PassMed Qs Flashcards by Charley Frew

What is the best option for long term feeding?

PEG tube feeding
(Feeding jejunostomy requires general anaesthetic)

How well did you know this?

Not at all

Perfectly

What medications should a patient with PAD be put on?

Clopidogrel (anti platelet)
Atorvastatin

How well did you know this?

Not at all

Perfectly

What procedure is used to cure UC without needing a stoma?

Panproctocolectomy and ileoanal pouch

How well did you know this?

Not at all

Perfectly

What is a FAST scan used for?

Focused Assessment with Sonography for Trauma

Looks for free fluid present in abdomen or thorax

How well did you know this?

Not at all

Perfectly

What is the best way to differentiate between biliary colic and acute cholecystitis?

Patients with acute cholecystitis will be systemically unwell

Fever
Tachycardia
Tachypnoea

How well did you know this?

Not at all

Perfectly

What to do with a baby presenting with a hydrocele?

Communication hydroceles are common in babies
Surgical Repair if it doesn’t repair in 1-2 years

How well did you know this?

Not at all

Perfectly

What is the end result with a Hartmann’s procedure?

End Colostomy

How well did you know this?

Not at all

Perfectly

What can a UTI increase the risk of?

Acute Urinary Retention

How well did you know this?

Not at all

Perfectly

What conditions can predispose you to having gallstones?

Chron’s
Diabetes

How well did you know this?

Not at all

Perfectly

What procedure would you perform for a mid-rectal tumour?

Anterior Resection

How well did you know this?

Not at all

Perfectly

What is the diagnosis for a patient with a widened mediastinum and persistent hypotension despite been giving multiple fluids?

Aortic Rupture

How well did you know this?

Not at all

Perfectly

What is the next step in management when you suspect appendicitis?

IV prophylactic abx before appendicectomy

How well did you know this?

Not at all

Perfectly

What is the benefit of epidural anaesthesia post colorectal surgery?

Faster return of normal bowel function

How well did you know this?

Not at all

Perfectly

What tests for females with RIF pain?

Pregnancy
USS abdomen (appendicitis)

How well did you know this?

Not at all

Perfectly

What score of ABPI would indicate the need for angioplasty?

<0.5 (critical limb ischaemia)

How well did you know this?

Not at all

Perfectly

When can you not use laparoscopic technique rather than open surgery?

Acute intestinal obstruction as increases risk of perforation

How well did you know this?

Not at all

Perfectly

What is the first test needed when a male patient presents with Erectile Dysfunction?

Serum Testosterone

How well did you know this?

Not at all

Perfectly

What is the management for acute pancreatitis and what should you not give?

IV fluids
IV Opioids
Oxygen (if hypoxic)

NEVER ABX

How well did you know this?

Not at all

Perfectly

What type of testicular tumour has normal AFP and HCG levels?

Seminoma

How well did you know this?

Not at all

Perfectly

Why may a patient that has had a laparoscopic cholecystectomy present to you weeks later with RUQ pain and jaundice?

Gallstones present in the common bile duct

How well did you know this?

Not at all

Perfectly

A man presents to you with a fever, right sided abdominal tenderness during a DRE. What is your diagnosis?

Appendicitis

How well did you know this?

Not at all

Perfectly

How would you manage sigmoid volvulus?

How would this differ if a patient is showing signs of peritonism?

Therapeutic flexible sigmoidoscopy with flatuence tube

Go straight to urgent laparotomy

How well did you know this?

Not at all

Perfectly

What drug can increase the risk of pancreatitis?

Sodium Valproate

How well did you know this?

Not at all

Perfectly

What would blood tests show on biliary colic?

Normal ALP/GgT
Normal AST + ALT
Normal CRP

How well did you know this?

Not at all

Perfectly

What markers in the blood would indicate pancreatitis severity?

Hypocalcaemia (below 2) Low oxygen (below 7?)

What site is the most common for ischaemic colitis?

Splenic flexure

What is the screening programme for AAA?

Single USS at 65 years old

What screening is required for suspected prostate cancer?

1. Multiparametric MRI Transrectal USS guided biopsy second line

What is the management for superficial thrombophlebitis?

Compression Stockings NSAIDs

What drug can be given for chronic renal stones/hypercalcaemia?

Bendroflumethiazide (increase Ca excretion)

What is the mechanism of tamsulosin?

Alpha-1 antagonist Relaxes smooth muscle of prostate and bladder

What are some side effects of tamsulosin?

Dizzines Postural Hypotension

CT kidney shows a mass with a cystic centre. What is the likely diagnosis?

Renal Adenocarcinoma

What else is needed when doing a wide local excision for breast cancer?

Sentinel Node biopsy Whole breast radiotherapy

A 27 year old woman presents to you in GP with a breast lump, what do you do?

Non urgent referral to breast clinic if under 30§

What is the first line treatment for cyclical mastalgia?

Supportive bra and analgesia (paracetamol)

A 76 year old female presents to you with a fragility fracture. What is the next steps of management?

Start alendrotnic acid if over 75 years following a fragility fracture while awaiting a DEXA scan

What are the causes for raised Prolactin?

Pregnancy Pyhsiological Prolactinoma Polycystic ovary syndrome Primary hypothyroidism Phenothiazines, metocloPramide, domPeridone

What medications should be held in a C Diff infection?

Opioids Increase risk of toxic megacolon

What cancer can Primary Sclerosing Cholangitis increase the risk of?

Cholangiocarcinoma

What is the most common microorganism in central line infections?

Staph epidermidis

What is the first line investigation for chron's patients with perianal fistulae?

MRI Pelvis

What are the surgical indications for UC patients?

Severe flares failing to respond to medical therapy Flare causing perforation/dilatation Chronic continuous disease causing impaired QoL Cancer

What are the surgical indications for Chron's patients?

Obstruction Severe perianal disease unresponsive to medical therapy Major bleeds Severe disability

What is the first line investigation for acute mesenteric ischaemia and what will it show?

Serum Lactate will be raised

How will a Proximal aortic dissection present? How may it appear on ECG?

Central tearing chest pain Aortic Regurgitation murmur ST elevation in II, III, aVF

What is the investigation for suspected aortic dissection?

CT Aortic Angiogram

Would normal libido indicate an organic or inorganic cause for erectile dysfunction?

Organic (Vascular or neurogenic cause)

How would a uric acid renal stone present?

Radioluscent (may not appear on CT) Recent chemo can increase urate levels

How does a cysteine renal stone present?

Radiodense on CT Family Hx

How does a struvite renal stone present?

Staghorn calculus

What are the risk factors for an emboli causing acute limb ischaemia?

AF Recent MI

What is the mechanism of action of goserelin?

GnRH agonist

How does chronic pancreatitis presents and what is its management?

Chronic back pain relived by leaning forward and worse after eating Analgesia and Creon

When would you use EVAR as oppose to bypass surgery?

Bypass for >10cm stenosis EVAR for less

In what conditions can Amylase increase?

Pancreatitis SBO

What imaging is required for suspected appendicitis?

NOTHING Clinical diagnosis only

How do you manage wound dehiscence?

Cover with saline soaked gauze and broad spectrum IV abx

What would be the difference between FAP and Lynch syndrome causing cancer on colonoscopy?

Lynch syndrome: Tumour of colon but rest of colonic mucosa normal FAP: Tumour of colon and rest of mucosa has polyps

Testicular swelling with mumps and testicular sweeping after cystoscopy. Which ones which?

Mumps - orchitis Cystoscopy - Epididymo-orchitis

A 68-year-old man is found to have a tumour 1cm from the anal sphincter. What operation should she have?

Abdomino-perineal excision of the colon and rectum

A 64-year-old lady is found to have a rectal tumour. What operation should she have?

Anterior resection

A patient presents to you in GP with asymptomatic inguinal hernia, what should you do?

Routine referral for surgical repair

How does a common bile duct stone present?

Epigastric pain radiating to back, worse on eating (misdiagnosed as peptic ulcer)

Obstructive jaundice and palpable smooth mass in RUQ?

Head of pancreas Ca (Courvoisier's law)

How do you manage a diverticular flare? (abdo pain, fever, blood in stool)

Send home with oral abx If doesn't improve within 3 days A&E for IV abx

What is a benefit of circumcision?

Reduces HIV transmission in heterosexual men

Main difference between colostomy and ileostomy?

Colostomy - flush to skin Ileostomy - spouted

Which nerve is at risk with a THR?

Sciatic

A patient presents with acute-onset loin-to-groin pain and fever. What is your next step?

Patients with obstructive urinary calculi and signs of infection require urgent renal decompression and IV antibiotics due to the risk of sepsis

What drug should you give before goserlin and why?

Flutamide Reduces the flare effect' (initial increase in luteinizing hormone production prior to receptor down-regulation)

How does diverticular disease present? How does appear it on CT? What is the best conservative management?

Persistant diarrhoea Diffuse abdo pain Blood in stool Mural thickening and the presence of pericolic fat stranding in the sigmoid colon Increase fruit and veg

What is the management of a diverticular stricture?

Laparotomy (flexi sigmoidoscopy is for volvulus)

Claudication pain in hip or calf, which artery is stenosed in each?

Hip - Iliac Calf - femoral

A 65-year-old man with a history of dyspepsia is found to have a gastric MALT lymphoma on biopsy. What treatment should be offered?

eradicate H. pylori

What condition would you see pigmented gallstones?

hemolytic anemia (sickle cell) liver cirrhosis

A boy presents with priapism (prolonged erection) what is the next investigation you should request?

Cavernosal blood gas analysis (differentiates from ischaemic and non-ischaemic priapism)

What side are varicoceles more common on?

Left side

A patient with ascending cholangitis has dilated hepatic ducts, what do you do?

ERCP and stent Laparoscopic cholecystectomy later

What is the first choice investigation for boerhave's?

CT Contrast Swallow

What is the most common form of prostate cancer?

Adenocarcinoma

What is a major risk factor for prostate radiotherapy?

increased risk of bladder, colon, and rectal cancer

What drug can be given if stress incontinence doesn't respond to pelvic floor training exercises?

Duloxetine

What IV drugs do you give in a diverticular flare?

IV ceftriaxone + metronidazole

How does cancer in Lynch syndrome present?

right sided colonic cancers (caecum) occur at a young age

What's a complication of gastrectomy?

vitamin B12 deficiency can cause degeneration of the spine

What is the management for acute cholecystitis?

Analgesia and intravenous fluids intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis

What is the management for acute mesenteric ischaemia? How may it present?

AF High lactate Sudden onset abdo pain Septic (fever, HR^...) Laparatomy

What should be the normal post-void in cathereterisation of a patient >65yrs patient?

<50 ml (500mls+ is chronic urinary retention) (800mls+ is acute on chronic)

How should you treat a baby with a congenital inguinal hernia?

Refer for surgery (don't wait)

How do you manage a pancreatic pseudocyst?

Conservatively initially

How does Meckel's diverticulum present?

Intermittent RIF pain Iron deficiency anaemia Pain worse after meals

Infection with which microorganism is likely to cause staghorn calculi?

Proteus mirabilis (urease producing)

How do type A and B aortic dissection differ?

Type A: Ascending aorta Radial-radial delay False lumen on imaging Type B: Descending aorta Radio-femoral delay

PassMed Qs Flashcards

(94 cards)