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YR3 - R3: Surgery > Week 3 - Practical Procedures, Drugs, Pain, Wounds, & Skin > Flashcards

Week 3 - Practical Procedures, Drugs, Pain, Wounds, & Skin Flashcards

1
Q

Give 6 examples of the drugs that are used to lessen pain in post-operative patients.

A
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2
Q

What is Palexia (Tapentadol)? Main actions?
Formulations?

A

Tapentadol is a centrally acting analgesic medication that is used for the management of moderate to severe acute pain. It is classified as an opioid analgesic but has a dual mechanism of action, combining mu-opioid receptor agonism and norepinephrine reuptake inhibition.

The main properties of tapentadol include:
1. Mu-opioid receptor agonism: Tapentadol activates the mu-opioid receptors in the brain and spinal cord, producing analgesic effects. It provides pain relief by reducing the perception of pain and altering the transmission of pain signals.
2. Norepinephrine reuptake inhibition: Tapentadol also inhibits the reuptake of norepinephrine, a neurotransmitter involved in the body’s pain modulation pathways. By increasing norepinephrine levels, tapentadol can enhance pain relief and provide an additional mechanism of action.

Tapentadol is available in immediate-release and extended-release formulations. Immediate-release tapentadol is typically used for acute pain management, while extended-release tapentadol is used for chronic pain management.

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3
Q

List 10 Factors that Impede Wound Healing?

A
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4
Q

List 4 of the common post-operative wound problems and how would you treat these?

A
  1. Surgical Site Infection (SSI)
  2. Wound Dehiscence
  3. Hematoma or Seroma Formation
  4. Delayed Wound Healing
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5
Q

What is meant by the terms “delayed primary closure” and “healing by secondary intention”?

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6
Q

List the common pathogens that produce wound infection.
- 8 Bacteria?
- 4 Viruses?
- 2 Fungi?

A
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7
Q

**Describe the methods that can be used to reduce/prevent wound infection in the surgical patient. **
- 3 Preoperative Measures?
- 5 Surgical Techniques and Practices?
- 4 Postoperative Care?
- 2 Infection control measures?
- Multidisciplinary collaboration?

A
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8
Q

List the different types of suture materials commonly used in surgery.
- 4 Absorbable Sutures?
- 4 Non-Absorbable Sutures?
- 2 Specialty Sutures?

A
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9
Q

**Indicate the standard time for removal of sutures for different parts of the body. **
- Face and Scalp?
- Trunk and Extremities?
- Joints and Tendons?

A
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10
Q

Perform simple interrupted skin sutures in a skin model.
Correctly remove sutures and staples.

A

See Geeky Medics.

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11
Q

Define the term ‘ulcer’.
- 5 Types of Ulcer Edges?

A

A morphologic descriptor used to describe several types of lesions. In dermatology, it refers to a loss of the epidermis, including the basement membrane, with exposure of the underlying dermis (partial thickness), subcutis (full thickness), or muscle, bone, or tendon. In gastroenterology, it refers to a lesion that extends beyond the mucosa (disrupts the muscularis mucosae) to involve the submucosa and beyond.

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12
Q

What are the 5 common types of ulcers of the skin?

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13
Q

What are the 5 common types of ulcers of the gastrointestinal tract?

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14
Q

Define: Fistula.

A

= an abnormal connection between two epithelium-lined surfaces.

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15
Q

Define: Sinus.

A

= A cavity, space, or channel in the body.
A sinus, in the context of human anatomy, refers to a cavity or hollow space within a tissue or organ. Sinuses can be found in various parts of the body, including the skull, bones, and respiratory system.

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16
Q

Define: Gangrene.

A

Gangrenous necrosis = A subtype of coagulative necrosis most commonly seen in the limbs and gastrointestinal tract (after chronic ischemia). Further divided into dry gangrene (caused by ischemia) and wet gangrene (caused by superinfection).
- Gangrene is a serious medical condition characterized by the death and decay of body tissue, typically as a result of a lack of blood supply or infection. It occurs when there is a significant disruption in the blood flow to a particular area, leading to tissue ischemia (lack of oxygen and nutrients) and subsequent tissue death.

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17
Q

Define: Ischaemia.

A

Ischemia (also spelled as “ischaemia”) refers to a condition characterized by an inadequate blood supply to a specific tissue, organ, or part of the body. It occurs when there is a reduced or completely blocked blood flow, resulting in a diminished supply of oxygen and nutrients to the affected area.

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18
Q

Define: Necrosis.
- 4 Types?

A
  • Necrosis is a type of cell and tissue death characterized by the irreversible damage and breakdown of cells in a localized area. It occurs as a result of various factors, including injury, infection, inadequate blood supply (ischemia), toxins, or certain medical conditions.
  • During necrosis, the affected cells lose their ability to maintain normal cellular processes and undergo structural and functional changes. This can lead to inflammation, loss of tissue integrity, and the release of cellular contents into the surrounding area.
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19
Q

Define: Abscess.

A

= An enclosed collection of pus within tissue. Usually caused by a bacterial infection.

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20
Q

List 6 complications/hazards of local anaesthetics.

A
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21
Q

Describe how you would obtain “informed consent” for removal of a melanoma under local anaesthetic from a patient’s forearm.
- 11 Steps?

A
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22
Q

What are the main types (5) of malignant melanoma and how would you confirm your diagnosis?

A

Malignant melanoma is a type of skin cancer that arises from melanocytes, the pigment-producing cells in the skin. There are several main types of malignant melanoma, each with distinct characteristics. To confirm a diagnosis of melanoma, a combination of clinical evaluation, dermatoscopic examination, and histopathological analysis is typically used.

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23
Q

A patient presents with an axillary abscess and surrounding cellulitis. Discuss your management.
- 7 Steps?

A
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24
Q

What are 5 indications for intravenous cannulation?

A

Intravenous (IV) cannulation is a common medical procedure that involves inserting a cannula into a vein to administer fluids, medications, or perform blood sampling.

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25
Q

What are 5 Contraindications for intravenous cannulation?

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26
Q

List 8 Complications of intravenous cannulation?

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27
Q

List 5 Indications for Venesection other than for blood tests?

A

Venesection, also known as phlebotomy or bloodletting, is a medical procedure in which a specific amount of blood is intentionally removed from a patient’s vein. It can be used for therapeutic or diagnostic purposes.

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28
Q

List 5 Contraindications for Venesection?

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29
Q

List 8 Complications of Venesection?

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30
Q

What are 4 Indications for Arterial puncture for blood gas analysis?

A

Arterial puncture for blood gas analysis is a medical procedure in which a small needle or lancet is used to obtain a sample of arterial blood for the measurement of oxygen, carbon dioxide, and pH levels.

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31
Q

What are 4 Contraindications for Arterial puncture for blood gas analysis?

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32
Q

What are 4 Complications of Arterial puncture for blood gas analysis?

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33
Q

What are 5 Indications for DRE?

A

A rectal examination, also known as a digital rectal examination (DRE), is a physical examination technique in which a healthcare professional inserts a gloved, lubricated finger into the patient’s rectum to assess the rectal and prostate areas.

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34
Q

What are 4 Contraindications for DRE?

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35
Q

What are 5 Complications of DRE?

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36
Q

What are 4 Indications for proctoscopy?

A

Proctoscopy is a medical procedure that involves the insertion of a proctoscope, a thin, flexible tube with a light and camera, into the rectum to visualize and examine the rectal and anal areas.

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37
Q

What are 4 Contraindications for proctoscopy?

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38
Q

What are 6 Complications for proctoscopy?

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39
Q

List 5 Indications for Nasogastric tube insertion?

A

Nasogastric (NG) tube placement is a medical procedure in which a flexible tube is inserted through the nose into the stomach. It is used for various diagnostic, therapeutic, or nutritional purposes.

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40
Q

List 5 Contraindications for Nasogastric tube insertion?

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41
Q

List 6 Complications of Nasogastric tube insertion?

A
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42
Q

What are 3 indications for faecal occult blood testing?

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43
Q

What are 3 Contraindications for faecal occult blood testing?

A
44
Q

What are 5 Complications of faecal occult blood testing?

A
45
Q

List 6 Indications for Female Urinary Catheterisation?

A
46
Q

List 4 Contraindications for Female Urinary Catheterisation?

A
47
Q

List 7 Complications of Female Urinary Catheterisation?

A
48
Q

6 Indications for Male Urinary Catheterisation?

A
49
Q

4 Contraindications for Male Urinary Catheterisation?

A
50
Q

6 Complications of Male Urinary Catheterisation?

A
51
Q

6 Complications of Male Urinary Catheterisation?

A
52
Q

List 4 Recommended vaccinations in people with functional or anatomical asplenia?

A
  1. Hib (Haemophilus influenzae type b) vaccine
  2. Influenza vaccine
  3. Meningococcal vaccines
  4. Pneumococcal vaccines
53
Q

Why are headaches associated with raised ICP worse in the morning?

A
  1. Been lying down
  2. Breathe less during sleep = hypoventilation = increased CO2 = vasodilation
54
Q

List 3 Mechanisms of Traumatic Brain Injury?

A
55
Q

Mechanisms of TBI
- Coup?
- Contrecoup?

A
  • The coup injury is caused when the head is stopped suddenly and the brain rushes forward hitting the skull and internal ridges.
  • Injury to the brain occurring directly beneath the area of impact.
  • The Contrecoup is caused when the brain bounces off the primary surface and impacts against the opposing side of the skull.
  • Injury to the brain directly opposite to the site of impact.
  • In the 17th century, Jean Louis Petit first described contrecoup injury.
  • In 1768, Louis Sebastian Saucerotte won the Prix de l’Académie Royale de Chirurgie prize for his paper describing contrecoup injuries in humans and experiments on animals and recommending treatments such as bloodletting and application of herbs to patients’ heads.
56
Q

Mechanisms of TBI
- Diffuse axonal injury?

A
  • DAI classically was believed to represent a primary injury (occurring at the instant of the trauma).
  • Currently, however, it is apparent that the axoplasmic membrane alteration, transport impairment, and retraction ball formation may represent secondary (or delayed) components to the disease
    process.
57
Q

What is Glutamate?

A
58
Q

What role does calcium play in neuroplasticity?

A
59
Q

Pathophysiology of TBI - Apoptosis?

A
60
Q

How do we prevent traumatic brain injuries - primary?

A
  • Education
  • Drink driving
  • Helmets
  • Seatbelts
61
Q

What are the 2 most important things to address when trying to prevent secondary brain injuries?

A
  1. Hypoxia
  2. Hypertension
62
Q

8 Gross pathologies associated with TBI?

A
  1. Extradural haematoma
  2. Subdural haematoma
  3. Traumatic subarachnoid haemorrhage
  4. Intraventricular haemorrhage
  5. Petechial haemorrhage
  6. Cerebral Contusion
  7. Intracerebral Haematoma
  8. Diffuse cerebral swelling
63
Q

What is this?
- 6 features?

A

= Extradural haematoma
2. 1. Bi Convex / Lentiform appearance
2. Limited by sutures
3. Meningeal artery tear or bone fracture
4. Temporal region most commonly
5. Sometimes Lucid interval
6. Survivable !!

64
Q

What is this?
- 4 Features?

A

= Subdural haematoma
1. Concave appearance
2. Not limited by sutures
3. Cortical cerebral artery or vein tear
4. More severe brain injury that extradural haematoma

65
Q

List 5 types of Herniation syndromes associated with TBI?

A
66
Q

What is an Uncal (transtentorial) herniation syndrome?

A
67
Q

Explain why we assess pupils in suspected TBI?

A

3rd cranial nerve - parasympathetic fibres only = loss of afferent component/dilation = loss of direct but not consensual??
Symptom of herniation

68
Q

What is Tonsillar Herniation syndrome?

A
69
Q

What is the Monroe Kellie Doctrine?

A
70
Q

Explain the Monroe Kellie Doctrine and ICP in normal physiology?

A

Blood & CSF can be pushed out to accomodate for raised ICP - eg. coughing or sneezing

71
Q

What is the ICP range for Partially compensated intracranial hypertension according to the The Monroe Kellie Doctrine?

A
72
Q

What is the ICP range for Uncompensated intracranial hypertension according to the The Monroe Kellie Doctrine?

A
73
Q

List 4 Symptoms of Raised Intracranial Pressure?

A
74
Q

What might the following GCS breakdown be caused by?

A
75
Q

What might the following GCS breakdown be caused by?

A
76
Q

What might the following GCS breakdown be caused by?

A
77
Q

Would you discharge this patient home? (ie. are they improving)

A

= NO - even though they have improved over days 1-5, they still have significant cerebral midline herniation and they have dropped from V5 to V4 in days 5-9 = gone from oriented to confused!!

78
Q

What will be included in your physical examination of a patient with a suspected TBI?
- Which muscle groups specifically?

A
79
Q

Describe the Immediate management of Head injury - Airway?

A

CALL NEUROSURGEON!

80
Q

Describe the Immediate management of Head injury - Breathing?

A

Feel - unsymmetrical chest expansion
Listen - air entry

81
Q

Describe the Immediate management of Head injury - Circulation?

A
82
Q

List 4 Definitive surgical management techniques for TBI?

A
83
Q

Medical management of TBI - 6 things to maintain cerebral perfusion?

A
84
Q

12 reasons why surgeons perform ward rounds?

A
  1. Inform the patient
  2. Monitor progress
  3. Ensure analgesia
  4. Monitor nutrition
  5. Check Fluid balance
  6. Check drains
  7. Prevent complications
  8. Identify complications
  9. To teach
  10. Plan discharge
  11. Liaise with nurses
  12. Liaise with allied health
85
Q

How can post-operative complications be classified?
How can post-operative haemorrhage be classified?

A

Complications
- General/Specific
- Immediate (less than 24h)
- Early (1 month)
- Late (>1 month)

Types of Haemorrhage
- Primary: At the time of surgery
- Reactionary: Tie slipping/Clot dislodging
- Secondary: To Infection

86
Q

What is SIRS? Diagnostic criteria?

A

SIRS = Systemic Inflammatory Response Syndrome
- SIRS is PERSISTENT

87
Q

Why do patients become tachypnoeic?

A

ANAEROBIC METABOLISM = ACIDOSIS
- RR more than 20 : Unwell
- RR more than 24 : CRITICALLY ILL

RESTLESSNESS

88
Q

10 types of analgesia options?

A
89
Q

What is shock? 4 mechanisms?

A

Shock = Inadequate
Cellular Perfusion
Mechanisms
1. Hypovolaemia
2. Cardiogenic
3. Obstructive
4. Vasodilatory

90
Q

5 Sites of bleeding that can be significant enough to cause hypovolaemic shock?

A
91
Q

List Sources of Pyrexia:
- 6 Infective?
- 7 Non-infective?

A
92
Q

Risk Factors for Post-operative Infection
- 7 Patient factors?
- 7 Wound factors?
- 4 Surgeon factors?

A
93
Q

5 points where pressure sores can occur?

A
  1. Scapula
  2. Ischial tuberosity
  3. Trochanter
  4. Malleoli
  5. Elbow
94
Q

4 commonest causes of post-operative shortness of breath?

A
  1. Atelectasis
  2. Retention of sputum
  3. Exacerbation COPD
  4. Aspiration
95
Q

Post-operative Thromboembolic Disease
- Epidemiology?
- Mortality?
- Virchow’s Triad?

A

Epidemiology
- 25% General Surgery have DVT
- 3% of Inpatient Deaths
- 0.8% of Patients undergoing Surgery Die

Mortality
- Untreated: 30%
- Treated: 2%

96
Q

Post-operative Thromboembolic Disease
- Clinical picture?
- Components of Modified Wells Score?
- Prophylactic measures?

A

MODIFIED WELLS SCORE
- Clinical Signs and Symptoms DVT
- An alternative diagnosis is less likely than PE
- Heart Rate>100
- Surgery in past 4 weeks
- Previous PE/DVT Haemoptysis
- Malignancy

97
Q

Post-operative DVT/PE
- 8 Investigations?
- 4 Complications?

A

Investigation
1. ABG
2. ECG
3. CXR
4. VQ
5. CT
6. PA
7. Duplex
8. D-Dimer

Complications
1. DEATH
2. Pulmonary Hypertension
3. Right Heart Failure
4. Post-Phlebitic Limb

98
Q

Post-operative Fistula
- Definition?
- 4 Types?
- 6 Aetiologies/causes?

A

Definition: “Abnormal communication between two epithelial surfaces”
1. Colo-vesical
2. Colo-vaginal
3. Enterocutaneous
4. Cholecysto-colic
5. Tracheo-oesophageal

99
Q

Post-operative Fistula
- Management? (4)
- 10 reasons for failure to heal?

A

Fistula Management
- Control of sepsis and wound care
- Provision of nutritional support
- Define anatomy
- Definitive procedure

100
Q

Day 1 Post-operative fever if no prior infection?

A

= Atelectasis
Tx = physio

101
Q

What is this post-op fever caused by?

A

= Abscess or drug fever

102
Q

Cause? Isolated on D5?

A

= catheter related sepsis - pull the line, send tip for cultures

103
Q

3 possible causes?

A

Malignancy
Old TB reactivation
PE

104
Q

What 2 things are you trying to distinguish between in a patient with post-operative confusion?
- Causes?

A

Delirium & Dementia

105
Q

5 Complications of post-op Parenteral feeding?
5 Complications of post-op Enteral feeding?

A
106
Q

Mechanism & Example of:
- Respiratory Alkalosis?
- Respiratory Acidosis?
- Metabolic Alkalosis?
- Metabolic Acidosis?

A

YR3 - R3: Surgery (8 decks)

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