GetAhead Surgery SBAs Flashcards
What’s the investigation in suspected causes of Myasthenia Gravis?
Tensilon test
*Tensilon = trade name for edrophonium bromide (short acting anti-cholinesterase)
- when administrated IV -> sudden improvement in muscle weakness (prolonged action of acetylcholine is allowed)
What’s a typical Rx of PID?
2 weeks of :
- Ofloxacin (anti-chlamydia and gonorrhoea) and
- Metronidazole (anti- anaerobes and protozoa)
*if significant systemic upset - IV antibiotics
What’s Fitz- Hugh- Curtis syndrome?
RUQ pain caused by inflammation of connective tissue around the liver by the pelvic infection (e.g. in PID)
What’s Herpes Simplex Keratitis?
- detection
- symptoms
- treatment
Infection of the cornea with Herpes Simplex Virus (HSV)
- it may be present after many years of first HSV encounter (dormant in the trigeminal nerve)
- Symptoms: painful, watery, red eye
corneal injection,
- Detection: cobalt blue light with fluorescein -> branch-line lesion= dendritic ulcer that contains live virus
- Treatment: aciclovir until an ulcer heals
- Complications: risk of corneal scarring and blindness -> urgent ophthalmological assessment is needed
*steroids are contraindicated - as they weaken immune system and increase viral burdne
What’s a triad of Budd-Chari syndrome?
- abdo pain
- hepatosplenomegaly
- ascities
*it’s venous flow obstruction secondary to thrombosis of hepatic vein
What’s ABCD2 score?
scoring / results
ABCD2 following TIA
A → age > 65 (1 point)
B → Blood pressure systolic >140 or diastolic >90 (1 point)
C → unilateral weakness (2 points), speech disturbance (1 point)
D → duration >60 minutes (2 points), 10-59 minutes (1 point)
D → diabetes (1 point)
Results: (total score 7)
- 4 or more → admission for inpatient assessment (re suitability for carotid endarterectomy)
Who needs an urgent admission following TIA? (2)
- 4 or more → admission for inpatient assessment (re suitability for carotid endarterectomy)
- Two or more episodes of TIA in a quick succession ‘crescendo TIA’) → need urgent admission regardless of ABCD2 score
What’s March fracture?
- undisplaced hairline fracture
- caused by repetitive stress e.g. marching, running
- common sites: neck of 2nd or 3rd metatarsal
- X ray mostly normal
- periosteal reaction (formation of a new bone/callus in response to stimuli) may be seen
- Rx: analgesia → pain resolves after few weeks (as the fracture union occurs)
What’s Marjolin’s ulcer?
- aggressive but slow - growing squamous cell carcinoma
- arises from the area of previously traumatised skin (e.g. scars, burns)
- lesions: ulcerated, raised and painless
- invade locally
- Dx: biopsy
- Rx: wide local excision
Hypertrophic vs keloid scars
Both occur when there is overgrowth of fibrous tissue within a healing scar
Hypertrophic:
- raised lesions
- within boundary of the original scar
Keloid:
- beyond original scar
Haemorrhagic Shock Class I criteria
Haemorrhagic Shock Class II criteria
Haemorrhagic Shock Class III criteria
Haemorrhagic Shock Class IV criteria
What’s Osler-Weber-Rendu syndrome?
Aka Hereditary Haemorrhagic Telangiectasia
- Autosomal Dominant condition
- Characteristics: telangiectasia, AV malformations at multiple sites, recurrent epistaxis
- Other problems: GI bleeds, hemoptysis, resp compromise due to AV malformations in the lungs, haemorrhagic strokes
- 10% patients have neuro features: headaches, seizures
What features would be suggestive that there is no C-spine injury (when can we remove C - spine collar)?
- patient is not drunk and not under the influence of any drugs
- patient is alert and oriented
- no head injury
- no neck pain
- no abnormal neurology
- no C- spine tenderness or deformity
*if any of these are present → must do imaging
* life- saving procedures take priority over C-spine injury
Adrenaline as local anaesthetic
- MoA
- contraindications
- MoA: Adrenaline will constrict the arteries → prolong the action of local anaesthetics by slowing down system absorption
- Contraindications: end arteries e.g. penis, nose and digits (due to risk of ischaemic necrosis)
Pseudobulbar vs bulbar palsy
Pseudobulbar
- bilateral UPPER motor neurone lesion (9th and 12th CN)
Bulbar
- bilateral LOWER motor neurone lesion (9th and 12th)
How long would it take for the fracture to heal?
- upper limb
- lower limb
- upper: 6-8 weeks
- lower: 12-16 weeks
*these numbers are halved in children
What’s Mackler’s triad?
- vomiting
- lower thoracic/chest pain
- subcutaneous emphysema
Suggestive of Boerhaave’s syndrome → a spontaneous transmural rupture of the oesophagus
What’s the triad of Zollinger-Ellison syndrome?
- gastrin-producing tumour
- gastric hypersecretion
- severe peptic ulceration
Rx: PPIs and tumour resection
What’s Maydl’s hernia?
- Hernia that contains ‘W’ loop of intestine within its sac
- Middle segment is liable to become strangulated
What’s a gluteal hernia?
- protrudes through a greater sciatic foramen
- results from the weakness or deficiency of gluteal muscle fibres
What’s a sciatic hernia?
- protrudes through the lesser sciatic foramen
What’s Littre’s hernia?
- hernia that contains Meckel’s diverticulum
What’s Spigelian hernia?
- protrudes through semilunar line
- usually below the level of umbilicus
- small
- develop in over 50s
- high risk of strangulation
What are (5) types of hypersensitivity + describe
- Type I (anaphylactic) → IgE-mediated from allergen exposure
- Type II (cytotoxic) → antibody-mediated
- Type III (complexes) → immune complex-mediated
- Type IV (delayed) → sensitised T cell - mediated
- Type V (stimulatory) → stimulatory anti-receptor antibody mediated
What’s Richter’s hernia?
- strangulation of one sidewall of the bowel within a hernia sac
- Richter’s hernia → features of strangulation (painful, erythematous) but without characteristics of obstruction
*to compare - strangulated hernia describes strangulation of the entire lumen of the bowel)
What’s incarcerated hernia?
- adhesions develop between hernia sac and its content
- painless, irreducible lump
- incarcerated hernia predispose to strangulation
What’s a strangulated hernia?
- necrosis occurs within 6 hours
condylomata acuminata vs condylomata lata
- condylomata acuminata = anal warts → due to HPV infection
- condylomata lata → due to secondary syphilis
What’s ganglion?
- benign, tense, cystic swelling
- often at the back of the wrist
- occurs due to degeneration of the fibrous tissue surrounding the joints
- often painless (may be painful if compress an adjacent nerve)
Asymptomatic ganglia do not require treatment
Symptomatic -> excision (may do aspiration but half will reoccur)
What’s pyogenic granuloma?
- acquired haemangioma
- occurs most often at the head, trunk, hands and feet
- it is a result of the trauma (occurs at the site of trauma/injury) (e.g. thorn prick)
- bright red nodule
- bleeds easily
- rapid grow in 2-3 weeks
- benign lesions
Rx: excision but small lesions may resolve on its on
(4) characteristics of osteoarthritis on x - ray
- loss (narrowing)of joint space → due to cartilage loss
- osteophytes
- subchondral sclerosis → laying down new bone
- cyst formation
What’s Juvenile RA?
- autoimmune arthritis
- children (under 16 yo)
- joint inflammation
- last more than 6 weeks
What’s Still’s disease?
- systemic form of juvenile arthritis (autoimmune arthritis in kids)
- intermittent high fever
- transient generalised ‘salmon-pink’ rash
- other features: arthralgia, myalgia, hepatosplenomegaly, pericarditis, lymphadenopathy
Dx: clinical + raised inflammatory markers
*RF and ANA are usually negative
Prognosis: self-limiting
What’s Osgood - Schlatter disease?
- affects athletic adolescents
- cause: traction of tibial tubercle at the point of insertion of the patellar tendon
Presentation: pain after activity, tender lump over the tibial tuberosity
Treatment: rest, analgesia, stop sport until the symptoms resolve
What is Sistrunk’s operation for?
Excision of the cyst and thyroglossal duct
What’s a short Synacthen test?
Ix for Addison’s (adrenal insufficiency)
plasma cortisol levels are measured → half an hour later: administration of single IM dose of ACTH → no raise of the cortisol after ACTH administration => adrenal insufficiency/Addison’s
(3) Features of Necrotising Enterocolitis (paeds)
- bile- stained vomit
- erythematous abdomen
- mucus and blood in the stool
AAA
- size of normal abdominal aorta
- what size does define aortic aneurysm
- what to do if aortic aneurysm is <4cm
- what to do if aortic aneurysm is 4.0-5.5 cm
- what to do if >5.5
- normal abdo aorta →2cm
- aortic aneurysm →dilation above 3cm
- <4cm → low risk of rupture →annual USS
- 4.0-5.5 cm → 6 monthly USS
- >5.5 cm → surgical intervention
Duke’s staging
Duke’s staging → grading of colorectal cancer
Dukes’ A → confined to bowel wall
Dukes’ B → invades through the bowel wall but does not involve the lymph nodes
Dukes’ C → invade through the bowels wall and involve lymph nodes
Dukes’D → distal metastases
What compartment pressure (mm/Hg) would indicate the need for urgent fasciotomy?
> 40 mmHg
What’s Cushing’s ulcer?
Development of peptic ulcer following raised intracranial pressure (e.g. head injury)
- mostly in the antrum of the stomach
- cause: stimulation of vagus nerve within brain → increased gastric acid secretion
What’s Curling’s ulcer?
- acute duodenal ulcer few days follwing severe burns
- cause: burn injury → reduced plasma volume → necrosis of gastric mucosa
What’s Decubitus ulcer?
Another name for pressure sore
What’s Martorell’s ulcer?
