Introduction to surgery

Transcription

1

2 Introduction to surgery

3 Make an outline of the surgical clinical history Describe the abdominal quadrants and its content Name at least 5 types of surgical intruments What is the informed consent? Name causes of acute surgical abdomen

4 Dr. Rodney Martínez

5 History A 19-year-old man presents with a 2-day history of abdominal pain. The pain started in the central abdomen and has now become constant and has shifted to the right iliac fossa. The patient has vomited twice today and is off his food. His motions were loose today, but there was no associated rectal bleeding.

6 The patient has a temperature of 37.8 C and a pulse rate of 110/min. On examination of his abdomen he has localized tenderness and guarding in the right iliac fossa. Urinalysis is clear. Examination

7 Work up Patient Normal Haemoglobin 14.2 g/dl g/dl Mean cell volume 86 fl fl White cell count 19 _ 109/L _ 109/L Platelets 250 _ 109/L _ 109/L Sodium 136 mmol/l mmol/l Potassium 3.5 mmol/l mmol/l Urea 5.0 mmol/l mmmol/l Creatinine 62 μmol/l μmol/l C-reactive protein 20 mg/l 5 mg/l

8 Questions What is the likely diagnosis? What organs are in that quadrant? What are the differential diagnoses for this condition? How would you manage this patient? What are the complications of any surgical intervention that may be required?

9 INTRODUCTION TO OB/GYN

10 Make an outline of the gynecological history Make an outline of the obstetrical history Make an outline of the preconceptive history Make an outline of the OB/GYN physical examination

11 Name at least 5 different structures of the female reproductive system and their functions Name 5 common manifestations in OB/GYN Name 3 types of abnormal bleeding in gynecology Name 5 different STI Name 3 causes of tumors in the breast

12 Dr. Rodney Martinez 12

13 History A 28-year-old woman attends the colposcopy clinic after an abnormal smear test. She is very anxious as she thinks that she might have cervical cancer. The smear is reported as severe dyskaryosis. She had a previous normal result at age 25 years. She has not had any postcoital or intermenstrual bleeding. 13

14 Her first sexual relationship started at the age of 14 years and she has had several partners since then. She lives with her current partner who she has been with for 3 years. She was diagnosed with genital herpes several years ago but has not had any attacks for at least 3 years. She smokes cigarettes per day and drinks only at the weekends. She has an intrauterine contraceptive device in situ. 14

15 Examination The cervix is macroscopically normal. At colposcopy, acetic acid is applied and an irregular white area is apparent to the left of the os. Lugol s iodine is applied and the same area stains pale while the rest of the cervix stains dark brown. A biopsy is taken 15

16 16

17 Cervical biopsy report: the sample received measures 4 mm _ 2 mm and contains enlarged cells with irregular nuclei consistent with CIN3 Work up 17

18 Key points Dyskariosis refers to abnormality from a smear. Dysplasia or cervical intraepithelial neoplasia are histological terms from a biopsy sample. CIN should be treated to prevent long-term progression to cervical carcinoma. LLETZ is the usual treatment for CIN, with yearly follow-up for 10 years. 18

19 Questions Make an outline of a gynecological and obstetrics history Make an outline of the gynecological examination How should this patient be managed? 19

20 Introduction to pediatrics

21 What is growth? What are their markers What is development? What are their markers Make an outline of the pediatric history Name at least 5 common problems in pediatrics Name at least 5 problems seen in developed and developing countries What is the APGAR test? What parameters does have? What is it for?

22 Dr. Rodney Martinez

23 Background Ian, a 2-year-old boy, is referred to the paediatric day unit by his GP with a history of fever, cough, blocked runny nose and sticky eyes for 6 days. His GP prescribed amoxicillin 2 days ago for otitis media, and that evening he started to develop a rash around his ears and hairline. His parents stopped giving the antibiotics, but the rash continued to spread over most of his body. The parents report that he has been very miserable and lethargic for the last 5 days. They thought the rash may be an allergic reaction to amoxicillin. He attends nursery but his parents are not aware of any other children there who have been unwell. His parents are well, and he has an older brother who has autism.

24 Examination Ian has a temperature of 38.5_C, his heart rate is 115 beats/min, respiratory rate 20/min, and oxygen saturation is 97 per cent in air. He weighs 14 kg (75th centile) and he is miserable and lethargic. He has a widespread maculopapular erythematous rash, which is coalescing over his face, neck and torso. Heart sounds are normal, capillary refill time is 2 s. There is no respiratory distress but he is coughing and there are lots of transmitted upper airway noises heard throughout his chest. His abdomen is normal. His nose is streaming with catarrh and he has a purulent discharge from his right ear. His pharynx is red and he has exudative conjunctivitis.

25 Physical examination

26 Questions Make a paediatric clinical history with the available information Name the growth and development markers in this case What is the most likely diagnosis? What essential piece of history has been omitted?

27 Introduction to Psychiatry

28 Make an outline of the psychiatric history What is the difference between an illusion and a hallusination Name at least 3 different mood disorders Name the 5 types of anxiety disorders Name at least 3 types of personality disorders and their characteristics What are the characteristics of the schizophrenia Name at least 3 different Childhood psychiatric conditions

29 A psychiatric case Joe is a 35 years old man, single, he lives by himself in an apartment. He works in a factory during the night shift working with machinery and hi consider himself a perfectionist. He has been single for the last 10 years, he feels that everybody has a problem, and after a while of been with someone he stays alone again. For the past 3 months he is certain than people enter his apartment at night when he is out and that they «touch and use» his belongings. He start to hear voices of his death mother talking to him telling Joe about his neighbor entering his house and using his TV and radio at night so Joe eventually confronts him. The neigbor tells Joe that «your are crazy man», and ask him to leave

30 Make and outline of what part of the mental history can be affected and why What type of psychiatric problem Joe may have? Why?