Procedures Flashcards

1
Q

Outline examination of thyroid gland?

A

Inspect - gland itself, swelling, distended neck veins, scars, neck contour etc
Assess clinical thyroid status - hypo, eu or hyperthyroid
Palpate neck, assess if discrete or diffuse swelling
Check with water swallow and tongue movements
Examine LN chains
Evaluate for retrosternal extension - percuss lower border of neck and upper chest
Pemberton’s manouevre
Auscultate gland for bruit

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

What other examination would you like to include in overtly hyperthyroid patients?

A

Cardiovascular examination - look for failure

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

Differentials for diffuse swelling thyroid + hypothyroidism?

A

Iodine deficiency

Hashimoto’s

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

Differentials for diffuse swelling thyroid + hyperthyroidism?

A

Graves, Hashimoto’s

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

Differentials for diffuse swelling thyroid + euthyroid?

A

Anaplastic cancer
Lymphoma
Medullary cancer

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

Differentials for discrete thyroid nodule and euthyroidism?

A

Follicular cancer
Papillary cancer
Non-functioning adenoma
Cyst

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

Differentials for discrete thyroid nodule and hyperthyroidism?

A

Functioning adenoma

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

Differentials for multiple thyroid nodules and euthyroidism/hyperthyroidism?

A

(toxic) multinodular goitre

Dominant nodule within MNG

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

Describe how to examine the parotid gland? Specific nerve to check?

A

Inspect from front to back of face, looking for obvious mass lesions
Lesion at angle of madible - consider parotd
Look at interior oral cavity - poor dentition, pharyngeal extension of mass, discharge from parotid duct
Palpate mass and comment on consistency, mobility etc
Palpate regional lymph nodes
Test facial nerve function

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

Most likely differential for mandibular angle swelling with no facial nerve involvement? What about with facial nerve invasion?

A

Pleomorphic adenoma

Facial nerve involvement suggests malignancy

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

Outline procedure for breast examination? Specific things to remember incl nerves?

A

Inspect with arms by sides and hands behind head
Palpate under areola and all regions of breast - normal then abnormal, express discharge if able
Examine axilla
Examine function of long thoracic (wing scapula - serratus anterior) and thoracodorsal nerves (lat dorsi)

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

Why is it important to examine the thoracodorsal nerve in breast exam? How do this?

A

Innervates latissimus dorsi - if considering latissimus dorsi pedicled flap but nerve impaired could cause atrophy of muscle and compromise prosthesis coverage

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

Why might there be impaired sensation in the axilla post-mastectomy?

A

Axillary node clearance - intercostobrachial nerves injured or divided

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

4 indications for mastectomy in treatment of breast cancer?

A

Patient choice
Large tumour where removal with conservation approach would give poor cosmesis
Multifocal lesions
Lobular cancers unless very small and focal

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

What scars may be easy to miss in breast examination?

A

Circumareolar, sentinel node scars, scars from reconstructive surgery e.g. lat dorsi (posterior), TRAM/DIEP at base of abdomen - may be hidden by underwear

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

What does distortion of breast on raising arms suggest?

A

Pectoral involvement with mass lesions

17
Q

What is the difference between a TRAM flap and a DIEP flap?

A
TRAM = transverse rectus abdominis musculocutaneous - tissue from abdominal muscle and soft tissue
DIEP = deep inferior epigastric perforators - spares abdominal muscle, only uses soft fat tissue and local blood vessels
18
Q

If breast lesion suspected as malignant on examination, what other areas should you examine?

A

Chest - effusions
Abdomen - hepatomegaly
Vertebral column - bony tenderness
Axilla - nodes

19
Q

What other hint should you look for if breast Ca patient has had wide local excision?

A

Radiotherapy tattoo

20
Q

Describe how to perform chest drain insertion with open technique?

A

Check equipment, ensure 30-34 Fr drain with underwater drainage system prepared and set up, 10ml 1% lidocaine for local
Position at 45 degrees if injuries permit
Safe triangle of affected side, infiltrate with local prep and drape
2cm transverse incision
Blunt dissection to pleural cavity
Finger sweep to ensure correct location and no underlying adhesions
Remove introducer from drain tube and guide into pleural cavity towards lung apex with clamp
When in satisfactory position use purse string sutures and anchor sutures with 1/0 silk
Connect drain to underwater system and apply dressing
Check drainage tube swinging and bubbling
Chest x-ray

21
Q

5 complications of chest drain insertion?

A

Damage to neurovascular bundle
Parnechymal lung injury
Injury to great vessels
Dislodgement or kinking of tube with re-development of tension
Not opening vent port of underwater seal system, revelopement of tension

22
Q

What is the safe triangle for insertion of a chest drain?

A

Midaxillary line of 5th intercostal space
Bordered by anterior edge of latissimus dorsi posteriorly
Lateral border of pectoralis major anteriorly
Line superior to horizontal level of nipple inferiorly and apex below axilla

23
Q

Where and how would you decompress a tension pneumothorax emergently? With what?

A

14G needle into second intercostal space, midclavicular line

24
Q

What is the cut off between large and small spontaneous pneumothorax and how does this influence management?

A

2cm at level of hilum
Small spontaneous can be left alone if no compromise
Consider aspiration of large pneumothorax, underlying lung disease or significant compromise - chest drain

25
Q

What is the difference between chest drains used for spontaneous and traumatic/tension pneumothorax?

A

Small seldinger type drains for spontaneous rather than large 30-34Fr drains for trauma

26
Q

Describe management of needle stick injury?

A

Immediate - wash wound carefully and encourage bleeding
Identify virology status of origin of needle
Determine risk
Take blood from source patient and clinician for virology
Discuss PEP with micro/occ health

27
Q

What BBV has highest seroconversion risk following needlestick? What about HIV/Hep C?

A

Hep B - 30% for percutaneous, non immune
HCV - 0.5-1.8%
HIV - 0.1-0.3%

28
Q

4 highest risk factors for seroconversion following needlestick injury?

A

Deep injury
Terminal HIV illness in source patient
Visual blood on device causing injury
Injury with needle that has been in artery or vein

29
Q

Describe how to assess foot and ankle?

A

Look feel move
Look both sitting and standing, exposure so can see knee and below - e.g. surgical stigmata, arches, genu valgum/varum, intoeing
Palpate main bony prominences and pulses, sensation
Move - plantar and dorsiflex
Subtalar joint inversion and eversion
Midtarsal/tarsometatarsal joints - hold heel still and grip forefoot in eversion and inversion
Toe movements
Walk - look at gait

30
Q

What are the 2 phases of the gait cycle? Which lasts longer?

A

Stance - heel strike to toe off - 62%

Swing - toe off to heel strike - 38%