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MSRA > Surgery > Flashcards

Surgery Flashcards

1
Q

Management of nocturia (3)

A
  1. Advice r.e moderate fluid intake at night
  2. Furosemide 40mg late afternoon
  3. Desmopressin
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2
Q

Pharmacological management for overactive bladder (2)

Non pharmacological management (1)

A
  1. Oxybutynin/ tolterodine/ darifenacin (antimuscarinics)
  2. Mirabegron
  3. Bladder retraining
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3
Q

How long pre op should a patient stop the COCP?

A

4 weeks

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4
Q

VTE prophylaxis for post elective hip operations

A 
10 days LMWH + further 28 days low or high dose aspirin
OR
28 days of LMWH with stockings 
OR
Rivaroxaban
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5
Q

VTE prophylaxis for post elective knee operations

A 
Aspirin low or high dose for 2 weeks 
OR 
LMWH with stockings for 2 weeks 
OR 
Rivaroxaban
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6
Q

VTE prophylaxis for post fragility fractures of the hip

A

LMWH for 28 days

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7
Q

Post vasectomy when can a man have UPSI?

A

Needs two semen analysis at week 16 and week 20

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8
Q

O/E bag of worms

Subfertility =

A

Varicocele

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9
Q 
What is a varicocele?
Which side is it more common?
Diagnostic investigation (1)
A

Abnormal enlargement of testicular veins, much more common on left side. Usually asymptomatic.
USS

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10
Q

Swollen, tender testis retracted upwards =

A

Testicular torsion

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11
Q

What is testicular torsion?

What is the name of the congenital abnormality which leads to likely bilateral case of testicular torsion?

A

Twisting of spermatic cord leading to ischaemia and sudden onset pain.
Bell clapper testis

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12
Q

Name four features of testicular torsion

A
  1. Loss of cremasteric reflex
  2. Sudden onset pain, erythema and swelling
  3. Prehn’s sign
  4. High riding testes
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13
Q

What is Prehn’s sign?

A

Prehn’s

elevation of the testis does not ease the pain?

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14
Q

Most common cancer in male aged 20-30 =

A

Testicular cancer

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15
Q

Name the two types of testicular cancers and their subtypes

Which is more common?

A
  1. Germ cell (95%)
    - seminomas
    - non seminomas
  2. Non germ cell (5%)
    - Leydig cell tumours
    - sarcomas
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16
Q

RF for testicular cancer (5)

A
  1. Infertility
  2. Cryptorchidism
  3. FH
  4. Klinefelters
  5. Mumps orchitis
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17
Q

What is cryptorchidism?

A

Undescended testes

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18
Q

Features of testicular cancer (6)

A
  1. Painless lump
  2. Hydrocele
  3. Gynaecomastia
  4. AFP + LDH may be raised in germ cell tumours
  5. HCG may be raised in seminomas
  6. Dragging sensation
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19
Q

Peak incidence for which cancers is aged 25yo and 35yo

A

(Non seminoma) Teratoma = 25yo

Seminoma = 35yo

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20
Q

What is a hydrocele?

Classification

A

Accumulation of fluid within the tunica vaginalis
Usually found anterior and below the testicle
Communicating and non communicating

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21
Q

What is the treatment for testicular cancer?

A
  1. Orchidectomy

2. Chemo/ RT

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22
Q

Subarachnoid haemorrhage

Causes of SAH (5)

A
  1. Trauma
  2. Berry aneurysm
  3. AV malformation
  4. Infective aneurysms
  5. Arterial dissection
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23
Q

Subarachnoid haemorrhage

What may you find on an ECG?

A

ST elevation

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24
Q

Subarachnoid haemorrhage

Name two investigations

A
  1. CT head
    - hyperdense on CT scan
  2. LP
    If CT negative
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25
Q

When would you do an LP for SAH?
How long after the onset of symptoms?
What are you looking for? (2)

A

If CT negative
At least 12 hours post onset of symptoms
Looking for xanthochromia
Normal or raised opening pressure

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26
Q

What investigation would you perform to find out the cause of spontaneous SAH?

A

CT intracranial angiogram +/- catheter angiogram

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27
Q

Management of intracranial aneurysm?

A
  1. Coil

2. Craniotomy + clip

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28
Q

Name six complications of an aneurysmal SAH?

A
  1. Re-bleed
  2. Vasospasm (delayed cerebral ischaemia)
  3. Hyponatraemia (SIADH)
  4. Seizures
  5. Hydrocephalus
  6. Death
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29
Q

What medication is given to avoid spasm and for what duration?

A

Nimodipine 21 days

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30
Q

What is epididymitis/ epididymo-orchitis?

A

Infection of the epididymis +/- testes resulting in pain and swelling

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31
Q

Common organisms and age

A

<35yo chlamydia + gonorrhea

>35yo Ecoli, pseudomonas

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32
Q

Name four features of epididymo-orchitis

A
  1. Cremaster reflex +ve

2. Prehn’s sign +ve

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33
Q

What is the cremaster reflex?

A

Stoke inner thigh, testicle retracts up

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34
Q 
Hydrocele features (3)
Location (1)
A
  1. Transilluminate
  2. Non painful swelling
  3. Can get above it
  4. Normally found anterior and below the testicle
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35
Q

Difference between communication and non communicating hydrocele

A

Communicating - likely congenital
Incomplete closure of processus vaginalis
Usually resolve within first few months

Non communicating
- excessive fluid production within the tunica vaginalis

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36
Q

Management of communicating hydroceles

A

Usually resolve on their own

If not resolved by 1-2yo - surgery

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37
Q

Management of non communicating hydroceles

A

Conservative management

Repeat USS to check for tumours

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38
Q

Hydroceles can form due to which three conditions?

A
  1. epididymo-orchitis
  2. testicular torsion
  3. testicular tumours
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39
Q

Left sided varicocele could indicate which cancer?

A

Renal cell carcinoma

40
Q

What is the most common cause of scrotal swellings in primary care?

A

Epididymal cysts

41
Q

Where are epididymal cysts found?

A

Posterior to the testicle

42
Q

Name three associated conditions with epididymal cysts

A
  1. polycystic kidney disease
  2. cystic fibrosis
  3. von Hippel-Lindau syndrome
43
Q

Name two RFs for RCC

A
  1. von Hippel- Lindau syndrome

2. Tuberous sclerosis

44
Q

What is Stauffer syndrome?

Associated with which cancer?

A

Paraneoplastic hepatic dysfunction syndrome
Typically presents as cholestasis/hepatosplenomegaly
Associated with RCC

45
Q

Name three endocrine effects of RCC

A
  1. Increased EPO –> polycythaemia
  2. High calcium secondary to PTH
  3. Increased renin + ACTH
46
Q

Mx of RCC

A
  1. Partial or total nephrectomy

2. Alpha-interferon and interleukin-2 for patients with metastases and to reduce tumour size

47
Q

Prostate ca

More common in which race?

A

Afro-Caribbean

48
Q

DRE for prostate ca (3)

A
  1. asymmetrical
  2. hard, nodular enlargement
  3. loss of median sulcus
49
Q

Name six causes of raised PSA

A
  1. Cancer
  2. BPH
  3. UTI/ prostatitis (to postpone PSA for one month)
  4. Recent instrumentation of urinary tract
  5. Ejaculation or vigorous exercise in last 48 hours
  6. Urinary retention
50
Q

Criteria for 2 week wait referral:

A

DRE hard nodular prostate
OR
Aged 50-69, PSA is >= 3.0 ng/ml

51
Q

Prostate ca

Features (3)

A
  1. Bladder outlet issues: hesitancy/ urgency
  2. Haematuria
  3. Back/testicular/ perianal pain
52
Q

Diagnostic Ix to confirm prostate ca

Who gets a biopsy?

A

MRI
Findings of MRI reported using a 5 point Likert scale
Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered

53
Q

What is a Likert scale? How do you interpret this?

A

Findings of MRI reported using a 5 point Likert scale

Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered

54
Q

Ix of choice for renal colic
When would you need to do it immediately?
Ix of choice for pregger

Pain management (2)

A

CTKUB non contrast within 24 hours
OR
USS for pregnant women
If fever or solitary kidney

  1. NSAIDs (any route) +/- IV paracetamol
  2. Opiates - tramadol
55
Q

Mx of stones
What size will pass?
When is it an emergency?
Mx (2)

A

<5mm will pass on its own (usually within 4 weeks)
>5mm and signs of ureteric obstruction for emergency:
1. Nephrostomy OR
2. Ureteric stent + catheter

56
Q

Mx of renal colic in non emergency settings >5mm (3)

A
  1. Lithotripsy (1st line)
  2. Ureteroscopy (if pregnant) (stent remains in for 4 weeks)
  3. Percutaneous nephrolithotomy (if complex renal calculi and staghorn calculi)
57
Q

Name three types of stones in renal colic

A
  1. Calcium
  2. Oxolate
  3. Uric acid
58
Q

How to prevent calcium stones (3)

A
  1. Fluids ++
  2. Low Na, low animal protein diet
  3. Thiazide diuretics
59
Q

How to prevent oxolate stones

A
  1. Cholestyramine

2. Pyridoxine

60
Q

How to prevent uric acid stones

A
  1. Allopurinol

2. PO bicarb

61
Q

Penile cancer is what type of cancer

A

Squamous cell carcinoma

62
Q

Penile ca RF (8)

A
  1. Age >50
  2. Balantitis - inflammation of the foreskin and head of penis
  3. Paraphimosis - foreskin is retracted and cannot be pulled back down
  4. Phimosis - foreskin cannot be retracted
  5. HIV
  6. HPV
  7. Poor hygiene
  8. Genital warts
63
Q

Peripheral arterial disease management (4)

If that doesn’t work trial _______

A
  1. Not smoking
  2. Atorvastatin 80mg OD
  3. Clopidogrel
  4. Exercise training programme
If exercise programme doesn't work 
naftidrofuryl oxalate (vasodilator)
64
Q

Management of acute limb (4)

A
  1. Angioplasty
  2. Stenting
  3. Bypass surgery
  4. Amputation
65
Q

What is a hytadid cyst?

Diagnostic investigation

A

Tapeworm parasite Echinococcus granulosus
Causes cysts in liver and lung
CT

66
Q

Biliary colic, jaundice, and urticaria think?

A

Hytadid cyst rupture in biliary tract

67
Q

Below and lateral to the pubic tubercle hernia =
More common in multiparous women
Rx

A

Femoral

High risk of strangulation therefore surgery required

68
Q

Above and medial to pubic tubercle hernia =

A

Inguinal

69
Q

Lateral ventral hernia

Rare and seen in older patients

A

Spigellian

70
Q

A hernia that typically presents with obstruction

More common in females =

A

Obturator hernia

71
Q

Congenital inguinal hernia
Where do they come from?
R/L
Mx

A

Patent processus vaginalis
60% right sided
Surgery soon after diagnosis due to risk of incarceration

72
Q

Infantile umbilical hernia
Where are they found?
Which race?
Mx

A

Symmetrical bulge under the umbilicus
More common in premature and Afro-Caribbean babies
Most resolve on their own by age 4-5 years

73
Q

Causes of pancreatitis

A 
Gallstones
ERCP
Trauma
Steroids
Mumps 
Autoimmune
Scorpion bites
High lipids, calcium, hypothermia, 
Ethanol 
Drugs (AZT, mesalazine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
74
Q

Anal fissure
Acute
Chronic

A

<6 weeks

>6 weeks

75
Q

Name three RFs for anal fissures

A
  1. Constipation
  2. Inflammatory bowel disease
  3. STIs e.g. HIV, syphilis, herpes
76
Q

Mx anal fissures (5)

Acute

A
  1. Dietary advice - high fibre, high diet
  2. Bulk forming laxatives
  3. Lubricants
  4. Topical anaesthetic
  5. Topical steroids
77
Q

Mx anal fissures

Chronic

A
  1. Topical GTN if not effective after 8 weeks, to refer to surgeons
78
Q

Chronic straining and constipation =

A

Solitary rectal ulcer

79
Q

Ano rectal abscess - common bacteria

A

E.coli + Staph Aureus

80
Q

Proctitis common causes (2)

A
  1. IBD

2. C. diff

81
Q

Most common bacteria causing ascending cholangitis
Charcot’s triad:
Rx

A 
E coli 
1. Fever, jaundice, RUQ pain
Rx 
1. IV abx
2. ERCP within 24-48 hours to remove obstruction
82
Q

What is phimosis?

A

Foreskin cannot be retracted

83
Q

What is paraphimosis?

A

Foreskin pulled back and cannot return to original position

84
Q

What is balanitis?

A

Inflammation of the foreskin and head of the penis

85
Q

What is balanitis xerotica obliterans?

A

Lichen sclerosis of male genitalia

Chronic, inflammatory skin disease

86
Q

What is hypospadias?

A

Opening of the urethra is on the underside of the penis instead of at the tip

87
Q

Management of rectal cancers:

A
  1. Anterior resection (needs at least 2cm distally)

2. Abdomino-perineal excision of rectum (APER)

88
Q

When would you opt for the APER?

A
  1. Involvement of the sphincter complex OR

2. Very low tumours

89
Q

Rectal cancer who needs chemo/ RT
T1 T2
T3
T4

A

T1T2 do not need chemo/ RT
Short course of chemo/ RT
Long course of chemo/RT

90
Q

What type of surgery?

Anal verge

A

APER

91
Q

What type of surgery?

Low rectum

A

Anterior resection

92
Q

What type of surgery?

Upper rectum

A

Anterior resection

93
Q

What type of surgery?

Sigmoid colon

A

High anterior resection

94
Q

What type of surgery?

Distal transverse, descending colon

A

Left hemicolectomy

95
Q

What type of surgery?

Caecal, ascending or proximal transverse colon

A

Right hemicolectomy

MSRA (22 decks)

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