Classifications

Question 1

Describe the classification of gastric ulcers

Answer 1

Johnson’s classification
Combination of anatomical and acid-secretion status

Type 1
- junction of fundic and antral mucosa on lesser curve
- normal to low acid
- most common type of gastric ulcer
- due to inadequate mucosal defence as opposed to

Type 2
- Gastric and duodenal ulcer
- Acid hypersecretion

Type 3
- Pre-pyloric
- Acid hypersecretion

Type 4
- GOJ/high lesser curve
- Reduced mucosal barrier

Type 5
- anywhere
- NSAID related

Question 2

Describe the child-Pugh classification

Answer 2

Used to assess liver disease provide a risk assessment for morbidity and mortality

A-E

A - albumin
B - bilirubin
C - coags
D - distension
E - encephalopathy

5-15 points

Operative mortality
A - 0-5% mortality
B - 10-15% mortality
C - >25% mortality

1-year survival
A - 100%
B - 80%
C - 45%

Lap chole risk
A <1%
B 10-20%
C >25%

Question 3

Who is at high risk of breast cancer, and what screening is recommended?

Answer 3

1. deemed high risk of ovarian cancer
2. 3 x 1st/2nd degree relatives on same side with breast/ovarian cancer
3. 2 x 1st/2nd degree relatives same side PLUS one of following:
   - BC <40years
   - bilateral BC
   - Ashkenazi Jewish ancestry
   - male breast cancer
4. 1 x 1st/2nd degree with BC <45yrs PLUS relative same side with bone or soft tissue sarcoma <45yrs
5. Member of family with high risk breast mutation e.g. BRCA1/2

Recommend -
- Annual screening with Mammo, MRI or USS
- Referral for genetic testing
- Consider risk reduction strategies (surgery, tamoxifen/raloxifene/RF modification)
- referral to Gynae for consideration of BSO
- advise regular self-examination

Question 5

Describe the BI-RADS classification

Answer 5

BI-RADS
0 - need additional imaging
1 - Negative - routine screening
2 - Benign - routine screening
3 - Probably benign - short interval F/U (6/12) a 0-2% risk cancer
4 - Suspicious - need tissue
4a low suspicion - 2-10%
4b moderate suspicion - 10-50%
4c high suspicion - 50-95%
5 - highly suggestive of malignancy - need tissue - >95%
6 - known Bx-proven

Question 6

What are the classes of shock?

Answer 6

Remember like tennis: 15, 30, 40

Class 1:
<15% blood volume loss
Increased pulse pressure
Slightly anxious

Class 2:
15-30%
Tachycardic 100-120
RR increased
Mild decrease UO
Slightly anxious

Class 3:
30-40%
HR120-140
Low BP
RR 30-40
Oliguric
Confused

Class 4:
>40% loss blood volume
HR >140
Hypotension
Tachypnoeic
Anuric
Confused

Question 7

What does AMPLE stand for in trauma secondary survey?

Answer 7

A - allergies
M - medications
P - PMH and pregnancy
L - last meal
E - events leading up to incident

Question 8

What does AMPLE stand for in trauma secondary survey?

Answer 8

A - allergies
M - medications
P - PMH and pregnancy
L - last meal
E - events leading up to incident