Basic Sciences Paper Flashcards
(428 cards)
1
Q
How many layers does the scalp consist of and what are they?
A
5 layers. Mnemonic ‘SCALP’
Skin
dense Connective tissue
epicranial Aponeurosis
Loose Areolar connective tissue
Periosteum
2
Q
What is the ‘danger area’ of the scalp?
A
loose connective tissue layer
it contains emissary veins = potential pathway for infection
3
Q
What is the arterial supply to the scalp?
A
External Carotid Artery - 3 branches; superficial temporal, posterior auricular, occipital
Ophthalmic Artery
4
Q
What is the deep venous drainage of the scalp?
A
pterygoid venous plexus
4
Q
What innervates the scalp between the anterolateral forehead and the vertex?
A
Supraorbital nerve - branch of ophthalmic (Trigeminal)
4
Q
What is the superficial venous drainage of the scalp?
A
superficial temporal, occipital, posterior auricular, supraorbital and supratrochlear veins
4
Q
What does the Zygomaticotemporal nerve supply?
A
temple area of the scalp
branch of maxillary nerve (trigeminal)
5
Q
What connects the scalp to the dural venous sinus and creates a potential infection route?
A
emissary veins
5
Q
What nerve supplies the anteromedial forehead?
A
Supratrochlear nerve - branch of ophthalmic nerve (Trigeminal)
6
Q
What is the innervation of the scalp?
A
Trigeminal Nerve
Cervical Nerve Roots C2 & C3
7
Q
What innervates the scalp anterosuperior to the auricle?
A
Auriculotemporal nerve
8
Q
What innervates the skin posterior to the ear?
A
Lesser occipital nerve - from anterior ramus division of C2
9
Q
What innervates the occipital region skin?
A
Greater occipital nerve - from posterior ramus of C2
10
Q
What does the great auricular nerve supply?
A
skin posterior to the ear and over the angle of the mandible
11
Q
Where does the great auricular nerve derive from?
A
Anterior rami of C2 & C3
12
Q
What does the Third Occipital Nerve supply?
A
Skin of the inferior occipital region
13
Q
Where does the third occipital nerve derive from?
A
posterior ramus of C3
14
Q
What muscle prevents closure of bleeding vessels and surrounding skin in a scalp laceration?
A
Occipitofrontalis muscle
15
Q
What 3 bones make up the anterior cranial fossa?
A
Frontal Bone
Ethmoid Bone
Sphenoid Bone
16
Q
What makes up the floor of the anterior cranial fossa?
A
frontal bone, ethmoid bone and the anterior aspects of the body and lesser wings of the sphenoid bone
17
Q
Where does the falx cerebri attach to?
A
Frontal crest - midline ridge of the frontal bone
and
Crista galli of the ethmoid bone
18
Q
What is either side of the crista galli?
A
Cribriform plate
19
Q
What is the role of the cribriform plate?
A
Supports olfactory bulb and has foramina that can transmit vessels and nerves
20
Q
Where are the anterior ethmoidal foramen and posterior ethmoidal foramen?
A
Larger foramina on the cribriform plate on the ethmoid bone
21
What travels through the anterior ethmoidal foramen?
Anterior ethmoidal artery, nerve, vein
22
What travels through the posterior ethmoidal foramen?
posterior ethmoidal artery, nerve and vein
23
What is the thinnest part of the anterior cranial fossa?
Cribriform Plate
24
What are the consequences of a cribriform plate fracture?
1. Anosmia - olfactory nerves can be sheared and therefore loss of sense of smell
2. CSF rhinorrhoea - fracture can tear the meningeal covering of the brain causing CSP leak = clear fluid from nasal cavity
25
What does the anterior cranial fossa contain?
anteroinferior portions of the frontal lobe
26
What does the middle cranial fossa contain?
pituitary gland
temporal lobes
27
What bones make up the middle cranial fossa?
Sphenoid
Temporal bones
28
What is the saddle shaped bony prominence that supports the pituitary gland and where is it?
Sella turcica
in the Middle Cranial Fossa
29
What are the 3 parts of the sella turcica?
1. tuberculum sellae
2. hypophysial fossa / pituitary fssa
3. dorsum sellae
30
What are the main foramina of the sphenoid bone in the middle cranial fossa?
1. optic canals
2. superior orbital fissure
3. foramen rotundum
4. foramen ovale
5. foramen spinosum
31
What travels through the optic canals?
1. Optic Nerves (CN II)
2. Ophthalmic arteries
32
What travels through the superior orbital fissure?
1. Oculomotor nerve (CN III)
2. Trochlear nerve (CN IV)
3. ophthalmic branch of the trigeminal nerve (CN V1)
4. Abducens nerve (CN VI)
5. ophthalmic veins and sympathetic fibres
33
What travels through the foramen rotundum?
1. maxillary branch of the trigeminal nerve (CN V2)
34
What travels through the foramen ovale?
1. mandibular branch of the trigeminal nerve (CN V3)
2. accessory meningeal artery
35
What travels through the foramen spinosum?
1. Middle meningeal artery
2. middle meningeal vein
3. meningeal branch of CN V3
36
What are the main foramina of the temporal bone in the middle cranial fossa?
1. Hiatus of the greater petrosal nerve
2. hiatus of the lesser petrosal nerve
3. Carotid Canal
37
What travels through the hiatus of the greater petrosal nerve?
1. greater petrosal nerve (branch of the facial nerve)
2. petrosal branch of the middle meningeal artery
38
What travels through the hiatus of the lesser petrosal nerve?
1. lesser petrosal nerve - branch of the glossopharyngeal nerve
39
What travels through the carotid canal?
1. Internal carotid artery
2. deep petrosal nerve
40
What is in the posterior cranial fossa?
brainstem and cerebellum
41
What bones make up the posterior cranial fossa?
1. occipital bone
2. two temporal bones
42
What is the anteromedial border of the posterior cranial fossa?
dorsum sellae of the sphenoid bone
43
What is the anterolateral border of the posterior cranial nerve?
superior border of the petrous part of the temporal bone
44
What is the posterior border of the posterior cranial fossa?
internal surface of the squamous part of the occipital bone
45
What is the floor of the posterior cranial fossa made of?
mastoid part of the temporal bone
squamous, condylar and basilar parts of the occipital bone
46
What parts make up the brainstem?
Medulla oblogata
pons
midbrain
47
What travels through the internal acoustic meatus?
1. Facial nerve (CN VII)
2. Vestibulocochlear nerve (CN VIII)
3. Labyrinthine artery
48
What are the main foramina in the posterior cranial fossa?
1. Internal acoustic meatus - temporal bone
2. foramen magnum - occipital bone
3. jugular foramina - occipital bone
4. hypoglossal canal - occipital bone
49
What travels through the foramen magnum?
1. medulla
2. meninges
3. vertebral arteries
4. ascending spinal accessory nerve
5. dural veins
6. anterior and posterior spinal arteries
50
What travels through the jugular foramina?
1. glossopharyngeal nerve
2. vagus nerve
3. descending spinal accessory nerve
4. internal jugular vein
5. inferior petrosal sinus
6. sigmoid sinus
7. meningeal branches of the ascending pharyngeal and occipital arteries
51
What travels through the hypoglossal canal?
1. hypoglossal nerve
52
What is MacEwen's Triangle or supra meatal triangle?
Mastoid Fossa - bony landmark of the temporal bone
53
What is the relevance of the mastoid fossa?
Important anatomical landmark in otologic surgery
54
What is the superior border of the mastoid fossa?
Supramastoid crest - extension of the upper border of the posterior root of the zygomatic process
55
What is the anterior border of the mastoid fossa?
Suprameatal Spine (Spine of Henle) - projection of bone at posterosuperior aspect of the opening of the external acoustic meatus
56
What is the posterior border of the mastoid fossa?
Hypothetical vertical line that is tangential to the mid-point of the posterior wall of the external auditory canal
57
What is the 'safe area' for beginning the drilling approach during a cortical mastoidectomy?
mastoid fossa/MacEwen's triangle - no structures other than mastoid antrum underneath
58
What is a cortical mastoidectomy for?
It's the removal of mastoid air cells especially for severe acute mastoiditis
59
Where is the infratemporal fossa located?
base of skull, deep to masseter muscle
60
What other fossae is the infratemporal fossa closely related to?
pterygopalatine fossa
temporal fossa
61
What is the lateral boundary of the infratemporal fossa?
condylar process and ramus of the mandible bone
62
What is the Medial border of the infratemporal fossa?
lateral pterygoid plate, tensor veli palatine, levator veli palatine and superior constrictor muscles
63
What is the Anterior border of the infratemporal fossa?
posterior border of the maxillary sinus
64
What is the Posterior border of the infratemporal fossa?
carotid sheath
65
What is the roof of the infratemporal fossa?
greater wing of the sphenoid bone
66
What is the floor of the infratemporal fossa?
medial pterygoid muscle
67
What muscles are located inside the infratemporal fossa?
medial and lateral pterygoids
68
What muscles insert/originate into the borders of the infratemporal fossa?
masseter and temporalis muscles
69
What nerves pass through the infratemporal fossa?
1. Mandibular nerve - branch of trigeminal CN V - motor and sensory
2. Auriculotemporal, buccal, lingual, inferior alveolar nerves - sensory branches of trigeminal
3. Chorda tympani - facial nerve CN VII branch
4. Otic ganglion - parasympathetic neurone cell bodies
70
What vasculature is contained in the infratemporal fossa?
1. Maxillary artery - terminal branch of external carotid - then gives rise to middle meningeal artery as it passes through
2. Pterygoid venous plexus
3. Maxillary vein
4. Middle meningeal vein
71
What structure could be damaged by a punch to the side of the skull?
the pterion
72
What is the Pterion?
It's the point where temporal, patietal, frontal and sphenoid bones meet
73
What can happen if you fracture the pterion?
Trauma can damage the MMA, causing raised ICP
74
What virus commonly causes infectious mononucleosis (glandular fever)?
Epstein-Barr virus
75
What is Epstein-Barr associated with?
Infectious mononucleosis
Burkitt's lymphoma
Nasopharyngeal carcinoma
Autoimmune diseases - SLE
76
What is the classical triad of infectious mononucleosis?
fever
pharyngitis
lymphadenopathy
77
What imaging needs to be done for infectious mononucleosis?
USS Abdo - splenomegaly (consideration for contact sport)
CT abdo - if concerned re: splenic rupture
78
How long post infection with EBV would you expect to see VCA-IgM (viral capsid antigens) for?
3-4 months
79
When do you expect to see VCA-IgG (viral capsid antigen) post EBV infection?
first detected at 2-4 weeks post infection and persist for life
80
Approx what distance is the duodenal papilla from the pylorus?
7-10 cm
81
What is the pathophysiology of aortic dissection?
1st - tear in tunica intima of aorta
2nd - degeneration of tunica media, blood tracks & causes false lumen
3rd -false lumen can occlude aortic branches
4th - blood vessel occlusion & change of blood flow = symptoms
82
What are the two types of classification system for an aortic dissection?
De Bakey (I-III) and Stanford (A & B)
83
Which classification of aortic dissection do you definitely surgically repair?
De Bakey I & II, Stanford A
84
What are the De Bakey Classifications?
I - intima tear @ ascending aorta and dissection affects descending aorta or abdo aorta
II - dissection in the ascending aorta
III - dissection in the descending aorta and propagates distally
85
What are the Stanford Classifications?
A - dissection in ascending aorta +/- aortic arch involvement +/- descending aorta involvement
B - dissection in descending aorta not affecting ascending aorta
86
What hormonal therapy can be used for carcinoid (neuroendocrine) tumours?
somatostatin analogues - octreotide or lanreotide
87
What hormonal therapy can be used for endometrial carcinomas?
Progestins
88
What hormonal therapy can be used for pheochromocytomas?
phenoxybenzamine - blocks alpha receptors
89
What hormonal therapy can be used for pre-menopausal ER +ve breast cancers?
tamoxifen - oestrogen antagonist
90
What hormonal therapy can be used for post-menopausal ER +ve breast cancers?
aromatase inhibitors - anastrozole, letrozole, exemestane
91
What hormonal therapy can be used for prostatic carcinomas?
Gonadotrophin-releasing hormone analogues - goserelin & buserelin
92
What is the blood supply to the ureter?
Upper part - renal artery
Middle - abdominal aorta
Lower - internal iliac arteries
93
What structures are in the renal hilum posterior to anterior?
Renal pelvis - most posterior
Renal artery
Renal vein - most anterior
94
What hormones & enzymes do the kidneys produce?
Erythropoietin
Renin
1,25-dihydroxyvitamin D
95
What level does the ureter arise at?
L2
96
What is the path of the ureter?
1. Arises at L2
2. Descends anteriorly to psoas major, adjacent to transverse processes of lx spine
3. Crosses bifurcation of common iliac artery at roughly SIJ level
4. Travels under uterine artery or vascular deferens
5. Enters bladder at level of ischial spines
97
What is the innervation of the ureter?
Ureteric plexus & sensation are from T12-L2
Pain refers to those dermatomes
98
What surface of the bladder is covered by peritoneum?
Only superior surface
99
What causes the detrusor muscle to relax/contract?
Autonomic nervous system
Parasympathetic = contract and urination - pelvic nerve S2-4 act on muscarinic (M3) receptors
Sympathetic = relaxation and urine storage - inferior hypogastric plexus T12-L2 act on adrenergic beta receptors
100
What extra urethral sphincter do men have?
Internal urethral sphincter
101
What are the 3 layers of the detrusor muscle?
Inner longitudinal
Middle circular
Outer longitudinal
102
What causes the external urethral sphincter to relax/contract?
Conscious control - somatic
Pudendal nerve S2-4 on nicotinic receptors
103
What causes the external urethral sphincter to relax/contract?
Conscious control - somatic
Pudendal nerve S2-4 on nicotinic receptors
104
Blood supply to AV node
Right coronary artery
105
Define expiratory reserve volume
Additional amount of air that can be exhaled after normal exhalation
106
Ductus venosus function
Shunt between umbilical vein and IVC
Delivers oxygenated blood from placenta to heart
Closes and becomes ligamentum venosum on underside of live
107
Commonest cause of osteomyelitis in non-sickle cell patient
Staph aureus
108
Define inspiratory reserve volume
Max vol of air that can be inspired in excess of normal inspiration
109
Which part of nephron is impermeable to water
Ascending loop of Henle
110
Useful landmark for femoral artery
Mid-inguinal point
111
Common cause of narrow anion gap metabolic acidosis
Type 1 renal tubular acidosis
112
Locations of ectopic testis
Perineal
Superficial inguinal.pouch
Femoral canal
Pre-penile
113
Superficial peroneal nerve supplies
Muscles of lateral compartment - eversion
Cutaneous sensation to foot dorsum except 1st dorsal Web space
114
Deep peroneal nerve
Muscles of anterior compartment
Sensation to 1st webbed space
115
Pharyngeal pouch
Defect between thyropharyngeus and cricopharyngeus
Killans dehiscence
116
MOA aliskiren
Direct renin inhibitors
For me of essential hypertension
117
Where is stellate ganglion located?
Between T1 and C8
118
Damage to stellate ganglion causes
Horners Syndrome
119
Causes of horners
Apical lung tumours (pancost)
First rib #
UL injury - klumpskes
120
Diaphragm insertion
Central tendon
121
Level abdominal.aorta passes through diaphragm
T12
122
IVC goes through diaphragm.
T8
123
Level oesophagus passes through diaphragm.
T10
124
Bleeding in clavicopectoral fascia is caused by which artery
Thoraco-acromial artery
125
Which is the commonest site of obstruction in cerebrospinal fluid flow
Cerebral aqueduct of sylvius
126
ACID --> EGGT hypersensitivity reaction
1. A -Atopy/anaphylactic - IgE
2. C - Cyto - IgG
3. I - Immune - G
4. D - delayed T cells
127
Primary metabolic effect of adrenaline
Glycolysis
128
Primary metabolic effect of adrenaline
Glycolysis
129
What forms tendinous part of diaphragm?
Septum transversum
130
What forms muscular part of diaphragm?
2 pleural peritoneal membranes and peripheral body wall muscle
131
What forms the crura of the diaphragm?
Mesentery of oesophagus
132
Structures passing diaphragm at T8
IVC
Right phrenic
133
Structures passing through diaphragm T10
Oesophagus
Vagus nerve
134
Structures passing through the diaphragm at T12
Abdo aorta
Thoracic duct
135
What are Aschoff-Rokitansky sinuses associated with?
Chronic cholecystitis
136
Annular pancreas
Embryology anomaly
Duodenal obstruction
2nd part of duodenum is completely/incompletely encased by the pancreas
Narrowing and dilation of prox dueodenum
137
Becks triad for tamponade
Hypotension
Muffled heart sounds
Distended neck veins
138
Nasolacrimal duct drains into...
Inferior meatus
139
What hormone is responsible for hydroxylation for vit D3?
PTH
140
levator ani muscles
Pubococcygeus
Puborectalis
Ileococcygeus
141
TFTs for Graves
Decreased TSH
Raised T4 and T3
142
S&S of small bowel atresia
Neonate
Bilious vomiting
Passed meconium but nothing since
Abdo distension
Dilated bowel loops on AXR
143
MOA UV light on micro organisms
Forms pyrimidine dimers and alter form of DNA and interfere with normal base pairing during DNA synthesis
144
Takayasu's arthritis
Large vessel inflammatory vasculitis affecting aorta & branches
Women over 40
145
Which factor is involved in extrinsic coag cascade
7
146
Brain cyst after infarction caused by
Liquidative necrosis
147
Most characteristic histological feature of invasive ductal carcinoma
Pleomorphism
Atypical ductal cells
148
Most characteristic histological feature of invasive ductal carcinoma
Pleomorphism
Atypical ductal cells
149
Practical treatment for hereditary angio-oedema
FFP
Ideally you need recombinant C1 esterase inhibitor but this is often not immediately available
150
Common organism for fourniers gangrene
Mixed flora
151
Most likely complication of chronic suppurative otitis media
Lateral sinus thrombosis
152
Formation of male external genitalia requires
Dihydrotestosterone
153
Vessel anterior to medial malleolus
Great saphenous vein
154
Cervix lymph drainage
Internal iliac lymph nodes
155
What activates classical complement pathway?
Immunoglobulins
156
SMA passes posterior to what?
Splenic vein
Neck of pancreas
157
Staghorn calculi
Recurrent UTIs
Urease producing bacteria
Struvite or calcium carbonate
Radio-opaque
158
Partial rectal prolapse in kids mx
Most resolve with Conservative management
159
Portal vein formed by
Splenic and SMV
160
Parasympathetic nerve fibres leave CNS
CN 3, 7, 9, 10
2nd, 3rd, 4th sacral segments of spinal cord
161
What sits in the superficial perineal space in males?
Corpus spongiosum
162
What drains the anterior region of the heart?
Great cardiac vein
163
Where does the great cardiac vein run down?
Anterior interventricular groove
164
Stab wound just below right nipple will damage what?
Pulmonary trunk
Other middle mediastinal contents
165
Primary structure forming posterior wall of inguinal canal
Conjoint tendon
166
Role of pneumotaxic centre
Upper part of pons
Controls rate and pattern of breathing
Regulates amount of air that can be taken into each breath
167
Number of secondary ossification centres between C3-L5
5
168
Blood vessel causing oesophageal varices
Left gastric vein
169
Left testicular vein drains into
Left renal vein
170
Right testicular vein drains into
IVC
171
Which pharyngeal arch and associated nerve is associated with a sinus opening into laryngeal cartilage & laryngeal musculature?
4th arch
Vagus nerve
172
MOA lidocaine
Blocks intracellular sodium channels
Stops influx of Na ions into cells
173
CN through jugular foramen
9, 10, 11
174
Antecubital fossa contents lateral to medial
TAN
Tendon, artery, nerve
175
Cremaster muscle arises from
Internal oblique & inguinal ligament
176
Space fluid collects in a testicular hydrocele
Tunica vaginalis
177
Axillary nerve innervation motor
Deltoid
Teres minor
Long head of triceps
178
Cells in Hodgkins lymphoma
Reed sterberg cells
Large abnormal lymphocytes containing more than one nucleus
179
Ligament present on posterior hilum of the spleen
Splenorenal ligament
Aka leinorenal/phrenosplenic ligament
180
Anterior inferior cerebellar artery syndrome
Aka lateral pontine stroke
Ipsilateral- nystagmus, hearing loss, limb ataxia,loss of pain/temp on face, facial weakness
Contralateral hemiplegia, hemiparesis, loss of pain/temp on body
181
In fetal circulation what delivers oxygenated placental blood to fetal heart
IVC
182
Cleft lip due to
Failure of medial nasal prominence to fuse with maxillary prominence on one or both sides due to inadequate migration of neural crest cells
183
Ductus arteriosus connects what
Pulmonary artery to proximal descending aorta
184
Multiple myeloma
Bence Jones proteins
High calcium
Anaemia
Lytic bone lesions
185
Ganglion if damaged causes loss of taste sensation anterior 2/3 of tongue
Geniculate ganglion - CN 7
186
Damage to Otic ganglion
Innervation parotid gland
Frey syndrome- salivation induces perspiration at parotid region
Salivatory nucleus
187
How many ligaments stabilise the TMJ
3
188
Innervation of the TMj
Auriculotemporal nerve
Cn V3
189
Role of secretin
Secreted in response to protein products, bile acid, fatty foods and increased acidity in duodenum
Acts on pancreas and stimulate bicarb production
Neutralises chyme
190
MAP calculation
Diastolic pressure - (systolic-diastolic)/3
191
CPP calculation
MAP-ICP
192
Which muscle inserts into gluteal tuberosity of femur
Gluteus maximus
193
What vessel supplies fetus with oxygen and nutrients from placenta?
Umbilical vein
194
Maturity onset diabetes of the young
Monogenic diabetes
Autosomal dominant
Non-ketotic
Beta cell dysfunction
Onset < 25
195
Osteosarcoma
Most common primary bone tumour
Men < 30
Long bones
Spread by blood to lungs
196
Angiosarcoma of liver
Non specific abdo pain, ascites
Elevation of liver enzymes, anaemia
Hypodemse that becomes hyperdense after contrast
PVC, arsenic and steroid exposure
197
Autonomic supply of parotid gland
Sympathetic- sup.cervjcal ganglion
P/Sympathetic - glossopharyngeal through otic ganglion
198
Nerve fibres carried by spinothalamic tract
2nd order fibres
Pain and temp
199
MOA botox
Blocks acetylcholine receptors
Binds presynaptically
Muscles relax
CNS and peripheral
200
Artery ligated during Whipples
Superior pancreaticoduodenal artery
201
Anaplastic thyroid cancer cells
Biphasic tumour population
Prominent mitotic figures
Necrotic and inflammatory background
Highly cellular
Single cells or focal atypical cells
202
What forms the inguinal ligament
External oblique aponeurosis
203
Organism causing staghorn renal calculus
Proteus mirabilis
204
Hangman's fracture
Pedicles of C2
205
Vein drains lateral wall of left ventricle
Left marginal vein
206
What can maintain a PDA after birth?
Prostaglandins
207
Gene associated with male breast cancer
BRCA2
208
Thymus originates from
Ventral portion of 3rd pharyngeal pouch
209
Enzyme responsible for protein digestion
Trypsin
210
During midget rotation what is the axis of rotation?
SMA
211
Direction of fibres of external and internal oblique
External = inferomedial
Internal = superomedially
212
Blood supply to greater curvature of stomach
Left and right gastroepiploic arteries
213
Renal amyloidosis
Mesangial apple-gree birefringence on Congo red staining under polarised light
214
Gold standard treatment in case of BBB with low HR
Pacing and resync therapy
215
Axonotmesis
Damage to axon and myelin sheath
Follows stretch or crush injury
Common after closed fractures or dislocations
216
Neuroblastoma
Kids < 5
Vague abdo symptoms
Adrenal gland
Lytic bone lesions
Surgery +/- chemo
217
Neuroblastoma
Kids < 5
Vague abdo symptoms
Adrenal gland
Lytic bone lesions
Surgery +/- chemo
218
Invasive ductal carcinoma
50-60 years
80% breast ca
Axillary lymphadenopathy
Irregular spiculated hyperdense lesion with micro calcification
219
Max safe dose of bupivacaine with or without adrenaline
2mg/kg
Max 150mg
220
Medication to give with septic shock with hypotension refractory to 2 litres fluid resus
Noradrenaline
221
Most common site of foreign body aspiration
Right inferior bronchus
222
Osteosarcoma
Bone malignancy kids and adolescents
"Sun burst" appearance x-ray
Long bones at metaphysis
Pain worse at night
Limp
Pain fever swelling
223
Iron deficiency anaemia
Low Hb low mcv
Low ferritin
High transferrin
224
Nerve most at risk from skull fracture to petrous part of temporal bone
Facial nerve
225
Ewings sarcoma
Boys 10-20 years
Femoral diaphysis then pelvis, ribs, vertebrae
Swelling, pain, systemic features
Onion skin appearance
226
Intraductal papilloma
Benign tumour
35-55 women
Bloody or clear nipple d/c
Central lump behind nipple
Round mass and well circumscribed
Fibrovascular core covered with epithelial and myoepithelial cells
227
Paraphimosis
Prepuce is retracted beyond the glans and cannot be replaced
Prevents venous return
Swelling and oedema of glans
228
Phimosis
Foreskin is tight
Retraction difficult
229
Killians dehiscence
Zenkers diverticulum
Between thyropharyngeus and cricopharyngeus muscles
230
Vessels arising from arch of aorta
Left subclavian
Left common carotid
Brachiocephalic trunk
231
Embryological origin of trachea
Foregut endoderm
4th gestational week
232
# extending from nasofrontal suture through the superior medial wall of maxillary bone, inferior laterally through lacrimal bone then along inferior orbital rim
Le Fort 2
233
Transverse fracture extending from nasofrontal suture along medial wall, floor, lateral wall of orbit into zygomaticofrontal junction and zygomatic arch
Le Fort 3
234
Consent form 2
Kid lacks capacity for procedure
Consent from parent
235
Consent form 2
Kid lacks capacity for procedure
Consent from parent
236
GCS eyes
4 - spontaneously
3 - to voice
2 - to pain
1 - none
237
GCS verbal
5 - orientated
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - none
238
GCS motor
6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - flexion to pain
2 - extension to pain
1 - none
239
Perilunate dislocation
Young adults
High energy trauma
Wrist hyperextension
Median nerve palsy
Dorsal displacement of the capitate, normal radiolunate alignment
AVR risk, compartment syndrome risk
240
Argon beam laser use
GI ulcers
Ophthalmology
Dermatology
Port wine stain rx
241
Which 4 CN supply parasympathetic nervous system
3, 7, 9, 10
242
What does the ciliary ganglion connect?
CN 3 to eye
P/sympathetic
243
What does the sphenopalatine ganglion connect?
CN 7 to lacrimal gland
244
What does submandibular ganglion connect?
CN 7 to submandibular and sublingual glands
245
What does the otic ganglion connect?
CN 9 to parotid gland
246
What veins form the axillary vein?
Basilic and brachial
247
Mirizzi's syndrome
Gallstones impacted in cystic duct or neck of gallbladder causing external compression and obstruction of common hepatic duct
248
Codmand triangle x-ray feature
Osteosarcoma
249
Hydrocele criteria
Painless
Difficult to feel testis
Chronic
Slowly increases with time
250
Right renal artery in relation to IVC and right renal vein
Posterior to IVC
Superior to renal vein
251
Where does the glossopharyngeal nerve arise from?
Anterior medulla
Groove between inferior cerebellar peduncle and the olive
252
Part of brain which limits inspiration
Pneumotaxic centre
253
First site of haematopoiesis
Yolk sac
254
Lateral border of Guyon's canal
Hamate
Transverse carpal ligaments
Flexor tendons
255
Lacrimal artery branch of
Ophthalmic artery
256
Foveolar cells
Surface mucous cells in stomach
Secrete mucus and bicarbonate
257
Action of bile salts for food digestion
Emulsification of fat
258
What artery arises from supracondylar Femoral artery?
Descending genicular artery
259
Which artery is a branch of the splenic artery and supplies the stomach?
Left gastroepiploic artery
260
Cells responsible for erythropoietin production
Interstitial cells in peritubular capillaries
261
Dorsal column carries
Ipsilateral proprioception, light touch, vibration
262
Spinothalamic tract lesion
Contralateral loss of pain and temperature sensation
263
Patent ductus arteriosus connects
Prox descending aorta to main pulmonary artery
264
Vertebral artery arises from
Subclavian artery
265
Half life of free T3 in blood
1 day
266
Clear cell carcinoma
Most common renal cancer
Smokers
Responds to cytogenetics therapy IL-2
267
Nerve commonly injured during axillary clearance for breast cancer
Intercostobrachial nerve
268
External acoustic meatus and tympanic membrane embryological origin
1st ectodermal cleft
269
Inferior border of quadrangular space
Teres major
270
Basilar artery terminates by dividing into..
Posterior cerebral artery
271
Marjolins ulcer
Chronic venous ulcer that's undergone malignant change
SCC
Longstanding ulcer tender and thickened edges
272
Assessing parathyroid adenoma pre-op scan
Sestamibi scan
273
Occipital artery is a branch of
External carotid
274
Occipital artery is a branch of
External carotid
275
What nerve runs posterior to the lateral malleous and what does it supply?
Sural nerve
Posterolateral aspect of bottom 1/3 of leg and lateral foot
276
Anal verge lymph drainage
Superficial inguinal lymph nodes
277
What drains to external iliac lymph nodes
Glans Penistone
Clit
Prostate
Fundus of bladder
Cervix and upper vagina
278
What drains into internal iliac lymph nodes
Pelvic viscera
Perineum
Membranous and cavernous urethra
Butt
Thigh
279
What can be given to patients with von Willebrand pre op
Desmopressin
280
Management addisonian crisis
IV hydrocortisone and saline
281
What UTI abx causes pulmonary fibrosis
Nitrofurantoin
282
Ludwig Angina
Rapid progressive gangrenous b/l cellulitis of the submandibular space
Risk of airway compromise
Can affect sublingual and submaxillary space
283
Nerves controlling ejaculation
Hypogastric plexus T12-L2
Sympathetic
284
What muscles control erection?
Parasympathetic
Pelvic nerves
S2-4
285
What x-ray view is needed if median nerve injury suspected with a wrist trauma?
True lateral view
286
Best investigation for renal vein thrombosis
CT angio
287
Yersinia enterocolitica
Gram negative bacillus
Diarrhoea, mesenteric adenitis, terminal ileitis, pseudo-appendicitis
4-7 days after exposure
Skin rash, joint pains, sepsis
288
Commonest breast cancer
Invasive ductal carcinoma
289
Main parathyroid blood supply
Inferior thyroid artery
290
Innervation of strap muscle
Ansa cervicalis
291
Relation of left common iliac vein to right iliac artery
Left Iliac vein passes posteriorly to right iliac artery
292
Tracheostomy landmarks
Suprasternal notch and cricoid cartilage
293
Where does chorda tympani exit the middle ear
Petrotympanic fissure
294
Notochord in adult
Nucleus pulposus
295
Role of median umbilical ligaments
Carry deoxygenated blood from fetus to placenta
296
Causes vasoconstriction on efferent arterioles
Angiotensin 2
297
Marker positive in most lymphomas
CD20
298
Marker positive in most lymphomas
CD20
299
Amyloidosis associated with multiple myeloma
AL amyloidosis
300
Amyloid appears under microscope with Congo red
Green with red birefringence
301
Marfan defect
Fibrillin-1 gene
302
Commonest lung cancer in non smokers
Adenocarcinoma (subtype of non small cell)
303
Artery for coronary artery bypass
Internal mammary artery
304
What muscle does the parotid pass through?
Buccinator
Crosses masseter
305
Plummer vinson syndrome associated with
Iron deficiency anaemia
306
Porta hepatis contains
Portal vein
Hepatic artery
Common hepatic duct
307
Cohort studies usually assess what type of risk
Relative risk
308
How can you manage a cystic duct leak?
Ercp and stent
309
Middle mediastinum contents
Pericardium
Heart
Aortic root
Arch of azygos
Main bronchi
310
Posterior mediastinum
Oesophagus
Thoracic aorta
Azygos vein
Thoracic duct
Vagus
Sympathetic nerve trunks
Splanchic nerves
311
Investigate pharyngeal pouches
NOT OGD
Fluroscopy swallowing studies
312
Posterior wall of Femoral canal
Pectineal ligament
313
Collateral venous systems alternate to SVC
Azygos
Internal mammary
Long Thoracic with connections to Femoral and vertebral veins
314
Trotters triad for nasopharyngeal cancer
Unilateral conductive hearing loss
Ipsilateral face and ear pain
Ipsilateral soft palate paralysis
EBV association
315
Cells secrete gastric acid
Parietal cells
316
Low Mg2+ causes
Diuretics
TPN
Diarrhoea
Alcohol
Low K, low Ca
317
Central tendon of diaphragm formed by
Septum transversum
318
Most superficial structure on parotid gland
Facial nerve
319
Another name for herceptin
Trastuzumab
320
Vessels in posterior triangle of neck
External jugular vein
Subclavian artery
321
Abx inhibiting cell wall formation
Penicillin
Cephalosporins
322
Inhibit protein synthesis
Aminoglycosides - misreading of mRNA
Chloramphenicol
Macrolides
Tetracycline
Fusidic acid
323
Abx which inhibit DNA synthesis
Quinolones
Metronidazole
Sulphonamides
Trimethoprim
324
Subacute thyroiditis
High T4
Painful goitre
Raised esr
Reduced uptake on iodine131 scan
Self limiting
Nsaids
Low tsh
325
What do sharpeys fibres attach to
Perisoteum
They are strong collagenous fibres
Attachment for muscles and tendons
326
Cystic artery is a branch of
Right hepatic artery
327
Bile production rate
150-1500ml per 24
328
First branch of external carotid artery
Sup thyroid artery
329
Homans op
For lymphandenopathy
Preserves overlying skin which must be in good condition
Reduces limb circumference by 1/3
330
What drug increases gastric emptying rate in vagotomised stomach?
Erythromycin
331
ABPI >1.2
Vessel calcification ie DM
332
ABPI 0.3-0.5
Significant stenosis
Compression bandage contraindicated
333
Venous ulcer
Above medial malleous
Indolent with basal granulation
Scarring
Non ischaemic edges
Haemosiderin deposition in gaiter area
334
Miller Cuff in vascular surgery
Vein boot
If vein isn't long enough for entire conduit then vein can be attached to end of PTFE graft
Better patency than PTFE alone
335
Antibodies in hashimotos
Thyroid peroxidase antibodies
336
Antibodies in graves
TSH receptor antibodies
Sometimes thyroid peroxidase
337
Commonest thyroid cancer
Papillary
338
Psammoma bodies (calcification), orphan Annie nuclei is what pathology?
Papillary thyroid cancer
339
Papillary cancer mets to
Lymph spread
Laterally located
340
Follicular thyroid cancer spread
Haematogenously
341
Follicular cancer presentation
Discrete nodule
Well encapsulated
342
Tumour of parafollicular cells
Medullary thyroid cancer
343
Medullary thyroid cancer
Calcitonin raised
MEN2A
Lymph or blood spread
Don't respond to radioiodine
344
Outermost layer spermatic cord is derived from
External oblique aponeurosis
345
Male urethra part surrounded entirely by bucks fascia
Spongiose part
346
Renal stones associated with chemotherapy
Uric acid stone
Radiolucent
347
Anal fissures associated with
STD
IbD
Leukaemia
Tb
Previous anal surgery
348
Glut max innervation
Inferior gluteal nerve
349
Cowden disease
PTEn mutation
Macrocephaly
Intestinal hamartomas
Risk of colorectal cancer
Breast cancer
Thyroid cancer
Uterine cancer
350
Specificity
True negative ÷ (true negative + false positive)
351
Holstein Lewis #
Distal 1/3 humerus #
Damage to radial nerve
352
Watercress farming associated with
Fasciola hepatica
353
Salter Harris Classification
Type 1 & 2
1. Transverse through growth plate
2. Through growth plate to metaphysis
354
Salter Harris Classification
Type 3 & 4 & 5
3. Through growth plate and epiphysis, metaphysis spared
4. Involves growth plate, metaphysis, epiphysis
5. Compression fracture of growth plate
355
B/l acoustic neuroma associated with
Neurofibromatosis type 2
356
Right subclavian originates from which aortic arch
4th
357
Middle rectal artery is a branch of
Internal iliac artery
358
Superior rectal artery is a branch of
IMA
359
Inferior rectal artery is a branch of
Internal pudendal artery
360
Cervical branch of facial nerve innervates
Platysma
361
Ansa cervicalis innervates
S. Sternohyoid
O. Omohyoid
S. Sternothyroid
362
Massive PE mx
Thrombolysis with alteplase 50mg
363
Which breast cancer classical mets to opposite breast
Invasive lobular carcinoma
364
Femoral canal borders
Laterally femoral vein
Medially lacunar ligament
Anteriorly inguinal ligament
Posterior pectineal ligament
365
Giardia lamblia presentation
Fat malabsorption (floating poo)
Greasy poo
Resistant to chlorine therefore transfer in pools
366
Stensens duct
Secretions from parotid gland
Enters mouth at 2nd molar
367
Boas sign
Acute cholecystitis
Hyperaesthesia tip of right scapula
368
Adductor canal compression
Young men
Compression of femoral artery by musculotendinous band from adductor magnus muscle
Weak popliteal pulse
Leg pain from.walking, reduced hair and reduced muscle mass in leg
369
What muscle separates the subclavian artery and vein
Anterior scalene muscle
370
Contents of carotid sheath
Common carotid
Internal carotid
Internal jugular
Vagus
371
What stiulates prolactin release?
TRH
Thyrotropin releasing hormone
372
Positive predictive value
True positive ÷ (TP + false positive)
373
Intestinal malrotation with volvulus rx for neonate
Ladds procedure
Laparotomy and division of adhesional bands
374
Psoas insertion
Lesser trochanter
375
Syringomyelia selectively affects
Spinothalamic tracts
376
GIST derived from
Interstitial pacemaker cells of cajal
377
Erythropoietin produced
Interstitial cells kidney
378
Granulomatous inflammation in arterial wall is a hallmark of
GCA
379
Replacement of stratified squamous epithelium with columnar epithelium containing goblet cells is an example of
Metaplasia
380
MOA succinylcholine
Binds and activates nicotinic acetylcholine receptors on muscle cell membrane
Brief depolarisation = muscle contraction
381
Physiological role of gall bladder
Concentration of bile
382
Enzyme causing pancreas auto digestion in pancreatitis
Trypsin
383
Posterior lobe of cerebellum role
Fine motor control of extremities
Dysmetria, intention tremors
384
Anterior lobe of cerebellum
Prone to damage from chronic alcohol abuse
385
Morison's pouch
Common fluid site for collection after cholecystectomy
Aka hepatorenal recess
In supracolic compartment
386
Cliostazol
Rx for I/M claudication in PAD
Prevents activation of myosin light chain kinase for smooth mm contraction = vasodilation
No significant heart impact
387
Marker for deep surgical site infections
Procalcitonin - bacterial infection marker
388
Histological feature associated with OP
Increased osteomyelitis lacunae and canaliculi
389
Hormone responsible for prostate enlargement
Dihydrotestosterone
390
Pfannestiel layers outside to inside
Skin
Superficial fascia
Anterior rectus sheath
Rectus abdominis
Trans fascia
Extraperitoneal connective tissue
Peritoneum.
391
Average stroke volume
70ml/beat
392
Hallmark histology of AAA
Disruption of elastic lamellae
393
Transporter to reabsorb calcium in kidneys stimulated by PTH
Type 5
Transient receptor potential vanillin type 5
394
Cells playing central role in granuloma formation
Macrophages
395
Upper 1/3 rectum lymph nodes drainage
Inferior mesenteric lymph nodes
396
Autoimmune hepatitis
Antismooth muscle and ANA
Definitive diagnosis by liver biopsy
397
NV structures passing through parotid superficial to deep
Nerve then Ext. Jugular vein then artery
398
Lymph drainage of lower rectum
Internal iliac lymph nodes
399
Primary mechanism for maintaining voltage in nerve cell
Na-K pump
400
Abdo wall layer that becomes internal spermatic fascia
Transversalis fascia
401
Muscle attached to inferior angle of scapula
Rhomboid minor
402
Cystic artery origin
Right hepatic artery
403
Origin of CN 9
Medulla oblongata
404
L
405
Blood supply to anterior abdo wall
Inferior epigastric artery
406
Scalp layer likely involved in scalp avulsion injury
Loose areolar tissue layer
407
Structure medial to right phrenic nerve
Vagus nerve
408
Formation of AV septal defect cause
Failure of endocardial cushion fusion
409
Iron absorption small bowel location
Duodenum
410
RSI anaesthetic
Etomidate
411
Left gastroepiploic artery is a branch of
Splenic artery
412
Line on x-ray for pelvic organ prolapse
Pubococcygeal line
413
Myelomenigocele can be associated with
Chiari type 2 malformation
414
Thyroglossal duct cyst histology
Resp type epithelium
Follicles in cyst wall
415
Where are B1 and B2 adrenoreceptors located
B1 cardiac ventricles
B2 blood vessels, gut smooth wall, bronchial smooth muscle, bladder wall
416
3rd part of duodenum
Posterior to sup.mesenteric vessels
Overlies aorta and IMA
417
Primary method for regulating intracellular pH
Cytoplasmic proteins
418
What nerves run anterior and posterior to the hila of left and right lungs
Anterior = phrenic
Posterior = Vagus
419
Carcinoid syndrome
Due to serotonin secretion
Can affect heart = cardiac valve lesions
420
Anatomical location of transverse perineal muscles
Between urethra and anus
421
Actinic keratosis
Premalignant to SCC
Older lighter skin
Sun exposure
Discrete, well circumscribed, red, macilopapular
Curettage and electrodessication
Liquid nitrogen and 5-FU rx
422
Hyperacute reaction is mediated by
Complements
423
Biochemical markers of hemolytic anaemia
Increased unconjugated hyperbilirubinaemia, excretion of urobilinogen, stercobilinogen in faeces
424
Cryoprecipitate contains
Fibrinogen
Factor 8
Von willebrand
