General Surgery

Question 1

What surgery and anastomosis for Caecal, ascending or proximal transverse colon?

Answer 1

Right hemicolectomy

Ileo-colic

Question 2

What surgery and anastomosis for Distal transverse, descending colon?

Answer 2

Left hemicolectomy

Colo-colon

Question 3

What surgery and anastomosis for sigmoid colon?

Answer 3

High anterior resection

Colo-rectal

Question 4

What surgery and anastomosis for Upper rectum?

Answer 4

Anterior resection (TME)

Colo-rectal

Question 5

What surgery and anastomosis for low rectum?

Answer 5

Anterior resection (Low TME)

Colo-rectal (+/- defunctioning stoma)

Question 6

What surgery and anastomosis for anal verge?

Answer 6

Abdomino-perineal excision of rectum

No anastamosis

Question 7

What are the criteria for CT head within 1 hour?

Answer 7

1) GCS < 13 on initial assessment
2) GCS < 15 at 2 hours post-injury
3) suspected open or depressed skull fracture
4) any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
5) post-traumatic seizure.
6) focal neurological deficit.
7) more than 1 episode of vomiting

Question 8

What are the criteria for CT head within 8 hours?

Answer 8

1) age 65 years or older
2) any history of bleeding or clotting disorders including anticogulants
3) dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
4) more than 30 minutes’ retrograde amnesia of events immediately before the head injury

Question 9

What are risk factors for transition cell carcinoma of bladder?

Answer 9

1) Smoking
2) Exposure to aniline dyes
3) Rubber manufacture
4) Cyclophosphamide

Question 10

What are risk factors for squamous cell carcinoma of bladder?

Answer 10

1) Schistosomiasis
2) Smoking

Question 11

What is the management for all patients with peripheral artery disease?

Answer 11

Statin
Clopidogrel

Question 12

What is the management of epididymo-orchitis?

Answer 12

ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days

Question 13

What is the management of BPH?

Answer 13

1st line: alpha-1 antagonists e.g. tamsulosin, alfuzosin
2n line: 5 alpha-reductase inhibitors e.g. finasteride

Question 14

What is the Parkland formula for fluid resuscitation in burns?

Answer 14

total body surface area of the burn % x weight (Kg) x 4ml

Question 15

What does iliac claudication manifest as?

Answer 15

Buttocks pain

Question 16

What does femoral claudication manifest as?

Answer 16

Calf pain

Question 17

What is the possible complication of too much fluid resuscitation following surgery?

Answer 17

Hyperchloraemiac acidosis

Question 18

What is the most common type of breast cancer?

Answer 18

Invasive ductal carcinoma AKA ‘No Special Type (NST)’

Question 19

What are risk factors for breast cancer?

Answer 19

1) HRT
2) Early menarche
3) Late menopause
4) COCP

Question 20

What is often the cause of epididymo-orchitis in young people?

Answer 20

Chlamydia

Question 21

What are the screening rules for AAA?

Answer 21

<3cm- normal: no further action

3-4.4cm- small aneurysm- rescan every 12 months

4.5-5.4cm- medium aneurysm: rescan every 3 months

≥ 5.5cm- large aneurysm: Refer within 2 weeks to vascular surgery for probable intervention

Question 22

What is the management of hydroceles?

Answer 22

• infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
• conservative in adults but may warrant further ix with US to look for underlying cause e.g. tumour.

Question 23

What is the manangement of hiatus hernia?

Answer 23

1) conservative e.g. weight loss
2) medical: PPI
3) surgical: only really has a role in symptomatic paraesophageal hernias

Question 24

What is the management of hydatid cyst?

Answer 24

Surgery (the cyst walls must not be ruptured during removal and the contents sterilised first)

Question 25

What are the 6 Ps of limb-threatening sichaemia?

Answer 25

pale
pulseless
painful
paralysed
paraesthetic
‘perishing with cold’

Question 26

What is the management of acute limb-threatening ischaemia?

Answer 26

Initial:
ABC
analgesia
IV unfractionated heparin
vascular review

Definitive:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation: for patients with irreversible ischaemia

Question 27

What is the management of peripheral artery disease?

Answer 27

1) Statin (atorvastatin 80mg)
2) Clopidogrel
3) Exercise training

If severe:
1) endovascular revascularization
2) surgical revascularization

Question 28

What is the first-line investigation for prostate Ca?

Answer 28

Multiparametric MRI

Question 29

What is the management of renal stones?

Answer 29

< 5mm and asymptomatic: watch and wait

5-10mm: shockwave lithotripsy
10-20 mm: shockwave lithotripsy OR ureteroscopy

> 20 mm: percutaneous nephrolithotomy

Question 30

What is the management of ureteric stones?

Answer 30

<10mm: shockwave lithotripsy +/- alpha blockers

10-20 mm ureteroscopy

Question 31

What are the most common causes of small bowel obstruction?

Answer 31

Adhesions

Followed by Hernias

Question 32

What is the management of subarachnoid haemorrhage?

Answer 32

1) Supportive (bed rest, analgesia, VTE prophylaxis, stop antithrombotics)
2) Oral Nimodipine (prevent vasospasm)
3) Intracranial aneurysm intervention (coil by IR)

Question 33

What is the management of volvulus?

Answer 33

1) sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion

2) caecal volvulus: management is usually operative. Right hemicolectomy is often needed