Clinical & Surgical

Front 1

which blood test indicates liver synthetic ability over a long-period of time (ie CLD), long half-life

Back 1

albumin

Front 2

what does an isolated rise in GGT indicate

Back 2

alcohol

Front 3

what cause must you consider in all abnormal LFTs

Back 3

drugs

Front 4

what blood tests specific for:
- wilson's disease
- haemochromatosis
- a1-antitrypsin def

Back 4

- W: Cu & caeruloplasmin
- ferratin / trandferrin
- a1-antitrypsin

Front 5

what blood tests specific for:
- autoimmune hep
- PBC
- PSC

Back 5

autoimmune hep: ANA, SMA, LKM-1

PBC: AMA (M2), IgM

PSC: ANA, SMA

Front 6

important q's to ask in hx

Back 6

stool & urine colour

SH:travel, transfusions, tattoos
- occupation, unprotected sex, alcohol, smoker

DH: OTC (inc paracetamol), herbal, illegal, supplements, steroids

FH

PMH: DM, hyperlipidaemia, interventions (ERCP), mumps, scorpion,

Front 7

what to look for on GENERAL (inspection) on examination (GI)

(i.e. not hands and stuff)

Back 7

nutrition (BMI), scars, distension (local/general), deformities, distended veins (caput medusa, JVP), masses, pulsations (AAA)

feverish, pallor, anaemia/jaundice.

Front 8

signs of liver disease on examination

Back 8

spider naevi, palmar erythema, gynaecomastia
liver FLAP
clubbing
leukonykia (hypoalbuminaemia)
jaundice/ anaemia
low/ high BMI
ascites/ caput medua
hepatosplenomegaly
ENCEPHALOPATHY

Front 9

what to look for on the hands in GI examination

Back 9

clubbing /koilonykia
leukonykia
nicotine stain
palmar erythema
liver flap
pulse

Front 10

what's first line therapy for variceal/ upper GI bleeding

Back 10

ABC & resuscitate (IVI)!!

ENDOSCOPY:
- sclerotherapy
- banding
- glue

CT- during active bleed

Front 11

what element used to treat angiodysplasia of the oesophagus via endoscopy

Back 11

ARGON

Front 12

ways of treating oesophageal strictures
- benign
- malignant

Back 12

DILATATION (balloon eg for achalasia)

STENT (malignancy)

Front 13

what procudure used to remove intralumenal objects (eg gallstones)

Back 13

ERCP- SPHINCTEROMETRY

Front 14

first line Ix for cholecystitis
2nd line

Back 14

★USS★- ?dilated BD?

stones- ERCP
no dilated BD--> MRCP

Front 15

tests/ Ixs for pancreatitis

Back 15

↑amylase
USS- exclude GS, assess obstruction/ complications (eg pseudocyst)
★CT★

Front 16

Ixs for suspected perforation
(general/ localised peritonism, systemic fever, shock, infection)

Back 16

★CXR★- subdiaphragmatic air
CT- source, gas/fluid

Front 17

first line Ix for appendicitis

Back 17

★USS★- more useful in children, exclude other causes

Front 18

Ixs for diverticulitis (inflammation of diverticulosis)

Back 18

★PR EXAM★
inflam markers: WCC, CRP
AXR
Ba enema
sigmoidoscopy/colonoscopy
★CT★

Front 19

first line Ix for distended abdomen

Back 19

★AXR★
- ?small or large bowel
- ?gas or fluid
- ?volvulus/ ileus

USS- fluid
CT- cause

Front 20

ALARM symptoms for dyspepsia

Back 20

dysphagia
GI blood loss (anaemia, haematemesis)
persistent vomitin
wt loss
mass

Front 21

Ixs for dysphagia with alarm symptoms (3)

Back 21

★H.pylori★ C-urea breath test
★ensoscopy★ +/- biopsy
Ba swallow

Front 22

Ixs for change in bowel habit

Back 22

★PR exam★
ba enema
★sigmoid-/ colon-soscopy★
AXR
CT

?Chron's- white-cell scan

Front 23

Ixs for jaundice

Back 23

BLOODS- FBC, U&Es, LFTs, CRP, virology, immunology, auto-abs

★USS★
- ?bile ducts dilated= post-hepatic
- ? mets
-? cirrhosis
- ?ascites

?biopsy
MRCP +/- ERCP
CT

Front 24

what mneumonic used to think of differentials

Back 24

VINDICATE
Vascular
Infection
Neoplasm
Drugs
Inflammatory
Congenital
Auto-immune
Trauma
Endocrine

Front 25

what organs/ structures likely to cause epigastric pain

Back 25

heart, oesophagus, stomach, duodenum, GB, bile ducts, liver, pancreas

Front 26

organs/ structures likely to cause RUQ pain

Back 26

liver, GB, bile ducts, duodenum, PNEUMONIA!

Front 27

organs/ structures likely to cause LUQ pain

Back 27

pancreas, stomach, splenic flexure (abscess, infarct), spleen, stomach, PNEUMONIA!

Front 28

organs/ structures likely to cause central abdo pain

Back 28

early appendicitis, pancreas, bowel, transverse colon

Front 29

organs/ structures likely to cause RLQ

Back 29

appendicitis, Chron's, colonic ca, ascending colon, (r.ovary & fillopian tube)

Front 30

organs/ structures likely to cause LLQ pain

Back 30

diverticulitis, colorectal / sigmoid ca (descending colon), colitis (likely ischaemic), ovary

Front 31

apart from GI causes, what other systems must you consider in a pt presenting with abdominal pain

Back 31

GU, repro

Front 32

baseline tests & initial management of pt with an acute abdomen

Back 32

O2, IV fluids, Abx's if infection (eg peritonitis)
analgesia +/- anti-emetic

BLOODS: FBC, U&Es, LFTs, amylase, CRP, ABG, cross-match ?transfusion
urine
ECG, CXR, AXR, USS

Front 33

what do skin changes (bruising/ darkening) indicate

Back 33

intra-peritoneal haemorrhage
acute haemorrhaginc pancreatitis

Front 34

S&Ss og mesenteric ischaemia
- acute
- chronic

Back 34

AF with;
1) ACUTE SEVERE abdominal pain - constant, central/RIF
hypovolaemia: low BP, high HR

2) SEVERE colicky post-prandial pain, PR bleeding, wt loss

COLONIC ischaemia- left sided pain, BLOODy D

Front 35

Ix & results for mesenteric ischaemia

Back 35

↑WCC, ↑Hb (due to plasma loss), ↑lactate
METABOLIC ACIDOSIS ↓HCO3-

AXR/ Ba enem- no gas, "thumb-printing" (submucosal swelling)
CT
★ANGIOOGRAPHY★

Front 36

causes of mesenteric ischaemia (4)

Back 36

★AF!★
vasculitis
trauma
strangulation of hernia/ volvulus

Front 37

&Ss bowel obstruction

Back 37

anorexia, nausea, VOMITING (bile-stained) - relief
COLICKY abdo pain (contsant in colon)
DISTENTION
constipation

Front 38

examination findings in bowel obstruction

Back 38

high-pitched tinkling BS
distention w/o shifting dullness
visible PERISTALSIS
tenderness

Front 39

differentiate bowel obstruction from a strangulation

Back 39

strangulation- more SHARP CONSTANT, localised, ?fever ? high WCC

obstruction- CENTRAL COLICKY

Front 40

Ixs for bowel obstruction
findings

Back 40

AXR: DISTENTION of gas PROXIMAL to obstruction
- SMALL b.: plicae (pic)
- LARGE b.: haustra

?ba enema

Front 41

management/ treatment of bowel obstruction:
- incomplete
- complete and strangulation

Back 41

INCOMPLETE: conservative
- IV fluids, NG tube + NBM, replace electrolytes

COMP+STRANG: emergency surgery!!!

Front 42

causes of bowel obstruction (BATH VIPS)

Back 42

BOLUS- food, faeceas, gallstone (impacted ileus)
Adhesions (congenital, iatrogenic)
TUMOUR
Hernias- strangulated

Volvulus
INTUSSUSCEPTION
Pseudo-obstruction
Strictures (chron's diverticulosis)

Front 43

causes of bowel distention

Back 43

5F;s:
Fat
Fluid
Faeces
Food
Feotus

Front 44

ddx of rectal bleeding (7)

Back 44

anal fissure
perianal haematoma
colorectal polys/ ca
diverticular disease
proctitis (inflam anal canal + rectum)/ gastroenteritis
IBD
haemorrhoids

Front 45

S&Ss haemorrhoids (piles)

Back 45

★PAINLESS★
FRESH blood PR
perianal itching
★CONSTIPATION/ straining!!!!!★
anaemia
(sometimes: mucus)

Front 46

what are piles (haemorrhoids)

Back 46

displaced & protuding rectal/ anal CAPILLARIES
- gravity, increased anal tone, straining

prone to rupture & bleed

(NB: not varicose veins)

Front 47

Ixs for haemorrhoids

Back 47

★PR exam★- only prolapsing piles visible, internal piles NOT PALPABLE!!!!!
proctoscopy
sigmoidoscopy

Front 48

management of haemorrhoids

Back 48

high fibre diet
topical
SCLEROSANTS
band LIGATION

4th deg: haemorrhoidectomy

Front 49

rectal prolapse can be:
1) partial
2) complete
- presentation S&Ss

Back 49

incontinence
protruding mass
blood & mucus PR
poor anal tone

Front 50

presentation S&Ss of anal fissure

Back 50

fresh BLOOD
PAINFUL on defaecation
constipation (holding back from pain)
ITCH
mucosal TAG

Front 51

3 mananagement options for anal fissure

Back 51

increase dietary FIBRE
GTN ointment
lateral sphincterotomy

Front 52

presentation S&Ss of anal FISTULA

Back 52

BLOOD
MUCUS
chron's
TB
Ca
opening distal from site of anus

Front 53

causes of an abdominal mass
(don't thing just GI...also repro & GU)
mneumonic: A CHEMICAL

Back 53

AAA

Chron's inflam
Hernia
Enlarged organ
Malignancy
Intussusception
Cyst/ abscess
Appendicitis
Lymphadenopathy

Front 54

physical examination of a mass

Back 54

shape, size
fluctuating (respiration/ palpation)
rashes/ lesions/ colour
pulsations
character: smooth/ craggy, hard, soft
tender
percuss: gas, solid, liquid (shifting)
BS?
bruits (AAA)

Front 55

3 cardiac/ vascular complications post-op

Back 55

haemorrhage
MI
DVT/ PE

Front 56

3 GI complications post op

Back 56

ileus
anastomotic dehiscence (pic)
adhesions

Front 57

what's an ileus (complication post-op)
presentation (S&Ss)

Back 57

painful obstruction of ileum/ small intesting
PARALYSIS of motility

ABSENT BS & peristalsis
VOMITIN
distention
dehydration (need electrolytes correcting)

Front 58

presentation S&Ss (helpful hx) in suspecting adhesions

Back 58

bowel OBSTRUCTION
vomiting, distention, constipation, abdo pain (colicky)
"tinkling" BS/ absent

prev abdo surgery

Front 59

cause of hernias

main type

Back 59

natural opening/ weak/ defect in muscle wall area
stretching, surgery, increased abdominal pressure

INGUINAL

Front 60

what does an irreducible hernia indicate

Back 60

obstructed (bowel contents cannot move through)
or strangulated (blood supply compromised)

- risk gangrene if arterial supply compromised

Front 61

what type of people at risk of femoral hernias

Back 61

old, thin FEMALES (x10 more common than M)

Front 62

what structure lies anterior and lateral to femoral canal

Back 62

anterior: inguinal lig
lateral: femoral vein

Front 63

relation to inguinal canal:
- floor
-roof
- anterior
- posterior
- medially

Back 63

FLOOR: inguinal lig
ROOF: transversalis fascia & internal oblique
ANT: external oblique anponeurosis
POST: transversalis
MEDIAL: conjoint tendon

Front 64

differentiate an indirect & direct inguinal heria
- anatomically
- clinically

Back 64

INDIRECT; lateral to inf epigastric vessels, through inguinal canal --> scrotum
DIRECT: medial to inf epi vessels, directly through wall. REAPPEARS with cough test

Front 65

what point is 1/2 way between pubic tubercle and ASIS

Back 65

DEEP inguinal ring

Front 66

which type of inguinal hernia better controlled with digital pressure

Back 66

indirect hernia

Front 67

what layer does the processus vaginalis take from the soma wall, what does it subsequently become

Back 67

from the parietal peritoneum
descends ahead of the testis into the scrotum
becomes the tunica vaginalis

Front 68

in the male, what layers of the abdominal wall does the testis descend through, which does it take into the scrotum

Back 68

parietal peritoneum--> tunica vaginalis (doesn't surround testis, lies in FRONT)

transversalis fascia --> internal spermatic fascia
transversus abdominus (not taken)
internal oblique--> CREMASTER muscle
external oblique APONSEUROSIS --> external spermatic fascia

Front 69

what structure if formed by joining of internal oblique and transversus abdominus, connecting these muscles to the pubic tubercle. Lateral to the inguinal canal

Back 69

conjoint tendon

Front 70

which layer of the abdominal wall does the cremaster muscle come from
which nerve is it supplied by

Back 70

INTERNAL oblique
genitofemoral nerve

Front 71

what structures past through the inguinal canal in the MALE
which are within the spermatic cord?

Back 71

SPERMATIC CORD:
- Vas deferens
- testicular artery
- pampiniform plexus
- genitofemoral nerve
(lymphatics & autonomic nerves)

ILIOINGUINAL nerve- outwith cord