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Surg Flashcards

1
Q

head injury, lucid interval

A

Extradural (epidural) haematoma

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2
Q

elderly, alcoholic, head injury, insidiuous onset symptom

A

Subdural haematoma

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3
Q

epigastric pain worse w eating

A

gastric ulcer

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4
Q

epigastric pain relieved w eating

A

duodenal ulcer

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5
Q

High risk of strangulation hernia

A

femoral

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6
Q

Periumbilical brusing

A

Cullens sign - pancreatitis

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7
Q

Flank brusing

A

Grey Turners sign - pancreatitis

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8
Q

Most common prostate CA

A

adenocarcinoma

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9
Q

Prostate CA Ix-dx

A 
Pelvic pain, urinary sx
PSA measure (>4)
DRE
Trans rectal USS + biopsy
MRI/CT and bone scan for staging
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10
Q

Prostate CA usually in ? zone

A

peripheral

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11
Q

Gleason score

A

awarded 1 score (1-5) for most dominant, and 1 for second most dominant (1-5), add them together. 10 worst prog.

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12
Q

Prostate CA tx in elderly, multiple co morb, low Gleason

A

watch and wait

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13
Q

Prostate CA Radiotherapy SE

A

proctitis, rectal malignancy

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14
Q

Prostate CA Surgical SE

A

ED

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15
Q

IX for ureteric stone

A

US then non-contrast CT to confirm

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16
Q

Meds for renal colic

A

NSAIDs
If admitted: IM diclofenac
Alpha blocker to help pass it

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17
Q

Renal colic Ix

A 
Urine dip and culture
serum CR and E (renal func)
FBC/CRP (infection)
Calcium/urate: underlying causes
Clotting factors and blood cultures if ?sepsis
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18
Q

Renal stone <5mm

A

pass within 4 weeks

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19
Q

Renal stones tx

A

Shockwave lithotripsy (SE solid organ injury, ureteric obstruction)

Uteroscopy (for pregnancy or where shockwaves not good, or complex case…stent left in situ for 4 weeks)

Percutaneous Nephrolithotomy (lithotripsy but inside)

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20
Q

renal stone <2cm in aggregate tx

A

lithotripsy

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21
Q

renal stone <2cm in preggo

A

Uteroscopy

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22
Q

Complex renal calculi and staghorn calculi

A

percutaneous nephrolithotomy

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23
Q

Ureteric calculi <5mm

A

manage expectantly

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24
Q

Oxalate stone tx

A

Cholestyramine (lower urinary oxalate secretion)

Pyridoxine (same)

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25
Uric acid stones tx
``` Allopurinol Oral bicarb (alkalinization) ```
26
Calcium stones tx
increase fluids low animal protein, low salt thiazides
27
Breast lesion, 18-25 year olds, mobile.
Fibroadenoma | Core biopsy if >4cm
28
Slit like retraction of nipple, cheese like discharge
Duct ectasia | Age related alteration of breast
29
Halo sign on mammogram
Breast cyst - compresses underlying fat | Aspirate if symptomatic
30
Achalasia
failure of LES to open when swallowing food
31
Statin for CVD
Atorvastatin 80mg
32
See both sides of bowel wall
Riggler's sign - pneumoperitoneum
33
Parkland fluid replacement over 24 h formula (only for crystalloids - hartmans/ringers)
SA% x weight x 4ml | give 50% over 8h, 50% over 16h
34
Burn resusc goal:
urine output of .5-1ml/kg/hr in adults
35
First 24 hours post burn fluid:
crystalloid
36
After 24 hr burn fluid:
colloid .5ml x SA x weight
37
Maintenance crystalloid burn fluid eq:
1.5ml x SA x weight
38
Colloids
Albumin | FFP
39
Crystalloids
NaCl .9% Ringers lactate Hartmans Glucose preparations
40
Aortic transection
Lucid then die Deceleration injury Widened mediastinum on XR
41
Duodeno-jejunal flexure disruption
Deceleration injury | Intra abdominal fluid but hemodynamically stable-ish
42
Hemopericardium
Tamponade | muffled heart sounds, paradoxical pulse, jugular vein distension
43
Normal diameter of abdominal aorta
1. 5cm F | 1. 7cm M
44
How long before surgery can you drink "clear fluids"
2h
45
Elective surgery prep:
``` Bloods: FBC, UE, LFT, Clotting, Group & save Urine Preg test Sickle cell test ECG/CXR DVT assessment ```
46
DM and surgery
high risk infx in poor control Omit drugs and check levels Insulin IV infusion, K supplement
47
Firboadenoma
Mobile Firm No malignancy risk
48
Fibroadenoma Tx
>3cm - surgical excision | Phyllodes tumour - wide excision
49
Breast cyst
Smooth, discrete lump Can be fluctuant Small increase in CA risk
50
Breast Cyst tx
Aspirate | If blood stained or keep refilling - biopsy or excision
51
Sclerosing Adenosis
Breast lump/pain Mammographic changes mimic carcinoma Cause distortion of lobular unit without hyperplasia No CA risk
52
Sclerosing Adenosis tx
biopsy lesion | dont need to be excised
53
Epithelial hyperplasia breast
Lumpiness or discrete lump | High risk of CA
54
Epithelial hyperplasia breast tx
If no atypical ft - conservative | If atypical - surgical resection
55
Breast fat necrosis
Traumatic aetiology Mimics carcinoma Can increase in size at first
56
Breast fat necrosis tx
imaging + core biopsy
57
Duct papilloma
present w nipple discharge can have mass if large Discharge usually from single duct No risk CA
58
Duct papilloma tx
Microdochectomy
59
CT head immediately
``` GCS <13 initialy GCS <15 at 2hr post Suspected open/depressed skull # Any sign of basal skull# Seizure after trauma Focal neuro deficit More than 1 vom ```
60
Basal skull # ft
hemotympanum panda eyes CSF leak from nose or ears Battle's sign (brusing @ mastoid)
61
CT head within 8h
>65 hx bleeding or clotting disorder dangerous mechanism (cyclist hit by car, ejection from car, fall from height >1m) >30 in retrograde amnesia of events right before injury On warfarin
62
Rectal prolapse
Elderly females | Constipaition, pain, incont, discharge of mucus, bleeding
63
TPN issues
altered LFTs and hepatic function
64
Acute cholecystitis sx
Systemically unwell Pain RUQ Murphy's sign LFTs usually normal
65
Acute cholangitis
jaundice | pain
66
Acute cholecystitis causes
90% from gallstones hospitalised or severely ill infection of gall CMV
67
Acute cholecystitis tx
IV abx | Early laparoscopic cholecystectomy within 1w
68
Anasthetic CI in penetrating eye injury/acute angle glaucoma
Suxamethonium - increases ocular pressure
69
ASA 1
healthy, non smoker, minimal alcohol
70
ASA 2
mild disease without functional limitations (smoker, social alcohol drinker, preg, obese, controlled DM/HTN, mmild lung dx)
71
ASA 3
Severe systemic disease (poor DM/HTN, COPD, >40BMI, hepatitis, alcohol abuse, pacemaker, reduced EF, renal disease, MI, CVA)
72
ASA 4
Severe systemic disease that is constant threat to life (recent MI, CVA, cardiac ischemia reduced EF, sepsis, DIC, ARD)
73
ASA 5
Not expected to survive w/o operation (ruptured AAA, massiva trauma, intra cranial bleed w mass effect, ischemic bowel)
74
ASA 6
Brain dead for organ harvesting
75
Criteria for brain stem death testing
Deep coma of known aetiology Reversible causes excluded No sedation Normal electrolytes
76
Brain death testing
Fixed pupils not responding to light No corneal reflex Absent oculo-vestibular reflex (no eye mvmt after 50ml ice cold water to each ear) No response to supra-orbital pressue No cougb reflex to bronchial stim or gag reflex to pharyngeal stim No resp effort when disconnected from ventilator
77
Lidocaine time
1h
78
Max dose lidocaine
3mg/kg (200mg max) 20ml of 1% 10ml of 2%
79
Lidocaine + adrenaline
lasts longer, reduced blood flow - DO NOT USE near extremities --> ischemia
80
Diverticular disease
Sigmoid | Change in bowel, rectal bleeding, abdo pain
81
Organic ED
gradual onset, lack of erection, normal libido
82
Psychogenic ED
sudden onset, decreased libido, good quality spontaneous/self stim erection, major life events, issues in relationship, psych problems, history of premature ejac
83
ED causing drugs
SSRI BB Alcohol Smoking
84
ED Ix
10y CVD risk | Free testosterone between 9-11am --> if low, repeat w FSH, LH and prolactin
85
ED tx
PDE-5 inhibitors (sildenafil/viagra) | Vacuum erection device
86
Extradural/epidural hematoma CT
so extra - bulges into brain
87
Extradural/epidural hematoma ft
raised ICP, can have lucid interval Between dura and skull Accel-Decel or blow to side of head Usually temporal, rupture of middle meningeal artery
88
Subdural hematoma CT
Subtle, stays along edge, crescent moon
89
Subdural hematoma ft
``` outermost meningeal layer frontal/parietal lobes Old age, alcoholism, anticoagulation Slow onset of sx Fluctuating consciousness/ confusion ```
90
Subarachnoid hem ft
``` sudden occipital headache Severe headache N/V Meningism (photophob, neck stiff) Coma Seizure Sudden death Spontaneous in context of ruptured cerebral aneurysm ```
91
Intracerebral hematoma
Collection of blood in substance of brain HTN, vascular lesion (aneurysm, AV malformation), cerebral amyloid, trauma, brain tumour, infarct) Present like stroke or decreased consciousness
92
Intracerebral hematoma CT
hyperdense (bright) within substance of brain
93
Muscle relaxant for rapid sequence induction for intubation
Suxamethonium
94
Propofol
sedating agent
95
Etomidate
sedating agent
96
Suxamethonium MOA
short acting depolarising muscle relaxant Binds nicotinic ACh receptors - persistent depolrization Fast onset
97
Tubcurarine, atracurium, vecuronium, pancuronium
Muscle relaxant competitive antagonist of nicotinic ACH receptors, non-depolarizing slow onset, long duration
98
If surgical patient not fasted, use
ETT - secures airway and protects from asipration
99
Do NOT give in hx of hyperpyrexia for surg
``` Inhaled GA (halothane, thiopental) Depolarising muscle relx (suxamethonium) ```
100
Appendicitis ft
tachy, low fever, RIF pain | Rovsing's sign (pain in RIF when palpate LIF)
101
Acute pancreatitis ft
``` alcohol or gallstones epigastric pain vomiting tenderr, ileus, low fever Cullens and Grey turner ```
102
Nephroblastoma (Willms)
``` <4y mass + hematuria Pyrexis Early mets to lung Nephrectomy Younger has better prog ```
103
Rectal fissure tx
stool softener GTN or Diltiazem Botulinum toxin if no response Internal sphincterotomy
104
Solitary rectal ulcer
chronic constipation + straining | Biopsy needed
105
Fissure in ano ft
Bright red blood Painful bleeding after poop, small amt Midline posterior
106
Hemorroids ft
``` Bright red blood Post poop blood on paper and in toilet Possibly altered BM habit Hx straining No local pain ```
107
Crohns ft
Bright red or mixed blood Bleeding w/ other sx (altered BM, malaise, Hx of fissures, abscesses) Can see fissure or fistula, indurated muscosa, strictures, skip lesions
108
UC ft
Bright red blood mixed w stool Diarrhea, weight loss, nocturnal incont, passage of mucous Proctitis, continuous mucosal lesion
109
Rectal CA ft
Bright red blood, mixed Altered BM, tenesmus, sx of mets Lesion mucosal Polyps
110
Rectal bleed Ix
DRE Proctosigmoidoscopy Colonoscopy if alterned BM
111
Rectal CA Ix
MRI of rectum for margins and nodal disease | CT CAP
112
Hemorrhoids tx
lifestyle Internal: Injection slcerotherapy or rubber band ligation External: hemorroidectomy - HALO or stapled
113
IBD tx
medical mgmt | Surgert for fistulating Crohns
114
Rectal CA tx
anterior resection or abdomino perineal excision of colon and rectum Total mesorectal excision
115
HER2 +ve chemo
Trastuzumab (herceptin)
116
ER +ve BCA chemo
``` Tamoxifen (pre/peri meno) aromatase inhibitors (post meno) - anastrozole ```
117
BCA + no axillary LN
Preop axillary US - if +ve then have sentinel node biopsy to assess
118
BCA + axillary LN
axillary node clearance - can lead to lymphedema and functional arm impairment
119
BCA Multifocal tumour surgery
Mastectomy
120
BCA Central tumour surgery
Mastectomy
121
BCA large lesion in small breast
Mastectomy
122
BCA DCIS >4cm
Mastectomy
123
BCA solitary lesion
wide local excision
124
BCA peripheral tumour
wide local excision
125
BCA small lesion in large breast
wide local excision
126
DCIS <4cm
wide local excision
127
When to give radiotherapy in BCA
after wide local excision OR mastectomy of T3/T4 OR 4+ +ve LN
128
Tamoxifem SE
endometrial CA VTE Menopausal sx
129
Pfannenstiel
C-section
130
Kocher scar
cholecystectomy
131
Rooftop + midline
Pancreatectomy
132
Lanz
appendix
133
Gable
rooftop incision
134
McEvedy's scar
groin - femoral hernia
135
Rutherford Morrison scar
Renal transplant
136
Contraindication to circumcision
Hypospadias
137
Indications for circumcision
phimosis Balanitis xerotica obliterans paraphimosis recurrent balanitis
138
Hasselbach's triangle
Med: rectus abdominis Lat: inferior epigastric vessels Inf: inguinal lig
139
Hernia within hasselbach's
direct
140
Hernia outside hasselbach's
indirect
141
Peyronie's disease
noncancerous | fibrous scar tissue develops on penis causing curved painful erections
142
Bilious vomiting on 1st day of life
intestinal atresia
143
Duodenal atresia
Presents within hours AXR w double bubble duodenoduodenostomy
144
Malrotation w volvulus
Due to incomplete rotation during embryogenesis Presents 3-7 days Peritonitis, hemodynamic instability Ladd's procedure
145
Jejunal/ileal atresia
From vascular insufficiency in utero Within 24h AXR show air-fluid level Laparotomy w resection and anastomosis
146
Meconium ileus
Usually CF Within 24-48h w abdo distension, bilious vom AXR shows air-fluid levels. Sweat test for CF Surgical decompression, resection if serosal damage
147
Necrotising enterocolitis
Common in premature, shows in 2nd week AXR dilated bowel loops, pneumatosis, portal venous air Supportive tx, laparotomy if perf or deterioration
148
Thrombosed hemorrhoid <72h
analgesia and ref for excision, after 72 hr just ice, stool soft, analgesia
149
Duct ectasia tx
Reassurance Young and bothersome: microdochectomy Older and bothersome: duct excision
150
Emergency bowel perf surgery
Hartmann's | Resection and formation of end colostomy/ileostomy, then it can be reversed later
151
Rectal CA chemo
5FU and oxaliplatin
152
Rectal CA involving sphincter complex or very low tumours:
Adomino-perineal excision of rectum
153
Rectal CA T1/T2 N0 tx
no radiation, straight to surg
154
CA in cecal, ascending or proximal transverse colon
Right hemicolectomy | Ileo-colic anastomosis
155
CA in distal transverse or descending colon
Left hemicolectomy | Colon-colon anastomosis
156
CA in sigmoid
high anterior resection | colo-rectal anastomosis
157
CA in upper rectum
``` Anterior resection (total mesorectal excision including LN and mesorectal fat) colo-rectal anastomosis ```
158
CA in low rectum
``` anterior resection (low TME) colo-rectal anastomosis +/- defunctioning stoma ```
159
CA at anal verge
abdomino-perineal excision of rectum | No anastomosis
160
Snowstorm sign and LN in axilla
ruptured implant
161
Intraductal papilloma
Clear or blood stained discharge from single duct | No risk of malignancy
162
Goserelin
Prostate Ca | GnRH agonist providing neg feedback to anterior pituitary
163
Localised prostate CA (T1/T2) tx
Conservative: watch & wait radical prostatectomy Radiotherapy (external beam and brachy)
164
Localised advabces prostate ca (T3T4)
hormonal therapy radical prostatectomy (ED is comp) Radiotherapy (ext/brachy - risk if bladder, colon and rectal CA)
165
Metastatic prostate ca hormone therapy
GnRH agonist (Goserelin) - cover w anti-androgen initially Anti-androgen - cyproterone acetate - prevents DHT binding Orchidectomy
166
Gastrostomy
Gastric decompression/ fixation Feeding Loc: epigastrium
167
Loop jejunostomy
Rare - V high output Following emergency laparotomy Any location
168
Percutaneous jejunostomy
For feeding, site in proximal bowel | LUQ
169
Loop ileostomy
``` Defunction colon (rectal Ca) RIF ```
170
End ileostomy
After complete excision of colon or where ileocolic anastomosis not planned Defunction colon RIF
171
End colostomy
When colon diverted or resected and anastomosis not primarily achievable LIF or RIF
172
Loop colostomy
defunction distal segment of colon | Anywhere
173
Cecostomy
Last resort, if colostomy not possible | RIF
174
Mucous fistula
Decompress distal segment of bowel following colonic division or resection Where closure of distal resection is not possible Any region
175
Hematuria + polycythemia
renal adenocarcinoma
176
Causes of hematuria
Trauma (renal tract, blunt/penetrating injury, RTA bladder trauma,pelvic fracture) Infx (TB) Malig (RCC, transitional cell urothelial, SCC/adenocarcinoma of bladder, prostate, penile SCC) Glomerulonephritis Stones Structure (BPH, vascular malformation, renal vein thrombosis, systic renal lesions PCK) Coagulopathy Drugs (tubular necrosis-aminoglyc,chemo, intersitial nephritis-penicillin, NSAID, sulphonamide, anticoags) Gyne (endometriosis Iatrogenic (catheter, radiotherapy)
177
AAA repair indications
>5.5cm Symptomatic Rapidly growing
178
Subdural hematoma vessels
bridging veins
179
Berry aneurysm location
circle of willis
180
extradural hematoma location
middle meningeal artery
181
cushing reflex
hypertension and bradycardia
182
Indications for splenectomy
uncontrollable splenic bleeding hilar vascular injuries devascularised spleen
183
Cerebral salt wasting syndrome
Common after subarachnoid hemorrhade | Lose sodium and water - kidneys still functioning so urine output high, fluid depletion
184
SIADH
kidneys hold onto too much H2O, end up diluting serum sodium and having concentrated urine (high)
185
SAH spontaneous causes
``` Intracranial aneurysm (85%. Assoc w adult polycystic kidneys, ehlers danlos, coarctaiton of aorta) AV malformation pituitary apoplexy arterial dissection Mycotic aneurysms Perumesenphalic ```
186
SAH dx
CT head - acute blood in basal cisterns, sulci, ventricular system. Can be negative LP - 12 hr after sx, xanthrochromia (rbc breakdown product) Normal/raised opening pressure Refer to neurosurg as soon as confirmed
187
SAH tx
if aneurysm - coil or clipping | Prevent vasospasm w nimodipine (CCB), induced HTN, hypervolemia, hemodilution
188
SAH complications
``` Re-bleed - usually in first 12h, repeat CT if suspected Vasospasm - 1-2w Hyponatremia - SIADH Seizures Hydrocephalus Death ```
189
portal HTN and lower GI bleding
rectal varices
190
Portal HTN ft
``` ascites splenomegaly caput medusae usually caused by cirrhosis high ALT and ALP Low albumin due to liver dmg Rectal varices ```
191
Small internal hemorrhoid tx
low conc. phenol in oil injection
192
88% aqueous phenol uses
ablation of nail bed in toe nail surgery
193
Local anesthetic toxicity tx
IV 20% lipid emulsion
194
Benzo toxicity tx
Flumazenil
195
Heparin reversal
IV protamine sulfate
196
Lidocaine MOA
affects NA channels in axon
197
Bupivacaine MOA
binds inracellular part of Na channel and blocks Na into cell --> prevents depolarization **cardiotoxic, not used in regional block
198
Pale stool + dark urine
Cholangitis
199
Jaundice, fever, RUQ pain
Cholangitis, Charco't triad
200
RUQ pain, Murphy's sign, fever
Cholecystitis
201
Infection of biliary tree
Ascending cholangitis | Usually e-coli
202
Cholecystitis tx
cholecystectomy
203
Cholangitis tx
ERCP
204
AF post colon surgery
Anastamotic leak, day 5-7
205
Ischemic colitis ft
severe abdo pain | passage of bloody stools
206
Testicular lump + gynecomastia
Testicular CA | increase estrogen:androgen ratio
207
testicular germ cell tumors
seminomas | non-seminomas (embryonal, yolk sac, teratoma, choriocarcinoma)
208
testicular non germ cell tumours
leydig cell tumour | sarcoma
209
Seminoma survival
95% if caught early
210
Germ cell tumours marker
AFP (60%), LDH (40%)
211
Seminoma markers
hCG in 20%
212
Prostatitis
Tender boggy prostate Can have referred pain to perineum, penis, rectum, back, abdomen Obstructive voiding fever/rigors
213
Prostatitis tx
14 days cirpofloxacin or ofloxacin (quinolone)
214
Critical limb ischemis
ABPI 0.3 | Gangrene, impalpable pulses
215
Foot w Hyperemia + ulceration
ABPI 0.5 | Severe vascular disease
216
T2DM c leg pain at rest, worse at night
ABPI >1.2 due to vessel calcification
217
Indirect hernia
through inguinal canal
218
Direct hernia
through posterior wall of inguinal canal
219
Coffee bean sign w 3 dense lines converging towards site of obstruction
sigmoid volvulus
220
Sigmoid volvulus assoc with:
``` older chronic constipation Chagas disease Neuro disease (PD, Duchenne) Psych (schizo) ```
221
Cecal volvulus assoc
all ages adhesions preg
222
Sigmoid volvulus tx
rigid sigmoidoscopy w rectal tube insertion
223
Cecal volvulus
right hemicolectomy
224
Colon Ca monitoring marker
CAE
225
anasthetic induction/facilitate intbubation of hemodynamically unstable
ketamine
226
Maintain anesthesia
desflurane
227
Propofol
``` GABA agonist rapid onset anti-emetic properties myocardial depression, hypotension maintains sedation, or for daycase ```
228
Sodium thiopentone
rapid onset - good for rapid sequence induction Myocardial depression, hypotension not for maintenance minimal analgesia
229
Ketamine
``` NMDA antagonist induction strong analgesia good for hemodynamically unstable can cause dissociative anesthesia resulting in nightmares ```
230
Etomidate
Good for cardiac safety no analgesia not for maintenance post op vom
231
Pancratitis fluids
crystalloids
232
Becks triad
raised JVP, muffled heart sounds, hypotension | In cardiac tamponade
233
Cushings triad
low RR, bradycardia, HTN | Seen in raised ICP

My notes - med (14 decks)

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