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surgery Flashcards

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1
Q

where are ileostomy

A

right iliac fossa

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2
Q

are ileostomy sprouted or flushed

A

sprouted

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3
Q

what is the output of ileostomy

A

liquid

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4
Q

where are colostomy more likely

A

left side

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5
Q

are colostomy flushed or sprouted

A

flushed

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6
Q

what is output of colostomy

A

solid

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7
Q

acute mesenteric ischaemia what PMH is patient likely to have

A

AF

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8
Q

management of acute mesenteric ischaemia

A

immediate laparotomy

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9
Q

what are most anal cancers

A

squamous cell carcinomas

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10
Q

why is anal cancer incidence rising

A

amongst men who have sex with men due to HPV

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11
Q

aorta width <3cm what is the action

A

no further action

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12
Q

aorta width 3-4.4cm what is the action

A

rescan every 12 months

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13
Q

aorta width 4.5-5.4cm what is the action

A

rescan every 3 months

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14
Q

aorta width >5.5cm what is the action

A

refer within 2 weeks to vascular surgery

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15
Q

risk factors for abdominal aortic aneurysms

A

smoking
hypertension
syphilis
Ehler Danlos
Marfan

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16
Q

ABPI < 1 is indicator of

A

peripheral arterial disease

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17
Q

ABPI >1.2 indicates

A

calcified, stiff arteries
advanced again

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18
Q

what is a normal ABPI

A

1-1.2

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19
Q

what ABPI is compression bandaging acceptable

A

> 0.8

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20
Q

what is marjolin ulcer

A

squamous cell carcinoma

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21
Q

where do marlin ulcer occur

A

sites of chronic inflammation
e.g. burns, osteomyelitis

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22
Q

what are features of acute limb threatening Ischaemia

A

6P’s
- pale
- pulseless
- painful
- paralysed
- paraesthetic
- perishing with cold

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23
Q

initial investigation in acute limb threatening ischaemia

A

handheld arterial Doppler examination

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24
Q

factors suggestive ischaemia due to thrombus

A
  • pre existing claudication
  • no obvious emboli source
  • reduced or absent pulses in contralateral limb
  • widespread vascular disease e.g. MI, stroke
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25
factors that suggest Ischaemia due to embolus
- sudden onset painful leg <24 hour - no history claudication - clinic source of emboli AF, MI, - proximal aneurysm
26
initial management of acute limb ischaemia
- ABC approach - IV opioids - IV unfractionated heparin
27
definitive management of acute limb ischaemia
- intra-arterial thrombolysis - surgical embolectomy - angioplasty - bypass surgery - amputation
28
features of critical limb ischaemia
- rest pain in foot for more than 2 weeks - ulceration - gangrene - patient hangs leg out of bed at night to ease pain
29
ABPI in critical limb ischaemia
< 0.5
30
features of intermittent claudication
- aching or burning in leg muscles following walking - relived within minutes of stopping - not present at rest
31
first line investigation for intermittent claudication
duplex ultrasound
32
what should be performed before any intervention in intermittent claudication
magnetic resonance angiography
33
what is a strong link for peripheral arterial disease
smoking
34
what should all patients be on with intermittent claudication
statin - atorvastatin 80mg
35
what is first line management for peripheral arterial disease
clopidogrel
36
definitive management of peripheral arterial disease
endovascular revascularisation surgical revascularisation - for long segment lesion >10cm
37
features of ruptured abdominal aortic aneurysm
- severe, central abodminla pain radiating to the back - pulsatile, expansile mass in abdomen - patient may be shocked (hypotension, tachycardia) or collapse
38
investigation for ruptured abdominal aortic aneurysm if stable
CT angiogram - if diagnosis in doubt
39
what is thrombophlebitis
inflammation associated with thrombosis of one of the superficial veins
40
what vein is usually affected in superficial thrombophlebitis
long saphenous vein
41
1st line management of superficial thrombophlebitis
NSAIDs - oral if severe compression stockings LMWH
42
investigation for superficial thrombophlebitis
ultrasound
43
risk factor for varicose veins
- ageing - female gender - pregnancy - obesity
44
features of varicose veins
- appearance - aching, throbbing - itching - bleeding - venous ulceration
45
investigation for varicose vein
venous duplex ultrasound - retrograde venous flow
46
conservative management for varicose vein
- leg elevation - weight loss - regular exercise - graduated compression stockings
47
severe varicose vein management
- endothermal ablation - radio frequency - foam sclerotherapy - surgery
48
what is coning
brainstem compression
49
unilaterally dilated pupil what nerve
3rd nerve compression secondary to tectorial herniation
50
bilaterally dilated pupil
bilateral 3rd nerve palsy poor CNS perfusion
51
bilaterally constricted pupil what is the cause
- opiates - pontine lesion - metabolic encephalopathy
52
features of hydrocephalus
- headache (worse in morning, when lying down) - nausea and vomiting - papilloedema - coma
53
child features of hydrocephalus
- bulging anterior fontanelle - failure of upward gaze (sunsetting eyes)
54
dementia, incontinence and disturbed gait =
normal pressure hydrocephalus
55
1st line investigation in hydrocephalus
CT head
56
what is gold investigation for hydrocephalus
lumbar puncture - diagnostic and therapeutic
57
management of severe hydrocephalus
external ventricular drain
58
management for long term CSF diversion
ventriculoperitoneal shunt
59
hepatocellular carcinoma tumour marker
serum AFP
60
altered sensation in arm and discomfit when using his hands above their head
cervical rib
61
gold investigation for intracranial haemorrhage
non contrast CT head
62
GCS limits for CT head within 1 hour
GCS <13 on initial assessment GCS <15 at 2 hours post injury
63
jaundice and RUQ pain suggestive of
biliary obstruction
64
when can patient shower after surgery
48 hours
65
what is used for cleaning the wound up to 48 hours after surgery
sterile saline
66
what does an uncle herniation cause
ipsilateral fixed, dilated pupil (due to compression of 3rd cranial nerve) contralateral paralysis
67
management of intracranial aneurysm following a SAH
coiling by an interventional neuroradiologist
68
what is given to reduce vasospasm following SAH
nimodipine
69
Charcot triad
fever jaundice RUQ pain
70
what is Charcot triad a sign of
ascending cholangitis
71
investigation for ascending cholangitis
ultrasound
72
management of ascending cholangitis
antibiotics ERCP - remove obstruction
73
what is a complication of SAH
SIADH
74
long term mechanical ventilation in trauma patients can result in
trachea-oesophageal fistula formation

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