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YEAR 6: PACES > Surgery 11 > Flashcards

Surgery 11 Flashcards

1
Q

What are the Centor criteria for tonsillitis?

A

Fever
Tonsillar exudates
Tender anterior cervical lymphoadenopathy
No cough

3 or more = give antibiotics

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2
Q

What is the difference between metachronous and synchronous cancers?

A

Synchronous - secondaries occurring within 6 months of primary cancer
Metachronous - secondaries occurring over 6 months after primary cancer

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3
Q

List some reasons for enucleation of the eye.

A 
Trauma 
Tumour (retinoblastoma)
Infection 
Phthisis bulbi (shrunken non-functional eye)
Sympathetic ophthalmia
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4
Q

Why do anastomoses of the sigmoid colon require a defunctioning loop ileostomy?

A

The sigmoid colon contains more solid faecal matter so exerts a higher pressure on its walls
This means that there is a higher risk of perforation/leak following anastomosis

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5
Q

Outline the management of diverticulitis.

A

Mild - bowel rest at home (fluids only)
Severe - NBM, drip and suck, antibiotics (ceftriaxone and metronidazole), analgesia
Obstruction/Perforation - Hartmann’s resection

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6
Q

What are the main types of perianal fistula and how are they treated?

A

Superficial - no involvement of sphincters - fistula laid open
Intersphincteric - only through internal sphincter - progressively tighten seton
Transphincteric - through both external and internal sphincters - fibrin glue to plug the fistula

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7
Q

Outline the management of haemorrhoids.

A

Conservative: fibre
Medical: topical hydrocortisone, laxatives
Surgical: rubber band ligation, injection sclerotherapy, haemorrhoidectomy

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8
Q

What is taken into account by the modified Glasgow score for pancreatitis?

A 
PaO2 < 8 kPa 
Age > 55 yrs 
Neutrophils 
Calcium < 2 mmol/L
Renal function (urea > 16 mmol/L)
Enzymes (liver and LDH) 
Albumin < 32 g/L 
Sugar (glucose > 10 mmol/L)

NOTE: use on admission and repeat within 48 hours; 3 or more is severe pancreatitis

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9
Q

List some causes of chronic pancreatitis.

A 
Gallstones 
Ethanol
Recurrent acute pancreatitis 
Cystic fibrosis 
Haemochromatosis 
Autoimmune

NOTE: complications include DM, pseudocysts and cancer

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10
Q

Define osteoarthritis.

A

Degenerative joint disorder characterised by loss of hyaline cartilage and new bone formation at the joint surface.

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11
Q

Which ligaments are sacrificed in total knee replacement?

A

ACL is usually sacrificed (however newer replacements may spare it)

IMPORTANT: do not do anterior draw on TKR patients

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12
Q

What are the pros and cons of cemented vs uncemented total hip replacement?

A

Cemented: better for older patients with poor bone quality and turnover
Uncemented: porous and bone in-growth, makes revision of hip more difficult

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13
Q

What are the 6 As of dealing with open fractures?

A

Analgesia
Assess neurovascular status, soft issues, photograph
Antisepsis: wound swab, copious irrigation, cover with betadine soaked dressing
Alignment (splint)
Anti-tetanus - check status (booster in last 10 years)
Antibiotics (flucloxacillin and benpen or co-amoxiclav)

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14
Q

What is the normal pressure of the lower oesophageal sphincter?

A

14-20 mm Hg

NOTE: oesophagus is 25 cm in length starting at cricoid cartilage, upper 2/3 has striated muscle, lower 1/3 is smooth muscle

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15
Q

What is a paramedian incision used for?

A

Access to kidneys, spleen and adrenals

NOTE: paramedian is technically more difficult but was thought to be associated with improved healing as the rectus abdominus is vascular unlike the linea alba (midline)

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16
Q

What is taken into account when deciding whether to use a dynamic hip screw or cannulated screws for fixation of a neck of femur fracture?

A

DHS: safer in patients who cannot partially weight bear so are at risk of fracture displacement (standard = 4 hole), better for intertrochanteric fractures
Cannulated screws: easier to remove in the future when patients need a hip replacement, less soft tissue damage, minimally invasive, used when NOT displaced

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17
Q

List the mechanisms that could cause GORD.

A

Anatomical disruption of gastro-oesophageal junction (e.g. hiatus hernia)
Hypotensive lower oesophageal sphincter (leads to transient lower oesophageal relaxation)
Delayed oesophageal acid clearance (e.g. cigarette smoking)

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18
Q

List some risk factors for gastric cancer.

A

H. pylori
Atrophic gastritis (pernicious anaemia)
Diet (cured meats)
Smoking

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19
Q

Wht are the three points at which the ureter narrows?

A

Uretopelvic junction
Pelvic rim
Vesicoureteric junction

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20
Q

How can the point during micturition at which blood is seen allude to the location of the pathology?

A

Beginning of stream = urethral
Throughout = renal
End = bladder

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21
Q

List some indications for 2 week cystoscopic referral.

A

All frank haematuria
Persistent haematuria + dysuria
Haematuria + lower urinary tract symptoms
Female retention

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22
Q

Outline the staging of renal cell carcinoma.

A 
T1 - < 7 cm
T2 - > 7 cm
T3 - involves perinephric tissue/renal vein 
T4 - beyond renal (Grota's) fascia 
N0 - no nodal disease 
N1 - regional nodal disease 
M0 - no mets 
M1 - mets
23
Q

List some investigations for varicose veins.

A

Duplex ultrasound

MR venography

24
Q

What are the two types of below knee amputation?

A

Skew flap - joining loose lateral flaps of skin over the end of the bone, vertical longitudinal scar along stump
Long posterior flap (Burgess) - using posterior calf muscle to cover bone, horizontal circumferential scar around stump

25
Q

What is the pes anserinus?

A

Conjoined tendons of three muscles entering into the anteromedial surface of the proximal tibia (semitendinosus, gracilis, sartorius)

26
Q

Which bursae are found around the knee joint?

A 
Suprapatellar 
Pre-patellar
Infrapatellar (subcutaneous and deep) 
Semimembranosus 
Pes anserine
27
Q

What are the main differences between epidural and spinal anaesthesia?

A

Epidural: into epidural space, longer onset (30 mins), last longer, doesn’t give full motor block, can leave an epidural catheter for top ups

Spinal: into subarachnoid space, usually one-time, very quick onset, profound motor block, smaller dose, cannot be done above L2 (needs to be below the conus medullaris to avoid spinal cord injury)

28
Q

List some complications of ocular protheses.

A 
Lagophthalmos (incomplete closure of eyelid over eye)
Enophthalmos
Rotating prosthesis
Prosthesis falling out 
Exophthalmos
29
Q

Describe the classification of joints.

A

Synovial joint - most common, connected by connective tissue forming a capsule with synovial fluid within the joint cavity (e.g. knee, elbow)

Fibrous Joint - connected by dense connective tissue, three types: sutures (e.g. skull), syndesmosis (e.g. tibiofibular), gomphosis (teeth to mandible)

Cartilaginous - connected by fibrocartilage or hyaline cartilage, primary cartilaginous (synchondroses such as growth plates) and secondary cartilaginous (pubic symphysis)

30
Q

List the main indications for operating on varicose veins.

A

Venous eczema and ulceration
Skin changes including lipodermatosclerosis
Oedema

31
Q

Describe the management of low-risk and high-risk invasive bladder cancer.

A

Low-risk: TURBT + intravesical mitomycin

High-risk: TURBT + intravesical BCG

32
Q

List some risk factors for umbilical and paraumbilical hernias.

A

Pregnancy
Ascites
Obesity

33
Q

Which operations may be conducted in patients with Crohn’s disease?

A

Ileocaecectomy
Abscess drainage
Stricturoplasty
Colectomy

34
Q

List some causes of leg length discrepancy.

A

True: congenital, post-traumatic, bone tumours
Apparent: scoliosis

35
Q

What are the contents of the adductor canal?

A

Femoral artery
Femoral vein
Femoral nerve
Saphenous nerve

Boundaries: adductor longus and magnus, vastus medialis, sartorius

36
Q

Which important pre-operative intervention reduces the risk of infection in patients undergoing an appendicectomy?

A

Single dose IV tazocin 30 mins before the operation

37
Q

What are the main aspects of conducting a hernia examination?

A 
Examine standing 
Cough (and feel for cough impulse)
Palpate pubic tubercle to orientate 
Examine for extension into scrotum 
Auscultate for bowel sounds 
Ask patient to reduce hernia and attempt to control it by placing finger at midpoint of inguinal ligament (deep ring)
Repeat with patients supine 
Palpate abdomen
38
Q

What are the branches of the coeliac trunk?

A

Left gastric artery
Splenic artery
Common hepatic artery

39
Q

Describe the main symptoms of ulnar collateral injury of the thumb.

A

Presents after abduction force to the thumb (e.g. falling when skiing)
Weak pincer grip
Reduced ROM of metacarpophalangeal joint of thumb
Needs immobilisation with thumb spica (complete rupture needs surgery)

NOTE: aka Skier’s thumb/Gamekeeper’s thumb

40
Q

What is a Bennett’s fracture?

A

Intra-articular fracture of the first metacarpal bone (often associated with boxing)

NOTE: usually requires ORIF, high risk of osteoarthritis later in life

41
Q

Where will you see scars other than in the breast for the different types of myocutaneous flap?

A

Latissimus dorsi - back over lat dorsi (looks a bit like lateral thoracotomy)
DIEP and TRAM - transverse lower abdominal scar (along the bikini line)

42
Q

How is a DIEP flap different from a TRAM flap?

A

TRAM is connected to blood vessels that travel down in the rectus abdominis. Traditionally, TRAM is on a pedicle containing the blood supply and is passed under the skin up to the breast. (abdominal muscles sacrificed)

DIEP is removed with its blood vessels from the lower abdomen and transplanted into the breast and connected to a supply near the breast. (abdominal muscles spared)

NOTE: muscle sparing TRAM is now possible with microsurgery (no longer has to be on a pedicle)

43
Q

What is the most common cause of cubitus varus?

A

Supracondylar fracture of the humerus

NOTE: can be corrected with osteotomy

44
Q

List and describe some types of toe deformity.

A

Hammer toe - flexion of PIJ
Mallet toe - flexion of DIJ
Clawed toe - dorsiflexion of MTP + flexion of PIJ and DIJ

Causes of toe deformities include ill-fitting shoes, OA, RA, CMT and Friedreich ataxia

45
Q

What is the most commonly used management option for Colles fractures?

A

Closed manipulation with haematoma block (local anaesthetic) followed by below-elbow backslab

NOTE: ORIF is sometimes needed however may not be the best option in elderly, osteoporotic patients with comorbidities and anaesthetic risks

NOTE: Smith’s fractures usually require manipulation under anaesthesia or ORIF

46
Q

What are the boundaries of the anatomical snuffbox?

A

Medial: extensor pollicis longus
Lateral: abductor pollicis longus + extensor pollicis brevis
Floor: scaphoid
Crossed by: radial artery

47
Q

Describe the incisions used in a 4-compartment fasciotomy.

A

Medial and lateral skin incisions

Through the lateral incision, you divide the fascia of the superficial and deep posterior compartments

48
Q

What is the difference between tennis elbow and golfer’s elbow?

A

Tennis: lateral epicondylitis (insertion of extensor carpi radialis brevis)
Golfer: medial epicondylitis

49
Q

List some risk factors for hernias.

A

Pregnancy
Obesity
Weight lifting
Chronic cough

50
Q

Which blood artery is a transplanted kidney usually connected to?

A

External iliac artery

51
Q

List some complications of supracondylar humerus fractures.

A

Gunstock deformity (cubitus varus due to malunion)
Compartment syndrome
Ischaemia (e.g. due to brachial artery injury) leading to a Volkmann ischaemic contracture
Median nerve damage

52
Q

Define compartment syndrome.

A

An increase in pressure within an osseofascial compartment (usually > 30 mm Hg diastolic)

53
Q

What operation is used to treat cataracts?

A

Phacoemulsification - involves emulsifying and aspirating the lens before inserting an implant

YEAR 6: PACES (22 decks)

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