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PlusM > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Boundaries of Hesselbach’s Triangle

A

Medial: Rectus abdominis
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament

MR LI II

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2
Q

Contents of the inguinal canal:

A

Spermatic cord (round ligament) + llioinguinal nerve

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3
Q

This is medial to the inferior epigastric artery

A

Direct inguinal hernia

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4
Q

This is lateral to the inferior epigastric artery

A

Indirect inguinal hernia

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5
Q

are ABOVE and medial to the pubic tubercle

A

Inguinal hernias

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6
Q

BELOW and lateral

A

femoral hernias

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7
Q

has impulse on coughing

A

Inguinal hernias

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8
Q

are usually irreducible (due to the narrow femoral canal)
and cough impulses are rarely detectable

A

Femoral hernias

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9
Q

Only they can extend into the scrotum

A

Indirect inguinal hernias

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10
Q

Incarcerated:

A

fixed to the wall

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11
Q

Strangulated:

A

obstructed bl. supply

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12
Q

Femoral hernia

A

(NAVY VAN

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13
Q

Groin hernias differences

A
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14
Q

Breast Anatomy

A
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15
Q

Breast cancer

A

Invasive ductal carcinoma.

Other types are
classified as ‘Special Type
Invasive lobular carcinoma
Ductal carcinoma-in-situ (DCIS)
Lobular carcinoma-in-situ (LCIS)

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16
Q

This is the most common type of breast
cancer. been renamed ‘No Special Type (NST).

A

Invasive ductal carcinoma.

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17
Q

One of the predisposing factors:
40% lifetime risk of breast/ovarian cancer

A

BRCA1, BRCA2 genes

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18
Q

Other predisposing factors:

A

1st-degree relative premenopausal relative with breast cancer (e.g. mother)

Nulliparity, 1st pregnancy > 30 years (twice risk of women having 1st child < 25 years)

Early menarche, late menopause (risk increases with more menstrual cycles as the breast undergoes division and apoptosis, which increases the risk of genetic mutation and tumor formation)

Combined hormone replacement therapy (relative risk increase * 1.023/year of use), COCP

Past breast cancer

Not breastfeeding

ionizing radiation

p53 gene mutations

Obesity

Previous surgery for benign disease (more follow-up, scar hides lump)

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19
Q

Decreased risk

A

Early pregnancy
Longer time breastfeeding

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20
Q

Management of Breast Cancer

A

1) Surgery: Around two-thirds of tumors can be removed with a wide-local excision.

Mastectomy x
® Multifocal tumor e
® Central tumor
® Large lesion in small breast
® DCIS >4cm

Wide Local Excision
®Solitary lesion
® Peripheral tumor
® Small lesion in large breast
® DCIS<4cm

2) Radiotherapy: to reduce recurrence.

3) Hormonal therapy: when tumor cells have hormone receptors, it blocks the effects of the hormones such as estrogen. Tamoxifen in pre-menopausal, in post-menopausal, aromatase inhibitors such as anastrozole (side-effects of tamoxifen include an increased risk of endometrial cancer, venous thromboembolism and menopausal symptoms)

4) Biological therapy: Trastuzumab, useful for HER-2 positive. Noting that it cannot be used in cardiac patients

5) Chemotherapy

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21
Q

Invasive ductal carcinoma extending to the epithelium

A

Breast ca
(Invasive Intraductal)

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22
Q

In situ carcinoma involving the nipple epidermis

A

Paget’s disease of the breast

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23
Q

Well-circumscribed lump with clear margins and separate from the
surrounding fatty tissue, there’s overgrowth of fibrous and glandular
tissue

A

Fibroadenoma

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24
Q

Fibrosis + epitheliosis with cystic formation

A

FbroadnoCIS

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25
Q

Cystic formation with mild epithelial hyperplasia in ducts

A

Fibrocystic changes of the breast

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26
Q

Breast cancer screening
* Women aged 50-74 years are offered mammogram

A

every 2 years

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27
Q

Breast cancer screening
* In high risk group, mammogram would be offered annually from ages

A

40-69

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28
Q

Core biopsy =

A

tru-cut biopsy

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29
Q

Sentinel LN biopsy is done

A

staging

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30
Q

Triple assessment of the breast

A
  1. Clinical
  2. Radiology
  • <35-= USG
  • > 35 = Mammogram
    3. FNAC
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31
Q

USG

A

is used in young patients instead of mammograms due to increased tissue density which reduces sensitivity and specificity of a mammography

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32
Q

There’re four instances in which prophylactic mastectomy is advised:

A
  1. Strong family history of breast cancer
  2. Presence of gene mutations (BRCA1 or BRCA2)
  3. Previous cancer in one breast
  4. Biopsies showing lobular carcinoma in situ and/ or atypical hyperplasia of the skin
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33
Q

Remember these are offered in cases in which patients has a strong family history and has genetic markers for the cancer

A

prophylactic bilateral mastectomies and prophylactic bilateral oophorectomies

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34
Q

Axillary lymph node clearance

Indications

A

+ Positive sentinel lymph node biopsy (SLNB)
* Invasive breast cancer

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35
Q

Common complications
Axillary lymph node clearance

A

Numbness around the scar and upper arm (can be permanent)

Lymphoedema (localized fluid retention and tissue swelling caused by a compromised lymphatic system)

Seroma (fluid collection at the site of operation)

Frozen shoulders

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36
Q

<30years

Often described as “breast mice’ as they are firm, discrete, non-
tender, highly mobile lumps

A

Fibroadenoma

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37
Q

Middle-aged women

Lumpy breasts which may be painful

Symptoms may worsen prior to menstruation

A

FibroadenoCIS (fibrocystic disease)
(Benign mammary dysplasia)

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38
Q

Breast cancer

A

Hard, irregular lump

There may be associated nipple inversion or skin tethering

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39
Q

Chronic eczematous changes (itching — erythema — scales — blood stained nipple discharge — inverted nipple)

Usually unilateral

Diagnosed by punch biopsy

A

Paget’s disease of the breast

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40
Q

Duct ectasia

A

Most common around the menopause

May present with a tender lump around the areola

® Green or brown nipple discharge

  • Nipple retraction

® Associated with smoking

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41
Q

Duct papilloma

A

Hyperplastic lesions rather than malignant or premalignant

Most common cause of blood-stained nipple discharge

There could be skin changes

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42
Q

Breast abscess

A

More common in lactating women

Unilateral, red, hot tender and fluctuant swelling

May present with purulent nipple discharge

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43
Q

Fat necrosis

A

More common in obese women

May follow trivial or unnoticed trauma

Firm & solitary localized lump and usually painless

Skin around the lump may be red, bruised or dimpled

Rare and may mimic breast cancer so further investigation is always
warranted

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44
Q

Ductal fistula

A

Suggested by para-areolar discharge

May follow abscess drainage or incision, there may be history of a spontaneous rupture of inflammatory mass preceding the fistula

Managed by excision under antibiotic cover

Recurrence is common

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45
Q

may also develop around the breast tissue

A

Lipomas and sebaceous cysts

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46
Q

CYStic and CYClical

A

fibroadenoClS

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47
Q

Haemorrhoidal tissue is part of the normal anatomy which contributes to anal continence. These mucosal
vascular cushions are found in the left lateral, right posterior, and right anterior portions of the anal canal (3 o’clock, 7 o’clock, and 11 o’clock respectively). Hemorrhoids are said to exist when they become enlarged, congested and symptomatic

A

Haemorrhoids

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48
Q

Features of Haemorrhoids

A

+ Painless rectal bleeding = the most common symptom

  • Pruritus

« Pain: intermittent and usually not significant unless piles are thrombosed

+ Soiling may occur with third- or fourth-degree piles

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49
Q

Types of Haemorrhoids

A

External
Internal

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50
Q

+ Originate below the dentate line (lower 1/3 of the anal canal)

« Prone to thrombosis, may be painful

A

External

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51
Q

« Originate above the dentate line (upper 2/3)

+ Do not generally cause pain

A

Internal

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52
Q
  • Severe recurrent rectal shooting pain
    in the absence of any rectal disease

® Usually oceurs at night, after bowl
action or following ejaculation

  • Anxiety is an associated feature
A

Proctalgia fugax

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53
Q

Grading of internal haemorrhoids:
Cannot be reduced |

A

Grade IV

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54
Q

Grading of internal haemorrhoids:
Do not prolapse out of the anal canal

A

Grade |

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55
Q

Grading of internal haemorrhoids:
Prolapse on defecation but reduce spontaneously

A

Grade ll

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56
Q

Grading of internal haemorrhoids:
Can be manually reduced

A

Grade lll

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57
Q

Management:
Soften stools =

A

increase dietary fiber and fluid intake

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58
Q

Management:
To alleviate symptoms =>

A

topical local anesthetics and steroids may be used

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59
Q

Management:
Outpatient treatments =

A

Rubber band ligation is superior to injection sclerotherapy

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60
Q

Management:
reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments

A

Surgery

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61
Q

Management:
Newer treatments:

A

Doppler guided hemorrhoidal artery ligation, stapled haemorrhoidopexy

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62
Q

« typically present with significant pain

« examination reveals a purplish, edematous, tender subcutaneous perianal mass

« if patient presents within 72 hours = referral should be considered for excision

« Otherwise patients can usually be managed conservatively with stool softeners, ice packs and analgesia

+ Symptoms usually settle within 10 days

A

Acutely thrombosed external haemorrhoids

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63
Q
  • Exquisite pain with defecation FRESH blood streaks covering the stools
  • The fear of pain is so intense they avoid bowel movements and get constipation
  • They refuse PR exam = PR done under anesthesia

s Acute: <6 weeks, chronic > 6 weeks

A

Anal fissure

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64
Q

In Anal fistula:
if low-submucosal or simple =

A

Lay open (fistulotomy),

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65
Q

In Anal fistula:
if complex/high (cross internal and external sphincters) =

A

Seton suture (ligation of fistula tract)

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66
Q

Complex fistulas can NOT be laid open as it could result in

A

fecal incontinence

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67
Q

60% are adenocarcinoma that occurs at the head of the pancreas

A

Pancreatic cancer

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68
Q

Risk factors of Pancreatic cancer

A
  • Smoking
  • Alcohol is an indirect RF as it causes chronic pancreatitis and liver cirrhosis
  • Diabetes
  • Chronic pancreatitis
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69
Q

Features of Pancreatic cancer

A
  • Head: - Obstructive jaundice = Dark urine, pale stool, pruritis.
  • Maybe painless although 70% are associated with epigastric or LUQ pain radiating to the back.
  • Body or Tail: Epigastric or LUQ pain radiating to the back, relieved by sitting forward
  • Both: Anorexia, weight loss or atypical weight loss
  • Migratory thrombophlebitis (Trousseau sign): felt as small lumps under the skin
    Investigations
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70
Q

nonspecific investigation of Pancreatic cancer

A

CA19-9

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71
Q

What are the other investigation of Pancreatic cancer?

A
  • Transabdominal US

« CT

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72
Q

Management of Pancreatic cancer?

A
  • Whipple’s resection (Pancreaticoduodenectomy): considered when no metastasis.
  • Side-effects :
    dumping syndrome (a group of symptoms, including weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery) and peptic ulcer disease
  • ERCP with stenting for palliation
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73
Q

Rare cancer of the bile duct

A

Cholangiocarcinoma

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74
Q

Features of Cholangiocarcinoma

A
  • Jaundice
  • RUQ pain
  • Weight loss
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75
Q

Features of

A
  • Jaundice
  • RUQ pain
  • Weight loss
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75
Q

Colorectal cancer:
Asymptomatic people with no personal /family hx of bowel cancer: iFOBT every 2 yearly (50-74)

A

Low risk

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76
Q

Colorectal cancer:
One first-degree relative with CRC dx <55 yrs: iFOBT every 2 yearly (40-49); then
colonoscopy every 5 years (50-74)

A

Moderate Risk

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77
Q

Colorectal cancer:
: At least THREE first-degree or second-degree relatives with CRC, with at least ONE relative
diagnosed > 55 yrs: iFOBT every 2 yearly (35-44); colonoscopy every 5 years (45-74)

A

High Risk

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78
Q

For all patients this should be given for at least 2.5 years commencing at 50 until 70 years of age are
recommended unless contraindicated.
 

A

Aspirin

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79
Q

more common than gastric ulcers, epigastric pain relieved by eating

A

Duodenal ulcers

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80
Q

epigastric pain worsened by eating

A

Gastric ulcers

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81
Q

Features of upper gastrointestinal hemorrhage may be seen (hematemesis, melena etc.)

A

Peptic ulcer disease

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82
Q

Pain initial in the central abdomen, then right iliac fossa

Anorexia is common

Tachycardia, low-grade pyrexia, tenderness in RIF

McBurney sign = rebound tenderness at McBurney point

Rovsing’s sign = mare pain in RIF than LIF when palpating LIF

A

Appendicitis

83
Q

Usually due to gallstones or alcohol

Severe epigastric pain

Vomiting is common

Examination may reveal tenderness, ileus and low-grade fever

Periumbilical discoloration (Cullen’s sign) and flank discoloration (Grey-Turner’s sign)

A

Acute Pancreatitis

84
Q

RUQ radiates to the right shoulder or the back and interscapular region

May be following a fatty meal. Slight misnomer as the pain may persist for hours

Obstructive jaundice may cause pale stools and dark urine
It is sometimes taught that patients are female, forties, fat and fair

Managed as acute cholecystitis

A

Biliary colic

85
Q

History of gallstones symptoms (see above)
Continuous RUQ pain.
Jaundice is NOT usually present with cholecystitis

Fever, raised inflammatory markers and white cells

Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

US = thick-walled, shrunken gallbladder

TTT = nil by mouth — analgesics (morphine) — IV fluids — antibiotics

Surgery = Laparoscopic cholecystectomy is usually indicated if patient is fit, if

perforated GB <> Open surgery

A

Acute Cholecystitis

86
Q

Colicky pain typically in the LLQ

Fever, raised inflammatory markers and white cells

A

Diverticulitis

87
Q

Severe central abdominal pain radiating to the back

Presentation may be catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock)

Patients may have a history of cardiovascular disease

A

Abdominal Aortic Aneurysm

88
Q

History of malignancy/previous operations
Vomiting

Not opened bowels recently

‘Tinkling’ bowel sounds

A

Intestinal Obstruction

89
Q

Management of biliary colic (when stones occlude the cystic duct):

A

Analgesia
Nil by mouth
Rehydrate
Elective laparoscopic cholecystectomy is usually indicated

90
Q

Complications of tonsillectomy:

A

Intraoperative:
-Hemorrhage => replace the loss
-Dental trauma

Postoperative:
- Reactive bleeding (during 24hours post-op) = explore + replace the loss

  • 2ry bleeding (up to 7days post-op) = admission + IV antibiotics
  • Temporary dysphagia.
91
Q

2ry hemorrhage is caused by necrosis of the blood vessels related to a previous repair, often precipitated by wound infection. The best step is

A

Admission and IV antibiotics.

92
Q

Asymptomatic fluid-filled midline neck mass below the level of hyoid bone

Most often in children and adolescents

Most common cause of midline masses in children = accounts for 75% of midline masses in children

A

Thyroglossal cyst

93
Q

How to diagnose Thyroglossal duct?

A
  1. US neck: to distinguish between solid and fluid-filled cyst = It can confirm the diagnosis
  2. MRI & CT: when malignancy is suspected\Large cyst
  3. Thyroid scan with tc-99m: to determine if there’s ectopic thyroid tissue
  4. FNAC
94
Q

In elective/planned operations:
+ Hb <10g/l =

A

investigate and postpone

95
Q

In elective/planned operations:
+ Hb <8g/l =

A

transfusion

96
Q
A
97
Q

In emergency operations:
+ Hb<10g/l >

A

transfusion

98
Q

In emergency operations:
Hb <8 g/l =

A

transfusion and stabilize before proceeding

99
Q

Post-op hypovolemia and oliguria can be caused by:

A

Hemorrhage

Adrenal cortex and posterior pituitary response to stress which release aldosterone and ADH respectively

100
Q
  • if the patient developed post-op hypotension and subsequent oliguria, it can be corrected by
A

Fluid challenge

101
Q

Fluid challenge

A

Rapid (up to 15 mins) administration of 500 ml crystalloid (normal saline/Hartmann’s)

Immediate reassessment, if there’s still evidence of hypovolemia — administer a further bolus of 250-500 ml

102
Q

post-op oliguria:
* Normotensive =

A

recheck the catheter

103
Q

post-op oliguria:
* Hypotensive = intra-abdominal bleeding =
 

A

IV fluids

104
Q

This is where celiac trunk stops supplying the gut and the superior mesenteric
artery takes over

A

Ampulla of Vater

105
Q

are defined as ‘a leak of luminal contents from a surgical join between two hollow viscera’

A

Anastomotic leaks

106
Q

After any GI surgery, there are 3 main concerns:
1. Anastomotic leaks
Definitive investigation ?

A

CT with contrast

106
Q

are defined as ‘a leak of luminal contents from a surgical join between two hollow viscera’

A

Anastomotic leaks

107
Q

Management of Anastomotic leaks?

A

Bowel rest (NBM), IV antibiotics and IV fluid.

Minor leaks maybe managed through observation and bowl rest alone with drainage if needed while exploratory laparotomy if a major leak

108
Q

Complication of Anastomotic leaks?

A

Peritonitis where there’s severe generalized abdominal pain with generalized guarding and rigidity

109
Q

Clinical Presentation of Anastomotic leaks?

A

=> abdominal pain and fever, typically 5-7 days post-operatively

110
Q

Risk factors for Anastomotic leaks?

A

immunosuppressed,
corticosteroids,
smoking,
diabetes,
peritoneal contamination,
rectal anastomosis

111
Q

are defined as ‘a leak of luminal contents from a surgical join between two hollow viscera’

A

Anastomotic leaks

111
Q

After any GI surgery, there are 3 main concerns: What are the other 2 concerns aside from Anastomotic leaks?

A
  1. Post-op bleeding
    * reactive bleeding (during 24hours post-op)
  • 2ry bleeding (up to 7days post-op)
  1. Surgical site infection and subsequent sepsis
112
Q

Hot tip: if the patient present 10 days after bowel surgery with abdominal pain, it’s most likely

A

Anastomotic leak

113
Q

Most common post-op complication is

A

INFECTION

114
Q

It’s better to remove the catheter post-op in 24-48h using TWOC procedure. Reinsert again if

A

PVRVs is 300-500ml with discomfort, voiding problems or feeling of fullness 2) PVRVs >500ml

115
Q

are defined as ‘a leak of luminal contents from a surgical join between two hollow viscera’

A

Anastomotic leaks

115
Q
  • PVRV is measure by
A

‘bladder scan’

116
Q

Acute pain + Bluish/purple in color

tender peri-anal lump near the anal verge

History of straining

TTT:
-Analgesics, stool softeners
-Incision and drainage

A

Perianal hematoma (external thrombosed hematoma)

117
Q

Red and tender + throbbing pain (worsens when sitting down).

Usually with low immunity / Diabetes / Crohn’s

Can be associated with constipation

TTT:
Incision and drainage
Antibiotics

A

Perianal abscess

118
Q

Antibiotic prophylaxis (IV) in colonic surgery should be given at the time of induction of anesthesia or within the
first 30 mins of the first excision:

A

+ Cefuroxime: to cover gram -ve and +ve.
* Metronidazole: against anaerobic bacteria.

119
Q

Esophageal atresia:

  • Prenatal signs =
A

Polyhydramnios, small stomach, absent fetal stomach bubble detected on US

120
Q

Esophageal atresia:
* Postnatal signs =

A

Cough, airway obstruction, secretions, blowing bubbles, distended abdomen, cyanosis, aspiration. Inability to pass a catheter into the stomach = X-ray show it coiled in the esophagus

121
Q

X-ray show double bubble sign (stomach & duodenum).

A

Duodenal atresia

122
Q

are two rare birth defects that cause a baby to be born with some of their internal
organs extending out of the body through a hole in the belly

A

Gastroschisis and Exomphalos

123
Q

hole in belly button

intestines covered by protective sac

A

Exomphalos

124
Q

hole next to the belly button

intestines not covered by a protective sac

A

Gastroschisis

125
Q

Non-specific as vomiting, tiredness, weight loss, abdominal pain and anemia

A

Gastric carcinoma

126
Q

Risk factors for Gastric carcinoma

A
  • Aging
  • H. pylori infection
  • Blood group A
  • Gastric adenomatous polyp
  • Pernicious anemia
  • Smoking
  • Diet: salty, spicy, nitrates
127
Q

Enlarged right supraclavicular LNs:

A

Hodgkin’s lymphoma
Lung cancer
Esophageal cancer

128
Q

Signs suggesting incurability:

A
  • Troisier’s sign: enlarged left supraclavicular lymph nodes (Virchow’s LN)
  • epigastric mass
  • hepatomegaly
  • jaundice
  • ascites
129
Q
  • Tumor of the pulmonary apex, on top of the right or left lung
  • Spreads to nearby tissues like ribs and vertebrae
  • Most are NSCLC
A

Pancoast tumor

130
Q

Cessation of Gl motility

A

Paralytic ileus:

131
Q

Absent bowel movements + NO pain =

A

Paralytic ileus

132
Q

Exaggerated bowl sounds + pain =

A

Mechanical obstruction

133
Q

Causes of Paralytic ileus

A
  • prolonged surgery, exposure and handling of the bowel
  • peritonitis and abdominal trauma
  • electrolyte disturbance
  • anticholinergics and opiates
  • immobilization
134
Q

What is the Clinical Picture of Paralytic ileus?

A
  • nausea, vomiting
  • abdominal distension
  • absent bowel sounds
135
Q

What is the imaging of the paralytic ileus?

A

Abdominal x-ray to show air/fluid filled loops of small and/or large bowel

136
Q

What is the management of the Paralytic Ileus?

A
  • Management: (Drip & Suck)
  • NG tube to empty the stomach from fluid & gas when the patient is nauseated or vomiting
  • IV Aluid
  • Maintain electrolyte balance
  • Reduce opiates and analgesia
  • Encourage the patient to mobilize
  • Lactulose or erythromycin can stimulate bowl movement
137
Q

inflammation of the diverticulum, common in >50yrs and low fiber intake

A

Diverticulitis:

138
Q

All patients with diverticular disease who are symptomatic or hemodynamically unstable require

A

urgent admission

139
Q

This is contraindicated in acute diverticulitis

A

Colonoscopy

140
Q

: pain is non-specific and intermittent

A

Intussusception

141
Q

Clinical Presentation of Diverticulitis

A
  • Rapid onset of LIF pain and tenderness
  • Nausea and vomiting.
  • Bloating and constipation -. –
  • Diarrhea
  • Features of infection: fever, tachycardia, raised WBCs and high CRP (>50 mg/L)
  • If perforated = guarding and rigidity
142
Q

What are the investigations of Diverticulitis?

A

CT abdomen and pelvis

143
Q
  • Treatment of Diverticulitis?
A
  • IV Antibiotics + IV Fluids
  • Increase dietary fiber intake
144
Q

Complications of Diverticultiis

A

Massive rectal bleeding that requires admission.

145
Q

herniation of the large colon

A

Diverticulum (plural diverticula

146
Q

the presence of asymptomatic diverticula

A

Diverticulosis

147
Q

symptomatic diverticula

A

Diverticular disease

148
Q

inflammation of the diverticula
 

A

Diverticulitis

149
Q

Diverticulitis is a left-side appendicitis

A

True

150
Q

Torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction

A

Sigmoid volvulus

151
Q

Usually an elderly man with chronic constipation

A

Sigmoid volvulus

152
Q

What are the clinical presentations of Sigmoid volvulus?

A

: patient suddenly develops a classic picture of painful intestinal obstruction:

  • abdominal distension
  • vomiting (classically with no nausea?)
  • pain
  • absolute constipation
153
Q

What is the investigation of Sigmoid volvulus?

A

X-ray shows a coffee bean sign (omega sign)

154
Q

What is the Management of Sigmoid Volvulus?

A

Rectal tube decompression,
Laparotomy and resection

155
Q

Anemia, Lt-sided colon cancer > Obstructive symptoms

A

Rt-sided colon cancer

156
Q

tend to be exophytic so it rarely causes obstruction of feces

A

Rt-sided colon cancer

157
Q

Old + changing bowel habits + bleeding PR + single ulcer =

A

Colorectal cancer until proven otherwise

158
Q

How is the colorectal cancer diagnosed?

A

Diagnosed by :

colonoscopy with biopsy,
barium enema,
CT scan

159
Q
  • PR bleeding. Deep red on the surface of stools.

» Change in bowel habit. Difficulty with defecation, sensation of incomplete evacuation, and painful defecation

A

Rectal location

160
Q

+ PR bleeding. Typically dark red

+ Change in bowel habit

A

Descending-sigmoid location

161
Q

Iron deficiency anaemia may be the only elective presentation

Weight loss

Mass in right iliac fossa

Disease more likely to be advanced at presentation

A

Right-sided location

162
Q

Up to 40% of colorectal carcinomas will present as emergencies.

» Large bowel obstruction (colicky pain, bloating, bowels not open)

« Perforation with peritonitis

= Acute PR bleeding

A

Emergency presentations

163
Q

is NOT for diagnosis however it’s useful for monitoring

A

CEA

164
Q

Anemia is not evident with left sided cancer because:

A
  1. Bleeding is noticed as fresh blood with stool, cancer cecum is far away, it won’t be presented with fresh blood
  2. Right colon is wider than left colon = obstruction is more prominent with the left side, let alone its exophytic
    nature
165
Q

bilateral ovarian malignancy due to metastasis from GIT cancer (most commonly gastric
carcinoma)

A

Krukenberg Tumor:

166
Q

Risk factors for colon cancer

A

1- Age.
2- Family history.
3- Smoking.

167
Q

most common salivary gland tumor
Parotid > submandibular > sublingual

Painless + slowly growing
Firm, single, nodular mass and usually mobile

Benign and can become malignant

Treated by superficial parotidectomy or enucleation

A

Pleomorphic adenoma (benign mixed tumor):

168
Q
  • mobile, soft, cystic mass and usually painless
A

Adenolymphoma
(Warthin’s tumor)

169
Q
  • bilateral swelling of all salivary glands
  • swelling of lacrimal glands resulting into narrowing of palpebral fissure
A

Mikulicz’s disease

170
Q
  • pain especially when eating
  • fever, redness, swelling
A

Parotiditis

171
Q
  • excessive sweating on cheeks when eating instead of salivation
  • due to nerve damage as a parotid surgery complication
A

Frey’s syndrome

172
Q

CA 125

A

Ovarian cancer

173
Q

Prostate specific antigen (PSA)

A

Prostatic carcinoma

174
Q

CA 15-3

A

Breast cancer

175
Q

CA 19-9

A

Pancreatic cancer

176
Q

LDH

A

Seminoma

177
Q

Carcinoembryonic antigen (CEA)

A

Colorectal cancer

178
Q

Alpha-fetoprotein (AFP)

A

Hepatocellular carcinoma, teratoma

179
Q

is an alternative to diagnostic ERCP for imaging the biliary tree and investigating biliary obstruction.

A

MRCP

180
Q

is used when US cannot detect CBD stones while the duct is dilated and/or LFT are abnormal.

A

MRCP

181
Q

Typical old patient, smoker

Persistent sore throat

A lump in the mouth or throat
Referred otalgia
Difficulty swallowing or moving mouth or jaw

Unexplained weight loss

A

Oropharyngeal carcinoma:

182
Q

Multifactorial (thrombotic event
or hypoperfusion such as shock,
HF or MI) causing transient
interruption of blood supply

A

Ischemic colitis

183
Q
  • Embolic (in patients with AF) causing total loss of blood supply to one segment of the bowel
  • decreased mesenteric arterial blood supply (in patients with hypotension 2ry to myocardial ischemia)
A

Mesenteric ischemia

184
Q

gradual onset (over hours)

pain starts at the LIF

moderate colicky pain and tenderness with bloody diarrhea

A

Ischemic colitis

185
Q
  • sudden onset of abdominal pain
  • severity of the pain exceeds the physical signs
  • absent bowel sounds
  • abdominal distension and tenderness
  • metabolic acidosis with high lactate
A

Mesenteric ischemia

186
Q
  • conservative
  • surgical
A

Ischemic colitis

187
Q
  • resuscitate (O;), rehydrate and administer IV
    analgesics and IV antibiotics
  • Urgent surgery to remove or bypass obstruction
  • removal of necrotic bowel maybe required
A

Mesenteric ischemia

188
Q

is caused by the reactivation of the varicella zoster virus in the
geniculate ganglion of the facial nerve.

A

Ramsay Hunt syndrome (herpes zoster oticus)

189
Q

Features of Ramsay Hunt syndrome (herpes zoster oticus

A
  • Pain deep within the ear is often the first feature (often radiates to the ear pinna)
  • facial nerve palsy
  • vesicular rash around the ear
  • other features include vertigo and tinnitus
190
Q

Management of Ramsay Hunt syndrome (herpes zoster oticus

A
  • oral acyclovir and corticosteroids are usually given
191
Q

Simple analgesics

A

aspirin, NSAIDs

192
Q

Weak opioids

A

codeine, tramadol

193
Q

Strong opioids:

A

morphine, fentanyl, diamorphine, oxycodone

194
Q

Nerve block

A

epidural

195
Q

After myocardial infarction, elective surgery should not be performed for the next

A

6 months

196
Q

Dysphonia (inability to create high-pitched voices), they would have
monotonous voice

A

Superior laryngeal nerve injury

197
Q

Hoarseness of voice

A

Unilateral RLN injury

198
Q

Aphonia and airway obstruction

A

Bilateral RLN injury

199
Q

If the patient presents with a typical lipoma where the mass hasn’t been growing at all =

A

Reassure

200
Q

If there’s a possible lipoma of liposarcoma and there’s uncertainty =

A

US

201
Q

If the US shows features of a liposarcoma =

A

MRI

202
Q

If there’s doubt of its diagnosis with imaging or if it’s interfering with the patient’s activities (e.g. difficulty sitting back against a chair) =

A

Removal by excision

PlusM (6 decks)

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