Abdominal/Surgery

Question 1

When is it safe to discharge blunt , isolated abdominal trauma?

Answer 1

Stable patient
Normal CT with contract

Question 2

What risk stratification does NICE recommend for UGI bleed? (2)

Answer 2

Blatchford first assessment
Rockall post OGD

Question 3

What does NICE recommend in UGI bleed in platelets <50

Answer 3

Replace if bleeding actively, otherwise withhold

Question 4

What are the NICE recommend targets and how they should be managed in UGI bleeding re:
1. plts
2. APPT/PT
3. Fibrinogen

Answer 4

1. Plts >50, replace if actively bleeding
2. APTT/PT < 1.5 x normal - give FFP
3. Fibrinogen >1.5, if still low post FFP give cryoprecipitate

Question 5

What does NICE recommend re: PPI in non-variceal bleeding?

Answer 5

Only give if bleeding seen on OGD, not before

Question 6

In addition to the usual management of UGI bleeding, what extra treatment should be initiated in a variceal bleed? (2)

Answer 6

1. Terlipressin
2. IV abx

Question 7

What does NICE recommend about restarting low dose aspirin post UGI bleed?

Answer 7

Continue once haemostasis achieved

Question 8

What dose NICE say re: clopidogrel post UGI bleed?

Answer 8

D/w risk/benefit with specialist

Question 9

What is the treatment for acute limb ischaemia initially in all adult patients?

Answer 9

5000 units IV heparin

Question 10

What is a normal ABPI and what suggests ischaemia?

Answer 10

1. 1.0-1.2
2. <0.5

Question 11

What is more common inguinal or femoral hernias?

Answer 11

Inguinal

Question 12

What gender is more likely to get inguinal hernias and who is more likely to get femoral hernias?

Answer 12

Inguinal = men
Femoral = women

Question 13

What are the 2 types of gangrene?

Answer 13

Type 1 - polymicrobial, aerobic and anaerobic organisms
Type 2 - monomicrobial

Question 14

Who does type 1 and type 2 necrotising fasciitis tend to affect respectively?

Answer 14

Type 1 - elderly and co-morbid
Type 2 - anyone

Question 15

Which type of necrotising fasciitis usually produces gas in tissues?

Answer 15

Type 1

Question 16

What organism is most likely to cause type 2 necrotising fasciitis?

Answer 16

Group A Strep

Question 17

What is the most common site of renal calculi to get stuck?

Answer 17

Vesico-ureteric junction

Question 18

Under what size should renal stones usually pass spontaneously?

Answer 18

< 5mm

Question 19

What medicine can be given to aid the passage of renal stones?

Answer 19

Alpha-blockers

Question 20

What makes up the Glasgow pancreatitis score? (8)

Answer 20

1 point for each

1. Pa02 <7.9
2. Age > 55
3. WCC >15
4. Calcium < 2.0
5. Urea > 16
6. LDH > 600
7. Albumin < 32
8. Glucose > 10

Question 21

What score in the Glasgow Pancreatitis Score means it is severe?

Answer 21

3 or more

Question 22

What size constitutes a AAA and what size mandates operative management (where appopriate)?

Answer 22

1. > 3cm
2. 5.5cm or more

Question 23

What makes up the Alvarado scoring system? (8)

Answer 23

1. Migration of pain
2. Anorexia
3. N/v
4. RIF tenderness
5. Rebound pain
6. Temp > 37.3
7. Leucocytosis > 10
8. Neutrophilia >75%

Question 24

What is the most common causative organism in SBP?

Answer 24

E.coli

Question 25

What scoring system is used to help identify necrotizing fasciitis?

Answer 25

LRINEC (Lab Risk Indicator for Nec Fasc)