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MRCS Muhesh > Questions from Pastest > Flashcards

Questions from Pastest Flashcards

1
Q

What is Bladder Exstrophy?

A

Congenital abnormality where the bladder is open and exposed on the outside. It is associated with adenocarcinoma of the bladder

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2
Q

By what mechanism does hydrofluoric acid cause electrolyte imbalance in burns patients?

A

Two mechanisms:

i) Hydrogen ions cause the inital skin damage (Because it is an acid)
ii) Fluoride - permeates the skin and binds calcium

Hypocalcaemia - is associated with cardiac arrhythmias (prolonged QT interval), muscle rigidity/cramps and hypertonicity

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3
Q

Diagnostic tests in acromegaly?

A

Best is Oral glucose tolerance test with GH:

GH is suppressed to <2 in normal people but often rises in people with acromegaly

IGF1 is more sensitive than GH and more reliable

Prolactin can be raised in 30% of patients

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4
Q

Innervation of the GI tract?

A

Parasympatehtic

Grossly - the vagus nerve supplies the GI tract up to the distal transverse colon. The rest of the GI tract i.e. splenic flexure onwards is innervated by pelvic splanchnic nerves.

Ganglia:

Coeliac - Lower oesophagus and stomach

Superior mesenteric -Duodenum–> jejenum, Caecum, Proximal ascending colon

Inferior mesenteric - Distal Transverse colon –> Sigmoid colon

There is lots of overlap between these

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5
Q

What is Gardner’s Syndrome?

1 MAJOR

and

9 other features

A

FAP (APC mutation. APC is a tumour suppressor gene)
+

Desmoid tumours,

Epidermal Cysts,

Lipomas,

Multiple Osteomas,

Small Intestinal Malign., Thyroid Malign, Pancreatic Malign. Biliary hepatoblastoma.

Connective Tissue Diseases

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6
Q

Three anatomical narrowings or the ureter

A

Ureteropelvic junction

Ureteric crossing over iliac vessels

Ureterovesicular junction

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7
Q

Genetic associations of:

Melanoma

Basell Cell Carcinoma

A

Melanoma: CDKN2A, BRCA1, CDK4

BCC: Gorlin Syndrome, PTCH2, Rombo syndrome, bazex-dupre-christol syndrome,

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8
Q

How many days after inadequate calorific intake should TPN/Enteral adjuncts be used?

A

7 Days

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9
Q

Where is:

Foregut/Midgut Junction

Midgut/Hindgut Junction

A

Foregut/Midgut junction - Major Duodenal Papillae. This is where common bile duct and pancreatic duct empty into duodenum

Foregut/Midgut Junction - Distal third of Transverse colon

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10
Q

Where does:

Papillary thyroid carcinoma metastasise too?

Follicular thyroid carcinoma metastaise too?

A

Papillary thyroid carcinoma - Cervical Lymph Nodes

Follicular thyroid carcinoma - Lung and bone

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11
Q

Which nerves are in close relation to the superior thyroid artery?

A

External laryngeal nerve - branch of the superior laryngeal nerve

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12
Q

Gold standard diagnosis for urethral injury

A

Retrograde Urethrography

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13
Q

Features of peutz jeghers

A

Autosomal Dominant Condition (Chr 19)

Small Bowel Hamartomas

Pigmentation of - skin, buccal mucosa, hands and genitalia

Small Risk of pancreatic, breast, lung, ovarian and endometrial malignancies

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14
Q

How does finasteride work

A

5 alpha reductase inhibitor

5 alpha reductause usually converts testosterone to dihydrotestosterone

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15
Q

Describe course of recurrent laryngeal nerve.

A

left:

Branches off of the vagus nerve as the vagus nerve traverses anteriorly over the aortic arch. It ascends posteriorly behind the ligamentam arteriosum + arch where it is in close relation to the inferior thyroid artery. It travels in a groove between the trachea (anterior) and the oesophagus (posterior).

right:

Branches off of the vagus nerve as the vagus nerve traverses anteriorly over the right subclavian artery. It ascends near the inferior thyroid artery. It travels in a groove between the trachea (anterior) and the oesophagus (posterior).

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16
Q

When to give n acetylcysteine?

A

Delayed presentation > 8 hours after ingestion

If serum paracetomal level is over the line

Staggered overdose

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17
Q

What are the hand muscles supplied by the median nerve?

A

LOAF

Lateral two lumbricals

Opponens pollicis

Abductor Pollicis brevis

Flexor Pollicis brevis

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18
Q

What is secreted by the gastric:

Chief Cells

Parietal Cells

Foveolar cells

A

Chief Cells - Pepsinogen (inactive enzyme that is activated once secreted. Breaks down protein into amino acids.

Parietal Cells - Intrinsic Factor (Needed for vitamin b12 absorption in the terminal ileum). Gastric Acid.

Foveolar Cells - Mucous Production

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19
Q

Surgeries for rectal tumours.

A

If mass is <5 cm from the anal verge –> Abdomino-perineal resection:

  • Anus removed, rectum and partial sigmoidectomy. End stoma left and plastics input for a gluteal flap.

low anterior resection if >5 cm from the anal verge

  • this is a function sparing procedure. as much rectum that can be spared is spared. affected portion and part of sigmoid removed. Colo-anal/rectal anastamosis performed.

Transanal endoscopic mucosal resection

  • Superficial rectal polyps or small neoplasms.
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20
Q

Describe the MEN conditions

A

Multiple Endocrine Neoplasia (Autosomal Dominant Disorder)

I - Pituitary, Pancreatit, Parathyroid

IIA- Medullary Thyroid Carcinoma, Phaechromocytoma, Parathyroid

IIB- Marfanoid Features, Mucosal Neuromas, Medullary Thyroid Carcinoma, Phaechromocytoma, Parathyroid

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21
Q
A
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22
Q

Radiographic Description of fibroadenoma?

Common location

Peak incidence

A

Radiographically - Ovoid smooth solid mass w/ low level internal echoes

Commonly - upper outer quadrant

Peak incidence - 20s to 30s

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23
Q

Describe Gel and Coombs Classification

A

Type I - Immediate. Mast Cell Degranulation –> Anaphylaxis, rash.

Type II - Need sensitisation. IgG and IgM. –> Autoimmunity, Haemolytic anaemia, Drug reactions

Type III - Soluble antigen/antibody complxes –> complement cascades. –> Nephritis, Faermer’s lung disease etc.

Type IV - T Cell mediated . Delayes presentation between 24 hour - 72 hours. E.g Contact Dermatitis

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24
Q

Stages of haemorrhagic shock?

A

I - <15% Loss/ <750 ml
II - 15-30% Loss/ <1500 ml. RR- 20-30. UO 20-30 ml/h

III - 30-40% loss/ <2000ml. Tachycardia 120-140. RR 30-40. UO 5-15 ml/h

IV - >2000ml. Tachycardia >140. RR >35. UO extremely low

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25
Q

Abdominal Aortic Aneurysm Screening age?

A

65 year old men - once off

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26
Q

Phaeochromocytoma

Aetiology

Symptoms

Treatment Principles

A

Aetiology:

  • Tumour arising from chromaffin cells of the adrenal medulla. Secrete catecholamines.

Symptoms:

  • Adrenergic - Sweating, hypertension, tachycardia, increased metabolic rate

Treatment Principles:

alpha block - prevents hypertensive crisis

beta block- heart rate control

  • adrenalectomy.
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27
Q

Hepatocellular Carcinoma:

Aetiology

Causes

Treatment

A

Aetiology

Malignant tumours of hepatocytes. Express AFP.

Causes

Hepatitis B,C

Cirrhosis (Alcoholic, PBC, PSC, Haemochromatosis)

Aflatoxins

Treatment

Annually to Bi-Annually surveillance of at risk patients with US+AFP

Resection, targetted ablation, chemotherapy, radiotherapy.

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28
Q

Grades of splenic injury

A

I - Either laceration <1cm or subcapsular haematoma <10% of surface area

II - Either laceration 1-3 cm or subcapsular haematoma 10% -50% surface area

III - Either laceration >3cm or subcapsular haematoma >50% surface area

IV - Segmental or hilar vascular injury or 25% devascularisation of spleen

V - Shattered spleen/ Hilar Injury with complete devascularisation

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29
Q

Sequential Organ Failure Assessment

What is it ?

Criteria

A

Sequential Organ Failure Assessment

Used to identify people at high risk of mortality from sepsis

RR > 20 breaths per minute

BP <100 mmHg

GCS <15

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30
Q

Types of Diabetes Insipidus

A

Diabetes Insipidus - this is where there is either a lack/reduced responsiveness to ADH

Central DI - Caused by lack of secretion of ADH (Vasopressin) from the posterior pituitary

Nephrogenic DI - Lack of response from the kidneys to ADH. Usually stimulates aquaporin 2 channels to become upregulated.

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31
Q

Drugs associated with development of C Difficile

Pathophysiology of C Difficile

A

Commonly antibiotics but also chemotherapeutic agents

Antibiotics: (Remember 4 Cs)

Cephalosporins

Co- Amoxiclav

Clindamycin

Ciprofloxacin

Pathophysiology:

Two toxins.

Enterotoxin - A

Cytotoxin - B

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32
Q

Salivary Gland Stones

Glands commonly affected?

A

Submandibular > Parotid

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33
Q

Define the TNM classification system for breast

A

T - refers to the primary tumour

Tis (In Situ) / T1 - <2cm / T2 2-5cm / T3 >5 cm / T4 spread to adjacent structures

N - refers to nodal involvement

N0 - None, N1 - Mobile axillary nodes, N2 - Fixed axillary nodes, N3 - Other surrounding node groups

M - refers to metastasis

M0 - None

M1 - involving other organ

34
Q

HIV Testing - when are the following tested for

p24 antigen

antibody

ELISA

A

p24 (viral core protein) - 4 weeks post-exposure

Antibody - 6 weeks - 3 months post exposure

ELISA - 6 months post exposure

35
Q

Gynaecomastia:

Causes

A

Liver Cirrhosis (increased aromatase enzyme activity —> more androgens converting to oestrogens)

Drugs - Anti-psychotics, Digoxin, Cimetidine, Ketoconazole, Oestrogens, Anti-testosterones (finasteride), Spironolactone

Sex Development Disorders - hypogonadism, kinefelter’s syndrome,

36
Q

Questions regarding portal vein

What two veins form the portal vein?

Where does the portal vein lie in relation to other portal triad structures?

What is the hepatoduodenal ligament?

At what level is the portal vein formed?

Relation to pancreas?

Branches?

A

What two veins form the portal vein?

Splenic Vein + Superior Mesenteric Vein

Where does the portal vein lie in relation to other portal triad structures?

It lies posterior to the other two structures - hepatic artery proper and common bile duct

What is the hepatoduodenal ligament?

Double layer of periotneum formed from the free edge of lesser omentum enclosing the portal triad

At what level is the portal vein formed?

Transpyloric plane - L1

Relation to pancreas?

Runs posterior to neck of pancreas

Branches?

2 - Left (II-IV) and Right (Anterior branch - V + VIII, Posterior branch - VI + VII)

37
Q

What is the cardiac index?

A

Cardiac output

________________________________

Body surface area

Usually between 2.5-4.0 L/min. It is useful in determining the cardiac function in view of different sizes of patients.

38
Q

Which type of genetic targets are these?

sis

erb B-2

ras

myc

bcl-2

A

sis - Platelet-derived growth factor activator

erb B-2 - Growth factor receptor oncogene

ras - Signal transducer

myc - transcription factor

bcl-2 - prorammed cell death regulator

39
Q

Suture Types:

Polypropylene (Prolene)

Silk

Nylon

Polyester

Polydioxanone Sulphate (PDS)

Polygalactin 910 (Vicryl)

Polyglycolic Acid (Dexon)

Polyglyconate (Monocryl)

A

Polypropylene (Prolene) - Non Absorbable

Silk - Non Absorbable

Nylon - Nonabsorbable

Polyester - Nonabsorbable

Polydioxanone Sulphate (PDS) - Absorbable

Polygalactin 910 (Vicryl) - Absorbable

Polyglycolic Acid (Dexon) - Monofilament Absorbable Suture

Polyglyconate (Monocryl) - Absorbable Suture

40
Q

Describe venous drainage of the GI Tract

A

Portal Vein - Formed from SMV and Splenic Vein at L1

Inferior mesenteric vein drains into splenic vein near confluence of portal vein.

41
Q

Which bacterial infection has pus containing sulphur granules

A

Actinomycosis

Gram Positive Anaerobic Bacterial infection

Commoner in diabetics + Immunosuppressed

Causes Granulomatous and Suppurative Inflammation

42
Q

What values correlate with cyanosis?

A

Thought that >2.0 g/dL of deoxyhaemoglobin/methaemoglobin reliably produce cyanosis

43
Q

Macroscopic + Microscopic + Extra-intestinal features Findings of:

Crohn’s

Ulcerative Colitis

A

Crohn’s

Macroscopic - cobblestoning, aphthous ulcers, rose thorn ulcers, abscesses, stricures and fistulae

Microscopic - Transmural inflammation + granuloma

Extra-intestinal - peri-anal, mouth ulcers, erythema nodosum, arthritis, spondloarthropathies, uveitis, episcleritis, Pyoderma Gangrenosum

Ulcerative Colitis

Macroscopic - Psuedopolyps, Friable mucosa, Featureless colon, Reduced haustrae, short colon, toxic megacolon

Microscopic - submucosal, mucosal inflammation, crypt abscess

Extra-intestinal - PSC, arthritis, spondyloarthropathies, uveitis, episcleritis, Pyoderma Gangrenosum

44
Q

What is the conus elasticus?

A

Conus elasticus is a yellow tissue that forms from the lateral part of cricothyroid membrane.

It has a free edge which forms the vocal ligament.

Connects the Cricoid, Thyroid and arytenoid cartilage

45
Q

What does antithrombin III do?

What drugs effect it?

A

Antithrombin III - inactivates coagulation enzmes fXa, fIX, fII, fVII, fXI, DXII

Heparin speeds up this process

46
Q

What is the epiploic foramen?

Boundaries

A

Foramen of winslow (epiploid, omental)

Communication between the greater and lesser sac of abdomen.

Borders:

Anterior - Hepatoduodenal ligament( Containing the biliary triad - CBD, Hepatic ARtery, hepatic portal vein)

Posterior - Peritoneum covering IVC - Just Left is the arota

Superior - Peritoneum covering caduate lobe of liver

Inferior - Peritoneum covering duodenum and hepatic artery

Left Lateral - Gastrosplenal and splenorenal ligament

47
Q

Mechanism of Warfarin Necrosis

A

Protein C and Factor VII inhibition is greater than the others in the initial period following warfarin initiation ——>

This makes a pro thrombotic state. Skin necrosis is caused

Particularly in young, large women

48
Q

Causes of low anion gap

A

Anion Gap=

Cations (K+ + Na+) - Anions (cl- - HCO3-)

High anion gap is caused by bicarb buffering (reduction in anion) —> therefore seems like more cations than anions

Normal anion gap - loss of bicarb through GI, renal loss, renal dysfunction (renal tubular acidosis)

Low anion gap = Caused by an apparent increase in anions.

Usually low albumin states ( where Chloride ions and Bicarb ions are retained to compensate for the negatively charged albumin loss)

Other causes of low anion gap = Hypergammaglobunimaemia (MM) Hypergcalcaemia hypermagnesaemia, lithium toxicity, hyperviscositiy, halide/bromide intoxication

49
Q
A
50
Q

Relation to the lung hila?

Phrenic Nerve

Vagal Nerves

Recurrent laryngeal Nerve

Aorta

Azygos Vein

A

Phrenic Nerve - Anteriorly to the hila

Vagal Nerves - Posteriorly to the hila

Recurrent laryngeal Nerve - Superior

Aorta - Posterior to left main bronchus

Azygos Vein - Posterior to right main bronches and travels anteriorly to join SVC

51
Q

Signs of Lidocaine Toxicity

Max dose w/ w/o adrenaline

A

Max Dose: With adrenaline - 7 mg/kg . Without adrenaline 3mg/kg

Signs of toxicity:

Perioral Paraesthesia

Hypotension

Convulsions

Dizziness

Cardiac Arrhythmias

Collapse

52
Q

Nutritional Requirements:

Sodium

Potassium

Calories

Protein/Fat/Glucose

A

Sodium - 1-2 mmol/kg/day

Potassium - 1mmol/kg/day

Calories - 25-30 kcal/kg/day

Protein/Fat/Glucose - 20:30:50

53
Q

Gallstone Ileus Management

A

Emergency laparotamy

  • Gallstone needs to be passed through into the large bowel to prevent furhter obstruction –> perferation. It can also be extracted via enterotomy.
  • Fistula between the gall bladder and duodenum (Cholecystoduodenal Fistula) does not require surgical closure.
54
Q

Polyhydramnios + Intestinal Obstruction

A

Duodenal Atresia - Congenital abscence of duodenal lumen

55
Q

Nasal Anatomy

What drains into the inferior meatus (2)

What drains into the middle meatus (5)

What drains into the superior meatus (2)

Where is the olfactory epithelium

A

Inferior meatus - Nasolacrimal Duct (Rostral), Auditory Canal (caudal)

Middle meatus - Maxillary Sinus, Anterior ethmoidal air cells( Semilunar hiatus), Frontal sinus (semilunar hiatus) Ethmoidal Bullae, Middle ethmoidal cells,

Superior Meatus - Posterior ethmoidal air cells, sphenoidal sinus

Olfactory epithelium lines the superior aspect of the superior nasal meatus - cribiform plate

56
Q

Where do small cell lung cancers usually effect?

2 Common Paraneoplastic Syndromes

Radiographically?

A

Main or lobar bronchi

SIADH, PTHrp (related protein),

Can also cause cerebellar syndromes - anti-yo antibodies, myaesthenia gravis, optic neuritis

Radiographically - Perihilar mass

If nodes are involved then the mediastinum can be widened

57
Q

Do the left or the right papillary muscles play a part in conduction system of heart?

A

Right

They communicate with the moderator band (originating from the interventricular septum)

58
Q

Anencephaly and Spina bifida

Dates and neuropre

A

Anencephaly - failure of cranial neuropore closure by day 25

Spina Bifida - failure of caudal neuropore closure by day 27

59
Q

Breast reconstruction

Types

Complications

A

Types: i) Cosmesis ii) Free tissue iii) Flap

Types of Flap:

  • TDAP -Lat Dorsi, Thoracodorsal perforator artery

TRAM - Transverse rectus abdominus myocutaneous

DIEP - Deep inferior eipigastric artery perforator

IGAP - inferior gluteal artery perforator

TUG - Transverse upper gracilis

Complications:

Scarring, haematoma, seroma, Abdominal wall hernias

Flap Necrosis - Usually effects outer areas. Can be due to insufficient arterial supply or impaired outflow (congestion/ thrombosis - venouss)

Cosmesis - Flap necrosis, infection, rippling, capsular contracture, leak, rupture

60
Q

Nerves: Roots and Actions

Pudendal

Obturator

Post-Ganglionic Parasympathetic

Genitofemoral

Ilioinguinal

A

Pudendal - S2 - S4 nerve roots from sacral plexus. Perineum, Pelvic Floor and external anal sphincter

Obturator - L2-L4 ventral rami of lumbar plexus. Adductor Magnus, longus and brevis. Gracilis. Obturator Externus. Cutaneous- middle part of medial thigh

Post-ganglionic parasympathetic- Pelvic spanchnic nerves. Involuntary supply of internal anal sphincter. Relaxes in response to pressure

Genitofemoral nerve- L1-L2. Divides into respective genital + femoral nerves in men. Supplies - creamscertic and dartos nerve. Sensory innervaton to tunica vaginalis, spermatic fascia and upper part of scrotum

Ilioinguinal nerve - L1. Sensory supply to genitalia (root of penis, scrotum. labia majora, mons pubis).

61
Q

Why is peritoneal insufflation difficult in terms of anaesthtics for people with lung pathology?

A

It causes splinting of the diaphragm and reduces lung movements:

This leads to reduced lung compliance needing higher airway pressures to achieve adequate oxygenation

62
Q

Brachial Plexus

3:1:0:3:5:5

A

3 Branches from roots : LSD

Long thoracic nerve, Nerve to subclavius, Doral Scapular nerve

1 from trunk:

Suprascapular Nerve

0 From divisions

3 from lateral cord: LML

Lateral Pectoral nerve

Musculocutaneous Nerve

Lateral Root of median Nerve

5 from medial cord: Miss Mary Makes Me Unhappy

Medial pectoral nerve, medial cutaneous nerve of forearm, medial cutaneous nerve of arm, medial root of median nerve, ulnar nerve

5 from posterior cord: 2STAR

2 Subscapular nerves (upper and lower)

Thoracodorsal nerve

Axillary Nerve

Radial Nerve

63
Q

GI manifestations of thermal injury

A

Paralytic ileus – Gastric dilatation

Curling’s Ulcers

Decreased Gastric Acid Production

Splanchnic vasoconstriction

64
Q

Hepatic blood flow numbers

Supply from the portal vein ?%

hepatic artery ?%

normal portal vein pressure

A

Portal vein - 75%

Hepatic Artery - 25%

Portal venous pressure - 5-7 mmHg

65
Q
A
66
Q

Duke Staging + 5 year survival

A

Stage A - Confined to mucosa 90-95% 5 year Survival

Stage B - Muscularis Propria

B1 - Grown into propria 75% - 80% 5 year survival

B2 - Through propria into serosa 60% 5 year survival

Stage C - Lymph Node Involvement

C1 - 1-4 regional lymph nodes 25-30%

C2 - >4 regional lymph nodes

Stage D - Distant metastases <1%

67
Q

Complications of FNA of lung

A

Pneumothorax: 17-26% (Increased risk with COPD/bullous lung disease, increase depth of lesion, small lesion size)

Haemothorax, Pneuonia, Empyema, Pulmonary Haemorrhage< Tumour Seeding, Cardiac Tamponage, Air Embolus, Need to re-bioopsy

68
Q

Features of Fat Embolus Syndrome

4 Major

7 Minor

A

Gurd and Wilson Criteria

Major: Petechiae in vest like distribution, Hypoxaemia, CNS depression, Pulmonary Oedema

Minor: Tachycardia, Pyrexia, Retinal Emboli, Fat in urine, Fat in sputum, Increased ESR, Haematocrit/Platelet Drop

69
Q

Facial Nerve Anatomy

Branches

Exiot foramen

Relations to other structures

Major Functions

A

Two Zulus Buggered My Cat

  • Temporalis, Zygomatic, Buccinator, Mandibular, Cervical

Facial Nerve - exits through stylomastoid foramen

Major Functions:

  • Controls facial expression
  • Taste to anterior two thirds of th tongue
  • Pre ganglionic Parasympathetic Fibers to several head and neck ganglia
70
Q

Nerve Supply to digastric muscle

A

Anterior - Supplied by the nerev to mylohyoid ( Sub branch of V3)

Posterior - Supplied by digastric branch of facial nerve

71
Q

Pathophysiology of neurogenic shock

A

Loss of sympathetic innervation —> Reduced Sympathetic innervation and Vasomotor tone .

This leads to venous ppooling–> Reduced venous return –> Reduced Pre-Load –> Reduced cardiac output

Clinically - warm peripheries, low BP, widened pulse pressure

72
Q

Exit foramina of the skull

A

Cribiform Plate I

Optic Canal II

Superior Orbital Fissure III, IV, V1 (Frontal Nerve, lacrimal, nasociliary) ​, VI

Inferior Orbital Fissure - V1 (Inferior Division), Parasympathetic Pterygopalatine (from facial nerve), Zygomatic branch (V2)

Foramen Rotundum V2

Foramen Ovale V3

Internal Acoustic Meatus VII, VIII

Jugular Foramen IX, X, XI

Hypoglossal Canal XII

73
Q

2 Most common sites for breast malignancy

A

Upper outer quadrant

Central/ Subareolar Region

74
Q

Classification for Diverticular Perforation

A

Hinchey I - Paracolic Abscess

Hinchey II - Pelvic Abscess

Hinchey III - Purulent Peritonitis

Hinchey IV - Faecal Peritonitis

75
Q

What is the:

i) cloaca

ii) sinovaginal bulb

A

Cloaca

5th - 7th week:

Cloaca divides urogenital sinus(anterior) and anal canal (posterior).

Urogenital Sinus —> Bladder, Urethra, Genital Tubercle

Anal Canal –> Rectum, Anal Canal

Sinovaginal

Formed from urogenital sinus —> Lower part of vagina

76
Q

Bacterial Flexor Tenosynovitis

Cardinal Signs

Bacterial Cause

A

Cardinal Signs:

partially flexed posture, fusiform swelling, tenderness across flexor tendon sheath, pain on passive extension.

Bacteria: Staph Aureus

Early –> IV Abx and splinting

Late –> Exploration +/- drainage

77
Q

What stimulates/ Inhibits Insulin release

Stimulates:

Amplifies:

Inhibits:

A

Stimulates: Glucose, Mannose, Leucine, Vagal Stimulation, Sulfonylureas

Amplifies: GLP-1, Gastrin inhibitory peptide, Cholecystikinin, Secretin, Gastrin, Beta Adrenergic Stimulation, Arginine.

Inhibits: Hypokalaemia, Somatostatin, Drugs( Dazoxide, Phenytoin, Vinlastine, Colchicine)

78
Q

Compartment Syndrome

Signs

Compartment Pressures

A

Signs:

Pain on passive stretch, Absent peripheral pulses, paraesthesia, paralysis

Rhabdomyolysis —> Hyperkalaemia, hyperphosphataemia, High URic Acid Levels, metabolic acidosis

Compartment Pressures

Normally 3-4 mmHg

If >30-35 mmHg —–> fasciotomy

79
Q

Anal Cancer

Common Type

Treatment

A

Common Type - Squamous Cell Carcinoma. Above dentate line tumours spread to perirectal and internal iliac lymph nodes.

Below dentate line tumours spread to inguinal and femoral nodes.

Treatment -

Radiotherapy + 5 FU (+/= mitomycin/ cisplatin)

AP Resection —> Only if recurrent or resistant tumours

80
Q

Relations of hte parotid gland

A

Anterior - masseter + Mandible

Superior - TMJ + External Auditory Meatus

Inferiorly - Posterior belly of digastric ( CNVII)

Medially- CN IX, X, XI, XII, IJV, ICA, Lateral Pharyngeal

Superficially ( superficial to deep ) - Facial Nerve, Retroauricular Vein, ECA

81
Q

SIRS Criteria

A

Two or more of following criteria:

Temp: >38, <35

HR >90 BPM

Tachy pnoea >20 or low PaCO2

WCC <4 / >12

MRCS Muhesh (3 decks)

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