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Surgery Flashcards

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1
Q

Breast lump- mobile, firm, non tender, smooth, upper outer quadrant

A

Fibroadenoma

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2
Q

When to refer a breast lump

A

2ww- 30 and over who have an unexplained breast lump with or without pain.

A non-urgent referral should be considered in patients under 30 with an unexplained breast lump with or without pain.

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3
Q

Menopausal woman with tender lump around her areola and green nipple discharge

A

mammary duct ectasia

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4
Q

Blood stained nipple discharge differentials

A

Duct papilloma
Ductal carcinoma in situ

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5
Q

Eczematous skin over the areola/nipple
Nipple inversion or retraction

A

Paget’s- malignant cells in the nipple-areola complex

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6
Q

Pagets disease of the nipple may be associated with

A

an underlying in situ or invasive ductal carcinoma.

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7
Q

Mastitis management

A

continue breast feeding
warm compress

if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection- fluclox (continue breast feeding)

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8
Q

Management of breast abscess

A

asipration
continue breast feeding

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9
Q

acute mesenteric ischaemia might have a history of

A

AF

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10
Q

80% anal cancers are

A

SCC

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11
Q

When is an anal fissure chronic

A

> 6weeks

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12
Q

90% anal fissures are where

A

posterior midline

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13
Q

Acute anal fissure mx

A

dietary advice

bulk forming laxative

lubricant

topical anaesthetic

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14
Q

Chronic anal fissure mx

A

topical GTN

After 8 weeks if ineffective refer for surgery/botox

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15
Q

Colorectal cancer can be associated with which inherited diseases

A

HNPCC
FAP

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16
Q

What is the CRC screening programme

A

FIT every 2 years from age 60-74, if abnormal then colonoscopy

Also a 1 off sigmoidoscopy aged 55

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17
Q

Caecal/ascending colon/proximal transverse colon cancer surgery

A

R hemicolectomy with ileocolic anastamosis

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18
Q

Distal transverse colon/descending colon cancer surgery

A

L hemicolecotomy with colo-colonic anastamosis

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19
Q

Sigmoid Ca surgery

A

high anterior resection with colorectal anastamosis

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20
Q

rectal cancer surgery

A

Anterior resection with colorectal anastamosis +/- defunctioning stoma

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21
Q

Anal cancer surgery

A

AP resection

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22
Q

Diverticulitis complications

A

perf or abscess

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23
Q

Can you do colonoscopy in diverticulitis

A

no risk perf

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24
Q

Mild diverticulitis rx

A

liquid diet
oral abx

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25
haemorrhoid positions
3, 7, 11 oclock
26
what type of haemorrhoids are more prone to thrombosis and pain
external
27
Gold standard for imaging a perianal abscess
MRI
28
What is psoas sign
in appendicitis pain on extending hip if retrocaecal appendix
29
80% pancreatic cancers type
adenocarcinoma
30
What is whipples procedure
pancreaticoduodenectomy for pancreatic head cancers
31
palpable gall bladder + painless obstructive jaundice is unlikely to be?
gallstones (more likely pancreatic ca)
32
How to differentiate direct and indirect inguinal hernia on examination
put finger over deep ring, if when they cough a bulge appears medially to the finger- direct
33
what type of hernia is more likely to strangulate
indirect
34
RUQ pain, fever
cholecystitis
35
RUQ, fever, jaundice
ascending cholangitis
36
do you get deranged LFTs in cholecystitis or cholangitis
cholangitis
37
Causes of pancreatitis
Gallstones Ethanol Trauma Steroids Mumps Autoimmune/ascaris infection Scorpion Hypertrig, high cholest, high calcium, hypothermia ERCP Drugs (azathioprine, mesalazine, bendroflumathiazide, furosemide, steroids, valproate)
38
Grey-Turner's sign suggests
retroperitoneal haemorrhage in pancreatitis
39
Best test for pancreatitis
lipase
40
What can happen to glucose in pancreatitis
can go high
41
severe episode of pancreatitis can result in what long term complication
diabetes malabsorption
42
Treatment options for BPH
α-blockers such as tamsulosin (relaxes smooth muscle)- works straight away 5α-reductase inhibitor such as finasteride (reduces conversion of testosterone) - may take 6-12 months TURP/TUIP
43
causes of epididymo-orchitis
STI ecoli (uti causes) mumps bechets amiodarone TB
44
Bag of worms scrotal swelling
varicocele
45
transilluminating scrotal swelling
hydrocele
46
painless smooth scrotal lump posterior and separate to the testicle
epididymal cyst.
47
superficial thrombophlebitis is associated with what else
Often DVT
48
Definitive treatment for thromboangiitis obliterans (buergers diease)
stop smoking
49
what is treponema pallidum
syphilis causitive agent
50
how long does a chancre last
6-8 weeks
51
Mx adult with a hydrocele
ultrasound to exclude underlying causes such as a tumour
52
what type of hernia in a child needs surgical repair
inguinal
53
mx umbilical hernia in a baby
nil- most self resolve by 4-5 yrs
54
who needs to confirm brain death
two separate senior and suitably qualified doctors on separate occasions
55
what can you give to help passage of ureteric stones
alpha blocker
56
When do you watchful wait in renal stones
< 5mm and asymptomatic
57
Ureteric obstruction due to stones together with infection mx
surgical emergency must be decompressed- by nephrostomy, stent or ureteric catheter.
58
Suspected renal colic imaging
Non-contrast CT-KUB
59
anaesthetic agent good for known PONV
propofol
60
when is a Hartmann's procedure used
in an emergency presentation of a sigmoid tumour- it involves resection and end colostomy rather than an anasatmosis If a tumour is associated with perforation then anastamosis is more risky
61
adjustment of biphasic or long acting insulins prior to surgery
normal day before Day of half morning dose, usual evening dose
62
adjustment of once daily insulins prior to surgery
reduce dose by 20% day before and day of
63
which oral hypoglycaemics do you need to adjust prior to surgery and how
metformin only if TDS (omit lunch dose day of) Sulphonylureas- omit morning dose on day of SGLT-2 inhibitors (-flozins)- omit day of
64
phaeochromocytoma surgery special prep
alpha and beta blockade.
65
carcinoid tumours surgery special prep
covering with octreotide
66
What type of stoma is flush to the skin
colostomy
67
Do seminomas or teratomas (testicular tumours) have better outcome?
Seminomas have a better prognosis than teratomas
68
Most common type of breast ca
Invasive ductal carcinoma
69
Ix of choice for suspected sub arach
non-contrast CT head
70
When to do an LP in suspected sub arach
if CT head is done more than 6 hours after symptom onset and is normal
71
Intervention in patient with sub arach secondary to an aneurysm (if they are relatively stable)
coil
72
What type of anaesthetic agents may cause malignant hyperthermia
Volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane)
73
Malignant hyperthermia signs
Rise in end tidal CO2 sweating
74
malignant hyperthermia rx
dantrolene
75
what ethnicity has increased rate of prostate ca
afro caribbean
76
reducible, asymptomatic inguinal hernia mx
routine surgical repair
77
When are breast fibroadenomas excised
>3cm
78
Fat necrosis of breast may mimic
breast ca as may develop into a hard, irregular breast lump that is tethered
79
in surgery for torsion should they fix both or one testes
both to prevent other one
80
Head injury, lucid interval
extradural
81
investigation of choice for varicose veins/chronic venous disease
venous duplex USS
82
Breast cyst mx
aspirated, those which are blood stained or persistently refill should be biopsied or excised

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