Surgery Formative Flashcards
Outline the Opioid Risk Tool?
A 23 year old previously healthy male presents with a perianal abscess which is incised and drained. No fistula is found at the time of the operation. Which scenario is most likely?
- A: A fistula will result
- B: Complete resolution is to be expected
- C: He is likely to have Crohn’s disease
- D: He will almost certainly develop a perianal thrombosis
- E: Recurrence is common
- B: Complete resolution is to be expected.
- Most abscesses resolve completely, 40% will fistulate.
A 34 year old male has a BMI calculated at 25 kg/m2.
What best describes his weight?
- A: Mildly overweight
- B: Morbidly obese
- C: Normal weight
- D: Obese
- E: Underweight
= A: Mildy overweight
A 76 year old male presents with a large bowel obstruction, due to an obstructing carcinoma of the sigmoid colon. His abdomen is tense and tender, he is tachycardic and tachypnoeic. Which treatment is least appropriate?
- A: Abdomino-perineal resection of rectum
- B: Caecostomy
- C: Hartmann’s procedure
- D: Stenting
- E: Total colectomy and ileo-rectal anastomosis
= A: Abdomino-perineal resection of rectum = NOT a treatment for carcinoma of the sigmoid colon
- B: Caecostomy is a procedure that involves bridging the caecum through the abdominal wall and opening it for drainage or decompression.
- C: Hartmann’s procedure is a type of colectomy that removes part of the colon and sometimes rectum (proctosigmoidectomy). The remaining rectum is sealed, creating what is known as Hartmann’s pouch. The remaining colon is redirected to a colostomy.
Which finding is most likely to indicate a lump found in a female’s breast is malignant?
- A: Erythema of the overlying skin
- B: Irregular borders of the lump
- C: Nipple inversion
- D: Palpable axillary lymphadenopathy
- E: Skin dimpling over the lump
= E: Skin dimpling over the lump - implies malignant process
Which statement regarding burns is correct?
- A: Carbon monoxide results in increased peripheral tissue oxygenation
- B: Crystalloid and colloid must be restricted for the first eight hours after the injury
- C: Fasciotomy may be required if eschar threatens ventilation
- D: The likelihood of inhalational injury increases with the size of the burn
- E: There is an initial decrease in cardiac output which persists over 48 - 72 hours
= D: The likelihood of inhalational injury increases with the size of the burn.
- The bigger the burn the bigger the fire, and hence increased risk of inhalation.
Which condition is least likely to occur with duodenal ulceration in an adult?
- A: Haematemesis
- B: Malignancy
- C: Melaena
- D: Perforation
- E: Pyloric stenosis
= B: Malignancy
- Duodenal ulcers are virtually never malignant.
A patient is found to have an extensive popliteal DVT seven days post-operatively. Which intervention is most appropriate?
- A: IV heparin
- B: IV tissue plasminogen activator (tPA)
- C: Oral dipyridamole
- D: Oral warfarin 10 mg
- E: SC heparin 5000 units
= A: IV heparin
- Patient requires immediate therapeutic anticoagulation.
Which lesion would not be expected to produce a lump in the groin?
- A: Femoral artery aneurysm
- B: Lipoma
- C: Metastatic nodal spread from testicular tumour
- D: Psoas abscess
- E: Saphena varix
= C: Metastatic nodal spread from testicular tumour. Testicular tumours spread to para-aortic nodes.
- Since the testes are originally retroperitoneal organs, the lymphatic drainage is to the lumbar and para-aortic nodes, along the lumbar vertebrae. This is in contrast to the scrotum, which drains into the nearby superficial inguinal nodes.
In the Australian population what is the commonest cause of haematemesis?
- A: Duodenal ulcer
- B: Gastric carcinoma
- C: Gastric ulcer
- D: Gastritis
- E: Oesophageal varices
= D: Gastritis
A 45 year old male returns from Bali with profuse vomiting and diarrhoea. He is febrile with a dry tongue and loss of skin turgor.
His pulse is 112 bpm and BP 110/60 mmHg. What fluid should be prescribed as IV therapy?
- A: 0.9% saline
- B: 5% albumin
- C: 5% dextrose
- D: 50% dextrose
- E: Hypertonic saline
= A: 0.9% saline
Replace like with like.
A 46 year old male presents with suspected choledocholithiasis.
Which test is most likely to be abnormally elevated?
- A: Acid phosphatase
- B: Alanine aminotransferase
- C: Alkaline phosphatase
- D: Aspartate aminotransferase
- E: Gamma glutamyl transferase
= C: Alkaline phosphatase
Acute toxic megacolon is most commonly a complication of which condition?
- A: Amoebic colitis
- B: Carcinoma of the colon
- C: Ischaemic colitis
- D: Large bowel obstruction
- E: Ulcerative colitis
= E: Ulcerative colitis
A patient sustained an elbow fracture with median nerve injury.
What would be expected to seen on examination?
- A: Hyperaesthesia of the little finger
- B: Inability to flex index finger
- C: Loss of sensation on radial border of hand
- D: Weakness of finger adduction
- E: Weakness of thumb adduction
= B: Inability to flex index finger - due to paralysis of the flexor muscle.
What is the most appropriate treatment for a 17 year old male presenting with a one-day history of a perianal haematoma (thrombosed external haemorrhoid)?
- A: Anal dilation
- B: Cold compress
- C: Emergency haemorrhoidectomy
- D: Incision under local anaesthetic
- E: Local anaesthetic suppository
= D: Incision under local anaesthetic - If detected early drainage affords best relief.
A 24 year old male presents with intermittent pain and discharge from his natal cleft (butt crack). What is least likely to account for his symptoms?
- A: Fistula in ano
- B: Infected sebaceous cyst
- C: Pilonidal disease
- D: Poor hygiene
- E: SCC natal cleft
= E: SCC natal cleft - is vanishungly fare.
A 36 year old male presents with severe right loin pain and microscopic haematuria. A plain abdominal X-ray shows a 2 cm calculus in the right renal pelvis. Which statement is correct?
- A: A SCC will develop if left untreated
- B: Medical therapy with oxalic acid will dissolve the stone
- C: The patient will require surgical intervention
- D: The stone is likely to pass spontaneously
- E: The stone will consist of cysteine
= C: The patient will require surgical intervention - A 2 cm calculus will not pass spontaneously.
What would be expected to be seen as a result of compression of the sciatic nerve roots?
- A: Faecal incontinence
- B: Loss of knee jerk reflex
- C: Sensory loss over knee
- D: Sensory loss over lateral calf
- E: Weakness of leg adductors
= D: Sensory loss over lateral calf
A pre-pubertal child presents with severe pain in the scrotum. What is the most likely cause of the pain?
- A: Haematocoele
- B: Idiopathic scrotal oedema
- C: Inguinal hernia
- D: Testicular torsion
- E: Torsion of the hydatid of Morgagni
= E: Torsion of the hydatid of Morgagni
- Torsion of the hydatid of Morgagni is more common than Testicular torsion.
Which clinical entity is most closely associated with elevated TSH levels?
- A: Colloid goitre
- B: Grave’s disease
- C: Hashimoto’s thyroiditis
- D: Surreptitious hyperthyroidism
- E: Thyroid carcinoma
= C: Hashimoto’s thyroiditis.
A 22 year old male with increasing dysphagia and regurgitation of foul-smelling partly digested food.
What is the most appropriate diagnosis?
- A: Achalasia
- B: Adenocarcinoma of the oesophagus
- C: Benign stricture
- D: Foreign body
- E: Mediastinal tumour
- F: Pharyngeal pouch
- G: Primary oesophageal motility disorder
- H: Retrosternal goitre
- I: Rolling hiatus hernia
- J: Scleroderma
- K: Sliding hiatus hernia
- L: Squamous cell carcinoma of the oesophagus
- M: Stroke
= A: Achalasia - too young for ca oesophagus
A 19 year old male with a three-year history of heartburn and gastrosophageal reflux and failure of PPI medication to control symptoms. What is the most appropriate diagnosis?
- A: Achalasia
- B: Adenocarcinoma of the oesophagus
- C: Benign stricture
- D: Foreign body
- E: Mediastinal tumour
- F: Pharyngeal pouch
- G: Primary oesophageal motility disorder
- H: Retrosternal goitre
- I: Rolling hiatus hernia
- J: Scleroderma
- K: Sliding hiatus hernia
- L: Squamous cell carcinoma of the oesophagus
- M: Stroke
= K: Sliding hiatus hernia
- Sliding hiatus hernia cause reflux, rolling do not as the GOJ is still patent with rolling HH.
What features in the history examination and investigation help to distinguish between small and large bowel obstruction? (4 marks)
- History (4)
- Examination (3)
- Investigations (3)
- Vomiting comes on later in LBO
- More distention with LBO
- Tenderness in RIF with competent ICV
- History of previous attacks with SBO
- History of previous surgery with SBO
- More likely to be anaemic with LBO
- More likely to give history of alteration in bowel habit with LBO
- Hernia more likely with SBO
- AXR will help: Small bowel has different appearance CT Scan
- Laparotomy is the ultimate differentiation
(Total 4 marks)
Discuss the differential diagnosis of a 70 year old male presenting to the emergency department complaining of left-sided abdominal pain. (4 marks) - List 9
- Cutaneous causes: Infection, Herpes
- Referred from back
- Hernia Muscular Colitis
- Diverticulitis
- Urosepsis
- Referred from hip
- Perforating bowel carcinoma
- Rarer = intra-abdominal tumours
- Left sided appendicitis (Total 4 marks)
Describe the surgical anatomy of the carpal tunnel with reference to carpal tunnel syndrome. (4 marks)
- Roof: Transverse carpal ligament
- Attached to scaphoid and trapezium and pisiform and hook of hamate
- Floor: Carpal bones
- Transmits: FDP, FDS, FPL Median nerve
- Situated on the palmar surface of the hand
- The nerve may be compressed giving rise to pain, numbness in the median fingers and wasting of the thenar eminence. (Total 4 marks)
Compare opioid & non-opioid systemic analgesia for surgical patients.
Compare epidural & nerve blocks as regional analgesia for surgical patients.
Compare local inflitration & continuous wound infusion local anaesthesia for surgical patients.
Compare Patient-Controlled Analgesia (PCA) & Multimodal Analgesia:
- Description?
- Advantages: 3 & 3?
- Disadvantages: 3 & 2?
