surgery

Question 1

which hernia is superior and medial to pubic tubercle

Answer 1

inguinal hernia

Question 2

which hernia is below and lateral to the pubic tubercle

Answer 2

femoral hernia

Question 3

mx of neurogenic shock

Answer 3

vasopressors

Question 4

what does double wall sign on AXR mean

Answer 4

free air in abdomen

Question 5

thrombosed haemorrhoid vs external haemorrhoid

Answer 5

thrombosed - anorectal pain and tender lump

external haemorrhoids do not tend to be painful

Question 6

cholecystitis vs cholangitis

Answer 6

cholecystitis = RUQ pain and fever
cholangitis = RUQ pain + fever + jaundice

Question 7

first line mx of haemorrhoids

Answer 7

increase dietary fibre and fluid intake

Question 8

is there jaundice in pancreatitis

Answer 8

no

Question 9

Grey-Turner’s sign vs Cullen’s sign

Answer 9

Grey Turner’s - bruising of flanks

Cullen’s - peri-umbilical bruising

Question 10

what anatomical landmark defines an upper vs a lower GI bleed

Answer 10

ligament of Treitz

Question 11

when should congenital inguinal hernias be operated on

Answer 11

refer immediately
<6 weeks - within 2 days
<6 months - within 2 weeks
<6 years - within 2 months

Question 12

operation for carcinoma of caecum

Answer 12

right hemicolectomy

Question 13

what is the Parkland formula for fluid resus in burns

Answer 13

volume of fluid = total body surface area of burn (%) x weight (kg) x 4 ml

Question 14

best long term enteral feeding route

Answer 14

PEG tube

Question 15

mx of sigmoid volvulus

Answer 15

unruptured - rigid sigmoidoscopy with rectal tube insertion

signs of peritonitis - urgent laparotomy

Question 16

factors indicating severe pancreatitis

Answer 16

age >55
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

Question 17

features of anal fissure

Answer 17

painful, bright red, rectal bleeding

Question 18

when is anterior resection used

Answer 18

upper and mid-rectal tumours

involves removal of the rectum

Question 19

when is abdomino-perineal resection used

Answer 19

removal of cancer at lower one-third of rectum, near anal margin

Question 20

features that point to wards ureteric calculus over pyelonephritis

Answer 20

possibility of dehydration, e.g. D&V before loin to groin pain

Question 21

hydatid cysts found on USS, next ix

Answer 21

CT abdo

Question 22

mx of diverticulitis flares

Answer 22

mild cases - oral ABX at home

if symptoms do not settle within 72h, or severe case, admit to hospital for IV ABX

Question 23

ix for chronic pancreatitis

Answer 23

CT pancreas with IV contrast

Question 24

how to differentiate between Crohn’s and UC on first presentation

Answer 24

Crohn’s - more common at ileocaecal junction and terminal ileum (RIF pain)
UC - starts distally and moves proximally (LIF first), also has bloody diarrhoea

Question 25

mx of acute pancreatitis

Answer 25

fluids and analgesia

Question 26

how to determine between direct and indirect inguinal hernia

Answer 26

after reducing, an indirect inguinal hernia can be controlled by putting pressure over the DEEP inguinal ring

Question 27

biliary complications of IBD

Answer 27

Crohn's - stones | UC - PSC

Question 28

features of proctitis

Answer 28

nocturnal diarrhoea incontinence bright red rectal bleeding it is a finding in UC

Question 29

mx of acute anal fissure

Answer 29

medically first with bulk-forming laxatives and dietary advice topical lubricants, anaesthetics and analgesia should be tried

Question 30

strongest risk factor for anal cancer

Answer 30

HPV infection

Question 31

surgical mx of anal fissues, when is it used

Answer 31

sphincterotomy | used when conservative mx has not worked

Question 32

mx of acute cholecystitis

Answer 32

analgesia IV fluids IV ABX lap chole within *1 week*

Question 33

ix for acute pancreatitis

Answer 33

1. serum amylase and lipase 2. USS lipase will confirm dx of acute pancreatitis, US will confirm cause of pancreatitis 3. CT abdomen

Question 34

gallstones no jaundice, where is the stone

Answer 34

cystic duct | cannot be anywhere that would cause a back up of bile towards the liver

Question 35

which bladder cancer has painless haematuria

Answer 35

transitional cell carcinoma of bladder

Question 36

define isograft, autograft, allograft, xenograft

Answer 36

isograft - identical twin donation autograft - self-donation (e.g. long saphenous vein to be used for CABG) allograft - genetically non-identical donation xenograft - different species donation

Question 37

definitive ix for SBO

Answer 37

abdominal CT | AXR is first line

Question 38

which oesophageal cancer does Barrett's increase risk of

Answer 38

adenocarcinoma

Question 39

hyperechoic liver lesion on USS

Answer 39

haemangioma

Question 40

what are calcium levels in osteomalacia vs osteoporosis

Answer 40

osteomalacia - low | osteoporosis - normal

Question 41

what type of cancer is RCC

Answer 41

adenocarcinoma

Question 42

which inguinal hernia is more common in children

Answer 42

indirect inguinal hernia

Question 43

initial mx of suspected ruptured AAA

Answer 43

immediate vascular review before any imaging, etc.

Question 44

indications for thoracotomy

Answer 44

loss of >1.5 litres blood initially or ongoing losses of >200ml/h for >2h

Question 45

best diagnostic investigation for acute abdominal pain

Answer 45

CT abdomen

Question 46

indications for splenectomy

Answer 46

haemodynamic instability uncontrollable splenic bleeding devascularised spleen

Question 47

sepsis following splenectomy is typically caused by which organism

Answer 47

pneumococcus (encapsulated organisms)

Question 48

ix for acute mesenteric ischaemic

Answer 48

lactate

Question 49

when can sutures or staples on the chest, stomach or back be removed

Answer 49

10-14 days post-op

Question 50

mx ascending cholangitis

Answer 50

emergency decompression of CBD w ERCP then elective cholecystectomy

Question 51

which analgesia is best for post-op analgesia in respiratory disease

Answer 51

epidural because opioids are contraindicated

Question 52

initial ix for acute limb ischaemia

Answer 52

ultrasound doppler

Question 53

complication of giving too much sodium chloride

Answer 53

hyperchloraemiac acidosis

Question 54

indications of poor prognosis in pancreatitis

Answer 54

``` age > 55 years **hypocalcaemia** hyperglycaemia hypoxia neutrophilia elevated LDH and AST ```

Question 55

what may balanitis xerotica obliterates cause

Answer 55

phimosis

Question 56

criteria for AAA surgery

Answer 56

asymptomatic but >5.5cm in diameter - elective surgery asymptomatic but enlarging by >1cm/year - elective surgery symptomatic - urgent surgery

Question 57

mx of symptomatic gallstone disease

Answer 57

laparoscopic cholecystectomy

Question 58

what is Boerhaave's syndrome

Answer 58

spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting

Question 59

ix for Boerhaave's syndrome

Answer 59

CT contrast swallow

Question 60

steps after insertion of NG tube

Answer 60

aspirate before administering any feed or medication if aspirate pH <5.5, safe to use if aspirate pH >5.5, CXR to determine position

Question 61

features of acute cholecystitis

Answer 61

``` constant RUQ pain fever positive Murphey's sign raised inflammatory markers NORMAL LFTs ```