Surgery

Question 1

Double duct sign is a sign of which condition

Answer 1

Pancreatic cancer

Question 2

Most common subtype of pancretic cancer

Answer 2

Over 80% of pancreatic tumours are adenocarcinomas which typically occur at the head of the pancreas.

Question 3

Pancreatic cancer associations

Answer 3

increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation

Question 4

Features of pancreatic cancer

Answer 4

Question 5

investigation of choice in pacreatic cancer

Answer 5

• ultrasound has a sensitivity of around 60-90%
• high-resolution CT scanning is the investigation of choice if the diagnosis is suspected
• imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

Question 6

management of pancreatic cancer

Answer 6

• less than 20% are suitable for surgery at diagnosis
• a Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease
• adjuvant chemotherapy is usually given following surgery
• ERCP with stenting is often used for palliation

Question 7

ischeamic colitis classic presentation

Answer 7

classic presentation (after a meal, intermittent and severe pain, pain out of proportion to clinical findings) and given his predisposing factors (prev. myocardial infarction, atrial fibrillation, hypertension).

Question 8

classical features of acute pancreatitis

Answer 8

classical features of acute pancreatitis: severe epigastric pain relieved by leaning forwards, accompanied by vomiting and fever.

Question 9

A 38-year-old woman with a diagnosis of oestrogen receptor-positive (ER+ve), HER2-negative breast cancer in her right breast has undergone wide local excision (WLE) and sentinel node biopsy. Histopathological examination reveals one positive sentinel node.

Her menstrual cycles last 28 days, and she experiences regular periods lasting four days at a time.

What further treatment should be offered to this patient?

Answer 9

**Radiotherpay and tamoxifen **

• In patients with breast cancer undergoing breast conserving surgery with adjuvant radiotherapy if, at sentinel node biopsy, less than 3 involved nodes are found then no further management of the axilla is required
• All patients who undergo WLE should receive adjuvant radiotherapy to reduce the risk of recurrence.
• Similarly, given that the patient has not been through menopause, as shown by her regular periods, and her tumour is ER+ve, they should also be commenced on hormonal therapy. Tamoxifen is a selective oestrogen receptor modula

Question 10

femoral hernias vs inguinal hernias anatomical position

Answer 10

femoral hernias, which are inferolateral to the pubic tubercle, from inguinal hernias which are supermedial to the pubic tubercle;

Question 11

Femoral hernias management

Answer 11

Femoral hernias need to be repaired, regardless of whether they are symptomatic, due to the risk of strangulation

Question 12

Mechanical valves - target INR:

Answer 12

Mechanical valves - target INR:
aortic: 3.0
mitral: 3.5

Question 13

mechanical valves anticoag of choice

Answer 13

**Warfarin **

Question 14

most common post op complications by timeline

Answer 14

Question 15

Pelvic inflammatory disease may progress to

Answer 15

Pelvic inflammatory disease may progress to perihepatitis (Fitz-Hugh Curtis Syndrome), characterised by RUQ pain

Question 16

Aromatase inhibitors (e.g. anastrozole) may cause …

Answer 16

Aromatase inhibitors (e.g. anastrozole) may cause osteoporosis

Question 17

definitive diagnostic investigation for small bowel obstruction

Answer 17

CT abdo is the definitive diagnostic investigation for small bowel obstruction

Question 18

what is given before an appendicectomy

Answer 18

Prophylactic IV antibiotics are given prior to appendicectomy

Question 19

Chronic anal
Fissure management

Answer 19

Chronic anal fissure - topical glyceryl trinitrate

Question 20

Anal fissure vs haemorrhoids in MCQs

Answer 20

Anal fissure painful, haemorrhoids painlesss unless thrombosed

Question 21

A 55-years-old man presents to the emergency department with severe epigastric pain and fever. He looks unkempt and affirms to be drinking 40 units of alcohol per week. He presented to the emergency department after suffering from the symptoms for two days, due to a phobia of hospitals.

Given the most likely diagnosis, which of the following is the single best investigation to order?

Answer 21

Serum lipase has a longer half-life than amylase when investigating suspected acute pancreatitis and may be useful for late presentations > 24 hours

Question 22

Inguinal hernias anatomical position relative to the pubic tubercle

Answer 22

Inguinal hernias and superior and medial to the pubic tubercle

Question 23

Periductal mastitis is common in…
examination findings and presentation and treatment

Answer 23

Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav
On examination, she has an indurated area at the lateral aspect of the nipple areolar complex. Imaging shows no mass lesions.

Question 24

Ileocaecal resection may result in vitamin ….deficiency

Answer 24

Ileocaecal resection may result in vitamin B12 deficiency
so will present with fatigue, weakness, and numbness in her hands and feet

Question 25

testicular torsion management

Answer 25

treatment is with urgent surgical exploration
if a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral