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3rd BDS IHD > General IHD and surgery > Flashcards

General IHD and surgery Flashcards

1
Q

how would we classify surgery (3)

A

type of surgery e.g. palliative, paediatric, reconstructive
time scale e.g. elective, urgent, emergency
magnitude: Major, medium, minor

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2
Q

what needs to be taken in a surgical history

A

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

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3
Q

what is micturation

A

struggle to pass urine

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4
Q

what is a specific history for a lump

A

Site
Onset
Duration
Size
Fixed vs mobile
Consistency
Pulsatile?
Other sites affected
Associated symptoms – N&V, pain, bleeding, neurology

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5
Q

give the specific questions for CVS examination

A

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

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6
Q

what is PND

A

peripheral nocturnal dyspnoea
waking up in middle of night breathless

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7
Q

what is orthopnoea

A

shortness of breath when laying down

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8
Q

what is claudication

A

pain in muscle when exercising, often the calves

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9
Q

what is Haemoptysis

A

blood in sputum

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10
Q

what is the specific respiratory history

A

Cough
Sputum – colour
Haemoptysis - blood in sputum
Wheeze
SOB/SOBOE - shortness of breath on exertion

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11
Q

give the specific GI history

A

Abdominal pain = Socrates
Masses
Nausea/vomiting
Haematemesis = vomiting blood
Diarrhoea/constipation
Maleana = blood in stool
Change in bowel habit
Weight/Appetite loss

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12
Q

what is haematemesis

A

blood in vomit

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13
Q

what is Maleana

A

blood in stool

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14
Q

what is genitourinary system

A

reproductive system and urine system

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15
Q

give the questions for a Genitourinary history

A

Dysuria - pain on urinating
Haematuria - blood in urine
Polyuria - urinating large amounts
Incontinence
Frequency
Urgency
Menopause/Menorhagia (heavy menstrual bleeding)
Discharge

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16
Q

what is dysuria

A

pain on urinating

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17
Q

what is haematuria

A

blood in urine

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18
Q

how do we take a MSK musculoskeletal examination (4)

A

Gait - watch how they walk
Joint/neck pain – multi, specific
Arthritis (OA, RA)
Joint swelling

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19
Q

how do we take a neurological history (4)

A

Seizures or epilepsy
Vasovagal episodes (faints)
Headaches
Neurosensory/neuromotor changes

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20
Q

what do we do for a bedside examination

A

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

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21
Q

how do we do a cardiorespiratory examination

A

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.

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22
Q

how would we do an abdominal examination? (4)

A

Inspection – Scars, distension, spider naevi, caput medusae, hernias
Palpation – 9 areas to palpate superficial and deeper, hepatomegaly, splenomegaly, hernias
Percussion – Tenderness
Ascultation – Bowel sounds

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23
Q

what is hepatomegaly and splenomegaly

A

large liver and large spleen

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24
Q

describe the abdominal pain felt by a patient with early and late appendicitis

A

early = central quadrant pain
late = lower right ‘iliac’ quadrant

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25
if a patient had gall stones or cholangitis, which quadrant would the patient feel pain
upper right
26
if a patient had pain in the upper left quadrant, what might be the cause (3)
spleen abscess splenomegaly spleen rupture
27
if a patient has pain in the upper central quadrant of the abdomen, what might this be
Esophagitis Peptic ulcer Pancreatis
28
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…….
29
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)
30
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
31
what three things should the anaesthetist check before surgery
Airway Assess co-morbidities Specific heart/lung investigation
32
what is the ASA
American society of anaesthesiologists
33
what is ASA grade I
healthy patient
34
what is ASA II
patient with Mild systemic disease with no functional limitation e.g. controlled hypertension
35
what is ASA III
Severe systemic disease with definite functional limitation e.g. COPD
36
what is ASA IV
Severe systemic disease that is a constant threat to life e.g. unstable angina
37
what is ASA V
Moribund patient who is not expected to survive for 24 hours with or without surgery e.g. ruptured aortic aneurysm
38
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
39
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)
40
what should be included in epidemiological history
Travel, vaccine and prophylaxis history, occupation, food/drink,recreational,sexual, animal contacts, special medical procedures, contacts.
41
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
42
what is the most common problem experienced with Travel, with the causative agents
Diarrhea E.coli, Salmonella, Campylobacter
43
what respiratory tract infection is common with travel
leigonella
44
what is a common travel disease related to poor hygeine
hep A oro-faecal route
45
where has high amobea outbreaks
south(east) asia
46
what are some diseases common in africa and south asia
malaria typhoid amobea Schistosomiasis
47
what is Schistosomiasis
parasitic infection found in asia and africa
48
if a patient is travelling what should we advise
vaccine schedule insect sprays and careful when eating foods bednets for mosquitos
49
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
50
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?
51
what is leptospirosis and who is at risk of this
weils disease people who swim in infected water canoe, kayak, wild swimmers
52
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
53
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
54
what infectuous disease comes with marijuana an alcohol
Alcohol TB, pneumonia, HIV Cannabis Pneumonia, early COPD, lung abscess
55
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)
56
what is a risk of cat infectious disease
toxoplasma
57
what is the infectious risk of tropical fish
Mycobacterium marinum
58
what infectious risk comes from reptiles
salmonella
59
what is the infectious risk of having a splenectomy
Pneumococcal bacteraemia
60
a pt has been having diarrhoea and has recently been on a cruise, what is the cause of this problem
likely to be norovirus
61
what respective vials do we use for transport of viral and bacterial swabs
viral = green bottle bacteria = black charcoal
62
why is a IgM test not overly helpful for diagnosis
not very specific may give cross reaction giving false positives
63
why is IgG count helpul
specific to antigens show past infection
64
what gives us the total anti-infection antibody count
IgG + IgM

3rd BDS IHD (14 decks)

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