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AKT > Surgery > Flashcards

Surgery Flashcards

1
Q

Screening for AAA
Who and age and investigation of choice

A

US
Males aged 65yo

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2
Q

Screening AAA
Interpretation

A

<3cm normal, no further action
3-4.4cm small aneurysm, rescan every 12 months
4.5-5.4cm medium aneurysm, rescan every 3 months
>=5.5cm large, refer within 2 weeks to vascular

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3
Q

When to refer to be seen within 2 weeks by a vascular surgeon for AAA
Mx

A

If symptomatic
OR
>=5.5cm
OR
Rapidly enlarging (>1cm/year)

Mx EVAR

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4
Q

Normal size of infrarenal aorta in females and males
What size is considered aneurysmal?
Name two major RF for a AAA

A

1.5cm females
1.7cm males
3cm aneurysm

Smoking
HTN

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5
Q

Epigastric pain relieved by eating =
Epigastric pain worsened by eating =

A

Duodenal
Gastric ulcers

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6
Q

Describe Cullen’s and Grey Turner’s sign
Seen in which condtion?

A

Periumbilical discolouration = Cullen’s
Turner’s = flank pain

Acute pancreatitis

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7
Q

Location of inguinal hernia + femoral hernia

A

Above and medial to pubic tubercle
Below and lateral to pubic tubercle

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8
Q

Hernia’s that are rare and often seen in older patients =

A

Spigelian hernia

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9
Q

Hernia more common in females and typically presents with bowel obstruction =

A

Obturator hernia

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10
Q

Congenital inguinal hernias are more common in ? (2)
Most commonly on what side?
Mx

A

Boys
Premature babies
Right sided
Mx surgically repaired soon after diagnosis

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11
Q

Infantile umbilical hernia are more common in (2)
Mx

A

Premature babies
Afro-Caribbean
Resolves without intervention

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12
Q

Most common organism causing acute bacterial prostatitis

A

E coli

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13
Q

Causes of pancreatitis

A

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
High calcium, trigylyc, hypotheramia
ERCP
Drugs

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14
Q

Name five drugs that can cause pancreatitis

A

Mesalazine
AZT
Bendroflumethiazide
Sodium valproate
Furosemide

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15
Q

Difference between acute and chronic fissure
RF (3)

A

<6 weeks versus >6 weeks

IBD, constipation, STIs

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16
Q

Mx of acute anal fissures (4)

A
  1. Soften stool - diet and high fluid, bulk forming laxatives (e.g fybogel)
  2. Lubricants prior to defecation
  3. Topical anaesthetics
  4. Analgesia
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17
Q

Mx of chronic anal fissures (2)

A
  1. GTN topical
  2. If not effective after 8 weeks then refer to secondary care for surgery or botox
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18
Q

ABPI interpretation
>1.2
1-1.2
0.9-1
<0.9
<0.5

A

> 1.2 calcified, stiff arteries
1-1.2 normal
0.9-1 acceptable
<0.9 PAD
<0.5 severe disease, refer urgently

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19
Q

Mx of venous ulcers
ABPI must be >=?

A

Compression bandaging
0.8

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20
Q

Adverse effects of selective oestrogen receptor modulators (e.g tamoxifen) (5)

MOA

A

Vaginal bleeding
Amenorrhoea
Hot flushes
VTE
Endometrial ca

oestrogen receptor antagonist and partial agonist

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21
Q

Aromatase inhibitors
Example
MOA
Adverse effects (4)

A

Anastrozole
Reduced peripheral oestrogen synthesis

Adverse effects
Osteoporosis
Hot flushes
Arthralgia
Insomnia

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22
Q

Ascending cholangitis is most commonly caused by which organism?

Mx (2)

A

E coli

IV abx
ERCP after 24-48 hours

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23
Q

Charcot’s triad ascending cholangitis
Ix

A

Jaundice
RUQ
Fever

USS

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24
Q

Balanitis general mx (3)

A

Wash foreskin
Saline washes
Hydrocortisone 1%

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25
Q

Balanitis bacterial mx

A

Fluclox or clarithro

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26
Q

Balanitis secondary to lichen sclerosus mx (2)

A

Clobetasol (high dose)
Circumcision

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27
Q

Fibroadenoma
When to surgically excise

A

> 3cm

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28
Q

Mx breast cyst (2)

A

Aspirate
If blood stained or persistently refill then biopsy/ excise

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29
Q

Breast lesions:
Traumatic aetiology
Mass may increase in size initially
=
Mx

A

Fat necrosis
Imaging and biopsy

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30
Q

Nipple discharge, mass
= which breast lesion?

A

Duct papilloma

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31
Q

BPH
Ix (4)

A

Urine dip
PSA
U+E
Urinary frequency volume chart for at least 3/7

32
Q

What is the IPSS?
Interpretation

A

International Prostate Symptoms Score?
20-35 = severe sx
8-19 = moderate sx
0-7 = mild sx

33
Q

BPH Mx (3)
SE of each

A
  1. Alpha-1 antag e.g tamsulosin, alfuzosin
    SE dry mouth, dizziness, postural hypotension
  2. 5-alpha reductase inhibitors e.g finasteride
    SE erectile dysfunction, reduced libido, ejaculation issues, gynaecomastia
  3. Surgery - TURP
34
Q

In BPH if symptoms persist after treatment with an alpha blocker alone and symptoms are largely storage and voiding symptoms what medicine can be started? (2)

A

Tolterodine or darifenacin

35
Q

What infection can increase the risk of bladder ca?
What type of bladder ca?

A

Schistosomiasis
SCC

36
Q

Most common type of bladder ca?

A

Transitional cell carcinoma

37
Q

When to refer for bladder ca?

A

45yo >= with
- unexplained visible haematuria without UTI
OR
- visible haematuria persistent after treatment of UTI

OR

60>= with
- unexplained non visible haematuria AND
- dysuria OR raised WCC

38
Q

RF for VTE
Surgery +GA - how long
Surgery pelvis or lower limb + GA how long?
BMI >
Age >

A

90 mins
60 mins
BMI >35
>60yo

39
Q

Pre-surgical interventions
Women should stop taking the COCP/HRT for how long prior to surgery?

A

4 weeks

40
Q

Post op prophylaxis VTE
Elective hip surgery (3)

A

LMWH for 10/7 folllowed by aspirin 75mg for 28 days
OR
LMWH for 28 days with stockings until discharge
OR
Rivarox

41
Q

Post op VTE prophylaxis
Elective knee surgery (3)

A

Aspirin for 14/7
OR
LMWH for 14/7 with stockings until discharge
OR
Rivarox

42
Q

Post fragility fractures VTE prophylaxis (2)

A

LMWH starting 6-12 hours post op for 1 month
OR
Fondaparinux starting 6 hours post surgery for 1 month

43
Q

Vasectomy failure rate
What needs to be done prior to UPSI

A

1 per 2,000

Semen analysis x2 usually at 16 and 20 weeks post op

44
Q

Success rate of vasectomy reversal if done within 10 years and after 10 years

A

55%
25%

45
Q

RF for varicose veins (4)

A

Increasing age
Female
Pregnancy
Obesity

46
Q

Conservative mx of varicose veins (4)

A

Leg elevation
Weight loss
Regular exercise
Graduated compression stockings

47
Q

When to refer to secondary care for varicose veins? (4)

A

Pain/ discomfort/ swelling
Bleeding
Skin changes
Venous leg ulcer

48
Q

Secondary care mx of varicose veins (3)

A

Endothermal ablation
Foam sclerotherapy
Surgery

49
Q

Bag of worms
Subfertility
More common on the left side
= which condition? What is it?
Ix (1)
Mx

A

Varicocele - abnormal enlargement of testicular veins
USS with doppler
Conservative, occasionally surgery

50
Q

Thrombosed haemorrhoids
Mx
Symptoms usually settle within?

A

If within 72 hours then referral for excision
Otherwise stool softeners, ice packs and analgesia
Symptoms usually settle within 10 days

51
Q

Most common type of testicular cancer?

A

Germ cell tumours

52
Q

Germ cell classifications

A

Seminomas
Non seminomas - e.g teratoma, choriocarcinoma, embryonal, yolk sac

53
Q

Peak incidence for
Seminomas
Teratomas

A

Seminomas 35yo
Teratomas 25yo

54
Q

RF for testicular cancer (5)

A

Infertility
Cryptorchidism
FH
Klinefelter’s
Mumps orchitis

55
Q

Non germ cell examples:

A

Leydig cell tumours
Sarcomas

56
Q

Features of testicular cancer (4)

A

Painless lump
Gynaecomastia
Hydrocele
Pain

57
Q

Tumour markers
Seminoma
Non seminoma

A

Seminoma HCG elevated elevated in 20%
Non seminoma AFP/ BHCG elevated in 80%
LDH in germ cell tumours (seminomas and non seminomas)

58
Q

Which type of testicular cancer is most likely to have a raised bHCG?

A

Non seminoma

59
Q

Mastitis mx (2)

A

Continue breastfedding
Fluclox 10-14 days

60
Q

Nocturia in men mx (3)

A

Moderating fluid intake
40mg furosemide in late afternoon
Desmopressin

61
Q

Overactive bladder mx (3)

A

Moderate fluid intake
Bladder retraining
Oxybutynin/ tolterodine/ darifenacin/ mirabegron

62
Q

Post op return to work following
Open repair
Lap repair of inguinal hernias

A

2-3 weeks
1-2 weeks

63
Q

Hydroceles may develop secondary to (3)

A

Epididymo-orchitis
Testicular torsion
Testicular tumours

63
Q

Usually anterior and below the testicle
You can get above the mass on examination
Transilluminates
=

A

Hydrocele

64
Q

Infantile hydrocele mx
Adults hydrocele mx

A

Usually resolve spontaneously by 1-2yo otherwise surgery
Conservative mx

65
Q

What type of cyst is caused by Echinococcus granulosus?
Most commonly found in which two organs?
Ix
First line
Best investigation

A

Hydatid cyst
Liver and lungs
First line US
CT

66
Q

biliary colic, jaundice, and urticaria

A

Hydatid cysts with biliary rupture

67
Q

Head injury
CT head immediately (5)

A

GCS <13 on initial assessment
GCS <15 2 hours post injury
Post traumatic seizure
Focal neurological deficit
>1 episode of vomiting

68
Q

CT head within 8 hours for adults with any of the following (4)
If they have experienced LOC or amnesia

A

65=>
Bleeding disorder
>30minutes retrograde amnesia events immediately before the injury
Dangerous mechanism of injury

69
Q

Lucid interval
Features of raised intracranial pressure
=
Often caused by what type of trauma? (2)

A

Extradural haematoma

Acceleration - deceleration
Blow to side of head

70
Q

Most common in old age, alcoholism and anticoagulated patients with a head injury

A

Subdural

70
Q

Grade I - IV haemorrhoids

A

I do not prolapse
II prolapse on defecation but reduce sponteneously
III manually reduced
IV cannot be reduced

71
Q

Which three types of drugs can cause erectile dysfunction?

A

SSRIs
BB
Finasteride

72
Q

Ix erectile dysfunction (2)

A

Qrisk including lipid and fasting glucose levels
Free testosterone between 9 and 11am

73
Q

What should be done next following a low or borderline free testosterone in erectile dysfunction?
If abnormal then?

A

FSH, LH, prolactin
If abnormal then refer to endocrinology

AKT (52 decks)

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