Questions

The Questions by subject

This page provides you with an insight into what sort of questions you may get asked. The only reason it has come about is because trainees have realised that the exam would have been a hell of a lot easier if you knew what you were letting yourself in for. They have the experience of passing and failing and through goodwill have posted the questions that they got asked for YOUR benefit. The portal for this has been the Dukes Club.

All we have done is taken the questions and listed them into specialties.

BENIGN

Altered bowel habit and symptoms of obstructed defaecation

Could you define symptoms and plan investigation and discuss treatment options?

Rectocele and selection for surgery, inc enterocele and cystocele

Could you describe and more importantly choose one that you would do for your 60 year old, 90 year old…..etc?
What are the pros and cons therefore each technique, and what are the complications?
If you were doing a Delorme’s and you get small perforation anteriorly – close hole or can convert to Altmeier’s

Perineal body abnormalities and reconstructions?
Functional bowel problems

Constipation and transit studies
Treatment of different types of constipation
Faecal incontinence
Anorectal physiology (yes it has been asked.)

Anal sphincters, innervation, function
Anal fissure, GTN, Diltiazem
Describe your technique for lateral sphincterotomy
Conservative and surgical treatment of anal fissures
Management of perianal haematoma
Investigation and management of fresh rectal bleeding
Management of massive rectal bleeding
Complications of diverticular disease
Fistulae

Pathophysiology / classification
Enterocutaneous fistula ( hot topic 2007)
Management of a colovesical fistula
Management of a rectovaginal fistula

Anorectal abscess and fistula:

what probe,
management

seton
lay open
advancement flap
role EAUS / MRI.

Management of a patient with anal pain

Specific problems may come in this form
“Anal fissure, postpartum 30 yr old woman. Medical/surgical pros/cons, evidence. Investigations. Role of Botox. What if she does not have increased sphincter tone? Advancement flaps.”

Crohns:

surgical management
pros and cons of stricturoplasty vs resection
features at operations,
surveillance,
medical management

Pilonidal: first line treatment, second line treatment and evidence for this.
Complications of stomas. Management of parastomal hernia.
Faecal incontinence
Cold leg post anterior resection
Discuss risks and benefits of pouch for UC patients
Operations for strictures in Crohns
Haemorrhoids & treatments

MALIGNANT

Rectal cancer

Alarm symptoms for colorectal referrals
Endoscopic findings
Staging of carcinoma of rectum

Colonoscopy pre / post operatively
merits of USS vs CT liver
Role MRI / endorectal USS
T staging & dysplasia, inc layers of bowel wall

Surgical treatment

Anterior resection +/- ileostomy
Drain or not?
Bowel prep or not?
APR vs TEMS ( hot topic 2007)
TME what does this mean?
What nerves can you damage during TME?
Pelvic exenteration
Excision of the vagina..how would you reconstruct it?
Leaks at anterior resection per op how test, how mx at different levels, then post op early, then on gastrograffin at follow up.
Anterior resection syndrome

Adjuvant therapy

Advantages and disadvantages of pre and post op radiotherapy
Trials involving radiotherapy ( Dutch, CRO7)

Recurrence

Pain 1 yr after APR. Investigations for ? recurrence? Role of PET scans. How does PET work?

Colonoscopy

Colorectal screening

Population
High risk groups

Risks / benfits
Malignant polyp: pathological staging and treatment according to depth of invasion…..Kikuchi

Anal cancer

Anal ulcer - investigations. Pathology of anal cancer. Management of an anal adenoCa.

THE ODD GOUP OF QUESTIONS

The autonomic nervous system, where in cord, outflow pathways
Pelvic anatomy of autonomic nerves and where damaged
Functional disturbance after rectal surgery (sexual)
Informed consent, critical incident reporting
DVT management and prophylaxis, basic LMWH pharmacology
Antibiotics and C.diff
Jehovas witness related questions

Anastomotic Leak
Strangulated hernia
Small bowel obstruction
Mesenteric ischaemia
Appendicitis
Post op complications of appendicitis
Pelvic abscess
Large bowel obstruction
Volvulus
Pseudo obstruction
Acute colitis
C dif Colitis
Toxic megacolon
Post op anterior resection with hypotension
Lymphoma post chemo perforation
UGI haemorrhage Surgical techniques
Bleeding varices
Management of Lower GI bleeding
Acute cholecystitis
Post cholecystectomy with bile leak
Oesophageal perforation
DU perforation conservative treatment
Foreign body ingestion
Compartmental Syndrome
Management of small bowel fistula
Perianal abscess with necrotizing fascitis in DM
Severe acute pancreatitis, management , necrosectomy, antibiotic prophylaxis, GI ileus in pancreatitis
Anal pain
Necrotising fascitis
Parastomal collections
Ischiorectal abscess
Small and large bowel obstruction
Jaundice
Mesenteric ischaemia
Abdominal compartment syndrome
Pregnant female with RIF pain
Torsion and acute scrotum
Obese patient
\Diabetes and surgery
IV drug abuser with groin abscess
Needle stick injury

GENERAL VIVA

Arm lymphodema, management
Leg lymphodema, and milroys management
AAA
Leaking aneurysm
Leaking AAA: Diagnosis, surgical management, how I repair one.
Ruptured AAA -decision to operate
Same patient: Femoral Embolectomy on day 3 anuria post AAA repair
60 year old with a 5.5cm AAA (?Use of EVAR)
Cardiac risk assessment of a 65yr old with angina with a 6.5cm AAA
How would you manage a patient presenting with a 6cm infrarenal aortic aneurysm in outpatients?
What is the acceptable left ventricular ejection systolic function for AAA repair surgery?
Why is aortic surgery a greater strain on the heart than colorectal surgery?
Femoral aneurysm repair
Varicose vein: long and short saphenous, complications of surgery including nerve damage
Varicose veins and deep venous insufficiency
Varicose veins and their management.
Critical limb ischaemia; acute limb ischaemia- investigations
Ischaemic arm in an old lady - investigations, anticoag, operations
Acute limb ischaemia
Femoral embolectomy
How would you manage a little old lady referred by casualty with a cold, insensate, paralysed foot ?
Justify your reasons for doing an On-Table angiogram after initial embolectomy rather than before
Which is the quicker acting – Streptokinase or TPA
What is the half-life of TPA
What are the common causes of death after reperfusion
Tell me about vasodilator metabolites
What is the place for fasciotomy
Post MI cold painful leg.
Ischaemic arm/brachial embolectomy

PD catheters

A-V fistulas

How would you manage a 28 yr old Type I diabetic with a hot swollen forefoot
What are the indications for primary amputation ?

23 year old with an Axillary vein thrombosis
Thoracoscopic sympathectomy

Thoracic outlet syndrome

Conservative management of PVD (Evidence behind the management)

Pucture of subclavian artery
How will you control the bleed?
Open control and access to subclavian artery discussed

Groin abscess in IV drug abuser – actually pseudoaneurysm – management. Suddenly ruptured, no vascular surgeon – apply pressure, still no vascular surgeon – proximal control – retroperitoneal access to ext iliac artery
Septic IVDA with a groin abscess. Hazards, investigations, management of false aneurysm, surgery

Mesenteric ischaemia in young patient, angiography, 2nd look laparotomy, jump grafts

Thoracoscopic sympathectomy

SPECIALITY VIVA

Methods of dialysis access in renal patients
Complications of AVFs
Patient with acute presentation of dissecting thoracic AAA - classification, investigation and management.
Male 70 yrs with asymptomatic IC stenosis – counselling before CEA, complications
Management of patient with single vessel (peroneal) run-off and foot ulcers
Exposure of peroneal artery
Persistent oozing after AAA repair – causes, management (of DIC)
IVDU patient with groin swelling – causes, investigation
Varicose veins - detailed elements of history/exam, investigations, management of combined deep and superficial venous reflux
Screening for AAA - UK small aneurysm trial
Endovascular stent vs open reair for AAA

No postings from Breast Trainees ( contact admin@wmsurgeons.com with your list and I'll post it here)

For a general candidate

Jaundice – elderly lady, differentials – clinical features
Acute cholecystitis
Management of a patient with acute cholecystitis who is on wafarin
Cholecystitis in and diabetic, 1/12 post MI
Timing of op in an ideal world after acute cholecystitis - evidence, problems
Consent for lap. Cholecystectomy
Lap chole: consent, use of cholangiography, ERCP etc
Preop Ix prior to Lap Chole: use of EUS, ERCP, then discussion of intraop cholangiography, who performs this? When to convert, what to do if +ve
Drains & Lap chole (bile leak)
Bile leaks of different sorts post lap chole, inx, causes, proving diagnosis, risks to inx, operative and non surgical approaches to each
Bile duct injuries- diagnosis and management
Management of post-op bile leak
Peritonnitis after lap chole
bleeding post lap chole with junior trainee only available in the hospital
Hypotension per op in lap chole, Mx, differential, tension pneumo
Abdominal distension after cholecystectomy (examiner claimed gallstone ileus is the most common cause of SBO in the over 65s !!!!!!!!!!!!)
How do you establish a pneumoperitoneum?
How do you perform a laparoscopic cholecystectomy with just one 10mm port and two 5mm ports?
What are the different techniques for removing a gallbladder from the abdomen when you only have one 10mm port and two 5mm ports?
Cholangitis and cbd stone management
Consenting and pre-op management of a patient undergoing elective splenectomy
How do you do a trauma splenectomy?
Complications of splenectomy
Splenectomy and prophylaxis
Elective splenectomy indications, preparation, complications
Splenic lesion on CT: what might be the causes and what are you going to do about it?
Management of upper GI bleeding
Haematemesis (operation for bleeding DU in detail) surgery for ugi bleed - wanted me to say I would operate on M-Weiss tear, not my usual practice
Oesophageal obstruction (bolus) – Management
Oesophageal Cancer.
Acid suppression?
How is the acid produced in stomach?
what are the natural protective mechanism?
How PPI , zantac and cimetidine work?
Principles of Highly selective vagotomy
35 yr old man with multiple DUs at endoscopy – management
Gastric Ulcer, Management.
Non-healing gastric ulcer, what next?
60 yr old on chemo for GI lymphoma presents with epigastric pain – possible causes
Above patient has free air - management if small perf DU, management if large perf GU.
Perforated peptic ulcer scenerio, resus and what operation, what if you couldnt find a perforation (lesser sac)
How do you do a gastrectomy.
GIST
Assessing severity in acute pancreatitis. Why?
Severe acute pancreatitis- managment, necrosectomy, ?antibiotic prophylaxis
Abdo pain & pseudocyst (ct scan)
Management of a pancreatic fistula
Jaundice and Hepato renal Syndrome
Portal hypertension, causes complications and DU

For Upper GI candidate

bile leak post lap chole (Dx, Ix, Mx), Mx Barrett’s oesophagus, endoscopic resection
Barretts oe, definition, management, esp of high grade dysplasia
Pseudocyst management, indications of management and how would I do it
Management of reflux, preop management, why 24 hr Ph study is important, how to convince patient, and consent for Lap
Fundoplication,
Which is better open or lap fundo, long term and short term
Patient 50 years, with jaundice, USS, shows dilated ducts, and multiple gallstones. What will u do?
ERCP
Shows no stones, but shows stricture at lower end of CBD, What will u do?
Discussed brushings, insertion of stent (plastic) for biliary drainage as ERCP has been done, and then stage.
Criteria for inoperability/staging methods/ types of pancreatectomy/etc asked.
Technique of performing ERCP
35 year old with severe reflux, uncontrolled with medications, how will u assess.
Discussed clinical/endoscopic/pH/Manometry.
Technique of pH and Manometry asked.
types of reflux operation
Adv and disadvantage of various fundoplications
Informed consent for Lap chole
Management of bile leak
Management of bile duct damage during lap chole
Investigate elderly patient with painless jaundice.
Endoscopic management of CBD stones
Barrett's Oesophagus
Epidemiology of gastro-oesophageal junctional tumours. Classification of tumours
H pylori and carcinogenesis
Laparoscopic cholecystectomy - consent, describe operation including Calot's triangle and Strasbourg's view (posterior window)
GISTs - dx, criteria for malignancy, surgery, glivec
Mx of bile leak day one postop lap chole - role of ERCP, CT-guided drainage, surgery. How to deal with Duct of Lushka injury
CBD injuries - Strasbourg and Bismuth classifications
Laparoscopic fundoplication - types of ops, ant vs post wraps, complications
Bile duct injury.
Bile leak post lap cholecystectomy
Damaged right hepatic duct. Different methods of repair.
Gastrointestinal stromal tumours.
GIST- options, recurrent disease ?adjuvant therapy ?Glivec- didnt know it, and it is not a monoconal antibody!)
Junctional tumours- definition, staging, management
Chemotherapy/chemoradiotherapy for oesophageal Ca
Achalasia
Surgery in pancreatitis - for g/s, for infected panc, for psedocysts, how, when, etc,
Pancreatic cystadenomas
Gall bladder cancer.. involving cystic duct
Ca Oeso staging investigations(Pros and cons in detail)
Neoadjuvant chemo for the same
Achalasia management options and describe the operation
Barrett oesophagus, dysplasia etc
Reflux disease BSG guidelines consent etc
Haematemesismanagement upto op details