Random facts 1

Question 1

Define oliguria

Answer 1

• a reduced urine output
• urine output of less than 0.5 ml/kg/hour

Question 2

Classical symptoms of ischaemic colitis

Answer 2

Ischaemic colitis

Classic presentation:

• after a meal
• intermittent and severe pain

pain out of proportion to clinical finding

Predisposing factors: increasing age, atrial fibrillation, other causes of emboli: endocarditis, malignancy, cardiovascular disease risk factors: smoking,hypertension, diabetes, cocaine use

Diagnosis: CT

Management

• usually supportive
• surgery may be required in a minority of cases if conservative measures fail. Indications would include generalised peritonitis, perforation or ongoing haemorrhage

Question 3

Clinical presentation of small bowel obstruction

Answer 3

Small bowel obstruction:

• intermittent pain
• clinical examination and imaging would likely show a distended abdomen
• obstruction on imaging

Question 4

Presentation of diverticulitis

Answer 4

Diverticulitis:

• PR bleed
• bowel symptoms on top
• pain

Question 5

Clinical presentation of ruptured ulcer

Answer 5

Ruptured ulcer:

• severe and diffuse abdominal pain
• likely present with epigastric pain at first

bloody emesis

Question 6

Complications of diverticulosis

Answer 6

Question 7

What’s the volvulus? (in general)

What are the common sites of it?

Answer 7

Volvulus - it’s torsion of the bowel loop around the mesentery -> obstruction and #blood flow

Types:

A. Sigmoid volvulus -> 80%

B. Coecal volvulus -> 20%

Question 8

Clinical picture of volvulus

Answer 8

Features

• constipation
• abdominal bloating
• abdominal pain
• nausea/vomiting

Question 9

Diagnosis of volvulus:

A. Sigmoid

B. Coecal

Answer 9

A. Sigmoid: ‘coffee bean sign’ + large bowel obstruction (large, dilated loop of the colon, often filled with air)

B. Coecal: ‘embryo sign’ + small bowel obstruction

Question 10

Treatment of volvulus

A. Coecal

B. Sigmoid

Answer 10

A. Coecal -> usually operative e.g. right hemicolectomy

B. Sigmoid -> right sigmoidoscopy + rectum tube insertion

Question 11

Malignant hyperthermia

• what’s that?
• mechanism of action/cause
• drugs that cause it

Answer 11

Malignant hyperthermia

hyperpyrexia + muscle rigidity following the reaction to anaesthetic drugs

MoA: the excessive release of Ca++ from the endoplasmic reticulum

Cause: defects in chromosome 19

Drugs:

halothane, suxamethonium, other drugs: antipsychotics (neuroleptic malignant syndrome)

*similar aetiology to neuroleptic malignant syndrome

Question 12

Management of malignant hyperthermia

Answer 12

Management

• dantrolene - prevents Ca2+ release from the sarcoplasmic reticulum

Question 13

Hartmann’s procedure

• what’s that
• use

Answer 13

Hartmann’s = proctosigmoidectomy

• resection of rectosigmoid colon + formation of end colostomy
• use: management of malignant obstruction of distal colon (when perforation occurs)

Question 14

MANAGEMENT of sigmoid volvulus

Answer 14

1st endoscopic decompression + flatus tube insertion

2nd surgery - preferably anastomosis (if decompression failed, ischaemia occur)

*in coecal volculus, surgery may be 1st line due to higher chanc of ischaemia

Question 15

3 most common feeding tube types

• names
• location

Answer 15

Question 16

Which artery is commonly associated with the GI bleed due to a duodenal ulcer?

Answer 16

Gastro-duodenal (posterior wall, 2nd part of duodenum)

Question 17

What’s Dieulafoy Lesion?

• presentation

Answer 17

Dieulafoy - abnormally large artery somewhere in the GI tract (it is due to arteriovenous malformation)

• Haematemesis and Malena - often with no prodromal symtpoms

Question 18

signs of basal skull fracture

Answer 18

Basal skull fracture:

• haemotympanum
• ‘panda’ eyes
• cerebrospinal fluid leakage from the ear or nose
• Battle’s sign

Question 19

Treatment (medical) of breast Ca that is ER +

• pre-menopausal women
• postmenopausal women

Answer 19

• Pre-menopausal -> Tamoxifen
• Post-menopausal -> Aromatase inhibitors

*In postmenopausal women, Tamoxifen would increase the risk of endometrial cancer

Question 20

What scoring system is used in the assessment of severity of GI bleed

Answer 20

The Blatchford score is used to determine the severity of a suspected GI bleed and whether or not the patient needs admitting +/- the requirement for urgent upper GI endoscopy

Question 22

What surgical incisions do you know?

• name them + location
• what surgeries to they mean

aim for 12 incisions’ names

Answer 22

Question 23

What is a lucid interval feature of?

Answer 23

Extradural haemorrhage = lucid period, usually following major head injury.

Question 24

What type of haemorrhage is fluctuating consciousness feature of?

Answer 24

Subdural = fluctuating consciousness, often following trivial injury in the elderly or alcoholics