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Year 3 Surgery > PassMed Qs > Flashcards

PassMed Qs Flashcards

1
Q

What is the best option for long term feeding?

A

PEG tube feeding
(Feeding jejunostomy requires general anaesthetic)

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2
Q

What medications should a patient with PAD be put on?

A

Clopidogrel (anti platelet)
Atorvastatin

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3
Q

What procedure is used to cure UC without needing a stoma?

A

Panproctocolectomy and ileoanal pouch

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4
Q

What is a FAST scan used for?

A

Focused Assessment with Sonography for Trauma

Looks for free fluid present in abdomen or thorax

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5
Q

What is the best way to differentiate between biliary colic and acute cholecystitis?

A

Patients with acute cholecystitis will be systemically unwell

Fever
Tachycardia
Tachypnoea

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6
Q

What to do with a baby presenting with a hydrocele?

A

Communication hydroceles are common in babies
Surgical Repair if it doesn’t repair in 1-2 years

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7
Q

What is the end result with a Hartmann’s procedure?

A

End Colostomy

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8
Q

What can a UTI increase the risk of?

A

Acute Urinary Retention

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9
Q

What conditions can predispose you to having gallstones?

A

Chron’s
Diabetes

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10
Q

What procedure would you perform for a mid-rectal tumour?

A

Anterior Resection

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11
Q

What is the diagnosis for a patient with a widened mediastinum and persistent hypotension despite been giving multiple fluids?

A

Aortic Rupture

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12
Q

What is the next step in management when you suspect appendicitis?

A

IV prophylactic abx before appendicectomy

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13
Q

What is the benefit of epidural anaesthesia post colorectal surgery?

A

Faster return of normal bowel function

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14
Q

What tests for females with RIF pain?

A
  1. Pregnancy
  2. USS abdomen (appendicitis)
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15
Q

What score of ABPI would indicate the need for angioplasty?

A

<0.5 (critical limb ischaemia)

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16
Q

When can you not use laparoscopic technique rather than open surgery?

A

Acute intestinal obstruction as increases risk of perforation

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17
Q

What is the first test needed when a male patient presents with Erectile Dysfunction?

A

Serum Testosterone

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18
Q

What is the management for acute pancreatitis and what should you not give?

A

IV fluids
IV Opioids
Oxygen (if hypoxic)

NEVER ABX

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19
Q

What type of testicular tumour has normal AFP and HCG levels?

A

Seminoma

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20
Q

Why may a patient that has had a laparoscopic cholecystectomy present to you weeks later with RUQ pain and jaundice?

A

Gallstones present in the common bile duct

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21
Q

A man presents to you with a fever, right sided abdominal tenderness during a DRE. What is your diagnosis?

A

Appendicitis

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22
Q

How would you manage sigmoid volvulus?

How would this differ if a patient is showing signs of peritonism?

A

Therapeutic flexible sigmoidoscopy with flatuence tube

Go straight to urgent laparotomy

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23
Q

What drug can increase the risk of pancreatitis?

A

Sodium Valproate

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24
Q

What would blood tests show on biliary colic?

A

Normal ALP/GgT
Normal AST + ALT
Normal CRP

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25
Q

What markers in the blood would indicate pancreatitis severity?

A

Hypocalcaemia (below 2)
Low oxygen (below 7?)

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26
Q

What site is the most common for ischaemic colitis?

A

Splenic flexure

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27
Q

What is the screening programme for AAA?

A

Single USS at 65 years old

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28
Q

What screening is required for suspected prostate cancer?

A
  1. Multiparametric MRI

Transrectal USS guided biopsy second line

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29
Q

What is the management for superficial thrombophlebitis?

A

Compression Stockings
NSAIDs

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30
Q

What drug can be given for chronic renal stones/hypercalcaemia?

A

Bendroflumethiazide
(increase Ca excretion)

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31
Q

What is the mechanism of tamsulosin?

A

Alpha-1 antagonist
Relaxes smooth muscle of prostate and bladder

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32
Q

What are some side effects of tamsulosin?

A

Dizzines
Postural Hypotension

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33
Q

CT kidney shows a mass with a cystic centre. What is the likely diagnosis?

A

Renal Adenocarcinoma

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34
Q

What else is needed when doing a wide local excision for breast cancer?

A

Sentinel Node biopsy
Whole breast radiotherapy

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35
Q

A 27 year old woman presents to you in GP with a breast lump, what do you do?

A

Non urgent referral to breast clinic if under 30§

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36
Q

What is the first line treatment for cyclical mastalgia?

A

Supportive bra and analgesia (paracetamol)

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37
Q

A 76 year old female presents to you with a fragility fracture. What is the next steps of management?

A

Start alendrotnic acid if over 75 years following a fragility fracture while awaiting a DEXA scan

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38
Q

What are the causes for raised Prolactin?

A

Pregnancy
Pyhsiological
Prolactinoma
Polycystic ovary syndrome
Primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone

39
Q

What medications should be held in a C Diff infection?

A

Opioids
Increase risk of toxic megacolon

40
Q

What cancer can Primary Sclerosing Cholangitis increase the risk of?

A

Cholangiocarcinoma

41
Q

What is the most common microorganism in central line infections?

A

Staph epidermidis

42
Q

What is the first line investigation for chron’s patients with perianal fistulae?

A

MRI Pelvis

43
Q

What are the surgical indications for UC patients?

A

Severe flares failing to respond to medical therapy
Flare causing perforation/dilatation
Chronic continuous disease causing impaired QoL
Cancer

44
Q

What are the surgical indications for Chron’s patients?

A

Obstruction
Severe perianal disease unresponsive to medical therapy
Major bleeds
Severe disability

45
Q

What is the first line investigation for acute mesenteric ischaemia and what will it show?

A

Serum Lactate will be raised

46
Q

How will a Proximal aortic dissection present? How may it appear on ECG?

A

Central tearing chest pain

Aortic Regurgitation murmur

ST elevation in II, III, aVF

47
Q

What is the investigation for suspected aortic dissection?

A

CT Aortic Angiogram

48
Q

Would normal libido indicate an organic or inorganic cause for erectile dysfunction?

A

Organic
(Vascular or neurogenic cause)

49
Q

How would a uric acid renal stone present?

A

Radioluscent (may not appear on CT)

Recent chemo can increase urate levels

50
Q

How does a cysteine renal stone present?

A

Radiodense on CT
Family Hx

51
Q

How does a struvite renal stone present?

A

Staghorn calculus

52
Q

What are the risk factors for an emboli causing acute limb ischaemia?

A

AF
Recent MI

53
Q

What is the mechanism of action of goserelin?

A

GnRH agonist

54
Q

How does chronic pancreatitis presents and what is its management?

A

Chronic back pain relived by leaning forward and worse after eating

Analgesia and Creon

55
Q

When would you use EVAR as oppose to bypass surgery?

A

Bypass for >10cm stenosis

EVAR for less

56
Q

In what conditions can Amylase increase?

A

Pancreatitis
SBO

57
Q

What imaging is required for suspected appendicitis?

A

NOTHING

Clinical diagnosis only

58
Q

How do you manage wound dehiscence?

A

Cover with saline soaked gauze and broad spectrum IV abx

59
Q

What would be the difference between FAP and Lynch syndrome causing cancer on colonoscopy?

A

Lynch syndrome:
Tumour of colon but rest of colonic mucosa normal

FAP:
Tumour of colon and rest of mucosa has polyps

60
Q

Testicular swelling with mumps and testicular sweeping after cystoscopy. Which ones which?

A

Mumps - orchitis
Cystoscopy - Epididymo-orchitis

61
Q

A 68-year-old man is found to have a tumour 1cm from the anal sphincter. What operation should she have?

A

Abdomino-perineal excision of the colon and rectum

62
Q

A 64-year-old lady is found to have a rectal tumour. What operation should she have?

A

Anterior resection

63
Q

A patient presents to you in GP with asymptomatic inguinal hernia, what should you do?

A

Routine referral for surgical repair

64
Q

How does a common bile duct stone present?

A

Epigastric pain radiating to back, worse on eating
(misdiagnosed as peptic ulcer)

65
Q

Obstructive jaundice and palpable smooth mass in RUQ?

A

Head of pancreas Ca
(Courvoisier’s law)

66
Q

How do you manage a diverticular flare?
(abdo pain, fever, blood in stool)

A

Send home with oral abx

If doesn’t improve within 3 days A&E for IV abx

67
Q

What is a benefit of circumcision?

A

Reduces HIV transmission in heterosexual men

68
Q

Main difference between colostomy and ileostomy?

A

Colostomy - flush to skin
Ileostomy - spouted

69
Q

Which nerve is at risk with a THR?

A

Sciatic

70
Q

A patient presents with acute-onset loin-to-groin pain and fever. What is your next step?

A

Patients with obstructive urinary calculi and signs of infection require urgent renal decompression and IV antibiotics due to the risk of sepsis

71
Q

What drug should you give before goserlin and why?

A

Flutamide

Reduces the flare effect’
(initial increase in luteinizing hormone production prior to receptor down-regulation)

72
Q

How does diverticular disease present? How does appear it on CT? What is the best conservative management?

A

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

73
Q

What is the management of a diverticular stricture?

A

Laparotomy

(flexi sigmoidoscopy is for volvulus)

74
Q

Claudication pain in hip or calf, which artery is stenosed in each?

A

Hip - Iliac
Calf - femoral

75
Q

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?

A

eradicate H. pylori

76
Q

What condition would you see pigmented gallstones?

A

hemolytic anemia (sickle cell)
liver cirrhosis

77
Q

A boy presents with priapism (prolonged erection) what is the next investigation you should request?

A

Cavernosal blood gas analysis

(differentiates from ischaemic and non-ischaemic priapism)

78
Q

What side are varicoceles more common on?

A

Left side

79
Q

A patient with ascending cholangitis has dilated hepatic ducts, what do you do?

A

ERCP and stent

Laparoscopic cholecystectomy later

80
Q

What is the first choice investigation for boerhave’s?

A

CT Contrast Swallow

81
Q

What is the most common form of prostate cancer?

A

Adenocarcinoma

82
Q

What is a major risk factor for prostate radiotherapy?

A

increased risk of bladder, colon, and rectal cancer

83
Q

What drug can be given if stress incontinence doesn’t respond to pelvic floor training exercises?

A

Duloxetine

84
Q

What IV drugs do you give in a diverticular flare?

A

IV ceftriaxone + metronidazole

85
Q

How does cancer in Lynch syndrome present?

A

right sided colonic cancers (caecum) occur at a young age

86
Q

What’s a complication of gastrectomy?

A

vitamin B12 deficiency

can cause degeneration of the spine

87
Q

What is the management for acute cholecystitis?

A

Analgesia and intravenous fluids

intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis

88
Q

What is the management for acute mesenteric ischaemia? How may it present?

A

AF
High lactate
Sudden onset abdo pain
Septic (fever, HR^…)

Laparatomy

89
Q

What should be the normal post-void in cathereterisation of a patient >65yrs patient?

A

<50 ml

(500mls+ is chronic urinary retention)
(800mls+ is acute on chronic)

90
Q

How should you treat a baby with a congenital inguinal hernia?

A

Refer for surgery (don’t wait)

91
Q

How do you manage a pancreatic pseudocyst?

A

Conservatively initially

92
Q

How does Meckel’s diverticulum present?

A

Intermittent RIF pain
Iron deficiency anaemia
Pain worse after meals

93
Q

Infection with which microorganism is likely to cause staghorn calculi?

A

Proteus mirabilis (urease producing)

94
Q

How do type A and B aortic dissection differ?

A

Type A:
Ascending aorta
Radial-radial delay
False lumen on imaging

Type B:
Descending aorta
Radio-femoral delay

Year 3 Surgery (3 decks)

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