B32

Question 1

Key aspects of the WHO operative checklist

Answer 1

Before Anaesthesia:
Confirm identity, procedure and consent
If the site is marked
Anaesthesia machine and medication check complete
Pulse oximeter functioning
Does the patient have -allergies, difficult airways/ aspiration risk, risk of blood loss

Before incision:
Introduce all team members
Confirm patient’s identity and incision site
Has antibiotic prophylaxis been given 60 mins prior
Anticipated critical events (to surgeon, anaesthetist and nurses)
Is essential imaging displayed

Before patient leaves room:
Verbally confirm - name of procedure, completion of instruments, specimen labelling, any equipment problems
Any key concerns for recovery and management

Question 2

Common risks associated with surgery?

Answer 2

Blood loss
Infection 
Reaction to drugs and surgery
Pain
Blood clots

Question 3

What are some of the psychosocial effects or surgery including stomas

Answer 3

Body image issues/ scars
Depression/anxiety - shock of surgery
Lifestyle: loss of independence, change in functional capacity
Change is roles of parents/partners - carers?
Sleep deprivation

Question 4

What are some of the psychosocial effects or surgery including stomas

Answer 4

Body image issues/ scars
Depression/anxiety - shock of surgery
Lifestyle: loss of independence, change in functional capacity
Change is roles of parents/partners - carers?
Sleep deprivation - pain or from admission into hospital

Question 5

Effects of stomas on patient’s self image?

Answer 5

Decrease in self-confidence,
Impairment in family relationships
Avoidance of social activities, Change in sexual relationships

Question 6

What micro-organisms commonly cause food poisoning?

Answer 6

Campylobacter - commonest reported cause of intestinal disease. Undercooked meat, unpasteurised/ bird-pecked milk
Salmonela - Eggs
E. Coli - cattle
Bacillus cereus - cooked rice
S. aureus - previously cooked food contaminated with skin/nasal flora
Cryptosporidium - foreign travel, pools (chlorine resistant), camping
Novovirus - commonest gastroenteritis. Semi-closed places (hospitals, cruises, schools)
Clostridium Perfringes - unrefridgerated store of food. Causes gas gangrene too

Question 7

What is the incubation period?

Answer 7

Time from eating to symptom onset

Question 8

What do you need to do as a doctor if you

suspect a case of food poisoning

Answer 8

Report to consultant responsible

Notify local food safety authority

Question 9

Which groups of individuals need to take

special precautions regarding food poisoning?

Answer 9

Persons with doubtful personal hygiene/unsatisfactory toilet hand-washing
Children in nursery or pre-school groups
People whose work involves prep
H&S care staff who have contact with highly susceptible persons (extremes of age, pregnancy,
immunosuppressed)

Question 10

Could you discuss the management of hospital

outbreaks of infective diarrhoea?

Answer 10

• Handwashing, bare below elbows, clean equipment, aseptic techniques, general ward hygiene, alcohol gel, prohibit potential reservoirs i.e. cooked food, flowers etc.
• BARRIER NURSING (use PPE – gloves, gowns)  Side rooms – quarantined bay
• Restrict ward access/visiting times – or CLOSE to visitors + new admissions
• Lift new cases after 72hrs symptom free

Question 11

What are the major avoidable risks for chronic
liver disease (remember to think globally as
well as in the UK)?

Answer 11

Alcohol:
Public health campaigns, minimum unit price, tax, license restrictions, sales restrictions
Obesity:
Public health campaigns, sugar tax, sale restrictions, education, provide healthy snacks at school
Viruses:
Vaccinate (Hep B/ Yellow fever), screen blood products, reduce needle sharing, contraception, disposable sharps, laws for tattoos
Drugs:
Needle banks, reduce OTC availability

Question 12

How might priorities for prevention of chronic liver disease differ internationally?

Answer 12

• Prevalence of disease
• Resources available
• Political support for intervention
• Population - attributable risk for different factors

Question 13

How does the breast cancer screening service operate in UK?

Answer 13

Women aged 50-71

Mammogram

Question 14

Epidemiology of breast cancer:

Answer 14

Most common cancer in UK – 15% of all new cancer cases
o Invasive
o 54,900 new cases yearly
o Highest incidence in >90yrs
o Most occur in upper-outer quadrant of breast
o Less common in deprived areas
o More common in white females