascending colon
What vessel forms the posterior border of the epiploic foramen?
What spinal level does this vessel commence?
The IVC - it lies behind the portal vein
Commences opposite the L5 vertebra
What structures are contained within epiploic foramen?
Hepatic artery
Portal vein - IVC lies behind this
CBD
What is the anatomical course of the sympathetic trunk as it passes from abdomen to thorax?
Posterior to the medial arcuate ligament over psoas major
Which type of shock causes bradycardia, warm peripheries and hypotension unresponsive to fluid resus?
Neurogenic shock
What is the primary pathophysiology seen in neurogenic shock?
Decreased systemic vascular resistance - vasomotor tone is lost due to sympathetic denervation
What type of hypoxia occurs in the presence of metabolic poisons (cyanide)?
Histotoxic hypoxia
In sickle cell disease what is the most common cause of osteomyelitis?
Salmonella
In acute osteomyelitis most common cause is staph aureus or strep pyogenes
Which rotator cuff muscle is responsible for internal rotation?
Subscapularis
Which 2 rotator cuff muscles are responsible for external rotation?
Infraspinatus and teres minor
Compare the drainage of lymph from the penile skin, the glans and erectile tissue?
Penile skin = superficial inguinal lymph nodes
The glans = Deep inguinal lymph nodes
Erectile tissue = internal iliac nodes
Name the 2 layers of superficial fascia of the anterior abdominal wall. Which is the superficial adipose layer and which is the deeper membranous layer ?
Fatty anterior layer = Camper’s fascia
Deeper membranous layer = Scarpa’s fascia
Compare the uses of polypropylene monofilament and polydioxanone monofilament?
Polypropylene - used for vascular anastomosis, has less plasticity than PDS
Polydioxanone monofilament (PDS) - commonly used to close abdominal wall, retains tensile strength and not totally absorbed for 6/12
Compare the type of metastatic bone disease seen from renal and prostate primaries (ie-sclerotic or lytic)?
Prostate = sclerotic
Renal= lytic
Typically, prostate cancer is the only one to cause sclerotic lesions
Which layers of the abdominal wall do the inferior epigastric vessels sit?
Between the transversus abodminis muscle and peritoneum
What is produced by chief cells in the stomach?
Pepsinogen
What is the ATLS formula for IV fluid prescribing in burns patients?
volume = 2ml x weight x %TBSA
This is total vol that should be given in 24 hours. Half of the calculated vol should be given in first 8 hours
Compare treatment of hyper acute and acute rejection of organ transplants?
Hyperacute rejection - removal of transplant
Acute rejection - corticosteroids
Compare the durations and mediators involved in hyperacute vs acute rejection of organ transplant?
Hyperacute rejection - occurs in minutes following transplantation. Antibody mediated
Acute rejection - occurs days/weeks following transplantation. Cell mediated
The medial and lateral femoral circumflex arteries are direct branches of what?
The profunda femoris artery
It is a branch from the lateral and posterior part of the femoral artery
Compare the treatment for Graves disease for those in 1st trimester of pregnancy and everyone else?
1st trimester pregnancy = Propylthiouracil (hepatotoxic)
Everyone else = carbimazole (causes congenital defects)
Which nerve is at greatest risk during posterior approach THR?
Sciatic nerve
Compare what is produced in adrenal cortex and adrenal medulla?
Adrenal medulla = “GFR ACD” - Aldosterone, cortisol, dihydroepiandosterone
Adrenal cortex = adrenaline, noradrenaline
Which triangular muscle sits anterior to the rectus abdominus?
Pyramidalis muscle
What forms the anterior border of the epiploic foramen?
Anterior border is the free edge of the lesser omentum
Which lobe of the liver forms the superior border of the epiploic foramen?
Caudate lobe of the liver is the superior border of the epiploic foramen
What acid base profile does prolonged vomiting cause?
Hypochloraemic metabolic alkalosis
Loss of H+ and Cl- from the gastric secretions being vomited up
Where do the anterior and middle scalene muscles insert into? How are they related to the brachial plexus?
Both insert into the first rib
The brachial plexus passes in between then anterior and middle scalene muscles
Which nerve sits on the anterior surface of the sternocleidomastoid muscle?
Transverse cervical nerve
Name the 4 components of the carpal tunnel?
Median nerve
Flexor pollicus longus
Flexor digitorum superficalis
Flexor digitorum profundus
Which nerve passes through the canal of Guyon in the hand?
Ulnar nerve
Guyons canal lies superficial to flexor retinaculum and lateral to pisiform bone
What are the palmar and dorsal boundaries of anatomical snuffbox?
Dorsal = Extensor pollicus longus
Palmar = Extensor pollicus brevis, Abductor pollicus longus
Which muscles contribute to the extension of the fingers at the interphalangeal joint?
Lumbricals
They arise from the Flexor digitorum profundus tendon.
They flex the MCPjs and IPJs in the fingers
Does the palmar cutaneous branch of the median nerve pass through the carpal tunnel?
No - it branches proximal to the carpal tunnel and passes superficial to the flexor retinaculum to supply sensation to palm of hand
Describe the medial and distal articulations of the scaphoid bone?
Medial articulation= Lunate
Distal articulation = Trapezium
Name the 4 carpal bones in the distal row? (from lateral to medial)
Trapezium
Trapezoid
Capitate
Hamate
Name the 4 carpal bones in the proximal row? (lateral to medial)
Scaphoid
Lunate
Trequetrum
Pisiform
Which tendon plays crucial role in the pincer grip of the thumb?
Flexor pollicus longus
The abductor pollicus longus is responsible for thumb abduction. Weakness of pincer grip is more related to flexion of the thumb rather than abduction (moving thumb away from palm)
Damage to which tendon is suggested by a positive Froments sign?
Damage to ADDuctor pollicus longus (ulnar nerve)
Which 2 tendons are inflamed in De Quervains tenosynovitis? Which compartment of the wrist do they travel in?
Extensor pollicus brevis
Abductor pollicus longus
They travel in first dorsal compartment and run along lateral aspect of wrist
Which vein does prostate cancer spread via?
Internal vertebral venous plexus
These veins are valveless so serve as a route for mets
What nerve travels through the diaphragm with the oesophagus at T10?
The left and right vagus nerves
Name the 3 components that pass through the diaphragm at T12?
Aorta
Azygous vein
Thoracic duct
Compare what the anterior and posterior interventricular arteries are branches of?
Anterior interventricualr artery = branch of left coronary artery. also known as the left anterior descending artery
Posterior inter ventricular artery = branch of right coronary artery
Which site does diverticular disease most commonly affect?
Sigmoid colon
Meckels most commonly affects ileocaecal area (small intestine)
Compare the nerves that follow the basilic and cephalic veins?
Basilic vein = medial cutaneous nerve
Cephalic vein = lateral cutaneous nerve
Which nerve forms as the medial nerve enters between the 2 heads of the pronator teres muscle?
Anterior interosseous nerve
Which artery is used in CABG to graft the LAD artery?
The left internal thoracic artery (also referred to as left internal mammary artery)
What stage of wound healing is migration and proliferation of fibroblasts into the wound seen?
The proliferation phase of wound healing
Describe the calcium and PTH levels in a patient with MEN I?
PTH: raised
Calcium: raised
MEN I can cause parathyroid hyperplasia or adenomas causing raised PTH and subsequent calcium
Which artery is affected in lateral medullary syndrome ?
Posterior Inferior cerebellar artery (PICA)
It is a branch of the vertebral artery and supplies the lateral medulla
Compare the arteries affected in lateral medullary syndrome and locked in syndrome?
Lateral medullary= Posterior inferior cerebellar artery
Locked in syndrome = Basilar artery (supplies the pons, medulla and lower midbrain)
What is the location of the internal venous plexus of the spine?
Within the epidural (extradural) fat
It is where epidural anaesthesia should be sited.
There is a complex plexus of veins without valves
Which cell type is involved in the process of wound healing in the proliferative stage?
Fibroblasts
What is the pneumonic and what are the branches to the internal carotid?
“Only Press Carotid Arteries Momentarily”
Ophthalmic artery
Posterior communicating
Choroidal
Anterior cerebral
Middle cerebral
The medial (adductor) compartment of the thigh is supplied by the obturator nerve. Which is the only muscle in this compartment not supplied by the obturator nerve?
Pectineus - it is supplied by the femoral nerve
What is the most common parotid tumour?
Pleomorphic adenoma
Compare who would present with Phyllodes tumour and a Fibroadenoma?
Both cause a firm, painless lump
Fibroadenoma - occurs in <30y/o’s
Phyllodes
Which type of endocarditis is associated with hypercoaguable states or advanced malignancy?
Marantic endocarditis
Found in the absence of infection and form along the lines of valve closure
Which part of the pancreas lies between the abdominal aorta and the SMA?
Uncinate process
Compare the widest and narrowest part of the male urethra?
Narrowest - Membranous part (extends from prostatic urethra)
Widest - Prostatic urethra (widest and most dilatable part of urethra)
Which substance enhances antithrombin III activity?
Heparin
Antithrombin III is a serine protease inhibitor- it inactivates several enzymes in the coag system
What is the role of Luteinising hormone in males?
Stimulation of leydig cells, causing testosterone secretion
What is stimulated by FSH in males?
FSH stimulates Sertoli cells to produce androgen binding proteins and inhibin
In males, which hormone is required for spermatogenesis and spermiogenesis?
FSH and testosterone
LH indirectly involved as it causes testosterone secretion
What connects the third and fourth ventricles to allow CSF to flow?
Aqueduct of Sylvius
What connects the paired lateral ventricles to the third ventricle?
Foramen of Monro (inter ventricular foramina)
Compare how damage to external or recurrent largnyeal would affect phonation ?
External laryngeal - innervates cricothyroid, responsible for high pitched phonation
Recurrent laryngeal - innervates rest of voice box - damage would result in hoarse voice
Describe the functions of Ortolani’s and Barlows test when testing for DDH?
Ortolani’s - tests to see if the hip is dislocated and can be relocated
Barlow’s - checks if the hip can be dislocated
Which 2 muscles does the spinal accessory nerve innervate?
Sternocleidomastoid
Trapezius
Compare organisms causing superficial and deep abscesses?
Superficial abscesses = Staph aureus, strep pyogenes
Deep abscesses = Gram neg species (E.Coli), anerobes (bacteroides)
What is the most common cause of secondary lymphoedema in the UK?
Malignant neoplastic lymphatic infiltration
Obstruction to the flow of lymph drainage causes lymphoedema
Which state is iron more easily absorbed in? Fe 2+ or Fe3+?
How do gastric acid secretions affect its absorption?
Fe2+ (ferrous state rather than ferric state) is more easily absorbed
When ferrous iron oxidised to ferric it becomes insoluble and can’t be absorbed
Gastric acid secretions lower the pH and aid absorption of Fe2+
What is haemosiderin? What is it composed of?
Haemosiderin is an iron storage complex
Composed of partially digested ferritin and lysosomes
Which is the only rotator cuff muscle to insert onto the lesser trochanter of the humerus?
What is this muscle innervated by?
Infraspinatus - innervated by the suprascapular nerve
Name the innervation of the muscles of the rotator cuff?
Supra and infraspinatus = supra scapular nerve
Subscapular nerve = upper and lower sub scapular nerve
Teres minor = axillary nerve
Recurrence of which type of thyroid cancer can be monitored for with calcitonin levels?
Medullary carcinoma
What can be tested for to assess for recurrence of follicular carcinoma?
Thryogglobulin serum levels
What forms the medial wall of the axilla?
Serratus anterior, ribs 1-4 and the intercostal muscles underlying it
Name the 3 conditions associated with MEN 2A?
Medullary thyroid carcinoma
Phaeochromocytoma
Hyperparathyroidism
What structure does the oesophagus pass through in the diaphragm?
Through the muscular sling of the right crus
Passes anterior to the medial arcuate ligament
Which part of the skull does the Eustachian tube penetrate?
Petrous temporal bone
The cartilaginous part of the Eustachian tube is intimately related to the greater wing of the sphenoid, but does not penetrate it
Which bone does the internal carotid artery enter to reach the intracranial cavity?
Temporal bone
The internal carotid artery passes alongside the sphenoid bone but not through it
Which antibiotic can be used in bacterial endocarditis if patients have penicillin allergies or an MRSA infection?
Linezolid
An oxazolidinone antibiotic , effective against gram positive bacteria including MRSA
Describe what is transmitted by lateral corticorticospinal, DCML and spinothalamic tracts? Where does each decussate?
Lateral corticospinal - motor nerves transmitted. Decussates @ medulla oblongata
DCML - Decussates at lower medulla. Transmits fine touch, proprioception and vibration
Spinothalamic - decussates in spinal canal. Transmits pain and temperature sensation
Describe the classic findings in brown sequard syndrome?
Brown sequard = hemisection of spinal cord
Ipsilateral - paresis, loss of fine touch, proprioception and vibration
Contralateral - loss of pain and temperature sensation
Describe baroreceptor firing response in a hypovolemic patient?
Baroreceptor firing reduces
This causes increased sympathetic activity - increased HR, vasoconstriction and increased cardiac contractility.
Parasympathetic firing is reduced, again increasing HR
Name vit K dependant clotting factors?
CFs 2, 7, 9, 10
Name the 3 factors that inhibit the coagulation cascade?
Antithrombin III
Protein C and S pathways
Deficiency of any of these will predispose to thrombosis
How is coagulation cascade initiated?
The exposure of circulating factor VII to tissue factor, which in turn activates factor X (extrinsic pathway)
Which muscles of the tongue are innervated by the hypoglossal nerve?
All extrinsic muscles of the tongue are innervated by the hypoglossal nerve, other than the palatoglossus muscle
Palatoglossus muscles is innervated by the vagus nerve
What is the cremasteric muscle an extension of?
The internal abdominal oblique muscle
In the cubital fossa, what is the most common anatomical arrangement from lateral to medial, of the median nerve, biceps tendon and brachial artery?
Biceps tendon
Brachial artery
Median nerve
Which tendon may rupture as a late complication of displaced colles fracture?
Extensor pollicus longus
Compare where the spinal cord ends for neonates/infants and adults?
Neonates/infants = L3
Adults = L1-2
Which nerve innervates the lattisimus dorsi muscle? Which procedure may this be injured in and how would it present clinically?
Thoracodorsal nerve innervates lat dorsi
Can be injured during axillary LN dissection in breast cancer
Lat Dorsi is responsible for extension, rotation and adduction of the arm
Compare the actions of the thoracodorsal and intercostobrachial nerve?
Both can be injured in axillary LN clearances
Thoracodorsal - innervates Lat Dorsi (rotation, extension and adduction of arm)
Intercostobrachial - sensory innervation over the axilla. No motor component
Where is erythropoietin produced?
Renal peritubular cells
Anaemia can be caused in patients with CKD as they produce less erythropoietin due to kidney damage
Compare innervations of the internal and external anal sphincters?
Internal - sympathetic and parasympathetic supply from the pelvic plexus
External - inferior rectal branch of pudendal nerve (S2,3,4)
Compare the differences seen in meningocele and myelominingocele?
Meningocele - a fluid filled (CSF) sac without the spinal cord
Myelomeningocele - fluid filled sac with the spinal cord in it (Most severe)
Spina bifida occulta- there is a covering of skin with no fluid filled sack
How is the majority of CO2 carried in the bloodstream?
As bicarbonate
Name the pneumonic and the 4 nerves arising from the posterior cord of brachial plexus?
STAR
Subscapular nerve (upper and lower)
Thoracodorsal nerve
Axillary nerve
Radial nerve
What vertebral level is the commonest level for termination of the spinal cord in adults?
Between L1 and L2
This is why lumbar punctures are done at L3-L4 - to avoid the spinal cord
In newborns, the spinal cord terminates at L3
Which structural abnormality can be fixed with a mayo repair?
Umbilical hernia
When passing through the carpal tunnel, which 2 tendons does the median nerve sit between?
Median nerve sits between the flexor pollicus longus tendon and flexor digitorum superficialis
An injury to which cord of the brachial plexus may cause wrist drop and weak shoulder abduction??
Posterior cord
Involves the radial nerve and axillary nerve
Describe the autoantibody seen in Grave’s disease?
What does it activate?
An IgG antibody known as a Long Acting Thyroid Stimulator (LATS)
It activates the thyrotropin receptor (TSHR) to stimulate the TSH receptor and increase iodine uptake and cyclic AMP production
What is the most potent androgen and essential in the development of male external genitilia?
Dihydrotrstosterone
What level do the carina sit and the start and end of the aortic arch?
Sternal angle of Louis - Vertebral level T4/5
This is also the level that the azygous vein joins the SVC
Name 4 things that happen at the Sternal angle of Louis (T4/5)
Carina sit here
Azygous vein joins SVC
Recurrant laryngeal loops round aortic arch
The start and end of aortic arch
The thoracic duct also moves from left to right
What is the thyroidea ima artery a direct branch of?
The brachiocephalic trunk
How does adding adrenaline to lidocaine affect rate of absorption?
The vasoconstriction caused by adrenaline reduces the rate of absorption of the lidocaine
This prolongs the duration of action of the lidocaine
Compare what carotid bodies and carotid baroreceptors regulate?
Carotid baroreceptors - regulate BP
Carotid bodies - regulate respiratory rate
Name where the majority of venous blood and lymph drains from the breast
Majority drains to axillary LNs and axillary vein
The breast covers 2/3 of pect major muscle and 1/3 serratus anterior muscle
What type of lesion is described as a benign overgrowth of fully differentiated normal components of tissues ?
Hamartoma
The most common hamartomas are vascular and include birthmarks like port wine stains
Gastrointestinal hamartomas are seen in Peutz-Jeghers syndrome
What nerve supplies sensory innervation to pubic symphysis and femoral triangles?
Ilioinguinal nerve
What is the anatomical name for Morrison’s pouch?
It does not usually contain fluid but if it does, where could fluid be from?
Hepatorenal recess or right hepatic space
Ascities can collect in Morrison’s pouch
Is a null hypothesis being accepted when it is false a type 1 or type 2 statistical error?
Type 2 error - it’s a false negative
Is a null hypothesis being rejected when it’s true a type 1 or 2 statistical error?
Type 1 error - its a false positive
Excessive release of which hormone following gastrectomy causes dumping syndrome?
Excessive release of insulin
Causes dizziness, sweating, palpitations and occasional collapse after big meals
What is the critical mediator of DIC?
Tissue Factor- exposed in septic and traumatic conditions
Name the 2 structures that pass anterior to the anterior scalene muscle?
Subclavian vein
Phrenic nerve
Name the 2 structures that pass in between the anterior and middle scalene muscle?
Subclavian artery
Brachial plexus
In thoracic outlet syndrome, these structures can be compressed against the 1st rib
What ABPI value may patients with T2DM and leg pain at rest have?
Why?
ABPI >1.2
They have vessel calcification, which will result in abnormally high ABPI readings
Which nerve is closely related to the middle meningeal artery?
The auriculotemporal nerve
It can be damaged along with the middle meningeal artery in an extra dural haematoma - this causes parasthesia of the ipsilateral external ear and outermost part of tympanic membrane
Which splenic structure lies most posteriorly and most anteriorly?
Most anterior = Gastro-splenic ligament
Most posterior = Lienorenal ligament
What does angiogenesis in wound healing occur as a result of?
Endothelial cell proliferation
Which cranial bone does the foramen spinosum lie?
Sphenoid bone
