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Muhesh Final Year from Passmed > Surgery > Flashcards

Surgery Flashcards

1
Q

Vomiting + Bradypnoea

What acid-base disturbance?

A

Metabolic Alkalosis with Partial Respiratory Compensation

Loss of fluid - Na, K, H and Cl

Hypoventilation occurs - Retains CO2

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2
Q

Bicarbonate threshold for metabolic acidosis or metabolic alkalosis

A

<22 mmol/l = metabolic acidosis or renal compensation for respiratory alkalosis

>26mmol/l = metabolic alkalosis or renal compensation for respiratory acidosis

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3
Q

What is the end result after pylorus preserving pancreaticoduodenectomy?

A

Pylorus of stomach attached to the small intestine

Pancreas attached to small intestine

Bile duct attached to small intestine

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4
Q

Acute appendicitis

Which antibiotic?

When should be given?

A

Co-Amoxiclav (or other broad spectrum)- to reduce SSI.

Be given at diagnosis and continued til operation at least.

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5
Q

Why give imipenem to Acute pancreatitis patients?

A

In the case of patients with pancreatitic necrosis, Imipenem can be given and has been shown to reduce the risk of superimposed infection

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6
Q

Hemiarthroplasty vs Dynamic Hip Screw

A

Hemiarthroplasty - Performed in intracapsular fractures due to the blood supply to the head of femur being threatened

Intracapsular - Edge of femoral head to insertion of capsule at hip joint

Dynamic Hip Screw - performed in extracapsular femoral fractures.

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7
Q

Hip Fracture Scoring System?

A

Garden System

Type I - Stable fracture with impaction

II - compelte fracture but undisplaced

III - Displaced fracture but has boney contact

IV - Complete boney disruption

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8
Q

What hip fractures would you use intramedullary devices for?

A

Reverse oblique

Transverse

Subtrochanteric

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9
Q

What is a marjolin’s ulcer?

A

SCC occuring at site of chronic inflammation or previous injury

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10
Q

Straight lines appear crooked or wavey:

i) Yellow round spots in bruch’s membrane

Rx

ii) choroidal neovscularisation, serous fluid leakage, blood.

Rx

A

i) Early age-related macular degeneration: - these spots are known as drusen. Previously dry age-related macular degeneration

Rx - Smoking cessation, supplementation with beta carotene, vit a, vit c and vit e

ii) Late age-related macular degeneration. Previously wet age-related macular degeneration

Rx - photocoagluation, anti VEGF, photodynamic therapy

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11
Q

Dx and Rx for Degenerative Cervical Myelopathy?

A

Dx:

MRI

CT in MRI contraindication (CT Myelogram)

Rx:

Decompressive surgery

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12
Q

Hypertensive retinopathy classification

A

Keith Wagener’s Classification

I - Arteriolar narrowing and tortuosity. Increased light reflex

II - Arteriovenous nipping

III - Cotton wool exudated. Flame and blot haemorrahges

IV - Papilloedema

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13
Q

Which humerus fracture is radial nerve damage most common from?

A

Fracture of the shaft of the humerous

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14
Q

Meniere’s Disease

Acute management

LT Management

A

Acute - Prochlorperazine - buccal or IM

LT Management - betahistine or vestibular relaxation

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15
Q

Rfs for Testicular cancer (5)

Dx

A

Cryptorchidism

Infertility

Kinefelter’s

Mumps Orchitis

FH

Dx - Ultrasound

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16
Q

Tear Drop Plaques

A

Guttate psoriasis

  • think strep throat
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17
Q

Asymptomatic pink patches

A

Ptyriasis Rosacea

Look for herald patch in the question

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18
Q

Itching around toes

Dx

Rx

A

Dx - Athlete’s foot usually especially if young

Rx - Topical Micanozole

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19
Q

Supraventricular Tachycardias

Dx

Rx

A

Dx - narrow complex tachycardia

Rx - If stable - Vagal manouveres them IM Adenosine (Verapamil in asthmatics)

If unstable - Electric cardioversion

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20
Q

Main indications for placing a chest tube in pleural infection? (3)

A

i) Frankly purulent or turbit pleural fluid
ii) Presence of organisms from pleural fluid samples
iii) pleural fluid ph <7.2

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21
Q

What to send pleural fluid sample offf for? (5)

A

i) pH
ii) Protein,
iii) LDH,
iv) Cytology
v) Microbiology

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22
Q

Light’s Criteria

When is it applied?

What are the criteria?

A

Applied when protein level is between 25-35 g/L

Light’s Criteria:

i) plerual fluid protein divided by serum protein >0.5
ii) pleural fluid LDH divided by serum LDH >0.6
iii) pleural fluid LDH more than two-thirds the upper limit of normal serum LDH

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23
Q

Pleural Fluid Findings:

Low glucose? - 2

Raised Amylase - 2

Heavy blood staining - 3

A

Low glucose: TB, Rheumatoid ARthritis

Raised Amylase - Pancreatitis, Oesophageal perforation

Heavy blood staining - TB, Mesothelioma, Pulmonary embolism

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24
Q

Nasal polyps associations? (6)

A

Asthma

Aspirin Sensitivity

Infective Sinusitis

CF

Kartagener’s (Primary ciliary dyskinesia)

Churg - Strauss Syndrome

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25
Q

Gag Reflex:

Afferent component

Efferent component

A

Afferent - Glossopharyngeal nerve CN IX

Efferent - Vagus Nerve CN X

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26
Q

Post Splenectomy Blood Film (4 features)

A
  • Howell Jolly Body
  • Pappenheimer Bodies
  • Target Cells
  • Irregularly contracted erythrocytes
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27
Q

Contraindications to Sildenafil (3)

Side effects of Sildenafil (5)

MOA of Sildenafil

A

CIs :

i) Pt. Taking nitrates (or nicorandil)
ii) Hypotension
iii) stroke/MI within 6 months

SEs:

i) Visual Disturbances
ii) Nasal congestion
iii) Flushing
iv) GI Side effects
v) Headache

MOA - Phosphodiesterase Type V Inhibitor

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28
Q

MOA:

Carbimazole vs Propylthiouracil

A

Carbimazole - This blocks thyroid peroxidase from coupling and iodinating tyrosine residues on TG

Propylthiouracil - Same central effect as carbimazole but additionally prevents peripheral conversion of T4 to T3

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29
Q

Subcapital Fracture of the HIP : AKA?

Treatment?

A

Intracapsular

Treated with hemiarthroplasty (in elderly)

Internal fixation ( in young)

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30
Q

Investigation modality of choice for pancreatic cancer?

A

HRCT

Ultrasound sensitivity - 60% - 90%

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31
Q

Bubbly urine

Underlying cause?

A

Enterovesical fistula

Can be caused by colorectal malignancy.

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32
Q

i) Incidence (peak) ii) Germ or non germ? iii) RFs for bvoth

Teratoma

Vs

Seminoma

A

Teratoma :

i) Incidence - 25 year old
ii) Germ - “Non-seminoma” (others - yolk sac, embyronal, choriocarcinoma)

Seminoma:

i) Incidence - 35 year old
ii) Germ - “Seminoma)

RFs - cryptorchidism, infertility, FH, Kinefelter, Mumps,

Non Germ Cell tumours - Leydig cell tumour, sarcoma

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33
Q

Most common form of renal malignancy

A
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34
Q

Chest Drain for:

Haemothorax

Pneumothorax

Surgical exploration?

A

Haemothorax - 36F due to clot formation in smaller drains

Pneumothorax - 14 F usually used

Surgical exploration - warranted if >1500 ml blood is drained immediately

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35
Q

Commencement of hormone therapy in prostate cancer:

What drugs (2)?

Why not only 1?

A

Drugs:

Goserelin Acetate - GnRH Analogue

Flutamide/ cypotoreton acetate - Anti-androgen

Flutamide protects against the flare effect which is essentially where GnRH analogues cause a transient increase in LH Levels, this is then followed by downregulation of sex hormones.

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36
Q

PSA Testing:

How long after:

Prostate biopsy?

Proven Urinary infection?

DRE?

Vigorous exercise?

Ejaculation?

A

6 weeks of a prostate biopsy

4 weeks following a proven urinary infection

1 week of digital rectal examination

48 hours of vigorous exercise

48 hours of ejaculation

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37
Q

PSA Upper Limits:

50-59

60-69

70>

A

50-59: 3.0

60-69: 4.0

70>: 5.0

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38
Q

Cherry red lesion seen PR/ on anal verge in child:

what is it?

implication?

A

Juvenile Polyp/ Hamartoma

These often signify the presence of an underlying familial polyposis condition

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39
Q

Pelvic fracture + displaced prostate +perineal/penis oedema or haematoma

Urinary retention + perineal haematoma + blood at meatus

A

Pelvic fracture + displaced prostate perineal/penis oedema or haematoma - membranous urethral rupture

Urinary retention + perineal haematoma + blood at meatus - Bulbar urethrl rupture - associated with straddle injuries (cycle)

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40
Q

Mx of BPH

And side effects

A

Watchful waiting

medical

Alpha 1 antagonists (tamsulosin, alfuzosin)

  • decrease smooth muscle tone in bladder and prostate.
  • SEs - dizzeness, postural hypotension, dry mouth

5a reductase inhibitors (finasteride)

  • stops testosterone being converted to DHT (causes prostate hypertrophy
  • erectile dsyfunction, reduce libido, ejaculatory dysfunction, gynaecomastia all related to testosterone/ oestrogen! Makes sense
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41
Q

Renal Stones:

i) rank them in order of most - least common

ii) state whether opaque or not

iii) Mean urine pH?

A

Calcium Oxolate - opaque

Mixed/ oxolate and phosphate - opaque

Triple phosphate - opaque

calcium phosphate - opaque (normal/ alkaline)

urate - radio lucent (ACIDIC URINE)

cysteine - semi- opaque (Ground glass)

xanthine - lucent

struvate - mildly opaque (Alkaline urine)

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42
Q

Lump found posterior to the testicle is morel ikely to be a …

A

Epidymal Cyst

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43
Q

FUlminant UC:

pancoloproctectomy or subtotal colectomy?

A

Subtotal colectomy

  • removal of the rectum increases risk of comploications signifiacntly
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44
Q

Breast cancer prognosis index?

Components of it?

A

Nottingham Prognostic Index

  • Tumur size x 0.2 + lymph node score + grade score
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45
Q

Fluid resuss in burns?

Threshold : Adults , children

Initial fluid calculation

Fluids after 24 hours

A

>15% burns in adults >10% burns in children

Initial fluid calculation -

parkland’s formula - 4 ml x %burns area x bw in kg

Give 50% in first 8 hours and 50% in next 16 hours

after 24 hours

  • adminiter colloids
  • more crystalloids
  • more fluids neede in elctric/ inhalation injuries
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46
Q

Two terrible ADR of suxamethonium

A

Sux - Depolarising NMB

Malignant Hyperthermia - Dantrolene and cooling blankets

Pseudocholinsterase Deficiency - impending respiratory arrest. Need to have mechanical ventilation until drug has washed out

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47
Q

Eponymous Fractures

Colles’

Smiths’

Bennett’s

Monteggia’s

Galeazzi

Pott’s

Barton’s

Jone’s

Dancer’s (pseudo-jones)

Lisfranc’s

A

Colles’ - transverse fracture of radius, 1 inch proximal to radio-carpal joint, dorsal displacement and angulation (fall onto extended outstratched hand)

Smiths’ - Volar angulation of distal radius fragment. (falling backwards onto the palm of an outstretched hand/ falling with wrists flexed)

Bennett’s - intra articular fracture of first carpo metacarpal joint. (impact on flexed metacarpal, caused by fist fights)

Monteggia’s - dislocation of proximal radioulnar joint in assocation with ulna fracture (outstretched hand with forced pronation)

Galeazzi - radial shaft fracture with dislocation of distal radioulnar joint

Pott’s - bimallelar ankle fracture (forced foot eversion)

Barton’s - distal radius fracture with radiocarpal dislocation (extended pronated wrist)

Jone’s - fifth metatarsal fracture

Dancer’s (pseudo-jones) - fifth meta tarsal fracture

Lisfranc’s - disuption of lisfranc ligament (tarsal metatarsal joint. widening of first and second metatarsal space/ midfoot dislocation)

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48
Q

Colles’ Fracture

A

transverse fracture of radius, 1 inch proximal to radio-carpal joint, dorsal displacement and angulation (fall onto extended outstratched hand)

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49
Q

Smiths’

A

Volar angulation of distal radius fragment. (falling backwards onto the palm of an outstretched hand/ falling with wrists flexed)

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50
Q

Bennett’s

A

intra articular fracture of first carpo metacarpal joint. (impact on flexed metacarpal, caused by fist fights)

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51
Q

Monteggia’s

A

Dislocation of proximal radioulnar joint in assocation with ulna fracture (outstretched hand with forced pronation)

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52
Q

Galeazzi

A

radial shaft fracture with dislocation of distal radioulnar joint

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53
Q

Pott’s

A

bimallelar ankle fracture (forced foot eversion)

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54
Q

Barton’s

A

distal radius fracture with radiocarpal dislocation (extended pronated wrist)

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55
Q

Jone’s

A

fifth metatarsal fracture

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56
Q

Dancer’s (pseudo-jones)

A

fifth meta tarsal fracture

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57
Q

Lisfranc’s

A
  • disuption of lisfranc ligament (tarsal metatarsal joint. widening of first and second metatarsal space/ midfoot dislocation)​
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58
Q

Dx of COPD

(2 features)

A

FEV1/FVC <70%

Symptoms suggestive of COPD

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59
Q

Rx for VT

Medication (2)

Interventional (Short term, long term)

DIfferentiating between VT and SVT

A

Medication - Amiodarone and Lidocaine

Interventional - Cardioversion short term, Pacing long term

Differentiating- Capture beats and Fusion beats seen in VT

Capture - SAN transiently syncs with ventricles so normal QRS duration is seen

Fusion - where sinus and ventricular beats coincide to produce a hybrid complex

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60
Q

Borders of the Femoral Canal

Lateral

Medial

Anterior

Posterior

Contents?

A

Lateral - Femoral Vein

Medial - Lacunar Ligament

Anterior - Inguinal ligament

Posterior - Pectineal Ligament

Lies medial to the femoral sheath

Contents - Lymphatic vessels and Cloquet’s Lymph node

Higher risk of strangulation than Inguinal hernia.

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61
Q

Breast Cancer Rx

DCIS - Indication for mastectomy / WLE?

Radiotherapy - Indication in WLE / Mastectomy

Hormonal therapy - Tamoxifen use vs aromatase inhibitor use (letrozole)

A

DCIS - Mastectomy if >4cm

Radiotherapy - WLE - always radiotherapy / Mastectomy radiotherapy if T3-T4 tumour

Hormonal therapy - Tamoxifen use in pre and peri-menopausal women / aromatase inhibitor use - for post menopausal women (letrozole)

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62
Q

Shock

Narrow pulse pressure suggestive of?

Widened pulse pressure suggestive of?

A

NPP - Hypovolaemic shock due to sympathetic stimulation

WPP - distributive shock due to peripheral vasodilation

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63
Q

Familial Polyposis Syndromes

Say the polyp burden, inheritance pattern, cancer risk and type of polyp

APC mutations

mut Y human homologue mutation

STK11 (LKB1) mutation

PTEN mutation

DNA mismatch repair mutations genes

A

APC mutations

FAP, AD inheritance, >100 colonic adenomas with a very high cancer risk (100%)

If polyposis is found upon screening family members/ sporadic cases—> resection + ileo-anal pouch or if low rectal polyp burden sub-total colectomy + IRA

mut Y human homologue mutation

MYH associated polyposis, chromosome 1p autosomal recessive inheritance with a very high cancer (and breast cancer risk) risk but later onset than FAP

Sub total colectomy + IRA

STK11 (LKB1) mutation

Peutz-jehgers, chromosome 19 autosomal dominant with a moderataely icnreased risk of - breast, ovarian, cervical, pancreatic, testicular, CRC, and gastric cancer.

polyps are hamartomas

PTEN mutation

Cowden disease, chromosome 10q22 autosomal dominant with a high cancer risk at any site including CRC.

multiple intestinal hamartomas and trichilemmomas

DNA mismatch repair mutations genes

HNPCC (Lynch Syndrome), increased risk of CRC, Endometrial, Gastric. CRC - more likely to be right sided

considered for prophylactic surgery as with FAP

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64
Q

Ab treatment in acute pancreatitis?

Why?

A

Imipenem

If pancreatic necrosis to prevent superinfection

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65
Q

History differentiating between paget’s and nipple eczema?

A

Paget - primary in the nipple then spreads to areolar

Eczema - primary in the areolar and later invovles the nipple

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66
Q

What drugs should PAD patients be on?

A

First line:

Clopidogrel + Statin

If can’t tolerate clopidogrel then aspirin

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67
Q

SCC of the oesophagus assocaited with?

A

Achalasia

Little history of GORD/Barrett’s as this would indicate adenocarcinoma

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68
Q

Tumour markers in

Seminoma

Non-seminomatous

Testicular Cancers

A

Seminoma - AFP Normal, HCG elevated SOMETIMES, LDH eleveated SOMETIMES

Non-seminomatous - AFP, HCG elevated often

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69
Q

Bochdalek Hernia

Vs

Morgagni Hernia

A

Bochdalek Hernia

Left sided diaphragmatic hernia usually containing the stomach

Morgagni Hernia

Right sided diaphragmatic hernia usually containing the transverse colon

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70
Q

Which artery is at risk with i) duodenal ulcer?

ii) lesser curve gastric ulcer?

A

i) Gastro-duodenal arterry
ii) Left gastric artery

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71
Q

Thyroid biomarkers

TPO Antiobdies

TSH R Antibodies

TG Antibodies

Calcitonin

A

TPO Antiobdies - Hashimoto’s (+grave’s)

TSH R Antibodies - Grave’s

TG Antibodies - Doesn’t distinguish between cancers but used in monitoring cancer follow up

Calcitonin - Medullary carcinoma of thyroid

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72
Q

Cystine Stones?

A

AR Disorder of transmembrane cystine transport

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73
Q
A
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74
Q

Fournier Gangrene?

A

Fournier gangrene - Necrotising Fascitis of the perineum

  • background immunosuppression
  • Polymicrobial (e-coli + bacteroides working together)

purple black skin discolouration, crepitus, septic shock , blisters

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75
Q

Mx of sigmoid volvulus? (1st, 2nd, 3rd line)

Associations

A

1 - Rigid sigmoidoscopy with flatus tube decompression

2 - percutaneous colostomy

3 - Hartmann’s for perforation

Associations

Elderly, constipated, chagas

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76
Q

Mx of caecal volvulus

A

Usually right hemicolectomy

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77
Q

Biologic for GISTS?

A

Imatinib

Only if KIT positive

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78
Q

EGF positive colorectal cancers

A

Cetuximab ( Epidermal growth factor inhibitor)

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79
Q

Lichen sclerosis of male genital area?

3 associations

A

Balanitis Xerotica Obliterans

Associations

  • phimosis
  • SCC
  • Predisposition to infection
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80
Q

Most common cause of epiddymo orchitis

Mx

A

Chlamydia

Mx

IM Ceftriaxone (500mg)

Doxy PO ( 100mg BD for 10-14 days)

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81
Q

Which blood product is greatest associated with TRALI?

A

Plasma components

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82
Q

Hernias:

Below and lateral to pubic tubercle

Above and medial to pubic tubercle

A

Below and lateral to pubic tubercle

Femoral Hernia

Above and medial to pubic tubercle

Inguinal Hernia

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83
Q

US Findings in liver masses?

i) hyperechoic
ii) Mixed echoity and heterogeneous texture
iii) Fluid filled cavity / hyper echoic walls
iv) Fluid filled structure with poorly defined boundaries
v) Ultrasound showing septa
vi) Large anechoic, fluid filled area with irregular margins,

A

i) hyperechoic - Haemangioma
ii) Mixed echoity and heterogeneous texture - Liver cell adenoma
iii) Fluid filled cavity / hyper echoic walls - Liver abscess ( hyperechoic walls if chronic )
iv) Fluid filled structure with poorly defined boundaries - Amoebic Abscess
v) Ultrasound showing septa - Hydatid Cyst
vi) Large anechoic, fluid filled area with irregular margins, - Cystadenoma

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84
Q

Where should you not use lidocaine/adrenaline mixtures?

A

In extremities due to risk of ischaemia

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85
Q

Tender lump around areola and discharge

A

Mammary Duct ectasia

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86
Q

Hard, irregular non-malignant breast lump

A

Fat necrosis

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87
Q

Hypertrophic vs keloid scar

A

Both disorders of excessive collagen

Keloid scars extend beyond boundaries of the original injuries but hypertrophic scars do not

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88
Q

Deceleration injuries

Contained Haematoma

Widened Mediastinum

Persistent hypotension

A

Aortic Rupture

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89
Q

Acute urinary retention immediate management (2 things)

A

Catheterisation + Urgent referral to Urology

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90
Q

Sites of deceleration injury

A

Aorta (Transection, rupture)

GI (Duodenal-jejunal flexure disruption)

Pulmonary Contusion

Cardiac Contusion

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91
Q

Schiller Duval bodies

A

Yolk sac tumours

  • resemble glomeruli
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92
Q

lowest gleason score consistent with prostate cancer

A

6

Two samples taken for gleason scoring and it is the sum of the two most common histological patterns seen

Higher the score —> the more agressive the cancer and greater risk for metastasis

93
Q

When do you give WRT surgerY?

LMWH

Fondaparinux

Dabigatran

Rivaroxaban

A

LMWH - 6-12 hours after surgery

Fondaparinux - 6 hours after surgery

Dabigatran - 14 hours after surgery

Rivaroxaban - 6-10 hours after surgery

94
Q

Hormonla therapy in bresat cancer?

A

Pre and peri menopausal women –> Tamoxifen for 5 years

Post menopausal women - Anostrazole (aromatae in hibitor)

95
Q

Spondylolisthesis

Sponydlolysis

A

Spondylolisthesis - one vertebra anteriorly dislocates over another

Spondyolysis - defect or stress fracture in pars interarticularis of vertebral arch

96
Q

Schuerrman’s disease

A

Juvenile osteochondrosis of the spine (osteonecrosis of the spine followed by endochondral ossification)

97
Q

CRC Screening

A

FOB kits every 2 years

60-74 years in England

50 - 74 years in Scotland

Abnormal results sent for colonoscopy

98
Q

Margin required for Anterior Resection in rectal tumours

A

2 cm distal clearance margin from dentate line

4-5 cm of the anal verge

99
Q

Patho behind Pilonidal Sinus

Rx?

A

Hair debris creates skin sinuses—> lined be squamous epithelium but contain granulation tissue

Rxz

Difficult to treat —> Treat abscess in the initial stage with Abx and drainage

Bascom procedure - excision of sinus and obliteration of cavity

Karydakis procedure - Excision of natal cleft

100
Q

Barton’s Fracture

A

Distal radius fracture –> with radiocarpal dislocation

101
Q

Intraarticular fracture of first MCP

A

Bennett’s

  • fist fights
102
Q

Barium or gastrograffin for looking for anastamotic leaks?

A

Gastrograffin

Barium is more toxic

103
Q

Single large tortuous arterile in the sub mucosa

rare cause of upper GI bleeding

A

Dieulafoy lesion

104
Q

Treatment for BPH

MOAs

And

SEs

Surgical Mx

A

Alpha 1 antagonists (tamsulosin Alfuzosin)

  • Decrease SM tone
  • dizzi, postural hypotension, dry mouth, depression

5 alpha reductase inhibitors

  • Blocks test–> DHT conversion (reduces prostate volume and slows disease progression)
  • Erectile Dysfunciton, reduced libido, ejaculation problems, gynaecomastia

Surgial Mx - TURP

105
Q

Left sided chest pai nfollowing vomiting

Rx

A

Boerrhave’s Syndrome —> the perforation normally effects the left side

Dx - CT and ocntrast

Rx

  • <12 hours primary repair

12- 24 hours : fistuala creation with T tube

>24 hours —> fulminent medastinitis = fatal

106
Q

Procedures in Gastric Ca

Proximally sited >5-10 cm from the OG Junction

<5 cm from OG junction

Junctional tumours

A

Proximally sited >5-10 cm from the OG Junction - Subtotal Gastrectomy

<5 cm from OG junction - Total gastrectomy

Junctional tumours - Gastro-oesophagectomy

Lymph node clearance is required (particularly Japanese adopt this practice)

+ adj chemo

107
Q

Mx after Sx for Degenerative Cervical myelopathy?

why?

A

Ongoing follow up

  • disease can recur on adjacent spinal levels
  • surgery can alter spinal dynamics predisposing to other pathologies
108
Q

Blurred vision:

Post transplant/immunosuppessed

Rx?

A

CMV Retinitis

- cotton wool spots

-infiltrates

- haemorrahges

Rx - IV Ganciclovir

109
Q

Pathology in acute tubular necrosis

A

Caused by - prolonged ischaemia or toxins

The tubules usually act to concentrate urine and retain sodium.

SO

Low urinary osmolality (not cocentrating urine)

Raised urinary sodium (not retaining them)

110
Q

What is the RIFLE criteria used for?

What is it?

A

AKI CLassification

111
Q

Urinary Sodium in :

pre renal uraemia

ATN

A

<20 mmol/mol in Pre renal uraemia

  • the kidneys try to retain sodium in order to maintain the circulatory volume

>30 mmol/mol in ATN

  • tubules no longer able to retain sodium due to cellular damage
112
Q

Example of GPIIb/IIIa receptor antagonist

When do you use?

A

Abciximab, Tirofiban

Used when the 6 month CV risk is high (>3%) post ACS and imminent PCI is planned (96 hours)

113
Q

Cause of normal pressure hydrocephalus

Imaging?

A

Reduced CSF resorption in arachnoid villi

  • due to: head injury, SAH, meningitis

Imaging - enlarged fourth ventricle

absence of subtantial sulcal atrophy

114
Q

Rx of long QT syndrome

Normal QT?

A

Mx:

if QTc <500 ms = Propanolol (dont use sotalol - as can exacerbate)

If QTx >500 ms = ICD

115
Q

Where is the coarctation of aorta in adults?

Signs?

A

After the left subclavian artery emerges from the aorta

  • so both upper limbs will have higher pressures/ earlier pulses than the femorals

Signs:

  • HF in children, hypertension in adults
  • Mid systolic murmur (heard best over the back)
  • Neurofibromatosis, turner’s syndroem
116
Q

Brown looking macrophages on colonoscopy?

A

Melanosis Coli

Associated with laxative abuse

117
Q

DIabetic medication MOA:

DPP4 inhibitors

GLP 1 mimetics

Thiazelidinones

Sulfonylureas

BIguanadine

A

DPP4 inhibitors

Gliptins.

Increase GLP1 levels by inibiting DPP4 which is an enzyme that usually increases GLP1 Levels –> reduce glucagon levels/ stimulate insulin release—> reduce glucose

GLP 1 mimetics (Exanatide)

ncreases GLP1 Levels –> reduce glucagon levels/ stimulate insulin release—> reduce glucose

Thiazelidinones (Pioglitazone)

Activate nuclear receptors –> increasing transcription of enzymes–> ultimately leading to increased fat storage in adipocytes causing cellular mechanism to require carbohydrate oxidation

Sulfonylureas (Glimepiride, gibenclamide, gliclazide)

Bind and close ATP sensitive K+ channels on beta cells—> cause depolarisation —> release of insulin

BIguanadine (Metformin)

Increases insulin sensitivity

118
Q

Hypopigmented areas and subungual fibromas

A

Tuberous Sclerosis

Hypopigmented = ash leaf spot

roughened patches of skin over lumbar spine (Shagreen patches)

adenoma sebaceum (angiofibromas): butterfly distribution over nose

subungual fibromata

café-au-lait spots rare

119
Q

Blood in diarrhoea

which IBD?

A

UC

More bloody diarrhoea than crohn’s..

120
Q

QRISK >10%

A

Offer Statin Therapy

121
Q

Causes of primary Hyper PTHism

(four causes –> first two account for 95%)

A

Adenoma

Hyperplasia

Multiple Adenoma

Carcinoma

122
Q

Diabetic Management in acute period following MI?

A

IV insulin to allow for tight glycaemic control –> Digami Study

123
Q

Diabetic Diagnosis

HbA1c

Fasting Glucose

Random Glucose

GTT

A

HbA1c:

<=41 normal. >= 48 diabetes

Fasting Glucose:

<=6 normal. >= 7 diabetes

Random Glucose:

>=11.1 diabetes

GTT:

<=7.7 normal. >=11.1 diabetes

124
Q

Hypocalcaemia ECG Changes

Most common

Then other two

A

QTc Prolongation

AF, TDP

125
Q

Displacement of ureters

Medially

Laterally

A

Medially - retroperitoneal fibrosis

Laterally- Retroperitoneal malignacies

126
Q

Hyperosmolar load —> enters jejunum –> drags more water in by osmosis

Distension, pain, diarrhoea

A

Dumping Syndrome

127
Q

Anorectal Abscess causes

A

E. Coli

Staph Aureus

Locations: 2 Ps and 2 Is

Perianal, Ischiorectal, Pelvirectal, Intersphincteric

128
Q

Anal Fistulae

Goodsall’s Rule?

Types of fistula?

A

Goodsall’s Rule

  • Transverse line through anus.
  • Fistulas occuring anterior to tihs = short radial tract
  • Fistulas occuring posterior to this = curvelinear route to psoterior line

Types of fistula - Intersphincteric (doesn’t go through external anal sphincter), transphincteric (through ext anal sphincter), suprasphincteric, etra sphincteric , superficial

If opening of fistula is within anal verge = superficial fistula

129
Q

What is hesselbach’s triangle?

A

Medial - Rectus Abdominus

Lateral - inferipor epigastric vessels

Infeiror - inguinal ligament

Hernias occuring within hesselbach’s triangle are usually direct

130
Q

Permissive Hypotension

A

Term used to descrieb the allowance for a lower systolic bp as long as the patient is able to speak etc.

Anything about >70 mm Hg in patients who have suspected AAA rupture, Aortic dissection = don’t give fluids as this can worsen teh situation

Surgery is what these patients need

131
Q

What investigations for rectal bleeding

A

Baseline

DRE

Proctosigmoidoscopy

Rectal manometry testing for people with refractory fissure in ano to prevent continence issues

132
Q

NHS Breast screening programme

A

Every 3 years from 47-73

133
Q

Cytoreductive drugs in RCC

A

Alpha interferon

IL-2

TK-I (Sorafenib, sunitinib)

134
Q

Clear cell histological pattern

A

RCC

135
Q

Why do solitary rectal ulcers ago?

A

Due to chronic constpiaton / straining

136
Q

Sentinel anal pile

Ulcer

Enlarged anal papillae

A

Chronic fissure (>6 weeks)

137
Q

FOBT:

Screening

Diagnostic tool

A

Screening: 2 yearly between 60 and 74

>=50 Unexplained abdo pain or Weight loss

<60 IDA or bowel habit change

>= 60 anaemia

138
Q

Urinary Stones:

Hypercalciuria

Hyperoxaluria

Hypocitraturia

Hyperuricosuria

Disorder of a transmembranous transporter leading to reduced absorption of?

Extensive tissue breakdown

Low urinary pH

Renal tubular Acidosis - WHich types?

Proteus infections

High urinary pH

A

Urinary Stones:

Hypercalciuria - Calcium Oxolate

Hyperoxaluria - Calcium Oxolate

Hypocitraturia - Calcium oxolate ( citrate forms complexes solubilising calcium)

Hyperuricosuria - Uric Acid stones

Disorder of a transmembranous transporter leading to reduced absorption (GI and renal) of Cystine - Cystine Stones

Extensive tissue breakdown - Uric Acid think about the urea being released in TL syndrome

Low urinary pH - Uric Acid

Renal tubular Acidosis - Calcium Phosphate ( types 1 and 3 RTAcidosis)

Proteus infections - Struvite

High urinary pH - Calcium Phosphate, Struvite (notably more alkali than calcium phosphate)

139
Q

Rubber manufacture

What other risk factors?

What type of Ca?

Other Ca of same organ?

A

TCC of bladder

RFs- Smoking, Aniline dyes ( textiles) , rubber manufacture, cyclophosphamide

SCC of bladder

  • significantly rarer in Western societies

RFs - BCG vaccine, Schistosomiasis, Smoking

140
Q

Which type of shock has a reduced Systemic Vascular Resistance?

What else is unique?

A

Distrubitive shock - Septic, anaphylactic, neurogenic

Distrubitive Shock Also has a normal/increased CO - other types of shock have Increased SVR + Decreased CO

141
Q

Why does neurogenic shock occur

A

Often due to - high spinal cord transection

Leading to - decreases Sympathetic tone or increased parasympathetic tone

—> decreased peripheral vascular resistance —> reduced preload

Use peripheral vasoconstrictors

142
Q

Blunt cardiac injury and cardiogenic shock?

Likely site of injury and proposed management?

A

Usually right heart is effected and it’s respective chamber/ valve injuries

  • Managed conservatively where possible with osbervations and ECG/ Echo
  • Surgical repair using cardiopulmonary bypass +/- intra-aortic balloon pump as bridge to surgery
143
Q

Haematuria + Elevated Hb?

A

Think about RCC (the haematuria might be due to renal vein thrombosis)

144
Q

Renal Scans:

Identifies cortical defects, ectopic or abhorrent kidneys

Filtered at level of glomerulus so provides infromation about GFR

Secreted by tubular cells so useful for renal imaging of patietns with known renal impairment

Assess bladder reflux using contrast media (via catheter)

Past used technique for finding calculi

Currently used technique for finding calculi

Malignancy assessing

A

DMSA - Identifies cortical defects, ectopic or abhorrent kidneys

DTPA - Filtered at level of glomerulus so provides infromation about GFR

MAG- 3- Secreted by tubular cells so useful for renal imaging of patietns with known renal impairment

Micturating cystourethrogram- Assess bladder reflux using contrast media (via catheter)

IV Urography - Past used technique for finding calculi

CT KUB - Currently used technique for finding calculi

CT/PET - Malignancy assessing

145
Q

Suture types

A

Absorbable

Vicryl

Dexon

PDS

Non absorbable

Silk

Prolene

Ethilon

Novafil

146
Q
A
147
Q

Why does BPH cause haematuria

A

Due to hypervascularity of the prostate gland

148
Q

Drugs + haematuria?

TN/IN

only TN

A

TN/ IN - Aminoglycosides (gentamicin), Chemotherapy (cyclophosphamide)

TN - NSAIDs, Penicillin, Sulphonamides

149
Q

Adsons test for cervical rib

A

Lateral flexion of neck away from affected arm + traction of the affected arm = absent radial pulse

150
Q

testicular torsion:

cremesteric reflex preserved

cremescteric reflex absent

pyrexia

A

cremesteric reflex preserved - appendage torsion

cremescteric reflex absent - spermatic cord torsion

pyrexia - not torsion

151
Q
A
152
Q

Aged 65 and over with head injury?

A

CT scan within 8 hours unless another clinical feature makes one within one hour more prudent

153
Q

Causes of bilateral / unilateral hydropnephropsis

A

Bilatera;

SUPER

Stenosis of the urethra

Urethral Valve

Prostate

extensive bladder tumour

retroperitoneal fibrosis

Unilateral

PACT

Pelvic Ureteric Obstruction

Aberrant Renal Vessels

Calculus

Tumours of renal pelvis

154
Q

Ix for hydronephrosis

A

USS first - identifies hydronephrosis

Intravenous urethrogram - Position of the blockage

Pyelography -

CT Scan is the most sensitive diagnostic

155
Q

Most common rx for acute cholectstitis

A

IV Abx + Lap Chole within 1 week

156
Q

Magnesium ammonium phsophate stones

A

STRUVITE

STAG HORN

157
Q

Smokers breast disease?

A

Periductal mastitis

  • recurrent infections
  • periareolar or subareolar
158
Q

Neuroblastoma

vs

Nephroblastoma

A

Neuroblastoma

  • originate from adrenals
  • Calcified

Nephroblastoma

  • Wilm’s
  • originate from the renals, associated with
  • hypertensive
159
Q

Following TURP:

Hyponatraemia

Fluid Overload

A

TUR SYNDROME - venous destruction and absorption of irrigation fluid

RFs - > surgical time, > height of bag, >resection, >blood loss, >irrigation fluid used, perforation, bad CHF

Triad of :

hYponatraemia

Fluid overload

Glycine toxicity

Fluid restrict and treat hyponatraemia

160
Q

Which stones are NOT opaque on x ray? (3)

A

Semi opaque - Cystine

Radio lucent - Urate and Xanthine

161
Q

Greasy Scale

Keratin Plugging

A

Seborrheic keratosis

162
Q

Mealnocytic Derm Lesions?

Appear at/soon after birth

Circular macules

Nodules arising from a previous macule

Develop over few months in children- pink/red

AD Inherited naevi *CDKN2A mutation increases risk of melanoma*

A

Congenital melanocytic naevi - Appear at/soon after birth

Junctional naevi - Circular macules

Compound naevi- Nodules arising from a previous macule

Spitz Naevi - Develop over few months in children- pink/red

Atypical naeuvs syndrome - AD Inherited naevi *CDKN2A mutation increases risk of melanoma*

163
Q

Central punctum containing sebum:

If lined with Epidermis?

Sheath hair follicle?

A

If lined with Epidermis? - Epidermoid Cyst

Sheath hair follicle? - Pilar Cyst

164
Q

Colonic Cancer Surgery:

Acute obstruction ?

Chemotherapuetic regime?

Radiotherapy?

APER or Anterior Resection?

Acute Perforation?

A

Acute obstruction ? - Resect or stent –> either end stoma/ or primary anastamosis with an experience surgeon. Whereas in rectal defunctioning loop colostomy.

Chemotherapuetic regime? - combination of 5FU and oxaliplatin

Radiotherapy - Only for rectal cancer as the rectum is an extraperitoneal structure. Used for T4 ( long course), and T3 tumours.

APER or Anterior Resection? - APER in the situation where tumour is located within 6 cm of the anal verge

Acute perforation - Basically dont anastamose. End colostomy (as with hartmann’s procedure)

165
Q

Mx of PAD (non acute)

A

Conservative:

Exercise therapy to enhance collateral formation

Optimisation of comorbidities

Stop Smoking

Diet

Medical:

Atorvo 80mg

Clopidogrel 75 mg Daily

Naftidrofurl Oxalate - Vasodilator

Clistoazol - PDI III Inhibitor (vasodilator and antiplatelet)

Interventional.Surgical:

Angioplasty - Dependent on TASC Clasfficiation

Stenting - Dependent on TASC Classification

Bypass Surgery

Amputation

166
Q

Indirect vs Direct Inguinal Hernia

A

Indirect: (Bubonocele, Funicular, Complete) Lateral to the inferior epigastric vessels

Due to patent processus vaginalis (failure of closure of deep ring)

Surrounded by internal spermatic fascia

Can reach scrotum ( complete)

DirecT: Medial to the inferior epigsatric vessels

Weak point in transversalis fascia of abdominal wall - hesselbach triangle (Inguinal ligament, inferior epigastric artery, rectus abdominus)

Can’t reach scrotum

167
Q
A
168
Q

What do you co prescribe with GnRH Agonist for the first few weeks?>

A

Anti androgen such as cyproterone acetate

This is because there is initial stimulation of LH leading to increased testosterone levels

169
Q

Porta hepatis

A

Is a fissure on inferior surface of liver where:

Left/ Right hepatic ducts

hepatic artery

portal vein

Compression due to lymphadenopathy can cause jaundice

170
Q
A
171
Q

What airway adjunct would you use to facilitate long term weaning?

A

Tracheostomy

172
Q

Joint prosthesis:

Cx

Causes for revision

A

Cx

  • VTE
  • Fracture intra-op
  • Nerve damage (sciatic nerve if posterior approach)

Causes for revision

  • aseptic loosening
  • pain
  • fractured/dislocated prosthesis
  • infection
173
Q

Protein defect in marfan’s

A

Fibrillin —> component of elastin

174
Q
A
175
Q

Distinguishing between Monomere segment and drum perf?

A

Monomere segment = healed drum perf

Monomere segment —> moves with valsava

176
Q

Myopic

Hypermetropic

A

Myopic - shortsightedness

Negative refractory error as the image focuses before the retina

Need concave shape lens

Hypermetropia - longsightedness

Positive refractory error as the image focuses after the retina.

Need convex lens

177
Q

What is gonioscopy?

A
178
Q

Rx of ear wax

A
  1. Olive Oil Drops
  2. Sodium Bicarb Drops
  3. Microsuction ( preffered to syringing)
179
Q
A
180
Q

Phalen’s vs Reverse Phalen’s

A

Reverse Phalen’s = Prayer hands

Phalen’s = Reverse prayer hands

Looking for the same pathology and keep for a minute

181
Q

Borders:

What is the deep inguinal ring

Borders of the inguinal canal

What is the femoral ring

Borders of the femoral canal

Femoral Triangle

hesselbach’s triangle

Inferior Lumbar Triangle

Superior Lumbar Triangle

Borders of the adductor canal

Calot’s triangle

A

Deep Inguinal ring - oval shaped opening in the transersalis fascia

Inguinal Canal -

Floor - inguinal ligament, lacunar ligament medially.

Roof - Arching fibres of internal oblique and transversus abdominus

Anteriorly - External oblique aponeurosis (and internal oblique). Superficial ring allows exits here

Posteriorly - Conjoint tendon medially and fascia transversalis. Deep ring permits entry through the fascia transversalis here)

Femoral ring - Beginning if femoral canal.

Anterior - inguinal ligament

Posterior - pectinal ligmanet

Medially - lacunar ligament

Laterally - Femoral vein

Borders of femoral canal - Continuous with the femoral ring so same borders

Contains lymph node of cloquet + other lymphatic structures

Femoral Triangle -

Superiorly - Inguinal ligament

Sartorius - Medially

Adductor Longus - Laterally

Hesselbach’s triangle - Defect through which direct inguinal hernias often occurs

Inferiorly - Inguinal ligament

Medially - Lateral border of rectus abdominus

Lateraly - Inferior epigastric artery / vein

Inferior Lumbar Triangle

Inferiorly - Iliac Crest

Postero-Medially - Latissumus Dorsi

Antero-Laterally - External Oblique

Superior Lumbar Triangle

Superiorly - 12th rib

Medially - Quadratus Lumborum

Laterally - Internal Oblique

Roof - External Oblique

Floor - Transveralis fascia

Borders of the adductor canal

Anterio-medial - Sartorius

Antero-lateral - Vastus Medialis

Posterior - Adductor longus+ Magnus

Calot’s triangle (Hepatobiliary triangle - cystic artery in the middle somewhere)

Inferoior - cystic duct

Medial - common hepatic duct

Superior - inferior surface of the liver

182
Q

Stensen’s Duct

Warthon’s Duct

A

Stensen’s duct - drains parotid. opens into vestibule of mouth near the upper 2nd molar

Warthon’s duct - drain’s submandibular and sublingual glands and emerges at the base of the tongue

183
Q

Hypercalcaemia

<3.0

>3.0

A

<3.0 - start with fluids

>3.0 - fluids and bisphosphonate

184
Q

Morgagni

vs

Bochdalek

A

Diaphragmatic hernias

Morgagni - right sided herniating right colon usually

Bochdalek - Left sided herniating stomach usually (BochdaLEFT)

185
Q

Looks clinically like a hip fracture

Orthogonal X Ray veiws are negative

What next?

A

NICE SAYS:

Occult hip fractures with negative X rays should be investigated with an MRI

(this is not always practical so CT scanning is often used..)

186
Q
A
187
Q

how do you use a tonometer

When is a tonometer not reliable

A

Line up the two semi circles and where they line up is the IOP

Not reliable where the cornea is thin

  • When this is the case they need to undertake phasing which involves a full day of IOP monitoring
188
Q

Optic dic diameters

What is the optic cup

What is the optic disc

Glaucoma - what happens to optic disc

A

Normal optic disc is about 1.7-2.0 mm

Optic Cup - Seen as central on the fundoscopy and is where the optic nerve fibres involute

optic disc - Periphery of the optic area

  • The optic cup grows so the cup:disc ratio increases

Cup is the bit in the middle

189
Q

Prophylactic Colectomy

FAP or LYNCH

A

FAP - definitely have one

Lynch (HNPCC) - can have one but depends on polyp load

  • Usually have Right sided colorectal Ca
190
Q

Why do you digitate the stoma site with a gloved ky jellied finger?

A

Looking for blood, stenosis and polyps

191
Q

Presumed pathology in anal fissures (non-crohn’s)

A

Presumed to be due to hypertonic internal sphincter

- this is why the surgery that is eventually offered is an internal sphincterotomy

192
Q

What are haemorrhoids

Therapeutic options

If there is PR bleeding and you see haemorrhoids what else should you do

A

Dilated vascular cushions in the lower anal canal that can become increased due to straining and congestion.

They have a normal physiological role in maintaining continence and contribute to the resting pressure of the anal canal

Classified using Banov Classification

Rx

Conserv - Increase fibre, reduce straining

Interventional - Barron’s Banding, Injection sclerotherapy, haemorrhoid stapling, Haemorrhoidectomy +/- ligation of contributing vessels

Bleeding even if you see haemorrohids warrants further investigation!

193
Q
A
194
Q

What splint for scaphoid fracture

A

Futura splint

195
Q

What to immobilise in context of closed fracture

A

Proximal and distal joint

196
Q

Define:

Varus

Valgus

A

Varus - Medial angulation of distal segment of bone/joint

(varus the pig)

Valgus - lateral angulation of distal segment of bone/joint

197
Q

Genu Valgum?

A

Knock knees

  • Valgus angulation of the tibia in relation to the knee/femur
198
Q

Signs associated with patellar dislocation

A

High riding patella

Knock Knee (Genu valgum)

Tibial torsion

199
Q

Schatzker classification

A

Tibial PLateau Fracatures

1/2 - Lateral Condyle (young)

3 - Depressed fracture not complete

4 - medial condyle

5 - both condyles

6- high energy communited fracture

200
Q

OA Paracetomal And topical nsaid for which joints?

A

Knee and hand

201
Q

Calcium pyrophosphate dihydrate

A

Pseudogout

RFs -

Haemochromatosis / wilsons

Hypomagnasaeamia/ Hypophospohataemia

Hypothyroidism

Acromegaly

Hyperparathyroidism

XR - chondrocalcinosis

Joint aspriation - Positively birefringent rhomboid shaped crystals

202
Q

T Score interpretation

A

T score is compared wiht normal young healthy people

> - 1.0 - normal

-1.0 - -2.5 - osteopenia

<-2.5 - osteoporosis

203
Q

Mild

Moderate

Severe

NPDR

PDR

A

Mild - >1 microaneurysm

Moderate - >3 microaneurysm

Hard Exudate

blot haemorrhages

Cotton wool spots

Venous beading looping

intraretinal microvascular abnormalities

Severe -

Blot haemorrhages and microaneurysms in 4 quadrants

Venous beading in at least 2 quadrants

IRMAs in at least 1 quadrant

PDR- Retinal neovascularisation

204
Q

Key side effects of prostalgandin analogues?

A

Iris pgimentation

Periocular pigmentation

Eyelash lengthening

205
Q

Horner’s syndroem causes

S

T

C

A

Ptosis, anhidrosis, Meiosis, Enopthalmus

Central - S’s (hypothalamus to cervical spine)

Face, arm and trunk anhidrosis

Stroke, Syringomyelia, MS, Tumour, encephalitis

Preganglionic - T’s (Spinal foramina to superior cervical ganglion)

Face Anhidrosis

Pancoast TUmour, Thyroidectomy, Truama, Cervical Rib

Postganglionic - C’s (Superior cervical ganglion through the carotid sheath to CN V1, To sympathetic fibres to levater palpebri + sphincter pupillae + ?sweat glands of face)

Nb not the salivatory glands because there are PNS

No anhidrosis? - maybe their can be depending on the cause?

CAROTID - aneurysm, dissection, tumour

Cavernous sinus thrombosis (CN V1 runs through this)

Cluster headache

206
Q

Definition: Sinus

A

Blind ending tract lined by either granulation or epithelial tissue which opens onto an epithelial surface

207
Q

Why is albumin low in IBD?

A

So called protein losing enteropathy

  • Generalised bowel inflammation can lead to erosions —> protein losing enteropathy. So LFTs will show hypoalbuminaemia
208
Q

GRUM

Monteggia

Galeazzi?

A

Galeazzi - Distal radial fracture with dislocation at the radio-ulnar joint

Monteggia - Proximal ulnar fracture with dislocation of head of radius

209
Q

Fluid Challenge - how much fluid

A

500 ml NS if No PMH / evidence of HF

250 ml NS if HO HF/ Evidence of HF

210
Q

Staging of Crohn’s Disease

Ix

A

Acutely - CXR/AXR (look for perf, megacolon etc.)

More comprehensive staging:

Colonscopy

Capsule enteroscopy

Push enteroscopy

MRI enterocolysis

Barium follow through

211
Q

Approached for femoral hernia (3)

A

Lockwood - Low approach (oblique) Below the inguinal ligament

Letheisen - oblique approach (over the inguinal ligament)

Mcevedy - Longitudinal approach (High) through the inguinal ligament

212
Q

Deciding whether someone needs an ankle x ray or not

A

Ottawa ankle rules

Mallelolar pain + 1 of:

Medial malleolus tenderness

lateral malleolus tenderness

Unable to walk four steps at time of injury and upon assessment

213
Q

Flamingo tinged tympanic membrane

Progressive conductive deafness

Rx?

A

Otosclerosis

AD condition that runs in families and is present from 30s

Rx - Hearing aids and Stapedectomy

214
Q

Stapes fixation at oval window?

A

Otosclerosis

  • replacement of normal bone my vasccular spongy bone
215
Q

Drusen vs exudates vs pan retinal coagulation

A

Drusen - orangey, ill defined edges, look around macula

Exudates - yellow looking, well defined edges, look for other retinal changes, should be leakage - look for blot haemorrhages

pan retinal coagulation - very well defined, lots of them,

216
Q

Dx AND Mx of Compartment syndrome

A

Intracomaprtment pressure >20 mmHg and definitely if >40 mmHg

Mx - Extensive and prompt fasciotomies

Agressive IV fluid to present myoglobinuria mediated AKI

Have 4-6 hours before musclce dies as a result of this micro(note not macro) vascular compression

217
Q

Mx for Weber Classification fractures

A

Distal fracture - consrevative management in all age grousp with Below knee plaster cast up to mid foot

Proximal Weber B/C or Maissoneuve fracture —> If old conservative measures. If young will need suergery due to the instability of the fracture

218
Q

When to start allopurinal for gout?

A

Two attacks in 12 months

tophi

renal disease

uric acid stones

prophylaxis if on diuretics/chemotherapy drugs

2 weeks after attack ahs settles

Nsaid/ colchicine cover while therapy is being initiated

219
Q

What might you see on funduscopy in amyaurosis fugax?

A

Exudates - Cholesterol emboli

220
Q

Photophobia

Red eye

A

Uveitis

Not so much seen in glaucoma

221
Q

special hip fracture managmenet mnemonic

A

RST give IM

Reverse oblique

subtrochanteric

transverse

Mx - with IM Device

222
Q
A
223
Q

mx of sudden onsent SNHL

A

High dose oral steroids striaght away for 7 days

Referral to ENT where:

Pure tone audiometry testing

MRI scan looking for vestbular schawannoma

Consideration for intra-tympanic steroids

224
Q

Laparoscopic hernia repair techniques

A

Open repair is still the criteria standard but well trained surgeons achieve better pain results using laparoscopic approaches.

TEP (Total Extraperitoneal Approach) and TAPP (Transabdominal preperitoneal approach)

TEP

  • Cut made infrainguinally or curvalinearly
  • a dissecting baloon is advanced midline to the pubic symphsis underneath the rectus muscle and inflated so as to see the posterior rectus sheath to achieve dissection then removed
  • Laparascope (port jsut beneath umbilicus) and two additional ports made along the arcuate line
  • Cooper (pectineal ligament) dissected. NB inguinal vessels in this region so need to be careful
  • Direct and femoral hernias can be reduced here but indirect hernias require further exploration and dissection away from the spermatic cord.
  • Sac can be reduced or can be ligated.
  • Mesh can be introduced overlying the spermatic cord and is fixated between the ASIS and the pubics symphysis

TAPP

  • Infraumbiliacl incision is made mindful of the umbilical stalk (Inflated with CO2 now)
  • Two more trochars are placed - one at umbilical and one lateral to the rectus
  • Small peritoneal incision made –> careful dissection of the spermatic cord from the hernial defect
  • Mesh is fixed to the pubis or the cooper ligament
225
Q
A
226
Q

Disorders of the umbilicus in neonates

Painful erythematous ?

Brown discharge?

STraw coloured discharge

A

Ompholitis - Painful erythematous

Patent vitello-intestinal duct - Brown discharge

Straw coloured - Persitetn Urachus

227
Q
A
228
Q

Rectal Cancer

What resection and when

Other adjuvant treatments

A

Resection - TME + >12 LN need to be excised following vasc supply

High anterior resection / low anterior resection - >6 cm from anal vergem > 2 m for sphincter complex/anorectal ring

APR - When malignancy is 6cm from anal verge / <2 cm from the sphincter complex/ anorectal ring

Minimal resection - Carcinoma in situ/ T1

T3/T4 are given adjuvant chemo radiotherapy/brachytherapy

229
Q

Site of cancer . excision . anastamosis

Emergency surgery. What do you do and what stoma

A

Caecum, ascending, proximal transverse - Right hemicolectomy + ileocolic anastamosis

Distal transverse - Descending colon - Left hemi colectomy + colo-colon anastamosis

SIgmoid - High anterior resection - Colo-rectal anastamosis

rectal - always +TME

Upper rectum - anterior resection - colo-rectal anastamosis

Low rectum - low/ultra low anterior resection - colo rectal anastamosis but inititally with defunctioning loop ileostomy.

<2 cm from sphincter complex - Abdomino perineal resection - End colostomy

Emergency

Rectal obstruction Loop colostomy

Sigmoid obstruction - Hartmann’s Emergency resection of bowel affected. Distal stump formation and proximal end ostomy formation

Colonic obstruction - Resection of portion of bowel + primary anastamosis

Muhesh Final Year from Passmed (11 decks)

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