Surgery

Question 1

What is the most common cause of painful PR bleed?

Answer 1

Fissure

Question 2

Where are anal fissures located?

Answer 2

midline and 12oclock position
distal to the dentate line

Question 3

What usually precedes an anal fissure?

Answer 3

ano-rectal abscess

Question 4

How does bladder cancer typically present?

Answer 4

macroscopic painless haematuria

can also have incidental finding of microscopic haematuria

Question 5

What should all >60YO + haematuria + raised white cell count +- ex smoker be referred to?

Answer 5

2WW urology

Question 6

Where are inguinal hernias located?

Answer 6

superior and medial to the pubic tubercle

Question 7

What is the most common type of hernia?

Answer 7

Inguinal
really common in men

Question 8

Typical features of inguinal hernias

Answer 8

location
reduces when patient lies down
reduces when pressure is applied

Question 9

How can subdural haematomas be classified?

Answer 9

Acute - symptoms within 48 hours of injury
Subacute - symptoms gradually develop days to weeks after injury
Chronic - weeks to months later, common in elderly

Question 10

What are conservative management of varicose veins?

Answer 10

weight loss
leg elevation
exercise
compression stockings

Question 11

What are the criteria for a CT scan within 1 hour after head injury?

Answer 11

GCS<13
GCS<15 after 2 hours of injury
retrograde amnesia of more than 30 mins before
suspected skull fracture
>1 episode of vomiting
focal neurological deficit
seizure
signs of basal skull fracture

Question 12

When should FIT test be suggested?

Answer 12

palpable abdominal mass
40YO+weight loss + abdo pain
IDA
change in bowel habits
<50YO with rectal bleed + weight loss/ abdo pain
>60YO and anaemia ( not IDA)

Question 13

Screening programme for bowel cancer

Answer 13

60 to 74 YO Male and females
FIT every 2 years

Question 14

What does incarcerated hernia mean?

Answer 14

hernia cannot be reduced

Question 15

Symptoms of a strangulated hernia

Answer 15

pain
fever
erythema around the skin of the hernia
nausea
vomiting
blood in stools
guarding
tenderness

Question 16

What is flail chest injury?

Answer 16

chest wall disconnects from thoracic cage

Question 17

How many lymph nodes need to be positive in sentile biopsy to get removed?

Answer 17

3/5

Question 18

Common cause of small bowel obstruction in adults

Answer 18

previous surgery causing adhesions
crohns
incarceration of hernias

Question 19

What hormonal treatment is used in HER+ and post menopausal women?

Answer 19

aromatase inhibitors

Question 20

How to pick up small bowel obstruction on XRAY?

Answer 20

Valvulae conniventes extend all the way across

Question 21

What should all patients with peripheral arterial disease be prescribed?

Answer 21

Atorvastatin 80 mg
Clopidogrel

Question 22

When should a LP be done when suspecting a SAH?

Answer 22

12 hours post onset of headache

Question 23

What is the most frequent colorectal cancer?

Answer 23

adenocarcinoma

Question 24

What are patients with chronic pancreatitis at risk of developing and how should they be managed?

Answer 24

Diabetes
annual HbA1c

Question 25

What vessel is most likely ruptured in an extradural haemorrhage?

Answer 25

middle meningeal

Question 26

How to treat local anaesthetic toxicity?

Answer 26

IV 20% lipid emulsion

Question 27

What are complications of transurethral resection?

Answer 27

TURP syndrome Urethral stricture/UTI Retrograde ejaculation Perforation of prostate

Question 28

What are the features of TURP syndrome?

Answer 28

HypoNa fluid overload glycin toxicity

Question 29

Surgical management of Distal transverse or descending colon cancer?

Answer 29

left hemicolectomy

Question 30

1st line pain relief for renal colic pain

Answer 30

NSAIDs

Question 31

What should be used as investigation for children and pregnant women in suspected kidney stones?

Answer 31

US

Question 32

Management for renal stones

Answer 32

watchful waiting if < 5mm and asymptomatic 5-10mm shockwave lithotripsy 10-20 mm shockwave lithotripsy OR ureteroscopy > 20 mm percutaneous nephrolithotomy

Question 33

Management for ureteric stones

Answer 33

shockwave lithotripsy +/- alpha blockers < 10mm shockwave lithotripsy +/- alpha blockers 10-20 mm ureteroscopy

Question 34

Symptoms of epididymo-orchitis

Answer 34

unilateral testicular swelling pain (gradually worsening) present cremasteric reflex erythema

Question 35

Treatment for epididymo-orchitis with unknown organism

Answer 35

IM Ceftriaxone oral doxy 10-14days

Question 36

Most common organism that causes cholangitis

Answer 36

E.Coli

Question 37

Where are femoral hernias located?

Answer 37

below and lateral of the pubic tubercle

Question 38

What is paralytic ileus?

Answer 38

common complication after bowel surgery

Question 39

What are non seminal testicular tumours associated with marker wise?

Answer 39

high HCG and AFP

Question 40

What is described as eczema like changes of the breast?

Answer 40

Pagets disease of the nipple

Question 41

What is first line management for small bowel obstruction?

Answer 41

IV fluids and NG tube insertion

Question 42

Management of cholecystitis

Answer 42

IV antibiotics and analgesia laparoscopic cholecystectomy within 1 week

Question 43

Management of cholangitis

Answer 43

IV antibiotics and analgesia ERCP within 24-48 hours

Question 44

When should a right hemicolectomy be performed?

Answer 44

Caecal, ascending or proximal transverse

Question 45

What is a sigmoid volvulus?

Answer 45

large bowel obstruction due to sigmoid torsion

Question 46

What is seen in an XRAY with sigmoid volvulus?

Answer 46

coffee bean

Question 47

When does an anastomosis leak usually present?

Answer 47

5-7 days post surgery

Question 48

Signs of an anastomosis leak

Answer 48

new onset AF

Question 49

What are complications of acute pancreatitis?

Answer 49

Peripancreatic fluid collections pseudocyst ARDs abscess

Question 50

How are asymptomatic renal stones <5mm managed?

Answer 50

watch and weight image again after 4 weeks Wh

Question 51

What needs to be excluded prior to circumcision?

Answer 51

diagnosis of hypospasdiasis

Question 52

What initial investigations should be performed with males with ED?

Answer 52

Glucose lipids free testosterone

Question 53

painless lump in scrotum + gynaecomastia

Answer 53

testicular cancer

Question 54

What pain relief is used for acute renal colic?

Answer 54

IM diclofenac

Question 55

What is first line investigation for prostate cancer?

Answer 55

multiparametric MRI

Question 56

What is a hartmans procedure?

Answer 56

resect area of bowel that is not functioning form ileostomy/colostomy temporarily colorectal anastomosis formation to reform continous bowel

Question 57

Treatment for superficial thrombophlebitis

Answer 57

NSAIDs Compression stockings

Question 58

What medication is used in chronic anal fissure?

Answer 58

Topical glyceryl trinitrate

Question 59

What drug is administered to patients post SAH to prevent spasm?

Answer 59

Nimodipine ( CCB)

Question 60

Continuous dribbling incontinence after prolonged labour

Answer 60

vesciovaginal fistulae