Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YEAR 6: PACES > Surgery 2 > Flashcards

Surgery 2 Flashcards

1
Q

What is the benefit of using an uncuffed ET tube?

A

Avoids damaging the larynx
Typically used in children
Cuffed ET tubes are better at preventing aspiration

NOTE: in terms of size, men need 8.5 and women need 7.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the clinical features of radial nerve palsy?

A

Wrist drop
Loss of sensation over the first dorsal interosseous (webbing)
May have sensory loss over dorsal forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why does an anterior resection require a loop ileostomy?

A

Rectal blood supply is poor so the colorectal anastomosis must be rested and, hence, covered by a loop ileostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What rehabilitation support should be offered to patients with a stoma?

A

Aim for normal diet
Good skin care and hygiene
Psychosexual support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a subtotal colectomy?

A

All colon excised except distal sigmoid and rectum
Temporary end ileostomy
Rectosigmoid stump may be exteriorised as a mucus fistula
Can be reverse 3 months later with complete proctectomy + ileal pouch anal anastomosis/permanent end ileostomy OR ileorectal anastomosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Other than the carpal tunnel, where else can the median nerve get trapped?

A 
Pronator syndrome (between heads of pronator teres)
Anterior interosseous syndrome (compression of anterior interosseous branch of median nerve in the deep head of pronator teres - causes muscle weakness only)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the management of ileus.

A

Correct underlying abnormalities (electrolytes and drugS)

Consider the need for parenteral nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the main indications for doing a total hip replacement as opposed to a hemiarthroplasty?

A

Mobilises with no more than 1 walking stick
Not cognitively impaired
Medically fit for anaesthesia and surgery (minimal comorbidities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline how to examine a stoma.

A

Look at the stoma (colour, surface, bag, contents, surroundings, devices)
Examine the rest of the abdomen
Ask to examine the perineum
Palpate around and inside the stoma with your little finger (need gloves and lube)

REPORT: site, calibre, number of lumens, functioning, healthy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does Thomas’ test look for?

A

Fixed flexion deformity in the knee

Causes: osteoarthritis, ACL injury, bucket handle meniscal tear, iliopsoas tightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Outline the management of popliteal aneurysms and its indications.

A

Surgical Indications: symptomatic, aneurysms containing thrombus, aneurysms > 2 cm
ACUTE Rx: embolectomy, femoral-distal bypass
STABLE: excision bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some causes of intradermal lumps?

A

Sebaceous cyst
Neurofibroma
Dermatofibroma

NOTE: the skin cannot be drawn over the lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the investigation of choice for suspected chronic pancreatitis?

A

CT scan with IV contrast (to look for pancreatic calcification)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the difference between a true and false aneurysm?

A

TRUE: dilation of the blood vessels involving all layers of the wall, fusiform or saccular
FALSE: collection of blood around a vessel wall that communicates with the lumen, usually iatrogenic (e.g. puncture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some associations of Terry’s nails.

A 
Chronic liver failure 
Diabetes mellitus 
Congestive heart failure 
Hyperthyroidism
Malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe how the location of varicose veins relates to the veins involved.

A

Medial and above or below the knee - great saphenous
Posterior and below the knee - short saphenous
Few varicosities with prominent skin changes - calf perforators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How should a breast lump be investigated further?

A

< 35 years: US
> 35 years: US + mammogram (oblique and craniocaudal)
MRI if multifocal disease or cosmetic implants present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Outline the management principles of claudication.

A

CONSERVATIVE: structured exercise programme, stop smoking, weight loss, foot care
MEDICAL: RF modification (BP, BM, lipids) , antiplatelets (clopidogrel), analgesia
INTERVENTIONAL: angioplasty, stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Under what circumstance is steroid injections for join pain contraindicated?

A

If they already have some form of join replacement (risks introducing infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the main indication for a loin incision?

A

Nephrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can you clear the C spine in a trauma patient?

A

CLINICAL: if any of the following are present (NEXUS criteria) then it cannot be cleared clinically and requires imaging
- Neurological deficit
- Spinal tenderness in the midline
- Altered consciousness
- Intoxication
- Distracting injury
RADIOLOGICAL: radiograph –> CT C-spine (if radiograph abnormal)

22
Q

List some differentials for epigastric masses.

A 
Gastric cancer 
Hepatomegaly 
Pancreatic cancer 
Pancreatic pseudocyst 
AAA
23
Q

Which investigations are used for achalasia?

A

Barium swallow
CXR - wide mediastinum, double right heart border
Manometry - failure of relaxation
OGD - exclude cancer

24
Q

Outline the management of wound dehiscence.

A

Cover in steril soaked gauze
IV antibiotics
Repair in theatre

25
Q

What operation might require a transverse muscle splitting incision?

A

Right hemicolectomy (along with a midline laparotomy and laparoscopic ports)

26
Q

What are the indications for operating on an AAA?

A

Symptomatic

Asymptomatic but > 5.5 cm or expanding > 1 cm/year

27
Q

What is the first-line investigation for diverticulitis?

A

CT scan

Other investigations for diverticulosis include gastrograffin enema/swallow and colonoscopy

28
Q

List some conditions that are associated with carpal tunnel syndrome.

A 
Hypothyroidism 
Pregnancy 
Rheumatoid arthritis 
Pregnancy
Amyloidosis 
Diabetes mellitus
29
Q

List some complications of urinary catheterisation.

A 
Creation of false tract 
Urethral rupture 
Paraphimosis 
Haematuria 
Infection 
Blockage

NOTE: urethral injury is a major contraindication for urinary catheterisation

30
Q

List the degrees of haemorrhoids.

A

1st Degree - haemorrhoids that do NOT prolapse
2nd Degree - prolapse with defecation but reduce spontaneously
3rd Degree - prolapse and require manual reduction
4th Degree - prolapse that CANNOT be reduced

31
Q

What is the main indication for a shouldered/Gabriel syringe?

A

Injection of haemorrhoids with 5% phenol in almond oil (sclerosant)
Used with a proctoscope to allow visualisation of the haemorrhoids

32
Q

List some complications of laparoscopic cholecystectomy.

A 
Conversion to open procedure 
Common bile duct injury 
Bile leak
Retained stones 
Intra-abdominal haemorrhage
33
Q

If you see a stoma on examination, what else should you examine?

A

Perineum - do see if it is a permanent stoma or a temporary stoma or if the anus has been excised.

34
Q

What are the features of acute limb ischaemia and which features are indications for immediate revascularisation?

A

Painful
Pulseless
Pale
Perishingly cold

Indications for immediate revascularisation: paralysis, paraesthesia

35
Q

What classification system is used for peripheral nerve injury?

A

Seddon classification
Neuropraxia: temporary interruption in conduction
Axonotmesis: disruption of axon with preservation of connective tissue framework (recovery is possible)
Neurotmesis: disruption of entire nerve fibre (recovery incomplete)

36
Q

What is refeeding syndrome?

A

Starvation (i.e. low carbs) leads to a catabolic state with low insulin and fat and protein catabolism leading to depletion of intracellular phosphate
Refeeding leads to a rise in insulin in response to the carbs resulting in increased cellular phosphate uptake
Hypophosphataemia –> rhabdomyolysis, respiratory insufficiency, arrhythmias, shock, seizures

NOTE: treated with phosphate supplementation

37
Q

What are the advantages and disadvantages of the use of myocutaneous flaps for breast reconstruction?

A

ADVANTAGES: useful when little muscle/skin remaining, good cosmetic result
DISADVANTAGES: increased blood loss, increased operation time, late complications (e.g. flap necrosis)

38
Q

What are the ways in which fractured can be held?

A

Closed –> plaster or traction (skin or skeletal)

Fixation

39
Q

Which investigation would provide a definitive diagnosis of small bowel obstruction?

A

Abdominal CT

NOTE: AXR is first-line but not definitive

40
Q

List some causes of gangrene.

A 
Diabetes (most common)
Embolism and thrombosis 
Raynaud's phenomenon 
Thrombangiitis obliterans 
Injury (e.g. extreme cold, trauma)
41
Q

What is the main indication for hip resurfacing?

A

Young, active people who are expected to outlive the replacement

42
Q

Why are varicoceles much more likely on the left side?

A

Left testicular vein drains into the left renal vein at a more vertical angle than the right testicular vein which drains into the IVC
Left renal vein can be compressed by bowel and renal pathology
Left testicular vein is longer than the right
Left testicular vein often lacks a terminal valve to prevent backflow

43
Q

What are the most common causes of epigastric hernias?

A

Lipoma

Incisional hernia where you can’t see the incision (most commonly port site from lap chole)

44
Q

Which classification system is used for intracapsular neck of femur fractures?

A 
Garden classification 
1 - incomplete and minimally displaced 
2 - complete and non-displaced 
3 - complete and partially displaced 
4 - completely displaced with no engagement of two fragments
45
Q

How should an NG tube be sized?

A

Measure from the tip of the nose to the epigastrium, going around the ear

46
Q

List some indications for total parenteral nutrition.

A 
Unable to swallow (e.g. oesophageal cancer)
Prolonged obstruction or ileus 
Short bowel syndrome 
Severe Crohn's disease 
Severe malnutrition

NOTE: parenteral nutrition has a high osmolality and is toxic to veins so requires central venous access

47
Q

List some complications of using ET tubes.

A

EARLY: oropharyngeal and laryngeal trauma, C-spine injury (atlanto-axial instability), oesophageal intubation, bronchial intubation
DELAYED: sore throat, tracheal stenosis, difficult wean

48
Q

What do you ‘feel’ for when examining a joint?

A

Tenderness
Effusion
Temperature

NOTE: the joint should be moved in every direction possible, first actively then passively

49
Q

Outline the conservative management of inguinal hernias.

A

Manage risk factors (e.g. chronic cough, constipation)
Weight loss
Hernia truss

50
Q

How can the integrity of a surgical bowel anastomosis be checked?

A

Intra-operative: fill pelvic cavity with saline, insufflate rectum with air and look for bubbles in the saline
Post-operative: water-soluble contrast enema

YEAR 6: PACES (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions