Block 1 Flashcards
(40 cards)
Explain about the asepsis and the method of asepsis
Asepsis refers to absence of infectious material or infection
Method :
I) Sterilization : technique necessary for the complete destruction or remove, of all microorganism that could contaminate any area , equipment or surface during an invasive procedure and constitute a health hazard.
II) Disinfection : processs of killing all,microorganism except spores on an inanimate object
Ex:
physical agents : sunlights , drying , heat-dry and moist , filtration , radiation
Chemical agents : alcohol , aldehyde , dye , halogens , gases
State the classification of ulcers
Specific ulcers
1) TB ulcer
2) Syphillis
3) Actinomycosis
4) Malignancies
- squamous cell carcinoma
- basal cell carcinoma
- malignant melanoma
- Marjolin’s ulcer
Non specific ulcers
- Infective
- Traumatic
- Trophic
-Tropical
- Diabetic
- Cryopathic
- Bazin’s ulcer
- Martorell ulcer
Describe the types of edges an ulcer might have with an example of each
1) Undermined edge
- subcutaneous tissue destroyed faster than skin
- overhanging skin is thin , friable , reddish-blue and unhealthy
- ex: TB ulcer
2) Punched out edge
- edge of ulcer drops at right angles to the skin surface
- ex: deep trophic ulcer ( DM , arterial ulcer , syphillis )
3) Sloping edge
- ex: healing traumatic ulcers , venous ulcers
4) Raised and pearly white , beaded edge
- ex : BCC
5) Rolled Out / everted edge
-due to fast growing cellular disease , edge of ulcer heaps up and spills over the normal skin
- ex : SCC , ulcerated adenocarcinoma
State the 5 aspects of patient treatment in case of diabetic foot ulcer
1) Strict glycaemic control
- diet ( low GI food )
- OADA , insulin use
2) Wound management
- cleaning and dressing everyday
3) Microbiological management
- antibiotics for infections
4) Vascular management
-sympathectomy to cause perpetual vasodilation — prevent ischemia
- arterial grafts to increase blood supply to ulcer area
5) education ( life-style modifications , awareness )
- exercise , diet , increased 3-6 monthly medical checkups , special footwear
- check feet often , moisturise
- wear shoe with clean dry socks
- stop smoking and alcohol
( ……………… ) ulcers are more commonly found on the medial malleolus of a lower limb with varicose vein
( …………… ) is commonly found on the upper part of face , above a line joining the angle of the mouth to the lobule of the ear
( …………… ) ulcers are common in the region of lymphadenopathy — neck , axils and groin
( ………….. ) ulcers are found at the heel , ball of toes
( ………… ) ulcers are found over old scars , burns
( ………….. ) ulcers are usually located in the anterior and outer aspects of the leg ( above lateral malleolus ) , dorsum of foot , toes or the heel
( …………. ) ulcers present on the genitals and groin
( Venous ) ulcers are more commonly found on the medial malleolus of a lower limb with varicose vein
( Rodent ulcers ) is commonly found on the upper part of face , above a line joining the angle of the mouth to the lobule of the ear
( TB ) ulcers are common in the region of lymphadenopathy — neck , axils and groin
( Diabetic ) ulcers are found at the heel , ball of toes
( Marjolin ) ulcers are found over old scars , burns
( Arterial ) ulcers are usually located in the anterior and outer aspects of the leg ( above lateral malleolus ) , dorsum of foot , toes or the heel
( Syphilitic ) ulcers present on the genitals and groin
Which type of tumor shows positive slipping sign ?
Lipomas
Diabetic foot ulcer arises as a results of ( ……………………………. )
Diabetic foot ulcer arises as a results of ( microvasculopathy , peripheral neuropathy and localised infection)
Atherosclerosis of small arteries of toe leads to peripheral neuropathy —> loss of sensation —> inability to feel pain —> ulceration & infections
Neuropathy also cause loss of sweating —> develops dry skin & cracks —> portal of entry of bacteria , motor function of foot also affected
List some preanaesthetic investigations and their indications
Complete blood count ( T&D count , Hb% , ESR , blood indices )
- Age > 60 years old
- Major surgery
- Clinical anemia
- Hematological disease
- Renal disease
- Chemotherapy
Renal profile ( urea , creatinine , GFR , electrolytes , uric acid )
- Age > 60y
- Major surgery
- Renal disease
- Liver disease
- DM
-CVD
- Abnormal nutritional status
- Diarrhoea , vomiting
ECG
- Male > 40 y , F >50 y
-CVD
-DM
- Renal disease
- Intracranial bleeding
Random blood sugar ( FBS , HBA1c )
- Age > 60y
- DM
-Liver dysfunction
CXR
- Age >60y
- Major thoracic / upper abdominal surgery
- Respiratory disease
- CVD
- Malignancy
State the early complication of fever ( occurs in the first 2 days )
1) Fever
- reactionary , not infection
2) Atelectasis of lung
- complete / partial collapse of lung
Describe what should be written in a discharge certificate
1) Diagnosis ( which the operation is done for )
2) Treatment done and by whom
3) Complication ( of the operation )
4) Advice for referring to back to hospital & indications for readmission if specific problems occur
5) Subsequent care / medicine plan
6) Follow up date
State the indications for nasogastric tube
1) To diagnose
- GI bleeding
- penetrating or blunt trauma
2) For therapeutic
- paralytic ileus
- gastric dilatation
- intestinal obstruction
- persistent vomiting
- removal of toxin and pill fragments
- heating or cooling for temp abnormalies ( hypo/hyperthermia)
3) Prophylactic measure
- to prevent aspiration in multiple trauma
- for decompression prior to abdominal surgery or peritoneal lavage
4) Instillation of materials
- medications
- contrast solution
- feeding
- charcoal
5) Indications requiring specialist referral
-oesophageal varies
- laryngectomy
- basal skull fracture
- unstable cervical spine injury
- oropharyngeal tumors or surgery
State swelling that move with deglutition
-Thyroid cyst
- thyroglossal duct cyst
- pretracheal and paratracheal lymph nodes
State a swelling that moves with tongue protrusion
1) Thyroglossal duct cyst
( ………………….. ) lymph node can enlarge in metastasis with malignancy
( left spraclavicular ( Virchow ) ) lymph node can enlarge in metastasis with malignancy
Swelling of short duration and pain ( ……………….. )
Swelling of long duration and pain (……………….. )
Swelling of short duration but painless ( ………………)
Swelling of long duration but painless (………………..)
Swelling of short duration and pain ( inflammation)
Swelling of long duration and pain ( chronic inflammation)
Swelling of short duration but painless ( malignant neoplasm )
Swelling of long duration but painless ( benign neoplasm )
Describe the median mental sinuses
- sinus on the chin as a result of chronic apical abscess due to pulp necrosis of mandibular tooth
- tooth is usually asymptomatic
( ……………….. ) operation is the treatment of thyroglossal cyst
It involves
(……………………….. )
(…………………………..)
(…………………………)
( Sistrunk ) operation is the treatment of thyroglossal cyst
It involves
( Middle part of the body of hyoid )
( thyroglossal cyst )
( entire thyroglossal tract up to foramen caecum in the tongue )
Describe the thyroglossal duct cyst
- most common development cyst in the neck
- occurs due to remnants / improper descent of thyroid gland from foramen caecum of tongue to its normal position below the thyroid cartilage
- moves with deglutition , and during tongue protrusion
- common sites
I) subhyoid
II) Suprahyoid
III) at level of thyroid cartilage
IV) At level of cricoid cartilage - DDX : epidermoid cyst , bronchial cyst , , pretracheal lymph nodes , collar stud abscess , lipoma , sebaceous cyst
Severe pain in the right hypochondriac region ( …………………. )
Epigastric region ( …………………… )
Left hypochondriac ( …………………. )
Right lumbar ( ………………….. )
Umbilical region ( …………………….. )
Left lumbar ( …………………… )
Right iliac ( ………………… )
Hypogastric region ( ……………………. )
Left iliac region ( ……………………… )
Severe pain in the right hypochondriac region ( cholecystitis )
Epigastric region ( pancreatitis )
Left hypochondriac ( chronic pancreatitis )
Right lumbar (cholelithiasis )
Umbilical region ( diverticulitis )
Left lumbar ( kidney stones)
Right iliac ( right appendicitis )
Hypogastric region ( cystitis ( bladder) )
Left iliac region ( acute diver units of colon )
Describe the clinical features of appendicitis
1) Sharp , localised pain in the right iliac region
2) Vomiting , nausea , diarrhea , constipation
3) Anorexia
4) Rebound tenderness & percussion pain over McBurney’s point
- Mc Burney’s point is 1 /3rd of distance from ant sup iliac spine to navel
5) Rovsing sign
- pain in lower right quadrant with palpating of lower left quadrant
6) Psoas sign
- passive extension of right hip joint which stretches iliopsoas muscle causes pain
State causes of appendicitis
1) Faecolith
2) Impacted stool
3) Appendiceal , caecal tumors
4 ) Lymohoid hyperplasia
State complications of appendicitis
1) Abscess formation
2) Rupture -> peritonitis
In pancreatitis , discolouration / bruises associated with fat necrosis are seen at the ( …………………………………………. ) and ( …………………. )
In pancreatitis , discolouration / bruises associated with fat necrosis are seen at the ( loin / flank ( Gray Turner’s sign ) and ( umbilicus ( Cullen ‘s sign ) )
State causes of pancreatitis
1) Gall stone obstruction
2) Ethanol /excess alcohol
3) Idiopathic
4) Trauma
5) Autoimmune
6 ) Mumps
