surgery

Question 1

what can raise PSA levels?

Answer 1

PSA levels may also be raised by:
benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 6 weeks after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

Question 2

Ix of priapism

Answer 2

Cavernosal blood gas analysis to differentiate between ischaemic and non-ischaemic: in ischaemic priapism pO2 and pH would be reduced whilst pCO2 would be increased.

Doppler or duplex ultrasonography: this can be used as an alternative to blood gas analysis to assess for blood flow within the penis (for kids)

Question 3

fasting and surgery

Answer 3

patients having surgery may drink clear fluids until 2 hours before their operation

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

Question 4

once daily long acting insulins and surgery

Answer 4

reduce by 20%

Question 5

SGLT2 and surgery

Answer 5

omit morning dose

Question 6

What nerve at risk with carotid endarterectomy

Answer 6

Hypoglossal

Question 7

Posterior hip approach, nerve at risk?

Answer 7

Sciatic

Question 8

Inguinal hernia repair, nerve at risk?

Answer 8

Ilioinguinal nerve

Question 9

what nerve at risk during anterior resection?

Answer 9

hypogastric autonomic nerves

Question 10

Nerve at risk during thyroidectomy

Answer 10

Laryngeal

Question 11

Posterior lymph node triangle ?

Answer 11

accessory nerve

Question 11

Lloyd Davies stirrups

Answer 11

Common perineal nerve

Question 12

intermittent claudication and ABPI

Answer 12

1 Normal
0.6-0.9 Claudication
0.3-0.6 Rest pain
<0.3 Impending

Question 13

1st line Rx Peripheral arterial disease

Answer 13

clopidogrel

Question 14

inguinal hernia

Answer 14

superior and medial to pubic tubercle

Question 15

most sensitive test for hiatus hernia

Answer 15

barium swallow

Question 16

Webers test lateralises to the opposite side with sensorineural hearing loss

Question 17

head injury and on warfarin?

Answer 17

If a patient is on warfarin who have sustained a head injury with no other indications for a CT head scan, perform a CT head scan within 8 hours of the injury.

Question 18

CT head scan within 8 hours of the head injury - for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:

Answer 18

age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

Question 19

ct head within 1 hour

Answer 19

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

Question 20

Where to external haemarrhoids originate?

Answer 20

Below the dentate line

Question 21

Grading of haemorrhoids

Answer 21

Grade I Do not prolapse out of the anal canal
Grade II Prolapse on defecation but reduce spontaneously
Grade III Can be manually reduced
Grade IV Cannot be reduced

Question 22

Direct inguinal hernias

Answer 22

Through Hasselbachs triangle
Medial to inferior epigastric

Direct and medial :)

Question 23

Indirect inguinal hernia

Answer 23

Passes lateral to the inferior epigastric artery

Failure of process vaginalis to close

Question 24

What is Parkland formula used for?

Answer 24

Calculating fluid for burns 4 ml x (total burn surface area (%)) x (body weight (kg))

Question 25

Colorectal cancer screening?

Answer 25

50-74

Question 26

1 in 10 patients at colonoscopy post screening will have malignancy

Answer 26

5 in 10 normal 4 in 10 polyp

Question 27

Who is WLE appropriate for?

Answer 27

Solitary lesion DCIS <4cm Peripheral lesion Small lesion large breast

Question 28

USOC breast referral criteria?

Answer 28

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are: aged 30 and over and have an unexplained breast lump with or without pain or aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people: with skin changes that suggest breast cancer or aged 30 and over with an unexplained lump in the axilla

Question 29

Non urgent breast referral?

Answer 29

Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain.

Question 30

familial breast ca

Answer 30

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 31

most common type breast ca

Answer 31

invasive ductal carcinoma 'No special type'

Question 32

AAA screening

Answer 32

single USS age 65 for males

Question 33

Size of AAA needing Rx?

Answer 33

>5.5cm

Question 34

Aromatase inhibitors in PM woman e.g Letrzole

Answer 34

Tamoxifen in pre-menopausal