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Surgery Flashcards

1
Q

Sulfonylureas on day of surgery

A

omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose

(gliclazide)

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2
Q

Metformin on day of surgery

A

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

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3
Q

DPPV, GLP1 and SGLT2 with surgery

A

DPPV and GLP1 take as normal
(-gliptins)(-tides)
SGLT2- omit on morn
(florin)

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4
Q

WLE with sentinel node -ve

A

Whole breast radiotherapy

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5
Q

Anti-oestrogen drugs

A

Tamoxifen- pre menopausal
Aromatase inhibitors- post menopausal

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6
Q

Medical therapy for renal stones

A

IM Diclofenac and a blocker

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7
Q

Mx of renal vs ureteric stones

A

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

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8
Q

Sudden hearing loss management

A

Sudden onset sensorineural hearing loss should be referred (within 24 hours) to ENT, for investigation and consideration of steroid therapy

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9
Q

Rinne vs Webers

A

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

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10
Q

Fat necrosis sx

A

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

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11
Q

Fibroadenosis sx

A

‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

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12
Q

Fibroadenoma sx

A

‘breast mice’ due as they are discrete, non-tender, highly mobile lumps

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13
Q

AAA screening

A

In the UK, all men aged 65 years are offered aneurysm screening with a single abdominal ultrasound.

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14
Q

Mx of hydrocele

A

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

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15
Q

Cause of hydrocele

A

epididymo-orchitis
testicular torsion
testicular tumours

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16
Q

Most important RF for transitional cell carcinoma

A

Smoking

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17
Q

High urine calcium and renal stones medication

A

Thiazide diuretics

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18
Q

Varicocele causes

A

Subfertility

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19
Q

Who gets screened fro breast cancer at a younger age

A

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

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20
Q

Mx of anal fissure

A

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

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21
Q

Painless ulcer on penis

A

Treponema pallidum

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22
Q

Hypoglossal vs glossopharyngeal nerve damage

A

XII- tongue towards lesion

IX-uvula away from lesion

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23
Q

Hydroceles in infants

A

Communicating hydroceles are common in newborn males and often resolve spontaneously

n cases where hydroceles are still present beyond 1 year of life routine referral to urology for consideration of repair is appropriate.

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24
Q

PVD medication

A

Statin and clop

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25
Surgical mx of PAD
Severe PAD or critical limb ischaemia may be treated by: endovascular revascularization percutaenous transluminal angioplasty +/- stent placement endovascular techniques are typically used for short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients surgical revascularization surgical bypass with an autologous vein or prosthetic material endarterectomy open surgical techniques are typically used for long segment lesions (> 10 cm),
26
Mx of biliary colic
Elective lap chole
27
Mx of AAA
< 3 cm No further action 3 - 4.4 cm Rescan every 12 months 4.5 - 5.4 cm Rescan every 3 months ≥ 5.5cm Refer within 2 weeks to vascular surgery for probable intervention
28
Medications causing pancreatitis
azathioprine, mesalazine*, bendroflumethiazide, furosemide, steroids, sodium valproate
29
When to refer for 2ww teste
non-painful enlargement or change in shape or texture of the testis
30
AAA rupture sx
Severe central abdominal pain radiating to the back Presentation may be catastrophic or sub-acute (persistent severe central abdominal pain with developing shock) Patients may have a history of cardiovascular disease
31
Low anterior vs AP resection
Low- mid to high rectum AP- low rectum- removes anus
32
Post hip and knee VTE
Hip LMWH for 10 days followed by aspirin (75 or 150 mg) for a further 28 days or LMWH for 28 days combined with anti-embolism stockings until discharge Knee Aspirin (75 or 150 mg) for 14 days or LMWH for 14 days combined with anti-embolism stockings until discharge
33
Haemorrhagic shock classification
1 <15% Pulse <100 Urine >30ml 2 15-30% Pulse >100 BP normal Urine 20-30ml Resp 20-30 Anxious 3 30-40% >120HR BP Low Resp 30-40 Urine 5-15ml Confused 4 >40% HR >140 BP Low Resp >35 Urine <5ml
34
Test prior to commencing Anastrozole
DEXA
35
Wernickes and Korsakoff
Wernicke's COAT Confusion Oculomotor dysfunction Ataxia Thiamine is treatment Korsakoff's CART (Cart them off - because it's incurable at this stage) Confabulation Anterograde and Retrograde amnesia Temperament altered
36
Subdural vs epidural sx
Subdural- old age, alcoholism and anticoagulation. Slower onset of symptoms than a epidural haematoma. There may be fluctuating confusion/consciousness Epidural some patients may exhibit a lucid interval
37
When are loop ileostomy used
Defunctioning of colon e.g. following rectal cancer surgery
38
Urinary calculi >5mm with positive urine dip
Patients with obstructive urinary calculi and signs of infection require urgent renal decompression and IV antibiotics due to the risk of sepsis
39
Incarcerated vs strangulated
Strangulated- blood supply to the herniated tissue is compromised, leading to ischemia or necrosis vomiting, the passage of bloody stools, and the patient having a toxic appearance Incarcerated non-reducible masses
40
Mx of inguinal hernia in child
Congenital inguinal hernias have a high rate of complications and should be repaired promptly
41
Mobile lump in a woman <30 and >30
<30 reassure >30 referral-FNA
42
Hartmann's procedure
Resection of rectosigmoid colon. An end colostomy is formed and rectal stump sewn. It is indicated by perforation of the rectosigmoid bowel, and subsequent peritonitis. Causes of perforation include colon cancer, diverticulitis, and trauma.
43
Mx of breast cyst
Aspiration those which are blood stained or persistently refill should be biopsied or excised
44
Sigmoid vs caecal volvulus
SIgmoid- coffee bean rigid sigmoidoscopy with rectal tube insertion Caecal- symptoms of small bowel obstruction rather than large bowel. The patient would be more likely to vomit and the x-ray would underline enlargement of the small bowel. management is usually operative. Right hemicolectomy is often needed
45
FIT testing
every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland. If the results of these are abnormal then the patient is offered a colonoscopy.
46
When is laryngeal mask CI
If not fasted
47
Mx of fibroadenoma
If >3cm surgical excision is usual
48
PSA post prostatectomy
PSA level should be 'undetectable' which is defined usually as a value less than 0.2ng/ml If any value- refer to oncology
49
squamous cell carcinoma RF
Schisto and smoking
50
percentage of patients with a positive faecal occult blood test have colorectal cancer
5-15%
51
Bilious vomiting, no stool, mx
Malrotation Usually 3-7 days after birth Ladd procedure
52
Mx of overactive bladder in men
bladder retraining should be offered antimuscarinic drugs should be offered if symptoms persist. NICE recommend oxybutynin
53
Mx of nocturia in men
advise about moderating fluid intake at night furosemide 40mg in late afternoon may be considered desmopressin may also be helpful
54
Mx of acute limb ischaemia
analgesia, IV heparin and vascular review
55
Mx of epididymo-orchitis: If unknown organism
ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
56
Ix of prostate cancer
Multiparametric MRI
57
Timing of PSA
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
58
Mx of woman with father with breast cancer
Referral to clinic
59
Assessing pancreases exocrine fucntion
Faecal elastase
60
Priapism mx
Cavernosal blood gas analysis If the priapism has lasted longer than 4 hours, the first-line treatment is aspiration of blood from the cavernosa, this is often combined with injection of a saline flush to help clear viscous blood that has pooled. If aspiration and injection fails, then intracavernosal injection of a vasoconstrictive agent such as phenylephrine is used and repeated at 5 minute intervals.
61
Priapism definition
Longer than 4 hours and is not associated with sexual stimulation.
62
Ix of SAH
Noncontrast CT head
63
ASA grading
ASA- normal 2-current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease 3- poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, 4- recent (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
64
long saphenous vein reveals that it is tender and hardened over a length of approximately 6cm mx
USS to rule out DVT
65
Venous disease Ix
Venous duplex US
66
% drug conc conversion to mg/ml
x10 Lido 2% 2x10 =20mg/ml

MSRA (11 decks)

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