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MSRA Revision > Surgery (Vasc, Colo, UGI, Breast...) > Flashcards

Surgery (Vasc, Colo, UGI, Breast...) Flashcards

1
Q

Anastrozole

  1. Class of drug?
  2. Indication (and why)?
  3. Main risks?
  4. Any pre-investigations required?
A

Anastrozole

  1. Aromatase Inhibitor
  2. Treatment of ER +ve breast CA in postmenopausal women - aromatisation accounts for majority of oestrogen in postmenopausal women
  3. Osteoporosis, arthralgia, myalgia
  4. DEXA scan - due to osteoporosis risk
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2
Q

Tamoxifen

  1. Class of drug?
  2. Indication?
  3. Risks?
A

Tamoxifen

  1. Selective Oestrogen Receptor Modulator (SERM) - Antagonist and partial agonist
  2. ER +ve breast CA
  3. VTE risk, endometrial CA, menstrual disturbance, hot flushes
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3
Q
  1. What are the two main sub-types of testicular CA?

2. Which has a worse prognosis?

A
  1. Seminomas and teratomas

2. Teratomas

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4
Q

Risk factors for testicular CA?

A

Infertility
Cryptorchidism
Family history, mumps orchitis
Klinefelter’s syndrome

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5
Q

Presenting features of testicular CA?

A

Testicular lump - painless
Hydrocoele
Gynaecomastia

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6
Q

Testicular CA - tumour markers?

A

hCG

AFP

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7
Q

Testicular CA

  1. Diagnosis?
  2. Treatment?
A

Testicular CA

  1. USS
  2. Orchidectomy +/- RT, chemo
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8
Q

Peripheral Arterial Disease - Management

  1. Conservative measures?
  2. Drugs for all patients (2)?
  3. Last-line drug for patients with poor QoL?
A
  1. Stop smoking, exercise, treat co-morbidities
  2. Statin & Clopidogrel
  3. Naftidrofuryl oxalate (vasodilator)
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9
Q

Aortic Dissection

  1. Presentation?
  2. Associations / risk factors?
  3. Classification?
  4. Imaging of choice?
A

Aortic Dissection
1. Tearing chest pain to back, weak pulses, HTN
2. HTN, Trauma, Marfan’s, Pregnancy
3. Type A = ascending aorta
Type B = descending aorta distal to L subclavian

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10
Q

Ascending Cholangitis

  1. Main bug?
  2. Name of classical triad?
  3. 4 features of triad?
  4. Diagnostic modality?
  5. Treatment?
A

Ascending Cholangitis

  1. E Coli
  2. Charcot’s Triad
  3. RUQ pain, fever, jaundice, raised inflammatory markers
  4. USS
  5. IV Abx, ERCP 24-48hrs after presentation to relieve obstruction
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11
Q

Colorectal CA Referral Criteria?

A

Unexplained weight loss and abdo pain >40
Unexplained PR bleed >50
IDA or change in bowel habit >60
+ve FIT

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12
Q

Faecal Immunochemical Test (FIT)

1. Screening details?

A

FIT

1. 60-74yo, or suspicion of bowel CA due to symptoms not quite meeting 2ww criteria

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13
Q

Renal Stones

  1. Diagnostic Modality?
  2. Drugs can give in ED?
  3. Drugs can give for medical management?
A

Renal Stones

  1. CT KUB
  2. Diclofenac
  3. Tamsulosin (alpha-blocker)
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14
Q 
Renal Stones - Management
What management option in the following?
1. Emergency (obstruction, previous transplant, infection)
2. Stone 2-5mm, non-pregnant?
3. Stone 2-5mm, pregnant?
4. Stone <5mm
5. Stone complex / staghorn calculus?
A

Renal Stones - Management

  1. Emergency = nephrostomy / stent to decompress
  2. 2-5mm and non-pregnant = shock wave lithotripsy
  3. 2-5mm and pregnant = ureteroscopy
  4. <5mm = conservative (Tamsulosin, watch and wait)
  5. Complex = percutaneous nephrolithotripsy
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15
Q

Chronic Pancreatitis

  1. Classic presentation?
  2. Risk factors?
  3. How to look for exocrine dysfunction?
  4. Imaging modality and finding?
  5. Treatment?
A

Chronic Pancreatitis

  1. Pain after fatty meal + steatorrhoea + diabetes
  2. Alcohol, CF, ductal obstruction
  3. Faecal elastase
  4. CT (calcification)
  5. Pancreatic enzyme supplement, analgesia, stop EtOH, treat obstruction
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16
Q

Acute Wound Dehiscence - Immediate Management (3 steps)

A
  1. Cover with saline-soaked gauze (prevent fluid loss)
  2. IV Abx
  3. Senior +/- theatre
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17
Q

Haemorrhoids

  1. Grading (1-4)?
  2. Treatment?
A

Haemorrhoids
1. Grade I - no prolapse
Grade II - prolapse on defaecation, spontaneously reduce
Grade III - manually reduce
Grade IV - cannot reduce
2. Fibre, local anaesthetics and steroids, rubber band ligation

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18
Q

Priapism

  1. Definition?
  2. Classification, which is more dangerous?
  3. Investigations?
  4. Treatment?
A

Priapism

  1. Erection >4hrs not related to sexual stimulation
  2. Ischaemic (more dangerous, impaired vasorelaxation), non-ischaemic (less dangerous, high arterial inflow, e.g. congenital)
  3. Cavernosal blood gas analysis, Doppler USS in young children
  4. Aspirate blood from cavernosa / surgery
19
Q

Breast CA Screening

  1. Screening Details?
  2. Criteria for referring for familial breast CA screening?
  3. Referral for non-screening referral?
A 
Breast CA Screening
1. 50-70y, every 3y
2. 1st/2nd degree relative +one of:
Age>40
B/L breast CA
Paternal side breast CA Hx
Male breast CA
Ovarian CA
Sarcoma in <45y
Jewish heritage
3. Age >30 and unexplained lump
Age >50 and nipple changes
20
Q

Volvulus
Which type of volvulus:
1. 80% cases, large bowel
2. 20% cases, small bowel

A

Volvulus

  1. Sigmoid
  2. Caecal
21
Q

Breast CA

  1. Most common sub-type?
  2. What is Paget’s disease of the nipple?
A

Breast CA

  1. Invasive ductal carcinoma
  2. Eczematous changes around the nipple, indicative of CA
22
Q

Breast CA - Management

  1. When mastectomy?
  2. When WLE?
  3. Adjuvant therapy?
  4. Hormone therapy: when indicated?
  5. Hormone therapy: pre-menopausal?
  6. Hormone therapy: post-menopausal?
  7. S/Es of SERMs?
A

Breast CA - Management

  1. Multifocal, central, large lesion, DCIS >4cm
  2. Solitary, peripheral, small lesion, DCIS <4cm
  3. RT for WLE / mastectomy if T3/4 or >4 nodes
  4. ER+ve breast CA
  5. Pre-menopausal = Tamoxifen (SERM)
  6. Post-menopausal = Anastrozole (Aromatase Inhibitor)
  7. VTE, endometrial CA, menopausal symptoms
23
Q

Hernias

  1. Inguinal location?
  2. Femoral location?
  3. Which has higher rates of strangulation?
A

Hernias

  1. Supero-medial to pubic tubercle
  2. Infero-lateral to pubic tubercle
  3. Femoral
24
Q

Hernias

  1. Define incarceration
  2. Define strangulation
A

Hernias

  1. Cannot reduce, risk of strangulation
  2. Tender, systemically unwell, surgical emergency
25
Q

Hernias in children

Management?

A

Hernias in Children

Surgical repair immediately (high risk of strangulation

26
Q

Prostate CA

1st line investigation for high PSA?

A

Prostate CA

MRI

27
Q

UGI Ulcers

  1. Relieved by eating?
  2. Worsened by eating?
A

UGI Ulcers

  1. Duodenal Ulcer
  2. Gastric Ulcer
28
Q

Breast Lumps

Young, non-tender, mobile

A

Fibroadenoma

29
Q

Breast Lumps

Lumpy breasts

A

Fibroadenosis

30
Q

Breast Lumps

Nipple changes, irregular hard lump, tethering

31
Q

Breast Lumps

Eczematous thickening of nipple

A

Paget’s disease (=CA)

32
Q

Breast Lumps

Tender lump +/- green discharge

A

Mammary Duct Ectasia

33
Q

Breast Lumps

Blood-stained discharge

A

Duct Papilloma

34
Q

Breast Lumps

Large breasts, trauma leading to lump

A

Fat Necrosis

35
Q

When to Stop Drugs Before Surgery

  1. Aspirin
  2. Warfarin
  3. NSAIDs
  4. COCP
  5. Parkinson’s
  6. DMARDs
  7. Clopidogrel
  8. SERMs e.g. Tamoxifen
  9. Antihypertensives
  10. LMWH
A

When to Stop Drugs Before Surgery

  1. Aspirin - 5 days
  2. Warfarin - 5 days
  3. NSAIDs - 1 day
  4. COCP - 4 weeks
  5. Parkinson’s - don’t stop
  6. DMARDs - stop before orthopaedic procedures
  7. Clopidogrel - 5 days
  8. SERMs e.g. Tamoxifen - 1 week
  9. Antihypertensives - day of surgery
  10. LMWH - 12-24hrs
36
Q

Diabetic Drugs Before Surgery

  1. When VRII?
  2. Metformin OD/BD
  3. Metformin TDS
  4. Sulfonylureas
  5. DPP-IV Inhibitors (Gliptins)
  6. GLP-1 (-tides)
  7. SGLT-2 inhibitors (-flozins)
  8. Long-acting insulin (e.g. Lantus)
  9. Biphasic insulin (e.g. Novomix)
A

Diabetic Drugs Before Surgery

  1. VRII: more than one meal missed, poor glycaemia control, risk of renal injury
  2. Metformin OD/BD = take as normal
  3. Metformin TDS = omit lunchtime dose
  4. Sulfonylureas = omit doses pre-surgery on day of surgery only
  5. DPP-IV Inhibitors (Gliptins) - take as normal
  6. GLP-1 (-tides) - take as normal
  7. SGLT-2 inhibitors (-flozins) - omit on day or surgery
  8. Long-acting insulin (e.g. Lantus) - reduce dose by 20%
  9. Biphasic insulin (e.g. Novomix) - half morning dose
37
Q

Vasectomy

What steps do you have to take before stopping barrier contraception?

A

Vasectomy

Semen analysis demonstrating azoospermia at 16 and 20 weeks post-op

38
Q

Subarachnoid Haemorrhage

  1. Treatment: raised ICP
  2. Treatment: stable
  3. Diagnosis?
  4. After surgery, treatment?
A

SAH

  1. Raised ICP = craniotomy and clipping
  2. Stable = coiling
  3. CT first, LP >12hrs (xanthocromia) if CT -ve
  4. Nimodipine 21 days and relative hypovolaemia
39
Q 
Colorectal CA Operations
What surgery based on site?
1. Emergency perforation
2. Sigmoid
3. Caecum, ascending/proximal transverse
4. Rectum
5. Anus
6. Distal transverse, descending
A
  1. Emergency perforation - Hartmann’s procedure (end colostomy)
  2. Sigmoid - High anteroir resection
  3. Caecum, ascending/proximal transverse - Rt hemicolectomy
  4. Rectum - Anterior resection
  5. Anus - AP excision of rectum
  6. Distal transverse, descending - Left hemi
40
Q

AAA

  1. Cut-off for normal AA size?
  2. Cut-off for “aneurysm”?
  3. Main RFs?
A

AAA

  1. <1.5cm female, <1.7cm male
  2. 3cm
  3. Smoking, HTN, Marfan’s
41
Q

Acute Pancreatitis

What criteria are in the Glasgow scoring system?

A 
Acute Pancreatitis
PaO2 <78
Age >55
Neuts >15
Calcium <2
Renal: urea >16
Enzymes: LDH >600
Albumin <32
Sugars: glucose >10
42
Q

Acute Pancreatitis

Main management?

A

Acute Pancreatitis

  1. Aggressive fluids
  2. Monitor U/O
  3. Analgesia
  4. Good nutrition
  5. ERCP / surgery
43
Q

Testicular Swellings
Cause for the following:
1. Posterior to testicle, separates from testicle
2. Soft, non-tender, transilluminating swelling, associations with torsion and CA
3. L-sided swelling, bag of worms
4. Painless lump, cannot separate from testicle
5. Cannot get above it, separates from testicle

A

Testicular Swellings

  1. Posterior to testicle, separates from testicle - epididymal cyst
  2. Soft, non-tender, transilluminating swelling, associations with torsion and CA - hydrocoele
  3. L-sided swelling, bag of worms - varicocoele
  4. Painless lump, cannot separate from testicle - CA
  5. Cannot get above it, separates from testicle - inguinal hernia

MSRA Revision (6 decks)

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