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MRCS HIGH YIELD QUESTIONS WITH CORRECT ANSWERS
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MRCS HIGH YIELD QUESTIONS WITH CORRECT ANSWERS
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MRCS HIGH YIELD QUESTIONS WITHCORRECT ANSWERS
What is the treatment of palliative colon cancer? - Answer Stents
Bypass surgery
Diversion stomas
What is the treatment of right colon cancer? - Answer Right hemicolectomy with ileo-
colic anastomosis
<5% leak rate
What is the treatment transverse colon cancer? - Answer Extended right hemicolectomy
with ileo-colic anastomosis
<5% leak rate
What is the treatment of splenic flexure colon cancer? - Answer Extended right
hemicolectomy with ileo-colic anastomosis
<5% leak rate (better than left hemicolectomy w/ colo-colic: 2-5%)
What is the treatment of left colon cancer? - Answer Left hemicolectomy with colo-colon
anastomosis
2-5% leak rate
What is the treatment of sigmoid colon cancer? - Answer High anterior resection with
colo-rectal anastomosis
5% leak rate
What is the treatment of upper rectal cancer? - Answer Anterior resection with total
mesorectal excision and Colo-rectal anastomosis
Likely radiotherapy
5% leak rate
,What is the treatment of low rectal cancer? - Answer Anterior resection with TME and
colo-rectal anastomsis (+/- defunctioning stoma)
Likely radiotherapy
10% leak rate
What is the treatment of anal verge rectal cancer? - Answer Abdomino-perineal excision
of colon and rectum
Likely radiotherapy
What is Hartmans procedure? - Answer Resection of sigmoid colon with end colostomy
How do you manage patients with large bowel obstruction resulting from carcinoma
above the peritoneal reflection? - Answer Resection
Stenting
Defunctioning
How do you manage patients with large bowel obstruction from rectal cancer? - Answer
*Defunctioning loop colostomy*
Then staging
What is the level of the inferior phrenic branches? - Answer T12 (paired, parietal)
What is the level of the coeliac trunk? - Answer T12 (unpaired, visceral)
What is the level of the SMA? - Answer L1 (unpaired visceral)
What is the level of the middle suprarenal arteries? - Answer L1 (paired visceral)
What is the level of the renal arteries? - Answer L1/L2 (paired visceral)
What is the level of the gonadal arteries? - Answer L2 (paired visceral)
What is the level of the lumbar arteries? - Answer L1-L4 (paired parietal)
What is the level of the IMA? - Answer L3 (unpaired visceral)
What is the level of the median sacral artery? - Answer L4 (unpaired parietal)
What is the level of the common iliac artery? - Answer L4 (paired terminal)
,What vessel may be divided to improve access to aneurysm neck in juxtarenal AAA?
What branch of aorta overlies this? - Answer Left renal vein (anterior relation of AA)
SMA overlies left renal vein
When do you offer surgery for AAA? - Answer Aneurysm 5.5-6cm (asymptomatic)
Symptomatic aneurysms
Rupture
How many layers of abdominal wall are found in AAAs? - Answer All 3 layers
What are the risks of AAA rupture depending on size? - Answer 5-5.9cm = 25% 5yr
6-6.9cm = 35%
7cm+ = 75%
What is the most appropriate fluid regime in rAAA? - Answer 1 litre Hartmanns over
4hours
(avoid high volume infusion)
Mnemonic for decending abdominal aorta branches? - Answer Prostitutes cause
sagging swollen red testicles (in men) living in sin
What vessels are the commonest cause of back bleeding during aortic surgery? -
Answer Lumbar arteries L1-4 are not cross clamped
Definition of abdominal compartment syndrome?
Risk factors? - Answer Sustained intraabdominal pressure >20mmHh with new organ
dysfunction
Obese patients, prosthetic meshes
Treatment of abdominal compartment syndrome? - Answer Laparotomy or laparostomy
(Bogota bag or VAC)
Incision for cholecystectomy? - Answer Kocher's - right subcostal margin
Incision for appendicectomy? - Answer Lanz incision
Gridiron (less cosmetically acceptable)
Incision for gynae surgery? - Answer Pfannelstiel
, Incision for strangulated femoral hernia? - Answer McEvedy's
Renal transplantation or iliac vessel surgery incision? - Answer Rutherford Morrison
Incision for upper abdominal (oesophageal, stomach, pancreatic or renal) operations? -
Answer Rooftop (+/- Mercedes)
In which bit of the colon would fluid levels be pathological? - Answer Descending colon
What does ground glass appearance on AXR signify? - Answer Large amounts of free
fluid
What investigations should you do prior to surgery for large bowel obstruction? - Answer
CT to exclude pseudo-obstruction
Or:
Sigmoidoscopy
Gastrograffin enema (NOT barium)
Eponymous sign when pain is elicited:
right thigh is passively extended with patient lying on side with extend? - Answer Psoas
stretch sign for retrocaecal appendix
Hyperasthaesia below the right scapula? - Answer Boas sign: Acute cholecystitis
Indications for gastrostomy - Answer Gastric decompression or fixation
Feeding
Indications for percutaneous jejunostomy - Answer Feeding
LUQ
Indications for loop ileostomy - Answer Defunctioning of colon e.g. following rectal
cancer surgery
RIF
Does a loop ileostomy decompress the large bowel? - Answer No - ileocaecal valve
competent
Indications for caecostomy - Answer Last resort - loop colostomy not possible
Indications for end iliostomy - Answer Panproctocolectomy or ileo-colic anastomosis not
planned
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