General

Question 1

Which tumours are associated with adrenal metastasis?

Answer 1

Lung and breast

Question 2

Adrenaline vs Noradrenaline

Answer 2

Adrenaline Alpha and Beta Noradrenaline predominantly alpha Alpha - peripheral vasoconstriction Beta - cardiac chronotropic and inotropic

Question 3

What is dopexamine

Answer 3

Splanchnic vasodilator

Question 4

Scaly, thick and greasy appearance.

Keratin plugs

Answer 4

Seborrhoeic Keratoses

Question 5

Name 4 clinical features of a mass/swelling that make it suspicious of being a sarcoma

Answer 5

> 5cm soft tissue mass

Deep / Intramuscular Location

Rapidly Growing

Painful

Question 6

Ewings vs Osteosarcoma

Answer 6

Ewings is a diaphyseal, small round tumour.

Radiologically - Onion Skin appearance- represneting lysis with periosteal elevation.

Osteosarcoma is usually a tumour of the metaphysis (osteoblastic cell origin)

Radiologically - sunburst appearance = sclerotic destruction

Question 7

Discuss Anterior Interosseus Nerve

Topography

Innervation

Answer 7

Topography:

Branch of the emdian nerve —> travels along anterior interossues membrane of the forear between flexor pollicus longus and flexor digitorum profondus ending at pronator quadratus

Innervates:

Flexor Pollicis Longus

Pronator Quadratus

Radial Half - FDP

Question 8

Anion Gap

Calc

Causes

Answer 8

Calculation (Na+K+)-(Cl+HCO3)

Normal 10-18

Low Anion Gap

hypoalbuminaemia, increased cations (MG++, Ca++, IgG),

Normal Anion Gap - Hyperchloraemic

Bicarb Loss, Renal Tubular Acidosis (moreso in type II), Drugs (Acetozolamide), Chloride Injection, Addison’s Disease (Type IV RTA)

High Anion Gap

Lactate, Ketoacidosis, Urate, Exogenous Acids

Question 9

Causes of delayed gastric emptying

Answer 9

Neuronal:

Vagotomy, Diabetic Gastroparesis (Vagal Nerve Disruption)

External Compression:

Pancreatic masses abutt the duodenum thereby delaying ewmptying,

Internal Obstruction:

Distal Gastric Malignancies, Pyloric Stenosis

Question 10

Ileostomy

Location

Construction

Complications

Answer 10

Location: Triangle between ASIS, Umbilicus and symphysis pubis.

Construction: 2cm incision, stoma length 2.5 cm, spouted, one third between umbilicus and ASIS.

Complications: Dermatitis, necrosis, prolapse, retraction, high output

Normal stoma output: 5-10 ml/kg/24 hour period. If >20 ml/kg/24 hour period —> IV fluids and supplementation

Question 11

Vagina lymph vessel drainage:

Superior

Inferior

Answer 11

Superior - drain into the internal + external iliac nodes

Inferior - drain into the superficial inguinal nodes

Question 12

Contents of jugular foramen

Bones forming jugular foramen

Answer 12

Bones: Posterior Occipital bone + Petrous portion of temporal bone

Contents - CN IX, X, XI. Inferior Petrosal Sinus, Sigmoid Sinus, Meningieal arteries (from occipital and ascending pharyngeal artery)

Question 13

Contents of Superior Orbital Fissure

Answer 13

CN III, IV, VI

Recurrent meningeal artery

Superior Opthalmic Vein

V1 - Lacrimal, Frontal and Nasociliary

Question 14

What do each of these secrete:

Parietal Cells

Chief Cells

Surface Mucosal Cells

Answer 14

Parietal Cells - HCl, Ca, Na, Mg, IF

Chief Cells - Pepsinogen

Surface Mucosal Cells - Mucus and Bicarbonate

Question 16

Dep Peroneal nerve

Course

Action

What (sometimes) atraumatic condition can it become compromised in?

Answer 16

L4-S2

Branch of common peroneal nerve at lateral aspect of fibula. Travels in anterior leg comparment. passes ankle anteriorly between two malleoli where it bifurcates:

Pre - Bifurcation: - Tibialis anterior, enxtensor hallucis longus, extensor digitorum longus, peroneus tertius

Lateral - Branch supplies extensor hallucis brevis and extensor digitorum brevis

Medial - cutaneous branch innervating skin at the webspace between 1st and 2nd digits

Acts to - evert foot, dorsiflex ankle and extend toes

It can become compromised in compartment syndrome of the anterior compartment

Question 17

Berry’s Sign

Answer 17

Absence of carotid pulse due to thyromegaly

Question 18

Thyroid Malignancy:

Psammoma Bodies

Skull Metastases

Elderly females

Answer 18

Pappilary - Psammoma Bodies. Picked up via FNA

Lymphatic spread

Follicular - Not well picked by FNA –> need hemithyroidectomy. Haematogenous spread (bones)

Anaplastic - Elderly females. Poor prognosis. palliative debulking

Question 19

Otosclerosis

Patho

Treatment

Answer 19

Fixation of stapes to oval window

Treatment involes stapedectomy + prosthesis insertion

Question 20

Pethidine caution in…

Answer 20

Renal patients

It has a toxic metabolite which accumulates in renal dysfunction —> Muscle twitching and convulsions

Question 21

Pharyngeal Pouch

Answer 21

True diverticulum (Zenker’s)

Involves all layers of mucosa.

Posteromedial herniation between thyropharyngeus and cricopharyngeus

Question 22

Discomfort after eating - think..

Answer 22

Chronic Mesenteric Ischaemia

Question 23

Mesenteric Vascular Disease

Answer 23

Acute Mesenteric Ischaemia - Embolic. Sudden onset pain, vomiting and diarrhoea

Acute on chronic - Post-prandial discomfort –> Acute

Mesenteric Venous Thrombosis –> Picture of weeks. Symptoms present when arterial inflow is compromised

Low flow mesenteric infarction –> inotrope use, intercurrent cardiovascular compromise

Question 24

Describe rectus sheath

Answer 24

Above costal margin –> Aponeurosis of external oblique aponeurosis

Between costal margin and arcuate line –> Anterior rectus sheath - External oblique aponeurosis + anterior internal oblique aponeurosis. Posterior rectus sheath- Posterior internal oblique aponeurosis + Transversus abdominus

Below arcuate line –> There is no posterior rectus sheath. External and internal oblique aponeurosis alongside transversus abdominus form anterior rectus sheath. posterior to this is transversalis fascia then peritoneum.

Arcuate line is 1/2 between umbilicus and pubic crest

Question 25

Transfusion protocol in major haemorrhage due to trauma

Answer 25

1:1:1 - Packed Red Cells, FFP and platelets

Question 26

**What are adrenal rests**

Answer 26

Adrenal rests - ectopic adrenal tissue. Commonly located on broadligament or spermatic cord.

Question 27

Extensor retinaculum Attachments Structures superficial to retinaculum Tunnels Tendons (8)

Answer 27

**Attachments** - Medial - pisiform and triquetral Lateral - Radius **Superficial structures -** Basilic + cephalic vein Dorsal cutaneous branch of ulnar nerve Superficial branch of radial nere **Tunnels** - 6 tunnels in total. **Tendons-** Enxtensor Carpi Ulnaris, Extensor Digiti Minimi, Extensor Digitorum and indicis, extensor pollicis longus, extensor carpi radialis longus tendon, extensor carpi radialis brevis tendon, abductor pollicis longus, extensor pollicis brevis tendon .

Question 28

What muscles are innervated by median nerve Forearm Distal forearm Hand

Answer 28

Forearm - Pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor pollicis longus, flexor digitorum profondus (radial half) Distal forearm - palmar cutaneous branch Hand - LOAF - Lateral 2 lumbricals, opponens pollicis, abductor pollicis previs, flexor pollicis brevis Sensory innervation to thumb and lateral 2.5 fingers

Question 29

Management of Renal Cell Carcinoma

Answer 29

T1 Malignancy - Partial Nephrectomy + Adjuvant chemotherapy T2 Malignancies - Total radical nephrectomy. Patients need early venous control prior to resection to rpesent tumour seeding.

Question 30

**JVP** Absent a waves Large a waves cannon waves prominent v waves slow y descent steep y descent JVP rises during inspiration Fixed Raised JVP

Answer 30

Absent A Waves - AF Large A Waves - Right ventricular hypertrophy, triscupid stenosis Cannon Waves - Complete Heart Block Prominent v waves - Tricuspid Regurgitation Slow y descent - Tricuspid stenosis, Right Atrial Myxoma Steep y descent - Right ventricular failure, Constrictive pericarditis, Tricuspid regurgitation JVP rises during inspiration - Kussmaul's sign of constrictive pericarditis Fixed Raised JVP - Superior Vena Cava Obstruction

Question 31

**Factors favouring EVAR**

Answer 31

Long neck of aneurysm (For fusiform aneurysms - neck is the unaffected proximal portion of artery) Good Groin Vessels Straight Iliac Vessels

Question 32

Billous Vomiting in Neonate - Rule out Briefly describe embryological problem What happens in the abdomen Investigations

Answer 32

Intestinal Malrotation (+volvulus) Normal **embryology** involves intestine entering abdominal cavity at 4 weeks --\> Then a 270 degree rotation so the: - caecum is in the RLQ - DJ flexure is to the left of vertebrae In intestinal malrotation - there is a missing 90% rotation --\> the duodenal loop is adjacent to the caecum with Lads Bands fixing it in place. **Then** the intestine undergoes 720 degree rotation --\> volvulus. Investigations : US - Abdomen: See where the SMA is in relation to the SMV (Normally SMA on left of SMV) Contrast abdominal scan: see where the DJ flexure is (usually to the left of vertebral bodies)

Question 33

**What is the ligament of treitz**

Answer 33

Ligament of Treitz: Suspensory ligament arising from right crus of diaphragm and attaching at the DJ flexure and usually at the 3rd + 4th parts of duodenum

Question 34

Microscopic difference between Thyroid: Follicular Adenoma Follicular carcinoma

Answer 34

Carcinoma has invasion of the capsule whereas adenoma do not.

Question 35

**Posterior Interossus Nerve** Origin Topography Muscles Innervated

Answer 35

Origin - Division of the radial nerve (occurs by lateral epicondyle between brachialis and brachioradialis) Crosses supinator where it formally becomes the posterior interossues nerve Innervates - Supinator + Extensor carpi ulnaris **Extensor** digitorum, indices, digiti minimi, extensor pollicis longus + brevis, abductor pollicis longus

Question 36

**Testicular Tumours** **RFs** **Investigations**

Answer 36

RFs- Cryptorchidism, Kinefelter's, Infertility, FH, Mumps orchitis Investigations - US, Tumour markets, CT- TAP for staging Classically Categorised: Seminoma (40 year olds) - AFP -ve, HCG \<20% +ve, LDH \<20% +ve Germ Cell (non-seminoma) (\<30 year olds) - 70% AFP +ve, 40% HCG +ve

Question 37

Cranial Nerve IX and X Muscle exceptions

Answer 37

IX - This innervates Stylopharyngues - muscle for swallowing. **All other pharyngeal muscles are innervated by Vagus nerve** This is because the stylopharyngeus develops from III pharyngeal arch. CN IX is also developed from this arch. X - Cricothyroideus is innervated by the external laryngeal nerve. **All other laryngeal muscles are innerated by Recurrent laryngeal nerve** This is because Cricothyroideus originates from arch IV alongside the vagus nerve. the RLN originates from arch VI

Question 38

**Causes of dysphagia**

Answer 38

Extrinsic: Mediastinal Masses, Cervical Spondylosis Oesophageal Wall: Achalasia, Diffuse oesophageal Spasm, Hypertensive Lower Oesophageal Sphincter Intrinsic: Stricture, Schatzki Ring, malignancy, Oesophagal Web Neurological: CVA, Bulbar Palsy, Multiple Sclerosis, Parkinson's Disease, Myasthaenia Gravis

Question 39

On Sentinel Node Biopsy of breast what might you find?

Answer 39

Isolated Tumour Cells or Evidence of Micrometastases **Isolated Tumour Cells -** Do not require axillary clearance **Micrometastases -** Depends on the extend of nodes involved. If there are lots of suspect nodes then FNA of theese nodes is the first thing to do. In practice --\> Positive SNLB usually equates to axillary node clearance

Question 40

**Current best practice.** **Varicose Veins** i) Investigation ii) Treatment

Answer 40

i) hand held doppler and then Venous Duplex ii) 1- Endothermal Ablation 2- Sclerotherapy 3 - surgery (trendelenberg procedure)

Question 41

**Obturator Nerve** Roots Topography Actions

Answer 41

Roots - L2 ,3 and 4 Topography - roots combine in psoas major and descend to lateral sacral margin --\> Cros sacroiliac joint --\> Descend through obturator internus entering the obturator groove. Lies lateral to internal iliac vessel + ureter Actions - Cutaneous - Medial thigh Motor - External obturator, Adductor magnus - upper portion, Adductor Longus, Adductor Brevis and gracilis.

Question 42

**Options if common bile duct has been opened/damaged?**

Answer 42

i) T Tube insertion and closure of the bile duct over it ii) Cholecoduodenostomy iii) Cholecojejunostomy

Question 43

**Options for relieving malignant obstructive jaundice (pancreatic head ca / cholangiocarcinoma)**

Answer 43

i) ERCP ii) PTC + Drainage + Stent Insertion

Question 44

Tongue Lymph Drainage

Answer 44

Anterior two thirds: Ipsilateral Drainage Posterior Third: Bilateral Drainage Tip of tongue: Submental --\> Deep cervical Midtongue: Submandibular --\> Deep cervical Posterior tongue: Deep cervical

Question 45

**Tongue innervation + Nerve topography**

Answer 45

Anterior Two thirds: **Lingual nerve -** originates as a branch of mandibular nerve (V3). passes tensor veli palitini --\> joined by chorda tympani (facial nerve CN VII). Courses by junction of vertical/horizontal mandibular ramus --\> passes by the third molar . The Trigeminal Portion --\> Sensation (General Sensory) The Facial Portion --\> Taste (Special Sensory Posterior Third **Glossopharyngeal nerve -** Sensation + Taste (General and special senory)

Question 46

Why may you have a normal ph acute mesenteric emobolus?

Answer 46

The bowel infarct --\> Lowers pH Vomiting --\> Raises pH

Question 47

**Four mechanisms of vomiting**

Answer 47

**Gag** - Touch Receptors in throat (CN IX), Pharyngeal Cosntrictors (CNX + CNIX for stylopharyngeus) **Labyrnthine** disorders - Motion Sickness **Stomach and duodenal distension -** stretch receptors **Central (brain) -** chemically induced (drugs etc.)

Question 48

**PR Bleeds** **Source**: Darker Blood Dark Blood Fresh red Blood Melaena **Investigations**

Answer 48

Darker Blood - Right sided bleed Dark Blood - Left sided bleed Fresh red Blood - Distal bleeding (haemorrhoids) Melaena - Upper GI **Investigations:** When blood --\> Flexi Sig first. If no lesion then consider colonoscopy When blood + unstable --\> Stabilise + CT Angio When melaena --\> OGD

Question 49

**When to admit for acute lower GI bleeding**

Answer 49

Age \>60 Significant Co-Morbidity Unstable Profuse bleeding Aspirin/NSAID use

Question 50

**Surgical options for splenic flexure malignancies:** **Obstructed** **Non-Obstructed**

Answer 50

**Obstructed** - i) Stenting ii) Extended Right Hemicolectomy. This involves taking the middle colic vessels (SMA) too unlike a right hemicolectomy. An ileo-colic anastamosis is fashioned. In general when performing resective colorectal surgery the arteries are followed and taken to ensure lymph nodes are removed as these are usually in close proximity to the arteries. Non-obstructed - i) Extended Right Hemi ii) Left hemi iii) Transverse colectomy (old-fashioned)

Question 51

**Rectal Cancer** What is the margin requirement What precludes the use of Anterior Resection What is TME What surgery for obstructed rectal cancer What additional treatment can be offered to rectal cancer patients (surgery, chemo + ?)

Answer 51

**Margin -** 2cm margin requirement **Anterior resection is precluded if** there is sphincter involvement or if the margin would involve the sphincter --\> The surgery of choice would be an APER (Abdomino-Perineal Resection) **TME -** total mesenteric excision. This involves the dissection of mesorectal fat + lymph nodes **Obstructive rectal tumours --\>** Defunctioning Loop Colostomy( Differs from colonic tumours where aim can be to resect and anastamose immediately if safe) **Rectal cancer can be treated with radiotherapy as it is extraperitoneal**

Question 52

Management of Weber Fractures

Answer 52

Weber Fractures - malleolar fractures A - Below syndesmosis. Full Weight Bearing with ankle boot B - At level of syndesmosis. If stable (Unimalleolar) then ankle boot and mobilise. If unstable - Below knee plaster and no weight bearing for six weeks C - Above level of syndesmosis - Inherently unstable. Fixation, syndesmosis reconstruction with screws.

Question 53

By what mechanism does ECF Volume depletion cause Metabolic Alkalosis

Answer 53

Losing significant bodily fluid through vomiting or diuretics results in a loss of Na+ + Cl- This leads to RAAS activation --\> aldosterone causes increased ENaC channels so more Sodium crosses from lumen into cells. Luminal K+ channels upregulated so potassium is lost to the lumen. Na+K+ATPase at interstitial side of cells is upregulated ---\> K+ is moved into the cell whereas Na+ is moved into interstitium. These three transporter changes lead to an increase loss of K+ to the collecting duct lumen and a preservation of Na+ Loss of K+ Leads to K+/H+ Buffering. K+ moves from cells into ECF in exchange for H+ -----:\> **Alkalosis**

Question 54

**Brisk duodenal ulcer** Treatment

Answer 54

Brisk Duodenal Ulcer - Usually posteriorly sited and invading the gastroduodenal artery. Duodenal ulcer pain occurs several hours after eating. Treatment: Resuscitate Surgery - Laparotomy --\> Duodenotomy. Underrunning the ulcer by biting above and below ulceration point which will also occlude artery. Transverse closure

Question 55

**Gastric Ulcer Surgical Management** **Antral ulcer** **Lesser Curve Ulcer**

Answer 55

Antral Ulcer- Partial Gastrectomy (If underunning doesn't work) Lesser curve ulcer - Partial Gastectomy / Under Running (Usually involves Left gastric artery) Some patients will need a total gastrectomy.

Question 56

Size threshold for surgical repair of rotator cuff tear

Answer 56

\> 2 cm

Question 57

**Where do the rotator cuff muscles attach**

Answer 57

Lesser Tuberosity - Subscapularis (subscapualr fossa) Greater Tuberosity - Supraspinatus (supraspinatus fossa), Infraspinatus (infraspinatus fossa), Teres Minor (lateral border)

Question 58

**Neer Classification**

Answer 58

For proximal humeral fractures Described as 2,3 or 4 part depending on how many fragments - Greater Tuberosity - LEsser Tuberosity - ARticular Surface - SHaft

Question 59

Supports for the uteres

Answer 59

Central Perineal Tendon - Perineal body. This is essential. Extends between vagina and anus. Round ligament - Uterine horns --\> through inguinal canal --\> mons pubis Transverse Cervical/ Cardinal Ligament - Attaches to obutrator fascia on pelvc side wall Uterosacral ligament - from uterus to anterior aspect of sacrum

Question 60

**what is the broad ligament**

Answer 60

The broad ligament is a fold of peritoneum that envelops the uterus, ovaries and fallopian tubes. It folds over the fundus of the uterus forming the: **Mesometrium (covers the uterus)** **Mesovarium (covers the ovaries)** **Mesosalpinx (covers the fallopian tubes)**

Question 61

**investigating large bowel obstruction**

Answer 61

First line: DRE, AXR, ?Rigid Sigmoidoscopy Then: CT- AP If inconclusive --\> Gastrograffin follow through

Question 62

**Impending signs of perf in LBO**

Answer 62

Caecal \>12 cm Competent Ileocaecal valve Caecal tenderness

Question 63

Managing local anaesthetic toxicity Max Doses

Answer 63

Intralipid: Bolus- 1.5 ml/kg over 1 minute Infusion - 0.25 ml/kg/minute If prilocaine is used then administere methylene blue 1st dose - neat/ 2nd dose w/adrenaline **Lignocaine -** 3 mg/kg. 7 mg/kg Bupivicaine - 2 mg/kg 2 mg/kg Prilocaine - 6 mg/kg 9 mg/kg **Prilocaine**

Question 64

**Procedures for lymphodoema**

Answer 64

Homans - skin preserving procedure ( where skin is good). Skin flaps formed and then underlying subcutaneous tissue excised Charles - skin and underlying subcut tissue all excised down to fascia. split skin grafts are applied. used for poor overlying skin condition. Lymphonvenous anastamosis - exclusively for proximal obstruction + good distal lymphatics. Anastamoses between distal lymph structure and deep vein.

Question 65

Why is tissue black in gangrene?

Answer 65

Hb degeneration and deposition of iron sulphide

Question 66

**Best test for vWD**

Answer 66

Bleeding Time (factor VIII may also be low) vWD can be Autosomal Dominant: Type I - Quantitative deficiency of vWF Type 2 - Qualitative impariment of synthesis of vWF Autosomal Recessive Type 3 - Absolute deficiency in vWF

Question 67

**Causes of diarrhoea** Campylobacter Shigella Salmonella EColi Yersinia Vibrio Cholera

Answer 67

Camp - Most common. Gram Negative Rod (comma shaped). Reactive Arthritis, GBS Shigella - Gram negative bacilli. Dysentry Salmonella - Gram negative, facultative anaerobe, enterobactericiae. ECOLI - ETEC, EIEC, EHEC Yersinia Enterocolitica - Gram Negative coccobacilli. Terminal Ileitis - mimic Crohn's/ Appendicitis. Cholera - Gram Negative Rods. Watery diarrhoea

Question 68

Sartorius

Answer 68

Supplied by Anterior Femoral Nerve (L2-L3) ASIS --\> proximal tibia Flexes - knee and hip Medially rotates femur.

Question 69

Which Coag factors to the following influence: Heparin Warfarin Liver Disease Disseminated Intravascular Coagulation

Answer 69

**Heparin -** 2,9, 10, 11 **Warfin -** 2, 7, 9 , 10 **Liver disease -** 1, 2 , 5 , 7, ,9, 10, 11 **DIC -** 1, 2, 5, 8, 11

Question 70

**Lymphatic drainage of male genitalia** To the: Inguinal Nodes Iliac Nodes **Where is the external sphincter (urethral) in males?** **Where does sperm enter urethra?**

Answer 70

**Deep Inguinal Nodes -** Spongy urethra, Glans Penis **Iliac Nodes -** membranous urethra, prostatic urethra **External Sphincter surrounds -** Membranous urethra (membranous urethra extends from prostate --\> perineal membrane) **Where does sperm enter urethra -** prostatic urethra

Question 71

**Colonic Polyp Risk (colonoscopy)** **Low** **Medium High**

Answer 71

Low: 1-2 adenomas - \< 1 cm **No follow Up** Medium: 3-4 adenomas/ 1 adenoma \>1cm - **3 year follow up** High: 5 or more Adenomas/ 3 adenomas + 1 being \>1cm - **1 year follow up**

Question 72

**Infective organism:** **Large bowel ulcers and necrosis**

Answer 72

EnteroInvasive E Coli

Question 73

**Structures passing through the Parotid Gland**

Answer 73

Facial Nerve (superficial) Retromandibular Vein ( next most superficial) External Carotid Artery (deep to the vein) Auriculotemporal nerve

Question 74

**What is diaphragm disease**

Answer 74

Due to long term NSAID use Small bowel becomes seperated into compartments where there is thickened circular mucosal abd submucosal membranes ---\> focal areas of small callibre lumens --\> frequent small bowel obstructions

Question 75

**Which nerve is responsible for flexing thumb**

Answer 75

Solely median nerve Forearm - flexor pollicis longus Hand - flexor pollicis brevis

Question 76

**What drain is used surgically after CBD exploration?**

Answer 76

T Tube: Latex. This is to induce a fibrotic reaction so a tract will form

Question 77

**What is sibson's fascia?**

Answer 77

Fascia overlying the apex of both lungs C7-first rib (inbetween thoracic cage + parietal pleura)

Question 78

**Right Lung Anatomy**

Answer 78

Three Lobes - Seperated by oblique and transverse fissure Azygous Vein - Just above hilum Superior vena cava + inominate vein - Groove is further above hilum Oesophagus - Behind Hilum Inominate Artarey - Near apex IVC groove- near lower part of the oesophageal groove

Question 79

**Left Lung Anatomy**

Answer 79

Two lobes - Seperated by oblique fissure Groove for aortic arch - Above HIlum Groove for subclavian artery - Furhter Above hilum Groove for descendign aorta - behind hilum Oesophagus - lower part of the lung

Question 80

JVP Deflections a c v x y

Answer 80

**Ascents** **a** - trial contraction c - ventri**c**ular contration v - atrial **v**enous filling **Descents** x - atrial relaxation y - ventricular filling / atrial emptying

Question 81

**Superficial peroneal nerve** **Deep peroneal nerve**

Answer 81

Arise when common peroneal bifurcates between fibula and peroneus longus **Superficial -** peroneal longus and brevis **Cutaneous -** lateral lower third of leg and most of dorsum of foot (except lateral foot which is supplied by sural nerve and medial leg which is supplied by saphenous nervee) **Deep -** Tibilaris anterior, peroneus tertius, Extensor hallucis longus, extensor digitorum longus + brevis Terminates into **medial** and **lateral branches** **C****utaneous supply** - first web space

Question 82

**Psoas Major and Minor**

Answer 82

Major - originates from lumbar vertebrae and attaches onto lesser trochanter Innervated - Anterior Rami of L1-L3 Minor - High lumbar origin and attaches to pubic crest (superior) Innevated - anterior rami of L1

Question 83

**Blood tests for carcinoid tumours** **Urine Tests**

Answer 83

Chromogranin A Neuron Specific Enolase Substance P Gastrin Urine- 5 HIAA 5 Hdyroxytriptamine

Question 84

**Tumour Genetics Colorectal** FAP HNPCC Cowden Peutz Jehger

Answer 84

FAP - APC mutations (TS Gene) HNPCC - MSH2, MLH1, PMS2 + GTBP (Amsterdam Criteria, DNA Mismatch repair Genes) Cowden - PTEN (Autosomal Dominant) Peutz Jehger - LKB1, STK11

Question 86

**Divisions of the laryngeal cavity**

Answer 86

Vestibule - Superior to vestibular folds Ventricle - between vestibular folds and vocal cord Infraglottic - vocal cord to cricoid cartilage

Question 87

**Muscles of the larynx (6/7)**

Answer 87

Posterior Cricoarytenoid - Abduct vocal fold Lateral Cricoarytenoid - Adduct Vocal fold Thyroarytenoid - Relax Vocal Fold Transverse + Oblique Arytenoids - Close Rima Glottidis Vocalis - Relaxes posterior part of vocal ligament and tenses anterior part of vocal ligament Cricothyroid - Tenses vocal ligament (Innervated by External Laryngeal Nerve)

Question 88

**Vascular Supply of Larynx** **Lymph Drainage**

Answer 88

Superior and Inferior Laryngeal Arteries ( branches of superior and inferior thyroid arteries ) Superior and inferior Laryngeal veins drain into the Superior and Middle thyroid veins Respectively **Lymph Drainage of Larynx:** Supraglottic - Upper Deep Cervical Subglottic - Prelaryngeal + Pretracheal + Inferior Deep Cervical Vocal Cords don't have lymphatic drainage

Question 89

**Femoral Triangle:** **Borders** **Structures**

Answer 89

**Borders**: Lateral - Femoral Vein Medial - Lacunar Ligament Anterior - Inguinal Ligament Posterior - Pectineal ligament **Structures**: Lymphatic Vessels, Cloquet's Lymph Node

Question 90

**Desmoid Tumours** Associated with which GI Disorder What Structures do they arise from

Answer 90

**Associated with FAP (APC Tumour Suppressor Gene Mutations)** **They are proliferations of myofibroblasts arising from Musculoaponeurotic Structures**

Question 91

**Male Genital injuries** i) Meatal Haematoma, Perineal Haematoma, Urinary Retention ii) High Riding Prostate, Perineal Oedema/ Haematoma, Pelvic Fracture iii) haematuria, suprapubic pain, inability to retrieve all irrigation through bladder

Answer 91

i) Bulbar Urethral Rupture ii) Membranous Urethral Rupture iii) Bladder Rupture For Urethral Injury: Ix - Ascending Urethrogram Mx - Surgical Suprapubic Catheter For Bladder Injury: Intraperitoneal - Laparotomy Extraperitoneal - Conservative

Question 92

**Diaphragmatic Apertures:** **T12** **T10** **T8**

Answer 92

T12 - Aortic T10 - Oesophageal Oesophagus + Vagus Trunks T8 - Caval IVC +Right Phrenic Nerve

Question 93

**Classifying Open Fractures** **What should be empirically done**

Answer 93

Gustillo and Anderson Classification System: **I** Low Energy wound \<1cm **II** - \>1cm wound with modeate soft tissue damage **IIIA -** High Energy (\>1cm) + Adequate tissue coverage **IIIB** - High Energy (\>1cm) + Inadequate soft tissue coverage **IIIC -** High Energy (\>1cm) + Arterial Injury **Empirically -** Tetanus Prophylaxis + Broad Spectrum Abx + Check neurovascular status + Debride and lavage

Question 94

**p53 germline mutations --\> Cancer\<45**

Answer 94

**Li-Fraumeni Syndrome** p53 is a tumour suppressor gene Individuals develop sarcoma \<45 years old

Question 95

**Gardner Syndrome**

Answer 95

**APC Gene Mutations** Multiple Polyposis Supernumeray Teeth Jaw + Skull Osteoma Hypertrophic Retinal Pigment Thyroid Cancer Cutaneous Lesions

Question 96

**Which hormones are reduced in stress response?**

Answer 96

Insulin Oestrogen Testosterone

Question 97

**Superior Vena Cava** **Formation** **What joins before entering right atrium?** **Sites of collateralisation in SVCO**

Answer 97

Forms from - Right and left Inominate veins ( these respectively form from Internal + Subclavian Veins) **Azygous vein forms before entring right atrium - Forms from union of ascending lumbar veins and subcostal veins.** **Collateralisation -** Primarily Azygous Internal Thoracic Vein - originates at superior epigastric vein and terminates in brachiocephalic vein Long thoracic Vein - drains from serratus anterior and pectoralis major to axillary vein. A connection between LTV and superficial epigastric vein (the thoracoepigastric vein) alows shunting

Question 98

**Median Nerve** Which branches supply what

Answer 98

**Median nerve supplies:** Flexor Carpi Radialis, Palmaris Longus, Flexor Digitorum Superficialis **Anterior interosseus nerve**: (branch given off in upper forearm) (Deep forearm muscles) Lateral part of flexor digitorom profondus, flexor pollicus longus, pronator quadratus **Palmar Cutaneous Branch:** (given off in the forearm) s Sensation to thenar eminence **Recurrent Muscular Branch:** (hand branch given off just after flexor retinaculum) Opponens Pollicis, Abductor Pollicis Brevis, Flexor Pollicis Brevis) **Digital Cutaneous branch:** (hand branch given off just after flexor retinaculum) Lateral lumbricals,

Question 99

**Blood Supply to CBD**

Answer 99

Hepatic Artery and branches of Gastroduodenal artery

Question 100

**Hepatobiliary Triangle**

Answer 100

Medially - Common Bile Duct Inferiorly - Cystic Duct Superiorly - Inferior Lobe of liver **Contents Cystic Artery**

Question 101

**Workup in oesophogeal Ca**

Answer 101

Staging CT Diagnostic Laparascopy --\> look for peritoneal disease PET CT **If none of these are positive then proceed to consider for surgery** Distal Ca --\> Ivor Lewis Two stage Proximal --\> Mckeown three stage

Question 102

**Blood supply to rectum** **What is the extraperitoenal rectum Surrounded by?** **Fascia surrounding rectum**

Answer 102

Three arteries **Superior -** From IMA **Middle -** From Internal Iliac **Inferior -** From Internal Pudendal (branch of internal iliac) **Extraperitoneal rectum is surrounded by -** Mesorectal fat containing lymph nodes (hence need for total mesorectal excision) **Anterior rectal fascia - Denonvillers** **Posterior rectal Fascia - Waldeyers**

Question 103

Innervation of the infrahyoid strap muscles

Answer 103

**Sternohyoid - Ansa cervicalis** **Sternothyroid - Ansa Cervicalis** **Thyrohyoid - C1 Spinal nerve (through hypoglossal nerve)** **Omohyoid - Superior belly - Superior root of ansa cervicalis - C1)** **Inferior Belly - Ansa Cervicalis** **Ansa cervicalis - Cervical plexus exists in carotid triangle** **- Two roots -** Superior Originates from C1, Inferior orginiates from C2+C3

Question 104

**Ligamentous Anatomy of the Ankle Joint** **Medial -** **Lateral -** 3 components **Between Tibia and Fibula -** 4 components

Answer 104

**Medial** - Deltoid Ligament **Lateral** - Lateral ligament complex: 3 components Anteriotalofibular ligament Calcaneofibular ligament Posteriotalofibular ligament **Syndesmosis -** ligament complex between distal fibula and tibia - 4 components Anterior-inferior tibiofibular ligament Transverse tibiofibular ligament Interosseus membrane Posterior-Inferior tibiofibular ligament

Question 105

X Ray indicators of Ankle Syndesmotic Injury

Answer 105

Decreased tibiofibular overlap Lateral/Medial joint clear space Lateral Talar Shift

Question 106

**principles for operating in acute cholecystitis**

Answer 106

\<48 hours surgery is a good idea \>5 days - surgery is best left deferred to 3 months to allow inflammation to settle

Question 107

**Mucinous colorectal cancer at young age** **Family history**

Answer 107

Likely to be Lynch Syndrome or HNPCC

Question 108

**Immunlogics and their uses** Bevacizumab Trastazumab Imatinib Basiliximab Cetuximab

Answer 108

Bevacizumab **(anti-VEGF)** - Colorectal, Renal, Glioblastoma Trastazumab **(anti-HER2) -** Breast Imatinib (**TK inhibitor) -** GIST, CML Basiliximab (**IL2 R) -** Post renal transplant Cetuximab (**Epidermal Growth Factor Receptor inhibitor)** - Colorectal

Question 109

**Fistulae** **When is it safe to conersvatively manage?** **Drug therapy for high output fistula** **Contraindication to probing perianal fistulae** **How to delinieate fistula tract?**

Answer 109

**Conservative management -** In the absence of IBD or distal obstruction **Octreotide** si used to reduce pancreatic secretions in the context of high output fistulae **Perianal fistulae** should not be probed in teh context of **acute inlammation** Fistula anatomy can be delineated using CT and barium studies

Question 110

**Management of Liver Metastases**

Answer 110

Patients with good physiological reserve - Chemotherapy + Surgical Resection 5 Year Survival can be as good as 20% With poor physiological reserve - Radiofrequency ablation

Question 111

**Glucocorticoids** At a cellular level - MOA Metabolic effects Regulatory Effects

Answer 111

**They bind to intracellular receptors -**these migrate to the nucleus acting as transcription factors **Metabolic:** Decrease uptuake and utilisation of glucose --\> increase gluconeogenesis Increase protein catabolism Potentiate lipolysis **Regulatory:** Negative Feedback on hypothalamus Prevent vasodilation and fluid loss from vessels Increase osteoclastic activity/ Decrease osteoblastic activity Decrease inflammation (Decrease B/T Cell clonal expansion)

Question 112

**Hip Joint** Vascular Supply Gold Standard Investigation for fractures if plain films are inconclusive Internal Fixation, Hemiarthroplasty or THR

Answer 112

**Vascular Supply** - Medial and lateral femoral circumflex arteries **(branches of profunda femoris)** which go onto anastamosis and enter the joint capsule **at the posterior neck base.** Ligament of teres provides small blood supply **Imaging -** MRI is gold standard if plain radiographs aren't good enough however in practice CT is sought **internal fixation -** Young displaced/undisplaced, Elderly undisplaced **Hemiarthroplasty -** Displaced **and** poor baseline mobility/ cognitive impariment/ medically unfit **THR -** Displaced **and** good baseline mobility/ no cognitive impairment/ medically fit

Question 113

**Colonic cancers with threatened resection margin mangement** **Rectal cancers with threatened resection margin management**

Answer 113

**Colonic cancers** with threatened resection margin mangement - **Primary Resection** **Rectal cancers** with threatened resection margin management - **Long course chemotherapy.**

Question 114

Nerve most commonly injured during superficial parotidectomy

Answer 114

**Greater Auricular Nerve** **-** ascending branch fo cervical plexus arising from 2nd and 3rd cervical nerves - Ascends sternoclediomastoideus coming underneath the platysma muscle - **Branches into anterior and posterior overly the parotid.**

Question 115

**Pancreatic Adenocarcinoma** **RFs** **Most common Location** **Ix** **Mx**

Answer 115

RFs- Smoking, Diabetes, Adenoma, FAP **Most commonly in the head of pancreas** Ix - USS, CT Scan **IF on CT** it is deemed unresectable **no further staging** **IF on CT** it is deemed **resectable --\>** PET/CT, ERCP/MRI, Staging Laparoscopy (peritoneal disease) Mx - **Head -** Whipple's **Body/Tail -** Distal Pancreatectomy **Adjuvant Chemotherapy** **ERCP**

Question 116

**Contents of the popliteal fossa**

Answer 116

**Most Medial** Artery Vein Tibial Nerve Common Peroneal Nerve Soemtimes sural nerve **Most Lateral**

Question 117

**What level do the following branches come off the aorta?** Coeliac Superior Mesenteric Inferior Mesenteric

Answer 117

Coeliac - T12 Superior Mesenteric - L1 Inferior Mesenteric - L3

Question 118

**What level do the following branches come off the aorta?** Inferior phrenic Lumbar Median Sacral

Answer 118

Inferior phrenic - T12 Lumbar - L1-L4 Median Sacral - L4

Question 119

**What level do the following branches come off of the aorta?** Middle suprarenal Renal Gonadal Common Iliac

Answer 119

Middle suprarenal - L1 Renal - L1-L2 Gonadal - L2 Common Iliac - L4

Question 120

**Colles Fracture**

Answer 120

Dinner fork deformity Transverse distal radius fracture Dorsal displacement and angulation

Question 121

**Smiths Fracture**

Answer 121

(reverse colles') Distal Radius transverse fracture Volar angulation of fragment

Question 122

**Bennett's Fracture**

Answer 122

Intraarticular fracture of 1st MCP Triangular fragment at ulnar base of metacarpal

Question 123

**Monteggia Fracture**

Answer 123

**Ulnar fracture** Proximal radioulnar joint dislocation

Question 124

**Galeazzi Fracture**

Answer 124

Radial shaft fracture Dislocation of distal radioulnar joint

Question 125

**Barton's Fracture**

Answer 125

Distal Radius fracture (Colles or Smiths) **with** radiocarpal dislocation

Question 126

**what nerve is responsible for otalgia post-tonsillar surgery**

Answer 126

Glossopharyngeal nerve

Question 127

**What is the most common site of intessusception paediatric?**

Answer 127

Ileo-caecal - This is usually maanged by fluroscopically guided air insufflation Ileo-ileal is less common but needs a laparotomy

Question 128

**Origins of gluteal arteries** **Gluteal Nerves**

Answer 128

Inferior gluteal artery - **anterior trunk of internal iliac artery** Superior gluteal artery - **posterior trunk of internal iliac artery** **Superior Gluteal Nerve -** L4, L5, S1 **Inferior Gluteal Nerve -** L5, S1, S2

Question 129

**Epigastric Pain and Audible Bruit**

Answer 129

Median Arcuate Ligament Syndrome: The median arcuate ligament of the diaphragm compresses the coelic trunk and coeliac ganglia. Pain realted to meals.

Question 130

Aortic Aneurysm - Iliac Involvement

Answer 130

Open Repair

Question 131

**What is the level of the transpyloric plane** **Contents of the transpyloric plane (13)**

Answer 131

**Transpyloric plane - L1!** Pylorus of the stomach Left Kidney Hilum + Right Kidney Hilum (Note right lower than left) Gall bladder fundus Pancreatic Neck Duodenojejunal Fixture Superior Mesenteric Artery Portal Vein Left and right Colic Flexure Roof of the transverse mesocolon 2nd part of the duodenum Upper Part of conus medullaris Spleen

Question 132

**Functional Renal Imaging** **DMSA** **Diethylene-triamine-penta-acetic acid** **MAG 3 Renogram** **Micturating Cystourethrogram** **Intravenous Urography** **PET/CT**

Answer 132

**DMSA** - Localises in the renal cortes. --\> Cortical defects, scarring, Ectopic or aborrhent kidneys. **Diethylene-triamine-penta-acetic acid DTPA -** Glomerular Filtration Agent. Provides useful information about eGFR **MAG 3 Renogram -** Secreted by tubular cells so good for imaging kidney in patients with existing renal impairment. **Micturating Cystourethrogram -** Assessment of bladder reflux. Bladder filled with contrast via catheter **Intravenous Urography -** Good for renal function, and detection of urinar tract calculi **PET/CT -** Staging

Question 133

**Statistical Tests:** **T Test** **Fishers Exact Test** **Spearmans Rank Test** **Mann Whitney U Test** **Bonferroni Test**

Answer 133

**T Test -** normal distribution **Fishers Exact Test -** determines the signfificance of athe deviation from null hypothesis. **Spearmans Rank Test -** significant relationship between two sets of data **Mann Whitney U Test -** nonparametric test of the null hypothesis that sample from one group is equally likely to be lesser than or greather than sample from another group **Bonferroni Test -** counteracts problems of multiple comparisons

Question 134

**Brachial PLexus Questions** In which fascia are the upper 3 rami of the brachial plexus contained within pre-axillary artery? Which part of the axillary artery does the plexus surround? where are the cords formed? Which divisions form which cords?

Answer 134

They are contained within the pre-vertebral fascia The plexus surrounds the second aprt of the axillary artery Cords are formed in the Axilla **Cords:** **Posterior Cord -** Dorsal divsions of C5- C8 (Upper, Middle and half of Lower Trunk) **Medial Cord-** Ventral divisions of C8-T1 (Lower Trunk) **Lateral Cord -** Ventral Divisions of C5-C7 (Upper and middle trunk)

Question 135

**Brachial Plexus Questions:** **What are the terminal nerves of the brachial plexus (not branches)?** **What forms the:** Long Thoracic Nerve Dorsal Scapular Nerve Upper Subscapular Nerve Thoracodorsal Nerve Lower Subscapular Nerve Axillary Nerve Suprascapular Nerve Nerve to subclavius Lateral pectoral Nerve Musculocutaneous Nerve Medial Cutaneous nerve of the arm Medial cutaneous nerve of the forearm Ulnar Nerve

Answer 135

**Terminal Nerves are - Radial Nerve ( From Posterior Cord)** **Median nerve (Lateral and Medial Cord)** **Derived from:** **Roots:** Posterior- Long Thoracic Nerve- C5-C7 Dorsal Scapular Nerve - C5 Anterior - Nerve to Subclavius - C5-C6 **Trunks:** Suprascapular Nerve - Upper Trunk **Cords :** Upper Subscapular Nerve - Posterior Cord Thoracodorsal Nerve - Posterior Cord Lower Subscapular Nerve - Posterior Cord Axillary Nerve - Posterior Cord Lateral pectoral Nerve - Medial and Lateral Cord Musculocutaneous Nerve - Lateral Cord Medial Cutaneous nerve of the arm - Medial Cord Medial cutaneous nerve of the forearm - Medial Cord Ulnar Nerve - Medial Cord

Question 136

**Describe Subclavian Steal syndrome**

Answer 136

Stenosis/ Occlusion of subclavian artery, proximal to the origin of the veryebral artery.

Question 137

**What surgery for Conjugated hyperbilirubinaemia in baby?**

Answer 137

Biliary atresia: **Kasai procedure -** Roux-en-Y portojejunostomy if this fails ---\> Liver transplant

Question 138

**Phrenic Nerve Topography**

Answer 138

C3- C5 Left: Deep to prevertebral fascia across scalenus anterior Crosses anterior to part 1 of subclavian artery Posterior to Subclavian vein and Internal Thoracic ---\> enters the thorax Lateral to left subclavian, aortic arch and left ventricle. Anterior to lung hilum and pierces diaphragm Right: Deep to prevertebral fascia across sclaneus anterior Croses anterior to 2nd part of subclavian artery Posterior to Subclavian vein and Internal Thoracic ---\> enters the thorax Travels anterior to right vagus and laterally to SVC passes over R atrium and exits through the caval opening at T8 of diaphragm

Question 139

Cancer arising of the kidney due to long term inflammation?

Answer 139

Squamous Cell Carcinoma

Question 140

**Scalenus Anatomy** **Innervation** **Which structures pass through**

Answer 140

**Scalenus Anterior Medius and Posterior** **-**Anterior and medius both insert onto first rib Posterior inserts onto second rib **Innervation:** Spinal Nerves C4-C6 **Brachial Plexus and subclavian artery both pass inbetween scalenus anterior and medius**

Question 141

Why use bupivicaine post-operatively over lidocaine?

Answer 141

It has a much longer duration of action than lignocaine and therefore can provide longlasting wound-site analgaesia

Question 142

**What would be the LA of choice in regional block?**

Answer 142

Prilocaine - this is much less cardiotoxic

Question 143

**Basilic Vein Path** **Cephalic Vein Path**

Answer 143

**Basilic** - is **Medial**. Originates from dorsla venous network ---\> passes most of the way superficially. Anterior to the antecubital fossa ---\> joins the cephalic vein the the median cubital vein Pierces the biceps fascia Ascending medially it becomes the axillary vein **Cephalic -** is **Lateral** Ascends lateralyl from the dorsal venous network. Travels lateral to antecubital fossa. Into Deltopectoral triangle inbetween pectoralis and deltoid Empties into axillary vein

Question 144

**Prostate Disease-Which lobe** **BPH** **Carcinoma** **Prostate** **Arterial Supply** **Venous Drainage** **Lymph Drainage**

Answer 144

BPH - Median Lobe Carcinoma - Posterior Lobe **Arterial Supply -** Inferior Vesical Artery (branch of internal iliac) **Venous Drainage -** Prostatic Venous PLexus ( to paravertebral veins) **Lymph Drainage -** internal iliac (+sacral)

Question 145

When are hepatocellular adenomas resected?

Answer 145

\>5 cm due to risk of rupture or In males due to high risk of malignancy

Question 146

**Coeliac Artery** Branches of coeliac artery Level of coeliac artery from aorta

Answer 146

**Level - T12** **Branches:** **Left Gastric -** Oesophageal and stomach branches **Common Hepatic -** Proper hepatic (branches into left and right hepatic- right giving off cystic artery), Right Gastric, Gastroduodenal (branches into r. gastroepiploic + superior pancreticoduodenal) **Splenic Artery -** Dorsal pancreatic, Short Gastric, Left gastro-omental, Greater Pancreatic

Question 147

**Anatomy of the foot arches**

Answer 147

Longitudinal: Posteriorly supported by calcaneum Laterally- passes over cuboid bone and lateral two metatarsal bones Medially - head of talus (summit) between the subtentaculum tali and navicular bone. Anterior pillar is navicular, cuneiforms and medial three metatarsals. Transverse: Between Anterior tarsus and posterior metatarsus.

Question 148

**What constitutes:** Sub Talar Joint

Answer 148

Facet on lower surface of talus body + Posterior facet on the upper surface of calcaneus Synovial

Question 149

**What constitutes:** **Talocalcaneonavicular joint**

Answer 149

Anteroinferiorly the navicular bone communicates with the subtentaculum tali of the calcaneus (Posteroinfeiorly) to provide a place for communication of the Talus to sit.

Question 150

**Hip Joint** **Intracapsular ligamnets** **Extra Capsular Ligaments** **Majority of blood supply to head of femur?**

Answer 150

Intrcapsular - Transverse Ligament Ligament of Teres Extracapsular: Ilofemoral Pubofemoral Ischofemoral **Medial and lateral circumflex femoral arteries (both branches of profunda femoris/ inferior gluteal artery)**

Question 151

**Which strucures pass through** **Inferior Sciatic Foramen** **Superior Sciatic Foramen** **Both**

Answer 151

**They are divided by sacrospinous ligament.** **Lesser** (Anterior - ischium tuberosity, Superior - Sacrospinous ligament + spine of ischium, Posterior - sacrotuberous ligament) Obturator Internus Tendon **Greater (**Anterior - greater sciatic notch of ilium, Posterior- sacrotuberous ligament, Inferior - sacrospinous ligament + ischial spine, superior - anterior sacroiliac ligament) **Nerves**- sciatic, Superior (above piriformis) and inferior gluteal nerves, posterior femoral cutaneous nerve, nerve to quadratus femoris, nerve to obturator internus) **Arteries + Veins -** Superior Gluteal A +V, Inferior Gluteal A+V, ) **Both** Pudendal Nerve Internal Pudendal A+V Nerve to obturator internus

Question 152

**Deep Perineal Pouch** Anatomical Location Contents

Answer 152

Anatomical location: Bounded inferiorly by inferior fascia of urogenital diaphragm and superiorly by superior fascia of urogenital diaphragm Contents: Urethral sphincter Transversus Perinei Nerves - Dorsal nerve of penis, perineal nerve branches Vessels - Urethral artery, deep artery of penis, dorsal artery of penis, origin of artery to bulb of penis

Question 153

**Left Common Carotid Anatomy** **Thorax -** **Neck -**

Answer 153

Originates from arch of aorta - **Thorax -** In contact with trachea, recurrent laryngeal nerve and oesophagus Left brachiocephalic vein passes anteriorly in front of it **Neck -** Runs beneath SCM and enters anterior triangle In carotid sheath with - vagus nerve, and (lateral to ) internal jugular vein vertebral artery and thoracic duct lie posterior to the artery in the neck **Bifurcate** at level of C3 vertebrae/ upper border of throid cartilage **Right Common Carotid -** **Same except** : Branch of brachiocephalic trunk. No thoracic duct on the right side

Question 154

**Sulphur Granules and Gram Positive Organisms -** Histology

Answer 154

Actinomycosis - Forms multiple sinuses The sulphur granules (round or oval basophilic masses)

Question 155

**Within what time should an open fracture be internally fixated?**

Answer 155

72 hours

Question 156

**Malignant Fibrous Histiocytoma** Four SubTypes Treatment

Answer 156

**Subtypes**: Storiform - Pleomorphic Myxoid Giant Cell Inflammatory **Treatment:** Surgical resection + pseudocapsule resection Chemotherapy

Question 157

**Large pathological deposit in bone** **?management**

Answer 157

Surgical Fixation - to prevent fractures

Question 158

**When do you consider surgery for polyps?**

Answer 158

Incomplete excision of malignant polyp (endoscopically) Malignant sessile polyp Malginant peduncalated polyp with submucosal invasion Polyops with poorly differentiated carcinoma Familial polyposis syndromes

Question 159

**Growth Plate Fracture Classifications**

Answer 159

**SALTER** **I S** traight through growth plate **II A** bove and through growth plate * *III B** elow and through growth plate * *IV T** hrough metaphysis epiphysis + growth plate **V E** Everyything (crush injury)

Question 160

**Which space does LP go?**

Answer 160

Subarachnoid

Question 161

**Popliteal Fossa** **Borders** **Contents**

Answer 161

Borders: Lateral: Biceps femoris, Lateral head of gastroc and plantaris Medial - Semimembranosis and semitendinosis, medial head of gastroc Floor - Popliteus, Femur Roof - Superficial and deep fascia Contents: Vascular: Popliteal artery, Popliteal Vein, Short Saphenous Vein Nerves: posterior cutaneous nerve of thigh, tibial nerve, genicular branch of of obturator nerve

Question 162

**Which vein is related to:** **Sural Nerve** **Saphenous Nerve**

Answer 162

Sural nerve: Short Saphenous Vein: Lateral side of foot. Passes inferio-lateral to the lateral malleolus. Enters popliteal fossa between gastroc heads. Saphenous Nerve: Long saphenous Vein: Medial side of foot. Passes anterior to medial malleolus. Traverses the medial posterior femoral epicondyle. Migrates laterally on anterior thigh.

Question 163

**Common extracolonic manifestation of FAP**

Answer 163

Duodenal and gastric polyps

Question 164

**Paediatric Neck Masses:** Cyst above the hyoid Cyst below the hyoid Anterior to SCM at the angle of mandible Posterior to SCM

Answer 164

Cyst above the hyoid - **dermoid -** heterogenous appearane Cyst below the hyoid - **Thyrogossal cyst -** thin walled and anechoic Anterior to SCM at the angle of mandible - **branchial cyst -** failure of obliteration of usualy 2nd arch. anechoic. can become infected Posterior to SCM - **cystic hygroma -** can be closely aassocated with surrounding structures. lymphatic malformation

Question 165

**Paediatric fluid management**

Answer 165

100 ml/kg/day - first 10 kg 50 ml/kg/day - second 10 kg 20 ml/kg/day - subsequent kgs Neonates: First day- 50-60 ml /kg/day Second day - 70 - 80 ml/ kg / day Third day - 80 - 100 ml /kg / day fourth day - 100-120 ml/kg/day 5-8 days - 120-150 ml /kg / day

Question 166

**Oxygen Dissociation Curve** **Causes of Right Shift** **Causes of left shift**

Answer 166

Right shift - Reduced affinity for oxygen --\> increased oxygen delivery **High** High H+ (Acidosis) High temp High 2-3 DPG CO2 Left shift - higher affinity for oxygen--\> lower oxygen delivery **Low** Low H+ (alkalosis Low Temp Low 2-3 DPG **DPG - is high in conditions where there is reduced oxygen delivery to tissues - High Altitude, Low Hb**

Question 167

**Tymus Histology** **ARterial Supply** **Venous Drainage**

Answer 167

Encapsulated Lobular Structure originating from III and IV pharyngeal arches Cortex - Lymphocytes Medulla - Concentric epithelial cells with keratinsed centre Arterial Supply: Internal mammary artery (or pericardiophrenic arteries) Venous Supply: Left Brachiocephalic vein

Question 168

Scaphoid abdomen

Answer 168

Abdomen sucked inwards: Think diaphragmatic hernia in newborn

Question 169

**management of diverticular stricture + LBO**

Answer 169

Laparatomy and hartmann's Dilating - contraindicated Stenting - often not useful

Question 170

**Wound healing - Predominant Cell Types** **Inflammation** **Regeneration** **Remodelling (Contraction)**

Answer 170

**Inflammation** Neutrophils. Early phase (first week) **Regeneration** Fibroblasts. (8 weeks) Microvascularisation **Remodelling (Contraction)** Differentiated fibroblasts. Microvessels regress so the scar looks pale.

Question 171

Exposure to vinyl chloride

Answer 171

Hepatic Angiosarcoma

Question 172

**Ileostomy effluent**

Answer 172

Na - 126 mmol/ L K+ - 22 mmol/L

Question 173

**Contents of Cavernous Sinus**

Answer 173

O TOM CAT Ophthalmic nerve Trochlear Nerve Ophthalmic nerve (V1) Maxillary nerve (V2) Internal Carotid Artery Abducens Nerve

Question 174

**Foramen of Munro** **Magendie** **Lushka**

Answer 174

**Munro:** Lateral Ventircles into Third ventricle **lushka:** Anteromedial apertures of the fourth ventricle **magendie:** Posteriorinferor of the fourth ventricle

Question 175

**what provides sensory innervation to posterior thigh**

Answer 175

Posterior Cutaneous Nerve of thigh: Direct branch of Sacral PLexus

Question 176

**SMA** **Origin from Aorta** **Branches**

Answer 176

L1 Inferior Pancreatico-duodenal artery Jejunal and Ileal Arcades **ileocolic** **right colic** **middle colic**

Question 177

**Musculocutaneous Nerve** **Origin?** **Action?**

Answer 177

Origin: Branch of Lateral Cord of brachial plexus Action: Continues into forearm as **lateral cutaneous nerve of forearm** Innervates - coracobrachialis, brachialis, biceps brachii

Question 178

**Structures passing through foramen ovale** **Through which bone is the foramen**

Answer 178

Sphenoid bone **OVALE** O - tic ganglion V - V3 Mandibular nerve A - accessory meningeal artery L - lesser petrosal nerve E- missary veins

Question 179

**Location and content of following skull foramina** **Ovale**

Answer 179

**Ovale** (sphenoid) Otic Ganglion, V3, Accessory Meningeal Art., Lessor Petrosal Nerve, Emissary Veins

Question 180

**Spinosum**

Answer 180

**Spinosum** (Sphenoid) Middle Meningeal Artery, Meningeal branch of mandibular nerve

Question 181

**Rotundum**

Answer 181

**Rotundum** (Sphenoid) V2

Question 182

**Foramen Lacerum - Location and contents**

Answer 182

**Lacerum** (Sphenoid) ICA, Nerve + Art. of pterygoid canal

Question 183

**Jugular Foramen - Location and Contents**

Answer 183

**Jugular** (temporal) Inf. Petrosal Sinus, IX, X, XI, Sigmoid Sinus (becomes Int. jug), Meningeal branches of occipital and ascend. pharyngeal art.

Question 184

**Foramen Magnum -** location and contents

Answer 184

**Foramen Magnum** (occipitaL) Medulla oblongata, Ant. + Post. Spinal Art. , Vert. Art

Question 185

**Stylomastoid Foramen - Location and contents**

Answer 185

**Stylomastoid** **Foramen** (Temporal) Stylomastoid Artery, CNVII

Question 186

Superior Orbital Fissure - Location and contents

Answer 186

**Superior Orbital Fissure (Sphenoid)** III, IX, V1, Recurrent meningeal artery, VI, Superior Ophthalmic Vein

Question 187

**Lymph Drainage of Auricle (Ear)** **Lateral upper Half** **Cranial Superior half** **Lower half and lobule**

Answer 187

**Lateral upper Half -** Superficial parotid **Cranial Superior half -** deep cervical + Mastoid **Lower half and lobule -** Superficial cervical

Question 188

**parotid malignancy:** perineural skip lesions Most common derived from secretory portion

Answer 188

perineural skip lesions **- Adenoid Cystic Carcinoma** 35% 5 year survival. Tendency for visceral spread Most common- **Mucoepidermoid carcinoma** Don't usually metastasise derived from secretory portion - **Adenocarcinoma**

Question 189

**Pharyngeal Pouch is between?**

Answer 189

Diverticulum between cricopharyngeus and thyropharyngeus

Question 190

**Oesophagus:** **Arterial** **Venous** **Lymphatic** Beginning and termination Location of strictures

Answer 190

**Upper Third:** Arterial **- Inferior Thyroid Artery** Venous - **inferior thyroid vein** lymph - **Deep cervical** **Middle Third:** Arterial - **Aortic Branches** Venous - **Azygous** Lymph - **Mediastinal** **Lower Third:** Arterial - **Left Gastric** venous - **left gastric** lymph - **gastric** **Begins - C6, Ends , T11** **Strictures:** Cricoid, Aortic Arch, Left Bronchus, Oesophageal Hiatus

Question 191

**Urine Calcium-Creatinine Clearance in :** **Primary Hyperparathyroidism** **Familial Hypocalciuric Hypercalcaemia**

Answer 191

**Primary Hyperparathyroidism (Kidneys try to remove calcium)** \>0.01 **Familial Hypocalciuric Hypercalcaemia (Autosomal Dominant loss of calcium sensing --\> High PTH despite high calcium, normal calcium resorption despite high calcium)** \<0.01

Question 192

**Drug Causes of Gynaecomasti**

Answer 192

Digoxin, Cimetidine, Dopamine receptor antagonists, Methyldopa, Cannabis, Oestrogens, Anabolic Steroids, **Spiro**, Finasteride Heroin Isoniazid etc. rare causes

Question 193

**Branches of External Carotid Artery**

Answer 193

MASS FLOP Maxillary Ascending Pharyngeal Superior Thyroid Artery Superficial temporal artery Facial Artery Lingual artery Occipital Artery Posterior Auricular Artery

Question 194

**Branches of subclavian artery**

Answer 194

VIT C&D Verterbral Internal thoracic Thyrocervical Trunk ( Inferior Thyroid, Suprascapular, Transverse Cervical) Costocervical Trunk (superficial intercostal + deep cervical) Dorsal Scapular (joins with transverse cervical) becoming Transverse Cervical --\> Superficial and Deep descending branches

Question 195

**What is in cryoprecipitate**

Answer 195

VIII Fibrinogen XIII vWF

Question 196

What is anular ligament? What articulates with the capitulum? What articulates with trochloea?

Answer 196

**Anular ligament-** Proximally located liagment between ulnar and radius to permit supination and pronation movements at the proximal radioulnar joint **Capitulum -** Distal end of humerus. This articulates with the concave groove on the radius head **Trochlea -** articulates with ulnar.

Question 197

Occluded posterior nasal airway in newborns

Answer 197

**choanal atresia** Cyanotic episodes when feeding

Question 198

Bilateral pulmonary infiltrates CVP Reading \<18 mmHg \>18 mmHg

Answer 198

\<18 mmHg = ARDS (fat embolus, sepsis, acute pancreatitis, trauma, lung injury, head injury) Low tidal volume ventilation, diuresis \>18mmHg = Pulmonary Oedema

Question 199

**Margins for melanoma resection**

Answer 199

Breslow thickness score: 1mm - 1cm margin 1-2mm - 1-2cm margin 3-4mm - 2-3 cm margin \>4mm - 3 cm margin Lymph resection + isolated limb chemotherapy infusion as adjuncts

Question 200

**Malignancy Arising as a result of chronic oedema**

Answer 200

Lymphangiosarcoma - these are agressive lesions

Question 201

What happens to the rectal stump

Question 202

**Ventilation** **What are the three cerebral areas responsible for ventilation and what do they respond to?** **Any non-cerebral areas involved?**

Answer 202

**Medulla** **Oblongata** This responds to increased interstitial H+ to increase ventilation (to blow off CO2). The **Apneustic** Centre in pons instigates inspiration whereas the **Pneumotaxic** Centre, also in the pons, inhibits inspiration. **Peripheral chemoreceptors** are in the carotids and arch of aorta --\> these respond to arterial pO2, pCO2 and H+

Question 203

**Ulnar Nerve** Origin Innervates? (10) Relationship to ulnar artery Topography

Answer 203

**Origin** - C8 T1, derived from **medial** cord of plexus **Innervates**: **Muscular Branch -** Flexor Carpi Ulnaris+ Flexor Digitorum Profondus (medial) **Deep Branch-** Flexor Digiti Minimi Abductor Digiti Minimi Opponens Digiti Minimi Adductor pollicis Interossei Muscles Medial 2 lumbricals (III and IV) Flexor Pollicis Brevis Palmaris brevis **Also -** **Dorsal** cutaneous branch, **palmar** cutaneous branch, **Superficial** (medial digits) branch Medial to the ulnar artery **Topography:** Medial side of upper arm then passes posterior to medial epicondyle Pierces two heads of flexor carpi ulnaris and travels deep to this near the ulna bone

Question 204

**where does the chorda tympani arise and from what?**

Answer 204

Inside the facial canal from the facial nerve - so not effected in facial nerve lesion at the parotid

Question 205

**Facial Nerve Topography** order of canals through whence it travels? 3 branches within facial canal? 2 branches immediately after exits the temporal bone? branches of facial nerve at parotid gland?

Answer 205

**I)** It enters the internal adutiory meatus travles through the facial canal and then exits via the stylomastoid foramen **ii) Greater petrosal nerve, nerve to stapedius and chorda tympani** **iii)** Posterior auricular nerve, branch to posterior belly of digastric +stylohyoid muscle **iv)** temporal, zygomatic, buccalis, marginal mandibular nerve, cervical

Question 206

**Sensory innervation of the mouth** Inferior Molars Inferior Canines and incisors Gingiva and supportive structures Upper teeth

Answer 206

Generally - **upper teeth** by the **maxillary nerve** **and lower teeth** by the **mandibular nerve** **Lower Teeth:** Molars - inferior alveolar nerve Canines and incisors - Incisive branch of inferior alveolar gingiva and supportive - lingual nerve **Upper teeth:** Superior alveolar plexus: Molars - Posterior Superior alveolar nerve (SAN) premolars - middle SAN front teeth - anterior SAN

Question 207

**Giant Cells** most commonly arise from?

Answer 207

Macrophages - Giant cells are collections of distinct cell types

Question 208

**Any distant metastases in oesophageal/gastric ca?**

Answer 208

Not for surgery and chemotherapy reserved for young and fit

Question 209

**Below which blood pressure does renal autoregulation of flow fail?**

Answer 209

\<80 systolic blood pressure

Question 210

WHat is a: Bankart Lesion Hill Sachs Lesion

Answer 210

**Bankart Lesion -** avulsion of anterior glenoid labrum **Hill Sachs Lesion -** chondral impaction on posteriosuperior humeral head from contact with glenoid rim

Question 211

**What stimulates insulin release(6)**

Answer 211

Glucose Amino Acids Secretin/CCK/Gastrin Vagal Cholinergic Action Fatty Acids Beta **adrenergic** drugs (blockers block release)

Question 212

**Ansa Cervicalis** Origin What fascia is it posterior to What does it innervate

Answer 212

Origin - C1 (superior root), C2-3 (inferior root) Posterior to - Pretracheal fascia Innervates - sternohyoid, sternothyroid, omohyoid

Question 213

**Anal Sphincter** Smooth and striated components Nervous supply

Answer 213

**Smooth muscle-** upper two thirds of anal canal **Striated muscle** - superficial to smooth muscle but surrounds the entire canal **Nerve supply-** inferior rectal branch of pudendal nerve **and** perineal nerve

Question 214

**Radial Nerve** Origin Innervates Branches

Answer 214

Origin: **Posterior** Cord of brachial plexus, C5 to T1 **Innervates:** **main branch -**Triceps, Anconeus, Brachioradialis, Extensor Carpi Radialis **posterior interossues nerve** (deep branch)- Supernator, extensor carpi ulnaris, extensor digitorum, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicis longus and brevis, abductor pollicis longus **sensory -**

Question 215

**Axilla** **aBoundries** **Contents**

Answer 215

Boundaries: Anterior - pec major, Posterior - lat dorsi Medial - serratus anterior + chest wall Lateral - Humeral Head **Contents:** Long Thoracic Nerve Thoracodorsal Trunk Axillary Vein Intercostobrachial nerves Lymphatics

Question 216

**Lymphatic drainage** **Inferior to the dentate line** **Superior to the dentate line**

Answer 216

**Inferior to the dentate line -** Inguinal lymph nodes **Superior to the dentate line** - Mesorectal

Question 217

**Which genetic condition do you see plexiform neurofibromas?**

Answer 217

NF Type I - can cause accelerated growth of limb

Question 218

**5 investigations for incidental adrenal lesions** **Beyond which size lesion shoudl you worry?**

Answer 218

Morning and midnight plasma cortisol Dex Suppression Test 24 Hour urinary cortisol 24 hour urinary catecholamines Serum potassium, aldosterone and renin \>4cm is 25% risk of malignancy

Question 219

**Absence Vas Deferens?**

Answer 219

Cystic Fibrosis

Question 220

**Inguinal Canal** Borders Contents Where do the testes lymph drain

Answer 220

Borders: Anterior - Aponeurosis of external Oblique Posterior - Transversalis Fascia Floor - Ingiinal Ligament and Lacunar Ligament (medially) Roof - Arching fibres of the transversus abdominus and internal oblique Superficial ring - External Oblqieu Deep ring - Transversalis Fascia **Contents** **3 Fascia -** External Spermatic Fascia (External oblique), Cremasteric Fascia (internal oblique), Internal Spermatic Fascia (transversalis fascia) **3 Arteries -** Testicular Artery, Artery to vas, Cremasteric Artery **2 Veins -** Testicular Vein (Left into left renal, right into IVC), Pampiniform Plexus, **3 Others -** Vas Deferens, Lymphatics **3 Nerves -** Genitofemoral, Ilioinguinal, Iliohypogastric **Where do testes drain to? -** para aortic

Question 221

What is the inverse of odds ratio?

Answer 221

Number needed to treat

Question 222

Smooth abdominal swelling in child - no worrying features. Mobile

Answer 222

Mesenteric cyst - usually need to be surgically removed - can undergo torsion rupture

Question 223

**hyposplenism blood film (4)**

Answer 223

Howell - Jolly body Target Cells Pappenheimer cells Irregularly contracted erythroyctes

Question 224

**What do you incise for median sternotomy?**

Answer 224

Interclavicular ligament + interclavicular fossa Sternum with bone saw pericardium

Question 225

**Masounieve Fracture**

Answer 225

Medial malleoulus Fracture Spiral fracture of proximal 1/3 fibula dorsal tibiofibular syndesmosis

Question 226

**key anatomical deformities of tallipes equinovarus (5)**

Answer 226

Adductes and inverted calcaneus Wedged shaped calcaneal articular surface +head of talus tibio-talar plantar flexion medial talar neck inclination medially displaced navicular and cuboid

Question 227

**Parathyroid neoplasms:** Most common cause? Indications for surgery in primary hyperparathyroidism?

Answer 227

Commonly - adenoma Indication for surgery: Ca++ \>1 above normal Calciuria \>400 mg/day Decreased creatinine clearance Life threatening hypercalcaeima Nephrolithiasis \<50 years age Neuromuscular symptoms Reduction in bone mineral density

Question 228

**what regulates ion exchange in the salivary glands?**

Answer 228

Aldosterone

Question 229

Management of traumatic pneumothorax and why?

Answer 229

Chest drain - Usually in context of traumatic pneumothorax there is damage to lung parenchyma = High chance of tension pneumo development

Question 230

**Describe the trendelenberg procedure**

Answer 230

Head tild and legs abducted Oblique incision medial to artery Ligation of tributaries Saphenofemoral junction double ligated Stripping of vein proximal (knee or upper calf)

Question 231

**Muscles attaching to the greater trochanter of femur** **POGGGO**

Answer 231

Piriformis Obturator Internus Gemelli, Gluteus medius, Gluteus Minimus Obturator Externus

Question 232

**What is the blood supply to the omentum**

Answer 232

Left Gastroeipoloic Artery (branch of splenic) Right Gastroepiploic Artery (branch of gastroduodenal)

Question 233

**What is common liver fluke?** **Disease?**

Answer 233

Fasciola Hepatica **Disease:** **Two -** Acute - fever, abdo pain, rash, and hepatomegaly Chronic - Obstructive jaundice due to worm maturing in bile ducts

Question 234

**What enters the IVC and at what level?**

Answer 234

Inferiorly: I LIKE TO RISE SO HIGH Common Iliacs fuse at **L5** Lumbar veins **L1-L5** Right Gonodal vein (Left generally drains into Left renal vein) **L2** Suprarenal veins and renal veins **L1** Hepatic vein, inferior phrenic vein **T8 -** also caval hiatus (diaphragmatic)

Question 235

**Body Fluid Volumes**

Answer 235

60% of a person is fluid **Intracellular - 60%** **Extracellular - 40%** **Plasma - 5%** **Interstitial - 24%** **Transcellular - 3%**

Question 236

**Treatments for meconium ileus**

Answer 236

PR Contrast (diagnostic and therapeutic) N-Acetyl Cysteine Enemas

Question 237

**Nerve fibres:** **A alpha** **A beta** **B fibres** **C Fibres**

Answer 237

**A alpha** - Motor proprioception **A beta -** touch and pressure **A delta -** myelinated pain fibres **B fibres -** autonomic **C Fibres -** unmyelinated c fibres

Question 238

**Red streaks and tender mass on limb?**

Answer 238

Lymphadenitis

Question 239

**External urethral sphincter supply**

Answer 239

Supplied by pudendal branches (S2-S4) Pudendal nerve also supplies - external anal sphincter + cutaneous innervation to the perineum

Question 241

**Structures posterior to the medial malleolus** **Anterior to medial malleolus** **Posterior to lateral malleolus:**

Answer 241

**Posterior to medial malleolus:** Tibialis Posterior Tendon Flexor Digitorum Longus Posterior Tibial Artery Tibial Nerve Hallucis Longus **Anterior to medial malleolus:** tibialis anterior tendon great saphenous vein **Posterior to lateral malleolus:** short saphenous vein, sural nerve (superficial) peroneus longus tendon, peroneus brevis tendon (deep)

Question 242

**Lichen Sclerosus - pathophysiology** **Treatment**

Answer 242

Pathophysiology - Abnormal fibroblast proliferation Treatment: 1 - High dose corticosteroid 2 - Calcineurin inhibitors (Tacrolimus) 3- Retinoids, methotrexate, steroid injections, photopherapy, cyclophosphamide

Question 243

**Which sarcomas metastasise to lymphatics**

Answer 243

SCARE Synovical Sarcoma Clear Cell Sarcoma Angiosarcoma Rhabdomyosarcoma Epitheloid sarcoma

Question 244

Which drug prevents conversion of plasminogen to plasmin?

Answer 244

Tranexamic Acid

Question 245

Which clotting factors are particularly heat sensitive?

Answer 245

Factor V Factor VIII Hence FFP is frozen

Question 246

**Branches of the external carotid artery**

Answer 246

**Some anatomists like freaking out poor medical students** Superior Thyroid Aryery Ascending Pharyngeal Linguial Artery Facial Artery Occipital Artery Posterior Auricular Maxillary Artery Superior Temporal Artery

Question 247

**Staging for perthe's disease**

Answer 247

**catterall staging system** **I -** Clinical + Histological **II -** Sclerosis +/- cystic changes **III -** Loss of integrity of femoral head **IV -** Loss of acetabular integrity

Question 248

**Muscular Compartments of lower limb**

Answer 248

**Anterior Compartment** innervated by - Deep Peroneal Nerve Tibialis Anterior, Peroneus Tertius, Extensor Hallucis longus, Extensor Digitorum Longus **Peroneal Compartment** innervated by - Superficial peroneal nerve peroneus longus, peroneus brevis **Superficial Posterior compartment** innervated by - tibial nerve Gastrocnemius, Soleus **Deep posterior compartment** innervated by - tibial nerve flexor digitorum longus, flexor hallucis longus, tibialis posterior

Question 249

**What is laplace's law?**

Answer 249

hollow circumferential organs: total wall tension depends on: i) circumference of wall ii) Thickness of wall iii) wall tension

Question 250

**Adrenal Anatomy** **Arterial Supply** **Venous drainage** **Adrenal Relations**

Answer 250

Adrenal Arteries: **Superior** from **inferior phrenic artery** **middle** from **aorta** **inferior** from **renal artery** Adrenal Veins: **Left** - into renal vein (as for testicular vein) **right -** directly into IVC **Adrenal Relations:** **Right: Posterior -** Diaphragm**, Anterior -** Hepatorenal pouch **+** bare area of liver**, Inferior -** Kidney**, Medial -** IVC **Left: Posterior -** diaphragm crus **, Inferior -** kidney**, Anterior -** pancreas and splenic vessels

Question 251

**What is a hadfield's procedure**

Answer 251

Total Duct Excision (For mammary duct ectasia)

Question 252

**Anterior and posterior relations of carotid sheath**

Answer 252

**Anterior:** Hypoglossal Nerve Ansa Cervicalis Omohyoid Muscle Only on right - Recurrent laryngeal nerve **Posterior:** C6 - Cervical Sympathetic Chain C7 - vertebral artery, thoracic duct Inferior thyroid artery

Question 253

**Why might gastritis cause anaemia?** **Which form of gastritis is foveolar hyperplasia associated with?** **factors increasing gastric acid production?** **Factors decreasing Gastric Acid production?** **(where are these produced)**

Answer 253

**Anaemia:** Loss of parietal cells - Loss of intrinsic factor production - loss of B12 absorption - macrocytic anaemia **Foveolar hyperplasia -** Reflux gastritis --\> due to bile reflux into the stomach **factors increasing gastric acid production?** Vagal stimulation, histamine, gastrin **Factors decreasing Gastric Acid production?** Cholecystokinin, secretin, somatostatin Gastrin - G cells in antrum of stomach CCK - I Cells in small intestine Secretin - S Cells in small intestine Somatostatin - D Cells in pancreas/stomach Vasoactive intestinal peptide - small intestine/ pancreas

Question 254

**Difference between gastroschisis and omphalocele?**

Answer 254

Gastroschisis - Right of umbilicus Bowel outside of abdominal wall not covered by peritoneum Omphalocele (Exomphalos) - Through umbilicus. The protruding GI organs are covered by peritoneum

Question 255

**The lifecycle and treatment of :** Ascariasis Enterobius Vermicularis Strongyloidiasis Anclyostoma Duodenale Giardiasis Cryptosporidium

Answer 255

**Life Cycle** **Treatment** Ascariasis (roundworm) Ingestion -\> lung migration -\> cough and autodigest Mebendazole Anclyostoma Duodenale (Hookworm) Skin penetration -\> Lung migration -\> cough and autodigest -\> Hooked to small intestine luminal wall Mebendazole Strongyloides Skin penetration -\> lung migration -\> Cough and autoingest Mebendazole Enterobius Vermicularis Oral ingestion. Pruritis Ani. Mebendazole Giardiasis Ingestion of cysts Metronidazole Cryptosporidium Ingestion of cysts Metronidazole

Question 256

**Dose of heparin for:** ## Footnote **Vascular Bypasses** **Cardiopulmonary bypasses**

Answer 256

**Vascular Bypasses** 3000 units prior to cross clamping **Cardiopulmonary bypasses** 30,000 units priot to initiating bypass

Question 257

**Amputation** Removal of femoral condyles Retention of patella

Answer 257

Gritti Stokes Amputation Patella is swung posteriorly to cover distal femoral surface

Question 258

Gross Thyroid Anatomy ## Footnote **Vascular supply of thyroid** **Arterial** **Venous**

Answer 258

Apex of thyroid cartilage to 4/th/5th tracheal ring. R + L lobe with isthmus in the middle. **Arterial:** **Superior Thyroid** (first branch of external carotid) **Inferior thyroid** (from thryocervical trunk - subclavian artery) **Venous SUpply:** **Superior** and **Middle** thyroid vein - Into Internal Jugular Vein **Inferior** thyroid vein - into brachiocephalic veins

Question 259

**Flexor tendons in carpal tunnel (9)**

Answer 259

4 FDP 4 FDS 1 Flexor Pollicis Longus

Question 260

**Types of electrosurgical current**

Answer 260

Blend - Less power than cutting. Alternates between cutting and coagulating Coagulate - Modulated current with high peak voltage. Cut - High power and current. Little thermal damage Fulgurate - Electrode not in contact with tissue. Low amplitude/ high voltage. Local superifical tissue destruction Dessicate - Electrode in contact with tissue. Low current/ high voltage. Loss of cellular water but not protein

Question 261

Answer 261

Question 262

**Descending Thoracic Aorta** **Relations** **branches**

Answer 262

**Relations** Anterior - Left Lung root, Pericardium, Oesophagus, Diaphragm Posterior - Vertebral Column, Azygos Vein, Right - Hemi Azygos Veins, Thoracic Duct Left - Left Pleura and lung **Branches** Bronchial Artery, Mediastinal Artery, Posterior Intercostal ARteries, Oesophageal Arteries

Question 263

**Sympathetic Ganglia Locations** **Cervical** **Thoracic** **Lumbar** **Damage to which causes:** **Horner Syndrome** **Ejaculatory problems**

Answer 263

Cervical: Superior - C2,C3 Middle - C6 Stellate - C7 Thoracic ganglia are segmentally arrange Lumbar ganglia - descend posterior to median arcuate ligament of diaphragm and lie anterior to vertebrae and medial to psoas **Horner Syndrome - T1** **Ejaculatory problems -** **L1**

Question 264

**Relations of the caecum**

Answer 264

Posterior: Psoas, Gonadal Vessels, Ureter, Iliacus, Femoral nerve, genitofemoral nerve, Anterior: Greater Omentum

Question 265

**Thoracic Duct** Where does it enter thorax What is it continuation of What does it drain What importantly doesnt it drain Relation to oesopahgus

Answer 265

**Thoracic Duct:** Enters the thorax alongisde the oesophagus at the oesophageal hiatus of **T12** It is a continuation of the **cisterna chlyii** The lymphatics of the **left** head and neck drain **directly** into the thoracic duct, which itself drains into the **left** **brachiochephalic** **vein**. the **right** side of the head and neck drain into the **right** lymphatic duct **which drains** into the **mediastinal duct** and then into the **right brachiocephalic vein** It lies **posterior to the oesphagus** then passing to the **left at T5**

Question 266

**Actions of PTH**

Answer 266

Bone - Osteoblasts binding --\> inreased RANKL expression --\> Activation of osteoclasts ---\> increase resorption Kidney - Resorption of calcium and mangesium from DCT. Decreased resorption of phosphate GI - PTH increases Vit D activation --\> increased GI calcium absorption

Question 267

**Localised oesophageal tumours with no mets:** **SCC vs ADenocarcinoma**

Answer 267

For SCC trial of chemoradithoerapy can be curative whereas for Adenocarcinoma surgery is the only curative option

Question 268

**WHy does H Pylori cause increased acid production?** **How can the duodenum have ulcers with H Pylori infection**

Answer 268

Urease enzyme hyrdrolyzes urea --\> Ammonia Ammonia causes antral G cells to produce more gastrin H Pylori itself causes ulcers due to chronic inflammatory changes. The duodenum comes to have these changes when it becoems colonsed. This occurs when the duodenal mucosa undergoes metaplasia as a result of excess acid --\> then allowing the H Pylori organisms to colonise the metaplastic tissue

Question 269

**ureter anatomy** Releation to iliac vessels and uterine artery Blood Supply

Answer 269

Releation to iliac vessels and uterine artery: Anterior to iliac bifurcation, posterior to uterine artery Blood Supply: Segmental: Renal, aortic, gonadal, common iliac, internal iliac

Question 270

**Features of MEN conditions**

Answer 270

Question 271

Digastric nervous supply

Answer 271

Anterior - Mylohyoid Nerve Posterior - Facial Nerve

Question 272

**Which artery do the following branch from?** **Superior Cerebellar Artery** **Anterior Inferior Cerebellar Artery** **Posterior inferior cerebellar artery**

Answer 272

**Basilar Artery** Superior Cerebellar Artery Anterior Inferior Cerebellar Artery **Vertebral ARtery** Posterior inferior cerebellar artery

Question 273

**Branches of:** **Vertebral Artery** **Basilar Artery** **Internal Carotid Artery**

Answer 273

**Vertebral Artery** Anterior Spinal ARtery, Posterior Spinal ARtery, Posterior Inferior Cerebellar Artery **Basilar Artery** Superior Cerebellar Artery, Anterior Inferior cerebellar Artery, Pontine ARteries, Labyrynthine ARtery, Posterior cerebral artery **Internal Carotid Artery** PComm,Anterior Cerebral Artery (AComm exists between htese two), Middle Cerebral ARtery, Anterior Choroidal ARtery

Question 274

**Seminoma Subtypes (4)**

Answer 274

Classical (lmyphocyte infiltrate in stroma) Spermatocytic (tumour cells remember spermatocytes) Anaplastic Syncitiotrophoblast Giant Cells

Question 275

Attachments of the extensor retinaculum of the wrist

Answer 275

Medial - pisiform and triquetral Lateral - Radius

Question 276

Management of Low Grade DCIS vs LCIS

Answer 276

DCIS - WLE LCIS - Monitoring

Question 277

**Drug Causes of hyper uricaemia (8)**

Answer 277

Ciclosporin Alcohol Nicotinic Acids Thiazides Loop Diuretics Ethambutol Aspirin Pyrazinimide

Question 278

**Which muscles form the pes anserinus?** **Where is it?**

Answer 278

Sartorius Gracilis Semintendinosis It is on the anteromedial proximal extermitiy of the tibia

Question 279

**Quadrangular Space** **Borders** **Contents**

Answer 279

Borders: Lateral - humerus, Superior - subscapularis + teres minor, Inferior - teres major, Medial - tricpes long head Content: Axillary Nerve Posterior Circumflex ARtery

Question 280

**Branches of the axillary artery** **Relations of axillary artery**

Answer 280

**First** **Part**: Superior Thoracic ARtery Above Pec Minor Axillary artery + vein enclosed within the axillary sheath. Anterior - Clavipectoral fascia, Posterior - Serratus Anterior, Long thora nerve, first intercostal space. **Second** **Part**: Thoraco-acromial and lateral thoracic arteries Behind Pec minor Here the cords relate to the artery true to their names. **Third** **Part**: Subscapular, anterior circ and posterior circ arteries Inferior to pec minor Posterior - subscapularis, lat dorsi, teres major

Question 281

**Relations of brachiocephalic artery** **Where does it bifurcate**

Answer 281

Right brachiocephalic vein + vagus - **laterally** trachea - **posteromedially** inferior thyroid vein - **anteriorly** **Bifurcates at level of sternoclavicular joint**

Question 282

What is para- amino hippuric acid (PAH) used to measure?

Answer 282

Renal Plasma Flow

Question 283

**What does sistrunks procedure involve**

Answer 283

Thyroglossal Cysts: Involves resection of: cyst, track, central hyoid portion + wedge of tongue muscle behind hyoid resection

Question 284

**TB or Sarcoid?** Asteroid Bodies Extensive Necrosis

Answer 284

Asteroid Bodies - Sarcoidosis Extensive Necrosis - Tuberculosis

Question 285

**When do you offer long course neoadjuvant chemoradiotherapy for rectal cancer??**

Answer 285

T4 tumours

Question 286

**Where are the following valves located in CXR?** **Tricuspid** **Mitral** **AOrtic**

Answer 286

**Tricuspid -** 5th ICS on right **Mitral -** 4th ICS on left **AOrtic -** 3rd ICS on right

Question 287

**lymph drainage of female internal genitalia** **Ovaries** **Uterine Fundus** **Uterine Body** **Cervix**

Answer 287

**Ovaries -** Para aortic **Uterine Fundus -** Para aortic + Inguinal **Uterine Body -** Iliac Lymph nodes **Cervix -** Presacral, Internal Iliac and External Iliac

Question 288

**Management of Axillary Vein Thrombosis**

Answer 288

Acute - Catheter GUided tPA Heparin / Warfarin if chronic

Question 289

**Hepatocellular Carcinoma** Staging System? Treatment?

Answer 289

**Barcelona Clinical Liver Classification** 0 - \<2 cm - resection A - \>3 cm / \<3 nodules. radiofrequency ablation or transplant B - \>3 nodules. Transarterial chemoembolisation C - Advanced tumours/ Portal vein invasion. Sorafenib D - supportive

Question 290

Air fluid level in chest in baby

Answer 290

Bronchogenic Cyst This should be CTd Thorascopic Resection at 6 weeks

Question 291

**Subclavian Artery Branches**

Answer 291

Vertebral Artery Internal Thoracic Artery Thyrocervical Trunk Costalcervical Trunk Dorsal Scapular Artery

Question 292

**Cellular characteristic of Hurthle Cell Tumours**

Answer 292

OXyphil Cells Scanty Thyroid Colloid This is a form of follicular

Question 293

**Where do the following genitalia structures arise/drain?** **Artery of Vas Deferens** **Creamsteric Artery** **Pampinofrm Plexus**

Answer 293

**Artery of Vas Deferens -** Inferior Vesical Artery (from internal iliac artery) **Creamsteric Artery -** Inferior Epigastric Artery (from external iliac artery) **Pampinofrm Plexus -** Venous Plexus (into testicular vein - left into renal vein, right directly into IVC)

Question 294

Best and worst prognostically Hodgkin's Lymphoma's? Alll Hodgkin's Lymphoma's

Answer 294

**Best - Lymphocyte Rich** **Worst - Lymphocyte Deplete** **Other Subtypes:** Nodular Sclerosing Mixed Cellularity Nodular Lymphocyte - predominant

Question 295

**Which fascia contains the base of the penis?**

Answer 295

Bucks Fascia

Question 296

**Erb's Vs Klumpke's Palsy**

Answer 296

**Klumpke's: (C7-T1)** Claw Hand (MCP extension/ IP flexion) Loss of sensation over medial forearm/hand Horner's Syndrome Loss of wrist flexors **Erb's Palsy: (C5-C6)** Waiter's Tip Extended Elbow, Pronates Forearm Adducted and internally rotated shoulder Impairment to - wrist extensors, Elbow flexor, external rotators

Question 297

**Muscles innervated by buccal branch of CN VII (6)**

Answer 297

**Buccal (Buccal membrane - mouth)** Zygomaticus Minor Risorius Buccinator Levator Anguli Oris ORbicularis Nasalis

Question 298

**Common Carotid:** **Pulse palpable at -** **Bifurcates at -**

Answer 298

Palpable at C6 against the transverse process of vertebra Bifurcates at C4

Question 299

**Merkel Cell Tumour** Histologically Related to? Treatment

Answer 299

Histologically : Sheets + nodules of hyperchromatic epithelial cells with ++ mitosis and apoptosis Lymphovascular invasion Related to sunlight damaged skin Treatment: Surgical excision (1 cm margin) + SLNB if \>10mm lesion Adjuvant radiotherapy

Question 300

**Which RLN has a more superiorly situated course?**

Answer 300

The **RIGHT** Remeber that this one arches around the subclavian posteriorly, whereas the left branches more distally and branches-\>arches around the anterior aspect of the arch of the aorta

Question 301

**Arterial Supply to the nose**

Answer 301

Sphenopalatine Artery (Maxillary ARtery ) Greater Palatine Artery (Maxillary Artery) Facial Artery (Anteriorly) Most Bleeding from Keisselbach's Plexus

Question 302

**Goodsalls Rule**

Answer 302

Anterior fistulae - internal opening opposite the external opening Posterior fistulae - curved track that passes toward the midline (6 o clock)

Question 303

**Constirctions of oesophagus (ABCD)**

Answer 303

Arch of Aorta Left Main Bronchus Cricoid Cartilage Diaphragmatic Hiatus

Question 304

**Cryotherapy shouldn't be used for..** **Radiotherapy shouldn't be used for..** **in context of cutaneous malignancy**

Answer 304

Cryotherapy - shouldnt be used for deep lesions Radiotherapy - shouldnt be used for lesions in regions which are prone to radionecrosis (nose)

Question 305

**in DIC which components of clotting are depleted fastest**

Answer 305

V, VIII and Platelets

Question 306

Signet Ring Cell proliferation in stomach

Answer 306

Linitis Plastica - Stomach Doesnt Distent on OGD

Question 307

**The oesophagus doesn't have which mucosal layer?**

Answer 307

Serosa

Question 309

**Effects of Adrenaline**

Answer 309

**Alpha -** Peripheral Vasoconstriction Insulin inhibition Glycogenolysis in liver/muscle and glycolysis in muscle **Beta -** 1 - Cardiac chronotrope + inotrope, increased renin secretion 2 - Skeletal muscle vasodilation + coronary artery vasodilation. Bronchodilation Glucagon secretion, ACTH secretion, Lipolysis in adipose tissue

Question 310

**Muscles Supplied by the Ansa Cervicalis**

Answer 310

**Ghost Thought Someone Stupid Shot Irene** Geniohyoid Thyrohyoid Superior Omohyoid Sternothyroid Sternohyoid Inferior Omohyoid

Question 311

**Common peroneal nerve** **Roots** **Where does it bifurcate**

Answer 311

**Roots -** L4 - S2 **Where does it bifurcate** Bifurcates at neck of fibula after descending posterior to biceps femoris into lateral part of popliteal fossa

Question 312

**Retromandibular Vein** **What are its tributaries** **Where does it go**

Answer 312

Arises from the joining of the maxillary vein and superficial temporal vein Descends through the parotid gland

Question 313

**Associations with anal fissure**

Answer 313

STI IBD Leukaemia TB

Question 314

**DTPA vs MAG3**

Answer 314

DTPA - good for assessment of GFR MAG3 - good for assessment of renal function in patients with known impairment

Question 315

**Which structures lie in the free border of lesser omentum?**

Answer 315

Hepatic Artery, CBD and Portal Vein

Question 316

**Contrainidications to surgical resection in lung malignancy?**

Answer 316

SVCO FEV1 \<1.5L Malignant Pleural Effusion Vocal Cord Paralysis Tumor near hilum

Question 317

contents of porta hepatis

Answer 317

Common hepatic Duct Hepatic Artery Portal Vein Nerve Fibres Lymphatic Drainage

Question 318

Calculating NNT?

Answer 318

1/(Control rate - Experimental Rate)

Question 319

**Digastric Muscle innervation**

Answer 319

Anterior Belly - Mylohoid Nerve Posterior Belly - Facial Nerve

Question 320

**Sessile Serated Polyps** Best management?

Answer 320

These are more commonly found on the right Should be removed

Question 321

**Displaced Anatomical Humeral Head Fractures require...**

Answer 321

Hemiarthroplasty - Due to high risk of AVN

Question 322

**Lesions giving early para-aortic lymphadenopathy**

Answer 322

Ovarian Testicular Uterine Fundus

Question 323

**Contents of superior mediastinum**

Answer 323

Arch of aorta SVC Brachiocephalic Veins Thoracic Duct Trachea Oesophagus Thymus Vagus Nerve Left RLN Phrenic Nerve

Question 324

**Contents of middle mediastinum**

Answer 324

Aortic Root Pericardium Heart Arch of azygos vein Main Bronchi

Question 325

**Contents of :** **Anterior Mediastinum** **Posterior Mediastinum**

Answer 325

Anterior: Thymic remnants, LNs, Fat Posterior: Oesophagus, Thoracic Aorta, Azygos Vein, Thoracic Duct, Vagus Nerve, Sympathetic Nerve Trunks, Splanchnic Nerves

Question 326

**Rockall Score** **WHen?** **Components?**

Answer 326

Following Endoscopy for UGI haemorrhage Components: A Age B BP C Co-morbidities D Diagnosis E vidence of bleeding

Question 327

**Kocher Criteria for Septic Arthritis**

Answer 327

**WIFE** WCC \>12 I - inability to weight bear Fever ESR \>40

Question 328

**Lateral Hip rotators** **Nerve supplies**

Answer 328

Piriformis - Ventral Rami of S1/S2 Obturator Internus - Nerve to obturator internus Superior Gemellus - Nerve to obturator internus Inferior Gemellus - Nerve to quadrator Femoris Quadrator Femoris - Nerve to quadrator Femoris

Question 329

Answer 329

Question 330

Answer 330

Question 331

**Drug Treatment for Colonic Pseudoobstruction**

Answer 331

Neostigmine

Question 332

**Basal Cell Carcinoma Margin for Excision**

Answer 332

5 mm

Question 333

**Neck Surface Anatomy**

Answer 333

C3 - Hyoid C4 - Thyroid Cartilage Notch C6 - Cricoid

Question 334

**What are the attachments of the spleen?**

Answer 334

Ileorenal Ligament (to the posterior abdominal wall) Gastrosplenic ligament ( to the stomach)

Question 335

**Hydrocele treatment in :** **adults** **children**

Answer 335

Adults - lords/ jabourlay's - plication/otomy of sac + ligation of PPV Children - ligations of PPV

Question 336

**management for biliary leak post lap chole**

Answer 336

ERCP + Stent

Question 337

**Biliary Decompression as an adjunct to curative pancreatic surgery**

Answer 337

ERCP + Stent Do not surgically bypass them

Question 338

**Features of von hippel-lindau syndrome**

Answer 338

Cerebellar hameangiomas Retinal Haemangiomas renal cysts phaeochromocytomas extra-renal cysts: epididymal, pancreatic, hepatic endolymphatic sac

Question 339

Enterocutaneous fistula at the umbilicus due to....

Answer 339

Failure of obliteration of omphalpmesenteric duct

Question 340

**Indications for surgery in hyperparathyroidism**

Answer 340

Age \>50 Serum Calcium \> 1 above mornal hypercalciuria \>400 mg/day Creatinine clearance \<30% Renal stones Neuromuscular Symptoms Reduction in bone density

Question 341

**Pink Serous Fluid discharge after laparatomy?**

Answer 341

Think about early dehiscence

Question 342

**Management of sudden full dehiscence**

Answer 342

Analgaesia, IV fluid, IV abx Cover wound with saline gauze Return to theatre STAT

Question 343

**Which nerve wraps around the middle meningeal artery\>**

Answer 343

Auriculotemporal nerve - branch of the mandibular nerve.

Question 344

Mass posterior to angle of mandible

Answer 344

Parotid Gland Tumour

Question 345

**Double Stranded DNA Virus** **Single Stranded RNA Virus**

Answer 345

DS DNA - HEP B SS RNA - HEPC + HIV

Question 346

**Where is bucks fascia**

Answer 346

Bucks fascia is continuous with the external spermatic fascia into the penis

Question 347

**Musculocutaneous Nerve** Roots Innervates Topography

Answer 347

Roots - C5-C& Innervates - Biceps, Brachialis, Corachobrachialis topography - Arises from lateral cord (C5-C7) of brachial plexus. Travels between the heads of the biceps muscles. Then inbetween biceps and brachialis. Terminates in forearm as the lateral cutaneous nerve of the arm

Question 348

**Does UC affect the anal canal**

Answer 348

No It starts from the rectum. Spares the anal canal and the transition zone

Question 349

CXR features of aortic disruption

Answer 349

Trachea deviated to the right Left Bronchus depression Most disruption is in proximal descending aorta

Question 350

**Greater Sciatic Foramen** **Boundaries** **Contents**

Answer 350

Boundaries: Anterolateral - Greater sciatic notch of ilum Posteriomedial - sacrotuberous ligament Inferior - Sacrospinous ligament Superior - Anterior sacroiliac ligament Contents: **Nerve:** **Sciatic** nerve **Superior** + **inferior** gluteal nerves **Pudendal** Nerve Posteror Femoral Cutaneous Nerve Nerve to quadrator femoris Nerve to obturator internus Vessels: **Superior + Inferior Gluteal Vessels** **Internal pudendal vessels**

Question 351

**Which breast cancer is more common in women breast feeding or who are pregnant**

Answer 351

Inflammatory Carcinoma - THese are more aggressive

Question 352

**Popliteal pulse disappears when leg fully extended**

Answer 352

Popliteal fossa entrapment syndrome main differential here would be adductor canal compression syndrome

Question 353

**Bariatric Surgery Selection Criteria**

Answer 353

\>40 BMI \>35 + Other significant disease that can be helped with wieght loss 6 months of other measures have not helped Fit for surgery Commit to follow up + specialist management

Question 354

**BEst way to assess for upper airway compression?**

Answer 354

Flow Volume Loop

Question 355

**Anaerobic Organism complicating difficult operations\>**

Answer 355

Bacteroides Fragilis - Gram Neg, Anaerobe, Rod Shaped Involved in majority of peritoneal infections

Question 356

**Branches of the external iliac artery**

Answer 356

Inferior Epigastric Artery (Anastamoses with superior epigastric artery, which is a branch of internal thoracic artery) Deep Circumflex Iliac ARtery Terminates as Femoral Artery

Question 358

**Obstructive Jaundice in the context of HIV patient likely to be due to...**

Answer 358

Sclerosing Cholangitis 2o to - CMV, Cryptosproidium or Microsporidia

Question 359

**Branches of the posterior cord of the brachial plexus**

Answer 359

Subscapular Nerves ( Subscapularis) T - horacodorsal A - xillary R - adial

Question 360

**What does serotonin do to vessels?**

Answer 360

Intact vessels - Vasodilation Damaged vessels/tissue - vasoconstriction

Question 361

**Four drugs commonly associated with parotid enlargement**

Answer 361

Thiouracil Isoprenaline Phenylbutazone Oestrogen Contraceptic pills

Question 362

**What is a:** **Pilon Fracture**

Answer 362

Pilon Fracture - Distal Tibia including the articular surface with ankle Tilloux Fracture - Child fracture involving the distal tibial epiphysis. Is an avulsion fracture due to the anterior tibiofibular ligament pull in an abduction injury.

Question 363

**Which Cord of the brachial plexus do the following nerves come from?** **Axillary Nerve** **Medial Pectoral Nerve** **Lateral Pectoral Nerve** **Medial Brachial Cutaneous Nerve** **Medial Antebrachial Cutaneous Nerve** **Subscapular Nerves** **Thoracodorsal nerve**

Answer 363

Posterior Cord (C5-T1) Posterior divisions of all trunks) - Subscapular Nerves, Thoracodorsal Nerve, Axillary Nerve Lateral Cord (C5-C7 Ventral Divisions of Upper and Middle Trunk) Lateral Pectoral Nerve Medial Cord (C8-T1 ventral Divisions of lower trunk) Medial Pectoral Nerve Medial Brachial Cutaneous Nerve Medial ANtebrachial Cutaneous Nerve

Question 364

**where are most anal fissures?**

Answer 364

Posterior midline (90%) Anterior midline (10%)

Question 365

**Nephroblastoma vs Nueroblastoma distinguishing features**

Answer 365

**nephroblastoma:** (Wilm's) Arise from the kidney. Associated with Hypertension No Calcification on CT **Neuroblastoma:** Arise from neural crest (often from adrenal Gland) Calcification on CT

Question 366

**Ventricular Tachycardia** Drug therapies

Answer 366

Amiodarone Lidocaine Procainamidwe **NOT VERAPAMIL**

Question 367

**Drug cause of SIADH**

Answer 367

Carbamezapine, SSRIs, Sulfonylureas, TCAs, vincristine, cyclophosphamide

Question 368

**Sites of ectopic testes**

Answer 368

Superficial Inguinal Pouch Base of Penis Femoral Triangle Perineum

Question 369

Multifocal high grade dysplasia of oesophagus Treatment?

Answer 369

**Resection** In old patients might be a place for local treatment - Endoscopic resection, photodynamic therapy

Question 370

**Strangulation risk** **Femoral** **Indirect Inguinal** **Direct Inguinal**

Answer 370

**Femoral - 40%** **Indirect Inguinal - Greater than direct inguinal** **Direct Inguinal - 3%**

Question 371

**Post Test Probability**

Answer 371

Post Test Odds/ (1+ Post Test Odds) Way of calculating the prevalence of a condition in a population that have had an intervention

Question 372

**where are most gastrinomas found?** **Three hallmark features for diagnosis of gastrinoma**

Answer 372

Duodenum, then pancreas **Features:** Fasting hypergastrinaemia Increased basal acid output Secretin Stimulation Positive

Question 373

**What is the remnant of the urachus?** **What is the arterial supply to the bladder?** **What is the venous drainage of the bladder?** **What is the lymph drainage of the bladder?**

Answer 373

Median umbilical ligament Arteries supplying the bladder: Inferior and superior vesical arteries from the **internal iliac artery** Venous drainage of the bladder: Vesicoprostatic venous plexus -\> drains into the internal iliac vein Lymph drainage of the bladder: External iliac nodes (lesser so to the internal and obturator nodes)

Question 374

**indications for CABG** **Conduits for CABG**

Answer 374

LMS/ LAD/ Left Circ Triple Vessel Disease Diffuse Disease **Conduits** Internal Mammary Artery Radial ARtery Long Saphenous Veins

Question 375

**Basophilic and mucoid material between intimal elastic fibers of an artery?**

Answer 375

Cystic Medial Necrosis Seen in age related degeneration + marfan's syndrome

Question 376

**ABx MOA** **Inhibiting Cell Wall FOrmation** **Inhibiting Protein Synthesis** **Inhibiting DNA Synthesis** **Inhibiting RNA Synthesis Cell Membrane**

Answer 376

**Inhibiting Cell Wall FOrmation** Penicillin, Cephalosporin, Glycopeptide **Inhibiting Protein Synthesis** **50S -** Macrolide, Linezolid, Chloramphenicol **30 S -** Aminoglycloside, Tetracycline, **Inhibiting DNA Synthesis** **DNA Gyrase** - Fluroquunilone Metronidazole, Sulphonamide, Trimethoprim **Inhibiting RNA Synthesis** Rifampicin **cell Membrane** Polymxin

Question 377

**Nerve Roots** **SUperior gluteal nerve** **Inferior Gluteal Nerve**

Answer 377

Superior - L4- S1 Inferior - L5 - S2

Question 378

**relations of submandublar gland**

Answer 378

**Superficial**: Lymph Nodes Facial Vein Marginal mandibular nerve + cervical Nerve **Deep:** Facial Artery Mylohyoid Muscle + Hypoglossus Wartons duct Lingual nerve Submandibular Ganglion Hypoglossal nerve

Question 379

**Femoral Nerve** **Roots** **Innervates**

Answer 379

Roots - L2 - L4 Innervates : Lateral cutaneous nerve of thigh, Intermediate cutaneous nerve of thigh, Saphenous nerve Vastus muscles, Quad femoris, Sartorius, Pectineus

Question 380

Calculating Relative risk

Answer 380

Experimental Event Rate / Control Event Rate = Relative Risk

Question 381

**Testing for HIV**

Answer 381

HIV PCR p24 antigen test

Question 382

**Breast Anatomy** **ARterial Supply** **Venous Drainage** **Lymph Drainage**

Answer 382

**Arterial Supply:** Internal Mammary External Mammary (lateral breast) Anterior intercostal arteries Thoraco-acromial artery **Venous Drainage:** Superficial venous plexus --\> subclavian, axillary and intercostal veins **Lymph -** **Axillary Nodes** Internal mammary chains

Question 383

**Crohn's Rectal Disease**

Answer 383

Can't make an ileoanal pouch- lots of cx Need end stoma

Question 385

**Muscles attaching to the radius**

Answer 385

Radial **Tuberosity** - Biceps Brachii **Body: Upper third -** Supinator, FDS, FPL **Middle third -** Pronator Teres **Lower part** - Pronator quadratus + Supinator tendon **Lower end:** 3 Grooves for tendons: Extensor muscles (carpi, pollicis longus, indices)

Question 386

**Pressure for pneumoperitoneum**

Answer 386

7-15 mmHg

Question 387

**Right Coronary ARtery supples:** **Left Coronary Artery Supplies:**

Answer 387

**Right Coronary ARtery supples:** RA Part of RV SA node (usually), AV Node Posterior Third of interventricular septum **Left Coronary Artery Supplies:** LA LV Part of RV SA node (less usually) anterior two thirds of interventricular septum

Question 388

**Coronary Sinus** Where is it What drains into it

Answer 388

**Posterior** part of **coronary** **groove** Receives blood from: **great** cardiac vein on **left** **middle** cardiac vein on **right** **small** cardiac vein on **right**

Question 389

**Which veins drain the loose areolar tissue of scalp?**

Answer 389

Emisary veins (potential for spread of infection to cranial cavity)

Question 390

**Perforated appendicitis - where is fluid most likely to collect**

Answer 390

pelvis

Question 391

**Which muscle relaxants do not cause histamine release**

Answer 391

Verocuronium + Suxamethonium

Question 392

**Where does sciatic nerve bifurcate and what into**

Answer 392

Bifurcates at superior aspect of the popliteal fossa: Tibial Nerve and Commmon Peroneal NErve

Question 393

**Mediators of acute inflammation**

Answer 393

Serotonin Histamine Prostaglandin Leukotrienes TNF Interleukins

Question 394

**Structures within the right atrium**

Answer 394

Musculi Pectinati Crista Terminalis Fossa Ovalis opening of coronary sinus

Question 395

**Causes of pruritis ani**

Answer 395

Systemic - DM, High Bili, Aplastic Anaemia, Leukaemia Mechanical - diarrhoea, constipation, anal fissure Infections- Stds Dermatological disease Drugs - Quinidine, Colchicine

Question 396

**Treatment of cyclical mastalgia**

Answer 396

Evening primrose oil, flax seed oil Danazol, tamoxifen

Question 397

**Scrotal Sensation**

Answer 397

Anterior - Ilioinguinal Nerve (L1) Posterior - Pudendal Nerve ( S2-S4)

Question 398

**Branchial Cyst** **Cystic Hygroma** **Locations on examination?**

Answer 398

Branchial Cyst - Anterior to SCM Cystric Hygroma - Posterior to SCM

Question 399

**Structures anterior to posterior in the hilar area:** **Right Lung** **Left Lung**

Answer 399

**Right Lung** **1.** Superior to hilum : SVC, Azygos Vein, Inominate Artery **2.** Behind the hilum:pulmonary ligament, Oesophagus (Superiorly). IVC (inferiorly just anterior to oesophagus ) **Left Lung** **1.** Superior to hilum: Arch of aorta, Subclavian artery, left inominate vein **2.** Behind the hilum: pulmonary ligament, descending aorta, oesophagus (inferiorly)

Question 400

**NPI Equation**

Answer 400

(0.2 x size of tumour) + Nodes + Grade Nodes: 0 nodes = 1 1-3 nodes = 2 \>3 nodes = 3 Grade: 1=1 2=2 3=3

Question 401

**How to differentiate between Anclyostoma Duodenale + Ascariasis infections?**

Answer 401

Anclyostoma - stool microscopy just larvae (if you're lucky) Ascariasis - worms and eggs

Question 402

**Myocardial Action Potential**

Answer 402

**Rapid Depolarisation - Na+ Influx** **Early repolarisation - K+ Efflux** **Plateue - Slow Ca++ Influx** **Final repolarisation - K+ Efflux**

Question 403

**Monteggia vs Galeazzi**

Answer 403

Montegia - Ulnar Fracture + Proximal radioulnar dislocation Galeazzi - Radial Fracture + Distal radioulnar dislocation

Question 404

**Structures passing posterior to lateral malleolus**

Answer 404

Peroneus longus and brevis

Question 405

**Actinomycysosis** **Best Diagnosis?**

Answer 405

Gram Positive Anaerobic Bacilli Diagnosis is through open drainage and culturing of material

Question 406

**Jugular Anatomy** External Internal

Answer 406

External - Superficial to SCM Internal - Deep to SCM in carotid sheath medial to common carotid. External: Formed from joining of posteior division of retromandibular vein + Posterior auricular vein joins subclavian vein and then internal joins more medially to form inominate vein

Question 408

**Cervical Drainage**

Answer 408

Through broad ligament to external iliac nodes Uterosacral fold to presacral Accompanying uterine vessels to internal iliac

Question 409

**Which structures are superior/deep to the extensor retinaculum** **What are the attachments of the retinaculum**

Answer 409

Superficial - Veins(cephalic and basilic veins) and Nerves (Dorsal cutaneous of ulnar nerve + Superficial of radial nerve) Deep - Tendons **Attachments** Ulnar side - Psisform And triquetrium Radial side - radial bone

Question 410

Axillary LNs If palpable/image confirmed lymphadenopathy? If no lymphadenopathy?

Answer 410

If palpable/image confirmed lymphadenopathy then proceed to **FNAC** If no lymphadenopathy then **Sentinel Lymph Node biopsy at surgery**

Question 411

**Axillary Artery:** **Parts** **Branches**

Answer 411

**From upper border of first rib (underneath the clavicle) to lower border of teres major** Parts: 1 - Superior to pec minor. Associated with brachial plexus and axillary vein 2 - Behind pec minor Cords of the plexus location are synonymous with their names here 3 - Inferior to pec minor Branches **High Thoracic** **Thoracoacromial** **Lateral thoracic** **Subscapular** **Posterior circumflex** **Anterior circumflex**

Question 412

**Where does the chorda tympani unite with the lingual nerve?**

Answer 412

Near the lateral pyerygoid

Question 413

**Which pharnygeal arches are the following structures derived from:** **Superior parathyroid glands** **Inferior parathyroid glands**

Answer 413

Superior - Fourth Pharyngeal Arch Inferior - Third Pharyngeal Arch

Question 414

**Structures at risk in carotid surgery**

Answer 414

Hypoglossal Nerve Greatuer Auricular Nerve Superior Laryngeal Nerve Common Facial + Internal Jugular Vein

Question 415

Why might the APTT be long in someone with Anti Phospholipid Syndrome?

Answer 415

They might have Lupus Anticoagulant. ALthugh in vivo this is prothrombotic, in vitro it increases APTT

Question 416

**From where does the scaphoid bone get its blood supply?**

Answer 416

From its distal end via a small branch of the radial artery

Question 417

**What goes through:** **Caval Hiatus** **Oesophageal Hiatus** **Aortic Hiatus**

Answer 417

Caval - IVC + Right Phrenic Oesophageal - Oesophagus + Vagal trunks Aortic - Aorta + Thoracic Duct

Question 418

**Nerves at risk in submandinbular gland excision**

Answer 418

Hypoglosal Nerve Lingual Nerve Marginal Mandibular Nerve

Question 419

**Limited liver mets in colorectal malignancy....**

Answer 419

Chemotherapy + Resection. Radiofrequency ablation for those not fit for surgery

Question 420

**Actions of corticosteroids**

Answer 420

**Metabolic** Decreased uptake/utilisation of glucose Increased gluconeogenesis Increased hyperglycaemia Increased protein catabolism Lipolysis **Regulatory** Negative feedback on hypothalamus CNS - decreased vasodilation/ decreased fluid exudation Decreased osteoblastic/ Increased osteoclastic Decreased inflammation

Question 421

**Branches of the vagas nerve**

Answer 421

Right - Recurrent laryngeal at the level of Right Subclavian artery in neck Left - RLN at level of aortic arch Both give off: **Superior and Inferior cervical cardiac branches** Right - Both Posterior to subclavian Left - Superior branch between arch of arota and trachea Whereas inferior tracks along with the vagus **Thoracic and cardiac branches (in thorax)**

Question 422

**Where do the different rotator cuff muscles attach to fibrous capsule**

Answer 422

Superior - Supraspinatus Anterior - Subscapularis Posterior - Teres Minor + Infraspinatus

Question 423

**left renal vein interesting anatomy**

Answer 423

It crosses the aorta just inferior to the SMA Receives tributaries from the testicular vein, suprarenal vein + inferior phrenic vein Level is at about L1/L2

Question 424

**Feeding in oesophageal perforation**

Answer 424

Should be through TPN as any other feeding can cause delayed healing or leak through perforation

Question 425

**Treatment of pancreatitic pseudocyst**

Answer 425

Endoscopic or radiological cystgastrostomy

Question 426

**nerve roots for** **Superior Gluteal nerve** **Inferior Gluteal nerve**

Answer 426

SGN - L4 - S1 IGN - L5 - S2

Question 427

What muscle is associated with the pudendal canal? Which space is it located within?

Answer 427

Obturator Internus Ischioanal fossa

Question 428

Bacteria most commonly associated with synergistic gangrene

Answer 428

E Coli + Bacteroides

Question 429

**Where are musculi pectinati predominantly ofund**

Answer 429

Right atrium - internal muscular ridges on the anterolateral surface of the chamber

Question 430

**Lymph drainage of ureter**

Answer 430

Upper - Para Aortic Lower - Common Iliac

Question 431

**Flattened Face =**

Answer 431

**Le Fort 2 or Le Fort 3 fracture**

Question 432

**What is in the lung pleural reflection?**

Answer 432

Bronchus, Pulmonary Artery, Pulmonary Vein

Question 433

**Relations of Coeliac Trunk**

Answer 433

Anterior - Lesser Omentum Right - Right coeliac ganglion + caudate lobe of liver Left - Left coeliac ganglion + gastric cardia Inferiorly - pancreas + renal vein

Question 434

Laparotomy approach in children

Answer 434

Transverse Supra Umbilical incision

Question 435

**Trotter's Triad**

Answer 435

Nasopharyngeal Carcinoma Unilateral Conductive Hearing Loss Ipsilateral Facial Pain Ipsilateral Palatal Paralysis

Question 436

**Thoracic Duct Path**

Answer 436

Starts at joining of left and right lumbar trunk + intestinal trunk (cisterna chylii) Traverses diaphragm through aortic hiatus then ascends between aorta and azygos vein Terminates in the left inominate vein

Question 437

Process of gastric dumping syndrome

Answer 437

Load enters the jejunum fast --\> Water enters the lumen --\> Distension of the jejunum and then diarrhoea Also causes insulin release (hypoglycaemia )

Question 439

**Salter Harris Classification System**

Answer 439

**I ( Straight) -** Through Physis **II (Above)** - Through physis and above to involve metaphysis **III ( Lower)** - Through physis and below to involve epiphysis **IV (Through)** - Through metaphysis, physis and epiphysis **V (****Everything Ruined)** - Crush / Compression

Question 440

**Ansa Cervicalis** **Roots** **Innervates** **Location**

Answer 440

Roots - Upper C1, Lower C2-C3 Innervates - Sternohyoid, Sternothyroid, Omohyoid - innervation comes from **inferior part of muscle** Location - Anterior to carotid sheath within the pre tracheal fascia

Question 441

**Where do these arteries originate?** **Artery of Vas** **Cremasteric Artery**

Answer 441

**Artery of Vas -** Inferior Vesicular Artery **​Cremasteric Artery -** Inferior epigastric artery

Question 442

**What does mandibular nerve innervate (motor)**

Answer 442

Masseter Temporalis Medial and Lateral Pterygoid Tensor Veli Palatini Tensor Tympani Mylohyoid Anterior belly of digastric

Question 443

**Quadratus Lumborum** Origin Insertion Action Innervation

Answer 443

Origin - Medial aspect of iliac crest and iliolumbar ligament Insertion - 12th Rib ACtion - Pulls rib cage inferiorly. Lateral flexion of spine Innervation - Anterior Rami of T12-L3

Question 444

**Multiple lytic / lucent appearances on X Ray** **(Soap Bubble)**

Answer 444

Osteoclastoma (Giant Cell Tumour)

Question 445

**Where is the coeliac plexus** **What contribuets to it**

Answer 445

Plexus is at T12/L1 inbetween oesopahgus (anterior) and aorta (posterior) It receives contributions from Greater splanchnic nerves, lesser splanchnic nerves, Vagus Nerves and Phrenic Nerves

Question 446

**Innervation to external urethral sphincter** **Autonomic Control of the bladder** **Innervation to internal urethral sphincter**

Answer 446

**External -**Pudendal Nerve (L2-L4) **Autonomic control of bladder -** Hypogastric plexuses **Internal -** Sympathetic fibers from T10 - L2 through inferior hypogastric plexus

Question 447

How does tranexamic acid work\>

Answer 447

Inhibits plasmin which is responsible for fibrin degradation

Question 448

**Location of the brcahial plexus in the neck**

Answer 448

Roots enclosed within an extension of prevertebral fascia Deep to platysma, omohyoid, transverse cervical artery + supra clavicular nerves.

Question 449

**Causes of avascular necrosis** **Plastic RAGS**

Answer 449

Plastic Rags Pancreatitis Lupus Alcohol Steroids Trauma Idiopathic, Infection Caisson Disease, Collagen Vascular Disease Radiotherapy, RA Amyloid Gaucher Disease Sickle Cell Disease

Question 450

**Directions of External Carotid Branches**

Answer 450

Anterior: Superior Thyroid Lingual Facial Posterior: Occipital posterior auricular Deep: Ascending Pharyngeal

Question 452

**Where is the intercostal bundle**

Answer 452

Lies in the **subcostal groove** Vein is most superior (least easily damaged) Artery Nerve (most inferior)

Question 453

**Cutaneous innervation of foot** Dorsolateral lateral plantar dorsum first web space proximo-medial heel

Answer 453

**Dorso**-**lateral** - Sural **Lateral** **Plantar** - Lateral Plantar Nerve **Dorsum** - Superficial peroneal **First Web Space** - Deep Peroneal **Proximo-medial** - Saphenous nerve **Heel** - Calcaneal Branch of Tibial Nerve

Question 454

**Treatment of haematocele?**

Answer 454

Surgical Exploration + Repair through scrotal approach

Question 455

**Where does the cervical sympathetic chain lie?**

Answer 455

Between the: Carotid Sheath (anteriorly) Prevertebral Fascia (Posteriorly)

Question 456

**Biceps Femoris** Origin Insertion Innervation Blood Supply

Answer 456

Origin - Ischial Tuberosity (long), Linea aspera/ Supracondylar ridge of femur (short) Insertion - Fibular Head Innervation - Sciatic nerve (Tibial - Long, Common Peroneal - Short) Blood Supply - Profunda Femoris, Inferior Gluteal, Superior Politeal Branches

Question 457

**What influences release of histamine from enterochromaffin cells in stomach?**

Answer 457

Elevated Serum Gastrin

Question 458

**Grading of knee collateral injury**

Answer 458

1 - Soem fibre disruption, no laxity (Conservative) 2 - Some ligament laxity (casting/ splinting) 3 - Joint instability, ligament is torn (Surgical Reconstruction)

Question 459

**Statistics:** **Likelihood ratio for positive test result** **likelihood ratio for negative test result**

Answer 459

PTR - Sensitivity/ (1-specificity) NTR - (1-sensitivity)/specificity

Question 460

**Describe lesser omentum**

Answer 460

Double layer of peritoneum extending from liver to the -stomach and duodenum Divided into two portions: hepatogastric ligament (attaches to lesser curve of stomach), hepatoduodenal ligament WIthin the folds - left and right gastric arteries hepatic artery, CBD, Portal vein, LNs, and hepatic plexuses

Question 461

**Describe Greater Omentum**

Answer 461

Double layer of peritoneum extending from greater curvature of stomach over the top of the small intestines and then coming back to cover the transverse colon Subdivisions: Gastrophrenic, Gastrocolic, +Gastrosplenic Ligament Blood Supply - Left (from splenic artery) and Right (gastroduodenal branch) Gastropeiploic Arteries

Question 462

**Posterior Triangle of neck contents**

Answer 462

**Nerves:** - Accessory nerve, phrenic nerve - Trunks of brachial plexus Cervical Plexus Branches - Supraclavicular nerve, Transverse Cervical Nerve, Greater Auricular Nerve, Lesser occipital nerve **vessels:** EJV, Subclavian artery **Muscles;** Inferior belly of omoyhyoid, Scalene **Lymph Nodes;** supraclavicular, occipital

Question 463

**What is the only muscle of the foot not innervated by the tibial nerve?**

Answer 463

Extensor Digitorum brevis ( Common Peroneal nerve)

Question 464

**Pituitary Anatomy**

Answer 464

In the sella turcica of the sphenoid bone. Covered by dura here. Originates from rathkes pouch (pharynx) Anterior side conected to hypothalamus by portal vein whereas posterior side connected via neurones **anterior hormones:** GH, LH, FSH, ACTH, MRH, TSH **posterior hormones:** ADH, Oxytocin

Question 465

**Sciatic nerve topography**

Answer 465

Convergence of L4-S3 Anterior rami at the inferior border of piriformis and emerges through the inferior part of greater sciatic foramen From here it descends underneath gluteus maximus Splits into Common peroneal + Tibial nerve superior to popliteal fossa

Question 466

**Anterior Interosseus Nerve Injury**

Answer 466

Loss of pronation of the arm (pronator quadratus) Loss of flexion of lateral fingers and thumb (FPL + FDP)

Question 467

**Greater Sac** **Lesser Sac**

Answer 467

**Greater Sac** Peritoneum encasing the majority of the intraperitoneal abdomen (save the lesser sac) **Lesser Sac** ​ Is the encasing of the cavity that is formed by the greater and lesser omentum. Margins: Anterior - Quadrate lobe of liver, stomach, lesser omentum, gastrocolic ligament Posterior - left kidney, adrenal gland, pancreas Inferior - Greater Omentum Superior - Liver Lateral - Spleen and ligaments anterior/posterior to the spleen

Question 468

**lateral malleolus** **Posterior structures**

Answer 468

Posterior: Peroneus longus and brevis tendons Sural nerve Short Saphenous Vein

Question 469

**Causes of thrombocytopenia** **Severe** **Moderate**

Answer 469

Severe- ITP, TTP, DIC, Haem Malignancy Moderate - HIT Drugs - quinine, diuretics, sulphonamide, thiazide, aspirin Alcohol liverdisease hypersplenism Viruses Pregnancy SLE/Antiphospholipid Syndrome B12 Deficiency

Question 470

**What are the branches of the maxillary artery**

Answer 470

Inferior alveolar Middle meningeal

Question 471

**Adductor Longus** Origin Insertion Innervation

Answer 471

Origin - Anterior body of pubis Insertion - middle third of linea aspera Innervation - Obturator Nerve (L2-L4)

Question 472

Adults: Where does spinal cord terminate Where does dural sac end

Answer 472

Spinal cord - L1 (L3 in newborns) Dural Sac - S2

Question 473

**Laxatives** Bulk forming laxatives Osmotic Laxatives Stimulant Laxatives

Answer 473

**Bulk forming laxatives** Bran, Psyllium, Methylcellulose **Osmotic Laxatives** magnesium sulphate, magnesium citrate, sodium phosphate, sodium sulphate, potassium tartate, polyethylene glycol, docusate **Stimulant Laxatives** Senna Picosuphate ricinoleic acid bisacodyl

Question 474

**Types of DCIS**

Answer 474

Comedo - Linear branching microcalcificaition Cribiform, micropapillary - multifocal

Question 475

**Pectoralis Major** Origin Insertion Nerve SUpply Actions **Pectoralis Minor** Origin Insertion Nerve SUpply Actions

Answer 475

**Major** Origin - medial two thirds of clavicle, manubrium and sternocostal angle Insertion - lateral edge of bicipital groove of humerus Nerve SUpply - Lateral Pectoral nerve Actions - Adducts + Medial ROtates humerus **Minor** Origin - Costochondral Junctions of third to fith ribs Insertion - Coracoid process of scapula ( medial border+ superior surface) Nerve SUpply - Medial + Lateral Pectoral Nerve Actions - Draws scapula inferiorly/ anteriorly against thoracic wall.

Question 476

**What drains into the** **SMV** **IMV**

Answer 476

SMV - up to the splenic flexure IMV - beyond the splenic flexure

Question 477

**Regarding Nerve Transection Injuries - what is the prognosis/ course of action** **Clean Simple Transection** **Complicated Transection**

Answer 477

Clean Simple Transection - the proximal axon will degenerate back to the first node of ranvier. Wallerian degeneration will causae the distal axon to degenerate too. The proximal axon will grow at a rate of 1mm per day Complicated Transection - Axonal growth will be impaired in the setting of fracture, haemorrhage, infection etc... Therefore practice is to delay approximation of the distal+proximal axons for a few weeks

Question 478

**Where does the female urethra drain lymphatic wise too**

Answer 478

Internal Iliac Nodes

Question 479

**Where is a hypervascular bone primary most likely to come from**

Answer 479

Kidney

Question 480

**Main difference between T Tests/ Fishers + Chi**

Answer 480

T Test - Compares normally distributed data Fishers + Chi - Tests categorical data

Question 481

**Quadrate lobe**

Answer 481

Functionally part of left lobe of liver Anatomically associates with right lobe of liver

Question 482

**Oesophagogastric Junction Tumours**

Answer 482

Type 1 - true oesophageal (barrett's) Type 2 - of the gastric cardia/ intestinal metaplasia Type 3 - Sub cardial cancers that spread across the junction Depending on staging these are treated by oesaphogogastrectomy

Question 483

**Innervation of lacrimal duct**

Answer 483

PNS Greater Petrosal nerve (Branch of CNVII in the facial canal) --\> Pterygopalatine ganglion ---\> gland innervated through zygomatic / lacrimal branches of maxillary nerve

Question 484

What is the thoracic outlet?

Answer 484

Where the subclavian vein, artery and brachial plexus exit the thorax. In between first rib and the clavicle

Question 485

**Which nerve supplies abductor pollicis longus?**

Answer 485

Radial

Question 486

Ear Nerves: What supples sensation to external ear? What innervates stapedius? What innervates tensor tympani?

Answer 486

What supples sensation to external ear? - Greater Auricular Nerve (Cervical Plexus C2-C3) + Auriculotemporal nerve ( Mandibular Nerve) What innervates stapedius? Nerve to stapedius ( CN VII) What innervates tensor tympani? CN V

Question 487

Composition of cervical canglion

Answer 487

Superior : C1 - C4 Middle: C5- C6 Inferior: C7-C8

Question 488

**Any rupture of urethra from membarnous urethra onwards ... Where doe urine accumulat?**

Answer 488

Connective tissue of the scrotum: Fascia adherence prevents urine from going posteriorly or laterally so it tracks retrograde

Question 489

**Borders of the** **Deep Perineal prouch** **Superficial Perineal Pouch** **Muscles of perineal body**

Answer 489

**Deep Perineal pouch** Superiorly - fascia of perineal floor Inferiorly - Perineal membane **Superficial perineal pouch** Superficial - perineal membrane Inferiorly - Superficial perineal fascia **perineal body:** Just superior to the anus. Muscles - Levator Ani, Bulbospongiosus, Transverse perineal muscles, External Anal Sphincter, External urethral sphincter.

Question 490

**Duke Classification System**

Answer 490

A - Confined to bowel B - Involving bowel wall C - Nodal Mets D- Distant mets

Question 491

**Biopsy features of barret's oesophagus**

Answer 491

Goblet Cell metaplasia Oesphageal Glands

Question 492

**Which rectal cancer patients require neoadjuvant radiochemotherapy**

Answer 492

T4

Question 493

**Radial Nerve Injury in the :** **Shoulder** **Arm** **Forearm**

Answer 493

Shoulder - Triceps Long Head Arm - Impairment to elbow extension Forearm - Wrist, finger extension and supination

Question 494

**Contents of** **Superficial perineal Pouch** **Deep Perineal Pouch**

Answer 494

Deep: Urethral Sphincter Urethra Vagina Deep Transverse Perineal Muscle Superficial: Erectile Tissue Superficial Transverse, Ischiocavernosus, bulbospangiousis Bartholin's Glands

Question 495

**Levator Ani Muscles**

Answer 495

Three paired muscles - pubococcygeus, puborectalis, ileococcygeus **Perineal Body to** pubic bodies of hip bone(anterior), to obturator internus (lateral), ischial spines of hip bone (posterior)

Question 496

**Relations of the prostate gland**

Answer 496

Anterior - Venous PLexus, Pubic Symphysis Posterior - Denonvilliers Fascia, Rectum, Ejaculatory Ducts, Lateral - Venous Plexus, Levator ani

Question 497

**First Line therapy for Nasopharyngeal Carcinoma**

Answer 497

Radiotherapy

Question 498

**Tetralogy of Fallot** **Feature**

Answer 498

VSD Overarching Aorta Right Ventricular Hypertroply RV outflow Obstruction Right to left shunting

Question 499

**Oxyphil Cells on thyroid histology =**

Answer 499

Follicular carcinoma

Question 500

**Thing in relation to carotids**

Answer 500

Inferior thyroid artery passes posterior to common carotids Thoracic Duct crosses the left common carotid Recurrent laryngeal nerve crosses the right common carotid

Question 501

**larynx:** Superior to vestibular folds Between vestibular folds, superior to vocal cords vocal cords to inferior bord of cricoid cartilage

Answer 501

**Vestibule -** Superior to vestibular folds **VEntricle -** Between vestibular folds, superior to vocal cords **Infraglottis -** vocal cords to inferior bord of cricoid cartilage

Question 502

**Differentiating feature of** **Central Horner's** **Pre Ganglionic Horner's Post ganglionic Horner's**

Answer 502

**Central Horner's -** Anhidrosis of ipsilateral face arm trunk * *Pre** **Ganglionic** **Horner's** - Anhidrosis of ipsilateral face * *Post ganglionic Horner's -** Anhidrosis of NOTHING

Question 503

**Which surgical device is good for managing splenic bleeding?**

Answer 503

Argon plasma coagulation system

Question 504

**Which arteries make up kiesselbach's plexus?**

Answer 504

Greater Palatine artery + SPhenopalatine Artery ## Footnote **(Both Maxillary Artery Branches - From ECA)**

Question 505

**What is a bankart lesion**

Answer 505

Injury to anterior inferior glenoid labrum This can cause recurrent anterior shoulder dislocation

Question 506

**Renal Tubular Acidosis** **Type 1** **Type 2** **Type 4**

Answer 506

Type 1 (Distal Tubule) - Impaired H+ Secretion, Hypokalaemia Type 2 (Proximal Tubule)- Impaired Bicarb Reabsorption, Hypokalaemia Type 4 (Collecting Ducts) - Addison's/Ald Resistance Hyperkalaemia

Question 507

**If the external fistula opening is at th following o clock where can you expect to find the internal opening** 2 o clock 4 o clock 7 o clock 11 o clock

Answer 507

2 o clock + 11 o clock are **anterior** - so the internal opening will be in a straight line from the external opening at the same o clock trajectory. 4 o clock + 7 o clock are **posterior** - so the internal opening will be in the midline at **6 o clock** after havine a curvilinear route

Question 508

**What are the posterio/medial relations of the left lobe of liver?**

Answer 508

Proximal stomach + abdominal oesophagus

Question 509

**Which valves have chordae tendinae**

Answer 509

Mitral and Tricuspid Mitral - 2 Cusps (one anterior)

Question 510

**Which two cranial nerves originate from between the posterior cerebral artery and the superior cerebellar artery**

Answer 510

Trochlear Nerve + Occuluomotor nerve

Question 511

**Which clotting constituents are consumed most quickly in DIC**

Answer 511

V, VIII and platelets

Question 512

**Layers of bowel wall**

Answer 512

Mucosa Submucosa **Submucosal Plexus (Meissner's)** Muscular Layer (First circular and then longitudinal - **Auerbach's plexus is in between them)** Serosa

Question 513

**Dark blood on aspiration in priapism?**

Answer 513

This indicates low flow priapism - the penis needs to be decompressed by further aspiration

Question 514

**Where are the motor root fibers of the trigeminal nerve?**

Answer 514

In the pons - distinctly not part of the trigeminal ganglion

Question 515

**Carcinoid Tumours - management** **\<2 Cm And in the appendix** **\>2 cm**

Answer 515

\<2 cm and in appendix - **Just appendicectomy** \>2 cm - **Radioisotipe scanning.** If radioisotope scanning demonstrates --\> lymph involvement then right hemi if margins on histology demonstrate compromise --\> right hemi

Question 517

**Contents of anterior triangle of neck**

Answer 517

Submandibular Gland Supra and infrahyoid muscles, Digastric Muscle Carotid Sheath ( Vagus, Carotid, Jugular) Ansa Cervicalis, Internal Jugular Vein, External jugular Vein, Anterior Jugular Vein

Question 518

**Associations of oesophageal atresia**

Answer 518

Distal tracheoosophageal fistula is teh common varient Associated with VACTERL (**Vertebral** anomalies, **anal** atresia, cardiac anomalies, thracheosophageal fistula/esophageal fistula, renal anomalies, limb defecvts).

Question 519

**Long Thoracic Nerve**

Answer 519

Ventral rami of C5- C7 ---\> inferior route iether infront or behind middle scalene muscle. Descends overlying the serratus anterior muscle

Question 520

**Renal stoens associated with...** **inborn errors of metabolism** **purine metabolism disorders** **infection**

Answer 520

**inborn errors of metabolism** - Cystine (radio-dense) **purine metabolism disorders -** Uric Acid (radiolucent) **infection -** Struvite (radio-dense)

Question 521

**In children - are teratomas usually malignant or benign**

Answer 521

Benign - so if there is a testicular mass in a child with ?metastatic disease its probably not teratoma

Question 523

**Where does the root of the :** **Right lung pass** **Left Lung Pass**

Answer 523

Right lung - SVC and Right Atrium Left Lung - Desceinding Aorta, Aortic arch

Question 524

**Pancreatic Relations**

Answer 524

Posterior: IVC, CBD, Renal Veins, SMA, SMV, Portal Vein, Diaphram, Psoas, Kidney, Adrenal, Aorta Anteror: 1st Part of Duodenum, Pylorus of stomach, Gastroduoednal ARtery, SMA + SMV, Stomach, DJ Flexure, Splenic Hilum Superior: Coeliac Trunk, SPlenic artery, Common Hepatic ARtery

Question 525

**Mutation associated with** **FAP** **Lynch** **Cowden** **MYH associated Polyposis** **Peutz jehgers**

Answer 525

FAP - APC Lynch - DNA mismatch repair genes Cowden - PTEN MYH associated polyposis - MYH Peutz Jehgers - STK11

Question 526

Management of \>1 cm sessile serrated polyps

Answer 526

Polypectomy

Question 527

**Fracture Healing Stages**

Answer 527

Clot and haematoma formation Clot Organisation ( Collagen) Bone production from periosteum Cartilage production (mesenchymal cells) Callus formation ( connective tissue + hyaline cartilage) Endochondrol ossification of cartilage **Trabecular bone formation --\> Compact bone by osteoclast mediated resorption of trabecular bone**

Question 528

**types of colonic peristalsis** **what does circular muscle do** **what does longitudinal muscle do**

Answer 528

Colonic peristalsis: Mas movement - waves of peristalsis through the whole colon Segmental Contraction - Local contractions to maximise absorption Antiperstaltic contractions - slow down food bolus toward ileum Circular muscle - contracts behind food bolus longitudinal muscle - propels food bolus forwards

Question 529

**WHere do the following originate** **Long Head BIceps** **Long Head Triceps**

Answer 529

Long head biceps - Supragelnoid Tubercle Long head Triceps - Infraglenoid tubercle

Question 531

**Iliacus** Origin Insertion Innervation Action Arterial Supply

Answer 531

Origin - Superior 2/3 of iliac fossa Insertion - Lesser trochanter of femur Innervation - Femoral nerve Action - Thigh Flexor Arterial Supply - Femoral Artery

Question 532

**What are the end branches of posterior tibial artery**

Answer 532

Medial and lateral planter arteries

Question 533

**Hip Fracture management** Subtrochanteric Reverse Oblique Inter-Trochanteric

Answer 533

Subtrochanteris - Intramedullary Nail Reverse Oblique - Intramedullary Nail Inter-trochanteric - DHS / IM Nail if unstable

Question 534

**Spinal Cord Lesions: Signs and causes** Dorsal Column Spinothalamic Central Cord Lesion Osteomyelitis Infarction Cord Compression Brown- Sequard

Answer 534

**Dorsal Column** - Vibration and proprioception lost. Tabes Dorsalis, SACD **Spinothalamic -** Loss of pain/temp. Syringomyelia **Central Cord Lesion** - Syringomyelia **Osteomyelitis -** Cervical region / Thoracic Region. Usually back pain **Infarction -** 2o to aortic surgery..Doral Columns Signs **Cord Compression -** UMN signs. Malignancy, haematoma, fracture **Brown- Sequard -** Hemisection of spinal cord. Ipsilateral paralysis, loss of proprioception and fine discrimination. Contralateral loss of pain and temp

Question 535

**What test can be used to compare two or more sets of non-parametric data?**

Answer 535

Kruskal Wallis One way variance test

Question 536

**Relations of the IVC**

Answer 536

Anterior: Small Bowel, 1 + 3 of duodenum Head of pancreas, Liver, Bile Duct RIght common iliac, Right gonadal artery Posterior: right renal artery, right psoas, right sympathetic chain, coeliac ganglion

Question 537

**Borders of anatomical snuffbox**

Answer 537

Posterior - EPL Anterior - APL, EPB Proximal- Radial Styloid Process Distal - Apex of snuffbox Floor - Scaphoid + trapezium

Question 538

**layers of periosteum**

Answer 538

Outer -Fibrous layer (Fibroblasts) Inner - Cambium layer ( osteogenic - containing osteoid progenitor cells) Sharpey's fibers connect it to bone

Question 539

**What are the compartments of the knee joint** **Bursae of knee joint** Anterior Lateral Medial **Which meniscus is attached to respective collateral ligament**

Answer 539

**Compartments** Tibiofemoral Patellofemoral **Bursae of knee joint** Anterior - Prepatellar Bursa, Deep Infrapatellar bursa (tibia and patellar ligament, Superficial infrapatellar bursa (tibial tuberosity and skin) Lateral - Between: i) lateral Gastroc and joint capsule, ii) lat colat lig + biceps tendon, iii) lat colat lig + popliteus tendon Medial - Between: i) medial gastroc + joing capsule ii) medial colat lig + pes anserius tendons, iii) membranosus + medial tibial condyle + medial gastroc head **Medial meniscus is attached to respective collateral ligament**

Question 540

**Musculocutaneous nerve continues into the forearm as the..**

Answer 540

Lateral cutaneous nerve of the forearm

Question 541

**Adductor Canal**

Answer 541

Lateral- Vastus Medialis Posterior - ADductor Longus and MAgnus Anterior - Sartorius Contents - Saphenous Neve, Superficial Femoral Vein, Superficial Femorl ARtery

Question 542

Drugs to manage VT

Answer 542

Amiodarone Lidocaine Procainamide

Question 543

**Brachial Plexus** **What are the roots of the BP ensheathed within in neck?** **What structures overly the brachial plexus in the neck?**

Answer 543

In the neck the BP is enclosed within an extension of the prevertebral fascia In the neck the brachial plexus is deep to: Platysma, Supraclavicular Nerves, Inferior belly of omohyoid, Transverse Cervical Artery. They then pass deep to the clavicle and suprascapular vessels on the way into the axilla

Question 544

**Why is facial vein more at risk than facial artery in submandibular gland surgery?**

Answer 544

The facial vein is more superficial a structure - it descends on the surface of the mandible and then superficial to the gland itself. The facial artery ascends from deep to the artery. then overlies the mandible

Question 545

**Branches of the mandibular nerve**

Answer 545

Auriculotemporal Lingual Inferior Alveolar Nerve to mylohoid Mental

Question 546

**What are the subtriangles of teh anterior neck triangle?**

Answer 546

Submandibular (Digastric) - Gland, Nodes, Facial A+V, CNXII **Digastric Muscle** Muscular - Strap Muscles, EJV **Omohyoid Muscle** (Anterior - Mylohyoid(CN V3), Posterior - Facial) Carotid - Sheath, Ansa Cervicalis

Question 547

List Some Cardiac Inotropes

Answer 547

Phosphodiesterase Inhibitors Adrenaline Noradrenaline Dopamine Dobutamine

Question 548

**Bladder cancer Treatment**

Answer 548

Superficial - TURBT Superficial but high grade/risk, recurrence - intravesical chemotherapy \>T2 - radical cystectomy

Question 549

**Lymphatic Drainage of:** **Scrotum** **Testes** **Prostate**

Answer 549

Scrotum - Inguinal Testes - Para- Aortic Prostate - Internal Iliac

Question 550

Ligaments of the Liver

Answer 550

**Ligamentum Teres** Remnant umbilical vein - joins left portal vein branch in porta hepatis **Ligamentum Venosum (Posterior)** Remnant of ductus venosus - **Falciform Ligament** Double peritoneal fold from umbilicus to anterior hepatic surface where divides into coronary and left triangular ligaments

Question 551

**Pelvic Floor Muscles** Floor Lateral Wall Where is the perineal body

Answer 551

**Pelvic Floor:** Floor - Levator Ani (Pudendal Nerve - Pubococcyg., iliococcyg, puborectalis), Coccygeus Lateral Wall - Piriformis + Obturator Internus The perineal body is inbetween the urogenital and rectal hiatus

Question 552

**Anatomical boundaires of the perinuem**

Answer 552

Diamond shaped structure Anteriorly - Pubic Symphysis Posteriorly - Tip of coccyx Laterally - inferior pubic rami, inferior ischial rami and sacrotuberous ligament

Question 553

**Muscles of the perineal body**

Answer 553

Levator Ani Bulbospongiosus Superficial and deep transverse perineal muscles external anal sphincter external urethral sphincter

Question 554

**Nerves associated with pharyngeal arches**

Answer 554

I - Trigeminal II - Facial III - Glossopharyngeal IV - Vagus VI - Vagus + RLN

Question 556

**Which abdominal viscera are retroperitoneal?**

Answer 556

Adrenals, Kidneys, Ureters Aorta + IVC Rectum Duodenum ( except proximal 2cm ), oesopahgus, pancreas Colon - not transverse or sigmoid

Question 557

**Which muscles cross the internal jugular vein?**

Answer 557

Omohyoid Sternocleidomastoideus

Question 558

**Lymph Drainage of the female urethra**

Answer 558

Internal Iliac Node (Whole length of the urethra)

Question 559

**Branches of thoracoacromial artery**

Answer 559

Pectoral - Breast and Pectorals Acromial - Deltoid and joint capsule Clavicular - sternoclavicular joint Deltoid - travels between pec major and deltoid in deltopectoral groove

Question 561

**Structures passing behind the medial malleolus:** **Anterior to Posterior**

Answer 561

Anterior : Tibialis Posterior Flexor Digitorum Lonugs Posterior Tibial Vein Posterior Tibial Artery Nerve Flexor Hallucis Longus

Question 563

**Treatments for extravasation injury** Doxirubicin Contrast media, TPN, Vinca Alkaloids Vinca Alkaloids ALone

Answer 563

Doxirubicin - COld Compress Contrast media, TPN, Vinca Alkaloids - Hyaluridonase Vinca Alkaloids ALone - Warm Compress

Question 564

**Breast Treatment** **When to use chemo** **When to use radio**

Answer 564

Chemo: Downstaging \>Grade 3 Lesions Axillary node Disease Radio: WLE Post Mastectomy - Large lesion, High Grade Lesion, vascular invasion

Question 565

**What is in the middle mediastinum (5)**

Answer 565

Pericardium Heart Aortic Root Arch of azygos vein Primary bronchi

Question 566

**Defect in osteopetrosis**

Answer 566

Osteoclast function impaired - So defective bone resorption

Question 567

**Cardiac Surgery Qs** **Incisions** **Cardiopulmonary bypass -** What is cannulated How much heparin **Conduits for bypass**

Answer 567

**Incisions - Midline sternotomy/ Left Submammary Incision** **Cannulated -** Aortic Roots + Right Atrium Heparin - 30,000 iU of unfractionated **Bypass Conduits-** Internal mammary, Radial, Long saphenous

Question 568

Borders of the triangular interval Content

Answer 568

Medial - Long head of triceps Lateral - Shaft of humerus Superiorly - Teres major Transmits the radial nerve from the axilla into the arm

Question 569

**HIV Testing: Window for positivity** p24 antigen Antibody

Answer 569

p24 antigen : 3-4 weeks Antibody: 4-6 weeks

Question 570

**Glasgow Pancreas Score**

Answer 570

P - PaO2 \<8 A - Age \>55 N - Neutrophils \>15 C - Calcium \<2.0 R - enal Urea \>10 E - Enzymes LDH Raised / AST raised A - ALbumin \>32 S - Hyperglycaemic

Question 571

**Stucturs in the right atriu**

Answer 571

Musculi Pectinati Crista Terminalis Opening of coronary sinus Fossa Ovalis

Question 572

**Artery Locations:** **Anterior Tibial** **Posterior** **Tibial** **Peroneal**

Answer 572

Anterior TIbial - In the anterior compartment (very close to deep peroneal nerve) Posterior Tibial - In the deep posterior compartment - more medial Peroneal - In the deep posterior compartment - more lateral Both of these are very close to the fibula + tibial nerve (their veins are either side of the tibial nerve)

Question 573

**Difference histologically between necrosis apoptosis**

Answer 573

Necrosis: Cell Membrane Problems Lysosomes Cellular Swelling Inflammation Apoptosis: Fragments of nucleus No inflammation Cell Membrane Intact No lysosomes

Question 574

**Structures posterior to medial malleolus:** Anterior to posterior

Answer 574

Tom Dick and Very Nervous Harry Tibialis Posterior Flexor Digitorum Profundus Tibial Artery and Vein Tibial Nerve ( supplies all intrinsic foot apart from Extensor hallucis Longus - Common peroneal Nerve) Flexor Hallucis Longus

Question 575

**Borders of the tympanic cavity**

Answer 575

Lateral - Tympanic membrane Medial - Bulge formed by **facial nerve**/ lateral wall of inner ear Roof - Temporal bone Floor - Temporal Bone (known as jugular wall) related to **internal jugular** Anterior Wall - bony plate. auditory tube + tensor tympani. related to **ICA** Posterior wall - mastoid wall borders the cavity from mastoid air cells. Mastoid antrum is a connection the air cells

Question 576

**Borders of the antecubital fossa** **Where does the brachial artery bifurcate** **Where does the ulnar artery lie in relation nerve**

Answer 576

Lateral - Brachioradialis Medially - Pronator Teres Superiorly - Line between the humeral condyles Floor - Supinator + Brachialis Contents - Medial to lateral - bicept tendon -\> brachial artery -\> median nerve Brachial artery bifurcates - radial head Ulnar artery is lateral to ulnar nerve

Question 577

**Layers of the SCALP?**

Answer 577

Skin Dense Connective Tissue Epicranial APoneurosis Loose Areolar Tissue ( Emissary Veins here) Periosteum

Question 578

**Pterygopalatine Fossa** **Borders** **Contents**

Answer 578

**Borders: Anterior**- Posterior wall of maxillary sinus **Posterior -** Sphenoid bone (pterygoid process) **inferior -** palatine bone and canal **Superior -** inferior orbital fissue **medial -** perpendicular plate of palatine bone **lateral -** pterygomaxillary fissure **Contents:** Maxillary Nerve (Foramen Rotundum opens here) Maxillary artery Pterygopalatine ganglion (Greater petrosal nerve of VII)

Question 579

**Infratemporal Fossa** Borders Contents

Answer 579

Borders: **Lateral -** Mandible condyle/ramus **medial -** lateral pterygoid plate, palatine + superior constrictor muscles **anterior** - posterior body of maxillary sinus **posterior -** carotid sheath **roof -** sphenoid wing **floor -** medial pterygoid **contents** related to ovale and spinosum medial and lateral pterygoids mandibular nerve, otic ganglion, chorda tympani, maxillary artery + vein Middle Meningeal vein (Artery is associated with the roof)

Question 580

**vertebral Column** Arches- Pedicles - Lamina - Spinous Processes - Rib articulations

Answer 580

Arches - exend posteriorly from the body to create the vertebral foramen through which spinal cord is transmitted Pedicles - Body to transverse process Lamina - transverse to spinous process SPinous Processes - Posterior most structure in the vertebrae. Cervical are bifid **Rib -** Superior + inferior demi facet - either side of vertebral body articulates with inferior/superior rib Costal facet of transverse spinous process - articulates with rib corresponding to that vertebrae

Question 581

**Which back muscles are involved in rotating the head?** **Of the deep spinal muscles:** **What are the intermediate and deep ones**

Answer 581

Splenius Capitis + Cervicis Intermediate : Medial to lateral Spinalis, Longissimus, Iliocostalis Deep: Multifidus + Semispinalis

Question 582

**Forearm Compartments**

Answer 582

**Anterior Superficial:** Flexor Carpi Ulnaris Palmaris Longus (median nerve deep to this near wrist) Flexor carpi Radialis Pronator Teres **Anterior Intermediate:** Flexor Digitorum Superficialis **Anterior Deep:** Flexor Digitorum Profundus, Flexor Pollicis Longus, Pronator Quadratus **Posterior Superficial:** Brachioradialis Extensor Carpi Radialis longus + brevis Extensor Digitorum Extensor Digiti Minimi Extensor carpi ulnaris Anconeus **Posterior Deep:** Supinator Abductor Pollcis Longus Extensor Pollicis Longus + Brevis Extensor indicis proprius

Question 583

Which flexor of the arm is innervated atypically?

Answer 583

Brachioradialis - innervated by the radial nerve

Question 584

**Nerves of lumbar plexus (6)**

Answer 584

**Lumbar Plexus : L1-L4** **IlioHypogastric - L1.** Internal Oblique + Transversus Abdom. **Ilioinguinal - L1.** Internal Ob + Transvers. Abd. Enters inguinal canal by piercing through the internal oblique **Genitofemoral - L1-L2.** Genital Branch - Cremaster Musc. Lateral Cutaneous Nerve of Thigh - L2-L3 **Obturator Nerve- L2-L4.** Obt. Extern, Adduct Long + Mag + Brev. (sometimes pectineus) + Gracilis **Femoral Nerve - L2-L4.** Quad Femor. Vastus Musc. Sartorius. Pectineus. Iliacus

Question 585

**Branches of thyrocervical trunk**

Answer 585

**Inferior Thyroid** **Suprascapular** **Transverse Cervical** The subscapular artery from the axillary artery (3rd part) anastamoses with the suprascapular + transverse cervical

Question 586

**Branches of the costocervical trunk**

Answer 586

**superficial intercostal** **deep cervical**

Question 587

**What happens to the dorsal scapular artery?**

Answer 587

Dorsal Scapular Artery: **Joing the superficial cervical artery (Thyrocervical Trunk and becomes:** **Transverse Cervical** This has superficial and deep branches

Question 589

**Branches of the sacral plexus**

Answer 589

S1-S4 (sciatic receives lumbar roots L4-L5) **Superior Gluteal Nerve - L4, L5, S1** Glut Med+ Min. TFL **Inferior Gluteal Nerve -** **L5 S1 S2.** GLut Max **Sciatic Nerve** - **L4 - S3.** Posterior thigh muscles + Part of aductor magnus. All muscles of lower leg via common peroneal + tibial branches **Posterior Cutaneous nerve of the thigh - S1 - S3** **Pudendal Nerve - S2-S4.** External urethral + anal sphincter. Levator Ani + perineal muscles **Nerve to piriformis** **Nerve to quadrator femoris** **Nerve to obturator internus**

Question 590

**Piriformis**

Answer 590

Nerve - Nerve to piriformis S2-S4 to Lesser trochanter

Question 591

**What do the following anastamose with + Signficance:** **Inferior Thyroid Artery** **Deep Cervical Artery** **Dorsal Scapular Artery**

Answer 591

**Inferior Thyroid Artery** Anastamoses with the superior thyroid artery --\> This is significant in Subclavian Steal as retrograde flow happens through this link **Deep Cervical Artery** Descending branch of occipital artery --\> Again another site of collateralisation in Subclavian Steal **Dorsal Scapular Artery** Circumflex Scapula Artery (from subscapular artery) + Suprascapular artery --\> Forms the scapular anastamosis.