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UKMLA Prep > Surgery > Flashcards

Surgery Flashcards

1
Q

What are fibroids?

A

Benign smooth muscle tumours of the uterus

They occur in approximately 20% of white and 50% of black women in later reproductive years.

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2
Q

What factors are associated with fibroids?

A
  • More common in Afro-Caribbean women
  • Rare before puberty
  • Develop in response to oestrogen
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3
Q

List common symptoms of fibroids. (7)

A
  • Asymptomatic
  • Menorrhagia
  • Iron-deficiency anaemia
  • Lower abdominal pain
  • Bloating
  • Urinary symptoms
  • Subfertility
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4
Q

What is the preferred method for diagnosing fibroids?

A

Transvaginal ultrasound

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5
Q

What is the management for asymptomatic fibroids?

A

No treatment needed other than periodic review

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6
Q

What treatments are used for menorrhagia secondary to fibroids?

A
  • Levonorgestrel intrauterine system (LNG-IUS)
  • NSAIDs (e.g., mefenamic acid)
  • Tranexamic acid
  • Combined oral contraceptive pill
  • Oral progestogen
  • Injectable progestogen
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7
Q

What medical treatments can shrink/remove fibroids?

A
  • GnRH agonists
  • Ulipristal acetate (not currently used due to liver toxicity concerns)
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8
Q

List surgical options for fibroid treatment.

A
  • Myomectomy
  • Hysteroscopic endometrial ablation
  • Hysterectomy
  • Uterine artery embolization
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9
Q

What is the prognosis for fibroids after menopause?

A

Fibroids generally regress after menopause

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10
Q

What is testicular torsion?

A

Twist of the spermatic cord resulting in testicular ischaemia and necrosis

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11
Q

What age group is most commonly affected by testicular torsion?

A

Males aged between 10 and 30 years

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12
Q

What are common symptoms of testicular torsion? (5)

A
  • Severe, sudden onset pain
  • Nausea and vomiting
  • Swollen, tender testis retracted upwards
  • Lost cremasteric reflex
  • Pain not eased by elevating the testis
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13
Q

What is the management for testicular torsion?

A

Urgent surgical exploration

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14
Q

What is the most common type of oesophageal cancer?

A

Adenocarcinoma

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15
Q

List risk factors for adenocarcinoma of the oesophagus.

A
  • GORD
  • Barrett’s oesophagus
  • Smoking
  • Obesity
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16
Q

What is the most common presenting symptom of oesophageal cancer?

A

Dysphagia

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17
Q

What is the diagnostic method for oesophageal cancer?

A

Upper GI endoscopy with biopsy

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18
Q

What is the initial treatment for operable oesophageal cancer?

A

Surgical resection (Ivor-Lewis type oesophagectomy)

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19
Q

What is intussusception?

A

Invagination of one portion of the bowel into the lumen of adjacent bowel

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20
Q

Which age group is most commonly affected by intussusception?

A

Infants between 6-18 months old

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21
Q

List symptoms of intussusception.

A
  • Severe crampy abdominal pain
  • Inconsolable crying
  • Vomiting
  • Bloodstained stool (‘red-currant jelly’)
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22
Q

What is the first-line investigation for intussusception?

A

Ultrasound

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23
Q

What is the management for perforation secondary to peptic ulcer disease?

A

Urgent surgical intervention

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24
Q

What is a fibroadenoma?

A

A mobile, firm, smooth breast lump, often referred to as a ‘breast mouse’

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25
Q

What is the most common acute abdominal condition requiring surgery?

A

Acute appendicitis

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26
Q

List common symptoms of acute appendicitis. (4)

A
  • Peri-umbilical pain radiating to the right iliac fossa
  • Anorexia
  • Nausea
  • Tenderness in RIF
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27
Q

What is the classic sign associated with appendicitis?

A

Migration of pain from the centre to the right iliac fossa

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28
Q

What is the typical management for appendicitis?

A

Appendicectomy

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29
Q

What is the common cause of hyperprolactinaemia?

A

Pituitary microadenomas

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30
Q

What is the most common type of nipple discharge associated with carcinoma?

A

Blood-stained discharge

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31
Q

What is urogenital prolapse?

A

Descent of one of the pelvic organs resulting in protrusion on the vaginal walls

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32
Q

What are the types of urogenital prolapse?

A
  • Cystocele
  • Rectocele
  • Uterine prolapse
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33
Q

What are common symptoms of a ruptured abdominal aortic aneurysm?

A
  • Severe central abdominal pain
  • Pulsatile mass
  • Shock
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34
Q

What is the immediate management for a suspected ruptured AAA?

A

Immediate vascular review for emergency surgical repair

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35
Q

What is the importance of understanding abdominal pain in clinical practice?

A

It encompasses a diverse range of conditions from benign to life-threatening

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36
Q

What is the characteristic pain presentation in gastric ulcers?

A

Epigastric pain worsened by eating

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37
Q

What is a common symptom associated with appendicitis?

A

Anorexia

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38
Q

What sign indicates more pain in the right iliac fossa than the left during appendicitis?

A

Rovsing’s sign

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39
Q

What are common causes of acute pancreatitis?

A

Alcohol or gallstones

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40
Q

What is Cullen’s sign?

A

Periumbilical discolouration

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41
Q

What is Grey-Turner’s sign?

A

Flank discolouration

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42
Q

What are the typical symptoms of biliary colic?

A

Pain in the RUQ radiating to the back and interscapular region

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43
Q

What is Murphy’s sign indicative of?

A

Acute cholecystitis

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44
Q

What is the typical pain location in diverticulitis?

A

Left lower quadrant (LLQ)

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45
Q

What is a key feature of abdominal aortic aneurysm (AAA) pain?

A

Severe central abdominal pain radiating to the back

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46
Q

What are common symptoms of intestinal obstruction?

A

Vomiting, not opened bowels recently, ‘tinkling’ bowel sounds

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47
Q

How is constipation defined?

A

Defecation that is unsatisfactory due to infrequent stools, difficult passage, or incomplete defecation

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48
Q

What is the first-line laxative treatment for constipation?

A

Bulk-forming laxative, such as ispaghula

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49
Q

What is a common complication of constipation?

A

Overflow diarrhoea

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50
Q

What characterizes femoral hernias?

A

A lump within the groin, mildly painful, non-reducible

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51
Q

What is the male-to-female ratio for femoral hernias?

A

1:3

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52
Q

What are common differentials to exclude for femoral hernias? (6)

A
  • Lymphadenopathy
  • Abscess
  • Femoral artery aneurysm
  • Hydrocoele or varicocele in males
  • Lipoma
  • Inguinal hernia
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53
Q

What age group is most commonly affected by intussusception?

A

Infants between 6-18 months

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54
Q

What is a classic sign of intussusception in infants?

A

Bloodstained stool - ‘red-currant jelly’

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55
Q

What is the investigation of choice for intussusception?

A

Ultrasound

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56
Q

What is the most common type of pancreatic tumor?

A

Adenocarcinomas

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57
Q

What is Courvoisier’s law?

A

In the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

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58
Q

What is the surgical procedure for resectable lesions in pancreatic cancer?

A

Whipple’s resection (pancreaticoduodenectomy)

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59
Q

What is a key feature of a ruptured abdominal aortic aneurysm (AAA)?

A

Pulsatile, expansile mass in the abdomen

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60
Q

What are the main causes of ascites with a SAAG > 11 g/L?

A
  • Liver disorders
  • Cardiac
  • Other causes
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61
Q

What is the management for tense ascites?

A

Therapeutic abdominal paracentesis

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62
Q

What is benign cyclical mastalgia?

A

A common cause of breast pain in younger females

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63
Q

How does cyclical mastalgia vary?

A

Intensity varies according to the phase of the menstrual cycle

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64
Q

What is the recommendation for prophylactic treatment in patients with cirrhosis and ascites?

A

Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved

This recommendation is made by NICE.

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65
Q

What is benign cyclical mastalgia?

A

A common cause of breast pain in younger females that varies in intensity according to the phase of the menstrual cycle.

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66
Q

What are common clinical features of cyclical mastalgia?

A
  • Varies in intensity according to the menstrual cycle
  • Not usually associated with point tenderness of the chest wall
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67
Q

What should management for cyclical mastalgia include?

A
  • Supportive bra
  • Conservative treatments: standard oral and topical analgesia
  • Referral after 3 months if pain persists affecting quality of life
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68
Q

What hormonal agents may be effective for cyclical mastalgia?

A
  • Bromocriptine
  • Danazol
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69
Q

What is mastitis?

A

Inflammation of the breast tissue, typically associated with breastfeeding.

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70
Q

What are the features of mastitis?

A
  • Painful, tender, red hot breast
  • Fever and general malaise may be present
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71
Q

What is the first-line management for mastitis?

A
  • Continue breastfeeding
  • Simple measures: analgesia and warm compresses
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72
Q

What is the first-line antibiotic for mastitis?

A

Oral flucloxacillin for 10-14 days

This is due to Staphylococcus aureus being the most common organism causing infective mastitis.

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73
Q

What can untreated mastitis develop into?

A

A breast abscess, which generally requires incision and drainage.

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74
Q

What are typical features of a breast lump associated with malignancy?

A
  • Typically painless
  • Classically described as fixed and hard
  • Breast skin changes
  • Bloody nipple discharge
  • Inverted nipple
  • Axillary mass
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75
Q

What is atrophic vaginitis?

A

Occurs in post-menopausal women, presenting with vaginal dryness, dyspareunia, and occasional spotting.

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76
Q

What are the causative organisms of pelvic inflammatory disease (PID)?

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Mycoplasma genitalium
  • Mycoplasma hominis
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77
Q

What are common features of PID?

A
  • Lower abdominal pain
  • Fever
  • Deep dyspareunia
  • Dysuria
  • Menstrual irregularities
  • Vaginal or cervical discharge
  • Cervical excitation
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78
Q

What is the first-line treatment for PID?

A
  • Stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
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79
Q

What are complications of PID?

A
  • Perihepatitis (Fitz-Hugh Curtis Syndrome)
  • Infertility (10-20% risk after one episode)
  • Chronic pelvic pain
  • Ectopic pregnancy
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80
Q

What is vaginal candidiasis commonly known as?

A

Thrush.

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81
Q

What are common predisposing factors for vaginal candidiasis?

A
  • Diabetes mellitus
  • Antibiotics
  • Steroids
  • Pregnancy
  • Immunosuppression (e.g., HIV)
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82
Q

What are the features of vaginal candidiasis?

A
  • ‘Cottage cheese’, non-offensive discharge
  • Vulvitis
  • Itch
  • Vulval erythema, fissuring, satellite lesions
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83
Q

What is the first-line treatment for vaginal candidiasis?

A

Oral fluconazole 150 mg as a single dose.

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84
Q

What defines recurrent vaginal candidiasis?

A

Four or more episodes per year.

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85
Q

What are the features of a femoral hernia?

A
  • Lump within the groin, usually mildly painful
  • Non-reducible, although can be reducible in some cases
  • Located inferolateral to the pubic tubercle
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86
Q

What are common complications of femoral hernias?

A
  • Incarceration
  • Strangulation
  • Bowel obstruction
  • Bowel ischaemia and resection
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87
Q

What is the management for femoral hernias?

A

Surgical repair is necessary, either laparoscopically or via laparotomy.

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88
Q

What percentage of abdominal wall hernias are inguinal hernias?

A

75%.

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89
Q

What are the features of inguinal hernias? (4)

A
  • Groin lump
  • Superior and medial to the pubic tubercle
  • Disappears on pressure or when the patient lies down
  • Discomfort and ache, often worse with activity
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90
Q

What is the recommended treatment for inguinal hernias?

A
  • Mesh repair is associated with the lowest recurrence rate
  • Unilateral hernias generally repaired with an open approach
  • Bilateral and recurrent hernias generally repaired laparoscopically
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91
Q

What are the common causes of acute upper gastrointestinal (GI) bleeding?

A
  • Oesophageal varices
  • Peptic ulcer disease
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92
Q

What are the presenting features of haematemesis?

A
  • Bright red blood or ‘coffee ground’ appearance
  • May be associated with peptic ulcer disease or oesophageal varices
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93
Q

What scoring system helps assess risk in acute upper GI bleeding?

A

The Glasgow-Blatchford score at first assessment.

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94
Q

What is indicated for a pregnancy test in the context of PID?

A

To exclude an ectopic pregnancy.

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95
Q

What is the first-line management for patients with mastitis who are systemically unwell?

A

Treat with antibiotics and continue breastfeeding.

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96
Q

What are the symptoms associated with a duodenal ulcer?

A
  • Haematemesis
  • Melena
  • Epigastric discomfort
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97
Q

What is the typical pain pattern for a duodenal ulcer?

A

Occurs several hours after eating.

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98
Q

What is the Blatchford score for men with haemoglobin levels of 10 - 12 g/L?

A

3

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99
Q

What is the Blatchford score for women with haemoglobin levels less than 10 g/L?

A

6

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100
Q

What is the Blatchford score for systolic blood pressure less than 90 mmHg?

A

3

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101
Q

What should be done for patients with a Blatchford score of 0?

A

Considered for early discharge

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102
Q

What is the first step in resuscitation for a patient with severe bleeding?

A

ABC, wide-bore intravenous access * 2

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103
Q

What is the platelet transfusion threshold for actively bleeding patients?

A

Platelet count of less than 50 x 10*9/litre

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104
Q

What should fresh frozen plasma be administered for?

A

Fibrinogen level of less than 1 g/litre or prothrombin time greater than 1.5 times normal

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105
Q

When should endoscopy be offered for patients with a severe bleed?

A

Immediately after resuscitation

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106
Q

What is the recommended management for patients with non-variceal upper gastrointestinal bleeding?

A

Proton pump inhibitors should be given if stigmata of recent haemorrhage shown at endoscopy

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107
Q

What medications should be given to patients at presentation with variceal bleeding?

A

Terlipressin and prophylactic antibiotics

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108
Q

What is the complication associated with portal hypertension?

A

Oesophageal varices

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109
Q

What is the only licensed vasoactive agent for acute treatment of variceal haemorrhage?

A

Terlipressin

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110
Q

What is the recommended intervention for uncontrolled variceal bleeding?

A

Transjugular Intrahepatic Portosystemic Shunt (TIPSS)

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111
Q

What is the primary prevention strategy for variceal haemorrhage?

A

Propranolol and endoscopic variceal band ligation (EVL)

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112
Q

What is the typical presentation of a femoral hernia?

A

A lump within the groin, usually mildly painful

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113
Q

What is the male to female ratio for femoral hernias?

A

1:3

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114
Q

What is a common complication of femoral hernias?

A

Strangulation

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115
Q

What is the management for a femoral hernia?

A

Surgical repair

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116
Q

What percentage of abdominal wall hernias are inguinal hernias?

A

75%

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117
Q

What is the lifetime risk of developing an inguinal hernia in men?

A

25%

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118
Q

What is the first-line treatment for an acute anal fissure?

A

Softening stool and dietary advice

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119
Q

What is the first-line treatment for a chronic anal fissure?

A

Topical glyceryl trinitrate (GTN)

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120
Q

What is mastitis typically associated with?

A

Breastfeeding

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121
Q

What is the first-line management for mastitis?

A

Continue breastfeeding

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122
Q

What is the most common organism causing infective mastitis?

A

Staphylococcus aureus

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123
Q

Fill in the blank: The first-line antibiotic for mastitis is _______.

A

oral flucloxacillin

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124
Q

What is volvulus?

A

Torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction

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125
Q

What is sigmoid volvulus?

A

Large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon

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126
Q

What percentage of volvulus cases are sigmoid volvulus?

A

Around 80%

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127
Q

What are common associations with sigmoid volvulus?

A
  • Older patients
  • Chronic constipation
  • Chagas disease
  • Neurological conditions (e.g., Parkinson’s disease)
  • Psychiatric conditions (e.g., schizophrenia)
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128
Q

What are common associations with caecal volvulus? (3)

A
  • Adhesions
  • Pregnancy
  • All ages
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129
Q

What are common features of volvulus? (4)

A
  • Constipation
  • Abdominal bloating
  • Abdominal pain
  • Nausea/vomiting
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130
Q

How is sigmoid volvulus diagnosed?

A

Usually diagnosed on abdominal film showing large bowel obstruction and coffee bean sign

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131
Q

What is the management for sigmoid volvulus?

A

Rigid sigmoidoscopy with rectal tube insertion

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132
Q

What is the management for caecal volvulus?

A

Operative management, often requiring right hemicolectomy

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133
Q

What are varicose veins?

A

Dilated, tortuous, superficial veins due to incompetent venous valves

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134
Q

What are common risk factors for varicose veins? (4)

A
  • Increasing age
  • Female gender
  • Pregnancy
  • Obesity
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135
Q

What symptoms may patients with varicose veins experience?

A
  • Aching
  • Throbbing
  • Itching
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136
Q

What are possible complications of varicose veins? (8)

A
  • Varicose eczema
  • Haemosiderin deposition
  • Lipodermatosclerosis
  • Atrophie blanche
  • Bleeding
  • Superficial thrombophlebitis
  • Venous ulceration
  • Deep vein thrombosis
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137
Q

What is the investigation of choice for varicose veins?

A

Venous duplex ultrasound

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138
Q

What conservative treatments are recommended for varicose veins?

A
  • Leg elevation
  • Weight loss
  • Regular exercise
  • Graduated compression stockings
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139
Q

What is a ruptured abdominal aortic aneurysm (AAA)?

A

A catastrophic or sub-acute presentation characterized by severe abdominal pain and shock

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140
Q

What is the mortality rate of a ruptured AAA?

A

Almost 80%

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141
Q

What are the features of a ruptured AAA?

A
  • Severe central abdominal pain radiating to the back
  • Pulsatile, expansile mass in the abdomen
  • Shock (hypotension, tachycardia) or collapse
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142
Q

What is the management for a ruptured AAA?

A

Immediate vascular review with a view to emergency surgical repair

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143
Q

What is peripheral arterial disease (PAD) strongly linked to?

A

Smoking

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144
Q

What is the recommended first-line medication for patients with PAD?

A

Clopidogrel

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145
Q

What are the treatment options for severe PAD?

A
  • Endovascular revascularization
  • Surgical revascularization
  • Amputation (reserved for critical limb ischaemia)
146
Q

What is a perianal abscess?

A

A collection of pus within the subcutaneous tissue of the anus

147
Q

What is the average age of patients with perianal abscesses?

A

Around 40 years

148
Q

What are common causes of perianal abscesses?

A

Generally colonized by gut flora such as E. coli

149
Q

What is the first-line treatment for perianal abscesses?

A

Surgical incision and drainage

150
Q

What is pelvic inflammatory disease (PID)?

A

Infection and inflammation of the female pelvic organs

151
Q

What is the most common causative organism of PID?

A

Chlamydia trachomatis

152
Q

What are common features of PID?

A
  • Lower abdominal pain
  • Fever
  • Deep dyspareunia
  • Dysuria
  • Vaginal discharge
153
Q

What is the first-line treatment for PID?

A

Stat IM ceftriaxone + 14 days of oral doxycycline + oral metronidazole

154
Q

What is a significant complication of PID?

A

Infertility, with a risk as high as 10-20% after a single episode

155
Q

What is pancreatic cancer most commonly associated with?

A
  • Increasing age
  • Smoking
  • Diabetes
  • Chronic pancreatitis
156
Q

What are common features of pancreatic cancer?

A
  • Painless jaundice
  • Pale stools
  • Dark urine
  • Pruritus
  • Weight loss
157
Q

What is the investigation of choice for suspected pancreatic cancer?

A

High-resolution CT scanning

158
Q

What is the management for resectable pancreatic cancer?

A

Whipple’s resection (pancreaticoduodenectomy)

159
Q

What is the peak age of incidence for ovarian cancer?

A

60 years

160
Q

What is the most common type of ovarian cancer?

A

Epithelial cancers, predominantly serous carcinomas

161
Q

What is a key risk factor for ovarian cancer?

A

Family history of BRCA1 or BRCA2 mutations

162
Q

What is the initial investigation for suspected ovarian cancer?

A

CA125 test

163
Q

What is the management for ovarian cancer?

A

Combination of surgery and platinum-based chemotherapy

164
Q

What are common causes of acute upper gastrointestinal bleeding?

A
  • Oesophageal varices
  • Peptic ulcer disease
165
Q

What is haematemesis?

A

The vomiting of blood, often bright red or described as ‘coffee ground’

166
Q

What laboratory finding may be seen in acute upper GI bleeding?

A

Raised urea due to the protein meal of the blood

167
Q

What is a common cause of raised urea in the blood?

A

‘Protein meal’ of the blood

Raised urea levels can be indicative of various conditions, but in this context, it refers to the intake of protein-rich meals.

168
Q

What are the presenting features of oesophageal varices?

A

Usually a large volume of fresh blood, may cause melena, often associated with haemodynamic compromise

Swallowed blood may lead to melena and re-bleeds are common until managed.

169
Q

What are the symptoms associated with peptic ulcer disease?

A

Abdominal pain

Abdominal pain is a common symptom indicating potential issues in the upper gastrointestinal tract.

170
Q

What is the Glasgow-Blatchford score used for?

A

Helps clinicians decide whether patients can be managed as outpatients

It is an initial risk assessment tool for patients with upper gastrointestinal bleeding.

171
Q

Which score is used after endoscopy to assess risk of rebleeding?

A

The Rockall score

It provides a percentage risk of rebleeding and mortality based on several clinical factors.

172
Q

What is the significance of a Blatchford score of 0?

A

Patients may be considered for early discharge

A score of 0 indicates a lower risk of serious complications.

173
Q

What are the management steps for acute upper gastrointestinal bleeding?

A
  • Resuscitation
  • Risk assessment
  • Endoscopy

Management often involves multiple steps to stabilize the patient and identify the source of bleeding.

174
Q

What should be administered if a patient is actively bleeding with a platelet count of less than 50 x 10^9/litre?

A

Platelet transfusion

This is crucial for patients experiencing significant bleeding to help with clotting.

175
Q

What is the first-line vasoactive agent recommended for variceal hemorrhage?

A

Terlipressin

Terlipressin is shown to be beneficial in initial haemostasis and preventing rebleeding.

176
Q

What is the most common type of bladder cancer?

A

Urothelial (transitional cell) carcinoma (>90% of cases)

This type of carcinoma is prevalent and can arise in various locations along the urinary tract.

177
Q

What is the TNM classification for bladder cancer T0?

A

No evidence of tumour

This stage indicates the absence of any detectable tumor.

178
Q

What percentage of patients with T1 bladder cancer have a good prognosis?

A

90%

T1 indicates non-invasive or superficial disease, which generally has a favorable outcome.

179
Q

What is one common cause of persistent non-visible haematuria?

A

Cancer (bladder, renal, prostate)

Persistent non-visible haematuria can indicate underlying malignancies and should be investigated.

180
Q

What is the test of choice for detecting haematuria?

A

Urine dipstick

It is a simple and effective method to screen for blood in the urine.

181
Q

What are the causes of transient or spurious non-visible haematuria?

A
  • Urinary tract infection
  • Menstruation
  • Vigorous exercise
  • Sexual intercourse

These conditions can cause temporary changes in urine appearance without true blood presence.

182
Q

What is the recommended management for patients aged 45 years or older with unexplained visible haematuria?

A

Urgent referral within 2 weeks

This guideline is crucial for early detection of possible malignancies.

183
Q

What does the term ‘field change’ refer to in urothelial carcinoma?

A

Effect of multifocal lesions due to environmental factors

This phenomenon explains why urothelial carcinomas often present as multiple lesions.

184
Q

What is a common complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

A

Exacerbation of hepatic encephalopathy

This is a significant risk due to changes in blood flow and ammonia metabolism.

185
Q

What are anticoagulants used for?

A

Preventing blood clot formation

Anticoagulants are medications that help reduce the risk of blood clots in various medical conditions.

186
Q

What is the commonest cause of glomerulonephritis worldwide?

A

IgA nephropathy (Berger’s disease)

IgA nephropathy typically presents with macroscopic haematuria following an upper respiratory tract infection.

187
Q

What are the key presentations of IgA nephropathy?

A
  • Recurrent episodes of macroscopic haematuria
  • Typically associated with recent respiratory tract infection
  • Nephrotic range proteinuria is rare
  • Renal failure is unusual

These symptoms are particularly observed in young males.

188
Q

What associated conditions are linked with IgA nephropathy? (3)

A
  • Alcoholic cirrhosis
  • Coeliac disease/dermatitis herpetiformis
  • Henoch-Schonlein purpura

These conditions can be associated with IgA nephropathy due to overlapping pathophysiological mechanisms.

189
Q

How does post-streptococcal glomerulonephritis differ from IgA nephropathy?

A
  • Post-streptococcal is associated with low complement levels
  • Main symptom is proteinuria
  • Interval between URTI and renal problems

IgA nephropathy typically presents without a significant interval between infection and symptoms.

190
Q

What is the initial treatment for persistent proteinuria in IgA nephropathy?

A

ACE inhibitors

If there is active disease or failure to respond, immunosuppression with corticosteroids may be necessary.

191
Q

What is the prognosis for patients with IgA nephropathy?

A
  • 25% develop ESRF
  • Good prognosis: frank haematuria
  • Poor prognosis: male gender, proteinuria > 2 g/day, hypertension, smoking, hyperlipidaemia, ACE genotype DD

ESRF stands for End-Stage Renal Failure.

192
Q

What is renal cell cancer also known as?

A

Hypernephroma

It accounts for 85% of primary renal neoplasms and arises from proximal renal tubular epithelium.

193
Q

What is the classical triad of symptoms for renal cell cancer?

A
  • Haematuria
  • Loin pain
  • Abdominal mass

Other symptoms may include pyrexia of unknown origin and endocrine effects.

194
Q

What are the types of stomas? (11)

A
  • Ileostomy
  • Colostomy
  • Gastrostomy
  • Loop jejunostomy
  • Percutaneous jejunostomy
  • Loop ileostomy
  • End ileostomy
  • End colostomy
  • Loop colostomy
  • Caecostomy
  • Mucous fistula

Each type serves different medical purposes and is situated based on clinical need.

195
Q

What is the usual location for an ileostomy?

A

Right iliac fossa

Ileostomies typically have a spouted appearance due to the liquid output.

196
Q

What are the key components of elective patient preparation for surgery?

A
  • Pre-admission clinic
  • Blood tests
  • Urine analysis
  • Pregnancy test
  • Sickle cell test
  • ECG/ Chest x-ray

These components help assess patient fitness and risks prior to surgery.

197
Q

Fill in the blank: Patients having surgery may drink clear fluids until ______ hours before their operation.

A

2

Clear fluids can help reduce headaches, nausea, and vomiting after surgery.

198
Q

What are potential complications of poorly managed diabetes during surgery?

A
  • Undetected hypoglycaemia
  • Increased risk of wound & respiratory infections
  • Increased risk of post-operative acute kidney injury
  • Increased length of hospital stay

Diabetes management is critical during surgical procedures.

199
Q

What should be done the day prior to surgery for diabetic patients?

A

Follow specific medication guidelines

Guidelines vary based on the type of medication and the timing of the surgery.

200
Q

What is the purpose of the World Health Organisation checklist before operations?

A

To ensure safety and reduce complications

The checklist includes various safety measures to be followed prior to surgical procedures.

201
Q

What anatomical principles are important to avoid complications during surgery?

A
  • Understanding local anatomy
  • Anticipating nerve injuries
  • Recognizing potential visceral injuries

Knowledge of anatomy helps predict and manage surgical complications effectively.

202
Q

What are common physiological derangements following surgery?

A
  • Bleeding
  • Infection
  • Arrhythmias
  • Electrolyte disturbances

These issues may arise due to surgical stress and patient factors.

203
Q

What is hypokalaemia in cardiac patients?

A

K+ <4.0

Hypokalaemia can lead to various cardiac complications.

204
Q

What is a common electrolyte disturbance following cranial surgery?

A

SIADH causing hyponatraemia

SIADH stands for Syndrome of Inappropriate Antidiuretic Hormone secretion.

205
Q

What can cause ileus following gastrointestinal surgery?

A

Fluid sequestration and loss of electrolytes

206
Q

What is a consequence of pulmonary oedema following pneumonectomy?

A

Increased sensitivity to fluid overload

207
Q

What is an anastamotic leak associated with?

A

Generalised sepsis causing mediastinitis or peritonitis

208
Q

What may follow any type of surgery and compromise grafts?

A

Myocardial infarct

209
Q

What baseline investigations are often helpful in acutely unwell surgical patients?

A
  • Full blood count
  • Urea and electrolytes
  • C-reactive protein
  • Serum calcium
  • Liver function tests
  • Clotting tests
  • Arterial blood gases
  • ECG
  • Chest x-ray
  • Urine analysis
210
Q

What imaging is used for identifying intra-abdominal abscesses?

A

CT scanning

211
Q

What is the guiding principle for managing complications in surgical patients?

A

Safe and timely intervention

212
Q

What should be avoided in patients with recent surgery during management?

A

Thrombolysis

213
Q

What is the first-line treatment for an acute anal fissure?

A
  • Softening stool
  • High-fibre diet
  • Bulk-forming laxatives
  • Lubricants
  • Topical anaesthetics
  • Analgesia
214
Q

What defines an anal fissure as chronic?

A

Present for more than 6 weeks

215
Q

What is intussusception?

A

Invagination of one portion of the bowel into the lumen of the adjacent bowel

216
Q

What is a late sign of intussusception in infants?

A

Bloodstained stool - ‘red-currant jelly’

217
Q

What is the investigation of choice for intussusception?

A

Ultrasound

218
Q

What is the typical appearance of rectal bleeding from a fissure in ano?

A

Bright red rectal bleeding

219
Q

What should all patients presenting with rectal bleeding undergo?

A

Digital rectal examination and procto-sigmoidoscopy

220
Q

What imaging is necessary for staging rectal cancer?

A
  • MRI of the rectum
  • CT scanning of chest, abdomen, and pelvis
221
Q

What is the first-line treatment for chronic anal fissure?

A

Topical glyceryl trinitrate (GTN)

222
Q

What are the common causes of splenic trauma?

A
  • Blunt trauma
  • Penetrating trauma
223
Q

What is the management for small subcapsular haematoma of the spleen?

A

Conservative management

224
Q

What is Beck’s triad associated with?

A

Cardiac tamponade

225
Q

What is the most common cause of tension pneumothorax?

A

Mechanical ventilation in a patient with pleural injury

226
Q

What should be avoided in managing external haemorrhage?

A

Tourniquets

227
Q

What is the cornerstone of trauma management?

A

ATLS principles

228
Q

What type of injury is most commonly associated with blunt cardiac injury?

A

Chest wall injury

229
Q

What should be performed for traumatic aortic disruption?

A

CT angiogram

230
Q

What is a common cause of death after road traffic accidents or falls?

A

Traumatic aortic disruption

231
Q

What is the typical management for simple pneumothorax?

A

Insert chest drain

232
Q

What is a common injury associated with stab wounds?

A

Liver injury

233
Q

What does blood at the urethral meatus suggest?

A

Urethral tear

234
Q

What is the most commonly injured organ in blunt abdominal trauma requiring laparotomy?

A

Spleen

Injuries occur in approximately 40% of blunt trauma cases.

235
Q

In stab wounds, which organ is most commonly injured?

A

Liver

This occurs in about 40% of cases.

236
Q

What is the most commonly injured organ in gunshot wounds to the abdomen?

A

Small bowel

This injury occurs in approximately 50% of cases.

237
Q

What does a high riding prostate on PR indicate?

A

Urethral disruption

238
Q

When should mechanical testing for pelvic stability be performed?

A

Once

239
Q

What is the indication for Diagnostic Peritoneal Lavage?

A

Document bleeding if hypotensive

240
Q

What is the advantage of an abdominal CT scan in trauma investigations?

A

Most specific for localising injury; 92 to 98% accurate

241
Q

What is a disadvantage of using ultrasound (USS) in trauma investigations?

A

Operator dependent and may miss retroperitoneal injury

242
Q

What percentage of couples will conceive within 1 year of regular intercourse?

A

84%

243
Q

What are the male factor infertility causes?

A

30%

244
Q

What test is performed to check ovulation in women?

A

Serum progesterone 7 days prior to expected next period

245
Q

What serum progesterone level indicates ovulation?

A

> 30 nmol/l

246
Q

What is the normal semen volume?

A

> 1.5 ml

247
Q

What pH is considered normal for semen analysis?

A

> 7.2

248
Q

What percentage of normal forms is required for sperm morphology?

A

> 4%

249
Q

What is the prevalence of fibroids in women?

A

Around 20% of white and around 50% of black women

250
Q

What is a common symptom associated with fibroids?

A

Menorrhagia

251
Q

What is the typical diagnosis method for fibroids?

A

Transvaginal ultrasound

252
Q

What is the management for asymptomatic fibroids?

A

Periodic review to monitor size and growth

253
Q

What is a treatment option for menorrhagia secondary to fibroids?

A

Levonorgestrel intrauterine system (LNG-IUS)

254
Q

What are GnRH agonists used for in the context of fibroids?

A

Reduce the size of the fibroid

255
Q

What surgical options are available for treating fibroids?

A
  • Myomectomy
  • Hysteroscopic endometrial ablation
  • Hysterectomy
  • Uterine artery embolization
256
Q

What happens to fibroids after menopause?

A

They generally regress

257
Q

What is a rare complication of fibroids during pregnancy?

A

Red degeneration - haemorrhage into tumour

258
Q

What is the classical surgical definition of a hernia?

A

The protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.

259
Q

List four risk factors for abdominal wall hernias.

A
  • Obesity
  • Ascites
  • Increasing age
  • Surgical wounds
260
Q

What are the common features of abdominal wall hernias?

A
  • Palpable lump
  • Cough impulse
  • Pain
  • Obstruction
  • Strangulation
261
Q

Which type of hernia accounts for 75% of abdominal wall hernias?

A

Inguinal hernia

262
Q

What is the typical demographic for inguinal hernias?

A

Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia.

263
Q

Describe the location of a femoral hernia.

A

Below and lateral to the pubic tubercle.

264
Q

True or False: Strangulation is rare in inguinal hernias.

A

True

265
Q

What characterizes an umbilical hernia?

A

Symmetrical bulge under the umbilicus.

266
Q

Define a paraumbilical hernia.

A

Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus.

267
Q

What is an epigastric hernia?

A

Lump in the midline between umbilicus and the xiphisternum.

268
Q

What is a richter hernia?

A

A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect.

269
Q

What is the common presentation of an obturator hernia?

A

Typically presents with bowel obstruction.

270
Q

What is the common risk factor for femoral hernias?

A

More common in women, particularly multiparous ones.

271
Q

Fill in the blank: Femoral hernias are more common in _______ than in nulliparous women.

A

multiparous women

272
Q

What are common complications of hernias?

A
  • Incarceration
  • Strangulation
  • Bowel obstruction
  • Bowel ischemia
273
Q

What is the management for femoral hernias?

A

Surgical repair is a necessity.

274
Q

What imaging is usually used for diagnosis of hernias?

A

Diagnosis is usually clinical, although ultrasound is an option.

275
Q

What is the most common cause of acute pancreatitis?

A

Gallstones and alcohol.

276
Q

What is the mnemonic used to remember causes of pancreatitis?

A

GET SMASHED

277
Q

List two local complications associated with acute pancreatitis.

A
  • Pseudocysts
  • Pancreatic abscess
278
Q

What is the Ranson score used for?

A

Identifying cases of severe pancreatitis which may require intensive care management.

279
Q

Fill in the blank: Severe acute pancreatitis is classified as having _______ organ failure.

A

persistent

280
Q

What is the recommended management for patients with gallstone-related acute pancreatitis?

A

Early cholecystectomy.

281
Q

What are the symptoms of strangulated hernias?

A
  • Pain
  • Fever
  • Increase in the size of a hernia
  • Erythema of the overlying skin
  • Bowel obstruction
282
Q

What is the typical treatment for infected pancreatic necrosis?

A

Either radiological drainage or surgical necrosectomy.

283
Q

True or False: Patients with acute pancreatitis should be made ‘nil-by-mouth’.

A

False

284
Q

What are common early complications after hernia repair?

A
  • Bruising
  • Wound infection
285
Q

What is the significance of the Glasgow score in pancreatitis?

A

It is used to assess the severity of pancreatitis.

286
Q

What is Cullen’s sign?

A

Periumbilical discolouration associated with pancreatitis but rare.

287
Q

What is the typical demographic for congenital inguinal hernias?

A

More common in premature babies and boys.

288
Q

What is the most common risk factor for incisional hernias?

A

May occur in up to 10% of abdominal operations.

289
Q

What is the typical approach for unilateral inguinal hernias repair?

A

Open approach.

290
Q

What is the Stanford classification used for?

A

Classifying aortic dissections.

291
Q

What is the DeBakey classification used for?

A

Classifying aortic dissections.

292
Q

What is the management approach for patients with infected necrosis?

A

Patients should undergo either radiological drainage or surgical necrosectomy depending on local expertise.

293
Q

What are the two types in the Stanford classification of aortic dissection?

A
  • Type A - ascending aorta, 2/3 of cases
  • Type B - descending aorta, distal to left subclavian origin, 1/3 of cases
294
Q

What are the three types in the DeBakey classification of aortic dissection?

A
  • Type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
  • Type II - originates in and is confined to the ascending aorta
  • Type III - originates in descending aorta, rarely extends proximally but will extend distally
295
Q

What is the investigation of choice for aortic dissection in stable patients?

A

CT angiography of the chest, abdomen, and pelvis.

296
Q

What is the recommended systolic blood pressure target for patients with Type A aortic dissection awaiting intervention?

A

100-120 mmHg.

297
Q

What are the common complications of a backward tear in aortic dissection?

A
  • Aortic incompetence/regurgitation
  • Myocardial infarction (inferior pattern due to right coronary involvement)
298
Q

What are the common features of aortic dissection?

A
  • Severe ‘sharp’ chest/back pain
  • Weak or absent pulses
  • Variation in systolic blood pressure between arms
  • Aortic regurgitation
  • Hypertension
299
Q

What typically causes acute mesenteric ischaemia?

A

Embolism resulting in occlusion of an artery supplying the small bowel, often the superior mesenteric artery.

300
Q

What is the management for acute mesenteric ischaemia?

A

Immediate laparotomy is usually required, especially if signs of advanced ischemia are present.

301
Q

What is chronic mesenteric ischaemia often described as?

A

‘Intestinal angina’ due to colicky, intermittent abdominal pain.

302
Q

What is ischaemic colitis?

A

An acute but transient compromise in blood flow to the large bowel, leading to inflammation, ulceration, and haemorrhage.

303
Q

What is a common investigation finding in ischaemic colitis?

A

‘Thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage.

304
Q

What is aortic regurgitation (AR)?

A

The leaking of the aortic valve that causes blood to flow in the reverse direction during ventricular diastole.

305
Q

What are the causes of aortic regurgitation due to valve disease?

A
  • Rheumatic fever
  • Calcific valve disease
  • Connective tissue diseases
  • Bicuspid aortic valve
  • Spondylarthropathies
  • Hypertension
  • Syphilis
  • Marfan’s, Ehler-Danlos syndrome
306
Q

What are the features of aortic regurgitation?

A
  • Early diastolic murmur
  • Collapsing pulse
  • Wide pulse pressure
  • Quincke’s sign
  • De Musset’s sign
307
Q

What is the management strategy for symptomatic patients with severe aortic regurgitation?

A

Surgical management, including aortic valve replacement.

308
Q

What are the common causes of aortic stenosis?

A
  • Degenerative calcification
  • Bicuspid aortic valve
  • William’s syndrome
  • Post-rheumatic disease
  • Subvalvular (HOCM)
309
Q

What is the typical management for symptomatic aortic stenosis?

A

Valve replacement.

310
Q

What are the two main options for valve replacement?

A
  • Biological (bioprosthetic) valves
  • Mechanical valves
311
Q

What is a key disadvantage of biological valves?

A

Structural deterioration and calcification over time.

312
Q

What is a major disadvantage of mechanical valves?

A

Increased risk of thrombosis requiring long-term anticoagulation.

313
Q

What is Tamoxifen used for?

A

Management of oestrogen receptor-positive breast cancer.

314
Q

What are the adverse effects of aromatase inhibitors?

A
  • Osteoporosis
  • Hot flushes
  • Arthralgia
  • Myalgia
  • Insomnia
315
Q

What is the Nottingham Prognostic Index used for?

A

To give an indication of survival in breast cancer patients.

316
Q

What is the calculation for the Nottingham Prognostic Index?

A

Tumour Size x 0.2 + Lymph node score + Grade score.

317
Q

What percentage of 5-year survival is associated with a Nottingham Prognostic Index score of 2.0 to 2.4?

A

93%.

318
Q

What is the typical surgical management for a multifocal tumour in breast cancer?

A

Mastectomy.

319
Q

What is the main surgical option for a solitary lesion in breast cancer?

A

Wide local excision.

320
Q

What is the grading system for lymph node involvement in breast cancer?

A

Score 1: 0 lymph nodes involved
Score 2: 1-3 lymph nodes involved
Score 3: >3 lymph nodes involved

321
Q

What is the 5-year survival percentage for a score of 2.5 to 3.4?

A

85%

322
Q

What factors impact the prognosis of breast cancer aside from lymph node involvement?

A
  • Vascular invasion
  • Receptor status
323
Q

What are the key management options for breast cancer?

A
  • Surgery
  • Radiotherapy
  • Hormone therapy
  • Biological therapy
  • Chemotherapy
324
Q

What is the recommended management for women with no palpable axillary lymphadenopathy?

A

Pre-operative axillary ultrasound followed by sentinel node biopsy if negative

325
Q

What are the indications for axillary node clearance during primary surgery?

A

Clinically palpable lymphadenopathy

326
Q

What type of surgery is typically performed for multifocal tumors?

A

Mastectomy

327
Q

What is the purpose of whole breast radiotherapy after wide-local excision?

A

To reduce the risk of recurrence by around two-thirds

328
Q

What type of hormonal therapy is used in post-menopausal women with ER +ve breast cancer?

A

Aromatase inhibitors such as anastrozole

329
Q

What are the important side effects of tamoxifen?

A
  • Increased risk of endometrial cancer
  • Venous thromboembolism
  • Menopausal symptoms
330
Q

What is the most common type of biological therapy used for breast cancer?

A

Trastuzumab (Herceptin)

331
Q

True or False: Trastuzumab can be used in patients with a history of heart disorders.

A

False

332
Q

What is neoadjuvant chemotherapy?

A

Cytotoxic therapy used prior to surgery to downstage a primary lesion

333
Q

What age group should be referred for suspected breast cancer with unexplained breast lumps?

A

Aged 30 and over

334
Q

What are some predisposing factors for breast cancer?

A
  • BRCA1, BRCA2 genes
  • 1st degree relative with premenopausal breast cancer
  • Nulliparity
  • Early menarche, late menopause
  • Obesity
335
Q

What is the age range for women to be offered the NHS Breast Screening Programme?

A

50-70 years

336
Q

What familial history factors warrant a referral for familial breast cancer assessment?

A
  • Age of diagnosis < 40 years
  • Bilateral breast cancer
  • Male breast cancer
  • Ovarian cancer
337
Q

What are the common types of breast cancer?

A
  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma-in-situ (DCIS)
  • Lobular carcinoma-in-situ (LCIS)
338
Q

What is Paget’s disease of the nipple associated with?

A

An underlying breast malignancy

339
Q

What characterizes inflammatory breast cancer?

A

Cancerous cells block lymph drainage resulting in an inflamed appearance of the breast

340
Q

What are the three types of colon cancer?

A

Sporadic, Hereditary non-polyposis colorectal carcinoma (HNPCC), Familial adenomatous polyposis (FAP)

Sporadic accounts for 95%, HNPCC for 5%, and FAP for less than 1%.

341
Q

What is the most common genetic mutation found in sporadic colon cancer?

A

Allelic loss of the APC gene

Other mutations include activation of K-ras oncogene and deletion of p53 and DCC tumor suppressor genes.

342
Q

What is HNPCC also known as?

A

Lynch syndrome

It is an autosomal dominant condition.

343
Q

What percentage of HNPCC patients typically develop cancer?

A

70-80%

Cancers are often poorly differentiated and highly aggressive.

344
Q

Which genes are most commonly involved in HNPCC?

A
  • MSH2 (60% of cases)
  • MLH1 (30%)
345
Q

What are the Amsterdam criteria for diagnosing HNPCC?

A
  • At least 3 family members with colon cancer
  • Cases span at least two generations
  • At least one case diagnosed before age 50
346
Q

What is Familial adenomatous polyposis (FAP)?

A

A rare autosomal dominant condition leading to hundreds of polyps

Patients inevitably develop carcinoma, usually related to a mutation in the APC gene.

347
Q

What surgical procedure do FAP patients generally undergo?

A

Total proctocolectomy with ileal pouch anal anastomosis (IPAA)

This typically occurs in their twenties.

348
Q

What is the third most common type of cancer in the UK?

A

Colorectal cancer

It is the second most common cause of cancer deaths.

349
Q

List common presenting features of colorectal cancer.

A
  • Change in bowel habits
  • Rectal bleeding
  • Abdominal pain and discomfort
  • Unexplained weight loss
  • Anaemia
  • Bowel obstruction
350
Q

What are the average locations of colorectal cancer?

A
  • Rectal: 40%
  • Sigmoid: 30%
  • Descending colon: 5%
  • Transverse colon: 10%
  • Ascending colon and caecum: 15%
351
Q

What is the recommended first-line test for suspected colorectal cancer?

A

Faecal Immunochemical Test (FIT)

NICE updated their guidelines in 2023 to emphasize FIT testing.

352
Q

When should a FIT test be used according to NICE guidelines?

A
  • With an abdominal mass
  • With a change in bowel habit
  • With iron-deficiency anaemia
  • Aged 40+ with unexplained weight loss and abdominal pain
  • Aged under 50 with rectal bleeding and unexplained symptoms
  • Aged 50+ with unexplained rectal bleeding, abdominal pain, or weight loss
  • Aged 60+ with anaemia without iron deficiency
353
Q

What should be done if a FIT test result is positive?

A

Refer on the suspected cancer pathway

Safety netting is recommended for negative results if there are ongoing concerns.

354
Q

What is the purpose of the NHS screening program?

A

To offer screening every 2 years to adults aged 60 to 74 in England and 50 to 74 in Scotland

Patients over 74 can request screening.

355
Q

What type of test is the FIT test?

A

A type of faecal occult blood (FOB) test detecting human haemoglobin

It quantifies the amount of blood in a stool sample.

356
Q

What is the TNM staging system used for?

A

To stage colorectal cancer, aiding in prognosis and treatment planning

357
Q

What is the primary treatment for colon cancer?

A

Surgery

Resectional surgery is the only option for cure.

358
Q

What are common chemotherapy regimens for colorectal cancer?

A
  • FOLFOX
  • FOLFIRI
359
Q

What is the Hartmann’s procedure?

A

Surgical resection of the sigmoid colon with end colostomy formation

It is done in emergency settings.

360
Q

What percentage of patients will have normal results at colonoscopy?

A

50%

40% will have polyps and 10% will be diagnosed with cancer.

UKMLA Prep (46 decks)

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