Surgery

Question 1

How can you prevent renal failure during surgery?

Answer 1

Pre-op - ensure good hydration, stop nephrotoxic drugs (NSAIDs + ACE-I)
During - avoid intra-op hypotension

Question 2

How do you treat paralytic ileus?

Answer 2

Rx: NG tube and hydration management with fluids - reduce opioids and encourage early mobility

Question 3

what are the complications of post of N&V

Answer 3

Complications: bleeding, incisional hernias, aspiration pneumonia (+ hypokalaemia)

Question 4

What are the complications of PUD?

Answer 4

Acute upper GI bleeding
Iron deficiency anaemia
Perforation
Gastric outlet obstruction due to chronic scarring

Question 5

What is the definitive treatment for bleeding oesophageal varices?

Answer 5

Endoscopy - coagulation or banding/clipping

Terlipressin

Question 6

What signs might you see in acute appendicitis?

Answer 6

Fever + tachycardia
Abdominal tenderness - maximal over McBurneys point (peritonism suggests perforation)
Rovsings sign +ve
Psoas sign and cope sign

Question 7

Describe the following signs

a) Rovsing’s sign
b) Psoas
3) Cope

Answer 7

a) Rovsing’s sign = pressing over the LIF gives more pain in the RIF
b) Psoas = pain when extending the hip
3) Cope = pain when flexing and internally rotating the hip

Question 8

Anatomically where is McBurneys point?

Answer 8

1/3rd the way from ASIS to umilicus