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Revision > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Dysphagia + regurgitation of stale food + halitosis
Dx
Investigation

A

Zenker’s diverticulum - pharyngeal pouch

Barium swallow - endoscopy is contraindicated

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2
Q

Old age patient with worsening dysphagia - for solids and then for soft foods and liquids
Long-standing gastric reflux
Suspect?

A

Oesophageal carcinoma

  • barium swallow = irregular narrowing + proximal shouldering
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3
Q

Most common type of oesophageal ca

A

Adenocarcinoma

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4
Q

How is dx of oesophageal ca made

A

Upper GI endoscopy + biopsy

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5
Q

RFs for oesophageal ca (2)

A

GERD

Barrett’s oesophagus

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6
Q

Features of gastric carcinoma

A

Virchows node
Wt loss old age tiredness vomiting dyspepsia anemia
May have associated hepatomegaly and ascites

Late stage metastasises to liver

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7
Q

RFs gastric carcinoma (6)

A 
Old age 
Blood group A
H pylori
Smoking 
Spicy food
Pernicious anemia
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8
Q

Haemoglobin levels before surgery

  • elective
  • emergency
A

Elective :
<10 - delay , investigate anemia
<8 -transfuse and defer surgery

Emergency
<10 - proceed with surgery
<8 - transfuse blood + proceed with surgery

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9
Q

Causes of hypercalcemia

A

Multiple myeloma
Sarcoidosis
SCC of lung
Breast and prostate ca

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10
Q

Diverticulosis mainly occurs on

A

Sigmoid colon - left lower abdomen

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11
Q

Analgesia after open surgery

A

Patient controlled analgesia with morphine

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12
Q

Operating on patients with history of MI

A

No elective surgery fro at least 6 months after MI

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13
Q

Features of obstructive jaundice

A

Jaundice, dark urine, pale stools

Raised ALP

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14
Q

Most appropriate investigation obstructive jaundice

A

US abdomen

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15
Q

Causes of obstructive jaundice

A

Choledolithiasis
Cancer head of pancreas - painless jaundice
Periampullary tumour

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16
Q

Feared complication of hemicolectomy

A

Anastomotic leak

- 5-10 days after surgery

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17
Q

RFs for anastomotic leak

A 
DM
Smoking
Immunocompromised - RA, asthma, COPD, steroid use 
Rectal anastomoses 
Peritoneal contamination
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18
Q

Complications of an anastomotic leak

A

Intra-abdominal abscess
Peritonitis

  • start BSA and do CT abdo pelvis with contrast
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19
Q

Investigation done for suspected colorectal ca

A

Colonoscopy

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20
Q

Presentations of colorectal ca
Left
Right

A

Left -
obstructive sx, changes in bowel habits, dark blood per rectum
+anemia + wt loss

Right - caecal
Microscopic bleeding, obstructive sx less common as diameter is wider

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21
Q

Abscess at site of skin suture

Treatment

A

Local exploration

ABx and drainage

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22
Q

Chariots triad seen in

A

FRJ
Fever + right upper abdominal pain + jaundice

Ascending cholangitis

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23
Q

Reynolds Pentad

A

Charcot’s + confusion + hypotension

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24
Q

Management of ascending cholangitis

A

Broad spectrum antibiotic - ampicillin-sulbactam

Biliary drainage

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25
Q

Complications of thyroidectomy (4)

A

Hypocalcemia - parathyroid damage/removal

Acute airway obstruction - hematoma
= evacuate hematoma

Nerve injury

  • unilateral to RLN - hoarseness
  • bilateral to RLN- aphonia, airway obstruction
  • ext branch sup laryngeal - dysphonia = loss of high pitched sounds = monotone

Wound infection

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26
Q

Rare and serious complication of hypocalcemia

A

Impetigo herpetiform

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27
Q

ECG findings hypocalcemia

A

Prolonged QT

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28
Q

Treatment of hypocalcemia

A

10 ml 10% calcium gluconate

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29
Q

Thyroid storm
Cause
Features

A

Manipulation of thyroid during surgery in hyperthyroid pt

Tachycardia, palpitation, high body temperature, diarrhoea, vomiting, reduced consciousness, tremors

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30
Q

Treatment of thyroid storm

A

Beta blockers - propanolol
- control tachy and tremors

High dose steroids - inhibits T4 to T3 conversion

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31
Q

Features of acute mesenteric ischemia

Causes

A

Sudden onset severe abd pain + tenderness - exceed physical signs
Abd distension + absent bowel sounds
VBG lactate is HIGH
Gangrene irreversible

AF - emboli occlude blood supply of large segment of mesentery
MI pt develops hypotension>low blood reaching mesentery

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32
Q

Treatment of acute mesenteric ischemia

A

O2

IV fluids, analgesia, antibiotics and then urgent surgery

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33
Q

Ischemic colitis
Features
Cause

A

Transient interruption of blood supply to colon
Gradual onset - over hours
Pain and tenderness = mod -severe, usually starts at LIF
+- bloody diarrhoea

Cause= multi factorial - HF, MI, shock etc

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34
Q

Treatment of ischemic colitis

A

Conservative or surgical management

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35
Q

Respiatory alkalosis while on oxygen face mask

Next step

A

= hyperoxemia

Reduce O2

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36
Q

Post op oliguria
Investigation
Management

A

Usually happens after epidural analgesia
Post void residual volume on bladder scan
If > 500 - re insert catheter

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37
Q

Post op - hypotensive and oliguric

A

Iv fluid challenge

Might be internal bleeding or acute renal injury

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38
Q

RFs for anorectal abscess (3)

A

DM
Immunocompromised
Chromes disease

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39
Q

Perianal fistula management

A

Superficial (simple/low fistula)
= lay open (fistulotomy)

Deep (complex/high)
- crosses internal and external sphincters
= seton suture, ligation on inter-sphincteric fistula tract

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40
Q

Diabetic pre-op management
(T2DM)
Major surgery
Minor surgery

A

Major
- stop oral hypoglycemic before surgery

Minor
- continue same routine

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41
Q

Diabetic pre-op management
(T1DM)
Major surgery
Minor surgery

A

Major
= sliding scale IV insulin before surgery , continue until diet per mouth restored
Or start IV insulin, dextrose and saline pre-op

Minor
= omit insulin on day of surgery

42
Q

No gastric bubbles seen

A

Oesophageal atresia

43
Q

Single bubble sign

A

Gastric/pyloric atresia

44
Q

Double bubble sign

A

Duodenal atresia

45
Q

Triple bubble sign

A

Jejunal atresia

46
Q

Post natal Xray shows NGT coiled in oesophagus

A

Oesophageal atresia

47
Q

RFs of rectal ca

A 
FHx
Smoking
Polyposis syndromes
Low fibre diet 
IBD
48
Q

Common precipitating factors of diverticulosis

A

Low fibre diet

Age > 50 Y

49
Q

Management of bleeding diverticulitis

A

Urgent surgical ward admission
FBC, CRP
Colonoscopy to correct/stop bleeding

50
Q

Haemorrhoid grading (4)

A

1- bleeding no prolapse
2- prolapse with delectation ; spontaneous reduction
3- prolapse with delectation - needs manual reduction
4- prolapsed, incarcerated - can’t be manually reduced

51
Q

Acute gastric distension/dilatation
Cause
Management

A

Blood supply of stomach affected in certain abdominal surgeries
Accumulation of air inside stomach

NGT insertion - deflate stomach

52
Q

How can acute gastric distension cause hypotension

A

Dilated stomach can compress surrounding vessels incl aorta so blood pressure drops

53
Q

Treatment of carpal tunnel

A

Cute transverse carpal ligament

Aka flexor retinaculum/anterior annular ligament

54
Q

Management of acute anal fissure (<6 wks)

A 
Huber high fluid diet 
Bulk forming laxative s- Lactulose
Petroleum jelly before defecating
Topical anaesthetics
Analgesia
55
Q

Chronic canal fissure management

A

Same as acute
GTN - 1st line for chronic anal fissure
If not effective after 8 weeks - 2ry referral for sphincterotomy or Botox

56
Q

Inguinal vs femoral hernia

A

Inguinal - above + medial to pubic tubercle , cough impulse, reducible
More in males

Femoral - below and lateral, rarely has cough impulse, irreducible (femoral canal is narrow)
- more in female , strangulate easily, below inguinal ligament

57
Q

RFs for inguinal hernias

A 
Male
Lifting heavy objects 
Old age
Chronic cough 
Prev abd surgery
58
Q

Types of inguinal hernia

A

Indirect - Passes through Deep and superficial inguinal ring , lies lateral to inf epigastric a.

Direct - passes through posterior wall of inguinal canal
Lies medial to inferior epigastric a.

59
Q

Cause of paralytic ileus (7)

A 
Post op complication
Electrolyte imbalance - hypokalemia, hypERcalcemia 
Anticholinergics
Post trauma 
Opiates 
Peritonitis
Immobilisation
60
Q

Features of paralytic ileus

A

Abd distension - bloated no passing of flatus
Absent bowel sound s
Nausea, vomiting

61
Q

Treatment of paralytic ileus

A

NGT and IV fluids

62
Q

When should WBCs and CRP be repeated post op

A

After 24 hrs

63
Q

Prophylactic ABx given before surgery of colon/rectum

A

Cefuroxime + metronidazole

Given within 30 mins of first incision or at anaesthesia induction

64
Q

Tumour marker for hepatocellular ca

A

AFP

  • is also a tumour marker for teratoma
65
Q

Perianal hematoma

Treatment

A

Analgesics

Self resolving

66
Q

Post thyroidectomy +SOB + stridor

Treatment

A

Cut subcutaneous sutures to relieve pressure

Consider intubation

67
Q

Dunphy sign

A

Increased pain with any coughing or movement.

Appendicitis

68
Q

Greatest risk factors for colorectal ca

A

Old age

Family history

69
Q

Greatest risk of urinary bladder ca

A

Smoking

70
Q

Sigmoid ca vs caecal ca

A

Sigmoid - left lower abdominal pain/mass + bleeding PR

Caecal - rt lower abdominal pain/mass
No bleeding PR

Both have old age, weight loss and anemia in common

71
Q

Commonest site of ischemic colitis

A

Splenic flexure and rectosigmoid

  • this area has fewer collaterals (weak spots / watersheds)
72
Q

Fluid filled mass in midline of the neck , moves upwards on tongue protrusion on swallowing
Likely dx?
Most appropriate investigation

A

Thyroglossal cyst

US

73
Q

Features of oropharyngeal ca

A

Lump/ulcer in mouth or throat
Referred otalgia
Persistent sore throat and painful swallowing
Typically old and a smoker

74
Q

Features of nasopharyngeal ca

A

Swollen cervical LNs
Eustachian tube obstruction - Otitis media, epistaxis, nasal obstruction
CHL, tinnitus

75
Q

RFs nasopharyngeal ca

A

EBV
Smoking
Alcohol

76
Q

Features of tonsil ca

A

Persistent sore throat
Progressive hoarseness
Dysphagia + painful swallowing
Palpable lump on ant lateral neck

77
Q

Tonsil ca spreads to

A

Mandible

Trismus + throat pain

78
Q

Features of Quinsy

A 
Trismus 
Saliva dribbling
Otalgia
Hot potato voice
Uvular deviation 
Red and inflamed bulge above and lateral to tonsil
79
Q

Plummer Vinson is common in

A

Postmenopausal women

It’s a RF for oropharyngeal ca

80
Q

Pt not breathing after being exposed to burn
Intubation has failed
What is the next step

A

Cricothyroidotomy

- cricothyroid membrane pierced

81
Q

Noisy hyperactive bowel sounds + constipation
Abd pain and distension
Likely dx
Next best step

A

Intestinal obstruction
IV fluids, analgesics order XR - multiple air fluid levels
Urgent referral to surgical ward

82
Q

Head of pancreas ca

Features

A 
Back pain
Wt loss, hx of smoking, alcohol
Obstructive jaundice 
= raised total and conjugated bilirubin 
Pale stool, dark urine, pruritus , raised ALP 
Abnormal LFTs
High blood glucose
83
Q

Head of pancreas ca vs cholangiocarcinoma

A

CC - pain in RUQ
P - pain in back

Blood glucose elevation only seen in pancreatic ca

CC = jaundice weight loss and RUQ pain

84
Q

Head of pancreas ca
Initial investigation
Investigation of choice

A

US

HRCT-IOC

85
Q

What used to assess prognosis of head of pancreas ca

A

CA 19-9

86
Q

Management of head of pancreas ca

A

W/o. Mets - whipples resection
= panceaticoduodenectomy

W/ mets - palliative ERCP with stent

87
Q

Colorectal screening

A

Fecal immunochemicaltest
60-74 = every 2 years = England
50-75 - in Scotland

88
Q

Cervical ca screening

A

Pap smear - cytology HPV
25-49 YO - every 3 years
50-64 Y - every 5 years

89
Q

Which hernia can descend into scrotum

A

Indirect inguinal hernia

90
Q

Common causative organism of breast abscess

A

S.aureus

91
Q

Courvoisiers sign

A

Non tender palpable distended gallbladder

Seen in pancreatic ca

92
Q

Testis ca

Request ____

A

Lactate dehydrogenase

93
Q

What increases risk of testicular ca* by x10

A

Hx of undescended testis

*seminoma esp , request LDH

94
Q

Treatment of bowel obst caused by advance malignancy or chemo

A

Palliative colostomy

95
Q

Most common site of fistula in Crohn’s disease

A

Rectovaginal - female

Male - bladder + rectum

96
Q

Surgical management of inguinal hernia

A

1st time - open repair with prosthetic mesh , placed posterior to the cord structures

Recurrent - laparoscopic approach , mesh

97
Q

Femoral hernia vs inguinal hernia management

A

Inguinal -
Surgery not required unless symptomatic or irreducible

Femoral - surgical repair even if asymptomatic

98
Q

Splenectomy vaccines

A

Pneumococcal + meningococcal. Vaccine
= pre splenectomy
*also given every 5 years after splenectomy

Influenza vaccine
= post splenectomy
* all hyposplenic or asplenic plts should receive this vaccine annually , best time is autumn Oct-Nov

99
Q

IDA is common presentation of what ca

A

Colon ca - right sided

Left sided too + blood in stool

100
Q

Newly formed ulcer on top of SCC

Think

A

SCC

101
Q

Suspected appendicitis

  • hemodynamically stable male/female
  • unstable
A

Unstable- theatre, exploaratory laparotomy y

Stable
- young fit male - threatre - laparoscopic
- young fit female - US, then take to theatre
= r/o gyne cause

Anyone >50 Y - CT to r/o cancer

102
Q

Most common type of colorectal ca

A

Adenocarcinoma

Revision (31 decks)

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