surgery

Question 1

useful test of exocrine function in chronic pancreatits

Answer 1

faecal elastase

Question 2

treating hyperkalemia?

Answer 2

Calcium gluconate is the first step in the management of severe hyperkalaemia as it stabilises the cardiac membrane and reduces the risk of ventricular fibrillation.

insulin and 10% dextrose

Question 3

testicular torsion, presence of a bell clapper deformity.

mx?

Answer 3

Testicular torsion surgery should involve fixation of both testes to prevent torsion of the other testes

Question 4

awaiting bowel surgery but had a perf. what procedure would be best at this point?

Answer 4

Hartmann’s procedure is often an emergency operation to remove an obstruction, persistent infection

Question 5

Acute pancreatitis: causes

Answer 5

zathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

Question 5

Acute pancreatitis: causes

Answer 5

zathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

Question 6

overweight lady, breast lump, decresing in size, played rugby but no truma, lump is poorly mobile

what is it?

Answer 6

Fat necrosis of the breast

Traumatic breast fat necrosis can occur after unnoticed injury

Question 7

presentation of extradural (epidural) haematoma vs subdural?

Artery involved in both?

Answer 7

extradural: middle meningeal artery!!

Question 8

Subarachnoid haemorrhage vs Intracerebral haematoma?

r/f?

Answer 8

Question 9

4cm fibroadenoma, mx?

Answer 9

Breast fibroadenoma: surgical excision is usual if >3cm

Question 10

base of skull fracture 3 components

Answer 10

Bleeding from ruptured vessels can leak into the middle ear (haemotympanum) or mastoid area (Battle’s sign), while ruptured CSF spaces may cause fluid to leak into the nose or auditory canal (CSF rhinorrhoea and otorrhoea).

Question 11

Sudden onset sensorineural hearing loss
mx?

Answer 11

should be referred (within 24 hours) to ENT, for investigation and consideration of steroid therapy

Question 12

Aromatase inhibitors (e.g. anastrozole) vs SERM may cause

Answer 12

osteoporosis, DEXA scan, hot flushes
arthralgia, myalgia insomnia

Question 13

Bilious vomiting in neonates

Duodenal atresia VS Malrotation with volvulus VS Meconium ileus

Answer 13

Question 14

Suspected epididymo-orchitis: TX?

Answer 14

ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days

Question 15

Surgical op inolving the rectum, what is the procedure?

Answer 15

Question 16

most common type of breast cancer

Answer 16

Invasive ductal carcinoma (no special type)

Question 17

A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.

Answer 17

Fibroadenosis

Question 18

A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.

Answer 18

Fibroadenoma

like mice

Question 19

abdominal aortic aneurysm. screening?

Answer 19

Single abdominal ultrasound at 65

Question 20

40-year-old female patient

father has recently been diagnosed with breast cancer.

advise?

Answer 20

Paternal family history of breast cancer - secondary care referral

Question 21

breast screening age and frequency?

Answer 21

50-70 years
every 3 years

Question 22

anal fissure mx?

Answer 22

less then 1 week- bulk forming stools

topical steroids

Question 23

Ascending cholangitis features?

Answer 23

Charcot’s cholangitis triad: fever, jaundice and right upper quadrant pain

Question 24

79-year-old man some blood in his stools, suspicious mass on the anal sphincter. management plans?

Answer 24

Rectal cancer on the anal verge → Abdomino-perineal excision of rectum

Question 25

most common cause of small bowel obstruction first-line imaging for suspected small bowel obstruction

Answer 25

Adhesions Abdominal x-ray

Question 26

How should his metformin vs sulfa be managed on the day of surgery?

Answer 26

Surgery / sulfonylureas on day of surgery: omit on the day of surgery exception is morning surgery in patients who take BD - they can have the afternoon dose

Question 27

amylase increased in?

Answer 27

pancreatitis

Question 28

CT head in 1 hour vs 8 hours guidelines?

Answer 28

Question 29

Male sterilisation - failure rate

Answer 29

1 in 2,000

Question 30

A 49-year-old woman presents with a tender lump around the areola associated with a green nipple discharge.

Answer 30

Mammary duct ectasia

Question 31

important complication of femoral hernias

Answer 31

Strangulation

Question 32

breast cyst mx?

Answer 32

Breast cysts should be aspirated

Question 33

most important when classifying the clinical severity of a case of acute pancreatitis?

Answer 33

Presence of any systemic or local complications

Question 34

renal stones otger then pain relief another med useful?

Answer 34

alpha adrenergic blocker Calcium channel blockers are also sometimes used to aid the spontaneous passage of the stone.

Question 35

what procedure to do depending on stone size?

Answer 35

Question 35

what procedure to do depending on stone size?

Answer 35

Question 36

classically described as a 'bag of worms'

Answer 36

Question 37

surgery in the morning takes 20 units of long acting insulin What should her once-daily dose of insulin be on the day before surgery?

Answer 37

once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery

Question 38

60-year-old man complaining of worsening pain in his left leg. known to have peripheral arterial disease left lower limb is pale and feels cold with no signs of oedema or trauma dorsalis pedis and posterior tibial pulses are absent on palpation and inaudible on a doppler exam. His right lower limb pulses are palpable. IV morphine has been administered. management ?

Answer 38

The initial management of acute limb ischaemia includes analgesia, IV heparin and vascular review

Question 39

blood-stained nipple discharge

Answer 39

Duct papilloma

Question 40

Propofol

Answer 40

an antiemetic and is therefore particularly useful for patients with a high risk of post-operative vomiting

Question 41

Prostate cancer - more common in

Answer 41

Afro-Caribbean population

Question 42

first-line investigation in suspected prostate cancer. after high psa

Answer 42

Multiparametric MRI

Question 43

58-year-old man PSA normal pr exam: irregular, hard and craggy prostate next step?

Answer 43

refer the patient as a 2-week wait referral.

Question 44

Brain death testing conformation?

Answer 44

Brain death testing should be undertaken by two separate doctors on separate occasions

Question 45

testicular cancer should be suspected

Answer 45

non-painful enlargement or change in shape or texture of the testis

Question 46

Penile cancer can present with ulceration

Answer 46

squamous cell carinoma

Question 47

emergency laparotomy what colostomy bag site?

Answer 47

end colostomy

Question 48

congenital inguinal hernias more common on what side?

Answer 48

RIGHT

Question 49

6-week check, you notice bilateral hydroceles mx?

Answer 49

Communicating hydroceles are common in newborn males and often resolve spontaneously

Question 50

Penile cancer is associated with... infection?

Answer 50

HIV

Question 51

imaging of choice in suspected renal colic

Answer 51

Non-contrast CT-KUB

Question 52

being treated for an episode of giant cell arteritis 20mg prednisolone daily. drug to prescribe prior to surgery?

Answer 52

Hydrocortisone supplementation is required prior to surgery for patients taking prednisolone

Question 53

Finasteride treatment of BPH may take ... how long to work>?

Answer 53

6 months

Question 54

national screening programme for colorectal cancer.

Answer 54

Faecal immunochemical test (FIT) test kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland 57%

Question 55

Lumpectomy is performed (wide excision) well-differentiated mucinous carcinoma tx?

Answer 55

Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds

Question 56

colorectal cancer marker?

Answer 56

Carcinoembryonic antigen

Question 57

most important risk factor for bladder cancer

Answer 57

smoking

Question 58

6-year-old boy noticed the erection ix?

Answer 58

Cavernosal blood gas analysis is a useful investigation for priapism

Question 59

when to refer a breast lump?

Answer 59

Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral

Question 60

Anal fissures- last thing to try?

Answer 60

sphincterotomy may be considered for cases that do not respond to conservative management

Question 61

Adult patients with a hydrocele.. mx?

Answer 61

ultrasound to exclude underlying causes such as a tumour

Question 62

patient has prostatitis, wants PSA when to do it?

Answer 62

Avoid performing a prostate specific antigen test within one month of prostatitis

Question 63

Inguinal hernia location?

Answer 63

superior and medial to the pubic tubercle

Question 64

subarachnoid haemorrhage mx?

Answer 64

most intracranial aneurysms are now treated with a coil by an interventional neuroradiologist

Question 65

anaesthetic may cause malignant hyperthermia

Answer 65

isoflurane, desflurane, sevoflurane

Question 66

Chronic anal fissure steps:

Answer 66

dietary modification, laxatives and topical anaesthetic, topical glyceryl trinitrate

Question 67

wound dehiscence in the central part of his laparotomy incision and small bowl is visible tx?

Answer 67

Cover the wound with sterile saline-soaked gauze and administer antibiotics while awaiting a senior review

Question 68

Patients with long saphenous vein superficial thrombophlebitis should ? mx?

Answer 68

ultrasound scan to exclude an underlying DVT