Surgery Flashcards
what medications and conditions can lead to priapism?
- medication
- PDE-5 inhibitors
- alpha-1 antagonists (prazosin)
- antidepressants (trazodone, SSRIs)
- sickle cell disease
- cauda equina syndrome
- leukaemia
- pevlic surgery or fracture
what is the fluid of choice for burns resuscitation?
LR
what intensive care intervention increases the chances of candidaemia?
central venous catheter
how should you interperet AFP in the context of diagnosing HCC?
AFP is elevated in 50% of HCC
positive result is highly suggestive
negative result cannot be used to rule out HCC
what is the difference between achalasia and EoE presentation?
progressive versus intermittent dysphagia
what are the biomarker patterns for seminoma and teratoma?
seminoma - AFP normal, bHCG elevated
teratoma - AFP elevated, bHCG elevated
what are the ottowa rules for XR foot/ankle?
ankle : tender at tip/posterior margin of medial/lateral malleolus
foot: tender at navicular, base of 5th metatarsal
both: cannot walk 4 steps, 2 on each foot
which parts of the bowel are most susceptible to ischaemia/necrosis from hypoperfusion?
splenic flexure
rectosigmoid junction
what is the management of a congenital umbilical hernia?
not to operate, just observe
most will close by age 5
consider surgery if they are irreducible, >1.5 cm or not resolving later in childhood
what are the interventions useful for lowering ICP?
raise head of the bed
hyperventilation
sedation
mannitol/hypertonic saline
removal of CSF - therapeutic LP, VP shunt
what are the complications of retropharyngeal abscess?
acute airway obstruction
contiguous spread leading to necrotizing posterior mediastinitis at the level of the diaphragm
spread to the carotid sheath and thrombosis of the internal jugular vein - CN IX, X, XI & XII defects
what blood test is used for monitoring medullary thyroid cancer following total thyroidectomy and why?
serum calcitonin
high rates of metastasis at the time of diagnosis
if it remains high will indicate a metastasis that needs identifying
if it becomes high again after a period of being normal will indicate a recurrance
which nerves will give referral otalgia in the setting of head and neck cancer? where will the lesions be?
glossopharyngeal - base of tongue
vagus - posterior oropharynx (larynx and hypopharynx)
what pathogens cause splenic collection?
how do they get there?
how is it diagnosed?
how is it treated?
strep, staph, salmonella
septic emboli - infective endocarditis
CT abdomen with contrast
splenectomy, antibiotics alone have a 50% mortality rate
how do you diagnose oesophageal perforation?
CXR
CT chest
barium swallow
what is the management of a cat bite?
cats have higher risk of wound infection
wound care with irrigation and decontamination
co-amox for 7 days
what would you typically find on culture of diabetic foot ulcers/osteomyelitis?
how do pathogens spread to the bone?
polymicrobial infection - Staph, Strep, Pseudomonas
contiguous spread
mutliple small necrotic ulcers over the lower abdomen
thrombocytopenia
on anticoagulation
Heparin-induced thrombocytopenia
gold-standard diagnosis for osteomyelitis?
open bone biopsy for culture
what intervention is needed to treat haemoptysis?
bronchoscopy - baloon tamponade, cautery
what is the differential for an anterior medistinal mass?
4 T’s
thymoma, ectopic thyroid, teratoma, terrible lymphoma
describe CT findings of focal nodular hyperplasia
triple contrast CT shows hyperdense lesion surrounding a central stellate scar
not related to OCP use, in contrast to hepatic adenoma
does not require intervention/treatment
what is dumping syndrome?
post-gastrectomy complication in as many as 50% patients
damage or resection of the pyloric sphincter leads to release of hypertonic, undigested stomach contents into the small bowel
fluid shift, autonomic activation and release of vasoactive intestinal peptide
treat with dietary modification
what are the echocardiogram features of severe AS?
what are the indications for valve replacement?
Severe = mean transvalvular pressure gradient >40 mmHg, aortic jet velocity >4.0 m/sec
usually has a valve area of <1.0 cm2 but not required
replacement: LVEF <50%, symptoms, undergoing another cardiac procedure
what is the diagnostic test for diverticular disease? what should be avoided?
CT with oral & IV contrast
sigmoidoscopy and colonoscopy are contra-indicated as there is a high risk of perforation
what are the indications for mitral valve replacement?
primary MR - LVEF 30-60%
if secondary to dilated CM, treat medically to reduce LV dilation
no role for surgical management; conversely, there is no role for medical management in primary MR
which trace metal element deficiency gives you impaired taste; pustular, crusting lesions; and alopecia?
Zinc
what structures can be damaged in a clavicle fracture?
brachial plexus
subclavian artery
what do you have to remember when thinking about tissue samples from testicular cancer?
scrotal/transscrotal approaches are associated with a worse outcome because they seed the tumour to the local lymphatic system and increase the risk of recurrance
what is the most common neurovascular injury with anterior shoulder dislocation?
axillary nerve damage, supplies deltoid
weakness of shoulder abduction
how do you manage a 2/3/4th metatarsal fracture?
the rest of the foot typically acts as a splint so fixation is unnecessary
rest and simple analgesia unless gross deformity
non-union is rare
what is the neurologic defect with a syringomyelia?
progressive loss of pain and temperature sensation at the level of the syrinx
flaccid paralysis seen if the syrinx expands to compress the ventral horn neurons
touch, proprioception and vibration sense are typically spared
what is the neurologic defect seen with cervical spondylosis?
weakness below the level of the lesion (UMN)
should be thought of like any other cord compression, associated neck pain and stiffness
what are the risk factors for pancreatic cancer?
smoking
obesity
chronic, nonhereditary pancreatitis
what is the triad of fat embolism?
respiratory distress
neurologic dysfunction (confusion)
petechial rash
when is HIDA scan the correct answer?
in the diagnosis of acute cholecystitis when US-RUQ proves inconclusive
nasopharyngeal cancer is associated with which infection?
EBV
what are the early and late complications of RYGB and their presentations?
early
- anastamotic leak (sepsis)
- bowel ischaemia (diffuse abdominal pain)
late
- gallstones from rapid weight loss (RUQ pain)
- stricture (dysphagia, bowel obstruction)
- marginal ulcer (pain, perforation, bleeding)
- dumping syndrome (diarrhoea, crampy abdominal pain, vasomotor symptoms)
what is the management of oesophageal perforation?
diagnosis with barium swallow
initial - NPO, IVF, PPI, antibiotics
contained? trial of medical management
non-contained? thoracotomy +/- laparotomy with debridement and repair
what is the determining factor in the prognosis of astrocytoma?
tumour grade/degree of anaplasia
GBM is another term for grade IV astrocytoma with very poor prognosis
