surgery

Question 1

Mx Anal fissure

Answer 1

Acute:
1. laxative, lubricants, topical anaesthetics, analgesia
2. topical GTN
3. ineffective after 8wks-> sphincterotomy/ Botulinum toxin injection

Question 2

Femoral vs inguinal hernia

Answer 2

inguinal hernia: medial to pubic tubercle
femoral: lateral to pubic tubercle

Question 3

difference btw strangulated vs incarcerated hernia

Answer 3

strangulated: surgical emergency-> blood supply cut off
incarcerated: unable to reduce

Question 4

hydrocele mx

Answer 4

infatile hydrocele-> usually resolve
adults: conservative approach depending on severit of presentation

Question 5

CRC screening

Answer 5

every 2 yr ALL M+F FIT test kit
60-74 years

Question 6

gastric ulcer which one worsening before or after eating

Answer 6

Worsened by eating

Question 7

cerebral perfusion pressure equation

Answer 7

CPP= MAP- ICP

Question 8

Cushing’s reflex

Answer 8

physio nervous system response to increase ICP= HTN, Bradycardia with wide pulse pressure to maintain cerebral perfusion pressure

Question 9

Normal Psa level

Answer 9

50-59: 3.0 ng/ml
60-79:4
>70: 5

Question 10

PAD &CLTI DX

Answer 10

us Doppler
ABPI pad- <0.9, CLTI <0.5
CT angiogram

Question 11

Medication mx PaD

Answer 11

St line clopisogrel
Statin 80mg

For CLTI- unfractionated heparin

Question 12

Mx stone <5mm

Answer 12

Typically spontaneously passes within 4 weeks of sx onset
More intensive and urgent tx indicated in presence of ureteric obstruction, renal developmental abnormality.

Ureteric obstruction and infection is surgical emergency-> needs nephrology/ ureteric stent/ ureteric catheter

Question 13

Priapism mx and dx

Answer 13

Dx largely clinical. Cavernosal blood gas low pH and pO2, high pCO2. Doppler/ duplex US

Ischaemic : if >4- aspiration of blood from cavernosa + saline flush. If aspiration fails intracavernosal injection vasoconstriction agent eg. Phenylephrine and repeated 5 min

N-ischaemic: no medical emergency

Question 14

Age related PSA

Answer 14

50-59 3.0ng/ml
60-69 4.0ng/ml
>70 5.0 no/ml

Question 15

1st Ix prostate cancer

Answer 15

Multiparametric MRI

Question 16

Tumour markers for germ cell testicular cancer

Answer 16

Seminoma
N-seminoma: embryonic, yolk sac, teratoma, choriocarcinoma.

Seminoma: High hCG
N-Seminoma: AFP/ beta-hCG

Question 17

Indication of CT head in 1 hour

Answer 17

GCS< 13 on initial assessment
GCS <15 @ 2hour post-injury
Signs of basal skull fracture
Post-traumatic seizure
Focal neuron deficit
>1 episodes of vomiting

Question 18

CT head within 8hrs

Answer 18

LOC or amnesia since injury
>65 years
Hx of injury/ clotting disorders incl anti-coag
Mech of injury
>30min retrograde amnesia of events

Question 19

Cerebral perfusion equasion

Cushing reflex

Answer 19

CPP= MAP- ICP

Cushing reflex: HTN reflex to maintain CPP and bradycardia with wide pulse pressure. Irregular breathing late sign impending brain herniation

Question 20

Duodenal vs gastric ulcer

Answer 20

Pain worsen by eating
Pain relieved by eating

Question 21

Cullen and grey turner sign

Answer 21

Seen in acute pancreatitis

Periumbilical- Cullen’s sign
Flank discolouration- grey turner sign

Question 22

Incarcerated vs strangulated hernia

Answer 22

Incarcerated irreducible
Strangulated blood supply cut off

Question 23

Common pathogen in ascending chokangitis

Answer 23

E. Coli

Question 24

Signs in ascending cholangitis

Answer 24

Charcots triad: RUQ, fever, jaundice

Reynolds pentad: HoTN, confusion, fever, RUQ, jaundice

Question 25

Grading of haemorrhoid

Answer 25

Grade I: no prolapse just prominent blood vessel Grade II: prolapse upon bearing down but spontaneous reduction Grade III: prolapse upon bearing down requiring manual reduction Grade IV: prolapse with inability to be manually reduced

Question 26

Definition of acute vs chronic anal fissure

Answer 26

Acute <6 weeks Chronic > 6weeks

Question 27

Low rectum and mid rectum CRC which resection

Answer 27

Low anterior resection

Question 28

Firoadenosis (fibrocystic disease, benign mammary dysplasia of breast)

Answer 28

Most common middle aged women Lumpy breast which may be painful. Sx may worsen prior to menstruation

Question 29

Duct papilloma vs mammary duct ectasia

Answer 29

Duct paipilloma: epithelial proliferation in large mammary duct, hyperplasticity lesion. Malignant or premalignant. May present with blood stained discharge Mammary duct ectasia: most common around menopause, tender lump around areola with green nipple discharge

Question 30

Most common breast cancer

Answer 30

Invasive ductal carcinoma

Question 31

Screening of breast cancer

Answer 31

Mammogram every 3 years 50-70 years

Question 32

Her2+ breast cancer mx

Answer 32

Trastuzumab

Question 33

Hormonal tx in breast cancer

Answer 33

Tamoxifen pre & post menopausal female pt Anastrozole used for post menopausal female patient

Question 34

SE of selective oestrogen receptor modulator

Answer 34

Ramixifen used in pre menopausal breast cancer. Menstrual disturbance, hot flushes, VTE and endometrial cancer

Question 35

Aromatase inhibitor SE

Answer 35

Anastrozole + letrozole= used in post menopausal breast cancer ER+ Osteoporosis: needs DEXAMETHASONE, hot fkushes, arthralgia, insomnia

Question 36

Acute limb threatening ischaemic sx

Answer 36

Pale pulseless painful paralysed paraethetic perishing with cold

Question 37

Thrombus vs embolus in acute limb threatening ischaemia

Answer 37

Thrombus: pre existing claudication with sudden deterioration, no obvious source of embolism, reduced or absent pulses in contrast limb, widespread vascular disease Embolus: painful leg, no hx of claudication, obvious source of embolus eg. AFib, recent MI, no evidence of PAD norms, pulses, evidence of pros aneurysm.

Question 38

Superficial thrombophlebitis mx

Answer 38

NSAIDS: topical for limited and mild disease, po for severe Topical hepariniids Compression stocking but need to check ABPI If affecting pros long saphenous vein then need to have US to r/o DVT. Pt with superficial thrombophlebitis teds and consider for prophy LMWH for 30d or fondaparinux for 45day Is CI NSAIDS 8-12 days Is extending to sapheno-femoral junction then therapeutic anticoagulant for 6-12 weeks

Question 39

Sign seen in duodenal atresia and which genetic syndrome common in

Answer 39

AXR double bubble sign, presents few hours after birth Down syndrome