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Surgery Flashcards

1
Q

What might be seen in x-ray to suggest Boerhaave’s over a Mallory Weiss tear?

A

Pneumoperitoneum

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2
Q

Management of Boerhaave’s disease

A

IV fluid resuscitation
IV antibiotics to cover/treat mediastinitis
Surgical correction

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3
Q

Features of Boerhaave’s disease

A 
Severe chest pain, worse on swallowing 
Vomiting up blood (or not)
Signs of shock
Subcutaneous emphysema
Pneumomediastinum, pleural effusions, pneumothorax on x-ray
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4
Q

Which investigation can help to confirm achalasia after a bird’s beak appearance has been seen on barium swallow?

A

Manometry

To assess the pressures in the oesophageal sphincters

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5
Q

Most common cause of LARGE bowel obstruction

A

Colorectal cancer

The way you know its large bowel is that the obstruction will be in the periphery of the abdomen

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6
Q

Most common cause of SMALL bowel obstruction

A

Adhesions from previous surgeries

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7
Q

Management of large bowel obstruction

A

Supportive care – analgesia, IV fluids, anti-emetics

Decompression of sigmoid volvulus – using flexible sigmoidoscope

Palliative care – a proportion of patients who present with malignant large bowel obstruction are not candidates for surgery. Palliative stenting of the obstruction can be performed to help relieve symptoms.

The majority of patients (70%) with large bowel obstruction require surgical intervention – laparoscopic or open colonic resection. This can involve a primary anastomosis or stoma formation

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8
Q

Emergency surgery for rectal cancer causing bowel obstruction

A

Loop colostomy

Too risk to go straight in and remove the cancer at this point, just make that bit of bowel defunctioning

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9
Q

What do you do with varicose veins that are symptomatic despite compression treatment?

A

Stripping

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10
Q

Single tortuous varicosity present on the postero-lateral aspect of the lower left leg indicates varicose veins of which vein?

A

Short saphenous

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11
Q

Management of tumour lysis syndrome

A

Rehydration and haemodialysis

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12
Q

Symptoms of hyponatraemia

A

Dizziness

Generalised weakness

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13
Q

Diuretics that can cause hyponatraemia

A

Thiazide diuretics e.g bendroflumethazide

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14
Q

Whirlpool sign on USS indicates…

A

Ovarian torsion

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15
Q

Which abdominal x-ray finding for caecal volvulus?

A

Embryo sign

Originates from the right lower zone (where the caecum is)

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16
Q

Which abdominal x-ray finding for sigmoid volvulus?

A

Coffee bean sign

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17
Q

Surgical options for chronic limb ischaemia

A

If one obvious artery blocked on CT angiogram, or venous doppler, you can perform percutaneous angioplasty
Other options = bypass and amputation

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18
Q

RF for limb ischaemia

A 
Smoking.
Diabetes mellitus.
Hypertension.
Hyperlipidaemia: high total cholesterol and low high-density lipoprotein (HDL) cholesterol are independent risk factors.
Physical inactivity.
Obesity.
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19
Q

Conservative/medical approach to chronic limb ischaemia

A

Antiplatelet therapy: with clopidogrel 75mg once daily. Aspirin is prescribed only if clopidogrel is not tolerated or contraindicated.
Lipid lowering therapy: with atorvastatin 80mg once nightly.
In diabetics, glycaemic control should be optimised.
High blood pressure should be managed appropriately.

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20
Q

Features of gallstone ileus

A

History of gallstones
Signs of bowel obstruction
Air in the biliary tree

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21
Q

USS signs of intussception

A

US abdomen reveals concentric echogenic and hypoechogenic bands
“Target sign”

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22
Q

Treatment of schistosomiasis

A

Praziquantel

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23
Q

Schistosomiasis is linked with which bladder cancer?

A

Squamous cell carcinoma

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24
Q

Management of ascending cholangitis

A 
Fluid
Antibiotics 
Biliary drainage
ERCP and stent insertion
SEPSIS protocol
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25
Management of diverticular disease
Patients with asymptomatic diverticulosis (i.e. diverticula are seen incidentally on imaging/endoscopy) do not require treatment. Patients with symptomatic diverticular disease should be advised to increase dietary fibre intake and hydration. If there is evidence of inflammation of the diverticula (diverticulitis) e.g. leukocytosis, fever, patients are initially managed with oral antibiotics (e.g. 7 days co-amoxiclav). Analgesia may also be required. This should be prescribed in a step-wise fashion, starting with oral paracetamol. A low residue diet should be advised. If patients fail to improve after 72 hours of oral antibiotics, admission to hospital for intravenous antibiotics (e.g. ceftriaxone and metronidazole) is required.
26
Which scoring system for head trauma?
Canadian CT head rule
27
Management of pancreatitis
Aggressive fluid resuscitation Aim to keep urine output > 30 mL/hour Start with a 1 litre bolus and try to maintain adequate urine output. This usually amount to a fluid requirement of 3 – 5 ml/kg/hr Catheterisation Analgesia Strong analgesia in the form of opioids are needed Anti-emetics IV antibiotics are shown to have no real effect in outcome unless necrotising pancreatitis is present. Necrotising pancreatitis is a complication of severe pancreatitis representing inadequate fluid resuscitation during initial management. It is usually diagnosed by CT scan. Calcium may be given if hypocalcaemia is present, but is not prescribed prophylactically. Insulin may also be given in the presence of hyperglycaemia due to the damaged pancreas reducing release of the hormone.
28
Treatment of epididymo-orchitis
Azathioprine or other antibiotics
29
How do you treat high output stoma (>1.5L/day)
Restrict oral fluids and prescribe IV dextrose | You can also prescribe loperamide to help reduce output aswell as omeprazole to reduce secretions
30
Complications of stoma
Complications can be classified into early and late complications. Early complications can be further classified into mechanical and functional complications. Early mechanical complications include bowel ischaemia/necrosis, bowel retraction, and para-stomal abscess formation. Early functional complications include poor stoma function and high output stoma. Late complications can be further classified into mechanical, functional, and psychosocial complications. Late mechanical complications include para-stomal hernia formation, bowel stenosis and prolapse, adhesion formation leading to bowel obstruction, and para-stomal dermatitis. Late functional complications include bowel dysmotility (leading to constipation/diarrhoea) and malabsorption (e.g. if the terminal ileum is removed this can cause B12 deficiency). The patient may also develop psychosocial complications, relating to difficulties with body image and sexual activity
31
3 components to MEN1
Para-pan-pit
32
Ix for Zollinger-Ellison syndrome
Secretin stimulation test
33
Features of Zollinger-Ellison syndrome
Refractory GORD and abdominal pain despite treatment | Weight loss
34
Management of Stanford B aortic dissections
Intravenous beta blockade (e.g. with IV labetalol). This reduces the pulsatile force on the intima, preventing propagation of the dissection and aortic rupture. Intravenous morphine. This provides analgesia and helps maintain haemodynamic stability by reducing sympathetic tone. If beta blockade is insufficient, alternative antihypertensive vasodilator therapy should be administered (e.g. nitroprusside or diltiazem). For type B dissection with complication (such as ischaemia, expansion, persistent pain, or aortic rupture), endovascular stent-graft repair is indicated.
35
Management of Stanford A aortic dissection
Immediate open repair
36
Ix for aortic dissection
CT angiography
37
Treatment of acute limb ischaemia
Surgical embolectomy Angiography to confirm the site If unsuccessful, can attempt on the table thrombolysis (very risky) ?LMWH, consult senior
38
Features of Boorhaave's perforation clinically
Hypotensive Pneumoperitoneum Common for the patient to NOT vomit up blood
39
Difference between Boorhaave's and oesophageal rupture
Boorhaves is due to increased pressure (e.g. vomiting), rupture could be from a fish bone or something
40
Pt, post-cholecystectomy, now has increasing abdo pain and the drain is draining bile There are deranged LFTs Most likely Dx and what the Ix and Mx?
Bile leak Dangerous, usually caused by slipped clips or a missed stone Ix with ERCP and stent it to allow for biliary drainage
41
Features of post-cholecystectomy syndrome
Presents many weeks/months after the operation Clinically stable Recurring abdominal pain and reflux symptoms
42
Features of cholecystitis
``` Right upper quadrant/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated) Fever Nausea and vomiting Right upper quadrant tenderness Murphy's sign positive ```
43
Mx of mild acute cholecystitis
Antibiotics and simple analgesia | Laparoscopic surgery within 6 weeks
44
Gene mutation in FAP
APC
45
Features of Peutz-Jeghers syndrome
Pigmented macules on lips (like freckles) | Multiple benign hamartomatous polyps
46
What is Trousseau's sign in regards to pancreatic cancer?
Migratory thrombophlebitis
47
Risk factors for pancreatic cancer
Smoking
48
Palliative options for pancreatic cancer
Endoscopic stent insertion into bile duct Palliative surgery if endoscopic stent insertion fails Chemotherapy Radiotherapy (only for localised advanced disease
49
Causes of post-op pyrexia
``` Wind (atelectasis and pneumonia) 1-2 Water (UTI) 3-5 Walk 5-6 Wound 5-7 Wonder about drugs 7+ ```
50
Urine related complication of long standing diverticular disease
Colovesical fistula Present with gassy urine Require surgical repair
51
Dx of chronic mesenteric ischaemia
CT angiography Usually in the superior mesenteric artery RF = AF Sx = recurrent abdo pain after meals
52
What are the components of severe pancreatitis
``` PaO2 < 8kPa (60mmHg) Age > 55 years Neutrophils - WBC >15 x109/l Calcium < 2mmol/l Renal function - Urea > 16mmol/l Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L Albumin < 32g/l Sugar - Glucose >10mmol/L ```
53
Which type of cancer does UC put you at risk of?
Cholangiocarcinoma (because of PSC)
54
Sx, RF, Mx of pilonidal abscess
Result of blockage of a pilonidal sinus in the anal cavity RF = Crohn's disease, excess hair Can get infected and cause an abscess (often at the base of the back) Mx = incision and drainage
55
Presence of tender, palpable mass in the RUQ | 1 week history of repeated episodes of RUQp, swinging fevers =>
Gallbladder empyema
56
Mx of gallbladder empyema
Drainage
57
RF of gallstones
Fat Forty Fertile Female
58
Courvoussiers law and Hx of UC =>
Cholangiocarcinoma
59
Features of rectal prolapse
``` A mass that extrudes during defecation Rectal mucus discharge Perianal pain Bleeding Faecal incontinence ```
60
Valvulae conniventes vs haustra
Valvulae = small bowel and go all the way across
61
Mx of chronic limb ischaemia
Exercise and diet | Supervised exercise programmes (helps to form collateral blood flow)
62
What should you do if you detect an AAA >3cm but <5.5cm
12w referral to vascular surgeons Try not to get mixed up with dates of screening. These are 3-4.5 yearly 4.5-5.5 3 monthly
63
Mx of shoulder dislocation
Relocation under anaesthesia | Place the arm in a broad arm sling
64
Is intertrochanteric intracapsular or extracapsular?
Extracapsular
65
Management of extra-capsular NOF
Open repair and internal fixation (ORIF) with dynamic hip screw placement
66
Mx of carpal tunnel syndrome
Splinting, local steroid injections and treatment of the underlying cause if it is secondary. If these fail, then decompression surgery is used- performed by dividing the tunnel roof (flexor retinaculum).
67
X-ray features of Colle's fracture
Dorsally angulated radial fracture | Snaps in the way you would expect
68
How can you differentiate between a meniscal injury and cruciate tear?
Often immediate swelling with cruciate tear | Need an MRI to tell for sure
69
2mo Hx of increasing pain on the sole of the foot in someone who does parkour =>
Stress fracture
70
Damage to which nerve causes winging of the scapula?
The long thoracic nerve
71
Low impact trauma now back pain and tenderness on palpation | Hx of steroid use, old age, female =>
Vertebral wedge fracture
72
Sx of cubital tunnel syndrome
Tingling in ring finger and little finger when they bend their arm for a while
73
Mx of cubital tunnel syndrome
Conservative = splint | Surgical decompression if refractory

Passmed finals (17 decks)

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