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  • A
    A admin
    Anatomy

    bcd1cd0f-3041-4ce2-89ed-9d6e9de208e3-image.jpeg

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    A admin
    [image: 1772829310831-fac314f8-cb56-4155-bdb5-d6bf1a2b3561-image.jpeg]
  • A
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    Communication

    ANXIOUS MOTHER (PERFORATED APPENDIX)

    STEM - You are a surgical SHO on call for emergency general surgical admissions. A 10-year-old girl Sarah was brought by her neighbour as an emergency with peritonitis, Her mother was at work when she was told that her daughter is in hospital.

    The child Sarah, is febrile and extremely ill, A perforated appendix is suspected and she is being resuscitated by your registrar before being taken to the operating theatre. You've just arrived in the hospital for your shift and haven't seen the patient. Your consultant, Mr, Mann is on his way from home, and will perform the operation, She became anxious when she realize that Mr. Mann is the same surgeon who operated upon her husband and couldn't save his life.

    Considering this communication skills station, you are asked to talk to this anxious mother and answer her queries.

    Doctor: Hello, good evening, I'm Dr. Z, one of the surgical doctors. Am I talking to Sarah's mother?

*Patient: It's not a good evening for me, doctor, at all. What's going on here? All of you have taken my child for an operation even without letting me know. How is this even possible?*

Doctor: I was told to speak with you about your child condition. Can we please have a seat so that we can discuss about everything a bit more detailed? Could you first tell me what do you know so far?

*Patient: My child had fever from yesterday; but still I went to my work. I have no clue, doctor. It's all happened because of not being in home.*

Doctor: First, you don't have to feel guilty because this could happen anyway. Your daughter was brought by your neighbour complaining of tummy pain. Our initial investigation revealed the suspicion of acute appendicitis.
She was managed by our registrar and received some TV fluids and antibiotics. We are now waiting for theconsultant who will operate upon her.

*Patient Are you sure that my daughter has acute appendicitis?*

Doctor: We are suspecting acute appendicitis as this is common condition and also her signs and symptoms denotes
this. But we cannot be certain 100% until we open and see. Usually we do a keyhole first, then look for it.
Then after observation we complete the procedure. if it ruptures and case general infection of your tummy, or
if this failed, we need to convert it to open appendectomy by giving a small incision over right lower tummy.

*Patient: Is it dangerous, doctor?*

Doctor: In children specifically, there is less fat inside the abdomen, so perforation can be particularly dangerous. In such case your child may go to a higher care area called HDU. But Mr. Mann is a very good surgeon, I can assure you that your childis in very good hands. We will be looking after her but there are still some concerns.

*Patient: Will the wound be disfiguring?*

Doctor: A small horizontal wound will leave a little scar, but we may need to expand the wound and this may leave a bigger scar.
We will try to make as little scar as possible. / As she is a girl, it's conecrning, but still we will try to make it as short as possible.

*Patient: Is there any other problem that could occur?*

Doctor: Yes, probably severe infection can block the reproductive tubes in young girls, so future sub fertility may
happen.

*Patient: Do you mean that she can’t get pregnant in the future?*

Doctor: I understand your apprehension, no need to worry because she has another fine working tube on the other side.

*Patient But Mr, Mann did operation for my husband, and he died,*

Doctor: I am so sorry to hear that. Please accept my sincere condolences. May I ask when and how he died?

*Patient: Mr. Mann did operation for him because he had colon cancer and he died few weeks after the operation at home.*

Doctor I am so sorry to hear that again. I think those are two different situations. I think your husband died from the cancer not the surgery and Mr. Mann one of best surgeon we have in the hospital who has a vast experience on this, we will take good care of your daughter.

*Patient: Can I change the consultant?*

Doctor: Of course, you can because it's within your rights. But it’s time consuming as the new consultant will study the case from the beginning. As i's a suirgical emergency it will have a deleterious impact on your child health.
So, I will not recommend you do that.

*Patient: Can I see her?*

Doctor: Obviously, you can see her. But she will be kept in observational room just after the operation. Once she regains her consciousness, you can definitely see her. Do you have any other concerns?

*Patient: I just need to be everything ok for my child.*

Doctor: Of course, my team is trying our best.
Lets summarize what we have been through here. Your child has been brought here by your neighbour complaining of tummy pain. Our initial investigation revealed acute appendicitis and we are now waiting for the consultant to operate upon her, and I’ve explained the risks and benefits of this operation.

We all are here to help and support you and to dive you a hand at any time. Should there be any concerns, please don’t hesitate to contact me at any moment. I will leave my bleep number at the nurse station.
Thank you so much for your co-operation.
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  • A
    A admin
    Anatomy

    0bcdae4b-2ff5-4847-ac82-57b88865bdb4-image.png

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    A admin
    [image: 1771698476334-d95f3cd9-302c-4e27-877a-490819bc82b3-image.png]
  • A
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    Communication

    STEM 1 - You are asked to take the history John, a middle-aged male on the 5th post-op day who has presented with low mood for 6 hours and loss of appetite. He is not willing to talk to anyone and seems to be lost, The nursing staff informs you that he has been sleeping poorly post-operatively.

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    PRESENTATION John, a 56-year-old occupation, previously fit/smoker/social drinker who is on his 5th POD following ... [e.g. right hemicolectomy], has showed signs of anhedonia, depression and fatigue. He has also showed some signs of positive core biological symptoms. Considering all of this, my provisional diagnosis is reactive (postoperative depression), I will also consider major depressive disorder, bipolar disorder. What will be your management? For mild condition Regular exercise Advice on sleep hygiene (regular sleep times, appropriate environment) = Psychosocial therapy -CBT Moderate to severe Regular exercise, advice on sleep hygiene CBT Medication -SSRIs High-intensity psychosocial intervention (CBT or interpersonal therapy) Immediate and considerable high risk to themselves or others: Admit to psychiatric ward (use Mental Health Act if necessary)
  • A
    A admin
    Communication

    Stem:
    You are the surgical SHO working in the general surgery department 4G ward at St Bartholomew’s hospital, London. Mrs. Eleanor Thompson, DOB: 15/06/1942 has been admitted for right-sided simple mastectomy and axillary lymph node clearance, the operation is uneventful, and a drain is inserted, postoperatively she has developed axillary swelling, discomfort and is short of breath, please update the consultant Mr. Mann about her current condition and ask for advice.

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    S — Situation “Hello, it’s David, the SHO on Ward 4G. I’m calling about Mrs Eleanor Thompson, DOB 15/06/1942, who is post-operative day 2 following a right mastectomy with axillary lymph node clearance. She has developed new right axillary swelling, discomfort, and mild shortness of breath, and I’m concerned about a possible early postoperative complication.” B — Background “She has moderate COPD, mild left ventricular failure, and hypertension. Her surgery two days ago was uneventful with 150 mL blood loss, and a drain was inserted. Since yesterday, her temperature has been slowly rising from 36.9 to 37.2 today. Importantly, the drain has had no output today, and the axilla appears swollen and mildly tender. Her daughter is requesting discharge today due to family childcare pressures, but given the clinical changes I feel this is unsafe.” A — Assessment “On examination, she has a swollen right axilla, mild tenderness, and no drain output. Her pain is controlled, and observations are otherwise stable apart from very mild temperature rise. Her bloods today show: WCC 10.2, Hb 11.5, platelets 230. My concern is a postoperative seroma, haematoma, or possibly early infection, or a blocked drain. Given her comorbidities and mild SOB, I also want to rule out cardiopulmonary causes.” R — Recommendation “I’d like you to review her urgently, please. I’d appreciate guidance on whether to: Attempt drainage (needle aspiration) or re-site/flush the drain, Start empirical antibiotics, Arrange ultrasound of the axilla, And confirm whether you agree she should not be discharged today. Could you please come to review her on Ward 4G, or advise on the next immediate steps?”
  • A
    A admin
    Communication

    MRCS Part B – Communication Station (SBAR Handover)

    Time allowed: Reading time: 9 minutes
    Interaction time: 9 minutes

    Candidate Instructions
    You are a S.H.O. admitting patients in the Emergency Department.

    A patient, Ms Jane Doe, a 62-year-old woman, has just arrived with neurological symptoms. The initial assessment and CT head have now been completed. You have reviewed the notes provided.
    Your task is to make a telephone call to the on-call Neurosurgical Registrar to hand over the case and request appropriate further management.

    You must use the SBAR framework to structure your handover.
    During the station, the examiner will play the role of the on-call neurosurgical registrar and may ask questions about the case or your clinical reasoning.

    You should:
    Identify yourself clearly at the start of the call.
    Provide relevant clinical information succinctly.
    Highlight any immediate concerns.
    State clearly what you are requesting.
    Answer any questions asked.
    Demonstrate safe clinical judgement and prioritisation.

    You should NOT physically examine the examiner or role player.
    You should NOT take a history from the patient.

    At the end of the interaction, close the call appropriately.
    Who you are calling
    On-call Neurosurgical Registrar
    The examiner will play this role.

    You should assume the neurosurgical registrar is based at the regional neurosurgical centre.
    CT imaging is available on PACS for them to review.
    Information available to you
    Patient notes including initial assessment, observations, drug history, CT result, and ED management (provided on the reading sheet).
    You may refer to these notes during the station.
    You do not have access to electronic records, except for what is included.
    Your Objective
    By the end of the call, you should have:
    Provided a clear, structured SBAR handover.
    Communicated the urgent issues (ICH, high BP, anticoagulation on warfarin).
    Requested an urgent neurosurgical review.
    Demonstrated awareness of immediate management priorities (BP control, reversal of anticoagulation, level of care).
    Shown safe communication, escalation, and closing.

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    Model answer SpoilerC — SCRIPTED SBAR PHONE CALL (9-minute phone station — candidate lines) (Opening / identification) “Hello, I’m Dr X, a SHO from the Emergency Department. May I ask who I’m speaking to? 
 I’m calling about a patient called Jane Doe, DOB 15/04/1963, hospital number 0123456 — a 62-year-old lady who arrived 15 minutes ago with a suspected intracerebral haemorrhage. I’d like you to review the patient.” SpoilerS — Situation (short) “She has an acute left basal ganglia intracerebral haemorrhage on CT with intraventricular extension. She arrived 15 minutes ago and is currently in ED resus bay 2.” SpoilerB — Background (brief relevant items) “Key background: Atrial fibrillation on warfarin. Hypertension. Allergies none. On arrival her GCS is 13 (E4 V4 M5), left-sided weakness with power 2/5 in left arm and leg, blood pressure 210/112 mmHg, SpO₂ 97% on air. Point-of-care INR 3.2.” SpoilerA — Assessment (clinical status & investigations) “CT head performed shows a ~3.2 cm left basal ganglia bleed with intraventricular extension; no acute hydrocephalus on initial CT. We’ve given IV labetalol 20 mg once and started oxygen 2 L/min. IV access established, bloods including clotting and group & save sent. She is NBM and being monitored. I’m concerned about ongoing anticoagulation (INR 3.2) and the high blood pressure.” SpoilerR — Recommendation (what you want them to do) “I would like urgent neurosurgical review to assess for surgical intervention/need for transfer. I also recommend immediate reversal of warfarin with PCC and IV vitamin K — could you authorise this or come see? Please advise BP target and agent; if agreeable we plan to target systolic <140 mmHg. Finally, please advise level of care (HDU/ITU) and whether you want a CT repeat and timing. I can send you the CT images to review on PACS and have the patient ready for review now in resus bay 2 — can you come to ED or should we arrange transfer?” Close “Thank you — I’m able to give you further information or bring the patient to the neurosurgical unit if advised. My contact is bleep 321. Do you need any additional details now?” D — Examiner / Marking tips & likely questions to expect Key points examiners look for (communication and clinical content): Clear identification and succinct SBAR structure. Immediate recognition of reversible causes and time-sensitive actions: urgent reversal of warfarin (PCC + vitamin K) and BP control. Clear request for neurosurgical review and suggestion of level of care (HDU/ITU). Safe airway plan (NBM, prepare for decline), monitoring plan and clear escalation triggers. Appropriate documentation: CT findings, GCS, observations, anticoagulant status and INR. Likely follow-up questions the examiner/onsite consultant may ask (prepare short answers): “What is the exact CT finding?” → Left basal ganglia ICH ~3.2 cm with intraventricular extension; no acute hydrocephalus. “What’s her INR and when was last warfarin dose?” → INR 3.2 (POC); husband reports she took warfarin that morning. “What have you given already?” → IV labetalol 20 mg once; oxygen; analgesia; IV access; bloods sent. “What BP target do you propose?” → Target systolic 130–140 mmHg if tolerated; recommend nicardipine infusion if boluses fail. “Is she a surgical candidate?” → Unsure — needs neurosurgical assessment; size and intraventricular extension raise concern; recommend urgent neurosurgical review for EVD/consider decompression/transfer. Pitfalls to avoid in the station Missing anticoagulation status. Forgetting to ask for neurosurgery. Not naming a BP target or asking for specific reversal agents. Failing to document GCS or a change in GCS as an escalation trigger.
  • A
    A admin
    History

    Stem:
    You are the surgical SHO on call. Mrs. Janice Green, a 54-year-old woman, has been complaining of chronic back pain. She has asked you to help her in your FY1 colleague, and an MRI was performed previously. The consultant has asked you to go in and take a focused history from her to narrow down the cause.
    Please take a history from the patient. You do not need to perform a physical examination. At the end of the consultation, you should try to explain and ask you to summarize your findings and ask you questions about the case.

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    Examiner: Please summarize your case. "Mrs Janice Green is a 54-year-old woman with 4 months of chronic lower back pain, dull and aching, sometimes shooting down both legs to her feet, increasing in intensity, keeping her awake at night, worsening. She denies numbness, weakness, or bladder/bowel problems. She has hypertension, is unemployed, and she primary carer for her disabled husband, reporting significant stress and functional limitation. She has had a previous MRI, and no other systemic symptoms. This is most likely mechanical back pain, but red flags include night pain and possible weight loss, so further evaluation and broad support are appropriate." Examiner: How would you manage this patient? I would inform my seniors, perform a clinical examination, and order some investigations including: Full blood count: Looking for anemia which may indicate malignancy, leukocytosis which may indicate infection or inflammatory causes. Serology: Which may indicate an autoimmune process such as rheumatoid arthritis. Plasma electrophoresis: For possibility of multiple myeloma. Liver function tests: For possibility of metastatic disease or as part of an extraintestinal manifestation of inflammatory bowel disease. Plasma amino-lipase: May be considered if pancreatitis is suspected. Urea and electrolytes: May be ordered especially if the suspected diagnosis is multiple myeloma, which is associated with renal failure. Radiological investigation may include: X ray of the spine: Looking for bony abnormalities. MRI of the spine: Looking for disc pathology, spinal cord/cauda equina compression, or to determine diagnosis such as facet joint arthropathy. Abdominal ultrasound scan: if an abdominal aortic aneurysm is suspected. CT scan of the abdomen: may be considered if a diagnosis of chronic pancreatitis is suspected. Treatment will be tailored to the underlying cause, in this case the likely cause is primary or secondary spine malignancy, it needs to be discussed in a MDT meeting, if disseminated malignancy it will likely include radiotherapy, chemotherapy, and pain management, if her pain is complex pain management teams may be included. Note: When formulating a management plan, inform the patient, it is not mandatory that you get the right diagnosis, just give a reasonable set of investigations that will help you reach the diagnosis, and treatment plan for the most likely diagnosis in a brief manner. Note: When formulating a management plan, always remember that you are NOT ALONE, always involve other parts of the team, for example, pain management team, radiologist, pharmacist... etc. according to the case you are dealing with.
  • A
    A admin
    History

    You are the surgical SHO in clinic.

    Mr. David Johnson,
    a 50-year-old former
    semi-professional football player,
    presents with right knee pain
    For the last 4 months.
    He underwent surgery on the same knee
    30 years ago following a football injury,
    but does not recall the exact details
    of the procedure.

    You are not required to perform clinical examination.

    Please take a focused history
    to assess the cause of his current knee pain.

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    A admin
    Discussion Examiner: Summarize your case and give a differential "Mr. David Johnson is a 50-year-old former football player with a background history of Diabetes mellitus on Metformin, who presents with 4 months of right knee pain. The pain is gradual in onset, dull and aching, worsens with activity and at the end of the day, and improves with rest. He reports morning stiffness of about 10 minutes. He had a knee injury and surgery 30 years ago, details of which are unclear. There are no associated swelling, redness, systemic symptoms, or other joint involvement." The most likely diagnosis is post-traumatic osteoarthritis on the account of his past knee injury, his pain also being in keeping with the differentiating and exacerbating include: Chronic meniscal tear. Inflammatory arthritis such as ankylosing spondylitis or rheumatoid arthritis. Primary or secondary bone malignancy. Osteonecrosis of the knee. Crystal arthropathy including gout and pseudogout. Septic arthritis, which is unlikely. Give your main diagnosis, and then list the others, try to make a list from the most likely to the less likely. Examiner: What is your management plan? I would first examine the patient, and inform my seniors to get their advice, this will allow me to order a more focused set of investigations, but investigations needed may include: Biochemical investigations: FBC: Looking for anemia, which is seen with malignancy, chronic disease, and inflammatory bowel disease, leukocytosis, which is seen with infective or inflammatory pathologies. CRP and ESR: As inflammatory markers. Serology: looking for autoimmune process is suspected such as rheumatoid arthritis. Imaging: X-ray of the knee in two views looking for signs of osteoarthritis. MRI scan of the knee which can better characterize osteoarthritis, detect early changes, and detect meniscal or ligamentous injuries. Examiner: How would you treat this case? After discussion with my seniors, treatment will be tailored to the underlying diagnosis, in this case osteoarthritis is most likely, treatment options can include: Conservative treatment: Achieve healthy weight and maintain exercise, this will reduce mechanical stress on the joint. Physiotherapy, focusing on strengthening the muscles around the knee. Analgesia, this may include paracetamol or NSAID's. Intra-articular steroid injections. Surgical management: Total or partial arthroplasty. Arthroscopy, in conclusion if there are loose bodies or meniscal tears, but it does not affect the progression of osteoarthritis. Realignment osteotomies, which are designed to redistribute weight away from the affected knee compartment, it can delay the need for arthoplasty. Examiner: If total knee replacement is carried out, what are the causes failure of total knee replacement? Aseptic loosening of the implant. Wear and tear in the joint. Early or late prosthetic joint infection. Periprosthetic fractures. Examiner: What do you mean by aseptic loosening? Aseptic loosening refers to the separation of the implant from the bone due to chronic inflammatory reaction, it does not involve bacterial infection, rather the debris from the wearing of implant components triggers an inflammatory reaction in the surrounding bone, leading to osteolysis, bone loss and implant loosening over time, it is a long term complication. Examiner: Will this patient be able to play soccer in 9 months after a total knee replacement, and why? Unlikely to be able to play soccer in 9 months, it is generally not recommended because this can damage the prosthesis and cause early loosening of the implant. Examiner: What X ray findings are consistent with osteoarthritis? Joint Space Narrowing (JSN)
  • A
    A admin
    Anatomy

    Right lung
    6fc893d9-8270-410f-990f-a9efc4f9fddf-image.png

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    A admin
    [image: 1760565114719-37a900b4-4bc1-48e8-a383-3383167529fa-image.png]
  • A
    A admin
    Anatomy

    70c14829-f482-4d15-ba22-61470850b2b5-image.png

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  • A
    A admin
    Anatomy

    Cervical
    C1 Atlas
    A) above B) Below
    c1dc9212-9f1f-416d-9de7-4249995370e1-image.png

    Facet for Dens of axis.

    Groove for vertebral artery.

    Lateral mass with inferior articular facet.

    ca903390-5b48-407e-8798-be0189989ef3-image.png

    Lateral mass with superior articular facet.

    Posterior arch.

    Posterior tubercle.

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    A admin
    anac1.html
  • A
    A admin
    Anatomy

    d4df5c10-8929-4e64-9a29-f39f7255d996-image.png

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  • A
    A admin
    Anatomy

    Lateral
    forearmA-P.png
    Medial

    Extensor Carpi Radius Longus.

    Extensor Carpi Radius Brevis.

    Abductor Pollicis Longus.

    forearmA-P.png

    Anconeus.

    Extensor Carpi Ulnaris.

    Extensor Digitorum.

    Extensor Digiti Minimi.

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    A admin
    Left hand from behind [image: 1760103624953-9f4ae09c-23ed-4f41-907e-e8b42e8dac62-image.png] 11 Extensor pollicis brevis. 12 Extensor pollicis longus. 6 Extensor carpi radialis longus. [image: 1760103624953-9f4ae09c-23ed-4f41-907e-e8b42e8dac62-image.png] 5 Extensor carpi radialis brevis. 9 Extensor digitorum 10 Extensor indicis [image: 1760103624953-9f4ae09c-23ed-4f41-907e-e8b42e8dac62-image.png] 8 Extensor digiti minimi 14 First dorsal interosseous 16 Second dorsal interosseous answers[image: 1760103639333-44029a07-c8b5-4502-b891-25e7ee396749-image.png]
  • A
    A admin
    Anatomy

    Identify 1 - 5 in this Left leg
    thigh2.png

    Adductor longus

    Sartorius

    Vastus medialis, intermedius, lateralis

    .

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    A admin
    Anterior [image: 1757607222780-090205a8-dc19-4036-baa6-c265e07a8591-image.png] Spoiler [image: 1757606977748-a7046645-fb1e-41d8-9a6a-60a411ec8218-image.png] Posterior [image: 1757606627233-8bb534ad-b401-4a07-8b0c-8ee290285be8-image.png] Spoiler[image: 1757606789866-c65988de-927e-49f3-a303-5fab5b16c349-image.png]
  • A
    A admin
    Anatomy

    Identify C-F
    31a65a45-fb7a-4896-92d0-3b55aa63a491-image.png

    Optic canal

    Foramen rotundum

    Formamen ovale

    Jugular foramen

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    A admin
    Station Topic: Brain Anatomy – Internal Carotid Artery Question (20 marks) [image: 1759597375048-2ab79662-441a-40de-b185-1c9d05240885-image.png] You are asked to demonstrate your knowledge of the internal carotid artery (ICA) and its relation to brain anatomy. Identify and describe the course of the internal carotid artery from the neck to the brain. (5 marks) Spoiler1 The ICA arises from the common carotid artery at the level of C3–C4 vertebrae. Cervical segment: Ascends vertically in the neck without branching. Petrous segment: Enters the carotid canal in the petrous temporal bone; runs anteromedially. Cavernous segment: Courses through the cavernous sinus; forms an S-shaped curve (the carotid siphon). Cerebral (supraclinoid) segment: Exits the cavernous sinus and pierces the dura mater at the roof of the cavernous sinus to enter the subarachnoid space; gives terminal branches to the brain. Tip: Remember mnemonic “Cervical, Petrous, Cavernous, Cerebral” to recall ICA segments. 2 List and explain the main branches of the internal carotid artery in the cranial cavity. (5 marks) SpoilerOphthalmic artery: First branch; supplies the orbit and optic nerve. Posterior communicating artery (PComm): Connects ICA to posterior cerebral artery; part of Circle of Willis. Anterior choroidal artery: Supplies choroid plexus, internal capsule, optic tract. Terminal branches: Anterior cerebral artery (ACA): Medial frontal and parietal lobes. Middle cerebral artery (MCA): Lateral convexity of cerebral hemisphere. Tip: ACA + MCA = terminal branches; remember PComm is part of collateral circulation. 3 Describe the areas of the brain supplied by these branches. (5 marks) SpoilerBranch Area Supplied Ophthalmic Eye, orbit, optic nerve Posterior communicating Connects ICA to posterior cerebral artery; collateral supply to occipital lobe Anterior choroidal Posterior limb of internal capsule, optic tract, globus pallidus, choroid plexus Anterior cerebral (ACA) Medial frontal and parietal lobes; leg motor/sensory cortex Middle cerebral (MCA) Lateral convexity of hemisphere; face and upper limb motor/sensory cortex, Broca/Wernicke areas Clinical Relevance of ICA (5 marks) Outline the clinical relevance of the internal carotid artery. Include at least two common pathologies and their implications. SpoilerAtherosclerosis / ICA stenosis: Can cause transient ischaemic attacks (TIAs) or stroke in MCA/ACA territories. Risk factors: hypertension, diabetes, smoking. Aneurysm formation: Common at bifurcation into MCA and ACA or posterior communicating artery. May cause subarachnoid haemorrhage or cranial nerve III palsy if PComm involved. Other considerations: SpoilerICA injury during carotid endarterectomy. Compression by tumours (e.g., pituitary adenoma in cavernous sinus) → ophthalmoplegia.
  • A
    A admin
    Anatomy

    Humerus A) Front C) Medial
    2c65f6cf-9dea-4ccc-8078-de7b92341c0e-image.png

    Greater tubercle.

    Lesser tubercle.

    Surgical neck.

    e6adde9a-bbb4-4ba2-8981-f9b853570a68-image.png

    Head.

    Intertubercular groove.

    Anatomical neck.

    792ea4d5-7b9c-44a1-8eb9-e752fd3b5c5d-image.png

    Lateral and Medial lip of intertubercular groove.

    ef3ea967-0656-48aa-89bb-9b99dfaa38c8-image.png

    Deltoid tuberosity

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    A admin
    Right humerus lower end, A) Front B) Behind [image: 1760100719273-504353c4-52fc-4100-b8c5-d7b78397d7f0-image.png] 2 Capitulum. 5 Lateral epicondyle. 13 Trochlea. [image: 1760100719273-504353c4-52fc-4100-b8c5-d7b78397d7f0-image.png] 7 Medial epicondyle. 8 Medial supracondyle ridge 10 Olecranon fossa.
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    Anatomy

    28058f70-8960-403c-ba38-249a36203e8d-image.png

    10 Epiglottis
    12 Internal laryngeal nerve
    13 Lamina of thyroid cartilage

    d51fd592-6a0f-464d-9485-4602c6063299-image.png

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    Anatomy

    Face.png

    L= Lingual
    I= Incisive
    M= Mental
    CT= Chprda tympani
    IA= Inferior Alveolar
    N= Nerve to mylohyoid

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    Anatomy

    bcb6a386-6eb7-48f0-bfbf-60a02e8fc76d-image.png
    A 35-year-old male is brought to the emergency department after a high-speed road traffic accident. He is pale, clammy, hypotensive (BP 80/50), tachycardic (HR 130), and confused. There is obvious major bleeding from a laceration to his thigh.

    You are asked to manage this patient according to the Major Haemorrhage Protocol (MHP).

    1. What is Initial Assessment and Immediate Actions (6 marks)
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    A admin
    Explain the steps in Resuscitation and Monitoring (5 marks)
  • A
    A admin
    Anatomy

    4ade664d-e8dd-419e-ab77-6743e3e7b3a9-image.png
    1 Where do the secretions of the parotid gland drain?

    The secretions of the parotid gland pass into the oral cavity via Stensons duct whose oral opening is opposite the second upper molar tooth.

    2 Which structures pass through the parotid gland?

    Facial nerve
    External carotid artery
    Retromandibular vein
    Auriculotemporal nerve

    3 What is the lymphatic drainage of the parotid gland?

    It contains lymph nodes within the substance of the gland itself. It then drains to the deep cervical nodes.

    4 Which nerves supply the parotid gland?

    Parasympathetic-Secretomotor
    Sympathetic-Superior cervical ganglion
    Sensory- Greater auricular nerve

    5 Outline where you would place the incision for a superficial parotidectomy.

    The incision runs posterior to the mandible and up inferior to the tragus of the ear. Loss of cutaneous sensation to the ear lobe is therefore a risk of the procedure.
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    S Shamzy2020
    @admin said in Station - parotid gland: Parasympathetic Parasympathetic (secretomotor) innervation The parasympathetic supply increases the production of watery saliva. Its pathway is long and complex, beginning with the glossopharyngeal nerve (CN IX). Origin: The preganglionic parasympathetic fibers arise from the inferior salivatory nucleus in the brainstem. Course: The fibers travel along the glossopharyngeal nerve and a small branch called the tympanic nerve, which passes through the middle ear. Synapse: The fibers continue as the lesser petrosal nerve and synapse in the otic ganglion, which is a collection of nerve cell bodies near the base of the skull. Supply: The postganglionic fibers then "hitchhike" along the auriculotemporal nerve (a branch of the trigeminal nerve) to reach and innervate the parotid gland. (Hence sometimes post parotidectomy when the great auricular nerve is sacrified or injured - it causes Frey's syndrome - where regenerating of parasympathetic fibers accidentally "rewire" themselves to connect with the sympathetic pathways that lead to the skin's sweat glands and blood vessels Sympathetic innervation The sympathetic supply reduces saliva production, causing a thicker, more viscous saliva via vasoconstriction. ‱ The postganglionic sympathetic fibers originate from the superior cervical ganglion and travel to the gland along the external carotid artery. Sensory innervation The parotid gland receives its sensory supply from two nerves. ‱ Auriculotemporal nerve: This nerve provides general sensory innervation directly to the substance of the gland. ‱ Great auricular nerve: This nerve, a branch of the cervical plexus (C2 and C3), supplies the sensory innervation to the tough fascia or capsule of the parotid gland.