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Flashcards in General Surgery 1 Deck (100):
1

Second investigation for pneumoperitoneum is CXR not helpful?

CT - if stable

2

Most common cause of splenic rupture?

Blunt trauma - immediately or delayed

3

Investigation for suspected bowel obstruction?

AXR

4

Ruptured AAA - which imaging should be done before surgery if possible?

CT

5

Pre-operatvie management of ruptured AAA?

Fluid resus - aim for systolic of 100 - no higher
O-ve blood until crossmatch available

6

Approximately how many units of crossmatched blood are required during a ruptured AAA repair?

10

7

Primary and secondary intention healing - which is quickest?

Primary

8

How does healing occur in secondary intention healing?

From the deeper layers by granulation tissue

9

Primary and secondary healing - edges opposed or unopposed?

Primary - opposed
Secondary - unopposed

10

Which type of healing has the worst scarring?

Secondary intention

11

4 indications for splenectomy?

Splenic injury - trauma
Splenic rupture following splenomegaly - infectious mononucleosis
Hypersplenism - hereditary spherocytosis
Neoplasm
Infection

12

What % of idiopathic thrombocytopenia purport patients are cured by a splenectomy?

70%

13

Which organisms are splenectomy patients more at risk of?

Encapsulated - neisseria meningitides, h influenza, strep pneumoniae

14

4 symptoms of post operative adhesion obstruction of the small bowel?

Colicky pain, distention, constipation, vomiting

15

Management of small bowel obstruction post op?

Fluids, NG - most resolve spontaneously

16

Indication of urgent surgery in small bowel obstruction?

Strangulation - continuous pain, decreased bowel sounds fever, tachycardia

17

Oesophageal varies are secondary to what? and what else can present with this?

Portal hypertension
Caput medusa

18

Where is a common site of atherosclerosis?

At a vessel bifurcation

19

When is the pain of intermittent claudication felt?

After walking a set distance, always the same distance

20

Why do legs with peripheral artery disease turn red when lowered during burgers test?

Because ischaemia causes vasodilation so blood rushes into the legs more than normal

21

5 stages of the fontaine classification?

I - asymptomatic vascular disease
II - Claudication >200m
III - Claudication <200m
IV - rest pain
V - gangrene or ulcers

22

How is ABPI calculated?

Ankle pressure/brachial pressure

23

Normal ABPI?

0.9-1.2

24

Claudication ABPI?

0.4-0.85 (severe <0.4) lower pressure in the ankle

25

Why might a calcified vessel give a false ABPI reading?

Because it is not compressible

26

3 types of phase on doppler?

Triphasic - normal
Biphasic - disease
Monophasic - severe disease

27

Benefit of duplex doppler?

Assesses the speed of flow - blood will speed up and slow down depending on occlusions

28

Definition of critical limb ischaemia?

Rest pain of 2 week and tissue loss - pain particularly when lying down with feet up

29

What is acute limb ischaemia?

Thrombosis at the site of existing disease

30

6 P's of acute limb ischaemia?

Pain
Pulselessness
Palor
Parasthesia
Paralysis
Perishing cold

31

What % of amputations need to be converted to higher amputations due to non healing?

10-15%

32

Nerve at risk of damage during carotid endarterectomy?

Hypoglossal

33

Two drugs to be started in peripheral vascular disease?

Statin (regardless of cholesterol)
Clopidogrel

34

What intervention should be performed first in PVD?

Exercise training

35

Name 3 surgical options in the management of PVD?

Angioplasty
Stenting
Bypass surgery

36

When is AAA screening performed?

At 65

37

What diameter or aorta is classed as an aneurysm?

3cm

38

At what size should an aneurysm be surgically repaired?

>5.5cm

39

What type of ulcers are diabetic patients with neuropathy more likely to get?

Neuropathic ulcers - at pressure points

40

What is a Marjolines ulcer?

A squamous cell carcinoma at the site of previous injury

41

What type of ulcer is associated with IBD?

Pyroderma gangrenosum

42

What is the imaging of choice for osteomyelitis?

MRI

43

What is the most common vessel used in CABG?

left internal mammary

44

What might cause a groin swelling after vascular surgery?

Femoral artery aneurysm

45

Name 1 sign of a dissected thoracic aneurysm?

Different BP's on each arm

46

Which vessels are affected in burgers disease?

Small and medium sized arteries, often tibial and radial

47

Name 1 non vascular examination to be done in the case of varicose veins?

Abdominal examination - can be caused by abdominal mass e.g. pregnancy

48

Which nerve palsy is the most common in cavernous venous sinus thrombosis?

6th nerve palsy

49

What causes hyper pigmentation in a venous ulcer?

haemosidirin

50

Where is the most common site for a AAA?

Infra renal

51

What are the two options in repairing a AAA?

Open repair or EVAR
Open is higher risk - but better for younger fitter patients
EVAR - better for older patients with short life expectancy

52

What causes varicose veins?

Failure of the venous valves causes back flow in to the superficial venous system and high venous pressure

53

What are the 3 options of treatment for varicose veins?

Compression stockings
Sclerotherapy
Surgery

54

What two points does the inguinal canal run between?

Deo inguinal ring and superficial ring

55

What is the contents of the inguinal canal (male)?

3 arteries - vas deferens, testicular, cermasteric
3 fascial layers
3 others - pampiniform plexus, vas deferens, lymphatics
3 nerves - genital, sympathetic, ilioinguinal

56

What is in the inguinal canal (female)?

Ilioinguinal nerve and round ligament

57

What are the borders of the inguinal canal?

Superior -internal oblique, tranversus abdominus
Anterior - 2 aponeurosis - internal and external oblique
Inferior - 2 ligaments - inguinal and lacunar
Posterior (2T's) - transversals fascia, conjoint tendon

58

Where does the inguinal ligament attach?

ASIS and pubic tubercle

59

What two factors are needed to form a hernia?

Weakness and an increase in pressure

60

What happens in a strangulated hernia?

There is a compromise to the blood supply

61

What happens in an incarcerated hernia?

The hernia is stuck in its sac

62

Name 3 risk factors for inguinal hernias?

Chronic cough
Overweight
Increased age
Male gender
Collagen disorders

63

What forms the sac of the hernia?

A protrusion of peritoneum

64

Where are inguinal hernias located anatomically?

Above the level of the pubic tubercle

65

Where are indirect and direct inguinal hernias in relation to the inferior epigastric artery?

Indirect - lateral
Direct - medial

66

Do indirect or direct hernias reach the scrotum?

Indirect - possible
Direct - rarely

67

Indirect and direct hernias, most common in which age groups?

Direct - older patients
Indirect - younger, may be congenital

68

Which type of hernia travels along the inguinal canal?

Indirect inguinal hernia

69

Which type of hernia pushes from behind the inguinal canal?

Direct inguinal hernia

70

What are the borders of the femoral Canal?

Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament

71

Where are femoral hernias anatomically?

Below and lateral to the pubic tubercle

72

Which gender is more at risk of femoral hernias?

Female

73

Why should femoral hernias be fixed more quickly?

Higher risk of complications, risk of small bowel obstruction

74

What is a herniorraphy?

Surgical repair of abdominal wall with a suture

75

What is herniotomy?

Excision of hernial sac after reducing contents

76

If there is a recurrence of a hernia how should it be fixed?

in the opposite way from original repair

77

Which nerve is at risk of damage during inguinal hernia repair?

Ilioinguinal

78

What are the categories of surgical complications?

Local - immediate, early, late
Systemic - immediate, early, late

79

What is a Madyl's hernia?

W shaped hernia, patient may be very unwell

80

What is a differential diagnosis for groin swelling in an IVDU?

Pseudoaneurysm

81

What adjuvant treatment is given after all WLE's in breast cancer?

Radiotherapy

82

When is hormonal therapy given in breast in cancer?

If oestrogen receptor positive +ve

83

What 2 drugs are used at hormonal therapy in breast cancer?

Pre and peri menopausal - Tamoxifen
Post menopausal - Aromatase inhibitors e.g. anastrozole

84

Name 3 side effects of hormonal therapy in breast cancer?

Endometrial cancer risk
VTE
Menopausal symptoms

85

When is biological therapy used in breast cancer?

When HER2 positive

86

Name 1 biological drug used in breast cancer?

Tastuzumab

87

What is CA125 a marker of?

Ovarian cancer

88

What is CA 19-9 a marker of?

Pancreatic cancer

89

What is Ca 15-3 a marker of?

Breast cancer

90

What is AFP a marker of?

HCC and teratoma

91

What is CEA a marker of?

Colorectal carcinoma

92

What is Thumb printing on AXR suggestive of?

Mesenteric ischaemia

93

What is ascending colangitis?

Bacterial infection of the biliary tree

94

What is the most common cause of extra dural haematoma?

Trauma

95

Name 2 causes of subdural haematoma?

Old age
Alcoholism
Anti coagulation

96

When should you do a CT in a patient with head injury while on warfarin?

Within 8 hours - if no obvious signs of bleed

97

What is the most common type of oesophageal cancer and what is associated with?

Adenocarcinoma - GORD and Barrets
Used to be squamous - smoking

98

What topical treatment is used for anal fissures?

GTN

99

Where does a marjolin ulcer arise from?

Site of previous injury

100

What type of cancer is pancreatic?

Adenocarcinoma