Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th year OSCE > Surg > Flashcards

Surg Flashcards

1
Q

Start a vascular exam by asking…

A

any pain or tenderness in abdomen or legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Importance of atrial fibrillation for lower limb vascular exam?

A

emboli causing PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Inspection for vascular exam…

A

Scars (graft in thigh), chronic venous insufficiency (legs), ulcers (feet, heels, ankles, toes),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where does femoral artery become politeal?

A

opening of adductor magnus, the adductor hiatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

palpate the femoral artery at…

A

midpoint of inguinal ligament between ASIS, pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

bruit in abdomen means stenosis of what…

A

abdo aorta, renal or mesenteric arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

where is popliteal anatomically?

A

in between heads of gastrocnemius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

borders of hesselbachs triangle and what hernias go through here

A

medial: lat wall of rectus abdominus
inferior: inguinal ligament
laterally: inferior epigastric vessels
direct hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where do indirect hernias pass through

A

deep inguinal ring… lateral to epigastric vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

deep inguinal ring/tunica vaginalis is originally derived from…

A

peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

4 Causes of peritonitis…

A

Blood, bowel contents, pus, inflammed or perforated organ/viscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Features of peritonitis

A

constant pain, worse with cough, movement, breathing
fever, tachy, tachypnoeic, abdo rigidness, absent bowel sounds
lying still!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ix for peritonitis

A

FBC, UEC, LFT (clotting, group and hold), blood culture, urinalysis, CRP, Pregnancy test, Erect CXR, abdo XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Low abdo pain Ddx by anatomy

A

appendicitis, ovary/uterus, bowel (caecum, ascending on left, decending, rectum on right), small bowel, ureters, hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is meckels diverticulum?

A

congenital diverticulum near ileocaecal valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What complications can meckels and therefore all diverticular have?

A

Infection, Rupture (haemorrhage, faecal peritonitis), obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List some gynae causes of abdo pain

A

PID, ovarian cyst/torsion, ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Similair appendicitis Ddx

A

Perforated ulcer, ruptured AAA, Crohns, mesenteric adenitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diverticular disease is only symptomatic in what percentage…

A

10-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Perforation of diverticuli can cause 2 things…

A

faecal peritonitis or walled off as abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Another complication of diverticular disease is

A

stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ddx epigastric pain by anatomy

A

AAA, biliary, pancreatitis, PUD, epigastric hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Air under diaphragm on CXR=

A

perforated viscus (but not seen in 30% of perforated ulcers- do CT to rule out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

4 cardinal features of intestinal obstruction

A

colicky pain, vomiting, absolute constipation, distension (CCVD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

3 main causes of small bowel obstruction

A

ADHESIONS!, hernia, caecal cancer

others= crohns, worms, gallstone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

abdo X-ray signs of small vs large bowel obstruction

A 
SBO= central loops with valvulae conniventes runnign across whole lumen of bowel
LBO= loops in periphery, haustra don't cross whole lumen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

progression of colicky pain to continuous + fever and tachycardia in SBO=
treatment=

A

ischaemia =/- perforation—> peritonitis

urgent laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

3 main Causes LBO

A

Cancer, Diverticular stricture, volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Sigmoid volvulus on abdo XR looks like

A

sausage, no air in rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Suspect pseudo-obstruction when…

Next step to Dx

A

still air in rectum even though loops of bowel are dilated

Gastrograffin NOT barium enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Apple core is characteristic of what Dx…

A

Obstructing colonic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What to suspect if patient has AF and has severe abdo pain without distension

A

Ischaemic bowel due to emboli from AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Sx of mild ischaemic bowel

A

diarrhoea, mild abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Rx for mild vs serious (sudden onset, pyrexia, unwell)

A

Mild: IVI, analgesia, antibiotics, close obs

Severe- rescuscitate, IVI, O2, Abx, laparotomy and resection of non-viable bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What should always be examined in male with lower abdo pain?

A

Testes!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does testicular torsion present

A

lower abdo pain +/- vomiting (not necessarily testicular pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What Dx to not miss in older patients with loin to groin pain who have never had before?

A

Leaking AAA- retroperitoneal haematoma can irritate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Pseudomembraneous colitis caused by which bug…

A

C.diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Do UTIs cause abdo pain generally?

A

NO!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Top 3 causes of LBO

A

Malignancy 60%, Diverticuli 20%, Volvulus 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What type of patients do pseudoobstruction occur in?

A

Severly ill, elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Early and late symptoms for LBO

A

Early: change in bowel habit, distension, los of appetite
Late: absolute constipation, vomiting, colicky pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Physical signs of LBO

A

Febrile, tachy, ill, hypotensive, distended, tender abdo, absent or obstructed bowel sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Ix for LBO

A

FBC, UEC, LFT, clotting, group and hold

Abdo XR, erect CXR to exclude free gas, gastrograffin,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Important investigation for malignancy in LBO

A

CT, endoscopy to take biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Mx for LBO

A 
Resuscitate: IVI, urinary catheter
Analgesia
Decompress: NG tube
Establish diagnosis
Definitive surgery, temp stoma, stent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Describe hartmanns procedure

A

Recto-sigmoid resection with closure of rectal stump and formation of end colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When use a colonic stent?

A

Temporising or palliative procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Mx of volvulus

A

stiff rectal tube passed with sigmoidoscope through twist–>imediate relief. surgery if ischaemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Mx pseudoobstruction

A

NBM, IVI, NG tube
Correct biochem abnormality, treat infection
Consider colonic stimulants eg erythro, metoclopramide
If conservative fails go surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

peroneal artery is a branch of which artery?

A

posterior tibial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

5 patterns of arterial disease

A

stenosis, thrombosis, emoblus, aneurysm, dissection (STEAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Stenosis of aorta-illiac segment usually cause loss of which pulse

A

femoral, but foot pulses may still be detected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Most common artery to cause claudication

A

SFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

SFA obstruction makes which pulses reduced

A

politeal, foot (femoral above it intact)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

More “distal” arterial disease usually occurs for what patients?

A

diabetes, very elderly (80+)

most diseases are proximal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Prevalence of PAD

A

For men: 10% at 65, 25% at 75… half this for women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Main risk factors for PAD

A

Smoking, Diabetes, hypertension, lipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Ddx of leg pain on walking

A

OA, Caludication, Spinal stenosis, peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What symptom indicates severe ischaemia?

A

rest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

IX for lower limb PVD

A

FBC, UEC, BSL, lipids.

ABI, duplex, angio if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

ABI normal values

A

.95-1.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

ABI rest pain value, critical ischaemia value

A

.3-.6

<.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What condition is ABI unreliable for and why?

A

Diabetes, arteries uncompressible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

When to treat PAD?

A

Depends on symptom severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Mx of PAD for symptom control

A

Smoking cessation, exercise, statin (although meds generally ineffective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Mx PAD to prevent systemic complication

A

Smoking, weight loss, BP control, lipid control

Aspirin, ACE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Surgical options for PAD

A

Angioplasty, bypass, endarterectomy, amputation

69
Q

Macrovascular complications of diabetes

A

IHD, Stroke, PVD

70
Q

Microvascular complications of diabetes

A

Retinopathy, nephropathy, neuropathy

71
Q

High ABIs can be misleading in which condition?

A

diabetes

72
Q

Diabetic foot ulcers are usually…

A

at pressure points, painless, punched out, still have palpable foot pulses

73
Q

Approach to diabetic foot ulcer

A

Abx–>Debride–>amputate

74
Q

Ix for carotid artery stenosis

A

CT head, duplex, CT angio

75
Q

Mx for carotid stenosis

A

asymptomatic= none
0-70% stenosis= aspirin
>70%= carotid endarterectomy

76
Q

Complications of carotid stenosis

A

TIA, stroke

77
Q

Amaurosis fugax..

A

mono-ocular visual loss due to retinal artery emboli/blockage/vasospasm

78
Q

Normal abdo aorta diameter

A

2cm

79
Q

Clinically signigicant AAA is how big

A

5.5cm

80
Q

AAA can be diagnosed by

A

ultrasound

81
Q

Mx of AAA (monitoring)

A

1-2 years if small, 6-12 months if >4cm

82
Q

Venous disease comprises 4 main diseases…

A

DVT, post thrombotic, varicose, ulceration

83
Q

Skin changes characteristic venous disease

A

haemosidderin, hair loss, shiny skinExamin

84
Q

Assess varicose veins by which Ix

A

duplex

85
Q

Mx varicose (only if symptomatic)

A

compression stockings, surgery

86
Q

Describe ulcer by looking at 3 things…

A

surrounding skin, ulcer edge (elevated, punched out, gradual), ulcer base (granulation, sloughy, necrotic)

87
Q

3 questions to approach pre-op workup for each system…

Example in each system

A

Is there a problem in this system that could affect recovery?
How should I investigate it?
How can I minimize potential impact of this problem?
Resp- Sx cough–>investigate
Cardio- meds
Renal- dehydration/renal failure, fluid balance
Gastro- NGT, fasting
Coag- warfarin reversal

88
Q

All unresolved infections need to be investigated before surg. t/f

A

true. Abx for pneumonia/UTI, Echo for cardio Sx

89
Q

General pre-op workup

A

Fast for 6 hours prior to GA
Consider- pre-hydration, ECG, CXR, Bloods (Group and Hold, cross match, Coags, FBC, UEC, LFT), other imaging as appropriate
Consent
Book theatre
Anaesthetics consult
Prophylactic Abx, TEDS, subcut heparin, calf compressors
Mark side of operation, follow theatre protocol, time in/out etc, clean operating enviro, scrub in

90
Q

Boundaries of anterior triangle of neck

A

midline, sternoclediomastoid, mandible

91
Q

Boundaries of posterior triangle of neck

A

sternocleidomastoid, trapezius, clavicle

92
Q

Post op fever at day 0-2 likely

A

SIRS

93
Q

Mx for post op fever day 0-2

A

observe, paracetamol, NO cultures!

unless >40–>emergency, malignant hyperexia (call anaesthetist)

94
Q

Fever at day 1-3, consider…

A

Aspiration, AMI, PE

95
Q

Investigating fever day 1-3 post op

A

ECG, CXR, bloods, ABG, CTPA/VQ

96
Q

Fever at day 4-7, consider

A

infections- wound, line, urine, internal (send everything for culture)

97
Q

Fever at day 7+ when patient had bowel anastamosis, likely…

A

anastomotic leak–>spiking sawtooth fevers

98
Q

How to treat anastamotic leak?

A

IVI, NBM, CT, Abx

99
Q

Post op pain management. call the…

A

acute pain team

100
Q

Principle of pain management without pain team

A

regular paracetamol + NSAID (if no contraindication), with stronger opiate for breakthrough

101
Q

Post op N+V usually caused by…

A

opiates

102
Q

List of post op complications

A

bleeding, fever, pain, N+V, low urine output, constipation/ileus, wound issues, stoma issues

103
Q

Ideal minimum urine output?

A

.5mL/kg/hr, often just 30mL/hr

104
Q

Causes low urine output (3 cats)

A

Pre-renal- dehydration, haemorrhage, pump fail (eg AMI, CCF), vasodilation (sepsis)
Renal- ATN (drugs, ischaemia)
Post-renal- retention due to drugs, pain, prostatism

105
Q

Most common cause low urine output? But must also exclude…

A

dehydration, HAEMORRHAGE!

106
Q

How many mL of blood loss needed for BP change?

A

1500mL (30% blood volume)

107
Q

Causes of post-op ileus

A

sympathetic drive from pain, response to surgery. opaites, electrolyte disturbance

108
Q

Manage post-op ileus

A

Exclude mechanical obstruction and support patient (IVI, analgesia, NBM, NGT, IDC, fluid balance- electrolyte balance)
try enema 2-3 days
if prolongs 7-10 days, confirm ileus with CT and initiate TPN

109
Q

Wound dehiscince management

A

Swab MC&S, remove clips/sutures, debride, irrigate, re-pack. start Abx

110
Q

Mx for constipation

A

fleet enema, suppositeries

if no bowel anastamosis give coloxyl, lactulose

111
Q

Mx for post op diarrhoea

A

mostly self limiting, but assess hydration (UE, Mg), send stool MC&S with request C.diff

112
Q

Venous ulcers pathophysiology

A

valve incompetence, thrombosis of vein thrombophlebitis–>venous hypertension–>ischaemia

113
Q

Venous ulcers description

A

superficial, irregular, painless

114
Q

Associated skin with venous insufficiency

A

bluish/purple, hemosiderrin (from long standing stasis)

115
Q

Arterial ulcer pathophysiology

A

From inadequate blood supply, common on pressure points

116
Q

Arterial ulcers are a contraindication to…

A

compression therapy

117
Q

Arterial ulcer description

A

More distal, pain at rest, regular shape. Punched out, very painful

118
Q

Surrounding skin for arterial ulcer

A

blanched, shiny tight skin due to under perfusion, loss of hair

119
Q

Arterial vs venous beurgers test?

A

Arterial= +ve

120
Q

Mx venous ulcers

A

regular exercise, compression stocking

121
Q

What is more common venous or arterial ulcer?

A

Venous by far (70%)

122
Q

Skin temp for venous vs arterial ulcer?

A

venous is warm, arterial is cold

123
Q

Complications of varicose veins

A

pain, dermatitis, ulcers, bleeding, clots

124
Q

Mx varicose veins

A

exercise, compression, elevation

stripping, endovenous ablation

125
Q

How does Charcot foot occur?

A

Peripheral neuropathy–>loss of pain and sensation–>repeated joint injury

126
Q

What to suspect for assymetric leg swelling

A

DVT, compartment syndrome

127
Q

Causes of DVT

A

compression, trauma, cancer, infection, stroke, HF, nephrotic syndrome

128
Q

RFs for DVT

A

surgery, immobilization, smoking, ovesity, flying, OCP!!!!

129
Q

Ix for DVT

A

D-dimer, doppler US

130
Q

Sx DVT

A

assymetrical swelling, pain, redness

131
Q

testing varicose veins

A

put fingers on saphenofemoral opening and tap varicose vein or ask for a cough

132
Q

Cause of midline neck swelling

A

Thyroid, thyroglossal cyst, submental LNs, dermoid cyst, chondroma

133
Q

Thyroglossal cyst vs thyroid goitre?

A

Thyroglossal moves on poking tongue out, goitre moves on swallowing

134
Q

Causes of anterior triangle swelling

A

LNs, branchial cyst, carotid aneurysm, laryngocoele, pharyngeal pouch

135
Q

Structures in anterior triangle

A

Internal carotid, lingual, facial arteries, superior thyroid, occipital arteries
Laryngeal nerve, hypoglossal nerve, lingual nerve, hypoglossal nerve

136
Q

Causes of submandibular triangle swelling

A

submandibular gland, sialedenitis, LNs, neoplasma, salivary stones

137
Q

Posterior triangle structures

A

accesory nerve, phrenic nerve, cervical plexus, brachial plexus
subclavian artery, suprascapular artery, transverse cervical artery
scalene muscles, inferior belly of omohyoid

138
Q

Causes of lumps in posterior traingle

A

Lymphoma, LNs, metastasis, cervical rib, subclavian artery aneurysm, cystic hydromas, lymphangioma, pharyngeal pouch

139
Q

Lateral neck swellings causes by anatomy

A

LNs
Salivary gland (stone, tumour)- submandib, parotid
Skin: sebaceous cyst, lipoma, cancer
Lymphatics: cystic hygroma
Carotid aneurysm: pulsatile, rarely a tumour
Pharynx: pharyngeal pouch

140
Q

Ix for swelling

A

FNA

141
Q

Causes of conductive hearing loss

A

Blockage, drum perforation, ossicle infection/osteoscleorsis, inadequate eustachian tube ventilation due to effusion from nasopharyngeal carcinoma

142
Q

Causes of sensironeural hearing loss

A 
Defect in cochlea, cochlear nerve or more central pathway
Drugs: gentamycin, chloroquine
Post infective: measles, mumps, flu
Menieres Disease
Presbyacusis (old age)
143
Q

Cancers for hearing loss

A

nasopharyngeal carcinoma, acoustic neuroma, chloesteatoma

144
Q

Positive rinne test is normal/abnormal hearing?

A

normal

145
Q

Webers test conductive loss=

sensory loss=

A

louder in affected ear

louder in unaffected ear

146
Q

What is osteosclerosis?

A

Heritable disease where ossicles overgrow causing conductive loss, tinnitus, vertigo

147
Q

Ear bones

A

maleus, incus, stapes

hammer, anvil, stirrup

148
Q

picture of ear right side is ant/posterior

A

anterior

149
Q

Whisper is how many decibels?

A

20dB

150
Q

loud music is howmany decibels?

A

80-120dB

151
Q

Audiogram points

A

air conduction better than bone

all points above 20dB

152
Q

When no gap between air and bone conduction what does this mean?

A

sensory hearing loss

153
Q

Which hernia is more common

A

indirect (80%)

154
Q

Can clinically differentiate hernias?

A

NO

155
Q

Pre-hepatic jaundice cause?

A

Haemolytic anaemia, malaria

156
Q

Hepatic cause jaundice

A

Gilberts, hepatitis, cirrhosis, paracetamol

157
Q

Post hepatic cause jaundice

A

Gallstones, biliary cirrhosis, cholangiocarcinoma, pancreatitis

158
Q

Mcburneys point in

A

1/3 ASIS to umbilicus

159
Q

Rosvings sign is

A

press in LLQ and pain goes to Mcburney

160
Q

Gastro causes clubbing

A

Inflammatory bowel ((UC, crohns), Cirrhosis, Coeliac disease

161
Q

Leuconychia sign of?

A

Chronic liver disease

162
Q

Palmar erythema and spider naevi caused by what?

A

Elevated estrogen- can be pregnancy, RA, thyrotoxicosis, liver disease

163
Q

Dupytrens DDx

A

alcohol, diabetes, liver disease

164
Q

Wilson’s disease sign

A

kayser fleischer rings (green ring in cornea periphery)

165
Q

Glossitis and angular stomatitis causes

A

iron deficiency, vitamin B12 deficiency

166
Q

Abdo distension (5 Fs)

A

Fat, fluid, fetus, flatus (obstruction), tumour

167
Q

Hepatomegaly causes

A

Alcoholic fatty liver, lymphoma, leukaemia, Hepatocellular carcionma, metastases, RHF, haemochromatosis, amyloid

168
Q

Hepatosplenomegaly causes

A

chronic liver with protal hypertension, lymphoma, leukaemia, CMV, EBV, amyloid, SLE

4th year OSCE (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions