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7/17/2019 9781848161887_fmatter
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roblems and Solutions
evision questions
in undergraduate surgery
S u r g e r y : P r o b l e m s a n d S o l u t i o n s D o w n l o
a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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Imperial College PressICP
Editors
Andrew Goldberg
The Nuffield Orthopaedic Centre
Oxford, UK
Gerard StansbyNewcastle University & Freeman Hospital
Newcastle Hospitals NHS Trust, UK
roblems and Solutions
evision questions
in undergraduate surgery
S u r g e r y : P r o b l e m s a n d S o l u t i o n s D o w n l o
a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
Published by
Imperial College Press
57 Shelton Street
Covent Garden
London WC2H 9HE
Distributed by
World Scientific Publishing Co. Pte. Ltd.
5 Toh Tuck Link, Singapore 596224
USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601
UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE
Printed in Singapore.
For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center,
Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from
the publisher.
ISBN-13 978-1-84816-187-0 (pbk)
ISBN-10 1-84816-187-5 (pbk)
Typeset by Stallion Press
Email: enquiries@stallionpress.com
All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or
mechanical, including photocopying, recording or any information storage and retrieval system now known or to
be invented, without written permission from the Publisher.
Copyright © 2008 by Imperial College Press
SURGERY: PROBLEMS AND SOLUTIONS
Revision Questions in Undergraduate Surgery
S u r g e r y : P r o b l e m s a n d S o l u t i o n s D o w n l o
a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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v
About the Authors
Gerard Stansby, MB, MCHir, FRCSProfessor Gerard Stansby qualified from Cambridge University and Addenbrooke’s
Hospital in 1982. He carried out many junior training posts in Cambridge and the
East Anglian area before moving to the Royal Free Hospital as Registrar and sub-
sequently Lecturer in Surgery. In 1993, he went to St. Mary’s Hospital in London
as a Senior Clinical Vascular Fellow and, in 1994, became Senior Lecturer in
General and Vascular Surgery at St. Mary’s Hospital and Imperial College,
London. In January 2000, he obtained his current position of Professor of Vascular
Surgery at the Freeman Hospital, University of Newcastle.
Professor Stansby is the author of more than 150 scientific articles and several
books and book chapters. His special interests include platelet–blood vessel wall
and vascular risk factors. He is co-chair of the TARGET-PAD group which aims
to improve the profile and understanding of PAD in the UK, a Council member of
the Vascular Society of Great Britain and Ireland, a Council member of the Venous
Forum and an editor for the Cochrane Peripheral Vascular Diseases group and
several medical journals. He has been an examiner for final medical students
at several medical schools in the UK and overseas and chairs the Newcastle
Surgical Undergraduate Teaching Committee.
Andrew Goldberg, MBBS, MD, FRCS (Tr&Orth)
Mr. Goldberg qualified from the Imperial College School of Medicine in 1994.
His specialist training was based on the Royal National Orthopaedic Hospital,
Stanmore and Royal Free Hospital Orthopaedic training programme in the North
East Thames Region. He is a fellow of the Royal College of Surgeons of England
and Ireland and a member of the British Orthopaedic Association. He obtainedhis CCT in Trauma and Orthopaedics in 2007 and now specialises in lower limb
surgery. Andy founded the Medical Futures Innovation Awards in 2001, which is
one of the UK’s highest healthcare accolades and assists medical professionals
progress their innovative ideas closer to implementation and patient benefit. Andy
authored a paper for the Parliamentary under Secretary of State for Health entitled,
“Encouraging, Supporting and Rewarding Innovation in the NHS” in 2004 and
was also a member of the DTi led Health Industries Taskforce (HITF). In 2007,
Andy was invited to sit on the UK Department of Health’s Innovation Council.Andy coined the term “ideapreneurs” and speaks regularly at national and inter-
national meetings on the subject of healthcare innovation. Andy has an MD thesis
on cartilage repair, based on pioneering work in human mesenchymal stem cells.
He also enjoys teaching medical students and finding ways to help convey complex
issues in easy to understand and memorable ways.
S u r g e r y : P r o b l e m s a n d S o l u t i o n s D o w n l o
a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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vii
Acknowledgements
To our parents and wives who are always there for us and always
a forethought. To our amazing children who give us reason to teach, share knowledge and enjoy what we do.
To all the contributing authors who brought their invaluable
depth of expertise. To all of the medical students , for their
suggestions before and after the book was written.
S u r g e r y : P r o b l e m s a n d S o l u t i o n s D o w n l o
a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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Preface
It is important to explain at the outset that we do not regard this as a typical “testyourself” book. There are no pass marks and it is not designed as a set of mock-
exam questions with model answers. We regard it as a way of learning or revising
a topic, by challenging yourself. The best approach is to attempt a question and
then use the answers provided to test or supplement your knowledge. We believe
that putting the answers immediately after the questions will suit many students
far better than the approach of most other revision aids, where the answers are hid-
den at the back. We would suggest you answer one question at a time (with the
answers covered) and then consider the given answer, before moving to the next
question. But of course it is your book — so you may do as you please! Obviously,
a revision aid cannot be exhaustative and so depending on your background level
of knowledge you may also wish to look up some points in a standard text book
before moving on. We have used the “single best answer” format in the MCQ’s
and EMQ’s as this appears to be in use in the majority of medical schools at the
present time. We hope that this format will result in an understanding of context
as well as the retention of facts.
Deliberately we have not linked the current book with our previous text book
“Surgical Talk”, as we felt students would wish to have completely fresh stand-
alone text. Of course there will be a large amount of overlap, but we make no
apologies for the fact that a few topics or answers may be found in one book but
not the other. However, as with “Surgical Talk”, this book aims for a level of
knowledge and the approach that would be expected of the better students arriv-
ing at finals. Some of the questions are deliberately quite difficult — but we hope
all are fair! Like “Surgical Talk” we have also included ENT, orthopaedics and
urology as well as general surgery so that you do not have to buy endless revision
aids to ensure you have surgery covered.
Finally we would like to thank our colleagues and friends who have con-
tributed the questions and answers. They are all very busy people and so we are
very grateful for their help.
Good luck with your revision and the exam. We hope this book will help you
prepare for surgical finals with enthusiasm and confidence.
Gerard Stansby
Andrew Goldberg
ix
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b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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Contributors
Muhammad Ishtiaq Ahmed, MRCSClinical Research Fellow, School of Surgical and Reproductive Sciences,
Newcastle University, UK
Douglas Aitken, FRCS (Gen Surg)
Specialist Registrar, Colorectal Surgery, Royal Victoria Infirmary,
Newcastle-upon-Tyne, UK
Ben Bannerjee, MD, FRCS
Consultant Surgeon and Honorary Senior Lecturer, Sunderland Royal Hospitals,
Sunderland, UK
Sheila Carey, FRCA
Specialist Registrar in Anaesthetics, Northern Deanery, UK
Richard M. Charnley, DM, FRCS
Consultant Hepato-Pancreato-Biliary Surgeon, Freeman Hospital,
Newcastle-upon-Tyne, UK
Joseph Cosgrove, FRCA
Consultant Anaesthetist, Freeman Hospital, Newcastle-upon-Tyne, UK
Praveen Dadireddy, MRCS
Trainee, ENT, Pilgrim Hospital, Boston, Lincolnshire, UK
S. Michael Griffin, MD, FRCS, FRCS Ed, FCS (HK)
Professor of Gastrointestinal Surgery, Northern Oesophagogastric Unit,
Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Monica Hansrani, MD, FRCS
Specialist Registrar, Vascular Surgery, Northern Deanery, UK
Alan F. Horgan, MD, FRCS
Consultant Colorectal Surgeon, Freeman Hospital, Newcastle-upon-Tyne, UK
Smout Jonathan, MD FRCS
Specialist Registrar, Vascular Surgery, Newcastle-upon-Tyne, UK
xi
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a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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xii Contributors
Nigel Jones, MS, FRCS
Consultant Surgeon, Freeman Hospital, Newcastle-upon-Tyne, UK
Tom Lennard, MD, FRCS
Professor of Breast and Endocrine Surgery and Head of School,
School of Surgical and Reproductive Sciences,
Newcastle University, UK
Rajiv Lochan, MS, FRCSEd
Specialist Registrar, Hepatobiliary Surgery, Freeman Hospital,
Newcastle-upon-Tyne, UK
Roy McGregor, BSc(Hons), FRCS(Urol)
Fellow in Urology, The Royal North Shore Hospital, Sydney, Australia
Ashraf Morgan, MS, FRCS
Staff Grade Surgeon, Pilgrim Hospital, Boston, Lincolnshire, UK
Ian Nesbitt, FRCA, Dip. ICM
Consultant Anaesthetist, Freeman Hospital, Newcastle-upon-Tyne, UK
Michael Oko, FRCS
Consultant ENT Surgeon, Pilgrim Hospital, Boston, Lincolnshire, UK
Klaus Overbeck, FRCS
Consultant Vascular Surgeon, Sunderland Royal Hospitals, Sunderland, UK
Dorota Overbeck-Zubrzycka, MD
Specialist Surgical Trainee, Northern Deanery, UK
Rehan Saif, MRCS
Clinical Research Fellow, School of Surgical and Reproductive Sciences,
Newcastle University, UK
Christopher Streets, BSc, MD, FRCS (Gen Surg)
Consultant, Department of Surgery, Bristol Royal Infirmary, UK
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a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
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Contents
About the Authors vAcknowledgements vii
Preface ix
Contributors xi
1. Trauma, Shock, Head Injuries and Burns 1
Sheila Carey and Jonathan Smout
2. Liver, Biliary Tract and Pancreas 25
Rajiv Lochan and Richard Charnley
3. Oesophagus, Stomach and Duodenum 53
Christopher Streets and Mike Griffin
4. Colon Rectum and Anus 79
Doug Aitken and Alan Horgan
5. The Acute Abdomen 103
Klaus Overbeck and Dorota Overbeck-Zubrzycka
6. Breast Surgery 131
Rehan Saif, Muhammad Ahmed and Tom Lennard
7. Head, Neck and Skin 157
Monica Hansrani and Nigel Jones
8. Hernias 181
Ben Bannerjee and Gerard Stansby
9. Fluid Balance and Parenteral Nutrition 203
Ian Nesbitt and Joe Cosgrove
10. Vascular Surgery 225
Gerard Stansby and Ben Bannerjee
11. Urology 247
Roy McGregor
12. Orthopaedics 273
Andrew Goldberg13. Ear, Nose and Throat 305
Michael Oko, Ashraf Morgan and Praveen Dadireddy
14. Pre- and Post-operative Management 327
Ian Nesbitt and Joe Cosgrove
xiii
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a d e d f r o m w w w . w o r l d s c i e n t i f i c . c o m
b y 4 1 . 2 1 2 . 2 6 . 1 8 2 o n 1 0 / 0 8 / 1 5 . F o r p e r s o n a l u s e o n l y .
Recommended