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Pastest Past papers Flashcards

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1
Q

Which pancreatic enzyme should be tested for in a pateint C/O pale greasy stools?

A

Faecal elastase

Elastase required for fat digestion
Low levels seen in chronic pancreatitis and pancreas exocrine insufficiency

Serum lipase and amylase raised in acute pancreatitis, not chronic

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2
Q

What is the most appropriate landmark for injection site for pudendal nerve block?

A

Ischial spine

Pudendal nerve passes close to ischial spine as it reenters pelvis through lesser sciatic foramen

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3
Q

How can positive pressure ventilation affect venous return?

A

PPV increases intrathoracic pressure, which reduces venous return to the R side of heart

This leads to reduction in cardiac output

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4
Q

What fissure does the chorda typmani pass through to exit the middle ear?

What nerve does it then go on to join?

A

Chorda tympani exits middle ear via petrotympanic fissure

Joins the lingual nerve (branch of mandibular branch of trigeminal nerve which supplies sensation to ant 2/3 of tongue)

This allows the chorda tympani to carry taste to ant 2/3 of tongue

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5
Q

Name the structure that lies deepest in popliteal fossa and the structure that lies most superfical (most posterior)?

A

Deepest/most anterior = popliteal artery

Most superficial/posterior = tibial nerve

The common peroneal (fibular) nerve travels along lateral aspect of popliteal fossa and is not located within central region

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6
Q

Compare what the ascending and descending loops of henele are permeable/impermeable to?

What is the role of the collecting duct?

A

Descending loop - permeable to water, impermeable to Na and Cl

Ascending Loop - permeable to Na, Cl, K, Impermeable to water

Collecting duct- under control of ADH, allows resorption of water and concentrates urine

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7
Q

Is the metaplasia seen in Barretts oesophagus irreversible or reversible?

A

Reversible metaplasia

If reflux is managed early on, the columnar epithelium may revert back to the original squamous epithelium

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8
Q

In the stress state, how does cortisol raise BMs?

A

Gluconeogenesis

Occurs mostly in liver

Cortisol also encourages lipolysis

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9
Q

Which muscle moves thumb away from hand at right angle?

A

Abductor pollicis brevis and Abductor pollicis longus

Responsible for thumb abduction

AP BREVIS Part of the thenar eminance, innervated by median nerve

AP LONGUS a muscle of posterior arm, innervated by posterior interosseous branch of radial nerve

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10
Q

Compare the relationship of the right and left vagus nerves to the oesophagus in the oesophageal hiatus?

A

Right vagus passes posterior to oesophagus in oesophageal hiatus

Left vagus passes anterior to the oesophagus in oesophageal hiatus

Occurs at T10

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11
Q

What is the position of the DJ flexure in a healthy infant?

A

Left side, transpyloric plane (L1)

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12
Q

Which structure most likely to be injured in emergency splenectomy?

A

Tail of pancreas

Hilum of spleen is at level of transpyloric plane, L1

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13
Q

Which nerve is assessed in froments sign?

Which muscle is this?

A

Ulnar nerve tested

Testing adductor pollicis

Patient will bend their thumb in a positive froments sign - this means the adductor pollicis is non functional, and they are relying on flexor pollicis longus, which is innervated by the anterior interosseous nerve (branch of median nerve)

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14
Q

Which baroreceptors have the highest sensitivity to changes in BP?

A

Carotid sinus baroreceptors

They transmit sensory innervation via the glossopharyngeal nerve to brainstems nucleus tractus solitarius

Aortic arch baroreceptors are less sensitive and responsive - mainly modulate BP via the vagus nerve, so slower than carotid sinus

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15
Q

Which nerve innervates extensor pollicis longus?

How will damage to this nerve present?

A

Posterior interosseous nerve - a branch of the radial nerve. Innervates extensor muscles

Damage will result in loss of thumb extension

Will be unable to lift the thumb off the table

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16
Q

What is a key feature on XR to identify jejunal dilatation?

A

Valvulae Conniventes

If them plus multiple air bubbles present on XR, suggestive of jejunal dilatation

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17
Q

Where is lymph from a lesion located laterally on the ant 2/3 of tongue most likely to drain initially?

A

Will drain to submandibular nodes

Lesions on tip of tongue will drain to submental nodes

Theyll both then drain to deep cervical nodes

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18
Q

What structure is a posterior relation to the adrenal glands?

A

The right and left crus of diaphragm

The Quadratus lumborum is located in the posterio abdominal wall and is a posterior relation to the lower 2/3 of the left kidney

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19
Q

Where does the radial nerve traverse from the posterior to anterior compartment of the arm?

A

The lateral intermuscular septum

A fascial plane seperating the anterior and posterior comaprtments of the arm

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20
Q

Which muscle of the thumb allows it to make a 90 degree angle with the palm?

A

Opponens pollicis muscle

Innervated by median nerve

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21
Q

Which nerve root is affected if patellar reflex is diminished?

A

L4

Dorsiflexion is L5

Ankle reflex is S1

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22
Q

Defects to which embryonic structure can result in VSDs?

A

Bulbus cordis

It forms the interventricular septum

Septum primum and secundum defects cause ASDs

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23
Q

Does kidney lie posterior or anterior to spleen?

A

Kidney lies posterior and slightly inferior to spleen

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24
Q

What is the most appropriote site for a tracheostomy?

A

Between second and third tracheal rings

Incision made below cricoid cartilage

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25
Which ligament is clamped in pringle's manoeuvre?
Hepatoduodenal ligament It contains the portal triad - hepatic artery, portal vein and CBD
26
Lesion to which CN results in patients adopting a head tilt to the opposite side of the affected eye to alleviate symptoms?
Trochlear nerve Dysfunction results in vertical diplopia, worse on looking down
27
Inflammation of what structure can occur secondary to oesophageal perforation?
Mediastinitis Inflammation of the mediastinum Presents with high grade fever, chest pain and creps in the neck and chest wall (secondary to perforation)
28
What is the first line imaging study for women >35y/o with breast symptoms?
Mammogram If <35y/o, do US
29
Describe presentation of GORD in infants?
Commonly vomiting after feeds, non bilious Normal biochemisty and continue to gain weight Occurs due to immaturity of the LOS Normally benign and self limiting
30
What is the most appropriote scan to diagnose Meckel's Diverticulum?
Technetium-99m pertechnetate scan Ectopic gastric mucosa in diverticulum causes GI pain and PR bleeding
31
Compare symptoms seen in intermittent claudication and critical limb ischaemia?
Intermittent claudication - pain on exertion, improves with rest. Diminished peripheral pulses Critical limb ischemia - pain occurs at rest, is extreme and worst at night ("rest pain"). Weak/absent pulses
32
Which renal condition presents with oliguria, haematuria and slough in urine? Which condition can it be a complication in?
Renal papillary necrosis Slough is necrotic tissue from renal papillae being passed in the urine Seen in diabetes, secondary to microvascular disease
33
What is seen in the urine in diabetic nephropathy?
Albuminuria Initially microalbumuria, progressing to macroalbuminuria Also causes gradual hypertension
34
Describe Hodgkins lymphoma on histology?
Large cells with large nuclei and prominent nucleoli This is the definition of reed steenberg cells - they have an "Owls eye appearance" Abundant cytoplasm with large bilobed nuclei
35
Which inflammatory mediatior causes hypotension and flushing when the tourniquet is released?
Bradykinin is initial mediator according to chat GBT Nitric oxide according to passmed Histamine according to pastest
36
Which arterial supply determines dominance of the coronary circulation?
Dominance of the LCA is determined by the artery that supplies the Posterior descending artery In L dominant system, the PDA arises from left circumflex artery In R dominant system, PDA originates from RCA (80% of cases) The coronary that gives rise to the PDA determines the dominance of the coronary circulation
37
What is the substrate for the action of renin?
Angiotensinogen An inactive precursor produced by liver and released into bloodstream Renin acts on angiotensinogen to produce angiotensin I
38
Compare the anatomical landmarks used to guide pudendal nerve blocks and Lumbar puncture?
Pudendal nerve block = ischial spine LP = Highest point of iliac crests (L4)
39
Compare pre and post ganglionic neurotransmitters in the sympathetic nervous system?
Preganglionic = ACh Postganglionic = norepinephrine In parasymp system, it is ACh in pre and post ganglionic
40
Name the 3 contents of Calots triangle?
Portal triad is located within Calots triangle. Also: Cystic artery (branch of hepatic artery) Cystic duct Common hepatic duct
41
Which part of the male urethra is particularly prone to stricture formation or trauma (in pelvic injuries)?
Membranous urethra It is the narrowest part of the urethra, passing through urogenital diaphragm Can be damaged in pelvic injuries or traumatic catheter removals
42
Which electrolyte abnormality cayses prolonged QT interval and TWI?
Hypocalcemia Seen in pancreatitis, with muscle cramps and parasthesia
43
What is Rigler's sign suggestive of on XR?
Pneumoperitoneum Also known as a double wall sign Seen in perforated peptic ulcer on CXR
44
Compare the types of inflammation that neutrophils and macrophages are seen in?
Neutrophils - acute inflammation. Phagocytose bacteria and release inflammatory mediators Macrophages - chronic inflammation. Engulf and diggest pathogens. Contribute to the formation of granulomas
45
Which nerve is most superficial nerve in posteriomedial knee?
Saphenous nerve Most susceptible to damage in baker's cyst removal Susceptible during posterio-medial approaches to the knee Common peroneal nerve travels laterally in popliteal fossa and is more susceptible in surgical approaches from lateral aspect
46
What is the mechanism of transport of potassium?
Primary active transport Uses energy to drive ions across cell membrane In Na/K pump, 2 K molecules are driven intracellularly and 3 Na molecules extracellularly for every ATP molecule consumed
47
Which artery supplies Meckel's diverticulum?
Ileocolic artery Supplies terminal ileum, caecum and appendix Middle colic artery supplies the transverse colon
48
Which breast cancer is most commonly associated with mircocalcifications?
DCIS
49
What is the most likely site of lines of Zahn?
Thrombus Alternating layers of pale platelet rich material and darker red fibrin In comparison, emboli typically lack this structured layering
50
Describe findings on biopsy in C.Diff?
Ulcers covered by fibrin and deposits This is pseudomembranous colitis due to C.Diff infection Pseudomonas are composed of fibrin, neutrophils and necrotic tissue and reflect severe mucosal inflammation
51
Which testicular cancer can cause gynecomastia?
Leydig cell tumours They can produce oestrogen, leading to gynaecomastia
52
Which nerve gives sensation to lower set of teeth?
Inferior alveolar nerve Branch of V3 Gives off mental nerve, which supplies chin, lower lip and anterior gum
53
Which receptors have the most vital role in regulating respiratory drive?
Central chemoreceptors Located in medulla oblongata and v sensitive to changes in pH of CSF, which reflects CO2 levels in blood - may become desensitised in COPD Baroreceptors are located in aortic arch and carotid sinus, and are responsible for maintaining BP
54
Name the first site cervical cancer may spread to?
Internal iliac lymph nodes External iliac LNs drain membranous urethra, bladder and upper part of vagina in women and prostate in men
55
Name the collagen type most commonly involved in keloid scarring?
Type 3 Excessive and perisistent deposition of type 3 collagen in keloid scarring
56
Where is the primary site of action of ADH?
Collecting duct Responsible for final urine concentration and volume adjustments ADH acts on aquaporin channels to allow water resorption
57
Which type of hepatitis can be transmitted through blood transfusions?
Hepatitis B Incubation period is typically 6 weeks to 6 months, causes deranged transaminases
58
What embryological defect results in Bochdalek's hernia in neonates?
Defects of the pleuroperitoneal membrane
59
What do the 2 medial umbilical ligaments carry during the fetal period?
Deoxygenated blood from fetus to placenta During fetal development, 2 umbilical arteries emerge from internal iliac arteries and carry deoxyg blood from fetus to the placenta, where it is oxygenated anad returned to fetus These arteries then regress post natally into the medial umbilical ligaments (fibrous remnants)
60
During fetal development, what carries oxygenated blood from placenta to fetus? Postnatally, what does this structure regress to?
Umbilical vein Regresses to ligamentum teres hepatis
61
Damage to which muscles in the hand directly lead to claw hand deformity?
Lumbricals They flex the MCP joints and extend the IP joints 3rd and 4th lumbricals innervated by ulnar nerve - damage to the nerve results in claw hand deformity (1st and 2nd innervated by median nerve)
62
Which embryological defect results in hypospadias?
Failure of urethral folds to fuse properly Also have downward curvature during erection
63
What electrolyte derangement can excessive amounts of 0.9%NaCl administration cause?
Hyperchloremic (metabolic) acidosis High chloride content displaces displaces the bicarbonate in blood
64
What is the best option for bypassing an occluded iliac artery in a co-morbid patient with poor cardiac function?
Axillo-bifemoral bypass Unlike aortobifemoral bypass, it avoids the need for a laparotomy, which is desirable in high risk patients Aortoifemoral bypass is considered gold standard in fit patients tho
65
Describe the calcium biochemical profile seen in osteoporosis?
Normocalcemia Bone quality is good, but issue is lack of quantity
66
How should a life threatening tension pneumothorax causing v low sats in an adult be managed immediately? Where should be targeted in children with this condition?
Adults - Needle thoracocentesis in 5th ICS, anterior to mid axillary line Children - Needle thoracocentesis in 2nd ICS, mid- clavicular line Chest tube insertion is definitive treatment but not appropriate in the acute environment initially
67
Name the 2 medications that should be administered in thyroid storm prior to surgery?
Beta blockers Thionamides eg-propylthiouracil - inhibit thyroid hormone synthesis
68
Compare branchial cysts and thyroglossal cysts?
Thyroglossal cysts - occur in midline and move up with tongue protrusion Branchial cysts - occur in lateral neck and do not move on tongue protrusion
69
What is the normal accepted rate of urine output, at ml/kg/hr?
0.5ml/kg/hr ie - 35ml/hr in a 70kg man
70
Describe the 68-95-99.7 rule for normal distributions?
68% of data falls within 1SD of the mean 95% of data falls within 2SD of the mean 99.7% of data falls within 3SD of the mean
71
Which testicular tumour causes significantly elevated AFP levels?
Yolk sac tumour Typically a hetrogeneous mass in testicle in young boys- most common tumour in young children
72
What is the most appropriate anaesthetic agent for rapid sequence intubation?
Ketamine Good in haemodynamically unstable patients as it increases HR and BP due to sympathomimetic effects Advantageous in RSI as it preserves airway reflexes and respiratory drive Etomidate or propofol also used Etomidate does not cause cardiac depression
73
Describe the electrolyte abnormality seen in TURP syndrome?
Hyponatremia Can lead to confusion, seizures Tx - fluid restrict and salt
74
What is the most likely electrolyte abnormality to occur in massive blood transfusion?
Hypocalcemia Citrate is used to prevent clotting of stored blood but also sequesters calcium Present with muscle cramps, tetany or arrhythmias
75
Which XR view is essential to evaluate carpal bone alignment and positioning?
True lateral view PA view with lateral deviation is good to evaluate scaphoid but not as effective for diagnosing lunate dislocation
76
What can be used to rapidly correct severe hyponatremia? What can hyponatremia cause in head trauma?
50ml of 3% hypertonic saline Hyponatremia in head trauma can exacerbate brain oedema and increase ICP In hyponatremia with head injury, diuretics are contraindicated - they further reduce Na Mannitol is used to reduce ICP in brain oedema, but does not address hyponatremia
77
Which paediatric condition presents with an olive shaped mass in RUQ and non-billious vomiting?
Pyloric stenosis - hypokalemic hypochloremic metabolic alkalosis Pyloromyotomy is definitive treatment but patient must be stabilised first
78
What is the mechanism of action of Atrial Natriuretic Peptide, esp in heart failure?
A vasodilatory hormone produced by atria in response to increased atrial pressure and vol Causes relaxation of vasc smooth muscle cells and vasodilation and promotes diuresis to reduce blood volume and BP
79
What is best management of highly comminuted patellar fractures?
Circumfrential cerclage wiring For larger, re-constructible fragments, tension band wire fixation is used
80
Definative management of orbital compartment syndrome?
Canthotomy Involves making an incision at the lateral canthus to relieve pressure
81
Which nerve carries sympathetic fibres to the lacrimal gland?
Greater petrosal nerve A branch of the facial nerve Damage to it results in reduced lacrimation
82
Name the formula used to calculate the number needed to treat?
NNT = 1/absolute risk reduction
83
Rate of initial fluid resuscitation in children?
20ml/kg
84
Which part of the stomach does the short gastric artery supply?
Gastric fundus Just below the diaphragm Short gastric arteries branch from splenic artery
85
What artery supplies the lesser curvature of the stomach?
Left and right gastric artery Right gastric is branch of common hepatic Left gastric is branch of splenic artery
86
What arteries supply the greater curvature of the stomach?
Right and left gastroepiplpoic arteries Left gastroepiploic - branch of splenic artery Right gastroepiploic - branch of gastroduodenal (branch of common hepatic in coeliac trunk)
87
Describe the histological finding in arterial walls due to CTD like Marfan's?
Medial necrosis with cystic wall degeneration Involves degeneration of the elastic fibres in the aortic wall Makes them prone to aneurysm formation and rupture
88
Compare the radiological appearances of Ewings sarcoma and osteosarcoma?
Both affect young children in the diaphysis and metaphysis of long bones Ewings sarcoma = destructive "onion skin" appearance due to layered new bone formation Osteosarcoma = mixed sclerotic and lytic lesion with aggressive sunburst pattern of periosteal reaction
89
Which condition presents with disproportionately greater loss of motor power in upper extremities than lower extremities?
Central cord syndrome Typically results following cervical hyperextension - causes vascular compromise of the cord
90
Site of action of furosemide?
Loop of Henle Specifically, the thick ascending loop - prevents reabsorption of Na and K - water follows Na... It is a loop diuretic
91
What is the most appropriate diagnostic scan for tertiary hyperparathyroidism?
Technetium-99m sestamibi scan It can localise parathyroid adenomas, which can be the cause of tertiary hyperparathyroidism
92
Which breast malignancy shows stromal proliferation and leaf like projections lined by epithelial cells?
Malignant phyllodes tumour Present as rapidly growing, palpable breast lumps with bloody nipple discharge
93
What nerve can be damaged in submandibular gland excision and what is it a branch of?
Lingual nerve Branch of the trigeminal nerve - damage is associated with ipsilateral numbness and loss of sensation in tongue
94
What pump is responsible for maintaining the voltage of a nerve cell?
NaK pump Transports 3Na out cell, 2K into cell
95
Within which spinal structure is the vertebral venous sinus located?
Dura mater Can be a site of bleeding during LP
96
Compare drainage of lymph below and above dentate line?
Below dentate line = superficial inguinal Above dentate line = internal iliac
97
Which muscle plays crucial role in pincer grip?
Flexor pollicis longus
98
Displacement of the Duojejunal junction to the right is indicative of what?
Midgut volvulus presents with bilious vomiting and severe abdo pain in babies
99
Most common site of VSD?
Peri-membranous Located in the left ventricular outflow tract
100
Definiton of metaplasia? What condition is it seen in?
Metaplasia - reversible replacement of one mature cell type with another Reversible metaplasia seen in GORD
101
Where is EPO produced in the kidney?
Interstitial cells
102
What is the most common site for a fluid collection following cholecystecotmy?
Morrison's pouch Also known as the hepatorenal recess and is the deepest part of the peritoneal cavity when supine
103
Which serum marker is used to assess for deep surgical site infections?
Serum procalcitonin
104
What on histology can reflect the reduced bone density seen in osteoporosis?
Increased osteocyte lacunae and canaliculi (both are like small channels which allow for communication between osteocytes) Osteoclast activity is increased in osteoporosis
105
Main site of glucose reabsorption in kidneys?
Proximal convoluted tubule Where the sodium-glucose (SGLT2) transporters are located
106
What is compartment inflamed in DeQuervians tenosynovitis? What test can be used to identify it?
1st extensor compartment of tendons Finklestein's test
107
Name the 2 tendons involved in Dequervians tenosynovitis?
Abductor pollicis longus Extensor pollicis brevis Pain and tenderness over radial styloid
108
Where is iron mostly absorbed?
Duodenum Folic acid absorbed in the jejunum B12 absorbed in the ileum
109
Which anaesthetic agent is considered best for rapid sequence intubation? Why?
Etomidate Rapid onset, preserves cerebral perfusion and minimal cardiovascular compromise
110
Most common cause of primary hyperparathyroidsim?
Parathyroid adenoma (85% of cases) High PTH, High calcium, low phosphate
111
In midgut volvulus, where is the DJ flexure displaced to?
DJ flexure displaced to the right of the spine In normal situations, it should be to the left of the spine
112
Compare lymph node drainage from fundus of uterus and drainage from the cervix and upper vagina?
Fundus of uterus = para aortic LNs Cervix and upper vagina = internal iliac nodes
113
What is the first investigation that should be carried out if bladder/urethral injury is suspected?
Retrograde urethrogram / CT cystography Involves injecting dye into the urethra and XRing, looking for extravasation Guides whether its safe to catheterise or if u need a suprapubic one
114
Ideally, when should orchidopexy be carried out for an undescended testicle in a child?
Orchidopexy by age 1 has best outcomes in terms of fertility and testicular health
115
Compare ECG findings in hypo and hypercalcemia?
Hypocalemia = QTc prolonged Hypercalcemia = QTc shortened
116
Which mediator is most important in vasodilation following release of the tourniquet?
Nitric oxide Oxygen levels drop when the tourniquet is up, leading to release of NO from endothelial cells Once tourniquet is released, vasodilation caused by NO helps to restore blood flow
117
Compare which tumour markers are raised in a seminoma and non-seminomatous cancers (like yolk sac)
Seminoma = bHCG Non-seminoma = AFP
118
How can diaphragmatic irritation cause referred shoulder pain?
Diaphragm innervated by C3, 4, 5 Referred pain from C4 can cause shoulder pain
118
What 2 substances should be given for reversal of high INR in warfarised patient who is haemodynamically unstable from bleeding? Which has a quicker onset of action?
Prothrombin complex concentrate and IV vit K Prothrombin complex concentrate has a quicker onset of action than IV vit K
119
Which type of polyp is associated with highest risk of malignancy?
Villous adenomas Seen in FAP - finger like or leaf like projections Tubular adenomas are the most common subtype of adenomatous polyps
120
What's the most appropriote first line imaging for a BRCA1 positive women with breast lesion?
Breast MRI - more sensitive than US NICE guidelines recommend annual MRI breast for BRCA1 carriers
121
Which coag factor is primarily involved in extrinsic pathway ?
Factor VII Factor VIII deficiency seen in haemophilia A
122
Which Ig is produced first in primary immune response?
IgM It has a pentamer structure and is excellent at agglutination It strongly activates complement
123
Which is the only Ig that can cross the placenta?
IgG it is most abundant in serum Key role in secondary immune response - involved in opsonisation and neutrilisation
124

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