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4th Year Exam > Senior Surgery > Flashcards

Senior Surgery Flashcards

1
Q

Name 3 clinical features of appendicitis

A
  1. Periumbilical pain localising to RLQ (worse on movement)
  2. Vomiting
  3. Fever
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2
Q

Name 3 lab tests for suspected appendicitis

A

FBC (looking for mild leukocytosis)

CPR

Urine beta-HCG (women of childbearing age)

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3
Q

Name 3 things that would contribute to complicated appendicitis

A

Gangrene

Intra-abdominal abscess

Purulent intra-abdominal fluid

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4
Q

Where is McBurney’s point?

A

1/3 of distance from ASIS to umbilicus

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5
Q

Why is flank/back pain relevant in suspected appendicitis?

A

Indicative of tip of appendix being located in retrocecal position

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6
Q

What is Rovsing’s sign?

A

Palpation of the LLQ causes pain in the RLQ (examination finding in appendicitis)

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7
Q

List 3 clinical findings in appendicitis

A
  1. Rebound tenderness
  2. Guarding
  3. Positive Rovsing’s sign
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8
Q

What is psoas sign?

A

Pain with passive right hip extension or active right thigh flexion (retrocecal appendix)

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9
Q

Give 3 risk factors of appendicitis

A

Age (15-25 is peak)
Female (until age 30)
Positive Fx

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10
Q

Give an imaging option for non-pregnant adults with suspected appendicitis

A

Abdominal CT

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11
Q

What is gold standard treatment currently for appendicitis

A

Laparoscopic appendectomy

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12
Q

Give 4 features of biliary colic

A
  1. Acute RUQ/epigastric pain
  2. N&V
  3. Dyspepsia
  4. Flatulence
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13
Q

Name 4 investigations which may be used in biliary colic

A

FBC
Amylase
CRP
Plain X-Ray

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14
Q

Define the pathophysiology of cholecystitis

A

Obstruction of cystic duct/Hartmann’s pouch

Pressure within gallbladder increases

Relative ischaemia

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15
Q

Give 4 management options for cholecystitis

A
  1. NBM then low fat diet
  2. IV fluid
  3. Analgesia
  4. Antibiotics
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16
Q

Give 2 complications of cholecystitis

A

Resolution with recurrence

Gangrene

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17
Q

List causes of pancreatitis using I GET SMASHED

A

Idiopathic

Gallstones
Ethanol
Trauma

Steroids 
Mumps 
Autoimmune
Scorpion sting 
Hyperlipidaemia/Hypercalcaemia 
ERCP 
Drugs
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18
Q

Give 3 features of acute pancreatitis

A

Acute epigastric pain radiating to back

N&V

Pyrexia

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19
Q

What is Cullen’s sign?

A

Haemorrhagic discolouration around umbilical area associated with acute pancreatitis

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20
Q

What is Grey Turner’s sign?

A

Haemorrhagic discolouration of left flank associated with acute pancreatitis

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21
Q

Briefly describe the pathophysiology of acute pancreatitis

A

Pancreatic enzymes prematurely activated and auto-digest, triggered by anything which injures acinar cells

=Local oedema, haemorrhage and necrosis

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22
Q

Give 4 lab tests which could be used in suspected acute pancreatitis

A 
WCC (raised)
CPR (raised)
Serum amylase (>3x upper limit)
Serum lipase
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23
Q

Give 3 imaging techniques used to diagnose pancreatitis

A

MRCP
Endoscopic US
Transabdominal USS

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24
Q

Outline the modified Glasgow (PANCREAS) score for pancreatitis

A
  • PaO2 <8kPa
  • Age >55 years
  • Neutrophils WBC>15 x109
  • Calcium <2mmol/l
  • Renal function (urea >16mmol/l)
  • Enzymes (ALT/AST >200)
  • Albumin <32g/l
  • Sugar - Glucose >10mmol/l
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25
Give 4 management steps for pancreatitis
Analgesia Fluid Respiratory support NO ABX
26
Give 2 acute and 2 chronic complications of pancreatitis
Acute - Necrosis + haemorrhage Chronic - Chronic pancreatitis + exocrine failure
27
How is spontaneous bacterial peritonitis diagnosed?
Ascitic fluid with >250 neutrophils/mm3 without intra-abdominal source of infection or malignancy
28
In which patient group is spontaneous bacterial peritonitis commonly seen?
Pt. with frequent life-threatening infection e.g. cirrhotic pt.
29
How is spontaneous bacterial peritonitis treated?
Iv ABX | IV Albumin
30
Define diverticulitis
Inflammation of the diverticula which is acutely symptomatic
31
Give 4 clinical features of diverticulitis
Acute lower abdominal pain (commonly left-sided) Fever N&V Constipation or diarrhoea
32
Give 4 examination findings for diverticulitis
Fever Generalised tenderness Guarding Distended abdomen
33
Briefly outline the pathophysiology of diverticulitis
Mucosa extrudes colon at weakest point Diverticula becomes blocked or directly in contact with food/faeces Pressure = erosion of wall leading to inflammation
34
Give 3 risk factors for diverticulitis
Age >40 Low fibre diet Western societies
35
In diverticulitis, what imaging is preferred for diagnostic conformation?
CT abdomen
36
Give 3 conservative management options for diverticulitis
IV Fluid Analgesia IV Triple therapy
37
Give a surgical management option for diverticulitis
Hartmann's procedure (sigmoid resection and end colostomy)
38
Give 4 causes of an upper GI bleed
Peptic Ulcer Varices Mallory-Weiss Tear Oesophageal cancer
39
Give 4 risks of an upper GI bleed
NSAID H. Pylori Smoking Alcohol
40
Which scoring system helps identify upper GI bleed patients and how safe they are for discharge?
Glasgow Blatchford Score ``` (0= low risk >0 = increasing risk) ```
41
Which score estimates mortality in pt. with active upper GI bleeding who have undergone endoscopy?
Rockall Score
42
Give 4 ways to acutely manage an upper GI bleed
IV Fluid Oxygen Blood administration Sengstaken tube
43
What should be used to prevent sepsis in pt. with ruptured oesophageal varices?
Prophylactic ABX
44
Give 4 lab tests to investigate visceral perforation
FBC Amylase (mildly elevated) Urinalysis Beta HCG
45
Give 2 imaging options in the investigation of visceral perforation
Erect CXR | CT abdo/pelvis
46
What is Rigler's sign?
Free intraabdominal gas adjacent to a gas-filled loop of bowel then both sides of the bowel wall are well-defined
47
Give 3 Tx options in visceral perforation
NG tube to free drainage Cross-match for blood IV PPI in upper GI perf.
48
What is a true aneurysm?
Involves every layer of the vessel wall
49
Give 4 risk factors for a AAA
Age Male Fx (male 1st degree relative) Smoking
50
How does a ruptured AAA usually present?
Acute severe back/lower abdominal pain
51
What is the Tx of a ruptured AAA?
Resuscitation | Open surgery or EVAR
52
Define acute limb ischaemia
Sudden decrease in limb arterial perfusion with potential threat to limb survival with onset <2 weeks
53
Name 6 things to assess for when examining an acutely ischaemic limb
``` Pallor Mottling Temperature CRT Active movement Passive movement ```
54
What are the 6Ps of an acutely ischaemic limb
``` Pain Pallor Paraesthesia Paralysis Pulselessness Poikilothermia (limb takes temperature of surrounding area so may not always be cold) ```
55
Give 3 causes of acute limb ischaemia
Thrombo-embolic (e.g. AF) Aneurysm Trauma
56
What type of imaging is nearly always needed to see the extent of limb ischaemia?
CT angiography or arterial duplex USS
57
Give one drug management option in treating acute limb ischaemia
IV Heparin
58
Outline classes of cellulitis and their management
I: no systemic toxicity, out-patient oral antibiotics II: +/- systemic illness, IV hospital Abx for 48 hours III: significant systemic disease, IV hospital Abx IV: sepsis syndrome/NF, IV + surgery
59
How are intra-abdominal abcesses managed?
ABX Drainage Laparoscopic washout
60
Give 4 steps in the management of peritonitis
Resuscitate IV ABX CXR +/- CTAP Theatre
61
Name 5 risk factors for gallstones
``` Female Fair Fertile Fat Forty ```
62
Outline three major steps in the pathogenesis of gallstones
1. Cholesterol Supersaturation 2. Biliary stasis 3. Increased bilirubin secretion
63
Name 3 complications of gallstones
Biliary colic Obstructive jaundice Gallstone ileus
64
Give 4 signs and symptoms of obstructive jaundice
Pale stool Dark urine Yellow sclera Pruritus
65
What is the commonly used diagnostic imaging and treatment for symptomatic gallstones?
Abdominal USS Laparoscopic cholecystectomy
66
Define GORD
Motility disorder caused by reflux of gastric contents into the oesophagus
67
Give three possible findings in a GORD history
Heartburn, especially after meals Bitter taste in mouth Epigastric and chest pain
68
Give 2 causes of GORD
Incompetent LOS | Hiatus Hernia
69
Give 2 risks of GORD
Obesity | NSAIDs
70
How is GORD diagnosed?
- usually from clinical history - endoscopy - ambulatory reflux monitoring
71
Give 3 treatment options for GORD
Lifestyle advice Antacids PPI
72
Define hiatus hernia
Displacement of abdominal organs (commonly stomach) through oesophageal hiatus of diaphragm into the mediastinum
73
Give 3 conservative treatment options for a hiatus hernia
Antacid H2 receptor antagonist PPI
74
Name a commonly performed surgical technique on hiatus hernia
Laparoscopic fundoplication
75
Give 3 symptoms of gastritis
Indigestion N&V Epigastric pain
76
Give 2 diagnostic lab tests for gastritis
QFIT stool test for blood | H. pylori breath test
77
Give 3 causes of gastritis
H. pylori Alcohol Smoking
78
Give 4 symptoms of peptic ulcer disease
Epigastric pain Constipation Nausea Weight loss
79
Give 2 main causes of peptic ulcer disease
H pylori infection (duodenal) | NSAIDs (gastric)
80
What is the imaging of choice for peptic ulcer disease?
Upper endoscopy
81
What is the standard treatment for H pylori associated peptic ulcer disease?
Omeprazole Clarithromycin Amoxicillin
82
How does chronic pancreatitis occur?
From longstanding inflammation of parenchyma to fibrous tissue. Fibrosis = connective tissue loss = exocrine insufficiency
83
Give 4 symptoms of chronic pancreatitis
Upper abdominal pain N&V Steatorrhoea Weight loss
84
Give 3 causes of chronic pancreatitis
Alcohol Idiopathic Autoimmune
85
Give 3 risk factors for pancreatic cancer
Smoking Diabetes High BMI
86
Give 4 signs and symptoms of pancreatic cancer
Painless obstructive jaundice Weight loss Pale stool/dark urine Palpable gallbladder
87
Give 4 blood tests used in pancreatic cancer Dx
FBC (normochromic anaemia) LFT CRP Tumour marker Ca19-9
88
What is Whipple's procedure?
Pancreaticduodenectomy +/- pylorus stunting for head of pancreas cancer
89
What is the surgical management option for cancer in the body/tail of pancreas?
Distal or total pancreatectomy
90
What are the most common types of oesophageal cancer?
Squamous cell | Adenocarcinoma
91
Give 4 risk factors for oesophageal cancer
Smoking Alcohol Hot beverages Barrett's oesophagus
92
Give 3 symptoms of oesophageal cancer
Weight loss Progressive dysphagia Anaemia
93
What is gold standard Dx procedure for oesophageal cancer?
Oesophago-gastro-duodenoscopy (OGD)
94
What is the treatment of early and advanced oesophageal cancer?
Early: Endoscopic mucosal resection Advanced: Chemo/surgery/palliative
95
Give 3 signs of gastric cancer on examination
Palpable abdominal mass Palpable Virchow's node Palpable Sister Mary Jane node (periumbilical)
96
How does H pylori infection increase the risk of gastric cancer?
H Pylori makes urease which produces ammonia Ammonia neutralises acid allowing alkaline microenvironment Leads to cell damage and neoplasia
97
Give 4 investigations for gastric cancer
FBC (microcytic anaemia) Ca125 tumour marker Upper GI endoscopy CT thorax
98
What are the surgical options for proximal and distal gastric cancers?
Proximal: Total gastrectomy Distal: Subtotal gastrectomy
99
Give 3 causes of bowel obstruction
Extra-luminal: Adhesion Intra-luminal: Foreign body Bowel wall: IBD
100
Give 3 symptoms of bowel obstruction
Colicky abdominal pain Constipation Vomiting ?faeculent
101
In an abdominal X-ray, what size should each part of bowel be?
Small bowel >3cm Large bowel >6cm Caecum >9cm 3,6,9 rule
102
What is the non-surgical management of bowel obstruction
DRIP AND SUCK (fluid and NG tube) Catheter Electrolyte replacement
103
Give 4 risk factors for colorectal cancer
IBD Genetic Smoking Fx
104
Give 3 symptoms of colorectal cancer
Obstructive symptoms Tenesmus Weight loss
105
Give 4 investigations for colorectal cancer
FBC (microcytic anaemia) CEA tumour marker Faecal occult blood Colonoscopy/sigmoidoscopy
106
What are the surgical management options for colorectal cancer (name 4)
Hemicolectomy (left or right) Sigmoid colectomy Anterior resection APR
107
Define diverticular disease
Occuring in the colon when high intra-luminal pressure causes lumen to herniate through weak spots in bowel wall
108
Give 4 symptoms of diverticular disease
Abdominal pain (cramps) Diarrhoea and constipation PR bleeding Bloating
109
Give 2 complications of diverticular disease
Fistula | Obstruction
110
Give 3 management options for diverticular disease
High fibre diet Antispasmodics Laxatives
111
Define haemorrhoids
Excessive amounts of normal end anal cushions
112
Where around the anus do haemorrhoids usually occur?
3, 7 and 11 o'clock
113
Give 3 investigations of haemorrhoids
PR Flexible Sigmoidoscopy Proctoscopy
114
Give 4 treatment options for haemorrhoids
Laxatives Topical cream Banding Sclerotherapy
115
Define the 4 classes of haemorrhoids
1: Not visible externally 2. Comes and goes from view 3. Stays but can be pushed back in 4. Cannot be pushed back in
116
Give 4 pathophysiological changes in Crohn's disease
Skip lesions Patchy inflammation (Cobblestone) Inflammatory cell infiltrate Granuloma
117
Give 4 pathophysiological changes in Ulcerative Colitis
Goblet cell loss Crypt abscesses Erosions Inflammatory cell infiltrate
118
Give 4 drugs used in Ulcerative colitis management
Aminosalicylates (remission) Corticosteriods (In relapse) Thiopurines Anti-TNF (E.g. infliximab)
119
Give 4 drugs used in Crohn's management
Glucocorticoids 5ASA Azathioprine Methotrexate
120
Give 3 complications of UC
Colorectal cancer Perforation Toxic Megacolon
121
Give 3 complications of Crohn's
Colorectal cancer Fistuale Renal disease
122
What are the SIRS criteria
Temp <36 or >38 HR>90 RR>20 WCC <4 OR >12
123
Define a polyp
Any growth from the lining of large bowel
124
What is an a) Pedunculated polyp b) Sessile polyp
a) On a stalk | b) Flat
125
Define hernia
Abnormal protrusion of a viscous through the wall of its containing cavity
126
What is an indirect hernia compared to a direct hernia?
Indirect: caused when inguinal ring fails to close Direct: usually when abdominal muscles become weak (doesn't disappear when pt. coughs)
127
Give 3 features of an ileostomy
Usually green effluent Filled with porridge consistency Spouted
128
Give 3 features of a colostomy
Usually faeces/brown effluent Flushed One lumen
129
Give 3 causes of chronic limb ischaemia
Atherosclerosis Vasculitis Fibromuscular dysplasia
130
Give 3 risks of Peripheral vascular disease
Smoking High BP Diabetes
131
What is Buerger's test?
Reactive hyperaemia when leg is elevated until white then dropped over the side of the bed (indicated PAD)
132
Give one imaging test used in chronic limb ischaemia
Ankle brachial pressure index (US doppler)
133
Give 2 medical and 2 surgical management options for chronic limb ischaemia
Antiplatelets, ACEI Bypass, amputation
134
Briefly describe the pathophysiology of carotid artery disease
Cholesterol deposit in endothelium to form plaque Plaque extends to lumen to reduce blood flow Thromboembolic debris = neurological injury
135
How does carotid artery disease present?
As a TIA or stroke
136
Name 2 imaging techniques for carotid artery disease
Doppler ultrasound | CT or MR angiography
137
Give 2 surgical management options for carotid artery disease
Carotid endarterectomy | Carotid angiogram + stent
138
Give 3 possible presentations of an aortic aneurysm?
Incidental Bruit on auscultation Pulsatile abdo. mass
139
How are aortic aneurysms repaired surgically?
EVAR (guide wire through femoral and stenting)
140
Define varicose veins
Dilated subcutaneous veins >/=3mm in diameter measured in upright position usually in lower legs
141
Define venous ulcer
Broken epithelium caused by venous hypertension
142
In breast clinic, which patients receive US and which receive mammography?
US: Under 40s Mammogram: Over 40s
143
Name 4 breast changes which can occur
Nipple discharge Inverted nipple Peu D'orange Tethering
144
What is a key question to ask in terms of a breast history?
Previous oestrogen exposure (e.g. OCP, breastfeeding, age when menstruation started)
145
What are the 1-5 grades for breast lumps?
1. Normal 2. Benign 3. Undetermined 4. Suspicious 5. Cancer
146
What is the difference between DCIS and invasive cancer?
DCIS does not breach BM
147
Give 4 treatment options for breast cancer
Wide local excision + radio Mastectomy Endocrine therapy Chemotherapy
148
What is Tamoxifen?
Oestrogen receptor blocker for breast cancer
149
What drug can be used in older breast cancer pt. instead of Tamoxifen?
Aromatase inhibitor
150
Give 4 causes of haematuria
Malignancy Stones Infection Trauma
151
Give 3 investigations of haematuria
Urinalysis CT KUB Cytoscopy
152
What is a red flag in terms of blood in the urine?
Painless visible haematuria
153
Give 3 risks of bladder cancer
Male Smoking Occupation (e.g. rubber, dye)
154
What investigation is used in suspected bladder cancer
US if under 40, non-smoker | CT if over 40, smoker
155
What surgical treatment is used in bladder cancer?
Transurethral resection of bladder tumour (TURB) and chemotherapy via catheter
156
Give 3 risks of renal cancer
Smoking Obesity PKD
157
What is Virchow's triad? | Indicates advanced renal cancer
Haematuria Flank pain Palpable abdo. tumour
158
Give 3 signs and symptoms of acute urinary retention
400-1000ml urine in bladder <24hr onset Painful urgency
159
Give 3 signs and symptoms of chronic urinary retention
Residual vol. <1L Painless >24hr onset
160
Give 3 investigations of urinary retention
Urinalysis PR exam PSA test (falsely raised in retention)
161
Give 2 drugs used to treat chronic urinary retention
Tamsulosin (alpha blocker to relax smooth muscle) Finasteride 5 alpha-reduactse inhibitor (decrease vol. in BPH)
162
Give 4 investigations for testicular cancer
AFP tumour marker HCG tumour marker LDH enzyme in blood US/CT
163
What is the surgical management of testicular cancer?
Radical inguinal orchidectomy
164
Give 3 features of epididymitis/orchiditis
Fever Swelling Reactive hydrocele
165
Give 3 investigations for epididymitis/orchiditis
Urinalysis + culture STI screen USS
166
Give 4 risks factors for UTI
Female Increasing age Diabetes Stones
167
Give 4 investigations for UTI
Urinalysis Urine culture Blood culture CT KUB
168
Give 3 treatment options for UTI
ABX Fluid Catheter
169
What is defined as a recurrent UTI
>2 infections in 6 months or 3 in 12 months
170
What type of cancer is most common in the prostate and where does it most commonly occur?
Adenocarcinoma in peripheral zone
171
Give 4 signs and symptoms of prostate cancer
Haematuria Urinary retention Painful micturition UTi
172
List the stages of the Gleason grading system for prostate cancer
``` 6 = well differentiated 7 = moderately differentiated >7 = poorly differentiated ```
173
Give 4 possible management options for prostate cancer
Watchful waiting Active surveillance Radiotherapy Radical Prostatectomy
174
Give 4 features in a history which may indicate renal stones
Flank pain Haematuria N&V Dysuria
175
List 4 things which may be found on examination in suspected Renal stones
Palpable kidneys Pt. constantly moving Pyrexial Tachycardia
176
What is the gold standard investigation for renal stones?
CT KUB
177
Give 2 definitive management options for renal stones
Extra-corporeal shock wave lithotripsy Percutaneous nephrolithotomy (needle through back to operate through)
178
Give 4 investigation options for suspected testicular torsion
Examination (cremasteric reflex test) Urinalysis Scrotal USS Urethral STI swab
179
How will testicular torsion present?
Testicle high in scrotum and lying horizontally | Swollen and painful
180
How and why should you investigate suspected testicular torsion if there is no time for an USS?
In theatre because there is a 6 hour window between a viable and dead testicle
181
Give 2 organic and 2 psychogenic causes of ED
CVD and Diabetes Stress and performance anxiety
182
Give a drug management option for ED
PDE-5 inhibitor e.g. Sildenafil (smooth muscle relaxation and increased penile blood flow)
183
Give 4 symptoms of BPH
Incomplete emptying Frequent urination Urgency Nocturia
184
How is BPH diagnosed?
History and Examination (including PR)
185
Give 3 pharmacological management options for BPH
Anticholinergic e.g. atropine Alpha-1 adrenergic blocker e.g. Tamsulosin Phosphodiesterase-5 inhibitor
186
What is the gold standard surgical option for symptomatic BPH
Transurethral resection of prostate
187
Give 4 symptoms of thyroid cancer
Painless neck mass Hoarseness Dysphagia Cough
188
Give 3 methods used in diagnosing thyroid cancer
Serum TSH level Ultrasound FNA biopsy
189
What is MEN type 1?
Autosomal dominant predisposition to tumours in pancreas, parathyroid and anterior pituitary gland
190
How is MEN1 clinically recognised?
- 2 or more primary tumours types | - Hypoglycaemia (due to excess insulin production)
191
What 3 tumour types occur in MEN2?
Medullary Thyroid cancer Parathyroid tumour Pheochromocytoma
192
Define pheochromocytoma and give 3 symptoms
Rare catecholamine producing tumour of chromaffin cells of adrenal medulla - High BP - Headache - Palpitations

4th Year Exam (20 decks)

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