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UCPEX > Surgery/Urology > Flashcards

Surgery/Urology Flashcards

1
Q

Most common causes of acute abdominal pain

A

Nonspecific - 43%
Acute appendicitis - 4-20%
Acute cholecystitis - 3-9%
SBO - 4%
Uterolithiasis - 4%

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2
Q

Most common, non-obstetric cause of surgical emergency in pregnancy

A

Appendicitis

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3
Q

2 causes of appendicitis

A

Obstructing faecolith (adults)
Enlarged mesenteric lymph node (children)

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4
Q

Best signs of appendicitis in adults vs children

A

Adults:
RLQ pain
Periumbilical pain localising to RIF
Abdominal rigidity

Children:
Decreased bowel sounds
Positive psoas sign - extension hip
Positive obturator sign - internal rotation thigh
Positive Rovsing’s sign

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5
Q

Complications of appendicitis

A

Perforation 17-32%
Peritonitis
Intraabdominal abscess
Bowel obstruction
Sepsis

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6
Q

Causes of pancreatitis

A

Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps, malignancy
Autoimmune
Scorpion sting
Hypercalcaemia, hyperlipidaemia
ERCP
Drugs

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7
Q

Pathognomonic signs of pancreatitis

A

Cullen’s sign - periumbilical subcutaeneous ecchymosis and oedema
Grey Turner sign - flank bruising

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8
Q

Atlanta criteria for diagnosis of pancreatitis

A
  1. Abdominal pain suggestive of pancreatitis
  2. Raised serum lipase/amylase x3 normal limit
  3. Characteristic findings on radiological imaging
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9
Q

Risk factors for AAA

A

Screening criteria:
Male
>65
Smoker

HTN
Atherosclerosis
Connective tissue disorder
Hyperlipidaemia

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10
Q

70 male with acute severe abdominal pain and haematuria.
Diagnosis not to miss:

A

AAA rupture involving renal arteries

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11
Q

Lifetime risk of AAA rupture of diameters:
5cm
6cm
7cm

A

5cm - 20%
6cm - 40%
7cm - 50%

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12
Q

4 types of bowel obstruction

A

Small bowel obstruction
Large bowel obstruction
Ileus
Psuedoobstruction (Parkinson’s, MS, hypothyroidism, Hirschsprung, diabetic neuropathy)

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13
Q

Diverticular disease
- location by ethnicity
- Age group prevalence

A

Caucasian - sigmoid colon
Asian - ascending colon
Age 40+, 65% prevalence by age 85

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14
Q

Management of diverticulitis in community

A

Mild uncomplicated - analgesia, liquid diet 2-3 days

Consider abx in patients with comorbidities, systemically unwell (but not for hospital), no improvement in 48 hours:

Metronidazole 400mg tds 5-7 days
PLUS
Cotrimoxazole 960mg BD 5 days
OR
Amoxicillin 500mg tds 7 days
OR
Cefalexin 500mg 2-3 times/day 5 days

OR
Augmentin 625mg tds 5 days

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15
Q

Risk factors for renal stones

A

Family hx renal stone
Prev renal stone
Chronic dehydration
Abnormality of renal tract
Obesity
Hyperparathyroidism
Gout
Idiopathic hypercalciuria

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16
Q

Referrral criteria for ureteric stones

A

Fever >38 deg
Pain uncontrolled
Bilateral stones
Stone >7mm
Known renal disease
Solitary kidney
Creatinine >160
Peritonitis

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17
Q

Obstructive causes of urinary retention

A

Neoplasm
Calculus
Blood clot
Faecal impaction
Strictures
FB

Men: BPH, phimosis, paraphimosis
Women: pelvic organ prolapse, pregnancy

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18
Q

Infection/inflammatory causes of urinary retention

A

Varicella
Lyme disease
Cystitis
Urethritis
HSV

Men: balanitis, prostatitis, prostatic abscess
Women: vulvovagnitis, Behcet disease, vaginal skin disease

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19
Q

Medication causes of urinary retention

A

Anticholinergics
Antihistamines
Antihypertensives
Antidepressants
Anti-Parkinson’s
Antipsychotics
Muscle relaxants
Sympathomimetics
Beta adrenergic

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20
Q

Neurological causes of urinary retention

A

Diabetic cystopathy
Spinal cord injury
Cauda equina
Spinal abscess
Guillain Barre
CVA
MS

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21
Q

AUA scoring for BPH severity

A

In the past month:
1. Frequency of sensation of not complete emptying
2. Frequency of repeat urination within 2 hours
3. Frequency of stopping and starting multiple times during void
4. Difficult to postpone urination
5. Weak stream
6. Push or strain to urinate
7. Number of time urinating overnight

Scoring 0-5 - none, less than 20%, less than half, half, more than half, always
Mild 0-7, moderate 8-19, severe 20-35

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22
Q

Criteria for post obstructive diuresis

A

Risk >1.5L draining post IDC
Creatinine >200

> 200mL/hour for 2 hours
3L over 24 hours

Replace with IVF 50% previous hour’s urine output

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23
Q

Risk for gallstones

A

Fat, female, fair (European), fertile (pre-menopausal), forty
Family hx
Sudden weight loss
Diabetes
Oral contraceptive
Pregnancy
Haemolytic disorder

24
Q

Charcot’s triad for ascending cholangitis

A

RUQ pain
Jaundice
Fever

25
Q

Complications of gallstones

A

Mirizzi syndrome
Gallstone ileus
Gallbladder cancer

26
Q

Differentiating internal haemorrhoids vs external haemorrhoids

A

Internal:
- Above dentate line
- No sensation (visceral innervation)
- Rectal mucosal lining
- Grade 1 - bulge into lumen
- Grade 2 - Prolapse with straining, spontaneous reduction
- Grade 3 - Prolapse with straining, manual reduction
- Grade 4 - Prolapsed and non-reducible, risk of strangulation

External:
- Below dentate line
- Painful (somatic innervation)
- Squamous epithelium

27
Q

High risk features for colorectal cancer

A

Family history
Personal hx ca or polyps
Persistent change in bowel habit
Blood mixed in stools
Tenesmus
Unexplained weight loss
Iron deficiency anaemia

28
Q

Risks for haemorrhoids

A

Constipation
Frequent defecation
Pregnancy
Prolonged sitting

29
Q

Causes of mesenteric ischaemia

A

Arterial thromboembolism
- Age >60
- AF
- Vasculopath
- Smoker
- Recent MI
- Valvular heart disease
- Aortic atherosclerosis/aneurysm

Venous thrombosis
- Younger patients
- Hypercoagulable
- Dehydration
- Portal HTN
- Abdominal infection
- Blunt trauma
- Pancreatitis
- Splenectomy
- Portal malignancy

30
Q

Mesenteric ischaemia vs colonic ischaemia presentation

A

Mesenteric:
Age >50
Usually has precipitating medical cause
Pain more severe
Patient seriously ill

Colonic:
>90
Can have predisposing lesion - ca, stricture, diverticulitis, faecal impaction
Moderate rectal bleeding/bloody diarrhoea

31
Q

Xray findings of ischaemic bowel

A

Thumb printing/thickened bowel loops
Air in portal vein (late finding)

32
Q

Risk factors for anal fissure

A

Constipation
IBD
Trauma
Anal cancer
STI, HIV
Childbirth and pregnancy

33
Q

Locations for anal fissures

A

Posterior midline - most common
Anterior midline - 8-25%
Lateral regions - consider Crohn’s, malignancy, HIV, TB

34
Q

Management of anal fissures

A

Topical anaesthetic gel
Topical GTN/diltiazem
Stool softeners
Frequent warm baths

Chronic (>6 weeks) - consider botox, internal sphinterotomy

Acute referral
- Large bleeding
- Concurrent infection/abscess

35
Q

Areas of abscess and fistula extension for complex perianal abscess

A

Ischiorectal abscess - in ischiorectal fossa
Intersphincteric abscess - Between internal and external anal sphincters

Fistulae:
- Intersphincteric
- Transphincteric
- Suprasphinteric
- Extrasphincteric

36
Q

Risk factors for perianal abscess

A

Male
Mean age 40
Diabetes, immunocompromised
STI
Anal fissures
Crohn’s disease
Receptive anal intercourse

37
Q

2 types of mastitis/breast abscess and microbial causes

A

Lactational
- Milk stasis, nipple damaged, latch problems, missed feeds/pump
- Usually peripheral breast
- Staph aureus,
Staph epidermidis, Strep
- Fluclox 1g tds 5-7 days

Non-lactational
- Squamous metaplasia of lactiferous ducts causing blockage
- Usually periareolar/subareolar
- Cracked, damaged nipples
- Aerobic and anaerobic bacteria
- Augmentin 625mg tds 7 days

38
Q

Signs and symptoms of ischaemic limb

A

Pain
Pallor
Paraesthesia
Pulselessness
Poikylothermia
Paralysis

39
Q

Palpable lump in testis, no pain or mild ache, possible concurrent hydrocoele

Dx? Management?

A

Testicular ca - 97% germinal seminoma
Average age 32

> urgent USS

40
Q

Gradual increasing unilateral testicular pain. Fever, discharge.
Tender swollen epididymis, normal cremasteric reflex.

Dx? Mangement?

A

Epididymitis
Most common cause of painful testicular swelling in post-pubertal males
- STI in sexually active to age 35
- UTI pathogen in others

STI swabs, MSU, contact trace and treat partners last 3 months, no intercourse for 2 weeks and 7 days after contacts treated

Ceftriaxone 500mg IM stat + doxycycline 100mg BD 14 days

If UTI - augmentin 625mg tds 10 days
OR cotrimoxazole 960mg BD 10 days OR ciprofloxacin 500mg BD 10 days

41
Q

Dull ache/throbbing in scrotum, worse on prolonged standing, “bag of worms” scrotal swelling

Dx? Management?

A

Varicocoele
Cause of reversible infertility

NSAIDs
Supportive underwear
Varicocoelectomy

42
Q

Painless scrotal swelling, not reducible, transilluminable

A

Hydrocoele

Presents in infancy or adulthood
Self-limiting in children (patent processus vaginalis)

Adults - aspirate and USS to r/o malignancy, infection

43
Q

Sudden onset testicular pain and high fever, nausea and vomiting. Testicle enlarged, indurated, tender.

A

Orchitis

Check parotid glands to rule out mumps

Scrotal support
Ice
Bed rest
Abx if indicated
Mumps orchitis risk of infertility

44
Q

Painful, red, firm scrotal mass. Vomiting. Irreducible. Non transilluminating.

A

Incarcerated inguinal hernia

Acute general surgery referral

45
Q

Acute severe testicular pain, swelling, ecchymosis, vomiting. Hx trauma.

A

Testicular rupture/haematoma

Acute urology referral

46
Q

Risk groups for testicular torsion

A

Neonates - undescended testes
Age 12-25
FHx or PHx testicular torsion
Bell clapper deformity

47
Q

Acute severe testicular pain, no fever, blue dot sign on scrotum

A

Torsion of testicular appendage

Need to rule out torsion

48
Q

Acute severe testicular pain, no fever, nausea and vomiting, abnormal gait.
May have hx preceding intermittent episodes.
High riding testicle, suprapubic tenderness, abnormal ipsilateral cremasteric reflex

A

Urgent paeds surg/urology referral
Surgical exploration within 6 hours of onset

49
Q

Causes of priapism

A
  • Idiopathic - most common
  • Blunt trauma
  • Intracavernosal injection of medication
  • Medications - anticoagulants, antipsychotics, sildenafil
  • Drugs - alcohol, cannabis, cocaine
  • Sickle cell disease - ischaemic priapism
50
Q

Priapism:
Presentation
Examination
Management

A

Persistent erection >2 hours in absence of sexual excitation

Engorged corpora cavernosa, flaccid corpus spongiosum and glans

Analgesia
Ice
Walk up stairs (arterial steal)
Refer to urology if not resolving

51
Q

Complications of paraphimosis

A

Ischaemia
Skin necrosis
Penile necrosis
Glans infarct
Gangrene
Urinary obstruction
Bladder distension
Post reduction scarring, phimosis

52
Q

Management of paraphimosis

A

Analgesia, lignocaine gel/EMLA

Ice method - wrap penis in glove, ice over swollen foreskin

Osmotic agent - do not use if penile necrosis.
- Sugar - apply to glans, cover, 2 hours
- 50% dextrose - soak in gauze, apply to glans, cover, 1 hour
- 20% mannitol - soak in gauze, apply to glans, cover, 45 mins

Compression - wrap compressive bandage distal > proximal. Leave for 20 mins

Manual reduction - lubricant, draw swollen foreskin forward, push glans backwards

Advice:
- No retraction 1/52
- No sexual intercourse
- Avoid irritants
- Observe for infection

53
Q

Bacterial causes of acute prostatitis

A

Gram-negative organisms (E. coli, Klebsiella, Proteus, Enterococcus)
Pseudomonas in IDUC
STI

Trimethoprim 300mg OD 2-4 weeks
Ciprofloxacin 500mg BD 4 weeks

Complicated, risk of resistance (recent travel Middle East, Asia, Africa) - Cefalexin 500mg BD/augmentin 625mg BD 2-4 weeks

4-6 weeks if chronic

54
Q

Complications of prostatitis

A

Chronic prostatitis
Chronic pelvic pain
Prostatic abscess
Bacteraemia
Epididymitis
Spinal/sacroiliac infection
Endocarditis (valvular disease)

55
Q

Symptoms and signs of prostatitis

A

Fever, malaise
Perineal pain
dysuria, frequency, slow flow, urgency
Prostate on DRE: firm, oedematous, tender +++

56
Q

Definition of microscopic haematuria

A

> 20x10^6/L RBC in 2 of 3 properly collected midstream urine specs, 7 days apart
No evidence of infection

57
Q

Causes of haematuria

A

Renal trauma
Renal disease
Acute glomerulonephritis (acute HTN, oliguria, oedema, ACR >30, red cell casts, rise eGFR)
Cystitis, pyelonephritis
Renal calculus
Prostatitis
BPH
Prostate ca
Menses
Vigorous exercise
Recent urological instrumentation
Bladder ca
Rupture AAA

UCPEX (13 decks)

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