short answer question surgery

UWI ID Number: ___-__________

SECTION B

Structured Answer Essay Questions

Instructions: Please write the answer in the space provided only. Note that marks vary for each response. Correct precise answers gain full marks. Responses that are close may be given partial marks.

Question 1

A 14-year-old boy presents with complaints of right knee pain of approximately 2 months' duration. He remembers falling during football training 2 months ago, but the trauma was not severe enough to seek medical attention. Shortly afterwards, he started having pain at night or after football practice. The pain would initially subside with rest and over-the-counter medication. However, for the past 2 weeks the pain has increased in intensity, causing him to limp. His mother has noticed his right thigh is slightly larger than the left. It is also warm and tender to touch.

a) State the MOST likely diagnosis AND list two (2) other conditions you could consider as reasonable differential diagnoses in this patient?

b) List any three (3) risk factors associated with the condition you chose above to be the most likely

c) What are the characteristic X-ray features that one might see if they imaged this patient’s right knee?

d) What further laboratory or imaging investigations would you consider ordering?

University of the West Indies

UWI ID Number: ___-__________

e) Name any one (1) staging system criteria used to stage this disease

f) How would you proceed in the treatment of this patient if he had high grade non-metastatic disease on presentation?

g) What is the characteristic feature of this lesion on microscopy?


UWI ID Number: ___-__________

Question 2

A 25-year-old woman presents with one episode of haematochezia. She is concerned because her mother died of colorectal cancer at 50 years of age. She has no further information about her family history. Physical examination is normal. She undergoes colonoscopy and is found to have 20 adenomas ranging in size from 4 to 15 mm.

a) What is the diagnosis? What gene mutation is likely to be responsible?

b) Briefly explain the “adenoma-to-carcinoma sequence”

c) What is “Gardner’s Syndrome”?

d) What other diagnostic test(s) would you consider ordering to obtain a complete evaluation?

e) What are her options for operative treatment and subsequent reconstruction?


UWI ID Number: ___-__________

f) If she is unwilling to undergo immediate surgical treatment and has no contraindications to delayed surgery what is/are her option(s)

Despite undergoing a procto-colectomy the patient still develops a malignancy.

g) In which location(s) of the gastro-intestinal tract could polyps still result in malignant transformation?


UWI ID Number: ___-__________

Question 3

A 32-year old man presents to the accident and emergency department with vomiting and severe abdominal pain; relieved on lying forwards but worse on lying flat. He was previously seen in the out-patient department 3 weeks ago with complaints of fatigue, muscle weakness, and constipation. He has a past medical history of renal stones and depression. He denies smoking or alcohol usage. Review of his blood results show evidence of elevated serum amylase and hypercalcemia

a) What clinical findings would you look for on physical examination?

a) List (3) complications associated with this condition

b) How would you manage this patient initially in the emergency room?

c) What imaging test(s) would you consider AND what results would you expect for each?


UWI ID Number: ___-__________

d) What is your interpretation of these results?

Assuming the results of the investigations ordered show no evidence that his symptoms were due to gall stones or alcohol.

e) What is the most likely cause of his symptoms

f) What investigations would you do to confirm your hypothesis?

g) What definitive surgical procedure(s) could be offered electively after his symptoms subside and he settles?

h) List four (4) complications associated with this elective surgical procedure;

i) If a first degree relative of this patient was discovered to have elevated serum calcium and a pancreatic or pituitary tumour, what familial syndrome would you consider?


UWI ID Number: ___-__________

Question 4

A 68-year-old man presents to the emergency department complaining of an inability to urinate during the previous 12 hours. He has severe lower abdominal pain. Prior to this, he noted a weaker force of urinary stream, difficulty in starting his urinary stream, and frequent episodes of waking at

night to pass urine. On examination, he has lower abdominal distention, which is dull to percussion.


UWI ID Number: ___-__________

Question 5

A 55-year-old woman is referred to your service for surgical management. She has severe Crohn’s disease and has failed medical therapy. She now requires bowel resection and is expected to need total parenteral nutrition (TPN) post-operatively.

a) With regards to the assessment of her nutritional status, pre-operatively

(i) What historical information would be important?

(ii) What clinical features would you look for on physical examination?

(iii) List three (3) anthropomorphic measurements that could be taken?

(iv) List five (5) laboratory investigations that you would order;


UWI ID Number: ___-__________

b) What would be the daily total caloric requirement (in Kcal per kilogram) if this patient was 60 kg?

The patient undergoes exploratory laparotomy and resection of approximately 160 cm of inflamed small bowel. A central venous catheter is inserted in her right subclavian vein for total parenteral nutritional support.

c) Outline the steps involved in central line placement and state what technique has made it easier and safer to place these lines

d) List five (5) early AND five (5) late complications associated with total parenteral nutrition;

e) List three (3) reasons why a patient with Crohn’s disease might need total-parental nutrition?


UWI ID Number: ___-__________

f) What are the effects of mal-nutrition in wound healing?


short answer question surgery

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