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General Flashcards

1
Q

Which respiratory measurements are reduced in the obese?

A

Tidal volume
Vital capacity
TLC
FRC

minute ventilation increased

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2
Q

Where in relation to the uterine artery does the ureter pass?

A

Posterior - ‘water under the bridge’

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3
Q

30d mortality of Haemorrhagic peptic ulcer?

A

8.6%

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4
Q

What is the required skin margin for a BCC?

A

5mm (95% clearance - 85% at 3mm)

If recurrent - 5-10mm

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5
Q

What is the most common cause of upper GI bleeding (in patients who have an OGD)?

A

Peptic ulcer (26%)

Then oesophagitis (17%)/gastritis (16%)/duodenitis (9%)

Varices (9%)

Malignancy (3%)
MW-tear (3%)

12% no cause found

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6
Q

Which nerve is often sacrificed in malignant parotid surgery?

A

Facial nerve

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7
Q

Which trace element is most important for wound healing?

A

Zinc

-copper less so

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8
Q

Within which ligament do the ovarian vessels run?

A

Suspensory ligament of ovary

May anastomose with uterine arteries in broad ligament

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9
Q

How do you insert a Sengstaken Blakemore tube (7)?

A

1) Insert to 50cm
2) inflate gastric balloon with increments of 100ml ensuring in stomach not oesophagus (i.e. gradual pressure increase), with IR to confirm position
3) Apply traction to balloon to OG junction (0.5-1kg)
4) If persistent bleeding inflated oesophageal balloon to 35-45mmHg
5) consider further traction up to 1.1kg if necessary
6) once haemostasis achieved, reduce pressure by 5mmHg every 3 hours and maintain at 24mmHg for 24 hours
7) Deflate balloon every 6 hours

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10
Q

What type Choledochal cyst is found with Caroli’s disease?

A

Type 5

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11
Q

What is the reversal agent for Dabigatran?

A

Idarucizumab

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12
Q

What are the characteristics of the Truelove and Witts criteria?

A 
For acute severe colitis
Frequency of blood stools >6
Temperature >37.8
Heart rate >90
Haemoglobin <10.5
ESR >30 (can exchange for CRP>30)

If signs of systemic toxicity the rate of colectomy goes from 8.5% –> 30% –> 48%

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13
Q

What is the typical threshold for radiological drainage of diverticular abscess?

A

4cm

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14
Q

What is the most common pathological organism in SBP in adults?

A

E.Coli and Klebsiella.

Consider prophylaxis with fluoroquinolones in high risk.

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15
Q

What is the eponymous name for a femoral hernia occurring behind the vessels?

A

Narath hernia

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16
Q

What is the evidence for use of SEMS for obstructing cancer?

A

The CREST trial (2019) - better short term outcomes and lower permanent stoma rate

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17
Q

What Ig crosses the placenta in RHD?

A

IgG

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18
Q

What is the daily recommended protein?

A

0.75g/kg

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19
Q

What is the most common site of sarcoma?

A

Extremeties in 40%

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20
Q

What cancers are associated with HPV 16/18?

A 
Cervical cancer
Anal cancer
Penile cancer
Vulval cancer
Oropharyngeal cancer
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21
Q

What is the most common cause of visceral ischaemia?

A

Embolism (50%)

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22
Q

What are the types of BCC?

A

Nodular (commonest 60%, frequently on face)
Superficial (can use 5-FU)
Morpheaform (more aggressive, needs Mohs)
Cystic
Basosquamous (also more aggressive)

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23
Q

Which ovarian tumour type is most frequently associated with torsion?

A

Teratoma

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24
Q

What is the most common USS finding in ectopic pregnancy?

A 
Adnexal mass (50-60%)
Extrauterine gestational sac (35-50%)
20% can have intrauterine fluid collection - pseudosac
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25
Q

What is the maximum dosing of Bupivicaine?

A

2mg/kg - but based on IBW, so 150mg
= 30ml 0.5%
= 60ml 0.25%

Not affected by adrenaline as related to protein binding

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26
Q

How are choledochal cysts managed?

A

Usually with complete duct excision/reconstruction
Risk of pancreatitis, cholangitis, stricture, malignancy (6-30%, usually type 1/4a)

Infants also need early excision due to risk of liver fibrosis (<1month)

Risk of biliary malignancy persists after excision

Type 4 may need hepatectomy or liver transplant, others can usually be managed with Roux-en-y

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27
Q

Which blood group plasma products can be infused into any recipient?

A

Group AB (reverse of PRC transfusion)

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28
Q

What is the eponymous name for a type 5 Choledochal cyst?

A

Caroli’s disease

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29
Q

From which muscle does the cremaster arise?

A

Internal oblique

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30
Q

What are the maximal doses of LAs?

A

Lidocaine 3mg/kg - max 200mg
Lidocaine + Adrenaline 7mg/kg - max 500mg
Bupivicaine 2mg/kg to max of 150mg

Calculated by IBW

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31
Q

What kind of diathermy is used for ERCP?

A

Monopolar cutting (risk of bleeding)

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32
Q

What proportion of inguinal hernias will present as an emergency?

A

about 5%

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33
Q

What are the general indications for intubation? (4)

A

Lungs - O2, CO2, Work of breathing
Brain - aspiration risk or ICP control
Heart - failure or advanced support
Control - facilitate transfer/intervention

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34
Q

Where does Adrenaline exert its main effects?

A

Beta1 receptors

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35
Q

What are the characteristics of the flow phase of response to trauma?

A 
Catabolic phase for 1-2 weeks
Anabolic recovery phase for months
-Negative nitrogen balance
-Increased BMR/REE
-Increased gluconeogenesis
-Increased glucagon, insulin, cortisol, insulin resistance
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36
Q

What are the management considerations of large perforated peptic ulcers (>4cm)?

A

1) raises suspicion of malignancy
2) 10-16% of gastric perforations (1% of cancers)
3) For giant ulcers, resection and reconstruction recommended (may need damage control)

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37
Q

What conditions are associated with CDH1 mutation?

A

Diffused gastric cancer and lobular breast carcinoma

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38
Q

Which portal vein does not follow normal pattern of biliary drainage?

A

Left portal vein (embryological conduit between umbilical vein and ductus venous)

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39
Q

What is the treatment of choice for TPN extravasation?

A

Hyaluronidase to periphery of extravasation site (within 60 minutes)

Promotes tissue permeability

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40
Q

What is the initial management of acute severe colitis?

A

100mg IV Hydrocortisone QDS
Stool culture x 3 for C.Diff
Consider Flexi and biopsy for CMV
Consider AXR (>5.5cm = megacolon)

If still severe on D3 consider rescue - Infliximab, Cyclosporin or surgery

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41
Q

What degree of bleeding can be detected by a CT Angiogram

A

0.3ml/min

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42
Q

How frequently does extravasation associated with chemotherapy occur?

A

6% of cases

Of which 30% result in ulceration

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43
Q

What is the benefit of splenectomy in Beta Thalassaemia?

A

Can decrease transfusion requirement by 50%

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44
Q

What is the definition of massive bleeding? (5)

A
  • Blood loss of 1/2 circulating volume in 3 hours
  • Blood loss of entire circulating volume in 24 hours
  • Ongoing blood loss of >150ml/min
  • Transfusion of 4 units PRC in 4 hours with ongoing bleeding
  • Transfusion of 10 units PRC in 24 hours
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45
Q

From which skin level is Breslow thickness measured?

A

top of stratum granulosum

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46
Q

What is the half life of albumin?

A

20 days

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47
Q

How is Aortic stenosis graded?

A

Pressure gradient and aortic valve area
Mild <25mmHg and >1.5cm valve area
Moderate 25-40, 1.0-1.5
Severe >40 <1

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48
Q

What is the most common cause of peritoneal catheter associated infections?

A

Coagulase negative Staphylococcus (Staph. epidermidis)

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49
Q

What is the recommended first line treatment for C.Diff

A

Oral Vancomycin (NICE 2021)

Then PO Fidaxomicin
Then PO Vancomycin + IV Metro

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50
Q

What are the types of Choledochal cysts?

A

5 types

1) Dilatation of CBD (80-90%)
2) Cystic diverticulum of CBD
3) Arising from duodenal CBD at ampulla
4) Cystic dilatations of both intra- and extra-hepatic biliary tree
4a) L/R HD and CBD (15%) L»R
4b) CHD and CBD
5) Cystic dilatation of intrahepatic biliary tree only

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51
Q

In what proportion of cases does sigmoid volvulus recur?

A

50-90% (endoscopic resolution in 70-80% of patients)
Contrast enemas successful in 5%
Rarely resolves spontaneously

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52
Q

What is the mechanism of action of linezolid and macrolides?

A

Inhibition of protein synthesis (50s subunit)

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53
Q

What are the potential complications of diverticular disease?

A 
Diverticulitis
Bleeding
Fistula
Perforation
Abscess
Phlegmon
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54
Q

Which trial described management of necrotising pancreatitis?

A

The PANTER trial described the step-up approach to management

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55
Q

What is the characteristic side effect of Anthracyclines?

A

Cardiotoxicity

-Doxorubicin, epirubicin

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56
Q

What is the best approach for repair of a small perforated peptic ulcer (<2cm)

A

No evidence of benefit to omental patch over suture closure

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57
Q

What management should be instituted in acute variceal haemorrhage

A

1) Resuscitation
2) Vasconstrictors - Terlipressin or somatostatin >octreotide
3) Antibiotics
4) OGD with Variceal Band Ligation

5) for patients with Childs B or Childs C <14 early covered TIPPS (<72hr)
2015 BSG Guidelines

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58
Q

How do Meckels diverticula most frequently present?

A 
Obstruction (40-50%)
Peptic Ulceration (25%)
Acute Inflammation (20%)
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59
Q

With normal renal function, how long before elective surgery should Rivaroxaban be stopped?

A

If low risk 24 hours
If high risk 48 hours

Restart 6-12 hours if low risk, if high risk then 48 hours

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60
Q

What is the treatment for chemotherapy extravasation?

A

Stop infusion, aspirate
Elevate limb
Warm compress with vinca alkaloids (vincristine)
Cold compresses with doxorubicin

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61
Q

Which nerve is at risk in an anterior approach to hip?

A

Femoral

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62
Q

How is T3 subdivided in rectal cancer?

A

T3a - <1mm from muscularis propria
T3b - 1-5mm from muscularis propria
T3c - >5mm from muscularis propria

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63
Q

What are the potential areas of portosystemic shunt in portal hypertension (4)

A

1) Rectum - Superior rectal (IMV) –> Middle/inferior rectal (Pudendal –> EIV)
2) Paraumbilical - recanalised vestigial umbilical vein –> Left portal vein
3) Oesophagus - left gastric vein –> azygous
4) Intrahepatic - portal vein and IVC

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64
Q

How long should antibiotics be given for in perforated peptic ulcer?

A

if not severely ill, consider 3-5 days - long course did not have any benefit in recent RCT

Antifungals should be given if immunocompromised, elderly, comorbid or prolonged ITU stay. First line would be fluconazole, upgraded to caspofungin if previously received fluconazole

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65
Q

Which artery typically causes bleeding from duodenal ulcers?

A

Gastroduodenal artery (must be triple looped)

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66
Q

What are the main stages of wound healing?

A

Haemostasis (platelets, fibrin rich clot)
Inflammation (neutrophils, Growth factors, fibroblasts, macrophages)
Regeneration (fibroblasts and epithelial cells, angiogenesis, looks like graduation tissue)
Remodelling (longest phase, fibroblasts –> myofibroblasts –> wound contraction)

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67
Q

How are Hepatitis C, D and E diagnosed?

A

Usually RNA PCR

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68
Q

In which Haematological condition are irradiated blood products required life long?

A

Hodgkins Lymphoma

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69
Q

An investigator wishes to determine whether individuals who have irritable bowel syndrome were likely to have been admitted to hospital as children with appendicitis. Which study type is appropriate?

A

Case controlled study. Used when the individual of interest already has the disease

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70
Q

What kind of diathermy is used for colonoscopy polypectomy?

A

Synergised diathermy using blend mode

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71
Q

What are the components of the Glasgow Score for Pancreatitis?

A 
PaO2<7.9
Age>55
WCC>15
Ca<2
Urea>16
LDH>600
Albumin<32
Glucose>10
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72
Q

What intestinal parasitic infection can present with respiratory/wheezing symptoms?

A

Strongyloides stercoralis

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73
Q

What is the mechanism of action of gentamicin?

A

Inhibition of the 30s ribosome

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74
Q

What is the characteristic metabolic finding of pyloric stenosis?

A

Hypokalaemic, hypochloremic metabolic alkalosis

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75
Q

What evidence is there for laparoscopic washout in diverticulitis?

A

The LADIES, SCANDIV and DILALA trials looked at this.

There was a lower permanent stoma rate, but much higher reintervention rate than patients undergoing a Hartmanns

Risk of missed perforation 30% and missed cancer 10%

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76
Q

What AntiA/B Ig is present in type O patients?

A

IgG (IgM for ABs)

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77
Q

What is the contents of cryoprecipitate (4)?

A

Factor 8
Factor 13
Fibrinogen
vWF

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78
Q

What is the most common organism in Shilgella infection?

A

Shigella soneii
Grame negative bacilli
Can give cipro if high risk

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79
Q

What is the cellular difference between acute and chronic inflammation

A

Acute - neutrophil dominant

Chronic - macrophage, plasma cells and lymphocytes

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80
Q

In whom do ovarian germ cell tumours tend to present?

A

Young patients <20 and AC/Asians

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81
Q

What general margin is required for sarcoma excision?

A

2cm

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82
Q

In patients with significant cardiac instability which anaesthetic agents may be favoured?

A

Etomidate (nb adrenal suppression, ponv)
Ketamine

Propofol and thiopentone can produce more cardiac depression

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83
Q

An abundance of free air is more likely seen with which visceral perforation?

A

Usually lower GI

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84
Q

What excision margins should be achieved with a BCC/SCC?

A

4mm sufficient (98% excision)

High risk SCC, size >2cm and poor differentiation –> 6mm

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85
Q

What is the enzymatic sequence for the creation of adrenaline?

A

Tyrosine –> Dopamine (by DOPA decarboxylase) –> NA –> A

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86
Q

What is the recommended treatment course for PID?

A

1 x 500mg IM Ceftriaxone + 14days of Doxy 100mgBD + Metro 400mg BD

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87
Q

What is the characteristic features of a contrast Xray for intestinal malrotation

A

Gasless abdomen, with corkscrew duodenum on contrast, with DJ flexure in RUQ
Usually isolated abnormality
Formation of LADDs band (caecum to RLQ retroperitoneum) and volving
1/500

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88
Q

What is the most frequent cause of acute Lower GI Bleeding?

A 
Diverticular disease (50%)
Angiodysplasia (40%)

Incidence of bleeding post polypectomy is 2%
85% resolve spontaneously

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89
Q

What are the types of opioid receptor?

A

δ (located in CNS)- Accounts for analgesic and antidepressant effects

k (mainly CNS)- analgesic and dissociative effects

Mu (central and peripheral) - causes analgesia, miosis, decreased gut motility

Nociceptin receptor (CNS)- Affect of appetite and tolerance to Mu agonists.

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90
Q

what type of bacteria is h.pylori?

A

Gram negative bacillus

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91
Q

How long before hernia repair should patients be advised to stop smoking?

A

4-6 weeks

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92
Q

Which botox is used clinically?

A

Botulinum toxin A

Inhibition of ACh release from NMJ

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93
Q

What are the three means of chronic inflammation?

A 
Persistent infections (e.g. Mycobacterium TB)
Prolonged exposure to no biodegradable substances (suture, silica)
Autoimmune conditions
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94
Q

What proportion of liver volume is right side?

A

60%

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95
Q

What size mesh should be used for an umbilical hernia of size 1-4cm?

A

3cm overlap

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96
Q

What is the most common site of secondary TB?

A

The lungs

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97
Q

What does Prothrombin Complex Concentrate (octaplex/berriplex) contain

A

II, VII, IX and X along with protein C/S

Works more quickly than FFP - ?superceded by berriplex?

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98
Q

Which type of renal stone is most radio dense on plain X-ray?

A

Calcium phosphate

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99
Q

How do you confirm successful intubation?

A

End tidal CO2

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100
Q

What is the minimum acceptable mesh pore size?

A

> 1mm

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101
Q

What is the required excision margin for a skin SCC?

A

<2cm well differentiated - 4mm

>2cm, poor or face - 6-10mm

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102
Q

What are the indications for renal replacement therapy?

A 
Diuretic resistant pulmonary oedema
Refractory hyperkalaemia
Metabolic acidosis
Symptomatic uraemia
Overdose of dialysable drugs
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103
Q

What is the rate of skip metastasis above the SLN in breast cancer?

A

3%

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104
Q

What is the most appropriate feeding strategy for patients with newly diagnosed Crohns disease?

A

Elemental - can induce remission in up to 80%

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105
Q

Where is most Na/water absorbed in the sb?

A

Ileum

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106
Q

What is the eponymous syndrome associated with adrenal haemorrhage?

A

Waterhouse-Friderichsen syndrome (fulminant meningoccemia)

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107
Q

What is the difference between lymphoedema praecox and lymphedema tarda?

A

Praecox presents in adolescence and tarda presents >35

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108
Q

What risk scores exist for Perforated peptic Ulcer?

A

Boey, PULP, ASA
NELA

Simple albumin is strongly prognostic

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109
Q

What are the indications for thoracotomy (5)?

A
  • Haemothorax - >1500ml immediately or >200ml/hs for 2-4 hours
  • Diaphragmatic/oesophageal laceration
  • Widening of mediastinum >8cm
  • Cardiac tamponade
  • Large unevaluated clotted haemothorax
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110
Q

What are the different type of E.Coli infection?

A

Enteroinvasive - dysentery, large bowel necrosis/ulcers
Enterotoxigenic - SI, travellers diarrhoea
Enterohaermorrhagic - 0157, haemorrhage colitis, HUS and TTP

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111
Q

What degree of tumour shrinkage is implied by a partial response?

A

At least 50%

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112
Q

What fluid resuscitation should patients with burns receive?

A

Parkland formula - %burn x weight (kg) x 4
Give half in 8 hours then half in 16 hours

Rule of 9s for adults
Children similar but more for head and less for legs

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113
Q

What is the optimum treatment for gastric variceal bleeding?

A

Cyanoarcylate injection or thrombin

2015 BSG Guidelines

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114
Q

What is the optimum skin preparation agent?

A

2% alcoholic chlorhexidine

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115
Q

What is amifostine?

A

A chemotherapy adjunct which is used to:

  • reduce nephrotoxicity of cisplatin
  • reduce the proctitis with radiation
  • reduce mucositis in head and neck cancers
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116
Q

What comprises a major haemorrhage protocol?

A

20ml/kg Blood
20ml/kg FFP
10ml/kg Platelets
5ml/kg Cryo

Aim for Hb>80, Platelets >75, Fibrinogen >1.5g/l (Cryo), INR<1.5 (FFP)

Nb TXA

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117
Q

What is the eponymous name of a hernia and hydrocele combined?

A

Gibbon hernia

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118
Q

From where are glomus tumours derived?

A

Tissue around AV shunts

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119
Q

What blood products should patients with variceal haemorrhage receive?

A

PRC target of 70-80g/l
Platelets if active bleeding and plt<50
FFP if fibrinogen <1g/L or PT/APTT>1.5
PCC for warfarinised patients

2015 BSG Guidelines

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120
Q

Why are neat alcohols not used for skin sterilisation?

A

Not sporicidal

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121
Q

What is the Hinchey classification of diverticulitis

A

1a) Pericolic inflammation
1b) Pericolic abscess
2a) Distant abscess amenable to drainage
2b) Complex abscess +/- fistula
3) Purulent peritonitis
4) Faecal peritonitis

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122
Q

What are the borders of a Petit hernia?

A

LD, Iliac crest and External oblique (inferior lumbar triangle)

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123
Q

From which AA are catecholamines primarily derived?

A

Tyrosine

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124
Q

What are the antiseptic preps of choice?

A

0.5% chlorhex in 70%alcohol hydrex

2% chlorhex in 70%alcohol (chloraprep)

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125
Q

What is hiflow nasal oxygen and its characteristics?

A

Ultra high flow oxygen rates - 50-60l/min

  • humidified
  • well tolerated
  • T1RF (although can washout CO2)
  • applies some PEEP due to flow rate
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126
Q

What is Bouveret’s syndrome?

A

Gastric outlet obstruction caused by gallstones

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127
Q

Which type of breast cancer is characterised by a lymphocytic infiltrate?

A

Medullary

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128
Q

What is the most common cause of intussusception?

A

Lymphoid hyperplasia in Peyer’s patches of gut. Most prominent in ileocolic segment

Other causes include Meckel’s diverticula, Duplication cysts, B cell lymphoma
Tend to present 2months to 2 years

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129
Q

When is oesophageal perforation most likely after ingesting Alkaline agents?

A

3 days. Perform OGD within 12-24 hours

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130
Q

What variables comprise the SOFA score (8)?

A 
MAP
GCS
Creatinine
Urine output
Platelet count
Bilirubin
Inotrope use
PaO2/FiO2 ratio
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131
Q

A Patey mastectomy requires division of which muscle?

A

Pectoralis minor

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132
Q

What is the diagnostic test for thalasaemia?

A

High performance liquid chromatography

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133
Q

What is the incidence of chronic pain after inguinal hernia repair?

A

10-15%

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134
Q

Which patients with melanoma should receive staging imaging?

A

IIC without SLNB or suspected III/IV

Consider MRI for <24

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135
Q

how does lidocaine work?

A

Blockade of axonal sodium channels

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136
Q

Types of hernias

1) Bochdalek
2) Obturator
3) Lumbar hernia
4) Richters Hernia
5) Morgagni Hernia
6) Littres Hernia

A

1) Most common congenital, 85% Left M>F, associated with lung hypoplasia
2) Hernia through obturator canal, F>M, behind pectinous muscle
3) Lumbar triangle (crest of ilium inferiorly, EO laterally and LD medially)
4) Antimesenteric border of bowel
5) Rare, herniation through foramen of Morgagni, more on right
6) Inguinal hernia containing Meckel’s diverticulum

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137
Q

what is the mechanism of action of TXA?

A

Prevents conversion of plasminogen to plasmin (and hence fibrin degradation)

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138
Q

Which artery can be encountered and is at risk during Femoral hernia repair (medially)

A

Obturator artery

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139
Q

What factors shift the oxygen-hb dissociation curve to the right?

A

Left shift = increased oxygen binding (decreased delivery)
Right shift = decreased oxygen binding (increased delivery)

CADET face right
CO2
Avid
DPG
Exercise
Temperature
140
Q

What is the pathological process in HIT?

A

Antibodies to Heparin-Platelet 4 complex (HP4)

141
Q

Which nerve is at risk in a posterior approach to the hip?

A

Sciatic (and both inferior/superior gluteal nerves)

142
Q

What is Beck’s triad?

A

Pericardial tamponade

  • Raised JVP
  • Muffled heart sounds
  • Narrow pulse pressure
143
Q

What size of non-enhancing area of pancreas defines necrosis?

A

> 3cm

144
Q

What are some characteristics associated with Choledochal cysts?

A

F:M = 4:1
Increased risk with anomalous pancreaticobiliary duct union (APBDU) or long common channel >10mm due to risk of enzyme reflux
80% present in childhood

145
Q

What is the minimal amount of blood required to produce melaena?

A

60ml

146
Q

How is the anion gap calculated?

A

(Na + K) - (Cl+HCO3)

Normal 10-18mmol/l

147
Q

What are the components of the Rockall score?

A

Age
Shock
Comorbidities (CLD/CRF/malig worse than IHD/others)
Diagnosis (MW

148
Q

What drains should be left after peptic ulcer repair?

A

Probably none, but could leave a suture site (WSES guidelines 2020)

149
Q

What is the inheritance of Peutz Jeghers syndrome?

A

Autosomal dominant

150
Q

What is Mackler’s triad?

A

Boerhaave’s syndrome

  • Vomiting
  • Pain
  • SC emphysema
151
Q

How does botox exert its effects?

A

Inhibition of release of Acetyl Choline into neuronal synapse

152
Q

What are the physiological effects seen with laparoscopy?

A

Increased - airway pressure, V/Q mismatch, SVR

Decreased - FRC, pulmonary compliance, venous return

153
Q

What are Kidney stones most frequently comprised of

A

40% Calcium oxalate

20% Calcium oxalate/phosphate
15% Calcium phosphate
15% Ammonium magnesium phosphate (Struvite)
10% Uric acid

154
Q

What is the mechanism of action of unfractionated heparin?

A

Activation of antithrombin 3

155
Q

which characteristics can be calculated from an art line?

A

Left ventricular contractility
Stroke volume
Peripheral vascular resistance
Fluid responsiveness

156
Q

What is the cause of pinworm?

A

Enterobiasis vermicularis

157
Q

With what tumours are Bartonella infections associated?

A

Vascular tumours such as haemangiosarcomas

158
Q

What is Bergmans triad?

A

Fat embolism

  • Dyspnoea
  • Petechiae of axilla or thorax
  • Altered mental status
159
Q

In which inherited bleeding tendency is bleeding time increased?

A

von Willebrand’s disease (nb other platelet problems as well)

160
Q

What is the eponymous name for a femoral hernia occurring anterior to the vessels?

A

Velpeau hernia

161
Q

What is the MUST tool?

A

Assessment of malnutrition
BMI (if <18.5 = 2)+ Unplanned weight loss(0-5,5-10,10) + acute illness/no intake >5 days

Score of 2/more or at high risk

162
Q

How should patients with UGI bleed be risk stratified?

A

Using the Glasgow-Blatchford score

0-1 - outpatient OGD
2-6 - I/P OGD
7+ - urgent I/P OGD

163
Q

What is the mechanism of action of gentamicin and tetracyclines?

A

Inhibit protein synthesis by 30s subunit

164
Q

In which situation are IgM Anti Heb B seen?

A

Acute infection

165
Q

Which mutation is associated with BCCs in Gorlin’s syndrome?

A

PTCH1

166
Q

In ABO incompatibility transfusion reactions in patients with blood type O what Ig is implicated?

A

IgG

167
Q

How does bupivacaine work?

A

Binds to intracellular portion of sodium channels

Very cardiotoxic - contraindicated in regional

Levobupivicaine (chirocaine) less cardio toxic and causes less vasodilation

168
Q

What is an important differential for pyogenic granuloma?

A

Amelanocytic melanoma

169
Q

How does chlorhexidine work?

A

lysis of cell wall

170
Q

What is Dieulafoys triad?

A

Appendicitis

  • hyperaesthesia
  • tenderness
  • guarding

over McBurney’s point

171
Q

What is the daily protein requirement?

A

0.8-1.5g/kg/day

172
Q

When should patients undergo radiologically guided drainage of pancreatic necrosis?

A

> 30% necrosis for culture

173
Q

How is cardiac output calculated?

A

CO = HR X SV

CO = MAP X SVR

174
Q

What is the Neve supply to biceps femoris?

A

Tibial nerve (L5,S1,S2)

175
Q

What are the different type of E.Coli infection?

A

Enteroinvasive - dysentery, large bowel necrosis/ulcers
Enterotoxigenic - SI, travellers diarrhoea
Enterohaermorrhagic - 0157, haemorrhage colitis, HUS and TTP

176
Q

What is the difference between Lynch 1 and Lynch 2 syndromes?

A

Lynch 1 CRC only

Lynch 2 - others (inc ovarian, endometrial)

177
Q

What are the characteristic findings of colonic CMV on biopsy

A

Multiple intranuclear inclusion biopsies on H&E

178
Q

What are some premalignant skin lesions?

A

Extra-mammary Paget’s disease
Bowen’s disease
Cutenaous horm
Giant congenital pigmented naevus

Adenoma sebaceum is not (benign flat lesions in tuberous sclerosis)

179
Q

What is the mechanism of action of quinolones and metronidazole?

A

Inhibit DNA synthesis

180
Q

What percentage of paediatric splenic injuries can be managed conservatively?

A

90%

181
Q

What should be done for secondary prophylaxis of oesophageal varies?

A

Repeat VBL 2-4 weekly until eradicated
NSBB

TIPPS if rebelled (PTFE Covered stents)
2015 BSG Guidelines

182
Q

Which infections can be associated with splenomegaly?

A

EBV
Malaria
Leishmainasis
Infective endocarditis

(Not listeria)

183
Q

What are the immediate physiological effects of laparoscopy?

A

Stretching of peritoneum –> vagal stimulation

Sinus Brady/nodal rhythm
Hypercarbia/acidosis

184
Q

Where do congenital diaphragmatic hernias most frequently occur?

A 
Posterolateral Bochdalek hernia
Defect in pleuroperitoneal fold
78% Left
20% right
2%bilateral
185
Q

What are the important determinants of a severe attack of pancreatitis?

A

1) Obesity
2) APACHE Score >8 in first 24 hours
3) After 48 hours any of:
CRP>150, Glasgow >3, persistent Organ failure

186
Q

How are type 4 hypersensitivity reactions primarily mediated?

A

T cells

187
Q

When should burn fluid resus be instituted?

A

> 15% BSA involvement (2nd degree or more)

188
Q

What are the excision margins for melanoma (pTis, pT1, pT2, pT3, pT4)

A

Stage 0 - 0.5cm
Stage 1 - 1cm
Stage 2 - 2cm

pTis - 2-5mm
pT1 (0-1mm) 1cm
pT2 (1-2mm) 1-2cm
pT3 (2-4mm)/pT4 - 2cm

189
Q

How long should Apixaban be discontinued prior to surgery

A

48 hours (half life is 12 hours)

For rivaroxaban and dabigatran probably 48-72 hours - variable half life

190
Q

What is the most common place for inguinal hernias to recur?

A

47% Pubic tubercle
40% deep ring
13% entire back wall

191
Q

What are the adverse consequences of massive transfusion?

A

Hypothermia
Hyperkalaemia
Acidosis
Hypocalcaemia

192
Q

What anticoagulant can be used for prevention of VTE in patients with HIT?

A

Fondaparinux (Synthetic Xa inhibitor)

193
Q

What is the T staging of melanoma?

A 
Tis
T0
T1 ≤1mm Breslow Thickness (to deepest point)
T2 1-2mm
T3 2-4mm
T4>4mm

Ta/b if ulcerated

194
Q

Which organ is most often injured in blunt abdominal trauma?

A

The spleen

195
Q

How is pancreatic necrosis defined on CT?

A

> 3cm area of no contrast uptake

196
Q

What size overlap of mesh for laparoscopic ventral hernias?

A

5cm

197
Q

What is the reversal success rate after vasectomy?

A

55% if <10 years

198
Q

In unstable patients, what are the risks of laparoscopy?

A

Increases in:

1) SVR
2) MAP
3) afterload
4) HR
5) IVC pressure
6) RR
7) Peak airway pressure
8) PaCO2

Decreases in:

1) SV
2) venous return
3) Thoracic compliance

199
Q

Risk factors for PUD?

A

1) NSAIDS (inhibit prostaglandin synthesis)
2) Smoking (inhibits HCO3- and nicotine increases H+)
3) H.pylori
4) Bariatric marginal ulcer
5) Fasting
6) Drugs
7) Zollinger-Ellison syndrome (consider if recurrent and multiple)
8) Alcohol

200
Q

In which types of sarcoma is neoadjuvant treatment used?

A

Ewings and Rhabdomyosarcoma

201
Q

Through which defect do Morgagni hernias occur?

A

Anterior space of Larrey

202
Q

Where are ectopic pregnancies most likely to occur?

A

Ampulla of Fallopian tube

203
Q

What grading system is used for SCC?

A 
Broder's grade
Grade 1 - well
2 - moderate
3 - poor
4  - anaplastic
204
Q

What are some causes of a raised anion gap acidosis?

A

Lactate: shock
Ketone: diabetic ketoacidosis, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol

205
Q

What is the Forrest classification of peptic ulcer bleeding?

A

Acute Haemorrage

1a) Active spurter
1b) Active oozing

Signs of recent haemorrhage

2a) Non-bleeding visible vessel
2b) Adherent clot
2c) Flat fomented haematin on ulcer base

Lesions without active bleeding
3) Clean -based ulcer

206
Q

What is the reversal agent for Rivaroxaban?

A

Andexanet alfa

207
Q

What are some risk factors for PONV?

A 
Female
Smoker
Previous history
Opiates
Hypotension
Ophthalmic/gynae surgery
208
Q

What ECG features may be seen with hypokalaemia?

A 
U waves
Small/absent T waves
Prolonged PR interval
ST depression
Long QT interval
209
Q

What factors does heparin administration affect?

A

2, 9, 10 and 11

210
Q

What is the reinfarct rate if a GA is performed within 1 month of a MI?

A

32%

211
Q

What is Meig’s syndrome?

A

Triad of benign ovarian tumour, ascites and pleural effusion that resolves after resection of tumour

212
Q

What is the most accurate means of establishing burns coverage?

A

Lund Browder chart > Wallace rule of nines

213
Q

Which mutations are associated with Polymerase ‘proof reading’ polyposis syndrome (PPAP)

A

POLD1/POLE genes

214
Q

Which antiretroviral is most classically associated with pancreatitis?

A

Didanosine

215
Q

What is the most common genetic influence on DVT?

A

FVL (7% prevalence)

Activated protein C deficiency

216
Q

What are the characteristics of antithrombin deficiency?

A

AD
Rare
Heparin ineffective
10 x risk

217
Q

What type of thrombosis is APL associated with?

A

Both arterial and venous

218
Q

How does dopamine work at intermediate doses?

A

Dopamine has varying effects due to alpha-1, beta-1 and dopaminergic acitivity

2-10ug/kg/min

Mostly Cardiac
B-1 –> increased contractility and HR
Increased CO and D effects –> increased mesenteric blood flow
Mild vasoconstriction

219
Q

How does CPAP differ from BIPAP?

A

CPAP continuous pressure of 10 (PEEP) up to 40-50% FiO2 (nb risk of aspiration)
Helps for T1RF

BIPAP dual level - PEEP + and inspiratory
the added hilevel helps for CO2 blow off in T2RF

220
Q

What is the total body water composition in males?

A

60% of weight therefore 42kg of 70kg

2/3 intracellular
1/3 extracellular - 75% interstitial 25% intravascular

221
Q

What is the risk of recurrent MI if surgery is conducted within 30 days of MI?

A

30%, 14% death

Decreases to:

  1. 7% at 2 months
  2. 4% at 3 months
  3. 9% at 6 months
222
Q

What is the most common type of hepatitis in children?

A

Hepatitis A

RNA Picornovirus
Usually resolves spontaneously

Hepatitis A IgM

223
Q

What is the minimum obligatory length of jejunum proximal to a jejunostomy required to avoid supplementary fluid/nutrition

A

100cm.

224
Q

An investigator wishes to determine the prevalence of acute colitis within a defined population. Which study type is appropriate?

A

Cross-sectional

225
Q

What are hedgehog inhibitors used for?

A

Metastatic unresectable BCCs

226
Q

In which setting should DOACs be avoided?

A

APL

227
Q

Which fingers tend to be affected most in Dupuytrens contracture?

A

Ring and little.

Middle may be affected in advanced cases. rarely index and thumb

228
Q

Which type of renal tract stones are more likely to occur with short gut syndrome?

A

Calcium oxalate stones - increased colonic absorption of calcium oxalate

229
Q

Which clotting factors are consumed most rapidly in DIC?

A

V and VIII

230
Q

What are the typical constituents of TPN?

A

Glucose, lipids, electrolytes. (No albumin)

231
Q

What cancers are associated with EBV?

A 
Burkitt's lymphoma
Hodgkin's lymphoma
Post transfusion lymphoma
Nasopharyngeal carcinoma
Gastric
232
Q

How can Hydatid cyst be classified?

A 
Gharbi classification
Type 1 - Purely cystic
Type 2 - membrane partly detached
Type 3 - Multicystic lesion with septae
Type 4 - Degenerated with pseudo-solid appearances
Type 5 Calcified cyst
233
Q

What is the most common cause of vascular prosthetic infections?

A

Stap epidermis

234
Q

What is the cause of hydatid cyst?

A

Echinococcus granulosus

Cestode with characterstic 3 segments
Rupture of mature cyst can cause reinfection or anaphylaxis

Two cyst walls - peri cyst (host) endocyst (organism)

Usually treat with mebendazole. Can use PAIR technique for multiple or deep seated if Type1/2

235
Q

What is Riglers triad?

A

Gallstone ileus AXR

  • SBO
  • Gallstone
  • Air in biliary tree
236
Q

What is the key plasma mediator of DIC?

A

Tissue factor - rich in lungs, brain and placenta, not normally exposed to blood

TF triggers extrinsic and then intrinsic clotting pathways

237
Q

How is SIRS defined?

A

Any two of:

T<36 or >38

HR>90

WCC>12 or <4 with >10% immature bands

RR>20 or PaCO2<4.26

238
Q

What are 5 inotropic agents used in critical care?

A

Noradrenaline α agonist Vasopressor action, minimal effect on cardiac output

Adrenaline α and β receptor agonist Increases cardiac output and peripheral vascular resistance

Dopamine β1 agonist Increases contractility and rate

Dobutamine β1 and β2 agonist Increases cardiac output and decreases SVR

Milrinone Phosphodiesterase inhibitor Elevation of cAMP levels improves muscular contractility, short half life and acts as vasodilator

239
Q

What ECG features may be seen with hyperkalaemia?

A

Peaked T waves
P wave flattening
Prolonged PR Interval
Widened QRS

240
Q

What is Whipple’s triad?

A

Insulinoma

  • Hypoglycaemia during attacks
  • Resolution of symptoms with correction of blood glucose
  • Symptomatic at low blood sugars
241
Q

What proportion of patients with asymptomatic hernias will present with increasing or pain or complications within 5 years?

A

25%

242
Q

What is the mechanism of action of Dabigatran?

A

Direct thrombin inhibition

243
Q

Is family history associated with inguinal hernia development?

A

Yes

244
Q

What are the components of the Glasgow Blatchford Score? (4+4)

A

Urea
Hb
SBP
HR

Maelena
CLD
CHF
Syndope

245
Q

What is the most common cause of GORD?

A

Increased transit lower oesophageal sphincter relaxations

246
Q

What type of ovarian cancer is strongly associated with BRCA?

A

Serous ovarian cancer - 10-20% risk of BRCA

247
Q

Prior to low bleeding risk procedures what is an acceptable platelet level?

A

> 50

248
Q

How can poorly differentiated skin SCCs be distinguished from melanoma?

A

Using S100 immunochemistry

249
Q

In patients with an UGI bleed, how should anticoagulants be managed?

A

Continue aspirin
Stop P2Y12 inhibitors until haemostasis UNLESS stents (40% risk of death/mi if stopped <1year), aiming to restart within 5-7 days
Stop warfarin and DOACs (nb idarucizumab and andexanet)

BSG guidelines 2020

250
Q

In ABO incompatibility transfusion reactions in patients with blood type A/B what Ig is implicated?

A

IgM

251
Q

How is Giardiasis treated?

A

Metronidazole

252
Q

What is the generic name for vicryl?

A

Polyglactin 910

253
Q

How can superficial partial thickness and deep partial thickness burns be differentiated?

A

no blanching with deep partial thickness

254
Q

Which familial condition is associated with papillary thyroid cancer?

A

FAP

255
Q

What is Borchardt’s triad?

A

Gastric volvulus

  • sudden epigastric pain
  • inability to vomit
  • inability to pass NG tube
256
Q

What is the difference between hypertrophic and keloid scars?

A

Excessive collagen not bound to original injury in keloid

257
Q

When should patients with perforated gastric ulcers have a repeat endoscopy?

A

6 weeks

258
Q

What is Quicke’s triad?

A

Haemobilia

  • Pain
  • UGI Bleed
  • Jaundice
259
Q

What are some causes of normal anion gap metabolic acidosis?

A

GI HCO3 loss
Renal tubular acidosis
Drugs e.g. acetazolamide
Addisons disease

260
Q

What are the characteristics of the ebb phase response to trauma?

A
  • Increased sympathetic activity
  • decreased BMR/energy expenditure
  • increased gluconeogenesis/glycogenolysis
261
Q

How long after placing a bare metal stent (cardiac) should surgery be delayed?

A

At least 1 month - 6 months for DES

Risk of sudden occlusion with BMS is less

262
Q

Which type of renal stone is most radio dense?

A

Calcium phosphate

263
Q

What is the inpatient mortality from variceal haemorrhage?

A

15%

264
Q

What is the cure rate of splenectomy for ITP?

A

90%

265
Q

What is Virchows triad

A

Risk of VTE

  • Flow
  • Vessel
  • Coagulability
266
Q

What is the most common cause of retroperitoneal abscess?

A

Renal infections (50%)

267
Q

What innervation does the genital branch of the genitofemoral nerve provide?

A

Cremaster muscle and side of scrotum/labia

268
Q

What is the incidence of a Meckels diverticulum?

A

2% (rule of 2s - 2inch/5cm long, 2feet (60cm) from IC valve - in ADULTS!, 2% incidence

269
Q

What evidence is there fore laparoscopic approach to perforated peptic ulcer disease?

A

Meta-analysis of 8 RCTs by Cirocchi

Concluded less pain/wound infections, but similar major outcomes

270
Q

What is Cushings triad?

A

Raised ICP

  • bradycardia
  • hypertension/raised PP
  • Irregular respirations
271
Q

What study reporting guidelines exist (6)?

A 
CONSORT - RCT
IDEAL - Surgical Innovation
MOOSE - Meta-analysis of observational studies
PRISMA - systematic Reviews
STROBE - Observational studies
TRIPOD - Predictive models
272
Q

How is minor surgery managed in Haemophillia A?

A

Desmopressin immediately prior

Severe may require repeated infusions of product

273
Q

How often is pneumococcal vaccine given post splenectomy?

A

5 yearly

274
Q

What is the difference between a Sengstaken-Blakemore and Minnesota tube?

A

SSB has 3 ports (two balloons, one gastric aspiration channel)
Minnesota has 4 - extra oesophageal aspiration channel

275
Q

Which clotting factors does Heparin prevent activation of?

A

2, 9, 10 and 11

276
Q

How does the momentum induce haemostasis?

A

Abundance of tissue factor activating extrinsic coagulation pathway

277
Q

Which nerve is at risk in a posterior approach to elbow?

A

Ulnar

278
Q

In which patients should VHL be screened for?

A

CNS haemangioblastomas

279
Q

How is an LA overdose treated?

A 
Stop injecting
High flow O2
CVS monitoring
Lipid emulsion (intralipid 20%) at 1.5ml/kg over 1 minute
Consider infusion at 0.25ml/kg/in
280
Q

What is Sipple’s syndrome?

A

MEN2a

281
Q

What is Bowens disease?

A

SCC insitu of skin

Full thickness atypic of dermal keratinocytes over a broad zone

282
Q

Where is most of dietary iron absorbed?

A

Duodenum

283
Q

What effect does chronic anaemia have on the O2Hb dissociation curve?

A

Shift to right as 2,3 DPG increased

284
Q

What is the initial inflation pressure of a Sengstaken Blakemore tube?

A

35-40mmHg, then deflated to 25mmHg when bleeding stops

285
Q

What is the mechanism of penicillins/cephalosporins?

A

Inhibition of cell wall formation

286
Q

When should a sentinel lymph node biopsy be offered for malignant melanoma?

A

Breslow thickness >1mm

287
Q

What proportion of circulating cortisol is protein bound

A

90%

288
Q

What is the most common cause of biliary disease in HIV?

A

(Secondary) Sclerosing cholangitis

from infections e.g. CMV, Crypto, Microsporidia

289
Q

What are the indications for transfer to burns centre?

A

> 15% BSA
Face/hands/genitals affected
Deep PT or FT burns
Significant electrical or chemical burns

290
Q

What is the best treatment for primary prophylaxis of variceal haemorrhage in Cirrhotic liver disease?

A

For Grade 2 or 3 varices - Non cardio selective beta blockers - propranolol>nadolol>carvedilol
For grade 1 varices without red signs, repeat OGD 1 year

2015 BSG Guidelines

291
Q

What is Becks triad?

A

For Cardiac tamponade - muffled heart sounds, raised JVP and low BP

292
Q

What antibiotic prophylaxis is required for endoscopy?

A

Routine - none
CVS disease - none

Therapeutic procedures - ERCP, PEG, PEC, EUSFNA –> 1 x dose

293
Q

What is MESNA?

A

A drug given to treat haemorrhagic cystic from cyclophosphamide

294
Q

How does water appear in a T2 weighted MRI

A

T2 = Water White

295
Q

If a non-operative approach is taken to perforated peptic ulcer, what treatments are required?

A

PPI
ABx
Anti-secretory (octreotide)

296
Q

What proportion of pancreatitis is caused by alcohol?

A

25%

50% GS
25% others

297
Q

What is the optimum treatment for diffuse gastric bleeding?

A

Argon plasma coagulation + PPI +/- proceed to surgery

298
Q

What are the metabolic effects of adrenergic receptor agonism?

A

Alpha

  • inhibits insulin release
  • stimulates glycogenolysis
  • stimulates glycolysis

Beta

  • Stimulates glucagon
  • Stimulates ACTH
  • stimulates lipolysis
299
Q

What are the greatest risk factors for rebreeding with UGI bleeds?

A 
Active bleeding 100%
Visible vessel 50%
Non bleeding ulcer with clot 30-35%
Oozing ulcer 10-27%
Clean based ulcer <3%
300
Q

What are the borders of a Grynfeltt hernia?

A

Quadratus lumborum, internal oblique muscle and 12th rib (Superior lumbar triangle)

301
Q

In premenopausal women which tumour markers are helpful for complex ovarian masses?

A

AFP, Beta-HCG, LDH

302
Q

What treatments are appropriate for UGI ulcer bleeds at endoscopy?

A

Combination therapy including Adrenaline injection +

1) Thermal method (APC or heater)
2) Clip
3) Fibrin or thrombin injection

PPI infusion

Biopsy to exclude cancer

Even in cancer, attempt endoscopic approaches first

303
Q

How does dopamine work at high doses?

A

Dopamine has varying effects due to alpha-1, beta-1 and dopaminergic acitivity

10-20ug/kg/min

Vasoconstrictive (a1) and cardiac
May reduce renal and mesenteric blood flow

304
Q

What is a Meckel’s diverticulum embryological origin?

A

Remnant of Vitelli intestinal duct (can be attached to umbilicus - rarely discharging)

305
Q

At what threshold chance of identifying a mutation should BRCA screening be offered?

A

10% chance

306
Q

An investigator wishes to determine whether individuals who work in one occupation are more likely to develop leukaemia than those in a different occupation. Which study type is most appropriate?

A

Cohort study - useful where groups are identified in advance of the condition

307
Q

What conditions are associated with Dupuytren’s contracture?

A

Idopathic
Liver cirrhosis
Alcoholism
TB (historically)

308
Q

What is the abnormality in patients with hereditary spherocytosis?

A

Spectrin deficiency –> RBC deformation

Risk of gallstones. Splenectomy when haemolytic crises increase

309
Q

What is the most common cause of acute bacterial diarrhoea?

A

Campylobacter jejuni

Spiral/comma shaped Gram-ve rods
Usually affects TI >colon
Can mimic appendicitis

310
Q

What is the failure rate for vasectomy?

A

1/2000

311
Q

how do sarcomas primary spread?

A

Haematogenous (often lung)

312
Q

How does dopamine work at low doses?

A

Dopamine has varying effects due to alpha-1, beta-1 and dopaminergic acitivity

Low does - <2ug/kg/min

  • Mostly renal
  • Increased blood flow (renal, cerebral, coronary and mesnteric due to vasodilatation (D receptors)
313
Q

Which ovarian tumour subtype has the worst prognosis?

A

Clear cell carcinoma

314
Q

What class of agent is 5-FU?

A

Antimetabolite (also Methotrexate, 6-mercaptopurine)

  • S-phase drug mimic of uracil incorporated into RNA
  • Skin changes, neurotoxicity, neuropathy, marrow suppression
315
Q

What class of agent is Doxorubicin?

A

Anthracycline (Adriamycin)

  • inhibits DNA/RNA synthesis
  • Risks - cardiac toxicity dose related, AML
316
Q

What type of agent is Etoposide?

A

Topoisomerase 2 inhibitor

317
Q

What type of agent is Cisplatin?

A 
Alkylating agent (also cyclophosphamide)
Crosslinks DNA in G1 phase

Risks - myelosuppression, ototoxicity, nephrotoxicity

318
Q

What type of agent is Vincristine?

A

Vinca alkaloid
M phase specific inhibition of microtubule formation

Main risk neurotoxicity

319
Q

How does paclitaxel work?

A

Prevents microtubule breakdown in m phase

Main risk is neuropathy

320
Q

What threshold HbA1c should be used to suggest referral for optimisation before elective surgery?

A

Above 8.5% or 69mmol/mol

CPOC guidelines 2021

321
Q

How should metformin be managed in the preoperative period?

A

If taken 1-2 times per day – continue
If taken 3 times per day - omit lunchtime dose

If contrast used and eGFR<60, omit on day and for 48 hours

(CPOC guidelines 2021)

322
Q

How should sulphonylureas be managed in the preoperative period?

A

Omit on morning of surgery

If AM operation and twice daily, can take PM

(CPOC guidelines 2021)

323
Q

How should glitazones, DPP4 inhibitors (Gliptins) and GLP-1 receptor agonists (e.g. exenatide) be managed preoperatively?

A

Take as normal

Omit SGLT-2 inhibitors (e.g. dapagliflozin) on day of surgery

(CPOC guidelines 2021)

324
Q

What glucose level defines hypoglycaemia?

A

<4mmol/l - ‘looming’ at 4-6

325
Q

What is the cause of toxic shock syndrome?

A

Exotoxin mediated illness most commonly by group A Strep (usually bad skin infection empyema, septic arthritis, new fasc) or Staph Aureus (more likely with tampons etc - menstrual vs non-menstrual)

326
Q

What are risk factors for toxic shock syndrome?

A

DM
Alcoholism
Injuries or surgical procedures

327
Q

What blood tests might be suggestive of necrotising fasciitis?

A 
CRP>150
WCC>25
Creatinine >141
Glucose >10
Hb<110
Sodium <135

Laboratory risk indicator for necrotising fasciitis (LRINEC)

328
Q

What treatment is required after drainage of uncomplicated paronychia?

A

No antibiotics

329
Q

What are risk factors for paronychia?

A 
Trauma
Artificial nails
manicures
Occupational
Oncychocryptosis
Onychophagia
330
Q

What is the lymphatic drainage of the uterus?

A

Fundus runs with ovarian vessels mostly - so to para-aortic, however some may pass through round ligament to inguinal nodes

Lower body - broad ligament –> iliac nodes

331
Q

What is the lymphatic drainage of the cervix?

A

3

  • laterally through broad ligament –> EI nodes
  • uterosacral fold –> presacral nodes
  • posterolaterally –> iliac nodes
332
Q

What is the diagnostic test for acute amoebic dysentery

A

Entamoeba histolytica stool ELISA

333
Q

Which chemotherapeutic agent causes dose related lung damage?

A

Bleomycin

334
Q

Which chemotherapeutic agent causes loss of deep tendon reflexes?

A

Vincristine

Also paralytic ileum, sensory motor neuropathy

335
Q

Which chemotherapeutic agent causes conjunctivitis and cerebellar toxicity?

A

Cytosine arabinoside

336
Q

Which chemotherapeutic agent causes dose related pancreatitis?

A

Asparginase

337
Q

What are the myotomes associated with reflexes - Biceps, Triceps, Supinator, Knee and Ankle?

A 
Biceps - C5/6
Triceps - C7/8
Supinator - C5/6
Knee  - L3/4
Ankle - S1/2
338
Q

Through which receptor does erythromycin exert its pro kinetic effects?

A

Motilin receptor

339
Q

What are the types of Necrotising Fasciitis?

A

Type 1 - polymicrobial (dm, immuno)
Type 2 - usually strep
Type 3 marine
Type 4 fungal

340
Q

How is sepsis defined in the SEPSIS 3 consensus?

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection

341
Q

What is the expected HbA1c threshold for elective surgery?

A

69mmol/l (8.5%)

342
Q

What is an appropriate tidal volume for ventilated patients with ARDS?

A

low volume 6ml/kg (as opposed >10ml/kg)

343
Q

In septic shock, when is Sodium bicarb indicated?

A

pH≤7.2 and AKI 2-3

344
Q

In sepsis when should enteral feeding be instituted?

A

within 72 hours

345
Q

Which muscle abducts the vocal cords?

A

Posterior cricoarytenoid (innervated by RLN)

FRCS (13 decks)

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