Exam (elaborations)
Surgical-Specialities
- Module
- Institution
Surgical-Specialities
[Show more]
Seller
Follow
Lansky
Content preview
MyPasTest: MRCS A Online - Jan Exam 201527. Surgical Specialities; General Surgery; Hepatobrilliary and Pancreatic Surgery (33)
01. A 65-year-old female presents with right upper quadrant pain and intermittent nausea and vomiting.
She reports that recently she has lost weight and recalls an ultrasound scan several years ago which
showed gallstones but as she was asymptomatic at the time did not undergo surgery. A cholecystectomy
is subsequently performed and the histology for this shows a tumour of the gallbladder. What is the most
likely type of tumour of the gallbladder? Select one answer only.
Adenocarcinoma« YOUR ANSWER (CORRECT ANSWER) Page
Haemangioma 1572
Sarcoma
Squamous cell carcinoma
Transitional cell carcinoma.
Around 85% of tumours of the gallbladder are associated with gallstones. The initial features can be very
similar to chronic cholecystitis with right upper quadrant pain, nausea and vomiting. Patients can also
develop weight loss, obstructive jaundice and a right upper quadrant mass may be palpable.
Adenocarcinomas are the most common tumour type accounting for 90% of tumours, followed by
squamous cell carcinomas which form around 10%.
02. An 18-year-old gap year student presents to A&E with right sided abdominal pain and rigors. On
examining him he is clammy to touch, has a temperature of 38.5 and is tender in the right upper quadrant.
His only medical history of note is dysentery whilst on a backpacking trip to Mexico 2 months ago.What is
the most likely diagnosis? Select one answer only.
Amoebic liver abscess« YOUR ANSWER (CORRECT ANSWER)
Cholangiorcarcinoma
Gallstones
Hydatid disease
Pancreatitis.
Amoebic liver abscesses often occur secondary to entamoeba histolytica infection in the gut entering the
portal circulation and spreading to the liver. The condition occurs mostly in endemic areas and affects
travellers visiting them. Clinical features include abdominal pain (most commonly in the right upper
quadrant), fever, rigors and nausea/vomiting. Some patients will report a history of dysentery recently.
Imaging with ultrasound scan or CT is useful in the diagnosis, and can be combined with aspiration which
produces a thick fluid resembling anchovy sauce. Treatment mostly consists of metronidazole sometimes
with percutaneous drainage.
03. Theme: Jaundice
A Acute cholangitis
B Biliary colic
C Chronic pancreatitis
D Duodenal carcinoma
E Gilbert’s disease
F Hepatitis C
G Hepatocellular carcinoma.
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
, MyPasTest: MRCS A Online - Jan Exam 2015
27. Surgical Specialities; General Surgery; Hepatobrilliary and Pancreatic Surgery (33)
For each description listed below, select the most appropriate diagnosis from the above list. Each option
may be used once, more than once, or not at all.
Scenario 1
A 30-year-old man underwent total colectomy 9 months ago for familial adenomatous polyposis (FAP) and now
presents with abdominal pain and jaundice; he is passing dark urine and pale stools.
A - Acute cholangitis « YOUR ANSWER Page
D - Duodenal carcinoma« CORRECT ANSWER. 1573
D – Duodenal carcinoma:
Patient 1 has FAP. Such patients have adenomas in the colon and duodenum. The commonest
extraintestinal manifestation of FAP is a duodenal carcinoma. Duodenal carcinoma should be suspected
in a patient with FAP who becomes jaundiced. The tumour here appears to be causing extrahepatic biliary
obstruction.
Scenario 2
A 70-year-old man presents with epigastric pain, jaundice, rigors and fever.
B - Biliary colic « YOUR ANSWER
A - Acute cholangitis « CORRECT ANSWER.
A – Acute cholangitis:
Patient 2 exhibits altered features of Charcot’s triad: fever, pain and rigors. Cholangitis is usually the
result of a stone in the common bile duct.
Scenario 3
A 40-year-old woman presents with right upper quadrant pain. She is nauseated, but does not have jaundice or
rigors.
C - Chronic pancreatitis « YOUR ANSWER
B - Biliary colic « CORRECT ANSWER.
B – Biliary colic:
Patient 3 is most likely to have biliary colic, as this does not usually cause jaundice.
04. Theme: Hepatobiliary Surgery
A Proximal pancreatoduodenectomy
B Distal pancreatectomy and splenectomy
C Total pancreaticoduodenectomy
D Endoscopic biliary stenting
E Cholecystojejunostomy
F Surgical biliary bypass.
For each of the following clinical situations listed below, select the single most likely surgical procedure
from the options above. Each option may be used once, more than once or not at all.
Scenario 1
A 60-year-old man was diagnosed with pancreatic carcinoma. Investigations revealed that the disease was limited
to the head and uncinate process of the pancreas with no evidence of lymph node involvement.
B - Distal pancreatectomy and splenectomy« YOUR ANSWER
A - Proximal pancreatoduodenectomy« CORRECT ANSWER.
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
, MyPasTest: MRCS A Online - Jan Exam 2015
27. Surgical Specialities; General Surgery; Hepatobrilliary and Pancreatic Surgery (33)
Scenario 2
An 80-year-old women was admitted with a 6-month history of weight loss and jaundice. She had a past medical
history of two myocardial infarctions, angina and chronic obstructive pulmonary disease (COPD). Computed
tomography (CT) scan confirmed the presence of pancreatic carcinoma.
A - Proximal pancreatoduodenectomy« YOUR ANSWER
D - Endoscopic biliary stenting« CORRECT ANSWER.
Page
Scenario 3 1574
A 67-year-old man was found to have carcinoma of the tail of the pancreas with no evidence of local spread on
laparotomy.
C - Total pancreaticoduodenectomy« YOUR ANSWER
B - Distal pancreatectomy and splenectomy« CORRECT ANSWER.
Distal pancreatectomy and splenectomy:
Ductal adenocarcinoma of the pancreas accounts for 90% of all malignant pancreatic exocrine tumours. It
has a propensity for perineural invasion within and beyond the gland and for rapid lymphatic spread. The
commonest sites of extralymphatic involvement are the liver, peritoneum and lung. Surgical excision
offers the only chance of cure in pancreatic cancer. Unfortunately only 20% of patients with cancer of the
head, and less than 3% of those with carcinoma of the body or tail, have lesions that are suitable for
resection.
For tumours confined to head or uncinate process of the pancreas, proximal pancreatoduodenectomy
may be considered to spare the remaining pancreas. Patients with signs of pancreatic outflow obstruction
and multiple co-morbidities may be more suitable for ERCP and stenting to avoid the physiological
burden of major surgery. As with the final scenario, tumours confined to the tail of the pancreas may be
amenable to distal pancreatectomy (plus splenectomy if appropriate) to preserve the rest of the pancreas
and its endocrine/exocrine function.
05. A surgical registrar is performing his 3rd solo laparoscopic cholecystectomy in a 47-year-old female.
When attempting to dissect out Calot’s triangle to identify the cystic artery great difficulty is experienced
as the anatomy appears aberrant. What proportion of patients have anomalies of the gallbladder and
biliary tree? Select one answer only.
<1%« YOUR ANSWER
10%« CORRECT ANSWER
40%
75%
>90%.
Calot’s triangle, also known as the cystohepatic or hepatobiliary triangle is an anatomic space which is of
great relevance when performing a laparoscopic cholecystectomy. It is bounded by the common hepatic
duct medially, cystic duct laterally and liver superiorly, and is used to locate the cystic artery which runs
within. Anomalies of the gallbladder or biliary tree are found within 10% of subjects and are important
during surgery.
They include:A long cystic duct travelling alongside the common hepatic duct. The gallbladder opening
directly into the side of the common bile duct i.e. the cystic duct is absent. Variation in the blood vessel
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Lansky. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £6.27. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
79976 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy revision notes and other study material for 14 years now