General Surgery

Question 1

Incision for open cholecystectomy

Answer 1

Kocher

Question 2

McBurney’s Point

Answer 2

1/3 from ASIS to umbilicus

Question 3

McBurney’s incision

Answer 3

Appendectomy through McBurney’s Point

Question 4

Rocky-Davis incision

Answer 4

Like a McBurney’s but transverse

Question 5

Incision for obstetric procedures

Answer 5

Pfannenstiel

Question 6

Incision for removing lung lobe/ lesion

Answer 6

Thoracotomy

Question 7

Incision down anterior border of SCM

Answer 7

carotid endarterctomy

Question 8

When can patients eat/ drink before surgery?

Answer 8

6 hours no food

Clear fluids until 2 hours before

Question 9

What inhibits wound healing?

Answer 9

Infection, ischaemia, DM, malnutrition, anaemia, steriods, cancer, radiation, smoking

Question 10

Is DVT more common in R or L iliac vein?

Answer 10

L more common - aortic bifurcation crosses/ compresses L iliac vein

Question 11

Homan’s sign?

Answer 11

Calf pain with dorsiflexion of foot: seen in third of patients with DVT

Question 12

Order of recovery of bowel function post-op

Answer 12

Small bowel > stomach > colon

Question 13

What is blind loop syndrome?

Answer 13

Bacterial overgrowth in small intestine

Question 14

What is dumping syndrome?

Answer 14

Delivery of hyperosmotic chyme to small intestine causing massive fluid shifts into the bowel
any procedure that bypasses pylorus

Contact nutrition: need high protein meals, low liquid

Question 15

Signs of dumping syndrome

Answer 15

Postprandial diaphoresis
Tachycardia
Abdo pain/ distention
Emesis
Increased flatus etc

Question 16

Causes of post-op hypotension

Answer 16

Hypovolaemia (iatrogenic, haemorrhage)
Sepsis
MI/ other cardiac reasons
Pneumothorax
PE
Cardiac tamponade
Medications, eg morphine

Question 17

Causes of post-op hypertension

Answer 17

Pain (from catecholamine release)
Anxiety
Hypercapnia
Hypoxia
Bladder distension

Question 18

Post-op tachycardia

Answer 18

Hypovolaemia/ third-spacing
Pain
Alcohol withdrawal
Anxiety/ agitation
Urinary retention
Cardiac causes

Question 19

When do post-op infections arise?

Answer 19

Typically post-op days 5 to 7

Question 20

Mx post-op infection

Answer 20

Remove sutures/ staples. Rule out dehiscence. Pack wound, open - wound culture + abx

Question 21

Which bacteria cause fever and wound infection within 24h op

Answer 21

Streptococcus

Clostridium (brown-bronze weeping tender wound)

Question 22

Complications of wound infection

Answer 22

Fistulae, sepsis, abscess, suppressed wound healing, superinfection

Question 23

What factors influence development of infections

Answer 23

Foreign body (eg sutures)
Decreased blood flow
Long ops
Poor approximation of tissues etc

Question 24

What is suppurative hidradenitis?

Answer 24

Infection/ abscess formation in an apocrine sweat gland

Question 25

Classic Ws of post-op fever

Answer 25

``` Wind (atelectasis): 1-2 days post-op Water (UTI): 3 days post-op Wound (infection): 5 days post-op Walking (DVT): 7 days post-op Wonder drugs (Drug fever) ```

Question 26

How to differentiate SBO and ileus on imaging?

Answer 26

In SBO there is a cut-off. Ileus = diffusely dilated

Question 27

What are sentinel loops on imaging?

Answer 27

Distension or air-fluid levels near a site of abdo inflammation

Question 28

What does loss of psoas shadow indicate?

Answer 28

Ascites or inflammation

Question 29

How long after a laparotomy is there free air under diaphragm?

Answer 29

Up to 7 days

Question 30

Adjuvant RX vs neoadjuvant rx

Answer 30

Therapy to aid/ assist surgical treatment | NEO = given before (eg pre-op chemo)

Question 31

Incidence of hernias

Answer 31

5-10% lifetime risk 50% are indirect 25% are direct 5% femoral

Question 32

What happens if you cut the inguinal nerve?

Answer 32

Numbness of inner thigh/ lateral scrotum | usually goes away in 6 months

Question 33

What gas is used in laproscopy?

Answer 33

CO2 | less combutible - better solubility in blood (less risk of gas embolus)

Question 34

Anatomical point of UGI and LGI bleed

Answer 34

Ligament of Trietz: post duodenum

Question 35

What tumours can produce carcinoid sx?

Answer 35

Liver mets | and some others

Question 36

Risk factors for acute acalculous cholecystitis

Answer 36

``` Prolonged fasting TPN Trauma Multiple transfusions Dehydration Prolonged post op/ ICU settings ```

Question 37

Cholangitis vs cholecystitis

Answer 37

Carcot's triad: fever, RUQ pain, jaundice versus RUQ pain. Murphy's positive

Question 38

What is gallstone ileus?

Answer 38

SBO caused by large gallstone