Surgery Flashcards
1
Q
What is Pseudomembranous Colitis?
A
- Acute inflammatory condition which occurs secondary to antibiotic use
- Clostridium Difficile (gram positive anaerobe)
- Presentation is usually within 3 - 9 days, although symptoms may develop up to 6 weeks after antibiotic use
- Presentation = proximal colon and caecum and present with a RLQ pain which may mimic appendicitis
- Diagnosis = stool testing for Clostridium Difficile toxins
- Complications = hypovolaemic shock, electrolyte imbalance, hypoalbuminaemia, perforation of the bowel and toxic megacolon
2
Q
What is the management of Pseudomembranous Colitis?
A
- Fluid Resuscitation (mild cases do not require admission)
- Oral Metronidazole for 10 days
- Resistant and recurrent cases are treated with Oral Vancomycin
- intravenous preparations are avoided as the drug does not reach the intestinal mucosa
- Anti-Diarrhoeal Agents must be avoided as this would lead to retention of the C. difficile toxin
3
Q
What is Neurogenic Shock?
A
- Bradycardia
- Sudden disruption or injury to the sympathetic nervous pathways
- Results in loss of vasomotor tone and pooling of blood in the peripheries
- Severe Hypotension
- Causes of neurogenic shock include injury to the brain and spinal cord, and acute emotional stress
4
Q
What is Spinal Shock?
A
- Transient state occurring after injury to the spinal cord
- Loss of all voluntary and reflex activity below the level of the injury
- Hypotonic Flaccid Paralysis which also affects the bladder and bowel
- This loss can be complete initially but may resolve over a period of days and weeks following the injury
5
Q
What are the key features of an Arterial Ulcer?
A
- Painful
- Deep
- Well Demarcated
- Heels, Toes and over Bony Prominences
- Due to Arterial Insufficiency and Ischaemia = Atherosclerosis
- Dusky Discolouration
- Shiny, Hairless Skin
- Thickening of the Toenails
- Intermittent Claudication
- Poor Pulses
- Coronary Angiography =define arterial lesions which may be improved by angioplasty or vascular reconstruction
6
Q
What are the key features of an Venous Ulcer?
A
- Middle Aged Women
- Cause = Venous Hypertension and assoc w Varicose Veins
- Medial Gaiter Area (from the ankle to the proximal calf)
- Shallow
- Sloughy
- Surrounding skin = Oedematous, Dark (caused by haemosiderin deposition), Eczematous and Thickened (lipodermatosclerosis)
7
Q
What history questions should you ask in a Vascular Patient station?
A
- Vascular Risk Factors:
- personal or family history of diabetes
- smoking habits
- exertional capacity before onset of claudication (e.g. walking distance, number of stairs they can climb)
8
Q
What are the associations of Primary Biliary Cirrhosis?
A
- Rheumatoid Arthritis
- Sjogren’s Syndrome
9
Q
ERCP - ‘beading’ of the biliary tree
A
Primary Sclerosing Cholangitis
10
Q
What is Buerger Disease?
A
- Vasculitis of medium-sized vessels
- Results in progressive obliteration of distal arteries
- Young Men (< 45 years)
- Smoke heavily
- Asians and Ashkenazi Jews
- HLA-B12
- Pain = main symptom
- Chronic Inflammation and Thrombosis can result in Ulceration and Gangrene (often requiring amputations)
- Arteriography = normal proximal vessels and distal occlusions with multiple ‘corkscrew’ collaterals
- Management = analgesia and stop smoking - if tobacco use is not ceased, multiple amputations will be unavoidable
11
Q
What is Takayasu Arteritis?
A
- Pulseless Disease or Aortic-Arch Syndrome
- Granulomatous Inflammation of the aorta and its major branches.
- Hypertension
- Arm Claudication
- Absent Pulses
- Bruits
- Visual Disturbance (transient amblyopia and blindness)
- Systemic Illness (malaise, fever, night sweats and weight loss)
- Younger Asian Women
- Diagnosis = Angiography which shows aorta narrowing and its major branches
- Management = steroids but the condition is progressive and death occurs within a few years
12
Q
What are the markers of poor prognosis in Pancreatitis?
A
13
Q
What are the investigation findings in Pancreatitis?
A
- Raised Amylase (above 4 times the normal upper limit)
- 40 - 140 U/L
- Elevated Serum Lipase (2 times upper normal limit)
- 0 - 160 U/L
14
Q
What are the potential complications of a Supracondylar Fracture?
A
-
Volkmann Ischaemic Contracture
- brachial artery injury = circulatory compromise and ischaemia = fibrosis of the forearm compartment
- secondary to untreated compartment syndrome
- forearm appears to be shortened and held in flexion at the wrist and the fingers
- Treatment = surgery
- Carpal Tunnel Syndrome = median nerve injury
- Ulnar Nerve Palsy = stretching of the ulnar nerve over an increasing valgus deformity
- Cubitus Varus Deformity (‘gunstock deformity’) = malunion of supracondylar fractures
15
Q
What are the features of Chagas Disease?
A
- Central and South America
- Trypanosoma Cruzi = protozoa
-
Primary Disease
- skin nodule – a chagoma
- fever, malaise, lymphadenopathy etc
-
Secondary Disease
- 30% after years
- dysphagia (similar to achalasia)
- destruction of the oesophageal myenteric plexus
- retained food eventually results in oesophageal dilatation
- ‘megaoesophagus’ can be seen on barium swallow
31
Q
Tumour Markers?
A
