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Finals > Surgery > Flashcards

Surgery Flashcards

1
Q

treatment options for fibroadenoma

A

below 3cm = watch and wait

above 4 cm = core biopsy

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2
Q

indications for a mastectomy

A

multifocal tumour
central tumour
large mass in a small breast
DCIS >4cm

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3
Q

indications for WLE

A

solitary lesion
peripheral tumour
small mass in a large breast
DCIS <4cm

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4
Q

role of radiotherapy in breast issues

A
  • after WLE

- after mastectomy on t3/4 tumours and with positive lymph nodes

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5
Q

ER postive therapy for pre/peri menopausal women

A

Tamoxifen

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6
Q

ER positive therapy for post-menopausal women. What class of drug is this?

A

Anastrozole

Aromatase inhibitor

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7
Q

Side effects of Tamoxifen treatment

A

increased risk of endometrial cancer
venous thromboembolism
menopausal symptoms

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8
Q

HER2+ve therapy? who cannot have it?

A

Trastuzumab (Herceptin)

Do not use in patients with heart disease

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9
Q

Breast screening programme screens who?

A

47-73 years old

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10
Q

58 year old women, smoker, thick green nipple discharge. what is the diagnosis and process behind this?

A

duct ectasia.

dilatation and shortening of ducts

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11
Q

location and use of: gastrostomy

A

epigastrium

gastric decompression/fixation, feeding

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12
Q

location and use of: loop jejunostomy

A

any location
rarely used because of high output
used after emergency lap procedure with early close

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13
Q

location and use of: percutaneous jejunostomy

A

LUQ

feeding

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14
Q

location and use of: loop ileostomy

A

RIF

defunctioning of colon

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15
Q

location and use of: end ileostomy

A

RIF
complete excision of colon
reversal more difficult
when ileocolic anastomosis not planned

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16
Q

location and use of: end colostomy

A

LIF/RIF

colon diverted/resected and anastomosis not achieved or wanted

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17
Q

location and use of: loop colostomy

A

any

to definition distal colon

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18
Q

location and use of: caecostomy

A

RIF

last resort

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19
Q

explain an anal fissure

A

longitudinal or elliptical tears of the squamous lining of the distal anal canal.
acute is less than 6 weeks

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20
Q

describe the management of an acute anal fissure

A

diet: increase fibre and fluid
bulk forming laxatives, lactulose if not tolerated
lubricants before defecation
topical anaesthetics

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21
Q

management of a chronic anal fissure

A

all of acute management
topical GTN for 8 weeks
surgery or botox

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22
Q

most common type of anal neoplasm

A

squamous cell carcinoma

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23
Q

method of imaging used to stage colorectal cancer

A

CT chest abdo pelvis

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24
Q

procedure needed and location of anastomosis: patient with cancer in caecum

A

right hemicolectomy

ileo-colic anastomosis

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25
Q

procedure needed and location of anastomosis: patient has cancer in distal transverse colon

A

left hemicolectomy

colo-colon anastomosis

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26
Q

procedure needed and location of anastomosis: patient has cancer in ascending colon

A

right hemicolectomy

ileo-colic anastomosis

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27
Q

procedure needed and location of anastomosis: patient has cancer in descending colon

A

left hemicolectomy

colo-colon anastomosis

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28
Q

Dukes staging

A

A- trapped in mucosa
B- invading bowel wall
C- lymph node mets
D- distant mets

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29
Q

procedure needed and location of anastomosis: patient has cancer in sigmoid colon

A

High anterior resection

colo-rectal

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30
Q

procedure needed and location of anastomosis: cancer in the UPPER rectum

A 
anterior resection (TME) 
colo-rectal
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31
Q

procedure needed and location of anastomosis: cancer in the LOWER rectum

A 
anterior resection (low TME) 
colo-rectal +/- stoma
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32
Q

procedure needed and location of anastomosis: cancer in the anal verge

A

APER

no anastomosis needed

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33
Q

obstructive colorectal cancer; palliative options

A

stent, bypass, diversion stoma

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34
Q

urgent referral to colorectal clinic criteria

A

over 40 - weight loss and abdominal pain
over 50 - rectal bleed
over 60 - ID anaemia or bowel change

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35
Q

radiological sign of sigmoid volvulus

A

large dilated loop of bowel

coffee bean sign

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36
Q

management of sigmoid volvulus

A

sigmoidoscopy and rectal tube insertion

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37
Q

management of caecal volvulus

A

right hemicolectomy

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38
Q

work up for patient with ?appendicitis

A

WCC, pregnancy test, CRP, amylase, urine dip

USS

39
Q

sign seen in appendicitis

A

Rosvings: palpate LIF and more pain felt in RIF

40
Q

what history would make you suspect mesenteric adenitis

A

recent URTI, history of fever, generalised abdominal pain

41
Q

what history makes intestinal obstruction most likely

A

previous surgeries or history of malignancy. colicky pain,, vomiting, not moved bowels in a while

42
Q

history of pancreatitis patients?

what signs are present

A

history of alcohol or gallstones, severe epigastric pain, vomiting.
Cullens sign - perumbilical discolouration
Grey-Turners - flank discolouration

43
Q

history in biliary colic

A

pain in RUQ radiating to the back, following a fatty meal, can cause obstructive jaundice (pale stools + dark urine) Female, fat, 40, fair

44
Q

most common hernias

A

inguinal

45
Q

what hernia is more common in women

A

femoral

46
Q

location of inguinal hernia

A

above and medial to pubic tubercle

47
Q

location of femoral hernia

A

below and lateral to pubic tubercle

48
Q

difference between umbilical and paraumbilical hernia

A

umbilical is symmetrical under belly button

paraumbilical is asymmetrical and either above or below

49
Q

what causes a congenital inguinal hernias in paeds

A

indirect hernia from a patent processes vaginalis.

60% are right sided

50
Q

location of direct inguinal hernia

A

medial to inferior epigastric artery

51
Q

location of indirect inguinal hernia

A

lateral to inferior epigastric artery

52
Q

what are hyatid cysts caused by

A

echinococcus granulosus

53
Q

reaction when hyatid cysts are formed (type of hypersensitivity)

A

type 1

54
Q

iatrogenic nerve injuries. nerve damaged in: posterior node biopsy

A

accessory nerve

55
Q

iatrogenic nerve injuries. nerve damaged in: Lloyd Davies stirrups

A

common peroneal

56
Q

iatrogenic nerve injuries. nerve damaged in: thyroidectomy

A

laryngeal nerve

57
Q

iatrogenic nerve injuries. nerve damaged in: anterior resection of rectum

A

hypoergastric autonomic nerves

58
Q

iatrogenic nerve injuries. nerve damaged in: axillary node clearance

A

long thoracic, thoracodorsal

59
Q

iatrogenic nerve injuries. nerve damaged in: inguinal hernia surgery

A

ilioinguinal nerve

60
Q

iatrogenic nerve injuries. nerve damaged in: posterior approach to hip

A

siatic nerve

61
Q

history of pancreatic cancer

A

painless jaundice, anorexia, weight loss, epigastric pain

62
Q

Ix of ?pancreatic cancer

A

USS, CT

63
Q

management of pancreatic cancer

A

Whipples procedure
palliative: ERCP + stent
give chemo

64
Q

what is the total available score in the GCS

A

15

65
Q

describe the GCS: Motor response

A 
obeys commands 6 
localises to pain 5 
withdraws from pain 4 
abnormal flexion 3
extends to pain 2 
none 1
66
Q

describe the GCS: vocal response

A 
orientated 5 
confused 4 
words 3 
sounds 2 
none 1
67
Q

describe the GCS: eye opening response

A

spontaneous 4
to speech 3
to pain 2
none 1

68
Q

describe the pathology of extradural haematoma

A

blood between the dura and the skull

69
Q

what brain injury may occur in an accerleration- deceleration trauma or a blow to the side of the head?

A

extradural haematoma

70
Q

features of an extradural haematoma

A

increased ICP, patients may have a lucid period

71
Q

describe the pathology of a subdural haematoma

A

bleeding into the outermost meningeal layer

72
Q

describe the management of a subarachnoid haemorrhage

A

increased ICP -> IV mannitol/furosemide

cerebral oedema -> decompressive craniotomy

73
Q

classic presentation of SAH

A

severe occipital headache, neck stiffness

74
Q

how long do you wait to do a lumbar puncture in SAH, what are you looking for?

A

wait 12 hours, Xanthrochromia

75
Q

how do alpha-1 antagonists work in BPH?
give an example.
give side effects

A

decrease smooth muscle tone
tamsulosin
SEs: dizziness, hypotension, dry mouth, depression

76
Q

how do 5alpha reductase inhibitors work
give an example
give side effects

A

block conversion of testosterone to DHT
finesteride
erectile dysfunction, decreases libido, gynaecomastia.
DECREASES PSA!

77
Q

what subtype of cancer are most bladder cancers

A

transitional cell

78
Q

management of epididymo-orchitis

A

IM ceftriaxone, doxycycline 100mg O, BD 10-14 days

79
Q

what is a Wilms tumour? who is affected?

A

nephroblastoma, first 4 years of life

80
Q

what part of the prostate does cancer usually form?

A

peripheral zones

81
Q

what might you feel on PR exam in prostate cancer

A

asymmetrical, hard, nodular, enlarged prostate, may be loss of the median sulcus

82
Q

what subtype of prostate cancer is most common

A

adenocarcinoma

83
Q

what nodes does prostate cancer spread to first

A

obturator nodes

84
Q

what system is used to score prostate cancer

A

Gleason

85
Q

most renal stones are made of

A

calcium oxalate

86
Q

how do you manage a renal stone

A

pain relief; diclofenac, alpha-adrenergic blockers
less than 5mm: pass
larger than 5mm: shock lithotripsy, urteroscopy (pregnant ladies), nephrolithotomy

87
Q

when is the cremasteric reflex lost

A

in testicular torsion

88
Q

hormonal blood results in seminoma (tumour markers)

A

afp normal, elevated hcg, elevated lactate

89
Q

how does AAA occur

A

failure of elastic proteins within the extracellular matrix

90
Q

normal AA measurements for females and males

A

female 1.5

male 1.7

91
Q

AAA with low rupture risk criteria

A

asumptomatic, less than 5.5cm diameter

management: USS surveillance

92
Q

AAA with high rupture risk

A

symptomatic, 5.5cm or greater, increases by 1 in a year

management: EVAR or open repair

93
Q

what is ABPI

A

ratio of systolic BP in lower legs to that of the arms. decrease pressure in legs indicates PAD

94
Q

what ABPI score indicates PAD

A

less than 0.9, less than 0.5 is severe

Finals (11 decks)

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