Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Finals > General surgery > Flashcards

General surgery Flashcards

(111 cards)

Start Studying
1
Q

When are the 3 times the WHO surgical safety checklist is completed?

A

Before the induction of anaesthesia
Before the first skin incision
Before the patient leaves theatre

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

what are some features of the WHO surgical safety checklist?

A

Patient identity
Allergies
Operation
Risk of bleeding
Introductions of all team members
Anticipated critical events
Counting the number of sponges and needles to ensure nothing is left inside the patient

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

what are aspects of a history that are important in a pre-operative assessment?

A

Past medical problems
Previous surgery
Previous adverse responses to anaesthesia
Medications
Allergies
Smoking
Alcohol use
Pregnancy

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

what are the ASA grades?

A

ASA I – normal healthy patient
ASA II – mild systemic disease
ASA III – severe systemic disease
ASA IV – severe systemic disease that constantly threatens life
ASA V – “moribund” and expected to die without the operation
ASA VI – declared brain-dead and undergoing an organ donation operation
E – this is used for emergency operations

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

what is a group and save?

A

sending off a sample of the patient’s blood to establish their blood group. The sample is saved in case they require blood to be matched to them for a blood transfusion.

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

what is a crossmatch?

A

process of actually taking a unit or more of blood off the shelf and assigning it to the patient in case they need it quickly. This is done where there is a higher probability that they will require blood products

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

How long should patients bet fasted of food and drink for before surgery?

A

6 hours of no food or feeds before operation
2 hours no clear fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what should you do to patients on Warfarin before surgery?

A

Stop it
monitor INR
can use treatment dose LMWH or unfractionated heparin infusion to bridge gap between stopping warfarin and surgery in high risk patients

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

What should you do to patients on DOACs before surgery?

A

Stop it 24-72hrs before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when should COCP an oestrogen containing HRT be stopped before surgery and why?

A

4 weeks
reduce risk of VTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the management of patients on long-term corticosteroids before/after surgery?

A

Additional IV hydrocortisone at induction and for the immediate postoperative period (e.g., first 24 hours)
Doubling of their normal dose once they are eating and drinking for 24 – 72 hours depending on the operation

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

what should be adjusted in patients on sulfonylureas before surgery?

A

can cause hypoglycaemia and are omitted until the patient is eating and drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the management of patients on insulin undergoing surgery?

A

Continue a lower dose (BNF recommends 80%) of their long-acting insulin
Stop short-acting insulin whilst fasting or not eating, until eating and drinking again
Have a variable rate insulin infusion alongside a glucose, sodium chloride and potassium infusion (“sliding-scale”) to carefully control their insulin, glucose and potassium balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the 4 different consent forms?

A

Consent Form 1: Patient consenting to a procedure
Consent Form 2: Parental consent on behalf of a child
Consent Form 3: Where the patient won’t have their consciousness impaired (e.g., a breast biopsy)
Consent Form 4: Where the patient lacks capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adequate analgesia in the post-operative period is important to encourage the patient to:

A

Mobilise
Ventilate their lungs fully (reducing the risk of chest infections and atelectasis)
Have an adequate oral intake

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

what are risk factors for post-operative nausea and vomiting?

A

Female
History of motion sickness or previous PONV
Non-smoker
Use of postoperative opiates
Younger age
Use of volatile anaesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

name 3 prophylactic antiemetics that may be prescribed for PONV and their contraindications

A

Ondansetron (5HT3 receptor antagonist) – avoided in patients at risk of prolonged QT interval
Dexamethasone (corticosteroid) – used with caution in diabetic or immunocompromised patients
Cyclizine (histamine (H1) receptor antagonist) – caution with heart failure and elderly patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name 5 post-operative complications

A

Anaemia
Atelectasis
Infections
Wound dehiscence
Ileus
Haemorrhage
Deep vein thrombosis and pulmonary embolism
Shock due to hypovolaemia (blood loss), sepsis or heart failure
Arrhythmias
Acute coronary syndrome and cerebrovascular accident
Acute kidney injury
Urinary retention
Delirium

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

what is the management of anaemia post-op?

A

Hb under 100 g/l – start oral iron (e.g., ferrous sulphate 200mg three times daily for three months)
Hb under 70-80 g/l – blood transfusion in addition to oral iron

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

what are possible third spaces?

A

Peritoneal cavity (forming ascites)
Pleural cavity (forming pleural effusions)
Pericardial cavity (forming a pericardial effusion)
Joints (forming joint effusions)

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

what are some sources of fluid output?

A

Urine output
Bowel or stoma output (particularly diarrhoea)
Vomit or stomach aspiration
Drain output
Bleeding
Sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are some signs of hypovolaemia?

A

Hypotension (systolic < 100 mmHg)
Tachycardia (heart rate > 90)
Capillary refill time > 2 seconds
Cold peripheries
Raised respiratory rate
Dry mucous membranes
Reduced skin turgor
Reduced urine output
Sunken eyes
Reduced body weight from baseline
Feeling thirsty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are some signs of fluid overload?

A

Peripheral oedema
Pulmonary oedema
Raised JVP
Increased body weight from baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the 3 main indications for IV fluids?

A

Resuscitation (e.g., sepsis or hypotension)
Replacement (e.g., vomiting and diarrhoea)
Maintenance (e.g., nil by mouth due to bowel obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Name 3 crystalloid fluids?
0.9% sodium chloride 5% dextrose 0.18% sodium chloride in 4% glucose Hartmann’s solution
26
how much sodium is in 1L of saline?
154 mmol
27
what volume over what time should resuscitation fluids be given?
500 ml fluid bolus over 15 minutes (“stat”) Repeat boluses of 250 – 500 mls of fluid if required, each time followed by a reassessment Seek expert help if the patient is not responding, particularly after 2 litres of fluid
28
what are the approximate requirements of maintenance IV fluids?
25 – 30 ml / kg / day of water 1 mmol / kg / day of sodium, potassium and chloride 50 – 100 g / day of glucose
29
Causes of acute generalised abdominal pain ?
Peritonitis Ruptured abdominal aortic aneurysm Intestinal obstruction Ischaemic colitis
30
causes of acute RUQ pain?
Biliary colic Acute cholecystitis Acute cholangitis
31
causes of acute epigastric pain?
Acute gastritis Peptic ulcer disease Pancreatitis Ruptured abdominal aortic aneurysm
32
causes of acute central abdominal pain?
Ruptured abdominal aortic aneurysm Intestinal obstruction Ischaemic colitis Early stages of appendicitis
33
causes of RIF pain?
Acute appendicitis Ectopic pregnancy Ruptured ovarian cyst Ovarian torsion Meckel’s diverticulitis
34
causes of acute LIF pain?
Diverticulitis Ectopic pregnancy Ruptured ovarian cyst Ovarian torsion
35
causes of acute suprapubic pain?
Lower urinary tract infection Acute urinary retention Pelvic inflammatory disease Prostatitis
36
causes of acute loin to groin pain?
Renal colic (kidney stones) Ruptured abdominal aortic aneurysm Pyelonephritis
37
causes of acute testicular pain
Testicular torsion Epididymo-orchitis
38
what are the signs of peritonitis?
Guarding Rigidity Rebound tenderness Coughing test Percussion tenderness
39
what is the initial management of an acute abdomen?
ABCDE assessment Alert seniors of unwell patients Nil by mouth if surgery may be required or they have features of bowel obstruction NG tube in cases of bowel obstruction IV fluids if required for resuscitation or maintenance IV antibiotics if infection is suspected Analgesia as required for pain management Arranging investigations as required (e.g., bloods, group and save and scans) Venous thromboembolism risk assessment and prescription if indicated Prescribing regular medication
40
where is McBurney's point?
one third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus
41
what are the classical features of appendicitis?
Central abdo pain -> RIF (McBurney's point) Anorexia N+V Low grade fever Rovsing's sign Guarding Rebound tenderness Percussion tenderness
42
what is Rovsing's sign?
palpation of the left iliac fossa causes pain in the RIF
43
What is a diagnosis of appendicitis base on?
clinical presentation and raised inflammatory markers
44
what is the main imaging option to confirm a diagnosis of appendicitis?
CT
45
name 3 key differentials for appendicitis
Ectopic pregnancy Ovarian cysts Meckel's diverticulum Mesenteric adenitis
46
what is the first line management of appendicitis?
Laparoscopic appendicectomy
47
Name 3 complications of an Appendicectomy
Bleeding, infection, pain and scars Damage to bowel, bladder or other organs Removal of a normal appendix Anaesthetic risks Venous thromboembolism
48
what are the big 3 causes of bowel obstruction?
Adhesions (small bowel) Hernias (small bowel) Malignancy (large bowel)
49
what are the main causes of intestinal adhesions?
Abdominal or pelvic surgery (particularly open surgery) Peritonitis Abdominal or pelvic infections (e.g., pelvic inflammatory disease) Endometriosis
50
what are the presenting features of bowel obstruction?
Vomiting (particularly green bilious vomiting) Abdominal distention Diffuse abdominal pain Absolute constipation and lack of flatulence “Tinkling” bowel sounds may be heard in early bowel obstruction
51
what is the key abdominal x-ray finding in bowel obstruction?
distended loops of bowel
52
53
what are some complications of bowel obstruction?
Hypovolaemic shock Bowel ischaemia Bowel perforation Sepsis
54
what is the initial management of bowel obstruction?
Nil by mouth IV fluids NG tube with free drainage
55
What is the 1st line and gold standard investigation for bowel obstruction?
1st: abdominal x-ray Gold: contrast abdominal CT
56
what would an erect chest x-ray show in intra-abdominal perforation?
air under the diaphragm
57
what are common causes of ileus?
Injury to the bowel Handling of the bowel during surgery Inflammation or infection in, or nearby, the bowel (e.g., peritonitis, appendicitis, pancreatitis or pneumonia) Electrolyte imbalance (e.g., hypokalaemia or hyponatraemia)
58
59
What are the signs and symptoms of ileus?
Vomiting (particularly green bilious vomiting) Abdominal distention Diffuse abdominal pain Absolute constipation and lack of flatulence Absent bowel sounds
60
what is the management of ileus?
Supportive care involves: Nil by mouth or limited sips of water NG tube if vomiting IV fluids to prevent dehydration and correct the electrolyte imbalances Mobilisation to helps stimulate peristalsis Total parenteral nutrition (TPN) may be required whilst waiting for the bowel to regain function
61
What is volvulus?
bowel twists around itself and the mesentery
62
what are the 2 main types of volvulus?
Sigmoid volvulus Caecal volvulus
63
Name 3 risk factors for volvulus
Neuropsychiatric disorders (e.g., Parkinson’s) Nursing home residents Chronic constipation High fibre diet Pregnancy Adhesions
64
what is the sign on abdominal xray of sigmoid volvulus?
“coffee bean” sign
65
what is the investigation to confirm a diagnosis of volvulus?
contrast CT scan
66
what are the 3 key complications of hernias ?
Incarceration Obstruction Strangulation
67
what are the 4 types of hiatus hernias
Type 1: Sliding Type 2: Rolling Type 3: Combination of sliding and rolling Type 4: Large opening with additional abdominal organs entering the thorax
68
what are the different degrees of haemorrhoids?
1st degree: no prolapse 2nd degree: prolapse when straining and return on relaxing 3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back 4th degree: prolapsed permanently
69
Name 3 risk factors for diverticulosis?
increased age Low fibre diets obesity NSAIDs
70
what are the symptoms of acute diverticulitis?
Pain and tenderness in the left iliac fossa / lower left abdomen Fever Diarrhoea Nausea and vomiting Rectal bleeding Palpable abdominal mass (if an abscess has formed) Raised inflammatory markers (e.g., CRP) and white blood cells
71
what is the management of uncomplicated diverticulitis?
Oral co-amoxiclav (at least 5 days) Analgesia (avoiding NSAIDs and opiates, if possible) Only taking clear liquids (avoiding solid food) until symptoms improve (usually 2-3 days) Follow-up within 2 days to review symptoms
72
what are complications of acute diverticulitis?
Perforation Peritonitis Peridiverticular abscess Large haemorrhage requiring blood transfusions Fistula (e.g., between the colon and the bladder or vagina) Ileus / obstruction
73
What are the three main branches of the abdominal aorta that supply the abdominal organs?
Coeliac artery Superior mesenteric artery Inferior mesenteric artery
74
what does the foregut include and what blood vessel is it supplied by?
stomach and part of the duodenum, biliary system, liver, pancreas and spleen. This is supplied by the coeliac artery.
75
what is the midgut and what is it supplied by?
distal part of the duodenum to the first half of the transverse colon. This is supplied by the superior mesenteric artery.
76
what is the hindgut and what is it supplied by?
second half of the transverse colon to the rectum. This is supplied by the inferior mesenteric artery.
77
what is the typical presentation of mesenteric ischaemia?
Central colicky abdominal pain after eating (starting around 30 minutes after eating and lasting 1-2 hours) Weight loss (due to food avoidance, as this causes pain) Abdominal bruit may be heard on auscultation
78
State 4 risk factors for mesenteric ischaemia
Increased age Family history Smoking Diabetes Hypertension Raised cholesterol
79
How do you diagnose mesenteric ischaemia?
CT angiography
80
what is the management of mesenteric ischaemia?
Reducing modifiable risk factors (e.g., stop smoking) Secondary prevention (e.g., statins and antiplatelet medications) Revascularisation to improve the blood flow to the intestines
81
how does acute mesenteric ischaemia present?
acute, non-specific abdominal pain. The pain is disproportionate to the examination findings. Patients can go on to develop shock, peritonitis and sepsis.
82
what will a blood gas in a patient with acute mesenteric ischaemia show?
metabolic acidosis and raised lactate
83
name 4 risk factors or bowel cancer
Family history of bowel cancer Familial adenomatous polyposis (FAP) Hereditary nonpolyposis colorectal cancer (HNPCC) Inflammatory bowel disease Increased age Diet (high in red and processed meat and low in fibre) Obesity and sedentary lifestyle Smoking Alcohol
84
what are some red flags for bowel cancer?
Change in bowel habit Unexplained weight loss Rectal bleeding Unexplained abdominal pain Iron deficiency anaemia Abdominal or rectal mass on examination
85
who and how often are FIT tests sent?
60 – 74 years are sent a home FIT test to do every 2 years
86
what is the gold standard investigation for bowel cancer?
Colonoscopy
87
what are most gallstones made of?
cholesterol
88
what are the 4 main risk factors for gallstones?
F – Fat F – Fair F – Female F – Forty
89
what is the main symptom of gallstones?
biliary colic
90
what is the first line investigation for gallstones?
ultrasound scan
91
what are some signs/symptoms of acute cholecystitis?
RUQ pain that may radiate to the shoulder Fever Nausea Vomiting Tachycardia Tachypnoea Right upper quadrant tenderness Murphy’s sign Raised inflammatory markers and white blood cells
92
what is Murphy's sign?
Place a hand in RUQ and apply pressure Ask the patient to take a deep breath in The gallbladder will move downwards during inspiration and come in contact with your hand Stimulation of the inflamed gallbladder results in acute pain and sudden stopping of inspiration
93
Name 3 complications of acute cholecystitis
Place a hand in RUQ and apply pressure Ask the patient to take a deep breath in The gallbladder will move downwards during inspiration and come in contact with your hand Stimulation of the inflamed gallbladder results in acute pain and sudden stopping of inspiration
94
what can be used to remove trapped gallstone?
Endoscopic retrograde cholangio-pancreatography (ERCP)
95
what are the most common organisms in acute cholangitis?
Escherichia coli Klebsiella species Enterococcus species
96
what is Charcot's triad in acute cholangitis?
Right upper quadrant pain Fever Jaundice (raised bilirubin)
97
what is the management of acute cholangitis?
Nil by mouth IV fluids Blood cultures IV antibiotics Involvement of seniors and potentially HDU or ICU endoscopic retrograde cholangio-pancreatography (ERCP)
98
what is Courvoisier’s law
palpable gallbladder along with jaundice is unlikely to be gallstones. The cause is usually cholangiocarcinoma or pancreatic cancer
99
what is the key presenting feature of cholangiocarcinoma?
Obstructive jaundice
100
how is a diagnosis of cholangiocarcinoma?
imaging (CT or MRI) plus histology from a biopsy
101
what cancer marker is raised in cholangiocarcinoma?
CA 19-9
102
what type of cancer are the majority of pancreatic cancers?
adenocarcinomas
103
where do the majority of pancreatic cancers occur?
head of the pancreas
104
what is the key presenting feature of pancreatic cancer?
Painless obstructive jaundice
105
Name 3 key causes of pancreatitis
Gallstones Alcohol Post-ERCP
106
what are the presenting symptoms of pancreatitis?
Severe epigastric pain Radiating through to the back Associated vomiting Abdominal tenderness Systemically unwell
107
what is raised more than 3 times the upper limit of normal in pancreatitis?
Amylase
108
what score is used to assess the severity of pancreatitis?
Glasgow Score 0 or 1 – mild pancreatitis 2 – moderate pancreatitis 3 or more – severe pancreatitis
109
what are the criteria for the Glasgow score for pancreatitis?
P – Pa02 < 8 KPa A – Age > 55 N – Neutrophils (WBC > 15) C – Calcium < 2 R – uRea >16 E – Enzymes (LDH > 600 or AST/ALT >200) A – Albumin < 32 S – Sugar (Glucose >10)
110
what is the most common cause of chronic pancreatitis?
Alcohol
111
what are some factors suggesting unsuitability for liver transplantation
Significant co-morbidities (e.g., severe kidney, lung or heart disease) Current illicit drug use Continuing alcohol misuse (generally 6 months of abstinence is required) Untreated HIV Current or previous cancer (except certain liver cancers)

Finals (21 decks)

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