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Medicine > 00 Surgical F1 > Flashcards

00 Surgical F1 Flashcards

1
Q

Estrogen OCP and HRT

Stop x weeks pre op

A

4 weeks preop

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2
Q

Contraindications gentamicin

A

Allergy
Myasthenia gravis
Renal impairment:
- caution eGFR

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3
Q

Before giving Tazocin

Ask

A

Penicillin allergy

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4
Q

Gentamicin dose

And max dose

A

5mg/ kg OD

Max 520mg

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5
Q

Dosing gentamicin

60

A 
Blood: eGFR 
5mg/kg OD: 1st dose
Pre dose level (20-24h)
Give 2nd dose w/o result
Dose level 1mg/L 
- withhold next dose 
- recheck level 12-24h later
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6
Q

Gentamicin dose level
Toxicity
V
Therapeutic

A

Toxic > 1mg/L

Therapeutic

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7
Q

Oramorph dose

A

10-20mg every 4h PO

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8
Q

Prescribing b blocker ask

A

Asthma?
PVD?
Low BP

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9
Q

Drinks that effect warfarin

A

Increase INR

  • cranberry, grapefruit juice
  • binge drinking EtOH
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10
Q

NBM rules

Elective surgery

A

No food from midnight
No food 2h
NBM

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11
Q

1 stone = x kg

A

6.35kg

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12
Q

RIFLE classification

A 
Risk: creatinine x1.5
Injury: creatinine x2
Failure: x3
Loss: RF> 4w
ESRF
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13
Q

Excessive N saline causes

A

Hyperchloraemic metabolic acidosis

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14
Q

Sentinel loop

A

Localised loop of bowel ileus

Associated abdo inflx: eg pancreatitis

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15
Q

Chemo for Colon Ca

A

Oxaliplatin

- SE neuropathy

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16
Q

Tx external rectal prolapse

A

Abdominal procedure
- rectopexy

Perineal procedure
- delormes

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17
Q

Ileus
V
Pseudo Ob

A

Ileus: SB
V
Pseudo Ob: large bowel

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18
Q

Intra abdominal air dissipates x time post op

A

48-72h post op

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19
Q

Proximal stomach Ca tx

A

Oesphagogastrectomy:
- Ca involving OGJ
Total gastrectomy

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20
Q

Colonic bleeding

A

Acute: endoscopy rarely helpful
Proctosigmoidoscopy ? Haemorrhoids

Unstable Pt
- angiogram CT: angio dysplasia bleeding point

Stable - elective colonoscopy

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21
Q

UC pt flair failed medical management

Tx

A

Subtotal colectomy

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22
Q

Groin lump Qs

A

Cough impulse
Pulsation and Expansile: true aneurysm
Both testes in scrotum?
Distal infx

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23
Q

Post op ? Bile duct injury

Tx

A

ERCP + stent

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24
Q

X% diverticulitis bleeds settle with conservative management in what time

A

70% in 24-48h

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25
Q

Diverticula bleeds characteristically…

A

Large volume dark red blood

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26
Q

Chronic Hep and cirrhosis Pt

Regular Ix

A

Serum AFP and liver USS
Every 6-12m

Ix nodules via MRI

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27
Q

Psoas abscess types

A

Primary: immunodepressed

Secondary: abdo ds: eg Crohns

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28
Q

Phelgmon

A

Walled off inflx mass
Without infx
May be palpable

29
Q

AXR sign toxic mega colon

A

LBO and thumb printing

30
Q

AXR can show

A

Obstruction
Sentinel loops
Perforation
Signs IBD

31
Q

EMR

A

Endoscopic mucosal resection

- for small areas Ca

32
Q

R hemi colectomy

Anastomsis

A

Ileocolic anastomoses

Low risk leak

33
Q

Ivor Lewis owsphagectomy

Anastomoses

A

Oesphagogastric
- high mortality
Cause mediastinitis

34
Q

L sided lesion Tx

A

L subtotal colectomy & anastomoses
L hemi and anastomisis
L hemi and colostomy
Colonic stent

35
Q

Recto sigmoid lesion

Tx

A

(Below peritoneal reflection)
Loop colostomy
High anterior resection

36
Q

Ileal resection

A

Crohns ds
Comp post op diarrhoea
- tx cholestyramine

37
Q

Risks of ERCP

A 
Injury to teeth
Bleeding
Perforation
Infx: cholangitis
Pancreatitis
Failure of procedure
38
Q

Ix

Rectal anastomotic leak

A

Gastrograffin enema

39
Q

Ix

Abscess

A

CT scan

40
Q

Ix

Anastomotic leak

A

Ct scan? Contrast?

41
Q

Ix

DVT

A

Doppler USS

42
Q

High dose analgesia
Morphine
Oxycodone
Fentanyl

A

Morphine > 40mg IV
Oxycodone > 40mg IV
Fentanyl > 300mcg IV

43
Q

NSAID contraindications

A 
Asthma
Ulcers
Renal failure: check U&E
Heart failure
Over 70
Other anticoagulants
44
Q

GI surgery rehiring prophylactic Abx

A 
Stomach and esophagus
Open biliary surgery
Resection: colon rectum
Appendicectomy
ERCP
Percutaneous endoscopic gastrostomy/ jejunostomy
45
Q

Surgical tx

Acute cholecystitis

A

Acute laparoscopic cholecystectomy

After 48-72h
- Abx & delayed cholecystectomy

46
Q

Drainage of pancreatic pseudo cyst

Via

A

Cystogatrostomy

47
Q

Low rectal Ca tx

A

APER

Abdomino perineal excision rectum

48
Q

Cholecystectomy incision

A

Kochers: R sub costal margin

49
Q

Appendix abscess

Sx

A

High fever
D&V
Pelvic pus is an irritant to rectum causing diarrhoea

50
Q

Decompress biliary tree via

A

ERCP

51
Q

TAP

A

Transversus abdominal plane block

  • bupivicaine via USS
  • use in extensive laparoscopic surgery
52
Q

Drains

A

Redivac: suction
Latex t tube
Low pressure drain
Corrugated drain

53
Q

Dysfunction anastomoses for low anterior resection with

A

Loop ileostomy

54
Q

Subtotal colectomy
Emergency
V
Elective

A

Emergency: end ileostomy
V
Elective: iliocolic anastomosis

55
Q

Mnemonic Rockall score

A 
ABCDE
Age
Blood pressure drop (shock)
Comorbidity
Diagnosis 
Evidence of bleeding
56
Q

Cause of pseudo ob

A

Electrolyte imbalance

57
Q

Tx pseudo ob

A

Supportive: correct electrolytes
Colonoscopic decompression
Neostigmine
Rarely surgery

58
Q

Ix pseudo ob

A

AXR + contrast enema

59
Q

Gastrograffin
V
Barium

A

Gastrograffin: leak
V
Barium: risk aspiration

60
Q

Cause mesenteric vein thrombosis

A

Thrombophilia ~60%

61
Q

Transfusion related lung injury

Cause

A

Plasma concentrates transfusion

  • micro vascular damage
  • diffuse CXR infiltrates
  • mortality is high
62
Q

Early signs abdo dihiscence

A

Seepage of serosanguinous fluid

  • remove superficial sutures
  • explore wound
  • theatre for closure
63
Q

High K

ECG changes

A

Peaked T waves
Loss p waves
Wide QRS

64
Q

Timing for burst abdomen

Post op

A

6d

65
Q

Bowel prep

Esp L sided surgery

A

Phosphate enema
Or
Oral laxative eg picolax

66
Q

Inguinal hernia strangulation risk

A

3% per year

More common with indirect hernias

67
Q

Causes post op pyrexia

A 
Anastomotic leak
Wind: atelectasis, infx
Wound infx
Water infx
Wonder where: abscess, central line sepsis
68
Q

Hartmann’s procedure =

A

Sigmoid resection
&
End colostomy

69
Q

Diversion proctitis

A

Rectal bleeding + pus

Post end colostomy

Medicine (20 decks)

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