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Medicine > 3rd Yr Surg > Flashcards

3rd Yr Surg Flashcards

1
Q

Anticoagulant Reversal:
Heparin
Warfarin (Raised INR, Bleeding)

A

Heparin: Protamine Sulphate

Warfarin:
Raised INR (5-8), No bleeding: Reduce Dose
Raised INR (> 8): PO Vitamin K
Bleeding: IV Vitamin K
Major Bleeding/Emergency: Prothrombin Complex (Beriplex)

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2
Q 
Transfusion Reactions + Features:
Overload
Acute Lung Injury
Non-Haem Febrile React
Acute Haem Febrile React
A

Overload:
Pulmon Oedema => SOB

Acute Lung Injury:
Inflamm => Pleural Effusion (+ New Infiltrates on CXR)

Non-haemolytic Febrile React:
Cytokines => Fever + Rigors

Acute Haem Febrile React:
Immune Response => Fever
Haemolysis => TachyC + HypoT

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3
Q 
Types of Hernias + Mx:
Femoral
Hiatus
Inguinal
Umbilical
A

Femoral (Inf + Lat):
Surg

Hiatus (Stomach -> LOS):
Reduce Weight
Alignates, PPi (Reduce Reflux)
Metocloperamide (Increase motility)
Nissens Procedure

Inguinal (Sup + Med):
Watch + Wait (+/- Surg)

Umbilical (< 3yo):
(If non-reducible by 3yo: Surg)

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4
Q

Post-Op Pneumonia Mx

A

Appropriate Analgesia + Early Chest Physio
Ciprofloxacin
(If Asp: Metronidazole)

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5
Q

Acute Pancreatitis Scoring

A 
Glasgow Score:
P: pO2 < 8KPa
A: Age > 55yo
N: Neutrophillia (WCC > 15)
C: Ca2+ < 2mmol
R: Renal (Urea > 16mmol)
E: Enzymes (LDH > 600)
A: Albumin < 32g/L
S: Sugar (Glu > 10mmol)
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6
Q

Causes of SBO + LBO

A 
SBO:
Adhesions
Hernias
Volvulus
CD

LBO:
Cancer
Diverticular D
Volvulus

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7
Q

Mx of Bowel Obstruct

Indications for Surg

A 
NBM
IV Fluids (Correct electrolyte disturbance) w/ Catheter
NGT (Decompress GI tract)
Analgesia + Antiemetic
(If Volvulus: Colonoscopy)

Surg (> 48hrs, Ischaemia/Perf, Reversible - Strangulated Hernia/Tumour)

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8
Q

Diverticular D Types + Features

A

Painful:
Intermittent LIF pain +/- IBS Sx

Acute:
Colicky LIF pain, IBS Sx, Fever

Bleeding:
Dark, Clotted blood (Spontaneous)
(Few/No Prodromal Sx)

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9
Q

Diverticular D Mx

A

Clear, liquid diet for 72hrs
IV Fluids
IV ABx
(Surg: Excision + => End Colostomy)

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10
Q

Ischaemic Colitis Sx - 6

A 
Lower Abdo pain
N+V
Bloody Diarrh
Tenderness, Guarding
Pyrexia
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11
Q

Ischaemic Colitis Ix

A 
Raised WCC
Ba Swallow (Thumbprinting: Submucosal Oedema)
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12
Q

Ischaemic Colitis Mx +/- Complication

A

NBM (Bowel Rest)
IV Fluids
(If Perf: Surg resection + Colostomy formation)

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13
Q

AAA Screening

A

All males > 65yo: (USS):

If < 3cm: No f/up required
If > 3cm: Annual screen
If > 4.5cm: 3 monthly screen
If > 5.5cm, Increase in > 0.5cm in 6 months: Urgent Surg
If Rupture: Emergency Surg
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14
Q

AAA Mx

A

If < 3cm: Annual f/up

If > 4cm: 3 monthly USS

If > 5.5cm, Increase in 0.5cm in 6 months: Surg

If Rupture: Emergency Repair

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15
Q

Def Claudication + Critical Limb Ischaemia

A

Claudication: Intermittent Limb pain

Critical Limb Ischaemia: Rest Pain

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16
Q

Critical Limb Ischaemia Types + Features

A

Embolus:
Acute, profound Pain (No Collaterals)
Contralat Pulse normal, No Claudication Hx

Thrombus:
Gradual Pain (Collaterals form)
Contralat Pulse weak, Claudication Hx

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17
Q

Critical Limb Ischaemia Ex

A

Pulseless, Pallor, Perishingly cold (Time for Initial Ix)
Pain, Paraesthesia, Paralysis (Immediate Mx Req)
Petechia/Fixed mottling (Irreversible)

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18
Q

Critical Limb Ischaemia Mx

A

ABCDE (O2, IV Fluids, Opiates)
5000 Units UFHep
(If Increasing Press/Pain: Fasciotomy - Prevent Compartment Synd)

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19
Q

Lap Cholecystectomy Complications

A 
-> Open procedure
Common Bile Duct Injury
Bile Leak
Intra-abdominal Haem
Fail (Retained Stones)
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20
Q

Causes of Jaundice Post-cholecystectomy:
Pre-hepatic
Hepatic
Post-hepatic

A

Pre-hepatic:
Haemolysis after Transfusions

Hepatic:
Halogenated Anaesthetics

Post-hepatic:
Ligation of CBD/CHD, Thermal Injury, Biliary Sepsis, Gallstone Retention

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21
Q

Hernioplasty Complications:
Early - 4
Late - 3

A

Early:
Urinary Retention, Haematoma, Inf, Injury

Late:
Ischaemic Orchitis (Thrombosis), Chronic Groin Pain/Paraesthesia, Recurrence
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22
Q

Hernioplasty Post-op Care

A 
Day Cases (Unless comorbidity)
Discharge w/ Mild Analgesia + Laxative
Return to work after 1wk
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23
Q

Nissens Fundoplication Purpose + Complications

A

Purpose: Repair LOS + Prevent Reflux/Hernia

Gas-bloat Synd (Inability to Belch or Vomit)
Dysphagia

24
Q

Appendicectomy Complications

A

Abscess formation, Rupture (+/- => Peritonitis), -> R Hemicolectomy

25
Q

Gastrectomy Complications:
Physical - 2
Metabolic - 2

A 
Weight loss (Early satiety/Loss of Appetite, Reduced Intake, Malabsorption, Vomiting/Diarrh)
Reflux, Bilious Vom
Vit Def (Lack of SB: Folate/Fe, Lack of Parietal Cells: B12)
Mineral Def (Lack of Ca2+) => Osteoporosis
26
Q

AAA Repair Complications:
Open
EVAR

A

MI, VTE
Renal Fail
Spinal/Mesenteric Ischaemia

Open: Graft Inf
EVAR: Graft Migration/Stenosis, Aneurysmal Leak (Endoleak)

27
Q

Carotid Endarterectomy Complications

A

MI, Stroke (Death w/in 1 month)
Haem => Haematoma
Hypoglossal N Damage (Fasciculations + Deviation Ipsilaterally)

28
Q

Bypass Graft Indications

A

Rest Pain
Very Short Claudication distance (< 100m)
Sx affecting patients QoL

29
Q

Bypass Grafts Complications

A

Haematoma
Distal Embolism
Thrombosis

30
Q

TURP Indication

A

Failed Med Tx for BPH

31
Q

TURP Complications:
Immediate - 3
Early - 2
Late - 3

A 
Immediate:
TUR Synd (Absorption of Fluids => Hypo-Na+), Haem, Inj

Early: Inf, Clot Retention/VTE

Late:
Retrograde Ejaculation, ED, Incontinence
Urethral Stricture (=> LUTSx)
Recurrence

32
Q

Surgery Complications:
Immediate - 3
Early - 6
Late - 4

A

Immediate (< 24hrs):
Surg Trauma, Intubation (=> Oropharyngeal Trauma), Primary Haem

Early (1 day - 1 month):
Secondary Haem, VTE
Urinary Retention, Constipation
Atelectasis, Pneumonia
Wound Inf (+ Abscess), Dehiscence (Anastomotic leak/Hernia)
ABx-associated Colitis (C Diff)

Late (> 1month):
Scarring, Adhesions (=> Obstruct), Neuropathy, Failure/Recurrence

33
Q

Laparoscopic vs Open Surg Advantages - 4

A

Reduced Pain
Reduced Complications (Wound Inf, Bleeding)
Quicker recovery

34
Q

Laparoscopic vs Open Surg Disadvantages - 4

A

Technically Challenging
Longer
More Expensive
Not amenable to all Surg

35
Q

Pre-op Medication changes
Stop - 5
Continue - 8

A 
Stop:
Anti-platelets, Anti-coags
COCP/HRT
K+ sparing (ACEi/ARB, Spironolactone)
PO DM meds
Lithium
Continue:
Inhalers
Steroids
AEDs
Cardiac meds (Beta-blockers, Statins)
Aspirin
PPi’s
Thyroid meds
Immunosupp meds
36
Q

Stoma Complications
Early - 3
Late - 4

A

Early:
Haem, High Output (=> Hypokalaemia), Psychological problems

Late:
Obstruct, Dermatitis (esp Ileostomy), Stoma Prolapse/Intusussception, Stenosis

37
Q

Healing Patho

A

Reactive (Haematoma):
Blood clot forms (Capillaries invade => Granulation Tissue)

Reparative:
Fibrocallous (Cartilage) secreted by Chondroblasts
Osteoblasts (Endochondrial Ossification) => Bony Callous

Remodelling:
Osteoclasts remove excess bone tissue (In response to Stress)

38
Q

Primary vs Secondary Bone Healing

A

Primary: (Aim of Int Fixation):
Well-opposed fragments (No bony Callus forms)

Secondary: (May require traction):
Formation of Callus (Less opposed)

39
Q

Radius # Mx

A

Closed Reduction + Cast 4wks

If Unstable: ORIF

40
Q

Scaphoid # Mx

A

Scaphoid cast 8-12wks

If displaced: ORIF

41
Q

Ankle # Classification

A

Weber:
A: Below Syndesmoses
B: At level Syndesmoses
C: Above Syndesmoses

42
Q

Ankle # Mx

A

Cast 6wks

If Unstable, Displaced/Talar shift, Open, Multi-malleolar: ORIF

43
Q

Tibial # Mx

A

Plaster of Paris

If Open/Unstable: Surg

44
Q

NOF # Mx

A

Analgesia, IV Fluid Resus
(Bisphosphonates + Adcal-D3)
LMWHep

Intracapsular:
Young + Fit: Cannulated Screws
Old + Mobile: THR
Old + Immobile: Hemiarthroplasty

Intertrochanteric: Dynamic Hip Screw
Extracapsular: Intramedullary Nails

45
Q

Back Pain Red Flags - 10

A 
Age < 20yo, > 55yo
Weight Loss, Fever, Night Sweats
Recent Trauma
Non-mechanical/Inflamm (Improves w/ Act)
Motor/Sens loss
Bladder/Bowel Impairment
Sexual Dysfunction
Saddle Paraesthesia
Steroid Use
Previous Malig, HIV
46
Q

Cauda Equina Mx

A

Urgent Referral for Surg decompression (w/in 48hrs)

47
Q

OA Mx:
Conservative
Med
Surg

A

Conservative:
Education, Reduce BMI, Exercise (+/- Physio)
Walking aids, Hot/Cold compress, OT

Med:
NSAIDs, Paracetamol, Codeine

Surg:
Joint Replacement
Joint Fusion (Younger Pt’s)
48
Q

Osteoporosis Mx

A 
Dietary Advice (Ca2+, Vit D)
Exposure to sunlight
Bisphosphonates (Alendronate)
Weight-bearing exercises
OT (Frailty Assess, Fall prevention, Hazard-free Home)
49
Q 
Ca2+, PO4(2-), ALP, PTH:
Osteoporosis
Primary Hyper-PTH
Secondary Hyper-PTH
Pagets D
Osteomalacia
Osteopetrosis
A

Osteoporosis: Normal

Primary Hyper-PTH: Increased PTH, ALP, Ca2+, Decreased PO4(2-)

Secondary Hyper-PTH: Decreased Ca2+, Increased PTH, ALP, PO4(2-)

Pagets D (Increased Bone Turnover): Increased ALP

Osteomalacia (Hypomineralisation): Decreased Ca2+, PO4(2-), Increased PTH, ALP

Osteopetrosis (Hypermineralisation): Normal

50
Q

Open #’s Classification

A

Gustilo-Anderson
I: < 1cm
II: 1-10cm
IIIa: > 10cm (w/ adequate soft tissue cover)
IIIb: > 10cm (w/ Inadequate soft tissue cover) - Requires Plastic Input
IIIc: Vascular Inj - Requires Vascular Input

51
Q

Hypermobility Scoring - 5

A 
Beighton:
Elbow Hyperextension
Knee Hyperextension
Thumb to Forearm
Little finger Extends > 90
Both palms on ground from standing
52
Q

Dupuytrens Contracture Patho

A

Fibrosis of Palmar Aponeurosis => Painless Contraction

53
Q

Dupuytrens Contracture Mx

A

Surg excision of Palmar Aponeurosis: Fasciectomy

54
Q

Clavicle # Mx

A

Rest + Supportive Sling

If Open, Neurovascular compromise, Floating Shoulder: Surg

55
Q

Atherosclerosis Patho

A

Endothelial Injury: (HT, Hyperlipid, Turbulent Blood flow)

Chronic Inflamm: (Lipid-laden Foam cells prod GF/Cytokines/ROS => Lymphocyte + SM Infiltration)

SM Proliferation: (Fatty streak -> Atherosclerotic Plaque)

56
Q

Mx

A

Manual reduction (w/ Anaesthetic)
Immobilisation
F/up PT

Medicine (13 decks)

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