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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
Q

What is a major contraindication for TED stockings?

A 
Arterial disease (e.g. peripheral vascular disease)
Severe skin breakdown (ulceration/infection)
26
Q

List some causes of haematuria.

A 
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
Q

What are the four stages of clubbing?

A

1) bogginess of nail bed
2) loss of nail angle
3) increased curvature
4) expansion of distal phalanx

28
Q

Which layers are cut in a midline laparotomy incision?

A 
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
Q

List some specific complications of colonic surgery.

A

EARLY: ileus, acute acalculous cholecystitis, anastomotic leak, enterocutaneous fistulae, abdominal abscess
LATE: adhesions (obstruction), incisional hernia

30
Q

List the different colours of vacutainer and their uses.

A

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
Q

Define aneurysm.

A

Abnormal dilatation of a blood vessels to > 50% of its normal diameter

32
Q

What are ganglion cysts?

A

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
Q

After how long is a surgical drain usually removed?

A

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
Q

List some complications of ERCP.

A

Pancreatitis (5%)
Bleeding (check clotting beforehand)
Bowel perforation
Contrast allergy

35
Q

What are the different types of internal fixation?

A

Intramedullary –> pins or nails

Extramedullary –> plate/screws or pins

36
Q

List some differentials for knee osteoarthritis.

A

Septic arthritis
Medial meniscus tear
Gout
Rheumatoid arthritis

37
Q

How are pharyngeal pouches treated?

A

Dohlman’s procedure - minimally invasive endoscopic stapling

38
Q

What is a neurofibroma?

A

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
Q

EPONYMOUS OPERATIONS: cancer of the head of the pancreas

A

Whipple’s - removal of head of pancreas

Also removes gastric antrum, gallbladder, proximal duodenum and regional lymph nodes

40
Q

Where are port sites usually found for a laparoscopic cholecystectomy?

A

Umbilicus
Epigastrium
Right costal margin
Right flank

41
Q

Outline the management of lumbar disc herniation.

A

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
Q

List some complications of fractures.

A

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
Q

EPONYMOUS OPERATIONS: varicocele

A

Palomo operation - high retroperitoneal approach for ligation of testicular veins, transverse incision at midinguinal point on level of ASIS

44
Q

List some indications for surgical thyroidectomy.

A 
Mechanical obstruction 
Malignancy 
Cosmetic 
Failure of medical treatment 
Mediastinal extension
45
Q

What are some causes of hip pain after a hip arthroplasty?

A 
Post-operative abductor weakness/rupture 
Leg length discrepancy 
Loosened prosthesis 
Prosthesis infection 
Radiating back pain
46
Q

List some complications of carotid endarterectomy.

A

Stroke or death
Haematoma
MI
Nerve injury (hypoglossal, great auricular (numb ear lobe), recurrent laryngeal nerve)

47
Q

What is the main indication for using a three-way urinary catheter?

A

Irrigate the bladder in patients at risk of clot retention (e.g. after TURP or patients with haematuria)

48
Q

List some causes of salivary gland swelling.

A 
Duct strictures 
Calculi
Sialadenitis 
Inflammatory (Sjogrens, sarcoid)
Tumours (80% in parotid)

NOTE: three main pairs of salivary glands - submandibular, sublingual and parotid

49
Q

List some differentials for LIF masses.

A 
Faecal mass
Colon cancer 
Diverticular mass 
Transplanted kidney
Ovarian tumour/fibroid
Ectopic kidney 
Iliac artery aneurysm
50
Q

What test is used when assessing a patient with suspected de Quervain’s tenosynovitis?

A

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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