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Surgery Extra Questions > SAQ Revision Sessions > Flashcards

SAQ Revision Sessions Flashcards

1
Q

What is the screening programme available for AAA?

A

Offered to men >65

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2
Q

AAA measures 6.1cm, what is the next step in management?

A

Urgent referral to vascular surgery for intervention

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3
Q

The man who has the AAA is tall and with slender fingers , what medical condition could he have?

A

Marfan’s Syndrome - predisposes to AAA

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4
Q

What are complications of an open AAA repair?

A

General-
Anaesthetic Reaction
Bleeding
Infection
DVT/PE
Damage to surrounding structures

Specific-
Renal Failure
Spinal Ischaemia

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5
Q

What are drawbacks of Endovascular Aneurysm Repair instead of Open AAA Repair?

A

Endoleak
Higher reintervention rate
Long term follow up required

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6
Q

What blood products are used to transfuse?

A

RBCs
Fresh Frozen Plasma
Platelets
Albumin

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7
Q

What is the ratio of RBC:FFP in the Massive Haemorrhage Protocol?

A

1:1

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8
Q

What are the 4 layers of the arterial vessel wall?

A

Tunica Intima
Tunica Media
Tunica Adventitia
Tunica Externa

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9
Q

What are the three components of the general anaesthetic triad?

A

Hypnosis
Analgesia
Muscle Relaxation

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10
Q

What are examples of Hypnosis drugs?

A

Propofol
Ketamine
Isoflurane

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11
Q

What are examples of Analgesia drugs?

A

Morphine
Fentanyl

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12
Q

What are examples of Muscle Relaxation drugs?

A

Rocuronium
Suxamethonium

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13
Q

What is the termination of the spinal cord known as?

A

Conus Medullaris

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14
Q

What is the level of the Conus Medullaris?

A

T12-L1

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15
Q

What are causes of Cauda Equina Syndrome?

A

Disc Prolapse
Tumour/Haematoma/Abscess
Trauma
Spondylolisthesis

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16
Q

What is the investigation for suspected Cauda Equina?

A

MRI Spine

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17
Q

What is the management of Cauda Equina?

A

Surgical decompression of cause within 48 hours

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18
Q

What are LNM signs?

A

Muscle Atrophy
Fasciculations
Hyporeflexia
Hypotonia

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19
Q

What are some complications of untreated Cauda Equina?

A

Permanent Paralysis
Faecal Incontinence
Urinary Incontinence
Sexual dysfunction

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20
Q

What nerve is compromised in Cauda Equina ?

A

Pudendal Nerve

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21
Q

How do you distinguish between direct and indirect hernia?

A

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

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22
Q

What is the gold standard investigation for SBO or LBO?

A

CT Abdo with contrast

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23
Q

What is the bedside management of a bowel obstruction?

A

NG Tube
NBM
I.V Fluids
I.V Analgesia
Anti-emetic

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24
Q

What are the 4 borders of the inguinal canal?

A

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

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25
Q

What are the complications of Inguinal Hernia Repair?

A

General-
Anaphylaxis to anaesthetic
Infection
Bleeding
DVT

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26
Q

Why is an ileostomy spouted not flushed to the skin?

A

Prevents localised dermatitis caused by alkaline stoma output

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27
Q

What are the causes of Paralytic Ileus?

A

Recent surgery
Bowel handling
Medications ( Opioids, CCBs)
Electrolyte Imbalance

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28
Q

How do we give TPN?

A

Through a Central Venous Line

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29
Q

What are the risks of TPN?

A

Electrolyte Imbalance
Dehydration
Hypoglycemia
Thrombosis

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30
Q

What are the most important aspects to explore with suspected bowel cancer?

A

Change in bowel habit
PR Bleed
Unintentional Weight Loss
Abdominal Pain

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31
Q

What test is most useful in diagnosing colorectal cancer?

A

Colonoscopy as you can visualise the whole colon and do a simultaneous biopsy

32
Q

What are the initial investigations for suspected colorectal cancer?

A

FBC (Check for anaemia),
LFTs (To check for liver metastases),
CEA

33
Q

What is the name of the classification system for colorectal cancer?

A

Duke’s Classification

34
Q

Define the grades of Duke’s classification.

A

A - Confined beneath the muscularis propia
B - Extends beyond the muscularis propia
C - Involvement of regional lymph nodes
D - Distant metastases

35
Q

What are some risk factors for colorectal cancer?

A

Male
Older
Obesity
HNPCC Gene
APC Gene
IBD
Low fibre diet
High meat intake

36
Q

What operation would be done for a tumour that is <5cm from the anus?

A

Anterior resection

37
Q

What operation would be done for a tumour <5cm from the anus?

A

AP Resection

38
Q

What operation is done for a cancer on the sigmoid colon or the rectosigmoid?

A

Hartman’s procedure

39
Q

What pathology may be present if a patient complains of gas and dark brown tinged material in their urine?

A

Colovesical fistula

40
Q

What is gas in the urine called?

A

Pneumaturia

41
Q

What is dark brown tinged material in the urine called?

A

Faecouria

42
Q

What diseases are associated with fistulae?

A

Malignancy
Crohn’s
Diverticulitis
Iatrogenic

43
Q

What system is used to classify intracapsular NOF fractures?

A

Garden classification

44
Q

What would you expect to see on inspection of a patient with a partially displaced intracapsular NOF fracture?

A

Shortened and externally rotated leg

45
Q

What is the arterial supply to the NOF?

A

Medial and lateral circumflex arteries

46
Q

What complication may occur if the arterial supply to the NOF is disrupted?

A

Femoral head avascular necrosis

47
Q

What is the treatment for a partially displaced intracapsular fracture of the NOF in an 85 year old woman?

A

Hemiarthroplasty - This is because she is a high risk patient. Low risk patients would have a total hip replacement.

48
Q

Name three types of bacteria that can cause a post op wound infection.

A

Staphylococcus Aureus
Staphylococcus Epidermis
Pseudomonas

49
Q

What is the treatment for a staph aureus wound infection?

A

Co-amoxiclav

50
Q

What is the treatment for a pseudomonas wound infection?

A

Ciprofloxacin

51
Q

Name the characteristics of OA on X-ray.

A

Loss of joint space
Erosions
Subchondral sclerosis
Subchondral cysts

52
Q

What are some differentials of testicular torsion?

A

Epididymo-orchitis
Inguino-Scrotal Hernia
Torsion of testicular appendage

53
Q

What factors in a history would make you consider torsion as a diagnosis?

A

Acute onset of scrotal pain
Younger patient
Unilateral pain following exertion

54
Q

What is the gold standard investigation for torsion and within what timeframe should it be completed?

A

Scrotal exploration within 6 hours

55
Q

What is the treatment for torsion?

A

If testicle is viable, then bilateral orchidopexy
If testicle is not viable, then orchidectomy

56
Q

How does torsion lead to the loss of the testicle?

A

Initial occlusion of venous return
Rising pressure within the tunica ( vaginalis and albuginea )
Impaired arterial supply causing necrosis

57
Q

When examining the breast why are the axillae included?

A

Tail of the breast tissue rises up in the axilla
Tumours can metastasise to the axilla via lymph nodes - feel lymphadenopathy

58
Q

Give visible symtpoms that may be visible on breast malignancy?

A

A breast mass
Peau d’orange
Scaling/eczema around the nipple
Blood stained discharge
Nipple inversion
Skin retraction

59
Q

State 4 sites breast cancer is most likely to metastasise to?

A

Bone
Lungs
Liver
Brain

60
Q

Name 6 risk factors for developing breast cancer?

A

Early menarche
Late menopause
Nulliparity
Family History
Previous breast cancer

61
Q

Name 2 causes of mastitis ?

A

Blocked mammary duct (milk stasis)
Skin trauma (nipple cracking lets infection in)

62
Q

Identify 4 signs you would see on examination of someone with chronic venous disease?

A

Lipodermatosclerosis ( champagne bottle shaped legs )
Haemosiderin staining
Venous ulcer
Venous Eczema
Oedema
Atrophie blanche
Thrombophlebitis

63
Q

What venous system are varicose veins found?

A

Superficial

64
Q

What veins tend to be affected by varicosities?

A

Short saphenous vein
Great saphenous vein

65
Q

What test would you do for venous varicosity pathology and why?

A

US doppler to see extent of venous reflux

66
Q

What is the pathophysiology of varicosities ?

A

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

67
Q

What are the differences between arterial and venous ulcers?

A

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

68
Q

What is the non-surgical management for venous ulcers?

A

Elevate legs/ reduce time standing up
Compression stockings
Topical emollients/moisturisers

69
Q

How do you calculate APBI?

A

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

70
Q

What does an ulcer with a rolled pearly white edge indicate ?

A

Marjolin’s ulcer

Typically from venous insufficiency or a wound, it’s a malignant change

71
Q

What are the 4 aspects of capacity?

A

Understand information
Ability to retain information
Reasoning ( ability to weigh pros and cons)
Be able to communicate their decision

72
Q

List the main objectives of pre-operative assessment?

A

To assess for complicated airway
Identify any comorbidities
Any previous reaction to anaesthetic
Medications
Determine fitness for anaesthesia (ASA score)

73
Q

A patient has suffered a previous MI, what pre-operative investigations should have been performed?

A

Blood tests - FBC, U&Es, Lipid profile, Hb1Ac, LFTs
ECG
ECHO of the heart
CXR
Exercise stress test

74
Q

When should the last dose of Apixaban for Atrial Fibrillation be taken pre surgery?

A

At least 24 hours prior

75
Q

Give some factors that contribute to a potentially difficult airway?

A

Obesity
Short neck
C spine for facial fracture
Micrognathia ( small jaw )

76
Q

What name is given to the scoring system for difficult intubation?

A

Mallampati - ability to visualise the soft palate

Surgery Extra Questions (9 decks)

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