isurg

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Parasagittal meningioma Tumour: Parasagittal meningioma Typical presentation Gradually progressive contralateral lower limb weakness Focal seizures in the leg UMN signs Why Compression of the Paracentral lobule (leg area of the Primary motor cortex). Exam clue Progressive leg weakness + seizures → parasagittal meningioma. Acoustic neuroma (vestibular schwannoma) Tumour: Vestibular schwannoma Typical presentation Unilateral hearing loss Tinnitus Balance problems Later: Facial numbness Facial weakness Why Compression of: Vestibulocochlear nerve (CN VIII) Facial nerve (CN VII) Exam clue Progressive unilateral deafness. Pituitary adenoma Tumour: Pituitary adenoma Typical presentation Bitemporal hemianopia Why Compression of the Optic chiasm. Other clues: Hormonal symptoms (galactorrhoea, acromegaly, Cushing's). Exam clue Loss of temporal visual fields. Cerebellopontine angle tumour Often a Vestibular schwannoma. Symptoms Hearing loss Facial numbness Ataxia Structures involved: Trigeminal nerve Facial nerve Vestibulocochlear nerve Exam clue Multiple cranial nerve deficits in the cerebellopontine angle. Frontal lobe tumour Commonly a Glioma. Typical presentation Personality change Disinhibition Poor judgement Sometimes urinary incontinence Structure affected: Frontal lobe Exam clue Behavioural change before neurological deficit. ✅ Very high-yield MRCS pattern Symptom Likely tumour Leg weakness Parasagittal meningioma Unilateral deafness Vestibular schwannoma Bitemporal hemianopia Pituitary adenoma Behaviour change Frontal lobe tumour Multiple cranial nerve palsies CPA tumour

You are the SHO in the orthopaedic department. A 35-year-old man, Mr. James Carter, sustained a knee injury following a sports accident three months ago and was diagnosed with a post-traumatic meniscal tear. He was listed for an arthroscopic meniscectomy, but his operation has been cancelled twice before due to emergency cases. Unfortunately, his surgery has been postponed again today for the same reason. Your task is to update Mr Carter and address his concerns.

Stem (Candidate Instructions) You are a surgical trainee in the outpatient clinic. Your next patient is John Smith, a 60-year-old man who has been referred by his GP with bleeding per rectum and unintentional weight loss. Take a focused history from the patient You do not need to perform an examination At the end, summarise your findings and outline your initial concerns to the examiner You have 6 minutes. Role Player (Patient Script) Spoiler60-year-old male 3-month history of intermittent rectal bleeding Blood is dark red, mixed with stool, sometimes on paper Associated change in bowel habit → looser stools, increased frequency Unintentional weight loss (~6–8 kg over 3 months) Occasional abdominal discomfort, no severe pain No PR bleeding previously If asked: No melaena No haematemesis Some fatigue No known haemorrhoids No inflammatory bowel disease history PMH: Hypertension Drugs: Amlodipine FH: Father had bowel cancer at 70 SH: Ex-smoker, moderate alcohol 16-Mark Scheme (Examiner Checklist) Introduction & Communication (2 marks) Introduces self, confirms patient identity, gains consent Open questioning style, allows patient to describe symptoms Presenting Complaint Exploration (4 marks) Bleeding history: Onset and duration Colour (fresh vs dark), relation to stool Quantity/frequency Mixed vs separate from stool Red flag features: Change in bowel habit Weight loss Tenesmus or urgency Associated Symptoms (3 marks) Abdominal pain or discomfort Symptoms of anaemia (fatigue, dizziness) Melaena / upper GI symptoms Mucus in stool / features suggestive of IBD Bowel History (2 marks) Baseline bowel habit vs current Stool consistency (loose, hard, alternating) Frequency and urgency Past Medical & Drug History (2 marks) GI conditions (polyps, IBD, haemorrhoids) Medication review (anticoagulants, antiplatelets, NSAIDs) Family History (1 mark) Colorectal cancer or polyps Social History (1 mark) Smoking and alcohol Functional impact / performance status Ideas, Concerns, Expectations (ICE) (1 mark) Elicits patient concern (e.g., cancer worry) Examiner questions Differentials SpoilerMalignancy Hemorrhoids Management SpoilerBlood, examination. High suspicion of colorectal malignancy Needs urgent investigation (e.g., 2-week wait referral, colonoscopy)

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@florianecaffart @Photosaurus hi hi merci !

Vagus nerve course in thorax & abdomen? Thorax: Left vagus nerve SpoilerCrosses in front of the left subclavian artery. Enters the thorax between the left common carotid and subclavian arteries. Descends on the left side of the aortic arch. Travels behind the phrenic nerve. Courses behind the root of the left lung. Deviates medially and downwards to reach the esophagus and form the esophageal plexus with the right vagus nerve. Right vagus nerve SpoilerCrosses in front of the first part of the subclavian artery. Travels behind the innominate vessels. Reaches the thorax on the right side of the trachea. Inclines behind the hilum of the right lung. Courses medially towards the esophagus to form the esophageal plexus with the left vagus nerve. Abdomen: SpoilerThe oesophageal plexus, formed by the union of the right and left vagus nerves, The vagus nerve enters the abdomen through the oesophageal hiatus at the level of the tenth thoracic vertebra (T10). It divides into the anterior and posterior vagal trunks, which innervate the stomach, small intestine, liver, gallbladder, pancreas, and spleen. Nerves in oesophageal hiatus? SpoilerAnt & post vagal trunks. What do they supply? SpoilerStomach, duodenum, jejunum, ileum, cecum, ascending colon, medial 2/3 of transverse colon, spleen, pancreas, gall bladder Muscle dissected to see thyroid? SpoilerSternohyoid muscle