general surgery

Question 1

retractile testis fx

Answer 1

retractile testis can be brought into the scrotum by the clinician and when released remains in the scrotum. If the examining clinician notes the testis to return rapidly into the inguinal canal when released then surgery is probably indicated.

Question 2

duodenal ulcer presentation and artery

gastric

Answer 2

pain a few hours after eating, gastroduodenal (posterior)

pain on eating, left gastric (lesser curve)

Question 3

Blatchford score vs

Rockall score

Answer 3

to determine the severity of a suspected GI bleed and whether or not the patient needs admitting +/- the requirement for urgent upper GI endoscopy.

used at endoscopy to assess possible prognosis in light of the patients diagnosis and other variables.

Question 4

renal cancers:
polycythaemia
hydronephrosis, dilation irregular
4 yo

Answer 4

adenocarcinoma
transitional cell carcinoma (commonly painless haematuria)
nephroblastoma

Question 5

liver cyst differential

Answer 5

simple cysts, cancers (cystic hepatocellular carcinoma or metastases), amoebic abscesses, hydatid cysts, pyogenic abscesses, and fungal microabscesses

Question 6

femoral canal

Answer 6

Laterally Femoral vein
Medially Lacunar ligament
Anteriorly Inguinal ligament
Posteriorly Pectineal ligament

Question 7

Dieulafoy Lesion

Answer 7

Often no prodromal features prior to haematemesis and malaena, but this arteriovenous malformation may produce quite considerable haemorrhage and may be difficult to detect endoscopically

Question 8

ix for fistulae

Answer 8

MRI

CT and barium?

Question 9

burns fluid resus

Answer 9

4ml x tbsa x body weight

50% first 8h 50% next 16h

Question 10

cryptorchidism (undescended testes)
ddx
tx

Answer 10

retractile testes

Orchidopexy at 6- 18 months of age. The operation usually consists of inguinal exploration, mobilisation of the testis and implantation into a dartos pouch.
Intra-abdominal testis should be evaluated laparoscopically and mobilised. Whether this is a single stage or two stage procedure depends upon the exact location.
After the age of 2 years in untreated individuals the Sertoli cells will degrade and those presenting late in teenage years may be better served by orchidectomy than to try and salvage a non functioning testis with an increased risk of malignancy.

Question 11

Lynch syndrome

Answer 11

hereditary non-polyposis colorectal cancer

Question 12

hyperkalaemia on ecg

Answer 12

Peaked or 'tall-tented' T waves (occurs first)
Loss of P waves
Broad QRS complexes
Sinusoidal wave pattern
Ventricular fibrillation

Question 13

complication of achalasia

Answer 13

SCC

Question 14

nerves:
burning pain of her anterior thigh which worsens on walking. There is a positive tinel sign over the inguinal ligament

She has pain over the inguinal ligament which radiates to the lower abdomen. There is tenderness when the inguinal canal is compressed.

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

Answer 14

lateral cutaneous nerve

inguinal hernia surgery and ilioinguinal nerve.

femoral nerve

Question 15

left chest pain and epigastric tenderness

Answer 15

boerhaaves

Question 16

definition of upper gi bleed

Answer 16

proximal to ligament of treitz

Question 17

Dumping syndrome

Answer 17

can be divided into early and late, may occur following gastric surgery. It occurs as a result of a hyperosmolar load rapidly entering the proximal jejunum. Osmosis drags water into the lumen, this results in lumen distension (pain) and then diarrhoea. Excessive insulin release also occurs and results in hypoglycaemic symptoms.

Question 18

use of:
calcitonin
thyroglobulin antibodies
thyroid peroxidase antibodies

Answer 18

• completeness of surgical resection
• elevated in thyroid cancer
• found in graves and hashimoto’s

Question 19

management of bleeding peptic ulcer that has not responded to endoscopy

Answer 19

laparotomy

Question 20

indication for splenectomy

Answer 20

haemodynamic instability and complete devascularisationof the spleen

Question 21

AFP associated with

Answer 21

HCC

Question 22

hepatic haemangioma

Answer 22

Most common benign tumours of mesenchymal origin
Incidence in autopsy series is 8%
Cavernous haemangiomas may be enormous
Clinically they are reddish purple hypervascular lesions
Lesions are normally separated from normal liver by ring of fibrous tissue
On ultrasound they are typically hyperechoic

Question 23

deccekeration injury
haemodynamically stable
free fluid abdomen

Answer 23

Duodeno-jejunal flexure disruption

Question 24

dermato fibroma

Answer 24

bigger on palpation, slightly pigmented

Question 25

hesselbachs triangle boundaries

Answer 25

Medial: Rectus abdominis
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament

Question 26

cullens sign

boas sign

Answer 26

peri umbilical haemorrhage- pancreatitis

hyperaesthesia under right scapula cholecystitis

Question 27

Spondylolisthesis features

Answer 27

This occurs when one vertebra is displaced relative to its immediate inferior vertebral body
May occur as a result of stress fracture or spondylolysis
Traumatic cases may show the classic ‘Scotty Dog’ appearance on plain films
Treatment depends upon the extent of deformity and associated neurological symptoms, minor cases may be actively monitored. Individuals with radicular symptoms or signs will usually require spinal decompression and stabilisation

Question 28

pseudomyxoma peritonei

Answer 28

Pseudomyxoma peritonei is a rare mucinous tumour most commonly arising from the appendix. The disease is characterised by the accumulation of large amounts of mucinous material in the abdominal cavity. It is rare, with an incidence of 1-2/1,000,000 per year

Question 29

retroperitoneal fibrosis

Answer 29

an uncommon condition and its aetiology is poorly understood. In a significant proportion the ureters are displaced medially. In most retroperitoneal malignancies they are displaced laterally. Hypertension is another common finding. A CT scan will often show a para-aortic mass

Question 30

Peptic stricture

Answer 30

Longer history of dysphagia, often not progressive. Usually symptoms of GORD. Often lack systemic features seen with malignancy

Question 31

peutz jeghers syndrome

Answer 31

STK11 (LKB1) mutation on chromosome 19 in some (but not all) cases, dominant
Multiple benign intestinal hamartomas
Episodic obstruction and intussusception
Increased risk of GI cancers (colorectal cancer 20%, gastric 5%)
Increased risk of breast, ovarian, cervical pancreatic and testicular cancers

Question 32

Cowden disease

Answer 32

Mutation of PTEN gene on chromosome 10q22, dominant
Macrocephaly
Multiple intestinal hamartomas
Multiple trichilemmomas
89% risk of cancer at any site
16% risk of colorectal cancer

Question 33

Angiodysplasia

Answer 33

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 34

Meckel’s diverticulitis

Answer 34

A Meckel’s diverticulum is a congenital abnormality that is present in about 2% of the population
Typically 2 feet proximal to the ileocaecal valve
May be lined by ectopic gastric mucosal tissue and produce bleeding

Question 35

Pilonidal sinus

Answer 35

Usually in the natal cleft of male patients after puberty.
It is more common in Caucasians related to their hair type and growth patterns.
The opening of the sinus is lined by squamous epithelium, but most of its wall consists of granulation tissue. Up to 50 cases of squamous cell carcinoma have been described in patients with chronic pilonidal sinus disease.
Hairs become trapped within the sinus.
Clinically the sinus presents when acute inflammation occurs, leading to an abscess. Patients may describe cycles of being asymptomatic and periods of pain and discharge from the sinus.
Treatment is difficult and opinions differ. Definitive treatment should never be undertaken when acute infection or abscess is present as this will result in failure.
Definitive treatments include the Bascom procedure with excision of the pits and obliteration of the underlying cavity. The Karydakis procedure involves wide excision of the natal cleft such that the surface is recontoured once the wound is closed. This avoids the shearing forces that break off the hairs and has reasonable results.

Question 36

classes of shock

Answer 36

Class I shock would be completely compensated for.

Class II shock would cause tachycardia.

Class III shock causes tachycardia and hypotension as well as confusion.

Class IV shock causes loss of consciousness as well as severe hypotension.