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Daisy Finals Revision > Surgery (not ortho) > Flashcards

Surgery (not ortho) Flashcards

1
Q

What is dumping syndrome?

A

Post gastric surgery
Hyperosmolar load rapidly enters jejunum. Osmosis drags water into lumen, resulting in lumen distension then diarrhoea
Also excessive insulin release -> hypoglycaemia

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2
Q

causes of small bowel obstruction?

A

adhesions
hernias
malignancy

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3
Q

features of small bowel obstruction on auscultation?

A

tinkling bowel sounds

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4
Q

initial mgt small bowel obstruction?

A

NBM
IV fluids
NG tube

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5
Q

small bowel obstruction on XR?

A

valvulae conniventes full width

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6
Q

large bowel obstruction on XR?

A

haustra only part width

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7
Q

dx: 36 year old day 3 post op after open appendicectomy presents with abdo distention and vomiting

A

paralytic ileus

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8
Q

initial mgt for paralytic ileus?

A

NBM
NG
IV fluids

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9
Q

how to speed up resolution of paralytic ileus?

A

mobilising
chewing gum

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10
Q

dx: 87 year old nursing home resident with acute abdo pain and vomiting

A

volvulus

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11
Q

types of volvulus?

A

sigmoid
caecal

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12
Q

x ray finding in volvulus?

A

coffee bean sign

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13
Q

conservative management option for volvulus?

A

endoscopic decompression

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14
Q

surgery options for sigmoid volvulus?

A

hartmann’s procedure

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15
Q

surgery options for caecal volvulus?

A

ileocaecal resection
right hemicolectomy

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16
Q

complications of hernias?

A

incarceration
obstruction
strangulation

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17
Q

surgical options for hernias?

A

tension free repair
tension repair (less preferred)

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18
Q

how to distinguish between a direct and indirect inguinal hernia?

A

indirect remains reduced with pressure at the deep ring

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19
Q

what are the boundaries of hesselbach’s triangle?

A

RIP
Rectus abdominis (medial)
Inferior epigastric vessels

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20
Q

types of hiatus hernias?

A

sliding (GOJ comes through) and rolling (fundus comes through)

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21
Q

risk factors for hiatus hernia?

A

inc age
obesity
pregnancy

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22
Q

usual surgical procedure for hiatus hernia?

A

laparoscopic fundoplication

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23
Q

clockface locations of the anal cushions?

A

3, 7 and 11 o’clock

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24
Q

classification off haemorrhoids?

A

1st degree: no prolapse
2nd: prolapse returns on relaxing
3rd: prolapse can be pushed in
4th: prolapse permanently

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25
Q

procedure to internally visualise haemorrhoids?

A

proctoscopy

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26
Q

non surgical options for haemorrhoids?

A

rubber band ligation
injection sclerotherapy
IR coagulation
bipolar diathermy

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27
Q

definitive investigation for small bowel obstruction?

A

abdo CT

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28
Q

treatment for fissure in ano?

A

stool softeners
topical diltiazem or GTN
botulinum toxin
sphincterotomy

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29
Q

mgt for fistula in ano?

A

lay open if low, no sphincter involvement or IBD
if complex, high or IBD insert seton and consider other options

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30
Q

presentation of mesenteric infarction?

A
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31
Q

key risk factor for mesenteric ischaemia?

A

AF

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32
Q

initial imaging for mesenteric ischaemia?

A

contrast CT

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33
Q

ABG findings in acute mesenteric ischaemia?

A

metabolic acidosis
raised lactate

34
Q

objectives during surgery for acute mesenteric ischaemia?

A

remove necrotic bowel
remove/bypass the thrombus

35
Q

overall mortality rate in acute mesenteric ischaemia?

A

over 50%

36
Q

management of femoral hernia?

A

always need repair
due to risk of strangulation

37
Q

pneumoperitoneum (free air under diaphragm on cxr and severe upper abdo pain?

A

perforated peptic ulcer

38
Q

fluid requirement formula in burns?

A

total requirement in 24h = 4 ml x (total burn surface area (%)) x (body weight (kg))
50% given in first 8 hours
50% given in next 16h

39
Q

scrotal swelling in 3 year old boy, mass doesnt transilluminate and impossible to palpate normal cord above it

A

indirect inguinal hernia

40
Q

surgery for distal transverse or descending colon cancer?

A

left hemicolectomy

41
Q

surgery for a mid-rectal tumour?

A

low anterior resection

42
Q

surgery for upper rectal tumour?

A

anterior resection

43
Q

surgery for lower rectal tumour?

A

abdomino-perineal resection

44
Q

surgery for caecal, ascending or proximal transverse colon cancer?

A

right hemicolectomy

45
Q

what does the coffee bean sign indicate?

A

volvulus

46
Q

associations with sigmoid volvulus?

A
  • older pts
  • chronic constipation
  • chagas disease
  • neurological conditions eg parkinson’s, duchenne muscular dystrophy
  • psychiatric conditions eg schizophrenia
47
Q

associations with caecal volvulus?

A
  • all ages
  • adhesions
  • pregnancy
48
Q

mgt of sigmoid volvulus?

A

decompression via rigid sigmoidoscopy and flatus tube insertion

49
Q

surgery for perforation as result of sigmoid colon tumour?

A

hartmann’s procedure

50
Q

mgt for chronic anal fissure?

A

topical GTN
try for 8 weeks then secondary care referral for sphincterotomy or botox

51
Q

mgt of acute anal fissure?

A

soften stool
lubricants eg petroleum jelly before defecation
topical anaesthetics
analgesia

52
Q

AAA >5.5cm mgt?

A

refer to vascular surgery within 2wks for probable intervention

53
Q

AAA 4.5-5.4cm mgt?

A

rescan every 3 months

54
Q

AAA 3-4.4cm mgt?

A

rescan every 12 months

55
Q

AAA <3cm mgt?

A

no further action

56
Q

when does AAA screening take place?

A

single abdominal ultrasound for males aged 65

57
Q

mgt for AA aneurysms increasing in size by over 1cm in a year?

A

refer to vascular surgery within 2 weeks

58
Q

medications for all patients with peripheral arterial disease?

A

clopidogrel
atorvastatin

59
Q

management for superficial thrombophlebitis?

A
  • antiembolic stockings and consider for LMWH
  • if LMWH contraindicated, 8-12 days of oral NSAIDs should be offered
60
Q

initial management of acute limb ischaemia?

A

analgesia, IV heparin and vascular review

61
Q

conservative mgt for varicose veins?

A

leg elevation
wt loss
regular exercise
graduated compression stockings

62
Q

surgical management for short segment stenosis eg <10cm in limb ischaemia?

A

endovascular revascularisation (percutaneous angioplasty)

63
Q

surgical management for short segment stenosis eg <10cm in limb ischaemia?

A

surgical revascularization (bypass)

64
Q

features of extradural haemorrhage?

A

lentiform
midline shift
caused by middle meningeal artery

65
Q

features of subdural haemorrhage?

A

slower onset of symptoms
crescent shaped on CT
fluctuating confusion/consciousness

66
Q

best imaging for ?C spine injury in trauma?

A

CT c spine

67
Q

criteria for CT head within 1 hour?

A

GCS <13 on initial assessment
GCS <15 at 2 hours post injury
suspected open or depressed skull fracture
post-traumatic seizure
focal neurological deficit
>1 episode of vomiting

68
Q

management for patients who have had a head injury and are on warfarin? (regardless of whether they have risk factors for intracranial bleed)

A

CT head within 8 hours

69
Q

electrolyte imbalance complication of subarachnoid haemorrhages?

A

hyponatraemia (due to SIADH)

70
Q

vessels responsible in subdural haematoma?

A

bridging veins

71
Q

when should LP be done to detect a SAH?

A

at least 12 hours after the start of the headache

72
Q

6 tests to confirm brain death?

A

pupillary reflex
corneal reflex
oculo-vestibular reflex (no eye movt in response to 50ml of ice cold water into each ear)
cough reflex
absent response to supraorbital pressure
no spontaneous respiratory effort

73
Q

triad of ascending cholangitis features?

A

fever, jaundice and RUQ pain
= charcots triad

74
Q

glasgow score for pancreatitis severity?

A

PANCREAS
PaO2 <7.9kPa
Age >55
Neutrophils (WCC >15)
Calcium <2mmol
Renal function - urea >16
Enzymes (lactate dehydrogenase >600)
Albumin <32
Sugar BG >10

75
Q

what score on glasgow pancreatitis scale indicates high risk for severe pancreatitis?

A

3 and above

76
Q

local complications of acute pancreatitis?

A

peripancreatic fluid collections
pseudocysts
pancreatic necrosis
pancreatic abscess
haemorrhage

77
Q

systemic complication of acute pancreatitis?

A

acute respiratory distress syndrome

78
Q

most common organism causing cholangitis?

A

e coli

79
Q

which malignancy does PSC put you at risk of?

A

cholangiocarcinoma

80
Q
A

Daisy Finals Revision (25 decks)

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