General surgery Flashcards
(145 cards)
1
Q
How long should patients avoid food or feeds and avoid any clear fluids before surgery? (2)
A
- 6 hours no food or feeds
- 2 hours no clear fluids
2
Q
What term refers to fluid output that is difficult to measure, such as via respiration, stools, burns and sweat? (1)
A
Insensible fluid losses
3
Q
What arteries supply the foregut, midgut and hindgut? (3)
A
- Foregut: coeliac artery
- Midgut: superior mesenteric artery
- Hindgut: inferior mesenteric artery
4
Q
What procedure involves removing the entire length of the large intestine? (1)
A
Panproctocolectomy
5
Q
What organ does pancreatic cancer usually spread to first? (1)
A
Liver
6
Q
What is the approximate daily maintenance requirements of glucose?
A
50-100g
7
Q
What are the two types of volvulus? (2)
A
- Sigmoid volvulus (more common)
- Caecal volvulus
8
Q
What complication can SGLT2 inhibitors (e.g., dapagliflozin) cause in dehydrated or acutely unwell patients? (1)
A
DKA
9
Q
Give two key complications of excessive normal 0.9% saline? (2)
A
- Hypernatraemia
- Hyperchloraemic metabolic acidosis
10
Q
What are the key causes of acute right upper quadrant pain? (3)
A
- Biliary colic
- Acute cholecystitis
- Acute cholangitis
11
Q
How long should the combined contraceptive pill be stopped prior to surgery? (1)
A
4 weeks
12
Q
What specific sign is suggestive of acute cholecystitis? (1)
A
Murphy’s sign
13
Q
What tumour marker may be used for monitoring bowel cancer during and after treatment? (1)
A
Carcinoembryonic antigen (CEA)
14
Q
What is a Gridiron incision used for? (1)
A
Open appendicetomy
15
Q
What blood test is used in females of child bearing age presenting with abdominal pain? Why? (2)
A
- Serum human chorionic gonadotropin (hCG)
- To exclude pregnancy
16
Q
What term describes when rapidly releasing pressure on the abdomen causes worse pain than the pressure itself? (1)
A
Rebound tenderness
17
Q
Where do cholangiocarcinomas originate? (1)
What is the typical histological type? (1)
A
- Bile ducts
- Adenocarcinoma
18
Q
What is the usual definitive management of acute appendicitis? (1)
A
Laparoscopic appendicectomy
19
Q
What condition refers to pus in the gallbladder? (1)
A
Gallbladder empyema
20
Q
What is the gold standard investigation for suspected bowel cancer? (1)
A
Colonoscopy
21
Q
What needs monitoring daily for patients on maintenance fluids? (3)
A
- Fluid status
- Fluid balance chart
- U&E blood tests
22
Q
What complication is metformin associated with in the perioperative period? (1)
A
Lactic acidosis
23
Q
What incisions may be used for a liver transplant? (2)
A
- “Rooftop” incision
- “Mercedes Benz” incision
24
Q
When would you avoid using ondansetron as a treatment for post-operative nausea and vomiting? (1)
A
Patients at risk of prolonged QT interval
25
What proportion of total body fluids are in the intracellular and extracellular spaces? (2)
1. 2/3 intracellular
2. 1/3 extracellular
26
What type of hernia occurs between the lateral border of the rectus abdominis muscle and the linea semilunaris? (1)
Spigelian hernia
27
What is the name for the mucosal folds that form lines extending the full width of the bowel? (1)
Where are they found? (1)
1. Valvulae conniventes
2. Small bowel
28
What three types of cancer are more prevalent than bowel cancer in the UK? (3)
1. Breast
2. Prostate
3. Lung
29
What does cholelithiasis mean? (1)
Gallstones are present
30
What is the name for when only part of the bowel wall and lumen herniate through a defect in the abdominal wall, with the other side of that section of the bowel remaining within the peritoneal cavity? (1)
Richter's hernia
31
Where is the deep inguinal ring located? (1)
The mid-way point from the ASIS to the pubic tubercle
32
What is the concentration of sodium in normal 0.9% saline? (1)
154 mmol/L
33
Using a clock face to describe the position, where are haemorrhoids usually located? (3)
1. 3 o'clock
2. 7 o'clock
3. 11 o'clock
34
What operation describes removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy? (1)
Hartmann's procedure
35
What blood tests specifically indicate acute inflammation of the pancreas? (2)
1. Amylase
2. Lipase
36
What term describes a situation where there are two points of obstruction along the bowel; meaning that there is a middle section sandwiched between two points of obstruction? (1)
When might this occur with a single point of obstruction in the large bowel? (1)
1. Closed-loop obstruction
2. When there is a competent ileocaecal valve
37
What pre-operative investigation is required specifically in diabetic patients? (1)
HbA1c in the last 3 months
38
What law states that a palpable gallbladder along with jaundice is unlikely to be gallstones? (1)
Courvoisier's law
39
Why do patients need a post-operative full blood count? (1)
To assess for anaemia secondary to blood loss
40
What procedure can be used to assess the biliary system and treat gallstones stuck in the ducts? (1)
Endoscopic retrograde cholangio-pancreatography (ERCP)
41
What are the key risk factors for cholangiocarcinoma? (2)
1. Primary sclerosing cholangitis
2. Liver flukes
42
What test is used in the bowel cancer screening program in England? (1)
Faecal immunochemical test (FIT)
43
What investigation and finding can be used to assess for intra-abdominal perforation? (2)
1. Erect CXR
2. Air under the diaphragm
44
What region does a direct inguinal hernia protrude through? (1)
Hesselbach's triangle/inguinal triangle
45
What is the first-line investigation in patients with symptoms of gallstone disease? (1)
Ultrasound
46
What system classifies the physical status of the patient for anaesthesia? (1)
American Society of Anesthesiologists (ASA) grading system
47
What is the characteristic presenting symptom of acute cholecystitis? (1)
RUQ pain
48
What can be seen on a venous blood gas in acute mesenteric ischaemia? (2)
1. Metabolic acidosis
2. Raised lactate
49
Where on the abdomen are you most likely to find an ileostomy? (1)
RIF
50
What is formed from a section of small bowel in patients with a urostomy? (1)
Ileal conduit
51
52
What are the contents of the femoral triangle from lateral to medial across the top of the thigh? (4)
1. Femoral nerve
2. Femoral artery
3. Femoral vein
4. Femoral canal
53
What scoring system is used to assess the severity of pancreatitis? (1)
Glasgow score
54
What are type 1 and type 2 hiatus hernias? (2)
Type 1: sliding
Type 2: rolling
55
What pattern of enzymes will be seen on liver function tests in patients with cholestasis? (2)
1. ALT and AST can raise slightly
2. With a higher raise in ALP "obstructive pattern"
56
What tumour suppressor gene is malfunctioning in FAP? (1)
Adenomatous polyposis coli (APC)
57
What space is full of fluid with ascites? (1)
Peritoneal cavity
58
Describe 2nd and 3rd degree haemorrhoids. (2)
1. 2nd degree: prolapse when straining and return on relaxing
2. 3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
59
What is the definition of a fistula? (2)
1. An abnormal connection
2. Between two epithelial surfaces
60
What sign refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic cancer? (1)
Trousseau's sign of malignancy
61
What is the inheritance pattern of familial adenomatous polyposis (FAP)? (1)
Autosomal dominant
62
What histological type are the majority of pancreatic cancers? (1)
Adenocarcinoma
63
What type of vomiting is suggestive of bowel obstruction? (1)
Green bilious vomiting
64
What common type of medication increases the risk of diverticulosis and diverticular haemorrhage? (1)
NSAIDS
65
What two incisions may be used for a caesarean section? (2)
1. Pfannenstiel (curved)
2. Joel-Cohen (straight)
66
What is the approximate daily maintenance requirements of water? (1)
25-30ml/kg/day
67
What are the three main causes of bowel obstruction? (3)
1. Adhesions
2. Hernias
3. Tumours
68
What does a raised serum lactate suggest in a patient with bowel obstruction? (1)
Bowel ischaemia
69
What cardiac condition is a key risk factor for acute mesenteric ischaemia? (1)
AF
70
What is the descriptive name for Lynch syndrome? (1)
What is the inheritance pattern? (1)
1. Hereditary non polyposis colorectal cancer (HNPCC)
2. Autosomal dominant
71
What are the three top causes of pancreatitis? (3)
1. Gallstones
2. Alcohol
3. Post ERCP
72
What are the two types of hernia repair? (2)
1. Tension free repair
2. Tension repair
73
What dietary changes do the NICE clinical knowledge summaries suggest in the management of uncomplicated acute diverticulitis? (1)
Only consume clear fluids (avoiding solid food) until symptoms improve
74
What are the three key complications of hernias? (3)
1. Incarceration
2. Obstruction
3. Strangulation
75
What term is used to describe when a portion of the lung collapses due to under-ventilation? (1)
Atelectasis
76
What structure does the common bile duct and pancreatic duct drain into before it opens into the duodenum? (1)
What is the name for the ring of muscle that surrounds this structure? (1)
1. Ampulla of Vater
2. Sphincter of Oddi
77
What procedure involves inserting a drain into the gallbladder? (1)
Cholecystostomy
78
What is the “classic triad” of chronic mesenteric ischaemia? (3)
1. Central colicky pain after eating
2. Weight loss
3. Abdominal bruit on auscultation
79
What are most gallstones made of? (1)
Cholesterol
80
What is the name for the pouches formed by the muscles in the bowel wall, which form lines that do not extend the full width of the bowel on an abdominal x-ray? (1)
Where are they found? (1)
1. Haustra
2. Large bowel
81
What incision is used for a renal transplant? (1)
Hockey-stick incision
82
What section of the GI tract is included in the midgut? (2)
1. From the distal part of the duodenum
2. to the first half of the transverse colon
83
Name the process of meeting a patient’s full nutritional needs via an intravenous infusion? (1)
Total parenteral nutrition (TPN)
84
What refers to a widening of the linea alba, forming a larger gap between the rectus muscles? (1)
Diastasis recti/rectus diastasis/recti divarication
85
What is the characteristic symptom of gallstones? (1)
Biliary colic
86
What incision is typically used in an open cholecystectomy? (1)
A right subcostal "Kocher" incision
87
What is used to reverse the effects of warfarin? (1)
Vitamin K
88
What are the three extracellular spaces? (3)
1. Intravascular
2. Interstitial
3. "Third" space
89
What do pale stools and dark urine indicate? (1)
What blood test is likely to be deranged? (1)
1. Obstruction to flow within the biliary system
2. Raised bilirubin
90
What are the key causes of acute unilateral testicular pain? (2)
1. Testicular torsion
2. Epididymo-orchitis
91
What pre-operative investigation is required routinely in all patients over 65 years (other than blood tests)? (1)
ECG
92
What is the name of the tender point on examination in appendicitis? (1)
Where is this located? (1)
1. Mcburney's point
2. One third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus
93
What procedure involves fitting a tight band around the base of a haemorrhoid to cut off the blood supply? (1)
Rubber band ligation
94
What investigation of the biliary system involves an MRI scan? (1)
MRCP
95
What travels through the inguinal canal in males?
Spermatic cord and its contents
96
What is the name of the condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops? (1)
When are you most likely to come across this condition? (1)
1. Ileus
2. Following abdominal surgery
97
What blood results may be deranged in acute diverticulitis? (2)
1. Raised inflammatory markers
2. Raised WBC
98
What are the upper limits of the normal diameter of the small bowel, colon and caecum on an abdominal x-ray? (3)
1. Small bowel 3cm
2. Colon 6cm
3. Caecum 9cm
99
Where on the abdomen are you most likely to find a colostomy? (1)
LIF
100
What scoring system can be used to calculate the probability of appendicitis? (1)
Alvarado score
101
What are haemorrhoids? (1)
Enlargement of the anal vascular cushions
102
What legal status can be given to a nominated person to allow them to make decisions on a patient’s behalf if they lack capacity? (1)
LPA
103
What is the approximate daily maintenance requirements of sodium, potassium and chloride? (1)
1mmol/kg/day
104
What term describes the separation of a surgical wound, notably after abdominal surgery? (1)
Wound dehiscence
105
What is Charcot’s triad and what does it indicate? (4)
1. RUQ pain
2. Fever
3. Jaundice (raised bilirubin)
4. Indicating acue cholangitis
106
What oral antibiotic do the NICE clinical knowledge summaries suggest for uncomplicated acute diverticulitis? (1)
Co-amoxiclav
107
What do guarding and rigidity on examination suggest? (1)
Peritonitis
108
What enzyme often needs replacing in chronic pancreatitis? (1)
Lipase
109
What name is given to a pancreaticoduodenectomy procedure, used to treat early pancreatic cancer? (1)
Whipple procedure
110
What operation involves removal of the head of the pancreas, duodenum, gallbladder and bile duct? (1)
Whipple procedure/pancreaticoduodenectomy
111
What part of the colon is removed in a Hartmann’s procedure? (1)
Rectosigmoid
112
What are the four memorable risk factors for gallstones? (4)
1. Fair
2. Fat (obese)
3. Female
4. Forty
113
What type of bowel sound may be heard in early obstruction? (1)
Tinkling
114
What characteristic sign may be seen on abdominal x-ray in volvulus? (1)
With which type does this occur? (1)
1. Coffee bean sign
2. Sigmoid volvulus
115
What is the name of the condition where the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa? (1)
Appendix mass
116
What are the contraindications to NSAIDs? (4)
1. Asthma
2. Renal impairment
3. Heart disease
4. Stomach ulcers
117
What type of suture technique involves a single absorbable suture side to side just below the skin to pull the skin edges together? (1)
Subcuticular
118
What underlying condition is associated with spontaneous bacterial peritonitis? (1)
Ascites in patients with liver disease
119
What term refers to the osmotic pressure gradient between two fluids across a membrane? (1)
Tonicity
120
What sign refers to pain extending from the inner thigh to the knee when the hip is internally rotated? (1)
What causes the pain? (1)
What type of hernia might be implicated? (1)
1. Howship-Romberg sign
2. Compression of the obturator nerve
3. Obturator hernia
121
What condition involves inflammation of the bile ducts? (1)
Cholangitis
122
What blood test gives an indication of the synthetic function of the liver and the patient's clotting function? (1)
INR
123
What hormone is secreted in response to fat entering the digestive system, causing contraction of the gallbladder? (1)
Where is it secreted from? (1)
1. Cholecystokinin (CCK)
2. Duodenum
124
What surgical procedure may be used to treat a hiatus hernia? (1)
Laparoscopic fundoplication
125
What four criteria are used to assess a patient’s capacity to make a decision? (4)
1. Understand
2. Retain
3. Weigh up the pros and cons
4. Communicate the decision
126
What tumour marker is most relevant in pancreatic cancer? (1)
CA 19-9 (carbohydrate antigen)
127
What incision is used for an open cholecystectomy? (1)
Kocher incision
128
What is the name for when two different loops of bowel are contained within a hernia? (1)
Maydl's hernia
129
What are common reasons for a patient to be on a fluid restriction? (3)
1. Heart failure
2. Renal failure
3. Hyponatraemia
130
Which hernia is superior and medial to the pubic tubercle? (1)
Inguinal
131
Are strangulated or incarcerated hernias painful? (1)
Strangulated
132
What is Rovsing's sign? (1)
In appendicitis palpation of the left iliac fossa causes pain in the right iliac fossa?
133
What is Cullen's sign? (1)
Severe acute peri-umbilical bruising in the setting of acute pancreatitis?
134
What is Boas' sign?
In acute cholecystitis there is hyperaesthesia beneath the right scapula.
135
What is required prior to appendicectomy? (1)
Prophylactic IV antibiotics
136
What is the characteristic pain in appendicitis? (1)
Initially central and then right lower abdomen (RIF)
137
Which hernia is inferior and lateral to the pubic tubercle? (1)
Femoral
138
What triad suggests cardiac tamponade? (3)
Beck's triad:
1. Hypotension
2. Muffled heart sounds
3. Raised JVP
139
What is the definitive investigation for small bowel obstruction?
CT abdomen
140
Where is an epigastric hernia? (1)
Lump in the midline between the umbilicus and the xiphisternum
141
What is Psoas stretch sign? (1)
Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended.
142
What is Murphy's sign? (1)
In cholecystitis there is pain/catch of breath elicited on palpation of the right hypochondrium during inspiration.
143
What is the initial management of small bowel obstruction? (3)
1. NBM
2. IV fluids
3. Nasogastric tube insertion ("drip and suck")
144
How should wound dihiscence be managed prior to surgical input? (2)
1. Wound covered with saline gauze
2. Broad spectrum IV abx e.g. IV ceftriaxone and metronidazole
145
