Clinical Flashcards
38 yo lady with known metastatic colon cancer to liver and lung is on oncology ward for neutropenia. Oncology SPR did a CXR which showed free air. Husband and her children say she has a good quality of life and was due to go on holiday in a few days.
What would you do and what other investigations might you consider? What is the difference between palliative and conservative?
If the family say they want her to go to theatre what would you do?
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10 mins to answer
You are the ST3 on call. Your consultatn is letting you do a laparotomy and small and small bowel resection for the first time on your own with your CT1. She is in her office, there is an FY1 covering the wards. After you started the procedure, you get a call from A&E saying there’s a 68 yo with IHD, DM and unstable BP and a CT confirming ruptured AAA. There is also an 11 year old boy with a 6 hrs history of swollen hemiscrotom.
What do you do?
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10 mins to answer
You are in outpatients clinic. You have received a call from recovery nurse regarding AAA repair patient from the elective list earlier today. The patient’s leg is cold and pale and the nurse cannot obtain a pulse from the doppler. Your consultant is in a funeral.
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10 mins to answer
You are the ST3 on call for general surgery in a rural DGH. You are on a night on-call and these are your first nights on call in this hospital. Your consultant is a colorectal consultant and you are on with a FY1 and a FY2 on the SHO rota. During the night, the emergency department registrar phones you that a 19 year old man has just been admitted to the Department with a stab wound to his left chest.
Please describe your actions and management and the organisation issues that need to be considered.
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10 mins to answer
You are the ST3 on call for general surgery in a busy DGH. The on call rota means that you do a week of long days and this is your 5th day of 7. The consultant is also on call with you for the week and he is not your usual consultant and this is your first week on call with him. It is 5pm and you are on the surgical admissions unit.
The next patient you see is a 65 yo patient with a 5 days hx of increasing abdominal distention and absolute constipation. He has no vomiting and has developed abdominal pain over last 24 hrs. Prior to the acute illness , he has no past surgical hx but does suffer from tablet controlled hypertension. He has had a 3 month hx of increasing diarrhoea.
When you go to meet him. You realise that you have met him 2 days ago when you saw him on the SAU and discharged him without tests with a diagnosis of infective gastroenteritis. The patient and his family recognise you as being the surgical registrar who had seen him previously but as you begin to take a history you glance through the previous notes and see that your previous examination and hx which you thought your SHO had recorded has not been documented.
Describe how you wound proceed and consider what clinical and management issues need to be addressed.
2.5 mins to read
10 mins to answer
You are the ST3 on call for general surgery in a busy DGH. A 13 yo boy has been admitted from his school after having been hit in the abdomen during a rugby match. His teacher informs you that he has no past medical history and the school nurse confirms this. He is complaining of left upper quadrant pain and is pale. On initial assessment, he is tachycardic and hypotensive. His abdomen is distended and he is tender in the left upper quadrant. There is no peritonism.
After initial fluid resuscitation with 1 L of crystalloid, his pulse and blood pressure have improved and on talking to him, he does not really appreciate the severity of his injuries or seem able to understand the issues concerned. He has had an arterial blood gas done, which shows Hb 8.1. As you continue your treatment, his parents arrive and inform you that they are Jehovah;s witness and refuse blood transfusion for their son.
Please describe the clinical and organisation issues need to be addressed.
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10 mins to answer
You are the new ST3 on a general and colorectal surgery firm. You have been in OPD all morning, which has finished an hour late and you have an afternoon operating list which starts in 10 minutes. The list consists of 2 open inguinal hernia repairs and excision of a lipoma under LA. It is an extra operating list to reduce waiting lists and the patients have not been seen by you or your consultants previously but have been seen and listed by other consultants. When you look through the letters for each patient, they are all in their mid forties and have no past medical or surgical history recorded and look like uncomplicated cases. You consultant has asked you to start the list.
Please talk through the clinical and management needs to be addressed.
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10 mins to answer
You are on call and the gastroenterologists would like you to see a patient with UC suffering with an acute flare up that they believe will need an urgent subtotal colectomy. The consultant on call with you is a breast surgeon. The colorectal consultant is not in the building at present. At the same time, you received a call that a suspected leaking AAA is being transferred from another hospital over to you. Lastly there is a child who is ten who is due for an appendicectomy and theatre have called asking if you are ready for them to send. Part of your team included a CT2 and an FY1. Consider what organisation and clinical issue need to be addressed.
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10 mins to answer
You are the ST3 on call. You are called by AE as they would like you to see an elderly severely demented woman who has sustained a head injury and has a GCS of 6. In addition, there is an 18 yo female who is hypotensive with RIF pain. Lastly there is a 25 yo who has been involved in an RTA. He has no obvious injuries and is haemodynamically stable. Part of your team includes a CT2 and an FY1. Consider what organisation and clinical issues need to be addressed.
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10 mins to answer
It is the weekend and you are the ST3 on call. You received a call from a DGH - a ruptured aneurysm is due to be transferred over, in addition you have just seen a patient who is a 45 yo with right sided abdominal pain who is haemodynamically stable that still has not been seen. You have a CT2 and an FY1 as part of your team. Consider what organisation and clinical issues need to be addressed.
2.5 mins to read
10 mins to answer
