Brainscape's Knowledge GenomeTM

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


See full index

YEAR 6: PACES > Surgery 3 > Flashcards

Surgery 3 Flashcards

1
Q

Which special test can be done to further assess a patient with suspected ulnar nerve injury?

A

Froment’s sign - flexion of thumb at interphalangeal joint due to weak adductor policis brevis

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

Describe the main physical characteristics of the spleen.

A

Located below ribs 9-11
Usually 9-11 cm in length
Weighs 150 g
Not usually palpable

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

List some causes of splenomegaly.

A

Infection (EBV, CMV, cat scratch disease)
Haemolytic disease (sickle cell, thalassemia, spherocytosis)
Malignancy (lymphoma, leukaemia)
Portal hypertension (cirrhosis)
Other (sarcoidosis, Felty syndrome)

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

List some types of absorbable suture.

A

Catgut (natural)
Monocryl (used for subcuticular skin closure)
Vicryl (subcutaneous closure, bowel anastomosis)
PDS (closing abdominal wall)

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

What should be done in the run up to thyroid surgery?

A

Make euthyroid using drugs (e.g. thionamides)
Stop 10 days before surgery (as they increase vascularity)
Alternative: just give propranolol
Check for phaeochromocytoma if medullary thyroid cancer
LARYNGOSCOPY: check vocal cords

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

List some complications of chest drains.

A 
Pain due to inadequate analgesia
Haemorrhage 
Organ perforation 
Incorrect location (abdomen)
Failure 
Long thoracic nerve damage (winging of scapula) 
Wound infection 
Blockage
Lifting the bottle above the patient can lead to retrograde flow into the chest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List some general surgical complications that can occur with most operations.

A

IMMEDIATE: oropharyngeal trauma (intubation), trauma to local structures, primary bleeding
EARLY: secondary bleeding, VTE, urinary retention, atelectasis, pneumonia, wound infection and dehiscence, antibiotics-associated colitis
LATE: scarring, neuropathy, treatment failure

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

Outline the surgical options in the management of osteoarthritis.

A

Arthroscopic washout (mainly knees, trim cartilage)
Realignment osteotomy (cut small area of bone to redistribute weight through the knee)
Arthroplasty (replacement)
Arthrodesis (surgical immobilisation of a joint)
Microfracture
Autologous chondrocyte implantation

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

Describe a Trendelenburg gait.

A

Sideways lurch of trunk to bring body weight over limb

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

List some surgical management options for varicose veins.

A

Trendelenberg (saphenofemoral ligation)
Short saphenous vein ligation (in popliteal fossa)
LSV stripping (no longer performed due to saphenous nerve damage)
Multiple avulsions
Cockett’s operation (perforator ligation)
SEPS (subfascial endoscopic perforator surgery)

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

What are the three phases of venous gangrene?

A

Phlegmasia alba dolens (white leg)
Phlegmasia cerulea dolens (blue leg)
Gangrene secondary to acute ischaemia

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

Outline how you would do a vascular examination.

A 
Radial (and radio-radial delay)
Brachial (and BP)
Subclavian 
Carotid (listen for bruits) 
Auscultate the precordium

Look at the abdomen and flanks for scars
Palpate for aneurysm (listen for aneurysm centrally and over renal vessels)

Inspect the feet and feel temperature
Femoral (and radio-femoral delay)
Popliteal
Pedal (dorsalis pedis and posterior tibial)
Listen for bruits (iliac, common femoral and adductor hiatus)

Request ABPI on both legs

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

List some indications for using a Swan Ganz catheter.

A

Measure pulmonary wedge pressure (measure of LA filling pressure)
Measure cardiac output
Used when accurate haemodynamic data is needed (e.g. cardiogenic shock, septic shock)

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

How long can a central line (e.g. PICC, Hickman or portacath) stay in place?

A

Until the end of treatment (this can be months to years)

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

What is an Ivor-Lewis oesophagectomy?

A

2-stage surgical procedure for removing tumours of the distal 2/3 of the oesophagus

1) abdominal roof top incision to assess for subdiaphragmatic spread and mobilise the stomach, remove para-oesophageal and cardiac lymph nodes
2) right thoracotomy to mobilise and resect the oesophagus and form anastomosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are oropharyngeal and nasopharyngeal tubes sized?

A

Oropharyngeal - from incisors to angle of mandible (insert upside down and rotate)
Nasopharyngeal - from the tragus of the ear to the tip of the nose (diameter of the little finger)

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

What are the borders of the femoral canal?

A

Lateral: femoral vein
Medial: lacunar ligament
Anterior: inguinal ligament
Posterior: pectineal ligament

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

Define stridor and list the different types.

A

Harsh, high pitched sound indicative of airway obstruction
INSPIRATORY: supraglottic or glottic
BIPHASIC: subglottic, extrathoracic trachea
EXPIRATORY: intrathoracic trachea

Causes: infection (croup), foreign body, stenosis, malignancy, trauma

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

List some complications of EVAR.

A 
MI
Spinal or mesenteric ischaemia
Renal failure 
Graft migration of stenosis 
Leakage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which classification system is used for distal fibula fractures?

A

Weber classification
A: below joint line (syndesmosis)
B: at joint line
C: above joint line

NOTE: B and C indicate possible injury to the syndesmotic ligaments between the tibia and fibula that can lead to instability

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

What are the main motor and sensory areas supplied by the ulnar nerve?

A

Motor: hypothenar muscles, medial lumbricals, interossei, adductor policis
Sensory: pulp of little finger

NOTE: in the forearm, the ulnar nerve innervates flexor carpi ulnaris and the medial half of flexor digitorum profundus

22
Q

What flow rate and percentage of oxygen can be administered through a non-rebreathe mask?

A

10-15 L/min

60-90% oxygen

23
Q

List some differentials for subacromial impingment.

A 
Rotator cuff tear (supraspinatus)
Frozen shoulder (global reduced range of motion)
Osteoarthritis 
Septic arthritis 
Gout 
Rheumatoid arthritis

NOTE: patients with a type 3 acromion (very hooked) are more likely to develop impingement

24
Q

In what scenario will it be difficult to both actively and passively move a joint?

A

Osteoarthritis

25
Q

Outline the management of varicoceles.

A

Non-Surgical: scrotal support, radiological embolisation
Surgical: generally recommended because of risk of infertility
- Palomo operation (vein exposed and ligated)
- Laparoscopic is possible

26
Q

Which test can be done when palpating a varicose vein?

A

Tap test (Chevrier’s test) - tap proximally and feel for an impulse distally

27
Q

List some operations that may require a Kocher’s incision?

A

Right: open cholecystectomy
Left: splenectomy

28
Q

What are the main motor and sensory areas supplied by the median nerve?

A

Motor: abductor policis brevis
Sensory: pulps of index and middle finger

29
Q

Describe the anatomy of Bouttoniere and Swan neck deformity.

A

Boutonierre: rupture of central slip of extensor expands allowing PIPJ to prolapse through the button hole
Swan neck: rupture of lateral slips allows PIPJ hyperextension

30
Q

How is a patient with suspected testicular cancer worked up?

A

Tumour markers (AFP, hCG, LDH)
Ultrasound
CT TAP
Histology after inguinal orchidectomy (out of deep inguinal ring)

NOTE: BEP and CHOP are the main chemotherapy agents used for testicular cancer (mainly non-seminoma)

31
Q

List some complications of AAA.

A 
Rupture
Embolisation (trash foot, missing pulses in popliteal aneurysms)
Thrombosis (acutely ischaemic leg)
Pressure (DVT)
Fistulation

NOTE: trash foot usually happens after AAA surgery

32
Q

What are the borders of the inguinal canal?

A

Anterior: external oblique and internal oblique (lateral 1/3)
Posterior: transversalis fascia + conjoint tendon (medial 1/3)
Floor: inguinal ligament
Roof: arching fibres for transversus abdominis + internal oblique

33
Q

Outline the treatment of nasal fractures.

A

If seen very early, reduce immediately before the swelling
Otherwise review at 7 days to assess alignment
Open fractures will require antibiotics
If a septal haematoma develops, patients should be referred for drainage

34
Q

What are the three compartments of the knee?

A

Medial
Lateral
Patellofemoral

35
Q

Outline the surgical management of intracapsular neck of femur fractures.

A

Garden 1 + 2: ORIF with cancellous screws
Garden 3 + 4: < 55 yrs - ORIF with screws; > 55 yrs - THR or hemiarthroplasty

NOTE: subtrochanteric fractures can be treated with intramedullary nails

36
Q

How should patients be prepared before a mastectomy?

A

Explain that a suction drain will be used to close the cavity and reduce the risk of haematoma/seroma formation
Explain that there will be an anaesthetised patch of skin in the upper medial part of the arm (intercostobrachial nerve)

37
Q

What is the order of size of peripheral venous cannulas?

A 
Yellow (SMALLEST - 24 gauge) 
Blue 
Pink
Green
Grey
Brown (BIGGEST - 14 gauge)

NOTE: flow rate is proportional to r^4 (Poiseuille’s law)

38
Q

List some indications for long-term catheterisation.

A 
Chronic bladder outlet obstruction 
Neurogenic bladder (e.g. MS, DM) with chronic retention

Alternative: clean intermittent self-catheterisation

39
Q

What is the technical term used to describe chronic neuropathic pain that occurs after an injury or fracture?

A

Reflex sympathetic dystrophy
Complex regional pain syndrome type 1 (Sudek’s atrophy)

NOTE: CRPS type 2 is persistent pain following injury due to nerve lesions

40
Q

List some complications of central venous catheter insertion.

A

IMMEDIATE: pneumothorax, arrhythmia, malposition into artery, air embolus, lost guide wire
EARLY: haematoma, infection, catheter occlusion
LATE: thrombosis, Horner’s syndrome (disruption of sympathetic chain), phrenic nerve damage (hiccup, weak diaphragm), venous stenosis, line-related sepsis

41
Q

Which follow-up treatment should be recommended for women who have had breast cancer treatment by wide local excision?

A

Whole breast radiotherapy

IMPORTANT: wide local excision should only be offered for DCIS < 4 cm

42
Q

What is a neobladder?

A

When a small segment of bowel is reconstructed to make a new bladder
Ureters are joined on to it at the top and the bottom is joined to the urethra
Patients can pee normally

43
Q

List some indications for a stoma.

A

Perforated or contaminated bowel (e.g. Hartmann’s)
Permanent (e.g. AP resection)
Diversion (protection of distal anastomosis (e.g. faecal peritonitis))
Decompression (e.g. bypass distal obstruction lesion)
Feeding (gastrostomy, jejunostomy)

44
Q

Outline the management of high risk superficial transitional cell carcinoma of the bladder.

A

Intravesical immunotherapy (BCG)
Close cystoscopic surveillance
Radical cystectomy

NOTE: carcinoma in situ is treated with BCG initially and radical cystectomy is offered if it fails. Laser therapy may be offered for low grade tumours

45
Q

What is a pyogenic granuloma?

A

Rapidly growing capillary haemangioma that appears bright red and bleeds very easily

NOTE: usually found on hands, face, gums and lips, often associated with previous skin trauma

46
Q

List some features you may notice on examination of an osteoarthritic hip.

A 
May be Trendelenburg positive 
Pain 
Stiffness 
Reduce range of motion (especially internal rotation) 
Fixed flexion deformity
47
Q

What are some complications of shoulder dislocation?

A

Recurrent dislocation
Axillary nerve injury
Avulsion injury/rotator cuff tear

48
Q

List some complications of knee replacement.

A

IMMEDIATE: fracture, cement reaction, vascular injury (superficial femoral artery), nerve injury (common peroneal nerve –> foot drop)
EARLY: DVT, deep infection
LATE: loosening, periprosthetic fracture, reduced range of motion and instability due to lost ACL

49
Q

How can inguinal and femoral hernias be distinguished on the basis of their location?

A

Inguinal: above and medial to pubic tubercle
Femoral: below and lateral to pubic tubercle

50
Q

List some causes of lymphoedema.

A

Primary: congenital absence of lymphatics, Milroy syndrome
Secondary: fibrosis (post-radiotherapy), infiltration (prostate cancer, filariasis), infection (TB), trauma

NOTE: primary lymphoedema can be congenital, praecox (after birth < 35 yrs) or tarda (> 35 yrs)

YEAR 6: PACES (22 decks)

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