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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
Why might a calcified vessel give a false ABPI reading?
Because it is not compressible
26
3 types of phase on doppler?
Triphasic - normal Biphasic - disease Monophasic - severe disease
27
Benefit of duplex doppler?
Assesses the speed of flow - blood will speed up and slow down depending on occlusions
28
Definition of critical limb ischaemia?
Rest pain of 2 week and tissue loss - pain particularly when lying down with feet up
29
What is acute limb ischaemia?
Thrombosis at the site of existing disease
30
6 P's of acute limb ischaemia?
``` Pain Pulselessness Palor Parasthesia Paralysis Perishing cold ```
31
What % of amputations need to be converted to higher amputations due to non healing?
10-15%
32
Nerve at risk of damage during carotid endarterectomy?
Hypoglossal
33
Two drugs to be started in peripheral vascular disease?
Statin (regardless of cholesterol) | Clopidogrel
34
What intervention should be performed first in PVD?
Exercise training
35
Name 3 surgical options in the management of PVD?
Angioplasty Stenting Bypass surgery
36
When is AAA screening performed?
At 65
37
What diameter or aorta is classed as an aneurysm?
3cm
38
At what size should an aneurysm be surgically repaired?
>5.5cm
39
What type of ulcers are diabetic patients with neuropathy more likely to get?
Neuropathic ulcers - at pressure points
40
What is a Marjolines ulcer?
A squamous cell carcinoma at the site of previous injury
41
What type of ulcer is associated with IBD?
Pyroderma gangrenosum
42
What is the imaging of choice for osteomyelitis?
MRI
43
What is the most common vessel used in CABG?
left internal mammary
44
What might cause a groin swelling after vascular surgery?
Femoral artery aneurysm
45
Name 1 sign of a dissected thoracic aneurysm?
Different BP's on each arm
46
Which vessels are affected in burgers disease?
Small and medium sized arteries, often tibial and radial
47
Name 1 non vascular examination to be done in the case of varicose veins?
Abdominal examination - can be caused by abdominal mass e.g. pregnancy
48
Which nerve palsy is the most common in cavernous venous sinus thrombosis?
6th nerve palsy
49
What causes hyper pigmentation in a venous ulcer?
haemosidirin
50
Where is the most common site for a AAA?
Infra renal
51
What are the two options in repairing a AAA?
Open repair or EVAR Open is higher risk - but better for younger fitter patients EVAR - better for older patients with short life expectancy
52
What causes varicose veins?
Failure of the venous valves causes back flow in to the superficial venous system and high venous pressure
53
What are the 3 options of treatment for varicose veins?
Compression stockings Sclerotherapy Surgery
54
What two points does the inguinal canal run between?
Deo inguinal ring and superficial ring
55
What is the contents of the inguinal canal (male)?
3 arteries - vas deferens, testicular, cermasteric 3 fascial layers 3 others - pampiniform plexus, vas deferens, lymphatics 3 nerves - genital, sympathetic, ilioinguinal
56
What is in the inguinal canal (female)?
Ilioinguinal nerve and round ligament
57
What are the borders of the inguinal canal?
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
Where does the inguinal ligament attach?
ASIS and pubic tubercle
59
What two factors are needed to form a hernia?
Weakness and an increase in pressure
60
What happens in a strangulated hernia?
There is a compromise to the blood supply
61
What happens in an incarcerated hernia?
The hernia is stuck in its sac
62
Name 3 risk factors for inguinal hernias?
``` Chronic cough Overweight Increased age Male gender Collagen disorders ```
63
What forms the sac of the hernia?
A protrusion of peritoneum
64
Where are inguinal hernias located anatomically?
Above the level of the pubic tubercle
65
Where are indirect and direct inguinal hernias in relation to the inferior epigastric artery?
Indirect - lateral | Direct - medial
66
Do indirect or direct hernias reach the scrotum?
Indirect - possible | Direct - rarely
67
Indirect and direct hernias, most common in which age groups?
Direct - older patients | Indirect - younger, may be congenital
68
Which type of hernia travels along the inguinal canal?
Indirect inguinal hernia
69
Which type of hernia pushes from behind the inguinal canal?
Direct inguinal hernia
70
What are the borders of the femoral Canal?
Anterior - inguinal ligament Medial - lacunar ligament Lateral - femoral vein Posterior - pectinate ligament
71
Where are femoral hernias anatomically?
Below and lateral to the pubic tubercle
72
Which gender is more at risk of femoral hernias?
Female
73
Why should femoral hernias be fixed more quickly?
Higher risk of complications, risk of small bowel obstruction
74
What is a herniorraphy?
Surgical repair of abdominal wall with a suture
75
What is herniotomy?
Excision of hernial sac after reducing contents
76
If there is a recurrence of a hernia how should it be fixed?
in the opposite way from original repair
77
Which nerve is at risk of damage during inguinal hernia repair?
Ilioinguinal
78
What are the categories of surgical complications?
Local - immediate, early, late | Systemic - immediate, early, late
79
What is a Madyl's hernia?
W shaped hernia, patient may be very unwell
80
What is a differential diagnosis for groin swelling in an IVDU?
Pseudoaneurysm
81
What adjuvant treatment is given after all WLE's in breast cancer?
Radiotherapy
82
When is hormonal therapy given in breast in cancer?
If oestrogen receptor positive +ve
83
What 2 drugs are used at hormonal therapy in breast cancer?
Pre and peri menopausal - Tamoxifen | Post menopausal - Aromatase inhibitors e.g. anastrozole
84
Name 3 side effects of hormonal therapy in breast cancer?
Endometrial cancer risk VTE Menopausal symptoms
85
When is biological therapy used in breast cancer?
When HER2 positive
86
Name 1 biological drug used in breast cancer?
Tastuzumab
87
What is CA125 a marker of?
Ovarian cancer
88
What is CA 19-9 a marker of?
Pancreatic cancer
89
What is Ca 15-3 a marker of?
Breast cancer
90
What is AFP a marker of?
HCC and teratoma
91
What is CEA a marker of?
Colorectal carcinoma
92
What is Thumb printing on AXR suggestive of?
Mesenteric ischaemia
93
What is ascending colangitis?
Bacterial infection of the biliary tree
94
What is the most common cause of extra dural haematoma?
Trauma
95
Name 2 causes of subdural haematoma?
Old age Alcoholism Anti coagulation
96
When should you do a CT in a patient with head injury while on warfarin?
Within 8 hours - if no obvious signs of bleed
97
What is the most common type of oesophageal cancer and what is associated with?
Adenocarcinoma - GORD and Barrets | Used to be squamous - smoking
98
What topical treatment is used for anal fissures?
GTN
99
Where does a marjolin ulcer arise from?
Site of previous injury
100
What type of cancer is pancreatic?
Adenocarcinoma

General Surgery (2 decks)

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