General Surgery

Question 1

TPN complications

Answer 1

sepsis, re-feeding syndromes
hepatic dysfunction-

Question 2

carotid endarectomy nerve damage

Answer 2

hypoglossal nerve

Question 3

Indications for thoracotomy in haemothorax include

Answer 3

> 1.5L blood initially
losses of >200ml per hour for >2 hours

Question 4

Answer 4

Riglers sign

Question 5

Posterior approach to total hip arthroplasty nerve damage

Answer 5

sciatic nerve- foot drop

Question 6

complications of enteral feeding

Answer 6

diarrhoea
aspiration
hyperglycaemia
refeeding syndrome

Question 7

long term feeding for unsafe swallow

Answer 7

PEG tube feeding

Question 8

Richter hernia

Answer 8

Richter’s hernia can present with strangulation without symptoms of obstruction
metabolic acidosis

Question 9

low heart rate alongside warm, flushed peripheries

Answer 9

neurogenic shock

Question 10

strangulated inguinal hernia management

Answer 10

do not attempt to manually reduce
open flat mesh repair repair

Question 11

FAST scans (focused assessment with sonography for trauma)

Answer 11

used in trauma to quickly assess the extent of free fluid in the chest, peritoneal or pericardial cavities

Question 12

septic shock

Answer 12

fall in systemic vascular resistance
increase HR
normal/increased cardiac output
decreased BP
warm peripheries

similar to neurogenic and anaphylactic - distributive shock

Question 13

hypovolemic shock

Answer 13

increased SVR
increased HR
decreased CO
decreased BP

Question 14

cariogenic shock

Answer 14

increased SVR
increased HR
decreased CO
decreased BP

Question 15

Abdominal wound dehiscence should initially be managed with

Answer 15

coverage of the wound with saline impregnated gauze + IV broad-spectrum antibiotics

return to theatre

Question 16

Bilateral and recurrent inguinal hernias

Answer 16

are generally repaired laparoscopically using a mesh

Question 17

unilateral inguinal hernias

Answer 17

repaired even if asymptomatic
open approach

Question 18

peri anal crohns biological therapy

Answer 18

infliximab

Question 19

neurogenic shock treatment

Answer 19

vasopressors

Question 20

A large hyperechoic lesion in the presence of normal AFP

Answer 20

haemangioma

Question 21

angiodysplasia presentation

Answer 21

Apart from bleeding, which may be massive, these arteriovenous lesions cause little in the way of symptoms. The right side of the colon is more commonly affected.

Question 22

inguinal hernia in children

Answer 22

indirect- persistent processus vaginalis

Question 23

In acute cholecystitis there is hyperaesthesia beneath the right scapula

Answer 23

Boas’ sign

Question 24

Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended.

Answer 24

Psoas stretch sign

Question 25

Answer 25

small bowel obstruction

Question 26

weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh.

Answer 26

femoral nerve injury

Question 27

congenital umbilical hernia

Answer 27

manage conservatively
(vs. inguinal –> repair ASAP)