Corrections Flashcards
What mx option is preferred for removal of renal stones in pregnant women?
Ureteroscopy
1st line investigation for unexplained rectal bleeding in patients aged over 50?
FIT test
NICE now recommend doing FIT testing before deciding whether to refer people of the urgent suspected colorectal cancer pathway for a colonoscopy.
Where is the splenic flexure?
Upper left abdomen, where the transverse colon bends to join the descending colon.
What is the management of splenic trauma dictated by?
1) associated injuries
2) haemodynamic status
3) extent of direct splenic injury
What are 3 indications of a splenectomy?
1) uncontrollable splenic bleeding
2) hilar vascular injuries
3) devascularised spleen
Is strangulation more common in direct or indirect hernias?
Indirect
What is the annual probability of strangulation in an inguinal hernia?
3%
Should abx be offered routinely to patients with acute pancreatitis?
No
Mx of renal stones >20mm?
percutaneous nephrolithotomy
What are the 3 medical benefits of routine circumcision?
1) reduces risk of penile cancer
2) reduces risk of UTI
3) reduces risk of acquiring STIs including HIV
Is toxic megacolon seen in UC or Crohn’s?
UC
What is the most effective mx option in renal cell carcinoma?
Radical nephrectomy (RCC is usually resistant to radiotherapy or chemotherapy)
What is the purpose of the psoas stretch sign?
(when the right thigh is passively extended with the patient lying on their side with their knees extended)
To detect acute retroperitoneal appendicitis
What is the definitive mx of ascending cholangitis?
ERCP
What is the definitive mx of biliary colic?
Elective laparoscopic cholecystectomy
Onset of N&V in LBO vs SBO?
N&V are early signs of SBO (suggests proximal lesion)
What stoma is done in a Hartmann’s?
End colostomy
What does a Hartmann’s involve?
1) resection of the sigmoid colon
2) closure of the rectal stump
3) formation of an end colostomy
There is a possibility of reversal of this procedure later if conditions are more favourable.
Mx of a a colonic cancer complicated by perforation and peritonitis?
Hartmann’s (emergency)
Next investigation if a DVT is suspected in thrombophlebitis?
US
What is indicated in recurrent balanitis?
Circumcision
Mx of prostate cancer or patients with low-grade disease, and significant co-morbidities?
Watchful wait
Mx of sigmoid volvulus?
rigid sigmoidoscopy with rectal flatus tube insertion
Contrast vs non-contrast CT KUB in renal stones?
Non-contrast CT KUB
What is the most common complication of ERCP?
Pancreatitis
What is removed in a panproctocolectomy?
Colon, rectum & anus
What can provide palliation of dysphagia in patients with oesophageal cancer?
Placement of an oesophageal stent
What is the mainstay of mx of venous ulcers?
Compression therapy –> multilayer bandages or compression stockings.
This improves venous return and reduces oedema.
What investigation does nephrotic syndrome in adults require?
Renal biopsy
What is best investigation for detecting a cervical spine fracture?
CT scan of neck
Role of chemo in mx of breast cancer?
May be used either prior to surgery (‘neoadjuvanant’ chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour.
What chemo is indicated in breast cancer if there is axillary node disease?
FEC-D chemotheraoy
What is the investigation of choice in an anal fistula?
MRI
What is the most common renal malignancy?
Renal adenocarcinoma
What are the 3 main patterns of presentation that may be seen in patients with peripheral arterial disease?
1) intermittent claudication
2) critical limb ischaemia
3) acute limb-threatening ischaemia
Features of critical limb ischaemia?
Features should include 1 or more of:
1) rest pain in foot for more than 2 weeks
2) ulceration
3) gangrene
How can pain be improved in critical limb ischaemia?
Patients often report hanging their legs out of bed at night to ease the pain.
What ABPI is suggestive of critical limb ischaemia?
<0.5
Interpretation of ABPI:
a) 1
b) 0.6-0.9
c) 0.3-0.6
d) 0.3
a) normal
b) claudication
c) rest pain
d) impending
Indications for a CT head within the hour in a head injury?
1) GCS <13 on initial assessment
2) GCS <15 at 2 hours post-injury
3) suspected open or depressed skull fracture
4) any sign of basal skull fracture
5) post-traumatic seizure
6) >1 episode of vomiting
7) focal neurological deficit.
Indiciations for a CT head within 8 hours in a head injury?
For adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:
1) age 65 years or older
2) any history of bleeding or clotting disorders including anticogulants
3) dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
4) more than 30 minutes’ retrograde amnesia of events immediately before the head injury
If a patient is on warfarin who have sustained a head injury, when should they have a CT head?
Within 8 hours of the injury
What is the most sensitive scan to diagnosis diffuse axonal injury?
MRI
Mx of patients who have had persistent erectile dysfunction?
Refer to urology
What type of shock causes warm peripheries?
1) neurogenic
2) septic
3) anaphylactic
What type of shock causes cool peripheries?
1) haemorrhagic
2) cardiogenic
What 2 types of stomas can be used when defunctioning of the colon is necessary?
1) loop colostomy
2) loop ileostomy
Loop colostomy vs ileostomy?
Loop colostomy:
- Can be used if ileocaecal valve is competent
Loop ileostomy:
- Can only be used if the ileocaecal valve is NOT competent (otherwise effective decompression of the colon is not effective)
Purpose of defunctioning and decompressing the distal colon in large bowel obstruction secondary to colon tumours?
to ensure appropriate healing following the surgical procedure to resect the tumour.
What should be used in the acute mx of renalcolic?
Diclofenac
Why can a varicocele be a sign of malignancy?
Due to compression of the renal vein between the abdominal aorta and the superior mesenteric artery
When can bariatric surgery be considered 1st line in obesity?
For adults with a BMI >50
What is typically the 1st line type of bariatric surgery?
laparoscopic-adjustable gastric banding (LAGB)
A patient is found to be positive for MRSA prior to surgery. What treatment should they be offered?
Nasal mupirocin & chlorhexidine for the skin
Where is the most common colonisation site of MRSA?
Anterior nares (nose)
How long is carbimazole often indicated for in Grave’s?
12-18m
Describe the different classifications of Duke’s classification for colorectal cancer
Duke’s A: tumour confined to the mucosa
Duke’s B: tumour invading the bowel wall
Duke’s C: lymph node metastases
Duke’s D: distant metastases
For the following sites of cancer, give the type of resection indicated
1) Caecal, ascending or proximal transverse
2) Distal transverse, descending colon
3) Sigmoid colon
4) Upper rectum
5) Low rectum
6) Anal verge
1) Right hemicolectomy
2) Left hemicolectomy
3) High anterior resection
4) Anterior resecton
5) Anterior resection
6) Abdomino-perineal excision of rectum
What can cause ongoing jaundice and pain after cholecystectomy?
Gallstones in the common bile duct
Initial mx of acute limb ischaemia?
Analgesia, IV heparin and vascular review
Where are 90% of anal fissures found?
On the posterior midline
If an anal fissure is found in an alternative location (i.e. other than posterior midline), what should be considered?
Consider underlying cause e.g. Crohn’s –> consider faecal calprotectin
When is a subtotal colectomy performed?
An emergency procedure performed in cases of fulminant colitis
What stoma is done after a subtotal colectomy?
An end ileostomy (and rectal stump is sewn).
An ileostomy is a stoma formed from the small bowel, specifically the terminal ileum, and it is spouted from the skin to prevent alkaline bowel contents from causing skin irritation when attaching and removing stoma bags.
Location of ileostomies?
RIF
What investigation should patients with intracranial bleeds who become unresponsive receive?
Urgent CT head to check for hydrocephalus
CT head scan is required within 8 hours for patients with a dangerous mechanism of injury.
What does this include?
falling more than 1 metre or from a height of ≥5 stairs
What is the most likely operation to be done for symptomatic chronic subdural bleeds?
Burr hole evacuation
What is a allograft?
Transplant of tissue from genetically NON identical donor from the same species
e.g. solid organ transplant from non related donor
What is an isograft?Graft of tissue between two individuals who are genetically identical
Graft of tissue between two individuals who are genetically identical
E.g. Solid organ transplant in identical twins
What is an autograph?
Transplantation of organs or tissues from one part of the body to another in the same individual
E.g. skin graft, long saphenous vein
What is a xenograft?
Tissue transplanted from another species
E.g. porcine heart valve
What nerve is at risk during a total hip replacement?
How does this manifest post-op?
Sciatic nerve
Manifests post-op as foot drop
What surgical option is indicated for medically-refractive ulcerative colitis?
Pan-proctocolectomy –> the entire large bowel and rectum are resected to remove the disease
What stoma is required following a pan-proctocolectomy?
Permanent end ileostomy
Mx of acute cholecystitis?
IV abx & early laparoscopic cholecystectomy within 1 week of diagnosis
How is fluid given in the first 24h after a burn?
50% over 8hrs followed by 50% over 16hrs
In an emergency setting where the bowel has perforated, the risk of an anastasmosis is greater.
What is done instead?
End colostomy - can be reversed later
Mx of inguinal hernias?
Routine surgical referral –> all inguinal hernias should usually be referred for repair, even if they are asymptomatic
What investigation is useful for determining whether the cause of the isolated hyperbilirubinaemia is due to haemolysis or Gilbert’s syndrome?
FBC
What gene is ankylosing spondylitis associated with?
HLA-B27 (there is a strong association with ulcerative colitis)
What are pigmented gallstones?
Primarily made of bilirubin and are associated with haemolytic anaemia and liver cirrhosis.
Mx of pharyngeal pouch?
Endoscopic stapling.
Triad of symptoms in gastric volvulus?
1) vomiting
2) pain
3) failed attempts to pass an NG tube
Initial investigation in acute limb threatening ischaemia?
1st –> Handheld arterial Doppler exam
If Doppler signals are present –> ankle-brachial pressure index (ABPI) should also be obtained.
Initial mx of acute limb ischaemia?
1) ABCDE
2) Analgesia: IV opioids
3) IV UH –> prevent thrombus propagation,
4) Vascular review
What is the definitive diagnostic investigation for small bowel obstruction?
CT abdomen
Mx of congenital inguinal hernias?
Refer to paediatric surgery –> have a high rate of complications
What are the 6 tests to confirm brain death?
1) pupillary reflex
2) corneal reflex
3) oculo-vestibular reflex
4) cough reflex
5) absent response to supraorbital pressure
6) no spontaneous respiratory effort
When can patients with a thrombosed haemorrhoid be referred for excision?
If they present within 72 hours
CT findings in diverticulitis?
Mural thickening of the colon and the presence of pericolic fat stranding in the sigmoid colon.
2 key causes of acute limb threatening ischaemia?
1) thrombus (due to rupture of atherosclerotic plaque)
2) embolus (e.g. 2ary to AF)
How many units of blood are typically crossmatched in a ruptured AAA?
6 units
What are solitary rectal ulcers assoicated with?
Chronic constipation and straining
Investigation in solitary renal ulcer syndrome?
The ulcer will need to be biopsied to exclude malignancy
Mx of acute limb ischaemia?
Analgesia, IV heparin and vascular review
Mx of vitiligo?
- sunblock for affected areas
- camouflage make up
- topical steroids
- topical tacrolimus
- phototherapy
What can a unilateral middle ear effusion in an adult be a presenting symptom of?
Nasopharyngeal carcinoma –> 2ww referral to ENT
What can exacerbate plaque psoriasis?
- trauma
- alcohol
- drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
- withdrawal of systemic steroids
What can trigger guttate psoriasis?
Strep infection
