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Y4 - Finals Edition > Lectures: Surgery C > Flashcards

Lectures: Surgery C Flashcards

1
Q

Pathogens which may lead to otitis externa

A

PSEUDOMONAS AERUGINOSIA

Staph aureus

E-Coli

Candida

Aspergillus

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2
Q

Otitis externa management

A
  1. Topical acidifiers
    • acetic acid (ear calm spray)
    • aluminium acetate drops
  2. Topical Abx
    • Ciprofloxacin drops
    • Gentamicin + hydrocortisone
  3. Oral Abx
    • flucloxacillin
    • ciprofloxacin
    • metronidazole (if anaerobic)
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3
Q

In malignant otitis externa, how long will patient be treated with Abx:

A

6 weeks of IV ABx

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4
Q

Two forms of chronic suppurative otitis media:

A

1. Active
- perforated eardrum with infection
+/- cholesteatoma
2. Inactive
- perforated eardrum WITHOUT infection

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5
Q

Management of chronic suppurative otitis media:

A

Active

  • may respond with topical Abx
    • ciprofloxacin drops
    • gentamicin + hydrocortisone drops

Surgery

  • stop infection spreading to brain
    • TYMPANOPLASTY (closing hole in ear drum)
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6
Q

How might you confirm diagnosis of BPPV:

A

Dix-Hallpike manoeuvre
- patient sits with head turned at 45 degrees and eyes wide open
- lies with one ear pointed to ground (1-2 mins)
- check for nystagmus

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7
Q

How might you treat BPPV:

A

Epley manoeuvre
- will make patient feel dizzy 20 mins after

Or Brandt Darroff

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8
Q

Management of Meniere’s disease

A
  1. Prochlorperazine (not long term)
  2. Trans tympanic steroids
  3. Chemical labyrinthectomy (gentamicin ablation)
    • majority of patients may lose hearing
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9
Q

Give example of a vestibular rehabilitation exercise

A

Cooksey-Cawthorne exercises

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10
Q

Key features of labrinthitis?

A
  • tinnitus
  • hearing loss
  • vertigo
  • post URTI
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11
Q

What medication may you give to aim to prevent vestibular migraine:

A
  • beta blockers
  • calcium channel blockers
  • anti-epileptic’s
  • tricyclic antidepressants
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12
Q

Grading system for facial palsy

A

House-Brackman grade 1-6

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13
Q

What causes Ramsay Hunt syndrome:

A

Herpes Zoster oticus

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14
Q

Management of facial palsy

A
  1. Prednisolone 1mg/kg (up to 60mg) daily for 1 week, then taper by 10mg ever 3 days thereafter
  2. PPI
  3. Viscotears
  4. Anti-virals if Ramsay Hunt (valacyclovir)
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15
Q

Sounds getting jumbled up making it difficult to hear is known as:

A

auditory processing disorder

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16
Q

What is Rhino-sinusitis characterised by?

A

Definition
- inflammation of nose and paranasal sinuses

Characterised by 2 or more symptoms
One should be: nasal blockage, obstruction, congestion
Or nasal discharge

Endoscopic findings:
- nasal polyps / recurrent and chronic rhinosinusitis

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17
Q

Differences between acute, recurrent and chronic rhino sinusitis:

A
  1. Acute: less than 12 weeks
  2. Recurrent: > 3 episodes throughout year
  3. Chronic: more than 12 weeks
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18
Q

Medical management for Chronic rhino-sinusitis with and without nasal polyps

A

WITHOUT NASAL POLYPS

  • saline nasal douching BD
  • Fluticasone propionate nasules 400mcg (1/2 in each nostril, 3 weeks)
  • clarithromycin 250mg BD 3 weeks

WITH NASAL POLYPS

  • prednisolone 0.5mg/kg 30-40mg OD 1 week
  • saline nasal douching BD
  • Fluticasone propionate nasules 400mcg
  • Doxycycline 100mg OD 3 weeks

SFC

Polyp = P = Pred

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19
Q

What cells produce mucus in the ear

A

goblet cells

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20
Q

Adenoids and tonsils produce what:

A

B-cells (IgG and IgA)
- therefore adenoidectomy might affect serum IgG but not reduce immunity significantly

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21
Q

Tonsils drain into what two nodes:

A
  1. Jugulodigastric nodes
  2. Midcervical nodes
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22
Q

Inflammation of what commonly leads to croup:

A

Cricoid ring
- narrowest part of airway in babies

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23
Q

Common bacterial causes of acute otitis media:

A
  1. H influenza
  2. S pneumoniae
  3. M catarrhalis
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24
Q

Recurrent tonsillitis is how many episodes:

A

5 per year for 2 years , 10 episodes over 2 years

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25
Q

small changes in airway diameter cause big changes in resistance is what law

A

Poiseuille’s law

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26
Q

What condition is the commonest cause of congenital stridor:

A

Laryngomalacia
- floppy larynx

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27
Q

Croup caused by what pathogen:

A

parainfluenza virus (4 months - 2 years)

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28
Q

Epiglottitis caused by what pathogen

A

haemophilus influenza (2-5 years) drooling

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29
Q

What gene mutation is present in 50% of all severe or profound hearing loss

A

GJB2

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30
Q

Group of fractures affecting the midface of skull are known as:

A

Le Fort Fractures
Type 1 - swelling of upper lip, loosening of teeth
Type 2 - midface deformity, upper jaw and nose
Type 3 - orbital, flattening of face

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31
Q

What is pulpitis:

A
  • causes SEVERE acute tooth pain
  • may be tooth with hole or filling
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32
Q

CT: What is the black eyebrow sign?

A
  • indicates air in superior part of orbit
  • indicates orbital fracture
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33
Q

Key features of retrobulbar haemorrhage?

A
  • pain behind eye
  • eye sticks out more than usual
  • opthalmoplegia
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34
Q

Management of retrobulbar haemorrhage:

A
  1. Steroids IV
  2. Acetazolamide (reduces IOP)
  3. Mannitol (osmotic diuretic)

After clinical diagnosis

  • surgical decompression
  • lateral canthotomy
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35
Q

What is a white eye blow out fracture:

A

Signs

  • eye will not look up or down
  • requires urgent treatment

OFTEN in younger patients

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36
Q

Summary of pre-malignant conditions

A

1. Fanconi anaemia: increased risk of AML
–> short, strabismus, bird like facies, macrocytic anaemia

2. Ataxia telangiectasia
–> DNA repair disorder, high AFP, ARecessive, trouble walking, slurred speech, muscle twitching, infections

3. Blooms syndrome
–> Arecessive, distinctic craniofacial features
–> photosensitive
–> cafe-au-lait spots

4. Li-Fraumeni syndrome
–> p53 issue, may dispose to sarcoma, breast, leukaemia and adrenals

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37
Q

What is Kaposi sarcoma?

A
  • cancer cells found in skin
  • or mucous membranes than line GI tract, from mouth to anus including stomach and intestines
  • purple patches or nodules on skin / mucous membranes
  • can spread to lymph nodes and lungs
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38
Q

What is Kaposi sarcoma?

A
  • cancer cells found in skin
  • or mucous membranes than line GI tract, from mouth to anus including stomach and intestines
  • purple patches or nodules on skin / mucous membranes
  • can spread to lymph nodes and lungs
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38
Q

Side effect profile for radiotherapy: ACUTE

A
  1. Mucositis
  2. Skin erythema or ulceration
  3. Loss of taste
  4. impaired nutrition
  5. Bleeding
  6. Infection
  7. Lymphoedema
39
Q

Side effect profile for radiotherapy: ACUTE

A
  1. Mucositis
  2. Skin erythema or ulceration
  3. Loss of taste
  4. impaired nutrition
  5. Bleeding
  6. Infection
  7. Lymphoedema
40
Q

Side effect profile for radiotherapy: LATE

A
  1. Impaired healing
  2. osteoradionecrosis
  3. impaired swallow / speech / taste
  4. xerostomia (oral dryness)
  5. dental caries (tooth decay)
  6. loss of hair
  7. radiation induced tumours
  8. cataracts
41
Q

Heterochromic cyclitis is

A

Chronic uveitis

42
Q

What is Kaposi sarcoma?

A
  • cancer cells found in skin
  • or mucous membranes than line GI tract, from mouth to anus including stomach and intestines
  • purple patches or nodules on skin / mucous membranes
  • can spread to lymph nodes and lungs
42
Q

Kearns-Sayre syndrome

A

rare neuromuscular disorder

43
Q

Kearns-Sayre syndrome

A

rare neuromuscular disorder

Triad
1. symptoms before age 20
2. pigmentary retinopathy (salt and pepper pigmentation)
3. Progressive external opthalmoplegia

44
Q

Sturge Weber syndrome

A
  • abnormal blood vessels on skin leading to reddish colour on one side of face (port-wine birthmark)
  • may be abnormal vessels on eye –> high eye pressure –> glaucoma
45
Q

Von Hippel Lindau disease

A
  • genetic disease that affects people of all ethnicities
  • characterised by tumour development
    –> CNS
    –> kidneys
    –> adrenal glands
    –> pancreas
46
Q

Summary of conditions affecting the eye:
1. Endocrine
2. Inflammatory and autoimmune
3. Infective
4. Congenital
5. Blood
6. Skin

A
  1. ENDOCRINE
    - DM, HTN, thyroid, hyperlipidaemia, acromegaly
  2. Inflammatory and autoimmune
    - rheumatoid arthritis
    - ankylosing spondylitis (anterior uveitis)
    - behcet’s (eye inflammation, mouth ulcers, genital ulcers)
46
Q

Summary of conditions affecting the eye:

A

Inflammatory and autoimmune
–> rheumatoid arthritis
–> ankylosing spondylitis (anterior uveitis)
–> Behcet’s (eye inflammation, mouth ulcers, genital ulcers)
–> sarcoidosis
–> Sjogren’s (autoimmune, tear and salivary glands)
–> GCA (swollen pale optic disc, flame haemorrhages)
–> multiple sclerosis (optic neuritis)
–> myasthenia gravis ( ptosis, diplopia)
–> pemphigoid (blistering lesions affecting mucous membranes)

47
Q

Summary of conditions affecting the eye: INFECTIVE

A
  1. Toxoplasmosis
  2. Fungal
  3. HIV / AIDs
  4. Lyme disease (ticks)
  5. Syphilis
  6. TB
  7. Herpes simplex
48
Q

Skin condition which could affect eye

49
Q

What is the classification of diabetic retinopathy

A

Background DR
–> Microaneurysms , dot and blot haemorrhages

MILD
–> Retinal haemorrhage, cotton wool spots

MODERATE
–> > 6 cotton wool spots, small intra-retinal microvascular abnormalities, dense HMA in 1-3 quadrants

SEVERE
–> Dense HMA 4 quadrants.
–> Multiple or large IRMAs, venous beading in 2 quadrants.

PROLIFERATIVE
–> new vessels on disc or elsewhere in fundus

50
Q

Background retinopathy key features on ophthalmoscopy

A
  • microaneurysms
  • retinal haemorrhages (dot and blot)
  • exudates (lipid and protein)
  • venous beading
51
Q

Cotton wool spots are a sign of:

51
Q

What is Kaposi sarcoma?

A
  • cancer cells found in skin
  • or mucous membranes than line GI tract, from mouth to anus including stomach and intestines
  • purple patches or nodules on skin / mucous membranes
  • can spread to lymph nodes and lungs
52
Q

Diabetic retinopathy vs maculopathy

A

Retinopathy –> damage to retina as a whole

Maculopathy –> leakage of blood vessels at macula

53
Q

Management of pre-proliferative and proliferative DR

A
  • retinal laser photocoagulation
    • reduces VEGF secretion
    • reducing tendency to grow new vessels
54
Q

Management of diabetic maculopathy

A
  1. Macular laser (to try and help preserve function of macula)
  2. Intravitreal anti-VEGF
    • Ranibizumab
    • Aflibercept
  3. Intravitreal steroid
    • dexamethasone implant
    • fluocinolone implant
55
Q

What is malignant hypertension?

A

sudden spike in blood pressure leading to end organ damage.

56
Q

What causes a macular star?

A

Hypertensive retinopathy

  • hard exudates can deposit on macula casing appearance of star
  • optic disc can also be seen
57
Q

Treatment of anterior uveitis

A
  1. Steroid drops with tapering
    a) PredForte, Maxidex
  2. Dilating drops
    a) cyclopentolate, atropine
  3. Peri-orbital steroid injections
    a) sub-conjunctival dexamethasone
57
Q

Posterior uveitis - infectious cause

A

Toxoplasmosis

58
Q

Ethambutol and associated eye problem

A

optic neuropathy

59
Q

Hydroxochloroquine and associated eye problem

A

bulls eye maculopathy

60
Q

COCP, tetracycline and associated eye problem

A

Idiopathic intracranial HTN

61
Q

Anti-cholinergic’s and associated eye problems

A

acute closure glaucoma

62
Q

Tamsulosin and associated eye problem

A

causes floppy iris

63
Q

Amiodarone and associated eye problem

A

corneal verticillate

64
Q

Name an organism that can cross an intact epithelium leading to corneal infection

A

Neisseria Gonococcus

65
Q

Acanthamoeba (protozoal) may be found in corneal infections in what demographic of patients:

A

contact lens wearers

main symptoms of acanthamoeba keratitis
- red eyes
- sensitivity to light
- extreme eye pain
- blurred vision
- excessive earing
- feeling of something in eye

66
Q

Management of corneal infection

A

Dilate pupils with cyclopentolate to help with pain relief
- Antibiotics
- Ciprofloxacin
- +/- teicoplanin

66
Q

What might be seen in the eye in herpetic disease:

A

dendritic ulcer

67
Q

Emergency management of acute (angle closure) glaucoma

A

1. Pilocarpine –> drops to constrict the pupil
2% Blue
4% Brown

2. Intravenous acetazolamide
- reduction in aqueous humour

3. Timolol eye drops
- beta blocker

4. Steroid eye drops

LASER IRIDITOMY + removal of lense

68
Q

Management of retinal detachment

A

Use scars to weld retina in place so it doesn’t detach

69
Q

Jackson’s burn zones

A

Zone of coagulation –> irreversible

Zone of stasis –> decreased tissue perfusion

Zone of hyperaemia –> increased tissue perfusion, tissue usually recovers

70
Q

Superficial burns

A
  • no blistering
  • pink and painful
  • e.g. sunburn
71
Q

Partial thickness burns: superficial

A
  • salmon pink
  • blanch
  • blister
  • very painful
72
Q

Partial thickness burns: deep

A
  • mottled changes
  • no blanch
  • less painful
73
Q

Full thickness burns

A
  • dry
  • leathery
  • waxy
  • does not blanch
  • white
  • painless
74
Q

Mx of Burns

A

ABCDE
–> urine output
–> first aid
–> TBSA%
–> tetanus
–> vascular compromise
1. Escharotomy
2. Fasciotomy

75
Q

Describe components of the reconstructive ladder

A
  • dressing
  • primary closure
  • delayed closure
  • split-thickness
  • full thickness
  • tissue expansion
  • pedicled flap
  • free flap
76
Q

The reconstructive ladder: dressings

A

Allowing wounds to heal by secondary intention

77
Q

The reconstructive ladder: Primary closure

A

Suturing/ closing wound

78
Q

The reconstructive ladder: Delayed closure

A

Allow wound to remain open

(vac dressing applying negative pressure)

79
Q

The reconstructive ladder: Split-thickness graft

A

Thin layer of shaved skin taken from one area, usually thigh and placed elsewhere

80
Q

The reconstructive ladder: Full thickness graft

A

Contain full epidermis and dermis

81
Q

The reconstructive ladder: Tissue expansion

A

Stretching skin to enable it to cover complex wounds

82
Q

The reconstructive ladder: Pedicled flap

A

flap still attached to original blood supply

83
Q

The reconstructive ladder: Free flap

A

Microscopically anastomosed

84
Q

Autograft

A

coming from patient themselves

85
Q

Allograft

A

same species as patient

86
Q

Xenograft

A

different species to patient

87
Q

What dressing may be used in a full thickness skin graft (FTSG)

A

Bolster dressing
- prevents sheer forces and haematoma formation

88
Q

Plasmatic imbibition

A
  • occurs within 24-48hrs
  • process in which nutrients and oxygen infiltrate through the capillaries <1mm away (thus the limitation on thickness)
  • FIBRIN BRIDGES CREATED
  • need a compressive dressing
89
Q

Inosculation

A

36-48 hours later

  • capillary buds sprout through the skin graft and connect to pre-existing vascular channel and create a new one
  • collagen bridges created
89
Q

Neurotization

A

nerve buds from bed grow into graft

90
Q

Summarise steps of graft healing

A
  • plasmatic imbibition
  • inosculation
  • neurotization

Y4 - Finals Edition (40 decks)

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