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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
Q

if a patient had gall stones or cholangitis, which quadrant would the patient feel pain

A

upper right

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26
Q

if a patient had pain in the upper left quadrant, what might be the cause (3)

A

spleen abscess
splenomegaly
spleen rupture

27
Q

if a patient has pain in the upper central quadrant of the abdomen, what might this be

A

Esophagitis
Peptic ulcer
Pancreatis

28
Q

how dow e summarise a history (4)

A

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
Q

what must be provided after surgery for the patient

A

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
Q

what are some important aspect of pre-op care

A

Safe surgery
-Informed consent
-Anticipate complications
-Blood loss prevention/replacement
-Infection issues
Safe anaesthetic
-Airway
-Assess co-morbidities
-Specific heart/lung investigation

31
Q

what three things should the anaesthetist check before surgery

A

Airway
Assess co-morbidities
Specific heart/lung investigation

32
Q

what is the ASA

A

American society of anaesthesiologists

33
Q

what is ASA grade I

A

healthy patient

34
Q

what is ASA II

A

patient with Mild systemic disease with no functional limitation e.g. controlled hypertension

35
Q

what is ASA III

A

Severe systemic disease with definite functional limitation e.g. COPD

36
Q

what is ASA IV

A

Severe systemic disease that is a constant threat to life e.g. unstable angina

37
Q

what is ASA V

A

Moribund patient who is not expected to survive for 24 hours with or without surgery e.g. ruptured aortic aneurysm

38
Q

what are some general aspects of post op care

A

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
Q

what organ systems should be checked and controlled post op

A

CVS (arrythmia, hypotension, hypertension)
RS (hypoxia, difficulty breathing, sputum retention
GI (nutrition, voiding, diarrhoea)
GU (retention urine,diuresis)
MS (mobility, pressure areas)

40
Q

what should be included in epidemiological history

A

Travel, vaccine and prophylaxis history, occupation, food/drink,recreational,sexual, animal contacts, special medical procedures, contacts.

41
Q

what should be invovled in travel history

A

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
Q

what is the most common problem experienced with Travel, with the causative agents

A

Diarrhea
E.coli, Salmonella, Campylobacter

43
Q

what respiratory tract infection is common with travel

A

leigonella

44
Q

what is a common travel disease related to poor hygeine

A

hep A oro-faecal route

45
Q

where has high amobea outbreaks

A

south(east) asia

46
Q

what are some diseases common in africa and south asia

A

malaria
typhoid
amobea
Schistosomiasis

47
Q

what is Schistosomiasis

A

parasitic infection
found in asia and africa

48
Q

if a patient is travelling what should we advise

A

vaccine schedule
insect sprays and careful when eating foods
bednets for mosquitos

49
Q

what occupations are red flags for disease

A

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
Q

what should be included in sexual history

A

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
Q

what is leptospirosis and who is at risk of this

A

weils disease
people who swim in infected water
canoe, kayak, wild swimmers

52
Q

what sports come with infectious disease risk

A

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
Q

what risks come with IV drug use

A

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
Q

what infectuous disease comes with marijuana an alcohol

A

Alcohol
TB, pneumonia, HIV
Cannabis
Pneumonia, early COPD, lung abscess

55
Q

what infectious risk comes with pets

A

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
Q

what is a risk of cat infectious disease

A

toxoplasma

57
Q

what is the infectious risk of tropical fish

A

Mycobacterium marinum

58
Q

what infectious risk comes from reptiles

A

salmonella

59
Q

what is the infectious risk of having a splenectomy

A

Pneumococcal bacteraemia

60
Q

a pt has been having diarrhoea and has recently been on a cruise, what is the cause of this problem

A

likely to be norovirus

61
Q

what respective vials do we use for transport of viral and bacterial swabs

A

viral = green bottle
bacteria = black charcoal

62
Q

why is a IgM test not overly helpful for diagnosis

A

not very specific
may give cross reaction giving false positives

63
Q

why is IgG count helpul

A

specific to antigens
show past infection

64
Q

what gives us the total anti-infection antibody count

A

IgG + IgM

3rd BDS IHD (14 decks)

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