Surgery Flashcards
What gene is mutated in breast/ ovarian cancer?
BRCA
What artery is stenosed if the patient has pain in their butt, thigh and calf?
Aorta
What artery is stenosed if the patient has intermittent claudication pain in their butt?
Common iliac artery
What artery is stenosed if the patient has intermittent claudication pain in their calf?
Superficial femoral artery
What artery is stenosed if the patient has intermittent claudication pain in their thigh?
Common femoral artery
If the heart rate is raised with a normal BP, in upper GI bleed what does this suggest and hence what is the most appropriate treatment?
Haemodynamic instability, so resuscitate with IV crystalloid.
What is the most common and second most common breast cancer types?
- Invasive ductal carcinoma
- invasive lobular carcinoma
Is lobular carcinoma in situ benign or malignant?
benign
What is the most appropriate analgesia for old patients after surgery?
Fascia ilia block
What is the most common and second most common type of testicular cancer?
- seminoma
- non seminomatous
What are the types of non-seminoma testicular cancers?
Teratoma
Embryonal carcinoma
Yolk sac tumour
Choriocarcinoma
In which testicular cancer (s) is b-HCG raised more in?
Non-seminomatous (raised in 80-85%)
A patient is in severe pain, with a low BP and their abdo is guarded with rebound tenderness. What is the first imaging?
Erect CXR for perforation
Post surgery, a patient has hallucinations, fluctuating consciousness and vital signs. What does this suggest?
Delirium
What sign is seen on CXR vs abo X-ray with a perforated peptic ulcer?
Dome sign - CXR
Rigler sign- abdo X-ray
A swelling on testes transilluminates and you can palpate above it. What does this suggest?
Epididymal cyst
At what haemoglobin level do you transfuse blood in a bleeding patient?
Hb <7
What is the management for more than 1 lump and a tumour >4cm on one breast?
Mastectomy then radiotherapy.
What is the first investigation for colorectal cancer before any bloods?
Abdominal examination
What is torsion of the Hydatid of Morgani and what is seen on examination?
Torsion of the testicular appendage. Gradually improved pain with a blue dot seen.
What kind of ulcer weeps serous fluids with swelling around it?
Venous ulcer
What is the stepwise management of an acute limb?
ABCDE
1. IV opioids
2. IV heparin -> surgery / intra-arterial thrombolysis
What are three risk factors for developing breast cancer?
- not having children
- early menarche
- late menopause
What is the triad for Leriche syndrome?
Aortoiliac occlusive disease
Erectile dysfunction
Reduced distal pulses
What is the name of the classification system used for pressure sores?
EPUAP
What are the four stages in the EPUAP for pressure sores and the treatments indicates?
- intact skin
- partial thickness loss of epi and dermis
1&2: hydrocolloid patches - full thickness, necrosis, subcutaneous tissue
- muscle, bone seen
3&4: surgery
When is breast screening offered to women and how often?
Aged 50-70 every 3 years
What is a false femoral artery aneurysm a complication of and what investigation and treatment is first line?
Complication of angiography
urgent USS and compression
How can chronic limb ischaemia be classified?
Fontaine classification
In which stage of Fontaine classification is ulcers and gangrene seen?
D
When is a femoral-femoral crossover surgery done?
Unilateral iliac occlusion
When is an aortobifemoral bypass done?
Bilateral iliac occlusion -> Leriche syndrome
In a bed bound patient with an unsalvagable lower limb what surgery is done?
Above the knee amputation
What investigation can be used for compartment syndrome?
Compartment needle manometry
What imaging is used to diagnose an unruptured AAA ?
CT aortogram
How can you treat a DVT in a patient with recurrent severe bleeding where anticoagulation is CI?
IVC filter to catch the embolus
If testicle is salvageable in testicular torsion what procedure is done?
Unilateral orchidopexy and contralateral fixation.
What is the next step after a hydrocele is found?
USS as could be caused by malignancy
What needs to be done before bandaging venous ulcers?
ABPI
When is embolectomy preferred over IV heparin when treating acute limb ischaemia?
If there are sensory and motor deficits
What grade haemorrhoids cannot be reduced manually and what surgery is indicated?
Grade 4
Surgical haemorrhoidectomy
What treatment is indicated fro grade 2 and 3 haemorrhoids?
Rubber band ligation
Sclerotherapy
What surgery treats rectal prolapse?
Rectopexy
What can be used to treat vaginal prolapse?
Ring pessary
When is a tonsillectomy indicated?
> 7 episodes in one year
5 episodes in 2 years
3 episodes in 3 years
2 peritonsillar abscesses at any point in life
When is a variable rate insulin fusion indicated before surgery?
Poor blood glucose control pre-op
Major surgery where more than 2 meals will be missed post surgery
What grade haemorrhoids needs manual reduction and can be reduced?
Grade 3
When is fine needle aspiration considered in fibrocystic disease?
When it is large and causing discomfort
After a major abdominal surgery what analgesia is preferred?
Epidural anaesthesis
avoid opioids-> constipation
In a diabetic going for morning surgery that is done by lunch, what should be done with their glicazide and metformin?
Omit glicazide and continue metformin
What advice should you give to a young person with backpain for a short duration?
Advise to continue usual activity
