Surgery 7 Flashcards
List two major complications of acute sinusitis.
Periorbital cellulitis
Brain abscess
Describe Perthes test.
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
What flow rate and percentage of oxygen can be administered through nasal prongs?
1-4 L/min
24-40% oxygen
List some indications for surgical treatment of UC.
ACUTE - Toxic megacolon - Perforation - Severe GI bleeding CHRONIC - Failure of medical management - Malignancy - Failure of maturation in children
List some causes of knee effusions.
Synovial fluid: synovitis
Blood: ACL rupture, intrarticular fracture, meniscal tear, bleeding diathesis
Pus: septic arthritis
What is a dominant peroneal artery?
Present in 5% of the population
Dorsalis pedis pulse is absent but a pulse can be felt just anterior to the lateral malleolus
What is the most appropriate surgical management option for most rectal tumours?
Anterior resection
NOTE: low rectal tumours should be managed with abdominoperineal resection
NOTE: Hartmann’s procedure is used for sigmoid tumours
What operations are likely to require a loop ileostomy?
Anterior resection (colon cancer) Bowel rest (Crohn's disease)
NOTE: this stoma is used to rest the bowel distal to the stoma
How should patients be positioned when examining their hernial orifices?
Start with them standing
Then repeat the examination with them lying down
Which investigations are usually requested for patients attending a rapid access clinic for haematuria?
MSU
Renal/bladder ultrasound
CT urogram (all > 50 yrs + all with frank haematuria)
Flexible cystoscopy
What is a bunion?
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
Outline the management of gangrene.
Take cultures
Debridement
Antibiotics (e.g. vancomycin, cephalosporins)
EPONYMOUS OPERATIONS: umbilical hernia
Mayo repair: double-breast the linea alba +/- sublay mesh
List some complications of open repair of AAA.
Mortality (elective: 5%; emergency: 50%) MI Renal failure Anastomotic bleeding Graft infection Spinal or mesenteric ischaemia Distal trash from thromboembolisation Aortoenteric fistula
EPONYMOUS OPERATIONS: femoral hernia
Lockwood approach - low incision over hernia with herniotomy and herniorrhaphy (ELECTIVE)
McEvedy approach - high approach in inguinal region with herniotomy and herniorrhaphy (EMERGENCY)
Describe how neck of femur fractures are defined based on their anatomical location.
INTRAcapsular: subcapital, transcervical, basicervical
EXTRAcapsular: intertrochanteric, subtrochanteric, reverse oblique intertrochanteric
What do you ‘look’ for when examining a joint?
Scars
Swelling
Deformity
Redness
What are the ways in which you can reduce closed and open fractures?
Closed –> manipulation or traction (skin or skeletal pins in bone)
Open –> mini-incision or full exposure
What operations would require a Mercedez-Benz/Rooftop incision?
Hepatobiliary surgery (e.g. liver transplant, Whipple’s, liver resection, gastric surgery)
What is the normal range of motion for a hip joint?
Abduction: 45 Adduction: 30 Flexion: 130 Internal rotation: 20 External rotation: 45
What is mallet finger?
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
EPONYMOUS OPERATIONS: chronic venous insufficiency
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
Outline bladder tumour staging.
Ta - within mucosa
T1 - into submucosa
T2 - into muscularis propria
T3 - into perivesical fat
EPONYMOUS OPERATIONS: undescended testicle
Dartos Pouch Procedure - mobilisation of testis and placement in a pouch via a hole in the dartos muscle
What is a major contraindication for TED stockings?
Arterial disease (e.g. peripheral vascular disease) Severe skin breakdown (ulceration/infection)
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
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
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
List some specific complications of colonic surgery.
EARLY: ileus, acute acalculous cholecystitis, anastomotic leak, enterocutaneous fistulae, abdominal abscess
LATE: adhesions (obstruction), incisional hernia
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
Define aneurysm.
Abnormal dilatation of a blood vessels to > 50% of its normal diameter
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
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
List some complications of ERCP.
Pancreatitis (5%)
Bleeding (check clotting beforehand)
Bowel perforation
Contrast allergy
What are the different types of internal fixation?
Intramedullary –> pins or nails
Extramedullary –> plate/screws or pins
List some differentials for knee osteoarthritis.
Septic arthritis
Medial meniscus tear
Gout
Rheumatoid arthritis
How are pharyngeal pouches treated?
Dohlman’s procedure - minimally invasive endoscopic stapling
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
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
Where are port sites usually found for a laparoscopic cholecystectomy?
Umbilicus
Epigastrium
Right costal margin
Right flank
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
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
EPONYMOUS OPERATIONS: varicocele
Palomo operation - high retroperitoneal approach for ligation of testicular veins, transverse incision at midinguinal point on level of ASIS
List some indications for surgical thyroidectomy.
Mechanical obstruction Malignancy Cosmetic Failure of medical treatment Mediastinal extension
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
List some complications of carotid endarterectomy.
Stroke or death
Haematoma
MI
Nerve injury (hypoglossal, great auricular (numb ear lobe), recurrent laryngeal nerve)
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)
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
List some differentials for LIF masses.
Faecal mass Colon cancer Diverticular mass Transplanted kidney Ovarian tumour/fibroid Ectopic kidney Iliac artery aneurysm
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
