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Passmed finals > Surgery > Flashcards

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
Q

Management of diverticular disease

A

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.

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26
Q

Which scoring system for head trauma?

A

Canadian CT head rule

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27
Q

Management of pancreatitis

A

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.

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28
Q

Treatment of epididymo-orchitis

A

Azathioprine or other antibiotics

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29
Q

How do you treat high output stoma (>1.5L/day)

A

Restrict oral fluids and prescribe IV dextrose

You can also prescribe loperamide to help reduce output aswell as omeprazole to reduce secretions

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30
Q

Complications of stoma

A

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
Q

3 components to MEN1

A

Para-pan-pit

32
Q

Ix for Zollinger-Ellison syndrome

A

Secretin stimulation test

33
Q

Features of Zollinger-Ellison syndrome

A

Refractory GORD and abdominal pain despite treatment

Weight loss

34
Q

Management of Stanford B aortic dissections

A

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
Q

Management of Stanford A aortic dissection

A

Immediate open repair

36
Q

Ix for aortic dissection

A

CT angiography

37
Q

Treatment of acute limb ischaemia

A

Surgical embolectomy
Angiography to confirm the site
If unsuccessful, can attempt on the table thrombolysis (very risky)
?LMWH, consult senior

38
Q

Features of Boorhaave’s perforation clinically

A

Hypotensive
Pneumoperitoneum
Common for the patient to NOT vomit up blood

39
Q

Difference between Boorhaave’s and oesophageal rupture

A

Boorhaves is due to increased pressure (e.g. vomiting), rupture could be from a fish bone or something

40
Q

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?

A

Bile leak
Dangerous, usually caused by slipped clips or a missed stone
Ix with ERCP and stent it to allow for biliary drainage

41
Q

Features of post-cholecystectomy syndrome

A

Presents many weeks/months after the operation
Clinically stable
Recurring abdominal pain and reflux symptoms

42
Q

Features of cholecystitis

A 
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
Q

Mx of mild acute cholecystitis

A

Antibiotics and simple analgesia

Laparoscopic surgery within 6 weeks

44
Q

Gene mutation in FAP

A

APC

45
Q

Features of Peutz-Jeghers syndrome

A

Pigmented macules on lips (like freckles)

Multiple benign hamartomatous polyps

46
Q

What is Trousseau’s sign in regards to pancreatic cancer?

A

Migratory thrombophlebitis

47
Q

Risk factors for pancreatic cancer

A

Smoking

48
Q

Palliative options for pancreatic cancer

A

Endoscopic stent insertion into bile duct
Palliative surgery if endoscopic stent insertion fails
Chemotherapy
Radiotherapy (only for localised advanced disease

49
Q

Causes of post-op pyrexia

A 
Wind (atelectasis and pneumonia) 1-2 
Water (UTI) 3-5
Walk 5-6
Wound 5-7
Wonder about drugs 7+
50
Q

Urine related complication of long standing diverticular disease

A

Colovesical fistula
Present with gassy urine
Require surgical repair

51
Q

Dx of chronic mesenteric ischaemia

A

CT angiography
Usually in the superior mesenteric artery
RF = AF
Sx = recurrent abdo pain after meals

52
Q

What are the components of severe pancreatitis

A 
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
Q

Which type of cancer does UC put you at risk of?

A

Cholangiocarcinoma (because of PSC)

54
Q

Sx, RF, Mx of pilonidal abscess

A

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
Q

Presence of tender, palpable mass in the RUQ

1 week history of repeated episodes of RUQp, swinging fevers =>

A

Gallbladder empyema

56
Q

Mx of gallbladder empyema

A

Drainage

57
Q

RF of gallstones

A

Fat
Forty
Fertile
Female

58
Q

Courvoussiers law and Hx of UC =>

A

Cholangiocarcinoma

59
Q

Features of rectal prolapse

A 
A mass that extrudes during defecation 
Rectal mucus discharge 
Perianal pain 
Bleeding 
Faecal incontinence
60
Q

Valvulae conniventes vs haustra

A

Valvulae = small bowel and go all the way across

61
Q

Mx of chronic limb ischaemia

A

Exercise and diet

Supervised exercise programmes (helps to form collateral blood flow)

62
Q

What should you do if you detect an AAA >3cm but <5.5cm

A

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
Q

Mx of shoulder dislocation

A

Relocation under anaesthesia

Place the arm in a broad arm sling

64
Q

Is intertrochanteric intracapsular or extracapsular?

A

Extracapsular

65
Q

Management of extra-capsular NOF

A

Open repair and internal fixation (ORIF) with dynamic hip screw placement

66
Q

Mx of carpal tunnel syndrome

A

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
Q

X-ray features of Colle’s fracture

A

Dorsally angulated radial fracture

Snaps in the way you would expect

68
Q

How can you differentiate between a meniscal injury and cruciate tear?

A

Often immediate swelling with cruciate tear

Need an MRI to tell for sure

69
Q

2mo Hx of increasing pain on the sole of the foot in someone who does parkour =>

A

Stress fracture

70
Q

Damage to which nerve causes winging of the scapula?

A

The long thoracic nerve

71
Q

Low impact trauma now back pain and tenderness on palpation

Hx of steroid use, old age, female =>

A

Vertebral wedge fracture

72
Q

Sx of cubital tunnel syndrome

A

Tingling in ring finger and little finger when they bend their arm for a while

73
Q

Mx of cubital tunnel syndrome

A

Conservative = splint

Surgical decompression if refractory

Passmed finals (17 decks)

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