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Year 3 - Surgery > Mixed > Flashcards

Mixed Flashcards

1
Q

Flail Chest

- Presentation

A

Flail chest

  1. Ant/lat ribs
  2. 2+ribs
  3. Fractured in 2+ places
  4. Move paradoxically with respiration
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2
Q

Flail chest

- Mx

A

Flail chest

  1. O2
  2. Analgesia
    - PCA
    - Epidural
  3. PPV
    - If resp failure
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3
Q

Beck’s Triad

  • Presentation
A

Beck’s Triad
- Cardiac tamponade

  1. Muffled heart sounds
  2. Decreased BP
  3. Raised JVP
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4
Q

Kussmaul’s Sign

A

Kussmaul’s Sign

  1. Raised JVP on inspiration
  2. RH dysfunction
    - Commonly in tamponade
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5
Q

Abdominal Trauma

- Indications for Laparotomy

A

Laparotomy for Trauma

  1. Unexplained shock
  2. Peritonism
  3. Intraperitonial gas
  4. Ruptured diaphragm
  5. Evisceration
    - Bowel
    - Omentum
  6. Gunshot wounds
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6
Q

Monroe-Kelly Doctrine

- Theory

A

Monroe-Kelly Doctrine

  1. Cranium is rigid box
  2. CSF and Blood compensate
  3. 100ml volume change
    - Raised ICP
  4. Herniation
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7
Q

Cushing’s reflex

- Features

A

Cushing’s reflex
- Imminent herniation

  1. HTN
  2. Bradycardia
  3. Irregular breathing
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8
Q

Basal Skull #

- Four signs

A

Basal skull signs

  1. Battle
  2. Pando
  3. Haemotympanum
  4. CSF Rhino/otorrhoea
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9
Q

Oesophageal Dysphagia

- Mural causes

A

Oesophageal dysphagia
- Mural cause

  1. Benign stricture
  2. Malignant stricture
  3. Oesophagitis
  4. Trauma
  5. Pharyngeal pouch
  6. Web (Plummer-Vinson)
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10
Q

Oesophageal Dysphagia

- Extra-mural causes

A

Extra-mural dysphagia

  1. Retrosternal goitre
  2. Mediastinal LN
    - eg. lymphoma
  3. Lunc Ca
  4. Thoracic AA
  5. Rolling hiatus hernia
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11
Q

Achalasia

- Pathophysiology

A

Achalasia

  1. Plexus degeneration
    - Myenteric/Auerbach’s
  2. Decreased peristalsis
  3. LOS fails to relax
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12
Q

Achalasia

- Mx

A

Achalasia Mx

Medical
1. CCBs/Nitrates

Interventional

  1. Botox injection
  2. Endoscopic balloon

Surgical
4. Heller’s cardiomyotomy

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13
Q

Oesophageal Cancer

- Histology

A

Oesophageal Cancer

65% Adenocarcinoma

  • Lower 3rd
  • GORD/Barrett’s/Dysplasia

35% SCC

  • Upper and middle
  • EtOH and Smoking
  • Worldwide commonest
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14
Q

Oesophageal Cancer

- Mx

A

Oesophageal cancer mx

  1. MDT

Surgery

  1. 25-30% operable
  2. Ivor-Lewis
    - 2 stage
    - Abdo and R thorax
  3. Neo-adjuvant chemo
    - Cisplatin + 5 FU
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15
Q

Oesophageal Cancer

- Palliative Care

A

Oesophageal palliation
- Majority of patients

  1. Laser coagulation
  2. Alcohol injection + spiro
  3. Stenting + hyoscine
  4. Analgesia
  5. Radio
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16
Q

GORD

- Predisposing drugs

A

GORD Predisposing

Neuro

  1. Anti-AChM
  2. TCAs

Vascular
3. Nitrates and CCB

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17
Q

GORD

- Mx

A

GORD

Conservative

  1. Weight loss and small meals
  2. Pillow angle & early meals
  3. Smoke, drink, spice

Medical

  1. Antacid otc.
  2. PPI
    - 1-2mo
  3. PPI
    - Double dose
  4. H2RA
    - Ranitidine

Surgical

  1. Nissen fundoplication
    - Repair diaphragm
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18
Q

Hiatus hernia

- Classification

A

Hiatus Hernias

  1. Sliding (80%)
    - GOJ slides
    - GORD associated
  2. Rolling (15%)
    - Non-GOJ stomach
    - Protrudes into chest
    - LOS intact (no GORD)
    - Risk of strangulation
  3. Mixed (5%)
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19
Q

Hiatus hernia

- Mx

A

Hiatus hernia

Conservative
1. Weight loss

  1. Manage reflux

Surgery

  1. All rolling hernias
    - Strangulation risk
  • Cruroplasty (reduce)
  • Fundoplication (wrap
  1. Refractory symptoms
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20
Q

Peptic Ulcer Disease

- Investigations

A

PUD Investigations

Bloods

  1. FBC (bleed)
  2. Urea

OGD

  1. Stop PPI 2 weeks before
  2. CLO/urease
    - Campylobacter-like organism
  3. Biopsy
21
Q

H Pylori

- First Line Erradication

A

Eradication Treatment

  1. PPI
  2. Clarithromycin
  3. Amoxicillin
22
Q

Peptic Ulcer Disease

- Surgical Options

A

PUD Surgeries

Vagotomy

  1. Truncal (w/ pyloroplasty)
    - Decreased acid
  2. Selective
    - Pylorus left intact
  3. Antrectomy
    - Distal half removed
  4. Subtotal Gastrectomy
    - Roux-en-Y loup
    - Performed for Zollinger-Ellison
23
Q

GI Bleed

- Scores

A

GI Bleed Scores

Rockall

  1. Re-bleed
    - 40% die
  2. Mortality
  3. Pre and post- OGD

(Glasgow-)Blatchford

  1. Inpatient or outpatient
  2. Stratifies risk
    - Hb, BP, BUN, Obs
24
Q

GI Bleed

- Variceal Mx

A

Variceal Bleed

  1. Resus and Blood
  2. Terlipressin IV
  3. ABx
    Cipro

OGD

  1. Adrenaline/laser
  2. Glue/clips
25
Q

Hypertrophic pyloric stenosis

- Mx

A

Pyloric stenosis

  1. Resus
  2. NGT
  3. Ramstedt pyloromyotomy
26
Q

Gastric Cancer

  • Mx
  • Prognosis
A

Gastric Cancer

Curative surgery
- 20-50% 5Y

  1. Endoscopic resection
  2. Gastrectomy
    - Partial/total
    - Roux-en-Y prevents reflux

Palliation
- <10% 5Y

  1. Analgesia, PPI
  2. Chemotherapy
    - Epirubicin, 5FU, Cisplatin
  3. Pyloric stenting
  4. Bypass procedure
27
Q

Gallstones

- Composition

A

Gallstones

  1. Mixed 75%
    - Multiple
    - Maily cholesterol
  2. Cholesterol
    - Large, solitary
    - Low salts and lethicin
  3. Pigment
    - Calcium bilirubinate
    - Haemolysis association
28
Q

Biliary Colic

- Mx

A

Biliary Colic Mx

Conservative

  • Rehydrate
  • NBM
  • Opioid

Surgical
- Lap chole (elective)

29
Q

Acute chole

  • Imaging
A

Acute chole Imaging

  1. AXR stones
  2. US
    - Stones
    - Dilation
    - Wall oedema
  3. MRCP
    - Dilated ducts
30
Q

Acute Chole

- Mx

A

Acute Chole

Conservative

  1. NBM
  2. Hydrate and analgesia

Medical

  1. ABx
    - Cefuroxime + met

Surgical
4. Elective Lap Chole

Complicated

  1. Empyema
    - Drainage
    - Cholecystectomy
31
Q

Obstructive jaundice

  • Differentials
A

Obstructive jaundice

  1. Stones (30%)
  2. HoP Ca (30%)
  3. Other (30%)
    - LNs
    - PBC/PSC
    - Drugs
    - Cholangio Ca
32
Q

Pancreas Ca

- Classifications

A

Pancreatic Cancer

  1. Ductal adenocarcinoma
    - 90%
  2. HoP
    - 60%
  3. Body of P
    - 25%
  4. Tail of P
    - 15%
33
Q

Pancreatic Ca

- Mx

A

Pancreatic Ca

  1. ERCP stenting and biopsy
  2. Surgery (No mets < 3cm)
    - Whipple’s
    - Distal pancreatectomy
  3. Paliation
    - ERCP
    - Bypass
    - Pain relief (plexus block)
34
Q

Common Fracture Palsies

  1. Ant shoulder
  2. Humeral shaft
  3. Elbow
  4. Hip dislocation
  5. Knee dislocation
A

Fracture Palsies

  1. Axillary
    - Ant shoulder
  2. Radial
    - Humeral shaft
    - Waiter’s tip
  3. Ulnar
    - Elbow dislocation
    - Claw hand
  4. Sciatic
    - Hip Dislocation
    - Foot drop
  5. Fibular
    - Knee dislocation
    - Foot drop
35
Q

Limping Child

- DDx

A

Limping Children

  1. DDH
    - Displaced femoral head
  2. Synovitis
    - Self-resolving pain
    - Post URTI
  3. Perthes
    - AVN and sclerosis
  4. Slipped CapFemEpi
    - P-I displacement of head
36
Q

Osteomyelitis

- Mx

A

Osteomyelitis mx

Conservative
1. Supportive

Medical

  1. IV ABx
    - Fluclox (MCS)

Surgical

  1. Abscess drainage
    - Glycopeptide+carbapenem
37
Q

Bone Metastasis

- Commonest primaries

A

Bone Metastasis

  1. Breast
  2. Lung
  3. Prostate
  4. Kidney
  5. Melanoma
38
Q

Osteochondroma

- Natural History

A

Osteochondroma

  1. 10-20 (m>f)
  2. Previous trauma
  3. Benign outgrowth
    - Cartilage-capped
39
Q

Chondrosarcoma

- Natural History

A

Chondrosarcoma

  1. 40+
    - 70% 5YS
  2. Pain and lump
    - Pelvis
    - Axial
  3. De-nova or from chondroma
  4. Lytic lesion
    - Popcorn calcification
40
Q

Osteoma

- Natural History

A

Osteoma

  1. Facial lump
    - Solitary
  2. Gardner Syndrome
    - Multiple
41
Q

Osteosarcoma

- Natural History

A

Osteosarcoma

  1. Adolescent (M>F)
  2. Pain, warmth, bruit
    - Knee
    - Metaphysis
  3. RFs: Paget’s/Radiation
  4. X- Ray
    - Sunburst (growth)
    - Codman’s triangle (speed)
42
Q

Ewing’s Sarcoma

- Natural History

A

Ewing’s Sarcoma

  1. <20
  2. Enlarging mass
    - Painful
    - Warm
  3. Systemic
    - Fever
    - ESR
    - WCC
  4. X-Ray
    - Long bone diaphysis
    - Lytic tumour
    - Onion-skin periostium
43
Q

Upper Limb Palsies

- High vs Low

A

Upper LImb Palsies

  1. Erb’s
    - Waiter’s Tip
    - C5/6 paraesthesia
  2. Klumpke’s
    - Claw hand
    - C8/T1 paraesthesia
44
Q

Carpal Tunnel

- Contents

A

Carpal tunnel contents

  1. FDS x4
  2. FDP x4
  3. MN
  4. FPL
45
Q

Carpal tunnel

- Mx

A

Carpal tunnel mx

Conservative
1. Wrist splints

Medical
2. Steroid injection

Surgical

  1. Decompression
    - Flexor retinaculum
46
Q

Dupuytren’s

- Natural History

A

Dupuytren’s

  1. Middle age/elderly
    - M>F
  2. Skin puckering
  3. Fixed flexion
    - Often bilateral
  4. Usually idiopathic
  5. Physio then fasciectomy
  6. Usually recurs
47
Q

Trigger finger

- Natural history

A

Trigger finger

  1. Tendon nodule cathing
  2. Fixed flexion
  3. Steroid injection
    - High recurrence
  4. Surgery
48
Q

Tight belts pain

- Natural history

A

Meralgia Paraesthetica

  1. Obesity, belts, underwear
  2. Lat fem cut nerve
    - ASIS and Inguinal lig
  3. Pain and paraesthesia
    - Relief on sitting

Year 3 - Surgery (7 decks)

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