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Surgery Extra Questions > General Surgery > Flashcards

General Surgery Flashcards

1
Q

A 48-year-old man with a background of alcohol dependence presents to the clinic with a 6-month history of persistent abdominal pain that is relieved by bending forward and worse after eating

What is the most likely diagnosis?

A

Chronic Pancreatitis

6 months
Alcohol History
Relieved by bending forwards
Worse after eating

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2
Q

What is a commonly recognised complication of enteral feeding?

A

Diarrhoea

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3
Q

A 22-year-old man suffers 20% partial and full thickness burns in a house fire , which I.V fluid is recommended?

A

Hartmann’s Solution

Want to replace the lost ions

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4
Q

What is Cullen’s Sign?

What does it indicate?

A

Severe acute peri-umbilical bruising

Indicates Acute Pancreatitis

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5
Q

What is Boas’ Sign?

What does it indicate?

A

Hyperaesthesia ( Excessive physical sensation) beneath the right scapula

Indicates Acute Cholecystitis

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6
Q

What is Psoas stretch sign?

What does it indicate?

A

Right thigh is passively extended with the patient lying on their side with their knees extended

Indicates Acute Appendicitis

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7
Q

What is Grey-Turner’s Sign?

What does it indicate?

A

Bruising in the flanks

Indicates Acute Pancreatitis

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8
Q

What is Murphy’s Sign?

What does it indicate?

A

There is pain/catch of breath elicited on palpation of the right hypochondrium during inspiration

Indicates Acute Cholecystitis

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9
Q

Where are femoral hernias located?

A

Inferolateral to the pubic tubercle

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10
Q

What is the first line treatment for a gastric MALT lymphoma?

A

Triple Eradication therapy

This is a type Non-Hodgkin Lymphoma that is heavily associated with H.Pylori Infection

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11
Q

What blood test marker is a good indicator of Acute Pancreatitis severity?

A

Hypocalcaemia ( >2mmol/L)

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12
Q

What imaging is best for Acute Pancreatitis and why?

A

Abdo USS

Important to determine the aetiology as this may affect management (e.g. patients with gallstones/biliary obstruction)

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13
Q

What is the management for Biliary Colic?

A

Analgesia
Anti-emetics
Low fat diet

First-line treatment will be an elective laparoscopic cholecystectomy as an outpatient in 6 months

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14
Q

What is the management of Chronic Pancreatitis?

A

Replacement of Pancreatic enzymes (Creon)
Analgesia

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15
Q

What is a respiratory complication of severe Acute Pancreatitis?

A

Acute Respiratory Distress Syndrome

There is a systemic inflammatory response due to autodigestion and inflammation of the pancreas.

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16
Q

What is the most common organism causing Cholangitis?

A

E.Coli

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17
Q

What kind of bowel obstruction causes tinkling bowel sounds?

A

Small bowel obstruction

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18
Q

Which type of hernia is more common in young children?

A

Indirect inguinal hernia

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19
Q

Which type of blood product gives the highest likelihood of TRALI?

A

Plasma

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20
Q

What is the treatment for appendicitis?

A

Prophylactic IV antibiotics
Then laparoscopic appendectomy

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21
Q

What types of cells are seen post splenectomy?

A

Howell- Jolly bodies
Target cells

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22
Q

Which types of shock cause warm peripheries?

A

Neurogenic
Septic
Anaphylactic

This is because peripheral vascular resistance is maintained ( widespread vasodilation )

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23
Q

What is Beck’s Triad of Cardiac Tamponade?

A

Hypotension
Muffled heart sounds
Raised JVP

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24
Q

What is the first and second line treatment for Achalasia?

A

1st Endoscopic balloon dilation of LOS

2nd line is Heller Cardiomyotomy

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25
Q

What is the appropriate regime for insulin before surgery?

A

Short acting blouses should be stopping when not eating ( will be NBM so stop them )

Long acting boluses can be continued to prevent hypoglycaemia

A variable rate insulin infusion should be started to keep tight glycemic control

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26
Q

Which bronchus are foreign bodies more likely to be aspirated into ?

A

Right main bronchus

Wider, shorter and more vertical than the left

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27
Q

What should be performed if a colonoscopy cannot due to adhesions etc?

A

CT Colonography

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28
Q

What is the rule of 9s for burns?

A

Used to work out the % of body covered by burns

Back = 18%
Front = 18%
Arm = 9%
Leg = 18%

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29
Q

How does Mesenteric Adenitis usually present?

A

Younger
Appendix like RLQ pain
Typically following viral or bacterial illness

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30
Q

What is the name of a kidney transplant scar?

A

Rutherford Morrison scar

Found in iliac fossas , wil feel a palpable mass beneth ( transplanted kidney)

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31
Q

What is a common complication of TPN?

A

Thrombophlebitis

TPN contains a combination of glucose, lipids and essential electrolytes. It is highly irritant to veins. While it can be given peripherally, it should only be given through central access.

32
Q

What does an AP Resection involve?

A

Removal of entire rectum, anal canal and anus. A permanent stoma is left in situ.

33
Q

What is the first line treatment for angiodysplasia?

A

Interventional colonoscopy

Diamthery cauterisation, adrenaline injection, photocoagulation, or clipping of blood vessesls

34
Q

What is the management of a perforated viscus?

A

Urgent surgical exploration and repair

35
Q

What gallbladder pathology are riggers and swinging fevers associated with?

A

Gallbladder empyema

36
Q

What is the treatment for wound dehiscence?

A

Apply gauze soaked in sterile water/saline and arrange for re-suturing in theatre

37
Q

Why might you do an Abdo US in suspected appendicitis

A

In females to rule out pelvic organ pathology

38
Q

Why are anti-hypertensives withheld on the day of a surgical procedure?

A

With general anaesthesia, the patient can get refractory hypotension if they are concurrently on antihypertensives as this also lowers BP

Propfol inhibits the sympathetic nervous system and by impairing baroreflex regulatory mechanisms

39
Q

What should be checked in all men presenting with Erectile Dysfunction?

A

Testosterone Levels

40
Q

What cancers are people with Lynch Syndrome more likely to develop?

A

Endometrial
Breast
Colon
Prostate
Ovarian
Gastric

41
Q

What is the Parkland formula for burns victims?

A

Weight(kg) x % body affected x 4mls

42
Q

Where is an epigastric hernia anatomically?

A

In the midline between the umbilicus and the xiphisternum

43
Q

What does a small bowel obstruction look like on CT?

A

Multiple loops of dilated small bowel
>3cm

44
Q

Which types of shock cause warm peripheries?

A

Distributive

Septic
Neurogenic
Anaphylactic

45
Q

What test should patients < 50 take before referral to Colorectal Cancer 2WW pathway?

A

FIT test

46
Q

What is the management of patients with a diverticulitis flare up ?

A

Send home with oral antibiotics
Safety netting - Review in 2 days, if hasn’t improved then go to A&E
Given I.V ceftriaxone + metronidazole

47
Q

How is a Sigmoid Volvulus managed?

A

Decompression via rigid sigmoidoscopy then insertion of a flatus tube?

48
Q

What is seen on examination in association with chronic fissures?

A

Sentinel skin tag around anus

49
Q

What is used to measure response to treatment in colon cancer?

A

CEA levels

50
Q

What do you give for chronic anal fissures after trying conservative measures?

A

Topical glyceryl trinitrate

51
Q

What should be done if a colonic tumour caused perforation?

A

In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →( Hartmanns’s )

Weeks or months later, the bowel can be anastomosed

52
Q

What type of anal fissure would warrant you to look for a n underlying cause?

A

Lateral ( 3 o’clock , 9 o’clock )

Could be malignancy
Could be Crohn’s

53
Q

What is the initial treatment for an anal fissure?

A

Acute-
Soften stool ( Movicol (Macrogrol))
Dietary fibre
Analgesia ( Paracetamol )
Topical Lidocaine

Persists for longer than a week -
Topical Glyceryl Trinitrate

Chronic ( >6 weeks ) -
Sphincterotomy ( dividing anal sphincter )
Botox injection into the anal sphincter

54
Q

What is the difference between mesenteric ischaemia and ischaemic colitis?

A

MI - Affects the small bowel
IC - Affects the large bowel

55
Q

What is the most useful test to check if there any leaks in a colorectal anastomosis ?

A

Gastrografin enema

56
Q

How should patients who present with peritonitis secondary to sigmoid volvulus be managed?

A

Skip the rigid sigmoidoscopy decompression, do urgent laparotomy

57
Q

What is the treatment for Acute Mesenteric Iscahemia?

A

Immediate laparotomy

58
Q

What is the best diagnostic test for a hiatus Hernia?

A

Barium Swallow fleuroscopy

59
Q

What complication can TIPSS lead to?

A

Hepatic encephalopathy

60
Q

What would be appropriate fluid management of Acute Appendicitis?

A

IV saline given 4-6 hourly, review fluid status between bags.

Requires aggressive due to vomiting and large third space losses

61
Q

What class of anti-emetic are Cimetidine and Ranitidine?

A

Histamine H2 Receptor Antagonist

Has the word dine in it, what do you have with food, water , water is H2O

62
Q

What class of anti-emetic are Domperidone and Metoclopramide?

A

D2 Receptor Antagonist

Domperidone has 2Ds in it
Metoclopramide ends in de , think deux like D2

63
Q

What class of anti-emetic is Cyclizine?

A

Histamine H1 Receptor Antagonist

Think cycling gold medal = 1st , so 1

64
Q

What class of anti-emetic is Hyoscine Hydrobromide?

A

Antimuscarinic

Think if gyms ‘bros’ don’t stay ‘hydr’ated , they won’t get big muscles ( antimuscarinic )

65
Q

What class of anti-emetic is Ondansetron?

A

Serotonin ( 5HT3 ) Receptor Antagonist

Has Se in it like Serotonin

66
Q

What is the most common site of a Carcinoid Tumour?

A

Appendix

67
Q

What quickly reverses Warfarin?

A

Prothrombin Complex Concentrate

68
Q

Which hormone promotes smooth muscle relaxation? ( Digestive system, urinary system and uterus)

A

Progesterone

69
Q

What is the first line for hepatic encephalopathy?

A

Lactulose PO

Promotes ammonia excretion

70
Q

Which type of hernia requires surgical repair even in symptomless?

A

Femoral - there is a high risk of strangulation

71
Q

What imaging is first line for a small bowel obstruction?

A

CT Abdo Pelvis with contrast

72
Q

What are the typical biochemical findings of osteomalacia?

A

Hypocalcaemia
Low urinary Ca2+

Due to Vitamin D deficiency ( needed in active form to absorb Ca2+ and Phosphate in from bowel)

73
Q

What are the typical biochemical findings of osteoporosis?

A

Bone profile is normal

Normal pth
Normal calcium
Normal phosphate

Due to degenerative changes

74
Q

How do you rememember the causes of post op fever?

A

5W’s of Post-op Pyrexia:
-Wind (1day): atelectasis/pneumonia
-Water(3days): UTI
-Wound(5days): surgical site infection/abscess
-Walking(7days): DVT/PE
-Wonder-drugs(Anytime): adverse drug reaction

Less than 24 hour - likely to be physiological stress response to surgery

75
Q

How does dosing work?

A

Example -

A drug is 2% strength, the dose prescribed is 400mg

If the drug was 1% strength, then there would be 1g of medicine in 100mls of solution.

So if the medication is 2% strength, there will be 2g in 100mls of solution.

You want to administer 400mg (0.4g) , 2/0.4 = 5
100/5 = 20mls of drug solution given

76
Q

What is Gilcher’s Rule to work out blood volume?

A

NORMAL
Female = 65ml x body weight (kg)
Male = 70ml x body weight (kg)

FAT
Female = 60ml x kg
Male = 65ml x kg

MUSCULAR
Female = 70ml x kg
Male = 75ml x kg

77
Q

Why does the pain move from the umbilicus to the RIF in appendicitis?

A

Peritonism ( local inflammation of peritoneum)

The pain will often migrate from the umbilical region (irritation of visceral peritoneum of the midgut) to the right iliac fossa (irritation of parietal peritoneum)

Surgery Extra Questions (9 decks)

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