PANCE Study Material: Male Reproductive Jargon

PANCE Study Material: Male Reproductive Jargon

HypOspadias = abnormal urethral opening underneath (remember hypO means "below")
Epispadias = abnormal urethral opening above (remember epi means "above")

*Phimosis = foreskin is too tight to retract over glans
*Paraphimosis = foreskin is too tight to return back to its usual position

*Usually congenital, but can be caused by trauma or infectious scarring




Source: Hardcore Pathology by Wahl

Retractors and Suckers, Student Life in the OR

Most PA students go through some surgical rotation during their schooling... and let's be honest, with the rare exception of an end-of-the-rotation treat, many students do little more than retract and suck. Although frustrating at times, this isn't a bad thing. We all need to crawl before we walk. The surgeons that you will be working with have several years of experience - you can't expect to participate in a major surgery with 3 days of surgical experience. 

I suggest that you take each opportunity to watch the surgeons closely (don't just stare off or focus solely on the anatomy). How do they hold the scalpel? Do they apply tension to the skin? Which way to they cut? Which tool do they use and when? You will pick up more than you think and when given your opportunity to participate- you will at least have a clue what to do.

Frazier suckers (different sizes)

Below are some instruments that you may see during your rotations. The pics are from an OR Instrument book. I don't see a real need to purchase the whole book because its coverage of surgical instruments is too wide spread.... it is better for an OR Tech who may be working with cardiology, orthopedic, neurosurgical, etc kits. It is, however, worth checking it out of the library to browse through before or during your surgery rotation.

Adson tissue forceps

 

Ferris Smith tissue forceps

 

DeBakey vascular forceps

 

Left --> Right: Goelet retractors, Army Navy retractors, Richardson retractors (med, large)

Source:  Instrumentation for the Operating Room: A Photographic Manual, 7e Shirley M. Tighe RN BA

NHSC Loan Repayment Webinar

Looking to utilize the NHSC to take care of some of your student loans? NHSC just put out a webinar explaining all of the rules/regulations associated with partaking in the Loan Repayment program.

Loan Repayment Webinar

Malignancy Buzz Words

What are the sign/sx and the associated diagnosis with the following buzz words?

(Answers below)

1. Virchow's node

2. Pancoast's

3. Lambert-Eaton
(NO PICTURE)

 
4. Trousseau's

5. Peau d'orange

 ANSWERS:

1. Virchow's node = palpable supraclavicular nodes [associated dx: stomach cancer]
2. Pancoast's = shoulder discomfort, Horner's syndrome [associated dx: apical lung tumors]
3. Lambert-Eaton = myasthenia [associated dx: small cell carcinoma]
4. Trousseau's = thrombophlebitis [associated dx: adenocarcinoma (breast, lung, prostate)]
5. Peau d'orange = edematous thickened breast skin [associated dx: late stage breast CA]





Pic sources: http://www.netterimages.com/image/10287.htm, www.studyblue.com, http://www.bmj.com/content/336/7656/1298?ijkey=kN/189nWkD8aw&keytype=ref&siteid=bmjjournals

Source: Medical Boards Step 2 Made Ridiculously Easy - Andreas Carl, MD

Heart Failure

Quick study material on heart failure:

LEFT SIDED

• dyspnea
• wheezing
• orthopnea
• S3/S4 gallop
• puLsus alternans

RIGHT

• peripheral edema
• nocturia
• JVD
• hepato/spleno-megaly

FUNCTIONAL CLASSES (1 = best, 4 = worst)

Pic source: http://www.remodulin.com/patient/diagnosing-pah.aspx
Source: Medical Boards Step 2 - Made Ridiculously Simple (Andreas Carl, MD)

Would You Treat People Differently If You Knew What They Were Thinking?

The Cleveland Clinic put together a pretty amazing video on "Empathy" - it addresses all of the different people, their thoughts, and issues -- Would you treat people differently if you knew what they were thinking?

This video can be viewed at: http://www.youtube.com/watch?feature=player_embedded&v=cDDWvj_q-o8

Placing External Ventricular Drains

What is an EVD?
A temporary system that allows drainage of CSF from the ventricles to an external closed system.

Caring for a patient undergoing EVD placement Great clinical guideline series by the American Association of Neuroscience Nurses

Preventing Infections When Placing EVDs (video)

Potential placement sites:

Paine's Point

Fraizer's Point

Kocher's Point

If you are having trouble uploading the video, here is the link: http://www.youtube.com/watch?v=x49rY0tZpVI

Pic source: http://www.brain-surgery.us/Drain_Placement.html#kocher

Transcranial Doppler

How does a transcranial doppler work?

• uses low-frequency U/S to evaluate flow velocity in cerebral vessels

Why might you order a transcranial doppler?

1. evaluation of basal cerebral arteries
2. finding spasms intercranially
3. evaluating the patency of the MCA (you would look for this in patients with carotid stenosis)

What the upside to transcranial dopplers?

1. no radiation
2. fast
3. non-invasive
4. can evaluate the circle of willis/intercranial carotids

What is the downside?

1. the outcomes is dependent on the person doing the test - skill and bias can play a role

Transcranial Doppler Video (a little old school - but good information)

Pic source: http://spencertechnologies.com

Source: Ferri's Best Test: A practical guide to clinical lab and medicine diagnostic imaging, Fred Ferri

Hematuria Workup

A diagnostic algorithm to consider when working up hematuria...

click on picture to enlarge

Source: Ferri's Best Test: A practical guide to clinical lab and medicine diagnostic imaging, Fred Ferri

IV Therapy Complications

"Let's give him/her some IV fluids." Seems like a simple enough order. IV therapy is part of medicine, but it is not without risks. It is important to know the risks so that you know what complications to look for in the seconds, hours, days after an IV has been started.

Thrombophlebitis - usually manifests with erythema, inflammation, and/or pain at the IV site (think about changing the IV q3 days to help prevent this)

Infiltration - this happens when whatever you are giving through the IV (meds/fluids) starts to leak into the surrounding tissue (this can cause a big problem - compartment syndrome - if the volume is large enough)

Blockage - something, a blood clot for example, can clog the IV making it unusable (flushes can help minimize the risk of this)

Air embolus

Source: Step up to Medicine 2nd ED Agabegi and Agabegi

Pic source: http://en.wikipedia.org/wiki/Intravenous_therapy