Surgery Formative Flashcards
A 22 year old sexually active female presents with sudden onset of right iliac fossa pain which gradually spreads out across her lower abdomen. The pain is constant. She is otherwise well. What is the most likely diagnosis?
E. Ruptured Ovarian Cyst
Sudden onset is something popping. Ovarian torsion can give rapid pain, but as the torsion does not involve free intraperitoneal blood, the pain does not spread out.
Which statement concerning use of hand-held Doppler for assessment of the vascular tree is incorrect?
B. An ABPI of less than 0.6 is suggestive of critical ischaemia
An ABPI of 0.3 or less suggests CI. The third artery is the peroneal artery, often heard in diabetics when the others are not.
A patient undergoes an emergency laparotomy for sepsis where it is necessary to resect the bowel. What possible findings at laparotomy would not preclude a primary anastomosis?
C. Intra-operative hypothermia
Whilst undesirable, this is not a contraindication. An anastomosis should not be performed in the presence of tension, faecal contamination or poor blood supply. This is mainly true for colonica anastomosis as the arterial supply is not as good as small bowel.
A young girl is admitted with a clinical diagnosis of appendicitis. What is most likely to be present?
D. Localised tenderness
Diagnosis is clinical, not based on tests. CRP may take 36 hours to rise. WCC elevation is variable.
What is not a contraindication to arterial puncture at the wrist?
D. Negative Allens Test
A Negative Allens Test means the hand has radial and ulnar supply. A positive Allen test means that radial artery is the sole supplier of blood to the hand and that placing an arterial line runs the risk of ischaemia.
What is not a sign of basilar skull fracture?
B. Epistaxis
Epistaxis may of course occur in conjunction with BOS fracture but is not a sign. Any of the others would lead you to make a clinical diagnosis of BOS fracture.
Which statement regarding calcium homeostasis is correct?
C. Parathyroid hormone causes phosphaturia
An elderly male is thought to have carotid stenosis. What is not usually a symptom of middle cerebral artery ischaemic events?
A. Bitemporal hemianopia
A patient presents with pain in the lower limb when they walk. What is not included in the differential diagnosis of lower limb claudication?
C. Herpes zoster infection
This seldom affects the lower limb and is a constant pain not made worse by walking.
A 32 year old female presents having been found to have a solitary mass in the left lobe of her thyroid gland. Clinically she is euthyroid. Which statement is correct?
D. It is likely to be a colloid nodule.
Most cold nodule in euthyroid patients are benign.
A young male presents with a scrotal swelling and is found to have a testicular mass. What condition does not cause a testicular mass?
B. Hydrocele
It is a scrotal mass not testicular, the hydrocoele fluid extends around the testis, meaning the testis is not palpable.
A patient requires a splenectomy as a result of trauma. Which statement regarding the splectomised patient is correct?
A. Commonest pathogen in overwhelming sepsis is S.pneumoniae.
A patient post-colectomy is unwell and manifesting signs suggestive of systemic inflammatory response syndrome (SIRS). Which findings are not compatible with the criteria for diagnosing SIRS?
B. pCO2 greater than 45mmHg
A patient has peripheral vascular disease due to atherosclerosis. Which treatment modality is least likely to help?
E. Treatment with beta-blockers
May worsen claudication
A patient presents with severe left-sided renal angle pain and is found to have a 1.5cm left uteretic calculus. Which statement is most likely to be correct?
B. Any degree of sepsis requires emergency intervention.
Infected obstructed system is a urological emergency.
A hypertensive male has been referred to your vascular clinic for treatment of renal artery stenosis. Which statement regarding renal artery stenosis is correct?
A. Bruits are best heard in the upper abdomen
A 65 year old male is admitted with a leaking abdominal aortic aneurysm (AAA). He undergoes emergency surgery with an open tube graft. Which complication is least likely to occur?
B. Aorto-enteric fistula
A 60 year old male presents with acute pancreatitis due to gallstones. Which result does not predict the severity of the attack?
**A. A lipase level of 40,000 U/L (RI < 60). **
Lipase level is irrelevant.
A 35 year old female presents to the breast clinic with mastalgia. Advice for this patient would include all of the following except:
A. Cyclical mastalgia improves with the oral contraceptive.
A 55 year old female with carcinoma of the breast, undergoes axilliary dissection and subsequently develops lymphodema of the arm. What advice is incorrect?
C. She should take a high sodium diet.
No one should have a high sodium diet.
Which symptom is not consistent with a diagnosis of lower urinary tract symptoms (LUTS)?
E. Loin pain
A 55 year old Asian male is diagnosed with hepatocellular cancer. Which statement is incorrect?
A. It is four times more frequent in females = incorrect. It is far more common in males.
Which statement concerning local anaesthetics is correct?
E. Ropivicaine is a partial vasoconstrictor
What is not a sign of L5-S1 disc herniation?
D. Weakness of foot extensors
A 65 year old male presents with jaundice due to adenocarcinoma of the pancreas. Which statement is most likely to be incorrect?
B. He is likely to have painful jaundice.
Jaundice is classically PAINLESS with carcinoma of the pancreas. CA19-9 is tumour marker for pancreatic cancer. The gallbladder is palpable - Courvoisier’s law. Tumours in the head of the pancreas cause jaundice and therefore present earlier and have a better prognosis than those in the tail.
Concerning inguinal hernia, which statement is correct?
A. 3% of the adult population will develop hernia
A patient presents with severe head trauma and an ICP probe is placed. What would you least expect to see with rising intracranial pressure?
D. Hypotension (Cushing reflex)
Which statement regarding hydatid disease is incorrect?
C. Humans ingest the larvae.
Humans do not ingest the larvae, the ingest the eggs.
Which statement concerning head injury is correct?
**A. Measuring intracranial pressure is a useful adjunct to management. **
Primary brain injury cannot be prevented as it has already happened, GCS is a useful predictor. The others are factually incorrect.
What is the least common cause of haematuria?
E. Urethral valves
Which statement concerning gangrene is correct?
A. Aggressive surgery is usually required
Which statement concerning fibroadenoma of the breast is incorrect?
B. Best visualised on a compression mammogram = Incorrect. They are best visualised on USS.
Which statement concerning Dupuytren’s contracture is incorrect?
E. Predominantly affects the middle finger
You are reviewing an elderly patient with an acute confusional state on the ward following major surgery. She has become increasingly confused. What is most likely to account for the change?
B. Chest infection.
Hypoxia is the most common cause.
A 77 year old male presents with an acutely ischaemic lower limb. Which finding is not compatible with an embolic cause?
D. Presence of incomplete ischaemia.
Embolic causes usually result in complete ischaemia.
Which statement concerning diverticular disease of the colon is correct?
E. The sigmoid is the most commonly affected area.
The diverticulum is false in that it does not include all constituents of the wall. Resection is very uncommon, commonest in areas of low fibre diet.
What condition does not require statutory notification by medical practitioners in Western Australia?
E. Surgical deaths
Surgical deaths do not require statutory notification. Participation in the Western Australian Audit of Surgical Mortality is a requirement of the Royal Australian College of Surgeon’s Contuining Professional Development Program, but there is no statutory requirement for surgical deaths to be notified to the Executive Director of Public Health.
A clinical audit involves comparing the observed quality of care with a standard. What does the standard used need to be?
D. Specific, measurable, acheivable, related to the aim of the audit and time bound.
What technique controls for confounding in epidemiological studies?
D. Randomisation
The purpose of randomisation is to ensure that known and potential prognostic factors are balanced between the treatment groups - ie. control for confounding and bias in patient allocation.
The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is based on three components: age, acute physiologic score (APS), and chronic health. According to the survival curve below, what is the absolute difference in 1 500-day survival between patients with APACHE score <20 and those with a score >20?
- A. Approximately 10%
- B. Approximately 45%
- C. Approximately 500 days
- D. Approximately 8-%
- E. Not possible to ascertain from this figure
B. Approximately 45%
Median survival time is when 50% of patients are still alive - draw a horizontal line from 0.5 on the vertical axis (fraction alive) to the survival curve for the patients with APACHE score >20 (solid black line), then draw a vertical line to the horizontal axis (number days) and you will see that it is 1000 days.
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. Diffuse axonal injury
E. Extradural haematoma
F. First cranial nerve injury
G. Fourth cranial nerve injury
H. Lower brachial plexus root injury
I. Sixth cranial nerve injury
J. Subdural haematoma
K. Third cranial nerve injury
L. Upper brachial plexus root injury
L. Upper brachial plexus root injury
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. Diffuse axonal injury
E. Extradural haematoma
F. First cranial nerve injury
G. Fourth cranial nerve injury
H. Lower brachial plexus root injury
I. Sixth cranial nerve injury
J. Subdural haematoma
K. Third cranial nerve injury
L. Upper brachial plexus root injury
C. Central cord syndrome
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. Diffuse axonal injury
E. Extradural haematoma
F. First cranial nerve injury
G. Fourth cranial nerve injury
H. Lower brachial plexus root injury
I. Sixth cranial nerve injury
J. Subdural haematoma
K. Third cranial nerve injury
L. Upper brachial plexus root injury
K. Third cranial nerve injury
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. Diffuse axonal injury
E. Extradural haematoma
F. First cranial nerve injury
G. Fourth cranial nerve injury
H. Lower brachial plexus root injury
I. Sixth cranial nerve injury
J. Subdural haematoma
K. Third cranial nerve injury
L. Upper brachial plexus root injury
A. Anterior cord syndrome
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. Diffuse axonal injury
E. Extradural haematoma
F. First cranial nerve injury
G. Fourth cranial nerve injury
H. Lower brachial plexus root injury
I. Sixth cranial nerve injury
J. Subdural haematoma
K. Third cranial nerve injury
L. Upper brachial plexus root injury
E. Extradural haematoma
A. Appendicitis
B. Biliary colic
C. Cholecystitis
D. Diverticulitis
E. Ischaemic bowel
F. Leaking AAA
G. Mechanical small bowel obstruction
H. Mesenteric adenitis
I. Pancreatitis
J. Pelvic inflammatory disorder
K. Perforated duodenal ulcer
L. Pseudo-obstruction
M. Renal colic
N. Ruptured ovarian cyst
H. Mesenteric adenitis
High temperature and sore throat are suggestive of mesenteric adenitis.
A. Appendicitis
B. Biliary colic
C. Cholecystitis
D. Diverticulitis
E. Ischaemic bowel
F. Leaking AAA
G. Mechanical small bowel obstruction
H. Mesenteric adenitis
I. Pancreatitis
J. Pelvic inflammatory disorder
K. Perforated duodenal ulcer
L. Pseudo-obstruction
M. Renal colic
N. Ruptured ovarian cyst
M. Renal colic - pain is colicky.
A. Appendicitis
B. Biliary colic
C. Cholecystitis
D. Diverticulitis
E. Ischaemic bowel
F. Leaking AAA
G. Mechanical small bowel obstruction
H. Mesenteric adenitis
I. Pancreatitis
J. Pelvic inflammatory disorder
K. Perforated duodenal ulcer
L. Pseudo-obstruction
M. Renal colic
N. Ruptured ovarian cyst
G. Mechanical small bowel obstruction
A. Appendicitis
B. Biliary colic
C. Cholecystitis
D. Diverticulitis
E. Ischaemic bowel
F. Leaking AAA
G. Mechanical small bowel obstruction
H. Mesenteric adenitis
I. Pancreatitis
J. Pelvic inflammatory disorder
K. Perforated duodenal ulcer
L. Pseudo-obstruction
M. Renal colic
N. Ruptured ovarian cyst
B. Biliary colic
A. Appendicitis
B. Biliary colic
C. Cholecystitis
D. Diverticulitis
E. Ischaemic bowel
F. Leaking AAA
G. Mechanical small bowel obstruction
H. Mesenteric adenitis
I. Pancreatitis
J. Pelvic inflammatory disorder
K. Perforated duodenal ulcer
L. Pseudo-obstruction
M. Renal colic
N. Ruptured ovarian cyst
K. Perforated duodenal ulcer
Sudden onset is something popping, leaking AAA would not be hypo
A. Anal fissure
B. Carcinoma of the caecum
C. Crohn’s disease
D. Hemorrhoids
E. Ischaemic colitis
F. Pseudomembranous colitis
G. Pseudo-obstruction
H. Rectal cancer
I. Sigmoid cancer
J. Sigmoid diverticulitis
K. Sigmoid volvulus
L. Ulcerative colitis
E. Ischaemic colitis
AF implies emblisation.
A. Anal fissure
B. Carcinoma of the caecum
C. Crohn’s disease
D. Hemorrhoids
E. Ischaemic colitis
F. Pseudomembranous colitis
G. Pseudo-obstruction
H. Rectal cancer
I. Sigmoid cancer
J. Sigmoid diverticulitis
K. Sigmoid volvulus
L. Ulcerative colitis
A. Anal fissure
Anal fissure is the most common cause of bright red rectal bleeding.
A. Anal fissure
B. Carcinoma of the caecum
C. Crohn’s disease
D. Hemorrhoids
E. Ischaemic colitis
F. Pseudomembranous colitis
G. Pseudo-obstruction
H. Rectal cancer
I. Sigmoid cancer
J. Sigmoid diverticulitis
K. Sigmoid volvulus
L. Ulcerative colitis
L. Ulcerative colitis
Crohn’s can display similar symptoms however Crohns less commonly affects the large bowel, this is more likely to be UC.
A. Anal fissure
B. Carcinoma of the caecum
C. Crohn’s disease
D. Hemorrhoids
E. Ischaemic colitis
F. Pseudomembranous colitis
G. Pseudo-obstruction
H. Rectal cancer
I. Sigmoid cancer
J. Sigmoid diverticulitis
K. Sigmoid volvulus
L. Ulcerative colitis
B. Carcinoma of the caecum
Right sided colonic lesions present with anaemia
A. Anal fissure
B. Carcinoma of the caecum
C. Crohn’s disease
D. Hemorrhoids
E. Ischaemic colitis
F. Pseudomembranous colitis
G. Pseudo-obstruction
H. Rectal cancer
I. Sigmoid cancer
J. Sigmoid diverticulitis
K. Sigmoid volvulus
L. Ulcerative colitis
D. Hemorrhoids
Painless bright red rectal bleeding is most likely to be haemorrhoids.
A. Biliary cancer
B. Bladder cancer
C. Breast cancer
D. Colorectal cancer
E. Gastric cancer
F. Liver cancer
G. Lung cancer
H. Oesophageal cancer
I. Prostate cancer
J. Renal cancer
K. Skin cancer
L. Testicular cancer
M. Thyroid cancer
F. Liver cancer
A. Biliary cancer
B. Bladder cancer
C. Breast cancer
D. Colorectal cancer
E. Gastric cancer
F. Liver cancer
G. Lung cancer
H. Oesophageal cancer
I. Prostate cancer
J. Renal cancer
K. Skin cancer
L. Testicular cancer
M. Thyroid cancer
I. Prostate cancer
A. Biliary cancer
B. Bladder cancer
C. Breast cancer
D. Colorectal cancer
E. Gastric cancer
F. Liver cancer
G. Lung cancer
H. Oesophageal cancer
I. Prostate cancer
J. Renal cancer
K. Skin cancer
L. Testicular cancer
M. Thyroid cancer
C. Breast cancer
A. Biliary cancer
B. Bladder cancer
C. Breast cancer
D. Colorectal cancer
E. Gastric cancer
F. Liver cancer
G. Lung cancer
H. Oesophageal cancer
I. Prostate cancer
J. Renal cancer
K. Skin cancer
L. Testicular cancer
M. Thyroid cancer
L. Testicular cancer
A. Biliary cancer
B. Bladder cancer
C. Breast cancer
D. Colorectal cancer
E. Gastric cancer
F. Liver cancer
G. Lung cancer
H. Oesophageal cancer
I. Prostate cancer
J. Renal cancer
K. Skin cancer
L. Testicular cancer
M. Thyroid cancer
E. Gastric cancer
