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Capsule notes > Surgery > Flashcards

Surgery Flashcards

1
Q

Size of aortic aneurysm before you need surgical repair

A

> 5.4cm

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2
Q

when would you urgently repair aortic aneurysm

A

high risk of rupture e.g. symptomatic or rapid expansion

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3
Q

if an aortic aneurysm doesn’t meet criteria for elective repair what should you do?

A

USS every 1y if 3-4.4cm

USS every 3m if 4.4-5.4cm

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4
Q

define bulbar (and pseudobulbar palsy)

A

problems with impaired lower cranial nerves (either the lower motor neurons or to the lower cranial nerve itself)
pseudo = upper motor neurone damage, also have emotional lability

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5
Q

how do you repair AAA

A

CT to assess extent of leak

synthetic grafting or endovascular repair

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6
Q

management of cholangitis

A

IV fluid resus
lactate
Antibiotics
pigtail drain (cholecystostomy) until ERCP

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7
Q

two causes of acute limb ischaemia

A

embolus (very acute, AF)

thrombosis of atherosclerotic plaque (more gradual, intermittent claudication history)

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8
Q

CT scan shows swirled appearance of mesentery. What is the diagnosis

A

Internal herniation of bowel, sometimes after gastric bypass

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9
Q

what vein is usually affected in varicose veins

A

Superficial venous system, most likely long saphenous

Could be short saphenous in the posterior/lateral leg

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10
Q

X ray changes and clinical picture of diaphragmatic hiatal hernia

A

gastric air-fluid level behind mediastinum

Epigastric pain, SOB and reduced air entry

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11
Q

Signs of bowel obstruction

A

colicky abdo pain, distension, vomiting, absolute constipation
hyper-resonance, high-pitched tinkling

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12
Q

Signs of pancreatitis

A

vomiting, severe abdo pain better leaning forward

gallstone clues, jaundice

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13
Q

What cholangitis is UC associated with

A

primary sclerosing cholangitis

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14
Q

signs of acute decompensated liver disease

A

encephalopathy, increased jaundice, deteriorating transaminases

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15
Q

charcot’s triad

+2 for Reynold’s pentad

A

1) fever
2) jaundice
3) RUQ pain

hypotension and altered mental status

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16
Q

6 P’s of limb ischaemia

A 
PARAESTHESIA
PARALYSED
pulseless
pallor
perishingly cold
painful
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17
Q

antibodies in PBC

A

Anti-mitochondrial

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18
Q

findings of extrahepatic cholestasis

A

high ALP
high conj bilirubin and unconj bilirubin
caused by gallstones, bile duct strictures, tumours blocking bile flow

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19
Q

definitive treatment for PSC

A

liver transplant

before this they need fat soluble vitamin supplements

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20
Q

Arterial ulcer management

A

ABPI, optimal diabetic control, angioplasty, antiplatelet and statin

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21
Q

what is achalasia

A

rare motility disorder from oesophageal ganglion degeneration.

Difficulty swallowing liquids and solids, regurgitation of food, retrosternal chest pain

diagnosis confirmed via oesophageal manometry
management: surgical myotomy or pneumatic dilation

oesophageal cancer and chagas disease are risks

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22
Q

glasgow score criteria

A 
age >55
pO2 <8
WCC >15
Calcium <2
ALT >100
LDH >600
glucose >10
urea >16
albumin <32
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23
Q

features of arterial ulcers vs neuropathic ulcers

A

arterial: painful, sharply defined, loss of pulses, dusky and loss of hair
neuropathic: painless, sites of trauma/weight bearing, loss of sensation and reflexes, present pulses

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24
Q

what is Rockall score

A 
Upper GI bleed severity score
Shock signs
Age
Likely Diagnosis
Co-morbidities
stigmata of acute bleeding
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25
Q

Investigations for pancreatic cancer

A 
Ca19-9
USS and CT
ERCP
Cytology on pancreatic juice and bile
needle biopsy
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26
Q

Treatment options for pancreatic cancer

A

Supportive
palliation by endoscopic/transhepatic stenting of malignant stricutre
Surgical palliation by biliary bypass
Whipple’s procedure

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27
Q

causes of jaundice post abdo surgery

A 
haemorrhage
wound infection
wound dehiscence
delayed wound healing
renal failure
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28
Q

What liver pathology is associated with COCP

A

hepatocellular adenoma

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29
Q

what other organ gets cysts in ADPKD

A

liver, well-demarcated round cysts

will not enhance with IV contrast

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30
Q

What is amputation through the ankle joint called

A

Syme’s amputation

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31
Q

what is a gallbladder empyema

A

complication of cholecystitis where abscess forms. Swinging fevers and palpable gallbladder
will need cholecystectomy or cholecystostomy
may come from infected mucocoeles

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32
Q

Define Mirizzi syndrome

A

gallstone impacted in neck of gallbladder causes extrinsic compression of CBD resulting in obstructive jaundice

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33
Q

what is gallstone ileus

A

mechanical SBO as a result of fistulous connection between gallbladder and SB. Gallstone enters the small bowel, impacting the ileocaecal valve

34
Q 
Define following signs
Cullens
Murphy's
Rigler
Sister Joseph's
A

Cullens = periumbilical bruising in retroperitoneal haemorrhage
Murphy’s = pain on expiration when hand is over gallbladder
Rigler’s = air on both sides of intestine in pneumoperitoneum
Sister Joseph’s = nodule at umbilicus assoc with intra-abdominal neoplastic disease

35
Q

which two cancers usually spread to form cannonball mets

A

renal cell carcinoma

choriocarcinoma

36
Q

how would you treat venous ulcers

A

limb elevation, wound toilet and nonstick dressing, split-skin graft if required
treat varicose veins after ulcer

37
Q

What is Peutz-Jegher’s syndrome

A

multiple intestinal hamartomatous polyps
freckles
small bowel tumours, stomach, pancreas and colon
AD inheritance

38
Q

how to treat bleeding gastric ulcer

A

stabilise and resuscitate with major haemorrhage protocols

upper GI endoscopy then IV PPI

39
Q

which 3 tests can you assess varicose veins

A

Simple tourniquet: lying down, raise legs and milk veins so all blood is gone. tie tourniquet around thigh (sapheno-femoral junction) and ask to stand and assess if fill (no filling is incompetent)
Trendelenberg: same but with a finger at the junction
Doppler: reflux assessment. place over sapheno-femoral junction and squeeze calf. 2 sounds heard in incompetence

40
Q

indications for surgical treatment of varicose veins

A

oedema
skin changes
venous eczema and ulceration

41
Q

what is the BP target for resuscitating AAA

A

<100 to prevent re-bleeding if initial leak is sealed

42
Q

which two infections can cause Right Iliac Fossa mass

A

Tuberculosis, yersinia

43
Q

investigations for oesophageal carcinoma

A

OGD
CT CAP - nodal spread
endoscopic ultrasound - T and local N staging
PET scan - staging and distal mets and small lymph nodes which are still involved

44
Q

treatment for metastatic oesophageal cancer in non-regional node

A

palliative chemo
radiological insertion of oesophageal stent (severe dysphagia)
laser treatment

45
Q

treatment for oesophageal cancer with mets in regional node

A

curative oesphagectomy

46
Q

risk factors for oesophageal carcinoma

A

GORD (adeno)
smoking (SCC)
achalasia

47
Q

pancreatitis investigations

A

serum amylase (diagnostic if over 1000)
contrast CT diagnostic
USS to look for gallstones

48
Q

pancreatitis management

A

IV fluids (5L in 2-3h)
analgesia
BG
oral feeding within 24h - consider NG and slow enteral feeding

ABx only if septic
ERCP only if gallstone expected

49
Q

what complications may follow resolved pancreatitis

A

pseudocysts - may lead to pancreatic ascites

pancreatic abscess - features of sepsis

50
Q

management of pseudocyst

A

conservatively

drained percutaneously at endoscopic ultrasound

think about how pseudocyst formed - may need ERCP to identify any leak/insert stents

51
Q

investigations for pancreatic exocrine insufficiency

A

faecal elastase

clinical judgement

52
Q

management of pancreatic exocrine insufficiency

A

oral pancreatic enzyme replacement (Creon, pancreas V, nutrizyme)

53
Q

treatment for PBC

A

UCDA

54
Q

causes of free intra-peritoneal air

A

laparotomy within 24h
perforated duodenal ulcer
perforated diverticulum

55
Q

causes of free retro-peritoneal air

A

perforated 3rd part duodenum, ascending colon or descending colon

56
Q

stress-induced ulcer after burns

Where is it?

A

Curling’s ulcer

stomach/duodenum

57
Q

ulcer after raised icp

A

Cushings ulcer

58
Q

what is zollinger ellison syndrome

A

peptic ulceration secondary to gastrin-secreting tumours

assoc with men1

59
Q

treatment for gallstone ileus

A

enterolithotomy and fistula repair

60
Q

what is a Marjolin ulcer

A

chronic venous ulcer undergoes SCC malignant change. Edges become raised/thickened and it becomes more painful

61
Q

investigation for renal stone

A

non-contrast of CT

62
Q

cytology finding on fibrocystic disease

A

cell debris and no malignant cells

63
Q

best analgesia for people with severe COPD

A

do not use opioids or NSAIDs

can use epidural

64
Q

when do leaking anastamoses usually present after surgery

A

day 3-5

65
Q

investigations for people with thyroid nodule and are euthyroid

A

USS neck

66
Q

investigation for people with thyroid nodule and are hyperthyroid

A

antibodies and scintigraphy

67
Q

best investigation for right sided hearing loss with normal tympanometry

A

MR internal acoustic meatus

68
Q

management for acute cholecystitis with normal LFTs and normal common bile duct

A

laparoscopic cholecystectomy

ERCP only if you’re worried about common bile duct issues

69
Q

fasting times before general anaesthetic

A

2h clear liquids, 6h foods

70
Q

management for stone causing obstruction, hydronephrosis and sepsis

A

nephrostomy as you need to drain the pus otherwise abx won’t work

then lithotripsy or stone extraction

71
Q

what nodes do the ovarian lymphatics drain to

A

para-aortic

72
Q

referral of pain from originally foregut structures

A

epigastrium

73
Q

referral of pain from originally midgut structures

A

umbilical

74
Q

referral of pain from originally hindgut structures

A

hypogastric

75
Q

radiation of pain from retroperitoneal structures

A

back

76
Q

what is rovsing’s sign

A

pain in right IF when left felt

appendicitis

77
Q

scoring for appendicitis

A

alvorado

>4 = likely appendicitis

78
Q

which neck lump moves with tongue protrusion but not swallowing

A

thyroglossal mass

79
Q

which neck lump moves with swallowing but not tongue protrusion

A

thyroid

80
Q

how to tell the difference between indirect and direct hernia

A

reduce hernia, occlude the deep ring and ask them to cough

indirect hernia will not come back

81
Q

how to tell difference between inguinal and femoral hernia

A

femoral is below crease of groin, low and lateral to pubic tubercle

82
Q

do hernias need to be surgically treated?

A

yes if complications or femoral

Capsule notes (7 decks)

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