Judgments
My-Mrcs-A-Notes.pdf
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Judgement of 19 pages for the course MEDICINE at MEDICINE (My-Mrcs-A-N)
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MRCS NOTES(1) Brachial plexus:
(1) Roots --> b/w Scalenous Anterior and Medius
(2) Trunks --> Posterior triangle of neck
(3) Divisions --> behind clavicle
(4) Cords --> In Axilla ( related to 2nd part of axillary artery)
(2) Phrenic nerve descends on anterior aspect of scalenous anterior and is in the posterior
triangle of neck throughout its course in the neck.
(3) Deep branch of ulnar nerve supplies interossei and adductor pollicis (froments sign when
this is damaged)
(1) Superficial branch supplies plamaris brevis.
(2) Middle finger has no palmar interossei.
(4) Recurrent branch of median nerve is purely motor and supplies the thenar eminence.
(5) Ulnar nerve is medial to ulnar artery and they both pass through the canal of Guyon canal
at the wrist.
(6) Ganzer muscle is an abberation of flexor pollicis longus and may affect the anterior
interoseeus nerve.
(7) Extensor Indicis is medial to extensor to extensor digitorum
(8) Right coronary artery originates from the anterior sinus, left coronary artery originates from
the left posterior sinus.
(9) Coronary sinus tributaries are great cardiac vein(running in anterior interventricular groove),
middle cardiac vein(running in posterior IV groove), and small cardiac vein(along the
marginal artery).
(1) Venea corda minimie/smallest cardiac veins/thebasian veins drain directly into the
heart.
(2) A left SVC drains into the coronary sinus.
(10)Right coronary artery supplies SA node in 60% of cases and AV node in 80% of cases.
RCA arises from anterior aortic sinus and LCA from left posterior aortic sinus.
(11)Heart valves are made up of extracellular matrix rich is dense collagen, elastin and
prostaglandins, along with valve interstitial cells.
(12)Porcine heart valves have the benefit of avoiding anticoagulation but have to be replaced
after 10 years because they get stenosed due to calcifications.
(13)Oblique cardiac recess is between pulmonary veins( LA and pericardium)
(1) Transverse is between pulmonary trunk and aorta anteriorly, and SVC and left atrium
posteriorly.
(14)Great cerebral vein is formed by the union of 2 internal cerebral veins, and joins the inferior
saggital sinus to form the straight sinus.
(15)Pia mater forms the choroid plexus with astrocytes.
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,(16) Dorsal rami of C1, L4 and L5 have no cutaneous branches.
(17) Diplopia walking downward and unable to abduct is trochlear nerve injury.
(18)Danger area of face is drained by
(1) anterior facial and ophthalmic veins
(2) Pterygoid venous plexus
(19)Opening of ampulla of Vater in on posteromedial aspect of 2nd part of duodenum(major
duodenal paiila), use monopolar cutting for sphincterotomy.
(1) Use monopolar blend for polypectomy
(20)Ischial spine:
(1) Anatomical landmark for puedendal nerve block, used for episiotomy.
(2) At the level of vesico-ureteric junction(for Xray detection of stones)
(3) marks the pelvic outlet.
(4) Level of levator ani
(21)Anal canal lympahtics drain to superficial inguinal nodes below the denate line and internal
illiac nodes above the dentate line.
(22) Distal articulation of cuboid and hamate are 4th and 5th metatarsal/metacarpal. Capitate is
the largest carpal bone and articulates with 2nd,3rd and 4th metacarpals.
(1) Scaphoid and lunate artiulate with radius.
(2) Capitate is related to profundus tendon
(23)Axillary nerve supplies deltoid and teres MINOR.
(1) teres major is supplied by lower subscapular nerve and thoracodorsal nerve aka
middle subscapular nerve.
(24)Nerve injury at hip surgery
(1) Posterior approach ---> Sciatic nerve
(2) Postolateral approach ---> Superior gluteal nerve
(25)Meralgia parasthetica is burning pain on anterolateral part of proximal thigh due to damage
of lateral cutaneous nerve of thigh under the lateral aspect of inguinal ligament.
(1) LCN of thigh and psoas major are both L2, L3.
(2) Femoral nerve supplies illiacus and lies on it.
(26) In carotid endarterectomy:
(1) Hypoglossal nerve can be damaged
(2) Facial vein is divided
(27)Cervical vertebrae:
(1) bifid spinous process, small body
(2) C7 is known as vertebrae prominens because it has a long spine
(3) foramen transversum is present in upper 6 vertebrae for transmission of vertebral
artery
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, (28)Thyroid horomones decrease oxidative phosphorylation by increasing uncoupling proteins
so that increase heat production takes place, so thyroid horomones increase in responce to
cold and decrease in responce to heat.
(1) If used alone for preop, iodine can intensify thyrotoxicosis.
(2) PTU increases vascularity of thyroid gland.
(29)Pregnancy and other growth states are risk factor for folic acid deficiency.
(30)Hassal corpuscles are found in the thymus, which is derived from 3rd parangeal pouch,
along with inferior thyroid.
(31)Most common cause of ARDS is sepsis.
(32)Hepatomegaly in Kwashiorkor patients is due to fatty infiltrates.
(33)Morton neuroma:
(1) aka intermetatarsal neuroma, betweeen metatarsals causes constant pain in foot.
the interdigital nerve transverses inferior to the intermetatarsal ligament. It may be
compressed or stretched by repetitive toe flexion and extension. This causes
reactive overgrowth of connective tissue and arterial sclerosis. This leads to nerve
ischemia and atrophy. Pain is due to nerves getting caught up in the scar tissue.
(2) Feels like walking on a marble
(3) Treatment involves getting a soft sole, NSAIDS, Sclerosing/Steroid Injections.
(4) Stress/March fracture is fracture of 2nd metatarsal(longest and thinest) head due to
repeated trauma.
(5) Freiberg disease is anterior metatarsalagia of 2nd metatarsal in pubertal growth.
(34)Pilon fracture is a fracture of tibia and fibula at the lower aspect, its fixation is done by a
external fixator known as delta frame.
(1) Delta frame has a transcalcaneal pin and a tibial pin
(2) Once soft tissue injury is resolved 2-3 weeks and ORIF is done with plates and
screws.
(35)Histology of RA:
(1) Hallmark is perivascular mononuclear infiltrates in the synvoium
(2) A pannus contains inflammatory cells, granulomatous tisse and fibroblasts.
(3) A rheumatoid nodule contain necrobiotic granulomatous inflammation.
(36)Claudication:
(1) Thigh claudication : Illiac vessels, if buttocks are involved then common illiac(leiriche
syndrome)
(2) Calf claudication : due to atheroma in superficial femoral artery at the level of the
adductor hiatus.
(3) Ankle claudication : Popliteal artery
(37)Doppler:
(1) Frequency observed after reflection of ultrasound waves varies on the approach of
the fluid. Higher frequency of approaching fluid and lesser frequency of leaving fluid.
(2) A normal artery has a triphasic waveform
(3) Mild stenosis : Increase in velocity and a biphasic waveform
(4) Tight stenosis : Even more increase in velocity and a monophasic waveform
(5) Distal to stenosis : decreased velocity and a monophasic signal.
(38)Enhanced Recovery Protocol aka ERAS:
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