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Year 6 > Surgery > Flashcards

Surgery Flashcards

1
Q

Example of depolarising neuromuscular drug

A

suxamethonium

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2
Q

key adverse events from suxamethonium

A

malignant hyperthermia
hyperkalaemia

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3
Q

reversal agent for malignant hyperthermia

A

IV dantrolene

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4
Q

MoA of suxamethonium

A

binds nACh, constant depolarisation of motor plate through non-competitive agonism

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5
Q

contraindications to suxamethonium

A

penetrating eye injuries
acute narrow angle glaucoma

this drug increases intra ocular pressure

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6
Q

use of suxamethonium

A

rapid sequence intubation

due to rapid onset and short duration of action

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7
Q

examples of non-depolarising neuromuscular blocking drugs

A

Tubocurarine, atracurium, vecuronium, pancuronium

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8
Q

MoA of non depolarising NMDs

A

Competitive antagonist of nicotinic acetylcholine receptors

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9
Q

main adverse effect of non depolarising NMD

A

hypotension

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10
Q

reversal agent for non depolarising NMD

A

neostigmine (Acetylcholinesterase inhibitor)

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11
Q

treatment of local anaesthetic toxicity

A

20% lipid emulsion

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12
Q

symptoms of local anaesthetic toxicity

A

agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, and dysarthria

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13
Q

consequences of local anaesthetic toxicity

A

seizures, respiratory arrest, and/or coma.

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14
Q

drugs that can cause ED

A

beta blockers
SSRIs

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15
Q

most common type of prostate cancer

A

adenocarcinoma (95%)

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16
Q

most common type of bladder cancer

A

transitional cell carcinoma

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17
Q

which airway adjunct is suitable for a seizing patient

A

nasopharyngeal

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18
Q

RELATIVE contraindication for nasopharyngeal airway

A

basal skull fracture

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19
Q

what is the main complication of axillary lymph node clearance

A

lymphoedema and functional arm impairment

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20
Q

how is the risk of DVT reduced in superficial thrombophlebitis

A

LMWH

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21
Q

where is the lesion in subclavian steal syndrome

A

proximal stenotic lesion of the subclavian artery results in retrograde flow through vertebral or internal thoracic arteries

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22
Q

main presentation of subclavian steal syndrome

A

syncope

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23
Q

aetiology of aortic coarctation

A

aortic stenosis at site of ductus arteriosus

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24
Q

how does inflammatory breast cancer present

A

progressive erythema and oedema in the absence of signs of infection such as WCC or CRP, fever or discharge

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25
Q

what size lump is the cut off for wide local excision

A

< 4cm

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26
Q

what size lump is the cut off for mastectomy

A

> 4cm

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27
Q

first line treatment of lactational mastitis

A

12-24 hours of effective milk removal i.e. continue breastfeeding

don’t start Abx just because they present after one day of symptoms

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28
Q

features of duct ectasia

A

nipple retraction
milky or cheesy or green discharge

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29
Q

describe the breast screening programme in the NHS

A

for women between 50 to 70, screened every 3 years

Over 70s are usually not invited but can request screening via their GP

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30
Q

what is the chemotherapy treatment for node positive breast cancer

A

FEC-D chemotherapy

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31
Q

what is the chemotherapy treatment for node negative breast cancer requiring chemo

A

FEC chemotherapy

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32
Q

first line mx of patient with mild symptoms related to varicose veins [4]

A

elevate legs
compression stockings
lose weight
regular exercise

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33
Q

key investigation of varicose veins

A

venous duplex ultrasound

demonstrates retrograde flow

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34
Q

when should varicose veins be referred to vascular [5]

A

significant/troublesome lower limb symptoms e.g. pain, discomfort or swelling

previous bleeding from varicose veins

skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)

superficial thrombophlebitis

an active or healed venous leg ulcer

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35
Q

what are the surgical treatments for varicose

A

endothermal ablation: using either radiofrequency ablation or endovenous laser treatment

foam sclerotherapy: irritant foam → inflammatory response → closure of the vein

surgery: either ligation or stripping

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36
Q

4 skin changes associated with varicose veins/chronic venous insufficiency

A

varicose eczema (also known as venous stasis)

haemosiderin deposition → hyperpigmentation

lipodermatosclerosis → hard/tight skin

atrophie blanche → hypopigmentation

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37
Q

what poses the greatest risk to developing TRALI

A

infusion with plasma components

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38
Q

what is normal CVP

A

In a healthy adult, the normal range for CVP is typically between 2 to 8 mmHg (millimeters of mercury) when measured at the end of expiration while the individual is at rest and in a supine (lying down) position.

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39
Q

signs of bowel perforation

what investigation must be done

A

severe abdominal pain, guarding, and rigidity.

An erect chest X-ray is the most appropriate initial imaging study for suspected bowel perforation because it can detect free air under the diaphragm (pneumoperitoneum)

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40
Q

what are the indications for thoracotomy in haemothorax

A

> 1.5L blood drained initially or losses of >200ml per hour for >2 hours

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41
Q

which congenital hernias can be managed conservatively and which ones need repair ASAP

A

conservative for umbilical till 4-5years old

repair for inguinal

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42
Q

examples of benign liver lesions [8]

A

hemangiomas
Liver cell adenoma
Mesenchymal hamartomas
Liver abscess
Amoebic abscess
Hyatid cysts
Polycystic liver disease
Cystadenoma

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43
Q

which nerve is at risk of damage when doing a carotid endarterectomy

how does damage present?

A

hypoglossal

It presents as ipsilateral tongue deviation towards lesion.

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44
Q

preferred method of detecting free air in the abdomen

A

CT abdo

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45
Q

difference between incarcerated and strangulated hernias

A

strangulated ones are painful unlike incarcerated hernias

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46
Q

what is the general treatment of inguinal hernias

A

treat medically fit patients even if they are asymptomatic

i.e. refer routinely to open mesh repair

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47
Q

how are surgically unfit patients treated for inguinal hernias

A

a hernia truss

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48
Q

how are unilateral inguinal hernias treated compared to bilateral hernias

surgical approach

A

unilateral inguinal hernias are generally repaired with an open approach

bilateral and recurrent inguinal hernias are generally repaired laparoscopically

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49
Q

Parkland formula for burns fluid resus

how is resus fluid distributed over the 24 hours

A

SA% x body weight x 4ml gives fluid replacement over 24 hours

50% over the first 8 hours
50% over the next 16 hours

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50
Q

which fluids are used in burns resus

A

crystalloids only

Hartmans and Ringers

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51
Q

what fluids are used in burns resus after 24 hours

A

colloids including albumin and FFP

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52
Q

which analgesia should be avoided post kidney transplant

A

NSAIDs

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53
Q

What should you do to ascertain the anatomy and subtype of inguinal swelling?

A

press on the deep inguinal ring and ask the patient to cough

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54
Q

where in the body should lidocaine never be used

A

it must never be used near extremities due to the risk of ischaemia

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55
Q

radiological sign indicating free air in the abdomen

A

rigler’s sign

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56
Q

nerve lesion due to Posterior triangle lymph node biopsy

A

accessory nerve lesion

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57
Q

nerve lesion due to Lloyd Davies stirrups

A

common peroneal nerve

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58
Q

nerve lesion due to Thyroidectomy

A

laryngeal nerve

59
Q

nerve lesion due to Anterior resection of rectum

A

hypogastric autonomic nerves

60
Q

nerve lesion due to Axillary node clearance

A

long thoracic nerve, thoracodorsal nerve and intercostobrachial nerve

61
Q

nerve lesion due to Inguinal hernia surgery

A

ilioinguinal nerve

62
Q

nerve lesion due to Varicose vein surgery

A

sural and saphenous nerves

63
Q

nerve lesion due to Posterior approach to the hip

A

sciatic nerve

64
Q

what size fibroadenoma is surgically excised

A

> 3cm

or causing discomfort and pain

65
Q

what is Whipple’s procedure for

A

pancreatic tumours

66
Q

management of those who’ve always had difficulties maintaining an erection

A

routine referral to urology

67
Q

how can you check for rectal anastomotic leak

A

gastrograffin enema

68
Q

treatment of acute anal fissure

A

1) soften stool
dietary advice: high-fibre diet with high fluid intake
2) bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
3) lubricants such as petroleum jelly may be tried before defecation
4) topical anaesthetics
5) analgesia

69
Q

treatment of chronic anal fissure

A
  • use acute treatment
  • 1st line: topical glyceryl trinitrate (GTN)

if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin

70
Q

type of resection for Caecal, ascending or proximal transverse colon

A

right hemicolectomy

71
Q

type of resection for Distal transverse, descending colon

A

left hemicolectomy

72
Q

type of resection for Sigmoid colon

A

high anterior

73
Q

type of resection for Upper rectum

A

anterior resection

74
Q

type of resection for Lower rectum

A

anterior resection (low TME)

75
Q

type of resection for Anal verge

A

Abdomino-perineal excision of rectum

76
Q

management of caecal volvulus

A

right hemicolectomy

77
Q

management of sigmoid volvulus

A

rigid sigmoidoscopy with rectal tube insertion

78
Q

when is a Hartmann’s procedure done

A

emergency resection of bowel especially perforation

79
Q

main investigation for diffuse axonal injury

A

MRI brain

80
Q

appearance of ileostomy

A

spouted

81
Q

appearance of colostomy

A

flushed

82
Q

outputs of ileostomy

A

liquid

83
Q

outputs of colostomy

A

solid

84
Q

main investigation for chronic pancreatitis

A

CT abdo

85
Q

monitoring for risk of diabetes in someone with chronic pancreatitis

A

annual HbA1c

86
Q

treatment of post op ileus

A

NBM and NG tube

87
Q

at which positions do haemorrhoids develop

A

3,7 and 11 o clock

88
Q

treatment of refractory crohns

A

infliximab

89
Q

position of anal fissures

A

6 and 12 o clock

90
Q

staging of oesophageal or gastric cancer

A

CT

91
Q

most common cause of chronic pancreatitis

A

chronic alcohol

92
Q

treatment of Gastric MALT lymphoma

A

treat the H.pylori with triple therapy

will respond if low grade

93
Q

head trauma related causes of third nerve compression

A

extradural bleed
transtentorial herniation

94
Q

treatment of thrombosed haemorrhoids

A

if presenting within 72 hours of onset of pain –> Surgery

Beyond 72 hours –> conservative management

95
Q

how does a thrombosed haemorrhoid present

A

typically present with significant pain and a tender lump
examination reveals a purplish, oedematous, tender subcutaneous perianal mass

96
Q

diagnostic investigation of boerhaaves syndrome

A

CT contrast swallow

97
Q

treatment of boerhaaves

A

Treatment is with thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible, surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.

98
Q

what may be observed in the chest wall of someone with boerhaaves

A

Subcutaneous emphysema

presents as crepitus

99
Q

which stoma is usually used after rectal cancer surgery

A

loop ileostomy

100
Q

4 risk factors of atherosclerotic vascular disease

A

smoking
HTN
hypercholestrolaemia
DM

101
Q

how does intermittent claudication present?

A

pain after walking. Gripping, tightening, burning pain in thighs, buttocks.

102
Q

intermittent claudication vs spinal stenosis

A

spinal stenosis pain is worse at rest and better with exercise.

103
Q

most common location of varicoceles

A

left side (80%)

104
Q

investigation of varicoceles

A

ultrasound with Doppler studies

105
Q

what does RUQ pain with bilious fluid in abdominal drain suggest

A

biliary leak usually post cholecystectomy

106
Q

which renal stones are semi opaque

A

cystine stones

107
Q

how does Pagets disease of the breast present

A

Reddening and thickening of nipple and areola

weeping, crusty lesion nipple when areola is spared sometimes

108
Q

adverse effects of aromatase inhibitors [4]

A

osteoporosis: NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer

hot flushes
arthralgia, myalgia
insomnia

109
Q

MoA of aromatase inhibitors

A

reduces peripheral oestrogen synthesis

110
Q

what should patients with PAD be started on [2]

A

statin e.g. atorvastatin 80mg and clopi

naftidrofuryl oxalate (in those with poor quality of life)

111
Q

what size segment should endovascular revascularization be used for in severe PAD/CLI

A

<10cm /short

also aortic iliac disease and high-risk patients

112
Q

what size segment should surgical revascularization be used for in severe PAD/CLI

A

> 10 cm /long

also multifocal lesions, lesions of the common femoral artery and purely infrapopliteal disease

113
Q

1st line management of PAD

A

supervised exercise programme

114
Q

what does surgical revascularisation in PAD consist of [2]

A

surgical bypass with an autologous vein or prosthetic material
endarterectomy

115
Q

what does endovascular revascularisation in PAD consist of

A

percutaenous transluminal angioplasty +/- stent placement

116
Q

women with no palpable axillary lymphadenopathy at presentation should have a …{investigation}

what if this investigation is negative….

A

pre-operative axillary ultrasound before their primary surgery

if negative then they should have a sentinel node biopsy to assess the nodal burden

117
Q

when is axillary node clearance indicated

A

when there is palpable axillary lymphadenopathy

118
Q

The ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicates ….[pathology]

A

extracapsular breast implant rupture.

due to leakage of the silicone, which then drains via the lymphatic system, giving the ‘snowstorm appearance’ both in the breast and the lymph nodes.

119
Q

diagnosis of Pagets disease of the breast [3]

A

Diagnosis is made by punch biopsy, mammography and ultrasound of the breast.

120
Q

treatment of Raynaud’s disease

A

calcium antagonists

121
Q

Dukes classification for colorectal cancer (A-D)

A

Tumour confined to the mucosa
Tumour invading bowel wall
Lymph node metastases
Distant metastases

122
Q

indication for CT head within the hour

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

123
Q

features of biliary colic

A

colicky right upper quadrant abdominal pain
worse postprandially, worse after fatty foods
the pain may radiate to the right shoulder/interscapular region
nausea and vomiting are common
in contrast to other gallstone-related conditions, in biliary colic there is no fever and liver function tests/inflammatory markers are normal

elective lap chole

124
Q

what BMI can be referred straight to bariatric surgery

A

> 50

> 35 if weight is causing/affecting a medical condition

125
Q

where do Lynch syndrome tumours tend to be found

A

ascending colon and hepatic flexure

126
Q

complications of NG feeding

A

diarrhoea
aspiration
hyperglycaemia
refeeding syndrome

127
Q

what agent causes hydatid cysts

where is it endemic to

A

Echinococcus granulosus

Mediterranean and Middle Eastern countriesin

128
Q

investigation of hydatid cysts

A

USS –> CT abdo to differentiate between pyogenic and amoebic cysts
serology

remove surgically

129
Q

amoebic abscess

A

Liver abscess is the most common extra intestinal manifestation of amoebiasis
Between 75 and 90% lesions occur in the right lobe
Presenting complaints typically include fever and right upper quadrant pain
Ultrasonography will usually show a fluid filled structure with poorly defined boundaries
Aspiration yield sterile odourless fluid which has an anchovy paste consistency
Treatment is with metronidazole

130
Q

hemangioma

A

Most common benign tumours of mesenchymal origin
Incidence in autopsy series is 8%
Cavernous haemangiomas may be enormous
Clinically they are reddish purple hypervascular lesions
Lesions are normally separated from normal liver by ring of fibrous tissue
On ultrasound they are typically hyperechoic

131
Q

liver mass associated with COCP use

A

liver cell adenoma

132
Q

Solitary rectal ulcer

A

Associated with chronic straining and constipation. Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)

133
Q

Dermatofibroma

A

Solitary dermal nodules
Usually affect extremities of young adults
Lesions feel larger than they appear visually
Histologically they consist of proliferating fibroblasts merging with sparsely cellular dermal tissues

134
Q

triad of gastric volvulus

A

vomiting, pain and failed attempts to pass an NG tube

135
Q

McEvedy’s

A

Groin incision e.g. Emergency repair strangulated femoral hernia

136
Q

Lanz

A

Incision in right iliac fossa e.g. Appendicectomy

137
Q

Gable

A

Rooftop incision

138
Q

The H causes of pancreatitis

A

Hypertriglyceridaemia
Hyperchylomicronaemia
Hypercalcaemia
Hypothermia

139
Q

emergency surgery in fulminant UC

A

subtotal colectomy

140
Q

Gingko leaf sign post laparoscopic surgery

A

subcutaneous emphysema

If the anterior chest wall is affected air can outline the pectoralis major muscle, giving rise to the ‘ginkgo leaf’ sign.

141
Q

treatment of fissure in any

A

Stool softeners, topical diltiazem or GTN, botulinum toxin, Sphincterotomy

142
Q

infectious disease that causes sigmoid volvulus

A

Chagas disease

143
Q
A

Year 6 (19 decks)

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