Surgery Flashcards
What is the preferred site for an emergency airway
The cricothyroid membrane
This is not a tracheostomy but it is below vocal chords and therefore bypasses any laryngeal obstruction
Best initial management for toe swelling and erythema and seropurulent drainage and ulceration of nail fold. Tender.
Partial avulsion of the medial nail plate and phenolization of the matrix
Meets criteria for moderate severity therefore evidence shows antibiotics before or after phenolization does not decrease healing time
Common complication of varicose vein sclerotherapy presenting as pain and redness and a superficial hard knot
Superficial thrombophlebitis
Side effects of sclerotherapy (13)
Hyperpigmentation Temporary swelling Capillary dilation Localised hives Vasovagal reflex Localised skin death Allergic reaction Superficial thrombophlebitis Arterial injection DVT PE Nerve damage Migraine headaches
What are varicose veins
Subcutaneous, dilated, tortuous veins greater than 3mm in diameter, usually caused by venous insufficiency and incompetent valves
What is sclerotherapy in the context of varicose vein treatment
Injecting vein lumen with a sclerosis get substance such as hypertonic saline, or a detergent solution or corrosive agent which reacts with vascular endothelium and seals the vein leading to permanent collapse.
Clinically effective for small varicose veins
Typical features of a basal cell carcinoma
Rolled out edges
Often beaded
Floor shows scabbing in places and breaking at others
Management of stress fractures
Avoiding activities that cause pain, with resumption of activities in 4-8 weeks as tolerated
Radiographs may not be positive for 2-6 weeks after onset of symptoms
Goligher’s classification of haemorrhoids and management
Grades internal haemorrhoids
Grade 1 - bleeding without prolapse
Conservative. High fibre, stool softeners and warm baths
Grade 2- prolapse with spontaneous reduction
Non surgical procedures such as band ligation
Grade 3- prolapse with manual reduction
Non surgical procedures such as band ligation
Grade 4- incarcerated irreducible prolapse
Requires surgical intervention
Where are internal haemorrhoids most likely situated
Haemorrhoid also venous cushions are situated in 3 main places
Left lateral 3oClock
Right posterior 11oClock
Right anterior 7oClock
Grades of splenic rupture
Grade 1 - capsular tear <1cm parenchyma depth with subscapular haematoma <10% surface area
Grade 2 - capsular tear 1-3cm parenchymal depth with supscapular haematoma 10-15% surface area or intraparenchymal <5cm
Grade 3 - capsular tear >3cm parenchyma depth, or any tear involving trabecular vessels with supscapular >50% or intraparenchymal >5cm or any expanding ruptured haematoma
Grade 4 - laceration involving segmental or hilar vessels, devascularising >25% of the spleen
Grade 5 - completely shattered spleen or hilar vascular injury, devascularising the entire spleen.
Post op day 2 for subarachnoid bleed secondary to ruptured aneurysm presents with arm weakness and altered consciousness
Likely diagnosis.
Vasospasm
Can develop several days after haemorrhage. They present with progressive weakness and alterations in consciousness
selective dorsal rhizotomy involves which fibres
Type 1 a sensory fibers
causes of urinary retention
outflow obstruction
Bladder innervation
Pharmacological
Infection
Drugs causing urinary retention
anticholingerics narcotics antihypertensives (methyldopa) OTC cold meds antihistamines psychosomatic drugs such as ecstasy
Types of renal stones
Calcium
Uric acid
Struvite
cystine
detrusor muscle innervation
contracts –> parasympathetic, acetyl choline
Relaxes –> sympathetic stimulation of alpha-adrenergic receptor
drugs commonly causing incontinence
Alcohol
Calcium channel blockers
Diuretics
Lithium
types of urinary incontinence
Stress
Urge
overflow
features of ureteric colic
episodes last less than 8 hours patients appear restless and writhing in pain Urine may be smoky due to haematuria Tenderness at the costovertebral angle abdominal back and muscle spasm intense colicky pain begins in loin and radiates around flank to the groin, thigh or labia and testicles sometimes associated with vomtiing Appear pale cool and clammy
Investigations for renal colic
Urine:microscopy, dip analysis
IVP: confirms opacity, level of obstruction, kidney function and anatomical abnormality
USS: may locate calculus but will exclude obstruction
CTKUB: preferred for most adults with stones
Risk factors for developing kidney stones
Decreased ingestion of green leafy vegetables Dehydration distal renal tubular acidosis G6PD deficiency Hereditary hyperparathyroidism increased urinary proteins IBD Medullary sponge kidney High sodium intake myeloproliferative disorders sarcoidosis sedentary life style
Differential diagnosis Renal colic
pyelonephritis papillary necrosis muscle pain herpes zoster acute renal infarction
most common cause of chronic unilateral nasal obstruction
nasal septal deviation
common causes of haematuria
- benign essential haematuria
- benign prostate hyperplasia
- urethral infection
- bladder infection
- urinary tract trauma
- nephrolithiasis
- urethral calculi
- bladder tumor
- renal cyst
- renal tumor
Parkland equation for Burns
4ml X weight in Kg X %BSA of burns
first 50% of ringers lactate is give in 8 hours and the next 50% over 16 hours
Colles fracture
dorsal displacement of the distal radius fragment
treatment of collet fracture
traction with extension, ulnar deviation, pronation, and flexion of the distal fragment
Lachmans test
strong evidence of ACL tear
