SURGERY

Question 1

Women who are at an increased risk of breast cancer due to their family history may be offered screening from a younger age. The following patients should be referred to the breast clinic for further assessment:

Answer 1

1. one first-degree female relative diagnosed with breast cancer at younger than age 40 years, or
2. one first-degree male relative diagnosed with breast cancer at any age, or
3. one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years, or
4. two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age, or
5. one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative), or
6. three first-degree or second-degree relatives diagnosed with breast cancer at any age

Question 2

Breast fibroadenoma: surgical excision is usual if size?

Answer 2

if >3cm

Fibroadenoma basics
Develop from a whole lobule
Mobile, firm, smooth breast lump - a ‘breast mouse’
12% of all breast masses
Over a 2 year period up to 30% will get smaller
No increase in risk of malignancy
If >3cm surgical excision is usual

Question 3

Extradural (epidural) haematoma: Features

Answer 3

features of raised intracranial pressure
some patients may exhibit a lucid interval

Question 4

Subdural haematoma features

Answer 4

Slower onset of symptoms than a epidural haematoma. There may be fluctuating confusion/consciousness

Question 5

Aromatase inhibitors (e.g. anastrozole) may cause

Answer 5

osteoporosis

NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer

Question 6

priapism investigation

Answer 6

Cavernosal blood gas analysis is a useful investigation for priapism

Question 7

Head injury: CT head within 1 hour

Answer 7

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

Question 8

Head injury: Ct within 8 hrs

Answer 8

age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

Question 9

first-line investigation of choice for suspected subarachnoid haemorrhage

Answer 9

Non-contrast CT head

Question 10

useful test of exocrine function in chronic pancreatits

Answer 10

Faecal elastase

Question 11

IBD test

Answer 11

Faecal calprotectin

Question 12

The most common type of penile cancer

Answer 12

The most common type of penile cancer

penile cancer is associated with HIV infection.

Question 13

First-line investigation in suspected prostate cancer

Answer 13

Multiparametric MRI has replaced TRUS biopsy as the first-line investigation in suspected prostate cancer

the results are reported using a 5-point Likert scale

If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered

If the Likert scale is 1-2 then NICE recommend discussing with the patient the pros and cons of having a biopsy.

Question 14

lidocaone toxicity antidote

Answer 14

lipid emulsions

Question 15

NICE advise that, as PSA levels may be increased, testing should not be done within at least:

Answer 15

6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

Question 16

drug for stable angina

Answer 16

B clockers or calcium channel blockers

B blockers contraindicated in asthma