Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Periop > Exam Qs > Flashcards

Exam Qs Flashcards

(51 cards)

Start Studying
1
Q

Risk factors for Biliary colic

A

5Fs

Fair, fat, forty, fertile, family hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of biliary colic

A
  • No inflammatory response
    • Sudden pain, dull, colicky (waxes and wanes, not true colick)
    • RUQ focus
    • N&V
    • Fatty foods make worse
    • Settles with analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations for biliary colic

A
  • FBC and CRP for inflammation
    • U&Es - assess for dehydration
    • LFTs - damage to liver can occur

Amylase - damage to pancreas can occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Imaging for biliary colic

A

Use USS AP. Look for:
• Presence of gallstones
• Gallbladder wall thickness - thicker = inflamed
• Bile duct dilatation

Can also use a CT scan with higher sensitivity. MRCP is gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of biliary colic

A
  • Analgesia eg morphine.
    • Elective cholecystectomy can avoid future recurrence with worse consequences

Offer lifestyle advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is courvisiers law

A

Courvoisier’s Law - If gallbladder palpable and jaundice, it’s a cancer of biliary tree or pancreas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of pancreatic cancer

A
  • Pain in abdomen radiating to back
    • Obstructive Jaundice
    • Steatorrhoea - pale and floating
    • Weight loss, cachexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs of pancreatic cancer

A

• Abdo mass palpable

Jaundiced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations of pnacreatic cancer

A
  • FBC - anemia of chronic disease
    • Pancreatic amylase
    • LFTs - Raised ALP, gamma-GT, bilirubin (obstructive jaundice)
    • CA19-9 tumour marker for pancreatic cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Imaging for pancreatic cancer and use

A
  • Abdo USS - Pancreatic mass, dilated biliary tree
    • CT scan - disease staging.
    • Endoscopic USS used for fine needle aspiration biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of pancreatic cancer

A 
• Surgery - Whipples:
		○ 40% mortality
		○ Due to risk of forming pancreatic fistula
	• Chemotherapy:
		○ After surgery use 5-FU
	• Palliative Care:

Biliary stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rectal carcinoma symptoms

A
  • Pain and fresh bleeding
    • Mucus and discharge from anus
    • Palpable mass
    • Pruritis
    • Tenesmus and fecal incontinence possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations for rectal carcinoma

A
  • FBCs - anemia of chronic disease
    • DRE
    • Biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Imaging for rectal carcinoma

A
  • USS guided FNA of inguinal lymph nodes
    • CT-thorax-abdo-pelvis for mets
    • MRI pelvis - local invasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of rectal carcinoma

A

• Chemo and radiotherapy:
○ 5-FU and external beam radiotherapy used
• Surgery:
○ After failure of chemoradiotherapy or early T1N0 carcinomas
○ Abdominoperineal resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of hemorrhoids

A
  • Painless fresh bleeding
    • Palpable mass
    • Pruritic
    • Soiling - mucus or impaired continence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

RFs of hemorrhoids

A
  • Chronic constipation
    • Age
    • Raised intra-abdo pressure eg pregnancy, chronic cough, ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Classification of hemorrhoids

A
  1. 1st degree - in rectum
    1. 2nd degree - prolapse through anus on defecation but spontaneously reduce
    2. 3rd - degree - prolapse on defecation but require digital reduction

4th degree - persistently prolapsed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations for hemorrhoids

A
  • Proctoscopy
    • FBC - anemia due to bleeding

Colonoscopy to exclude malginancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of hemorrhoids

A

• Conservative:
○ 1st and 2nd degree treated with rubber band ligation
• Surgical:
○ Hemorrhoidectomy if symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Endovascular repair vs open repair - differences

Study These Flashcards
A
  • Long term is same
    • EV better short term - decreased hospital stay and 30 day mortality. But higher rate of reintervention and aneurysm rupture
    • Young fit pts open repair is better
22
Q

Acute limb ischemia etiology

Study These Flashcards
A

3 main causes:
• Thrombosis in situ
• Embolism
• Trauma inc compartment syndrome

23
Q

acute limb ischemia management - initially, conservatively, surgically, and long term

Study These Flashcards
A

Initial:
• Oxygen
• IV access
• Heparin

Conservative:
• LMWH

Surgical:
• Bypass surgery if completely occluded
• Angioplasty and stenting
• If limb non salvagable, amputate.

Long term:
• Lifestyle changes
• Low dose aspirin or clopidogrel
• Treat predisposing factors eg AF.

24
Q

Clinical features of acute limb ischemia

Study These Flashcards
A 
6 Ps:
	• Pain
	• Pulseless
	• Perishingly cold
	• Parasthesia
	• Paralysis
	• Pallor

Sudden onset

25
Investigations for acute limb ischemia
* Bloods - FBC, clotting, U&E (electrolyte imbalances), serum lactate (ischemia), thrombophilia screen * ECG - AF * Doppler USS both limbs * Consider CT angiography
26
What is leriche syndrome?
* PAD affecting aortic bifurcation. | * Buttock or thigh pain with erectile dysfunction
27
RFs for chronic limb ischemia
* Smoking * Diabetes * Hypertension * Hyperlipidemia * Age Family Hx
28
Staging and symptoms for chronic limb ischemia
Stage I Asymptomatic Stage II Intermittent claudication Stage III Ischaemic rest pain Stage IV Ulceration or gangrene, or both
29
3 definitions of chronic limb ischemia
* Ischemic rest pain for 2wks+, needing opiate analgesia * Presence of gangrene * ABPI <0.5
30
2 Differentials for chronic limb ischemia
* Spinal stenosis - symptoms relieved by sitting rather than sitting * Acute limb ischemia
31
Investigations for chronic limb ischemia
``` • ABPI - ○ <0.9 mild. <0.8 moderate. <0.5 severe. ○ >1.2 - calcification and hardening of arteries can cause falsely high ABPI • Doppler USS • CVS risk assessment: ○ Blood pressure ○ Blood glucose ○ Lipid profile ○ ECG ``` Buerger's test • Raise pts legs while supine • They go pale until theyre lowered again • Angle of <20 degs indicates severe ischemia
32
Management of chronic limb ischemia
``` Medically: • Lifestyle advice • Statins • Aspirin or clopidogrel • Optimise diabetes control ``` Surgically: • Angioplasty • Bypass grafting • Amputation
33
D dimer reference ranges
<230 ng/ml - negative test
34
Admitting t1 diabetics for surgery
1. Need to be first on morning list and admitted night before op 2. Night before - reduce subcut insulin dose by 1/3rd. 3. Omit morning insulin and use IV insulin infusion 4. Prescribe 5% dextrose at a rate of 125ml/hr and check BM every 2 hrs Continue until they can eat and drink. Then give SC insulin 20 mins before meal and stop their IV infusion 45 minutes after they’ve eaten.
35
Admitting t2dm for surgery
• Diet controlled, no changes needed. • If on oral hypoglycemics: a. Stop metformin on morning of surgery, others stopped night before b. Put on IV insulin with 5% dextrose and commence as with type 1.
36
Whyd does post op hypotension occur
• Occurs due to drugs, epidurals, or hypovolemia
37
Why can hypovolemia occur during surgery
○ Blood loss ○ Sepsis ○ GI losses - diarrhoea, vomiting ○ Low albumin
38
Why can epidurals cause hyp0otension and treatment
○ Block sympathetic nerve fibres - decreasing systemic resistance ○ Pooling of blood in peripheries mimicks hypovolemia ○ Treatment - elevate legs only, small bolus fluid
39
Treatment for post op hypotension
○ Bloods if indicated | ○ Fluid boluses 250-500 ml
40
How do you treat hyperkalaemia
``` • Stabilise myocardium ○ IV calcium gluconate • Reduce serum K ○ Salbutamol nebs and insulin with dextrose • Reduce total body K ○ Oral calcium resonium ```
41
How do you treat hypokalaemia
* Treat cause | * IV K replacement
42
State the ASA grading system and % mortality resulting
ASA Grade Criteria Absolute mortality (%) I Normal, healthy 0.1 II Mild systemic disease 0.2 III Severe systemic illness, a functional limitation of their activity 1.8 IV Severe systemic illness, constant threat to life 7.8 V Moribund 9.4
43
What is a hartmanns procedure. whats it used for
* Rectosigmoid resection with formation of an end colostomy and closure of rectal stump * Anastomosis with reversal of colostomy may be possible later * Used to treat obstructive cancers in rectosigmoid
44
Symptoms of adhesions?
* Colicky pain * Constipation * Fecal vomiting Abdo distension
45
Investigations and imaging for adhesions?
* Bloods - FBC, U&E, Clotting, group and save, Crossmatch * ABG - serum lactate for ischemia signs * Imaging - Abdo Xray, abdo CT
46
Managament of adhesions?
• Conservative: ○ Tube decompression - tube passed into stomach and allows built up pressure to be released ○ Pt to be NBM and given IV fluids and analgesia • Surgical: Laparoscopic adhesiolysis
47
Where can epidural and spinal be done?
epidural - anywhere | spinal - below L2
48
Abx prophylaxis given for GI - open without sepsis, intra abdo with sepsis, laparoscopic
* Open without sepsis - Gentamycin IV + metronidazole 500g * Intra-abdo with sepsis - piperacillin-tazobactam 4.5g TDS IV and gentamicin IV * Laparoscopic surgery - co-amox 1.2g IV
49
Abx prophylaxis for vascular
• Fluclox 1g IV
50
Prophylaxis for VTE
* LMWH - Dalteparin | * TED stockings - if ABPI is >0.9 and no history of arterial disease
51
What is an ivor lewis procedure?
esophagectomy

Periop (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions