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EXAM PREP- YR 3 > surgical exam Qs i get wrong > Flashcards

surgical exam Qs i get wrong Flashcards

1
Q

A 78-year-old man complains of a long history of shoulder pain and more recently weakness. On examination active attempts at abduction are impaired. Passive movements are normal.

A

Rotator cuff tears- common in elderly, may occur after minor trauma or long standing impingement

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2
Q

A 63-year-old lady undergoes an axillary clearance for breast cancer. She makes steady progress. However, 8 weeks post operatively she still suffers from severe shoulder pain. On examination she has reduced active movements in all planes and loss of passive external rotation.

A

Adhesive capsulitis- initial painful stage folloed by joint stiffness

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3
Q

Carpal tunnel syndrome- hx

A

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night

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4
Q

Carpal tunnel syndrome- examination

A

weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms

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5
Q

What infection are pts with rib fracture prone to & why? How to prevent this?

A

Patients with rib fractures can find their deep breathing limited by pain. This causes susceptibility to chest infections as they cannot cough adequately to clear secretions.
Adequate analgesia is vital in rib fractures to ensure breathing is not affected by pain; inadequate ventilation may predispose to chest infections
Chest physiotherapy with breathing exercises helps

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6
Q

Iliopsoas abscess most common causative organism

A

Staph aureus

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7
Q

Initial imaging for Achilles tendon rupture?

A

USS

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8
Q

What is morton’s neuroma?

A

Benign neuroma affecting intermetatarsal plantar nerve
Commonly 3rd inter-metatarsophalangeal space
More common females
Forefoot pain
worse on walking
shooting or burning

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9
Q

Lateral knee pain in runners, no trauma…

A

Iliotibial band syndrome

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10
Q

Most common site of stress fractures

A

2nd metatarsal- longest metatarsal bone, thin and vulnerable to stress fracturesq

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11
Q

Adhesive capsulitis- which movement is classically impaired

A

External rotation

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12
Q

Fat embolism- triad of symptoms

A

Respiratory
Neurological
petechial rash (after the first two)

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13
Q

Signs of fluid depletion

A
  • Dry mucous membranes and reduced skin turgor
  • Decreasing urine output (should target >0.5 ml/kg/hr)
  • Orthostatic hypotension

In worsening stages:

  • Increased capillary refill time
  • Tachycardia
  • Low blood pressure
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14
Q

Signs of fluid overload

A
  • Raised JVP
  • Peripheral or sacral oedema
  • Pulmonary oedema
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15
Q

Ix when there’s fluid problems in a pt

A

Fluid input/output chart
Daily weight chart
U&Es - dehydration, renal hypoperfusion, electrolyte abnormalities

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16
Q

NICE daily requirements

A

Water: 25 mL/kg/day
Na+: 1.0 mmol/kg/day
K+: 1.0 mmol/kg/day
Glucose: 50g/day

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17
Q

Gold standard diagnosis osteomyelitis

A

Bone biopsy at debridement

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18
Q

Which movements are most affected in frozen shoulder

A

All active and passive movements

external rotation more than internal rotation or abduction

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19
Q

What happens if u give anticoagulation in compartment syndrome

A

Worsens it

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20
Q

Red, hot swollen joint in diabetic patient- what you considering?

A

Charcot’s foot

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21
Q

Treatment for Dupuytren’s contracture

A

Consider surgery when pt cannot lay hand flat on table- metacarpophalangeal joints can’t be straightened
Other mx options include injectable enzyme therapy

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22
Q

Causes of Dupuytren’s contracture

A 
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
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23
Q

What is epicondylitis

A

Epicondylitis is caused by repeated strain leading to inflammation of the common extensor tendon at the epicondyle.
Golfers- medial epicondyle- pain on resisted pronation
Tennis- lateral epicondyle- pain on resisted wrist extension

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24
Q

First line ix for suspected osteoporotic vertebral fracture

A

X-ray of whole spine

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25
Q

How to diagnose De Quervains tenosynovitis

A

Clinical diagnosis
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

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26
Q

Mx undisplaced scaphoid fracture

A

Cast 6-8 weeks

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27
Q

Groin lump differentials

A 
Hernia
Saphena varix
Femoral artery aneurysm
Lymphaedenopathy
Lipoma
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28
Q

Scrotal lump differentials

A 
Hydrocoele
Varicocoele
Epididymal cyst
Epididymitis
Testicular tumour- malignant or benign
Testicular torsion
Inguinal hernia
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29
Q

Foot drop- causes

A

Weakness of foot dorsiflexors

Possible causes- common peroneal nerve lesion (most common)- often compression @ neck of fibula

L5 radiculopathy
Sciatic nerve lesion
Superficial or deep pernoeal nerve lesion
CNS lesions (with other features)- stroke

30
Q

Mx of foot drop

A

Conservative if due to peroneal nerve
Avoid crossing legs, squatting, kneeling
~2-3mnths to heal

31
Q

Sensory supply of anterolateral thigh

A

Lateral femoral cutaneous nerve (lateral cutaneous nerve of thigh)
Nerve roots L2,L3

32
Q

Sensory function of obturator nerve

A

Middle part of medial thigh

33
Q

Femoral nerve divisions + sensory functions

A

Anterior- anterior cutaneous branches- anteromedial and posteromedial thigh
Posterior- saphenous nerve -skin of medial leg and foot

and branches to quad fem

34
Q

What supplies the posterior thigh

A

Posterior cutaneous nerve of the thigh/ posterior femoral cutaneous nerve

Extends to posterior leg, about 1/3 the way

35
Q

Sensory supply posterolateral leg

A 
Sural nerve (from tibial and common fib)
Also supplies lateral foot
36
Q

What muscles make up the Achilles tendon

A

Gastrocnemius
Soleus
Plantaris

37
Q

Following radiotherapy for prostate cancer, what can pts develop

A

Patients are at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer

38
Q

Analgesia in acute mx of renal colic

A

IM diclofenac

39
Q

First line ix in suspected prostate cancer

A

Multiparametric MRI

40
Q

First line ix of testicular mass

A

USS

41
Q

Gold standard ix renal stones

A

non contrast CT KUB

42
Q

Criteria for inpatient admission for renal stones

A

Post-obstructive acute kidney injury
Uncontrollable pain from simple analgesics
Evidence of an infected stone(s)
Large stones (>5mm)

43
Q

Renal calculi mx- obstructed, or infected

A

Stent insertion-
Retrograde stent insertion, via ureter

Or percutaenous nephrostomy is a tube into renal pelvis (antegrade stent)

44
Q

When to consider extra corporeal shock wave lithotripsy in renal stones mx

A

<2cm

If impacted in upper ureter may consider ureteroscopy

45
Q

Staghorn calculus mx

A

Large, proximal stones- percutaneous nephrolithototomy

46
Q

Complications of TURP

A

TURP syndrome (hypoNa, fluid overload, glycine toxicity)
Urethral stricture/ UTI
Retrograde ejac
Prostate perforation

47
Q

Schistosoma infection is closely linked to risk of developing what cancer

A

squamous cell carcinoma bladder

48
Q

How long to delay a PSA test after prostatitis

A

1 month

49
Q

Periureteric fat stranding indicates what…

A

Recent stone passage if no ureteric calculus passage

50
Q

Ix for erectile dysfunction

A

10yr CVS risk (lipid and fasting glucose serum levels)

Free testosterone in the morning between9 and 11
If low or borderline, repeat with FSH, LH and prolactin. If abnormal, endo referral

51
Q

Which artery is compromised in scaphoid fracture

A

Dorsal carpal branch radial artery

52
Q

Causes of hip AVN

A

long-term steroid use
chemotherapy
alcohol excess
trauma

53
Q

How does cauda equina present (early and late signs)

A

Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include urinary incontinence

54
Q

Suspected psoas abscess- imaging?

A

CT scan

55
Q

Compartment syndrome is commonly associated with which fractures?

A

Supracondular

TIbial

56
Q

Symptoms of compartment syndrome

A

Pain, especially on movement (even passive)
excessive use of breakthrough analgesia should raise suspicion for compartment syndrome
Parasthesiae
Pallor may be present
Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
Paralysis of the muscle group may occur

57
Q

Will X-ray help with compartment syndrome diagnosis?

A

No

58
Q

What is bennetts fracture

A

Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal

59
Q

What is potts fracture

A

Bimalleolar ankle fracture

Forced foot eversion

60
Q

What is cubital tunnel syndrome

A

Cubital tunnel syndrome is caused by compression of the ulnar nerve @ elbow
and can present with tingling/numbness of the 4th and 5th finger

61
Q

Undisplaced patella fracture mx

A

Conservative- brace or cast

62
Q

Subluxation of radial head (pulled elbow) mx

A

analgesia and passively supination of the elbow joint whilst the elbow is flexed to 90 degrees

63
Q

Which movement is most affected in frozen shoulder

A

External Rotation

64
Q

Clinical features of acute limb ischaemia

A

6 Ps

pale, pulseless, perishingly cold, paraesthesia, paralysis, pain

65
Q

Gold standard ix for acute limb ischaemia

A

CT angiography

66
Q

Acute PR bleeds, haemodynamically stable, mx?

A

Supportive mx

67
Q

Most common cause of small bowel obstruction

A

Adhesions

68
Q

What is angiodysplasia

A

Features- rectal bleeding and anaemia
Most common vascular abnormality of GIT
Responsible for 6% lower GI bleeding and up to 8% upper GI bleed

69
Q

Causes of serum amlyase rise

A

Infections- mumps
Intra-abdominal pathology- peptic ulcer or bowel perforation, intestinal obstruction, pancreatitis
Drugs- morphine
Renal failure

70
Q

Which artery is at risk with duodenal ulcers

A

Gastroduodenal artery

71
Q

Imaging for fistula in ano

A

MRI to see its course

72
Q

Congenital hernias mx

A

inguinal: repair ASAP
umbilical: manage conservatively

EXAM PREP- YR 3 (4 decks)

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