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Yr 5 - Surgery > Corrections 2 > Flashcards

Corrections 2 Flashcards

1
Q

If the serum or lipase levels are inconclusive and there is a high suspicion of acute pancreatitis, what test should be done next?

A

CT abdomen with contrast

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2
Q

What investigation in acute pancreatitis can give information about possible complications such as pancreatic necrosis or pseudocyst formation?

A

CT abdomen with contrast

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3
Q

What can cause persistent mild elevation of amylase following pancreatitis?

A

Pseudocysts

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4
Q

What is a key systemic complication of acute pancreatitis?

A

ARDS

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5
Q

What timeline separates an acute from a chronic anal fissure?

A

<6 weeks: acute

> 6 weeks: chronic

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6
Q

What is the 1st line treatment for a chronic anal fissure?

A

Topical GTN

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7
Q

When should 2ary care referral be considered in an anal fissure?

A

If topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery or botulinum toxin

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8
Q

Risk of AAA rupture in men vs women?

A

AAAs are more common in men BUT risk of rupture is higher in women.

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9
Q

Does diabetes confer a higher risk of developing a AAA or of it rupturing when diagnosed?

A

NO - diabetes don’t undergo screening any earlier

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10
Q

Gold standard imaging in an AAA?

A

CT angiogram

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11
Q

2 surgical options in elective repair of AAA?

A

1) open repair

2) elective endovascular repair (EVAR)

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12
Q

Is a type A (ascending) or type B (descending) aortic dissection more common?

A

Type A (2/3)

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13
Q

Describe deBakey aortic dissection classification

A

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

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14
Q

Which classification of aortic dissection is confined to the ascending aorta? (deBakey)

A

Type II

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15
Q

Which classification of aortic dissection originates in the descending aorta? (deBakey)

A

Type III

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16
Q

The location of pain in an aortic dissection depends on the dissection origin.

Location of pain:

a) ascending aortic dissection
b) descending dissection

A

a) anterior chest pain
b) intrascapular back pain

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17
Q

Give some signs that may be seen in aortic dissection that reflect organ malperfusion due to loss of blood flow in the true lumen?

A

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

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18
Q

Investigation of choice in aortic dissection?

A

CT angiography of the chest, abdomen and pelvis –> false lumen is a key finding

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19
Q

Complications of a:

a) backward tear
b) forward tear

in aortic dissection?

A

a) aortic incompetence/regurgitation, inferior MI (RCA)

b) unequal arm pulses and BP, stroke, renal failure

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20
Q

Describe murmur in AS

A

Harsh systolic crescendo-decrescendo ejection murmur, most prominent at the right second intercostal space and radiating to the carotids.

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21
Q

Why can AS result in GI bleeding?

A

Due to angiodysplasia (Heyde’s syndrome).

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22
Q

When does murmur in AS become more prominent?

A

a) leaning forwards
b) expiration

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23
Q

When does murmur in AS become softer?

A

The more severe the stenosis is

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24
Q

What other features may be seen in AS?

A

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

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25
Q

Prior to surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) what 2 investigations are done?

A

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

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26
Q

AS mortality rate in symptomatic patients?

A

25% in 1 year, 50% in 2 years

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27
Q

What are the indications for surgical repair in AS?

A

1) Symptomatic

2) Severe AS: aortic jet velocity ≥4 m/s, mean trans-valvular pressure gradient ≥ 40 mmHg, and aortic valve area ≤1 cm2.

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28
Q

What mean trans-valvular pressure gradient indicates severe AS?

A

≥40mmHg

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29
Q

What can be used as a palliative measure for patients in AS?

A

Percutaneous balloon valvotomy i

30
Q

Complications of AS?

A

1) HF
2) AF & arrhythmias
3) Sudden cardiac death
4) GI bleeidng
5) Endocarditis

31
Q

Mx of breast abscess:

a) <5cm
b) >5cm (or those that don’t resolve with needle aspiration)

A

a) needle aspiration

b) surgical incision and drainage with washout

32
Q

What abx are indicated in breast abscess?

A

Oral flucloxacillin

33
Q

Abx in lactational vs non-lactational mastitis?

A

Lactational: oral flucloxacillin

Non-lactational: oral co-amoxiclav

34
Q

Duration of abx in mastitis?

A

10-14d

35
Q

What are 3 complications related to TPN?

A

1) sepsis

2) re-feeding syndrome

3) hepatic dysfunction

36
Q

How long after prostatitis or a UTI should a PSA be performed?

A

Wait 6 weeks

37
Q

How long after urological intervention e.g. prostate biopsy should a PSA be performed?

A

6 weeks

38
Q

What is the most commonly performed operation for rectal tumours?

A

Anterior resection (except in lower rectal tumours)

39
Q

Is male or female sterilisation a more effective method of contraception?

A

Male

40
Q

When is semen analysis typically performed post-vasectomy?

A

Semen analysis needs to be performed TWICE following a vasectomy before a man can have unprotected sex (usually at 12 weeks)

41
Q

Mx of abdominal wound dehiscence?

A

1) coverage of wound with saline impregnated gauze

2) IV broad spectrum abx (e.g. ceftrixone & metronidazole)

42
Q

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

a) loop ileostomy
b) loop colostomy

43
Q

Recognised complications of enteral feeding?

A

1) diarrhoea
2) aspiration
3) hypeglycaemia
4) refeeding syndrome

44
Q

Why is gynaecomastia a common presenting feature of testicular cancer?

A

2ary to excess hCG or oestrogen

45
Q

Mx of patients with suspected clinically localised prostate cancer?

A

2ww for multiparametric MRI

46
Q

When should you consider 2ww referral for multiparametric MRI for suspected prostate cancer?

A

1) If their prostate feels malignant on DRE

or

2) Raised PSA

47
Q

When should you consider a PSA?

A

1) LUTS
or
2) Erectile dysfucntion
or
3) Visible haematuria

48
Q

What topical anaesthetic is often used in the mx of acute anal fissures?

A

Lidocaine

49
Q

When is topical GTN typically offered in an anal fissure?

A

> 1 week

50
Q

When is ICP monitoring indicated in head injury?

A

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

51
Q

What ethnic group is prostate cancer more common in?

A

Afro-Caribbean

52
Q

Most common location of colorectal cancers?

A

Rectum (40%)

53
Q

Inheritance of Lynch syndrome?

A

Autosomal dominant

54
Q

Inheritance of FAP?

A

Autosomal dominant

55
Q

Which gene is most commonly involved in Lynch syndrome?

A

MSH2 (mismatch repair gene)

56
Q

What are the APC genes?

A

Tumour suppressor genes

57
Q

Describe screening programme for bowel cancer

A

60-74 yo –> home FIT test every 2 years

58
Q

When should a FIT test be offered?

A

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

59
Q

1st line investigation in suspected bowel cancer?

A

FIT test

If FIT result raised –> 2ww suspected cancer pathway

60
Q

What surgery is typically indicated in HNPCC?

A

panproctocolectomy

61
Q

What ethnic group are uterine fibroids more common in?

A

Afro-Caribbean women

62
Q

1st line symptomatic mx of uterine fibroids?

A

IUS

63
Q

What age does intussusception typically affect?

A

6m - 3y

64
Q

What type of oesophageal cancer can achalasia predispose to?

A

Squamous cell

65
Q

What type of oesophageal cancer can diet rich in nitrosamines predispose to?

A

Squamous cell

66
Q

Indications 2ww referral (for US) in ovarian cancer?

A

1) ascites
2) pelvic/abdo mass (which is not obviously uterine fibroids)

67
Q

Indications of Ca-125?

A

Symptoms suggestive of ovarian cancer e.g. bloating, early satiety

68
Q

Risk factors for a perianal abscess? (3)

A

1) IBD (especially Crohn’s)

2) Diabetes

3) Underlying malignancy

69
Q

Gold standard imaging in a perianal abscess?

A

MRI

70
Q

Mx of a perianal abscess?

A

1st line –> incision & drainage

abx only used if there is systemic upset 2ary to abscess

71
Q
A

Yr 5 - Surgery (6 decks)

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