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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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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




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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: [email protected]

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




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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.




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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.




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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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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,


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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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,


Rajiv Lochan, MS, FRCSEd

Specialist Registrar, Hepatobiliary Surgery, Freeman Hospital,


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,


Christopher Streets, BSc, MD, FRCS (Gen Surg)

Consultant, Department of Surgery, Bristol Royal Infirmary, UK




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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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