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Medicine and Surgery Mushkies > Passmed General Surgery, Colorectal, and Upper GI Mushkies > Flashcards

Passmed General Surgery, Colorectal, and Upper GI Mushkies Flashcards

1
Q

Maximum normal diameter of small bowel?

A

35mm

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2
Q

Maximum normal diameter of large bowel?

A

55mm

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3
Q

Small bowel on AXR feature?

A

Valvulae conniventes extend all the way across

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4
Q

Large bowel on AXR feature?

A

Haustra extend about a third of the way across

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5
Q

Is there any relevance to the clinical mx of direct vs. indirect hernias?

A

No

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6
Q

Lowest recurrence rate type of hernia repair?

A

Mesh repair

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7
Q

Open hernia repair time to return to work?

A

2-3 weeks

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8
Q

Lap hernia repair time to return to work?

A

1-2 weeks

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9
Q

Bascom procedure?

A

Excision of pits and obliteration of the underlying cavity of a pilonidal sinus

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10
Q

Karydakis procedure?

A

Wide excision of the natal cleft such that the surface is recountoured once the wond is closed

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11
Q

Pathophysiology of pilonidal sinus?

A

Hair debris creating sinuses in the skin

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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

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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

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14
Q

Boas’ sign?

A

Hyperaesthesia below the right scapula in cholecystitis

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15
Q

First line mx of hypovolaemic shock in an adult?

A

500ml crystalloid over 15 minutes e.g. Hartmann’s or PlasmaLyte

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16
Q

5 types of shock?

A
  1. Cardiogenic
  2. Neurogenic
  3. Anaphylactic
  4. Haemorrhagic
  5. Septic
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17
Q

Overall hallmarks of sepsis?

A

Excessive inflammation, coagulation and fibrinolytic suppression

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18
Q

Average adult blood volume as % of body weight?

A

7%

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19
Q

Arterial pressure required to generate a palpable femoral pulse?

A

> 65mmHg

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20
Q

Most common cause of neurogenic shock?

A

Spinal cord transection, resulting in decreased sympathetic tone or increased parasympathetic tone

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21
Q

Soap bubble appearance on X ray?

A

Giant cell tumour, presenting as pain or pathological fractures

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22
Q

5 bone metastases sources?

A
  1. Breast
  2. Lung
  3. Thyroid
  4. Renal
  5. Prostate
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23
Q

Causes of pathological fractures?

A
  1. Metastatic fractures
  2. Bone disease
  3. Local benign conditions
  4. Primary malignant tumours
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24
Q

4 bone diseases that cause pathological fractures?

A
  1. Osteoporosis
  2. Osteogenesis imperfecta
  3. Metabolic bone disease
  4. Paget’s disease
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25
Q

2 local benign conditions that cause pathological bone fractures?

A
  1. Chronic osteomyelitis

2. Solitary bone cyst

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26
Q

3 primary malignant tumours that cause pathological fractures?

A
  1. Chondrosarcoma
  2. Osteosarcoma
  3. Ewing’s tumour
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27
Q

2 eponymous signs of acute pancreatitis?

A
  1. Cullen’s sign = periumbilical discoloration

2. Grey-Turner’s sign = flank discoloration

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28
Q

Mesenteric adenitis is preceded by?

A

A recent URTI

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29
Q

How does one look for air under diaphragm?

A

Erect CXR

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30
Q

Post gastrectomy syndromes?

A
  1. Small capacity
  2. Dumping syndrome
  3. Bile gastritis
  4. Afferent and efferent loop syndromes
  5. Anaemia (B12 deficiency)
  6. Metabolic bone disease
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31
Q

Dumping syndrome pathophysiology?

A
  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
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32
Q

RTAs involving passengers wearing seatbelts incorrectly can result in?

A

Lacerations to the carotid artery

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33
Q

Trimodal death distribution following trauma?

A
  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
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34
Q

High riding prostate on PR?

A

Urethral disruption

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35
Q

Blood at urethral meatus?

A

Urethral tear

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36
Q

Spina bifida occulta may affect up to what % of the population?

A

10%

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37
Q

Ankylosing spondylitis HLA?

A

HLA B27

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38
Q

Scheuermann’s disease?

A

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

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39
Q

Mx of Scheuermann’s disease?

A
  1. Physio and analgesia

2. Severe –> bracing or surgical stabilisation

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40
Q

Scoliosis defn?

A

Curvature of the spine in the coronal plane

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41
Q

Classification of scoliosis?

A
  1. Structural

2. Non-structural

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42
Q

Non-structural scoliosis most common in what demographic?

A

Adolescent females

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43
Q

Classification of structural scoliosis?

A

Affects >1 vertebral body

  1. Idiopathic
  2. Congenital
  3. Neuromuscular
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44
Q

Mx of severe/progressive structural spina bifida?

A

Bilateral rod stabilisation of the spine

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45
Q

Spina bifida defn?

A

Non fusion of the vertebral arches during embryonic development

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46
Q

3 types of spina bifida?

A
  1. Myelomeningocele
  2. Meningocele
  3. Spina bifida occulta
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47
Q

Spondylolysis defn?

A

Congenital or acquired deficiency or the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/L5

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48
Q

Spondylolisthesis defn?

A

Condition where one vertebra is displaced relative to its immediate inferior vertebral body, that may occur as a result of stress fracture or spondylolysis

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49
Q

Scottie Dog appearance?

A

Traumatic Spondylolisthesis

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50
Q

Main antigens that give rise to organ transplant rejection?

A
  1. ABO blood group
  2. HLA
  3. Minor histocompatability genes
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51
Q

Types of organ rejection?

A
  1. Hyperacute = ABO incompatible
  2. Acute = T cell mediated
  3. Chronic
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52
Q

Score for assessment of Upper GI bleed?

A

Blatchford score

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53
Q

Dieulafoy lesion?

A

A large tortuous arteriole most commonly in the stomach wall (submucosal) that erodes and bleeds.

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54
Q

Multiple rib fractures with >= rib fractures in 2 or more ribs?

A

Flail chest

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55
Q

Mediastinal traversing wound defn?

A

Entrance wound in one hemithorax and exit wound/foreign body in opposite hemithorax

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56
Q

Cause of duodeno-jejunal flexure disruption?

A

Deceleration injury

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57
Q

DALM in rectum?

A

Dysplasia associated lesion or mass

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58
Q

Tumour marker in Cholangiocarcinoma?

A

Ca19-9 raised in 80% cases

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59
Q

Primary liver tumours?

A
  1. HCC
  2. Cholangiocarcinoma
  3. Hepatoblastoma
  4. Sarcomas
  5. Lymphomas
  6. Carcinoids
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60
Q

HCC prognosis?

A

Poor, overall survival is 15% at 5 years

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61
Q

Second most common type of liver malignancy?

A

Cholangiocarcinoma

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62
Q

Main RF for cholangiocarcinoma?

A

PSC

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63
Q

Total hip replacement nerve injury?

A

Sciatic nerve

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64
Q

Best initial Ix for presence of fluid in the abdomen and thorax?

A

FAST scan

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65
Q

FAST scan acronym?

A

Focused assessment with sonography for trauma

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66
Q

Mx of anal fissure?

A
  1. Conservative = stool softeners
  2. Medical = Topical GTN or diltiazem
  3. Surgical = Botulinum injection, sphincterotomy
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67
Q

Haemorrhoids Mx?

A
  1. Conservative = stool softeners, avoid straining

2. Surgery

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68
Q

Perianal abscess Mx?

A

Incision and drainage

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69
Q

Most definitive mx for fissure in ano?

A

Lateral internal sphincterotomy = the tx is permanent and nearly all pts will recover

70
Q

Fistula in ano Mx?

A
  1. Fistulotomy (laying it open) if fistula is below sphincter and uncomplicated
  2. Draining seton suture
  3. LIFT procedure = ligation of intersphincteric tract
71
Q

Parkland formula?

A
  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
Q

Fluid of choice in burns?

A

Crystalloid e.g. Hartmann’s/Ringer’s Lactate

73
Q

Fluid resus end point in burns?

A

Urine output of 0.5-1.0 ml/kg/hour in adults

74
Q

Mx of transitional cell carcinoma?

A

Nephroureterectomy

75
Q

Rigler’s sign?

A

Double wall sign, denoting presence of air along luminal and peritoneal aspect of bowel wall on AXR

76
Q

Portal HTN and lower GI bleeding?

A

Rectal varices

77
Q

4 RFs for abdominal wall hernias?

A
  1. Obesity
  2. Ascites
  3. Increasing age
  4. Surgical wounds
78
Q

Richter’s hernia?

A

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
Q

Mx of congenital inguinal hernia?

A

Surgical repair soon after dx due to risk of incarceration

80
Q

Mx of infantile umbilical hernia?

A

Conservative, vast majority resolve on their own by 4-5 y/o

81
Q

Indications for thoracotomy in haemothorax?

A
  1. > 1.5L blood initially

2. >200ml for 2 hours

82
Q

Congenital undescended testis defn?

A

One that has failed to reach the bottom of the scrotum by 3 months

83
Q

Reasons for correction of cryptorchidism?

A
  1. Reduce risk of infertility
  2. Examination for cancer
  3. Avoid torsion
  4. Cosmetic
84
Q

Males with undescended testis are 40 times as likely to develop what cancer?

85
Q

Best Ix for hydatid cysts?

86
Q

Cause of hydatid cyst?

A

Echinococcus granulosus

87
Q

What type of reaction does a hydatid cyst precipitate?

A

Type 1 hypersensitivity

88
Q

Mx of hydatid cyst?

A

Surgery (wall must not be ruptured during removal and the contents sterilised first)

89
Q

90% hydatid cysts occur in the?

A

Liver and lungs

90
Q

In haemorrhagic shock, at what % of blood loss does BP start to fall?

A

Until 30% blood volume is lost

91
Q

What bloods can be deranged by TPN?

92
Q

3 complications of TPN?

A
  1. Refeeding syndrome
  2. Thrombophlebitis
  3. Hepatic dysfunction
93
Q

Nutcracker oesophagus on barium swallow?

A

Diffuse oesophageal spasm

94
Q

Most sensitive test for acute pancreatitis?

95
Q

DDx for high amylase?

A
  1. Pancreas = acute pancreatitis, pseudocyst
  2. Gallbladder = acute cholecystitis
  3. Bowel = mesenteric infarct, perforated viscus
  4. Medical = DKA
96
Q

Hernia below and lateral to pubic tubercle?

A

Femoral hernia

97
Q

Carotid endarterectomy nerve injury?

A

Ipsilateral hypoglossal nerve

98
Q

Borders of the femoral canal?

A
  1. Lateral = femoral vein
  2. Medial = lacunar ligament
  3. Anterior = inguinal ligament
  4. Posterior = pectineal ligament
99
Q

Contents of femoral canal?

A
  1. Lymphatic vessels

2. CLoquet’s lymph node

100
Q

Physiological significance of femoral canal?

A

Allows femoral vein to expand to allow for increased venous return to the lower limbs

101
Q

4 post splenectomy blood film features?

A
  1. Howell-Jolly bodies
  2. Pappenheimer bodies
  3. Target cells
  4. Irregular contracted erythrocytes
102
Q

Thyroid cancer follow-up?

A

Thyroglobulin Antibodies

103
Q

Why does hypocalcaemia occur in pancreatitis?

A

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
Q

Definition of an upper GI bleed?

A

A haemorrhage with an origin proximal to the Ligament of Treitz

105
Q

What is the ligament of Treitz?

A

Suspensory muscle of the duodenum, found at the duodenojejunal flexure

106
Q

Definition of a lower GI bleed?

A

A haemorrhage with an origin distal to the Ligament of Treitz

107
Q

Normal CVP?

108
Q

Definitive diagnostic Ix for small bowel obstruction?

109
Q

Trastuzumab?

110
Q

Biologic for complex peri anal Crohns?

A

Infliximab

111
Q

Hiatus hernia defn?

A

Herniation of part of the stomach above the diaphragm

112
Q

Classification of hiatus hernias?

A
  1. Sliding = 95%, GOJ moves above diaphragm

2. Rolling = paraoesophageal, GOJ remains below diaphragm but a separate part herniates through the oesophageal hiatus

113
Q

Pancreatitis amylase levels?

A

At least 4 times the upper limit

114
Q

Non visible diaphragm after trauma?

A

Diaphragmatic trauma

115
Q

Maximum safe dose of Lidocaine?

116
Q

3 absorbable sutures?

A
  1. Vicryl
  2. Dexon
  3. PDS
117
Q

4 non-absorbable sutures?

A
  1. Silk
  2. Novafil
  3. Prolene
  4. Ethilon
118
Q

After how long do absorbable sutures usually disappear?

119
Q

Removal time for face sutures?

120
Q

Removal time for scalp, limb, chest sutures?

121
Q

Removal time for hand, foot, back sutures?

A

10-14 days

122
Q

Sinusoidal ECG pattern?

A

Severe hyperkalaemia

123
Q

4 types of transplant?

A
  1. Allograft
  2. Isograft
  3. Autograft
  4. Xenograft
124
Q

Mx of amoebic liver abscess?

A

Metronidazole

125
Q

A large hyperechoic lesion in the presence of normal AFP?

A

Haemangioma

126
Q

Para-aortic mass and medially displaced ureters?

A

Retroperitoneal fibrosis

127
Q

Pseudomyxoma peritonei?

A

Rare mucinous tumour most commonly arising from the appendix

128
Q

Pregnancy and frank haematuria?

A

Placenta percreta

129
Q

Boundaries of Hesselbach’s triangle?

A
  1. Medial = rectus abdominis
  2. Lateral = inferior epigastric vessels
  3. Inferior = inguinal ligament
130
Q

Main location of anal fissures?

A

Posterior midline

131
Q

Haemorrhoid positions?

A

3, 7 and 11 o clock

132
Q

External haemorrhoid?

A

Below the dentate line, prone to thrombosis, may be painful

133
Q

Internal haemorrhoid?

A

Above the dentate line, dont cause pain generally

134
Q

One-off flexy sig screening offered at what age?

135
Q

Screening for bowel cancer?

A
  1. Faecal immunochemical Test (FIT) screening (60-74 y/o)

2. One-off flexible sigmoidoscopy

136
Q

Dukes classification for colorectal cancer?

A
  1. A = confined to mucosa
  2. B = invading bowel wall
  3. C = lymph node metastases
  4. D = distant metastases
137
Q

Mx of rectal prolapse?

A
  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
Q

Strongest risk factor for anal cancer?

A

HPV infection

139
Q

Majority of anal cancers are what type?

A

Squamous cell cancers

140
Q

Volvulus defn?

A

Torsion of the colon around its mesenteric axis, resulting in compromised blood flow and closed loop obstruction

141
Q

Caecal volvulus associations?

A
  1. Adhesions

2. Pregnancy

142
Q

Sigmoid volvulus associations?

A
  1. Chronic constipation
  2. Chagas disease
  3. Neuro = PD, DMD
  4. Psych = schizophrenia
143
Q

Coffee bean sign?

A

Sigmoid volvulus

144
Q

Sigmoid volvulus mx?

A

Rigid sigmoidoscopy with rectal tube insertion

145
Q

Caecal volvulus mx?

A

Usually operative with a right hemicolectomy

146
Q

AP resection performed when?

A

Tumours in the distal 1/3rd of the rectum

147
Q

Gastric volvulus triad?

A
  1. Vomiting
  2. Pain
  3. Failed attempts to pass an NG tube
148
Q

Why is rectum spared of diverticular disease?

A

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
Q

Hinchey classification for diverticulitis perforation?

A
  1. Para-colonic abscess
  2. Pelvic abscess
  3. Purulent peritonitis
  4. Faecal peritonitis
150
Q

SRUS?

A

Solitary rectal ulcer syndrome, with fibromuscular obliteration on biopsy

151
Q

Monitoring response to tx of colon cancer?

152
Q

Initial mx of diverticulitis flare?

A

Oral Abx at home, if they dont improve within 3 days –> hospital for IV ceftriaxone and metronidazole

153
Q

Where are diverticula most commonly found?

A

Sigmoid colon

154
Q

Perianal abscess defn?

A

Collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincter

155
Q

Benefit of epidural anaesthesia after abdo surgery?

A

Faster return of normal bowel function

156
Q

How to assess if anastomosis has healed?

A

Gastrograffin enema

157
Q

Most common causative agent of ascending cholangitis?

158
Q

What is Lemierre’s syndrome?

A

Infectious thrombophlebitis of the internal jugular vein

159
Q

Lemierre’s syndrome bacteria?

A

Fusobacterium necrophorum

160
Q

Reynold’s pentad of ascending cholangitis?

A
  1. Fever
  2. RUQ pain
  3. Jaundice
  4. Hypotension
  5. COnfusion
161
Q

Mx of ascending cholangitis?

A
  1. IV ABx

2. ERCP after 24-48hrs to relieve any obstruction

162
Q

Ginkgo leaf sign?

A

Surgical emphysema of the anterior chest wall, outlining the pectoralis major muscle

163
Q

5 RFs of gallstones?

A

Fat, fair, fertile, femole, forty

164
Q

Cushing’s triad?

A

Raised ICP

  1. HTN
  2. Bradycardia
  3. Decreased RR
165
Q

Mx of acute cholecystitis?

A
  1. IV Abx

2. Early lap chole within 1 week of diagnosis

166
Q

Glasgow scale of Pancreatitis severity?

A
  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
Q

Pathophysiology of acute pancreatitis?

A

Autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

168
Q

Mx of Gastric MALToma?

A

H. pylori eradication

169
Q

Pigmented gallstones?

A

Haemolytic anaemia

170
Q

Chronic pancreatitis dx?

A

CT pancreas, looking for pancreatic calcification

171
Q

Complications of acute pancreatitis?

A
  1. Local = peripancreatic fluid collections, pseudocysts, necrosis, abscess, haemorrhage
  2. Systemic = ARDS
172
Q

Mx of obstructive jaundice due to unresectable pancreatic carcinoma?

A

Biliary stenting

Medicine and Surgery Mushkies (52 decks)

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