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Adam's Weak Spots > Surgery + Procedural Interventions > Flashcards

Surgery + Procedural Interventions Flashcards

1
Q

What are the primary roles of
surgery/procedures in palliative care?

A
  • Prevent symptoms/negative outcomes
  • Relieve symptoms
  • Improve QOL
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2
Q

What biochemical measure is a broad predictor of good surgical outcome in PC?

A

Albumin

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3
Q

What is the primary procedural approach
to managing functional neuroendocrine ca?

A

RFA (esp. liver lesions)

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4
Q

Which are the 2 most common cancers associated with malignant bowel obstruction?

A

Colon ca
Ovarian ca

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5
Q

Which patients would benefit from
surgical opinion in MBO?

A

All

except not within GOC
except prognosis <days to short weeks

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6
Q

What are 5 contraindications to surgical
intervention in MBO?

A
  1. Multilevel obstruction
  2. Palpable abdominal mass(es)
  3. Peritoneal carcinomatosis
  4. Poor function (not quantified)
  5. Short prognosis
  6. Ascites (relative)
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7
Q

What is the success rate of stenting for
reachable MBOs?

A

> 70%, higher in colorectal

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8
Q

What are the 3 most common
complications of endoscopic stenting?

A
  • Perforation
  • Stent migration
  • Stent occlusion
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9
Q

What procedure is available for
fungating breast wounds?

A

“Toilet” (i.e. hygiene) mastectomy

total chest wall debridement and reconstruction

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10
Q

Which 3 cancers are most likely to cause
malignant skin issues?

A
  • Primary skin ca (obviously)
  • Breast
  • Soft-tissue sarcoma
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11
Q

List 3 surgical methods of bypassing
the biliary tract (i.e. not ERCP)

A
  1. Choledochojejunostomy
  2. Choledochoduodenotomy
  3. Cholecystojejunostomy

i.e. drain liver into bowel

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12
Q

Which is superior for GOO–stent or surgery?

A

Stenting (10% failure)
vs.
Surgery (40-90% failure)

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13
Q

Which is superior for biliary tract obstruction?

A

Stenting

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14
Q

What is the infection risk with abdominal PleurX insertion?

A

20-30%

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15
Q

Which dangerous procedure is rarely done
for refractory ascites?

A

Peritoneovenous shunting

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16
Q

What is the cutoff prognosis for
splenectomy vs. radiation in heme malig.?

A

> 6mo, do surgery

2* increased recurrence risk w. radiation

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17
Q

Is bony pain inflammatory or neuropathic?

A

Neither–different marker profile

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18
Q

What features of physical exam are essential in the patient with bony mets and back pain?

A

NEUROLOGICAL EXAM

SLR
deep tendon reflexes
strength testing

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19
Q

Which bony changes must be present for a
metastasis to appear on X-ray?

A

50% medulla loss
30% cortical loss

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20
Q

What are the 2 (3ish) types of bony mets?

A

Sclerotic (osteoblastic)
Lytic (osteoclastic)
Mixed

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21
Q

Which cancer is most associated with
sclerotic bony mets?

A

Prostate

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22
Q

Which cancers are ass’d with lytic bony mets?

A

Lung
Renal
Thyroid
Myeloma

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23
Q

What is the sensitivity of a bone scan?

A

80%

24
Q

Which bony lesions tend not to
appear on bone scan?

A

Highly aggressive mets (lung, melanoma)
Mets that are not healing (myeloma)

25
Q

PET vs. bone scan for which bony mets?

A

PET–lytic (95% sens.)
bone scan–sclerotic (100% sens.)

26
Q

Which patients with impending/actual pathological #s should be referred to ortho?

A

All except the extremely ill

27
Q

What is the median prognosis for a patient
with bony metastases?

A

8 months

higher in breast, thyroid
lower in lung

28
Q

What is another common cause of fracture in malignancy, other than pathological?

A

Osteoporosis

  • androgen deprivation therapy
  • older patients
29
Q

What are the 4 features of the Mirels score to predict pathological # risk?

A
  • Pain
  • Site
  • Blastic vs. lytic
  • Proportion of cortex involved
30
Q

How is the Mirels score calculated?

A

Each item is scored 1-3

Pain (mild, moderate, impairing function)
Site (UL, LL, trochanteric)
Cortex (<⅓, ⅓-⅔, >⅔)
Type (blastic, mixed, lytic)

31
Q

Which 2 components provide most
of a bone’s strength?

A

Calcium hydroxyapatite (compression)
Collagen (tension)

32
Q

What forces is bone weakest to?

A

Shear
Torsion

33
Q

How do small bony mets increase # risk?

A

Small surface defects
→ disproportionate drop in shear strength

20% of bone diameter → 60% drop
>50% → 90% drop

34
Q

Most common limb site of pathological #

A

Proximal femur
(90% of femur #, 60% of limb #)

35
Q

What is the weakest form of bony fixation?

A

Plate fixation with screws

36
Q

Which ortho option is most successful?

A

Hemi- or total arthroplasty

37
Q

How should epiphyseal # be managed?

A

Arthroplasty

38
Q

How should diaphyseal # be managed?

A

Intramedullary fixation

39
Q

What is the hardest location to fix
an appendicular bone?

A

Metaphysis 2* many tendon attachments

40
Q

What force causes the majority of humeral #?

A

Torsion

41
Q

Are metallic or plastic stents more
successful for biliary obstruction?

A

Metal–90% vs. 70%

41
Q

What function loss is expect with both shoulder and elbow surgery for #?

A

Reduced abduction/overhead
Reduced extension

42
Q

What is the advantage of a plastic stent?

A

It can be replaced

metal stents must be stented over

43
Q

What did plastic-coated metal stents for
esophageal obstruction replace?

A

Rigid plastic tubes inserted under GA

44
Q

What are 4 reasons to embolise in palliative care settings?

A
  • Hemostasis
  • Analgesia
  • Tumour shrinkage
  • Reduce hormone release from func. ca
45
Q

What is the risk of embolising
hormone-secreting tumours?

A

++ hormone release in short term
consider prophylactically treating

(e.g. phenoxybenzamine)

46
Q

Which organ is especially appropriate for tumour embolisation?

A

Liver, esp. HCC

46
Q

In which liver population should you avoid arterial embolisation?

A

Cirrhosis–consider direct tumour lysis instead

47
Q

What is the post-embolisation syndrome?

A
  1. Fever
  2. Increased pain
  3. WBCs
  4. Malaise
  • reflects tumour necrosis
  • if longer than a few days, consider infx
  • if CRP markedly elevated, consider infx
48
Q

What is the rate of vertebroplasty complication in malignant disease?

A

<10%

49
Q

What are the risks of vertebroplasty?

A
  • Spinal cord damage
  • Bleeding at injection site
  • Allergic reaction
  • Infection
50
Q

What are the three forms of tissue ablation?

A
  • Heat (laser, RFA, U/S, etc.)
  • Cold (liquid N2)
  • Chemical (EtOH, acetic acid)
51
Q

What are the limitations of EtOH ablation?

A

Can only diffuse c. 3cm, so no bigger tumours unless you inject multiple sessions

52
Q

Which technique is the main option for ablation?

A

Radiofrequency
(i.e. heat)

53
Q

What features of a renal cell ca would make it more appropriate for RFA?

A
  • Small tumour
  • Peripheral location
  • Poor surgical candidate

Adam's Weak Spots (8 decks)

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