1
Q
amount of urine that is considered urinary retention?
A
300mls
2
Q
causes of urinary retention
A
anaesthesia (especially spinal)
medications (morphine, anticholinergics)
UTI
alcohol
3
Q
pros and cons suprapubic catheter
A
better for sexual function and long term use
risk of bowel injury when putting in
4
Q
what is phimosis
A
tight forsaken so unable to visualise glans
5
Q
what is paraphimosis
A
tight retracted foreskin
leads to glans necrosis
6
Q
what do you do if there are clots in urine
A
3 way catheter- drain and wash out
7
Q
visible haematuria imaging
A
USS bladder or KUB and cystoscopy
CT urogram if normal
8
Q
what is priapism
A
unwanted and painful erection caused by blood not leaving the penis
over 3 hours
emergency situation- drain blood
9
Q
what do you give in uncontrolled pain caused by kidney stones
A
diclofenac
reduce kidney filtration and help pain
10
Q
when do you refer a stone to urology
A
over 5mm or in ureter
11
Q
testicular torsion differentials
A
Epididymal cysts, hydrocele, hernia, testicular cancer
12
Q
testicular cancer history
A
acute or chronic pain, lump on examination
under 40 yo
13
Q
drugs stopped pre-opritavely
A
Lithium
DOACs
Clozapine
Anti-platelets
SGLT2 inhibitors
some anticholinesterases
COCP / HRT
MAOIs
K+ sparing diuretics
NSAIDs
Aspirin
Immunosuppressants -
Steroids
Biologics
14
Q
lithium before surgery
A
stop 24 hours before MAJOR surgery
15
Q
ACEi and ARB before surgery
A
stop 24 hours before surgery
16
Q
clozapine before surgery
A
last dose is night before
17
Q
SGLT2 inhibitors before surgery
A
stop 2 days before
18
Q
anticholinesterases before surgery
A
centrally acting- galantamine and rivastigmine
stop 24 hours before
19
Q
NSAIDs before surgery
A
generally- continue unless undergoing neurological, spinal, cardiac or ortho surgery
20
Q
aspirin before surgery
A
continue in 75mg
unless neuro / spinal surgery
safe in epidural
21
Q
anti platelets before surgery
A
generally stop 7 days before and replace with aspirin
22
Q
immunosuppressants before surgery
A
risk benefit analysis- but generally stopped before as it reduces healing
23
Q
steroids before surgery
A
convert to iv hydrocortisone
surgery is stressful so they may require more
24
Q
diuretics before surgery
A
don’t give on morning of surgery
25
diabetes before surgery
if they have poor glycaemic control- VR insulin
26
COCP or HRT before surgery
stop 4 weeks before major surgery
27
definition of acute abdomen
an issue present for less than a week, needs admission and has not previously been investigated or treated
28
visceral vs somatic pain in abdomen & causes of each
somatic pain is sharp and well localised
irritation of parietal peritoneum, somatic nerves
guarding, rigidity
viscersal pain is deep and not well localised
sensitive to tension and ischeamia
mediated by sympathetic NS
29
what imaging do you use for ?appendicitis
USS for females of reproductive age, the CT if not clear
CT for everyone else
its easier to exclude ovarian pathology on USS
30
Rovsing's sign
pain felt on the left when pressing on the right
not replicated on the left
caused by
31
Meckel's diverticulum
basically a second appendix
32
how does the site of duodenal ulcer change the complications?
posterior ulcer erodes into artery and caused a bleed
anterior ulcer causes perforation and peritonism
33
what is a volvulus
bowel twisted around its mesentry, causing ischemia
34
what are hausta and valvulae coniventes
haustra are in the large bowel, lines do not go right across
vlvulae coniventes are on the small bowel and do go all the way across
35
what is murphy's sign
pain on inspiration when palpating for liver
as liver hits hand, you get pain from acute cholecystitis and it arrests inspiration
you cant replicate it on the left
36
how do you image ?gall stones
USS, CT doesnt show 90% of them
37
blood tests that would indicate bile duct obstruction
raised LFTs, ALP will be highest
38
blood test that would show pancreatitis
amylase or lipase
if it is 3 times over normal limit, you cant rule it out,
if it is over 1000 then its most likely to be pancreatitis
39
what is ercp
endoscopic visualisation of the comon bile duct with the ability to remove gall stones
40
complications of ercp
pancreatitis, infection, perforation
41
what is charcot's triad
fever, jaundice, RUQ pain
suggestive of ascending cholangitis
42
what is raynold's pentad
fever, jaundice, RUQ pain
*hypotension & confusion*
suggestive of ascending cholangitis
43
causes of pancreatitis
i get smashed
iatrogenic
*gall stones
*ethanol
*trauma
steroids
mumps
autoimmune
scorpion sting
hyperlipiaemia, hypercalcaemia
ercp
drugs (thiazides, furosemide, tetracyclines, azathioprine)
*most common causes
44
what is Cullen's sign
bruising around belly button
late pancreatitis, indicates haemorrhage
45
what is grey turner's sign
bruising of flanks
late pancreatitis, indicates haemorrhage
46
diagnostic criteria for pancreatitis
history suggestive of
amylase over 330 (3x norm ofral limit)
CT scan shows
47
prognosis for pancreatitis
CRP and NEWS
amylase decreases over time so is not good for prognosis
48
what are the types of shock & examples
distributive- sepsis, anaphylaxis
haemorragic- bleeding
obstructive- PE, tamponade
constrictive- MI
49
what is septic shock
when BP does not respond to 2-3L of fluids
50
what can raise amylase
51
early management steps for acute abdomen
antibiotics
antiemetics
painkillers
IV fluids
NBM
52
Causes of GI perforation
Upper GI-
peptic ulcer
gastric tumour
Iatrogenic (OGD, ERCP)
small bowel diverticualr perforation
Lower GI-
perforated diverticular disease
perforated colonic tumour
perforation proximal to distal obstruction
Iatrogenic (colonoscopy)
53
causes of SBO
in the wall
tumours
stricture (Crohn's, TB)
in the lumen
foreign bodies
gallstones
outside the wall
adhesions
hernia
tumours
54
causes of LBO
in the wall
tumours
diverticular disease
ischeamic stricture
in the lumen
faecal impaction
outside the wall
volvulus
pelvic tumours
uncommonly- hernias and adhesions
55
symptoms of bowel obstruction
not passing flatus
vomiting
colicky pain
distension
56
signs of bowel obstruction
dehydration, hypotension, tachycardia
distention, peristalsis, high pitched, tinkling bowel sounds
*constant pain, fever and tenderness suggest strangulation*
57
acute cholecystitis & biliary colic management
bc- analgesia
ac- analgesia & IV abx
both- op laprascopic cholecystectomy
58
what bacteria cause most cases of acute cholecystitis
Esch-eri-chia coli
klebsiella pneumoniae
59
management of stoned in CBD
MRCP, ERCP
if not clear then cbd explorationand cholecystectomy
if clear, op cholecystectomy
60
drugs that can cause pancreatitis
thiazide
azathioprine
tetracyclines
valporate
furosemide
oestrogen
steroids
sulphonamides
61
symptoms of pancreatitis
epigastric pain, might radiate to back
n&v
aggrivated by movement, releived by sitting up
62
signs of pancreatitis
epigastric tanderness
distention
tachycardia & fever
jaundice
63
management of pancreatitis
o2, fluids, painkillers
64
AAA risk factors
male
age
smoking
caucasian
obesity
genetics- marfan's, EDS, polycystic kidney disease, Turner's syndrome
-ve risk factors
asia, diabetes, female
65
clinical features of aaa
hypotension
back / abdo pain (visceral pain, epigastric / back, can't get comfortable, can be mild pain)
pulsatile mass
trash foot
flank bruising
66
pathophysiology of aaa
weakening in th wall of the aorta due to loss of collagen and disarrangement of elastin, lots of pro-inflammatory markers
67
how is aaa imaged
USS
CT Angiogram if operating
68
screening criteria for aaa
65 yo males
if over 3cm- yearly
4.5-5.4- 3 monthly
operate at 5.5cm
69
screening programme criteria (5)
there is an accepted treatment
can reduce deaths- treatment that saves lives by starting treatment early
cost effective test that is sensitive, specific and easy to interpret
important disease
cost effective to treat early
70
what is done for small aneurysms?
optimise cardiovascular risk, maybe start on antiplatelet, statin, reduce smoking
71
ant v post raaa
anterior bleeds into peritoneal cavity- most die
posterior- bleeds retro peritoneal space, can form a tamponading effect
72
what makes an aortic dissection complicated
Refractory hypotension
malperfusion syndrome (limb ischaemia, deranged you&e, bowel ischaemia)
rapid expansion on CT
73
when does aaa need repairing?
5.5cm, from 5.0 in women
74
what do you need to check after aaa repair?
foot perfusion - pulse, doppler, how it feels to pt
kidney functions
75
open vs evar repair of aaa
open- more definitive, bigger procedure
evar- uses a stent to seal off the sack, needs surveillance due to complications
76
risk factors for aortic dissection
male
genetics (Marfan's, eds, lds)
cocaine
smoking
inflammation- vasculitis, GCA
Trauma (coronary angiogram, rapid deceleration in a crash)
77
stanford classification for aortic dissection
a- ascending
b- descending
78
symptoms of aortic dissection
pain between shoulder blades
similar to indigestion or MI
79
pathophysiology of aortic dissection
split in tunica media which leads to distention of the tunica adventitia to create a false lumen and true lumen
can lead to an artery coming off of the false lumen- reduced blood flow
80
symptoms of carotid artery disease
strokes and tia- aphasia, dysphasia, motor, sensory
(not cerebellar)
81
internal carotid supplies
ipsilateral eye and brain
ACA, MCA & PCA
motor & sensory cortexes
82
goal of carotid endarctectomy
remove things that could embolise
83
when is cea done
best done in 2 weeks after CVA
women- max 4 weeks, men max 12 weeks
84
fontaine classification
1- no sx
2- pain on exertion
3- rest pain
4- gangrene or necrosis
85
abpi results
under 0.85- reduced flow
over 1.4- calcified
86
6Ps of acute limb ischaemia
painful
pulseless
parasthesia
perishingly cold
paralysis
pallor
87
emboli vs thrombus
emboli- from distant site
thrombus- occlusion from clotting
88
treatment of acute limb ischeamia
revascularisation
heparin
pain killers
89
management of diabetic foot infection
broad spectrum abx & XR foot
early debridement- prevent osteomyelitis
may gave DKA or HHS
90
arterial vascular hx PC- limb
LLC/rest pain/tissue loss
Duration, Laterality, Character, Impact on QOL, Treatments
91
arterial vascular hx PC- carotid
strokes, tia, treatments, laterality, recovery, function
- motor, sensory, speech, eye
92
arterial vascular hx PC- aneurysm
Incidental/Asymptomatic/Symptomatic
Location, Rate of growth, Treatment
93
cardiovascular risk factors in vascular hx
diabetes, hypertension, CCF
previous MI, angina, stents, CABG, TIA, CVA
smoking
other pmhx
94
drug hx vascular
anti platelet, aspirin, htn, statins, antidiabetics
95
family, social hx vascular
aneurysms
exercise tolerance, adls
96
venous hxpc
Pain, Swelling, Aching, Itching, Phlebitis, Bleeding, Ulceration
Duration, Character, Laterality, Impact on QOL, Treatments
97
venous risk factors
DVT, leg fracture, COCP, BMI, reduced ankle mobility, Central venous lines
98
ortho hxpc
mechanism of injury
previous injuries or surgery
99
ortho examination
neurovascular distal to injury
100
open facture management
clean the wound
take a photo
cover would
go to theatre next day
unless- marine, farmyard, sewage - theatre quicker
101
imaging of fractures
2 plain film XR 90 degrees apart
MRI is best, CT is common
102
ACL vs Meniscus hx
ACL- immediate swelling, doesn't continue,
meniscus- delayed swelling (next day), continues, mechanical sx (clicking, locking)
103
what affects fractures healing
pt factors: smoking, nutrition, age,
fracture factors: site, mechanism of injury, severity of fracture, surgery,
104
when does a child with ortho issue need admitting?
concerns of NAI
systemically unwell
105
suprachondylar fracture concerns
median nerve
brachial artery
106
is it a growth plate or a fracture?
look at their age and what growth plates you expect to see
107
which was does shoulder normally dislocate? what's the exception
anteriorly
posterior in seizure
108
what do you need to check you don't damage when relocating a humerus? how?
axillary nerve
regimental badge sensation before and after
109
complications of poorly healed fracture
110
when would you do a dynamic hip screw
intertrochanteric proximal femur fracture (definitely extra capsular)
111
when would you use intramedullary nail with external fixation
femur (or tibia) shaft fractures
112
when would you do hemiarthroplasty
displaced NOF fracture in older / less active pts
-uses more than a stick, cognitively impaired, not fit for anaesthesia for THR
113
when would you do total hip replacement
displaced NOF fracture in more active pts, especially those with osteoarthritis
114
definition of a hernia
out pouching of mucosa through a muscle wall
115
where are diverticula most common
sigmoid due to high intraluminal pressures
116
diverticulosis definition
presence of diverticula in the GI
117
diverticular disease
symptomatic diverticula
118
sx of diverticular disease
lower abdominal pain
bloating
constipation
rectal bleeding
119
hernias and pubic tubercle
neck of hernia
superior and medial is inguinal
inferior and lateral is femoral
120
inguinal hernias and inferior epigastric vessels
femoral artery before inguinal ligament
indirect neck is lateral
direct neck is medial
Year 5
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