Surgery

Question 1

What is a direct inguinal hernia?

Answer 1

Hernia pushes its way directly through Hasselback’s triangle, an area of weakness in the posterior wall of the inguinal canal, medial to the inferior epigastric vessels.

Question 2

What is an indirect inguinal hernia?

Answer 2

Hernia passes through the internal inguinal ring and possibly back out through the external inguinal ring

Question 3

What conservative measures may be recommended to patients with direct inguinal hernias?

Answer 3

Lose weight and stop smoking

Question 4

What are the contents of the inguinal canal?

Answer 4

External spermatic fascia, cremasteric fascia, internal spermatic fascia, Vas deferens, obliterated processus vaginalis, gonadal vessels, genital branch of the genitofemoral serve, ilioinguinal nerve
In females - the round ligament of the uterus.

Question 5

What is the management of acute mesenteric ischaemia?

Answer 5

IV fluid, IV analgesia, IV antibiotics, heparin.
Consider catheter thrombolysis if arteriography is taking place.
Laparotomy is required to remove dead bowel

Question 6

What is the management of chronic mesenteric ischaemia?

Answer 6

Percutaneous transluminal angioplasty and stenting

Question 7

How does chronic mesenteric ischaemia present?

Answer 7

Severe, coliky, post-prandial pain.
Weight loss - due to anorexia
PR bleeding
N/V

Question 8

How should triple-negative breast cancer be managed?

Answer 8

Surgery - Breast-conserving vs Mastectomy + SNB
Radiotherapy
+/- Chemotherapy if stage indicates this is necessary

Question 9

What drug is available for ER+ve breast cancer in postmenopausal women?

Answer 9

Aromatase inhibitors

Question 10

What drug is available for ER+ve breast cancer in premenopausal women?

Answer 10

Tamoxifen

Question 11

What is the mechanism of action of tamoxifen and explain how this is associated with the potential risks of treatment?

Answer 11

SERM - acts as an oestrogen agonist in endometrial tissue so it increases proliferation and therefore risk of cancer

Question 12

What drug therapy is available for HER2+ve breast cancer?

Answer 12

Trastuzumab

Question 13

What procedure may be indicated in a woman with a positive sentinel node biopsy during breast cancer surgery?

Answer 13

Axillary node clearance?

Question 14

What is the major risk associated with axillary node clearance?

Answer 14

Lymphoedema

Question 15

What are the causes of small bowel obstruction?

Answer 15

Adhesions, hernias, gallstone ileus, foreign body, intussusception

Question 16

What are the causes of large bowel obstruction?

Answer 16

Colon cancer, constipation, diverticular stricture, volvulus,

Question 17

What is the immediate management of bowel obstruction?

Answer 17

NBM
Analgesia
NG tube aspiration and free drainage
IV fluids

Question 18

What is the first-line drug therapy for BPH?

Answer 18

Tamsulosin (alpha-blocker) or Finasteride (5alpha reductase inhibitor)

Question 19

What are the common clinical features of BPH?

Answer 19

Nocturia, frequency, urgency, dribbling, poor flow, hesitancy, overflow incontinence, haematuria.

Question 20

What is the initial management for a ruptured AAA?

Answer 20

Page vascular surgery and anaesthetics
Bloods: Amylase, FBC, VBG
Actions: IV access, crossmatch and transfuse with O neg, permissive hypotension, catheterise, give IV co-amoxiclav
Theatre

Question 21

What are the 6 P’s of acute limb ischaemia?

Answer 21

Pulseless, perishingly cold, pallor, paraesthesia, paralysis, pain

Question 22

What is chronic critical limb ischaemia

Answer 22

more than 2 weeks of rest pain, gangrene, or ulceration?

Question 23

What would a patient with iliac stenosis complain of?

Answer 23

Buttocks claudication

Question 24

How should peripheral arterial disease be investigated?

Answer 24

Bloods: FBC, U/Es, Lipids, HbA1C, ESR/CRP, 
ECG
Consider thrombophilia screen
ABPI
Colour duplex US leg
MR/CT angiography to plan intervention