1
Q
uSulfonylureas on day of surgery
A
omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose
(gliclazide)
2
Q
Metformin on day of surgery
A
Morn OP-
If taken once or twice a day - take
as normal
If taken three times per day, omit lunchtime dose
Afternoon OP-
If taken once or
twice a day - take as normal
If taken three times per day, omit lunchtime dose
3
Q
DPPV, GLP1 and SGLT2 with surgery
A
DPPV and GLP1 take as normal
(-gliptins)(-tides)
SGLT2- omit on morn
(florin)
4
Q
WLE with sentinel node -ve
A
Whole breast radiotherapy
5
Q
Anti-oestrogen drugs
A
Tamoxifen- pre menopausal
Aromatase inhibitors- post menopausal
6
Q
Medical therapy for renal stones
A
IM Diclofenac and a blocker
7
Q
Mx of renal vs ureteric stones
A
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
Uretic stones
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
8
Q
Sudden hearing loss management
A
Sudden onset sensorineural hearing loss should be referred (within 24 hours) to ENT, for investigation and consideration of steroid therapy
9
Q
Rinne vs Webers
A
Webers- loudest in ear with no SN loss
If conductive loss- may be louder
When a patient has conductive hearing loss in one ear, the sound will be amplified on that side.
Rinne
Air should be louder
If not conductive loss
10
Q
Fat necrosis sx
A
More common in obese women with large breasts
May follow trivial or unnoticed trauma
typical firm and round but may develop into a hard, irregular breast lump
11
Q
Fibroadenosis sx
A
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
12
Q
Fibroadenoma sx
A
‘breast mice’ due as they are discrete, non-tender, highly mobile lumps
13
Q
AAA screening
A
In the UK, all men aged 65 years are offered aneurysm screening with a single abdominal ultrasound.
14
Q
Mx of hydrocele
A
Adult patients with a hydrocele require an ultrasound to exclude underlying causes such as a tumour
infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
15
Q
Cause of hydrocele
A
epididymo-orchitis
testicular torsion
testicular tumours
16
Q
Most important RF for transitional cell carcinoma
A
Smoking
17
Q
High urine calcium and renal stones medication
A
Thiazide diuretics
18
Q
Varicocele causes
A
Subfertility
19
Q
Who gets screened for breast cancer at a younger age
A
one first-degree female relative diagnosed with breast cancer at younger than age 40 years
one first-degree male relative diagnosed with breast cancer
two 1st (or1+2)-degree relatives
one (1/2) relative diagnosed with breast cancer at any age and diagnosed with ovarian cancer at any age
three first-degree or second-degree relatives diagnosed with breast cancer at any age
20
Q
Mx of anal fissure
A
acute anal fissure (< 1 week)
soften stool
chronic anal fissure
the above techniques should be continued
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
21
Q
Painless ulcer on penis
A
Treponema pallidum
22
Q
Hypoglossal vs glossopharyngeal nerve damage
A
XII- tongue towards lesion
IX-uvula away from lesion
23
Q
Hydroceles in infants
A
Communicating hydroceles are common in newborn males and often resolve spontaneously
n cases where hydroceles are still present beyond 1 year of life routine referral to urology for consideration of repair is appropriate.
24
Q
PVD medication
A
Statin and clop
25
Surgical mx of PAD
Severe PAD or critical limb ischaemia may be treated by:
endovascular revascularization
percutaenous transluminal angioplasty +/- stent placement
endovascular techniques are typically used for short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients
surgical revascularization
surgical bypass with an autologous vein or prosthetic material
endarterectomy
open surgical techniques are typically used for long segment lesions (> 10 cm),
26
Mx of biliary colic
Elective lap chole
27
Mx of AAA
< 3 cm No further action
3 - 4.4 cm Rescan every 12 months
4.5 - 5.4 cm Rescan every 3 months
≥ 5.5cm
Refer within 2 weeks to vascular surgery for probable intervention
28
Medications causing pancreatitis
azathioprine, mesalazine*, bendroflumethiazide, furosemide, steroids, sodium valproate
29
When to refer for 2ww teste
non-painful enlargement or change in shape or texture of the testis
30
AAA rupture sx
Severe central abdominal pain radiating to the back
Presentation may be catastrophic or sub-acute (persistent severe central abdominal pain with developing shock)
Patients may have a history of cardiovascular disease
31
Low anterior vs AP resection
Low- mid to high rectum
AP- low rectum- removes anus
32
Post hip and knee VTE
Hip
LMWH for 10 days followed by aspirin (75 or 150 mg) for a further 28 days
or
LMWH for 28 days combined with anti-embolism stockings until discharge
Knee
Aspirin (75 or 150 mg) for 14 days
or
LMWH for 14 days combined with anti-embolism stockings until discharge
33
Haemorrhagic shock classification
1
<15%
Pulse <100
Urine >30ml
2
15-30%
Pulse >100
BP normal
Urine 20-30ml
Resp 20-30
Anxious
3
30-40%
>120HR
BP Low
Resp 30-40
Urine 5-15ml
Confused
4
>40%
HR >140
BP Low
Resp >35
Urine <5ml
34
Test prior to commencing Anastrozole
DEXA
35
Wernickes and Korsakoff
Wernicke's COAT
Confusion
Oculomotor dysfunction
Ataxia
Thiamine is treatment
Korsakoff's CART (Cart them off - because it's incurable at this stage)
Confabulation
Anterograde and
Retrograde amnesia
Temperament altered
36
Subdural vs epidural sx
Subdural- old age, alcoholism and anticoagulation.
Slower onset of symptoms than a epidural haematoma. There may be fluctuating confusion/consciousness
Epidural
some patients may exhibit a lucid interval
37
When are loop ileostomy used
Defunctioning of colon e.g. following rectal cancer surgery
38
Urinary calculi >5mm with positive urine dip
Patients with obstructive urinary calculi and signs of infection require urgent renal decompression and IV antibiotics due to the risk of sepsis
39
Incarcerated vs strangulated
Strangulated- blood supply to the herniated tissue is compromised, leading to ischemia or necrosis
vomiting, the passage of bloody stools, and the patient having a toxic appearance
Incarcerated
non-reducible masses
40
Mx of inguinal hernia in child
Congenital inguinal hernias have a high rate of complications and should be repaired promptly
41
Mobile lump in a woman <30 and >30
<30 reassure
>30 referral-FNA
42
Hartmann's procedure
Resection of rectosigmoid colon.
An end colostomy is formed and rectal stump sewn. It is indicated by perforation of the rectosigmoid bowel, and subsequent peritonitis. Causes of perforation include colon cancer, diverticulitis, and trauma.
43
Mx of breast cyst
Aspiration
those which are blood stained or persistently refill should be biopsied or excised
44
Sigmoid vs caecal volvulus
SIgmoid- coffee bean
rigid sigmoidoscopy with rectal tube insertion
Caecal- symptoms of small bowel obstruction rather than large bowel. The patient would be more likely to vomit and the x-ray would underline enlargement of the small bowel.
management is usually operative. Right hemicolectomy is often needed
45
FIT testing
every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland. If the results of these are abnormal then the patient is offered a colonoscopy.
46
When is laryngeal mask CI
If not fasted
47
Mx of fibroadenoma
If >3cm surgical excision is usual
48
PSA post prostatectomy
PSA level should be 'undetectable' which is defined usually as a value less than 0.2ng/ml
If any value- refer to oncology
49
squamous cell carcinoma RF
Schisto and smoking
50
percentage of patients with a positive faecal occult blood test have colorectal cancer
5-15%
51
Bilious vomiting, no stool, mx
Malrotation
Usually 3-7 days after birth
Ladd procedure
52
Mx of overactive bladder in men
bladder retraining should be offered
antimuscarinic drugs should be offered if symptoms persist. NICE recommend oxybutynin
53
Mx of nocturia in men
advise about moderating fluid intake at night
furosemide 40mg in late afternoon may be considered
desmopressin may also be helpful
54
Mx of acute limb ischaemia
analgesia, IV heparin and vascular review
55
Mx of epididymo-orchitis: If unknown organism
ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
56
Ix of prostate cancer
Multiparametric MRI
57
Timing of PSA
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
58
Mx of woman with father with breast cancer
Referral to clinic
59
Assessing pancreases exocrine fucntion
Faecal elastase
60
Priapism mx
Cavernosal blood gas analysis
If the priapism has lasted longer than 4 hours, the first-line treatment is aspiration of blood from the cavernosa, this is often combined with injection of a saline flush to help clear viscous blood that has pooled.
If aspiration and injection fails, then intracavernosal injection of a vasoconstrictive agent such as phenylephrine is used and repeated at 5 minute intervals.
61
Priapism definition
Longer than 4 hours and is not associated with sexual stimulation.
62
Ix of SAH
Noncontrast CT head
63
ASA grading
ASA- normal
2-current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease
3- poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis,
4- recent (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
64
long saphenous vein reveals that it is tender and hardened over a length of approximately 6cm mx
USS to rule out DVT
65
Venous disease Ix
Venous duplex US
66
% drug conc conversion to mg/ml
x10
Lido 2%
2x10 =20mg/ml
67
After RTA distended tender bladder dx and mx
Urethral injury since not able to urinate
Retrograde urogram
Suprapubic catheter
68
When to treat superficial vein thrombosis
If SVT is within 3 cm of the sapheno-femoral junction (SFJ) → treat with therapeutic anticoagulation for 3 months
If SVT is distal but ≥5 cm in length → give prophylactic anticoagulation (e.g., rivaroxaban) for 6 weeks
SVT not meeting those criteria → manage with NSAIDs and/or topical treatments only, no anticoagulation
69
Assessment of breast lump
Imaging:
Under 40 years: Ultrasound is first-line to differentiate cystic vs solid lesions.
Over 40 years: Mammography is performed to assess for suspicious features.
Tissue diagnosis: If imaging is indeterminate or suspicious:
Fine needle aspiration cytology (FNAC) or core needle biopsy to obtain histology.
Core Needle Biopsy:
Preferred for solid breast masses suspicious for malignancy on imaging or clinical exam.
FNAC (Fine Needle Aspiration Cytology):
When a quick, minimally invasive preliminary diagnosis is needed.
For cystic or fluctuant lesions to differentiate cyst from abscess or solid mass.
70
Indications for a thoracotomy with haemothorax
Indications for thoracotomy in haemothorax include >1.5L blood initially or losses of >200ml per hour for >2 hours
71
Patient with bilateral calf pain and ABPI of 0.8
If <0.9 confirms PAD
Should prescribe clopi and statin
72
Who needs pre/intraoperative steroids
Currently taking systemic steroids, and:
≥5 mg/day prednisolone (or equivalent)
For >3 weeks
Stopped systemic steroids within the last 12 months, and:
Took ≥20 mg/day prednisolone for >3 weeks
Any dose of steroids >3 weeks with Cushingoid features (e.g. moon face, striae, central obesity)
Has a diagnosis of primary or secondary adrenal insufficiency (e.g. Addison’s, pituitary disease)
On long-term replacement steroids for adrenal conditions
73
Screening for breast cancer
Breast cancer screening is offered to all women aged 50-70 years (mammogram every 3 years)
74
Acute Mesenteric Ischaemia (AMI) vs Ischaemic Colitis (IC)
- AMI: Sudden arterial occlusion (often embolic, e.g. from atrial fibrillation) causing ischaemia primarily to the small intestine.
- IC: Usually transient hypoperfusion or non-occlusive ischaemia affecting the colon, especially watershed areas (splenic flexure, rectosigmoid junction).
Clinical Presentation:
- AMI: Sudden, severe abdominal pain disproportionate to examination findings; may have nausea, vomiting, and rapid progression to peritonitis.
- IC: More gradual onset of crampy lower abdominal pain with bloody diarrhoea; systemic signs less pronounced.
75
What do you need to investigate in children with UTI
VUR is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI), being found in around 30% of children who present with a UTI. As around 35% of children develop renal scarring it is important to investigate for VUR in children following a UTI
76
Drugs that impair wound healing
Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs
77
Marker to monitor colorectal cancer
CEA
78
What does BRCA1 increase chance of in men
Prostate cancer
79
When to give VTE post surgery
6 hrs
80
Most commonly affected vessel with calf claudication
SFA
81
Which testicular cancer responds well to chemo/radio
Seminoma
82
red spots on his lips and tongue with PR bleeding
Hereditary haemorrhagic telangiectasia
83
When to refer using a suspected cancer pathway referral for breast cancer if they are:
aged 30 and over and have an unexplained breast lump with or without pain or
aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
84
Parkland formula and fluid delivery
4 x weight x burns SA
Half given in first 8 hours
85
85
When to do hot lap chole
Guidelines: NICE CG188 advises offering early laparoscopic cholecystectomy within 1 week of diagnosis for patients with mild to moderate acute cholecystitis.
Severe acute cholecystitis: Surgery may still be considered early if the patient is stable and fit, but often requires more careful assessment due to increased risk of complications.
Gallstone pancreatitis: Early cholecystectomy (usually during the same admission) is recommended once pancreatitis has resolved, to prevent recurrence.
86
Which anaesthetic agent is a good anti emetic
Propofol
87
Tumour markers in testicular cancer
Seminomas: - Usually normal or mildly elevated
- May have raised β-hCG (human chorionic gonadotrophin) in ~15-20% cases
- AFP (alpha-fetoprotein) is typically normal (AFP elevation excludes pure seminoma)
Non-seminomatous germ cell tumours (NSGCT): - AFP: Elevated in yolk sac tumours and embryonal carcinoma components
- β-hCG: Elevated in choriocarcinoma and some embryonal carcinomas
- Lactate dehydrogenase (LDH): May be elevated, correlates with tumour burden but is nonspecific
88
Commonest cause for large painless PR bleeding
Colonic diverticular bleeding
89
When to refer under 2ww for breast cancer
Breast lump in age >30
Unexplained axillary lump in age >30
Age >50 with unilateral nipple changes
Peau d’orange or other suspicious skin changes
<30 with lump – consider non-urgent referral
90
Galactocele vs blocked milk ducts vs Breast engorgement
Breast engorgement – Bilateral, diffuse swelling and tenderness occurring shortly after milk production increases, not a focal lump.
: Galactocele – Painless, mobile lump due to milk retention cyst, not typically tender or associated with a white nipple spot.
Blocked- Small, painful lump white spot, pain often improves after feeding
91
Differentiating Direct vs Indirect hernia
Direct:
Hernia passes medial to inferior epigastric artery (through Hesselbach's triangle).
Indirect:
Hernia passes lateral to inferior epigastric artery via deep ring.
Reduce hernia and apply pressure to deep ring:
No reappearance = Indirect.
Reappearance = Direct.
92
Chronic pancreatitis features
Post-prandial pain + DM + Steatorrhoea
93
Mx of anal tissue
Laxative and fibre
If symptoms persist > 1 week
1st line: Topical 0.4% glyceryl trinitrate (GTN) ointment BD for 6–8 weeks.
Second-line: Topical diltiazem 2%.
94
Ix and mx of chronic mesenteric ischaemia
CT angiography (gold standard for diagnosis).
Risk factor modification: smoking cessation, statins, blood pressure control.
Angiography with stenting (most common), or bypass surgery if needed.
95
Features of ischaemic colitis
Aetiologies: septic shock, heart failure, thrombosis, embolism.
👀 Clinical Features
Acute onset cramping abdominal pain.
Haematochezia (bloody diarrhoea).
Fevers
96
Ix of ischaemic colitis
CT abdomen: first-line imaging.
97
Mx of acute diverticulitis
Admit if:
Systemically very unwell
Evidence of complicated diverticulitis (abscess, perforation, sepsis).
Primary care management (mild cases):
PO antibiotics:
1st line: Co-amoxiclav 625 mg TDS for 5 days (NICE recommendation).
Penicillin allergy: Cefalexin 500 mg TDS + Metronidazole 400 mg TDS for 5 days.
98
Mx of haemorrhoids
Treat constipation with laxatives, increase dietary fibre and fluid intake.
Topical Treatments
Symptomatic relief : Steroid + local anaesthetic preparations (e.g., hydrocortisone + lidocaine).
Secondary Care Options
Non-Surgical:
Rubber band ligation – often used 1st-line for 1st/2nd-degree haemorrhoids.
NICE CKS - “best available outpatient treatment”
Surgical:
Haemorrhoidectomy – reserved for more severe or persistent cases.
99
Pseudo-obstruction
large bowel dilatation without mechanical cause, often associated with electrolyte disturbance or drugs (opiates).
Massive colonic dilatation + no transition point on CT, electrolyte imbalance = think pseudo-obstruction.
100
Discrete lump in breast, increases in size before period
Breast cyst
MSRA
flashcards
Decks in class (23)
# Cards
