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eMRCS questions > Recalls > Flashcards

Recalls Flashcards

1
Q

Where are Paneth cells present

A

Crypt of liberkuhn

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2
Q

Half life of platelets

A

10 d

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3
Q

Tx of patient with low BP, high K and low Na

A

IV hydrocortisone

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4
Q

Difference between aortic stenosis and sclerosis

A

Stenosis radiates to carotids

Sclerosis-Thick and calcified on echo

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5
Q

Paediatric cardiac differentials

A

Cyanotic
TA- left ventricle connect to PA
TGA- no murmur
ToF- loud ESM

Hypoxic
VSD- pan systolic murmur
ASD- foreamen oval doesn’t close, ESM at ULSE
PDA- pul artery and aorta connected - continuous machine like murmur at ULSE, subclavian thrill- indomethacin

Coartaction- ESM

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6
Q

Hypotensive patient out of hospital what medication do you use to anaesthetise

A

Ketamine

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7
Q

Mx of testicular torsion

A

Immediate exploration under GA

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8
Q

Bilateral lung opacities- differentiating between ARDS and pul oedema

A

Pul wedge pressure
Normal- ARDS
High>18- pul oedema

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9
Q

Blood film post splenectomy

A

Increase WCC
Howell Jolly
Target Cells
Siderocytes
Increase Plts

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10
Q

Mx of lower leg compartment syndrome

A

4 compartment release

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11
Q

Pre tibial injury management

A

Laceration with min haematoma- evacuate haematoma, stern strip without tension

With severe haematoma or necrosis- debride, STG under anaesthesia

Degloving- reconstruct under GA

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12
Q

Drug of choice for Biers block

A

0.5% prilocaine

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13
Q

Causes of bloody diarrhoea

A

C- campylobacter- bloating
H- haemolytic e coli-
E- entamoeba histolytica - liver cyst- metronidazole
S- shigella- food poisoning
S- salmonella - india

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14
Q

Space involved for Ludwig angina

A

Submandibular

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15
Q

Leg shortened and internally rotated

A

Post hip dislocation

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16
Q

After gastric banding, patient getting sweating, palpitations what is the cause

A

Dumping syndrome

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17
Q

Histological appearance of osteoporosis

A

Normal minerals, decreased volume

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18
Q

Patient fell onto chin, reduced mouth opening, jaw not aligned, pre auricular tenderness where is the fracture

A

Coronoid process

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19
Q

Unilateral buttock claudication vessel

A

Common internal iliac

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20
Q

Gardner, thorn stuck in arm, cellulitis and lymphangitis causative organism

A

Staph aureus

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21
Q

Criteria for CT head in 1 hour

A

a GCS score of 12 or less on initial assessment in the emergency department

a GCS score of less than 15 at 2 hours after the injury on assessment in the emergency department

suspected open or depressed skull fracture

any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)

post-traumatic seizure

focal neurological deficit

more than 1 episode of vomiting.

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22
Q

CT head within 8 hours criteria

A

had some loss of consciousness or amnesia since the injury and

age 65 or over

any current bleeding or clotting disorders

dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of more than 1 m or 5 stairs)

more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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23
Q

If alcohol intoxication and head injury

A

Admit and see if meet criteria

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24
Q

Cerebellar lesion symptom

A

Dysdiadokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech
Hypotonia

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25
Blood supply and symptoms correlating in brain
Anterior- legs >arms, face Middle- arms, face>legs , aphasia Posterior- occipital PICA- lateral medulla Ipsilateral ataxia, nystagmus, dysphagia, facial numbness, CN palsy Contralateral: limb sensory loss Lacunar- Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
26
Stroke types
TACI- middle and anterior Hemiparesis/hemisensory loss Homonymous hemianopia Cog dysfunction PACI- smaller arteries 2/3 Lacunar - smaller arteries around internal capsules/thalamus/basal ganglia isolated hemiparaesis, hemisensroy loss POCI- vetebrobasillar arteries- ataxia, cranial nerve, vision, vertigo
27
IVDU groin swelling cause
False aneurysm
28
Senescence of cancer cells
Telomerase
29
Levels of glucose with diabetic diagnosis
Fasting 6.1-6.9 - impaired glucose tolerance >7- DM 2 hour glucose 7.8-11 impaired glucose tolerance >11.1- DM
30
Chorda tympani foramen
petrotympanic fissure
31
Superior thyroid artery ligated now can't produce high pitch voice, muscle damaged
Cricothyroid
32
Orbital fracture, loss of lacrimation nerve damage?
Greater petrosal Branch of facial
33
Branches of facial nerve
Greater petrosal Nerve to stapedius Chorda tympani Posterior auricular Post diagastic Stylohyoid
34
Greater petrosal nerve pathway and function
Exits temporal vie hiatus of facial canal Across lacerum Combines with deep petrosal nerve- nerve to pterygoid canal Into pteryopalatine fossa- and ganglion Innervated mucosal gland of oral, nasal, pharynx and lacrimal gland
35
Chorda tympani pathway
Exits at petrotympanic fossa Combines with lingual from V3 in infra temporal fossa- go to submandibular ganglion Travel to submandibular and sublingual salivary glands and tongue
36
Which cell produces complement
Hepatocytes
37
LN drainage of pelvic area
Superficial inguinal- lower 1/3 vagina, vulva and scrotum, inferior anal canal (superficial to fascia and inferior to ligament) Deep - glans penis and clitoris, distal spongy urethra External iliac - cervix, body of uterus, superior bladder, upper 1/3 vagina Internal iliac - prostate, cervix, middle 1/3 vagina, inferior rectum, superior anal canal Para aortic- gonads, uterine fundus
38
External iliac branches
Inferior epigastric Deep circumflex iliac
39
Branches of internal lilac
Anterior Umbilical Superior vesicle Obturator Inferior vesical Uterine + vaginal Middle rectal Internal pudendal Inferior gluteal Posterior Iliolumbar Lateral sacral Superior gluteal
40
Feature of Horners and numbness medial side of elbow lesion
T1
41
Nerve roots in horners
C8, T1
42
What structure is medal to phrenic nerve when entering from neck to thorax
Brachiocephalic vein
43
ATN features
Slough in urine - brown granular casts No response to fluid challenge Urine sodium >30 Specific gravity low Osmolality-<300 Cause Ischaemia Myoglobin Contrast NSAIDs Gent/vanc, amph B
44
Damage to what structure causes CSF to leak our of ear
Tegmen Tympani
45
Red, smooth, velvety patch on tongue
Erythroplakia Associated with smoking
46
Blood in urethral meatus and high riding prostate- injury to which part of urethra
Membranous
47
Anterior vs posterior urethral injury presentation
Anterior Blood in scrotum Normal prostate Perineal tenderness Urine in superficial perineal space Posterior High riding prostate Suprapubic tenderness Urine in deep perineal space
48
Split vs full thickness graft uses
Full- face and small areas, fingers Better cosmetics- pigmentation Primary Contraction (before giving ) Small areas Donor must be closed Split- takes faster, more likely to take successfully Larger area and granulated area- can give if periosteum intact Worse cosmetic Secondary contraction (after donated)
49
When to refer woman with lump
30 and over
50
Autolysis in pancreatitis enzyme
Trypsin
51
What can excess saline cause
Hypercholaemic acidosis
52
Where are central chemoreceptors located
Medulla
53
Structure most at risk for preparing tibia in knee replacement
Popliteal artery
54
How NEC presents
Premature babies Biliary vomiting Abdo distention Blood stained stool AXR- gas cyst
55
Hirschprung disease presention
Failure to pass meconium Abdo distention Bile stained vomit Absence of Auerbach(motility) and meissners (secretions and blood flow) plexus Require irrigation
56
Intussuscpetion presentation
Colic Vomit Recurrent jelly- late sign Sausage mass Most common obstruction 3m-2 yrs USS- target mass Drip and suck
57
Pyloric stenosis presentation
2w-8w Projectile vomiting Non bilious Olive mass Ramstedt pylotmyotomy
58
Duodenal atresia presentation
<6hrs after birth- bilious vomit AXR- double bubble sing Downs Duodenodeuoneostomy
59
SUFE vs Perthes disease
SUFE- slipped head, older, fat Loss of internal rotation of flexed hip Perthes- necrosis of epiphysis, younger 4-8yrs , hip/knee pain, shortening
60
Thyroid storm management
B blockers Thionamide
61
Nerve supply of labia major
Ilioinguinal
62
Structure greatest risk of damage in splenectomy
Tail of pancreas
63
Organism unlikely to be killed in autoclave at 100 degrees
Clostordium
64
Best method for sterilisation of arthroscopes
Gluteraldehyde
65
Meconium ileus vs Hirschprungs
Meconium ileus- stuck in SI- small colon Hirschprungs- stuck in colon- large colon
66
Sweating palpitation after bariatric surgery cause
Dumping- vagotomised early gastric relaxation
67
Which vessel off coeliac has tortuous appearance
Splenic
68
Case with endometrial, ovarian and colorectal cancer
Lynch
69
Young patient with severe breast pain
Reassure and dishcharge
70
Post pancreatitis diffuse fluid around head
Necrosis
71
Synovial Joint types
Hinge (elbowelbow joint, ankle joint, knee joint)- movements in 1 plane Saddle (carpometacarpal joint)- convex concave shape Planar (acromioclavicular joint, subtler)- flat so roll over anther Pivot (proximal and distal radioulnar joints, atlantoaxial joint)- rotation only Condyloid (wrist joint, metacarpophalangeal joint, metatarsophalangeal joint)- contains a convex surface which articulates with a concave elliptical cavity. They are also known as ellipsoid joints. Ball and socket (hip joint)-It permits free movement in numerous axes.
72
Joint class by movement
Synarthrosis – immovable. Amphiarthrosis – slightly moveable. Diarthrosis – freely moveable.
73
Types of cartilaginous joints
Synchondroses In a synchondrosis, the bones are connected by hyaline cartilage. These joints are immovable (synarthrosis). An example of a synchondrosis is the joint between the diaphysis and epiphysis of a growing long bone. Symphyses Symphysial joints are where the bones are united by a layer of fibrocartilage. They are slightly movable (amphiarthrosis). Examples include the pubic symphysis, and the joints between vertebral bodies.
74
Histology of medullary thyroid cancer
Amyloid stroma
75
Diarrhoea related ABG
Metabolic acidosis
76
Sensation behind ear
Lesser occipital
77
5.5 aneurysm of EIA with ovarian mets
Surveillance
78
Types of fibrous joints
Sutures- immovable Gomphoses- immovable- teeth Syndesmoses-slightly movable joints (amphiarthroses). They are comprised of bones held together by an interosseous membrane
79
Most common glottic cancer
SCC
80
Which artery has retrograde flow in subclavian stela
Vertebral - as lesion proximal
81
Severe renal disease with foot ischameic ix
Duplex as contrast CI
82
Breast carcinoma with headache and vomiting tx
Dexamethasone
83
SCC histology
Keratin pearls
84
Cause of Brady in head injury
Increase aortic sinus activity
85
Heartburn and food sticking in throat
Pharyngeal pouch
86
Landmark for pudendal block
Ischial spine
87
Dysphagia, chest pain, normal endosocpy
DOS
88
Mx of 8mm stone at uterovesicle junciton
JJ sent
89
Teardrop sign in maxillary sinus
Orbital floor fracture
90
Truma, RAPD, proptosis, ophthalmoplegia mx
lateral canthotomy and cantholysis
91
Thyroglossal cyst ix
US + FNA
92
Absent of limb
Amelia
93
Homonymous hemianopia lesion
Optic tract
94
Cisterna Cali level and where throacic duct starts
L1 Starts at t12
95
Histological features of RA
Necrobiosis granuloma
96
Scan for parathyroid tumour
Setsmibi scan
97
Supply of pelvic diaphragm
S3
98
Pleuroperitoneal canal not developed
Bochaladek hernia
99
Cause of hyposppadius
Malformation of urogenital fold
100
Isovolemic contraction
In cardiac cycle where all valves are closed- no change in volume Just after tricuspid and mitral close
101
First test to rise post trauma
CRP
102
Origin of CN
Midbrain – the trochlear nerve (IV) comes from the posterior side of the midbrain. It has the longest intracranial length of all the cranial nerves. Midbrain-pontine junction – oculomotor (III). Pons – trigeminal (V). Pontine-medulla junction – abducens, facial, vestibulocochlear (VI-VIII). Medulla oblongata Posterior to the olive: glossopharyngeal, vagus, accessory (IX-XI). Anterior to the olive: hypoglossal (XII).
103
Bleeding source post LP
Vertebral venous plexus
104
Nerve for gag reflex
IX
105
UMN vs LMN facial palsy
UMN- able to LMN- can't lift eyebrow
106
Knee dislocation and absent dorsalis pedis pulse
Supracondylar femur fracture- popliteal artery damaged
107
On 15mg of pred before surgery, what mx
Double on day and for next 2-3d
108
Types of polyp in FAP
Tubular adenoma
109
Neck mass with compressive symptoms
Retrosternal goitre
110
What is anterior/infeiror to left adrenal
Body of pancreas
111
Resting membranes is kept by
K
112
Carboxyhaemaglobin levels indicating CO poison
9%
113
What structure is unlikely to be damaged at angle of Louis
Brachiocephalic!
114
Oncolytic large epithelial cell with lymphocytes in thyroid
Hashimotos
115
Obturator origin
L2-
116
IBD fat wrapping
Crohns
117
Apocrine metaplasia, epithelial overgrowth and papillary projections, discrete lump in breast
Benign cyst
118
Which muscle is attached to the most inferior part of scapula
Teres major
119
Superolateral limit of axillary dissection
Axillary vein
120
What prevents uterus prolapse in delviery
Transverse cardinal ligament
121
Patient with blood everywhere and prolonged PT and T
Oesophageal varices
122
Which part of the kidneys produce EPO
Interstitial fibroblasts
123
Reciprocal of ARR
Number needed to treat
124
Fever, chest pain, dyspnea, recent OGD- widened mediastinum
Mediastintis
125
Eye exophthalmos, limited eye movement, bruit
Carotid cavernous fistula
126
Cystic medial necrosis in aneurysm
Connective tissue disorder- Marfans
127
Measurements for FU with medullary thyroid cancer
CEA Calcitonin
128
Popcorn calcification
Fibroadenoma
129
What does not change in size when muscle contracts
A band
130
Parts of sarcomere
2 z lines I band - actin attached to z liens A band - thick myosin H zone gap between I bands
131
Mean 100 SD 20 what is the range
60-140 Since 2 SD to encapsulate all
132
Complications of carotid surgery
Vocal cord paralysis * Superior laryngeal nerve Tongue paralysis * Hypoglossal nerve Parasthesia * Greater auricular nerve
133
Line of zahn
Thrombus
134
Remnant of embryonic notochord
Nucleus Pulposus
135
Mild clawing of little and ring finger, loss of sensation cause
Compression at elbow
136
Flail chest/rib fracture with low sats mx
Intubate
137
Post head injury, low sodium, plasma osmolarity mx
Vasopressors agonist
138
Meds for low flow/sickle priapism
Phenylephrine
139
Muscle preventing spread of infection from mouth to neck
Mylohyoid
140
Injury to angle of the jaw, muscle effected?
Medial pterygoid
141
Bainbridge reflex
Increased HR to increased blood volume
142
Discitis in infants
0-6m staph 6m-4y Kingella kingae
143
Gram + organisms
Staph and strep cocci ABCDE bacilli
144
How many half lives to clear 95% drug
5.5
145
Mx of superficial thrombus
NSAIDS
146
Cause of pseduoclaudication of calf
Lumbar stenosis
147
What is removed in Whipple's procedure
Head of pancreas CBD Gallbladder Duodenum Proximal jejenum Pylorus
148
Unfit patient with bilateral common iliac
Axilla femoral in unfit
149
Urachus cancer type
Adenocarcinoma
150
What is Anterior to cervix of palpation
Fundus of bladder (base)
151
Tonsillar SCC with multiple nodes mx
Chemoradio
152
Epistaxis in superior nasal septum
Anterior ethmoidal
153
Most vessel effected in Little's area
Sphenopalatine
154
Chronic osteomyelitis with rectal bleeding, which shows amorphous pink substance
Amyloid
155
Coeliac supplies what structure not from foregut
Spleen
156
Mx of bile leak post cholecystectomy
ERCP and stent
157
Patient with hypotension- what baroreceptor responds first
Carotid body
158
Wich lobes are supplied by right hepatic artery
Right lobe and caudate
158
Most likely virus from needle stick
Hep B
159
Where does erythropoeiss start in fetus
Yolk sac then liver and spleen
160
What electrolyte disturbance is associated with normal gap acidosis
High Cl
161
Eyelid droop, cheek dryness, abnormal reflex
Stellate ganglion
162
Transplanted heart increase CO
Increase stroke
163
Thyroid with Cd20 cell and atypical lymph
Hodgkin lymphoma
164
First to activate in RAAS
Renin
165
Examples of ASA 2
Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30
166
Examples of ASA 3
One or more moderate to severe diseases. Poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, history (>3 months) of MI, CVA, TIA, or CAD/stents. Severe PE, high requirement for insulin in DM
167
Examples for ASA 4
Recent (<3 months) MI, CVA, TIA or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, shock, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis PE with HELP or cardiomyopathy
168
Amyloid in myeloma
AL
169
Q SOFA score
GCS <15 RR >22 BP <100 Score 2/3 high risk
170
Aim of ERAS
Decreased hospital stay 30d
171
Extrinsic factor
7
172
Which steps in coag cascade require Ca
IX X II Stablising clot
173
Internal jugular vein insertion
At the triangle's apex formed by the sternocleidomastoid muscle's two heads above the medial clavicle and is usually 5 cm superior to the clavicle. This should be lateral to the carotid pulsation Medial clavicle to ear
174
Modified radical mastectomy removes
skin, areola, nipple, and most axillary lymph nodes, but the pectoralis major muscle is spared
175
Median, Medial, lateral umbilical folds
Medan- urachus Medial- umbilical arteries Lateral -urachus
176
Reflexes of brainstem death
Pupillary lights- 2,3 Corneal- V1, 7 Vesrtibulo-occular- 8,3,6 Pain- V, VII Gag- IX, X Cough- X, X Afferent , efferent
177
Veins inside fall cerebri
Inferior and superior sagittal
178
Transverse sinus
Connected sigmoid and confluence In tentorium cerebri
179
Dermatomes of lower leg
L4 medial L5 dorsum and lateral S1 little toe and lateral
180
Defect in AVSD origin
Endocardial cushion
181
Slough in urine
ATN
182
Carotid sinus vs body
Body- chemo Sinus- baro
183
Tx of high INR
INR >5- hold warfarin INR >5 minor bleed - oral vit K hold warfarin Greater than 8 with no bleeding — stop warfarin and give phytomenadione by mouth using the intravenous preparation orally Greater than 8 with minor bleeding — stop warfarin and give phytomenadione by slow intravenous injection. Major bleed- IV PCC, Vit K - can give FFP if PCC unavailable Restart warfarin when <5
184
Where lactulose is absorbed
Not absorbed Broken down in gut bio by flora
185
Ova and cyst with blood diarrhoea tx
Metronidazole for entamoeba histolytica
186
Recovery of reflexes post SCI
Polysynaptic- plantar, crem Then from caudal to rostal
187
Comminuted patella fracture
Tension binding wiring
188
Audit on how long for letter to get to doctor
Audit of process
189
Location of gallbladder surface anaotmy
Under 9th Costal margin TP plane Where rectus sheath meets costal margin
190
Major cell in granuloma
Macrophage
191
Granulomatous pyelonephritis post stone mx
Nephrectomy
192
Classification of wounds
Clean - not inflamed or contaminated Clean contaminated - resp, Biliary, GI- minimal spill Contaminated -spillage Dirty- active infection- exudate
193
Appendicitis organism
Bacteroids
194
Tender painful swelling below angle of mandible
Supurrative lymphadenitis
195
Infliximab MOA
Anti TNFa
196
Pharyngeal pouch of tympanic cavity and Eustachian tube
1st
197
Loss of sensation in first 3 fingers what view x ray
True lateral view
198
X rays for SUFE
AP and frog lateral pelvis
199
% of blood in pulmonary vasculature at rest
10-15%
200
Nerve innervating ejaculation
Lumbar splanchnic
201
Anal fissure relative to dentate
Posterior and distal
202
Horseshoe kidney associated
PUJ obstruction
203
Ix for Ivc thrombus
MRI best But initial- venogram
204
Antibiotics not be give with fibrosis
Nitro
205
Burns patient with oedema
Hypoalbuminaeia
206
COPD lung volume changes
Increased residual volume
207
Lactate is formed in which cycle
Cori cycle
208
Multiple transfusions low Ca
Citrate toxicity
209
Non caeseatign granuloma
Sarcoid
210
Pleural pain refera to abdo cause
Intercostal nerves
211
Hypertricglyceridaema vs HC defect
HTG- lipoprotein lipase enzyme HC- LDL receptor deficient
212
Part of temporal forming pterion
Squamous
213
Diarrhoea form pork and eggs
C jejuni
214
Management of omphalcele/gastroc
Small <4/5cm- surgical repair Large- staged repari Omphal- intact sac- elective Small sac rupture- surgical Large rupture- staged delayed
215
Scan for tertiary hyperparathyroid
Tchnetium sestambi scan
216
Purpose of gallbladder
Concentration of bile
217
Sections of cerebellum and correlating symptoms
Anterior lobe- ataxia, unsteady gait- alcohol Posterior lobe- fine movements of hands, intention tremors Vermis- posture- axial ataxia
218
Cilostazol
Antiplatelet drug and a vasodilator
219
Biggest factors effecting suitability for renal transplant
Controlled HTN and DM CB health
220
Osteoporosis histological features
Increased osteocytes lacunae and canaliculi
221
Brachial cyst vs hygroma
Hygrome transilluminates
222
PTH transported for Ca in Kidney, SI
TRPV5- kidney 6- SI
223
Noradrenaline on CBF
Usually no effect But if v hypotensive increase MAP and CBF
224
Area of bleeding in LP
Dura mata
225
Nerves initiating micturition
Pelvic splanchnic
226
What should be measured in anaphylaxis
Tryptase
227
Chronic pancreatitis severe pain mx
Endoscopic procedure for stricture
228
Most likely origin of VSD
Peri membranous
229
Inferior epigastric to rectus abdominus
Posterior
230
What is right to 2nd duodenum
Hepatic plexus of colon
231
Derivatants of spermatic fascia
External spermatic fascia – derived from the aponeurosis of the external oblique muscle. Cremaster muscle and fascia – derived from the internal oblique muscle. Internal spermatic fascia – derived from the transversalis fascia.
232
Muscles effected by inferior angle of scapula fracture
Lat dorsi Teres major
233
Hypothyroid and hypothermia tx
IV warm fluid and levo
234
Which level of scalp separates in avulsion injury
Loose areolar
235
What is medial to phrenic at thoracic outlet
Vagus As IJV meets subclavian at first rib
236
What artery is preserved in anterior resection
Left colic
237
Popcorn cells in lymph nodes
Nodular lymph HL
238
Agent for rapid induction
Etomidate-if haem unstable Propofol
239
Line used on x ray for pelvic organ prolapse
Pubococcygeal line
240
Number of Na/K for each ATP
3 Na out for 2 K inW
241
When can you do a hemithyroidectomy
If 1-4cm and no LN involvement / extra thyroid involvement
242
When to use radio iodine therpay in thyroid cancer
RAI should be offered after a total or completion thyroidectomy, if a person has: a primary tumour at stage T3 or T4, regional lymph node involvement, pathological findings associated with a poor prognosis (including multifocal disease), or evidence of distant metastases.
243
SIADH vs hypercalcaemia specific urine gravity
SIADH- high Ca- Low
244
Bening vs malignant phyllodes tumour features
Significant atypic in cells High mitotic index
245
Action of neostigmine and use in anaesthesia
ACHe inhibitor To reverse NM blockers- vecuronium
246
Where collections occur after cholecystectomy
Morrison Pouch
247
HIV, Hep c and b from needlestick
0.3% hiv 1.8 hep c 30 b
248
TF relative to RA below arcuate
Posterior
249
Calculating CO figures
70ml x HR
250
Bone landmark for aortic bifurication
ASIS- L4
251
Histological finding of AAA
Distruption of elastic lamella
252
Definitive diagnosis of AIH
Biopsy portal inflammatory infiltrate, regenerative rosettes
253
Where thyroglossal cyst attaches to tongue
Foreman caecum
254
AB for RA
Anti CCP
255
Pharyngeal Pouch origin for tympanic membrane and ET
1st
256
2nd pharyngeal pouch forms
Palatine tonsil
257
Third and 4th pharyngeal pouch form
3rd- inferior para Thymus 4th - superior para and C cells
258
When to refer GORD for surgery
Refractory symptoms or strictures/barrets
259
Nuclear atypia thyroid cancer
Papillary Follicular doesn't
260
What does the deep iliac circumflex anastomose with
Lateral circumflex femoral by ASIS
261
Obstructive vs restrictive spirometry
Obs- <0.7 FEV1/FVC Restrictive near 1
262
Muscles involved in pincer grip
FPL, FPB, AP
263
Clef lip which arch
1ST
264
Nerve innervating posterior thigh and popliteal fossa
Posterior cutaneous nerve of thigh
265
Muscles causing ulnar paradox
FDP
266
When does the gut move back into abdomen in development
11-13
267
What is the cremistatic artery a branch of
IE
268
Distruption in somite formation can lead to
Scoliosis, skeletal defects and muscle malformation
269
Premature endochonral ossification can lead to
Lead sto scoliosis kyphosis, lordosis
270
Cause of varicocele
Incompetence spermatic veins
271
What level V nodal dissection risks
Accessory nerve damage - drooping shoudler
272
Diagnosis of PSC
MRCP
273
Features suggesting chronic over acute panc
Normal amylase and lipase Steatorrhoea Calcification on CT
274
Malaria features
Spleno hepatomegaly Low WCC Low Plt
275
Maintainers of GA
Halothane- neg inotrope Isoflurane- most used- malignant hyperthermia Sevoflurane NO- weak anaesthetic , potent analgeisa
276
Bladder rupture causes and mx
Haematoma/contusion- conservative Intraperitoneal - high energy blow to distended bladder Lap and reapir Extra- pelvic- usually catheter 10d
277
Vasodilation mediator after touring release
NO
278
Ix for mandibular fracture
CT
279
Finding iliac aneurysm <3cm
Rupture risk rare FU generally not required
280
Mx of ovarian cancer
Surgery then adjuvant chemo
281
Initial mx of incarcerated hernia
Gentle manipulation under sedation/anaesthesia
282
Diagnostic test for Ewing
Image guided biopsy
283
Teardrop sign seen on X ray
Infraorbital fracture
284
Approach for high abdominal teste positions
Fowler Stephens
285
Intrabdominal teste management
<2cm deep ring - orchidoplexy >2cm- Fowler Stephens- 2 stage approach- 1st identify and ligate then months later- position
286
When to repair AAA
>5.5cm Symptomatic >1cm/year
287
Before what age for orchidoplexy
12m
288
GCS for urgent CT head
289
Important blood test for sepsis
Lactate
290
Crush injury to leg with CK >1000
Urgent surgical decompression of compartments
291
Kidney transplant with oligouria, and high creatinine for 2 days
Delayed graft function Declined urine output unresponsive to fluid challenge Defined by need for dialysis post transplant or failure of creatinine to drop by 10% on 3 consecutive days
292
T2DM, glucose at 18, needs urgent cholecystectomy what mx
Sliding IV insulin until between 6-10
293
Root for referred shoulder pain
C4
294
Hypopigmented macule and periungual fibromas
Tuberous sclerosis
295
TG, TSH, calcitonin with papillary reoccurrence
TG high TSH high Calcitonin normal
296
Pale leg with CKD 3 ix
Duplex
297
Investigation of choice for COPD
Spirometry pre and post bronchodilators
298
Spread of prostate cancer from which veins
Venous plexus of prostate- Santorini To Batsons- venous of vertebral canal
299
Long term management of mod/severe crohns
Biological agent- Anti TNF If stricter and accesses or failure of med management- surgery
300
Mx of rectal prolapse in child
Analgesia and manual reduction
301
Pentameter antibody
IgM
302
Old scar than now has turned. hard, with elevated Ca
Dystrophic calcification Where damaged tissue calcifies
303
Double bubble sign X ray
Duodenal atresia
304
Cause of lateral winging of scapula, during abudction
Accessory nerve damage Long throacic causes medial winging
305
What fluid should be given when in metabolic alkalosis
Saline
306
What forms lateral border of Guyons canal
Hamate With transverse carpal lip and flexor tendons
307
Artery contributing most to breast
Internal thoracic
308
Pelvic vs retrocaecal appendicitis signs
Pelivc- over obturator Internus- pain on flexion and IR of hip Retro- pain on passive extension- Cope psoas sign as running over psoas
309
What area of brain generate rhythm of resp
Pre Botzinger complex
310
Olivary nucleus function
Superior -Part of auditory pathway Inferior- relay between spine and cerebellum
311
Earache with green pus- organism ?
Pseudomonoas- otitis media
312
Anatomical marking for spinal anaesthesia
Supracrestal line- L4
313
Origin of genicular arteries
5 originate from popliteal Lateral sup, lateral inf medial sup, medial inferior, middle Descending genicular- femoral 1st before passing into adductor hiatus
314
Stages of Cushign reflex
Ischaemia causes sympathetic- HTN and tachy Then stimulation of baro- bradycardia
315
Metabolic disorder with fast citrate infusion
Metabolic alkalosis
316
Half life of T3, T4, PTH
T3- 1 day T4- 5-7 days PTH- 5 mins
317
Supply of temporal lobe
Middle and posterior
318
Diplopia looking to left, convergent squint on extreme gaze
Abducens palsy
319
Erythema, does not extend beyond DIP
Felon- abscess fo compartment of finger pulp
320
Structure most at risk for penetrating injury to apex of femoral triangle
Femoral artery
321
Which nerve is most likely damaged in ablation to posterolateral right atrium
Right phrenic
322
ICU patient with oedema in gallbladder but no gallstones
Acalculous cholecystitis Happens in ICU- settles with ABx
323
Cervical cancer, now has weakness of adduction
Obturator LN spread
324
SCC of tonsil, LN spread tx
Unilateral modified radical neck dissection- removal of LN I-V
325
Mx of oropharyngeal cancer
Supraomohyoid- LN 1-2- N0 for SCC/malignant melanoma anteriro to ear or lower eyelid Selective- 1-4- N0/1- SCC of lateral tongue, oral cavity Lateral- 2-4- any N- without extracapsular spread for SCC of larynx, thyroid cancer, melanoma with + LN Postero lateral- 2- 5- posterior to ear Modified- I-V- bulky LN disease with extracapular spread involving below 1- spares Accessory 2- XI and IJV 3- spares XI, IJV and SCM Radical- Removes I-V- including XI, IJV, SCM- bulky extracapsular In midline or bilateral nodal involvement - bilateral neck dissection
326
Neck dissection levels
1- submental and submandibular 2- upper jugular 3- middle jugular 4- lower jugular 5- posterior triangle 6- central compartment 7- superior mediastinal
327
Nodal drainage patterns of head and neck cancers
Oral Cavity: I-III Oropharynx: II-IV Nasopharynx: II-IV Hypopharynx: II-IV Larynx: II-IV Thyroid: VI
328
Level of DJ flexure
Transpyloric- just below
329
What forms sinus tarsi
Calcanaeus and talus
330
Right Renal artery relative to IVC and renal vein
Posterior to IVC and superior to vein
331
Location of origin of IX
Anterior medulla
332
Medial longitudinal fasciulus
Cross over between CN 3,4, 6
333
Hering Breuer reflex
Strech receptors in lung inhibiting overinflation of lung
334
Point of entry for lap gas entry
Usually umbilicus- but if unavailable due to prior scar Palmers point- 3cm below left costal margin MCL
335
Hurthle cell cancer histology
>75% are oxyphil/oncocytic cells of follicular carcinoma
336
Most common place for blockage of CSF
Aqueduct of slyvius
337
Types of anti fungal and function
Ketokonazole- prevents ergosterol formation by P450 Ampho B and nystatiing- impair membrane by complexing with ergestotrol
338
Origin of lacrimal artery
Ophthalmic Runs along upper border of lateral rectus
339
Cells that secrete mucous in stomach
Foverolar
340
When to do a total thyroidectomy
If >1cm or if multifocal
341
Malignancy associated with Pagets
Osteosarcoma
342
Innervation of lacrimal gland
Lacrimal nerve a branch of Ophthalmic nerve -sensory Zygomaticotemporal- autonomic
343
Heinz bodies, triggers
G6PD- triggered by fava, cipro, antimalarial and sulphur containing drugs
344
Normal FRC and IRV
FRC- 2-3L IRV- 2-3L
345
Ligaments of uterus
Pubocervical Caridnal- lateral to cervic Uterosacral mosteiro
346
Most common renal cancer and most likely to respond to cytokine therapy
Clear cell carcinoma Il2
347
Features of chromophobs, medullary, papillary carincoma of kidney
Chromophobe- intercalated cells of DCT, homogenous contrast enhancement Medullary- sickle cells traits, renal medulla near renal papillar Papillary- renal tubular epithelium, multifocal/bilateral, calcification
348
Origin of tympanic membrane, external acoustic meatus, ear ossicles and inner ear
Tympanic and EAM- 1st ectodermal cleft/pharyngeal Ossicles- malleus and incus -Meckels cartilage Inner- otocyst
349
Organs that contain oxyphil cells (oncocytes)
Parathyroid, thyroid, pituitary, kidney, salivary
350
Which muscles is damaged if lower 2/3 of fibular fractures
FHL
351
TP, FDL and FH attachments
TP- tibia, fibular, interosseous to navicular and medial cuneforms FDL- tibia- 4 tendons- to lateral phalanges FHL- fibular to great tow
352
Beady appearance on MRCP
PSC
353
Tx of duodenal atresia
Duodenojejunostomy
354
80 with lumbar fracture, what ix
Calcium profile
355
Cerebral contusion vs haemorrhage
Haemorrhage- reduced consciousness, lucid internal
356
Peroneal nerve relative to malleolus
Anterior to lateral
357
Mx of spinal abcess
Surgical
358
Screening of HNPCC
Colonoscopy every 2 years from 20
359
Mx of crural arteries
<25cm- conservative >25cm- endovascular repair
360
Nutrition for intubated patient
TPN
361
Mx of metatarsal stress fractures
Rest 3-4w
362
Endovascular repair vs bypass for aortoilliac, femoropopliteal and infrapopliteal lesions
Aortoiliac - Angio <3cm If total occlusion FP- stenotic <10cm Bypass >10cm Infrapop- <50cm Great saphenous vein for longer
363
Spirometry low FEV1, FVC, low FEV1/FVC- not reversed with bronchodilators
COPD
364
What portion of oesophageal would require repair if injured
Thoracic- as can lead to mediastinitis
365
When does PJ present and with what
Infancy Colicky pain Freckles around lips Recurrent jelly stools
366
Order of tests in prostate cancer
Confirm diagnosis first with PSA and MRI Then stage with CT CAP
367
Leg biopsy shows blue round cells
Ewing sarcomma
368
What is shown on biopsy for osteochondroma, osteosarcoma, Ewing
OC- chorndroblasts- cobblestone/chickenwire OS-mesenchymal cells atypic ES- blue round cells
369
What is given in palliation of cerebral mets
Dex
370
Anaesthesia used for hip replacement
Spinal
371
Facial colliculus syndrome
Causes facial palsy and abudcen palsy- compression of pons
372
Externally rotated hip, sensory loss below knee what fracture
Acetabulum- causes compression of peroneal part of sciatic If displaced or causing nerve compression- surgery
373
Mx of vWD before surgery
Mild- desmopressin Severe/not respond to desmo- Cryo
374
Where to insert needle for tension
5th ICS
375
Late vs early dumping syndorme
Early <30 mins Late- 1-3 hours
376
Tender drawn up teste
Torsion
377
Consent if patient is unable to give consent for life saving procedure
Consent 4- acting in best interest
378
Rhadomyalisis with renal failure
Haemodialysis
379
Closure of tibial flap
Glue
380
4.7cm AAA monitoring
3m <4.5cm 12m 1 off screening for men >65
381
Nerve damaged just above umbilicus
Thoracoabdominal
382
Elective surgery with a Hba1c of 72
Postpone surgery until better controlled if elevtive If for cancer- close ops and insulin
383
Dislocation of talus, 10 yrs later pain which is severe what dx
OA of joint
384
Adequate Hba1c prior to surgery and mx
<69 If >69 or CBG >12 and on insulin VRII
385
Hypotension and melena post ERCP
GI bleed
386
Mx of malignancy induced hypercalcaemia
Zolendronate
387
Mx of ulnar and radial shaft fractures
ORIF - as unstable
388
Most common cause of lytic bone lesions in children
Neuroblastoma
389
Progression of VUR
Recurrent urine infections - boys Scarring before 5 DMTA scan
390
ABG of Cushing syndrome
Hypokalaemia Metabolic alkalosis High glucose
391
Transfer to burns unit
>3% in adults 2% in children Hands, feet, face, gentalia, circumferential Full thickness Not in 2w
392
Mx of superficial partial thickness burn
Deroof blister and occlusive dressing
393
When to flap over graft
Exposed bone no periosteal cover, exposed tendons, irradiation wounds- avascular
394
What sx can hemisection in cerivcal spine produce
Horners ipsilateral
395
Patient is having surgery for spread of melanoma now has DVT what mx
IV herparin
396
Tracheostomy effect on compliance, resistance, RV, VC, dead space
Increase compliance Reduce resistance and dead space No effect of RV or VC
397
When to ORIF ankle fractures
Weber B with alar shaft Weber C Displaced bimalleolar Trimalleolar Open
398
What conc is 1% of a drug
10mg /1ml
399
If under 30, what sx make it appropriate for triple assessment of breast
Any discrete palpable lump
400
Patient about to undergo elective knee replacement, MRSA + what next?
Delay surgery and decolonisation
401
Tx of Graves
Anti thyroid- if cannot tolerate or does not work, mod/severe opthalmopathy - definitive treatment Radioiodine-- CI pregnancy, <5, opthalmo, larger goitre Surgery- large goitre
402
Radical prostectomy
Removed of prostate and seminal vesicles Offered if LE >10yrs, no mets
403
ACD vs IDA
ACD- usually normocytic High ferritin
404
Nerve damaged with petrous part of temporal bone
Facial
405
Complications of hypothyroid in surgery
Decreased CO, HR, anaemia High cholestrol- CHD
406
Level of LP in children and adults and where conus terminates
Adult Conus- L1-2 LP 3-4 Child Conus- L3 LPL4-5
407
Patient on treatment dose LMWH, and develops DVT what next
Apixiban long term
408
Osteosarcomma vs Ewing presentation
Osteo- metaphysic, distal femur/prox tibia ES- diaphysis or pelvis/ribs/vertebrae
409
Lidocaine dosing
3mg/kg
410
CO and SVR in septic shock
Increased CO and reduced SVR
411
Tumour marker of seminoma
LDH or bHCG
412
Biomarker indicative of anastomotic breakdown
Albumin <3 Transferrin <150
413
Pyrexia psot surgery timeline
1- systemic response 2-3 - atelectasis 3-7- wound, urinary , anastomotic 7- DVT
414
Mx of nasal cartilage defect post surgery
Nasolabial flap with ear cartilage graft
415
Urinary retention, foreskin retracted over swollen glans
Paraphimosis
416
Mx of rib fractures in those unable to cough and those with resp conditions
Unable to cough 24 observation Resp- HDU
417
Patient requiring splectomy for HS, gallstones present what mx
Offer cholecystectomy same time as splenectomy
418
CI for immunisation
Anaphylaxis, immunodefiiceincy with lives Fever- relative
419
Destruction of frontal bone, goitre, no LN
Follicular - bone mets as doesn't use LN
420
Organism in Fouriners
Mixed flora
421
Origin of trachea
Foregut endoderm
422
Sign in, time out, sign out
Sign in before anaesthesia Name, procedure, allergies, ABx, blood available Timeout- confirm, blood loss, diathermy, abx, specimen, vte- start before knife Time out- recorded procedure, specimens, lines flushed, equipment problems, VTE abx, daycase?
423
Sodium conc in 0.9% saline
154mmol/l
424
Reflex loss with facial nerve in parotidectomy
Corneal efferent limb
425
Pre op carb drink effects
May reduce insulin resistance
426
Spread of HL vs NHL
HL- contiguous spread NHL- non contiguous spread, multiple LN groups, extranodal at time of diagnosis
427
Colicky pain 12.5cm Dilated intraheptic ducts 4m post cholecystectomy
Retained biliary in CBD 10cm considered normal
428
Part of the spine most effected by congenital scoliosis
Thoracic
429
Perilunate dislocation features
The capitate and other carpal bones are displaced dorsal to the lunate Median nerve palsy Wrist hyperextension injury Dorsal displacement of capitate normal radiolunate alignment Urgent closed reduction
430
Laser in endoscopy, derm, opthalmo
Argon beam
431
Retrograde amnesia for CT in 8 hour
>30mins
432
Mid shaft tibial fracture repair
IM nail
433
Vessel involved in tracheoarterial fistula causing bleeding
Inominate artery (BC)
434
Where thyroid ima branches from
BC trunk
435
Vein draining anterior surface of heart
Great cardiac vein
436
Supply of pons
Anteromedial- basilar and pontine perf arteries Lateral- lateral pontine from basillar AICA and superior cerebellar Anterolateral- AICA
437
Which centre controls rate of breathing
Pneumotaxic centre
438
Apneustic vs pneumotaxic centres
Apneustic- increase depth and duration of inspiration PT- decreases duration of inspiration- increases rate of breathing
439
Number of primary and secondary ossification centres in verebrae
3- primary 5- puberty- one in tip of spinous process, each transverse, one ring epiphysis of sup and inf surface of vertebral bodies
440
High pressure veins in oesophageal varices
Left gastric
441
Where the majority of congenital pharyngeal abnormalities occur
2nd arch
442
Where does pulp of finger start in DRE
Posterior
443
Pseudomonas Cystic Fibrosis antibiotics
Cef and tobramycin 10-14d
444
Origin of cremastatic muscle
Internal oblqiue and inguinal lig
445
Resp factor effected most in obese patients
ERV
446
Lateral medullary vs lateral pontine
AICA- pons Its ataxia, nystagmus, loss of temp in face and facial weakness, loss of hearing PICA- medulla Horners, dizziness, absent gag
447
Cleft lip cause
Medial nasal prominence fails to fuse with max prominence
448
Abx in erythema with STG
Mero- due to pseudo
449
Ductus arterioles attachment
PA to descending proximal aorta
450
Ganglion for taste
Geniculate ganglion
451
Organism for dental abscess
Bacteriodes
452
Ligaments of TMJ
Lateral ligament (main TMJ lig), sphenomandibular, stylomandibular
453
Supply of TMJ
Temporal auricular nerve
454
Direction of dislocation, articulation surface of TMJ, boney surfaces
Anterior Fibrocartilage, articulation disc, 2 synovial cavities Mandibular fossa, articular tubercle from squamous, head of mandible
455
Layers in pfannistinel incision
Skin, sub fat, superficial fascia, anterior rectus sheath, muscleTF, extraperitoneal fat, peritoneum
456
RUQ pain, high ALP, xanthelasma, test
PBS- anti mito
457
MODY diagnosis
Before 25 late onset AD Non ketotic No AB B cell dysfunction
458
Main test for renal cancer diagnosis
CT with contrast
459
CT of liver is hypotenuse then hyperdense with contrast
Angiosarcomma
460
6yo with weight loss, tremors and gait instabilty, urinalysis reveal neutral aminoaciduria where is the problem
PCT Hartup disease
461
Main source of cardiomyocyte energy
Fatty acid oxidation
462
COPD TLV, RV
Increased
463
What supplies proximal duodenum
Superior pancreaticoduodenal
464
Muscle most likely involved in perineal tears
Transverse peroneal
465
Antiemetic for raised ICP
Cyclizine
466
Goire, bilateral LN, cells arranged in clusters, pleomorphic nuclei, coarse chromatin, mitotic figures
Anaplastic carcinoma
467
Function of EO vs IO
EO- fibres run inferiorly and medially from ribs Contralateral rotation IO- -superiorly and medially from iliac crest Ipsilaterally rotates
468
Which cardiac vein drains the lateral wall of left ventricle and which delivers retro Cardioplegic shock
Left marginal Coronary sinus
469
Gene mutation with male breast cancer in FH
BRCA 2
470
Second pharyngeal arch artery
Stapedial
471
Dorsal vs ventral portion of 3rd pharyngeal pouch
Dorsal inferior para Ventral thymus
472
Methacholine test
Bronchoconstricts asthmatics- muscarinic agonist Reduces FEV1/FVC
473
Location of vertebral endplate
Between vertebral body and disc
474
Horizontal vs vertical inguinal nodes
Vertical- drain legs Horizontal drain perineal
475
Mechanism of nerve injury
Neuropraxia- streching Axontemesis- closed fractures Neurotmesis- high energy crush, penetration
476
What is anterior to pancreas
Pylorus
477
When should you use apixiban over LMWH
Creatinine clearance <30
478
Colles fascia in perineum
Deep layer of superficial perineal fasciae Continuous with Scarpers and form superfiical perineal pouch
479
Location of Bartholin vs Bulbourethral gland
Bartholin superficial -5,7 o'clock BU-deep by membranous urethra
480
Vaginal drainage
Superior – drains to external iliac nodes Middle – drains to internal iliac nodes Inferior – drains to superficial inguinal lymph nodes.
481
MSK structure origin in pharyngeal arches
1st- maxilla, mandible, malleus, incus 2nd- styloid, stapdeius, lesser horn of hyoid 3rd- greater horn of hyoid 4th- thyroid cartilage and epiglottis 6th-cricoid and arytenoid
482
Pharyngeal pouches form
1st ET and middle ear 2nd palatine tonsil 3rd- dorsal Inf parathyroid and ventral thymus 4th dorsal sup para ventral C cells
483
What separates transverse sinus of heart vs oblique
Transverse- PA ant and aorta then SVC posterior Superior to Left atrium Oblique- PV
484
Articulations of carpal bones to which metacarpal
Trapezium- 1st and 2nd Trapezoid- 2nd Capitate- largest 3rd Hamate- 4,5th
485
Mx of a baby with GORD
Full history - reducing volume of feed or thicker formula Then gaviscon (alginate) Then can consider PPI/H2
486
Milk alkali syndrome
Ingested Ca causing renal failure with alkalosis
487
Mild vs mod vs severe traumatic brain injury
Mild - LOC <30 mins, amnesia <1d, GCS 13-15 Mod >30 mins <24hrs, amnesia <7d- GCS 9-12 Severe- LOS >24hrs, amnesia >7d, GCS 3-8
488
Pre op tests
DO not routinely do Hba1c without diagnosis DO not do CXR ECHo only if murmur, cardiac symptom or sc of HF Minor surgery- not real tests needed Int surgery- ECG, U+E- ASA 3/4 Consider Spiro Major surgery- FBC for all U+E, ECG ASA 2 and above
489
FHH biochem
Mild elevated Ca Mild/normal PTH Low level excreted in urine
490
AP vs Anterior
<3cm from dentate AP >3cm Anterior
491
When to use IVC filter
If AC contraindicated
492
How long will oral iron take to replenish
4w
493
Drug increasing risk of SCC and MOA
Tacrolimus Downregulates T cell - calcaneurin inhibitor
494
Mx of open fracture
IV abx, tetanus, stabilisation, dressing immediately 1/2- ceph/co 3- cephalopods +amino Debride <12hrs for 3 <24 for 1/2 Irrigation in theatre(<3 for 1, 3-6 for 2, >6for 3) External temporary fixation Done immediately if gross contamination, compartment or devascularised
495
Pain releif post hip replacemtn
Regular para PRN morphine
496
When to use tourniquet in haemorrhage
In patients with major limb trauma use a tourniquet if direct pressure has failed to control life‑threatening haemorrhage.
497
Position of patient for hip replacement posterior vs lateral/anterior approach
Lateral decubitus-post Supine if direct lateral/ant
498
C diff causing septic shock and renal failure mx
Emergent colectomy
499
Location of spermatocele in teste
Posterior
500
US shows complex cyst, FNA shows fluid filled but blood what next
Biopsy
501
Sx of bile leak post op
RUQ pain, malaise, difficult surgery Normal bloods- if retained stone causes abnormal bloods and fever
502
Behcets triad
Ulcer in mouth and genital Arthralgia
503
Rinne and Webers
Rinne + If air>bone Conductive- negative SN- gives false positive Weber- lateralises to uneffected
504
Mx of itching in cancer of ducts/panc
ERCP and stent
505
Mx of lasy with pneumothorax no symptoms
Admit for observation As no sx Re image in 2-4w
506
TEA in rib fractures
Can use after oral CI in thoracic vertebral, spinal injury, epidural haematoma and clopi
507
Grey mass on floor of mouth, painless, young
Ranula
508
Deformity in supracondylar fx
Varus- gunstock- carrying angle reduced if malunion
509
Grafts for arm and palm bruns
Meshed split for arm and forearm and other larges areas Full thickness- palm, face and neck if small If large-unmeshed ST graft
510
Mx of nec fasc
Debridement IV amp, clind, cipro
511
Biggest RF of AAA
HTN
512
Anaemia, jaundice, enlarged spleen
HS- defect in membrane
513
MAP target in non HTN patients
65-70
514
Bi lobed nuclei with large LN
HL
515
Gangrenous toe with one vessel run off
Below knee amputation
516
Mx of sudek dystrophy
Symp ganglionic block
517
FOOSH, median nerve compression
Lunate dislocation
518
Feels like stadning on a marble between 3rd and 4th
Morton neuroma
519
Late X ray sign of Perthes
Sagging rope sign sclerosis of NOF
520
Flap for sections of leg
Pros third-Gastrocnemius flap Middle- soleus Distal- sural
521
Regurg and vomitting, recurrent chest inf
GORD
522
Value for arm/leg tourniquet in surgery
250mmHg- 200 in child 300-thigh Should not exceed 2hrs
523
Antiphospholipid tx
Lowdose aspirin if childbearing age Warfarin
524
Embryological Defect in passing faeces in vagina
Urorectal septum
525
Arteries forming Arc of Riolan
Middle and left colic
526
Where fluid collects in anterior vs posterior gastric ulcer
Paracolic gutter anterior Lesser- posterior
527
Where LCA arrises from
Left posterior aortic sinus
528
Ventilator associated pneumonia
Pseudomonas
529
When is a tourniquet inappropriate
If open trauma wound- as want to assess for vascular injury
530
Components of cochlea
Perilymph in scala vestibule Endolymph in scala media (coclea duct) Perilymph in scala tympani Low frequencies go whole way High -short
531
Lido max
500mg with adrenaline 200 without irrespective of body weight
532
How to find transpyloric plane on surface
Hafway between suprasternal notch and pubic symphysis
533
Levels in axillary clearance
Lateral 1 Behind 2 Medial 3
534
Naproxen MAO
Non selective COX inhibitor
535
Ondansetron MOA
Serotonin Antgagonist
536
What tumour is very radio-sensitive
Seminoma
537
When to use delayed primary closure
>12 hours after injury presentation if >5cm >18 hrs if small Complex wound- bites Wait 4-5 days
538
Warfarin causing skin necrosis cause
Protein C deficiency
539
Side effect of alkylating agent
Gout
540
Which cancers are radioinsensitive
Adenocarcinomas
541
Tx of early vocal cord cancers
Radio- since SCC are sensitive
542
Dx of bladder vs urethral injury
Bladder- CT cystoscopy Urethral- retrograde cyst
543
Part of the cell cycle that RNA is synthesised and which part does p53 act on
RNA in G1 and 2 p53- prevents going into S
544
Histology of keloids
Whorls of collagen with no pattern
545
What do B adrenergic receptors actviate on a cellular level
Adenylate cyclase
546
Botulism MOA
Prevents pre synaptic release
547
Most likely side effect of adjuvant chemo in breast cancer
Secondary leukaemia
548
Breakdown of suxamethonium
AchE
549
Reversal of depolarising vs non depolarising muscle relaxants
Non- neostigmine Sux- plasma cholineesterases
550
What tumour is assocaited with paraganglionoma
Phaeo
551
Structures relative to perineal body
Posterior- EAS Lateral- transverse perineal Anterior- bulbo
552
Main method of intracellular vs extra buffer
Proteins - intra Bicarb- extra
553
Ganglion for palm and axilla sweating
T2 and 3- palm 4- axilla
554
What limits haematoma in brain
Suture lines
555
What is in cryoprecipitate
VIII and fibrinogen vWF
556
Hormone respone to hypothermia
Increase catecholamines and thyroxine
557
Test for correlation of 2 variables
Pearson- parametric Spearmans - non
558
Location of CTZ, receptors
within the dorsal surface of the medulla oblongata, on the floor of the fourth ventricle of the brain Histamine, dopamine, serotonin
559
How obesity causes CV mechanical issues
Expanded blood volume- reduces ventricular compliance
560
Main source of energy with starvation
Serum FA
561
Clark level of melanoma
Epidermis Papillary dermis Junction of papilary and reticular Reticular Sub fat
562
Adrenal mass with lung mets with cushings
Radical adrenalaectomy Lung lobe resection
563
True vs false vocal cords
True- free edge of quadrangular membrane that forms false vocal cord
564
If contamination risk like a bile leak what suture should you use
Mono non absorbable -lowest risk of infection
565
Effective preventative measures for MRSA patient
Barrier nursing
566
Dukes surivial rates
A- 95 B-75 C-45 D-5
567
Alkylating agent examples
Platinum Cyclophosphamide
568
Where in bowel is radio given as adjuvent
Rectum
569
Mx of bone mets pain
Radio and NSAIDs
570
Re infarction after surgery with recent MI %
30 days -37% 3-6 months- 16% 1 yr- 5%
571
Benzo MOA
Enhances GABA
572
Hep B exposure- management
Non responder 10-100 - one dose <10- HBIG and booster dose, plus 2nd at 1 month If responder >100- no action No vaccine- accelerated course, HBIG and first dose
573
Hormonal therapy in phaeo, endometrial, prostate cancer
Phaeo- phenoxybenzamine Endo- progestins Prostate- gGNRH analgoues
574
Tetanus managemetn
Exposure- no vaccine Vaccine + HTIG Clean wound- no need Dirty or requiring surgical intervention >6 hrs- Last dose <10 yrs- nothing >10 years- booster 11 yrs old should've had 3 doses
575
Drug causing gingival hypertropgy
Ciclosporin
576
What does infliximab make you prone to
TB
577
SE of methotrexate
Fibrosis of liver and lungs
578
What alters the dose of caphalosporins
Creatinine clearance
579
Mx of otitis media
<4d - delayed abc >4d - amox
580
Most common cause of lymphedema in UK
Mets causing obstruction
581
Cancers that chemo is effective against
Leukaemia Lymphoma Teste Ewing Wilms Retino
582
Abdo vessels located between campers and scarpers
Superficial inferior epigastric
583
Lateral sinus thrombosis sx
Papilloedema, rasied ICP, tenderness over mastoid Compression of CN 9-11 if develops
584
Renal pathology FEN
Pre- <1% FEN Renal 2-4 Post >4%
585
Tacrolimus moa
Calcaneurin inhibitor- inhibit IL2
585
Which bone burr holes go through
Temporal then frontal then parietal
586
Pregnanct last at term with air under diaphragm
Lapartomy
587
Number of paranasal sinus and which is most prone to infection
4 Maxillary as by teeth
588
Nec fasc common organism
Strep pyo
589
What delvers depolarisation to papillary muscles
Right- moderator band Purkinje fibres
590
Crohns patient presents with septic perianal abcess mx
Exploration under GA and drainage As would be complex- so not to do under local
591
4th ventircle relative to pons
Directly posterior
592
Allatnois
Connects umbilical cord to cloaca
593
Dissection of which vessel next to superior cervical ganglion
Internal carotid
594
Diagnostic of SAH in CSF
Xanthochromia- breakdown of Hb
595
What uses the cori cycle
Myocytes
596
How erythrocytes get energy
anaerobic conversion of glucose by the Embden-Meyerhof pathwa
597
Last to regain function in radial nerve palsy
EPL and EI
598
Weakness in dorsiflexion, where is sensory deficit
Root L4 SO medial leg !
599
Primary large pneumothorax mx
>2cm or symptoms Needle aspiration then chest drain
600
Fourineres gangrene organism
Group A strep - pyogene
601
What causes popeye deformity
Prioximal rupture- long head at supraglenoidal
602
What does PAH measure
Renal blood floe
603
What week does the uterus rise above the pelvic rim
12th week
604
Sensation to posterior 1/3 od tongue
IX
605
Approach for hemiarthroplasty
Anterolateral approach
606
Checking rectal anastomosis
Water soluble contrasat enema
607
Biggest arterial contributor to femoral head
Medial femoral circumflex
608
Mx of basicervical fracture
DHS
609
Homan sign
Passive Dorsiflexion pain- DVT
610
Complication of not being euthyroid before surgical management of Graves
Thyroid storm
611
Loss of sensation of upper cheek, upper front teeth and lateral nose
Infra orbital- from V2
612
NSAIDs on kidneys
Vasoconstriction of afferent
613
ANGT2 on renal function
Increased resistance in efferent- increased GFR Hence ACEi reduce GFR
614
Which nerve is responsible for Frey syndrome
AT
615
McMurray test
For meniscus
616
Wells score for DVT and PE
DVT >/=2 PE >4
617
Spiking fevers, headache, neck rigidity after acute mastoiditis
Sigmoid sinus thrombophelbitis
618
Mx of urteric stone
<10mm litho 10-20 uteroscopy
619
USS of foot shows fibrosis and teardrop mass
Mortons neuroma
620
Factors in Extrinis pathway
VII and TF cofactor
621
Transplanted heart nerve supply
No nerve supply - so cannot feel pain Controlled by hormones in circulation
622
Patient has asymptomatic pneumothorax, for surgery what mx
Chest drain
623
Suffering from cold, now painful around medial eye, no eye symptoms
Ethmoidal sinusitis
624
Recent cold, proptosis and opthalmoplegia
Orbital cellulitis
625
Feeding after cystectomy
Sloppy diet
626
Osteocondritis dissectans
Affecting cartilage and subchondral bone Medial condyle Crescent shaped lytic lesion
627
Feeding after oesophgectomy
Jejenostomy
628
Distended abdo, thin hair, dermatitis, malnourished
Protein deficiency
629
Co-trimoxazloe is prophylactive for
Pneumocystic jirovecii
630
Tests for subacromial impingement
Neer Hawkin Jobe
631
Difficulty speaking loudly after throat surgery
RLN damage
632
Mx of testicular cacner
Seminoma Just teste- surgery, surveillance If reocurs- radio is good LN- surgery and chemo, sperm bank Mets- chemo then surgery NSemi Just test- surgery and surveillance (CTAP 3-6, AFP 1-2m)- chemo or RPLN if reoccur LN- Surgery, RPLN, chemo, sperm bank Mets- chemo and surgery
633
Seminoma vs NS
Semi- 30-40 LDH, bHCG Homogenous If mets- radio Lymphocytic infiltrate NS- 20-30 Tumour markers more common - AFP, bHCG If mets- chemo
634
SUFE x ray
Slipped femoral metaphysis relative to epiphysis Femoral head Not intersecting Klein line
635
What does lymphatic nodal involvement follow
Arterial
636
What nodes is affected first from spleen, pancreas and liver
Coelaic
637
Protein affected in haemachromotosis
HFE
638
CRPS 1 vs 2
1- pain after traum with no nerve damage 2- nerve damage
639
Flexion of hand after supracondylar fracture
Volkman Ischaemic contracture
640
Tourniqet effect on bleeding
Hypercoagulable effect
641
Mx of antithrombin def
Warfarin
642
Malocclusion of teeth and CSF rhino
Le fort 2 1 doesnot effect CSF
643
EOL antiemetic
Levomepromazine
644
What must be conducted prior to varicose surgery
Duplex US
645
When to do a hemithyroidectomy
Can be offered if T1-2 (<4cm) No LN or mets, well differentiated
646
Compartment of sural nerve
Superficial
647
Infection of little finger spreads to
Proximal of flexor retinaculum
648
If oesophagectomy with anastomosis what vessel supplies the remains of gastric
Right gastroepiploic
649
Supply of glut max
Inferior gluteal
650
Nerve affected in episiotomy
Pudendal
651
Nerve closely related to origin of meningeal artrery
AT
652
Neurovasculaure content of deep pouch in males
Dorsal nerve of penis, muscular branches of the perineal nerve Deep and dorsal arteries of penis, stem of origin of artery to the bulb of penis, urethral artery.
653
Structure at most risk with clavicle fracture
Subclavian vein
654
Vessel damage at SF ligation
Deep external pudendal
655
Foremen in sphenoid vs temporal vs occipital
Ovale, spinosum, rotundum, SOF- sphenoid Jugular, stylomastoid, IAM- temoroal Magum,hypoglossal - occipital
656
External tympanic membrane cells
Stratified squamous
657
What causes compression in annular pancreas
Ventral pancreas
658
Where does foreamen lacerum lie
Between sphenoid and temporal
659
Innervation of brachioradialis
Radial
660
Lymphatic drainage of membranous and prostatic urethra
Internal iliac
661
Where does sigmoid sinus drain
Internal jugular
662
Incision for Whipples procedure
Rooftop
663
Level of cardioeosophgeal junction
T11
664
Where are oxyphil cells found
Parathyroid
665
Which structure lies in closest proximity to hamate in carpal tunnel
FDP
666
Which foremen does lesser petrosal nerve pass through
Ovale
667
Lymphatic drainage of female urethra
Internal iliac
668
Order of structures in cavernous sinus
Medial Internal carotid Abducens Lateral Oculomotor Trochlear Opth Max
669
Arterial and venous supply of adrenals
Sup- inf phrenic Middle- Aorta Inf- Renal Venous Right- Direct Left- renal
670
Attachments of omohyoid
Superior belly arises from the hyoid bone and inferior belly arises from the scapula. Two muscle bellies are connected by an intermediate tendon, which is anchored to the clavicle by the deep cervical fascia
671
Which layer is the facial vein located beneath
Deep fascia of neck
672
Location of coeliac plexus
Anterior to aorta
673
Attachment of pharyngeal constrictors
Sup - pterygomandibular lig, mandible, medial pterygoid of sphenoid to raphe Mid- stylohyoid and hyoid to raphe Inf- thyroid, cricoid to phayngeal raphe
674
Which vein drains middle colic
SMV
675
Ligaments of ankle joint
Deltoid medially Anterior, posterior talofibular Calcaneofibular
676
What lies medial to dorsalis pedis
EHL
677
Terminal division of external carotid And origin in relation to internal
Superficial temporal and maxillary Origin anteromedial
678
What is divided on lateral approach to hip surgery
Lateral circumflex
679
Origin of compartment of pancreas
The pancreas develops from a ventral and dorsal endodermal outgrowth from the duodenum Ventral - uncinate and major duct Dorsal-minor duct, head, body and tail
680
Incision for elective vs emergency hernia
Elective- Low - Lockwood (below canal) or Lotheissen (through canal) Emergency- High- McEvedy
681
Narrowing of oesophagus
ABCD Aorta Bronchi Cricoid Diaphragm
682
Lymphatics of ear
The lateral surface of the upper half drains to the superficial parotid lymph nodes The cranial surface of the superior half drains to the mastoid nodes and deep cervical lymph nodes The lower half and lobule drain into the superficial cervical lymph nodes.
683
Ribs encountered in posterior approach for kindeys
11-12th
684
What forms lateral wall of deep inguinal ring
TF
684
Artery under lateral third clavicle
Thoracoacromial
685
Supply of pec minor
Medial pectoral
686
Fascial layer that will expose ansa cervicalis
Pre tracheal
687
Lymphatic drainage of ureters
Upper - aortic Lower- common iliac
688
Proximal vs distal Horners
Proximal- hypothalmospinal tract Distal- post ganglionic- at carotids or beyond (anhidrosis mild)
689
Superficial ring borders
Lateral- EO Anterior to pubic tubercle
690
Best incision for appendectomy
Lanz
691
Main arterial branch in omentum
Gastroepiploic
692
What needs to be divided in sympathectomy
Parietal pleura
693
What forms pterion
Greater wing of spehnoid Parietal Squamous temporal Frontal
694
Point of entry of pelvis of ureters
Infront of Bifurcation of common illiac
695
Lump, cough impulse and thrill
Saphena varix
696
Pain just distal to ASIS
Lateral cutaenous nerve of thigh
697
Hypothenar wasting, unable to oppose thumb root
T1
698
Boy presents with Syndactyl- what has happened here
Failure of apoptosis
699
Hodgkin lymphoma with poor prognosis
Lymphocyte depleted
700
HIV and depleted CD20 with generalised LN swelling- what infection
Myco avium
701
Splecetomy with pneumonia
CMV
702
Scan to find primary tumour site
PET scan
703
Injury to cervical area, what muscoskeletal area the lowest that can be damaged without causing issues to breathing
Cricoid C6- not affecting phrenic
704
Tx of C diff infection
Vanc oral first line Second Fidoxamicin Life threatening- Vanc oral and IV met
705
Low BP, low Na, high K what diagnostic test
SynACTHen
706
Mantoux test type
4- delayed
707
Loss of lordosis weight lifter
Spondylithiasis
708
Location of lateral cutaneous nerve
L2,3 lateral to psoas major
709
Long term catheter organisms
Proteus and pseudomonoas
710
Serosonginous discharge cominig from single breast duct
Papilloma
711
Lump transilluminates, not present all day
Hydrocele
712
TNM colon cancer
T1- submucosa 2-MP 3- subserosa 4- other organs N1- <3 LN 2- >3 3- distal nodes
713
When must you use FFP by
<24 hrs of defreezing
714
ACL artery
Middle geniculate
715
Pathology of mortons neuroma
Synovium Fibrosis And Nerve Inflammation (between 3rd and 4th)
716
Arch origin of Ductus arteriolis
6th
717
Most common organism for cellulitis
Strep pyogenes
718
Foul ,diarrhoea, steatorrhoea, what organisms, what shape and tx
Giardia Pear Metronidazole
719
Diarrhoea fter eating chicken with cramps, what gram, dx and associated condition
C jejuni Gram -ve rod GBS
720
Meningitic symptoms with HIV, what test
Crypto neoformans India pink
721
Signs of carbon monoxide poisoning or inhalation injury
High resp rate Confusion Tiredness
722
How can you lower ICP
Lower CO2
723
Level of hilum of lung and incision for access
T5-7 6th IC Space Posterior Axillary Line
724
Hypodense on CT brain
Infarction
725
What is bladder exostrophy associated with
Hypospadism
726
Trauma with thigh swelling, decreased pulse and sensation distally
Femoral Shaft fracture
727
Tertiary hyperparathyroidism pathology
Hyperplasia
728
Spleen location
Ribs 9-11
729
Patient died after trauma with delayed fixation of fracture what do you see on CT head
Petachial haemorrhage
730
Cardioesophgeal from incisors length
40cm
731
Nerves damage preventing erection after surgery
Pelvic splanchnic
732
Which region do ureter pierce bladder
Posterior
733
Primary vs secondary hypothyroidism
Primary- thyroid damage Secondary- pituitary damage- prolactinoma
734
Splenomegaly, BM shows megas- what is the cause of low plts
Spleen plt destruction
735
How many litres per minute does a male athlete produce
5-6L
736
AAA pathology
Loss of medial elastin Medial cystic necrosis - in marfan
737
Most sensitive regulator of ADH
Hypothalamic osmoreceptors
738
What is secreted in response to oral glucose
GIP
739
What inhibits gastric emptying
CCK SS
740
What are micelles crucial to
Vit ADEK absorption
741
Layer of cartilage most responsible for resistance to stress
Transitional (middle)
742
Most important factor mediating blood flow in muscle
Vasodilator metabolites
743
Involuntary athetoid movement where is the lesion
Basal ganglion Globus pallidus
744
What is formed by osteoblast prior to osteoid
Collagen
745
What do non myelinated neurons lack
Nodes of Ranvier
746
Stored blood affinity
Less DPG so greater affinity
747
Dorsal respiratory group
Produces inspiration
748
Pneumonectomy reduces VC by
33%
749
Adrenorecptors insulin/glucagon
B stimulates insulin, a inhibits B inihibtis glucagon, a stimulates
750
% of calcium ionised and bound to albumin
40- 50% ionised 45% to albumin
751
Intracellular recptors
Cortisol Aldo Vit D Test
752
Osmolaltiy of medulla to concentrate urine
High
753
Renal threshold
Plasma conc which above, substances start to appear in urine
754
Pudendal passes between which 2 muscles at GSF and relative to sciatic nerve
Piriformis and cocygeus Medal to Siactic
755
Vessel bleed in tonsilectomy
External palatine vein
756
Where are accessory spleens found
hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads
757
What does chorda tympani run medially to in middle ear
Pars Flaccida
758
Is the gallbladder intraperitoneal
The fundus is
759
When are the ligaments of the knee taut and is the patella intr/extra ynovial
when in extension Posterior aspect is intrasynovial
760
Why is it easy to insert a CVP line
No valves IVC has 0 too
761
Blood supply of bile duct
Hepatic artery
762
Breast cancer with lymphcytic ifiltrate
Medullary
763
Subacute thyroiditis features
High T4 Low TSH Reduced uptake Tender
764
Imaging with young woman with lump with implants
USS then MRI
765
Pagets vs nipple eczema
Pagets- nipple first Eczema- areolar
766
Med causing goitre and hypothyroid
Lithium
767
WLE has + resection margin in breast
Mastectomy
768
Thyroid cancer related to radiation
Papillary
769
Biggest risk factor for DE
Smoking
770
2cm invasive carcinoma of breast with axillary involvement
WLE and axillary clearance
771
What does dobutamine act on to reduce BP
B2
772
Painful thyroid swelling with defective epithelial cells and siderophages
Thyroid cyst Siderophage is a haemosiderin containing macrophage
773
Optic pathway in parietal lobe
Optic radiation
774
Vessel most likely injured at lesser trochanter
Circumflex vessels
775
Sinus tarsi between
Calcaneus and talus
776
Histology of methothilioma
Epithelial tumor and tubular cells
777
ON AC but no severe RF of head injuiry
CT <8hrs
778
MOA of TXA
Prevents formation of plasmin
779
Post renal transplant, anuric, double DR matched, urine flowing with irrigation
Renal venous thrombosis
780
Needle aspitation in 2ICS most likley structure damaged
2nd IC nerve
781
Amyloid in heart
ATTR
782
Nerve root of musculocutaneous
C5,6,7
783
pH less that on aspiration of gastric tube
<5.5
784
Air noted under diaphragm after snare polypectomy mx
If during procedure- clips If after and not peritonitic- NBM, abx and wait Peritonitic- surgery
785
What wave in JVP is effected in tricuspid stenosis
A wave
786
CRYPT ABSCESSES
UC
787
Relative risk, RRR, ARR and NNT calculation
RR= (outcome exposed/total expose)/ (outcome not exposed/total not exposed) RRR=1- RR ARR= reverse of RR NNT=1/ARR
788
Right renal artery relation
Posterior to IVC
789
Posterior compartment of leg deepest structure?
Tibial artery
790
Posteromedial approach to Baker's cyst, which part of neurovascular bundle is most superficial and susceptible to damage?
Saphenous vien
791
Normal PEF
500L/min
792
Where to ligate thoracic duct
Aortic hiatus on left
793
Numbness of cheek and upper frontal teeth after trauma to face, anesthesia on that side of the nose
Infraorbital
794
Vertebral level of cervical ganglion
Superior - C1-4 Middle - C6 Sterllate- C7, T1
795
Formation of ureterostomy
Removes a short piece of your small bowel (ileum). Join the cut ends of the ileum back together. Ureters attached to one end of this piece of ileum.
796
Uretereostomy with ileum electrolyte abnormality
Hyperchloremia
797
Barorecptor response to hypotension
Carotid sinus baroreceptors are responsive to both increases or decreases in arterial pressure, while aortic arch baroreceptors are only responsive to increases in arterial pressur
798
Immediate inferior pole of left adrenal gland
Splenic artery
799
Types of ectopic in Meckels
Gastric and pancreatic
800
Where does fluid accumulate in perf appendix
Pelvis
801
Genes involved in colorectal cancer pathway
APC c myc K ras p53
802
Rithcers and Littres hernia
Anti mesenteric Ritcher Littres- Meckels
803
What is Cullens vs Grey Turners sign
Cullen- intrabdominal bleed Grey Turner- retroperitoneal
804
Surgery for UC
Elective- pan procto Emergency whilst unwell- Subtotal and end ileostomy
805
SBO, pain radiated from groin to knee
Obturator hernia
806
When to re scope after polyp findings
Large non pedunculated colorectal polyps - One off scope at 3 years High risk findings More than 2 premalignant polyps including 1 or more advanced colorectal polyps (>1cm or dysplastic) OR More than 5 pre malignant polyps- Or- adenoma >1cm thats dysplastic One off scope at 3 years (If tumour is left ) Large non pedunculated colorectal polyps (LNPCP) R1 or non en bloc resection- Site check at 2-6 months and then a further scope at 12 months
807
Surgery on obstruction of rectum, left and right colon
Rectum- loop colostomy Left- End colostomy Right- Right hemi and ileo-colic
808
Most common fistula in ano
Intersphincteric
809
Medication that can aid pseduo-obstruction
Neostigmine
810
Normal CBD width
<8mm
811
Cell origin of all pancreatic adenocarcinomas
Ductal epithelium
812
Managemement of T4 colon cancers
Chemoradio
813
Management of T3,N1 colon cancer
Resect then chemo (decide chemo on final hisotlogy)
814
Work up before cholecystectomy
LFT and USS for CBD width
815
Bariatric surgery associated with delayed gastric emptying
Anterior GJ
816
Achalasia patholgy
Loss of ganglion in myenteric plexus
817
Pancreatic necrosis on CT, suspicion it is infected what next
FNA If confirmed Necrosectomy
818
What to do after ERCP failed with panc carcinoma
Percutaenous transhepatic cholangiogram and drain
819
Blood supply of Meckels
Vitelline- branch of ileal
820
Fundoplication, now delayed gastric emptying
Damaged vaguis
821
Stone in CBD, impossible to remove what next
Choledochoduodenostomy
822
Where haematoma collects ini penile fracture
Bucks
823
Delayed presentation of External iliac thrombus- what management
Thrombectomy and below knee fasciotomy- low risk above knee
824
Fem pop bypass but has varicose veins
PTFE with miller cuff
825
Nerves at risk for brachial cyst excision
Mandibular branch of facial nerve, greater auricular nerve and accessory nerve
826
Which lobe does BPH and prostate cancer effect
BPH- median Postate C- posteriro
827
When to DEXA scan vs treat
Bisphosphonate, calcium and vitamin D supplementation should be given to all patients aged over 75 years after having a fracture. A DEXA scan is only needed of the patient is aged below 75 years.
828
Open patella fracture management
Debride Encirclage wires and primary closure
829
Most common paranasal sinus cancer
Ethmoidal
830
Sarcoid vs cacner of partoid
Sarcoid bilateral
831
An x-ray shows a distal radial fracture with radiocarpal dislocation.
Barton
832
Febrile with a smooth swelling overlying the superomedial aspect of the right eye
Ethmoidal sinusitis
833
Superloateral limit of axillary dissection
Axillary vein
834
Distended abdo, hiccups after burns
Acute gastric dilation
835
What is deficient at the area of prolapsed disc
Annulus fibrosus
836
Prev aortic graft, become pulseless Other side healthy what mx
Fem fem
837
First symptom of raised ICP
Altered mental status
838
Supply of EAM
AT and vagus
839
Supply of external ear
Skin of posterior ear- LO Superior- AT Inferior- GA EAM- AT and vagus
840
Ulcerated, lesion after injury, rasied red
Pyogenic granuloma
841
INR before surgery
<1.5 If above - give oral vit k
842
Levator scapula attachment and innervation
C1-4 TP Dorsal scapular
843
Rhomboid major and minor attachment and innervation
Minor- C7-T1 Major- T2-5 Dorsal scapular
844
Attachment of triceps
Lateral- sup to radial groove Medial - inf to radial groove Long- infraglenoid
845
Which toes do not have palmar interossei
1st and 2nd
846
Asvascular necrosis x ray signs
Early- opaque - hyperaemia Late- radiolucent and subchondral collapse
847
Posterior urethral fold symptoms and embryology
Hesitancy, poor stream, UTI, even resp problems as child Abnormal intergration of Wollfian duct
848
Mx of hydrocele
In young- inguinal ligation of patent processus vaginalis In adults- scrotal jabouley approach
849
Neuro vs nephroblastoma
Neuro- calcified Nephro- non
850
TCC of renal pelvis cause and tx
Textiles Radical nephroureterectomy
851
Wheelchair bound, IHD, popliteal occlusion
Amputation
852
Thiazide on Ca
Hypercalc
853
Hormones reduced after surgery
Test, oestrogen adn insulin
854
Dead space vs RV measurements
Dead space- Fowler- N2 RV- helium
855
Part of JVP where Tricuspid closes
C wave
856
Normal anion gap
8-14
857
Normal anion gap acidosis causes
H - Hyperalimentation/hyperventilation A - Acetazolamide R - Renal tubular acidosis D - Diarrhoea U - Ureteral diversion P - Pancreatic fistula/parenteral saline
858
What vitamin is pancreatic independent in absorption
Folate
859
Body fluid volumes
Plasma- 3, 5% Interstitial- 10, 24% Transcellular-1, 3%
860
Airway management in short case with sevoflurane
Laryngeal mask Used in day surgery
861
Fluid that is the most electrolyte rich
Hartmanns
862
When to stop UFH infusion
6 hours before
863
Bronchiectasis vs scoliosis lung pattern
BE- obstructive Scoliosis- restrictive
864
KIT + tumour Drug
Imatinib
865
Relaxant agent not used in burns and one that is degraded by hydrolysis and may cause histamine release
Suxamethonium- due to HyperK Atracurium is degraded by a process of ester hydrolysis. This uses non specific plasma esterases
866
Composition of cryo
vWF VIII Fib XIII
867
Immunological therapy in Crohns
Infliximab
868
TPN calories
25-35 kcal/kg/day (lower if BMI > 25) If severely ill and malnourished, the initial calories administered is reduced by 50% in the first few days. 10cal/kg/day with oral thiamine and B supplements
869
CI to epidural
Active infection Appendicitis i.e
870
Hypovolaemia PAWP, CO, SVR
Low low high
871
When is a Caudal block used
For nerves affecting lumbar or sacral area
872
Only vasopressor that doesnt require central line
Metaraminol
873
What is associated with anal/oral cancer
HPV16/18
874
Medially displaced ureters vs lateral
Lateral- retroperitoneal malignancy Medial- fibrosis
875
Which coag factors does jaundice impair
2,7, 9, 10 Since impairs Vit K
876
What can you see with severe atrophic gastritis
Gastric ulcer, anaemia Gastric polyps Cancer
877
Mx of gastric cardia cancer
Total gastrectomy with RNY
878
PTEN mutation
Cowden disease Macrocephaly Multiple intestinal harmatomas Breast cancer, thyroid Colorectal
879
What is used to stain cytoplasm and nuclei
haematoxylin and eosin
880
Location and type of polyp in HNPCC
Mucinous and right sided
881
Splenomegaly haem causes
* Myelofibrosis * Chronic Myeloid Leukaemia * Visceral leishmaniasis (kala-azar) * Malaria * Gaucher's syndrome
882
Symptomatic AAA with occluded iliac artery mx
Open reapir
883
osteopetrosis is best explained by a defect in which of the following?
Osteoclasts
884
Echinococcus granulosus infections
typically produce a type I hypersensitivity reaction which is characterised by an urticarial rash. With biliary rupture a classical triad of biliary colic, jaundice and urticaria occurs Hydatid cyst
885
Diabetic drugs with surgery
Stop acarbose, sulphonyl, glitides, pio, dp4, SGLT2- once VRII commenced, restart once eating and drinking GLP1 can be takern as normal during infusion Pio, DP4 (gliptins), GLP1 can be taken as normal peri op Sulph, SGLT2 omitted Metformin omitted if miss more than 1 meal, or if risk of AKI (GFR <60 or contrast) VRII if BD metformin or glucose >12 on 2 occasions
886
Troublesome persistent green breast discharge
Hadfield procedure Total duct excision
887
PDA vs coarctation murmur location
Coar- 4th ICS PDA- under clavicle
888
Parotid malignancy most likely to spread and cause facial nerve damage
Adenoid cystic
889
plain x-ray of the affected site shows multiple lytic and lucent lesions with clearly defined borders. What is the most likely diagnosis?
Osteoclastoma Soap bubbles
890
Osteoid osteoma
Lesion affects cortex and radiologically consists of a lucent centre surrounded by reactive sclerosis Severe pain- respond to NSAIDs
891
Skin rash in glucagonoma
skin rash of erythematous blisters involving the abdomen and buttocks. The blisters have an irregular border and both intact and ruptured vesicles
892
Cytotoxic hypersensitivty
Type 2 Antibodies formed against antigens
893
Tx of hydatid cyst
Surgery and mebedazole
894
Only surgery needing one lung ventilation
VATS
895
Mx of hernia electviely
Adult- Mesh repair- Lichen Routine If incarcerated- urgent referral Strangulate-d admit Mesh on TF and IO Shouldice- if pus or bowel content contaminating canal - no mesh Child- herniotomy Within 2 weeks - urgent No mesh Recurrent or bilateral- lap
896
Granulation tissue by wound, what can help it heal
Silver nitrate
897
Types of current
Cutting- continous low voltage Coag- peaks of high voltage Des- low current, high voltage, water loss, no protein Fulguration- low amp high volatge, held away Blend- alternating cutting and coag
898
Anastomosis most and least likely to leak
Most- oesophageal and rectal Least- small bowel
899
Mesh location in inguinal canal
Posterior to cord On TF and IO Fixed to inguinal ligament- prolene
900
What is assocaioted with malrotation
Exomphlaos and congenital diaphragmatic hernia
901
Hirschprungs disease mx
Full thickness suction rectal biopsy. The condition is managed with washouts initially. At between 9 and 12 months of age, definitive surgery (usually resection and primary anastomosis) is performed.
902
Dermoid appearance
Dermoid cysts are usually multiloculated and heterogeneous. Most are located above the hyoid
903
Skew effects on mode median mean
Neg- mode> median>mean Shifted right Pos- mean>median>mode Shifted left
904
Coefficient of variation calculation
SD/mean
905
Ix of non healing venous ulcer and in lichen sclerosis
Punch biopsy to ensure not malignant Punch biopsy too
906
Friable skin lesion, slough off and scars
Keratoancanthoma
907
Mx of infected sebaceous cyst
Incision and drainage with excision of cyst wall and packing
908
Which nerve does Le Fort 2 fracture effect
Infraorbital
909
Orbital apex syndorme sx
SOF syndrome and ipsilateral pupillary defect
910
Vertigo, dysarthria then collapse
Basillar occlusion Suggests posterior inarct
911
Hormones increasing and decreasing with hypothermia
Increase- TSH, adrenaline, CS, aldo, glucagon Decrease- insulin
912
Flat face fracture
Le Fort 3
913
UO targets in burns patients
Normal burns - 30ml/hr Electrical- 100
914
Seen last in compartment syndrome
Loss of pulse
915
Sequestration vs aplastic
Aplastic- reticulocytes low
916
Loss of sensation in left cheek, fullness in gingivobuccal sulcus and proptosis
Maxillary cacner
917
Varicella vesicles over tip of nose where else can they be
Cornea
918
Old lady rapidly enlarging thyroid now has stridor
Anaplastic carcinoma
919
Movement of mandible on wide openeing and discloation
disclocates anterirorly
920
TMJ disc
Fibrous
921
Axis and atlas features
Axis- bifid, small transverse foramina, odontoid Atlas- no body, anterior and posterior arch, PA has a groove for the vertebral artery and C1 spinal nerve.
922
Tooth infection organism
Bacteroides
923
Difference in vertebrae
Cervical- transverse foramina, triangle foramen, bifid spinous Thoracic- demifacet for ribs Oblique SP Circular SF Lumbar Triangular Short SP
924
Hypothyroid cholestrol
High
925
Ulcer effects which artery at junction of gastric body and antrum
Right G.epi
926
Plaster management
If there is axial instability (whereby the fracture is able to rotate along its long axis), such as combined tibia-fibula metaphyseal fractures or combined radius-ulna metaphyseal fractures, the plaster should cross both the joint above and below Spiral fracture
927
Virus responsible for kaposi
HHV8
928
Loss of sensation back of elbow, weak supination what root
C5
929
Lymph drainage of scrotum
Medial superifical
930
Cause of direct hernia
TF weakness
931
Alar catilage exposed, which flap to use
Local rotational
932
Old man with bronchitis with rib fracture mx
Admit and analgesia
933
Burn with blisters mx
Occlusive dressing
934
FOOSH parasthesia of thumb and index
Lunar dislocation
935
Sensation of ear lobe
GA
936
Urine with SAH
Natriuresis with polyuria is common after aneurysmal subarachnoid hemorrhage Diluted urine
937
Opening of major papilla
Postero medial 2nd part of duo
938
Mobilise spleen from abdo wall
Splenorenal
939
Inguinal lymphnodes and bleeding in female
Vuvlal cancer
940
What drains anterior surface of heart
Great cardiac
941
Medial vs lateral plantar sensory supply
3.5 vs 1.5 lateral
942
Meconium passed PV - what hasnt happened
Cloaca septum to form As hindgut and claoca initially 1
943
Why is maxillary sinus prone ot infection
position of their ostia high on their superomedial walls Doesnt drain well
944
Best long term management of post phlebetic syndorme
Compression stockings
945
Isovolemic contraction vs relaxion with valve
Mitral close- contraction Aortic- relaxation
946
Pain, loss of lordosis
Prolapsed disc
947
What causes steathorrea in gastrinoma
Reduced panc enzymes- lipase
948
Site action of aldo
Collecting
949
Sacral dermatomes
S1 covers the heel, little toe, and posterolateral S2 covers the posteromedial thighs. S3 cover the medial side of the buttocks and genital (ischial tibs) S4-5 covers the perineal region and genital S5 is of course the lowest dermatome and represents the skin immediately at and adjacent to the anus.
950
Sickle cell pneumonia
Strep pneumonia
951
If combined folate and B12 def which start first
B12
952
PGE gastric effect
Increase mucosal Decrease acidand secretions
953
Function of Vit C in wound
Requires in hydroxy proline and lysin for cross linking
954
Best respiratory test predictor of morbidity after surgery
FEV1 <1L
955
Popcorn cells in lymph nodes
Nodular Lymphocyte predominate HL
956
Most common side effects of blood products
RBC- pyrexia FFP- urticaria
957
Other cancer BRCA puts you at risk for
Ovarian
958
What causes angiomyolipomata
Tuberous scleorsis
959
Features of Von Hippel Lindau
cerebellar haemangiomas retinal haemangiomas: vitreous haemorrhage renal cysts (premalignant) phaeochromocytoma
960
What phase of gastric acid secretion is abolished with vagotomy
Cephalic
961
Which cell is the main secretor of TNFa
Macrophages
962
What secretes CSF
Choroid plexus In each ventricle
963
What parietal cells secrete
secrete HCl, Ca, Na, Mg and intrinsic factor not Chief cells: secrete pepsinogen Surface mucosal cells: secrete mucus and bicarbonate
964
Large villous adenoma in rectum abnormality
Hypok
965
Altitude effect on oxygen dissociation curve
Shift to right DPG is increased in conditions associated with poor oxygen delivery to tissues, such as anaemia and high altitude.
966
What area is effected by opioids in respiration
Medullary respiration centre
967
Normal ICP
<15mmHg
968
Best investigation for upper airway compression
Flow volume loop
969
Ebb vs flow phase
Ebb- reduced energy consumption Hypothermia, reduced CO, reduced glucose tolerance Increased cate, cortisol, aldo 24 hours Flow- increase cortisol, adrenaline Increased glycogenolysis, increased gluconeogenesis Insulin insensitivity , but increased Increased temp, CO, oxygen consumption
970
Contributors to long saphenous
Medial marginal Superficial epigastric Superficial iliac circumflex Superficial external pudendal veins

eMRCS questions (45 decks)

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