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CS INT > Clinica > Flashcards

Clinica Flashcards

1
Q

What are the differentials for Abdominal pain post op (colectomy)

A 
Anastomotic leak
Septic shock
Haemorrhagic shock
Perforation 
Obstruction
Wound infection
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2
Q

Differentials for post op shock

A 
Haemorrhage 
Sepsis (depends how long after)
PE
MI
Anaphylaxis
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3
Q

Post cholecystectomy Ix

A

Bedside: ECG, BM, Urine dip (+pregnancy)
Bloods: FBC, U/Es, LFTS, CRP, amylase/lipase +/-D-dimer
Imaging: Erect CXR, Abdo USS looking free fluid. If stable, consider CT abdo
If not stable may need Dx Laparotomy

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4
Q

Haemorrhagic shock classification

A
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5
Q

Ix for drop in urine output

A

Bedside: BM, ECG, Urine dip and Microscopy, bladder scan
Bloods: classic + lactate
Imaging: USS Kidneys (?hydro)
Special: paired urine and serum osmolality

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6
Q

Pre-renal causes of AKI

A

Local: renal artery stenosis or renal vein thrombosis

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7
Q

Renal causes of AKI

A

ATN

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8
Q

Post renal causes of AKI

A 
Upper: 
- Intraluminal: stone
- Extraluminal: retroperitoneal fibrosis, malignant compression
Lower:
- Urethral stricture
- prostate
- blocked catheter
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9
Q

Treatment of hyperkalaemia

A
  1. calcium gluconate 10%:10ml
  2. Insulin + Dextrose: 10 units in 50mls of 50% dextrose
  3. Nebulised salbutamol
  4. Resonium

Continued cardiac monitoring

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10
Q

Indications for dialysis

A

Resistant fluid overload
Resistant high K
High Urea (encephalopathy)
Resistant met acidosis

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11
Q

How haemodialysis different from haemofiltration

A

Dialysis: counter flow of blood and dialysate fluid separated by semi-permeable membrane

Filtration: High hydrostatic pressure pushing blood into semi-permeable membrane, forming ultrafiltrate (small molecules and electrolytes pass through the membrane). Ultrafiltrate is then disposed and replaced by normal fluid

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12
Q

Scoring system for AKI

A

RIFLE from KDIGO (Kidney disease, improving global outcomes)

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13
Q

Management of failed 12Fr catheter

A

Try a larger cath
If not try a tieman
If not consider suprapubic or percutaneous needle aspiration

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14
Q

Differentials swollen leg post op

A

DVT
Cellulitis
Lymphoedema
Fracture

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15
Q

Well’s DVT score

A
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16
Q

Wells DVT score interpretation

A
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17
Q

Duration of anticoagulation for DVT

A

3-6 months
3 months for unprovoked
3 months for provoked but the provoking factor no longer present (eg post op)
3-6 months for cancer

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18
Q

Complications of DVTs

A

PE

Post-thrombotic syndrome (pain, swelling, haemosiderin, varicose veins)

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19
Q

Prevention of DVTs

A

Compression stocking
Elevation
Early mobilisation
Anticoagulation

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20
Q

A to E assessment for post op tonsilar bleed

A 
Airway 
C: Patency 
O: Suction
Breathing
C: RR, SpO2, expansion, Breath sounds
O: 15L non-rebreathe
Circulation
C: HR, BP, peripheral and central cap refill, HS
O: 
- 2 large bore cannulae, bloods (clotting, G+S, +/- Xmatch, culture, VBG), 
- IV hartmanns if tachycardic. 
- Consider catheter for fluid balance
Disability
C: BM, GCS, Pupils
Exposure
C:rash, abdo exam, wound site
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21
Q

Tonsillar bleed mx before operation

A

Inform senior
Abx
Fluids/blood
Control bleeding:
1. LA spray with adrenaline
2. If obvious bleeding point: Cauterise with silver nitrate stick
3. if no obvious bleeding point: gargle hydrogen peroxide 3% diluted 1:4

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22
Q

Manual reduction technique for paraphimosis

A
  1. apply general pressure

2. thumbs on the glans, index finger behind the prepuce slowly pushing back

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23
Q

Pathophysiology of paraphimosis

A

Retracted prepuce proximal to glans forms a constricting ring
Impedes venous and lymphatic return
Causing engorgement of vessels distally
Swelling causes further obstruction ultimately cutting the arterial supply

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24
Q

Analgesia for paraphimosis reduction

A

LA without adrenaline

penile block or ring block

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25
Q

Other non-operative approach to paraphimosis

A

Osmotic method: gauze soaked with 50% dextrose

Dundee method: making multiple needle tracts in the swollen glans to create path for fluid drainage under pressure

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26
Q

Mx of intra-abdominal abcess

A
  1. abx

2. drainage (percutaneous or surgical)

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27
Q

Possum scoring system

A

Physiological and operative severity score for enUmeration of mortality and morbidity
Developed in 1991 by Copeland et al, revised by Portsmouth in 1998

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28
Q

Anticoagulation mx for pt needing urgent operation on warfarin for metalic valve

A

Consult cardiology and trust guideline

Might reverse with vit K whilst starting on UFH

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29
Q

Sepsis 6

A

Take: culture, lactate, UO
Give: O2, fluids, Abx

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30
Q

SIRS def

A

Symptoms and signs of infection

2 or more of the following: HR:90, RR>20, WCC>12 or<4

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31
Q

SIRS vs Sepsis vs Septic shock

A

SIRS: systemic inflammation
Sepsis: SIRS + confirmed/suspected source of infection
Severe sepsis: Sepsis + organ dysfunction (eg low urine output or high lactate)
Septic shock: severe sepsis and persistent hypotension despite resus

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32
Q

Scoring system for UGI bleeding

A

Rockall or Blatchford
Pre and post endoscopy rockall scores
Predicts the need for endoscopy or risk of re-bleeding (post endoscopy rockall)

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33
Q

Mx of UGI bleeding

A

Depends on the cause

If peptic ulcer: IV omeprazole
If oesophageal varices: IV terlipressin to reduce splanchnic flow, reducing bleeding, and prophylactic abx

Endoscopy

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34
Q

Riglers sign

A

Air present on both sides of bowel wall

Sign of bowel perforation

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35
Q

Common causes of small bowel obstruction

A

Adhesions

Hernia

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36
Q

Common causes of large bowel obstruction

A

Malignancy
Volvulus
Diverticulitis

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37
Q

Causes of bowel obstruction

A

Intraluminal
Gallstone ileus, ingested foreign body, faecal impaction

Mural
Cancer, inflammatory strictures*, intussusception**, diverticular strictures, Meckel’s diverticulum, lymphoma

Extramural
Hernias, adhesions, peritoneal metastasis, volvulus

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38
Q

Mx of sigmoid volvulus

A

A-E, bowel decompression using riles tube and IVI + analgesia

1st line: Rigid Sigmoidoscopy and insertion of flatus tube
2nd line: flexi sigmoidoscopy
3rd line: Surgical ?sigmoidectomy

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39
Q

Types of necrotising fasciitis

A

Type 1: polymicrobial:aerobic and anaerobic
Type 2: Haemolytic group A strep: strep pyogenes
Type 3: Gas gangrene: clostridium perfringes

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40
Q

Special test for Necrotising fasciitis

A

Finger Sweep test:

an incision over the suspected area may reveal:

  • dishwasher coloured fluid
  • pus exudate
  • necrotic tissue

If the tissue dissects easily with minimal resistance: positive finger sweep test

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41
Q

Risk factors for necrotising fasciitis

A

Immunocompromised eg DM, HIV, malignancy
Post op
Trauma eg IVDU, burn

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42
Q

Prognosis of necrotising fasciitis

A

Early diagnosis and debridement improves outcome

Mortality between 20-50%

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43
Q

Contraindications for skin graft

A

General: patient fitness for op
Local: vascularity, growth of micro-organisms, necrotic tissue

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44
Q

Signs of appendicitis

A

Rosving
Rebound tenderness
Psoas sign
Obturator sign

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45
Q

Rosving sign

A

LIF palpation causes pain in RIF

?appendicitis

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46
Q

Psoas sign

A

Extend hip causes RIF pain

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47
Q

Psoas sign

A

HIP Extension against resistance causes RIF pain

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48
Q

Complication of acute appendicitis

A

Sepsis - septic shock - multi-organ failure

Periappendicular abscess

Perforation of appendix

Death

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49
Q

Complication of acute appendicitis

A

Sepsis - septic shock - multi-organ failure

Periappendicular abscess

Perforation of appendix

Death

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50
Q

Why you have to operate on appendicitis but cholecystitis might be treated with ABX

A

Appendix supplied by appendicular artery (small end artery) which could get thrombosed with sepsis, leading to gangrene and perforation

Cholecystitis: gallbladder supplied by both cystic and right hepatic arteries, even if one thromboses, another likely to be able to supply the appendix

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51
Q

6 Ps of acute limb ischaemia

A 
Painful 
Pallor
Pulseless
Perishingly cold
Paralysis 
Paresthesia
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52
Q

Ix of acute limb ischaemia

A

Bedside: ECG, BM
Bloods: FBC, UEs, CRP, G+S, lactate, ?thrombophilia screen
Imaging: Areterial duplex or CT angio

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53
Q

Rutherford classification of acute limb ischaemia

A

> 6 hours likely to be irreversible

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54
Q

Mx of acute limb ischaemia

A

Heparinise whilst awaiting imaging
Rutherford I and IIa: conservative with
- heparin loading and infusion (monitor APTT)
Rutherford IIb or worse: surgical

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55
Q

Surgical mx for acute limb ischaemia

A

If the cause is embolic, the options are:

  • Embolectomy via a Fogarty catheter
  • Local intra-arterial thrombolysis*
  • Bypass surgery (if there is insufficient flow back)

If the cause is due to thrombotic disease, the options are:

  • Local intra-arterial thrombolysis
  • Angioplasty (Fig. 3)
  • Bypass surgery

If >6hrs: amputation

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56
Q

3 components of normal doppler waveform

A

Multiphasic
Pulsatile
Regular amplitude

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57
Q

Causes of acute limb ischaemia

A

Acute thrombotic in situ (60%): acute occlusion in a vessel with pre-existing atherosclerosis

Embolic (30%): Cardiac (AF, MI, prosthetic/damaged valve), malignancy

Others: trauma , infection, dissecting aneurysm

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58
Q

ABPI interpretation

A 
>1.3: arterial calcification seen in DM, RA, vasculitis 
0.8< -- <1.3 normal
0.5< -- <0.8 moderate PAD: claudication
0.3< -- <0.5 severe PAD: rest pain
<0.3 critical limb ischaemia
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59
Q

Complications of ischaemic limb if left untreated

A

Loss of limb (40%)

Death (20%)

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60
Q

Complications of ischaemic limb when treated

A

Reperfusion syndrome ->compartment syndrome/chronic pain

Complications of thrombolysis: CVE, retroperitoneal bleed

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61
Q

Chronic limb ischaemia rutherford vs fontaine classification

A
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62
Q

Mx of critical limb ischaemia

A

Urgent vascular referral for consideration for surgical intervention :

  • stent
  • bypass
  • amputation
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63
Q

ATLS acute assessment

A

C: triple c-spine immobilisation should be established until spine is declared clear
A: cant do head tilt chin lift or jaw thrust (c-spine). start with airway adjuncts if needed and call anaesthetists
B: Check for haemothorax, pneumothorax, cardiac tamponade, flail chest. Apply 15L non-rebreathe regardless of COPD
C:
IV access*2, Warmed crystalloid 30ml/kg initial bolus (10ml/kg if HF),
- look for bleeding: floor and 4 more
D: GCS, pupils, BM, temp. Analgesia as per WHO
E: expose,log roll, abdo exam, check integrity of pelvis and apply binder

AMPLE Hx

Secondary Survey

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64
Q

Ample hx

A 
Allergies
Medication
PMHs
Last meal
Events
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65
Q

Imaging Ix for Trauma

A

Chest, c-spine, pelvic XR

FAST scan

Full trauma series CT TAP +/- head

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66
Q

How to differentiate between haemothorax and pneumothorax

A

Haem: dull percussion, no distended neck veins, deviated trachea
Pneum: hyper-resonant, distended neck veins, deviated trachea

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67
Q

Definition of massive haemothorax

A

Chest drain empties 1.5L or more than 200ml/hr for 2 hrs

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68
Q

Mx of massive haemothorax

A

Transfusion
Chest drain
Explorative surgery to control bleeding

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69
Q

Epigastric pain differentials

A 
GI:
- pancreatitis
- Cholecystitis 
- peptic ulcer
- GORD
- obstruction
Cardiac:
- MI 
- pericarditis 
Vascular: 
- AAA 
Endocrine:
- DKA
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70
Q

Normal amylase

A

<100

if it is 3 times or more is most likely pancreatitis

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71
Q

Risk factors for gallstones

A

Fat
Female
Fertile
Forty

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72
Q

Causes of pancreatitis

A 
GETSMASHED 
Gallstones 
Alcohol
Trauma 
Steroids
Mumps 
Autoimmune eg SLE
Scorpion 
High Ca, High Lipid, low temp
ERCP
Drugs: azothioprin, NSAIDs, thiazides
73
Q

Severity of pancreatitis scoring

A

APACHE II

Glasow score

74
Q

APACHE score

A
75
Q

Glasgow pancreatic score

A
76
Q

Criteria for CT scanning in pancreatitis patients

A

Not until after 48/72hrs: inflammatory changes are not radiographically present
Unless suspecting pancreatic carcinoma

If mild pancreatitis, unlikely to need CT
If severe pancreatitis, will definitely need CT for: assessing complications, provide prognostic info (risk of necrosis/infection)

77
Q

Complications of pancreatitis

A 
Necrosis +/- infection
Pseudocyst 
ARDS
Chronic pancreatitis 
Retroperitoneal haemorrhage: grey-turner/cullens
Death
78
Q

Mx of gallstone pancreatitis

A

MRCP + Cholecystectomy

If bile duct stones/or unfit for surgery: ERCP and sphincterotomy

79
Q

Acute groin pain differentials

A 
Gen Surg:
- Hernia: femoral or inguinal and 2ndary small bowel obstruction 
Ortho:
- Psoas abscess 
- OA flare
Vascular: 
- femoral aneurysm
- saphenous varix
- AAA
Others: 
- lipoma 
- lymphadenopathy
80
Q

Commonest type of hernia

A

Gen population: Direct inguinal hernia
Paeds: indirect inguinal (patent process)
Elderly female: femoral

81
Q

Femoral triangle anatomy

A 
Femoral canal 
Femoral sheath (artery and vein)
82
Q

Femoral canal boundaries

A

Medial: Lacunar lig
Ant: pectineal muscle
Post: Inguinal ligament
Lat: femoral vein

Note great saphenous coming in! common source of bleeding post herniotomy

83
Q

Femoral canal content

A

Fat

Lymph nodes of cloquet

84
Q

Differentials for testicular swelling

A 
General:
- direct inguinal hernia
Uro:
- torsion
- hydrocele 
- varicocele 
Trauma
- haematocele
Malignancy
- tumour 
Infective:
- mumps
- epididymo-orchitis
85
Q

<p>Types of non seminoma</p>

A

<p>Teratoma</p>

<p>Yolk sac tumour</p>

<p>Choriocarcinoma</p>

86
Q

<p>Testicular germ cell tumour types</p>

A

<p>Seminoma</p>

<p>Non seminoma</p>

87
Q

<p>Seminoma vs non seminoma age group</p>

A

<p>Seminoma: ~ 40 yo</p>

<p>Non seminoma: 20-30 yo</p>

88
Q

<p>Testicular germ cell tumour types</p>

A

<p>Seminoma</p>

<p>Non seminoma</p>

89
Q

Blood test for testicular cancer

A

AFP
bHCG
LDH

90
Q

Risk factors for testicular cancer

A

FHx
Down syndrome
Klinefelters syndrome
Cryptorchidism

91
Q

Surgical approach for testicular cancer

A

Inguinal (not testicular) approach as minimised seeding

92
Q

Presentation of testicular torsion

A 
Hx:
- Sudden onset severe pain
- N+V +/- abdo pain
O/E:
- Globally tender, high riding/transverse 
- absence of cremasteric reflex
93
Q

Blood supply to femoral head

A
94
Q

Weight bearing status following Hemi/total/DHS/Cannulated hip screw

A

Hemi/total: weight bear as tolerated

DHS/Cannulated hip screw: minimally weight bearing/non weight bearing for 6 weeks to facilitate fracture healing

95
Q

Hemi vs total for intracapsular NOF

A

Hemi if:

  • immobile
  • low AMTS
  • Co-morbid/high risk of GA
96
Q

How many hip fractures?

Mortality

A

30 day: 10%

1 yr: 30%

97
Q

Surgical approach to hip replacement

A

Anterolateral for hemi

Posterior for total

98
Q

Mx of pertrochanteric hip fractures

A

DHS

99
Q

Mx of subtrochanteric fractures

A

IM nail

100
Q

Assessment of neurovascular status in children with upper limb fracture

A

Median: ‘ok’ sign -> flexor policis longus (FPL) and flexor digitorum profundus (FDP) + sensation on the thumb

Ulnar: middle finger over index finger: intrinsic hand muscles + sensation of little finger

Radial: extend wrist + Sensation on the back of the hand

CRT + radial +ulnar pulses

101
Q

Mx of radial fracture in children

A

Backslab + NBM
Discuss with senior
Consent and mark for TENS wires or plates and screws

102
Q

Mx of spiral femoral fractures in kids

A

Plating or TENS nailing of femur

103
Q

Signs of non-accidental injury

A

Multiple fractures at different stages of healing

Scapula, ribs, lateral clavicle, skull fracture

104
Q

How long does it take for fractures to heal

A

4 wks for hard callus to appear on xray
4-6 wks start of mobilisation: 3 months completion of callus formation
3-6 wks of healing time in kids
Remodelling up to 6 months

105
Q

BOA guidelines: compartment syndrome Ix and management

A

In pt with clear signs/sx,

  1. any circumferential dressing should be removed and pt reviewed after 30 mins
  2. If persists, needs urgent decompression

In pt with Dx uncertainty

  1. record intracompartmental pressures
  2. If diastolic blood pressure - the compartment pressure < 30 mmHg ; suggests positive
  3. Needs to D/w consultant if positive whether needs decompression
  4. If absolute compartment pressure >40mmHg, it is definitely compartment syndrome
106
Q

BOA guidelines: compartment syndrome Hx and exam

A
  1. Time: of injury and evaluation
  2. Mechanism of injury/RFs
  3. Pain: out of proportion? on passive extension
  4. Analgesia: ?regional, response to analgesia
  5. Neurovascular status
  6. GCS
107
Q

Treatment for lower leg compartment syndrome

A

2 incision 4 compartment fasciotomy

108
Q

BOA guidelines: Spinal clearance principles in trauma

A
  1. Inclusion: unconscious, unable to cooperate or who have distracting injuries
  2. Examine the entire spine on arrival: any injury found requires urgent imaging
  3. If unlikely to be conscious in 48hr, need radiological imaging
  4. Radiological imaging: CT Head (extend to c spine), CT CAP for coronal view, AP and lateral xray of thoracic and lumbar. needs reporting by a radiologist before clearing the spinal immobilisation measures. MRI needed for cord injury
109
Q

BOA Guidelines for open fractures

A
  1. Need orthoplastics
  2. Prophylactic abx
  3. Neurovascular exam before and after reduction
  4. Re-align and splint
  5. CT trauma +/- angio
  6. Informal debridement to remove gross contamination, take pics, then cover with saline soaked gauze and occlusive dressing
110
Q

BOA guideline: Timing to debride an open fracture

A

Debridement should be performed using fasciotomy lines for wound extension where possible
— Immediately for highly contaminated wounds (agricultural, aquatic, sewage) or when there is an associated vascular compromise
(compartment syndrome or arterial disruption producing ischaemia).
— within 12 hours of injury for other solitary high energy open fracture
— within 24 hours of injury for all other low energy open fractures.

111
Q

When would you use haemofiltration or haemodyalisis

A

Dialysis: less expensive, less technical
Filtration: Less effect on BP, lower risk of hyperlipidaemia

112
Q

BOA Guidelines on operating on Fraily trauma pts

A

1 . TEP

  1. Timing:
    - orthogeries review within 72 hrs
    - operate within 36 hrs, aim for FWB
    - PT on day 1 post op
  2. Orthogeries assessment includes:
    - bone health
    - anticoagulation
    - Multifactorial fall assessment
    - nutrition
    - pain mx
113
Q

Causes of hip fractures in elderly

A

Weakness caused by:

  • osteoporosis
  • met deposits
  • metabolic conditions eg pagets
  • rarely osteomyelitis
114
Q

Ix for painless haematuria

A

Bedside: urine dip, bladder scan
Bloods; routine
Imaging: CT KUB
Special: flexi/rigid cystoscopy

115
Q

Causes of D1 post-operative pyrexia

A
  1. Pulmonary atelectasis
  2. Infection prior to operation: catheter, cannula, LURTI/UTI
  3. PE
116
Q

How to manage pulmonary atelectasis post op

A
  1. Analgaesia : PCA
  2. Oxygen if low sats
  3. Chest physio
  4. If issues with oxygenation, contact outreach
117
Q

Risk factors for abdo wound dehiscence

A

Pre-op: wound healing impairment
RF: DM, anaemia, jaundice, malignancy, vit c deficiency
Peri-op:
- Surgical: poor suturing, increased bowel handling
- equipment: poor sutures
Post- op:
- anything that increases intra-abdo pressure: cough, high BMI, constipation

118
Q

Jenkin rule

A

suture length should be at least four times the wound
sutures placed 1cm apart
1cm bites

119
Q

Surgery for wound dehiscence

A
  1. debride non viable tissue around the wound edges
  2. repair with non absorbant sutures eg nylon 1.0 or PDS including peritoneum, rectus sheath, fascia layers but not skin
  3. separate skin closure
120
Q

Difference between incisional hernia and wound dehiscence

A

Skin intact in incisional hernia

121
Q

Complications of any fracture

A

Early: bleeding, infection, NV compromise
Intermediate: compartment syndrome, bleeding infection
Long term: malunion or non-union

122
Q

Complications of any fracture

A

Early: bleeding, infection, NV compromise
Intermediate: compartment syndrome, bleeding infection
Long term: malunion or non-union

123
Q

What nerve damaged in supracondylar fractures

A

Anterior interosseus nerve branches off median in the proximal forearm:

Innervates flexor pollucis longus and digitorum profundus (cant make the ok sign)

124
Q

What nerve damaged in supracondylar fractures

A

Anterior interosseus nerve branches off median in the proximal forearm

125
Q

How to classify supracondylar fractures

A

Gartland classification

126
Q

How to prepare someone for theatre

A 
NBM + maintenance IVF 
Mark and consent
Anaesthetics: ECG and CXR
Bloods: G+S + routine + INR
Covid Swab 
TEP form
VTE 
Inform: SpR, ITU, Emergency theatre staff
127
Q

Differentials for UGI Bleed

A 
Oesophageal varices
Duodenal or peptic ulcers
Malignancy 
Trauma
Gastritis/Oesophagitis 
Mallory-weis tear
Arterio-venous malformation
128
Q

<p>Arterial supply of nose bleed</p>

A

<p>Internal and external carotid artery plexus (Little's area or kiesselbach's plexus)</p>

<p>Mainly sphenopalatine and greater palatine arteries (branches of the maxillary artery)</p>

<p></p>

<p></p>

129
Q

<p>ENT Mx of epistaxis</p>

A

<p>If anterior:Simple anterior: 1st: silver nitrate cautery 2nd: packing</p>

<p>If posterior: balloon tamponade (if anterior packing has failed)</p>

<p></p>

<p>Abx post nasal packing</p>

130
Q

Immediate mx of epistaxis

A

Press on the cartilagenous part of the nose for 15 to 20 mins whilst leaning forward to avoid the blood flow posteriorly and risk occluding the airway

131
Q

When to give abx in epistaxis

A

If no source of bleed found, nose is usually packed for 48hrs.
Abx needed if pack is in place for more than 48 hrs
Toxic shock syndrome is a complication otherwise

132
Q

What does grade 2 shock and abdo pain imply

A

Should be interpreted as ruptured AAA until proven otherwise

133
Q

Most common site of AAA

A

Infrarenal 80%

Suprarenal 20%

134
Q

RFs for AAA

A 
Male
Age >55
HTN
Smoking 
High Cholesterol 
FHx
135
Q

Differentials for bowel obstruction

A
  1. large bowel obstruction
  2. small bowel obstruction
  3. Pseudo-obstruction
  4. ileus
136
Q

Pseudo-obstruction vs ileus

A

Both are acute distention of bowels in absence of any mechanical obstruction
Ileus (Ogilvie’s syndrome) includes both small and large bowel
Pseudo includes only large bowel (mainly caecum and ascending colon)

137
Q

Causes of pseudo obstruction or paralytic ileus

A

Meds: opiates
Electrolyte imbalance
Neurological: MS, parkinsons
Trauma: including recent surgery

138
Q

Mx of pseudo obstruction

A

NBM IV fluids 24-48hr
If not resolved, flatus tube decompression
Sometimes could give neostigmine to help reduce the secretions
Minority will need resection

139
Q

Difference in history of Small bowel vs large bowel obstruction

A

Large bowel: constipation proceeds nausea

Small bowel: (profuse) vomiting proceeds constipation, spasmatic crampy abdo pain

140
Q

Bowel sound in obstruction

A

Tinkling

141
Q

Indications for AXR

A

Obstruction
Perforation
Volvulus
Toxic megacolon in acute IBD

142
Q

Complications of small bowel obstruction if managed conservatively

A

Sepsis

Intra-abdominal abscess

143
Q

Complications of small bowel obstruction if managed surgically

A

Early complications such as infection and haemorrhage
Intermediate such as bleeding, anastomatic leak, abdo wound dehiscence
Late: short gut syndrome, chronic pain

144
Q

Different types of skin grafts

A

Split thickness:

  • includes the germinal layer,
  • leaves islands of germinal layer in the donor site, allowing it to heal by re-epithelisasation and is able to become a donor site in 6 wks

Full-thickness:

  • includes all layers of dermis and epidermis
  • needs to be sutured close (or closure by split-thickness skin graft)

Composite graft:
- includes special tissue like cartilage for nasal reconstruction

145
Q

Criteria for Burns referral to a tertiary centre

A
  • Partial thickness > 10%
  • hands, feet, face, genitalia , or major joints
  • full-thickness burns in any age group
  • Electrical, chemical, inhalation burns
  • Burns injury in patients with co-morbidities that could affect recovery
    • Any patient with burns and concomitant trauma (such as fractures) in which the burn poses the greatest risk of morbidity or mortality.
    • Burned children in hospitals without qualified personnel or equipment for the care of children
    • Burn injury in patients requiring special social, emotional or long term rehabilitative support.
146
Q

DDx for hip pain in 13 yo

A

SUFE
Undiagnosed Perthes
Muscular injury
Trauma

147
Q

Examination findings for SUFE

A

Shortened, externally rotated hip
Reduced internal rotation
Waldling gait with external rotation

148
Q

Mx of SUFE

A

May require a period of bed rest

May need fixation with a cannulated hip screw

149
Q

Transpyloric plane landmark for?

A 
Hilum of the left kidney
SMA
Fundus of gallbladder
Neck of pancreas
1st part of deuodenum 
portal vein
150
Q

Calot triangle borders

A

Cystic duct
Common hepatic duct
Inferior hepatic border

151
Q

Inguinal canal borders:

  • superficial ring
  • deep ring
  • anterior wall
  • posterior wall
  • roof
  • floor
A
  • superficial ring
  • deep ring
  • anterior wall: ext oblique
  • posterior wall: transversalis fascia + conjoint tendon medially
  • roof: int oblique, transversus abdominus
  • floor: inguinal ligament
152
Q

6 Ps of acute limb ischaemia

A 
Pulseless
Parasthaesia
Pain
Perishingly cold
Paralysis
Pallor
153
Q

Major haemorrhage definition

A

Loss of entire blood volume in 24 hrs (eg 5 L in 70kg man)

Loss of 50% in 3 hours

154
Q

Beck’s triad

A

Muffled heart sounds
Hypotension
Raised JVP

155
Q

Factors increasing risk of hip dislocation post replacement

A

Patient:

  • F >M (*2)
  • Age
  • obesity
  • alcohol

Surgical:

  • posterior approach>antero-lateral
  • capsular excision
  • smaller femoral head size
156
Q

Anterio-lateral vs posterior approach risk vs benefit

A

A-L: increased risk of

  • sciatic n palsy,
  • trochanteric bursitis
  • post op bleed

Posterior:
- increased risk of dislocation

157
Q

Risk factors for anastamotic leak

A

Patient:

  • age (old)
  • gender (male)
  • malnutrition
  • long term steroids
  • Smoking and alcohol

Operative:

  • poor operative technique
  • increased bowel handling
  • level of anastemosis (left sided worse than right sided)

Post op:

  • sepsis
  • constipation
158
Q

Operative mx of anastemotic leak

A
  1. faecal diversion
    Washout + Loop ileostomy or colostomy
  2. Hartmanns procedure
    Resection of anasetomsis and closing the proximal stump
    (difficult to reconstruct later)
159
Q

Alternative to erect CXR if patient cannot sit up

A

Left lateral decubitus film (lean on the left side)

Air between liver and abdo wall

160
Q

Operative mx of a perforated ulcer

A

Omental patch repair if large through a upper midline laparotomy incision
(could sometimes self seal with conservative mx)

161
Q

<p>Intussesseption month of presentation</p>

A

<p>Winter months (some link with flu like symptoms pre-disposing)</p>

162
Q

<p>Age of presentation for intussusception</p>

A

<p>6-9months old</p>

163
Q

<p>Intussusception sx</p>

A

<p>colicky pain</p>

<p>D+V<br></br>
Sausage shaped mass</p>

<p>Red currant jelly stool</p>

164
Q

<p>Pyloric stenosis age</p>

A

<p>4-6 wks of life</p>

165
Q

<p>Pyloric stenosis Sx</p>

A

<p>projectile non bile stained vomit</p>

166
Q

<p>Pyloric stenosis Ix</p>

A

<p>Test feed</p>

USS: thickened pylorus, target sign

167
Q

<p>Pyloric stenosis mx</p>

A

<p>Ramstedt pyloromyotomy (open or laparoscopic)</p>

168
Q

Causes of urinary outlet obstruction

A

Prostate:

  • benign or malignant
  • prostatitis

Urethral structure

Constipation

Neurological: MS, DMII

169
Q

Gleason scoring for prostate

A

Given as two numbers
Refers to predominant and second most predominant cell type
6 or more tend to do worse
4 or less tend to do better

170
Q

Gleason scoring for prostate

A

Given as two numbers
Refers to predominant and second most predominant cell type
6 or more tend to do worse
4 or less tend to do better

171
Q

Cierny Mader staging system

A 
Osteomyelitis staging 
1 and 2 abx, 3 and 4 surgical rx 
1. medulla
2. superficial 
3. localised
4. diffuse
172
Q

Mx of cardiac tamponade

A

Pericardiocentesis

In post op pts: re-do sternotomy and removal of blood in pericardial sac

173
Q

What are the common sites of post op infection

A

6 Cs:

Cannula
Catheter
Calf: dvt
Cut (incision)
Chest
Collection
174
Q

Boerhaave syndrome

A

Maklers triad:

  • surgical emphysema
  • recurrent vomiting
  • oesophageal perf
175
Q

3 types of wound healing

A

Primary intension: wound closed by sutures
Secondary: closed from base up by granulation formation
Tertiary: delayed closure, first wait for granulation tissue, then close the top

176
Q

Supracondylar fracture classification

A

Gartlands classification
1: cast immobilisation 4 wks
2: closed reduction and percutaneous pinning (CRPP)
3 and 4: CRPP or open reduction

176
Q

Supracondylar fracture classification

A

Gartlands classification
1: cast immobilisation 4 wks
2: closed reduction and percutaneous pinning (CRPP)
3 and 4: CRPP or open reduction

177
Q

Different types of haemorrhage

A

Primary: during operation
Reactive: within 24hrs post-op - clot dislodgement, or rise in BP post op leading to bleeding
Secondary: 7 days post op most likely infection, injury

178
Q

Volkmanns contracture

A

Forearm fracture could lead to ischaemia and necrosis of forearm muscles
Leads to fibrosis and shortening, especially the flexor component

CS INT (13 decks)

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