Clinical scenarios

Question 1

AAA management if haemodynamically stable

Answer 1

EVAR

Question 2

Worst outcomes in AAA

Answer 2

suprarenal and pararenal
management of suprarenal aneurysms compromises renal blood supply with significant morbidity

Question 3

NHS AAA screening program

Answer 3

single USS at 60yo
3-4.4cm: small, follow up in 2 years
4.4-5.4cm: follow up in 3 months
>5.5cm: urgent referral + CTA

Question 4

Risk factors for AAA

Answer 4

smoking
male
>65
arethrosclerosis
HTN
Marfan’sA

Question 5

Assessing limbs in secondary survey

Answer 5

Ask
Look
Feel
Move
Neurovascular

Question 6

Signs of devascularised limb

Answer 6

Hard signs: 6Ps
Soft signs: proximity to vascular structures, non expanding hameatoma, reduced pulses

Question 7

NCEPOD

Answer 7

1: immediate
2. urgent
3. expedited
4. elective

Question 8

why is fluid resus imp in compartment syndrome

Answer 8

muscle damage + ischaemia -> rhabdo

Question 9

pressure diagnostic of compartment syndrome

Answer 9

40hmhg

Question 10

Massive haemothorax

Answer 10

> 1500mls in chest drain immediately
200mls/hr for 2 consecutive hours

Question 11

Complications of supracondylar fracture

Answer 11

Early: Neurovascular injury, infection, haemorrhage
Immediate: compartment syndrome
Late: volkman ischaemic contracture, malunion

Question 12

Malunion

Answer 12

healing of fracture in an abnormal/deformed position

Question 13

Non-union

Answer 13

arrest in fracture healing process

Question 14

Classification of supracondylar fractures

Answer 14

Gartland classification
I: undisplaced
II: displaced with intact cortex
III: complete displacement

Question 15

Motor function of hand

Answer 15

Median: A-ok
Radial: pray
Ulnar: wrist extension

Question 16

Abscess

Answer 16

Pus filled epitheliased cavity

Question 17

NCEPOD

Answer 17

National Confidential Enquiry into Perioperative Deaths: aimed at reducing perioperative morbidity and mortalityA

Question 18

Anastomotic leak risk factors

Answer 18

Modifiable: smoking, alcohol, obesity, steroids
Non-modifiable: Male, age >60, distal rectal anastomosis, DM, high ASA, pulmonary/vascular disease

Question 19

Sepsis

Answer 19

Life threatening organ dysfunction caused by dysregulated host immune system

Question 20

Septic shock

Answer 20

Subset of sepsis with circulator/metabolic dysfunction associated with higher mortality than sepsis alone

Question 21

Shock

Answer 21

life threatening condition characterised by tissue perfusion that is inadequate to meet metabolic demands

Question 22

Well’s score

Answer 22

1-4: d-dimer
>4: CTPA

Question 23

Classes of shock

Answer 23

Tennis scores
I: 0-15, 750mls
II: 15-30, 1.5L, HR up
III: 30-40, 2L, BP low
IV: >40, >2L

Question 24

CT head within an hour

Answer 24

GCS 12 or less at scene
Open/depressed skull fracture
>1 episode of vomiting
GCS <15 2 hours later
Basal skull fracture
Siezure
Focal deficit

Question 25

factors contributing to dehiscence

Answer 25

Pre: protein deficient, smoker, jaundice, diabetic, ascites peri: poor technique, wrong suture, poor knots post: increased intrabdominal pressure

Question 26

Pyloric stenosis blood gas

Answer 26

hypochol, hypok, metabolic alkalosis

Question 27

Garden's classification

Answer 27

I: partial, undisplaced II: complete, undisplaced III: complete partially displaced IV: complete, completely displacedB

Question 28

Bile leak management

Answer 28

ERCP + stent Lap washout

Question 29

Burns surface area

Answer 29

Wallace rule of 9s Head and neck: 9% Arm: 9% Ant torso: 18% Post torso: 18% Leg: 18% Perinum: 1%

Question 30

Stoma

Answer 30

Surgically created communication between hollow viscus and skin

Question 30

Parkland formula

Answer 30

4ml*kg*TBSA% First half given over 8 hrs

Question 31

Complications of stoma

Answer 31

Early: haemorrhage, ischaemia, parastomal abscess LAte: hernia, obstruction, stoma prolapse

Question 32

Indications for dialysis in AKI

Answer 32

Acidosis Electrolyte imbalance Intoxications Overload Uraemia