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General Surgery Flashcards

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1
Q

What is Paget’s Disease of the Nipple?

A

eczematoid change in the nipple - 50% have underlying mass lesion, usually invasive carcinoma

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2
Q

management of post-op ileus

A

correct deranged electrolytes - replace intravenously

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3
Q

appearance of sigmoid volvulus

A

‘coffee bean’ sign, lines of coffee bean converge towards site of obstruction.

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4
Q

associations with sigmoid disease (5)

A 
increasing age
chronic constipation
chagas disease
neurological conditions
psychiatric conditions
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5
Q

associations with caecal volvulus (3)

A

all ages
adhesions
pregnancy

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6
Q

caecal volvulus appearance on x-ray

A

small bowel obstruction

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7
Q

managmene of volvulus

A

sigmoid - rigid sigmoidoscopy with flatus tube insertion

caecal - operative, usually right hemicolectomy

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8
Q

what is a breast fibroadenoma

A

a benign tumour which forms from a whole lobule. mobile and firm.

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9
Q

management of breast fibroadenoma

A

30% will regress on their own

if >3cm surgical excision usually

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10
Q

post splenectomy blood film features (4)

A

Howell-Jolly bodies
Pappenheimer bodies
target cells
irregular contracted erythrocytes

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11
Q

features of small bowel obstruction on AXR

A

diameter >35mm

valvulae conniventes extend all the way across bowel loops

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12
Q

features of large bowel obstruction on AXR

A

diameter >55mm

haustra extend about a third of the way across the bowel loops

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13
Q

non surgical breast cancer Mx

A
  • radiotherapy - all women with breast conserving surgery or women with T3-T4 tumours who have mastectomy
  • hormonal therapy is used for women with hormone positive tumours - tamoxifen in pre/perimenopausal women and anastrozole in post menopausal women
  • HER2 positive can use herceptin (CIed in heart disorders)
  • Chemotherapy may be used neoadjuvantly or to treat axillary node disease
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14
Q

neurogenic shock

A

interruption of the autonomic nervous system resulting in reduced sympathetic or increased parasympathetic tone, resulting in decreased peripheral vascular resistance and vasodilation

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15
Q

Presentation of duodenal ulcer

A

post-prandial pain worst several hours after meals

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16
Q

what is a dieulafoy lesion?

A

small arterial lesions in the stomach - result in significant haematemesis and malena

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17
Q

clinical features of liver disease (6)

A 
jaundice
gynaecomastia
spider naevi
caput medusae 
ascites
malnourished appearance
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18
Q

classification of haemorrhagic shock

A

I - compensated
II - tachycardia
III - tachycardia, hypotension and confusion
IV- LOC + severe hypotension

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19
Q

Breast cysts - presentation

A

smooth, discrete lump which may be fluctuant.

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20
Q

breast cysts - management

A

aspirate, may be excised if blood stained or persistently refill

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21
Q

sclerosing adenosis -presentation and management

A

breast lumps or breast pain, mammographic changes mimic carcinoma. Biopsy results, excision optional.

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22
Q

what is angiodysplasia

A

AV lesions causing lower GI bleeds, which can be massive. No other symptoms.

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23
Q

what is a hepatic haemangioma

A

most common benign liver tumour, hyperechoic on USS, may be symptomatic if large

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24
Q

Blatchford score

A

assessment of need for admission and urgency of endoscopy in upper GI bleeds.

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25
Rockall score
post endoscopy for upper GI bleed to estimate rebleeding risk and mortality
26
bubbly urine is suggestive of ...
...enterovesical fistula
27
Causes of nipple discharge (6)
``` breast abscess -puss duct ectasia - thick green or brown galactorrhoea - pituitary tumour/ emotional/iatrogenic physiological milk production intraductal papilloma- blood-stained carcinoma - blood-stained ```
28
Causes of tender breast lumps (3)
breast abscess mammary duct ectasia fibroadenosis
29
Causes of non-tender breast lumps (3)
fat necrosis breast cancer fibroadenoma
30
Marker for bowel cancer
CEA
31
Dukes staging
Dukes A - tumour confined to the mucosa Dukes B - Tumour invaded bowel wall Dukes C - Local lymph node involvement Dukes D - distant metastases
32
Iron deficiency anaemia in over 60s - what you gonna do?
Urgent referral to colorectal surgeon for suspected colon cancer.
33
Acute Mx of anal fissure
dietary advice: high-fibre diet with high fluid intake bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried lubricants such as petroleum jelly may be tried before defecation topical anaesthetics analgesia
34
Chronic Mx of anal fissure
acute Mx should be continued topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
35
Resection and anastomosis for tumours in Caecal, ascending or proximal transverse colon
Right hemicolectomy | Ileo-colic
36
Resection and anastomosis for tumours in Distal transverse, descending colon
Left hemicolectomy | Colo-colon
37
Resection and anastomosis for tumours in Sigmoid colon
High anterior resection | Colo-rectal
38
Resection and anastomosis for tumours in Upper rectum
``` Anterior resection (TME) Colo-rectal ```
39
Resection and anastomosis for tumours in Low rectum
``` Anterior resection (Low TME) Colo-rectal (+/- Defunctioning stoma) ```
40
Resection and anastomosis for tumours in Anal verge
Abdominoperineal excision of rectum | None
41
Complications of diverticular disease (6)
``` Diverticulitis Haemorrhage Development of fistula Perforation and faecal peritonitis Perforation and development of abscess Development of diverticular phlegmon ```
42
Classification of diverticular disease
I Para-colonic abscess II Pelvic abscess III Purulent peritonitis IV Faecal peritonitis
43
Management of diverticular disease
Increase dietary fibre intake Mild attacks - antibiotics. Peri colonic abscesses should be drained either surgically or radiologically. Recurrent episodes of acute diverticulitis requiring hospitalisation are a relative indication for a segmental resection. grade IV perforations (generalised faecal peritonitis) will require a resection and usually a stoma. High risk of postoperative complications and usually require HDU admission. Less severe perforations may be managed by laparoscopic washout and drain insertion
44
Investigation to ensure no anastomotic leak following colonic anastomosis formation
gastrografin enema
45
Anal cancer risk factors (7)
- HPV 16 and 18 infection causes 80-85% of SSCs - Anal intercourse and a high lifetime number of sexual partners increases the risk of HPV infection. - MSM - Those with HIV and those taking immunosuppressive medication for HIV are at a greater risk of anal carcinoma. - Women with a history of cervical cancer or cervical intraepithelial neoplasia (CIN) are also at greater risk of anal cancer. - Immunosuppressive drugs used in transplant recipients increase the risk of anal cancer. - Smoking is also a risk factor.
46
Screening for colon cancer
at 55 one-off flexible sigmoidoscopy to detect polyps | FOB test every 2 years from 60 to 74 (from 50 in Scotland)
47
peptic ulcer pain
duodenal - several hours after eating / worse when hungry | gastric - worsened by eating
48
which artery tends to be perforated in duodenal ulcers?
gastroduodenal artery
49
Congenital Inguinal Hernias Anatomy Management
Indirect hernias resulting from a patent processus vaginalis Should be surgically repaired soon after diagnosis as at risk of incarceration
50
Bowel obstruction - investigation
AXR initially | if small bowel suggestive then get CT abdomen to confirm
51
Nere at risk of damage in total hip replacement and symtptoms
sciatic nerve - foot drop
52
Haemothorax | management
wide bore 36F chest drain. Indications for thoracotomy include loss of more than 1.5L blood initially or ongoing losses of >200ml per hour for >2 hours. consider delaying management if likely to cause ongoing bleeding in an unstable patient
53
lower GI bleed in liver disease patients? likely diagnosis?
rectal varices due to portal hypertension
54
What causes abdominal wall haematoma?
- trauma, either directly to the abdominal wall or iatrogenic trauma from surgery - spontaneous following excessive straining due to valsalva manoeuvres, coughing.
55
Presentation of abdominal wall haematoma
painful, discoloured mass | signs of hypovolemia (tachycardia and hypotension)
56
Complications of TPN (4)
Thrombophlebitis liver dysfunction sepsis refeeding syndrome
57
What is Rovsings sign?
appendicitis - palpation of the left iliac fossa causes pain in the right iliac fossa
58
What is Boas sign?
-cholecystitis - hyperaesthesia beneath the right scapula
59
What is Murphys sign?
cholecystitis - pain as the inferior liver border is brought down on a palpating hand as the patient inhales, causing a 'catch' in their breath.
60
What is Cullens sign?
peri-umbilical bruising - pancreatitis (other intraabdominal haemorrhage)
61
What is Grey-Turners sign?
flank bruising - pancreatitis (or other retroperitoneal haemorrhage)
62
Glasgow PANCREAS score
P - PaO2 <8kPa A - Age >55-years-old N - Neutrophilia: WCC >15x10(9)/L C - Calcium <2 mmol/L R - Renal function: Urea >16 mmol/L E - Enzymes: LDH >600iu/L; AST >200iu/L A - Albumin <32g/L (serum) S - Sugar: blood glucose >10 mmol/L
63
Complications of gastrectomy (7)
``` Dumping syndrome Weight loss, early satiety Iron-deficiency anaemia Osteoporosis/osteomalacia Vitamin B12 deficiency increased risk of gallstones increased risk of gastric cancer ```
64
What is Dumping syndrome
post gastrectomy early: food of high osmotic potential moves into small intestine causing fluid shift late (rebound hypoglycaemia): surge of insulin following food of high glucose value in small intestine - 2-3 hours later the insulin 'overshoots' causing hypoglycaemia
65
Laproscopy complications (5)
- general risks of anaesthetic - vasovagal reaction (e.g. bradycardia) in response to abdominal distension - extra-peritoneal gas insufflation: surgical emphysema - injury to gastro-intestinal tract - injury to blood vessels e.g. common iliacs, deep inferior epigastric artery
66
Causes of raised serum amylase (6)
``` Acute pancreatitis Pancreatic pseudocyst Mesenteric infarct Perforated viscus Acute cholecystitis Diabetic ketoacidosis ```
67
Causes of pancreatitis (GET SMASHED)
Gallstones *** common Ethanol *** common Trauma Steroids Mumps (other viruses include Coxsackie B) Autoimmune (e.g. polyarteritis nodosa), Ascaris infection Scorpion venom Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia ERCP Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
68
Diagnostic test for chronic pancreatitis
CT Pancreas with contrast
69
presentation of biliary colic
Episodic, colicky RUQ or epigastric pain and nausea | no fever, no vomiting
70
Presentation of cholecystitis
Fever, vomiting, constant RUQ pain | no jaundice
71
Presentation of cholangitits
Jaundice, fever, RUQ pain (Charcot's Triad) | +/- Hypotension and confusion (Reynolds Pentad)
72
``` Gastric MALT lymphoma Cause Mx Prognosis Associated feature ```
H. pylori infection in 95% of cases, 80% respond to H. pylori eradication good prognosis paraptoteinaemia

Finals (34 decks)

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