Surgery Flashcards
Sulfonylureas on day of surgery
omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose
(gliclazide)
Metformin on day of surgery
Morn OP-
If taken once or twice a day - take
as normal
If taken three times per day, omit lunchtime dose
Afternoon OP-
If taken once or
twice a day - take as normal
If taken three times per day, omit lunchtime dose
DPPV, GLP1 and SGLT2 with surgery
DPPV and GLP1 take as normal
(-gliptins)(-tides)
SGLT2- omit on morn
(florin)
WLE with sentinel node -ve
Whole breast radiotherapy
Anti-oestrogen drugs
Tamoxifen- pre menopausal
Aromatase inhibitors- post menopausal
Medical therapy for renal stones
IM Diclofenac and a blocker
Mx of renal vs ureteric stones
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
Uretic stones
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
Sudden hearing loss management
Sudden onset sensorineural hearing loss should be referred (within 24 hours) to ENT, for investigation and consideration of steroid therapy
Rinne vs Webers
Webers- loudest in ear with no SN loss
If conductive loss- may be louder
When a patient has conductive hearing loss in one ear, the sound will be amplified on that side.
Rinne
Air should be louder
If not conductive loss
Fat necrosis sx
More common in obese women with large breasts
May follow trivial or unnoticed trauma
typical firm and round but may develop into a hard, irregular breast lump
Fibroadenosis sx
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
Fibroadenoma sx
‘breast mice’ due as they are discrete, non-tender, highly mobile lumps
AAA screening
In the UK, all men aged 65 years are offered aneurysm screening with a single abdominal ultrasound.
Mx of hydrocele
Adult patients with a hydrocele require an ultrasound to exclude underlying causes such as a tumour
infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
Cause of hydrocele
epididymo-orchitis
testicular torsion
testicular tumours
Most important RF for transitional cell carcinoma
Smoking
High urine calcium and renal stones medication
Thiazide diuretics
Varicocele causes
Subfertility
Who gets screened fro breast cancer at a younger age
one first-degree female relative diagnosed with breast cancer at younger than age 40 years
one first-degree male relative diagnosed with breast cancer
two 1st (or1+2)-degree relatives
one (1/2) relative diagnosed with breast cancer at any age and diagnosed with ovarian cancer at any age
three first-degree or second-degree relatives diagnosed with breast cancer at any age
Mx of anal fissure
acute anal fissure (< 1 week)
soften stool
chronic anal fissure
the above techniques should be continued
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
Painless ulcer on penis
Treponema pallidum
