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Year 6 - Surgery > Surgery: General > Flashcards

Surgery: General Flashcards

1
Q

Ddx for Young Female RIF Pain

A

GI: appendicitis, mesenteric adenitis, terminal ileitis, constipation, IBS

GU: ureteric calculus + UTI

Gyn: ectopic preg, tubo-ovarian pathology abscess/cyst/torsion, endometriosis, PID, mittelschmerz

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2
Q

Ddx of Appendicitis

A

GI: mesenteric adenitis, terminal ileitis, caecal diverticulitis, Meckel’s diverticulum

GU: testicular torsion, ureteric calculus, UTI

Gyn: ectopic preg, tubo-ovarian pathology abscess/cyst/torsion, endometriosis, PID, mittelschmerz

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3
Q

Ddx of Terminal Ileitis

A

Inflammation: CD + backwash ileitis

Infection: yersinia, salmonella, c difficile, mycobacterium

Malignancy: adenocarcinoma, metastatic, lymphoma, carcinoid

Plus spondyloarthropathies + vasculitides

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4
Q

RFs for PONV

A

Patient: female, younger, non-smoker, prev ep, motion sickness

Surgical: prolonged, abdo lap, intracranial, middle ear, squint, gynae, poor pain control after

Anaesthetic: prolonged, intraop bleed, inhalational agents, overuse of bag and mask ventilation, spinal, opioids

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5
Q

Alternative causes of PONV

A

Infection, GI (ileus or obstrc), metabolic (hyperCa, uraemia, DKA), meds, raised ICP, anxiety

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6
Q

Mx of PONV

A

Prophylactic - antiemetics, dex at induction, anaesthetic measures

Conservative - adequate fluids, adequate analgesia, ensure no obstrc

Pharmaceutical - multimodal therapy

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7
Q

The red flag condition for N+V?

A

Incarcerated Hernia

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8
Q

The red flag conditions for epigastric pain? (2)

A

MI + Leaking AAA (also flank pain)

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9
Q

The red flag condition for RUQ pain?

A

RLL Pneumonia

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10
Q

The red flag condition for groin pain?

A

Torted Testes

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11
Q

The red flag conditions for RIF pain? (2)

A

Large bowel obstrc + ruptured ectopic preg (also LIF pain)

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12
Q

What would pain out of proportion to clinical findings suggest?

A

Ischaemic Bowel

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13
Q

What is the most common acute abdo dx worldwide?

A

Appendicitis

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14
Q

Antiemetics if impaired gastric emptying

A

Metoclopramide or Domperidone

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15
Q

Antiemetic if suspected obstrc

A

Hyoscine

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16
Q

Antiemetic if metabolic

A

Metoclopramide

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17
Q

Antiemetics if opioid induced

A

Ondansetron or Cyclizine

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18
Q

What is involved in the pre-op examination?

A

General - identify any underlying undx pathology

Airway - predict difficulty of intubation

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19
Q

Outline the ASA classification

A

I - normal healthy pt

II - mild systemic disease: current smoker, preg, BMI 30-40

III - severe systemic disease: BMI >40

IV - above + constant threat to life

V - moribund + won’t survive w/o op

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20
Q

What does the ASA grade correlate with?

A

Risk of post op comps and absolute mortality

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21
Q

What is included in the airway examination?

A

Any obv facial abnormalities e.g. retrognathia

Degree of mouth opening, dentition and loose teeth, Mallampati classification

Neck ROM and distance b/w thyroid cartilage and chin <6.5cm difficult intubation

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22
Q

The pre-op drug regime

A

To stop - OCP/HRT, hypoglycaemics, clopidogrel, warfarin

To alter - S/C insulin + long term steroids

To start - LMWH, TED stockings, abx

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23
Q

CIs for NG Tube

A

Absolute - mid face trauma + recent nasal surgery

Relative - coag abnormalities, recent alkaline ingestion, oesophageal varices/strictures

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24
Q

How do you measure the length of a NG tube?

A

Tip of nose, to earlobe, to bottom of xiphoid process

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25
Q

NG Tube Insertion Tips

A

Agree signal to stop procedure

Inspect for deviated septum and visible polyps

Aim the tube horizontally along the nasal cavity floor

Advance with each swallow and ask pt to tuck chin

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26
Q

What pH indicates gastric acid?

A

<5.5

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27
Q

Which veins can you insert a central venous catheter? (3)

A

Internal jugular, subclavian, femoral

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28
Q

Why might a pt need a CVC? (3)

A

Meds that require administration centrally: vasopressors, inotropes, TPN, chemo

Access to extracorporeal circuit for haemodialysis

To monitor central venous pressure

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29
Q

How long does central venous access give you?

A

CVC - days to wks

PICC - wks to mnths

Tunnelled - mnths to yrs

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30
Q

What are the comps of central venous access?

A

Immediate: haemorrhage, pneumothorax, arterial puncture, arrhythmias, cardiac tamponade, air embolism

Delayed: venous stenosis, thrombosis, erosion of vessel, line fracture, catheter colonisation, line related sepsis

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31
Q

What is a common indication for a PICC line?

A

Following an oesophagectomy or Whipple’s procedure for chemo

They’re sited by specialist nurses, checked in place by CXR, only the radiologist or ICU consultant can approve placing

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32
Q

What are the borders of the triangle of safety for chest drain insertion?

A

Lateral edges of pectoralis major and latissimus dorsi, apex of axilla, fifth intercostal space

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33
Q

Absorbable Sutures

A

Vicryl, monocryl, PDS

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34
Q

Non-Absorbable Sutures

A

Nylon, prolene, silk

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35
Q

The different ways of giving oxygen therapy

A

Nasal Cannula - max 4L/min and can deliver 25-35% FiO2

Face Mask - max 10L/min and can deliver 25-60% FiO2

Non Rebreathe - max 15L/min and can deliver 80-85% FiO2

Level 2 Care - high flow nasal cannula and NIV

Level 3 Care - mechanical ventilation

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36
Q

What is the dual blood supply of the liver?

A

70% Portal Vein + 30% Hepatic Artery

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37
Q

What joins to form the portal vein?

NB: the PV has NO valves

A

Splenic + Superior Mesenteric

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38
Q

What’s the most common site of rupture in Boerhaave syndrome?

A

Lower 1/3 in the left posterolateral distal oesophagus

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39
Q

What are the main causes of Boerhaave syndrome? (3)

A

Alcoholics, GORD, iatrogenic

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40
Q

Mackler Triad

A

Vomiting, lower chest pain, surgical emphysema

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41
Q

Hamman Sign

A

O/e mediastinal crunch synchronous w the heartbeat

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42
Q

Ix for Boerhaaves

A

CXR - pneumomediastinum, pneumothorax, pleural effusion

Oesophagram - extraversion of contrast material

CT w Gastrografin - identify the site of perforation

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43
Q

Which is the rough estimate b/w litres per minute and approximate FiO2?

A

It inc in increments of 4% for every LPM given:

1 - 24%
2 - 28%
3 - 32%
4 - 36%
5 - 40%
6 - 44%
7 - 48%
8 - 52%
9 - 56%
10 - 60%
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44
Q

Definition of definitive airway

A

A tube in the trachea w a cuff e.g. ET tube or a tracheostomy

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45
Q

What common cancers met to bone?

A

Men - prostate - sclerotic bone mets

Women - breast - lytic bone mets

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46
Q

Which hernia is most likely to strangulate?

A

Femoral > Inguinal

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47
Q

How do you know the bag + valve mask is working? (3)

A

The chest is rising, the mask is misting, end tidal CO2

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48
Q

Why is CO2 used during laparoscopy? (3)

A

Inert
Soluble
Inflammable

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49
Q

How does gastric ca typically present?

A

Dyspepsia + Anaemia

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50
Q

What are the causes of a post op fever?

A

The 5W’s: wind, water, wound, walking, wonder drugs ie pneumonia, UTI, infection at incision organ blood, PE/DVT, drugs/transfusion

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51
Q

How do you prep someone for surgery as an F1?

A
  1. NBM + Fluids
  2. Drugs: Allergies, Bleeding Risk, VTE, Abx
  3. Airway Difficulty
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52
Q

What is the surg safety checklist before induction of anaesthesia? (3)

A

Pt confirmed identity, site, procedure + given consent

The site is marked, anaesth machine + meds checked, pt has pulse ox on

Any allergies recorded, risk of blood loss, assessed difficulty of airway

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53
Q

What is the surg safety checklist before skin incision? (5)

A

Staff introductions, confirm pt name site procedure, abx prophylaxis, anticipated critical events, essential imaging displayed

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54
Q

Which xray view shows the occiput?

A

Towne’s

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55
Q

What is done during the primary survey?

A

Intubation and ventilation, two large bore cannulas (14G), bloods (FBC, U&Es, clotting, glucose, crossmatch), IV fluid, monitoring (pulse, BP, oximetry, RR), ECG, arrange plain films

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56
Q

What is done during the secondary survey?

A

Full examination, medical history, NGT and urinary catheter (unless contraindicated), further imaging

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57
Q

The eye component of GCS

A

Spontaneous opening – 4

To speech – 3

To pain – 2

No response – 1

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58
Q

The verbal component of GCS

A

Orientated response – 5

Confused conversation – 4

Inappropriate words – 3

Incomprehensible sounds – 2

No response to pain – 1

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59
Q

The motor component of GCS

A

Obeys commands – 6

Localises pain – 5

Normal flexion to pain (withdrawal) – 4

Abnormal flexion to pain (decorticate i.e. flexes upper extends lower) – 3

Extends all to pain – 2

No response to pain – 1

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60
Q

What is the presence of a fixed dilated pupil highly suggestive of?

A

Raised ICP requiring urgent neurosurgical intervention

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61
Q

How do chronic SDH often px?

A

A vague history of sx such as fluctuating conciousness, headache, personality change & confusion

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62
Q

RFs for SDH

A

Elderly, susceptible to falls (alcoholics and epileptics), on long term anticoag

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63
Q

SDH shape on CT

A

Crescent

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64
Q

EDH shape on CT

A

Biconvex

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65
Q

Where does the blood tend to extend along in SDH?

A

Falciform ligament & tentorium cerebelli

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66
Q

What are the clinical signs of hydrocephalus? (5)

A

Inc head circumference, open ant fontanelle will bulge and become tense, failure of upward gaze, dilated scalp veins, bradycardia

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67
Q

Why do pts w hydrocephalus px w failure of upward gaze?

A

Compression of the superior colliculus of the midbrain

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68
Q

Aetiology of obstrc and non-obstrc hydrocephalus

A

Obstrc: tumour, intraventricular/subarachnoid haemorrhage, aqueduct stenosis

Non-Obstrc: meningitis, post-haemorrhagic, choroid plexus tumour

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69
Q

What is the triad of sx for normal pressure non-obstrc hydrocephalus?

A

Dementia, incontinence, disturbed gait

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70
Q

Typical subdural haematoma pt

A

Elderly alcoholic on anticoag w hx of head injury and insidious onset of fluctuating confusion and dec consciousness

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71
Q

When does diffuse axonal injury occur?

A

When the head is rapidly ac/decelerated

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72
Q

Imaging: Extradural vs Subdural

A

convEX=EXtradural

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73
Q

Cushings triad of raised ICP

A

HTN, bradycardia, irregular respirations

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74
Q

When should you CT head immediately following head injury?

A

GCS <13 on initial ass or <15 at 2hrs

Suspected open/depressed skull # or any sign of basal skull #

Post-traumatic seizure or focal neuro deficit

> 1 episode of vomiting

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75
Q

What are the signs of basal skull #? (4)

A

Panda eyes, CSF leakage from nose/ear, Battle’s sign, haemotympanum

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76
Q

When should you CT head within 8hrs following head injury?

A

If they’re on warfarin OR amnesia/LOC since injury who are 65+yrs, hx of clotting disorders, dangerous mech of injury, >30mins retrograde amnesia

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77
Q

What is the minimum cerebral perfusion pressure in adults + children?

A

Adults: 70mmHg | Children: 40-70mmHg

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78
Q

Oculomotor nerve lesion (3)

A

Down and out eye, loss of accommodation, pupillary dilation

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79
Q

Ddx of bilaterally constricted eyes (3)

A

Opiates, pontine lesions, metabolic encephalopathy

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80
Q

What findings in the CSF would prove SAH?

A

Xanthochromia w N/raised opening pressure

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81
Q

What are causes of spontaneous SAH? (3)

A

Intracranial aneurysm, AV malformation, pituitary apoplexy

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82
Q

What conditions are a/w berry aneurysms? (3)

A

PCKD, Ehlers-Danlos, Coarctation of the Aorta

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83
Q

What should you do as soon as SAH is confirmed?

A

Refer to neurosurgery, identify cause w CT intracranial angiogram +/- catheter angiogram, keep on bed rest w well controlled BP

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84
Q

Tx for spontaneous SAH caused by intracranial aneurysm

A

Ideally within 24hrs

Majority: coil by interventional neuroradiologist

Minority: craniotomy and clipping by neurosurgeon

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85
Q

Comps of aneurysmal SAH (5)

A

Rebleeding, vasospasm, hypoNa, seizures, hydrocephalus

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86
Q

How do you prevent vasospasm?

A

21d course of nimodipine

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87
Q

How do you confirm SAH?

A

CT -> if neg perform LP @ 12hrs to distinguish b/w a traumatic tap

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88
Q

Which views are taken during mammograms?

A

Oblique + Craniocaudal

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89
Q

At which age do you perform a mammogram

A

> 40y

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90
Q

What are the mammographic features of breast ca

A 
Ill-defined or spiculated mass
Parenchymal distortion
Overlying skin thickening
Malignant calcifications
Enlarged axillary lymph nodes
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91
Q

What are the US features of breast ca

A

Ill-defined usually hypoechoic mass
Distal acoustic shadowing
Surrounding halo
Abnormal axillary nodes

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92
Q

What are US useful for distinguishing b/w?

A

Solid vs cystic lump

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93
Q

If breast US confirms a ca where else should you US?

A

The axilla to help plan tx

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94
Q

If the mammogram and US are equivocal what method of imaging should you perform next?

A

MRI

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95
Q

Outline the components of triple assessment

A

Hx and exam, imaging (US/mammography), histology (core biopsy/FNA/VAM)

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96
Q

Why are core biopsies often preferred to FNA?

A

They provide more detail inc ER, PR and HER2 status

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97
Q

How would you stage breast ca?

A

If pt has sx perform FBC, U&Es, LFTs, bone profile & if any are abnormal CXR, liver US, bone scan

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98
Q

Breast ca tx

A

If fit surgery, if not primary endo therapy, if >3cm neo-adjuvant chemo

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99
Q

Factors to consider when planning surgery

A

Pts choice, mass size relative to breast size, position

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100
Q

What is the most likely outcome if the tumour is behind the nipple?

A

Mastectomy

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101
Q

The most common histological subtype

A

Invasive ductal carcinoma

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102
Q

Ratio of invasive ductal:invasive lobular prevalence

A

17:3

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103
Q

Outline the NHS breast screening programme

A

Mammogram every 3yrs b/w 50-70y

Typically 4/100 will need further testing with 1/100 being diagnosed w cancer

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104
Q

When would you consider radiotherapy following mastectomy?

A

High risk of local recurrence e.g. involved margins, vascular/dermal invasion, heavily node positive

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105
Q

RFs for Breast Cancer

A

Age, FHx, BRCA, Prev, Oestrogen: nulliparity, first preg >30yrs, early menarche, late menopause, HRT, obesity

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106
Q

Mx of Mastitis

A

Encourage to continue breastfeeding; if sys unwell, nipple fissure, not improving after 12-24hrs start 2w flucloxacillin and continue feeding; if abscess incise and drain

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107
Q

What conditions does ANDI encompass?

A

Fibroadenosis
Cyst Formation
Epitheliosis
Papillomatosis

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108
Q

When do you perform a mastectomy > wide local excision for DCIS?

A

> 4cm

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109
Q

What is the Nottingham Prognostic Index?

A

(Tumour Size x 0.2) + LN Score + Grade Score = NPI

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110
Q

What is the most common type of breast cancer?

A

Invasive Ductal Carcinoma

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111
Q

Why do we not routinely screen pts under 40?

A

Mammography has a red sensitivity in denser breast tissue

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112
Q

When is MRI the ix of choice?

A

Pts w implants

Plus: in younger pts who might have a strong fhx and as second line imaging for breast masses

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113
Q

Ddx for Solid Breast Mass

A

Localised benign area, carcinoma, cyst, fibroadenoma, periductal mastitis, duct ectasia, abscess

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114
Q

Which subtype of fibroadenomas can recur and must be excised?

A

Phyllodes

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115
Q

Which age group are breast cysts most common?

A

Perimenopausal

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116
Q

Ddx of Spiculated Mass

A

Cancer + Radial Scar

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117
Q

What age group can aromatase inhibitors be used for?

A

Post-Menopausal

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118
Q

At what size should you core biopsy a fibroadenoma?

A

> 4cm

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119
Q

What scan should be performed before starting a pt on an aromatase inhibitor?

A

DEXA

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120
Q

Who should undergo a 2wk referral?

A

Aged >=30 who have an unexplained breast lump with or w/o pain and consider in those w an unexplained lump in the axilla

Aged >=50 who have unilateral nipple sx

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121
Q

Ddx of Bloody Discharge

A

Carcinoma + Intraductal Papilloma

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122
Q

Ddx of Duct Ectasia

A

Carcinoma + Periductal Mastitis

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123
Q

Mx of Mastitis

A

The first line is to continue breastfeeding but if sys unwell, nipple fissure, sx not improving after 12-24hrs add flucloxacillin 10-14d

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124
Q

Tx of Breast Abscess

A

Incision + Drainage

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125
Q

How does Paget’s disease of the breast present?

A

An eczematoid change ie reddening and thickening of the nipple a/w underlying breast cancer

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126
Q

What are the three branches of the coeliac axis?

A

Left Gastric, Hepatic, Splenic

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127
Q

Where does the right gastric artery come from?

A

Hepatic

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128
Q

What are the three branches of the superior mesenteric artery?

A

Right Colic, Ileocolic, Middle Colic

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129
Q

What does the ileocolic artery supply?

A

Terminal Ileum, Caecum, Appendix

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130
Q

What are the three branches of the inferior mesenteric artery?

A

Left Colic, Sigmoid, Superior Rectal

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131
Q

Where are the watershed areas?

A

The second part of the duodenum: junction of the coeliac + SMA

The splenic flexure: junction of the superior + inferior mesenteric arteries

You either leave/take it you don’t anastomose around it

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132
Q

How many pple have a right colic artery?

A

5-10%

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133
Q

What is the indication for a right hemicolectomy?

A

Cancer in caecum, ascending colon, hepatic flexure

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134
Q

Why is knowledge of the arterial supply so important?

A

You require healthy ends to form an anastomosis + aids lymphadenectomy

Stage histologically, prognostic, chemo requirements

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135
Q

Why do you remove the blood vessels during GI surgery?

A

Lymphadenectomy

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136
Q

Sigmoid Colectomy vs Hartmann’s

A

Sigmoid Colectomy: only treats benign disease eg diverticular disease or strictures

Ant Resection: tx cancer in the sigmoid and forming a colorectal anastomosis

Hartmann’s: 
emergency
Bowel obstrc
pathology has to be removed and close off the distal sigmoid/rectum and bring out an end stoma
Can be done anywhere along the colon
\+/- reversible in the future
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137
Q

Why is a sigmoid colectomy NOT a cancer operation?

A

It doesn’t harvest every lymph node from the originating vessel but only the sigmoid artery

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138
Q

Anterior Resection vs APER

A

AR: leaves a variable length of rectum and the anus which you can anastomose

APER: removes rectum + anus for when the tumour is on or invading the anal sphincter

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139
Q

What are the requirements for an anterior resection?

A

You have to have a 1cm clearance of healthy bowel b/w tumour and anal sphincter so you can anastomose

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140
Q

What sx do pts complain of if the tumour is low lying?

A

Incontinence, urgency, bleed + the feeling of sitting on something if it’s that low

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141
Q

How does the lower part of rectum and anus survive following an AR?

A

It has a dual blood supply: despite the superior rectal artery being removed it still has the inferior rectal artery coming from the pudendal artery

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142
Q

Where are the majority of colorectal cancers?

A
  1. Rectum
  2. Sigmoid
  3. Caecum
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143
Q

If you have a splenic flexure tumour you can not make an anastomsis here after

A

T

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144
Q

What blood supply is removed during a left hemicolectomy?

A

Left Colic

Left branch of middle colic

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145
Q

Extended R Hemi > L Hemi

A

Ileocolic, right colic, whole middle colic, left colic

Anastomose ileum to sigmoid colon

Better oncologically

Blood supply to small-large bowel anastomosis is better than large-large

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146
Q

What blood supply is removed during a right hemicolectomy?

A

Right Colic

Ileocolic

Right branch of middle colic

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147
Q

What anastomosis do we do following a right hemicolectomy?

A

Side to side stapled small bowel to transverse colon

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148
Q

What artery do you take during an AR or an APER?

A

Inf Mesenteric Artery

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149
Q

Why is a left hemi such a rare operation?

A

The Watershed Area + the difficulty of anastomosing the transverse colon

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150
Q

What operation would you op for to tx a transverse colon tumour?

A

Either right hemi or extended right hemi depending where the tumour was along the transverse colon

151
Q

Defunction vs Hartmann’s

A

Both used in the emergency setting likely following bowel obstrc

If the pathology is left in it is NOT a Hartmann’s procedure

The defunctioning stoma is looped small/large bowel to rest the distal bowel before reversing

152
Q

How can you tell which stoma it is?

A

Spouted R - Ileostomy
Flattened L - Colostomy

If it’s on the right side of the abdomen it’ll be small bowel EXCEPT if it’s transverse colon

If it’s on the left side of the abdomen it’ll be large bowel

If still in doubt check the contents of the bag

153
Q

When else would you see a loop

Emerg op

A

After a low anterior resection and you want the anastomosis to heal

154
Q

Ix

A

CT - free air, points of obstrc, thickened bowel
US - hollow viscus w stones

OGD/Colonoscopy
Endoscopy - diagnostic + therapeutic (polypectomy, clip bleeding ulcer, colonic stent as a bridge to surgery)

CTC - order in clinic not acute, less severe bowel prep as colonscopy, leas invasive, virtual colonscopy, can’t take biopsy or polypectomy)

MRI - rectal cancers, solid viscus, high resolution defined tissue planes to determine who requires preop radiotherapy + what requires resection

Laparoscopy - diagnostic, drain cysts, appendectomy

155
Q

What is the telltale sign of a stone on US?

A

It casts an acoustic shadow

156
Q

What do you want to know if a pt has postop pyrexia?

A

The Time of Onset

Day 0-2: tissue damage and necrosis, haematoma formation, pulmonary collapse, infection at site of surgery

Day 3-5: sepsis + pneumonia

Day 5-7: anastamotic leak, fistula formation, DVT/PE

157
Q

How should you ix

A

Hx: cough, sputum, dysuria, freq, calf pain

O/e: wounds, drain sites, chest, abdomen, calves

Ix: cultures + CXR

158
Q

Postop Pain

A

Wound pain vs chest pain

Erythematous, hot, pus

Wound: maximal in first 72hrs but if worsening check for infection

Chest: cardiac retrosternal +/- arm radiation vs pleuritic sharp, localised, worse on inspiration

Abdo: sepsis, leak, urinary retention

159
Q

Urine Output

A

Physiological response to surgery/stress or

prerenal failure, acute renal failure, urinary retention

160
Q

Why TNM

A

Prognostic

Guide whether need adjuvant therapy after surgery

161
Q

How does the TNM and Dukes staging map up together?

A

Duke A = T1-2

Duke B = T3-4

Duke C = N1+

Duke D = M1+

162
Q

How do you examine a stoma?

A

Tbc

163
Q

When is a Whipple’s procedure appropriate for treating carcinoma of the head of pancreas?

A

Only in <20% of pts where no distant metastases and vascular invasion is still at a minimum otherwise perform ERCP and biliary stenting

164
Q

Which part of the colon is retroperitoneal?

A

Ascending, Descending, Rectum

165
Q

What lies on the transpyloric plane?

A

MSK: vertebra L1 and 9th costal cartilage

Vasc: origin of SMA and formation of portal vein

Visceral: pylorus, GB fundus, DJ junction, neck of pancreas and hila of kidneys

166
Q

Which drugs can cause acute pancreatitis?

A 
Azathioprine
Mesalazine
Didanosine
Bendroflumethiazide
Furosemide
Pentamidine
Steroids
Sodium Valproate
167
Q

What can pts commonly get following a cholecystectomy?

A

Common bile duct stone or injury: wks vs days

168
Q

Ix for chronic pancreatitis

A

Faecal elastase and CT pancreas w IV contrast

169
Q

Ddx of hyperamylasaemia

A 
Acute Pancreatitis
Pancreatic Pseudocyst
Mesenteric Infarct
Perforated Viscus
Acute Cholecystitis
DKA
170
Q

Typical hx of chronic pancreatitis

A

Abdo pain following meals, takes pancreatic enzymes, steatorrhoea, diabetes, chronic alcohol abuse

171
Q

Biliary Colic vs Cholecystitis vs Cholangitis

A

Not sys unwell just colicky pain

Sys unwell and murphy’s pos

Charcot’s triad (fever, jaundice, RUQ pain) - Reynolds pentad (w altered mental status and shock)

172
Q

What disease does chronic pancreatitis put you at risk of? Annual ix?

A

Type 3c diabetes ie pancreatogenic therefore annual HbA1c measurements

173
Q

Most common causative organism of ascending cholangitis

A

E coli then klebsiella and enterobacter

174
Q

Which test is useful when considering Wilson’s disease?

A

Ceruloplasmin

175
Q

What are a/w pigmented gallstones?

A

Sickle cell anaemia

176
Q

What ultrasound finding is a strong RF for cholangiocarcinoma?

A

A Porcelain GB ie intramural wall calcification

177
Q

The Modified Glasgow Score

A 
PaO2
Age
Neutrophilia
Calcium
Renal Function
Enzymes
Albumin
Sugar

> =3 ?ITU

178
Q

What is the radiological sign of surgical emphysema?

A

The air outlines the pec major resulting in the ginkgo leaf sign

179
Q

Tx of acute cholecystitis

A

Analgesia, IV fluids and abx, early lap cholecystectomy within wk of dx

180
Q

What typically has pain that radiates to the interscapular region?

A

Biliary colic NOT peptic ulcers

181
Q

What is Beck’s triad?

A

Cardiac tamponade pts: hypotension, raised JVP, muffled heart sounds

182
Q

Whats is Cushing’s triad?

A

Raised ICP: hypertension, bradycardia, irr/dec RR

183
Q

What are the comps of a gastrectomy?

A

Dumping syndrome, early satiety, wt loss, osteoporosis, IDA, vit B12 def, subacute combined degen of spinal cord, inc risk of gastric ca and GS

184
Q

What does the H in GET SMASHED include?

A

Hypertriglyceridaemia
Hyperchylomicronaemia
Hypercalcaemia
Hypothermia

185
Q

Ddx of rectal bleeding

A

Fissure
Haemorroids
IBD
Cancer

186
Q

What do all pts presenting w rectal bleeding require?

A

DRE and procto-sigmoidoscopy, if clear view cannot be obtained bowel prep w enema and flexible sigmoidoscopy, altered bowel habit colonoscopy and XS pain EUA

187
Q

What type is anal ca on biopsy?

A

Squamous Cell Carcinoma

188
Q

What typically causes anal ca?

A

HPV infection therefore those immunocompromised are most at risk

189
Q

Tx of Anal Cancer

A

Chemoradiotherapy

190
Q

What does a biopsy report showing fibromuscular obliteration suggest?

A

Solitary rectal ulcer syndrome where extensive collagenous deposits are often seen

191
Q

Mx of Haemorrhoids

A

Consrv: dietary advice +/- topical analgesics and bulk forming laxatives

Non-Op: rubber band ligation or injection sclerotherapy

Surgical: excisional haemorrhoidectomy or stapled haemorrhoidopexy

192
Q

What is nocturnal diarrhoea and incontinence typical of?

A

IBD

193
Q

Which part of the bowel is often spared from diverticular disease?

A

The rectum as it lacks taenia coli

194
Q

What is the Hinchey classification of complicated diverticulitis?

A

I - paracolonic abscess

II - pelvic abscess

III - purulent peritonitis

IV - faecal peritonitis

195
Q

Why is a loop ileostomy better than a loop colostomy following a colonic anastomosis?

A

Small bowel heals well vs the reversal of a loop colostomy carries the same risk of anastomotic leak as the original surgery

196
Q

Anterior vs Abdominal Perineal Resection

A

If the malignancy is >5cm from the anal verge, anterior, temporary loop ileostomy

If the malignancy is <5cm from the anal verge, AP, permanent end colostomy

197
Q

What is Hartmann’s procedure?

A

Similar to a high anterior resection in that the rectal stump is retained but usually in emerg setting when high risk of anastomotic breakdown and a temporary end colostomy is formed instead

198
Q

Comps of bowel resection

A

I: haemorrhage, injury to spleen and ureter, anaesthetic risks

E: haemorrhage, infection, pain, anastomotic leak, blood clots

L: hernia + adhesions

199
Q

Urostomy vs Ileostomy vs Colostomy

A

Urostomy: RIF, sprouted, urine drains via an ileal conduit

Ileostomy: RIF, sprouted, liquid faecal effluent

Colostomy: LIF, flushed, semisolid faecal effluent

200
Q

Temporary loop vs end ileostomy

A

A temp end ileostomy is formed when it is considered unsafe to form an anastomosis at that time

201
Q

Comps of a stoma

A

Itself: early (haemorrhage, ischaemia, retraction) + late (fistulae and prolapse)

Around: early (abscess) + late (parastomal hernia and dermatitis)

Systemic: early (obstruction, dehydration, hypoK) + late (sepsis and psych)

202
Q

What is toxic megacolon seen in?

A

UC

203
Q

Ddx of acute pancreatitis

A

Perf peptic ulcer, gastritis, atypical MI

204
Q

What are the general mx principles of pancreatitis? (3)

A

NBM, fluid resus, analgesia

205
Q

Which volvulus is more common?

A

Sigmoid 8:2 Caecal

206
Q

Mx of Sigmoid Volvulus

A

Use a rigid sigmoidoscopy and insert a rectal tube unless there’s bowel obstruction and peritonitis go straight to an urgent midline laparotomy

207
Q

Mx of Caecal Volvulus

A

A right hemicolectomy is often required

208
Q

Outline Dukes Classification

A

A: confined to bowel

B: invading bowel wall

C: lymph node mets

D: distant mets

209
Q

Which enema is used to ix anastomosis healing as it’s less toxic if there is a leak?

A

Gastrografin > Barium

210
Q

Ix for >60yo pt w tiredness and IDA

A

Colonoscopy (diagnostic) > faecal occult blood (screening)

211
Q

How do thrombosed haemorrhoids px?

A

Sx: sig pain preceded by straining

Signs: purplish, oedematous, tender s/c perianal mass

212
Q

Tx for Thrombosed Haemorrhoids

A

Within 72hrs consider excision otherwise analgesia, ice pack and stool softeners

213
Q

What analgesia should be avoided postoperatively following major abdo surgery in pts w resp disease?

A

Opioid

214
Q

Anaesthesia: Epidural > Spinal

A

It can be topped up and titrated

215
Q

When should you give blood following an upper GI bleed?

A

If there’s signs of grade III/IV shock OR Hb <70

216
Q

Mx of Anal Fissure

A

Consrv: dietary advice, bulk forming laxative, lubricants before defecation, 5% lidocaine ointment, analgesia

Medical: if presenting >1wk sx then add 0.2-0.4% GTN ointment or topical diltiazem

Surgical: if above ineffective after 8wks then refer for botulinum toxin injection or lateral partial internal sphincterotomy

217
Q

Where are 90% of anal fissures found?

A

On the posterior midline therefore consider an underlying cause if they’re found elsewhere

218
Q

What are the RFs and mx for urinary incontinence?

A

Types: stress, urge, mixed, overflow, functional

Both: exclude DM/UTI, bladder diaries, urodynamic testing, encourage reduction of caffeine/fizzy drinks, optimise wt

Stress RFs: age, obesity, children, traumatic delivery, pelvic surgery

Stress Mx: 1. 3m pelvic floor exercises 2. SNRI eg duloxetine OR surgical eg burch colposuspension

Urge RFs: age, obesity, smoking, DM, FHx

Urge Mx: 1. 6w bladder training 2. antimuscarinic eg oxybutynin 3. beta-3 agonist eg mirabegron 4. surgical eg botox injection

219
Q

What imaging should pts whose tumours lie below the peritoneal reflection have to evaluate their mesorectum?

A

MRI

220
Q

What does an anastomosis require to heal?

A
  1. Adequate blood supply 2. Mucosal apposition 3. No tissue tension
221
Q

What are the causes of chronic pancreatitis?

A

Common: Alcohol; Smoking; AI

Rarely: Cystic Fibrosis; Haemochromatosis; Duct Obstruction; Pancreas Divisum

222
Q

What are the ddx for pain following a meal?

A
  1. Gastric Ulcer 2. Biliary Colic 3. Pancreatitis
223
Q

Ix for Chronic Pancreatitis

A

US +/- CT

224
Q

Cholecystitis vs Cholangitis

A

Jaundice

225
Q

Tx of Cholangitis

A

IV Abx + ERCP

226
Q

How are haemorrhoids graded?

A

I: remain in the rectum

II: prolapse on defecation but spontaneously reduce

III: prolapse on defecation but require digital reduction

IV: remain persistently prolapsed

227
Q

What are solitary rectal ulcer a/w?

A

Chronic straining and constipation

228
Q

Ix for Solitary Rectal Ulcer

A

Once biopsied to exclude malignancy workup includes endoscopy, defecating proctogram, ano-rectal manometry studies

229
Q

Who are the typical pts who get a sigmoid volvulus?

A

Older pts w chronic constipation, Chagas disease, Parkinson’s disease, Duchenne muscular dystrophy, schizophrenia

230
Q

Who are the typical pts who get a caecal volvulus?

A

Any Age
Adhesions
Pregnancy

231
Q

What stoma is required for an emergency Hartmann’s procedure?

A

End Colostomy

232
Q

Ix for Rectal Intussusception

A

Defecating Procotogram

233
Q

Where are the three anal cushions located?

A

At 3, 7 and 11 o’clock

234
Q

What is Goodsall’s rule?

A

It determines the path of an anal fistula: if anterior the track is in a straight line vs if posterior the internal opening is always at 6 o’clock

235
Q

Most common stone composition

A

CaOx

236
Q

Which rare inherited condition can predispose to stones?

A

Cystinuria

237
Q

What may be underlying recurrent stones?

A

Metabolic problems - hyperPTH, gout, cystinuria

Anatomical problems - PUJ obstrc, horseshoe kidney, ureteric stricture

238
Q

What is the gold standard imaging for stones?

A

Non-contrast CT KUB

239
Q

Renal colic ddx

A

AAA, biliary colic, constipation, bowel obstrc, ectopic pregnancy

240
Q

When would you admit a pt w renal colic?

A

Single kidney, renal impairment, pyrexia, continuing pain, large stone, severe obstrc on CT, pregnant

NB: otherwise can be discharged w stone clinic OPA

241
Q

Tx of stones

A 
Conservative
Tamsulosin
ESWL
Ureteroscopy
PCNL
242
Q

What is the conservative advice?

A

Ensure high fluid intake 2.5-3L/day, red salt and animal proteins esp red meat, don’t cut back on dairy just ca sups

NB: attend A&E if pyrexia or pain not controlled by analgesia

243
Q

Haematuria ddx

A

Underlying malignancy UNTIL proven otherwise along the length of the urinary tract, infection, trauma, drugs, urological hx e.g. 2° haemorrhage

244
Q

When would you admit a pt w haematuria?

A 
Clots/retention
Anaemic/renal impairment
Tachycardic/hypotensive
Prolonged bleeding
Elderly/frail

NB: otherwise encourage fluids, ix cause, next available haematuria clinic app

245
Q

Describe the three way catheter used for haematuria

A

Attachments: inflates balloon, urine bag, wash inflow for bladder irrigation

246
Q

What are the two important ix to do for haematuria?

A

CT Urogram and Cystoscopy

247
Q

Most common bladder ca

A

Transitional cell carcinoma

248
Q

Which type of bladder ca does schistosomiasis cause?

A

Squamous cell carcinoma

249
Q

Bladder ca RFs

A

Smoking, aniline dyes, rubber, textiles, printing

250
Q

Mx of bladder ca

A

TURBT
Flexible cystoscopy surveillance
Intravesical chemo (mitomycin C) or immuno (BCG)
Radical cystectomy or radio

251
Q

What does TURBT stand for?

A

Transurethral Resection of Bladder Tumour

252
Q

Bladder ca classification

A

Carcinoma in situ

Ta - affects the epithelium

T1 - invades subepithelial connective tissue

T2a - invades superficial muscle

T2b - invades deep muscle

T3a - invades perivesical tissue microscopically

T3b - invades perivesical tissue macroscopically

T4 - invades contiguous organs

253
Q

LUTS FUNDD HIPSS

A

Storage Sx:
Freq
Urgency
Nocturia

Post-Micturition Sx:
Dribbling
Dysuria

Voiding Sx:
Hesitancy
Intermittency
Poor Flow
Straining
Sensation of Incomplete Emptying
254
Q

BPE vs BPH

A

Benign Prostate Enlargement (clinical dx) vs Hyperplasia (histo dx)

255
Q

What are the three components of the hald diagram?

A

LUTS, BPE, Bladder Outflow Obstrc

256
Q

BPH RFs

A

Age, hormonal, obesity, diabetes, dyslipidaemia, genetic

257
Q

Epi of BPH

A

Afro-Caribbean

258
Q

Epi of stones

A

Caucasian

259
Q

Medical mx of BPH

A

Tamsulosin - alpha blocker

Finasteride - 5 alpha reductase inhibitor

Solifinacen - anticholinergic

Mirabegron - beta 3 agonist

Sildenafil - PDE5 inhibitor

260
Q

Surgical mx of BPH

A

TURP
HoLEP
Urolift
Rezum

261
Q

How do you assess urinary retention?

A

Palpate suprapubic swelling, dull to percuss, bladder scan, consider CISC if post pelvic surgery, urethral catheterisation

262
Q

What do you do if urethral catheterisation fails?

A

Use a catheter introducer, flexi guided, go suprapubic

263
Q

Mx of acute retention

A

Painful and <1-1.5L

Catheter and alpha blockers, record residual urinalysis u&e, consider TWOC

264
Q

Mx of chronic retention

A

Painless and >1-1.5L

Leave the catheter in, ultrasound, monitor residuals, F/U, consider surgery if enlarged prostate

265
Q

What does TWOC stand for?

A

Trial WithOut Catheter

266
Q

List the different types of Foleys

A

Short Term:
Simplastic
PTFE Coated

Long Term:
Hydrogel Coated & Silicone

267
Q

What are the most common px of urinary sepsis?

A

UTI, pyelonephritis, pyonephrosis, shock, multi organ failure, ARDS

268
Q

Who should you involve if the pt has urinary sepsis?

A

Urologist, microbiology, HDU/ITU

269
Q

What is a medical emerg in urology?

A

Pyonephrosis - obstrc w infection - requires nephrostomy (local anaes) or stent (general anaes)

270
Q

What can cause a raised PSA?

A 
BPH
UTI
Urinary Retention
Catheterisation
Prostate Cancer
271
Q

What is the most sensitive test for testicular ca?

A

Urgent same day ultrasound showing hypoechoic area

272
Q

What is Fournier’s gangrene?

A

Fulminant infective nec fas of perineum +/- suprapubic and thighs, rapidly spreads, offensive odour, crepitus under the skin, severe pain

273
Q

Tx of Fournier’s gangrene

A

Urgent broad spec abx + radical debridement -> referral to plastics for graft

274
Q

Which pts are most at risk of Fournier’s gangrene?

A

Diabetics + Immunosuppressed

275
Q

What must you always do after placing a catheter?

A

Pull the foreskin forward to prevent paraphimosis and document that you have

276
Q

What should you be considering in a pt w haematuria?

A

The anatomical area (ultrasound lower vs cystoscopy upper) and cause (infection, calculi, malignancy)

277
Q

What do you want to perform for suspected malignancy?

A

Tissue biopsy to confirm dx (ureteroscopy + biopsy) and consider both local and regional staging (CT urogram + CT chest)

278
Q

What should be noted if you suspect a staghorn calculus on plain AXR?

A

Establish if the pt has had contrast in the last few hrs as it may not have been excreted due to a distal obstruction

279
Q

Ddx for Acute Scrotal Pain

A

Torsion
Trauma
Infection
Malignancy

280
Q

When is Prehn’s sign pos?

A

Scrotal elevation relieves pain in epididymitis but not torsion

281
Q

When do you refer pts for suspected bladder/renal cancer?

A

Aged 45 and over with: unexplained visible haematuria w/o urinary tract infection or visible haematuria that persists or recurs after successful tx of UTI

Aged 60 and over with: unexplained non-visible haematuria and either dysuria or a raised WCC

282
Q

What is nutcracker syndrome?

A

Left varicocele due to compression of the testicular vein by RCC as it joins left renal vein

283
Q

RFs for RCC

A 
Smoking
Industry
Dialysis
HTN
Obesity
PCKD
284
Q

Where do most prostate adenocarcinomas arise?

A

Posterior Peripheral Zone

285
Q

What can germ cell tumours be divided up into?

A

Seminomas

Non-Seminomas: embryonal, yolk sac, teratoma, choriocarcinoma

286
Q

What can non-germ cell tumours be divided up into?

A

Leydig + Sarcomas

287
Q

Late comps of radical prostatectomy

A

Incontinence, ED, urethral stenosis

288
Q

What is retrograde ejaculation a common comp of?

A

Alpha blockers and TURP

289
Q

What post void volumes are considered physiological in pts aged above/below 65yrs?

A

<50ml if <65y

<100ml if >65y

290
Q

What is chronic urinary retention defined as?

A

Presence of >500ml within the bladder after voiding

291
Q

What does a post catheterisation urine volume of >800ml suggest?

A

Acute on chronic urinary retention

292
Q

What meds can cause acute urinary retention?

A 
Anticholinergics
Benzodiazepines
Antihistamines
Opioids
TCAs
293
Q

Ddx for urinary retention

A

Urethral obstrc: BPH, stricture, calculi, cystocele, constipation

Plus meds, neuro, UTI, postop, postpartum

294
Q

Why do adult pts w a hydrocele require an urgent ultrasound?

A

To exclude any underlying causes such as a tumour

295
Q

Aside from tumours what else can hydroceles develop secondary to?

A

Epididymo-orchitis and testicular torsion

296
Q

How does epididymo-orchitis present?

A

Acute pain and swelling following urological intervention, pyrexia, pos urine dip

297
Q

What is a/w mumps?

A

Orchitis

298
Q

Which side are varicoceles typically?

A

The left because the testicular vein drains into the renal vein as opposed to directly into the IVC

299
Q

Screen for LUTS

A

Storage: FUND + Voiding: HIPS

Frequency
Urgency
Nocturia
Dysuria

Hesitancy
Incomplete
Poor Stream
Straining

300
Q

Mx of nocturia

A

Advise moderating fluid intake at night, furosemide 40mg late afternoon, consider desmopressin

301
Q

Mx of predominantly overactive bladder

A

Conservative: moderating fluid intake + bladder retraining

Pharmaco: antimuscarinic -> mirabegron

302
Q

Mx of predominantly voiding sx

A

Conservative: prudent fluid intake + pelvic floor training

Pharmaco: alpha blocker, use 5α reductase inhibitor if prostate, use antimuscarinic if mixed sx

303
Q

Give examples of antimuscarinic drugs

A

Oxybutynin
Tolterodine
Darifenacin

304
Q

What can be used as immediate pain relief for renal colic?

A

IM Diclofenac

305
Q

Mx of stones

A

<5mm: watch + wait

<10mm: alpha blocker, oral nifedipine, SWL

10-20mm: URS

> 20mm: PCNL

SWL = Shockwave Lithotripsy
URS = Ureteroscopy
PCNL = Percutaneous Nephrolithotomy
306
Q

Aetiology of hydronephrosis

A

Unilateral: PACT + Bilateral: SUPER

Pelvic-Ureteric Obstrc
Aberrant Renal Vessels
Calculi
Tumours of Renal Pelvis

Stenosis of Urethra
Urethral Valve
Prostatic Enlargement
Extensive Bladder Tumour
Retro-Peritoneal Fibrosis
307
Q

What should be performed on all pts w renal colic within 14hrs of admission?

A

Non contrast CT KUB

NB: if pyrexic, solitary kidney, uncertain dx perform immediately

308
Q

What are the medical indications for circumcision?

A

Phimosis
Paraphimosis
Recurrent Balanitis
Balanitis Xerotica Obliterans

309
Q

What is important to exclude prior to circumcision?

A

Hypospadias

310
Q

Tx of acute balanitis

A

Dependent on underlying cause: STI - abx, candida - antifungal, dermatitis - topical hydrocortisone

311
Q

What should men presenting w ED be screened for?

A

Underlying diabetes, CVD and hypogonadism therefore test glucose, lipid profile, testosterone

312
Q

What is generally considered to be a normal age-adjusted serum PSA?

A

50-59yrs: <3ng/ml
60-69yrs: <4ng/ml
>70yrs: <5ng/ml

313
Q

Urethral injury: bulbar vs membranous rupture

A

Bulbar: most common, straddle type injury, triad of 1) urinary retention 2) perineal haematoma 3) blood at the meatus

Membranous: either extra or intra peritoneal, pelvic #, penile/perineal oedema/haematoma and upwards displacing prostate on PR

314
Q

Ix + Mx of urethral injury

A

Ascending urethrogram + surgically placed suprapubic catheter

315
Q

Ix + Mx of bladder injury

A

IVU/Cystogram + extra: conservative or intra: laparotomy

316
Q

SEs of alpha blockers e.g. tamsulosin and alfuzosin

A

Dizziness, postural hypotension, dry mouth

Tamsulosin doesn’t help w posture, no wonder dizziness can foster!

317
Q

SEs of 5 α reductase inhibitor e.g. finasteride

A

Sexual dysfunction, ED, reduced libido, ejaculation problems, gynaecomastia

318
Q

What is a TURP syndrome?

A

Presents w CNS, resp and systemic sx caused by irrigation w glycine resulting in hypoNa and hyperammonia

319
Q

How is bladder voiding measured?

A

By urodynamic studies

320
Q

RFs for testicular ca

A 
FHx
Infertility
Klinefelter’s
Cryptorchidism
Mumps Orchitis
321
Q

When should PSA testing not be done within?

A

At least: 48hrs of ejaculation or vigorous exercise, 1w DRE, 4w proven urinary infection, 6w prostate biopsy

322
Q

Which drug is a recognised non infective cause of epididymitis?

A

Amiodarone

323
Q

Which reflex is lost following testicular torsion?

A

Cremasteric

324
Q

What is a common cause of a hydrocele in children?

A

A patent processus vaginalis

325
Q

Tx of hydrocele

A

Children - trans inguinal ligation of PPV

Adults - Lords or Jabouley procedure

326
Q

Raised AFP and HCG: seminoma or non-seminoma?

A

Non-Seminoma

327
Q

Classical triad of RCC

A

Loin Pain
Haematuria
Abdo Mass

328
Q

Most effective mx option in RCC

A

Partial/total radical nephrectomy

329
Q

RFs for prostate ca

A

Age
FHx
Obesity
Afro-Caribbean

330
Q

RFs for bladder ca

A

Transitional cell carcinoma: smoking, aniline dyes, rubber manufacture, cyclophosphamide

Squamous cell carcinoma: smoking + schistosomiasis

331
Q

What medical benefits does circumcision reduce the risk of?

A

UTI, HIV, penile cancer

332
Q

How can hydroceles be divided?

A

Communicating: PPV

Non-Communicating: XS fluid production within tunica vaginalis

333
Q

Which ca classically results in cannonball mets in the lungs?

A

RCC + Choriocarcinoma

334
Q

What should your work up inc for a left varicocele?

A

Must exclude RCC

335
Q

Tx of Infantile Hydrocele

A

Reassurance and surgical repair ie Lord’s or Jaboulay’s if it does not resolve within 1-2yrs

336
Q

Urethral Injury: Bulbar vs Membranous

A

Bulbar: more common; straddle type injury; triad of urinary retention, perineal haematoma and blood at the meatus

Membranous: extra or intraperitoneal; usually due to pelvic fracture; penile/perineal oedema/haematoma and high riding prostate

337
Q

Ix for Urethral Injury

A

Ascending Urethrogram

338
Q

Mx of Urethral Injury

A

Suprapubic Catheter

339
Q

How does rhabdomyolysis cause AKI?

A

ATN

340
Q

What causes acute interstitial nephritis?

A

Drugs, Autoimmune, Infection

341
Q

Comps of TURP

A

Turp Syndrome
Urethral Stricture/UTI
Retrograde Ejaculation
Perforation of Prostate

342
Q

Why does TURP syndrome occur?

A

When irrigation fluid enters the systemic circulation leading to: dilutional hyponatraemia, fluid overload, glycine toxicity

343
Q

ED: Organic vs Psychogenic

A

Organic: gradual onset, normal libido, lack of tumescence, recent op/trauma, DHx, SHx

Psychogenic: sudden onset, dec libido, good quality spontaneous or self stimulated erections, major life event, problems or changes in a relationship, prev psychological problems, hx of premature ejaculation

344
Q

Ix for ED

A

Calculate CVD risk by measuring lipid and fasting glucose

Measure free testosterone b/w 9-11am and if low repeat along with FSH, LH and prolactin

345
Q

Mx of ED

A
  1. PDE-5 Inhibitor 2. Vacuum Device

Any hormone abnormalities refer to endo and if a young male who has always had difficulty refer to urology

346
Q

Which type of renal stones are radiolucent?

A

Urate + Xanthine

347
Q

What are stag horn calculi composed of?

A

Struvite: Magnesium Ammonium Phosphate or Triple Phosphate

348
Q

What pH of urine do struvite stones form in?

A

Alkaline

349
Q

Which renal stones are inherited?

A

Cystine

350
Q

How long after ejaculation, vigorous exercise and prostatitis/UTI should you wait before measuring PSA?

A

Ejaculation/Exercise: 48hrs

Prostatitis/UTI: 1mnth

351
Q

How does torsion of the testicular appendage present?

A

Hx: sudden onset pain in one hemiscrotum w no other urinary sx

O/e: the superior pole will be tender with a blue discolouration and the cremasteric reflex is usually preserved

352
Q

Which pathogen most commonly causes acute bacterial prostatis?

A

E Coli

353
Q

Mx of Acute Bacterial Prostatitis

A

14d Quinolone + STI Screen

354
Q

Acute Bacterial Prostatitis RFs

A

Recent UTI; urogenital instrumentation; intermittent bladder catheterisation; recent prostate biopsy

355
Q

How does your age group match with the most likely organism responsible for epididymo-orchitis?

A

<35: Chlamydia

>35: E. Coli

356
Q

Does a vasectomy work immediately?

A

No

357
Q

When can UPSI begin following a vasectomy?

A

After semen analysis x2 usually done at 16 and 20wks

358
Q

What is important to ask about alongside past surgical hx?

A

Anaesthetic hx

?issues, ?well intra and post op, ?PONV

359
Q

IV Induction Agents

A

Sodium Thiopentone - rapid sequence of induction

Etomidate - short acting agent w no analgesic properties

Propofol - GABA receptor agonist used for inducing and maintaining

Ketamine - NMDA receptor antagonist used if haemodynamically unstable

360
Q

What ops require G+S beforehand?

A

Thyroidectomy, lap chole, appendicectomy, elective c/s, hysterectomy

361
Q

What ops require XM 2 units beforehand?

A

Salpingectomy + THR

362
Q

What ops require XM 4-6 units beforehand?

A

Elective AAA repair, upper GI surg, hepatectomy, cystectomy, oophorectomy

363
Q

Where is IO access typically undertaken?

A

Anteromedial aspect of proximal tibia

364
Q

How is local anaesthetic toxicity treated?

A

IV 20% Lipid Emulsion

365
Q

What are CIs to adding adrenaline to locals?

A

Pt on TCA or MAOI

366
Q

What are the causative agents for malignant hyperthermia?

A

Halothane
Suxamethonium
Antipsychotics

367
Q

Tx for Malignant Hyperthermia

A

IV Dantrolene

368
Q

Muscle Relaxants

A

Suxamethonium - depolarising

Rocuronium - non depolarising

369
Q

Which drugs are classically used as an antiemetic at the start/end of an op?

A

At the start dexamethasone then ondansetron at the end

370
Q

What drugs will you find in the emergency tray?

A

Epinephrine: cardiac arrest, anaphylaxis, bronchospasm

Amiodarone: arrhythmia

Atropine: bradycardia

Ephedrine: hypotension

Hydralazine: hypertension

371
Q

What is used to reverse muscle relaxants?

A

Neostigmine 2.5mg + Glycopyrronium 500mcg

The first is an anticholinesterase inhibitor whilst the latter inhibits ACh to reduce SEs

372
Q

What are the two benefits of fentanyl?

A

Pain control AND it reduces the amount of gas required for induction

373
Q

What is the CI to suxamethonium?

A

Any penetrating eye injuries or acute narrow angle glaucoma as it inc IOP

Year 6 - Surgery (6 decks)

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