Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What is Paget’s Disease of the Nipple?

A

eczematoid change in the nipple - 50% have underlying mass lesion, usually invasive carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

management of post-op ileus

A

correct deranged electrolytes - replace intravenously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

appearance of sigmoid volvulus

A

‘coffee bean’ sign, lines of coffee bean converge towards site of obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

associations with sigmoid disease (5)

A 
increasing age
chronic constipation
chagas disease
neurological conditions
psychiatric conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

associations with caecal volvulus (3)

A

all ages
adhesions
pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

caecal volvulus appearance on x-ray

A

small bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

managmene of volvulus

A

sigmoid - rigid sigmoidoscopy with flatus tube insertion

caecal - operative, usually right hemicolectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is a breast fibroadenoma

A

a benign tumour which forms from a whole lobule. mobile and firm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

management of breast fibroadenoma

A

30% will regress on their own

if >3cm surgical excision usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

post splenectomy blood film features (4)

A

Howell-Jolly bodies
Pappenheimer bodies
target cells
irregular contracted erythrocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

features of small bowel obstruction on AXR

A

diameter >35mm

valvulae conniventes extend all the way across bowel loops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

features of large bowel obstruction on AXR

A

diameter >55mm

haustra extend about a third of the way across the bowel loops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

non surgical breast cancer Mx

A
  • radiotherapy - all women with breast conserving surgery or women with T3-T4 tumours who have mastectomy
  • hormonal therapy is used for women with hormone positive tumours - tamoxifen in pre/perimenopausal women and anastrozole in post menopausal women
  • HER2 positive can use herceptin (CIed in heart disorders)
  • Chemotherapy may be used neoadjuvantly or to treat axillary node disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

neurogenic shock

A

interruption of the autonomic nervous system resulting in reduced sympathetic or increased parasympathetic tone, resulting in decreased peripheral vascular resistance and vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of duodenal ulcer

A

post-prandial pain worst several hours after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a dieulafoy lesion?

A

small arterial lesions in the stomach - result in significant haematemesis and malena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

clinical features of liver disease (6)

A 
jaundice
gynaecomastia
spider naevi
caput medusae 
ascites
malnourished appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

classification of haemorrhagic shock

A

I - compensated
II - tachycardia
III - tachycardia, hypotension and confusion
IV- LOC + severe hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Breast cysts - presentation

A

smooth, discrete lump which may be fluctuant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

breast cysts - management

A

aspirate, may be excised if blood stained or persistently refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

sclerosing adenosis -presentation and management

A

breast lumps or breast pain, mammographic changes mimic carcinoma. Biopsy results, excision optional.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is angiodysplasia

A

AV lesions causing lower GI bleeds, which can be massive. No other symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is a hepatic haemangioma

A

most common benign liver tumour, hyperechoic on USS, may be symptomatic if large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Blatchford score

A

assessment of need for admission and urgency of endoscopy in upper GI bleeds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Rockall score

A

post endoscopy for upper GI bleed to estimate rebleeding risk and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

bubbly urine is suggestive of …

A

…enterovesical fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of nipple discharge (6)

A 
breast abscess -puss
duct ectasia - thick green or brown
galactorrhoea - pituitary tumour/ emotional/iatrogenic 
physiological milk production
intraductal papilloma- blood-stained
carcinoma - blood-stained
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of tender breast lumps (3)

A

breast abscess
mammary duct ectasia
fibroadenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Causes of non-tender breast lumps (3)

A

fat necrosis
breast cancer
fibroadenoma

30
Q

Marker for bowel cancer

A

CEA

31
Q

Dukes staging

A

Dukes A - tumour confined to the mucosa
Dukes B - Tumour invaded bowel wall
Dukes C - Local lymph node involvement
Dukes D - distant metastases

32
Q

Iron deficiency anaemia in over 60s - what you gonna do?

A

Urgent referral to colorectal surgeon for suspected colon cancer.

33
Q

Acute Mx of anal fissure

A

dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia

34
Q

Chronic Mx of anal fissure

A

acute Mx should be continued
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin

35
Q

Resection and anastomosis for tumours in Caecal, ascending or proximal transverse colon

A

Right hemicolectomy

Ileo-colic

36
Q

Resection and anastomosis for tumours in Distal transverse, descending colon

A

Left hemicolectomy

Colo-colon

37
Q

Resection and anastomosis for tumours in Sigmoid colon

A

High anterior resection

Colo-rectal

38
Q

Resection and anastomosis for tumours in Upper rectum

A 
Anterior resection (TME)
Colo-rectal
39
Q

Resection and anastomosis for tumours in Low rectum

A 
Anterior resection (Low TME)
Colo-rectal (+/- Defunctioning stoma)
40
Q

Resection and anastomosis for tumours in Anal verge

A

Abdominoperineal excision of rectum

None

41
Q

Complications of diverticular disease (6)

A 
Diverticulitis
Haemorrhage
Development of fistula
Perforation and faecal peritonitis
Perforation and development of abscess
Development of diverticular phlegmon
42
Q

Classification of diverticular disease

A

I Para-colonic abscess
II Pelvic abscess
III Purulent peritonitis
IV Faecal peritonitis

43
Q

Management of diverticular disease

A

Increase dietary fibre intake
Mild attacks - antibiotics.
Peri colonic abscesses should be drained either surgically or radiologically.
Recurrent episodes of acute diverticulitis requiring hospitalisation are a relative indication for a segmental resection.
grade IV perforations (generalised faecal peritonitis) will require a resection and usually a stoma. High risk of postoperative complications and usually require HDU admission. Less severe perforations may be managed by laparoscopic washout and drain insertion

44
Q

Investigation to ensure no anastomotic leak following colonic anastomosis formation

A

gastrografin enema

45
Q

Anal cancer risk factors (7)

A
  • HPV 16 and 18 infection causes 80-85% of SSCs
  • Anal intercourse and a high lifetime number of sexual partners increases the risk of HPV infection.
  • MSM
  • Those with HIV and those taking immunosuppressive medication for HIV are at a greater risk of anal carcinoma.
  • Women with a history of cervical cancer or cervical intraepithelial neoplasia (CIN) are also at greater risk of anal cancer.
  • Immunosuppressive drugs used in transplant recipients increase the risk of anal cancer.
  • Smoking is also a risk factor.
46
Q

Screening for colon cancer

A

at 55 one-off flexible sigmoidoscopy to detect polyps

FOB test every 2 years from 60 to 74 (from 50 in Scotland)

47
Q

peptic ulcer pain

A

duodenal - several hours after eating / worse when hungry

gastric - worsened by eating

48
Q

which artery tends to be perforated in duodenal ulcers?

A

gastroduodenal artery

49
Q

Congenital Inguinal Hernias
Anatomy
Management

A

Indirect hernias resulting from a patent processus vaginalis

Should be surgically repaired soon after diagnosis as at risk of incarceration

50
Q

Bowel obstruction - investigation

A

AXR initially

if small bowel suggestive then get CT abdomen to confirm

51
Q

Nere at risk of damage in total hip replacement and symtptoms

A

sciatic nerve - foot drop

52
Q

Haemothorax

management

A

wide bore 36F chest drain.
Indications for thoracotomy include loss of more than 1.5L blood initially or ongoing losses of >200ml per hour for >2 hours.
consider delaying management if likely to cause ongoing bleeding in an unstable patient

53
Q

lower GI bleed in liver disease patients? likely diagnosis?

A

rectal varices due to portal hypertension

54
Q

What causes abdominal wall haematoma?

A
  • trauma, either directly to the abdominal wall or iatrogenic trauma from surgery
  • spontaneous following excessive straining due to valsalva manoeuvres, coughing.
55
Q

Presentation of abdominal wall haematoma

A

painful, discoloured mass

signs of hypovolemia (tachycardia and hypotension)

56
Q

Complications of TPN (4)

A

Thrombophlebitis
liver dysfunction
sepsis
refeeding syndrome

57
Q

What is Rovsings sign?

A

appendicitis - palpation of the left iliac fossa causes pain in the right iliac fossa

58
Q

What is Boas sign?

A

-cholecystitis - hyperaesthesia beneath the right scapula

59
Q

What is Murphys sign?

A

cholecystitis - pain as the inferior liver border is brought down on a palpating hand as the patient inhales, causing a ‘catch’ in their breath.

60
Q

What is Cullens sign?

A

peri-umbilical bruising - pancreatitis (other intraabdominal haemorrhage)

61
Q

What is Grey-Turners sign?

A

flank bruising - pancreatitis (or other retroperitoneal haemorrhage)

62
Q

Glasgow PANCREAS score

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

63
Q

Complications of gastrectomy (7)

A 
Dumping syndrome
Weight loss, early satiety
Iron-deficiency anaemia
Osteoporosis/osteomalacia
Vitamin B12 deficiency
increased risk of gallstones
increased risk of gastric cancer
64
Q

What is Dumping syndrome

A

post gastrectomy
early: food of high osmotic potential moves into small intestine causing fluid shift
late (rebound hypoglycaemia): surge of insulin following food of high glucose value in small intestine - 2-3 hours later the insulin ‘overshoots’ causing hypoglycaemia

65
Q

Laproscopy complications (5)

A
  • general risks of anaesthetic
  • vasovagal reaction (e.g. bradycardia) in response to abdominal distension
  • extra-peritoneal gas insufflation: surgical emphysema
  • injury to gastro-intestinal tract
  • injury to blood vessels e.g. common iliacs, deep inferior epigastric artery
66
Q

Causes of raised serum amylase (6)

A 
Acute pancreatitis
Pancreatic pseudocyst
Mesenteric infarct
Perforated viscus
Acute cholecystitis
Diabetic ketoacidosis
67
Q

Causes of pancreatitis (GET SMASHED)

A

Gallstones ** common
Ethanol ** common
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

68
Q

Diagnostic test for chronic pancreatitis

A

CT Pancreas with contrast

69
Q

presentation of biliary colic

A

Episodic, colicky RUQ or epigastric pain and nausea

no fever, no vomiting

70
Q

Presentation of cholecystitis

A

Fever, vomiting, constant RUQ pain

no jaundice

71
Q

Presentation of cholangitits

A

Jaundice, fever, RUQ pain (Charcot’s Triad)

+/- Hypotension and confusion (Reynolds Pentad)

72
Q 
Gastric MALT lymphoma
Cause
Mx
Prognosis
Associated feature
A

H. pylori infection in 95% of cases, 80% respond to H. pylori eradication

good prognosis

paraptoteinaemia

Finals (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions