Communication / Other

Question 1

Types of wounds

Answer 1

Type 1 - clean wounds surgically created in sterile environment
Type 2 - clean contaminated, sharp cleanly incised, minimally contaminated
Type 3 - contaminated wound, no frank infection or dead tissue but dirty wound
Type 4 - infected or grossly contaminated wound, severely damaged tissue with devascularisation

Question 2

Wound debridement steps

Answer 2

Gross contamination and FB removed
Irrigation and scrub to remove debris
Prep and drape
Excise all dead tissue, debride back to bleeding tissue
Further irrigation
Adequate haemostasis
Closure with or without drain

Question 3

Primary intention definition

Answer 3

All layers sutured
Narrow gap filled with fibrin
Epithelial growth into the dermis

Question 4

Secondary intention definition

Answer 4

Open defect fills with clot and exudate
Phagocytes digest tissue
Capillary ingrowth to form granulation tissue
Fibroblasts migrate in and form collagen
Epithelium migrates in from the wound edges

Question 5

Laceration 5yo face - suture?

Answer 5

5/0 nylon
Non-absorbable monofilament

Question 6

Posterior wall of hernia - suture?

Answer 6

0 nylon
Non-absorbable, but will lose strength over time due to hydrolysis

Question 7

Abdominal wall closure - suture?

Answer 7

1 Prolene - Non-absorbable
1 PDS - delayed absorption

Question 8

CBD repair - suture?

Answer 8

5/0 prolene (non)
5/0 vicryl (ab)

Question 9

Brachial artery anastomosis - suture?

Answer 9

4/0 or 5/0 prolene (non-ab)

Question 10

Steps to counselling an intern

Answer 10

Ensure safe and appropriate environment
Approachable and understanding
Ask if they are ok, any troubles
Mention issue you have noticed - late, not doing jobs
Clarify expectations and why things not happening
Discuss strategies for improvement
Ask how team can help
Plan follow up meeting to catch up

Question 11

Surgery in pregnancy - important points

Answer 11

• Limited high quality trials due to safety
• No anaesthetic agents have been shown to be teratogenic
• Fetal HR monitoring
• Elective - postpone until post-partum
• Pregnant woman should never be denied indicated surgery regardless of trimester
• Non-urgent surgery - 2nd trimester (out of initial development stage and contractions / spontaneous abortion less likely)
• Notify LMC
• Neonatal, paediatric, obstetric services available
• Consent for LSCS
• Regional > GA if possible
• Healthy mum = healthy baby

Question 12

Needlestick injury to do

Answer 12

First aid - wash with soap and running water
Report to health and safety - type of injury and how it happened, donor HIV / hep
High risk - post exposure prophylaxis within 1 hour, hep B IgG within 72 hours, safe sex 3/12, do not donate blood until cleared
Bloods from source and recipient - HIV, Hep B, Hep C, LFT, BHCG
Document incident forms
Prevention going forward

Question 13

Wrong side operation communication

Answer 13

Stay calm stop operating
Check marked site, consent, list, booking form, imaging, patient notes
Confirm and notify consultant
Finish or close wrong side depending on stage
Restart and do correct side
Debrief with team - what went wrong, how to prevent
Explain to patient and family, full disclosure, apologise, discuss implications for patient, discuss analysis and learning
Document and discuss with medicolegal team / at M&M

Question 14

For consent to be valid:

Answer 14

1. Person must understand implications of Rx
2. Consent free without coercion
3. Consent specific and valid in relation to procedure discussed
4. In a way the pt understands

Question 15

Competency definition

Answer 15

Determined by a patient’s ability to comprehend and retain treatment information in order to consider the information to reach a decision

Question 16

OGD complications

Answer 16

Injury to teeth and lips
Bleeding
Perforation
Adverse effects from sedation

Question 17

DVT and warfarin counselling

Answer 17

Introduce, example purpose
Reason for warfarin - after one clot, have increased risk for further clots in the next three months
Liver makes clotting proteins, which need vitamin k, warfarin blocks vitamin k and so proteins don’t work
Daily dosing with INR monitoring
Decrease INR monitoring once levels steady
Bleeding or bruising risk and what to do - stop, ED, medical alert bracelet
Drug interactions - EtOH, abx, aspirin, OCP, some food
Pregnancy - teratogenic

Question 18

Obesity counselling - Ask

Answer 18

Would you like to talk about your weight
Are you concerned about your weight

Question 19

Obesity counselling - Assess

Answer 19

How long has it been a problem for you? Trends?
Previous interventions / diets / exercise tried and why they failed
Measurements - BMI, body fat, weight, height
Calculate IBW
Assess health status
Assess patient’s readiness to change
Psychological issues and barriers

Question 20

Obesity counselling - Advise

Answer 20

Emphasise personal health risks and benefits of weight loss
Treatment options - lifestyle, behavioural, psychological, medications, low calorie diets, bariatric surgery

Question 21

Obesity counselling - Agree

Answer 21

Must get patient to buy into the plan
Agree on follow up appointment to monitor progress

Question 22

Obesity counselling - Assist

Answer 22

Assist patient to identify and address the barriers and facilitators to weight loss
Recommend appropriate people and programmes to help

Question 23

Breast FNA communication - advantages

Answer 23

Less trauma and disfigurement
OP procedure under LA
Helps diagnosis, can suggest but not diagnostic
Helps with planning
Treats cysts

Question 24

Breast cancer diagnosis counselling

Answer 24

Introduction, bring friend / support person
Ask patient what they know so far
Explain events so far
Ask if they are okay to hear the results
Explain results and what this means
Sorry about diagnosis, empathy etc
Going to give lots of information, can bring you back in future as it will be hard to remember it all
Ask if okay to continue

Aim of treatment - remove cancer, local control, cosmesis, LNs

Surgery - WLE + RadioRx vs mastectomy + LNs

Radiation - damages abnormal cancer DNA, healthy cells survive but there are side effects

Chemo - systemic treatment to kill cancer cells and prevent recurrence, adjuvant therapy post OT vs pre OT to shrink.

Hormonal - tamoxifen blocks oestrogen

Biologic - herceptin binds HER2 and prevents growth if cancer has the receptor

Follow up appt
Written material
Express regret again

Questions