General Surgery Flashcards
(117 cards)
1
Q
What are the manifestations of Peripheral Arterial Disease?
A
Range from no symptoms, atypical extremity symptoms, typical exertional symptoms, to rest pain or gangrene
Systemic approach involves classification, quantification, functional impairment determination, risk factor identification, and a comprehensive treatment plan.
2
Q
What is claudication?
A
Symptoms range from fatigue to aching whilst walking; pain due to ischaemic neuropathy and local intramuscular acidosis from anaerobic metabolism; alleviated by brief rest.
3
Q
Define chronic limb threatening ischaemia.
A
Reduced blood supply threatening extremity viability; manifests as ischaemic rest pain or tissue loss; lasts two weeks or longer; requires opioid analgesia; perfusion pressure less than 50 at ankle or 30 at toe.
4
Q
What is the normal range for Ankle Brachial Pressure Index (ABPI)?
A
Normal: 1-1.4; Borderline: 0.9-0.99; Abnormal: 0.9 or less; Incompressible vessels: greater than 1.4.
5
Q
What is the natural history of claudication at 5 years?
A
Limb loss of 2-5%.
6
Q
What are the outcomes for Chronic Limb Ischaemia (CLI) at presentation?
A
- 25% medical treatment
- 25% primary amputation
- 50% revascularization
7
Q
What risk factors are associated with atherosclerosis?
A
- Advanced age
- Race
- Male gender
- DM
- HT
- Smoking
- Dyslipidaemia
- CRF
- Hyperhomocysteinemia
- Hyperfibrinogenemia
- Elevated CRP
8
Q
Name non atherosclerotic causes of ischaemia.
A
- Thromboangitis obliterans
- Popliteal aneurysm
- Aortic coarctation
- Fibromuscular dysplasia
- Takayasu disease
- Arteritis
- Popliteal entrapment
- Primary vascular tumour
- Adventitial cystic disease
- Peripheral emboli
- Thrombosis of persistent sciatic artery
9
Q
What are the Rutherford categories for chronic limb ischaemia?
A
- Mild claudication
- Moderate claudication
- Severe claudication
- Rest pain
- Minor tissue loss
- Major tissue loss
10
Q
What does the Fontaine classification include?
A
- Claudication
- Rest pain
- Tissue loss
11
Q
What types of disease can be identified through physical examination?
A
- Aorto-iliac disease
- Femoro-popliteal disease
- Tibio-peroneal disease
12
Q
What are the components of cardiac and cerebrovascular evaluation?
A
- Unstable coronary syndromes
- Significant arrhythmias
- Severe valvular heart disease
- Decompensated heart failure
13
Q
List the diagnostic studies used for haematological assessment.
A
- FBC
- U&E
- Lipid profile
- CRP
- Hypercoagulable state
14
Q
What imaging modalities are used in vascular diagnostics?
A
- DUS
- CTA
- MRA
- Formal angiography
15
Q
What factors influence imaging modality selection?
A
- Renal function
- Level of disease
- Anticipated intervention
16
Q
What are the components of medical management for vascular conditions?
A
- Risk factor modification
- Smoke cessation
- Antiplatelet therapy
- Statins
- Supervised exercise program
- Pentoxifylline
- Cilostazol
- Naftidrofuryl
- Levocarnitine
- Prostaglandins
17
Q
What are the types of interventions in vascular management?
A
- Endovascular (angioplasty, stenting)
- Open surgery (anatomical, extra-anatomical)
18
Q
Define an aneurysm.
A
Abnormal permanent dilatation of an artery by 50% of its normal diameter; practical definition for AAA is 3cm or greater.
19
Q
What are the classifications of aneurysms?
A
- True versus false
- Anatomic (ectasia, arteriomegally, aneurysmosis)
- Shape (fusiform, saccular)
20
Q
List the etiologic categories of aneurysms.
A
- Degenerative
- Inflammatory
- Post-dissection
- Trauma
- Developmental (persistent sciatic)
- Congenital
- Infectious
21
Q
What are the location categories for aneurysms?
A
- Aorta (thoracic, thoraco-abdominal, abdominal)
- Iliac
- Popliteal
- Visceral
- Cerebrovascular
22
Q
What factors are involved in decision making for intervention?
A
- Symptomatic
- Asymptomatic (size, shape/type)
23
Q
What medical management options are available for aneurysms?
A
- Cessation of smoking
- Medications (beta blockers, ACE inhibitors, statins, doxycycline)
24
Q
What are the types of open surgical treatment for aneurysms?
A
- Transabdominal
- Retroperitoneal
25
What are the complications associated with open surgery?
* Cardiac
* Renal
* Respiratory
* Neurology
* Death
26
What factors are considered in endovascular treatment?
* Neck anatomy (length, angulation, calcification)
* Anatomy
* Size
* Bifurcation
* Access vessels
27
List the complications associated with endovascular treatment.
* Renal
* Endoleak
* Graft migration
* Graft limb occlusion
* Graft sepsis
* Mortality
28
29
What is the commonest cause of cancer-related death in women worldwide?
Breast cancer
## Footnote
Incidence and mortality rates have risen rapidly in Africa
30
What are common risk factors for breast cancer?
* Female gender
* Age
* Family history/hereditary mutations
* Personal history of breast cancer
* Longstanding HRT/contraceptive use
* Early menarche, late menopause
* Previous chest wall irradiation
* Lifestyle factors
31
What are common presentations of breast cancer?
* Lump
* Skin changes
* Nipple retraction
* Nipple discharge
* Rash, redness
* Screening-detected lesion
32
What components are included in the triple assessment for breast cancer diagnosis?
* Clinical history and examination
* Imaging (mammogram and ultrasound)
* Pathology (core biopsy preferred for primary)
33
Which types of carcinoma are classified as invasive breast cancer?
* Ductal carcinoma
* Lobular carcinoma
34
What are the classifications of non-invasive breast cancer?
* DCIS (Ductal Carcinoma In Situ)
* LCIS (Lobular Carcinoma In Situ)
35
What does the TNM classification stand for in breast cancer staging?
* T = size, involvement of skin/chest wall
* N = lymph nodes (axillary and supraclavicular)
* M = distant metastasis (Bone, lung, liver, brain)
36
What factors influence breast cancer prognosis?
* Tumor biology
* Stage
* Age
* Response to therapy
37
What are the main treatment modalities for breast cancer?
* Surgery
* Radiation
* Chemotherapy
* Targeted therapy
38
Why is a multidisciplinary team approach essential in breast cancer treatment?
Breast cancer is widely heterogeneous, requiring a patient-centered, individualized approach.
39
What roles are included in a multidisciplinary team for breast cancer care?
* Breast Surgery
* Radiation Oncology
* Medical Oncology
* Plastic Surgery
* Nuclear Medicine
* Radiology
* Pathology
* Patient
* Other Allied Services
40
What is the primary goal of surgical management in breast cancer?
Ensure a proper diagnosis and timely treatment planning.
41
What is breast conserving surgery (BCS)?
Surgery that conserves an affected organ, often requiring radiation to complete breast conservation therapy.
42
What is the range of local recurrence rates after breast conserving therapy (BCT)?
8.8-14% after BCT and 2.3-7% after mastectomy.
43
What are important factors in selecting an approach for breast cancer treatment?
* Patient factors (age, comorbidities, preference)
* Oncological factors (size, lymph node status, tumor biology)
* Local breast factors (multicentricity, size of breast vs tumor)
44
What is the purpose of axillary lymph node dissection (ALND)?
It is a traditional method for axillary evaluation and a prognostic indicator in early-stage breast cancer.
45
What is sentinel lymph node biopsy (SLNB)?
A standard of care in clinically node-negative axilla that provides accurate assessment with less morbidity.
46
What are the potential complications of breast cancer surgery?
* Lymphoedema
* Seroma
* Cording, axillary webs
* Nerve injury
* Shoulder dysfunction
47
What is oncoplastic breast surgery (OPBS)?
Surgical approaches that combine oncological resection with plastic surgery techniques.
48
What are the two broad techniques used in oncoplastic breast surgery?
* Volume-displacement using glandular transposition
* Volume replacement using autologous tissues
49
What was the initial finding from the first trial of breast conserving therapy in 1973?
Well validated with equivalent survival rates.
50
What was the result of intraoperative pathology during surgery?
If positive, generally leads to completion axillary dissection.
51
Fill in the blank: The _______ is a common screening method for breast cancer diagnosis.
[mammogram]
52
True or False: Breast cancer prognosis is solely influenced by tumor size.
False
53
What is the significance of the Ki67 index in breast cancer pathology?
It is a proliferative index that helps in assessing tumor aggressiveness.
54
55
What are the key features of an acute abdomen?
• Sudden onset
• Severe abdominal pain
• Abdominal tenderness
• Often requires emergency surgical therapy
## Footnote
Acute abdomen is a critical condition that necessitates prompt medical attention.
56
What is visceral pain in the abdomen?
• Midline, dull, deep, poorly localized
• Associated with nausea, vomiting, anorexia
• Triggered by inflammation, ischaemia, geometric changes
## Footnote
Visceral pain is often referred to specific areas based on the origin of the pain.
57
What is somatic pain in the abdomen?
• Sharp, severe, well localized
• Triggered by irritation of the parietal peritoneum
## Footnote
Somatic pain is typically more easily identified and localized compared to visceral pain.
58
List common surgical causes of acute abdomen.
• Appendicitis
• Diverticulitis
• Perforated peptic ulcer
• Hollow viscous perforation
• Gall bladder perforation
• Bowel obstruction
• Strangulated/Incarcerated herniae
• Mesenteric ischaemia
• Trauma
## Footnote
These conditions often require surgical intervention.
59
What tests are essential for establishing the cause of acute abdominal pain?
• History and examination
• Blood tests (FBC, U&E, CRP, etc.)
• Pregnancy test
• Urine Dipstick/MC&S
• CXR, ECG
• Abdominal ultrasound
• CT-scan
## Footnote
A thorough evaluation is critical to diagnose the underlying cause.
60
What is appendicitis?
• Inflammation/perforation of the vermiform appendix
• Pain migrates from peri-umbilical area to McBurney's point in the RIF
• Most common general surgical procedure performed
## Footnote
Appendicectomy can be performed via open or laparoscopic approaches.
61
What is the incidence of gallstones in women and men by age 60?
• 25% women
• 12% men
## Footnote
Factors such as obesity and certain demographics can increase the incidence.
62
What are gallstones primarily made of?
• Cholesterol (85%)
• Bile pigment (15%)
## Footnote
Other components can include calcium bilirubinate, calcium phosphate, and calcium carbonate.
63
What are the indications for elective surgical intervention?
• Improve quality of life
• Prolong patient's life
• Save the patient's life
• Non-life-threatening diseases
## Footnote
The risks of surgery must not outweigh the benefits.
64
What are the indications for emergency surgical intervention?
• The risk of not operating outweighs the risk of the surgery
• Perforation
• Ischaemia
• Bleeding
• Bowel obstruction
## Footnote
Emergency indications often involve life-threatening conditions.
65
What is the aim of exploratory laparotomy?
• Identify unknown pathology
• Access known pathology
• Control bleeding
• Limit/control contamination
## Footnote
It is a critical procedure for diagnosing and managing acute abdominal conditions.
66
What are the types of abdominal incisions?
• Midline laparotomy
• Muscle splitting incisions
• McBurney’s incision
• Lanz incision
• Pfannenstiel incision
• Laparoscopic incision
## Footnote
The choice of incision depends on the underlying condition and surgical approach.
67
What are immediate surgical complications of abdominal surgery?
• Iatrogenic injury to bowel, blood vessels, lymphatic vessels, solid organs
• Serosal tears
• Sepsis
## Footnote
These complications can lead to severe outcomes, including fatal exsanguination.
68
What are common medical post-operative complications?
• Atelectasis
• Pneumonia
• DVT
• UTI
• Delirium
• Constipation
## Footnote
These complications can affect recovery and overall health post-surgery.
69
What does ERAS stand for?
Enhanced Recovery After Surgery
## Footnote
ERAS protocols aim to improve recovery times and outcomes following surgery.
70
True or False: Gynaecological emergencies can present as abdominal pain.
True
## Footnote
Conditions such as ovarian torsion and ectopic pregnancy can cause acute abdominal symptoms.
71
72
What are early post-operative complications?
Wound, pulmonary complications, cardiovascular system complications, gastrointestinal complications, CNS complications, vascular (thrombo-embolic disease), endocrine system complications, thermal regulations.
73
What are the types of wounds in surgery?
Clean wound, clean contaminated, contaminated wound, dirty.
74
What are patient factors that increase the risk of wound complications?
Poor nutrition, diabetes mellitus, elderly age, obesity.
75
What are common wound complications?
* Haematoma
* Seroma
* Surgical site infection
* Wound dehiscence.
76
What are signs of surgical site infections?
* Erythema
* Pus oozing from the wound
* Fever
* Elevated inflammatory markers.
77
What complications can arise from wound dehiscence?
Bowel evisceration.
78
What are pulmonary risk factors for surgery?
* Smoking
* Asthma/COPD
* Obesity
* Previous history of lung disease (e.g., TB).
79
What are pulmonary complications after surgery?
* Bronchospasm
* Atelectasis
* Aspiration pneumonia
* Pulmonary edema
* Pulmonary embolism
* Respiratory failure.
80
What is the most common cause of post-operative fever within 48 hours?
Atelectasis.
81
What are the signs of atelectasis?
* Tachypnea
* Dyspnea
* Reduced air entry
* Fever
* Tachycardia.
82
What are prevention methods for atelectasis?
* Adequate analgesia
* Early mobilisation
* Chest physio.
83
What are risk factors for aspiration pneumonia?
* Elderly patients
* Diabetics (gastroparesis)
* CVA
* Pregnancy
* Bowel obstruction
* Severe GORD.
84
What can cause pulmonary edema?
Congestive cardiac failure, fluid overload.
85
What cardiovascular risk factors are associated with surgery?
* Hypertension
* Diabetes mellitus
* Smoking
* Ischemic heart disease
* Congestive cardiac failure
* Arrhythmias.
86
What are cardiovascular complications that can occur post-surgery?
* Myocardial infarction
* Arrhythmias
* Congestive cardiac failure
* Respiratory complications.
87
What are gastrointestinal risk factors for surgery?
* Diabetes
* Major abdominal surgery
* Poor nutritional status
* Vasculopathy.
88
What are gastrointestinal complications post-surgery?
* Paralytic ileus
* Internal herniation
* Anastomotic breakdown
* Bowel ischemia.
89
What does the 5 Ws mnemonic for post-operative fever stand for?
* Wind: lung complications
* Water: UTI/IV line-related sepsis
* Wound complications
* Walk: DVT from immobilisation
* Wonder drugs: drugs/antibiotics fever, transfusion reaction.
90
What are renal system risk factors associated with surgery?
* Hypertension
* Diabetes mellitus
* Renal failure
* Pelvic surgery.
91
What are renal system complications that can arise post-surgery?
* Urinary retention
* Acute kidney injury
* Urinary tract infection.
92
What are neurology risk factors for surgery?
* Carotid surgery
* Vasculopathy
* Epilepsy
* Brain surgery
* Metabolic and electrolyte derangements
* Alcohol intoxication.
93
What complications can occur in the neurology system post-surgery?
* Stroke
* Delirium
* Seizures.
94
What are endocrine system risk factors associated with surgery?
* Thyroid and adrenal surgery
* Thyroid and adrenal disease
* Diabetes mellitus.
95
What complications can arise from endocrine system issues post-surgery?
* Insulin intolerance
* Thyroid storm
* Diabetic ketoacidosis
* Hypothyroidism
* Adrenal crisis.
96
What are venous thrombosis complications related to surgery?
* Deep venous thrombosis
* Pulmonary embolism.
97
98
What are the types of hysterectomy?
* Abdominal Hysterectomy
* Vaginal Hysterectomy
* Wertheim's Hysterectomy
* Laparoscopic Hysterectomy
## Footnote
Each type varies in approach and technique.
99
What are the approaches to performing a hysterectomy?
* Abdominal
* Vaginal
* Conventional laparoscopic
* Robot-assisted laparoscopic
## Footnote
Different approaches may be chosen based on patient needs and surgeon preference.
100
What are common indications for a hysterectomy?
* Uterine leiomyomas (Fibroids)
* Pelvic organ prolapse
* Pelvic pain or infection (e.g., endometriosis, pelvic inflammatory diseases)
* Abnormal uterine bleeding
* Malignant and premalignant disease
## Footnote
These conditions can significantly impact a woman's quality of life.
101
What are some alternatives to hysterectomy?
* Embolization for fibroids
* Mirena for abnormal uterine bleeding
* Endometrial ablation for abnormal uterine bleeding
* Ring pessary for prolapse
* Chemotherapy and radiation therapy
## Footnote
These alternatives may provide symptom relief without the need for surgery.
102
Should ovaries be removed during a hysterectomy?
* The risk of ovarian cancer is very low
* Only remove if pathological
* Remove if patient at risk for ovarian cancer (e.g., BRCA gene aberration)
## Footnote
Retaining ovaries can have significant health benefits.
103
What are reasons to keep ovaries during a hysterectomy?
* SEX and LIBIDO
* Cardiac disease
## Footnote
Ovaries play a crucial role in hormonal balance and overall health.
104
What are potential complications of a hysterectomy?
Prolapse of the bladder, vault, rectum
Bowel obstruction
Pain
Menopause if ovaries are removed
## Footnote
Complications can vary based on individual circumstances and the type of procedure performed.
105
What is the definition of menopause?
Permanent cessation of menstrual periods
## Footnote
It is retrospectively defined after a woman has experienced 12 months of amenorrhea.
106
What is the median age of menopause onset?
51.4 years
## Footnote
Menopause before age 40 is considered abnormal.
107
What are bone-related consequences of menopause?
* Joint pain
* Decrease in bone density
* Osteopenia
* Osteoporosis
* Increased fracture risk
## Footnote
Bone density loss is most rapid during the year before and two years after the final menstrual period.
108
What are common genitourinary symptoms during menopause?
* Atrophy symptoms
* Vaginal dryness
* Dyspareunia
* Sexual dysfunction
## Footnote
These symptoms are prevalent during the late menopausal transition and postmenopausal years.
109
What percentage of women experience hot flushes during menopause?
Up to 80 percent
## Footnote
A significant number of women may seek medical attention for this symptom.
110
What is the duration of a hot flush?
2 to 4 minutes
## Footnote
Hot flushes typically resolve spontaneously within 4 to 5 years of onset.
111
What is the treatment for menopausal symptoms in women with a uterus?
Both estrogen and progesterone are needed
## Footnote
The combination is important for managing symptoms effectively.
112
What is the treatment for menopausal symptoms in women who have had a hysterectomy?
Only estrogen is needed
## Footnote
This simplification in treatment is due to the absence of uterine tissue.
113
What risks are associated with HRT according to the WHI study?
* Increased breast cancer in patients taking the combination of estrogen and progesterone
* No increased risk in the estrogen-only group
## Footnote
This underscores the importance of individualized treatment plans.
114
What is the effect of estrogen taken orally on vaginal atrophy?
Estrogen taken orally does not work in the vagina
## Footnote
Local estrogen application is more effective for vaginal symptoms.
115
What are contraindications for hormone replacement therapy (HRT)?
* Current, past or suspected breast cancer
* Known or suspected estrogen-dependent malignant tumors
* Undiagnosed genital bleeding
* Untreated endometrial hyperplasia
* Previous idiopathic or current VTE
* Known arterial CHD
* Active liver disease
* Porphyria cutanea tarda
* Thrombophilia
## Footnote
These conditions may increase risks associated with HRT.
116
What are alternatives to HRT?
* Phyto-oestrogens (e.g., from soy and red clover)
* Black cohosh (avoid in breast cancer treatment)
## Footnote
Alternatives may have minimal effects on menopausal symptoms compared to placebo.
117
How does exercise impact menopause?
* Increases cardiorespiratory function
* Increases HDL and decreases LDL
* Alters hip to waist ratio
* Increases bone mass
* Decreases lower back pain
* Reduces hot flushes
* Improves mood and reduces stress
## Footnote
Regular exercise can significantly improve overall health during menopause.
