Week 3 questions Flashcards
What’s the most likely diagnosis?
What four initial investigations would you arrange?
Question 4
The abdominal film shows thick-walled loops of oedematous colon in the right upper quadrant. No free air was seen on chest or abdominal radiographs. You suspect possible pseudomembranous colitis as a diagnosis. Which three of the following are true concerning this condition?
Bearing in mind your suspected diagnosis, what further measures and investigations would you consider?
The use of antimotility agents such as narcotics and loperamide in active C difficile infection is discouraged because use of these agents may result in more severe colitis.
Traditional teaching is that drugs like loperamide (Imodium) and diphenoxylate-atropine (Lomotil) will prolong the exposure of the C. diff toxin to the epithelial lining of the colon. This is said to risk causing complications including toxic megacolon.
Complications of pseudomembranous colitis include:
You must perform a DRE (digital rectal examination) with verbal consent on Mr Frank Smith. True or false?
When performing a DRE you need a chaperone. True or false?
Feedback
Up to date blood results are needed but importantly the G&S/Cross match needs to be checked, especially if blood will be needed. The consenting process aims to inform patients of the procedure, the benefits, and risks/complications. This ensures they can make an informed decision. Consent should be obtained by someone who is competent to complete the operation themselves. Pre-op cannulation of a patient and prescribing IVF may not be routinely necessary, but there are some obvious indications to:
1) If indicated with pre-op enema/ bowel prep
2) Diabetic (if needs sliding scale)- insulin controlled or multiple oral hypoglycaemic agent
3) If the patient could remain NBM for long periods (surgery waiting times over several hours)
VTE risk assessment is integral to avoiding PE/DVTs.
Each hospital has different specific protocols in regards to diabetics; so access them and follow protocol. Generally:
1) Diabetics will be first on the list
2) As part of the pre-assessment you will need to assess: the patient’s level of control (approx BM readings during the day), medication/ insulin regime (short vs long acting and prescribe.
3) Most type 1 diabetics will need a sliding scale once they are NBM.
Anti-coagulants should generally be stopped 5 days prior to surgery; if this hasn’t occurred you should inform your seniors.
Lastly, always keep track of your patients so add them to the team list.
Types of surgery
-Emergency – loss of life or limb (limb ischemia)
-Urgent- (diabetic foot)
Scheduled- (weeks to months)
-Elective – Inguinal hernia (if patient is asymptomatic)
Prior to a blood transfusion does Mr Globe needs to give verbal consent?
Which two of the following abnormalities are likely to result in digoxin accumulation?
