PassMed Qs Flashcards
What is the best option for long term feeding?
PEG tube feeding
(Feeding jejunostomy requires general anaesthetic)
What medications should a patient with PAD be put on?
Clopidogrel (anti platelet)
Atorvastatin
What procedure is used to cure UC without needing a stoma?
Panproctocolectomy and ileoanal pouch
What is a FAST scan used for?
Focused Assessment with Sonography for Trauma
Looks for free fluid present in abdomen or thorax
What is the best way to differentiate between biliary colic and acute cholecystitis?
Patients with acute cholecystitis will be systemically unwell
Fever
Tachycardia
Tachypnoea
What to do with a baby presenting with a hydrocele?
Communication hydroceles are common in babies
Surgical Repair if it doesn’t repair in 1-2 years
What is the end result with a Hartmann’s procedure?
End Colostomy
What can a UTI increase the risk of?
Acute Urinary Retention
What conditions can predispose you to having gallstones?
Chron’s
Diabetes
What procedure would you perform for a mid-rectal tumour?
Anterior Resection
What is the diagnosis for a patient with a widened mediastinum and persistent hypotension despite been giving multiple fluids?
Aortic Rupture
What is the next step in management when you suspect appendicitis?
IV prophylactic abx before appendicectomy
What is the benefit of epidural anaesthesia post colorectal surgery?
Faster return of normal bowel function
What tests for females with RIF pain?
- Pregnancy
- USS abdomen (appendicitis)
What score of ABPI would indicate the need for angioplasty?
<0.5 (critical limb ischaemia)
When can you not use laparoscopic technique rather than open surgery?
Acute intestinal obstruction as increases risk of perforation
What is the first test needed when a male patient presents with Erectile Dysfunction?
Serum Testosterone
What is the management for acute pancreatitis and what should you not give?
IV fluids
IV Opioids
Oxygen (if hypoxic)
NEVER ABX
What type of testicular tumour has normal AFP and HCG levels?
Seminoma
Why may a patient that has had a laparoscopic cholecystectomy present to you weeks later with RUQ pain and jaundice?
Gallstones present in the common bile duct
A man presents to you with a fever, right sided abdominal tenderness during a DRE. What is your diagnosis?
Appendicitis
How would you manage sigmoid volvulus?
How would this differ if a patient is showing signs of peritonism?
Therapeutic flexible sigmoidoscopy with flatuence tube
Go straight to urgent laparotomy
What drug can increase the risk of pancreatitis?
Sodium Valproate
What would blood tests show on biliary colic?
Normal ALP/GgT
Normal AST + ALT
Normal CRP
What markers in the blood would indicate pancreatitis severity?
Hypocalcaemia (below 2)
Low oxygen (below 7?)
What site is the most common for ischaemic colitis?
Splenic flexure
What is the screening programme for AAA?
Single USS at 65 years old
What screening is required for suspected prostate cancer?
- Multiparametric MRI
Transrectal USS guided biopsy second line
What is the management for superficial thrombophlebitis?
Compression Stockings
NSAIDs
What drug can be given for chronic renal stones/hypercalcaemia?
Bendroflumethiazide
(increase Ca excretion)
What is the mechanism of tamsulosin?
Alpha-1 antagonist
Relaxes smooth muscle of prostate and bladder
What are some side effects of tamsulosin?
Dizzines
Postural Hypotension
CT kidney shows a mass with a cystic centre. What is the likely diagnosis?
Renal Adenocarcinoma
What else is needed when doing a wide local excision for breast cancer?
Sentinel Node biopsy
Whole breast radiotherapy
A 27 year old woman presents to you in GP with a breast lump, what do you do?
Non urgent referral to breast clinic if under 30§
What is the first line treatment for cyclical mastalgia?
Supportive bra and analgesia (paracetamol)
A 76 year old female presents to you with a fragility fracture. What is the next steps of management?
Start alendrotnic acid if over 75 years following a fragility fracture while awaiting a DEXA scan
What are the causes for raised Prolactin?
Pregnancy
Pyhsiological
Prolactinoma
Polycystic ovary syndrome
Primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone
What medications should be held in a C Diff infection?
Opioids
Increase risk of toxic megacolon
What cancer can Primary Sclerosing Cholangitis increase the risk of?
Cholangiocarcinoma
What is the most common microorganism in central line infections?
Staph epidermidis
What is the first line investigation for chron’s patients with perianal fistulae?
MRI Pelvis
What are the surgical indications for UC patients?
Severe flares failing to respond to medical therapy
Flare causing perforation/dilatation
Chronic continuous disease causing impaired QoL
Cancer
What are the surgical indications for Chron’s patients?
Obstruction
Severe perianal disease unresponsive to medical therapy
Major bleeds
Severe disability
What is the first line investigation for acute mesenteric ischaemia and what will it show?
Serum Lactate will be raised
How will a Proximal aortic dissection present? How may it appear on ECG?
Central tearing chest pain
Aortic Regurgitation murmur
ST elevation in II, III, aVF
What is the investigation for suspected aortic dissection?
CT Aortic Angiogram
Would normal libido indicate an organic or inorganic cause for erectile dysfunction?
Organic
(Vascular or neurogenic cause)
How would a uric acid renal stone present?
Radioluscent (may not appear on CT)
Recent chemo can increase urate levels
How does a cysteine renal stone present?
Radiodense on CT
Family Hx
How does a struvite renal stone present?
Staghorn calculus
What are the risk factors for an emboli causing acute limb ischaemia?
AF
Recent MI
What is the mechanism of action of goserelin?
GnRH agonist
How does chronic pancreatitis presents and what is its management?
Chronic back pain relived by leaning forward and worse after eating
Analgesia and Creon
When would you use EVAR as oppose to bypass surgery?
Bypass for >10cm stenosis
EVAR for less
In what conditions can Amylase increase?
Pancreatitis
SBO
What imaging is required for suspected appendicitis?
NOTHING
Clinical diagnosis only
How do you manage wound dehiscence?
Cover with saline soaked gauze and broad spectrum IV abx
What would be the difference between FAP and Lynch syndrome causing cancer on colonoscopy?
Lynch syndrome:
Tumour of colon but rest of colonic mucosa normal
FAP:
Tumour of colon and rest of mucosa has polyps
Testicular swelling with mumps and testicular sweeping after cystoscopy. Which ones which?
Mumps - orchitis
Cystoscopy - Epididymo-orchitis
A 68-year-old man is found to have a tumour 1cm from the anal sphincter. What operation should she have?
Abdomino-perineal excision of the colon and rectum
A 64-year-old lady is found to have a rectal tumour. What operation should she have?
Anterior resection
A patient presents to you in GP with asymptomatic inguinal hernia, what should you do?
Routine referral for surgical repair
How does a common bile duct stone present?
Epigastric pain radiating to back, worse on eating
(misdiagnosed as peptic ulcer)
Obstructive jaundice and palpable smooth mass in RUQ?
Head of pancreas Ca
(Courvoisier’s law)
How do you manage a diverticular flare?
(abdo pain, fever, blood in stool)
Send home with oral abx
If doesn’t improve within 3 days A&E for IV abx
What is a benefit of circumcision?
Reduces HIV transmission in heterosexual men
Main difference between colostomy and ileostomy?
Colostomy - flush to skin
Ileostomy - spouted
Which nerve is at risk with a THR?
Sciatic
A patient presents with acute-onset loin-to-groin pain and fever. What is your next step?
Patients with obstructive urinary calculi and signs of infection require urgent renal decompression and IV antibiotics due to the risk of sepsis
What drug should you give before goserlin and why?
Flutamide
Reduces the flare effect’
(initial increase in luteinizing hormone production prior to receptor down-regulation)
How does diverticular disease present? How does appear it on CT? What is the best conservative management?
Persistant diarrhoea
Diffuse abdo pain
Blood in stool
Mural thickening and the presence of pericolic fat stranding in the sigmoid colon
Increase fruit and veg
What is the management of a diverticular stricture?
Laparotomy
(flexi sigmoidoscopy is for volvulus)
Claudication pain in hip or calf, which artery is stenosed in each?
Hip - Iliac
Calf - femoral
A 65-year-old man with a history of dyspepsia is found to have a gastric MALT lymphoma on biopsy. What treatment should be offered?
eradicate H. pylori
What condition would you see pigmented gallstones?
hemolytic anemia (sickle cell)
liver cirrhosis
A boy presents with priapism (prolonged erection) what is the next investigation you should request?
Cavernosal blood gas analysis
(differentiates from ischaemic and non-ischaemic priapism)
What side are varicoceles more common on?
Left side
A patient with ascending cholangitis has dilated hepatic ducts, what do you do?
ERCP and stent
Laparoscopic cholecystectomy later
What is the first choice investigation for boerhave’s?
CT Contrast Swallow
What is the most common form of prostate cancer?
Adenocarcinoma
What is a major risk factor for prostate radiotherapy?
increased risk of bladder, colon, and rectal cancer
What drug can be given if stress incontinence doesn’t respond to pelvic floor training exercises?
Duloxetine
What IV drugs do you give in a diverticular flare?
IV ceftriaxone + metronidazole
How does cancer in Lynch syndrome present?
right sided colonic cancers (caecum) occur at a young age
What’s a complication of gastrectomy?
vitamin B12 deficiency
can cause degeneration of the spine
What is the management for acute cholecystitis?
Analgesia and intravenous fluids
intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis
What is the management for acute mesenteric ischaemia? How may it present?
AF
High lactate
Sudden onset abdo pain
Septic (fever, HR^…)
Laparatomy
What should be the normal post-void in cathereterisation of a patient >65yrs patient?
<50 ml
(500mls+ is chronic urinary retention)
(800mls+ is acute on chronic)
How should you treat a baby with a congenital inguinal hernia?
Refer for surgery (don’t wait)
How do you manage a pancreatic pseudocyst?
Conservatively initially
How does Meckel’s diverticulum present?
Intermittent RIF pain
Iron deficiency anaemia
Pain worse after meals
Infection with which microorganism is likely to cause staghorn calculi?
Proteus mirabilis (urease producing)
How do type A and B aortic dissection differ?
Type A:
Ascending aorta
Radial-radial delay
False lumen on imaging
Type B:
Descending aorta
Radio-femoral delay
