Surgery Flashcards
Caecal, ascending or proximal transverse colon - disease at this level requires what kind of surgery and anastomosis?
Right hemicolectomy
Ileo-colic anastomosis
Distal transverse, descending colon - disease at this level requires what kind of surgery and anastomosis?
Left hemicolectomy
Colo-colon anastomosis
Sigmoid colon -disease at this level requires what kind of surgery and anastomosis?
High anterior resection
Colo-retal anastomosis
Rectum- disease at this level requires what kind of surgery and anastomosis?
Anterior resection
Colo-rectal anastomosis +/- defunctioning stoma if lower rectum
Anal verge - disease at this level requires what kind of surgery?
Abdomino-perineal excision of rectum
Peripheral arterial disease, which antiplateley?
Clopidogrel. Should also be on a statin.
Which anaesthetic agent is particularly useful in preventing post op N&V?
Propofol
Which anaesthetic agent in useful in trauma and why?
Ketamine - doesn’t cause a drop in BP
What are the adjuvants used for hormone receptor +ve breast cancer in pre versus post menopausal women?
Tamoxifen - pre and peri menopausal
Anastrozole (aromatase inhibitor) - post menopausal
What is charcot’s triad?
Fever, jaundice and right upper quadrant pain
= Ascending cholangitis
When is AAA screening offered?
One off screening for men age 65 is offered
How do you manage different paediatric hernias?
inguinal: repair ASAP
umbilical: manage conservatively
How is lidocaine toxicity treated?
IV lipid emulsion
What do you do with diabetic meds if having an operation?
Metformin - omit lunchtime dose only if TDS, otherwise continue as normal
Sulfonylurea (gliclazide) - omit pre-op dose
SGLT inhibitor (empaglifozin) - omit day of surgery
OD insulin (long acting) - reduce dose by 20% day before and day of surgery
BD insulin - 50% morning dose day of surgery
What medication can be used to prevent renal stones in someone prone to them who also has a high calcium?
Thiazide diuretic
When should you cosnider surgical excision for a firboadenoma?
> 3cm
Claudication in which vessels causes pain in the calves versus pain in the buttocks in peripheral vascular disease?
Buttock pain - iliac stenosis
Calves - femoral artery
What’s the difference between strangulated and incarcerated hernias?
Incarcerated - Hernia sac is imprisoned (incarcerated) but the prisoner (bowel) is still okay (has blood supply, bowel contents may still pass)
Strangulated - Hernia sac is incarcerated but the bowel blood supply is cut off (strangulated)
All strangulated hernias are incarcerated. Not all incarcerated hernias are strangulated.
What kind of line does TPN need to be given by?
Needs to be central - eg subclavian.
Not a midline - this is still considered peripheral.
When would you do a loop colostomy versus a loop ileostomy?
In emergency surgery to defunction the distal part of the bowel and divert contents away from it to allow healing.
Loop ileostomy is often perferable as it has a lower complications rate.
Loop colostomy can be considered to defunction a distal part of colon.
What family history of cancer merits a referral to the breast clinic, even in the absence of examination findings?
1 first degree or second degree relative with breast cancer (any age)
+
1 first degree or second degree with ovarian cancer (any age)
One of them should be a first degree relative
OR any parental history of breast ca (dad with breast cancer)
When are qfits offered as screening in Scotland?
Screening kits are sent every 2 years to all patients 50-74 years in Scotland.
What are the time frames for when you can check the PSA (what you need to abstain from etc) ?
6 weeks after prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
What is the modified Parkland’s formula for fluid resuscitation in burns patients?
2mls x kg x % Burns
50% given in the first 8 hours and then 50% in the next 16 hours
What size of AAA requires what monitoring
<3cm normal
> 3cm- scan every 12 months
> 4.5cm scan every 3 months
> 5.5cm refer to vascular surgery within 2 weeks
What is the treatment for epididymo-orchitis?
Ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
Other than diclofenac, which other medication can be helpful in patients with renal stones?
Alpha blockers - eg tamsulosin - can relax smooth muscle and aid passage
Criteria for CT <1hr versus within 8 hr
Within 1hr:
- Basal skull fracture signs
- Neurological deficit
- GCS <13 on initial assessment or <15 2hrs after injury
- Sick more than x1 post injury
- Seizure post injury
Within 8hrs:
- Age over 65
- Bleeding risk: anti-coagulation, clotting disorder
- Concussion: retrograde amnesia before head injury
- Dangerous mechanism of injury: e.g. hit by car / fall from height / from 1m height or >5 stairs
Which medication is used in subarachnoid haemorrhage to prevent vasospasm?
Nimodipine
Which anaesthetics are associated with malignant hyperthermia?
Isoflurane, desflurane, sevoflurane
MH is a genetic disorder, manifesting due to calcium overload in the skeletal muscle causing sustained muscular contraction and rhabdomyolysis, resulting in excess anaerobic metabolism causing acidosis. End-tidal CO2 increases as a result, along with body temperature which causes diaphoresis (excess sweating).
