Single Best Answers in Surgery

405 Pages·2009·3.07 MB·English

by  Darren K Patten

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Single Best Answers in
SURGERY
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Single Best
Answers in
SURGERY
Darren K Patten BSc(Hons) MBBS AICSM Final year medical student (2008),
Imperial College London School of Medicine, Department of Biosurgery and
Surgical Oncology, St Mary’s Hospital, Imperial College Healthcare Trust,
London, UK
David Layfield BSc(Hons) MBBS Foundation Year Trainee, North West
Thames Foundation School, St Mary’s Hospital, Imperial College Healthcare
Trust, London, UK
Shobhit Arya BSc(Hons) MBBS AICSM Foundation Year Trainee, Oxford
Foundation School, Oxford, UK
Daniel R Leff MBBS MRCS(Eng) Clinical Research Fellow, Department of
Biosurgery and Surgical Oncology, St Mary’s Hospital, Imperial College
Healthcare Trust, London, UK
Paraskevas A Paraskeva MBBS(Hons) PhD FRCS(Gen Surg) Senior Lecturer
and Consultant Surgeon, Department of Biosurgery and Surgical Oncology,
St Mary’s Hospital, Imperial College Healthcare Trust, London, UK
Editorial Advisor
Professor the Lord Darzi of Denham KBE HonFREng FMedSci Professor of
Surgery and Head of Department, Paul Hamlyn Chair of Surgery, Department
of Biosurgery and Surgical Technology, Division of Surgery, Oncology,
Reproductive Biology and Anaesthetics, Faculty of Medicine, Imperial College,
London, UK; Lord Darzi is also Parliamentary Under Secretary of State at the
Department of Health
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Dedication
To Mum, Dad (June 1948–February 1994) and my brother for their inspiration
and support.
Darren K Patten
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Contents
Contributors ix
Foreword x
Preface xi
How to approach an SBA exam xii
Acknowledgements xiv
Abbreviations xv
Common reference intervals xvii
SECTION 1: PRE- AND POSTOPERATIVE MANAGEMENT 1
Questions 2
Answers 13
SECTION 2: FLUID BALANCE AND NUTRITION 23
Questions 24
Answers 31
SECTION 3: TRAUMA 39
Questions 41
Answers 51
SECTION 4: ABDOMEN: UPPER GASTROINTESTINAL AND
HEPATOBILIARY SURGERY 65
Questions 67
Answers 77
SECTION 5: ABDOMEN: LOWER GASTROINTESTINAL SURGERY 95
Questions 97
Answers 106
SECTION 6: ABDOMEN: THE ACUTE ABDOMEN 121
Questions 123
Answers 133
SECTION 7: BREAST SURGERY AND ENDOCRINE DISEASE 145
Questions 146
Answers 155
SECTION 8: VASCULAR SURGERY 163
Questions 164
Answers 173
SECTION 9: UROLOGY 187
Questions 189
Answers 199
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viii Contents
SECTION 10: ORTHOPAEDICS 217
Questions 219
Answers 228
SECTION 11: NEUROSURGERY 243
Questions 244
Answers 251
SECTION 12: ENT SURGERY 265
Questions 266
Answers 273
SECTION 13: OPHTHALMIC SURGERY 279
Questions 280
Answers 287
SECTION 14: LUMPS, BUMPS, SKIN AND HERNIAS 293
Questions 294
Answers 301
SECTION 15: PRACTICE EXAM 311
Questions 314
Answers 342
Index 383
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Contributors
Authors
Darren K Patten BSc(Hons) MBBS AICSM, Foundation Year Trainee, Oxford
Foundation School, Imperial College London School of Medicine, Department of
Biosurgery and Surgical Oncology, St Mary’s Hospital, Imperial College
Healthcare Trust, London, UK
At the time of writing Darren Patten was a Final year medical student at Imperial
College London School of Medicine
David Layfield BSc(Hons) MBBS, Foundation Year Trainee, North West Thames
Foundation School, St Mary's Hospital, Imperial College Healthcare Trust,
London, UK
Shobhit Arya BSc(Hons) MBBS AICSM, Foundation Year Trainee, Oxford
Foundation School, Oxford, UK
Daniel R Leff MBBS MRCS(Eng), Clinical Research Fellow, Department of
Biosurgery and Surgical Oncology, St Mary's Hospital, Imperial College
Healthcare Trust, London, UK
Paraskevas A Paraskeva MBBS(Hons) PhD FRCS(Gen Surg), Senior Lecturer and
Consultant Surgeon, Department of Biosurgery and Surgical Oncology, St Mary’s
Hospital, Imperial College Healthcare Trust, London, UK
Editorial Advisor
Professor the Lord Darzi of Denham KBE HonFREng FMedSci, Professor of
Surgery and Head of Department, Paul Hamlyn Chair of Surgery, Department of
Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive
Biology and Anaesthetics, Faculty of Medicine, Imperial College, London, UK;
Lord Darzi is also Parliamentary Under Secretary of State at the Department of
Health
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Foreword
Examination and assessment have become increasingly important to medical
undergraduates in recent times. More interest in standardizing exams and
improving the relevance of evaluation has been a key change in the practice of
question setting. As many medical schools go through curriculum changes and
review of their processes, we feel there is an increasing demand for help for
medical students in preparing for exams and providing them with clarity. Single
best answer questions, although not a new phenomenon, are being increasingly
adopted by both undergraduate and postgraduate examination boards. Currently
there is a deficiency of books to aid students, and I feel this book adds
significantly to the literature to facilitate the revision of surgery and the
understanding of the correct execution of the exam. This book has a mix of
senior and junior authors, allowing it to address the modern needs of students
and provide the most up-to-date advice.
Professor the Lord Ara Darzi of Denham
KBE HonFREng FMedSci
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Preface
The single best answer (SBA) question format is gradually being implemented
across a vast number of medical schools in the UK, for the written exam
component of the undergraduate medicine and surgery course. Single best
answers have been shown to be a better modality not only for testing knowledge
but also for testing judgement in clinical practice.
Single Best Answers in Surgery contains 450 SBA questions arranged in a topic
by topic format and a practice exam. The questions test core and advanced
knowledge across the undergraduate surgical curriculum and also cater for final
year medical students sitting the written papers in surgery. Detailed explanations
for each question are provided at the end of each topic section, describing how
the correct answer is reached over the other possible options to the question.
Not only will this book act as a question bank, it will also act as a useful
revision aid, providing the reader with the fundamental knowledge to sit the
undergraduate surgical written exam with confidence!
Darren K Patten and Paraskevas A Paraskeva
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How to approach a single best answer
exam
The first step in perfecting your exam technique is to follow the format set by
your medical school and practise answering many of these questions well in
advance of the exam. For example, little benefit is drawn from using true/false
questions as a revision tool when the exam format is based on a bank of single
best answer (SBA) questions.
In the context of SBA questions, you will usually be awarded one mark for every
question that is answered correctly. Some medical schools implement negative
marking, where one mark is deducted per wrong answer. This makes guesswork
highly unfavourable and may result in you obtaining significantly low marks.
However, in the majority of UK medical schools there is no negative marking so
you should aim to answer all of the questions.
The SBA question consists of an introductory theme, a question stem (which in
most cases consists of a clinical vignette but may occasionally be a theory-based
fact), followed by five possible responses (A–E), of which one of them is the most
likely suited answer to the question.
How to answer SBAs
First, we recommend that you attempt to answer an SBA question in just under a
minute. This can be hard at first but, through practice, it is achievable and will
leave you with some spare time to re-check your responses or go over questions
that you are unsure about.
A method of answering an SBA is to cover up (with a piece of paper or your
hand) the five possible options and carefully read just the theme and stem. By
doing this, you may be able to think of the answer which will usually be one of
the five options given in that question. In some cases where questions tend to be
less straightforward, the method of delineating the wrong options first is usually
very helpful as this will leave you with fewer possible options and with a higher

chance of opting for the correct answer.
Some students tend to lose marks by blindly answering SBAs and extended
matching questions (EMQs) by using pattern recognition of the words used in the
stems. In some cases this may prove to be successful, but distracters may be
placed in the stem which may change the entire meaning of the question, which
would in turn demand an alternative response to the one initially thought. The
best way to avoid this is to read the question carefully and understand fully
what the SBA question is asking of you. In an SBA, all of the options available
may not be ideal, but you still have to select the best of those available.