surgery Flashcards
Mx Anal fissure
Acute:
1. laxative, lubricants, topical anaesthetics, analgesia
2. topical GTN
3. ineffective after 8wks-> sphincterotomy/ Botulinum toxin injection
Femoral vs inguinal hernia
inguinal hernia: medial to pubic tubercle
femoral: lateral to pubic tubercle
difference btw strangulated vs incarcerated hernia
strangulated: surgical emergency-> blood supply cut off
incarcerated: unable to reduce
hydrocele mx
infatile hydrocele-> usually resolve
adults: conservative approach depending on severit of presentation
CRC screening
every 2 yr ALL M+F FIT test kit
60-74 years
gastric ulcer which one worsening before or after eating
Worsened by eating
cerebral perfusion pressure equation
CPP= MAP- ICP
Cushing’s reflex
physio nervous system response to increase ICP= HTN, Bradycardia with wide pulse pressure to maintain cerebral perfusion pressure
Normal Psa level
50-59: 3.0 ng/ml
60-79:4
>70: 5
PAD &CLTI DX
us Doppler
ABPI pad- <0.9, CLTI <0.5
CT angiogram
Medication mx PaD
St line clopisogrel
Statin 80mg
For CLTI- unfractionated heparin
Mx stone <5mm
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
Priapism mx and dx
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
Age related PSA
50-59 3.0ng/ml
60-69 4.0ng/ml
>70 5.0 no/ml
1st Ix prostate cancer
Multiparametric MRI
Tumour markers for germ cell testicular cancer
Seminoma
N-seminoma: embryonic, yolk sac, teratoma, choriocarcinoma.
Seminoma: High hCG
N-Seminoma: AFP/ beta-hCG
Indication of CT head in 1 hour
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
CT head within 8hrs
LOC or amnesia since injury
>65 years
Hx of injury/ clotting disorders incl anti-coag
Mech of injury
>30min retrograde amnesia of events
Cerebral perfusion equasion
Cushing reflex
CPP= MAP- ICP
Cushing reflex: HTN reflex to maintain CPP and bradycardia with wide pulse pressure. Irregular breathing late sign impending brain herniation
Duodenal vs gastric ulcer
Pain worsen by eating
Pain relieved by eating
Cullen and grey turner sign
Seen in acute pancreatitis
Periumbilical- Cullen’s sign
Flank discolouration- grey turner sign
Incarcerated vs strangulated hernia
Incarcerated irreducible
Strangulated blood supply cut off
Common pathogen in ascending chokangitis
E. Coli
Signs in ascending cholangitis
Charcots triad: RUQ, fever, jaundice
Reynolds pentad: HoTN, confusion, fever, RUQ, jaundice
Grading of haemorrhoid
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
Definition of acute vs chronic anal fissure
Acute <6 weeks
Chronic > 6weeks
Low rectum and mid rectum CRC which resection
Low anterior resection
Firoadenosis (fibrocystic disease, benign mammary dysplasia of breast)
Most common middle aged women
Lumpy breast which may be painful. Sx may worsen prior to menstruation
Duct papilloma vs mammary duct ectasia
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
Most common breast cancer
Invasive ductal carcinoma
Screening of breast cancer
Mammogram every 3 years 50-70 years
Her2+ breast cancer mx
Trastuzumab
Hormonal tx in breast cancer
Tamoxifen pre & post menopausal female pt
Anastrozole used for post menopausal female patient
SE of selective oestrogen receptor modulator
Ramixifen used in pre menopausal breast cancer.
Menstrual disturbance, hot flushes, VTE and endometrial cancer
Aromatase inhibitor SE
Anastrozole + letrozole= used in post menopausal breast cancer ER+
Osteoporosis: needs DEXAMETHASONE, hot fkushes, arthralgia, insomnia
Acute limb threatening ischaemic sx
Pale pulseless painful paralysed paraethetic perishing with cold
Thrombus vs embolus in acute limb threatening ischaemia
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.
Superficial thrombophlebitis mx
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
Sign seen in duodenal atresia and which genetic syndrome common in
AXR double bubble sign, presents few hours after birth
Down syndrome
