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ISCE prep > Surgery > Flashcards

Surgery Flashcards

1
Q

Clinical features of a ruptured AAA

A 
Abdo pain
Back or loin pain
Pulsatile abdo mass
Distal embolisation causing limb ischaemia 
Shock, syncope
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2
Q

What is an aneurysm

A

Dilatation of an artery to more than 50% of its normal diameter

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3
Q

AAA screening programme

A

Abdominal USS for men in their 65th year (50% mortality reduction from screening programme)
If detected then 3-5 yearas in surveillance

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4
Q

Investigations for AAA

A

USS

Followed by a CT with contrast

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5
Q

Management for AAA

A

Lifestyle- smoking cessation, BP control, commence statin and aspirin, weight loss and exercise
MEDICAL
3-4.4cm then a yearly USS
4.5-5.5 3 monthly USS
SURGICAL
>5.5cm in diameter, symptomatic or expanding more than 1cm annually
Open repair or endovascular repair- similar outcomes

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6
Q

Management of ruptured AAA

A 
High flow oxygen
IV access- 2X large bore cannulae
Urgent bloods- FBC, U&Es, clotting
Crossmatch, minimum 6 units 
Keep BP <100mmHg
Local vascular consultant referral- if unstable then transfer to theatre for open surgical repair
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7
Q

Causes of acute mesenteric ischaemia

A

Thrombus in-situ- atherosclerosis
Embolism- cardiac causes (eg. AF)
Non-occlusive cause- hypovolaemic or cardiogenic shock
Venous occlusion and congestion- coagulopathy, malignancy, autoimmune

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8
Q

Clinical features of acute mesenteric ischaemia

A

Generalised abdo pain, out of proportion to clinical findings, diffuse and constant
Nausea and vomiting associated
In later stages, globalised peritonitis

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9
Q

Investigations for acute mesenteric ischaemia

A

ABG- acidosis and serum lactate
Bloods- FBC, U&Es, clotting, amylase, LFTs, group and save
Imaging- CT scan with IV contrast

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10
Q

Management of acute mesenteric ischaemic

A

Urgent resuscitation with early senior involvement
IV fluids, catheter, fluid balance chart
Broad-spectrum antibiotics (potentially perforating and faecal contamination and bacterial translocation
early ITU input
Excision of necrotic or non-viable bowel and/or revascularisation of the bowel

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11
Q

Risk factors for peripheral arterial disease

A 
Smoking
DM
Hypertension
Hyperlipidaemia
Increasing age
Family history 
Obesity and physical activity
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12
Q

Clinical features from mild to severe for peripheral arterial disease

A

Asymptomatic
Intermittent claudication (after a fixed distance)- relived by rest within minutes
Ischaemic rest pain
Ulceration or gangrene

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13
Q

Critical limb ischaemia definition

A

Two weeks of ischaemic rest pain
Presence of ischaemic lesions or gangrene
ABPI <0.5

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14
Q

Normal ABPI

A

> 0.9

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15
Q

Investigations for peripheral arterial disease

A

ABPI
Doppler USS
CT or MR angiography
Cardiovascular risk assessment- ECG, BP, BM, lipid profile

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16
Q

Management of peripheral arterial disease

A

Conservative- lifestyle advice,
Medical- statin therapy, anti-platelet therapy, optimise DM control
Surgical if critical- Angioplasty, bypass grafting, amputations

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17
Q

Causes of haematuria

A

Infection- pylonephritis, cystitis, prostatitis
Malignancy- prostate adenocarcinoma, urothelial carcinoma
Renal calculi
Trauma or recent surgery
Radiation cystitis
Parasitic eg. schistosomiasis

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18
Q

Clinical features of renal calculi

A

Ureteric colic pain- sudden onset, severe, flank–>pelvis pain
Nausea and vomiting
Haematuria (often non-visible)
Rigors, fever or lethargy (may indicate concurrent infection)

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19
Q

Differential diagnoses for flank pain

A 
Renal calculi
Pyelonephritis 
Ruptured AAA
Biliary pathology
Bowel obstruction 
Lower lobe pneumonia 
MSK related
20
Q

Investigations for renal calculi

A

Urine dip- microscopic haematuria (90%) and infection
Bloods- FBC, CRP, U&Es, urate and calcium levels
Retrieval of the stone and analysis
Non-contrast KUB

21
Q

Management of renal calculi

A

Adequate fluid resuscitation- likely to be dehydrated
Majority of cases pass spontaneously- sufficient analgesia and NSAIDs per rectum
Sepsis management
Stent insertion or nephrostomy if obstructive or significant infection

22
Q

Clinical features of pyelonephritis

A

Classical triad of fever, unilateral loin pain and nausea and vomiting
Co-existing features of lower UTI may be present- frequency, dysuria, urgency
Visible or non-visible haematuria
Features of sepsis

23
Q

Investigations for pyelonephritis

A

Urinalysis- nitrates and leucocytes
Urinary beta HCG if fertile age
Urine culture and start empirical treatment once sent
Routine bloods- FBC, CRP, U&Es
Renal USS and if obstruction is suspected then non-contrast CT KUB

24
Q

Management of pyelonephritis

A

If systemically unwell then A to E and appropriate resuscitation
Empirical antibiotics according to local protocols and IV fluids as appropriate
Suitable analgesia and anti-emetics
If complicated consider admission- catheterisation and HDU monitoring

25
Q

Clinical features of testicular torsion

A

Sudden onset unilateral testicular pain, often associated with n&v
Referred abdo pain
Testis will have a higher position compared to the contralateral side
Can appear swollen and is extremely tender
Absent cremasteric reflex
Pain continues despite elevation (unlike epididymo-orchitis)

26
Q

Investigations for testicular torsion

A

Clinical diagnosis so suspected cases go straight to theatre for scrotal exploration
Doppler USS can be used to investigate
Urine dipstick for potential infective component

27
Q

Management of testicular torsion

A

Surgical emergency in 4-6 hours before significant ischaemic damage occurs
Urgent surgical exploration
Strong analgesics and anti-emetics
NBM with maintenance fluids
Bilateral orchidopexy to prevent further episodes

28
Q

Triple assessment for breast pathology

A

2-week-wait referral criteria
Full history and examination
Ultrasound (<35 or male) or mammography
Biopsy of any suspicious mass or lesion

29
Q

Aetiology of galactorrhoea

A

Idiopathic- 40%
Pituitary adenoma- prolactinoma
Drug induced- SSRIs, anti-psychotics, H2-antagonists
Neurological- through inhibition of dopamine
Hypothyroidism- elevated TRH can stimulate prolactin
Renal or liver failure

30
Q

Clinical features of mastitis

A

Tenderness, swelling and erythema

Important to ensure there is no localised abscess formation occurring (may be systemic features-fever and lethargy)

31
Q

Management of mastitis, lactational vs non

A

Lactational- continued milk drainage or feeding

Systemic antibiotic therapy and simple analgesics

32
Q

Clinical features of mammary duct ectasia

A

Coloured nipple discharge (blood stained requires triple assessment)
A palpable mass
Nipple retraction
Shows dilated calcified ducts on mammographic examination

33
Q

Clinical features of fat necrosis of the breast

A

Usually asymptomatic or a lump

Can present with fluid discharge, skin dimpling, pain or nipple inversion less commonly

34
Q

Clinical features of a fibroadenoma

A

Highly mobile lesions
Well-defined and rubbery on palpation
May be multiple and bilateral
Very low malignant potential

35
Q

Clinical features of a papilloma

A

Often present with bloody or clear nipple discharge but if larger can present as a mass
Can appear similar to ductal carcinomas on imaging and so often require triply assessment

36
Q

Physiological gynaecomastia

A

In adolescents commonly occurs due to delayed testosterone surge relative to oestrogen
Less commonly in older population from reducing testosterone levels

37
Q

Aetiology of increased oestrogen leading to pathological gynaecomastia

A 
Liver disease
Hyperthyroidism
Obesity
Adrenal tumours
Certain testicular tumours
38
Q

Medications that can cause gynaecomastia

A 
Digoxin
Metronidazole 
Spironolactone 
Chemotherapy 
Antipsychotics
Anabolic steroids
39
Q

Most common type of non-invasive breast malignancy

A

Ductal Carcinoma in Situ

40
Q

Clinical features of breast cancer

A 
Breast lumps, asymmetry, swelling
Abnormal nipple discharge
Nipple retraction
Skin changes
Mastalgia
Palpable lump in axilla
41
Q

Breast screening service in the UK

A

Women aged 50-70 invited for a mammogram every 3 years

Abnormalities–> triple assessment

42
Q

Clinical presentation of Paget’s disease

A

Itching or redness in the nipple or areola
Flaking and thickened skin
Painful or sensitive
Often underlying neoplasm

43
Q

Genetic mutations associated with breast malignancy

A

BRCA1, BRCA2, PTEN or TP53

44
Q

CT head immediately head injury guidelines

A 
GCS <13 initially 
GCS <15 at 2 hours post-op
Suspected open or depressed skull fracture 
Signs of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
>1 episode of vomiting
45
Q

Signs of basal skull fracture

A

Haemotympanum
Panda eyes
Battle’s sign (post-auricular ecchymosis)
CSF leakage from ear or nose

46
Q

Murphy’s sign positive

A

Acute cholecystitis

RUQ palpation on inspiration- pain

ISCE prep (6 decks)

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