Surgery

Question 1

Management of a fibroadenoma?

Answer 1

They are usually treated conservatively, but they are referred for surgical excision if they are more than 3 cm in size or causing discomfort

Question 1

What is a normal vs abnormal ABPI?

Answer 1

a ‘normal’ ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease

Question 2

Menieres presentation?

Answer 2

recurrent episodes of vertigo (last mins - hrs), tinnitus and HL (sensorineural).
Aural fullness/ pressure
nystagmus and +ve Rombergs
typically symptoms are unilateral but bilateral symptoms may develop after a number of years

Question 3

What is the management of AAA found on imaging?

Answer 3

<3cm normal
3-4.4cm scan every 12m
4.5-5.4cm scan every 3m
>5.5cm urgent refer to surgery

Question 4

How do you manage insulin dependent diabetics who are having surgery (with the long acting insulin)?

Answer 4

once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery

Question 5

What is the surgical management of a fistula?

Answer 5

A draining seton is used for complex perianal fistulae in patients with Crohn’s disease

Question 6

How do you interpret audiograms for the three different types of HL?

Answer 6

1) Conductive: Normal BC, Reduced AC - on the graph there should be an ‘Air bone gap ‘
2) SNHL: Both BC and AC reduced, No Air bone gap.
3) Mixed: reduced AC and reduced BC but AC is reduced more (i.e. there is an “Air bone gap” but with BC reduced/not normal)

Hearing range: <20dB is normal

Question 7

Viral labrynthitis vs vestibular neuronitis?

Answer 7

Both have viral illness preceding
Vestibular neuronitis = NO HL or tinnitus

Question 8

What surgical op is done for low rectal tumours vs high rectum/sigmoid tumours vs anal tumours/ low rectal vs rest of colon?

Answer 8

sigmoid/high rectal tumours can be managed with high anterior resection.

low rectum managed with low anterior resection

Right hemicolectomy is for caecum/ ascending colon

Left hemicolectomy is for descending colon

abdominoperineal excision of rectum is for low rectal or anal tumours.

Question 9

BRACA gene referral criteria?

Answer 9

If the person concerned only has one first-degree or second-degree relative diagnosed with breast cancer they do NOT need to be referred unless any of the following are present in the family history:
age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (two or more relatives on the father’s side of the family)

Question 10

What blood vessels are mainly affected in intermittent claudication? What sx would they cause

Answer 10

Claudication affecting the femoral vessels is likely to present with calf pain rather than iliac claudication which causes buttock pain

Question 11

When can you not E+D before surgery>

Answer 11

Patients are generally advised to fast from non-clear liquids/food for at least 6 hours before surgery

Question 12

Duct papilloma vs mammary duct ectasia?

Answer 12

Mammary duct ectasia
Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

Duct papilloma
Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge

Question 13

How is peripheral arterial disease managed medically?

Answer 13

Treat co-morbidities
All patients with peripheral arterial disease should take clopidogrel and atorvastatin

Question 14

What allergy are nasal polyps associated with?

Answer 14

aspirin - part of samter’s triad (aspirin sens, asthma + nasal polyp)

Question 15

How do you distinguish between femoral hernias and inguinal hernias on examination?

Answer 15

femoral hernias, areinferolateralto the pubic tubercle

inguinal hernias aresupermedialto the pubic tubercle;

Question 16

strangulated vs incarcerated hernia

Answer 16

strangulated hernia = blood supply to hernia lost leading to necrosis,

incarerated = non-reducible but no necrosis yet

Question 17

What is buergers disease?

Answer 17

Buerger’s disease, or thromboangiitis obliterans, is a condition characterised by progressive inflammation and thrombosis of the small and medium arteries in the hands and feet. It can present as acute ischaemia or chronic progressive ischaemic changes to the skin/tissues. Ultimately it may result in gangrene of the affected area, often needing amputation. It is strongly associated with an extensive smoking history. The exact pathophysiology is not fully understood.

Question 18

Mx of acute limb ischaemia?

Answer 18

IV heparin and vascular review. Will need CT angio to visualise

Question 19

Manouvere to diagnose vs treat BPPV?

Answer 19

Dix to Diagnose, Epley to End

Question 20

How does sialadenitis present?

Answer 20

Parotitis secondary to stone obstrution in ducts
Will be purulent discharge from duct and foul taste in mouth
sometimes can see stones

Question 21

Describe the 4 different grades of haemorrhoids

Answer 21

I do not prolapse
II prolapse on defecation but reduce spontaneously
III can be manually reduced
IV cannot be reduced

Question 22

What is a Hartmanns procedure?

Answer 22

resection of the sigmoid colon is performed and an end colostomy is fashioned, can be reversed at a later date

Used for eg perforation secondary to sigmoid tumour

Question 23

How do you treat local anaesthetic toxicity?

Answer 23

Local anesthetic toxicity can be treated with IV 20% lipid emulsion

Question 24

What stoma is formed post hemicolectomy to protect the bowel?

Answer 24

A loop ileostomy can be used to defunction the colon to protect an anastomosis

This is done instead of a loop colostomy as it allows the large bowel to heal. SMall bowel heals well so ileostomy low risk