Welcome ! I'm Dr. Ahmad and I will be pleased to offer help.. email me: ad_icare@yahoo.com أهلا و سهلا: يسعدنا إنضمامك لنا من خلال صفحتنا على الفيس بوك: استشارة صحية

20 golden rules in medical ethics

Tuesday, 23 March 2010

1. Patient is number one :always place the interests of the patient first

2. Always respond to the patient

3. Tell the patient everything , even he/she does not ask

4. Work on developing a rapport on an ongoing basis. Always seek a good, long-term relationship with the patient

5. Listen , reflect , encourage

6. Negotiate rather than order

7. Notice and respond to new information

8. Admit to the patient when you make a mistake

9. Never "pass off" your patient to someone else

10. Express empathy, then give control : " I'm sorry , what would you like to do? "



11. Agree on problem before moving to solution

12. Be sure you understand what the patient is talking about before intervening

13. Patients do not get to select inappropriate treatments

14. Be sure who your patient is

15. Never lie

16. Accept the health beliefs of patients

17. Accept the patient's religious beliefs and participate if possible

18. Anything that increases communication is good

19. Be an advocate for the patient

20. The key is not so much what you do , but how you do it

Surgery notes , to be always remembered

Hernia
Q. Define hernia
Protrusion of any viscus from its normal cavity through an abdominal opening

Q. What are the types of hernia ?
Ans: Inguinal , umbilical , paraumbilical , femoral , incisional

Q. What is the difference between direct and indirect inguinal hernia ?

Ans: Indirect inguinal hernia



direct inguinal hernia


If the difference isn't clear yet , then better watch this video:


video

Q. Why is it common for inguinal and femoral hernia to occur on the right side more than the left side ?


Ans: The right testis descends into the scrotum later than the left. The processus vaginalis is , therefore, patent for a longer period and atrophies later than the left side. In addition , the sigmoid colon on the left side protects against possible herniation.


Notes:

--> Hernia are the most common cause of intestinal obstruction worldwide

--> Femoral hernias are irreducible

--> Pantaloon hernia : a combination of direct and indirect inguinal hernia. It is also called hernia en bisac

--> Maydl's hernia: W shaped hernia . During surgery , it is important to pull on the medial limbs as the gangerenous loop may not be within the sac.


--> Richter's hernia: a hernia in which the content of the hernia is a part of the circumference of an intestinal loop





Thyroid gland

--> Muscle of the larynx not innervated by the recurrent laryngeal nerve:
Cricothyroid muscle (innervated by superior laryngeal nerve)

--> Ophthalmologic signs of hyperthyroidism:
Exophthalmos , Lid lag , Lid retraction , Periorbital swelling

--> Treatment of thyroid storm:
IV fluids , Hypothermia , Acetaminophen , Propranolol , Propylthiouracil, Iodine

--> Why is the pulse pressure wide in patients with thyrotoxicosis ?
Due to increased blood flow and vasodilatation.

--> What voice problem will a patient have if there is injury to external branch of superior laryngeal nerve ?
Loss of high-pitched tone (cricothyroid makes the vocal cords tense so increases the pitch of voice tone.

Q. What are the types of simple goiter ?

Ans. Nodular and Diffuse

Q. What are the types of toxic goiter ?

Ans. Diffuse (primary) , Nodular (secondary) , Toxic nodule

Q. What are the types of malignant goiter ?

Ans. Follicular , medullary , papillary , anaplastic


Q. What will be the result of thyroid hormones level in Simple nodular goiter?

Ans. Normal.

Q. Why are anti-thyroid drugs contraindicated in retrosternal goiter?
Ans. Because antithyroid drugs cause enlargement of the thyroid gland that may cause pressure manifestations.
Q. Why is retrosternal goiter common in males ?
Ans. Due to strong strap muscles and short neck than females.




 

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