Misc 9 Flashcards by Michael Grant

What are isolated juvenile polyps usually?

Hamartomas with no risk malignancy

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Lynch syndrome carries risk of which cancers?

Colorectal Ca

Endometrial Ca

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What is the nerve supply to the oesophagus?

Upper half = recurrent laryngeal nerve

Lower half = oesohpageal plexus (vagus)

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Describe the segmental blood supply to the oesophagus?

Upper third = inf thyroid veins and artery
Middle third = direct from thoracic aorta, azygos veins
Lower third = left gastric artery and veins branches

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Finding which cells on path examination of the thyroid would suggest inadvertant removal of parathyroid?

Oxypihl cells

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Most common benign liver lesion?

Haemangioma

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Main RF for hepatic adenomas?

OCP/high hormonal potency agents

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1 word summaries of 4 types of hypersensitivity reactions?

1 - allergic/anaphylactic
2 - cytotoxic
3 - immune complex
4 - delayed t cell

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1 word summaries of 4 stages of wound healing?

1 - haemostasis
2 - inflammation
3 - regeneration
4 - remodelling

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Give 3 main causes of chronic inflammation?

Chronic, persistent infection with delalyed hypersensitivty type
Prolonged exposure to nonbiodegradable surfaces e.g. silicon or suture material
Autoimmune condiions

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Most common primary immunodef?

IgA deficiency

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Describe roughly how to do open AAA repair?

Laparotomy
Mobilise bowel and duodenum out way
Mobilise aneurysm  neck and base
Start systemic heparinization
Cross clamp proximally then distally
Longitudinal aortotomy
Atherectomy
Graft repair - straight or bifurcating
Suture in
Clamps off
Haemostase
Close aneurysm sac
Close abdo wall and skin

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When is the highest risk of cardiac event during AAA repair?

When clamps removed - reperfusion

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What BP would you aim in ruptured AAA?

80-100 systolic - permissive hypotension

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Which 3 forearm tendons dont participate in the flexor retianculum?

Flexor carpi radialis and ulnaris

Palmaris lonogus

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Injury to whic area of the hand carries highest risk of migration of infection? Why?

Palmar surface of little finger - flexor sheath of little finger is continuous with common flexor sheath which extends proximally under flexor retianculum

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Criteria for diagnosing IBS?

Rome criteria

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Operation for inguinal hernia repair in kids vs adults? Why?

In kids - herniotomy, usually indirect

In adults - herniorraphy

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Procedure of choice for a pleomorphic adenoma?

Superficical parotidectomy with facial nerve presrvation

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What is the most common unilateral vs bilateral benign parotid tumour?

Unilateral = pleomorphic adenoma
Bilateral = Warthins tumour

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Which parotid tumour is more common in men than women?

Warthins tumour

Most common malignant parotid tumour? Second most?

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

Procedure of choice for malignant parotid tumours?

Radical/excisional parotidectomy

What about prolene makes it sutitable for vascular anastomoses?

Monofilmaent with memory that doesnt incite tissue reaction and is non-absorbable

Why is PDS useful in abdo wall closure?

Strong monofilament, synthetic so minimal tissue reaction. Absorbed over long period of time

Why is lidocaine less useful for e.g. lap port sites for post op analgesia? What is preferred?

Short acting | Better is bupivocaine or chirocaine

Which LA cant be used in regional blocks? Why?

Bupivocaine - cardiotoxic, in case tourniquet fails

What is agent of chocie for e.g. Biers block?

Prilocaine

What is the role of arterial thrombolysis in acute limb ischaeima?

Better for acute on chronic thrombosis, and beter than peripheral thrombolysis, but avoid if recent surgery or stroke. Consider with/wihtout clot aspiration

Where may T tube drains be useful? Why?

E.g. in bile duct - to generate fibrosis along drain tract so less risk of leak on removal

What are cleaning, sterilisation and disinfection?

``` Cleaning = removal of all visible foreign bodies, must be done first Disinfection = reduction in number of microorganisms Sterilisation = eradication of all microorganisms ```

Nosocomial surgical site infections occur within how long of surgery?

30 days; 1 year if prosthesis used

What is the LN drainage of the anorectum?

Rectum above dentate line = mesorectal LNs | Anal canal below dentate line = inguinal canal

Which fascia are related to the rectum and removed in mesorectal excision?

Denonvilliers anteriorly | Waldeyers fascia posteriorly

Aterial supply to trachea?

``` Superior = inferior thyroid artery Inferior = bronchial artery ```

Surface marking for the sciatic nerve in the buttock?

Midway between greater troch and ischial tuberosity

What is the NHS UK bowel screening programme?

Over 55s invited for 1 off flexi sig | 60-74 = FIT testing every 2 years

How would you investigate and manage ?SCC of tonsil?

EUA and tonsillectomy for histology | If confirmed - MRI, CT CAP and discuss at MDT

What are the levels of LNs in the neck?

1 - submental/submandibular 2 - upper 1/3 IJV - from skull base to hyoid 3 - middle 1/3 IJV - from hyoid to cricoid 4 - lower 1/3 IJV - from cricoid to clavicle 5 - posterior triangle 6 - from hyoid to suprasternal notch 7 - superior mediastinal

What are the 3 types of neck LN dissection?

Radical/en bloc - all removed, SCM, IJV, CN11 Modified radical - all removed but SCM/IJV/CN11 preserved Selective - Removal of certain LN chains and preservation of SCM IJV CN11

Who might an oncology MDT involve?

``` Surgeons Oncologists Radiologists Pathologists SNs Depending on location e.g. dietician/SALT for head and neck, stoma nurses/dieticians GI, plastics/derm for skin ```

Indications for TURP for BPH?

Severe BPH sx refractory to medical management Unusually large or shaped prostate Renal failure/recurrent UTI secondary to obstruction Recurrent gross haematuria Large bladder diverticular

What should patients with Gleason over 7 or PSA over 10 undergo?

Staging scans

What investigation might patients with a bile leak need?

ERCP to look for leak site - extravasation of contrast into abdomen

How are post op bile leaks managed?

IV fluids and antibiotics Refer to tertiary HPB centre for either stenting or reconstruction (bilienteric anastomosis) e.g. Roux en Y choledochoduodenostomy

What is the Dukes classification for? Describe it

``` CRC 1 - mucosa only 2 - through musclar layer 3 - LNs 4 - distant mets ```

What imaging is best for cancers of the urinary tract depending on suspciion of location?

Kidneys - CT renal Ureter/bladder - CT urogram Prostate - MRI

What ABPI would be consistent with critical limb ischaemia?

Less than 0.5

What is a pharyngeal pouch also called and where does it arise?

Zenkers diverticulum - just above cricopharyngeus, below inferior constrictor, through killian's dehiscence

Surface marking for SFJ?

4cm inferior and lateral to pubic tubercle

Relatnioship between femoral triangle and subsartorial canal?

Boundaries of fem triangle are sartorius and aductor longus | Vessels/nerve descend below sartorius, new boundaries are adductor longus and vastus medialis

What is at the end of the subsartorial canal?

Hiatus in adductor magnus