Surgery Flashcards
What viral test should be performed in someone with penile cancer?
HIV
(risk factor for penile cancer)
Which congenital testicular abnormality is a risk factor for torsion?
Bell clapper deformity
(free swinging testicle in scrotum, like bell clapper)
What is the diagnostic imaging investigation in varicose veins? What does it show?
Duplex USS
Demonstrates retrograde flow in the veins
When should you refer varicose veins to secondary care?
Skin changes
Venous ulcers
Significant pain
Most common testicular swelling in primary care?
(painless, mobile lump separate to testis, located posteriorly)
Epididymal cyst
Is there a screening programme for AAA?
Yes, single USS at age 65
What are the 2ww criteria for haematuria?
if >45 and haematuria despite UTI resolution
if >60 and there is haematuria with either dysuria or raised WCC on bloods
What are the causes of transient vs persistent causes of non visible haematuria?
Transient = exercise, sex, UTI
persistent = renal stones, cancer, renal issues such as IgA nephropathy, prostatitis, BPH, urethritis (chlamydia)
Which procedure is done in an emergency to treat bowel obstruction/perforation in sigmoid colon?
Hartmann’s
=Anterior resection + End colostomy (you do not do an anastomosis in emergency setting)
If cancer is removed electively in distal colon and primary anastomosis done, which procedure done to protect anastomosis
Loop ileostomy to defunction the anastomosis
If cancer is removed electively in ascending colon or proximal transverse colon, which procedure done to connect?
Ileocolic anastomosis
What should PSA level be after total prostate removal?
Undetectable!
If it is detectable, refer urgently back
What is FIT test screening programme?
Every 2 years 60-74 yrs England, 50-74yrs Scotland
What is Breast cancer screening programme?
mammogram every 3years 50 -74
AAA screening programme for population?
Single Abdominal USS aged 65
Breast cancer 2ww referral?
over 30 and unexplained breast lump
over 50 and unilateral nipple discharge/blood/changes
if unexplained breast lump in <30, refer non-urgently
What causes PSA to rise?
Ejaculation or exercise previous 48hrs
BPH
Prostatitis or UTI in last 6 weeks
Cancer middle third rectum - which procedure?
Anterior resection
What factors affect end tidal CO2 and what can cause it to increase?
Factors are CO2 production, blood perfusion to lungs, ventilation
Fever, increased BP, increased HR, hypoventilation (means there’s more CO2 per breath is overall breathing rate lower)
Which anaesthetic has risk of malignant hyperthermia and what are the signs?
-fluranes
- sweating
- increased CO2 production, causing rise in end tidal CO2
When should you fluid resuscitate a Burns patient?
How do you calculate volume over 24hrs?
If over 15% surface area burned
percentage as a number x weight in kg x 4mls.
Give half of that in the first 8hrs
Aside from pregnancy and cancer, what other situation is a d-dimer not useful in ?DVT?
If there is superficial thrombophlebitis (AKA long saphenous vein thrombophlebitis), it will be elevated as well, so can’t be used to exclude DVT
Suspect superficial vein thrombophlebitis if tender along saphenous vein.
In this case, need to go straight to USS
Which features of breast cancer family history warrant breast clinic referral for genetic testing?
If 1st degree relative AND
-under 40
-bilateral breast ca
-male sex
-also family history of ovarian cancer in 1st degree relative
Which anaesthetic agent good for PONV?
Propofol (also acts as anti-emetic)
Which vein should TPN go into and why?
Via central line into subclavian, because it is highly phlebitic.
Painless growing sore on penis, weight loss + immunosuppression?
Penile cancer
(is squamous cell and associated with immunosuppression such as HIV)
Management of acute limb ischaemia?
Opioid analgesia, UNFRACTIONATED HEPARIN, URGENT VASCULAR REVIEW
If someone is 2ww for prostate cancer, which diagnostic investigation will they have?
Multiparametric MRI (no longer transrectal biopsy)
1st line management for BPH?
Tamsulosin (alpha blocker)
Then add on finasteride (takes up to 6 months to work, so no immediate relief of symptoms)
Characteristics of epididymal cyst?
Painless fluctuant cyst which can be felt separately to testes, usually posterior.
If you can’t ‘get above’ testicular swelling, what aetiology does this suggest?
Inguinal hernia
Difference in symptoms between breast abscess vs duct ectasia?
breast abscess red hot tender swelling, more common if lactating
whereas duct ectasia, lump + green discharge
Difference in symptoms between ductal papilloma vs breast cancer?
remember ductal papilloma is benign
ductal papilloma - bloody discharge, sometimes you feel a lump, sometimes you don’t
breast cancer - painless lump felt
NB// like breast cancer, fat necrosis is also hard irregular and tethered. Occurs more in obese women and usually the trauma is minor or goes unnoticed.
Cause of squamous cell carcinoma of bladder?
Schistosomiasis
Management of renal stones?
<5mm watch+wait
5-10mm shockwave lithotripsy
10-20 utereteroscopy
>20mm percutaneous nephrolithotomy
Peri-operative management of diabetic medications?
How do you treat Local Anaesthetic Toxicity?
IV 20% Lipid Emulsion
(NB// the toxicity occurs either due to accidental IV administration or too much LA)
How long before operation can you last eat and drink
Can eat 6hrs before
can drink 2hrs before
Management of Oestrogen receptor positive breast cancer?
if Pre-menopausal -> Tamoxifen
if Postmenopausal -> Anastrazole
Investigations for SAH?
Non-contrast CT head - if normal on 6hrs - no need for LP
if normal after 6hrs, do LP after 12hrs
Once diagnosis confirmed, need to do CTA to identify cause e.g aneurysm
Management of SAH?
if aneurysm -> coil to prevent rebleed
Also give nemodipine (CBB which prevents cerebral vasospasm - this prevents delayed cerebral ischaemia)
If hydrocephalus, may need shunt (e.g. external ventricular drain), IV mannitol
Complications of SAH?
Re-bleed
Cerebral vasospasm (delayed cerebral ischaemia)
Hydrocephalus
Why does hydrocephalus occur in SAH?
Which congenital hernias do you immediately repair and which do you observe?
congenital inguinal hernia = repair
umbilical hernia = most resolve by 4-5 yrs, wait until they are at least 2
Medical management of intermittent claudication?
CLOPIDOGREL
Statin (because this is secondary prevention of established CVD)
What are the CT Head criteria <1hr?
What are the CT Head criteria <8hrs?
To prevent further renal stones, which medications reduce which type of stone formation?
