❗️ ‘gold standard’ for complete morphological evaluation of the biliary tree as it offers detailed information about the integrity of the biliary tract ➡️ MRCP.

❗️ confirm the presence of a bile leak or biliary obstruction ➡️ HIDA.

❗️ most common bile leak following cholecystectomy is from ➡️ cystic duct.

❗️ most common type of Cancer of the gallbladder ➡️ adenocarcinomas.

❗️ most important factor that determines treatment in pancreatic injury ➡️ pancreatic duct has been disrupted or not.

❗️ most common cause of death in the immediate period of pancreatic injury ➡️ bleeding.
❗️ most common cause of death in the late period of pancreatic injury ➡️ sepsis.

❗️ Antibiotics are not indicated in mild pancreatitis.

❗️ first step in management of severe acute pancreatitis ➡️ Admission to HDU/ICU.

❗️ most frequent cause of chronic pancreatitis ➡️ alcohol.

❗️ most common pancreatic cancers ➡️ ductal adenocarcinomas.

❗️ Ductal adenocarcinomas arise most commonly in the ➡️  head of the pancreas.

❗️ most common cause of tissue necrosis and suppuration ➡️ Staphylococcus aureus.

❗️ most common cause of chronic abscesses ➡️ Mycobacterium and Actinomyces.

❗️ Ix of choice for hydrocele ➡️ scrotal US.

❗️ Ix of choice for varicocele ➡️ doppler US.

❗️ most common site for varicocele ➡️ left.

❗️ most common site for undescended testes ➡️ right.

❗️ most common site for testicular tumor ➡️ right.

❗️ most common cystic lesion in scrotum ➡️ spermatocele.

❗️ Diagnosis for testicular tumor ➡️ pathological evaluation.

❗️Needle aspiration contraindicated in testicular tumor

❗️ trans-scrotal approach for biopsy or orchiectomy should be avoided

❗️ most common cause of epididmo-orchitis ➡️ E. coli.

❗️ Ix of choice for epididmo-orchitis ➡️ doppler US.

❗️ Rx of choice (1st line) for epididmo-orchitis ➡️Antibiotics.

? most common type of hernia in men ➡️ inguinal hernia.

? most common strangulated hernia ➡️ femoral hernia.

? most common peptic ulcer ➡️ duodenal ulcer.

? most common site for duodenal ulcer ➡️ first part of the duodenum.
? most common site for gastric ulcer ➡️ lesser curvature (incisura angularis).
? most common type of peptic ulcer associated with malignancy ➡️ peptic ulcer.

? most common Cause of upper gastrointestinal bleeding ➡️ peptic ulcer.

? most common type of gastric polyp ➡️ metaplastic.

? most common site for gastric CA ➡️ proximal stomach.

? most common sites for GIST metastases ➡️ Peritoneum and liver.

? most common organisms causing Primary pneumococcal peritonitis ➡️ Haemophilus spp., group A streptococci and a few Gram-negative.

? most common form of TB peritonitis ➡️ wet.

? most common cause of Chylous ascites ➡️ lymphoma.

? most common site for mesentric adenitis ➡️ ileocaecal region.

?most common cause of intestinal obstruction In western countries ➡️ adhesions and bands.

? most common type of lung CA associated with smoking ➡️ Squamous cell carcinoma.

? most common type of lung CA not associated with smoking ➡️  adenocarcinoma.

? most common form of shock ➡️ Hypovolaemic

?most common cause of Necrotising fasciitis ➡️ Streptococcus pyogenes (group A streptococcus)

?most common chronic wounds ➡️ leg ulcer.

❗️ most common cause of acute liver failure ➡️ Viral hepatitis (hepatitis A, B, C, D, E).
❗️ most useful clinical sign in chronic liver failure ➡️ fapping tremor.

❗️ first imaging modality for the investigation of jaundice and right upper quadrant pain ➡️ ultrasound.

❗️ First-line, non-invasive cholangiography ➡️ MRCP.

❗️ Determination of the patency of the intra- and extrahepatic biliary system ➡️ HIDA scan.

❗️ most common cause of portal hypertension ➡️ cirrhosis.

❗️ most common site for variceal bleeding ➡️ lower oesophagus.

❗️ most common CA associated with Primary sclerosing cholangitis ➡️ cholangiocarcinoma.

❗️ most common bacteria linked to ascending cholangitis ➡️ Escherichia coli.

❗️ most common predisposing factor to ascending cholangitis ➡️ Biliary stone disease.

❗️ most common source of Liver abscess ➡️ Biliary tract pathology.

❗️ most common benign liver lesions ➡️ Haemangiomas.

❗️ most common primary liver cancer ➡️ hepatocellular carcinoma.

❗️ most commonly injured intra-abdominal organ ➡️ spleen.

❗️ most common organism causing Schistosomiasis splenomegaly ➡️ Schistosoma mansoni.

❗️ most common benign tumour of the spleen ➡️ Haemangiomas.

❗️ most common cause of neoplastic enlargement of spleen ➡️ lymphoma.

❗️ Splenomegaly : spleen has to enlarge threefold before it is palpable.

❗️ Hypersplenism = Splenomegaly + (anaemia, leukopenia or thrombocytopenia) + compensatory bone marrow hyperplasia + improvement after splenectomy.

❗️Papillary thyroid carcinoma is the most common.
❗️Medullary carcinoma originates from the C-cells.
❗️Anaplastic carcinoma is the least common.

? A 70-year-old man presents with ❗️constipation and ❗️confusion. His ❗️serum calcium is 3.7 mmol/L and his ❗️phosphate is 0.5 mmol/L.  Dx  ➡️  Primary hyperparathyroidism.

? A 40-year-old banker attends a well-man clinic. His serum calcium is 2.9 mmol/L and his phosphate is 0.8 mmol/L. His PTH levels are 9 pmol/L. The ❗️urine calcium creatinine ratio is very low.  Dx  ➡️   Familial hypocalciuric hypocalcaemia.

? A young woman underwent a ❗️thyroidectomy for a large multinodular goitre. 8 hours after the operation, she developed ❗️tingling and numbness around her mouth.  Dx  ➡️Hypoparathyroidism.

? A middle-aged woman presents with a long-standing goitre. She is clinically euthyroid.  Dx  ➡️  Multinodular goitre.

? A young woman presents with a firm enlarged ❗️goitre with ❗️bruit. She complains of symptoms suggestive of ❗️hyperthyroidism.  DX  ➡️  Graves’ disease.

? Follicular carcinoma of the thyroid is the second most common after papillary carcinoma. It
arises later in life and is prone to bloodborne metastasis. Secondaries to the lung are the most
common cause of death.

? An ❗️82-year-old woman presents with a thyroid nodule, weight loss, backache and
hypercalcaemia.  Dx  ➡️  Anaplastic carcinoma

? An elderly woman with previous history of ❗️Hashimoto’s thyroiditis presents with an irregular, hard nodule in her right thyroid lobe.  Dx  ➡️  lymphoma.

? A 28-year-old has a ❗️parathyroid adenoma and ❗️elevated levels of calcitonin.  Dx  ➡️  Medullary Carcinoma.

? A 12-year-old boy presents with a nodule and regional lymph node enlargement.  Dx  ➡️  Papillary Carcinoma.

?A 35-year-old man complains of ❗️vague abdominal pains associated with ❗️bone pains and periodical nausea. He was on dialysis since the age of 22 for 10 years, after which he received a ❗️❗️renal transplant which has been successful so far. On examination he has a fistula in his forearm and a transverse lower abdominal scar.  Dx  ➡️   Tertiary hyperparathyroidism.

? A 58-year-old man complains of a general feeling of ill health for several months for which he did not bother to seek medical advice. Recently, however, he has developed❗️ abdominal pain radiating to the back. Three years ago he had a proved attack of ❗️right ureteric colic for which no further treatment was necessary after the stone passed spontaneously.  Dx  ➡️   primay hyperparathyroidism.

? A 52-year-old woman complains of ❗️pain in the bones of her hands and feet, pruritis and muscle weakness resulting in reduced mobility. This has become worse recently. She has suffered from ❗️❗️chronic renal failure for which she has been on haemodialysis for 5 years.  Dx  ➡️   secondary hyperparathyroidism.

?A 55-year-old man with a ❗️long history of duodenal ulcer presents with intermittent ❗️projectile vomiting for 4 weeks. The vomitus contains ❗️stale food and is ❗️nonbilious. He is dehydrated, with a visible gastric peristalsis and succussion splash.  Dx  ➡️  Tetany from gastric outlet obstruction.

#endocrine

?A worried ❗️23-year-old woman, who started taking ❗️the combined contraceptive pill 3 months ago, presents with a 1-day history of discovering a ❗️painless lump in the right breast. The patient states that the lump was ❗️not there a month ago. On examination, a ❗️slightly mobile, discrete, ❗️well-defined, ❗️non-tender, ❗️firm 1 cm diameter lump is found. There is ❗️no lymphadenopathy.  Dx  ➡️  Fibroadenoma.

? A 36-year-old nulliparous woman attends your clinic with a 7-day history of left ❗️breast pain after being involved in a❗️car accident. On examining her breast, you notice a hard, irregular 3 cm, immobile, tender lump. You also notice some skin tethering and overlying bruising in the region of the lump. Ultrasound features suggest a benign pathology.  Dx  ➡️  Fat necrosis.

? A 33-year-old, non-smoking, ❗️breastfeeding woman is ❗️10 days postpartum. She has a 4-day history of a slight ❗️crack on the surface of her left nipple. She presents with a 2-day history of ❗️severe continuous pain in the left breast, ❗️spiking pyrexia up to 38.8 with ❗️rigours which has prevented her from sleeping. On examination, you find the outer quadrants of the left breast to be red, warm and tender with a ❗️hard 3 cm lump at the edge of the left nipple.  Dx ➡️  Breast abscess.

? A ❗️65-year-old nulliparous woman presents to your clinic with a ❗️lump in her left breast, which was discovered 7 months ago. On examination you find a ❗️hard, ill-defined, non-tender, 3.5 cm lump behind the left nipple. The patient has also had ❗️bloody, non-purulent discharge from a single duct on the left nipple for over 3 months.  Dx  ➡️  Breast CA.

? 47-year-old perimenopausal woman presents with a 3-week history of ❗️green discharge from the right nipple. On examination, the right nipple is non-tender, has a ❗️‘slit-like’ appearance and is retracted.  Dx  ➡️  Mammary duct ectasia.

?A 67-year-old woman, with a 25-year smoking history, on hormone replace ment therapy, presents to clinic expressing concerns regarding an increase in the size of her right breast over the last 4 months. On examination, you find a ❗️non-tender, mobile, lobulated ❗️10 cm mass with relatively smooth edges in the right breast. The right breast is significantly larger than the left and has a ❗️‘teardrop’ appearance and the skin looks normal.  Dx  ➡️  Malignant phylloides tumour.

? A worried 59-year-old city worker arrives at your clinic with a 1-month history of having noticed a ❗️non-itchy, persistent, ❗️burning rash in the region of her right breast. On examination, you find the right nipple and the skin overlying the areola to be ❗️red and ❗️eczematous.  Dx  ➡️  Paget's disease of the nipple.

? A ❗️21-year-old nulliparous woman presents to your clinic with a 1-month history of ❗️bilateral breast pain. The pain, which is dull and achy in nature, is poorly localized and widespread across both breasts. The pain gradually ❗️increases in severity and is ❗️worse just ❗️before her menses. The pain usually starts to ❗️get better once her menses start. On examination, both breasts are tender. There are no lumps, skin changes or obvious swellings.  Dx  ➡️  Cyclical mastalgia.

? A ❗️58-year-old postmenopausal woman has been seen in clinic following discovery of a ❗️3 cm, non-tender, irregular, firm lump in the ❗️upper outer quadrant of the left breast. ❗️Mammography and ❗️ultrasound imaging respectively reveal that the lump has areas of ❗️calcification and is a solid mass.  next step  ➡️  core biopsy.

#breast

rectum ..

pancreas ..

gallbladder

primary & secondary survey ?