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.

MRCS_Haematuria_OnePage.pdf

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@florianecaffart @Photosaurus hi hi merci !

What is the most common part of the duct that is involved in a stone? SpoilerMiddle 1/3 Why is this site most affected? SpoilerDue to looping of lingual nerve around duct, and thick mucus secretion and have to pour secretion in floor of mouth against gravity What are digastric triangle boundaries and their nerve supply? SpoilerSuperior: Inferior border of the mandible Anterior: Anterior belly of the di gastric muscle Posterior: Posterior belly of the digastric muscle Nerve supply SpoilerThe anterior belly of the digastric muscle is innervated by the mylohyoid nerve, which is a branch of the mandibular nerve The posterior belly of the digastric muscle is innervated by the digastric branch of the facial nerve. Names & actions of extrinsic muscles of the tongue SpoilerGenioglossus: protrusion of the tongue & depression of the tongue tip Hyoglossus: retraction of the tongue & depression of the lateral margins of the tongue Styloglossus: retraction of the tongue & elevation of the sides of the tongue Palatoglossus: Elevation of the posterior part of the tongue If you have injury of Hypoglossal, lingual or marginal mandibular what will the patient have? Marginal mandibular SpoilerDrippling of saliva from corner of affected side Poor speech articulation (slurred speech) Asymmetry on smiling or crying Hypoglossal SpoilerParalysis and atrophy in ipsilateral side Deviation to ipsilateral side on protrusion Poor speech articulation Lingual SpoilerLoss of general sensation from ant 2/3 of tongue and floor of mouth Loss of taste sensation from tongue only Boundaries of Posterior Triangle SpoilerBoundary Description Apex Sternocleidomastoid and the Trapezius muscles at the Occipital bone Anterior Posterior border of the Sternocleidomastoid Posterior Anterior border of the Trapezius Base Middle third of the clavicle Origin & Insertion of Omohyoid SpoilerBelly Origin Insertion Inferior belly superior border of scapula near the suprascapular notch intermediate tendon Superior belly intermediate tendon body of hyoid bone Study Notes Hypoglossal nerve SpoilerBecause the genioglossus muscle on the healthy side "pushes" the tongue, it will deviate toward the side of the injury when the patient sticks it out. Why lingual nerve injury causes loss of taste, even though it primarily carries general sensation? SpoilerWhile the Lingual nerve is a branch of the Mandibular nerve and carries general sensation (touch, pain, temperature), it also acts as a "highway" for taste fibers.The Chorda Tympani Connection. The reason a lingual nerve injury (specifically if it occurs after the two nerves join) causes loss of taste is due to the Chorda Tympani, a branch of the Facial nerve (CN VII). The Join: High up in the infratemporal fossa, the Chorda Tympani "hitches a ride" with the Lingual nerve. The Shared Path: From that point forward, they travel together as one physical cord. "Tell" Hypoglossal (XII)Motor to tongue muscles Tongue deviates toward the side of the lesion.Lingual General sensation + TasteNumbness of the anterior 2/3 and loss of taste on that side. Marginal MandibularMotor to lower lip muscles The "crooked smile"—the corner of the mouth droops. Omohyoid, remember that its two bellies are held together by an intermediate tendon. This tendon is actually tethered to the clavicle by a deep layer of fascia. This is why when the muscle contracts, it doesn't just pull the hyoid down; it also helps maintain the patency of the internal jugular vein!