Surgery Flashcards
What is the most important first investigation in priapism?
Cavernosal blood gas analysis - distinguishes between ischaemic and non-ischaemic
What investigation should be requested prior to initiation of anastrozole?
DEXA scan
How long may it take finasteride to take effect - a 5-alpha-reductase inhibitors?
Up to 6 months
What is the imaging modality of choice in suspected renal calculi?
Non-contrast CT-KUB
How should metformin be taken in relation to a patient whom is having an operation?
Take as normal day before. Only omit dose on day of surgery if taken 3 times a day - in which case omit lunchtime dose
How should sulphonylureas be taken in relation to a patient whom is having an operation?
Take as normal day before. If on morning list, omit morning dose (whether taken OD or BD). If taken BD, evening dose can be given. If on afternoon list, omit all doses that day
How should DPP IV inhibitors (-gliptins) be taken in relation to a patient whom is having an operation?
Take as normal, no omitted doses before or on day of surgery
How should GLP-1 analogues (-tides) be taken in relation to a patient whom is having an operation?
Take as normal, no omitted doses before or on day of surgery
How should SGLT-2 inhibitors (-flozins) be taken in relation to a patient whom is having an operation?
Take as normal day before surgery, omit on day of surgery
How should once daily insulins be taken in relation to a patient whom is having an operation?
Reduce dose by 20% on day before, and day of, surgery
How should twice daily biphasic insulins, or ultra-long acting insulins be taken in relation to a patient whom is having an operation?
No dose change day before. On day of surgery, halve the usual morning dose, evening dose should be unchanged
What is the colorectal screening programme?
FIT screening kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland
What are the outcomes of colonoscopy in those that have been invited as a result of positive screening?
5/10 = normal result
4/10 = polyps, removed
1/10 - malignancy
Which drug is given to reduce the risk of vasospasm in aneurysmal SAH?
Nimodipine
What dose whole breast radiotherapy reduce the risk of in patients whom have had a WLE?
Recurrence - by approximately 2/3rds
Which drugs can increase the risk of pancreatitis?
Azathioprine
Mesalazine
Bendroflumethiazide
Furosemide
Pentamidine
Steroids
Sodium valproate
What is malignant hyperthermia?
A rare, serious side effect of volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane), which cause all skeletal muscle to rapidly contract, including during a neuromuscular blockade. MH is a genetic disorder, manifesting due to calcium overload in the skeletal muscle causing sustained muscular contraction and rhabdomyolysis, resulting in excess anaerobic metabolism causing acidosis. End-tidal CO2 increases as a result, along with body temperature which causes diaphoresis (excess sweating)
What are Grade I haemorrhoids?
Do not prolapse out of the anal canal
What are Grade II haemorrhoids?
Prolapse on defecation but reduce spontaneously
What are Grade III haemorrhoids?
Can be manually reduced
What are Grade IV haemorrhoids?
Cannot be reduced
What is Prehn’s sign?
Occurs in testicular torsion, when elevation of the testis does not ease the pain
What are the features of a breast abscess on ultrasound?
- Hypoechoeic collection
- Vascular rim around abscess
- No vascularity within the abscess
Which type of breast lump can display ‘popcorn calcification’?
Fibroadenoma
Which laxative should be use din the context of an ileostomy?
Magnesium sulphate
What type of cancer is most common in the oesophagus?
SCC
How can you distinguish between a paraumbilical and spiegelian hernia?
Paraumbilical - occur immediately ABOVE or BELOW the umbilicus
Spigelian - occur LATERAL to the umbilicus
How do you distinguish between epigastric and duodenal ulcers?
Duodenal = RELIEVED by eating, and therefore often patients gain weight
When are Hartmann’s procedures perfromed?
In emergency, e.g. perforation - end colostomy/ileostomy created (which can be reversed later)
When should women stop taking COCP/HRT prior to surgery?
28 days before
How do you treat an anal fissure refractory to GTN?
Sphincterotomy
Do congenital hernia (hernia in very young children) have high complication rates?
Yes - they should be referred for operative management
What is the first-line drug for BPH?
Alpha-1-antagonist
How should breast cysts be managed?
Aspiration
What is the most common type of breast cancer?
Invasive ductal carcinoma
What are the indications for a CT head within 1 hour?
- GCS < 13 on initial assessment
- GCS < 15 at 2 hrs post-injury
- Suspected open or depressed skull fracture
- Sign of basal skull fracture
- Post-traumatic seizure
- Focal neurological deficit.
- > 1 episode of vomiting
What are the indications for a CT head within 8 hours?
- > /= 65 y/o
- Hx of bleeding or clotting disorders/anticogulants
- Dangerous MOI
- > 30 mins retrograde amnesia
