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YEAR 6: PACES > Surgery 7 > Flashcards

Surgery 7 Flashcards

1
Q

List two major complications of acute sinusitis.

A

Periorbital cellulitis

Brain abscess

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2
Q

Describe Perthes test.

A

Tests for deep vein occlusion
High tourniquet around the leg and tell the patient to walk for 5 mins
Deep obstruction causes swelling and pain

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3
Q

What flow rate and percentage of oxygen can be administered through nasal prongs?

A

1-4 L/min

24-40% oxygen

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4
Q

List some indications for surgical treatment of UC.

A 
ACUTE
- Toxic megacolon
- Perforation 
- Severe GI bleeding 
CHRONIC
- Failure of medical management 
- Malignancy
- Failure of maturation in children
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5
Q

List some causes of knee effusions.

A

Synovial fluid: synovitis
Blood: ACL rupture, intrarticular fracture, meniscal tear, bleeding diathesis
Pus: septic arthritis

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6
Q

What is a dominant peroneal artery?

A

Present in 5% of the population

Dorsalis pedis pulse is absent but a pulse can be felt just anterior to the lateral malleolus

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7
Q

What is the most appropriate surgical management option for most rectal tumours?

A

Anterior resection

NOTE: low rectal tumours should be managed with abdominoperineal resection
NOTE: Hartmann’s procedure is used for sigmoid tumours

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8
Q

What operations are likely to require a loop ileostomy?

A 
Anterior resection (colon cancer)
Bowel rest (Crohn's disease)

NOTE: this stoma is used to rest the bowel distal to the stoma

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9
Q

How should patients be positioned when examining their hernial orifices?

A

Start with them standing

Then repeat the examination with them lying down

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10
Q

Which investigations are usually requested for patients attending a rapid access clinic for haematuria?

A

MSU
Renal/bladder ultrasound
CT urogram (all > 50 yrs + all with frank haematuria)
Flexible cystoscopy

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11
Q

What is a bunion?

A

Deformity of the metatarsophalangeal joint (swelling may be due to bursitits or a bony anomaly)

NOTE: associated with wearing ill-fitting footwear and rheumatoid arthritis

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12
Q

Outline the management of gangrene.

A

Take cultures
Debridement
Antibiotics (e.g. vancomycin, cephalosporins)

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13
Q

EPONYMOUS OPERATIONS: umbilical hernia

A

Mayo repair: double-breast the linea alba +/- sublay mesh

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14
Q

List some complications of open repair of AAA.

A 
Mortality (elective: 5%; emergency: 50%)
MI 
Renal failure 
Anastomotic bleeding 
Graft infection 
Spinal or mesenteric ischaemia 
Distal trash from thromboembolisation 
Aortoenteric fistula
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15
Q

EPONYMOUS OPERATIONS: femoral hernia

A

Lockwood approach - low incision over hernia with herniotomy and herniorrhaphy (ELECTIVE)
McEvedy approach - high approach in inguinal region with herniotomy and herniorrhaphy (EMERGENCY)

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16
Q

Describe how neck of femur fractures are defined based on their anatomical location.

A

INTRAcapsular: subcapital, transcervical, basicervical
EXTRAcapsular: intertrochanteric, subtrochanteric, reverse oblique intertrochanteric

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17
Q

What do you ‘look’ for when examining a joint?

A

Scars
Swelling
Deformity
Redness

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18
Q

What are the ways in which you can reduce closed and open fractures?

A

Closed –> manipulation or traction (skin or skeletal pins in bone)
Open –> mini-incision or full exposure

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19
Q

What operations would require a Mercedez-Benz/Rooftop incision?

A

Hepatobiliary surgery (e.g. liver transplant, Whipple’s, liver resection, gastric surgery)

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20
Q

What is the normal range of motion for a hip joint?

A 
Abduction: 45
Adduction: 30
Flexion: 130
Internal rotation: 20
External rotation: 45
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21
Q

What is mallet finger?

A

Flexion deformity of distal phalanx
Caused by damage to extensor tendon of terminal phalanx (e.g. avulsion fracture due to catching a cricket ball)

NOTE: managed by using a distal phalanx splint holding it in extension for 6 weeks to allow tendon reattachment

22
Q

EPONYMOUS OPERATIONS: chronic venous insufficiency

A

Trahere transplantation - transplant of axillary vein with valve into deep venous system
Kistner operation - venous valvuloplasty
Palma operation - bypass venous obstruction with contralateral great saphenous vein

23
Q

Outline bladder tumour staging.

A

Ta - within mucosa
T1 - into submucosa
T2 - into muscularis propria
T3 - into perivesical fat

24
Q

EPONYMOUS OPERATIONS: undescended testicle

A

Dartos Pouch Procedure - mobilisation of testis and placement in a pouch via a hole in the dartos muscle

25
What is a major contraindication for TED stockings?
``` Arterial disease (e.g. peripheral vascular disease) Severe skin breakdown (ulceration/infection) ```
26
List some causes of haematuria.
``` Renal cell carcinoma Glomerulonephritis Calculi Bladder tumour Haemorrhagic cystitis Urethral injury Prostatitis Strenuous exercise ``` NOTE: 2 week wait should be used for all frank haematuria, persistent haematuria with dysuria, micro/macrohaematuria with LUTS, female retention with pain and haematuria
27
What are the four stages of clubbing?
1) bogginess of nail bed 2) loss of nail angle 3) increased curvature 4) expansion of distal phalanx
28
Which layers are cut in a midline laparotomy incision?
``` Skin Subcutaneous fat Camper's fascia Scarpa's fascia Linea alba Transversalis fascia Pre-peritoneal fat Peritoneum ``` NOTE: the reason the linea alba is a good place to make an incision is because it is avascular
29
List some specific complications of colonic surgery.
EARLY: ileus, acute acalculous cholecystitis, anastomotic leak, enterocutaneous fistulae, abdominal abscess LATE: adhesions (obstruction), incisional hernia
30
List the different colours of vacutainer and their uses.
PURPLE: FBC, X-match, CD4 (contains EDTA to prevent clotting and keep cells alive) YELLOW: serum biochemistry, enzymes (contains activated gel that promotes clotting and separates serum from cells) RED: immunology, antibodies, immunoglobulin, protein electrophoresis (contains nothing) GREEN: plasma chemistries, enzymes (contains lithium heparin) BLUE: coagulation (contains citrate which chelates calcium and prevents clotting) GREY: glucose (contains fluoride oxalate which anticoagulates and inhibits glycolysis) BLACK: ESR (contains citrate) Order of Draw: cultures (aerobic --> anaerobic), blue, yellow, green, purple, grey
31
Define aneurysm.
Abnormal dilatation of a blood vessels to > 50% of its normal diameter
32
What are ganglion cysts?
Cystic swelling related to a synovial-lined structure (e.g. joint or tendon) Often found around the wrist Examination: soft, subcutaneous, may be tethered to tendon NOTE: 50% recurrence after surgical excision
33
After how long is a surgical drain usually removed?
Once drainage has stopped or < 25 mL/day Perioperative bleeding/haematoma = 24-48 hours Intestinal anastomosis = > 5 days T-tube = 6-10 days (this is inserted into the common bile duct) NOTE: the drain may be removed 2 cm per day to allow the tract to gradually heal
34
List some complications of ERCP.
Pancreatitis (5%) Bleeding (check clotting beforehand) Bowel perforation Contrast allergy
35
What are the different types of internal fixation?
Intramedullary --> pins or nails | Extramedullary --> plate/screws or pins
36
List some differentials for knee osteoarthritis.
Septic arthritis Medial meniscus tear Gout Rheumatoid arthritis
37
How are pharyngeal pouches treated?
Dohlman's procedure - minimally invasive endoscopic stapling
38
What is a neurofibroma?
Benign nerve sheath tumour arising from Schwann cells associated with NF1 Solitary or multiple, pedunculated, fleshy consistency, pressure can cause paraesthesia NOTE: check for cafe-au-lait spots, Lisch nodules, axillary freckles
39
EPONYMOUS OPERATIONS: cancer of the head of the pancreas
Whipple's - removal of head of pancreas | Also removes gastric antrum, gallbladder, proximal duodenum and regional lymph nodes
40
Where are port sites usually found for a laparoscopic cholecystectomy?
Umbilicus Epigastrium Right costal margin Right flank
41
Outline the management of lumbar disc herniation.
CONSERVATIVE: 2 days bed rest, keep active, lifting training, psychosocial support MEDICAL: simple analgesia, facet joint injections, short-term diazepam SURGICAL: percutaneous microdiscectomy, endoscopic discectomy, hemilaminotomy + discectomy
42
List some complications of fractures.
GENERAL: fat embolus, DVT, infection, prolonged immobility (UTI, chest infections, sores) SPECIFIC: neurovascular injury, muscle/tendon injury, non-union/malunion, local infection, degenerative changes, reflex sympathetic dystrophy
43
EPONYMOUS OPERATIONS: varicocele
Palomo operation - high retroperitoneal approach for ligation of testicular veins, transverse incision at midinguinal point on level of ASIS
44
List some indications for surgical thyroidectomy.
``` Mechanical obstruction Malignancy Cosmetic Failure of medical treatment Mediastinal extension ```
45
What are some causes of hip pain after a hip arthroplasty?
``` Post-operative abductor weakness/rupture Leg length discrepancy Loosened prosthesis Prosthesis infection Radiating back pain ```
46
List some complications of carotid endarterectomy.
Stroke or death Haematoma MI Nerve injury (hypoglossal, great auricular (numb ear lobe), recurrent laryngeal nerve)
47
What is the main indication for using a three-way urinary catheter?
Irrigate the bladder in patients at risk of clot retention (e.g. after TURP or patients with haematuria)
48
List some causes of salivary gland swelling.
``` Duct strictures Calculi Sialadenitis Inflammatory (Sjogrens, sarcoid) Tumours (80% in parotid) ``` NOTE: three main pairs of salivary glands - submandibular, sublingual and parotid
49
List some differentials for LIF masses.
``` Faecal mass Colon cancer Diverticular mass Transplanted kidney Ovarian tumour/fibroid Ectopic kidney Iliac artery aneurysm ```
50
What test is used when assessing a patient with suspected de Quervain's tenosynovitis?
Finkelstein test - examiner grasps the thumb and sharply ulnar deviates the hand causing pain along the distal radius NOTE: main tendons affected are extensor policis brevis and abductor policis longus

YEAR 6: PACES (22 decks)

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