General Surgery — Flashcards

Flashcard 131: What is the management for sudden-onset hearing loss?

Answer: • High-dose oral corticosteroids (prednisolone)

Flashcard 132: What drugs can cause malignant hyperthermia?

Answer: • Suxamethonium • Halothane

Flashcard 133: Who should assess all post-tonsillectomy haemorrhages?

Answer: ENT specialist

Flashcard 134: In the management of breast cancer, the FEC-D regimen is used to:

Answer: • Downstage a primary tumor before surgery (neoadjuvant treatment) • Treat systemic microscopic disease if axillary nodes are positive after surgery (adjuvant treatment)

Extra: FEC-D is a chemotherapy regimen commonly used for Breast Cancer. FEC = Fluorouracil, Epirubicin, Cyclophosphamide. D = Docetaxel.

Flashcard 135: When is Tamoxifen used in Breast Cancer management?

Answer: • ER/PR +ve premenopausal women (First-line) • ER/PR +ve postmenopausal women (Alternative to Aromatase Inhibitors) • Chemoprevention in high-risk women • Male breast cancer (DOC)

Extra: Tamoxifen is a Selective Estrogen Receptor Modulator (SERM). While primarily the drug of choice for hormone receptor-positive premenopausal women, it can be used in postmenopausal women if Aromatase Inhibitors (AIs) are contraindicated or not tolerated. It also significantly reduces the risk of recurrence and is used for primary prevention in high-risk individuals. Unlike AIs, Tamoxifen is also the standard for treating male breast cancer.

Flashcard 136: What should be done with ACE inhibitors and ARBs prior to surgery?

Answer: Discontinue 24 hours before due to risk of hypotension with anaesthesia

Flashcard 137: Treatment for quinsy?

Answer: IV antibiotics + surgical drainage; tonsillectomy may be considered in 6 weeks

Flashcard 138: What distinguishes vestibular neuronitis from labyrinthitis?

Answer: Hearing is preserved (normal) in vestibular neuronitis, whereas hearing loss occurs in labyrinthitis.

Extra: Both conditions present with acute vertigo and nystagmus (often preceded by a viral infection). The presence or absence of auditory symptoms is the key clinical differentiator.

Flashcard 139: What do Auricular haematomas warrant?

Answer: Same-day ENT assessment and prompt incision & drainage (I&D) to prevent 'cauliflower ear' deformity.

Flashcard 140: How should a patient on warfarin with an INR of 5.0–9.0 and no significant bleeding be managed?

Answer: Omit 1–2 doses of warfarin, monitor INR, and reduce the maintenance dose.

Extra: ACCP Guidelines for Warfarin Reversal: 1. INR < 4.5 (No bleed): Reduce dose or omit one dose. 2. INR 4.5–10 (No bleed): Routine use of Vitamin K is NOT recommended. 3. INR > 10 (No bleed): Give Oral Vitamin K (2.5–5 mg). 4. Major Bleeding (Any INR): Give IV Vitamin K (5–10 mg) and 4-factor Prothrombin Complex Concentrate (PCC).