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MSRA > Surgery > Flashcards

Surgery Flashcards

1
Q

Breast lump- mobile, firm, non tender, smooth, upper outer quadrant

A

Fibroadenoma

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2
Q

When to refer a breast lump

A

2ww- 30 and over who have an unexplained breast lump with or without pain.

A non-urgent referral should be considered in patients under 30 with an unexplained breast lump with or without pain.

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3
Q

Menopausal woman with tender lump around her areola and green nipple discharge

A

mammary duct ectasia

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4
Q

Blood stained nipple discharge differentials

A

Duct papilloma
Ductal carcinoma in situ

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5
Q

Eczematous skin over the areola/nipple
Nipple inversion or retraction

A

Paget’s- malignant cells in the nipple-areola complex

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6
Q

Pagets disease of the nipple may be associated with

A

an underlying in situ or invasive ductal carcinoma.

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7
Q

Mastitis management

A

continue breast feeding
warm compress

if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection- fluclox (continue breast feeding)

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8
Q

Management of breast abscess

A

asipration
continue breast feeding

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9
Q

acute mesenteric ischaemia might have a history of

A

AF

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10
Q

80% anal cancers are

A

SCC

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11
Q

When is an anal fissure chronic

A

> 6weeks

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12
Q

90% anal fissures are where

A

posterior midline

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13
Q

Acute anal fissure mx

A

dietary advice

bulk forming laxative

lubricant

topical anaesthetic

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14
Q

Chronic anal fissure mx

A

topical GTN

After 8 weeks if ineffective refer for surgery/botox

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15
Q

Colorectal cancer can be associated with which inherited diseases

A

HNPCC
FAP

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16
Q

What is the CRC screening programme

A

FIT every 2 years from age 60-74, if abnormal then colonoscopy

Also a 1 off sigmoidoscopy aged 55

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17
Q

Caecal/ascending colon/proximal transverse colon cancer surgery

A

R hemicolectomy with ileocolic anastamosis

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18
Q

Distal transverse colon/descending colon cancer surgery

A

L hemicolecotomy with colo-colonic anastamosis

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19
Q

Sigmoid Ca surgery

A

high anterior resection with colorectal anastamosis

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20
Q

rectal cancer surgery

A

Anterior resection with colorectal anastamosis +/- defunctioning stoma

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21
Q

Anal cancer surgery

A

AP resection

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22
Q

Diverticulitis complications

A

perf or abscess

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23
Q

Can you do colonoscopy in diverticulitis

A

no risk perf

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24
Q

Mild diverticulitis rx

A

liquid diet
oral abx

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25
Q

haemorrhoid positions

A

3, 7, 11 oclock

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26
Q

what type of haemorrhoids are more prone to thrombosis and pain

A

external

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27
Q

Gold standard for imaging a perianal abscess

A

MRI

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28
Q

What is psoas sign

A

in appendicitis pain on extending hip if retrocaecal appendix

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29
Q

80% pancreatic cancers type

A

adenocarcinoma

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30
Q

What is whipples procedure

A

pancreaticoduodenectomy for pancreatic head cancers

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31
Q

palpable gall bladder + painless obstructive jaundice is unlikely to be?

A

gallstones (more likely pancreatic ca)

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32
Q

How to differentiate direct and indirect inguinal hernia on examination

A

put finger over deep ring, if when they cough a bulge appears medially to the finger- direct

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33
Q

what type of hernia is more likely to strangulate

A

indirect

34
Q

RUQ pain, fever

A

cholecystitis

35
Q

RUQ, fever, jaundice

A

ascending cholangitis

36
Q

do you get deranged LFTs in cholecystitis or cholangitis

A

cholangitis

37
Q

Causes of pancreatitis

A

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune/ascaris infection
Scorpion
Hypertrig, high cholest, high calcium, hypothermia
ERCP
Drugs (azathioprine, mesalazine, bendroflumathiazide, furosemide, steroids, valproate)

38
Q

Grey-Turner’s sign suggests

A

retroperitoneal haemorrhage in pancreatitis

39
Q

Best test for pancreatitis

A

lipase

40
Q

What can happen to glucose in pancreatitis

A

can go high

41
Q

severe episode of pancreatitis can result in what long term complication

A

diabetes
malabsorption

42
Q

Treatment options for BPH

A

α-blockers such as tamsulosin (relaxes smooth muscle)- works straight away

5α-reductase inhibitor such as finasteride (reduces conversion of testosterone) - may take 6-12 months

TURP/TUIP

43
Q

causes of epididymo-orchitis

A

STI
ecoli (uti causes)
mumps
bechets
amiodarone
TB

44
Q

Bag of worms scrotal swelling

A

varicocele

45
Q

transilluminating scrotal swelling

A

hydrocele

46
Q

painless smooth scrotal lump posterior and separate to the testicle

A

epididymal cyst.

47
Q

superficial thrombophlebitis is associated with what else

A

Often DVT

48
Q

Definitive treatment for thromboangiitis obliterans (buergers diease)

A

stop smoking

49
Q

what is treponema pallidum

A

syphilis causitive agent

50
Q

how long does a chancre last

A

6-8 weeks

51
Q

Mx adult with a hydrocele

A

ultrasound to exclude underlying causes such as a tumour

52
Q

what type of hernia in a child needs surgical repair

A

inguinal

53
Q

mx umbilical hernia in a baby

A

nil- most self resolve by 4-5 yrs

54
Q

who needs to confirm brain death

A

two separate senior and suitably qualified doctors on separate occasions

55
Q

what can you give to help passage of ureteric stones

A

alpha blocker

56
Q

When do you watchful wait in renal stones

A

< 5mm and asymptomatic

57
Q

Ureteric obstruction due to stones together with infection mx

A

surgical emergency

must be decompressed- by nephrostomy, stent or ureteric catheter.

58
Q

Suspected renal colic imaging

A

Non-contrast CT-KUB

59
Q

anaesthetic agent good for known PONV

A

propofol

60
Q

when is a Hartmann’s procedure used

A

in an emergency presentation of a sigmoid tumour- it involves resection and end colostomy rather than an anasatmosis

If a tumour is associated with perforation then anastamosis is more risky

61
Q

adjustment of biphasic or long acting insulins prior to surgery

A

normal day before

Day of half morning dose, usual evening dose

62
Q

adjustment of once daily insulins prior to surgery

A

reduce dose by 20% day before and day of

63
Q

which oral hypoglycaemics do you need to adjust prior to surgery and how

A

metformin only if TDS (omit lunch dose day of)

Sulphonylureas- omit morning dose on day of

SGLT-2 inhibitors (-flozins)- omit day of

64
Q

phaeochromocytoma surgery special prep

A

alpha and beta blockade.

65
Q

carcinoid tumours surgery special prep

A

covering with octreotide

66
Q

What type of stoma is flush to the skin

A

colostomy

67
Q

Do seminomas or teratomas (testicular tumours) have better outcome?

A

Seminomas have a better prognosis than teratomas

68
Q

Most common type of breast ca

A

Invasive ductal carcinoma

69
Q

Ix of choice for suspected sub arach

A

non-contrast CT head

70
Q

When to do an LP in suspected sub arach

A

if CT head is done more than 6 hours after symptom onset and is normal

71
Q

Intervention in patient with sub arach secondary to an aneurysm (if they are relatively stable)

A

coil

72
Q

What type of anaesthetic agents may cause malignant hyperthermia

A

Volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane)

73
Q

Malignant hyperthermia signs

A

Rise in end tidal CO2
sweating

74
Q

malignant hyperthermia rx

A

dantrolene

75
Q

what ethnicity has increased rate of prostate ca

A

afro caribbean

76
Q

reducible, asymptomatic inguinal hernia mx

A

routine surgical repair

77
Q

When are breast fibroadenomas excised

A

> 3cm

78
Q

Fat necrosis of breast may mimic

A

breast ca as may develop into a hard, irregular breast lump that is tethered

79
Q

in surgery for torsion should they fix both or one testes

A

both to prevent other one

80
Q

Head injury, lucid interval

A

extradural

81
Q

investigation of choice for varicose veins/chronic venous disease

A

venous duplex USS

82
Q

Breast cyst mx

A

aspirated, those which are blood stained or persistently refill should be biopsied or excised

MSRA (21 decks)

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