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Finals Revision > Surgery > Flashcards

Surgery Flashcards

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1
Q

Storage LUTS

A

Urgency
Frequency
Nocturia
Urge incontinence

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2
Q

Voiding LUTS

A 
Hesitancy 
Intermittency 
Straining 
Terminal dribbling 
Incomplete emptying
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3
Q

What tool can be used for measuring QoL impact of LUTS?

A

International prostate symptom score (IPSS)

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4
Q

Inspection of scrotal lump should include note of …

A 
Site
Size
Shape 
Symmetry
Skin changes
Scars
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5
Q

When palpating a scrotal lump, comment on …

A 
Consistency 
Attachments 
Mobility 
Pulsation 
Fluctuation 
Irreducibility 
Regional LNs
Edge 
Tenderness
Temperature
Trans illumination
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6
Q

Testicular cancer markers

A

LDH
AFP
Beta HCG

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7
Q

What is a hydrocoele?

A

Peritoneal fluid accumulation between layers of the tunica vaginalis

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8
Q

What is a varicocoele?

A

Dilatation of the pampiniform plexus

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9
Q

Causes of acute urinary retention

A 
BPH
UTI 
Constipation 
Urethral stricture
CaP
Anti-muscarinics 
Spinal/epidural 
Peripheral neuropathy 
UMN disease
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10
Q

Investigations need for acute urinary retention

A

Urine dip
Urine culture
Post-void bladder scan
US kidneys (hydronephrosis)

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11
Q

Commonest cause of chronic urinary retention

A

BPH

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12
Q

Management of chronic retention

A

Treatment of underlying cause
Long term catheter
Intermittent self catheterisation

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13
Q

Causes of haematuria

A 
UTI 
Renal/bladder ca 
CaP
Stones
BPH
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14
Q

Causes of pseudo haematuria

A 
Rifampicin 
Hyperbilirubinaemia 
Methyldopa
Myogloburia
Beeturia
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15
Q

Investigations for haematuria

A 
Urine dipstick and culture
Bloods
PSA
Flexible cystoscopy 
US KUB 
CT urogram
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16
Q

Causes of stress incontinence

A 
Post partum 
Constipation 
Obesity 
Post menopause
Post surgery
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17
Q

Causes of urge incontinence

A

Neurogenic
Infection
Cancer
Medication - cholinesterase inhibitors

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18
Q

Mx of stress incontinence

A 
Pelvic floor exercises 
Tension free vaginal tape 
Open colposuspension 
Intramural bulking agent
Artificial urinary sphincter
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19
Q

Mx of urge incontinence

A

Bladder training
Anti-muscarinics
Botox
Percutaneous sacral nerve stimulation

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20
Q

Borders of the femoral triangle

A

Superior - inguinal ligament
Lateral - medial border of sartorius
Medial - medial border of adductor longus
Base - adductor longus, pettiness and iliopsoas
Roof - fascia lata

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21
Q

Contents femoral triangle lateral to medial

A

Femoral nerve
F. Artery
F. Vein
Femoral canal - lymphatics

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22
Q

when does the femoral artery become the popliteal artery?

A

After passing through the adductor hiatus

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23
Q

What does the popliteal artery split into?

A

Anterior tibial artery

Tibioperoneal trunk : divides into posterior tibial and peroneal (fibular) arteries

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24
Q

Sciatic nerve roots

A

L4-S3

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25
Sciatic nerve bifurcates into ...
Tibial nerve | Common fibular nerve
26
Ix to order for suspected epididymitis
Urine dipstick Bloods - infection markers NAAT - STIs US imaging
27
Mx of testicular torsion
Urgent surgical exploration - bilateral orchidopexy | Orchidectomy if testis compromised
28
Primary testicular tumours can be classified simply as....
Germ cell | Non-germ cell
29
What are the 2 broad types of germ cell tumour?
Seminoma | Non-seminoma
30
Which types of tumours are classed as non-seminoma testicular tumours?
Yolk sac Choriocarcinoma Teratoma
31
What are non-germ cell testicular tumours?
Usually benign, Leydig or Sertoli cell origin
32
Undescended testes increases the risk of what type of tumour?
Germ cell tumours
33
What is the advice around sex if diagnosed with urethritis?
Abstain for 7 days after the antibiotic course ends
34
Define reactive arthritis
Sterile inflammatory arthritis caused by distant infection producing an autoimmune response in the joints
35
Where does a pharyngeal pouch form?
Between the 2 parts of the inferior constrictor of the pharynx (thyropharyngeus and cricopharyngeus) Killian’s dehiscence
36
What is Barrett’s oesophagus?
Metaplasia from stratified squamous to simple columnar
37
What angle causes the worst pain with impingement of the shoulder?
60-120
38
What special test can be performed for shoulder impingement?
Hawkins test Shoulder abduct to 90 and then internal rotate Pain - positive test
39
Secondary causes of osteoporosis
``` Cushing’s syndrome Steroids RA Malabsorption Chronic renal failure Immobilisation Weightlessness ```
40
Extra-articular manifestations of RA
``` Anaemia Subcutaneous nodules Kerato-conjunctivitis Pleural/cardiac disease Vasculitis ```
41
Signs in the hands for RA
Ulnar deviation Boutonnières Swan neck
42
Most specific blood test for RA
Anti CCP
43
Commonest joint affected in gout
MTP of big toe
44
What would microscopy of joint fluid in gout show?
Uric acid crystals Needle shaped Negatively birefringent
45
Acute mx of gout
NSAIDs Colchicine Steroids
46
Stages of fracture healing
Haematoma formation Soft callus formation Hard callus Bone remodelling
47
Charcot’s triad for cholangitis
Fever RUQ pain Jaundice
48
What is Reye’s syndrome?
Encephalopathy and fatty degeneration of liver Often fatal Caused by giving aspirin to <16 y/o
49
What are the branches of the arch of the aorta?
Brachiocephalic trunk Left common carotid Left subclavian
50
What are the branches of the SMA?
Ileocolic Right colic Middle colic
51
What are the branches of the IMA?
Left colic Sigmoid Superior rectal
52
Risk factors for wound dehiscence
``` Diabetes steroids Smoking Obesity Emergency surgery Abdominal surgery >6 hour surgery Prolonged ventilation ```
53
What is the management for wound dehiscence?
``` Washing out with saline Vacuum assisted closure Analgesia IV fluids IV abx ```
54
Define anastomotic leak
Leak of luminal contents from a surgical join
55
What features of a cystic region would make you suspicious for malignancy?
Septations Wall enhancements Nodularity
56
Commonest organisms causing cholangitis
E.coli Klebsiella Enterococcus
57
What is Leriche syndrome?
A form of peripheral arterial disease affecting aortic bifurcation Causes buttock and thigh pain and is associated with erectile dysfunction
58
Types of urinary stones
``` Calcium oxalate Calcium phosphate Struvite Urate Cystine ```
59
Common locations for stones
PUJ Crossing pelvic brim VUJ
60
What is the gold standard imaging for ?urinary stones?
non contrast CT KUB
61
Symptoms of rectal prolapse
``` Faecal incontinence Constipation Mucus discharge Bleeding Tenesmus Visible prolapse ```
62
what constitutes the portal triad?
Hepatic artery Portal vein Bile duct
63
Drug causes of gynaecomastia
``` Digoxin isoniazid Spironolactone Cimetidine Oestrogen Methyldopa ```
64
Name 3 hereditary polyp disorders
Familial adenomatous polyposis Lynch syndrome Gardner’s syndrome
65
What is the triad of HUS?
Haemolytic anaemia Thrombocytopenia AKI
66
HUS is associated with what infection?
E.coli
67
How long before surgery is breast milk allowed?
4 hours
68
How long before surgery is formula milk allowed?
6 hours
69
What are the paraneoplastic effects of RCC?
``` EPO = polycythaemia PTH = hypercalcaemia Renin = hypertension ```
70
Ix required for priapism
Corporeal blood gas - determines whether ischaemic or non ischaemic
71
What is Fournier’s gangrene?
necrotising fasciitis of the perineum
72
A haemorrhage for pancreatitis will cause what signs?
Cullen’s | Grey turners
73
What is the commonest cause of atelectasis in post-op patients?
Decreased respiratory effort due to pain
74
What are the 3 basic principles of fracture management?
Reduce Hold Rehabilitate
75
What are the benefits of reduction of a fracture?
``` Anatomical alignment - aesthetic Tamponade bleed Decreased swelling Decreased risk of neuropraxia Decreased pressure on vessels ```
76
What is the organism of Lyme disease?
Borrelia burgdofen
77
Commonest cancers to met to bone
``` Renal Thyroid Prostate Lung Breast ```
78
What is bacterial endophthalmitis?
Bacterial infection inside the eye with vitreous involvement
79
What is Ludwig’s angina?
Necrotising infection of the deep neck tissues Threat to airway due to swelling Can spread to mediastinum
80
Presentation of duct ectasia
Green/yellow nipple discharge Palpable mass Nipple retraction
81
What is a cystic hygroma?
benign fluid filled sac caused by a malformation of the lymphatic system
82
What are branchial cysts?
Congenital masses which arise in the lateral aspect of the neck due to incomplete obliteration of the branchial clefts
83
What causes the sx of BPPV?
Presence of otoliths in the semicircular canal Movement of the head moves the crystals and causes abnormal movement of endolymph Vertigo
84
What diagnostic exam is used for BPPV?
Dix-Hallpike manoeuvre
85
What is used to treat BPPV?
Epley’s manoeuvre
86
What is the cause of Ménière’s disease?
Increase in the endolymphatic pressure caused by dysfunction in sodium channels drawing fluid in
87
What is the mx of Ménière’s disease?
Acute - prochlorperazine | Prophylaxis - betahistine
88
How long does the vertigo typically last in BPPV?
Seconds
89
How long does the vertigo typically last in Ménière’s disease?
Minutes to hours
90
How long does the vertigo typically last in vestibular neuronitis?
Days
91
What are the types of thyroid cancer?
Papillary Follicular Anaplastic Medullary
92
Which is the commonest type of thyroid cancer?
Papillary
93
Which thyroid cancer is most associated with a rise in calcitonin levels?
Medullary
94
Which thyroid cancer is associated with MEN2?
medullary
95
What is the most aggressive form of thyroid cancer?
Anaplastic
96
what is the duct of the parotid gland called?
Stensen’s
97
What is the duct of the submandibular gland called?
Wharton’s
98
Which salivary gland is most likely to develop stones?
Submandibular
99
What makes up the Cushing’s triad?
Irregular respiration Bradycardia Systolic hypertension
100
What Ix is used to diagnose an AV malformation?
Digital subtraction angiography
101
Risk factors for diverticular disease
``` >50 y/o Low dietary fibre Obesity Smoking NSAIDs ```
102
Risk factors for peptic ulcers
``` H. Pylori NSAIDs Smoking Alcohol Steroids Stress ```
103
Defence mechanisms against stomach ulcers
Mucus Bicarbonate Mucosal blood flow Prostaglandins
104
risk factors for gallstones
``` Increased age family hx Sudden weight loss Loss of bile salts (ileal resection) Diabetes Oral contraceptives ```
105
Management of CIN
Large loop excision of transformation zone (LLETZ) | Cold knife cone
106
Uterine prolapse stages
1. Uterus in upper 1/2 vagina 2. Uterus descended almost to opening 3. Uterus protrudes out of vagina 4. Uterus completely out of vagina
107
Naegle rule for EDD
1st day LMP + 1 year - 3 months +7 days
108
Perineal tear stages
1. Injury to perineal skin only 2. Injury to perineal muscle but not involving anal sphincter 3. Involves anal sphincter 4. Involving anal epithelium
109
Mx of shoulder dystocia
``` Call for help Advise to stop pushing Consider episiotomy McRoberts manoeuvre - knees to chest Suprapubic pressure Corkscrew manoeuvre ```
110
What is zavenelli manoeuvre?
Return foetal head to pelvis for delivery via C section | Used in shoulder dystocia
111
How long before surgery should you stop COCP?
4 week before
112
When can you restart the COCP after surgery?
2 weeks post op if mobile
113
When do you need to do a pre-op CXR?
If any cardio resp symptoms or disease | > 65 years old
114
When do you need to do an echo pre op?
Poor LV function | Ix murmurs
115
When do you need an ECG pre op?
Hypertension Hx of cardiac disease > 55 years old
116
When do you need pulmonary function tests pre-op?
Known pulmonary disease | Obesity
117
Which conditions would require a lateral C spine x-ray pre surgery?
RA | AS
118
How do we manage insulin peri operatively?
``` Stop long acting insulin night before Omit AM insulin Start sliding scale VRII Check BM hourly aim for 7-11 Continue VRII until tolerating food ```
119
When to stop aspirin/clop pre op?
If risk of bleeding high | 7 days before
120
What is the mx of warfarin pre op if low VTE risk?
Stop warfarin 5 days before | INR < 1.5
121
What is the mx of warfarin pre-op if high VTE risk?
``` Stop warfarin 5 days before Start LMWH Stop LMWH 12-18 hours pre-op Restart LMWH 6 hours post op Restart warfarin next day Stop LMWH when INR > 2 ```
122
What precipitates malignant hyperthermia?
Halothane | Suxamethonium
123
How is malignant hyperthermia inherited?
Autosomal dominant
124
0.9% saline contains how many mmol of NaCl?
154
125
What are the electrolyte changes in refeeding syndrome?
Low K, Mg, PO4
126
What are the causes of neurogenic shock?
Spinal anaesthesia Hypoglycaemia Cord injury > T5 Closed head injury
127
Define hypothermia
Core temp (rectal) < 35
128
What is the patho of achalasia?
Degeneration of myenteric plexus | LOS fails to relax
129
Describe the pain of a duodenal ulcer
Pain before meals and at night | Relieved by eating
130
Describe the pain of gastric ulcer
Worse on eating | Relieved by antacids
131
How long before an OGD do you need to stop PPIs?
2 weeks
132
What is the Rockall score?
Used in haematemesis to predict risk of rebleeding and mortality
133
Common antibiotics used for cholecystitis
Cefuroxime and metronidazole
134
Describe reynold’s pentad
``` For cholangitis Fever RUQ pain Jaundice Shock Confusion ```
135
What is Trousseau sign?
Thrombophlebitis migrans secondary to pancreatic cancer
136
Define diverticulum
Mucosa herniated through muscularis propria at points of weakness where perforating arteries enter
137
Imaging for a thyroid lump
High res US Radionucleotide scan - hot vs cold CT
138
Breast reconstruction techniques
Implant Lat Dorsi myocutaneous flap Transverse rectum abdominis myocutaneous flap
139
Where is the vomiting centre?
Medulla oblongata
140
Which NTs act on the vomiting centre?
Histamine | 5HT3 (serotonin)
141
Where is the chemoreceptor trigger zone?
Area postrema | Inferior aspect of the 4th ventricle
142
Which NTs act at the CTZ?
Dopamine | 5HT3
143
Which anti-emetics are most useful in opioid induced nausea?
Ondansetron | Cyclizine
144
Commonest type of anal cancer
Squamous
145
Risk factors for anal cancer
``` HPV HIV Age Smoking Crohn’s ```
146
Define aneurysm
Dilatation of a vessel by more than 50% of normal diameter
147
Who gets screened for AAA?
All men 65 years abdo US
148
Describe the f/u for confirmed AAA
3-4.4 cm yearly US 4.5 - 5.4cm 3 monthly US >5.5 cm = surgery
149
How do we support a clavicle fracture?
Broad arm sling
150
How do we immobilise a shoulder dislocation?
Broad arm sling
151
What is the commonest type of melanoma?
Superficial spreading
152
What type of melanoma grows downwards quickly?
Nodular
153
What medications do we give in termination of pregnancy?
Mifepristone | Misoprostol
154
What is mifepristone?
Anti progesterone
155
What is misoprostol?
Prostaglandin analogue
156
Define ASA 1
Normal healthy person
157
Define ASA 3
Severe illness causing functional limitations
158
Severe blockage of a vessel would have an ABPI of ...
< 0.
159
Surgical neck of humerus fracture is likely to injure ...
Axillary nerve
160
What is the management of surgical neck humerus fracture?
Collar and cuff
161
What is the management of humerus shaft fracture?
U slab or hanging cast
162
What is the management of a scapular fracture?
Broad arm sling
163
What is the management for clavicle fracture?
Broad arm sling
164
What is the management of a boxer’s fracture?
Ulna gutter cast
165
What is the management of a femoral shaft fracture?
Thomas/traction splint
166
What is the management of tibial plateau fracture?
Long leg backslab
167
What are the signs of acute glaucoma?
Semi dilated non reactive pupil Red Corneal oedema
168
What is the mx of acute glaucoma? STAMP
``` Supine Timolol Acetazolamide Mannitol Pilocarpine ```
169
Briefly describe the grades of HTN retinopathy
1 narrowing 2 nipping 3 diabetic type changes 4 optic disc swelling
170
What type of cataracts are associated with diabetes?
Posterior subcapsular
171
What is the cataract surgery called?
Phaecoemulsification and lens implant

Finals Revision (6 decks)

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