Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General Surgery > Revision > Flashcards

Revision Flashcards

1
Q

What is the commonest salivary gland malignancy?

A

Adenocarcinoma (remember that 80% of all salivary tumours are Pleomorphic adenoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In a patient with a ? salivary gland cancer, which nerve must you test?

A

Facial
Ask if any change in hearing or taste?
Look for symmetry
Check facial movement - raise eyebrows, smile, puff out cheeks
Consider doing corneal reflex (affererent = trigeminal, efferent = facial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Frey’s syndrome?

A

A complication of surgery to remove parotid tumour. Patient sweats while eating due to abnormal connection between autonomic and facial nerve fibres)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most likely diagnosis in a patient with chest pain, shock and surgical emphysema?

A

Oesophageal perforation - a surgical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common type of hiatus hernia?

A

Sliding accounts for 80%

Part of the gastro-oesophageal junction enters the thorax

Rolling accounts for 5% (with the rest mixed) and describes the proximal part of the stomach, moving into the thorax (higher risk of strangulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Upper 2/3 oesophagus = squamous

A

Lower 1/3 = adenocarcinoma (barrets)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why are beta blockers used in the prophylaxis of oesophageal varices?

A

Reduce portal pressure

(this is important as each time oesophageal varices bleed, the mortality is 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Heller’s operation used for?

A

Management of achalasia (muscles of stomach and LOS is divided down to the muscosa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where is the anatomical cut-off for an upper GI bleed?

A

The ligament of Treitz (found at the duodojejunal flexures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which condition is treated with a Ramstedt pyloromyotomy?

A

Pyloric stenosis

Non-bilious vomit and olive in RUQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Meckels diverticulum?

A

Persistence of the vitello-intestinal duct

Problems are mainly ulceration and haemorrhage as many contain gastric mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common site of diverticulosis?

A

Sigmoid colon
(remember diverticulosis is simply the presence of diverticula)
Itis = inflamed
Diseases = causing pain and change in bowel habit

(gastrograffin enema can be good for detecting diverticulosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications of diverticular disease?

A 
Perforation
Bowel obstruction
Haemorrhage
Fistula 
Abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A Hartmann’s procedure is primarily used for emergency surgery of colorectal tumour/ inflammation. Describe it?

A

Resection of rectosigmoid colon with closure of anorectal stump and formation of an end colostomy

(there is potential for reversal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which 2 tumour markers are used for bowel cancer?

A

CEA

CA 19-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Duke’s criteria for colorectal cancer

A 
A = confined to bowel wall (90% survival)
B = through bowel wall (60% survival)
C = regional lymph nodes (30% survival)
D = distant mets (5% survival)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which gene is faulty in FAP?

A

Autosomal dominant disruption of APC gene

Which is an important tumour suppressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of anal fissure?

A
  • Examine if possible
  • increase fibre and stool softeners
  • medical e.g. GTN cream, Botox (helps to relax sphincter)
  • surgical for failed medical management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What conditions do you have to rule out in a patient with a perianal abscess?

A

1) Cancer
2) TB/ immunosupression
3) Crohns’

The main complication of an abscess is fistula formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What condition needs excluded in a child with a rectal prolapse?

A

CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 2 different types of rectal prolapse?

A

1) Full thickness - prolapse of all layers of the rectum through anus
2) Mucosal - prolapse of rectal mucosa through anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anal cancer is rare and associated with HPV and receptive intercourse. Histologically what is the most common type?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Remember valvulae conniventes are found only in SMALL bowel and cross the entire bowel

A

Haustra are found in LARGE bowel and do NOT cross the entire bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Red currant jelly stool in a baby?

A

Intussusception

Abdo pain, sausage shaped mass
Surgery only if reduction with an air enema fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How could you differentiate between a mechanical bowel obstruction and an ileus?

A

History e.g. if just had bowel surgery and no other risk factors —> ileus from touching bowel is most likely

NO bowel sounds - often tinkling in mechanical obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 2 main complications of a hernia?

A

Obstruction

Strangulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Briefly describe the anatomy of the inguinal canal

A

Floor = inguinal ligament Roof = internal oblique/ transversus abdominus
Anterior wall = external/ internal oblique
Poster = transversalis fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the contents of the inguinal canal?

A

Spermatic cord/ round ligament
Genital branch of genitofemoral nerve
Ilioinguinal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the difference between a direct and indirect inguinal hernia?

A

Indirect = enters and passes through inguinal canal and can therefore descend into scrotum (LATERAL to inferior epigastic vessels)

Direct = bulge though weakened posterior wall —> cannot descend into scrotum (Medial to the inferior epigastric vessels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hernia superior and medial to the pubic tubercle = inguinal hernia

A

Hernia inferior and lateral to pubic tubercle = femoral hernia
(more common in older women)

These require surgery due to the higher risk of strangulation/ obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Patient has positive Murphy sign. What is this? How is it performed?

A

Palpate the gall bladder with 2 fingers
Ask the patient to take a deep breath in - this will push the liver + gall bladder causing pain and sharp stop of breathing in a patient with CHOLECYSTITIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the difference between ascending cholangitis and cholecystitis?

A

Cholangitis = gall stone impacted in CBD —> infection and jaundice (classically jaundice, RUQ and fever)

Cholecystitis = stone impacts and blocks gall bladder outlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Thrombophlebitis migrants = tender nodules in affect blood vessels. What are they associated with?

A

Pancreatic and lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is Courvoisiers Law?

A

In jaundice, if the gall bladder is palpable then it is unlikely to be due to stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Dercums disease?

A

Typical patient is an obese middle aged female with multiple, tender lipomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is Fournier’s Gangrene?

A

Necrotizing fasciitis of the penis/ scrotum

(more common in alcoholics/ immunosupressed etc)W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is Marjolin’s ulcer?

A

An SCC which develops in a chronic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Breslow thickness <1mm —> 5 year survival is 95-100%

A

> 4mm —> 5 year survival is <50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

1st line treatment for heart failure = ACEI + Beta blocker

A

2nd line = spironolactone, ARB or hydralazine + nitrate

Digoxin + cardiac re-synchronisation therapy is 3rd line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which additional heart sound is most likely in left sided heart failure?

A

Third heart sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is malnutrition diagnosed clinically with regard weight loss?

A

Unintentional weight loss of >10% within 3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

A Whipples resection is used for pancreatic cancers which are operable. The cancer is removed and the remaining pancreas and duodenum is joined. What is the major complication?

A

A leak of the anastomoses- monitor drain fluid for amylase. If present then discuss with senior and arrange imaging

This can be potentially fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Parkland formula for fluid resuscitation in burn victims

A

Surface area % x weight in kg x 4ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the cut off for orthostatic hypotension?

A

Fall in SBP of >20 or DBP of >10

OR systolic BP < 90 on standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is hepatorenal syndrome?

A

A type of progressive kidney failure seen in patients with severe liver damage often cirrhosis

Type 1 = occurs in <2 weeks, doubling of creatinine OR halving of creatinine clearance. Need liver transplant but VERY poor prognosis

Type 2 = slowly progressive, often due to ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Nitrates are contraindicated in patients with aortic stenosis due to the risk of profound hypotension

A

Furesomide is the best option as it will provide symptomatic relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How should a patient with suspected heart failure be investigated?

A

Previous MI = echo within 2 weeks

No previous MI = measure BNP, if high then echo within 2 weeks
If raised but not high then echo within 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

In patients with NAFLD, the enhanced liver fibrosis blood test should be offered to assess advanced fibroisis

A

It combines hyaluronic acid + procollagen + tissue inhibitor of metalloproteinase 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which drug could be used in an old lady who suffers from orthostatic hypotension which has not improved with conservative measures?

A

Fludrocortisone (it increases Na and H20 reabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Peugeot Jeghers syndrome

A

Autosomal dominant
Numerous polyps in the GI tract —> GI bleeding, malignancy and intussusception
Pigmented freckles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Best surgical option for a patient with UC and toxic mega-colon?

A

Sub-total colectomy

Remove everything apart from the rectum (touching the rectum has a high risk of complications)

(panproctocolectomy with ileoanal pouch is only offered electively)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How do you calculate ABPI?

A

Highest ankle pressure / highest brachial pressure

<0.9 = PAD
< 0.5 = critical limb ischameia
>1.3 = probably atherosclerosis

(remember that leg pressure should normally be slightly higher)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Why is rest pain worse at night in intermittent claudication?

A

BP falls at night

Feet are elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is leriche syndrome?

A

Combination of buttock claudication and impotence

55
Q

Most likely diagnosis in a 30 year old male with claudication in lower limbs. He is a heavy smoker.

A

Buerger’s disease - inflammation and occlusion of medium sized vessels

MUST stop smoking

56
Q

What is the difference between Raynaud’s disease and Raynaud’s phenomenon?

A

Disease = idiopathic, usually occurs in females

Phenomenon = occurs secondary to other causes e.g. SLE or other CTD

(Remember spasm of arteries in the hands and toes causes —> white (ischameia) —> blue (hypoxia) —>hyperaemia

57
Q

Remember that venous ulcers are classically…

A 
Shallow
Irregular and shallow edge
On the gaiter area
Associated with little pain
Granulation tissue
58
Q

Give some examples of the different types of aneurysms?

A

True aneurysm = abnormal dilatation of ALL layers of this vessel

Congenital : berry aneurysm
Degenerative : AAA
Inflammatory : Kawasaki
Infection
Trauma
59
Q

When does the AAA screening programme start?

A

Men aged 65

remember that 95% of AAA are infra-renal

60
Q

Remember that 10% of men with a AAA will also have a popliteal aneurysm

A

If you find a popliteal aneurysm then have a feel of the tummy

61
Q

What is the main risk factor for aortic dissection?

A

Chronic hypertension
It causes a shearing of the tunica intima (innermost layer) and allows the accumulation of blood between the tunica intima and media —> false lumen

Other RF include Marfan’s and Ehlers-danlos

62
Q

Complications of aortic dissection?

A

Aneurysm
Bleed into pericardium > tamponade
Bleed into mediastinum (very bad)
Compress other vessels e.g. cubclavian

63
Q

What is the difference between type A and B aortic dissection?

A

A = involves ascending aorta —> very bad and is a surgical emergency

B = starts at the subclavian artery —> medical management of BP

Obviously B has a MUCH better prognosis

Suspect a dissection in everyone with unequal pulses (and a widened mediastinum on CXR)

64
Q

Fibroadenomas are usually harmless. In what circumstances should you consider excision?

A

1) age >40
2) >4cm
3) increasing in size
4) patient choice??

65
Q

Most likely cause in a youngish women with a small lump in the sub-areloar area. There is blood stained nipple discharge

A

Duct papilloma

A benign neoplasm of the duct requiring surgical exicision

66
Q

Likely diagnosis in lady with a nipple lump (including secretions) and retractions as well as nipple discharge
The

A

Duct ectasia
Dilatation of mammary ducts

May need surgery if excessive discharge

It is a benign condition

67
Q

How would you describe cyclical breast pain?

A

Breast pain/ heaviness worse in mid-cycle

Obvious cyclical nature

Not harmful so mainstay is reassurance and consideration of analgesia as required (if sure there is no cancer)

68
Q

Advice for mastitis

A

1) use hot compress
2) limit wearing a bra
3) keep feeding - express as much milk as possible
4) come back if not settled in 12-24 hours for antibiotics
5) if there is an abscess it will need drained

69
Q

Give a differential for gynaecomastia?

A

1) Drugs e.g. spironolactone, digoxin
2) obesity/ FH
3) Oestrogen secreting tumour
4) renal failure

Consider treatment options such as tamoxifen or damazol

Surgery rarely required

70
Q

RF for breast cancer

A

1) Personal/ FH
2) HRT
3) Obesity
4) OCP
5) Alcohol
6) Female
7) Age
8) early menarche, late menopause
9) nulliparous

71
Q

Remember that grading is done under the microscope e.g. what the cells look like

A

Staging is TNM - it uses lots of information and puts it all together

72
Q

Wide local excision is ALWAYS followed by radiotherapy in breast cancer

A

Mastectomy if tumour too large, breast to small or patient choice

Radiotherapy is offered after mastectomy if tumour stage is T3 or above

73
Q

What is the main complication of axillary node biopsy and radiotherapy for breast cancer?

A

Lymphoedema of the arm

74
Q

Level 2 clearance = nodes lateral and deep to pec minor

A

Level 3 clearance = also includes apical nodes

75
Q

Drug used in oestrogen receptor +ve breast cancer?

A

Tamoxifen (oestrogen receptor blocker)

76
Q

Side effects of tamoxifen

A
  • hot flushes
  • vaginal dryness
  • reduced libido
  • cataract
  • taste change
  • skin rashes
  • low mood/ poor concentration
  • VTE
  • Tumour flare (if spread to bones)
  • Endometrial hyperplasia
77
Q

Who receives gosereline for breast cancer?

A

ER+VE breast cancer in pre-menopausal ladies

78
Q

Letrozole/ anastrazole is used for ER +ve breast cancer in post-menopausal women

A

Letrozole is an aromatase inhibitor which reduces peripheral oestrogen synthesis

79
Q

Which adjuvant treatment should be considered in a HER2 +ve breast cancer?

A

Tratuzumab (Herceptin)

Remember it is only useful in the 20% of tumours that are HER2 positive

80
Q

Chemoprevention is offered to women at high risk of developing breast cancer. What agent should be used?

A

Pre-menopausal = tamoxifen for 5 years (if no increased risk of VTE)

Post-menopausal = letrozole for 5 years

81
Q

How is BRCA1 inherited?

A

It is autosomal dominant —> 50% of children will be affected

It causes a 40% lifetime risk of breast/ ovarian cancer

82
Q

Lady presents with progressive breast swelling and redness. No pain, discharge or lumps. Systemically well. WBC normal. CA 15-3 elevated?

A

Most likely an inflammatory breast cancer

83
Q

How do you calculate the Nottingham prognostic index?

A

Tumour size x 0.2 + lymph node score + grade score

Score <2.4 = 95% 5 year survival
Score >5.4 = 50% 5 year survival

84
Q

Remember that fat necrosis can cause a hard irregular lump

A

Which may also be tethered to the skin —> must do a mammogram to exclude cancer

85
Q

In breast lumps, 4cm is the magic number

A 
<4cm = WLE
>4cm = mastectomy

For a fibroadenoma, refer for removal if >3cm and causing discomfort

86
Q

Multiple ducts with ‘creamy/ green’ discharge = duct ectasia

nipple inversion too

A

Singular duct with blood stained discharge = introduction papilloma (may need a microdocechtomy - removal of the affected duct)

87
Q

Breast lump with halo sign?

A

The halo sign is highly suggestive of a benign process e.g. a cyst which is usually a soft, fluctuations swelling

88
Q

Andrew is going to have a thryoidectomy. What are the risks?

A

1) Normal bleeding, infection and anaesthetic risk
2) Recurrent laryngeal nerve damage —> voice change
3) hypothyroid —> thyroxine
4) Parathyroid —> calcium problem

89
Q

Differential of a goitre?

A 
Graves
Hashimoto 
Toxic multinodular goitre
Iodine deficiency
Thyroid cancer
De Quervains (hyper and then hypo thyroid)
90
Q

Patient with goitre, hypothyroidism and biopsy showing fibrosis and infiltration by IgG 4 plasma cells?

A

Riedel’s thyroiditis

91
Q

Papillary thyroid cancer is commonest and does NOT usually spread

A

Follicular cancer usually spreads via blood

papillary is private, follicular floats in blood

92
Q

Which type of thyroid cancer in a patient with MEN II?

A

Medullary (it secretes calcitonin which is a very useful marker for recurrence)

93
Q

Which thyroid cancer affects elderly people, is rapidly progressive and spreads to lymph nodes and local tissue early?

A

Anaplastic

94
Q

Diagnosis of carcinoid tumour?

A

24 hour urine collection for 5-HIAA
Imaging e.g. CT/ USS
MIBG = nuclear medicine scan to detect primary

Treatment is with resection BUT somatostatin analogues e.g. octreotide

95
Q

Men 1 P’s (parathyroid, pancreas and pituitary)

A

Men 2a TAPs (thyroid medullary, adrenal phaeochromocytoma and parathyroid) and Men2b is a MAN (Marfinoid, medullary, adrenal phaeochromocytoma and neuromas)

96
Q

How is the area of a burn worked out??

A

Wallace rule of 9’s

Head and neck = 9%
Each arm = 9%
Anterior trunk = 18%
Posterior trunk = 18%
Each leg = 18 %
Perineum = 1%
97
Q

Remember that body fluid composition is 2/3 intracellular and 1/3 extracellular e.g. plasma, interstitial fluid

A

The traditional maintenance fluids = 1 salty (saline) and 2 sweet (5% dextrose) with 20 mmol K in each bag

98
Q

What is coup and centre-coup with regard to head injuries?

A

Coup = injury at the site of impact e.g. where you hit your head

Contrecoup = injury at the opposite side (where the head has struck on the rebound)

Contrecoup is usually more severe

99
Q

Secondary brain injury can occur after hypoxia. How do you calculate cerebral perfusion pressure?

A

Cerebral perfusion pressure = BP - ICP

this explains why head injury reduces cerebral perfusion pressure as it increases ICP

100
Q

Management of patient with SAH?

A

1) ABCDE
2) prompt imaging and referral to appropriate neurosurgeon
3) nimidopine (CCB to prevent vasospsam)
4) BP control (pressure high enough to allow perfusion but not risk bleeding)
5) Rebleeding is a major complication and cause of death - hope the coil/ embolisation works well

101
Q

Sub-dural = bridging veins which are damaged and bleed

Alcoholics and old people

A

Extra-Dural = extra-dural vessels bleed due to trauma
Lucent period
Immediate surgical decompression

102
Q

Talk about the anatomy of nerve roots being affected by prolapsed discs?

A

C-spine:

  • there is a mis-match e.g. the C6 nerve root travels under C5 pedicel
  • both central and lateral prolapses affect the same nerve root

Lumbar spine:

  • match: L5 nerve root travels under L5 pedicle
  • Central prolapse affects the nerve root below e.g. central L4/5 prolapse affects L5 nerve root
  • Lateral prolapse affects the nerve root above e.g. lateral L4/5 prolapse affects L4 nerve root
  • As most symptomatic prolapses are CENTRAL - it follows that most will affect the nerve root below
103
Q

Communicating hydrocephalus = the pathways are working but there is impaired CSF absorption
E.g. meningitis or SAH

A

Non-communication = a lesion is obstructing the flow of CSF e.g. tumour or congenital

104
Q

Give 5 causes of carpal tunnel syndrome?

A

1) pregnancy
2) obesity
3) RA
4) Hypothyroid
5) acromegaly

105
Q

Erb’s palsy = upper (C5/6)

Remember U&E’s in waiters position

A

Klumpke palsy = T1 (lower)

Claw hand and wasting of hand muscles

106
Q

In which area should you check for sensory loss in a patient with a wrist drop?

A

Check for sensation in the anatomical snuff box

Can they extend their wrist?

107
Q

What is the most likely cause of rectal bleeding following a Hartmann’s procedure?

A

Hartmann’s removes the affected bowel and leaves the rectum and anus unattached —> no passage of faeces etc

The most likely cause of painless bleeding is therefore diversion proctitis

108
Q

Sudden onset painless profuse rectangle bleeding =

A

Diverticular disease

109
Q

Differential diagnosis for milky white ascitic fluid?

A

1) infection
2) Chylous ascites - due to intra-operative damage of the thoracic duct

Diagnosis of chylous ascites is by confirming there is a dry high lipid level

110
Q

What is balanitis xerotica obliterans?

A

The male equivalent of lichen sclerosis

Painful, itchy white spots which are associated with a number of complications including increased risk of infection, increased risk of SCC and scarring which leads to phimosis (inability to retract foreksin) and urethral strictures

111
Q

What is the cause of neurogenic or spinal shock?

A

Typically transaction of the spinal cord which disrupts the autonomic system

Usually deceased sympathetic tone
—> vasodilatation = skin is warm and flushed and CO is reduced due to low preload

112
Q

Rest pain and claudication is ABPI <0.5

A

Ulceration and gangrene if ABPI <0.3

113
Q

Cause of epididymo-orchitis

A
  • young, sexually active = chlamydia or gonorrhoea

- older, no sex, urinary infections etc = E.COLI

114
Q

Testicular lump which cannot be separated from the testes and transluminates?

A

Hydrocoele (collection of fluid in the tunica vaginalis)

Although hydrocoeles are benign, they are associated with testicular cancer which has to be excluded on USS

In CHILDREN it is associated with a patent processes vaginalis

115
Q

What is an ASA grade?

A

The classification used to determine patients physical status prior to anaesthetic
ASA 1 = healthy patient, non-smoker
ASA 2 = mild disease e.g. smoker, well controlled DM/ HTN
ASA 3 = severe systemic disease e.g. COPD, poorly controlled HT/DM, previous MI
ASA 4 = severe systemic disease that is a constant threat to life e.g. recent MI, stroke
ASA 5 = moribund - not expected to survive operation e.g. massive trauma or ruptured AAA

116
Q

Congenital umbilical hernias usually resolve by age 4-5 so no treatment is required

More common in premature babies

A

Congenital inguinal hernia have a high risk of strangulation —> need surgical correction ASAP

117
Q

Pancreatic pseudocyst is a very common complication of pancreatitis. How should it be managed?

A

If systemically well = conservatively e.g. close monitoring

If unwell = radiological FNA (the use of a drain or endoscopy would introduce infection)

118
Q

How does duodenal atresia typically present?

A

With non-projectile vomiting in the first few hours after birth in a baby with Down’s syndrome
An AXR will show the double bubble sign

119
Q

How to remember Cullen’s and Grey Turner’s?

A

Cullen = central (periumbilical bruising)

Grey Tunrners = 2 words for 2 flanks affected

120
Q

How do you test for brainstem death?

A
  • pupils - fixed, no response
  • no corneal reflex
  • no oculus-vestibular reflex (eye movement after injection of ice water into ears)
  • no response to pain
  • no cough reflex
  • no respiratory effort
121
Q

What is suxamethonium apnoea?

A

Some patients have an autosomal dominant mutation meaning they lack a specific acetylcholinesterase which breaks down suxamethonium

As a result, the muscle relaxant takes longer to wear off so patients need intubated for a while

122
Q

Remember a ileostomy is spouted - this means the end is raised above the skin so the surrounding skin is not irritated by alkaline fluid from the gut

A

Colostomies are flush to the skin

123
Q

Management of ALL patients with intermittent claudication?

A

1) Stop smoking
2) graded exercise
3) statin (atorvostatin 80mg)
4) antiplatlet e.g. clopidogrel
5) manage existing hypertension
6) amputation is required

124
Q

Management options for an uncomplicated anal fissure

A

1) relieve constipation with high fibre diet, lots of fluid and bulk forming laxative
2) analgesia such as paracetemol
3) topical anaesthetics
4) lubricants to be used prior to defaecation
5) GTN spray for chronic fissure (>6 weeks)

125
Q

All Ca and phosphate containing stones are radio-opaque so easily seen on AXR

A

Urate and xanthine stones are radio-lucent

Cystine stones are semi-opaque

126
Q

Remember that renal cell carcinoma is also called renal adenocarcinoma

A

It is the commonest type of kidney cancer and is associated with paraneoplastic syndromes such as polycythameia, hypercalcamia and thrombocytopenia

127
Q

Management of renal colic in patients with a fever and evidence of hydronephrosis on imaging.
(Non-contrast CT is imaging of choice)

A

Surgical decompression is required as she is obstructed and there is a evidence of infection —> at risk of urosepsis.

128
Q

What advice should a man be given after having a vasectomy?

A

1) not effective immediately - will need to use barrier contraception for a few weeks afterwards
2) return after 12 weeks for a semen analysis —> if clear can have unprotected sex
3) risk of infection and bruising
4) 5% of men have chronic testicular pain

129
Q

Popcorn calcification or cotton wool spots?

A

Chondrosarcoma

Typically affects the pelvis of middle aged people

130
Q

Codman’s triangle

A

A triangular area of new sub-peritoneal bone that is creased when the periosteum is raised away from the bone

Associated with osteosarcoma - the commonest malignant bone tumour

131
Q

Sunray spiculation

A

Associated with osteosarcoma which is also linked with codman’s triangle

132
Q

Onion skin periosteal reaction

A

Ewing’s sarcma

Onion and wings is super tasty

133
Q

Asymptomatic AAA <5.5cm in diameter are treated with US surveillance

A

Symptomatic, aortic diameter >5.5.cm or rapidly enlarging = surgery (EVAR or open)

General Surgery (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions