Surgical conditions

Question 1

What does SOCRATES stand for

Answer 1

Site
Origin
Character
Radiation
Associated symptoms
Time
Exacerbation or releiving
Severity

Question 2

What are the 3 types of pain someone can have?

Answer 2

Somatic
Visceral
Neuropathic

Question 3

What is Somatic pain?

Answer 3

MSK or body surface

Question 4

What is visceral pain?

Answer 4

Internal organs

Question 5

What is neuropathic pain?

Answer 5

Spinal Cord and peripheral nerves

Question 6

Where is the pancreas located?

Answer 6

Epigastric area

Question 7

Where can pain radiate to if you have pancreas pain?

Answer 7

The back

Question 8

What do you check if someone has Peritonitis?

Answer 8

Amylase

Question 9

What kind of pain might someone have if they have toothache?

Answer 9

MSK pain

Question 10

What kind of pain is post op pain likely?

Answer 10

Somatic +/- visceral

Question 11

4 steps to manage pain?

Answer 11

1. Oral/topical analgesic
2. Local analgesia
3. Regional analgesia (spinal/epidural)
4. Patient controlled analgesia

Question 12

What might you use for local analgesia around a wound?

Answer 12

Bupvicaine

Question 13

What is the WHO pain ladder?

Answer 13

Step 1- mild pain- non-opiod +/- adjuvent analgesia
Step 2- mild-moderate pain- opiod for pain + non-opiod +/- adjuvent analgesia
Step 3- Severe pain- opiod for pain + non-opiod +/- adjuvent analgesia

Question 14

What is a simple analgesia?

Answer 14

Paracetamol

Question 15

What are examples for NSAIDS?

Answer 15

Aspirin, Ibuprofen, Biclofenac, Naproxen, Celocoxib

Question 16

When should you be cautious with Biclofenac?

Answer 16

Cardiovascular disease

Question 17

What is a mild opiate?

Answer 17

Codeine, co-codamol

Question 18

What is a moderate opiate?

Answer 18

Tramadol

Question 19

What is a strong opiate?

Answer 19

Morphine, Oxycodone, Pethadine

Question 20

Why is Pethadine not recommended post operatively?

Answer 20

It is metabolised by the renal system

Question 21

What are adjuvents to Analgesia?

Answer 21

Gabapentin, Carbamazipine, Amytriplyline

Question 22

What are some side effects of opiates?

Answer 22

N & V
Constipation
Toxicity
Respiratory depression

Question 23

NSAIDS cause various side effects, what are they?

Answer 23

Renal impairment
Hepatic impairment
Avoided in pregnancy
Gi pathology- ulceration and GORD
Asthma symptoms may be worsened
Risk of Cv disease- MI

Question 24

What are signs of Opiod toxicity?

Answer 24

Decreased consciousness
Pin point pupils
Seizures
Muscles spasm
Cyanosis

Question 25

What should you do if someone is suffering from opiod toxicity?

Answer 25

ABCDE approach | Naloxone 0.4-2mg at intervals of 2-3 mins.

Question 26

Electrolytes will be altered- explain what happens

Answer 26

Vomiting will depite the body of water and HCl- leading to hypochloremic alkalosis

Question 27

What are the K levels of someone with hypochloremic alkalosis?

Answer 27

<3.5mmol/L

Question 28

What is post op Pyrexia?

Answer 28

Fever

Question 29

Post op pyrexia day 1-2 cause?

Answer 29

Atelectasis (fluid)

Question 30

Post op pyrexia day 3-4 cause?

Answer 30

Pneumonia (after anasthetic in operation)

Question 31

Post op pyrexia day 4-5 cause?

Answer 31

Anatomostic leak

Question 32

Post op pyrexia day 7-8 cause?

Answer 32

Would infection

Question 33

Post op pyrexia 8+ cause?

Answer 33

DVT

Question 34

What is sepsis?

Answer 34

``` SIRS is when 2 or more of: temp is <36/>38 HR>90 RR>20 WCC<4 >12 BG >7.7mmol/L ```

Question 35

What is sepsis shock?

Answer 35

Severe sepsis when BP is constantly low and failed response to fluid

Question 36

What is the Sepsis 6??

Answer 36

1. Oxygen 2. Take blood tests 3. IV antibiotics 4. Fluid challenge 5. Measure lactate 6. Measure urine output

Question 37

What is primary haemorrhage?

Answer 37

Continuous bleeding during surgery

Question 38

What is secondary haemorrhage?

Answer 38

1-2 weeks post op due to infection

Question 39

What is reactive bleeding?

Answer 39

Bleeding stable until high BP

Question 40

What are the signs of a class 3 haemorrhage?

Answer 40

``` Blood loss: 1500-2000ml %: 30-40 Pulse >120 BP: Decreased RR: 30-40 Symptoms- confused Urine output- 5-15ml ```

Question 41

What drug if someone had DVT?

Answer 41

Heparin