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MRCS Part B - Paul Edit > Consent > Flashcards

Consent Flashcards

1
Q

What are 4 particular risks to consent for in laparoscopic surgery?

A

Damage to viscera
Damage to vessels
Conversion to open
Iatrogenic injuries missed at time of surgery

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2
Q

Specific risks for consent in appendicetomy?

A

Normal appendix
Wound infections
Pelvic abscesses - higher risk if laparoscopic
Need for bowel resection / stoma

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3
Q

Explain 2 methods of obtaining pneumoperitoneu,?

A

Open hassan technique - incision around imbilicus, dissect down under direct vision to peritoneum, blunt trochar in, lap port inserted and CO2 attached
Veress needle - stap incision, needle down into peritoneum, that is spring loaded and stops when hit peritoneum. can put drop of saline down to make sure in

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4
Q

2 non-radio opaque renal stones?

A

Xanthine

Urate

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5
Q

Semi opque renal stone?

A

Cystine

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6
Q

2 kinds of coupling complications in lap surgery?

A

Direct

Capacitance

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7
Q

Why do post op haematoma thyroid patients get airway obstruction?

A

Laryngeal oedema secondary to reduced venous return

Rarely due to direct compression unless concurrent laryngomalcia

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8
Q

What is Stenson duct?

A

Parotid duct

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9
Q

What 2 veins form the EJV?

A

Retromandibular (maxilalry and STV)

Posterior auricular

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10
Q

What does the EJV drain into?

A

SCV

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11
Q

Waht forms the boudnaries of the quadrangular space and whats in it?

A 
Long head tricep (lat border)
Teres major below
Teres minor above
Humerus laterally
Axillary artery and posterior circumflex humeral nerve
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12
Q

What forms the boundaries of the triangular space and whats in it?

A

Long head tricep (med border)
Teres major below
Teres minor above
Circumflexx scapular artery

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13
Q

What muscle is inbetween the quad and trinagular space?

A

Long head triceps

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14
Q

What forms the boundaires of the tirnagular interval and what is in it?

A 
Long head tricep (med border)
Teres major above
Lateral head tricep laterally
Radial nerve
Profunda brachii
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15
Q

Where is the canal of Guyon? Borders

A

Ulnar aspect of wrist just superficial to carpal tunnel (floor)
Palmar carpal ligaments is roof
Hook of hamate is radiail border
Pisiform is ulnar border

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16
Q

4 nerves innervated by superior gluteal nerve?

A

Glut med
Glut min
Tensor fascia latae
Piriformis

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17
Q

What RFs are there of wounds for tetanus?

A

Heavy contamination w soil/faeces
Devitalised tissue
Old neglected wound
Puncture wounds

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18
Q

What is the vaccine schedule for tetanus?

A

2, 3 and 4 months

Boosters at 4 and 14

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19
Q

What is the full treatment for tetanus - 3 things?

A

Penicillin, metronidazole and tetanus Ig

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20
Q

Discuss role of tetanus in wound management?

A

If fully vasccinated less than 10 years ago - doesnt need anything
If fully vaccinated more than 10 years ago give booster, plus Ig if dirty / high risk wound
If unvaccinated - start immunisation and give Ig if dirty/ high risk

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21
Q

Clinical features and pathology of tetanus?

A

Caused by C tetani from dirty wounds
Produces spores and tetanospasmin, a neurotoxin that inhibits release of inhibitory GABA / neurotransmitters
Retrograde axonal transport once diffused to spinal cord
Widespread tetany, autonomic disturbance, dysrhythmias

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22
Q

What is the most common GAS implicated in e.g. nec fasc, toxic shock, impetigo and pharnygitis?

A

Strep pyogenes

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23
Q

Give 3 virulence factors associated w severe GAS infection?

A

Streptokinase, hyaluroindase and streptolysins

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24
Q

What may the concern be if an area of severe dysplasia is picked up on biopsy for Barretts?

A

That there is already invasive cancer somewhere else that hasnt been picked up due to sampling error

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25
Q

Give 3 treatment options for barretts with severe dysplasia?

A

Photodynamic therapy
Laser ablation
Segmental resection

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26
Q

Describe how abscesses are formed?

A

Large site of pus where centre becomes hypoxic, impeding clearance of pus by phagocytes
Contained in anatomical area

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27
Q

What is the definition of an empyema?

A

Collection of pus within a hollow viscus

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28
Q

What is a spore?

A

Single celled reproductive unit capable of giving rise to new individuals without sexual fusion

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29
Q

What are the 3 channels for in an endocscope?

A

Instrumentation
Aspiration/suction
Irrigation

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30
Q

What are the physis, diaphysis, metaphsis and epiphysis?

A 
Physis = growth plate
Epiphysis = end of bone next to growth plate
Diaphysis = body of bone
Metaphysis = bit next to physis on body side
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31
Q

What is an osteoclastoma otherwise known as? Benign or malgiannt?

A

Giant cell tumour of bone

Benign usually

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32
Q

What scoring system can risk striatfy potential for path fractures in bony mets?

A

Mirels scoring system - 9 or more = impending fracture so fix, 7 or less = dont fix

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33
Q

Which branchial cleft is most commonly implicated in cysts?

A

Second

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34
Q

What investigation can be done for structures with a sinus tract to the surface

A

Sinogram

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35
Q

What classically is found if aspirate a branchial cyst?

A

Choelsterol granules

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36
Q

4 reasons why surgery is recommended for branchial cysT?

A

High risk of infection
Dont spontaneously regress
Risk of mass effect etc
Low risk malignant potential

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37
Q

Describe how you woudl examine a neck lump?

A

Wash hands, introduce, consent etc
Sat up away from wall
General inspection
Neck inspection
Insecpt on tongue protrusion and drinking
Palpate - each level (anterior triangle, SCM, post triangle, LNs)
Asuculate
Offer to examine ENT system and systemic LNs
Specifically examine SM gland if indiicated including milking it, or facial nerve if parotid, or systemic for thyroid

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38
Q

Investigations for ?submandibular sialolithiathisis?

A

US

Sialogram

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39
Q

Management options for submandibular gland?

A 
Conservative
Sialogram may be thereapeutic
Lay open duct and retrieve stone (leave open to avoid stricutirng)
Silaendoscopy
Sumbandmibular gland excision
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40
Q

How to examine CV system?

A 
Wash hands, indtroduce self
General insecption
Hand inspection - stigmata of IE etc
Radial pulse, radio radial delay
Central pulse
JVP - hepatojugular reflex
Eyes - cholesterol
Mouth - IDA
Chest - scars etc
Heaves and thrills
Apex beat
Each valve area ausculatate - diaphgram for systolic murmurs, bell for diastolic
Leaning forward for AR, on side for MS
Into axilla for mitral, carotid for aortic
Peripheral odedemma
Offer to eamine rest of pulses and respiratory system
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41
Q

How to examine pperipharl vascular system?

A 
Wash hands, consent, expose
Inspect around, hands, face + eyes, abomen/thorax and LLs
Feel radial pulses and for RR delay
Central - brachial and carotid
Aorta
Femoral - and radio femoral delay
SFA over hunters canal
Popliteal
DP
Post tib
Examine feet for temp, NV status, CRT, oedema
Asuclautate carotids, aorta, femoral, popliteal
Buegers  test
ABPI
42
Q

How to do Buegers test?

A

Lift each leg off bed in turn and keep elevated
Angle that goes white = buegers angle - over 20 suggests PVD
then hang over bed and watch go red/dusky purple

43
Q

ABPI values?

A

Over 1 - ?diabetes
0.4-0.7 = intermittent cluadication
less than 0.4 = critical ischaemia

44
Q

What i the normal doppler artieral waveform? What is abnormal?

A

Triphasic normal

May be mono or biphasic

45
Q

What is diagnostic of critical limb ischaemia?

A

ABPI less than 0.4

Rest pain, or tissue loss (gangrene/ulcers)

46
Q

Describe how to do a venous examination of the lower limb?

A

Wash hands, consent, exposure and positioning
Inspect - varicose veins, skin discolouration, scarring etc
Palpate - for temperature, saphena varix, LNs
Tap test, cough test and tourniquet tests
Doppler assessment
Complete by doing abdo and arterial eaxms

47
Q

How wwould you do a cough impulse test in varicose veins?

A

Palpate saphenofemoral junction jjust med to femo artery

Ask patient to cough

48
Q

How would you do a tap test in varicose veins?

A

Tap above and below and feel for upwards/downard transmission of tap
Retrograde tap transmission is a sign of venous impcomtpetne

49
Q

How would you do a doppler venous assessment of the lower limbs?

A

Standing
Probe over SF junction
Compress calf listening for whoosh - if second woosh suggests imcompetence of SFJ
Repeat over short saphenous and popliteal junction

50
Q

Ix for venous insufficiency with skin changes?

A

Venous duplex scan

51
Q

What causes varicose veins?

A

Usually - valve incomepetence resulting in elevated superficial venous pressure as deep comes back into superficial
Also DVT, pregnancy, hormonal changes

52
Q

Management of varicose veins?

A

For mild - mod - consider conservative with weight loss, compression stockings, exercise, leg elevation
For severe / skin changes - consider surgical intervention incl surgical avulsion, sclerotherapy or endovenous/radiofreuqency ablation

53
Q

How to examine respriartory system?

A

Wash hands, introduce self, consent and position/exposure
General inspection
Hands inspection and feel pulse, check for CO2 flap
Check face + mouth
Inspect chest for scars, expansion etc
Palpate - chest expansion, tactile fremitus, trachea and cervical LNs
Percuss - chest throughout
Asuculate - lung fields throughout incl apex, vocal fremitus
Offer to examine LNs, cardio system

54
Q

What does disparity ain active and passive shoulder movements suggest?

A

Rotator cuff tear

55
Q

What special tests are there for rotator cuff fucntions?

A

Jobes test for supraspinatus - thumb down and abduct
Gerbers lift off test for subscapularis
Infraspinatus/teres minor - resisted external rotation

56
Q

What test is there for recurrent anterior shoulder dislocation?

A

Shoulder apprehension test

57
Q

What is anterior shoulder discloation usually associated with in younger people?

A

Labral tear - bankart lesion

58
Q

What is anterior shoulder disolcation usually assoicated with in older people?

A

Rotator cuff injury due to degerenative changes

59
Q

What is a bankart lesion?

A

Injury to anterior glenoid labrum, capsule and ligaments of shoulder due to recurrent dislocations

60
Q

What is a hill sacks lesion?

A

Indentation on posterolateral humeral head caused by impaction against anteroinferior glenoid rim during anterior dislocation

61
Q

How would you examine the spine?

A

Wash hands, introduce self, consent and exposure / position
Inspect each part in turn - from front sides and back
Watch gait
Adams forward bend test for scoliosis
Feel all the way down
Chest expansnion if kyphoscoliosis
Assess movement of cervical spine
Then thoracolumbar (thoraco only really rotation)
Schobers test for flexion (or measure fingers - floor distance
Spurlings test

62
Q

How would you perform Schobers test?

A

Mark iliac crest level and 10cm above, 5cm below
Bend forward to touch toes without bending knees
Remark differences - if over 5cm normal, if under 5cm abnormal

63
Q

What is Spurlings test?

A

For cervical stenosis - ear to shoulder then apply axial load

64
Q

What is lasegues sign?

A

Like SLR for sciatica

65
Q

Causes of acquired kyphosis?

A 
Osteoporsis and fractures
Spondylosis
Bad posture
Cancer infilitration
TB
66
Q

How woudl you examine a stoma?

A

Inspect with bag off - number of lumens, position, spouted vs unspouted, skin changes
Check for parastomal hernia
Finger in for ?stenosis
Light in for ?mucosal health

67
Q

What is a left upper quad stoma likely to be?

A

Transverse loop colostomy

68
Q

Things to consider when siting stoma?

A 
Bony prominences, skin folds and scars
Belt/bra line
Patient can get to it easliy
No local lesions or infections
Within rectus abdomins muscle (if poss)
Mark sitting and standing
69
Q

How to examine submandibular region?

A

Wash hands, introduce, consent and exposure
Inspect neck itself
Inspect oral cavity incl with tongue depressor
Palpate the neck and gland areas, and LN areas
Bimanually palpate gland through mouth - ballot - also duct
Test tongue sensation and movement
Coplete by examining parotids, rest of ENT system

70
Q

How can you test mylohyoid muscle?

A

Push tongue to roof of mouth

71
Q

How to do AMTS?

A 
Age?
Time?
Remember 42 west street
Year?
Name of this palce?
My job? This persons job?
DOB?
When did WW2 end?
Who is the current PM/monarch?
Count 20-1?
Recall address?
72
Q

Prep for colonscopy?

A

Couple days befroe - low fibre diet, drink plenty of fluids
Day before - clear fluids and bowel prep
Day of - NBM 6 hours, sips until 2 hours before
Omit BP medications perioperatively
Ensure have adequate social support

73
Q

Do you need to stop anticoagulation for a colonscopy?

A

Nope

74
Q

Alternatvies to OGD/colonscopy?

A

For OGD - barium swallow/XRs

For colon - CT colonography

75
Q

What is a Bartons fracture?

A

Fracture of the distal radius with involvement of joint surface and radiocarpal dislocation

76
Q

What is a fracture of the distal radius with involvement of joint surface and radiocarpal dislocation called?

A

Bartons fracture

77
Q

What is a Bennetts fracture?

A

Fracture of the thumb - base of metacarpal

78
Q

What is a fracture of the base of the thumb called?

A

Bennetts

79
Q

What is a boxer’s fracture?

A

Fracture of the neck of the 5th metacarpal

80
Q

What is a chance fracture?

A

Horizontal fracture of the veterbal body

81
Q

What is a horizontal fracture ofht evebertal body called?

A

Chance fracture

82
Q

What is a Chauffeur’s fracture?

A

Intra-articular fracture of radial styloid

83
Q

What is an intra articular fracture of the radial styloi called?

A

Chauffers fracture

84
Q

What is a Colles fracture?

A

Distal radial fracture with dorsal angulation - FOOSH

85
Q

What is a distal radial fracutre with dorsal angulation called?

A

Colles

86
Q

What is a galleazi fracture?

A

Radial shaft fracture with dislocation of the radio ulnar joint

87
Q

What is a radial shaft fracture with dislocation of the radio ulnar joint called?

A

Galleazzi

88
Q

What is a Hangmans fracture?

A

Fracture through both pedicles of C2

89
Q

What is a fracture through both pedicles of C2 called?

A

Hangmans fracture

90
Q

What is a Jefferson fracture?

A

Burst fracture of C1 due to axial loading

91
Q

What is a lisfranc injury?

A

Fracture disocatino of the midfoot - forced plantar flexion or weight through midfoot

92
Q

What is a monteggia fracture?

A

proximal ulna fracture with dislocation of radial head

93
Q

What is a proximal ulna fracture with dislocation of radial head called?

A

Monteggia

94
Q

What is a Rolando fracture?

A

Intra articular comminuted fracture of the base of the 1st metacarpal

95
Q

What is a Intra articular comminuted fracture of the base of the 1st metacarpal?

A

Rolando fracture

96
Q

What is a Smiths fracture?

A

Opposite of a colles - distal radial fracture with volar displacement (fall with flexed wrist)

97
Q

What is a distal radial fracture with volar displacement called?

A

Smiths

98
Q

What are the Salters Harris fractures?

A 
1 - straight through grwoth plate
2 - above
3 - lower
4 - through everything
5 - rammed (crush fracture)
99
Q

What is the most common salter harris fracture?

A

2 - above

100
Q

What are the Weber ankle fractures?

A 
A = least bad  - below syndesmosis - boot
B = at level of syndesmosis - variable
C = most bad - proximal fib so unstable - fix
101
Q

What nerves come off the brachial plexus - not the main ones?

A

Long thoracic nerve of bell - C5-7
Dorsal scapular - C5
Nerve to subclavius - C5/6
Suprascapular - superior trunk
Lateral cord - lat pectoral nerve
Posterior cord - upper and lower subscapular, thoracodorsal nerves
Medial cord - med cut nerve of arm and forearm, medial pectoral nerve

102
Q

Contents of hunters canal?

A

Femoral artery and vein
Saphenous nerve
Nerve to vastus medialis

MRCS Part B - Paul Edit (29 decks)

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