MD2 Interest

Question 1

Describe the Whipples procedure and it’s indication.

Answer 1

Whipples procedure is used to treat pancreatic masses, typically pancreatic cancer. The procedure involves removes the head of pancreas as well as the part of the duodenum associated with the pancreas. This leaves three ‘floating’ organs - the stomach with/without proximal duodenum, remaining biliary tree (hepatic ducts) and the tail of the pancreas.
The jejunum is raised and attached to the tail of pancreas most proximally followed soon by the attachment of the biliary tree.
Downstream the stomach and remaining duodenum are attached to more distal jejunum.
5 year survival rate is 25%.

Question 2

What is an ERCP, what is it used for?

Answer 2

Type of endoscopy used to assess pathologies of the biliary tree or pancreas. Endoscope goes to duodenum.

Question 3

Best test to check for resected prostate tumour recurrence or met?

Answer 3

PSA test - only made by prostatic tissue

Question 4

Which are the two broad causes of inability to move/apply force (great qn to ask patients).

Answer 4

Is the issue with POWER or with PAIN.

Question 5

Is redness a good indicator of cellulitis progression? If not, what is?

Answer 5

Redness typically last longer than the infection itself, a better gauge for patient progression is patient habits, such as walking around, general mood, eating etc.
That can be followed by checking inflammatory markers.

Question 6

What is the Tx for Dog and cat bites?

Answer 6

Clean and Antibiotics (augmentin commonly) and tetanus jab. Rabies if in different part of the world.

Question 7

New onset headache over the age of 60 should be treated as ____ until proven otherwise.

Answer 7

Giant cell arteritis

Question 8

What is a capture beat? What diagnosis does it accompany?

Answer 8

Capture beat is a normal QRS complex amidst abnormal QRS findings. A normal positive QRS amongst wide and negative QRS complexes is a capture beat. Capture beats indicate the patient is in VTach. Physiologically, the capture beat is a coincidental occurrence where the P waves managed to cause ventricular depolarisation in Vtach, instead of the ectopics.

Question 9

In which patients is fentanyl preferred to morphine?

Answer 9

Patients with renal disease. Fentanyl is solely processed by the liver.

Question 10

Compare the clinical uses of ceftriaxone and cephazolin.

Answer 10

These are both cephalosporins, but cephazolin is a 1st gen and ceftriaxone is 3rd gen. The further along in terms of generation, the more gram neg is targeted and the less gram + is targeted.

As such, Cephazolin is used for mainly gram + coverage, and is therefore common in surgery.
Ceftriaxone used mainly for gram - and therefore used a lot in medicine.

Question 11

What is the first sign of anaphylaxis?

Answer 11

HR increases, then BP falls, then airway becomes difficult.

Question 12

What is a common cause of pre-surgical nausea?

Answer 12

Hypotension

Question 13

What is the metabolite of codeine?

Answer 13

Morphine

Question 14

What is myeloma and what could be a sign of myeloma on regular blood test?

Answer 14

Myeloma is a Plasma B cell cancer that produces a huge amount of monoclonal antibodies called paraproteins. ‘Globulin’ on blood test may be higher than usual in myeloma.

Question 15

Why does myeloma cause anemia?

Answer 15

Myeloma causes overcrowding of the bone marrow and resource shunting into cancer production - no resources/room for RBCs.

Question 16

How can an immunoglobulin screen indicate myeloma?

Answer 16

Test indicates relative ratio of different Ig types - if one is way up and the others are low, it indicates myeloma.

Question 17

Is radiotherapy just for malignant conditions?

Answer 17

No, can be used for any unwanted growth of tissue eg. keloids or gynocomastia

Question 18

What are some side effects of radiotherapy?

Answer 18

Fatigue is the main one, redness/pinkness is common only at site of therapy. Later on scar tissue can form at the site.

Question 19

What is the most devastating side effect of acute hyponatremia?

Answer 19

Brain herniation - often in athletes who guzzle too much water

Question 20

Which two broad categories can be applied to PE’s?

Answer 20

Provoked or unprovoked.
Provoked = did something to cause it, eg. long flight, surgery etc.

Unprovoked - didn’t do anything - typically cancer.

Question 21

What is the ideal stoma output?

Answer 21

Less than 1L a day

Question 22

What is a Boari Flap?

Answer 22

Almost like an Ivor Lewis but for ureter and bladder - ureter portion is resected and then bladder is brought up to meet it.

Question 23

How can methotrexate be used as chemo?

Answer 23

Folate inhibitors stop DNA synthesis, killing rapidly dividing cells.

Question 24

What is the curable paradox of aggressive lymphoma?

Answer 24

The more aggressive the easier it is to cure. Indolent lymphomas are essentially incurable.

Question 25

What is neoadjuvant therapy?

Answer 25

Therapies used to shrink tumours that are not surgery - (used adjacent to surgery). Eg. radiation and chemotherapy

Question 26

Why do Ivor Lewis Patients often have lung complications?

Answer 26

Lung is forcibly collapsed to make room for anastomoses, chest drain common to remove leaked air (pneumothorax).

Question 27

What is the impact of hormonal contraception on gynae cancers and breast cancers?

Answer 27

All hormonal contraceptives (due to all of them including progesterone) will decrease the rate of gynae cancers by 30% due to no ovulation and therefore less cell turnover. However, the risk of breast cancer is slightly increased with all hormonal contraceptives.

Question 28

How could you differentiate between epidido-orchitis and testicular torsion?

Answer 28

Cremasteric reflex - testicle will not rise in torsion but will rise in orchitis.
Prehn’s sign - pain will not reduce in torsion but will reduce in orchitis.