Corrections 2

Question 1

If the serum or lipase levels are inconclusive and there is a high suspicion of acute pancreatitis, what test should be done next?

Answer 1

CT abdomen with contrast

Question 2

What investigation in acute pancreatitis can give information about possible complications such as pancreatic necrosis or pseudocyst formation?

Answer 2

CT abdomen with contrast

Question 3

What can cause persistent mild elevation of amylase following pancreatitis?

Answer 3

Pseudocysts

Question 4

What is a key systemic complication of acute pancreatitis?

Answer 4

ARDS

Question 5

What timeline separates an acute from a chronic anal fissure?

Answer 5

<6 weeks: acute

> 6 weeks: chronic

Question 6

What is the 1st line treatment for a chronic anal fissure?

Answer 6

Topical GTN

Question 7

When should 2ary care referral be considered in an anal fissure?

Answer 7

If topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery or botulinum toxin

Question 8

Risk of AAA rupture in men vs women?

Answer 8

AAAs are more common in men BUT risk of rupture is higher in women.

Question 9

Does diabetes confer a higher risk of developing a AAA or of it rupturing when diagnosed?

Answer 9

NO - diabetes don’t undergo screening any earlier

Question 10

Gold standard imaging in an AAA?

Answer 10

CT angiogram

Question 11

2 surgical options in elective repair of AAA?

Answer 11

1) open repair

2) elective endovascular repair (EVAR)

Question 12

Is a type A (ascending) or type B (descending) aortic dissection more common?

Answer 12

Type A (2/3)

Question 13

Describe deBakey aortic dissection classification

Answer 13

Type I: originates in ascending aorta and propagates to at least the aortic arch

Type II: originates in and is confined to the ascending aorta

Type III: originates in descending aorta

Question 14

Which classification of aortic dissection is confined to the ascending aorta? (deBakey)

Answer 14

Type II

Question 15

Which classification of aortic dissection originates in the descending aorta? (deBakey)

Answer 15

Type III

Question 16

The location of pain in an aortic dissection depends on the dissection origin.

Location of pain:

a) ascending aortic dissection
b) descending dissection

Answer 16

a) anterior chest pain
b) intrascapular back pain

Question 17

Give some signs that may be seen in aortic dissection that reflect organ malperfusion due to loss of blood flow in the true lumen?

Answer 17

1) Stroke from carotid artery involvement

2) Myocardial infarction from coronary ostia obstruction

3) Paraplegia from spinal artery compromise

4) Mesenteric ischemia leading to abdominal pain

5) Renal failure from renal artery occlusion

Question 18

Investigation of choice in aortic dissection?

Answer 18

CT angiography of the chest, abdomen and pelvis –> false lumen is a key finding

Question 19

Complications of a:

a) backward tear
b) forward tear

in aortic dissection?

Answer 19

a) aortic incompetence/regurgitation, inferior MI (RCA)

b) unequal arm pulses and BP, stroke, renal failure

Question 20

Describe murmur in AS

Answer 20

Harsh systolic crescendo-decrescendo ejection murmur, most prominent at the right second intercostal space and radiating to the carotids.

Question 21

Why can AS result in GI bleeding?

Answer 21

Due to angiodysplasia (Heyde’s syndrome).

Question 22

When does murmur in AS become more prominent?

Answer 22

a) leaning forwards
b) expiration

Question 23

When does murmur in AS become softer?

Answer 23

The more severe the stenosis is

Question 24

What other features may be seen in AS?

Answer 24

1) Slow rising and low volume carotid pulse

2) Narrow pulse pressure

3) Soft or absent second heart sound (S2)

4) Signs of heart failure - pitting lower limb oedema, bilateral basal crackles

5) AS

Question 25

Prior to surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) what 2 investigations are done?

Answer 25

1) Coronary angiogram -> to identify co-existing CAD and conduct concomitant coronary revascularisation if possible 2) TOE --> to assess for endocarditis and mitral valve abnormalities

Question 26

AS mortality rate in symptomatic patients?

Answer 26

25% in 1 year, 50% in 2 years

Question 27

What are the indications for surgical repair in AS?

Answer 27

1) Symptomatic 2) Severe AS: aortic jet velocity ≥4 m/s, mean trans-valvular pressure gradient ≥ 40 mmHg, and aortic valve area ≤1 cm2.

Question 28

What mean trans-valvular pressure gradient indicates severe AS?

Answer 28

≥40mmHg

Question 29

What can be used as a palliative measure for patients in AS?

Answer 29

Percutaneous balloon valvotomy i

Question 30

Complications of AS?

Answer 30

1) HF 2) AF & arrhythmias 3) Sudden cardiac death 4) GI bleeidng 5) Endocarditis

Question 31

Mx of breast abscess: a) <5cm b) >5cm (or those that don't resolve with needle aspiration)

Answer 31

a) needle aspiration b) surgical incision and drainage with washout

Question 32

What abx are indicated in breast abscess?

Answer 32

Oral flucloxacillin

Question 33

Abx in lactational vs non-lactational mastitis?

Answer 33

Lactational: oral flucloxacillin Non-lactational: oral co-amoxiclav

Question 34

Duration of abx in mastitis?

Answer 34

10-14d

Question 35

What are 3 complications related to TPN?

Answer 35

1) sepsis 2) re-feeding syndrome 3) hepatic dysfunction

Question 36

How long after prostatitis or a UTI should a PSA be performed?

Answer 36

Wait 6 weeks

Question 37

How long after urological intervention e.g. prostate biopsy should a PSA be performed?

Answer 37

6 weeks

Question 38

What is the most commonly performed operation for rectal tumours?

Answer 38

Anterior resection (except in lower rectal tumours)

Question 39

Is male or female sterilisation a more effective method of contraception?

Answer 39

Male

Question 40

When is semen analysis typically performed post-vasectomy?

Answer 40

Semen analysis needs to be performed TWICE following a vasectomy before a man can have unprotected sex (usually at 12 weeks)

Question 41

Mx of abdominal wound dehiscence?

Answer 41

1) coverage of wound with saline impregnated gauze 2) IV broad spectrum abx (e.g. ceftrixone & metronidazole)

Question 42

What is the surgery of choice to defunction and decompress the large colon in: a) proximal colon tumours b) distal colon tumours e.g. descending colon

Answer 42

a) loop ileostomy b) loop colostomy

Question 43

Recognised complications of enteral feeding?

Answer 43

1) diarrhoea 2) aspiration 3) hypeglycaemia 4) refeeding syndrome

Question 44

Why is gynaecomastia a common presenting feature of testicular cancer?

Answer 44

2ary to excess hCG or oestrogen

Question 45

Mx of patients with suspected clinically localised prostate cancer?

Answer 45

2ww for multiparametric MRI

Question 46

When should you consider 2ww referral for multiparametric MRI for suspected prostate cancer?

Answer 46

1) If their prostate feels malignant on DRE or 2) Raised PSA

Question 47

When should you consider a PSA?

Answer 47

1) LUTS or 2) Erectile dysfucntion or 3) Visible haematuria

Question 48

What topical anaesthetic is often used in the mx of acute anal fissures?

Answer 48

Lidocaine

Question 49

When is topical GTN typically offered in an anal fissure?

Answer 49

>1 week

Question 50

When is ICP monitoring indicated in head injury?

Answer 50

1) appropriate in those who have GCS 3-8 and normal CT scan 2) mandatory in those who have GCS 3-8 and abnormal CT scan

Question 51

What ethnic group is prostate cancer more common in?

Answer 51

Afro-Caribbean

Question 52

Most common location of colorectal cancers?

Answer 52

Rectum (40%)

Question 53

Inheritance of Lynch syndrome?

Answer 53

Autosomal dominant

Question 54

Inheritance of FAP?

Answer 54

Autosomal dominant

Question 55

Which gene is most commonly involved in Lynch syndrome?

Answer 55

MSH2 (mismatch repair gene)

Question 56

What are the APC genes?

Answer 56

Tumour suppressor genes

Question 57

Describe screening programme for bowel cancer

Answer 57

60-74 yo --> home FIT test every 2 years

Question 58

When should a FIT test be offered?

Answer 58

1) ≥50 with unexplained abdominal pain OR weight loss 2) <60 with changes in their bowel habit OR iron deficiency anaemia 3) ≥60 who have anaemia even in the absence of iron deficiency

Question 59

1st line investigation in suspected bowel cancer?

Answer 59

FIT test If FIT result raised --> 2ww suspected cancer pathway

Question 60

What surgery is typically indicated in HNPCC?

Answer 60

panproctocolectomy

Question 61

What ethnic group are uterine fibroids more common in?

Answer 61

Afro-Caribbean women

Question 62

1st line symptomatic mx of uterine fibroids?

Answer 62

IUS

Question 63

What age does intussusception typically affect?

Answer 63

6m - 3y

Question 64

What type of oesophageal cancer can achalasia predispose to?

Answer 64

Squamous cell

Question 65

What type of oesophageal cancer can diet rich in nitrosamines predispose to?

Answer 65

Squamous cell

Question 66

Indications 2ww referral (for US) in ovarian cancer?

Answer 66

1) ascites 2) pelvic/abdo mass (which is not obviously uterine fibroids)

Question 67

Indications of Ca-125?

Answer 67

Symptoms suggestive of ovarian cancer e.g. bloating, early satiety

Question 68

Risk factors for a perianal abscess? (3)

Answer 68

1) IBD (especially Crohn's) 2) Diabetes 3) Underlying malignancy

Question 69

Gold standard imaging in a perianal abscess?

Answer 69

MRI

Question 70

Mx of a perianal abscess?

Answer 70

1st line --> incision & drainage abx only used if there is systemic upset 2ary to abscess