Surgery

Question 1

What is the triad of anaesthesia

Answer 1

Hypnosis, muscle relaxation, analgesia

Question 2

What are some complications of anaesthesia?

Answer 2

Respiratory depression

Nausea

Question 3

What are some general complications of surgery?

Answer 3

Infection

Haemorrhage

Question 4

What are some patient risk factors for surgery?

Answer 4

CAD
DM
Haemophilia

Question 5

What are some criteria for Well’s scoring?

Answer 5

Active cancer
Paralysis 
Major surgery within 2 weeks
Local tenderness
Entire leg swollen 
Calf swelling >3cm 
Pitting oedema 
Collateral superficial veins 
Previous DVT 
(Alternative diagnosis more likely = -2)

Question 6

What Well’s score makes DVT unlikely?

Answer 6

Less than 1 - do D dimer

Question 7

What are some causes of bilateral leg swelling?

Answer 7

Right heart failure
Renal or liver failure - decreased albumin
Venous insufficiency
Pregnancy

Question 8

What are some complications of biliary surgery?

Answer 8

Cholangitis, pancreatitis

Bile duct stricture

Question 9

Where are colostomies usually situated?

Answer 9

Left iliac fossa

Question 10

What are the different types of colostomy?

Answer 10

Loop - temporary, protects distal anastomosis, 2 lumens

End - usually permanent

Question 11

Where are ileostomies usually situated?

Answer 11

Right iliac fossa, spouted

Question 12

Where are urostomies usually situated?

Answer 12

Right iliac fossa, 2 ureters attached to piece of small bowel

Question 13

What are some stoma complications?

Answer 13

Infection 
Not draining 
High output 
Hernia
Retraction 
Ischaemia
Bleeding

Question 14

What are some causes of acute abdomen?

Answer 14

Peritonitis 
Ruptured AAA 
Appendicitis 
Pancreatitis 
Diverticulitis 
Ruptured ulcer

Question 15

What are the boundaries of the inguinal canal?

Answer 15

Muscle - internal oblique
Aponeurosis - external oblique
Ligament - inguinal
Tendon - transversals fascia

Question 16

Where is the deep ring of the inguinal canal?

Answer 16

Halfway along the inguinal ligament

Question 17

Where is the superficial ring of the inguinal canal?

Answer 17

Superior and medial to the pubic tubercle

Question 18

What are the features of a direct inguinal hernia?

Answer 18

Passes through posterior wall of the inguinal canal

Question 19

What are the features of HNPCC?

Answer 19

Autosomal dominant
Risk 80%
Biennial colonoscopy 25-75 years

Question 20

What are the features of FAP?

Answer 20

Mutation in APC suppressor gene 
Multiple colorectal adenomas - malignant transformation
Risk 100% by age 50 
Sigmoidoscopy from 12 years
Prophylactic surgery by age 25

Question 21

What are the red flags for bowel cancer?

Answer 21

Positive faecal occult blood
Over 40 + abdo pain + weight loss
Over 50 + rectal bleeding
Over 60 + IDA or change in bowel habit

Question 22

Where does bowel cancer spread to?

Answer 22

Liver, lung, bone

Question 23

What type of surgery is done for caecal/ascending bowel tumours?

Answer 23

Right hemicolectomy

Question 24

What type of surgery is done for transverse/descending bowel tumours?

Answer 24

Left hemicolectomy

Question 25

What type of surgery is done for sigmoid bowel tumours?

Answer 25

Sigmoid colectomy

Question 26

What type of surgery is done for low rectal tumours?

Answer 26

AP resection

Question 27

What type of surgery is done for emergency/palliative bowel tumours?

Answer 27

Hartmann's procedure

Question 28

When is bowel screening done?

Answer 28

60-75 years with faecal occult blood test

Question 29

What are the red flags for oesophageal cancer?

Answer 29

Dysphagia, weight loss, hoarseness, retrosternal chest pain

Question 30

What are the risk factors for gastric cancer?

Answer 30

Pernicious anaemia, h pylori, smoking

Question 31

What are the signs of chronic mesenteric ischaemia?

Answer 31

Severe colicky post-prandial pain Weight loss Upper abdominal bruit

Question 32

What are the criteria for obesity surgery?

Answer 32

``` BMI over 40 Failure of non-surgical options for 6 months Fit for surgery Intensive management Well motivated patient ```

Question 33

What are the treatment options for haemorrhoids?

Answer 33

``` Increase fluid and fibre Stool softener Rubber band ligation Diathermy Excisional haemorrhoidectomy ```

Question 34

What are some complications of diverticular disease?

Answer 34

``` Perforation Haemorrhage Fistulae Abscesses Post-infective strictures ```

Question 35

What are the symptoms of biliary colic?

Answer 35

RUQ -> back pain

Question 36

What are the symptoms of acute cholecystitis?

Answer 36

Continuous RUQ or epigastric pain Vomiting, fever, local peritonism Murphy's sign

Question 37

What are the symptoms of cholangitis?

Answer 37

Charcot's triad - RUQ pain, jaundice, rigors

Question 38

What are the causes of pancreatitis?

Answer 38

``` Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Hyperlipidaemia ERCP Drugs ```

Question 39

What are the symptoms and signs of pancreatitis?

Answer 39

Severe epigastric to back pain relieved by sitting forwards Vomiting Cullen's - periumbilical bruising Grey Turner's - flank bruising

Question 40

What tests should be done for pancreatitis?

Answer 40

FBC, LFTs, UEs, blood sugar Amylase, lipase, ABG CT

Question 41

What are the symptoms and signs of kidney stones?

Answer 41

Spasms of loin to groin pain Nausea and vomiting Pelvic pain, dysuria, interrupted flow Renal angle tenderness

Question 42

What investigations should be done for renal stones?

Answer 42

FBC, UE Urine dip Non-contrast CT

Question 43

What are the treatment options for renal stones?

Answer 43

Pass spontaneously >5mm medical expulsive - nifedipine/tamsulosin >48 hours extracorporeal shockwave lithotripsy

Question 44

What are some causes of urinary tract obstruction?

Answer 44

Stones, clot, tumour Stricture, neuromuscular dysfunction Abdominal/pelvic mass

Question 45

What are the symptoms and signs of acute lower urinary tract obstruction?

Answer 45

Severe suprapubic pain and acute confusion | Distended, palpable bladder

Question 46

What are some causes of haematuria?

Answer 46

``` RCC Glomerulonephritis HSP UTI Menstrual Rifampicin Rhabdomyolysis ```