Science deck Flashcards
Upper GI bleed while being on lots of PPI
Gastrinoma and Zollinger Ellison Syndrome
Phaeochromocytoma and the rule of 10s
10% of cases are bilateral.
10% occur in children.
11% are malignant (higher when tumour is located outside the adrenal).
10% will not be hypertensive.
How can you tell if an incidental adrenal lesion is benign
Factors suggesting benign disease on CT include(4):
Size less than 3cm
Homogeneous texture
Lipid rich tissue
Thin wall to the lesion
What is the standard first-line treatment for anal cancer
Combined chemoradiotherapy is the standard treatment for anal cancer
Anal cancer
Arise inferior to the dentate line
Strongly linked to HPV type 16 infection
Other risk factors include ano-receptive intercourse, smoking and immunosuppression
Presenting symptoms include anal discomfort, discharge or pruritus
Lymphatic spread typically occurs to the inguinal nodes
Diagnosis is made by EUA and biopsies
Staging is with CT scanning of the chest, abdomen and pelvis
First-line treatment is typically with chemoradiotherapy
Second line treatment for non-metastatic disease is with salvage radical abdominoperineal excision of the anus and rectum
Where is the vomiting centre located?
Medulla oblongata
What are the indications for an escharotomy?
Indicated in circumferential full-thickness burns to the torso or limbs.
Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)
Which anaesthetic agent has the strongest ant emetic properties
Propofol
What type of hypersensitivity reaction is TB
Type 4 (delayed) - Granulomas delayed
Extra-intestinal features of IBD
Extraintestinal manifestation of inflammatory bowel disease: A PIE SAC
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing
Renal Stones management
Size First line option
Less than 5mm and asymptomatic Watchful waiting
Less than 10mm ESWL
10-20mm ESWL or ureteroscopy
Greater than 20mm (including staghorn calculi) PCNL
Ureteric stone
Size First line option
Less than 5mm Watchful waiting
5-10mm ESWL (if upper ureter)
10-20mm Ureteroscopy
Which type of renal stone most commonly develops in chemo patients
Uric acid stones, theses are radiolucent and will not show up on XRKUB. Chemotherapy and cell death can increase uric acid levels
Which clotting factors are affecting by temperature
Factors V and VIII are sensitive to temperature which is the reason why FFP is frozen soon after collection.
Klippel-Trenaunay-Weber (KTW)
port-wine stains, varicose veins, and bony or soft-tissue hypertrophy.
Breast Cancer
Surgery is performed in most patients suffering from breast cancer.
Chemotherapy may be used to downstage tumours and allow breast-conserving surgery. Hormonal therapy may also be used for the same purposes.
Radiotherapy is given to most patients who have undergone breast-conserving surgery (some older patients receiving hormone treatment and who have small low-grade tumours may safely avoid DXT.
Therapeutic mammoplasty is an option for some patients but requires symmetrizing surgery in most cases.
Patients who have undergone mastectomy may be offered a reconstructive procedure either in conjunction with their primary resection or as a staged procedure at a later date.
Surgical options
Mastectomy vs Wide local excision
Mastectomy Wide Local Excision
Multifocal tumour Solitary lesion
Central tumour Peripheral tumour
Large lesion in small breast Small lesion in large breast
DCIS >4cm DCIS <4cm
Patient Choice Patient choice
Central lesions may be managed using breast conserving surgery, where an acceptable cosmetic result may be obtained, this is rarely the case in small breasts
Axillary disease
As a minimum, all patients with invasive breast cancer should have their axilla staged. In those who do not have overt evidence of axillary nodal involvement this can be undertaken using sentinel lymph node biopsy.
Patients with a positive sentinel lymph node biopsy or who have imaging and cytological or histological evidence of axillary nodal metastasis should undergo axillary node clearance or axillary irradiation.
Axillary node clearance is associated with the development of lymphoedema, increased risk of cellulitis and frozen shoulder.
How would you manage any surgical bleed.
Bleeding is a process that is encountered in all branches of surgery. The decision as to how best to manage bleeding depends upon the site, vessel and circumstances.
Management of superficial dermal bleeding
This will usually cease spontaneously. If it is troublesome then direct use of monopolar or bipolar cautery devices will usually control the situation. Scalp wounds are a notable exception and the bleeding from these may be brisk. In this situation the use of mattress sutures as a wound closure method will usually address the problem.
Superficial arterial bleeding
If the vessel can be safely identified then the easiest method is to apply a haemostatic clip and ligate the vessel.
Major arterial bleeding
If the vessel can be clearly identified and is accessible then it may be possible to apply a clip and ligate the vessel. If the vessel is located in a pool of blood then blind application of haemostatic clips is highly dangerous and may result in collateral injury. In this situation evacuating the clot and packing the area is often safer. The pack can then be carefully removed when the required instruments are available. Some vessels may retract and bleeding may then be controlled by dissection of surrounding structures or under-running the bleeding point.
Major venous bleeding
The safest initial course of action is to apply digital pressure to the bleeding point. To control the bleeding the surgeon will need a working suction device. Divided veins may require ligation. Incomplete lacerations of major veins (e.g. IVC) are best repaired. In order to do this it is safest to apply a Satinsky type vascular clamp and repair the defect with 5/0 prolene.
Bleeding from raw surfaces
This may be mixed bleeding and can be troublesome. Spray diathermy and argon plasma coagulation are both useful agents. Certain topical haemostatic agents such as surgicell are useful in encouraging clot formation and may be used in conjunction with, or instead of, the above agents.
FACT
If there is a bowel resection, primary anastomosis and then bleeding is reported along with abdominal pain, it is more likely that the patient has Chron’s and not UC as resections are not undertaken for UC
How do you manage paediatric hydrocele
In children, a hydrocele is most commonly due to a persistent processus vaginalis. The swelling is intermittent and in most cases that are diagnosed in infancy the hydrocele resolves. Cases that persist beyond two years of age are best managed surgically and the surgical approach is usually made via the inguinal canal where the patent processus is identified and ligated.
Which substance related to thyroid function has its effects mediated by a nuclear receptor
Triiodothyroxine
Which of the following blood products can be administered to a non ABO matched recipient?
Platelets
Where are the prosthetic heart valves usually located on CXR
Remember AMT - 345
Aortic - 3
Usually located medial to the 3rd interspace on the right.
Mitral - 4
Usually located medial to the 4th interspace on the left.
Tricuspid - 5
Usually located medial to the 5th interspace on the right.
Duct ectasia
Dilatation breast ducts.
Most common in menopausal women
Discharge typically thick and green in colour
Most common in smokers
Breast carcinoma
Often blood stained
May be underlying mass or axillary lymphadenopathy