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Surgery Flashcards

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1
Q

Management of nocturia (3)

A
  1. Advice r.e moderate fluid intake at night
  2. Furosemide 40mg late afternoon
  3. Desmopressin
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2
Q

Pharmacological management for overactive bladder (2)

Non pharmacological management (1)

A
  1. Oxybutynin/ tolterodine/ darifenacin (antimuscarinics)
  2. Mirabegron
  3. Bladder retraining
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3
Q

How long pre op should a patient stop the COCP?

A

4 weeks

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4
Q

VTE prophylaxis for post elective hip operations

A 
10 days LMWH + further 28 days low or high dose aspirin
OR
28 days of LMWH with stockings 
OR
Rivaroxaban
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5
Q

VTE prophylaxis for post elective knee operations

A 
Aspirin low or high dose for 2 weeks 
OR 
LMWH with stockings for 2 weeks 
OR 
Rivaroxaban
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6
Q

VTE prophylaxis for post fragility fractures of the hip

A

LMWH for 28 days

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7
Q

Post vasectomy when can a man have UPSI?

A

Needs two semen analysis at week 16 and week 20

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8
Q

O/E bag of worms

Subfertility =

A

Varicocele

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9
Q 
What is a varicocele?
Which side is it more common?
Diagnostic investigation (1)
A

Abnormal enlargement of testicular veins, much more common on left side. Usually asymptomatic.
USS

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10
Q

Swollen, tender testis retracted upwards =

A

Testicular torsion

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11
Q

What is testicular torsion?

What is the name of the congenital abnormality which leads to likely bilateral case of testicular torsion?

A

Twisting of spermatic cord leading to ischaemia and sudden onset pain.
Bell clapper testis

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12
Q

Name four features of testicular torsion

A
  1. Loss of cremasteric reflex
  2. Sudden onset pain, erythema and swelling
  3. Prehn’s sign
  4. High riding testes
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13
Q

What is Prehn’s sign?

A

Prehn’s

elevation of the testis does not ease the pain?

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14
Q

Most common cancer in male aged 20-30 =

A

Testicular cancer

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15
Q

Name the two types of testicular cancers and their subtypes

Which is more common?

A
  1. Germ cell (95%)
    - seminomas
    - non seminomas
  2. Non germ cell (5%)
    - Leydig cell tumours
    - sarcomas
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16
Q

RF for testicular cancer (5)

A
  1. Infertility
  2. Cryptorchidism
  3. FH
  4. Klinefelters
  5. Mumps orchitis
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17
Q

What is cryptorchidism?

A

Undescended testes

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18
Q

Features of testicular cancer (6)

A
  1. Painless lump
  2. Hydrocele
  3. Gynaecomastia
  4. AFP + LDH may be raised in germ cell tumours
  5. HCG may be raised in seminomas
  6. Dragging sensation
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19
Q

Peak incidence for which cancers is aged 25yo and 35yo

A

(Non seminoma) Teratoma = 25yo

Seminoma = 35yo

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20
Q

What is a hydrocele?

Classification

A

Accumulation of fluid within the tunica vaginalis
Usually found anterior and below the testicle
Communicating and non communicating

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21
Q

What is the treatment for testicular cancer?

A
  1. Orchidectomy

2. Chemo/ RT

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22
Q

Subarachnoid haemorrhage

Causes of SAH (5)

A
  1. Trauma
  2. Berry aneurysm
  3. AV malformation
  4. Infective aneurysms
  5. Arterial dissection
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23
Q

Subarachnoid haemorrhage

What may you find on an ECG?

A

ST elevation

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24
Q

Subarachnoid haemorrhage

Name two investigations

A
  1. CT head
    - hyperdense on CT scan
  2. LP
    If CT negative
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25
When would you do an LP for SAH? How long after the onset of symptoms? What are you looking for? (2)
If CT negative At least 12 hours post onset of symptoms Looking for xanthochromia Normal or raised opening pressure
26
What investigation would you perform to find out the cause of spontaneous SAH?
CT intracranial angiogram +/- catheter angiogram
27
Management of intracranial aneurysm?
1. Coil | 2. Craniotomy + clip
28
Name six complications of an aneurysmal SAH?
1. Re-bleed 2. Vasospasm (delayed cerebral ischaemia) 3. Hyponatraemia (SIADH) 4. Seizures 5. Hydrocephalus 6. Death
29
What medication is given to avoid spasm and for what duration?
Nimodipine 21 days
30
What is epididymitis/ epididymo-orchitis?
Infection of the epididymis +/- testes resulting in pain and swelling
31
Common organisms and age
<35yo chlamydia + gonorrhea | >35yo Ecoli, pseudomonas
32
Name four features of epididymo-orchitis
1. Cremaster reflex +ve | 2. Prehn's sign +ve
33
What is the cremaster reflex?
Stoke inner thigh, testicle retracts up
34
``` Hydrocele features (3) Location (1) ```
1. Transilluminate 2. Non painful swelling 3. Can get above it 4. Normally found anterior and below the testicle
35
Difference between communication and non communicating hydrocele
Communicating - likely congenital Incomplete closure of processus vaginalis Usually resolve within first few months Non communicating - excessive fluid production within the tunica vaginalis
36
Management of communicating hydroceles
Usually resolve on their own | If not resolved by 1-2yo - surgery
37
Management of non communicating hydroceles
Conservative management | Repeat USS to check for tumours
38
Hydroceles can form due to which three conditions?
1. epididymo-orchitis 2. testicular torsion 3. testicular tumours
39
Left sided varicocele could indicate which cancer?
Renal cell carcinoma
40
What is the most common cause of scrotal swellings in primary care?
Epididymal cysts
41
Where are epididymal cysts found?
Posterior to the testicle
42
Name three associated conditions with epididymal cysts
1. polycystic kidney disease 2. cystic fibrosis 3. von Hippel-Lindau syndrome
43
Name two RFs for RCC
1. von Hippel- Lindau syndrome | 2. Tuberous sclerosis
44
What is Stauffer syndrome? | Associated with which cancer?
Paraneoplastic hepatic dysfunction syndrome Typically presents as cholestasis/hepatosplenomegaly Associated with RCC
45
Name three endocrine effects of RCC
1. Increased EPO --> polycythaemia 2. High calcium secondary to PTH 3. Increased renin + ACTH
46
Mx of RCC
1. Partial or total nephrectomy | 2. Alpha-interferon and interleukin-2 for patients with metastases and to reduce tumour size
47
Prostate ca | More common in which race?
Afro-Caribbean
48
DRE for prostate ca (3)
1. asymmetrical 2. hard, nodular enlargement 3. loss of median sulcus
49
Name six causes of raised PSA
1. Cancer 2. BPH 3. UTI/ prostatitis (to postpone PSA for one month) 4. Recent instrumentation of urinary tract 5. Ejaculation or vigorous exercise in last 48 hours 6. Urinary retention
50
Criteria for 2 week wait referral:
DRE hard nodular prostate OR Aged 50-69, PSA is >= 3.0 ng/ml
51
Prostate ca | Features (3)
1. Bladder outlet issues: hesitancy/ urgency 2. Haematuria 3. Back/testicular/ perianal pain
52
Diagnostic Ix to confirm prostate ca | Who gets a biopsy?
MRI Findings of MRI reported using a 5 point Likert scale Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
53
What is a Likert scale? How do you interpret this?
Findings of MRI reported using a 5 point Likert scale | Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
54
Ix of choice for renal colic When would you need to do it immediately? Ix of choice for pregger Pain management (2)
CTKUB non contrast within 24 hours OR USS for pregnant women If fever or solitary kidney 1. NSAIDs (any route) +/- IV paracetamol 2. Opiates - tramadol
55
Mx of stones What size will pass? When is it an emergency? Mx (2)
<5mm will pass on its own (usually within 4 weeks) >5mm and signs of ureteric obstruction for emergency: 1. Nephrostomy OR 2. Ureteric stent + catheter
56
Mx of renal colic in non emergency settings >5mm (3)
1. Lithotripsy (1st line) 2. Ureteroscopy (if pregnant) (stent remains in for 4 weeks) 3. Percutaneous nephrolithotomy (if complex renal calculi and staghorn calculi)
57
Name three types of stones in renal colic
1. Calcium 2. Oxolate 3. Uric acid
58
How to prevent calcium stones (3)
1. Fluids ++ 2. Low Na, low animal protein diet 3. Thiazide diuretics
59
How to prevent oxolate stones
1. Cholestyramine | 2. Pyridoxine
60
How to prevent uric acid stones
1. Allopurinol | 2. PO bicarb
61
Penile cancer is what type of cancer
Squamous cell carcinoma
62
Penile ca RF (8)
1. Age >50 2. Balantitis - inflammation of the foreskin and head of penis 3. Paraphimosis - foreskin is retracted and cannot be pulled back down 4. Phimosis - foreskin cannot be retracted 5. HIV 6. HPV 7. Poor hygiene 8. Genital warts
63
Peripheral arterial disease management (4) | If that doesn't work trial _______
1. Not smoking 2. Atorvastatin 80mg OD 3. Clopidogrel 4. Exercise training programme ``` If exercise programme doesn't work naftidrofuryl oxalate (vasodilator) ```
64
Management of acute limb (4)
1. Angioplasty 2. Stenting 3. Bypass surgery 4. Amputation
65
What is a hytadid cyst? | Diagnostic investigation
Tapeworm parasite Echinococcus granulosus Causes cysts in liver and lung CT
66
Biliary colic, jaundice, and urticaria think?
Hytadid cyst rupture in biliary tract
67
Below and lateral to the pubic tubercle hernia = More common in multiparous women Rx
Femoral | High risk of strangulation therefore surgery required
68
Above and medial to pubic tubercle hernia =
Inguinal
69
Lateral ventral hernia | Rare and seen in older patients
Spigellian
70
A hernia that typically presents with obstruction | More common in females =
Obturator hernia
71
Congenital inguinal hernia Where do they come from? R/L Mx
Patent processus vaginalis 60% right sided Surgery soon after diagnosis due to risk of incarceration
72
Infantile umbilical hernia Where are they found? Which race? Mx
Symmetrical bulge under the umbilicus More common in premature and Afro-Caribbean babies Most resolve on their own by age 4-5 years
73
Causes of pancreatitis
``` Gallstones ERCP Trauma Steroids Mumps Autoimmune Scorpion bites High lipids, calcium, hypothermia, Ethanol Drugs (AZT, mesalazine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate) ```
74
Anal fissure Acute Chronic
<6 weeks | >6 weeks
75
Name three RFs for anal fissures
1. Constipation 2. Inflammatory bowel disease 3. STIs e.g. HIV, syphilis, herpes
76
Mx anal fissures (5) | Acute
1. Dietary advice - high fibre, high diet 2. Bulk forming laxatives 3. Lubricants 4. Topical anaesthetic 5. Topical steroids
77
Mx anal fissures | Chronic
1. Topical GTN if not effective after 8 weeks, to refer to surgeons
78
Chronic straining and constipation =
Solitary rectal ulcer
79
Ano rectal abscess - common bacteria
E.coli + Staph Aureus
80
Proctitis common causes (2)
1. IBD | 2. C. diff
81
Most common bacteria causing ascending cholangitis Charcot's triad: Rx
``` E coli 1. Fever, jaundice, RUQ pain Rx 1. IV abx 2. ERCP within 24-48 hours to remove obstruction ```
82
What is phimosis?
Foreskin cannot be retracted
83
What is paraphimosis?
Foreskin pulled back and cannot return to original position
84
What is balanitis?
Inflammation of the foreskin and head of the penis
85
What is balanitis xerotica obliterans?
Lichen sclerosis of male genitalia | Chronic, inflammatory skin disease
86
What is hypospadias?
Opening of the urethra is on the underside of the penis instead of at the tip
87
Management of rectal cancers:
1. Anterior resection (needs at least 2cm distally) | 2. Abdomino-perineal excision of rectum (APER)
88
When would you opt for the APER?
1. Involvement of the sphincter complex OR | 2. Very low tumours
89
Rectal cancer who needs chemo/ RT T1 T2 T3 T4
T1T2 do not need chemo/ RT Short course of chemo/ RT Long course of chemo/RT
90
What type of surgery? | Anal verge
APER
91
What type of surgery? | Low rectum
Anterior resection
92
What type of surgery? | Upper rectum
Anterior resection
93
What type of surgery? | Sigmoid colon
High anterior resection
94
What type of surgery? | Distal transverse, descending colon
Left hemicolectomy
95
What type of surgery? | Caecal, ascending or proximal transverse colon
Right hemicolectomy

MSRA (22 decks)

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