Jan 2023 Recalls Flashcards by Sophie Vaughan-Williams

What is the half life of platelets?

7-10 days

How well did you know this?

Not at all

Perfectly

A bullet is shot at the right side of the rectus muscle where is meets the right costal margin, which organ is most likely affected?

Gallbladder

How well did you know this?

Not at all

Perfectly

Where are paneth cells located?

Crypt of Lieberkuhn - small intestine

How well did you know this?

Not at all

Perfectly

Effect of respiratory depression on ABG?

Respiratory acidosis due to hypoventilation

How well did you know this?

Not at all

Perfectly

What acquired bleeding disorder occurs with warfarin?

Prothrombin deficiency

How well did you know this?

Not at all

Perfectly

A female with rheumatoid arthritis and asthma is on Prednisolone 10mg BD and Salbutamol. Comes into hospital unwell with fever and vomiting. They are hypotensive. What medication do you need to consider giving?

Hydrocortisone 100mg IV

How well did you know this?

Not at all

Perfectly

Features of aortic sclerosis

Ejection systolic murmur - no radiation to carotids
Diagnosed on ECHO - thickening and calcification of aortic valve leaflets, no motion restriction

How well did you know this?

Not at all

Perfectly

Child is tired and breathless after playing football. Harsh continuous murmur heard under left clavicle. What is the problem?

Patent ductus arteriosus - machinery continuous murmur

How well did you know this?

Not at all

Perfectly

Primigravida, 24 years old. Third trimester. Father died of MI at 60. Presents with sudden chest tightness, cyanotic with congested neck veins. What is the cause?

Acute massive PE

Causes right heart strain, hence the congested neck veins.
Cyanotic due to hypoxia.

How well did you know this?

Not at all

Perfectly

Which medication would you choose to sedate a hypotensive patient for intubation if on a helicopter?

Ketamine

How well did you know this?

Not at all

Perfectly

10 days after an anterior resection, a patient developed SOB and cough. ECG was normal. Which initial investigation should you do?

Apparently the answer was CTPA, although I would do CXR first.

?weird wording

How well did you know this?

Not at all

Perfectly

Why will a patient have high K, low urine output and raised creatinine after abdominal aortic aneurysm surgery?

AKI
Needs fluids, stop nephrotoxic drugs

How well did you know this?

Not at all

Perfectly

Features of testicular torsion eg sudden onset scrotal pain, testis elevated and tender, absent cremasteric reflex whilst eating. What do you do?

Immediate exploration under GA - RSI.

Do not wait 6 hours to be fasted

How well did you know this?

Not at all

Perfectly

After abdominal aortic aneurysm repair a patient has increased ventilatory demand, a pulmonary artery wedge pressure 20, dilated neck veins and low BP. CXR shows bilateral lung opacities. What is the diagnosis?

Pulmonary oedema

Pulmonary artery wedge pressure - normal range 6-12, is also known as pulmonary artery occlusion pressure. It is an indirect way of measuring left atrial pressure and the gold standard for diagnosis of acute pulmonary oedema.

How well did you know this?

Not at all

Perfectly

What would you expect to see on a post splenectomy blood film at 1 week?

Howell-Jolly bodies
Target cells
Pappenheimer bodies
Acanthocytes
RBC pitting
Thrombocytosis

Transiently raised WCC- if still raised after 5 days then think of infection

How well did you know this?

Not at all

Perfectly

Pretibial flap injury 6x2cm. Periosteum is intact but edges cannot be approximated. What is the management?

Definitely Split thickness skin graft

I think the lacerated flap needs excising first

How well did you know this?

Not at all

Perfectly

What is seen on histology for amyloidosis?

When stained with congo red, it appears apple green birefringence in polarized light

How well did you know this?

Not at all

Perfectly

What is the choice of anaesthetic drug for a biers block?

Prilocaine 0.5%

An amide local anaesthetic
Slightly less cardiotoxic than bupivicaine and lidocaine

How well did you know this?

Not at all

Perfectly

Mother of 3 children, came with pruritus ani, scotch tape showed eggs. What is causative organism?

Enterobius vermicularis

How well did you know this?

Not at all

Perfectly

Patient presenting with bloody diarrhoea. Stool shows both eggs and cysts. Given the diagnosis, what is the treatment?

It is either giardia or cryptosporidium

Both are treated with metronidazole.

How well did you know this?

Not at all

Perfectly

Knee injured during football match, can’t continue playing. Immobilised for one week. After one week, tender swelling
2.5cm above knee medial joint line and excessive lateral angulation of knee compared to the other one. Which ligament is damaged?

Medial collateral ligament

Lateral angulation = Valgus deformity

How well did you know this?

Not at all

Perfectly

A patient has had a thumb cast on for 4 weeks for an undisplaced fracture. When cast is removed the patient is unable to lift thumb off the table and patient can’t extend IPJ even after stabilising thumb CM joint. What is damaged?

Extensor pollicis longus tendon

How well did you know this?

Not at all

Perfectly

Which part of the scaphoid is at risk of avascular necrosis?

Proximal pole

Preiser’s Disease
Scaphoid blood supply is dorsal carpal branch of the radial artery via retrograde flow

How well did you know this?

Not at all

Perfectly

Which spaces are usually involved with Ludwig’s angina?

Submandibular, sublingual and submental.

Ludwigs angina is cellulitis of he floor of the mouth.
It presents with pain on moving tongue, difficulty swallowing saliva, pain on opening mouth.
Often requires surgical drainage

How well did you know this?

Not at all

Perfectly

Patient is experiencing pain 10 years post mid tarsal dislocation. What is the cause?

Secondary arthritis

Patient involved in car crash, hits back of driver's seat, leg is shortened and internally rotated, all motor function of leg lost. What is the injury?

Posterior hip dislocation Common injury in car crash Presents with internally rotated, shortened and adducted leg

After gastric bariatric surgery, patient has been getting symptoms of sweating, palpitations, convulsions. What would be the cause?

Dumping syndrome ?Vagotomised early gastric relaxation

What is the histological appearance of osteoporosis?

Reduction in the amount of osteoid matrix (decreased volume), but normal mineralisation of it

A patient has fallen onto their chin, reduced mouth opening, jaws are not aligned like they used to and they are unable to bite. There is pre auricular tenderness. Which part of mandible fracture?

Mandibular condylar fracture

Patient 6 months post tooth extractionis now presenting with pus, multiple sinuses and yellow granules.

Actinomycosis

Teeth extracted, pt develops numbness of gum, chin and lower lip. Which nerve traversing through the body of mandible is responsible?

Mental nerve - terminalbranch of the inferior alveolar nerve Traverses through mandibular canal in mandible.

Patient underwent Colonoscopy under conscious sedation. On the ward, the patient is unresponsive and the nurse informs you that the respiratory rate is slow. You examine the patient and he is sleeping. Despite the dark room, his pupils are constricted. What reversal agent is required?

Naloxone

Unilateral Buttock claudication, causative vessel

common iliac artery

A gardener gets a thorn stuck in their arm. A photo is provided showing surrounding cellulitis and lymphangitis 2 days later. What is the causative organism?

Sporothrix schenckii

Which is the cause of vasoconstriction on efferent arterioles?

Angiotensin 2

Senescence of cancer cells

Telomerase

Superior thyroid artery ligated, now can't produce high pitched voice, injury to?

Cricothyroid muscle

What cells produce complement factors?

Hepatocytes

What is the lymph node drainage of the glans of the penis

deep inguinal lymph nodes

What is the histology of giant cell arteritis?

chronic granulomatous macrophages lymphocytes inflammation

What clinical examination test is used to determine achilles tender rupture?

Simmonds Thompson test - squeeze calf

What nerve root is damaged if there are features of horners syndrome and numbness on the medial side of elbow?

Patient with diabetes presenting with oliguria, hematuria. There is slough in urine. Diagnosis?

Acute tubular necrosis

80 year old lady who smoked for 20 years, smooth, red and velvety patch on her tongue. What are the patches called?

Erythroplakia

Temporal bone fracture after high velocity accident, patient has otorrhea. Damage to which structure causes CSF to leak externally via ear?

Tegmen Tympani Also known as the tegmental wall or roof of the tympanic cavity, is a thin plate of the petrous part of the temporal bone that separates the intracranial compartment and middle ear.

20y/o man, Urethral rupture, blood at urethral meatus and high riding prostate What part of urethra injured:

Membranous urethra

Which syndrome involves both endometrial and colorectal cancer?

Lynch syndrome

3% burn in forearm with crusting, dry and loss of sensation, management post debridement?

Split thickness skin graft

Acutely swollen and painful knee. No hemarthrosis, Apyrexial and WCC normal. Definitive diagnosis by?

Arthroscopy

Which enzyme is responsible for autolysis in pancreatitis?

Trypsin

What is the formula for NNT

1/ARR

Admitted with acute pancreatitis..patient managed..repeat CT imaging after 4 days shows diffuse fluid around the head body/tail of pancreas are non-enhancing ?cause

Pancreatic necrosis

Where are the central chemoreceptors located?

Medulla

Where does furosemide act in the kidney?

Ascending loop of henle

What structure is at risk when preparing tibia with saw for knee replacement surgery?

Popliteal artery

6 months old boy with 24 hrs history of abdomen distension, pyrexial, screaming, vomiting bile stained, small amount of blood and mucus on PR

Intussusception

Where does ADH act in the kidney?

Distal convoluted tubule and collecting duct

Traumatic aorta injury present to emergency with widened mediastinum, where is most likely

Descending aorta

What bacteria will not be killed if autoclave is on 100 degrees celsius

clostridium difficile

What is the nerve supply of the labia majora

ilioinguinal nerve L1

78 year old male traumatic head injury patient, long time taking to recover, need long term nutritional support ?

PEG

Structure at greatest risk during splenectomy

Pancreas tail

Lung function tests showing restrictive pattern. What is the cause?

Pulmonary fibrosis

Non differentiated thyroid cancer. What screen test for recurrence?

Thyroglobulin

Where is the brachial artery in relation to the biceps tendon?

Medial In the ACF (lateral to medial) is: - Radial nerve - Biceps tendon - Brachial artery - Median nerve

Elderly man, has referred back pain to legs, improves on pushing trolley n climbing uphill. While increases with going down hill.. cause?

Lumbar canal stenosis

Residual 250 cm ileum after distal ileocolic resection. What nutritional support is necessary?

Oral supplementation

What type of joint is the carpometacarpal joint of thumb?

Saddle

Management of aortic aneurysm between 4.5 and 5.5cm?

3 monthly USS

What is seen on the histology for medullary thyroid cancer?

Stroma with amyloid deposits. Round, plasmacytoid, polygonal or spindle cells in nests Round nuclei with finely stippled to coarsely clumped chromatin

What nerves arise at the cerebellopontine angle?

Trigeminal- more pons really Facial Vestibulocochlear

According to embryology, why does cleft lip occur?

Occurs when the medial nasal prominence and maxillary prominence fail to fuse.

How does diarrhoea lead to metabolic acidosis?

Loss of bicarbonate

What nerve innervates the temporalis muscle?

Mandibular CNV3

What nerve provides scalp sensation behind ear?

Lesser occipital nerve

70 years old woman with extensive ovarian cancer, 5.5 cm aneurysm of external iliac artery. Management:

Surveillance in 3 months

Patient with anaemia and autoimmune thyroiditis with atrophic gastritis, endoscopy normal. Size of RBC?

Large oval Megaloblastic macrocytic anaemia (pernicious anaemia)

smoker, unilateral laryngeal swelling, nodule on vocal cord, no LN involvement. What type of cancer?

SCC

What is little's area?

AKA Kiesselbach's plexus. It is the anastamosis of 5 arteries: - anterior ethmoidal - posterior ethmoidal - Sphenopalatine - Greater palatine - Septal branch of the - Superior labial artery

What is the least reliable sign for examination of compartment syndrome?

Absent pulse - late sign

Cause of sudden onset L forearm pain and superiorly displaced mitral valve leaflets during systole on echo

Brachial artery embolism

Subclavian steal syndrome, retrograde flow in which vessel?

Vertebral

Laceration 3cm from wrist joint, reduced wrist flexion, ulnar deviation. Which nerve is injured?

Median

Severe renal disease with foot ischemia. Which investigation is most appropriate?

US duplex

45 female with discrete breast nodules showing dense fibrous tissue with no microcalcification, Diagnosis?

Fibrocystic

What is cushing's triad?

Widened pulse pressure Bradycardia Irregular respirations

Known breast carcinoma, now presenting with headache and vomiting?

Think increased SOL Dexamethasone

What do keratin pearls indicated?

Oesophageal SCC

What is raised in yolk sac variant of testicular tumour?

AFP

What is buck's fascia?

Deep layer of penile fascia that covers both corpus carvernosa and corpus spongiosum

What is the landmark for a pudendal block?

Ischial spine

Which muscle relaxant is depolarising?

Suxamethonium

8mm ureteric stone at ureterovesical junction. Pyrexial 38.9 with dilation

Cystoscope and JJ stent

What electrolyte disturbance causes perioral tingling?

Hypocalcaemia

Patient with recently diagnosed pancreatitis who suffered from seizures. Muscle weakness, hyper reflexia . ECG shows prolonged QT?? and T-wave inversion, which electrolyte?

Hypocalcaemia

Teardrop sign in the maxillary sinus, what is the cause?

Orbital floor fracture

Thyroglossal cyst investigation?

USS and FNAC

Define amelia

complete absence of the skeletal parts of a limb

Bone mets after breast cancer ,management of pain?

NSAIDs

Where does the lower part of the anal canal drain its lymphatics to?

superficial inguinal lymph nodes

Le fort level 3 fractures require which type of airway management?

tracheostomy

Lesion in what structure causes a homonymous hermianopia?

Optic tract

Level 5 lymph node dissection of neck. What nerve is at risk of damage?

Spinal accessory nerve

What condition are Necrobiosis granulomas associated with ?

Rheumatoid arthritis

Where does the vagus nerve enter the abdominal cavity?

Oesophageal hiatus

What type of cancer is myasthaenia gravis associated with?

Thymoma

What blood test can help diagnose allergies?

Tryptase - comes from mast cells

Where are IgA antibodies produced?

Mucus membranes of digestive tract

What is a sestamibi scan used for?

to evaluate function of parathyroid glands

What nerve supplies the skin on the dorsum of the foot?

Superficial peroneal nerve

What nerve root supplies pelvic diaphragm?

What type of cancer is caused from schistosomiasis haematobium?

Bladder SCC

What type of hernia occurs when the pleuroperitoneal canal persists?

Bochdalek hernia

Why does hypospadias occur?

Urogenital fold on ventral penis

What ECG change is seen due to hypothermia?

J wave

Where are the nuclei for CN 9 and 10 located?

Medulla oblongata

Where would bleeding post lumbar puncture come from ?

Vertebral venous plexus

Asthmatic on 15mg prednisolone for emergency repair of tibia, how to increase dose?

Double dose on day of surgery and next 2-3 days

lady with bilateral inguinal node..likely from

labia minora/clitoris

From ejaculatory duct sperm transmit to which part?

prostatic urethra

chorda tympani skull exit ?

Petrotympanic fissure

How smoking lead to ischemic foot ?

oxygen radicals effect nicotinic receptors

lymphatic drainage of the caecum

ileocolic

What types of polyps are seen in FAP

tubular adenoma

Neck mass with compressive symptoms?

retrosternal goitre

Supply to which structure defines left heart dominance?

circumflex artery

Cause of varicocele, blockage in which vessel?

testicular vein Need to do abdominal USS to exclude tumour compressing vein

What maintains the resting potential?

Stricture in biliary ducts is associated with which disease?

Ulcerative colitis

How does prostate ca metastasise to spine?

Vertebral venous plexus

What is the idication for a ventilatory support in a burn patient?

carboxyhemoglobin 20%

Type of gallbladder stone in sickle cell patient ?

pigment and cholesterol

Which structure crosses external iliac vessel to enter deep inguinal ring?

Inferior epigastric vessels

Factors responsible for coagulopathy and hyprfibrinolysis in poly trauma

Activated protein c and plasminogen

When a tourniquet is released, what causes vasodilation in systemic arterioles?

Histamine

16 yr old with soft tissue mass?

ewings sarcoma

Which nerves are responsible for maintaining an erection

I think pudendal although the answer on this recall was parasympathetic pelvic splanchnic nerves

What is the action of the psoas muscle?

Flexion and abduction

Which nerve root supplies extensor hallicus longus?

What is the lymphatic drainage of the body of the uterus?

external iliac lymph nodes

Which type of shock causes a low SVR?

Septic

What nerve provides taste sensation to the anterior 2/3 of the tongue?

Facial nerve via the chorda tympani

Where does the facial nerve exit the skull?

Stylomastoid foramen It leaves the cranial cavity via the internal acoustic meatus, then travels through the facial canal to exit the skull via the stylomastoid foramen.

Histology of a discrete palpable lump in the breast of a 34- year-old woman has shown Apocrine metaplasia, epithelial overgrowth and papillary projections. What is the most Likely pathological process ?

Benign breast cyst