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MSRA > surgery > Flashcards

surgery Flashcards

1
Q

difference between femoral and inguinal hernias

A

femoral = INFEROLATERAL to pubic tubercle
usually not reducible

inguinal = SUPRAMEDIAL to pubic tubercle
more commonly reducible

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2
Q

BPH mgt:

A
  1. watchful waiting
  2. alpha-1 antagonists
  3. 5 alpha reductase inhibitors
  4. combination of 2&3
  5. TURP
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3
Q

alpha-1 antagonists examples

A

tamsulosin
alfuzosin

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4
Q

alpha-1 antagonists

mechanism:

A

reduce smooth muscle tone of prostate and bladder

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5
Q

alpha-1 antagonists adverse effects (4)

A

dizziness
postural hypotension
dry mouth
depression

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6
Q

5 alpha-reductase inhibitors

examples:

A

finasteride

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7
Q

5 alpha-reductase inhibitors
mechanism:

A

block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH

indicated if severely enlarged prostate

note causes reduction in prostate volume and so slows disease progression – however takes time and sx may not improve for 6 months

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8
Q

5 alpha-reductase inhibitors SE:

A

decrease PSA concentrations by up to 50%
erectile dysfunction
reduced libido
ejaculation problems gynaecomastia

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9
Q

prostate ca ix:

A

1st line = multiparametric MRI
then TRUS guided biopsy

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10
Q

cancer of:

caecum/ ascending/ proximal transverse colon

i. type of resection
ii. anastomosis

A

i. R hemicolectomy
ii. ileo-colic

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11
Q

cancer of:

distal transverse/ descending colon

i. type of resection
ii. anastomosis

A

i. L hemicolectomy
ii. colo-colon

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12
Q

cancer of:

sigmoid colon

i. type of resection
ii. anastomosis

A

i. high anterior resection
ii. colo-rectal

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13
Q

cancer of:

upper rectum

i. type of resection
ii. anastomosis

A

i. anterior resection (TME)
ii. colo-rectal

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14
Q

cancer of:

low rectum

i. type of resection
ii. anastomosis

A

i. anterior resection (low TME)
ii. colo-rectal (+/- defunctioning stoma)

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15
Q

cancer of:

anal verge

i. type of resection
ii. anastomosis

A

i. Abdomino-perineal excision of rectum
ii. none

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16
Q

sigmoid volvulus associations

A

older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia

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17
Q

sigmoid volvulus on AXR

A

large bowel obstruction (large, dilated loop of colon, often with air-fluid levels)
coffee bean sign

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18
Q

sigmoid volvulus mgt

A

rigid sigmoidoscopy + rectal tube insertion

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19
Q

caecal volvulus associations:

A

adhesions
pregnancy

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20
Q

caecal volvulus AXR findings

A

small bowel obstruction

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21
Q

caecal volvulus mgt

A

operative - often needs R hemicolectomy

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22
Q

criteria for CT head within 1 hour of injury:

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
>1x vomiting

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23
Q

criteria for CT head within 8 hrs of head injury:

A

any of following RF:
age 65+
hx bleeding/ clotting disorders/ anticoagulants
dangerous mechanism of injury
> 30 mins retrograde amnesia of events immediately before the head injury

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24
Q

nerve injured in carotid endartectomy

A

IPSILATERAL hypoglossal nerve CN XII

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25
Q

acute anal fissure mgt:

A
  • soften stool
  • lubricants
  • topical anaesthetics
  • analgesia
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26
Q

chronic anal fissure mgt:

A

topical GTN
refer to secondary care for sphincterotomy or botox if no effect from GTN in 8 weeks

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27
Q

SERM (selective oestrogen receptor modulators)

type of breast cancer it is used to treat?

example?

A

oestrogen-receptor +ve

e.g. tamoxifen

28
Q

SERM adverse effects:

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

29
Q

aromatase inhibitors

type of breast cancer it is used to treat?

example?

A

ER +ve in post menopausal women
(as it reduces peripheral oestrogen synthesis)

e.g. anastrazole
letrozole

30
Q

aromatase inhibitors adverse effects:

A

osteoporosis (do DEXA when initiating)
hot flushes
arthralgia, myalgia
insomnia

31
Q

biological therapy
i. type of breast cancer it is used to treat

A

HER2 +ve

32
Q

biologics for breast cancer:
i. most common
ii. CI

A

i. trastuzumab (Herceptin)
ii. cardiac disease

33
Q

drug for vasospasm prevention in SAH

A

nimodipine

34
Q

Charcot’s triad

what condition do we see it in?

A
  1. fever
  2. jaundice
  3. RUQ pain

ascending cholangitis (bacterial infection of biliary tree, most commonly e. coli)

35
Q

epidydimal cyst features

A

separate from body of testicle
posterior to testicle

36
Q

epidydimal cyst associations (3)

A

PCKD
CF
von Hippel Lindau

37
Q

hydrocele definition

A

accumulation of fluid within tunica vaginalis

can be communicating communicating: due to patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum. common in newborn males, usually resolve within first months of life
non-communicating: caused by excessive fluid production within the tunica vaginalis

38
Q

hydroceles may develop secondary to:

A

epididymo-orchitis
testicular torsion
testicular tumours

39
Q

hydrocele features:

A

soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates
the testis may be difficult to palpate if hydrocele is large

40
Q

suspected epididymo-orchitis

A

ceftriaxone 500mg im stat + PO doxycycline 100mg BD for 10-14 days

41
Q

epididymo-orchitis most common cause

A

chlamydia

42
Q

biliary colic cx (5)

A

acute cholecystitis (most common)
ascending cholangitis
acute pancreatitis
gallstone ileus
gallbladder cancer

43
Q

mammary duct ectasia

A

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’

44
Q

Duct papilloma

A

Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge

45
Q

fat necrosis

A

More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted

46
Q

criteria for brain stem death testing (4)

A

Deep coma of known aetiology
Reversible causes excluded
No sedation
Normal electrolytes

47
Q

Hartmann’s procedure
what is it?

A

resection of the relevant portion of bowel + formation of end colostomy/ileostomy.

can be reversed - end colostomy is closed following the formation of a colorectal anastomosis, restoring continuity of the bowel

48
Q

supplementation of prednisolone prior to:

i. minor surgery
ii. moderate procedure
iii. major procedure

A

i. nil

ii. 50mg hydrocortisone prior to induction, 25mg every 8 hrs for 24 hours

iii. 100mg hydrocortisone before induction, 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached.

49
Q

varicocele

i. what is it?
ii. association

A

i. abnormal enlargement of testicular veins (“bag of worms”)
ii. infertility

50
Q

bladder cancer RF
urothelial (transitional cell) carcinoma

A

smoking
exposure to alanine dyes
rubber manufacture
cyclophosphamide

51
Q

bladder ca RF SCC

A

schistosomiasis
smoking

52
Q

gastric vs duodenal ulcers

i. which is more common

ii. pain WORSE on eating

A

i. duodenal ulcers

ii. gastric

53
Q

duodenal atresia

i. age at presentation
ii. dx
iii. rx

A

i. few hours PN

ii. double bubble sign on AXR, sometimes with xontrast study

iii. Duodenoduodenostomy

54
Q

malrotation + volulus

i. age at presentation
ii. dx
iii. rx

A

i. 3-7 days PN

ii. Upper GI contrast study may show DJ flexure is more medially placed, USS may show abnormal orientation of SMA and SMV

iii. LAdd’s procedure

55
Q

Jejunal/ ileal atresia

i. age at presentation
ii. dx
iii. rx

A

i. within 24hrs PN

ii. air fluid levels on AXR
iii. laparotomy with primary resection and anastomosis

56
Q

meconium ileus

i. age at presentation
ii. dx
iii. rx

A

more common in cystic fibrosis

i. 24-28hrs PN
ii. air-fluid levels on AXR, sweat test to confirm CF
iii. surgical decompression

57
Q

NEC

i. age at presentation
ii. dx
iii. rx

A

i. week 2 PN
ii. Dilated bowel loops on AXR, pneumatosis and portal venous air
iii. conservative

58
Q

AAA screening:

i. small aneurysm
ii. medium aneurysm
iii. large aneurysm

A

i. 3-4.4cm
rescan in 12 months

ii. 4.5-5.4cm
rescan in 3 months

iii. >5.5cm
2 week referral to vascular for probable intervention

59
Q

AAA screening - what is offered?

A

single USS abdomen to males aged 65

60
Q

non-malignant causes of elevated PSA

A

BPH
prostatitis/ UTO
ejaculation
vigorous exercise
urinary retention
instrumentation of urinary tract

61
Q

PSA testing should not be done within:

A

6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

62
Q

drug class used to manage over-active bladder

A

anti-muscarinics

63
Q

renal stones mgt

A

watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy

64
Q

ureteric stones mgt

A

shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy

65
Q

what % of people with +ve FIT test have colorectal cancer?

A

5-15%

66
Q

CRC screening - what is offered?

A

FIT test every 2 years to pts aged:

60-74 in England
50-74 in Scotland

67
Q
A

MSRA (14 decks)

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