Images and Instruments Flashcards
1
Q
Explain the different needle ends for spinal needles in the picture
A
- left = traumatic needle for cutting
- Higher risk of post-LP headache, severe headaches which may need blood patching for Sx, additional hospital visits for pain
- right = pencil-point, atraumatic, blunt needle for blunt dissection
- Now the needle of choice for LP bc of reduced post-LP headache and backache
2
Q
What is this? What can it be used to give? Indications?
A
- Venturi mask (see coloured bit)
- 2 numbers: % FiO2 this mask delivers, and the flow rate of 100% O2 required to achieve that FiO2
- Different colours -> different FiO2 (24%, 28%, 31%, 35%, 40%, 60%)
- Used for COPD when want to use a precise FiO2
3
Q
What is this? What can you give through it? Complications?
A
- Nasal cannula
- 0.5-4L O2/minute (28-44%)
- Complications: nasal sores, epistaxis (so apply water-based creams)
4
Q
How do you manage renal calculi?
A
- Mx/Ix
- NSAID e.g. IM diclofenac
- Possibly alpha-blocker
- Non-contrast CT KUB w/in 14hrs (immediate if fever, solitary kidney or uncertain Dx e.g. AAA)
- Obstruction and infection -> emergency decompression w/ nephrostomy tube, ureteric catheter or ureteric stent
- <5mm -> conservative Mx
- 5mm-2cm OR <5mm AND either obstruction, renal developmental abnormality or previous renal transplant -> ureteroscopy if pregnant, otherwise shockwave lithotripsy
- Complex renal calculi and staghorn calculi -> percutaneous nephrolithotomy
- Secondary prevention
- Ca stone -> high fluid intake, low animal protein, low salt diet, thiazides
- Oxalate stone -> cholestyramine, pyridoxine
- Uric acid stone -> allopurinol, urinary alkalinisation e.g. oral bicarbonate
5
Q
How do you stabilise the cervical spine? How do you measure the collar?
A
- Stiff neck collar stabilises cervical spine in trauma, along w/ 2 sandbags and tape (triple immobilisation)
- Size: measure no. of fingers from clavicle to angle of mandible compared to measuring peg on the collar
6
Q
What’s this? What are the X-ray findings? Causes? Acute Mx? Ongoing Mx?
A
- Pulmonary oedema
- Causes: MI, arrhythmia, fluid overload (renal, iatrogenic), ARDS (sepsis, post-op, trauma), upper airway obstruction, neurogenic (head injury)
- CXR: Alveolar oedema (bat wing appearance), Kerley B lines, cardiomegaly, upper lobe diversion, pleural effusion
- Acute Mx: sit up, 15L O2, FBC, U&Es, trop, BNP, ABG, 2.5-5mg IV diamorphine + 10mg IV metoclopramide, 40-80mg IV furosemide, 2 puff GTN, Hx, Ex, CXR, ECG, echo,
- Ongoing Mx: daily weights, VTE prophylaxis, repeat CXR, change to oral furosemide, ACEi and BB if HF, consider spironolactone
7
Q
What is this? Indications?
A
- Chest drain
- Indications: pneumothorax (don’t need to change bottle), tension pneumothorax after needle decompression, malignant pleural effusion (need to keep changing bottle), empyema, traumatic haemothorax
- Seldinger technique is how you put in a chest drain – thread a hollow bit of tubing over a sharp object
8
Q
What’s this? Types? RFs? Presentation? Mx?
A
- Pneumothorax
- Closed (air leaks from lung into pleural cavity), or open (defect in chest wall communicated w/ exterior air)
- Pneumothorax RFs: pre-existing lung disease (COPD, asthma, CF, lung Ca), CTD (Marfan’s, RA), ventilation, smoking, trauma, iatrogenic, spontaneous
- Presentation: dyspnoea, pleuritic chest pain, sweating, tachypnoea, tachycardia
- Mx
- Primary
- <2cm and no SOB -> discharge with OP CXR, stop smoking
- >2cm -> aspirate -> chest drain if still >2cm
- Secondary
- >2cm or >50yo or SOB -> chest drain and admit for 24hrs
- 1-2cm -> aspirate -> chest drain and admit if still >1cm
- <1cm -> O2 and admit for 24hrs
- Iatrogenic
- Aspirate / observe, or chest drain if ventilated / COPD
- Primary
9
Q
What’s this? Causes? Presentation? What Ix would you do and what are the findings? Mx?
A
- Subarachnoid haemorrhage
- Traumatic or spontaneous
- Spontaneous causes: aneurysm (85%) (berry aneurysm ass.w. PKD, Ehlers-Danlos, coarctation of aorta), AV malformation, pituitary apoplexy, arterial dissection
- Presentation: thunderclap occipital headache, N+V, meningism (photophobia, neck stiffness), coma, seizures, sudden death
- Ix
- CT head: acute blood (hyperdense/bright) in basal cisterns, sulci, 7% are normal
- LP: if CT -ve, done 12hrs after Sx onset for xanthochromia (RBC breakdown)
- CTA to look for aneurysm or AV malformation
- Mx: refer to neurosurgery ASAP, neuroradiologists can ~ coil aneurysms, if not neurosurgeons can clip via craniotomy, bed rest, BP control, avoid straining, nimodipine for 21d to prevent vasospasms, external ventricular drain for hydrocephalus
10
Q
What’s this?
A
Laparoscopic port
11
Q
What is this? Indications? How do you insert it? How do you size it?
A
- Oropharyngeal (OP) airway or Guedel airway
- Indications: airway compromise but GCS>8
- E.g. snoring, drowsy + weird airway noises
- Less well tolerated than NP airway if higher GCS (don’t use if gagging when putting in)
- Insertion: insert upside down (insert correct way up in children), then rotate as you advance
- Size: angle of mouth to angle of jaw, go for slightly bigger if in between
12
Q
What bloods for yellow, grey, red botles?
A
- Yellow/gold: contains silica and serum separating gel – immunology, microbiology, biochemistry, U+Es, LFTs, endocrinology, toxicology, oncology
- Grey: contains Na fluoride and K oxalate – glucose, lactate
- Red: contains silica particles – toxicology, drug levels, antibodies, hormones, bacterial and viral serology
13
Q
What’s this? What size is it? Indications? How do you put it in? How do you check it’s in the right place? Contraindications?
A
- Wide bore (Ryle’s) NG tube
- 16/+ French = wide
- Indications: when you want to suck things out i.e. decompression e.g. bowel obstruction, oesophageal/gastric perforation (want to suck out acid before surgical repair to avoid leaking into abdomen or mediastinum), aspirating toxins (overdose), can be used to insert drugs/contrast
- How to put in: through nose, lower down whilst taking sips of water
- Confirm position: acidic pH according to local guidelines (maybe <3?), most hospitals now require X-ray, mostly only registrars can sign off on the X-ray
- X-ray: tube descends down midline, bisects carina, crosses diaphragm in midline, tip sits below diaphragm
- May re-image if worried about migration
- Once inserted, tape tube down, put a mark on the tube at the entrance of the nose, consider re-imaging if this mark has moved
- When decompressing the stomach, if you can no longer aspirate, it might have migrated up
- CI: nasal injuries, base of skull fractures, UGI stricture
14
Q
What’s this? How does it happen? RFs? X-ray findings? Mx?
A
- Sigmoid volvulus
- Torsion of the colon around it’s mesenteric axis -> compromised blood flow and closed loop obstruction
- Sigmoid
- 80% of volvulus
- Ass.w. older pts, chronic constipation, Chagas disease, neuro conditions (Parkinson’s, Duchenne muscular dystrophy), psych conditions (schizophrenia)
- X-ray: coffee bean sign, LBO (haustra) often w/ air-fluid levels
- Mx: rigid sigmoidoscopy w/ rectal tube insertion
15
Q
What is this? How does it work? Advantages and disadvantages? Indications? How do you check it’s in the right place?
A
- iGel
- Similar to LMA but has a thermoplastic elastomer that moulds to the peri-laryngeal framework w/ pt temperature
- Advantages: moulds to and seals off oropharyngeal opening hence prevents aspiration, has gastric channel for passage of NG tube, can be used as a conduit for intubation, easy to put in, don’t need to visualise vocal cords, reduced trauma to oropharynx (compared to intubation), put in if reasonably well and don’t need an airway for long, lower risk of bronchospasm bc doesn’t enter trachea
- Disadvantages: not if elderly/risk of vomiting/need for long time, inflation can cause pressure lesions and nerve palsies
- Indications: step before intubation, elective procedures, cardiac arrest, pre-hospital airway Mx
- Check position: attach end-tidal CO2 monitor (high CO2 means it’s in the lungs), listen for breath sounds at lung bases bilaterally, moisture in the tube, look for symmetrical chest expansion, no gurgling over epigastrium
16
Q
What is this? How can you tell?
A
- Needle holder
- Crosshatched design to increase grip on needle
- Longitudinal ridge also helps w/ mounting the needle & allows safety of the needle
17
Q
What is this? What’s it used for?
A
- Self-retaining retractor
- Used to hold wounds open e.g. during hernia repair / appendicectomy
18
Q
What’s this? Causes?
A
- TB, abscess (Staph, Klebsiella, Pseudomonas), squamous cell cancer, PE, RA, Wegener’s granulomatosis, aspergillosis, histoplasmosis
19
Q
What is this? How is it inserted? How can you differentiate it from other lines? Indications? Where does it end? How is it used? Complications?
A
- Hickmann line
- Inserted centrally, a portion is buried under the skin and Dacron (antimicrobial and high friction) surrounds part of the tube to “theoretically” stop infection tracking proximally from the skin surface to the tip (retrograde), and to form bonds w/ the surrounding tissue so it doesn’t move out of place
- Insertion: ~ by anaesthetist/specialist nurse, Seldinger kit contains cannula, guide wire, dilator, scalpel and introducer needle
- Similar to a Tessio line (which doesn’t have the Dacron cuff and is buried deeper in the skin)
- Shorter than a PICC, but has a Dacron cuff (vs no cuff on central venous catheter)
- Indications: take blood (emergency venous access), repeatedly put medications in (~over 3+ days), ~ chemo or long term Abx (weeks-months needing medications), used for medications that need to be centrally administered (harmful orally/peripherally, irritant, vasopressors, inotropes), central venous pressure monitoring, parenteral nutrition
- Specific indications: often in immunosuppressed pt needing e.g. chemo over several weeks as more discrete
- End centrally, ~ at entrance of SVC
- How is it used: clean port, suck things out or put things in
- Don’t need to anticoagulate, but when injecting medication, push it through in bursts to create turbulence at the tip to move any clots in the tip into the bloodstream where they’ll be destroyed, v. occasionally might give a little bit of heparin into the line followed by saline to dissolve the clot
- Complications: infection, thrombosis, venous irritation, migration, misplacement
20
Q
What is this? How does it work? Indications? Advantages?
A
- Tracheostomy kit
- Definitive airway (protects from aspiration)
- Indications: often used in ICU for ventilation, also upper airway obstruction or after laryngeal surgery
- Advantages: more efficient ventilation bc of decreased dead space; allows more effective airway suctioning
21
Q
What is this? What’s it used for? How’s it used?
A
- Rigid sigmoidoscope
- Can visualise distal half of sigmoid, often used in colorectal OP clinics (bedside tool)
- Sigmoid is about 25cm
- Need to inflate rectum/sigmoid w/ air to be able to see (insufflation)
- Has a light to be able to see
- Pt if L lateral position, DRE before, then insert towards umbilicus w/ lubricant
- Used to treat sigmoid volvulus or intussusception
- ?Can take biopsies e.g. for UC
22
Q
What is this? How do you differentiate the types? Indications for each type?
A
Stoma bag
Colostomy
- Large bowel ~ LIF, solid contents, flush to skin (no spout)
- Indications:
- Permanent end colostomy e.g. abdominoperineal resection of large rectal cancers
- Temporary end colostomy to rest the bowel e.g. diverticulitis, obstruction, two-stage Hartmann’s
- Loop colostomy to protect distal anastomoses after recent surgery
Ileostomy
- Small bowel ~ RIF, liquid contents, spouted (contents are alkaline and hence irritating to skin)
- Indications:
- Permanent end-ileostomy e.g. panproctocolectomy for UC or FAP
- Temporary end-ileostomy during emergency bowel resection when unsafe to form an anastomosis at that time e.g. intra-abdominal sepsis or bleeding
- Temporary loop ileostomy to protect distal anastomoses
Urostomy
- RIF, contain urine
- Indications: after a cystectomy (bladder removal)
- Created by taking an ileal conduit (piece of ileum) and connecting it between the skin and the ureter
23
Q
What is this? How does it work? What can you give through it? Advantages?
A
- Optiflow (nasal high flow)
- Sealed against nostrils (fatter nostril connectors) -> can deliver true 100% O2 (no atmospheric mixing)
- Up to 60L/min
- Advantages: humidified and warmed so not as irritating as nasal cannulae; such a high velocity so -> small amount of +ve pressure, so can help avoid ventilation in some pts (not technically CPAP bc not significant +ve pressures); positive pressure also helps recruit more alveolar space; can still E+D and talk (vs non-rebreathe mask)
24
Q
What is this? (NB is 1L)
A
- Urinary leg catheter bag
- 1L or less capacity (smaller so not too heavy when walking around, which will tug on the bladder)
25
Q
What bloods for dark green, light green, rust bottles?
A
- Dark green: contains Na heparin – ammonia, renin, aldosterone, insulin
- Light green: contains Li heparin and plasma separator – routine biochemistry
- Rust - viral immunology
26
Q
What is this? Commonest causes? How do you assess severity? Mx?
A
- Pneumonia
- ~ Strep pneumo, Haemophilus influenzae in COPD, Staph aureus following influenza
- Atypicals: Mycoplasma pneumoniae, Legionella pnuemophilia, Klebsiella pneumoniae (alcoholics), PCP (HIV)
- CURB65: confusion (AMST<=8), urea >7, RR>30, BP <=90/60, age >=65
- 0 -> community Mx
- 1 -> assess SaO2 -> >92% community Mx and CXR -> bilateral/multilobular shadowing -> hospital admission
- 2/+ -> hospital Mx
- CXR -> consolidation
- Low-severity CAP -> 5d amoxicillin (or macrolide/tetracycline)
- Moderate/high-severity CAP -> 7-10d amoxicillin + macrolide
27
Q
What is this? What size is it? Indications? How do you put it in? How do you confirm it’s in the right place? Contraindications?
A
- Narrow-bore feeding NG tube
- 8-10 French = small
- Indications: when you want to put things in, feeding support (enteral nutrition) based on MDT assessment by dieticians, SALT and medical team
- How to put in: through nose, lower down whilst taking sips of water
- How to put in: through nose, lower down whilst taking sips of water
- Confirm position: acidic pH according to local guidelines (maybe <3?), most hospitals now require X-ray, mostly only registrars can sign off on the X-ray
- X-ray: tube descends down midline, bisects carina, crosses diaphragm in midline, tip sits below diaphragm
- May re-image if worried about migration
- Once inserted, tape tube down, put a mark on the tube at the entrance of the nose, consider re-imaging if this mark has moved
- When decompressing the stomach, if you can no longer aspirate, it might have migrated up
- CI: nasal injuries, base of skull fractures, UGI stricture, gastric outlet obstruction (put in NJ, PEG or PEJ instead endoscopically)
28
Q
What’s this? What are the different presentations associated with it and how do you manage them?
A
- Gallstones
- Biliary colic = stone lodged in cystic duct
- Acute cholecystitis = inflammation of the gallbladder ~ from gallstones -> RUQ, fever, Murphy’s sign (inspiratory arrest), deranges LFTs only in Mirizzi
- Acute cholangitis = bacterial infection of biliary tree, ~ due to E. coli and gallstones -> Charcot’s triad of RUQ, fever and jaundice; Reynold’s pentad is additionally hypotension and confusion
- Ix: LFTs, USS, MRCP, intraoperative cholangiography
- Mx: only if stones in CBD; biliary colic and acute cholecystitis get lap chole; broad-spec Abx, fluids and ERCP for cholangitis; cholecystotomy if frail
29
Q
What is this? How long does it last? What’s it ~ made of? What size is commonly used?
A
- Two-way (foley) catheter
- Short-term lasts 28 days
- ~ made of PVC or Teflon, sometimes latex
- ~ 14Ch (14 French)
30
Q
What’s this? What are the different types and when do they tend to occur? RFs?
A
- Renal stones
- Types
- Ca oxalate most common, radio-opaque
- Ca phosphate in renal tubular acidosis, high urinary pH, radio-opaque
- Struvite in chronic infections, slightly radio-opaque
- Cystine from inherited disorder or absorption, radiodense
- (Uric acid from low urinary pH, tissue breakdown e.g. Ca, children w/ inborn errors of metabolism, radiolucent)
- RFs: dehydration, hypercalciuria, hyperparathyroidism, hypercalcaemia, cystinuria, high dietary oxalate, renal tubular acidosis, PKD, loop diuretics, steroids, theyophylline, (gout and ileostomy increase urate stone risk)
31
Q
What’s this and what does it show? What causes it? Presentation? Mx?
A
- Extradural haemorrhage
- Collection of blood between skull and dura
- Causes: trauma (~ low-impact e.g. blow to head, fall, acceleration-deceleration)
- Presentation: LOC -> lucid interval -> rapid deterioration as it expands -> herniation, fixed dilated pupils (compression of C3)
- Ix: CT often shows collection in temporal region (where thin skull of the petrion overlies the middle meningeal artery), biconvex (lentiform), hyperdense, limited by suture lines
- Mx: craniotomy, surgical evacuation
32
Q
What is this? What’s it used for? How does it work?
A
- Nebuliser
- Used to deliver medications (bronchodilators) for e.g. asthma, COPD, sometimes hyperkalaemia
- Nebulisers are droplets of medication (powder/liquid) -> made into aerosols w/ O2 -> can breathe in the medication
- Start on about 2L if don’t need O2 (just to make the medication into an aerosol)
- If they were already on O2, just continue the O2 at the same L as before
- Nebs only last about 5 mins so dw about CO2 retention thingy for COPD pts
33
Q
What is this? How long does it last? Indications? Complications?
A
- Three-way catheter
- Short-term 28 days, or long-term 3 months (look on the packet where it says long-term)
- Indications: ongoing haematuria (clots block it) or significant debris/sediment in the bladder (chronic catheterisation -> debris)
- Allows irrigation of the bladder: push warm saline through one lumen, debris/blood comes out the other lumen
- Complications of long term catheters: UTI, strictures, urethral erosion
35
Q
What is this? How’s it inserted? Indications? How can you differentiate it from other lines? Where does it end? How is it used? Complications?
A
- PICC line (peripherally inserted central catheter)
- Inserted peripherally ~ in vein in arm, threaded until tip ends really proximally in SVC, ~ put in by PICC specialist nurses on the ward and then X-ray to confirm location
- Insertion: ~ by anaesthetist/specialist nurse, Seldinger kit contains cannula, guide wire, dilator, scalpel and introducer needle
- Indications: take blood (emergency venous access), repeatedly put medications in (~over 3+ days), ~ chemo or long term Abx (weeks-months needing medications), used for medications that need to be centrally administered (harmful orally/peripherally, irritant, vasopressors, inotropes), central venous pressure monitoring, parenteral nutrition
- Specific indications: when need about 8w of Tx, departmental preference
- ~ 2 lumen, can be 1 lumen
- End centrally, ~ at entrance of SVC
- How is it used: clean port, suck things out or put things in
- Don’t need to anticoagulate, but when injecting medication, push it through in bursts to create turbulence at the tip to move any clots in the tip into the bloodstream where they’ll be destroyed, v. occasionally might give a little bit of heparin into the line followed by saline to dissolve the clot
- Complications: infection, thrombosis, venous irritation, migration, misplacement
36
Q
What is this? Indications?
A
- ABG needle (technically heparinised ABG syringe and needle)
- Indications: ABG, VBG (lactate, electrolytes (Na, K, Ca, Cl), end stage renal failure, quicker than sending to lab, Hb in trauma), can use on pleural aspiration to see if acidic (pH <7.3 suggests empyema and hence drain indication)
37
Q
What’s this?
A
Epidural needle on the right
Spinal needle on the left
39
Q
What is this? Where does it end? Indications? How’s it inserted? How’s it used? Complications? How do you differentiate it from other lines?
A
- Central venous catheter
- End centrally, ~ at entrance of SVC
- Indications: take blood (emergency venous access), repeatedly put medications in (~over 3+ days), ~ chemo or long term Abx (weeks-months needing medications), used for medications that need to be centrally administered (harmful orally/peripherally, irritant, vasopressors, inotropes), central venous pressure monitoring, parenteral nutrition
- Specific indications: when need about 8w of Tx, departmental preference
- Insertion: ~ by anaesthetist/specialist nurse, Seldinger kit contains cannula, guide wire, dilator, scalpel and introducer needle
- Inserted centrally, ~ in subclavian or internal jugular artery under visualisation by surgeon or specialist access nurse
- How is it used: clean port, suck things out or put things in
- Don’t need to anticoagulate, but when injecting medication, push it through in bursts to create turbulence at the tip to move any clots in the tip into the bloodstream where they’ll be destroyed, v. occasionally might give a little bit of heparin into the line followed by saline to dissolve the clot
- Complications: pneumothorax on insertion (for central venous catheter), then infection, thrombosis, venous irritation, migration, misplacement
- Shorter length than PICC line, no Dacron cuff like Hickmann line
- ~ 2 or 3 lumen
40
Q
What is this? How does it work? What are the indications? How do you insert it? How do you check it’s in the right place? What are the complications?
A
- (Cuffed/uncuffed) – cuffing tamponades against the trachea to stop it moving, and to help stop aspiration
- Mouth -> pass vocal cords -> trachea
- Definitive airway: vomiting won’t -> aspiration
- Indications: ventilation when risk of airway collapse for any reason e.g. GA (elderly, obese), complicated upper airway surgeries, neuromuscular diseases), GCS<8 (trauma)
- Insertion: ~ by anaesthetist, using laryngoscope +/ bougie, balloon inflated, oxygen attached, position checked, secured w/ tape
- Check position: attach end-tidal CO2 monitor (high CO2 means it’s in the lungs), listen for breath sounds at lung bases bilaterally, moisture in the tube, look for symmetrical chest expansion, no gurgling over epigastrium, directly visualise as it passes the vocal cords (fibreoptic camera)
- Complications: inappropriate placing (oesophageal), injury to larynx, pneumothorax, atelectasis, infection
41
Q
What is this? What are the indications? What are the complications?
A
- Indications: to aid intubation, to visualise the larynx for Dx of vocal problems/strictures
- Complications: soft tissue injury, laryngeal/pharyngeal scarring, ulceration, abscess formation
43
Q
What is this? How does it work? Advantages and disadvantages? Indications? How do you insert it? How do you check it’s in the right place?
A
- Laryngeal mask airway (LMA)
- Supraglottic device
- When you swallow, the epiglottis flops back to stop food going into the airway
- This isn’t a definitive airway bc it sits above the glottis, hence there’s a risk of aspiration
- Advantages: easy to put in, don’t need to visualise vocal cords, reduced trauma to oropharynx (compared to intubation), put in if reasonably well and don’t need an airway for long, lower risk of bronchospasm bc doesn’t enter trachea
- Disadvantages: not if elderly/risk of vomiting/need for long time, inflation can cause pressure lesions and nerve palsies
- Indications: step before intubation, elective procedures, cardiac arrest, pre-hospital airway Mx
- Insertion: insert w/ number facing towards you when behind pt
- Check position: attach end-tidal CO2 monitor (high CO2 means it’s in the lungs), listen for breath sounds at lung bases bilaterally, moisture in the tube, look for symmetrical chest expansion, no gurgling over epigastrium
44
Q
What is this? What can you give through it? How does it work?
A
- Non-rebreathe mask
- 10-15L/min (up to 90%) from the wall, when the pt breathes in they take in air from the reservoir bag
45
Q
What is this? How does it work? How do you set it up? How do you check it’s working?
A
- Chest drain bottle
- Sterile water up to the “prime level” line
- One tube terminates lower down inside, and one higher up
- The bit that’s lower finishes under the water, and you connect that part to the chest drain to form a one-way wate-based valve
- The higher one doesn’t connect to anything; it allows air bubbles to escape through atmospheric re-equilibration
- Check it’s working through “swinging and bubbling” – pt breathes in -> water level inside the tube moves up and down
- Pneumothorax will also have bubbling
46
Q
What’s this? Causes? Mx?
A
- SBO
- 3cm, 6cm, 9cm (caecum)
- Valvulae conniventes all the way across in SBO, haustra only across 1/3 in LBO
- Causes of SBO: adhesions, hernia, foreign body, gallstones, masses, tumours, volvulus
- Causes of LBO: colon cancer (~ sigmoid), diverticular disease, volvulus
- Mx: NG decompression, IV fluids
47
Q
What’s this? What are the different causes of this sort of X-ray finding and how do you differentiate the causes?
A
- Lung whiteout from ?lung collapse
- Trachea central: consolidation, pulmonary oedema, mesothelioma
- Trachea pulled towards white out: pneumonectomy, complete lung collapse (cancer, asthma, foreign body), pulmonary hypoplasia
- Trachea pushed away from white out: pleural effusion, diaphragmatic hernia, large thoracic mass
48
Q
What is this? What’s it used for?
A
- Flexible sigmoidoscope
- Can visualise entire sigmoid, used for more thorough investigation to look for diverticular disease
- Can only biopsy w/ colonoscopy
- Has a light to be able to see
- Don’t need as much bowel prep as colonoscopy, possibly give them an enema on the day of the procedure to clear out the bottom of the bowel (sigmoid)
49
Q
What’s this? How does it happen? RFs? X-ray signs? Mx?
A
- Caecal volvulus
- Torsion of the colon around it’s mesenteric axis -> compromised blood flow and closed loop obstruction
- Caecal
- 20% of volvulus
- X-ray: fetal sign, SBO (valvulae conniventes)
- Ass.w. adhesions, pregnancy
- Mx: ~ operation, may need right hemicolectomy
50
Q
What’s this? Causes?
A
- Mets: breast, colorectal, renal, bladder, prostate
51
Q
What’s this? Causes? Mx?
A
- LBO
- 3cm, 6cm, 9cm (caecum)
- Valvulae conniventes all the way across in SBO, haustra only across 1/3 in LBO
- Causes of SBO: adhesions, hernia, foreign body, gallstones, masses, tumours, volvulus
- Causes of LBO: colon cancer (~ sigmoid), diverticular disease, volvulus
- Mx: NG decompression, IV fluids
52
Q
What is this? What’s it used for?
A
- Proctoscope
- Can visualise rectum, bit of anal canal
- Rectum is about 15-20cm
- Can use to inject/band haemorrhoids
- L lateral position, DRE first, then attach to light source, insert w/ lubrication
53
Q
What is this? What’s it used for?
A
- Clamp (haemostat)
- Only horizontal lines in one direction (not crosshatched)
- Used for compression of vessels to prevent bleeding
- Apply 2 haemostats, cut in between / hand tie / suture -> remove haemostats
- Can be curved or straight
54
Q
What is this? What can you give through it? Indications?
A
- Bag-valve mask
- Indications: CPR, pre-oxygenation before GA, during GA, trauma ventilation
- Up to 100% O2 w/ flows above 10L/min
55
Q
What is this? What can you give through it?
A
- Simple face mask
- 6-10L/min O2, but still being diluted by atmospheric air, so FiO2 not 100%
56
Q
What’s this? Tell me about the different types. What other Ix would you do?
A
- Lung Ca
- Types
- Small cell: 15%, worse prognosis, central, ADH, ACTH, Lambert-Eaton
- Non-small cell
- Adenocarcinoma: most common in non-smokers, peripheral
- Squamous: central, PTHrP -> high Ca, clubbing
- Large cell: peripheral, poor prognosis, b-HCG
- Ix: CXR, CT, bronchoscopy for biopsy, PET scan
57
Q
What’s this? What causes it? How do you classify it? Mx?
A
- Ischaemic stroke
- Sudden interruption in vascular supply to brain
- Ischaemic (thrombotic, embolic)
- Oxford Stroke / Bamford Classification
- Mx of ischaemic stroke: CT, 300mg aspirin, <4.5hrs -> thrombolysis w/ alteplase (if not CI), otherwise thrombectomy up to 24hrs, carotid endarterectomy if >70% stenosis
- Secondary prevention: clopidogrel
58
Q
What’s this and what’s it for?
A
- Nasal speculum (Thudicum)
- To open and expand nasal cavity
60
Q
What is this? Indications? How long can you use it for?
A
- Cannula
- Indications: blood taking, IV access, tension pneumothorax (safe triangle, mid-axillary line, above 5th ICS, between posterior border of pec major and anterior border of lat dorsi
- Need to change every 3-4days
- Wide bore (green/grey 16G) if bleeding
61
Q
What’s this and what does it show? Types? Causes? Presentation? Mx?
A
- Subdural haemorrhage
- Collection of blood w/in the subdural space
- Acute, subacute, chronic (weeks-months)
- Causes: high-impact trauma, rupture of small bridging veins in subdural space in elderly, alcoholics, or shaken baby syndrome
- Presentation: variable acutely, chronically confusion, reduced consciousness, neuro deficit
- Ix: CT shows crescentic, collection, not limited by suture lines (bright/hyperdense acutely, hypodense/dark chronically), can have mass effect causing midline shift/herniation
- Mx: small can be Mx conservatively, otherwise can surgically monitor ICP, do decompressive craniectomy or burr holes
62
Q
What’s this? Different types and causes? Presentation?
A
- Pleural effusion
- Transudate <30g/L protein: HF, hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption), hypothyroidism, Megi’s syndrome
- Exudate >30g/L protein: infection (pneumonia, TB, subphrenic abscess), CTD (RA, SLE), neoplasia (lung Ca, mesothelioma, mets), pancreatitis, PE, Dressler’s syndrome
- Lights criteria for borderline cases
- Presentation: dypnoea, non-productive cough, chest pain, dull to percuss, reduced breath sounds, reduced chest expansion
63
Q
What’s this? What are the types? How do you classify it?
A
- Haemorrhagic stroke
- Sudden interruption in vascular supply to brain
- Haemorrhagic (intracerebral, subarachnoid)
- Oxford Stroke / Bamford Classification
64
Q
What is this and what’s it used for?
A
- Trucut (biopsy) needle
- Used to take histological specimens from lesions e.g. breast lumps / liver
- Can be under LA
65
Q
What is this? (NB goes up to 2L)
A
- Night catheter bag
- 2L capacity (larger so don’t have to get out of bed)
66
Q
What is this? What’s it used for?
A
- Devers retractor
- Used in surgery (e.g. open abdo surgery) to hold tissue apart
67
Q
What is this? Indications? Contraindications? How do you size it?
A
- Nasopharyngeal (NP) airway
- Indications airway compromise but GCS>8
- E.g. snoring, drowsy + weird airway noises
- CI: nasal deformity, facial/nasal/base of skull fractures
- Size: tip of nose to bottom of earlobe, go for slightly bigger if in between, diameter based on pt’s little finger
- Safety pin at end to stop inhalation
68
Q
What’s this? How does it happen? Mx?
A
- Tension pneumothorax: can be following trauma, one way valve -> increased pressure, mediastinum/trachea shifts away, hyper-resonance, needle decompression and chest tube
