MSRA > Surgery 2 > Flashcards

Surgery 2 Flashcards

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1
Q

What is flexible sigmoidoscopy screening?

A

Flexi sig offered as one off to 55yo

Can self refer up to age of 60yo for one of flexi sig if has had not had one at age 55yo

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2
Q

Symptoms of fat necrosis (3)

A

Traumatic cause
Mimics breast ca
Can increase in size initially

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3
Q

Indirect inguinal hernia caused by

Direct inguinal hernia caused by

A

Incomplete closure of processus vaginalis

Defect in transversalis fascia on Hesselbach triangle

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4
Q

Passes medial to inferior epigastric artery

Passes lateral to inferior epigastric artery

A

Direct

Indirect

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5
Q

Difference between external and internal haemorrhoids

A

External - below dentate line

Internal - above dentate line

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6
Q

External or internal?

  1. Prone to thrombosis, may be painful
  2. Generally do not cause pain
A

External

Internal

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7
Q

What is the grading system for haemorrhoids?

A

I - do not prolapse
II - prolapse on defecation, reduce spontaneously
III - can be manually reduced
IV - cannot be reduced

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8
Q

Mx haemorrhoids (5)

A
  1. Soft stool (laxatives)
  2. Local anaesthetics
  3. Rubber band ligation (outpt dept)
  4. Sclerotherapy
  5. Surgery
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9
Q

Presentation of acutely thrombosed haemorrhoids

A

Purplish, oedematous, tender subcutaneous perianal mass

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10
Q

Mx of acutely thrombosed haemorrhoids

A

If within 72hrs of onset –> surgery for excision

Otherwise conservative management

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11
Q

May experience a lucid interval =

A

extradural haematoma

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12
Q

Extradural haematoma caused by:

Location

A

Acceleration-deceleration trauma OR
Blow to head
Temporal secondary to middle meningeal artery

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13
Q

Old and alcoholism are RF for which type of head injury?

A

Subdural

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14
Q

Subdural bleed feature (1)

Location (1)

A
  1. Slow onset of symptoms

2. Frontal and parietal lobes

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15
Q

What is the Cushing’s reflex?

A

Hypertension and bradycardia following head injury

Usually pre-terminal

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16
Q

What medication can be used for life threatening rising ICP?

A

IV mannitol/ furosemide

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17
Q

Indications for CT head immediately (7)

A
  1. GCS < 13 on initial assessment
  2. GCS < 15 after 2 hours
  3. Post traumatic seizure
  4. > 1 episode of vomiting
  5. Focal neurology deficit
  6. Suspected open/ depressed fracture
  7. Suspected basal fracture (panda eyes)
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18
Q

What is Battle’s sign?

A

Bruise that extends across the entire backside of your ear

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19
Q

CT within 8 hours (5)

A
  1. If on warfarin

If has experienced LOC or amnesia AND

  1. > 65yo
  2. Hx of bleeding/ clotting disorders
  3. More than 30 minutes’ retrograde amnesia of events immediately before the head injury
  4. Serious accident (fall from a height of greater than 1 metre or 5 stairs, or RTA)
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20
Q

What is a duct papilloma?
How do they present?
Mx

A

Benign mass originating usually from singular duct
Blood stained nipple discharge or mass
Microdochectomy

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21
Q

Mx of BPH

A
  1. Watch and wait
  2. Alpha 1 anagnosits (tamsulosin)
  3. 5 alpha reductase inhibitors (finasteride)
  4. TURP
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22
Q

Double bubble sign on AXR =

A

duodenal atresia

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23
Q

Duodenal atresia presentation (2)

A
  1. Few hours post birth

2. Bilious vomiting

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24
Q

When would you do a Ladd’s procedure?

A

Malrotation with volvulus

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25
Malrotation with volvulus | Presentation (2)
1. Bilious vomiting 2. 3-7 days post birth 3. May have signs of haemodynamic instability
26
Dilated bowel loops on AXR, pneumatosis and portal venous air =
Necrotosing enterocolitis
27
Necrotosing enterocolitis | Features (2)
1. Bilious vomiting | 2. Second week of life
28
Necrotosing enterocolitis | Mx
If non perforated conservative and supportive | If perforated - laparotomy and resection
29
CF + Air- fluid levels on AXR | Mx
Meconium ileus | Surgical decompression +/- resection
30
Mec ileus | Features (3)
1. Bilious vomiting 2. Abdominal distension 3. Within 24-48 hours of life
31
AXR will show air-fluid levels | Within 24 hours of delivery
Jejunal/ ileal atresia
32
Jejunal/ ileal atresia | Mx
Laparotomy with primary resection and anastomosis
33
Criteria for brain stem death testing (4)
1. Deep coma known cause 2. Nil electrolyte imbalance 3. Nil reversible causes 4. Nil sedation
34
Brain stem death testing (6)
1. Caloric test 2. Nil corneal reflex 3. Pupills fixed and dilated 4. Nil cough reflex 5. Nil response to supraorbital pressure 6. Nil respiratory effort
35
What is a caloric test?
50mls of ice cold water into each year
36
Who can perform brain stem death testing?
Two doctors both with at least 5 years of post grad experience At least one consultant No one from transplant team
37
Tender, fluctuant mass in a lactating women = | Commonly caused by which organism
Breast abscess commonly caused by Staph Aureus
38
When would you excise a fibroadenoma? (size) | Describe a fibroadenoma
>3cm | Breast lumps, firm, mobile, non tender
39
Nipple inversion/ skin tethering, hard , irregular lump
Breast ca
40
``` Common around menopause Tender lump around nipple Green nipple discharge Benign Can become infected ```
Mammary duct ectasia
41
Blood stained discharge | Single duct wart like
Duct papilloma
42
Breast screening
50-70yo | Mammogram every 3 years
43
FH of breast ca criteria for earlier screening
1. x1 1st degree female relative diagnosed with breast ca <40yo OR male 1st degree relative at any age 2. x1 1st degree relative with bilateral breast ca <50yo 3. x2 1st degree relatives OR x1 1st degree and x1 2nd degree relative at any age 4. x1 1st/2nd degree relative with breast ca AND 1st/2nd degree relative with ovarian ca at any age 5. x3 2nd degree relatives with breast ca at any age
44
RF for breast ca (8)
1. COCP 2. Nulliparity 3. Late menopause, early menarche 4. BRCA1 BRCA 1 5. 1st degree relative with premenopausal breast ca 6. Nil breastfeeding 7. Ionising radition 8. Obestiy
45
2ww referral for breast ca
>30yo unexplained breast lump (with or w/o pain) | >50yo discharge, retraction or other changes of concern in one breast only
46
Consider 2ww referral for breast ca
skin changes that suggest breast ca OR | unexplained lump in axilla
47
Name four types of breast ca
Invasive or in situ Lobular or ductal DCIS LCIS Invasive lobular Invasive ductal
48
Most common breast cancer
Invasive ductal (also known as no special type)
49
Eczemetous changes (reddening and thickening) of nipple areolar Underlying malignancy Usually invasive carcinoma
Paget's disease
50
Blocking lymph drainage = which type of breast ca
Inflammatory breast cancer
51
Size and type of cancer that can be offered wide local excision
DCIS <4cm
52
Who is offered RT for breast ca
1. Anyone with wide local excision | 2. If had mastectomy, if has T3 or T4, or >= 4 axillary nodes
53
Tamoxifen SE (3)
1. Risk of VTE 2. Risk of endometrial cancer 3. Menopausal symptoms
54
HER2 +ve use which medication?--> | Cannot be used if -->
Herceptin (trastuzumab) | Hx of heart disorders
55
ER+ve breast ca use (2)
1. Tamoxifen (oestrogen receptor antag + partial agonist) | 2. Anastrozole (aromatose inhib) if post menopausal
56
Squamous cell carcinoma bladder ca RF (1)
Schistosomiasis
57
Transitional cell carcinoma RF (3)
Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine Rubber manufacture Cyclophosphamide
58
Screening for AAA
Aged 65yo all offered a single abdominal USS
59
Mx infantile hydroceles
1. Usually resolve 1 month from delivery | 2. If not resolved by 1yo then can be referred to urology
60
Epididymo-orchitis Mx if unknown organism
ceftriaxone 500mg IM single dose, plus doxycycline 10-14 days
61
Mx breast cyst =
Aspiration If blood stained or refill then biopsy/ excise Increased risk of breast ca
62
Testing of PSA should not be done how long after the below: | Prostate biopsy
6 weeks
63
Testing of PSA should not be done how long after the below: | UTI
4 weeks
64
Testing of PSA should not be done how long after the below: | DRE
1 week
65
Testing of PSA should not be done how long after the below: | Ejaculation + Exercise
48 hours
66
First line investigation for suspected haemorrhoids
Proctoscopy and rigid sigmoidoscopy
MSRA
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