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MRCS Past Questions Knowledge > Extras > Flashcards

Extras Flashcards

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1
Q

Aetiology of RTA?

A

Pre renal hypoperfusion
Drugs- gentamicin
Rhabdo- myoglobin
ACEi/NSAIDs

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2
Q

Effects of AL and AA amyloid?

A

AL- nephrotic syndrome, restritive cardiac disease, GI bleeding
AA- hepato/splenomegaly, nephrotic syndrome

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3
Q

Where do you find isolated Amyloid deposits?

A

Thyroid
Renal Tract
Aorta

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4
Q

Renal stones management?

A 
A2E, MDT
C- watch and wait + analgesia if <4mm
S- ESWL if <2cm and visible on KUB
Renal ureteroscopy + stent
PCNL
Open
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5
Q

Causes of ED?

A 
Neuro- spine/neuropathies/DM
Cardiac- PVD
Endocrine- hypothyroidism, hypongonadism
Meds- antidepressant, anticholinergics, anti androgens, antipsychots
Pscyh
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6
Q

Risk of AAA surgery?

A

MI/distal thromboembolism
Renal/colonic ischaemia
Graft infection, thrombosis, endo leak
Adhesions/fistula

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7
Q

When should varicosities have surgical fixation?

A

If skin comprimise or IR failure

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8
Q

When to go for open and lap hernia repair?

A

Lap hernia repair- equal complication and failure rates to open, quick return to work
Open- can be done under LA, no pneumoperitoneum

Worth operating as 0.3-3% complication rate => complications lead to 5% operative mortality/morbidity

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9
Q

Stoma complications!!!

A

Stoma related- prolapse, stenosis, retraction, skin effects, hernia
General- high output, stones, short gut syndrome (fluid/electrolyte imbalances)

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10
Q

Hyperthyroidism management and when for surgery?

A

MDT
M- carbimazole- treats hyperT, Propanolol- controls sympts
Radioactive iodine- if MNG/grave’s
Surgery- if relapsing to medical/DTx/large goitre-cosmetic/air way obstruction

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11
Q

Consequence not to forget of respiratory diseases/COPD?

A

Cor Pulmonale!!!

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12
Q

Operative risks of COPD

Work up to do to minimise risks?

A

Poor lung function, increased infection risk, on steroids, cor pulmonale?

Atelectasis leading to pneumonia
Poor cough
Decreased ventilatory drive
Aspiration risk

Work them up!!
Stop smoking and optimise medication
Regional A
Early mobilisation
Sit up early
BiPAP/HDU bed
Analgesia
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13
Q

When to op for cold vs hot cholecystectomy

Abx for cholecystitis

A

Hot if <72 hours of sympt- adhesions not formed by then
However, technically a lot more difficult
Make sure to do intra op cholangiogram

Cold 6-8 weeks later, once inflammation subsided

Abx- co-amox/cephalosporin +- met

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14
Q

Aetiology of post op fever?

A 
Wind- PE/pneumonia
Water- UTI
Wound- SSI
What did we do- anastomotic leak
Pancreatitis
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15
Q

Management of anastamotic leak?

A 
A2E
Abx
NBM + fluids/TPN
CTAP
R/O other causes
Prep for op
Escalate

Op- washout/resection/stoma

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16
Q

Definition of critical limb ischaemia?

A

ABPI <0.4

Rest pain/ulceration/necrosis/gangrene

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17
Q

How to complete vascular exam?

A 
ABPI/BP
Doppler
Arterial Duplex
Fundoscopy
Urine dip
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18
Q

Investigation and treatment of sialolithasis?

A

Ix- US, sialogram, CT
Rx- C- lemon drops, good hydration, good oral hygiene, massage
M-abx
S- sialogram/lay open duct/remove gland

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19
Q

Gynaecomastia DDx?

A 
Physiological- Old age/puberty
Think reduced testosterone
Testicular atrophy
Renal disease
Chemo
Finasteride
Kleinfelters

Increased oestrogen
Prolactinoma
Leydig cell tumour/testicular tumour
Breast Ca
Adrenal tumours
Medications- spiro/antipsychotics
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20
Q

IBS treatment?

Study These Flashcards
A

R/o other causes
Dietician
Fibre
Buscopan- antispasmodics

21
Q

Management of chronic pancreatitis?

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A

Stop alcohol
Good analgesia
Good nutrition- pancreatic enzyme supplements (creon), avoid fats, vitamins
Surgically- remove stone blockage/masses blocking

22
Q

Bladder cancer management?

Study These Flashcards
A

Stage
MDT
Intravesical BCG/chemo
DTx/Chemo

S- TURBT/Radical

23
Q

PE management?

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A

Massive vs non massive
Massive- thrombolysis-ALS, embolectomy for saddle?
Non massive- trust, LMWH
Convert to warfarin/NOAC for 3/6 months

24
Q

ECG findings on PE?

Study These Flashcards
A

Sinus tachy

S1Q3T3

25
NCEPOD statuses?
``` 1a- Life threatening 1b<6hours 2<24hours 3<7 days- expedited 4- elective ```
26
Management of carpal tunnel?
``` Exclude underlying causes- fluid retention, neuropathies-DM, Neck/proximal, thyroid C- night splinting for at least 3 weeks M- steroid injections/WHO EMG/Nerve conduction S- carpal tunnel release ```
27
Role of angiotensin II?
Vascoconstriction/SNS activation Aldosterone/ADH release Na/H20 reabsorption, K excretion
28
RA pathophys?
Autoimmunitiy leading to acute inflam in joint Synovitis Damage
29
Ix and Management of RA?
``` Rf and anti- CCP C- physio, exercise, warm packs M- DMARDs- metho, sulfas, infliximab Steroids for acute flares S-athroplasty ```
30
Pathophys of boutonnieres/swan necking?
Boutonierre's rupture of central slip on extensor surface | Swan necking- rupture of volar plate
31
TPN indications?
GI- short gut syndrome, IBD, fistula, radiation enteritis, bowel rest Systemic- burns, 10% body weight loss, trauma, sepsis +MOF
32
Why not too much glucose in TPN?
Glucose leads to oxidation which leads to CO2=> resp failure Hyperglcaemia bad in acutely unwell Fatty liver Fatty acid deficiency
33
How to test level of epidural block
Ice packs- temp first to be affected
34
Difference between spinal cord lesions?
Ant cord- ant spinal artery ischaemia Bilateral loss of motor pain/temp/sensation. Intact vibration/proprioception Brown sequard- contraL pain/temp, IpsiL paralysis/vibration/proprioception Central cord Sensory and motor deficit- upper more than lower Hyperextension injuries in elderly
35
Causes of metabolic alkalosis?
``` Vomiting/Diarrhoea GOO Diuretics Conns Barrter's Bicarb infusion ```
36
How to calculate HR in ECG
300/large squares between QRS | 6 x total number in strip
37
How is CO2 transported in blood?
Dissolved Buffer system Bound to Hb
38
What is the chloride shift? | What is the counter current mechanism in kidneys?
Chloride- Cl- shifted into RBCs to maintain cellular electrical charge, exchanged with bicarb Controls Hb affinity for O2 Counter current- thin descending limb in permeable, thick ascending is impermeable Enables generation of osmotic gradient for water reabsorption/concentration of urine
39
DIC bloods and how to treat?
Low Fibrinogen and platelets, raised D dimer and APTT/PT FFP, Cryo, platelets
40
ARDS treatments?
``` Treat underlying causes Ventilate and oxygenate Consider proning ECMO Steroids/ABx- varying success TPN- optimise nutrition ```
41
Role of thyroid hormone?
Increased growth and metabolism | Increase sensitivity to adrenaline
42
Pulmonary oedema management?
``` A2E Oxygen Sit up Morphine to help V/Q matching GTN infusion IV furosemide ITU- dialysis/ventilation ```
43
What is preload? | Starlings law?
Preload is equal to the end diastolic volume Pre load proportional to afterload Mycocardial contractility preportional to stretch
44
Management of enterocutaneous fistulas?
``` A2E/MDT SNAP Sepsis- treat Nutrition + fluids + electrolytes Anatomy- define Protect skin Plan ``` Surgical role is to treat infection and distal obstruction
45
Rhabdo causes and treatment?
``` Burns Crush Reperfusion Trauma Hypothermia ``` ``` A2E Aggresive rehydration Forced diuresis Alkalinisation of urine Treat hyperkalaemia- calcium gluconate ```
46
Role of HCL?
Activates pepsinogen to pepsin- breaks down proteins | Antimicrobial
47
How does NSAIDs lead to peptic ulcers?
Irritate mucosal lining Reduce blood supply to mucosa COX inhibitors leading to decreased prostogladin production leading to less mucous secretion
48
What does TIPSS stand for?
Transjugular intrahepatic portosystemic shunt
49
Why raisd platelets in acute bleed?
Dehydration | Acute phase reactant to acute inflamm

MRCS Past Questions Knowledge (6 decks)

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