Fellowship course Week 11 – Surgery

WRITTEN EXAMINATIONSHORT ANSWER QUESTIONS

EXAMINATION TIME: 60 Minutes

Candidate nameQuestion 1 (17 marks) 6 minutes

i) List five (5) ultrasound features of a normal appendix. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

ii) List six (6) ultrasound features of appendiceal inflammation. (6 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

6. _______________________________________________________________________

Candidate nameQuestion 1 (continued)

iii) State (3) pros of CT abdomen in the diagnostic process of suspected appendicitis. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

iv) State (3) cons of CT abdomen in the diagnostic process of suspected appendicitis. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

Question 2 (12 marks) 6 minutes

Candidate name

A 65 year old male presents with 4 days of scrotal pain. BP95/70, PR 110, Sats 98%. BSL 16.

A photograph of the patient is taken.

i) What is the diagnosis? (1 marks)

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ii) What is the significance of this condition? State three (3) points of significance. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

iii) List two (2) risk factors for the development of this condition? State two (2) points of significance. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

Candidate nameQuestion 2 (Continued)

Analgesia is provided. Disposition is arranged.

iv) List two (2) key treatment steps that you would institute in the first 20 minutes of your care. Provide one (1) justification for each choice. (4 marks)

Treatment step(2 marks)

Justification(2 marks)

1

2

v) List two (2) treatment methods that are utilised for definitive treatment. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Candidate nameQuestion 3 (12 marks) 6 minutes

An 82 year old woman presents with 10 hours of abdominal pain. Your clinical assessment leads to a clinical diagnosis of mesenteric ischaemia.

a. List three (3) options for definitive imaging in this patient. State one (1) relevant pro and one (1) con for each of these options. (9 marks)

Imaging option(3 marks)

Pro(3 marks)

Con(3 marks)

1.

2.

3.

Candidate nameQuestion 3 (continued)

A diagnosis of mesenteric ischaemia is supported by your chosen imaging.

b. State three (3) factors that may affect a decision regarding operative treatment for this patient. (3 marks)

1. __________________________________________________________________________

2. __________________________________________________________________________

3. __________________________________________________________________________

Candidate name

Question 4 (13 marks) 6 minutes

A 68 year old year old female presents to ED with an acutely painful right leg.

i) List five (5) examination features that would support the diagnosis of an ischaemic leg. (5 marks)

1. ________________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

Candidate nameQuestion 4 (continued)

ii) List five (5) key investigations that you would order in the Emergency Department if you suspected an ischaemic leg. (5 marks)

1. ________________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

A proximal left femoral artery thrombosis is confirmed.

iv) List three (3) specific treatments options that may be utilised to treat this condition. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

Candidate nameQuestion 5 (15 marks) 6 minutes

A 60 year old male is brought to the Emergency Department with confusion, fever and a painful left leg.

A photograph of his left leg is taken:

Candidate nameQuestion 5 (continued)

i) State the most likely diagnosis. (1 mark)

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ii) List four (4) investigations that you would perform in this case. Provide one (1) justification for each choice. (8 marks)

Investigation(4 marks)

Justification(4 marks)

1.

2.

3.

4.

Candidate nameQuestion 5 (continued)

Analgesia and fluids are provided.

iii) State three (3) treatments that you would consider for this patient. Provide one (1) justification for each choice. (6 marks)

Treatment(3 marks)

Justification(3 marks)

Candidate name1.

2.

3.

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Question 6 (15 marks) 6 minutes

A 26 year old man presents with a history of a painful penis. There is no history of trauma.

A photo of the patient is taken:

Candidate nameQuestion 6 (continued)

i) State the diagnosis. (1 mark)

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ii) List two analgesic medications that you would utilise for this patient. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

iii) State four (4) steps utilised in the Dundee-Perth technique of reversal of this problem. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

Candidate nameQuestion 6 (continued)

iv) State five (5) steps for an alternative technique (other than the Dundee-Perth technique) for the reversal of this problem (after appropriate analgesia is provided). (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

The patient represents 1 month later with balanitis.

v) List three (3) steps in the treatment of this problem. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

Candidate nameQuestion 7 (12 marks) 6 minutes

i) State the definition of priapism. (1 mark)

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A 35 year old male presents to ED with priapism.

ii) List five (5) likely causes of priapism in this man. (5 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

Candidate nameQuestion 7 (continued)

iii) State six (6) key management steps for this patient in the emergency department. (6 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

6. _____________________________________________________________________

Candidate nameQuestion 8 (16 marks) 6 minutes

A 38 year old female presents to the Emergency Department with left sided abdominal pain.

A CT scan is taken:

Candidate nameQuestion 8 (continued)

i) State four (4) abnormal findings shown in this image. (4 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. ____________________________________________________________________

ii) List three (3) further key investigations that you would perform for this patient. Provide one (1) justification for each choice. (6 marks)

Investigation(3 marks)

Justification(3 marks)

1.

2.

3.

Candidate nameQuestion 8 (continued)

iii) List six (6) factors that would influence your disposition for this patient. (6 marks)

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

4. _________________________________________________________________________

5. _________________________________________________________________________

6. _________________________________________________________________________

Candidate nameQuestion 9 (12 marks) 6 minutes

A 15 year-old boy presents to your ED with his parents, with a painful right testicle for the last 6 hours.

a. List four (4) key clinical features that may help to distinguish torsion from epididymitis in this patient. (4 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

b. List two (2) pros for the use of Ultrasound in this patient. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

Candidate nameQuestion 9 (continued)

c. List two (2) cons for the use of Ultrasound in this patient. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

An ultrasound is performed within 1 hour and confirms a right testicle with no flow.

d. List four (4) pieces of information that you would communicate to the patient and his parents. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _____________________________________________________________________

Candidate nameQuestion 10 (12 marks) 6 minutes

An 83 year old male presents to Emergency Department with abdominal pain.

An X-ray is taken:

Candidate nameQuestion 10 (continued)

i) State two (2) abnormalities shown in this X-ray. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

ii) List four (4) risk factors for the development of this condition. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

Candidate nameQuestion 10 (continued)

iii) List three (3) potential complications of this condition. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

iv) List the two (2) corrective treatments required for this condition. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________