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OSCE Examinations > Surgary 👩🏻‍⚕️💚 > Flashcards

Surgary 👩🏻‍⚕️💚 Flashcards

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1
Q

What is the description of venous ulcers?

A

Shallow ulcers with a granulated base.

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2
Q

What causes venous ulcers?

A

Venous insufficiency leading to valvular incompetence, impaired venous return, venous hypertension, and trapping of WBCs.

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3
Q

What are the risk factors for venous ulcers?

A
  • Old age
  • Varicose veins
  • Pregnancy
  • Obesity
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4
Q

What is the pathophysiology of venous ulcers?

A

Activation of WBCs releases inflammatory mediators, resulting in tissue injury and poor healing.

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5
Q

What investigations are used for venous ulcers?

A
  • US of the veins
  • Ankle Brachial Pressure Index
  • Swab cultures
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6
Q

What are the management steps for venous ulcers?

A
  • Leg elevation
  • Exercise to promote calf muscle pump action
  • Weight reduction
  • Compression bandaging, changed 2-3 times per week
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7
Q

What is the description of arterial ulcers?

A

Small, deep lesions with well-defined borders and a necrotic base.

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8
Q

What causes arterial ulcers?

A

Reduction in arterial blood flow leading to decreased perfusion.

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9
Q

What are the risk factors for arterial ulcers?

A
  • Smoking
  • Diabetes
  • Hypertension
  • Hyperlipidemia
  • Old age
  • Obesity
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10
Q

What are the clinical features of arterial ulcers?

A
  • Intermittent claudication (pain when walking)
  • Critical limb ischemia (pain at night)
  • Cold limbs with reduced or absent pulses
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11
Q

What investigations are used for arterial ulcers?

A
  • Ankle Brachial Pressure Index
  • US
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12
Q

What are the management options for arterial ulcers?

A
  • Conservative: Lifestyle changes (smoking cessation, weight loss, exercise)
  • Medical: Pharmacological management for cardiovascular disease risk modification
  • Surgical: Angioplasty or bypass grafting
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13
Q

What causes neuropathic ulcers?

A

Peripheral neuropathy leading to loss of protective sensation.

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14
Q

What are the risk factors for neuropathic ulcers?

A

Diabetes.

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15
Q

What are the clinical features of neuropathic ulcers?

A

Burning/tingling, painless ulcers on pressure points.

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16
Q

What investigations are used for neuropathic ulcers?

A
  • HbA1c
  • Microbiology swab
  • Touch/vibration tests
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17
Q

What is the management for neuropathic ulcers?

A

HbA1c optimization, diet/exercise improvement.

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18
Q

What is cellulitis?

A

Bacterial infection of the dermis and subcutaneous fat.

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19
Q

What are the risk factors for cellulitis?

A
  • Obesity
  • Old age
  • Diabetes
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20
Q

What are the signs and symptoms of cellulitis?

A
  • Red, hot, painful area
  • Increases in size
  • Borders not sharp
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21
Q

What causes cellulitis?

A

Bacteria entering through cuts/abrasions (Streptococci, Staph aureus).

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22
Q

How is cellulitis diagnosed?

A

Clinical; differential diagnosis includes DVT.

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23
Q

What is the treatment for cellulitis?

A
  • Antibiotics
  • Analgesia
  • Elevation
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24
Q

What are the causes of postoperative fever categorized as ‘Wind’?

A
  • Pneumonia
  • Atelectasis
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25
What are the causes of postoperative fever categorized as 'Water'?
UTI.
26
What are the causes of postoperative fever categorized as 'Walking'?
DVT/PE.
27
What are the causes of postoperative fever categorized as 'Wound'?
* Surgical site infection * Abscess
28
What are the causes of postoperative fever categorized as 'Wonder drugs'?
* Drug fever * IV line infections
29
What is the management for postoperative fever?
Assess and treat each cause, IV fluids, analgesia, antibiotics.
30
What are the SIRS criteria?
* Temp > 38°C * RR > 20 * HR > 90 BPM * WCC > 12
31
What is septic shock?
Severe sepsis with resistant hypotension.
32
What is involved in the clinical assessment for sepsis?
ABCDEs, vital signs, history, exam.
33
What investigations are used for sepsis?
* Bloods * Cultures * Radiology
34
What is the management for sepsis?
* High-flow O2 * IV fluids * Broad-spectrum antibiotics
35
What are the characteristics of acute ischaemia in PAD?
Urgent management; pain, pallor, pulselessness.
36
What are the risk factors for peripheral arterial disease (PAD)?
* Hyperlipidaemia * Smoking * Diabetes
37
What are the characteristics of chronic ischaemia in PAD?
Claudication during exertion or rest pain.
38
What management options are available for PAD?
* Lifestyle changes * Pharmacological * Surgical options
39
What is the lifetime incidence of appendicitis?
6%.
40
What are the symptoms of appendicitis?
* Central abdominal pain → RLQ pain * Nausea/vomiting
41
What are the signs of appendicitis?
* McBurney’s point tenderness * Low-grade fever
42
What investigations are used for appendicitis?
* WCC * hCG * USS * CT scan
43
What is the treatment for appendicitis?
* IV fluids * Appendectomy * Perioperative antibiotics
44
What are the aetiologies of pancreatitis?
* Idiopathic * Gallstones * Ethanol * Autoimmune * Etc.
45
What is the pathophysiology of pancreatitis?
Activation of proteolytic enzymes leading to inflammation.
46
What are the symptoms of pancreatitis?
* Fever * Epigastric pain * Nausea and vomiting
47
What are the signs of pancreatitis?
* Tender rigid abdomen * Guarding
48
What investigations are used for pancreatitis?
* Increased amylase/lipase * Imaging
49
What is the management for pancreatitis?
Supportive care, address underlying causes.
50
What is an incisional hernia?
Protrusion of abdominal contents through a previous surgical incision.
51
What causes incisional hernias?
Surgical incisions weaken the abdominal wall, leading to herniation under increased intra-abdominal pressure.
52
What are the risk factors for incisional hernias?
* Emergency surgery * BMI > 25 * Midline incisions * Wound infection * Pre-operative chemotherapy * Older age * Smoking
53
What are the clinical features of incisional hernias?
Non-pulsatile, reducible, soft, and non-tender mass at the incision site.
54
How are incisional hernias diagnosed?
Primarily clinical diagnosis; ultrasound or CT may assist.
55
What is the management for incisional hernias?
Surgical repair (laparoscopic with mesh); associated with high recurrence rates.
56
What does peripheral vascular disease (PVD) refer to?
Peripheral arterial disease (PAD) from atherosclerosis; venous equivalent is chronic venous insufficiency (CVI).
57
What are the risk factors for arterial and venous conditions in PVD?
* Arterial: Smoking, diabetes, CVD factors. * Venous: Pregnancy, trauma, surgery, hormones, history of DVT/PE, varicose veins.
58
What are the arterial signs in PVD?
* Pallor * Mottling * Gangrene * Deep/painful ulcers
59
What are the venous signs in PVD?
* Swelling * Eczema * Shallow/painless ulcers
60
What tests are used for PVD?
* Palpate pulses * Buerger’s test for arterial * Cough impulse and Trendelenburg tests for venous
61
What are the differential diagnoses for arterial and venous conditions in PVD?
* Arterial: Neurogenic claudication, osteoarthritis, peripheral neuropathy. * Venous: Heart failure, liver cirrhosis.
62
What investigations are used for arterial conditions in PVD?
* Duplex ultrasound * CT/MR angiography * ABPI
63
What investigations are used for venous conditions in PVD?
* Duplex ultrasound * CT/MR venography for complex cases
64
What is the management for arterial conditions in PVD?
* Risk factor management * Antiplatelet therapy (clopidogrel) * Surgical options
65
What is the management for venous conditions in PVD?
* Weight loss * Exercise * Compression stockings * Education on leg elevation
66
What is a diverticulum?
Sac-like protrusion from a hollow organ.
67
What is diverticulosis?
Multiple diverticula, mainly in the sigmoid colon.
68
What is diverticulitis?
Inflammation of diverticula.
69
What are the risk factors for diverticulitis?
* Low-fibre diet * Obesity * Inactivity * Age-related muscle weakness
70
What is the pathophysiology of diverticulitis?
Increased pressure leads to erosion, inflammation, and possible perforation.
71
What are the clinical features of diverticulitis?
* LLQ pain * Constipation/diarrhoea * Nausea/vomiting * Low-grade fever
72
What investigations are used for diverticulitis?
* AXR: Thickened wall, free air if perforated * CT Scan: Assesses severity
73
What is the treatment for uncomplicated diverticulitis?
Clear fluids and antibiotics.
74
What is the treatment for complicated diverticulitis?
Admit for IV antibiotics and NPO.
75
What is the surgical intervention for recurrent diverticulitis or perforation?
May involve Hartmann’s procedure.
76
What are the referral indications for breast disease?
* Discrete breast mass * Nipple changes or discharge * Persistent asymmetry or breast pain * Strong family history of breast cancer
77
What is the triple assessment for breast disease?
* Clinical Assessment: Medical history and physical exam * Radiology: Ultrasound, mammography (if > 35), MRI (high risk) * Pathology: Fine needle aspiration (FNA) cytology
78
What are the risk factors for breast cancer?
* Female gender * Early menarche * Increasing age * Late first child * Previous breast cancer * Delayed menopause * Smoking * Prolonged OCP/HRT use * Strong family history
79
What are the characteristics of lumps in breast disease?
Common in upper outer quadrant; may be hard or firm.
80
What is the most common type of breast cancer?
Invasive Ductal Carcinoma (80%).
81
What is the treatment for DCIS?
Treated with lumpectomy or mastectomy.
82
What is the screening recommendation for breast cancer?
Mammography for women > 30; screening every 2 years from 45-69.
83
What is the immediate action for palpable breast lumps?
Immediate FNA biopsy.
84
What is the prevalence of malignant breast disease?
Affects 1 in 11 women; mortality rate of 30%.
85
What are the treatment options for malignant breast disease?
* Breast conservation surgery * Mastectomy * Chemotherapy * Radiotherapy
86
What is a fibroadenoma?
Common benign tumour, 60% of breast lumps in young women.

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