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Oishi's Final year flashcards > Surgery > Flashcards

Surgery Flashcards

1
Q

Features of traumatic aortic rupture?

A

Deceleration injuries
Contained haematoma (persistent hypotension)
Widened mediastinum (CXR)
May be depression of bronchi +/- tracheal deviation

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2
Q

Borders of the femoral canal?

A

Lateral: Femoral vein
Medial: Lacunar ligament
Anterior: Inguinal ligament
Posterior: Pectineal ligament

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3
Q

Contents of femoral canal?

A

Lymphatic vessels

Cloquet’s lymph node

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4
Q

When should LP done in suspected SAH?

A

12 hours after onset of headache

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5
Q

What would you find on biopsy in temporal arteritis?

A

Temporal artery intimal proliferation with skip lesions

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6
Q

How often to scan a triple A of 3 - 4.4 cm?

A

Rescan every 12 months

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7
Q

How often to scan a triple A of 4.5 - 5.4 cm?

A

Rescan every 3 months

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8
Q

What to do if AAA >=5.5cm?

A

Refer within 2 weeks to vascular surgery for probable intervention

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9
Q

first-line investigation for suspected prostate cancer?

A

Multiparametric MRI

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10
Q

What is a large hyperechoic lesion of the liver in the presence of normal AFP likely to be?

A

Haemangioma

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11
Q

Which renal stones are radio-lucent?

A

urate + xanthine stones

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12
Q

What does a pelvic fracture and highly displaced prostate suggest?

A

Membranous urethral rupture

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13
Q

What does a pelvic fracture and lower abdominal peritonism suggest?

A

Bladder rupture

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14
Q

Surgical tx for distal 2/3rds transverse or descending colon cancer?

A

left hemicolectomy

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15
Q

What surgery is used to excise upper rectal tumours?

A

high anterior resection

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16
Q

Who is suxamethonium contraindicated in?

A

Patients with penetrating eye injuries or acute narrow angle glaucoma (increases intra-ocular pressure)

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17
Q

What is a Richter hernia and how does it present?

A

Only the antimesenteric border of the bowel herniates through the fascial defect
Characterised by the absence of symptoms of obstruction even in the presence of strangulation, as the bowel lumen is patent while bowel wall is compromised

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18
Q

What does an ABPI > 1.2 indicate?

A

may indicate calcified, stiff arteries. This may be seen with advanced age or PAD

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19
Q

What does an ABPI 1 - 1.2 indicate?

A

Normal

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20
Q

What does an ABPI <0.9 indicate?

A

likely PAD. Values < 0.5 indicate severe disease which should be referred urgently

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21
Q

What is the best agent for induction of anaesthesia in a haemodynamically unstable agent?

A

Ketamine

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22
Q

What severe side effect is important to be aware of when using etomidate anaesthetic agent?

A

Adrenal suppression

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23
Q

Surgery / sulfonylureas on day of surgery?

A

Omit on the day of surgery

Exception is morning surgery in patients who take BD - they can have the afternoon dose

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24
Q

How to calculate the nottingham prognostic index for breast cancer?

A

Tumour Size x 0.2 + Lymph node score + Grade score

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25
Q

Colorectal cancer referral guidelines?

A

patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces

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26
Q

Where is a gastrostomy and what is it used for?

A

Epigastrium
Gastric decompression or fixation
Feeding

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27
Q

Where is a loop jejunostomy and what is it used for?

A

Anywhere
Seldom used as very high output
May be used following emergency laparotomy with planned early closure

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28
Q

Where is a percutaneous jejunostomy and what is it used for?

A

LUQ

Usually performed for feeding purposes and site in the proximal bowel

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29
Q

Where is a loop ileostomy and what is it used for?

A

RIF
Defunctioning of colon e.g. following rectal cancer surgery
Does not decompress colon (if ileocaecal valve competent)

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30
Q

Where is an end ileostomy and what is it used for?

A

RIF
Usually following complete excision of colon or where ileocolic anastomosis is not planned
May be used to defunction colon, but reversal is more difficult

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31
Q

Where is an end colostomy and what is it used for?

A

RIF/LIF

Where a colon is diverted or resected and anastomosis is not primarily achievable or desirable

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32
Q

Where is a loop colostomy and what is it used for?

A

Anywhere
To defunction a distal segment of colon
Since both lumens are present the distal lumen acts as a vent

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33
Q

Where is a caecostomy and what is it used for?

A

RIF

Stoma of last resort where loop colostomy is not possible

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34
Q

Where is a mucous fistula and what is it used for?

A

Anywhere
To decompress a distal segment of bowel following colonic division or resection
Where closure of a distal resection margin is not safe or achievable

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35
Q

Tx for anal fissures not responding to conservative tx?

A

Referral for sphincterotomy or botulinum toxin

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36
Q

Mx of thrombosed haemorrhoid if presentation within 72hrs?

A

Haemorrhoidectomy

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37
Q

Which operation is used in an emergency for bowel cancer?

A

Hartmann’s procedure

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38
Q

A syndrome consisting of a PTEN mutation and intestinal hamartomas?

A

Cowden disease

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39
Q

A syndrome which may be present in a patient with multiple intestinal hamartomas and pigmentation spots around the mouth?

A

Peutz-Jeghers syndrome

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40
Q

A syndrome which causes right sided colonic tumours at a young age?

A

Lynch syndrome

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41
Q

Mackler’s triad (Boerrhave’s)?

A

Severe vomiting
Dyspnoea
Chest pain

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42
Q

Diagnostic ix in boerhaave’s?

A

CT contrast swallow

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43
Q

Most common type of renal cell carcinoma?

A

Adenocarcinoma

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44
Q

Which anaesthetic agent should not be used in pneumothorax?

A

Nitrous oxide

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45
Q

Pre-op hydrocortisone doses for pts on long term steroid therapy?

A

Minor procedure under local: no supplementation required
Moderate procedure: 50mg hydrocortisone before induction and 25mg every 8h for 24h
Major surgery: 100mg hydrocortisone before induction and 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached

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46
Q

Tx for malignant HTN as a SE of suxamethonium?

A

Dantrolene

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47
Q

What is Mirizzi’s syndrome?

A

When a gallstone in the cystic duct causes compression on the common hepatic duct, resulting in jaundice

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48
Q

Blockage of which duct in the biliary tree does not cause jaundice?

A

Cystic duct/gall bladder neck

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49
Q

What vein should TPN be administered into?

A

Central vein e.g. subclavian (phlebitic)

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50
Q

Tx for acute cholecystitis?

A

intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis

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51
Q

Tx for ascending cholangitis?

A

ERCP

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52
Q

What plt level indicates need for platelet transfusion for thrombocytopenia before surgery/ an invasive procedure?

A

<50×109/L for most patients
50-75×109/L if high risk of bleeding
<100×109/L if surgery at critical site

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53
Q

Who do you not give plt transfusions to?

A

Chronic bone marrow failure
ITP
HIT
TTP

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54
Q

Typical presentation of anterior uveitis?

A

painful red eye associated with reduced visual acuity, photophobia, a small pupil and ciliary flush

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55
Q

Typical presentation of Acute angle closure glaucoma?

A 
severe pain (may be ocular or headache)
decreased visual acuity, patient sees haloes
semi-dilated fixed pupil
hazy cornea
eye feels hard on palpation
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56
Q

What do you see in the urine of someone with acute tubular necrosis?

A

granular, muddy-brown urinary casts

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57
Q

Classic triad in acute interstitial nephritis?

What would you see in the urine?

A

Rash
Fever
Eosinophilia
Urine - white cell casts

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58
Q

What is the Parkland formula for fluid resuscitation in burns?

A

Volume of fluid = total body SA of burn (%) x weight (Kg) x 4ml
50% given in first 8 hours
50% given in next 16 hours

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59
Q

Common causes of a sudden painless loss of vision

A

ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis –> occlusion of central retinal vein and occlusion of central retinal artery)
vitreous haemorrhage
retinal detachment
retinal migraine

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60
Q

Features of Central retinal vein occlusion?

What is seen on fundoscopy?

A

incidence increases with age, more common than arterial occlusion
severe retinal haemorrhages are usually seen on fundoscopy

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61
Q

Causes of Central retinal vein occlusion?

A

glaucoma
polycythaemia
hypertension

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62
Q

Features of Central retinal artery occlusion?

A

afferent pupillary defect

‘cherry red’ spot on a pale retina

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63
Q

Causes of Central retinal artery occlusion?

A

Thromboembolism (from atherosclerosis)

Arteritis (e.g. temporal arteritis)

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64
Q

Features of Vitreous haemorrhage?

A

sudden visual loss, dark spots

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65
Q

Causes of Vitreous haemorrhage?

A

diabetes, bleeding disorders, anticoagulants

66
Q

What usually precedes retinal detachment?

A

Flashes of light or floaters

67
Q

Anal cancer triad?

A

PR bleed
Pruritis ani
Incontinence

68
Q

Criteria for THR rather than hemi-arthroplasty?

A

Independent
Mobile (1 mile max with a stick)
Not cognitively impaired

69
Q

Vaccinations normally given a few weeks prior to splenectomy?

A

HIB vaccine
Streptococcus pneumonia vaccine
Meningococcal A, B and C vaccine

70
Q

RFs for transitional cell carcinoma?

A

Smoking
Dyes
Analgesic abusers (phenacetin)

71
Q

CIs to MRI?

A

Anything metal - pacemaker, recent hip replacement <6 weeks, aneurysm clip

Relative CIs:
Confusion
Infection
Pregnant (1st trimester)

72
Q

Where does the facial nerve exit the skull?

A

Stylomastoid foramen

73
Q

What is Heerfort’s syndrome?

A

a rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis, and low grade fever

74
Q

Most common parotid malignancy?

A

Mucoepidermoid carcinoma

75
Q

Which branch of the facial nerve is responsible for lacrimation?

A

Greater superficial petrosal nerve branch

76
Q

Which artery is usually the cause of posterior nose bleeds?

A

Sphenopalatine artery - branch of the internal maxillary artery

77
Q

5 vessels which supply Kiesselbach’s plexus in the anterior nasal septum?

A

superior labial, anterior ethmoidal, posterior ethmoidal, greater palatine and sphenopalatine arteries

78
Q

Causes of presenile cataracts?

A 
Steroids
Uveitis
DM
High myopia
Significant trauma
79
Q

What triad do you see on fundoscopy of Retinitis pigmentosa?

A

arteriolar attenuation
bone–spicule peripheral retinal pigmentation
waxy optic disc pallor

80
Q

Cup to disc ratio in Primary open angle glaucoma?

A

> 0.6

81
Q

Causes of optic disc contour to become indistinct/blurry?

A

Optic neuritis
Anterior ischaemic optic neuropathy
Papilloedema

82
Q

Proliferative diabetic retinopathy tx?

A

pan retinal laser photocoagulation

83
Q

Diabetic macular oedema tx?

A

intravitreal injections of anti-VEGFs

84
Q

What is the name for transparent conjunctival swelling inferior to the cornea?

A

Chemosis

85
Q

If the eye is proptotic, and the proptosis is pulsatile with an audible bruit, what diagnosis do you suspect?

A

Carotico-cavernous fistula

86
Q

Which is the appropriate treatment for acute angle closure glaucoma?

A 
IV acetazolamide
Prostaglandin analogue eye drops
Beta blocker eye drops
Pilocarpine eye drops
Topical steroids
87
Q

3 causes of an abnormally large pupil?

A

pharmacological
third nerve palsy
acute glaucoma

88
Q

Incompetence of which vein would be noted from the groin to the medial aspect of the lower leg?

A

long saphenous vein

89
Q

Incompetence of which vein would be noted from the popliteal fossa along the calf to the lateral malleolus?

A

short saphenous vein

90
Q

What level does the aorta bifurcate?

A

L4

91
Q

What is the normal insensible loss from a pt per day?

A

50 ml/h (or about 0.5 – 1.0 ml/kg/h)

92
Q

What is the daily sodium requirement?

A

1-2 mmol/kg

93
Q

What is the daily potassium requirement?

A

0.5 – 1mmol/kg

94
Q

421 rule of maintenance fluids?

A

4mls/kg/hr for the first 10kg, 2mls/kg/hr for next 10kg and 1ml/kg/hr for the remaining weight

95
Q

Mx of thrombosed haemorrhoids >72 hours?

A

stool softeners, ice packs and analgesia

96
Q

Tx for renal Stone burden of less than 2cm in aggregate?

A

lithotripsy

97
Q

Tx for Ureteric calculi less than 5mm?

A

Expectant mx

98
Q

Tx for Stone burden of less than 2cm in pregnant females?

A

Ureteroscopy

99
Q

Tx for Complex renal calculi and staghorn calculi?

A

Percutaneous nephrolithotomy

100
Q

Tx for stone causing obstruction/infective signs?

A

Percutaneous nephrostomy

+ IV abx

101
Q

Leriche syndrome?

A

Athersclerotic occlusion of abdo aorta and iliacs
Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses

102
Q

Buerger’s disease?

A

Acute inflammation of blood vessels in hands and feet
Ulceration and gangrene
Younger males who are heavy smokers

103
Q

What are cotton wool spots?

A

pre-capillary arteriolar occlusion, leading to retinal infarction

104
Q

What are the fluid requirements for maintenance fluids?

A

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis

105
Q

Meds for prophylaxis of kidney stones?

A

Calcium stones - thiazide diuretics
Urate stones - allopurinol, bicarb to promote urinary alkalinisation
Oxalate stones - pyridoxine/cholestyramine

106
Q

Features of papilloedema on fundoscopy?

A

Venous engorgement: usually first sign
Loss of venous pulsation (but many normal patients may have no pulsation)
Blurring of optic disc margin
Elevation of optic disc
Loss of optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc
Small haemorrhages

107
Q

Surgery for cholesteatoma?

A

Canal wall up mastoidectomy

108
Q

Indications for a TIPS procedure?

A

Actively bleeding oesophageal varices refractory to other tx
Gastric/ectopic varices
Refractory ascites
Budd-Chiari syndrome

109
Q

Absolute CIs for TIPS procedure?

A 
CCF
Severe TR
Severe pulmonary HTN
Polycystic liver disease
Sepsis
110
Q

Tx if someone grows MRSA on nasal swab pre-op?

A

Nasal mupirocin + chlorhexidine for skin

111
Q

Borders of the safe triangle?

A

Base of the axilla
Lateral edge pectoralis major
5th intercostal space
Anterior border of latissimus dorsi

112
Q

What to do if you see a unilateral nasal polyp?

A

Refer to ENT

113
Q

Tx for small bilateral nasal polyps?

A

saline nasal douche and intranasal steroids

114
Q

Initial mx for abdominal wound dehiscence?

A

coverage of the wound with saline impregnated gauze + IV broad-spectrum antibiotics

115
Q

Causes of unilateral hydronephrosis? PACT

A

Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

116
Q

Causes of bilateral hydronephrosis? SUPER

A 
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
117
Q

What kind of polyps in IBD?

A

Pseudopolyps (actually just swollen areas of bowel)

118
Q

Congenital cause for primary lymphoedema?

A

Milroy disease

119
Q

Tx of local anaesthetic toxicity?

A

IV 20% lipid emulsion

120
Q

Maximum total local anaesthetic doses?

A

Lignocaine 1% plain - 3mg/ Kg - 200mg (20ml)
Lignocaine 1% with 1 in 200,000 adrenaline - 7mg/Kg - 500mg (50ml)
Bupivicaine 0.5% - 2mg/kg- 150mg (30ml)

121
Q

What is dumping syndrome and what is it a complication of?

A

Complication of gastric surgery
Occurs due to a hyperosmolar load rapidly entering the proximal jejunum. Osmosis drags water into the lumen, causing lumen distension (pain) and diarrhoea. Excessive insulin release also occurs and results in hypoglycaemic symptoms.

122
Q

1st line ix for suspected bladder cancer?

A

Flexible cystoscopy

123
Q

Acceptable post void residual volume?

A

<50 ml in patients aged < 65 years

< 100ml in patients aged > 65 years

124
Q

Definition of chronic urinary retention?

A

> 500ml within the bladder after voiding

125
Q

What volume suggests acute-on-chronic urinary retention?

A

Post-catheterisation urine volume of >800 ml

126
Q

What does perinephric fat stranding suggest?

A

pyelonephritis

127
Q

What does periureteric fat stranding suggest?

A

passed stones

128
Q

Medical indications for circumcision?

A

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

129
Q

RF for Renal transitional cell carcinoma?

A

exposure to chemicals in the textile, plastic and rubber industry

130
Q

What is Rigler’s triad and what are the components?

A

Demonstrates gallstone ileus
SBO
Pneumobilia
Ectopic gallstones

131
Q

Causes of pneumobilia?

A 
Gallstone ileus
Emphysematous cholecystitis
Pyogenic cholecystitis
Post-ERCP
Post-cholecystectomy
Blunt abdo trauma
Incompetent sphincter of Oddi
132
Q

What is Bouveret syndrome?

A

Gastric outlet obstruction secondary to impacted gallstones

133
Q

Features of carcinoid syndrome?

A

Paroxysmal flushing
Diarhhoea
Bronchospasm
Abdo pain - precipitants include alcohol, stress and caffeine

134
Q

Tx for carcinoid syndrome?

A

Surgical resection

Symptomatic tx: octreotide

135
Q

Ix for urethral stricture?

A

Retrograde Urethography

136
Q

Tx of mumps orchitis?

A

Analgesia and bed rest

137
Q

Tx of epididymo-orchitis?

A

Abx

138
Q

Drug cause of epididymitis?

A

Amiodarone

139
Q

How does anhydrosis determine the site of the lesion in Horner’s syndrome?

A

just face = pre-ganglionic lesion: Pancoast’s, cervical rib

head, arm, trunk = central lesion: stroke, syringomyelia

absent = post-ganglionic lesion: carotid artery

140
Q

Ramsay hunt tx?

A

Oral aciclovir and steroids

141
Q

Herpes zoster opthalmicus tx?

A

Oral aciclovir

142
Q

Otitis externa mx?

A

Mild: topical acetic acid 2% spray

More severe: 7 days of abx eardrops +/- steroid eardrops

143
Q

Tx for acute necrotizing ulcerative gingivitis?

A

Paracetamol + PO metronidazole + chlorhexidine mouthwash

144
Q

Samter’s triad?

A

asthma + aspirin sensitivity + nasal polyposis

145
Q

Audiogram findings for hearing loss?

A

Normal = anything above 20dB

a) conductive hearing loss = fall in air conduction + normal bone conduction
b) sensorineural loss = fall in air + fall in bone (to the same level)
c) mixed = conductive + sensorineural = 2x fall in air + 1x fall in bone

146
Q

Causes of gingival hyperplasia? PANIC

A 
Phenotoin
AML
Nifidipine
infection - bacterial
Ciclosporins
147
Q

Tx of acute otitis media with perforation?

A

Oral abx

148
Q

Complication of TIPS procedure?

A

exacerbation of hepatic encephalopathy

149
Q

Lemon yellow tinge… Dx?

A

Pernicious anaemia

150
Q

How is severity of Clostridium difficile infection determined?

A

WCC
Normal = mild
Raised but <15 = moderate
>15 = severe

151
Q

Features of Scheuermann’s disease?

A

Epiphysitis of the vertebral joints - Xray: epiphysial plate disturbance and anterior wedging
Affects teens
Progressive kyphosis

152
Q

Features of Spondylolisthesis?

A

Athletic female teens
O/E: one spinous process might feel more or less prominent
One vertebra is displaced relative to its immediate inferior vertebral body
Xray: Scotty dog

153
Q

Mx of adults with hydrocele?

A

Urgent USS to exclude tumour if 18-40 or testes not palpable

154
Q

Which muscle relaxant is used for rapid sequence induction for intubation?

A

Suxamethonium

155
Q

Tx for RCC?

A

Tumour <7cm: partial nephrectomy
Tumour >7cm: total nephrectomy
Mets: Alpha-interferon

156
Q

What to do for patients with symptoms which do not meet 2WW criteria for bowel cancer but have new worrying symptoms?

A

Faecal immunochemical test

157
Q

What 2 vessels does a TIPS procedure connect?

A

hepatic vein to the portal vein

158
Q

How is Chronic urinary retention classified?

A

high pressure urinary retention if renal function is impaired or if there is hydronephrosis
low pressure if not

159
Q

Best ix for distal anastamotic leaks post colorectal surgery?

A

gastrografin enema

160
Q

Which tumours press on the frontal lobe?

A

Meningioma

161
Q

Which tumours press on the cerebellum?

A

Astrocytoma

162
Q

What catheter do you use for neurogenic bladder?

A

Clean intermittent catheterisation

Oishi's Final year flashcards (10 decks)

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