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General Surgery > general > Flashcards

general Flashcards

1
Q

90% of varicose are on which side

A

left

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2
Q

is pain common in variocele

A

no, 3% will have heavy or dragging sensation

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3
Q

are abnormal semen parameters associated with variocele

A

yes

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4
Q

what should you do with a right sided variocele?

A

this is rare and should be referred to urologist

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5
Q

Epididymal cysts are the most common cause of scrotal swellings seen in primary care?

A

epididymal cysts

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6
Q

where are epididymal cysts found in relation to the testicle ?

A

posterior to the testicle (separate to the body of the testicle)

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7
Q

accumulation of fluid within the tunica vaginalis?

A

hydrocele

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8
Q

Hydroceles may develop secondary to? (3)

A

epididymo-orchitis
testicular torsion
testicular tumours

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9
Q

hydrocele is a clinical diagnosis but what should be done if there is doubt about diagnosis?

A

US

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10
Q

what are varicose associated with?

A

subfertility

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11
Q

a bag of worms?

A

variocele (80% are left sided)

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12
Q

management of variocele?

A

usually conservative

surgery can be considered if patient troubled by pain

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13
Q

bilateral variocele occurs in what percentage of cases?

A

10

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14
Q

what head injury is associated with fluctuating consciousness?

A

subdural haematoma

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15
Q

majority of extradural haematomas occur where?

A

temporal region as bones are thinner

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16
Q

features of extradural haematoma

A

lucid intervals

features of raised inter cranial pressure

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17
Q

risk factors for subdural haematoma

A

Risk factors include old age, alcoholism and anticoagulation. (subd)

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18
Q

Classically causes a sudden occipital headache

A

SAH

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19
Q

groin lump: disappears on pressure or when the patient lies down?

A

inguinal hernia

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20
Q

for inguinal hernias, what is associated with lowest recurrence rate

A

mesh repair

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21
Q

green-brown discharge and an abscess with puss discharging from the nipple?

A

duct ectasia

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22
Q

nipple discharge Blood stained discharge is most likely to be associated with

A

duct papilloma

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23
Q

what is discharge typically like in duct ectasia?

A

thick, green/brown purulent

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24
Q

in intraductal papilloma you usually get blood stained discharge. is there usually a palpable lump?

A

no

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25
Q

what kind of patients is duct papilloma more common in ?

A

younger

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26
Q

what needs to be performed twice after a vasectomy before a man can have sex?

A

semen analysis

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27
Q

can vasectomy be reversed?

A

yes, success rate is around 55%

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28
Q

1st line for chronic anal fissure?

A

topical GTN

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29
Q

the inflammation in thrombophlebitis is associated with what?

A

thrombus in the vein

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30
Q

what do you need to suspect in thrombophlebitis?

A

DVT

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31
Q

management of thrombophlebitis?

A

NSAIDS
compression stockings
topical heparinoids

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32
Q

prostate cancer - why do they not cause symptoms early on ?

A

they tend to develop in the periphery of the prostate so don’t cause obstruction etc

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33
Q

what might you find on PR exam in prostate cancer?

A

asymmetrical hard nodular enlargement with loss of median sulcus

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34
Q

which scan would be used to look for osteoblastic mets in prostate cancer?

A

isotope bone scan

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35
Q

> = 60 with recurrent or persistent UTI ?

A

referral for suspected bladder cancer

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36
Q

analgesia of choice for renal colic?

A

diclofenac

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37
Q

imaging for renal colic ?

A

US then CT

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38
Q

which diuretics cause increased risk of calcium stones?

A

thiazide

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39
Q

which ethnic groups have increased risk of prostate cancer?

A

afro carribean

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40
Q

40% of men presenting with infertility have a ?

A

variocele

41
Q

patient with thrombophlebitis should be referred for ?

A

ultrasound to rule out DVT

42
Q

testicular swelling that you cannot get above?

A

inguinal hernia

43
Q

what is seen in more than 5% of patients following a vasectomy ?

A

chronic testicular pain

44
Q

PSA levels may be raised in ?

A

benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

45
Q

circumcision reduces rate of transmission of ?

A

HIV

46
Q

indications for circumcision ?

A

phimosis
paraphimosis
BXO
recurrent balanitis

47
Q

acute management of renal colic?

A

IM diclofenac

48
Q

when do you use trustuzamab?

A

HER2 positive

49
Q

epigastric pain relieved by eating ?

A

duodenal ulcer

50
Q

which ulcer causes epigastric pain worse after eating?

A

duodenal

51
Q

AAA - diameter greater than ? is considered aneurysmal

A

3cm

52
Q

pathophysiology of AAA?

A

loss of the intima with loss of elastic fibres from the media

53
Q

most widely used LA?

A

lidocaine

54
Q

what percentage of men with raised PSA have prostate cancer?

A

1/3

55
Q

non specific dermatitis causing balanitis. treatment ?

A

topical hydrocortisone 1% once daily and an imidazole cream

56
Q

95% of testicular tumours are germ cell. How can germ cell tumours be categorised?

A

seminomas and non seminomas

57
Q

non seminomas - example ?

A

embryonal, yolk sac, teratoma and choriocarcinoma

58
Q

examples of non germ cell tumours?

A

leydig and sarcomas

59
Q

most common presentation of testicular cancer?

A

painless testicular lump in young man

60
Q

other possible features of testicular cancer?

A

gynaecomastia and hydrocele

61
Q

Klinefelter’s syndrome is a risk factor for testicular cancer. what is this?

A

condition where men have an extra X chromosome

62
Q

what kind of biopsy do you do in suspected prostate cancer?

A

TRUS guided biopsy

63
Q

BPH typically presents with what sort of symptoms ?

A

lower urinary tract

64
Q

what medications can be used in BPH?

A

alpha 1 antagonists (tamsulosin/alfuzosin)

5ar inhibitors eg finasteride

65
Q

how does tamsulosin work in BPH?

A

decreases smooth muscle tone in the prostate and bladder

66
Q

what is considered first line in BPH?

A

tamsulosin

67
Q

side effects of alpha 1 antagonists?

A

diziness, postural hypotension, dry mouth and depression

68
Q

how does finasteride work?

A

inhibits conversion of testosterone into 5HT, which is known to induce BPH

69
Q

adverse effects of finasteride ?

A

erectile dysfunction, reduced libido, ejaculation problems and gynaecomastia

70
Q

Adjuvant hormonal therapy for ER +ve breast cancer?

A

anastrazole

71
Q

if breast tumours are positive for hormone receptors, what adjuvant hormonal therapy is offered?

A

in pre and peri menopausal women - tamoxifen is used

in post menopausal women - anastrozole

72
Q

tests you carry out for erectile dysfunction

A

LFT
Lipids
Fasting glucose
Testosterone

73
Q

when can you go back to work after an inguinal hernia repair?

A

2-3 weeks

74
Q

acute and chronic prostatitis time frame?

A

3 months

75
Q

painless prostate, with a smooth and enlarged prostate on examination in combination with lower urinary tract symptoms.

A

BPH

76
Q

chronic prostatitis tx

A

quinolone

77
Q

what has better prognosis - seminoma or teratoma?

A

seminoma (teratoma terrible compared to seminoma)

78
Q

a new hydrocele may be first sign of?

A

testicular malignancy (need to ultrasound)

79
Q

wihch tumour marker can be used to monitor patients with colorectal cancer?

A

CEA

80
Q

what is usually found along with anal fissures?

A

skin tag

81
Q

men and women aged 50-74 get screening for colorectal cancer every ? years?

A

2 years

82
Q

what clock positions do haemarrhoids usually appear?

A

3 o’clock, 7 o’clock and 11 o’clock

three seven eleven

83
Q

symptomatic AAA have high risk of ?

A

rupture and should undergo endovascular repair (EVAR)

84
Q

what size is an AAA considered high rupture risk?

A

> 5.5cm, or rapidly enlarging at over 1 cm per year

85
Q

treatment of epididymo orchitis?

A

ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days

86
Q

epididymo orchitis - presentation

A

pain and swelling of the testicle

87
Q

example of quinolone antibiotics?

A

floxacin (ciprofloxacin, ofloxacin)

88
Q

treatment of prostatitis?

A

quinolone for 28 days

89
Q

most common pathogen for acute prostatitis?

A

e coli

90
Q

what drugs are not helpful in anal fissures?

A

ss

steroids

91
Q

management of an umbilical hernia in an infant ?

A

conservative management (most resolve by age 4-5)

92
Q

2 examples of anti muscarinic drugs used in over active bladder?

A

oxybutanin, tolterodine

93
Q

compression bandaging may be used as long as ABPI is above ?

A

0.8

94
Q

most likely diagnosis in a man with chronic balanitis who has Reiter’s syndrome and has a well-demarcated erythematous plaque with a ragged white border on his penis

A

Circinate balanitis

95
Q

how often is breast cancer screening done (and between what ages)

A

every three years between 50-70

96
Q

does surgery for varicose improve pregnancy rates?

A

no - it should not be offered as a form of fertility treatment

97
Q

most likely diagnosis for a lady who has recently given birth, who has painful, bright red rectal bleeding

A

anal fissure

98
Q

red flag symptoms for BPH?

A

weight loss and back pain

General Surgery (26 decks)

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