Surgery 2 Flashcards by H JP

What is the difference between spondylolysis and spondylolisthesis?

Spondylolysis - usually affects L4/L5
Spondylolisthesis - occurs when one vertebra is displaced relative to its immediate inferior vertebral body, can result following a stress fracture or spondylolysis

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What is Scheuermann’s disease?
What may be seen on XR (2)

Progressive kyphosis
Epiphyseal plate disturbance and anterior wedging

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When to refer someone with cyclical mastalgia?

Pain has not responded to conservative measures after 3 months and is affecting quality of life

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Associations for renal cell cancer (4)
Age and gender
RF
x2 conditions associated with it

Middle aged men
Smoking
Von Hippel Lindau syndrome
Tuberous sclerosis

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RCC classical triad of symptoms

Haematuria
Loin pain
Abdominal mass

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Other features of RCC (2)

Pyrexia of unknown origin
Varicocele (left sided)

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What is Stauffer syndrome?

Cholestasis/ hepatosplenomegaly
(Paraneoplastic disorder associated with RCC)

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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
=

Fat necrosis

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May present with blood stained discharge
Breast disorder
=

Duct papilloma

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Green nipple discharge
Most common around menopause
Tender lump around areola
=

Mammary duct ectasia

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Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
=

Fibroadenosis

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discrete, non-tender, highly mobile lumps

Fibroadenoma

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Define priapism
Age at presentation (2)

Persistent penile erection lasting >4 hours
5-10yo
20-50yo

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Causes of priapism (4)

Sickle cell
Medication e.g sildenafil
Cocaine
Trauma

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Mx priapism

Ischaemic - medical emergency, aspiration and saline flush injection

Non ischaemic - observation

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Circumcision reduces the risk of (3)

UTI
Penile cancer
STI

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What is phimosis and paraphimosis?
Hypospadias

Phimosis - inability to retract skin
Paraphimosis - foreskin is retrsacted and unable to pull back to original position

Urethra opening not at end of penis

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Bowel ca
Who should be referred? (4)

patients >= 40 years with unexplained weight loss AND abdominal pain

patients >= 50 years with unexplained rectal bleeding

patients >= 60 years with iron deficiency anaemia OR change in bowel habit

tests show occult blood in their faeces

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Consider referral under 2ww bowel ca (3)

Rectal or abdominal mass
Unexplained anal mass/ ulceration
<50yo with rectal bleeding AND AP/change in bowel habit/ weight loss/ IDA

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NHS screening programme for bowel ca

Every 2 years
Men and women aged 60-74 England, 50-74 in Scotland
Over 74yo can request

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Who should receive a FIT test (outside of screening) (3)

patients >= 50 years with unexplained abdominal pain OR weight loss

patients < 60 years with changes in their bowel habit OR iron deficiency anaemia

patients >= 60 years who have anaemia even in the absence of iron deficiency

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How long does lidocaine last?

1 hour

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Name three absorbable suture materials (3)
How long before they disappear?

Vicryl
Dexon
PDS
7-10 days

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When should you remove non absorbable sutures
Face
Scalp/limbs/chest
Hand/ foot/ back

3-5 days
7-10 days
10-14 days

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What is the most common pituitary tumour? Microadenoma versus macro in size

Prolactinoma <1cm >1cm

Who should be referred early for bariatric surgery?

BMI 40-50

Types of restrictive bariatric surgery (3)

Lap adjustable gastric banding (1st line if BMI 30-39) Sleeve gastrectomy (reduce stomach by 15%) Intragastric balloon (can be left in for 6 months)

What is Paget's disease? Diagnostic test

Eczematoid changes of nipple associated with an underlying breast malignancy Punch biopsy + mammography

How to tell the difference between Paget's disease of the breast and eczema

Paget's involves the nipple primarily and then spreads to areolar. The opposite occurs in eczema

PAD mx (4)

1. Stop smoking 2. Statin 80mg atorvastatin 3. Clopidogrel 4. Exercise training (supervised)

RF for prostate ca (4)

Increasing age Obesity Afro-Caribbean FH

1st line investigation for prostate ca How are the results reported?

MR 5-point Likert scale

Likert scale interpretation

>=3 --> MR prostate biopsy 1-2 discuss pros and cons with pt r.e biopsy

What score is used to predict prognosis in prostate ca?

Gleason

Patients with superficial thrombophlebitis may also have a ?

DVT

Mx superficial thrombophlebitis (2) If option 2 is CI then ?

Compression stockings Consider LMWH for 30 days or fonda for 45 days If LMWH is CI then PO NSAIDs for 8-12 days

Patients with superficial thrombophlebitis at, or extending towards, the sapheno-femoral junction can be considered for?

Therapeutic anticoagulation for 6-12 weeks

Often history of dysuria and urethral discharge Swelling may be tender and eased by elevating testis = which testicular swelling? Usually caused by?

Epididymo-orchitis Chlamydia

Single or multiple swelling May contain clear or opalescent fluid (spermatoceles) Usually occur over 40 years of age Painless Lie above and behind testis It is usually possible to 'get above the lump' on examination = which testicular condition?

Epidiymal cysts

Epididymal cysts are associate with? (3) Ix Mx

Polycystic kidney disease CF Von Hippel Lindau US Surgery

Causes of spontaneous SAH (3)

Intracranial aneurysm AV malformation Arterial dissection

How to prevent vasospasm in SAH

21 day course of nimodipine

Renal stones analgesia of choice Ix

NSAID Non contract CT KUB within 14 hours of admission

Mx renal stones <5mm <2cm <2cm but pregnant Complex renal calculi or staghorn

<5mm pass spontaneously (within 4 weeks) <2cm = lithotripsy <2cm but pregnant = ureteroscopy Complex renal calculi or staghorn = percuteneous nephrolithotomy

If oxalate stones what two medications can be trialled to prevent reoccurrence?

Cholestyramine OR Pyridoxine

When may trastuzumab (Herceptin) be used in breast ca? CI in which patients?

HER2 +ve patients Hx of heart disorders

When may hormonal therapy be used in breast ca? What (2) medications can be used and when?

ER+ve breast ca Anastrozole if post menopausal Tamoxifen if pre and peri

Who is recommended to have breast RT? (3)

Wide local excision Mastectomy T3-T4 Four or more positive axillary nodes

Who is offered a wide local excision (WLE) or mastectomy DCIS<4cm DCIS>4cm Large lesion, small breast Small lesion, large breast Peripheral versus central tumour Multifocal versus solitary

WLE Mast Mast WLE WLE versus mast Mast versus WLE

2ww breast criteria

30>= unexplained breast lump 50>= with discharge/retraction/ any changes

When to consider a 2ww for breast? (2)

Skin changes that suggest breast ca OR >=30 unexplained lump in axilla

Non urgent referral for breast in?

<30 with unexplained breast lump

RF breast ca (10)

1. BRCA 2. 1st degree relative pre-menopausal 3. Nulliparity 4. 1st pregnancy >30yo 5. Early menarche 6. Late menopause 7. Combined HRT 8. COCP 9. Not breastfeeding 10. Obesity

Screening programme breast:

50-70yo mammogram offered to females every 3 years

If the person concerned only has one first-degree or second-degree relative diagnosed with breast cancer they do NOT need to be referred unless any of the following are present in the family history (9)

age of diagnosis < 40 years bilateral breast cancer male breast cancer ovarian cancer Jewish ancestry sarcoma in a relative <45yo glioma or childhood adrenal cortical carcinomas complicated patterns of multiple cancers at a young age paternal hx of breast ca (two or more relatives on the father's)

Who can be offered a breast clinic referral earlier than screening due to their FH?

one first-degree female relative diagnosed with breast cancer at younger than age 40 years OR one first-degree male relative diagnosed with breast cancer at any age OR one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years OR two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age OR one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree OR second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative) OR three first-degree or second-degree relatives diagnosed with breast cancer at any age

Breast ca classification (4) Which is the most common?

Ductal versus lobular Carcinoma in situ versus invasive Invasive ductal (no special type) - most common Invasive lobular DCIS LCIS

Obesity mx BMI 25–29.9

1. Diet and physical activity 2. Consider starting drug treatment with BMI of 27 with RF (such as type 2 diabetes, hypertension, or dyslipidaemia)

Obesity mx 30-34.9

1. Diet and exercise 2. Consider drug rx if has RF 3. Consider assessment for bariatric surgery

Obesity mx >35 >50

1. Diet and exercise 2. Consider drug treatment 3. Bariatric surgery 1. Bariatric is first line if BMI >50

Drug treatment for obesity (2)

1. Orlistat BMI >28 with RF or BMI >30, discontinue after 12 weeks if ineffective (not lost at least 5% body weight) - no restriction on how long it can be prescribed for. 2. Liraglutide BMI >27 with RF or BMI >30 as an adjunct to a reduced calorie diet and increased physical activity (prescribed in secondary care)

Surgery 2 Flashcards

(61 cards)