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YEAR 6: PACES > Surgery 4 > Flashcards

Surgery 4 Flashcards

1
Q

What are the advantages and disadvantages of monofilament sutures?

A

ADVANTAGES: reduced risk of infection, less friction against tissues
DISADVANTAGES: harder to handle, knots may slip, less tensile strength

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2
Q

What might require a thoracoabdominal incision?

A

Oesophagogastrectomy

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3
Q

List some anatomical structures that are found at the transpyloric plane of Addison.

A 
Pylorus 
Fundus of gallbladder
Origin of SMA 
Duodenojejunal junction
Neck of the pancreas 
Hila of the kidneys 
L1 
Formation of the portal vein 
9th costal cartilage

NOTE: it is half way between jugular notch and syphysis pubis

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4
Q

Outline the screening programme for AAA.

A

Single ultrasound scan for males aged 65 years

< 3 cm = normal
3-4.5 cm = rescan in 1 year
4.5-5.4 cm = rescan in 3 months
>5.5 cm = 2 week vascular surgery referral

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5
Q

EPONYMOUS OPERATIONS: hydrocele

A

Lord’s repair - plication of tunica vaginalis

Jaboulay’s repair - eversion of tunica vaginalis

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6
Q

List some complications of surgical drains.

A

Infection
Damage caused by mechanical pressure or suction
Limit patient mobility

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7
Q

List some causes of varicose veins.

A

Primary (95%): prolonged standing, pregnancy, obesity
Secondary (5%): valve destruction (DVT), obstruction (pelvic mass), AV malformation, syndromes (Klippel-Trenaunay, Parkes-Weber)

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8
Q

Outline the management of chronic limb ischaemia.

A

CONSERVATIVE: optimise risk factors, clopidogrel and statin, foot care
INTERVENTIONAL: angioplasty, stenting, chemical sympathectomy
SURGICAL: endarterectomy, bypass grafting, amputation

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9
Q

List some complications of feeding NG tubes.

A

Nasal trauma
Malposition (cranium)
Blockage
Electrolyte imbalance (refeeding syndrome)

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10
Q

List some complications of gastrectomy.

A

PHYSICAL: increase gastric cancer risk, reflux/bilious vomiting, abdominal fullness, stricture, stump leakage
METABOLIC
- Dumping syndrome (abdo distension, flushing, fainting, sweating)
- Blind loop syndrome (malabsorption and diarrhoea)
- Vitamin deficiency (B12, iron and folate)
- weight loss due to malabsorption

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11
Q

What specific type of X-ray should be taken in orthopaedic patients with hip and knee problems?

A

Weight-bearing X-ray

NOTE: for knee, also take lateral and skyline X-rays to look for patelofemoral joint osteoarthritis

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12
Q

How does the angle of shoulder abduction at which pain is elicited relate to the cause of the pain?

A

60-120 degrees: impingement or rotator cuff tendonitis

140-180 degrees: acromioclavicular osteoarthritis

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13
Q

What are the contents of the inguinal canal in females?

A

Round ligament
Ilioinguinal nerve
Genital branch of the genitofemoral nerve

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14
Q

What is swinging of the chest drain?

A

The fluid level moves up and down with inspiration and expiration
If there is no bubbling, it either means that the lung is up, the air leak is sealed off or the drain is blocked

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15
Q

What is the investigation of choice for hydroceles?

A

Ultrasound

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16
Q

What demarcates the 9 quadrants of the abdomen?

A

Transpyloric plane: across L1 from the tip of the 9th costal cartilage
Supracristal plane: across L4 at the highest point of the iliac crest

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17
Q

What are the three compartments of the abdomen in which you may feel for masses?

A

Subcutaneous
Visceral
Retroperitoneal

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18
Q

List some causes of salivary gland swelling.

A 
DIFFUSE
- infection (parotitis)
- Sjogren' syndrome
- sarcoidosis
- systemic (bulimia, anorexia, chronic liver disease) 
LOCALSED
- calculus 
- lipoma 
- salivary gland neoplasm
- lymphoma/leukaemia
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19
Q

What urine dipstick results would you expect to see in post-hepatic jaundice?

A

High bilirubin

No urobilinogen

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20
Q

What bony and soft tissue lesions may be seen on an X-ray in shoulder dislocation?

A

Bankart lesion: damage to glenoid labrum

Hill-Sachs lesion: cortical depression in posterolateral part of humeral head

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21
Q

What is gangrene and what are the different types?

A

Definition: irreversible tissue death from poor vascular supply
Wet: tissue death + infection
Dry: tissue death only

22
Q

List some complications of using a laryngoscope.

A

Laryngeal and oropharyngeal trauma

C-spine injury (e.g. in atlanto-axial instability)

23
Q

What is a dermatofibroma?

A

Benign neoplasm of dermal fibroblasts

Usually seen on the legs of women, firm, woody feel may look like malignancy

24
Q

What is Admirand’s triangle?

A

A system outlining the conditions under which cholesterol crystallises to form gallstones
The following conditions favour the crystallisation of gallstones
Low lecithin
Low bile salts
High cholesterol

25
Q

What is the main benefit of a port a cath?

A

Very low risk of infection as skin breech is minimal

Typically used for long-term administration of chemotherapy/antibiotics

26
Q

EPONYMOUS OPERATIONS: refractory GORD

A

Nissen fundoplication - wrapping the fundus around the lower oesophageal sphincter

27
Q

List some causes of problems with fracture union.

A 
Infection 
Ischaemia 
Interfragmentary movement 
Interposition of soft tissue 
Intercurrent illness
28
Q

What is a Ryles nasogastric tube used for?

A

Draining the stomach (part of drip and suck)
Also used for persistent vomiting (e.g. pancreatitis)

NOTE: Ryles tubes are wide-bore, stiffer (prevent collapse during aspiration) and have a radio-opaque line with a metal tip (whereas feeding NG tubes are finer bore and made of soft silicone)

29
Q

How can you check for correct positioning of an ET tube?

A 
Inspect for symmetrical chest movements 
Listen over the epigastrium for gurgling 
Listen over each lung for air entry 
Use CO2 monitor 
CXR (should be just above carina)
30
Q

List some causes of radial nerve palsy.

A

VERY HIGH (triceps paralysis + wrist drop + finger drop)
- compression just below brachial plexus (e.g. crutches)
HIGH (wrist drop + finger drop)
- mid-shaft humeral fracture
LOW (finger drop)
- occurring at elbow, only involves posterior interosseous nerve (sensation preserved), fracture or dislocation

31
Q

What signs in the hand would you see in ulnar nerve palsy?

A

Partial claw hand (little and ring fingers)
Wasting of hypothenar eminence and dorsal interossei
Loss of sensation in ulnar distribution

32
Q

What are the principles of dealing with any fracture?

A

Reduce (closed or open)
Hold (no metal or metal)
Rehabilitate (move, physiotherapy and use)

33
Q

Outline the post-operative advice given to patients undergoing surgical hernia repair.

A 
Pee before leaving 
Early mobilisation 
Provide effective analgesia
Avoid constipation (lactulose) 
Keep the area clean and dry 
Can bathe immediately 
Work in 1-2 weeks (6 weeks if heavy lifting)
34
Q

What electrolyte is an indicator of pancreatitis severity?

A

Hypocalcaemia

NOTE: hypercalcaemia causes pancreatitis

35
Q

Why might the pedal pulses of a patient with diabetes be preserved until late in the disease?

A

Calcification in the walls of the vessel

NOTE: this also causes an abnormally high ABPI

36
Q

Outline the surgical approaches to managing femoral hernias.

A

ELECTIVE: Lockwood Low approach (low incision over hernia with herniotomy/herniorrhaphy)
EMERGENCY: McEvedy High approach (approach through inguinal region to allow inspection and resection of non-viable bowel, then herniotomy/herniorrhaphy)

37
Q

What are the two different techniques of breast reconstruction?

A

Implants

Myocutaneous flap

38
Q

List some operations that may require a midline laparotomy.

A

EMERGENCY: perforated ulcer, trauma, ruptured AAA
ELECTIVE: colectomy, AAA, vascular bypass

NOTE: midline laparotomy offers good access, bloodless lien, minimal nerve/muscle injury but involves a long midline scar and pain

39
Q

List some indications for using a disposable proctoscope.

A

Investigation of perianal pathology (e.g. haemorrhoids, low rectal cancer)
Examination or biopsy of anal canal and lower rectum
Therapeutic (banding or sclerotherapy)

40
Q

List some complications of cannulation.

A

Haematoma
Malplacement
Blockage
Superficial thrombophlebitis

41
Q

What is the upper limit of a post-void residual volume in patients under 65 yrs and over 65 yrs?

A

< 65 yrs = < 50 mL

> 65 yrs = < 100 mL

42
Q

What are the roles of nerves L4, L5 and S1?

A

L4: foot inversion and dorsiflexion
L5: great toe dorsiflexion, great toe and medial dorsum sensation
S1: foot eversion and plantar flexion, ankle jerk, little toe and lateral sole sensation

43
Q

Outline the management principles of osteoarthritis.

A

Modification of ADLS and risk factors (e.g. weight loss)
Physiotherapy, OT
Analgesia according to WHO ladder (paracetamol –> NSAIDs –> codeine –> morphine)
Steroid injection
Surgery (arthroplasty)

44
Q

What are the consequences of depressed fractures of the zygoma?

A

Binocular vision post-facial trauma and pain on opening the jaw

45
Q

Which veins can be used as access for central venous catheters?

A

Internal jugular vein
Subclavian vein
Femoral vein

They are inserted using Seldinger technique under local anaesthetic with ultrasound guidance. A CXR should be ordered after insertion to confirm correct placement.

46
Q

EPONYMOUS OPERATIONS: Pharyngeal pouch repair

A

Dohlman procedure - minimally invasive endoscopic stapling

47
Q

What is a PICC line?

A

Peripherally inserted central catheter

Inserted into a peripheral vein (e.g. cephalic vein) and it is advanced until the tip is in the SVC

48
Q

List some indications for partial nephrectomy.

A

Solitary kidney
Bilateral renal masses
Renal impairment

NOTE: radiofrequency ablation and cryotherapy are minimally invasive way of treating small renal cancers

49
Q

What are the main radiological features of rheumatoid arthritis?

A

Soft tissue swelling
Periarticular osteopaenia and erosions
Severe deformity

NOTE: fewer patients have deformities now because of adequate treatment

50
Q

Outline the national bowel cancer screening programme.

A

Faecal immunochemical test (FIT) - all men and women aged 60-74 every 2 years (can be done at home)
FlexiSig - one-off test for all men and women ageed 55 years (if positive –> full colonoscopy)

YEAR 6: PACES (22 decks)

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