Surgical

Question 1

which location is the most common for peptic ulcer diease?

Answer 1

duodenum (more common than gastric!)

Question 2

What is the typical presentation of a duodenal ulcer?

Answer 2

Epigastric pain temporarily RELIEVED by eating +/- signs/ symptoms of a upper GI bleed

Question 3

What is the typical presentation of a gastric ulcer?

Answer 3

Epigastric pain WORSENED by eating +/- signs/symptoms of upper GI bleed

Question 4

What is the typical presentation of appendicitis?

Answer 4

Periumbilical -> RIF pain. Anorexia. Pyrexia. Rovsing’s Sign (pain felt in RIF when pressing on LIF)

Question 5

Classic presentation of ascending cholangitis?

Answer 5

Charcot’s triad: fever/rigors + RUQ pain + jaundice / elevated bilrubin

Caused by bacterial infection (E.coli most common) of the biliary tree secondary to obstruction of biliary outflow by gallstone etc.

Question 6

Hepatic LFTs versus cholestatic picture of LFTs?

Answer 6

ALP + bilirubin = cholestatic / obstructive picture

ALT + AST = hepatic picture

Question 7

What are the criteria to be considered for bariatric surgery according to NICE?

Answer 7

BMI > 40
OR
BMI > 35 with a comorbidity that would be IMPROVED by the surgery eg diabetes
(Hx of drug abuse / certain mental ill health is a relative contraindication due to concerns re attending follow up)

Question 8

Management options for transitional cell bladder cancer?

Answer 8

Carcinoma in situ / localised = TURB (transurethral resection of the bladder) or intravesical BCG 
Locally invasive (T3) where it has penetrated the detrusor layer = radical cystectomy with ileal conduit 
T4 tumours (invaded the serosal layer) = chemotherapy, inoperable

Question 9

Tumour that develops in the parotid gland?

Answer 9

Pleomorphic adenoma

Question 10

Types of thyroid tumour?

Answer 10

Papillary carcinoma - overall the most common - typically younger patients (<40) - good prognosis
Anaplastic carcinoma - rare but rapidly growing compressing local structures and early lymph node spread
Medullary carcinoma -> produces calcitonin -> get hypocalcaemia

Question 11

If a breast cancer is HER2 positive, what chemotherapy can we use on it ?

Answer 11

Herceptin (trastuzumab)

-> can be cardiotoxic so pts need to be monitored for heart failure

Question 12

For which type of breast cancer is anastrazole used and what should you co-prescribe with it?

Answer 12

For oestrogen-receptor positive BC

Reduces bone density so need to co-prescribe a bisphosphonate

Question 13

Which conditions are more common in those with undescended testes?

Answer 13

Infertility
Testicular cancer
Testicular torsion
Inguinal hernia (may present as acute abdomen)

Question 14

Spigelian versus para-umbilical hernia?

Answer 14

Spigelian hernia = occurs at the border of the rectus sheath = slightly lateral to the umbilicus -> need to be surgical removed as carry high risk of bowel obstruction!

Para-umbilical hernia = slightly above or below the umbilicus

Question 15

Which organism most commonly causes gas gangrene?

Answer 15

Clostridum perfringens

Question 16

Which organism most commonly causes necrotising fascitits?

Answer 16

Group A strep