SURGICAL FINALS Passing the Clinical - PasTest

S E C T I O N 1ManagementThe question ‘How would you manage a patient with this condition?’comes up again and again. The term ‘management’ is sometimes usedloosely to be synonymous with treatment. However, managementrefers to history, examination, special investigations and treatment.You should always begin by saying ‘I would take a thorough history andperform a full examination.’ Go on to describe the special investigationsthat you would request and only then describe the treatment. If askedabout the management of trauma or shock, never forget to say: ‘Thisis an emergency. I would first check the airway, the breathing and thecirculation (ABC).’Special investigationsWhen asked about special investigations, start with simple investigationssuch as urinalysis and blood tests: haematological (FBC, clotting studies,group and save), biochemical (U&Es, LFTs, TFTs, amylase) and urinalysis.Then go on to describe relevant imaging investigations (chest radiograph,ultrasonography and Doppler sonography, angiography, bariumstudies, CT and MRI), endoscopy and biopsies (cytology and histology).Remember that all older patients being considered for surgery shouldhave a chest radiograph and ECG (think: 1 fluids, 2 tissues and 3 imaging).TreatmentIf asked about the treatment of any disease, always divide your answerinto conservative, medical and surgical. Under conservative treatment,consider the contributions from all other healthcare providers suchas nurses, physiotherapists, occupational therapists and socialservices. Under medical treatment, consider drugs, chemotherapy andradiotherapy.18