CSHK Part 1 MCQ cheat sheet

Acute appendicitis: Alvarado score components are migratory pain, anorexia, nausea/vomiting, right iliac fossa tenderness, rebound tenderness, fever, and leukocytosis; a score of 7 or more supports operative management.

Small bowel obstruction: erect chest and abdominal films show valvulae conniventes centrally; CT defines transition point; surgery is indicated for strangulation signs (fever, tachycardia, constant pain, raised lactate) or failure of conservative therapy.

Large bowel obstruction with a competent ileocaecal valve risks closed-loop perforation; caecal diameter above 9-10 cm on plain film is a warning threshold.

Hernias: femoral hernia carries the highest strangulation risk because of the narrow, rigid lacunar ligament; repair is offered urgently even when asymptomatic.

Thyroid surgery: recurrent laryngeal nerve injury causes hoarseness (unilateral) or airway obstruction (bilateral); external branch of superior laryngeal nerve injury causes loss of high pitch.

Post-thyroidectomy hypocalcaemia presents with perioral tingling and Chvostek/Trousseau signs; check corrected calcium and manage with oral or IV calcium.

Breast cancer: sentinel lymph node biopsy uses blue dye and/or radioisotope; axillary dissection is reserved for clinically node-positive disease or failed mapping.

Acute pancreatitis: Ranson and Glasgow-Imrie scores predict severity; gallstone pancreatitis with cholangitis or persistent obstruction warrants urgent ERCP.

Bowel anastomosis healing depends on adequate blood supply, tension-free repair, and absence of distal obstruction; albumin below 30 g/L and steroids increase leak risk.

Coronary artery bypass grafting: left internal mammary artery to left anterior descending gives best long-term patency; bilateral internal mammary artery use increases sternal wound infection risk in diabetics.

Cardiac tamponade: Beck's triad is hypotension, distended neck veins, and muffled heart sounds; bedside echocardiography shows diastolic right ventricular collapse and IVC plethora.

Aortic dissection: Stanford type A involves the ascending aorta and requires emergency surgery; type B is managed medically unless complicated by malperfusion or rupture.

Postoperative atrial fibrillation after cardiac surgery is common; rate control with beta-blockers and correction of electrolytes is first-line, with amiodarone for refractory cases.

Lung cancer staging: mediastinal lymph node involvement (N2) is assessed by EBUS-TBNA or mediastinoscopy before resection; PET-CT is used to detect distant metastases.

Pneumothorax: tension pneumothorax is a clinical diagnosis requiring immediate needle decompression and chest drain, never awaiting imaging.

Flail chest with pulmonary contusion is managed with analgesia, physiotherapy, and ventilatory support; operative fixation is considered for severe instability.

Malignant pleural effusion is managed with talc pleurodesis or indwelling pleural catheter; trapped lung precludes pleurodesis.

Thoracotomy complications include post-thoracotomy pain syndrome, atelectasis, and prolonged air leak; air leak beyond 5 days may require pleurodesis or reoperation.

Glasgow Coma Scale: eye (1-4), verbal (1-5), motor (1-6); total 3-15; score of 8 or less indicates need for airway protection.

Head injury: pupillary dilatation with reduced consciousness suggests ipsilateral uncal herniation; urgent CT and neurosurgical referral are required.

Extradural haematoma: biconvex (lentiform) hyperdensity on CT, often middle meningeal artery injury; may have a lucid interval.

Subdural haematoma: crescent-shaped collection crossing sutures; chronic form is common in the elderly and alcoholics and treated by burr-hole drainage.

Subarachnoid haemorrhage: thunderclap headache; CT within 6 hours is highly sensitive, otherwise lumbar puncture for xanthochromia after 12 hours.

Hydrocephalus: endoscopic third ventriculostomy is preferred for obstructive (non-communicating) hydrocephalus; ventriculoperitoneal shunt for communicating types.

Brain tumours: glioblastoma is the most common primary malignant brain tumour in adults; dexamethasone reduces peritumoural oedema.

Lumbar disc prolapse: posterolateral herniation compresses the traversing nerve root (e.g., L4/5 disc affects L5); cauda equina syndrome requires emergency decompression.

Spinal cord injury: high-dose steroids are not routinely recommended; priority is immobilisation, airway and haemodynamic support, and early imaging.

Hypertrophic pyloric stenosis presents at 3-6 weeks with projectile non-bilious vomiting; ultrasound shows pyloric muscle thickness of 3 mm or more and canal length of 14 mm or more; correct hypochloraemic alkalosis before pyloromyotomy.

Intussusception: infants aged 3-12 months with colicky pain, redcurrant jelly stool, and a sausage-shaped mass; air or contrast enema is both diagnostic and therapeutic.

Bilious vomiting in a neonate is a surgical emergency until malrotation with volvulus is excluded; upper GI contrast study shows a corkscrew sign.

Inguinal hernia in infants carries high incarceration risk and is repaired promptly; in older children, herniotomy alone suffices.

Undescended testis: orchidopexy is performed between 6 and 18 months of age to reduce malignancy and fertility risk.

Oesophageal atresia with tracheo-oesophageal fistula presents with frothy secretions, choking on feeds, and a coiled nasogastric tube; VACTERL associations must be screened.

Congenital diaphragmatic hernia causes respiratory distress and scaphoid abdomen; management avoids immediate surgery, prioritising gentle ventilation and pulmonary hypertension treatment.

Appendicitis in children often presents atypically; ultrasound is first-line imaging and perforation is more common than in adults.

Renal colic: non-contrast CT KUB is the gold standard; stones below 5 mm usually pass spontaneously; stones above 10 mm rarely pass and need intervention.

Testicular torsion is a clinical emergency; Doppler ultrasound should not delay exploration; salvage is highest within 6 hours of onset.

Prostate cancer: PSA, digital rectal examination, and multiparametric MRI guide biopsy; Gleason/Grade Group scoring determines risk stratification.

Benign prostatic hyperplasia: symptom assessment with IPSS; alpha-blockers relax smooth muscle, 5-alpha-reductase inhibitors shrink glands over 30 mL.

Bladder cancer: painless visible haematuria is the classic presentation; cystoscopy and transurethral resection of bladder tumour are diagnostic and therapeutic.

Urinary tract infection in men is often complicated; recurrent infection warrants investigation for obstruction, stones, or anatomical abnormality.

Fournier's gangrene is a necrotising fasciitis of the perineum requiring urgent surgical debridement and broad-spectrum antibiotics.

Hydrocele in adults may reflect underlying testicular pathology; ultrasound is indicated when the testis is not clearly palpable.

Burn depth: superficial partial-thickness blanches and is painful; full-thickness is white or charred, insensate, and requires excision and grafting.

Parkland formula for adult burns: 4 mL/kg per percent total body surface area of crystalloid in 24 hours, half in first 8 hours from injury time.

Rule of nines in adults: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%.

Skin grafts: split-thickness grafts survive by imbibition, inosculation, and revascularisation; full-thickness grafts have better contour and less contraction.

Flap monitoring: free flaps are assessed by colour, capillary refill, temperature, and Doppler signal; venous congestion shows a blue, swollen flap with brisk bleeding.

Hand injuries: high-pressure injection injuries and fight-bite wounds require urgent surgical debridement and antibiotics.

Cleft lip repair is typically performed around 3 months of age using the Millard rotation-advancement technique; cleft palate repair around 6-12 months.

Basal cell carcinoma is the most common skin cancer; excision with adequate margins is curative; melanoma requires wider margins based on Breslow thickness.

Abdominal aortic aneurysm: elective repair is considered when diameter reaches 5.5 cm in men or grows more than 1 cm per year; rupture presents with back pain and hypotension.

Peripheral arterial disease: ankle-brachial index below 0.9 indicates disease; critical limb ischaemia shows rest pain, ulceration, or gangrene with ABI typically below 0.4.

Acute limb ischaemia: the six Ps are pain, pallor, pulselessness, paraesthesia, paralysis, and perishing cold; immediate heparinisation and revascularisation are required.

Carotid stenosis: endarterectomy is indicated for symptomatic stenosis of 70-99% and considered for 50-69%; benefit is greatest when performed within 2 weeks of symptoms.

Varicose veins: duplex ultrasound maps saphenous reflux; endovenous ablation is first-line for truncal reflux.

Deep vein thrombosis: proximal (popliteal or above) thrombosis is treated with anticoagulation; isolated calf vein thrombosis may be managed with serial ultrasound or anticoagulation.

Aortic dissection and aneurysm share risk factors of hypertension and smoking; type B dissection is managed with blood pressure control unless complicated.

Graft infection presents with fever, pain, and pseudoaneurysm; treatment often requires graft excision and extra-anatomic bypass.