Gen / Uro Surgery

Question 1

Why appendicitis pain 1st periumbilical and then moves to right iliac fossa ?

Answer 1

initially irritation of visceral peritoneum by inflammed appendix -> T10 dermatome (midgut) (periumbilical)

As progresses - parietal peritoneum affected and slowly localises to there

Question 2

Define hernia

Answer 2

the protrusion of a structure through the wall of the cavity in which it is usually contained

Question 3

Direct vs indirect inguinal in relation to inferior epigastric vessles

Answer 3

Indirect = lateral 
direct = medial

Question 4

2 options for haemorrhoids Mx

Answer 4

conservative - increase fluid / fibre

medical - laxatives

surgical - rubber band ligation, cryotherapy, haemorrhoidectomy

Question 5

foregut, midgut, hindgut blood supply

Answer 5

F - Celiac trunk
m - superior mesenteric
h - inferior mesenteric

Question 6

Seen on bloods of mesenteric ischemia

Answer 6

metabolic acidosis

Raised:
Amylase 
WCC 
lactate
hB

Question 7

Mx of mesenteric ischemia surgery aim?

mx pre surgery?

Answer 7

remove necrotic tissue
revascularise

Fluid resus
Abx
heparin
Analgesia

Question 8

Function of red pulp / white plup of spleen?

Answer 8

Red - destroys defunct RBCs

White - lymphoid tissue for immune system

Question 9

2 indications for splenectomy?

What organisms suseptable to after and therefore Mx?

Answer 9

Trauma, spontaneious rupture, hypersplenism, Ca, abscess

Encapulated bacteria

• lifelong prophylactic Abx (penV / eryth)
• Vaccinations

Question 10

What are howell-jolly bodies ? When seen?

Answer 10

RBCs where nuclear remenant is still seen

No spleen - as would usually filter these out

Question 11

Acute pancreatitis key Blood test?

Answer 11

Serum Lipase

amylase good but can be normal

Question 12

2 early and 2 late comps of acute pancreatitis

Answer 12

Shock, ARDS, sepsis, DIC, renal failure

abscess, chronic pancreatitis, necrosis, thrombosis of spenic/duodenal arteries

Question 13

clinical sign to differentiate ileus / mechanical obstruction

Answer 13

No bowel sounds - ileus

tinkling - obstruction

Question 14

How to differentiate small and large bowel obstruction

Answer 14

axr

Question 15

immediate Mx of bowel obstruction

Answer 15

drip and suck

[NBM
NG tube -suck gastiric contents produced
IV fluids ]

Question 16

name 2 things found in bile

Answer 16

bile salt 
bile pigment 
cholesterol 
phospholipid 
water

Question 17

Name 2 types of bile stone

Answer 17

pigment stone
cholesterol stone
mixed

Question 18

Name the 4 lobes of the liver and the ligament that divides the anterior 2 segments

Answer 18

right, left, caudate, quadrate

falciform ligament

Question 19

4 causes of acute urinary retention?

2 key examinations to do?

Answer 19

UTI, BPH, pelvic nerve damage, constipation
anticholinergic/opiate/antidepressants

Abdo / peripheral nerve (Cauda equina)

Question 20

Acute vs chronic rentention - volume/pain?

Answer 20

Chronic = bigger Eg 1.5L and painless

Question 21

What is post-obstructive diuresis ? mx?

Answer 21

post retention -> keep producing large volumes of urine

Hourly urine output monitoring with IV replacement of fluid loss

Question 22

2 classes + drug for BPH + mech

Answer 22

alpha-1 receptor antagonist - tamulosin
->relaxes smooth muscle

anti-androgen 5-alpha reductase inhibitor - finasteride
->inhibits conversion of testosterone -> dihydrotestoterone

Question 23

Suspicious of bladder Ca
2 initial Ix after urinanalysis?
2Mx?
3 ways it can spread?

Answer 23

Renal tract USS
Flexible cystoscopy
urinary cytology
[KUB XR/CT]

TURBT
Intravesical chemo

Local: Pelvic Eg ureters, rectum, pelvic wall
Lymp: Iliac / paraaortic nodes
Haem: liver, lungs, bones

Question 24

Why Abx cover for prostate biopsy

Answer 24

prevent bowel flora as transrectal biopsy

Question 25

Score for prostate Ca prognosis

Answer 25

gleason

Question 26

Likely histology of renal Ca in child? adult?

Answer 26

c - nephroblastoma | Adult - RCC

Question 27

2 Factors which affect suitability for major surgery

Answer 27

Stage of tumour | Comorbidities - IHD, COPD, Obesity

Question 28

2 pros and 2 cons of laparoscopic

Answer 28

Reduced perioperative pain Reduced hospital stay Reduced bleeding Less visible scar Increased length of op poorer operative views need specialist equipment and training

Question 29

3 RFs for RCC

Answer 29

``` VHL Age male smoking obesity HTN ```

Question 30

Suspect renal stone 1st bedside test? Dx ix?

Answer 30

Urinalaysis | CTKUB

Question 31

Why pain in uretic stones? | Why pain radiate to groin ?

Answer 31

Spasm from peristalsis trying to relieve obstruction -> ischemia and pain Visceral pain to kidney + ureter follows similar path to somantic nerve supply to gonads

Question 32

renal Stone -> fever | post ABCDE + fluids + abx what Mx?

Answer 32

percutaneous nephrostomy | -> relieve infected obstruction of urine

Question 33

Where is a hydrocoele? Initial Ix? Radiolgical?

Answer 33

In the tunica vaginalis Transilluminate with a torch USS

Question 34

2 secondary causes of hydrocoele

Answer 34

trauma infection tumour

Question 35

hydrocoele in <1 indicates? Mx?

Answer 35

indicates a patent process vaginalis conservative - most will resolve by 1

Question 36

2 TURP specific complications

Answer 36

TURP syndrome bladder wall injury retrograde ejaculation

Question 37

Pros of spinal over GA

Answer 37

Less resp complications quicker dischage better pain relief post op less bleeding

Question 38

What happens in TURP

Answer 38

irrigation fluid enters prostatic bed | -> fluid overload and hypoNa (seizures etc.)

Question 39

Define stress and urge incontinence

Answer 39

Stress - Urine leaks when raised abdo pressure + vesical pressure > urethral spnincter Urge - Sudden urge due to overactive nerve supply

Question 40

3 causes of stress incontinence

Answer 40

pelvic floor damage - eg childbirth / surgery chronic cough obesity

Question 41

conservative mx of incontinece

Answer 41

weight loss, smoking cessation, less drinks / alcohol / caffine, pelvic floor exercises pessaries

Question 42

2 psychological impacts of incontinece

Answer 42

Embarrassment in public cant do activities as need to be near toilet social stigma of incontince

Question 43

incontinece - 1 drug + mechanism + 3 SE

Answer 43

oxybutinin / desmopressin anticholinergic - less spasms Dry mouth, constipation, difficulty urinating, blurred vision, acute closed angle glaucoma, drowsie, dizzy

Question 44

2 causes of reccurent UTI

Answer 44

immunsupression bladder outlet obstruction neuropathic bladder colovesical fistula

Question 45

2 causes of urethral stricture

Answer 45

``` trauma insertion of foreign bodies long term catheter gonno/chlamid lichen sclerosis [usually at meatus] ```

Question 46

2 Ix for urethral stricture 1mx

Answer 46

cystoscopy urinanalysis renal function urodynamic testing with flow cystometry Urethroplasty urethotomy

Question 47

Why would you get bladder diverticulum and what happens?

Answer 47

high pressures eg stricture -> outpouching | -> chronic infection with Ecoli / pseudomonas /