General Surgery Stuff Flashcards
1
Q
What do high pitched bowel sounds indicate?
A
Possible obstruction - get Abdo CT with contrast
2
Q
Which nerve is at risk of damage during posterior triangle LN biopsy?
A
Accessory nerve
3
Q
Which nerve is at risk of damage on Lloyd Davies stirrups?
A
Common peroneal nerve
4
Q
Which nerve is at risk of damage during a thyroidectomy?
A
Recurrent laryngeal nerve
5
Q
Which nerve is at risk of damage during an anterior resection of the rectum?
A
Hypogsastric autonomic nerve
6
Q
Which nerves are at risk of damage during axillary node clearance? (3)
A
Long thoracic nerve
Thoracodorsal nerve
Intercostobrachial nerve
7
Q
Which nerve is at risk of damage during inguinal hernia repair?
A
Ilioinguinal nerve
8
Q
Which nerves are at risk during varicose vein surgery? (2)
A
Sural nerve
Saphenous nerve
9
Q
Which nerve is at risk during the posterior approach to the hip?
A
Sciatic nerve
10
Q
Which nerve is at risk during carotid endarterectomy?
A
Hypoglossal nerve
11
Q
What should the maximum diameter of the small bowel be?
A
35mm
12
Q
What should the maximum diameter of the large bowel be?
A
55mm
13
Q
What diagnosis would progressive dysphagia of solids and liquids, without GORD suggest?
A
Achalasia
14
Q
What cancer is achalasia associated with?
A
Squamous cell carcinoma of the oesophagus
15
Q
What are the features of Stage I Haemorrhagic shock?
A
<750ml
HR <100
<15% loss
16
Q
What are the features of Stage II Haemorrhagic shock?
A
750-1500ml
HR >100
BP normal
15-30% loss
17
Q
What are the features of Stage III Haemorrhagic shock?
A
1500-2000ml
HR >120
BP reduced
30-40% loss
18
Q
What are the features of Stage IV Haemorrhagic shock?
A
>2000ml HR >140 BP reduced RR >35 >40% loss Lethargic
19
Q
What is the classification of an UPPER GI bleed?
A
Proximal to ligament of Treitz aka suspensory muscle of the duodenum
Boundary between the duodenum and jejunum
20
Q
What is Parkland’s formula?
A
The volume of Hartman’s solution required for 2nd/3rd degree burns victims over first 24hours
21
Q
How is Parkland’s formula calculated?
A
4ml x BSA x weight
1/2 over 8hrs, 1/2 over next 16hrs
22
Q
What is a FAST scan?
A
Assesses for free fluid around kidneys, spleen, liver, bladder and pericardium (+pneumothroax)
23
Q
What is the general management for haemorrhoids? (3)
A
Stool softeners
Topical Diltiazem or GTN
24
Q
What are some specific managements for small and large haemorrhoids?
A
Small = phenolic solution injection Large = haemorrhoidectomy
25
What are the general management options for anal fissures?
1st line = Topical Diltiazem or GTN for 6wks
2nd line = Botox injection
Sphincterectomy
26
What is the surgical management of a fistula in ano?
Low/not involving sphincter/non-IBD = lay open
| High/complex/IBD = seton suture
27
What kind of surgery is appropriate for large external haemorrhoids?
Miller-Morgan style conventional haemorrhoidectomy
28
What are the disadvantages of a Miller-Morgan haemorrhoidectomy?
Very painful
| Lots of tissue removal -> risk of anal stenosis
29
What is the surgical management of fissure in ano?
Lateral internal sphincterectomy (most effective)
30
Why is a lateral internal sphincterectomy not ideal for females?
Causes pelvic floor damage which may be exacerbated by pregnancy -> faecal incontinence
31
Where are anal fissures usually located?
Posterior midline
32
What must be consider if multiple or unusually located fissures are present?
Investigation for IBD or internal prolapse
33
What artery is most at risk with a perforated duodenal ulcer on posterior wall?
Gastroduodenal artery
34
What is the most likely cause of major duodenal haemorrhage?
Perforated posterior ulcer damaging the gasproduodenal artery
35
What is the definition of congenital cryptorchidism?
Undescended testis at 3 months of life
36
What is the management of congenital cryptorchidism?
Wait until 6 months, if not descended, need orchidoplexy at 6-18 months of life
37
Why must congenital crytorchidism be corrected before 2yrs of life?
Sertoli cells degrade after 2yrs
38
What is the function of Sertoli cells?
Secrete ABP -> promotes spermatogenesis
| Secrete inhibib -> negative feedback on pituitary -> decreases FSH secretion
39
What stimulates Sertoli secretion of ABP?
FSH from pituitary and testosterone from Leydig cells
| Must be in combination
40
How may retroperitoneal fibrosis appear on CT?
Medially displaced ureters with a para-aortic mass
41
What may indicate a hypoglossal nerve injury?
Tongue pointing TOWARDS the lesion
42
Which cells may be present on a post-splenectomy blood film? (4)
Howell-Jolly cells
Pappenheimer cells
Target cells
Irregular contracted erythrocytes
43
Where are femoral hernias found?
Below and lateral to pubic tubercle
44
Who gets femoral hernias?
Multiparous women
45
What are the risks of femoral hernias?
High risk of obstruction and strangulation -> require surgery
46
Where are inguinal hernias found?
Above and medial to pubic tubercle
47
Who gets inguinal hernias?
95% are male
| 25% lifetime risk for males
48
How common is strangulation in inguinal hernias?
Rare
49
What is Cowden disease?
Macrocephaly and multiple intestinal hamartomas
| PTEN mutation
50
What is FAP?
Autosomal dominant APC gene mutation causing many colonic adenomas (generally >100)
51
What is the lifetime cancer risk for FAP?
100%
52
What is the management of FAP?
Annual flexible sigmoidoscopy from 15yrs
Then 5 yearly from 20yrs if no polyps found
If polyps found = colonic resection
53
What is Peutz-Jegher's syndrome?
Autosomal domination STK11 mutation (Chr19) causing multiple benign intestinal hamartomas
54
What is the management of Peutz-Jegher's syndrome?
2-3 yearly pan-intestinal endoscopy
55
What is a classic extra-intestinal feature of Peutz-Jeghers syndrome?
Pigmentation spots around mouth
56
What may be the diagnosis for someone who presents with persistent hypotension following a deceleration injury?
Aortic rupture
57
What CXR feature may be present with aortic rupture?
Widened mediastinum
58
What is a Dieulafoy lesion?
Bleeding caused by a SINGLE large tortuous arteriole in submucosa (of stomach)
59
What are the classic features of a duodenal ulcer?
Pain several hours after eating, relieved with food
60
What is Bevacizumab?
Anti-VEGF
| Used in colorectal ca, renal ca and glioblastoma management
61
What is Basiliximab?
IL-2 binding site
| Used in renal transplants
62
What is Cetuximab?
Epidermal GF inhibitor
| Used in EGF +ve colorectal ca management
63
What is normal Central Venous Pressure?
2-6mmHg
64
What is a general surgical cause of bubbly urine with recurrent UTIs?
Enterovesical fistula
| Often secondary to colorectal cancer
65
What may cause haematuria and polycythaemia?
Renal vein thrombosis
| Often secondary to renal cell cancer
66
What is Li Fraumeni syndrome?
p53 mutation causing sarcomas, breast cancer, leukaemia and adrenal tumours
67
What may be the diagnosis for a patient with a lower GI bleed and portal hypertension?
Rectal varices
68
What investigation is required is an anal fistula is diagnosed?
Pelvic MRI
| In order to characterise fistula course
69
What causes a Sine wave ECG?
Severe hyperkalaemia >9
70
What is the management of congenital inguinal hernias?
Prompt surgical repair
| High complication rate if not
71
What is the management of congenital umbilical hernias?
Managed conservatively
72
What may be the diagnosis for a stable patient who is found to have free abdominal fluid after a deceleration injury?
Duodenal-jejunal flexure disruption
73
The risk of what type of cancer is increased in patients with UC and PSC?
Cholangiocarcinoma
74
What tumour marker is raised in cholangiocarcinoma?
CA19-9 raised in 80%
| Also CEA and CA125
75
What is a Ritcher's hernia?
Hernia of only anti mesenteric border of bowel
| Can present with strangulation in absence of obstruction
76
What is used in vatical management?
Terlipressin
| Sengstaken-Blakemore tubes
77
What should be considered if a bleeding ulcer cannot be repaired endoscopically after 2+ attempts?
Laparotomy and ulcer underrunning
78
What are the indications for laparotomy and ulcer underrunning? (4)
>60yrs
Continued bleeding despite endoscopy
Recurrent bleeding
Known CVD with poor response to hypotension
79
What is the annual risk of strangulation of inguinal hernias?
3%
| More common in indirect
80
What is flail chest associated with?
Pulmonary contusion
81
What is the classic feature of colonic angiodysplasia?
Brisk PR bleeding
82
How does colonic angiodysplasia appear on colonoscopy?
Small erythematous lesions
| Generally in right colon
83
What is the likely cause of post-AAA PR bleeding?
Ischaemic colitis
| Secondary to inferior mesenteric artery ligation
84
What is the cause of a pyogenic liver abscess in a Middle Eastern background?
Entamoeba histiolytica abscess
85
What is the management of entamoeba histiolytica abscess?
Metronidazole
86
What are the causes of hyper-echoic liver lesions on USS? (2)
Hepatocellular carcinoma
| Haemangioma
87
How do you differentiate between HCC and haemangioma?
```
HCC = raised AFP
Haemangioma = normal AFP
```
88
What is a haemangioma?
Benign mesenchymal tumour
89
What is a mesenchymal hamartoma?
Congenital benign tumour
Generally present in infants
May compress normal liver
90
What is the difference between a hamartoma and a haemangioma?
```
Hamartoma = benign growth of normal mature cells in abnormal distribution
Haemangioma = type of hamartoma composed of vascular tissue
```
91
What kind of cyst appears as a unilocular lesion with no epithelial lining and a thick cyst wall?
Hyatid cyst
92
What causes a hydatid cyst?
Echinococcus granulosus infection
| Found in Middle East
93
How do hydatid cysts appear on USS?
Uniloculated lesion with no epithelial lining and a thick cyst wall
94
What feature may be present on an FBC with a hydatid cyst?
Eosinophilia (33%)
95
What is the management of a hydatid cyst?
Cyst sterilisation with mebendazole THEN +/- surgical excision
96
What is contraindicated in hydatid cyst management?
Percutaneous aspiration
97
What investigation best differentiates between hydatid and amoebic cysts?
CT
98
What is a cystadenoma?
Rare solitary multilocular lesion with malignant potential
99
What do the blood results show with a cystadenoma?
LFTs generally normal
100
How do cystadenomas appear on USS?
Large anechoic, fluid-filled area with irregular margins
101
What is the management of ALL cystadenomas?
Surgical resection
| Due to malignant potential
102
What causes a hydatid cyst?
Echoinococcus granulosus infection
| Due to Type I Hypersensitivity
103
Where, other than the liver, are hydatid cysts commonly found?
Lungs
104
What are the 5 types of thyroid cancer?
```
Papillary
Follicular adenoma
Follicular carcinoma
Medullary carcinoma
Anaplastic carcinoma
```
105
What percentage of thyroid cancer is papillary?
70%
106
Who gets papillary thyroid cancer?
Young females
| Good prognosis
107
How does papillary thyroid cancer appear on histology?
Pale empty nuclei
108
How does papillary thyroid cancer metastasize?
Via lymphatics
109
What is the management of papillary thyroid cancer?
Total thyroidectomy with adjuvant radioiodine
110
What monitoring is required post-thyroidectomy in papillary thyroid cancer?
Yearly thyroglobulin levels to detect recurrence
111
What percentage of thyroid cancer is follicular adenoma/carincoma?
20%
112
What is the management of follicular thyroid cancer?
Same as papillary
113
What is the difference between follicular adenoma and carcinoma?
Both solitary nodules
| Follicular carcinomas show microscopic capsular and vascular invasion
114
What percentage of thyroid cancer is medullary?
5%
115
Which cells do medullary thyroid cancers originate from/
Parafollicular C cells
| These are neural crest cells, not thyroid tissue
116
What is used as a tumour marker in medullary thyroid cancer?
Serum calcitonin raised
117
What percentage of medullary thyroid cancer is familial?
20%
| Part of MEN-2
118
What would indicate a poor prognosis for medullary thyroid cancer?
Nodal disease
119
What percentage of thyroid cancer is anaplastic?
1%
| More common in elderly females
120
What is the management of anaplastic thyroid cancer?
Resection
Unresponsive to chemotherapy
Often require palliation with isthmusectomy and radiotherapy
Local invasion is common
121
What malignancy is associated with Hashimoto's?
Lymphoma
122
What would suggest a psoas abscess? (3)
Systemic infection features
Groin swelling
Pain exacerbated with hip extension
123
What is Boas' sign?
Hyperaesthesia beneath right scapula in acute cholecystitis
124
What are the 3 indications for an emergency splenectomy?
Uncontrollable splenic bleeding
Hilar vascular injuries
Devascularised spleen
125
What must you be aware of with TPN?
Can cause deranged LFTs and refeeding syndrome
126
What are common causes of diaphragm rupture?
RTA and blunt trauma
| Cause large radial tears
127
Which side are diaphragm ruptures more common on?
Left
128
How may a diaphragm rupture appear on CXR?
Indistinct left hemidiaphragm
129
What is Meckel's diverticulum?
Congenital diverticula in terminal ileum
130
What is a complication of Meckel's diverticulum?
May contain gastric mucosa
Over time causes ulceration and bleeding
Causes iron-deficient anaemia
131
What symptom may indicate gastric mucosa in a Meckel's diverticulum?
Pain after eating
132
What is Meckel's diverticulum a remnant of?
Omphalomesenteric duct (yolk stalk)
133
What is the rule of 2s for Meckel's diverticulum?
```
2% of population
2 feet proximal to ileocaecal junction
2 inches long
Presents at 2yrs
2 types of mucosa (gastric and pancreatic)
2:1 M:F
```
134
How does Meckel's diverticulum most commonly present?
PR bleeding followed by obstruction, volvulus and intussusception
