General IHD and surgery Flashcards
how would we classify surgery (3)
type of surgery e.g. palliative, paediatric, reconstructive
time scale e.g. elective, urgent, emergency
magnitude: Major, medium, minor
what needs to be taken in a surgical history
Drug history – Drug, dose, acute or continuing
Allergy History – name and reaction
Social Hx – Alcohol, smoking, Occupation, mobility, accommodation, Activities of daily living
Family – Lives with, familial diseases
what is micturation
struggle to pass urine
what is a specific history for a lump
Site
Onset
Duration
Size
Fixed vs mobile
Consistency
Pulsatile?
Other sites affected
Associated symptoms – N&V, pain, bleeding, neurology
give the specific questions for CVS examination
Chest pain
Palpitations
Orthopneoa - breathlessness on laying down
Intermittent claudication - pain caused by too little blood flow to muscles during exercise = calves
PND - peripheral noctural dyspnea - wake up breathless
Peripheral oedema
what is PND
peripheral nocturnal dyspnoea
waking up in middle of night breathless
what is orthopnoea
shortness of breath when laying down
what is claudication
pain in muscle when exercising, often the calves
what is Haemoptysis
blood in sputum
what is the specific respiratory history
Cough
Sputum – colour
Haemoptysis - blood in sputum
Wheeze
SOB/SOBOE - shortness of breath on exertion
give the specific GI history
Abdominal pain = Socrates
Masses
Nausea/vomiting
Haematemesis = vomiting blood
Diarrhoea/constipation
Maleana = blood in stool
Change in bowel habit
Weight/Appetite loss
what is haematemesis
blood in vomit
what is Maleana
blood in stool
what is genitourinary system
reproductive system and urine system
give the questions for a Genitourinary history
Dysuria - pain on urinating
Haematuria - blood in urine
Polyuria - urinating large amounts
Incontinence
Frequency
Urgency
Menopause/Menorhagia (heavy menstrual bleeding)
Discharge
what is dysuria
pain on urinating
what is haematuria
blood in urine
how do we take a MSK musculoskeletal examination (4)
Gait - watch how they walk
Joint/neck pain – multi, specific
Arthritis (OA, RA)
Joint swelling
how do we take a neurological history (4)
Seizures or epilepsy
Vasovagal episodes (faints)
Headaches
Neurosensory/neuromotor changes
what do we do for a bedside examination
see if there is a frame
any inhalers
if patient is on oxygen
if patient has police around
swollen oedema
vital signs : BP, HR, RR, temp
how do we do a cardiorespiratory examination
Inspection – are they well? Scars, deformity, use of accessory muscles, JVP
Palpation – Pain, apex beat, air entry, central trachea? Peripheral oedema
Percussion – resonance vs dull
Ascultation – heart sounds, chest resonance, air entry, chest sounds.
how would we do an abdominal examination? (4)
Inspection – Scars, distension, spider naevi, caput medusae, hernias
Palpation – 9 areas to palpate superficial and deeper, hepatomegaly, splenomegaly, hernias
Percussion – Tenderness
Ascultation – Bowel sounds
what is hepatomegaly and splenomegaly
large liver and large spleen
describe the abdominal pain felt by a patient with early and late appendicitis
early = central quadrant pain
late = lower right ‘iliac’ quadrant
if a patient had gall stones or cholangitis, which quadrant would the patient feel pain
upper right
if a patient had pain in the upper left quadrant, what might be the cause (3)
spleen abscess
splenomegaly
spleen rupture
if a patient has pain in the upper central quadrant of the abdomen, what might this be
Esophagitis
Peptic ulcer
Pancreatis
how dow e summarise a history (4)
Impression – A one paragraph summary of the case
Differential Diagnosis – at least three
Investigations – bloods, urine test, imaging, special tests eg respiratory function, ECG, ECHO,
Management – NBM? Analgesia, IV fluids, prep for theatre…….
what must be provided after surgery for the patient
post operative care:
General
Pain
Fluid intake/loss
Nausea & vomiting
DVT prevention - low molecular weight herparin and DVT stockings
Organ systems
CVS (arrythmia, hypotension, hypertension)
RS (hypoxia, difficulty breathing, sputum retention
GI (nutrition, voiding, diarrhoea)
GU (retention urine,diuresis)
MS (mobility, pressure areas)
what are some important aspect of pre-op care
Safe surgery
-Informed consent
-Anticipate complications
-Blood loss prevention/replacement
-Infection issues
Safe anaesthetic
-Airway
-Assess co-morbidities
-Specific heart/lung investigation
what three things should the anaesthetist check before surgery
Airway
Assess co-morbidities
Specific heart/lung investigation
what is the ASA
American society of anaesthesiologists
what is ASA grade I
healthy patient
what is ASA II
patient with Mild systemic disease with no functional limitation e.g. controlled hypertension
what is ASA III
Severe systemic disease with definite functional limitation e.g. COPD
what is ASA IV
Severe systemic disease that is a constant threat to life e.g. unstable angina
what is ASA V
Moribund patient who is not expected to survive for 24 hours with or without surgery e.g. ruptured aortic aneurysm
what are some general aspects of post op care
pain control
DVT prevention - low molecular weight herparin and DVT stockings
nutrition and hydration if unable to eat
safety and accompaniment if on drugs
Nausea & vomiting
what organ systems should be checked and controlled post op
CVS (arrythmia, hypotension, hypertension)
RS (hypoxia, difficulty breathing, sputum retention
GI (nutrition, voiding, diarrhoea)
GU (retention urine,diuresis)
MS (mobility, pressure areas)
what should be included in epidemiological history
Travel, vaccine and prophylaxis history, occupation, food/drink,recreational,sexual, animal contacts, special medical procedures, contacts.
what should be invovled in travel history
place of travel
reigon within country
route e.g. how they got there, indirect flights
people who travelled with
contact with fresh foods, markets, diseases relevent in these countries
what is the most common problem experienced with Travel, with the causative agents
Diarrhea
E.coli, Salmonella, Campylobacter
what respiratory tract infection is common with travel
leigonella
what is a common travel disease related to poor hygeine
hep A oro-faecal route
where has high amobea outbreaks
south(east) asia
what are some diseases common in africa and south asia
malaria
typhoid
amobea
Schistosomiasis
what is Schistosomiasis
parasitic infection
found in asia and africa
if a patient is travelling what should we advise
vaccine schedule
insect sprays and careful when eating foods
bednets for mosquitos
what occupations are red flags for disease
Health Care Workers
Blood borne Viruses, LRTIs, diarrhoea
Farm Workers
Leptospirosis, Coxiella, Orf
Sewage Workers
Leptospirosis, Hepatitis A, Gastroenteritis
Sex Workers
HIV,HepB, HSV, gonococcus, syphilis, chlamydia etc
Pet Shop owners
psittacosis
Abbatoir Workers
anthrax
Military
what should be included in sexual history
Number of partners
Male or Female or Both
CSW
Use of condoms
Travel sexual history
of index and partner
have they had STI screening
history of any STIs
current long term partner and where are they from?
how many partners in last year?
what is leptospirosis and who is at risk of this
weils disease
people who swim in infected water
canoe, kayak, wild swimmers
what sports come with infectious disease risk
Canoeists
Leptospirosis, gastroenteritis
Swimmers
Fungal infections, pox viruses, Leptospirosis, gastroenteritis
Cavers
Histoplasmosis, Marburg
Trekkers
Lyme Disease, other Tick-borne diseases
Rugby Players
HSV, fungal infections
what risks come with IV drug use
Hepatitis C, Hepatitis B, HIV, Endocarditis, Skin & Soft tissue infection including anthrax, aspergillus
from infected needle, heroine spoons and even clean spoons can inject commensals e.g. Staph. Aureues
what infectuous disease comes with marijuana an alcohol
Alcohol
TB, pneumonia, HIV
Cannabis
Pneumonia, early COPD, lung abscess
what infectious risk comes with pets
Dogs
Campylobacter species, Toxocara, rabies
Cats
Toxoplasma, Bartonella, pasteurella
Rodents
Rat Bite Fever, salmonella
Terrapins & Reptiles
Salmonella
Psittacine Birds
Chlamydia psittaci
Tropical Fish
Mycobacterium marinum
Wild and Domestic Fowl
Avian influenza
Agricultural animals (city farms etc)
Coxiella spp, salmonella, E.coli (eg 0157)
what is a risk of cat infectious disease
toxoplasma
what is the infectious risk of tropical fish
Mycobacterium marinum
what infectious risk comes from reptiles
salmonella
what is the infectious risk of having a splenectomy
Pneumococcal bacteraemia
a pt has been having diarrhoea and has recently been on a cruise, what is the cause of this problem
likely to be norovirus
what respective vials do we use for transport of viral and bacterial swabs
viral = green bottle
bacteria = black charcoal
why is a IgM test not overly helpful for diagnosis
not very specific
may give cross reaction giving false positives
why is IgG count helpul
specific to antigens
show past infection
what gives us the total anti-infection antibody count
IgG + IgM
