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General surgery Flashcards

1
Q

How long should patients avoid food or feeds and avoid any clear fluids before surgery? (2)

A
  1. 6 hours no food or feeds
  2. 2 hours no clear fluids
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2
Q

What term refers to fluid output that is difficult to measure, such as via respiration, stools, burns and sweat? (1)

A

Insensible fluid losses

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3
Q

What arteries supply the foregut, midgut and hindgut? (3)

A
  1. Foregut: coeliac artery
  2. Midgut: superior mesenteric artery
  3. Hindgut: inferior mesenteric artery
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4
Q

What procedure involves removing the entire length of the large intestine? (1)

A

Panproctocolectomy

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5
Q

What organ does pancreatic cancer usually spread to first? (1)

A

Liver

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6
Q

What is the approximate daily maintenance requirements of glucose?

A

50-100g

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7
Q

What are the two types of volvulus? (2)

A
  1. Sigmoid volvulus (more common)
  2. Caecal volvulus
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8
Q

What complication can SGLT2 inhibitors (e.g., dapagliflozin) cause in dehydrated or acutely unwell patients? (1)

A

DKA

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9
Q

Give two key complications of excessive normal 0.9% saline? (2)

A
  1. Hypernatraemia
  2. Hyperchloraemic metabolic acidosis
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10
Q

What are the key causes of acute right upper quadrant pain? (3)

A
  1. Biliary colic
  2. Acute cholecystitis
  3. Acute cholangitis
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11
Q

How long should the combined contraceptive pill be stopped prior to surgery? (1)

A

4 weeks

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12
Q

What specific sign is suggestive of acute cholecystitis? (1)

A

Murphy’s sign

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13
Q

What tumour marker may be used for monitoring bowel cancer during and after treatment? (1)

A

Carcinoembryonic antigen (CEA)

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14
Q

What is a Gridiron incision used for? (1)

A

Open appendicetomy

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15
Q

What blood test is used in females of child bearing age presenting with abdominal pain? Why? (2)

A
  1. Serum human chorionic gonadotropin (hCG)
  2. To exclude pregnancy
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16
Q

What term describes when rapidly releasing pressure on the abdomen causes worse pain than the pressure itself? (1)

A

Rebound tenderness

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17
Q

Where do cholangiocarcinomas originate? (1)
What is the typical histological type? (1)

A
  1. Bile ducts
  2. Adenocarcinoma
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18
Q

What is the usual definitive management of acute appendicitis? (1)

A

Laparoscopic appendicectomy

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19
Q

What condition refers to pus in the gallbladder? (1)

A

Gallbladder empyema

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20
Q

What is the gold standard investigation for suspected bowel cancer? (1)

A

Colonoscopy

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21
Q

What needs monitoring daily for patients on maintenance fluids? (3)

A
  1. Fluid status
  2. Fluid balance chart
  3. U&E blood tests
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22
Q

What complication is metformin associated with in the perioperative period? (1)

A

Lactic acidosis

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23
Q

What incisions may be used for a liver transplant? (2)

A
  1. “Rooftop” incision
  2. “Mercedes Benz” incision
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24
Q

When would you avoid using ondansetron as a treatment for post-operative nausea and vomiting? (1)

A

Patients at risk of prolonged QT interval

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25
Q

What proportion of total body fluids are in the intracellular and extracellular spaces? (2)

A
  1. 2/3 intracellular
  2. 1/3 extracellular
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26
Q

What type of hernia occurs between the lateral border of the rectus abdominis muscle and the linea semilunaris? (1)

A

Spigelian hernia

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27
Q

What is the name for the mucosal folds that form lines extending the full width of the bowel? (1)
Where are they found? (1)

A
  1. Valvulae conniventes
  2. Small bowel
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28
Q

What three types of cancer are more prevalent than bowel cancer in the UK? (3)

A
  1. Breast
  2. Prostate
  3. Lung
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29
Q

What does cholelithiasis mean? (1)

A

Gallstones are present

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30
Q

What is the name for when only part of the bowel wall and lumen herniate through a defect in the abdominal wall, with the other side of that section of the bowel remaining within the peritoneal cavity? (1)

A

Richter’s hernia

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31
Q

Where is the deep inguinal ring located? (1)

A

The mid-way point from the ASIS to the pubic tubercle

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32
Q

What is the concentration of sodium in normal 0.9% saline? (1)

A

154 mmol/L

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33
Q

Using a clock face to describe the position, where are haemorrhoids usually located? (3)

A
  1. 3 o’clock
  2. 7 o’clock
  3. 11 o’clock
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34
Q

What operation describes removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy? (1)

A

Hartmann’s procedure

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35
Q

What blood tests specifically indicate acute inflammation of the pancreas? (2)

A
  1. Amylase
  2. Lipase
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36
Q

What term describes a situation where there are two points of obstruction along the bowel; meaning that there is a middle section sandwiched between two points of obstruction? (1)
When might this occur with a single point of obstruction in the large bowel? (1)

A
  1. Closed-loop obstruction
  2. When there is a competent ileocaecal valve
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37
Q

What pre-operative investigation is required specifically in diabetic patients? (1)

A

HbA1c in the last 3 months

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38
Q

What law states that a palpable gallbladder along with jaundice is unlikely to be gallstones? (1)

A

Courvoisier’s law

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39
Q

Why do patients need a post-operative full blood count? (1)

A

To assess for anaemia secondary to blood loss

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40
Q

What procedure can be used to assess the biliary system and treat gallstones stuck in the ducts? (1)

A

Endoscopic retrograde cholangio-pancreatography (ERCP)

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41
Q

What are the key risk factors for cholangiocarcinoma? (2)

A
  1. Primary sclerosing cholangitis
  2. Liver flukes
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42
Q

What test is used in the bowel cancer screening program in England? (1)

A

Faecal immunochemical test (FIT)

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43
Q

What investigation and finding can be used to assess for intra-abdominal perforation? (2)

A
  1. Erect CXR
  2. Air under the diaphragm
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44
Q

What region does a direct inguinal hernia protrude through? (1)

A

Hesselbach’s triangle/inguinal triangle

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45
Q

What is the first-line investigation in patients with symptoms of gallstone disease? (1)

A

Ultrasound

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46
Q

What system classifies the physical status of the patient for anaesthesia? (1)

A

American Society of Anesthesiologists (ASA) grading system

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47
Q

What is the characteristic presenting symptom of acute cholecystitis? (1)

A

RUQ pain

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48
Q

What can be seen on a venous blood gas in acute mesenteric ischaemia? (2)

A
  1. Metabolic acidosis
  2. Raised lactate
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49
Q

Where on the abdomen are you most likely to find an ileostomy? (1)

A

RIF

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50
Q

What is formed from a section of small bowel in patients with a urostomy? (1)

A

Ileal conduit

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51
Q
A
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52
Q

What are the contents of the femoral triangle from lateral to medial across the top of the thigh? (4)

A
  1. Femoral nerve
  2. Femoral artery
  3. Femoral vein
  4. Femoral canal
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53
Q

What scoring system is used to assess the severity of pancreatitis? (1)

A

Glasgow score

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54
Q

What are type 1 and type 2 hiatus hernias? (2)

A

Type 1: sliding
Type 2: rolling

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55
Q

What pattern of enzymes will be seen on liver function tests in patients with cholestasis? (2)

A
  1. ALT and AST can raise slightly
  2. With a higher raise in ALP “obstructive pattern”
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56
Q

What tumour suppressor gene is malfunctioning in FAP? (1)

A

Adenomatous polyposis coli (APC)

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57
Q

What space is full of fluid with ascites? (1)

A

Peritoneal cavity

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58
Q

Describe 2nd and 3rd degree haemorrhoids. (2)

A
  1. 2nd degree: prolapse when straining and return on relaxing
  2. 3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
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59
Q

What is the definition of a fistula? (2)

A
  1. An abnormal connection
  2. Between two epithelial surfaces
60
Q

What sign refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic cancer? (1)

A

Trousseau’s sign of malignancy

61
Q

What is the inheritance pattern of familial adenomatous polyposis (FAP)? (1)

A

Autosomal dominant

62
Q

What histological type are the majority of pancreatic cancers? (1)

A

Adenocarcinoma

63
Q

What type of vomiting is suggestive of bowel obstruction? (1)

A

Green bilious vomiting

64
Q

What common type of medication increases the risk of diverticulosis and diverticular haemorrhage? (1)

65
Q

What two incisions may be used for a caesarean section? (2)

A
  1. Pfannenstiel (curved)
  2. Joel-Cohen (straight)
66
Q

What is the approximate daily maintenance requirements of water? (1)

A

25-30ml/kg/day

67
Q

What are the three main causes of bowel obstruction? (3)

A
  1. Adhesions
  2. Hernias
  3. Tumours
68
Q

What does a raised serum lactate suggest in a patient with bowel obstruction? (1)

A

Bowel ischaemia

69
Q

What cardiac condition is a key risk factor for acute mesenteric ischaemia? (1)

70
Q

What is the descriptive name for Lynch syndrome? (1)
What is the inheritance pattern? (1)

A
  1. Hereditary non polyposis colorectal cancer (HNPCC)
  2. Autosomal dominant
71
Q

What are the three top causes of pancreatitis? (3)

A
  1. Gallstones
  2. Alcohol
  3. Post ERCP
72
Q

What are the two types of hernia repair? (2)

A
  1. Tension free repair
  2. Tension repair
73
Q

What dietary changes do the NICE clinical knowledge summaries suggest in the management of uncomplicated acute diverticulitis? (1)

A

Only consume clear fluids (avoiding solid food) until symptoms improve

74
Q

What are the three key complications of hernias? (3)

A
  1. Incarceration
  2. Obstruction
  3. Strangulation
75
Q

What term is used to describe when a portion of the lung collapses due to under-ventilation? (1)

A

Atelectasis

76
Q

What structure does the common bile duct and pancreatic duct drain into before it opens into the duodenum? (1)
What is the name for the ring of muscle that surrounds this structure? (1)

A
  1. Ampulla of Vater
  2. Sphincter of Oddi
77
Q

What procedure involves inserting a drain into the gallbladder? (1)

A

Cholecystostomy

78
Q

What is the “classic triad” of chronic mesenteric ischaemia? (3)

A
  1. Central colicky pain after eating
  2. Weight loss
  3. Abdominal bruit on auscultation
79
Q

What are most gallstones made of? (1)

A

Cholesterol

80
Q

What is the name for the pouches formed by the muscles in the bowel wall, which form lines that do not extend the full width of the bowel on an abdominal x-ray? (1)
Where are they found? (1)

A
  1. Haustra
  2. Large bowel
81
Q

What incision is used for a renal transplant? (1)

A

Hockey-stick incision

82
Q

What section of the GI tract is included in the midgut? (2)

A
  1. From the distal part of the duodenum
  2. to the first half of the transverse colon
83
Q

Name the process of meeting a patient’s full nutritional needs via an intravenous infusion? (1)

A

Total parenteral nutrition (TPN)

84
Q

What refers to a widening of the linea alba, forming a larger gap between the rectus muscles? (1)

A

Diastasis recti/rectus diastasis/recti divarication

85
Q

What is the characteristic symptom of gallstones? (1)

A

Biliary colic

86
Q

What incision is typically used in an open cholecystectomy? (1)

A

A right subcostal “Kocher” incision

87
Q

What is used to reverse the effects of warfarin? (1)

88
Q

What are the three extracellular spaces? (3)

A
  1. Intravascular
  2. Interstitial
  3. “Third” space
89
Q

What do pale stools and dark urine indicate? (1)
What blood test is likely to be deranged? (1)

A
  1. Obstruction to flow within the biliary system
  2. Raised bilirubin
90
Q

What are the key causes of acute unilateral testicular pain? (2)

A
  1. Testicular torsion
  2. Epididymo-orchitis
91
Q

What pre-operative investigation is required routinely in all patients over 65 years (other than blood tests)? (1)

92
Q

What is the name of the tender point on examination in appendicitis? (1)
Where is this located? (1)

A
  1. Mcburney’s point
  2. One third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus
93
Q

What procedure involves fitting a tight band around the base of a haemorrhoid to cut off the blood supply? (1)

A

Rubber band ligation

94
Q

What investigation of the biliary system involves an MRI scan? (1)

95
Q

What travels through the inguinal canal in males?

A

Spermatic cord and its contents

96
Q

What is the name of the condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops? (1)
When are you most likely to come across this condition? (1)

A
  1. Ileus
  2. Following abdominal surgery
97
Q

What blood results may be deranged in acute diverticulitis? (2)

A
  1. Raised inflammatory markers
  2. Raised WBC
98
Q

What are the upper limits of the normal diameter of the small bowel, colon and caecum on an abdominal x-ray? (3)

A
  1. Small bowel 3cm
  2. Colon 6cm
  3. Caecum 9cm
99
Q

Where on the abdomen are you most likely to find a colostomy? (1)

100
Q

What scoring system can be used to calculate the probability of appendicitis? (1)

A

Alvarado score

101
Q

What are haemorrhoids? (1)

A

Enlargement of the anal vascular cushions

102
Q

What legal status can be given to a nominated person to allow them to make decisions on a patient’s behalf if they lack capacity? (1)

103
Q

What is the approximate daily maintenance requirements of sodium, potassium and chloride? (1)

A

1mmol/kg/day

104
Q

What term describes the separation of a surgical wound, notably after abdominal surgery? (1)

A

Wound dehiscence

105
Q

What is Charcot’s triad and what does it indicate? (4)

A
  1. RUQ pain
  2. Fever
  3. Jaundice (raised bilirubin)
  4. Indicating acue cholangitis
106
Q

What oral antibiotic do the NICE clinical knowledge summaries suggest for uncomplicated acute diverticulitis? (1)

A

Co-amoxiclav

107
Q

What do guarding and rigidity on examination suggest? (1)

A

Peritonitis

108
Q

What enzyme often needs replacing in chronic pancreatitis? (1)

109
Q

What name is given to a pancreaticoduodenectomy procedure, used to treat early pancreatic cancer? (1)

A

Whipple procedure

110
Q

What operation involves removal of the head of the pancreas, duodenum, gallbladder and bile duct? (1)

A

Whipple procedure/pancreaticoduodenectomy

111
Q

What part of the colon is removed in a Hartmann’s procedure? (1)

A

Rectosigmoid

112
Q

What are the four memorable risk factors for gallstones? (4)

A
  1. Fair
  2. Fat (obese)
  3. Female
  4. Forty
113
Q

What type of bowel sound may be heard in early obstruction? (1)

114
Q

What characteristic sign may be seen on abdominal x-ray in volvulus? (1)
With which type does this occur? (1)

A
  1. Coffee bean sign
  2. Sigmoid volvulus
115
Q

What is the name of the condition where the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa? (1)

A

Appendix mass

116
Q

What are the contraindications to NSAIDs? (4)

A
  1. Asthma
  2. Renal impairment
  3. Heart disease
  4. Stomach ulcers
117
Q

What type of suture technique involves a single absorbable suture side to side just below the skin to pull the skin edges together? (1)

A

Subcuticular

118
Q

What underlying condition is associated with spontaneous bacterial peritonitis? (1)

A

Ascites in patients with liver disease

119
Q

What term refers to the osmotic pressure gradient between two fluids across a membrane? (1)

120
Q

What sign refers to pain extending from the inner thigh to the knee when the hip is internally rotated? (1)
What causes the pain? (1)
What type of hernia might be implicated? (1)

A
  1. Howship-Romberg sign
  2. Compression of the obturator nerve
  3. Obturator hernia
121
Q

What condition involves inflammation of the bile ducts? (1)

A

Cholangitis

122
Q

What blood test gives an indication of the synthetic function of the liver and the patient’s clotting function? (1)

123
Q

What hormone is secreted in response to fat entering the digestive system, causing contraction of the gallbladder? (1)
Where is it secreted from? (1)

A
  1. Cholecystokinin (CCK)
  2. Duodenum
124
Q

What surgical procedure may be used to treat a hiatus hernia? (1)

A

Laparoscopic fundoplication

125
Q

What four criteria are used to assess a patient’s capacity to make a decision? (4)

A
  1. Understand
  2. Retain
  3. Weigh up the pros and cons
  4. Communicate the decision
126
Q

What tumour marker is most relevant in pancreatic cancer? (1)

A

CA 19-9 (carbohydrate antigen)

127
Q

What incision is used for an open cholecystectomy? (1)

A

Kocher incision

128
Q

What is the name for when two different loops of bowel are contained within a hernia? (1)

A

Maydl’s hernia

129
Q

What are common reasons for a patient to be on a fluid restriction? (3)

A
  1. Heart failure
  2. Renal failure
  3. Hyponatraemia
130
Q

Which hernia is superior and medial to the pubic tubercle? (1)

131
Q

Are strangulated or incarcerated hernias painful? (1)

A

Strangulated

132
Q

What is Rovsing’s sign? (1)

A

In appendicitis palpation of the left iliac fossa causes pain in the right iliac fossa?

133
Q

What is Cullen’s sign? (1)

A

Severe acute peri-umbilical bruising in the setting of acute pancreatitis?

134
Q

What is Boas’ sign?

A

In acute cholecystitis there is hyperaesthesia beneath the right scapula.

135
Q

What is required prior to appendicectomy? (1)

A

Prophylactic IV antibiotics

136
Q

What is the characteristic pain in appendicitis? (1)

A

Initially central and then right lower abdomen (RIF)

137
Q

Which hernia is inferior and lateral to the pubic tubercle? (1)

138
Q

What triad suggests cardiac tamponade? (3)

A

Beck’s triad:
1. Hypotension
2. Muffled heart sounds
3. Raised JVP

139
Q

What is the definitive investigation for small bowel obstruction?

A

CT abdomen

140
Q

Where is an epigastric hernia? (1)

A

Lump in the midline between the umbilicus and the xiphisternum

141
Q

What is Psoas stretch sign? (1)

A

Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended.

142
Q

What is Murphy’s sign? (1)

A

In cholecystitis there is pain/catch of breath elicited on palpation of the right hypochondrium during inspiration.

143
Q

What is the initial management of small bowel obstruction? (3)

A
  1. NBM
  2. IV fluids
  3. Nasogastric tube insertion (“drip and suck”)
144
Q

How should wound dihiscence be managed prior to surgical input? (2)

A
  1. Wound covered with saline gauze
  2. Broad spectrum IV abx e.g. IV ceftriaxone and metronidazole

Finals (11 decks)

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