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MRCS part A NOTES

By Dr.Firas Alwazny

 ARDS : causes decrease lung compliance

 Peptic ulcer can cause urinary tract stone due to milk alkile syndrome
 M2 AMA (Antimitochondrial antibodies) is highly indicative of primary
biliary cirrhosis .
 The most common bone tumer under age 21 years is osteochondroma
“exostosis”
 Blue small round cells in bone , pain swelling , small age , onion skin
appearance of bone = ewing’s tumor
 Human albumin solution can cause hypernatremia
 Haematocolpos = imperforated hymen
 Endometrial hyperplasia associated with fibrothecoma
 Lentigo maligna = melanoma in face
 Acral melanomas = palm and sole
 Antimicrosomal antibody = hashimoto thyroiditis
 Anticentromer antibody = scleroderma
 Antimitochondria antibody = primary biliary cirrhosis
 cANCA = Wegener’s granulomatosis
 pANCA = Churg-Strauss syndrome
 Low-frequency waves are detected in the scala tympani, high--frequency
waves are detected in the scala vestibuli. Both contain perilymph.

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 The scala media is filled with potassium-rich endolymph. Normal hearing

frequency ranges from 20 to 20,000 Hz.
 Hepatocellular ca presents below the age of 50s
 Giant cell tumor : lytic lesion in epiphysis extend to soft tissue affect
medle age , with pain and swelling
 the presence of sclerosing cholangitis is indicative of ulcerative colitis
 heparin ; Prevents activation factors 2,9,10,11
 warfarin ; Affects synthesis of factors 2,7,9,10
 DIC ; Factors 1,2,5,8,11
 Protein C is a vitamin K dependent substance
 IV Pamidronate IV Zoledronate for hypercalcemia
 First line management for hypercalcemia is iv fluid N/S
 Mnemonic to remember causes of right shift of the oxygen dissociation
curve:
CADET face RIGHT
C O2
A cidosis
2,3-DPG
E xercise
T emperature
 Action of furosemide = ascending limb of the loop of Henle
 thiazide type diuretics in the distal tubule
 potassium sparing diuretics cortical collecting tubule.
 TUMOR MARKERS

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Breast 15-3
Pancrease 19-9
Ovary 125
Colone CEA
 modified Glasgow criteria enable early diagnosis of severe acute
pancreatitis : age , glucose , wbc , ca , asp , LDH , urea , O2 , albumin
 low serum-ascites albumin gradient (<1.1) indicates an exudate
 Dual-energy X-ray absorptiometry (DEXA) is currently the most precise and
accurate method for diagnosing osteoporosis.
 MEN syndrome !!!!
 Inflammatory bowel disease !!!
 Factors V and VIII are sensitive to temperature
 Drugs causing SIADH : ABCD
A nalgesics: opioids, NSAIDs
B arbiturates
C yclophosphamide/ Chlorpromazine/ Carbamazepine
D iuretic (thiazides)
 Diagnosing dehydration can be complicated, laboratory features
include:
o Hypernatraemia
o Rising haematocrit
o Metabolic acidosis
o Rising lactate
o Increased serum urea to creatinine ratio
o Urinary sodium <20 mmol/litre
o Urine osmolality approaching 1200mosmol/kg

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 Causes of increased anion acidosis: MUDPILES

M - Methanol
U - Uraemia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol
S – Salicylates

 Mnemonic of the drugs causing hyperuricaemia as a result of reduced

excretion of urate
'Can't leap'
C iclosporin
A lcohol
N icotinic acid
T hiazides
L oop diuretics
E thambutol
A spirin
P yrazinamide

 measure obtain renal plasma flow = Para-amino hippuric acid (PAH)

 Cushings triad
 Widening of the pulse pressure
 Respiratory changes (Cheyne Stokes style respiration.)
 Bradycardia & hypertension

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 Causes of Increased Serum K+ 'Machine' :

 M - Medications - ACE inhibitors, NSAIDS , potassium sparing

diuretics, heparin , ciclosporin . beta blockers
 A - Acidosis - Metabolic and respiratory
 C - Cellular destruction - Burns, traumatic injury
 H – Hypoaldosteronism (Addison disease), haemolysis
 I - Intake - Excessive
 N - Nephrons, renal failure
 E - Excretion – Impaired
o Salbutamol is a recognised treatment for hyperkalaemia.
o ECG changes seen in hyperkalaemia include tall-tented T waves, small
P waves, widened
QRS leading to a sinusoidal pattern and asystole .
 leptin decreases appetite
 ghrelin increases appetite

 Cause of low magnesium

Diuretics
Total parenteral nutrition
Diarrhoea
Alcohol
Hypokalaemia, hypocalcaemia
(ECG features similar to those of hypokalaemia)
 Inflamations causes increase ferritin protein , ferritin is an acute protein
phase .
 Decrease ferritin = iron deficiency anemia

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 Acute phase proteins :

CRP
procalcitonin
ferritin
fibrinogen
alpha-1 antitrypsin
caeruloplasmin
serum amyloid A
haptoglobin
complement
 ECG :
U wave : hypokalemia
dalta wave : WBW syndrome
J wave : hypothermia

 Rifampicin, phenytoin, levodopa, methyldopa, and quinine all cause

pseudohaematuria.

 Normal Gap Acidosis: HARDUP

H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline

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 Mnemonic for the causes of hypercalcaemia:

CHIMPANZEES
C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly and Addison's Disease
N eoplasia
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis
 Hartmans solution is the most electrolyte rich.
 Carcinoid tumor : in blood is Chromogranin A
Urine 5HIAA
 Trotter's triad (diagnosis of nasopharyngeal carcinoma)
Unilateral conductive hearing loss
Ipsilateral facial & ear pain
Ipsilateral paralysis of soft palate

 Hypersensitivity reactions: ACID

type 1 –Anaphylactic
type 2 --Cytotoxic
type 3 --Immune complex
type 4 --Delayed hypersensitivity
 prominent oxyphil cells(hurthle cells) = follicular ca of thyroid

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 Lymphocytic infiltrates and fibrosis are typically seen in Hashimotos

thyroiditis. In Lymphoma only dense lymphatic type tissue is usually
present.
 Glucagonoma is strongly associated with necrolytic migratory erythema
+ diarrhea + wt loss
 Post splenectomy blood film features:
Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
 Lynch Syndrome
Autosomal dominant
Develop colonic cancer and endometrial cancer at young age
 Oncogenes are : sis , myc ,ret , src , ras , erb-B
 Breslow levels of melanoma !!!
 Aschoff-Rokitansky sinuses are the result of hyperplasia and
herniation of epithelial cells through the fibromuscular layer of the
gallbladder wall.
 the most common childhood brain tumour is astrocytoma

 Primary sclerosing cholangitis and Uveitis are much more common in

UC

 Ewings sarcoma : typically between 10 and 20 years of age , Location

by femoral diaphysis is commonest site , Histologicall

 Reed Sternberg cells are seen in Hodgkins disease. it is a small round

tumour

 Glioma sub types

Ependymomas- Ependymal cells
Astocytomas- Astrocytes (including glioblastoma)
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Oligodendrogliomas- Oligodendrocytes
Mixed- e.g. oligoastrocytomas
 Kartagener's syndrome The primary problem is of immotile cilia
syndrome. When associated with situs inversus
 Li-Fraumeni Syndrome : AD Consists of germline mutations to p53 ,
High incidence of malignancies particularly sarcomas and leukaemias .
 Lynch Syndrome : AD colonic cancer and endometrial cancer at young
age .
 Gardners syndrome : AD , colorectal polyposis , Extra colonic diseases
include: skull osteoma, thyroid cancer and epidermoid cysts , desmoid
tumor .
 Blood film in hyposplenism:
Howell-Jolly bodies
Pappenheimer bodies
Poikilocytes (Target cells)
Erythrocyte containing siderotic granules
Heinz bodies
 Epstein-Barr virus
Burkitt's lymphoma
Hodgkin's lymphoma
Post transplant lymphoma
Nasopharyngeal carcinoma
 Human papillomavirus 16/18 Cervical cancer Anal cancer Penile cancer
Vulval cancer Oropharyneal cancer
 Human herpes virus 8 Kaposi's sarcoma
 DIC Will tend to consume factors five and eight intially (and platelets).
 gastric gastro-intestinal stromal tumour contain Interstitial cells of Cajal

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 Causes of lymphadenopathy
Mnemonic: Hodgkins disease
H aematological: Hodgkins lymphoma, NHL, Leukaemia
O ncological: metastases
D ermatopathic lympadenitis
G aucher's disease
K awasaki disease
I nfections: TB, glandular fever, Syphilis
N iemann Pick disease
S erum sickness
D rug reaction (phenytoin)
I mmunological (SLE)
S arcoidosis
E ndocrinological (Hyperthyroidism)
A ngioimmunoplastic lymphadenopathy
S LE
E osinophilic granulomatosis

 Post transplant complications

CMV: 4 weeks to 6 months post transplant
EBV: post transplant lymphoproliferative disease. > 6 months post
transplant
 Patients with Leydig cell tumours may present with gynaecomastia
before they notice testicular enlargement.
 Neuroblastomas are a relatively common childhood tumour and have a
strong tendency to developing widespread lytic metastasis.
 Papillary thyroid ca : Histologically, they may demonstrate psammoma
bodies (areas of calcification) and so called 'orphan Annie' nuclei

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 Leriche syndrome
Classically, it is described in male patients as a triad of symptoms:
1. Claudication of the buttocks and thighs
2. Atrophy of the musculature of the legs
3. Impotence (due to paralysis of the L1 nerve)
* Extraintestinal manifestation of inflammatory bowel disease:
A PIE SAC
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
* Clubbing olonic pseudoobstruction = (Ogilvies syndrome)
* Most superficial structure on the parotid gland = facial nerve
* Nerves at risk during a carotid endarterectomy:
Hypoglossal nerve
Greater auricular nerve
Superior laryngeal nerve
 The mid inguinal point in the surface marking for the femoral artery.
 Transpyloric plane
Level of the body of L1
Pylorus stomach
Left kidney hilum (L1- left one!)
Right hilum of the kidney (1.5cm lower than the left)
Fundus of the gallbladder
Neck of pancreas
Duodenojejunal flexure
Superior mesenteric artery
Portal vein
Left and right colic flexure
Root of the transverse mesocolon

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2nd part of the duodenum

Upper part of conus medullaris
Spleen
 Structures passing through the lesser and greater sciatic foramina
(medial to lateral): PIN
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
 Mnemonic for muscle attachment on greater trochanter is POGO:
Piriformis
Obturator internus
Gemelli
Obturator externus
 Deep lateral hip rotators
Piriformis
Gemelli
Obturator internus
Quadratus femoris
 Mnemonic for the branches of the subclavian artery: VIT C & D
V ertebral artery
I nternal thoracic
T hyrocervical trunk
C ostalcervical trunk
D orsal scapular
 Features of Klumpkes Paralysis
Claw hand (MCP joints extended and IP joints flexed)
Loss of sensation over medial aspect of forearm and hand
Horner's syndrome
Loss of flexors of the wrist

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 Erbs Palsy C5, C6 lesion

The features include:
Waiter's tip position
Loss of shoulder abduction (deltoid and supraspinatus paralysis)
Loss of external rotation of the shoulder (paralysis of
infraspinatus)
Loss of elbow flexion (paralysis of biceps, brachialis and
brachioradialis)
Loss of forearm supination (paralysis of Biceps)
 Ankle reflex : s1 , s2
 Knee reflex : L2,3,4
 Biceps reflex : C5,6
 Triceps reflex : C7,8
 Contraindications to lung cancer surgery include SVC obstruction,
FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
 Venus ulcer = punch biopsy
 seborrhoeic warts = shave biopsy
 melanoma = excisional biopsy
 electrode is placed in direct contact with the tissue and is
characterized by low current and high voltage over a broad area =
desiccation
 electrode is held away from the tissue. The current utilizes a low
amplitude and high voltage = fulguration
 Inhibit cell wall formation
penicillins
cephalosporins
 Inhibit protein synthesis
aminoglycosides (cause misreading of mRNA)
chloramphenicol
macrolides (e.g. erythromycin)
tetracyclines
fusidic acid
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 Inhibit DNA synthesis

quinolones (e.g. ciprofloxacin)
metronidazole
sulphonamides
trimethoprim
 Inhibit RNA synthesis
rifampicin
 Punched out ulcer = peptic ulcer
 Rolled ulcer = gastric adeno ca
 Homans surgery = lymph vessels anastomosis
 Human papilloma virus 16/18 can cause sq cell ca
 Human papilloma virus 8 can cause kaposi sarcoma
 Epstein par virus can cause spontaneous spleen rupture
 Weber's syndrome: ipsilateral third nerve palsy with contralateral
hemiplegia - caused by midbrain strokes
 Etomidate can cause adrenal suppression and postoperative
vomiting but it is save for heart
 Pyrexia is the most common adverse event in transfusing packed
red cells
 Urticaria is the most common adverse event following infusion of
FFP
 Platlets transfusion can cause iatrogenic infection by G+ bacteria
 ARDS ; pulmonary capillary wedge pressure of less than 18 mm Hg)
, It usually consists of type I respiratory failure.
 Hypokalaemia with alkalosis
• Vomiting
• Diuretics
• Cushing's syndrome
• Conn's syndrome (primary hyperaldosteronism)
Hypokalaemia with acidosis
• Diarrhoea
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• Renal tubular acidosis

• Acetazolamide
• Partially treated diabetic ketoacidosis
 Cause of low magnesium
• Diuretics
• Total parenteral nutrition
• Diarrhoea
• Alcohol
• Hypokalaemia, hypocalcaemia
 Onufs nucleus is located in the anterior horn of S2 and is the origin of
neurones to the external urethral sphincter.
 Proteases facilitate protein and B12 absorption. Folate digestion is
independent of the pancreas.
 Hartmans solution is the most electrolyte rich.
 The acute phase response includes:
 Acute phase proteins
Reduction of transport proteins (albumin, transferrin)
Hepatic sequestration cations
Pyrexia
Neutrophil leucocytosis
Increased muscle proteolysis
Changes in vascular permeability
 Transfer factor the carbon monoxide transfer factor (TLCO)
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
hyperkinetic states male gender, exercise
low: everything else
 SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs,
tricyclics
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 Flow volume loop is the investigation of choice for upper airway

compression.
 TRH stimulates prolactin release. Dopamine suppresses the release
of prolactin.
 Bleeding post operatively, epistaxis and menorrhagia may indicate a
diagnosis of vWD. Haemoarthroses are rare. The bleeding time is
usually normal in haemophilia (X-linked) and vitamin K deficiency.
 Inhibition of insulin release:
Alpha adrenergic drugs
Beta blockers
Sympathetic nerves
 Tranexamic acid inhibits plasmin and this prevents fibrin degradation.
 Increased FRC:
Erect position
Emphysema
Asthma
 Decreased FRC:
Pulmonary fibrosis
Laparoscopic surgery
Obesity
Abdominal swelling
Muscle relaxants
 Erythromycin enhances gastric emptying by acting via the motilin
receptor in the gut.
 Lead poisoning : Full blood count: microcytic anaemia. Blood film
shows red cell abnormalities including basophilic stippling and
clover-leaf morphology
 Achondroplasia : defect in fibroblast growth factor receptor , AD
Radiological features
• Large skull with narrow foramen magnum
• Short, flattened vertebral bodies
• Narrow spinal canal
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• Horizontal acetabular roof

• Broad, short metacarpals
 The Ann Arbor staging system for hodgkin lymphoma , A Reed
Sternberg cell may be identified histologically Infection with Ebstein
Barr virus is linked to the condition (particularly mixed cellularity
lymphoma).
 Koebner Phenomenon :
• Psoriasis
• Vitiligo
• Warts
• Lichen planus
• Lichen sclerosus
• Molluscum contagiosum
 Glucagonoma : Symptoms include diarrhoea, weight loss and
necrolytic migratory erythema.
 Brown tumours of bone are associated withHyperparathyroidism
 An Asteroid body in an individual with sarcoid
 Comedo type DCIS is usually associated with microcalcifications.
Cribriform lesions are usually multifocal but less likely to form
microcalcifications.
 Classical seminoma is the commonest subtype
and histology shows lymphocytic stromal infiltrate.
 In man 2a parathyroid hyperplasia , in MAN 1 parathyroid adenoma
 astrocytoma is the commonest brain tumour in children .
 Aschoff-Rokitansky sinuses are the result of hyperplasia and
herniation of epithelial cells through the fibromuscular layer of the
gallbladder wall.
 Hassall's corpuscles are the concentric ring of epithelial cells seen in
the medulla of the thymus.
 Hurthle cell tumours are a variant of follicular neoplasms in which
oxyphil cells predominate.

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 The Lauren classification describes a diffuse type of adenocarcinoma

(Linitis plastica type lesion)
 Dercums disease is characterized by multiple lipomas. It is also
referred to as adiposis dolorosa.
 Stipple cells are found in lead poisoning
 Diverticular disease is one of the commonest causes of colovesical
fistula
 A Klatskin tumor is a cholangiocarcinoma
 Osteoclastoma has a characteristic appearance on x-ray with
multiple lytic and lucent areas (Soap bubble)
 Angiosarcoma of the liver is linked to working with vinyl chloride “pvc”
 Tuberous sclerosis associated with Angiomyolipoma .
Feltys syndrome:
Rheumatoid disease
Splenomegaly
Neutropenia
 Villous adenomas carry the highest risk of malignant transformation.
 Trotter's triad (diagnosis of nasopharyngeal carcinoma)
Unilateral conductive hearing loss
Ipsilateral facial & ear pain
Ipsilateral paralysis of soft palate
 Gardner's syndrome is an AD disorder, characterised by: Colonic
polyps, supernumerary teeth, jaw osteomas, congenital hypertrophy
of retinal pigment osteomas of the skull, thyroid cancer, epidermoid
cysts, fibromas and sebaceous cysts.
 Kartagener's syndrome : The primary problem is of immotile cilia
syndrome. When associated with situs inversu Kartagener's
syndrome is diagnosed.
 Desmoid tumours consist of a clonal proliferation of myofibroblasts.

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 Most cases of Pagets disease of the nipple are associated with

invasive ductal carcinoma.
 Branches of axillary artery :
First part : superior thoracic artery
Second part : thoracoacromial artery , lateral thoracic artery
3th part : subscapular artery(largest branch) , ant and post circumflex
artery
 Branches of subclavian artery
Branches “VIT C & D”
• Vertebral artery
• Internal thoracic artery
• Thyrocervical trunk
• Costocervical trunk
• Dorsal scapular artery
 Trachea start at C6 and end at T5
 Eosuphagus : Upper half is supplied by recurrent laryngeal nerve
 Thoracic duct : Lies posterior to the oesophagus for most of its
intrathoracic course. Passes to the left at T5.
 Right coronary artery :
• The sino atrial node (60% cases)
• The atrio ventricular node (80% cases)
 the pes anserinus formed by Sartorius Gracilis and semitendinous
muscle
 Capitate bone is the largest of the carpal bones.
 The penis takes autonomic nerves from the nervi erigentes
 The obturator nerve arises from L2, L3 and L4
 The fibrous capsule attaches to the anatomical neck superiorly and
the surgical neck inferiorly
 Addoctor canal : It contains the saphenous nerve and the superficial
branch of the femoral artery and vein .

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 The pituitary gland : The anterior pituitary develops from Rathkes

pouch .
 The deep external pudendal artery runs under the long saphenous
vein close to its origin and may be injured.
 To treat hyperhidrosis the sympathetic ganglia at T2 and T3 should
be divided.
 The profunda brachii artery is the largest branch and then continues
in the radial groove of the humerus.
 The azygos vein is routinely divided during an oesophagectomy to
allow mobilisation.
 Posterior Tibial Artery Larger terminal branch of the popliteal artery
 Femoral artery med inguinal point
 DeeStructures deep to ext retinaculum (Anterior):
Tom Has Very Nice Dogs & Pigsp inguinal ring : med point of
inguinal ligament
 Structures posterior to the medial malleolus:
Deep to flexor retinaculum (Posteromedially)
Tom Does Very Nice Hats
 The brachialis inserts some of its fibres into the fibrous joint of the
elbow capsule and when it contracts, it helps to flex the joint.
 Parasympathetic for parotid gland from CN9 to otic ganglion to
auriculotemporal nerve (a branch of the mandibular nerve (V3) to
reach the parotid gland .
 The inferior gluteal artery arises from the anterior trunk of the internal
iliac artery
 The superior gluteal artery arises from the posterior trunk of the
internal iliac artery
 The parasympathetic fibres to the lacrimal apparatus transit via the
pterygopalatine ganglion.
 Most of the branches of the anterior (superficial) femoral nerve are
cutaneous. However, it does also supply sartorius.

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 8 cm is still within normal limits. However, caecal diameters of 9 and

10 are pathological and should prompt further investigation.
 The ankle reflex is elicited by tapping the Achilles tendon with a
tendon hammer. It tests the S1 and S2 nerve roots.
 Extensor hallucis longus is derived from L5 and loss of EHL function
is a useful test to determine whether this level is involved.
 The most likely lesion to occur in the cerebello-pontine angle is an
acoustic neuroma lead to CN5 lesion
 The prostatic and membranous urethra drain to the internal iliac
nodes.
 Ansa cervicalis arise from C 1,2,3
 Features of Klumpkes Paralysis C8,T1 lesion
Claw hand (MCP joints extended and IP joints flexed)
Loss of sensation over medial aspect of forearm and hand
Horner's syndrome
Loss of flexors of the wrist
 The external urethral sphincter is innervated by branches of the
pudendal nerve, therefore the root values are S2, S3, S4.
 The upper ureter drains to the para-aortic nodes, the lower ureter
drains to the common iliac nodes.
 Should the strap muscles require division during surgery they should
be divided in their upper half. This is because their nerve supply from
the ansa cervicalis enters in their lower half.
 The lymphatic drainage of the spongy urethra and the glans penis is
to the deep inguinal nodes. The prostatic and membranous urethra
drains to the internal iliac nodes.
 Oxyphil cells are typically found in parathyroid glands
 The suspensory muscle of the duodenum which is referred to as the
ligament of Treitz is most important. The ligament of Treves is
located between the ileum and caecum.

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 Ascaris lumbricoides usually occurs after individuals have visited

places like sub Saharan Africa or the far east.
 Children typically develop this complication by E-coli infection
 Bacteroides is commonly present in severe peritoneal infections
 Prilocaine side effect is methemoglubin reversed by methylene blue
 Osgood Schlatters disease inflammation of patellar ligament
 A Hill-Sachs lesion for Glenohumeral dislocationr
 A HolsteinLewis fracture is a fracture of the distal third of the
humerus resulting in entrapment of the radial nerve.
 In cardiogenic shock pulmonary pressures are often high. This is the
basis for the use of venodilators in the treatment of pulmonary
oedema.
 Pyrexia is the most common adverse event in transfusing packed red
cells Urticaria is the most common adverse event following infusion
of FFP
 Immunosuppressed patients. Transfusion associated GVHD can
occur 4-30 days after a transfusion
 Use desmopressin for vanwellebrand disease
 Platelets are stored at room temperature and must be used soon
after collection This places them at increased risk of culturing gram
positive organisms.
 Atracurum lead to histamine release .
 Neostigmine can cause bradycardia and atropine is often
administered concomitantly to counter this effect.
 The cremasteric reflex is usually preserved when the torsion affects
the appendage only.
 Calcium phosphate stones are the most radiodense stones, calcium
oxalate stones slightly less so. Uric acid stones are radiolucent
 Milroy's disease is present from birth and is due to failure of the
lymphatic vessels to develop. Note that Meige's disease develops
AFTER 1 year from birth , TARDA after 35 years old

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 Homans procedure is a reasonable first line operative option for

lymph vessels deformity
 Basal cell carcinoma : the most common ca of skin .
 Dermarofibroma and pyogenic granuloma : accure at the site of
previous truma .
 Pleomorthic adenoma of parotid gland : TTT superficial surgical
excision.
 Nimodipine drug for subarachnoid bleeding
 Middle crerbral artery is the largert artery lies between temporal and
frontal lope in latetal sulcus
 A McEvedy incision is traditionally used to approach incarcerated
femoral hernias
 In case of paralytic ileus , insert nasogastric tube for stomach lavage
 The most common cause of biliary disease in patients with HIV is
sclerosing cholangitis due to infections such as CMV,
Cryptosporidium and Microsporidia
 Pancreatitis in the context of HIV infection may be secondary to anti-
retroviral treatment (especially didanosine) or by opportunistic
infections e.g. CMV
 UC less common in smokers
 Diarrhea with sever abdominal pain = campylobacter
 Fistula in ano in patients with Crohns disease should be managed
with insertion of seton.
 Once the bowel has been disconnected, a degree of inflammation is
commonly seen in the quiescent bowel. This is typically referred to as
diversion colitis.
 Diverticular disease is the commonest cause of lower GI bleeding in
adults.
 Combined chemoradiotherapy is the standard treatment for anal
cancer
 Failed colonoscopy should be managed with a CT colonoscopy

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 Fissure in ano : The next most appropriate management option when

GTN or other topical nitrates has failed is to consider botulinum toxin
injection.
 Infliximab is a popular choice in managing complex peri anal Crohns.
 Colonic cancers are staged with CT scanning of the chest, abdomen
and pelvis.
 acute colonic pseudo-obstruction TTT is neostigmine
 Proctalgia fugax is a functional anorectal disorder characterized by
severe, intermittent episodes of rectal pain that are self-limited.
 Iv terlipressin for relief portal HTN
 Intersphincteric fistulas are the commonest type
 The most common sarcoma is liposarcoma
 The cause of dark pigmented gall stone is unconjugated bilirubin
 Nerve root of horner syndrome is C8 , T1
 Mesonephros give off epidedemis vas deferens
 Metanephrus give off ureter kidney pelvis collecting tubule .
 The anatomical dead space can be determined using Fowler’s method
 Physiological dead space can be determined from the Bohr equation.

THE END …

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