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Year 6 > Senior surgery > Flashcards

Senior surgery Flashcards

1
Q

what is the definitive treatment of variceal bleeding?

A

oesophageal varices - gastric band ligation

gastric varices -

  1. something about a sclerotherapy
  2. Transjugular intrahepatic portosystemic shunts (TIPS)
  3. Balloon occluded retrograde transvenous obliteration techniques (BORTO)
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2
Q

A patient presents with Lymphadenopathy of the neck. what are the causes? how would you ivx?

A

5 causes: Reactive, Malignancy, TB, Sarcoid, Lymphoma

Ivx:
1. Full history + full ENT exam including flexible endoscopy

Imaging (if suspecting malignancy):

  1. USS + FNA Cytology
  2. CXR if sarcoid (hilar lymphadenopathy)
  3. CT neck- chest (if suspecting malignancy)

PACES:
If cancer refer to head and neck cancer MDT (must mention to pass)

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3
Q

How is lymphadenopathy managed?

A

Refer to MDT - have to mention this in PACES

radio/chemotherapy / surgery or combo

managed ‘en bloc’: removing/radiating lymph nodes at same time to prevent mets.

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4
Q

what are the differentials for painless unilateral tonsil enlargement?

A

should be considered cancer until proven otherwise

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5
Q

what is the most common cancer of head and neck? associations?

A

tonsil cancer

association: HPV virus!!

younger - hpv associated
older - smoking associated tonsil cancer; squamous cell carcinomas

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6
Q

how does nasopharynx cancer present? epidemiology?

A

Swelling/lump in the neck

Associated with smoking and EBV

endemic in SE Asia, China, Hong Kong

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7
Q

How would you ivx a unilateral odd looking swelling in the nasopharynx?

A

?Nasopharyngeal cancer

Usually need an endoscope to see it

Refer to ENT for urgent endoscope

Mx: Head and Neck cancer MDT

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8
Q

How does laryngeal cancer present?

A

Hoarseness! >6wks -> ivx as matter of urgency

worsening dysphasia

aspirations - esp iff of thin fluids eg water

reduced tongue movements

lump in the neck

SOB - if tumour obstructing airway

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9
Q

how does thyroglossal cyst present?

A

midline lump in neck.

moves up and down with protrusion of tongue

what - embryological remnant of descent of thyroid gland

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10
Q

how is thyroglossal cyst mx?

A
  1. Confirm with USS
  2. Sistrunks procedure:
    - remove the whole tract and middle third of hyoid bone (otherwise can return)
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11
Q

how does a branchial cyst present?

A

smooth, firm, fluctuant swelling
painless - unnoticed
3rd decade
1/3 way down anterior border sternocleidomastoid

complications:
infection - eg after URTI
fistula - asymptomatic until infection

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12
Q

how to ivx and mx branchial cyst?

A

USS - contains cholesterol crystals

Rx - complete excision including tract

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13
Q

waht histology are parotid tumours?

A

Benign - pleimorphic adenomas - lots of different cell types - most common

Warthins tumour - monomorphic adenoma - second most common

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14
Q

main worries with parotid tumours?

A

Facial nerve CN7 runs through parotid

can cause facial paralysis

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15
Q

Ivx and mx of Parotid tumours?

A

Ivx: USS + FNA Cytology
Mx: watch and wait, surgery

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16
Q

list potential causes of enlarged submandiibular gland?

A

Stones - especially if dehydrated (can remove stones)

Benign pleomorphic adenoma

Malignant cancer - rare

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17
Q

how do we mx perichondritis?

A

PO Co-amoxiclav

IV “ - if more severe

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18
Q

how do we treat pinna haematoma? complications

A
  1. Treat head injury (consider NAI)
  2. Examine and check other ear
  3. Incise and drain

if untreated -> cartilage Ischaemia + death -> fibrosis/scarring of pinna (cauliflower ear) as seen in rugby players/boxers

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19
Q

how do we mx foreign bodies in the ear?

A

Most are NOT an emergency

watch battery in ear is! as can cause chemical burn

drown bugs in olive oil

retreat objects with forceps under microscopic guidance

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20
Q

what are the causes of facial palsy? ivx?

A

Neurological: Stroke (forehead sparing as UMN lesion)

Idiopathic: Bells Palsy - diagnosis of exclusion

Infectious: Herpes zoster oticus aka Ramsay-Hunt syndrome (vesicles around ear), cholesteatoma

Malignancy: Parotid tumours

To ivx: full hx+exam, look in and around the ears, feel for parotid lumps, check forehead

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21
Q

Mx of facial palsy? complications?

A

Complications: corneal abrasion as cant close eyelid

  1. Steroids
  2. Eye drops
    2b. Eye patch
  3. Valciclovir - if HZV

Refer to ENT clinic

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22
Q

what is the pathophysiology of epistaxis?

A

90% anterior epistaxis so bleed from littles area/ keisselbachs plexus

causes: digital truama, pregnancy, irritants,

10% posterior - elderly:
anticoagulants, hereditary HT

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23
Q

mx of epistaxis?

A

Anterior epistaxis:

Simple measures:
- lean forward, squeeze soft part of nose where plexus is for 10 mins

Not working:
refer to ENT - silver nitrate cautery

Posterior epistaxis (bleeding is profuse, from both nostrils, and the bleeding site cannot be identified on speculum):
simple measures dont work
- need nasal packing via ribbon guaze or rapid rhino (shouldnt see pack if done correct)
- admission, full set of bloods
24
Q

how do we mx fractured nose?

A

As soon as it happens - grab onto it and pull back into place

otherwise within 3 weeks it will heal into broken position = needs rebreaking

25
Q

complications of fractured nose?

A

Septal haematoma -> cartilage iscahmeia + necrosis -> saddle nose deformity

note fractured nose = head injury -> full HI assessment

26
Q

Tonsilitis, Quinsy

A

see paeds cards

27
Q

what is ludwigs angina?

A

a rapidly advancing infection of floor of mouth which spreads to displace tongue upwards?

pts cant move tongue - ariway risk!!!

28
Q

how to mx ludwigs angina?

A

Airways secured

Fluids, IV abx

CT scan

Admit - may need surgical input

29
Q

SEE paeds notes

A

epiglottitis

otitis media
otitis externa
rhinitis and allergies

30
Q

Difference between stridor and stretor?

A

stretor - snoring (upper airway)

stridor - upper airway obstruction

31
Q

different types of stridor? location of issue?

A

inspiratory - supra glottis-glottis

biphasic - subglottis

expiratory - tracheal

32
Q

how to manage stridor?

A

adrenaline nebs

ENT involvement - flexible endoscopy

if tiring/falling O2 sats - anaesthetics for oxygenation/ intubation

33
Q

define indications for grommet?

A

Otitis media with effusion “glue ear”

recurrent otitis media

34
Q

How does a cholesteatoma present?

A

is a destructive cyst of middle ear

Evidence of ear discharge.

Presence of a deep retraction pocket, with or without granulation tissue and skin debris.

Crust or keratin in the upper part of the tympanic membrane.
The tympanic membrane may be perforated.

Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane,
{waxy appearnace of top part of tympanic membrane}

lesion around tympanic membrane

35
Q

complications of cholesteatoma?

A

Emergency admission should be arranged for people with a suspected cholesteatoma associated with a serious complication, including:

A facial nerve palsy or vertigo.

Other neurological symptoms (including pain) or signs that could be associated with the development of an intracranial abscess or meningitis.

Need semi-urgent referall to ENT if no serious complications

36
Q

how is a cholesteatoma mx?

A

surgicval removal

37
Q

difference between rhinits, rhinosinusitis, and acute sinusitis?

A

rhinitis - asthama of the nose

rhinosinusitis - chronic inflammation can have polyps

acute sinusitis - bacterial infection

38
Q

how does rhinosinusitis present?

A 
1.Nasal block/obstruction
\+-
A.facial pain / pressure
B.hyposmia 
(reduces sense of taste smell, bad breath, poor sleep)

2.examination findings: nasal polyps
(have to do CT to ivx)

Chronic -> >12wks+

39
Q

how does rhinosinusitis NOT present?

A

unilaterally - if this is the case suspect tumour!

40
Q

how to mx rhinosinusitis?

A

Long term nasal steroid

Surgical mx

41
Q

how does acute sinusitis present?

A

facial pain bilaterally - can be quite disabling

purulent nasal discharge

following URTI

42
Q

TAKE AWAY FORM ENT lectures?

A

nasal decongestants are evil

43
Q

what is the difference between meckle’s and sigmoid diverticulitis?

A

meckle’s - has pr bleed & central- RIF pain

sigmoid diverticulitis - no bleeding with the constipation, LIF pain

44
Q

woman with cyclical bilateral breast pain. mass in breast -> diffuse nodularity in axillary breast tail. aspiration finds brown fluid, no malignant cells. ddx?

A

fibrocystic disease

45
Q

Post-op patient with history fo severe COPD and Hypertension.

what is most appropriate analgesia in early postop period?

A

Epidural anaesthesia

you wouldnt give patient controlled IV analgesia becuase could potentially cause respiratory compriomise as these consist of opioid analgesia.

46
Q

woman finds small lump. it is within thyrroid gland. she is euthyroid. asymptomatic. what is most appropriate ivx?

A

USS of neck

because may be eeuthyroid with;
thyroglossal cyst, non-toxic goitres, thyroid adenoma

we want to differentiate the cause

47
Q

increased bowel sounds with obstruction sx presentation. ddx?

A

Hyperactive bowel sounds are often found before a blockage. It is quite common to find one quadrant with hyperactive bowel sounds and one with none or hypoactive ones.

This is because the intestine is attempting to clear the blockage with increased peristalsis. You may also hear high-pitched sounds and rushing noises

48
Q

what is NBM timings before surgery?

A

2h for clear liquid

6h for solids

49
Q

woman post op. immobile, hasnt had chest physio due to pain. overweight. lungs quite at both bases. ddx?

A

all risk factors for Atelectasis!

50
Q

pt has severe hydrroneprosis on USS with septic picture - fever, tacky. has been given IV abx and fluids. what next?

A

Nephrostomy!!!

then can remove stone with lithotripsy later

51
Q

a venous ulcer is slowly healing. abpi in both legs is normal. what do you do next?

A

Give them compression stockings!!

they need this next.

52
Q

what regional nodes do ovarian tumours spread to?

A

initially - paraaortic nodes

secondary - iliac nodes

53
Q

how does boerhaaves syndrome present?

A

is an oesophageal rupture

elderly?
Just eaten a large meal
forceful vomiting

hypotension, tacchy - shock
central chest pain
maybe epigastric pain
subcutaneous emphysema

-> forceful emesis, subxiphoid chest pain, and subcutaneous emphysema - termed the Mackler Triad

54
Q

what is the utility of an Internal auditory meatus MRI scan?

A

An IAM MRI scan is a useful type of MRI for investigating symptoms of earache, dizziness, tinnitus and problems with balance.

55
Q

How do we prevent contrast induced nephropathy / AKI? eg when someone has hx of renal impairment / transplant and needs contrast, what do we do first?

A

IV 0.9% saline

or
Sodium bicarbonate, N-acetylcysteine, for prevention of radiocontrast-induced nephropathy.

56
Q

what is the most rapidly spreading and lethal infection in humans

A

Clostridium Perferinges Gas gangrene

Year 6 (17 decks)

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