Surgery Flashcards
1
Q
occlusion of which artery can cause acute mescenteric ischemia?
A
superior mesenteruc artery
2
Q
classical PMHx finding for Pt with acute mesenteric ischemia
A
Afib
3
Q
classical Px of mesenteric ischaemia
A
abdo pain severe and out of keeping with exam findings
4
Q
Tx for mesenteric ischemia
A
immediate laparotmy
5
Q
Px of anal fissures
A
painful bright red rectal bleeding
6
Q
where are 90% of anal fissures found? what should be considered if they’re found elsewhere?
A
- on the posterior line
- alternate cause like Crohn’s
7
Q
Mx of acute anal fissure
A
soften stool (dietary advice), bulk-forming laxative like (lactulose)
8
Q
fissures are distal to the __________
A
dentate line
9
Q
Tx options for haemorrhoids
A
- conservative
- rubber band ligation
- haemorrhoidectomy
10
Q
diverticulitis Mx
- mild attacks
- severe/recurrent attacks
- perforations
A
- mild attacks: increase dietary fibre intake, Mx with Abx
- severe/recurrent attacks: segmental resection
- perforations: resection + stoma
11
Q
suspected abscess in diverticulitis - Ix of choice?
A
CT
12
Q
If diverticulitis doesn’t settle with orab abx for 72h?
A
admit for IV abx
13
Q
______________ classification describes the extent of spread of colorectal cancer
A
Dukes’
14
Q
external/vs internal haemorrhoids:
A
external originate below dentate line
internal originate above dentate line
15
Q
xray finding for ischaemic colitis
A
thumbprinting
16
Q
most common cause of LBO + other causes
A
tumour
volvulus, diverticular disease
17
Q
Ix of choice for LBO?
A
Abdo XRAY - intra-peritoneal gas indicates colonic perforation
CT scan
18
Q
most common type of hernia? where does it occur?
A
inguinal hernia
superior and medial to public tubercle
19
Q
extensive physical training or coughing (from lung diseases), obesity can cause which hernia
A
epigastric hernia
20
Q
which hernia in children needs immediate surgical repair? which resolves by itself in 4-5years?
A
immediate repair: congenital inguinal hernia
self resolving: infantile umbilical hernia
21
Q
Cryptorchidism Mx
A
orchidopexy at 6-18m of age
22
Q
most bladder cancers are _____ cell carcinomas
A
transitional
23
Q
most sensitive test for hiatus hernia
A
barium swallow
24
Q
electrolyte imbalances caused by blood transfusion
A
- hypoC - FFP and platelets have citrate –> chelate calcium
- hyperK
25
Leading cause of transfusion related deaths
Transfusion related lung injury
26
Upper GI bleed - 2nd line if OGD fails?
pH and manometry studies with contrast
27
cholecystitis - Ix and Tx
US
early laparoscopic cholecystectomy
28
lab Ix for acute pancreatitis
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
raised amylase, lipase
29
acute pancreatitis causes
Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
30
Boerjaave's syndrome - Dx and Tx
subcutaneous emphysema on chest wall
diagnosis is CT contrast swallow
Thoracotomy and lavage (within 12h) or insertion of T tube
31
Courvoisier sign
a palpable mass in the right upper quadrant (Cholangiocarcinoma)
32
__________ can be used to measure exocrine pancreatic function in chronic pancreatitis
faecal elastase
33
C/I to laparoscopic surgery
haemodynamic instability/shock
raised intracranial pressure
acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)
uncorrected coagulopathy
34
jaundiced Pt with malignancy: Mx
a stent will need to be inserted
35
digital rectal examination: tender, boggy prostate gland =
Acute bacterial prostatitis
36
Acute bacterial prostatitis Tx
- 14-day course of a quinolone (ciprofloxacin)
- STI screen
37
Ix for BPH
- U&Es
- PSA
urinary frequency-volume chart
- IPSS
38
Mx for BPH
- alpha-1 antagonist: tamsulosin
decreases smooth muscle tone of the prostate and bladder
- 5 alpha-reductase inhibitor: finasteride
blocks conversion of testosterone to dihydrotestosterone [start if high risk of progression]
- TURP
39
[bladder cancer]
- RFs for transitional cell carcinomas
- RFs for squamous cell carrcinomas
- RFs for transitional cell carcinomas: smoking, exposure to aniline dyes
- RFs for squamous cell carrcinomas: schistomiasis
40
what happens when catheterised after chronic urinary retention?
decompression haematuria
41
It is important to exclude ____________prior to circumcision as the foreskin may be used in surgical repair
hypospadias
42
suspected epididymo-orchitis: what must you exclude?
torsion
43
Ix for erectile dysfunction
1. 10 year cardiovascular risk, lipid, glucose
2. free testosterone
44
Mx of erectile dysfunction
1. PDE-5 inhibitors: sildenafil (Viagra)
2. Vacuum erection devices
45
features of hydrocele. Ix?
- soft, non-tender swelling aterior to and below the scrotum
- you can get above the mass on examination
- transilluminates
Dx clinically but can do US to exclude underlying cause.
In babies can resolve spontaneously by 1-2 years.
46
Hydropnephrosis: causes of unilateral/bilateral
Unilateral: PACT
- Pelvic-ureteric obstruction (congenital or acquired)
- Aberrant renal vessels
- Calculi
- Tumours of renal pelvis
Bilateral: SUPER
- Stenosis of the urethra
- Urethral valve
- Prostatic enlargement
- Extensive bladder tumour
- Retro-peritoneal fibrosis
47
Ix for hydronephrosis
1. US
2. CT scan to detect stones
48
Mx of hydronephrosis
1. remove obstruction, drain urine
2. Acute obstruction: nephrostomy tube
3. Chronic obstruction: ureteric stent/pyeloplasty
49
how to differentiate between ischemic and non-ischemic priapasm
Cavernosal blood gas analysis
50
1st line Ix for suspected prostate cancer
multiparametric MRI
51
most common type of renal cell cancer
clear cell
52
renal colic Mx
1. Pain relief: NSAIDs, IV paracetamol if NSAID C/I
2. for distal urteteric stones <10mm in size: alpha blockers
Imaging
- non-contrast KUB
- if pregnant woman/children: USS
If stone is <5mm and asymptomatic: watchful waiting
5-10 mm: shockwave lithotripsy
10mm - 20mm: shockwave lithiotripsy OR ureteroscopy
>20mm: percutaneous nephrolithotomy
Uretic stones:
- shcokwave lithiotripsy/alpha-blockers if <10mm
- 10-20mm: urteteroscoopy
53
ureteric obstruction from stones + infection =
surgical emergency!! decompress (nephrostomy tube placement, insertion of ureteric catheters and ureteric stent placement)
54
preventing renal stones
calcium: high fluids, low salt, potassium citrate, thiazide diuretics (increase distal tubular calcium resorption)
oxalate: cholesystramine
uric acid: allopurinol
55
renal tubular acidosis is a RF for
renal stones
56
_______ may be the presenting feature of testicular cancer
_______ may be the presenting feature of renal cancer
hydrocele
varicocele
57
screening AAA
a single abdominal ultrasound for males aged 65
58
AAA Mx
1. rescan every 3 months:
2. urgent 2 week referral to vascular surgery:
1. rescan every 3 months: 4.5-5.4cm
2. urgent 2 week referral to vascular surgery: >5.5cm
59
other than >5.5cm, what else makes an AAA at high risk of rupture
enlarging >1cm/year
60
Tx for AAA
elective endovascular repair (EVAR)
61
___________________is suggestive of critical limb ischaemia.
An ankle-brachial pressure index (ABPI) of < 0.5
Patients often report hanging their legs out of bed at night to ease the pain.
62
PAD Mx
Atorvastatin 80mg + clopidogrel + exercise training
Surgical: endovascular/surgical revascularization
63
The following are all NICE criteria for referring a patient to secondary care for consideration of interventional treatment of varicose veins as laid out in the NICE CKS summary:
significant/troublesome lower limb symptoms e.g. pain, discomfort or swelling
previous bleeding from varicose veins
skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)
superficial thrombophlebitis
an active or healed venous leg ulcer
64
how can you tell there is a subcutaneous emphysema on CXR?
You can see the striations of pec major lateral to the right lung field. Pec major is only visible if there is subcut emphysema.
65
For a young patient who has always had difficulty achieving an erection -->
referral to urology is appropriate
66
Scrotal swelling you can't get above:
inguinal hernia
67
An ________ may cause bubbly urine
enterovesical fistula
an enterovesical fistula is frequently a result of colorectal malignancy
68
A sinusoidal ECG pattern is indicative of
severe hyperkalaemia
69
what blood test abnormalities would TPN cause?
TPN is known to result in derangement of liver function tests
70
strangulated primary unilateral inguinal hernias are usually repaired via ________ approach
an open
71
what type of amnesia is an indication for a CT head scan?
Over 30 minutes retrograde amnesia is an indication for a CT scan following a head injury, not anterograde amnesia
72
_______is a recognised complication of enteral feeding
Diarrhoea
73
inguinal hernia Mx rules for children
< 6 weeks old = correct within 2 days
< 6 months = correct within 2 weeks
< 6 years = correct within 2 months
74
pain during flexion and a palpable nodule at the base of her right ring finger are classic signs of
trigger finger
75
A 19-year-old man is attacked outside a club and beaten with a baseball bat. He sustains a blow to the right side of his head. He is brought to the emergency department and a policy of observation is adopted. His Glasgow coma score (GCS) deteriorates and he becomes comatose. Which of the following haemodynamic parameters is most likely to be present?
Hypertension and bradycardia are seen prior to coning. The brain autoregulates its blood supply by controlling systemic blood pressure.
Fast and weak- there's a leak. Slow and strong-something in the head wrong
76
Pt becomes apnoeic after anesthesia - most likely cause? (esp if FHx)
suxomethonium apnoea
77
SBO + tingling down medial left thigh + tender mass per rectum?
obturator hernia
78
Pt needs twice as much propofol to be induced for surgery + becomes confused after and develops seizure
post-alcohol withdrawal, give IV lorazepam
79
A painful, non-healing ulcer secondary to trauma in a woman with a past medical history of vascular disease (myocardial infarction) =
PAD
80
Mx of acute limb ischemia
1. without motor dysfunction
2. with motor dysfunction
1. without motor dysfunction: IV heparin
2. with motor dysfunction: urgent embolectomy
81
A 52-year-old female patient is brought to the emergency department with altered mental status and decreased responsiveness. She is at risk for airway obstruction due to her tongue falling back. Which airway adjunct is most appropriate for this patient?
oropharyngeal, used for Pts with decreased responsiveness
