Surgery

Question 1

What type of suture is used in a circumcision?

Answer 1

Absorbable, rapidly dissolving sutures
“Vicryl Rapide”

Question 2

Describe the characteristics of a full thickness burn

Answer 2

Painless
Non-blanching (due to nerve and microvascular damage)
Charred/leathery skin

Question 3

Describe the characteristics of a partial thickness burn

Answer 3

Painful due to exposure of the nerves
Affect deeper dermis layer

Question 4

Describe the characteristics of a superficial burn

Answer 4

Red
Painful
Only affects epidermis

Question 5

What is the analgesic of choice in renal colic?

Answer 5

NSAIDs (diclofenac)

Question 6

What is prescribed if NSAIDs are contraindicated or not providing sufficient pain relief in renal colic?

Answer 6

IV paracetamol

Question 7

What class of drug is prescribed in patients with a distal <10mm ureteric stone?

Answer 7

Alpha blockers (tamsulosin, alfuzosin)

Question 8

What is the imaging of choice in renal colic?

Answer 8

CT KUB
(USS for pregnant patients and children)

Question 9

Discuss the management of renal stones

Answer 9

Renal stones
- watchful waiting if < 5mm and asymptomatic
- 5-10mm shockwave lithotripsy (ESWL)
10-20 mm shockwave lithotripsy OR ureteroscopy
- > 20 mm percutaneous nephrolithotomy

Uretic stones
- shockwave lithotripsy +/- alpha blockers
- 10-20 mm ureteroscopy

Question 10

Describe the difference between inguinal and femoral hernias

Answer 10

A femoral hernia will pass inferior and lateral to the pubic tubercle, whereas an inguinal hernia will be seen superior and medial to it

Question 11

Describe Prehn’s sign

Answer 11

Lifting of the scrotum/testicle to assess any change in pain (commonly used to asses testicular torsion)

Question 12

What are common side effects of axillary node clearance?

Answer 12

Lymphedema and functional arm impairment

Question 13

When is axillary node clearance indicated at primary surgery?

Answer 13

Patients with breast cancer who present with clinically palpable lymphadenopathy

Question 14

Discuss the pre-operative management of patients with breast cancer without palpable axillary lymphadenopathy

Answer 14

Axillary ultrasound and sentinel node biopsy (if negative USS)

Question 15

When is a mastectomy indicated?

Answer 15

• Multifocal tumour
• Large tumour, small breast
• DCIS (ductal carcinoma in-situ) > 4cm
• Central tumour

Question 16

When is a wide local excision of breast cancer indicated?

Answer 16

• Solitary lesion
• Small tumour, large breast
• DCIS (ductal carcinoma in-situ) < 4cm
• Peripheral tumour

Question 17

When is radiotherapy offered in breast cancer patients?

Answer 17

• After a wide local excision
• After a mastectomy in T3/T4 tumours
• After a mastectomy in patients with 4+ positive lymph nodes

Question 18

What is the initial first aid for minor scalds?

Answer 18

Irrigate the burn with cool or tepid water for between 10-30 minutes, followed by application of a layer of cling film as a dressing

Question 19

Which nerve can be damaged in an appendectomy?

Answer 19

Ilioinguinal

Question 20

An indirect hernia is associated with damage to which nerves?

Answer 20

Ilioinguinal and/or iliohypogastric

Question 21

What are the signs typical of an anastomotic leak?

Answer 21

Atrial fibrillation, increasing confusion, signs of sepsis

Question 22

What drug can cause gynecomastia?

Answer 22

Digoxin

Question 23

What is the first line treatment of acute limb ischaemia?

Answer 23

IV heparin, analgesia and a vascular review

Question 24

What drug is used first line in the management of peripheral arterial disease?

Answer 24

Clopidogrel

Question 25

Describe an arterial ulcer

Answer 25

Arterial ulcers are typically painful, commonly found on the heel, pale, dry cracked skin, and poor blood supply (weak/decreased pulses)

Question 26

Describe the features of a venous ulcer

Answer 26

Large, shallow, painless ulcer

Question 27

What is the screening process for AAA and who qualifies?

Answer 27

Duplex ultrasound Offered to men over 65 years-old

Question 28

What size of AAA requires intervention?

Answer 28

> 5.5 cm in men

Question 29

What are the typical features of varicose veins/chronic venous disease?

Answer 29

- Lower limb swelling - worse at the end of the day - Lipodermatosclerosis (tight, hardened skin) - Venous ulcers (shallow and irregular ulcers) - haemosiderin deposition (skin hyperpigmentation) - Itching - Varicose eczema

Question 30

What is the investigation of choice for chronic venous insufficiency?

Answer 30

Venous duplex ultrasound

Question 31

What is thrombophlebitis?

Answer 31

Clot formation within a vein

Question 32

What is the treatment of thrombophlebitis?

Answer 32

Compression stockings once arterial insufficiency has been excluded (ABPI)