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General Surgery > General Surgery 1 > Flashcards

General Surgery 1 Flashcards

1
Q

Second investigation for pneumoperitoneum is CXR not helpful?

A

CT - if stable

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2
Q

Most common cause of splenic rupture?

A

Blunt trauma - immediately or delayed

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3
Q

Investigation for suspected bowel obstruction?

A

AXR

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4
Q

Ruptured AAA - which imaging should be done before surgery if possible?

A

CT

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5
Q

Pre-operatvie management of ruptured AAA?

A

Fluid resus - aim for systolic of 100 - no higher

O-ve blood until crossmatch available

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6
Q

Approximately how many units of crossmatched blood are required during a ruptured AAA repair?

A

10

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7
Q

Primary and secondary intention healing - which is quickest?

A

Primary

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8
Q

How does healing occur in secondary intention healing?

A

From the deeper layers by granulation tissue

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9
Q

Primary and secondary healing - edges opposed or unopposed?

A

Primary - opposed

Secondary - unopposed

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10
Q

Which type of healing has the worst scarring?

A

Secondary intention

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11
Q

4 indications for splenectomy?

A

Splenic injury - trauma
Splenic rupture following splenomegaly - infectious mononucleosis
Hypersplenism - hereditary spherocytosis
Neoplasm
Infection

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12
Q

What % of idiopathic thrombocytopenia purport patients are cured by a splenectomy?

A

70%

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13
Q

Which organisms are splenectomy patients more at risk of?

A

Encapsulated - neisseria meningitides, h influenza, strep pneumoniae

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14
Q

4 symptoms of post operative adhesion obstruction of the small bowel?

A

Colicky pain, distention, constipation, vomiting

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15
Q

Management of small bowel obstruction post op?

A

Fluids, NG - most resolve spontaneously

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16
Q

Indication of urgent surgery in small bowel obstruction?

A

Strangulation - continuous pain, decreased bowel sounds fever, tachycardia

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17
Q

Oesophageal varies are secondary to what? and what else can present with this?

A

Portal hypertension

Caput medusa

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18
Q

Where is a common site of atherosclerosis?

A

At a vessel bifurcation

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19
Q

When is the pain of intermittent claudication felt?

A

After walking a set distance, always the same distance

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20
Q

Why do legs with peripheral artery disease turn red when lowered during burgers test?

A

Because ischaemia causes vasodilation so blood rushes into the legs more than normal

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21
Q

5 stages of the fontaine classification?

A 
I - asymptomatic vascular disease
II - Claudication >200m
III - Claudication <200m
IV - rest pain 
V - gangrene or ulcers
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22
Q

How is ABPI calculated?

A

Ankle pressure/brachial pressure

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23
Q

Normal ABPI?

A

0.9-1.2

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24
Q

Claudication ABPI?

A

0.4-0.85 (severe <0.4) lower pressure in the ankle

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25
Q

Why might a calcified vessel give a false ABPI reading?

A

Because it is not compressible

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26
Q

3 types of phase on doppler?

A

Triphasic - normal
Biphasic - disease
Monophasic - severe disease

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27
Q

Benefit of duplex doppler?

A

Assesses the speed of flow - blood will speed up and slow down depending on occlusions

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28
Q

Definition of critical limb ischaemia?

A

Rest pain of 2 week and tissue loss - pain particularly when lying down with feet up

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29
Q

What is acute limb ischaemia?

A

Thrombosis at the site of existing disease

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30
Q

6 P’s of acute limb ischaemia?

A 
Pain
Pulselessness
Palor
Parasthesia 
Paralysis 
Perishing cold
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31
Q

What % of amputations need to be converted to higher amputations due to non healing?

A

10-15%

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32
Q

Nerve at risk of damage during carotid endarterectomy?

A

Hypoglossal

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33
Q

Two drugs to be started in peripheral vascular disease?

A

Statin (regardless of cholesterol)

Clopidogrel

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34
Q

What intervention should be performed first in PVD?

A

Exercise training

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35
Q

Name 3 surgical options in the management of PVD?

A

Angioplasty
Stenting
Bypass surgery

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36
Q

When is AAA screening performed?

A

At 65

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37
Q

What diameter or aorta is classed as an aneurysm?

A

3cm

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38
Q

At what size should an aneurysm be surgically repaired?

A

> 5.5cm

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39
Q

What type of ulcers are diabetic patients with neuropathy more likely to get?

A

Neuropathic ulcers - at pressure points

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40
Q

What is a Marjolines ulcer?

A

A squamous cell carcinoma at the site of previous injury

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41
Q

What type of ulcer is associated with IBD?

A

Pyroderma gangrenosum

42
Q

What is the imaging of choice for osteomyelitis?

A

MRI

43
Q

What is the most common vessel used in CABG?

A

left internal mammary

44
Q

What might cause a groin swelling after vascular surgery?

A

Femoral artery aneurysm

45
Q

Name 1 sign of a dissected thoracic aneurysm?

A

Different BP’s on each arm

46
Q

Which vessels are affected in burgers disease?

A

Small and medium sized arteries, often tibial and radial

47
Q

Name 1 non vascular examination to be done in the case of varicose veins?

A

Abdominal examination - can be caused by abdominal mass e.g. pregnancy

48
Q

Which nerve palsy is the most common in cavernous venous sinus thrombosis?

A

6th nerve palsy

49
Q

What causes hyper pigmentation in a venous ulcer?

A

haemosidirin

50
Q

Where is the most common site for a AAA?

A

Infra renal

51
Q

What are the two options in repairing a AAA?

A

Open repair or EVAR
Open is higher risk - but better for younger fitter patients
EVAR - better for older patients with short life expectancy

52
Q

What causes varicose veins?

A

Failure of the venous valves causes back flow in to the superficial venous system and high venous pressure

53
Q

What are the 3 options of treatment for varicose veins?

A

Compression stockings
Sclerotherapy
Surgery

54
Q

What two points does the inguinal canal run between?

A

Deo inguinal ring and superficial ring

55
Q

What is the contents of the inguinal canal (male)?

A

3 arteries - vas deferens, testicular, cermasteric
3 fascial layers
3 others - pampiniform plexus, vas deferens, lymphatics
3 nerves - genital, sympathetic, ilioinguinal

56
Q

What is in the inguinal canal (female)?

A

Ilioinguinal nerve and round ligament

57
Q

What are the borders of the inguinal canal?

A

Superior -internal oblique, tranversus abdominus
Anterior - 2 aponeurosis - internal and external oblique
Inferior - 2 ligaments - inguinal and lacunar
Posterior (2T’s) - transversals fascia, conjoint tendon

58
Q

Where does the inguinal ligament attach?

A

ASIS and pubic tubercle

59
Q

What two factors are needed to form a hernia?

A

Weakness and an increase in pressure

60
Q

What happens in a strangulated hernia?

A

There is a compromise to the blood supply

61
Q

What happens in an incarcerated hernia?

A

The hernia is stuck in its sac

62
Q

Name 3 risk factors for inguinal hernias?

A 
Chronic cough
Overweight
Increased age
Male gender
Collagen disorders
63
Q

What forms the sac of the hernia?

A

A protrusion of peritoneum

64
Q

Where are inguinal hernias located anatomically?

A

Above the level of the pubic tubercle

65
Q

Where are indirect and direct inguinal hernias in relation to the inferior epigastric artery?

A

Indirect - lateral

Direct - medial

66
Q

Do indirect or direct hernias reach the scrotum?

A

Indirect - possible

Direct - rarely

67
Q

Indirect and direct hernias, most common in which age groups?

A

Direct - older patients

Indirect - younger, may be congenital

68
Q

Which type of hernia travels along the inguinal canal?

A

Indirect inguinal hernia

69
Q

Which type of hernia pushes from behind the inguinal canal?

A

Direct inguinal hernia

70
Q

What are the borders of the femoral Canal?

A

Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament

71
Q

Where are femoral hernias anatomically?

A

Below and lateral to the pubic tubercle

72
Q

Which gender is more at risk of femoral hernias?

A

Female

73
Q

Why should femoral hernias be fixed more quickly?

A

Higher risk of complications, risk of small bowel obstruction

74
Q

What is a herniorraphy?

A

Surgical repair of abdominal wall with a suture

75
Q

What is herniotomy?

A

Excision of hernial sac after reducing contents

76
Q

If there is a recurrence of a hernia how should it be fixed?

A

in the opposite way from original repair

77
Q

Which nerve is at risk of damage during inguinal hernia repair?

A

Ilioinguinal

78
Q

What are the categories of surgical complications?

A

Local - immediate, early, late

Systemic - immediate, early, late

79
Q

What is a Madyl’s hernia?

A

W shaped hernia, patient may be very unwell

80
Q

What is a differential diagnosis for groin swelling in an IVDU?

A

Pseudoaneurysm

81
Q

What adjuvant treatment is given after all WLE’s in breast cancer?

A

Radiotherapy

82
Q

When is hormonal therapy given in breast in cancer?

A

If oestrogen receptor positive +ve

83
Q

What 2 drugs are used at hormonal therapy in breast cancer?

A

Pre and peri menopausal - Tamoxifen

Post menopausal - Aromatase inhibitors e.g. anastrozole

84
Q

Name 3 side effects of hormonal therapy in breast cancer?

A

Endometrial cancer risk
VTE
Menopausal symptoms

85
Q

When is biological therapy used in breast cancer?

A

When HER2 positive

86
Q

Name 1 biological drug used in breast cancer?

A

Tastuzumab

87
Q

What is CA125 a marker of?

A

Ovarian cancer

88
Q

What is CA 19-9 a marker of?

A

Pancreatic cancer

89
Q

What is Ca 15-3 a marker of?

A

Breast cancer

90
Q

What is AFP a marker of?

A

HCC and teratoma

91
Q

What is CEA a marker of?

A

Colorectal carcinoma

92
Q

What is Thumb printing on AXR suggestive of?

A

Mesenteric ischaemia

93
Q

What is ascending colangitis?

A

Bacterial infection of the biliary tree

94
Q

What is the most common cause of extra dural haematoma?

A

Trauma

95
Q

Name 2 causes of subdural haematoma?

A

Old age
Alcoholism
Anti coagulation

96
Q

When should you do a CT in a patient with head injury while on warfarin?

A

Within 8 hours - if no obvious signs of bleed

97
Q

What is the most common type of oesophageal cancer and what is associated with?

A

Adenocarcinoma - GORD and Barrets

Used to be squamous - smoking

98
Q

What topical treatment is used for anal fissures?

A

GTN

99
Q

Where does a marjolin ulcer arise from?

A

Site of previous injury

100
Q

What type of cancer is pancreatic?

A

Adenocarcinoma

General Surgery (2 decks)

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