Surgical Summary Q's Flashcards
what hormones offered to female breast CA sufferers if hormone positive? (pre and post menopause)
tamoxifen (pre) aromatase inhibitors such as anastrozole (post)
Patient presents with suspected GORD. what in the hx would exclude sinister cause?
ALARM Symptoms
exterminating h pylori?
triple therapy Omeprazole metronidazole clari
RF for gallstones
fat, fertile, female, forty, ??
charcots triad, and condition in which it is relevant?
Jaundice, fever, rigors, RUQ pain ascending cholangitis
how to assess severity of acute panc
PANCREAS PaO2 Age Neutrophils Ca Renal FUnc (Urea) Enzymes Albumin Sugar (BM)
clinical findings for left and right sided colon CA and how could you grade severity?
Right - weight loss, abdo pain, abdo mass, rectal bleeding Left - bowel alteration, tenesmus, PR mass, weight loss, rectal bleeding DUKES criteria
patient presents with rectal bleeding, what must be done in clinic before referring?
Proctoscope PR Abdo exam
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?
anastomotic leak wound infection sepsis??
what might be seen in patient with S + L bowel obstruction
S - earlier vomiting, less distension, colicky pain, no poo L - tinkling, later vomiting, more distension, pain, tympanic percuss
what might cause a L + S bowel obstruction? (3)
S - hernia, adhesions, CA L - volvulus, faecal, diivertic?? CA
art/ven/neuro Ulcers???
???
rf for arterial disease and venous disease
Art - DM, chol, HTN, venous - immob, surg, fractures, obese, on OCP
what is RF for 2 types of oesophageal CA
adeno - barrets squamous - smoking and alcohol
what must be excluded/diagnosed if a peptic ulcer is suspected? what is other option of common cause?
H Pylori! NSAID use
how might a CA in oes stomach be staged?
endoscopic USS (stomach) ,biopsy, CT
complications of gallstones
pancreatitis, acute cholecystitis, gallbaldder CA
what is key prinicple when investigating acute abdo
diagnose and exclude others! a negative test is as valuable as a positive one
man in his 60’s presents to clinic with yellow sclera, and a small palpable mass in RUQ. what is top differential?
head of panc CA (adenoCA) Gallstones??
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)
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
if malignancy diagnosed, what investigations should be done to stage the disease? (4)
CT (stage and bone mets) LFTs (liver mets) FBC (lymph nodes) cxray (lung mets)
what screening is carried out for colorectal CA? (3) and who is offered?
FOB (all 60-74) rigid sigmoid (optional at 55) colonscopy or high risk (fh, lynch, FAP)
proctocolectomy means…?
everything downstream of the excised bowel is removed leaving a colostomy/ileostomy bag.
patient is 76, presents with moderate abdo pain and rectal bleeding, what must be excluded/top DDx
ischaemic colitis
how to distinguish on abdo xray whether small or large bowel?
small bowel valvulae span entire width
signs of venous disease? (4)
tight calfs/oedema, varicose veins, venous dermatitis, ulcers on medial malleolar
red flags for nipple discharge? (3)
unilat? red?
in a patient with acute abdo, what are the indications for laparotomy (2)
generalised peritonitis? strangulation hernia, ischaemic bowel,
how to monitor circulation/ assess immediate blood loss
JVP, UO, Cap Refil, BP and HR
what could be done to assess severity of rectal bleeding?
weight loss, BP change? Hb low?
management of renal stones
CONS - give fluids, analgesia(NSAIDS) and wait to pass SURG - extracorpeal lithotripsy, percutaneous nephrolithotomy, cystoscope and catch, ?????
patient with hx of AF attends A+E with severe abdo pain, but no clinical findings on abdo exam, what is spot diagnosis?
acute mesenteric ischaemia
when bowel obstruction suspected, what pathway of thinking should you take in managment?
Small or Large Mechanical or Ileus Simple (blocked) Closed Loop (volvulus) or strangulated
little fella with sudden pain in ballsack, what o/e and what would confirm torsion?
bellclapper, colour change, phrens sign neg-ve, high riding, Doppler USS
RF for testes CA and markers. also what might be seen o/e
FHx, afp, ldh, Bhcg o/e - painless mass, hydrocele, backpain (mets)
acute urinary retention CF
???
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?
BPH CONS - tamulosin (alpha adrenoreceptor antagonist) and finesteride (5alpha reductase inhib) +/- catherterise SURG - TURP
how might you confirm prostate CA over BPH?
transrectal US and biopsy PSA??
which of female cancer genes is inherited and which is not?
BRCA 1+2 are, HER2 IS NOT
if pt presents with lump in central neck and low calcium, what is diagnosis?
medullary thyroid cancer
what is one of key rules for steroid therapy?
never stop suddenly // doube the dose in times of sickness
what symptoms may be seen in patient with ??phaeochromocytoma?
headache, shakes, palpitations, anxiety
??carcinoid syndrome, name 3 CF and how would be diagnosed?
flushing, diarr, hepatomegaly 5HIAA in urine
3 managment methods in NON-variceal upper gi bleeding
- clips and adreniline - thermal co-ag and adreniline - fibrin/thrombin and adreniline + give PPI for all
what can cause generalised peritonitis
rupture of any abdominal organ: - appendix - colon - ulcer
how would you determine next step in treatment and severity in upper gi bleed?
blatchford or rockall score chart
rf for kidney stones
anything that increase ca or increased urate - tea, choc, rhubarb - hyperparathy, diet, increase bone resorp also diuretics and allopurinol
triad for Renal CA and treatment
abdo pain, mass felt, haematuria –> radical nephrectomy (adrenals as well) / partial
bladder CA CF + I + T
painless haematuria, cystoscopy and biopsy TURBT or radical cystectomy
treatment for ascending UTI with rigor and route of admin
iv amox and gent
how would you manage a patient with an STI?
contact tracing refer GUM ABx’s
Breast CA????
????
Initial Bloods for all Acute Abdo cases?
FBC, LFT, U+E, Amylase/Lipase, BM, CRP
ABG
if woman = serum BhcG
urineanalysis in all patients
Cross match if surg anticipated
acute appendix intial tests (3)
CRp and WCC and urineanalyis
Diverticulitis management (early and late)
Medical if possible:
ABx’s, fluids and analgesia +/- stool softeners
then investigate with CT or barium enema
??SURGERY
