Passmed

Question 1

WHO surgical safety checklist items

Answer 1

1. sign in - before induction of anesthesia
2. time out - before incision of the skin
3. sign out - before the patient leaves the operating room

Question 2

What has to be checked during sign in on the WHO surgical safety checklist

Answer 2

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

Question 3

NICE guidelines to referral for colorectal cancer

Answer 3

2WW:
patients >= 40 years with unexplained weight loss AND abdominal pain

patients >= 50 years with unexplained rectal bleeding

patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces

Question 4

What imaging should be used if cholecystitis is suspected but not confirmed on ultrasound

Answer 4

HIDA/hepatobiliary scintigraphy: This nuclear medicine test measures the function of the gallbladder and its drainage into the small intestine

Question 5

Describe pyoderma gangrenosum

Answer 5

Purple, violaceous and undermined ulcer
May become deep if the tissue necrosis.
Typically very painful
Occur on the lower legs
Large
Starts with erythematous nodules or pustules which ulcerate

Question 6

What procedure should be done for cancer at the following sites:
Caecal
Ascending
Proximal transverse colon
Distal transverse colon
Descending colon
Sigmoid colon
Upper rectum
Lower rectum
Anal verge

Answer 6

Caecal: R hemicolectomy + ileo-colic anastomosis
Ascending: R hemicolectomy + ileo-colic anastomosis
Proximal transverse colon: R hemicolectomy + ileo-colic anastomosis
Distal transverse colon: L hemicolectomy + colo-colon anastomosis
Descending colon: L hemicolectomy + colo-colon anastomosis
Sigmoid colon: high anterior resection + colo-rectal anastomosis
Upper rectum: anterior resection + colo-rectal anastomosis
Lower rectum: anterior resection + colo-rectal anastomosis +/2- defunctioning stoma
Anal verge: abdomino-perineal excision of rectum

Question 7

What investigation is indicated prior to surgery to assess the nodal burden in breast cancer?

Answer 7

No palpable lymphadenopathy and negative axillary US -> Sentinel node biopsy

Question 8

Difference between acute tubular necrosis and acute interstitial nephritis

Answer 8

ATN: Period of hypotension + renal impairment (e.g. taking nephrotoxic meds) -> urinary casts and ATN

AIN: drug-induced hypersensitivity -> fever, rash, eosinophilia

Question 9

Complications of TURP

Answer 9

TURP syndrome (1. Hyponatraemia 2. fluid overload 3. glycine toxicity)
Urethral stricture and UTI
Retrograde ejaculation
Perforation of the prostate

Question 10

medications used for RSI

Answer 10

Induction agent
Neuromuscular agent e.g. suxamethonium / rocuronium (risk of allergy)

Question 11

Examples of non-depolarising muscle agents

Answer 11

Atracurium
Pancuronium

Question 12

When is suxamethonium contraindicated

Answer 12

Suxamethonium is contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure