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finals > surgery > Flashcards

surgery Flashcards

1
Q

which hernia is superior and medial to pubic tubercle

A

inguinal hernia

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2
Q

which hernia is below and lateral to the pubic tubercle

A

femoral hernia

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3
Q

mx of neurogenic shock

A

vasopressors

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4
Q

what does double wall sign on AXR mean

A

free air in abdomen

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5
Q

thrombosed haemorrhoid vs external haemorrhoid

A

thrombosed - anorectal pain and tender lump

external haemorrhoids do not tend to be painful

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6
Q

cholecystitis vs cholangitis

A 
cholecystitis = RUQ pain and fever
cholangitis = RUQ pain + fever + jaundice
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7
Q

first line mx of haemorrhoids

A

increase dietary fibre and fluid intake

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8
Q

is there jaundice in pancreatitis

A

no

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9
Q

Grey-Turner’s sign vs Cullen’s sign

A

Grey Turner’s - bruising of flanks

Cullen’s - peri-umbilical bruising

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10
Q

what anatomical landmark defines an upper vs a lower GI bleed

A

ligament of Treitz

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11
Q

when should congenital inguinal hernias be operated on

A

refer immediately
<6 weeks - within 2 days
<6 months - within 2 weeks
<6 years - within 2 months

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12
Q

operation for carcinoma of caecum

A

right hemicolectomy

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13
Q

what is the Parkland formula for fluid resus in burns

A

volume of fluid = total body surface area of burn (%) x weight (kg) x 4 ml

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14
Q

best long term enteral feeding route

A

PEG tube

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15
Q

mx of sigmoid volvulus

A

unruptured - rigid sigmoidoscopy with rectal tube insertion

signs of peritonitis - urgent laparotomy

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16
Q

factors indicating severe pancreatitis

A 
age >55
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
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17
Q

features of anal fissure

A

painful, bright red, rectal bleeding

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18
Q

when is anterior resection used

A

upper and mid-rectal tumours

involves removal of the rectum

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19
Q

when is abdomino-perineal resection used

A

removal of cancer at lower one-third of rectum, near anal margin

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20
Q

features that point to wards ureteric calculus over pyelonephritis

A

possibility of dehydration, e.g. D&V before loin to groin pain

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21
Q

hydatid cysts found on USS, next ix

A

CT abdo

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22
Q

mx of diverticulitis flares

A

mild cases - oral ABX at home

if symptoms do not settle within 72h, or severe case, admit to hospital for IV ABX

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23
Q

ix for chronic pancreatitis

A

CT pancreas with IV contrast

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24
Q

how to differentiate between Crohn’s and UC on first presentation

A

Crohn’s - more common at ileocaecal junction and terminal ileum (RIF pain)
UC - starts distally and moves proximally (LIF first), also has bloody diarrhoea

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25
Q

mx of acute pancreatitis

A

fluids and analgesia

26
Q

how to determine between direct and indirect inguinal hernia

A

after reducing, an indirect inguinal hernia can be controlled by putting pressure over the DEEP inguinal ring

27
Q

biliary complications of IBD

A

Crohn’s - stones

UC - PSC

28
Q

features of proctitis

A

nocturnal diarrhoea
incontinence
bright red rectal bleeding
it is a finding in UC

29
Q

mx of acute anal fissure

A

medically first with bulk-forming laxatives and dietary advice
topical lubricants, anaesthetics and analgesia should be tried

30
Q

strongest risk factor for anal cancer

A

HPV infection

31
Q

surgical mx of anal fissues, when is it used

A

sphincterotomy

used when conservative mx has not worked

32
Q

mx of acute cholecystitis

A

analgesia
IV fluids
IV ABX
lap chole within 1 week

33
Q

ix for acute pancreatitis

A
  1. serum amylase and lipase
  2. USS
    lipase will confirm dx of acute pancreatitis, US will confirm cause of pancreatitis
  3. CT abdomen
34
Q

gallstones no jaundice, where is the stone

A

cystic duct

cannot be anywhere that would cause a back up of bile towards the liver

35
Q

which bladder cancer has painless haematuria

A

transitional cell carcinoma of bladder

36
Q

define isograft, autograft, allograft, xenograft

A

isograft - identical twin donation
autograft - self-donation (e.g. long saphenous vein to be used for CABG)
allograft - genetically non-identical donation
xenograft - different species donation

37
Q

definitive ix for SBO

A

abdominal CT

AXR is first line

38
Q

which oesophageal cancer does Barrett’s increase risk of

A

adenocarcinoma

39
Q

hyperechoic liver lesion on USS

A

haemangioma

40
Q

what are calcium levels in osteomalacia vs osteoporosis

A

osteomalacia - low

osteoporosis - normal

41
Q

what type of cancer is RCC

A

adenocarcinoma

42
Q

which inguinal hernia is more common in children

A

indirect inguinal hernia

43
Q

initial mx of suspected ruptured AAA

A

immediate vascular review before any imaging, etc.

44
Q

indications for thoracotomy

A

loss of >1.5 litres blood initially or ongoing losses of >200ml/h for >2h

45
Q

best diagnostic investigation for acute abdominal pain

A

CT abdomen

46
Q

indications for splenectomy

A

haemodynamic instability
uncontrollable splenic bleeding
devascularised spleen

47
Q

sepsis following splenectomy is typically caused by which organism

A

pneumococcus (encapsulated organisms)

48
Q

ix for acute mesenteric ischaemic

A

lactate

49
Q

when can sutures or staples on the chest, stomach or back be removed

A

10-14 days post-op

50
Q

mx ascending cholangitis

A

emergency decompression of CBD w ERCP then elective cholecystectomy

51
Q

which analgesia is best for post-op analgesia in respiratory disease

A

epidural because opioids are contraindicated

52
Q

initial ix for acute limb ischaemia

A

ultrasound doppler

53
Q

complication of giving too much sodium chloride

A

hyperchloraemiac acidosis

54
Q

indications of poor prognosis in pancreatitis

A 
age > 55 years
**hypocalcaemia**
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
55
Q

what may balanitis xerotica obliterates cause

A

phimosis

56
Q

criteria for AAA surgery

A

asymptomatic but >5.5cm in diameter - elective surgery
asymptomatic but enlarging by >1cm/year - elective surgery
symptomatic - urgent surgery

57
Q

mx of symptomatic gallstone disease

A

laparoscopic cholecystectomy

58
Q

what is Boerhaave’s syndrome

A

spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting

59
Q

ix for Boerhaave’s syndrome

A

CT contrast swallow

60
Q

steps after insertion of NG tube

A

aspirate before administering any feed or medication
if aspirate pH <5.5, safe to use
if aspirate pH >5.5, CXR to determine position

61
Q

features of acute cholecystitis

A 
constant RUQ pain
fever
positive Murphey's sign
raised inflammatory markers
NORMAL LFTs

finals (25 decks)

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