Year 3 - Surgery > Mixed > Flashcards

Mixed Flashcards

(48 cards)

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1
Q

Flail Chest

- Presentation

A

Flail chest

  1. Ant/lat ribs
  2. 2+ribs
  3. Fractured in 2+ places
  4. Move paradoxically with respiration
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2
Q

Flail chest

- Mx

A

Flail chest

  1. O2
  2. Analgesia
    - PCA
    - Epidural
  3. PPV
    - If resp failure
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3
Q

Beck’s Triad

  • Presentation
A

Beck’s Triad
- Cardiac tamponade

  1. Muffled heart sounds
  2. Decreased BP
  3. Raised JVP
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4
Q

Kussmaul’s Sign

A

Kussmaul’s Sign

  1. Raised JVP on inspiration
  2. RH dysfunction
    - Commonly in tamponade
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5
Q

Abdominal Trauma

- Indications for Laparotomy

A

Laparotomy for Trauma

  1. Unexplained shock
  2. Peritonism
  3. Intraperitonial gas
  4. Ruptured diaphragm
  5. Evisceration
    - Bowel
    - Omentum
  6. Gunshot wounds
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6
Q

Monroe-Kelly Doctrine

- Theory

A

Monroe-Kelly Doctrine

  1. Cranium is rigid box
  2. CSF and Blood compensate
  3. 100ml volume change
    - Raised ICP
  4. Herniation
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7
Q

Cushing’s reflex

- Features

A

Cushing’s reflex
- Imminent herniation

  1. HTN
  2. Bradycardia
  3. Irregular breathing
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8
Q

Basal Skull #

- Four signs

A

Basal skull signs

  1. Battle
  2. Pando
  3. Haemotympanum
  4. CSF Rhino/otorrhoea
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9
Q

Oesophageal Dysphagia

- Mural causes

A

Oesophageal dysphagia
- Mural cause

  1. Benign stricture
  2. Malignant stricture
  3. Oesophagitis
  4. Trauma
  5. Pharyngeal pouch
  6. Web (Plummer-Vinson)
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10
Q

Oesophageal Dysphagia

- Extra-mural causes

A

Extra-mural dysphagia

  1. Retrosternal goitre
  2. Mediastinal LN
    - eg. lymphoma
  3. Lunc Ca
  4. Thoracic AA
  5. Rolling hiatus hernia
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11
Q

Achalasia

- Pathophysiology

A

Achalasia

  1. Plexus degeneration
    - Myenteric/Auerbach’s
  2. Decreased peristalsis
  3. LOS fails to relax
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12
Q

Achalasia

- Mx

A

Achalasia Mx

Medical
1. CCBs/Nitrates

Interventional

  1. Botox injection
  2. Endoscopic balloon

Surgical
4. Heller’s cardiomyotomy

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13
Q

Oesophageal Cancer

- Histology

A

Oesophageal Cancer

65% Adenocarcinoma

  • Lower 3rd
  • GORD/Barrett’s/Dysplasia

35% SCC

  • Upper and middle
  • EtOH and Smoking
  • Worldwide commonest
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14
Q

Oesophageal Cancer

- Mx

A

Oesophageal cancer mx

  1. MDT

Surgery

  1. 25-30% operable
  2. Ivor-Lewis
    - 2 stage
    - Abdo and R thorax
  3. Neo-adjuvant chemo
    - Cisplatin + 5 FU
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15
Q

Oesophageal Cancer

- Palliative Care

A

Oesophageal palliation
- Majority of patients

  1. Laser coagulation
  2. Alcohol injection + spiro
  3. Stenting + hyoscine
  4. Analgesia
  5. Radio
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16
Q

GORD

- Predisposing drugs

A

GORD Predisposing

Neuro

  1. Anti-AChM
  2. TCAs

Vascular
3. Nitrates and CCB

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17
Q

GORD

- Mx

A

GORD

Conservative

  1. Weight loss and small meals
  2. Pillow angle & early meals
  3. Smoke, drink, spice

Medical

  1. Antacid otc.
  2. PPI
    - 1-2mo
  3. PPI
    - Double dose
  4. H2RA
    - Ranitidine

Surgical

  1. Nissen fundoplication
    - Repair diaphragm
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18
Q

Hiatus hernia

- Classification

A

Hiatus Hernias

  1. Sliding (80%)
    - GOJ slides
    - GORD associated
  2. Rolling (15%)
    - Non-GOJ stomach
    - Protrudes into chest
    - LOS intact (no GORD)
    - Risk of strangulation
  3. Mixed (5%)
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19
Q

Hiatus hernia

- Mx

A

Hiatus hernia

Conservative
1. Weight loss

  1. Manage reflux

Surgery

  1. All rolling hernias
    - Strangulation risk
  • Cruroplasty (reduce)
  • Fundoplication (wrap
  1. Refractory symptoms
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20
Q

Peptic Ulcer Disease

- Investigations

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A

PUD Investigations

Bloods

  1. FBC (bleed)
  2. Urea

OGD

  1. Stop PPI 2 weeks before
  2. CLO/urease
    - Campylobacter-like organism
  3. Biopsy
21
Q

H Pylori

- First Line Erradication

Study These Flashcards
A

Eradication Treatment

  1. PPI
  2. Clarithromycin
  3. Amoxicillin
22
Q

Peptic Ulcer Disease

- Surgical Options

Study These Flashcards
A

PUD Surgeries

Vagotomy

  1. Truncal (w/ pyloroplasty)
    - Decreased acid
  2. Selective
    - Pylorus left intact
  3. Antrectomy
    - Distal half removed
  4. Subtotal Gastrectomy
    - Roux-en-Y loup
    - Performed for Zollinger-Ellison
23
Q

GI Bleed

- Scores

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A

GI Bleed Scores

Rockall

  1. Re-bleed
    - 40% die
  2. Mortality
  3. Pre and post- OGD

(Glasgow-)Blatchford

  1. Inpatient or outpatient
  2. Stratifies risk
    - Hb, BP, BUN, Obs
24
Q

GI Bleed

- Variceal Mx

Study These Flashcards
A

Variceal Bleed

  1. Resus and Blood
  2. Terlipressin IV
  3. ABx
    Cipro

OGD

  1. Adrenaline/laser
  2. Glue/clips
25
Hypertrophic pyloric stenosis | - Mx
Pyloric stenosis 1. Resus 2. NGT 3. Ramstedt pyloromyotomy
26
Gastric Cancer - Mx - Prognosis
Gastric Cancer Curative surgery - 20-50% 5Y 1. Endoscopic resection 2. Gastrectomy - Partial/total - Roux-en-Y prevents reflux Palliation - <10% 5Y 3. Analgesia, PPI 4. Chemotherapy - Epirubicin, 5FU, Cisplatin 5. Pyloric stenting 6. Bypass procedure
27
Gallstones | - Composition
Gallstones 1. Mixed 75% - Multiple - Maily cholesterol 2. Cholesterol - Large, solitary - Low salts and lethicin 3. Pigment - Calcium bilirubinate - Haemolysis association
28
Biliary Colic | - Mx
Biliary Colic Mx Conservative - Rehydrate - NBM - Opioid Surgical - Lap chole (elective)
29
Acute chole - Imaging
Acute chole Imaging 1. AXR stones 2. US - Stones - Dilation - Wall oedema 3. MRCP - Dilated ducts
30
Acute Chole | - Mx
Acute Chole Conservative 1. NBM 2. Hydrate and analgesia Medical 3. ABx - Cefuroxime + met Surgical 4. Elective Lap Chole Complicated 5. Empyema - Drainage - Cholecystectomy
31
Obstructive jaundice - Differentials
Obstructive jaundice 1. Stones (30%) 2. HoP Ca (30%) 3. Other (30%) - LNs - PBC/PSC - Drugs - Cholangio Ca
32
Pancreas Ca | - Classifications
Pancreatic Cancer 1. Ductal adenocarcinoma - 90% 2. HoP - 60% 3. Body of P - 25% 4. Tail of P - 15%
33
Pancreatic Ca | - Mx
Pancreatic Ca 1. ERCP stenting and biopsy 2. Surgery (No mets < 3cm) - Whipple's - Distal pancreatectomy 3. Paliation - ERCP - Bypass - Pain relief (plexus block)
34
Common Fracture Palsies 1. Ant shoulder 2. Humeral shaft 3. Elbow 4. Hip dislocation 5. Knee dislocation
Fracture Palsies 1. Axillary - Ant shoulder 2. Radial - Humeral shaft - Waiter's tip 3. Ulnar - Elbow dislocation - Claw hand 4. Sciatic - Hip Dislocation - Foot drop 5. Fibular - Knee dislocation - Foot drop
35
Limping Child | - DDx
Limping Children 1. DDH - Displaced femoral head 2. Synovitis - Self-resolving pain - Post URTI 3. Perthes - AVN and sclerosis 4. Slipped CapFemEpi - P-I displacement of head
36
Osteomyelitis | - Mx
Osteomyelitis mx Conservative 1. Supportive Medical 2. IV ABx - Fluclox (MCS) Surgical 3. Abscess drainage - Glycopeptide+carbapenem
37
Bone Metastasis | - Commonest primaries
Bone Metastasis 1. Breast 2. Lung 3. Prostate 4. Kidney 5. Melanoma
38
Osteochondroma | - Natural History
Osteochondroma 1. 10-20 (m>f) 2. Previous trauma 3. Benign outgrowth - Cartilage-capped
39
Chondrosarcoma | - Natural History
Chondrosarcoma 1. 40+ - 70% 5YS 2. Pain and lump - Pelvis - Axial 3. De-nova or from chondroma 4. Lytic lesion - Popcorn calcification
40
Osteoma | - Natural History
Osteoma 1. Facial lump - Solitary 2. Gardner Syndrome - Multiple
41
Osteosarcoma | - Natural History
Osteosarcoma 1. Adolescent (M>F) 2. Pain, warmth, bruit - Knee - Metaphysis 3. RFs: Paget's/Radiation 4. X- Ray - Sunburst (growth) - Codman's triangle (speed)
42
Ewing's Sarcoma | - Natural History
Ewing's Sarcoma 1. <20 2. Enlarging mass - Painful - Warm 3. Systemic - Fever - ESR - WCC 4. X-Ray - Long bone diaphysis - Lytic tumour - Onion-skin periostium
43
Upper Limb Palsies | - High vs Low
Upper LImb Palsies 1. Erb's - Waiter's Tip - C5/6 paraesthesia 2. Klumpke's - Claw hand - C8/T1 paraesthesia
44
Carpal Tunnel | - Contents
Carpal tunnel contents 1. FDS x4 2. FDP x4 3. MN 4. FPL
45
Carpal tunnel | - Mx
Carpal tunnel mx Conservative 1. Wrist splints Medical 2. Steroid injection Surgical 3. Decompression - Flexor retinaculum
46
Dupuytren's | - Natural History
Dupuytren's 1. Middle age/elderly - M>F 2. Skin puckering 3. Fixed flexion - Often bilateral 4. Usually idiopathic 5. Physio then fasciectomy 6. Usually recurs
47
Trigger finger | - Natural history
Trigger finger 1. Tendon nodule cathing 2. Fixed flexion 3. Steroid injection - High recurrence 4. Surgery
48
Tight belts pain | - Natural history
Meralgia Paraesthetica 1. Obesity, belts, underwear 2. Lat fem cut nerve - ASIS and Inguinal lig 3. Pain and paraesthesia - Relief on sitting
Year 3 - Surgery
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