Patient with abdominal pain

Question 1

When should surgical intervention (either preventative endovascular stent repair or insertion of a graft) be offered to patients with stable AAA?

Answer 1

If the aneurysm is bigger than 5cm.

For smaller aneurysms, conservative management with lifestyle modification and regular US screening.

Question 2

What is Charcot’s triad and which conditions may it be seen in?

Answer 2

RUQ tenderness, fever, jaundice.

Biliary tract infections (cholecystits, cholangitis)

Question 3

What is Reynold’s pentad and which condition may it be seen in?

Answer 3

RUQ tenderness, fever, jaundice, shock, mental confusion.

Particularly associated with ascending cholangitis.

Question 4

What imaging modality is used to confirm a diagnosis of acute cholecystitis?

Answer 4

Ultrasound

Question 5

What is the definitive treatment for cholecystitis?

Answer 5

Early laparoscopic cholecystectomy

Question 6

What is the best investigation to order if suspicion of cholangitis is high?

Answer 6

Endoscopic Retrograde Cholangiopancreatograpy (ERCP) - directly visualises bile duct stone or obstruction and can perform biliary stone extraction at the same time.

Question 7

Is vomiting an early or late symptom in small bowel obstruction?

Answer 7

Early

Question 8

Is vomiting an early or late symptom in large bowel obstruction?

Answer 8

Late

Question 9

Is constipation an early or late symptom in small bowel obstruction?

Answer 9

Late

Question 10

Is constipation an early or late symptom in large bowel obstruction?

Answer 10

Early

Question 11

Which form of bowel obstruction typically produce more severe colicky abdo pain?

Answer 11

Small bowel obstruction.

Question 12

What is the first investigation to order in suspected ovarian cysts?

Answer 12

Transvaginal Ultrasound

Question 13

After TVUS for ovarian cysts, what other investigations may be ordered?

Answer 13

CA125, laparotomy (to biopsy to determine nature of the cyst), MRI/CT

Question 14

How are ovarian cysts managed?

Answer 14

Depends on the nature of the cysts
<5cm/simple/non-malignant: 6 monthly USS and CA125
>5cm/complex/malignant: Laparoscopic cyst removal

Question 15

What is the key investigation that is diagnostic of acute pancreatitis?

Answer 15

Serum lipase (preferably) or amylase.
Value is >=3 x the upper limit of normal = pancreatitis

Question 16

What action tends to help temporarily relieve pain in patients with kindey stones?

Answer 16

Writhing around, a lot of movement

Question 17

What first investigations should be ordered for suspected nephrolithiasis (kidney stone)?

Answer 17

CT KUB

FBC, urinalysis, U+Es, pregnancy test

Question 18

How are kidney stones managed?

Answer 18

If they haven’t passed spontaneously …
<10mm: medical expulsion with tamsulosin PO
>10mm or failed medical therapy: surgical removal (lithotripsy usually sufficient)

Question 19

Are duodenal or gastric ulcers more common?

Answer 19

Duodenal ulcers are ~ 3x more common than gastric ulcers

Question 20

Does eating relieve or exacerbate gastric ulcer pain?

Answer 20

Exacerbates

Question 21

Does eating relieve or exacerbate duodenal ulcer pain?

Answer 21

Relieves. Duodenal ulcer pain is worse when hungry/at night