Week 8

Question 1

If a pain shifts, what type of pain is it?

Answer 1

Visceral

Question 2

If a pain is spreading, what type of pain is it?

Answer 2

Somatic

Question 3

What type of pain does inflammation cause?

Answer 3

Throbbing

Question 4

What type of pain does obstruction cause?

Answer 4

Colic

Question 5

What does tenderness to percussion suggest?

Answer 5

Peritonism

Question 6

What does the iliopsoas test test for?

Answer 6

Appendicitis

Question 7

what is an acute abdomen?

Answer 7

Less than 10 days

Progressive intra-abdominal condition

Causes severe morbidity or threat to life

Question 8

What is Rosvig’s sign?

Answer 8

Sign of appendicitis

If palpation of the abdomen makes RIF pain worse

Question 9

What are the initial investigations for the acute abdomen?

Answer 9

Bloods

CHECK AMYLASE

ABG

Plain radiology

Question 10

What is the Hartmann’s procedure?

Answer 10

Removal of sigmoid colon

Leave the rectum in

Question 11

What are haemorrhoids?

Answer 11

Enlarged vascular cushions in the lower rectum and anal canal

Question 12

If a patient comes in with painless bleeding from the rectum and itchiness, what do they have?

Answer 12

Haemorrhoids

Question 13

When the patient is in the lithotomy position, where do haemorrhoids tend to occur?

Answer 13

Same places as the branches of the superior haemorrhoidal artery

3 o’clock

7 o’clock

11 o’clock

Question 14

What is the HALO procedure used for?

Answer 14

Haemorrhoidal artery ligation

Question 15

What is rectal prolapse?

Answer 15

Protruding mass from the anus, especially during defecation

Examination shows poor anal tone

Question 16

What is the treatment for anal fissures?

Answer 16

Dietary advice and stool softeners

Lateral sphyncterotomy

Botox injection

Question 17

What is the management for an anal fistula?

Answer 17

Laying open

Insertion of Seton

LIFT procedure

Glue

Defunctioning colostomy

Question 18

If a patient comes in with a low grade fever, calf tenderness and shiny skin along with swelling, what do they have?

Answer 18

DVT

Question 19

What tests should you do on a patient who you suspect has a DVT?

Answer 19

D-dimer

Doppler ultrasound

Venography

Question 20

What can be done to prevent a DVT?

Answer 20

Compression stockings

Low-dose subcutaneous heparin

Early mobilisation

Question 21

What is atelectasis?

Answer 21

Collapse or closure of the lung resulting in reduced gas exchange

Can lead to pneumonia

Question 22

What is an ileus?

Answer 22

Paralysis of intestinal mobility

Question 23

What can cause ileus?

Answer 23

Handling of bowel

Peritonitis
Injury

Immobilisation

Hypokalaemia

Drugs

Question 24

How does an ileus present?

Answer 24

Vomiting

Abdominal distension

Dehydration

Silent Abdomen

Question 25

What is anastomotic dehiscence?

Answer 25

Breakdown of anastomosis caused by: Poor technique Poor blood supply Tension on anastomosis

Question 26

What are the symptoms of an upper small bowel obstruction?

Answer 26

Acute onset (within hours) Large volumes vomited

Question 27

What are the symptoms of a distal small bowel/large bowel obstruction?

Answer 27

Colicky abdominal pain and distension Vomiting (possibly faeculent)

Question 28

If a patient vomits up copious amounts of bile-stained fluid, where is the obstruction?

Answer 28

Upper small bowel

Question 29

If a patient vomits up semi-digested food eaten a day or two ago with no bile, where is the obstruction?

Answer 29

Gastric

Question 30

If a patient vomits up thick, brown, foul smelling vomitus, where is the obstruction?

Answer 30

More distal

Question 31

What can chronic, incomplete obstruction lead to within the bowel?

Answer 31

Hypertrophy of the muscle of the bowel wall proximally This gives the classic 'colicky' pain

Question 32

If there is a bowel obstruction, what do the bowel sounds sound like?

Answer 32

Tinkling

Question 33

What is the most useful initial investigation for a suspected bowel obstruction?

Answer 33

Supine abdominal X-ray

Question 34

In what conditions do inflammatory strictures usually occur?

Answer 34

Crohn's disease Diverticular disease

Question 35

What is Ogilvie's syndrome?

Answer 35

Pseudo-obstruction Acute dilatation of the colon in acutely unwell patients

Question 36

What 3 arteries make up the spermatic chord?

Answer 36

Testicular artery Artery to vas Cremasteric artery

Question 37

What 3 nerves make up the spermatic chord?

Answer 37

Ilio-inguinal Genital branch of genito femoral Sympathetic

Question 38

What is contained within the spermatic chord

Answer 38

``` Testicular artery Artery to vas Cremasteric artery Ilio-inguinal nerve Genital branch of genito femoral nerve Sympathetic nerve Pampiniformvenous plexus Vas Lymphatics ```

Question 39

Where is the inguinal ring?

Answer 39

2cm above the centre of the inguinal canal

Question 40

What is an obturator hernia?

Answer 40

Cause of small bowel obstruction in elderly females Hernia of the pelvic floor

Question 41

What is the first line investigation for cholecystitis/biliary colic?

Answer 41

Ultrasound

Question 42

What is the second line investigation for cholecystitis/biliary colic?

Answer 42

MRCP &/or ERCP

Question 43

What investigations do you do to confirm pancreatitis?

Answer 43

Bloods SERUM AMYLASE Ultrasound - rule out biliary problems CT

Question 44

What is the first line investigation for perforation?

Answer 44

Erect chest X-ray Then CT

Question 45

What is the first line investigation in appendicitis?

Answer 45

Ultrasound

Question 46

What is the first line investigation in diverticulitis?

Answer 46

CT

Question 47

What is the first line investigation in bowel gas/fluid retention?

Answer 47

If bowel source: AXR If fluid suspected - ultrasound

Question 48

What can be used to investigate acute GI bleeding?

Answer 48

Endoscopy CT with IV contrast

Question 49

What can be used to investigate dysphagia?

Answer 49

Endoscopy Barium swallow