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Surgery Flashcards

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1
Q

Screening for AAA
Who and age and investigation of choice

A

US
Males aged 65yo

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2
Q

Screening AAA
Interpretation

A

<3cm normal, no further action
3-4.4cm small aneurysm, rescan every 12 months
4.5-5.4cm medium aneurysm, rescan every 3 months
>=5.5cm large, refer within 2 weeks to vascular

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3
Q

When to refer to be seen within 2 weeks by a vascular surgeon for AAA
Mx

A

If symptomatic
OR
>=5.5cm
OR
Rapidly enlarging (>1cm/year)

Mx EVAR

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4
Q

Normal size of infrarenal aorta in females and males
What size is considered aneurysmal?
Name two major RF for a AAA

A

1.5cm females
1.7cm males
3cm aneurysm

Smoking
HTN

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5
Q

Epigastric pain relieved by eating =
Epigastric pain worsened by eating =

A

Duodenal
Gastric ulcers

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6
Q

Describe Cullen’s and Grey Turner’s sign
Seen in which condtion?

A

Periumbilical discolouration = Cullen’s
Turner’s = flank pain

Acute pancreatitis

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7
Q

Location of inguinal hernia + femoral hernia

A

Above and medial to pubic tubercle
Below and lateral to pubic tubercle

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8
Q

Hernia’s that are rare and often seen in older patients =

A

Spigelian hernia

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9
Q

Hernia more common in females and typically presents with bowel obstruction =

A

Obturator hernia

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10
Q

Congenital inguinal hernias are more common in ? (2)
Most commonly on what side?
Mx

A

Boys
Premature babies
Right sided
Mx surgically repaired soon after diagnosis

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11
Q

Infantile umbilical hernia are more common in (2)
Mx

A

Premature babies
Afro-Caribbean
Resolves without intervention

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12
Q

Most common organism causing acute bacterial prostatitis

A

E coli

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13
Q

Causes of pancreatitis

A

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
High calcium, trigylyc, hypotheramia
ERCP
Drugs

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14
Q

Name five drugs that can cause pancreatitis

A

Mesalazine
AZT
Bendroflumethiazide
Sodium valproate
Furosemide

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15
Q

Difference between acute and chronic fissure
RF (3)

A

<6 weeks versus >6 weeks

IBD, constipation, STIs

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16
Q

Mx of acute anal fissures (4)

A
  1. Soften stool - diet and high fluid, bulk forming laxatives (e.g fybogel)
  2. Lubricants prior to defecation
  3. Topical anaesthetics
  4. Analgesia
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17
Q

Mx of chronic anal fissures (2)

A
  1. GTN topical
  2. If not effective after 8 weeks then refer to secondary care for surgery or botox
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18
Q

ABPI interpretation
>1.2
1-1.2
0.9-1
<0.9
<0.5

A

> 1.2 calcified, stiff arteries
1-1.2 normal
0.9-1 acceptable
<0.9 PAD
<0.5 severe disease, refer urgently

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19
Q

Mx of venous ulcers
ABPI must be >=?

A

Compression bandaging
0.8

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20
Q

Adverse effects of selective oestrogen receptor modulators (e.g tamoxifen) (5)

MOA

A

Vaginal bleeding
Amenorrhoea
Hot flushes
VTE
Endometrial ca

oestrogen receptor antagonist and partial agonist

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21
Q

Aromatase inhibitors
Example
MOA
Adverse effects (4)

A

Anastrozole
Reduced peripheral oestrogen synthesis

Adverse effects
Osteoporosis
Hot flushes
Arthralgia
Insomnia

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22
Q

Ascending cholangitis is most commonly caused by which organism?

Mx (2)

A

E coli

IV abx
ERCP after 24-48 hours

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23
Q

Charcot’s triad ascending cholangitis
Ix

A

Jaundice
RUQ
Fever

USS

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24
Q

Balanitis general mx (3)

A

Wash foreskin
Saline washes
Hydrocortisone 1%

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25
Balanitis bacterial mx
Fluclox or clarithro
26
Balanitis secondary to lichen sclerosus mx (2)
Clobetasol (high dose) Circumcision
27
Fibroadenoma When to surgically excise
>3cm
28
Mx breast cyst (2)
Aspirate If blood stained or persistently refill then biopsy/ excise
29
Breast lesions: Traumatic aetiology Mass may increase in size initially = Mx
Fat necrosis Imaging and biopsy
30
Nipple discharge, mass = which breast lesion?
Duct papilloma
31
BPH Ix (4)
Urine dip PSA U+E Urinary frequency volume chart for at least 3/7
32
What is the IPSS? Interpretation
International Prostate Symptoms Score? 20-35 = severe sx 8-19 = moderate sx 0-7 = mild sx
33
BPH Mx (3) SE of each
1. Alpha-1 antag e.g tamsulosin, alfuzosin SE dry mouth, dizziness, postural hypotension 2. 5-alpha reductase inhibitors e.g finasteride SE erectile dysfunction, reduced libido, ejaculation issues, gynaecomastia 3. Surgery - TURP
34
In BPH if symptoms persist after treatment with an alpha blocker alone and symptoms are largely storage and voiding symptoms what medicine can be started? (2)
Tolterodine or darifenacin
35
What infection can increase the risk of bladder ca? What type of bladder ca?
Schistosomiasis SCC
36
Most common type of bladder ca?
Transitional cell carcinoma
37
When to refer for bladder ca?
45yo >= with - unexplained visible haematuria without UTI OR - visible haematuria persistent after treatment of UTI OR 60>= with - unexplained non visible haematuria AND - dysuria OR raised WCC
38
RF for VTE Surgery +GA - how long Surgery pelvis or lower limb + GA how long? BMI > Age >
90 mins 60 mins BMI >35 >60yo
39
Pre-surgical interventions Women should stop taking the COCP/HRT for how long prior to surgery?
4 weeks
40
Post op prophylaxis VTE Elective hip surgery (3)
LMWH for 10/7 folllowed by aspirin 75mg for 28 days OR LMWH for 28 days with stockings until discharge OR Rivarox
41
Post op VTE prophylaxis Elective knee surgery (3)
Aspirin for 14/7 OR LMWH for 14/7 with stockings until discharge OR Rivarox
42
Post fragility fractures VTE prophylaxis (2)
LMWH starting 6-12 hours post op for 1 month OR Fondaparinux starting 6 hours post surgery for 1 month
43
Vasectomy failure rate What needs to be done prior to UPSI
1 per 2,000 Semen analysis x2 usually at 16 and 20 weeks post op
44
Success rate of vasectomy reversal if done within 10 years and after 10 years
55% 25%
45
RF for varicose veins (4)
Increasing age Female Pregnancy Obesity
46
Conservative mx of varicose veins (4)
Leg elevation Weight loss Regular exercise Graduated compression stockings
47
When to refer to secondary care for varicose veins? (4)
Pain/ discomfort/ swelling Bleeding Skin changes Venous leg ulcer
48
Secondary care mx of varicose veins (3)
Endothermal ablation Foam sclerotherapy Surgery
49
Bag of worms Subfertility More common on the left side = which condition? What is it? Ix (1) Mx
Varicocele - abnormal enlargement of testicular veins USS with doppler Conservative, occasionally surgery
50
Thrombosed haemorrhoids Mx Symptoms usually settle within?
If within 72 hours then referral for excision Otherwise stool softeners, ice packs and analgesia Symptoms usually settle within 10 days
51
Most common type of testicular cancer?
Germ cell tumours
52
Germ cell classifications
Seminomas Non seminomas - e.g teratoma, choriocarcinoma, embryonal, yolk sac
53
Peak incidence for Seminomas Teratomas
Seminomas 35yo Teratomas 25yo
54
RF for testicular cancer (5)
Infertility Cryptorchidism FH Klinefelter's Mumps orchitis
55
Non germ cell examples:
Leydig cell tumours Sarcomas
56
Features of testicular cancer (4)
Painless lump Gynaecomastia Hydrocele Pain
57
Tumour markers Seminoma Non seminoma
Seminoma HCG elevated elevated in 20% Non seminoma AFP/ BHCG elevated in 80% LDH in germ cell tumours (seminomas and non seminomas)
58
Which type of testicular cancer is most likely to have a raised bHCG?
Non seminoma
59
Mastitis mx (2)
Continue breastfedding Fluclox 10-14 days
60
Nocturia in men mx (3)
Moderating fluid intake 40mg furosemide in late afternoon Desmopressin
61
Overactive bladder mx (3)
Moderate fluid intake Bladder retraining Oxybutynin/ tolterodine/ darifenacin/ mirabegron
62
Post op return to work following Open repair Lap repair of inguinal hernias
2-3 weeks 1-2 weeks
63
Hydroceles may develop secondary to (3)
Epididymo-orchitis Testicular torsion Testicular tumours
63
Usually anterior and below the testicle You can get above the mass on examination Transilluminates =
Hydrocele
64
Infantile hydrocele mx Adults hydrocele mx
Usually resolve spontaneously by 1-2yo otherwise surgery Conservative mx
65
What type of cyst is caused by Echinococcus granulosus? Most commonly found in which two organs? Ix First line Best investigation
Hydatid cyst Liver and lungs First line US CT
66
biliary colic, jaundice, and urticaria =
Hydatid cysts with biliary rupture
67
Head injury CT head immediately (5)
GCS <13 on initial assessment GCS <15 2 hours post injury Post traumatic seizure Focal neurological deficit >1 episode of vomiting
68
CT head within 8 hours for adults with any of the following (4) If they have experienced LOC or amnesia
65=> Bleeding disorder >30minutes retrograde amnesia events immediately before the injury Dangerous mechanism of injury
69
Lucid interval Features of raised intracranial pressure = Often caused by what type of trauma? (2)
Extradural haematoma Acceleration - deceleration Blow to side of head
70
Most common in old age, alcoholism and anticoagulated patients with a head injury
Subdural
70
Grade I - IV haemorrhoids
I do not prolapse II prolapse on defecation but reduce sponteneously III manually reduced IV cannot be reduced
71
Which three types of drugs can cause erectile dysfunction?
SSRIs BB Finasteride
72
Ix erectile dysfunction (2)
Qrisk including lipid and fasting glucose levels Free testosterone between 9 and 11am
73
What should be done next following a low or borderline free testosterone in erectile dysfunction? If abnormal then?
FSH, LH, prolactin If abnormal then refer to endocrinology

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