emergency presentations

Question 1

stop warfarin how many days before surgery

Answer 1

6

Question 2

low INR means what

Answer 2

blood is clotting too quickly

Question 3

what can be given in addition to vit K if surgery cannot be delayed

Answer 3

dried prothrombin complex

Question 4

what drugs are P2Y12 inhibitors

Answer 4

clopidogrel/prasugrel

Question 5

during periods of stress eg illness or surgery the body’s requirement for cotriosteriods

Answer 5

Increases

Question 6

when should ace/arbs be stopped before surgery

Answer 6

24hrs

Question 7

methylene blue is used to do what in parathyroid surgery

Answer 7

identify gland

Question 8

pheochromocytoma surgery will need what

Answer 8

alpha and beta blockers

Question 9

surgery for carcinoid tumours will need covering with

Answer 9

ocretotide

Question 10

generally speaking for moderate to severe surgery where pt been on long term steroids switch from oral steroids to

Answer 10

IV hydrocortisone

Question 11

do not use adrenaline or monopoly diathermy in areas where there is

Answer 11

end arteries

Question 12

what artery is a favourite target for laparoscopic ports and surgical drains

Answer 12

inferior epigastric artery

Question 13

posterior triangle lymph node biopsy can damage

Answer 13

accessory nerve

Question 14

what nerve may be damaged in axillary node clearance

Answer 14

long thoracic

Question 15

nerve at risk during thyroid surgery

Answer 15

recurrent laryngeal

Question 16

nerve at risk during carotid endarterectomy

Answer 16

hypoglossal

Question 17

use of verres needle to establish pneumoperitoneum can cause

Answer 17

bowel perforation

Question 18

failure to delineate clots triangle can damage

Answer 18

bile duct

Question 19

parotidectomy can damage

Answer 19

facial nerve

Question 20

ligating splenic hilum can damage

Answer 20

tail of pancreas

Question 21

arrhythmia following cardiac surgery may be due to

Answer 21

hypokalaemia

Question 22

following cranial surgery

Answer 22

SIADH causing hyponatraemia

Question 23

post pneumonectomy

Answer 23

pulmonary oedema

Question 24

anastomotic leaks can cause generalised sepsis causing

Answer 24

mediastinitis or peritonitis

Question 25

what test to do if ureteric injury suspected

Answer 25

sending peritoneal fluid for U+E

Question 26

what scan if pericardial effusion suspected post cardiac surgery

Answer 26

echo

Question 27

what is a contadinidcation to thrombolysis

Answer 27

recent surgery

Question 28

why might heparin be preferable to LMWH

Answer 28

easier to reverse

Question 29

the 4 T's of PPH

Answer 29

tone, trauma, tissue, thrombin

Question 30

lying a woman flat in PPD as it

Answer 30

maximises blood return

Question 31

why is warmed crystalloid given in PPH

Answer 31

reduce risk of hypothermia

Question 32

1.2.3 medical mx for PPH

Answer 32

oxytocin, ergometrine then carboprost

Question 33

secondary PPH is typically due to

Answer 33

retained placental tissue or endometritis

Question 34

around d90% of anal fissures occur in the

Answer 34

posterior midline

Question 35

if anal fissures not found in posterior midlein should

Answer 35

consider underlying dx eg crohns

Question 36

first line laxative for fissure

Answer 36

bulk forming

Question 37

first line treatment for a chronic anal fissure

Answer 37

topical GTN

Question 38

surgery that can be done for chronic anal fissure

Answer 38

sphincterotomy

Question 39

intermittent cramps abdo pain that infant may draw their knees up and turn pale

Answer 39

intussusception

Question 40

ix of choice for intussusception

Answer 40

US

Question 41

first line for intussusception

Answer 41

reduction by air

Question 42

bowel invaginate or telescopes

Answer 42

intussusception

Question 43

red currant jelly stools may be seen in

Answer 43

intussusception

Question 44

sausage shape mass in abdomen

Answer 44

intussusception

Question 45

bright red painful bleeding that occurs post poo

Answer 45

fissure in ano

Question 46

do haemorrhoids cause pain

Answer 46

no

Question 47

all those with rectal bleeding need

Answer 47

rectal exam & sigmoidoscopy

Question 48

may want to defer rectal exam if thinking

Answer 48

fissure

Question 49

mx of fissure in any

Answer 49

GTN ointment or diltiazem cream

Question 50

mx of haemorrhoids

Answer 50

internal 0 injection sclerotherapy or rubber band ligation external - haemorrhoidectomy

Question 51

most common cause of scrotal swelling in primary care

Answer 51

epididymal cyst s

Question 52

varioceles are much more common on what side

Answer 52

left

Question 53

varioceles are associated with

Answer 53

infertility

Question 54

testicular tumour do what ix

Answer 54

US and serum AFP and B-hcg

Question 55

tender selling with dysuria and discharge

Answer 55

epididymis-orchitis

Question 56

what can be a presenting feature of testicular cancer in young men

Answer 56

hydrocele

Question 57

what should also happen in surgery for testicular torsion

Answer 57

the contralateral testis should also be fixed

Question 58

what might be the presenting feature of renal cell carcinoma

Answer 58

varicocele

Question 59

infertile men are 3 times more likely to develop

Answer 59

testicualr cancer

Question 60

what unusual symptom can be seen in testicular cancer

Answer 60

gynaecomastia

Question 61

most common type of testicular cancer

Answer 61

seminoma

Question 62

what tumour marker is normal in seminoma

Answer 62

AFP

Question 63

what presents at a younger age seminoma or non seminoma

Answer 63

non

Question 64

what drug is recognised for causing epidymitis

Answer 64

amiodarone

Question 65

Tenderness is usually confined to the epididymis, which may facilitate differentiating it from torsion where pain usually affects the entire testis.

Question 66

features of torsion of appendix testis or appendix epididymis

Answer 66

blue dot sign

Question 67

what is the biggest rf for suicide

Answer 67

being male ( more so than history of self harm)

Question 68

what fluids should be given in sepsis

Answer 68

500ml of crystalloid over less than 15 mins

Question 69

SOFA can be used for

Answer 69

identify sepsis

Question 70

different types of shock

Answer 70

septic, haemorrhage, neurogenic, cariogenic and anaphylactic

Question 71

Sepsis is defined as an infection that triggers a particular Systemic Inflammatory Response Syndrome (SIRS). This is characterised by body temperature outside 36 oC - 38 o C, HR >90 beats/min, respiratory rate >20/min, WBC count >12,000/mm3 or < 4,000/mm3.

Answer 71

Patients with infections and two or more elements of SIRS meet the diagnostic criteria for sepsis. Those with organ failure have severe sepsis and those with refractory hypotension -septic shock.

Question 72

average blood volume is

Answer 72

7% of body weight

Question 73

When assessing trauma patients it is worth remembering that in order to generate a palpable femoral pulse an arterial pressure of >65mmHg is required.