Surgery passmed points Flashcards
what type of cancer is assoc with barretts oesophagus
adenocarcinoma
what is the MOA of anastrozole
aromatase inhibitor
- same as letrozole
- give to post menop women with breast cancer
how to treat local anaesthetic toxicity?
IV 20% lipid emulsion
- occurs if too much LA gets into venous system
signs and symptoms of ductal ectasia?
benign
symmetrical slit like contraction of nipple
cheese like discharge
best treatment for stones caused by high calcium?
thiazide like diuretics
management plan for women with breast cancer but no palpable axillary lymphadenopathy?
pre-op axillary US before primary surgery and if negative = sentinel LN biopsy to assess nodal burden
management plan for women with breast cancer and palpable axillary lymphadenopathy?
axillary LN clearance is indicated at primary surgery
can cause arm lymphoedmea and functional arm impairment
complication of patients on long term mechanical ventilation?
Tracheosophageal fistula
-> due to increased pressure of tracheosomy or prolonged intubation
complications of a TOF in pts with long term mechanical ventilation
aspiration pneumonia
air leak
cough
what type of cancer is comedo necrosis associated with?
breast -> ductal carcinoma in situ
this has high rate of progression to invasive
how long to stop COCP before a surgery
4 weeks before
indications for open revascularisation/bypass surgery in PAD?
diffuse disease
or stenosis >10cm
what is fibroadenosis?
fibrocystic disease, benign mammary dysplasia
Most common in middle-aged women
‘Lumpy’ breasts which may be painful.
Symptoms may worsen prior to menstruation
MC cause of discitis
staph aureus
TPN should be administered via
central vein -> PICC into subclavian vein
diclofenac nt working for renal stones -> next pain relief is?
iv paracetamol
when is time out performed
before first skin incision
when is a sign in done
before induction of anaesthesia
when is a sign out done
before pt leaves operation room
electrolyte abn assoc with SAH
hyponatriema
pt has UTI/prostatits, when can i do PSA test
after 6 weeks
inheritance pattern of susceptibility of malignant hyperrthermia
auto dominant
so if mum has it, you have 50% chance
pt with intracranial bleed that becomes unresponsive, what do you do>
CT head -> ?hydrocephalus
if its a rebleed will see that on ct head then can due ateriogram to see where it is but if do that first could miss hydrocephalus
how can a pt clean wounds post surgery
up to 48 hours = sterile saline
after 48 hours = shower
isolated fever in post op pt 24 hours after surgery?
physiological systemic inflam reaction
factors that point towards organic cause of Ed
Gradual onset of symptoms
Lack of tumescence
Normal libido
critical limb ischaemia vs acute limb threatening
critical limb developes over 2 weeks
medications for peripheral AD
clopidogrel and atorvastatin
initial mx of acute limb ischaemia
analgesia
IV heparin
vascular review
what is the prognostic test for pancreatitis
blood glucose >10
how to investigate bladder wall repair after partial cystectomy
cystogram
blockage of which duct does not cause jaundice?
cystic duct as bile still able to flow through cbd to sphincter of oddi
thumbprinting on AXR indicates?
ischaemic colitis
due to mucosal oedema/haemorrhage
irregular testicular lump with normal HCG and AFP?
seminoma
teratoma and yolk sac usually have raised levels of these
teratomas for troops 20-30
seminomas for sergeants 30-40
sergeants dont leave a mess = normal markers
when should a variable rate insulin infusion be set up for surgery
pts on insulin having majory surgery -> more than 1 meal missed
poorly controlled DM
when is lignocaine not mixed with adrenaline
in minor ops on finger toes penis as no collateral blood flow so necrosis
tx for kidney stone <2cm
lithotripsy +/- alpha blocker first
if impacted in upper ureter or 10mm-20mm = ureteroscopy
(stent left for 4 weeks after procedure)
tx for kidney stone >2cm
percutaneous nephrolithotomy
indications for thoractomy
> 1.5L blood lose initally
200ml lost per hourfor >2hours
A pelvic fracture and highly displaced prostate?
membranouse urethral rupture
when is femoral A bypass surgery indicated over endovasc revasc
with long segment >10cm
imaging to check anastomosis
gastrograffin enema
gnrh side effects
causes tumour flare
bone pain
bladder obstruction
side effect of etomidate used for rapid sequence induction
adrenal suppression
which stones are ardio-lucent on xray
urate and xanthine
how can you tell if there is free air in abdomen from AXR
rigglers sign
- double wall sign
which anal fissure is a red flag
lateral 3 oclock position
strongest rf for anal cancer
HPV infection
hydrocephalus px in a child
increased head circumference
bulging fontanelle
sunsetting of eyes -> impaired upward gaze caused by pressure on tectal plate
dilated scalp veins
bradycardia
seizure
coma
tx for prostatitis
14 days of ciprofloxacin
what nerve is at risk for a carotid endartectomy
hypoglossal
when is best to use oropharyngeal airway
bridge until more definitive airway
when is a laryngeal mask good and bad to use
good: easy to use, no paralysis needed, day surgery
bad: poor control of gastric reflux, cant use for high pressure ventilation
when is a tracheostomy usefu;
used in slow weaning in ITU
when is endotracheal tube useful
optimal control of airway
paralysis needed
capnogaphy to check if oesophageal intubation
classic finding o/e of patient with pulseless peripheries
takayasus arteritis
young asian females
mx with steroids
subclavian steal syndrome presents as
caused by prox stenosis causing retrograde flow through vertebral or internal thoracic A
synocopal
duplex scan
examination findings in co arc of aorta
rib notching
systolic murmur
difference in BP between arms and legs
prevention medication for calcium stones
potassium citrate
what bmi should be considered for immediate referral for bariatric surgery
> 50
if a pt is symptomatic with RCC what is the most likely stage
stage 4
what nerve is involved in cremasteric reflex
afferent/sensory = femoral branch of genitofem
efferent/motor = genital branch of GF nevre
which anaesthetic agent is hepatotoxic
halothane
which form of testicular cancer has a better prognosis? seminoma vs teratoma
seminoma
in a pt with superficial thrombophelbitis, who requires an urgent scan
if it affects the proximal long saphenous vein
> 5cm of STB have greater risk of DVT
complications of total parenteral nutrition
sepsis
thrombophlebitis
hepatic dysfunction -> derranged LFT that would suggest obstructive jaundice this is due to paraenteral feeding not causing CCK to be released so you get stasis of gallbladder
signs of subcutaneous emphysema on cxr
will be able to see pec major striations
acute anal fissure treatment <1 week
soften stool
fibre
topical lidocaine
topical diltiazem or GTN is only started if it persists for 1 week+
consequences of SAH
HD tv? Remember VHS tapes
Hydrocephalus
Death
Re-bleed -> within 12 hours
Vasospasm -> 7-14 days
hyponatriema -> SIADH
seziures
partial vs radical nephrectomy in RCC
T1<7cm can be considered for partial
serum lipase vs serum amylase in diagnosis of acute appendicitis
lipase is more specific and sensitive to amylase
lipase is more expensive test
types of enteral feeding
NG tibe
peg/RIG -> long term >4 weeks
jejunosotomy
