Surgery Flashcards
1
Q
fistula
A
an abnormal connection between two epithelial surfaces
2
Q
Hartmann’s procedure
A
removal of rectosigmoid colon
closure of anal stump
colostomy
3
Q
Whipple’s procedure
A
removal of head of pancreas, duodenum, gallbladder and bile duct
4
Q
Hockey stick incision
A
renal transplant
5
Q
Absorbable stiches 2
A
vicryl
monocryl
6
Q
non absorbable stitches 2
A
nylon
polypropylene
7
Q
WHO checklist times
A
before induction
before first incision
before patient leaves theatre
8
Q
WHO checklist contents
A
intros identity allergy operation bleeding risk anticipated events equipment count
9
Q
3 ix before surgery
A
ECG if >65yo or heart disease
HbA1c within 3 months for all DM
U&Es for patients at risk of AKI/taking diuretics
10
Q
stop warfarin when?
A
5 days before
11
Q
when is warfarin bridging needed
A
high risk (mechanical valves, recent VTE) LMWH or unfractioned heparin
12
Q
when to stop HRT/COCP
A
4 weeks before
13
Q
how to deal with steroid dependent patients
A
IV hydrocortisons at induction and for 24h post op
double oral dose once E+D
14
Q
how to deal with insulin dependent diabetics
A
stop short acting insulin while fsting
continue long acting insulin at 80%
sliding scale with gluocse, salien and K+
15
Q
3 aims of post op analgesia
A
mobilise
ventilate
adequate oral intake
16
Q
RF for post op N+V
A
female motion sickness previous PONV non smoker opiates younger volatile anaesthetics
17
Q
how to give TPN
A
centrally
thromboplebitis risk
18
Q
presentation og thrid spacing
A
hypovolaemia
fluid overload
19
Q
excessive dextrose causes
A
hyponatraemia
oedema
20
Q
excessive saline causes
A
hyperchloraemia metabolic acidosis
21
Q
when to use human albumin solution
A
decompensates liver disease to rebalance oncotic presure
22
Q
isotonic fluids
A
normal saline
hartmanns
23
Q
hypotonic fluids
A
dextrose
0.18% saline
24
Q
hypertonic fluids
A
3% saline
25
fluid requirements
25-30ml/kg/day water
1mmol/kg/day electrolytes
50-100g glucose/day to prevent ketosis
26
recommended maintenance regime
25-30ml/kg/day of 0.18% saline in 4% glucose with 27mmol K+
27
px of appendicitis but ix negative
diagnostic laparoscopy
28
meckels diverticulum
a malformation of the distal ileum that is usually asymptomatic but can bleed, inflame or rupture, or cause a volvulus or intussusception
29
mechanism of third spacing
GI tract secretes fluid normally
obstruction prevent fluid getting to large bowel to be reabsorbed
accumulation of fluid in bowel
30
3 main causes of bowel obstruction
adhesions (small)
hernia (small)
tumours (large)
31
2 mechanisms of closed loop obstruction
2 points of obstruction
| 1 obstruction distal to competant ileocaecal valce
32
initial management of obstruction
drip and suck
33
ix for bowel obstruction
U&Es then contrast CT
34
ileus vs pseudoobstruction
```
ileus = small bowel
pseduo = large bowel
```
35
bowel sounds in mechanical vs non mechanical obstruction
tinkling in mechanical
| absent in non mechanical
36
coffee bean sign means
volvulus
37
location of volvulus
sigmoid
38
3 causes of volvulus
chronic constipation
high fibre diet
excessive laxatives
39
management of volvulus
endoscopic decompression in left lateral position and flatus tube
40
3 complications of hernias
incarceration (irreducible)
strangulation
obstruction
41
classification of haemorrhoids
1st - no prolapse
2nd - prolapse only on straining
3rd - can be pushed back
4th - cannot be pushed back
42
how to diagnose internal haemorrhoids
protoscopy as often not felt on PR
43
how does anusol work
shrinks haemorrhoids
44
non surgical treatments of haemorrhoids
rubber band ligation
injection sclerotherapy
infrared coagulation
bipolar diathermy
45
surgical treatments of haemorrhoids
artery ligation
haemorroidectomy
stapled
46
thrombosed haemorrhoids
strangulation
purple
v painful - admit for pain relief
47
diverticulosis
presence of diverticula
48
diverticular disease
symptomatic
49
diverticulitis
infectin of inflammation
50
where do diverticula never form and why
rectum
| supported by outer longitudinal muscle
51
which laxatives in diverticular disease
bulk forming
| never stimulant
52
what is a mass in acute diverticulitis
abscess
53
management of acute diverticulitis
PO coamoxiclav 5 days
analgesia (not NSIAD/opiate)
clear fluids only 2 days
admit if severe
54
complications of diverticula
```
perforation
peritonitis
peridiverticular abscess
large haemorrhage
fistula
ileus or obstruction
```
55
foregut artery
coealic artery
56
midgut artery
superior mesenteric
57
hindgut artery
inferior mesenteric
58
ix for acute mesenteric ischaemis
contrast CT
59
ix for chronic mesenteric ischamia
CT angiography
60
cause of acute mesenteric ischaemis
thrombus secondary to AF
61
management of chronic mesenteric ischaemia
percutaneous stenting
62
bowel cancer screening
Home FIT tests
2 yearly
60-74yo
63
second line ix if pt cant have colonscopy
CT colonography
64
use of CEA
predict relapse
65
acute cholecystitis on USS
thick gallbladder wall
stones or sludge in gallbladder
fluid
66
when is MRCP used
if USS does not show stones but does show duct dilation, or bilirubin is raised
67
5 uses of ERCP
```
contrast injection and XR
spincterotomy
stone clearance
stent insertion
biopsy
```
68
incision for open cholescystectomy
right subcostal Kocher incision
69
cause of acalculus cholecystitis
prolonged fasting causing bile build up
70
charcots triad
fever
jaundice
RUQ pain
71
2nd line after ERCP
percutaneous transhepatic cholangiogram drain
72
what and where is cholangiocarcinoma
adenocarcinoma
| where R and L ducts join to form CBD
73
presentation of pancreatic cancer
jaundice
new diabetics
rapidly worsening diabetes
74
pancreatic ca referral
>40 jaundice = 2ww
| >60 wt loss + 1 symptoms = direct CT
75
Trousseau's sign of malignancy
migratory thrombophlebitis
76
immunosuppression following liver transplant
steroids
tacrolimis
azathioprine
77
incision for liver transplant
rooftop or Mercedes benz
78
describe internal bladder sphincter
smooth muscle
| autonomic
79
describe external bladder sphincter
skeletal muscle
| voluntary
80
where is the renal angle
between 12th rib and spine
81
causes of a nephrogenic bladder
```
MS
DM
stroke
Parkinson's
brain/SC injury
spina bifida
```
82
define hydronephrosis
swelling of the renal pelvis and calyces
83
where does idiopathic hydronephrosis occur
pelviureteric junction
84
when to catheterise in retention
>500ml post void
85
drug for BPH acute retention
tamsulosin
86
mechanism and SE of tamsulosin
alpha blocker
smooth muscle relaxer
SE: postural hypotension
87
mechanism and SE of finasteride
5a reductase inhibitor
blocks conversion of testosterone to DHT
gradually shrinks prostate over several months
SE: erectile dysfunction
88
time for chronic prostatitis
3 months
89
when to treat chronic prostatitis and for how long
treat if sx <6/12 or infection hx
| treat for 6 weeks doxycycline
90
acute prostatitis treatment
ofloxacin 2-4 weeks
91
fluctuant mass on PR
prostate abscess - acute prostatitis
92
where does prostate cancer spread
lymph nodes
| bones
93
2 scans for prostate csncer
multiparametric MRI
| isotope bone scan
94
SE and management for external beam RT
proctitis - pred suppository
95
4 organisms for epidiymoorchitis
e coli
chlamydia
gonorrhoea
mumps
96
urethral discharge + epidymoorchitis =
STI
97
1 positive and 2 negatives of quinolones
good for gram -ve
tendon rupture
lowers seizure threshold
98
what is testicular torsion
twisting of the spermatic cord
99
common deformity in testicular torsion
bell clapper
100
torsion USS sign
whirlpool
101
what is hydrocele
fluid in tunica vaginalis
102
left sided varicocele suggests
obstruction of left testicular vein caused by renal cell carcinoma
103
varicocele that doesnt disapper when laying down
retroperitoneal tumour blocking renal vein
104
AFP raised in
teratoma
105
BhCG raised in
teratoma and seminoma
106
lactate raised in
non specific testicular cancer
107
best indicator of UTI on dipstick
nitrites
108
nitrite -ve, RBC -ve, leu +ve
don't treat unless clinically indicated
109
why avoid nitro in 3rd trimester
neonatal haemolysis
110
who to avoid nitro in
eGFR <45
111
abx length for simple uti
3 days
112
7 day abx for uti for...
men
pregnant women
catheter
113
5-10 days abx for uti for...
immunosuppressed
abnormal anatomy
impaired renal function
114
severe pyelonephritis that's not responding to Rx
renal abscess
| kidney stone
115
Ix for recurrent pyelonephritis
DMSA scan for scarring
116
cystoscopy findings doe interstitial cystitis
hunner lesions
| granulations
117
bladder cancer histology
transitional cells carcinoma
| squamous if schistosomiasis
118
which kidney stone is not seen on XR
uric acid
119
cystine stones
autosomal recessive
120
scan for kidney stones
NCCTKUB within 24 hours
121
drug to help stones pass
tamsulosin
122
drugs for recurrent stones
potassium citrate
| thiazides
123
histology of renal cell cancer
clear cell adenocarcinoma
124
cannonball mets are seen in
renal cell cancer
125
how may renal cell cancer present
paraneoplastic syndromes - polycythaemic, HTN, hypercalcaemia, Stauffer's syndrome
126
how to match renal transplants
HLA ABC on chromsome 6
127
where are renal transplants connected
external iliac vessels
128
OSCE findings for renal transplant
hockey stick incision
| palpable mass in iliac fossa
129
SE of tacrolimus
tremor
130
SE of cyclosporin
gum hypertrophy
131
O/E for immunosuppression
seborrhoeic warts
| skin cancers
132
leriche syndrome
occlusion of the distal aorta or proximal common iliac artery causing thigh/buttock pain, absent femoral pulses and male impotence
133
arterial disease colour
dependent rubor
134
buerger's test colours
pale on raising
blue on lowering
red after lowering
135
high ABPI
calcification in DM
136
critical limb ischaemia ABPI
<0.3
137
venous ulcers MDT
```
vascular surgery
tissue viability
dermatology
pain clinics
DM ulcer clinic
```
138
drugs to avoid in venous ulcers
NSAIDs
139
bilateral DVT
misdiagnosis of chronic venous insufficiency or HF
140
how to measure for a DVT
10cm below tibial tuberosity
| 3cm difference
141
when to use VQ scan
sig renal impairment
| contrast allergy
142
DVT in APA
warfarin and LMWH
143
varicose veins
distended superficial veins >3mm in diameter
144
reticular veins
dilated blood vessels in the skin 1-3mm in diameter
145
telangectasia
dilated blood vessels in the skin <1mm in diameter
146
cause of varicose veins
incompetent valves in the perforators
147
signs of chronic venous insufficiency
haemosiderin staining
venous staining
lipodermatosclerosis
148
tests for varicose veins
```
tap test
cough test
Trendelenburg test
Perthe test
duplex USS
```
149
Rx of varicose veins
lifestyle
endothermal ablation
sclerotherapy
stripping
150
Rx of CVI
emollients
topical steroid for venous eczema
potent steroid for lipodermatosclerosis
151
Panniculitis
inflammation of SC fat
152
atrophie blanche
patches of smooth white scar tissue on the skin, often surrounded by hyperpigmentation
153
lymphodema content
protein rich
154
lymphoedema vs lipodema
lipodema spares feet
155
how to measure limb volume
```
circumfrential measurements
water displacement
perometry
bioelectric impedence spectrometry
lymphoscintigraphy
```
156
Rx for lymphoedema
```
massage
specific exercises
compression stockings
weight loss
skin care
lymphaticovenular anastamosis
```
157
AAA size for yearly scan
3-4.5cm
158
AAA size for 3 monthly scans
4.5-5.5cm
159
elective AAA repair
symptomatic
growing >1cm/year
growing >0.5cm/6 months
diameter >5.5cm
160
when to inform DVLA for aneurysm
>6cm
161
when to stop driving for aneurysm
>6.5cm
162
how to confirm AAA rupture
```
unstable = theatre
stable = CT angiogram
```
163
where does aortic dissection typically affect
right lateral ascending aorta
164
Type A dissection
ascending before brachiocephalic
165
Type B dissection
descending after left subclavian
166
RF for dissection
```
aortic conditions (biscuspid, coarctation, valve replacement, CABG)
connective tissue disease
```
167
bp in dissection
initially HTN then hypotensive
difference between arms
radial pulse deficit
168
problem with MI + dissection
thrombolysis can cause fatal progression of dissetion
169
Ix for dissection
USS
| CT angiogram
170
complications of dissection
```
MI
CVA
paraplegia
tamponade
AR
death
```
171
nerve injuries in endarterectomy
facial (marginal mandibular) - lower lip droop
glossopharyngeal - dysphagia
recurrent laryngeal - hoarse
hypoglossal - unilateral tongue paralysis
172
Buerger disease aka
thromboangiitis obliterans
173
Buerger disease ix
corkscrew collaterals on angiogram
174
Buerger disease px
blue fingers/toes
