Surgery Flashcards
1
Q
ER + Breast cancer in post-menopausal
A
Anastrozole
2
Q
Management of Barrett’s
A
Surveillance + High dose PPI
3
Q
Dysplasia in Barrett’s
A
Endoscopic mucosal resection or radiofrequency ablation
4
Q
Metabolic acidosis, elevated lactate and thumbprinting sign
A
Ischemic Colitis
5
Q
Gold standard for ischemic colitis
A
CT
6
Q
COCP should be stopped for how long before surgery
A
4 weeks
7
Q
Painless jaundice
A
Pancreatic cancer
8
Q
Crohn’s and Goblet cells
A
increased
9
Q
Bloody diarrhea in IBD
A
UC
10
Q
crypt Abscess
A
UC
11
Q
pseudopolypoid appearance
A
UC
12
Q
Hypercalcemia in pancreatitis
A
Cause of pancreatitis
13
Q
hypocalcemia in pancreatitis
A
severity
14
Q
Halitosis and Episodic dysphagia
A
pharyngeal Pouch
15
Q
Barrett’s increases the risk of what cancer
A
adenocarcioma
16
Q
Dysphagia to solids and liquids from the start
A
Achalasia
17
Q
Treatment of Achalasia (surgical)
A
Hellers cardiomyotomy
18
Q
Rovsig’s sign
A
Palpating LIF pains the RIF
19
Q
Appendictomy requires prophylactic Abx T or F
A
True
20
Q
Anal sphincter cancer
A
APER
21
Q
Rectum
A
Anterior resection
22
Q
Unstable and acute patient with colon cancer
A
Hartmann’s procedue
23
Q
Painless jaundice and palpable GB
A
Pancreatic Cancer
24
Q
Halo sign on mammogram
A
Breast cyst
25
Slit like retraction of the nipple
Duct ectasia
26
Small AAA
3 to 4.4 cm - rescan every 12 months
27
Medium AAA
4.5 to 5.4
| rescan every 3 months
28
large AAA
>=5.5 cm refer within 2 weeks
29
AAA screening
Single abdominal USS at 65
30
Pharyngeal pouch treatment; Presenting with Dysphagia, regurgitation and halitosis
Surgery
31
Gold standard investigation for Aortic dissection
CT angiography of the chest, abdomen and pelvis (CTA-CAP)
32
Anastrazole side effects
Osteoporosis (most imp); hot flushes, insomnia and myalgia
33
Biliary colic pain radiates to
Interscapular region
34
Ileocecal resection causes what deficiency; It may cause glossitis
Vitamin B12 deficiency
35
Type of Shock
PAP low
CO low
SVR high
Hypovolemia
36
Type of shock
PAP high
CO low
SVR high
Cardiogenic shock
37
Type of shock
PAP low
CO high
SVR low
SEPTIC SHOCK
38
Smoker, infection of breast (recurrent); induration of the nipple areole
Periductal mastitis
39
Bright red bleeding, much-epithelial defect in the posterior midline of the anus; what is the diagnosis and what is the surgical management
Anal fissure - Sphinctertomy
40
Haemorrhoids - Painless, bleeding and pruritus
Rubber band ligation
41
What is seton insertion used for
Anal fistula
42
6 Ps of acute limb ischemia
Pale, pulseless, pain, perishing cold, paralysis and paraesthesia
43
Aortic dissection on imaging
CXR: widened mediastinum
| CT angiography: False lumen
44
Poor weight gain, young infant, erythematous blanching rash, colicky abdominal pain, vomiting after feeds
Cows milk protein intolerance
45
PAD chronic management drugs
Statin + clopidogrel
46
Treatment of Achalasia
Pneumatic balloon dilation
Heller cardiomyotomy- surgery
47
Surgical management of GORD (severe)
Nissan Fundoplication
48
Rovsing’s Sign in appendicitis
RIF pain on palpation of LIF
49
Caecal, ascending or proximal transverse colon
Right hemicolectomy
50
Distal transverse, descending colon
Left hemicolectomy
51
Sigmoid colon
Higher anterior resection
52
Upper rectum
Anterior resectiom TME
53
Lower rectum
Anterior resection low TME
54
Anal verge
APER
55
Paralytic lieus management
Insert an NG tube
56
UC with avoiding stoma
Panproctocolectomy and ileoanal pouch
57
Only treatment for asystole
Adrenaline
58
All patients with an unprovoked DVT must be offered this test
CT scan abdomen and pelvis to identify possible cancer
59
All patients with mechanical valves require treatment with
Aspirin and Warfarin
60
scale formation at sites of minor injury and typically when injury is healing; can last months to week
Psoriasis
61
Airway that protects lungs from regurgitated stomach contents
Tracheal tube
62
Severe headache 24 hours after spinal anaesthetic
Low pressure headache
63
Cyclical pain, FNA- fluid, brown, no malignant change, 6 month history
Fibrocystic disease
64
CXR shows mediastinal surgical emphysema; air and fluid level in pleural cavity
Perforation of esophagus
65
Narrowed tubular structure; Food to fluid dysphagia, may be malnourished or cachectic
Oesophageal strictures
66
GOJ enters the thorax (sphincter)
Sliding hiatus hernia
67
proximal part of stomach herniates into thorax
Rolling hiatus hernia
68
Investigation of Hiatus hernia
barium swallow
69
Surgical management of hiatus hernia
Open/laparoscopic Nissen's Fundoplication; indicated in rolling hiatus hernia due to risk of volvulus
70
Risk factors of oesophageal cancer
smoking, alcohol, diet, Barrett's and achalasia
71
Acute management of varices
Clotting abnormalities, IV terlipressin, OGD + sclerotherapy or banding of varices
72
Prophylaxis of varices
Beta blockers + OGD + sclerotherapy/banding
| TIPSS
73
Achalasia can be mimicked by this disorder
Chagas Disease (T. Cruzi)
74
Test for Achalasia
Barium swallow (Birds beak) and proximal dilatation
75
treatment of Achalasia - Endoscopic and medical
Endoscopic pneumatic dilatation or Botulinum Toxin injection at OGD
76
Surgical treatment of Achalasia
Heller's operation
77
Protrusion through Killian's Dehiscence is called
Pharyngeal pouch or Zenker's Diverticulum
78
Surgical management of duodenal ulcer
suture ligation + vagotomy and pyloroplasty
79
Malignanct peptic ulcer surgery
Distal gastrectomy - Billroth
80
Bleeding proximal to this anatomical structure is classified as Upper GI bleeding
Ligament of Treitz
81
Upper GI bleeding mortality score
Rockall score
82
surgical treatment of pyloric stenosis
Ramstedt pyloromyotomy (incision of pylorus muscle)
83
Persistence of segment of the vitello-intestinall duct is called
Meckel's Diverticulum
84
complicated diverticulitis surgical management
Hartmann's procedure and colostomy reversal 3-6 months later
85
Tumour markers of colon cancer
CEA and CA19-9; Faecal occult blood
86
classification in colon cancer
Modified Dukes criteria
87
FAP genetics
Autosomal dominant
| APC gene
88
Painless bright red PR bleeding, perianal lump and pruritus Ani
Hemorrhoids
89
Management of hemorrhoids
Grade 1-3: sclerosant injection/ banding/cryotherapy
| grade 4: hemorrhoidectomy
90
painful anal tear and mucosa, posterior to midline, bright red PR bleeding, skin tags
Fissure
GTN cream, botox
Surgery: lateral sphincterotomy
91
constipation + Colicky pain + distention and vomiting
Complete bowel onstruction
92
Tinkling bowel sounds
SBO
93
SBO and stragulation
laparotomy
94
Intussuception management
Reduction with air enema
95
Cholangiocarcinoma is associated with
PSC; IBD
96
CA19-9
Pancreatic cancer
97
ABPI
>1 normal
0.9-0.6: claudication
0.6 to 0.3: rest pain
<0.3: critical ischemia
98
buttock claudication + impotence
Aorto-iliac disease - Leriche's Syndrome
99
Inflammed medium sized vessels; male smokers and occlusion
Buerger's disease aka Thromboangiitis Obliterans
100
Unilateral temporary blindness due to carotid emboli
Amaurosis fugax
101
painful at rest, punched out, poor pulses, pallor cyanosis
Arterial ulcers
102
Ischemic limb and ulcer - Investigation
Biopsy and revascularization or amputation
103
DVT history, venous eczema, lipodermatosclerosis, pain when dressing are applied; gaiter distribution
compression bandaging
104
Marjolin's Ulcer
Squamous cell carcinoma in ulcer, venous ulcer, biopsy is needed; excise
105
What type of dissection starts at the origin of left subclavian artery
Type B
106
fibroepithelial neoplasm; majority are benign but can be malignant, firm breast lump
phyllodes tumor
107
Most common breast carcinoma in situ
DCIS
108
Lobar carcinoma in situ needs bilateral or unilateral excision?
Bilateral
109
Eczematous skin change to the nipple; associated to a lump
Paget's
110
Commonest post op complication within first 24 hours is
Reactionary hemorrhage
111
5-7 days post op most likely complication
WOund infection
112
Circulating volume less than capacity of IV compartment
is common to all forms of shock
113
Most useful guide to monitor fluid replacement
Urine output
114
Triple assessment
History and exam + Imaging + Biopsy/FNA
115
Most common cause of bleeding from the nipple
Duct papilloma
116
Most indicative of Appendicitis
McBurney’s point
117
Multiple fluid levels in small bowel + Air in biliary tree
Gallstone lieu’s
118
Calf symptoms
Superficial femoral occlusion
119
History of vascular disease, absent bowel sounds, abdominal pain, lactic acidosis (key sign)
Mesenteric ischemia
120
Change in bowel habit + Left iliac fossa pain + Infection (pyrexia)
Diverticulitis
121
Milk production outside lactation is called? and its causes
Galatorrhea
| nipple stimulation and prolactinoma of anterior pituitary
122
Cause of acute mastitis
S.. Aureus
| treat with Flucoxacillin
123
Periductal mastitis is common in
Smokers
* blocked duct through keratin
may present with nipple traction
124
Green-brown nipple discharge
mammary duct ectasia
| inflammation of the duct, subareolar ducts inflammation, post-menopausal women, breast mass
125
Related to trauma, calcification on mammogram
Fat necrosis
126
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
Fibrocystic disease
127
bloody discharge
intraductal papilloma
single duct only
Treat- Microdiscectomy
128
Fibrous tissue and gland, benign, premenopausal, mobile, well circumscribed, marble like and estrogen sensitive
Fibroadenoma
> 3cm exicise surgically
Mastectomy if large lesion
129
Phyllodes tumour
Fibroadenoma like tumor, leaf like projections and can be malignant
130
smooth discrete lump; fluctuant, small increased risk of cancer
breast cyst- aspirated
131
risk factors of breast cancer
Female, age, early menarche, late menopause, obesity,, atypical hyperplasia and 1st degree relative
132
What is the functional unit of breast
Terminal duct lobule
133
DCIS
malignant + basement membrane
134
Epidermis + malignant in the duct
Paget's
135
Malignant lobule
LCIS
136
Invasion into connective tissue
Invasive lobular cancer
137
Comedo type DCIS
High grade cells with necrosis and dystrophic calcification in center of ducts
138
DCIS + nipple involvement + erythema
Pagets
139
Most common type of breast cancer
Invasive ductal carcinoma
140
Breast is erythematous, mastitis, no resolve with ABx
inflammatory breast cancer
141
BRCA1 is related to
medullary carcinoma
142
Do a sentinel when the axilla cannot be palpated and positive USS
That means no nodes are present and exision of one node can tell us if clearance is required
143
Poor prognosis of breast cancer
triple negative
144
BRCA1 and 2 are Inherited
Autosomal dominant
145
BRCA1 is related to what other cancer
ovarian
146
BRCA 2
related to male breast cancer
147
DCIS >4cm
Mastectomy
148
DCIS <4 cm
wide local excision
149
NHS breast screening
50-70 every three years
150
Clinically palpable axillary nodes
Axillary node clearance is indicated
151
SE of Axillary node clearance
Lymphedema and functional arm impairment
152
Radiotherapy indications
whole breast - Wide local exicision
| T3/T4 or those with 4 or more positive nodes - Mastectomy
153
Premenopausal ER+
tamoxifen
154
Post-menopausal ER+
Anastrazole
155
SE of Tamoxifen
Endometrial cancer; VTE and menopausal sxs
156
Biological therapy
Trastuzumab or Herceptin
HER2 positive
CI heart disease
157
Chemotherapy
Axillary node disease FEC-D
158
AAA screening
USS in all men 65 year old
159
Risks of AAA
Smoking, male, increased age, hypertension, FH, CAD, MArfans,
160
Infrarenal aortic diameter of more than 3 Cm
Usually arises below the renal arteries and above the bifurcation into iliacs
161
Classic presentation - Severe abdominal pain radiating to back and presence of a pulsating mass
AAA
162
Diagnosis
USS- large cystic lesion
| Gold standard is CT or MRI
163
Management of AAA
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
Surgery type in AAA
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
Complication of AAA EVAR graft
Bloody stools relating to ischemic colitis
| Endo-leak
166
<3 cm
3 to 4.4
4.5 to 5.4
>5.5
<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
Emergency AAA repair
Oxygen, Keep SBP <100, MHP, Cef + metronidazole; Dacron graft
168
Tear of the intima, allowing blood through the media of the aortic wall
Aortic dissection
169
Most common cause of dissection
Hypertension
170
Sharp pain, sudden onset, radiating to back, tearing, pulse deficit- weak carotid, brachial or femoral, variation in systolic BP, ST elevation in inferior leads
Aortic dissection
171
Type A dissection
AA +/- DA
172
Type B dissection
distal to subclavian artery in descending aorta
173
Type A leads to complications such as
heart failure, aortic valve insufficiency, cardiac tamponade and shock
174
Diagnosis gold standard of dissection
CT angiogram of chest, abdomen, pelvis
TOE- oesophageal unstable or TTE
175
AA + DA
Type 1 debakey
176
AA only
Type 2
177
DA only
type 3
178
Most common cause of death in aortic dissection
pericardial tamponade
| others: renal artery stenosis
179
Type A
Surgical + BP management
180
Type B
Conservative, IV labetalol
181
backward tear complications in dissection
AR, MI inferior wall
182
Forward tear complication in dissection
Unequal pulses and stroke + renal failure
183
Poor blood supply to skin + PAD causes
Arterial ulcers
184
Pooling of blood and waste products in the skin secondary to venous deficiency such as varicose and phlebitis
Venous ulcers
185
Combination of ulcers
Mixed
186
Ulcer with absent pulse, pallor, small, regular, grey colour, not bleeding, more painful, pain with elevation and improved by hanging
Arterial ulcer
187
An ulcer which is edematous, flushed, hyperpigmented, varicose eczema, larger, irregular border, likely to bleed and relieves with elevation and worse on hanging
Venous ulcer
188
Brown pigmentation, lipodermatosclerosis, eczema, above ankle, painless, DVT, varicose, medial malleolus, hemosiderin
Venous
management
1st line 4 layer compression bandage
189
Squamous cell carcinoma, occuring at chronic inflammation sites such as burns or osteomyelitis
Marjoin's ulcer
190
Pyoderma gangrenosum
IBD, RA, stoma sites pustules that can ulcerate
191
Pentoxyfylline improves
VV: microcirculatory blood flow and improves healing rates
192
Surgical management of varicose veins
Compression stocking
Pentoxifylline
ENdothermal ablation (radiofrequency) endovenous laser
foam sclerotherapy
Others: trendelberg (sapgenofemoral), SSV (popliteal)
193
Investigation of Varicose veins
Duplex uss
194
Origin of CVA and TIA
internal carotid A
195
neurological symptoms related to Internal carotid
Amaurosis fugax- central retinal artery
Hemianopia
internal capsular stroke
196
Diagnosis carotid disease
All patients with TIA/CVA within last 6 months - Duplex
| 2nd line MRA or CTA - inconclusive duplex
197
Management of carotid A disease
Antiplatelet such as aspirin, dipyridamole, smoking cessation, BP and diabetes
Statin for cholestrol
Acute thrombolysis in CT proven ischemia
198
ABCD2 risk score in TIA
>50 and symptomatic
| >70% stenosis
199
Complication of CEA
hypoglossal nerve and glossopharyngeal nerve
great auricular - numb ear lobe
hoarse voice - recurrent laryngeal
200
Stenting can be considered
young patients with carotid disease
201
Aching, burning legs, can walk predictable distances and relived with rest
Intermittent claudication
202
investigation of Intermittent claudication
Duplex USS, ABPI
203
Rest pain in foor >2 weeks, ulcer or gangrene
pain eases on hanging legs
ABPI <0.5
Critical limb ischemia
204
6 Ps: pale, pulseless, paralysed, paraesthetic and cold
Acute limb ischemia
205
Thrombus
pre-existing claudication and deterioration
206
Emboli
no claudication, AF, MI, normal pulses in contralateral limb
207
ABPI scores
1 = normal
0.6 to 0.9 = claudication
0.3 to 0.6 = rest pain
<0.3 = impending
208
management of PAD
Smoking cessation, statin 80mg, Clopidogrel 1st line
209
Severe pad and critical limb ischemia
Angioplasty, stenting and bypass
210
Drugs used PAD
Naftridrifuryl oxlate and cilostazol
211
Doppler
Normal is triphasic
Mild stenosis is biphasic
Severe stenosis is monophasic
212
ABPI >1.4
Calcification due to DM and chronic renal failure
213
Endovascular treatment
p/c transluminal angioplasty + stenting
214
Diagnosis of thrombosis acute limb
angiography
215
Treatment of thrombosis and embolus acute limb
Thrombolysis and bypass- thrombus
| Embolectomy + warfarin - emboli- Fogarty catheter
