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surgery Flashcards

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1
Q

difference between femoral and inguinal hernias

A

femoral = INFEROLATERAL to pubic tubercle
usually not reducible

inguinal = SUPRAMEDIAL to pubic tubercle
more commonly reducible

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2
Q

BPH mgt:

A
  1. watchful waiting
  2. alpha-1 antagonists
  3. 5 alpha reductase inhibitors
  4. combination of 2&3
  5. TURP
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3
Q

alpha-1 antagonists examples

A

tamsulosin
alfuzosin

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4
Q

alpha-1 antagonists

mechanism:

A

reduce smooth muscle tone of prostate and bladder

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5
Q

alpha-1 antagonists adverse effects (4)

A

dizziness
postural hypotension
dry mouth
depression

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6
Q

5 alpha-reductase inhibitors

examples:

A

finasteride

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7
Q

5 alpha-reductase inhibitors
mechanism:

A

block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH

indicated if severely enlarged prostate

note causes reduction in prostate volume and so slows disease progression – however takes time and sx may not improve for 6 months

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8
Q

5 alpha-reductase inhibitors SE:

A

decrease PSA concentrations by up to 50%
erectile dysfunction
reduced libido
ejaculation problems gynaecomastia

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9
Q

prostate ca ix:

A

1st line = multiparametric MRI
then TRUS guided biopsy

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10
Q

cancer of:

caecum/ ascending/ proximal transverse colon

i. type of resection
ii. anastomosis

A

i. R hemicolectomy
ii. ileo-colic

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11
Q

cancer of:

distal transverse/ descending colon

i. type of resection
ii. anastomosis

A

i. L hemicolectomy
ii. colo-colon

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12
Q

cancer of:

sigmoid colon

i. type of resection
ii. anastomosis

A

i. high anterior resection
ii. colo-rectal

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13
Q

cancer of:

upper rectum

i. type of resection
ii. anastomosis

A

i. anterior resection (TME)
ii. colo-rectal

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14
Q

cancer of:

low rectum

i. type of resection
ii. anastomosis

A

i. anterior resection (low TME)
ii. colo-rectal (+/- defunctioning stoma)

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15
Q

cancer of:

anal verge

i. type of resection
ii. anastomosis

A

i. Abdomino-perineal excision of rectum
ii. none

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16
Q

sigmoid volvulus associations

A

older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia

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17
Q

sigmoid volvulus on AXR

A

large bowel obstruction (large, dilated loop of colon, often with air-fluid levels)
coffee bean sign

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18
Q

sigmoid volvulus mgt

A

rigid sigmoidoscopy + rectal tube insertion

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19
Q

caecal volvulus associations:

A

adhesions
pregnancy

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20
Q

caecal volvulus AXR findings

A

small bowel obstruction

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21
Q

caecal volvulus mgt

A

operative - often needs R hemicolectomy

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22
Q

nerve injured in carotid endartectomy

A

IPSILATERAL hypoglossal nerve CN XII

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23
Q

acute anal fissure mgt:

A
  • soften stool
  • lubricants
  • topical anaesthetics
  • analgesia
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24
Q

chronic anal fissure mgt:

A

topical GTN
refer to secondary care for sphincterotomy or botox if no effect from GTN in 8 weeks

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25
SERM (selective oestrogen receptor modulators) type of breast cancer it is used to treat? example?
oestrogen-receptor +ve e.g. tamoxifen
26
SERM adverse effects:
menstrual disturbance: vaginal bleeding, amenorrhoea hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects venous thromboembolism endometrial cancer
27
aromatase inhibitors type of breast cancer it is used to treat? example?
ER +ve in post menopausal women (as it reduces peripheral oestrogen synthesis) e.g. anastrazole letrozole
28
aromatase inhibitors adverse effects:
osteoporosis (do DEXA when initiating) hot flushes arthralgia, myalgia insomnia
29
biological therapy i. type of breast cancer it is used to treat
HER2 +ve
30
biologics for breast cancer: i. most common ii. CI
i. trastuzumab (Herceptin) ii. cardiac disease
31
drug for vasospasm prevention in SAH
nimodipine
32
Charcot's triad what condition do we see it in?
1. fever 2. jaundice 3. RUQ pain ascending cholangitis (bacterial infection of biliary tree, most commonly e. coli)
33
epidydimal cyst features
separate from body of testicle posterior to testicle
34
epidydimal cyst associations (3)
PCKD CF von Hippel Lindau
35
hydrocele definition
accumulation of fluid within tunica vaginalis can be communicating communicating: due to patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum. common in newborn males, usually resolve within first months of life non-communicating: caused by excessive fluid production within the tunica vaginalis
36
hydroceles may develop secondary to:
epididymo-orchitis testicular torsion testicular tumours
37
hydrocele features:
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle confined to the scrotum, you can get 'above' the mass on examination transilluminates the testis may be difficult to palpate if hydrocele is large
38
suspected epididymo-orchitis
ceftriaxone 500mg im stat + PO doxycycline 100mg BD for 10-14 days
39
epididymo-orchitis most common cause
chlamydia
40
biliary colic cx (5)
acute cholecystitis (most common) ascending cholangitis acute pancreatitis gallstone ileus gallbladder cancer
41
mammary duct ectasia
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'
42
Duct papilloma
Local areas of epithelial proliferation in large mammary ducts Hyperplastic lesions rather than malignant or premalignant May present with blood stained discharge
43
fat necrosis
More common in obese women with large breasts May follow trivial or unnoticed trauma Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump Rare and may mimic breast cancer so further investigation is always warranted
44
criteria for brain stem death testing (4)
Deep coma of known aetiology Reversible causes excluded No sedation Normal electrolytes
45
Hartmann's procedure what is it?
resection of the relevant portion of bowel + formation of end colostomy/ileostomy. can be reversed - end colostomy is closed following the formation of a colorectal anastomosis, restoring continuity of the bowel
46
supplementation of prednisolone prior to: i. minor surgery ii. moderate procedure iii. major procedure
i. nil ii. 50mg hydrocortisone prior to induction, 25mg every 8 hrs for 24 hours iii. 100mg hydrocortisone before induction, 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached.
47
varicocele i. what is it? ii. association
i. abnormal enlargement of testicular veins ("bag of worms") ii. infertility
48
bladder cancer RF urothelial (transitional cell) carcinoma
smoking exposure to alanine dyes rubber manufacture cyclophosphamide
49
bladder ca RF SCC
schistosomiasis smoking
50
gastric vs duodenal ulcers i. which is more common ii. pain WORSE on eating
i. duodenal ulcers ii. gastric
51
duodenal atresia i. age at presentation ii. dx iii. rx
i. few hours PN ii. double bubble sign on AXR, sometimes with xontrast study iii. Duodenoduodenostomy
52
malrotation + volulus i. age at presentation ii. dx iii. rx
i. 3-7 days PN ii. Upper GI contrast study may show DJ flexure is more medially placed, USS may show abnormal orientation of SMA and SMV iii. LAdd's procedure
53
Jejunal/ ileal atresia i. age at presentation ii. dx iii. rx
i. within 24hrs PN ii. air fluid levels on AXR iii. laparotomy with primary resection and anastomosis
54
meconium ileus i. age at presentation ii. dx iii. rx
more common in cystic fibrosis i. 24-28hrs PN ii. air-fluid levels on AXR, sweat test to confirm CF iii. surgical decompression
55
NEC i. age at presentation ii. dx iii. rx
i. week 2 PN ii. Dilated bowel loops on AXR, pneumatosis and portal venous air iii. conservative
56
AAA screening: i. small aneurysm ii. medium aneurysm iii. large aneurysm
i. 3-4.4cm rescan in 12 months ii. 4.5-5.4cm rescan in 3 months iii. >5.5cm 2 week referral to vascular for probable intervention
57
AAA screening - what is offered?
single USS abdomen to males aged 65
58
non-malignant causes of elevated PSA
BPH prostatitis/ UTO ejaculation vigorous exercise urinary retention instrumentation of urinary tract
59
PSA testing should not be done within:
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
60
drug class used to manage over-active bladder
anti-muscarinics
61
renal stones mgt
watchful waiting if < 5mm and asymptomatic 5-10mm shockwave lithotripsy 10-20 mm shockwave lithotripsy OR ureteroscopy > 20 mm percutaneous nephrolithotomy
62
ureteric stones mgt
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers 10-20 mm ureteroscopy
63
what % of people with +ve FIT test have colorectal cancer?
5-15%
64
CRC screening - what is offered?
FIT test every 2 years to pts aged: 60-74 in England 50-74 in Scotland

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