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Surgery Flashcards

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1
Q

Size of aortic aneurysm before you need surgical repair

A

> 5.4cm

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2
Q

when would you urgently repair aortic aneurysm

A

high risk of rupture e.g. symptomatic or rapid expansion

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3
Q

if an aortic aneurysm doesn’t meet criteria for elective repair what should you do?

A

USS every 1y if 3-4.4cm

USS every 3m if 4.4-5.4cm

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4
Q

define bulbar (and pseudobulbar palsy)

A

problems with impaired lower cranial nerves (either the lower motor neurons or to the lower cranial nerve itself)
pseudo = upper motor neurone damage, also have emotional lability

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5
Q

how do you repair AAA

A

CT to assess extent of leak

synthetic grafting or endovascular repair

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6
Q

management of cholangitis

A

IV fluid resus
lactate
Antibiotics
pigtail drain (cholecystostomy) until ERCP

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7
Q

two causes of acute limb ischaemia

A

embolus (very acute, AF)

thrombosis of atherosclerotic plaque (more gradual, intermittent claudication history)

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8
Q

CT scan shows swirled appearance of mesentery. What is the diagnosis

A

Internal herniation of bowel, sometimes after gastric bypass

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9
Q

what vein is usually affected in varicose veins

A

Superficial venous system, most likely long saphenous

Could be short saphenous in the posterior/lateral leg

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10
Q

X ray changes and clinical picture of diaphragmatic hiatal hernia

A

gastric air-fluid level behind mediastinum

Epigastric pain, SOB and reduced air entry

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11
Q

Signs of bowel obstruction

A

colicky abdo pain, distension, vomiting, absolute constipation
hyper-resonance, high-pitched tinkling

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12
Q

Signs of pancreatitis

A

vomiting, severe abdo pain better leaning forward

gallstone clues, jaundice

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13
Q

What cholangitis is UC associated with

A

primary sclerosing cholangitis

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14
Q

signs of acute decompensated liver disease

A

encephalopathy, increased jaundice, deteriorating transaminases

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15
Q

charcot’s triad

+2 for Reynold’s pentad

A

1) fever
2) jaundice
3) RUQ pain

hypotension and altered mental status

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16
Q

6 P’s of limb ischaemia

A 
PARAESTHESIA
PARALYSED
pulseless
pallor
perishingly cold
painful
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17
Q

antibodies in PBC

A

Anti-mitochondrial

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18
Q

findings of extrahepatic cholestasis

A

high ALP
high conj bilirubin and unconj bilirubin
caused by gallstones, bile duct strictures, tumours blocking bile flow

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19
Q

definitive treatment for PSC

A

liver transplant

before this they need fat soluble vitamin supplements

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20
Q

Arterial ulcer management

A

ABPI, optimal diabetic control, angioplasty, antiplatelet and statin

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21
Q

what is achalasia

A

rare motility disorder from oesophageal ganglion degeneration.

Difficulty swallowing liquids and solids, regurgitation of food, retrosternal chest pain

diagnosis confirmed via oesophageal manometry
management: surgical myotomy or pneumatic dilation

oesophageal cancer and chagas disease are risks

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22
Q

glasgow score criteria

A 
age >55
pO2 <8
WCC >15
Calcium <2
ALT >100
LDH >600
glucose >10
urea >16
albumin <32
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23
Q

features of arterial ulcers vs neuropathic ulcers

A

arterial: painful, sharply defined, loss of pulses, dusky and loss of hair
neuropathic: painless, sites of trauma/weight bearing, loss of sensation and reflexes, present pulses

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24
Q

what is Rockall score

A 
Upper GI bleed severity score
Shock signs
Age
Likely Diagnosis
Co-morbidities
stigmata of acute bleeding
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25
Investigations for pancreatic cancer
``` Ca19-9 USS and CT ERCP Cytology on pancreatic juice and bile needle biopsy ```
26
Treatment options for pancreatic cancer
Supportive palliation by endoscopic/transhepatic stenting of malignant stricutre Surgical palliation by biliary bypass Whipple's procedure
27
causes of jaundice post abdo surgery
``` haemorrhage wound infection wound dehiscence delayed wound healing renal failure ```
28
What liver pathology is associated with COCP
hepatocellular adenoma
29
what other organ gets cysts in ADPKD
liver, well-demarcated round cysts | will not enhance with IV contrast
30
What is amputation through the ankle joint called
Syme's amputation
31
what is a gallbladder empyema
complication of cholecystitis where abscess forms. Swinging fevers and palpable gallbladder will need cholecystectomy or cholecystostomy may come from infected mucocoeles
32
Define Mirizzi syndrome
gallstone impacted in neck of gallbladder causes extrinsic compression of CBD resulting in obstructive jaundice
33
what is gallstone ileus
mechanical SBO as a result of fistulous connection between gallbladder and SB. Gallstone enters the small bowel, impacting the ileocaecal valve
34
``` Define following signs Cullens Murphy's Rigler Sister Joseph's ```
Cullens = periumbilical bruising in retroperitoneal haemorrhage Murphy's = pain on expiration when hand is over gallbladder Rigler's = air on both sides of intestine in pneumoperitoneum Sister Joseph's = nodule at umbilicus assoc with intra-abdominal neoplastic disease
35
which two cancers usually spread to form cannonball mets
renal cell carcinoma | choriocarcinoma
36
how would you treat venous ulcers
limb elevation, wound toilet and nonstick dressing, split-skin graft if required treat varicose veins after ulcer
37
What is Peutz-Jegher's syndrome
multiple intestinal hamartomatous polyps freckles small bowel tumours, stomach, pancreas and colon AD inheritance
38
how to treat bleeding gastric ulcer
stabilise and resuscitate with major haemorrhage protocols | upper GI endoscopy then IV PPI
39
which 3 tests can you assess varicose veins
Simple tourniquet: lying down, raise legs and milk veins so all blood is gone. tie tourniquet around thigh (sapheno-femoral junction) and ask to stand and assess if fill (no filling is incompetent) Trendelenberg: same but with a finger at the junction Doppler: reflux assessment. place over sapheno-femoral junction and squeeze calf. 2 sounds heard in incompetence
40
indications for surgical treatment of varicose veins
oedema skin changes venous eczema and ulceration
41
what is the BP target for resuscitating AAA
<100 to prevent re-bleeding if initial leak is sealed
42
which two infections can cause Right Iliac Fossa mass
Tuberculosis, yersinia
43
investigations for oesophageal carcinoma
OGD CT CAP - nodal spread endoscopic ultrasound - T and local N staging PET scan - staging and distal mets and small lymph nodes which are still involved
44
treatment for metastatic oesophageal cancer in non-regional node
palliative chemo radiological insertion of oesophageal stent (severe dysphagia) laser treatment
45
treatment for oesophageal cancer with mets in regional node
curative oesphagectomy
46
risk factors for oesophageal carcinoma
GORD (adeno) smoking (SCC) achalasia
47
pancreatitis investigations
serum amylase (diagnostic if over 1000) contrast CT diagnostic USS to look for gallstones
48
pancreatitis management
IV fluids (5L in 2-3h) analgesia BG oral feeding within 24h - consider NG and slow enteral feeding ABx only if septic ERCP only if gallstone expected
49
what complications may follow resolved pancreatitis
pseudocysts - may lead to pancreatic ascites pancreatic abscess - features of sepsis
50
management of pseudocyst
conservatively drained percutaneously at endoscopic ultrasound think about how pseudocyst formed - may need ERCP to identify any leak/insert stents
51
investigations for pancreatic exocrine insufficiency
faecal elastase | clinical judgement
52
management of pancreatic exocrine insufficiency
oral pancreatic enzyme replacement (Creon, pancreas V, nutrizyme)
53
treatment for PBC
UCDA
54
causes of free intra-peritoneal air
laparotomy within 24h perforated duodenal ulcer perforated diverticulum
55
causes of free retro-peritoneal air
perforated 3rd part duodenum, ascending colon or descending colon
56
stress-induced ulcer after burns | Where is it?
Curling's ulcer | stomach/duodenum
57
ulcer after raised icp
Cushings ulcer
58
what is zollinger ellison syndrome
peptic ulceration secondary to gastrin-secreting tumours assoc with men1
59
treatment for gallstone ileus
enterolithotomy and fistula repair
60
what is a Marjolin ulcer
chronic venous ulcer undergoes SCC malignant change. Edges become raised/thickened and it becomes more painful
61
investigation for renal stone
non-contrast of CT
62
cytology finding on fibrocystic disease
cell debris and no malignant cells
63
best analgesia for people with severe COPD
do not use opioids or NSAIDs can use epidural
64
when do leaking anastamoses usually present after surgery
day 3-5
65
investigations for people with thyroid nodule and are euthyroid
USS neck
66
investigation for people with thyroid nodule and are hyperthyroid
antibodies and scintigraphy
67
best investigation for right sided hearing loss with normal tympanometry
MR internal acoustic meatus
68
management for acute cholecystitis with normal LFTs and normal common bile duct
laparoscopic cholecystectomy ERCP only if you're worried about common bile duct issues
69
fasting times before general anaesthetic
2h clear liquids, 6h foods
70
management for stone causing obstruction, hydronephrosis and sepsis
nephrostomy as you need to drain the pus otherwise abx won't work then lithotripsy or stone extraction
71
what nodes do the ovarian lymphatics drain to
para-aortic
72
referral of pain from originally foregut structures
epigastrium
73
referral of pain from originally midgut structures
umbilical
74
referral of pain from originally hindgut structures
hypogastric
75
radiation of pain from retroperitoneal structures
back
76
what is rovsing's sign
pain in right IF when left felt | appendicitis
77
scoring for appendicitis
alvorado | >4 = likely appendicitis
78
which neck lump moves with tongue protrusion but not swallowing
thyroglossal mass
79
which neck lump moves with swallowing but not tongue protrusion
thyroid
80
how to tell the difference between indirect and direct hernia
reduce hernia, occlude the deep ring and ask them to cough | indirect hernia will not come back
81
how to tell difference between inguinal and femoral hernia
femoral is below crease of groin, low and lateral to pubic tubercle
82
do hernias need to be surgically treated?
yes if complications or femoral

Capsule notes (8 decks)

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