Surgery Flashcards
(174 cards)
1
Q
what is preferred airway manoeuvre if concerned about cervical spine
A
jaw thrust
2
Q
what has a poor control against reflux of gastric contentes
A
laryngeal mask
3
Q
what provides optical control of aiway & can be used short and long term
A
endotracheal tube
4
Q
what do you monitor for endotracheal tube
A
end tidal CO2(capnography)
5
Q
asa 2
A
current smoker
6
Q
asa 4
A
seveer syste,ic disease that is a constant threat to life
7
Q
asa 5
A
pt who is not expected to survive without the operation
8
Q
asa 6
A
brain dead pt
9
Q
what can get rpaid onset of action of aneasthesia so used for rapid sequence of induction
A
sodium thiopentone
10
Q
suitable aneasthesia for those who are haemodynamically unstable as it produces little myocardial depression
A
ketamine
also doesnt cause a drop in pressure so useful in trauma
11
Q
Total gastrectomy, oophorectomy, oesophagectomy
Elective AAA repair, cystectomy, hepatectomy
A
defos need tranfusion so cross match 4-6 units
12
Q
adverse effects of volatile liquid anaesthetics eg …flurane
A
Malignant hyperthermia
13
Q
nitroux oxide should be avoided in
A
pneumothorax
14
Q
good thing about propofol
A
anti emetic effects
15
Q
peripheral venous cannula unsuitable for inotropes and total parenteral nutrition
A
16
Q
where is preferred for a central line
A
internal jugular - have multiple lumesn allowing for multiple infusions but cannot be rapid infusions
17
Q
where or intraoesseous access
A
antero medial proximal tibia
18
Q
tunnelled lines eg Hickman lines popular for
A
long term therapetuctic requirements and go in IJV
19
Q
PICC
A
peripherally inserted central cannula
20
Q
grey cannula flow rate
A
180ml/min
21
Q
lidocaine works by
A
blockage of sodium channels
22
Q
how to treat lidocaine toxicity
A
lipid emulsion
23
Q
what local anaesthetic has a long duration of action
A
Bupivacaine
24
Q
shat reduces efficacy of local anaesthetic
A
if tissues are acidotic eg if in an abscess
25
why might adrenaline be added when lignocaine is being used
it prolongs the duration of action and permites usage of higher doses
contraindicated if taking MAOI's or tricyclic antidepressants
26
suxamethonium can cuase
malignant hyperthermia
27
mx of malignant hyperthermia
dantrolene
28
examples of muscle relaxants
suxamethonium and other drugs ending in nium
29
the muscle relaxants ending in nium can be reversed by
neostigmine ( not for suxamtheonium tho)
30
Nasopharyngeal airway good if
decreased GCS
31
when are nasopharyngeal airways relatviely contraindicated
base of skull fractures
32
suxamethonium
can also cuase tranient hyperkalemia
- malignant hyperthermia
- muscle relaxant of chocie for rapid sequence induction for intubation
- may cause fasiculations
contraidnicated if got eye injuries or acute angle glaucomas as increases intra ocular pressure
33
NG feeding contraidncited follwoing
head injruy
34
total parental nutrition should be administered via a central line as it is
strongly phlebitic
35
Total parental nutrition long term is associated with
fatty liver
36
what fluids preferred post op
balanced eg hartmanns over saline - prevents hyperchloaremic acidosis
37
isolated fever 24hrs post op
physiological systemic ifnalmamtory response
38
what can help with post op ileus
fixing electrolytes
39
mx of post op ileus
nil by mouth intially
40
(surgery requiring a long fasting period of more than one missed meal) or whose diabetes is poorly controlled, will usually require a variable rate intravenous insulin infusion (VRIII)
41
is stopping warfarin but got high VTE risk then can ggive LMWH stopping 24hrs before surgery
stop warfarin 5 days before
42
pts on long term steriods then surgery
Convert to IV hydrcortisone
43
acei/arbs should be discontineed how long before surgery
24hrs
44
stop clipdogrel/prpasugrel how long before surgery
7
45
why might cream be ised post thoracic duct surgery
prevent infection and promote healing
46
what given for carcinoid tumours to prevent carcinpid syndromes
octrotide - controls symptoms like flushign and diarrhoea
47
avoid using what where there are end arteries
using adrenaline and monopolar diatehrmy
48
worry about long thoracic nerve in
axillary node clearance
49
what is an important target to avoid for laparoscopic ports and surgical drains
inferior epigastric artery
50
worry about hypoglossal nerve in what surgery
carotid endarterectomy
51
Use of Verres Needle to establish pneumoperitoneum. worry about
bowel perforation
52
failure to delineate calots triangle
bile duct injury
53
ligating splenic hilum
tail of pancreas
54
what can happen follwing penumonectomy
pulmoanry oedema
55
what identifies abscess post op
CT
56
Sending peritoneal fluid for U+E (if ureteric injury suspected) or amylase (if pancreatic injury suspected)
57
Remember that recent surgery is a contra indication to thrombolysis and that in some patients IV heparin may be preferable to a low molecular weight heparin (easier to reverse).
time out refers to before incision of skin
58
if need to remove hair for surgery
use clipper with single head and not razor as they increasae infection risk
59
what temp probes are used during surgery
oesophageal
60
Use forced air-warming devices from the start of anaesthesia for surgeries longer than 30 minutes or for high-risk patients.
61
what VTE prophylaxis is given as an altenative to LMWH in pts with CKD
Unfractionated heparin
62
before surg when should women be advised to stop taking
oral contraceptive pill/ hrt - 4 weeks before
63
all pts getting what surg should get pharmacological VTE prophylaxis
hip and knee replacements
64
Conditions such as jaundice will impair fibroblast synthetic function and immunity with a detrimental effect in most parts of the healing process.
65
keloid scars pas beyond boudnaries of original injury what scars dont
hypertrophic scar
66
fibroademona greater than 4cm qualify for
core biopsy to exclude phyllodes tumour
67
breast cysts have what appearance on mammography
halo appearance
68
duct ectasia
breast ducts shorten and dialte
may cuase cheese like nipple discharge and slit like retraction of nipple
no specific treatement is requried
69
what scna confirms fluid filled nature of breast cyst
US
70
tamoxifen can contribute to what cancer
endometrial
71
tamoxifen for
anastrozole (aromatase inhibitor for)
tamoxifen - premenopusal
anastrozole - post menopuasual women
72
adverse effect for aromatase inhinitor
osteoporosis so DEXA when initiating pt on it
73
aromatase inhinitor and tamofen do what to oestrogen
block it or reduce synthesis
74
do breast cysts have an increased risk of breast cancer
small increased risk
- should aspirate it
75
fat necrosis
40% have a traumatic aetiology
76
duct papilloma usually present with
nipple discharge
77
most common type of breast cancer
invasive ductal carcinoma
78
women with breast cancer with no palpable axillary lymphadenopathy should have axilalry US, if neg should have sneinel node biopsy
if have aplpable axillary lymphadenopathy, axillary node clearance is indicated at primary surgery
79
what is recommended psot surgery for women who have had a wide local ecision as it cna reduce risk of recurrence by around 2/3s
whole breast radiotherapy
80
tamofen also used in
pre and periomeopausal owmn
81
Important side effects of tamoxifen include an increased risk of endometrial cancer, venous thromboembolism and menopausal symptoms.
HER2 positive = trastuzumab
82
chemo that can be used in postive axillary node
FEC-D
83
women under 30 with unexplained breast lump
consider non urgent referral
84
obesity is a rf for
breast cancer
85
not having kids is a rf for
breast cancer
86
mammogram
50-70 every 3 years
87
if first degree relative had breast cancer before when may get screenign at younger age
relative had it before 40
88
jewish ancestry has increased risk of breast cnacer as greater amounts of
BRCA1 and 2
89
FIbroadenosis )fibrocystic dsiease)
most common in middle aged women - lumpy breasts which may be painful - symptoms may worsen prior to mesntruation
90
tender lump around areola +- green discharge
mammary duct ectasia
(dialtion of large breast ducts & maot common around menpause)
91
may present with duct stained discharge
duct papilloma
92
when do you normally excise fibroadenoma is
>3cm
93
breast pain that varies with menstrual cycle
cyclical mastalgia
94
Cyclical mastalgia is not usually associated with point tenderness of the chest wall (more likely to be Tietze's syndrome).
95
mx of cyclical mastalgia
supprotive bra
analgesia
if still not impriving can try hormonal treatmetn such as danazol
96
dialtion & shortening of breast ducts near nipple - typcialy present with nipple retract & ocassionaly creamy discharge
duct ectasia
97
galactorrhoea can occur from
emotional events or also from histamine antagonsists
98
intracductal papilloma
commoner in young pts
may cuase blood stained discharge
there is usually no palpable lump
99
duct ectasia discharge is usually thick and green
it is a normal variant of breast evolution
100
Paget's disease differs from eczema of the nipple in that it involves the nipple primarily and only latterly spreads to the areolar (the opposite occurs in eczema).
Diagnosis is made by punch biopsy, mammography and ultrasound of the breast.
101
rule of thumb for ileosot,y
RIF
spouted
liquid
102
what can be used to defunction the colon to protect an anastomosis
Loop ileostomy
103
ix for acute mesenteric iscahemic
CT angio
104
mx of acute mesenteric ischaemia
immediate laparotomy
105
most anal cancers are
squamous
106
HPV causes 80-85% of SCC anal cancers especially subtype
16
107
if anal fissure not occur in posterior midline but in other locations other underlying cuases should be cosndeired eg
crohsn
108
what is first line for chronic anal fissure
topcial GTN
109
mx of acute anal fissue
high fibre
bulk forming laxative
lubricants before pooing
110
leak through colorectal anastomosis
abdo pain and fever 5-7 dyas post op
ix of chocie - CT with contrast
111
sentinel pile is
external haemorrhoid that often develops as a result of udnerlyig anal fissure
112
most common cancer in rectum
adeno
113
anal itching in kids
worms
114
- postprandial abdominal pain (classically crampy, 30–60 mins after eating)
chronic mesenteric ischameia
115
most common location of colorectal cancer
40% are rectal
116
All patients with newly diagnosed colorectal cancer should have the following for staging:
carcinoembryonic antigen (CEA)
CT of the chest, abdomen and pelvis
their entire colon should have been evaluated with colonoscopy or CT colonography
patients whose tumours lie below the peritoneal reflection should have their mesorectum evaluated with MRI.
117
when might need to do an end colostomy
bowel perforation as anastomosis not ggod due to contamination & poor tissue quality
118
FIT test done in scotland
every 2 yearrs from age 50-74
119
what should be done before colonoscopy in suspected colorectal cancer
120
if got unexpaliend abdo pain or weight loss and over 50
do FIT TEST
121
most colorectal cancers arise from polyps so need to
reomove if seen on colonscopy as they have premalignant potential
122
where is often spared in diverticular disease
rectum as it lacks taenia coli
123
where most likely to get diverticulitis
sigmoid colon
124
diverticuliti spain is usualky where
left lower quadrant as thats where sigmoid is
125
pneumaturia or faecaluria
colovesical fistula
126
what is not routinely recommended as have low value in diverticulitis
abdo xray
127
mx for mild diverticulitis
oral antibiotics, liquid diet and anlegia
may need IV antibiotics if more severe
128
what type of haemorrhoids cause pain
external
129
transient compromise to blood flow in large bowel
ischaemic colitis
130
what is more likely to occur in watershed areas eg splenic flexure
ishcaemic colitis - may see thumb printing on abdo X-ray due to mucosal oedema/haemorrhage
131
what is the presenting compliant in 30% of colonic malignancies
large bowel obstruction
-this is particularly the case in more distal colonic and rectal tumours, as these tend to obstruct earlier due to the smaller lumen diameter
- 60% of large bowel obstruction are due to tumours
132
first line ix for large bowel obstruction
abdo xray
133
initial steps for bowel obstruction
- NBM, IV fluids, ng to drain , iv antibiotics
134
what is often done in the emergency mx of large bowel malignancy
hartmanns - resection with end colostomy
135
hardened tissue in anal region could be
perianal abscess
136
In young patients with external stigmata of fissure and a compatible history it is acceptable to treat medically and defer internal examination until the fissure is healed. If the fissure fails to heal then internal examination becomes necessary along the lines suggested above to exclude internal disease
137
staying rectal malignancy
MRI of rectum + CT of chest abdo and pelvis
138
first line for fissure in and
GTN ointment
139
2nd line for fissure in ano
Botulinum toxin
140
Lifestyle advice, for small internal haemorrhoids can consider injection sclerotherapy or rubber band ligation. For external haemorrhoids consider haemorrhoidectomy.
141
IBD pts getting surgery
IBD pts have a high incidence of DVT and need thromboprophylaxis
142
most common site for crohns
terminal ileum
143
terminal ileum crohns may affect enterohepatic bile salt recycling and increase the risk of
gallstones
144
if thrombosed haemorrhoids present within 72 hrs can
be excised
145
most common volvulus
sigmoid colon
146
how does Volvus present
constipation
abdo paina nd blaoting
n+V
147
ix for volvulus
usually diagnosed on abdo xray
148
brainstem compression is called
cloning
149
Displacement of the cingulate gyrus under the falx cerebri
subfalcine
150
if get tonsillar herniation - if raised ICP affects cardioresp centre. If seen without raised ICP think
Chairi 1 malformation
151
herniation when brain is displaced through a defect in the skull
transcalvarial
152
as ICP rises what happens
hypertension
153
awaiting theatre for extradural haemoatoma may give what for rising ICP
mannitol/ frusemide
154
ICP monitoring required if
GCS 8 or less
155
minimum cerebral perfsuon pressure in adults
70
156
head injury and more than 1 episode of vomiting
CT head within 1hr
157
in subdural haematoma there may be
fluctuating confusion/consciousness
158
increase in headcirumference in kid
hydrocephalus as infants skull sutures not yet fused
159
sunsetting eyes is hydrocephalus in kids due to compression of
superior colliculus
160
what can cause a reduction of reabsorption of arachnoid granulations
meningitis or post haemorrhage
161
appearance of normal pressure hydrocephalus
large ventricles but normal intracranial pressure
162
Lumbar puncture should not be used in what hydrocephalus
obstructing
163
if CT head is done within 6 hours of symptom onset and is normal
new guidelines suggest not doing a lumbar puncture
FOr SAH
164
do what after SAH confirmed
CT intracranial angio to indemnify aneurysm or AVM
165
intracranial aneurysms are at risk of rebleeding and therefore require prompt intervention, preferably within 24 hours
most intracranial aneurysms are now treated with a coil by interventional neuroradiologists, but a minority require a craniotomy and clipping by a neuro
166
rebreeding in a SAH should get repeat CT but associated with a high
mortality
167
menigngism may also be seen in
SAH - photophobia, neck stiffness
168
Fluctuations in the level of consciousness are common.
subdural haematoma
169
burr holes used for
subdural haematoma
170
duodenal atresia - vomiting a few hrs after birth -axr double bubble sign
171
volvulus
3-7 days after birth vomiting- do Ladds procedure
172
meconium ileum
24-48hrs of life with abdo distension and bilious vomiting
abdo xray
sweat test to confirm cystic fibrosis
173
2nd week of life with dilated bowel loops on axr
necrotising enterocolitis
174
intusucception presents with
colicky abdo pain with a mass on examination
