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1
Q

Functions of bile salts? (2)

A

Excretion of cholesterol

Emulsification of fat

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2
Q

Commonest causes of gallstones? (2)

A 
Excess of cholesterol excretion
Chronic haemolysis (pigment stones)
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3
Q

Signs associated with cholecystitis?

A

RUQ tenderness and rigidity

Murphy’s sign- catching of breath at maximal inspiration while RUQ is being palpated

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4
Q

Antibiotic therapy for biliary tree infection?

A

Amox met gent

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5
Q

Investigations in suspected gallstones?

A

Ultrasound

MRCP

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6
Q

Surgical treatment of gallstones? (2)

A

Laparoscopic or open cholecystectomy if causing cholecystitis;
ERCP if impacted in the CBD

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7
Q

Acute abdomen:

a) sudden pain that is constant
b) pain on coughing/moving
c) helped by drawing knees up to chest; patient writhes around

A

a) suggests perforation of a viscus
b) peritonism
c) colicky pain

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8
Q

Higher volume, frequency and pitch of bowel sounds?

A

Obstruction

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9
Q

Absence of bowel sounds?

A

Ileus

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10
Q

Clinical signs:

a) Bruising around the umbilicus
b) bruising in the left flank
c) LIF palpation producing RIF pain

A

a) Cullen’s sign (pancreatitis)
b) Grey Turners sign (pancreatitis)
c) Rosving’s sign appendicits

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11
Q

Condition which presents similarly to appendicitis and may follow an URTI?

A

Mesenteric adenitis

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12
Q

Inflammatory bowel disease: cobblestoning, fissures, transmural inflammation

A

Crohn’s disease

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13
Q

Inflammatory bowel disease: rose-thorn ulcers, non-caseating granulomas, mucosal inflammation

A

Ulcerative colitis

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14
Q

Systemic manifestations of IBD? (4)

A

Anterior uveitis
Ankylosing spondylitis
Erythema nodosum
Pyoderma gangrenosum

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15
Q

Investigation of suspected IBD? (3)

A

Faecal calprotectin
CRP
Colonscopy and biopsy

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16
Q

Scoring system used to assess the severity of a flare of UC?

A

Truelove and Witt’s

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17
Q

Treatment of perianal fistula?

A

Seton suture

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18
Q

Medical management of IBD?

A

Induction of remission (steroids, mesalamine)

Maintenance of remission (AZT, mercaptopurine, mesalamine)

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19
Q

Transverse colon diameter greater than 6cm indicates…

A

Toxic megacolon

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20
Q

The levels of which enzyme should be assayed before commencing azathioprine?

A

TPMT

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21
Q

What are haemorrhoids?

A

Prolapsed and enlarged anal cushions containing AV communications

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22
Q

How are haemorrhoids clinically classified? (4)

A

I- don’t prolapse
II- prolapse during defaecation, reduce spontaneously
III- always prolapsed, manually reducible
IV- irreducible

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23
Q

Management of haemorrhoids?

a) conservative
b) surgical

A

a) fluids, stool softener, dietary fibre

c) haemorrhoidectomy

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24
Q

Management of anal fissure? (3)

A

Conservative management of constipation
GTN/diltiazem cream to relax sphincter
Lateral sphincterotomy

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25
Rectal bleeding + abnormal vessels on colonoscopy?
Angiodysplasia of the colon
26
Causes of acute pancreatitis (6)
``` Gallstones Alcohol ERCP Trauma Hypercalcaemia Cancer ```
27
Radiological investigation in suspected pancreatitis?
Contrast enhanced CT abdomen
28
Management of acute pancreatitis? (3)
Opiate pain relief Fluids Enteral feeding if unable to eat/drink within 48-72 hrs
29
Complications of acute pancreatitis? (3)
Infected necrosis Pseudocyst Abscess
30
Epigastric pain worsened by eating + steatorrhoea + diabetes in an alcoholic
Chronic pancreatitis
31
CT finding in chronic pancreatitis?
Speckles of calcification
32
Diameter cut-off for surgery in AAA?
5.5cm
33
Investigation of AAA? (3)
Ultrasound CT MR angiography
34
Surgical options for AAA repair? (2)
Open aneurysm repair | EVAR
35
Jaundice with elevated ALP, moderately elevated ALT/AST
Obstructive jaundice
36
Pyrexia + rigors + jaundice + tender liver
Pyogenic liver abscess
37
How can chronic liver disease cause anaemia, thrombocytopenia and leucopenia?
Portal hypertension leading to splenomegaly
38
Definitive management of bleeding oeseophageal varices (3)
Terlipressin Endoscopic variceal band ligation (Sengstaken-Blakemore tube as a temporary holding measure)
39
Procedure which can be used to decompress the portal system?
Transjugular intrahepatic portosystemic shunt (TIPSS)
40
Prevention of variceal bleeding (3)
Beta blockers Sclerotherapy Band ligation
41
Herniation of mucosa through the circular colon wall at the sites of arterial penetration
Diverticular disease
42
Complications of diverticular disease? (4)
Diverticulitis/pericolic abscess Obstruction Fistula formation Bowel perforation
43
Dysuria + cloudy urine + pneumaturia
Colovesical fistula
44
Definitive treatment of diverticular haemorrhage?
Angiographic embolization | or surgical resection
45
Solitary thyroid nodule- DDx? (3)
Cyst Adenoma Cancer
46
Four types of thyroid cancer in order of prevalence?
Epithelial: Papillary and Follicular Anaplastic Medullary
47
Rapidly-growing, highly malignant thyroid cancer
Anaplastic
48
Which thyroid cancer has the highest cure rate?
Papillary
49
Thyroid tumour arising from parafollicular cells, secretes calcitonin?
Medullary cancer
50
Medullary cancer and pharochromocytoma often arises as part of what syndrome?
MEN 2
51
Primary hyperparathyroidism is usually due to...
Solitary adenoma of the parathyroid gland
52
Psammoma calcification is diagnostic of...
Papillary thyroid cancer
53
Chovstek and Trosseau are signs of...
Hypocalcaemia
54
Parathyroid, pancreatic and pituitary adenomas- which MEN?
MEN 1
55
Waterhosue-Friderichsen syndrome
Diffuse adrenal haemorrhage
56
AXR- central gas shadows with valvulae conniventes
Small bowel obstruction
57
AXR- peripheral gas shadows with haustra (do not cross lumen)
Large bowel obstruction
58
Management of bowel obstruction?
Keep NBM, NG tube and IV fluids
59
"Coffee bean" sign
Sigmoid volvulus
60
Commonest locations of colorectal Ca? (2)
Rectum (45%) and sigmoid (25%)
61
Staging for confirmed colon Ca?
Contrast enhanced CT chest, abdo pelvis
62
Colorectal cancer- surgery for low sigmoid or high rectal cancer?
Anterior resection
63
Colorectal cancer- surgery for tumours low in the rectum?
Abdominoperineal resection + permanent colostomy
64
Numerous hamartmaous polyps in GI tract + pigmented lesions on lips, oral mucosa, face, palm and soles
Peutz Jeugher syndrome
65
Abd pain + bloody diarrhoea + fever in a known vasculopath
Mesenteric ischaemia
66
Adhesions usually cause obstruction of which segment of bowel?
Small bowel
67
Which is the only thyroid cancer that spreads haematogenously?
Follicular

Surgery (21 decks)

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