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Year 3 > Surgery > Flashcards

Surgery Flashcards

1
Q

ER + Breast cancer in post-menopausal

A

Anastrozole

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2
Q

Management of Barrett’s

A

Surveillance + High dose PPI

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3
Q

Dysplasia in Barrett’s

A

Endoscopic mucosal resection or radiofrequency ablation

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4
Q

Metabolic acidosis, elevated lactate and thumbprinting sign

A

Ischemic Colitis

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5
Q

Gold standard for ischemic colitis

A

CT

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6
Q

COCP should be stopped for how long before surgery

A

4 weeks

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7
Q

Painless jaundice

A

Pancreatic cancer

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8
Q

Crohn’s and Goblet cells

A

increased

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9
Q

Bloody diarrhea in IBD

A

UC

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10
Q

crypt Abscess

A

UC

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11
Q

pseudopolypoid appearance

A

UC

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12
Q

Hypercalcemia in pancreatitis

A

Cause of pancreatitis

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13
Q

hypocalcemia in pancreatitis

A

severity

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14
Q

Halitosis and Episodic dysphagia

A

pharyngeal Pouch

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15
Q

Barrett’s increases the risk of what cancer

A

adenocarcioma

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16
Q

Dysphagia to solids and liquids from the start

A

Achalasia

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17
Q

Treatment of Achalasia (surgical)

A

Hellers cardiomyotomy

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18
Q

Rovsig’s sign

A

Palpating LIF pains the RIF

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19
Q

Appendictomy requires prophylactic Abx T or F

A

True

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20
Q

Anal sphincter cancer

A

APER

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21
Q

Rectum

A

Anterior resection

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22
Q

Unstable and acute patient with colon cancer

A

Hartmann’s procedue

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23
Q

Painless jaundice and palpable GB

A

Pancreatic Cancer

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24
Q

Halo sign on mammogram

A

Breast cyst

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25
Q

Slit like retraction of the nipple

A

Duct ectasia

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26
Q

Small AAA

A

3 to 4.4 cm - rescan every 12 months

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27
Q

Medium AAA

A

4.5 to 5.4

rescan every 3 months

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28
Q

large AAA

A

> =5.5 cm refer within 2 weeks

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29
Q

AAA screening

A

Single abdominal USS at 65

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30
Q

Pharyngeal pouch treatment; Presenting with Dysphagia, regurgitation and halitosis

A

Surgery

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31
Q

Gold standard investigation for Aortic dissection

A

CT angiography of the chest, abdomen and pelvis (CTA-CAP)

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32
Q

Anastrazole side effects

A

Osteoporosis (most imp); hot flushes, insomnia and myalgia

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33
Q

Biliary colic pain radiates to

A

Interscapular region

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34
Q

Ileocecal resection causes what deficiency; It may cause glossitis

A

Vitamin B12 deficiency

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35
Q

Type of Shock
PAP low
CO low
SVR high

A

Hypovolemia

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36
Q

Type of shock
PAP high
CO low
SVR high

A

Cardiogenic shock

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37
Q

Type of shock
PAP low
CO high
SVR low

A

SEPTIC SHOCK

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38
Q

Smoker, infection of breast (recurrent); induration of the nipple areole

A

Periductal mastitis

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39
Q

Bright red bleeding, much-epithelial defect in the posterior midline of the anus; what is the diagnosis and what is the surgical management

A

Anal fissure - Sphinctertomy

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40
Q

Haemorrhoids - Painless, bleeding and pruritus

A

Rubber band ligation

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41
Q

What is seton insertion used for

A

Anal fistula

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42
Q

6 Ps of acute limb ischemia

A

Pale, pulseless, pain, perishing cold, paralysis and paraesthesia

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43
Q

Aortic dissection on imaging

A

CXR: widened mediastinum

CT angiography: False lumen

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44
Q

Poor weight gain, young infant, erythematous blanching rash, colicky abdominal pain, vomiting after feeds

A

Cows milk protein intolerance

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45
Q

PAD chronic management drugs

A

Statin + clopidogrel

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46
Q

Treatment of Achalasia

A

Pneumatic balloon dilation

Heller cardiomyotomy- surgery

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47
Q

Surgical management of GORD (severe)

A

Nissan Fundoplication

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48
Q

Rovsing’s Sign in appendicitis

A

RIF pain on palpation of LIF

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49
Q

Caecal, ascending or proximal transverse colon

A

Right hemicolectomy

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50
Q

Distal transverse, descending colon

A

Left hemicolectomy

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51
Q

Sigmoid colon

A

Higher anterior resection

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52
Q

Upper rectum

A

Anterior resectiom TME

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53
Q

Lower rectum

A

Anterior resection low TME

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54
Q

Anal verge

A

APER

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55
Q

Paralytic lieus management

A

Insert an NG tube

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56
Q

UC with avoiding stoma

A

Panproctocolectomy and ileoanal pouch

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57
Q

Only treatment for asystole

A

Adrenaline

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58
Q

All patients with an unprovoked DVT must be offered this test

A

CT scan abdomen and pelvis to identify possible cancer

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59
Q

All patients with mechanical valves require treatment with

A

Aspirin and Warfarin

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60
Q

scale formation at sites of minor injury and typically when injury is healing; can last months to week

A

Psoriasis

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61
Q

Airway that protects lungs from regurgitated stomach contents

A

Tracheal tube

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62
Q

Severe headache 24 hours after spinal anaesthetic

A

Low pressure headache

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63
Q

Cyclical pain, FNA- fluid, brown, no malignant change, 6 month history

A

Fibrocystic disease

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64
Q

CXR shows mediastinal surgical emphysema; air and fluid level in pleural cavity

A

Perforation of esophagus

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65
Q

Narrowed tubular structure; Food to fluid dysphagia, may be malnourished or cachectic

A

Oesophageal strictures

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66
Q

GOJ enters the thorax (sphincter)

A

Sliding hiatus hernia

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67
Q

proximal part of stomach herniates into thorax

A

Rolling hiatus hernia

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68
Q

Investigation of Hiatus hernia

A

barium swallow

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69
Q

Surgical management of hiatus hernia

A

Open/laparoscopic Nissen’s Fundoplication; indicated in rolling hiatus hernia due to risk of volvulus

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70
Q

Risk factors of oesophageal cancer

A

smoking, alcohol, diet, Barrett’s and achalasia

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71
Q

Acute management of varices

A

Clotting abnormalities, IV terlipressin, OGD + sclerotherapy or banding of varices

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72
Q

Prophylaxis of varices

A

Beta blockers + OGD + sclerotherapy/banding

TIPSS

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73
Q

Achalasia can be mimicked by this disorder

A

Chagas Disease (T. Cruzi)

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74
Q

Test for Achalasia

A

Barium swallow (Birds beak) and proximal dilatation

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75
Q

treatment of Achalasia - Endoscopic and medical

A

Endoscopic pneumatic dilatation or Botulinum Toxin injection at OGD

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76
Q

Surgical treatment of Achalasia

A

Heller’s operation

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77
Q

Protrusion through Killian’s Dehiscence is called

A

Pharyngeal pouch or Zenker’s Diverticulum

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78
Q

Surgical management of duodenal ulcer

A

suture ligation + vagotomy and pyloroplasty

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79
Q

Malignanct peptic ulcer surgery

A

Distal gastrectomy - Billroth

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80
Q

Bleeding proximal to this anatomical structure is classified as Upper GI bleeding

A

Ligament of Treitz

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81
Q

Upper GI bleeding mortality score

A

Rockall score

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82
Q

surgical treatment of pyloric stenosis

A

Ramstedt pyloromyotomy (incision of pylorus muscle)

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83
Q

Persistence of segment of the vitello-intestinall duct is called

A

Meckel’s Diverticulum

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84
Q

complicated diverticulitis surgical management

A

Hartmann’s procedure and colostomy reversal 3-6 months later

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85
Q

Tumour markers of colon cancer

A

CEA and CA19-9; Faecal occult blood

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86
Q

classification in colon cancer

A

Modified Dukes criteria

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87
Q

FAP genetics

A

Autosomal dominant

APC gene

88
Q

Painless bright red PR bleeding, perianal lump and pruritus Ani

A

Hemorrhoids

89
Q

Management of hemorrhoids

A

Grade 1-3: sclerosant injection/ banding/cryotherapy

grade 4: hemorrhoidectomy

90
Q

painful anal tear and mucosa, posterior to midline, bright red PR bleeding, skin tags

A

Fissure
GTN cream, botox
Surgery: lateral sphincterotomy

91
Q

constipation + Colicky pain + distention and vomiting

A

Complete bowel onstruction

92
Q

Tinkling bowel sounds

93
Q

SBO and stragulation

A

laparotomy

94
Q

Intussuception management

A

Reduction with air enema

95
Q

Cholangiocarcinoma is associated with

96
Q

CA19-9

A

Pancreatic cancer

97
Q

ABPI

A

> 1 normal
0.9-0.6: claudication
0.6 to 0.3: rest pain
<0.3: critical ischemia

98
Q

buttock claudication + impotence

A

Aorto-iliac disease - Leriche’s Syndrome

99
Q

Inflammed medium sized vessels; male smokers and occlusion

A

Buerger’s disease aka Thromboangiitis Obliterans

100
Q

Unilateral temporary blindness due to carotid emboli

A

Amaurosis fugax

101
Q

painful at rest, punched out, poor pulses, pallor cyanosis

A

Arterial ulcers

102
Q

Ischemic limb and ulcer - Investigation

A

Biopsy and revascularization or amputation

103
Q

DVT history, venous eczema, lipodermatosclerosis, pain when dressing are applied; gaiter distribution

A

compression bandaging

104
Q

Marjolin’s Ulcer

A

Squamous cell carcinoma in ulcer, venous ulcer, biopsy is needed; excise

105
Q

What type of dissection starts at the origin of left subclavian artery

106
Q

fibroepithelial neoplasm; majority are benign but can be malignant, firm breast lump

A

phyllodes tumor

107
Q

Most common breast carcinoma in situ

108
Q

Lobar carcinoma in situ needs bilateral or unilateral excision?

109
Q

Eczematous skin change to the nipple; associated to a lump

110
Q

Commonest post op complication within first 24 hours is

A

Reactionary hemorrhage

111
Q

5-7 days post op most likely complication

A

WOund infection

112
Q

Circulating volume less than capacity of IV compartment

A

is common to all forms of shock

113
Q

Most useful guide to monitor fluid replacement

A

Urine output

114
Q

Triple assessment

A

History and exam + Imaging + Biopsy/FNA

115
Q

Most common cause of bleeding from the nipple

A

Duct papilloma

116
Q

Most indicative of Appendicitis

A

McBurney’s point

117
Q

Multiple fluid levels in small bowel + Air in biliary tree

A

Gallstone lieu’s

118
Q

Calf symptoms

A

Superficial femoral occlusion

119
Q

History of vascular disease, absent bowel sounds, abdominal pain, lactic acidosis (key sign)

A

Mesenteric ischemia

120
Q

Change in bowel habit + Left iliac fossa pain + Infection (pyrexia)

A

Diverticulitis

121
Q

Milk production outside lactation is called? and its causes

A

Galatorrhea

nipple stimulation and prolactinoma of anterior pituitary

122
Q

Cause of acute mastitis

A

S.. Aureus

treat with Flucoxacillin

123
Q

Periductal mastitis is common in

A

Smokers
* blocked duct through keratin
may present with nipple traction

124
Q

Green-brown nipple discharge

A

mammary duct ectasia

inflammation of the duct, subareolar ducts inflammation, post-menopausal women, breast mass

125
Q

Related to trauma, calcification on mammogram

A

Fat necrosis

126
Q

fibrosis of connective tissue and hypertrophy of lobules and ducts; some carry increased risk of carcinoma (invasive), cysts and apocrine metaplasia, worse pain before period

A

Fibrocystic disease

127
Q

bloody discharge

A

intraductal papilloma
single duct only
Treat- Microdiscectomy

128
Q

Fibrous tissue and gland, benign, premenopausal, mobile, well circumscribed, marble like and estrogen sensitive

A

Fibroadenoma
> 3cm exicise surgically
Mastectomy if large lesion

129
Q

Phyllodes tumour

A

Fibroadenoma like tumor, leaf like projections and can be malignant

130
Q

smooth discrete lump; fluctuant, small increased risk of cancer

A

breast cyst- aspirated

131
Q

risk factors of breast cancer

A

Female, age, early menarche, late menopause, obesity,, atypical hyperplasia and 1st degree relative

132
Q

What is the functional unit of breast

A

Terminal duct lobule

133
Q

DCIS

A

malignant + basement membrane

134
Q

Epidermis + malignant in the duct

135
Q

Malignant lobule

136
Q

Invasion into connective tissue

A

Invasive lobular cancer

137
Q

Comedo type DCIS

A

High grade cells with necrosis and dystrophic calcification in center of ducts

138
Q

DCIS + nipple involvement + erythema

139
Q

Most common type of breast cancer

A

Invasive ductal carcinoma

140
Q

Breast is erythematous, mastitis, no resolve with ABx

A

inflammatory breast cancer

141
Q

BRCA1 is related to

A

medullary carcinoma

142
Q

Do a sentinel when the axilla cannot be palpated and positive USS

A

That means no nodes are present and exision of one node can tell us if clearance is required

143
Q

Poor prognosis of breast cancer

A

triple negative

144
Q

BRCA1 and 2 are Inherited

A

Autosomal dominant

145
Q

BRCA1 is related to what other cancer

146
Q

BRCA 2

A

related to male breast cancer

147
Q

DCIS >4cm

A

Mastectomy

148
Q

DCIS <4 cm

A

wide local excision

149
Q

NHS breast screening

A

50-70 every three years

150
Q

Clinically palpable axillary nodes

A

Axillary node clearance is indicated

151
Q

SE of Axillary node clearance

A

Lymphedema and functional arm impairment

152
Q

Radiotherapy indications

A

whole breast - Wide local exicision

T3/T4 or those with 4 or more positive nodes - Mastectomy

153
Q

Premenopausal ER+

154
Q

Post-menopausal ER+

A

Anastrazole

155
Q

SE of Tamoxifen

A

Endometrial cancer; VTE and menopausal sxs

156
Q

Biological therapy

A

Trastuzumab or Herceptin
HER2 positive
CI heart disease

157
Q

Chemotherapy

A

Axillary node disease FEC-D

158
Q

AAA screening

A

USS in all men 65 year old

159
Q

Risks of AAA

A

Smoking, male, increased age, hypertension, FH, CAD, MArfans,

160
Q

Infrarenal aortic diameter of more than 3 Cm

A

Usually arises below the renal arteries and above the bifurcation into iliacs

161
Q

Classic presentation - Severe abdominal pain radiating to back and presence of a pulsating mass

162
Q

Diagnosis

A

USS- large cystic lesion

Gold standard is CT or MRI

163
Q

Management of AAA

A

asymptomatic - Pharma and lifestyle - Statin, antiplatelet, antihypertensive and beta blocker
If asx and >5.5 cm and 0.5 cm per year expansion - surgery

Symptomatic: Surgery

164
Q

Surgery type in AAA

A

EVAR has decreased perioperative mortality
NO decrease in mortality by 5 years due to fatal endograft failure
EVAR requires lifeling surviellance
Open: durable for younger patients

165
Q

Complication of AAA EVAR graft

A

Bloody stools relating to ischemic colitis

Endo-leak

166
Q

<3 cm
3 to 4.4
4.5 to 5.4
>5.5

A

<3 cm = Normal
3 to 4.4 = small - rescan 12 months
4.5 to 5.4 = Medium - rescan every 3 months
>5.5 - refer 2 weeks to intervention

167
Q

Emergency AAA repair

A

Oxygen, Keep SBP <100, MHP, Cef + metronidazole; Dacron graft

168
Q

Tear of the intima, allowing blood through the media of the aortic wall

A

Aortic dissection

169
Q

Most common cause of dissection

A

Hypertension

170
Q

Sharp pain, sudden onset, radiating to back, tearing, pulse deficit- weak carotid, brachial or femoral, variation in systolic BP, ST elevation in inferior leads

A

Aortic dissection

171
Q

Type A dissection

172
Q

Type B dissection

A

distal to subclavian artery in descending aorta

173
Q

Type A leads to complications such as

A

heart failure, aortic valve insufficiency, cardiac tamponade and shock

174
Q

Diagnosis gold standard of dissection

A

CT angiogram of chest, abdomen, pelvis

TOE- oesophageal unstable or TTE

175
Q

AA + DA

A

Type 1 debakey

176
Q

AA only

177
Q

DA only

178
Q

Most common cause of death in aortic dissection

A

pericardial tamponade

others: renal artery stenosis

179
Q

Type A

A

Surgical + BP management

180
Q

Type B

A

Conservative, IV labetalol

181
Q

backward tear complications in dissection

A

AR, MI inferior wall

182
Q

Forward tear complication in dissection

A

Unequal pulses and stroke + renal failure

183
Q

Poor blood supply to skin + PAD causes

A

Arterial ulcers

184
Q

Pooling of blood and waste products in the skin secondary to venous deficiency such as varicose and phlebitis

A

Venous ulcers

185
Q

Combination of ulcers

186
Q

Ulcer with absent pulse, pallor, small, regular, grey colour, not bleeding, more painful, pain with elevation and improved by hanging

A

Arterial ulcer

187
Q

An ulcer which is edematous, flushed, hyperpigmented, varicose eczema, larger, irregular border, likely to bleed and relieves with elevation and worse on hanging

A

Venous ulcer

188
Q

Brown pigmentation, lipodermatosclerosis, eczema, above ankle, painless, DVT, varicose, medial malleolus, hemosiderin

A

Venous
management
1st line 4 layer compression bandage

189
Q

Squamous cell carcinoma, occuring at chronic inflammation sites such as burns or osteomyelitis

A

Marjoin’s ulcer

190
Q

Pyoderma gangrenosum

A

IBD, RA, stoma sites pustules that can ulcerate

191
Q

Pentoxyfylline improves

A

VV: microcirculatory blood flow and improves healing rates

192
Q

Surgical management of varicose veins

A

Compression stocking
Pentoxifylline
ENdothermal ablation (radiofrequency) endovenous laser
foam sclerotherapy

Others: trendelberg (sapgenofemoral), SSV (popliteal)

193
Q

Investigation of Varicose veins

A

Duplex uss

194
Q

Origin of CVA and TIA

A

internal carotid A

195
Q

neurological symptoms related to Internal carotid

A

Amaurosis fugax- central retinal artery
Hemianopia
internal capsular stroke

196
Q

Diagnosis carotid disease

A

All patients with TIA/CVA within last 6 months - Duplex

2nd line MRA or CTA - inconclusive duplex

197
Q

Management of carotid A disease

A

Antiplatelet such as aspirin, dipyridamole, smoking cessation, BP and diabetes
Statin for cholestrol
Acute thrombolysis in CT proven ischemia

198
Q

ABCD2 risk score in TIA

A

> 50 and symptomatic

>70% stenosis

199
Q

Complication of CEA

A

hypoglossal nerve and glossopharyngeal nerve
great auricular - numb ear lobe
hoarse voice - recurrent laryngeal

200
Q

Stenting can be considered

A

young patients with carotid disease

201
Q

Aching, burning legs, can walk predictable distances and relived with rest

A

Intermittent claudication

202
Q

investigation of Intermittent claudication

A

Duplex USS, ABPI

203
Q

Rest pain in foor >2 weeks, ulcer or gangrene
pain eases on hanging legs
ABPI <0.5

A

Critical limb ischemia

204
Q

6 Ps: pale, pulseless, paralysed, paraesthetic and cold

A

Acute limb ischemia

205
Q

Thrombus

A

pre-existing claudication and deterioration

206
Q

Emboli

A

no claudication, AF, MI, normal pulses in contralateral limb

207
Q

ABPI scores

A

1 = normal
0.6 to 0.9 = claudication
0.3 to 0.6 = rest pain
<0.3 = impending

208
Q

management of PAD

A

Smoking cessation, statin 80mg, Clopidogrel 1st line

209
Q

Severe pad and critical limb ischemia

A

Angioplasty, stenting and bypass

210
Q

Drugs used PAD

A

Naftridrifuryl oxlate and cilostazol

211
Q

Doppler

A

Normal is triphasic
Mild stenosis is biphasic
Severe stenosis is monophasic

212
Q

ABPI >1.4

A

Calcification due to DM and chronic renal failure

213
Q

Endovascular treatment

A

p/c transluminal angioplasty + stenting

214
Q

Diagnosis of thrombosis acute limb

A

angiography

215
Q

Treatment of thrombosis and embolus acute limb

A

Thrombolysis and bypass- thrombus

Embolectomy + warfarin - emboli- Fogarty catheter

Year 3 (11 decks)

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