Gen Surg

Question 1

Rx of haemorrhoids

Answer 1

hot baths
anusol
avoid constipaton - high fibre diet, hydration
band ligation
haemarrhoidectomy/artery ligation

Question 2

RF for diverticulosis

Answer 2

NSAIDs, older age, low fibre diet, obesity

Question 3

Presentation of diverticulitis

Answer 3

Pain and tenderness in the left iliac fossa / lower left abdomen
Fever
Diarrhoea
Nausea and vomiting
Rectal bleeding
Palpable abdominal mass (if an abscess has formed)
Raised inflammatory markers (e.g., CRP) and white blood cells

Question 4

Rx of diverticulitis

Answer 4

co amoxicillin for 5 days
analgesia (avoid NSAIDs and opiates)
avoid solid food until improved (2-3 days later)

Question 5

rx of diverticulitis if acute abdomen

Answer 5

Nil by mouth or clear fluids only
IV antibiotics
IV fluids
Analgesia
Urgent investigations (e.g., CT scan)
Urgent surgery may be required for complications

Question 6

complications of diverticulitis

Answer 6

perforation and peritonitis
abscess
large haemorrhage
fistula
ileus or obstruction

Question 7

Presentation of acute cholecystitis

Answer 7

fever
RUQ
positive Murphys sign

Question 8

ix of choice of acute cholecystitis

Answer 8

USS

Question 9

Presentation of ascending cholangitis

Answer 9

fever, RUQ pain, jaundice (charcots triad)

Question 10

Ix and Rx of ascending cholangitis

Answer 10

Ix - USS
Rx - IV abx. ERCP after 24-48hrs to relieve any obstruction

Question 11

rx of acute cholecystitis

Answer 11

IV abx
Lap Cholecystectomy within 1 week

Question 12

Rx of acute pancreatitis

Answer 12

fluid resus - can have large 3rd space losses. Aggressive fluid resus, Aim for urine output >0.5ml/kg
maintain nutrition
analgesia

Question 13

RF for biliary colic

Answer 13

Female
Fat
Forty
Fertile (pregnancy rf)

Question 14

Presentation of biliary colic

Answer 14

RUQ pain, worse with fatty foods
n+v

No fever or deranged LFTS!

Question 15

Rx of biliary colic/ gallstones

Answer 15

elective lap chole

Question 16

pathophys of appendicitis

Answer 16

lymphoid hyperplasia or a faecolith → obstruction of appendiceal lumen → gut organisms invading the appendix wall → oedema, ischaemia +/- perforation

Question 17

Features of acute appendicitis

Answer 17

periumbilical pain radiating to RIF
may vomit
Mild pyrexia - high temp would indicate mesenteric adenitis

Question 18

Examination signs in acute appendicitis

Answer 18

Rovsings - palpation in the LIF causes pain in the RIF
Rebound tenderness

Question 19

rx of appendicitis

Answer 19

appendicectomy and abx
if perfed - abdominal lavage

Question 20

ix in appendicitis

Answer 20

typically raised CRP and WBC combined with clinical hx are enough to diagnose

Question 21

femoral vs inguinal hernias

Answer 21

femoral - less common, more common in women than men, more likely to strangulate. Located inferolateral to pubic tubercle

inguinal - most common, more common in men, less likely to strangulate. Indirect and direct. Located superomedial to pubic tubercle

Question 22

ddx for hernias

Answer 22

Lymphadenopathy
Abscess
Femoral artery aneurysm
Hydrocoele or varicocele in males
Lipoma
Femoral vs Inguinal hernia

Question 23

presentation of strangulated hernia

Answer 23

pain and tender, systemically unwell, irreducible

Question 24

rx of femoral hernias

Answer 24

surgery bc of high risk of strangulation

Question 25

RF for hernias

Answer 25

obesity, increasing age surgical wounds

Question 26

complications of TPN

Answer 26

referring syndrome infection thrombophlebitis (if used a peripheral vein but usually put centrally)

Question 27

definition of volvus

Answer 27

torsion of the colon around its mesenteric axis

Question 28

rf for sigmoid volvulus

Answer 28

older chronic constipation parkinsons

Question 29

rf for PUD

Answer 29

HPylori NSAIDs Steroids Bisphopshonates SSRIs

Question 30

H Pylori triple therapy

Answer 30

PPI + amoxicillin + metro or clarithro if pen allergic - PI, metro and clarithro

Question 31

indications for upper GI endoscopy

Answer 31

age > 55 years symptoms > 4 weeks or persistent symptoms despite treatment dysphagia relapsing symptoms weight loss

Question 32

ddx for dysphagia

Answer 32

oesophageal ca oesophagitis myasthenia graves pharyngeal pouch achalasia