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General Medicine > Surgery > Flashcards

Surgery Flashcards

0
Q

What causes colicky abdominal pain in intestinal obstruction

A

Increased peristalsis against the obstruction

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1
Q

What is wallaces rule of 9s

A 
For burns
Head and neck = 9%
Upper limb = 9%
Anterior lower limb = 9%
Whole lower limb = 18%
Anterior torso = 18%
Posterior torso = 18%
Perineum = 1%
Hand = 1%
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2
Q

What is a volvulus

A

Twisting of a bowel loop around its mesenteric axis

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3
Q

Risk factors for volvulus Development

A

Long sigmoid,
narrow mesenteric attachment,
constipated loop

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4
Q

What does the coffee bean sign on abdo xr indicate

A

Volvulus

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5
Q

Management of volvulus

A

Passage of a flatus tube into the sigmoid colon

Failure - laparotomy

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6
Q

What is gallstone ileus

A

Gallstone erodes into the duodenum
Forms cholecysto-duodenal fistula
Gallstone then blocks the ileo-caecal valve - obstruction
Air enters the biliary tree - can be seen on xray.

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7
Q

Causes of paralytic ileus

A 
Post op
Peritonitis
Spinal surgery
Hypokalaemia
Uraemia 
Anticholinergic drugs
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8
Q

Presentation for paralytic ileus

A

Vomiting, distension, absolute constipation

NO pain

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9
Q

Abdominal x-ray findings of paralytic ileus

A

Gas in the whole small and large bowel

No discrete obstruction

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10
Q

Management of paralytic ileus

A

Fluids
NG tube
Pethidine for pain (doesnt slow GI motility)
Anti-emetics

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11
Q

What is hartmann’s pouch

A

The neck of the gallbladder

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12
Q

Why is biliary colic not true colic

A

The pain is continuous and not in waves

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13
Q

Where is the pain of biliary colic felt

A

Initially epigastric for right upper quadrant

Then Radiates around both costal margins

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14
Q

Differential diagnosis of severe upper abdominal pain

A

Biliary colic
Pancreatitis
Perforated peptic ulcer
Ruptured aneurysm

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15
Q

What is a right sub-costal incision used for

A

Open cholecystectomy

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16
Q

Gas used for insuflation in laparoscopic surgery

A

CO2

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17
Q

Benefits of laparoscopic surgery

A 
Smaller wounds/scars
Less post-operative pain
Reduced risk of wound infection
Reduced post-operative chest infections 
Earlier mobilisation
Earlier discharge
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18
Q

Contraindications to laparoscopic surgery

A

Suspected cancer
Bleeding disorders
(Multiple adhesions)

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19
Q

What is a mucocele of the gallbladder

A

Gallstone impacts the gallbladder neck

Mucus builds up and distends the gallbladder

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20
Q

What is cholangitis

A

Infection of the biliary tree

Usually associated with obstruction

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21
Q

Presentation of cholangitis

A

Pain
Jaundice
Pyrexia and rigors

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22
Q

Risk factors for gallbladder carcinoma

A

Long term gallstones
Gallbladder polyps
Gallbladder calcification

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23
Q

What is a porcelain gallbladder

A

Calcification of the gallbladder

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24
Q

Types of pancreatic cancer

A

Ductal adenocarcinoma (poor prognosis)
Ampullary carcinoma
Islet cell tumours
Cystic tumours

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25
Q

Presentation of ductal pancreatic cancer

A 
Obstructive jaundice (if at head of pancreas -80%)
Severe upper abdominal pain
Weight loss
Anorexia
Malaise
Thrombophlebitis migrans
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26
Q

Management of pancreatic cancer

A

If too advanced for resection - biliary stent

Surgical resection (15% of ductal ca)

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27
Q

When is whipples procedure done?

A

Tumours of the head of the pancreas / peri-ampullary

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28
Q

Compenets of the modified Glasgow score

A 
PaO2 < 8kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L
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30
Q

Define hernia

A

Protrusion of a viscus, or part of a viscus, through the walls of its containing cavity into an abnormal position

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31
Q

What is the neck of a hernia

A

The margin of the defect through which it has protruded

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32
Q

What does a ‘reducible’ hernia mean

A

When the contents of the hernia can be returned to the abdominal cavity.
Either spontaneously or with manipulation

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33
Q

What does an ‘incarcerated’ hernia mean

A

An irreducible hernia
Which is irreducible due to adhesions within the sac.
Not obstructed or strangulated.

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34
Q

What does an ‘obstructed’ hernia mean?

A

Bowel within the hernia is obstructed.

Patient may have - pain, distension, vomiting and absolute constipation

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35
Q

What does a ‘strangulated’ hernia mean

A

The blood supply to the contents of the hernia is occluded by pressure from the neck of the hernia
Usually veins occlude 1st - causing swelling - causing arterial occlusion

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36
Q

What is a richters hernia

A

Where part of the bowel wall is caught in the sac and may become strangulated.

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37
Q

Where do femoral hernias herniate through

A

Through the femoral canal - usually contains fat and LN

Appear below and lateral to the pubic tubercle

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38
Q

What hernias are below and lateral to the pubic tubercle

A

Femoral hernias

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39
Q

When does a femoral hernia need repairing

A

ALL femoral hernias require repair

High risk of strangulation

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40
Q

Types of inguinal hernia

A

Direct inguinal hernia

Indirect inguinal hernia

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41
Q

What hernia is above and medial to the pubic tubercle

A 
Inguinal hernia 
(But they leave the abdominal cavity above and lateral to the pubic tubercle)
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42
Q

Passage of indirect inguinal hernias

A

Through the deep inguinal ring
Along inguinal canal
Emerge through the superficial inguinal ring

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43
Q

Passage of direct inguinal hernias

A

Enter the inguinal canal directly via a weakness in its posterior wall.
Emerge from the superficial inguinal ring

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44
Q

What type of hernia often extends into the scrotum

A

Indirect inguinal hernias

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45
Q

Differential diagnosis of a lump in the groin

A 
Inguinal hernia
Femoral hernia
Inguinal lymph node
Saphena varix
Femoral artery aneurysm
Encysted hydrocoele 
Lipoma
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46
Q

Factors leading to the development of incisional hernias

A 
Obesity
Old age
Chronic cough
Straining due to constipation 
Post-op wound infection 
Post-op haematoma
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47
Q

What is the normal difference between adult and congenital umbilical hernias

A

Congenital umbilical hernias herniate through the umbilicus itself.
Adult umbilical hernias are usually para-umbilical.

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48
Q

What is a spigelian hernia

A

A hernia into the posterior rectus sheath at the point where it becomes deficient.

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49
Q

What is an obturator hernia

A

V rare hernia.
In pelvic area - into obturator foramen.
Can cause pain to be felt on inner thigh
Old F

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50
Q

What does a modified Glasgow score of 3 or more indicate

A

Severe pancreatitis

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51
Q

What is fibrocystic breast disease

A

Aberrations of normal development
Small cyst formation
Fibrosis
Hyperplasia of duct epithelium

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52
Q

Presentation of fibrocystic breast disease

A

Bilateral, diffuse lumpiness and breast pain.

Often cyclical

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53
Q

Features of a fibroadenoma

A

Discrete, firm, freely mobile lump
2-3cm in size
Most common aged 15-25

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54
Q

What is a phyllodes tumour

A

Rapid growing
Tumour of Fibroepithelial stroma of breast
Leaf-like appearance on histology
Usually benign

55
Q

What is peau d’orange

A

Orange skin appearance of skin of breast
Can occur in breast cancer
Cutaneous lymphoedema
Skin dimpling

56
Q

What is a cystic hygroma

A

Congenital benign proliferation of lymph vessels.
Posterior triangle of neck.
Multi-cystic swelling.

57
Q

Features of a cystic hygroma

A

Posterior triangle of neck.
Multi-cystic swelling.
Fleshy and compressible
Trans illuminate brightly

58
Q

Boundaries of the posterior triangle of the neck

A

SCM muscle anteriorly
Anterior border of trapezius
Middle 1/3 of clavicle

59
Q

Features of a salivary duct carcinoma

A 
>50yo
Rapid growth
Regional lymph node involvement
Rapid metastasis 
Facial nerve involvement --> weakness
60
Q

What is a branchial cyst

A

Cystic degeneration of lymphoid tissue
Commoner in M on LHS
Anterior triangle

61
Q

Features of a branchial cyst

A

Anterior triangle - anterior to bordere of SCM
Smooth
Non-tender
Fluctuant swelling
Does not trans-illuminate
Aspiration reveals creamy fluid containing cholesterol crystals

62
Q

What is a thyroglossal cyst

A

Congenital cystic remnant of the thyroglossal tract

63
Q

Features of a thyroglossal cyst

A

Smooth midline lump

Moves on tongue protrusion

64
Q

What is a sialolithiasis

A

Salivary gland stone

65
Q

Presentation of salivary duct stone

A

Immense pain on salivation

Enlarged gland

66
Q

Post-hepatic causes of jaundice

A 
Biliary obstruction 
- Extrahepatic cholestasis:
       > Bile duct strictures (can be benign or malignant).
       > Common duct stone.
       > Cancer of the head of the pancreas.
       > Tumour of the ampulla of Vater.
       > Pancreatitis.
       > Cancer of the gallbladder.
- Intrahepatic cholestasis:
       > Primary biliary cirrhosis 
       > Drugs (e.g phenothiazines).
       > Primary sclerosing cholangitis
       > Dubin-Johnson syndrome (autosomal recessive) 
       > Rotor's syndrome.
67
Q

What type of jaundice causes pale stools and dark urine

A

Conjugated

Suggests a post-Hepatic cause

68
Q

What type of incision is used for an appendicectomy?

A

Gridiron (at right angles to the line between ASIS and umbilicus -1/3 way along)
Lanz (more transverse and closer to ASIS)

69
Q

Where is McBurney’s point

A

1/3 way between the ASIS and umbilicus

Tender on palpation in acute appendicitis

70
Q

When is a midline laparotomy incision used + where is it

A

For urgent abdominal surgery or exploratory surgery

Upper = Xiphisternum to umbilicus
Lower = umbilicus to pubic symphysis
Trauma cases = Xiphisternum to pubic symphysis

71
Q

When is a pfannenstiel incision used

A

Caesarean section
Ovarian operations
Bladder and prostate operations

72
Q

When is a subcostal (kocher) incision used

A

Right sided for cholecystectomy

Left sided for splenectomy

73
Q

Management of thrombophlebitis caused by cannula

A

Remove cannula
Elevate limb
NSAIDs
If signs of infection start abx

74
Q

Presentation of the breast cyst

A

Sudden, painful swelling in the breast

Commonest in 40s

75
Q

What is mastitis

A

Infection of a lactiferous duct by staphylococcus aureus

Transmitted by infants nasopharynx in lactation

76
Q

Presentation of mastitis

A

Cellulitis of breast
Pyrexia
tachycardia
leucocytosis

77
Q

Presentation of fat necrosis in the breast

A

Middle age obese women
History of breast trauma
Painless, irregular, firm lump
+/- Skin thickening, retraction

78
Q

What is mondor’s disease of the breast

A

Rare
Thrombophlebitis of superficial veins of bathe breast and anterior chest wall.
Painful, inflamed cord-like structure tethered to skin

79
Q

Presentation of a cervical rib

A

Lump in the neck
Paresthesia / pain in T1 distribution
Horners syndrome
Subclavian artery can be pinched - reduced blood flow to arm

80
Q

Commonest benign tumour of the salivary glands

A

Pleomorphic adenoma

81
Q

What is a chemodectoma

A

Tumour of the carotid body chemoreceptors arising in carotid bifurcation
Slowly enlarging neck mass with carotid pulsation

82
Q

Presentation of sternocleidomastoid tumour

A

Tilting of head - torticollis
Painless fibrous mass in SCM muscle
Tx = passive stretching of muscle

83
Q

When can aorto-enteric fistulas occur

How do they present

A

Rare complication of abdominal aortic aneurysm repair

Presents as massive GI bleeding, hypovolaemia, collapse

84
Q

Risk factors for gastric carcinoma

A 
Chronic peptic alteration
Helicobacter pylori infection
Gastric polyps
Pernicious anaemia
Ménétrier's disease 
Blood group A
Eating pickled foods
Smoking
Alcohol
85
Q

What is Ménétrier’s disease

A

Rare condition of hyperplasia of mucus producing cells in stomach,
Causes protein losing enteropathy
And reduced gastric acid secretion

86
Q

What is the most common type of gastric cancer

A

Adenocarcinoma

87
Q

What is troisiers sign

A

Supraclavicular lymphadenopathy on the left hand side = vichows node
Gastric cancer

88
Q

What is a krunkenburg tumour

A

Secondary ovarian tumour - From adenocarcinoma of the stomach

89
Q

What is a sister Joseph nodule

A

Hard red lump in the umbilicus

Signifies gastric carcinoma

90
Q

Management of haemorrhoids

A 
Increase dietary fibre
Increase water
Injections sclerotherapy
Banding
Surgical haemorrhoidectomy
91
Q

What is an amyand hernia

A

Hernia containing the appendix in the sac

92
Q

Management of achalasia

A

Balloon dilation of the oesophagus

Hellers cardiomyotomy

93
Q

What malignancy does achalasia predispose to?

A

Squamous cell carcinoma of the oesophagus

94
Q

Symptoms of hiatus hernia

A

Asymptomatic
Gastro-oesophageal reflux
Dyspepsia

95
Q

Complications of hiatus hernia

A 
Weight loss
Oesophagitis
Oesophageal ulceration
Oesophageal stricture
Aspiration pneumonia
96
Q

What is the surgical procedure for hiatus hernia

A

nissen’s fundoplication

97
Q

Presentation of toxic megacolon

A 
Acute
Abdominal pain
Abdominal distension 
Diarrhoea
Blood stained stools
Fever
Tachycardia
98
Q

Xray findings of toxic megacolon

A

Colon dilation >6cm
Colonic wall thickening
Multiple air-fluid levels
Disrupted haustral pattern

99
Q

Management of toxic megacolon

A

HDU
Fluid rescus
Antibiotics
Corticosteroids
Daily abdominal X-rays to assess progression
If dilation worsening consider collectomy

100
Q

What is CA-19-9 raised in

A

Pancreatic cancer

101
Q

Tumour marker of pancreatic cancer

A

CA 19-9

102
Q

Tumour marker of ovarian cancer

A

CA 125

103
Q

When is CA 125 raised

A

Ovarian cancer

104
Q

What tumour is alpha-fetoprotein raised in

A

Hepatocellular carcinoma
Liver metastasis
Germ cell tumours

105
Q

What tumour maker is raised in prostate cancer

A

PSA

prostate specific antigen

106
Q

When is CA15-3 raised

A

Breast cancer

107
Q

Tumour marker of breast cancer

A

CA 15-3

108
Q

What is beta-HCG a tumour marker for

A

Choriocarcinoma (trophoblastic disease)

Testicular tumours

109
Q

What is calcitonin a tumour marker for

A

Medullary thyroid cancer

110
Q

What is CEA (carcino-embryonic antigen) a tumour marker for

A

Colorectal cancer

111
Q

Tumour marker of colorectal cancer

A

CEA

carcino-embryonic antigen

112
Q

When is monoclonal immunoglobulin G raised

A

Multiple myeloma

113
Q

What is s-100 a tumour Marker for

A

Malignant melanoma

114
Q

What cystic neck lump occurs at the lower posterior edge of SCM

A

Cystic hygroma

Lymph-angioma

115
Q

What cystic neck lump occurs at the upper anterior edge of SCM

A

Branchial cyst

116
Q

When does a cystic hygroma present

A

Birth / early childhood

117
Q

When does a branchial cyst present

A

Adolescence / easily adulthood

118
Q

What nerve is contained in the posterior triangle of the neck

A

Accessory nerve

119
Q

Where can a lipoma NOT form?

A

Palms
Soles
Scalp

120
Q

Does a lipoma have a punctum

A

No

121
Q

What nerve runs through the parotid gland

A

5 branches of the facial nerve

122
Q

Signs of peritonitis

A 
Tenderness 
Reflex guarding 
Absent bowel sounds
Pyrexia
Pain to percussion
Extremely unwell 
Distant palpation pain
123
Q

Is small of large bowel obstruction more common?

A

Small

124
Q

Mechanism of sentinel node identification in breast cancer

A

Injection of vital blue dye + technetium labelled colloid
To identify sentinel node
Allows histology on single node

125
Q

What type of drug is herceptin + when is it used

A

Immunotherapy / biological therapy

Used in breast cancer following chemotherapy

126
Q

What is tamoxifen

A

Oestrogen receptor antagonist

127
Q

Complications of hernias

A 
Irreducibility 
Obstruction
Strangulation
Peritonitis
Infarction
128
Q

What % of patients presenting with a hernia have bilateral ones

A

10%

129
Q

Presentation of an incisional hernia

A

Appear months after surgery
Usually abdominal
Exaggerated when lying by lifting head off bed
Wide neck - low risk of obstuction / strangulation

130
Q

Where is the inguinal ligament

A

Between the pubic tubercle and the ASIS

131
Q

What is the difference between the mid-inguinal point and the mid-point of the inguinal ligament

A

mid-inguinal point = 1/2 way between symphysis pubis and ASIS = location of femoral pulse
Mid-point of inguinal ligament = 1/2 way between pubic tubercle + ASIS = location of deep inguinal ring

132
Q

What is the process behind dupuytrens contracture

A

Thickening of the palmar aponeurosis
Doesn’t involve flexor tendons but prevents them working properly.
Is not painful

133
Q

Risk factors for dupuytrens contracture

A 
Family hx
Alcohol excess
Cigarette smoking
Diabetes
Peyronie's disease 
Phenytoin

General Medicine (25 decks)

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