Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCS Part B > Procedures > Flashcards

Procedures Flashcards

1
Q

Take Blood Cultures

A

1- WIPER - Wash hands, introduce, patient permission/procedure explanation, expose, reposition

2 - Prepare - Gloves,

Antisceptic cleaning material (clorhexidine/alcohol)

Tourniquet, Needle, Blood Culture Bottles (aerobic + anaerobic), Gauze, Microbiology request form

3 - Procedure - Re wash hands and apply appropriate protection

Clean skin - 30 seconds allowing a further 30 seconds to dry

Clean bottle tops

Introduce needle to vein and then fill both bottles (aerobic first)

Remove needle and apply gauze + tape

4 - Labelling

Label the patients samples at the bedside and ensure the form is adequately filled in

5 - Wash hands again

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

i) Risk of transmission through needle stick for HIV, Hep B, Hep C

ii) What to do in case of needlestick/sharps injury

A

i) HIV - 0.3%

Hep C - 3%

Hep B - 30%

ii) Clean with soap and water

Report to manager and to OT/A&E if out of hours

Have someone consent the patient for viral testing

Baseline bloods for yourself, 3 months and 6 months

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

Catheter

A

Wash hands

Ask for patient obs and notes

Assess for pain or discomfort

WIPER - Wash, Introduce, Explain / Permission, Expose, Reposition

Prepare - Catheter 12 fr/ 14 fr (long term/ short term)

Syringe to fill baloon, Instillagel, Gloves x 2 ,

Catheter bag, Swabs, Drape, cleaning solution

Create a sling,

Retract penis

Clean penis with swabs (one per swipe / in to out)

Drape

Change Gloves

Prepare catheter

Handle the penis with one hand + swab

Penis at 90 degrees

Instillagel

Insert catheter

Inflate

Attach urine bag

Wash hands, thank patient, explain post-procedure management

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

i) What to do if no urine comes out catheter?

ii) Differentials

A

i) 1) Examine Patient
2) Bladder washout + bladder scan
3) If bladder fills with solution on scan:
- Order renal function tests / FBC/ CLotting/ Group and save / Blood Gas
- Order US KUB / CT if OOH and cannot wait
ii) Differentials:

Pre - Renal (renal hypoperfusion) - Hypovolaemia, Renal Artery Disease, (always suggest ruptured AAA)

Renal - Glomerulonephritis, Interstitial nephritis, Acute Tubular necrosis

Post - Renal - Catheter blocked, Catheter malfunction, Catheter misplacement, Outflow obstruction (stones, tumour, stricture, prostate)

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

Chest Drain Insertion

A

WIPER - Wash hands, Introduce, Procedure + Permission, Expose, Reposition (Hand above/behind head)

Consent form + Risks - Explain intention + risks (Failure, Pain, Bleeding, Infection, Damage to other structures - blood vessels, nerves, liver, heart, need to have surgery)

Check - not on anticoagulants, no allergies

Equipment -

Sterile gloves and gown

Cleaning Solution

Drape

LA solution w/without adrenaline + Green/Orange syringe

Gauze, Scalpel + No. 11 blade.

Suture Material - 1 silk

Large haemostat/ Scissors

Spencer clamp x 2

Large bore chest tube 24-30 fr

Tubage + underwater seal

Dressing

Procedure:

Position correctly

Landmark - 5th ICS mid axillary line

Obtain an assistant

Prepare yourself and prep patients.

Clamp both ends of chest drain.

Apply drape.

Lidocaine (by weight) - to skin, periosteum and pleura

Transverse Skin incision just superior to rib

Blunt dissection using haemostat/scissors until pleura is encountered in controlled manner. Spread haemostat widely and withdraw while open.

Insert finger and rotate 360 degrees to check position

Take tube attached to clamp and insert it into incision aiming posteriorly + superiorly for air/ posteriorly and infeirorly for blood

Suture tube in place ensuring attached to underwater seal. Anchor suture just next to tubing along site of incision and then wrap suture around tube to secure before tying again.

Post-procedure-

CXR

Analgaesia

Chest Drain Monitoring

Obs

Document procedure

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

i) Causes of pneumothorax

ii) What is a large pneumothorax

A

i) Primary - Spontaneous

Secondary - Underlying lung disorder, Trauma

Iatrogenic - Central Lines, Biopsies, Pacemakers, Barotrauma

ii) >2cm rim of air on CXR

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

Removal of skin lesion

A

WIPER

Consent form, Hospital Number, Patient name, DOB

Consent - Risks - Bleeding, Infection, Scar formation, Pain, Re-excision of margins

Equipment -

sterile preparation ( solution, gloves + gown)

Local anaesthetic (1% Lidocain + 1:80,000 adrenaline)

Needle (injecting + drawing up) + Syringe

Marker

Specimen Pot. Histology Form

Suture - Monocryl for subcuticular. Prolene for interrupted.

Dressing

Sharps Bin

Diathermy (precaution)

Excision:

WHO Checklist

Prep Yourself

Clean and Drape

Mark the patient (2mm border for excision, 4mm for SCC, Melanoma dependent on breslow thickness)

Anaesthetise (check drug with examiner beforehand)

Elpitical incision around the marker - 3x1 ratio

Ask about subcutaneous marking stitch

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

What type of stitch is:

i) Prolene
ii) Vicryl
iii) PDS
iv) silk

A

i) Prolene - Synthetic, non-braided, non-absorbable suture
ii) Vicryl - synthetic, braided, absorbable suture
iii) PDS - synthetic, non-braided, absorbable suture
iv) SIlk - Natural, braided, non-absorbable suture

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

i) What is diathermy?
ii) Complications of diathermy

A

i) High Frequency Alternating Current providing:

localised heat to coagulate or cut tissue

ii) Smoke - carcinogenic

Burns

Fire

Capacitance coupling (if the insulator rests against tissue that has high capacity to store energy/current –> pathway of least resistance becomes the tissue rather than the air) –> leading to burn

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

i) What does SCC look like histologically?

A

i) Proliferation of atypical keratinocytes, keratin pearls + invasion of dermis (otherwise is Bowen’s Disease)

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

Features of LA overdose

A

Seperately patients can have anaphylaxis

Overdose:

Perioral Tingling

Paraesthesia

Later -> Reduced GCS, Seizures, Arrhythmias ..

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

Pacemaker precautions

A

i) Recent pacemaker check
ii) Provision of CPR / Temporary pacing available in theatre
iii) Monoplar to be avoided - if necessary in short bursts with the electrode far away from pacemaker in a direction so current will be guided away from the pacemaker
iv) Bipolar used in short bursts
v) Avoid putting on same side as metal prothesis

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

i) Specific intraoperative risks for COPD patients

ii) Postoperative risks

iii) Mitigation

A

i) Splinting of diaphragm due to pneumoperitoneum can reduce TV
ii) Respiratory complicatiosn post-op : T2RF, Atelectasis, Pneumonia, ECOPD
iii) Pre: Smoking Cessation, Discuss HDU bed, CXR, ABG, Spirometry

Intra: Avoid GA, Lower abdominal incision (less chest complications)

Post: - Early Mobilisation after surgery, Chest Physio, Postive Pressure Breathing, Spirometer , Upright posture , Analgaesia (judiciously)

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

Define:

i) Cleaning

ii) Disinfection

iii) Sterilisation

A

i) Cleaning- Removal of debris
ii) Disinfection - Reduction of number of microorganisms
iii) Sterilisation - killing of microorganisms

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

Stopping Warfarin

A

i) Check Local Guidance and Discuss with haematologist
ii) Stratified into :

Generally only operate if INR <1.4

Low Thromboembolic RIsk:

Stop 5 days pre op

Start when e+d

High Thromboembolic Risk :

Stop 4 days pre op

Provide LMWH cover

Stop LMWH - 12-18 hours pre -op

Restart LMWH 6 hours post op

Stop LMWH when INR is in range again

Very High Risk (Valves):

Unfractionated Heparin Infusion

APTT Checks 6 hourly and stopped 6 hours pre-procedure

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

Necessary steps to prevent wrong side surgery

A

Pre - Op:

History + Exam again

Review Notes

Review Imaging

Consent - specify the side
Mark correct side

Op:

WHO CHecklist

Patient ID Confirmation + side confirmation in theatre

17
Q

Post MI risks of re-infarction

A

Within 3 weeks - 80%

Within 3 months - 40%
After 6 months - 5%

18
Q
A
19
Q

OCP and surgery?

A

Stop 4 weeks beforehand due to VTE risk

20
Q
A
21
Q

Metformin before surgery

A

i) Consider stopping 48 hours before to reduce risk of acidosis.
ii) Monitor BMs as may need a sliding scale
iii) Book 1st

22
Q

How to prep patients before draping

A

1) Remove hair - don’t shave
2) Apply skin prep in circular motion from in to out - give enough room to extend incisions + to place drains
3) Dab any pooling of prep to prevent burns
4) Dry edges where drape will be applied
5) apply drape

23
Q

Talk me through different antiseptics

A

Chlorhexidene (>4 hours)

Good for bacteria / Viruses

Not good for spores and fungi

Betadine (<4 hours)

Good for bacteria, viruses, fungi and spores

Isopropyl Alcohol

Good for bacteria, viruses, fungi

Not food for spores

24
Q

Why do we drape

A
  • Creates clean environment
  • Provides a barrier from microorganisms
  • Keeps clean equipment clean
  • Controls fluids

Characteristscs - Durable (Wet/Dry), Resistant to microorganisms, Non - toxic, Flexible, Electrotatic, Breathable, Doesn’t set alight

25
Q

Examples of sterilisation

Types of chemical sterilisaton substance

A

Autoclaves - Surgical instruments

Cold/ Chemical - Endoscopes

Gas - Sutures / Eletricals

Ionising - Catheters, Syringes

Formaldehyde, GLutaraldehyde, Ethylene Oxide, Hydrogen Peroxide

26
Q

NECPOD Classification for intervention

A

I - Immediate. Life saving.

Ia - Within 6 hours. ORgan or limb saving

II - <24 hours. Appendicitis

III - Days. Stable patients but expedited procedures (soon to obstruct bowel tumours)

IV - Elective

27
Q

ASA Classification

A

American society of anaesthesiologist classificaton predicting morbidity/mortality

I - Fit and well

II - Mild Systemic Disease

III - Significant systemic disease but well controlled

IV - Severe systemic disease constant threat to live

V - Expected to die within 24 hours ill with/ without operation

28
Q

i) Layers incised through midline incision

ii ) Principles of incision

A

i) Skin

Subcut Fat

SCarper’s Fascia

Line Alba

Transversalis Fascia

Extraperitoneal Fat

Peritoneum

ii) Principles - Good abdominal access, can be extended, muscle fibers split not cut, avoid nerve damage, good closure possibility

29
Q

Abdominal Incisions

A
30
Q

i) Trendelenburg Position

ii) Reverse trendelenburg position

iii) Lithotomy position

iv) Lloyd Davies position

v) Prone

A

i) Trendelenburg - Supine with head down
ii) Reverse Trendelenburg - Supine with head up
iii) Lithotomy - Legs flexed at hips and knees with ankles in stirrups
iv) Lloyd Davies- legs flexed at hips and knees with ankles in pneumatic stirrups
v) Prone - on stomach

31
Q

Surgical Wounds:

i) Clean

ii) Clean Contaminated

iii) Contaminated

iv) Dirty

A

i) Clean - Skin is breached but no other mucosal breach

ii) Clean Contaminated - PLanned mucosal breach with no spillage/contamination

iii) Contaminted - Macroscopic soiling

iv) Dirty - Contamination before surgery (ruptured viscus, peritonitis)

32
Q

Sutures:

i) Natural

ii) Synthetic

iii) absorbable

iv) non absorbable

v) Multifilament

vi) Monofilament

A

i) Natural - Silk, Catgut

ii) Synthetic- monocryl, vicryl, prolene, ethilon, PDS

iii) Absorbable - Monocryl, Vicryl, PDS

iv) Non-absorbable - Prolene, Ethilon, Silk

v) Multifilament - Vicryl, Silk, Catgut

vi) Monofilament - Prolene, Ethilon, PDS

33
Q

What would you use to close:

Skin Laceration

Mass midline

Bowel Anastamosis

Vascular Anastamosis

Drains

A

Skin Laceration - Prolene/ Ethilon/ Vicryl

Mass midline closure - PDS

Bowel Anastamosis - Vicryl / Staples

Vascular Anastamosis - Prolene

Drains - Silk

34
Q

Over how much area should the electrode pad for monoplar cover

A

70 cm squared

35
Q

Open limb trauma - how to investigate / debride

A

Initially ATLS - ensure patient is adequately resuscitated

Cannulae - Warmed crystalloid + Broad spectrum antibiotics ( check allergies, cehck trust guideliens) and Tetanus prophylaxis

Debridement:

1. Remove obvious debris with forceps. Use a retractor to remove debris that is not immediately visible

2. Irrigate wound gently (ensure eye protection) with 0.9% Saline. Retract and irrigate further

3, Debride - Excise dead/de-vitalised tissue carefully. If something bleeds it is viable.

Retract and continue the debridement/removal of debris being mindful of neurovascular structures

4. Pack wound with alginate/aquacel/hydrofiber dressings to reduce the dead space and cover with saline impregnated gauze

36
Q

Options for LA

A

Immediate:

Lidocaine

Procaine

Prilocaine

Longer Acting:

Bupvicaine

Tetracaine

37
Q

Hydrocele Surgical options

A

1. Aspiration

2. Lord’s :

  • Scrotal incision
  • Drainage of sac
  • Minimal/No excision of sac followed by plication of sac walls

3. Jaboulay’s

Anterior Scrotal incision down to tunica vaginalis

Blunt dissect out hydrocele sac

Trocar to drain sac

Excise Sac walls

Suture sac together with interrupted sutures

MRCS Part B (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions