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surgery Flashcards

1
Q

where are ileostomy

A

right iliac fossa

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2
Q

are ileostomy sprouted or flushed

A

sprouted

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3
Q

what is the output of ileostomy

A

liquid

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4
Q

where are colostomy more likely

A

left side

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5
Q

are colostomy flushed or sprouted

A

flushed

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6
Q

what is output of colostomy

A

solid

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7
Q

acute mesenteric ischaemia what PMH is patient likely to have

A

AF

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8
Q

management of acute mesenteric ischaemia

A

immediate laparotomy

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9
Q

what are most anal cancers

A

squamous cell carcinomas

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10
Q

why is anal cancer incidence rising

A

amongst men who have sex with men due to HPV

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11
Q

aorta width <3cm what is the action

A

no further action

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12
Q

aorta width 3-4.4cm what is the action

A

rescan every 12 months

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13
Q

aorta width 4.5-5.4cm what is the action

A

rescan every 3 months

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14
Q

aorta width >5.5cm what is the action

A

refer within 2 weeks to vascular surgery

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15
Q

risk factors for abdominal aortic aneurysms

A

smoking
hypertension
syphilis
Ehler Danlos
Marfan

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16
Q

ABPI < 1 is indicator of

A

peripheral arterial disease

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17
Q

ABPI >1.2 indicates

A

calcified, stiff arteries
advanced again

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18
Q

what is a normal ABPI

A

1-1.2

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19
Q

what ABPI is compression bandaging acceptable

A

> 0.8

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20
Q

what is marjolin ulcer

A

squamous cell carcinoma

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21
Q

where do marlin ulcer occur

A

sites of chronic inflammation
e.g. burns, osteomyelitis

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22
Q

what are features of acute limb threatening Ischaemia

A

6P’s
- pale
- pulseless
- painful
- paralysed
- paraesthetic
- perishing with cold

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23
Q

initial investigation in acute limb threatening ischaemia

A

handheld arterial Doppler examination

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24
Q

factors suggestive ischaemia due to thrombus

A
  • pre existing claudication
  • no obvious emboli source
  • reduced or absent pulses in contralateral limb
  • widespread vascular disease e.g. MI, stroke
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25
Q

factors that suggest Ischaemia due to embolus

A
  • sudden onset painful leg <24 hour
  • no history claudication
  • clinic source of emboli AF, MI,
  • proximal aneurysm
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26
Q

initial management of acute limb ischaemia

A
  • ABC approach
  • IV opioids
  • IV unfractionated heparin
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27
Q

definitive management of acute limb ischaemia

A
  • intra-arterial thrombolysis
  • surgical embolectomy
  • angioplasty
  • bypass surgery
  • amputation
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28
Q

features of critical limb ischaemia

A
  • rest pain in foot for more than 2 weeks
  • ulceration
  • gangrene
  • patient hangs leg out of bed at night to ease pain
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29
Q

ABPI in critical limb ischaemia

A

< 0.5

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30
Q

features of intermittent claudication

A
  • aching or burning in leg muscles following walking
  • relived within minutes of stopping
  • not present at rest
31
Q

first line investigation for intermittent claudication

A

duplex ultrasound

32
Q

what should be performed before any intervention in intermittent claudication

A

magnetic resonance angiography

33
Q

what is a strong link for peripheral arterial disease

A

smoking

34
Q

what should all patients be on with intermittent claudication

A

statin - atorvastatin 80mg

35
Q

what is first line management for peripheral arterial disease

A

clopidogrel

36
Q

definitive management of peripheral arterial disease

A

endovascular revascularisation
surgical revascularisation - for long segment lesion >10cm

37
Q

features of ruptured abdominal aortic aneurysm

A
  • severe, central abodminla pain radiating to the back
  • pulsatile, expansile mass in abdomen
  • patient may be shocked (hypotension, tachycardia) or collapse
38
Q

investigation for ruptured abdominal aortic aneurysm if stable

A

CT angiogram - if diagnosis in doubt

39
Q

what is thrombophlebitis

A

inflammation associated with thrombosis of one of the superficial veins

40
Q

what vein is usually affected in superficial thrombophlebitis

A

long saphenous vein

41
Q

1st line management of superficial thrombophlebitis

A

NSAIDs
- oral if severe
compression stockings
LMWH

42
Q

investigation for superficial thrombophlebitis

A

ultrasound

43
Q

risk factor for varicose veins

A
  • ageing
  • female gender
  • pregnancy
  • obesity
44
Q

features of varicose veins

A
  • appearance
  • aching, throbbing
  • itching
  • bleeding
  • venous ulceration
45
Q

investigation for varicose vein

A

venous duplex ultrasound - retrograde venous flow

46
Q

conservative management for varicose vein

A
  • leg elevation
  • weight loss
  • regular exercise
  • graduated compression stockings
47
Q

severe varicose vein management

A
  • endothermal ablation - radio frequency
  • foam sclerotherapy
  • surgery
48
Q

what is coning

A

brainstem compression

49
Q

unilaterally dilated pupil what nerve

A

3rd nerve compression secondary to tectorial herniation

50
Q

bilaterally dilated pupil

A

bilateral 3rd nerve palsy
poor CNS perfusion

51
Q

bilaterally constricted pupil what is the cause

A
  • opiates
  • pontine lesion
  • metabolic encephalopathy
52
Q

features of hydrocephalus

A
  • headache (worse in morning, when lying down)
  • nausea and vomiting
  • papilloedema
  • coma
53
Q

child features of hydrocephalus

A
  • bulging anterior fontanelle
  • failure of upward gaze (sunsetting eyes)
54
Q

dementia, incontinence and disturbed gait =

A

normal pressure hydrocephalus

55
Q

1st line investigation in hydrocephalus

A

CT head

56
Q

what is gold investigation for hydrocephalus

A

lumbar puncture
- diagnostic and therapeutic

57
Q

management of severe hydrocephalus

A

external ventricular drain

58
Q

management for long term CSF diversion

A

ventriculoperitoneal shunt

59
Q

hepatocellular carcinoma tumour marker

A

serum AFP

60
Q

altered sensation in arm and discomfit when using his hands above their head

A

cervical rib

61
Q

gold investigation for intracranial haemorrhage

A

non contrast CT head

62
Q

GCS limits for CT head within 1 hour

A

GCS <13 on initial assessment
GCS <15 at 2 hours post injury

63
Q

jaundice and RUQ pain suggestive of

A

biliary obstruction

64
Q

when can patient shower after surgery

A

48 hours

65
Q

what is used for cleaning the wound up to 48 hours after surgery

A

sterile saline

66
Q

what does an uncle herniation cause

A

ipsilateral fixed, dilated pupil (due to compression of 3rd cranial nerve)
contralateral paralysis

67
Q

management of intracranial aneurysm following a SAH

A

coiling by an interventional neuroradiologist

68
Q

what is given to reduce vasospasm following SAH

A

nimodipine

69
Q

Charcot triad

A

fever
jaundice
RUQ pain

70
Q

what is Charcot triad a sign of

A

ascending cholangitis

71
Q

investigation for ascending cholangitis

A

ultrasound

72
Q

management of ascending cholangitis

A

antibiotics
ERCP - remove obstruction

73
Q

what is a complication of SAH

A

SIADH

74
Q

long term mechanical ventilation in trauma patients can result in

A

trachea-oesophageal fistula formation

finals (25 decks)

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