Surgery Flashcards
What is this disease
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Achalasia
30 year old patient had sister dx with breast cancer at age 47. How should they be screened?
As first degree relative <50, they should start annual screening at age 40 until 74.
Man with two first degree relatives dx with colon cancer (aged 74, 87). Screening?
FOBT every 2 years from 40-49
Colonscopy 5 yearly from 50-74
4 physical exam signs for appendicitis
Pain at McBurney’s point, Rovsing’s sign, Psoas sign, Obturator sign
Anterior nose bleed from what area?
Kieselbach’s plexus/ Little’s area
Treatment for achalasia? Ideal (1) + short term relief (1) + very old people (1)
Myotomy
Botulinum toxin
Endoscopic balloon dilatation
What sign is this and for what disease?
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Grey-Turner’s sign, acute pancreatitis
Pathophysiology indirect inguinal hernia
Failure of process vaglinalis to close
Parotid tumour without facial nerve involvement?
Pleomorphic adenoma
Scrotal swelling, attached to the testis and can be palpated posteriorly or at the upper pole of the testis
Epididymal cyst
What’s Psoas sign? What’s it for?
Right leg hip flexion against resistance causes RIF pain
Sign for appendicitis
Needle thoracotomy landmarks?
2nd intercostal space along the midclavicular line
Mets most likely to go to bone? (5)
Breast, Lung, Thyroid, Renal, Prostate
Pancreatic cancer tumour markers? (2)
CA 19-9 and CEA
Most common cause of bloody nipple discharge and differentials (4)?
Intraductal papilloma
Mastitis
Invasive carcinoma
Pages disease of breast
Inflammatory breat cancer
Mx of simple breast cyst in young woman?
Reassurance and no follow up
Most diagnostic test for acute pancreatitis?
Lipase
Familial risk for breast cancer increases with what gene?
Increase risk of what other cancers?
BRCA mutation
Prostate, ovarian, pancreatic
What do you offer BRCA mutation positive women?
Prophylactic bilateral masectomy and bilateral oophrectomy
Familial adenomatous polyposis mx?
Prophylactic colocectomy
What is this disease
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Diffuse oesophageal spasm
Radiation for colon cancer or rectal cancer?
Rectal
NO radiotherapy for colon
What causes this infection?
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Echinococcus granulosus
Where is McBurney’s point? What does it represent?
Right illiac fossa; 1/3 of the distance from ASIS to umbilicus
Maximum tenderness for appendicitis
What cancers are associated in lynch syndrome?
Lynch CEO
Colon cancer
Endometrial cancer
Ovarian cancer
Treatment of ascending cholangitis? (3)
IVABx (amoxycillin, gentamicin, metronidazole)
Emergent ERCP
Urgent or elective cholecysectomy
Clinical sign for painless gallbladder palpation?
Courvoisier’s sign
Chest drain placement landmarks?
4th intercostal space (along nipple line) in between anterior and median axillary line (safe triangle)
Investigation of mesenteric ischemia?
CT angiography
Severe for Ranson’s criteria within 48 hours?
GALL (ETOH)
Glucose ++
Age >55 years
Leukocytes ++
LDH++
Pathophysiology of direct inguinal hernia?
Weakness in transversalis fascia area of the Hesselbach triangle
Highest chance of colon cancer reoccurance in what time frame?
First 3 years
Women with dysphagia + iron deficiency anaemia?
Plummer-Vinson syndrome (oesopheal webs)
Next step if suspect urethra injury in trauma?
Urethrogram
What’s this condiiton? Associated clinical features?
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Eosinophilic oesophagitis
Young people with history of atopy
History of recurrent episodes of dysphagia
Failure to respond to proton pump inhibitors
Mx of high grade dysplasia in oesophagus?
Radiofrequency ablation
Treatment for diffuse oesophageal spasm
Calcium channel blockers
What’s Obturator sign?
What’s it for?
Flexion and internal rotation of right hip causes RIF pain
Sign of appendicitis
Initial (1) and best (1) test to work up potential oesophageal cancer?
Barium swallow
Endoscopy and biopsy
Investigation for boerhaave syndrome?
Contrast oesophragm with gastrogaffin
What is this and what disease?
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Cullen’s sign, acute pancreatitis
Pathophysiology of achalasia?
Absent myenteric plexus (inhibitory neurons causing unopposed lower oesophageal sphincter constriction)
Raynold’s pentad of gallstones?
Fever, RUQ pain, jaundice, hypotension, altered mental status
Involvement of what structures makes a pancreatic cancer unresectable in a Whipple’s procedure? (4)
Superior mesenteric artery
Superior mesenteric vein
Common hepatic artery
Portal vein
Most common cause of green nipple discharge?
Duct ectasia
5 causes of acute pancreatitis
Alcohol, gallstones, hypertriglyceridemia, Post ERCP, HIV drugs
2 possible causes of painless jaundice?
Head of pancreas tumour, cholangiocarcinoma
Indirect inguinal hernia location (2)
Above and medial to pubic tubercle
Lateral to epigastric vessels
Direct inguinal hernia location (2)
Above and medial to pubic tubercle
Medial to epigastric vessels
Clinically benign breast mass, not consistant with hormonal change. Further investigations?
Imaging:
<35 U/S or >35 Mammogram
Symptomatic cyst -> FNA
Solid or complex lesion -> core biopsy
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Posterior nose bleed from what area?
Woodruff’s plexus
When do you do a colonscopy for UC?
8 years post dx, then repeated yearly
What disease will show crepitation on auscultation of suprasternal notch?
Boerhaave syndrome
Charcot’s triad of gallstones?
Fever, RUQ pain, jaundice
Swelling of scrotum; visable when standing, soft, non tender, no cough reflex, seperate to testis, extends up inguinal canal, cannot reduce into abdominal cavity
Varicocele
What is Rovsing’s sign? What’s it for?
Palpation of LIF causes pain in RIF
Sign for appendicitis
Investigations for achalasia (3)
Initial: barium swallow (bird beak)
Confirmation: Manoetric studies
Additional: Endoscopy + biopsy to rule out cancer
5 gall stone diseases?
Cholelithiasis (stones in gallbladder)
Biliary colic (stone enters Hartman’s pouch after fatty meals)
Cholecystitis (stone in cystic duct causing gallbladder inflam)
Choledocholithiasis (stone in common bile duct + jaundice)
Ascending cholangitis (infected stone in common bile dust)
Breast cancer estrogen and progesterone positive; hormonal treatment pre-menopause and post-menopause?
Pre: tamoxifen (risk of endometrial cancer)
Post: arotamse inhibitors (letrozole)
What is Schatzki’s ring?
Benign thickening of lower oesophageal sphincter
Initial (1) and definitive (1) imaging for cholangiocarcinoma?
Abdominal US + MRCP
Follow up after surgical ressection of colon cancer?
First 3 years: CEA level every 3 months
Colonscopy after 1 year, then every 3-5 years
Lump below and lateral to pubic tubercle
Femoral hernia
Lump above and medial to pubic tubercle
Inguinal hernia
Man’s brother got dx with colon cancer at age 47. Screening?
FOBT every 2 years from 40-49
Colonscopy 5 yearly from 50-74
Corkscrew barium swallow?
Diffuse oesophageal spasm
South-East Asian man with lymphadenopathy, unilateral conductive hearing loss + recurrent nose bleeds; most likely diagnosis?
Nasopharyngeal carcinoma
40 year old patient. A large, smooth, firm, multinodular mass is palpable on the left breast. USS large, solid, mobile, hypoechoic, well-circumscribed left breast mass. Dx and Mx?
Phyllodes tumor + WLE
Sudden onset epigastric pain, radiating to left shoulder tip, haematemesis, feeling light headed. Dx, Ix, Mx?
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Perforated peptic ulcer
CBE, EUC, group and hold, endoscopy
ALS, Fluid resuscitation, endoscopy for cauterization
What’s this and how do you treat?
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Divarication
Weight loss and physiotherapy