General Surgery Flashcards
What surgery and anastomosis for Caecal, ascending or proximal transverse colon?
Right hemicolectomy
Ileo-colic
What surgery and anastomosis for Distal transverse, descending colon?
Left hemicolectomy
Colo-colon
What surgery and anastomosis for sigmoid colon?
High anterior resection
Colo-rectal
What surgery and anastomosis for Upper rectum?
Anterior resection (TME)
Colo-rectal
What surgery and anastomosis for low rectum?
Anterior resection (Low TME)
Colo-rectal (+/- defunctioning stoma)
What surgery and anastomosis for anal verge?
Abdomino-perineal excision of rectum
No anastamosis
What are the criteria for CT head within 1 hour?
1) GCS < 13 on initial assessment
2) GCS < 15 at 2 hours post-injury
3) suspected open or depressed skull fracture
4) any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
5) post-traumatic seizure.
6) focal neurological deficit.
7) more than 1 episode of vomiting
What are the criteria for CT head within 8 hours?
1) age 65 years or older
2) any history of bleeding or clotting disorders including anticogulants
3) dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
4) more than 30 minutes’ retrograde amnesia of events immediately before the head injury
What are risk factors for transition cell carcinoma of bladder?
1) Smoking
2) Exposure to aniline dyes
3) Rubber manufacture
4) Cyclophosphamide
What are risk factors for squamous cell carcinoma of bladder?
1) Schistosomiasis
2) Smoking
What is the management for all patients with peripheral artery disease?
Statin
Clopidogrel
What is the management of epididymo-orchitis?
ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days
What is the management of BPH?
1st line: alpha-1 antagonists e.g. tamsulosin, alfuzosin
2n line: 5 alpha-reductase inhibitors e.g. finasteride
What is the Parkland formula for fluid resuscitation in burns?
total body surface area of the burn % x weight (Kg) x 4ml
What does iliac claudication manifest as?
Buttocks pain
What does femoral claudication manifest as?
Calf pain
What is the possible complication of too much fluid resuscitation following surgery?
Hyperchloraemiac acidosis
What is the most common type of breast cancer?
Invasive ductal carcinoma AKA ‘No Special Type (NST)’
What are risk factors for breast cancer?
1) HRT
2) Early menarche
3) Late menopause
4) COCP
What is often the cause of epididymo-orchitis in young people?
Chlamydia
What are the screening rules for AAA?
<3cm- normal: no further action
3-4.4cm- small aneurysm- rescan every 12 months
4.5-5.4cm- medium aneurysm: rescan every 3 months
≥ 5.5cm- large aneurysm: Refer within 2 weeks to vascular surgery for probable intervention
What is the management of hydroceles?
- infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
- conservative in adults but may warrant further ix with US to look for underlying cause e.g. tumour.
What is the manangement of hiatus hernia?
1) conservative e.g. weight loss
2) medical: PPI
3) surgical: only really has a role in symptomatic paraesophageal hernias
What is the management of hydatid cyst?
Surgery (the cyst walls must not be ruptured during removal and the contents sterilised first)
What are the 6 Ps of limb-threatening sichaemia?
pale
pulseless
painful
paralysed
paraesthetic
‘perishing with cold’
What is the management of acute limb-threatening ischaemia?
Initial:
ABC
analgesia
IV unfractionated heparin
vascular review
Definitive:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation: for patients with irreversible ischaemia
What is the management of peripheral artery disease?
1) Statin (atorvastatin 80mg)
2) Clopidogrel
3) Exercise training
If severe:
1) endovascular revascularization
2) surgical revascularization
What is the first-line investigation for prostate Ca?
Multiparametric MRI
What is the management of renal stones?
< 5mm and asymptomatic: watch and wait
5-10mm: shockwave lithotripsy
10-20 mm: shockwave lithotripsy OR ureteroscopy
> 20 mm: percutaneous nephrolithotomy
What is the management of ureteric stones?
<10mm: shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
What are the most common causes of small bowel obstruction?
Adhesions
Followed by Hernias
What is the management of subarachnoid haemorrhage?
1) Supportive (bed rest, analgesia, VTE prophylaxis, stop antithrombotics)
2) Oral Nimodipine (prevent vasospasm)
3) Intracranial aneurysm intervention (coil by IR)
What is the management of volvulus?
1) sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
2) caecal volvulus: management is usually operative. Right hemicolectomy is often needed
