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AS / OS Paces RT > Abdo vivas > Flashcards

Abdo vivas Flashcards

1
Q

signs of chronic liver diseae

A 
clubbing
leukonychia
palmar erythema
D contract
jaudnice
spider naevi
gynaecomastia
loss of ax hair
caput medusae 
hepmegaly if not cirrhotic 
splenomegaly 
ascites
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2
Q

signs of cause of CLD

A

black ethnicity - saroidosis more likely

slate grey skin + diabetes = haemochormatosis

track marks - hep C

xanthelasma - PBC

goitre / middle aged female - autoimmune

emphysema - A1AT deficiency

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3
Q

signs of decompensation in lvier disaes

A

flapping tremor + confusion = enceph

jaundice, ascites

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4
Q

signs of kidney transplant o/e

A

old AV fistula
Rutherford Morrison scar
smooth mass underlying scar in IF

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5
Q

signs of cause of renal failure + need for kidney transplant

A

cap glucose moniotring marks = daibets

hearing aid - Alport

collapsed nasal bridge = Gwith PA

buttefly rash SLE
sternotomy - vascular

flank masses - PKD

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6
Q

evidence of poor functioning kidney

A

uraemia - itching, flap

pale - aneamia

retaining fluid

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7
Q

complications of immunosuppression o/e

A

tremor (calcineurin x), cushingoid/brusing (Steroids), skin lesions (ca)

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8
Q

signs of cause of hepatomegaly o/e

A

signs of CLD

raised LNs - malignancy

peripheral oedema / JVP - heart faiure

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9
Q

signs of splenomegaly cause o/e

A

hand deformity (RA/ Felty’s )

signs of CLD

pallor (leuk,lympho, hameolysis, myeloproflif)

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10
Q

polycystic kidneys o/e

A 
AV fistula
HTN
pale conjunctiva
flank scar
bilateral ballotable flnk masses
hepmeg
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11
Q

signs of liver transplant o/e

A

signs of CLD

Mercedes Benz scar

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12
Q

signs of cause for liver transplant

A

black ethnicity - saroidosis more likely

slate grey skin + diabetes = haemochormatosis

track marks - hep C

xanthelasma - PBC

goitre / middle aged female - autoimmune

emphysema - A1AT deficiency

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13
Q

combined kidney pancreas transplant o/e

A

LIF sar
RIF scar
smooth mass under LIF scar

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14
Q

signs of diabetic complicaions

A

visual aids, Charcot joints
toe ulcers
amputations
neuroapthy

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15
Q

previous renal replacemnt therpay

A

AV fistula
central line scars
peritoneal dialysis scars

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16
Q

polycythaemia rubra vera o/e

A

dusky cyanosis
HTN
facial plethora
splenomegaly

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17
Q

hereditary spherocytosis o/e

A

pale conj
mild jaundice
splenomegaly

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18
Q

primary biliary cirrhosis o/e

A 
middle aged female
jaundice
hyperpigmented 
excoriations
xanthelasma
hepatomegaly
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19
Q

top 4 causes of end stage renal failure

A
  1. Diabetes 2. HTN 3. GN 4. PKD
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20
Q

PR exam summary

A

lie left lateral. Check for blood, fistula, fissures, warts, piles, prolapse. Comment on tone, prostate, bowel, faeces. Ind – constipation, retention, masses

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21
Q

hernia examination

A

examine standing up. Palpate scrotum, inguinal region, compress lump + cough, deep inguinal ring mid ASIS+tubercle -> reduce into deep ring ask to cough, see if reappears. Direct if so, if not indirect. Hand off – hernia projects straight forward if direct and slides obliquely if indirect. Percuss/ausc.

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22
Q

inguinal hernia direct vs indirect

A

direct = superior to PT, herniates through superficial ring. Indirect = between deep ring + scrotum. Can be contained.

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23
Q

femoral hernia o;e

A

always inferior and lateral to pubic tubercle. Less common

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24
Q

testicular exmiantino

A

stand up, examine side on. Inspect all over. Palpate testes, epididymis, spermatic cord. If pain relieved by elevation – epididymitis, if not think of torsion. Absent cremasteric reflex in torsion usually. Check SCL nodes.

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25
Q

hydrocoele

A

– fluid around testicles. Young – patent proceccus vaginalis. Old may be smaller and secondary to tumour/trauma/inf. US testicle and sac repair.

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26
Q

varicocoele

A

dilated venous plexus in scrotum ‘bag of worms’ feel. Dull ache. Left sided commoner. Can have surg to clip vein.

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27
Q

epididymal cyst

A

– separate, fluid-filled sac above epididymis

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28
Q

testicular tumour o/e

A

hard irregular lump, inseparable from testicle

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29
Q

inguinoscrotal hernia

A

can’t get above on palpation

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30
Q

epididymitis

A

pain, swelling at back of T. may be STI or UTI bugs. Systemically unwell. Give abx. Drain any abscess.

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31
Q

testicular torsion

A

– painful, high-riding testicle with horizontal lie. V painful + swollen. Usually young with trauma/exercise hx. Surgical emergency. Senior + NBM.

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32
Q

abdo scars

A

Abdo scars – Kocher RUQ (Gallbladder ops), Loin (renal ops), Mercedes Benz / Rooftop (liver transplant, upper GI surgery), midline lap, paramedian (spleen, kidney, adrenal), RIF/LIF (stoma sites), Pfannenstiel (c section, pelvic surgery), Lanz or McBurney (appendix), Rutherford Morrison – longer McB = kidney transplant, bowel surgery) also may see laparoscopic port scars

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33
Q

renal dialysis summary (indications, types, complications)

A

Renal dialysis – maintains electrolytes and removes plasma waste products. AKI indications = Acidosis Electro abnorm Intoxicants Overload Uraemia, CKD when eGFR <15ml/min. CKD = haemodialysis / peritoneal AKI = haemodialysis / haemo – filtration. Complications – headache, itch, muscle cramps, disequilibrium syndro (cerebral oedema from osmotic chng), low BP, haemolysis + hyperK, sepsis.

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34
Q

haemodialysis details (incl access)

A

AV fistula + either a tunnelled central venous catheter (stays for months) or non tunnelled (10 days)

blood taken from vein, pumped along semi permeable membrane, dialysate fluid pumped in oppo direction on other side. toxins diffuse out over gradient.

conventional - 4hrs, 3x weekly
short daily - 2 hrs /day
noctural - 6-8 hrs nightly 6 days a week

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35
Q

lifestyle modifications needed while on haemodialysis

A

fluid restrict, salt restrict, potassium restrict, phosphate restrict

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36
Q

peritoneal dialysis details

A

Peritoneal – Tenckhoff catheter. Continuous ambulatory (replace fluid bags 3-5 x daily or automated overnight over 8-10 hrs. peritoneum acts as the membrane.

37
Q

haemofiltration why

A

used for more critically ill patients as less haemodynamic instability caused.

38
Q

AV fistula o/e

A

o/e -> location, any inflamm, collapsing as should on arm elevation, any collateral veins, any oedema or ischaemia/Steal syndrome. Normal thrill and easy compression. Occlude vein above + see art pulsation- normal.

can be in wrist, ACF, upper arm basilic vein

39
Q

venous stenosis of AV fistula

A

Venous stenosis – high pitched murmur, collateral veins, pulsatile vein w/out manoeuvre.

40
Q

AV fistula info

A

AV fistula info – 6 weeks to dilate vein. Distal needle – afferent needle, proximal needle= efferent (both in AV fistula).

41
Q

AV fistula cautions and complications

A

). Complications – thrombosis, v stenosis, aneurysm, infection, distal ischaemia (S syndro). Cautions – no bloods / cannula on AVF arm, no BP measure that side, keep clean, check daily

42
Q

why have an AV fistula over a CVC?

A

Why AVF over CVC – lower re-circulation a/efferent mingling, less infection, higher flow rate – more efficient filtration, less clotting.

43
Q

Tenckhoff catheter

A

catheter placed through abdo wall to access the peritoneum for dialysis.

always check for acute abdo / peritonism o/e.

either replace dialysate manually many times a day or auto repair auto replace overnight!

44
Q

complications of peritoneal dialysis

A

peritonitis, infection, constipation, pleural effusion, hernias, weight gain

but at home and can travel

45
Q

contraindications to peritoneal dialysis

A

adhesions (i.e. prev surgery), stoma, hernias, IBD

46
Q

kidney failure o/e basic summ

A

o/e look for cause, evidence of dialysis + if active/historic, signs of Isupp

47
Q

indications for renal transplant

A

Transplant ind – ESRF <15ml/min (diabetes, PKD, HTN, GN).

48
Q

contraind to renal tansplant

A

Contraind – cardiac/lung failure, liver disease, cancer, active inflamm.

49
Q

kidney transplant procedure

A

Procedure – pre op screen donor/recipient (HLA, x match, inf screen). Screen donor also with ultrasound, surgical bloods, urine tests. Donor kidney (loin scar) anastamosed with external iliac vein/artery

50
Q

post op renal transplant

A

Post op Isupp = pred, tacrolimus, myco mofetil.

pred + calcineurin inhibitor + antimetabolie

51
Q

complications kidney transplant

A

Complications – rejection (hyperacute – during op, acute – flu prodrome, reducing function + tenderness over many weeks, chronic – reducing func over years).

oppo infections, sepsis, EBV post tansplant lymphoprolif disorder, UTI, graft thrombosis

52
Q

kidney T prognosis

A

. Lasts up to 15 years. Prognostic factors for kidney – donor type/age, cold time.

53
Q

colostomy types

A

end or loop

end (either AP resection for low rectal tumours – permanent- or Hartmann’s procedure to resect rectosigmoid lesions + reverse once deflamed). Loop – loop of intact bowel brought out with 2 openings. Protects distal bowel i.e. if obstruction, palliative distal tumours, anastamosed lower down (reverse later).

54
Q

ileostomy types

A

end or loop

end – subtotal or total colectomy +/- reversal with anoileal join up later. Loop – protects anastomosis lower down or protects anus e.g. IBD/ca.

55
Q

urostomy

A

short piece of ileum removed + acts as bladder (after cystectomy).

56
Q

stoma complications

A

– early (high output >1L/day dehydrates and loses K+, retraction, ileus, ischaemia), late (parastomal hernia, prolapse, fistulae, malnutrition

57
Q

stoma care

A

) stoma care – stoma nurse expert, empty bag 2/3 full + irrigate / single-use bag, stays on in shower, first 2 months loads fluids/little fibre. Eat right to avoid block/diarr/odour

58
Q

hepatomegaly detailed summary of cause

A

malignancy (primary or secondary)

congestoin - RHF, BuddChiari hep vein clot

haem - lympohoma, leukaemia, myelofib

inf - EBV, viral hepatitis

anatomical -Riedel’s lobe

other - NAFLD, alcholic, sarcoid, amyloid, i.e.

alcoholics - splenomegaly more likley as cirrhotic shirnks

59
Q

splenomegaly detailed causes

A

infiltration - leukaemia, lymphoma, myeloprolif

increased function - extravascular haemolysis, infection response (malaria, EBV, HIV)

congestion - cirrhosis, splenic vein obstruction

60
Q

massive splenomeglay causes

A

CML

myelofibrosis, malaria

61
Q

hep splenomegaly

A

hepatosplenomegaly – chronic liver disease with portal HTN, haem (leuk,lympho, MPDs), inf (viral hep, CMV/EBV, malaria), infilt (amyloid, sarcoid)

62
Q

causeschronic liver disase

A

chronic liver disease – causes -> alcohol, NAFLD, viral cause, AI, haemochrom

63
Q

inv cause CLD

A

viral serology, AI screen, alpha fetoprotein, trans/ferritin, copper/caeruloplas, glucose/lipids, AAT, TTG, LFTs, abdo US/CT, biopsy

64
Q

manage and monitor CLD

A

Manage CLD – treat cause, optimise nutrition, stop drinking, 6 monthly FBC/LFT/alb/coag/afeto + USS, OGD every 3 years. Treat complic – varices (band, TIPS), ascites (spiro, low salt, fluid restrict), enceph (lactulose, rifamixin), coag (vit K). elastography grades cirrhosis.

65
Q

acute CLD complications x 3

A

decompensation
hepatorenal failure
spontaneous bacterial peritonitis

66
Q

acute decompensation nCLD

A

jaundice, ascites, enceph

causes: SBP, sepsis, dehyd/aki, upper gi bleed, constipation, drugs, HCC

treat cause, lactulose enemas, avoid sedaation

67
Q

hepatorenal failuer

A

worsening renal function in CLD with no other cause andno response to fluids

fluid balance and weihts, suspend diuretics + nephrotoxics, give human albuin solution and terlipressin

68
Q

SBP

A

septic with ascites

dx with asciitc tap

give IV abx, human albumin solution

69
Q

inguinal lig

A

ASIS to pubic tubercle

70
Q

deep inguinal ring location

A

midpoint of inguinal lig

superficial ring = just above pubic tubercle

71
Q

borders of inguinal canal

A

internal oblique roof

external oblique anterior

inguinal lig floor

transversalsis fascia posterior

72
Q

contents of inguinal canal

A

male - spermatic cord + ilioinguinal nerve

cord = 3 arteries, 3 nerves, 3 others

females = round ligament of uterus and ilioinuinal nerve

73
Q

femoral artery position vs deep inguinal ring position

A

fem artery= midpoint of ASIS and Symphysis

deep ring - midpoint of ASIS and tubercle (slightly lateral to symphisis)

74
Q

direct vs indirect inguinal hernia

A

direct - go through superficial ring, can’t be ontrolled by pressuring deep ring

indirect - runs down ing canal, can control with pressure over deep ring

75
Q

inguinal vs femoral hernia

A

femoral is inferior and lateral to pubic tubercle

direct inguinal is superior to pubic tubercle

indirect can occur anywhere between deep ring and scrotum

76
Q

open hernia repair

A

if irreducible obstructed or strnagled

77
Q

ddx groin lump

A

psoas abscess, femoral neurofibroma, ing LNs, fem aneurysm, hydrocoele of cord

78
Q

summarisse DDx of goitre

A

goitre 1. Grave’s 2. Multinodular goitre (Dx USS) 3. Physiological (pregnancy / puberty). Diffuse = simple (phsyiol/iodine), AI, infective+painful, iatro nodular = multinodular, toxic multinod (hyperT), solitary nodule (cyst/ca)

79
Q

complications of large goitre

A

compression symtoms

trachea - SOB
nerve - dysphonia
oesophageal - dysphagia
SVCO - facial swelling, dizzy, headache, blurred vision, syncope
pre gang Horner’s = ptosis, miosis, anhidroiss

80
Q

ACTH dependent Cushing’s

A 
Cush disease (tumour secreting ACTH)
ectopic ACTH (Lung ca)
81
Q

ACTH indpendent Cushing’

A

steroids
adrenal adenoma/ca
adrenal hyperplasia

82
Q

inv processes Cushing’s syndrome

A

dex suppression test (not suppressed)
24 hr urinary cortisol

plasma ACTH

if low - CT adrenals

if high - high dose test (ectopic not suppressed)

either CT thorax or MR pituitary after that

83
Q

management Cushing’s disease

A

metyrapone/ketoconazole for symptoms
resect tumours
remove adrenals if can’t find source

84
Q

manage acromegaly

A

IGF1 screening
no GH suppression during glucose tolerance test
MR pit to visualise
prolactin levels to exclude simult prolactinoma

trans sphenoidal resection
ocretotide

85
Q

complications of acromegaly

A

colon cancr (need surveillance), impaired glucose tolerance/DM, cardiomyopathy

86
Q

dupytren’s table top test

A

can’t lay hand flat due to flexed fingers (usually ring/little)

87
Q

Dupytren’s contract assoc and treat

A

dupytren’s causes – assoc with CLD, FH, anti epileptics, DM, tissue disord
manage with splinting, physio, steroid inj, surgical = partial fasciotomy / fasciectomy.

88
Q

Carpal Tunnel DDx

A

thoracic outlet syndrome
pronator teres syndrome

watch and wait
splint at night
sterod inj
NSAIDs
surgical release

AS / OS Paces RT (11 decks)

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