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PLABABLE 2.0 > Surgery > Flashcards

Surgery Flashcards

1
Q

True or False:

CEA is not a tumor marker

A

True

CEA should not be requested as a screening tests for CRCA. Instead, colonoscopy should be done for a patient highly suspicious for CRCA.
CEA is then used after surgery to assess response and prognosis.

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2
Q

Greatest RIsk Factors

Colorectal CA
Bladder
Ovarian
Ectopic Pregnancy

A

Colorectal CA - age
Bladder - smoking
Ovarian - family history
Ectopic Pregnancy - PID

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3
Q

A 60-year old man has a history of constipation now presents with fever, tachycardia, acute onset of severe left iliac fossa pain, tenderness and guarding.
Likely diagnosis?
Most appropriate management?

A

Acute diverticulitis
Start IV antibiotics

***Remember: guarding = peritonitis; Admit and start IV abx

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4
Q

A 40-year old female presents with a painful swelling on her right groin. SHe has been having vomiting and abdominal distennsion and not been able to pass stool for 2 days. This groin lump is below the inguinal ligament on the right groin.
Likely Diagnosis?

A

Femoral Hernia

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5
Q

32-year old man + uncomplicated lap chole + At present: RUQ pain with guarding, fever, tachycardia + elevated WBC and CRP
Most appropriate investigation

A

CT abdomen

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6
Q

Painful, fluctuating mass over the breast or near the nipple

A

Nipple Abscess

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7
Q

Brown/ Green/ Colored discharge per nipple

A

Duct ectasia

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8
Q

History of trauma + firm, round, solitary, localised lump

A

Fat necrosis

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9
Q

20-40 year old + bleeding per nipple + skin changes

A

Ductal Papilloma

Investigation: Galactogram

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10
Q

Old woman + bleeding per nipple + ulceration + eczema-like changes + itching

A

Paget’s disease of the breast and nipple

Investigation: Punch biopsy

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11
Q

Firm, non-tender, mobile mass in the breast of a young (15-30)

A

Fibroadenoma

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12
Q

Mastalgia, increase in the breast size, lumpiness (increased nodularity) of the breast, reproductive age + appears during or before menses and disappears after menses

A

Fibroadenosis

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13
Q

Fixed, irregular, hard, painless lump + nipple retraction + Peau d’orange + local fixed or firm axillary LN

A

Breast cancer

Investigation: Core biopsy

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14
Q

Offensive yellow discharge near the nipple + history of abscess

A

Ductal (Mammary) fistula

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15
Q

Prolonged redness around the areola + hx of using antibiotics which improved the symptom + smoker + greenish discharge per nipple +

A

Periductal mastitis

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16
Q

Investigation for Zenker’s diverticulum (pharyngeal pouch)

A

Barium swallow (NOT endoscopy as it has risk of perforation)

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17
Q

Elective surgery + Hgb < 10

A

Defer surgery

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18
Q

Elective surgery + Hgb < 8

A

Transfuse then Defer surgery

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19
Q

Emergency Surgery + Hgb < 10

A

Proceed with surgery

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20
Q

Emergency Surgery + Hgb < 8

A

Transfuse then proceed with surgery

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21
Q

Initial management of hypercalcemia

A

FLUIDS (then bisphosphonates)

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22
Q

Bone pain due to metastases

A

Radiotherapy then bisphosphonates

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23
Q

Post-MI, when to undergo elective surgery?

A

After 6 months

***Remember that patients s/p MI should not undergo surgery for at least 6 mos after MI

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24
Q

Important RF for anastomotic leak

A

DM

***Remember other important RF for anastomotic leak such as immunocompromised state (DM, smoking, prolonged use of steroids)

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25
Q

5-10 days post-op + patient experienced pain in the anastomotic site + fever + reduced bowel sounds

A

Anastomotic Leak

Diagnostic: CT scan of the abdomen and pelvis with contrast

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26
Q

Old age + painless bleeding per rectum + altered bowel habits + anemia + weight loss

A

Colon CA
Colonoscopy

***Left-sided presents with fresh blood while right-sided presents with IDA (Right side has wider diameter; right-sided CA is less likely to present with obstructive symptoms)

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27
Q

S/P thyroidectomy + hypocalcemia features

Management?

A

Calcium gluconate 10% 10mL

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28
Q

S/P thyroidectomy + airway obstruction in the first 24 hours

Management?

A

Open the surgical incision to evacuate the hematoma

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29
Q

S/P thyroidectomy + hoarseness of voice

A

Unilateral injury to the RLN

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30
Q

s/p thyroidectomy + aphonia and airway obstruction

A

Bilateral injury to the RLN

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31
Q

s/p thyroidectomy + dysphonia (loss of high-pitch) OR mono-toned voice

A

Injury to the External Laryngeal Nerve (or EXTERNAL branch of the superior LARYNGEAL NERVE)

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32
Q

Sudden onset of severe abdominal pain + Tenderness + history of AF or MI + high lactate

A

Acute Mesenteric Ischemia

O2, IVF, Analgesic, Antibiotics, Urgent surgery

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33
Q

Gradual onset (over hours) of abdominal pain + moderately severe + starts at the left iliac fossa + bloody diarrhea

A

Conservative or surgical

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34
Q

When should we offer prophylactic mastectomy?

A

BIOPSY: atypical hyperplasia or LCIS
FAMILY HISTORY: strong fam hx of BRCA
PAST MEDICAL HISTORY: previous BRCA in one breast
GENETICS: BRCA1 or BRCA2

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35
Q

If there is a strong fam hx or BRCA mutations, how would you advice on screening for breast cancer?

A

Aged 40-70, mammogram every year

***Remember that Mammogam is offered for all women aged 50-70 every 3 years.

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36
Q

Commonest breast tumor in adolescene and young women + firm, painless, non-tender, mobile breast mass + breast mice
Diagnosis?
Diagnostic?

A

Fibroadenoma

Clinicall + Ultrasound + FNAC

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37
Q

Superficial or Simple or Low perianal fistula

A

Fistulotomy (Lay Open)

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38
Q

Deep or Complex or High Fistula + fistula that crosses internal and external sphincters

A

Seton suture + Ligation of intersphincteric fistula tract

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39
Q

Axillary LN clearance can lead to this condition wherein there redness and swelling of the upper limb

A

Upper limb lymphoedema

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40
Q

Treatment for upper limb lymphoedema secondary to axillary LN clearance

A

Physiotherapy and arm exercise

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41
Q

Tender mass near the anus + tender, swollen, erythematous with throbbing pain that is worse on sitting + fever + constipation
Diagnosis?
Management?
Risk Factor?

A

Anorectal Abscess

I&D + Antibiotics

DM, Immunocompromised

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42
Q

What value needs to be satisfied to decide on reinserting catheter if a patient presents with post-operative oliguria?

A

PVRV > 500 mL

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43
Q

Histopathology: invasive intradu Histopathology: invasive intraductal carcinoma of the breast extending to the epithelium

A

Breast cancer

44
Q

In situ carcinoma involving the nipple epidermis

A

Paget’s disease

45
Q

Encapsulated adipocytes within a fibrotic stroma

A

Hamartoma

46
Q

Proliferation and expansion of the stroma with low cellularity

A

Fibroadenoma

47
Q

A well-circumscribed lump with clear margins and separate from the surrounding fatty tissue. There are overgrowths of fibrous and glandular tissue

A

Fibroadenoma

48
Q

Duct-like epithelium surrounded by fibrous bridging

A

Fibroadenoma

49
Q

Cystic formations with mild epithelial hyperplasia (fibrosis, epitheliosis and cystic formation)

A

Fibrocystic changes (Fibroadenosis)

50
Q

Pre-op management of a known diabetic type II on OHA before a major surgery

A

Stop OHA before surgery

51
Q

Pre-op management of a known diabetic type II on OHA before a minor surgery

A

Continue the same routine

52
Q

Pre-op management of a known diabetic type I on INSULIN before a major surgery

A

Start sliding scale insulin IV before surgery and continue until diet per mouth is re-established

OR

Start IV Insulin, Dextrose and saline

53
Q

Pre-op management of a known diabetic type I on INSULIN before a minor surgery

A

Omit insulin on the day of surgery

54
Q

No gastric bubbles

A

Esophageal atresia

55
Q

Single bubble

A

Gastric/Pyloric Atresia

56
Q

Double-bubble

A

Duodenal Atresia

57
Q

Triple Bubble

A

Jejunal Atresia

58
Q

A pregnant woman attends for anomaly scan at 31-weeks AOG. She has polyhydramnios. Ultrasound showed no fetal gastric bubbles.

A

Esophageal atresia

59
Q

Most appropriate step in the management of a bleeding diverticulitis

A

Urgent Admission into the surgical ward

60
Q

Post abdominal surgery + epigastric fullness + nausea and vomiting + tenderness + hypotension + tachycardia
Diagnosis?
Mgt?

A

Acute Gastric Distension

NGT for decompression

61
Q

An important risk factor for Carpal Tunnel Syndrome due to fluid retention

A

Pregnancy

62
Q

Also known as flexor retinaculum or anterior annular ligament

A

Carpal Tunnel Ligament

63
Q

Extremely painful especially on defecation + patient refuses rectal exam + blood streaks in the stools + constipation and straining

A

Anal fissure

64
Q

First-line management of an acute anal fissure

A

High-fibre diet with increased OFI

Bulk-forming laxatives

65
Q

Prophylactic antibiotic prior to colectomy

A

30 mins prior to procedure or during induction of anesthesia:
CEFUROXIME + METRONIDAZOLE

66
Q

ABOVE and medial to the pubic tubercle vs. BELOW and LATERAL to the pubic tubercle

A

Inguinal Hernia vs. Femoral Hernia

67
Q

Hepatomegaly + palpable liver + weight loss + history of cirrhosis + tiredness + RUQ pain
Diagnosis?
Tumor marker?

A

Hepatocellular carcinoma

AFP

68
Q

Throbbbing anal pain esp on defecation and on sitting + gradual pain with increasing severity + tender swelling/mass around the anus that might be erythematous with or without fever + No blood

A

Perianal abscess

I&D

69
Q

Patient s/p thyroid surgery develops shortness of breath and stridor.

First step?

A

Cut the subcutaneous sutures

70
Q

Greatest risk factors for colorectal cancer

A

Old Age

Family History

71
Q

Old age + anemia + bleeding per rectum + weight loss + left lower abdominal mass or pain
Diagnosis?

A

Sigmoid Carcinoma

72
Q

Old age + anemia + weight loss + right lower abdominal mass or pain

A

Cecal carcinoma

73
Q

Between sigmoid and cecal carcinoma, which is more likely to present with bleeding per rectum and why?

A

Cecal CA is LESS likely to show bleeding per rectum as bleeding in the cecum has longer travel and it incorporates in the feces. Also, it is MORE LIKELY to present with obstructive symptoms.

74
Q

What are the common sites of ischemic colitis?

A

Splenic flexure and Rectosigmoid colon

75
Q

Most appropriate investigation on a fluid-filled mass in the midline of the neck below the hyoid bone of a child. This moves upward on tongue protrusion and swallowing.

A

Ultrasound (NOT FNAC)

76
Q

Differentiate presentation of oropharyngeal carcinoma from oesophageal carcinoma

A

Esophageal carcinoma: old age + gradually worsening dysphagia + long-standing gastric reflux (Upper GI endoscopy + biopsY)

Oropharyngeal CA: old age + otalgia + dysphagia + lesion/ulcer at the back of the tongue + palpable, non-tender cervical lymphadenopathy

77
Q

Important site of spreading of a tonsillar cancer

A

Mandible

78
Q

A patient with known case of tonsillar cancer presents with pain in the throat with trismus

A

Think of cancer spreading to the mandible

79
Q

Severe trismus + drippling of saliva + otalgia + hot potato voice + uvular deviation + red and inflamed bulge beside the tonsil

A

Quinsy or peritonsillar abscess

80
Q

Magic number in terms of management of anal fissure

A

6 weeks:
Acute anal fissure - Less than 6 weeks
Chronic anal fissure - more than 6 weeks

81
Q

First-line treatment for a chronic anal fissure

A

Topical GTN

82
Q

Passes through the deep and the superficial inguinal ring and lies LATERAL to the inferior epigastric artery

A

Indirect inguinal hernia

83
Q

Passes through the Posterior wall of the inguinal canal

A

Direct inguinal hernia

84
Q

A patient who is NOT BREATHING after exposed to burn + failed intubation
Next step?
What structure should be pierced?

A

Cricothyroidotomy

Cricothyroid membrane

85
Q

CXR findings of an intestinal obstruction

A

Multiple air-fluid levels

86
Q

Abdominal pain + distention + tenderness + empty rectum + noisy hyperactive bowel sounds + constipation
Diagnosis?
X-ray findings?
Next best step?

A

Intestinal Obstruction
Multiple air-fluid levels
Urgent refer to surgical ward

87
Q

Back pain + weight loss + history of smoking or alcohol + obstructive jaundice (elevated TB, B2; pale stool, dark urine and itching; elevated ALP); abnormal LFT; HYPERGLYCEMIA + palpable gallbladder

A

Carcinoma of the head of the pancreas

88
Q

Prognostic investigation for cancer of the head of the pancreas?

A

CA 19-9

89
Q

Investigation of choice for CA of head of the pancreas?

Initial diagnostic of choice?

A

HRCT

UTZ

90
Q

In patient with CA of the head of the pancreas with no proven metastasis, what is the management?

A

Whipple’s resection (pancreaticoduodenectomy)

91
Q

CA of the head of the pancreas + metastasis

Management?

A

Palliative ERCP with stent

92
Q

Screening for CRCA

A

FIT for 60-74 years q2years

93
Q

Screening for BRCA

A

For high Risk: mammogram annually for aged 40-70

For all women aged 50-70, mammogram every 3 years

94
Q

Screening for cervical cancer

A

PAP smear Every 3 years for aged 25-49; every 5 years for 50-64

95
Q

The most common causative organism for breast abscess

A

S. aureus

96
Q

Bleeding at the time of surgery

Diagnosis?
Management?

A

Primary Hemorrhage

Replace blood or return to theatre if severe

97
Q

Bleeding within 24 hours after surgery (e.g., while in the RR)

Diagnosis?
Management?

A

Reactionary Hemorrhage

Replace blood; Wound re-exploration (possible slipping of ligatures)

98
Q

Surgical bleeding 1-2 weeks post-op

A

Secondary hemorrhage

Admit and IV antibiotics (usually due to necrosis of blood vessels)

99
Q

Most common site of vaginal fistula?

A

Rectovaginal fistula

100
Q

If very high suspicion for bile leak, diagnostic of choice?

A

ERCP

101
Q

If low suspicion of bile leak and high suspicion of abscess

A

CT abdomen

102
Q

Management for cyclical mastalgia

A

Advise patient to wear a supportive bra
OR
Advise better-fitting bra in the day and soft support bra at night
OR
Paracetamol

103
Q

ATLS Class 1 of Shock

A

Blood loss - less than 750mL or less than 15%
BP - normal
HR - 60-100 bpm
RR - 14-20cpm

104
Q

ATLS Class 2 of Shock

A

Blood Loss 15-30% or 750-1500ml
BP normal
HR 101-120
RR 21-30

105
Q

ATLS Class 3 of Shock

A

Blood Loss of 1500-2000mL (30-40%)
BP decreased
HR 121-140
RR 31-40

106
Q

ATLS Class 4 of Shock

A

Blood Loss of >2000mL (>40%)
BP decreased
HR > 140 bpm
RR >35cpm

107
Q

Other name for that structure that needs releasing in a carpal tunnel syndrome

A 
Transverse carpal ligament
OR
Flexor retinaculum
OR
Anterior annular ligament

PLABABLE 2.0 (33 decks)

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