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EXAM PREP- YR 3 > surgical exam Qs i get wrong > Flashcards

surgical exam Qs i get wrong Flashcards

1
Q

A 78-year-old man complains of a long history of shoulder pain and more recently weakness. On examination active attempts at abduction are impaired. Passive movements are normal.

A

Rotator cuff tears- common in elderly, may occur after minor trauma or long standing impingement

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2
Q

A 63-year-old lady undergoes an axillary clearance for breast cancer. She makes steady progress. However, 8 weeks post operatively she still suffers from severe shoulder pain. On examination she has reduced active movements in all planes and loss of passive external rotation.

A

Adhesive capsulitis- initial painful stage folloed by joint stiffness

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3
Q

Carpal tunnel syndrome- hx

A

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night

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4
Q

Carpal tunnel syndrome- examination

A

weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms

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5
Q

What infection are pts with rib fracture prone to & why? How to prevent this?

A

Patients with rib fractures can find their deep breathing limited by pain. This causes susceptibility to chest infections as they cannot cough adequately to clear secretions.
Adequate analgesia is vital in rib fractures to ensure breathing is not affected by pain; inadequate ventilation may predispose to chest infections
Chest physiotherapy with breathing exercises helps

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6
Q

Iliopsoas abscess most common causative organism

A

Staph aureus

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7
Q

Initial imaging for Achilles tendon rupture?

A

USS

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8
Q

What is morton’s neuroma?

A

Benign neuroma affecting intermetatarsal plantar nerve
Commonly 3rd inter-metatarsophalangeal space
More common females
Forefoot pain
worse on walking
shooting or burning

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9
Q

Lateral knee pain in runners, no trauma…

A

Iliotibial band syndrome

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10
Q

Most common site of stress fractures

A

2nd metatarsal- longest metatarsal bone, thin and vulnerable to stress fracturesq

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11
Q

Adhesive capsulitis- which movement is classically impaired

A

External rotation

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12
Q

Fat embolism- triad of symptoms

A

Respiratory
Neurological
petechial rash (after the first two)

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13
Q

Signs of fluid depletion

A
  • Dry mucous membranes and reduced skin turgor
  • Decreasing urine output (should target >0.5 ml/kg/hr)
  • Orthostatic hypotension

In worsening stages:

  • Increased capillary refill time
  • Tachycardia
  • Low blood pressure
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14
Q

Signs of fluid overload

A
  • Raised JVP
  • Peripheral or sacral oedema
  • Pulmonary oedema
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15
Q

Ix when there’s fluid problems in a pt

A

Fluid input/output chart
Daily weight chart
U&Es - dehydration, renal hypoperfusion, electrolyte abnormalities

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16
Q

NICE daily requirements

A

Water: 25 mL/kg/day
Na+: 1.0 mmol/kg/day
K+: 1.0 mmol/kg/day
Glucose: 50g/day

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17
Q

Gold standard diagnosis osteomyelitis

A

Bone biopsy at debridement

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18
Q

Which movements are most affected in frozen shoulder

A

All active and passive movements

external rotation more than internal rotation or abduction

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19
Q

What happens if u give anticoagulation in compartment syndrome

A

Worsens it

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20
Q

Red, hot swollen joint in diabetic patient- what you considering?

A

Charcot’s foot

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21
Q

Treatment for Dupuytren’s contracture

A

Consider surgery when pt cannot lay hand flat on table- metacarpophalangeal joints can’t be straightened
Other mx options include injectable enzyme therapy

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22
Q

Causes of Dupuytren’s contracture

A 
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
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23
Q

What is epicondylitis

A

Epicondylitis is caused by repeated strain leading to inflammation of the common extensor tendon at the epicondyle.
Golfers- medial epicondyle- pain on resisted pronation
Tennis- lateral epicondyle- pain on resisted wrist extension

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24
Q

First line ix for suspected osteoporotic vertebral fracture

A

X-ray of whole spine

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25
How to diagnose De Quervains tenosynovitis
Clinical diagnosis Finkelstein's test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
26
Mx undisplaced scaphoid fracture
Cast 6-8 weeks
27
Groin lump differentials
``` Hernia Saphena varix Femoral artery aneurysm Lymphaedenopathy Lipoma ```
28
Scrotal lump differentials
``` Hydrocoele Varicocoele Epididymal cyst Epididymitis Testicular tumour- malignant or benign Testicular torsion Inguinal hernia ```
29
Foot drop- causes
Weakness of foot dorsiflexors Possible causes- common peroneal nerve lesion (most common)- often compression @ neck of fibula L5 radiculopathy Sciatic nerve lesion Superficial or deep pernoeal nerve lesion CNS lesions (with other features)- stroke
30
Mx of foot drop
Conservative if due to peroneal nerve Avoid crossing legs, squatting, kneeling ~2-3mnths to heal
31
Sensory supply of anterolateral thigh
Lateral femoral cutaneous nerve (lateral cutaneous nerve of thigh) Nerve roots L2,L3
32
Sensory function of obturator nerve
Middle part of medial thigh
33
Femoral nerve divisions + sensory functions
Anterior- anterior cutaneous branches- anteromedial and posteromedial thigh Posterior- saphenous nerve -skin of medial leg and foot and branches to quad fem
34
What supplies the posterior thigh
Posterior cutaneous nerve of the thigh/ posterior femoral cutaneous nerve Extends to posterior leg, about 1/3 the way
35
Sensory supply posterolateral leg
``` Sural nerve (from tibial and common fib) Also supplies lateral foot ```
36
What muscles make up the Achilles tendon
Gastrocnemius Soleus Plantaris
37
Following radiotherapy for prostate cancer, what can pts develop
Patients are at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer
38
Analgesia in acute mx of renal colic
IM diclofenac
39
First line ix in suspected prostate cancer
Multiparametric MRI
40
First line ix of testicular mass
USS
41
Gold standard ix renal stones
non contrast CT KUB
42
Criteria for inpatient admission for renal stones
Post-obstructive acute kidney injury Uncontrollable pain from simple analgesics Evidence of an infected stone(s) Large stones (>5mm)
43
Renal calculi mx- obstructed, or infected
Stent insertion- Retrograde stent insertion, via ureter Or percutaenous nephrostomy is a tube into renal pelvis (antegrade stent)
44
When to consider extra corporeal shock wave lithotripsy in renal stones mx
<2cm If impacted in upper ureter may consider ureteroscopy
45
Staghorn calculus mx
Large, proximal stones- percutaneous nephrolithototomy
46
Complications of TURP
TURP syndrome (hypoNa, fluid overload, glycine toxicity) Urethral stricture/ UTI Retrograde ejac Prostate perforation
47
Schistosoma infection is closely linked to risk of developing what cancer
squamous cell carcinoma bladder
48
How long to delay a PSA test after prostatitis
1 month
49
Periureteric fat stranding indicates what...
Recent stone passage if no ureteric calculus passage
50
Ix for erectile dysfunction
10yr CVS risk (lipid and fasting glucose serum levels) Free testosterone in the morning between9 and 11 If low or borderline, repeat with FSH, LH and prolactin. If abnormal, endo referral
51
Which artery is compromised in scaphoid fracture
Dorsal carpal branch radial artery
52
Causes of hip AVN
long-term steroid use chemotherapy alcohol excess trauma
53
How does cauda equina present (early and late signs)
Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include urinary incontinence
54
Suspected psoas abscess- imaging?
CT scan
55
Compartment syndrome is commonly associated with which fractures?
Supracondular | TIbial
56
Symptoms of compartment syndrome
Pain, especially on movement (even passive) excessive use of breakthrough analgesia should raise suspicion for compartment syndrome Parasthesiae Pallor may be present Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise Paralysis of the muscle group may occur
57
Will X-ray help with compartment syndrome diagnosis?
No
58
What is bennetts fracture
Intra-articular fracture of the first carpometacarpal joint Impact on flexed metacarpal, caused by fist fights X-ray: triangular fragment at ulnar base of metacarpal
59
What is potts fracture
Bimalleolar ankle fracture | Forced foot eversion
60
What is cubital tunnel syndrome
Cubital tunnel syndrome is caused by compression of the ulnar nerve @ elbow and can present with tingling/numbness of the 4th and 5th finger
61
Undisplaced patella fracture mx
Conservative- brace or cast
62
Subluxation of radial head (pulled elbow) mx
analgesia and passively supination of the elbow joint whilst the elbow is flexed to 90 degrees
63
Which movement is most affected in frozen shoulder
External Rotation
64
Clinical features of acute limb ischaemia
6 Ps | pale, pulseless, perishingly cold, paraesthesia, paralysis, pain
65
Gold standard ix for acute limb ischaemia
CT angiography
66
Acute PR bleeds, haemodynamically stable, mx?
Supportive mx
67
Most common cause of small bowel obstruction
Adhesions
68
What is angiodysplasia
Features- rectal bleeding and anaemia Most common vascular abnormality of GIT Responsible for 6% lower GI bleeding and up to 8% upper GI bleed
69
Causes of serum amlyase rise
Infections- mumps Intra-abdominal pathology- peptic ulcer or bowel perforation, intestinal obstruction, pancreatitis Drugs- morphine Renal failure
70
Which artery is at risk with duodenal ulcers
Gastroduodenal artery
71
Imaging for fistula in ano
MRI to see its course
72
Congenital hernias mx
inguinal: repair ASAP umbilical: manage conservatively

EXAM PREP- YR 3 (4 decks)

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