Pran teaching cases

Question 1

Pilonidal disease

• pathophysiology
• presentation
• management

Answer 1

pathophysiology: chronic inflammatory reaction of hair in natal cleft, causes blind ended epithelialised tract
presentation: asymptomatic, or chronic discharge or abscess, often hairdressers
management: I&D of abscess, elliptical excision of sinus, close wound off midline of natal cleft

Question 2

Perianal abscess

• pathophysiology
• presentation
• management

Answer 2

pathophysiology: anal glands open at the dentate line, if they get blocked they build up through the path of least resistance ie towards the skin
presentation: painful lump in perineum near anus, low grade sepsis ie fever, malaise
management: I&D, antibiotics, +/- seton if fistula present

Question 3

Psoas abscess

• pathophysiology
• presentation
• management

Answer 3

pathophysiology:
- primary: haematogenous spread (IVDU, immunosuppression)
- secondary: ruptured appendix, tuba-ovarian abscess, pyelonephritis, IBD

presentation: progressive pain over few days, hip/back/butt region, maybe febrile, limping child with fever, painful hip flexion
management: drain with CT guidance, if that fails then surgical drainage

Question 4

LBO

• pathophysiology
• presentation
• management

Answer 4

pathophysiology:
- functional: pseudo-obstruction, salmonella, campylobacter, shigella, hypothyroid, opioids
- mechanical: polyps, pelvic tumour, volvulus

presentation: constipation, abdominal distension, abdominal pain

management: depends on cause
- conservative: laxatives, increase mobility
- surgical: sub total colectomy if ischaemic bowel
- sigmoid volvulus - flexible sigmoidoscopy

Question 5

Thyroid nodule

• pathophysiology
• presentation
• management

Answer 5

pathophysiology - depends on diagnosis ie cancer, cyst, adenoma, MNG

presentation - palpable nodule, hyper or hypothyroid symptoms, change in voice, change in overlying skin

management

• TFT, USS, +/-FNA
• bethesda classification - pathological grading system to determine likelihood of cancer
• nucleotide scan ONLY in hyperthyroidism

Question 6

Thyroidectomy consent - specific risks

Answer 6

damage recurrent laryngeal nerve - hoarse voice
note: use electrodes to monitor nerve activity during operation to avoid injury

haematoma - airway obstruction

damage parathyroid - low calcium

Question 7

Breast cancer

Answer 7

…