Surgery Flashcards
Breast lump- mobile, firm, non tender, smooth, upper outer quadrant
Fibroadenoma
When to refer a breast lump
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.
Menopausal woman with tender lump around her areola and green nipple discharge
mammary duct ectasia
Blood stained nipple discharge differentials
Duct papilloma
Ductal carcinoma in situ
Eczematous skin over the areola/nipple
Nipple inversion or retraction
Paget’s- malignant cells in the nipple-areola complex
Pagets disease of the nipple may be associated with
an underlying in situ or invasive ductal carcinoma.
Mastitis management
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)
Management of breast abscess
asipration
continue breast feeding
acute mesenteric ischaemia might have a history of
AF
80% anal cancers are
SCC
When is an anal fissure chronic
> 6weeks
90% anal fissures are where
posterior midline
Acute anal fissure mx
dietary advice
bulk forming laxative
lubricant
topical anaesthetic
Chronic anal fissure mx
topical GTN
After 8 weeks if ineffective refer for surgery/botox
Colorectal cancer can be associated with which inherited diseases
HNPCC
FAP
What is the CRC screening programme
FIT every 2 years from age 60-74, if abnormal then colonoscopy
Also a 1 off sigmoidoscopy aged 55
Caecal/ascending colon/proximal transverse colon cancer surgery
R hemicolectomy with ileocolic anastamosis
Distal transverse colon/descending colon cancer surgery
L hemicolecotomy with colo-colonic anastamosis
Sigmoid Ca surgery
high anterior resection with colorectal anastamosis
rectal cancer surgery
Anterior resection with colorectal anastamosis +/- defunctioning stoma
Anal cancer surgery
AP resection
Diverticulitis complications
perf or abscess
Can you do colonoscopy in diverticulitis
no risk perf
Mild diverticulitis rx
liquid diet
oral abx
haemorrhoid positions
3, 7, 11 oclock
what type of haemorrhoids are more prone to thrombosis and pain
external
Gold standard for imaging a perianal abscess
MRI
What is psoas sign
in appendicitis pain on extending hip if retrocaecal appendix
80% pancreatic cancers type
adenocarcinoma
What is whipples procedure
pancreaticoduodenectomy for pancreatic head cancers
palpable gall bladder + painless obstructive jaundice is unlikely to be?
gallstones (more likely pancreatic ca)
How to differentiate direct and indirect inguinal hernia on examination
put finger over deep ring, if when they cough a bulge appears medially to the finger- direct
what type of hernia is more likely to strangulate
indirect
RUQ pain, fever
cholecystitis
RUQ, fever, jaundice
ascending cholangitis
do you get deranged LFTs in cholecystitis or cholangitis
cholangitis
Causes of pancreatitis
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune/ascaris infection
Scorpion
Hypertrig, high cholest, high calcium, hypothermia
ERCP
Drugs (azathioprine, mesalazine, bendroflumathiazide, furosemide, steroids, valproate)
Grey-Turner’s sign suggests
retroperitoneal haemorrhage in pancreatitis
Best test for pancreatitis
lipase
What can happen to glucose in pancreatitis
can go high
severe episode of pancreatitis can result in what long term complication
diabetes
malabsorption
Treatment options for BPH
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
causes of epididymo-orchitis
STI
ecoli (uti causes)
mumps
bechets
amiodarone
TB
Bag of worms scrotal swelling
varicocele
transilluminating scrotal swelling
hydrocele
painless smooth scrotal lump posterior and separate to the testicle
epididymal cyst.
superficial thrombophlebitis is associated with what else
Often DVT
Definitive treatment for thromboangiitis obliterans (buergers diease)
stop smoking
what is treponema pallidum
syphilis causitive agent
how long does a chancre last
6-8 weeks
Mx adult with a hydrocele
ultrasound to exclude underlying causes such as a tumour
what type of hernia in a child needs surgical repair
inguinal
mx umbilical hernia in a baby
nil- most self resolve by 4-5 yrs
who needs to confirm brain death
two separate senior and suitably qualified doctors on separate occasions
what can you give to help passage of ureteric stones
alpha blocker
When do you watchful wait in renal stones
< 5mm and asymptomatic
Ureteric obstruction due to stones together with infection mx
surgical emergency
must be decompressed- by nephrostomy, stent or ureteric catheter.
Suspected renal colic imaging
Non-contrast CT-KUB
anaesthetic agent good for known PONV
propofol
when is a Hartmann’s procedure used
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
adjustment of biphasic or long acting insulins prior to surgery
normal day before
Day of half morning dose, usual evening dose
adjustment of once daily insulins prior to surgery
reduce dose by 20% day before and day of
which oral hypoglycaemics do you need to adjust prior to surgery and how
metformin only if TDS (omit lunch dose day of)
Sulphonylureas- omit morning dose on day of
SGLT-2 inhibitors (-flozins)- omit day of
phaeochromocytoma surgery special prep
alpha and beta blockade.
carcinoid tumours surgery special prep
covering with octreotide
What type of stoma is flush to the skin
colostomy
Do seminomas or teratomas (testicular tumours) have better outcome?
Seminomas have a better prognosis than teratomas
Most common type of breast ca
Invasive ductal carcinoma
Ix of choice for suspected sub arach
non-contrast CT head
When to do an LP in suspected sub arach
if CT head is done more than 6 hours after symptom onset and is normal
Intervention in patient with sub arach secondary to an aneurysm (if they are relatively stable)
coil
What type of anaesthetic agents may cause malignant hyperthermia
Volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane)
Malignant hyperthermia signs
Rise in end tidal CO2
sweating
malignant hyperthermia rx
dantrolene
what ethnicity has increased rate of prostate ca
afro caribbean
reducible, asymptomatic inguinal hernia mx
routine surgical repair
When are breast fibroadenomas excised
> 3cm
Fat necrosis of breast may mimic
breast ca as may develop into a hard, irregular breast lump that is tethered
in surgery for torsion should they fix both or one testes
both to prevent other one
Head injury, lucid interval
extradural
investigation of choice for varicose veins/chronic venous disease
venous duplex USS
Breast cyst mx
aspirated, those which are blood stained or persistently refill should be biopsied or excised
