PassMed

Question 1

most likely explanation for ongoing pain + jaundice after cholecystectomy?

Answer 1

Gallstones in the common bile duct

Question 2

Most common type of colorectal cancer?

Answer 2

adenocarcinoma

Question 3

Caecol volvulus is associated with…
Toxic megacolon is associated with…

Answer 3

1) previous surgery, Crohn’s
2) UC

Question 4

T or F, amylase level correlates with severity of pancreatitis?

Answer 4

False

though calcium does!

Question 5

Compare an end vs loop stoma?

Answer 5

Loop can be reversed

Question 6

What type of bowel surgery is indicated if there is a malignancy in the ascending colon?

Answer 6

Loop ileostomy

Question 7

What bowel resection in a splenic fixture or descending colon cancer?

Answer 7

Left hemicolectomy

Question 8

hyper vs hypo kalemia on ECG

Answer 8

hyper –> peaked T waves, wide QRS
hypo –> prominent U waves

Question 9

Airway management in followin scenarios:
1) long-term weaning in ICU
2) inguinal repair, day case
3) laparotomy SBO

Answer 9

1) tracheostomy
2) laryngeal mask (don’t need muscle paralysis for this surgery, quick recovery)
3) endotracheal (due to high risk of regurg/vomit)

Question 10

Diabetic preparing for surgery, well-controlled with sulphonylurea (gliclizide). What to do re: diabetic control for surgery?

Answer 10

Withhold morning dose.

If they had poorly controlled diabetes/long as fuck fasting periods, would withhold and change to a variable rate insulin infusion

Question 11

HER-2 positive biologic treatment

Answer 11

Trastuzumab/Herceptin

Question 12

Biologic in peri-anal Crohn’s disease w/ multiple fistalue?

Answer 12

Infliximab

Question 13

T or F Crohn’s patients are susceptiable to haemorrhoids?

Answer 13

No, susceptible to fissures!!!

Question 14

Steatorrhoea in chronic pancreatitis medical management

Answer 14

Pancreatic enzyme supplement to aid with digestion

Question 15

What tumour location –> right hemicolectomy?

Answer 15

Cacum, ascending or hepatic flexure

Question 16

What surgery for tumour in sigmoid colon?

Answer 16

High anterior resection

Question 17

What are the two types of hitaus hernia?

Answer 17

Sliding (95%), the esophagus-stomach junction literally moves up above the diaphragm into thorax

Rolling - a diff part of the stomach goes up

Question 18

What does time out mean in the WHO checklist?

Answer 18

when the patient is anaesthetised before first skin incision, where the team talks about cool secret information

Question 19

What 7 things need to be checked before preceding with operation on the WHO safety checklist?

Answer 19

1) Patient confirms identity, site, procedure and consent
2) Site marked
3) Anaesthesia safety check
4) Pulse oximeter on patient and functioning
5) Known allergies
6) Difficult airway/aspiration risk?
7) Risk of blood loss?

Question 20

Jaundice but normal liver + cholestatic results…

Answer 20

Do a FBC! Could be haemolysis or Giberts syndrome (liver doesn’t process bilirubin)

Question 21

Gold standard for confirming SBO?

Answer 21

CT abdomen

XRAY usually first line - shows dilatation and perforation

Question 22

What is rosvings sign?

Answer 22

pain felt R) when push on L), indicative of appendicitis

Question 23

Script: severe epigastric pain worse leaning forward, vomiting,

Answer 23

pancreatitis

Question 24

T or F: amylase is specific to pancreatitis

Answer 24

False, can rise in small bowel obstruction

Question 25

Treatment for low grade gastric MALT lymphoma

Answer 25

Eradicate H Pylori

Question 26

How do we eradicate H pylori?

Answer 26

Omeprazole, amoxicillin and clarithromycin

Question 27

Critieria for 2 week referral for ?CRC

Answer 27

>40 with weight loss + abdo pain >50 with bleed >60 Fe+ anaemia or change bowel habit All occult blood tests. CONSIDER it in other circumstances (e.g. <50 bleed and weight loss) | FIT test if symptoms and don't reach the criteria

Question 28

Blood features post-splenectomy?

Answer 28

Howell-Jolly bodies inclusions of DNA remants in RBCs usually removed by spleen as 'quality control'. tiny little dots inside cells. | Not pathological

Question 29

How to treat local anaesthetic toxicity? e.g. accidentally put lignocaine in a vessel

Answer 29

20% lipid emulsion

Question 30

How to treat benzo overdose?

Answer 30

Flumazenil | competitive antagonist

Question 31

TAC overdose?

Answer 31

sodium bicarbonate

Question 32

What is a Hartmann's procedure, why is it preferred over a hemicolectomy in an emergency?

Answer 32

Hartmann's involves removing bad bowel and forming a stoma, stitch the rectum shut totally. Can be reversed later by stitching them back together. Better in an emergency due to not needing an anastomosis

Question 33

Where are diverticula most common?

Answer 33

Sigmoid colon

Question 34

How does diverticular disease present?

Answer 34

change in bowel habit, rectal bleeding, abdo pain. mimics malignancy! --> colonoscopy

Question 35

What common medication can cause slower fracture healing?

Answer 35

NSAIDs

Question 36

Risk factors for pigment gallstones?

Answer 36

Cirrhosis, haemolysis (e.g. sickle cell anaemia), biliary stasis

Question 37

What medication must be given before an appendicectomy?

Answer 37

Prophylactic antibiotics

Question 38

What does diverticulitis look like on a CT?

Answer 38

mural thickening of the colon and presence of pericolon fat stranding | e.g. bleed, low grade fever, pain

Question 39

lifestyle - How to treat diverticular disease?

Answer 39

Increase fruit + vege (fibre)!

Question 40

Where does UC begin?

Answer 40

the rectum

Question 41

Where is Crohn's most commonly found?

Answer 41

terminal ileum

Question 42

Chronic pancreatitis is associated with ____ and should be monitored _______

Answer 42

diabetes! annual Hba1c

Question 43

What is the general advice around COCP for surgery?

Answer 43

Stop taking 4 weeks in advance due to thromboembolism risk

Question 44

Are the following safe for surgery: 1) beta blockers 2) amlodipine 3) levothyroxine

Answer 44

Yes all are safe to take on the day of surgery.

Question 45

What is the difference between a strangulated and incarcerated hernia?

Answer 45

Incarcerated = cant reduce, but not painful Strangulated = cant reduce + very painful

Question 46

How to differentiate between acute cholecystitis and ascending cholangitis?

Answer 46

Very similar presentation - both have RUQ pain, fever, raised inflammatory markers. HOWEVER, ascending cholangitis more likely to have ABNORMAL LIVER TESTS. - think about the anatomy :)

Question 47

Abdominal pain, bloating and vomiting following bowel surgery?

Answer 47

Post op ileus | + presents with electrolytes