surgery SAQs

Question 1

Pt with breast tumour has lymph node assessment via US that shows no abnormalities –> Mx of lymph node status?

Answer 1

do Sentinel lymph node biopsy instead of axillary lymph node clearance

Question 2

what other cancer is BRCA1 associated with?

Answer 2

• Ovarian cancer
• Pancreatic Cancer
• Prostate Cancer

Question 3

what surgical options may be offered to Pts who test positive for BRCA1?

Answer 3

• Bilateral [prophylactic] mastectomy
• With bilateral oophorectomy

Question 4

Ix for suspected compartment syndrome?

Answer 4

Needle manometry

Question 5

What is chronic compartment syndrome? How does it present?

Answer 5

During periods of exertion, pressure within the
restricted compartment will rise and blood flow is restricted. This will cause the symptoms to
begin. During rest, the pressure falls, and symptoms begin to resolve. It differs to acute
compartment syndrome and is not a medical emergency.

Bilateral involvement
Happens on exertion
No neurovascular compromise
Relapsing and remitting pain

Question 6

Abx therapy for osteomyelitis?

Answer 6

6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for the first 2 weeks

Question 7

how would metastatic spinal cord compression differ from cauda equina?

Answer 7

Pain is worse on coughing or straining
Slower/more gradual onset of symptoms
Greater systemic disturbances
Upper motor neuron signs typically seen
- increased tone, brisk reflexes, upgoing plantar responses

Question 8

3 thenar muscles supplied by median nerve

Answer 8

Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis

Question 9

which artery are you most worried about in NoF?

Answer 9

circumflex artery

Question 10

Which nerve roots make up the sciatic nerve?

Answer 10

L4-S3

Question 11

What breast condition is associated with smoking? What is the Mx of this condition?

Answer 11

non-lactational mastitis
co-amoxiclav 500/125 mg three times a day for 10–14
days.

Question 12

Refer people using a suspected breast cancer pathway referral (for an appointment within 2
weeks) for breast cancer if:

Answer 12

• They are aged 30 years and over and have an unexplained breast
  lump with or without pain, or
• They are aged 50 years and over with any of the following symptoms
  in one nipple only: Discharge, Retraction, Other changes of concern.

Question 13

what cell marker is raised in breast cancer?

Answer 13

CA15-3

Question 14

what test must be done before starting Herceptin?

Answer 14

echo, it is associated with cardiotoxicity

Question 15

which subtype of breast cancer has the worst prognosis? (based on receptor positivity)?

Answer 15

triple negative (ER -ve, PR -ve, HER2 -ve)

Question 16

complications of obstructive jaundice

Answer 16

● AKI.
● Sepsis.
● Encephalopathy.
● Coagulopathy.
● Hepatic failure.
● Renal failure.
● Malabsorption

Question 17

Which type of bacteria are Pts with cholangitis susceptible to?

Answer 17

Gram-negative sepsis (1 mark). When the biliary tree is obstructed,
intraluminal pressure can rise to >20mmHg causing small gaps to
open up between the cells lining the vessel allowing bacteria in. There
are other theories including bile backing up into the liver meaning
Kupffer cells (specialised macrophages in the liver) cannot work
efficiently leading to SIRS (1 mark).

Question 18

State the two most common causes of squamous cell carcinoma

Answer 18

Alcohol.
Smoking.