Brainscape's Knowledge GenomeTM

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


See full index

YEAR 6: PACES > Surgery 5 > Flashcards

Surgery 5 Flashcards

1
Q

What is enhanced recovery after surgery (ERAS) and how is it achieved?

A

Aims to optimise patients before surgery and reduce the risk of adverse outcomes
PRE-OP: aggressive physiological optimisation, smoking cessation for > 4 weeks, avoid prolonged fast, carb loading
INTRA-OP: short-acting anaesthetics, epidural, minimally invasive, avoid drains and NG tubes
POST-OP: aggressive pain/nausea management, early mobilisation and physiotherapy, early resumption of oral intake, remove drains and catheters ASAP

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

Outline the management of meniscal tears.

A

Symptomatic (analgesia)
Arthroscopic or open partial meniscectomy/meniscal repair

IMPORTANT: the lateral 1/3 of the meniscus has a rich blood supply so tears may heal by themselves or with surgery; the medial 2/3 has a poor blood supply so requires meniscectomy

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

Which changes in the skin give rise to a seborrhoeic keratosis?

A

Hyperkeratosis - thickening of corneum
Acanthosis - thickening of spinosum
Hyperplasia of basal cells

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

List the special tests used in a shoulder exam and state the anatomical structure that is being tested.

A

Jobe’s empty can test: supraspinatus
Forced external rotation of shoulder with elbow at 90 degrees: infraspinatus + teres minor
Gerber’s lift off: subscapularis
Scarf test: acromioclavicular joint dysfunction
Hawkin’s test: impingement
Apprehension test: glenohumeral joint instability

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

Which investigation should be requested in suspected renal tract cancer?

A

Renal tract ultrasound

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

List some differentials for RIF masses.

A 
Transplanted kidney 
Caecal cancer 
Appendix mass 
Incisional hernia 
Ovarian tumour/fibroid uterus 
Ectopic kidney 
Iliac artery aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What adjacent structures can be damaged during a fracture?

A

Nerves
Vessels
Ligaments
Tendons

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

List some different types of bypass surgery for chronic limb ischaemia.

A

Anatomical: femoral-popliteal, femoral-distal, aorto-bifemoral
Extra-Anatomical: axillo-fem, fem-fem crossover

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

What are the two main techniques used for hip replacement? Describe them.

A

Posterior Approach: involves reflecting the short external rotators, good access, higher dislocation rate, sciatic nerve injury (footdrop)
Anterolateral Approach: incision over greater trochanter dividing fascia lata, abductors are reflected, lower dislocation risk, superior gluteal nerve injury (Trendelenburg gait)

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

What features of a fracture can be described from a plain X-ray?

A 
Location (which bone) 
Pieces (simple, multifragmentary?)
Pattern (transverse, oblique, spiral)
Displaced/undisplaced (speaking about the distal end)
Translated/angulated 
Plane of radiograph

NOTE: translated means lateral movement of the fracture’ (lateral, medial, anterior, posterior) and angulation is rotation of the fracture component (varus or valgus)

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

What are the boundaries of Hesselbach’s triangle?

A

Medial: rectus abdominis muscle
Lateral: inferior epigastric artery
Inferior: inguinal ligament

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

List some types of non-absorbable suture.

A

Silk (used to secure drains)
Prolene (skin wounds and arterial anastomosis)
Ethilon (skin wounds)
Metal (skin wounds, sternotomy closure)

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

What does limited active movement but normal passive movement suggest?

A

Either a muscular problem (e.g. tendon rupture) or an innervation issue

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

List some contraindications for IV urography.

A 
Contrast allergy 
Renal impairment 
Pregnancy 
Severe asthma 
Metformin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some causes of thoracic outflow obstruction.

A

Cervical rib
Clavicle fracture
Pathological enlargement of 1st rib

NOTE: DDx - Raynaud’s, axillary vein thrombosis, cervical spondylosis, Pancoast tumour

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

Describe the examination features of a sebaceous cyst.

A

Occur at sites of hair growth (e.g. scalp, face, neck, chest)
Central punctum
Firm, smooth and intradermal

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

List some differentials for RUQ masses.

A

Hepatomegaly
Hepatic mass (e.g. cyst)
Gallbladder
Right kidney

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

When should the COCP be stopped prior to elective surgery?

A

4 weeks

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

What is a trigger finger?

A

Flexion of middle or ring finger
Caused by tendon nodule catching on the proximal side of the tendon sheath (usually FDS tendon)

NOTE: managed with steroid injections or sheath incision

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

At what vertebral levels do the coeliac trunk, SMA and IMA branch off the aorta?

A 
Coeliac trunk: L1
SMA: L1
Renal arteries: L2
IMA: L3
Bifurcation of aorta: L4/L5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List some gastrointestinal causes of clubbing.

A

Cirrhosis
Crohn’s disease
Coeliac disease
GI lymphoma

22
Q

Describe two types of urostomy.

A

Ileal conduit (incontinent) - ureters are attached to a portion of resected ileum which is exteriorised as a stoma (remaining ileum is re-anastomosed)

Indiana pouch (continent) - pouch created from 2 feet of resected ascending colon and portion of ileum including the ileocaecal valve. Ureters anastomosed to colonic end and ileal end is exteriorised. IC valve prevents leak, patient self-catheterises to drain into a pouch.

NOTE: there are two types of ileal conduit - Bricker (2 ureters straight into the ileal conduit) and Wallace (2 ureters joined together before entering the ileal conduit)

23
Q

Outline the management of arterial ulcers.

A 
Pain management 
Risk factor modification 
Clopidogrel
IV prostaglandins 
Chemical lumbar sympathectomy
24
Q

How can you confirm the location of an NG tube?

A

Aspirate gastric contents and check pH (< 5.5)
Insufflate air and auscultate for bubbling (do not do this in bowel obstruction)
CXR - tip below the diaphragm

NOTE: contraindicated in basal skull fracture

25
Q

List some indications for using an oropharyngeal or nasopharyngeal airway.

A

Airway adjunct in patients with impaired consciousness

26
Q

EPONYMOUS OPERATIONS: varicose veins

A

Trendelenberg - saphenofemoral junction ligation

Cockett - perforator ligation

27
Q

List some complications of surgical management of varicose veins.

A

EARLY: haematoma, wound sepsis, nerve damage (long saphenous)
LATE: superficial thrombophlebitis, DVT, recurrence

28
Q

List some complications of pancreatitis.

A

EARLY: hypovolaemia (shock), SIRS, hyperglycaemia, hypocalcaemia
LATE: pseudocyst, pancreatic necrosis, infection, abscess, bleeding, thrombosis, fistula

29
Q

How can varicose veins be treated?

A

CONSERVATIVE: weight loss, avoid prolonged standing, compression stockings, emollients
Injection sclerotherapy
Endovernous laser or radiofrequency ablation
Surgery

30
Q

Which operations are likely to require an end colostomy?

A

Permanent: AP resection (colon cancer)
Temporary: Hartmann’s (diverticulitis)

31
Q

How can a seminoma be distinguished from a teratoma?

A

Seminoma: usually normal markers
Teratoma: high AFP + high bhCG
NOTE: seminomas are treated with radiotherapy of para-aortic nodes and combination chemo (BEP); teratomas are treated with combination chemo (BEP) alone

NOTE: BEP = bleomycin, etoposide, cisPlatin

32
Q

What causes Trendelenburg sign?

A

Weakness of hip abductors (mainly gluteus medius)

May be caused by superior gluteal nerve injury

33
Q

List some causes of spider naevi.

A

More than 3 is abnormal
Chronic liver disease
Pregnancy
COCP

34
Q

Which Foley catheters tend to be used in men and women?

A

Male: 16-18 French
Female: 12-14 French

NOTE: French is the diameter of the catheter in mm

35
Q

What is the main reason for using external fixation?

A

When there is extensive soft tissue injury (open fracture) or a complex periarticular fracture

You don’t want to put hardware in if there’s no soft tissue or if the tissue is contaminated - wait for inflammatory response to stop

36
Q

What are the pros and cons of an anterolateral approach to hip replacement as opposed to a posterior approach?

A

Anterolateral: lower dislocation rate but higher risk of trendelenberg gait
Posterior: higher dislocation rate but you don’t go through abductors so you do not get a trendelenberg gait

37
Q

Outline the management of compartment syndrome.

A

Elevate and remove any bandages/cast

Fasciotomy

38
Q

Describe the tourniquet test/Trendelenberg test for venous insufficiency.

A

Position the patient supine, elevate their legs and milk their veins
Apply the tourniquet as high up as possible or compress the SFJ
Stand the patient
CONTROLLED: incompetence above tourniquet, release tourniquet to confirm filling
UNCONTROLLED: incompetence below tourniquet

39
Q

List some differentials for posterior neck lumps.

A

Lymph nodes
Cervical rib
Cystic hygroma
Pharyngeal pouch

40
Q

What are the main indications for adenoidectomy?

A

OSA in children
Glue ear with failed grommets
Malignancy

41
Q

What is a Galeazzi fracture?

A

Fracture of radial shaft between middle and distal 1/3 + dislocation of distal radio-ulnar joint

42
Q

What is the Parkland formula for fluid resuscitation in burns?

A

Fluid resuscitation in the first 24 hours = % surface area x weight x 4 mL

43
Q

List some complications of Nissen fundoplication.

A

Gas-bloat syndrome (can’t belch or vomit)

Dysphagia (if wrap around is too tight)

44
Q

What are the features of critical limb ischaemia?

A

Ankle artery pressure < 40 mm Hg
Rest pain or tissue loss
Symptoms for > 2 weeks

NOTE: classified using Fontaine classification (1 - asymptomatic, 2 - claudication, 3 - rest pain, 4 - ulceration and gangrene)

45
Q

What are some key differences between hypertrophic scars and keloids?

A

Hypertrophic scars are confined to the wound margins and appears soon after injury and regress spontaneously
Keloids extend beyond the wound margin, appear months after injury and continue to grow

46
Q

Outline the criteria for having a tonsillectomy.

A

Clinically significant tonsillitis 7 or more times for 1 year, 5 or more times for 2 years or 3 or more times for 3 years

47
Q

What are the surgical management options for BPH?

A

TURP
HoLEP (holmium laser enucleation of the prostate)
Urolift (involves stapling back the lateral lobes of the prostate - lower risk of retrograde ejaculation so better for younger people)

NOTE: HoLEP is used for very big prostates

48
Q

Outline the management of Raynaud’s phenomenon.

A

Wear gloves and avoid cold
Stop smoking
CCBs (e.g. nifedipine)
IV prostacyclin

49
Q

What is the normal range of flexion in a knee joint?

A

0-140 degree

50
Q

List some complications of stomas.

A 
EARLY
- haemorrhage 
- ischaemia
- high output (hypokalaemia - use loperamide/codeine)
- parastomal abscess
- stoma retraction
DELAYED
- parastomal hernia
- obstruction (adhesions, herniation)
- dermatitis
- stoma prolapse
- stenosis or stricture 
- fistulae 
- psychosexual dysfunction

YEAR 6: PACES (22 decks)

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