Surgery

Question 1

Causes of acute abdominal pain and %

Answer 1

Unknown/non-specific 43%
Appendicitis 4-20%
Cholecystitis 3-9%
SBO 4%
Kidney stones 4%

Question 2

Appendicitis lifetime risk

Answer 2

8% males
6.7% females
Perforation 17-32%

Question 3

Causes of acute pancreatitis

Answer 3

GET SMASHHED
Gallstones (40%)
ERCP (4%)
Idiopathic
Trauma
Scorpions
Drugs
Mumps
Auto-immune
Hyperlipidaemia
Hyperlipidaemia
Ethanol (35%)
Drugs - 2%
(azathioprine, frusemide, oestrogen’s, sulphonamides, sodium valproate, tetracyclines)
Pancreatic abnormalities eg Sphincter of Oddi dysfunction
Vascular

Question 4

AAA statistics - mortality and risk of rupture

Answer 4

Pre-hospital rupture 60-80%
Emergency repair 40%
Elective repair 4-6%
Lifetime risk of rupture by size:
5cm 20% 6cm 40% 7cm 50%

Question 5

Diverticular disease stats

Answer 5

75% asymptomatic
65% of people aged 85 and over

Question 6

Renal colic stats

Answer 6

10% of population
30-40% recurrence in 5 years rate

Question 7

Renal colic risk factors

Answer 7

Chronic dehydration
FHx nephrolithiasis
Abnormal anatomy of GU tract
Hypercalcaemia
Hx renal stones
Gout
Obesity
Hyperparathyroidism

Question 8

Causes of urinary obstruction by gender

Answer 8

Obstruction
M - BPH, prostatic cancer, phimosis
F - pelvic organ prolapse
Both - neoplasm, blood clots, faecal impaction/constipation, stricture
Infection/inflammation
M - prostatitis, balanitis
F - lichen sclerosis
Both HSV, cystitis
Neuro
Both - diabetic cystopathy, GB syndrome, caudal equine, spinal disease/abscess, CVA, MS
Medications
Antihistamines - scopaderm
Antipsychotics - haloperidol
Anticholinergics - oxybutynin
Muscle relaxants - diazepam
Sympathomimetics - pseudoephedrine

Question 9

Gallstone stats

Answer 9

15% of people have gallstones
15-25% of these are symptomatic

Question 10

Haemorrhoid facts

Answer 10

25-50% of population
Can be internal or external
Internal are viscerally innervated (painless) and above the dentate line.
External are somatically innervated (painful)

Question 11

Haemorrhoid grading
(internal haemorrhoids only, there is no grading system for external haemorrhoids)

Answer 11

Grade 1 - internal haemorrhoid prolapses past dentate line but not externally
Grade 2 - prolapses externally with straining but spontaneously reduced
Grade 3 - prolapses with straining and requires manual reduction
Grade 4 - unable to reduce

Question 12

Ischaemic bowel risk factors

Answer 12

Can be small bowel (mesenteric ischaemia) or large (colonic ischaemia)
Mesenteric ischaemia appears more unwell

Age >60
Vasculopaths
AF
AAA/aortic atherosclerosis
Valvular disease
Smokers
Recent MI

Can occur due to venous thrombosis which is rare and occurs in younger patients. RF for this are:
-blunt abdominal trauma
-hypercoaguable state
-pancreatitis
-abdo infections
-portal hypertension
-dehydration
-portal malignancy

Question 13

Anal fissure

Answer 13

Causes:
Slight ischaemia due to blood supply in posterior midline being lowest point, increased anal sphincter pressure, trauma/microtrauma, constipation

If not posterior midline consider Crohn’s disease, HIV, malignancy, TB

RF:
IBD
HIV/STI
Constipation
Anal cancer
Childbirth
Trauma eg FB or excessive wiping/constipation

Question 14

Perianal abscess types and RF

Answer 14

Simple - arises from glandular crypts in anus or rectum. Infected anorectal gland
Complex - involves different planes eg ishiorectal, intersphincteric (between internal and external sphincters)

RF:
M:F 2:1
Receptive anal intercourse
Anal STI
Anal fissure
Smokers
DM/immunocompromise
Crohn’s disease

Question 15

Perianal fistula - causes

Answer 15

Anorectal abscess #1
Crohn’s disease
Malignancy
Radiation
HIV/TB
Prior surgery
FB

Question 16

Breast abscesses by location

Answer 16

Lactational - peripheral
Non-lactational - peri-areolar, sub-areolar

Question 17

Breast abscess treatment

Answer 17

Lactating - fluclox, aspiration
Non-lactating - augmenting, aspiration, FU

Question 18

6 Ps of limb ischaemia

Answer 18

Pain (POOP)
Pallor
Pulselessness
Paraesthesia
Poikilothermia (perishingly cold)
Paralysis

Question 19

Scrotal masses - causes

Answer 19

Cancer
Hydrocoele
Varicocoele
Hernia
Spermatocoele

Question 20

Priapism causes and treatment

Answer 20

Intracavernous injections
Medications eg psychiatric, ED, anticoagulants, recreational drugs
Unknown cause
Trauma
Sickle cell disease

Tx
Ice
Analgesia
Walk up stairs
Refer urology emergently

Question 21

Paraphimosis risk factors and treatment

Answer 21

Older men
Partial phimosis
Poor hygiene
Balanitis

Tx:
Use topical analgesia
Ice
Sugar
Manual reduction

Question 22

Causes of macroscopic haematuria

Answer 22

50% unknown, 30-40% malignancy
Benign masses eg BPH, renal
Stones
Infective
Nephropathy
Malignant
Traumatic
Iatrogenic - TRUS/TURP/ECSWL/renal biopsy/ureteric stents/catheter/radiation

Question 23

Higher risk for bladder/urinary tract cancer

Answer 23

Age >40
Smoking hx
Chronic cystitis
Gross haematuria
Irradiation
Occupational chemical/dyes or cyclophosphamide exposure

Question 24

Causes of microscopic haematuria

Answer 24

70% unknown, 5% malignancy
UTI 4-20%
BPH 10%
Stones 5%
Bladder cancer 3%
Renal cystic disease 2%
Renal disease 2%
Kidney cancer <1%
Prostate cancer <1%
Urethral stricture <1%

Question 25

Microscopic haematuria definition

Answer 25

> 20x10 to the 6/L RBCs on 2 out of 3 samples collected at least 7 days apart, confirmed with microscopy, without infection