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
WHat is De Quervain’s tenosynovitis?
De Quervain’s tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
Features: typically females 30 - 50 yrs. Pain radial side of wrist and rad
Features
Wrist pain over the radial styloid process.
abduction of the thumb is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
Management: pain relief, seroid injection, splint, sometimes surgery
What are the ottawa rules?
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
-inability to walk four weight-bearing steps immediately after the injury and in the emergency department
How does adhesive capsulitis present?
Stiff shoulder
resuced actibe and passibe ROM in abduction, int and ext rotation - esp external
Difficulty sleeping on that side
painful freezing phase, an adhesive phase and a recovery phase
Subacromial impingement patients often complain of pain on overhead activities and demonstrate a painful arc of abduction on examination - worse between 90 and 120 degrees. There may also be popping, snapping or grinding.
Rotator cuff tears can occur either due to specific trauma or chronic impingement. Patients will normally describe weakness as well as pain and there may be muscle wasting and tenderness on palpation. There may be a painful arc of movement and weakness of the affected muscle.
Patients with calcific tendinopathy would normally have tenderness on palpation of the affected area and be reluctant to move the arm. There may be overlap with symptoms of impingement syndrome making this a less likely answer.
Acromioclavicular degeneration presentation?
popping, swelling, clicking or grindings and a positive scarf test
Subacromial impingement presentation?
pain on overhead activities and demonstrate a painful arc of abduction on examination - worse between 90 and 120 degrees. There may also be popping, snapping or grinding.
Rotator cuff injury presentation?
Rotator cuff tears can occur either due to specific trauma or chronic impingement.
weakness as well as pain and there may be muscle wasting and tenderness on palpation. There may be a painful arc of movement and weakness of the affected muscle.
calcific tendinopathy presentation
tenderness on palpation of the affected area and reluctance to move the arm.
Menieres presentation?
recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years
Vestibular neuritis presentation?
typically characterised by a single episode of severe vertigo lasting days rather than recurrent episodes. It often follows a viral infection and may be associated with nausea and vomiting but does not typically cause tinnitus or hearing loss.
Golfers vs tennis elbow
Golfer’s elbow or medial epicondylitis produces tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.
Tennis elbow or lateral epicondylitis produces tenderness over the lateral epicondyle and lateral elbow pain on resisted wrist extension.
Men play golf (golfer’s medial), lads play tennis (tennis is lateral)
golF - pain on wrist Flexion - in golf you flex the wrist
tEnnis - pain on wrist Extension - in tennis you extend the wrist
hydrocele vs epidermal cyst?
epidermal cyst - separate from the body of the testicle + found posterior to the testicle
epidermal cyst - in tunica vaginalis - soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle. Can get above it unlike a hernia
What cancer is a varicocele associated with?
RCC
What is charcots triad? WHich condition does it occur in?
ascending cholangitis triad: fever, jaundice and right upper quadrant pain
