Surgery Flashcards

(33 cards)

1
Q

What is Pseudomembranous Colitis?

A
  • Acute inflammatory condition which occurs secondary to antibiotic use
  • Clostridium Difficile (gram positive anaerobe)
  • Presentation is usually within 3 - 9 days, although symptoms may develop up to 6 weeks after antibiotic use
  • Presentation = proximal colon and caecum and present with a RLQ pain which may mimic appendicitis
  • Diagnosis = stool testing for Clostridium Difficile toxins
  • Complications = hypovolaemic shock, electrolyte imbalance, hypoalbuminaemia, perforation of the bowel and toxic megacolon
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2
Q

What is the management of Pseudomembranous Colitis?

A
  • Fluid Resuscitation (mild cases do not require admission)
  • Oral Metronidazole for 10 days
  • Resistant and recurrent cases are treated with Oral Vancomycin
    • intravenous preparations are avoided as the drug does not reach the intestinal mucosa
  • Anti-Diarrhoeal Agents must be avoided as this would lead to retention of the C. difficile toxin
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3
Q

What is Neurogenic Shock?

A
  • Bradycardia
  • Sudden disruption or injury to the sympathetic nervous pathways
  • Results in loss of vasomotor tone and pooling of blood in the peripheries
  • Severe Hypotension
  • Causes of neurogenic shock include injury to the brain and spinal cord, and acute emotional stress
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4
Q

What is Spinal Shock?

A
  • Transient state occurring after injury to the spinal cord
  • Loss of all voluntary and reflex activity below the level of the injury
  • Hypotonic Flaccid Paralysis which also affects the bladder and bowel
  • This loss can be complete initially but may resolve over a period of days and weeks following the injury
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5
Q

What are the key features of an Arterial Ulcer?

A
  • Painful
  • Deep
  • Well Demarcated
  • Heels, Toes and over Bony Prominences
  • Due to Arterial Insufficiency and Ischaemia = Atherosclerosis
  • Dusky Discolouration
  • Shiny, Hairless Skin
  • Thickening of the Toenails
  • Intermittent Claudication
  • Poor Pulses
  • Coronary Angiography =define arterial lesions which may be improved by angioplasty or vascular reconstruction
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6
Q

What are the key features of an Venous Ulcer?

A
  • Middle Aged Women
  • Cause = Venous Hypertension and assoc w Varicose Veins
  • Medial Gaiter Area (from the ankle to the proximal calf)
  • Shallow
  • Sloughy
  • Surrounding skin = Oedematous, Dark (caused by haemosiderin deposition), Eczematous and Thickened (lipodermatosclerosis)
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7
Q

What history questions should you ask in a Vascular Patient station?

A
  • Vascular Risk Factors:
    • personal or family history of diabetes
    • smoking habits
    • exertional capacity before onset of claudication (e.g. walking distance, number of stairs they can climb)
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8
Q

What are the associations of Primary Biliary Cirrhosis?

A
  • Rheumatoid Arthritis
  • Sjogren’s Syndrome
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9
Q

ERCP - ‘beading’ of the biliary tree

A

Primary Sclerosing Cholangitis

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10
Q

What is Buerger Disease?

A
  • Vasculitis of medium-sized vessels
  • Results in progressive obliteration of distal arteries
  • Young Men (< 45 years)
  • Smoke heavily
  • Asians and Ashkenazi Jews
  • HLA-B12​
  • Pain = main symptom
  • Chronic Inflammation and Thrombosis can result in Ulceration and Gangrene (often requiring amputations)
  • Arteriography = normal proximal vessels and distal occlusions with multiple ‘corkscrew’ collaterals
  • Management = analgesia and stop smoking - if tobacco use is not ceased, multiple amputations will be unavoidable
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11
Q

What is Takayasu Arteritis?

A
  • Pulseless Disease or Aortic-Arch Syndrome
  • Granulomatous Inflammation of the aorta and its major branches.
  • Hypertension
  • Arm Claudication
  • Absent Pulses
  • Bruits
  • Visual Disturbance (transient amblyopia and blindness)
  • Systemic Illness (malaise, fever, night sweats and weight loss)
  • Younger Asian Women
  • Diagnosis = Angiography which shows aorta narrowing and its major branches
  • Management = steroids but the condition is progressive and death occurs within a few years
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12
Q

What are the markers of poor prognosis in Pancreatitis?

A
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13
Q

What are the investigation findings in Pancreatitis?

A
  • Raised Amylase (above 4 times the normal upper limit)
    • 40 - 140 U/L
  • Elevated Serum Lipase (2 times upper normal limit)
    • 0 - 160 U/L
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14
Q

What are the potential complications of a Supracondylar Fracture?

A
  • Volkmann Ischaemic Contracture
    • brachial artery injury = circulatory compromise and ischaemia = fibrosis of the forearm compartment
    • secondary to untreated compartment syndrome
    • forearm appears to be shortened and held in flexion at the wrist and the fingers
    • Treatment = surgery
  • Carpal Tunnel Syndrome = median nerve injury
  • Ulnar Nerve Palsy = stretching of the ulnar nerve over an increasing valgus deformity
  • Cubitus Varus Deformity (‘gunstock deformity’) = malunion of supracondylar fractures
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15
Q

What are the features of Chagas Disease?

A
  • Central and South America
  • Trypanosoma Cruzi = protozoa
  • Primary Disease
    • skin nodule – a chagoma
    • fever, malaise, lymphadenopathy etc
  • Secondary Disease
    • 30% after years
    • dysphagia (similar to achalasia)
    • destruction of the oesophageal myenteric plexus
    • retained food eventually results in oesophageal dilatation
    • megaoesophagus’ can be seen on barium swallow
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16
Q

What is the treatment of Anaphylaxis?

A
  • Adrenaline i
    • bronchodilate
    • vasoconstrict,
    • IM (10 mL of 1:1000 solution)
  • IV antihistamines (e.g. chlorphenamine) and IV hydrocortisone are used to assist in dampening the inflammatory response
  • Fluids are used for hypotension
  • Salbutamol can be administered simultaneously to aid the relief of bronchospasm
17
Q

What is the cause of Appendicitis?

A
  • Inflammation of the appendix
  • Secondary to obstruction of the appendiceal opening into the caecum.
  • Causes of obstruction include faecoliths and lymphoid hyperplasia secondary to viral infections
18
Q

What are the signs of Appendicitis?

A
  • Localized peritonitis over McBurney point (found 1/3 of the way between the ASIS and umbilicus)
  • Palpation over the LIF may cause pain in the rRIF (Rovsing Sign)
  • Location (of inflamed appendix)
    • bladder = urinary frequency
    • rectum = diarrhoea
    • psoas muscle = patient will feel most comfortable lying with the hip flexed
19
Q

What are the key features of Acromegaly?

A
  • GH secreting tumour
  • GH = anabolic
  • SoL = early morning headache that is worse on coughing and straining
  • Risks = colon cancer and atheromatous disease
  • Diagnosis = glucose tolerance test (75 g glucose - GH not suppressed)
  • Treatment
    • surgery = transphenoidal
    • medical = octreotide (somatostatin analogues)
  • N.B. Tumour before bone epiphysis fusion = gigantism
20
Q

Cholangiocarcinoma vs Pancreatic Cancer?

A

Cholangiocarcinoma

  • Adenocarcinoma of the Biliary Tree
  • Assoc w UC, PSC and Crohn’s
  • Poor Prognosis = 6 months (not amenable to surgery at time of presentation
  • 50-70 years old
  • F = M
21
Q

What is Brown-Séquard Syndrome?

A
  • Hemisection
  • Ipsilateral = loss of motor and dorsal columns (decussates at the level of entry into the spinal cord)
  • Contralateral = loss of spinothalamic (decussates at medulla)
  • Best prognosis of all spinal cord lesions
22
Q

What is the treatment of Wilson’s Disease?

A

Penicillamine = chelates copper and encourages its excretion

23
Q

Ampicillin and Amoxicillin precipitates a widespread rash in which condition?

A

Infectious Mononucleosis = don’t give it!

24
Q

What are the features of Anal Carcinoma?

A
  • SCC (80%)
  • Elderly population
  • Associated w Human Papilloma Virus (types 16, 18, 31 and 33) and Anal Warts
  • Non-Specific Symptoms:
    • pain
    • discomfort
    • itching
    • intermittent bleeding
    • inguinal lymphadenopathy
25
What is the **diagnosis** and **treatment** of _Anal Carcinoma_?
_Diagnosis_ * **Biopsy** * **Rectal Examination** under **anaesthesia** * **CT/MRI** can be used to assess the **extent** of **pelvic spread** _Management_ * **_Localized_** = **radiotherapy** with or without **excision** * **_Larger_** = **abdominoperineal (AP) resection** with **colostomy** * sigmoid colon, rectum and anus are removed * defect in the perineum is closed with a mesh or muscle flap
26
What are the key **features** of a _Para-Umbilical Hernia_?
* **Adults** * **Multiparous Women** * **Above/Below Umbilicus** in the **Linea Alba** * **Narrow Neck** = **Strangulation**
27
What is a _Pseudo-Polyp_?
* **Inflammatory Bowel Disease** * In an area of oedematous, swollen bowel surrounded by ulcerations, it looks as if the **oedema** is protruding from the walls of the bowel wall as a polyp * In reality, these ‘polyps’ are merely areas of **swollen bowel mucosa**
28
What is _Morton Neuroma_?
* Between **3rd** & **4th Metatarsal** of the **Foot** * Middle-Aged Women * **Pain** (shooting) when wearing **shoes** (relieved when removed) * _Diagnosis_ = **clinical** (_but_ confirm w **MRI** or **US**) * Foot X-rays = Normal * _Treatment_ = **surgical excision** (= **cure**)
29
What is _Plantar Fasciitis_?
* **Pain** in the **heels** when **walking** * **Inflammation** of the **fascia** as it **inserts** into the **calcaneum**
30
What are some potential **complications** of _Angiography_?
* _False Aneurysm_ (commonly after trauma or iatrogenic = **pulsatile**, **minimally tender**) * **ultrasound-guided compression** * **embolisation** * **surgery** * _Groin Abscess_ = **tender** and **fluctuant** but not pulsatile
31
_Tumour Markers_?
32
What are the **key features** of _Duct Ectasia_?
* Skin/**Nipple Retraction** * **Greenish**/Brown Nipple **Discharge**
33
What is _Intraductal Papilloma_?
* **Benign** Tumours of **Lactiferous Glands** * **Pre-Menopausal Women** * **Pain** within the **Nipple** or **Areola** * Associated w **Discharge** which may be **Blood-Stained** * In most cases there is _no_ associated breast lump * _Investigations_ = * **cytology** (**_no_ malignant cells**) * **ultrasound** (more sensitive than mammography for intraductal papillomas) * **ductography** * lump present = **biopsy** * _Treatment_ = * **conservative** * significant symptoms or a **risk** of **malignancy** = **surgical excision** of the affected duct can be undertaken (**microdochectomy**)