Surgery Tips 3

Question 1

Varicocele grade 1

Answer 1

Not visible, but palpable if the patient uses a Valsalva maneuvre
Mx- reassure and observation

Question 2

Varicocele grade 2

Answer 2

Not visible, but palpable if the patient does not use a Valsalva maneuvre
Mx - asymptomatic and normal semen parameters (semen analysis every 1-2yrs), symptomatic or abnormal semen parameters (surgery)

Question 3

Varicocele grade 3

Answer 3

Varicocele is visible
Mx - asymptomatic and normal semen parameters (semen analysis every 1-2yrs), symptomatic or abnormal semen parameters (surgery)

Question 4

Prostate cancer management

Answer 4

Localised prostate cancer (T1/T2) - conservative (active monitoring & watchful waiting), radical prostatectomy, radiotherapy (external beam and brachytherapy)
Localised advanced prostate cancer (T3/T4) - hormonal therapy, radical prostatectomy, radiotherapy (external beam and brachytherapy)
Metastatic prostate cancer disease - hormonal therapy - synthetic GnRH agonist + anti-androgen (goserelin + cyproterone acetate), orchidectomy

Question 5

Haemorrhoids

Answer 5

Location - 3, 7, 11 o’clock position
Internal or external
Mx - conservative, rubber band ligation, haemorrhoidectomy

Question 6

Fissure in ano

Answer 6

Location: midline 6 (posterior midline 90%) & 12 o’clock position
Usually isolated
Distal to the dentate line
Chronic fissure > 6/52 - triad (ulcer, sentinel pile, enlarged anal papillae)
Mx - stool softeners, topical diltiazem, botulinum toxin injection,

Question 7

Proctitis

Answer 7

Causes - CD, UC, clostridium difficile

Question 8

Ano rectal abscess

Answer 8

Causes - e. coli, staph aureus

Positions - perianal, ischiorectal, pelvirectal, intersphincteric

Question 9

Anal fistula

Answer 9

Due to previous ano-rectal abscess
Types - intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric
Goodsalls rule determines location

Question 10

Rectal prolapse

Answer 10

Associated with childbirth and rectal intussceception

May be internal or external

Question 11

Pruritus ani

Answer 11

Systemic and local causes

Question 12

Anal neoplasm

Answer 12

Squamous cell carcinoma commonest (adenocarcinoma in rectum)

Question 13

Solitary rectal ulcer

Answer 13

Associated with chronic straining and constipation

Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)

Question 14

Cardiac tamponade

Answer 14

Beck’s triad of hypotension, muffled heart sounds and raised JVP

Question 15

Young pt with small bowel obstruction

Answer 15

Appendicitis

Question 16

Oesophageal rupture

Answer 16

Spontaneous rupture may occur following an episode of vomiting
Left postero-lateral oesophageal is commonest site
Severe chest pain without cardiac diagnosis, signs suggestive of pneumonia without convincing history and there is history of vomiting
Erect CXR shows infiltrate or effusion

Question 17

Squamous cell carcinoma of the oesophagus

Answer 17

Progressive dysphagia, FLAWS

No GORD symptoms

Question 18

Adenocarcinoma of the oesophagus

Answer 18

Progressive dysphagia + GORD symptoms +FLAWS

Question 19

Peptic stricture

Answer 19

Long history of dysphagia (not progressive) + GORD symptoms + no systemic features

Question 20

Dysmotility disorder

Answer 20

Dysphagia that is episodic and non progressive

Retrosternal pain accompanies the episodes