general surgery q

Question 1

Pancreatic pseudocyst?

Answer 1

1. Manage conservatively initially

2. radiological fine needle aspiration

Question 2

A 75-year-old man is admitted with sudden onset severe generalised abdominal pain, vomiting and a single episode of bloody diarrhoea. On examination he looks unwell and is in uncontrolled atrial fibrillation. Although diffusely tender his abdomen is soft.

Answer 2

mbolic events present with sudden pain and forceful evacuation.
Acute on chronic events usually have a longer history and previous weight loss.
On examination the pain is typically greater than the physical signs would suggest. Arterial pH and lactate
Arterial phase CT scanning is the most sensitive test Immediate laparotomy and resection of affected segments, in acute embolic events SMA embolectomy may be needed.

Question 3

imaging for perforation

Answer 3

erect chest x-ray will demonstrate pneumoperitoneum as air under the diaphragm. A supine chest x-ray will be unable to do this.

Question 4

cryptochordism

Answer 4

1. A congenital undescended testis is one that has failed to reach the bottom of the scrotum by 3 months of age.
2. Orchidopexy at 6- 18 months of age. The operation usually consists of inguinal exploration, mobilisation of the testis and implantation into a dartos pouch.

Question 5

Modified-Glasgow Score

Answer 5

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

Question 6

Infantile umbilical hernia

Answer 6

Symmetrical bulge under the umbilicus
More common in premature and Afro-Caribbean babies
The vast majority resolve without intervention before the age of 4-5 years
Complications are rare

Question 7

haematuria in pregancy

Answer 7

Placenta percreta73%

Pregnancy and frank haematuria, especially if there is a history of placenta previa or prior caesarean section, should indicate this diagnosis. There is invasive placental implantation into the myometrium, which can rarely extend into the bladder causing severe bleeding.

Question 8

51-year-old woman presents with recurrent episodes of epigastric pain radiating through to her back, typically brought on by eating a heavy meal. She drinks around 20 units of alcohol per week. During the current episode she noticed that her sclera were yellow.

Answer 8

Common bile duct stones30%

This is a typical history of common bile duct stones. Patients often complain of epigastric pain rather than the typical right upper quadrant discomfort. This often leads to gallstones being mistaken for dyspepsia.

Question 9

Which anatomical landmark will allow the categorisation of the bleed during urgent endoscopy?

Answer 9

The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the ligament of Treitz

Question 10

A diagnosis of chronic pancreatitis is suspected. Which of the following imaging modalities would be best to confirm this diagnosis?

Answer 10

CT pancreas is the preferred diagnostic test for chronic pancreatitis - looking for pancreatic calcification

Question 11

A 72-year-old woman presents with a 2 day history of colicky abdominal pain and a 24 hour history of vomiting. Her past medical history includes: hypertension, glaucoma, hysterectomy (1992). On examination her abdomen is distended with tinkling bowel sounds.

Answer 11

Given the history of previous intra-abdominal surgery; the most likely diagnosis would be small bowel obstruction secondary to adhesions. Typically patients with small bowel present with vomiting early and absolute constipation late.

Question 12

A 68 year of man presents with recurrent episodes of left sided ureteric colic and haematuria. Investigations show some dilatation of the renal pelvis but the outline is irregular.

Answer 12

transitional cell carcinoma, can occur anywhere along the urinary tract.

Question 13

A 17-year-old male is admitted with lower abdominal discomfort. He has been suffering from intermittent right iliac fossa pain for the past few months. His past medical history includes a negative colonoscopy and gastroscopy for iron deficiency anaemia. The pain is worse after meals. Inflammatory markers are normal.
Crohns disease
The correct answer is: Meckels diverticulum50%

This scenario should raise suspicion for Meckels as these may contain ectopic gastric mucosa which may secrete acid with subsequent bleeding and ulceration.

Answer 13

A Meckel’s diverticulum is a congenital abnormality that is present in about 2% of the population
Typically 2 feet proximal to the ileocaecal valve
May be lined by ectopic gastric mucosal tissue and produce bleeding