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Surgery Flashcards

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1
Q

Extra intestinal features of IBD inc disease activity ones

A
  • anterior uveitis
  • primary sclerosing cholangitis
  • pyoderma gangrenosum
  • finger clubbing

disease activity:
- arthritis
- episcleritis
- erythema nodosum
- osteoporosis

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2
Q

Sigmoid vs caecal volvulus and mx of each

A

Sigmoid: coffee bean sign + large bowel obstruction
Caecal: embryo sign + small bowel obstruction

If caecal operative surgery, if sigmoid endoscopic decompression via rectal tube insertion + sigmoidoscopy

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3
Q

Symptoms and signs of hepatocellular carcinoma

A

Symptoms:
- RUQ pain
- pruritus
- B symptoms

Signs:
- jaundice
- bruising
- confusion
- hepatomegaly
- ascites

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4
Q

Management of upper gi bleeds: supportive, variceal, non variceal, PUD

A
  • Supportive: iv fluids, transfusion, analgesia, endoscopy within 24 hours
  • Variceal: terlipressin, abx quinolone, endoscopy + ligation, if doesn’t work then transjugular intrahepatic portosystemic shunt, if still not then sengstaken tube. Prophylaxis via propranolol
  • Non variceal: ppi
  • PUD: adrenaline injections, cauterisation
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5
Q

Pancreatic cancer symptoms + signs + ix vs cholangiocarcinoma

A

Pancreatic:
- Symptoms: pruritus, weight loss, abdo pain, diabetes, pancreatitis
- Signs: painless jaundice, abdo mass (hepatomeg if mets, enlarged gb, epigastric mass), steatorrhoea, migratory thrombophlebitis (trousseau sign)
- Ix: LFTs (cholestatic pic so inc ALP/yGGT), Ca199, USS abdo, gold standard HRCT shows dilated CBD + pancreatic ducts so double duct sign)

Cholangiocarcinoma:
- Symptoms: persistent biliary colic, anorexia, abdo pain, steatorrhoea, pruritus
- Signs: jaundice, enlarged gb, periumbilical lymphadenopathy (sister Mary Josephs nodes), virchows node
- Ix: LFTs (cholestatic so inc ALP/yGGT), ca199, uss, MRCP gold standard

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6
Q

Symptoms and signs of gastric cancer

A

Symptoms:
- early satiety
- abdo pain
- melena
- n+v
- b symptoms

Signs:
- left supraclavicular lymphadenopathy (trosiers sign)
- acanthosis nigricans
- epigastric mass

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7
Q

Ottawa rules to have an Ankle xray

A

medial or lateral malleolus tenderness
inability to walk 4 steps

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8
Q

Knee injuries:
- meniscal injury
- collateral injury
- cruciate injury

A
  • meniscal: twisting and weight bearing injury where medial more prone. Symptoms worst when straightening knee. Apleys test +
  • collateral: side of knee contact injury with mcl more common
  • cruciate: ACL more common and needs surgical reconstruction. Lachmans + and drawers test. PCL when dashboard injury and post sag sign and drawers test
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9
Q

Causes of post operative pyrexia

A

0-5 days: uti, pneumonia, skin infection
>5 days: vte, wound infection, anastomotic leak

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10
Q

Risk factors for post operative ileus

A

Intestinal handling
Decreased post op movement
Opioids
Electrolyte abnormalities

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11
Q

What’s in qSOFA score

A

rr>21
altered mental state
sys bp <100

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12
Q

What diabetic medications do we omit day of surgery

A

metformin (lunch time dose)
gliflozins
sulfonylureas (morning dose)

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13
Q

What is in WHO checklist

A

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

1) Before the induction of anaesthesia (sign in)
2) Before the incision of the skin (time out)
3) Before the patient leaves the operating room (sign out)

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14
Q

IV anaesthetics
- propofol
- thiopental
- etomidate
- ketamine

A
  • propofol: painful injection, hypotension. Also antiemetic effects
  • thiopental: laryngospasm
  • etomidate: adrenal suppression, myoclonus. Used if haem instability as doesn’t cause hypotension
  • Ketamine: hallucinations, also used in haem instability as doesn’t cause reduction in bp
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15
Q

Inhaled anaesthetics:
- isoflurane/sevoflurance
- nitrous oxide

A
  • isof: myocardial depression, malig hyperthermia
  • NO: don’t use in pneumothorax
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16
Q

Local anaesthetics:
- lidocaine
- cocaine
- bupivacaine

A
  • lidocaine: arrhythmia. Treat toxicity with 20% lipid emulsion
  • cocaine: arrythmias, tachycardia
  • bupivacaine: long duration action, cardiotoxic

Can add adrenaline to these drugs to prolong duration action. Contraind if MAOIs/TCAs or use on extremities

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17
Q

Muscle relaxants:
- suxamethonium
- atracurium

A
  • suxamethonium: fast onset + short duration action. Hyperkal, malig hyperthermia, apnoea if lack of acetylcholinesterase. Can’t use if eye problems as can inc IOP
  • atracurium: lasts 30 mins, reverse by neostigmine. Facial flushing, tachyc, hypotension
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18
Q

ASA grades

A

1 - normal
2 - mild disease, smoker, social drinker, bmi 30-40
3 - functional limitations/poorly controlled, bmi >40
4 - <3 months cvs accident
5 - likely to die without operation

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19
Q

Drugs which cause pancreatitis

A

azathioprine
mesalazine
bendroflumethiazide
furosemide
steroids
sodium valproate

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20
Q

How to distinguish PAD from spinal stenosis

A

Stenosis pain better walking uphill/leaning forwards
Bicycle test to distinguish - if symptoms present then not spinal stenosis

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21
Q

What is the Simmonds triad (achilles tendon rupture)

A

Palpate
Examine angle of declination at rest
Calf squeeze test

Needs orthodontist referral!!

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22
Q

First line vs gold standard for perianal abscesses

A

1st line: clinical dre
gold: transperineal uss

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23
Q

Management for discitis

A

8 weeks IV abx
ECHO

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24
Q

How to tell difference between biliary colic, acute cholecystitis, and ascending cholangitis

A

biliary colic: ruq pain worse after eating only
acute cholecystitis: fever, murphys sign + (when hand on gb ask them to breath in and they stop bc of pain)
ascending cholangitis: also jaundice, hypotension, confusion. Deranged LFTs (inc ALP/yggt)

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25
First line for gallstones Gold standard
1st line: USS Gold: MRCP
26
Main blood finding in mesenteric infarction
High lactate / wcc Needs urgent surgery
27
1st line mx for wound dehiscence Definitive
1st line: cover with sterile gauze, Iv abx, iv fluids, analgesia gold s: theatre
28
Most common fractures causing compartment syndrome
tibial suprachondylar (humerus)
29
Location of hernias: - umbilical - paraumbilical - epigastric - spigelian - richters
- umbilical: under umbilicus - paraumbilical: asymmetrical directly above or below umbilicus - epigastric: midline between umbilical and xiphisternum - Spigelian: semilunar line - Richters: strangulation without bowel obstruction symptoms
30
Bilious vomiting in neonates differentials
Nec enterocolitis: 2nd week life Meconium ileus: 48 hours post, DISTENSION + bilious vomiting Intestinal atresia: uss, vomit straight after foods Malrotation: 7 days post, ladds procedure
31
Medical diseases needing circumcision
phimosis recurrent balanitis balanitis xerotica obliterans paraphimosis
32
Management for prostate cancer - local vs mets
Local: watchful wait, active surveillance, prostatectomy, external beam radiotherapy, brachytherapy Mets: ghrh agonists goserelin + cyproterone acetate 3 days before to reduce tumour flare, or bicalutamide androgen rec blocker
33
Gold standard ix for renal cell carcinoma
CT abdo pelvis
34
Most common type of renal cell carcinoma
clear cell
35
Management for colitis vs crohns
colitis: induce remission: rectal mesalazine, 4 weeks after oral mesalazine, pred. If severe and on IV hydrocortisone and if doesn't work add on Ciclosporin Crohns: induce remission: pred maintenance: stop smoking, azathioprine, mercaptopurine
36
Monteggia fracture Bennetts fracture Galeazzi fracture Bartons fracture
Monteggia fracture: ulnar fracture + radioulnar dislocation Bennetts fracture: thumb metacarpal fracture Galeazzi fracture: radial shaft fracture + radioulnar dislocation Bartons fracture: colles/smiths with radiocarpal dislocation
37
Ix and mx for suspected renal stones in pregnant woman
USS ureteroscopy
38
CT scan within 1 hour vs 8 hours criteria
1 hour: >1 episode vomiting, suspected fracture, gas <13, seizure, neuro deficit 8 hours: >65, anticoags, dangerous injury, >30 mins amnesia
39
What kidney stones can you see on xray vs can't Which stones are alkaline and which is acidic
Can see opaque on xray: calcium oxalate, calcium phosphate, struvite Can't see radiolucent ones: urate, cystine Alkaline: stuvite Uric acid: acid
40
When to send off MSU for uti
>65 hematuria preg male child
41
Haematuria ix for visible vs non visible
if visible + luts and suspect bladder then cystoscopy if visible and not sure what it is then uss if visible and suspect rcc then ct urogram
42
Forced eversion vs inversion ankle injury
Inversion: anterior talofibular ligament sprain Eversion: deltoid ligaments
43
First line ix for PAD Gold s
1st line: duplex USS Gold s: CT angiogram
44
First line ix for acute limb ischaemia Gold s
1st line: handheld doppler arterial uss gold s: CT angiogram
45
Age for abdominal USS screening
65
46
When to do endovascular revascularisation (angioplasty + stent) vs surgical revascularisation (bypass, endarterectomy)
endovasc revasc: short segment stenosis <10cm, aortic iliac disease, high risk patients surgical: long segment lesions >10cm, multifocal lesions, common femoral artery, infrapopliteal
47
Management of superficial thrombophlebitis
compression stockings lmwh 30 days (if contraindicated then 8-12 days oral nsaids)
48
Management for carotid artery disease
dual anti platelet - clopidogrel and aspirin carotid endarterectomy If stenosis >50% + SYMPTOMS Needs carotid duplex uss or ct angiography
49
Leriche syndrome triad of symptoms
ED, buttock pain, absent femoral pulses/atrophy of legs
50
Symptoms buergers disease
25-35 year old man who smokes painful blue fingers + ulcers
51
Nipple eczema vs pagets disease
nipple eczema starts at areolar then involves nipple paget is nipple first then areola
52
Side effects of hormonal breast cancer treatment
Tamoxifen (ER antagonism, pre menopausal) : hot flushes, endometrial cancer Anastrozole (aromatase inhibitor reduces oestrogen synthesis, post): osteoporosis, arthralgia Trastuzumab Herceptin
53
Fat necrosis sign on USS Breast cyst sign
Fat: hyper echoic Cyst: halo
54
Symptoms of mammary duct ectasia vs intraductal papilloma
Ectasia: post meno yellow discharge Papilloma: pre meno bloody discharge
55
Risk factors for testicular cancer
undescended testes, fx infertility Klinefelter's syndrome mumps orchitis
56
What to prescribe if mixed voiding and storage symptoms in man who hasn't responded to alpha blocker tamsulosin
tolterodine darifenacin
57
Test to find out function of pancreas in chronic pancreatitis
faecal elastase - used if imaging inconclusive
58
What is boerhaaves syndrome
spontaneous rupture of oesophagus after lots of vomiting which can cause mediastinitis. Needs CT contrast swallow and thoracotomy and lavage if <12 hours or T tube insertion to create fistula between skin and oesophagus
59
Contraindications to laparoscopic surgery
shock inc icp intestinal obstruction uncorrected coagulopathy
60
Complications of gastrectomy
dumping syndrome rebound hypoglycaemia early satiety iron deficiency anaemia osteoporosis vit b12 deficiency
61
Complications of diverticular disease
Fistulas - colovesical (pneumaturia) Strictures (laprotomy) Peritonitis Haemorrhage Abscess (if <5cm abx, if >5cm drain)
62
Most common cause of large bowel obstruction
cancer
63
When to stop ppi before ogd
2 weeks before
64
Cancers associated with Lynch syndrome
colorectal endometrial pancreatic gastric
65
Sign of bowel necrosis on CT
Pneumatosis intestinalis Less contrast infiltration
66
Abdo pain post op pre 5 days vs post 5 days
pre: ileus post: anastomotic leak
67
What is toxic megacolon
Chronic dilatation of colon where high risk of perforation
68
Management of acute diverticulitis
Home with oral abx, liquid diet, analgesia If no improvement in 72 hours admit for iv ceftriaxone and metronidazole
69
Thrombosed haemorrhoid management
if <72 hours excise If >72 hours bulk forming, ice, analgesia
70
Biopsy findings of gastric cancer
signet ring cells
71
Do you remove gallstones if assymptomatic
nope
72
Staging for cancer in pelvis
mri (ct + staging laproscopy îs for more abdomen)
73
Prevention of each kidney stone
ca - thiazides struvite - ammonium chloride urate - allopurinol cystine - penicillamine
74
gold standard for venous insufficiency
duplex uss apbi after this
75
fontaine classification for pad
1. assymp 2. intermittent claudication 3. rest pain 4. necrosis or gangrene
76
Most common risk factor for transitional cell bladder cancer
smoking (others aniline dyes, rubber, cyclophosphamide, schistosomiasis)
77
First line ix for bladder ca Gold s
1st line: urine dip (haematuria?) Gold s: cystoscopy + biopsy
78
Causative organisms for epididymo orchitis
Chlamydia trachomatis neisseria gonorrhoeae ecoli
79
GS ix for AVN hip
mri
80
GS ix for psoas abscess
CT abdo
81
Features of staph aures
gram + coag +
82
Abdominoperineal resection vs low anterior resection
abdop: anus, rectum and sigmoid ant: if malig in upper 2/3 rectum
83
Tibial shaft fracture cast type
above knee cast
84
Salter Harris fracture types
1: physis 2: physis + metaphysis 3: physis + epiphysis 4. physis + epiphysis + metaphysis 5: crush injury of physis 3,4,5 need surgery
85
Prolapsed disc signs
L3 root compression: sensory anterior thigh, weak hip flexion/knee extension, reduced knee reflex, + femoral stretch L4: ant knee + med malleolus sensory loss, weak knee extension, reduced knee reflex, + femoral stretch L5: sensory loss dorsum foot, weak foot dorsiflexion, + sciatic stretch S1: sensory loss posterolat leg + lat foot, weak planter flexion, reduced ankle reflex, + sciatic stretch
86
Prolapsed disc mx
nsaid + ppi if no improvement after 6 weeks mri
87
Artery causing AVN head if NOF
medial circumflex artery
88
Sign of osteoporotic vertebral fracture on xray
wedging
89
NV testing for hand nerves
radial: thumb extension ulnar: thumb adduction median: thumb abduction
90
Common sites for osteomyelitis in adults vs child
adult: epiphysis child: metaphysis
91
Mx for Gardens 1/2 NOF
cannulated screw!!
92
What is neuralgia paraesthetica
compression lateral femoral cutaneous nerve
93
Mx malignant hyperthermia
iv dantrolene
94
MRSA mx
nasal mupirocin + chlorhexadine 5 days
95
Types of post op haemorrhage
prim within op reactive within 24 hours secondary 7-10 days remember to assess perfusion as bp is a late sign!!
96
Classes of haemorrhagic shock
1: <750ml 2: 750-1500ml, hr 100-120, 3: 1500-2000ml, 30-40% blood loss, bp decreased 4: >2000ml, >40%, HR/RR>40, UNCONSCIOUS
97
Metabolic abnormality if too much iv fluids
Hyperchloraemic metabolic acidosis
98
Meds that cause ED
b blockers ssris antiepileptics
99
Complications of TURP
T ur syndrome : hyponat, fluid overload U rethral stricture/UTI R etrograde ejaculation P erforation of the prostate
100
GS ix in appendicitis in F vs M
F: uss M: CT (unless thin + classic symptoms)
101
How to minimise bleeding risk pre-op
stop anticoag + d assay coag screen, fbc hydrate + monitor fluid balance
102
cannonball metastases
RCC
103
Periop steroid mx
Hydrocortisone 100 mg by IV injection should be given at induction of anaesthesia in adult patients with adrenal insufficiency from any cause, followed by a continuous infusion of hydrocortisone until the patient can take double their usual oral glucocorticoid dose by mouth
104
Sepsis 6
1. IV access + bloods + cultures 2. Escalate to senior 3. Monitor NEWS + urine output 4. Give IV fluids 5. Give abx + source control 6. Give oxy
105
Sepsis screening
1. think if looks unwell, risk factors, or NEWS2>4 2. confirm infection suspected 3. look for organ dysfunction via sofa, news2
106
Axillary node screening for breast cancer
palpable nodes before surgery = clearance non palp = offer uss axillary before surgery = + clearance if uss - then sentinel node biopsy if can't find sentinel node then 3 random nodes test
107
Mx PAD (chronic limb ischaemia)
supervised exercised programme to make collateral arteries clopidogrel + statin endovascular angioplasty + stent or open bypass
108
A-E mx for acute limb ischaemia
supportive - oxygen, analgesia, fluids etc unfractionated heparin contact vascular surgeons for revascularisation via thrombectomy/thrombolysis etc

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