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MSRA > Surgery > Flashcards

Surgery Flashcards

1
Q

Features of mammary duct ectasia?

A

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’

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2
Q

Anatomy of direct and indirect inguinal hernias?

A

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

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3
Q

Cause of direct and indirect inguinal herniae?

A

Direct:
Defect or weakness in the transversalis fascia area of the Hesselbach triangle

Indirect:
Failure of the processus vaginalis to close

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4
Q

Risk of strangulation in inguinal herniae compared to femoral?

A

Low in inguinal, high in femoral

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5
Q

Ages of inguinal herniae?

A

older - direct

Indirect - may occur in children

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6
Q

Location appearance and output for ileostomy vs colostomy?

A

Ileostomy

  • Right iliac fossa
  • Spouted
  • Liquid output

Colostomy

  • More likely left, can be anywhere
  • Flush to the skin
  • Solid output
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7
Q

Peptic ulcers pain follwoign eating, which is which>

A

Gastric - worse by eating

Duodenal - better after eating

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8
Q

Up to how long would finasteride take to work for BPH?

A

6 months

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9
Q

Rules for sulphonylureas when going to have surgery?

A
  • omit on the day of surgery

- exception is morning surgery in patients who take BD - they can have the afternoon dose

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10
Q

What is malignant hyperthermia?

A

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).

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11
Q

Management of fibroadenoma?

A

<3cm then monitor

> 3cm may need to excise

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12
Q

What is the cut-off age for an unexplained breast lump to be referred under 2ww

A

30 years

Can have non-urgent referral if under 30

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13
Q

How to manage congenital inguinal hernia?

A

Urgent referral due to incarceration risk

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14
Q

PSA levels increased due to what and how long ago?

A 
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
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15
Q

What is first-line in treating BPH?

A

alpha-1 antagonists e.g. tamsulosin, alfuzosin

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16
Q

Most common type of breast cancer?

A

Invasive ductal carcinoma

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17
Q

non-surgical treatments for breast cancer?

A

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.

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18
Q

What factors would mean mastectomy over wide local excision for breast cancer?

A

mastectomy:

  • Multifocal
  • Central
  • Large lesion in small breast
  • DCIS >4cm

The opposite would lead to wide local excision.

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19
Q

When is the screening for AAA? What is it?

A

Single abdo USS >65yrs

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20
Q

Most common bacteria in breast abscess?

A

Staphylococcus aureus

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21
Q

Adverse effects of aromatase inhibitors (anastrazole)

A 
osteoporosis
- NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
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22
Q

Adverse effects of Tamoxifen

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

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23
Q

NHS breast cancer screenign programme details?

A

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’.

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24
Q

Management of oral metformin prescription when undergoing surgery?

A

OD or BD: take as normal

TDS: miss lunchtime dose

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25
Q

What are the details of the colorectal cancer screening programme in the UK?

A

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.

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26
Q

What GA would you use to induce someone who has had N&V post op before ?

A

Propofol (it has antiemetic actions).

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27
Q

what do you offer men post vasectomy to confirm success?

A

Semen analysis at 16 and 20 weeks.

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28
Q

Oral antidiabetic meds day before surgery?

A

All oral antidiabetic medications should be taken as normal the day before surgery

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29
Q

Complications of measles?

A

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

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30
Q

clenched hands, rocker bottom feet and clubbed feet in a foetus might indicate?

A

Edwards

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31
Q

What could you prescribe for labial adhesions if there are complications?

A

Oestrogen cream

32
Q

What are the causes of cyanotic congenital heart disease?

A

tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia

33
Q

What is Caput succedaneum?

A

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.

34
Q

Difference between Caput Succadeneum and Cephalohaematoma?

A

Haematoma does not cross suture lines and will take months to resolve

Caput will resolve within days.

35
Q

What investigation do all breech babies get if born after 36 weeks?

A

All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery

36
Q

What is benign rolandic epilepsy?

A

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

37
Q

First line management for paediatric constipation?

A

diet advice and movicol

38
Q

Emergency treatment for croup? (in hospital)

A

high-flow oxygen

nebulised adrenaline

39
Q

Presentation of Roseola Infantum or Sixth disease?

A

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

40
Q

What genetic condition is associated with aortic stenosis?

A

Williams syndrome

41
Q

What genetic syndromes cause hypotonia in kids?

A

Down’s syndrome - most common

Prader-Willi syndrome

42
Q

Management of bow leggedness in kids <3?

A

Normal variant - reassurance

43
Q

If you can’t get ‘above’ a testicular swelling - likely diagnosis?

A

Inguinal hernia

44
Q

Features of hydrocele?

A

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

45
Q

Features of varcocele?

A

Diffuse painless swelling - lumpy/bag of worms separate from testicle.

46
Q

Failure rate of male sterilisation?

A

1 in 2,000

47
Q

What is a duct papilloma, how does one present?

A

Local areas of epithelial proliferation in large mammary ducts

Hyperplastic lesions rather than malignant or premalignant

May present with blood stained discharge

48
Q

What is a hartmanns procedure, when would you perform?

A

Resection of the sigmoid colon is performed and an end colostomy is fashioned

Lesion in the sigmoid with perforation.

49
Q

resection for lesions in Distal transverse, descending colon?

A

Left hemi

50
Q

resection for Caecal, ascending or proximal transverse colon lesions?

A

Right hemi

51
Q

Resection for lesions in the sigmoid?

A

High anterior resection

52
Q

Resection for lesions in the rectum?

A

Anterior resection

if anal verge then Abdomino-perineal excision of rectum

53
Q

Testicular cancer seminoma or teratoma better survival?

A

Seminoma

54
Q

What medication is used to prevent cerebral vasospasm in SAH?

A

Nimodipine

55
Q

Management of asymptomatic inguinal herniae?

A

routine referral for repair

56
Q

Management of breast cysts?

A

Cysts should be aspirated, those which are blood stained or persistently refill should be biopsied or excised

57
Q

Haemorrhoid grades?

A

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

58
Q

Intervention for renal stones?

A

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

59
Q

Drug causes of pancreatitis?

A

azathioprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

60
Q

GET SMASHED Mnemonic?

A

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)

61
Q

ABPI that is abnormal?

A

An ankle-brachial pressure index of < 0.9 is suggestive of PAD, with an index < 0.5 suggesting critical limb ischaemia

62
Q

Complications of measles?

A

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

63
Q

clenched hands, rocker bottom feet and clubbed feet in a foetus might indicate?

A

Edwards

64
Q

What could you prescribe for labial adhesions if there are complications?

A

Oestrogen cream

65
Q

What are the causes of cyanotic congenital heart disease?

A

tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia

66
Q

What is Caput succedaneum?

A

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.

67
Q

Difference between Caput Succadeneum and Cephalohaematoma?

A

Haematoma does not cross suture lines and will take months to resolve

Caput will resolve within days.

68
Q

What investigation do all breech babies get if born after 36 weeks?

A

All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery

69
Q

What is benign rolandic epilepsy?

A

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

70
Q

First line management for paediatric constipation?

A

diet advice and movicol

71
Q

Emergency treatment for croup?

A

high-flow oxygen

nebulised adrenaline

72
Q

Presentation of Roseola Infantum or Sixth disease?

A

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

73
Q

What genetic condition is associated with aortic stenosis?

A

Williams syndrome

74
Q

What genetic syndromes cause hypotonia in kids?

A

Down’s syndrome - most common

Prader-Willi syndrome

75
Q

Management of bow leggedness in kids <3?

A

Normal variant - reassurance

76
Q

Age to be considered precoscious puberty?

A

<8 in girls

<9 in boys

MSRA (22 decks)

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