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Surgical Diseases MCQs > Surgery oral doc > Flashcards

Surgery oral doc Flashcards

1
Q
  1. cervical cysts - types
A

Thyroglossal duct cyst – a remnant of the thyroglossal duct that forms durng the embryonic development of the thyroid gland

Branchial cleft cyst – remnants of the second branchial cleft or cervical sinus

Cystic hygroma – congenital malformation consisting of cyst-like cavities containing lymph which arise from an embryonic remnant of the jugular lymph sac

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2
Q
  1. Thyroid cancer- types
A

Papillarry carcinoma 50%,
follicular carcinoma 25%
non-differentiated anaplastic carcinoma, 10%
medullary carcinoma, 3-5%
lymphoma 1%

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3
Q
  1. How to classify the differentiated thyroid cancer - according to age
A

age (over 55 and under 55 - under 50 is stage 1 and 2 )

young\children - papillary
under 40 - follicular

> 55 anaplastic

medullary all age groups

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4
Q
  1. -hiatal hernia - types, which one is most dangerous and why
A

Hiatal hernias are sliding, paraesophageal, mixed and complex. Paraesophageal hernias are the most dangerous because the entire stomach herniates into the thoracic cavity and rotates on its axis which will then cause strangulation.

Sliding hiatal hernias, where the gastroesophageal junction (GEJ) and the gastric cardia migrate into the thorax, account for 95% of hiatal hernias.

In paraesophageal hernias (PEH), only the gastric fundus herniates into the thorax, whereas in mixed hiatal hernias, the GEJ as well as the gastric fundus herniate.

Complex hiatal herniasare rare and characterized by protrusion of any abdominal organ other than the stomach. Nearly half of all patients with hiatal hernia are asymptomatic and require no medical or surgical intervention.

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5
Q
  1. Types of breast carcinoma
A

Carcinoma in situ (ductal carcinoma in situ, lobular carcinoma in situ),

invasive carcinoma (invasive ductal, invasive lobular, inflammatory breast cancer)

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6
Q
  1. Breast carcinoma Tx

struggling

A

Early stage disease (1/2) – surgery which can be mastectomy or lumpectomy and radiotherapy
HER2+ - chemotherapy and Trastuzumab
ER/PR+ - endocrine therapy
BRCA1/2 – PARP inhibitors

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7
Q
  1. Cervical cyst types
A

Thyroglossal duct cyst – a remnant of the thyroglossal duct that forms durng the embryonic development of the thyroid gland

Branchial cleft cyst – remnants of the second branchial cleft or cervical sinus

Cystic hygroma – congenital malformation consisting of cyst-like cavities containing lymph which arise from an embryonic remnant of the jugular lymph sac

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8
Q
  1. Complications of Crohn’s disease
A

Small bowel obstruction, toxic dilation, abscess formation, perforation and haemorrhage, colon cancer, primary biliary cirrhosis

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9
Q
  1. Types of thyroid carcinoma
A

Papillary carcinoma, follicular carcinoma, non-differentiated anaplastic carcinoma, medullary carcinoma, lymphoma

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10
Q
  1. What are the endocrine tumours of the pancreas
A

Glucagonomas, insulinomas, somatostatinomas, Gastrinomas, Vipomas

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11
Q
  1. Most common endocrine tumour of pancreas
A

Insulinomas 70%

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12
Q
  1. 2nd most common endocrine tumour of pancreas
A

Gastrinomas

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13
Q
  1. 3 stages of empeyma
A

Exudative, Fibrinopurulent, organization

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14
Q
  1. Complications of gastrinoma
A

Chance of becoming malignant,

Zollinger-Ellison Syndrome (severe peptic ulceration)

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15
Q
  1. Ulcerative colitis complications
A

Toxic megacolon, increased risk of colon cancer, venous thrombosis, perforation and massive bleeding

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16
Q
  1. Cause of mesenteric ischaemia
A

Arterial embolus, arterial thrombosis, vasospasm and venous thrombosis

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17
Q
  1. Benign tumour of the breast
A

Fibroadenomas, adneomas, papillomas

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18
Q
  1. Panaritium, Types of panaritium A
A

Panaritium is an infection of the fingers or toes with nailbed inflammation.

Types - paronychia, Felon and blistering distal dactylitis

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19
Q
  1. abdominal penetrating trauma
A

Caused by gunshots or sharp objects. Pleura or peritoneum are compromised.

Preliminary care involves tetanus prophylaxis, broad spec antibiotics, analgesics and anxiolytics.

Assess for peritoneal or retroperitoneal penetration and intra-abdominal haemorrhage by FAST (focused assessment with sonography for trauma) exam. Treat via emergency exploratory laparotomy

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20
Q
  1. Definition of thoracic penetrating trauma
A

Injury caused by a sharp object piercing the skin of the thoracic region, damaging the underlying tissues and resulting in an open wound

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21
Q
  1. Types of Breast cancer
A

Carcinoma in situ, invasive carcinomas, fibroadenomas, adenomas, papillomas

22
Q
  1. Symptoms of Breast Treatment of breast cancer
A

Tamoxifen – may cause endometrial carcinoma, menopausal symptoms, venous thromboembolism

Trastuzumab – reduced ejection fraction

Chemotherapy – immunosuppression, hair loss, weight loss, N&V, anemia, bleeding, fatigure

23
Q
  1. Types of lymph node dissection
A

Axillary LN dissection, inguinal LN dissection, cervical m retroperitoneal

24
Q
  1. Why do we do lymph node dissection
A

To help prevent the spread of cancers via lymphatic routes

25
Q
  1. Types of Traumatic Pneumothorax
A

Simple (closed), Open and tension

26
Q
  1. Flail Chest
A

A segment of the chest wall that does not have continuity with the rest of the thoracic cage. Normally results from blunt trauma where there are 3 or more ribs fractured in 2 or more places

27
Q
  1. Thyrotoxicosis
A

A clinical condition that occurs due to high concentration of thyroid hormones. Can be primary (disorder in thyroid) or secondary (disorder in pituitary)

.
Clinical features include: muscle weakness & tremor, nervousness and insomnia, goiter, moist warm skin & sweating, increased lacrimation, fine hair, palpitations

Diagnosis – History, physical exam, lab tests for TSH levels (primary – TSH is low to undetectable, secondary – TSH elevated), elevated free fractions of T3 and T4, thyroid antibodies

Treatment – Beta blockers (propranolol), Carbimzaole and Levothyroxine, surgery (indications – markedly enlarged thyroid, contraindication to drugs, nodular transformation of thyroid during antithyroid drug therapy). Thyrotoxic crisis Tx – eliminate cause and control symptoms, antithyroid drugs at high doses, glucocorticoids

28
Q
  1. classifications of paranitium - in one sentence describe sepsis
A

Panaritium can be acute or chronic. Sepsis – acute life-threatening condition that is characterized by organ dysfunction due to abnormal host immune response to infection

29
Q
  1. lymphadenopathy definition
A

The swelling of lymph nodes which can be secondary to bacterial, viral or fungal infections, autoimmune disease and malignancy

30
Q
  1. Thyroid gland - cancer (histology, staging, mx)
A

Histological types – papillary carcinomas, follicular carcinoma, non-differentiated anaplastic carcinoma, medullary carcinoma, lymphoma.

Treatment – hemi-thyroidectomy or total thyroidectomy, also neck dissection to remove LNs in the area

31
Q
  1. Graves and Hashimotos
A

Graves – autoimmune condition where there is production of TSH receptor IgG antibodies which stimulate production of thyroid hormones and cause an overactive thyroid gland

Hashimotos – chronic, autoimmune disease with lymphocytic infiltration of thyroid gland with high titres of anti-microsomal, anti-thyroid peroxidase and anti-thyroglobulin antibodies which causes auto-immune destruction of thyroid gland and hypothyroidism

32
Q
  1. Breast cancer- types, surgery, triple assessment
A

Carcinoma in situ, invasive carcinomas, fibroadenomas, adenomas, papillomas

Surgery – mastectomy, lumpectomy, chemotherapy, radiotherapy, endocrine therapy

Triple assessment – clinical assessment, radiological assessment (maamography for over 35s, US for those under 35), cytological assessment (fine needle aspiration or core needle biopsy)

33
Q
  1. Thoracic trauma - deadly dozen, penetrating/ blunt
A

Lethal six – airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax and flail chest

Hidden six – thoracic aortic disruption, tracheobronchial disruption, myocardial contusion, traumatic diaphragmatic tear, esophageal disruption, pulmonary contusion

34
Q
  1. Stages of pleural empyema and tx
A

Exudative, fibrinopurulent and organization stages

Exudative – thoracostomy to drain fluid, intrapleural administration of fibrinolytic agents

Fibrinupurulent – chest tube drainage, VATS debridement if chest tube drainage is ineffective

Organisation – VATS debridement, pleurectomy and lung decortication via open thoracotomy

35
Q
  1. Lung abscess – types, staging, acute vs. chronic
A

Acute = <6 weeks, chronic = >6 weeks

Primary – origin is within the lung (aspiration),

secondary – secondary to underlying disease like pneumonia or bronchiectasis

36
Q
  1. Bronchiectasis - classification, complications (bleeding/abscess)
A

Bronchiectasis: irreversible abnormal dilation of bronchial tree

Classification: cylindrical, saccular and mixed (or varicose)
Complications:
A) Recurrent bronchupulomary infectison -> COPD -> resp failure -> Cor Pulmonale
B) Pulmonary Haemorrhage
C) Lung Abscess
Most severe complication is massive bleeding, resulting from erosions of hypertrophic bronchial arteries

37
Q
  1. Acute mediastinitis - causes, Sx, mx
A

Causes: oesophageal perforation or median sternotomy due to
complication of esophagoscopy, Boerhaave syndrome, swallowing caustic substances like lye, oesophageal ulcers

Sx: pt become acutely ill within few hrs, fever, chills, severe chest pain (retrosternal), tachycardia, dyspnea

Mx: Parenteral antibiotics, emergency surgical exploration in severe mediastinitis, surgical drainage,

38
Q
  1. Definition of sepsis
A

Sepsis is an acute life-threatening condition characterized by organ dysfunction due to an abnormal host immune response to an infection

39
Q
  1. Mediastinal tumours - based on location
A

Mediastinum is divided into 4 compartments: superior, anterior, middle, and posterior.
Tumors can be divided into tumors of anterior, middle and posterior compartments.

anterior eg: thymoma, Hodgkin’s\non-Hodgkin’s

middle: esophageal tumor, parathyroid adenoma

posterior: neurogenic\ neuroendocrine tumors

40
Q
  1. Retrosternal and mediastinal goitre
A

Intrathoracic goiter is a primary mediastinal goitres, also referred to as ectopic or aberrant goitres, do not possess any direct fibrous or paraenchymal connections to the cervical portion of the gland and its vascular supply is derived from the chest. Although usually intrathoracic goitres involve the anterior mediastinum, up to 10% of them may be located within the posterior mediastinum.

The term retrosternal goiter is defined as a part of the enlarged thyroid gland extending through the thoracic inlet. The retrosternal goiter is in continuity with an enlarged cervical thyroid gland. These goitres derive their blood supply from cervical branches of the superior and inferior thyroid arteries and therefore can be resected almost uniformly via a cervical collar incision

41
Q
  1. Hernias - types, inguinal direct vs indirect,
A

Types: femoral, inguinal (direct, indirect), umbilical, epigastric, Spigellian, Incisional
Indirect inguinal hernias protrude through inguinal canal while direct does not. Pantaloon hernia has parts that are direct and indirect.

42
Q
  1. Abdominal trauma - penetrating and blunt, dx (FAST scan), mx, solid vs hollow organ
A

penetrating abdominal trauma is injury that occur when object pierces parietal peritoneum and goes in peri cavity. penetrating trauma can cause; laceration of solid organs and perorate hollow organs which must be discovered and repaired in laparotomy

blunt trauma is when traumatic object doesn’t not pierce parietal peri and skin not broken. can cause laceration of solid org and bleeding and hemorrhagic shock and perforation
Focused assessment with sonography in trauma (commonly abbreviated as FAST) is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum) after trauma
Mx: laprotomy

43
Q
  1. Diaphragmatic hernias - hiatal hernias (types and mx), congenital hernias
A

Hiatal types: sliding, paraoesophageal and mixed (type 1,2 and 3 respectively)
tx: sliding does not require treatment unless reflux disease they produce sx specific to hernia presence. Type 2 and 3 is operative repair.

44
Q
  1. PUD and complications
A

A peptic ulcer is an erosion in a segment of the GI mucosa, typically in the stomach (gastric ulcer) or first few centimetres of the duodenum (duodenal ulcer), that penetrates through the muscularis mucosae
There are 5 complications of peptic ulcer disease:
1. Haemorrhage
2. Perforation of peptic ulcer
3. Gastric outlet obstruction
4. Penetration and Fistulas
5. Malignant transformation

45
Q
  1. Acute pancreatitis - *pathophysiology
A

Intrapancreatic activation of pancreatic enzymes: secondary to pancreatic ductal outflow obstruction (e.g., gallstones, cystic fibrosis) or direct injury to pancreatic acinar cells (e.g., alcohol, drugs) leads to increased proteolytic and lipolytic enzyme activity → destruction of pancreatic parenchyma -> ↑pro-inflammatory cytokines= Interstitial edema, endothelial injury= ischemia o Normally, pancreatic enzymes are in an inactive, pro-enzyme state (zymogens) within the pancreas -> Premature conversion/activation leaks to autodigestion of pancreas

46
Q
  1. Acute appendicitis - *elderly vs pregnancy
A

Acute appendicitis in older patients can be difficult to diagnose: patients delay seeking care and presentation may be atypical

Diagnosis of appendicitis in pregnancy is difficult: appendix is displaced by the gravid uterus and the abdominal wall is lifted from the appendix by the gravid uterus

47
Q
  1. Bowel obstruction - LBO vs SBO causes
A

LBO: carcinoma, volvulus, diverticular disease
SBO: adhesions (open surgery. Peritonitis, endometriosis), hernia

48
Q
  1. Colorectal cancer - left vs right sided
A

biological differences between left-sided and right-sided colon cancers, including the biomarkers present on each side and the aggressiveness of the cancer. Patients with left-sided tumors typically have a better prognosis than those with right-sided tumors.3 Left-sided colon cancer tends to respond better to chemotherapy compared to right-sided colon cancer, and patients have a better prognosis if diagnosed at later stages (III and IV) than right-sided colon cancer.

49
Q
  1. Complications of diverticulitis
A

Abscess {adjacent to the affected colon (pericolic abscess), in the adjacent mesentery (mesocolic abscess), or separately in the peritoneal cavity, such as in the pelvis or subphrenic areas}; generalized peritonitis; retroperitoneal perforation; fistulas {colovesical fistula, colovaginal fistula, enterocolic fistula, colocutaneous fistula}; colonic stricture; diverticular hemorrhage

50
Q
  1. What is diverticulum and Types of diverticulum
A

A diverticulum is an abnormal sac or pouch protruding from the wall of a hollow organ.

True diverticulum, such as Meckel’s diverticulum, contains all layers of the bowel wall and represents a congenital abnormality.

False diverticulum is acquired herniation of mucosa through the muscle layer and occurs most frequently in the colon

Surgical Diseases MCQs (4 decks)

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