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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
Fragility fracture of Hip Pelvis or Femur
1 month of LMWH
26
Platelets targets in surgery
>50 for everything 50-75 for high risk >100 for invasive surgery, intracranial bleeds or major bleeding Platelets transfusions are used to elevate levels
27
What test is used to categorise Varicose veins?
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
28
What does a positive Trendelenburg test indicate?
As the veins do not fill this indicates a saphenofemoral valve insufficiency
29
A groin swelling which disappear when lying down and is worse on coughing. Bluish tinge
Sapheno Varix
30
What is the commonest vein used in vein grafting?
Great saphenous
31
If the pre assessment MRSA screen comes back positive what is done?
Mupirosin nasally | Chlorhexidine for the skin
32
Pain Purulent discharge and fluctuant swelling at the top of the buttocks
Pilonidal disease
33
Management of Pilonidal disease
Acute - incision and drainage | Chronic - Cystectomy
34
Tumour arising in the caecum, ascending or proximal transverse colon.
Right hemicolectomy | Ileocolic anastomoses - this anastomoses doesn't need to be defunct whilst healing.
35
Tumour arising from distal transverse or descending colon.
Left Hemicolectomy | Colo-Colon anastomoses
36
Tumour arising from sigmoid colon.
Anterior resection | Colo rectal anastomoses
37
Tumour rising from anal verge or within 8 cm.
Abdominal perineal excision of the rectum.
38
If any tumour has perforated what is the surgery of choice?
Hartmans procedure Resect sigmoidcolon + end colostomy End colostomy can be reversed at a later date
39
Post Operative Complication - Wind Water Wound Walking
Days 1 - 2 = Pneumonia, PE Days 2 - 5 = UTI Days 5 - 7 = Wound infection or abscess Days >5 = DVT PE etc
40
When does acute limb ischaemia become critical limb ischaemia?
When there is tissue loss and duration of rest pain in foot for over two weeks.
41
What is involved in acute limb ischaemia?
``` 6 Ps Pulseless Palour Parasthesia Perishingly cold Paralysed Pain ```
42
What are the two causes of acute limb ischaemia?
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
Management of Acute Limb Ischaemia
Handheld Doppler -> ABPI -> IV heparin -> vascular surgeons
44
What is the name of the surgery used in Achalasia
Hellers Cardiotomy
45
How can local anaesthetic toxicity be reversed?
20% lipid emulsion IV
46
An isolated raised temperature within 24 hours of a surgery.
Likely to be physiological
47
If someone is one once daily insulin. How should the be altered prior to surgery?
Reduce dose by 20% on the day prior to and the day of surgery.
48
Most accurate way to assess burn percentage in a child?
Lund and Browder chart
49
When are graduated compression hosiery used?
In non ulcerated legs
50
When are compression bandages used?
In ulcerated or post surgical
51
Management of splenic trauma
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
What is a Richters hernia?
Signs of bowel strangulation but no bowel obstruction
53
Incision commonly used in C section
Pfannenstiel
54
Incision commonly used in cholecystectomy
Kuchers - right subcostal margin
55
Incision commonly used in appendicectomy
Lanz
56
Incision used in emergency strangulated femoral hernia
Mc Evedys
57
What is the commonest incision for gaining access to the abdomen?
Midline incision
58
What is the commonest incision used in renal transplant?
Rutherford and Morrison
59
Hydrocoele management in paediatrics
Refer to surgery if not closed by 1 year
60
When do you refer burns to secondary care?
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
Wound dehiscence
Superficial - cover with sterile saline soaked gauze + non urgent senior review Deep - Cover with sterile saline soaked gauze + urgent senior review
62
What is the best form of analgesic control post operatively?
Patient controlled analgesia
63
Metformin on the day of surgery?
If taken OD or BD - taken as normal | If taken TDS - omit lunch time dose
64
Coarse of antibiotics in uncomplicated appendicitis
1 day IV abx is enough
65
If someone is on longterm steroids how should they be managed during surgery?
Supplement with hydrocortisone
66
What is regarded as poor glycaemic control in surgery? Indicating the need for isulin during surgery.
>69
67
Acute Limb ischaemia
< 2week duration | 6 P's
68
Critical limb ischemia
> 2 weeks Gangrene Non healing wounds
69
ABPI and critical limb ischaemia
``` <0.5 = suggestive of critical limb ischaemia <0.3 = impending threat ```
70
In a patient with respiratory disease what is the preferred method of post operative analgesia?
Epidural | Opioids should be avoided

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

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