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Surgery Flashcards

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1
Q

Features of mammary duct ectasia?

A

Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

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2
Q

Anatomy of direct and indirect inguinal hernias?

A

Direct:
Protrudes through Hesselback triangle
Passes medial to the inferior epigastric artery

Indirect:
Protrudes through the inguinal ring
Passes lateral to the inferior epigastric artery

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3
Q

Cause of direct and indirect inguinal herniae?

A

Direct:
Defect or weakness in the transversalis fascia area of the Hesselbach triangle

Indirect:
Failure of the processus vaginalis to close

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4
Q

Risk of strangulation in inguinal herniae compared to femoral?

A

Low in inguinal, high in femoral

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5
Q

Ages of inguinal herniae?

A

older - direct

Indirect - may occur in children

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6
Q

Location appearance and output for ileostomy vs colostomy?

A

Ileostomy

  • Right iliac fossa
  • Spouted
  • Liquid output

Colostomy

  • More likely left, can be anywhere
  • Flush to the skin
  • Solid output
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7
Q

Peptic ulcers pain follwoign eating, which is which>

A

Gastric - worse by eating

Duodenal - better after eating

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8
Q

Up to how long would finasteride take to work for BPH?

A

6 months

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9
Q

Rules for sulphonylureas when going to have surgery?

A
  • omit on the day of surgery

- exception is morning surgery in patients who take BD - they can have the afternoon dose

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10
Q

What is malignant hyperthermia?

A

a rare, serious side effect of volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane), which cause all skeletal muscle to rapidly contract, including during a neuromuscular blockade. MH is a genetic disorder, manifesting due to calcium overload in the skeletal muscle causing sustained muscular contraction and rhabdomyolysis, resulting in excess anaerobic metabolism causing acidosis. End-tidal CO2 increases as a result, along with body temperature which causes diaphoresis (excess sweating).

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11
Q

Management of fibroadenoma?

A

<3cm then monitor

> 3cm may need to excise

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12
Q

What is the cut-off age for an unexplained breast lump to be referred under 2ww

A

30 years

Can have non-urgent referral if under 30

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13
Q

How to manage congenital inguinal hernia?

A

Urgent referral due to incarceration risk

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14
Q

PSA levels increased due to what and how long ago?

A 
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
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15
Q

What is first-line in treating BPH?

A

alpha-1 antagonists e.g. tamsulosin, alfuzosin

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16
Q

Most common type of breast cancer?

A

Invasive ductal carcinoma

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17
Q

non-surgical treatments for breast cancer?

A

Radiotherapy - T3/4 and those who have had wide local excision.

Hormonal - if they have +ve receptors (ER, HER, PR) use tamoxifen in pre and peri-menopausal. If they are post menopausal and ER receptor +ve then anastrazole

Biological - herceptin (trastuzumab) if HER2 +ve could be considered

Chemo- depends on situation.

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18
Q

What factors would mean mastectomy over wide local excision for breast cancer?

A

mastectomy:

  • Multifocal
  • Central
  • Large lesion in small breast
  • DCIS >4cm

The opposite would lead to wide local excision.

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19
Q

When is the screening for AAA? What is it?

A

Single abdo USS >65yrs

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20
Q

Most common bacteria in breast abscess?

A

Staphylococcus aureus

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21
Q

Adverse effects of aromatase inhibitors (anastrazole)

A 
osteoporosis
- NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
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22
Q

Adverse effects of Tamoxifen

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

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23
Q

NHS breast cancer screenign programme details?

A

The NHS Breast Screening Programme is offered to women between the ages of 50-70 years. Women are offered a mammogram every 3 years. After the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments’.

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24
Q

Management of oral metformin prescription when undergoing surgery?

A

OD or BD: take as normal

TDS: miss lunchtime dose

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25
What are the details of the colorectal cancer screening programme in the UK?
One off colonoscopy was abandoned. We now offer FIT tests every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland. Patients aged over 74 years may request screening.
26
What GA would you use to induce someone who has had N&V post op before ?
Propofol (it has antiemetic actions).
27
what do you offer men post vasectomy to confirm success?
Semen analysis at 16 and 20 weeks.
28
Oral antidiabetic meds day before surgery?
All oral antidiabetic medications should be taken as normal the day before surgery
29
Complications of measles?
otitis media: the most common complication pneumonia: the most common cause of death encephalitis: typically occurs 1-2 weeks following the onset of the illness) subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness febrile convulsions keratoconjunctivitis, corneal ulceration diarrhoea increased incidence of appendicitis myocarditis
30
clenched hands, rocker bottom feet and clubbed feet in a foetus might indicate?
Edwards
31
What could you prescribe for labial adhesions if there are complications?
Oestrogen cream
32
What are the causes of cyanotic congenital heart disease?
tetralogy of Fallot transposition of the great arteries (TGA) tricuspid atresia
33
What is Caput succedaneum?
Caput succedaneum describes oedema of the scalp at the presenting part of the head, typically the vertex. This may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery. No treatment needed.
34
Difference between Caput Succadeneum and Cephalohaematoma?
Haematoma does not cross suture lines and will take months to resolve Caput will resolve within days.
35
What investigation do all breech babies get if born after 36 weeks?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
36
What is benign rolandic epilepsy?
seizures characteristically occur at night seizures are typically partial (e.g. paraesthesia affecting face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements) child is otherwise normal
37
First line management for paediatric constipation?
diet advice and movicol
38
Emergency treatment for croup? (in hospital)
high-flow oxygen | nebulised adrenaline
39
Presentation of Roseola Infantum or Sixth disease?
high fever: lasting a few days, followed later by a maculopapular rash Nagayama spots: papular enanthem on the uvula and soft palate febrile convulsions occur in around 10-15% diarrhoea and cough are also commonly seen
40
What genetic condition is associated with aortic stenosis?
Williams syndrome
41
What genetic syndromes cause hypotonia in kids?
Down's syndrome - most common | Prader-Willi syndrome
42
Management of bow leggedness in kids <3?
Normal variant - reassurance
43
If you can't get 'above' a testicular swelling - likely diagnosis?
Inguinal hernia
44
Features of hydrocele?
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle the swelling is confined to the scrotum, you can get 'above' the mass on examination transilluminates with a pen torch the testis may be difficult to palpate if the hydrocele is large
45
Features of varcocele?
Diffuse painless swelling - lumpy/bag of worms separate from testicle.
46
Failure rate of male sterilisation?
1 in 2,000
47
What is a duct papilloma, how does one present?
Local areas of epithelial proliferation in large mammary ducts Hyperplastic lesions rather than malignant or premalignant May present with blood stained discharge
48
What is a hartmanns procedure, when would you perform?
Resection of the sigmoid colon is performed and an end colostomy is fashioned Lesion in the sigmoid with perforation.
49
resection for lesions in Distal transverse, descending colon?
Left hemi
50
resection for Caecal, ascending or proximal transverse colon lesions?
Right hemi
51
Resection for lesions in the sigmoid?
High anterior resection
52
Resection for lesions in the rectum?
Anterior resection if anal verge then Abdomino-perineal excision of rectum
53
Testicular cancer seminoma or teratoma better survival?
Seminoma
54
What medication is used to prevent cerebral vasospasm in SAH?
Nimodipine
55
Management of asymptomatic inguinal herniae?
routine referral for repair
56
Management of breast cysts?
Cysts should be aspirated, those which are blood stained or persistently refill should be biopsied or excised
57
Haemorrhoid grades?
Grade I Do not prolapse out of the anal canal Grade II Prolapse on defecation but reduce spontaneously Grade III Can be manually reduced Grade IV Cannot be reduced
58
Intervention for renal stones?
Stone burden of less than 2cm in aggregate - Lithotripsy Stone burden of less than 2cm in pregnant females - Ureteroscopy Complex renal calculi and staghorn calculi - Percutaneous nephrolithotomy Ureteric calculi less than 5mm - Manage expectantly
59
Drug causes of pancreatitis?
azathioprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
60
GET SMASHED Mnemonic?
Gallstones Ethanol Trauma Steroids Mumps (other viruses include Coxsackie B) Autoimmune (e.g. polyarteritis nodosa), Ascaris infection Scorpion venom Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia ERCP Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
61
ABPI that is abnormal?
An ankle-brachial pressure index of < 0.9 is suggestive of PAD, with an index < 0.5 suggesting critical limb ischaemia
62
Complications of measles?
otitis media: the most common complication pneumonia: the most common cause of death encephalitis: typically occurs 1-2 weeks following the onset of the illness) subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness febrile convulsions keratoconjunctivitis, corneal ulceration diarrhoea increased incidence of appendicitis myocarditis
63
clenched hands, rocker bottom feet and clubbed feet in a foetus might indicate?
Edwards
64
What could you prescribe for labial adhesions if there are complications?
Oestrogen cream
65
What are the causes of cyanotic congenital heart disease?
tetralogy of Fallot transposition of the great arteries (TGA) tricuspid atresia
66
What is Caput succedaneum?
Caput succedaneum describes oedema of the scalp at the presenting part of the head, typically the vertex. This may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery. No treatment needed.
67
Difference between Caput Succadeneum and Cephalohaematoma?
Haematoma does not cross suture lines and will take months to resolve Caput will resolve within days.
68
What investigation do all breech babies get if born after 36 weeks?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
69
What is benign rolandic epilepsy?
seizures characteristically occur at night seizures are typically partial (e.g. paraesthesia affecting face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements) child is otherwise normal
70
First line management for paediatric constipation?
diet advice and movicol
71
Emergency treatment for croup?
high-flow oxygen | nebulised adrenaline
72
Presentation of Roseola Infantum or Sixth disease?
high fever: lasting a few days, followed later by a maculopapular rash Nagayama spots: papular enanthem on the uvula and soft palate febrile convulsions occur in around 10-15% diarrhoea and cough are also commonly seen
73
What genetic condition is associated with aortic stenosis?
Williams syndrome
74
What genetic syndromes cause hypotonia in kids?
Down's syndrome - most common | Prader-Willi syndrome
75
Management of bow leggedness in kids <3?
Normal variant - reassurance
76
Age to be considered precoscious puberty?
<8 in girls | <9 in boys

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