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Year 6 - Surgery > Mr Hardy Teaching > Flashcards

Mr Hardy Teaching Flashcards

1
Q

What does management equal?

A

Mx = Dx + Tx

Where dx is the combination of hx, exam, ix

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2
Q

The Surgical Sieve

A

VITAMINS CDE

Vascular

Infection / Inflammation

Traumatic / Toxins

Autoimmune

Metabolic

Iatrogenic / Idiopathic

Neoplastic

Social

Congenital

Degenerative

Endocrine / Exocrine

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3
Q

How would you categorise the factors contributing to a complication of surgery?

A

Pre, Operative, Post

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4
Q

RFs for haemorrhage post op

A

Pre: failure to stop NSAIDs + hereditary clotting disorders

Op: use of monopolar diathermy causing collateral damage

Post: started on anticoagulants + infection that moves the suture knot

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5
Q

Virchow’s Triad

A

Endothelial Injury
Hypercoagulability
Venous Stasis

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6
Q

RFs for superficial infection post op

A

Pre: young/old, smoker, diabetic, steroids, immunocomp, cardiac/renal/vasc disease, preexisting infection

Op: death by a thousand cuts, failure to wash out dead tissue, too much suture tension causing ischaemia

Post: poor wound care

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7
Q

Celsus Tetrad

A 
Rubor
Calor
Tumor
Dolor
Functio Laesa
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8
Q

How would you categorise complications of a fracture?

A

IMMEDIATE <24h
Local: 1° haemorrhage and soft tissue injury

Syst: hypovolaemic shock and asphyxia

EARLY <2w
Local: reactionary/2° haemorrhage, wound dehiscence, infection, compartment syndrome, Volkmann’s contracture

Syst: fat embolism, DVT, PE, ARDS, atelectasis, c diff, constipation, acute urinary retention, confusion, bed sores

LATE >2w
Local: malunion, nonunion, stiffness, loosening, CRPS

Syst: atelectasis - pneumonia, acute urinary retention - cystitis - sepsis, psychological

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9
Q

Haemorrhage: Reactionary vs Secondary

A

Reactionary - rise in bp following fluid therapy for hypovolaemia

Secondary - erosion of a vessel from a spreading infection

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10
Q

What is a late systemic comp of a right hemicolectomy?

A

Pernicious Anaemia

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11
Q

How are abx used in surgery?

A

Prophylactic: immunocomp, at inc risk of infection, consequences would be serious

Treatment: local + spreading

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12
Q

How are abx used prophylactically?

A

Immunocomp: young/old, smoker, diabetic, steroids, chemo, cancer, HIV, TB

At inc risk of infection: surgery involving the appendix, large bowel, gynae

Consequences would be serious: heart valve, prosthetic limb, VP shunt, mesh

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13
Q

How are abx used as treatment?

A

Local (no abx: incision -> drainage) - abscess, empyema, pyelonephritis, osteomyelitis

Spreading (abx: broad -> narrow) - cellulitis, septicaemia, meningitis, ascending cholangitis

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14
Q

How can you categorise the presentation of any tumour?

A

Primary, Secondary, General vs Hx/Sx, Exam/Signs, Special Ix

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15
Q

Px of testicular seminoma

A

Hx: 1° painless lump + 2° inguinal lump, abdo pain, back pain + 3° FLAWS

O/e: 1° SSSSSS, can get above, no transillumination + 2° inguinal LN, retroperitoneal lesion, chest lesion + 3° anaemic

Ix: 1° imaging and histology + 2° CT-CAP + 3° FBC, hyperCa, tumour markers

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16
Q

How would you describe a lump? (6)

A 
Site
Size
Shape
Surface
Surrounds
conSistency
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17
Q

Px of breast ca

A

Hx: 1° lump, pain, bloody discharge + 2° axillary lump, night bone pain, cough + 3° FLAWS

O/e: 1° inverted nipple, tethering, peau d’orange + 2° axillary lymphadenopathy, bony tenderness, oedema + 3° anaemic

Ix: 1° imaging and histology + 2° CXR + 3° FBC, hyperCa, tumour markers

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18
Q

What is breast triple assessment?

A

Hx+Exam, US/Mammography, FNA/Biopsy

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19
Q

What cancers metastasise to bone? (6)

A 
Bronchus
Breast
Brostate
Byroid
Bidney
\+ Sometimes Bowel
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20
Q

How would you categorise tumours of the bone?

A

Benign: simple cyst, osteoid osteoma, osteochondroma, enchondroma, fibrous dysplasia

1° Malignant: ewing’s, osteosarcoma, chondrosarcoma, myeloma

2° Malignant: metastasis

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21
Q

Mneumonic for describing any disease

A

Dressed In a Surgeon’s Gown A Physician Might Make Some Significant Progress

Definition
Incidence
Sex
Geography
Aetiology
Pathogenesis
Macroscopic Path
Microscopic Path
Symptoms
Signs
Prognosis
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22
Q

What is myeloma?

A

Definition: neoplasia of plasma cells

Incidence: most common primary malignant bone ca affecting those b/w 50-70yrs

Sex: M>F | Geography: AfroC | Aetiology: genetics

Pathogenesis: production of monoclonal immunoglobulins

Macro + Micro Path: haematogenous spread, raised ESR, rouleaux on blood film, B cells w reduced cytoplasm, dense band on serum electrophoresis, bence-jones protein in urine

Sx + Signs: related to the high calcium, renal failure, anaemia, affect on bone

Prognosis: pt factors, staging and grading, response to therapy

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23
Q

What is the skull on x-ray like in MM?

A

Pepper Shaker / Moth Eaten

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24
Q

What does the median nerve supply?

A

2LOAF

Lateral two lumbicals
Oppones pollicis
Abductor pollicis brevis
Flexor pollicis brevis

NB: all other intrinsic hand muscles are supplied by the ulnar nerve

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25
Q

What does the hand look like following the three possible nerve lesions?

A

DR CUMA

Dropped wrist = Radial

Claw hand = Ulnar

Ape hand = Median

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26
Q

What is a mallet finger?

A

Avulsion of the extensor tendon from the distal phalynx requiring a splint for 6-8wks followed by 1-2wks at night

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27
Q

What should you NOT do when taping up a mallet splint?

A

Tape over the holes

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28
Q

What is the thickest cartilage in the body?

A

Patella hyaline cartilage

29
Q

The four stages of # healing

A

Haematoma
Inflam
Callus
Remodelling

30
Q

What do you do if there’s asymmetrical lympadenopathy in the neck?

A

Look in both the mouth and ears

31
Q

How much does smoking reduce your oxygen carriage by?

A

Dec by 20% - due to the irreversible binding of carbon monoxide - takes 2wks of stopping to recover

32
Q

How would you tell someone has a post op ileus?

A

I’d take a full history to gather the sx, an examination to elicit signs and perform appropriate ix

Hx: bloating, failure to pass flatus/faeces, N+V

O/e: abdo distention + absent BS

Ix: bloods + imaging

33
Q

What ix for you perform for a suspected ileus?

A

Bloods - FBC, ESR, CRP, U+Es (hypoNa, hypoK, hyperCa), TFTs (hypothyroidism)

Imaging - CT abdo + pelvis w contrast

34
Q

RFs for post op ileus

A

Pre: inc age, electrolyte derangement, use of anti-cholinergic meds

Op: XS intestinal handling, peritoneal contamination, type of op (intestinal resection + pelvic surgery)

Post: use of opioid meds

35
Q

Saint’s Triad

A

Cholelithiasis
Hiatal Hernia
Diverticular Disease

36
Q

Direct vs Indirect Inguinal Hernias

A

Direct - comorbid elderly obese heavy lifter w prev surg + emerge medial to inf epigastric + lump above pubic tubercle

Indirect - younger male pt + emerge lateral to inf epigastric + lump below pubic tubercle

37
Q

What are the indications for intramedullary nailing?

A

Fractures: extracapsular NOF+ humerus/femur/tibial shaft

38
Q

What are the CIs for intramedullary nailing? (3)

A

Small medullary canal, prior malunion, infection

39
Q

What are the indications for internal fixation?

A 
Joint #
Compound #
Multiple Injury
Diff Reduction
Lost Reduction
Malignancy
40
Q

How can a fracture be described on a radiograph?

A

Pt Details, Skeletal Maturity, Location

Open vs Closed

Simple vs Comminuted

Displaced, Translated, Angulated

Any Other Abnormalities

41
Q

How can gout lead to OA?

A

Gout - Chondrocalcinosis - Meniscal Tear - OA

42
Q

List of PMHx to ask

A 
Asthma
Allergies
Angina
TB
Jaundice
Epilepsy
Diabetes
Rh Fever
Heart Attack
Stroke
High BP
Gout
43
Q

How do you tx a #?

A 
Classify
Comps
Displacement
Reduction
Stability
Immobilise
Rehabilitate
44
Q

Which meniscus is more likely to tear horizontally?

A

Lateral

45
Q

What are the different meniscal tears and their progressions?

A

Horizontal -> Flap

Radial -> Parrot Beak

Vertical -> Bucket Handle

46
Q

What should you consider when treating a pt?

A

CAGES: comps, age, general condition, etiology, site/sx/stage

47
Q

What instrument is used to measure joint ROM?

A

Goniometer

48
Q

Why is Lister’s tubercle important?

A

It acts as a pulley to EPL

49
Q

Osteophyte vs Spur

A

Location

Osteophyte: found at the joint margin w hyaline cartilage

Spur: found at the tendon insertion into bone

50
Q

Which foods predispose to gout?

A
  1. Chocolate
  2. Offal
  3. Oily Fish
  4. Game Birds
  5. Shellfish
  6. Red Meat
  7. Cruciferous
  8. Chickpeas

Fizzy Drinks + ETOH

51
Q

Bone vs Calcium

A

Bone - heterogenous - trabeculae

Calcium - homozygous - arteriosclerosis

52
Q

What are the layers of the periosteum?

A

Outer Fibrous + Inner Cambial

53
Q

What are the planes of translation?

A

X: medial v lateral

Y: proximal v distal

Z: anterior v posterior

54
Q

What are the planes of angulation?

A

X: valgus v varus

Y: int v ext rotation

Z: volar v dorsal

55
Q

Ddx for Ant Knee Pain

A

OA, Plicae/Meniscal Tear, Hoffa’s Syndrome, Patella Bursitis, Referred

56
Q

What are the four plicae of the knee?

A

Medial
Lateral
Suprapatellar
Infrapatellar

57
Q

Which plicae is most/least likely to tear?

A

Most: medial

Least: lateral

58
Q

Why does a smaller meniscal tear result in more damage?

A

Pressure = Force / Area

Therefore small area high pressure

59
Q

Maisonneuve #: DISGAPMMSSP

A

A spiral fracture of proximal third of fibula a/w unstable ankle injury

Predominantly male pts from sporting injuries accounting for 5% of all ankle injuries

The pain is worse on ext rotation and can progress to valgus deformity, peroneal nerve palsy or OA but good recovery w fixation and physio

60
Q

How do you inc the likelihood of seeing Hoffa’s syndrome on MRI?

A

Get the pt to run before scanning

61
Q

When does Hoffa’s syndrome become chronic?

A

@6wks

62
Q

Tx for Hoffa’s Syndrome

A

If acute and no wear of cartilage mx consrv w NSAIDs, physio, taping/bracing vs chronic requires day case arthroscopic resection of scarring

63
Q

Sepsis Six

A

3 IN: oxygen, abx, fluids

3 OUT: lactate, blood cultures, urine output

64
Q

What is the order of insertion in the pes anserinus?

A

Work ant-post w Say Grace before Tea: Sartorius, Gracilis, semiTendinosus

65
Q

How many sacral and coccygeal vertebrae are there?

A

S5 + C4

66
Q

What are the three main causes of a Baker’s cyst?

A

OA, semimembranosus tendonitis, meniscal tear

67
Q

What does a ruptured bakers cyst mimic?

A

DVT

68
Q

Which direction is a THR likely to wear the polyethylene?

A

Superior + Anterior

Year 6 - Surgery (27 decks)

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