General Surg

Question 1

What does the use of ‘c’ mean in TNM staging?

Answer 1

Staging performed using clinical methods e.g. examination, imaging, etc.

Question 2

What does the use of ‘p’ mean in TNM staging?

Answer 2

Staging performed by pathologist using resected specimen

Question 3

What does the ‘Y’ symbol mean in TNM staging?

Answer 3

Analysis following cancer treatment (e.g. radio, chemo)

Question 4

What does the ‘R’ symbol mean in TNM staging?

Answer 4

Presence / absence of any residual tumour after treatment

Question 5

Describe difference in RX, R0, R1, R2

Answer 5

RX - residual tumour could not be assessed
R0 - no residual tumour
R1 - microscopic residual tumour
R2 - macroscopic residual tumour

Question 6

Describe each of these:

- Macule, patch, papule, plaque, nodule, tumour vesicle, bulla

Answer 6

See diagram in toronto notes

Question 7

Describe the SCAMDA method of describing a skin lesion

Answer 7

Size
Colour
Arrangement (e.g. annular, linear)
Morphology (primary (e.g. macule, vesicle, etc.) and secondary lesions (e.g. crust, scar))
Distribution (e.g. dermatomal, symmetrical, extensor)
Adjacent structures (hair, nails, MM)

Question 8

What are some indications for catheterisation?

Answer 8

• Relieving obstruction, retention
• Clot retention with gross haematuria
• Bladder irrigation
• Monitoring fluid input and output
• Clear catch, uncontaminated urine sample
• During surgical procedures with spinals
• During epidurals
• Treating incontinence (rare)

Question 9

What are some contraindications for catheterisation?

Answer 9

ABSOLUTE = Known or suspected urethral injury

• Blood at urethral meatus
• Gross haematuria
• Perineal haematoma

RELATIVE = urethral stricture, recent surgery, difficult patient

Question 10

What is the purpose of a FAST scan? What are the indications?

Answer 10

To identify free fluid (usually blood) in the peritoneum, percardium, pleural spaces, identifies pneumothorax
Indications: blunt / penetrating trauma, unexplained hypotension, trauma in pregnancy

Question 11

How would you describe a wound?

Answer 11

Site
Size
Shape
Edges, base
Smooth
Surrounding skin
Pain? Signs of infection

Question 12

What are the different types of melanoma?

Answer 12

1. Superficial spreading (most common 70%)
2. Nodular (15%, papule or nodule)
3. Lentigomaligna (old people)
4. Acral letiginous (fingernails)

Question 13

BCC

Answer 13

Superficial:
'Non-healing scabs'
Think pink/red plaque, scaly
Nodular:
Papules with telangiectasias
Flesh coloured with pearly rolled borders
Sometimes with central ulceration
Very slow growing

Question 14

SCC

Answer 14

Usually occurs on sun-damaged skin
Hyperkeratotic, crusted, indurated, may ulcerate
Erythematous papule or plaque 
'Non-healing scabs'
Grow over time

Question 15

Melanoma

Answer 15

Asymmetrical
Indistinct, variable border
Varied colour - blue/black/grey
Diameter >7mm
Bleeding / crusting
Rapidly growing

Question 16

What is the ABCDEFG method for determining melanoma?

Answer 16

Asymmetry
Borders irregular
Colour
Diameter >6mm - further ix
Elevated
Firm
Growing

Question 17

What are the important risk factors for skin cancer?

Answer 17

Fair skinned and hair and eyes
Lots of freckles
UV radiation (damaged p53) and sun exposure
FHx
Past hx of other skin cancers

Question 18

What margins do you need for SCC, BCC and melanoma removal?

Answer 18

BCC 3-6mm
SCC 4-6mm
2cm for melanoma also deep

Question 19

What investigations do you need to do for skin cancer?

Answer 19

Dermatoscopy
Punch biopsy (abnormal melanocytic proliferation in the epidermis and/or dermis typical of melanoma)
Sentinel node biopsy
CXR, CT, PET, MRI brain (mets)