Questions from Pastest

Question 1

What is Bladder Exstrophy?

Answer 1

Congenital abnormality where the bladder is open and exposed on the outside. It is associated with adenocarcinoma of the bladder

Question 2

By what mechanism does hydrofluoric acid cause electrolyte imbalance in burns patients?

Answer 2

Two mechanisms:

i) Hydrogen ions cause the inital skin damage (Because it is an acid)
ii) Fluoride - permeates the skin and binds calcium

Hypocalcaemia - is associated with cardiac arrhythmias (prolonged QT interval), muscle rigidity/cramps and hypertonicity

Question 3

Diagnostic tests in acromegaly?

Answer 3

Best is Oral glucose tolerance test with GH:

GH is suppressed to <2 in normal people but often rises in people with acromegaly

IGF1 is more sensitive than GH and more reliable

Prolactin can be raised in 30% of patients

Question 4

Innervation of the GI tract?

Answer 4

Parasympatehtic

Grossly - the vagus nerve supplies the GI tract up to the distal transverse colon. The rest of the GI tract i.e. splenic flexure onwards is innervated by pelvic splanchnic nerves.

Ganglia:

Coeliac - Lower oesophagus and stomach

Superior mesenteric -Duodenum–> jejenum, Caecum, Proximal ascending colon

Inferior mesenteric - Distal Transverse colon –> Sigmoid colon

There is lots of overlap between these

Question 5

What is Gardner’s Syndrome?

1 MAJOR

and

9 other features

Answer 5

FAP (APC mutation. APC is a tumour suppressor gene)
+

Desmoid tumours,

Epidermal Cysts,

Lipomas,

Multiple Osteomas,

Small Intestinal Malign., Thyroid Malign, Pancreatic Malign. Biliary hepatoblastoma.

Connective Tissue Diseases

Question 6

Three anatomical narrowings or the ureter

Answer 6

Ureteropelvic junction

Ureteric crossing over iliac vessels

Ureterovesicular junction

Question 7

Genetic associations of:

Melanoma

Basell Cell Carcinoma

Answer 7

Melanoma: CDKN2A, BRCA1, CDK4

BCC: Gorlin Syndrome, PTCH2, Rombo syndrome, bazex-dupre-christol syndrome,

Question 8

How many days after inadequate calorific intake should TPN/Enteral adjuncts be used?

Answer 8

7 Days

Question 9

Where is:

Foregut/Midgut Junction

Midgut/Hindgut Junction

Answer 9

Foregut/Midgut junction - Major Duodenal Papillae. This is where common bile duct and pancreatic duct empty into duodenum

Foregut/Midgut Junction - Distal third of Transverse colon

Question 10

Where does:

Papillary thyroid carcinoma metastasise too?

Follicular thyroid carcinoma metastaise too?

Answer 10

Papillary thyroid carcinoma - Cervical Lymph Nodes

Follicular thyroid carcinoma - Lung and bone

Question 11

Which nerves are in close relation to the superior thyroid artery?

Answer 11

External laryngeal nerve - branch of the superior laryngeal nerve

Question 12

Gold standard diagnosis for urethral injury

Answer 12

Retrograde Urethrography

Question 13

Features of peutz jeghers

Answer 13

Autosomal Dominant Condition (Chr 19)

Small Bowel Hamartomas

Pigmentation of - skin, buccal mucosa, hands and genitalia

Small Risk of pancreatic, breast, lung, ovarian and endometrial malignancies

Question 14

How does finasteride work

Answer 14

5 alpha reductase inhibitor

5 alpha reductause usually converts testosterone to dihydrotestosterone

Question 15

Describe course of recurrent laryngeal nerve.

Answer 15

left:

Branches off of the vagus nerve as the vagus nerve traverses anteriorly over the aortic arch. It ascends posteriorly behind the ligamentam arteriosum + arch where it is in close relation to the inferior thyroid artery. It travels in a groove between the trachea (anterior) and the oesophagus (posterior).

right:

Branches off of the vagus nerve as the vagus nerve traverses anteriorly over the right subclavian artery. It ascends near the inferior thyroid artery. It travels in a groove between the trachea (anterior) and the oesophagus (posterior).

Question 16

When to give n acetylcysteine?

Answer 16

Delayed presentation > 8 hours after ingestion

If serum paracetomal level is over the line

Staggered overdose

Question 17

What are the hand muscles supplied by the median nerve?

Answer 17

LOAF

Lateral two lumbricals

Opponens pollicis

Abductor Pollicis brevis

Flexor Pollicis brevis

Question 18

What is secreted by the gastric:

Chief Cells

Parietal Cells

Foveolar cells

Answer 18

Chief Cells - Pepsinogen (inactive enzyme that is activated once secreted. Breaks down protein into amino acids.

Parietal Cells - Intrinsic Factor (Needed for vitamin b12 absorption in the terminal ileum). Gastric Acid.

Foveolar Cells - Mucous Production

Question 19

Surgeries for rectal tumours.

Answer 19

If mass is <5 cm from the anal verge –> Abdomino-perineal resection:

• Anus removed, rectum and partial sigmoidectomy. End stoma left and plastics input for a gluteal flap.

low anterior resection if >5 cm from the anal verge

• this is a function sparing procedure. as much rectum that can be spared is spared. affected portion and part of sigmoid removed. Colo-anal/rectal anastamosis performed.

Transanal endoscopic mucosal resection

• Superficial rectal polyps or small neoplasms.

Question 20

Describe the MEN conditions

Answer 20

Multiple Endocrine Neoplasia (Autosomal Dominant Disorder)

I - Pituitary, Pancreatit, Parathyroid

IIA- Medullary Thyroid Carcinoma, Phaechromocytoma, Parathyroid

IIB- Marfanoid Features, Mucosal Neuromas, Medullary Thyroid Carcinoma, Phaechromocytoma, Parathyroid

Question 22

Radiographic Description of fibroadenoma?

Common location

Peak incidence

Answer 22

Radiographically - Ovoid smooth solid mass w/ low level internal echoes

Commonly - upper outer quadrant

Peak incidence - 20s to 30s

Question 23

Describe Gel and Coombs Classification

Answer 23

Type I - Immediate. Mast Cell Degranulation –> Anaphylaxis, rash.

Type II - Need sensitisation. IgG and IgM. –> Autoimmunity, Haemolytic anaemia, Drug reactions

Type III - Soluble antigen/antibody complxes –> complement cascades. –> Nephritis, Faermer’s lung disease etc.

Type IV - T Cell mediated . Delayes presentation between 24 hour - 72 hours. E.g Contact Dermatitis

Question 24

Stages of haemorrhagic shock?

Answer 24

I - <15% Loss/ <750 ml
II - 15-30% Loss/ <1500 ml. RR- 20-30. UO 20-30 ml/h

III - 30-40% loss/ <2000ml. Tachycardia 120-140. RR 30-40. UO 5-15 ml/h

IV - >2000ml. Tachycardia >140. RR >35. UO extremely low

Question 25

**Abdominal Aortic Aneurysm Screening age?**

Answer 25

65 year old men - once off

Question 26

**Phaeochromocytoma** Aetiology Symptoms Treatment Principles

Answer 26

Aetiology: - Tumour arising from chromaffin cells of the adrenal medulla. Secrete catecholamines. Symptoms: - Adrenergic - Sweating, hypertension, tachycardia, increased metabolic rate Treatment Principles: alpha block - prevents hypertensive crisis beta block- heart rate control - adrenalectomy.

Question 27

**Hepatocellular Carcinoma:** Aetiology Causes Treatment

Answer 27

**Aetiology** Malignant tumours of hepatocytes. Express AFP. **Causes** Hepatitis B,C Cirrhosis (Alcoholic, PBC, PSC, Haemochromatosis) Aflatoxins **Treatment** Annually to Bi-Annually surveillance of at risk patients with US+AFP Resection, targetted ablation, chemotherapy, radiotherapy.

Question 28

**Grades of splenic injury**

Answer 28

I - Either **laceration** \<1cm or **subcapsular haematoma** \<10% of surface area II - Either **laceration** 1-3 cm or **subcapsular haematoma** 10% -50% surface area III - Either **laceration \>3cm** or **subcapsular haematoma \>**50% surface area IV - **Segmental or hilar vascular injury** or **25% devascularisation of spleen** V - **Shattered spleen/ Hilar Injury with complete devascularisation**

Question 29

Sequential Organ Failure Assessment What is it ? Criteria

Answer 29

**Sequential Organ Failure Assessment** Used to identify people at high risk of mortality from sepsis RR \> 20 breaths per minute BP \<100 mmHg GCS \<15

Question 30

Types of Diabetes Insipidus

Answer 30

**Diabetes Insipidus -** this is where there is either a lack/reduced responsiveness to ADH **Central DI -** Caused by lack of secretion of ADH (Vasopressin) from the posterior pituitary **Nephrogenic DI -** Lack of response from the kidneys to ADH. Usually stimulates aquaporin 2 channels to become upregulated.

Question 31

**Drugs associated with development of C Difficile** Pathophysiology of C Difficile

Answer 31

Commonly **antibiotics** but also **chemotherapeutic agents** **Antibiotics:** (Remember 4 Cs) **C**ephalosporins **C**o- Amoxiclav **C**lindamycin **C**iprofloxacin **Pathophysiology:** Two toxins. Enterotoxin - A Cytotoxin - B

Question 32

**Salivary Gland Stones** **Glands commonly affected?**

Answer 32

Submandibular \> Parotid

Question 33

**Define the TNM classification system for breast**

Answer 33

**T - refers to the primary tumour** Tis (In Situ) / T1 - \<2cm / T2 2-5cm / T3 \>5 cm / T4 spread to adjacent structures **N -** **refers to nodal involvement** N0 - None, N1 - Mobile axillary nodes, N2 - Fixed axillary nodes, N3 - Other surrounding node groups **M -** **refers to metastasis** M0 - None M1 - involving other organ

Question 34

**HIV Testing -** when are the following tested for ## Footnote **p24 antigen** **antibody** **ELISA**

Answer 34

p24 (viral core protein) - 4 weeks post-exposure Antibody - 6 weeks - 3 months post exposure ELISA - 6 months post exposure

Question 35

**Gynaecomastia:** **Causes**

Answer 35

**Liver Cirrhosis** (increased aromatase enzyme activity ---\> more androgens converting to oestrogens) **Drugs -** Anti-psychotics, Digoxin, Cimetidine, Ketoconazole, Oestrogens, Anti-testosterones (finasteride), Spironolactone **Sex Development Disorders -** hypogonadism, kinefelter's syndrome,

Question 36

**Questions regarding portal vein** What two veins form the portal vein? Where does the portal vein lie in relation to other portal triad structures? What is the hepatoduodenal ligament? At what level is the portal vein formed? Relation to pancreas? Branches?

Answer 36

**What two veins form the portal vein?** Splenic Vein + Superior Mesenteric Vein **Where does the portal vein lie in relation to other portal triad structures?** It lies posterior to the other two structures - hepatic artery proper and common bile duct **What is the hepatoduodenal ligament?** Double layer of periotneum formed from the free edge of lesser omentum enclosing the portal triad **At what level is the portal vein formed?** Transpyloric plane - L1 **Relation to pancreas?** Runs posterior to neck of pancreas **Branches?** 2 - Left (II-IV) and Right (Anterior branch - V + VIII, Posterior branch - VI + VII)

Question 37

What is the cardiac index?

Answer 37

Cardiac output \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Body surface area Usually between 2.5-4.0 L/min. It is useful in determining the cardiac function in view of different sizes of patients.

Question 38

**Which type of genetic targets are these?** sis erb B-2 ras myc bcl-2

Answer 38

sis - Platelet-derived growth factor activator erb B-2 - Growth factor receptor oncogene ras - Signal transducer myc - transcription factor bcl-2 - prorammed cell death regulator

Question 39

**Suture Types:** Polypropylene (Prolene) Silk Nylon Polyester Polydioxanone Sulphate (PDS) Polygalactin 910 (Vicryl) Polyglycolic Acid (Dexon) Polyglyconate (Monocryl)

Answer 39

Polypropylene (Prolene) - Non Absorbable Silk - Non Absorbable Nylon - Nonabsorbable Polyester - Nonabsorbable Polydioxanone Sulphate (PDS) - Absorbable Polygalactin 910 (Vicryl) - Absorbable Polyglycolic Acid (Dexon) - Monofilament Absorbable Suture Polyglyconate (Monocryl) - Absorbable Suture

Question 40

Describe venous drainage of the GI Tract

Answer 40

Portal Vein - Formed from SMV and Splenic Vein at L1 Inferior mesenteric vein drains into splenic vein near confluence of portal vein.

Question 41

Which bacterial infection has pus containing sulphur granules

Answer 41

**Actinomycosis** Gram Positive Anaerobic Bacterial infection Commoner in diabetics + Immunosuppressed Causes Granulomatous and Suppurative Inflammation

Question 42

**What values correlate with cyanosis?**

Answer 42

Thought that \>2.0 g/dL of deoxyhaemoglobin/methaemoglobin reliably produce cyanosis

Question 43

**Macroscopic + Microscopic + Extra-intestinal features Findings of:** **Crohn's** **Ulcerative Colitis**

Answer 43

**Crohn's** Macroscopic - cobblestoning, aphthous ulcers, rose thorn ulcers, abscesses, stricures and fistulae Microscopic - Transmural inflammation + granuloma Extra-intestinal - peri-anal, mouth ulcers, erythema nodosum, arthritis, spondloarthropathies, uveitis, episcleritis, Pyoderma Gangrenosum **Ulcerative Colitis** Macroscopic - Psuedopolyps, Friable mucosa, Featureless colon, Reduced haustrae, short colon, toxic megacolon Microscopic - submucosal, mucosal inflammation, crypt abscess Extra-intestinal - PSC, arthritis, spondyloarthropathies, uveitis, episcleritis, Pyoderma Gangrenosum

Question 44

What is the conus elasticus?

Answer 44

Conus elasticus is a yellow tissue that forms from the lateral part of cricothyroid membrane. It has a free edge which forms the vocal ligament. Connects the Cricoid, Thyroid and arytenoid cartilage

Question 45

**What does antithrombin III do?** **What drugs effect it?**

Answer 45

Antithrombin III - inactivates coagulation enzmes fXa, fIX, fII, fVII, fXI, DXII Heparin speeds up this process

Question 46

**What is the epiploic foramen?** **Boundaries**

Answer 46

Foramen of winslow (epiploid, omental) Communication between the greater and lesser sac of abdomen. **Borders:** Anterior - Hepatoduodenal ligament( Containing the biliary triad - CBD, Hepatic ARtery, hepatic portal vein) Posterior - Peritoneum covering IVC - Just Left is the arota Superior - Peritoneum covering caduate lobe of liver Inferior - Peritoneum covering duodenum and hepatic artery Left Lateral - Gastrosplenal and splenorenal ligament

Question 47

**Mechanism of Warfarin Necrosis**

Answer 47

Protein C and Factor VII inhibition is greater than the others in the initial period following warfarin initiation ------\> This makes a pro thrombotic state. Skin necrosis is caused Particularly in young, large women

Question 48

**Causes of low anion gap**

Answer 48

Anion Gap= Cations (K+ + Na+) - Anions (cl- - HCO3-) High anion gap is caused by bicarb buffering (reduction in anion) ---\> therefore seems like more cations than anions Normal anion gap - loss of bicarb through GI, renal loss, renal dysfunction (renal tubular acidosis) **Low anion gap** = Caused by an apparent increase in anions. Usually low albumin states ( where Chloride ions and Bicarb ions are retained to compensate for the negatively charged albumin loss) Other causes of low anion gap = Hypergammaglobunimaemia (MM) Hypergcalcaemia hypermagnesaemia, lithium toxicity, hyperviscositiy, halide/bromide intoxication

Question 50

**Relation to the lung hila?** **Phrenic Nerve** **Vagal Nerves** **Recurrent laryngeal Nerve** **Aorta** **Azygos Vein**

Answer 50

**Phrenic Nerve -** Anteriorly to the hila **Vagal Nerves -** Posteriorly to the hila **Recurrent laryngeal Nerve -** Superior **Aorta -** Posterior to left main bronchus **Azygos Vein -** Posterior to right main bronches and travels anteriorly to join SVC

Question 51

**Signs of Lidocaine Toxicity** **Max dose w/ w/o adrenaline**

Answer 51

**Max Dose:** With adrenaline - 7 mg/kg . Without adrenaline 3mg/kg **Signs of toxicity:** Perioral Paraesthesia Hypotension Convulsions Dizziness Cardiac Arrhythmias Collapse

Question 52

**Nutritional Requirements:** Sodium Potassium Calories Protein/Fat/Glucose

Answer 52

Sodium - 1-2 mmol/kg/day Potassium - 1mmol/kg/day Calories - 25-30 kcal/kg/day Protein/Fat/Glucose - 20:30:50

Question 53

**Gallstone Ileus Management**

Answer 53

Emergency laparotamy - Gallstone needs to be passed through into the large bowel to prevent furhter obstruction --\> perferation. It can also be extracted via enterotomy. - Fistula between the gall bladder and duodenum (Cholecystoduodenal Fistula) does not require surgical closure.

Question 54

**Polyhydramnios + Intestinal Obstruction**

Answer 54

Duodenal Atresia - Congenital abscence of duodenal lumen

Question 55

**Nasal Anatomy** **What drains into the inferior meatus (2)** **What drains into the middle meatus (5)** **What drains into the superior meatus (2)** **Where is the olfactory epithelium**

Answer 55

Inferior meatus - Nasolacrimal Duct (Rostral), Auditory Canal (caudal) Middle meatus - Maxillary Sinus, Anterior ethmoidal air cells( Semilunar hiatus), Frontal sinus (semilunar hiatus) Ethmoidal Bullae, Middle ethmoidal cells, Superior Meatus - Posterior ethmoidal air cells, sphenoidal sinus Olfactory epithelium lines the superior aspect of the superior nasal meatus - cribiform plate

Question 56

**Where do small cell lung cancers usually effect?** 2 Common Paraneoplastic Syndromes Radiographically?

Answer 56

Main or lobar bronchi SIADH, PTHrp (related protein), Can also cause cerebellar syndromes - anti-yo antibodies, myaesthenia gravis, optic neuritis Radiographically - Perihilar mass If nodes are involved then the mediastinum can be widened

Question 57

**Do the left or the right papillary muscles play a part in conduction system of heart?**

Answer 57

**Right** They communicate with the moderator band (originating from the interventricular septum)

Question 58

**Anencephaly and Spina bifida** **Dates and neuropre**

Answer 58

Anencephaly - failure of cranial neuropore closure by day 25 Spina Bifida - failure of caudal neuropore closure by day 27

Question 59

**Breast reconstruction** Types Complications

Answer 59

Types: i) Cosmesis ii) Free tissue iii) Flap Types of Flap: - TDAP -Lat Dorsi, Thoracodorsal perforator artery TRAM - Transverse rectus abdominus myocutaneous DIEP - Deep inferior eipigastric artery perforator IGAP - inferior gluteal artery perforator TUG - Transverse upper gracilis Complications: Scarring, haematoma, seroma, Abdominal wall hernias Flap Necrosis - Usually effects outer areas. Can be due to insufficient arterial supply or impaired outflow (congestion/ thrombosis - venouss) Cosmesis - Flap necrosis, infection, rippling, capsular contracture, leak, rupture

Question 60

**Nerves: Roots and Actions** **Pudendal** **Obturator** **Post-Ganglionic Parasympathetic** **Genitofemoral** **Ilioinguinal**

Answer 60

**Pudendal** - S2 - S4 nerve roots from sacral plexus. Perineum, Pelvic Floor and external anal sphincter **Obturator -** L2-L4 ventral rami of lumbar plexus. Adductor Magnus, longus and brevis. Gracilis. Obturator Externus. Cutaneous- middle part of medial thigh **Post-ganglionic parasympathetic-** Pelvic spanchnic nerves. Involuntary supply of internal anal sphincter. Relaxes in response to pressure **Genitofemoral nerve-** L1-L2. Divides into respective genital + femoral nerves in men. Supplies - creamscertic and dartos nerve. Sensory innervaton to tunica vaginalis, spermatic fascia and upper part of scrotum **Ilioinguinal nerve -** L1. Sensory supply to genitalia (root of penis, scrotum. labia majora, mons pubis).

Question 61

Why is peritoneal insufflation difficult in terms of anaesthtics for people with lung pathology?

Answer 61

It causes splinting of the diaphragm and reduces lung movements: This leads to reduced lung compliance needing higher airway pressures to achieve adequate oxygenation

Question 62

**Brachial Plexus** **3:1:0:3:5:5**

Answer 62

**3** Branches from roots : **LSD** Long thoracic nerve, Nerve to subclavius, Doral Scapular nerve **1** from trunk: Suprascapular Nerve **0** From divisions **3** from lateral cord: **LML** Lateral Pectoral nerve Musculocutaneous Nerve Lateral Root of median Nerve **5** from medial cord: **Miss Mary Makes Me Unhappy** Medial pectoral nerve, medial cutaneous nerve of forearm, medial cutaneous nerve of arm, medial root of median nerve, ulnar nerve **5** from posterior cord: **2STAR** 2 Subscapular nerves (upper and lower) Thoracodorsal nerve Axillary Nerve Radial Nerve

Question 63

**GI manifestations of thermal injury**

Answer 63

Paralytic ileus -- Gastric dilatation Curling's Ulcers Decreased Gastric Acid Production Splanchnic vasoconstriction

Question 64

**Hepatic blood flow numbers** Supply from the portal vein ?% hepatic artery ?% normal portal vein pressure

Answer 64

Portal vein - 75% Hepatic Artery - 25% Portal venous pressure - 5-7 mmHg

Question 66

**Duke Staging + 5 year survival**

Answer 66

Stage A - Confined to mucosa **90-95% 5 year Survival** Stage B - Muscularis Propria B1 - Grown into propria **75% - 80% 5 year survival** B2 - Through propria into serosa **60% 5 year survival** Stage C - Lymph Node Involvement C1 - 1-4 regional lymph nodes **25-30%** C2 - \>4 regional lymph nodes Stage D - Distant metastases **\<1%**

Question 67

**Complications of FNA of lung**

Answer 67

Pneumothorax: 17-26% (Increased risk with COPD/bullous lung disease, increase depth of lesion, small lesion size) Haemothorax, Pneuonia, Empyema, Pulmonary Haemorrhage\< Tumour Seeding, Cardiac Tamponage, Air Embolus, Need to re-bioopsy

Question 68

**Features of Fat Embolus Syndrome** **4 Major** **7 Minor**

Answer 68

**Gurd and Wilson Criteria** Major: Petechiae in vest like distribution, Hypoxaemia, CNS depression, Pulmonary Oedema Minor: Tachycardia, Pyrexia, Retinal Emboli, Fat in urine, Fat in sputum, Increased ESR, Haematocrit/Platelet Drop

Question 69

**Facial Nerve Anatomy** **Branches** **Exiot foramen** **Relations to other structures** **Major Functions**

Answer 69

**Two Zulus Buggered My Cat** - Temporalis, Zygomatic, Buccinator, Mandibular, Cervical **Facial Nerve** - exits through stylomastoid foramen **Major Functions:** - Controls facial expression - Taste to anterior two thirds of th tongue - Pre ganglionic Parasympathetic Fibers to several head and neck ganglia

Question 70

**Nerve Supply to digastric muscle**

Answer 70

Anterior - Supplied by the nerev to mylohyoid ( Sub branch of V3) Posterior - Supplied by digastric branch of facial nerve

Question 71

**Pathophysiology of neurogenic shock**

Answer 71

**Loss of sympathetic innervation ---\> Reduced Sympathetic innervation and Vasomotor tone .** This leads to venous ppooling--\> Reduced venous return --\> Reduced Pre-Load --\> Reduced cardiac output **Clinically - warm peripheries, low BP, widened pulse pressure**

Question 72

**Exit foramina of the skull**

Answer 72

Cribiform Plate **I** Optic Canal **II** **Superior Orbital Fissure III, IV, V1 (**Frontal Nerve, lacrimal, nasociliary**) ​, VI** Inferior Orbital Fissure - **V1** (Inferior Division), **Parasympathetic Pterygopalatine** (from facial nerve), **Zygomatic branch (**V2) Foramen Rotundum **V2** Foramen Ovale **V3** Internal Acoustic Meatus **VII, VIII** Jugular Foramen **IX, X, XI** Hypoglossal Canal **XII**

Question 73

2 Most common sites for breast malignancy

Answer 73

**Upper outer quadrant** **Central/ Subareolar Region**

Question 74

**Classification for Diverticular Perforation**

Answer 74

Hinchey I - Paracolic Abscess Hinchey II - Pelvic Abscess Hinchey III - Purulent Peritonitis Hinchey IV - Faecal Peritonitis

Question 75

**What is the:** **i) cloaca** **ii) sinovaginal bulb**

Answer 75

**Cloaca** **5th - 7th week:** Cloaca divides urogenital sinus(anterior) and anal canal (posterior). **Urogenital Sinus ---\>** Bladder, Urethra, Genital Tubercle **Anal Canal --\>** Rectum, Anal Canal **Sinovaginal** Formed from urogenital sinus ---\> Lower part of vagina

Question 76

**Bacterial Flexor Tenosynovitis** **Cardinal Signs** **Bacterial Cause**

Answer 76

**Cardinal Signs:** partially flexed posture, fusiform swelling, tenderness across flexor tendon sheath, pain on passive extension. **Bacteria: Staph Aureus** Early --\> IV Abx and splinting Late --\> Exploration +/- drainage

Question 77

**What stimulates/ Inhibits Insulin release** **Stimulates:** **Amplifies:** **Inhibits:**

Answer 77

**Stimulates:** Glucose, Mannose, Leucine, Vagal Stimulation, Sulfonylureas **Amplifies:** GLP-1, Gastrin inhibitory peptide, Cholecystikinin, Secretin, Gastrin, Beta Adrenergic Stimulation, Arginine. **Inhibits:** Hypokalaemia, Somatostatin, Drugs( Dazoxide, Phenytoin, Vinlastine, Colchicine)

Question 78

**Compartment Syndrome** **Signs** **Compartment Pressures**

Answer 78

**Signs:** Pain on passive stretch, Absent peripheral pulses, paraesthesia, paralysis Rhabdomyolysis ---\> Hyperkalaemia, hyperphosphataemia, High URic Acid Levels, metabolic acidosis **Compartment Pressures** Normally 3-4 mmHg If \>30-35 mmHg -----\> fasciotomy

Question 79

**Anal Cancer** Common Type Treatment

Answer 79

**Common Type -** Squamous Cell Carcinoma. Above dentate line tumours spread to perirectal and internal iliac lymph nodes. Below dentate line tumours spread to inguinal and femoral nodes. **Treatment -** Radiotherapy + 5 FU (+/= mitomycin/ cisplatin) AP Resection ---\> Only if recurrent or resistant tumours

Question 80

**Relations of hte parotid gland**

Answer 80

Anterior - masseter + Mandible Superior - TMJ + External Auditory Meatus Inferiorly - Posterior belly of digastric ( CNVII) Medially- CN IX, X, XI, XII, IJV, ICA, Lateral Pharyngeal Superficially ( superficial to deep ) - Facial Nerve, Retroauricular Vein, ECA

Question 81

**SIRS Criteria**

Answer 81

Two or more of following criteria: Temp: \>38, \<35 HR \>90 BPM Tachy pnoea \>20 or low PaCO2 WCC \<4 / \>12