Monday 16th Flashcards
(27 cards)
pneumoperitoneum
an abnormal finding suggestive of a perforated abdominal viscus (e.g. a perforated duodenal ulcer)
Rigler’s sign
double wall sign
AXR: intestinal perforation
- numerous loops of small bowel outlined by gas both within the lumen and free within the peritoneal cavity
- Ascites is also seen, with mottled gas densities over bilateral paracolic gutters
- serosal surface should not be visible as it is normally in contact with other intra-abdominal content of similar density (other loops of bowel, omentum, fluid)
- gas abuts the serosal surface rendering it visible
- Film obtained supine = absence of air-fluid levels, ascites pools in the paracolic gutters, with fluid mixed in with gas bubbles
Molluscum contagiosum
- common skin infection
- Viral
- Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels
- majority of cases occur in children (often in children with atopic eczema), with the maximum incidence in preschool children aged 1-4 years
- characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter
- Lesions appear in clusters in areas anywhere on the body (except palms and soles)
- Children: lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur
- Adults: sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen
- Rarely, lesions can occur on the oral mucosa and on the eyelids
- Self-limiting. Spontaneous resolution usually occurs within 18 months
- Treatment is not usually recommended
- use simple trauma or cryotherapy
→ Itching = emollient + mild topical corticosteroid (e.g. hydrocortisone 1%)
→ infected (e.g. oedema, crusting) = topical antibiotic (e.g. fusidic acid 2%)
Patients with an uncertain tetanus vaccination history
- booster vaccine + immunoglobulin
- unless the wound is very minor and < 6 hours old
Bishop’s score
used to predict whether induction of labor will be required.
- A score of 5 or less suggests that labour is unlikely to start without induction
- vaginal PGE2 for cervical ripening and labour induction
Induction of labour
Indications:
- prolonged pregnancy, e.g. > 12 days after estimated date of delivery
- prelabour premature rupture of the membranes, where labour does not start
- diabetic mother > 38 weeks
- rhesus incompatibility
Method:
- membrane sweep
- intravaginal prostaglandins
- breaking of waters
- oxytocin
First cervical smear is inadequate
smear should be repeated within 3 months.
Negative hrHPV: test of cure (TOC) pathway
Individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community
Positive hrHPV
- samples are examined cytologically
- if the cytology is abnormal → colposcopy
Positive hrHPV: Abnormal cytology
- borderline changes in squamous or endocervical cells
- low-grade dyskaryosis
- high-grade dyskaryosis (moderate)
- high-grade dyskaryosis (severe)
- invasive squamous cell carcinoma
- glandular neoplasia
Positive hrHPV: Normal cytology
test is repeated at 12 months
Cytology is normal (i.e. hrHPV +ve but cytologically normal) the test is repeated at 12 months
- if the repeat test is now hrHPV -ve → return to normal recall
- if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
- If hrHPV -ve at 24 months → return to normal recall
- if hrHPV +ve at 24 months → colposcopy
If the sample is ‘inadequate’
- repeat the sample within 3 months
- if two consecutive inadequate samples then → colposcopy
Bell’s palsy
- acute, unilateral, idiopathic, facial nerve paralysis
- aetiology is unknown, ?HSV
- peak incidence is 20-40 years and the condition is more common in pregnant women
- lower motor neuron facial nerve palsy - forehead affected*
- post-auricular pain (may precede paralysis)
- altered taste
- dry eyes
- hyperacusis
- no treatment
- prednisolone only
- combination of aciclovir and prednisolone
- Now recommended that prednisolone 1mg/kg for 10 days should be prescribed for patients within 72 hours of onset of Bell’s palsy
- Eye care: prescription of artificial tears and eye lubricants
Prognosis: if untreated around 15% of patients have permanent moderate to severe weakness
Benign ethnic neutropaenia
Common in people of black African and Afro-Caribbean ethnicity
-
Neutropaenia
< 1.5 * 109
- predisposes to severe infection
Neutropaenia: Causes
- Viral: HIV, EBV, hepatitis
- Drugs: cytotoxics, carbimazole, clozapine
- benign ethnic neutropaenia
- haematological malignancy: myelodysplastic malignancies, aplastic anaemia
- rheumatological conditions
- SLE: mechanisms include circulating antineutrophil antibodies
- Rheumatoid arthritis: e.g. hypersplenism as in Felty’s syndrome
- severe sepsis
- haemodialysis
Post op complications: Right-hemicolectomy + ileostomy
- patients may develop significant volume depletion, electrolyte and acid-base disturbances (metabolic acidosis) if the ileostomy output increases or if dietary intake is disrupted or altered
- Hence, it is important to monitor fluid balance including stoma output in these patients.
Cancer: Caecal, ascending or proximal transverse colon
Right hemicolectomy
Ileo-colic
Cancer: Distal transverse, descending colon
Left hemicolectomy
Colo-colon
Cancer: Sigmoid colon
High anterior resection
Colo-rectal
Cancer: Upper rectum
Anterior resection (TME)
Colo-rectal
Cancer: Low rectum
Anterior resection (Low TME)
Colo-rectal (+/- Defunctioning stoma)
