surgery Flashcards
useful test of exocrine function in chronic pancreatits
faecal elastase
treating hyperkalemia?
Calcium gluconate is the first step in the management of severe hyperkalaemia as it stabilises the cardiac membrane and reduces the risk of ventricular fibrillation.
insulin and 10% dextrose
testicular torsion, presence of a bell clapper deformity.
mx?
Testicular torsion surgery should involve fixation of both testes to prevent torsion of the other testes
awaiting bowel surgery but had a perf. what procedure would be best at this point?
Hartmann’s procedure is often an emergency operation to remove an obstruction, persistent infection
Acute pancreatitis: causes
zathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
Acute pancreatitis: causes
zathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
overweight lady, breast lump, decresing in size, played rugby but no truma, lump is poorly mobile
what is it?
Fat necrosis of the breast
Traumatic breast fat necrosis can occur after unnoticed injury
presentation of extradural (epidural) haematoma vs subdural?
Artery involved in both?
extradural: middle meningeal artery!!
Subarachnoid haemorrhage vs Intracerebral haematoma?
r/f?
4cm fibroadenoma, mx?
Breast fibroadenoma: surgical excision is usual if >3cm
base of skull fracture 3 components
Bleeding from ruptured vessels can leak into the middle ear (haemotympanum) or mastoid area (Battle’s sign), while ruptured CSF spaces may cause fluid to leak into the nose or auditory canal (CSF rhinorrhoea and otorrhoea).
Sudden onset sensorineural hearing loss
mx?
should be referred (within 24 hours) to ENT, for investigation and consideration of steroid therapy
Aromatase inhibitors (e.g. anastrozole) vs SERM may cause
osteoporosis, DEXA scan, hot flushes
arthralgia, myalgia insomnia
Bilious vomiting in neonates
Duodenal atresia VS Malrotation with volvulus VS Meconium ileus
Suspected epididymo-orchitis: TX?
ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
Surgical op inolving the rectum, what is the procedure?
most common type of breast cancer
Invasive ductal carcinoma (no special type)
A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.
Fibroadenosis
A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.
Fibroadenoma
like mice
abdominal aortic aneurysm. screening?
Single abdominal ultrasound at 65
40-year-old female patient
father has recently been diagnosed with breast cancer.
advise?
Paternal family history of breast cancer - secondary care referral
breast screening age and frequency?
50-70 years
every 3 years
anal fissure mx?
less then 1 week- bulk forming stools
topical steroids
Ascending cholangitis features?
Charcot’s cholangitis triad: fever, jaundice and right upper quadrant pain
79-year-old man some blood in his stools, suspicious mass on the anal sphincter.
management plans?
Rectal cancer on the anal verge → Abdomino-perineal excision of rectum
most common cause of small bowel obstruction
first-line imaging for suspected small bowel obstruction
Adhesions
Abdominal x-ray
How should his metformin vs sulfa be managed on the day of surgery?
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
amylase increased in?
pancreatitis
CT head in 1 hour vs 8 hours guidelines?
Male sterilisation - failure rate
1 in 2,000
A 49-year-old woman presents with a tender lump around the areola associated with a green nipple discharge.
Mammary duct ectasia
important complication of femoral hernias
Strangulation
breast cyst mx?
Breast cysts should be aspirated
most important when classifying the clinical severity of a case of acute pancreatitis?
Presence of any systemic or local complications
renal stones
otger then pain relief another med useful?
alpha adrenergic blocker
Calcium channel blockers are also sometimes used to aid the spontaneous passage of the stone.
what procedure to do depending on stone size?
what procedure to do depending on stone size?
classically described as a ‘bag of worms’
surgery in the morning
takes 20 units of long acting insulin
What should her once-daily dose of insulin be on the day before surgery?
once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery
60-year-old man
complaining of worsening pain in his left leg.
known to have peripheral arterial disease
left lower limb is pale and feels cold with no signs of oedema or trauma
dorsalis pedis and posterior tibial pulses are absent on palpation and inaudible on a doppler exam. His right lower limb pulses are palpable. IV morphine has been administered.
management ?
The initial management of acute limb ischaemia includes analgesia, IV heparin and vascular review
blood-stained nipple discharge
Duct papilloma
Propofol
an antiemetic and is therefore particularly useful for patients with a high risk of post-operative vomiting
Prostate cancer - more common in
Afro-Caribbean population
first-line investigation in suspected prostate cancer. after high psa
Multiparametric MRI
58-year-old man
PSA normal
pr exam: irregular, hard and craggy prostate
next step?
refer the patient as a 2-week wait referral.
Brain death testing conformation?
Brain death testing should be undertaken by two separate doctors on separate occasions
testicular cancer should be suspected
non-painful enlargement or change in shape or texture of the testis
Penile cancer can present with ulceration
squamous cell carinoma
emergency laparotomy
what colostomy bag site?
end colostomy
congenital inguinal hernias more common on what side?
RIGHT
6-week check, you notice bilateral hydroceles
mx?
Communicating hydroceles are common in newborn males and often resolve spontaneously
Penile cancer is associated with… infection?
HIV
imaging of choice in suspected renal colic
Non-contrast CT-KUB
being treated for an episode of giant cell arteritis
20mg prednisolone daily.
drug to prescribe prior to surgery?
Hydrocortisone supplementation is required prior to surgery for patients taking prednisolone
Finasteride treatment of BPH may take … how long to work>?
6 months
national screening programme for colorectal cancer.
Faecal immunochemical test (FIT) test kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland
57%
Lumpectomy is performed (wide excision)
well-differentiated mucinous carcinoma
tx?
Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds
colorectal cancer marker?
Carcinoembryonic antigen
most important risk factor for bladder cancer
smoking
6-year-old boy
noticed the erection
ix?
Cavernosal blood gas analysis is a useful investigation for priapism
when to refer a breast lump?
Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral
Anal fissures- last thing to try?
sphincterotomy may be considered for cases that do not respond to conservative management
Adult patients with a hydrocele.. mx?
ultrasound to exclude underlying causes such as a tumour
patient has prostatitis, wants PSA
when to do it?
Avoid performing a prostate specific antigen test within one month of prostatitis
Inguinal hernia
location?
superior and medial to the pubic tubercle
subarachnoid haemorrhage
mx?
most intracranial aneurysms are now treated with a coil by an interventional neuroradiologist
anaesthetic may cause malignant hyperthermia
isoflurane, desflurane, sevoflurane
Chronic anal fissure steps:
dietary modification, laxatives and topical anaesthetic, topical glyceryl trinitrate
wound dehiscence in the central part of his laparotomy incision and small bowl is visible
tx?
Cover the wound with sterile saline-soaked gauze and administer antibiotics while awaiting a senior review
Patients with long saphenous vein superficial thrombophlebitis should ?
mx?
ultrasound scan to exclude an underlying DVT
