CPRS Case 3: Aortic dissection Flashcards

1
Q

***Role of how procedures can be performed in patients unable to give consent

A

Treatment for dealing with emergency situation can be given without obtaining prior consent

Unconscious patients
- competent patient unable to give consent
—> views of family members should be considered
—> provided that such views are
1. Compatible with patient’s best interests
2. Compatible with patient’s right of self-determination

Emergency situation:

  • Doctor may proceed without actual / legally authorised consent is in a situation of emergency or necessity to save patient’s life
  • Only course of action is to act in best interest of patient
  • Decision as to what is in patient’s best interest from doctor’s view is strictly a medical one, and is expected to be professionally formed
  • Discussion with family may assist if time permit but
  • Family view’s are not determinative
  • Decision making process should be documented in patient’s records
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2
Q

Explanation by doctor to patient in treatment decision

A
  • patient should be given enough time to make the decision
  • pateints’ refusal must be respected and documented
  • doctors’ duty to ensure patient truly understand the explanation by being careful and patient
  • explanation should be given in clear, simple and consistent language
  • explanation should cover not only significant risk but also risks of serious consequence even the probability is low
  • should not withhold information necessary for making a proper decision for any reason unless the information will cause serious harm to the patient (serious effect on patient’s mental health)
  • upsetting or causing him to refuse treatment is not proper justification for withholding information
  • must record reason in medical record if withhold information/ regularly review his decision to see whether the information could be given at a later stage
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3
Q

Main structure in plain x-ray of chest

A

Male vs female: amount of breast tissue

Main visible structures:

  • trachea
  • heart
  • ribs
  • scapulae
  • lungs

Invisible/obscured structures:

  • sternum
  • esophagus
  • pleura
  • fissures
  • aorta
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4
Q

Pathology of thrombosis

A

See CPRS lecture 41

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5
Q

Risk factors for atherosclerosis

A

See CPRS lecture 41

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6
Q

Basic abnormalities of serum lipids

A

See CPRS lecture

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7
Q

Effect of atherosclerosis on flow through blood vessel

A

See CPRS lecture 41

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8
Q

Complications of atherosclerotic plaque

A

See CPRS lecture 41

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9
Q

Interpret results of Chest X ray

A

Widened mediastinum:

  1. Aortic dissection: Separation of media and intima
    - Type A: ascending aorta (chest pain)
    - Type B: other parts of aorta (back pain)
    - sharp and stabbing pain
  2. Aortic aneurysm
    - SOB
    - chest, back, abdominal pain
    - dysphagia
    - hoarseness, difficulty speaking
  3. Cardiac tamponade (pericardial effusion)
  4. Mediastinal tumour
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10
Q

Interpret results of CT scan

A

See Radiology practical

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11
Q

Interpret ECG results

A

See CPRS lecture + Dr JoJo Hai Clinical skills ppt

PR interval: time intervals from onset of atrial depolarisation to onset of ventricular depolarisation
QT interval: duration of ventricular depolarisation and repolarisation
RR interval: duration of ventricular cardiac cycle
PP interval: duration of atrial cycle

  1. Determine regularity:
    - P-P interval —> regular atrial rhythm
    - R-R interval —> regular ventricular rhythm
  2. Calculate HR:
    1x大格/ 5x小格 = 0.2 seconds
    Count no. of R waves in 6 second strip (30大格) —> multiply by 10
  3. Identify the rhythm
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12
Q

2 investigation performed for a patient with suspected vascular obstruction of chest

A
  1. ECG

2. CT scan

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13
Q

4 major non-communicable diseases and their common characteristics

A

CCRD (mortality arranged in order)

  1. Cardiovascular disease
  2. Cancers
  3. Chronic respiratory disease
  4. Diabetes

Common characteristics:

  • non-contagious
  • complex etiology
  • multiple risk factors
  • long latency
  • prolonged course of illness
  • functional impairment / disability
  • all age group
  • low / middle income countries
  • largely preventable
  • attributed to common risk factors e.g. alcohol, smoking, diet, inactivity
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14
Q

Why NCD is highly prevalent in Hong Kong and worldwide

A
  1. Modifiable behavioural risk factors
    - Tobacco use
    - Physical inactivity
    - Alcohol use
    - Unhealthy diet
  2. Metabolic/physiological risk factors
    - Raised BP
    - Overweight / obesity
    - Hyperglycemia
    - Hyperlipidemia
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15
Q

What constitute a risk factor for disease

A

Risk factor: any attribute, characteristics or exposure of an individual that increases the likelihood of developing a disease / injury

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