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Oishi's Final year flashcards > Senior surgery > Flashcards

Senior surgery Flashcards

1
Q

Truelove and Whitt’s criteria for acute severe colitis?

A 
Frequency of stool >6
Overtly bloody stool
Fever (>37.5)
Tachycardia (>90)
Anaemia (Hb<105)
Raised ESR (>30)
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2
Q

1st line tx for severe UC flare?

A

IV hydrocortisone 100mg 6 hourly
LMWH
AdCal-D3

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3
Q

2nd line tx for severe UC flare?

A

Ciclosporin

infliximab if contraindicated

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4
Q

Initial ix in someone with ?bowel obstruction?

A

Basic obs
PR
Supine AXR

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5
Q

Difference between caecal voluvulus and sigmoid volvulus on axr?

A 
Sigmoid = upside down U
Caecal = U
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6
Q

Initial mx of volvulus?

A

Sigmoidoscopy and passage of decompressing flatus tube

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7
Q

Why does sigmoid volvulus occur?

A

Due to twisting of the bowel on lax mesentery

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8
Q

Tx for recurrent sigmoid volvulus?

A

Sigmoid colectomy

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9
Q

Which side of colon cancer is more likely to obstruct?

A

Left

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10
Q

Which side of colon cancer is more likely to cause anaemia?

A

Right

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11
Q

Who is a barium enema contraindicated in?

A

Patients at risk of perforation

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12
Q

What does presence of air in the rectum in obstruction suggest?

A

Left side obstruction unlikely

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13
Q

How is pseudo-obstruction usually managed?

A

Conservatively
Correct electrolyte abnormalities
Colonoscopic decompression can be useful acutely

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14
Q

AXR diameter for small and large bowel obstruction

A

Small >3cm

Large >5cm

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15
Q

Most likely cause of peritonitis?

A

Perforated viscus

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16
Q

Common causes of free intra-peritoneal air (pneumoperitoneum)?

A

Laparotomy 24 hours ago
Perforated duodenal ulcer
Perforated diverticulum

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17
Q

Perforation of which structures can cause air to accumulate retroperitoneally?

A

3rd part of duodenum
Ascending colon
Descending colon

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18
Q

Causes of toxic megacolon?

A

UC
Infective colitis
Crohn’s

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19
Q

What level does serum amylase need to be to confirm pancreatitis?

A

> 1000

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20
Q

How can a pancreatic pseudocyst be managed?

A

1st line = Conservative - Admit for bowel rest (nil by mouth), parenteral nutrition (TPN), regular imaging, and observation (up to 12 weeks)
2nd line = Endoscopic ultrasound guided drainage
3rd line = cystogastrostomy

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21
Q

How to measure pancreatic insufficiency?

A

Clinical judgement

Faecal elastase

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22
Q

Glasgow Imrie Score for acute pancreatitis? When do you use it?

A 
PaO2< 7.9kPa
Age >55y/o
Neutrophils (WBC > 15)
Calcium < 2mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L

Use it 48 hours after admission!

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23
Q

Complications of ERCP?

A 
Perforation
Aspiration pneumonia
Haemorrhage
Acute pancreatitis
Ascending cholangitis
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24
Q

When might you see porcelain gallbladder?

A

In chronic cholecystitis and gallstones

Premalignant

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25
Q

Signs of pyogenic liver abscess?

A

Liver enlargement
RUQ pain
Sepsis

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26
Q

CIs to liver biopsy?

A

INR >1.3
Platelets <100×109/L
Acute confusional state
Extensive ascites

27
Q

Common cause of increased bowel sounds?

A

small bowel obstruction

28
Q

Common cause of decreased bowel sounds?

A

Post-op ileus

29
Q

What value do you aim for K to be above in ileus?

A

K+ >4mmol (maximise chance of peristalsis starting)

30
Q

What do you need to give before administering TPN?

A

IV pabrinex

31
Q

Most common type of inguinal hernia?

A

Indirect (80%)

32
Q

Anatomical landmark for inguinal hernia?

A

Superior and medial to pubic tubercle

33
Q

Anatomical landmark for femoral hernia

A

Inferior and lateral to pubic tubercle

34
Q

How would you differentiate clinically between a direct or indirect hernia?

A

Reduce hernia and place 2 fingers above deep ring
Get pt to cough
If the hernia is controlled (suggesting that it commences at the deep ring) it is an indirect one; if it protrudes it is direct

35
Q

Contents of spermatic cord?

A

3 arteries: testicular, cremasteric and artery to the vas deferens
3 nerves: genitofemoral nerve, sympathetics (and ilioinguinal – not actually in cord, but in canal)
3 other structures: vas deferens, veins (pampiniform plexus) and lymphatic

36
Q

Most common surgical mx of inguinal hernias?

A

Lichtenstein mesh repair

37
Q

Ix for achalasia?

A

Barium swallow
Upper GI endoscopy
Oesophageal manometry

38
Q

Seminoma histology?

A

“cut potato”

mixture of large round tumour cells with clear cytoplasm and normal small mature lymphocytes

39
Q

Where do testicular seminomas spread to first?

A

Para aortic lymph nodes

40
Q

What does a seminoma produce?

A

placental alkaline phosphatase (PLAP)

41
Q

What does a teratoma produce?

A

AFP

42
Q

Retroperitoneal organs? SAD PUCKER

A 
S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)oesophagus
R: rectum
43
Q

Fundoscopy findings in dry macular degeneration?

A

Drusen - yellow round spots in Bruch’s membrane

44
Q

Which line is best for long term chemo?

A

Hickman line

45
Q

indications for surgical involvement in sigmoid volvulus ?

A

repeated failed attempts at decompression
necrotic bowel noted at endoscopy
suspected (or proven) perforation or peritonitis

46
Q

first-line option for adults with a BMI >50 trying to lose weight?

A

Refer for bariatric surgery consideration

47
Q

Fundoscopy findings in wet macular degeneration?

A

choroidal neovascularisation

48
Q

Causes of tunnel vision?

A 
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
49
Q

What drug should be given in SAH and why?

A

Nimodipine is used to prevent vasospasm in aneurysmal subarachnoid haemorrhages

50
Q

Most likely causes of blown right pupil (third cranial nerve compression)?

A

Extradural haemorrhage

trans tentorial herniation

51
Q

flexible sigmoidoscopy a lesion is biopsied and reported as showing ‘fibromuscular obliteration’ - what is it most likely to be?

A

Solitary rectal ulcer syndrome

52
Q

Cause for ongoing jaundice and pain after cholecystectomy?

A

Gallstones may be present in the CBD

53
Q

When not to check a serum PSA?

A 
Following:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
54
Q

Medical tx in peripheral arterial disease?

A

Atorvastatin 80mg

Clopidogrel

55
Q

SE of Aromatase inhibitors (e.g. anastrozole)?

A

Osteoporosis

56
Q

Drugs which can be dialysed out? BLAST

A 
Barbiturates
Lithium
Alcohol
Salicylates
Theophylline
57
Q

What condition are pigmented gallstones associated with?

A

Sickle cell disease

58
Q

What surgical tx is used for rectal prolapse?

A

Delorme procedure

59
Q

Which anaesthetic agent can cause an addisonian crisis?

A

Etomidate

60
Q

Which cyst is anterior to the sternocleidomastoid?

A

Branchial cyst (don’t transilluminate)

61
Q

How might orbital fractures present?

A

Infra-orbital/upper lip numbness

Diplopia

62
Q

Features of proctitis (UC)?

A

Rectal bleeding
Constipation/diarrhoea
Nocturnal incontinence

63
Q

What tx is typically used for aneurysm after SAH?

A

Aneurysm coiling

Oishi's Final year flashcards (9 decks)

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