General surgery document i found

Question 1

Investigation for suspected AAA?

• quick test
• gold-standard

Answer 1

1) Do an ultrasound FAST scan - quick and non-invasive, cannot accurately diagnose but this can be deduced from the clinical scenario (e.g. hypotensive, deteriorating)
2) Gold-standard: CT aortagram

Question 2

Management of chronic anal fissure (>6 weeks)

Answer 2

First line is GTN

if this doesn’t work after 8 weeks, consider referral for surgery/botox

Question 3

What is Gardener’s syndrome? And pattern of inheritance?

Answer 3

Autosomal dominant
Multiple colonic polyps
Due to colonic polyps, most patients will undergo colectomy to reduce risk of colorectal cancer

Question 4

Management of cardiac tampnade

Answer 4

Urgent decompression of the pericardial sac
Thoracotomy (lateral incision between the ribs) or sternotomy (midline incision through the sternum)
In the emergency setting, a thoracotomy is better than a sternotomy
Pericardiocentesis (percutaneous needle decompression of the pericardium) is a viable and temporary measure of relieving cardiac tamponade when thoracotomy is not available

Question 5

One of the first signs of anaesthetic poisoning?

Answer 5

Perioral tingling

Question 6

Antidote for severe local anaesthetic toxicity?

Answer 6

IV lipid emulsion

known as “lipid rescue”

Question 7

Daily fluid loss for an adult?

Answer 7

2.5-3.0 litres

Question 8

Daily requirement of sodium for an adult?

Answer 8

~100-150mmol

3L of detrose saline or 1L of normal saline and 2L of 5% dextrose would provide the normal amount of sodium

Question 9

Should you give potassium post-op?

Answer 9

Technically not necessary because damaged cells release potassium

Question 10

Treatment of acute pancreatitis?

Answer 10

Fluid resucitation and oxygen

Question 11

How would you manage asymptomatic AAA?

Answer 11

Asymptomatic abdominal aortic aneurysms are generally followed up in the outpatient setting until they reach 5.5cm, at which point elective surgery is recommended. The risk of rupture is greatest when the aneurysm is greater than 5.5cm and the benefits of undergoing elective surgery outweigh that of emergency repair of a rupture

Question 12

Surgery for poorly controlled ulcerative colitis?

Answer 12

Pan-colectomy is the resection of the entire colon with the formation of an ileostomy, which is indicated for poorly controlled ulcerative colitis

Question 13

When would you use uteroscopy for removal of renal stones?

Answer 13

You would use it in individuals where lithotripsy is contraindicated (e.g. pregnant women)