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MRCS part B > 2 > Flashcards

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1
Q

what is a retrovirus

A

virus that carries its genetic blue print in form of RNA, revers transcriptase converts RNA to DNA

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2
Q

what are the 6 Ps

A

pain, pallor, paraesthesia, pulseless, paralysis, perisingly cold

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3
Q

inability to get above scrotal mass suggests?

A

inguinal hernia

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4
Q

complete scrotal exam

A

full abdominal exam, US scan of testes

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5
Q

causes of pneumoperitoneum

A

perforated viscus, DU/GU, appendix, diverticulum, penetrating trauam, cancer (perforated), NEC, IBD perf, brekadown of surgical anastomosis, recent laparotomy/laparoscopy, post endoscopy

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6
Q

DDx of LIF pain

A

diverticulitis
renal colic
epididymitis
cancer
inflammatory bowel disease
in females, ovarian torsion/large ovarian cyst, ectopic pregnancy, pelvic inflammatory disease

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7
Q

what is charcots triangle

A

fever, RUQ pain and jaundice

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8
Q

what to see in US in cholecystitis

A

sonographic +ve Murphy’s sign
thickening of gallbladder wall
gallstones in gallbaldder
pericholesystatic fluid
CBD dilatation

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9
Q

what is a hydrocele

A

accumulation of fluid within the tunica vaginalis

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10
Q

outline PANCREAS criteria

A

pao2 <8, age >55, neutrophils >15, calcium <2, urea >15, LDH >600, albumin <32, sugar >10

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11
Q

why decrease in calcium in pancreatitis

A

fatty acid saponification-free fatty acids mix with calcium in blood making calcium salts that dont dissolve and stress response holding

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12
Q

why increase in blood glucose in pancreatitis

A

destruction of pancreatic B islet cells that produce insulin, stress response, increased cortisol, gluconeogenesis and glycogenolysis

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13
Q

how is vitamin D metabolised

A

vitamin D3 is formed in the skin by conversion of 7 dehydrocholesterol under UV light
Vitamin D2 is derived from plant sterol ergosterol
vitamin D is metabolised first to 25 dyhydroxyvitamin D in liver then to hormonal form 1,25 dihydroxyvitamin D in kidney

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14
Q

what is dry gangrene

A

coagulation necrosis without liquefaction ie mummification of tissue without infection

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15
Q

what is wet gangrene

A

coagulation necrosis complicated by infective heterolysis and consequent liquefaction necrosis

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16
Q

what is a perianal abscess

A

cryptoglandular in origin or secondary to anorectal pathology and often communicate with ano rectum

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17
Q

wht is a pilonidal sinus

A

trapping of hair in midline pits located at natal cleft, no communication with ano rectum

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18
Q

how is bile released

A

after eating CCK is released from duodenum which stimulates gallbladder contraction and relaxes sphincter of oddi

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19
Q

does culture of abscess have any bearing on likley cause

A

yes coliforms are increased chance of fistula being present

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20
Q

how and where does bilirubin conjugate c

A

conjugates in the liver with glucuronic acid by the enzyme glucouronultransferase

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21
Q

complications of acute pancreatits

A

local: pseudocyst, peripancreatic collection, splenic vein thrombosis, necrotising pancreatitis, bleeding-gastroduodenal artery, portal vein thrombosis, jaundice
ileus, GI bleed
resp: ARDS
DIC
metabolic: hypocalcaemia, hypomagnesaemia, hypoalbuminaemia, hyperglycaemia
CVS: shock arrythmia

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22
Q

components of pseudocyst

A

collection of amylase fluid, necrotic tissue, blood enclosed in fibrous wall of granulation tissue, location lesser sac

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23
Q

what is CEA like in pseudocyst vs tumour

A

high in tumour low in pseudocyst

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24
Q

what can persistently high amylase be suggestive of

A

pancreatic pseudocyst

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25
what does smooth endoplasmic reticulum do
lipid production and detoxification
26
what does rough endoplasmic reticulum do
protein production
27
what does golgi apparatus do
protein modification and export
28
what type of joint are sutures of skull
fibrous joint
29
what age do sutures of skull fuse and become immovable
around 20-25
30
what is early fusion of skull sutures called
craniosynostosis
31
what is contained within the foramen spinosum
middle meningeal artery and vein, meningeal branch of mandibular nerve
32
which parts of duodenum are retroperitoneal
2nd, 3rd and 4th parts are retroperitoneal
33
what are the relations of the 3rd part of duodenum
it is located inferiorly to pancreas SMV and SMA are located anteriorly
34
where in relation to peritoneum is first part of duodenum
intraperitoneal
35
where is the CBD in relation to the pancreas
descends behind the head of the pancreas before opeing into 2nd part of duodenum
36
where does SMA lie in relation to pancreas
SMA lies behind neck of pancreas and anterior to uncinate process
37
what lies posterior to neck of pancreas
splenic and SMV unite to form hepatic portal vein
38
what are the boundaries of the popliteal fossa
superior medially: semimembranosus superiorlaterally: biceps femoris inferior medially: medial head of gastrocnemius inferiorlaterally: lateral head of gastrocnemius
39
what are the contents of the popliteal fossa
popliteal artery, popliteal vein, tibial nerve, common fibular nerve
40
what are the innervation of the hamstring muscles
posterior thigh is innervated by tibial nerve apart from short head of biceps which is innervated by common fibular nerve
41
what innervates posterior leg
tibial nerve
42
which nerve innervates anterior leg
deep fibular nerve
43
what is transmitted in foramen spinosum
middle meningeal artery and nerve and meningeal branch of mandibular nerve
44
borders of anatomical snuffbox
medial (ulnar)-tendon of extensor pollicis longus radial (lateral)-tendon of extensor pollicis brevis proximal border-styloid porcess of radius floor: carpal bones, scaphoid and trapezium
45
what are the potential side effects of lcoal anaesthetic
tremors, restlessness, headaches, blurred vision vasodilatation can lead to severe hypotension and CV collapse
46
1% lidocain contains 10mg lidocaine per ml
47
carotid canal and IAM are located in which part of temporal bone
petrous part
48
where do roots exit
inbetween scalenius anterior and mediah
49
where do trunks exit
base of posterior triangle in behind 3rd part of subclavian artery
50
where do divisions come off
behind middle 1/3 of clavicle
51
where are cords
related to 2nd part of axillary artery
52
causes of thyroid swelling
single multinodular goitre toxic multinodular goitre thyroid neoplasm
53
advantage of radioiodine
no surgery however may aggrevate eye sings, avoid pregnancy and close physical contact and depends on availability of isotope facilities
54
how could common peroneal nerve be damaged
radiofrequency ablation fracture head/neck of fibula prolonged tight plaster case #/dislocation of knee
55
clinical picture of common peroneal injury
weakness of foot dorsiflexion(TA muscle), weakness in toe extension (EDL and EHL), weakness in foot eversion (PL and PB), sensory loss in dorsum of foot sensory loss of anterolateral aspect of lower leg
56
how could injury to sciatic nerve result in common peroneal injury
dislocation of hip #femur hip surgery
57
treatment of foot drop
ankle/foot orthosis to support foot while walking physiotherapy surgical treatment for exploration, decompression, repair, tendon transfer
58
differential diagnoses of L4-L5 impingement
disc herniation spinal tumour-primary or secondary DM vitamin B12 deficiency drug therapy spinal canal stenosis syphilis myelopathy
59
what type of joint is ankle
synovial hinge joint
60
what type of joint is subtalar joiint
synovial plane joint
61
what do quadriceps dp
knee extension
62
what is sequestrum
piece of dead bone/tissue formed within a diseased or injured bone, typically in chronic osteomyelitis
63
what is an involucrum
complication of osteomyelitis and represents a thick sheath of periosteal new bone surrounding a sequestrum
64
why may pus break through the bone
increased pressure due to increased osmolality which causes tissue breakdown or due to a large cloacal opening in the involucrum so pus will escape through a sinus tract
65
at what age is osteomyelitis associated with kingella infection
4 months to 4 years
66
what is most common cause of osteomyelitis
staph aureus
67
what is the staging of osteomyelitis
Cierny-Mader staging
68
what is the pathogenesis of osteomyelitis
invasion and inflammation, suppuration, necrosis (sequestration), new bone formation and resolution
69
what are the fate of abscess
resolution, rupture, spread, chronic abscess formation
70
how can ulnar nerve get damaged
medial epiconylitis-golfers elbow, cubital tunnel syndrome due to synovial inflammation or ganglia OA-osteophytes neuropathy secondary to alcohol or DM, hypothyroidism brachial plexus abnormalities
71
what are the potential problems of local anaesthetic
tremors, restlessness, headaches, blurred vision, nausea, vomiting vasodilatation can lead to severe hypotension and CV collapse
72
where does medullary thyroid cancer arise from
parafollicular C cells
73
differential diagnosis of carpal tunnel
cervical disc disease diabetic neuropathy
74
what investigations could you do for carpal tunnel
electromyography and nerve conduction studies, could consider MRI and blood tests for thyroid and glucose
75
where do trunks exit
base of posterior triangle behind third part of subclavian artery
76
where do roots exit
between scalenius anterior and medius
77
where do divisiions happen
behind middle 1/3 of clavicle
78
where are cords
related to 2nd part of axillary arter
79
where does ACL attach
anterior tibia to lateral intercondylar notch
80
bones that make up the lateral arch of foot
cuboid, calcaneus, lateral two metatarsals
81
bones that make up medial arch of foot
calcaneus, talus, navicular, 3 cuneiforms and first three metatarsal bones
82
what are the branches of the sciatic nerve
L4-S3
83
describe the course of sciatic nerve
exits through greater sciatic foramen passing inferiorly to lower border of piriformis, 1/2 way between greater trochanter and ischial tuberosity
84
what cutaneous function does sciatic nerve have
no direct cutaneous functions tibial supplies skin of posterolateral leg, lateral foot and sole of foot common fibular supplies skin of lateral leg and dorsum of foot
85
what is sural nerve a branch of
common fibular and tibial
86
what is piriformis syndrome
compression of sicatic nerve by piriformis muscle
87
what is the venous drainage of the heart
great, middle and small cardiac vein posterior vein oblique vein-all drain into coronary sinus anterior cardiac vein and thesbian veins open into right atrium and ventricle
88
how is a thrombus formed
atheromatous plaque is disrupted by intra-plaque haemorrhage or mechanical forces,exposing sub-endothelial collagen and necrotic plaque contents to blood platelets adhere and are activated releasing thromboxane A2, ADP, serotonin causing furhter platelet aggregation and vasospasm
89
what is contained within the spermatic cord
3 layers of fascia 3 arteries-artery to vas deferens, testicular artery, cremasteric artery 3 nerves-genital branch of genitofemoral, ilioinguinal (outside of cord), sympathetic 3 other-vas/round ligament, pampiniform plexus of veins, lymph nodes
90
what overlies the cords of brachial plexus
pectoralis minor
91
what mediates type III reaction
antigen-antibody eg SLE
92
what mediates type II reaction
IgG or IgM antibody mediated cytotoxic reaction includes haemolytic disease of newborn, autoimmune haemolytic anaemia, goodpastures syndrome
93
types of hypovolaemic shock
plasma loss through burns, haemorrhage, GI loss through vomiting/diarrhoea, decreased intake or diuresis
94
causes of hypothyroidism
1. drugs eg lithium or amiodarone 2. surgery-iatrogenic 3. autoimmune eg hashimotos 4. iodine deficiency 5. transient thyroiditis 6. congenital
95
what are the three zones of burns
central zone of coagulation-likely unsaveable due to maximal heat damage then surrounding zone of stasis-decreased tissue perfusion potentially salvageable then zone of hyperaemia-will invariably recover unless prolonged sepsis/hypoperfusion : central coagulation, then surrounding stasis, then surrounding hyperaemia
96
give three indications of platelet transfusion
haemorrhage in thrombocytopaenia DIC known thrombocytopaenia prior to a procedure
97
how does bile help digestions
bile is released when CCK is released from duodenum after a meal, this relaxes sphincter of oddi allowing bile into duodenum it breaks down fatty substances into smaller droplets which increased surface area for pancreatic lipase form structures called micelles whic transport into enterocytes where they are reassembled into triglycerides and packed with protien into chylomicrons
98
risk factors for fistula formation
bowel anastomosis cancer crohns disease radiation to skin immunosuppression diabetes infection
99
pathophysiology of duputrens
increase in type III collagen compared to type I collagen cytokine mediated transformation of fibroblasts into myofibroblasts whose contractile properties are exaggerated and abnormal
100
treatment of duputrens
conservative, splinting, steroid injections, or collagenase injections operative-fasciectomy or percutaneous cord release under LA
101
what is psoas sign
increase of pain with patient in left lateral position, extension of right hip increases pain
102
describe obturator sign
if inflammed appendix is incontact with obturator internus-increased pain on passive internal rotation of flexed thigh
103
where are pectinate muscles
in atria of heart
104
where are trebeculae carna
rounded irregular muscles columns which project from right and left ventricle
105

MRCS part B (2 decks)

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