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3rd Yr Surg Flashcards

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1
Q

Anticoagulant Reversal:
Heparin
Warfarin (Raised INR, Bleeding)

A

Heparin: Protamine Sulphate

Warfarin:
Raised INR (5-8), No bleeding: Reduce Dose
Raised INR (> 8): PO Vitamin K
Bleeding: IV Vitamin K
Major Bleeding/Emergency: Prothrombin Complex (Beriplex)

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2
Q 
Transfusion Reactions + Features:
Overload
Acute Lung Injury
Non-Haem Febrile React
Acute Haem Febrile React
A

Overload:
Pulmon Oedema => SOB

Acute Lung Injury:
Inflamm => Pleural Effusion (+ New Infiltrates on CXR)

Non-haemolytic Febrile React:
Cytokines => Fever + Rigors

Acute Haem Febrile React:
Immune Response => Fever
Haemolysis => TachyC + HypoT

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3
Q 
Types of Hernias + Mx:
Femoral
Hiatus
Inguinal
Umbilical
A

Femoral (Inf + Lat):
Surg

Hiatus (Stomach -> LOS):
Reduce Weight
Alignates, PPi (Reduce Reflux)
Metocloperamide (Increase motility)
Nissens Procedure

Inguinal (Sup + Med):
Watch + Wait (+/- Surg)

Umbilical (< 3yo):
(If non-reducible by 3yo: Surg)

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4
Q

Post-Op Pneumonia Mx

A

Appropriate Analgesia + Early Chest Physio
Ciprofloxacin
(If Asp: Metronidazole)

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5
Q

Acute Pancreatitis Scoring

A 
Glasgow Score:
P: pO2 < 8KPa
A: Age > 55yo
N: Neutrophillia (WCC > 15)
C: Ca2+ < 2mmol
R: Renal (Urea > 16mmol)
E: Enzymes (LDH > 600)
A: Albumin < 32g/L
S: Sugar (Glu > 10mmol)
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6
Q

Causes of SBO + LBO

A 
SBO:
Adhesions
Hernias
Volvulus
CD

LBO:
Cancer
Diverticular D
Volvulus

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7
Q

Mx of Bowel Obstruct

Indications for Surg

A 
NBM
IV Fluids (Correct electrolyte disturbance) w/ Catheter
NGT (Decompress GI tract)
Analgesia + Antiemetic
(If Volvulus: Colonoscopy)

Surg (> 48hrs, Ischaemia/Perf, Reversible - Strangulated Hernia/Tumour)

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8
Q

Diverticular D Types + Features

A

Painful:
Intermittent LIF pain +/- IBS Sx

Acute:
Colicky LIF pain, IBS Sx, Fever

Bleeding:
Dark, Clotted blood (Spontaneous)
(Few/No Prodromal Sx)

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9
Q

Diverticular D Mx

A

Clear, liquid diet for 72hrs
IV Fluids
IV ABx
(Surg: Excision + => End Colostomy)

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10
Q

Ischaemic Colitis Sx - 6

A 
Lower Abdo pain
N+V
Bloody Diarrh
Tenderness, Guarding
Pyrexia
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11
Q

Ischaemic Colitis Ix

A 
Raised WCC
Ba Swallow (Thumbprinting: Submucosal Oedema)
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12
Q

Ischaemic Colitis Mx +/- Complication

A

NBM (Bowel Rest)
IV Fluids
(If Perf: Surg resection + Colostomy formation)

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13
Q

AAA Screening

A

All males > 65yo: (USS):

If < 3cm: No f/up required
If > 3cm: Annual screen
If > 4.5cm: 3 monthly screen
If > 5.5cm, Increase in > 0.5cm in 6 months: Urgent Surg
If Rupture: Emergency Surg
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14
Q

AAA Mx

A

If < 3cm: Annual f/up

If > 4cm: 3 monthly USS

If > 5.5cm, Increase in 0.5cm in 6 months: Surg

If Rupture: Emergency Repair

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15
Q

Def Claudication + Critical Limb Ischaemia

A

Claudication: Intermittent Limb pain

Critical Limb Ischaemia: Rest Pain

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16
Q

Critical Limb Ischaemia Types + Features

A

Embolus:
Acute, profound Pain (No Collaterals)
Contralat Pulse normal, No Claudication Hx

Thrombus:
Gradual Pain (Collaterals form)
Contralat Pulse weak, Claudication Hx

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17
Q

Critical Limb Ischaemia Ex

A

Pulseless, Pallor, Perishingly cold (Time for Initial Ix)
Pain, Paraesthesia, Paralysis (Immediate Mx Req)
Petechia/Fixed mottling (Irreversible)

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18
Q

Critical Limb Ischaemia Mx

A

ABCDE (O2, IV Fluids, Opiates)
5000 Units UFHep
(If Increasing Press/Pain: Fasciotomy - Prevent Compartment Synd)

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19
Q

Lap Cholecystectomy Complications

A 
-> Open procedure
Common Bile Duct Injury
Bile Leak
Intra-abdominal Haem
Fail (Retained Stones)
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20
Q

Causes of Jaundice Post-cholecystectomy:
Pre-hepatic
Hepatic
Post-hepatic

A

Pre-hepatic:
Haemolysis after Transfusions

Hepatic:
Halogenated Anaesthetics

Post-hepatic:
Ligation of CBD/CHD, Thermal Injury, Biliary Sepsis, Gallstone Retention

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21
Q

Hernioplasty Complications:
Early - 4
Late - 3

A

Early:
Urinary Retention, Haematoma, Inf, Injury

Late:
Ischaemic Orchitis (Thrombosis), Chronic Groin Pain/Paraesthesia, Recurrence
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22
Q

Hernioplasty Post-op Care

A 
Day Cases (Unless comorbidity)
Discharge w/ Mild Analgesia + Laxative
Return to work after 1wk
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23
Q

Nissens Fundoplication Purpose + Complications

Study These Flashcards
A

Purpose: Repair LOS + Prevent Reflux/Hernia

Gas-bloat Synd (Inability to Belch or Vomit)
Dysphagia

24
Q

Appendicectomy Complications

Study These Flashcards
A

Abscess formation, Rupture (+/- => Peritonitis), -> R Hemicolectomy

25
Gastrectomy Complications: Physical - 2 Metabolic - 2
``` Weight loss (Early satiety/Loss of Appetite, Reduced Intake, Malabsorption, Vomiting/Diarrh) Reflux, Bilious Vom ``` ``` Vit Def (Lack of SB: Folate/Fe, Lack of Parietal Cells: B12) Mineral Def (Lack of Ca2+) => Osteoporosis ```
26
AAA Repair Complications: Open EVAR
MI, VTE Renal Fail Spinal/Mesenteric Ischaemia Open: Graft Inf EVAR: Graft Migration/Stenosis, Aneurysmal Leak (Endoleak)
27
Carotid Endarterectomy Complications
MI, Stroke (Death w/in 1 month) Haem => Haematoma Hypoglossal N Damage (Fasciculations + Deviation Ipsilaterally)
28
Bypass Graft Indications
Rest Pain Very Short Claudication distance (< 100m) Sx affecting patients QoL
29
Bypass Grafts Complications
Haematoma Distal Embolism Thrombosis
30
TURP Indication
Failed Med Tx for BPH
31
TURP Complications: Immediate - 3 Early - 2 Late - 3
``` Immediate: TUR Synd (Absorption of Fluids => Hypo-Na+), Haem, Inj ``` Early: Inf, Clot Retention/VTE Late: Retrograde Ejaculation, ED, Incontinence Urethral Stricture (=> LUTSx) Recurrence
32
Surgery Complications: Immediate - 3 Early - 6 Late - 4
Immediate (< 24hrs): Surg Trauma, Intubation (=> Oropharyngeal Trauma), Primary Haem ``` Early (1 day - 1 month): Secondary Haem, VTE Urinary Retention, Constipation Atelectasis, Pneumonia Wound Inf (+ Abscess), Dehiscence (Anastomotic leak/Hernia) ABx-associated Colitis (C Diff) ``` Late (> 1month): Scarring, Adhesions (=> Obstruct), Neuropathy, Failure/Recurrence
33
Laparoscopic vs Open Surg Advantages - 4
Reduced Pain Reduced Complications (Wound Inf, Bleeding) Quicker recovery
34
Laparoscopic vs Open Surg Disadvantages - 4
Technically Challenging Longer More Expensive Not amenable to all Surg
35
Pre-op Medication changes Stop - 5 Continue - 8
``` Stop: Anti-platelets, Anti-coags COCP/HRT K+ sparing (ACEi/ARB, Spironolactone) PO DM meds Lithium ``` ``` Continue: Inhalers Steroids AEDs Cardiac meds (Beta-blockers, Statins) Aspirin PPi’s Thyroid meds Immunosupp meds ```
36
Stoma Complications Early - 3 Late - 4
Early: Haem, High Output (=> Hypokalaemia), Psychological problems Late: Obstruct, Dermatitis (esp Ileostomy), Stoma Prolapse/Intusussception, Stenosis
37
Healing Patho
Reactive (Haematoma): Blood clot forms (Capillaries invade => Granulation Tissue) Reparative: Fibrocallous (Cartilage) secreted by Chondroblasts Osteoblasts (Endochondrial Ossification) => Bony Callous Remodelling: Osteoclasts remove excess bone tissue (In response to Stress)
38
Primary vs Secondary Bone Healing
Primary: (Aim of Int Fixation): Well-opposed fragments (No bony Callus forms) Secondary: (May require traction): Formation of Callus (Less opposed)
39
Radius # Mx
Closed Reduction + Cast 4wks | If Unstable: ORIF
40
Scaphoid # Mx
Scaphoid cast 8-12wks | If displaced: ORIF
41
Ankle # Classification
Weber: A: Below Syndesmoses B: At level Syndesmoses C: Above Syndesmoses
42
Ankle # Mx
Cast 6wks | If Unstable, Displaced/Talar shift, Open, Multi-malleolar: ORIF
43
Tibial # Mx
Plaster of Paris | If Open/Unstable: Surg
44
NOF # Mx
Analgesia, IV Fluid Resus (Bisphosphonates + Adcal-D3) LMWHep Intracapsular: Young + Fit: Cannulated Screws Old + Mobile: THR Old + Immobile: Hemiarthroplasty Intertrochanteric: Dynamic Hip Screw Extracapsular: Intramedullary Nails
45
Back Pain Red Flags - 10
``` Age < 20yo, > 55yo Weight Loss, Fever, Night Sweats Recent Trauma Non-mechanical/Inflamm (Improves w/ Act) Motor/Sens loss Bladder/Bowel Impairment Sexual Dysfunction Saddle Paraesthesia Steroid Use Previous Malig, HIV ```
46
Cauda Equina Mx
Urgent Referral for Surg decompression (w/in 48hrs)
47
OA Mx: Conservative Med Surg
Conservative: Education, Reduce BMI, Exercise (+/- Physio) Walking aids, Hot/Cold compress, OT Med: NSAIDs, Paracetamol, Codeine ``` Surg: Joint Replacement Joint Fusion (Younger Pt’s) ```
48
Osteoporosis Mx
``` Dietary Advice (Ca2+, Vit D) Exposure to sunlight Bisphosphonates (Alendronate) Weight-bearing exercises OT (Frailty Assess, Fall prevention, Hazard-free Home) ```
49
``` Ca2+, PO4(2-), ALP, PTH: Osteoporosis Primary Hyper-PTH Secondary Hyper-PTH Pagets D Osteomalacia Osteopetrosis ```
Osteoporosis: Normal Primary Hyper-PTH: Increased PTH, ALP, Ca2+, Decreased PO4(2-) Secondary Hyper-PTH: Decreased Ca2+, Increased PTH, ALP, PO4(2-) Pagets D (Increased Bone Turnover): Increased ALP Osteomalacia (Hypomineralisation): Decreased Ca2+, PO4(2-), Increased PTH, ALP Osteopetrosis (Hypermineralisation): Normal
50
Open #’s Classification
Gustilo-Anderson I: < 1cm II: 1-10cm IIIa: > 10cm (w/ adequate soft tissue cover) IIIb: > 10cm (w/ Inadequate soft tissue cover) - Requires Plastic Input IIIc: Vascular Inj - Requires Vascular Input
51
Hypermobility Scoring - 5
``` Beighton: Elbow Hyperextension Knee Hyperextension Thumb to Forearm Little finger Extends > 90 Both palms on ground from standing ```
52
Dupuytrens Contracture Patho
Fibrosis of Palmar Aponeurosis => Painless Contraction
53
Dupuytrens Contracture Mx
Surg excision of Palmar Aponeurosis: Fasciectomy
54
Clavicle # Mx
Rest + Supportive Sling | If Open, Neurovascular compromise, Floating Shoulder: Surg
55
Atherosclerosis Patho
Endothelial Injury: (HT, Hyperlipid, Turbulent Blood flow) Chronic Inflamm: (Lipid-laden Foam cells prod GF/Cytokines/ROS => Lymphocyte + SM Infiltration) SM Proliferation: (Fatty streak -> Atherosclerotic Plaque)
56
Mx
Manual reduction (w/ Anaesthetic) Immobilisation F/up PT

Medicine (13 decks)

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