Management Flashcards

1
Q

Treatment for Varicose Veins

A

Conservative - Stockings, Avoid prolonged standing, weight loss

Interventional-

Multiple Stab Avulsion

Radiofrequency Ablation

Endothermal Ablation

Foam sclerotherapy

Perforator Avulsion

Ligation

Trendelenburg Procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Treatment for foot drop

A

Conservative - Anlagaesia for neuropathic Pain

Physiotherapy - strengthening anterior and lateral leg compartment

Splints and braces - focus on preventing contractures

Orthotics

Surgery - within 3-6 months

Nerve repair - either direct or using a nerve graft/conduit

Reduced compression on nerve (aetiology dependent)

Nerve/tendon transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

i) Monopolar vs bipolar
ii) cutting vs coagulation

A

i) Monopolar -single electrode. Tissue effects very localised to electrode. current needs to leave the body so chooses path of least resistance –> need a dispersion pad on the patient.

Bipolar - two electrodes. Current confined between two electrodes

If you must use unipolar diathermy with a programmable in-situ electrical device the pad should be placed as far as possible from the device

ii)Cutting - Low voltage continuous current which is concentrated over a small area. Electrode not in contact with tissue.

Coagulation - High voltage interrupted dispersed over a large area.

Other- dessication, fulguration and vaporisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of intraoperative hypotension:

1) Generally

2) Particular in pregnancy

A

1) Drugs - Most anaesthetic agents, being administered anti-hypertensive agents on same day as surgery

Hypovolaemia/Haemorrhage
Anaphylaxis

LA Toxicity

Tension pneumo

LV Outflow obstruction

Then typical causes: Infection/Systemic inflammatory response/ cardiogenic/ arrhythmia

2) Pregnancy (if complications arise you may want an obstetrician) :

Being supine - Compresses the IVC

Placental Abrution

PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nutrition in Head and Neck Cancer patients:

1) Advanced cancer receiving multi-modal treatment

2) Post operative dysphagia

A

1) Factors to consider are:

i) Benefit of enteral feed - reduction in weight loss, reduction in treatment toxicity, ?improved QOL, ?higher chance of return to pre-morbid ADL
ii) Method of delivery - due to long term nature of feeding PEG/PEJ are preferred. Long term NG/NJ –> Erosions in the nose and poor cosmesis
2) Post operative dysphagia:
i) Ideally encourage oral intake if safe
ii) If unsafe –> try to ascertain how long alternative feeding method will be required.

<1 month - consider NG

>1 month - Consider PEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Methods of shoulder reduction

A

1) Milch - Supine. Abduct - external rotate - thumb pressure to humeral head
2) Kocher - Adduct arm. Flex elbow. Traction on humerus. External rotation and then forward flexion+internal rotation
3) Stimson - prone on bed. gentle traction with weight over 15-20 minutes
4) Hippocratic - Countertraction in axilla. Humerul traction with in/ext rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe X Ray - what else might be associated on x ray?

Management

A

i) Anterior dislocation of humerus (Adducted and externally rotated)

Hill - Sachs lesion - Fracture of humeral head as it is impacted against glenoid

Bankart lesion - Fracture of the glenoid labrum as humerus presses against labrum

ii) Management:

History + Examine NV Status

Consent

Analgaesia (Gas/Sedative)

Inline downward traction + Countertraction (with/without internal or external rotation)

Polysling for 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Carpal Tunnel Surgery Steps

A

Check, Mark and SIte appropriately. WHO checklist.

LA to incision site and down to median nerve.

Scrub. Apply tourniquet to 200mmHg.

Incision: i) Draw line from between 2nd + 3rd web space to palmaris longus tendon

ii) A line from first web space to the hook of hamate

iii) Then from the intersect line to the distal wrist crease

Careful dissection avoiding palmar nerves.

Divide the palmar fascia –> Identify the carpal ligaments –> incise ligament

Protect the median nerve

Close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Subclavian Line Insertion

Structures at risk

A

Subclavian Vein - Just deep to middle third clavicle.

Patient Supine, head down, with head facing the opposite way from site of insertion.

Point needle and syringe medially, posteriorly and cephalad at junction 1cm between lateral/medial third of clavicle.

Pull back on syringe as inserting needle.

When inside vein insert catheter using selldinger technique

CXR to check position - Tip should be in SVC

Risk - pleura, Subclavian artery, thoracic duct (left), phrenic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nerves that can be damaged in inguinal hernia repair?

A

Ilioinguinal Nerve - Runs from deep ring to superficial ring.

innervates the anterior scrotum, base of penis, upper + medial thigh

Iliohypogastric Nerve - Runs beneath external oblique piercing it near the superficial ring. innervates skin above pubis

Genitofemoral nerve - Travels through the inguinal canal to innerate cremasteric muscle.

motor - cremaster sensory - scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management - Hip Fracture:

i) Intertrochanteric

ii) Subtrochanteric

iii) Intracapsular

A

Basics to talk about - pain management, neurovascular compromise of distal limb, procedures would be performed under fluroscopic guidance in theatre to ensure adequate reduction

i) Intertrochanteric/Subtrochanteric - Extracapsular so a dynanamic hip screw/ IM Nailing

ii) Intracapsular :

I,II - Fix with a cannulated screw (preserve the femoral head)

III, IV - Hemiarthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Garden Classification of HIp Fractures

A

Radiological Classification System for Intracapsular hip fractures.

I - Stable fracture/ Valgus Impaction

II - Non Displaced - Complete Fracture

III - Displaced but maintenance of end to end contact between fragments

IV - Completely displaced fracture

III + IV associated with AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What neurovascular structures are at risk in anteromedial approach to the knee?

A

Geniculate Arteries

Saphenous Nerve

Great Saphenous Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Achalasia

1) Grossly the pathophysiology

2) Classic radiological sign

3) Classic manometry findings

A

1) achalasia is caused by loss of myenteric plexus resulting in the discoordinated persitaltic movements observed and the non relaxation of the lower oesophageal sphincter
2) Classically seen on barium swallow as a “birds beak appearance”
3) Manometry
- Non-relaxing hypertensive oesophagea sphincter
- Aperistaltic smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lumbar Puncture:

i) Anatomical Landmarks

ii) Which layers do you go through?

A

i) Supracrestal line - line between the iliac crests that corresponds to L4/L5

L3/L4 - L4/L5 Best places to go

ii) Skin, Fat, Fascia, Supraspinous Lig, Interspinous Lig, Ligamental Flavum, Epidural Space, Dura, Arachnoid Space (The CSF is here in the subarachnoid space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to perform cricothyroid puncture

A

Identify Cricothyroid membrane

- Dip between thyroid and cricoid cartilage felt inferior to the laryngeal notch

Insert 12/14 Guage Cannula into the membrane with syringe containing air. Inject air into the trachea and then secure the cannula to an oxygen supply via Y Connector

Ventilate 1 second on 4 seconds off

Ensure Help is on the way to secure definitive airway

17
Q

i) Consent for Embolectomy

ii) What is reperfusion injury

iii) Specific Extra Procedures/Medications required after embolectomy

A

i) General - Bleeding, Infection, Damage to structures (femoral Vein/ Nerve), Anaesthetic Risk, Death

Specific - Arterial Damage (intima), pseudoaneurysm formation, Failure, Need for bypass or amputation, Reperfusion Injury, Need for fasciotomy (to prevent compartment syndrome)

ii) Reperfusion injury is the dissemination of toxic metabolites formed during periods of ischaemia into the circulation leading to:

  • Cardiac Consequences (arrhythmias, arrest)
  • SIRS
  • Organ Dysfunction

These patients likely need to be managed in a higher care setting with more monitoring.

iii) These patients will often need:

Fasciotomy

IV Heparin (+ Long Term Anticoagulation)

18
Q

Flail Chest Management

A

ATLS Approach

The oxygenation issues often associated with flail chest are in more cases attributable to underlying pulmonary injury (i.e. contusion) than due to the rib fractures themselves.

Medical - Oxygen where necessary.

Analgaesia

Regular Chest Physio

May need CPAP

May need chest drain if haem/pneumo thorax

Surgical -

May need chest drain insertion

Surgical Fixation is not always necessary but if other intrathoracic surgery is required then ribs are often fixed at this point

19
Q

Femoral Hernia Management - Which approach?

A

Laparoscopic

Open:

Mcevedy’s - Suprainguinal (When strangulation)

Lockwood - Infrainguinal

Lotheissen’s - Transinguinal approach