Surgery Flashcards
What type of suture is used in a circumcision?
Absorbable, rapidly dissolving sutures
“Vicryl Rapide”
Describe the characteristics of a full thickness burn
Painless
Non-blanching (due to nerve and microvascular damage)
Charred/leathery skin
Describe the characteristics of a partial thickness burn
Painful due to exposure of the nerves
Affect deeper dermis layer
Describe the characteristics of a superficial burn
Red
Painful
Only affects epidermis
What is the analgesic of choice in renal colic?
NSAIDs (diclofenac)
What is prescribed if NSAIDs are contraindicated or not providing sufficient pain relief in renal colic?
IV paracetamol
What class of drug is prescribed in patients with a distal <10mm ureteric stone?
Alpha blockers (tamsulosin, alfuzosin)
What is the imaging of choice in renal colic?
CT KUB
(USS for pregnant patients and children)
Discuss the management of renal stones
Renal stones
- watchful waiting if < 5mm and asymptomatic
- 5-10mm shockwave lithotripsy (ESWL)
10-20 mm shockwave lithotripsy OR ureteroscopy
- > 20 mm percutaneous nephrolithotomy
Uretic stones
- shockwave lithotripsy +/- alpha blockers
- 10-20 mm ureteroscopy
Describe the difference between inguinal and femoral hernias
A femoral hernia will pass inferior and lateral to the pubic tubercle, whereas an inguinal hernia will be seen superior and medial to it
Describe Prehn’s sign
Lifting of the scrotum/testicle to assess any change in pain (commonly used to asses testicular torsion)
What are common side effects of axillary node clearance?
Lymphedema and functional arm impairment
When is axillary node clearance indicated at primary surgery?
Patients with breast cancer who present with clinically palpable lymphadenopathy
Discuss the pre-operative management of patients with breast cancer without palpable axillary lymphadenopathy
Axillary ultrasound and sentinel node biopsy (if negative USS)
When is a mastectomy indicated?
- Multifocal tumour
- Large tumour, small breast
- DCIS (ductal carcinoma in-situ) > 4cm
- Central tumour
When is a wide local excision of breast cancer indicated?
- Solitary lesion
- Small tumour, large breast
- DCIS (ductal carcinoma in-situ) < 4cm
- Peripheral tumour
When is radiotherapy offered in breast cancer patients?
- After a wide local excision
- After a mastectomy in T3/T4 tumours
- After a mastectomy in patients with 4+ positive lymph nodes
What is the initial first aid for minor scalds?
Irrigate the burn with cool or tepid water for between 10-30 minutes, followed by application of a layer of cling film as a dressing
Which nerve can be damaged in an appendectomy?
Ilioinguinal
An indirect hernia is associated with damage to which nerves?
Ilioinguinal and/or iliohypogastric
What are the signs typical of an anastomotic leak?
Atrial fibrillation, increasing confusion, signs of sepsis
What drug can cause gynecomastia?
Digoxin
What is the first line treatment of acute limb ischaemia?
IV heparin, analgesia and a vascular review
What drug is used first line in the management of peripheral arterial disease?
Clopidogrel
Describe an arterial ulcer
Arterial ulcers are typically painful, commonly found on the heel, pale, dry cracked skin, and poor blood supply (weak/decreased pulses)
Describe the features of a venous ulcer
Large, shallow, painless ulcer
What is the screening process for AAA and who qualifies?
Duplex ultrasound
Offered to men over 65 years-old
What size of AAA requires intervention?
> 5.5 cm in men
What are the typical features of varicose veins/chronic venous disease?
- Lower limb swelling - worse at the end of the day
- Lipodermatosclerosis (tight, hardened skin)
- Venous ulcers (shallow and irregular ulcers)
- haemosiderin deposition (skin hyperpigmentation)
- Itching
- Varicose eczema
What is the investigation of choice for chronic venous insufficiency?
Venous duplex ultrasound
What is thrombophlebitis?
Clot formation within a vein
What is the treatment of thrombophlebitis?
Compression stockings once arterial insufficiency has been excluded (ABPI)
