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MRCP Part 1 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

How can you differentiate the following in terms of pain, fever and jaundice?
Biliary Colic
Acute cholecystitis
Ascending cholangitis

A

Colic: Intermittent pain
Acute cholecystitis: Constant pain + fever
Ascending cholangitis*: Constant pain + Fever+ jaundice/raised bilirubin
*Also have confusion and hypotension

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2
Q

What is the first line imaging for biliary pathology

A

USS to exclude obstruction

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3
Q

What is the treatment for the following?
Biliary Colic
Acute Cholecystitis
Ascending cholangitis

A

Colic: Cholecystectomy within 6 weeks
Cholecystitis: Cholecystectomy in 1 week
Cholangitis: Urgent ERCP (24-48hrs)

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4
Q

How can the following be differentiated from colic/acute cholangitis/ascending cholangitis?
Primary sclerosing cholangitis
Primary biliary sclerosis
Cholangiocarcinoma

A

Have RUQ pain and jaundice
No fever
PSC/PBC cause itching
RUQ mass +/- shoulder/umbilical nodes in cholangiocarcinoma

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5
Q

What is the first and definitive line investigation in PSC/PBC?

A

USS for obstruction
MRCP for biliary tree visualisation

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6
Q

What is the first line and definitive imaging in cholangiocarcinoma?

A

USS
CT

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7
Q

What condition gives a ‘beaded’ appearance on MRCP?

A

PSC

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8
Q

What RUQ pain condition is most associated with ulcerative colitis?

A

PSC

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9
Q

How does PSC and PBC differ in terms of immune markers?

A

PSC: p-ANCA
PBC: AMA-2, raised IgM

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10
Q

What can be used to treat itch due to raised bilirubin?

A

Cholestyramine

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11
Q

Outline the treatments for
PSC
PBC
Cholangiocarcinoma

A

PSC: Liver transplant
PBC: Ursodeoxycholic acid  transplant
Cholangiocarcinoma: Typically palliative measures (can potentially resect if really

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12
Q

What are the causes of acute pancreatitis?

A

I GET SMASHED
Idiopathic
Gallstones
Ethanol (alcohol)
Trauma
Steroids
MUMPS/malignancy
Autoimmune
Scorpion sting
Hypercalcaemia
ERCP
Drugs

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13
Q

What scoring system is used for severe pancreatitis?

A

Glasgow criteria: PANCREAS
PaO2 < 8
Age >55
Neutrophils >15
Calcium < 2
Renal (urea > 16)
Enzymes LDH +++

Albumin <32
Sugar >10

Severe pancreatitis >=3

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14
Q

What are the investigations for acute pancreatitis?

A

1st: Amylase/lipase (>=3x is diagnostic)
GS: CT with contrast
USS to check for obstructive cause

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15
Q

What is the management of acute pancreatitis?

A 
Slow enteral (NG tube) feeding 
IV Fluids and analgesia
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16
Q

Milder pancreatitis symptoms 3 weeks post acute pancreatitis indicates what?

A

Pseudocyst
Milder symptoms and amylase raise
Conservative management

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17
Q

How do you investigate chronic pancreatitis?

A
  1. CT with contrast for calcification
  2. Faecal elastase for malabsorption if above unclear
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18
Q

How often should chronic pancreatitis have Hb1AC monitored?

A

Annually

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19
Q

Painless jaundice indicates what?

A

Pancreatic cancer until proven otherwise

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20
Q

What is the first line and GS investigations for pancreatic cancer?

A

1st: USS for obstruction
GS: High-res CT

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21
Q

What cancer marker is relevant to pancreatic cancer?

A

CA 19-9 (also cholangiocarcinoma)

22
Q

How do you manage pancreatic cancer?

A

2 week referral
Whipple’s or stenting for palliative cases

23
Q

Umbilical pain that shifts to RIF worse on movement and pressing LIF is likely

A

Appendicitis
Rovsing’s sign is the LIF pressing causing RIF pain

24
Q

Appendicitis symptoms + high fever + peritonitism indicates

A

Perforation

25
Q

How is appendicitis diagnosed?

A

Clinical history + raised WCC diagnostic
+ Urine analysis for pregnancy + renal colic
+ CT if another diagnosis more likely

26
Q

What is the treatment for appendicitis?

A

Prophylactic Abx + laparoscopic appendectomy

27
Q

What are the features of bowel obstruction?

A

Green, bilious vomiting
Constipation +/- tinkling bowel sounds
Abdominal distention + pain

28
Q

How can you differentiate between small and large bowel obstruction

A

Small // Large
Adhesions, post-op ileus, hernia, intussusception // Malignancy, stricture, volvulus

29
Q

What are the investigations for suspected obstruction

A
  1. AXR for gross cause
  2. Contrast CT for more detail
    CXR to exclude obstruction
30
Q

How does an ileus present differently to a volvulus

A

Ileus has absent rather than tinkling bowel sounds

31
Q

How does a caecal and sigmoid volvulus present image differently?

A

Caecal foetal sign
Sigmoid  coffee bean
White line tends to be on side of volvulus

32
Q

How does bowel lumen dilation help diagnose obstruction

A

How does bowel lumen dilation help diagnose obstruction 3/6/9 rule
>3cm: Small
>6cm: Caecal
>9cm: Sigmoid

33
Q

Patient presents with severe, sudden onset general abdominal pain. They are systemically well but have a history of AF, what is the likely diagnosis?

A

Mesenteric ischaemia

34
Q

How can the following causes of bowel ischaemia be differentiated?
Acute mesenteric ischaemia
Chronic mesenteric ischaemia
Ischaemic colitis

A

AMI: Acute pain, disproportionate to Obs
CMI: Colicky pain, rarer
IC: Transient pain, bloody diarrhoea, ‘thumbprinting on X-ray’. Cocaine use in young people

35
Q

How do you image for bowel ischaemia

A

USS for obstruction
CT for diagnosis
+ lactic acidosis and raised WCC on blood

36
Q

What is the management for acute mesenteric ischaemia and ischaemic colitis?

A

AMI: Emergency surgery
IC: Supportive

37
Q

What hernias are found in the following places?
Superior and medial to pubic tubercle
Below and lateral to pubic tubercle
Symmetrical bulge under umbilicus
Asymmetrical bulge under umbilicus

A

Superior + medial: Inguinal
Below and lateral: Femoral
Symmetrical bulge under umbilicus: Umbilical
Asymmetrical bulge under umbilicus: Paraumbilical

38
Q

How can you determine if an inguinal hernia is direct or indirect? Why is this significant?

A

Reduce and press 2/3 between ASIS and pubic symphysis then get patient to cough
Indirect will be restrained
Direct will not
Indirect more likely to be bowel so run risk of bowel strangulation

39
Q

What is the management of an umbilical hernia in a child?

A

Observe for resolution until 2
If unresolved then operate

40
Q

Fresh painless PR bleeding and altered bowel habit in patient without lumps or itch on PR exam indicates what

A

Diverticular disease

41
Q

LIF pain (sometimes RIF), fever and systemically unwell +/- PR bleeds points towards what colorectal issue?

A

Diverticulitis

42
Q

How do you investigate diverticulitis?

A

CT with contrast

43
Q

mixed PR bleeding and altered bowel habit in elderly patient with microcytic anaemia suggests what?

A

Colon cancer

44
Q

Who must get referred for suspected colorectal cancer?

A

>=40yrs: abdo pain + weight loss
>=50yrs: Unexpected bleeding
>=60yrs: Change in bowel habit/microcytic anaemia with low ferritin

45
Q

What does this AXR show

A

Small bowel obstruction

Valvulae conniventes: White lines going FULL WIDTH across bowel

46
Q

What does the following x ray show?

A

pneumoperitoneum

Can see wall above diaphram on both sides

47
Q

What are the causes of post-op pyrexia?

A

Wind: Pneumonia, atelectasis (1-2 days)

Water: UTI (>3 days)

Wound: Infections (>5 days)

Walking: DVT (>1 week)

Wonder drugs/What did we do

+ abscess

48
Q

What blood changes are seen in TPN?

A

Low phosphate, magnesium, zinc

High glucose

49
Q

What points towards toxic megacolon over sigmoid volvulus?

A

History of UC/IC

More systemically unwell

50
Q

Diarrhoea, abdo pain, joint pain +/- neuro or cardiac deficits is caused by what?

A

Whipple’s disease (Tropheryma whipplei)

PAS positive macrophages

Co-trimox

MRCP Part 1 (32 decks)

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