Misc 9 Flashcards
What are isolated juvenile polyps usually?
Hamartomas with no risk malignancy
Lynch syndrome carries risk of which cancers?
Colorectal Ca
Endometrial Ca
What is the nerve supply to the oesophagus?
Upper half = recurrent laryngeal nerve
Lower half = oesohpageal plexus (vagus)
Describe the segmental blood supply to the oesophagus?
Upper third = inf thyroid veins and artery
Middle third = direct from thoracic aorta, azygos veins
Lower third = left gastric artery and veins branches
Finding which cells on path examination of the thyroid would suggest inadvertant removal of parathyroid?
Oxypihl cells
Most common benign liver lesion?
Haemangioma
Main RF for hepatic adenomas?
OCP/high hormonal potency agents
1 word summaries of 4 types of hypersensitivity reactions?
1 - allergic/anaphylactic
2 - cytotoxic
3 - immune complex
4 - delayed t cell
1 word summaries of 4 stages of wound healing?
1 - haemostasis
2 - inflammation
3 - regeneration
4 - remodelling
Give 3 main causes of chronic inflammation?
Chronic, persistent infection with delalyed hypersensitivty type
Prolonged exposure to nonbiodegradable surfaces e.g. silicon or suture material
Autoimmune condiions
Most common primary immunodef?
IgA deficiency
Describe roughly how to do open AAA repair?
Laparotomy Mobilise bowel and duodenum out way Mobilise aneurysm neck and base Start systemic heparinization Cross clamp proximally then distally Longitudinal aortotomy Atherectomy Graft repair - straight or bifurcating Suture in Clamps off Haemostase Close aneurysm sac Close abdo wall and skin
When is the highest risk of cardiac event during AAA repair?
When clamps removed - reperfusion
What BP would you aim in ruptured AAA?
80-100 systolic - permissive hypotension
Which 3 forearm tendons dont participate in the flexor retianculum?
Flexor carpi radialis and ulnaris
Palmaris lonogus
Injury to whic area of the hand carries highest risk of migration of infection? Why?
Palmar surface of little finger - flexor sheath of little finger is continuous with common flexor sheath which extends proximally under flexor retianculum
Criteria for diagnosing IBS?
Rome criteria
Operation for inguinal hernia repair in kids vs adults? Why?
In kids - herniotomy, usually indirect
In adults - herniorraphy
Procedure of choice for a pleomorphic adenoma?
Superficical parotidectomy with facial nerve presrvation
What is the most common unilateral vs bilateral benign parotid tumour?
Unilateral = pleomorphic adenoma Bilateral = Warthins tumour
Which parotid tumour is more common in men than women?
Warthins tumour
Most common malignant parotid tumour? Second most?
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Procedure of choice for malignant parotid tumours?
Radical/excisional parotidectomy
What about prolene makes it sutitable for vascular anastomoses?
Monofilmaent with memory that doesnt incite tissue reaction and is non-absorbable
Why is PDS useful in abdo wall closure?
Strong monofilament, synthetic so minimal tissue reaction. Absorbed over long period of time
Why is lidocaine less useful for e.g. lap port sites for post op analgesia? What is preferred?
Short acting
Better is bupivocaine or chirocaine
Which LA cant be used in regional blocks? Why?
Bupivocaine - cardiotoxic, in case tourniquet fails
What is agent of chocie for e.g. Biers block?
Prilocaine
What is the role of arterial thrombolysis in acute limb ischaeima?
Better for acute on chronic thrombosis, and beter than peripheral thrombolysis, but avoid if recent surgery or stroke. Consider with/wihtout clot aspiration
Where may T tube drains be useful? Why?
E.g. in bile duct - to generate fibrosis along drain tract so less risk of leak on removal
What are cleaning, sterilisation and disinfection?
Cleaning = removal of all visible foreign bodies, must be done first Disinfection = reduction in number of microorganisms Sterilisation = eradication of all microorganisms
Nosocomial surgical site infections occur within how long of surgery?
30 days; 1 year if prosthesis used
What is the LN drainage of the anorectum?
Rectum above dentate line = mesorectal LNs
Anal canal below dentate line = inguinal canal
Which fascia are related to the rectum and removed in mesorectal excision?
Denonvilliers anteriorly
Waldeyers fascia posteriorly
Aterial supply to trachea?
Superior = inferior thyroid artery Inferior = bronchial artery
Surface marking for the sciatic nerve in the buttock?
Midway between greater troch and ischial tuberosity
What is the NHS UK bowel screening programme?
Over 55s invited for 1 off flexi sig
60-74 = FIT testing every 2 years
How would you investigate and manage ?SCC of tonsil?
EUA and tonsillectomy for histology
If confirmed - MRI, CT CAP and discuss at MDT
What are the levels of LNs in the neck?
1 - submental/submandibular
2 - upper 1/3 IJV - from skull base to hyoid
3 - middle 1/3 IJV - from hyoid to cricoid
4 - lower 1/3 IJV - from cricoid to clavicle
5 - posterior triangle
6 - from hyoid to suprasternal notch
7 - superior mediastinal
What are the 3 types of neck LN dissection?
Radical/en bloc - all removed, SCM, IJV, CN11
Modified radical - all removed but SCM/IJV/CN11 preserved
Selective - Removal of certain LN chains and preservation of SCM IJV CN11
Who might an oncology MDT involve?
Surgeons Oncologists Radiologists Pathologists SNs Depending on location e.g. dietician/SALT for head and neck, stoma nurses/dieticians GI, plastics/derm for skin
Indications for TURP for BPH?
Severe BPH sx refractory to medical management
Unusually large or shaped prostate
Renal failure/recurrent UTI secondary to obstruction
Recurrent gross haematuria
Large bladder diverticular
What should patients with Gleason over 7 or PSA over 10 undergo?
Staging scans
What investigation might patients with a bile leak need?
ERCP to look for leak site - extravasation of contrast into abdomen
How are post op bile leaks managed?
IV fluids and antibiotics
Refer to tertiary HPB centre for either stenting or reconstruction (bilienteric anastomosis) e.g. Roux en Y choledochoduodenostomy
What is the Dukes classification for? Describe it
CRC 1 - mucosa only 2 - through musclar layer 3 - LNs 4 - distant mets
What imaging is best for cancers of the urinary tract depending on suspciion of location?
Kidneys - CT renal
Ureter/bladder - CT urogram
Prostate - MRI
What ABPI would be consistent with critical limb ischaemia?
Less than 0.5
What is a pharyngeal pouch also called and where does it arise?
Zenkers diverticulum - just above cricopharyngeus, below inferior constrictor, through killian’s dehiscence
Surface marking for SFJ?
4cm inferior and lateral to pubic tubercle
Relatnioship between femoral triangle and subsartorial canal?
Boundaries of fem triangle are sartorius and aductor longus
Vessels/nerve descend below sartorius, new boundaries are adductor longus and vastus medialis
What is at the end of the subsartorial canal?
Hiatus in adductor magnus
