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Surgery 2 Flashcards

1
Q

What is flexible sigmoidoscopy screening?

A

Flexi sig offered as one off to 55yo

Can self refer up to age of 60yo for one of flexi sig if has had not had one at age 55yo

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2
Q

Symptoms of fat necrosis (3)

A

Traumatic cause
Mimics breast ca
Can increase in size initially

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3
Q

Indirect inguinal hernia caused by

Direct inguinal hernia caused by

A

Incomplete closure of processus vaginalis

Defect in transversalis fascia on Hesselbach triangle

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4
Q

Passes medial to inferior epigastric artery

Passes lateral to inferior epigastric artery

A

Direct

Indirect

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5
Q

Difference between external and internal haemorrhoids

A

External - below dentate line

Internal - above dentate line

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6
Q

External or internal?

  1. Prone to thrombosis, may be painful
  2. Generally do not cause pain
A

External

Internal

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7
Q

What is the grading system for haemorrhoids?

A

I - do not prolapse
II - prolapse on defecation, reduce spontaneously
III - can be manually reduced
IV - cannot be reduced

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8
Q

Mx haemorrhoids (5)

A
  1. Soft stool (laxatives)
  2. Local anaesthetics
  3. Rubber band ligation (outpt dept)
  4. Sclerotherapy
  5. Surgery
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9
Q

Presentation of acutely thrombosed haemorrhoids

A

Purplish, oedematous, tender subcutaneous perianal mass

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10
Q

Mx of acutely thrombosed haemorrhoids

A

If within 72hrs of onset –> surgery for excision

Otherwise conservative management

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11
Q

May experience a lucid interval =

A

extradural haematoma

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12
Q

Extradural haematoma caused by:

Location

A

Acceleration-deceleration trauma OR
Blow to head
Temporal secondary to middle meningeal artery

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13
Q

Old and alcoholism are RF for which type of head injury?

A

Subdural

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14
Q

Subdural bleed feature (1)

Location (1)

A
  1. Slow onset of symptoms

2. Frontal and parietal lobes

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15
Q

What is the Cushing’s reflex?

A

Hypertension and bradycardia following head injury

Usually pre-terminal

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16
Q

What medication can be used for life threatening rising ICP?

A

IV mannitol/ furosemide

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17
Q

Indications for CT head immediately (7)

A
  1. GCS < 13 on initial assessment
  2. GCS < 15 after 2 hours
  3. Post traumatic seizure
  4. > 1 episode of vomiting
  5. Focal neurology deficit
  6. Suspected open/ depressed fracture
  7. Suspected basal fracture (panda eyes)
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18
Q

What is Battle’s sign?

A

Bruise that extends across the entire backside of your ear

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19
Q

CT within 8 hours (5)

A
  1. If on warfarin

If has experienced LOC or amnesia AND

  1. > 65yo
  2. Hx of bleeding/ clotting disorders
  3. More than 30 minutes’ retrograde amnesia of events immediately before the head injury
  4. Serious accident (fall from a height of greater than 1 metre or 5 stairs, or RTA)
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20
Q

What is a duct papilloma?
How do they present?
Mx

A

Benign mass originating usually from singular duct
Blood stained nipple discharge or mass
Microdochectomy

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21
Q

Mx of BPH

A
  1. Watch and wait
  2. Alpha 1 anagnosits (tamsulosin)
  3. 5 alpha reductase inhibitors (finasteride)
  4. TURP
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22
Q

Double bubble sign on AXR =

A

duodenal atresia

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23
Q

Duodenal atresia presentation (2)

A
  1. Few hours post birth

2. Bilious vomiting

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24
Q

When would you do a Ladd’s procedure?

A

Malrotation with volvulus

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25
Q

Malrotation with volvulus

Presentation (2)

A
  1. Bilious vomiting
  2. 3-7 days post birth
  3. May have signs of haemodynamic instability
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26
Q

Dilated bowel loops on AXR, pneumatosis and portal venous air =

A

Necrotosing enterocolitis

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27
Q

Necrotosing enterocolitis

Features (2)

A
  1. Bilious vomiting

2. Second week of life

28
Q

Necrotosing enterocolitis

Mx

A

If non perforated conservative and supportive

If perforated - laparotomy and resection

29
Q

CF + Air- fluid levels on AXR

Mx

A

Meconium ileus

Surgical decompression +/- resection

30
Q

Mec ileus

Features (3)

A
  1. Bilious vomiting
  2. Abdominal distension
  3. Within 24-48 hours of life
31
Q

AXR will show air-fluid levels

Within 24 hours of delivery

A

Jejunal/ ileal atresia

32
Q

Jejunal/ ileal atresia

Mx

A

Laparotomy with primary resection and anastomosis

33
Q

Criteria for brain stem death testing (4)

A
  1. Deep coma known cause
  2. Nil electrolyte imbalance
  3. Nil reversible causes
  4. Nil sedation
34
Q

Brain stem death testing (6)

A
  1. Caloric test
  2. Nil corneal reflex
  3. Pupills fixed and dilated
  4. Nil cough reflex
  5. Nil response to supraorbital pressure
  6. Nil respiratory effort
35
Q

What is a caloric test?

A

50mls of ice cold water into each year

36
Q

Who can perform brain stem death testing?

A

Two doctors both with at least 5 years of post grad experience
At least one consultant
No one from transplant team

37
Q

Tender, fluctuant mass in a lactating women =

Commonly caused by which organism

A

Breast abscess commonly caused by Staph Aureus

38
Q

When would you excise a fibroadenoma? (size)

Describe a fibroadenoma

A

> 3cm

Breast lumps, firm, mobile, non tender

39
Q

Nipple inversion/ skin tethering, hard , irregular lump

40
Q 
Common around menopause
Tender lump around nipple
Green nipple discharge
Benign
Can become infected
A

Mammary duct ectasia

41
Q

Blood stained discharge

Single duct wart like

A

Duct papilloma

42
Q

Breast screening

A

50-70yo

Mammogram every 3 years

43
Q

FH of breast ca criteria for earlier screening

A
  1. x1 1st degree female relative diagnosed with breast ca <40yo OR male 1st degree relative at any age
  2. x1 1st degree relative with bilateral breast ca <50yo
  3. x2 1st degree relatives OR x1 1st degree and x1 2nd degree relative at any age
  4. x1 1st/2nd degree relative with breast ca AND 1st/2nd degree relative with ovarian ca at any age
  5. x3 2nd degree relatives with breast ca at any age
44
Q

RF for breast ca (8)

A
  1. COCP
  2. Nulliparity
  3. Late menopause, early menarche
  4. BRCA1 BRCA 1
  5. 1st degree relative with premenopausal breast ca
  6. Nil breastfeeding
  7. Ionising radition
  8. Obestiy
45
Q

2ww referral for breast ca

A

> 30yo unexplained breast lump (with or w/o pain)

>50yo discharge, retraction or other changes of concern in one breast only

46
Q

Consider 2ww referral for breast ca

A

skin changes that suggest breast ca OR

unexplained lump in axilla

47
Q

Name four types of breast ca

A

Invasive or in situ
Lobular or ductal

DCIS
LCIS
Invasive lobular
Invasive ductal

48
Q

Most common breast cancer

A

Invasive ductal (also known as no special type)

49
Q

Eczemetous changes (reddening and thickening) of nipple areolar
Underlying malignancy
Usually invasive carcinoma

A

Paget’s disease

50
Q

Blocking lymph drainage = which type of breast ca

A

Inflammatory breast cancer

51
Q

Size and type of cancer that can be offered wide local excision

52
Q

Who is offered RT for breast ca

A
  1. Anyone with wide local excision

2. If had mastectomy, if has T3 or T4, or >= 4 axillary nodes

53
Q

Tamoxifen SE (3)

A
  1. Risk of VTE
  2. Risk of endometrial cancer
  3. Menopausal symptoms
54
Q

HER2 +ve use which medication?–>

Cannot be used if –>

A

Herceptin (trastuzumab)

Hx of heart disorders

55
Q

ER+ve breast ca use (2)

A
  1. Tamoxifen (oestrogen receptor antag + partial agonist)

2. Anastrozole (aromatose inhib) if post menopausal

56
Q

Squamous cell carcinoma bladder ca RF (1)

A

Schistosomiasis

57
Q

Transitional cell carcinoma RF (3)

A

Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide

58
Q

Screening for AAA

A

Aged 65yo all offered a single abdominal USS

59
Q

Mx infantile hydroceles

A
  1. Usually resolve 1 month from delivery

2. If not resolved by 1yo then can be referred to urology

60
Q

Epididymo-orchitis Mx if unknown organism

A

ceftriaxone 500mg IM single dose, plus doxycycline 10-14 days

61
Q

Mx breast cyst =

A

Aspiration
If blood stained or refill then biopsy/ excise
Increased risk of breast ca

62
Q

Testing of PSA should not be done how long after the below:

Prostate biopsy

63
Q

Testing of PSA should not be done how long after the below:

UTI

64
Q

Testing of PSA should not be done how long after the below:

DRE

65
Q

Testing of PSA should not be done how long after the below:

Ejaculation + Exercise

66
Q

First line investigation for suspected haemorrhoids

A

Proctoscopy and rigid sigmoidoscopy

MSRA (22 decks)

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