Surgery

Question 1

Caecal, ascending or proximal transverse colon - disease at this level requires what kind of surgery and anastomosis?

Answer 1

Right hemicolectomy

Ileo-colic anastomosis

Question 2

Distal transverse, descending colon - disease at this level requires what kind of surgery and anastomosis?

Answer 2

Left hemicolectomy

Colo-colon anastomosis

Question 3

Sigmoid colon -disease at this level requires what kind of surgery and anastomosis?

Answer 3

High anterior resection

Colo-retal anastomosis

Question 4

Rectum- disease at this level requires what kind of surgery and anastomosis?

Answer 4

Anterior resection

Colo-rectal anastomosis +/- defunctioning stoma if lower rectum

Question 5

Anal verge - disease at this level requires what kind of surgery?

Answer 5

Abdomino-perineal excision of rectum

Question 6

Peripheral arterial disease, which antiplateley?

Answer 6

Clopidogrel. Should also be on a statin.

Question 7

Which anaesthetic agent is particularly useful in preventing post op N&V?

Answer 7

Propofol

Question 8

Which anaesthetic agent in useful in trauma and why?

Answer 8

Ketamine - doesn’t cause a drop in BP

Question 9

What are the adjuvants used for hormone receptor +ve breast cancer in pre versus post menopausal women?

Answer 9

Tamoxifen - pre and peri menopausal

Anastrozole (aromatase inhibitor) - post menopausal

Question 10

What is charcot’s triad?

Answer 10

Fever, jaundice and right upper quadrant pain

= Ascending cholangitis

Question 11

When is AAA screening offered?

Answer 11

One off screening for men age 65 is offered

Question 12

How do you manage different paediatric hernias?

Answer 12

inguinal: repair ASAP
umbilical: manage conservatively

Question 13

How is lidocaine toxicity treated?

Answer 13

IV lipid emulsion

Question 14

What do you do with diabetic meds if having an operation?

Answer 14

Metformin - omit lunchtime dose only if TDS, otherwise continue as normal

Sulfonylurea (gliclazide) - omit pre-op dose

SGLT inhibitor (empaglifozin) - omit day of surgery

OD insulin (long acting) - reduce dose by 20% day before and day of surgery

BD insulin - 50% morning dose day of surgery

Question 15

What medication can be used to prevent renal stones in someone prone to them who also has a high calcium?

Answer 15

Thiazide diuretic

Question 16

When should you cosnider surgical excision for a firboadenoma?

Answer 16

> 3cm

Question 17

Claudication in which vessels causes pain in the calves versus pain in the buttocks in peripheral vascular disease?

Answer 17

Buttock pain - iliac stenosis

Calves - femoral artery

Question 18

What’s the difference between strangulated and incarcerated hernias?

Answer 18

Incarcerated - Hernia sac is imprisoned (incarcerated) but the prisoner (bowel) is still okay (has blood supply, bowel contents may still pass)

Strangulated - Hernia sac is incarcerated but the bowel blood supply is cut off (strangulated)

All strangulated hernias are incarcerated. Not all incarcerated hernias are strangulated.

Question 19

What kind of line does TPN need to be given by?

Answer 19

Needs to be central - eg subclavian.

Not a midline - this is still considered peripheral.

Question 20

When would you do a loop colostomy versus a loop ileostomy?

Answer 20

In emergency surgery to defunction the distal part of the bowel and divert contents away from it to allow healing.

Loop ileostomy is often perferable as it has a lower complications rate.
Loop colostomy can be considered to defunction a distal part of colon.

Question 21

What family history of cancer merits a referral to the breast clinic, even in the absence of examination findings?

Answer 21

1 first degree or second degree relative with breast cancer (any age)
+
1 first degree or second degree with ovarian cancer (any age)

One of them should be a first degree relative

OR any parental history of breast ca (dad with breast cancer)

Question 22

When are qfits offered as screening in Scotland?

Answer 22

Screening kits are sent every 2 years to all patients 50-74 years in Scotland.

Question 23

What are the time frames for when you can check the PSA (what you need to abstain from etc) ?

Answer 23

6 weeks after 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 24

What is the modified Parkland’s formula for fluid resuscitation in burns patients?

Answer 24

2mls x kg x % Burns

50% given in the first 8 hours and then 50% in the next 16 hours

Question 25

What size of AAA requires what monitoring

Answer 25

<3cm normal

> 3cm- scan every 12 months

> 4.5cm scan every 3 months

> 5.5cm refer to vascular surgery within 2 weeks

Question 26

What is the treatment for epididymo-orchitis?

Answer 26

Ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days

Question 27

Other than diclofenac, which other medication can be helpful in patients with renal stones?

Answer 27

Alpha blockers - eg tamsulosin - can relax smooth muscle and aid passage

Question 28

Criteria for CT <1hr versus within 8 hr

Answer 28

Within 1hr:
- Basal skull fracture signs
- Neurological deficit
- GCS <13 on initial assessment or <15 2hrs after injury
- Sick more than x1 post injury
- Seizure post injury

Within 8hrs:
- Age over 65
- Bleeding risk: anti-coagulation, clotting disorder
- Concussion: retrograde amnesia before head injury
- Dangerous mechanism of injury: e.g. hit by car / fall from height / from 1m height or >5 stairs

Question 29

Which medication is used in subarachnoid haemorrhage to prevent vasospasm?

Answer 29

Nimodipine

Question 30

Which anaesthetics are associated with malignant hyperthermia?

Answer 30

Isoflurane, desflurane, sevoflurane

MH is a genetic disorder, manifesting due to calcium overload in the skeletal muscle causing sustained muscular contraction and rhabdomyolysis, resulting in excess anaerobic metabolism causing acidosis. End-tidal CO2 increases as a result, along with body temperature which causes diaphoresis (excess sweating).