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General Surgery 3 rd  Year Revision Nick Harvey MemorableMedicine.com
Meeting the patient Introduce (full name) Explain role / nature of consultation Gain consent Wash hands
Surgical History Don’t forget the basics (age, occupation etc) Change in bowel habit PR blood and/or mucous +/- lump Dysphagia Jaundice Abdominal pain, dyspepsia Urology – renal/ureteric colic, BPH/prostate Ca, testicle Ca Vascular – AAA, PVD, varicose veins, ulcers, TIA/stroke Breast – pain/discharge/size/other lumps; prev lumps; menarche/menopause/cycle) Thyroid – status Qs (incl swallowing) Orthopaedics – OA/RA, trauma Fever/night sweats Weight loss Pain NB: risk factors, symptoms of complications PMH, DH, SH, FH.
Dysphagia
Jaundice
Examination Abdominal PR Breast Hernias Neck/Thyroid (incl thyroid status) Swellings Varicose veins Peripheral vascular disease Ulcers Observation chart OSCE MARK SHEETS DON’T KNOW WHAT THE PATIENT HAS SO DO EVERYTHING!
Abdominal Examination Inspection Ask about tenderness  Palpation (pt level, eye contact) Percussion Auscultation Eponyms  Special tests
Breast Examination
Groin Hernias
Neck/Thyroid Examination Remember: Tongue protrusion Swallow Palpate trachea Offer to examine thyroid status
Investigations Bloods FBC, U&Es, LFTs, INR, amylase, CRP, Ca 2+ , TFTs Tumour markers, autoantibodies G&S, cross-match XRs Cultures Cytology (FNA) and histology U/S CT Endoscopy (incl ERCP) Contrast enemas/swallows MRI (esp MRCP)
Investigating Jaundice
Management Medical/Conservative ABC (oxygen!) Analgesia – WHO ladder Antibiotics PPI/avoid NSAIDs/weight loss Anticoagulation NBM NG tube iv fluids Surgical (incl consent) Laparoscopy/laparotomy/other incision Types of colectomy … Radiological & Endoscopic EVAR, coils, stents,
Complications Anaesthetic Immediate Arrhythmias, pneumothorax, anaphylaxis… General Early UTI, basal atelectasis, pneumonia, c diff, DVT, PE Surgery Immediate Primary haemorrhage, damage to a nearby structure (nerve, ureter, bowel) Early Infection, leak, dehiscence, secondary haemorrhage, ileus, pain  Late Adhesions, recurrence, pain

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General Surgery Revision

  • 1. General Surgery 3 rd Year Revision Nick Harvey MemorableMedicine.com
  • 2. Meeting the patient Introduce (full name) Explain role / nature of consultation Gain consent Wash hands
  • 3. Surgical History Don’t forget the basics (age, occupation etc) Change in bowel habit PR blood and/or mucous +/- lump Dysphagia Jaundice Abdominal pain, dyspepsia Urology – renal/ureteric colic, BPH/prostate Ca, testicle Ca Vascular – AAA, PVD, varicose veins, ulcers, TIA/stroke Breast – pain/discharge/size/other lumps; prev lumps; menarche/menopause/cycle) Thyroid – status Qs (incl swallowing) Orthopaedics – OA/RA, trauma Fever/night sweats Weight loss Pain NB: risk factors, symptoms of complications PMH, DH, SH, FH.
  • 6. Examination Abdominal PR Breast Hernias Neck/Thyroid (incl thyroid status) Swellings Varicose veins Peripheral vascular disease Ulcers Observation chart OSCE MARK SHEETS DON’T KNOW WHAT THE PATIENT HAS SO DO EVERYTHING!
  • 7. Abdominal Examination Inspection Ask about tenderness Palpation (pt level, eye contact) Percussion Auscultation Eponyms Special tests
  • 10. Neck/Thyroid Examination Remember: Tongue protrusion Swallow Palpate trachea Offer to examine thyroid status
  • 11. Investigations Bloods FBC, U&Es, LFTs, INR, amylase, CRP, Ca 2+ , TFTs Tumour markers, autoantibodies G&S, cross-match XRs Cultures Cytology (FNA) and histology U/S CT Endoscopy (incl ERCP) Contrast enemas/swallows MRI (esp MRCP)
  • 13. Management Medical/Conservative ABC (oxygen!) Analgesia – WHO ladder Antibiotics PPI/avoid NSAIDs/weight loss Anticoagulation NBM NG tube iv fluids Surgical (incl consent) Laparoscopy/laparotomy/other incision Types of colectomy … Radiological & Endoscopic EVAR, coils, stents,
  • 14. Complications Anaesthetic Immediate Arrhythmias, pneumothorax, anaphylaxis… General Early UTI, basal atelectasis, pneumonia, c diff, DVT, PE Surgery Immediate Primary haemorrhage, damage to a nearby structure (nerve, ureter, bowel) Early Infection, leak, dehiscence, secondary haemorrhage, ileus, pain Late Adhesions, recurrence, pain