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Medicine Notes Medical Finals & OSCEs Notes

Surgical Procedures Notes

Updated Surgical Procedures Notes Notes

Medical Finals & OSCEs Notes

Medical Finals & OSCEs Notes

Approximately 119 pages

This is my collection of typed notes and diagrams made for my Finals in Medicine, both the written exams and the Objective Structured Clinical Examinations, OSCEs, which we all dread. I found that making not only academic notes, but also notes of practical use for the OSCEs was very valuable.

This pack includes OSCE notes of clinical examination walkthroughs and clinical signs, examination interpretation, presentation and summaries for various OSCE subjects, as well as chest x-ray Interpretati...

The following is a more accessible plain text extract of the PDF sample above, taken from our Medical Finals & OSCEs Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Surgical Procedures Notes

Cystoscopy

Indications: haematuria protocol for bladder cancer; unusual cells found in urine sample look for bladder cancer; look at urinary blockage e.g. prostatic enlargement; look at urinary tract stones

Procedure: cystoscope into urethra, up into bladder, sterile liquid flows to inflate the bladder. Can take a biopsy or remove a stone.

Adverse effects: haematuria, pain. urethral damage can cause incontinence after rigid cystoscopy.

Any other info: flexible=local anaesthetic, rigid=general anaesthetic

Ureteroscopy

Indications: remove kidney stones

Procedure: thin cystoscope up through urethra, bladder, then ureters. Can have a basket to retrieve stone fragments.

Adverse effects: same as cystoscopy

Any other info: ‘pyeloscopy’ can go up into the renal pelvis

Nephrectomy (radical)

Indications: RCC, urothelial cancer of the kidney, living donor kidney transplantation. Renal masses >7cm.

Procedure: general anaesthetic open or laparoscopic. Can be taken out transvaginally.

Adverse effects: pain. Electrolyte and fluid balance disturbances due to kidney dysfunction. Infection, bleeding.

Partial nephrectomy

Indications: solitary kidney tumour or when removing the entire kidney could result in kidney failure or dialysis due to pathology in the other kidney. Standard where the renal mass is <4cm. Also most masses 4-7cm in size.

Procedure: GA open, laparoscopic or robotic

Adverse effects: bleeding, pain, infection, urinary leak

Any other info: better kidney function and quality of life than radical nephrectomy

Extracorporeal shock wave Lithotripsy (ESWL)

Indications: treatment of kidney stones or gallstones (or salivary stones!)

Procedure: non-invasive. Acoustic pulse. USS-guided. Fragments the stones into smaller pieces that pass. Ureteric stent can be used as well. takes about an hour. Works best with stones 4mm-20mm diameter in the kidney. Lower success if in the ureters.

Adverse effects: capillary damage with renal haemorrhage. Can lead to renal failure!

Any other info: alternatives are laser lithotripsy or percutaneous nephrolithotomy

Laser lithotripsy

Indications: removal of stones from anywhere in urinary tract

Procedure: via a cystoscope or utereroscope or pyeloscope, a laser fibre is used to deliver pulses to pulverise the stone into pieces so that they are washed out. LA or GA. Minimally invasive.

Adverse effects: very safe

Percutaneous nephrolithotomy

Indications: remove stones from the kidney that are larger than can be done by lithotripsy. Best: stones >2cm near the renal pelvis.

Procedure: do a retrograde pyelogram to locate the stone. Loin incisionneedle passed into kidney pelvis. Guide wire inserted, Seldinger technique, pass a nephroscope to take out small stones. May have to crush first with ultrasound probes.

Adverse effects: injury to colon or renal blood vessels, sepsis, pleural effusion if done through 11th intercostal space

Sclerotherapy

Indications: treat blood vessel malformations, in particular varicose veins and haemorrhoids

Procedure: can be Us-guided. Can use glycerol or foam sclerosants to control reflux from sapheno-femoral or sapheno-popliteal junctions. Non-invasive and quick.

Adverse effects: rarely, DVT, thrombophlebitis, allergic reaction. If injected outside the vein, scarring and skin necrosis.

Carotid endarterectomy

Indications: prevent stroke by correcting carotid artery stenosis. Stenosis >70% on duplex scan. Does not matter whether symptomatic or asymptomatic.

Procedure: LA (rarely GA) open artery and remove atherosclerotic plaque. Assess cerebral perfusion using EEG. Alternatively, can do a carotid stent through a catheter from the femoral artery with balloon dilation and a wire-mesh stent. This is not as good.

Adverse effects: perioperative stroke risk or TIA. Haematomatracheal compression. Hypoglossal nerve damage. Horner’s syndrome is rare. Restenosis often occurs.

Contraindication: complete internal carotid artery obstruction (no point) or existing ipsilateral stroke (cannot cure, don’t want to worsen)

N.B.: If both arteries are suitable for repair, do not do both together, do them separately.

Abdominal aortic aneurysm repair

Indications: elective when aneurysm diameter >5.5cm on USS. growth per year of >0.5cm. emergency haemorrhage or other high risk of rupture. When blood flow is compromised e.g. to renal arteries.

Procedure: may be via an open incision or EVAR: endovascular aneurysm repair. In open, use a tube graft sutured the length of the aneurysm. EVAR=minimally invasive, via the groin and femoral arteries, place a stent-graft.

Adverse effects: 3.4% mortality for elective open repair. 1.7% for EVAR. Stent migration. Spinal or mesenteric ischaemia and distal embolic events. ‘endoleak’=failure of graft to stop blood flow to the aneurysm. Aortoenteric fistulamassive haemorrhage and death. EVAR is safer at the time but has a higher risk at 5 yrs so if life expectancy is long then do an open repair. It is not a risk of the operation to dislodge a thrombus.

When doing an AAA repair of a suprarenal or juxtarenal AAA there is clamping above the renal arteries leading to 10-15% risk of end-stage renal failure.

EVAR Contraindications: short neck length, tortuosity or angulation of iliac artery or aneurysm neck, iliac stenotic disease making catheter passing difficult.

Transurethral resection of prostate (TURP)

Indications: BPH ‘gold standard’ surgical treatment. If medical fails or there are complications (bladder stones, bladder infection, hydronephrosis).

Procedure: Remove part of prostate through urethra. Endoscopic. heated loop. General or spinal anaesthesia.

Adverse effects: retrograde ejaculation – reduced fertility – 90%. Bladder incontinence, usually for a few weeks – 10%. Urethral strictures. Haematuria for 2 weeks. Clot retention, haematospermia. UTI. Urinary retention. Erectile dysfunction 10%, usually temporary. 8% failure rate. 6% lasting stress incontinence. 10% will need a repeat TURP...

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