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mrcs - General > AS > Flashcards

AS Flashcards

1
Q

Management Hyperpyrexia

A

Dantrolene and cooling

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2
Q

Inidcations for emergency thoracotomy

A

> 1.5L drained on insertion

> 200ml/hr for 2-4 hours

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3
Q

Definition of flail chest

A

Fractures of 2 or more adjacent ribs

With 2 or more fractures on each rib

Mx: epidural and PCA –> need good respiratory effots
if conservative fails –> PPV

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4
Q

Kussmaul’s sign

A

Increased JVP on inspiration

=cardiac tamponade

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5
Q

Pulsus paradoxus

A

Systolic blood pressure FALLS >/10 mmHg on inspiration

=cardiac tamponade

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6
Q

Beck’s triad

A

Hypotension

Raised JVP

Muffled heart sounds

=cardiac tamponade

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7
Q

low voltage QRS ± electrical alternans

A

= cardiac tamponade

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8
Q

+ve diagnostic peritoneal lavage

A

> 100,000 RBCs/mm3,

Bile/intestinal contents

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9
Q

Anterior urethral injury

A

Spongy urethra: penile + bulbar

Saddle injuries / instrumentation

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10
Q

Posterior urethral injury

A

Membranous injuries

Pelvic fractures

High-ridingm prostate

Blood at meatus

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11
Q

Indications for intubation with head injury

A

GCS <8

PaO2 <9 on RA
PaO2 <13 on O2
PaCO2 >6

Spontaneous hyperventilation –> PaCO2 <4

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12
Q

Management of achalasia

A

Med: CCBs, nitrates

Int: botox injection, endoscopic balloon dilatation

Surg: Heller’s cardiomyotomy (open or lap)

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13
Q

Plummer Vinson

A

Severe iron deficiency anaemia

  • -> hyperkeratinisation of upper 3rd oesophagus
  • -> web formation

Pre-malignant: 20% risk of Squamous cell carcinoma

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14
Q

Management oesophageal cancer

A

Neo-adjuvant chemo: 5-FU + cisplatin

Ivor-lewis: 2 stage. abominal and R thoracotomy

McKeown: 3 stage, abdominal + R thorocotomy + L neck

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15
Q

Indications for Nissen fundoplication

A

Severe symptoms

AND

Refractory to medical therapy

AND

Confirmed reflux

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16
Q

Antrectomy with vagotomy

A

Billroth 1: directly to duodenum

Billroth 2 /Polya: to small bowel loop with duodenal
stump oversewn

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17
Q

Metabolic complications of by-pass

A

Dumping syndrome

  • Abdo distension, flushing, n/v, fainting, sweating
  • Early: osmotic hypovolaemia
  • Late: reactive hypoglycaemia

Blind loop syndrome → malabsorption, diarrhoea
-Overgrowth of bacteria in duodenal stump

Vitamin deficiency

  • ↓ parietal cells → B12 deficiency
  • Bypassing proximal SB → Fe + folate deficiency
  • Osteoporosis

Wt. loss: malabsorption of ↓ calories intake

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18
Q

Indications for surgical intervention in upper GI bleeding

A

Re-bleeding

Bleeding despite transfusing 6u

Uncontrollable bleeding at endoscopy

Initial Rockall score ≥3, or final >6.

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19
Q

Ramstedt pyloromyotomy

A

Divide down to mucosa

Mx for pyloric stenosis

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20
Q

Blood group A

A

Risk factor for GASTRIC CANCER

  • Atrophic gastritis (→ intestinal metaplasia)
  • Pernicious anaemia / AI gastritis
  • H. pylori
  • Diet: ↑ nitrates – smoked, pickled, salted (↑ Japan)
  • Nitrates → carcinogenic nitrosamines in GIT
  • Smoking
  • Blood group A
  • Low SEC
  • Familial: E. cadherin abnormality
  • Partial gastrectomy
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21
Q

Sister Mary Joseph nodule

A

Transcoelmic spread to umbilicus from gastric carcinoma

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22
Q

OGD: well-demarcated spherical mass c¯ central

punctum

A

= GIST

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23
Q

Management of GIST

A

Medical: Imatinib (tyrosine kinase inhibitor)

Surgical: resection

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24
Q

Rigler’s triad

A

= gallstone ileus

Pneumobiliia
Small bowel obstruction
Gallstone in RLQ

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25
Q

Tc pertechnecate scan +ve in 70%

A

Meckel’s diverticulum

Detects gastric mucosa

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26
Q

Carcinoid syndrome

A

=by-pass of first pass metabolims

= Live rmetastasis

Usually appendix primary

Increased serotonin:

  • Flushing: paroxysmal, upper body ± wheals
  • Intestinal: diarrhoea
  • Valve fibrosis: tricuspid regurg and pulmonary stenosis
  • whEEze: bronchoconstriction
  • Hepatic involvement: bypassed 1st pass metabolism
  • Tryptophan deficiency → pellagra (3Ds)
27
Q

Tx carcinoic crisis

A

High dose octreotide

28
Q

Cope sign

A

Flexion + internal rotation of R hip → pain

= Appendix lying close to obturator internus

29
Q

Psoas sign

A

Extension of hip –> pain

= Retrocaecal appendicitis

30
Q

Appendix mass

A

=complication of appeniditis

Omentum and small bowel stuck to appendix

Mx:

  • NBM and ABx
  • Interval appendectomy
  • 6 week colonoscopy to r/o malignancy

If doesn’t resolve –> appendix abscess

  • -> percutaneous driange
  • -> ultimate management in failed cases –> R hemicolectomy
31
Q

Components of Truelove and Witts

A

Grading UC

Motions
PR bleed
Temp
HR
Hb 
ESR (<30, >30)
32
Q

Day 3 Acute UC

A

On day 3: stool freq >8 or CRP >45

Predicts 85% chance of needing a colectomy during
the admission

Emergency medical Mx:
-ciclosporin, infliximab or visilizumab (anti-T cell)

33
Q

UC 1st lien management

A

Induction:
sulfasalazine or mesalazine AND prednisolone

Mainteance:
sulfasalazine or mesalazine
2nd line: azathioprine or mercaptopurine

34
Q

Emergency surgery for UC

A

Total / Sub-total colectomy + End-ileosotmy
+/- mucous fistula

3 months later:

a) Completion proctectomy + Ileal-pouch anal anastomosis (IPAA) or end ileostomy
b) Ileorectal anastomosis (IRA)

35
Q

Maintaining remission Crohns

A

1st line: azathioprine or mercaptopurine

2nd: methotrexate

(Note difference, no 5-ASAs)

36
Q

Induction Crohn’s

A

1st line

    • Ileocaecal: budesonide
    • Colitis: sulfasalazine

2nd line: prednisolone (tapering)
3rd line: methotrexate
4th line: infliximab or adalimumab

37
Q

Hinchey Grading

A

Diverticulitis perforation

I- IV

III and IV –> surgeyr
-indicated by peritonitis (III: purlent, IV: faecal)

38
Q

Gardeners

A

TODE

Thyroid tumours
Osteomas of the mandible, skull and long bones
Dental abnormalities: supernumerary teeth
Epidermal cysts

39
Q

5q21`

A

= APC gene –> FAP

Autosomal dominant

40
Q

Lynch 1

A

HNPCC

AD

Lynch 1 = right sided CRC

41
Q

Lynch 2

A

HNPCC

AD

Lynch 2 = colorectal cancer
+endometrial
+prostate
+breast

42
Q

Diagnosis of HNPCC

A

3, 2, 1 rule

≥3 family members over 2 generations c¯ one <50yrs

43
Q

STK11 gene

A

Peutz-Jeghers syndrome

AD

Mucosal hyperpigmentation
CRC, pancreatic, breast, lung, ovaries, uterus

44
Q

Peutz-Jeghers

A

AD - STK11 gene

Mucocutaneous hyper-pigmentation
Multiple GI hamartomatou spolyps
–> intussusception
–> haemorrhage

Cancer:

  • CRC
  • Pancreatic
  • Breast
  • Ovarian
  • Uterine
  • Lung
45
Q

Cowden syndrome

A

AD

Macrocephaly + skin stigmata

Intetsinal hamartomas

Increased risk of extra-intestinal cancers

46
Q

Goodalll’s Rule

A

Posterior fistula drian –> 6

Anterior fisture drain radially

47
Q

Anal lymph drainage

A

Above dentate line → internal iliac nodes

Below dentate line → inguinal nodes

48
Q

HPV oncogenic strains

A

16, 18,

31, 33

49
Q

McEvedy Approach

A

High approach
Inguinal

EMERGENCY in obstruction

–> allows inspection for ischaemic bowel

50
Q

Lockwood Approach

A

= LOW

Elective

Low incision over hernia c¯ herniotomy and herniorrhaphy (suture ing. ligt. to pectineal ligt.)

51
Q

Classification of malignant melanoma

A

Superficial Spreading: 80%

  • Irregular boarders, colour variation
  • Commonest in Caucasians
  • Grow slowly, metastasise late = better prognosis

Lentigo Maligna Melanoma

  • Often elderly pts.
  • Face or scalp

Acral Lentiginous

  • Asians/blacks
  • Palms, soles, subungual (c¯ Hutchinson’s sign)

Nodular Melanoma

  • All sites
  • Younger age, new lesion
  • Invade deeply and metastasis early = poor prog

Amelanotic
-Atypical appearance → delayed Dx

52
Q

Malignant parotid tumours

A

Malignant (CN7 palsy + fast growing)

1st: Mucoepidermoid
2nd: Adenoid cystic

53
Q

Transverse rectus abdominis myocutaneous flap

A

Gold-standard
Pedicled (inf. epigastric A.)
Or free: attached to internal thoracic A

CI if poor circulation: smokers, obese, PVD, DM
Risk of abdominal hernia

54
Q

Latissimus dorsi myocutaneou sflap

A

Pedicled flap: skin, fat, muscle and blood supply

Supplied by thoracodorsal A. via subscapular A.

Usually used c¯ an implant

55
Q

Definiton of chronic limb ischaemia

A

Ankle artery pressure <50mmHg

Toe <30mmHg (diabetics)

And either:

  • Persistent rest pain requiring analgesia for ≥2wks
  • Ulceration or gangrene
56
Q

Critical limb ischaemia

A

Rest pain

  • Especially @ night
  • Usually felt in the foot
  • Pt. hangs foot out of bed
  • Due to ↓ CO and loss of gravity help

Ulceration
Gangrene

57
Q

Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses

A

Leriche’s syndrome

58
Q

Buerger’s angle

A

≥90: normal

20-30: ischaemia

<20: severe ischaemia

59
Q

Fontaine classification

A

A: asymptomatic

B: intermittenet claudication
A = >200m
B = <200M

C: rest pain

D: ulceration or gangrene

60
Q

Doppler waveforms

A

Normal: triphasic

Mild stenosis: biphasic

Severe stenosis: monophasic

61
Q

ABPI values

A

Asymptomatic / Fontaine 1 = 0.8-0.9

Claudication / Fontaine 2 = 0.6-0.8

Rest pain / Fontaine 3 = 0.3-0.6

Ulceration and gangrene / Fontaine 4 = <0.3

Exercise test important:
ABPI measured before and after: 20% ↓ is sig

62
Q

Indicationds for end-arterectomy

A

Symptomatic
+ >70% occlusion = major indication
>50% occlusion if low operative risk <75 years age

Asymptomatic
≥60% benefit if low risk

63
Q

Aneurysm monitoring

A

UK Small Aneurysm Trial suggested that AAA <5.5cm
in maximum diameter can be monitored by US (/CT)

<4cm: yearly monitoring

4-5.5cm: 6 monthly monitoring

64
Q

Indications for aortic aneurysm intervention

A

Symptomatic (back pain = imminent rupture)

Diameter >5.5cm

Rapidly expanding: >1cm/yr

Causing complications: e.g. emboli

mrcs - General (24 decks)

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