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Phase 4 > Surgery > Flashcards

Surgery Flashcards

1
Q

fistula

A

an abnormal connection between two epithelial surfaces

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2
Q

Hartmann’s procedure

A

removal of rectosigmoid colon
closure of anal stump
colostomy

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3
Q

Whipple’s procedure

A

removal of head of pancreas, duodenum, gallbladder and bile duct

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4
Q

Hockey stick incision

A

renal transplant

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5
Q

Absorbable stiches 2

A

vicryl

monocryl

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6
Q

non absorbable stitches 2

A

nylon

polypropylene

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7
Q

WHO checklist times

A

before induction
before first incision
before patient leaves theatre

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8
Q

WHO checklist contents

A 
intros
identity
allergy
operation
bleeding risk
anticipated events
equipment count
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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

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10
Q

stop warfarin when?

A

5 days before

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11
Q

when is warfarin bridging needed

A 
high risk (mechanical valves, recent VTE)
LMWH or unfractioned heparin
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12
Q

when to stop HRT/COCP

A

4 weeks before

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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

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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+

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15
Q

3 aims of post op analgesia

A

mobilise
ventilate
adequate oral intake

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16
Q

RF for post op N+V

A 
female
motion sickness
previous PONV
non smoker
opiates
younger
volatile anaesthetics
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17
Q

how to give TPN

A

centrally

thromboplebitis risk

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18
Q

presentation og thrid spacing

A

hypovolaemia

fluid overload

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19
Q

excessive dextrose causes

A

hyponatraemia

oedema

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20
Q

excessive saline causes

A

hyperchloraemia metabolic acidosis

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21
Q

when to use human albumin solution

A

decompensates liver disease to rebalance oncotic presure

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22
Q

isotonic fluids

A

normal saline

hartmanns

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23
Q

hypotonic fluids

A

dextrose

0.18% saline

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24
Q

hypertonic fluids

A

3% saline

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25
Q

fluid requirements

A

25-30ml/kg/day water
1mmol/kg/day electrolytes
50-100g glucose/day to prevent ketosis

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26
Q

recommended maintenance regime

A

25-30ml/kg/day of 0.18% saline in 4% glucose with 27mmol K+

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27
Q

px of appendicitis but ix negative

A

diagnostic laparoscopy

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28
Q

meckels diverticulum

A

a malformation of the distal ileum that is usually asymptomatic but can bleed, inflame or rupture, or cause a volvulus or intussusception

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29
Q

mechanism of third spacing

A

GI tract secretes fluid normally
obstruction prevent fluid getting to large bowel to be reabsorbed
accumulation of fluid in bowel

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30
Q

3 main causes of bowel obstruction

A

adhesions (small)
hernia (small)
tumours (large)

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31
Q

2 mechanisms of closed loop obstruction

A

2 points of obstruction

1 obstruction distal to competant ileocaecal valce

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32
Q

initial management of obstruction

A

drip and suck

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33
Q

ix for bowel obstruction

A

U&Es then contrast CT

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34
Q

ileus vs pseudoobstruction

A 
ileus = small bowel
pseduo = large bowel
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35
Q

bowel sounds in mechanical vs non mechanical obstruction

A

tinkling in mechanical

absent in non mechanical

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36
Q

coffee bean sign means

A

volvulus

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37
Q

location of volvulus

A

sigmoid

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38
Q

3 causes of volvulus

A

chronic constipation
high fibre diet
excessive laxatives

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39
Q

management of volvulus

A

endoscopic decompression in left lateral position and flatus tube

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40
Q

3 complications of hernias

A

incarceration (irreducible)
strangulation
obstruction

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41
Q

classification of haemorrhoids

A

1st - no prolapse
2nd - prolapse only on straining
3rd - can be pushed back
4th - cannot be pushed back

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42
Q

how to diagnose internal haemorrhoids

A

protoscopy as often not felt on PR

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43
Q

how does anusol work

A

shrinks haemorrhoids

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44
Q

non surgical treatments of haemorrhoids

A

rubber band ligation
injection sclerotherapy
infrared coagulation
bipolar diathermy

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45
Q

surgical treatments of haemorrhoids

A

artery ligation
haemorroidectomy
stapled

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46
Q

thrombosed haemorrhoids

A

strangulation
purple
v painful - admit for pain relief

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47
Q

diverticulosis

A

presence of diverticula

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48
Q

diverticular disease

A

symptomatic

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49
Q

diverticulitis

A

infectin of inflammation

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50
Q

where do diverticula never form and why

A

rectum

supported by outer longitudinal muscle

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51
Q

which laxatives in diverticular disease

A

bulk forming

never stimulant

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52
Q

what is a mass in acute diverticulitis

A

abscess

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53
Q

management of acute diverticulitis

A

PO coamoxiclav 5 days
analgesia (not NSIAD/opiate)
clear fluids only 2 days
admit if severe

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54
Q

complications of diverticula

A 
perforation
peritonitis
peridiverticular abscess
large haemorrhage
fistula
ileus or obstruction
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55
Q

foregut artery

A

coealic artery

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56
Q

midgut artery

A

superior mesenteric

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57
Q

hindgut artery

A

inferior mesenteric

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58
Q

ix for acute mesenteric ischaemis

A

contrast CT

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59
Q

ix for chronic mesenteric ischamia

A

CT angiography

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60
Q

cause of acute mesenteric ischaemis

A

thrombus secondary to AF

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61
Q

management of chronic mesenteric ischaemia

A

percutaneous stenting

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62
Q

bowel cancer screening

A

Home FIT tests
2 yearly
60-74yo

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63
Q

second line ix if pt cant have colonscopy

A

CT colonography

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64
Q

use of CEA

A

predict relapse

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65
Q

acute cholecystitis on USS

A

thick gallbladder wall
stones or sludge in gallbladder
fluid

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66
Q

when is MRCP used

A

if USS does not show stones but does show duct dilation, or bilirubin is raised

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67
Q

5 uses of ERCP

A 
contrast injection and XR
spincterotomy
stone clearance
stent insertion
biopsy
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68
Q

incision for open cholescystectomy

A

right subcostal Kocher incision

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69
Q

cause of acalculus cholecystitis

A

prolonged fasting causing bile build up

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70
Q

charcots triad

A

fever
jaundice
RUQ pain

71
Q

2nd line after ERCP

A

percutaneous transhepatic cholangiogram drain

72
Q

what and where is cholangiocarcinoma

A

adenocarcinoma

where R and L ducts join to form CBD

73
Q

presentation of pancreatic cancer

A

jaundice
new diabetics
rapidly worsening diabetes

74
Q

pancreatic ca referral

A

> 40 jaundice = 2ww

>60 wt loss + 1 symptoms = direct CT

75
Q

Trousseau’s sign of malignancy

A

migratory thrombophlebitis

76
Q

immunosuppression following liver transplant

A

steroids
tacrolimis
azathioprine

77
Q

incision for liver transplant

A

rooftop or Mercedes benz

78
Q

describe internal bladder sphincter

A

smooth muscle

autonomic

79
Q

describe external bladder sphincter

A

skeletal muscle

voluntary

80
Q

where is the renal angle

A

between 12th rib and spine

81
Q

causes of a nephrogenic bladder

A 
MS
DM
stroke
Parkinson's
brain/SC injury
spina bifida
82
Q

define hydronephrosis

A

swelling of the renal pelvis and calyces

83
Q

where does idiopathic hydronephrosis occur

A

pelviureteric junction

84
Q

when to catheterise in retention

A

> 500ml post void

85
Q

drug for BPH acute retention

A

tamsulosin

86
Q

mechanism and SE of tamsulosin

A

alpha blocker
smooth muscle relaxer
SE: postural hypotension

87
Q

mechanism and SE of finasteride

A

5a reductase inhibitor
blocks conversion of testosterone to DHT
gradually shrinks prostate over several months
SE: erectile dysfunction

88
Q

time for chronic prostatitis

A

3 months

89
Q

when to treat chronic prostatitis and for how long

A

treat if sx <6/12 or infection hx

treat for 6 weeks doxycycline

90
Q

acute prostatitis treatment

A

ofloxacin 2-4 weeks

91
Q

fluctuant mass on PR

A

prostate abscess - acute prostatitis

92
Q

where does prostate cancer spread

A

lymph nodes

bones

93
Q

2 scans for prostate csncer

A

multiparametric MRI

isotope bone scan

94
Q

SE and management for external beam RT

A

proctitis - pred suppository

95
Q

4 organisms for epidiymoorchitis

A

e coli
chlamydia
gonorrhoea
mumps

96
Q

urethral discharge + epidymoorchitis =

A

STI

97
Q

1 positive and 2 negatives of quinolones

A

good for gram -ve
tendon rupture
lowers seizure threshold

98
Q

what is testicular torsion

A

twisting of the spermatic cord

99
Q

common deformity in testicular torsion

A

bell clapper

100
Q

torsion USS sign

A

whirlpool

101
Q

what is hydrocele

A

fluid in tunica vaginalis

102
Q

left sided varicocele suggests

A

obstruction of left testicular vein caused by renal cell carcinoma

103
Q

varicocele that doesnt disapper when laying down

A

retroperitoneal tumour blocking renal vein

104
Q

AFP raised in

A

teratoma

105
Q

BhCG raised in

A

teratoma and seminoma

106
Q

lactate raised in

A

non specific testicular cancer

107
Q

best indicator of UTI on dipstick

A

nitrites

108
Q

nitrite -ve, RBC -ve, leu +ve

A

don’t treat unless clinically indicated

109
Q

why avoid nitro in 3rd trimester

A

neonatal haemolysis

110
Q

who to avoid nitro in

A

eGFR <45

111
Q

abx length for simple uti

A

3 days

112
Q

7 day abx for uti for…

A

men
pregnant women
catheter

113
Q

5-10 days abx for uti for…

A

immunosuppressed
abnormal anatomy
impaired renal function

114
Q

severe pyelonephritis that’s not responding to Rx

A

renal abscess

kidney stone

115
Q

Ix for recurrent pyelonephritis

A

DMSA scan for scarring

116
Q

cystoscopy findings doe interstitial cystitis

A

hunner lesions

granulations

117
Q

bladder cancer histology

A

transitional cells carcinoma

squamous if schistosomiasis

118
Q

which kidney stone is not seen on XR

A

uric acid

119
Q

cystine stones

A

autosomal recessive

120
Q

scan for kidney stones

A

NCCTKUB within 24 hours

121
Q

drug to help stones pass

A

tamsulosin

122
Q

drugs for recurrent stones

A

potassium citrate

thiazides

123
Q

histology of renal cell cancer

A

clear cell adenocarcinoma

124
Q

cannonball mets are seen in

A

renal cell cancer

125
Q

how may renal cell cancer present

A

paraneoplastic syndromes - polycythaemic, HTN, hypercalcaemia, Stauffer’s syndrome

126
Q

how to match renal transplants

A

HLA ABC on chromsome 6

127
Q

where are renal transplants connected

A

external iliac vessels

128
Q

OSCE findings for renal transplant

A

hockey stick incision

palpable mass in iliac fossa

129
Q

SE of tacrolimus

A

tremor

130
Q

SE of cyclosporin

A

gum hypertrophy

131
Q

O/E for immunosuppression

A

seborrhoeic warts

skin cancers

132
Q

leriche syndrome

A

occlusion of the distal aorta or proximal common iliac artery causing thigh/buttock pain, absent femoral pulses and male impotence

133
Q

arterial disease colour

A

dependent rubor

134
Q

buerger’s test colours

A

pale on raising
blue on lowering
red after lowering

135
Q

high ABPI

A

calcification in DM

136
Q

critical limb ischaemia ABPI

A

<0.3

137
Q

venous ulcers MDT

A 
vascular surgery
tissue viability
dermatology
pain clinics
DM ulcer clinic
138
Q

drugs to avoid in venous ulcers

A

NSAIDs

139
Q

bilateral DVT

A

misdiagnosis of chronic venous insufficiency or HF

140
Q

how to measure for a DVT

A

10cm below tibial tuberosity

3cm difference

141
Q

when to use VQ scan

A

sig renal impairment

contrast allergy

142
Q

DVT in APA

A

warfarin and LMWH

143
Q

varicose veins

A

distended superficial veins >3mm in diameter

144
Q

reticular veins

A

dilated blood vessels in the skin 1-3mm in diameter

145
Q

telangectasia

A

dilated blood vessels in the skin <1mm in diameter

146
Q

cause of varicose veins

A

incompetent valves in the perforators

147
Q

signs of chronic venous insufficiency

A

haemosiderin staining
venous staining
lipodermatosclerosis

148
Q

tests for varicose veins

A 
tap test
cough test
Trendelenburg test
Perthe test
duplex USS
149
Q

Rx of varicose veins

A

lifestyle
endothermal ablation
sclerotherapy
stripping

150
Q

Rx of CVI

A

emollients
topical steroid for venous eczema
potent steroid for lipodermatosclerosis

151
Q

Panniculitis

A

inflammation of SC fat

152
Q

atrophie blanche

A

patches of smooth white scar tissue on the skin, often surrounded by hyperpigmentation

153
Q

lymphodema content

A

protein rich

154
Q

lymphoedema vs lipodema

A

lipodema spares feet

155
Q

how to measure limb volume

A 
circumfrential measurements
water displacement
perometry
bioelectric impedence spectrometry
lymphoscintigraphy
156
Q

Rx for lymphoedema

A 
massage
specific exercises
compression stockings
weight loss
skin care
lymphaticovenular anastamosis
157
Q

AAA size for yearly scan

A

3-4.5cm

158
Q

AAA size for 3 monthly scans

A

4.5-5.5cm

159
Q

elective AAA repair

A

symptomatic
growing >1cm/year
growing >0.5cm/6 months
diameter >5.5cm

160
Q

when to inform DVLA for aneurysm

A

> 6cm

161
Q

when to stop driving for aneurysm

A

> 6.5cm

162
Q

how to confirm AAA rupture

A 
unstable = theatre
stable = CT angiogram
163
Q

where does aortic dissection typically affect

A

right lateral ascending aorta

164
Q

Type A dissection

A

ascending before brachiocephalic

165
Q

Type B dissection

A

descending after left subclavian

166
Q

RF for dissection

A 
aortic conditions (biscuspid, coarctation, valve replacement, CABG)
connective tissue disease
167
Q

bp in dissection

A

initially HTN then hypotensive
difference between arms
radial pulse deficit

168
Q

problem with MI + dissection

A

thrombolysis can cause fatal progression of dissetion

169
Q

Ix for dissection

A

USS

CT angiogram

170
Q

complications of dissection

A 
MI
CVA
paraplegia
tamponade
AR
death
171
Q

nerve injuries in endarterectomy

A

facial (marginal mandibular) - lower lip droop
glossopharyngeal - dysphagia
recurrent laryngeal - hoarse
hypoglossal - unilateral tongue paralysis

172
Q

Buerger disease aka

A

thromboangiitis obliterans

173
Q

Buerger disease ix

A

corkscrew collaterals on angiogram

174
Q

Buerger disease px

A

blue fingers/toes

Phase 4 (7 decks)

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