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Finals > Surgery > Flashcards

Surgery Flashcards

Vascular - General surgery - HPB -

1
Q

Definition of AAA

A

Dilatation of the aorta >3cm

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2
Q

Risk factors for AAA

A

Increasing age
Smoker
Male
HTN
Hyperlipidaemia
FMHx

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3
Q

When is screening for AAA done

A

In males in their 65th year of life

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4
Q

How frequently are AAA scanned when under surveillance?

A

3.0-4.4cm: Yearly ultrasound
4.5-5.4cm: 3-monthly ultrasound

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5
Q

What are the indications for surgical intervention in AAA?

A

AAA>5.5 cm
Expanding >1 cm/yr
Symptomatic AAA

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6
Q

When do you need to notify the DVLA of a AAA?

A

Stop driving is >6.5 cm

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7
Q

What is an aortic dissection

A

Tear in the intima layer of the aortic wall
Allows blood to separate the tunica intima and media

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8
Q

What are the risk factors for aortic dissection?

A

Male
50-70 years
Connective tissue disorders
HTN
Atherosclerotic disease
Bicuspid aortic valve

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9
Q

Describe Stanford classification of aortic dissection

A

Type A-Involves ascending aorta
Type B-Does not involve ascending aorta

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10
Q

Describe the DeBakey classification of aortic dissection

A

Type I-Originates in the ascending aorta and propagates at least to the aortic arch
Type II-Confined to the ascending aorta
Type III-Originates distal to the subclavian artery in the descending aorta
(IIIb extends beyond the diaphragm)

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11
Q

What are the possible complications of aortic dissection?

A

Aortic rupture
Aortic regurgitation
Myocardial ischaemia (Secondary to coronary artery dissection)
Cardiac tamponade
Stroke or paraplegia (Secondary to cerebral artery or spinal artery involvement)

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12
Q

What can cause bowel obstruction?

A

Top 3:
Adhesions
Hernias
Malignancy
Also:
Volvulus
Diverticular disease
Strictures e.g. second to IBD
Intussusception

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13
Q

What are the upper limits of the normal diameter of bowel?

A

Small- 3cm
Large- 6cm
Caecum- 9cm

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14
Q

Small bowel vs large bowl on xray

A

Small- central with valvulae conniventes
Large- peripheral with haustra

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15
Q

Complications of bowel obstruction?

A

Perforation
Ischaemia
Hypovolaemic shock- third spacing
Infection- stasis causes increased permeability of bowel wall

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16
Q

What are some causes of generalised abdo pain in acute abdo?

A

Peritonitis
Ruptured abdominal aortic aneurysm
Intestinal obstruction
Ischaemic colitis

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17
Q

What are some causes of RUQ abdo pain in acute abdo?

A

Biliary colic
Acute cholecystitis
Acute cholangitis

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18
Q

What are some causes of epigastric pain in acute abdo?

A

Acute gastritis
Peptic ulcer disease
Pancreatitis
Ruptured abdominal aortic aneurysm

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19
Q

What are some causes of central abdo pain in acute abdo?

A

Ruptured abdominal aortic aneurysm
Intestinal obstruction
Ischaemic colitis
Early stages of appendicitis

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20
Q

What are some causes of RIF abdo pain in acute abdo?

A

Acute appendicitis
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
Meckel’s diverticulitis

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21
Q

What are some causes of LIF abdo pain in acute abdo?

A

Diverticulitis
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion

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22
Q

What are some causes of suprapubic pain in acute abdo?

A

Lower urinary tract infection
Acute urinary retention
Pelvic inflammatory disease
Prostatitis

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23
Q

What are some causes of loin to groin pain in acute abdo?

A

Renal colic (kidney stones)
Ruptured abdominal aortic aneurysm
Pyelonephritis

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24
Q

What are some causes of testicular pain in acute abdo?

A

Testicular torsion
Epididymo-orchitis

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25
Q

What is an ileus?

A

A condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops

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26
Q

What can cause ileus?

A

Injury to the bowel
Abdo surgery involving handling of the bowel
Inflammation or infection in or near the bowel
Electrolyte imbalance e.g. hypoK or hypoNa

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27
Q

Key examination finding to differentiate between ileus and obstruction?

A

Ileus will have absent bowel sounds, obstruction will have tinkling bowel

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28
Q

What are the two most common types of volvulus and what populations do they affect?

A

Sigmoid most common- older pt
Caecal volvulus- younger pt

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29
Q

What are the causes/risk factors of sigmoid volvulus?

A

Chronic constipation
Excessive laxative use
High fibre diet
Nursing home residents
Pregnancy
Neuropsychiatric disorders e.g. PD
Adhesions

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30
Q

What is the sign of volvulus on AXR?

A

Coffee bean sign- dilated and twisted sigmoid

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31
Q

What are the management options for sigmoid volvulus?

A

Endoscopic decompression (recurrence ~60%)
Laparotomy
Hartmann’s/ ileocaecal resection/ R hemicolectomy- if ischaemic bowel

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32
Q

What are the 3 complications of hernias? And how do they present

A

Incarceration- non reducible
Obstruction- vomiting, generalised abdo pain, absolute constipation
Strangulation -non reducible and causing ischaemia. Significant pain.

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33
Q

What is the difference between a direct and indeircet inguinal hernia, and who tends to get them?

A

Direct- through hesselbach’s triangle and out the superficial inguinal ring. Common in older pts
Indirect- through the deep inguinal ring, along the inguinal canal and out the superficial inguinal ring. Common in younger patients, from incomplete closure of processus vaginalis

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34
Q

What are the borders of Hesselbach’s triangle?

A

Rectus abdo muscle
Inferior epigastric vessels
Inguinal ligament

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35
Q

Where are the two types of inguinal hernia, in relation to the epigastric vessels?

A

Direct- medial
Indirect- lateral

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36
Q

What are the risk factors for inguinal hernia?

A

Intra abdo pressure- chronic cough, heavy lifting, chronic constipation
High BMI
Increasing age
Male gender

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37
Q

What are the potential complications following elective inguinal hernia repair?

A

Haematoma/seroma
Recurrence
Chronic pain
Damage to surrounding structures- may cause sub fertility

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38
Q

Where is an inguinal hernia vs a femoral hernia palpated?

A

Inguinal- superiomedial to the pubic tubercle
Femoral- inferiolateral to the pubic tubercle

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39
Q

What are the risk factors for a femoral hernia?

A

Female
Pregnancy
Increasing age
Raised intra abdo pressure- lifting, cough, constipation

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40
Q

What are haemorrhoids?

A

Enlarged anal vascular cushions

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41
Q

What are the risk factors for haemorrhoids?

A

Constipation and straining
Pregnancy
Obesity
Lifting/chronic cough
Increased age
Portal venous hypertension
Cardiac failure
FMH

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42
Q

What are the different degrees of haemorrhoids?

A

1- remain in rectum
2- prolapse on defecation but spontaneously reduce
3- prolapse on defecation and require reduction
4- always prolapsed

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43
Q

What are the management options for haemorrhoids?

A

Conservative- inc fluid and fibre, laxatives
Lignocaine gel may be given
Rubber band ligation -1/2 degree
Haemorrhoid artery ligation
Haemorrhoidectomy

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44
Q

What are the complications of surgical interventions for haemorrhoids?

A

Recurrence
Anal stricturing
Faecal incontinence

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45
Q

What is Charcot’s triad and what does it indicate?

A

Ascending cholangitis:
RUQ pain
Fever
Jaundice

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46
Q

What is Raynaud’s Pentad?

A

Charcots triad (fever, RUQ pain, jaundice), plus:
Confusion
Hypotension

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47
Q

What is the gold standard management for ascending cholangitis?

A

ERCP

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48
Q

What is the main, significant complication of ERCP?

A

Pancreatitis

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49
Q

What is Murphy’s sign and what does it indicate?

A

Breathing arrested by pain when asked to deeply inspire while palpating under the right hypochondrium
Acute cholecystitis likely

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50
Q

What are the risk factors for gallstones?

A

Fat
Female
Fertile (pregnant or COCP)
Forty
FMHs
Also- haemolytic anaemia for pigment stones, malabsorption

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51
Q

What is biliary colic?

A

When the gallbladder neck is impacted by a gallstone.
No inflam response, but causes pain.

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52
Q

Describe the pain of biliary colic, and associated symptoms

A

RUQ sudden, dull, intermittent pain. May radiate to epigastrium or back.
May be precipitated by consumption of fatty foods.
Often accompanied by N+V

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53
Q

How does the pain of acute cholecystitis differ from biliary colic?

A

Pain will still be RUQ or epigastrium, but will be constant. Also, associated with signs of inflam like fever or lethargy.
Tender O/E, and +ve murphy’s sign

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54
Q

What is the first line investigation for gallstones, and what is gold standard?

A

Trans abdo US
MRCP

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55
Q

What are some absolute C/I to laparoscopic surgery?

A

Multiple dilated bowel loops- risk of perf
Haemodynamic shock and instability
Uncorrected coagulopathy
Raised intracranial pressure

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56
Q

What is the difference between a tracheostomy and a laryngectomy?

A

In a tracheostomy, a surgical opening is created to access the trachea, with the larynx remaining intact.
In laryngectomy, the larynx is removed, and the trachea is brought to the skin surface as a stoma.

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57
Q

What is the most common cause of acute mesenteric ischaemia?

A

Embolism causing occlusion of an artery supplying the small bowel e.g. superior mesenteric artery
(thus pts often have pmh of af)

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58
Q

What is the classic presentation of a patient with acute mesenteric ischaemia?

A

The abdominal pain is typically severe, of sudden onset and out-of-keeping with physical exam findings

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59
Q

How is acute mesenteric ischaemia managed?

A

Immediate laparotomy

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60
Q

What are the causes of acute mesenteric ischaemia?

A

Arterial embolism e.g. due to AF, IE, aortic aneurysm
Arterial thrombosis e.g. due to atherosclerosis
Venous thrombosis e.g. due to hypercoagulable states
Non occlusive e.g. HF, shock, major surgery

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61
Q

What will an ABG show in mesenteric ischaemia?

A

Metabolic acidosis

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62
Q

How is mesenteric ischaemia diagnosed?

A

Clinical picture + CT angiography

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63
Q

How does chronic mesenteric ischaemia present?

A

Colicky, post prandial abdo pain
Weight loss
+/- GI bleed

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64
Q

What are the risk factors for chronic mesenteric ischaemia?

A

Increasing age >60
Smoking
HTN
Hyperlipidaemia
DM
AF

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65
Q

How is chronic mesenteric ischaemia managed?

A

RF modification
Symptom relief- vasodilators
Revascularisation- Percutaneous transluminal angioplasty (PTA) with or without stenting or surgical revascularization (for patients with severe symptoms or if conservative management failed)

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66
Q

What are the two most important markers for identifying and monitoring pancreatitis?

A

Amylase- only raised in initial acute pancreatitis
Lipase- can be used to monitor disease activity. More sensitive and specific.

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67
Q

What are the causes of acute pancreatitis?

A

GET SMASHED:
Gallstones (most common worldwide)
Ethanol (most common cause in Europe)
Trauma
Steroids
Mumps
Autoimmune disease (e.g., Polyarteritis Nodosa/SLE)
Scorpion bite
Hypercalcaemia, hypertriglycerideaemia, hypothermia
ERCP
Drugs

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68
Q

What drugs can cause pancreatitis?

A

FATSHEEP:
Furosemide
Azathioprine/Asparaginase
Thiazides/Tetracycline
Statins/Sulfonamides/Sodium Valproate
Hydrochlorothiazide
Estrogens
Ethanol
Protease inhibitors and NRTIs

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69
Q

What is the typical description of the pain associated with pancreatitis?

A

Stabbing, epigastric pain radiating to the back.
Relieved sitting forward or fetal position

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70
Q

What are the eponymous signs of pancreatitis?

A

Grey Turner’s
Cullen’s sign

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71
Q

What model is used to grade the severity of pancreatitis, and what are the parameters?

A

Modified Glasgow criteria
(Remember PANCREAS):
PaO2 < 8kPa (60mmHg)
Age > 55 years
Neutrophils - WCC >15 x109/l
Calcium < 2mmol/l
Renal function - Urea > 16mmol/l
Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L
Albumin < 32g/l
Sugar - Glucose >10mmol/L

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72
Q

What is the meaning of a score of 3 or more on modified Glasgow criteria?

A

Severe pancreatitis necessitating transfer to HDU/ITU

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73
Q

How is acute pancreatitis managed?

A

Treat underlying cause
Supportive managed with aggressive fluid resus:
-Catheter and fluid resus to maintain UO >30mL/hr
-Analgesia
-Anti emetics
-Replacement of calcium
-Insulin if becoming hyperglycaemic

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74
Q

What are the local and systemic complications of pancreatitis?

A

Local:
Peripancreatic fluid collection
Pseudocyst
Pancreatic abscess
Pancreatic necrosis
Haemorrhage
Systemic:
ARDS
Hypovolaemia
DM
DIC

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75
Q

What are the complications of pancreatic necrosis?

A

Infection, SIRS, organ failure

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76
Q

What is a pancreatic pseudocyst?

A

A fluid-filled sac that lacks a true epithelial lining, formed as a consequence of inflammation and necrosis of the pancreas

77
Q

What is the pathophysiology of acute pancreatitis?

A

Causes of pancreatitis will cause inflammation which will trigger a premature and exaggerated activation of the digestive enzymes within the pancreas.
-pancreatic inflammatory response causes an increase in vascular permeability and fluid shifts
-enzymes released will cause autodigestion of fats (fat necrosis) and blood vessels
-fat necrosis causes release of free fatty acids that bind with calcium to form deposits, causing hypocalcaemia

78
Q

What is the finding on AXR consistent with pancreatitis?

A

Sentinel loop sign (dilated proximal bowel)

79
Q

How does chronic pancreatitis present?

A

Chronic pain
Endocrine insufficiency (islets of L damage)- hyperglycaemia
Exocrine insufficiency (acinar cell damage)- malabsorption, weight loss, diarrhoea, steatorrhea

80
Q

How is chronic pancreatitis managed?

A

Treat underlying
Mainstay is analgesia, often pregabalin is preferred.

81
Q

What are the causes of chronic pancreatitis?

A

Most common- alcohol abuse or idiopathic
Hyperlipidaemia
Infection- e.g. HIV, mumps etc
CF
Autoimmune pancreatitis
Malignancy or strictures

82
Q

What is the most common type of cystic neoplasm of the pancreas?

A

Serous cystadenoma

83
Q

What is the most common type of pancreatic cancer?

A

Ductal adenocarcinoma - from exocrine pancreas

84
Q

Where is pancreatic cancer most commonly found?

A

Head of the pancreas

85
Q

What are the risk factors for pancreatic cancer?

A

Advanced age
Male
Smoking
Obesity
Chronic pancreatitis (20 plus yrs of condition)
Diabetes
Genetic- BRCA and HNPCC

86
Q

How does pancreatic cancer usually present? Signs and symptoms

A

Usually at a later stage:
Obstructive jaundice
Weight loss
Abdominal pain
Late onset diabetes
O/e: cachectic, malnourished, jaundiced, abdo mass in epigastrium

87
Q

What is the tumour marker for pancreatic cancer? And how is it used?

A

CA 19-9
(best for monitoring response to treatment, poor specificity for initial diagnosis)

88
Q

What is the gold standard imaging for initial pancreatic cancer diagnosis?

A

CT imaging with IV contrast

89
Q

What is the curative management of pancreatic cancer?

A

Radical resection
Head of pancreas- Whipple’s/pancreaticoduodenectomy
Body or tail- distal pancreatectomy and splenectomy

90
Q

What does a Whipple’s procedure entail?

A

Removal of:
Head of pancreas
Antrum of stomach
2/3 of proximal duodenum
Common bile duct
Gallbladder
(due to shared gastroduodenal artery)
Reattachment:
Tail of pancreas, hepatic duct and stomach are attached to jejunum

91
Q

What are the standard pre op investigations for an elective surgery?

A

Bedside- ECG, urine analysis, bHCG, MRSA swab, covid test
Bloods- FBC, U&E, LFTs, Clotting, G&S
Sickle cell test

92
Q

What are the NBM pre op guidelines?

A

Clear fluids up to 2 hours pre op
Food must be held for at least 6 hours pre op

93
Q

When is variable rate insulin given pre op?

A

-If diabetic is missing more than one meal
-Poorly controlled diabetes
-Risk of renal injury (eGFR<60 or use of contrast)

94
Q

How is metformin managed pre operatively?

A

Take as normal, but max BD on day of surgery

95
Q

What antidiabetic medications are omitted on the day of surgery?

A

Sulfonyureas e.g. gliclazide
SGLT2 inhibitors -flozins

96
Q

How are basal bolus insulin regimes managed pre operatively?

A

Reduce basal dose by 20% the day before and day of surgery
E.g. Lantus, Levemir
Stop bolus insulin and begin sliding scale when patient is NBM

97
Q

What special pre operative preparation is needed in colorectal surgeries? And why?

A

Bowel preparation -esp in left sided surgery
Reduce chance of infection, and clear bowel for visibility in colonoscopy

98
Q

What is the risk of metformin pre operatively?

A

Lactic acidosis- mostly is there is renal impairment

99
Q

When is warfarin stopped pre operatively? What is the target INR?

A

5 days prior to surgery
INR needs to be <1.5

100
Q

When is COCP/HRT stopped pre operatively?

A

4 weeks prior

101
Q

What antiplatelets are stopped pre operatively and when?

A

Clopidogrel- 7 days prior
All others can continue e.g. aspirin

102
Q

When are ACEi stopped pre operatively?

A

24 hours preoperatively (normally taken at night so omit the day before)

103
Q

How are steroids managed pre operatively?

A

Continue
Specialist will adjust dose, depends on type of surgery etc.
Likely switch to IV hydrocortisone when pt is NBM

104
Q

What is the conversion of prednisolone to hydrocortisone?

A

5mg PO pred= 20mg IV hydrocortisone

105
Q

What is angiodysplasia?

A

Formation of AV malformations
Most commonly in the caecum and ascending colon
It is the most common cause for bleeding from the small bowel

106
Q

How is a definitive diagnosis of angiodysplasia made? (in stable pt)

A

Endoscopy
OGD, colonoscopy, or capsule(small bowel)

107
Q

What is the pathophysiology of angiodysplasia?

A

Congenital- hereditary haemorrhagic telangiectasia
Acquired- reduced submucosal venous drainage due to chronically reduced colon contraction(peristalsis). Causes dilated and tortuous veins. Leads to AV communications.

108
Q

What are the two most common presentations of angiodysplasia?

A

New onset anaemia.
PR bleed.

109
Q

What is the gold standard investigation for colorectal cancer?

A

Colonoscopy with biopsy

110
Q

What is the curative management for caecal, ascending colon or transverse colon tumours? What vessels are removed?

A

Right hemicolectomy (extended for transverse)
Ileocolic, right colic and right branch of middle colic vessels

111
Q

What is the curative management for descending colon tumours? What vessels are removed?

A

Left hemicolectomy
Middle colic, inferior mesenteric vein, left colic vessels

112
Q

What is the curative management for sigmoid colon tumours? What vessels are removed?

A

Sigmoidcolectomy
IMA is fully dissected

113
Q

What is the curative management for high rectal tumours?

A

Anterior resection

114
Q

What is the curative management for low rectal tumours (<5cm from anus)?

A

Abdominoperineal resection

115
Q

What is a Hartmann’s procedure and when is it used?

A

Complete resection of rectosigmoid colon(or affected area of colon), plus end colostomy and closure of rectal stump.
Used in emergency surgery management of obstruction or perforation.

116
Q

How may a colorectal cancer presenting with bowel obstruction be relieved?

A

Decompressing colostomy
Endoscopic stenting

117
Q

What is the most common type of anal cancer, and from below what line does it arise?

A

Squamous cell carcinoma
Below the dentate line

118
Q

What is the dentate line?

A

Separates upper 2/3 and lower 1/3 third of anal canal.
Above is columnar epithelium, below is stratified squamous epithelium

119
Q

What is achalasia?

A

Primary motility disorder of the oesophagus, in which the LOS fails to relax, and there is an absence of peristalsis in the oesophagus

120
Q

What does a birds beak appearance on barium swallow indicate?

A

Achalasia

121
Q

What is the gold standard investigation for oesophageal motility disorders?

A

Oesophageal manometry

122
Q

How is achalasia managed?

A

Medical- sublingual nifedipine. Botox injections into LOS.
Surgical- Laparoscopic heller myotomy(cardiomyotomy)
Endoscopic balloon dilatation

123
Q

What is the main complication following a heller myotomy or per oral endoscopic myotomy?

A

GORD

124
Q

What does a corkscrem appearance on barium swallow indicate?

A

Diffuse oesophageal spasm

125
Q

What is the most common site of peptic ulcers?

A

Lesser curvature of the stomach, or first part of duodenum

126
Q

How do NSAIDs cause peptic ulcers?

A

Inhibiting prostaglandin synthesis, resulting in reduced glycoprotein, mucus and phospholipid secretion by gastric epithelial cells

127
Q

How does H.Pylori cause peptic ulcer disease?

A

Gram negative
Releases proteases to damage mucosal cells
Urease neutralises acidity so H.Pylori can survive
Adhesins help to adhere to epithelium

128
Q

How long are PPIs given in peptic ulcers?

A

4-6 weeks

129
Q

What is triple therapy for peptic ulcer?

A

Management of peptic ulcer caused by H.Pylori
PPI + 2 Abx for 14 days
Amoxicillin and clarithromycin/metronidazole

130
Q

What are the 6 P’s in acute limb threatening ischaemia?

A

Pale
Pulseless
Painful
Paralysed
Paraesthesia
Perishing cold

131
Q

What are the two initial investigations in acute limb-threatening ischaemia?

A

Handheld arterial doppler
ABPI

132
Q

What is the initial management of acute limb-threatening ischaemia?

A

A-E approach
Analgesia
IV unfractionated heparin
Vascular review

133
Q

What are the options for definitive management of acute limb-threatening ischaemia?

A

Intra arterial thrombolysis
Surgical embolectomy
Angioplasty
Bypass surgery
Amputation

134
Q

What are the features of critical limb ischaemia?

A

Rest pain
Ulceration
Gangrene
ABPI < 0.5

135
Q

What is intermittent claudication?

A

Aching or burning in the leg muscles following walking
Occurs at the same point/distance
Relieved within minutes of stopping

136
Q

How are the results of ABPI interpreted?

A

1.2: suggests abnormal thickening of vascular walls (typically in diabetes)
0.9 - 1.2: Normal
0.8 - 0.9: Mild disease
0.5 - 0.8: Moderate disease
<0.5: Severe disease

137
Q

What are the conservative and medical management options for PAD?

A

Smoking cessation, weight management, supervised exercise programme.
CVD risk management- clopidogrel, statin, BP management, glycaemic control
Vasodilator for pain relief if severe and revasc unsuitable- naftidrofuryl oxalate

138
Q

What are the surgical management options for PAD?

A

Endovascular revascularisation (percutaneous angioplasty and stent)
Surgical revascularisation (surgical bypass)

139
Q

What are the risk factors for chronic limb ischaemia?

A

Smoking
DM
HTN
Hyperlipidaemia
Inc age
FMH
Obesity

140
Q

What is Buerger’s test?

A

Used in limb ischaemia
Lie the patient supine and raising their legs until they go pale and then lowering them until the colour returns.
Buerger’s angle less than 20 degrees indicates severe ischaemia

141
Q

What are the complications of chronic limb ischaemia?

A

Sepsis- secondary to infected gangrene
Acute on chronic ischaemia
Amputation
Reduced mobility and quality of life

142
Q

What is a pseudo aneurysm?

A

Breach to the arterial wall, resulting in blood accumulation between the tunica media and tunica adventitia.

143
Q

What are the causes of pseudoaneurysm?

A

Damage to the vessel wall:
Cardiac catheterisation
Repeated injections e.g. IVDU
Trauma
Vasculitis
Pancreatitis- in splenic artery

144
Q

Where are pseudoaneurysms most commonly formed?

A

Femoral artery

145
Q

How does a pseudoaneurysm present?

A

Pulsatile, painful, tender lump

146
Q

What are the complications of pseudoaneurysms?

A

Can cause distal arterial occlusion resulting in limb ischaemia
Infection, quickly leading to sepsis

147
Q

What is the gold standard investigation for diagnosing pseudoaneurysms?

A

Duplex US
Shows turbulent forward and backward flow

148
Q

What are the management options for pseudoaneurysms?

A

US guided compression- 30 mins of applying pressure to the neck of the pseudoaneurysm
Thrombin injection- into the lumen of the pseudoaneurysm under US guidance
Endovascular stenting
Surgical repair or ligation

149
Q

What are the risk factors for varicose veins?

A

Female
Pregnancy
Prolonged standing
FMH

150
Q

What are the complications of varicose veins?

A

Skin changes- haemosiderin deposition etc
Thrombophlebitis
Ulceration
Bleeding

151
Q

What is the gold standard for investigating varicose veins

A

Duplex US- assess for valve incompetency

152
Q

Who should be referred to vascular for varicose veins?

A

Symptomatic primary or recurrent
Skin changes e.g. pigmentation or eczema
Superficial vein thrombosis
Venous leg ulcer

153
Q

What are the medical/surgical treatment options for varicose veins

A

Thermal ablation
Foam sclerotherapy
Vein ligation, stripping and avulsion

154
Q

What are the complications of the treatment of varicose veins?

A

50% recurrence rate in 10 years
Haemorrhage
Thrombophlebitis
DVT
Nerve damage- saphenous or sural

155
Q

What is the difference in presentation in wet and dry gangrene?

A

Wet- signs of infection e.g. pyrexia, sepsis. Poorly demarcated from surrounding tissue.
Dry- no signs of infection. Well demarcated.

156
Q

What causes dry gangrene?

A

Reduced blood flow due to:
Atherosclerosis
Thrombosis
Vasospasm (cocaine use or Raynaud’s)

157
Q

What are the different types of wet gangrene?

A

Necrotising fasciitis
Gas gangrene
Gangrenous cellulitis

158
Q

What are the different causative organisms of the different types of wet gangrene?

A

Nec fasc- strep pyogenes
Gas- C. perfringes
Cellulitis- immunocompromised

159
Q

How is gangrene managed?

A

Surgical debridement or amputation.
Plus abx for wet gangrene.

160
Q

What are the two vascular emergencies to be considered in an acutely painful lower limb?

A

Critical limb threatening ischaemia
DVT

161
Q

What is the most common complication of varicocele?

A

Infertility

162
Q

What is a varicocele?

A

Enlargement of scrotal veins

163
Q

What are the management options for varicocele?

A

Watchful waiting- if asymptomatic
Embolisation
Surgical repair

164
Q

What are the risk factors for TCC of the bladder?

A

Smoking
Aromatic amines
Cyclophosphamide

165
Q

What are the risk factors for SCC of the bladder?

A

Schistosomiasis infection
Long term catheterisation
Recurrent bladder stones

166
Q

What are the management options for muscle invasive bladder cancer?

A

Stage T2 and above:
Radical cystectomy with urinary diversion (ileal conduit or neobladder)

167
Q

What are the management options for non muscle invasive bladder cancer?

A

CIS, Ta, T1:
TURBT
Mitomycin C chemo
BCG immunotherapy

168
Q

What are the initial imaging investigations for bladder ca?

A

CT urogram
Flexible cystoscopy

169
Q

What are the tumour markers in testicular cancer?

A

AFP (specific to seminomas)
bHCG
LDH

170
Q

What are the most common types of testicular cancer and in what age groups?

A

Seminoma. Seen in ~35y/o
Non seminoma- Teratoma most common. Seen in ~25 y/o

171
Q

What is Courvoisier’s law?

A

In the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
(likely due to pancreatic cancer or cholangiocarcinoma)

172
Q

What is the most common loction of diverticulum and why?

A

Sigmoid colon
Majority of water has been reabsorbed, leading to higher intraluminal pressures

173
Q

What is a diverticulum?

A

Outpouching of mucosa through the muscle of the intestine

174
Q

What are the possible complications of diverticulitis?

A

Perforation
Bleeding
Abscess
Strictures
Fistulas

175
Q

What are the possible complications of appendicitis?

A

Perforation
Appendix mass- omentum and small bowel adhere to the appendix
Abscess
Sepsis
Paralytic ileus

176
Q

What is the definition of a hernia?

A

The protrusion of a structure through a wall of a cavity in which it is usually contained

176
Q

What are the causes of cholangitis?

A

Gallstones
Head of pancreas malignancy
PSC
Cholangiocarcinoma
Bile duct stricture

177
Q

What bacteria are pt with obstructive jaundice susceptible to and why?

A

Gram negative bacteria
Increased intraluminal pressure allows leakage of bacteria in.

178
Q

When is the FIT test offered?

A

Every 2 years for 60-74 y/os

179
Q

What are the key findings on CXR and CT angiography of aortic dissection?

A

CXR- widened mediastinum
CT angio- false lumen

180
Q

What complication may occur after catheterisation of a patient in acute urinary retention, and why?

A

Post obstructive diuresis
Loss of medullary concentration gradient in kidneys
Can worsen AKI

181
Q

How are LUTS broadly divided and what are examples of each?

A

Storage- frequency, urgency, nocturia, dysuria
Voiding- hesitancy, poor stream, dribbling

182
Q

Name 2 locations that stones may cause urinary obstruction

A

Vesico-ureteric junction
Pelvic- ureteric junction

183
Q

What is a false aneurysm?

A

A collection of blood around a blood vessel wall that communicates with the lumen.

184
Q

What are the causes of AAA?

A

CTD - marfans, ehlers danlos
Atherosclerosis
Abdominal trauma

185
Q

What are some signs of chronic venous disease that may be seen on the lower limbs?

A

Venous ulcer
Varicose veins
Haemosierin deposits
Lipodermatosclerosis
Varicose eczema

186
Q

What are the subgroups of limb viability? (in limb ischaemia)

A

Viable
Threatened
Irreversible

187
Q

What are the two types of drugs (and their MoA) used in ER positive breast cancer, and what decides which treatment is given?

A

Pre menopausal:
Selective oestrogen receptor antagonism e.g. Tamoxifen
Post menopausal:
Inhibition of peripheral oestrogen synthesis AKA aromatase inhibitors e.g. anastrozole

Finals (8 decks)

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