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FINALS > Surgery > Flashcards

Surgery Flashcards

1
Q

Signs of Cardiac Tamponade

A

Becks triad:
- Elevated venous pressure —> Distended neck veins
- reduced arterial pressure —> Decreased BP
- reduced heart sounds —> Distant heart sounds

Pulses paradoxus

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2
Q

Management of cardiac tamponade

A

Fluid resuscitation
Pericardiocentesis

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3
Q

Difference between cardiac tamponade and pericardial effusion

A

Cardiac tamponade = a pericardial effusion large enough to raise the pericardial pressure
—> reduced filling of the heart during diastole —> decreased CO during systole

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4
Q

DDx for Painful scrotal lump

A

Epididymis-orchitis
Testicular torsion
Varicocele
Epididymal cyst
Strangulated inguinal hernia

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5
Q

DDx for painless scrotal lump

A

Hydrocele
Testicular tumour

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6
Q

DDx for a perinatal lump

A

Abscess
Pilonidal Sinus
Fistula
Anal Fissure
Sebaceous cyst
Crohn’s disease
External haemorrhoids

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7
Q

What is Seton Suture drainage?

A

Treatment for Anal fistula
Piece of thread remains in fistula tract to keep it open and allow drainage
Gradually tightened to enable healing and closure

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8
Q

Conditions predisposing to anal fistula

A

Crohns
Diverticula’s disease
TB
Malignancy

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9
Q

Locations of anal cushions

A

3 o’clock (Left lateral)
7 o’clock (right posterior)
11 o’clock (right anterior)

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10
Q

Epithelium type below dentate line / above dentate line

A

Below = squamous
Above = columnar

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11
Q

Management of Haemorrhoids (conservative, non-surgical, surgical)

A
  1. Conservative: Fluid&fibre, laxatives, topical analgesia, toileting advise
  2. Non-surgical: rubber band ligation / injectable sclerosants
  3. surgery: haemorrhoid artery ligation / haemorrhoidectomy

ACUTELY PAINFUL THROMBOSED HAEMORRHOID: analgesia + ice pack + instillagel + laxative

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12
Q

Causes of unilateral hydronephrosis

A

Pelvic - ureteric obstruction
Aberrant renal arteries
Calculi
Tumours of renal pelvis

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13
Q

Causes of Bilateral Hydronephosis

A

Stenosis of urethra
Urethral valve
Prostatic enlargement
Bladder tumour
Retro-peritoneal fibrosis

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14
Q

Most common type of colorectal cancer

A

Adenocardinoma

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15
Q

Which bladder cancer does Schisotosoma infection increase risk of ?

A

Squamous cell carcinoma

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16
Q

Glad standard imaging for suspected renal colic

A

Non-contrast CT KUB

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17
Q

Surgical causes of Right Upper Quadrant pain

A

Gallstone disease
- biliary colic
- cholecystitis
- cholangitis
Hepatitis
Liver abscess

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18
Q

Causes of Epigastric pain

A

Pancreatitis
Peptic ulcer
Inferior MI
Oesophagitis/GORD

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19
Q

Causes of Left Upper Quadrant pain

A

Spenic abscess
Splenic rupture

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20
Q

Causes of Flank pain

A

Renal calculi
Pyelonephritis
UTI

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21
Q

Causes of umbilical region pain

A

Early appendicitis
Bowel obstruction
Strangulated umbilical hernia

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22
Q

Causes of Right iliac fossa pain

A

Late appendicitis
Ureteric colic
Crohns
Testicular torsion
Ectopic pregnancy
Meckel’s diverticulitis
PID
Ovarian Cyst
Salpingitis
Hernia

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23
Q

Causes of hypogastric region pain

A

Testicular torsion
Urinary retention
Cystitis
PID

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24
Q

Causes of Left iliac fossa pain

A

Diverticulitis
Ulcerative colitis
Testicular torsion
Ectopic pregnancy
Sigmoid volvulus
Constipation
PID
Ovarian cyst
Salpingitis
Hernia

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25
Q

When to consider mesenteric ischemia?

A

Out of proportion pain +/- metabolic acidosis

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26
Q

Medical causes of acute abdominal pain

A

DKA
UTI
Basal lobe pneumonia
Poisoning / OD
Addison’s disease
Hypercalcaemia
Bacterial peritonitis
Mesenteric adenitis
Constipation

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27
Q

What is Mesenteric adenitis?

A

a syndrome characterized by right lower quadrant pain secondary to an inflammatory condition of mesenteric lymph nodes.
Commonly mistaken for acute appendicitis

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28
Q

Character of peritonitic pain

A

Worse on inspiration
pt often lies still, shallow breaths
Rigidity / guarding

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29
Q

Difference between MRCP and ERCP?

A

Magnetic resonance cholangiopancreatography (MRCP) is an alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for investigating biliary obstruction.
MRCP = non-invasive procedure

Both used in suspected pancreatic cancer, pancreatitis, gallstones and bile duct problems

30
Q

Causes of Acute Appendicitis

A

I GET SMASHED

Idiopathic (20%)
Gallstones (40%)
Ethanol (35%)
Trauma (15%)
Steroids
Mumps (CMV, EBV)
Autoimmune (SLE, polyarteritis nodosa)
Scorpion venom (lol)
Hyperlipidaemia, hypercalacemia, hypothermia
ERCP
Drugs (thiazides, sulphonamides, ACEi, NSAIDs)

31
Q

Investigations in Acute pancreatitis

A

Routine bloods - FBC, U&Es, LFTs, clotting, calcium, lipids
Pregnancy test
Serum lipase/amylase
Erect CXR - to rule out perf.
ABG - monitor the acid-base status
USS - if gallstones suspected
MRCP/CT - extent of damage
Endoscopic USS - if other imaging negative

32
Q

Scoring system for severity of acute pancreatitis

A

Modified Glasgow Score (MGS)
or
Ranson’s criteria

33
Q

Why is pancreatitis caused by hypercalcaemia and causes hypocalcemia

A

Hypercalcaemia - calcium deposition in the pancreatic duct and calcium activation of trypsinogen in the pancreas.

Enzymes released from the pancreas -> autodigestion of fats and blood vessels –> fat necrosis and sometimes hemorrhage

Fat necrosis –> release of fatty acids –> react with serum calcium –> hypocalcemia

34
Q

APACHE II Score

A

Assesses disease severity in patients admitted to ICU

35
Q

Early complications of acute pancreatitis

A

Hypovolaemic shock —> renal failure
Hyperglycaemia / hypocalacemia
DIC & Sepsis
Acute respiratory distress syndrome

36
Q

Late complications of pancreatitis

A

Pseudocyst (= collection of necrotic tisssue and fluid forming 4-6 weeks after acute pancreatitis)
Abscess
Splenic/duodenal/SMA infarct
Chronic pancreatitis –> cancer

37
Q

Management of pancreatitis

A
  1. ABCDE: IV fluids, O2, catheter, analgesia
  2. Identify and treat the cause e.g. cholecystectomy for gallstones
  3. Close monitoring
  4. only NBM if very unwell (consider NG tube)
38
Q

What is third space fluid loss?

A

third-spacing occurs due to decreased oncotic pressure in the intravascular space –> fluid will “leak out” of the intravascular space into the interstitial space

(this can include the interstitial spaces in the brain leading to cerebral oedema!)

39
Q

Causes of third-spacing

A

Decreased protein levels
Heart Failure
Increased capillary permeability
Liver failure
Lymphatic obstruction
Major Surgery
Pancreatitis
Sepsis syndrome
Severe Burns
Trauma
Viral and Bacterial infections

40
Q

What is meckel’s diverticulum?

A

One of most common GI congenital disorders
May have ectopic acid-secreting gastric or pancreatic tissue
Remnant of embryological vitello-intestinal duct
Located in the distal ileum

41
Q

Meckel’s diverticulum: Rule of 2s

A

2% of population
2 years old = peak presentation
2:1 ratio M:F
2 inches long
2 feet proximal to ileocaecal valve
2 types of ectopic tissue (gastric/pancreatic)

42
Q

Meckel’s diverticulum: Presentation/complications

A

Could be asymptomatic for whole life

General inflammation: presents similar to acute appendicitis

GI Bleeding
- bright red blood in stools

Obstructive symptoms (Abdo pain, vomiting, constipation)
- Intussuseption
- Caecal volvulus

Pain = RIF

43
Q

Meckels diverticulum: Investigations

A

Technetium Scan
CT
(USS)

44
Q

What is +ve Rovsing’s Sign?

A

Pain in RIF when LIF is pressed

Suggests acute appendicitis

45
Q

What is +ve Psoas sign?

A

Pain on right hip extension

Elicited by having the patient lie on his or her left side while the right thigh is flexed backward. Pain may indicate an inflamed appendix overlying the psoas muscle

46
Q

What is +ve Obturator sign?

A

Pain on internal hip rotation

Discomfort felt by the subject/patient on the slow internal movement of the hip joint, while the right knee is flexed. It indicates an inflamed pelvic appendix that is in contact with the obturator internus muscle

47
Q

Where is McBurney’s Point?

A

1/3 of the way between anterior, superior iliac spine and umbilicus

48
Q

Difference between:
- Diverticula
- Diverticulum
- Diverticulosis
- Diverticular disease
- Diverticulitis

A

Diverticular (Pleural) and Diverticulum (Singular) = outpouching of bowel wall at areas of high pressure

Diverticulosis = asymptomatic presence of diverticula

Diverticular disease = Diverticulosis + symptoms

Diverticulitis = inflammation of diverticula (due to stagnated contents)

49
Q

Complications of diverticular disease

A

Perforation
Obstruction
Fistula
Pericolonic abscess (Pus in bowel wall)

50
Q

Common site for diverticulum

A

Sigmoid colon

51
Q

Risk factors for diverticular disease

A

Diet: Low fibre, high fat (constipation)
Age: >50yrs, male gender
Obesity
Connective tissue disease e.g. Marfan’s, Ehlers danlos (weak bowel wall)

52
Q

Management of diverticular disease

A

Conservative: fluids & fibre, smoking cessation & weight loss

Medical: Analgesia, bulk-forming laxatives

53
Q

Management of diverticulitis

A

ABCDE
Analgesia
Broad spectrum Abx if unwell
IV fluids

54
Q

Presentation of diverticular disease

A

Left sided colicky pain
Relief with defecation
Altered bowel habit
Sudden Painless bleed - bright read

mimics colorectal cancer

55
Q

Presentation of diverticulitis

A

Severe LIF pain - acute, worse with movement
Localised guarding and tenderness in LIF
Systemic upset

56
Q

Causes of Paediatric bowel obstruction

A

Intussusception
Faecal impaction
Hernia
Malrotation/atresia
Hirschsprung’s
Pyloric stenosis
Adhesions
Imperforate anus

57
Q

Tumour marker for colorectal cancer

A

Carcinoembryonic antigen (CEA)

58
Q

Management of a reducible femoral hernia

A

Surgical repair within 2 weeks

All femoral hernias needs to be repaired - regardless of whether they are symptomatic

High risk of strangulation

59
Q

Define incarcerated hernia

A

Non-reducable

60
Q

Define strangulated hernia

A

Can follow incarceration
It is where the arterial supply is compromised

61
Q

Common causes of acute mesenteric ischaemia

A
  1. EMBOLISM (50%) (Acute Mesenteric Arterial Embolism, AMAE) - cardiac causes
  2. Thrombus-in-situ (Acute Mesenteric Arterial Thrombosis, AMAT) - atherosclerosis
  3. Non-occlusive cause (Non-Occlusive Mesenteric Ischemia, NOMI) - e.g. hypovolaemia shock, cardiogenic shock
62
Q

Clinical features of acute mesenteric ischaemia

A

Generalised abdominal pain, out of proportion to the clinical findings

Diffuse and constant pain, with associated nausea/vomiting

non-specific tenderness

Late stages - globalised peritonism from perf

63
Q

Acute mesenteric ischemia: ABG results

A

Increased Lactate
Acidosis

64
Q

Imaging for acute mesenteric ischemia

A

CT with IV contast (oral contrast avoided)

65
Q

Acute mesenteric ischaemia - findings on CT

A

Oedematous bowel (secondary to the ischaemia and vasodilatation)
Then may progress to a loss of bowel wall enhancement and then to pneumatosis (gas within the wall)

66
Q

Acute mesenteric ischemia - management

A

Urgent resusitation
Broad spectrum antibiotics

Definitive management:
- revascularisation of the bowel
- Excision of necrotic or non-viable bowel

67
Q

Acute mesenteric ischaemia definitive diagnosis

A

CT angiography

68
Q

Equation for serum osmolality

A

(2 x Na+) + glucose + Urea

69
Q

Normal urine output

A

0.5-1.5 mL/kg/hour

70
Q

Type of urine sample for suspected epididymo-orchitis

A

Guided by age

sexually active younger adults: NAAT for STIs (first catch)

older adults with a low-risk sexual history: MSSU

71
Q

Function of a loop ileostomy

A

= defunctioning stoma, diverts bowel contents away from the entire colon

Easier to reverse than a loop colostomy

FINALS (19 decks)

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