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Terms in this set (435)

Splenic injury grade. What is the name of this classification?
MOORE classification.
Beware of size of laceration!
Grade 1 is < 1cm
Grade 2 is > 1cm
Does the hypoglossal nerve exit through the foramen magnum?
No.

Exits cranium via it's own foramen. Hypoglossal foramen.
Does the apical ligament of the dens pass through the foramen magnum?
Yes.
What sensory message does the lateral geniculate nucleus (LGN) transfer in the thalamus?
Vision
Into which vein does the thoracic duct drain into?
Left brachiocephalic vein. It enters the vein behind the left sternoclavicular joint.
What is the disease called bicornuate uterus? How does it present?
It occurs when there is incomplete or partial fusion of the paramesonephric or Mullerian ducts and results in a uterus to 2 separate horns.

It presents as recurrent pregnancy loss and cervical incompetence.
What is Mullerian agenesis? How does this present?
Congenital conditions in which the Mullerian ducts fail to develop in a female. This causes an absent uterus and absent fallopian tubes.

Presents as a lack of menstruation.
What needle and material would you use in a subcuticular stich of a skin incision?
4-0 monocryl

- minimal tissue reaction
- absorbable suture (will not cut through tissue)
Which head and neck cancers can cause otalgia?
1. Carcinoma of the larynx
2. Carcinoma of the epiglottis

The ear is supplied by the vagus and glossopharyngeal nerves (sensory) and any malignant interference in these nerves can cause referred otalgia. The epiglottis is supplied by the vagus nerve.
How would a vestibular schwanoma present?
Also called, acoustic neuroma, its is a benign intracranial tumour of the myelin cells in the vestibulocochlear nerve.

- Unilateral hearing loss +/- tinnitus and balance issues
- No otalgia
- If progressess and compresses the trigeminal nerve, can cause tingling in the face
Indications for surgery in peptic ulcer disease? ''I CHOP''
I - Intractability (failed medical management)
C - Cancer (gastric ulcers only)
H - Haemorrhage
O - Obstruction (gastric outlet obstruction secondary to scarring/stricture formation)
P - Perforation
How does hyponatremia present?
may be Asx or may present w/ confusion, lethargy, muscle cramps, hyporeflexia, and nausea
Can progress to seizures, coma, or brain stem herniation.

Synonymous with extracellular fluid loss (vomiting, diarrhoea, high stoma output).

In severe hyponatraemia, there is tachycardia and hypotension.
What is Boa's sign? What does it indicate?
It is hypersensitivity bellow the right scapula which can be cause by phrenic irritation. (ie. cholecystitis)
What is the most common cause of meconium ileus in a newborn baby?
Cystic fibrosis. Autosomal recessive condition associated with the abnormal production of mucus high in slat content.

The pancreas undergoes dysplasia, loss of pancreatic enzymes and build up of mucus, this causes intra-luminal intestinal obstruction (generally in the terminal ileum). Affected bowel is filled with heavy meconium and be dilated, making it likely for a volvulus to develop.
What is a common outcome of Hirschprung's disease?
Megacolon.
Where is the transpyloric plane?
Imaginary transverse plane with a surface marking mid-way between the jugular notch (suprasternal notch) and the pubic symphysis.

- origin of the superior mesenteric artery
- origin of the pancreatic neck
- the 1st part of the duodenum
- the pylorus
- the renal hila
- the duodenojejunal flexure
- the gallbladder fundus
- origin of the hepatic portal vein
- origin of the transverse mesocolon
- origin of the splenic hilum
Differentiate the Stensen's duct, the Bartholin's duct and the Wharton's duct. "Before We Swallow"
(Swallow) Stensen's duct: arises from the parotid gland and travels along the lateral aspect of the masseter, before piercing the buccinator and opening into the oral cavity opposite the superior second molar tooth.

(Before) Bartholin's duct: joins the sublingual gland to the oral cavity. Opens under the tongue.

(We) Wharton's duct: joins the submandibular gland to the oral cavity via a single duct. Open under the tongue.
What is the pterion?
The region where the frontal, parietal, temporal, and sphenoid join together
Which bone is attached to the tympanic membrane in the ear?
The malleus.
In compartment syndrome, is the pain made worse on extension of flexion of the affected muscles?
Pain is worse on passive stretching (ie. extension) of the affected muscles! Not flexion.

This is a surgical emergency as increasing pressure in the compartment exceeds perfusion pressure, causing hypoxia and ischaemia. Requires urgent fasciotomy.
What are the boundaries of the 'safe triangle' when inserting a chest drain?
1. 5th intercostal space inferiorly
2. the posterior border of pectoral major anteriorly
3. the anterior border of latissimus doors posteriorly

ie. 5th intercostal space, mid-axillary line
How do you grade prostate cancer?
Graded using the Gleason grading system, two grades awarded 1 for most dominant grade (on scale of 1-5) and 2 for second most dominant grade (scale 1-5). The two added together give the Gleason score. Where 2 is best prognosis and 10 the worst.
How do you stage prostate cancer?
Staged with the TNM classification system.
What is the risk of having a child with cleft palate?
0.1%

4% if you already have a child with cleft palate.
What are the criteria for the Child-Pugh classification system for cirrhosis?
What is Dejerine-Roussy syndrome?
Spontaneous pain with particularly unpleasant quality, sometimes described as burning, tearing, knifelike or stabbing but often difficult to characterize. Cutaneous stimulation can also lead to painful or unpleasant sensation.

Caused by a stroke affecting the thalamus.
How do you manage different stages of empyema?
How does neurogenic shock present?
- Hx of spinal cord injury
- loss of sympathetic tone below the lesion
- can cause bradycardia and hypotension if head injury
- it does not respond to fluids as the first problem is loss of sympathetic tone
What is a very likely diagnosis in a patient presenting with unilateral facial nerve palsy?
Malignant parotid gland neoplasm. (only 15-20% are malignant)
What is Octaplex or Beriplex? When would you use it?
Octaplex is PCC, Prothrombin Complex Concentrate. It contains clotting factors 2, 7, 9 and 10.

It is used in the reversal of warfarin (for up to 6-12h). Can also use Vitamin K.
How can you differentiate oliguria due to pre-renal renal failure rather than acute tubular necrosis?
Check the urinary sodium concentration!
Review Hashimoto's thyroiditis. What auto-antibodies is this condition associated with?
Features:
- features of hypothyroidism
- goitre: firm, non-tender
- anti-thyroid peroxidase (TPO) and also anti-thyroglobulin (Tg) antibodies + anti-microsomal antibodies

Associations:
- other autoimmune conditions e.g. coeliac disease, type 1 diabetes mellitus, vitiligo
- Hashimoto's thyroiditis is associated with the development of MALT lymphoma
What is the lymphatic drainage of the oesophagus?
Divided into thirds!
Describe the borders, roof and floor of the antecubital fossa.
What is golfer's elbow?
medial epicondylitis, inflammation of common flexor tendon of medial epicondyle
How do you assess the depth of a burn?
How do you assess the extent of a burn?
3 techniques:

1. Wallace's Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%

2. Lund and Browder chart: the most accurate method

3. the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA
How do we grade and manage liver injuries?
Grades I to III: mostly conservative + monitoring

Grade IV - V: Laparatomy and periheatic packing or Pringle's manoeuvre
What are the foramina of Magendie and Lushka?
They are wholes in the roof of the 4th ventricle that communicate directly into the subarachnoid space.

The CSF circulates between the ventricles through canals. The lateral ventricles communicate with the third ventricle through the interventricular foramen (foramen of Monro); the third and fourth ventricles communicate through the cerebral aqueduct and the fourth ventricle communicates with the spinal fluid in the arachnoid space through two lateral apertures (foramen of Luschka) and a median aperture (foramen of Magendie), not shown.
In a below knee amputation, how much (in cm) of tibia is needed to fit a below-knee prothesis?
At least 8cm, but 15cm is preferred.

Note, the anterior aspect of the tibia must also be bevelled
What layer provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?
The end-thoracic fascia.
What receptors does adrenaline bind to?
Beta-receptors: chronotropic and inotropic stimulation
Alpha-receptors: increase in peripheral vascular resistance
What 4 factors affect the oxygen saturation to haemoglobin dissociation curve?
1. concentration of H+ (pH)
2. Temperature (follows the pattern of CO2)
3. DPG (increase in levels causes displacement to the right = lower affinity)
4. CO2 (follows the pattern of temperature)
Describe the complement cascade. How do they attack pathogens?
Opsonisation, inflammation and membrane perforation

C5-C9 = membrane perforation complex
Why are skin grafts rarely rejected by the recipient?
"Burned" tissue is relatively immunosuppressed. Despite skin having a high HLA (Human Leucocyte-Antigen) expression.
Describe the nerve supply to the thigh and leg.
What antibodies act as tumour markers and for which cancers?
What tumour antigens act as tumour markers and for which cancers?
What is a Marjolin's ulcer? How is it diagnosed and treated?
Chronic venous ulcer that has undergone malignant change. Type of Squamous cell carcinoma.
Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years
Mainly occur on the lower limb

Diagnosed on biopsy. Often described as having tender and thickened edges.
What are the differences between the mid point of the inguinal ligament and the mid-inguinal point?
What is the main cause for primary parathyroidism?
in 85% of cases, it a parathyroid adenoma.
What is gastrochisis?
When the bowels come through the abdomen and peritoneal muscle to the right of the umbilicus, not covered in a sac
What is an important side effects of adjuvant chemotherapy for breast cancer?
There is a 20% increased risk of developing a non-breast related cancer, often AML or Myelodysplastic Syndrome.
How long would you wait before changing a tracheostomy tube once it has newly been inserted?
At least post-operative day 3.
What are causes of post-operative pyrexia?
C - Catheter (urinary tract infection)
C - Cannula/Central line (phlebitis or drug allergy)
C - Cut/Cellulitis/ anastomotic leak
C - Chest atelectasis (days 2-3 post op) or Pulmonary embolism (PE)
C - Calf deep vein thrombosis (DVT) VT (days 7-10 post op)
C - Collection (of pus, eg pelvic, subphrenic)
Name 4 cranial parasympathetic ganglia.
1. Otic
2. Submandibular
3. Pterygopalatine
4. Ciliary
What is Thoracic Outlet Syndrome? How can it present?
Group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the space between your clavicle and your first rib (thoracic outlet).

Presentation: on the affected side
- acute oedema
- cyanosis
- pain (95% of cases present with neuropathic pain)
- reduced sensation
- weakness
- muscle fatigue

If venous compression, this is called Paget-Schroetter Syndrome, presents with arm swelling, cyanosis and a feeling of arm heaviness.

If arterial compression, presents with claudication, pain in hand, pallor and cold intolerance.
What is the Meckel's diverticulum "rule of 2's"?
2 - occurs in 2% of the population
2 - it shows a 2 :1 male to female ratio
2 - it is approximately 2 in (5 cm) long; it is found 2 ft (60 cm) from the ileocaecal valve
2 - 1 in 2 will contain ectopic tissue: gastric or pancreatic
2 - only 2% are symptomatic
2 - it is an important cause of rectal bleeding in the under 2s
What ECG change is associated with hypothermia?
J waves! Also called Osborn waves.
Describe the nerve supply to the skin of the upper limb.
Note: the musculocutaneous nerve becomes the lateral cutaneous nerve of the forearm and supplies sensation to the anterograde-lateral forearm.
Which clotting factor is not a serine protease?
Factor 13., it is a transglutaminase.

All the others are serine proteases.
Where does the thyroid ima artery arise from? What does it supply?
It arises from the brachiocephalic artery and supplies the isthmus of the thyroid gland.
What is the foramen of Winslow? How does it related to the portal vein?
Foramen of Winslow is the epiploic foramen, that connects the greater sac from the lesser sac. The portal vein lies anterior to this foramen.
Where does the caudate lobe lie in relation to the inferior vena cava? Portal vein?

Where does the Segment I of the liver lie in relation to the portal vein?
It lies posterior to the portal vein.

But anterior to the inferior vena cava.

Segment I is posterior to the portal vein!
What coronary vessel supplies the AtrioVentricular node (AV node) in the heart?
The atrioventricular nodal branch, a branch from the posterior inter ventricular artery (right coronary artery..
What is first line investigation in an asymptomatic singular thyroid nodule?
Fine needle aspiration with US guidance and cytology. Likely multi nodular cyst
What is cystinuria?
Homocystinuria is a rare autosomal recessive disease caused by a deficiency of cystathionine beta synthase. This results in severe elevations in plasma and urine homocysteine concentrations.

Features
- often patients have fine, fair hair
- musculoskeletal: may be similar to Marfan's - arachnodactyly etc
- neurological patients may have learning difficulties, seizures
- ocular: downwards (inferonasal) dislocation of lens
- increased risk of arterial and venous thromboembolism
- also malar flush, livedo reticularis

Diagnosis is made by the cyanide-nitroprusside test, which is also positive in cystinuria.

Treatment is vitamin B6 (pyridoxine) supplements.

Can see the stones on US scan
What is Kartagener's Syndrome?
Primary Ciliary Dyskinesia = absent Dynein in the cell's cytoskeleton

immotile cilia due to dynein arm defect, male and female infertile, bronchiectasis, recurrent sinusitis, associated with situs inversus
What does hypoxic death of cells in the central nervous system cause upon death?
Liquefactive necrosis.
What artery does the radial artery give off in the hand? What anatomical landmark does it cross? What artery does the ulnar artery give off in the hand?
Radial artery:
- crosses the floor of the anatomical snuffbox
- pierces the first interosseous muscle to form the deep palmar arch

Ulnar artery:
- gives off the superficial palmar arch
What is the treatment protocol for anal fissures?
What does CO2 do to blood vessels?
It vasodilates them!
What is the most common type of bladder injury associated with pelvic fractures?
Extraperitoneal perforation.
How do we treat testicular germinal cell tumours?
How does a bronchoalveolar carcinoma present? What does it look like on an CXR?
It is a subtype of non-small cell lung cancer that grows along the alveoli and respect lung segments.

CXR: pneumonia-like consolidation + atypical cells on bronchoalveolar lavage
What findings on bronchoalveolar lavage are associated with sarcoidosis?
Increased lymphocytes with braised CD4:CD8 count. No atypical cells.
What are the main investigations for painless haematuria?
1. CT Urogram
2. Flexible cystoscopy
What are risk factors for squamous cell carcinoma of the bladder vs. transitional cell carcinoma of the bladder?
Squamous cell carcinoma of bladder:
- chronic irritation of the bladder (long term catheter)
- schistosomiasis (parasitic infection)

Transitional cell carcinoma of the bladder:
- aniline dyes in the textile industry
- reagents in rubber
- smoking
- analgesic abuse
Summarise the phases of the cell cycle.
What is the management of hyperhidrosis?
1. Topical aluminium
2. Intra-dermal botox injections
3. Thoracoscopic ablation of specific ganglia
What are the indications for a head CT according to NICE?
What is the management of a growing abdominal aneurysm in the UK?
What is the pathophysiology of Von Willebrand disease?
What are the ATLS guidelines regarding calculating IV fluid for burns patients?
What is Pott's puffy tumour? What is it a complication of?
It is a rare complication of acute sinusitis. It is characterised a subperiosteal abscess and osteomyelitis related to the frontal sinus and sometimes the mastoid.

Investigated with CT or MRI head

Treat with surgical incision and drainage + IV antibiotics.
What is the difference between the Rockall score and Blatchford score in UGIB?
Glasgow-Blatchford score:
- predicts the risk of requiring intervention (transfusion, endoscopic or surgical intervention)

Rockall score:
- predicts the risk of re-bleeding and death
What is a common cause of early post-operative Type I respiratory failure?.
Atelectasis (more common in asthmatics or COPD)
- alveolar hypoventilation secondary to inadequate breathing due to pain or inappropriate clearing of secretions
Discuss the derivatives of the 6 pharyngeal pouches.
First pouch
- auditory tube (Pharyngotympanic Eustachian tube), middle ear, mastoid antrum, and inner layer of the tympanic membrane.
Nerve supply: mandibular nerve.

Second pouch
- middle ear, palatine tonsils
Nerve supply: facial nerve.

Third pouch
Dorsal and Ventral wings
Dorsal wings: inferior parathyroid glands
Ventral wings: thymus.
Nerve supply: Cranial Nerve IX, glossopharyngeal nerve.

Fourth pouch
- superior parathyroid glands
- parafollicular C-Cells of the thyroid gland.
- Musculature and cartilage of larynx (along with the sixth pharyngeal arch).
Nerve supply: Superior laryngeal nerve.

Fifth pouch
Rudimentary structure, becomes part of the fourth pouch contributing to thyroid C-cells.

Sixth pouch
The fourth and sixth pouches contribute to the formation of the musculature and cartilage of the larynx.
Nerve supply: recurrent laryngeal nerve.
What muscles are potentially absent in the body?
P - Palmaris longus
P - Plantaris
P - Peroneus tertius: lower leg muscle that contributes to eversion and dorsiflexion
P - Psoas minor
P - Pyramidalis: small, triangular, vertical muscle that lies anterior to the rectus abdnominis and attaches to the linea alba
What muscle is responsible for opening the mouth?
Lateral pterygoid
What is the inheritance pattern of Haemophilia A?
X-linked recessive
What nerve supplies the trachea?
Recurrent laryngeal nerve
What toxin does E. Coli produce? Pseudomonas aeruginosa? Staph aureus? Clostridium botulinum?
E.Coli = Verotoxin
Pseudomonas = Exotoxin A
Stap aureus = toxic shock toxin + hyaluronidase
C. botulinum = neurotoxin
Is Familial Adenomatous Polyposis Autosomal dominant or recessive? Malignant or pre-malignant?
Autosomal dominant pre-malignant condition.
Which clotting factor are Vitamin K dependent?
Factor 2 (prothrombin), factor 7, 9 and 10
What are the differences between UC and Chron's?
What is the pathophysiology of Kholer's disease?
Pathological avascular necrosis of the navicular bone in the foot causing delay of ossification and pain.
When would you use a Browne's tube when assessing the sterility of surgical instruments?
A Browne's tube is placed amongst the instruments to assess when sterilisation is complete. They will change from red to green.
Why are Chron's patients more likely to develop gallstones? What would these gallstones primarily be made of?
What are the borders of the greater and lesser sciatic foramen?
Where would you perform an IM injection into the buttox?
in the upper outer quadrant!
How can you sterilise surgical equipment?
- Gamma radiation
- Hot air at 160 degrees for 2 hours
- Steam at 135 degrees + formaldehyde = most common! (only 15-30mins)
- Ethylene oxide gas
What is an indication for urgent clamshell thoracotomy?
- Massive haemothorax (>1500 mls blood loss on initial chest drain insertion)
- Persistent haemorrhage of 200 ml/h for 4 or more hours
What are cyclists likely to develop?
Pudendal nerve entrapment syndrome
- pain
- urinary and faecal incontinence
- sensory symptoms in the perinium and genital area
What are the nerve roots of the pudendal nerve?
S2 - S4
"S2, 3 , 4 keep the shit off the floor"
What is the blood supply to the temporal lobe?
Middle AND Posterior cerebral arteries.
Describe the anatomy of the sinuses in the skull.
What is a cause of impotence in young men?
Diabetes

Other causes: vascular disease, pelvic or spinal surgery, long term PPI treatment
Which pole of the kidneys fuses in horseshoe kidney?
List the superficial muscles of the forearm.
What are causes of aneurysms in the body?
A - Atherosclerosis
M - Mycotic (secondary to endocarditis) - often caused by staph. aureus
S - Syphilitic
C - Connective tissue disorders eg Marfan syndrome, Ehlers-Danlos syndrome
T - Trauma
B - Berry aneurysm (and other congenital aneurysms)
What are the essential components of TPN (Total Parenteral Nutrition)?
- nitrogen
- carbohydrate
- fat
- minerals
- vitamins
What is Poupart's ligament?
It is the inguinal ligament.
What is the duct of Santorini?
It is the accessory pancreatic duct.
Describe how the Thoracic Duct is formed?
What is Gitleman's Syndrome?
Autosomal recessive kidney tubule disorder
- low potassium and magnesium
- decreased excretion of calcium in the urine
- elevated blood pH

Genetic mutations resulting in improper function of the thiazide-sensitive sodium-chloride symporter located in the distal convoluted tubule of the kidney. The distal convoluted tubule of the kidney serves a minimal role in salt absorption and a greater role in managing the excretion of electrolytes like magnesium and calcium to produce more concentrated urine.
What is Liddle Syndrome?
Genetic disorder (autosomal dominant):
- early HTN
- low plasma renin activity
- metabolic alkalosis
- low blood potassium
- normal to low levels of aldosterone.

Abnormal kidney function, with excess reabsorption of sodium and loss of potassium from the renal tubule, and is treated with a combination of low sodium diet and potassium-sparing diuretics (e.g. amiloride).
What is the initial physiological response to surgery?
What is the Cardiac Index?
haemodynamic parameter that relates the cardiac output (CO) from left ventricle in one minute to body surface area (BSA)

CI = CO/body surface area
Does the first rib move with respiration?
No
Does the complement system play a role in the coagulation cascade? What are the 3 pathways in the complement system?
Yes!
Especially regarding the contact activation pathway.
How do you differentiate UC from Crohn's?
How do you treat Paget's disease?
What hormone is dramatically high in the stress response following surgery?
What are the branches of the facial nerve?
temporal, zygomatic, buccal, mandibular, cervical
What is a Phyllodes tumour? How do you treat it?
List the secretory cells in the stomach. Where are they each located in the gastric pits?
What is the mortality rate associated with ruptured AAA presenting to hospital?
50%
What does nerve gas do to the heart? How does is cause heart failure?
What types of infections are asplenic patients more likely to get?
Where is renin produced in the kidney? What triggers its production?
Produced in the juxtaglomerular apparatus, increased secretion is triggered by reduced renal perfusion.
Name a retrocystic structure in the male.
Seminal vesicles.
What is the test for Acromegaly?
Glucose tolerance test + Growth Hormone (GH) levels
Describe signs in Brown-Sequard Syndrome.
Caused by lateral hemisection of the spinal cord

Features:
- ipsilateral weakness below lesion
- ipsilateral loss of proprioception and vibration sensation
- contralateral loss of pain and temperature sensation
How do you estimate the weight of a child? How do you calculate the need for IV maintenance fluid in children?
Estimating weight:
weight = (age +4) x 2

Calculating IV maintenance fluid:
100ml/kg for the first 10kg
50ml/kg for the next 10kg
20ml/kg for the remaining kgs
Total to give over 24 hours
What are signs of axillary nerve palsy?
- weak abduction of the shoulder
- weak extension/flexion and medial/lateral rotation of the shoulder
What is the role of Luteinizing Hormone (LH) in men? Where is it produced? What does it act on?

What is the role of FSH in men?
LH: produced in the anterior pituitary gland once stimulated by the Gonadotrophin Releasing Hormone (GnRH). it acts on the interstitial cells of the testis (Leydig cells) to secrete testosterone.

FSH: stimulates spermatogenesis in the Sertoli cells in the seminiferous tubules.
Describe the type of Salter-Harris fractures.
What does the vasa recta supply in the kidney?
It supplies the loop of Henle.
What is Froment's test?
With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the flexor pollicis longus of the thumb to maintain grip pressure causing a pinching effect.

Clinically, this compensation manifests as flexion of the interphalangeal joint of the thumb (rather than adduction, as would occur with correct use of the adductor pollicis).
What are the ways for us to define massive haemorrhage?
1) loss of > 50% of total blood volume in 3h
2) loss of > 100% total blood volume in 24h
3) blood loss >150ml/hr
Which is the superficial and fatty layer? Camper or Scarpa's layer?
Camper's fascia layer is fatty and more superficial.
Describe how IV dextrose is metabolised in the body when administered. Is it an isotonic solution?
How do neoplastic cells metastasize?
They secrete proteases to break away from their normal cohesive structure.
Which structure lies in the free edge of the lesser omentum?
The portal vein!
What are other variables we can use to estimate eGFR?
- inulin clearance
- creatinine clearance
What is Virchow's node? What is it a sign of?
Left supraclavicular node enlargement from metastatic carcinoma of the stomach
How is pepsinogen activated into pepsin?
- acid ph
- previously activated pepsin (auto-catalytic process)
What is Gerota's fascia? Where is it clinically relevant?
What type of joint is the TMJ? What type of cartilage lines it?
What are the 4 type of hypersensitivity reactions?
Are patients with UC and PSC more at risk of needing a total restorative proctocolectomy? What are the indications and contra-indications to this procedure?
Describe the anatomy of the chorda tympani nerve. What does it supply? Could it be injured in Parotid gland surgery? What structures may be injured in Parotid gland surgery and how may this present?
The chorda tympani nerve would not be injured in parotid surgery (which means you would keep taste and sensation of the anterior 2/3rd of the tongue.

However, the afferent limb of the corneal reflex is carried by the ophthalmic division of CN5, but the efferent limb is carried by the zygomatic branches of the CN7. Therefor, you may injure this and lose the corneal reflex on the ipsilateral side.
What part of the skull does the eustachian tube penetrate? Where is the opening in the mouth?
The petrous temporal bone. It connects the middle ear to the nasopharynx.

Opening: above the soft palate adjacent to the tubal tonsil
Explain tertiary hyperparathyroidism. When does it occur? How is it managed?
Where does the long thoracic nerve branch from in the brachial plexus?
Directly from the roots of C5 to C7 (number 2)
What ligament sustains the medial longitudinal arch of the foot?
The calacaneonavicular (or spring) ligament.
Which thyroid cancer is associated with exposure to radiation? How do cells present in histology?
Papillary carcinoma
- cells contain Orphan Annie nuclei (pale, empty looking nuclei)
- also contain pasammoma bodies
What are ways of assessing the exocrine function of the pancreas?
- Faecal elastase (exocrine insufficiency)
- Lundh meal followed by measurement of lipase levels
How do your classify hemorrhagic shock?
Describe the structures involved in the flow of CSF from the lateral ventricles to the 4th ventricle.
Lateral ventricles -> Foramen of Monro -> 3rd ventricle -> cerebral aqueduct of Sylvius -> 4th ventricle
What is the equation to estimate vital capacity in an average patient?
VC = 70 ml x (weight in kg)
Describe the Wallace rule of nine when estimating the percentage burn surface area.
Are gastric adenocarcinomas radiotherapy sensitive? What about seminomas (testicle)? What about ovarian cancer?
- Gastric adenocarcinoma: not sensitive to radiotherapy
- Seminomas: very sensitive to radiotherapy
- Ovarian: not sensitive to radiotherapy
What is the step by step process in bone healing and remodeling following a fracture?
Describe the arterial blood supply to the thyroid gland.
Why do we avoid giving Metoclopramide in children, young adults and Parkinson's patients (as an anti-emetic)?
It is a dopamine receptor antagonist.
It should not be used in these patients due to the high risk of dystonia (acute dystonic events) and extra-pyramidal side effects.
During a thyroidectomy, what structure must you identify prior to ligating the superior thyroid artery?
The external branch of the superior laryngeal nerve.
Do the basilic and cephalic veins join directly?
No!

The axillary vein is formed by the joining of the basilic and brachial veins in the mid-arm. In the deltopectoral groove, the cephalic vein joins the axillary vein.
What muscles of the hand are innervated by the median nerve? What is mnemonic to remember these?
L - Lateral two lumbricals
O - Opponens pollicis
A - Abductor pollicis brevis
F - Flexor pollicis brevis
What are the clinical effects of a large body surface burn?
- immunosuppression
- hypermetabolic states leading to hyperthermia and glycogenolysis
- hypovolaemia due to loss of protein and fluid in the interstitial space
What is Starling's law of the cardiac myocytes?
What happens when you have chronic vomiting?
Hypochloraemic alkalosis because you lose your H+ and Cl- ions.
What is the role of active Vitamin D?
Increased reabsorption of phosphate and calcium from the gut.
Nerves at what spinal level innervate the hamstring muscles or knee flexors?
L5 to S1
Describe the Garden Classification of NOF fracture.
What are adverse risk factor to wound healing?
V - Vitamin deficiency
I - Infection (local and general)
T - Technique
A - Arterial supply (especially vascular disease or trauma)
M - Malnutrition
I - Icterus (secondary to hepatobiliary disease, haemolysis or uraemia)
N - Necrotic tissue
S - Sugar (diabetes mellitus)
A - Anaemia/age
B - Blood clot (haematoma formation)
C - Cancer (local or distant)
D - Drugs (cytotoxic agents and steroids)
E - Edge tension (especially in obesity)
What is a Hill-Sachs lesion?
Compression fracture in the posterolateral head of the humerus.

It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
What is the difference between wet gangrene and dry gangrene?
Wet gangrene: both arteries and veins are affected
Dry gangrene: only arteries are affected
How can you manage hyperhidrosis of the upper limbs and upper trunk?
- local aluminum topical application
- Botulinum Toxin injection
- Upper thoracic sympathectomy

Note: you would NOT consider a cervical sympathectomy as this would cause Horner's Syndrome.
What is the difference between Empty-Sella Syndrome and the Sheehan Syndrome?
Empty-Sella Syndrome: shrinking of the pituitary gland making the visulaisation of it in the sella tunica impossible

Sheehan Syndrome: post-partum pituitary gland necrosis
What is associated burden of disease attributed to principal causes of colorectal cancer?
What is Klippel-Trenaunay syndrome?
Its a congenital venous disease characterized by multiple varicosities of the superficial system and hypoplastic or absent deep veins.
What is the action and nerve supply of the serratus anterior muscle?
Action: rotates the scapula + protracts and stabilizes the scapula

Nerve supply: long thoracic nerve
What is the abdominal aorta aneurysm screening program in the UK?
Performing an abdominal aortic ultrasound measurement in all men aged 65 years.
What is Swan-Ganz catheterisation?
Pulmonary artery catheterization (PAC), or right heart catheterization, is the insertion of a catheter into a pulmonary artery. Its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs. The pulmonary artery catheter allows direct, simultaneous measurement of pressures in the right atrium, right ventricle, pulmonary artery, and the filling pressure ("wedge" pressure) of the left atrium. The pulmonary artery catheter is frequently referred to as a Swan-Ganz catheter.

Complication: transient RBBB that last <24h
What is the max dose of lidocaine?
3 mg/kg up until a MAXIMUM dose of 200 mg
Where is a neuroblastoma likely to arise in a child?
Along the sympathetic chain (ie. adrenal medulla, sympathetic neurones and melanocytes)
In what percentage of people is the AV node supplied by the right coronary artery?
90%
What is the maximum duration for a tourniquet to be applied safely?
1.5 to 2 hours max
If it need more, it need to be deflated for at least 5 mins, before re-applying pressure
How do you calculate a patient's daily fluid requirements?
What are signs and symptoms of compartment syndrome?
P - Pain out of Proportion to injury
P - Pain on Passive flexion
P - Palpate tense compartment
P - Pallor, Paralysis, Pulseless, Paraesthesiae (all these are seen in the late stage of the condition)
What is Linitis Plastica? What organ does it affect? What does it look like on further investigation?
- It is a diffuse type of cancer
- Malignant cells invade the stomach causing rigidity and stiffness of the stomach
- The stomach looks thick with reduced distensibility on endoscopy
- Biopsy reveals malignant cells that look like signet rings
- Prognosis is poor, tx is radical surgery or palliative chemotherapy
How would a gastric carcinoid cancer present on histology?
- enterochromaffin like cells (ECL)
- type of neuroendocrine cells in the gastric mucosa
What is the indication for folic acid in pregancy?
Women should take folic acid BEFORE conception and continue this for a minimum of 12 weeks. The aim is to reduce the incidence of neural tube defects.
Describe hyaline cartilage.
DESCRIPTION: bluish-white, shiny ground substance with thin, fine collagen type II fibers and chondrocytes that produce both collagen and proteoglycans. It is avascular.

LOCATION: Ends of long bones, anterior ends of ribs, nose, parts of larynx, trachea, bronchi, bronchial tubes, and embryonic and fetal skeleton.

FUNCTION: Provides smooth surfaces for movements at joints, as well as flexibility and support.
What is a choriocarcinoma? What does it mimic?
It is a uterine tumour that mimics pregnancy because it produces a large amount of b-HCG hormone (causing hyperemesis gravidarum). It is often a result of a molar pregnancy.
Describe where you would position your skin incision in a carpal tunnel decompression surgery?
- made in line with the radial border of the ring finger
- from the distal wrist crease to the Kaplan's line (line from apex of the interdigital fold between thumb and index finger to the hook of the hamate)

You do NOT cross the wrist at a right angle with the incision as this may cause a hypertrophic and painful scar and put further pressure on the wrist joint.
What structure does the Guyon's canal contain in the wrist?
- it is medial to the carpal tunnel
- contains the ulnar artery and the ulnar nerve
- it is bordered by the pisiform (ulnar side) and the hook of the hamate (radial side)
What are indications for tracheostomy? What are the effects of having this in place?
C - Congenital (laryngeal webs, subglottic stenosis)
R - Radiotherapy (to neck causing stenosis)
I - Infections (epiglottis, Ludwig's angina)
M - Malignancy
P - Protection of bronchotracheal tree
P - Paralysis (bilateral) of cords
R - Respiratory failures
I - Intubation (prolonged)
N - Neurological (e.g myasthenia gravis, multiple sclerosis)
T - Trauma to upper airway
S - Secretions (bronchial)

It does the following:
- reduces airway resistance
- reduces work of breathing
- reduces dead space
- more deformable trachea
Describe the national breast cancer screening programme in the UK.
- Includes women aged 47-73
- Women are offered a mammogram every 3 years.

After the age of 70 years women may still have mammograms but are 'encouraged to make their own appointments'.
What are common symptoms of carcinoid tumours?
- usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
- may also occur with lung carcinoid as mediators are not 'cleared' by the liver

Features:
- flushing (often earliest symptom)
- diarrhoea
- bronchospasm
- hypotension
- right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
- other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing's syndrome
- pellagra can rarely develop as dietary tryptophan is - diverted to serotonin by the tumour
- are the most commonly found type of tumour in the appendix

Investigation:
- urinary 5-HIAA - serotonin
- plasma chromogranin A y
Which type of IV fluid will increase the amount of intavascular fluid (as opposed to extravascular or interstitial)?
Hypertonic Saline
- with a higher amount of Na+, the osmotic effect of the solution will dram more fluid from the extravascular space into the intravascular space.
What are the 3 components of cryoprecipitate?
1. Von willebrand Factor
2. Factor VIII (8)
3. Fibrinogen
What is the nerve supply to the long head of the biceps femoris muscle? What about the short head? What are its actions?
Long head: tibial nerve
Short head: common peroneal (fibular) nerve
Actions: flexes knee joint, laterally rotates knee joint (when knee is flexed), extends hip joint (long head only)
Where is the location of the internal venous plexus of the spine?
Within the extradural fat.
At what vertebral level does the abdominal aorta divide into the 2 common iliac arteries?
L4
How do we estimate prognosis of breast cancer?
We use the Nottingham Prognostic Index bases on the following:
- Tumour Size
- Lymph node score
- Grade score
What is the median umbilical ligament a remnant of?
- Urachus
- It is a connection that joins the umbilicus to the bladder
Is the risk of radiation induced cancer from an radiological investigations different in children compared to adults?
Yes.
For children <16, lifetime cancer risks are doubled compared to adults.
What nerve innervates the tonsilar fossa in the throat? Why can inflammation of the tonsils present as earache?
Glossopharyngeal nerve.
This nerve gives off a branch called Jacobson's nerve that is a sensory branch to the ear.
What is the post-operative day where an MI is most likely to occur?
Post-op Day 1
What is a FAST scan? What is is good at picking up? What is it unlikely to pick up?
FAST = Focused Assessment of Sonography in Trauma

Good: intraperitoneal fluid (damage to aorta, spleen, liver)

Bad: unable to detect retroperitoneal injury (would not pick up renal lacerations for example)
Describe the different classifications of aortic dissections.
Remember:
Stanford A involves the Ascending aorta.
Stanford B starts Beyond braciocephalic vessels.
Is a full thickness burn of >5% of the body surface an indication to refer someone to the specialized burns unit?
Yes.
What is the resting heart rate in a patient with a transplanted heart?
Sinus tachycardia at approx 100bpm. This is because the vagus nerve is unlikely to innervate the sinoatrial node which means there is no ''braking'' effect of the vagus nerve.
What is the difference in spirometry between restrictive and obstructive conditions?
Does biceps brachii supinate or pronate the arm?
It supinates it!
It is innervated by the musculocutaneous nerve.
Where is CSF produced? Does it contain more or less protein than plasma?
It is produced by the choroid plexus, located in the lateral, third and fourth ventricles. It is then re-absorbed by the arachnoid villi into the cerebral venous sinuses.

It contains about half (0.5) of the amount of protein compare to plasma.
Does Carcinoid Syndrome sometimes look like Crohn's on barium enema or CT?
Yes.
It can cause mucosal ulceration mimicking Crohn's.
What is the Starling equation on fluid movement in a vessel?
Where is the regimental patch? What nerve supplies this area of the skin?
It is located on the lateral aspect of the shoulder. It is supplied by the axillary nerve.
Describe the different ASA grades.
What are signs of Cushing's Syndrome?
Obesity
Proximal muscle wasting and weakness
Acne
Hair growth
Striae (stretch marks)
Moon face
Buffalo hump
What are the indications for a referral to a specialist burns unit? What about indications to discuss a burns case with a specialist consultant?
What is the most common cause for anal fistula? What about other causes?
Most common cause is anorectal abscesses.

Other causes:
- surgical complication
- trauma/ penetrating injury
- TB
- Crohn's disease (NOT UC, as not transmural)
Explain the action and innervation of the lumbrical muscles in the hand.
Actions:
- flex the MCPJs
- extend the interphalangeal joints

Innervation:
- lateral two: median nerve
- medial two: ulnar nerve
What are possible complications of appendicitis?
W - Wound infection
R - Respiratory problems (atelectasis, pneumonia)
A - Abscess (pelvic)
P - Portal pyaemiaIIleus (paralytic)
F - Faecal fistula
H - Hernia (right inguinal)
O - Obstruction (adhesions)
T - Thromboembolic phenomenon (deep vein thrombosis (DVT)/pulmonary emboli (PE))
What are important factors that increase the risk of post-operative infection?
- extensive use of diathermy
- dead/damaged tissue in a wound
- mass ligature
- inadequate haemostasis
- presence of ''dead space''
What percentage of women and men who develop breast cancer have family history of breast cancer?
Only 10%
Once haemorrhage has been ruled out in the chest by CXR and the pelvis by pelvic X-ray in an unstable patient, what should be the next step?
- FAST scan
- urgent CT scan

However if the patient has generalised peritonitis and refractory hypotension, you should investigate and treat with an URGENT LAPAROTOMY!
What is Meckel's diverticulum?
Remnant of the omphalomesenteric duct/vitelline duct, which connects the yolk sac the primitive midgut in the embryo.
What are common side effects of chemotherapy (alkylating agents)?
- gout (hyperuricaemia)
- nausea and vomiting
- bone marrow suppression
- alopecia
List 3 landmarks to remember the dermatomes.
T4 dermatome: the nipples
T7: the xiphoid process
T10: the umbilicus
What is the definition of priaprism? How do you manage low flow vs. high flow priaprism?
A prolonged, unwanted and non sexually related erection for > 4h
What is compartment syndrome? What are the normal pressures of a compartment? How do you recognise this condition? How do you treat this?
What do the following structures become after birth?
- Urachus
- Vitelline duct
- Cloaca
- Mullerian duct
- Wolffian duct
- Urachus -> median umbilical ligament
- Viteline duct -> Meckel's diverticulum
- Cloaca -> urogenital sinus (anterior) + anorectal sinus (posterior)
- Mullerian duct -> female reproductive system
- Wolffian duct -> male reproductive system
What is the Gleason Score?
Histologic grades 2-10 for prostate cancer:
Low score = well differentiated
High score = poorly differentiated

Two grades awarded 1 for most dominant grade (on scale of 1-5) and 2 for second most dominant grade (scale 1-5). The two added together give the Gleason score. Where 2 is best prognosis and 10 the worst.
What are the signs of raised intracranial pressure or ''coning''?
Notably: HTN and bradycardia
How do you manage a popliteal aneurysm? What are the indications for surgery?
What veins are most likely to be injured during a tracheostomy?
- Inferior thyroid veins
- anterior jugular veins
Is the azygos vein in the left or the right side? What about the hemiazygos vein?
Does fluid in third space loss have a similar composition as interstitial fluid?
List the structures in the antecubital fossa, from medial to lateral.
My Brother Throws Rad Parties
Mnemonic
M: median nerve
B: brachial artery
T: tendon of biceps
R: radial nerve
P: posterior interosseous branch of radial nerve
What is the Thompson test?
A positive test results when squeezing of the calf muscle does not plantarflex the foot - suggest damage to the Achilles tendon
How do theatres keep a clean air flow to reduce risk of infection?
Is apoptosis energy dependent? What about necrosis?
Apoptosis = energy dependent
Necrosis = not energy dependent
What is club foot? What is it associated to? How is it managed?
It is a congenital malformation where there is inversion, adduction of the forefoot compared to hindfoot and plantarflexion of the foot.

Associated with:
- Prune-belly Syndrome
- Arthrogryposis
- Myelomeningocele

Tx: series of cast to slowly reshape the foot into the right place = Ponsetti's Method

or

Surgery to the Achille's tendon to lengthen the tendon.
What is a cancerous complication of Paget's disease?
What is a complication of Clostridium Difficile involving the large intestine and causing pseudomembranes?
Pseudomembranous colitis
What is the difference between dry and wet gangrene?
What coronary arteries supply what parts of the heart?
What are the 3 definitions of major hemorrhage?
What bacteria can cause abdominal aortic aneurysms?
- Salmonella
- Staph aureus
- Streptococcus
What are causes and features of hepatocellular carcinoma?
What radiological investigation is most useful when planning facial surgery following a fracture?
A facial CT scan as it delineates soft tissue damage adequately.
What are the contents of the carpal tunnel?
What is a difference between a clean wound, clean contaminated wound, contaminated, dirty and infected?
What do glucagon and growth hormone do to serum glucose levels?
Both increase serum glucose concentration.
How many mls of blood can the pulmonary vessels accommodate in a normal adult?
Up to 500 mls. It acts as a reservoir for the left ventricle.
What are the 3 divisions of the Trigeminal nerve? What are the branches of the ophthalmic division?
- Ophthalmic (Frontal, Lacrimal and Nasociliary)
- Maxillary
- Mandibular
What does Protein C in coagulation?
It inactivates the pro-coagulants factor Va and VIIIa.
A deficiency in this protein will lead to excessive coagulation and VTE.
Syncopal episodes and sudden death should make you think of what congenital heart deffect?
Bicuspid Aortic Valve.
What proportion of gallstones can be seen on plain abdo X-ray?
15%. Best to do an abdo USS.
How do you calculate IV fluid maintenance in children?
What is Mirrizzi's Syndrome? What causes it? How does it present? How do we treat it?
What immunological cells predominate inflammation when a foreign abject is present in the body?
Giant cells
What are the borders of the Hesselbach triangle?
Rectus abdominis muscles (or the linea semilunaris to be more precise!)
What antibodies are commonly detected in Hashimoto's thyroiditis?
What happens to your body when you fast?
Splenectomy increases the risk of infection by which type of organisms? Name at least one.
Encapsulated organisms.
eg. Neisseria meningitidis/ Strep. pneumoniae/ haemophilus influenza
What epithelium lines the ureter?
Transitional epithelium.
What are the 3 types of bladder cancer? Which is most common in the UK?
What bacteria is most associated with the production of gas gangrene?
Note: it is a type of wet gangrene.
What are the characteristic differences between the jejunum and the ileum?
What are all the phases of mitosis?
Describe the anatomical course taken by the sciatic nerve. What 2 branches does it give off and where?
What is the radiation exposure caused by one abdominal X-ray?
What do prostaglandins do to the kidneys?
They increase the renal blood flow and glomerular filtration rate.
Describe the course that the recurrent laryngeal nerve takes to reach the vocal cords.
What is qSOFA? What do we use it for? What are the criteria?
Quick screening tool to assess sepsis in patients outside of ICU.
Is Carbimazole safe to use in pregnancy? If not, why? What alternative would you use?
No, not safe. Associated with congenital defects.

Use Propythiouracil instead. It inhibits the production of thyroid hormones by inhibiting the enzyme thyroid peroxidase.
Are platelets kept in a fridge?
No, at room temperature in an ''agitator''. Fresh Frozen plasma and RBC are.
What landmark would you use when attempting a subclavian vein cannulation?
What is diathermy? What are the different types? What are the maximum current amplitude and frequencies?
Heat generated by the passage of high-frequency alternating current.

It can be monopolar or bipolar.

Currents up to 500 mA are safe at frequencies between 400 kHz and 10 MHz
Which gastric cells secrete intrinsic factor?
Parietal cells.
What is the innervation to the gracillis muscle?
Describe the classification of facial fractures. What is the total number of categories?
What are Curling's ulcers?
Is the breast a sweat gland?
Yes. It is considered a modified apocrine sweat gland as opposed to a eccrine sweat gland.
What is Ewing's Sarcoma?
Type of malignant bone cancer originating from the mesenchymal origin.

Commoner in males
Incidence of 0.3 / 1, 000, 000
Onset typically between 10 and 20 years of age
Location by femoral diaphysis is commonest site
Histologically it is a small round tumour
Blood borne metastasis is common and chemotherapy is often combined with surgery
What other movement happens to the tibia during knee flexion?
It internally rotates. This is enabled by the contraction of the popliteus muscle.
Describe the draining of blood into the inferior vena cava.
Describe the levels of lymph node clearance in breast surgery.
Level 1: removal of the axillary nodes lateral and inferior to the pectorals minor muscle
Level 2: removal of nodes found deeper posterior to the pectorals minor muscle
Level 3 (or Full Clearance): removal of the nodes superior and medial to the pectoralis minor muscle
Do you use contrast in an endovascular aneurysm repair (EVAR) operation?
Yes, you do during stunting procedure. This can lead to AKI post op.
What are the contents that run through in the foramen oval in the skull?
What structures make the "H" of the portages hepatis? Is the caudate lobe superior or inferior to the quadrate lobe?
Caudate lobe is caudal, and superior to the quadrate lobe.
What are the contents of the lesser omentum? How does it relate to the epiploic foramen?
What are characteristic features of chronic cholecystitis?
- fibrotic, thick walled gallbladder
- Aschoff-Rokitansky sinuses
- mucosal herniation containing bile
Describe the different types of JVP waves one can visualise?
How do you best manage non-union following a fracture of the humerus?
You undergo plating and bone graft rather than intramedullary nailing as it has a better union success rate.
Is staph aureus coagulase positive or negative? What about staph epididermis?
Staph aureus = coagulase positive
Staph epididermis = coagulase negative

Both are Gram +ve cocci.
What is base excess on an ABG? What does it tell you? When is is positive? When is it negative?
The base excess is another surrogate marker of metabolic acidosis or alkalosis:

A high base excess (> +2mmol/L) indicates that there is a higher than normal amount of HCO3- in the blood, which may be due to a primary metabolic alkalosis or a compensated respiratory acidosis.

A low base excess (< -2mmol/L) indicates that there is a lower than normal amount of HCO3- in the blood, suggesting either a primary metabolic acidosis or a compensated respiratory alkalosis.
Describe the blood supply to the breast. What are the major two blood vessels?
- Lateral thoracic artery
- Internal mammary artery
Can oncogene activation occur in benign tumour? What distinguishes benign from malignant tumours?
Yes it can. Evidence of a ''high mitotic rate'' or cellular turnover as well as a high nucleus:cytoplasmic ratio are classic for malignant tumour.
At what vertebral level is the plan of Louis? What is this a landmark for anatomically?
Where do the vertebral arteries meet to form the basilar artery?
They meet under the surface of the brainstem.
Describe the different important hip disorders in children. What are the common 6 and what age group are they more likely to be diagnosed in?
What is the pathology of Hirschprung disease? How do you diagnose this condition?
Hirschsprung's disease is caused by an aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses. Although rare (occurring in 1 in 5,000 births) it is an important differential diagnosis in childhood constipation

Possible presentations
- neonatal period e.g. failure or delay to pass meconium
- older children: constipation, abdominal distension

Associations
3 times more common in males
Down's syndrome
List 4 risk factors for Hodgkin's Lymphoma.
- HIV
- Epstein-Barr virus
- Solid organ transplant
- Reduced exposure to childhood infections
What artery is occluded during Pringle's Manoeuvre?
What are risk factors for developing a Keloid scar?
- tension on the wound
- dark coloured skin
- male sex
- hx of previous keloid scar
- site of the wound (
- delayed healingsternum, shoulder, neck)
What is the pathology of 'phlegmasia alba dolens'?
Which women affected by breast cancer should systematically be offered genetic testing for BRCA1 and BRCA2 mutations?
Women aged under 40 affected by triple negative breast cancer.
Is it the wavelength or the amplitude of a laser that determines the penetration length of the light through tissues?
It is the wavelength.
Between what mean arterial pressures is cerebral blood flow regulated?
50 and 160 mmHg
Which parts of the duodenum are retroperitoneal? Intraperitoneal?
D1 - descending part = intraperitoneal
D2,3 and 4 = retroperitoneal
What is the most commonly used method of sterilisation of surgical equipment?
Saturated steam.
Describe the pyramid of quality of research.
What is opsonization?
When complements (from the complement cascade) coats a microbe and provides binding sites for phagocytes to phagocytose.
How do we measure tracheostomy tubes?
By the inner diameter of the tube.
What is the difference between a single and a double cuff pneumatic tourniquet? When would you use one rather than the other?
Describe the movements of the tongue. What nerve innervates the tongue with motor fibres?
- retracted up and back = styloglossus muscle
- protruded = genioglossus
- depressed = hypoglossus
All 3 muscles are innervated by the hypoglossal nerve.
What is the difference between valgus deformation and varus deformation?
What is melanosis coli? How does it present and what is it associated with?
What is the difference between the gubernaculum and the Wolffian duct in men? What condition is associated with the gubernaculum?
How can you describe a Bochdalek's hernia?
B - Bochdalek hernias are
B - Bad
B - Big
B - occur in Babies
B - are found at the Back of the chest
What are the main roles of the menisci?
1. shock absorbers
2. load transferers
3. stabilise the knee
What is the difference between the pre-central gyrus and post-central gyrus?
In the frontal lobe is the precentral gyrus, which is located rostral to the central sulcus. The precentral gyrus is called the somato-motor cortex because it controls volitional movements of the contralateral side of the body.
How many segments and pulmonary veins does the right lung have?
Describe the significance of Anti-HBs in the bloodstream.
Is it ok for a patient to be operated on for an elective disease if they have had an MI in the last 6 months and are appropriately investigated before surgery?
No. It is not recommended patients have an operation within 6 months of an MI.
Which neurovascular structures run through the parotid gland?
The facial nerve (CN VII), external carotid artery, retromandibular vein all pierce the parotid gland.

The external carotid artery gives off the superficial temporal and maxillary arteries within the gland.
Describe the cardiac action potential.
What is the Gustillo-Anderson classification of open fractures?
Patient require tetanus tx if there have not received at least 3 doses of vaccination with the last dose within the last 5 years.

Bony fragments with no bony attachments to them should be removed as they will not heal.
What is Frey's Syndrome?
Known complication of parotidectomy with gustatory sweating due to inappropriate regeneration of sympathetic and parasympathetic nerve fibers.
What is Felty's syndrome triad?
1) Rheumatoid arthritis
2) Splenomegaly
3) Neutropaenia
Describe the relationship between flow of liquid through a lumen using the Poiseuille's Law.
It states that the flow (Q) of fluid is related to a number of factors: the viscosity (n) of the fluid, the pressure gradient across the tubing (P), and the length (L) and diameter(r) of the tubing.
Describe the path of the phrenic nerve.
What is the national screening age where a person is offered an abdo USS to screen for abdominal aortic aneurysm?
65 (NOT 60!)
What nerve can be anaesthetized during a carotid endarterectomy to perform a cervical plexus block? Where would you inject local anaesthetic?
What organism is most commonly the one to cause epididymitis in children?
E. Coli
Describe the Garden classification of NOF.
What is the difference in the mechanism of action of ketoconazole. nystatin or Amphoteracin B?
What are causes of post-op ARDS?
B - Blood transfusion (massive)/Burns
E - Embolism (fat, air or amniotic fluid)
A - Aspiration
T - Trauma (polytrauma, direct chest trauma)AAcute pancreatitis
R - Radiation (eg post-radiotherapy)
D - DIC/Drug overdose/near-Drowning/Dialysis/Diffuse pneumonia (viral, fungal or bacterial)
S - Sepsis/Shock/Smoke inhalation
What type of immune cell secretes interleukins?
Activated macrophages!
Should diabetics be put at the beginning of the operating list, or at then end? Why?
They should be at the beginning of the list to prevent prolonged starvation. They should also be placed on sliding scale until all parameters (BMs, K+ levels, eating normally) are within range post op.
What are the contents of the inguinal canal in females?
1. Round ligament of the uterus
2. Illioingiuinal nerve
What structures are retroperitoneal? How do you remember these structures?
SAD PUCKER
What are the two signs of retroperitoneal bleeding?
What two areas does the diaphragm separate? What is the equivalent of the diaphragm in the pelvis? What two areas does it separate?
The diaphragm separates the thoracic cavity from the abdominal cavity.

The equivalent of the diaphragm in the pelvis is the levator ani. it separates the pelvic cavity from the perineum.
Are adenocarcinomas of stratified squamous epithelial origin radiosensitive? What about adenocarcinomas of columnar epithelial origin? Where is this distinction very important?
Stratified Squamous origin = radiosensitive (radiotherapy)

Columnar origin = radioresistant!

This particularly important when differentiating tumours of the anal canal!
How can you differentiate the jejunum compared to the ileum with regards to thickness, mesenteric fat, plicae circulares, lumen size, Peyer's patches and arterial arcades?
The jejunum has a thicker wall, less mesenteric fat, more plicae circulares, a wider lumen, fewer Peyer's patches and fewer arterial arcades then the ileum.
What structure is closely related to the body of the pancreas and particularly important when trying to mobilise the splenic flexure?
You are able to enter the lesser sac between the transverse mesocolon and the body of the pancreas is a common method for laparoscopic mobilisation of the splenic flexure.
What is the best approach when operating on a ruptured kidney? Where is the adrenal gland located in relation to the kidney?
If the kidney is ruptured, the best approach is through the anterior abdominal wall by a midline incision (not through the 12th rib).

A simple nephrectomy is indicated in cases of a non-functioning kidney.

The adrenal gland lies over the medial border and superior to the renal hilum.
How to you manage a sigmoid volvulus?
1. flatus tube
2. flexible sigmoidoscopy
What type of cancer is myasthenia gravis associated with? What is a differential diagnosis for a large anterior mediastinal mass?
What cells secrete Secretin? When is it secreted and what does this hormone do?
Secretin is released by S cells in the duodenum (as opposed to I cells that release CCK).

Secretin is released in response to acidic (low pH) gastric contents.

It increases the release of bicarbonate and release of bile from the gallbladder.
It also inhibits gastrin release and release of gastric acid secretion.
Describe the arrangement of the structures in the porta hepatis.
The hepatic duct lies in front and to the right, the hepatic artery to the left, and the portal vein behind and between the duct and artery.
What is the difference between Gitelman's Syndrome and Liddle Syndrome? Which one presents with hypertension?
What does intubating and mechanically ventilating a patient do to the intra-thoracic pressure? How will this affect the venous return and cardiac output?
How can you differentiate an infected AAA from and inflammatory AAA?
1. An infected AAA will be associated with raised procalcitonin levels (produced by bacterial toxins)

2. Inflammatory AAA will be associated with raised ESR.
At what vertebral level is the plane of Louis? What costal cartilage does this represent? At what level does the SVC enter the right atrium?
What are different types of Odontoid fractures? Which one is the most common? How would you manage this?
Type II, which is a fracture through the base of the dens, is considered the most common.

Tx: surgical reduction and immobilisation with a halo and body cast.
What are the tributaries to the portal vein? At what spinal level does it form? What is the Pringle's manoeuvre?
What is the lienorenal ligament? What structures are found within it?
Describe the origin of colorectal cancers? are most genetic or sporadic (2ndart to risk factors)?
What are the contents of the superior vs. inferior orbital fissure?
What is the pathophysiology behind alpha-1 antitrypsin deficiency? What does this present as?
How do we classify liver injuries?
What is the difference between the right and left adrenal glands? Does the right adrenal gland touch the bare area of the liver? What is an easy way to remember the difference in shape of the two glands?
Where do medulloblastomas originate from? What do they present as? Where do they metastasize?
Where does the spinal cord end? What about CSF and the subarachnoid space?
What components play a role in hyperacute graft rejection vs. acute graft rejection? How would you treat each condition?
Tx:
Hyperacute: this is antibody driven, removal of the transplant is the best treatment.

Acute (within 1 week to 3 months): this is cell mediated, use corticosteroids, azathioprine and ciclosporin.
Describe the nerve innervation to the 4 compartments of the lower leg.
Where would you place a tracheostomy? Why?
How do you manage a scaphoid fracture?
Spica cast + follow up in 2 weeks for repeat X-ray.
What hormone is responsible for preventing lactation during pregnancy? What hormone promotes lactogenesis after birth?
What type of lymphocyte is cytotoxic?
What causes intussusception in children in most cases?
What are the branches of the superficial femoral artery?
Branches of the superficial femoral artery
P - Profunda femoris (deep femoral artery)
M - Medical circumflex artery
L - Lateral circumflex artery
D - Deep genicular arteries
P - Perforating arteries
What are the common causes of pancreatitis? What appearance on X-ray is associated with this diagnosis?
G - Gallstones (leading cause in UK)
E - Ethanol
T - Trauma
S - Steroids
M - Mumps (also Coxsackie)
A - Autoimmune (polyarteritis nodosa)
S - Scorpion bite (common in Trinidad)
H - Hypercalcaemia /Hypothermia/ Hyperlipidaemia
E - ERCP/Emboli
D - Drugs (thiazides, azathioprine, oestrogens)

A ''sentinel loop'' (or central loop) may be seen = paralytic ileus of duodenal or jejunal small bowel caused by local inflammation of the pancreas.
How do you manage a Colle's fracture? Does this require surgery?
What ligament does the Lachman's test assess?
At what spinal level is the portal vein formed?
What is the main role of Tissue Plasminogen Activator?
Are hypospadias present on the ventral glans or ventral penile shaft in most cases?
What is the treatment of patients who have received a splenectomy? What vaccinations do they need?
What are the extents of the lungs vs. the pleura?
Describe the structure of an antibody. Where does an antigen bind to this structure?
What nerve innervates the platysma muscle?
The facial nerve, as it is a muscle of facial expression.
Describe the type of hypersensitivity reactions. What is their timeframe to reveal the hypersensitivity reaction?
What are features of neurogenic shock? What sub-classification of ''shock'' is this a part of?
What is the difference between alginate, hydrogel and iodine based dressings? When would you use ne over the other?
What hormones does the anterior vs. posterior pituitary produce?
What are the branches of the coeliac axis?
Describe the mechanism of action of b-lactams, macrolides, quinolones, rifampicin and trimethoprim.
Where do gluteus medius and minimus insert?
What is Cushing's Triad? What is it a sign of?
1. Raised Blood Pressure
2. Bradycardia
3. Irregular breathing

It is a sign of raised intracranial pressure.
What is the difference between ferritin and transferrin?
Describe ASA grades.
Describe the relationship between the lingual nerve, the mandibular branch of the facial nerve and the submandibular gland.
Where is the CTZ located? Is it inside or outside of the blood brain barrier?
It is located in the floor of the 4th ventricle, OUTSIDE of the blood brain barrier.
What are endotoxins? Where are they located in a bacteria? What inflammatory pathway do they activate?
What is the maximum continuous amount of time a tourniquet can be applied for?
Ideally, no more than 1.5 to 2 hours. You should release the tourniquet every 2 hours for 15 minutes to allow reperfusion of tissues.
How does physiological hypervolemia influence pregnant women who are hemorrhaging? What should you do to prevent excessive blood loss urgently?
Turn them to their left side!
Which cranial nerve does not actually originate from the brain?
The accessory nerve (11th).
Where does the right common carotid artery bifurcate? Where does the facial artery arise?
What are Duke's major and minor criteria when diagnosing IE?
Describe the differences between conductive and respiratory zones in the lungs.
What muscles insert on the linea aspera of the femur?
Linea aspera is located on the posterior aspect of the femur.
- adductor longus and brevis
- vastus lateralis
- vastus medialis
- adductor magnus
- short head of biceps femoris
What are the two types of lactic acidosis?
Type A = tissue hypoperfusion
Type B = toxin induced impairment of cellular metabolism
Describe the anatomy and branches of the axillary artery.
What do the testis and round ligament of the uterus originate from? what about the labia majora and the scrotum?
What percentage of total calcium in the body is available for regulating calcium serum levels?
1%
What are common and rare complications of epidural anesthesia?
What is the purpose of the femoral canal?
What is the best way to diagnose hereditary haemochromatosis?
What does the suprchiasmatic nucleus of the hypothalamus regulate?
What are the 4 histological divisions of the prostate gland?
What is acanthosis nigricans associated with?
Insulin resistance (Type II DM)
Malignancy (gastric carcinoma)
What interleukins and proteins are pro-inflammatory? Which are anti-inflammatory?
What are the 2 structures of the cervix? What cells line these?
Endocervix = simple columnar epithelium
Ectocervix = stratified squamous
What does p < 0.05 mean?
Less than 5 in 100
95% sure
What proteins will increase in the acute inflammatory phase? Will albumin increase?
Describe the various cells of the pancreas. What do they each secrete?
How do you differentiate rotator cuff injury from subacromial impingement syndrome?
Differentiate Thrombin time from APTT. Why is this relevant?
Describe the order and contents of the popliteal fossa.
Why are women menstrual cycle free post-partum when they breastfeed for up to 40 days?
Differentiate Kussmaul's sign and pulsus paradoxus.
Review these sutures.
How much is a fluid bolus in a child?
What is the role of apolipoprotein B-100?
What are the 3 steps of the WHO checklist?
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