Mr Hardy & Gupte Flashcards
What does management equal?
Mx = Dx + Tx
Where dx is the combination of hx, exam, ix
The Surgical Sieve
VITAMINS CDE
Vascular
Infection / Inflammation
Traumatic / Toxins
Autoimmune
Metabolic
Iatrogenic / Idiopathic
Neoplastic
Social
Congenital
Degenerative
Endocrine / Exocrine
How would you categorise the factors contributing to a complication of surgery?
Pre, Operative, Post
RFs for haemorrhage post op
Pre: failure to stop NSAIDs + hereditary clotting disorders
Op: use of monopolar diathermy causing collateral damage
Post: started on anticoagulants + infection that moves the suture knot
Virchow’s Triad
Endothelial Injury
Hypercoagulability
Venous Stasis
RFs for superficial infection post op
Pre: young/old, smoker, diabetic, steroids, immunocomp, cardiac/renal/vasc disease, preexisting infection
Op: death by a thousand cuts, failure to wash out dead tissue, too much suture tension causing ischaemia
Post: poor wound care
Celsus Tetrad
Rubor Calor Tumor Dolor Functio Laesa
How would you categorise complications of a fracture?
IMMEDIATE <24h
Local: 1° haemorrhage and soft tissue injury
Syst: hypovolaemic shock and asphyxia
EARLY <2w
Local: reactionary/2° haemorrhage, wound dehiscence, infection, compartment syndrome, Volkmann’s contracture
Syst: fat embolism, DVT, PE, ARDS, atelectasis, c diff, constipation, acute urinary retention, confusion, bed sores
LATE >2w
Local: malunion, nonunion, stiffness, loosening, CRPS
Syst: atelectasis - pneumonia, acute urinary retention - cystitis - sepsis, psychological
Haemorrhage: Reactionary vs Secondary
Reactionary - rise in bp following fluid therapy for hypovolaemia
Secondary - erosion of a vessel from a spreading infection
What is a late systemic comp of a right hemicolectomy?
Pernicious Anaemia
How are abx used in surgery?
Prophylactic: immunocomp, at inc risk of infection, consequences would be serious
Treatment: local + spreading
How are abx used prophylactically?
Immunocomp: young/old, smoker, diabetic, steroids, chemo, cancer, HIV, TB
At inc risk of infection: surgery involving the appendix, large bowel, gynae
Consequences would be serious: heart valve, prosthetic limb, VP shunt, mesh
How are abx used as treatment?
Local (no abx: incision -> drainage) - abscess, empyema, pyelonephritis, osteomyelitis
Spreading (abx: broad -> narrow) - cellulitis, septicaemia, meningitis, ascending cholangitis
How can you categorise the presentation of any tumour?
Primary, Secondary, General vs Hx/Sx, Exam/Signs, Special Ix
Px of testicular seminoma
Hx: 1° painless lump + 2° inguinal lump, abdo pain, back pain + 3° FLAWS
O/e: 1° SSSSSS, can get above, no transillumination + 2° inguinal LN, retroperitoneal lesion, chest lesion + 3° anaemic
Ix: 1° imaging and histology + 2° CT-CAP + 3° FBC, hyperCa, tumour markers
How would you describe a lump? (6)
Site Size Shape Surface Surrounds conSistency
Px of breast ca
Hx: 1° lump, pain, bloody discharge + 2° axillary lump, night bone pain, cough + 3° FLAWS
O/e: 1° inverted nipple, tethering, peau d’orange + 2° axillary lymphadenopathy, bony tenderness, oedema + 3° anaemic
Ix: 1° imaging and histology + 2° CXR + 3° FBC, hyperCa, tumour markers
What is breast triple assessment?
Hx+Exam, US/Mammography, FNA/Biopsy
What cancers metastasise to bone? (6)
Bronchus Breast Brostate Byroid Bidney \+ Sometimes Bowel
How would you categorise tumours of the bone?
Benign: simple cyst, osteoid osteoma, osteochondroma, enchondroma, fibrous dysplasia
1° Malignant: ewing’s, osteosarcoma, chondrosarcoma, myeloma
2° Malignant: metastasis
Mneumonic for describing any disease
Dressed In a Surgeon’s Gown A Physician Might Make Some Significant Progress
Definition Incidence Sex Geography Aetiology Pathogenesis Macroscopic Path Microscopic Path Symptoms Signs Prognosis
What is myeloma?
Definition: neoplasia of plasma cells
Incidence: most common primary malignant bone ca affecting those b/w 50-70yrs
Sex: M>F | Geography: AfroC | Aetiology: genetics
Pathogenesis: production of monoclonal immunoglobulins
Macro + Micro Path: haematogenous spread, raised ESR, rouleaux on blood film, B cells w reduced cytoplasm, dense band on serum electrophoresis, bence-jones protein in urine
Sx + Signs: related to the high calcium, renal failure, anaemia, affect on bone
Prognosis: pt factors, staging and grading, response to therapy
What is the skull on x-ray like in MM?
Pepper Shaker / Moth Eaten
What does the median nerve supply?
2LOAF
Lateral two lumbicals
Oppones pollicis
Abductor pollicis brevis
Flexor pollicis brevis
NB: all other intrinsic hand muscles are supplied by the ulnar nerve