Surgery Flashcards
Management of a fibroadenoma?
They are usually treated conservatively, but they are referred for surgical excision if they are more than 3 cm in size or causing discomfort
What is a normal vs abnormal ABPI?
a ‘normal’ ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease
Menieres presentation?
recurrent episodes of vertigo (last mins - hrs), tinnitus and HL (sensorineural).
Aural fullness/ pressure
nystagmus and +ve Rombergs
typically symptoms are unilateral but bilateral symptoms may develop after a number of years
What is the management of AAA found on imaging? What imaging is done?
<3cm normal
3-4.4cm scan every 12m
4.5-5.4cm scan every 3m
>5.5cm urgent refer to surgery
If abdo aneurysm is rapidly enlarging or >5cm on USS then CT, USS initial ix in asx pulsatile abdo mass and for screening programme
How do you manage insulin dependent diabetics who are having surgery (with the long acting insulin)?
once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery
What is the surgical management of a fistula?
A draining seton is used for complex perianal fistulae in patients with Crohn’s disease
How do you interpret audiograms for the three different types of HL?
1) Conductive: Normal BC, Reduced AC - on the graph there should be an ‘Air bone gap ‘
2) SNHL: Both BC and AC reduced, No Air bone gap.
3) Mixed: reduced AC and reduced BC but AC is reduced more (i.e. there is an “Air bone gap” but with BC reduced/not normal)
Hearing range: <20dB is normal
Viral labrynthitis vs vestibular neuronitis?
Both have viral illness preceding
Vestibular neuronitis = NO HL or tinnitus
What surgical op is done for low rectal tumours vs high rectum/sigmoid tumours vs anal tumours/ low rectal vs rest of colon?
sigmoid/high rectal tumours can be managed with high anterior resection.
low rectum managed with low anterior resection
Right hemicolectomy is for caecum/ ascending colon
Left hemicolectomy is for descending colon
abdominoperineal excision of rectum is for low rectal or anal tumours.
BRACA gene referral criteria?
If the person concerned only has one first-degree or second-degree relative diagnosed with breast cancer they do NOT need to be referred unless any of the following are present in the family history:
age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (two or more relatives on the father’s side of the family)
What blood vessels are mainly affected in intermittent claudication? What sx would they cause
Claudication affecting the femoral vessels is likely to present with calf pain rather than iliac claudication which causes buttock pain
When can you not E+D before surgery>
Patients are generally advised to fast from non-clear liquids/food for at least 6 hours before surgery
Duct papilloma vs mammary duct ectasia?
Mammary duct ectasia
Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
Duct papilloma
Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge
How is peripheral arterial disease managed medically?
Treat co-morbidities
All patients with peripheral arterial disease should take clopidogrel and atorvastatin
What allergy are nasal polyps associated with?
aspirin - part of samter’s triad (aspirin sens, asthma + nasal polyp)
How do you distinguish between femoral hernias and inguinal hernias on examination?
femoral hernias, areinferolateralto the pubic tubercle
inguinal hernias aresupermedialto the pubic tubercle;
strangulated vs incarcerated hernia
strangulated hernia = blood supply to hernia lost leading to necrosis,
incarerated = non-reducible but no necrosis yet
What is buergers disease?
Buerger’s disease, or thromboangiitis obliterans, is a condition characterised by progressive inflammation and thrombosis of the small and medium arteries in the hands and feet. It can present as acute ischaemia or chronic progressive ischaemic changes to the skin/tissues. Ultimately it may result in gangrene of the affected area, often needing amputation. It is strongly associated with an extensive smoking history. The exact pathophysiology is not fully understood.
Mx of acute limb ischaemia?
IV heparin and vascular review. Will need CT angio to visualise
Manouvere to diagnose vs treat BPPV?
Dix to Diagnose, Epley to End
How does sialadenitis present?
Parotitis secondary to stone obstrution in ducts
Will be purulent discharge from duct and foul taste in mouth
sometimes can see stones
Describe the 4 different grades of haemorrhoids
I do not prolapse
II prolapse on defecation but reduce spontaneously
III can be manually reduced
IV cannot be reduced
What is a Hartmanns procedure?
resection of the sigmoid colon is performed and an end colostomy is fashioned, can be reversed at a later date
Used for eg perforation secondary to sigmoid tumour
How do you treat local anaesthetic toxicity?
Local anesthetic toxicity can be treated with IV 20% lipid emulsion
What stoma is formed post hemicolectomy to protect the bowel?
A loop ileostomy can be used to defunction the colon to protect an anastomosis
This is done instead of a loop colostomy as it allows the large bowel to heal. SMall bowel heals well so ileostomy low risk
What is schwartz sign?
pink tinged eardrum
indicates otoscleoris
How long to the different causes of vertigo last?
secs-mins- BPPV
hours - menieres
dys -labrynthitis/ vestibular neuritis
How do you investigate a pharyngeal pouch?
OGD is CI as can tear pouch!!
investigate with barium swallow
WHat dose a boggy, swollen nose indicate, esp with trauma?
septal haematoma - needs drainage or could lead to necrosis of face
Management of constipation in ileostomy?
magnesium sulphate
mx of arterial ulcer?
hydrocolloid dressing
if necrotic/ infected - debridgement/ maggot therapy abx and potengtial amuptation
What is angiodysplasia?
tortuous cappilary lesions in bowel wall, cause PR bleeding, due to high pressure in venous system so may also have eg varicose veins
Presentation of nasopharyngeal cancer?
EBV is associated with nasopharyngeal cancer, more common in chinese, causes epistaxis, nasal obstruction, cervical lymphadenopathy, deafness from ETD, nasal voice
Most coanemmon site of colorectal cancer?
Rectum = most common site of colorectal cancer
When do you treat perforated TM?
Treat perf TM if caused by infection, otherwise watch and wait
