General surgery (passmed) Flashcards
What are the two ‘signs’ of appendicitis to do with discolouration?
Periumbilical discolouration
- Cullen’s sign
Flank discolouration
- Grey-Turner’s sign is described but rare
What is the sign for Cholecystitis, pain in the RUQ when pressed?
Murphy’s
What is Rovsing’s sign for?
Appendicitis
Classic differentials for abdo swelling?
Pregnancy Intestinal obstruction Ascites Urinary Retention Ovarian Ca.
Location and aetiology of inguinal hernias and femoral hernias?
What type has the highest risk of strangulation?
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
Difference in an umbilical and paraumbilical hernia?
Paraumbilical is an asymmetric bulge - half is covered by skin
What are the three biological therapies used in Rheumatoid arthritis and Crohns disease?
Adalimumab
Infliximab
Etanercept
What is cryptorchidism?
A congenital undescended testis
What is Scheuermann’s disease?
- Presentation (symptoms and signs)
- What is it
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)
Types of scoliosis?
Structural and non-structural
Non structural typically disappears upon movement
What are the three categories of spina bifida?
Myelomeningocele
- The worst, may have neurological defects
Meningocele
- ?just needs to be closed
Occulta
- Fine, about 10% of babies
What is Spondylolysis?
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.
What is Spondylolisthesis?
One vertebra is displaced relative to its immediate inferior vertebral body
May occur as a result of stress fracture or spondylolysis
Treatment for spondylolisthesis?
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.
What determines whether you should gastric feed/feed elsewhere?
Upper GI function
If dysfunction then jejunal/duodenal
What are the four types of fistulae, and their features?
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
Management of fistulas?
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)
What is the Parkland formula for fluid resus in burns?
4 x (total burn surface are x weight (kg))
Half given in first 8 hours
At what percentage body surface cover should you fluid resus in kids and adults?
> 15% in adults
> 10% in kids