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PACES Management > Surgery > Flashcards

Surgery Flashcards

1
Q

Management of testicular cancer

A 
sperm bank
orchidectomy
can insert prosthesis
CT TAP for mets
chemo for mets
LN dissection
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2
Q

Management of kidney stones with no obstruction

A

Hydration and NSAIDs (diclofenac PR)

<5mm or <10mm and pt agrees: expectant management +/- alpha blocker/CCB

<10mm: SWLT +/ alpha blockers

10-20mm: SWL OR uroscopy
2nd: percutaneous nephrolithotomy

> 20mm: percutaneous nephrolithotomy

post: increase fluids, lemon juice, avoid fizzy drinks, decrease salt
consider metabolic testing

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3
Q

Management of kidney obstruction

A

Ureteric stent past obstruction
OR
percutaneous nephrostomy tube via interventional radiology

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4
Q

BPH management

A 
Alpha blockers (tamsulosin)
5-alpha inhibitors (finasteride)

Surgery: TURP
REZUM
HoLEP
Urolift

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5
Q

Difference between stomas

A

ileostomy: spouted, right side, corrosive paste-like stools
colostomy: flush, left side, poo stools
urostomy: spouted, lower right side, mucus and urine

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6
Q

Indications for Hartmann’s procedure

A

obstruction/perforation secondary to sigmoid tumour or diverticulitis

colostomy stoma

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7
Q

Management of colorectal cancer

A

Sigmoidoscopy -> colonoscopy
Contrast CT
Check for spread (liver)

resection
(anterior and abdomino-perineal = rectum to sigmoid, left and right hemicolectomy for colon, hartmann = emergency sigmoid)

High rectal cancer = Anterior
Middle rectal = Anterior
Low = AP

+/- neoadjuvant chemoradiotherapy

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8
Q

complications post-operatively abdominal surgery

A

ileus: peristalsis halted, low electrolytes and dehydration but positive fluid balance (NG + fluids)
dehiscence: day 6 fever and sepsis

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9
Q

why is splenic flexure vulnerable to ischaema

A

marginal artery of Drummond is tenuous here and absent in 5% of pt

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10
Q

Management of duct ectasia

A

conservative management

consider microdochetomy if young
consider total duct excision if old

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11
Q

management of breast fat necrosis

A

triple assessment

conservative

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12
Q

management of acute mastitis

A

conservative: analgesia, warm compresses, continue breastfeeding

Abx: fluclox
2nd: amoxi
MRSA: trimethoprim

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13
Q

management of breast abscess

A

USS only as MMG untolerated

analgesia, warm compresses, continue breastfeeding if possible

USS guided aspiration (consider I+D if necrotic)
culture fluid
abx

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14
Q

management of fibroadenoma

A

rescan in 3-6m of first instance for rapid enlargement

<4cm conservative
>4cm or quickly enlarging consider excision

biopsy if over 25/large conscerns regarding phyllodes tumor

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15
Q

management of fibroadenosis

A

conservative

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16
Q

management of intraductal papilloma

A

microdochetomy (excision of single duct behind nipple)

if older/finished family, remove all ducts behind nipple (but not the nipple)

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17
Q

management of Phyllodes tumour

A

consider surgery

18
Q

Types of breast cancer

A

invasive ductal most common
invasive lobular 2nd most common

DCIS
LCIS

19
Q

What is the triple assessment

A

history and exam
imaging: USS <40, mammogram and USS >40, MRI if implants
FNA/biopsy

20
Q

Management of breast cyst

A

USS aspiration if large and painful

21
Q 
Nipple discharge colour diagnoses:
green
yellow
milky
Blood
A

Green: multi-duct discharge (smokers)
Yellow: ectasia
Milky: prolactinoma
Blood: cancer, DCIS, papilloma

22
Q

management of cancer with blood nipple discharge

A

removal of nipple-areolar complex

treat cancer

23
Q

management of breast cancer

A

USS +/- biopsy of abnormal axillary lymph nodes

triple assessment
MRI if lobular cancer suspected

CT for staging
consider bone scan if >3cm/LN+

Surgery: mastectomy or WLE
removal of lymph nodes

Chemo: if LN+, triple negative disease OR HER2+ve

Radiotherapy: >4cm, LN+, skin/muscle involvement

Tamoxifen if ER+: tamox if premenopausal, letrozole if post-menopausal

24
Q

management of prostate cancer

A

most conservative + follow-up

consider surgery, radiotherapy, hormonal therapy

25
Q

Investigations for RCC

A

cystoscopy, renal USS, CT urogram

26
Q

management of stress incontinence

A

referral to specialist
lifestyle advice: WL, pelvic floor exercises 3m

duloxetine

consider surgery

27
Q

management of urge incontinence

A

lifestyle advice: bladder retraining for 6w, avoid triggers

oxybutinin, tolterodine

mirabegron

Sacral nerve stimulation

surgery: botox injection

28
Q

Difference between testicular lumps

hydrocele
varicocele
epididymal cyst
spermatocele
cancer
A

hydrocele: painless, transillumination, testicle palpable within cyst
varicocele: bag of worms, worse standing up, post-sex

epididymal cyst: smooth cyst in head of epididymis, fluctuant, separate from testicle, transilluminates

spermatocele: exactly same as epididymal cyst, just full of sperm
cancer: craggy, hard, solid mass

29
Q

management of PAD

A

conservative: no smoking, WL, foot care, 12w supervied exercise programme
medical: statin, anti-platelet, management of risk factors

Intermittent claudication: naftidrofuryl, cilostazol, pentoxifylline

surgical: bypass, embolectomy

30
Q

Management of chronic venous insufficiency

A

compression bandanges if ABPI >0.8
moisturising cream

Medical: pentoxifylline, consider abx, NOT nsaids

ulcer: dress ulcer
varicose: sclerotherapy, ablation, ligation

31
Q

management of Raynaud’s

A

smoking cessation
avoid cold
nifedipine

32
Q

management of venous thrombophlebitis

A

compression stockings
NSAIDS if <5cm
DOAC if >5cm
surgery +/- LMWH

33
Q

major haemorrhage protocol

A

baseline bloods inc fibrinogen

if trauma and <3h from injury, tranexamic acid 1g 10 mins
IV infusion of 1g over 8h
warm fluids

specific blood products ASAP
low hb -> red cells
PT >1.5 -> FFP
fibrinogen <1.5 -> cryo
platelets <75 -> platelets
34
Q

indications for amputation

A

Dead: gangrene
Deadly: Wet gangrene, AV fistula, spreading cellulitis
Dead useless: severe intractible pain with CLI, paralysis, trauma

35
Q

Types of amputations

A

Above knee: easiest to do, may not be able to walk with prosthesis
Below knee: harder, heal less reliably, may be more mobile
Transmetatarsal: Diabetes mellitus

Also through knee, ankle

36
Q

Below knee amputation flaps

A

AP (Fish mouth)

Lateral-medial

37
Q

Two forms of AAA

A

Fusiform (aneurysm everywhere)

Sacular (bulb)

38
Q

Location of most AAA

A

infrarenal

39
Q 
Buzzwords for 
Fibroadenoma
Phyllodes tumour
Duct ectasia
Fibroadenosis
Intraductal papilloma
Breast cyst
Paget's disease of nipple
A

Fibroadenoma: young, breast mouse
Phyllodes tumour: similar to fibroadenoma, bigger/grows faster, 40s
Duct ectasia: menopause, green discharge, tender lump around areola
Fibroadenosis: middle aged women, lumpy tender breasts, worse before period
Intraductal papilloma: blood stained discharge, 40-60s, local areas of hyperplasia
Cyst: sudden tender tense lump
Pagets: eczematoid change, may be bloody discharge, nipple inversion

40
Q

What does breast screening involve

A

3yearly national screening, 2 mammograms

between ages 50-71

41
Q

Colorectal cancer screening

A

56, 60-74: FIT testing every 2y.

If +ve, colonoscopy

42
Q

describe Gleason scale

A

Made of two numbers e.g. 2+2
Made of grading of cells of largest area of tumour + cells of 2nd largest

6 or less = slow growing, watchful waiting
8 or more = aggressive

PACES Management (11 decks)

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