Surgery Flashcards
What is the most common cause of painful PR bleed?
Fissure
Where are anal fissures located?
midline and 12oclock position
distal to the dentate line
What usually precedes an anal fissure?
ano-rectal abscess
How does bladder cancer typically present?
macroscopic painless haematuria
can also have incidental finding of microscopic haematuria
What should all >60YO + haematuria + raised white cell count +- ex smoker be referred to?
2WW urology
Where are inguinal hernias located?
superior and medial to the pubic tubercle
What is the most common type of hernia?
Inguinal
really common in men
Typical features of inguinal hernias
location
reduces when patient lies down
reduces when pressure is applied
How can subdural haematomas be classified?
Acute - symptoms within 48 hours of injury
Subacute - symptoms gradually develop days to weeks after injury
Chronic - weeks to months later, common in elderly
What are conservative management of varicose veins?
weight loss
leg elevation
exercise
compression stockings
What are the criteria for a CT scan within 1 hour after head injury?
GCS<13
GCS<15 after 2 hours of injury
retrograde amnesia of more than 30 mins before
suspected skull fracture
>1 episode of vomiting
focal neurological deficit
seizure
signs of basal skull fracture
When should FIT test be suggested?
palpable abdominal mass
40YO+weight loss + abdo pain
IDA
change in bowel habits
<50YO with rectal bleed + weight loss/ abdo pain
>60YO and anaemia ( not IDA)
Screening programme for bowel cancer
60 to 74 YO Male and females
FIT every 2 years
What does incarcerated hernia mean?
hernia cannot be reduced
Symptoms of a strangulated hernia
pain
fever
erythema around the skin of the hernia
nausea
vomiting
blood in stools
guarding
tenderness
What is flail chest injury?
chest wall disconnects from thoracic cage
How many lymph nodes need to be positive in sentile biopsy to get removed?
3/5
Common cause of small bowel obstruction in adults
previous surgery causing adhesions
crohns
incarceration of hernias
What hormonal treatment is used in HER+ and post menopausal women?
aromatase inhibitors
How to pick up small bowel obstruction on XRAY?
Valvulae conniventes extend all the way across
What should all patients with peripheral arterial disease be prescribed?
Atorvastatin 80 mg
Clopidogrel
When should a LP be done when suspecting a SAH?
12 hours post onset of headache
What is the most frequent colorectal cancer?
adenocarcinoma
What are patients with chronic pancreatitis at risk of developing and how should they be managed?
Diabetes
annual HbA1c
What vessel is most likely ruptured in an extradural haemorrhage?
middle meningeal
How to treat local anaesthetic toxicity?
IV 20% lipid emulsion
What are complications of transurethral resection?
TURP syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of prostate
What are the features of TURP syndrome?
HypoNa
fluid overload
glycin toxicity
Surgical management of Distal transverse or descending colon cancer?
left hemicolectomy
1st line pain relief for renal colic pain
NSAIDs
What should be used as investigation for children and pregnant women in suspected kidney stones?
US
Management for renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
Management for ureteric stones
shockwave lithotripsy +/- alpha blockers
< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
Symptoms of epididymo-orchitis
unilateral testicular swelling
pain (gradually worsening)
present cremasteric reflex
erythema
Treatment for epididymo-orchitis with unknown organism
IM Ceftriaxone
oral doxy 10-14days
Most common organism that causes cholangitis
E.Coli
Where are femoral hernias located?
below and lateral of the pubic tubercle
What is paralytic ileus?
common complication after bowel surgery
What are non seminal testicular tumours associated with marker wise?
high HCG and AFP
What is described as eczema like changes of the breast?
Pagets disease of the nipple
What is first line management for small bowel obstruction?
IV fluids and NG tube insertion
Management of cholecystitis
IV antibiotics and analgesia
laparoscopic cholecystectomy within 1 week
Management of cholangitis
IV antibiotics and analgesia
ERCP within 24-48 hours
When should a right hemicolectomy be performed?
Caecal, ascending or proximal transverse
What is a sigmoid volvulus?
large bowel obstruction due to sigmoid torsion
What is seen in an XRAY with sigmoid volvulus?
coffee bean
When does an anastomosis leak usually present?
5-7 days post surgery
Signs of an anastomosis leak
new onset AF
What are complications of acute pancreatitis?
Peripancreatic fluid collections
pseudocyst
ARDs
abscess
How are asymptomatic renal stones <5mm managed?
watch and weight
image again after 4 weeks Wh
What needs to be excluded prior to circumcision?
diagnosis of hypospasdiasis
What initial investigations should be performed with males with ED?
Glucose
lipids
free testosterone
painless lump in scrotum + gynaecomastia
testicular cancer
What pain relief is used for acute renal colic?
IM diclofenac
What is first line investigation for prostate cancer?
multiparametric MRI
What is a hartmans procedure?
resect area of bowel that is not functioning
form ileostomy/colostomy temporarily
colorectal anastomosis formation to reform continous bowel
Treatment for superficial thrombophlebitis
NSAIDs
Compression stockings
What medication is used in chronic anal fissure?
Topical glyceryl trinitrate
What drug is administered to patients post SAH to prevent spasm?
Nimodipine ( CCB)
Continuous dribbling incontinence after prolonged labour
vesciovaginal fistulae
