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MRCS > PTM - 2 > Flashcards

PTM - 2 Flashcards

1
Q

Factors contributing to lower oesophageal sphincter preventing reflux

A

Acute angle of entry of oesophagus (angle of his)

Phreno-oesophageal ligament encircling the GOJ

Prominent mucosal folds in GOJ

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2
Q

What is achalasia

A

Oesophageal dysmotility

caused by disordered coordination of the perstaltic action of smooth muscle + non-relaxation of LES (loss of myenteric plexus)

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3
Q

Manometry findings of achalasia

A

High pressure in lower oesophageal sphincter

Failure to relax lower oesophageal sphincter on swallowing

Aperistalsis

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4
Q

Where do ophthalmic veins drain

A

Cavernous sinus

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5
Q

Clinical fx of orbital blow fracture

A

Infraorbital sensory loss
Enophthalmos
Diplopia
Orbital emphysema

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6
Q

Posterior relations of kidney

A

Diaphragm
Psoas
Quadratus lumborum

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7
Q

What lies anterior to IVC at its origin

A

Right common iliac artery

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8
Q

What ligament joins coracoid to clavicle

A

Coracoclavicular ligament made off conoid and trapezoid ligaments

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9
Q

Under which ligament does supraspinatous get impinged

A

coracoacrominal ligament

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10
Q

Boundaries of posterior mediastinum

A

Superior = T4/5
Anterior: pericardium
Posterior: T5-T12 body
Lateral: pleura
Inferior: diaphragm

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11
Q

Path of azygous vein

A

Formed by union of first ascending lumbar and subcostal vein below diaphragm, right of vertebral column.
Enters diaphragm through aortic hiatus
Ascends in the posterior thorax
Empties into SVC

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12
Q

Tributaries of azygous vein

A

Hemiazygous vein (joins at T8)

Accessory hemiazygous vein (Joins at T7)

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13
Q

Path of hemiazygous vein

A

Forms from left ascending lumbar + left subcostal
Ascends left of vertebral column before entering azygous at T8

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14
Q

Path of accessory hemiazygous vein

A

Formed by the union of 4th-8th left intercostal vein
Descends on the left before draining into azygous at T7

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15
Q

Path of sympathetic trunk

A

Exits the skull through carotid canal
Travels lateral to vertebral column from base of skull to coccyx
Passes anterior to the neck of the first rib
Passes behind median arcuate ligament of the diaphragm

Lowest cervical and upper thoracic join to form stellate ganglion
Thoracic ganglia give greater, lesser and least splanchnic nerves

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16
Q

Path of thoracic duct

A

Formed at the confluence of left and right lumbar lymph trunks and left and right intestinal lymph trunks (cisterna chyli)

Crosses diaphragm through the aortic hiatus at T12

Crosses from right to left at T4/5

Empties into the angle between internal jugular and subclavian vein

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17
Q

Where does the right thoracic lymphatic trunk drain into?

A

Into the right brachiocephalic vein

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18
Q

What does right lymphatic trunk drain?

A

Right upper limb
Right lung
Right breast
Right head+neck

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19
Q

Between which layers is the intercostal bundle found

A

Between innermost intercostal and internal intercostal

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20
Q

Blood supply to intercostal space

A

Anterior:
- interior thoracic -> top 6 intercostal arteries
- musculophrenic -> bottom 6

Posterior:
- subclavian -> costocervical: highest inercostal -> top 2 intercostal
- descending aorta -> remaining branches

21
Q

On which cartilage is thyroid gland located

A

Below the thyroid cartilage
Isthmus below the cricoid cartilage

Attaches to 2-4th tracheal ring by Berry ligament

22
Q

How to perform needle cricothyroidotomy

A

Aseptic field
14G needle with syringe half filled with sterile water
Extend neck, cricothyroid recess
Aspirate as entering,
Once bubbles, remove syringe
Make sure help on its way

23
Q

Innervation of strap muscles

A

Ansa cervicalis except thyrohyoid (C1)

24
Q

Pharyngeal origin of thyroid

A

1st pharyngeal arch

25
Q

Pharyngeal arch origin of parathyroid

A

Superior parathyroids: 4th pharyngeal arch

Inferior parathyroid: 3rd pharyngeal along with thymus

26
Q

Most common site of cerebral anaeurysm

A

85% in anterior circulation (ant cerebral and communicating arteries 35%, ICA and post communicating 35%)

27
Q

Ix for subarachnoid haemorrhage

A

CT H picks up 95%

Lumbar puncture after 12 hrs for xanthochromia

CT angio for aneurysms

28
Q

What age do the cranial sutures ossify

A

18-24 months

29
Q

Craniosynostosis

A

Condition where cranial sutures are fused at birth

30
Q

Boundaries of middle cranial fossa

A

Anterior: lesser wing of sphenoid and anterior margin of chiasmatic groove

Lateral: lesser wing of sphenoid + temporal bone

Posterior: Crest of temporal bone and dorsum selae

31
Q

Where are cavernous sinuses found

A

Either side of sella turcica

32
Q

What drains into cavernous sinus

A

Superficial middle cerebral
Superior and inferior ophthalmic
Sphenoparietal

33
Q

What muscle responsible for tongue protrusion

A

Genioglossus

34
Q

Which nerve at risk of damage during submandibular gland excision

A

Marginal mandibular
Lingual
Hypoglossal

35
Q

Where are parts of brachial plexus

A

Roots: between anterior and middle scalene
Trunks: base of posterior triangle
Divisions: Posterior to middle 1/3 of clavicle
Cords: 2nd part of axillary artery
End branches: 3rd part of axillary artery

36
Q

Klumpske palsy cause

A

Damage to lower part of brachial plexus usually during breech delivery and shoulder dystocia

37
Q

Klumpske presentation

A

Claw hand (damage to ulnar nerve and median)

38
Q

Erbs palsy cause

A

RTA stretching the upper brachial plexus nerve roots (falling/streaching shoulder)

39
Q

Erbs presentation

A

Waiter’s tip

40
Q

Why sensation to thenar eminence intact in carpal tunnel

A

palmar cutaneous branch of median comes off before the tunnel

41
Q

Nerve supply to parietal and visceral pleura

A

Parietal: intercostal and phrenic nerve

Visceral: pulmonary plexus autonomic nerves (vagus and sympathetic)

42
Q

Why sensation to thenar eminence intact in carpal tunnel

A

palmar cutaneous branch of median comes off before the tunnel

43
Q

What drains into cavernous sinus

A

Superficial middle cerebral
Superior and inferior ophthalmic
Sphenoparietal

44
Q

On which cartilage is thyroid gland located

A

Below the thyroid cartilage
Isthmus below the cricoid cartilage

Attaches to 2-4th tracheal ring by Berry ligament

45
Q

Blood supply to intercostal space

A

Anterior:
- interior thoracic -> top 6 intercostal arteries
- musculophrenic -> bottom 6

Posterior:
- subclavian -> costocervical: highest inercostal -> top 2 intercostal
- descending aorta -> remaining branches

46
Q

Between which layers is the intercostal bundle found

A

Between innermost intercostal and internal intercostal

47
Q

Boundaries of posterior mediastinum

A

Superior = T4/5
Anterior: pericardium
Posterior: T5-T12 body
Lateral: pleura
Inferior: diaphragm

48
Q

Under which ligament does supraspinatous get impinged

A

coracoacrominal ligament

49
Q

What lies anterior to IVC at its origin

A

Right common iliac artery

MRCS (29 decks)

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