SAQ Revision Sessions Flashcards
What is the screening programme available for AAA?
Offered to men >65
AAA measures 6.1cm, what is the next step in management?
Urgent referral to vascular surgery for intervention
The man who has the AAA is tall and with slender fingers , what medical condition could he have?
Marfan’s Syndrome - predisposes to AAA
What are complications of an open AAA repair?
General-
Anaesthetic Reaction
Bleeding
Infection
DVT/PE
Damage to surrounding structures
Specific-
Renal Failure
Spinal Ischaemia
What are drawbacks of Endovascular Aneurysm Repair instead of Open AAA Repair?
Endoleak
Higher reintervention rate
Long term follow up required
What blood products are used to transfuse?
RBCs
Fresh Frozen Plasma
Platelets
Albumin
What is the ratio of RBC:FFP in the Massive Haemorrhage Protocol?
1:1
What are the 4 layers of the arterial vessel wall?
Tunica Intima
Tunica Media
Tunica Adventitia
Tunica Externa
What are the three components of the general anaesthetic triad?
Hypnosis
Analgesia
Muscle Relaxation
What are examples of Hypnosis drugs?
Propofol
Ketamine
Isoflurane
What are examples of Analgesia drugs?
Morphine
Fentanyl
What are examples of Muscle Relaxation drugs?
Rocuronium
Suxamethonium
What is the termination of the spinal cord known as?
Conus Medullaris
What is the level of the Conus Medullaris?
T12-L1
What are causes of Cauda Equina Syndrome?
Disc Prolapse
Tumour/Haematoma/Abscess
Trauma
Spondylolisthesis
What is the investigation for suspected Cauda Equina?
MRI Spine
What is the management of Cauda Equina?
Surgical decompression of cause within 48 hours
What are LNM signs?
Muscle Atrophy
Fasciculations
Hyporeflexia
Hypotonia
What are some complications of untreated Cauda Equina?
Permanent Paralysis
Faecal Incontinence
Urinary Incontinence
Sexual dysfunction
What nerve is compromised in Cauda Equina ?
Pudendal Nerve
How do you distinguish between direct and indirect hernia?
Reduce the hernia
Cover the deep inguinal ring ( midpoint of inguinal ligament)
Ask patient to cough
This will stop an indirect hernia as it comes through the deep inguinal ring
What is the gold standard investigation for SBO or LBO?
CT Abdo with contrast
What is the bedside management of a bowel obstruction?
NG Tube
NBM
I.V Fluids
I.V Analgesia
Anti-emetic
What are the 4 borders of the inguinal canal?
Roof = Internal Oblique and Transversus Abdominis
Anterior = Aponeurosis of External Oblique
Posterior = Transversalis Fascia
Floor = Inguinal Ligament
I Only Talk About
Elephants Or
Tigers Fucking
If Large
What are the complications of Inguinal Hernia Repair?
General-
Anaphylaxis to anaesthetic
Infection
Bleeding
DVT
Why is an ileostomy spouted not flushed to the skin?
Prevents localised dermatitis caused by alkaline stoma output
What are the causes of Paralytic Ileus?
Recent surgery
Bowel handling
Medications ( Opioids, CCBs)
Electrolyte Imbalance
How do we give TPN?
Through a Central Venous Line
What are the risks of TPN?
Electrolyte Imbalance
Dehydration
Hypoglycemia
Thrombosis
What are the most important aspects to explore with suspected bowel cancer?
Change in bowel habit
PR Bleed
Unintentional Weight Loss
Abdominal Pain
What test is most useful in diagnosing colorectal cancer?
Colonoscopy as you can visualise the whole colon and do a simultaneous biopsy
What are the initial investigations for suspected colorectal cancer?
FBC (Check for anaemia),
LFTs (To check for liver metastases),
CEA
What is the name of the classification system for colorectal cancer?
Duke’s Classification
Define the grades of Duke’s classification.
A - Confined beneath the muscularis propia
B - Extends beyond the muscularis propia
C - Involvement of regional lymph nodes
D - Distant metastases
What are some risk factors for colorectal cancer?
Male
Older
Obesity
HNPCC Gene
APC Gene
IBD
Low fibre diet
High meat intake
What operation would be done for a tumour that is <5cm from the anus?
Anterior resection
What operation would be done for a tumour <5cm from the anus?
AP Resection
What operation is done for a cancer on the sigmoid colon or the rectosigmoid?
Hartman’s procedure
What pathology may be present if a patient complains of gas and dark brown tinged material in their urine?
Colovesical fistula
What is gas in the urine called?
Pneumaturia
What is dark brown tinged material in the urine called?
Faecouria
What diseases are associated with fistulae?
Malignancy
Crohn’s
Diverticulitis
Iatrogenic
What system is used to classify intracapsular NOF fractures?
Garden classification
What would you expect to see on inspection of a patient with a partially displaced intracapsular NOF fracture?
Shortened and externally rotated leg
What is the arterial supply to the NOF?
Medial and lateral circumflex arteries
What complication may occur if the arterial supply to the NOF is disrupted?
Femoral head avascular necrosis
What is the treatment for a partially displaced intracapsular fracture of the NOF in an 85 year old woman?
Hemiarthroplasty - This is because she is a high risk patient. Low risk patients would have a total hip replacement.
Name three types of bacteria that can cause a post op wound infection.
Staphylococcus Aureus
Staphylococcus Epidermis
Pseudomonas
What is the treatment for a staph aureus wound infection?
Co-amoxiclav
What is the treatment for a pseudomonas wound infection?
Ciprofloxacin
Name the characteristics of OA on X-ray.
Loss of joint space
Erosions
Subchondral sclerosis
Subchondral cysts
What are some differentials of testicular torsion?
Epididymo-orchitis
Inguino-Scrotal Hernia
Torsion of testicular appendage
What factors in a history would make you consider torsion as a diagnosis?
Acute onset of scrotal pain
Younger patient
Unilateral pain following exertion
What is the gold standard investigation for torsion and within what timeframe should it be completed?
Scrotal exploration within 6 hours
What is the treatment for torsion?
If testicle is viable, then bilateral orchidopexy
If testicle is not viable, then orchidectomy
How does torsion lead to the loss of the testicle?
Initial occlusion of venous return
Rising pressure within the tunica ( vaginalis and albuginea )
Impaired arterial supply causing necrosis
When examining the breast why are the axillae included?
Tail of the breast tissue rises up in the axilla
Tumours can metastasise to the axilla via lymph nodes - feel lymphadenopathy
Give visible symtpoms that may be visible on breast malignancy?
A breast mass
Peau d’orange
Scaling/eczema around the nipple
Blood stained discharge
Nipple inversion
Skin retraction
State 4 sites breast cancer is most likely to metastasise to?
Bone
Lungs
Liver
Brain
Name 6 risk factors for developing breast cancer?
Early menarche
Late menopause
Nulliparity
Family History
Previous breast cancer
Name 2 causes of mastitis ?
Blocked mammary duct (milk stasis)
Skin trauma (nipple cracking lets infection in)
Identify 4 signs you would see on examination of someone with chronic venous disease?
Lipodermatosclerosis ( champagne bottle shaped legs )
Haemosiderin staining
Venous ulcer
Venous Eczema
Oedema
Atrophie blanche
Thrombophlebitis
What venous system are varicose veins found?
Superficial
What veins tend to be affected by varicosities?
Short saphenous vein
Great saphenous vein
What test would you do for venous varicosity pathology and why?
US doppler to see extent of venous reflux
What is the pathophysiology of varicosities ?
Blood from superficial veins pass into the deep veins via the perforating veins. Valves within the veins prevent retrograde flow from deep to superficial. However due to valvular incompetence there is reflux of blood and increased venous hypertension and overdistension of these veins causing varicosities
What are the differences between arterial and venous ulcers?
Venous
ulcers tend to be located about the ankles
Shallow
Irregular edges
Granulated base
Moist and exudates
Tend to be associated with oedema, skin hyperpigmentation and dermatitis
Mild pain
Arterial
tend to be on the feet toes and pressure points
Deep
Well defined edges
Dry wound bases and minimal exudate
Pale, shiny, cold, hair loss
Severe pain, worsens on activity
What is the non-surgical management for venous ulcers?
Elevate legs/ reduce time standing up
Compression stockings
Topical emollients/moisturisers
How do you calculate APBI?
Each leg separately
Systolic ankle pressure/ systolic brachial pressure
Any value 0.9-1.3 is safe to prescribe stockings as no evidence of PAD
What does an ulcer with a rolled pearly white edge indicate ?
Marjolin’s ulcer
Typically from venous insufficiency or a wound, it’s a malignant change
What are the 4 aspects of capacity?
Understand information
Ability to retain information
Reasoning ( ability to weigh pros and cons)
Be able to communicate their decision
List the main objectives of pre-operative assessment?
To assess for complicated airway
Identify any comorbidities
Any previous reaction to anaesthetic
Medications
Determine fitness for anaesthesia (ASA score)
A patient has suffered a previous MI, what pre-operative investigations should have been performed?
Blood tests - FBC, U&Es, Lipid profile, Hb1Ac, LFTs
ECG
ECHO of the heart
CXR
Exercise stress test
When should the last dose of Apixaban for Atrial Fibrillation be taken pre surgery?
At least 24 hours prior
Give some factors that contribute to a potentially difficult airway?
Obesity
Short neck
C spine for facial fracture
Micrognathia ( small jaw )
What name is given to the scoring system for difficult intubation?
Mallampati - ability to visualise the soft palate
