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Surgical TP.

indd 1

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Problems and Solutions

Revision questions
in undergraduate surgery

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Editors

Andrew Goldberg
The Nuffield Orthopaedic Centre
Oxford, UK

Gerard Stansby

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Newcastle University & Freeman Hospital


Newcastle Hospitals NHS Trust, UK

Problems and Solutions

Revision questions
in undergraduate surgery

ICP

Surgical TP.indd 2

Imperial College Press

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Published by
Imperial College Press
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Covent Garden
London WC2H 9HE
Distributed by
World Scientific Publishing Co. Pte. Ltd.
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USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601

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UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE

British Library Cataloguing-in-Publication Data


A catalogue record for this book is available from the British Library.

SURGERY: PROBLEMS AND SOLUTIONS


Revision Questions in Undergraduate Surgery
Copyright 2008 by Imperial College Press
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.

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

Printed in Singapore.

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About the Authors


Gerard Stansby, MB, MCHir, FRCS
Professor Gerard Stansby qualified from Cambridge University and Addenbrookes
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 subsequently Lecturer in Surgery. In 1993, he went to St. Marys Hospital in London
as a Senior Clinical Vascular Fellow and, in 1994, became Senior Lecturer in
General and Vascular Surgery at St. Marys 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 plateletblood 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 obtained
his 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 UKs 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 Healths Innovation Council.
Andy coined the term ideapreneurs and speaks regularly at national and international 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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Page 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 test
yourself book. There are no pass marks and it is not designed as a set of mockexam 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 hidden 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 MCQs
and EMQs 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 standalone 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 arriving 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 contributed 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

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Contributors
Muhammad Ishtiaq Ahmed, MRCS
Clinical Research Fellow, School of Surgical and Reproductive Sciences,
Newcastle University, UK

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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

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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

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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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Contributors

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Contents
About the Authors
Acknowledgements
Preface
Contributors

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1. Trauma, Shock, Head Injuries and Burns


Sheila Carey and Jonathan Smout

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xi
1

2. Liver, Biliary Tract and Pancreas


Rajiv Lochan and Richard Charnley

25

3. Oesophagus, Stomach and Duodenum


Christopher Streets and Mike Griffin

53

4. Colon Rectum and Anus


Doug Aitken and Alan Horgan

79

5. The Acute Abdomen


Klaus Overbeck and Dorota Overbeck-Zubrzycka

103

6. Breast Surgery
Rehan Saif, Muhammad Ahmed and Tom Lennard

131

7. Head, Neck and Skin


Monica Hansrani and Nigel Jones

157

8. Hernias
Ben Bannerjee and Gerard Stansby

181

9. Fluid Balance and Parenteral Nutrition


Ian Nesbitt and Joe Cosgrove

203

10. Vascular Surgery


Gerard Stansby and Ben Bannerjee

225

11. Urology
Roy McGregor

247

12. Orthopaedics
Andrew Goldberg

273

13. Ear, Nose and Throat


Michael Oko, Ashraf Morgan and Praveen Dadireddy

305

14. Pre- and Post-operative Management


Ian Nesbitt and Joe Cosgrove

327

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