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Pathology and final year > SPECIALTY SURGERY > Flashcards

SPECIALTY SURGERY Flashcards

1
Q

30 year old male smoker with painful blue fingertips

A

Buergers disease
aka thromboangiitis obliterans

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2
Q

What features of a AAA means there should be should there be surgical repair

A

above 5.5cm
symptomatic ie pain
rapidly growing

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3
Q

features of an acutely ischaemic limb

A

6 Ps

PAIN
PULSELESS
PARASTHESIA
PARALYSIS
PALE
PERISHINGLY COLD

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4
Q

What emergency treatments are there for acute limb ischaemia?

A

surgical embolectomy
Intra-venous heparin
Intra-arterial thrombolysis

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5
Q

ABSOLUTE contraindications for intra-arterial thrombolysis?

A

Non-viable limb (irreversible ischaemic change – insensate/fixed skin mottling)

Internal bleeding

Suspected aortic dissection

Prolonged or traumatic CPR

Previous allergic reaction

Heavy vaginal bleeding

Pregnancy or < 18 wks postnatal

Acute pancreatitis

Severe liver disease

Active lung disease with cavitation

Oesophageal varices

Recent trauma or surgery (< 2 wks)

Recent head trauma

Cerebral neoplasm

Recent haemorrhagic stroke

Severe hypertension (>200/120 mmHg)

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6
Q

RELATIVE contraindications for intra-arterial thrombolysis?

A

History of severe hypertension

Peptic ulcer

History of CVA

Bleeding diathesis

Anticoagulants

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7
Q

Complications of aortic dissection

A

o Cardiac complications include aortic rupture, aortic regurgitation, myocardial
ischaemia and congestive heart failure.

o Stroke and ischaemic neuropathy → Neurological deficit can occur in up to
40% of patients, and can dominate the clinical picture

o Mesenteric ischaemia

o Renal failure

o Death

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8
Q

Complications of surgery

A

Bleeding
Infection
Damage to surrounding structures
Return to theatre
VTE

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9
Q

difference in the managament of type A and type B aortic dissection

A

type A:
Medical emergency
A-E
surgical repair

type B:
A-E
If stable, best managed medically with BP and pain control
Lifestyle: smoking cessation

long term patients may be considered for thoracic endovascular repair
(TEVAR).

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10
Q

risk factors for AAA

A

o Increasing age
o Male gender 9:1 M:F
o Atherosclerotic disease
o Smoking
o Hypertension

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11
Q

Screening for AAA

A

o Screening in the UK offers an abdominal USS for all men at 65.

o Patients with a AAA >5.5cm should be seen by a vascular service within 2
weeks and considered for surgical intervention.

o Patients with AAA 4.5 – 5.4cm should be followed up by a vascular service
with 3-monthly USS.

o Patients with AAA 3.0 – 4.4cm should be followed up by a vascular service
with yearly USS.

o Patients <3cm can be discharged from the surveillance service.

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12
Q

common cause of acute limb ischaemia

A

o Embolism
o Trauma
o Aortic dissection
o Peripheral artery disease (PAD) progression
o Iatrogenic damage during surgery

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13
Q

common cause of chronic limb ischaemia

A

atherosclerotic disease

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14
Q

clinical features of chronic limb ischaemia

A

o Symptoms are usually bilateral.

o Claudication – patients initially have intermittent claudication, a cramping
pain brought on by exercise and relieved by rest.

o As the disease progresses patients begin to experience pain at rest.

o Finally, the blood supply becomes poor enough to result in gangrene and
tissue loss.

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15
Q

examination findings of chronic limb ischaemia

A

▪ Inspection may reveal marbled skin, hair loss, muscle wasting, arterial
ulcers and tissue loss.

▪ On palpation the limb will be cold, with weak or absent pulses and
delayed capillary refill time.

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16
Q

Classification system used for acute limb ischaemia

A

Rutherford classification:

I- viable
IIa- threatened: salvagable if promptly treated
IIb- threatened: salvagable with immediate revascularisation
III- major tissue loss or permanent nerve damage inevitable

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17
Q

Investigations for acute limb ischaemia

A

Bedside:
Doppler USS of the legs
ABPI
ECG

Bloods:
FBC
VBG- esp lactate
G&S
clotting profile

Imaging:
CT angiography

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18
Q

Management of acute limb ischaemia

A

A-E
15% O2 NRB
IV access and fluids
NBM
unfractionated heparin
analgaesia
surgical revascularisation

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19
Q

complications of revascularisation surgery

A

▪ Reperfusion injury:
* Revascularisation leads to increased blood flow and venous
return to flush out the toxic metabolites from the ischaemic
tissue. This results in a systemic inflammatory response.

▪ Compartment syndrome:
* Revascularisation can also lead to tissue swelling due to
oedema and the inflammatory response of reperfusion injury.
* Patients with long ischaemic time often have prophylactic
fasciotomies to prevent this.

▪ Rhabdomyolysis:
* The release of toxic muscle cell components from damaged
ischaemic muscle into the circulation.
* This can lead to AKI due to myoglobin release, and metabolic
disturbances such as hyperkalaemia and metabolic acidosis.

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20
Q

cholecystitis Mx

A

Medical:
IV fluids
analgaesia
IV antibiotics

surgical:
laparoscopic cholesystectomy within a week

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21
Q

causes of cholecystitis

A

gall stones causing statis of bile in gall bladder causing infection

gives breeding ground for infection so give prophylactic Abx

esp. Klebsiella

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22
Q

what are gall stones made of

A

pigment stones
cholesterol stones

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23
Q

RF for gall stones

A

Asian hispanic ethnicitis
Pregnancy

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24
Q

what is biliary colic

A

movement of bile stones in the gall bladder with contraction

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25
Q

Features of biliary colic

A

RUQ pain radiating to shoulder tip
no signs of inflammation ie fever

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26
Q

features of cholecystitis

A

Constant RUQ
murphys +ve
fever

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27
Q

murphys sign

A

palpate RUQ get pt to take deep breath in- arrest in breathing

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28
Q

what is Caltot’s triangle in laparoscopic cholecystectomy

A

triangle surgeons want to visualise as it contains R hepatic artery

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29
Q

what are the benefits cholecystostomy and when would it be done

A

regional anaesthetic
USS guidance

used in ppl who are bad candidates for GA and cholecystectomy

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30
Q

what is acute/ascending cholangitis

A

blockage of common bile duct by a stone causing stasis and infection

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31
Q

charcots triad

A

jaundice
RUP
fever

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32
Q

reynolds pentad

A

jaundice
RUP
fever
sepsis/ hypotension
Altered mental state

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33
Q

most common causative organisms for acute cholangitis

A

Klebsiella
E.coli
streptococcus
pseudomonas

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34
Q

Management of acute cholangitis

A

medical management

USS abdomen- dilated common bile duct
MRCP- contrast
ERCP

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35
Q

complications of ERCP

A

Pancreatitis
bleeding
damage to surrounding structures
Infection
risk of aspiration
death

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36
Q

What is mirizzi syndrome

A

gallstone at the neck of the gallbladder which impinges and compresses hepatic duct

cholecystitis that presents as cholangitis

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37
Q

Features of acute pancreatitis

A

acute burning abdo pain radiating to back
guarding
low grade fever
reduced bowel sounds

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38
Q

How do gall stones cause pancreatitis

A

blockage of pancreatic duct so retrograde flow of pancreatic enzymes which damages pancreas

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39
Q

how does alcohol cause pancreatitis

A

causes dysfunction of duodenal sphincter so back flow in biliary tract

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40
Q

causes of pancreatitis - classify

A

obstruction
-gallstones
-alcohol

toxic/metabolic
- hypercalcaemia
- hypertriglyceridaemia

Iatrogenic
- steroids
-ERCP

infection
- mumps

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41
Q

What is grey turners sign

A

haemorrgae of retroperitoneal vessels

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42
Q

what is cullens sign

A

blood translocating along umbilical embryological remnant

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43
Q

Scoring systems of pancreatitis

A

Glasgow imrie score
(spells pancreas)

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44
Q

Investigations for pancreatitis

A

bedside:
examine
A-E

bloods:
ABG
FBC- WCC
U&Es
LFTs
albumin
amylase
lipase - most sensitive and specific but more expensive
Bone profile- Ca
lipid profile- triglycerides

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45
Q

why might someone have low PaO2 in pancreatitis

A

ARDS
fluid in lungs not caused by HF

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46
Q

Cause of shock in pancreatitis

A

3rd spacing
inflammation causing leakage of fluids into 3rd spaces leading to distributive shock

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47
Q

Complications of acute pancreatitis

A

Local
abscess
pseudocyst- fibrous scar tissue causing a cyst (not epithelial tissue)
chronic pancreatitis

ARDS
hypocalcaemia
glucose hommeostasis derangement
hypovolaemic shock
DIC

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48
Q

additional medications to give in alcoholic pancreatitis

A

pabrinex
chlorodiazepoxid- prevent delerium tremens

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49
Q

appendicitis mimics

A

mittelschmerz (ovulation pains)
ovarian torsion
testicular torsion
ovarian cyst rupture
ectopic pregnancy
Mesenteric adenitis- lymphadenopathy in abdomen
PID

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50
Q

What is Mcbernies point

A
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51
Q

why do you typically get change in location of pain from general to focussed in appendicitis

A

visceral peritonium is poorly innervated so pain is more general
as inflammation gets worse it irritated the parietal peritonium which has better innervation causing more localised pain

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52
Q

what is Rovsvigs sign

A

palpation of LIF will cause pain in RIF

dragging peritoneum over appendix

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53
Q

what is psoas sign

A

hyperextension of hip

dragging psoas muscle over appendix causing pain

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54
Q

complications of appendicitis

A

perforation
appendiceal mass- omentum policiling affect
appendiceal abscess

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55
Q

signs of chronic venous insufficiency

A

haemosiderin deposition and pigmentation

venous eczema

oedema

venous ulcers and atrophy blanche

lipodermosclerosis

varicose veins

telangectasia

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56
Q

Investigations for vascular disease

A

Bedside:
Hand held doppler of vessels
ankle- brachial pressure index (assess for arterial disease. the lower the index the worse the arterial supply peripherally)

Bloods:
RFs for peripheral vascular disease:
HbA1c
lipid profile
clotting
G&S if requiring surgery

Imaging:
Duplex USS- visualises deep and superficial vessels, shows flow direction and characteristics
CT angiogram
MRI

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57
Q

RFs for AAA

A

Proven:
smoking
age >60
male
genetics

Possible:
HPTN
hyperlipidaemia
>BMI

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58
Q

classical triad of a ruptured AAA

A

pain- abdo/ back
hypotension
pulsatile abdominal mass

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59
Q

Investigations for AAA

A

bedside:
examination
abdo USS (100% sensitive)
BP

bloods
pre surgery: G&S and clotting
FBC, U&Es, lipid

Imaging
CT- important for planning surgery

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60
Q

what arteries do the visceral arteries branch from?

A

coeliac axis
superior mesenteric artery
inferior mesenteric artery

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61
Q

common causes of acute mesenteric ischaemia

A

atherosclerotic disease
cardiac emboli eg. from AF
aortic anerysm
aortic dissection
arteritis
hypercoaguability
malignancy causing venous compression
hypotension/ shock

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62
Q

clinical presentation of acute mesenteric ischaemia

A

abdo pain disproportionate to abdominal findings

vomiting and diarrhoea

abdo distension

rectal bleeding and sepsis as the bowel becomes gangrenous

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63
Q

first line investigation for acute mesenteric ischaemia

A

bloods not useful dont waste time

CT angiography gold standard

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64
Q

clinical features of chronic mesenteric ischaemia

A

mesenteric angina- post prandial pain due to digestion not getting metabolic demands

epigastric, gradual worsening, plateau of pain then slow resolution
-initially after large meals

weight loss and food aversion

diarrhoea, vomiting and bloating

mat have bruits

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65
Q

standard things to think about when managing a vascular patient

A

Conservative:
- diet and exercise
- blood sugar control

Medical:
Mx of CVD RFs
- antihypertensives
- statin
- anticoag

Surgical
- consideration for surgery:
–> surgical bloods (G&S, clotting), fluids, NBM

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66
Q

complications of ischaemia-reperfusion

A

compartment syndrome- acute inflammation of muscle after restoring perfusion

systemic complications of ROS and neutrophil activatios:

  • renal failure (metabolic acidosis, hyperkalaemia, ATN)
  • ARDS
  • arrhythmias, cardiogenic shock
  • hepatic failure
  • gastrointestinal endothelial oedema leading to endotoxic shock
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67
Q

risk factors for VTE

A

Pregnancy and 6weeks post partum
malignancy
Immobility
obestity
hyperlipidaemia
OCP
dehydration
antiphospholipid syndrome
myeloproliferative (CML, PCRV)

Inherited
- factor V leiden
- protein C def
- protein S def
- antithrombin def

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68
Q

scoring system for the likelihood of a DVT

A

wells score

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69
Q

pathophysiology of varicose veins

A

superficial venous reflux or incompetence, usually due to failure of valve mechanism

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70
Q

pathophysiology of skin changes with varicose veins

A

abnormal pressures within the venous system induced by reflux causes subsequent extravasation of blood into tissues

  • deposition of haemosiderin, eczema, atrophie blanche, lipodermatosclerosis, ulceration
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71
Q

what is an aneurysm

A

stretching of all the lumen of the artery and loss of ability to recoil

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71
Q

above what size is deamed an AAA

A

> 3cm

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71
Q

causes of lower limb ulceration

A

vascular:
- arterial disease
- venous disease
- vasculitis

Infection/ inflammation:
- osteomyeltitis
- staph abscess / cellulitis
- syphilis
- Yaws
- cutaneous anthrax
- cutaneous TB
- leprosy
- cutaneous leishmaniasis

Trauma

Metabolic
- diabetes- neuropathy

Iatrogenic
- steroids

Neoplastic
- BCC
- SCC
- melanoma
- lymphoma
- sarcoma eg. kaposi

Congenital
- sickle cell disease
- thalassaemia

Nutritional
- vitamin C def
- zinc def

dermatology
- pyoderma gangrenosum

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72
Q

what condition is associated with aortic aneurysm common in females

A

Takayasus aortitis

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73
Q

3-4.4cm

4.5-5.5

> 5.5

A

refer USS every year

USS every 3 months

seen by vascular in 2 wekks

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74
Q

management of AAA

A

conservative
- lifestyle changes

medical
- anti hypertensives

surgical
- open repair
- endovascular aortic repair (EVAR)

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75
Q

What is intermittent claudication vs critical limb ischaemia

A

stable angina of the lower limbs
and unstable angina- rest pain

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76
Q

important things to ask in Hx of intermittent claudication

A

How far until pain
what specifically stops activity- pain, breathless, joints
location of pain
characteristic of pain
does the pain go away after rest?

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77
Q

blood thinner used in plaque disease

A

anti platelet
eg. clopidogrel
becasue want to stop platelets adhereing to plaque

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78
Q

positive buergers gets

A

pallor then reactive hyperaemia in affected limb

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79
Q

what does calcification do to the ABPI

A

becomes unreliable as cant compress artery when taking BP

80
Q

triad of for Leriche syndrome

A

bilaterally absent femoral pulses
bilateral intermittent claudicaition
erectile dysfunction

81
Q

what is leriche syndrome

A

issue is high up at aorto-iliac junction

both legs affected, both femorals and the pudendal artery which supplies the penis

82
Q

Mx of intermitent claudication

A

conservative:
manage CVD RFs

medical
Clopidogrel
Atorvostatin
Naftidrofuryl oxalate (5HT2 receptor antagonist causing peripheral vasodilator. CI with renal calculi)

Surgery
- endovascular angioplasty and stenting
- endarterectomy
- bypass surgery

83
Q

thrombus vs embolus

A

thrombus a clot adheres to a vessel wall

embolus dislodged and moved elsewhere

84
Q

blood thinner used in AF

A

anti coag
eg. DOAC

due to poor blood flow in heart leading to stasis and increased risk of clotting

85
Q

acute limb ischaemia Ix

A

Bedside:
ECG
ABPI
doppler/ duplex USS

bloods:
ABG, FBC, U&Es, CK, clotting, G&S

imaging
digital subtraction angiography

86
Q

Management of acute limb ischaemia

A

conservative
- IV fluids,
- analgaesia
- O2

med
- antiplatelet eg. clopidogrel
- anticoag eg unfractionated heparin

surgical revascularisation
- endovascular thrombolysis - directly to the clot
- endovascular thrombo-embolectomy- foggety catheter
- open thrombectomy
- bypass surgery

amputation is non viable limb

87
Q

Management of chronic venous insufficiency ulcer

A

compression bandage
elevation
encourage exercise
debridement
clean with saline
dressings

88
Q

CI for compression stockings

A

peripheral arterial disease

89
Q

Marjolin’s ulcer

A

SCC inside of an ulcer

ulcer with horny growth

90
Q

aortic dissection RFs

A

HPTN
smoking
cocaine
connective tissue disease

91
Q

what is an aortic dissection

A

intimal wall tear in aorta causing a false lumen

pseudoaneurysm

92
Q

Ix for aortic dissection

A

bedside
- BP in both arms
- ECG

bloods:
-G&S, clotting
-ABG

Imaging
- CXR: widened mediastinum
- CT

93
Q

Mx of type B aortic dissection

A

HPTN control
IV beta blockers eg. labetelol

94
Q

Mx of type A

A

immediate surger
call cardiothoracics and ITU

TEVAR

95
Q

Breast examination findings:

  • Rubbery firm mobile mass.
  • Well circumscribed and smooth.
  • Usually non-tender.
A

Fibroadenoma

96
Q

Changes with menstrural cycles and pregnancy

A

fibroadenoma
breast cyst

97
Q

NICE recommendations for referring to breast clinic on the 2 week referral wait

A

-Age >30 with an unexplained breast lump or axillary lump

  • Age > 50 with unilateral nipple discharge or retraction
  • Any patient with skin changes suggestive of malignancy
98
Q

clinical presentation of breast cysts

A

o Cysts can be solitary or multiple
o Often fluctuate with menstruation, increasing in size or becoming tender just
prior to menstruation.
o Exam:
§ Smooth and mobile lump
- non tender

99
Q

Management of breast cyst

A

o Asymptomatic breast cysts require no management, and usually self-resolve
o Symptomatic breast cysts can be aspirated, which is usually definitive
treatment.
o After aspiration cysts can recur and may need repeat aspiration.

100
Q

Mastalgia causes

A

True mastalgia:
- most commonly pre menstruation tenderness
§ Symptoms usually worsen 2 weeks prior to menstruation, relieved
with the onset of menstruation.
§ Bilateral
§ Breast tenderness
§ Lumpiness
§ Fullness and heaviness of the breast

Extra-mammary:
- pulled muscle
- costrochondritis

101
Q

What is an intraductal papilloma

A

A benign growth of ductal epithelial cells

102
Q

clinical features of an intraductal papilloma

A

o Bloody or clear nipple discharge
o The patient may or may not have a palpable mass

103
Q

Investigations and management for pt presenting with nipple discharge

A

Referred to one stop breast clinic under 2ww for mammogram and USS

Core biopsy

excision of growth as biopsy cant distinguish well between benign and malignant papillomas

Excision can either be surgical (open diagnostic biopsy) or by vacuum excision
(performed by the radiologists under image guidance)

104
Q

What are scleritic lesions of the breast

A

Characterised by a fibroelastotic core with radiating ducts and lobules in a stellate
arrangement.

types:
sclerosing adenosis, radial scars and
complex sclerosing lesions (CSLs)

105
Q

Clinical features of a phyllodes tumor

A

Both benign and malignant phyllodes tumors will rapidly grow

May feel very similar to a fibroadenoma i.e. well-circumscribed and
smooth

106
Q

Mastitis RFs

A

o Milk stasis:
- Poor infant attachment
-Reduced number or duration of feeds

o Nipple trauma
o Immunosuppression
o Smoking

107
Q

Clinical features of mastitis

A

o Painful breast
o Overlying erythema
o Generally unwell – fever and malaise

o Examination:
-Tender breast
-Hot to touch with erythema
-May be systemically unwell with tachycardia, tachypnoea and fever

108
Q

Management of acute mastitis

A

o Conservative:
- Reassurance that the breast should return to normal shape and
function following treatment
- Patients should be encouraged to continue breast feeding
-If breastfeeding is too painful or the child refuses, women should
express milk via hand/pump instead.

o Medical:
-Regular analgesia –> Paracetamol (generally avoid ibuprofen whilst
breastfeeding)
- oral Abx: fluclox or erythromycin if pen allergy

If signs of sepsis pt should be referred immediately to the ED

If abscess- USS drainage

109
Q

Green/brown/white nipple discharge and sub areolar pain

peri/post menopausal

A

duct ectasia

110
Q

Features of fat necrosis

A

o Hard painless lump
o Skin may have overlying bruising
o Examination:
-Firm lump
-May see overlying skin changes

often follows trauma/ surgery/ radiotherapy

111
Q

Most common type of breast cancer

A

ADENOCARCINOMA
Invasive ductal carcinoma
(70% of malignancies)

Invasive lobular carcinoma (20%)

112
Q

Breast cancer RFs

A

Oestrogen exposure:
- COCP
- HRT
- early menarche
- late menopause
- nulliparity
- obesity

Genetics
- FHx
- BRCA
- previous breast cancer

113
Q

Clinical features of breast cancer

A
  • painless lump usually found in the upper outer quadrant

skin changes:
- peau d’orange (Damage or obstruction of lymphatics leads to oedema of the
breast and an orange peel like appearance)
-skin teathering (Malignant spread to the suspensory ligaments (of Astley
Cooper) from the dermis to posterior breast capsule, causing
tethering of the skin.)

Nipple changes:
- bloody discharge
- nipple inversion
-pagets disease of the breast (rare form of breast cancer originating from specific paget cells in the nipple)

114
Q

Describe the TNM staging of breast cancer

A

o T1 = <2cm, no skin fixation
o T2 = 2-5cm, skin fixation
o T3 = 5-10cm, ulceration and pectoral fixation
o T4 >10cm, chest wall expansion, skin involved

o N1 = Axillary LN’s mobile
o N2 = Axillary LN’s fixed
o N3 = extra-axillary.

o M0 = no metastasis
o M1 = metastasis

115
Q

Investigations for suspected breast cancer

A

referred under the 2ww cancer pathway

one-stop clinic for triple assessment

  1. clinical examination
  2. imaging: <35 USS, >35 USS+ mammography
  3. Biopsy
    solid lump –> core biopsy
    cystic lump –> FNA for cytology

biopsies undergo immunohistochemistry to test for OR, PR and Her2 receptors

116
Q

what is the single most important prognostic factor of breast cancer

A

nodal involvement

117
Q

MOA of tamoxifen and when is it used

A

a selective oestrogen receptor modulator

in pre menopausal women who have ER+ breast cancer

118
Q

MOA of letrozole and anastrozole

A

aromatase inhibitor

used in ER+ve post menopausal women as Aromatisation accounts for the majority of oestrogen production in this group

119
Q

examples of chemotherapy agents used in breast cancer

A

Docetaxel
Doxorubicin

120
Q

MOA of Trastuzumab

A

mAb against HER2 receptor

121
Q

progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3.

A

inflammatory breast cancer

122
Q

types of kidney stones and which is the most common?

A

Calcium oxalate (most common)
calcium phosphate
uric acid stones
struvite stones (produced by bacteria)
cystine stones (AR cystinuria)

123
Q

RFs for kidney stones

A

hyper

124
Q

pathophysiology of struvite stones

A

in people with recurrent upper UTI, the bacteria can metabolise urea into ammonia which then crystalises into struvite

can for a staghorn calculin in the renal pelvis and this can be seen on plain Xray

125
Q

Loin to groin pain differentials

A

renal colic
testicular torsion
ruptured AAA

126
Q

investigations for suspected renal calculi

A

bedside:
- urine dipstick (haematuria), urine MS&C
- pregnancy test
- obs (signs of sepsis)

bloods:
- FBC, CRP (infection)
- U&Es, bone profile (biochemical assessment)
- renal profile (AKI)

Imaging
- CT KUB- imaging of choice
- plain Xray but 1/3 of stones are radiolucent
- ultrasound KUB (less radiation but harder to get a clear picture if larger body habitus)

127
Q

management of acute renal stones

A

conservative:
- analgaesia - NSAIDS (PR / IM diclofenac)
- antiemetics if N&V
- watch and wait- for stones <5mm, let the stones pass
- tamsulosin (a blocker- SM relaxant) can help stone pass
- lifestyle advice: low oxalate diet (spinach, beetroot, black tea), low purine diet (kidney, anchovies, spinach) hydration

medical intervention if:
- signs of infection/ sepsis
- servere pain
- not able to pass
- occupation (eg. pilots)

options:
- extracorporeal shockwave lithotripsy
-flexible ureterorenoscopy
- percutaneous nephrolithotomy
- Abx- IV co-amoxiclav/ cefotaxime/ ciprofloxacin

128
Q

where is the collection of fluid in congenital hydrocele

A

within a panant processus vaginalis

129
Q

secondary causes of hydrocele

A

fluic in tunica vaginalis secondary to trauma, tumor

130
Q

diffuse lumpy swelling in scrotum associated with infertility

A

varicocele

131
Q

managemet of epidydimal cyst

A

supportive- NSAIDs
aspiration

132
Q

swelling in scrotum, non tender, cant palpate above

A

inguinal hernia

133
Q

anatomy of inguinal hernia

A
134
Q

most common causes of epidydimal orchitis in young men

A

chlamydia and gonorrhoes

135
Q

Abx for epidydimo orchitis in young sexually active man

A

IM cef, 14days doxy

136
Q

most common cause of epidydimo orchitis in older men

A

E coli

137
Q

management of scrotal haematoma

A

USS
emergency referral to hospital
cover with Abx
if particularly large- aspirate

138
Q

RFs for testicular cancer

A

undescended testes
hernia in infancy

139
Q

common types of testicular cancers

A

Germ cell tumor- seminoma, teratoma

140
Q

where do testicular cancers fisrt metastasise to

A

parailiac lymphnodes

141
Q

Ix for testicular cancer

A

USS
tumor markers- AFP, bHCG, LDH
CT/ MRI

142
Q

clinical features of torsion

A

sudden onset pain
loin to groin
N+V
pain and swelling of testes

143
Q

surgical management of torsion

A

bilateral orchidopexy
also consent for orchidectomy

144
Q

bedside investigations mneumonic

A

PUBES

Peakflow
uranalysis
BCG
ECG
Swabs

145
Q

common sites for stones to get stuck

A

pelvicuteric junction
crossing iliac vessels at pelvic brim
vesicoureteric junction

146
Q

RFs for stones

A

hypercalcaemia
dehydration
congenital anatomical defects eg. horseshoe kidney
hydronephrosis

147
Q

CI for ESWL

A

severe athereosclerosis or calcifide vessels

148
Q

urgent treatment of stones

A
  • sepsis
  • obstruction
  • congenital renal abnormalitis
  1. nephrostomy tube placement
  2. uteric stent placement
  3. open sugery
149
Q

what is pyonephrosis

A

obstruction and build up of pus in kidney

150
Q

ECG changes in hyperkalamia

A

tall tented T waves
PR prolongation
arrythmia
loss of P waves

151
Q

medication that can help K+ excretion in the kidneys in chronic hyperkalaemia

A

calcium resonium

152
Q

causes of acute urinaary retention

A

prostatic obstruction
urethral strictures
anticholinergics
alcoohol
cauda equina syndrome
clot retention

153
Q

causes of chronic urinary retention

A

pelvic malignancy
diabetes
MS
prostate enlargement

154
Q

Investigations for BPH/ prostate cancer

A

bedside
DRE- smooth in BPH, hard and craggy in cancer
urine analysis
IPSS

bloods
PSA
U&Es
FBC, CRP
renal profile

imaging
transrectal USS
MRI

special
biopsy

155
Q

Mx of BPH

A

conservative
- avoid caffiene/ alcohol
bladder training

medical
- a blockers eg. tamsulosin
5a reductase (eg. finasteride)

surg
transurethral resection of the prostate (TURP)

156
Q

Complications of TURP

A

the glycine used in the surgery can cause hyponatraemia so must do post op U&Es

157
Q

RFs for transitional cell carcinoma

A

smoking
exposure to aromatic amines (pains, rubber, dye)
chronic cystitis
pelvic irradiation

158
Q

most common renal cell carcinoma

A

clear cell carcinoma

159
Q

medical condition associated with renal cell carcinoma

A

von hippel lindau syndrome

160
Q

CXR finding in metastatic renal cell carcinoma

A

cannon ball mets in the lung

161
Q

key family history cancers in breast hx

A

breast
bowel
ovarian

162
Q

breast exam on inspection

A

skin changes - peau d’orange, erythema, puckering
nipple changes
symmetry
discharge
visible masses

163
Q

what is peau d’orange

A

inflammation of cupus suspensory ligamnets causing dimpling

164
Q

nipple changes

A

nipple inversion, discharge, eczema, scaling/ dryness

165
Q

what are you assessing for when assessing a breast mass

A

size
border
temperature
tenderness
fixed/ tethering
consistency

166
Q

3 questions for discharge

A

quantity, quality, colour

167
Q

breast lump ddx

A

physiologically normal breast lump
benign cystic changes
fibroadenoma
abscess (esp smokers)
carcinoma

168
Q

breast screening

A

between 50-70
every 3 years
mammography

169
Q

paternal breast cancer FHx

A

refer to breast clinic even if no lump as paternal very strong

170
Q

fibrocystic changes

A

lumpt breast
pain
changes with menstrual cycle

171
Q

Important before giving steroids esp dexamethasone

A

check glucose
perscribe PPIs

172
Q

difference between DCIS and invasive carcinoma

A

in situ hasnt invaded basement membrane yet

both are malignant cells

173
Q

what is sentinal node biopsy

A

inject blue radioactive dye into lump area
see first node it drains to by sensor to radioactivity
take node and send to histology
will let you know if its hot or cold -ie has the cancer spread to that node?

174
Q

invasive breast cancers

A

ductal carcinoma (best prognosis)
lobular carcinoma
inflammatory breast cancer (poorest prog)

175
Q

prosnostic indicator after breast cancer diagnosis

A

Nottinham prosnostic indicator

176
Q

chemotherapy used in breast cancer

A

taxane based

177
Q

duration of hormonal therapy in breast cancer

A

5 years

178
Q

side effect of anastrazole

A

osteoporosis

179
Q

side effect of tamoxifen

A

VTE
vaginal bleeding
endometrial Ca
amenorrhoea

180
Q

symptoms under anticipatory prescribing

A

pain - paracetamol, NSAIDS, opiods
secretions - hyoscine
agitation - midazolam
N+V - metaclopromide, cyclizine
breathlessness - opiods, fan

181
Q

bowel obstruction management

A

drip and suck

conservative
NG tube and aspirate
IV fluids maintenance
NBM
admit to surgery
let reg know

medical
analgaesia
gastrograffin- form of contrast. lessens oedema in bowel wall and improves obstruction
AXR at this point

surgery

might not go to surgery for a couple of days

182
Q

bowel ileus

A

common post bowel surgery
paralytic
tinkling bowel sounds

183
Q

obstruction like conditions

A

bowel ileus/ parylitic ileus
pseudo obstruction- adynamic bowel. lots of trapped wind due to disruption of nervous system of bowel

184
Q

small bowel obstruction causes of

A

intraluminal
- bezoars
gallstone ileus

intramural
- malignancy(neuroendocrine, melanoma)
IBD complications

extrinsic
- adhesions
hernias

185
Q

large bowel obstruction casues

A

intraluminal
faecal impaction
foreign bodies

intramural
colorectal cancer
diverticularstrictures
IBD comp

extrinsic
adjacent cancers
volvulus
hernias

186
Q

what is closed loop obstruction

A

obstruction in large bowel if there is an airtight iliocaecal valve

ticking time bomb for perforation

get a CT and call on call reg for immediate surgery

187
Q

triad of features in right sided colorectal cancers

A

Fe def anaemia
change in bowel habits
weight loss

188
Q

common presentation of left sided cancer

A

bowel obstruction

189
Q

what are complications of haemerrhoids?

A
  • PR bleeding
  • Thrombosis
  • soiling
190
Q

what are haemerrhoids

A

sweeling of venous plexus in rectum/ anus

191
Q

Mx of haemerhhoids

A

conservative:
- analgaeis
- cooling packs
-increase fibre in diet

medical
- stool softeners

Invasive
- rubber band ligation
- injection sclerotherapy
- haemorroidectomy
- haemorrhoidal artery ligation

192
Q

best investigation for suspected bowel obstruction

A

CT abdo pelvis with contrast

can differentiate between pseudo and true obstruction

best visualisation before surgery

193
Q

cause of frank haematuria

A

Bladder/ renal cancer
prostate cancer
glomerulonephritis
renal colic
severe UTI

194
Q

what is murphys sign?

what is it a sign of?

A

inspiratory arrest on palpation of the RUQ

Acute cholesystitis

195
Q

what is charcots triad and what is it a sign of?

A

RUQ pain, fever and jaundice

ascending cholangitis

196
Q

what is reynolds pentad

A

RUQ pain
fever
jaundice
hypotension
altered GCS

197
Q

what is riglers sign and what is it indicative of?

A

gas both within the lumen and free within the peritoneal cavity.

perforation

198
Q

Managament of BPH

A

conservative:
- watch and wait
- safety netting on urinary retention symptoms (abdo pain, reduced urination)

Medical:
- alpha 1 antagonists (Tamsulosin) to relax SM

surgical
- transurethral resection of the prostate (TURP)

199
Q

side effects of tamsulosin

A

dizziness
postural hypotension
dry mouth
depression

200
Q
A

Pathology and final year (21 decks)

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