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Things I don't know, but need to know, for fourth year > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What are you allowed to have up to two hours from surgery.

A

Clear Fluids
Fruit Juice no bits
Ice Lollies
Coffee Tea no Milk

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2
Q

How long before surgery should a patient be fasted for?

A

6 hours

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3
Q

How should a patient on oral medication for well controlled diabetes be managed during surgery?

A

Take medication as normal up to day before surgery.

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4
Q

How should a patient on insulin be managed during surgery?

A

Good Glycemic control and a non invasive surgery - Control using normal methods
Poor glycemic control or invasive surgery - Variable rate insulin infusion

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5
Q

What is the advice for stopping the COCP prior to Surgery?

A

Stop 4 weeks prior

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6
Q

What diabetic mediation should be stopped the day of surgery?

A

Sulfonylurea

SGLT2i

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7
Q

What diabetic medication can be taken throughout the day of surgery?

A

DDP-4i - gliptins

GLP-1 analogues - tides

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8
Q

Whats the surgery of choice in a vaginal vault prolapse?

A

Sacrocolpopexy

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9
Q

A 3 year old presents with a large symptomatic umbilical hernia what is the management?

A

Elective repair in those with a symptomatic umbilical hernia who are presenting around 2 or 3 years old.

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10
Q

When is an asymptomatic umbilical hernia surgically managed?

A

If it hasn’t resolved by 4-5 years.

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11
Q

Describe DUKEs staging and how it relates to the management of Colon Cancer.

A

A - Doesn’t extend beyond muscularis - Hemicolectomy
B - Extends beyond muscularis but still limited to the colon - Hemicolectomy
C - Local Lymph node involvement - Surgery + Chemotherapy
D - Distant Metastasis - Surgery + Radiotherapy

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12
Q

In rectal carcinoma when is a Anterior Resection used?

A

If >8cm from anal canal or involving proximal 2/3 of rectum

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13
Q

In rectal carcinoma resection when is an Abdomino perineal method used?

A

If <8cm from anal canal or involving distal 1/3 of rectum.

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14
Q

Alongside surgery what is used in Stages III and IV in rectal carcinoma?

A

Stage III - Chemotherapy

Stage IV - Chemoradiotherapy

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15
Q

How long should most DOACs be stopped prior to surgery. What is the exception to this?

A

48 hours

Edoxaban may need 72 hours if eGFR is below 50

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16
Q

Short acting local anaesthetic

A

Lidocaine

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17
Q

Longer acting local anaesthetic

A

Bupivocaine

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18
Q

Local anaesthetic of choice in IV regional anaesthesia

A

Prilocaine

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19
Q

Inguinal hernia repair in children

A

<6 weeks - 2 day wait
<6 months - 2 week wait
<6 years - 2 month wait

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20
Q

When is endovascular surgery done in peripheral vascular disease?

A

Percutaneous transluminal angioplasty
<10cm
Aortic or iliac disease
High risk

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21
Q

When is open bypass or endarterectomy done in peripheral vascular disease?

A

> 10cm
Multifocal
Infrapopliteal

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22
Q

General rule around VTE prophylaxis in surgery?

A

Any lower limb or pelvic procedure requires LMWH from 6 house after surgery for up to a month

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23
Q

Elective hip replacement - VTE prophylaxis

A

Dalteparin from 6 hours for 28 days

TED stocking

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24
Q

Elective knee replacement - VTE prophylaxis

A

LMWH - 14 days

TED stocking

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25
Q

Fragility fracture of Hip Pelvis or Femur

A

1 month of LMWH

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26
Q

Platelets targets in surgery

A

> 50 for everything
50-75 for high risk
100 for invasive surgery, intracranial bleeds or major bleeding
Platelets transfusions are used to elevate levels

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27
Q

What test is used to categorise Varicose veins?

A

Trendelenburg - raise the leg and massage veins to empty them

  • place tourniquet at the top of the leg and ask patient to stand up
  • if vein doesn’t fill up this is a positive test
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28
Q

What does a positive Trendelenburg test indicate?

A

As the veins do not fill this indicates a saphenofemoral valve insufficiency

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29
Q

A groin swelling which disappear when lying down and is worse on coughing.
Bluish tinge

A

Sapheno Varix

30
Q

What is the commonest vein used in vein grafting?

A

Great saphenous

31
Q

If the pre assessment MRSA screen comes back positive what is done?

A

Mupirosin nasally

Chlorhexidine for the skin

32
Q

Pain Purulent discharge and fluctuant swelling at the top of the buttocks

A

Pilonidal disease

33
Q

Management of Pilonidal disease

A

Acute - incision and drainage

Chronic - Cystectomy

34
Q

Tumour arising in the caecum, ascending or proximal transverse colon.

A

Right hemicolectomy

Ileocolic anastomoses - this anastomoses doesn’t need to be defunct whilst healing.

35
Q

Tumour arising from distal transverse or descending colon.

A

Left Hemicolectomy

Colo-Colon anastomoses

36
Q

Tumour arising from sigmoid colon.

A

Anterior resection

Colo rectal anastomoses

37
Q

Tumour rising from anal verge or within 8 cm.

A

Abdominal perineal excision of the rectum.

38
Q

If any tumour has perforated what is the surgery of choice?

A

Hartmans procedure
Resect sigmoidcolon + end colostomy
End colostomy can be reversed at a later date

39
Q

Post Operative Complication - Wind Water Wound Walking

A

Days 1 - 2 = Pneumonia, PE
Days 2 - 5 = UTI
Days 5 - 7 = Wound infection or abscess
Days >5 = DVT PE etc

40
Q

When does acute limb ischaemia become critical limb ischaemia?

A

When there is tissue loss and duration of rest pain in foot for over two weeks.

41
Q

What is involved in acute limb ischaemia?

A 
6 Ps
Pulseless
Palour
Parasthesia 
Perishingly cold
Paralysed 
Pain
42
Q

What are the two causes of acute limb ischaemia?

A

Embolic disease - acute onset no preceding claudication, other leg no signs or symptoms, evidence of aneurysm above.
Thrombotic disease - preceding history of claudication, other leg shows signs of PVD,

43
Q

Management of Acute Limb Ischaemia

A

Handheld Doppler -> ABPI -> IV heparin -> vascular surgeons

44
Q

What is the name of the surgery used in Achalasia

A

Hellers Cardiotomy

45
Q

How can local anaesthetic toxicity be reversed?

A

20% lipid emulsion IV

46
Q

An isolated raised temperature within 24 hours of a surgery.

A

Likely to be physiological

47
Q

If someone is one once daily insulin. How should the be altered prior to surgery?

A

Reduce dose by 20% on the day prior to and the day of surgery.

48
Q

Most accurate way to assess burn percentage in a child?

A

Lund and Browder chart

49
Q

When are graduated compression hosiery used?

A

In non ulcerated legs

50
Q

When are compression bandages used?

A

In ulcerated or post surgical

51
Q

Management of splenic trauma

A

Conservative - analgesia and observation
- Small haematoma and minimal intra-abdominal fluid

Laparotomy with conservation - Increased intra-abdominal fluid, moderate haemodynamic instability and <50% of spleen affected

Resection - Hilar injury and major haemorrhage

52
Q

What is a Richters hernia?

A

Signs of bowel strangulation but no bowel obstruction

53
Q

Incision commonly used in C section

A

Pfannenstiel

54
Q

Incision commonly used in cholecystectomy

A

Kuchers - right subcostal margin

55
Q

Incision commonly used in appendicectomy

A

Lanz

56
Q

Incision used in emergency strangulated femoral hernia

A

Mc Evedys

57
Q

What is the commonest incision for gaining access to the abdomen?

A

Midline incision

58
Q

What is the commonest incision used in renal transplant?

A

Rutherford and Morrison

59
Q

Hydrocoele management in paediatrics

A

Refer to surgery if not closed by 1 year

60
Q

When do you refer burns to secondary care?

A

All deep dermal or full thickness
Superficial dermal - >3% TBSA in men >2% in women
- genitalia, face, hands, feet, flexural surfaces, neck and torso
All inhalation, chemical or electrical burns
Query Non accidental injury

61
Q

Wound dehiscence

A

Superficial - cover with sterile saline soaked gauze + non urgent senior review
Deep - Cover with sterile saline soaked gauze + urgent senior review

62
Q

What is the best form of analgesic control post operatively?

A

Patient controlled analgesia

63
Q

Metformin on the day of surgery?

A

If taken OD or BD - taken as normal

If taken TDS - omit lunch time dose

64
Q

Coarse of antibiotics in uncomplicated appendicitis

A

1 day IV abx is enough

65
Q

If someone is on longterm steroids how should they be managed during surgery?

A

Supplement with hydrocortisone

66
Q

What is regarded as poor glycaemic control in surgery? Indicating the need for isulin during surgery.

A

> 69

67
Q

Acute Limb ischaemia

A

< 2week duration

6 P’s

68
Q

Critical limb ischemia

A

> 2 weeks
Gangrene
Non healing wounds

69
Q

ABPI and critical limb ischaemia

A 
<0.5 = suggestive of critical limb ischaemia 
<0.3 = impending threat
70
Q

In a patient with respiratory disease what is the preferred method of post operative analgesia?

A

Epidural

Opioids should be avoided

Things I don't know, but need to know, for fourth year (31 decks)

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