Abdominal

Question 1

Earliest complication of ileostomy

Answer 1

Necrosis

Question 2

Lienorenal ligament

Answer 2

Posterior to the spleen
Splenic artery+vein
Tail of the pancreas

Question 3

Acute mesenteric embolus

Answer 3

Set an onset abdominal pain followed by profused diarrhoea
May be associated with vomiting
Rapid clinical deterioration and
Test high white cell count lactate amylase may all be abnormal particularly in established disease. These can be normal in the early phases

Question 4

Acute in chronic mesenteric ischaemia

Answer 4

Usually longer prodromal history

Post prandial abnormal discomfort and weight loss

Question 5

Low flow mesenteric infarction

Answer 5

This occurs in patients with multiple comorbidities in profusion significantly compromised by overuse of inotropes with background cardiovascular compromise
The end result is that the ball is not in adequately profused any forwards occur from the mucosa outwards

Question 6

Which anatomical element will be least likely encountered when transverse incision is made 2/3 -umbilicus-symphysis

Answer 6

Posterior lamina of the recrus sheath

Question 7

Accessory adrenal tissue frequent location

Answer 7

Mostly firmed only from vortex
Broad ligament or spermatic cord
However it can be found anywhere, even intracranial

Question 8

Bilious vomiting in neonates

Answer 8

Think intestinal malrotation, volvulus

Question 9

Necrotising entérocolites

Answer 9

Prematurity is the main risk
Early features abdominal distension and passage of bloody stools
X-ray pneumatics is intestinales and evidence of free air
Increased risk when empirical antibiotics are given to infants beyond 5 days
Treatment total gut rest and TPN
Laparotomy

Question 10

Recommandation for ER thoracotomy

Answer 10

Penetrating thoracic trauma that is followed by cardiac arrest

Question 11

Paget vs Eczema of the breast

Answer 11

Paget will affect the nipple first and then spread to the areolar area

Question 12

The most important structure involved in supporting the uterus

Answer 12

Central perineal tendon

If this is injured->uterus prolapse

Question 13

Lymphoedema primary

Answer 13

Congenital -milroy’s disease
1-35 years: meige’s disease
> 35 years Tarda

Question 14

Malignant hyperthermia arterioles

Answer 14

Fibrinoid necrosis

Question 15

Spigelian hernia

Answer 15

Arcuate line

Question 16

Lumbar hernia

Answer 16

Crest of ilium inferiorly
External oblique laterally
Latissimus dorsi medially

Question 17

Obturator hernia

Answer 17

Herniation through the obturator canal
Commoner in females
Lies behind pectineus muscle
Will present with obstruction

Question 18

Richter hernia

Answer 18

Small bowel is strangulated within hernia
May present with obstruction
Where vomiting is prominent -paralytic ileus from peritonitis( these hernias can perforate)

Question 19

Littres hernia

Answer 19

Hernia containing Meckel’s diverticulum

Question 20

E colo symptoms

Answer 20

Enterohepathogenic
Enteroinvasive: dysentery, large bowel necrosis/ulcer
Enterotoxic:small intestine, travels diarrhoea
Enterohaemorrhagic:0157, cause a haemorrhagic colitis, haemolytic uraemic syndrome and thrombocytopaenic purpura

Question 21

Yesenia enterocolitica

Answer 21

Gram negative, coccobacili
Typically produces a protracted terminal ileitis that may mimic Crohns
DD appendicitis
May progress to septicaemia in susceptible individuals
Usually sensitive to quinolone or tetracyclines

Question 22

Exploration of CBD drain tube

Answer 22

Latex T tube- form fibrosis

Question 23

CNS drain

Answer 23

Low suction drain

/ free drainage- sub dural haematoma

Question 24

CVS drain

Answer 24

Underwater seal drain

Question 25

Most frequent abdominal emergency in children under 1

Answer 25

Intussuseption

Question 26

Carcinoid syndrome tests

Answer 26

5-HIAA -urine Somatostatin receptor scintigraphy CT scan Chromogranin A

Question 27

Structures passing through the diaphragm

Answer 27

Aorta+ thoracic duct -aortic hiatus Vagal trunks accompany the oesophagus- muscle part R R Frenic+ iVC -caval opening L frenic- anterior to central tendon on the left

Question 28

Spleen structure

Answer 28

Réticuloendothélial organ Red pulp-venous sinuses Réticuloendothélial cords-white pulp

Question 29

Hernia repair

Answer 29

Open/ laparoscopic Open Lichtenstein repair Shouldice - acceptable

Question 30

Dercums

Answer 30

Multiple lipomas | Adipose is dolorosa

Question 31

Segmental resection for pts with polyps

Answer 31

``` Incomplete excision if malignant polyps Malignant sessile polyps Malignant pedunculated polyp with submucosal invasion Polyps with poorly diff. Carcinoma Familial polyposis ```

Question 32

Acute pseudo-obstruction medical treatment

Answer 32

If supportive treatment doesn’t work- neostigmine

Question 33

Treatment Barrett

Answer 33

Long term PPI Consider ph and manometry studies Regular endoscopic monitoring. Quadratic biopsies

Question 34

Total vs sub total gastrectomie

Answer 34

If <5 cm from from the OD- total | If 5-20 from the OF - subtotal

Question 35

Origin of most pancreatic carcinoma

Answer 35

Ductal