Surgery Flashcards
Features of traumatic aortic rupture?
Deceleration injuries
Contained haematoma (persistent hypotension)
Widened mediastinum (CXR)
May be depression of bronchi +/- tracheal deviation
Borders of the femoral canal?
Lateral: Femoral vein
Medial: Lacunar ligament
Anterior: Inguinal ligament
Posterior: Pectineal ligament
Contents of femoral canal?
Lymphatic vessels
Cloquet’s lymph node
When should LP done in suspected SAH?
12 hours after onset of headache
What would you find on biopsy in temporal arteritis?
Temporal artery intimal proliferation with skip lesions
How often to scan a triple A of 3 - 4.4 cm?
Rescan every 12 months
How often to scan a triple A of 4.5 - 5.4 cm?
Rescan every 3 months
What to do if AAA >=5.5cm?
Refer within 2 weeks to vascular surgery for probable intervention
first-line investigation for suspected prostate cancer?
Multiparametric MRI
What is a large hyperechoic lesion of the liver in the presence of normal AFP likely to be?
Haemangioma
Which renal stones are radio-lucent?
urate + xanthine stones
What does a pelvic fracture and highly displaced prostate suggest?
Membranous urethral rupture
What does a pelvic fracture and lower abdominal peritonism suggest?
Bladder rupture
Surgical tx for distal 2/3rds transverse or descending colon cancer?
left hemicolectomy
What surgery is used to excise upper rectal tumours?
high anterior resection
Who is suxamethonium contraindicated in?
Patients with penetrating eye injuries or acute narrow angle glaucoma (increases intra-ocular pressure)
What is a Richter hernia and how does it present?
Only the antimesenteric border of the bowel herniates through the fascial defect
Characterised by the absence of symptoms of obstruction even in the presence of strangulation, as the bowel lumen is patent while bowel wall is compromised
What does an ABPI > 1.2 indicate?
may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
What does an ABPI 1 - 1.2 indicate?
Normal
What does an ABPI <0.9 indicate?
likely PAD. Values < 0.5 indicate severe disease which should be referred urgently
What is the best agent for induction of anaesthesia in a haemodynamically unstable agent?
Ketamine
What severe side effect is important to be aware of when using etomidate anaesthetic agent?
Adrenal suppression
Surgery / sulfonylureas on day of surgery?
Omit on the day of surgery
Exception is morning surgery in patients who take BD - they can have the afternoon dose
How to calculate the nottingham prognostic index for breast cancer?
Tumour Size x 0.2 + Lymph node score + Grade score
Colorectal cancer referral guidelines?
patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces
Where is a gastrostomy and what is it used for?
Epigastrium
Gastric decompression or fixation
Feeding
Where is a loop jejunostomy and what is it used for?
Anywhere
Seldom used as very high output
May be used following emergency laparotomy with planned early closure
Where is a percutaneous jejunostomy and what is it used for?
LUQ
Usually performed for feeding purposes and site in the proximal bowel
Where is a loop ileostomy and what is it used for?
RIF
Defunctioning of colon e.g. following rectal cancer surgery
Does not decompress colon (if ileocaecal valve competent)
Where is an end ileostomy and what is it used for?
RIF
Usually following complete excision of colon or where ileocolic anastomosis is not planned
May be used to defunction colon, but reversal is more difficult
Where is an end colostomy and what is it used for?
RIF/LIF
Where a colon is diverted or resected and anastomosis is not primarily achievable or desirable
Where is a loop colostomy and what is it used for?
Anywhere
To defunction a distal segment of colon
Since both lumens are present the distal lumen acts as a vent
Where is a caecostomy and what is it used for?
RIF
Stoma of last resort where loop colostomy is not possible
Where is a mucous fistula and what is it used for?
Anywhere
To decompress a distal segment of bowel following colonic division or resection
Where closure of a distal resection margin is not safe or achievable
Tx for anal fissures not responding to conservative tx?
Referral for sphincterotomy or botulinum toxin
Mx of thrombosed haemorrhoid if presentation within 72hrs?
Haemorrhoidectomy
Which operation is used in an emergency for bowel cancer?
Hartmann’s procedure
A syndrome consisting of a PTEN mutation and intestinal hamartomas?
Cowden disease
A syndrome which may be present in a patient with multiple intestinal hamartomas and pigmentation spots around the mouth?
Peutz-Jeghers syndrome
A syndrome which causes right sided colonic tumours at a young age?
Lynch syndrome
Mackler’s triad (Boerrhave’s)?
Severe vomiting
Dyspnoea
Chest pain
Diagnostic ix in boerhaave’s?
CT contrast swallow
Most common type of renal cell carcinoma?
Adenocarcinoma
Which anaesthetic agent should not be used in pneumothorax?
Nitrous oxide
Pre-op hydrocortisone doses for pts on long term steroid therapy?
Minor procedure under local: no supplementation required
Moderate procedure: 50mg hydrocortisone before induction and 25mg every 8h for 24h
Major surgery: 100mg hydrocortisone before induction and 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached
Tx for malignant HTN as a SE of suxamethonium?
Dantrolene
What is Mirizzi’s syndrome?
When a gallstone in the cystic duct causes compression on the common hepatic duct, resulting in jaundice
Blockage of which duct in the biliary tree does not cause jaundice?
Cystic duct/gall bladder neck
What vein should TPN be administered into?
Central vein e.g. subclavian (phlebitic)
Tx for acute cholecystitis?
intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis
Tx for ascending cholangitis?
ERCP
What plt level indicates need for platelet transfusion for thrombocytopenia before surgery/ an invasive procedure?
<50×109/L for most patients
50-75×109/L if high risk of bleeding
<100×109/L if surgery at critical site
Who do you not give plt transfusions to?
Chronic bone marrow failure
ITP
HIT
TTP
Typical presentation of anterior uveitis?
painful red eye associated with reduced visual acuity, photophobia, a small pupil and ciliary flush
Typical presentation of Acute angle closure glaucoma?
severe pain (may be ocular or headache) decreased visual acuity, patient sees haloes semi-dilated fixed pupil hazy cornea eye feels hard on palpation
What do you see in the urine of someone with acute tubular necrosis?
granular, muddy-brown urinary casts
Classic triad in acute interstitial nephritis?
What would you see in the urine?
Rash
Fever
Eosinophilia
Urine - white cell casts
What is the Parkland formula for fluid resuscitation in burns?
Volume of fluid = total body SA of burn (%) x weight (Kg) x 4ml
50% given in first 8 hours
50% given in next 16 hours
Common causes of a sudden painless loss of vision
ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis –> occlusion of central retinal vein and occlusion of central retinal artery)
vitreous haemorrhage
retinal detachment
retinal migraine
Features of Central retinal vein occlusion?
What is seen on fundoscopy?
incidence increases with age, more common than arterial occlusion
severe retinal haemorrhages are usually seen on fundoscopy
Causes of Central retinal vein occlusion?
glaucoma
polycythaemia
hypertension
Features of Central retinal artery occlusion?
afferent pupillary defect
‘cherry red’ spot on a pale retina
Causes of Central retinal artery occlusion?
Thromboembolism (from atherosclerosis)
Arteritis (e.g. temporal arteritis)
Features of Vitreous haemorrhage?
sudden visual loss, dark spots
