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Focused 2 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Where are most anal fissures located?

A

Posterior midline >90% (if alternative location think of underlying diagnosis e.g. CD)

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2
Q

What is the management for acute anal fissures (<1 week)? 5 aspects

A
  • high fibre diet
  • bulk forming laxatives
  • lubricants eg petroleum jelly
  • topical anaesthetics
  • analgesia
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3
Q

What are 3 options for the management of chronic anal fissures?

A
  1. Same as acute
  2. Topical GTN
  3. If GTN not effective for 8 weeks - spinchterotomy or BOTOX
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4
Q

Where are the mucosal vascular cushions found anally?

A

3, 7 and 11 o’clock

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5
Q

What are haemorrhoids?

A
  • haemorrhoidal tissue is part of the normal anatomy, contributes to anal continuence
  • mucosal vascular cushions found in L lateral, R posterior and R anterior portions of anal canal
  • haemorrhoids exist when they are enlarged, congested and symptomatic
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6
Q

What are external vs internal haemorrhoids?

A
  • external - originate below the dentate line
  • internal - originate above dentate line
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7
Q

How are haemorrhoids graded?

A

Grade I - do not prolapse out of anal canal
Grade II - prolapse on defecation, reduce spontaneously
Grade III - can be manually reduced
Grade IV - cannot be reduced

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8
Q

What is considered the first line management for haemorrhoids?

A

increase dietary fibre + fluid

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9
Q

What are 5 aspects of the management of haemorrhoids?

A
  1. increase dietary fibre + fluids
  2. topical local anaesthetics + steroids
  3. OP: rubber band ligation (superior), injection sclerotherapy
  4. Surgery - large symptomatic haemorrhoids, not responding to OP treatments
  5. Newer: Doppler-guided haemorrhoidal artery ligation, stapled haemorrhoidopexy
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10
Q

What is the presentation of acutely thrombosed external haemorrhoids?

A

significant pain; purplish, oedematous, tender subcutaneous perianal mass

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11
Q

What is the management of acutely thrombosed external haemorrhoids?

A

if patient presents within 72h - consider referral for excision
outside of 72h - stool softeners, ice packs, analgesia

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12
Q

What is a spinal epidural abscess?

A

Collection of pus overlying the dura mater of the spinal cord

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13
Q

What is the investigation of choice to diagnose spinal epidural abscess?

A

Whole spine MRI

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14
Q

What is the commonest organism causing spinal epidural abscess?

A

Staphylococcus aureus

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15
Q

In addition to the 4 Fs what are 4 additional risk factors for biliary colic / gallstones?

A
  1. diabetes mellitus
  2. Crohn’s disease
  3. Drugs: fibrates, COCP
  4. Rapid weight loss e.g. weight reduction surgery
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16
Q

What is the lifelong antiplatelet management of peripheral arterial disease?

A

Clopidogrel

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17
Q

What type of bowel obstruction is most likely to be caused by an incarcerated hernia?

A

SMALL bowel obstruction

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18
Q

What is the leading cause of small bowel obstruction in developed countries?

A

postoperative adhesions (60%)

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19
Q

What are 4 causes of small bowel obstruction?

A
  1. postoperative adhesions (commonest)
  2. malignancy
  3. Crohn’s disease
  4. hernias
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20
Q

What is meant by simple SBO?

A

non-strangulated - occurs when loop of distended bowel twists on its mesenteric pedicle, arterial occlusion leads to bowel ischaemia and necrosis

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21
Q

What is the commonest cause of strangulated small bowel obstruction?

A

adhesions

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22
Q

What will abdominal Xray show in small bowel obstruction?

A

central gas shadows, no gas in large bowel; small bowel identified by valvulae conniventes that completely cross the lumen

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23
Q

What are the 3 types of bowel ischaemia?

A
  1. acute mesenteric ischaemia (small bowel)
  2. chronic mesenteric ischaemia)
  3. colonic ischaemia (large bowel) commonest
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24
Q

What are the 2 watershed areas of the colon?

A
  • splenic flexure
  • rectosigmoid junction

prone to ischaemia as they receive overlapping blood supply from most distal branches of SMA + IMA arteries

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25
Q

What are 4 causes of acute bowel ischaemia?

A
  1. arterial embolus (e.g. AF, mural thrombus after MI)
  2. arterial thrombosis e.g. etherosclerosis
  3. venous thrombosis e.g. hypercoagulability
  4. intestinal hypoperfusion e.g. shock, HF
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26
Q

What is the investigation of choice for suspected intestinal ischaemia?

A

CT

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27
Q

What is the management of acute bowel ischaemia?

A
  • surgical - needs to be assessed for viability + if necrotic needs to be resected
  • in some instances, endovascular thrombolysis/thrombectomy may be beneficial
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28
Q

What is the management of chronic bowel ischaemia?

A
  • if asymptomatic: conservative - smoking cessation & antiplatelet therapy
  • if symptomatic: oepn or endovascular revascularisation
  • nutrition - often malnourished at time of onset
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29
Q

What is the most important factor for improving survival in acute mesenteric ischaemia?

A

diagnosis before the occurrence of intestinal infarction

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30
Q

Which type of bowel ischaemia has the most favourable prognosis?

A

colonic ischaemia

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31
Q

What is Buerger’s disease?

A

thromboangiitis obliterans - non-atherosclerotic vasculitis affecting predominantly medium-sized arteries

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32
Q

What is the typical patient affected by Buerger’s disease?

A

young males who smoke

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33
Q

What are common symptoms of Buerger’s disease?

A
  • paraesthesia / cold sensation in fingers or limbs
  • rest pain
  • pain in lower limbs improves when leg hangs over edge of bed
  • ulceration / gangrene
  • superficial thrombophlebitis
  • Raynaud’s phenomenon
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34
Q

What is the commonest cause of varicose veins?

A

Reflux in great saphenous vein and small saphenous vein

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35
Q

What are 4 risk factors for varicose veins?

A
  1. Pregnancy
  2. Obesity
  3. Increasing age
  4. Female gender
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36
Q

What symptoms may patients complain of with varicose veins?

A

Itching, aching, throbbing

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37
Q

What are 8 symptoms which may be seen with chronic venous insufficiency?

A
  1. Varicose eczema
  2. Haemosiderin deposition
  3. Lipodermatosclerosis- hard/tight skin
  4. Atrophie Blanche - hypopigmentation
  5. Bleeding
  6. Superficial thrombophlebitis
  7. Venous ulceration
  8. DVT
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38
Q

What is the investigation of choice for varicose veins / chronic venous insufficiency?

A

Venous duplex US - shows retrograde flow

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39
Q

What are 4 conservative measures for varicose veins?

A
  1. Leg elevation
  2. Weight loss
  3. Regular exercise
  4. Graduated compression stockings
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40
Q

What are 5 reasons to refer varicose veins to secondary care?

A
  1. Significant / troublesome lower limb pain, discomfort or swelling
  2. Previous bleeding from varicose veins
  3. Skin changes secondary to chronic CVI (eczema, hyperpigmentation)
  4. Superficial thrombophlebitis
  5. Active or healed venous leg ulcer
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41
Q

What are 3 possible active treatment options for varicose veins?

A
  1. Endothermal ablation (radiofrequency or endovenous laser treatment)
  2. Foam sclerotherapy (irritant foam - inflammatory response - vein closure)
  3. Surgery - ligation or stripping
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42
Q

What is the management of peripheral arterial disease?

A
  • treat comorbidities: HTN, DM, obesity
  • atorvastatin 80mg
  • clopidogrel
  • exercise training programme
  • quit smoking
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43
Q

What are 2 surgical approaches for severe PAD or critical limb ischaemia?

A
  1. endovascular revascularisation
  2. surgical revascularisation
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44
Q

How can endovascular revascularisation be performed in severe/critical PAD?

A

percutaneous transluminal angioplasty +/- stent placement

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45
Q

When are endovascular rather than surgical revascularisation approaches preferred in PAD?

A

short segment stenosis e.g. <10cm, aortic iliac disease and high-risk patients

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46
Q

What are 2 types of surgical revasculisation in PAD?

A
  1. surgical bypass with autologous vein or prosthetic material
  2. endarterectomy
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47
Q

Which patients are open surgical techniques in PAD preferred for?

A

long segment lesions (>10cm), multifocal lesions, lesions of common femoral artery and purely infrapopliteal disease

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48
Q

When is amputation used in PAD?

A

patients with critical limb ischaemia who are not suitable for other interventiosn such as angioplasty or bypass surgery

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49
Q

What are 2 specific drugs licensed for use in PAD?

A
  1. naftidrofuryl oxalate: vasodilator, sometimes used for patients with poor QOL
  2. cilostazol: phosphodiesterase III inhibitor with both antiplatelet and vasodilator effects
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50
Q

Which patients with breast cancer are offered surgery?

A

vast majority - with exception of frail, elderly lady with metastatic disease (may be better managed with hormonal therapy)

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51
Q

What determines breast cancer management prior to surgery?

A

presence/absence of palpable axillary lymphadenopathy
* absent: pre-op axillary US before primary surgery, if negative - sentinel node biopsy
* clinically palpable - axillary node clearance at primary surgery

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52
Q

What are 4 factors that determine whether mastectomy or wide local excision should be performed for breast cancer?

A
  1. multifocal = mastectomy, solitary = WLE
  2. central = mastectomy, peripheral = WLE
  3. large lesion small breast = mastectomy, small lesion in large breast = WLE
  4. DCIS >4cm = mastectomy, DCIS <4cm = WLE
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53
Q

What anti-cancer treatment is offered after wide local excision for breast cancer?

A

whole-breast radiotherapy

may reduce risk of recurrence by 2/3

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54
Q

When is radiotherapy offered after mastectomy in breast cancer? 2 situations

A
  1. T3-T4 tumours
  2. 4 or more positive axillary nodes
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55
Q

Which hormonal therapy drugs are used in breast cancer and when?

A
  • tamoxifen: pre- and peri-menopausal women
  • anastrozole / aromatase inhibitors: post-menopausal
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56
Q

What accounts for the difference in hormone therapy for breast cancer in pre- vs post-menopausal women?

A

in post-menopausal women, aromatisation accounts for most oestrogen production

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57
Q

What are 3 important side effects of tamoxifen?

A
  1. increased risk of endometrial cancer
  2. venous thromboembolism
  3. menopausal symptoms
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58
Q

What is the commonest type of biological therapy for breast cancer?

A

trastuzumab (Herceptin)

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59
Q

When is biological therapy e.g. trastuzumab used in breast cancer?

A

HER2 positive (20-25% of tumours)

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60
Q

In which patients is trastuzumab contraindicated?

A

heart disorders

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61
Q

What are 2 situations when chemotherapy is used in breast cancer?

A
  1. neoadjuvant chemotherapy to downstage primary lesion
  2. after surgery if there is axillary node disease - FEC-D used
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62
Q

What are 2 medical options for the management of obesity?

A
  1. orlistat (Alli - OTC lower dose version)
  2. liraglutide
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63
Q

What is the mechanism of action of orlistat?

A

pancreatic lipase inhibitor

64
Q

What are the adverse effects of orlistat?

A

faecal urgency / incontinence and flatulence

65
Q

What are the criteria for prescribing orlistat?

A
  • BMI >28 with associated risk factors OR
  • BMI >30

and:
* continued weight loss e.g. 5% at 3 months

66
Q

What is the maximum duration orlistat should be prescribed for?

A

<1 year

67
Q

How is liraglutide administered?

A

once daily subcutaneous injection

68
Q

What are the NICE critiera for liraglutide use for weight loss?

A

BMI >35, prediabetic hyperglycaemia

69
Q

What are the locations of haemorrhoids classically?

A

3, 7, 11 o’clock

70
Q

What are the key features of an anal fissure?

A
  • painful rectal bleeding
  • midline location - 6 and 12
  • can become chronic (>6 weeks): ulcer, sentinal pile, enlarged anal papillae
71
Q

What are 2 causes of ano-rectal abscesses?

A
  1. E. coli
  2. Staph aureus
72
Q

What is the commonest anal neoplasm?

A

squamous cell carcinoma

73
Q

What is a solitary rectal ulcer?

A

associated with chronic straining and constipation - histology shows mucosal thickening, lamina propra replaced with collagen + smooth muscle (fibromuscular obliteration)

74
Q

What should be done if someone is investigated for DVT, has a raised d-dimer and is commenced on DOAC, then ultrasound is negative?

A

stop DOAC and repeat Doppler US in 1 week

75
Q

What should be done if someone has a high DVT Wells score, but then negative proximal leg vein US?

A

d-dimer - if negative consider alternative diagnosis
if positive stop DOAC and repeat US in 1 week

76
Q

What is the maximum duration of time to wait for investigations of DVT (d-dimer / dopper US) to come back?

A

4 hours - if a proximal leg vein US / d-dimer cannot be carried out within 4 hours interim therapeutic anticoagulation should be administered

77
Q

What is the only way to cure colorectal cancer?

A

resectional surgery

78
Q

What are the resection and anastomosis performed for caecal, ascending or proximal transverse colon cancers?

A
  • right hemicolectomy
  • ileo-colic anastomosis
79
Q

What are the resection and anastomosis performed for distal transverse or descending colon cancers?

A
  • left hemicolectomy
  • colo-colon
80
Q

What are the resection and anastomosis performed for sigmoid colon cancers?

A
  • high anterior resection
  • colo-rectal
81
Q

What are the resection and anastomosis performed for upper rectum cancers?

A
  • anterior resection (TME)
  • colo-rectal
82
Q

What are the resection and anastomosis performed for low rectum cancers?

A
  • anterior resection (low TME)
  • colo-rectal +- defunctioning stoma
83
Q

What are the resection and anastomosis performed for anal verge cancers?

A
  • abdomino-perineal excision of rectum
  • no anastomosis
84
Q

Whhen is chemotherapy used in colorectal cancer?

A
  • neoadjuvant for rectal cancers
  • adjuvant
  • metastatic disease
85
Q

What are 2 common chemotherapy regimens for colorectal cancer?

A
  1. FOLFOX
  2. FOLFIRI
86
Q

When is radiotherapy used in colorectal cancer?

A

rectal cancers - neoadjuvant or adjuvant

87
Q

What are 2 types of targeted therapies used in colorectal cancer and when are they used?

A
  • bevacizumab (anti-VEGF)
  • cetuximab (anti-EGFR)
  • used particularly for metastatic disease
88
Q

How does the management of colorectal cancer change in the emergency setting e.g. bowel obstruction?

A
  • risk of anastomosis much greater - particularly if colon-colon
  • end colostomy safer, performed in acute setting and can be reversed later
89
Q

What is Hartmann’s procedure?

A

when emergency sigmoid colon resection performed and end-colostomy fashioned; reversed at later date

90
Q

Are ileo-colic anastomoses safe in the emergency setting?

A

yes (unlike left-sided resections with anastomoses)

91
Q

What is the management of asymptomatic gallstones in the gallbladder?

A

reassure - no management required if found incidentally and symptom-free for 12 months before diagnosis

92
Q

What is the commonest aetiology of CBD gallstones in the west?

A

most result from migration from the gallbladder

93
Q

What is the diagnostic workup for gallstones?

A

abdominal US, LFTs

94
Q

If gallstones are suspected in the bile duct but do not show on abdominal US, what are 2 diagnostic options?

A
  1. MRCP
  2. intraoperative imaging
95
Q

What is the management of acute cholecystitis?

A

cholecystectomy - ideally within 48h of presentation

96
Q

What is the management of gallbladder abscess?

A
  • Ideally surgery although subtotal cholecystectomy may be needed if Calot’s triangle is hostile
  • In unfit patients, percutaneous drainage may be considered
97
Q

What is the management of cholangitis?

A
  • Fluid resuscitation
  • Broad-spectrum intravenous antibiotics
  • Correct any coagulopathy
  • Early ERCP
98
Q

What is the presentation of gallstone ileus?

A
  • Patients may have a history of previous cholecystitis and known gallstones
  • Small bowel obstruction (may be intermittent)
99
Q

What is the management of gallstone ileus?

A
  • Laparotomy and removal of the gallstone from small bowel, the enterotomy must be made proximal to the site of obstruction and not at the site of obstruction.
  • The fistula between the gallbladder and duodenum should not be interfered with
100
Q

What may cause acalculous cholecystitis?

A

patients with intercurrent illness e.g. diabetes, organ failure; systemically unwell

101
Q

What is the management of acalculous cholecystitis?

A

If patient fit then cholecystectomy, if unfit then percutaneous cholecystostomy

102
Q

What is the management of asymptomatic gallstones in the CBD?

A

surgical management should be considered

103
Q

What is done during cholecystectomy surgery to confirm anatomy or exclude CBD stones? 2 options

A
  • intraoperative cholangiography
  • laparoscopic US
104
Q

What are 2 options if CBD stones are found intra-operatively during cholecystectomy?

A
  1. early ERCP in day or so afterwards
  2. immediate surgical exploration of bile duct
105
Q

What is the cut off size for bile ducts that should not be explored during surgery (cholecystectomy)?

A

<8mm

106
Q

What size of gallstones may be safely left in the biliary tree and will usually pass spontaneously?

A

<5mm

107
Q

What are 4 risks of ERCP?

A
  1. bleeding
  2. duodenal perforation
  3. cholangitis
  4. pancreatitis
108
Q

What is abdominal wound dehiscence?

A

all layers of abdominal mass closure fail and viscera protrude externally (30% mortality)

109
Q

How can abdominal wound dehiscence be classified?

A
  • superficial (skin wound alone fails)
  • complete (failure of all layers)
110
Q

What are 7 factors that increase the risk of abdominal wound dihiscence?

A
  1. malnutrition
  2. vitamin deficiencies
  3. jaundice
  4. steroid use
  5. major wound contamination e.g. faecal peritonitis
  6. poor surgical technique (mass closure technique preferred)
111
Q

What are 5 aspects of the management of sudden full abdominal wound dehiscence?

A
  1. cover wound with saline impregnated gauze (on ward)
  2. IV AB - broad spec
  3. IVF
  4. analgesia
  5. arrange return to theatre
112
Q

What are the key features of a breast fibroadenoma?

A
  • common < 30 years
  • breast mice - discrete, non tender, mobile
113
Q

What are the key features of fibroadenosis?

A
  • lumpy painful breasts
  • middle aged women
  • symptoms may worsen prior to menstruation
114
Q

What are the key features of breast cancer?

A
  • hard irregular lump
  • may be nipple inversion / skin tethering
115
Q

What are the key features of Paget’s disease of the breast?

A
  • intraductal carcinoma
  • reddening and thickening (may resemble eczema) of nipple / areola
116
Q

What are the key features of mammary duct ectasia?

A
  • dilatation of large breast ducts
  • common around menopause
  • tender lump around areola +- green nipple discharge
  • if ruptures - local inflammation
  • sometimes referred to as plasma cell mastitis
117
Q

What are the the key features of duct papilloma?

A
  • local areas of epithelial proliferation in large mammary ducts
  • hyperplastic lesions rather than malignant or premalignant
  • blood stained discharge
118
Q

What are the key features of breast abscess?

A

common in lactating women
red, hot tender swelling

119
Q

What is the screening programme for colorectal cancer?

A
  • FIT sent every 2 years
  • aged 60-74 years in England
  • aged 50 - 74 years in Scotland
120
Q

What proportion of patients with positive FIT have cancer at colonoscopy?

A

approx 1 in 10 (4/10 have polyps)

121
Q

What is the precursor to most colorectal cancers?

A

adenomatous polyps

122
Q

What organism is the commonest cause of breast abscess in lactational women?

A

Staphylococcus aureus

123
Q

What is the management of breast abscess?

A

incision + drainage or needle aspiration (using US) + abx

124
Q

When is breast cancer screening offered?

A

every 3 years (mammogram) between age 50- 70 years

125
Q

What are 9 indications for referral to the breast clinic for screening in patients with a first or second degree relative with breast cancer?

A
  1. age of diagnosis < 40 y
  2. bilateral breast cancer
  3. male breast cancer
  4. ovarian cancer
  5. Jewish ancestry
  6. sarcoma in a relative younger than age 45 years
  7. glioma or childhood adrenal cortical carcinomas
  8. complicated patterns of multiple cancers at a young age
  9. paternal history of breast cancer (two or more relatives on the father’s side of the family)
126
Q

What are 6 indications for referring a woman to breast clinic for further assessment to be screened from a younger age?

A
  1. first-degree female relative diagnosed with breast cancer at younger than age 40 years
  2. first-degree male relative diagnosed with breast cancer at any age
  3. first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years
  4. two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any agee
  5. first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative), or
  6. three first-degree or second-degree relatives diagnosed with breast cancer at any age
127
Q

What is the management of breast cysts?

A
  • aspiration of cyst (risk of breast cancer)
  • blood stained / persistently refill: biopsy or excise
128
Q

What is the management of a fibroadenoma?

A
  • > 3cm: surgical excision
  • Phyllodes tumours - widely excise, (mastectomy if large)
129
Q

What is breast sclerosing adenosis?

A

radial scars and complex sclerosing lesions

130
Q

What are 4 features of the presentation of breast sclerosing adenosis?

A
  1. breast lump or pain
  2. mammographic changes which may mimic carcinoma
  3. distortion of distal lobular unit without hyperplasia
  4. disorder of involution
131
Q

Is breast sclerosing adenosis pre-malignant?

A

no

132
Q

What is the management of breast sclerosing adenosis?

A

lesions should be biopsied, excision not mandatory

133
Q

How does epithelial hyperplasia of the breast present?

A

generalised lumpiness thorugh to discrete lump

134
Q

What is epithelial hyperplasia of the breast?

A

increased cellularity of terminal lobular unit, atypical features may be present

135
Q

What features in breast epithelial hyperplasia confer a greater risk of malignancy?

A
  • atypical features
  • FH of breast cancer
136
Q

What is the management of a duct papilloma?

A

microdochectomy

137
Q

What is a normal ABPI?

A

0.9-1.2 (<0.9 - arterial disease, > 1.3 can also indicate arterial disease due to arterial calcification)

138
Q

What is the first line management of venous ulceration?

A

compression banaging (4 layer)

139
Q

What are 3 aspects of the maangement of venous ulceration?

A
  1. compression bandaging
  2. oral pentoxifylline (peripheral vasodilator)
  3. flavinoids
140
Q

What type of volvulus acconuts for the majority of cases? What is the remainder?

A
  • sigmoid volvulus - 80% of cases
  • caecal volvulus - 20% ocases
141
Q

How can you distinguish between sigmoid and caecal volvulus?

A

sigmoid causes large bowel obstruction, caecal volvulus causes small bowel obstruction

142
Q

What are 5 associations of sigmoid volvulus?

A
  1. older age
  2. chronic constipation
  3. Chagas disease
  4. neurological conditions - Parkinson’s, Duchenne MD
  5. Psychiatric conditions e.g. schizophrenia
143
Q

What are 3 associations of caecal volvulus?

A
  1. affects all ages
  2. adhesions
  3. pregnancy
144
Q

What is the sign on AXR of sigmoid volvulus?

A

coffee bean sign

145
Q

What is the management of sigmoid volvulus?

A

rigid sigmoidoscopy with rectal tube insertion

146
Q

What is the management of caecal volvulus?

A

operative - often R hemicolectomy

147
Q

What are the initial steps for investigation for suspected acute limb-threatening ischaemia?

A
  • handheld arterial Doppler exam
  • if Doppler signals present - ABPI
148
Q

In acute limb-threatening ischaemia what are 4 features suggestive of thrombus?

A
  1. pre-existing claudication + sudden deterioration
  2. no obvious embolic source
  3. reduced/absent pulses in contralateral limb
  4. widespread vascular disease e.g. MI, stroke, TIA, previuos vascular surgery
149
Q

In acute limb-threatening ischaemia what are 5 features suggestive of embolus?

A
  1. sudden onset of painful leg (<24h)
  2. no h/o claudication
  3. obvious source of embolus e.g. AF, recent MI
  4. no evidence of peripheral vascular disease (normal pulses contralateral limb)
  5. evidence proximal aneurysm (abdo aorta, popliteal)
150
Q

What is the initial management of acute limb-threatening ischaemia?

A
  • analgesia - IV opioids
  • IV UFH
  • vascular review
151
Q

What are 5 options for definitive management in acute limb threatening ischaemia?

A
  1. intra-arterial thrombolysis
  2. surgical embolectomy
  3. angioplasty
  4. bypass surgery
  5. amputation - if irreversible ischaemia
152
Q

Is there an increased risk of malignancy with fibroadenoma?

A

no

153
Q

What is the commonest type of breast cancer?

A

invasive ductal carcinoma (no special type)

154
Q

What are 4 commonest types of breast cancer?

A
  1. invasive ductal carcinoma (commonest)
  2. invasive lobular carcinoma
  3. ductal carcinoma in situ (DCIS)
  4. lobular carcinoma in situ (LCIS)
155
Q

What is an indication to refer someone with a forearm laceration to plastics?

A

involvement of tendon sheath

156
Q

What are 4 aspects of staging in patients diagnosed with colorectal cancer?

A
  1. CEA
  2. CT TAP
  3. colnoscopy OR CT colonography
  4. if tumour below peritoneal reflection - mesorectal evluation with MRI
157
Q

When is hormonal therapy offered for breast cancer?

A

if tumours positive for hormone receptors

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