Surgery

Question 1

Colovesical fistula Px and Rx

Answer 1

Px:
Background of diverticular disease
Dark sediment in urine
Recurrent UTIs

Rx:
Resection of involved bowel + primary anastomosis

Question 2

Ix of choice for haemorrhoids

Answer 2

PROCTOSCOPY + rigid sigmoidoscopy
- Flexi sig if nothing found

(If dark red blood or CIBH, consider colonoscopy as first choice)

Question 3

Causes of haemorrhoids

Treatment options

Answer 3

Idiopathic (most common)
Pregnancy
Heart failure
Chronic constipation
Pelvic mass
Portal hypertension

Rx options:
sclerotherapy
banding
haemorrhoidectomy

Question 4

Surgical treatment for localised Paget’s disease fo the nipple

Answer 4

Breast conserving surgery

Question 5

Surgical treatment for DCIS

Answer 5

Breast conserving surgery

Question 6

Electrolyte changes in referring syndrome

Answer 6

hypoK
hypoMg
hypoPO4

Question 7

Patient on PN has deranged LFTs. What complication of PN is this?
What is the Rx?

Answer 7

Cholestasis

Rx: Increase amount of enteral feed

Question 8

Options for debridement of necrotic ulcer

Answer 8

Surgical or maggot therapy

Question 9

Pain and reduced ileostomy output

Dx and Rx?

Answer 9

Constipation

Rx: MgSO4 (osmotic laxative) - best in context of ileostomy

Question 10

Gaucher’s disease presentation and pathology

Answer 10

Lysosomal storage disease prevalent in Ashkenazi Jews

Px: bleeding, bruising, hepatosplenomegaly, deranged LFTs, pancytopenia

Lipid accumulates in organs causing pancytopenia, hepatosplenomeg etc.

BM aspirate: lipid laden macrophages

Question 11

14yo with long term exertion knee pain now has bone pain worse at night

o/e: swelling medial aspect of knee

Knee XR: Codman triangle and fir tree like appearance

Answer 11

Osteosarcoma

Question 12

Mammograms not suitable for assessment for breast lump if patient young or old?

Answer 12

Young - makes image difficult to interpret

Question 13

Intussecuption Px and Ix

Answer 13

Bowel obstruction from 5mo-3yo
“Redcurrant jelly” stools
USS: bullseye

Question 14

Neonate can’t feed + mucus filled vomit + can’t pass NG

?cause

Answer 14

trachea-oesophageal fistula

Question 15

Grading and Staging of a tumour definitions

Answer 15

Grade: histopathological cell differentiation
Stage: extend of local and distant spread

ie. high grade tumours can still be resectable if stage low

Question 16

Area of red/white discolouration in a alcohol heavy smoker

Answer 16

Squamous cell ca
(alcohol and smoking both RFs)

Can also present as a non-healing ulcer

Question 17

Slow growing left sided facial mass inferior to angle of mandible. Dx and Rx?

Answer 17

Pleomorphic adenoma (benign)
Parotidectomy

Can involve facial nerve but be suspicious of malignancy if present

Question 18

Fast growing and spreading thyroid cancer occurring in older patients with poor prognosis

Answer 18

Anaplastic

Question 19

Thyroid cancer in younger patients with good prognosis

Answer 19

Papillary

Question 20

Thyroid cancer that can cause hypocalcaemia due to calcitonin production

Answer 20

Medullary

Question 21

IV Trastuzumab (Herceptin) indication + MoA

Answer 21

Indication: HER2 +ve breast cancer

MoA: Binds HER2 to reduce cell division

Question 22

Tamoxifen indication + MoA

Answer 22

Indication: Oestrogen receptor positive breast cancer

MoA: SERM antagonises oestrogen receptors in breast tissue

NB. BUT agonises oestrogen in endometrium ie. increased ca risk

Question 23

Anastrazole indication + MoA

Answer 23

Indication: Oestrogen receptor positive breast cancer

MoA: aromatase inhibitor ie. reduce production of oestrogen

NB. reduces bone density ie. co-prescribe bisphosphonate

Question 24

Associated risks of undescended testis

Answer 24

Inguinal hernia
Testicular torsion
Testicular cancer
Infertility

NB. not epididymo-orchitis

Question 25

Smooth superficial mass immediately below and lateral to umbilicus. Dx and Rx?

Answer 25

Spigelian hernia Rx: Surgical repair - high risk of strangulation

Question 26

Colorectal screening programme: what test? who gets it? how often?

Answer 26

Faecal occult blood test OR Faecal immunochemical test (FIT or FOB) Every 2 years 60-74 in England Every 2 years 50-74 in Scotland

Question 27

Acute anal fissure Rx

Answer 27

``` o Dietary advice o Bulk forming laxatives (first line) -> then try lactulose o Topical anaesthetics o Lubricants o Analgesia o (NOT top steroids) ```

Question 28

Chronic anal fissure Rx

Answer 28

o Above acute measures o Topical GTN o If persists after 8/52 -> refer 2ndary care for consideration of botulinum toxin

Question 29

What is tylosis

Answer 29

AD syndrome ~: - oesophageal SCC - hyperkeratosis of palmoplantar aspect of palms/soles

Question 30

Breast cancer urgent referral indication | Breast cancer routine referral indication

Answer 30

Cancer pathway:  30+ and unexplained breast lump  50+ with unilateral nipple Sx  Skin changes that suggest ca (consider)  30+ with unexplained lump in axilla (consider) o Non-urgent referral:  <30 + unexplained breast lump

Question 31

Undescended testicle complications

Answer 31

``` Infertlity Cancer Inguinal hernia Torsion (NOT infection) ```

Question 32

Longstanding venous ulcer. Now sloughy, tender and edges raised.

Answer 32

Marjolin's ulcer: malignant transformation of chronically inflamed skin

Question 33

Scoring criteria for acute pancreatitis

Answer 33

Ranson - only useful for alcoholic pancreatitis | Glasgow