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MRCS - Part A > Other > Flashcards

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1
Q

What is the lymphatic drainage of the vagina?

A

Superior aspect of the vagina - internal and external iliac nodes
Inferior aspect of the vagina - superficial inguinal nodes

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2
Q

Where do tumours of the uterine body metastasise to? As in, which nodes?

A

External Iliac lymph nodes

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3
Q

What type of hypersensitivity reaction is a organ rejection over years and what cell mediates this?

A

Type IV hypersensitivity
T lymphocyte mediated

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4
Q

When HLA typing for renal transplant, which are the most important antigens?

A

DR > B > A

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5
Q

What is the mechanism of action of neostigmine?

A

They prolong the action of acetylcholine by inhibiting the action of the enzyme acetylcholinesterase

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6
Q

Features of MEN IIB

A

Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Marfanoid appearance

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7
Q

Features of Gardner’s syndrome

A

AD disorder
Mutation of APC gene located on chromosome 5

Colonic polyps (FAP)
Supernumerary teeth
Jaw and skull osteomas
Congenital hypertrophy of retinal pigment.
Papillary Thyroid cancer
Epidermoid cysts, fibromas and sebaceous cysts

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8
Q

How does tranexamic acid work?

A

Antifibrinolytic
Competitively inhibits the activation of plasminogen to plasmin
Prevents fibrin degradation

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9
Q

What type of tumour causes hypervascular metastases?

A

Renal cell carcinoma

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10
Q

What substance is commonly used to sterilize endoscopic equipment?

A

Glutaraldehyde solution
Also used for laparoscopic equipment

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11
Q

What type of biopsy is used for a suspected lymphoma?

A

Excision biopsy

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12
Q

Define metaplasia

A

Conversion to a different cell type
Eg Gastric mucsoa in the duodenum

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13
Q

What are the symptoms of Wernicke encephalopathy?

A

Triad of ophthalmoplegia, acute confusion and ataxia

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14
Q

Marfan’s disease is due to a defect on the gene for which protein?

A

Fibrillin

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15
Q

Features of a giardia infection

A

Abdominal pain
Diarrhoea - floats as fat not absorbed
Bloating
Resistant to chlorination so found in swimming pool

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16
Q

What skin lesion has the following characteristics:
Solitary dermal nodules
Usually affect extremities of young adults
Lesions feel larger than they appear visually
What is their histology?

A

Dermatofibroma
Histologically they consist of proliferating fibroblasts merging with sparsely cellular dermal tissues

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17
Q

What is Choanal atresia?

A

Congenital disorder where posterior nasal airway occluded by soft tissue or bone.
Babies with unilateral disease may go unnoticed.
Presents with episodes of cyanosis during feeding, which improve when the baby cries
They can only breathe through their mouth

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18
Q

What is the Koebner phenomenon?

A

It describes skin lesions which appear at the site of injury. It is seen in:
Psoriasis
Vitiligo
Warts
Lichen planus
Lichen sclerosus
Molluscum contagiosum

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19
Q

What type of immunoglobulin is responsible for hyperacute organ rejection?

A

IgG - antibody mediated

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20
Q

What type of ulcer base is heaped up?

A

SCC - Marjolin’s ulcer

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21
Q

What causes hydatid cyst?

A

Tapeworm parasite Echinococcus granulosus

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22
Q

What is the medical management of hydatid cysts?

A

Albendazole or mebendazole.
Praziquantzel in pre-operative stages

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23
Q

What are the radiological features of achondroplasia?

A

Large skull with narrow foramen magnum
Short, flattened vertebral bodies
Narrow spinal canal
Horizontal acetabular roof
Broad, short metacarpals

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24
Q

What is the mechanism of action of glucocorticoids?

A

By binding to intracellular receptors that are then transported to the nucleus where they affect gene transcription

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25
What cancers are associated with EBV?
Burkitt's lymphoma Hodgkin's lymphoma Post transplant lymphoma Nasopharyngeal carcinoma
26
What oesophageal malignancy is associated with achalasia?
SCC
27
What are Burton's lines?
Blue lines on gum, indicative of lead poisoning
28
Acute intermittent porphyria is due to deficiency in what enzyme?
Porphobilinogen deaminase
29
What are the symptoms of acute intermittent porphyria?
Abdominal: Abdo pain, vomiting, constipation Neurological: motor neuropathy Psychiatric: depression Autonomic: hypertension, tachycardia Dark red urine
30
What sort of genetic inheritance is acute intermittent porphyria?
Autosomal dominant
31
What sort of genetic inheritance is achondroplasia?
Autosomal dominant
32
What is seen on histology for actoinomycosis?
Gram positive organisms with sulphur granules
33
What cells make up the islets of langhans and what do they secrete?
Beta cells - insulin Alpha cells - Glucagon Delta cells - somatostatin F cells - pancreatic polypeptide
34
Causes of hypomagnaesaemia
Diuretics Total parenteral nutrition Diarrhoea Alcohol Hypokalaemia, hypocalcaemia
35
What is the half life of insulin?
<30 mins
35
What is seen on microscopic evaluation of amyloid tissue?
birefringence under polarised light
36
What is the commonest cause of filariasis (elephantiasis)?
Wuchereria bancrofti
37
What type of cancer is linked to working with PVC (vinyl chloride)?
Hepatic angiosarcoma
38
Causes of oxygen dissociation curve moving left?
Increased affinity for oxygen Due to decreased oxygen requirement by the tissue such as 1. Alkalosis 2. Hypothermia 3. Reduced levels of DPG 4. Polycythaemia 5. HbF
39
What is the Bohr effect?
Hemoglobin's oxygen binding affinity is inversely related both to acidity and to the concentration of carbon dioxide i.e. a decrease in carbon dioxide provokes an increase in pH, which results in hemoglobin picking up more oxygen. and an increase in CO2 provokes a decrease in pH and subsequent decrease in oxygen affinity
40
Causes of decreased oxygen binding affinity?
Increased CO2 Increased H+ (lower pH) Increased DPG Increased temp
41
What receptors does ondansetron act on?
5HT3 chemoreceptor of the area postrema (medulla oblongata)
42
What are popcorn cells?
They are a variant of reed sternburg cells that are seen in nodular lymphocyte predominant hodgkins lymphoma. They appear as a hyper nodulated nucleus with a small nucleoli
43
What are the 5 parts of the JVP waveform?
Upwards A - atrial contraction (missing in AF) C - ventricular contractionand tricuspic closure V - atrial filling Downwards X - atrium relaxes and tricuspid moves down Y - ventricular filling/atrial emptying
44
Why does hyperventilation lead to circumoral parasthesia and muscular twitching?
Hyperventilation -> Respiratory alkalosis -> lowers ionised calcium levels
45
What substance is released from the sympathetic nervous system to stimulate the adrenal medulla?
Acetylcholine
46
What sort of gene is p53 and where is it located?
Tumour suppressor gene located on chromosome 17
47
What is the formula for mean arterial pressure?
MAP = DP + 1/3(SP – DP)
48
What is the formula for systemic vascular resistance?
SVR = ((MAP-CVP)/CO ) x80
49
Which cell type is the only one to not have mitochondria?
Erythrocyte
50
How do erythrocytes generate energy?
Glycolytic pathways
51
What amino acids are collagen made up by?
Glycine and prolene
52
What are the 3 main features of MENII
Medullary thyroid cancer Hyperparathyroidism (hypertrophy) Phaeocromocytoma
53
Which factors are affected by warfarin?
II, VII, IX, X and protein C
54
What are the 2 classes of potassium sparing diuretics and where do they act in the kidney?
Aldosterone antagonists eg spironolactone and eplerenone Epithelial sodium channel blockers eg amiloride and triamterene Collecting ducts
55
What cells secrete pepsinogen?
Chief cells
56
What factors increase and decrease renin secretion?
Increase: Catecholamines Erect posture Sympathetic nerve stimulation Hypotension Hyponatraemia Decrease: NSAIDs Beta blockers
57
What factors cause release of glucagon from alpha cells in the islets of langherhans?
Decreased plasma glucose Increased catecholamines Increased plasma amino acids Sympathetic nervous system Acetylcholine Cholecystokinin
58
What are the ECG features of hypokalaemia?
U waves Small or absent T waves (occasionally inversion) Prolonged PR interval ST depression Long QT interval
59
Which infectious organism demonstrates both worms and eggs within faeces? What are other features of it?
Ascaris lumbricoides No anal pruritus Sub-saharan africa or asia
60
What parasitic organism causes anal pruritus?
Enterobius vermicularis
61
What renal condition is associated with muddy brown casts and increasing creatinine?
Acute tubular necrosis
62
What substances are tested for in blood and urine for carcinoid syndrome?
Blood - chromogranin A, neuron-specific enolase (NSE), substance P, and gastrin Urine - 5 HIAA (metabolite of serotonin)
63
Features of keratoacanthoma
Rapid growing dome shaped erythematous lesion Central keratin which begins to necrose and slough off
64
Where does aldosterone act on the nephron?
Distal convoluted tubule and collecting duct
65
Where does parathyroid hormone act on the nephron?
Proximal and distal convoluted tubule
66
How do thiazide diuretics work?
Inhibits the reabsorption of sodium in the distal convoluted tubule. Examples incude bendroflumethiazide, chlortalidone, cyclopenthiazide, indapamide and xipamide.
67
Where does furosemide act on the nephron? And how does it work?
It acts on the sodium/potassium/chloride co-transporter on the thick ascending loop of henle
68
What hormone inhibits ADH?
Anti natriuretic peptide release from stretched cardiac atria due to increased BP
69
What is the action of ADH?
Increases aquaporin 2 channels in collecting ducts and therefore water reabsorption
70
What is the equation to for anion gap? And what is the normal anion gap?
(Na+ + K+) - (Cl- + HCO3-) 10-18 mmol/L
71
What are the causes of a normal anion gap acidosis?
Hyperalimentation/hyperventilation A - Acetazolamide R - Renal tubular acidosis D - Diarrhoea U - Ureteral diversion P - Pancreatic fistula/parenteral saline
72
What amino acids are catecholamines derived from?
Tyrosine
73
What drugs impair wound healing?
Drugs: NSAIDs, chemotherapy, steroids, immunosuppressive drugs
74
What non drug factors impair wound healing?
D iabetes I nfection, irradiation D rugs eg steroids, chemotherapy N utritional deficiencies (vitamin A, C & zinc, manganese), Neoplasia O bject (foreign material) T issue necrosis H ypoxia E xcess tension on wound A nother wound L ow temperature, Liver jaundice
75
What is the thin bluish - white margin that appears around a skin graft about a week later? At what rate does this process occur?
Re-epithelialisation 1mm/day
76
What cell type is associated with desmoid tumours?
Myofibroblasts
77
Name a type of anthracycline and describe their mechanism of action
Doxorubicin and epirubicin Inhibits DNA and RNA synthesis by intercalating base pairs
78
When performing minor surgery in the scalp, which of the following regions is considered a danger area as regards spread of infection into the CNS? And why?
Loose connective tissue Contains emissary veins which pass intracranially
79
What factors can cause a falsely elevated 5-HIAA 24 hours urinary level?
Food: spinach, cheese, wine, caffeine, tomatoes Drugs: Naproxen, Monoamine oxidase inhibitors Recent surgery
80
What is the correct diagnostic investigation for suspected lymphoma in the context of axillary lymphadenopathy?
Excision biopsy of lymph node
81
What are the features of Li-Fraumeni Syndrome?
Autosomal dominant Due to germline mutations to p53 tumour suppressor gene Sarcomas and leukaemias
82
What is plexiform neurofibroma?
A hallmark finding of neurofibromatosis type 1. A sheet of neurofibromatosis tissue encases major nerves which attracts extra blood circulation and can accelerate growth of the affected limb
83
What is the mechanism of action of glucocorticoids?
binding intracellular receptors that are then transported to the nucleus where they affect gene transcription
84
How do catecholamines work?
Increasing cAMP levels by adenylate cyclase stimulation. This increases intracellular calcium ion mobilisation and thus the force of contraction.
85
What are the effects of binding to the following cell receptors: a1 and a2 B1 B2 D1 D2
a1 and a2 - vasoconstriction B1 - increased cardiac contractility and HR B2 - vasodilatation and bronchodilation D1 - renal and spleen vasodilatation D2 - inhibits release of noradrenaline
86
What receptors do the following drugs act on: Adrenaline Noradrenaline Dobutamine Dopamine
Adrenaline - a1, a2, B1, B2 Noradrenaline - a1 Dobutamine - B1 Dopamine - D1, D2
87
What happens to cardiac output and systemic vascular resistance during hypovolaemia?
Cardiac output - Low Systemic vascular resistance - High
88
What factors mediate vasodilation?
histamine prostaglandins nitric oxide platelet activating factor complement C5a (and C3a) lysosomal compounds
89
What are the effects of cholecystokinin?
Increases secretion of enzyme-rich fluid from pancreas Contraction of gallbladder and relaxation of sphincter of Oddi Decreases gastric emptying Trophic effect on pancreatic acinar cells Induces satiety
90
What medicine is used to treat carcinoid syndrome?
Octreotide
91
What is Kartagener's syndrome?
Triad of situs invertus, chronic sinusitis and bronchiectasis The primary problem is of immotile cilia
92
What blood test is diagnostic of EBV infection?
EBV causes infectious mononucleosis It is tested for with Paul Bunnell test
93
What condition are elliptical cells associated with?
Hereditary spherocytosis
94
What skin condition is glucagonoma associated with?
necrolytic migratory erythema
95
What are asteroid bodies indicative of?
sarcoidosis
96
Which 2 types of bacteria are most likely to cause a liver abscess?
E.coli Klebsiella pneumoniae Both are gram -ve rods
97
What is inulin used for?
To estimate glomerular filtration rate
98
What substance is used to determine renal plasma flow?
Para-amino hippuric acid
99
What paraneoplastic syndrome is seen with squamous cell carcinoma of the lung?
Hyperparathyoidism Ca High PTH High PO4 low
100
What is the histological composition of a hamartoma?
A combination of cartilage, connective tissue, smooth muscle, fat, and respiratory epithelium
101
What virus is associated with Kaposi's sarcoma?
Human herpes virus 8
102
What is the effect of beta blockers on insulin release?
Inhibits release of insulin

MRCS - Part A (16 decks)

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