Corrections 2 Flashcards
If the serum or lipase levels are inconclusive and there is a high suspicion of acute pancreatitis, what test should be done next?
CT abdomen with contrast
What investigation in acute pancreatitis can give information about possible complications such as pancreatic necrosis or pseudocyst formation?
CT abdomen with contrast
What can cause persistent mild elevation of amylase following pancreatitis?
Pseudocysts
What is a key systemic complication of acute pancreatitis?
ARDS
What timeline separates an acute from a chronic anal fissure?
<6 weeks: acute
> 6 weeks: chronic
What is the 1st line treatment for a chronic anal fissure?
Topical GTN
When should 2ary care referral be considered in an anal fissure?
If topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery or botulinum toxin
Risk of AAA rupture in men vs women?
AAAs are more common in men BUT risk of rupture is higher in women.
Does diabetes confer a higher risk of developing a AAA or of it rupturing when diagnosed?
NO - diabetes don’t undergo screening any earlier
Gold standard imaging in an AAA?
CT angiogram
2 surgical options in elective repair of AAA?
1) open repair
2) elective endovascular repair (EVAR)
Is a type A (ascending) or type B (descending) aortic dissection more common?
Type A (2/3)
Describe deBakey aortic dissection classification
Type I: originates in ascending aorta and propagates to at least the aortic arch
Type II: originates in and is confined to the ascending aorta
Type III: originates in descending aorta
Which classification of aortic dissection is confined to the ascending aorta? (deBakey)
Type II
Which classification of aortic dissection originates in the descending aorta? (deBakey)
Type III
The location of pain in an aortic dissection depends on the dissection origin.
Location of pain:
a) ascending aortic dissection
b) descending dissection
a) anterior chest pain
b) intrascapular back pain
Give some signs that may be seen in aortic dissection that reflect organ malperfusion due to loss of blood flow in the true lumen?
1) Stroke from carotid artery involvement
2) Myocardial infarction from coronary ostia obstruction
3) Paraplegia from spinal artery compromise
4) Mesenteric ischemia leading to abdominal pain
5) Renal failure from renal artery occlusion
Investigation of choice in aortic dissection?
CT angiography of the chest, abdomen and pelvis –> false lumen is a key finding
Complications of a:
a) backward tear
b) forward tear
in aortic dissection?
a) aortic incompetence/regurgitation, inferior MI (RCA)
b) unequal arm pulses and BP, stroke, renal failure
Describe murmur in AS
Harsh systolic crescendo-decrescendo ejection murmur, most prominent at the right second intercostal space and radiating to the carotids.
Why can AS result in GI bleeding?
Due to angiodysplasia (Heyde’s syndrome).
When does murmur in AS become more prominent?
a) leaning forwards
b) expiration
When does murmur in AS become softer?
The more severe the stenosis is
What other features may be seen in AS?
1) Slow rising and low volume carotid pulse
2) Narrow pulse pressure
3) Soft or absent second heart sound (S2)
4) Signs of heart failure - pitting lower limb oedema, bilateral basal crackles
5) AS
Prior to surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) what 2 investigations are done?
1) Coronary angiogram -> to identify co-existing CAD and conduct concomitant coronary revascularisation if possible
2) TOE –> to assess for endocarditis and mitral valve abnormalities
AS mortality rate in symptomatic patients?
25% in 1 year, 50% in 2 years
What are the indications for surgical repair in AS?
1) Symptomatic
2) Severe AS: aortic jet velocity ≥4 m/s, mean trans-valvular pressure gradient ≥ 40 mmHg, and aortic valve area ≤1 cm2.
What mean trans-valvular pressure gradient indicates severe AS?
≥40mmHg
What can be used as a palliative measure for patients in AS?
Percutaneous balloon valvotomy i
Complications of AS?
1) HF
2) AF & arrhythmias
3) Sudden cardiac death
4) GI bleeidng
5) Endocarditis
Mx of breast abscess:
a) <5cm
b) >5cm (or those that don’t resolve with needle aspiration)
a) needle aspiration
b) surgical incision and drainage with washout
What abx are indicated in breast abscess?
Oral flucloxacillin
Abx in lactational vs non-lactational mastitis?
Lactational: oral flucloxacillin
Non-lactational: oral co-amoxiclav
Duration of abx in mastitis?
10-14d
What are 3 complications related to TPN?
1) sepsis
2) re-feeding syndrome
3) hepatic dysfunction
How long after prostatitis or a UTI should a PSA be performed?
Wait 6 weeks
How long after urological intervention e.g. prostate biopsy should a PSA be performed?
6 weeks
What is the most commonly performed operation for rectal tumours?
Anterior resection (except in lower rectal tumours)
Is male or female sterilisation a more effective method of contraception?
Male
When is semen analysis typically performed post-vasectomy?
Semen analysis needs to be performed TWICE following a vasectomy before a man can have unprotected sex (usually at 12 weeks)
Mx of abdominal wound dehiscence?
1) coverage of wound with saline impregnated gauze
2) IV broad spectrum abx (e.g. ceftrixone & metronidazole)
What is the surgery of choice to defunction and decompress the large colon in:
a) proximal colon tumours
b) distal colon tumours e.g. descending colon
a) loop ileostomy
b) loop colostomy
Recognised complications of enteral feeding?
1) diarrhoea
2) aspiration
3) hypeglycaemia
4) refeeding syndrome
Why is gynaecomastia a common presenting feature of testicular cancer?
2ary to excess hCG or oestrogen
Mx of patients with suspected clinically localised prostate cancer?
2ww for multiparametric MRI
When should you consider 2ww referral for multiparametric MRI for suspected prostate cancer?
1) If their prostate feels malignant on DRE
or
2) Raised PSA
When should you consider a PSA?
1) LUTS
or
2) Erectile dysfucntion
or
3) Visible haematuria
What topical anaesthetic is often used in the mx of acute anal fissures?
Lidocaine
When is topical GTN typically offered in an anal fissure?
> 1 week
When is ICP monitoring indicated in head injury?
1) appropriate in those who have GCS 3-8 and normal CT scan
2) mandatory in those who have GCS 3-8 and abnormal CT scan
What ethnic group is prostate cancer more common in?
Afro-Caribbean
Most common location of colorectal cancers?
Rectum (40%)
Inheritance of Lynch syndrome?
Autosomal dominant
Inheritance of FAP?
Autosomal dominant
Which gene is most commonly involved in Lynch syndrome?
MSH2 (mismatch repair gene)
What are the APC genes?
Tumour suppressor genes
Describe screening programme for bowel cancer
60-74 yo –> home FIT test every 2 years
When should a FIT test be offered?
1) ≥50 with unexplained abdominal pain OR weight loss
2) <60 with changes in their bowel habit OR iron deficiency anaemia
3) ≥60 who have anaemia even in the absence of iron deficiency
1st line investigation in suspected bowel cancer?
FIT test
If FIT result raised –> 2ww suspected cancer pathway
What surgery is typically indicated in HNPCC?
panproctocolectomy
What ethnic group are uterine fibroids more common in?
Afro-Caribbean women
1st line symptomatic mx of uterine fibroids?
IUS
What age does intussusception typically affect?
6m - 3y
What type of oesophageal cancer can achalasia predispose to?
Squamous cell
What type of oesophageal cancer can diet rich in nitrosamines predispose to?
Squamous cell
Indications 2ww referral (for US) in ovarian cancer?
1) ascites
2) pelvic/abdo mass (which is not obviously uterine fibroids)
Indications of Ca-125?
Symptoms suggestive of ovarian cancer e.g. bloating, early satiety
Risk factors for a perianal abscess? (3)
1) IBD (especially Crohn’s)
2) Diabetes
3) Underlying malignancy
Gold standard imaging in a perianal abscess?
MRI
Mx of a perianal abscess?
1st line –> incision & drainage
abx only used if there is systemic upset 2ary to abscess
