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eMRCS questions > Recalls > Flashcards

Recalls Flashcards

1
Q

Where are Paneth cells present

A

Crypt of liberkuhn

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2
Q

Half life of platelets

A

10 d

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3
Q

Tx of patient with low BP, high K and low Na

A

IV hydrocortisone

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4
Q

Difference between aortic stenosis and sclerosis

A

Stenosis radiates to carotids

Sclerosis-Thick and calcified on echo

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5
Q

Paediatric cardiac differentials

A

Cyanotic
TA- left ventricle connect to PA
TGA- no murmur
ToF- loud ESM

Hypoxic
VSD- pan systolic murmur
ASD- foreamen oval doesn’t close, ESM at ULSE
PDA- pul artery and aorta connected - continuous machine like murmur at ULSE, subclavian thrill- indomethacin

Coartaction- ESM

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6
Q

Hypotensive patient out of hospital what medication do you use to anaesthetise

A

Ketamine

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7
Q

Mx of testicular torsion

A

Immediate exploration under GA

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8
Q

Bilateral lung opacities- differentiating between ARDS and pul oedema

A

Pul wedge pressure
Normal- ARDS
High>18- pul oedema

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9
Q

Blood film post splenectomy

A

Increase WCC
Howell Jolly
Target Cells
Siderocytes
Increase Plts

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10
Q

Mx of lower leg compartment syndrome

A

4 compartment release

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11
Q

Pre tibial injury management

A

Laceration with min haematoma- evacuate haematoma, stern strip without tension

With severe haematoma or necrosis- debride, STG under anaesthesia

Degloving- reconstruct under GA

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12
Q

Drug of choice for Biers block

A

0.5% prilocaine

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13
Q

Causes of bloody diarrhoea

A

C- campylobacter- bloating
H- haemolytic e coli-
E- entamoeba histolytica - liver cyst- metronidazole
S- shigella- food poisoning
S- salmonella - india

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14
Q

Space involved for Ludwig angina

A

Submandibular

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15
Q

Leg shortened and internally rotated

A

Post hip dislocation

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16
Q

After gastric banding, patient getting sweating, palpitations what is the cause

A

Dumping syndrome

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17
Q

Histological appearance of osteoporosis

A

Normal minerals, decreased volume

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18
Q

Patient fell onto chin, reduced mouth opening, jaw not aligned, pre auricular tenderness where is the fracture

A

Coronoid process

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19
Q

Unilateral buttock claudication vessel

A

Common internal iliac

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20
Q

Gardner, thorn stuck in arm, cellulitis and lymphangitis causative organism

A

Staph aureus

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21
Q

Criteria for CT head in 1 hour

A

a GCS score of 12 or less on initial assessment in the emergency department

a GCS score of less than 15 at 2 hours after the injury on assessment in the emergency department

suspected open or depressed skull fracture

any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)

post-traumatic seizure

focal neurological deficit

more than 1 episode of vomiting.

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22
Q

CT head within 8 hours criteria

A

had some loss of consciousness or amnesia since the injury and

age 65 or over

any current bleeding or clotting disorders

dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of more than 1 m or 5 stairs)

more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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23
Q

If alcohol intoxication and head injury

A

Admit and see if meet criteria

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24
Q

Cerebellar lesion symptom

A

Dysdiadokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech
Hypotonia

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25
Q

Blood supply and symptoms correlating in brain

A

Anterior- legs >arms, face

Middle- arms, face>legs , aphasia

Posterior- occipital

PICA- lateral medulla
Ipsilateral ataxia, nystagmus, dysphagia, facial numbness, CN palsy
Contralateral: limb sensory loss

Lacunar- Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

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26
Q

Stroke types

A

TACI- middle and anterior
Hemiparesis/hemisensory loss
Homonymous hemianopia
Cog dysfunction

PACI- smaller arteries
2/3

Lacunar - smaller arteries around internal capsules/thalamus/basal ganglia
isolated hemiparaesis, hemisensroy loss

POCI- vetebrobasillar arteries- ataxia, cranial nerve, vision, vertigo

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27
Q

IVDU groin swelling cause

A

False aneurysm

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28
Q

Senescence of cancer cells

A

Telomerase

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29
Q

Levels of glucose with diabetic diagnosis

A

Fasting
6.1-6.9 - impaired glucose tolerance
>7- DM

2 hour glucose
7.8-11 impaired glucose tolerance
>11.1- DM

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30
Q

Chorda tympani foramen

A

petrotympanic fissure

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31
Q

Superior thyroid artery ligated now can’t produce high pitch voice, muscle damaged

A

Cricothyroid

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32
Q

Orbital fracture, loss of lacrimation nerve damage?

A

Greater petrosal
Branch of facial

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33
Q

Branches of facial nerve

A

Greater petrosal
Nerve to stapedius
Chorda tympani
Posterior auricular
Post diagastic
Stylohyoid

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34
Q

Greater petrosal nerve pathway and function

A

Exits temporal vie hiatus of facial canal
Across lacerum
Combines with deep petrosal nerve- nerve to pterygoid canal
Into pteryopalatine fossa- and ganglion
Innervated mucosal gland of oral, nasal, pharynx and lacrimal gland

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35
Q

Chorda tympani pathway

A

Exits at petrotympanic fossa
Combines with lingual from V3 in infra temporal fossa- go to submandibular ganglion
Travel to submandibular and sublingual salivary glands and tongue

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36
Q

Which cell produces complement

A

Hepatocytes

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37
Q

LN drainage of pelvic area

A

Superficial inguinal- lower 1/3 vagina, vulva and scrotum, inferior anal canal
(superficial to fascia and inferior to ligament)

Deep - glans penis and clitoris, distal spongy urethra

External iliac - cervix, body of uterus, superior bladder, upper 1/3 vagina

Internal iliac - prostate, cervix, middle 1/3 vagina, inferior rectum, superior anal canal

Para aortic- gonads, uterine fundus

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38
Q

External iliac branches

A

Inferior epigastric
Deep circumflex iliac

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39
Q

Branches of internal lilac

A

Anterior
Umbilical
Superior vesicle
Obturator
Inferior vesical
Uterine + vaginal
Middle rectal
Internal pudendal
Inferior gluteal

Posterior
Iliolumbar
Lateral sacral
Superior gluteal

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40
Q

Feature of Horners and numbness medial side of elbow lesion

A

T1

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41
Q

Nerve roots in horners

A

C8, T1

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42
Q

What structure is medal to phrenic nerve when entering from neck to thorax

A

Brachiocephalic vein

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43
Q

ATN features

A

Slough in urine - brown granular casts
No response to fluid challenge
Urine sodium >30
Specific gravity low
Osmolality-<300

Cause
Ischaemia
Myoglobin
Contrast
NSAIDs
Gent/vanc, amph B

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44
Q

Damage to what structure causes CSF to leak our of ear

A

Tegmen Tympani

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45
Q

Red, smooth, velvety patch on tongue

A

Erythroplakia
Associated with smoking

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46
Q

Blood in urethral meatus and high riding prostate- injury to which part of urethra

A

Membranous

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47
Q

Anterior vs posterior urethral injury presentation

A

Anterior
Blood in scrotum
Normal prostate
Perineal tenderness
Urine in superficial perineal space

Posterior
High riding prostate
Suprapubic tenderness
Urine in deep perineal space

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48
Q

Split vs full thickness graft uses

A

Full- face and small areas, fingers
Better cosmetics- pigmentation
Primary Contraction (before giving )
Small areas
Donor must be closed

Split- takes faster, more likely to take successfully
Larger area and granulated area- can give if periosteum intact
Worse cosmetic
Secondary contraction (after donated)

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49
Q

When to refer woman with lump

A

30 and over

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50
Q

Autolysis in pancreatitis enzyme

A

Trypsin

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51
Q

What can excess saline cause

A

Hypercholaemic acidosis

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52
Q

Where are central chemoreceptors located

A

Medulla

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53
Q

Structure most at risk for preparing tibia in knee replacement

A

Popliteal artery

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54
Q

How NEC presents

A

Premature babies
Biliary vomiting
Abdo distention
Blood stained stool

AXR- gas cyst

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55
Q

Hirschprung disease presention

A

Failure to pass meconium
Abdo distention
Bile stained vomit

Absence of Auerbach(motility) and meissners (secretions and blood flow) plexus

Require irrigation

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56
Q

Intussuscpetion presentation

A

Colic
Vomit
Recurrent jelly- late sign
Sausage mass

Most common obstruction 3m-2 yrs

USS- target mass
Drip and suck

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57
Q

Pyloric stenosis presentation

A

2w-8w

Projectile vomiting
Non bilious
Olive mass

Ramstedt pylotmyotomy

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58
Q

Duodenal atresia presentation

A

<6hrs after birth- bilious vomit
AXR- double bubble sing
Downs

Duodenodeuoneostomy

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59
Q

SUFE vs Perthes disease

A

SUFE- slipped head, older, fat
Loss of internal rotation of flexed hip

Perthes- necrosis of epiphysis, younger 4-8yrs , hip/knee pain, shortening

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60
Q

Thyroid storm management

A

B blockers
Thionamide

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61
Q

Nerve supply of labia major

A

Ilioinguinal

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62
Q

Structure greatest risk of damage in splenectomy

A

Tail of pancreas

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63
Q

Organism unlikely to be killed in autoclave at 100 degrees

A

Clostordium

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64
Q

Best method for sterilisation of arthroscopes

A

Gluteraldehyde

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65
Q

Meconium ileus vs Hirschprungs

A

Meconium ileus- stuck in SI- small colon

Hirschprungs- stuck in colon- large colon

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66
Q

Sweating palpitation after bariatric surgery cause

A

Dumping- vagotomised early gastric relaxation

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67
Q

Which vessel off coeliac has tortuous appearance

A

Splenic

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68
Q

Case with endometrial, ovarian and colorectal cancer

A

Lynch

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69
Q

Young patient with severe breast pain

A

Reassure and dishcharge

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70
Q

Post pancreatitis diffuse fluid around head

A

Necrosis

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71
Q

Synovial Joint types

A

Hinge (elbowelbow joint, ankle joint, knee joint)- movements in 1 plane

Saddle (carpometacarpal joint)- convex concave shape

Planar (acromioclavicular joint, subtler)- flat so roll over anther

Pivot (proximal and distal radioulnar joints, atlantoaxial joint)- rotation only

Condyloid (wrist joint, metacarpophalangeal joint, metatarsophalangeal joint)- contains a convex surface which articulates with a concave elliptical cavity. They are also known as ellipsoid joints.

Ball and socket (hip joint)-It permits free movement in numerous axes.

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72
Q

Joint class by movement

A

Synarthrosis – immovable.
Amphiarthrosis – slightly moveable.
Diarthrosis – freely moveable.

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73
Q

Types of cartilaginous joints

A

Synchondroses
In a synchondrosis, the bones are connected by hyaline cartilage. These joints are immovable (synarthrosis).

An example of a synchondrosis is the joint between the diaphysis and epiphysis of a growing long bone.

Symphyses
Symphysial joints are where the bones are united by a layer of fibrocartilage. They are slightly movable (amphiarthrosis).

Examples include the pubic symphysis, and the joints between vertebral bodies.

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74
Q

Histology of medullary thyroid cancer

A

Amyloid stroma

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75
Q

Diarrhoea related ABG

A

Metabolic acidosis

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76
Q

Sensation behind ear

A

Lesser occipital

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77
Q

5.5 aneurysm of EIA with ovarian mets

A

Surveillance

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78
Q

Types of fibrous joints

A

Sutures- immovable

Gomphoses- immovable- teeth

Syndesmoses-slightly movable joints (amphiarthroses).
They are comprised of bones held together by an interosseous membrane

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79
Q

Most common glottic cancer

A

SCC

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80
Q

Which artery has retrograde flow in subclavian stela

A

Vertebral - as lesion proximal

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81
Q

Severe renal disease with foot ischameic ix

A

Duplex as contrast CI

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82
Q

Breast carcinoma with headache and vomiting tx

A

Dexamethasone

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83
Q

SCC histology

A

Keratin pearls

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84
Q

Cause of Brady in head injury

A

Increase aortic sinus activity

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85
Q

Heartburn and food sticking in throat

A

Pharyngeal pouch

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86
Q

Landmark for pudendal block

A

Ischial spine

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87
Q

Dysphagia, chest pain, normal endosocpy

A

DOS

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88
Q

Mx of 8mm stone at uterovesicle junciton

A

JJ sent

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89
Q

Teardrop sign in maxillary sinus

A

Orbital floor fracture

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90
Q

Truma, RAPD, proptosis, ophthalmoplegia mx

A

lateral canthotomy and cantholysis

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91
Q

Thyroglossal cyst ix

A

US + FNA

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92
Q

Absent of limb

A

Amelia

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93
Q

Homonymous hemianopia lesion

A

Optic tract

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94
Q

Cisterna Cali level and where throacic duct starts

A

L1

Starts at t12

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95
Q

Histological features of RA

A

Necrobiosis granuloma

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96
Q

Scan for parathyroid tumour

A

Setsmibi scan

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97
Q

Supply of pelvic diaphragm

A

S3

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98
Q

Pleuroperitoneal canal not developed

A

Bochaladek hernia

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99
Q

Cause of hyposppadius

A

Malformation of urogenital fold

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100
Q

Isovolemic contraction

A

In cardiac cycle where all valves are closed- no change in volume
Just after tricuspid and mitral close

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101
Q

First test to rise post trauma

A

CRP

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102
Q

Origin of CN

A

Midbrain – the trochlear nerve (IV) comes from the posterior side of the midbrain. It has the longest intracranial length of all the cranial nerves.
Midbrain-pontine junction – oculomotor (III).
Pons – trigeminal (V).
Pontine-medulla junction – abducens, facial, vestibulocochlear (VI-VIII).
Medulla oblongata
Posterior to the olive: glossopharyngeal, vagus, accessory (IX-XI).
Anterior to the olive: hypoglossal (XII).

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103
Q

Bleeding source post LP

A

Vertebral venous plexus

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104
Q

Nerve for gag reflex

A

IX

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105
Q

UMN vs LMN facial palsy

A

UMN- able to

LMN- can’t lift eyebrow

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106
Q

Knee dislocation and absent dorsalis pedis pulse

A

Supracondylar femur fracture- popliteal artery damaged

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107
Q

On 15mg of pred before surgery, what mx

A

Double on day and for next 2-3d

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108
Q

Types of polyp in FAP

A

Tubular adenoma

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109
Q

Neck mass with compressive symptoms

A

Retrosternal goitre

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110
Q

What is anterior/infeiror to left adrenal

A

Body of pancreas

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111
Q

Resting membranes is kept by

A

K

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112
Q

Carboxyhaemaglobin levels indicating CO poison

A

9%

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113
Q

What structure is unlikely to be damaged at angle of Louis

A

Brachiocephalic!

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114
Q

Oncolytic large epithelial cell with lymphocytes in thyroid

A

Hashimotos

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115
Q

Obturator origin

A

L2-

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116
Q

IBD fat wrapping

A

Crohns

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117
Q

Apocrine metaplasia, epithelial overgrowth and papillary projections, discrete lump in breast

A

Benign cyst

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118
Q

Which muscle is attached to the most inferior part of scapula

A

Teres major

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119
Q

Superolateral limit of axillary dissection

A

Axillary vein

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120
Q

What prevents uterus prolapse in delviery

A

Transverse cardinal ligament

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121
Q

Patient with blood everywhere and prolonged PT and T

A

Oesophageal varices

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122
Q

Which part of the kidneys produce EPO

A

Interstitial fibroblasts

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123
Q

Reciprocal of ARR

A

Number needed to treat

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124
Q

Fever, chest pain, dyspnea, recent OGD- widened mediastinum

A

Mediastintis

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125
Q

Eye exophthalmos, limited eye movement, bruit

A

Carotid cavernous fistula

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126
Q

Cystic medial necrosis in aneurysm

A

Connective tissue disorder- Marfans

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127
Q

Measurements for FU with medullary thyroid cancer

A

CEA
Calcitonin

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128
Q

Popcorn calcification

A

Fibroadenoma

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129
Q

What does not change in size when muscle contracts

A

A band

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130
Q

Parts of sarcomere

A

2 z lines
I band - actin attached to z liens
A band - thick myosin

H zone gap between I bands

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131
Q

Mean 100 SD 20 what is the range

A

60-140

Since 2 SD to encapsulate all

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132
Q

Complications of carotid surgery

A

Vocal cord paralysis * Superior laryngeal nerve
Tongue paralysis * Hypoglossal nerve
Parasthesia * Greater auricular nerve

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133
Q

Line of zahn

A

Thrombus

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134
Q

Remnant of embryonic notochord

A

Nucleus Pulposus

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135
Q

Mild clawing of little and ring finger, loss of sensation cause

A

Compression at elbow

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136
Q

Flail chest/rib fracture with low sats mx

A

Intubate

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137
Q

Post head injury, low sodium, plasma osmolarity mx

A

Vasopressors agonist

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138
Q

Meds for low flow/sickle priapism

A

Phenylephrine

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139
Q

Muscle preventing spread of infection from mouth to neck

A

Mylohyoid

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140
Q

Injury to angle of the jaw, muscle effected?

A

Medial pterygoid

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141
Q

Bainbridge reflex

A

Increased HR to increased blood volume

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142
Q

Discitis in infants

A

0-6m staph
6m-4y Kingella kingae

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143
Q

Gram + organisms

A

Staph and strep cocci

ABCDE bacilli

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144
Q

How many half lives to clear 95% drug

A

5.5

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145
Q

Mx of superficial thrombus

A

NSAIDS

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146
Q

Cause of pseduoclaudication of calf

A

Lumbar stenosis

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147
Q

What is removed in Whipple’s procedure

A

Head of pancreas
CBD
Gallbladder
Duodenum
Proximal jejenum
Pylorus

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148
Q

Unfit patient with bilateral common iliac

A

Axilla femoral in unfit

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149
Q

Urachus cancer type

A

Adenocarcinoma

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150
Q

What is Anterior to cervix of palpation

A

Fundus of bladder
(base)

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151
Q

Tonsillar SCC with multiple nodes mx

A

Chemoradio

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152
Q

Epistaxis in superior nasal septum

A

Anterior ethmoidal

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153
Q

Most vessel effected in Little’s area

A

Sphenopalatine

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154
Q

Chronic osteomyelitis with rectal bleeding, which shows amorphous pink substance

A

Amyloid

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155
Q

Coeliac supplies what structure not from foregut

A

Spleen

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156
Q

Mx of bile leak post cholecystectomy

A

ERCP and stent

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157
Q

Patient with hypotension- what baroreceptor responds first

A

Carotid body

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158
Q

Wich lobes are supplied by right hepatic artery

A

Right lobe and caudate

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158
Q

Most likely virus from needle stick

A

Hep B

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159
Q

Where does erythropoeiss start in fetus

A

Yolk sac then liver and spleen

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160
Q

What electrolyte disturbance is associated with normal gap acidosis

A

High Cl

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161
Q

Eyelid droop, cheek dryness, abnormal reflex

A

Stellate ganglion

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162
Q

Transplanted heart increase CO

A

Increase stroke

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163
Q

Thyroid with Cd20 cell and atypical lymph

A

Hodgkin lymphoma

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164
Q

First to activate in RAAS

A

Renin

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165
Q

Examples of ASA 2

A

Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30<BMI<40), well-controlled DM/HTN, mild lung disease

Well controlled PE, HTN gestational DM

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166
Q

Examples of ASA 3

A

One or more moderate to severe diseases. Poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, history (>3 months) of MI, CVA, TIA, or CAD/stents.

Severe PE, high requirement for insulin in DM

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167
Q

Examples for ASA 4

A

Recent (<3 months) MI, CVA, TIA or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, shock, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

PE with HELP or cardiomyopathy

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168
Q

Amyloid in myeloma

A

AL

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169
Q

Q SOFA score

A

GCS <15
RR >22
BP <100

Score 2/3 high risk

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170
Q

Aim of ERAS

A

Decreased hospital stay 30d

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171
Q

Extrinsic factor

A

7

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172
Q

Which steps in coag cascade require Ca

A

IX
X
II
Stablising clot

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173
Q

Internal jugular vein insertion

A

At the triangle’s apex formed by the sternocleidomastoid muscle’s two heads above the medial clavicle and is usually 5 cm superior to the clavicle.

This should be lateral to the carotid pulsation

Medial clavicle to ear

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174
Q

Modified radical mastectomy removes

A

skin, areola, nipple, and most axillary lymph nodes, but the pectoralis major muscle is spared

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175
Q

Median, Medial, lateral umbilical folds

A

Medan- urachus
Medial- umbilical arteries
Lateral -urachus

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176
Q

Reflexes of brainstem death

A

Pupillary lights- 2,3
Corneal- V1, 7
Vesrtibulo-occular- 8,3,6
Pain- V, VII
Gag- IX, X
Cough- X, X

Afferent , efferent

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177
Q

Veins inside fall cerebri

A

Inferior and superior sagittal

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178
Q

Transverse sinus

A

Connected sigmoid and confluence

In tentorium cerebri

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179
Q

Dermatomes of lower leg

A

L4 medial
L5 dorsum and lateral
S1 little toe and lateral

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180
Q

Defect in AVSD origin

A

Endocardial cushion

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181
Q

Slough in urine

A

ATN

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182
Q

Carotid sinus vs body

A

Body- chemo
Sinus- baro

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183
Q

Tx of high INR

A

INR >5- hold warfarin
INR >5 minor bleed - oral vit K hold warfarin
Greater than 8 with no bleeding — stop warfarin and give phytomenadione by mouth using the intravenous preparation orally
Greater than 8 with minor bleeding — stop warfarin and give phytomenadione by slow intravenous injection.
Major bleed- IV PCC, Vit K - can give FFP if PCC unavailable

Restart warfarin when <5

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184
Q

Where lactulose is absorbed

A

Not absorbed
Broken down in gut bio by flora

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185
Q

Ova and cyst with blood diarrhoea tx

A

Metronidazole for entamoeba histolytica

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186
Q

Recovery of reflexes post SCI

A

Polysynaptic- plantar, crem

Then from caudal to rostal

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187
Q

Comminuted patella fracture

A

Tension binding wiring

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188
Q

Audit on how long for letter to get to doctor

A

Audit of process

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189
Q

Location of gallbladder surface anaotmy

A

Under 9th Costal margin
TP plane

Where rectus sheath meets costal margin

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190
Q

Major cell in granuloma

A

Macrophage

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191
Q

Granulomatous pyelonephritis post stone mx

A

Nephrectomy

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192
Q

Classification of wounds

A

Clean - not inflamed or contaminated
Clean contaminated - resp, Biliary, GI- minimal spill
Contaminated -spillage
Dirty- active infection- exudate

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193
Q

Appendicitis organism

A

Bacteroids

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194
Q

Tender painful swelling below angle of mandible

A

Supurrative lymphadenitis

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195
Q

Infliximab MOA

A

Anti TNFa

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196
Q

Pharyngeal pouch of tympanic cavity and Eustachian tube

A

1st

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197
Q

Loss of sensation in first 3 fingers what view x ray

A

True lateral view

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198
Q

X rays for SUFE

A

AP and frog lateral pelvis

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199
Q

% of blood in pulmonary vasculature at rest

A

10-15%

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200
Q

Nerve innervating ejaculation

A

Lumbar splanchnic

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201
Q

Anal fissure relative to dentate

A

Posterior and distal

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202
Q

Horseshoe kidney associated

A

PUJ obstruction

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203
Q

Ix for Ivc thrombus

A

MRI best

But initial- venogram

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204
Q

Antibiotics not be give with fibrosis

A

Nitro

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205
Q

Burns patient with oedema

A

Hypoalbuminaeia

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206
Q

COPD lung volume changes

A

Increased residual volume

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207
Q

Lactate is formed in which cycle

A

Cori cycle

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208
Q

Multiple transfusions low Ca

A

Citrate toxicity

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209
Q

Non caeseatign granuloma

A

Sarcoid

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210
Q

Pleural pain refera to abdo cause

A

Intercostal nerves

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211
Q

Hypertricglyceridaema vs HC defect

A

HTG- lipoprotein lipase enzyme

HC- LDL receptor deficient

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212
Q

Part of temporal forming pterion

A

Squamous

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213
Q

Diarrhoea form pork and eggs

A

C jejuni

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214
Q

Management of omphalcele/gastroc

A

Small <4/5cm- surgical repair
Large- staged repari

Omphal- intact sac- elective
Small sac rupture- surgical
Large rupture- staged delayed

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215
Q

Scan for tertiary hyperparathyroid

A

Tchnetium sestambi scan

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216
Q

Purpose of gallbladder

A

Concentration of bile

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217
Q

Sections of cerebellum and correlating symptoms

A

Anterior lobe- ataxia, unsteady gait- alcohol

Posterior lobe- fine movements of hands, intention tremors

Vermis- posture- axial ataxia

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218
Q

Cilostazol

A

Antiplatelet drug and a vasodilator

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219
Q

Biggest factors effecting suitability for renal transplant

A

Controlled HTN and DM

CB health

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220
Q

Osteoporosis histological features

A

Increased osteocytes lacunae and canaliculi

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221
Q

Brachial cyst vs hygroma

A

Hygrome transilluminates

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222
Q

PTH transported for Ca in Kidney, SI

A

TRPV5- kidney

6- SI

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223
Q

Noradrenaline on CBF

A

Usually no effect

But if v hypotensive increase MAP and CBF

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224
Q

Area of bleeding in LP

A

Dura mata

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225
Q

Nerves initiating micturition

A

Pelvic splanchnic

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226
Q

What should be measured in anaphylaxis

A

Tryptase

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227
Q

Chronic pancreatitis severe pain mx

A

Endoscopic procedure for stricture

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228
Q

Most likely origin of VSD

A

Peri membranous

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229
Q

Inferior epigastric to rectus abdominus

A

Posterior

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230
Q

What is right to 2nd duodenum

A

Hepatic plexus of colon

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231
Q

Derivatants of spermatic fascia

A

External spermatic fascia – derived from the aponeurosis of the external oblique muscle.

Cremaster muscle and fascia – derived from the internal oblique muscle.

Internal spermatic fascia – derived from the transversalis fascia.

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232
Q

Muscles effected by inferior angle of scapula fracture

A

Lat dorsi
Teres major

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233
Q

Hypothyroid and hypothermia tx

A

IV warm fluid and levo

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234
Q

Which level of scalp separates in avulsion injury

A

Loose areolar

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235
Q

What is medial to phrenic at thoracic outlet

A

Vagus

As IJV meets subclavian at first rib

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236
Q

What artery is preserved in anterior resection

A

Left colic

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237
Q

Popcorn cells in lymph nodes

A

Nodular lymph HL

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238
Q

Agent for rapid induction

A

Etomidate-if haem unstable
Propofol

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239
Q

Line used on x ray for pelvic organ prolapse

A

Pubococcygeal line

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240
Q

Number of Na/K for each ATP

A

3 Na out for 2 K inW

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241
Q

When can you do a hemithyroidectomy

A

If 1-4cm and no LN involvement / extra thyroid involvement

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242
Q

When to use radio iodine therpay in thyroid cancer

A

RAI should be offered after a total or completion thyroidectomy, if a person has:
a primary tumour at stage T3 or T4,

regional lymph node involvement,

pathological findings associated with a poor prognosis (including multifocal disease),

or evidence of distant metastases.

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243
Q

SIADH vs hypercalcaemia specific urine gravity

A

SIADH- high
Ca- Low

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244
Q

Bening vs malignant phyllodes tumour features

A

Significant atypic in cells
High mitotic index

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245
Q

Action of neostigmine and use in anaesthesia

A

ACHe inhibitor

To reverse NM blockers- vecuronium

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246
Q

Where collections occur after cholecystectomy

A

Morrison Pouch

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247
Q

HIV, Hep c and b from needlestick

A

0.3% hiv
1.8 hep c
30 b

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248
Q

TF relative to RA below arcuate

A

Posterior

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249
Q

Calculating CO figures

A

70ml x HR

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250
Q

Bone landmark for aortic bifurication

A

ASIS- L4

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251
Q

Histological finding of AAA

A

Distruption of elastic lamella

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252
Q

Definitive diagnosis of AIH

A

Biopsy

portal inflammatory infiltrate, regenerative rosettes

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253
Q

Where thyroglossal cyst attaches to tongue

A

Foreman caecum

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254
Q

AB for RA

A

Anti CCP

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255
Q

Pharyngeal Pouch origin for tympanic membrane and ET

A

1st

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256
Q

2nd pharyngeal pouch forms

A

Palatine tonsil

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257
Q

Third and 4th pharyngeal pouch form

A

3rd- inferior para
Thymus

4th - superior para and C cells

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258
Q

When to refer GORD for surgery

A

Refractory symptoms or strictures/barrets

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259
Q

Nuclear atypia thyroid cancer

A

Papillary
Follicular doesn’t

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260
Q

What does the deep iliac circumflex anastomose with

A

Lateral circumflex femoral by ASIS

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261
Q

Obstructive vs restrictive spirometry

A

Obs- <0.7 FEV1/FVC
Restrictive near 1

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262
Q

Muscles involved in pincer grip

A

FPL, FPB, AP

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263
Q

Clef lip which arch

A

1ST

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264
Q

Nerve innervating posterior thigh and popliteal fossa

A

Posterior cutaneous nerve of thigh

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265
Q

Muscles causing ulnar paradox

A

FDP

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266
Q

When does the gut move back into abdomen in development

A

11-13

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267
Q

What is the cremistatic artery a branch of

A

IE

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268
Q

Distruption in somite formation can lead to

A

Scoliosis, skeletal defects and muscle malformation

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269
Q

Premature endochonral ossification can lead to

A

Lead sto scoliosis kyphosis, lordosis

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270
Q

Cause of varicocele

A

Incompetence spermatic veins

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271
Q

What level V nodal dissection risks

A

Accessory nerve damage - drooping shoudler

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272
Q

Diagnosis of PSC

A

MRCP

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273
Q

Features suggesting chronic over acute panc

A

Normal amylase and lipase
Steatorrhoea
Calcification on CT

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274
Q

Malaria features

A

Spleno hepatomegaly
Low WCC
Low Plt

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275
Q

Maintainers of GA

A

Halothane- neg inotrope
Isoflurane- most used- malignant hyperthermia
Sevoflurane
NO- weak anaesthetic , potent analgeisa

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276
Q

Bladder rupture causes and mx

A

Haematoma/contusion- conservative

Intraperitoneal - high energy blow to distended bladder
Lap and reapir

Extra- pelvic- usually catheter 10d

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277
Q

Vasodilation mediator after touring release

A

NO

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278
Q

Ix for mandibular fracture

A

CT

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279
Q

Finding iliac aneurysm <3cm

A

Rupture risk rare

FU generally not required

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280
Q

Mx of ovarian cancer

A

Surgery then adjuvant chemo

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281
Q

Initial mx of incarcerated hernia

A

Gentle manipulation under sedation/anaesthesia

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282
Q

Diagnostic test for Ewing

A

Image guided biopsy

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283
Q

Teardrop sign seen on X ray

A

Infraorbital fracture

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284
Q

Approach for high abdominal teste positions

A

Fowler Stephens

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285
Q

Intrabdominal teste management

A

<2cm deep ring - orchidoplexy

> 2cm- Fowler Stephens- 2 stage approach- 1st identify and ligate then months later- position

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286
Q

When to repair AAA

A

> 5.5cm
Symptomatic
1cm/year

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287
Q

Before what age for orchidoplexy

A

12m

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288
Q

GCS for urgent CT head

A

</= 12 initial
<15 2 hours

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289
Q

Important blood test for sepsis

A

Lactate

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290
Q

Crush injury to leg with CK >1000

A

Urgent surgical decompression of compartments

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291
Q

Kidney transplant with oligouria, and high creatinine for 2 days

A

Delayed graft function
Declined urine output unresponsive to fluid challenge

Defined by need for dialysis post transplant or failure of creatinine to drop by 10% on 3 consecutive days

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292
Q

T2DM, glucose at 18, needs urgent cholecystectomy what mx

A

Sliding IV insulin until between 6-10

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293
Q

Root for referred shoulder pain

A

C4

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294
Q

Hypopigmented macule and periungual fibromas

A

Tuberous sclerosis

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295
Q

TG, TSH, calcitonin with papillary reoccurrence

A

TG high
TSH high
Calcitonin normal

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296
Q

Pale leg with CKD 3 ix

A

Duplex

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297
Q

Investigation of choice for COPD

A

Spirometry pre and post bronchodilators

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298
Q

Spread of prostate cancer from which veins

A

Venous plexus of prostate- Santorini

To Batsons- venous of vertebral canal

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299
Q

Long term management of mod/severe crohns

A

Biological agent- Anti TNF

If stricter and accesses or failure of med management- surgery

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300
Q

Mx of rectal prolapse in child

A

Analgesia and manual reduction

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301
Q

Pentameter antibody

A

IgM

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302
Q

Old scar than now has turned. hard, with elevated Ca

A

Dystrophic calcification

Where damaged tissue calcifies

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303
Q

Double bubble sign X ray

A

Duodenal atresia

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304
Q

Cause of lateral winging of scapula, during abudction

A

Accessory nerve damage

Long throacic causes medial winging

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305
Q

What fluid should be given when in metabolic alkalosis

A

Saline

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306
Q

What forms lateral border of Guyons canal

A

Hamate
With transverse carpal lip and flexor tendons

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307
Q

Artery contributing most to breast

A

Internal thoracic

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308
Q

Pelvic vs retrocaecal appendicitis signs

A

Pelivc- over obturator Internus- pain on flexion and IR of hip

Retro- pain on passive extension- Cope psoas sign as running over psoas

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309
Q

What area of brain generate rhythm of resp

A

Pre Botzinger complex

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310
Q

Olivary nucleus function

A

Superior -Part of auditory pathway

Inferior- relay between spine and cerebellum

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311
Q

Earache with green pus- organism ?

A

Pseudomonoas- otitis media

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312
Q

Anatomical marking for spinal anaesthesia

A

Supracrestal line- L4

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313
Q

Origin of genicular arteries

A

5 originate from popliteal
Lateral sup, lateral inf medial sup, medial inferior, middle

Descending genicular- femoral 1st before passing into adductor hiatus

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314
Q

Stages of Cushign reflex

A

Ischaemia causes sympathetic- HTN and tachy

Then stimulation of baro- bradycardia

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315
Q

Metabolic disorder with fast citrate infusion

A

Metabolic alkalosis

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316
Q

Half life of T3, T4, PTH

A

T3- 1 day
T4- 5-7 days

PTH- 5 mins

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317
Q

Supply of temporal lobe

A

Middle and posterior

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318
Q

Diplopia looking to left, convergent squint on extreme gaze

A

Abducens palsy

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319
Q

Erythema, does not extend beyond DIP

A

Felon- abscess fo compartment of finger pulp

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320
Q

Structure most at risk for penetrating injury to apex of femoral triangle

A

Femoral artery

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321
Q

Which nerve is most likely damaged in ablation to posterolateral right atrium

A

Right phrenic

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322
Q

ICU patient with oedema in gallbladder but no gallstones

A

Acalculous cholecystitis

Happens in ICU- settles with ABx

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323
Q

Cervical cancer, now has weakness of adduction

A

Obturator LN spread

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324
Q

SCC of tonsil, LN spread tx

A

Unilateral modified radical neck dissection- removal of LN I-V

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325
Q

Mx of oropharyngeal cancer

A

Supraomohyoid- LN 1-2- N0 for SCC/malignant melanoma anteriro to ear or lower eyelid

Selective- 1-4- N0/1- SCC of lateral tongue, oral cavity

Lateral- 2-4- any N- without extracapsular spread for SCC of larynx, thyroid cancer, melanoma with + LN

Postero lateral- 2- 5- posterior to ear

Modified- I-V- bulky LN disease with extracapular spread involving below
1- spares Accessory
2- XI and IJV
3- spares XI, IJV and SCM

Radical- Removes I-V- including XI, IJV, SCM- bulky extracapsular

In midline or bilateral nodal involvement - bilateral neck dissection

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326
Q

Neck dissection levels

A

1- submental and submandibular
2- upper jugular
3- middle jugular
4- lower jugular
5- posterior triangle
6- central compartment
7- superior mediastinal

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327
Q

Nodal drainage patterns of head and neck cancers

A

Oral Cavity: I-III
Oropharynx: II-IV
Nasopharynx: II-IV
Hypopharynx: II-IV
Larynx: II-IV
Thyroid: VI

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328
Q

Level of DJ flexure

A

Transpyloric- just below

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329
Q

What forms sinus tarsi

A

Calcanaeus and talus

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330
Q

Right Renal artery relative to IVC and renal vein

A

Posterior to IVC and superior to vein

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331
Q

Location of origin of IX

A

Anterior medulla

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332
Q

Medial longitudinal fasciulus

A

Cross over between CN 3,4, 6

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333
Q

Hering Breuer reflex

A

Strech receptors in lung inhibiting overinflation of lung

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334
Q

Point of entry for lap gas entry

A

Usually umbilicus- but if unavailable due to prior scar

Palmers point- 3cm below left costal margin MCL

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335
Q

Hurthle cell cancer histology

A

> 75% are oxyphil/oncocytic cells of follicular carcinoma

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336
Q

Most common place for blockage of CSF

A

Aqueduct of slyvius

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337
Q

Types of anti fungal and function

A

Ketokonazole- prevents ergosterol formation by P450

Ampho B and nystatiing- impair membrane by complexing with ergestotrol

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338
Q

Origin of lacrimal artery

A

Ophthalmic

Runs along upper border of lateral rectus

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339
Q

Cells that secrete mucous in stomach

A

Foverolar

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340
Q

When to do a total thyroidectomy

A

If >1cm or if multifocal

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341
Q

Malignancy associated with Pagets

A

Osteosarcoma

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342
Q

Innervation of lacrimal gland

A

Lacrimal nerve a branch of Ophthalmic nerve -sensory
Zygomaticotemporal- autonomic

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343
Q

Heinz bodies, triggers

A

G6PD- triggered by fava, cipro, antimalarial and sulphur containing drugs

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344
Q

Normal FRC and IRV

A

FRC- 2-3L
IRV- 2-3L

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345
Q

Ligaments of uterus

A

Pubocervical
Caridnal- lateral to cervic
Uterosacral mosteiro

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346
Q

Most common renal cancer and most likely to respond to cytokine therapy

A

Clear cell carcinoma
Il2

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347
Q

Features of chromophobs, medullary, papillary carincoma of kidney

A

Chromophobe- intercalated cells of DCT, homogenous contrast enhancement

Medullary- sickle cells traits, renal medulla near renal papillar

Papillary- renal tubular epithelium, multifocal/bilateral, calcification

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348
Q

Origin of tympanic membrane, external acoustic meatus, ear ossicles and inner ear

A

Tympanic and EAM- 1st ectodermal cleft/pharyngeal

Ossicles- malleus and incus -Meckels cartilage

Inner- otocyst

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349
Q

Organs that contain oxyphil cells (oncocytes)

A

Parathyroid, thyroid, pituitary, kidney, salivary

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350
Q

Which muscles is damaged if lower 2/3 of fibular fractures

A

FHL

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351
Q

TP, FDL and FH attachments

A

TP- tibia, fibular, interosseous to navicular and medial cuneforms

FDL- tibia- 4 tendons- to lateral phalanges

FHL- fibular to great tow

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352
Q

Beady appearance on MRCP

A

PSC

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353
Q

Tx of duodenal atresia

A

Duodenojejunostomy

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354
Q

80 with lumbar fracture, what ix

A

Calcium profile

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355
Q

Cerebral contusion vs haemorrhage

A

Haemorrhage- reduced consciousness, lucid internal

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356
Q

Peroneal nerve relative to malleolus

A

Anterior to lateral

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357
Q

Mx of spinal abcess

A

Surgical

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358
Q

Screening of HNPCC

A

Colonoscopy every 2 years from 20

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359
Q

Mx of crural arteries

A

<25cm- conservative
>25cm- endovascular repair

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360
Q

Nutrition for intubated patient

A

TPN

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361
Q

Mx of metatarsal stress fractures

A

Rest 3-4w

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362
Q

Endovascular repair vs bypass for aortoilliac, femoropopliteal and infrapopliteal lesions

A

Aortoiliac - Angio <3cm
If total occlusion

FP- stenotic <10cm
Bypass >10cm

Infrapop- <50cm
Great saphenous vein for longer

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363
Q

Spirometry low FEV1, FVC, low FEV1/FVC- not reversed with bronchodilators

A

COPD

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364
Q

What portion of oesophageal would require repair if injured

A

Thoracic- as can lead to mediastinitis

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365
Q

When does PJ present and with what

A

Infancy
Colicky pain
Freckles around lips
Recurrent jelly stools

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366
Q

Order of tests in prostate cancer

A

Confirm diagnosis first with PSA and MRI

Then stage with CT CAP

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367
Q

Leg biopsy shows blue round cells

A

Ewing sarcomma

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368
Q

What is shown on biopsy for osteochondroma, osteosarcoma, Ewing

A

OC- chorndroblasts- cobblestone/chickenwire

OS-mesenchymal cells atypic

ES- blue round cells

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369
Q

What is given in palliation of cerebral mets

A

Dex

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370
Q

Anaesthesia used for hip replacement

A

Spinal

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371
Q

Facial colliculus syndrome

A

Causes facial palsy and abudcen palsy- compression of pons

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372
Q

Externally rotated hip, sensory loss below knee what fracture

A

Acetabulum- causes compression of peroneal part of sciatic

If displaced or causing nerve compression- surgery

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373
Q

Mx of vWD before surgery

A

Mild- desmopressin
Severe/not respond to desmo- Cryo

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374
Q

Where to insert needle for tension

A

5th ICS

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375
Q

Late vs early dumping syndorme

A

Early <30 mins
Late- 1-3 hours

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376
Q

Tender drawn up teste

A

Torsion

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377
Q

Consent if patient is unable to give consent for life saving procedure

A

Consent 4- acting in best interest

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378
Q

Rhadomyalisis with renal failure

A

Haemodialysis

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379
Q

Closure of tibial flap

A

Glue

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380
Q

4.7cm AAA monitoring

A

3m

<4.5cm 12m

1 off screening for men >65

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381
Q

Nerve damaged just above umbilicus

A

Thoracoabdominal

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382
Q

Elective surgery with a Hba1c of 72

A

Postpone surgery until better controlled if elevtive

If for cancer- close ops and insulin

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383
Q

Dislocation of talus, 10 yrs later pain which is severe what dx

A

OA of joint

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384
Q

Adequate Hba1c prior to surgery and mx

A

<69

If >69 or CBG >12 and on insulin
VRII

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385
Q

Hypotension and melena post ERCP

A

GI bleed

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386
Q

Mx of malignancy induced hypercalcaemia

A

Zolendronate

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387
Q

Mx of ulnar and radial shaft fractures

A

ORIF - as unstable

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388
Q

Most common cause of lytic bone lesions in children

A

Neuroblastoma

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389
Q

Progression of VUR

A

Recurrent urine infections - boys
Scarring before 5
DMTA scan

390
Q

ABG of Cushing syndrome

A

Hypokalaemia
Metabolic alkalosis
High glucose

391
Q

Transfer to burns unit

A

> 3% in adults
2% in children
Hands, feet, face, gentalia, circumferential
Full thickness
Not in 2w

392
Q

Mx of superficial partial thickness burn

A

Deroof blister and occlusive dressing

393
Q

When to flap over graft

A

Exposed bone no periosteal cover, exposed tendons, irradiation wounds- avascular

394
Q

What sx can hemisection in cerivcal spine produce

A

Horners ipsilateral

395
Q

Patient is having surgery for spread of melanoma now has DVT what mx

A

IV herparin

396
Q

Tracheostomy effect on compliance, resistance, RV, VC, dead space

A

Increase compliance
Reduce resistance and dead space
No effect of RV or VC

397
Q

When to ORIF ankle fractures

A

Weber B with alar shaft
Weber C
Displaced bimalleolar
Trimalleolar
Open

398
Q

What conc is 1% of a drug

A

10mg /1ml

399
Q

If under 30, what sx make it appropriate for triple assessment of breast

A

Any discrete palpable lump

400
Q

Patient about to undergo elective knee replacement, MRSA + what next?

A

Delay surgery and decolonisation

401
Q

Tx of Graves

A

Anti thyroid- if cannot tolerate or does not work, mod/severe opthalmopathy - definitive treatment

Radioiodine– CI pregnancy, <5, opthalmo, larger goitre
Surgery- large goitre

402
Q

Radical prostectomy

A

Removed of prostate and seminal vesicles
Offered if LE >10yrs, no mets

403
Q

ACD vs IDA

A

ACD- usually normocytic
High ferritin

404
Q

Nerve damaged with petrous part of temporal bone

A

Facial

405
Q

Complications of hypothyroid in surgery

A

Decreased CO, HR, anaemia

High cholestrol- CHD

406
Q

Level of LP in children and adults and where conus terminates

A

Adult
Conus- L1-2
LP 3-4

Child
Conus- L3
LPL4-5

407
Q

Patient on treatment dose LMWH, and develops DVT what next

A

Apixiban long term

408
Q

Osteosarcomma vs Ewing presentation

A

Osteo- metaphysic, distal femur/prox tibia

ES- diaphysis or pelvis/ribs/vertebrae

409
Q

Lidocaine dosing

A

3mg/kg

410
Q

CO and SVR in septic shock

A

Increased CO and reduced SVR

411
Q

Tumour marker of seminoma

A

LDH or bHCG

412
Q

Biomarker indicative of anastomotic breakdown

A

Albumin <3
Transferrin <150

413
Q

Pyrexia psot surgery timeline

A

1- systemic response
2-3 - atelectasis
3-7- wound, urinary , anastomotic
7- DVT

414
Q

Mx of nasal cartilage defect post surgery

A

Nasolabial flap with ear cartilage graft

415
Q

Urinary retention, foreskin retracted over swollen glans

A

Paraphimosis

416
Q

Mx of rib fractures in those unable to cough and those with resp conditions

A

Unable to cough 24 observation

Resp- HDU

417
Q

Patient requiring splectomy for HS, gallstones present what mx

A

Offer cholecystectomy same time as splenectomy

418
Q

CI for immunisation

A

Anaphylaxis, immunodefiiceincy with lives

Fever- relative

419
Q

Destruction of frontal bone, goitre, no LN

A

Follicular - bone mets as doesn’t use LN

420
Q

Organism in Fouriners

A

Mixed flora

421
Q

Origin of trachea

A

Foregut endoderm

422
Q

Sign in, time out, sign out

A

Sign in before anaesthesia
Name, procedure, allergies, ABx, blood available

Timeout- confirm, blood loss, diathermy, abx, specimen, vte- start before knife

Time out- recorded procedure, specimens, lines flushed, equipment problems, VTE abx, daycase?

423
Q

Sodium conc in 0.9% saline

A

154mmol/l

424
Q

Reflex loss with facial nerve in parotidectomy

A

Corneal efferent limb

425
Q

Pre op carb drink effects

A

May reduce insulin resistance

426
Q

Spread of HL vs NHL

A

HL- contiguous spread
NHL- non contiguous spread, multiple LN groups, extranodal at time of diagnosis

427
Q

Colicky pain 12.5cm Dilated intraheptic ducts 4m post cholecystectomy

A

Retained biliary in CBD

10cm considered normal

428
Q

Part of the spine most effected by congenital scoliosis

A

Thoracic

429
Q

Perilunate dislocation features

A

The capitate and other carpal bones are displaced dorsal to the lunate

Median nerve palsy
Wrist hyperextension injury

Dorsal displacement of capitate normal radiolunate alignment

Urgent closed reduction

430
Q

Laser in endoscopy, derm, opthalmo

A

Argon beam

431
Q

Retrograde amnesia for CT in 8 hour

A

> 30mins

432
Q

Mid shaft tibial fracture repair

A

IM nail

433
Q

Vessel involved in tracheoarterial fistula causing bleeding

A

Inominate artery (BC)

434
Q

Where thyroid ima branches from

A

BC trunk

435
Q

Vein draining anterior surface of heart

A

Great cardiac vein

436
Q

Supply of pons

A

Anteromedial- basilar and pontine perf arteries

Lateral- lateral pontine from basillar
AICA and superior cerebellar

Anterolateral- AICA

437
Q

Which centre controls rate of breathing

A

Pneumotaxic centre

438
Q

Apneustic vs pneumotaxic centres

A

Apneustic- increase depth and duration of inspiration

PT- decreases duration of inspiration- increases rate of breathing

439
Q

Number of primary and secondary ossification centres in verebrae

A

3- primary

5- puberty- one in tip of spinous process, each transverse, one ring epiphysis of sup and inf surface of vertebral bodies

440
Q

High pressure veins in oesophageal varices

A

Left gastric

441
Q

Where the majority of congenital pharyngeal abnormalities occur

A

2nd arch

442
Q

Where does pulp of finger start in DRE

A

Posterior

443
Q

Pseudomonas Cystic Fibrosis antibiotics

A

Cef and tobramycin 10-14d

444
Q

Origin of cremastatic muscle

A

Internal oblqiue and inguinal lig

445
Q

Resp factor effected most in obese patients

A

ERV

446
Q

Lateral medullary vs lateral pontine

A

AICA- pons
Its ataxia, nystagmus, loss of temp in face and facial weakness, loss of hearing

PICA- medulla
Horners, dizziness, absent gag

447
Q

Cleft lip cause

A

Medial nasal prominence fails to fuse with max prominence

448
Q

Abx in erythema with STG

A

Mero- due to pseudo

449
Q

Ductus arterioles attachment

A

PA to descending proximal aorta

450
Q

Ganglion for taste

A

Geniculate ganglion

451
Q

Organism for dental abscess

A

Bacteriodes

452
Q

Ligaments of TMJ

A

Lateral ligament (main TMJ lig), sphenomandibular, stylomandibular

453
Q

Supply of TMJ

A

Temporal auricular nerve

454
Q

Direction of dislocation, articulation surface of TMJ, boney surfaces

A

Anterior

Fibrocartilage, articulation disc, 2 synovial cavities

Mandibular fossa, articular tubercle from squamous, head of mandible

455
Q

Layers in pfannistinel incision

A

Skin, sub fat, superficial fascia, anterior rectus sheath, muscleTF, extraperitoneal fat, peritoneum

456
Q

RUQ pain, high ALP, xanthelasma, test

A

PBS- anti mito

457
Q

MODY diagnosis

A

Before 25 late onset
AD

Non ketotic
No AB
B cell dysfunction

458
Q

Main test for renal cancer diagnosis

A

CT with contrast

459
Q

CT of liver is hypotenuse then hyperdense with contrast

A

Angiosarcomma

460
Q

6yo with weight loss, tremors and gait instabilty, urinalysis reveal neutral aminoaciduria where is the problem

A

PCT
Hartup disease

461
Q

Main source of cardiomyocyte energy

A

Fatty acid oxidation

462
Q

COPD TLV, RV

A

Increased

463
Q

What supplies proximal duodenum

A

Superior pancreaticoduodenal

464
Q

Muscle most likely involved in perineal tears

A

Transverse peroneal

465
Q

Antiemetic for raised ICP

A

Cyclizine

466
Q

Goire, bilateral LN, cells arranged in clusters, pleomorphic nuclei, coarse chromatin, mitotic figures

A

Anaplastic carcinoma

467
Q

Function of EO vs IO

A

EO- fibres run inferiorly and medially from ribs
Contralateral rotation

IO- -superiorly and medially from iliac crest
Ipsilaterally rotates

468
Q

Which cardiac vein drains the lateral wall of left ventricle and which delivers retro Cardioplegic shock

A

Left marginal

Coronary sinus

469
Q

Gene mutation with male breast cancer in FH

A

BRCA 2

470
Q

Second pharyngeal arch artery

A

Stapedial

471
Q

Dorsal vs ventral portion of 3rd pharyngeal pouch

A

Dorsal inferior para
Ventral thymus

472
Q

Methacholine test

A

Bronchoconstricts asthmatics- muscarinic agonist

Reduces FEV1/FVC

473
Q

Location of vertebral endplate

A

Between vertebral body and disc

474
Q

Horizontal vs vertical inguinal nodes

A

Vertical- drain legs
Horizontal drain perineal

475
Q

Mechanism of nerve injury

A

Neuropraxia- streching

Axontemesis- closed fractures

Neurotmesis- high energy crush, penetration

476
Q

What is anterior to pancreas

A

Pylorus

477
Q

When should you use apixiban over LMWH

A

Creatinine clearance <30

478
Q

Colles fascia in perineum

A

Deep layer of superficial perineal fasciae

Continuous with Scarpers and form superfiical perineal pouch

479
Q

Location of Bartholin vs Bulbourethral gland

A

Bartholin superficial -5,7 o’clock

BU-deep by membranous urethra

480
Q

Vaginal drainage

A

Superior – drains to external iliac nodes
Middle – drains to internal iliac nodes
Inferior – drains to superficial inguinal lymph nodes.

481
Q

MSK structure origin in pharyngeal arches

A

1st- maxilla, mandible, malleus, incus
2nd- styloid, stapdeius, lesser horn of hyoid
3rd- greater horn of hyoid
4th- thyroid cartilage and epiglottis
6th-cricoid and arytenoid

482
Q

Pharyngeal pouches form

A

1st ET and middle ear
2nd palatine tonsil
3rd- dorsal Inf parathyroid and ventral thymus
4th dorsal sup para
ventral C cells

483
Q

What separates transverse sinus of heart vs oblique

A

Transverse- PA ant and aorta then SVC posterior
Superior to Left atrium

Oblique- PV

484
Q

Articulations of carpal bones to which metacarpal

A

Trapezium- 1st and 2nd
Trapezoid- 2nd
Capitate- largest 3rd
Hamate- 4,5th

485
Q

Mx of a baby with GORD

A

Full history - reducing volume of feed or thicker formula
Then gaviscon (alginate)
Then can consider PPI/H2

486
Q

Milk alkali syndrome

A

Ingested Ca causing renal failure with alkalosis

487
Q

Mild vs mod vs severe traumatic brain injury

A

Mild - LOC <30 mins, amnesia <1d, GCS 13-15

Mod >30 mins <24hrs, amnesia <7d- GCS 9-12

Severe- LOS >24hrs, amnesia >7d, GCS 3-8

488
Q

Pre op tests

A

DO not routinely do Hba1c without diagnosis
DO not do CXR

ECHo only if murmur, cardiac symptom or sc of HF

Minor surgery- not real tests needed

Int surgery- ECG, U+E- ASA 3/4
Consider Spiro

Major surgery- FBC for all
U+E, ECG ASA 2 and above

489
Q

FHH biochem

A

Mild elevated Ca
Mild/normal PTH
Low level excreted in urine

490
Q

AP vs Anterior

A

<3cm from dentate AP
>3cm Anterior

491
Q

When to use IVC filter

A

If AC contraindicated

492
Q

How long will oral iron take to replenish

A

4w

493
Q

Drug increasing risk of SCC and MOA

A

Tacrolimus

Downregulates T cell - calcaneurin inhibitor

494
Q

Mx of open fracture

A

IV abx, tetanus, stabilisation, dressing immediately
1/2- ceph/co
3- cephalopods +amino

Debride <12hrs for 3
<24 for 1/2
Irrigation in theatre(<3 for 1, 3-6 for 2, >6for 3)
External temporary fixation

Done immediately if gross contamination, compartment or devascularised

495
Q

Pain releif post hip replacemtn

A

Regular para
PRN morphine

496
Q

When to use tourniquet in haemorrhage

A

In patients with major limb trauma use a tourniquet if direct pressure has failed to control life‑threatening haemorrhage.

497
Q

Position of patient for hip replacement posterior vs lateral/anterior approach

A

Lateral decubitus-post

Supine if direct lateral/ant

498
Q

C diff causing septic shock and renal failure mx

A

Emergent colectomy

499
Q

Location of spermatocele in teste

A

Posterior

500
Q

US shows complex cyst, FNA shows fluid filled but blood what next

A

Biopsy

501
Q

Sx of bile leak post op

A

RUQ pain, malaise, difficult surgery

Normal bloods- if retained stone causes abnormal bloods and fever

502
Q

Behcets triad

A

Ulcer in mouth and genital
Arthralgia

503
Q

Rinne and Webers

A

Rinne + If air>bone
Conductive- negative
SN- gives false positive

Weber- lateralises to uneffected

504
Q

Mx of itching in cancer of ducts/panc

A

ERCP and stent

505
Q

Mx of lasy with pneumothorax no symptoms

A

Admit for observation
As no sx
Re image in 2-4w

506
Q

TEA in rib fractures

A

Can use after oral

CI in thoracic vertebral, spinal injury, epidural haematoma and clopi

507
Q

Grey mass on floor of mouth, painless, young

A

Ranula

508
Q

Deformity in supracondylar fx

A

Varus- gunstock- carrying angle reduced if malunion

509
Q

Grafts for arm and palm bruns

A

Meshed split for arm and forearm
and other larges areas

Full thickness- palm, face and neck if small
If large-unmeshed ST graft

510
Q

Mx of nec fasc

A

Debridement
IV amp, clind, cipro

511
Q

Biggest RF of AAA

A

HTN

512
Q

Anaemia, jaundice, enlarged spleen

A

HS- defect in membrane

513
Q

MAP target in non HTN patients

A

65-70

514
Q

Bi lobed nuclei with large LN

A

HL

515
Q

Gangrenous toe with one vessel run off

A

Below knee amputation

516
Q

Mx of sudek dystrophy

A

Symp ganglionic block

517
Q

FOOSH, median nerve compression

A

Lunate dislocation

518
Q

Feels like stadning on a marble between 3rd and 4th

A

Morton neuroma

519
Q

Late X ray sign of Perthes

A

Sagging rope sign sclerosis of NOF

520
Q

Flap for sections of leg

A

Pros third-Gastrocnemius flap

Middle- soleus

Distal- sural

521
Q

Regurg and vomitting, recurrent chest inf

A

GORD

522
Q

Value for arm/leg tourniquet in surgery

A

250mmHg- 200 in child
300-thigh
Should not exceed 2hrs

523
Q

Antiphospholipid tx

A

Lowdose aspirin if childbearing age

Warfarin

524
Q

Embryological Defect in passing faeces in vagina

A

Urorectal septum

525
Q

Arteries forming Arc of Riolan

A

Middle and left colic

526
Q

Where fluid collects in anterior vs posterior gastric ulcer

A

Paracolic gutter anterior

Lesser- posterior

527
Q

Where LCA arrises from

A

Left posterior aortic sinus

528
Q

Ventilator associated pneumonia

A

Pseudomonas

529
Q

When is a tourniquet inappropriate

A

If open trauma wound- as want to assess for vascular injury

530
Q

Components of cochlea

A

Perilymph in scala vestibule
Endolymph in scala media (coclea duct)
Perilymph in scala tympani

Low frequencies go whole way
High -short

531
Q

Lido max

A

500mg with adrenaline
200 without irrespective of body weight

532
Q

How to find transpyloric plane on surface

A

Hafway between suprasternal notch and pubic symphysis

533
Q

Levels in axillary clearance

A

Lateral 1
Behind 2
Medial 3

534
Q

Naproxen MAO

A

Non selective COX inhibitor

535
Q

Ondansetron MOA

A

Serotonin Antgagonist

536
Q

What tumour is very radio-sensitive

A

Seminoma

537
Q

When to use delayed primary closure

A

> 12 hours after injury presentation if >5cm

> 18 hrs if small

Complex wound- bites

Wait 4-5 days

538
Q

Warfarin causing skin necrosis cause

A

Protein C deficiency

539
Q

Side effect of alkylating agent

A

Gout

540
Q

Which cancers are radioinsensitive

A

Adenocarcinomas

541
Q

Tx of early vocal cord cancers

A

Radio- since SCC are sensitive

542
Q

Dx of bladder vs urethral injury

A

Bladder- CT cystoscopy
Urethral- retrograde cyst

543
Q

Part of the cell cycle that RNA is synthesised and which part does p53 act on

A

RNA in G1 and 2

p53- prevents going into S

544
Q

Histology of keloids

A

Whorls of collagen with no pattern

545
Q

What do B adrenergic receptors actviate on a cellular level

A

Adenylate cyclase

546
Q

Botulism MOA

A

Prevents pre synaptic release

547
Q

Most likely side effect of adjuvant chemo in breast cancer

A

Secondary leukaemia

548
Q

Breakdown of suxamethonium

A

AchE

549
Q

Reversal of depolarising vs non depolarising muscle relaxants

A

Non- neostigmine

Sux- plasma cholineesterases

550
Q

What tumour is assocaited with paraganglionoma

A

Phaeo

551
Q

Structures relative to perineal body

A

Posterior- EAS
Lateral- transverse perineal
Anterior- bulbo

552
Q

Main method of intracellular vs extra buffer

A

Proteins - intra

Bicarb- extra

553
Q

Ganglion for palm and axilla sweating

A

T2 and 3- palm
4- axilla

554
Q

What limits haematoma in brain

A

Suture lines

555
Q

What is in cryoprecipitate

A

VIII and fibrinogen
vWF

556
Q

Hormone respone to hypothermia

A

Increase catecholamines and thyroxine

557
Q

Test for correlation of 2 variables

A

Pearson- parametric

Spearmans - non

558
Q

Location of CTZ, receptors

A

within the dorsal surface of the medulla oblongata, on the floor of the fourth ventricle of the brain

Histamine, dopamine, serotonin

559
Q

How obesity causes CV mechanical issues

A

Expanded blood volume- reduces ventricular compliance

560
Q

Main source of energy with starvation

A

Serum FA

561
Q

Clark level of melanoma

A

Epidermis
Papillary dermis
Junction of papilary and reticular
Reticular
Sub fat

562
Q

Adrenal mass with lung mets with cushings

A

Radical adrenalaectomy
Lung lobe resection

563
Q

True vs false vocal cords

A

True- free edge of quadrangular membrane that forms false vocal cord

564
Q

If contamination risk like a bile leak what suture should you use

A

Mono non absorbable -lowest risk of infection

565
Q

Effective preventative measures for MRSA patient

A

Barrier nursing

566
Q

Dukes surivial rates

A

A- 95
B-75
C-45
D-5

567
Q

Alkylating agent examples

A

Platinum
Cyclophosphamide

568
Q

Where in bowel is radio given as adjuvent

A

Rectum

569
Q

Mx of bone mets pain

A

Radio and NSAIDs

570
Q

Re infarction after surgery with recent MI %

A

30 days -37%
3-6 months- 16%
1 yr- 5%

571
Q

Benzo MOA

A

Enhances GABA

572
Q

Hep B exposure- management

A

Non responder 10-100 - one dose

<10- HBIG and booster dose, plus 2nd at 1 month

If responder >100- no action

No vaccine- accelerated course, HBIG and first dose

573
Q

Hormonal therapy in phaeo, endometrial, prostate cancer

A

Phaeo- phenoxybenzamine
Endo- progestins
Prostate- gGNRH analgoues

574
Q

Tetanus managemetn

A

Exposure- no vaccine
Vaccine + HTIG

Clean wound- no need

Dirty or requiring surgical intervention >6 hrs-
Last dose <10 yrs- nothing
>10 years- booster

11 yrs old should’ve had 3 doses

575
Q

Drug causing gingival hypertropgy

A

Ciclosporin

576
Q

What does infliximab make you prone to

A

TB

577
Q

SE of methotrexate

A

Fibrosis of liver and lungs

578
Q

What alters the dose of caphalosporins

A

Creatinine clearance

579
Q

Mx of otitis media

A

<4d - delayed abc
>4d - amox

580
Q

Most common cause of lymphedema in UK

A

Mets causing obstruction

581
Q

Cancers that chemo is effective against

A

Leukaemia
Lymphoma
Teste
Ewing
Wilms
Retino

582
Q

Abdo vessels located between campers and scarpers

A

Superficial inferior epigastric

583
Q

Lateral sinus thrombosis sx

A

Papilloedema, rasied ICP, tenderness over mastoid

Compression of CN 9-11 if develops

584
Q

Renal pathology FEN

A

Pre- <1% FEN
Renal 2-4
Post >4%

585
Q

Tacrolimus moa

A

Calcaneurin inhibitor- inhibit IL2

585
Q

Which bone burr holes go through

A

Temporal then frontal then parietal

586
Q

Pregnanct last at term with air under diaphragm

A

Lapartomy

587
Q

Number of paranasal sinus and which is most prone to infection

A

4

Maxillary as by teeth

588
Q

Nec fasc common organism

A

Strep pyo

589
Q

What delvers depolarisation to papillary muscles

A

Right- moderator band

Purkinje fibres

590
Q

Crohns patient presents with septic perianal abcess mx

A

Exploration under GA and drainage

As would be complex- so not to do under local

591
Q

4th ventircle relative to pons

A

Directly posterior

592
Q

Allatnois

A

Connects umbilical cord to cloaca

593
Q

Dissection of which vessel next to superior cervical ganglion

A

Internal carotid

594
Q

Diagnostic of SAH in CSF

A

Xanthochromia- breakdown of Hb

595
Q

What uses the cori cycle

A

Myocytes

596
Q

How erythrocytes get energy

A

anaerobic conversion of glucose by the Embden-Meyerhof pathwa

597
Q

Last to regain function in radial nerve palsy

A

EPL and EI

598
Q

Weakness in dorsiflexion, where is sensory deficit

A

Root L4

SO medial leg !

599
Q

Primary large pneumothorax mx

A

> 2cm or symptoms Needle aspiration then chest drain

600
Q

Fourineres gangrene organism

A

Group A strep - pyogene

601
Q

What causes popeye deformity

A

Prioximal rupture- long head at supraglenoidal

602
Q

What does PAH measure

A

Renal blood floe

603
Q

What week does the uterus rise above the pelvic rim

A

12th week

604
Q

Sensation to posterior 1/3 od tongue

A

IX

605
Q

Approach for hemiarthroplasty

A

Anterolateral approach

606
Q

Checking rectal anastomosis

A

Water soluble contrasat enema

607
Q

Biggest arterial contributor to femoral head

A

Medial femoral circumflex

608
Q

Mx of basicervical fracture

A

DHS

609
Q

Homan sign

A

Passive Dorsiflexion pain- DVT

610
Q

Complication of not being euthyroid before surgical management of Graves

A

Thyroid storm

611
Q

Loss of sensation of upper cheek, upper front teeth and lateral nose

A

Infra orbital- from V2

612
Q

NSAIDs on kidneys

A

Vasoconstriction of afferent

613
Q

ANGT2 on renal function

A

Increased resistance in efferent- increased GFR

Hence ACEi reduce GFR

614
Q

Which nerve is responsible for Frey syndrome

A

AT

615
Q

McMurray test

A

For meniscus

616
Q

Wells score for DVT and PE

A

DVT >/=2
PE >4

617
Q

Spiking fevers, headache, neck rigidity after acute mastoiditis

A

Sigmoid sinus thrombophelbitis

618
Q

Mx of urteric stone

A

<10mm litho
10-20 uteroscopy

619
Q

USS of foot shows fibrosis and teardrop mass

A

Mortons neuroma

620
Q

Factors in Extrinis pathway

A

VII and TF cofactor

621
Q

Transplanted heart nerve supply

A

No nerve supply - so cannot feel pain
Controlled by hormones in circulation

622
Q

Patient has asymptomatic pneumothorax, for surgery what mx

A

Chest drain

623
Q

Suffering from cold, now painful around medial eye, no eye symptoms

A

Ethmoidal sinusitis

624
Q

Recent cold, proptosis and opthalmoplegia

A

Orbital cellulitis

625
Q

Feeding after cystectomy

A

Sloppy diet

626
Q

Osteocondritis dissectans

A

Affecting cartilage and subchondral bone
Medial condyle
Crescent shaped lytic lesion

627
Q

Feeding after oesophgectomy

A

Jejenostomy

628
Q

Distended abdo, thin hair, dermatitis, malnourished

A

Protein deficiency

629
Q

Co-trimoxazloe is prophylactive for

A

Pneumocystic jirovecii

630
Q

Tests for subacromial impingement

A

Neer
Hawkin
Jobe

631
Q

Difficulty speaking loudly after throat surgery

A

RLN damage

632
Q

Mx of testicular cacner

A

Seminoma
Just teste- surgery, surveillance
If reocurs- radio is good
LN- surgery and chemo, sperm bank
Mets- chemo then surgery

NSemi
Just test- surgery and surveillance (CTAP 3-6, AFP 1-2m)- chemo or RPLN if reoccur
LN- Surgery, RPLN, chemo, sperm bank
Mets- chemo and surgery

633
Q

Seminoma vs NS

A

Semi- 30-40
LDH, bHCG
Homogenous
If mets- radio
Lymphocytic infiltrate

NS- 20-30
Tumour markers more common - AFP, bHCG
If mets- chemo

634
Q

SUFE x ray

A

Slipped femoral metaphysis relative to epiphysis
Femoral head Not intersecting Klein line

635
Q

What does lymphatic nodal involvement follow

A

Arterial

636
Q

What nodes is affected first from spleen, pancreas and liver

A

Coelaic

637
Q

Protein affected in haemachromotosis

A

HFE

638
Q

CRPS 1 vs 2

A

1- pain after traum with no nerve damage
2- nerve damage

639
Q

Flexion of hand after supracondylar fracture

A

Volkman Ischaemic contracture

640
Q

Tourniqet effect on bleeding

A

Hypercoagulable effect

641
Q

Mx of antithrombin def

A

Warfarin

642
Q

Malocclusion of teeth and CSF rhino

A

Le fort 2

1 doesnot effect CSF

643
Q

EOL antiemetic

A

Levomepromazine

644
Q

What must be conducted prior to varicose surgery

A

Duplex US

645
Q

When to do a hemithyroidectomy

A

Can be offered if T1-2 (<4cm)
No LN or mets, well differentiated

646
Q

Compartment of sural nerve

A

Superficial

647
Q

Infection of little finger spreads to

A

Proximal of flexor retinaculum

648
Q

If oesophagectomy with anastomosis what vessel supplies the remains of gastric

A

Right gastroepiploic

649
Q

Supply of glut max

A

Inferior gluteal

650
Q

Nerve affected in episiotomy

A

Pudendal

651
Q

Nerve closely related to origin of meningeal artrery

A

AT

652
Q

Neurovasculaure content of deep pouch in males

A

Dorsal nerve of penis, muscular branches of the perineal nerve
Deep and dorsal arteries of penis, stem of origin of artery to the bulb of penis, urethral artery.

653
Q

Structure at most risk with clavicle fracture

A

Subclavian vein

654
Q

Vessel damage at SF ligation

A

Deep external pudendal

655
Q

Foremen in sphenoid vs temporal vs occipital

A

Ovale, spinosum, rotundum, SOF- sphenoid

Jugular, stylomastoid, IAM- temoroal

Magum,hypoglossal - occipital

656
Q

External tympanic membrane cells

A

Stratified squamous

657
Q

What causes compression in annular pancreas

A

Ventral pancreas

658
Q

Where does foreamen lacerum lie

A

Between sphenoid and temporal

659
Q

Innervation of brachioradialis

A

Radial

660
Q

Lymphatic drainage of membranous and prostatic urethra

A

Internal iliac

661
Q

Where does sigmoid sinus drain

A

Internal jugular

662
Q

Incision for Whipples procedure

A

Rooftop

663
Q

Level of cardioeosophgeal junction

A

T11

664
Q

Where are oxyphil cells found

A

Parathyroid

665
Q

Which structure lies in closest proximity to hamate in carpal tunnel

A

FDP

666
Q

Which foremen does lesser petrosal nerve pass through

A

Ovale

667
Q

Lymphatic drainage of female urethra

A

Internal iliac

668
Q

Order of structures in cavernous sinus

A

Medial
Internal carotid
Abducens

Lateral
Oculomotor
Trochlear
Opth
Max

669
Q

Arterial and venous supply of adrenals

A

Sup- inf phrenic
Middle- Aorta
Inf- Renal

Venous
Right- Direct
Left- renal

670
Q

Attachments of omohyoid

A

Superior belly arises from the hyoid bone and inferior belly arises from the scapula. Two muscle bellies are connected by an intermediate tendon, which is anchored to the clavicle by the deep cervical fascia

671
Q

Which layer is the facial vein located beneath

A

Deep fascia of neck

672
Q

Location of coeliac plexus

A

Anterior to aorta

673
Q

Attachment of pharyngeal constrictors

A

Sup - pterygomandibular lig, mandible, medial pterygoid of sphenoid to raphe

Mid- stylohyoid and hyoid to raphe

Inf- thyroid, cricoid to phayngeal raphe

674
Q

Which vein drains middle colic

A

SMV

675
Q

Ligaments of ankle joint

A

Deltoid medially

Anterior, posterior talofibular
Calcaneofibular

676
Q

What lies medial to dorsalis pedis

A

EHL

677
Q

Terminal division of external carotid
And origin in relation to internal

A

Superficial temporal and maxillary

Origin anteromedial

678
Q

What is divided on lateral approach to hip surgery

A

Lateral circumflex

679
Q

Origin of compartment of pancreas

A

The pancreas develops from a ventral and dorsal endodermal outgrowth from the duodenum

Ventral - uncinate and major duct
Dorsal-minor duct, head, body and tail

680
Q

Incision for elective vs emergency hernia

A

Elective- Low - Lockwood (below canal) or Lotheissen (through canal)
Emergency- High- McEvedy

681
Q

Narrowing of oesophagus

A

ABCD
Aorta
Bronchi
Cricoid
Diaphragm

682
Q

Lymphatics of ear

A

The lateral surface of the upper half drains to the superficial parotid lymph nodes

The cranial surface of the superior half drains to the mastoid nodes and deep cervical lymph nodes

The lower half and lobule drain into the superficial cervical lymph nodes.

683
Q

Ribs encountered in posterior approach for kindeys

A

11-12th

684
Q

What forms lateral wall of deep inguinal ring

A

TF

684
Q

Artery under lateral third clavicle

A

Thoracoacromial

685
Q

Supply of pec minor

A

Medial pectoral

686
Q

Fascial layer that will expose ansa cervicalis

A

Pre tracheal

687
Q

Lymphatic drainage of ureters

A

Upper - aortic
Lower- common iliac

688
Q

Proximal vs distal Horners

A

Proximal- hypothalmospinal tract

Distal- post ganglionic- at carotids or beyond
(anhidrosis mild)

689
Q

Superficial ring borders

A

Lateral- EO

Anterior to pubic tubercle

690
Q

Best incision for appendectomy

A

Lanz

691
Q

Main arterial branch in omentum

A

Gastroepiploic

692
Q

What needs to be divided in sympathectomy

A

Parietal pleura

693
Q

What forms pterion

A

Greater wing of spehnoid
Parietal
Squamous temporal
Frontal

694
Q

Point of entry of pelvis of ureters

A

Infront of Bifurcation of common illiac

695
Q

Lump, cough impulse and thrill

A

Saphena varix

696
Q

Pain just distal to ASIS

A

Lateral cutaenous nerve of thigh

697
Q

Hypothenar wasting, unable to oppose thumb root

A

T1

698
Q

Boy presents with Syndactyl- what has happened here

A

Failure of apoptosis

699
Q

Hodgkin lymphoma with poor prognosis

A

Lymphocyte depleted

700
Q

HIV and depleted CD20 with generalised LN swelling- what infection

A

Myco avium

701
Q

Splecetomy with pneumonia

A

CMV

702
Q

Scan to find primary tumour site

A

PET scan

703
Q

Injury to cervical area, what muscoskeletal area the lowest that can be damaged without causing issues to breathing

A

Cricoid
C6- not affecting phrenic

704
Q

Tx of C diff infection

A

Vanc oral first line
Second Fidoxamicin

Life threatening- Vanc oral and IV met

705
Q

Low BP, low Na, high K what diagnostic test

A

SynACTHen

706
Q

Mantoux test type

A

4- delayed

707
Q

Loss of lordosis weight lifter

A

Spondylithiasis

708
Q

Location of lateral cutaneous nerve

A

L2,3 lateral to psoas major

709
Q

Long term catheter organisms

A

Proteus and pseudomonoas

710
Q

Serosonginous discharge cominig from single breast duct

A

Papilloma

711
Q

Lump transilluminates, not present all day

A

Hydrocele

712
Q

TNM colon cancer

A

T1- submucosa
2-MP
3- subserosa
4- other organs

N1- <3 LN
2- >3
3- distal nodes

713
Q

When must you use FFP by

A

<24 hrs of defreezing

714
Q

ACL artery

A

Middle geniculate

715
Q

Pathology of mortons neuroma

A

Synovium Fibrosis And Nerve Inflammation

(between 3rd and 4th)

716
Q

Arch origin of Ductus arteriolis

A

6th

717
Q

Most common organism for cellulitis

A

Strep pyogenes

718
Q

Foul ,diarrhoea, steatorrhoea, what organisms, what shape and tx

A

Giardia

Pear

Metronidazole

719
Q

Diarrhoea fter eating chicken with cramps, what gram, dx and associated condition

A

C jejuni

Gram -ve rod

GBS

720
Q

Meningitic symptoms with HIV, what test

A

Crypto neoformans

India pink

721
Q

Signs of carbon monoxide poisoning or inhalation injury

A

High resp rate
Confusion
Tiredness

722
Q

How can you lower ICP

A

Lower CO2

723
Q

Level of hilum of lung and incision for access

A

T5-7
6th IC Space Posterior Axillary Line

724
Q

Hypodense on CT brain

A

Infarction

725
Q

What is bladder exostrophy associated with

A

Hypospadism

726
Q

Trauma with thigh swelling, decreased pulse and sensation distally

A

Femoral Shaft fracture

727
Q

Tertiary hyperparathyroidism pathology

A

Hyperplasia

728
Q

Spleen location

A

Ribs 9-11

729
Q

Patient died after trauma with delayed fixation of fracture what do you see on CT head

A

Petachial haemorrhage

730
Q

Cardioesophgeal from incisors length

A

40cm

731
Q

Nerves damage preventing erection after surgery

A

Pelvic splanchnic

732
Q

Which region do ureter pierce bladder

A

Posterior

733
Q

Primary vs secondary hypothyroidism

A

Primary- thyroid damage
Secondary- pituitary damage- prolactinoma

734
Q

Splenomegaly, BM shows megas- what is the cause of low plts

A

Spleen plt destruction

735
Q

How many litres per minute does a male athlete produce

A

5-6L

736
Q

AAA pathology

A

Loss of medial elastin

Medial cystic necrosis - in marfan

737
Q

Most sensitive regulator of ADH

A

Hypothalamic osmoreceptors

738
Q

What is secreted in response to oral glucose

A

GIP

739
Q

What inhibits gastric emptying

A

CCK
SS

740
Q

What are micelles crucial to

A

Vit ADEK absorption

741
Q

Layer of cartilage most responsible for resistance to stress

A

Transitional (middle)

742
Q

Most important factor mediating blood flow in muscle

A

Vasodilator metabolites

743
Q

Involuntary athetoid movement where is the lesion

A

Basal ganglion
Globus pallidus

744
Q

What is formed by osteoblast prior to osteoid

A

Collagen

745
Q

What do non myelinated neurons lack

A

Nodes of Ranvier

746
Q

Stored blood affinity

A

Less DPG so greater affinity

747
Q

Dorsal respiratory group

A

Produces inspiration

748
Q

Pneumonectomy reduces VC by

A

33%

749
Q

Adrenorecptors insulin/glucagon

A

B stimulates insulin, a inhibits

B inihibtis glucagon, a stimulates

750
Q

% of calcium ionised and bound to albumin

A

40- 50% ionised
45% to albumin

751
Q

Intracellular recptors

A

Cortisol
Aldo
Vit D
Test

752
Q

Osmolaltiy of medulla to concentrate urine

A

High

753
Q

Renal threshold

A

Plasma conc which above, substances start to appear in urine

754
Q

Pudendal passes between which 2 muscles at GSF and relative to sciatic nerve

A

Piriformis and cocygeus

Medal to Siactic

755
Q

Vessel bleed in tonsilectomy

A

External palatine vein

756
Q

Where are accessory spleens found

A

hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads

757
Q

What does chorda tympani run medially to in middle ear

A

Pars Flaccida

758
Q

Is the gallbladder intraperitoneal

A

The fundus is

759
Q

When are the ligaments of the knee taut and is the patella intr/extra ynovial

A

when in extension

Posterior aspect is intrasynovial

760
Q

Why is it easy to insert a CVP line

A

No valves

IVC has 0 too

761
Q

Blood supply of bile duct

A

Hepatic artery

762
Q

Breast cancer with lymphcytic ifiltrate

A

Medullary

763
Q

Subacute thyroiditis features

A

High T4
Low TSH
Reduced uptake
Tender

764
Q

Imaging with young woman with lump with implants

A

USS then MRI

765
Q

Pagets vs nipple eczema

A

Pagets- nipple first

Eczema- areolar

766
Q

Med causing goitre and hypothyroid

A

Lithium

767
Q

WLE has + resection margin in breast

A

Mastectomy

768
Q

Thyroid cancer related to radiation

A

Papillary

769
Q

Biggest risk factor for DE

A

Smoking

770
Q

2cm invasive carcinoma of breast with axillary involvement

A

WLE and axillary clearance

771
Q

What does dobutamine act on to reduce BP

A

B2

772
Q

Painful thyroid swelling with defective epithelial cells and siderophages

A

Thyroid cyst

Siderophage is a haemosiderin containing macrophage

773
Q

Optic pathway in parietal lobe

A

Optic radiation

774
Q

Vessel most likely injured at lesser trochanter

A

Circumflex vessels

775
Q

Sinus tarsi between

A

Calcaneus and talus

776
Q

Histology of methothilioma

A

Epithelial tumor and tubular cells

777
Q

ON AC but no severe RF of head injuiry

A

CT <8hrs

778
Q

MOA of TXA

A

Prevents formation of plasmin

779
Q

Post renal transplant, anuric, double DR matched, urine flowing with irrigation

A

Renal venous thrombosis

780
Q

Needle aspitation in 2ICS most likley structure damaged

A

2nd IC nerve

781
Q

Amyloid in heart

A

ATTR

782
Q

Nerve root of musculocutaneous

A

C5,6,7

783
Q

pH less that on aspiration of gastric tube

A

<5.5

784
Q

Air noted under diaphragm after snare polypectomy mx

A

If during procedure- clips

If after and not peritonitic- NBM, abx and wait

Peritonitic- surgery

785
Q

What wave in JVP is effected in tricuspid stenosis

A

A wave

786
Q

CRYPT ABSCESSES

A

UC

787
Q

Relative risk, RRR, ARR and NNT calculation

A

RR= (outcome exposed/total expose)/ (outcome not exposed/total not exposed)

RRR=1- RR
ARR= reverse of RR

NNT=1/ARR

788
Q

Right renal artery relation

A

Posterior to IVC

789
Q

Posterior compartment of leg deepest structure?

A

Tibial artery

790
Q

Posteromedial approach to Baker’s cyst, which part of neurovascular
bundle is most superficial and susceptible to damage?

A

Saphenous vien

791
Q

Normal PEF

A

500L/min

792
Q

Where to ligate thoracic duct

A

Aortic hiatus on left

793
Q

Numbness of cheek and upper frontal teeth after trauma to face,
anesthesia on that side of the nose

A

Infraorbital

794
Q

Vertebral level of cervical ganglion

A

Superior - C1-4

Middle - C6

Sterllate- C7, T1

795
Q

Formation of ureterostomy

A

Removes a short piece of your small bowel (ileum).

Join the cut ends of the ileum back together.

Ureters attached to one end of this piece of ileum.

796
Q

Uretereostomy with ileum electrolyte abnormality

A

Hyperchloremia

797
Q

Barorecptor response to hypotension

A

Carotid sinus baroreceptors are responsive to both increases or decreases in arterial pressure, while aortic arch baroreceptors are only responsive to increases in arterial pressur

798
Q

Immediate inferior pole of left adrenal gland

A

Splenic artery

799
Q

Types of ectopic in Meckels

A

Gastric and pancreatic

800
Q

Where does fluid accumulate in perf appendix

A

Pelvis

801
Q

Genes involved in colorectal cancer pathway

A

APC
c myc
K ras
p53

802
Q

Rithcers and Littres hernia

A

Anti mesenteric Ritcher
Littres- Meckels

803
Q

What is Cullens vs Grey Turners sign

A

Cullen- intrabdominal bleed
Grey Turner- retroperitoneal

804
Q

Surgery for UC

A

Elective- pan procto

Emergency whilst unwell- Subtotal and end ileostomy

805
Q

SBO, pain radiated from groin to knee

A

Obturator hernia

806
Q

When to re scope after polyp findings

A

Large non pedunculated colorectal polyps - One off scope at 3 years

High risk findings
More than 2 premalignant polyps including 1 or more advanced colorectal polyps (>1cm or dysplastic)
OR
More than 5 pre malignant polyps-
Or- adenoma >1cm thats dysplastic
One off scope at 3 years

(If tumour is left ) Large non pedunculated colorectal polyps (LNPCP) R1 or non en bloc resection- Site check at 2-6 months and then a further scope at 12 months

807
Q

Surgery on obstruction of rectum, left and right colon

A

Rectum- loop colostomy
Left- End colostomy
Right- Right hemi and ileo-colic

808
Q

Most common fistula in ano

A

Intersphincteric

809
Q

Medication that can aid pseduo-obstruction

A

Neostigmine

810
Q

Normal CBD width

A

<8mm

811
Q

Cell origin of all pancreatic adenocarcinomas

A

Ductal epithelium

812
Q

Managemement of T4 colon cancers

A

Chemoradio

813
Q

Management of T3,N1 colon cancer

A

Resect then chemo (decide chemo on final hisotlogy)

814
Q

Work up before cholecystectomy

A

LFT and USS for CBD width

815
Q

Bariatric surgery associated with delayed gastric emptying

A

Anterior GJ

816
Q

Achalasia patholgy

A

Loss of ganglion in myenteric plexus

817
Q

Pancreatic necrosis on CT, suspicion it is infected what next

A

FNA
If confirmed Necrosectomy

818
Q

What to do after ERCP failed with panc carcinoma

A

Percutaenous transhepatic cholangiogram and drain

819
Q

Blood supply of Meckels

A

Vitelline- branch of ileal

820
Q

Fundoplication, now delayed gastric emptying

A

Damaged vaguis

821
Q

Stone in CBD, impossible to remove what next

A

Choledochoduodenostomy

822
Q

Where haematoma collects ini penile fracture

A

Bucks

823
Q

Delayed presentation of External iliac thrombus- what management

A

Thrombectomy and below knee fasciotomy- low risk above knee

824
Q

Fem pop bypass but has varicose veins

A

PTFE with miller cuff

825
Q

Nerves at risk for brachial cyst excision

A

Mandibular branch of facial nerve, greater auricular nerve and accessory nerve

826
Q

Which lobe does BPH and prostate cancer effect

A

BPH- median
Postate C- posteriro

827
Q

When to DEXA scan vs treat

A

Bisphosphonate, calcium and vitamin D supplementation should be given to all patients aged over 75 years after having a fracture. A DEXA scan is only needed of the patient is aged below 75 years.

828
Q

Open patella fracture management

A

Debride
Encirclage wires and primary closure

829
Q

Most common paranasal sinus cancer

A

Ethmoidal

830
Q

Sarcoid vs cacner of partoid

A

Sarcoid bilateral

831
Q

An x-ray shows a distal radial fracture with radiocarpal dislocation.

A

Barton

832
Q

Febrile with a smooth swelling overlying the superomedial aspect of the right eye

A

Ethmoidal sinusitis

833
Q

Superloateral limit of axillary dissection

A

Axillary vein

834
Q

Distended abdo, hiccups after burns

A

Acute gastric dilation

835
Q

What is deficient at the area of prolapsed disc

A

Annulus fibrosus

836
Q

Prev aortic graft, become pulseless
Other side healthy what mx

A

Fem fem

837
Q

First symptom of raised ICP

A

Altered mental status

838
Q

Supply of EAM

A

AT and vagus

839
Q

Supply of external ear

A

Skin of posterior ear- LO
Superior- AT
Inferior- GA
EAM- AT and vagus

840
Q

Ulcerated, lesion after injury, rasied red

A

Pyogenic granuloma

841
Q

INR before surgery

A

<1.5

If above - give oral vit k

842
Q

Levator scapula attachment and innervation

A

C1-4 TP
Dorsal scapular

843
Q

Rhomboid major and minor attachment and innervation

A

Minor- C7-T1
Major- T2-5

Dorsal scapular

844
Q

Attachment of triceps

A

Lateral- sup to radial groove
Medial - inf to radial groove
Long- infraglenoid

845
Q

Which toes do not have palmar interossei

A

1st and 2nd

846
Q

Asvascular necrosis x ray signs

A

Early- opaque - hyperaemia

Late- radiolucent and subchondral collapse

847
Q

Posterior urethral fold symptoms and embryology

A

Hesitancy, poor stream, UTI, even resp problems as child

Abnormal intergration of Wollfian duct

848
Q

Mx of hydrocele

A

In young- inguinal ligation of patent processus vaginalis

In adults- scrotal jabouley approach

849
Q

Neuro vs nephroblastoma

A

Neuro- calcified
Nephro- non

850
Q

TCC of renal pelvis cause and tx

A

Textiles

Radical nephroureterectomy

851
Q

Wheelchair bound, IHD, popliteal occlusion

A

Amputation

852
Q

Thiazide on Ca

A

Hypercalc

853
Q

Hormones reduced after surgery

A

Test, oestrogen adn insulin

854
Q

Dead space vs RV measurements

A

Dead space- Fowler- N2
RV- helium

855
Q

Part of JVP where Tricuspid closes

A

C wave

856
Q

Normal anion gap

A

8-14

857
Q

Normal anion gap acidosis causes

A

H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline

858
Q

What vitamin is pancreatic independent in absorption

A

Folate

859
Q

Body fluid volumes

A

Plasma- 3, 5%
Interstitial- 10, 24%
Transcellular-1, 3%

860
Q

Airway management in short case with sevoflurane

A

Laryngeal mask
Used in day surgery

861
Q

Fluid that is the most electrolyte rich

A

Hartmanns

862
Q

When to stop UFH infusion

A

6 hours before

863
Q

Bronchiectasis vs scoliosis lung pattern

A

BE- obstructive
Scoliosis- restrictive

864
Q

KIT + tumour
Drug

A

Imatinib

865
Q

Relaxant agent not used in burns and one that is degraded by hydrolysis and may cause histamine release

A

Suxamethonium- due to HyperK

Atracurium is degraded by a process of ester hydrolysis. This uses non specific plasma esterases

866
Q

Composition of cryo

A

vWF
VIII
Fib
XIII

867
Q

Immunological therapy in Crohns

A

Infliximab

868
Q

TPN calories

A

25-35 kcal/kg/day (lower if BMI > 25)

If severely ill and malnourished, the initial calories administered is reduced by 50% in the first few days.

10cal/kg/day with oral thiamine and B supplements

869
Q

CI to epidural

A

Active infection

Appendicitis i.e

870
Q

Hypovolaemia PAWP, CO, SVR

A

Low low high

871
Q

When is a Caudal block used

A

For nerves affecting lumbar or sacral area

872
Q

Only vasopressor that doesnt require central line

A

Metaraminol

873
Q

What is associated with anal/oral cancer

A

HPV16/18

874
Q

Medially displaced ureters vs lateral

A

Lateral- retroperitoneal malignancy

Medial- fibrosis

875
Q

Which coag factors does jaundice impair

A

2,7, 9, 10
Since impairs Vit K

876
Q

What can you see with severe atrophic gastritis

A

Gastric ulcer, anaemia
Gastric polyps
Cancer

877
Q

Mx of gastric cardia cancer

A

Total gastrectomy with RNY

878
Q

PTEN mutation

A

Cowden disease

Macrocephaly
Multiple intestinal harmatomas

Breast cancer, thyroid
Colorectal

879
Q

What is used to stain cytoplasm and nuclei

A

haematoxylin and eosin

880
Q

Location and type of polyp in HNPCC

A

Mucinous and right sided

881
Q

Splenomegaly haem causes

A
  • Myelofibrosis
  • Chronic Myeloid Leukaemia
  • Visceral leishmaniasis (kala-azar)
  • Malaria
  • Gaucher’s syndrome
882
Q

Symptomatic AAA with occluded iliac artery mx

A

Open reapir

883
Q

osteopetrosis is best explained by a defect in which of the following?

A

Osteoclasts

884
Q

Echinococcus granulosus infections

A

typically produce a type I hypersensitivity reaction which is characterised by an urticarial rash. With biliary rupture a classical triad of biliary colic, jaundice and urticaria occurs

Hydatid cyst

885
Q

Diabetic drugs with surgery

A

Stop acarbose, sulphonyl, glitides, pio, dp4, SGLT2- once VRII commenced, restart once eating and drinking

GLP1 can be takern as normal during infusion

Pio, DP4 (gliptins), GLP1 can be taken as normal peri op

Sulph, SGLT2 omitted

Metformin omitted if miss more than 1 meal, or if risk of AKI (GFR <60 or contrast)
VRII if BD metformin or glucose >12 on 2 occasions

886
Q

Troublesome persistent green breast discharge

A

Hadfield procedure
Total duct excision

887
Q

PDA vs coarctation murmur location

A

Coar- 4th ICS
PDA- under clavicle

888
Q

Parotid malignancy most likely to spread and cause facial nerve damage

A

Adenoid cystic

889
Q

plain x-ray of the affected site shows multiple lytic and lucent lesions with clearly defined borders. What is the most likely diagnosis?

A

Osteoclastoma

Soap bubbles

890
Q

Osteoid osteoma

A

Lesion affects cortex and radiologically consists of a lucent centre surrounded by reactive sclerosis

Severe pain- respond to NSAIDs

891
Q

Skin rash in glucagonoma

A

skin rash of erythematous blisters involving the abdomen and buttocks. The blisters have an irregular border and both intact and ruptured vesicles

892
Q

Cytotoxic hypersensitivty

A

Type 2
Antibodies formed against antigens

893
Q

Tx of hydatid cyst

A

Surgery and mebedazole

894
Q

Only surgery needing one lung ventilation

A

VATS

895
Q

Mx of hernia electviely

A

Adult- Mesh repair- Lichen
Routine
If incarcerated- urgent referral
Strangulate-d admit

Mesh on TF and IO

Shouldice- if pus or bowel content contaminating canal - no mesh

Child- herniotomy
Within 2 weeks - urgent
No mesh

Recurrent or bilateral- lap

896
Q

Granulation tissue by wound, what can help it heal

A

Silver nitrate

897
Q

Types of current

A

Cutting- continous low voltage
Coag- peaks of high voltage
Des- low current, high voltage, water loss, no protein
Fulguration- low amp high volatge, held away
Blend- alternating cutting and coag

898
Q

Anastomosis most and least likely to leak

A

Most- oesophageal and rectal
Least- small bowel

899
Q

Mesh location in inguinal canal

A

Posterior to cord
On TF and IO
Fixed to inguinal ligament- prolene

900
Q

What is assocaioted with malrotation

A

Exomphlaos and congenital diaphragmatic hernia

901
Q

Hirschprungs disease mx

A

Full thickness suction rectal biopsy.

The condition is managed with washouts initially.

At between 9 and 12 months of age, definitive surgery (usually resection and primary anastomosis) is performed.

902
Q

Dermoid appearance

A

Dermoid cysts are usually multiloculated and heterogeneous. Most are located above the hyoid

903
Q

Skew effects on mode median mean

A

Neg- mode> median>mean
Shifted right

Pos- mean>median>mode
Shifted left

904
Q

Coefficient of variation calculation

A

SD/mean

905
Q

Ix of non healing venous ulcer and in lichen sclerosis

A

Punch biopsy to ensure not malignant

Punch biopsy too

906
Q

Friable skin lesion, slough off and scars

A

Keratoancanthoma

907
Q

Mx of infected sebaceous cyst

A

Incision and drainage with excision of cyst wall and packing

908
Q

Which nerve does Le Fort 2 fracture effect

A

Infraorbital

909
Q

Orbital apex syndorme sx

A

SOF syndrome and ipsilateral pupillary defect

910
Q

Vertigo, dysarthria then collapse

A

Basillar occlusion

Suggests posterior inarct

911
Q

Hormones increasing and decreasing with hypothermia

A

Increase- TSH, adrenaline, CS, aldo, glucagon

Decrease- insulin

912
Q

Flat face fracture

A

Le Fort 3

913
Q

UO targets in burns patients

A

Normal burns - 30ml/hr

Electrical- 100

914
Q

Seen last in compartment syndrome

A

Loss of pulse

915
Q

Sequestration vs aplastic

A

Aplastic- reticulocytes low

916
Q

Loss of sensation in left cheek, fullness in gingivobuccal sulcus and proptosis

A

Maxillary cacner

917
Q

Varicella vesicles over tip of nose where else can they be

A

Cornea

918
Q

Old lady rapidly enlarging thyroid now has stridor

A

Anaplastic carcinoma

919
Q

Movement of mandible on wide openeing and discloation

A

disclocates anterirorly

920
Q

TMJ disc

A

Fibrous

921
Q

Axis and atlas features

A

Axis- bifid, small transverse foramina, odontoid

Atlas- no body, anterior and posterior arch, PA has a groove for the vertebral artery and C1 spinal nerve.

922
Q

Tooth infection organism

A

Bacteroides

923
Q

Difference in vertebrae

A

Cervical- transverse foramina, triangle foramen, bifid spinous

Thoracic- demifacet for ribs
Oblique SP
Circular SF

Lumbar
Triangular
Short SP

924
Q

Hypothyroid cholestrol

A

High

925
Q

Ulcer effects which artery at junction of gastric body and antrum

A

Right G.epi

926
Q

Plaster management

A

If there is axial instability (whereby the fracture is able to rotate along its long axis), such as combined tibia-fibula metaphyseal fractures or combined radius-ulna metaphyseal fractures, the plaster should cross both the joint above and below

Spiral fracture

927
Q

Virus responsible for kaposi

A

HHV8

928
Q

Loss of sensation back of elbow, weak supination what root

A

C5

929
Q

Lymph drainage of scrotum

A

Medial superifical

930
Q

Cause of direct hernia

A

TF weakness

931
Q

Alar catilage exposed, which flap to use

A

Local rotational

932
Q

Old man with bronchitis with rib fracture mx

A

Admit and analgesia

933
Q

Burn with blisters mx

A

Occlusive dressing

934
Q

FOOSH parasthesia of thumb and index

A

Lunar dislocation

935
Q

Sensation of ear lobe

A

GA

936
Q

Urine with SAH

A

Natriuresis with polyuria is common after aneurysmal subarachnoid hemorrhage

Diluted urine

937
Q

Opening of major papilla

A

Postero medial 2nd part of duo

938
Q

Mobilise spleen from abdo wall

A

Splenorenal

939
Q

Inguinal lymphnodes and bleeding in female

A

Vuvlal cancer

940
Q

What drains anterior surface of heart

A

Great cardiac

941
Q

Medial vs lateral plantar sensory supply

A

3.5 vs 1.5 lateral

942
Q

Meconium passed PV - what hasnt happened

A

Cloaca septum to form

As hindgut and claoca initially 1

943
Q

Why is maxillary sinus prone ot infection

A

position of their ostia high on their superomedial walls

Doesnt drain well

944
Q

Best long term management of post phlebetic syndorme

A

Compression stockings

945
Q

Isovolemic contraction vs relaxion with valve

A

Mitral close- contraction

Aortic- relaxation

946
Q

Pain, loss of lordosis

A

Prolapsed disc

947
Q

What causes steathorrea in gastrinoma

A

Reduced panc enzymes- lipase

948
Q

Site action of aldo

A

Collecting

949
Q

Sacral dermatomes

A

S1 covers the heel, little toe, and posterolateral
S2 covers the posteromedial thighs.
S3 cover the medial side of the buttocks and genital (ischial tibs)
S4-5 covers the perineal region and genital
S5 is of course the lowest dermatome and represents the skin immediately at and adjacent to the anus.

950
Q

Sickle cell pneumonia

A

Strep pneumonia

951
Q

If combined folate and B12 def which start first

A

B12

952
Q

PGE gastric effect

A

Increase mucosal
Decrease acidand secretions

953
Q

Function of Vit C in wound

A

Requires in hydroxy proline and lysin for cross linking

954
Q

Best respiratory test predictor of morbidity after surgery

A

FEV1 <1L

955
Q

Popcorn cells in lymph nodes

A

Nodular Lymphocyte predominate HL

956
Q

Most common side effects of blood products

A

RBC- pyrexia
FFP- urticaria

957
Q

Other cancer BRCA puts you at risk for

A

Ovarian

958
Q

What causes angiomyolipomata

A

Tuberous scleorsis

959
Q

Features of Von Hippel Lindau

A

cerebellar haemangiomas
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma

960
Q

What phase of gastric acid secretion is abolished with vagotomy

A

Cephalic

961
Q

Which cell is the main secretor of TNFa

A

Macrophages

962
Q

What secretes CSF

A

Choroid plexus
In each ventricle

963
Q

What parietal cells secrete

A

secrete HCl, Ca, Na, Mg and intrinsic factor

not
Chief cells: secrete pepsinogen
Surface mucosal cells: secrete mucus and bicarbonate

964
Q

Large villous adenoma in rectum abnormality

A

Hypok

965
Q

Altitude effect on oxygen dissociation curve

A

Shift to right

DPG is increased in conditions associated with poor oxygen delivery to tissues, such as anaemia and high altitude.

966
Q

What area is effected by opioids in respiration

A

Medullary respiration centre

967
Q

Normal ICP

A

<15mmHg

968
Q

Best investigation for upper airway compression

A

Flow volume loop

969
Q

Ebb vs flow phase

A

Ebb- reduced energy consumption
Hypothermia, reduced CO, reduced glucose tolerance
Increased cate, cortisol, aldo
24 hours

Flow- increase cortisol, adrenaline
Increased glycogenolysis, increased gluconeogenesis
Insulin insensitivity , but increased
Increased temp, CO, oxygen consumption

970
Q

Contributors to long saphenous

A

Medial marginal
Superficial epigastric
Superficial iliac circumflex
Superficial external pudendal veins

eMRCS questions (45 decks)

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