Surgery

Question 1

what medications and conditions can lead to priapism?

Answer 1

• medication
  
  • PDE-5 inhibitors
  • alpha-1 antagonists (prazosin)
  • antidepressants (trazodone, SSRIs)
• sickle cell disease
• cauda equina syndrome
• leukaemia
• pevlic surgery or fracture

Question 2

what is the fluid of choice for burns resuscitation?

Answer 2

LR

Question 3

what intensive care intervention increases the chances of candidaemia?

Answer 3

central venous catheter

Question 4

how should you interperet AFP in the context of diagnosing HCC?

Answer 4

AFP is elevated in 50% of HCC

positive result is highly suggestive

negative result cannot be used to rule out HCC

Question 5

what is the difference between achalasia and EoE presentation?

Answer 5

progressive versus intermittent dysphagia

Question 6

what are the biomarker patterns for seminoma and teratoma?

Answer 6

seminoma - AFP normal, bHCG elevated

teratoma - AFP elevated, bHCG elevated

Question 7

what are the ottowa rules for XR foot/ankle?

Answer 7

ankle : tender at tip/posterior margin of medial/lateral malleolus

foot: tender at navicular, base of 5th metatarsal

both: cannot walk 4 steps, 2 on each foot

Question 8

which parts of the bowel are most susceptible to ischaemia/necrosis from hypoperfusion?

Answer 8

splenic flexure

rectosigmoid junction

Question 9

what is the management of a congenital umbilical hernia?

Answer 9

not to operate, just observe

most will close by age 5

consider surgery if they are irreducible, >1.5 cm or not resolving later in childhood

Question 10

what are the interventions useful for lowering ICP?

Answer 10

raise head of the bed

hyperventilation

sedation

mannitol/hypertonic saline

removal of CSF - therapeutic LP, VP shunt

Question 11

what are the complications of retropharyngeal abscess?

Answer 11

acute airway obstruction

contiguous spread leading to necrotizing posterior mediastinitis at the level of the diaphragm

spread to the carotid sheath and thrombosis of the internal jugular vein - CN IX, X, XI & XII defects

Question 12

what blood test is used for monitoring medullary thyroid cancer following total thyroidectomy and why?

Answer 12

serum calcitonin

high rates of metastasis at the time of diagnosis

if it remains high will indicate a metastasis that needs identifying

if it becomes high again after a period of being normal will indicate a recurrance

Question 13

which nerves will give referral otalgia in the setting of head and neck cancer? where will the lesions be?

Answer 13

glossopharyngeal - base of tongue

vagus - posterior oropharynx (larynx and hypopharynx)

Question 14

what pathogens cause splenic collection?

how do they get there?

how is it diagnosed?

how is it treated?

Answer 14

strep, staph, salmonella

septic emboli - infective endocarditis

CT abdomen with contrast

splenectomy, antibiotics alone have a 50% mortality rate

Question 15

how do you diagnose oesophageal perforation?

Answer 15

CXR

CT chest

barium swallow

Question 16

what is the management of a cat bite?

Answer 16

cats have higher risk of wound infection

wound care with irrigation and decontamination

co-amox for 7 days

Question 17

what would you typically find on culture of diabetic foot ulcers/osteomyelitis?

how do pathogens spread to the bone?

Answer 17

polymicrobial infection - Staph, Strep, Pseudomonas

contiguous spread

Question 18

mutliple small necrotic ulcers over the lower abdomen

thrombocytopenia

on anticoagulation

Answer 18

Heparin-induced thrombocytopenia

Question 19

gold-standard diagnosis for osteomyelitis?

Answer 19

open bone biopsy for culture

Question 21

what intervention is needed to treat haemoptysis?

Answer 21

bronchoscopy - baloon tamponade, cautery

Question 22

what is the differential for an anterior medistinal mass?

Answer 22

4 T’s

thymoma, ectopic thyroid, teratoma, terrible lymphoma

Question 23

describe CT findings of focal nodular hyperplasia

Answer 23

triple contrast CT shows hyperdense lesion surrounding a central stellate scar

not related to OCP use, in contrast to hepatic adenoma

does not require intervention/treatment

Question 24

what is dumping syndrome?

Answer 24

post-gastrectomy complication in as many as 50% patients

damage or resection of the pyloric sphincter leads to release of hypertonic, undigested stomach contents into the small bowel

fluid shift, autonomic activation and release of vasoactive intestinal peptide

treat with dietary modification

Question 25

what are the echocardiogram features of severe AS?

what are the indications for valve replacement?

Answer 25

Severe = mean transvalvular pressure gradient >40 mmHg, aortic jet velocity >4.0 m/sec

usually has a valve area of <1.0 cm² but not required

replacement: LVEF <50%, symptoms, undergoing another cardiac procedure

Question 26

what is the diagnostic test for diverticular disease? what should be avoided?

Answer 26

CT with oral & IV contrast

sigmoidoscopy and colonoscopy are contra-indicated as there is a high risk of perforation

Question 27

what are the indications for mitral valve replacement?

Answer 27

primary MR - LVEF 30-60%

if secondary to dilated CM, treat medically to reduce LV dilation
no role for surgical management; conversely, there is no role for medical management in primary MR

Question 28

which trace metal element deficiency gives you impaired taste; pustular, crusting lesions; and alopecia?

Answer 28

Zinc

Question 29

what structures can be damaged in a clavicle fracture?

Answer 29

brachial plexus

subclavian artery

Question 30

what do you have to remember when thinking about tissue samples from testicular cancer?

Answer 30

scrotal/transscrotal approaches are associated with a worse outcome because they seed the tumour to the local lymphatic system and increase the risk of recurrance

Question 31

what is the most common neurovascular injury with anterior shoulder dislocation?

Answer 31

axillary nerve damage, supplies deltoid

weakness of shoulder abduction

Question 32

how do you manage a 2/3/4th metatarsal fracture?

Answer 32

the rest of the foot typically acts as a splint so fixation is unnecessary

rest and simple analgesia unless gross deformity

non-union is rare

Question 33

what is the neurologic defect with a syringomyelia?

Answer 33

progressive loss of pain and temperature sensation at the level of the syrinx

flaccid paralysis seen if the syrinx expands to compress the ventral horn neurons

touch, proprioception and vibration sense are typically spared

Question 34

what is the neurologic defect seen with cervical spondylosis?

Answer 34

weakness below the level of the lesion (UMN)

should be thought of like any other cord compression, associated neck pain and stiffness

Question 35

what are the risk factors for pancreatic cancer?

Answer 35

smoking

obesity

chronic, nonhereditary pancreatitis

Question 36

what is the triad of fat embolism?

Answer 36

respiratory distress

neurologic dysfunction (confusion)

petechial rash

Question 38

when is HIDA scan the correct answer?

Answer 38

in the diagnosis of acute cholecystitis when US-RUQ proves inconclusive

Question 39

nasopharyngeal cancer is associated with which infection?

Answer 39

EBV

Question 40

what are the early and late complications of RYGB and their presentations?

Answer 40

early

• anastamotic leak (sepsis)
• bowel ischaemia (diffuse abdominal pain)

late

• gallstones from rapid weight loss (RUQ pain)
• stricture (dysphagia, bowel obstruction)
• marginal ulcer (pain, perforation, bleeding)
• dumping syndrome (diarrhoea, crampy abdominal pain, vasomotor symptoms)

Question 41

what is the management of oesophageal perforation?

Answer 41

diagnosis with barium swallow

initial - NPO, IVF, PPI, antibiotics

contained? trial of medical management

non-contained? thoracotomy +/- laparotomy with debridement and repair

Question 42

what is the determining factor in the prognosis of astrocytoma?

Answer 42

tumour grade/degree of anaplasia

GBM is another term for grade IV astrocytoma with very poor prognosis