Surgery Flashcards

1
Q

Terminal ileum resection is associated with what kind of malabsorption?

A

Bile acids because they are resorbed in the terminal ileum.

Note that fats are resorbed in the jejunum. ***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mobile, firm, smooth and rubbery breast lump in a young woman

A

Fibroadenoma ***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Do what with a solid testicular mass or acute hydrocele in a young patient?

A

Exclude malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis of testicular cancer

A

Diagnosis is established by pathological evaluation of specimen obtained by radical inguinal orchidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Does orchiopexy reduce the risk of testicular carcinoma?

A

Surgical descent (orchiopexy) of undescended testis does not eliminate the risk of malignancy, but allows for earlier detection by self-examination and reduces the risk of infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors testicular cancer

A
  • Cryptorchidism
  • Atrophy
  • Sex hormones
  • HIV infection
  • Infertility
  • Family Hx
  • Past Hx of testicular cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tumour markers testicular ca

A

Beta-hCG, LDH, AFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for achilles tendon rupture

A
  • Longstanding tendonitis
  • Fluoroquinolones (famously ciprofloxacin)
  • Rheumatoid arthritis
  • Gout
  • Corticosteroid use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Simmond’s Test?

A

Simmonds’ test (also called the Thompson test or Simmonds-Thompson test) is used in lower limb examination to test for the rupture of the Achilles tendon.

The patient lies face down with feet hanging off the edge of the bed. If the test is positive, there is no movement of the foot (normally plantarflexion) on squeezing the corresponding calf, signifying likely rupture of the Achilles tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of achilles tendon rupture

A
  • Sural nerve injury
  • Re-rupture
  • Infection
  • Note the most common site of Achilles tendon rupture is 2-6 cm from its insertion where the blood supply is the poorest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management achilles tendon rupture

A
  • Athletic- surgical repair
  • Non-athletic - cast in plantarflexion 8-12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of scaphoid fracture

A
  • pain with resisted pronation
  • tenderness in the anatomical “snuff box”, over scaphoid tubercle, and pain with long axis compression into scaphoid
  • usually nondisplaced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of anatomical snuff box tenderness with normal X-Ray

A
  • A fracture may not be radiologically evident up to 2 wk after acute injury, so if a patient complains of wrist pain and has anatomical snuff box tenderness but a negative x-ray, treat as if positive for a scaphoid fracture and repeat x-ray 2 wk later to rule out a fracture;
  • if x-ray still negative, order CT or MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Riskiest part of the scaphoid to fracture

A

The proximal pole of the scaphoid receives as much as 100% of its arterial blood supply from the radial artery that enters at the distal pole. A fracture through the proximal third disrupts this blood supply and results in a high incidence of AVN/nonunion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Brachial plexus injuries accompany clavicular fractures in which area?

A

Proximal third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The major risk factor for slipped capital femoral epiphysis

A

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of slipped capital femoral epiphysis

A

Once SCFE is suspected, the patient should be non-weight bearing + remain on strict bed rest.

In severe cases, after enough rest the patient may require physical therapy to regain strength and movement back to the leg. SCFE is an orthopaedic emergency, as further slippage may result in occlusion of the blood supply and avascular necrosis (25%). Almost all cases require surgery, which usually involves the placement of one or two pins into the femoral head to prevent further slippage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which fracture is typically characterized by numbness and weakness of the pinkie finger with partial involvement of the ring finger as well, the “ulnar 1½ fingers”?

A

hamate bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DVT Prophylaxis in Hip Fractures

A

LMWH (i.e. enoxaparin 40 mg SC bid), fondaparinux, low dose heparin on admission, do not give <12 h before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

High-voltage pulsed galvanic stimulation (HGVS) can be used to prevent what?

A

Proctalgia fugax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Usual site for diverticulsosis

A

95% involve sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinical features of diverticulosis

A
  • uncomplicated diverticulosis: asymptomatic (70-80%)
  • episodic abdominal pain (often LLQ), bloating, flatulence, constipation, diarrhea
  • absence of fever/leukocytosis
  • no physical exam findings or poorly localized LLQ tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Investigation of choice in acute episodes of diverticulitis

A

Contrast CT

Colonoscopy 4-6 weeks after acute episode is over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diverticulitis complications

A

Complications (25% of cases)

  • Abscess: palpable, tender abdominal mass
  • Fistula: colovesical (most common), coloenteric, colovaginal, and colocutaneous
  • Colonic obstruction: due to scarring from repeated inammation
  • Perforation: generalized peritonitis (feculent vs. purulent)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diverticultis treatment

A

Medical treatment - NPO, IVF, and IV antibiotics (e.g. IV ceftriaxone + metronidazole)

  • Phlegmon/small pericolic abscess - Medical
  • Large abscess/fistula - Medical, abscess drainage ± resection with primary anastomosis
  • Purulent peritonitis (ruptured abscess) - Resection or Hartmann procedure
  • Feculent peritonitis - Hartmann procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Risk factors for haemorrhoids

A

increased intra-abdominal pressure:

  • chronic constipation
  • pregnancy
  • obesity
  • portal HTN
  • heavy lifting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Definition of an anal fissure

A

Tear of anal canal below dentate line

(very sensitive squamous epithelium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment options for chronic anal fissures

A
  • Stool softeners, increased fibre intake, and sitz baths
  • topical nitroglycerin or calcium channel blocker (nifedipine or diltiazam): increases local blood flow, promotes healing, and relieves sphincter spasm
  • Lateral internal anal sphincterotomy (most effective): relieves sphincter spasm to increase blood flow and promote healing; reserved for medically-refractory cases due to 5% chance of fecal incontinence
  • Alternative treatment: botulinum toxin A; inhibits release of acetylcholine (ACh), reducing sphincter spasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Benefits of laparoscopic vs open appendicectomy

A
  • Wound infection less likely
  • Intra-abdominal abscesses 2x more likely
  • Reduced pain on POD #1
  • Reduced hospital stay by 1.1 d
  • Sooner return to normal activity, work, and sport
  • Costs outside hospital are reduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Breast cancer risk factors

A
  • Gender (99% female)
  • Age (83% >50 yr)
  • Personal history of breast cancer and/or prior breast biopsy (regardless of pathology)
  • FH of breast cancer (greater risk if relative was first degree and premenopausal)
  • High breast density, nulliparity, first pregnancy >30 yr, menarche <12 yr, or menopause >55 yr
  • Decreased risk with lactation, early menopause, and early childbirth
  • Radiation exposure (e.g. mantle radiation for Hodgkin’s disease)
  • >5 yr HRT use, >10 yr OCP use
  • BRCA1 and BRCA2 gene mutations
  • Alcohol use, obesity, and sedentary lifestyle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the triple test for diagnosis of breast cancer?

A
  1. Clinical breast exam
  2. Imaging (U/S for <30 yr, mammography + U/S for >30 yr)
  3. Pathology (biopsy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bad prognostic indicators breast cancer

A
  • >5cm
  • High grade lesion’
  • Node positive
  • Oestrogen receptor negative
  • Inflammatory cancer
  • Positive margins
  • Lymphovascular invasion
  • Epidermal inclusion cyst
  • Dermal lymphatics involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Treatment options for stage I + II breast cancer

A

For stage I

Breast Conserving Surgery + axillary node dissection + radiotherapy

For stage II

Chemotherapy for premenopausal women or

postmenopausal and ER negative, followed by tamoxifen

if ER+

Mastectomy offers no survival benefit for stage I+II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Women who have received tamoxifen require follow up for which other malignancy?

A

Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Antibiotics in the management of appendicitis

A
  • Cefazolin + metronidazole if uncomplicated, peri-operative dose is adequate
  • Consider treatment with post-operative antibiotics for perforated appendicitis
  • For patients who present with an abscess (palpable mass or phlegmon on imaging and often delayed diagnosis with symptoms for >4-5 d), consider radiologic drainage + antibiotics x 14 d ± interval appendectomy once inflammation has resolved = (controversial)
  • Recent research supports antibiotic only treatment as reasonable for uncomplicated appendicitis, with 10-20% recurrence rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Elderly ppl presenting with appendicitis should have what investigation and why?

A

Colonoscopy to exclude neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of epidural hematoma

A

Treatment is generally by urgent surgery in the form of a craniotomy or burr hole. Without treatment, death typically results.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Indications for surgery in a blowout fracture

A
  • Any size defect with enopthalmos or hypoglobus
  • Diplopia
  • Entrapment of extraocular muscles
  • Fracture of orbital floor >50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Indications for surgical decompression in subdural haematoma

A
  • Unstable vital signs
  • Raised intracranial pressure
  • Clinical or CT signs of brain herniation (eg midline shift)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Characteristics of lumbar spinal stenosis pain

A
  • Worse on extension of the spine (therefore worse walking downhill)
  • Relieved by flexion of the spine
  • Relieved by sitting down
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Assessment of cruciate ligaments

A

The drawer test is used in the initial clinical assessment of suspected rupture of the cruciate ligaments. The pt is supine with hips flexed to 45 degrees, knees flexed to 90 degrees and feet flat on table. The examiner sits on the examination table in front of the knee and grasps the tibia just below the joint line of the knee. The thumbs are placed along the joint line on either side of the patellar tendon. The tibia is then drawn forward anteriorly. If the tibia pulls forward or backward more than normal, the test is considered positive. Excessive displacement of the tibia anteriorly suggests ACL injury, and excessive posterior displacement of tibia may indicate injury of posterior cruciate ligament.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Best treatment for a buckle (greenstick) fracture

A

Removable splint for 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the system by which toxic levels of thyroid hormone can contribute to premature death?

A

Via the SERCA-phospholamban system which affects contractility of cadiac muscles leading to potential palpitations, sinus tachcarida and atrial fibrillation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Rubber band ligation is a treatment for which type of haemorrhoid?

A

Internal only. Would be too painful otherwise.

45
Q

What’s the appropriate management of a thrombosed haemorrhoid presenting within 48 hours?

A

Elliptical excision of the haemorrhoid under local anaesthetic

46
Q

What’s the mainstay of treatment for patellofemoral syndrome?

A

Exercise

47
Q

Nerves potentially injured in a proximal humerus fracture

A

Axillary (supplies motor to deltoid and sensory to a patch over deltoid) and suprascapular

48
Q

Management of thyroid nodule with normal TSH

A

FNA + ultrasound

If TSH is suppressed do a radionucleide scan and then only do an FNA if there is no increased uptake

49
Q

Investigation of choice for a middle aged or elderly person presenting with pain LLQ, fever, peritonism, anorexia and leukocytosis

A

CT abdo

50
Q

Cause of scapular winging after axillary lymph node dissection in breast cancer surgery

A

Long thoracic nerve injury

51
Q

What’s this and what is it for?

A

Supination-flexion technique for radial head subluxation

52
Q

What is autonomic dysreflexia?

A

Autonomic dysreflexia (AD) is a condition of uncontrolled sympathetic response secondary to a precipitant, that generally occurs in patients with injury to the spinal cord at levels of T6 and above.

53
Q

What is this? Which vessel is usually responsible?

A

Epidural hematoma

Middle meningeal artery

54
Q

Poor Prognostic Indicators for Epidural Hematoma

A
  • Older age
  • Low GCS on admission
  • Pupillary abnormalities (especially nonreactive)
  • Longer delay in obtaining surgery (if needed)
  • Post-operative elevated ICP
55
Q

Structures potentially at risk in knee dislocation

A

Popliteal artery 30-35%

Common peroneal nerve 15-30%

Tibial nerve

56
Q

What does a high serum ascites albumin gradient (SAAG) gradient (SAAG >1.1 g/dL) indicate?

A

Portal hypertension

57
Q

What are the first and second biggest causes of ascites?

A
  1. Portal hypertension
  2. Peritoneal carcinomatosis
58
Q

Management of clavicle fractures

1) Middle #
2) Displaced distal third #
3) Comminuted # in a child

A
  1. Conservative
  2. ORIF
  3. Conservative
59
Q

What does the swirl sign indicate?

A

Active haemorrhage

60
Q

What are grade I haemorrhoids and how do you treat them?

A

Grade I = bleeding without prolapse

High fibre diet, stool softeners, warm baths

61
Q

What are grade II and III haemorrhoids and how do you treat them?

A

Grade II- prolapse w spontaneous reduction

Grade III- prolapse w manual reduction

Initially treat non-surgically w rubber band ligation

62
Q

Preferred method of biopsy for any suspicious skin lesion

A

Complete elliptical excision

63
Q

Management of 2nd + 3rd metatarsal stress fractures

A

Rest, ice, acetominophen

64
Q

The testicular tumour with the worst prognosis

A

Choriocarcinoma

65
Q

When should preoperative antibiotics be given?

A

An hour before surgery

66
Q

Major side effects of azathioprine post renal transplant

A

BM suppression + hepatotoxicity

67
Q

Gold standard invetigation for diagnosing a pituitary adenoma

A

Brain MRI

68
Q

Treatment of alcohol withdrawl in a pt over 65 or with liver disease

A

Lorazepam (or a short acting benzo) 1-4mg 1-2hourly

69
Q

Significance of intramural gas on abdo X-ray

A

Intramural gas can be seen in intestinal ischaemia and eventually bowel infarction. This is the most concerning aetiology for intramural gas.

Gas in the bowel wall in the neonatal period, whatever its shape, is diagnostic of necrotising enterocolitis.

70
Q

What is this?

Generalised diffuse and constant pain, out of proportion to the clinical findings

Associated nausea and vomiting in around 75% of cases

Hx of AF or other embolic sources

A

Acute mesenteric ischaemia

71
Q

Definitive Ix for mesenteric ischaemia

A

CT scan with IV contrast (as a triple phase scan, with thin slices taken in the arterial phase)

72
Q

Key points about acute mesenteric ischaemia

A
  • Acute mesenteric ischaemia is most commonly caused by an embolus, yet may also be caused by a thrombus-in-situ, venous occlusion, or non-occlusive causes
  • Patients present with excessive pain, out of proportion to clinical findings with typically an otherwise unremarkable examination
  • Ensure to assess for potential sources of embolus
  • Definitive diagnosis is made via CT angiography
  • Surgical treatment involves either bowel resection or revascularisation, however mortality rates are >50% even in treated cases
73
Q

Compartment syndrome basics

A
  • Compartment syndrome is most common in the lower limbs, typically following traumatic injury or fractures
  • Diagnosis is clinical, the main symptom being pain disproportionate to the injury or worsening despite treatment
  • Definitive treatment is with an emergency open fasciotomy
  • Monitor the patient for rhabdomyolysis and reperfusion syndrome as potential complications
74
Q

Left sided supraclavicular lymph node

A

Virchow’s node, ca stomach

75
Q

Modality of choice for assessment of facial skeleton

A

CT

76
Q

Complications of compartment syndrome

A
  • Rhabdomyolysis
  • Renal failure due to myoglobinuria
  • Volkman’s ischaemic contracture
77
Q

Management of compartment syndrome

A

Fasciotomy

78
Q

Evaluate adolescents with varicoele with what?

A

Testicular volume estimation. If normal, observe with annual follow up

79
Q

Varicose veins usually involve which vein system?

A

Saphenous

80
Q

First step in a haemodynamically stable lower GI bleeed. Second step if this doesn’t identify the cource of bleeding.

A
  1. Colonoscopy
  2. CT angiography
81
Q

The most common causes of mechanical small bowel obstruction

A
  1. Adhesions
  2. Hernias
82
Q

Treatment for haemorrhoids with the best evidence base

A

Fibre

83
Q

Canadian colorectal cancer screening programme

A

50-75 FOBT two yearly or sigmoidoscopy 10 yearly

84
Q

Gold standard Ix for urthethral injury in men

A

Retrograde urethrography

85
Q

Potential consequence of myoglobinuria

A

Acute kidney injury

86
Q

First investigation in fibroadenomatous disease in symptomatic women under 30

A

Ultrasound- to establish cystic vs solid lesion

87
Q

Haematoma after thyroidectomy- initial management

A

This is a life-threatening situation- explore the wound first before you intubate though

88
Q

An emergency tracheotomy goes where?

A

Cricothyroid membrane

89
Q

What is a Maisonneuve fracture?

A

Maisonneuve fracture refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus. It is caused by a pronation-external rotation mechanism.

90
Q

Signs of rotator cuff tear

A

Positive active painful arc test

Positive drop arm test

Weakness in external rotation

91
Q

Name three nonsurgical modalities to investigate lower GI bleeding

A
  1. Colonoscopy
  2. Radionuclide scan
  3. Angiography
92
Q

Tests of ACL stability

A
  • Anterior Drawer
  • Lachman
  • Pivot Shift
93
Q

Rovsing’s sign

A

If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.

94
Q

Cystoid macular edema is the most common complication of which operation?

A

Cataracts

95
Q

The most common cause of unilateral nasal obstruction

A

Septal deviation

96
Q

What is extended FAST?

A
  • Focussed Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound examination performed at the time of presentation of a trauma patient.
  • It is considered as an ‘extension’ of the trauma clinical assessment process, to aid rapid decision making.
  • The chief aim of the study, in a trauma patient, is to identify intraperitoneal free fluid (assumed to be haemoperitoneum in the context of trauma) allowing for an immediate transfer to theatre, CT or other.
97
Q

Procedure for a chronic anal fissure

A

Lateral sphincterotomy

98
Q

Best treatment for persisting de Quervains tendinopathy

A

Local corticosteroid injection

99
Q

Initial management of large spontaneous pneumothorax >3cm in a healthy and stable person

A

Just needle aspiration

Smaller ones <3cm you can just give supplemental oxygen and observe

If it is a tension pneumothorax and they are unstable they can have needle decompression then chest tube

100
Q

Ca pancreas risk factors

A
  • Male
  • African origin
  • Smoking

Also

  • Chronic pancreatitis
  • High fat diet
  • Diabetes
101
Q

The best test for detecting an ACL tear

A

Lachman test

102
Q

Psoas sign

A

The psoas sign indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).

103
Q

Who gets an ankle x-ray in the Ottawa ankle rules?

A

There is any pain in the malleolar zone; and,

Any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
  • Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
  • An inability to bear weight both immediately and in the emergency department for four steps.
104
Q

Clinical Predictors of Increased Perioperative Cardiovascular Risk

A

Major

  • Unstable coronary syndromes
  • Acute or recent myocardial infarction with evidence of important ischemic risk by clinical symptoms or noninvasive study
  • Unstable or severe angina (Canadian class III or IV)
  • Decompensated heart failure
  • Significant arrhythmias
  • High-grade atrioventricular block
  • Symptomatic ventricular arrhythmias in the presence of underlying heart disease
  • Supraventricular arrhythmias with uncontrolled ventricular rate
  • Severe valvular disease
105
Q

Which part of the duodenum is the most prone to rupture in blunt abdominl trauma?

A

The second part

106
Q

What are these suggestive of?

a) Crescent-shaped haematoma
b) lens shaped haematoma
c) multiple petechial haemorrhages
d) whitening of subarachnoid cisterns
e) ring enhancing lesion

A
  • a) subdural haemorrhage
  • b) epidural haemorrhage
  • c) diffuse axonal injury
  • d) subarachnoid haemorrhage
  • e) metastatic lesion, demyelinating disease, or brain abscess
107
Q

Potential radiotherapy strategy for single, inoperable or deep seated brain metsastases

A

Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional abnormalities and small tumors of the brain. It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue.

108
Q
A
109
Q

Management of a basal cell carcinoma

A

Excise it with a 1cm margin

Lymph node clearance is not required

Metastatic work up is not required

***