MRCS

Question 1

Liposarcoma

Answer 1

1. Most common variant sarcoma
2. Have a pseudocapsule that should be completely removed
3. Can grow quite large before producing symptoms (pain or fullness in abdomen)
4. Surgery is the mainstay of treatment
5. Cell type has no implication of survival and prognosis.
6. Frequently have pulmonary metastasis.

Question 2

Retroperitoneal sarcoma

Answer 2

10-20% of all sarcoma are retroperitoneal

Question 3

Anastomotic leak

Answer 3

Manifest early after post op

Question 4

Obstructed internal hernia

Answer 4

Medical condition wherein an internal organ protrudes through the peritoneal or mesentery but remains within the abdominal cavity

Question 5

Steatorrhoea (pale sticky bulky stools)

Answer 5

Deficiency of lipase

Question 6

Lipase

Answer 6

Breakdown fats into fatty acids and triglycerides

Question 7

Boerhavve’s syndrome

Answer 7

• Full thickness (transmural) perforation of esophagus at the left lower end
• Caused by a sudden rise in intraesophageal pressure during forceful or repeated vomitting.
• Usually, after heavy meal.
• Tear is most commonly in the lower third of the esophagus, 2-3cm proximal to gastroesophageal junction.
• gastrograffin tests will confirm the diagnosis.
• perforation not confined to the defect which is seen, it can extend either way under the muscular and requires myotomy to see full longitudinal extent. Layered closure with intercostal muscle flap should be done.
• 20-30% mortality if not treated at time.
• Full thickness suturing is required.

Question 8

Urinary bladder

Answer 8

Ureters join the posterior surface of urinary bladder.

Apex of the bladder is connected to the umbilicus by median umbilical ligament, which is a remnant of the urachus.

Question 9

Acute pancreatitis

Answer 9

Diagnosis confirmed by amylase, lipase, and CT finding.

Question 10

Symptoms of pancreatitis

Answer 10

Abdominal pain, radiate to the back
Acute: nausea and vomiting, fast HR, fast and shallow breathing, fever
Chronic: indigestion and pain after eating, LOA, LOW, fatty poop, dizziness due to low BP

Question 11

Causes of pancreatitis

Answer 11

Gallstones
Heavy drinking
Hypertriglyceridemia
Infection
Autoimmune pancreatitis
Inherited gene mutations
Complication of cystic fibrosis
Hypercalcemia
Ischemia
Cancer
Traumic injury
Medications

Question 12

Complications of severe acute pancreatitis

Answer 12

Necrosis and infection > septic shock > multi organ failure
Pancreatic pseudocysts > may become infected/ larger/ bleed
Chronic pancreatitis > scarring of tissue (fibrosis)

Question 13

Complications of chronic pancreatitis

Answer 13

Exocrine pancreatic insufficiency (EPI), malabsorption and malnutrition.
Hypoglycemia,hyperglycemiaandType 1 diabetes.
Chronic pain
Increased risk of pancreatic cancer

Question 14

Modified Glasgow score

Answer 14

PaO2 <8kPa (60mmHg)
Age >55yo
Neutrophils >15x10⁹/L
Calcium <2mmol/L
RP: urea >16mmol/L
Enzymes: AST/ALT >200iu/L or LDH >600iu/L
Albumin <32g/L
Sugar >10mmol/L

Question 15

Structural (Mechanical) Disorders of esophagus

Answer 15

Intrinsic Encroachment
 — Mucosal rings and webs: Schatzki, Plummer-Vinson, or multi ringed esophagus (eosinophilic esophagitis)
 — Strictures (inflammatory or fibrotic): peptic, caustic, pill, or radiation-induced
 — Esophageal tumors: adenocarcinoma, squamous cell carcinoma, metastatic (breast or melanoma), leiomyoma, lymphoma, or granular cell tumor
 — Systemic diseases: scleroderma (multifactorial), pemphigus/pemphigoid, lichen planus, or Crohn’s disease
 — Miscellaneous: postsurgery (laryngeal, esophageal, or gastric cancers), acute esophageal infections, esophageal diverticulae, or foreign bodies

Extrinsic Compression
 — Mediastinal masses: lung cancer, lymphoma, lymph node, or thyromegaly
 — Vascular compression: dysphagia lusoria (aberrant right subclavian artery), dysphagia aortica (right-sided aorta), or cardio-megaly (enlarged left atrium)
 — Miscellaneous: cervical spine osteophytes/spondylosis or fundoplication

Motor Disorders
 — Primary: achalasia, diffuse esophageal spasm, hypertensive lower esophageal sphincter, ineffective esophageal motility disorder, or nutcracker esophagus
 — Secondary: connective tissue diseases, scleroderma, CREST syndrome, diabetes, Chagas disease, or para neoplastic syndrome

Question 16

tension pneumothorax

Answer 16

Penetrating injury has produced a one way valve, air enters the pleural space but can not leave

Mechanical compression of IVC gives rise to hypotension.

Treatment involves immediate decompression with a large-bore cannula inserted into the second intercostal space on the midclavicular line on the side of tension pneumothorax before a definitive chest drain is provided.