EMQs in Clinical Medicine.pdf - Peshawar Medical College

182 The abdomen and surgery
B
G
A 65-year-old man complains of left calf claudication of 50 m.
Angiography reveals a 10-cm stenosis of the superficial femoral artery.
The superficial femoral artery becomes the popliteal artery in the
popliteal fossa. A femoral–popliteal bypass is the treatment of choice for
this scenario where there is significant occlusive disease of the superficial
femoral artery.
A 74-year-old man with atrial fibrillation who suffered a stroke a
week ago presents with an ischaemic cold foot. Arteriography reveals
that there is an occlusion at the popliteal artery.
With acute ischaemia secondary to embolism, surgical embolectomy with
a Fogarty catheter is indicated. Intra-arterial local thrombolysis involves
the use of thrombolytics such as streptokinase/t-PA (tissue plasminogen
activator). Thrombolysis would be contraindicated in this trauma
scenario because of the patient’s recent history of stroke.
68 Postoperative complications
Answers: A H D L G
A
H
D
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A 40-year-old man presents with a hoarse voice after subtotal
thyroidectomy.
The recurrent laryngeal nerve is prone to being stretched or cut during
thyroid surgery as a result especially of its close relation to the inferior
thyroid artery. A patient with a recurrent laryngeal palsy may complain
of dyspnoea on exertion if the cord is fixed in an adducted position.
A 40-year-old woman presents with pain and swelling in her left calf
after pelvic surgery.
Early mobilization where possible and the use of compressive stockings are
important measures in reducing the risk of deep vein thrombosis (DVT).
A 62 year old presents with sudden onset shortness of breath 10 days
after a hip replacement.
Pelvic surgery and orthopaedic surgery are major risk factors for
thromboembolic events such as pulmonary embolism (PE) and DVT.
A 40-year-old man presents with tetany after a near-total thyroidectomy.
Hypocalcaemia resulting from a hypoparathyroid state after surgery
gives signs of tetany and perioral paraesthesia. The presence of carpopedal
spasm when the brachial artery is occluded, with a blood pressure
cuff inflated above systolic blood pressure, is known as Trousseau’s sign.
Chvostek’s sign involves tapping over the parotid gland and eliciting
twitching of the facial muscles (this results from neuromuscular
excitability).