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5th (Final year) > General surgery (passmed) > Flashcards

General surgery (passmed) Flashcards

1
Q

What are the two ‘signs’ of appendicitis to do with discolouration?

A

Periumbilical discolouration
- Cullen’s sign

Flank discolouration
- Grey-Turner’s sign is described but rare

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2
Q

What is the sign for Cholecystitis, pain in the RUQ when pressed?

A

Murphy’s

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3
Q

What is Rovsing’s sign for?

A

Appendicitis

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4
Q

Classic differentials for abdo swelling?

A

Pregnancy
Intestinal obstruction
Ascites
Urinary Retention
Ovarian Ca.

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5
Q

Location and aetiology of inguinal hernias and femoral hernias?

What type has the highest risk of strangulation?

A

Direct Inguinal
- Above and medial to pubic tubercle
- Medial to epigastric vessels
- Weakness in transversalis fascia

Indirect Inguinal
- Above and medial to pubic tubercle
- Lateral to epigastric vessels
- Failure of the processus vaginalis to close

Femoral
- Below and lateral to the pubic tubercle

Femoral has the highest risk of strangulation

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6
Q

Difference in an umbilical and paraumbilical hernia?

A

Paraumbilical is an asymmetric bulge - half is covered by skin

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7
Q

What are the three biological therapies used in Rheumatoid arthritis and Crohns disease?

A

Adalimumab
Infliximab
Etanercept

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8
Q

What is cryptorchidism?

A

A congenital undescended testis

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9
Q

What is Scheuermann’s disease?
- Presentation (symptoms and signs)
- What is it

A

Epiphysitis of the vertebral joints is the main pathological process

Presentation:
- Predominantly affects adolescents
- Symptoms include back pain and stiffness
- X-ray changes include epiphyseal plate disturbance and anterior wedging
- Clinical features include progressive kyphosis (at least 3 vertebrae must be involved)

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10
Q

Types of scoliosis?

A

Structural and non-structural

Non structural typically disappears upon movement

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11
Q

What are the three categories of spina bifida?

A

Myelomeningocele
- The worst, may have neurological defects

Meningocele
- ?just needs to be closed

Occulta
- Fine, about 10% of babies

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12
Q

What is Spondylolysis?

A

Congenital or acquired deficiency of the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/ L5.

May be asymptomatic and affects up to 5% of the population.

Spondylolysis is the commonest cause of spondylolisthesis in children.

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13
Q

What is Spondylolisthesis?

A

One vertebra is displaced relative to its immediate inferior vertebral body

May occur as a result of stress fracture or spondylolysis

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14
Q

Treatment for spondylolisthesis?

A

Treatment depends upon the extent of deformity and associated neurological symptoms, minor cases may be actively monitored. Individuals with radicular symptoms or signs will usually require spinal decompression and stabilisation.

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15
Q

What determines whether you should gastric feed/feed elsewhere?

A

Upper GI function

If dysfunction then jejunal/duodenal

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16
Q

What are the four types of fistulae, and their features?

A

Enterocutaneous
- Intestines to skin
- High or low output (>500ml is high)

Enteroenteric/enterocolic
- Small bowel or large bowel

Enterovaginal
- Bowel to vagina

Enterovesicular
- Bowel to bladder
- Pneumouria

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17
Q

Management of fistulas?

A

Most will heal by themselves if not associated with underlying inflammatory condition

If enterocutaneous then need to protect skin, e.g. use stoma bag.

Can use octreotide if high volume (less pancreatic secretions)

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18
Q

What is the Parkland formula for fluid resus in burns?

A

4 x (total burn surface are x weight (kg))

Half given in first 8 hours

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19
Q

At what percentage body surface cover should you fluid resus in kids and adults?

A

> 15% in adults

> 10% in kids

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20
Q

Summary of low acute GI management?

A

Consider admission if:
* Over 60 years
* Haemodynamically unstable/profuse PR bleeding
* On aspirin or NSAID
* Significant co-morbidity

Management:
- All patients should have a history and examination, PR and proctoscopy
- Colonoscopic haemostasis aimed for in post polypectomy or diverticular bleeding

21
Q

Groin lumps key questions

A

Is there a cough impulse

Is it pulsatile AND is it expansile (to distinguish between false and true aneurysm)

Are both testes intra scrotal

Any lesions in the legs such as malignancy or infections (?lymph nodes)

Examine the ano rectum as anal cancer may metastasise to the groin

Is the lump soft, small and very superficial (?lipoma)

22
Q

Scrotal lumps key questions

A

Is the lump entirely intra scrotal

Does it transilluminate (?hydrocele)

Is there a cough impulse (?hernia)

23
Q

What are hydatid cysts?

Investigations and management?

A

Caused by the tapeworm parasite Echinococcus granulosus

Need CT and surgery

24
Q

Boundaries of hesselbachs triangle?

A

Medial: Rectus abdominis
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament

25
Q

Management of inguinal hernias?

A

If at risk, or if patient is well then surgical repair (usually mesh)

Open if first time

Laparoscopic if recurrence or bilateral

26
Q

Common types of liver tumours?

A

95 % are mets from another primary

Primaries

HCC
- Normally secondary to chronic Hep B infection

Cholangiocarcinoma
- PSC biggest risk factor

27
Q

Management of pancreatitis?

A

Enteral nutrition

Abx
- Imipenem
- May not be worth it if mild disease

Surgery
- If due to gallstones, then early cholecystectomy
- If obstructed biliary system due to stones then ERCP
- Maybe debridement or aspiration if necrosis
- If infected necrosis then radiological drainage or necrosectomy

28
Q

Definitions of massive haemorrhage?

A

Loss of blood volume in 24 hours (7% of weight)

Loss of 50% blood volume in 3 hours

Loss of blood volume >150ml a minute

29
Q

What are the three main types of antigen that may give rise to rejection in organ transplant?

A

ABO
HLA
MHC

30
Q

Most common type of pancreatic cancer?

A

Adenocarcinoma of the head of the pancreas

31
Q

Presentation of pancreatic cancer?

A

Classically painless jaundice

Patients typically present in a non-specific way with anorexia, weight loss, epigastric pain

Loss of exocrine function (e.g. steatorrhoea)

Atypical back pain is often seen

32
Q

Investigation choices for pancreatic cancer?

A

Ultrasound has a sensitivity of around 60-90%

High resolution CT scanning is the investigation of choice if the diagnosis is suspected

33
Q

Primary malignant bone tumours?

A

Chondrosarcoma
Osteosarcoma
Ewing’s tumour

34
Q

Where are pilonidal cysts normally located?

A

Midline of natal cleft

35
Q

What is Meckel’s diverticulum

A

A Meckel’s diverticulum is a congenital abnormality that is present in about 2% of the population

Typically 2 feet proximal to the ileocaecal valve

May be lined by ectopic gastric mucosal tissue and produce bleeding, and RIF pain

36
Q

Types of shock?

A

There are five

Septic
Haemorrhagic
Neurogenic
Cardiogenic
Anaphylactic

37
Q

What is the aetiology in neurogenic shock?

A

Spinal cord transection, usually at a high level.

There is a resultant interruption of the autonomic nervous system.

The result is either decreased sympathetic tone or increased parasympathetic tone

38
Q

What is the aetiology in cardiogenic shock?

A

The main cause is ischaemic heart disease

39
Q

Presentation of small bowel obstruction?

A

Central abdominal pain

Nausea and vomiting

‘constipation’ with complete obstruction
abdominal distension may be apparent, particularly with lower levels of obstruction

40
Q

What does TPN include, where should it ideally be given?

A

Bags contain combinations of glucose, lipids and essential electrolytes, the exact composition is determined by the patients nutritional requirements.

Ideally given centrally (PICC line)

41
Q

What are the types of transplant?

A

Allograft
Transplant of tissue from genetically non identical donor from the same species.

Isograft
Graft of tissue between two individuals who are genetically identical

Autograft
Transplantation of organs or tissues from one part of the body to another in the same individual e.g. Skin graft

Xenograft
Tissue transplanted from another species e.g. Porcine heart valve

42
Q

When would you perform a diagnostic peritoneal lavage?

A

Document bleeding if hypotensive

43
Q

UGIB presentation?

A

Haematemesis and/ or malaena
Epigastric discomfort
Sudden collapse

44
Q

After UGIB endoscopy what score do you need to do?

A

Rockwall score to determine risk of re-bleeding

45
Q

Polycythaemia occurs in which renal ca.?

A

Adenocarcinoma of the kidney

46
Q

In a pt with haemothorax at what point do you want to do a thoracotomy?

A

> 1.5L of blood loss initially or >220/hour for the next two hours.

47
Q

How can you tell apart FAP and HNPCC (lynch)?

A

HNPCC does not have loads of polyps

48
Q

Most common scoring system in pancreatitis?

A

Glasgow

49
Q

Small bowel obstruction management?

A

Drip (Iv fluids) and suck (NG tube)

5th (Final year) (34 decks)

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