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FINALS: PASSMED/QUESMED > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Medical management of SBO?

A

IV fluids and gastric decompression, or ‘drip-and-suck’

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2
Q

Neutrophil predominant leucocytosis suggests what?

A

Appendicitis

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3
Q

Why is appendicitis pain felt in umbilical first?

A
  • Inflammation of the visceral peritoneum is felt in T10 which corresponds to periumbilical region -> no somatic sensation here
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4
Q

Why does appendicitis pain move to RIF?

A

Parietal peritoneum becomes involved which receives somatic innervation therefore pain is localised to area affected

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5
Q

What is a diverticulum?

A

Outpouching of the gut mucous through the muscle wall

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6
Q

Which part of the colon is diverticula common in?

A

Sigmoid - as majority of water has already been reabsorbed by this stage therefore high intraluminal pressures

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7
Q

Diverticulosis vs Diverticulitis vs Diverticular disease

A

Diverticulosis - presence of diverticula
Diverticular disease - symptomatic diverticula
Diverticulitis - inflammation of the diverticula

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8
Q

What is the possible complications of diverticulitis?

A
  • Perforation
  • Bleeding
  • Abscess
  • Fistulas
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9
Q

What are the 6 Ps of limb ischaemia?

A

Pallor, pain, pulseless, paraesthesia, perishingly cold, paralysis

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10
Q

Acute limb ischaemic vs critical limb ischaemia?

A

Critical - last longer than 2 weeks and foot will be warm with pink appearance

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11
Q

What is the management of acute limb ischaemia?

A

Immediate referral to vascular
Thrombotic cause - angio/surgery
Embolic cause - embolectomy

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12
Q

What is initially added with GnRH agonists for metastatic prostate cancer?

A

Anti-androgens to prevent tumour flare which can cause bone pain, bladder obstruction and other symptoms

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13
Q

fever, hypotension and a rash → desquamation

A

Staph toxic shock syndrome

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14
Q

Different surgical signs

A

Rosving - appendicitis
Boas - cholecystitis
Murphy’s - cholecystitis
Cullens - pancreatitis
Grey-Turner - pancreatitis

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15
Q

What are risk factors for abdominal wall hernias?

A
  • Obesity
  • Ascites
  • Increasing age
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16
Q

What are features of abdominal wall hernias?

A
  • Palpable lump
  • Cough impulse
  • Pain
  • Obstruction
  • Strangulation
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17
Q

What is the most common hernia and who is it common in?

A

Inguinal - men

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18
Q

Lump in the midline between the umbilicus and xiphisternum?

A

Epigastric hernia -> common in those doing extensive physical training/chronic cough

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19
Q

Management of congenital inguinal hernias?

A

Surgical repair ASAP as risk of incarceration

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20
Q

What is abdominal wound dehiscence?

A
  • When the layers of abdominal mass closure fail and the viscera protrude out
  • RF include malnutrition, jaundice and poor surgical technique
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21
Q

What is the management of sudden full dehiscence?

A
  • Coverage of wound with saline gauze
  • IV Abx
  • Analgesia
  • Fluids
  • Return to theatre
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22
Q

What blood test would point to appendicitis?

A

Neutrophil-predominant raised WCC

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23
Q

Investigations for Appendicitis?

A

Thin, male patients - clinical
Women - US useful to rule out pelvic pathology

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24
Q

How to reduce wound infection rates in appendicectomy?

A

Prophylactic IV Abx

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25
Q

What is cryptorchidism?

A

Undescended testis which fails to reach bottom of scrotum by 3 months

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26
Q

What is the major complication of undescended testes?

A

Testicular cancer - massive increased risk

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27
Q

What is the treatment of cryptoorchidism?

A

Orchidopexy at 6-18 months

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28
Q

A sinusoidal ECG pattern is indicative of what?

A

Severe hyperkalaemia

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29
Q

What are common complications of enteral feeding?

A

Diarrhoea

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30
Q

What is a femoral hernia?

A

When a section of the bowel passes into the femoral cancel - more common in females

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31
Q

How to differentiate a femoral vs inguinal hernia?

A

Femoral - inferolateral to the pubic tubercle below the inguinal ligament
Inguinal - super media to the pubic tubercle

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32
Q

What is the management of inguinal hernias?

A

Surgical repair due to the high risk of strangulation

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33
Q

Direct vs indirect inguinal hernia?

A

Direct - Through Hesselback triangle medial to the inferior epigastric artery
Indirect - Through inguinal ring, lateral to the inferior epigastric artery -> more common in infants

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34
Q

What causes direct and indirect inguinal hernias?

A

Direct - defect/weakness in the transversalis fascia area of the Hesselback triangle
Indirect - Failure of the processus vaginalis to close

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35
Q

What is a hiatus hernia?

A

Herniation of part of the stomach above the diaphragm

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36
Q

What is the most common type of hiatus hernia?

A

Sliding - gastroesophageal junction moves above the diaphragm

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37
Q

How does a hiatus hernia present?

A
  • Heartburn
  • Dysphagia
  • Regurg
  • Chest pain
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38
Q

How to manage hiatus hernia?

A
  • Barium swallow
  • Conservative: weight loss
  • Medical: PPI
  • Surgical: only for symptomatic
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39
Q

How to manage inguinal hernias?

A
  • Refer and treat even if asymptomatic
  • Unliteral: open surgery
  • Bilateral/recurrent: laparoscopy
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40
Q

What are the 2 most common liver cancers?

A
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
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41
Q

What are HCC tumours?

A
  • Common in liver cirrhosis and chronic Hep B infections
  • CT/MRI
  • Elevated AFP
  • Examine testes to rule out testicular tumours
  • Surgical resection
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42
Q

What is cholangiocarcinoma?

A
  • Tumour of bile ducts
  • Presents with jaundice
  • Associated with PSC
  • Obstructive liver picture with elevated CA19-9, CEA, CA-125
  • CT/MRI/MRCP
  • Surgical resection
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43
Q

Admission criteria for acute lower GI bleed?

A
  • Over 60
  • Unstable
  • On aspirin/NSAIDs
  • Significant co-morbidities
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44
Q

What are complications of massive haemorrhage?

A
  • Hypothermia
  • Hypocalcaemia
  • Hyperkalaemia
  • Delayed transfusion reactions
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45
Q

Which nerve can be damaged in carotid endardectomy?

A

Hypoglossal

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46
Q

Where is the most common site of oesophageal rupture?

A

Left postero-lateral oesophagus

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47
Q

What is the name for free air in the abdomen?

A

Pneumoperitoneum - Rigler’s sign

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48
Q

What is haemorrhagic shock?

A
  • Occurs following trauma
  • Control bleeding and then transfuse if needed
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49
Q

What is neurogenic shock?

A
  • Occurs following spinal cord transection
  • Decreases peripheral vascular resistance causing shock
  • Decreases CO -> shock
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50
Q

What is cardiogenic shock?

A
  • Caused by IHD
  • Supportive treatment plus echo needed
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51
Q

What is the most common cause of SBO?

A
  • Adhesions
  • Hernias
52
Q

How does SBO present?

A
  • Diffuse abdo pain
  • Vomiting then constipation
  • Lack of flatulence
  • Abdo distension and tinkling bowel sounds
53
Q

How is SBO managed?

A
  • Abdo X ray
  • CT - gold standard
  • Patients need to be NBM, IV Fluids and NG tube with free drainage
54
Q

What is a strangulated hernia?

A

Blood supply to the hernia is compromised causing episodes of pain and an irreducible hernia

55
Q

Management of strangulated hernias

A
  • Immediate surgery
  • Do not manually try to reduce whilst waiting for surgery
56
Q

What line divides internal and external haemorrhoids?

A

Dentate line

57
Q

What are symptoms of haemorrhoids?

A
  • Itching
  • Rectal fullness
  • Soiling
  • Pain
58
Q

What are investigations for haemorrhoids?

A

FBC
Proctoscopy
Sigmoidoscopy

59
Q

What are conservative options to manage haemorrhoids?

A
  • Increase fluid/fibre intake
  • Analgesia
  • Bed rest
  • Topical steroids/anaesthetics
60
Q

What are medical/surgical management options to manage haemorrhoids?

A
  • Rubber band ligation
  • Cryotherapy
  • Haemorrhoidectomy
  • Stapled haemorrhoidopexy
61
Q

What are complications of haemorrhoids?

A
  • Ulceration
  • Strictures
  • Thrombosis
  • Infection
  • Anaemia
62
Q

How would acute mesenteric ischaemia show on ABG?

A

Metabolic acidosis

63
Q

What bloods can indicate AMI?

A

Raised WCC, raised lactate, raised Hb

64
Q

What is the management of AMI?

A
  • Laparotomy
  • Fluids, Abx, Analgesia, Heparin
65
Q

What does red pulp and white pulp of spleen do?

A

Red - filter and destroys RBC
White - Lymphoid tissue which acts on immune system

66
Q

What are indications for splenectomy?

A
  • Trauma
  • Spontaneous rupture
  • Hypersplenism
  • Abscess
  • Neoplasia
67
Q

What are Howell-Jolly bodies?

A

RBC where the nuclear remnant is still seen

68
Q

What are complications of pancreatitis?

A

Early - shock, sepsis, DIC, renal failure
Late - necrosis, abscess, thrombosis of arteries, chronic pancreatitis

69
Q

Where is pain in small bowel vs large bowel?

A

Small - pain is higher as midgut structure

70
Q

Ileus vs mechanical obstruction

A

Absence of bowel sounds - ileus
Tinkling bowel sounds - mechanical obstruction

71
Q

What is the management of bowel obstruction?

A

Bowel rest - drip and suck: NBM with NG tube

72
Q

What are types of gallstones?

A
  • Pigment stones
  • Cholesterol stones
  • Mixed stones
73
Q

What is Murphy’s sign?

A
  • 2 fingers in RUQ and patient breathes in which causes pain and they stop breathing in fully
  • Repeat test in left which does not cause pain
74
Q

What are causes of HCC?

A
  • Viral hepatitis
  • Cirrhosis
  • Parasites
  • Steroids
  • COCP
75
Q

What tumour marker is associated with HCC?

A

AFP

76
Q

C-KIT gene mutation

A

Gastrointestinal stromal tumour

77
Q

Bruising to flanks?

A

Grey-Turners -> Pancreatitis

78
Q

Iron deficiency anaemia, dysphagia, pallor?

A

Plummer-Vinson syndrome

79
Q

What is Mirizzi syndrome?

A

A complication of gallstones where a duct is compressed by a gallstone

80
Q

What are complications of obstructive jaundice?

A
  • Sepsis
  • Encephalopathy
  • Coagulopathy
  • Hepatic failure
81
Q

What bacteria are people with obstructive jaundice susceptible to?

A

Gram neg sepsis

82
Q

What is the bilirubin pathway?

A
  • By product of haem metabolism
  • Excreted through bile into the bowel
  • Metabolised to urobilinogen and stercobilinogen
83
Q

Treatment of metastatic oesophageal cancer with recurrent vomiting?

A

Stenting to allow food to pass and relieve symptoms

84
Q

What bacteria are post splenectomy patients susceptible to?

A
  • Strep pneumoniae
  • H influenzae
  • E coli
  • Klebsiella pneumoniae
85
Q

Gastric vs Duodenal ulcer

A
  • Both more common in men
  • Duodenal in younger patients
86
Q

Investigation for suspected bowel perforation?

A

Erect CXR

87
Q

What is Hartmann’s procedure?

A

Sigmoid colon is removed and stoma created

88
Q

Medical management of anal fissure?

A

Acute
- High fibre and fluid
- Bulk forming laxatives

Chronic
- Topical GTN
- Sphincterotomy if GTN does not help

89
Q

What can be used to defunction the colon to prevent an anastomosis?

A

Loop ileostomy

90
Q

What drugs can cause pancreatitis?

A
  • Azathioprine
  • Mesalazine
91
Q

Large volume paracentesis for ascites requires what to reduce mortality risk?

A

IV human albumin solution

92
Q

Why is it important to assess airway of someone with burns?

A

Thermal injury to the airway can lead to airway oedema and obstruction so intubation may be needed

93
Q

How to assess extent of burns?

A
  • Wallace Rule of Nines
  • Lund and Browder chart
94
Q

What are signs of superficial burns?

A

Red, painful, dry and no blisters

95
Q

What are signs of partial thickness superficial burns?

A

Pale pink, blistered with slow capillary refill

96
Q

What are signs of partial thickness dermal burns?

A

White with reduced sensation and painful for deep pressure

97
Q

What are signs of full thickness burns?

A

White/black burns, no blisters with no pain

98
Q

What are indications of referral to secondary care for burns?

A
  • All deep dermal and full thickness burns
  • Superficial burns of more than 3% of body surface area in adults or more than 2% of body area in children
  • Electrical/chemical burns
  • NAI
99
Q

What is the Parkland formula for calculating fluids?

A

TBSA of burn x Weight (kg) x 4

100
Q

Management of burns

A
  • ABCDE
  • Analgesia/emollients for superficial burns
  • Catheterise
101
Q

Rectal cancer on the anal verge

A

Abdomino-perineal excision of the rectum

102
Q

Why is the epidural analgesia good post abdominal surgery?

A

Accelerates the return of normal bowel function

103
Q

Isolated fever in well patient in first 24 hours following surgery

A

Normal physiological reaction to operation

104
Q

How should patients taking steroids be managed before surgery?

A

Switch to IV hydrocortisone

105
Q

What is psoas sign?

A

Extending right hip causes pain in RIF -> appendicitis

106
Q

What is Courvosier’s sign?

A

Painless jaundice with a palpable gallbladder is usually indicative of pancreatic/gallbladder cancer

107
Q

What do you not do in emergency settings with bowel obstructions caused by tumours?

A

Resect the bowel -> do colostomy

108
Q

What is migratory thrombophlebitis?

A

Trousseau sign -> pancreatic cancer

109
Q

Ascending cholangitis definitive management?

A

ERCP

110
Q

What is the gold standard investigation for diverticulitis?

A

CT abdomen pelvis with contrast

111
Q

How to distinguish between femoral and inguinal hernias?

A

Femoral - inferior + lateral to the pubic tubercle
Inguinal - superior + medial to the pubic tubercle

112
Q

Recurrent UTIs + passing gas in urine in someone with diverticular disease?

A

Colovesical fistula formation -> cystoscopy

113
Q

When should ACE inhibitors be stopped before surgery?

A

Day before

114
Q

Management of post op poor urine output?

A
  • Fluid challenge to assess whether hypovolaemic
  • Manage underlying causes
  • Catheterise if persisting to assess urine output
115
Q

Most common organism which causes cholecystitis?

A

E coli

116
Q

Indications of all the different colonic resections

A

AP resection - tumours <8cm from anal margin
Anterior resection - tumours >8cm from anal margin
Left hemicolectomy - tumours of descending colon, proximal sigmoid
Right hemicolectomy - tumours of caecum, ascending colon and hepatic flexure
Sigmoid colectomy - tumours of sigmoid colon
Hartmann’s - used in an emergency to form temporary end colostomy

117
Q

Hernias - men vs women

A

Inguinal - men
Femoral - women

118
Q

When should Clopidogrel be stopped before surgery?

A

7 days before

119
Q

High risk ingested objects such as batteries must be managed how?

A

Immediate endoscopy for removal

120
Q

What is a diagnostic paracentesis?

A

Ascitic tap -> should be done for anyone with SBP

121
Q

Prophylaxis of colon polyps in patient with strong FH to prevent cancer?

A

Panproctoprolectomy

122
Q

What is important to check in post operative ileus?

A

Electrolytes

123
Q

Colostomy ve ileostomy?

A

Colostomy - flat to the skin
Ileostomy - spouted

124
Q

Indications for thoracotomy in haemothorax?

A
  • > 1.5L of blood loss initially
  • > 200ml per hour for >2 hours
125
Q

What is left vs right hemicolectomy used for?

A

Left - tumour in distal transverse colon/descending
Right - tumour in proximal transverse/ascending

FINALS: PASSMED/QUESMED (22 decks)

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