Transcript All of medicine in 12 hours…

iBSc: Question 3
By Alan McLeod
Getting the best marks
Read the whole question – a latter
section may give you a clue about
an earlier one.
To see how many points you need
look at the marks allocated – for
example a 3 point question is
generally looking for 3 salient
points
If giving a list answer put the best
answers first – examiners will not
usually mark answers too far
down a list
Always write something – it may
get you part of a mark and is
anonymised so no one will think
you are stupid!
If you genuinely have no clue then
re-write the question to see if this
sparks some ideas.
If not then move on and come
back at the end. And remember –
always write something.
Good luck!
Question 3
Mr El-Hawrini, a 29
year old lawyer has
been involved in a
motorcycle accident
during which he lost
consciousness
• Q3.1
• Describe the most
vital checks you
would make when he
arrives into A+E (5)
Question 3
A Diagnosis of
extradural
haemorrhage is
made.
Q3.2
• What blood vessel is
responsible for this
bleed. (1)
Q3.3
• List three symptoms
from a typical history
that might lead to this
diagnosis (3)
Q3.4 Label the arrowed structures (8)
Skull
Potential space
Subarachnoid space
Skull
Question 3
In addition to his
head injury, Mr ElHawrini has
sustained the
fracture pictured
Q3.5
What is this fracture (2)
Question 3
Bones are capable of Q3.6
• Describe the typical
self-healing under
pattern of long-bone
the right
healing (4)
circumstances.
Q3.7
• Describe four factors
that might interfere
with this healing (4)
Question 3
Sadly, Mr El-Hawrini
dies. You are given
the job of delivering
the news to his wife
– you use the
SPIKES protocol.
• Q3.8
• Describe the SPIKES
protocol (6)
Factors influencing Healing
Local
Systemic
•
•
•
•
•
•
•
•
•
Tissue damage
Tissue loss
Infection
Foreign body
Patient age
Nutritional status
Smoking / alcohol
Steroids
Systemic illnesses
such as diabetes,
renal, lung, cardiac.
The Answers
View these on ‘note view’ rather
than on full screen – additional
notes are provided for some slides
Emergency Management
D Danger?
Check that the scene is safe
R Run
Check for response
H Happily
Call for HELP!
A Away and
Check and secure airway and Cspine
B Buy
Check breathing, Resp rate
C Chocolate! Pulse, Heart rate
Emergency Management
D ‘Disability’
E ‘Exposure’
DEFG
Neuro exam: minimum is pupil
size / response + GCS or AVPU
1: Expose to seek injuries
2: Keep warm + take temperature
Don’t Ever Forget Glucose!!!
Extradural
Subdural
Subarachnoid
Between skull and
periosteal dura
Between periosteal and
meningeal dura
Into subarachnoid
space
Middle meningeal a.
Cerebral vein
Cerebral artery
Major trauma
Trivial trauma in elderly
Berry aneurysm
Loss of consciousness
for a short time
Days – months pass (as
pressure builds up slowly
within the skull)
Sudden onset intense
headache with stiff neck
(as aneurysm bursts).
Headache, drowsiness
and confusionPossible
hemiparesis / sensory
loss
Possible papilloedema
and retinal haemorrhage
Lucid period lasting
hours – days (as
pressure builds up within
the skull)
Drowsiness, coma,
death if no intervention
Diagnosed by CT or
MRI.
Coma, death if no
intervention (or may
resolve on their own)
Diagnosed by CT or
MRI.
Usually vomiting,
possible loss of
consciousness for hours
 days
Diagnosed by CT or
MRI.
Head Trauma
Skull
Periosteal Dura mata
Meningeal Dura mata
Potential space
Arachnoid mata
Subarachnoid space
Pia mata
Middle Meningeal A.
Cerebral Artery
Cerebral Vein
Extradural Haemorrhage
Skull
Periosteal Dura mata
Meningeal Dura mata
Potential space
Arachnoid mata
Subarachnoid space
Pia mata
Middle Meningeal A.
Cerebral Artery
Cerebral Vein
Subdural Haemorrhage
Skull
Periosteal Dura mata
Meningeal Dura mata
Potential space
Arachnoid mata
Subarachnoid space
Pia mata
Middle Meningeal A.
Cerebral Artery
Cerebral Vein
Subarachnoid Haemorrhage
Skull
Periosteal Dura mata
Meningeal Dura mata
Potential space
Arachnoid mata
Subarachnoid space
Pia mata
Middle Meningeal A.
Cerebral Artery
Cerebral Vein
Monteggia and Galleazzi
Fracture-dislocations
Medics
Monteggia (a)
Under
Pressure
Ulnar shaft
Proximal Radioulnar Joint
Get
Galleazzi (b)
Really
Radial Shaft
Drunk
Distal RUJ
Bone Healing
Mins – 3 days
• Haematoma and
Necrotic tissue
2 days – 2 weeks
• Phagocytosis
• Provisional callus
3 weeks on
• Firm callus
• Mineralisation
Weeks - months
• Remodeling
SPIKES – Bad News…
S
P
I
K
E
S
SETTING UP: Having info ready; involving family as appropriate; location and
privacy; time constraints, sit down; connect.
Perception: What does the patient already know of believe?
Invitation: find out what sort of invitation the patient is extending – do they
want to know everything or do they wish to be told less
Knowledge: as Invited in simple language
Emotion and Empathy: Assessing the patients emotions and dealing with them
empathically
Summary and Strategy: Going back though it all again, identifying points that
need futher expalnation and formulating a plan.
The End
The slides here should allow you to mark
your own work – remember 1 mark per
answer up to the maximum for the
question. Multiply by 3 to get percentage
points. I assume a 60% pass mark. Sorry
but I am unable to give further advice on
answers due to time constraints.