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Flashcards in GetAhead Surgery SBAs Deck (49)
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1

What's the investigation in suspected causes of Myasthenia Gravis?

Tensilon test 

*Tensilon = trade name for edrophonium bromide (short acting anti-cholinesterase)

- when administrated IV -> sudden improvement in muscle weakness (prolonged action of acetylcholine is allowed)

2

What's a typical Rx of PID? 

2 weeks of :

  • Ofloxacin (anti-chlamydia and gonorrhoea) and
  • Metronidazole (anti- anaerobes and protozoa) 

*if significant systemic upset - IV antibiotics

3

What's Fitz- Hugh- Curtis syndrome?

RUQ pain caused by inflammation of connective tissue around the liver by the pelvic infection (e.g. in PID) 

4

What's Herpes Simplex Keratitis?

- detection 

- symptoms

- treatment

Infection of the cornea with Herpes Simplex Virus (HSV) 

  • it may be present after many years of first HSV encounter (dormant in the trigeminal nerve) 
  • Symptoms: painful, watery, red eye

corneal injection,

  • Detection: cobalt blue light with fluorescein -> branch-line lesion= dendritic ulcer that contains live virus 

 

  • Treatment: aciclovir until an ulcer heals

 

  • Complications: risk of corneal scarring and blindness -> urgent ophthalmological assessment is needed

*steroids are contraindicated - as they weaken immune system and increase viral burdne

5

What's a triad of Budd-Chari syndrome?

- abdo pain 

- hepatosplenomegaly 

- ascities 

 

*it's venous flow obstruction secondary to thrombosis of hepatic vein 

6

What's ABCD2 score? 

scoring / results

ABCD2 following TIA 

 

A → age > 65 (1 point) 

B → Blood pressure systolic >140 or diastolic >90 (1 point)

C → unilateral weakness (2 points), speech disturbance (1 point)

D → duration >60 minutes (2 points), 10-59 minutes (1 point)

D → diabetes (1 point)

 

Results: (total score 7)

  • 4 or more → admission for inpatient assessment (re suitability for carotid endarterectomy)

7

Who needs an urgent admission following TIA? (2)

  • 4 or more  admission for inpatient assessment (re suitability for carotid endarterectomy)

 

  • Two or more episodes of TIA in a quick succession 'crescendo TIA') → need urgent admission regardless of ABCD2 score

8

What's March fracture?

  • undisplaced hairline fracture
  • caused by repetitive stress e.g. marching, running
  • common sites: neck of 2nd or 3rd metatarsal
  • X ray mostly normal
  • periosteal reaction (formation of a new bone/callus in response to stimuli) may be seen
  • Rx: analgesia → pain resolves after few weeks (as the fracture union occurs)

9

What's Marjolin's ulcer?

  • aggressive but slow - growing squamous cell carcinoma
  • arises from the area of previously traumatised skin (e.g. scars, burns)
  • lesions: ulcerated, raised and painless
  • invade locally 
  • Dx: biopsy 
  • Rx: wide local excision

10

Hypertrophic vs keloid scars

Both occur when there is overgrowth of fibrous tissue within a healing scar 

 

Hypertrophic:

  • raised lesions
  • within boundary of the original scar

Keloid: 

  • beyond original scar

 

11

12

Haemorrhagic Shock Class I criteria

13

Haemorrhagic Shock Class II criteria

14

Haemorrhagic Shock Class III criteria

15

Haemorrhagic Shock Class IV criteria

16

What's Osler-Weber-Rendu syndrome?

Aka Hereditary Haemorrhagic Telangiectasia 

  • Autosomal Dominant condition 

 

  • Characteristics: telangiectasia, AV malformations at multiple sites, recurrent epistaxis

 

  • Other problems: GI bleeds, hemoptysis, resp compromise due to AV malformations in the lungs, haemorrhagic strokes

 

  • 10% patients have neuro features: headaches, seizures

17

What features would be suggestive that there is no C-spine injury (when can we remove C - spine collar)?

  • patient is not drunk and not under the influence of any drugs
  • patient is alert and oriented 
  • no head injury
  • no neck pain
  • no abnormal neurology
  • no C- spine tenderness or deformity 

*if any of these are present → must do imaging

* life- saving procedures take priority over C-spine injury  

18

Adrenaline as local anaesthetic 

- MoA

- contraindications

  • MoA: Adrenaline will constrict the arteries → prolong the action of local anaesthetics by slowing down system absorption

 

  • Contraindications: end arteries e.g. penis, nose and digits (due to risk of ischaemic necrosis)

 

19

Pseudobulbar vs bulbar palsy

Pseudobulbar 

- bilateral UPPER motor neurone lesion (9th and 12th CN) 

 

Bulbar

- bilateral LOWER motor neurone lesion (9th and 12th) 

20

How long would it take for the fracture to heal?

  • upper limb
  • lower limb

  • upper: 6-8 weeks
  • lower: 12-16 weeks 

 

*these numbers are halved in children

21

What's Mackler's triad

  • vomiting
  • lower thoracic/chest pain
  • subcutaneous emphysema

 

Suggestive of Boerhaave's syndrome → a spontaneous transmural rupture of the oesophagus 

22

What's the triad of Zollinger-Ellison syndrome?

  • gastrin-producing tumour
  • gastric hypersecretion
  • severe peptic ulceration 

Rx: PPIs and tumour resection

23

What's Maydl's hernia?

  • Hernia that contains 'W' loop of intestine within its sac
  • Middle segment is liable to become strangulated

 

24

What's a gluteal hernia?

  • protrudes through a greater sciatic foramen 
  • results from the weakness or deficiency of gluteal muscle fibres 

25

What's a sciatic hernia?

  • protrudes through the lesser sciatic foramen

26

What's Littre's hernia?

  • hernia that contains Meckel's diverticulum 

27

28

What's Spigelian hernia?

  • protrudes through semilunar line
  • usually below the level of umbilicus
  • small
  • develop in over 50s
  • high risk of strangulation 

29

What are (5) types of hypersensitivity + describe 

  • Type I (anaphylactic) → IgE-mediated from allergen exposure 
  • Type II (cytotoxic) → antibody-mediated
  • Type III (complexes) → immune complex-mediated
  • Type IV (delayed) → sensitised T cell - mediated
  • Type V (stimulatory) → stimulatory anti-receptor antibody mediated 

30

What's Richter's hernia?

  • strangulation of one sidewall of the bowel within a hernia sac
  • Richter's hernia → features of strangulation (painful, erythematous) but without characteristics of obstruction 

*to compare - strangulated hernia describes strangulation of the entire lumen of the bowel)