Surgery

Question 1

treatment options for fibroadenoma

Answer 1

below 3cm = watch and wait

above 4 cm = core biopsy

Question 2

indications for a mastectomy

Answer 2

multifocal tumour
central tumour
large mass in a small breast
DCIS >4cm

Question 3

indications for WLE

Answer 3

solitary lesion
peripheral tumour
small mass in a large breast
DCIS <4cm

Question 4

role of radiotherapy in breast issues

Answer 4

• after WLE

- after mastectomy on t3/4 tumours and with positive lymph nodes

Question 5

ER postive therapy for pre/peri menopausal women

Answer 5

Tamoxifen

Question 6

ER positive therapy for post-menopausal women. What class of drug is this?

Answer 6

Anastrozole

Aromatase inhibitor

Question 7

Side effects of Tamoxifen treatment

Answer 7

increased risk of endometrial cancer
venous thromboembolism
menopausal symptoms

Question 8

HER2+ve therapy? who cannot have it?

Answer 8

Trastuzumab (Herceptin)

Do not use in patients with heart disease

Question 9

Breast screening programme screens who?

Answer 9

47-73 years old

Question 10

58 year old women, smoker, thick green nipple discharge. what is the diagnosis and process behind this?

Answer 10

duct ectasia.

dilatation and shortening of ducts

Question 11

location and use of: gastrostomy

Answer 11

epigastrium

gastric decompression/fixation, feeding

Question 12

location and use of: loop jejunostomy

Answer 12

any location
rarely used because of high output
used after emergency lap procedure with early close

Question 13

location and use of: percutaneous jejunostomy

Answer 13

LUQ

feeding

Question 14

location and use of: loop ileostomy

Answer 14

RIF

defunctioning of colon

Question 15

location and use of: end ileostomy

Answer 15

RIF
complete excision of colon
reversal more difficult
when ileocolic anastomosis not planned

Question 16

location and use of: end colostomy

Answer 16

LIF/RIF

colon diverted/resected and anastomosis not achieved or wanted

Question 17

location and use of: loop colostomy

Answer 17

any

to definition distal colon

Question 18

location and use of: caecostomy

Answer 18

RIF

last resort

Question 19

explain an anal fissure

Answer 19

longitudinal or elliptical tears of the squamous lining of the distal anal canal.
acute is less than 6 weeks

Question 20

describe the management of an acute anal fissure

Answer 20

diet: increase fibre and fluid
bulk forming laxatives, lactulose if not tolerated
lubricants before defecation
topical anaesthetics

Question 21

management of a chronic anal fissure

Answer 21

all of acute management
topical GTN for 8 weeks
surgery or botox

Question 22

most common type of anal neoplasm

Answer 22

squamous cell carcinoma

Question 23

method of imaging used to stage colorectal cancer

Answer 23

CT chest abdo pelvis

Question 24

procedure needed and location of anastomosis: patient with cancer in caecum

Answer 24

right hemicolectomy

ileo-colic anastomosis

Question 25

procedure needed and location of anastomosis: patient has cancer in distal transverse colon

Answer 25

left hemicolectomy | colo-colon anastomosis

Question 26

procedure needed and location of anastomosis: patient has cancer in ascending colon

Answer 26

right hemicolectomy | ileo-colic anastomosis

Question 27

procedure needed and location of anastomosis: patient has cancer in descending colon

Answer 27

left hemicolectomy | colo-colon anastomosis

Question 28

Dukes staging

Answer 28

A- trapped in mucosa B- invading bowel wall C- lymph node mets D- distant mets

Question 29

procedure needed and location of anastomosis: patient has cancer in sigmoid colon

Answer 29

High anterior resection | colo-rectal

Question 30

procedure needed and location of anastomosis: cancer in the UPPER rectum

Answer 30

``` anterior resection (TME) colo-rectal ```

Question 31

procedure needed and location of anastomosis: cancer in the LOWER rectum

Answer 31

``` anterior resection (low TME) colo-rectal +/- stoma ```

Question 32

procedure needed and location of anastomosis: cancer in the anal verge

Answer 32

APER | no anastomosis needed

Question 33

obstructive colorectal cancer; palliative options

Answer 33

stent, bypass, diversion stoma

Question 34

urgent referral to colorectal clinic criteria

Answer 34

over 40 - weight loss and abdominal pain over 50 - rectal bleed over 60 - ID anaemia or bowel change

Question 35

radiological sign of sigmoid volvulus

Answer 35

large dilated loop of bowel | coffee bean sign

Question 36

management of sigmoid volvulus

Answer 36

sigmoidoscopy and rectal tube insertion

Question 37

management of caecal volvulus

Answer 37

right hemicolectomy

Question 38

work up for patient with ?appendicitis

Answer 38

WCC, pregnancy test, CRP, amylase, urine dip | USS

Question 39

sign seen in appendicitis

Answer 39

Rosvings: palpate LIF and more pain felt in RIF

Question 40

what history would make you suspect mesenteric adenitis

Answer 40

recent URTI, history of fever, generalised abdominal pain

Question 41

what history makes intestinal obstruction most likely

Answer 41

previous surgeries or history of malignancy. colicky pain,, vomiting, not moved bowels in a while

Question 42

history of pancreatitis patients? | what signs are present

Answer 42

history of alcohol or gallstones, severe epigastric pain, vomiting. Cullens sign - perumbilical discolouration Grey-Turners - flank discolouration

Question 43

history in biliary colic

Answer 43

pain in RUQ radiating to the back, following a fatty meal, can cause obstructive jaundice (pale stools + dark urine) Female, fat, 40, fair

Question 44

most common hernias

Answer 44

inguinal

Question 45

what hernia is more common in women

Answer 45

femoral

Question 46

location of inguinal hernia

Answer 46

above and medial to pubic tubercle

Question 47

location of femoral hernia

Answer 47

below and lateral to pubic tubercle

Question 48

difference between umbilical and paraumbilical hernia

Answer 48

umbilical is symmetrical under belly button | paraumbilical is asymmetrical and either above or below

Question 49

what causes a congenital inguinal hernias in paeds

Answer 49

indirect hernia from a patent processes vaginalis. | 60% are right sided

Question 50

location of direct inguinal hernia

Answer 50

medial to inferior epigastric artery

Question 51

location of indirect inguinal hernia

Answer 51

lateral to inferior epigastric artery

Question 52

what are hyatid cysts caused by

Answer 52

echinococcus granulosus

Question 53

reaction when hyatid cysts are formed (type of hypersensitivity)

Answer 53

type 1

Question 54

iatrogenic nerve injuries. nerve damaged in: posterior node biopsy

Answer 54

accessory nerve

Question 55

iatrogenic nerve injuries. nerve damaged in: Lloyd Davies stirrups

Answer 55

common peroneal

Question 56

iatrogenic nerve injuries. nerve damaged in: thyroidectomy

Answer 56

laryngeal nerve

Question 57

iatrogenic nerve injuries. nerve damaged in: anterior resection of rectum

Answer 57

hypoergastric autonomic nerves

Question 58

iatrogenic nerve injuries. nerve damaged in: axillary node clearance

Answer 58

long thoracic, thoracodorsal

Question 59

iatrogenic nerve injuries. nerve damaged in: inguinal hernia surgery

Answer 59

ilioinguinal nerve

Question 60

iatrogenic nerve injuries. nerve damaged in: posterior approach to hip

Answer 60

siatic nerve

Question 61

history of pancreatic cancer

Answer 61

painless jaundice, anorexia, weight loss, epigastric pain

Question 62

Ix of ?pancreatic cancer

Answer 62

USS, CT

Question 63

management of pancreatic cancer

Answer 63

Whipples procedure palliative: ERCP + stent give chemo

Question 64

what is the total available score in the GCS

Answer 64

15

Question 65

describe the GCS: Motor response

Answer 65

``` obeys commands 6 localises to pain 5 withdraws from pain 4 abnormal flexion 3 extends to pain 2 none 1 ```

Question 66

describe the GCS: vocal response

Answer 66

``` orientated 5 confused 4 words 3 sounds 2 none 1 ```

Question 67

describe the GCS: eye opening response

Answer 67

spontaneous 4 to speech 3 to pain 2 none 1

Question 68

describe the pathology of extradural haematoma

Answer 68

blood between the dura and the skull

Question 69

what brain injury may occur in an accerleration- deceleration trauma or a blow to the side of the head?

Answer 69

extradural haematoma

Question 70

features of an extradural haematoma

Answer 70

increased ICP, patients may have a lucid period

Question 71

describe the pathology of a subdural haematoma

Answer 71

bleeding into the outermost meningeal layer

Question 72

describe the management of a subarachnoid haemorrhage

Answer 72

increased ICP -> IV mannitol/furosemide | cerebral oedema -> decompressive craniotomy

Question 73

classic presentation of SAH

Answer 73

severe occipital headache, neck stiffness

Question 74

how long do you wait to do a lumbar puncture in SAH, what are you looking for?

Answer 74

wait 12 hours, Xanthrochromia

Question 75

how do alpha-1 antagonists work in BPH? give an example. give side effects

Answer 75

decrease smooth muscle tone tamsulosin SEs: dizziness, hypotension, dry mouth, depression

Question 76

how do 5alpha reductase inhibitors work give an example give side effects

Answer 76

block conversion of testosterone to DHT finesteride erectile dysfunction, decreases libido, gynaecomastia. DECREASES PSA!

Question 77

what subtype of cancer are most bladder cancers

Answer 77

transitional cell

Question 78

management of epididymo-orchitis

Answer 78

IM ceftriaxone, doxycycline 100mg O, BD 10-14 days

Question 79

what is a Wilms tumour? who is affected?

Answer 79

nephroblastoma, first 4 years of life

Question 80

what part of the prostate does cancer usually form?

Answer 80

peripheral zones

Question 81

what might you feel on PR exam in prostate cancer

Answer 81

asymmetrical, hard, nodular, enlarged prostate, may be loss of the median sulcus

Question 82

what subtype of prostate cancer is most common

Answer 82

adenocarcinoma

Question 83

what nodes does prostate cancer spread to first

Answer 83

obturator nodes

Question 84

what system is used to score prostate cancer

Answer 84

Gleason

Question 85

most renal stones are made of

Answer 85

calcium oxalate

Question 86

how do you manage a renal stone

Answer 86

pain relief; diclofenac, alpha-adrenergic blockers less than 5mm: pass larger than 5mm: shock lithotripsy, urteroscopy (pregnant ladies), nephrolithotomy

Question 87

when is the cremasteric reflex lost

Answer 87

in testicular torsion

Question 88

hormonal blood results in seminoma (tumour markers)

Answer 88

afp normal, elevated hcg, elevated lactate

Question 89

how does AAA occur

Answer 89

failure of elastic proteins within the extracellular matrix

Question 90

normal AA measurements for females and males

Answer 90

female 1.5 | male 1.7

Question 91

AAA with low rupture risk criteria

Answer 91

asumptomatic, less than 5.5cm diameter | management: USS surveillance

Question 92

AAA with high rupture risk

Answer 92

symptomatic, 5.5cm or greater, increases by 1 in a year | management: EVAR or open repair

Question 93

what is ABPI

Answer 93

ratio of systolic BP in lower legs to that of the arms. decrease pressure in legs indicates PAD

Question 94

what ABPI score indicates PAD

Answer 94

less than 0.9, less than 0.5 is severe