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1
Q

retroperitoneal structures

A
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2
Q

what is the most likely site of perforation in complete large bowel obstruction

A

caecum

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3
Q

what is the approximate volume of bile to enter the duodenum per 24 hours

A

500ml

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4
Q

extraintestinal manifestations of colitis

A

erythma nodosum
apthous ulcers
nail clubbing
episcleritis
anterior uveitis
acute arthropathy/enteropathic arthritis
iritis

primary sclerosing cholangitis
ankylosing spondylitis

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5
Q

causes of hyperkalaemia

A

MACHINE
M - medications (ACE inhibitors, NSAIDS)
A - acidosis (metabolic and respiratory)
C - cellular destruction (burns, traumatic injury)
H - hypoaldosteronism, haemolysis
I - intake (excessive)
N - nephrons (renal failure)
E - excretion (impaired)

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6
Q

gene associated with ankylosing spondylitis

A

HLA-B27

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7
Q

gene associated with giant cell arteritis

A

HLA-DR4

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8
Q

causes of pancreatits

A

GET SMASHED

Gallstones
Ethanol (Alcohol)
Trauma
Steroids
Mumps
Autoimmune disease, such as Systemic Lupus Erythematosus (SLE) or Sjogren’s syndrome
Scorpion venom (a rare and unlikely cause in most countries)
Hypercalcaemia
Endoscopic retrograde cholangio-pancreatography (ERCP)
Drugs, such as Azathioprine, NSAIDs, or Diuretics

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9
Q

protocol for dilated AAA

A

small AAA: 3.0cm to 4.4cm
repeat ultrasound scan in 12 months

medium AAA: 4.5cm to 5.4cm
repeat ultrasound scan in 3 months

large AAA: 5.5cm or bigger
referral to specialist vascular team in 2 weeks

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10
Q

what are the risk factors for developing gallstones from acute cholecystitis

A

the 5 F’s
fat (bmi greater than 30 kg/m2)
female
fertile (one or more children)
fair (caucasian)
forty (age greater than or equal to 40 years)

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11
Q

common gall stone compositions

A

cholesterol stones – purely of cholesterol from excess cholesterol production (linked with poor diet, obesity)

pigment stones – from excess bile pigments production (commonly seen in those with known haemolytic anaemia)

mixed stones - comprised of a mixture of both cholesterol and pigment

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12
Q

common renal stone compositions

A

calcium oxalate
calcium phosphate
urate stone

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13
Q

causes of c.diff

A

spread from infected person via faeco-oral route
broad abx use (eg. ceftriaxone, ciprofloxacin)

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14
Q

list some different anatomical positions of the appendix

A

Pre-ileal – anterior to the terminal ileum – 1 or 2 o’clock.
Post-ileal – posterior to the terminal ileum – 1 or 2 o’clock.
Sub-ileal – parallel with the terminal ileum – 3 o’clock.
Pelvic – descending over the pelvic brim – 5 o’clock.
Subcecal – below the cecum – 6 o’clock.
Paracecal – alongside the lateral border of the cecum – 10 o’clock.
Retrocecal – behind the cecum – 11 o’clock

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15
Q

landmarks at T12, L1, L2, L3 and L4

A

T12 - coeliac trunk
L1 - superior mesenteric artery
L2 - testicular artery and renal artery
L3 - inferior mesenteric artery
L4 - bifurcation of aorta

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16
Q

gene associated with a family history of breast and ovarian cancer

A

BRCA genes (1 and 2)

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17
Q

drugs that cause renal impairment/should be considered to stop

A

DIAMOND

Diuretics
IV contrast
ACE inhibitor /ARBs
Metformin
Opiates (not completely contraindicated but consider smaller dose)
NSAIDS
Digoxin

+ aminoglycosides (gentamicin)

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18
Q

hep b antigens (acute infection, past infection, chronic infection and never infected but vaccinated)

A
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19
Q

ecg changes in hyperkalaemia

A

tented t waves
prolonged QRS complex
absent p waves
asystole

20
Q

ecg changes in hypokalaemia

A

ST depression
t wave flattening/inversion
prominent u waves (best seen in the precordial leads V2-V3)

21
Q

how does pseudogout differ from gout in investigations

A

on joint aspiration in gout, you will see needle shaped, negatively birefringent, monosodium urate crystals under polarised light

in pseudogout, you will see weakly-positively birefringent, rhomboid-shaped, calcium pyrophosphate dihydrate crystals

22
Q

what are the 4 TB medications and their side effects

A

rifampicin - causes urine/tears to turn orange or drug induced hepatitis
isoniazid - peripheral neuropathy
pyrazinamide - drug-induced hepatitis, gout
ethambutol - optic neuropathy

23
Q

what are the indications of renal replacement therapy in aki patients

A

hyperkalaemia refractory (resistant) to medical therapy
metabolic acidosis refractory to med therapy
resistant fluid overload
uraemic pericarditis
uraemic encephalopathy - vomiting, confusion, drowsiness, reduced consciousness

24
Q

landmarks at S2 and S3

A

S2 - posterior superior iliac spines
S3 - posterior inferior iliac spines

25
Q

intra-peritoneal structures

A

SALTDSPR
S: stomach
A: appendix
L: liver
T: transverse colon
D: duodenum (first part)
S: small intestines (jejunum and ileum)
P: pancreas (only tail)
R: rectum (upper third)

26
Q

different stoma types

A
  • colostomy - flush to the skin and are not spouted, as the stool produce is less alkali due to the enzymes present in the large bowel, typically in LIF
  • ileostomy - commonly in RIF, using the small bowel, spouted as then enzymes in the small bowel can irritate the skin and the stool has a more liquid consistency
  • urostomy - created after a cystectomy, typically located in RIF, bag will contain urine
  • loop colostomy or loop ileostomy - contains two loops of bowels which are visible, often done to protect distal anastomoses and to allow the bowel to recover before reconnecting the bowel
27
Q

management of influenza

A

antipyretic
anti-viral – oseltamivir (Tamiflu)

28
Q

staining technique for TB

A

Ziehl–Neelsen stain

29
Q

borders of the inguinal triangle

A

medial – lateral border of the rectus abdominis muscle
lateral – inferior epigastric vessels
inferior – inguinal ligament

30
Q

borders of the femoral triangle

A

roof - fascia lata
superior - inguinal ligament
lateral - medial border of sartorius
medial - medial border of adductor longus

31
Q

drugs that cause drug-induced SLE

A

carbamazepine
chlorpromazine
isoniazid
pyrazinamide
infliximab

32
Q

common locations for renal stone impaction/colic

A

pelvic-ureteric junction
vesico-ureteric junction
pelvic brim

33
Q

what are the indications of surgery in patients with renal stones

A

pain not managed medically
stone is over 7mm
they only have one kidney
bilateral stones
sepsis

34
Q

prophylaxis for PONV

A

ondansetron (5HT3 receptor antagonist) – avoided in patients at risk of prolonged QT interval

dexamethasone (corticosteroid) – used with caution in diabetic or immunocompromised patients

cyclizine (histamine (H1) receptor antagonist) – caution with heart failure and elderly patients

35
Q

CSF in viral meningitis

A

clear CSF with a high-normal protein, high-normal glucose and a very high WCC mainly lymphocytes

36
Q

CSF in bacterial meningitis

A

cloudy, turbid CSF with high protein, low glucose and a high white cell count which are mostly neutrophils

37
Q

cause and symptoms of post cholecystectomy syndrome

A

attributed to changes in the bile flow after removal of the gallbladder but symptoms go away over time

  • diarrhoea
  • indigestion
  • epigastric or right upper quadrant pain and discomfort
  • nausea
  • intolerance of fatty foods
  • flatulence
38
Q

extrapulmonary manifestation of squamous cell lung cancer

A

hypercalcaemia

39
Q

extrapulmonary manifestations of small cell lung cancer

A

SIADH (ectopic ADH secretion)

Cushing’s syndrome (ectopic ACTH secretion)

limbic encephalitis (small cell lung cancer causes the immune system to make antibodies in the brain, esp against the limbic system)

40
Q

differentials of upper GI bleed

A

cancer

oesophageal varices

Mallory Weiss tears

PUD

41
Q

which zone does BPH primarily affect

A

transitional zone

42
Q

which zone does prostate cancer primarily affect

A

peripheral zone

43
Q

risk of transmission of hep B in needlestick injury

A

1/3 (much lower if recipient is vaccinated)

44
Q

risk of transmission of hep C in needlestick injury

A

1/30

45
Q

risk of transmission of HIV in needlestick injury

A

1/300 (much lower if patient’s on ARV)

46
Q

staining technique for malaria

A

Geimsa staining

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