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*** Exam Medicine > Surgical Summary Q's > Flashcards

Surgical Summary Q's Flashcards

1
Q

what hormones offered to female breast CA sufferers if hormone positive? (pre and post menopause)

A

tamoxifen (pre) aromatase inhibitors such as anastrozole (post)

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2
Q

Patient presents with suspected GORD. what in the hx would exclude sinister cause?

A

ALARM Symptoms

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3
Q

exterminating h pylori?

A

triple therapy Omeprazole metronidazole clari

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4
Q

RF for gallstones

A

fat, fertile, female, forty, ??

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5
Q

charcots triad, and condition in which it is relevant?

A

Jaundice, fever, rigors, RUQ pain ascending cholangitis

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6
Q

how to assess severity of acute panc

A

PANCREAS PaO2 Age Neutrophils Ca Renal FUnc (Urea) Enzymes Albumin Sugar (BM)

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7
Q

clinical findings for left and right sided colon CA and how could you grade severity?

A

Right - weight loss, abdo pain, abdo mass, rectal bleeding Left - bowel alteration, tenesmus, PR mass, weight loss, rectal bleeding DUKES criteria

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8
Q

patient presents with rectal bleeding, what must be done in clinic before referring?

A

Proctoscope PR Abdo exam

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9
Q

patient has just had a hemicolectomy and is now back in the ward. after 3 hours, their BP drops and they are in pain. what 3 complications may have ensued?

A

anastomotic leak wound infection sepsis??

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10
Q

what might be seen in patient with S + L bowel obstruction

A

S - earlier vomiting, less distension, colicky pain, no poo L - tinkling, later vomiting, more distension, pain, tympanic percuss

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11
Q

what might cause a L + S bowel obstruction? (3)

A

S - hernia, adhesions, CA L - volvulus, faecal, diivertic?? CA

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12
Q

art/ven/neuro Ulcers???

A

???

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13
Q

rf for arterial disease and venous disease

A

Art - DM, chol, HTN, venous - immob, surg, fractures, obese, on OCP

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14
Q

what is RF for 2 types of oesophageal CA

A

adeno - barrets squamous - smoking and alcohol

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15
Q

what must be excluded/diagnosed if a peptic ulcer is suspected? what is other option of common cause?

A

H Pylori! NSAID use

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16
Q

how might a CA in oes stomach be staged?

A

endoscopic USS (stomach) ,biopsy, CT

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17
Q

complications of gallstones

A

pancreatitis, acute cholecystitis, gallbaldder CA

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18
Q

what is key prinicple when investigating acute abdo

A

diagnose and exclude others! a negative test is as valuable as a positive one

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19
Q

man in his 60’s presents to clinic with yellow sclera, and a small palpable mass in RUQ. what is top differential?

A

head of panc CA (adenoCA) Gallstones??

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20
Q

Stem of Q leads you to diagnose a bowel obstruction, what investigation must always be done immediately? if complete obstruction is diagnosed by abdo xray, what method of management will you initiate (3)

A

erect chest xray (perf) place pt NBM and insert an NG tube to decompress bowel. insert IV line and give fluids insert catheter and setup fluid balance chart analgesia

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21
Q

if malignancy diagnosed, what investigations should be done to stage the disease? (4)

A

CT (stage and bone mets) LFTs (liver mets) FBC (lymph nodes) cxray (lung mets)

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22
Q

what screening is carried out for colorectal CA? (3) and who is offered?

A

FOB (all 60-74) rigid sigmoid (optional at 55) colonscopy or high risk (fh, lynch, FAP)

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23
Q

proctocolectomy means…?

A

everything downstream of the excised bowel is removed leaving a colostomy/ileostomy bag.

24
Q

patient is 76, presents with moderate abdo pain and rectal bleeding, what must be excluded/top DDx

A

ischaemic colitis

25
Q

how to distinguish on abdo xray whether small or large bowel?

A

small bowel valvulae span entire width

26
Q

signs of venous disease? (4)

A

tight calfs/oedema, varicose veins, venous dermatitis, ulcers on medial malleolar

27
Q

red flags for nipple discharge? (3)

A

unilat? red?

28
Q

in a patient with acute abdo, what are the indications for laparotomy (2)

A

generalised peritonitis? strangulation hernia, ischaemic bowel,

29
Q

how to monitor circulation/ assess immediate blood loss

A

JVP, UO, Cap Refil, BP and HR

30
Q

what could be done to assess severity of rectal bleeding?

A

weight loss, BP change? Hb low?

31
Q

management of renal stones

A

CONS - give fluids, analgesia(NSAIDS) and wait to pass SURG - extracorpeal lithotripsy, percutaneous nephrolithotomy, cystoscope and catch, ?????

32
Q

patient with hx of AF attends A+E with severe abdo pain, but no clinical findings on abdo exam, what is spot diagnosis?

A

acute mesenteric ischaemia

33
Q

when bowel obstruction suspected, what pathway of thinking should you take in managment?

A

Small or Large Mechanical or Ileus Simple (blocked) Closed Loop (volvulus) or strangulated

34
Q

little fella with sudden pain in ballsack, what o/e and what would confirm torsion?

A

bellclapper, colour change, phrens sign neg-ve, high riding, Doppler USS

35
Q

RF for testes CA and markers. also what might be seen o/e

A

FHx, afp, ldh, Bhcg o/e - painless mass, hydrocele, backpain (mets)

36
Q

acute urinary retention CF

A

???

37
Q

patient with hx of nocturia, poor flow but no blood in urine, no weight loss and only a small increase in PSA. what is top ddx and what would first line therapy be?

A

BPH CONS - tamulosin (alpha adrenoreceptor antagonist) and finesteride (5alpha reductase inhib) +/- catherterise SURG - TURP

38
Q

how might you confirm prostate CA over BPH?

A

transrectal US and biopsy PSA??

39
Q

which of female cancer genes is inherited and which is not?

A

BRCA 1+2 are, HER2 IS NOT

40
Q

if pt presents with lump in central neck and low calcium, what is diagnosis?

A

medullary thyroid cancer

41
Q

what is one of key rules for steroid therapy?

A

never stop suddenly // doube the dose in times of sickness

42
Q

what symptoms may be seen in patient with ??phaeochromocytoma?

A

headache, shakes, palpitations, anxiety

43
Q

??carcinoid syndrome, name 3 CF and how would be diagnosed?

A

flushing, diarr, hepatomegaly 5HIAA in urine

44
Q

3 managment methods in NON-variceal upper gi bleeding

A
  • clips and adreniline - thermal co-ag and adreniline - fibrin/thrombin and adreniline + give PPI for all
45
Q

what can cause generalised peritonitis

A

rupture of any abdominal organ: - appendix - colon - ulcer

46
Q

how would you determine next step in treatment and severity in upper gi bleed?

A

blatchford or rockall score chart

47
Q

rf for kidney stones

A

anything that increase ca or increased urate - tea, choc, rhubarb - hyperparathy, diet, increase bone resorp also diuretics and allopurinol

48
Q

triad for Renal CA and treatment

A

abdo pain, mass felt, haematuria –> radical nephrectomy (adrenals as well) / partial

49
Q

bladder CA CF + I + T

A

painless haematuria, cystoscopy and biopsy TURBT or radical cystectomy

50
Q

treatment for ascending UTI with rigor and route of admin

A

iv amox and gent

51
Q

how would you manage a patient with an STI?

A

contact tracing refer GUM ABx’s

52
Q

Breast CA????

A

????

53
Q

Initial Bloods for all Acute Abdo cases?

A

FBC, LFT, U+E, Amylase/Lipase, BM, CRP

ABG

if woman = serum BhcG

urineanalysis in all patients

Cross match if surg anticipated

54
Q

acute appendix intial tests (3)

A

CRp and WCC and urineanalyis

55
Q

Diverticulitis management (early and late)

A

Medical if possible:

ABx’s, fluids and analgesia +/- stool softeners

then investigate with CT or barium enema

??SURGERY

*** Exam Medicine (20 decks)

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