Surgical Flashcards
What is the management of bell’s palsy?
Oral prednisolone within 72 hours of onset
After what time period of having bell’s palsy should you refer to ENT?
After 3 weeks - then urgent referral
What are the features of a meniscal tear?
Knee-locking, knee giving-way, after a twisting injury, swelling occurs several hours after the injury
What are the features of a cruciate ligament injury?
popping noise/sensation, rapid swelling, inability to return to activity, can be caused by twisting movements
What are the features of ankylosing spondylitis?
Lower back pain and stiffness of insidious onset, worse in morning, improves with exercise, schober’s test <5cm
What is the first line investigation of a testicular mass?
USS
What is the management of rib fractures?
analgesic ladder, then regional nerve block
What is flail chest?
Consecutive rib fractures, causing paradoxical movements during respiration - can cause contusional injury
What is a late sign of cauda equina syndrome?
Urinary incontinence
What are the signs of cauda equina?
low back pain, bilateral sciatic pain, reduced sensation perianally, decreased anal tone, urinary dysfunction
What is investigation do you do in cauda equina?
MRI
How do you manage a pre-operative low haemoglobin?
Pre-op blood transfusion
What type of resection would you do for a cancer of the rectum?
Anterior resection
How long prior to surgery should women stop taking the COCP?
4 weeks
Which diabetes medication regimes change before/after an operation?
metformin and sulfonylureas - omit lunch dose, take rest as normal
SGLT-2 inhibitors - omit on day of surgery
once daily insulin - reduce dose by 20%, day before and day of surgery
Humulin M3 - halve morning dose
What is the position of an inguinal and a femoral hernia?
inguinal - medial and superior to the pubic tubercle
femoral - inferior and lateral to the pubic tubercle
What type of surgery is done for a tumour of the rectum?
Anterior resection (if sigmoid colon then high anterior resection)
What type of surgery is done for a tumour of the ano-rectal junction?
abdomino-perineal excision of rectum
What is a Hartmann’s procedure?
Sigmoid excision, with end colostomy formed
What is the management of an anal fissure?
If < 1 week: laxatives and high fibre. Try analgesia. If < 1 weeks, continue with these and trial GTN. After 8 weeks - refer for sphincterotomy
What is a normal ABPI?
- Anything less than 1 indicates peripheral arterial disease
What is the management of acute pancreatitis?
IV fluids and opioid analgesia
How long after a UTI/prostatitis should you test PSA?
After 6 weeks
What medication can be used to decrease the incidence of calcium stones?
thiazide-like diuretics
What is the management of a young person who has always had difficulty maintaining an erection?
refer to urology
What is the gold standard investigation for small bowel obstruction?
CT abdo. XRay is first line
What is the management of small bowel obstruction?
NBM, IV fluids, NG tube drainage
What is the management of a femoral hernia?
Urgent surgical repair due to risk of strangulation
What are the features of ascending cholangitis?
Fever, RUQ pain, jaundice (can also get hypotension and confusion)
What investigation is done for ascending cholangitis?
US
When is AAA screening?
For men over 65yrs - a single ultrasound
What are each types of stoma for and where are they?
spouted stoma in right iliac fossa - ileostomy
flush stoma in left iliac fossa - colostomy
Double stoma - loop anastomosis - can be reversed and usually following anterior resection
What do you do if there is a normal CT head within 6 hours of suspected SAH?
Do not do LP. Consider alternative diagnosis
When should LP done in suspected SAH?
After 12 hours to allow for xanthochromia formation
What are the features of diverticulitis?
altered bowel habit, rectal bleeding, abdominal pain
What is the first line investigation for a acute limb ischaemia?
handheld arterial doppler. if doppler signals present ABPI
Which types of shock have warm peripheries?
Septic, anaphylactic and neurogenic
Which surgery is often used for emergency bowel resections?
Hartmanns - resection of sigmoid and formation of end colostomy
What is the management of appendicitis?
Appendicectomy, with prophylactic IV Abx
What are the preventative doses of aspirin and clopidogrel?
75mg (300mg is a loading dose)
Why how does goserelin help prostate cancer?
GnRH agonist - causes over stimulation of pituitary, raise in T, followed by low T levels
What is the first line medication for symptom management in prostate hyperplasia?
Alpha-1 antagonists (tamsulosin)
what hormonal therapy is used for breast cancer?
Tamoxifen in pre + peri menopausal women
Aromatase inhibitors (anastrozole) in post-menopausal women
How long before surgery should you fast?
6 hours for food/non clear liquids, 2 hours for clear liquids
Should you take sulfonylureas (gliclazide) on the day of surgery?
No, omit morning dose, if afternoon operation, omit both doses. omit due to risk of hypoglycaemia
Should you take SGLT-2 inhibitors on the day of surgery?
No
What is the difference in presentation between acute cholangitis and acute cholecystitis?
Cholangitis - fever, RUQ pain, jaundice (charcot’s triad), lft changes
cholecystitis - RUQ pain, no jaundice, fever, raised WCC, mild LFT changes
What is the management of acute cholangitis?
IV Abx, ERCP
What is the difference in presentation between an incarcerated hernia and a strangulated one?
Incarcerated is less painful, but is non-reducible. Blood can still flow to tissue.
Strangulated hernias are more painful due to lack of blood supply
When do patients get steatorrhoea and diabetes mellitus in chronic pancreatitis?
5-25 years after disease starts - measure HbA1c annually
What are the common complications of a trans-urethral resection of the prostate?
erectile dysfunction and incontinence
What hormonal therapy is given in oestrogen positive breast cancer?
tamoxifen in pre and peri-menopausal women, anastrozole in post
Which biological therapy can be used in breast cancer?
Herceptin (trastuzumab) only in HER2 positive tumours
Which medication can be used to reduce hypercalciuria?
Thiazide diuretics
What is the management of hernias in children?
Umbilical - manage conservatively (Um no need for surgery)
Inguinal - repair ASAP
(In for surgery)
What is the difference in presentation between perianal fissure and fistula?
Fistula - can predispose to absesses can cause raised temperatures, can cause pus, throbbing pain, more incontinence than bleeding
Fissure - sharp pain is only usually on defecation, bleeding
What is the management of an anal fissure?
Stool softeners, lubricants, local anaesthetics.
If chronic - give GTN, if not working after 8 weeks, try sphincterotomy or botulinum toxin
What is the first line management of symptoms caused by an enlarged prostate?
Alpha-1 antagonists, second line is 5-alpha-reductase inhibitors
What is the management of varicose veins?
1st line: compression stockings, exercise, leg elevation
refer to secondary care id skin changes: can do endothermal ablation, foam sclerotherapy, ligation or stripping
What are the indications for a thoracotomy in a haemothorax?
> 1.5L blood loss
or > 200ml blood loss every hour for > 2 hours
What is the difference between acute and critical limb ischaemia?
Critical = chronic, > 2 weeks, end stage of PAD, gangrene, ulcers, pain at rest
Acute = sudden onset ischaemia to a limb, usually due to a thrombus
What investigations should be done for acute limb ischaemia?
hand held doppler, if signals present ABPI
Which medications typically cause erectile dysfunction?
SSRIs and beta blockers and alcohol
What is the first line management of peripheral arterial disease?
atorvastatin 80mg and clopidogrel
What is reynolds pentad?
Charcot’s triad (fever, jaundice, RUQ pain) plus hypotension and confusion - seen in ascending cholangitis
How long after cholecystitis should you have a cholecystectomy?
within 1 week
