Today we covered some key areas in surgery for the acem exam.

Mesenteric ischemia
The 4 key patterns of presentation include
embolic – AF or ventricular aneurysm related – 50% of all MI
low flow states
venous thrombosis
each of these have a specific risk factor profile which are distinct
recognising aetiology, sensitive or specific findings on clinical assessment, and diagnosis on CTA is important, as well as severity grading or assessment of complications such as infarction and organ failure is key.
Management options of
laparotomy for bowel resection or
​vs angiography for clot retrieval or local papaverine is considered

diagnostic criteria – 2 of 3 – lipase Elevation, clinical features, imaging findings
classification -oedematous vs necrotic
severity assessment – based on organ failure
prognostic scores : be ale to compare and contrast
– BISAP – renal function, effusion, gcs, sirs, 60 yo
ransons, apache, sirs,
have some knowledge of imaging of the pancreas

Toxic megacolon was covered in detail, reviewing the 2 common presentations from IBD or clostridium difficile. Imaging diagnosis of tvs colon > 6 cm and
diagnostic criteria including systemic illness and anaemia, wcc elevation, sirs
the treatment options varied with underlying cause
associations of metabolic alkalosis, hypokalaemia, dysmotility agents

Clostridial infecting and predictors or risk factors for clostridial such as antibiotic use, COPD, hospital admission were discussed in detail.

Lastly we covered MCQ golden rules:

read the question
assess if you have the knowledge in an area, or not
your gut feeling is only good if you have reviewed the area concerned
always study the topic highlighted in the mcq
know why an option is correct and why incorrect

good resources for MCQ:

de Alwis Emergency medicine mcq
Dunn mcq’s / Tintinalli mcq’s
​emcee practice