Miscellaneous

Question 1

Colorectal cancer referral guidelines

Answer 1

>40 , WL and abdo pain
>50 PR bleeding
>60 IDA/CIBH
rectal/abdo mass
consider

Question 2

Upper GI referral guidelines

Answer 2

Dysphagia
>55 weight loss and any of upper abdo pain, reflux dyspepsia

non-urgent, >55 treatment resistant dyspepsia, upper abdo pain with low Hb, thrombocytosis with any of N, V, WL, reflux, dyspepsia, upper abdo pain

Question 3

Post-op complicaitons

Answer 3

Immediate: primary haemorrhage, basal atelectasis, shock, low urine output

Early: acute confusion, fever, secondary haemorrhage, pneumonia, wound or anastomsosi dehiscence, DVT, acute urinary retention, UTI, psot-op wound infection
paralytic ileus

Late: adhesions, incisional hernia, persistent sinus, recurrence, keloids

Question 4

Wells score fo rPE

Answer 4

Alternative less likely 3.5
Signs and symptoms of DVT 3.5
Tachycardia 1.5
3 days immobility/4 weeks surgery 1.5
previous DVT/PE 1.5
Malignancy 1
Haemoptysis

4 or less unlikely

more than 4 likely

Question 5

Stimulant laxatives

Answer 5

Senna 2-4 tablets
Bisacodyl 5-10mg
Docusate sodium 500mg
avoid in obstruction

Question 6

Osmotic laxatives

Answer 6

Macrogol 1-3 sachets daily in divided doses

dissolved in water

Question 7

Treatment for opioid induced constipation

Answer 7

Dietary fiber

Osmotic (macrogol+senna)

Question 8

Before disclosure

Answer 8

Try to gain consent
Ensure harm from not disclosing
Warn patient before hand
Anonymise if possible
Minimum information
Minimum number of people

Question 9

Duty of Candour conversation

Answer 9

given in person
account of all known facts
indicate further investigations will be undertaken
include an apology
be recorded in writing

Question 10

Five key principles of MCA

Answer 10

Presumption of capacity
Supported 
Unwise do not equal lack of capacity
Best interests
Least restrictive

Question 11

Before treating patient who lacks capacity

Answer 11

LPA/deputy of court?
Advance decision

then- best interests
advance statements?
friends/relatives

least restrictive
quality of life

Question 12

Justifications for withdrawing treatment for patients with capacity

Answer 12

Futility
Lack of clinical benefit
Patient refusal

Question 13

Justifications for withdrawing treatment for patients without capacity

Answer 13

Futility
Not invest interests
prior refusal/advance decision