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RCSI Clinical Surgery > Chapter 1 - Principles of Surgery > Flashcards

Chapter 1 - Principles of Surgery Flashcards

1
Q

What’s the items for taking hx of presenting complaint?
SR.COPD.SARAH

A

Site
Radiation
-
Character
Onset
Periodicity
Duration
-
Severity
Associated symptoms
Relieving factors
Aggravating factors
History of this symptoms

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2
Q

Components of Upper GI symptoms?

A

Dyspepsia
Dysphagia
GORD/Heartburn
Haematemesis
Altered bowel habit
Rectal bleeding
Tenesmus

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3
Q

Components of Hepatobiliary symptoms?

A

Jaundice
- Yellowish discoloration of sclera and skin due to hyperbilirubinemia

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4
Q

Components of Peripheral Arterial Disease symptoms?

A

Claudications
- Pain calf, thigh, buttock precipitated by exercise and relieved by rest due to inadequate blood flow
Rest pain
- Severe, burning pain in limb affected by inadequate arterial flow. present at rest.

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5
Q

Ddx of RUQ pain?

A
  • Biliary colic
  • Cholecystitis /Cholangitis
  • Hepatitis
  • Pneumonia RLL
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6
Q

Ddx of epigastric pain?

A
  • PUD/ Gastritis
  • Pancreatitis
  • GORD
  • Cardiac: inferior MI/ Pericarditis
  • Ruptured AAA
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7
Q

Ddx of LUQ pain?

A
  • Pneumonia LLL
  • Splenic abcess/ infarct
  • Gastric ulcer
  • Gastritis
  • Herpes zoster
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8
Q

Ddx of Right lumbar pain?

A
  • Renal colic
  • Pyelonephritis
  • MSK: sciatica, lumbar disc, bone mets
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9
Q

Ddx of umbilical pain?

A
  • UTI
  • Appendicitis
  • Small bowel obstruction (SBO)
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10
Q

Ddx of Left lumbar pain?

A
  • Renal colic
  • Pyelonephritis
  • MSK: sciatica/ lumbar disc/ bony mets
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11
Q

Ddx of RIF pain?

A
  • Appendicitis
  • Ectopic pregnancy
  • Ovarian cyst rupture/ torsion
  • PID
  • Renal colic
  • Inguinal hernia
  • IBD
  • Psoas abscess
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12
Q

Ddx of suprapubic pain?

A
  • Urine retention
  • UTI
  • Proctitis
  • PID
  • IBD
  • Osteitis pubis
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13
Q

Ddx of left iliac fossa pain?

A
  • Diverticulits
  • Ectopic pregnancy
  • Ovarian cyst rupture/ torsion
  • PID
  • Renal colic
  • Inguinal hernia
  • IBD
  • Psoas abscess
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14
Q

In case of cholangitis, what are the Charcot’s triad and Reynold’s pentad?

A

Charcot’s triad: pain, fever/chills, jaudice.

Reynold’s pentad: Above + shock/hypotension, confusion.

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15
Q

Ddx of diffuse abdominal pain?

A
  • Gastroenteritis
  • Acute mesentric ischemia
  • Chronic mesentric ischemia
  • Bowel obstruction
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16
Q

Difference between SBO and LBO?

A

SBO (high): First, billous vomit; later constipation.
LBO (low): First constipation; later faeculant vomiting. O/e: distension, tympanic abdomen, high pitched bowel sounds.

17
Q

Define Rovsing sign?

A

LIF palpation increases RIF pain

18
Q

How to illicit obturator sign?

A

Lie supine, flex hip and knee 90 degrees. Passively internally rotate the hip, causing pain. Retrocaecal appendicitis can inflame obturator internus, which stretches in this maneuver.

19
Q

What are the 3 types of drains and its function?

A
  • Open passive drains: Provide a conduit for drainage of secretions
  • Closed passive drains: Siphon effect of gravity and capillary action
  • Closed active drains: Generate active suction
20
Q

Poor nutrition leads to?

A
  • Impaired albumin production
  • Impaired wound healing and collagen deposition
  • Skeletal muscle weakness (icu myopathy)
  • Reduced neutrophil and lymphocyte function
21
Q

What are the types of nutritional supports?

A
  • Oral
  • Nasogastric or nasojejunal
  • Feeding gastrotomy or jejunostomy
  • TPN
  • Central TPN
22
Q

What are the risk of inserting CVC?

A
  • Haematoma/haemorrhage
  • Line superinfection
  • Line obstruction/kinking/malplacement
23
Q

What are the TPN-assiociated complications?

A
  • Hyperosmolarity
  • Lack of glycemic control
  • Nutrient deficiency
  • Liver dysfunction, cholestasis and pancreatic atrophy
  • Fluid overload
24
Q

What lab ix thats need to be monitor in patient with TPN?

A
  • Daily U&E and glucose until stabilised on TPN
  • LFT twice weekly
  • Magnesium, copper, manganese, zink and phosphate weekly

RCSI Clinical Surgery (16 decks)

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