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MSRA 2023 > surgery > Flashcards

surgery Flashcards

1
Q

Mx Anal fissure

A

Acute:
1. laxative, lubricants, topical anaesthetics, analgesia
2. topical GTN
3. ineffective after 8wks-> sphincterotomy/ Botulinum toxin injection

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2
Q

Femoral vs inguinal hernia

A

inguinal hernia: medial to pubic tubercle
femoral: lateral to pubic tubercle

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3
Q

difference btw strangulated vs incarcerated hernia

A

strangulated: surgical emergency-> blood supply cut off
incarcerated: unable to reduce

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4
Q

hydrocele mx

A

infatile hydrocele-> usually resolve
adults: conservative approach depending on severit of presentation

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5
Q

CRC screening

A

every 2 yr ALL M+F FIT test kit
60-74 years

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6
Q

gastric ulcer which one worsening before or after eating

A

Worsened by eating

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7
Q

cerebral perfusion pressure equation

A

CPP= MAP- ICP

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8
Q

Cushing’s reflex

A

physio nervous system response to increase ICP= HTN, Bradycardia with wide pulse pressure to maintain cerebral perfusion pressure

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9
Q

Normal Psa level

A

50-59: 3.0 ng/ml
60-79:4
>70: 5

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10
Q

PAD &CLTI DX

A

us Doppler
ABPI pad- <0.9, CLTI <0.5
CT angiogram

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11
Q

Medication mx PaD

A

St line clopisogrel
Statin 80mg

For CLTI- unfractionated heparin

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12
Q

Mx stone <5mm

A

Typically spontaneously passes within 4 weeks of sx onset
More intensive and urgent tx indicated in presence of ureteric obstruction, renal developmental abnormality.

Ureteric obstruction and infection is surgical emergency-> needs nephrology/ ureteric stent/ ureteric catheter

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13
Q

Priapism mx and dx

A

Dx largely clinical. Cavernosal blood gas low pH and pO2, high pCO2. Doppler/ duplex US

Ischaemic : if >4- aspiration of blood from cavernosa + saline flush. If aspiration fails intracavernosal injection vasoconstriction agent eg. Phenylephrine and repeated 5 min

N-ischaemic: no medical emergency

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14
Q

Age related PSA

A

50-59 3.0ng/ml
60-69 4.0ng/ml
>70 5.0 no/ml

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15
Q

1st Ix prostate cancer

A

Multiparametric MRI

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16
Q

Tumour markers for germ cell testicular cancer

A

Seminoma
N-seminoma: embryonic, yolk sac, teratoma, choriocarcinoma.

Seminoma: High hCG
N-Seminoma: AFP/ beta-hCG

17
Q

Indication of CT head in 1 hour

A

GCS< 13 on initial assessment
GCS <15 @ 2hour post-injury
Signs of basal skull fracture
Post-traumatic seizure
Focal neuron deficit
>1 episodes of vomiting

18
Q

CT head within 8hrs

A

LOC or amnesia since injury
>65 years
Hx of injury/ clotting disorders incl anti-coag
Mech of injury
>30min retrograde amnesia of events

19
Q

Cerebral perfusion equasion

Cushing reflex

A

CPP= MAP- ICP

Cushing reflex: HTN reflex to maintain CPP and bradycardia with wide pulse pressure. Irregular breathing late sign impending brain herniation

20
Q

Duodenal vs gastric ulcer

A

Pain worsen by eating
Pain relieved by eating

21
Q

Cullen and grey turner sign

A

Seen in acute pancreatitis

Periumbilical- Cullen’s sign
Flank discolouration- grey turner sign

22
Q

Incarcerated vs strangulated hernia

A

Incarcerated irreducible
Strangulated blood supply cut off

23
Q

Common pathogen in ascending chokangitis

A

E. Coli

24
Q

Signs in ascending cholangitis

A

Charcots triad: RUQ, fever, jaundice

Reynolds pentad: HoTN, confusion, fever, RUQ, jaundice

25
Q

Grading of haemorrhoid

A

Grade I: no prolapse just prominent blood vessel

Grade II: prolapse upon bearing down but spontaneous reduction

Grade III: prolapse upon bearing down requiring manual reduction

Grade IV: prolapse with inability to be manually reduced

26
Q

Definition of acute vs chronic anal fissure

A

Acute <6 weeks
Chronic > 6weeks

27
Q

Low rectum and mid rectum CRC which resection

A

Low anterior resection

28
Q

Firoadenosis (fibrocystic disease, benign mammary dysplasia of breast)

A

Most common middle aged women
Lumpy breast which may be painful. Sx may worsen prior to menstruation

29
Q

Duct papilloma vs mammary duct ectasia

A

Duct paipilloma: epithelial proliferation in large mammary duct, hyperplasticity lesion. Malignant or premalignant. May present with blood stained discharge

Mammary duct ectasia: most common around menopause, tender lump around areola with green nipple discharge

30
Q

Most common breast cancer

A

Invasive ductal carcinoma

31
Q

Screening of breast cancer

A

Mammogram every 3 years 50-70 years

32
Q

Her2+ breast cancer mx

A

Trastuzumab

33
Q

Hormonal tx in breast cancer

A

Tamoxifen pre & post menopausal female pt

Anastrozole used for post menopausal female patient

34
Q

SE of selective oestrogen receptor modulator

A

Ramixifen used in pre menopausal breast cancer.

Menstrual disturbance, hot flushes, VTE and endometrial cancer

35
Q

Aromatase inhibitor SE

A

Anastrozole + letrozole= used in post menopausal breast cancer ER+

Osteoporosis: needs DEXAMETHASONE, hot fkushes, arthralgia, insomnia

36
Q

Acute limb threatening ischaemic sx

A

Pale pulseless painful paralysed paraethetic perishing with cold

37
Q

Thrombus vs embolus in acute limb threatening ischaemia

A

Thrombus: pre existing claudication with sudden deterioration, no obvious source of embolism, reduced or absent pulses in contrast limb, widespread vascular disease

Embolus: painful leg, no hx of claudication, obvious source of embolus eg. AFib, recent MI, no evidence of PAD norms, pulses, evidence of pros aneurysm.

38
Q

Superficial thrombophlebitis mx

A

NSAIDS: topical for limited and mild disease, po for severe
Topical hepariniids
Compression stocking but need to check ABPI

If affecting pros long saphenous vein then need to have US to r/o DVT. Pt with superficial thrombophlebitis teds and consider for prophy LMWH for 30d or fondaparinux for 45day
Is CI NSAIDS 8-12 days

Is extending to sapheno-femoral junction then therapeutic anticoagulant for 6-12 weeks

39
Q

Sign seen in duodenal atresia and which genetic syndrome common in

A

AXR double bubble sign, presents few hours after birth

Down syndrome

MSRA 2023 (22 decks)

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