Misc 8 Flashcards
1
Q
What are the 4 subtriangles of the anterior triagnel of neck?
A
Submandibular
Submental
Carotid
Muscular
2
Q
What are the 2 subtriagnels of the posterior triangle of neck?
A
Occipital
Subclavian
3
Q
What innervates omohyoid?
A
Ansa cervicalis
4
Q
Which nerve passes just anterior to the external carotid artery?
A
Hypoglossal
5
Q
Why is ligating the facial artery ok in tersm of muscles not necrosing?
A
Anastomosis from lingual
6
Q
Motor innervations of V3?
A
Masseter and muscles of mastication
Mylohyoid
Ant belly digastric
7
Q
Level of tracheoseophageal junction?
A
T4/5
8
Q
Which PNS ganglion innervates parotid?
A
Otic
9
Q
Which region does pre aurigcular LN drain?
A
Superior deep cervical
10
Q
What are diploic veins?
A
Venous connection between outer and inner cortical bones of skull
11
Q
What bones comprise the pterion?
A
Sphenoid, frontal, parietal, temporal
12
Q
Which 3 muscles attach to styloid process?
A
Stylohyoid
Styloglossus
Posterior belly digastric
13
Q
What joint exists between peg and atlas?
A
Pivot synovial joint
14
Q
What are the movements of the temporomandibular joint? What is responsible for them?
A
Protrusion - pterygoids
Retraction - temporalis, masseter, digastric, geniohyoid
Elevation - temporalis, masseter, medial pteyroids
Depgression - digastric, geniohyoid, mylohyoid
Lateral - lateral pterygoids
15
Q
Blood supply to temporalis?
A
Deep temporal artery from maxillary from ECA
16
Q
3 nreves at risk during submandibular gland surgery?
A
Hypoglossal, lingual and marginal mandibular
17
Q
Surface anatomy of parotid duct?
A
Middle third of line between phylum and antitragic notch, 1 cm below zygomatic arch
18
Q
What kind of secretions do parotid gland procude?
A
Serous
19
Q
What connects spinal nerves to the sympathetic chain?
A
Rami communicantes
20
Q
Blood supply to bladder?
A
Vesical arteries via internal iliac
21
Q
What are the peritoneal relections of the bladder?
A
Superior and upper posterior surfaces (dome)
22
Q
Innervation of detrusor?
A
PNS via pelvic splanchnic
23
Q
What ligaments conrtubte to the stability of the atlanto-axial joint?
A
Cruciate - transverese and linogitdunial
Alar
24
Q
What level is the hyoid?
A
C3
25
Why cant you feel the upper cervical spinous processes?
Bifid and atach to nuchal ligament
26
what level does the oesophagus begin?
C6
27
What is the main component of the deltoid ligament of ankle?
Tibionavicular lig
28
Which position is ankle most stable in? Why?
Dorsiflexion, widest diameter of talus
29
Define a hernia?
Protrusion of a viscus or part thereof from cavity which it is normally contained in
30
Describe how to examine the hand?
Ensure comfort, fully expose elbows and examine whole hand/forearm for scars e.g. CT release
Examine nails
Examine for muscle wasting or deformity
Feel - MCPJ squeeze as screen, ASB tenderness
Functional movements
CT tests - Tinels and Phalens
Ulnar test - Froment
De Quervains tenosynovitis - finkelsteins
Nerves - median (APB), ulnar (minimi abduction), radial (wrist ext)
Pulses
To complete - say would examine elbow
Full history and XRs
31
Describe how to examine the knee?
Full exposure to underweat to ankles
Look from front, back and sides for deformity/scars/wasting and gait assessment
Feel - warmth, effusions (gutter test and patella tap), along jointlines, patella tracking
Move - flexion/extension, hyperextend with foot lift and full flexion with heel to bottom
Specials - collateral legs, rawer tests, lackmann for ACL, mcmurrays for meniscus, SLR
To complete - examine hip and ankle, history and XRs and neurovascular function
32
Descrbiei how to examine the shoulder?
Full exposure ideally with top rmeoved
ensure comfort
Look for obvious deformity incl winging or swelling, scars from previous surgery, wasting of fossae/deltoid
Feel - from distal to prox- humerus, ACJ, clavicle, coracoid, scapula, SCJ
Move - full abduction + adduction, assess for painful arc, flex/ext, int rot, ext rot
Passive movements feeling GHJ and ACJ for crepitus
Resisted movements for rotator cuff
Neuro - axillary nerve - deltoid and regimental badge
Subacromial impingement - Hawkins/jobe
ACJ - scarf test
Instability - Drawer/aprehension test
Examine c-spine and elbow, history and Xrays
33
What are the differernt parts of painful arc shoulder ax?
Initiation = supraspinatus pathology
painful 70-100 degrees = GHJ painful arc e.g. subacromial impingenemtn
painful 170 degrees = pain due to ACJ
34
Describe how to examine the hip?
```
Full exposure down to underwear
Standing ideally
Loko - scars, deformity including limb length, rotation, scoliosis, pelvic tilt, muscle wasting
Gait - antalgic/trendelenberg/ataxi/high stepping/circumduction
Trendelendberg test
Then on couch - feel joint, trochanter, asis, ramus/symphysis
Measure apparent (symphysis to med mal) and true (ASIS to med mal) lengths
Move - active then passive incl SLR
Thomas test - for hip flexor contracture - fully flex both hips, hand under lordosis, extend each leg
NV assessment, examine spine and knee, hx and XRs
```
35
What does a cirfcumducting gait suggest?
Weakness of hip flexors
36
Whta is a positive trendelenberg test?
Sound side sags - weakness of tested side hip abductors causing sagging of contralat normal side
37
How would you measure true and apparent leg lengths for hip exam?
```
True = ASIS to med mal
Apparent = fixed midline point to med mal
```
38
What are you palpating for in hip exam?
Greater troch - bursitis
| Movement with hand on ASIS for pain/crepitis
39
Questions ins the AMT?
```
Age/DOB
Place/time/year
Recognise
Recall
20-1
Moarch/PM
WW2 dates
```
40
Rough prognostic scores for Glasgow mortality in pancreatitis?
Score 0-2 = 2%
3-4 = 15% (severe pancreatitis)
5-6 = 40%
7-8 = 100%
41
Reasons for pancreatitis causing low Ca?
Fat saponification (fat digestion which releases free fatty acids which form calcium salts)
Low albumin
ARF causing hypoCa, hypoMg
42
How do pancreatic pseudocysts occur?
In severe pancreatitis, leakage of pancreatic fluids causes inflammatory response and encysts fluid with fibrous tissue
43
4 safety features of PCA?
Locked unit
Non-return valve on line
Measured dosing
Lockout if freq use
44
What are the SIRS criteria?
RR over 20
tachycardia over 90
temp over 38 or less than 36
WCC over 12 or less than 4
45
Level of epidural block depends on what 3 things?
Dose
Duration
Position
46
Lifespan of a RBC in body?
120 days
47
When do cross match, what 3 main things are being xmatched?
ABO
Rhesus
Kell
48
What are the 4 stages of fracture healing?
Haematoma and inflammation
Cartilagenous callus
Bony callus
Re-modelling
49
Crieteria for evacuating aSDH?
Associated with neurolgial deficit
Over 1cm thick
Over .5cm midline shift
50
Give the 5 portocaval anastamosis veins?
Left gastric (oesophageal branches) and short gastric to distal oesophageal veins
Slenic vein to left renal vein in lienorenal ligament
Retroperitoneum - SMV to petroperitoneal/lumbar veins to IVC
Paraumbilical vein to aubcutaneous periumbicilal veins
Anal - SRV to IMV, upper anal canal veins to iliac
51
Shelf life of platelets?
5 days
52
3 indications for platelet transfusion?
Massive transfusion over 4 units
Plaetelets less than 50 and symptomatic/for surgery
DIC
53
Give 3 mechanisms of haemostsis?
Vasospasm
Platelet plug
Coagulation
54
What does TPN contain?
Carbs, fluid, protoein, fat, electrolytes, nitrogen, trace elements
55
What are 4 issues with using continuous glucose as only energy source?
Hyperglycaemia
Poor utilization during stress
Excess is converted to fat
Produces excessive CO2
56
5 complications of TPN?
```
Sepsis from line
Hyperglycaemia
Electrolyte disturbances
Cholestasis
Bowel mucosal atrophy
```
57
What is the implication of mucosal atrophy in e.g. TPN use?
Translocation of bacteria to blood stream causing sepsis
58
Define ARDS?
Acute diffuse inflammatory lung injury leading to increased pulmonary vascular permeability, increased lung weight, loss of aerated lung tissue with hypoxaemia and bilateral radiographic opacities, associated with decreased lung compliance
Not fully explained by cardiac failure or fluid overload
59
What is the criteria for diagnosing ARDS called?
Berlin criteria
60
How to treat acute hypocalcaemia?
IV 10mls 10% calcium gluconate over 10 mins
61
Give 4 physiological roles of calcium in the body?
Cardiac
Nervous system
Haemostasis
Bone
62
2 reasons for post op hypocalcaemia in thyroidectyom
Ischaemia to parathyroids
| Inadvertent removal
63
Why may hypoCa cause SOB?
Tetany - laryngoosapsm causing upper airway obstruction
64
hy is there paroxysaml aciduria in gastric outlet obstruction?
Chloride depletion means Na/Cl and Na/K/Cl pumps dont function properly in kidneys
Aldosterone Na/K exchanger utilised until K depleted
Then Na/H exchanger used to retain Na
So H booted out
65
How do the kidneys compensate long term for caidosis?
Produce and excrete ammonium - geneerate HCo3 which goes into circulation, and excreting H+ as phosphate and amoonia
66
What is bilirubin metabolised to (acids)
Glucoronic and taurocolic acids
67
The use of which fluid is impliacted in TURP syndrome? Why is it used?
Glycine - irrigating fluid
| Used because electrocautery loop is used to pferorm, so cant use normal saline as could disseminate current
68
4 complications seen in TURP syndrome?
Hypervolaemia
Hypothermia
Hyponatraemia
Hyperammonaemia
69
Define ARDS (short version)?
Diffuse alveolar damage and lung capillary endothelial injury causing non-cardiogenic pulmonary oedema with reduced lung compliance and hypoxaemia
70
Define Barretts oesophagus?
Columnar metaplasia of stratified squamous epithelium of the esophagus yielding an increased risk of developing adenocarcinoma
71
What is Breslow thickness measured to and from?
From top of stratum granulosum to deepest point of tumour involvement
72
What is PVL and what is it seen in?
Cytotoxin seen in most community associated MRSA
73
What is the other way of staging mellanoma other thant Breslow?
Clarks level
74
What measurement can be used to identify ARDS?
Swan Ganz - PCWP less than 18
75
4 diagnostic citeria for ARDS?
Acute onset (less than 1 week)
Ratio - pao2:fio2 low
Diffuse pulmonary infiltrates on CXR
Swan Ganz catheter - PCWP less than 18
76
What is the principle of Mohs micrographic surgery?
Serial sectiosn taken and examined histologically until all margins are clear
77
What ventilatory factors might be useful in managing ARDS?
Mechanical - high PEEP, small tidal volumes
Proning
Inhaled nitric oxide
78
Give 4 benefits of using PEEP in ventilation?
Improves alveolar recruitment
Increases compliance
Increase functional residual capacity
Reduced physiological shunting and increased VQ ratio
79
Give 4 things that the blood brain barrier is permeable to?
Lipids
Lipid solube .e.g drugs
Glucose
Respiratory gases
80
What 2 things make up the blood brain barrier?
Tight junctiosn between cerebral capillary endothelial cells
| Astrocytic foot processes at basal membranes of cererbal capillaries
81
What is the value of cerebral blood flow? How much of CO is this?
750ml per min
| 15% of CO
82
What is the normal CPP?
70-100mmHg
83
Which lung volumes on spirometry are directly measured?
Tidal volume
Vital capacity
Inspiratory capacity (via tidal volume + inspiratory reserve volume)
84
What is the functional residual capacity?
Volume of gas in lungs at the end of expiration
85
What level of COHb is abnormal and suggests carbon monoxide posioinoing?
Over 10%
86
Hoe is vitamin D producdes?
```
Vitamin D3 (colecalciferol) is formed in skin when cholesterol precursor exposed to UV light
This is activated in liver (25 hydro) and then kidney (1 hydro) to activated vit D
```
87
Max safe dose of bupivocaine?
2ml/kg with or without adrenaline
88
Maximum safe dose of prilocaine?
6ml/kg
89
What is vicryl made of?
Polyglactin
90
2 monofilmanet absorbable sutures?
Monocryl and PDS
91
What are langers lines precisely and why are they important?
Topological lines drawn on map of human body correspodning to natural orientation of collagen fibres in dermis, and generally parallel to orientation of underlying muscle fibres. Promote good wound healing
92
When doing FNAC, how many times should you pass through the needle
5-6 times through tissue
93
Describe how to do surgical cricothyroidotomy?
2cm vertical incision over cricothyroid membrane
Horiztonal incision through membrane
Tracheal hook in to stabilise trachea
Insert dilator
Take dilator out and insert tube into trachea
94
Where is a tracheostomy tube inserted?
Between 2nd and 3rd tracheal rings, following division of the thyroid isthmus
95
How to size a hard collar?
Top of shoulder to bottom of jaw, with finger widths
| Then apply to collar adjustment bit
96
Clotting factors in intrisic pathway?
8-12
97
Clotting factors in extrinsic pathway?
2, 7, 10
98
What is the difference between metatstatic and dystrophic calcification? Example of latter
```
Metastatic = calcification of normal tissue in hypercalcaemia
Dystrophic = deposition of calcium in abnormal tissues e.g. vascular collagen diseases, with normal calcium. e.g. DCIS breast Ca
```
99
Why is stapling not used in primary anastaomsosis in the setting of bowel obstruction?
Bowel usually thick and inflamed, too thick to hold staples
100
What are the signs of viability in bowel?
Pink, peristalsing, perfused
101
What is the difference between the adreanl venous drainage on right vs left?
Right straight into IVC
| Left into renal vein
102
What is the difference between a ghon focus and ghon complex?
```
Focus = primary pulmonary TB lesion
Complex = lesion plus affected LN
```
103
What infusion may be used to inentigy parathydoi tissue when doing parathyroidectomy?
Methylene blue
104
What should you check to confirm resection in hyperPTH resection?
Frozen section
| Measure PTH in serum - should normalise after 30 mins
105
What effect does PTH have on PO4 and why?
Lowers it - via phosphaturia to increase Ca reabsorption
106
3 factors inducing release of pancreatic exocrine secretion?
Vagal mediated cephalic stimulus - sight and smell of food
Vagal mediated gastric phase - gastric distension
Hormonal intestinal phase - CCK, and secretin (biarcb)
107
What med might be useful in pancreatic fistula with high output and why?
Somatostatin analgoue e.g. octreotide - reduces exocrine secretion
108
How would you examine and manage an anal fistula?
```
Lithotomy position
DRE + rigid sigmoid/proctoscopy
Vertical incision over abscess and evacuate pus
Irrigate, curette
Insert alginate based pack
```
109
What is Goodsall's rule for fistula in ano?
If anterior to transverse anal line and within 2cm of anal canal, will have straight tract to internal opening
If posterior to line and witihin 2cm of canal, will curve posteriorly to open in posterior midline
110
Potential management strateiges for anal fistula?
Setons
Fistulotomy
Advancement flaps, glue, plugs etc
111
What causess the dicrotic notch in art line?
Elastic recoil of arteries as heart ceases to eject column of blood
112
Calculating MAP?
DBP + 1/3 SBP-DBP
113
Define renal clearance of a substance?
Volume of plasma completetly cleared of a substance in 1 minute
114
4 factors that make inulin ideal for measuring GFR?
Freely filtered at glomerulus
Not secreted or reabsorbed in tubules
Not metabolised by kideny
NDoesnt in itself afect the GFR
115
What is the Hawthorne effect in audit?
Perforamnce affected by knowledge that process or prerson is being monitored
116
3 ECG signs of hyperK?
Flattening of p waves
Tenting of t waves
Widening of QRS
117
Why can hyperventilation cause low Ca?
Increased excretion of CO2 and resp alkalosis
H+ ions dissociate from albumin, which then preferentially binds calcium
So ionised calcium level falls
118
Describe metabolism of bilirubin?
Formed via breakdown of red cells in Kuppfer cells of liver - unconjugated and transported to the liver, where is conjugated with glucoronic acid and secreted in bile
Conjugated bili not absorbed from small bowel due to size, hydrolysed in terminal ileum and then reduced to uro/stercobilinogen
Res tis reabsorbed and enters enterohepatic circulation
119
Usual capnoperitoneum pressure?
10-12mmHg
120
How does herparin work?
Activated antithrombin 3 inactivates thrombin
121
What test might be useful in vWD patients pre op?
Desmopressin challenge
