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.
2
Q
What factors are associated with fibroids?
A
- More common in Afro-Caribbean women
- Rare before puberty
- Develop in response to oestrogen
3
Q
List common symptoms of fibroids. (7)
A
- Asymptomatic
- Menorrhagia
- Iron-deficiency anaemia
- Lower abdominal pain
- Bloating
- Urinary symptoms
- Subfertility
4
Q
What is the preferred method for diagnosing fibroids?
A
Transvaginal ultrasound
5
Q
What is the management for asymptomatic fibroids?
A
No treatment needed other than periodic review
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
7
Q
What medical treatments can shrink/remove fibroids?
A
- GnRH agonists
- Ulipristal acetate (not currently used due to liver toxicity concerns)
8
Q
List surgical options for fibroid treatment.
A
- Myomectomy
- Hysteroscopic endometrial ablation
- Hysterectomy
- Uterine artery embolization
9
Q
What is the prognosis for fibroids after menopause?
A
Fibroids generally regress after menopause
10
Q
What is testicular torsion?
A
Twist of the spermatic cord resulting in testicular ischaemia and necrosis
11
Q
What age group is most commonly affected by testicular torsion?
A
Males aged between 10 and 30 years
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
13
Q
What is the management for testicular torsion?
A
Urgent surgical exploration
14
Q
What is the most common type of oesophageal cancer?
A
Adenocarcinoma
15
Q
List risk factors for adenocarcinoma of the oesophagus.
A
- GORD
- Barrett’s oesophagus
- Smoking
- Obesity
16
Q
What is the most common presenting symptom of oesophageal cancer?
A
Dysphagia
17
Q
What is the diagnostic method for oesophageal cancer?
A
Upper GI endoscopy with biopsy
18
Q
What is the initial treatment for operable oesophageal cancer?
A
Surgical resection (Ivor-Lewis type oesophagectomy)
19
Q
What is intussusception?
A
Invagination of one portion of the bowel into the lumen of adjacent bowel
20
Q
Which age group is most commonly affected by intussusception?
A
Infants between 6-18 months old
21
Q
List symptoms of intussusception.
A
- Severe crampy abdominal pain
- Inconsolable crying
- Vomiting
- Bloodstained stool (‘red-currant jelly’)
22
Q
What is the first-line investigation for intussusception?
A
Ultrasound
23
Q
What is the management for perforation secondary to peptic ulcer disease?
A
Urgent surgical intervention
24
Q
What is a fibroadenoma?
A
A mobile, firm, smooth breast lump, often referred to as a ‘breast mouse’
25
What is the most common acute abdominal condition requiring surgery?
Acute appendicitis
26
List common symptoms of acute appendicitis. (4)
* Peri-umbilical pain radiating to the right iliac fossa
* Anorexia
* Nausea
* Tenderness in RIF
27
What is the classic sign associated with appendicitis?
Migration of pain from the centre to the right iliac fossa
28
What is the typical management for appendicitis?
Appendicectomy
29
What is the common cause of hyperprolactinaemia?
Pituitary microadenomas
30
What is the most common type of nipple discharge associated with carcinoma?
Blood-stained discharge
31
What is urogenital prolapse?
Descent of one of the pelvic organs resulting in protrusion on the vaginal walls
32
What are the types of urogenital prolapse?
* Cystocele
* Rectocele
* Uterine prolapse
33
What are common symptoms of a ruptured abdominal aortic aneurysm?
* Severe central abdominal pain
* Pulsatile mass
* Shock
34
What is the immediate management for a suspected ruptured AAA?
Immediate vascular review for emergency surgical repair
35
What is the importance of understanding abdominal pain in clinical practice?
It encompasses a diverse range of conditions from benign to life-threatening
36
What is the characteristic pain presentation in gastric ulcers?
Epigastric pain worsened by eating
37
What is a common symptom associated with appendicitis?
Anorexia
38
What sign indicates more pain in the right iliac fossa than the left during appendicitis?
Rovsing's sign
39
What are common causes of acute pancreatitis?
Alcohol or gallstones
40
What is Cullen's sign?
Periumbilical discolouration
41
What is Grey-Turner's sign?
Flank discolouration
42
What are the typical symptoms of biliary colic?
Pain in the RUQ radiating to the back and interscapular region
43
What is Murphy's sign indicative of?
Acute cholecystitis
44
What is the typical pain location in diverticulitis?
Left lower quadrant (LLQ)
45
What is a key feature of abdominal aortic aneurysm (AAA) pain?
Severe central abdominal pain radiating to the back
46
What are common symptoms of intestinal obstruction?
Vomiting, not opened bowels recently, 'tinkling' bowel sounds
47
How is constipation defined?
Defecation that is unsatisfactory due to infrequent stools, difficult passage, or incomplete defecation
48
What is the first-line laxative treatment for constipation?
Bulk-forming laxative, such as ispaghula
49
What is a common complication of constipation?
Overflow diarrhoea
50
What characterizes femoral hernias?
A lump within the groin, mildly painful, non-reducible
51
What is the male-to-female ratio for femoral hernias?
1:3
52
What are common differentials to exclude for femoral hernias? (6)
* Lymphadenopathy
* Abscess
* Femoral artery aneurysm
* Hydrocoele or varicocele in males
* Lipoma
* Inguinal hernia
53
What age group is most commonly affected by intussusception?
Infants between 6-18 months
54
What is a classic sign of intussusception in infants?
Bloodstained stool - 'red-currant jelly'
55
What is the investigation of choice for intussusception?
Ultrasound
56
What is the most common type of pancreatic tumor?
Adenocarcinomas
57
What is Courvoisier's law?
In the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
58
What is the surgical procedure for resectable lesions in pancreatic cancer?
Whipple's resection (pancreaticoduodenectomy)
59
What is a key feature of a ruptured abdominal aortic aneurysm (AAA)?
Pulsatile, expansile mass in the abdomen
60
What are the main causes of ascites with a SAAG > 11 g/L?
* Liver disorders
* Cardiac
* Other causes
61
What is the management for tense ascites?
Therapeutic abdominal paracentesis
62
What is benign cyclical mastalgia?
A common cause of breast pain in younger females
63
How does cyclical mastalgia vary?
Intensity varies according to the phase of the menstrual cycle
64
What is the recommendation for prophylactic treatment in patients with cirrhosis and ascites?
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
## Footnote
This recommendation is made by NICE.
65
What is benign cyclical mastalgia?
A common cause of breast pain in younger females that varies in intensity according to the phase of the menstrual cycle.
66
What are common clinical features of cyclical mastalgia?
* Varies in intensity according to the menstrual cycle
* Not usually associated with point tenderness of the chest wall
67
What should management for cyclical mastalgia include?
* Supportive bra
* Conservative treatments: standard oral and topical analgesia
* Referral after 3 months if pain persists affecting quality of life
68
What hormonal agents may be effective for cyclical mastalgia?
* Bromocriptine
* Danazol
69
What is mastitis?
Inflammation of the breast tissue, typically associated with breastfeeding.
70
What are the features of mastitis?
* Painful, tender, red hot breast
* Fever and general malaise may be present
71
What is the first-line management for mastitis?
* Continue breastfeeding
* Simple measures: analgesia and warm compresses
72
What is the first-line antibiotic for mastitis?
Oral flucloxacillin for 10-14 days
## Footnote
This is due to Staphylococcus aureus being the most common organism causing infective mastitis.
73
What can untreated mastitis develop into?
A breast abscess, which generally requires incision and drainage.
74
What are typical features of a breast lump associated with malignancy?
* Typically painless
* Classically described as fixed and hard
* Breast skin changes
* Bloody nipple discharge
* Inverted nipple
* Axillary mass
75
What is atrophic vaginitis?
Occurs in post-menopausal women, presenting with vaginal dryness, dyspareunia, and occasional spotting.
76
What are the causative organisms of pelvic inflammatory disease (PID)?
* Chlamydia trachomatis
* Neisseria gonorrhoeae
* Mycoplasma genitalium
* Mycoplasma hominis
77
What are common features of PID?
* Lower abdominal pain
* Fever
* Deep dyspareunia
* Dysuria
* Menstrual irregularities
* Vaginal or cervical discharge
* Cervical excitation
78
What is the first-line treatment for PID?
* Stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
79
What are complications of PID?
* Perihepatitis (Fitz-Hugh Curtis Syndrome)
* Infertility (10-20% risk after one episode)
* Chronic pelvic pain
* Ectopic pregnancy
80
What is vaginal candidiasis commonly known as?
Thrush.
81
What are common predisposing factors for vaginal candidiasis?
* Diabetes mellitus
* Antibiotics
* Steroids
* Pregnancy
* Immunosuppression (e.g., HIV)
82
What are the features of vaginal candidiasis?
* 'Cottage cheese', non-offensive discharge
* Vulvitis
* Itch
* Vulval erythema, fissuring, satellite lesions
83
What is the first-line treatment for vaginal candidiasis?
Oral fluconazole 150 mg as a single dose.
84
What defines recurrent vaginal candidiasis?
Four or more episodes per year.
85
What are the features of a femoral hernia?
* Lump within the groin, usually mildly painful
* Non-reducible, although can be reducible in some cases
* Located inferolateral to the pubic tubercle
86
What are common complications of femoral hernias?
* Incarceration
* Strangulation
* Bowel obstruction
* Bowel ischaemia and resection
87
What is the management for femoral hernias?
Surgical repair is necessary, either laparoscopically or via laparotomy.
88
What percentage of abdominal wall hernias are inguinal hernias?
75%.
89
What are the features of inguinal hernias? (4)
* 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
90
What is the recommended treatment for inguinal hernias?
* Mesh repair is associated with the lowest recurrence rate
* Unilateral hernias generally repaired with an open approach
* Bilateral and recurrent hernias generally repaired laparoscopically
91
What are the common causes of acute upper gastrointestinal (GI) bleeding?
* Oesophageal varices
* Peptic ulcer disease
92
What are the presenting features of haematemesis?
* Bright red blood or 'coffee ground' appearance
* May be associated with peptic ulcer disease or oesophageal varices
93
What scoring system helps assess risk in acute upper GI bleeding?
The Glasgow-Blatchford score at first assessment.
94
What is indicated for a pregnancy test in the context of PID?
To exclude an ectopic pregnancy.
95
What is the first-line management for patients with mastitis who are systemically unwell?
Treat with antibiotics and continue breastfeeding.
96
What are the symptoms associated with a duodenal ulcer?
* Haematemesis
* Melena
* Epigastric discomfort
97
What is the typical pain pattern for a duodenal ulcer?
Occurs several hours after eating.
98
What is the Blatchford score for men with haemoglobin levels of 10 - 12 g/L?
3
99
What is the Blatchford score for women with haemoglobin levels less than 10 g/L?
6
100
What is the Blatchford score for systolic blood pressure less than 90 mmHg?
3
101
What should be done for patients with a Blatchford score of 0?
Considered for early discharge
102
What is the first step in resuscitation for a patient with severe bleeding?
ABC, wide-bore intravenous access * 2
103
What is the platelet transfusion threshold for actively bleeding patients?
Platelet count of less than 50 x 10*9/litre
104
What should fresh frozen plasma be administered for?
Fibrinogen level of less than 1 g/litre or prothrombin time greater than 1.5 times normal
105
When should endoscopy be offered for patients with a severe bleed?
Immediately after resuscitation
106
What is the recommended management for patients with non-variceal upper gastrointestinal bleeding?
Proton pump inhibitors should be given if stigmata of recent haemorrhage shown at endoscopy
107
What medications should be given to patients at presentation with variceal bleeding?
Terlipressin and prophylactic antibiotics
108
What is the complication associated with portal hypertension?
Oesophageal varices
109
What is the only licensed vasoactive agent for acute treatment of variceal haemorrhage?
Terlipressin
110
What is the recommended intervention for uncontrolled variceal bleeding?
Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
111
What is the primary prevention strategy for variceal haemorrhage?
Propranolol and endoscopic variceal band ligation (EVL)
112
What is the typical presentation of a femoral hernia?
A lump within the groin, usually mildly painful
113
What is the male to female ratio for femoral hernias?
1:3
114
What is a common complication of femoral hernias?
Strangulation
115
What is the management for a femoral hernia?
Surgical repair
116
What percentage of abdominal wall hernias are inguinal hernias?
75%
117
What is the lifetime risk of developing an inguinal hernia in men?
25%
118
What is the first-line treatment for an acute anal fissure?
Softening stool and dietary advice
119
What is the first-line treatment for a chronic anal fissure?
Topical glyceryl trinitrate (GTN)
120
What is mastitis typically associated with?
Breastfeeding
121
What is the first-line management for mastitis?
Continue breastfeeding
122
What is the most common organism causing infective mastitis?
Staphylococcus aureus
123
Fill in the blank: The first-line antibiotic for mastitis is _______.
oral flucloxacillin
124
What is volvulus?
Torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction
125
What is sigmoid volvulus?
Large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon
126
What percentage of volvulus cases are sigmoid volvulus?
Around 80%
127
What are common associations with sigmoid volvulus?
* Older patients
* Chronic constipation
* Chagas disease
* Neurological conditions (e.g., Parkinson's disease)
* Psychiatric conditions (e.g., schizophrenia)
128
What are common associations with caecal volvulus? (3)
* Adhesions
* Pregnancy
* All ages
129
What are common features of volvulus? (4)
* Constipation
* Abdominal bloating
* Abdominal pain
* Nausea/vomiting
130
How is sigmoid volvulus diagnosed?
Usually diagnosed on abdominal film showing large bowel obstruction and coffee bean sign
131
What is the management for sigmoid volvulus?
Rigid sigmoidoscopy with rectal tube insertion
132
What is the management for caecal volvulus?
Operative management, often requiring right hemicolectomy
133
What are varicose veins?
Dilated, tortuous, superficial veins due to incompetent venous valves
134
What are common risk factors for varicose veins? (4)
* Increasing age
* Female gender
* Pregnancy
* Obesity
135
What symptoms may patients with varicose veins experience?
* Aching
* Throbbing
* Itching
136
What are possible complications of varicose veins? (8)
* Varicose eczema
* Haemosiderin deposition
* Lipodermatosclerosis
* Atrophie blanche
* Bleeding
* Superficial thrombophlebitis
* Venous ulceration
* Deep vein thrombosis
137
What is the investigation of choice for varicose veins?
Venous duplex ultrasound
138
What conservative treatments are recommended for varicose veins?
* Leg elevation
* Weight loss
* Regular exercise
* Graduated compression stockings
139
What is a ruptured abdominal aortic aneurysm (AAA)?
A catastrophic or sub-acute presentation characterized by severe abdominal pain and shock
140
What is the mortality rate of a ruptured AAA?
Almost 80%
141
What are the features of a ruptured AAA?
* Severe central abdominal pain radiating to the back
* Pulsatile, expansile mass in the abdomen
* Shock (hypotension, tachycardia) or collapse
142
What is the management for a ruptured AAA?
Immediate vascular review with a view to emergency surgical repair
143
What is peripheral arterial disease (PAD) strongly linked to?
Smoking
144
What is the recommended first-line medication for patients with PAD?
Clopidogrel
145
What are the treatment options for severe PAD?
* Endovascular revascularization
* Surgical revascularization
* Amputation (reserved for critical limb ischaemia)
146
What is a perianal abscess?
A collection of pus within the subcutaneous tissue of the anus
147
What is the average age of patients with perianal abscesses?
Around 40 years
148
What are common causes of perianal abscesses?
Generally colonized by gut flora such as E. coli
149
What is the first-line treatment for perianal abscesses?
Surgical incision and drainage
150
What is pelvic inflammatory disease (PID)?
Infection and inflammation of the female pelvic organs
151
What is the most common causative organism of PID?
Chlamydia trachomatis
152
What are common features of PID?
* Lower abdominal pain
* Fever
* Deep dyspareunia
* Dysuria
* Vaginal discharge
153
What is the first-line treatment for PID?
Stat IM ceftriaxone + 14 days of oral doxycycline + oral metronidazole
154
What is a significant complication of PID?
Infertility, with a risk as high as 10-20% after a single episode
155
What is pancreatic cancer most commonly associated with?
* Increasing age
* Smoking
* Diabetes
* Chronic pancreatitis
156
What are common features of pancreatic cancer?
* Painless jaundice
* Pale stools
* Dark urine
* Pruritus
* Weight loss
157
What is the investigation of choice for suspected pancreatic cancer?
High-resolution CT scanning
158
What is the management for resectable pancreatic cancer?
Whipple's resection (pancreaticoduodenectomy)
159
What is the peak age of incidence for ovarian cancer?
60 years
160
What is the most common type of ovarian cancer?
Epithelial cancers, predominantly serous carcinomas
161
What is a key risk factor for ovarian cancer?
Family history of BRCA1 or BRCA2 mutations
162
What is the initial investigation for suspected ovarian cancer?
CA125 test
163
What is the management for ovarian cancer?
Combination of surgery and platinum-based chemotherapy
164
What are common causes of acute upper gastrointestinal bleeding?
* Oesophageal varices
* Peptic ulcer disease
165
What is haematemesis?
The vomiting of blood, often bright red or described as 'coffee ground'
166
What laboratory finding may be seen in acute upper GI bleeding?
Raised urea due to the protein meal of the blood
167
What is a common cause of raised urea in the blood?
'Protein meal' of the blood
## Footnote
Raised urea levels can be indicative of various conditions, but in this context, it refers to the intake of protein-rich meals.
168
What are the presenting features of oesophageal varices?
Usually a large volume of fresh blood, may cause melena, often associated with haemodynamic compromise
## Footnote
Swallowed blood may lead to melena and re-bleeds are common until managed.
169
What are the symptoms associated with peptic ulcer disease?
Abdominal pain
## Footnote
Abdominal pain is a common symptom indicating potential issues in the upper gastrointestinal tract.
170
What is the Glasgow-Blatchford score used for?
Helps clinicians decide whether patients can be managed as outpatients
## Footnote
It is an initial risk assessment tool for patients with upper gastrointestinal bleeding.
171
Which score is used after endoscopy to assess risk of rebleeding?
The Rockall score
## Footnote
It provides a percentage risk of rebleeding and mortality based on several clinical factors.
172
What is the significance of a Blatchford score of 0?
Patients may be considered for early discharge
## Footnote
A score of 0 indicates a lower risk of serious complications.
173
What are the management steps for acute upper gastrointestinal bleeding?
* Resuscitation
* Risk assessment
* Endoscopy
## Footnote
Management often involves multiple steps to stabilize the patient and identify the source of bleeding.
174
What should be administered if a patient is actively bleeding with a platelet count of less than 50 x 10^9/litre?
Platelet transfusion
## Footnote
This is crucial for patients experiencing significant bleeding to help with clotting.
175
What is the first-line vasoactive agent recommended for variceal hemorrhage?
Terlipressin
## Footnote
Terlipressin is shown to be beneficial in initial haemostasis and preventing rebleeding.
176
What is the most common type of bladder cancer?
Urothelial (transitional cell) carcinoma (>90% of cases)
## Footnote
This type of carcinoma is prevalent and can arise in various locations along the urinary tract.
177
What is the TNM classification for bladder cancer T0?
No evidence of tumour
## Footnote
This stage indicates the absence of any detectable tumor.
178
What percentage of patients with T1 bladder cancer have a good prognosis?
90%
## Footnote
T1 indicates non-invasive or superficial disease, which generally has a favorable outcome.
179
What is one common cause of persistent non-visible haematuria?
Cancer (bladder, renal, prostate)
## Footnote
Persistent non-visible haematuria can indicate underlying malignancies and should be investigated.
180
What is the test of choice for detecting haematuria?
Urine dipstick
## Footnote
It is a simple and effective method to screen for blood in the urine.
181
What are the causes of transient or spurious non-visible haematuria?
* Urinary tract infection
* Menstruation
* Vigorous exercise
* Sexual intercourse
## Footnote
These conditions can cause temporary changes in urine appearance without true blood presence.
182
What is the recommended management for patients aged 45 years or older with unexplained visible haematuria?
Urgent referral within 2 weeks
## Footnote
This guideline is crucial for early detection of possible malignancies.
183
What does the term 'field change' refer to in urothelial carcinoma?
Effect of multifocal lesions due to environmental factors
## Footnote
This phenomenon explains why urothelial carcinomas often present as multiple lesions.
184
What is a common complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
Exacerbation of hepatic encephalopathy
## Footnote
This is a significant risk due to changes in blood flow and ammonia metabolism.
185
What are anticoagulants used for?
Preventing blood clot formation
## Footnote
Anticoagulants are medications that help reduce the risk of blood clots in various medical conditions.
186
What is the commonest cause of glomerulonephritis worldwide?
IgA nephropathy (Berger's disease)
## Footnote
IgA nephropathy typically presents with macroscopic haematuria following an upper respiratory tract infection.
187
What are the key presentations of IgA nephropathy?
* Recurrent episodes of macroscopic haematuria
* Typically associated with recent respiratory tract infection
* Nephrotic range proteinuria is rare
* Renal failure is unusual
## Footnote
These symptoms are particularly observed in young males.
188
What associated conditions are linked with IgA nephropathy? (3)
* Alcoholic cirrhosis
* Coeliac disease/dermatitis herpetiformis
* Henoch-Schonlein purpura
## Footnote
These conditions can be associated with IgA nephropathy due to overlapping pathophysiological mechanisms.
189
How does post-streptococcal glomerulonephritis differ from IgA nephropathy?
* Post-streptococcal is associated with low complement levels
* Main symptom is proteinuria
* Interval between URTI and renal problems
## Footnote
IgA nephropathy typically presents without a significant interval between infection and symptoms.
190
What is the initial treatment for persistent proteinuria in IgA nephropathy?
ACE inhibitors
## Footnote
If there is active disease or failure to respond, immunosuppression with corticosteroids may be necessary.
191
What is the prognosis for patients with IgA nephropathy?
* 25% develop ESRF
* Good prognosis: frank haematuria
* Poor prognosis: male gender, proteinuria > 2 g/day, hypertension, smoking, hyperlipidaemia, ACE genotype DD
## Footnote
ESRF stands for End-Stage Renal Failure.
192
What is renal cell cancer also known as?
Hypernephroma
## Footnote
It accounts for 85% of primary renal neoplasms and arises from proximal renal tubular epithelium.
193
What is the classical triad of symptoms for renal cell cancer?
* Haematuria
* Loin pain
* Abdominal mass
## Footnote
Other symptoms may include pyrexia of unknown origin and endocrine effects.
194
What are the types of stomas? (11)
* Ileostomy
* Colostomy
* Gastrostomy
* Loop jejunostomy
* Percutaneous jejunostomy
* Loop ileostomy
* End ileostomy
* End colostomy
* Loop colostomy
* Caecostomy
* Mucous fistula
## Footnote
Each type serves different medical purposes and is situated based on clinical need.
195
What is the usual location for an ileostomy?
Right iliac fossa
## Footnote
Ileostomies typically have a spouted appearance due to the liquid output.
196
What are the key components of elective patient preparation for surgery?
* Pre-admission clinic
* Blood tests
* Urine analysis
* Pregnancy test
* Sickle cell test
* ECG/ Chest x-ray
## Footnote
These components help assess patient fitness and risks prior to surgery.
197
Fill in the blank: Patients having surgery may drink clear fluids until ______ hours before their operation.
2
## Footnote
Clear fluids can help reduce headaches, nausea, and vomiting after surgery.
198
What are potential complications of poorly managed diabetes during surgery?
* Undetected hypoglycaemia
* Increased risk of wound & respiratory infections
* Increased risk of post-operative acute kidney injury
* Increased length of hospital stay
## Footnote
Diabetes management is critical during surgical procedures.
199
What should be done the day prior to surgery for diabetic patients?
Follow specific medication guidelines
## Footnote
Guidelines vary based on the type of medication and the timing of the surgery.
200
What is the purpose of the World Health Organisation checklist before operations?
To ensure safety and reduce complications
## Footnote
The checklist includes various safety measures to be followed prior to surgical procedures.
201
What anatomical principles are important to avoid complications during surgery?
* Understanding local anatomy
* Anticipating nerve injuries
* Recognizing potential visceral injuries
## Footnote
Knowledge of anatomy helps predict and manage surgical complications effectively.
202
What are common physiological derangements following surgery?
* Bleeding
* Infection
* Arrhythmias
* Electrolyte disturbances
## Footnote
These issues may arise due to surgical stress and patient factors.
203
What is hypokalaemia in cardiac patients?
K+ <4.0
## Footnote
Hypokalaemia can lead to various cardiac complications.
204
What is a common electrolyte disturbance following cranial surgery?
SIADH causing hyponatraemia
## Footnote
SIADH stands for Syndrome of Inappropriate Antidiuretic Hormone secretion.
205
What can cause ileus following gastrointestinal surgery?
Fluid sequestration and loss of electrolytes
206
What is a consequence of pulmonary oedema following pneumonectomy?
Increased sensitivity to fluid overload
207
What is an anastamotic leak associated with?
Generalised sepsis causing mediastinitis or peritonitis
208
What may follow any type of surgery and compromise grafts?
Myocardial infarct
209
What baseline investigations are often helpful in acutely unwell surgical patients?
* 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
What imaging is used for identifying intra-abdominal abscesses?
CT scanning
211
What is the guiding principle for managing complications in surgical patients?
Safe and timely intervention
212
What should be avoided in patients with recent surgery during management?
Thrombolysis
213
What is the first-line treatment for an acute anal fissure?
* Softening stool
* High-fibre diet
* Bulk-forming laxatives
* Lubricants
* Topical anaesthetics
* Analgesia
214
What defines an anal fissure as chronic?
Present for more than 6 weeks
215
What is intussusception?
Invagination of one portion of the bowel into the lumen of the adjacent bowel
216
What is a late sign of intussusception in infants?
Bloodstained stool - 'red-currant jelly'
217
What is the investigation of choice for intussusception?
Ultrasound
218
What is the typical appearance of rectal bleeding from a fissure in ano?
Bright red rectal bleeding
219
What should all patients presenting with rectal bleeding undergo?
Digital rectal examination and procto-sigmoidoscopy
220
What imaging is necessary for staging rectal cancer?
* MRI of the rectum
* CT scanning of chest, abdomen, and pelvis
221
What is the first-line treatment for chronic anal fissure?
Topical glyceryl trinitrate (GTN)
222
What are the common causes of splenic trauma?
* Blunt trauma
* Penetrating trauma
223
What is the management for small subcapsular haematoma of the spleen?
Conservative management
224
What is Beck's triad associated with?
Cardiac tamponade
225
What is the most common cause of tension pneumothorax?
Mechanical ventilation in a patient with pleural injury
226
What should be avoided in managing external haemorrhage?
Tourniquets
227
What is the cornerstone of trauma management?
ATLS principles
228
What type of injury is most commonly associated with blunt cardiac injury?
Chest wall injury
229
What should be performed for traumatic aortic disruption?
CT angiogram
230
What is a common cause of death after road traffic accidents or falls?
Traumatic aortic disruption
231
What is the typical management for simple pneumothorax?
Insert chest drain
232
What is a common injury associated with stab wounds?
Liver injury
233
What does blood at the urethral meatus suggest?
Urethral tear
234
What is the most commonly injured organ in blunt abdominal trauma requiring laparotomy?
Spleen
## Footnote
Injuries occur in approximately 40% of blunt trauma cases.
235
In stab wounds, which organ is most commonly injured?
Liver
## Footnote
This occurs in about 40% of cases.
236
What is the most commonly injured organ in gunshot wounds to the abdomen?
Small bowel
## Footnote
This injury occurs in approximately 50% of cases.
237
What does a high riding prostate on PR indicate?
Urethral disruption
238
When should mechanical testing for pelvic stability be performed?
Once
239
What is the indication for Diagnostic Peritoneal Lavage?
Document bleeding if hypotensive
240
What is the advantage of an abdominal CT scan in trauma investigations?
Most specific for localising injury; 92 to 98% accurate
241
What is a disadvantage of using ultrasound (USS) in trauma investigations?
Operator dependent and may miss retroperitoneal injury
242
What percentage of couples will conceive within 1 year of regular intercourse?
84%
243
What are the male factor infertility causes?
30%
244
What test is performed to check ovulation in women?
Serum progesterone 7 days prior to expected next period
245
What serum progesterone level indicates ovulation?
> 30 nmol/l
246
What is the normal semen volume?
> 1.5 ml
247
What pH is considered normal for semen analysis?
> 7.2
248
What percentage of normal forms is required for sperm morphology?
> 4%
249
What is the prevalence of fibroids in women?
Around 20% of white and around 50% of black women
250
What is a common symptom associated with fibroids?
Menorrhagia
251
What is the typical diagnosis method for fibroids?
Transvaginal ultrasound
252
What is the management for asymptomatic fibroids?
Periodic review to monitor size and growth
253
What is a treatment option for menorrhagia secondary to fibroids?
Levonorgestrel intrauterine system (LNG-IUS)
254
What are GnRH agonists used for in the context of fibroids?
Reduce the size of the fibroid
255
What surgical options are available for treating fibroids?
* Myomectomy
* Hysteroscopic endometrial ablation
* Hysterectomy
* Uterine artery embolization
256
What happens to fibroids after menopause?
They generally regress
257
What is a rare complication of fibroids during pregnancy?
Red degeneration - haemorrhage into tumour
258
What is the classical surgical definition of a hernia?
The protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
259
List four risk factors for abdominal wall hernias.
* Obesity
* Ascites
* Increasing age
* Surgical wounds
260
What are the common features of abdominal wall hernias?
* Palpable lump
* Cough impulse
* Pain
* Obstruction
* Strangulation
261
Which type of hernia accounts for 75% of abdominal wall hernias?
Inguinal hernia
262
What is the typical demographic for inguinal hernias?
Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia.
263
Describe the location of a femoral hernia.
Below and lateral to the pubic tubercle.
264
True or False: Strangulation is rare in inguinal hernias.
True
265
What characterizes an umbilical hernia?
Symmetrical bulge under the umbilicus.
266
Define a paraumbilical hernia.
Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus.
267
What is an epigastric hernia?
Lump in the midline between umbilicus and the xiphisternum.
268
What is a richter hernia?
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect.
269
What is the common presentation of an obturator hernia?
Typically presents with bowel obstruction.
270
What is the common risk factor for femoral hernias?
More common in women, particularly multiparous ones.
271
Fill in the blank: Femoral hernias are more common in _______ than in nulliparous women.
multiparous women
272
What are common complications of hernias?
* Incarceration
* Strangulation
* Bowel obstruction
* Bowel ischemia
273
What is the management for femoral hernias?
Surgical repair is a necessity.
274
What imaging is usually used for diagnosis of hernias?
Diagnosis is usually clinical, although ultrasound is an option.
275
What is the most common cause of acute pancreatitis?
Gallstones and alcohol.
276
What is the mnemonic used to remember causes of pancreatitis?
GET SMASHED
277
List two local complications associated with acute pancreatitis.
* Pseudocysts
* Pancreatic abscess
278
What is the Ranson score used for?
Identifying cases of severe pancreatitis which may require intensive care management.
279
Fill in the blank: Severe acute pancreatitis is classified as having _______ organ failure.
persistent
280
What is the recommended management for patients with gallstone-related acute pancreatitis?
Early cholecystectomy.
281
What are the symptoms of strangulated hernias?
* Pain
* Fever
* Increase in the size of a hernia
* Erythema of the overlying skin
* Bowel obstruction
282
What is the typical treatment for infected pancreatic necrosis?
Either radiological drainage or surgical necrosectomy.
283
True or False: Patients with acute pancreatitis should be made 'nil-by-mouth'.
False
284
What are common early complications after hernia repair?
* Bruising
* Wound infection
285
What is the significance of the Glasgow score in pancreatitis?
It is used to assess the severity of pancreatitis.
286
What is Cullen's sign?
Periumbilical discolouration associated with pancreatitis but rare.
287
What is the typical demographic for congenital inguinal hernias?
More common in premature babies and boys.
288
What is the most common risk factor for incisional hernias?
May occur in up to 10% of abdominal operations.
289
What is the typical approach for unilateral inguinal hernias repair?
Open approach.
290
What is the Stanford classification used for?
Classifying aortic dissections.
291
What is the DeBakey classification used for?
Classifying aortic dissections.
292
What is the management approach for patients with infected necrosis?
Patients should undergo either radiological drainage or surgical necrosectomy depending on local expertise.
293
What are the two types in the Stanford classification of aortic dissection?
* Type A - ascending aorta, 2/3 of cases
* Type B - descending aorta, distal to left subclavian origin, 1/3 of cases
294
What are the three types in the DeBakey classification of aortic dissection?
* 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
What is the investigation of choice for aortic dissection in stable patients?
CT angiography of the chest, abdomen, and pelvis.
296
What is the recommended systolic blood pressure target for patients with Type A aortic dissection awaiting intervention?
100-120 mmHg.
297
What are the common complications of a backward tear in aortic dissection?
* Aortic incompetence/regurgitation
* Myocardial infarction (inferior pattern due to right coronary involvement)
298
What are the common features of aortic dissection?
* Severe 'sharp' chest/back pain
* Weak or absent pulses
* Variation in systolic blood pressure between arms
* Aortic regurgitation
* Hypertension
299
What typically causes acute mesenteric ischaemia?
Embolism resulting in occlusion of an artery supplying the small bowel, often the superior mesenteric artery.
300
What is the management for acute mesenteric ischaemia?
Immediate laparotomy is usually required, especially if signs of advanced ischemia are present.
301
What is chronic mesenteric ischaemia often described as?
'Intestinal angina' due to colicky, intermittent abdominal pain.
302
What is ischaemic colitis?
An acute but transient compromise in blood flow to the large bowel, leading to inflammation, ulceration, and haemorrhage.
303
What is a common investigation finding in ischaemic colitis?
'Thumbprinting' may be seen on abdominal x-ray due to mucosal oedema/haemorrhage.
304
What is aortic regurgitation (AR)?
The leaking of the aortic valve that causes blood to flow in the reverse direction during ventricular diastole.
305
What are the causes of aortic regurgitation due to valve disease?
* Rheumatic fever
* Calcific valve disease
* Connective tissue diseases
* Bicuspid aortic valve
* Spondylarthropathies
* Hypertension
* Syphilis
* Marfan's, Ehler-Danlos syndrome
306
What are the features of aortic regurgitation?
* Early diastolic murmur
* Collapsing pulse
* Wide pulse pressure
* Quincke's sign
* De Musset's sign
307
What is the management strategy for symptomatic patients with severe aortic regurgitation?
Surgical management, including aortic valve replacement.
308
What are the common causes of aortic stenosis?
* Degenerative calcification
* Bicuspid aortic valve
* William's syndrome
* Post-rheumatic disease
* Subvalvular (HOCM)
309
What is the typical management for symptomatic aortic stenosis?
Valve replacement.
310
What are the two main options for valve replacement?
* Biological (bioprosthetic) valves
* Mechanical valves
311
What is a key disadvantage of biological valves?
Structural deterioration and calcification over time.
312
What is a major disadvantage of mechanical valves?
Increased risk of thrombosis requiring long-term anticoagulation.
313
What is Tamoxifen used for?
Management of oestrogen receptor-positive breast cancer.
314
What are the adverse effects of aromatase inhibitors?
* Osteoporosis
* Hot flushes
* Arthralgia
* Myalgia
* Insomnia
315
What is the Nottingham Prognostic Index used for?
To give an indication of survival in breast cancer patients.
316
What is the calculation for the Nottingham Prognostic Index?
Tumour Size x 0.2 + Lymph node score + Grade score.
317
What percentage of 5-year survival is associated with a Nottingham Prognostic Index score of 2.0 to 2.4?
93%.
318
What is the typical surgical management for a multifocal tumour in breast cancer?
Mastectomy.
319
What is the main surgical option for a solitary lesion in breast cancer?
Wide local excision.
320
What is the grading system for lymph node involvement in breast cancer?
Score 1: 0 lymph nodes involved
Score 2: 1-3 lymph nodes involved
Score 3: >3 lymph nodes involved
321
What is the 5-year survival percentage for a score of 2.5 to 3.4?
85%
322
What factors impact the prognosis of breast cancer aside from lymph node involvement?
* Vascular invasion
* Receptor status
323
What are the key management options for breast cancer?
* Surgery
* Radiotherapy
* Hormone therapy
* Biological therapy
* Chemotherapy
324
What is the recommended management for women with no palpable axillary lymphadenopathy?
Pre-operative axillary ultrasound followed by sentinel node biopsy if negative
325
What are the indications for axillary node clearance during primary surgery?
Clinically palpable lymphadenopathy
326
What type of surgery is typically performed for multifocal tumors?
Mastectomy
327
What is the purpose of whole breast radiotherapy after wide-local excision?
To reduce the risk of recurrence by around two-thirds
328
What type of hormonal therapy is used in post-menopausal women with ER +ve breast cancer?
Aromatase inhibitors such as anastrozole
329
What are the important side effects of tamoxifen?
* Increased risk of endometrial cancer
* Venous thromboembolism
* Menopausal symptoms
330
What is the most common type of biological therapy used for breast cancer?
Trastuzumab (Herceptin)
331
True or False: Trastuzumab can be used in patients with a history of heart disorders.
False
332
What is neoadjuvant chemotherapy?
Cytotoxic therapy used prior to surgery to downstage a primary lesion
333
What age group should be referred for suspected breast cancer with unexplained breast lumps?
Aged 30 and over
334
What are some predisposing factors for breast cancer?
* BRCA1, BRCA2 genes
* 1st degree relative with premenopausal breast cancer
* Nulliparity
* Early menarche, late menopause
* Obesity
335
What is the age range for women to be offered the NHS Breast Screening Programme?
50-70 years
336
What familial history factors warrant a referral for familial breast cancer assessment?
* Age of diagnosis < 40 years
* Bilateral breast cancer
* Male breast cancer
* Ovarian cancer
337
What are the common types of breast cancer?
* Invasive ductal carcinoma
* Invasive lobular carcinoma
* Ductal carcinoma-in-situ (DCIS)
* Lobular carcinoma-in-situ (LCIS)
338
What is Paget's disease of the nipple associated with?
An underlying breast malignancy
339
What characterizes inflammatory breast cancer?
Cancerous cells block lymph drainage resulting in an inflamed appearance of the breast
340
What are the three types of colon cancer?
Sporadic, Hereditary non-polyposis colorectal carcinoma (HNPCC), Familial adenomatous polyposis (FAP)
## Footnote
Sporadic accounts for 95%, HNPCC for 5%, and FAP for less than 1%.
341
What is the most common genetic mutation found in sporadic colon cancer?
Allelic loss of the APC gene
## Footnote
Other mutations include activation of K-ras oncogene and deletion of p53 and DCC tumor suppressor genes.
342
What is HNPCC also known as?
Lynch syndrome
## Footnote
It is an autosomal dominant condition.
343
What percentage of HNPCC patients typically develop cancer?
70-80%
## Footnote
Cancers are often poorly differentiated and highly aggressive.
344
Which genes are most commonly involved in HNPCC?
* MSH2 (60% of cases)
* MLH1 (30%)
345
What are the Amsterdam criteria for diagnosing HNPCC?
* At least 3 family members with colon cancer
* Cases span at least two generations
* At least one case diagnosed before age 50
346
What is Familial adenomatous polyposis (FAP)?
A rare autosomal dominant condition leading to hundreds of polyps
## Footnote
Patients inevitably develop carcinoma, usually related to a mutation in the APC gene.
347
What surgical procedure do FAP patients generally undergo?
Total proctocolectomy with ileal pouch anal anastomosis (IPAA)
## Footnote
This typically occurs in their twenties.
348
What is the third most common type of cancer in the UK?
Colorectal cancer
## Footnote
It is the second most common cause of cancer deaths.
349
List common presenting features of colorectal cancer.
* Change in bowel habits
* Rectal bleeding
* Abdominal pain and discomfort
* Unexplained weight loss
* Anaemia
* Bowel obstruction
350
What are the average locations of colorectal cancer?
* Rectal: 40%
* Sigmoid: 30%
* Descending colon: 5%
* Transverse colon: 10%
* Ascending colon and caecum: 15%
351
What is the recommended first-line test for suspected colorectal cancer?
Faecal Immunochemical Test (FIT)
## Footnote
NICE updated their guidelines in 2023 to emphasize FIT testing.
352
When should a FIT test be used according to NICE guidelines?
* 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
What should be done if a FIT test result is positive?
Refer on the suspected cancer pathway
## Footnote
Safety netting is recommended for negative results if there are ongoing concerns.
354
What is the purpose of the NHS screening program?
To offer screening every 2 years to adults aged 60 to 74 in England and 50 to 74 in Scotland
## Footnote
Patients over 74 can request screening.
355
What type of test is the FIT test?
A type of faecal occult blood (FOB) test detecting human haemoglobin
## Footnote
It quantifies the amount of blood in a stool sample.
356
What is the TNM staging system used for?
To stage colorectal cancer, aiding in prognosis and treatment planning
357
What is the primary treatment for colon cancer?
Surgery
## Footnote
Resectional surgery is the only option for cure.
358
What are common chemotherapy regimens for colorectal cancer?
* FOLFOX
* FOLFIRI
359
What is the Hartmann's procedure?
Surgical resection of the sigmoid colon with end colostomy formation
## Footnote
It is done in emergency settings.
360
What percentage of patients will have normal results at colonoscopy?
50%
## Footnote
40% will have polyps and 10% will be diagnosed with cancer.
