Surgery + Met

Question 1

Vovlulus Ix + mx

Answer 1

AXR - coffee bean sign (sigmoid - more in elderly)
CT contrast for dx
NBM, NG, IV fluids, endoscopic decompression, flexi sig +/- surg

Question 2

Gallstones Ix and outcomes of these

Answer 2

↑ bili, pale stool, dark urine = obstruction
↑ ALP = obstruction
US = 1st line +/- MRCP

Question 3

Maintenance fluids

Answer 3

25-30ml/kg/day water
1 mmol/kg/day Na/K/Cl
50-100g/day glucose

Question 4

Pancreatic cancer - most common type, symptoms, 2ww referral

Answer 4

Most adenocarcinoma
Obstructive jaundice
Survival 6m
New onset DM, worsening control
40+ jaundice or 60+ WL = additional symptoms (CT direct access)

Question 5

Cholangiocarcinoma Rfs, symptoms

Answer 5

RF = PSC (UC is RF) , liver flukes (parasites)
Obs jaundice - pale stool, dark urine, jaundice, itching, painless J (more common in pancreatic ca)
Palpable gallbladder - mass in RUQ
↑ Ca19-9

Question 6

2 ww for bowel cancer

Answer 6

40+ abdo pain + UE WL
50+ unexplained rectal bleeding
60+ change in bowel/IDAFIT 60-74 every 2 years

Question 7

Haematuria, loin pain, abdo mass, varicoele

Answer 7

Renal carcinoma

Radical nephrectomy
Haematuria, loin pain, abdo mass, varicoele
(blader is more painless haematuria)

Question 8

Fluid resus in burns

Answer 8

Parkland f (in 24hrs)= 4 x TBSA% x weight kg.
Half of this is given in first 8 hours

Question 9

occlusion in distal aorta-thigh/bum claudication + absent fem pulse, male impotence

Answer 9

Leriche syndrome

Question 10

Normal ABPI

Answer 10

0.9-1.3 = N
0.6-0.9 = Mild PAD
0.3-0.6 = Mod-severe PAD
<0.3 = severe-critical

Question 11

Hemosiderin staining, venous eczema, lipodermatosclerosis
Gaiter area

Answer 11

chronic venous insufficiency

Question 12

Male smoker 25-35
Painful blue discoloration fingertips/toes -> ulcers/gangrene
Corkskrew collateral ona angiogram

Answer 12

Buerger disease - thrombosis in small/m blood vessels

Question 13

AAA - size and surveillance

Answer 13

> 3cm
US - 65 for Dx, CT in stable pts with symptoms for repair
3-4.4 = yearly follow up
4.5-5.4 = 3m follow up
5.5+. symptoms/ 1cm+ growth in a year = repair

Question 14

Pulsus paradoxus, hypotension, ↑ JVP, quiet heart sounds

Answer 14

cardiac tamponade

Question 15

Ejection systolic high pitched murmur, slow rising pulse, narrow pulse pressure

Answer 15

aortic stenosis

Question 16

What congenital problem is coarctation of aorta ass with

Answer 16

turner syndrome

Question 17

Pneumothorax mx

Answer 17

No SOB, <2cm = follow up 2-4 weeks
SOB +/- >2cm = aspiration and if fails then chest drain
Unstable/bilat/secondary ones - chest drain

Tension - large bore cannula into 2nd ICS in midclavicular line

Question 18

Painless, smooth, round, well circumscribed mobile lump. 20-40. Respond to female hormones

Answer 18

fibroadenoma

Question 19

2 ww BC

Answer 19

(Hard, irregular tethered)
UE lump in 30+
Unilateral nipple changes 50+

Question 20

30-50, often perimenopausal
Smooth, mobile, fluctuant

Answer 20

Breast cyst

Question 21

hormonal tx for breast cancer

Answer 21

Tamoxifen - premenopausal
Aromatase inhibitors for post-M (letrozole)
For 5-10 years for ER+

Question 22

Breast cancer surgery - no palp LNs in axilla vs palpable Las in axilla

Answer 22

Prior to surg:
No palp LNS in axilla - pre op axillary US. If + then sentinel node biopsy
Palp LNs - axillary node clearance at surg 9can give arm lymphoedema etx)
Whole breast radiotherapy after surgery (WLE). if mastectomy offered to T3-4 or 4+ LNs.

Question 23

Causes gynaecomastia

Answer 23

More oestrogen
↑ prolactin or dopamine antagonist (anti-psych)
Physiological/idiopathic
↑ Oestrogen - obesity, testicular ca, hyperT, SCLC
↓ testosterone
Anabolic steroids, digoxin, spironolactone, GNrh agonists, opiates, marijuana, alcohol

Question 24

Galactorrhoea causes

Answer 24

Breast milk production not ass with preg/breast feeding
Usually raised prolactin
Prolactinomas - MEN1
Mx - dopamine agonists

Question 25

Menopausal
Thick + green nipple discharge
smokers

Answer 25

Mammary duct ectasia
Dilation large ducts
Not associated with cancer
Menopausal
Thick + green
smokers

Question 26

Younger, blood stained nipple discharge , no palpable lumps
Warty lesions (benign)
Excise

type breast cancer

Answer 26

Intraductal papillota

Question 27

When o do CT head

Answer 27

<1hr= GCS<13 initial or <15 2hrs post injury, suspected skull fracture, seizure, 1+ ep vomiting, neuro def
<8hr = 65+, on anticoags, dangerous mech injury, 30+ mins amnesia imm before injury

Question 28

Trauma/blow to head. Temporal region.
Middle meningeal artery
↑ ICP features, lucid interval

Answer 28

extradural

Question 29

Mostly frontal/parietal lobes. Old age, alcohols, anticoag. Slower onset symptoms than epidural and may fluctuate confusion. consciousness

Answer 29

subdural

Question 30

In infants - _^ head circumference, bulging fontanelle, sunsetting of eyes (impaired upward gaze)

Answer 30

hydrocephalus

Question 31

Mx increased calcium

Answer 31

Saline - if cant tol then furosemide
Bisphosphonates or calcitonin

Question 32

Mx high potassium

Answer 32

Severe >6.5…
Calcium gluconate - stabilise heart
Insulin/dextrose infusion - short term
+/- salbutamol for temp ↓
Long t - calcium resonium

Question 33

Causes high potassium - meds

Answer 33

AKI. K sparing diuretics, ACEi, ARB, met acidosis, addisons