new part A 2020 Flashcards by Ra Nd

Surface marking of the femoral artery?

Mid-inguinal point

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Content of the adductor canal in order?

from lateral to medial: a continuation of the apex of the femoral triangle.
Laterally: Lateral cutaneous nerve of the thigh, femoral nerve, Femoral artery, femoral vein.

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Discuss Femoral triangle

It is medially bound by the adductor longus, laterally sartorius, superiorly inguinal ligament, floor is pectinus.

Content L to M: Nerve, artery, vein, lacunar ligament.

Femoral sheathe contains all the above except the lacunar ligament because it is medial. in the female contains Cloquet’s node (also Rosenmuller’s node)

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Mid inguinal point Vs mid point of inguinal ligament?

Mid inguinal point is from ASIS to the pubic symphsis, this gives the landmark inferiorly to the femoral artery.

Mid point of inguinal ligament is lateral compared to the former(ASIS to pubic tubercle). this represents inferiorly the landmark of the femoral nerve and the deep inguinal ring.

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Conn’s syndrome Vs Addison disease?

Addisons: Adrenal insufficiency
Conns: Hyperaldosteronism.

Adrenal insuficieny / Addison:
Not enough cortisol, glucocorticoids, mineralcorticoids, not enough aldosterone -> Hyponat, Hyperkal, Increased ACTH due to lack of adrenal activity, hence increased melanin. Low BP, low mood, Hypercalcaemia from Reduced GFR due to lower volume.

Conns/ Hyperaldosteronism: Opposite of Addisons. Hypernat, hypokal, hypocal, hypomag. Not too much aldo, high BP.

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Papillary thyroid Ca. What do you know about it?

80-85% of all thyroid Ca.
Spread via Lymphatics
Psamomma bodies.
Orphan anni cells.

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Tell me about otitis media.

Common in paeds.
Strep pneumo, strep pyogens, staph aureus, H. Influenzae.

Dural venous thrombophlebitis posterior to the ear of the mastoid air cells.

Mastoid air cells are part of the temporal bone.

When tX, first line is Abx, exploratory is reserved is resistant.

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Tell me the 12 CN Nerves.

CN I: Olfactory nerve
CN II: Optic nerve
CN III: Oculomotor nerve
CN IV: Trochlear nerve
CN V: Trigeminal nerve (First ph. pouch) V1 opthalmic, V2 Max, V3 Mand
CN VI: Abducens nerve
CN VII: Facial nerve (2nd Ph. pouch)
CN VIII: Vestibulocochlear n.
CN IX: Glossopharyngeal n. (3rd Ph. pouch)
CN X: Vagus Nerve (4th Ph. pouch)
CN XI: Accessory Nerve
CN XII: Hypoglossal Nerve

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Foramen rotundum contents and which bone

Max nerve, V2
opening in the greater wing Sphenoidal bone.
Anterio-medial to foraman ovale.
it connects the middle cranial fossa to the pterygopalatine fossa.

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Foraman ovale content

Mandibular nerve
motor root of the trigeminal nerve
accessory meningeal artery
lesser petrosal nerve
emissary vein

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Foraman spinosum content

Middle meningeal artery
Middle meningeal vein
Maybe also nervus spinosus

Posterior lateral to ovale.

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Hypoglossal nerve. Tell me what you know

Hypoglossal nerve.
Innervates the intrinsic muscles of the tongue.
Lesions cause ipsilateral deviations
Runs through the hypoglossal canal located in the occipital bone medially and superiorly to the occipital condyles.

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CN X. Tell me about it.

Vagus nerve.
From the 4th Ph. Pouch.
Innervates the palate. Ipsilateral deviations to the site of lesion.
Travels through the jugular foramen.

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Hassall’s corpuscles

Anterior mediastinum, also called thymic corpuscles found in thymus.

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What muscle opens the jaw?

Lateral Ptreygoid

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Muscles of mastication

Masster, temporalis, medial and lateral pterygoid

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Buccinator muscle function?

Tightens the cheeks and presses them against the teeth while chewing.

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List common organisms causes necrotising fasciitis

Psudomonas aerugoniosa _____G-ve, rod, sweet/grape smell
Clostridium perf. ____G+ve rod
E.coli ____G-ve rod
MRSA ____G+ve rod

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Post splenectomy vaccines?

H.influenza type B
N. meningiditis
Strep pneumoniae

(ALL encapsulated)

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which H.Influenza is encapsulated?

H. influenza B is encapsulated, A is not

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Deep peroneal nerve root

L4-S2

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Cholecystokinin (CKK) function?

Relaxes sphincter of Oddi.
Contracts gall bladder
Constricts pyloric sphincter
Inhibits appetite by acting on hypothalamus

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Lynch syndrome

Autosomal dominant due to mismatch repair gene defect/ Part of the HNPCC. Associated with Endometrial, ovarian, colorectal. and other genitourinary tumors
Histologically likely to be mucinous and likely to be right sided.
strong genetic history

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Hodgkins lymphoma

Reed sternberg cells (Bi-lobed nucleated B lymphocytes).
subMandibular node swelling.
Night sweats.
Fever

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AML

Auer rod

Sarcoidosis histology

Non-caseating granuloma

TB histology

Caesating granuloma with central necrosis

Respiratory accessory muscles

Scalene muscles and sternocleidomastoid

Celiac trunk arises at which level

T12

Paired bilateral aortic arteries branches

T12- inferior phrenic arteries, middle suprarenal arteries L1/L2: RENAL ARTERIES L2: gonadal arteries

4 Parasympathetic cranial ganglion

Ciliary, Otic, submandibular and pterygopalatine. stellate is sympathetic

Kaposi sarcoma associated with which disease

HHV-8, common with HIV, appears as a purple lesion on the mucosa or skin or internally.

Urachus dervied from ?

Allantois

Lumbar cistern anatomical level?

L1/L2 extending to S2

Midgut to hindgut transition point?

Proximal two thirds to distal third of the transverse colon

foregut to midgut transition point

Half way boundary at D2

First aortic arch?

Maxillary artery

second aortic arch

pharyngeal artery and stapedial artery

third aortic arch

common carotid and internal carotid

4th aortic arch

R subclavian on the R side and aortic arch on the L

6TH AORTIC ARCH

R & L pulmonary arteries

Medullary thyroid carcinoma

Amyloid deposition in 80% Part of MEN 2 cancer of the parafollicular cells raised calcitonin levels

antecubital fossa anatomy

Medially: lateral border of pronator teres Laterally: medial border of brachioradialis Floor is proximally brachialis and distally by supinator. Roof is skin and fascia of bicipital aponeurosis which arises from biceps brachii. Biceps brachii tendon is the most lateral border and medially is the brachial artery and median nerve. Medial cubital vein is above the aponeurosis and below the skin

Hodgkins vs non-Hodgkins features?

NHL is systemic lymphadenopathy, HL is localized lymph nodes

Medial arch of the foot anatomy

Made from the tibilias posterior inserts into the navicular tuberosity and base of the medial cuneiform. Travels through the tarsal tunnel

Tarsal tunnel anatomy

Anterior to posterior: Post. tibial tendn, flexor digitorum longus, post tibial artery, vein, nerve and flexor hallucis longus tendon. Flexor retinaculum. Tarsal tunnel is posterior to medial mall. and anterior to it is the great saphenous vein.

features of pulmonary sarcoidosis

Bilateral hilar lymphadenopathy raised ACE levels SOB

How does Gastrin work?

Binds to enterochromaffin cells by binding to CCK but does not bind directly to histamine cells

NICE guidelines for CT within 8 hrs for head injuries criteria?

Age of 65 years or older history of bleeding disorder >30 minutes of retrograde amnesia dangerous mechanism of injury

Post op infection time

After 72 hrs

where is potassium excreted in the nephron

Collecting ducts

most common location for urinary calculi to impact

VUJ

cat scratch disease ?

Bartonella henselae from cat saliva

Lyme disease

B.BURGDORFERI. EXODUS TIC ERYTHEMA MIGRANS BULLS EYE LESION Causes heart block

VACTERL

vertebral defect, anal atresia, cardiac defect, tracheo-oesophageal fistula, renal anomaly and limb anomalies

Solitary nucleus function and location

Antero medial on the medulla oblongata Purely sensory: Taste sensation from the tongue via chorda tympani of CN7 sensory info from the middle ear chemoreceptors in the carotid body baroreceptors in the aortic body.

Embryonic structure that forms nucleus pulposus

Notochord

Carotid sheath anatomy ?

medial: common carotid artery, internal carotid artery, Vagus nerve, internal jugular vein. at C3-C4 the common carotid bifurcates to the external carotid. Oesophagus is medial to the carotid sheath Vagus nerve is posterior lateral to the common carotid artery. Lobes of the thyroid are anterior to the sheath

Fluid maintenance in children

100ml/kg/24hr for the first 10kgs of the body weight 50 ml/kg/24hr for the next 10kgs of the body weight 20 ml/kg//24hr for the remainder weight

which foramen does the facial nerve leave the skull

Stylomastoid foramen

Aspirate in gout

Negative birefringent needle shaped crystals

Which vessels originates from the right ventricle and drains into the right atrium

Anterior cardiac vein

Which vein drains the inferior surface of the heart and drains into the coronary sinus?

Middle cardiac vein

Where does the hypoglossal nerve exit the skull?

Superior and medial to each occipital condyle

Hip extensor muscles?

Gluteus maximus Hamstrings ( Semitendinosus, semimembranosus and biceps femoris) Adductor magnus

Function of the gluteus medius?

Primary abductor of hip. Posterior portion causes hip extension and external rotation

Classify Salmonella, and give relation to orthopaedics

Encapsulated Gram negative rod. common cause of osteomyelitis in patients with sickle cell anaemia because of serial splenic infarct causing splenic dysfunction

On bimanual examination what is felt anteriorly to the vagina?

Base of the bladder

what is the level of luschka joint

C3 to T1

Which organism appears on Ziehl-Neelsen and Lowenstein-Jensen?

Mycobacterium TB

what is the most influential factor on prognosis of breast cancer?

Nodal involvement, the more nodes involved the lesser the prognosis

Duration of analgesia of lidocaine?

90 mins

Antagonist of benzodiazepines and GABA agonist

Flumazenil

Duration of bupivacaine?

6-8 hours

Diabetic develops swelling and abscess after tooth extraction. Pus is oozing from the affected gum. Swab shows anaerobic Gram positive bacterium?

Actinomyces israelii, produces yellow sulfur granules. DM causes immunodeficiency

Which of the following structures forms from the second pharyngeal arch?

Muscles of facial expression

Expected ECG findings in isolated obstruction of the circumflex coronary artery?

I and V5-V6

patient with traumatic brain injury, CT shows isolated contusion in a deep brain region. BP is 88/56 mmHg, HR 100bpm, temperature is 40.5 degrees. Plasma sodium is 121. What area of the brain is most likely affected?

Hypothalamus

Deep posterior compartment of leg content?

Popliteus, tibialis posterior, flexor hallucis longus and flexor digitorium longus. innervated by tibial nerve

Superficial posterior compartment of leg content?

Gastrocnemius, soleus and plantaris, innervated by tibial nerve

Lateral compartment of leg?

Peroneus longus and brevis, innervated superficial peroneal nerve

Anterior compartment content of leg?

tibialis anterior, extensor hallucis longus, extensor digitorum and peroneus tertius. innervated by deep peroneal nerve