Surgery

Question 1

What is the most important first investigation in priapism?

Answer 1

Cavernosal blood gas analysis - distinguishes between ischaemic and non-ischaemic

Question 2

What investigation should be requested prior to initiation of anastrozole?

Answer 2

DEXA scan

Question 3

How long may it take finasteride to take effect - a 5-alpha-reductase inhibitors?

Answer 3

Up to 6 months

Question 4

What is the imaging modality of choice in suspected renal calculi?

Answer 4

Non-contrast CT-KUB

Question 5

How should metformin be taken in relation to a patient whom is having an operation?

Answer 5

Take as normal day before. Only omit dose on day of surgery if taken 3 times a day - in which case omit lunchtime dose

Question 6

How should sulphonylureas be taken in relation to a patient whom is having an operation?

Answer 6

Take as normal day before. If on morning list, omit morning dose (whether taken OD or BD). If taken BD, evening dose can be given. If on afternoon list, omit all doses that day

Question 7

How should DPP IV inhibitors (-gliptins) be taken in relation to a patient whom is having an operation?

Answer 7

Take as normal, no omitted doses before or on day of surgery

Question 8

How should GLP-1 analogues (-tides) be taken in relation to a patient whom is having an operation?

Answer 8

Take as normal, no omitted doses before or on day of surgery

Question 9

How should SGLT-2 inhibitors (-flozins) be taken in relation to a patient whom is having an operation?

Answer 9

Take as normal day before surgery, omit on day of surgery

Question 10

How should once daily insulins be taken in relation to a patient whom is having an operation?

Answer 10

Reduce dose by 20% on day before, and day of, surgery

Question 11

How should twice daily biphasic insulins, or ultra-long acting insulins be taken in relation to a patient whom is having an operation?

Answer 11

No dose change day before. On day of surgery, halve the usual morning dose, evening dose should be unchanged

Question 12

What is the colorectal screening programme?

Answer 12

FIT screening kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland

Question 13

What are the outcomes of colonoscopy in those that have been invited as a result of positive screening?

Answer 13

5/10 = normal result
4/10 = polyps, removed
1/10 - malignancy

Question 14

Which drug is given to reduce the risk of vasospasm in aneurysmal SAH?

Answer 14

Nimodipine

Question 15

What dose whole breast radiotherapy reduce the risk of in patients whom have had a WLE?

Answer 15

Recurrence - by approximately 2/3rds

Question 16

Which drugs can increase the risk of pancreatitis?

Answer 16

Azathioprine
Mesalazine
Bendroflumethiazide
Furosemide
Pentamidine
Steroids
Sodium valproate

Question 17

What is malignant hyperthermia?

Answer 17

A rare, serious side effect of volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane), which cause all skeletal muscle to rapidly contract, including during a neuromuscular blockade. MH is a genetic disorder, manifesting due to calcium overload in the skeletal muscle causing sustained muscular contraction and rhabdomyolysis, resulting in excess anaerobic metabolism causing acidosis. End-tidal CO2 increases as a result, along with body temperature which causes diaphoresis (excess sweating)

Question 18

What are Grade I haemorrhoids?

Answer 18

Do not prolapse out of the anal canal

Question 19

What are Grade II haemorrhoids?

Answer 19

Prolapse on defecation but reduce spontaneously

Question 20

What are Grade III haemorrhoids?

Answer 20

Can be manually reduced

Question 21

What are Grade IV haemorrhoids?

Answer 21

Cannot be reduced

Question 22

What is Prehn’s sign?

Answer 22

Occurs in testicular torsion, when elevation of the testis does not ease the pain

Question 23

What are the features of a breast abscess on ultrasound?

Answer 23

1. Hypoechoeic collection
2. Vascular rim around abscess
3. No vascularity within the abscess

Question 24

Which type of breast lump can display ‘popcorn calcification’?

Answer 24

Fibroadenoma

Question 25

Which laxative should be use din the context of an ileostomy?

Answer 25

Magnesium sulphate

Question 26

What type of cancer is most common in the oesophagus?

Answer 26

SCC

Question 27

How can you distinguish between a paraumbilical and spiegelian hernia?

Answer 27

Paraumbilical - occur immediately ABOVE or BELOW the umbilicus
Spigelian - occur LATERAL to the umbilicus

Question 28

How do you distinguish between epigastric and duodenal ulcers?

Answer 28

Duodenal = RELIEVED by eating, and therefore often patients gain weight

Question 29

When are Hartmann’s procedures perfromed?

Answer 29

In emergency, e.g. perforation - end colostomy/ileostomy created (which can be reversed later)

Question 30

When should women stop taking COCP/HRT prior to surgery?

Answer 30

28 days before

Question 31

How do you treat an anal fissure refractory to GTN?

Answer 31

Sphincterotomy

Question 32

Do congenital hernia (hernia in very young children) have high complication rates?

Answer 32

Yes - they should be referred for operative management

Question 33

What is the first-line drug for BPH?

Answer 33

Alpha-1-antagonist

Question 34

How should breast cysts be managed?

Answer 34

Aspiration

Question 35

What is the most common type of breast cancer?

Answer 35

Invasive ductal carcinoma

Question 36

What are the indications for a CT head within 1 hour?

Answer 36

1. GCS < 13 on initial assessment
2. GCS < 15 at 2 hrs post-injury
3. Suspected open or depressed skull fracture
4. Sign of basal skull fracture
5. Post-traumatic seizure
6. Focal neurological deficit.
7. > 1 episode of vomiting

Question 37

What are the indications for a CT head within 8 hours?

Answer 37

1. > /= 65 y/o
2. Hx of bleeding or clotting disorders/anticogulants
3. Dangerous MOI
4. > 30 mins retrograde amnesia