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MSRA > Surgery > Flashcards

Surgery Flashcards

1
Q

AAA screening and Mx

A

<3 - nil further action
3 - 4.4 - rescan every 12 mo
4.5 - 5.4 - rescan 3 mo
> 5.5 - refer withing 2w to vasc surgery

Also refer if enlarging >1cm/yr

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2
Q

Stoma type used to defunction the colon (eg after rectal cancer surg)

A

Loop Ileostomy
RIF

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3
Q

Stoma type - defunction the colon

A

End ileostomy - RIF

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4
Q

Hernia location - inguinal vs femoral

A

Inguinal - above and medial to pubic tubercle (NB - strangulation rare, more common in men)
Femoral - below and lateral (high risk strangulation, more common in women)

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5
Q

Acute panc - causes

A

GET SMASHED

Gallstones, Ethanol, Trauma, Steroids, Mumps, AI, Scorpion, Hypercal/Hypothy, ERCP, Drugs

Drugs;
Azathioprine, Mesalazine, Na Val, furos

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6
Q

Persistent abdo pain and mild amylase elevation post Acute panc

A

Panceratic pseudocyst - occur 4w after attack

Tx - observe for up to 12 weeks as may resolve. If needing intervention - cystogastrostomy ro aspiration

If get infected - can -> panc abscess

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7
Q

ASA classification

A

ASA I - healthy, non smoker

ASA II - mild disease - well controlled DM/HTN, smoker, Alco excess

ASA III - Severe systemic disease - poorly controlled DM/HTN, COPD, morbid obesity, regular dialysis

ASA IV - severe disease that is constant threat to life - recent MI, Sepsis, End stage renal disease and not undergoing dialysis

AVA V - pt is expected to die without operation

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8
Q

Tx for anal fissure

A

if < 1w = acute
Bulk forming lax, topical GTN, lubricants

If >1w = chronic
Topical GTN 8W then refer

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9
Q

Adverse effects of SERMs

A

(Tamoxifen)
SEs; menstrual disturbances, hot flushes, VTE, endometrial cancer

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10
Q

Adverse effects Aromatase i

A

(anastrozole)
SEs; osteoporosis, hot flushes, insomnia

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11
Q

Tx for Fibroadenoma

A

No inc malig
If >3cm - excise

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12
Q

Tx for Breast cyst

A

Aspirate - fi blood stained or cyst refills - biopsy and excise

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13
Q

Bilious vomiting in neonate, few hours after birth
AXR - double bubble sign

A

Duodenal atresia

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14
Q

Abdominal distention and bilious vomiting withing first 24-48hrs life

A

Meconium ileus
AXR - fluid levels seen
Do sweat test to check for CF

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15
Q

Bilious vomiting in second week of life

A

NEC
AXR - dilated loops of bowel

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16
Q

Most common cause of breast abscess in lactational women

A

Staph Aureus

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17
Q

Most common breast cancer

A

Invasive ductal carcinoma (no special type (NST))

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18
Q

Middle aged woman
Lumpy breasts, more painful during menstruation

A

Fibroadenosis

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19
Q

eczematous changes over nipple

A

Pagets disease of the breast
Asso with intraductal carcinoma

20
Q

tender lump around the areola +/- a green nipple discharge

A

Mammary duct ectasia

21
Q

Blood stained nipple discharge

A

Duct papilloma

22
Q

Resection for cancer in caecal, ascending or proximal transverse colon

A

R hemicolectomy
Ileo-colic anasomosis

23
Q

Resection for cancer in distal transverse or descending colon

A

L hemicolectomy
colo-colon anatamosis

24
Q

Resection for cancer in Sigmoid colon

A

High anterior resection
colo-rectal anastamosis

25
Resection for cancer in rection
Anterior resection Colo-rectal anastomosis
26
Resection for cancer in anal verge
Abdomino-operitoneal excision of rectum
27
Potential adverse effects of volatile liquid anaethetics
(isoflurane, desflurane) Adverse effects; Myocardial depression, malignant hyperthermia
28
Haemorrhoid classification
Grade I Do not prolapse out of the anal canal Grade II Prolapse on defecation but reduce spontaneously Grade III Can be manually reduced Grade IV Cannot be reduced
29
Key criteria for head scan in head injury
CT scan within 1 hr; GCS <13 on admission or < 15 after 2 hrs , >1 episode vomiting, seizure, focal neurological deficit CT scan in 8 hrs; Aged 65+, bleeding/clotting issues/Drugs, dangerous mech of inj
30
soft, non-tender swelling of hemi-scrotum that transiluminates Mx?
Hydrocele - often secondary to epididymo-orchitis, torsion, cancer Infantile - should resolve by 1-2yr, if not, repair Adult - exclude cancer etc, conservative Mx
31
Tx for lidocaine toxicity
IV 20% lipid emulsion
32
Tx options for PAD
Lifelong Clopi + statin Treat co-morb - smoking, HTN, DM, obesity
33
Rules for Metformin before surgery
Day before - take as normal Day of - if OD/BD - takes as normal If TDS - omit lunchtime dose
34
Rules for sulfonylureas before surgery
Day before - take as normal Day of - omit if OD if BD - omit morning dose, can take afternoon dose if morning surgery
35
Rules for DPPi, SGLT2i and GLP1i
DPP + GLP- take as normal SGLT2i - omit on day of surgery
36
Rules for insulins before surgery
OD insulins - reduce dose by 20% on day before and day of surgery BD insulins - nil change day before. Day of - 1/2 morning dose, normal evening dose
37
Causes of priapsm
(persistent erection > 4hrs) Idiopathic, sickle cell, ED meds (viagra), trauma
38
Ix in Priapism
Cavernosal blood gas analysis to differentiate between ischaemic and non-ischaemic (in ischaemic priapism pO2 and pH would be reduced whilst pCO2 would be increased.)
39
Middle aged smoker, haematuria, loin pain, palpable abdominal mass
Renal cell cancer Can sec EPO (-> polycythaemia) or PTH (-> hypercal) Asso with varicocele
40
Mx for renal colic
NSAIDs Alpha blockers - promote smooth muscle relaxation and dilation or ureter (ease stone passing) Renal stones - if <5mm (watch and wait and should pass spontaneously) 5-20mm - shockwave lithotripsy or ureteroscopy >20mm - percutaneous nephrolithotomy
40
Prevention of calcium stones
high fluid intake , thiazide diuretics
41
Prevention of Oxalate stones
Cholestyramine or pyridoxine
42
Prevention of uric acid stones
Allopurinol Urinary alkylisation with PO bicarb
43
Tx for SAH
Supportive - bed rest, analgesia Nimodipine - prevents vasospasm Coiling/clipping within 24 hrs
44
Types of testicular tumours
= most common tumour in men 20-30 95% = germ cell tumours (seminomas and non semimous (teratoma)) rest = leydig tumour and sacrcomas
45
Tumour markers in testicular cancer
seminomas: hCG may be elevated in around 20% non-seminomas: AFP and/or beta-hCG are elevated in 80-85% LDH is elevated in around 40% of germ cell tumours

MSRA (21 decks)

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