General Surgery

Question 1

Patient presents with unilateral left sided scrotal varicose veins / varicocele. What pathology should be suspected?

Answer 1

Renal cell carcinoma

Question 2

Name the 6 Ds of nipple changes

Answer 2

1. Paget’s Disease
2. Depression
3. Deviation
4. Displacement
5. Discharge
6. Destruction

Question 3

Name the 6 Fs of abdominal distention

Answer 3

1. Fat
2. Flatus
3. Foetus
4. Faeces
5. Fluid
6. Fatal growth eg tumour

Question 4

State Courvoisier’s law

Answer 4

A patient with painless enlarged palpable gallbladder with jaundice is unlikely to be due to gallstones

Question 5

Describe the physiological reason behind Courvoisier’s law

Answer 5

Gallstones will cause chronic inflammation and lead to fibrosis and contraction of the gallbladder, making it non-palpable eventually

Question 6

Boundaries of the anterior triangle of the neck

Answer 6

Superior: Lower angle of the jaw / mandible
Medial: Middle of the neck
Lateral: Anterior border of the SCM

Question 7

Boundaries of the posterior triangle of the neck

Answer 7

Anterior: Posterior border of the SCM
Posterior: Anterior border of the trapezius
Inferior: Middle 1/3 of the clavicle

Question 8

Inguinal ligament landmark

Answer 8

Between the ASIS and pubic tubercle

Question 9

Middle of the inguinal ligament

Answer 9

Midpoint between the ASIS and pubic tubercle

Question 10

Mid-inguinal point

Answer 10

Midpoint between the ASIS and pubic symphysis

Question 11

Boundaries of Hasselbach’s Triangle

Answer 11

Lateral: Inferior epigastric artery
Medial: Rectus abdominis
Inferior: Inguinal ligament

Question 12

Spot Dx: Patient presents with abdominal pain and distension. Auscultation of the abdomen reveals tinkling bowel sounds. Dx?

Answer 12

Bowel obstruction / Mechanical obstruction

Question 13

Name the contents of the spermatic cord

Answer 13

3 Vessels
1. Testicular artery / vein
2. Artery / vein to the vas deferens
3. Cremasteric artery / vein

3 Nerves
1. Genital branch of the genitofemoral nerve
2. Nerve to the cremasteric muscle
3. Sympathetic / Autonomic nerves

3 Others
1. Pampiniform plexus
2. Vas deferens
3. Lymphatics

Question 14

Boundaries of the inguinal canal

Answer 14

MALT (rule of 2)
Superior / Roof (2 Muscles)
1. Internal oblique
2. Transversus abdominis

Anterior (2 Aponeurosis)
1. Internal oblique aponeurosis
2. External oblique aponeurosis

Inferior (2 Ligaments)
1. Inguinal ligament
2. Lacunar ligament

Posterior (2 Ts)
1. Transversalis fascia
2. conjoint Tendon

Question 15

Name the 4 cardinal signs of intestinal obstruction

Answer 15

1. Distension
2. Vomiting
3. Constipation / Obstipation
4. Pain

Question 16

Obstruction of the common hepatic duct caused by a stone impacted in the cystic duct. Diagnosis?

Answer 16

Mirrizi syndrome

Question 17

Acute colonic pseudo-obstruction (ACPO); condition where the large bowel expands without an obstruction. Dx?

Answer 17

Ogilvie syndrome