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YEAR 6: PACES > Surgery 6 > Flashcards

Surgery 6 Flashcards

1
Q

List some causes of jaundice after cholecystectomy.

A 
Gallstone retention
Biliary sepsis 
Thermal injury 
Ligation of common hepatic or common bile duct 
Haemolysis after transfusion 
Halogenated anaesthetics
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2
Q

List some complications of joint prosthesis.

A 
Cement reaction 
Deep infection 
Fracture 
Dislocation 
Loosening 
Failure
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3
Q

What is a major issue with the use of fine needle aspiration to investigate a thyroid lump?

A

Cannot distinguish between adenoma and follicular cancer

NOTE: before thyroid surgery, patients need to have their vocal cords assessed

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4
Q

What are the contents of the spermatic cord?

A

3 Fascia: external and internal spermatic fascia, and fascia or cremasteric muscle
3 Arteries: testicular artery, artery of the ductus deferens, cremasteric artery
2 Nerves: testicular nerves, nerve to cremaster
Pampiniform plexus
Vas deferens
Lymphatic vessels
Tunica vaginalis

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5
Q

What are the indications for an urgent CT head scan (within 8 hours) in patients who have had a head injury?

A

Age 65 years or older
Any history of bleeding or clotting disorders
Dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
More than 30 minutes’ retrograde amnesia of events immediately before the head injury

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6
Q

List some indications for surgical treatment of CD.

A 
ACUTE
- obstruction secondary to stenosis
- perforation 
- severe GI bleed 
CHRONIC
- perianal disease (e.g. fistula, abscess) 
- failure of medical treatment 
- entero-cutaneous fistulae
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7
Q

What are the three main sites at which valvular incompetence occurs?

A

Saphenofemoral junction: 3 cm below and lateral to pubic tubercle
Saphenopopliteal junction: popliteal fossa
Perforators: draining the great saphenous vein (Cockett - 3 medial calf perforators; Hunter - 1 medial thigh perforator)

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8
Q

Define herniorrhaphy and herniotomy.

A

Herniotomy - ligation and excision of hernial sac

Herniorrhaphy - repair of abdominal wall defect

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9
Q

List some indications for using a circular bowel stapler.

A

Rectal anastomosis
Gastrectomy
Haemorrhoids
Rectal prolapse

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10
Q

List some features of chronic venous insufficiency.

A 
Haemosiderosis 
Atrophie blanche 
Lipodermatosclerosis 
Venous eczema 
Venous ulcers
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11
Q

Which types of grafts can be used for bypass surgery in patients with peripheral vascular disease?

A

Saphenous vein graft (preferred for bypass below inguinal ligament)
Above IL: Dacron graft
Below IL: PTFE graft

NOTE: saphenous vein grafts are preferred for more distal operations because the risk of thrombosis is lower and the graft has better longevity

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12
Q

List some causes of smooth and irregular hepatomegaly.

A

Smooth: CCF, cirrhosis, lymphoreticular disease, Budd-Chiari syndrome, amyloidosis
Irregular: secondary mets, macronodular cirrhosis, polycystic disease, primary HCC

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13
Q

What is a post-phlebitic limb?

A

A limb which has features of chronic venous insufficiency due to previous deep vein thrombosis

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14
Q

What are the indications for carotid endarterectomy?

A 
SYMPTOMATIC (ECST or NASCET guidelines) 
Usually > 70% stenosis 
Some recommend > 50% stenosis 
Perform within 2 weeks of presentation 
ASYMPTOMATIC: patients with stenosis >60% benefit
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15
Q

List some indications for using colloids.

A

Fluid challenge
Hypovolaemic shock
Burns

Complications: anaphylaxis, volume overload

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16
Q

What ABPI is required for the use of compression bandages?

A

ABPI > 0.8

NOTE: other treatment options include oral pentoxyfylline, topical antiseptics and split-thickness skin grafts

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17
Q

List some complications of varicose veins.

A

Itching (venous eczema)
Bleeding
Swelling
Skin changes (haemosiderin deposition, lipodermatosclerosis, venous ulcers)

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18
Q

How is thyroid cancer managed?

A

Total thyroidectomy
T4 to suppress TSH
With or without radioiodine

NOTE: thyroglobulin is used as a tumour marker (and calcitonin in medullar thyroid cancer)

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19
Q

What is the normal range for central venous pressure?

A

0-6 mm Hg

NOTE: fluid overload is associated with a high CVP

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20
Q

List some secondary causes of Raynaud’s phenomenon.

A

Blood: polycythaemia, cryoglobulinaemia, cold agglutinins
Arterial: atherosclerosis, thrombangiitis obliterans
Drugs: beta-blockers, OCP
Cervical rib: thoracic outlet obstruction
Autoimmune: SLE, RA, SS

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21
Q

What is Saint’s triad?

A

A condition in which diverticular disease, hiatus hernia and cholelithiasis occur at the same time

22
Q

List some complications of using proctoscopes.

A

Haemorrhage

Perforation

23
Q

List some differentials for exophthalmos.

A 
Graves' disease 
Orbital cellulitis 
Trauma
Masses (meningioma, glioma) 
Cavernous sinus thrombosis
24
Q

Describe the national AAA screening programme.

A

Men aged 65 years offered a one-time ultrasound scan

25
Q

What is a Fogarty embolectomy catheter used for?

A

Management of an acutely ischaemic limb

NOTE: insert into femoral artery at groin, pass catheter distal to embolus, inflate balloon and withdraw

26
Q

List some complications of tracheostomy.

A

IMMEDIATE: haemorrhage, trauma, pneumothorax
EARLY: tracheal erosion, tube displacement/obstruction, surgical emphysema, aspiration pneumonia
LATE: tracheomalacia, tracheo-oesophageal fistula, tracheal stenosis

27
Q

Describe the typical presentation of ACL injury.

A 
Caused by deceleration and rotational movements 
Hear a pop 
Inability to continue activity 
Haemarthrosis within 4-6 hours 
Instability/giving way following injury
28
Q

What are the two different types of prosthesis that can be used for hip arthoplasty?

A

Cemented (e.g. Thompson) - recommended by NICE, better in porous bone
Uncemented (e.g. Austin-Moore) - better for good quality bone (i.e. young patients)

29
Q

Outline the measures taken to prevent DVT in orthopaedic patients.

A 
TED stockings
Hydration
Minimise length of surgery 
Intermittent pneumatic compression devices 
LMWH (also DOACs)
Early mobilisation 
Good analgesia
Physiotherapy
30
Q

List some complications of appendicectomy.

A

Abscess formation
Increased risk of hernia (injury to ilioinguinal nerve)
Adhesions
Bleeding

NOTE: at the operation, if the appendix looks macroscopically normal you remove it anyway (may have microscopic inflammation) and check for other causes (Meckel’s, gynaecological)

31
Q

What are the advantages of tracheostomy over ET tubes?

A 
Easier to wean patients 
No need for sedation 
Reduced discomfort 
Reduced risk of glottis trauma 
Reduced dead space (reduced work of breathing)
32
Q

Which special tests can be used to elicit symptoms in patients with suspected carpal tunnel syndrome?

A

Phalen’s test (hands in prayer position)
Tinel’s sign (tapping over the median nerve)

Also look for wasting of thenar eminence and sensory loss over median nerve distribution

33
Q

Which operations would require a Pfannenstiel incision?

A

Caesarean section
Gynaecological surgery
Lower urinary tract surgery
Extraction of excised organs (along with laparoscopic port sites)

34
Q

List some risk factors of incisional hernias.

A

PRE-operative: age, diabetes, drugs (e.g. steroids), obesity, malnutrition
INTRA-operative: surgical skill, small suture bites, inappropriate suture choice, incision type
POST-operative: increased intra-abdominal pressure (e.g. cough), infection, haematoma

35
Q 
Which nerve roots are responsible for the following reflexes?
Ankle
Knee
Triceps 
Biceps
A

Ankle: S1-S2
Knee: L3-L4
Biceps: C5-C6
Triceps: C7-C8

36
Q

Which two types of incision are used for appendicectomy and how are they different?

A

McBurney’s: oblique
Lanz: transverse

NOTE: Lanz is favoured because it is hidden in a skin crease. Both follow Langer’s lines and carry a risk of injury to the ilioinguinal and iliohypogastric nerve (risk of inguinal hernia)

37
Q

What are the main indications for amputation of a leg?

A

Dead (peripheral vascular disease, thrombangiitis obliterans)
Dangerous (sepsis, malignancy)
Damaged (trauma, burns, frostbite)
Damned nuisance (pain, neurological damage)

38
Q

Define varus and valgus.

A

Varus: deformity characterised by displacement of the distal part towards the midline
Valgus: deformity characterised by the displacement of the distal part away from the midline

39
Q

List some complications of Colles fracture.

A

Median nerve injury
Frozen shoulder
Tendon rupture (especially EPL)
Mal-/non-union

40
Q

What is Calot’s triangle and what are its borders?

A

An anatomical space located at the porta hepatis that is dissected during a cholecystectomy
Superior: inferior edge of liver
Medial: common hepatic duct
Inferior: cystic duct
Contains: cystic artery, Calot’s node with or without aberrant hepatic artery

41
Q

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

A

ADVANTAGES: simpler technique
DISADVANTAGES: worse cosmetic results, requires lots of available skin, risk of complications (capsular contracture, infection, implant leakage)

42
Q

What is a branchial cyst?

A

A cyst found in the anterior triangle of the neck at the anterior border of SCM due to failure fusion of the 2nd or 3rd branchial arches

NOTE: it contains cholesterol crystals and can be medically treated with sclerotherapy or surgically excised

43
Q

Outline the management of carpal tunnel syndrome.

A

NON-SURGICAL: treat underlying cause, wrist splints (hold it in extension), local steroid injections
SURGICAL: carpal tunnel decompression by dividing the flexor retinaculum

44
Q

What are the general recommendations on how to prepare for surgery regarding oral intake?

A

Drink clear fluids until 2 hours before the operation
Do not consume solid fluids for 6 hours before the operation

NOTE: for emergency surgery, rapid sequence induction will be conducted

45
Q

List some complications of hip arthroplasty.

A

IMMEDIATE: nerve injury (superior gluteal nerve, sciatic nerve), fracture, cement reaction
EARLY: DVT, deep infection, dislocation
LATE: loosening, leg length discrepancy, revision (most replacements last 10-15 years)

46
Q

Where can the ulnar nerve be compressed?

A

Elbow: cubital tunnel
Wrist: Guyon’s canal

NOTE: other causes of ulnar nerve palsy include supracondylar fractures of the humerus and elbow dislocation

47
Q

Outline the ASA classification system.

A

1 - normal healthy patient
2 - mild systemic disease (e.g. hypertension, smoker)
3 - severe systemic disease (poorly controlled diabetes, COPD, morbid obesity, end stage renal disease)
4 severe systemic disease that is a constant threat to life (recent MI, severe valve dysfunction, sever heart failure)
5 - moribund and not expected to survive without an operation (ruptured AAA)
6 - declared brain dead and organs are being removed for donor purposes

48
Q

List some risk factors for wound infections.

A

PRE-OP: age, comorbidities (DM), pre-existing conditions (e.g. appendix perforation), colonisation (MRSA)
OPERATIVE: type of operation, duration, pre-operative antibiotics
POST-OP: contamination from staff

49
Q

List some causes of unilateral leg swelling.

A

DVT
Trauma (e.g. compartment syndrome, muscle rupture)
Venous disease
Lymphoedema (Milroy syndrome, surgery, radiotherapy, TB, filariasis)
Malignancy (sarcoma)

50
Q

What is the most common type of salivary gland neoplasm?

A

Pleomorphic adenoma (80% and usually in the parotid)

Others: adenolymphoma, mucoepidermoid tumour (MALIGNANT), adenoid cystic tumour (MALIGNANT)

NOTE: pleomorphic adenomas are treated with superficial parathyroidectomy

YEAR 6: PACES (22 decks)

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