Passmed General Surgery, Colorectal, and Upper GI Mushkies Flashcards
1
Q
Maximum normal diameter of small bowel?
A
35mm
2
Q
Maximum normal diameter of large bowel?
A
55mm
3
Q
Small bowel on AXR feature?
A
Valvulae conniventes extend all the way across
4
Q
Large bowel on AXR feature?
A
Haustra extend about a third of the way across
5
Q
Is there any relevance to the clinical mx of direct vs. indirect hernias?
A
No
6
Q
Lowest recurrence rate type of hernia repair?
A
Mesh repair
7
Q
Open hernia repair time to return to work?
A
2-3 weeks
8
Q
Lap hernia repair time to return to work?
A
1-2 weeks
9
Q
Bascom procedure?
A
Excision of pits and obliteration of the underlying cavity of a pilonidal sinus
10
Q
Karydakis procedure?
A
Wide excision of the natal cleft such that the surface is recountoured once the wond is closed
11
Q
Pathophysiology of pilonidal sinus?
A
Hair debris creating sinuses in the skin
12
Q
Grey turners sign pathophysiology?
A
Pancreatitis process results in local fat destruction, this results in blood tracking down the tissue planes of the retroperitoneum and appearing as flank bruising
13
Q
Psoas sign?
A
Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended
14
Q
Boas’ sign?
A
Hyperaesthesia below the right scapula in cholecystitis
15
Q
First line mx of hypovolaemic shock in an adult?
A
500ml crystalloid over 15 minutes e.g. Hartmann’s or PlasmaLyte
16
Q
5 types of shock?
A
- Cardiogenic
- Neurogenic
- Anaphylactic
- Haemorrhagic
- Septic
17
Q
Overall hallmarks of sepsis?
A
Excessive inflammation, coagulation and fibrinolytic suppression
18
Q
Average adult blood volume as % of body weight?
A
7%
19
Q
Arterial pressure required to generate a palpable femoral pulse?
A
> 65mmHg
20
Q
Most common cause of neurogenic shock?
A
Spinal cord transection, resulting in decreased sympathetic tone or increased parasympathetic tone
21
Q
Soap bubble appearance on X ray?
A
Giant cell tumour, presenting as pain or pathological fractures
22
Q
5 bone metastases sources?
A
- Breast
- Lung
- Thyroid
- Renal
- Prostate
23
Q
Causes of pathological fractures?
A
- Metastatic fractures
- Bone disease
- Local benign conditions
- Primary malignant tumours
24
Q
4 bone diseases that cause pathological fractures?
A
- Osteoporosis
- Osteogenesis imperfecta
- Metabolic bone disease
- Paget’s disease
25
2 local benign conditions that cause pathological bone fractures?
1. Chronic osteomyelitis
| 2. Solitary bone cyst
26
3 primary malignant tumours that cause pathological fractures?
1. Chondrosarcoma
2. Osteosarcoma
3. Ewing's tumour
27
2 eponymous signs of acute pancreatitis?
1. Cullen's sign = periumbilical discoloration
| 2. Grey-Turner's sign = flank discoloration
28
Mesenteric adenitis is preceded by?
A recent URTI
29
How does one look for air under diaphragm?
Erect CXR
30
Post gastrectomy syndromes?
1. Small capacity
2. Dumping syndrome
3. Bile gastritis
4. Afferent and efferent loop syndromes
5. Anaemia (B12 deficiency)
6. Metabolic bone disease
31
Dumping syndrome pathophysiology?
1. Post gastric surgery
2. Hyperosmolar load rapidly entering the proximal duodenum --> osmosis drags water into the lumen, resulting in lumen distension (pain) and then diarrhoea
3. Excessive insulin release also occurs and results in hypoglycaemic sx
32
RTAs involving passengers wearing seatbelts incorrectly can result in?
Lacerations to the carotid artery
33
Trimodal death distribution following trauma?
1. Immediately following injury = brain/spinal/cardiac/great vessel damage
2. Early hours following injury = splenic rupture/subdurals/haemopneumothoraces
3. Days following injury = sepsis/MOD
34
High riding prostate on PR?
Urethral disruption
35
Blood at urethral meatus?
Urethral tear
36
Spina bifida occulta may affect up to what % of the population?
10%
37
Ankylosing spondylitis HLA?
HLA B27
38
Scheuermann's disease?
Self limiting skeletal disorder of childhood where the vertebrae grow unevenly with respect to the sagittal plane - posterior angle is often greater than anterior, usually resulting in progressive thoracic kyphosis
39
Mx of Scheuermann's disease?
1. Physio and analgesia
| 2. Severe --> bracing or surgical stabilisation
40
Scoliosis defn?
Curvature of the spine in the coronal plane
41
Classification of scoliosis?
1. Structural
| 2. Non-structural
42
Non-structural scoliosis most common in what demographic?
Adolescent females
43
Classification of structural scoliosis?
Affects >1 vertebral body
1. Idiopathic
2. Congenital
3. Neuromuscular
44
Mx of severe/progressive structural spina bifida?
Bilateral rod stabilisation of the spine
45
Spina bifida defn?
Non fusion of the vertebral arches during embryonic development
46
3 types of spina bifida?
1. Myelomeningocele
2. Meningocele
3. Spina bifida occulta
47
Spondylolysis defn?
Congenital or acquired deficiency or the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/L5
48
Spondylolisthesis defn?
Condition where one vertebra is displaced relative to its immediate inferior vertebral body, that may occur as a result of stress fracture or spondylolysis
49
Scottie Dog appearance?
Traumatic Spondylolisthesis
50
Main antigens that give rise to organ transplant rejection?
1. ABO blood group
2. HLA
3. Minor histocompatability genes
51
Types of organ rejection?
1. Hyperacute = ABO incompatible
2. Acute = T cell mediated
3. Chronic
52
Score for assessment of Upper GI bleed?
Blatchford score
53
Dieulafoy lesion?
A large tortuous arteriole most commonly in the stomach wall (submucosal) that erodes and bleeds.
54
Multiple rib fractures with >= rib fractures in 2 or more ribs?
Flail chest
55
Mediastinal traversing wound defn?
Entrance wound in one hemithorax and exit wound/foreign body in opposite hemithorax
56
Cause of duodeno-jejunal flexure disruption?
Deceleration injury
57
DALM in rectum?
Dysplasia associated lesion or mass
58
Tumour marker in Cholangiocarcinoma?
Ca19-9 raised in 80% cases
59
Primary liver tumours?
1. HCC
2. Cholangiocarcinoma
3. Hepatoblastoma
4. Sarcomas
5. Lymphomas
6. Carcinoids
60
HCC prognosis?
Poor, overall survival is 15% at 5 years
61
Second most common type of liver malignancy?
Cholangiocarcinoma
62
Main RF for cholangiocarcinoma?
PSC
63
Total hip replacement nerve injury?
Sciatic nerve
64
Best initial Ix for presence of fluid in the abdomen and thorax?
FAST scan
65
FAST scan acronym?
Focused assessment with sonography for trauma
66
Mx of anal fissure?
1. Conservative = stool softeners
2. Medical = Topical GTN or diltiazem
3. Surgical = Botulinum injection, sphincterotomy
67
Haemorrhoids Mx?
1. Conservative = stool softeners, avoid straining
| 2. Surgery
68
Perianal abscess Mx?
Incision and drainage
69
Most definitive mx for fissure in ano?
Lateral internal sphincterotomy = the tx is permanent and nearly all pts will recover
70
Fistula in ano Mx?
1. Fistulotomy (laying it open) if fistula is below sphincter and uncomplicated
2. Draining seton suture
3. LIFT procedure = ligation of intersphincteric tract
71
Parkland formula?
1. Volume of fluid for burns in 24 hours = TBSA of burn % x weight x 4ml
2. 50% given in first 8 hours, 50% given in next 16 hours
72
Fluid of choice in burns?
Crystalloid e.g. Hartmann's/Ringer's Lactate
73
Fluid resus end point in burns?
Urine output of 0.5-1.0 ml/kg/hour in adults
74
Mx of transitional cell carcinoma?
Nephroureterectomy
75
Rigler's sign?
Double wall sign, denoting presence of air along luminal and peritoneal aspect of bowel wall on AXR
76
Portal HTN and lower GI bleeding?
Rectal varices
77
4 RFs for abdominal wall hernias?
1. Obesity
2. Ascites
3. Increasing age
4. Surgical wounds
78
Richter's hernia?
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect, can present with strangulation without symptoms of obstruction
79
Mx of congenital inguinal hernia?
Surgical repair soon after dx due to risk of incarceration
80
Mx of infantile umbilical hernia?
Conservative, vast majority resolve on their own by 4-5 y/o
81
Indications for thoracotomy in haemothorax?
1. >1.5L blood initially
| 2. >200ml for 2 hours
82
Congenital undescended testis defn?
One that has failed to reach the bottom of the scrotum by 3 months
83
Reasons for correction of cryptorchidism?
1. Reduce risk of infertility
2. Examination for cancer
3. Avoid torsion
4. Cosmetic
84
Males with undescended testis are 40 times as likely to develop what cancer?
Seminoma
85
Best Ix for hydatid cysts?
CT
86
Cause of hydatid cyst?
Echinococcus granulosus
87
What type of reaction does a hydatid cyst precipitate?
Type 1 hypersensitivity
88
Mx of hydatid cyst?
Surgery (wall must not be ruptured during removal and the contents sterilised first)
89
90% hydatid cysts occur in the?
Liver and lungs
90
In haemorrhagic shock, at what % of blood loss does BP start to fall?
Until 30% blood volume is lost
91
What bloods can be deranged by TPN?
LFTs
92
3 complications of TPN?
1. Refeeding syndrome
2. Thrombophlebitis
3. Hepatic dysfunction
93
Nutcracker oesophagus on barium swallow?
Diffuse oesophageal spasm
94
Most sensitive test for acute pancreatitis?
Lipase
95
DDx for high amylase?
1. Pancreas = acute pancreatitis, pseudocyst
2. Gallbladder = acute cholecystitis
3. Bowel = mesenteric infarct, perforated viscus
4. Medical = DKA
96
Hernia below and lateral to pubic tubercle?
Femoral hernia
97
Carotid endarterectomy nerve injury?
Ipsilateral hypoglossal nerve
98
Borders of the femoral canal?
1. Lateral = femoral vein
2. Medial = lacunar ligament
3. Anterior = inguinal ligament
4. Posterior = pectineal ligament
99
Contents of femoral canal?
1. Lymphatic vessels
| 2. CLoquet's lymph node
100
Physiological significance of femoral canal?
Allows femoral vein to expand to allow for increased venous return to the lower limbs
101
4 post splenectomy blood film features?
1. Howell-Jolly bodies
2. Pappenheimer bodies
3. Target cells
4. Irregular contracted erythrocytes
102
Thyroid cancer follow-up?
Thyroglobulin Antibodies
103
Why does hypocalcaemia occur in pancreatitis?
Due to the saponification of fats. As lipase leaks out of the damaged pancreas, it breakdown fat into triglycerides and fatty acids. Fatty acids combine with calcium to produce soap.
104
Definition of an upper GI bleed?
A haemorrhage with an origin proximal to the Ligament of Treitz
105
What is the ligament of Treitz?
Suspensory muscle of the duodenum, found at the duodenojejunal flexure
106
Definition of a lower GI bleed?
A haemorrhage with an origin distal to the Ligament of Treitz
107
Normal CVP?
0-6 mmHg
108
Definitive diagnostic Ix for small bowel obstruction?
CT abdo
109
Trastuzumab?
Herceptin
110
Biologic for complex peri anal Crohns?
Infliximab
111
Hiatus hernia defn?
Herniation of part of the stomach above the diaphragm
112
Classification of hiatus hernias?
1. Sliding = 95%, GOJ moves above diaphragm
| 2. Rolling = paraoesophageal, GOJ remains below diaphragm but a separate part herniates through the oesophageal hiatus
113
Pancreatitis amylase levels?
At least 4 times the upper limit
114
Non visible diaphragm after trauma?
Diaphragmatic trauma
115
Maximum safe dose of Lidocaine?
3mg/kg
116
3 absorbable sutures?
1. Vicryl
2. Dexon
3. PDS
117
4 non-absorbable sutures?
1. Silk
2. Novafil
3. Prolene
4. Ethilon
118
After how long do absorbable sutures usually disappear?
7-10 days
119
Removal time for face sutures?
3-5 days
120
Removal time for scalp, limb, chest sutures?
7-10 days
121
Removal time for hand, foot, back sutures?
10-14 days
122
Sinusoidal ECG pattern?
Severe hyperkalaemia
123
4 types of transplant?
1. Allograft
2. Isograft
3. Autograft
4. Xenograft
124
Mx of amoebic liver abscess?
Metronidazole
125
A large hyperechoic lesion in the presence of normal AFP?
Haemangioma
126
Para-aortic mass and medially displaced ureters?
Retroperitoneal fibrosis
127
Pseudomyxoma peritonei?
Rare mucinous tumour most commonly arising from the appendix
128
Pregnancy and frank haematuria?
Placenta percreta
129
Boundaries of Hesselbach's triangle?
1. Medial = rectus abdominis
2. Lateral = inferior epigastric vessels
3. Inferior = inguinal ligament
130
Main location of anal fissures?
Posterior midline
131
Haemorrhoid positions?
3, 7 and 11 o clock
132
External haemorrhoid?
Below the dentate line, prone to thrombosis, may be painful
133
Internal haemorrhoid?
Above the dentate line, dont cause pain generally
134
One-off flexy sig screening offered at what age?
55 y/o
135
Screening for bowel cancer?
1. Faecal immunochemical Test (FIT) screening (60-74 y/o)
| 2. One-off flexible sigmoidoscopy
136
Dukes classification for colorectal cancer?
1. A = confined to mucosa
2. B = invading bowel wall
3. C = lymph node metastases
4. D = distant metastases
137
Mx of rectal prolapse?
1. Delormes procedure = excises mucosa and plicates the rectum (high recurrence rates) may be used for external prolapse.
2. Altmeirs procedure = resects the colon via the perineal route has lower recurrence rates but carries the risk of anastamotic leak
3. Rectopexy
138
Strongest risk factor for anal cancer?
HPV infection
139
Majority of anal cancers are what type?
Squamous cell cancers
140
Volvulus defn?
Torsion of the colon around its mesenteric axis, resulting in compromised blood flow and closed loop obstruction
141
Caecal volvulus associations?
1. Adhesions
| 2. Pregnancy
142
Sigmoid volvulus associations?
1. Chronic constipation
2. Chagas disease
3. Neuro = PD, DMD
4. Psych = schizophrenia
143
Coffee bean sign?
Sigmoid volvulus
144
Sigmoid volvulus mx?
Rigid sigmoidoscopy with rectal tube insertion
145
Caecal volvulus mx?
Usually operative with a right hemicolectomy
146
AP resection performed when?
Tumours in the distal 1/3rd of the rectum
147
Gastric volvulus triad?
1. Vomiting
2. Pain
3. Failed attempts to pass an NG tube
148
Why is rectum spared of diverticular disease?
Usual diverticular site is between the taenia coli where vessels pierce the muscle to supply the mucosa. For this reason, the rectum, which lacks taenia, is often spared.
149
Hinchey classification for diverticulitis perforation?
1. Para-colonic abscess
2. Pelvic abscess
3. Purulent peritonitis
4. Faecal peritonitis
150
SRUS?
Solitary rectal ulcer syndrome, with fibromuscular obliteration on biopsy
151
Monitoring response to tx of colon cancer?
CEA
152
Initial mx of diverticulitis flare?
Oral Abx at home, if they dont improve within 3 days --> hospital for IV ceftriaxone and metronidazole
153
Where are diverticula most commonly found?
Sigmoid colon
154
Perianal abscess defn?
Collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincter
155
Benefit of epidural anaesthesia after abdo surgery?
Faster return of normal bowel function
156
How to assess if anastomosis has healed?
Gastrograffin enema
157
Most common causative agent of ascending cholangitis?
E. coli
158
What is Lemierre's syndrome?
Infectious thrombophlebitis of the internal jugular vein
159
Lemierre's syndrome bacteria?
Fusobacterium necrophorum
160
Reynold's pentad of ascending cholangitis?
1. Fever
2. RUQ pain
3. Jaundice
4. Hypotension
5. COnfusion
161
Mx of ascending cholangitis?
1. IV ABx
| 2. ERCP after 24-48hrs to relieve any obstruction
162
Ginkgo leaf sign?
Surgical emphysema of the anterior chest wall, outlining the pectoralis major muscle
163
5 RFs of gallstones?
Fat, fair, fertile, femole, forty
164
Cushing's triad?
Raised ICP
1. HTN
2. Bradycardia
3. Decreased RR
165
Mx of acute cholecystitis?
1. IV Abx
| 2. Early lap chole within 1 week of diagnosis
166
Glasgow scale of Pancreatitis severity?
1. PaO2< 7.9kPa
2. Age > 55 years
3. Neutrophils (WBC > 15)
4. Calcium < 2 mmol/L
5. Renal function: Urea > 16 mmol/L
6. Enzymes LDH > 600IU/L
7. Albumin < 32g/L (serum)
8. Sugar (blood glucose) > 10 mmol/L
167
Pathophysiology of acute pancreatitis?
Autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis
168
Mx of Gastric MALToma?
H. pylori eradication
169
Pigmented gallstones?
Haemolytic anaemia
170
Chronic pancreatitis dx?
CT pancreas, looking for pancreatic calcification
171
Complications of acute pancreatitis?
1. Local = peripancreatic fluid collections, pseudocysts, necrosis, abscess, haemorrhage
2. Systemic = ARDS
172
Mx of obstructive jaundice due to unresectable pancreatic carcinoma?
Biliary stenting
