Surgical Miscellaneous Flashcards
What are 3 indications that cellulitis is improving on examination?
Shrinks in size (use marker to track progression)
Blister formation
Wrinkling around area that is now healed
When asking about surgical history, what should you ask?
What the surgeries were and when they occurred
Open vs laparoscopic vs robotic
Complications, repeat admission
You are in a long case and youre suggesting surgical management of a disease. In preparation for any surgery, what will you do?
What if the patient was also a diabetic?
I will evaluate CV and Resp RFs primarily to ensure the patient is fit for surgery
CV: Exam, ECG, ECHO, and if needed, angiogram
Resp: Exam, PFT, CXR, ABG
I will ensure all imaging is available and sent appropriate requests
I will check patients medications and adjust them in line with hospital regulations e.g. anticoagulants, antiplateleys MAOI, etc…
I will request anaesthetic opinion and evaluation as needed
Diabetic: I will also ensure perioperative management of diabetes with regards to glycaemic control, preferably insulin
Perfect your 10 steps for the management of any acute abdomen
ABC. You must still state the basic steps you will do in each. Here is just the important points
1) Admit to hospital +/- Consider need for HDU/ICU
2) ABCDE: Send out FBC w/differentials, U&E, CRP, LFTs, and coag profile, ABG
3) NPO for all, Wide bore NG tube if vomiting/SBO, Intubate if GCS 8 or under or if vomiting
4) O2 if in doubt until ABG becomes available (15L 100% O2 via non-rebreather mask)
5) 2x large bore cannulas, IV fluids at 100ml/hr until losses worked out via intake/output chart +/- urinary catheter (aim >0.5ml/kg/hr)
6) Type and save, group and hold, Group and cross match 4 units of blood (10 for AAA). If Hb<7 (or <8 if Cardiac hx) give in 1:1:1 aiming for Hb>8 and >10 in CVD
7) Analgesia (Paracetamol, NSAIDS, Morphine/oxynorm/oxycontin)
8) Antiemetics if needed (Ondansetron)
9) Antibiotics: Coamox/pip taz + Gent/Metronidazole (except in pancreatitis, wait for blood cultures to come back)
10) DVT prophylaxis (TEDs, Clexane, LMWH)
If >4 units used, activate Major Transfusion protocol
What is way to think of complications if stuck?
Anaesthesia -> Entry -> surrounding structures -> Procedure components and what can go wrong with each -> Post-op
What are the general complications of most surgeries?
Infectious: Wound site infection, sepsis, UTI (catheter use during surgery), Aspiration pneumonia
Bleeding: Post-op bleeding, haematoma
Thromboembolic: DVT, PE, stroke
Cardiovascular: MI, arrhythmia, A.fib, stroke
Anaesthetics: Atelectasis/barotrauma from intubation, GA intolerance, if spinal, LP (traumatic, incorrect)
Other: !!Complex regional pain syndrome!!, delayed wound healing, Adhesions!!
In a long case, you are asked to give your investigations of a certain disease. What is the full list of bedside investigations that you can pick out from?
Blood:
Glucometer
ABG/VBG
Urine:
Urine dipstick
Urinalysis M,C&S
Imaging:
Portable CXR
POCUS
Portable US (bladder)
Other:
Vital signs incl. pulse oximetry
ECG
DRE
Fundoscopy
Peak flow
A patient post-thyroidectomy is more likely to have hyper or hypocalcaemia?
What signs are shown?
How is it managed?
Hypo
Signs: Perioral paraesthesia, Trousseau signs, Chvostick sign
Tx: 10ml 10% IV Calcium Gluconate over 10 minutes
+ Vit. D supplements
What are the main indications for thyroid surgery
4 Cs
Cancer: Papillary, follicular, hurthle cell, medullary, anaplastic
Compression: Goitre or mass compressing trachea or SVC or other nearby structures
Carbimazole (just means medical tx has been exhausted)
Cosmetic
What cancers use neoadjuvant chemoradiotherapy?
Oesophageal Ca
Rectal Ca (specifically, not all colorectal)
Breast Ca
Ovarian Ca
Bladder (in some cases)
How would you describe the following terms for a patient?
Stoma:
PFA:
CT:
NG tube:
Stoma: Bag on tummy
PFA: X-ray of tummy
CT: Put in tunnel
NG tube: Drip for feeding
What Thy score is considered normal?
2
1 is equivalent to the hospital burning down (e.g. no sample, patient did not attend etc…)
A nurse undergoes primary immunisation against hepatitis B. What levels should be checked four months later to ensure an adequate response to immunisation?
Anti-HBs
What is the Seldinger technique?
Go through it
The seldinger technique is a minimally invasive technique for gaining access to vessels and hollow organs. It may or may not be guided by US or fluoroscopy
It involves
1) inserting a small gauge needle (with an attached syringe) into the vessel and confirming with an aspirate of blood
2) withdraw the syringe and advance the guide wire -confirm location of guide wire with free movement/US/Fluoroscopy
3) withdraw needle and advance dilator
4) withdraw dilator and advance catheter over guide wire
5) withdraw guide wire and aspirate + flush with !heparinised saline to ensure patency
In what situations is the seldinger technique used?
Any reason to obtain
Venous access (meds, fluids, food)
Arterial line (BP/serial BP, Repeat ABG)
Perm cath (haemodialysis)
Insertion of a drain or tube (chest drain, pleural effusion, biliary drainage
After every surgery discussed in a history, what should you ask?
Complications? ICU admission
Were you able to eat well after surgery?
Stay in hospital after the surgery
Drains post-op
Youre performing a general inspection on a patient in the long case and you notice they have compression stockings on. How will you know which one theyre wearing and the likely reason they are wearing it?
Grade 1 = White/yellow = TEDs = VTE prophylaxis (15-20mmHg)
Grade 2 = Brown/Blue = Venous insufficiency (20-25) NOTE: brown is used here according to the lecture
Grade 3 = Brown/Green = Lymphoedema (or severe venous insufficiency) (25-35)
Extra cuz rarely actually used: Grade 4 = Purple = Very severe lymphoedema/venous insufficiency (40+)
I am a blood cell in the internal judgular vein. Take me to the heart
The internal jugular veins (on each side) join with the subclavian veins (on each side) to form the 2 brachiocephalic veins (recall only one -R-sided- brachiocephalic artery).
The 2 brachiocephalic veins merge together to form the SVC
You notice a central line inserted on general inspection. How would you know if it is inserted into the Internal jugular or the subclavian?
Internal jugular => above clavicle and directed downwards/vertical
Subclavian => under clavicle and directed sideways (as per path of vein)
What electrolytes are included in hatmann’s solution
Na 131
K+ 5
Ca2+ 2
Cl- 111
HCO3 or lactate - 29
Representing physiological values
Give the top 5 indications for a colonoscopy
Tenesmus
PR bleed
Unexplained weight loss
Change in bowel habit
Family hx of colon cancer/genetic susceptibility e.g. FAP/lynch…
Give the top 5 indications for an OGD
Dysphagia
Odynophagia
Haematemesis
Post-prandial vomiting
Unexplained weight loss
Your colleague tells you your patient has a raised CA-125, so you tell him to refer them to gynaecology oncology… then you realise its actually a male. Why is it raised?
Primary peritoneal malignancy (not relevant for long case)
A raised CA-19-9 indicated which cancers?
Upper GI cancers => Gastric, cholangiocarcinoma, and pancreas
Define a fistula
An abnormal connection between 2 !!epithelial!! surfaces
What is the difference between an ulcer and an erosion?
An ulcer is the complete breakdown in continuity of the epithelium and further whereas an erosion is the incomplete breakdown….
A patient has just been admitted under your care. What are the 4 components of VTE prophylaxis that you should ensure?
1) TEDs
2) LMWH
3) Adequate hydration
4) Early/frequent mobilisation and movement
A patient doesnt really have the best liver and you would like to put her on TPN post-op. What are the implications of TPN on the hepatic system
Fatty liver -> Deranged LFTs, Cholestasis => Cholelithiasis…
Sentinel node biopsy uses what radiolabled isotope?
Technetium-99
Define cellulitis
What about dermatitis?
Inflammation of the !subcutaneous! layers with involvement of the overlying skin
Dermatitis is inflammation of the skin
Oncology:
TNM staging is used for most cancers. What does each stand for?
What is the R score?
Staging can have a prefix such as pTNM, cTNM, and yTNM. What does each mean?
Who HAS to be at an MDT meeting on a cancer patient?
T: Tumour
N: Loco-Regional!! Lymph nodes
M: Metastasis and distant LNs!!!
After resection of a tumour, margins are typically left and a sample is sent to pathology to check for residual cancer cells
R0 = Resection margins completely clear
R1 = Microscopic margin positivity
R2 = Macroscopic margin positivity (seen in ovarian staging laparotomy)
pTNM = Pathological TNM staging based on specimen
cTNM = Clinical/Radiological staging
yTNM = Patient has already recieved neoadjuvant treatment
The long thoracic nerve may be affected in many surgeries such as breast surgery. Where does the long thoracic nerve run
a) Anterior clavicular line
b) Mid-clavicular line
c) Posterior clavicular line
d) Anterior axillary line
e) Mid-axillary line
f) Posterior Axillary Line
e - Mid-axillary line
A patient needs a chest drain in. You try and locate the safety triangle but they are morbidly obese (BMI >45). What can you do to mitigate the risk.
Try best to locate 4th/5th ICS and place tube !!Anterior to the mid-axillary line!! as the long thoracic nerve runs in the mid-axillary line
Why should a chest drain never be clamped?
Risk of transforming non-tension pneumothorax to a tension pneumothorax
Youre looking at an erect CXR. Is it better to assess left or right side (cant say both)
Right due to homogeneity of the liver. Left side has gastric bubble
Give the top 4 complications of gastric surgery
Give 4 examples of surgeries involving the stomach
Anastomotic leak
Dumping syndrome
Cholestasis
Pernicious anaemia
Bariatric surgery (Bypass, sleeve)
Gastrectomy
Oesophagectomy
Hiatus Hernia repair (Laparoscopic reduction, gastropexy, and Nissen Fundoplication)
A patient presents with signs and symptoms of bowel obstruction with severe N+V. What can you do that is both diagnostic and therapeutic (3)?
1) Wide bore NG
2) Gastrograffin
3) OGD w/ techniques (esp in the case of bleeding) but must rule out perforation
NGs can be fine bore or large bore. When would you use each?
Fine bore for feeding
Wide bore for draining (e.g. in obstruction)
How is Gastrograffin given to the patient?
NG tube (does it matter which? not rly, whatever is in situ)
It can also be given via enema both for therapeutic and diagnostic purposes involving the large bowel
What is meant by “neat” Gastrograffin?
Neat = undiluted
better for imaging and therapeutic effect
Explain the process of how to use gastrograffin in the management of an upper GI SBO
1) Insert an NG tube (if not already placed)
2) Aspirate until dry
3) Give “Neat” Gastrograffin via NG tube
4) Schedule PFA for 2 hours (pretty strict)
Gastrograffin is both diagnostic and therapeutic. Discuss how it is both. Include indications for use.
Key uses:
GI perforation fistula, obstruction, stricture… (including esophagus, PUD…)
Contrast studies in dysphagia (as a modified barium swallow)
Post-op leaks
Bariatric procedures
therapeutic:
Osmotic effect of gastrograffin may resolve obstruction
Gastrograffin has been replacing barium studies recently discuss the benefits of gastrograffin over barium and the reverse.
Benefits
1) Can relieve bowel obstruction via osmotic effect
2) water-soluble => wont cause peritonitis if leaks
3) Rapid transit => faster results
Risks:
1) Aspiration risk -> Chemical pneumonitis
2) Contra-indicated in dehydration due to osmotic effect => worsening dehydration
3) Hypersensitivity to iodine in gastrograffin
List the 5 different types of bariatric surgery
Gastric balloon
Gastric Banding
Gastric Sleeve
Roux-En-Y Gastric Bypass (roux=limb which is the section of the small intestine that connects to the new gastric pouch and the Y shape is formed by the connection of the bypassed intestine and the biliopancreatic limb)
SADI-S (Single Anastomosis Duodeno-ileal bypass with sleeve gastrectomy) - The new one
What are the main 2 indications for bariatric surgery
BMI > 40
BMI > 35 with comorbidities (e.g. diabetes)
You want to consent a patient to a procedure. What is the general outline that you should follow?
1) Assess the patient’s capacity to consent
2) Obtain patient info and anaesthetic feasibility (e.g. fasting)
3) What is the procedure and why we are doing it
4) Complications + Alternatives
5) Reassurance and discussion
Septic shock is different from all types of shock. What 2 characteristic features of it separate it from the rest?
1) reduced oxygen uptake by cells
2) Vasodilation of pre-capillary vessels and Vasoconstriction of the post-capillary vessels => oedema
What are the 6 Cs for post-op fever
Cut => surgical site infectiion
Catheter => IV (e.g. thrombophlebitis) or urinary
Collection => abscess or haematoma
C. Difficile => due to heavy antibiotic use
Chest => pneumonia (VAP) or atelectasis (weaning)
Clot => DVT or PE (both cause fever)
Surgical procedures can be categorised based on sterility and risk of infection in the surgical field. What are the categories and give an example of each
Clean -> Orthopaedic procedures (no tract involved)
Clean-contaminated -> Appendicectomy, scopes, ENT controlled entry into tract)
Contaminated -> Any bowel procedure e.g. hemicolectomy (breach of viscera)
Dirty -> peritonitis eg. perforated PU or Hinchey 3,4 in diverticulitis
How would you differentiate between a clean and contaminated surgery if you didnt know where the surgery is categorised?
A surgery is considered contaminated if the surgery invades the viscera
Give 3 ways you can tell there is a recurrent laryngeal nerve injury on a patient
1) Bovine Cough (youtube it)
2) Ask patient to speak (Hoarsness)
3) Nasal endoscopy
A patient post-thyroidectomy has some hoarsness in their voice. What quick way can you determine if its due to recurrent laryngeal nerve injury or strap haematoma?
Nerve injury would be directly post-op
strap haematoma needs a few hours to develop
Is a strap haematoma venous or arterial blood?
Venous
MRCP and cholecystectomy on index admission is performed much more often in younger patients. Why do we ask them to fast before an MRCP?
Cholecystokinin release from food leads to peristalsis and hence constriction of the CBD => dilation not fully appreciated
Your patient is having massive haematemesis. As part of your workup, you order a U&E. What results would you expect?
Hypokalaemia from the excessive vomitting
Pseudohypernatraemia from the dehydration
“Disproportionately raised” Urea to creatinine ratio due to both digestion of the blood in the stomach AND Pre-renal injury secondary to hypovolaemia
You are in a long case and you get to the point about reversing coag and all that. You now want to bring up tranexamic acid. What will you say
Tranexamic acid 1g TDS BUT
recent studies including the HALTED Trial for tranexamic acid has shown little therapeutic benefit yet increased risk of VTE outcomes.
When discussing OGD techniques, this should be described as a 2-step technique. What is meant by that
basically one step is the adrenaline injection, argon plasma, sclerotherapy….
The second step is actually stopping the bleeding for the future which is clipping, oversowing, banding etc…
What concentration and volume of adrenaline is injected intraoperatively to stop an upper GI bleed
Concentration: 1:10,000
Volume: 20ml
You are in the long case and you are discussing stopping bleeding with OGD techniques and bring up adrenaline. Consultant asks you how does adrenaline stop the bleeding. What will you say (2)?
1) Vasoconstriction
2) Pressure from the volume (which is why we give 20 ml)
You are discussing Graham patch repair with a surgical colleague. It is separated into 2 parts. What are they?
1) Oversowing
2) Ommental patch
List the layers of the bowel wall from inside to outside
1) Lumen
2) Mucosa
3) Submucosa (containing Meissner’s plexus)
4) Muscularis propria: Inner circular -> Auerbach -> Outer longigtudinal
5) Serosa/adventitia
You are about to perform a lumbar puncture. List the layers you will go through.
Where does the spinal cord terminate? Where is the needle inserted?
Which layer contains the CSF?
Which layer/part of the lumbar puncture is the one with resistance and has the characteristic “pop” sound?
Spinal cord ends at L1/L2 and needle inserted in L3/L4 or L4/L5 (more common)
1) Skin
2) Subcut fat and connective tissue
3) Supraspinous ligament
4) Interspinous ligament
5) Ligamentum flavum (Pop)
6) Epidural space
7) Dura mater
8) Arachnoid mater
9) Subarachnoid space (CSF)
List the layers of the scalp and continue all the way till you get to the brain
which later contains the the veins and hence would indicate a large bleed?
Skin
Connective tissue
Aponeurosis
Loose areolar tissue (veins => large bleed)
Periosteum
Skull (outer table -> diploe -> inner table)
Meninges: Dura, arachnoid, pia
Cerebral cortex
The saying “They can vomit once or twice but never thrice” is referring to what?
Peritonitis (from PUD, Gallstone pathologies, pancreatitis……)
Interns are responsible for monitoring post-op complications. This is prevented via a …..?
what is it and what is included in it?
Wound bundle. It is a standardised set of evidence-based practices that aim to !!prevent surgical site infections (SSI)!!
Similar to ERAS but specifically targeting SSIs
1) Pre-op optimization as in ERAS (Pre-op bathing, glucose control, thyroid control , smoking cessation 4 weeks pre-op, antibiotic prophylaxis, skin prep and hair removal)
2) Intra-op aspetic technique, normothermia, wound protection, antibiotic re-dosing)
3) Post-op: Dressing care, wound monitoring for erythema, drainage, swelling, managing drain, patient education
Say “ I wanna put in a drip “ in exam speak
I will site a 16G Cannula in the antecubital fossa
What is the transfusion trigger for a patient presenting with a bleed?
Typically Hb<7
If cardiac hx <8
I have updated it in the 10 steps and the section is as follows now:
Type and save/ group and hold/ Group and cross match 4 units of blood (10 for AAA). If Hb<7 (or <8 if Cardiac hx) give in 1:1:1 aiming for Hb>8 and >10 in CVD
Always ask about rigors because if they have it its typically sepsis secondary to
cholangitis
Pyelonephritis
Abscess
(pneumonia but less likely)
What is a “defunctioning” stoma?
A stoma that has 2 lumens whereby they brought out a loop of bowel to the surface, cut the top and fixate.
Think of an arm being a loop of bowel and then flex at the elbow, the elbow is the stoma with 2 holes (lumens) in it
How would you differentiate between a hydrocele and an inguinal hernia?
If it is neither of them, what else can it be?
When discussing the management of perforated PUD, what is the chance that the perforation would close spontaneously?
50%
When discussing the management of pancreatic pseudocyst as a complication of acute pancreatitis, what is the possibility of it self-resolving?
50%
What medication is typically prescribed alongside Metformin?
What class is it and how does it work?
Sitagliptin
It is a DPP4 inhibitor which inhibits the breakdown of GLP-1 => increasing insulin secretion while suppressing glucagon secretion
The consultant asks you to prepare a patient for an ERCP procedure. (or any procedure really). What will you do?
First Contact Anaesthetics and Theatre
1) Review patient’s chart for relevant medical history, medications, allergies etc.
2) Consent patient, giving information on procedure, reason for doing it, what it entails, alternatives, and complications
3) Optimise patient for surgery which involves Fasting/NPO (8hrs), Establish IV access (fluids during NPO), Bowel Prep, Urinary catheter, stop relevant medications
4) Pre-procedure investigations to assess baseline, cardiovascular, and respiratory clearance.
5) Confirm anaesthesia plan (Sedation vs aneaesthesia)
6) Documentation
What is Bowel prep?
Bowel prep is part of the pre-operative workup of a patient especially when undergoing GI procedures. It involves the following
1) Dietary Restrictions:
a) Low-fibre diet 2-3 days before,
b) Clear liquid diet 24 hours before
c) NPO 8hrs before
2) Laxatives: polyethylene glycol +/- Senna
What factors delay wound healing?
What can be done via Endoscopy (general, anything)
1) Visualisation
2) Biopsy (all 4 quadrants, 1 cm)
3) US (LN, Small gallstones, depth of invasion)
4) Bleeding: Ablation, sclerotherapy injection
5) Achalasia: Botox injection, Pneumatic dilatation, endoscopic myotomy
6) Endoscopic mucosal resection, radiofrequency ablation, submucosal dissection
Im sure theres more
What is 1 stone in Kg?
6.35
Virchow’s node is the last node in the thoracic duct.
What is the sign called when it is enlarged?
What cancer is most associated with this finding?
Troissier’s sign
Gastric cancer (that is how it was first described)
Weight loss from cancer also manifests itself via loss in muscle bulk. What is that called?
What is the gold standard for measuring this?
Sarcopenia
Gold standard = MRI psoas
Why do we perform an exploratory/staging laparoscopy for patients with adenocarcinoma? Why is this the gold standard?
For peritoneal mets (we take cytology)
This is performed as CT can only detect this in very advanced disease when cure is no longer an option
When performing a PET CT FDG, what organs are normally lit up?
Brain
Bladder
Heart
Liver
Spleen
Post-op pyrexia, give your differentials
what antibiotic would you give?
From early to late (7Cs)
Chest - Atelectasis/pneumonia/aspiration
Catheter (UTI)
Cannula (site infection/sepsis)
Central line (same(
Collection (abscess/surgical site infection)
Calves (DVT/PE)
C.Diff (collitis/toxic megacolon)
Others:
Blood transfusion reaction!!!
Thyrotoxicosis
Malignant hyperthermia
Best = Piptaz
Correct answer: Guided by site of infection, cause, and hospital antimicrobial guidelines
Why would an alcoholic be refused surgery?
Withdrawal causes
1) increased risk of seizures
2) 50% risk of death with anaesthetics
When percussing the liver. Where should you start (if you were working up to down)
2nd ICS MCL
In an abdominal exam, when performing superficial palpation, What layer are you assessing for pain?
What about deep palpation?
What about rebound tenderness?
Superficial (parietal peritoneum)
Deep ( Visceral peritoneum)
Omentum or the snap of the superficial peritoneum to the visceral peritoneum which are inflamed
What diagnosis is being shown in this image?
What is the likely cause?
Air pockets on the edge of the lung. So it can be either
1) Subcut emphysema secondary to trauma e.g. rib fracture
2) Paraseptal emphysema secondary to chronic lung disease e.g. COPD, IPF… (This is what is shown in the image as it is within the lung)
Oesophageal perforation:
What is the most common cause?
What is the most common location for the perforation?
What triad would the patient present with?
How is it managed?
70% of esophageal perforations are due to iatrogenic cause
Most common location of perforation is the left posterolateral space
Mackler’s triad
1) Vomit
2) Chest pain
3) Subcutaneous emphysema
ABCDE + Options
Conservative if very small perforatio
Stenting + percutaneous drainage
Primary closure (<24 hrs)
Oesophagostomy
Oesophagectomy
A patient with a previous endoscopy yesterday falls on a table. You palpate over the left posterolateral space. What does it feel like?
feels like air bubbles moving around. feels like Rice crispies
Child fall off bike
Pancreatic injury/haematoma
Duodenal haematoma
What is the blood supply to blood vessels?
What is the blood supply to nerves?
Vasa Vasorum
Vasa Nervosum
When performing Buerger’s test and assess for hyperaemia, what is the reason behind it?
Separates it from other pathologies that may have redness over the legs e.g. cellulitis, erythema nodosum…
PAD is reactive => hyperaemia occurs after a brief state of reduced blood supply (while raising the leg) => reactive hyperaemia
You want to perform an ABPI. How will you do it?
1) Lie patient flat in room temperature for 5 minutes
2) Take Brachial BP from both arms and take the highest
3) Take Ankle BP from all 3 arteries (post tibial, ant. tibial, peroneal)
4) Take Toe pressures
Which of the 3 ankle vessels do not continue to the foot?
Peroneal
The other 2 (ant and post tibial) continue to form a transmetatarsal anastomotis
Which toe is toe pressure taken from?
It can be taken from any toe but typically big toe
Discuss boots used in vascular surgery patients
TCC - Total contact cast/ CROW boot - Charcot restraint orthotic walker
Gold standard for use in diabetic foot ulcers to offload pressure by distributing weight evenly
IPC - Intermittent Pneumatic Compression (Vascuease)
Used in venous insufficiency and DVT (pre and post). Uses air chambers which inflate and deflate to mimic action of the gastrocnemius muscle.
What does TcPO2 stand for?
What is the normal value? What about for CLI?
Where is it taken from most commonly?
Transcutaneous oxygen tension/pressure
Normal = 50mmHg
CLI = <30
Taken most commonly from the dorsum of the foot or from plantar surface (more accurate in diabetics)
List all the investigations you may perform to diagnose CLI along with the parameters. (dont think of too acute to do them, just state them)
Clinical, pulses etc
Doppler/Duplex US
CT/MR angiogram
Numbers to know 2,35,35,510,51
TBI <0.2 (normal >0.75)
Toe pressure <30 (normal 50)
Transcutaneous oxygen Tension <30 (normal 50)
Ankle pressure <50 (normal 100)
ABPI <0.5 (normal >1)
A patient with AAA repair notices weakness on one limb. what is the most likely cause?
This patient most likely had an EVAR for AAA repair which can cause infarction to the anterior spinal artery as a complication leading to lateral paralysis (which is just one sided paralysis)
If someone has one autoimmune disorder, what else should you ask about in a history?
Other autoimmune diseases that are linked =>
Thyroid
Caeliac disease
T1DM
Rheumatoid
Vasculitis
CTDs
When should a patient ideally stop smoking before an elective surgery?
6 weeks
