General surgery

Question 1

Rovsing’s sign

Answer 1

Appendicitis

Question 2

Boas sign (hyperalgesia below right scapula)

Answer 2

Cholecystitis

Question 3

Murphy’s sign

Answer 3

Cholecystitis

Question 4

Inguinal hernias in relation to pubic tubercle

Answer 4

Above and medial to pubic tubercle

Question 5

Femoral hernia in relation to pubic tubercle

Answer 5

Below and lateral

Question 6

Spigelian hernia

Answer 6

Lateral ventral hernia - older pts.

hernia through Spigelian fascia between rectus abdominus and semiluinar line

Question 7

Richter’s hernia

Answer 7

Can present w/ symptoms of strangulation without bowel obstruction

Question 8

Congenital inguinal hernia:

should these be repaired:

Answer 8

Yes as soon after diagnosis due to risk of incarceration

Question 9

Infantile umbilical hernia
Most common in:
should these be repaired:

Answer 9

Afro-caribbean infants

Most resolve before the age of 4-5 years

Question 10

Wound dehiscence mx.

Answer 10

Coverage of wound with saline impregnated gauze
IV broad-spectrum antibiotics
Analgesia
IV fluids

Question 11

Major pre-disposing factor for liver abscess

Answer 11

Biliary sepsis

Question 12

Most common extra-intestinal manifestation of Amoebiasis

Answer 12

Liver abscess

Question 13

Hydatid cysts are seen with which infection:

Answer 13

Echinococcus (tape worm)

Question 14

Cryptorchidism
Complications:
tx.

Answer 14

Infertility, testicular cancer, testicular torsion, cosmetic appearance
Orchidopexy at 6-18 months of age

Question 15

Spondylolithesis classical appearance on X-ray

Answer 15

Scotty dog.

Question 16

ECG findings Hyperkalaemia:

Answer 16

Peaked, tall-tented T waves
Loss of P waves
Broad QRS 
Ventricular fibrillation 
Sinusoidal wave pattern

Question 17

Complications of enteral feeding:

Answer 17

Diarrhoea, aspiration, metabolic (hyperglycaemia, refeeding syndrome)

Question 18

Diagnostic investigation for femoral hernia

Mx.

Answer 18

Usually clinical although ultrasound is used

Surgical repair is essential due to the risk of incarceration

Question 19

High out-put fistula may be managed with which endocrine drug:

Answer 19

Octreotide - reduces pancreatic secretions

Question 20

When is most fluid lost after burning:

Answer 20

24 hours after

Question 21

Parkland formula

Answer 21

4 ml X (total burn surface area) X body mass (KG)

Fluids given:
50 % in the first 8 hours
50 % in the next 16 hours

Question 22

In burns what blood components should be monitored:

Answer 22

Packed red cells, plasma sodium, base excess and lactate

Question 23

In-direct inguinal hernia

Anatomy:

Answer 23

Protrudes down through inguinal ring passes lateral to the inferior epigastric artery

Question 24

Direct inguinal hernia

Anatomy:

Answer 24

Protrudes through Hesselback triangle passes medial to the epigastric artery.

Question 25

Hiatus hernia mx.:

Answer 25

All pts. benefit from wt. loss Medical - PPI Surgical - only has a role in para-oesophageal hernias

Question 26

Hiatus hernia most sensitive test:

Answer 26

Barium swallow although many have endoscopy and HH is found incidentally

Question 27

First-line imaging hydatid cysts:

Answer 27

Ultra-sound used 1st line | CT used to differentiate between hydatid and amoebic cysts

Question 28

Normal small bowel diameter on XR

Answer 28

35mm

Question 29

Normal large bowel diameter on XR

Answer 29

55 mm | 5.5 cm

Question 30

Hepatocellular carcinoma diagnostic investigations

Answer 30

CT/ MRI (or both) serial AFP No place for biopsy

Question 31

What should also be examined in cases of increased AFP

Answer 31

Testes

Question 32

Main risk factor for cholangiocarcinoma

Answer 32

PSC

Question 33

Cholangiocarcinoma - markers elevated:

Answer 33

CA-19-9 CEA CA125

Question 34

Indications for surgery in a lower GI bleed:

Answer 34

Pts. > 60 years Continued bleeding despite endoscopic intervention Recurrent bleeding Known cardio disease

Question 35

Lower GI bleeding - unstable pt. ix.

Answer 35

CT Angiogram

Question 36

Stable pt. lower GI bleeding ix.

Answer 36

Colonoscopy

Question 37

Lower GI bleed believed to be haemorrhoidal ix.

Answer 37

Proctosigmoidoscopy

Question 38

Massive haemeorrhage - Transfusion electrolyte disturbances

Answer 38

Hypothermia (transfused blood is cold) Hypocalcaemia (FFP and platelets contain calcium chelating compounds) Hyperkalaemia (plasma RBCs stored for 4-5 weeks have more potassium)

Question 39

Massive haemorrhage definition

Answer 39

Whole blood volume in 24 hours or 50% of circulating blood in 3 hours loss of 150 ml/minute -

Question 40

Axillary node clearance - potential nerve injuries:

Answer 40

Long thoracic, thoracodorsal nerve and intercostobrachial nerve

Question 41

Carotid endarterectomy potential nerve injury

Answer 41

hypoglossal

Question 42

Posterior triangle biopsy potential nerve injury

Answer 42

(spinal) Accessory nerve (CNXI)

Question 43

Anterior resection of rectum: potential nerve injury

Answer 43

Hypogastric autonomic nerves

Question 44

posterior approach hip potential nerve injury

Answer 44

Sciatic nerve

Question 45

Which transplants are greatest risk of rejection

Answer 45

Renal

Question 46

Pneumoperitoneum ix. of choice:

Answer 46

CXR

Question 47

What type of injury will deteriorate with vigorous ventilation attempts:

Answer 47

Tension pneumothoraces

Question 48

What are cardiac contusions? | How to manage?

Answer 48

Essentially bruising of the myocardium - often overlying sternal fracture Px. as cardiac arrhythmias - Perform echocardiography to exclude pericardial effusions and tamponade

Question 49

What does blood at the urethral meatus indicate:

Answer 49

Urethral tear

Question 50

What does high riding prostate on PR exam indicate:

Answer 50

Urethral disruption

Question 51

Diaphragm disruptions are more common on which side?

Answer 51

Left

Question 52

Long term TPN infusions should be administered through what type of vein:

Answer 52

A central vein - preferably via PICC line

Question 53

Xenograft:

Answer 53

Transplantation of tissue from another species

Question 54

Commonest cause of organic erectile dysfunction:

Answer 54

Vascular causes

Question 55

Tamsulosin MoA

Answer 55

a-1 antagonist

Question 56

Commonest cause of large bowel obstruction:

Answer 56

Colorectal carcinoma