Surgery

Question 1

What is pseudocholinesterase deficiency ?

Answer 1

A rare genetic abnormality in the production of plasma cholinesterases

Question 2

What does pseudocholinesterase deficiency lead to in anaesthesia?

Answer 2

Increased duration of muscle relaxants, it leads to respiratory arrest - patient must be mechanically ventilated

Question 3

What question is asked in pre-anaesthetic assessment to try and stop complications occurring?

Answer 3

Family history as pseudocholinesterase deficiency is hereditary

Question 4

What drug can cause pseudocholinesterase deficiency?

Answer 4

Suxamethonium - this is a muscle relaxant

Question 5

What are the uses of muscle relaxant suxamethonium?

Answer 5

Short term muscle relaxants in surgery or mechanical ventilation or facilitate rapid sequence intubation

Question 6

Describe fibroadenoma lump

Answer 6

Mobile, firm, smooth, clearly defined edges (discrete), rubbery

Question 7

What is a fibroadneoma?

Answer 7

Overgrowth of one breast lobule - epithelial and fibrous component

Question 8

What age are fibroadenomas most common?

Answer 8

Under 30

Question 9

Diagnosis of fibroadenoma?

Answer 9

Ultrasound followed by core biopsy

Question 10

Ultrasound fibroadenoma

Answer 10

Single round solid mass, well circumscirbed and lobulated

Question 11

Core biopsy fibroadenoma

Answer 11

Epithelial and stromal elements

Question 12

Surgical excision for fibroadenoma?

Answer 12

> 3cm, for cosmosis or symptomatic

Question 13

Cyproterone acetate in prostate cancer?

Answer 13

-Anti androgen works by blocking androgen receptors
-It also acts on pituitary gland reducing secretion of LH which is responsible for stimulating testosterone production in testes

Question 14

What is a common consequence of subarachnoid haemorrhage?

Answer 14

syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Question 15

What electrolyte abnormality does SIADH lead to ?

Answer 15

Hyponatremia due to dilutional effects of excessive water retention

Question 16

Goserelin in prostate cancer?

Answer 16

Androgen deprivation therapy - GnRH agonist - reduces the levels of testosterone and other androgens in the body which stimulate growth of prostate cancer cells

Question 17

What is the flare effect with goserelin?

Answer 17

It acts on the pituitary gland stimulating the release of LH and FSH initially this inital stimulation can cause temporary surge in testosterone - continued use causes desensitisation

Question 18

Symptoms of tumour flare with GnRH agonists?

Answer 18

Bone pain, bladder obstrucion

Question 19

What medication can be given alongside GnRH agonsits such as goserelin?

Answer 19

Anti androgens such as cyproterone acetate

Question 20

Describe volvulus

Answer 20

Twisting of a loop of intestine around itself and the mesentery - this can lead to obstruction, ischemia and necrosis

Question 21

What is the most common volvulus?

Answer 21

Sigmoid volvulus

Question 22

Describe sigmoid volvulus

Answer 22

Large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon

Question 23

Caecael volvulus

Answer 23

Ceaceal volvulus twists around mesentry

Question 24

what si the mesentry?what is