Surgery Flashcards
Features of mammary duct ectasia?
Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
Anatomy of direct and indirect inguinal hernias?
Direct:
Protrudes through Hesselback triangle
Passes medial to the inferior epigastric artery
Indirect:
Protrudes through the inguinal ring
Passes lateral to the inferior epigastric artery
Cause of direct and indirect inguinal herniae?
Direct:
Defect or weakness in the transversalis fascia area of the Hesselbach triangle
Indirect:
Failure of the processus vaginalis to close
Risk of strangulation in inguinal herniae compared to femoral?
Low in inguinal, high in femoral
Ages of inguinal herniae?
older - direct
Indirect - may occur in children
Location appearance and output for ileostomy vs colostomy?
Ileostomy
- Right iliac fossa
- Spouted
- Liquid output
Colostomy
- More likely left, can be anywhere
- Flush to the skin
- Solid output
Peptic ulcers pain follwoign eating, which is which>
Gastric - worse by eating
Duodenal - better after eating
Up to how long would finasteride take to work for BPH?
6 months
Rules for sulphonylureas when going to have surgery?
- omit on the day of surgery
- exception is morning surgery in patients who take BD - they can have the afternoon dose
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).
Management of fibroadenoma?
<3cm then monitor
> 3cm may need to excise
What is the cut-off age for an unexplained breast lump to be referred under 2ww
30 years
Can have non-urgent referral if under 30
How to manage congenital inguinal hernia?
Urgent referral due to incarceration risk
PSA levels increased due to what and how long ago?
6 weeks of a prostate biopsy 4 weeks following a proven urinary infection 1 week of digital rectal examination 48 hours of vigorous exercise 48 hours of ejaculation
What is first-line in treating BPH?
alpha-1 antagonists e.g. tamsulosin, alfuzosin
Most common type of breast cancer?
Invasive ductal carcinoma
non-surgical treatments for breast cancer?
Radiotherapy - T3/4 and those who have had wide local excision.
Hormonal - if they have +ve receptors (ER, HER, PR) use tamoxifen in pre and peri-menopausal. If they are post menopausal and ER receptor +ve then anastrazole
Biological - herceptin (trastuzumab) if HER2 +ve could be considered
Chemo- depends on situation.
What factors would mean mastectomy over wide local excision for breast cancer?
mastectomy:
- Multifocal
- Central
- Large lesion in small breast
- DCIS >4cm
The opposite would lead to wide local excision.
When is the screening for AAA? What is it?
Single abdo USS >65yrs
Most common bacteria in breast abscess?
Staphylococcus aureus
Adverse effects of aromatase inhibitors (anastrazole)
osteoporosis - NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer hot flushes arthralgia, myalgia insomnia
Adverse effects of Tamoxifen
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer
NHS breast cancer screenign programme details?
The NHS Breast Screening Programme is offered to women between the ages of 50-70 years. Women are offered a mammogram every 3 years. After the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments’.
Management of oral metformin prescription when undergoing surgery?
OD or BD: take as normal
TDS: miss lunchtime dose
What are the details of the colorectal cancer screening programme in the UK?
One off colonoscopy was abandoned.
We now offer FIT tests every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland. Patients aged over 74 years may request screening.
What GA would you use to induce someone who has had N&V post op before ?
Propofol (it has antiemetic actions).
what do you offer men post vasectomy to confirm success?
Semen analysis at 16 and 20 weeks.
Oral antidiabetic meds day before surgery?
All oral antidiabetic medications should be taken as normal the day before surgery
Complications of measles?
otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis
clenched hands, rocker bottom feet and clubbed feet in a foetus might indicate?
Edwards
What could you prescribe for labial adhesions if there are complications?
Oestrogen cream
What are the causes of cyanotic congenital heart disease?
tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia
What is Caput succedaneum?
Caput succedaneum describes oedema of the scalp at the presenting part of the head, typically the vertex. This may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery.
No treatment needed.
Difference between Caput Succadeneum and Cephalohaematoma?
Haematoma does not cross suture lines and will take months to resolve
Caput will resolve within days.
What investigation do all breech babies get if born after 36 weeks?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
What is benign rolandic epilepsy?
seizures characteristically occur at night
seizures are typically partial (e.g. paraesthesia affecting face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements)
child is otherwise normal
First line management for paediatric constipation?
diet advice and movicol
Emergency treatment for croup? (in hospital)
high-flow oxygen
nebulised adrenaline
Presentation of Roseola Infantum or Sixth disease?
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
What genetic condition is associated with aortic stenosis?
Williams syndrome
What genetic syndromes cause hypotonia in kids?
Down’s syndrome - most common
Prader-Willi syndrome
Management of bow leggedness in kids <3?
Normal variant - reassurance
If you can’t get ‘above’ a testicular swelling - likely diagnosis?
Inguinal hernia
Features of hydrocele?
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
the swelling is confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates with a pen torch
the testis may be difficult to palpate if the hydrocele is large
Features of varcocele?
Diffuse painless swelling - lumpy/bag of worms separate from testicle.
Failure rate of male sterilisation?
1 in 2,000
What is a duct papilloma, how does one present?
Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge
What is a hartmanns procedure, when would you perform?
Resection of the sigmoid colon is performed and an end colostomy is fashioned
Lesion in the sigmoid with perforation.
resection for lesions in Distal transverse, descending colon?
Left hemi
resection for Caecal, ascending or proximal transverse colon lesions?
Right hemi
Resection for lesions in the sigmoid?
High anterior resection
Resection for lesions in the rectum?
Anterior resection
if anal verge then Abdomino-perineal excision of rectum
Testicular cancer seminoma or teratoma better survival?
Seminoma
What medication is used to prevent cerebral vasospasm in SAH?
Nimodipine
Management of asymptomatic inguinal herniae?
routine referral for repair
Management of breast cysts?
Cysts should be aspirated, those which are blood stained or persistently refill should be biopsied or excised
Haemorrhoid grades?
Grade I Do not prolapse out of the anal canal
Grade II Prolapse on defecation but reduce spontaneously
Grade III Can be manually reduced
Grade IV Cannot be reduced
Intervention for renal stones?
Stone burden of less than 2cm in aggregate
- Lithotripsy
Stone burden of less than 2cm in pregnant females
- Ureteroscopy
Complex renal calculi and staghorn calculi
- Percutaneous nephrolithotomy
Ureteric calculi less than 5mm
- Manage expectantly
Drug causes of pancreatitis?
azathioprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
GET SMASHED Mnemonic?
Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
ABPI that is abnormal?
An ankle-brachial pressure index of < 0.9 is suggestive of PAD, with an index < 0.5 suggesting critical limb ischaemia
Complications of measles?
otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis
clenched hands, rocker bottom feet and clubbed feet in a foetus might indicate?
Edwards
What could you prescribe for labial adhesions if there are complications?
Oestrogen cream
What are the causes of cyanotic congenital heart disease?
tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia
What is Caput succedaneum?
Caput succedaneum describes oedema of the scalp at the presenting part of the head, typically the vertex. This may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery.
No treatment needed.
Difference between Caput Succadeneum and Cephalohaematoma?
Haematoma does not cross suture lines and will take months to resolve
Caput will resolve within days.
What investigation do all breech babies get if born after 36 weeks?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
What is benign rolandic epilepsy?
seizures characteristically occur at night
seizures are typically partial (e.g. paraesthesia affecting face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements)
child is otherwise normal
First line management for paediatric constipation?
diet advice and movicol
Emergency treatment for croup?
high-flow oxygen
nebulised adrenaline
Presentation of Roseola Infantum or Sixth disease?
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
What genetic condition is associated with aortic stenosis?
Williams syndrome
What genetic syndromes cause hypotonia in kids?
Down’s syndrome - most common
Prader-Willi syndrome
Management of bow leggedness in kids <3?
Normal variant - reassurance
Age to be considered precoscious puberty?
<8 in girls
<9 in boys
