In the exam if you are getting a history
along these lines, go for venous.
Diabetes. You know these are all the terminologies
they use. The patient with ulcers at the tips
of the toes, neuropathy, renal compromise,
blah blah blah, diabetic. Okay, that's it.
Right. We’re done now. Now just to
summarize, as you know, a lot of things we
had to rush through. Despite that, we have
finished by six o'clock. Now what you need
to do is go back, revise all these things
what we've discussed, things which I haven’t
covered or we haven’t covered are the different
types of cancers. Out of the cancers, we have
covered melanoma in quite a bit detail, skin
cancers are done. Colorectal cancers, we
did. Breast, prostate and thyroid. Three things
read up. Okay. Read about microbiology, it
comes up. Other thing we haven't covered
Where would you suggest that we read up on
microbiology, because you know none of the
MRCS books have that and they are specifically
asking what type of organisms, how does it
work, what are the things going to be in there.
You know, it’s not one question. It’s four or five usually.
Yeah, it’s like, what’s the organism or
the inflammatory cell acting as well?
Granulomas and -- Well, if you take, what
if I take TB or something.
Well, this is it, if you read the scenario
or something. It then asks you what type of
inflammatory cell is most likely to be there.
So the microbiology, getting back to the point.
Which reference book would you suggest?
I don't think there's any book as I said.
The only book we suggest is for part B, which
is also applicable for part A is David Lowe's
Surgical pathology book, which has got a section
of microbiology. David Lowe. L-O-W-E. I think
the book has been around for about ten years,
David Lowe. He is a pathologist
but he has covered the basics of microbiology
in that section. We should use
this for paper 2?
No, no it is good for paper 1 as well. But
definitely, it is used for paper 2. Have you guys
have Andrew Raftrey’s book? Applied Basics Surgical, yes,
and that has got a slightly good microbiology
section. That's quite useful. I really can't think
of any other book.
I don't know when you do
you do angioplasty over by-pass? Angioplasty, let’s
take the femoral artery.
If you have a narrowing of the femoral artery,
this is classically, you have little bit of
flow there. You can do an angioplasty there
just to dilate the blockage. But imagine you
have an embolus blocking it completely. You
can't do an angioplasty.
If there's no peripheral pulses palpable?
Then angioplasty won't probably won't work.
There is reduced flow in the angiogram, then
you can try to dilate, similar to the coronary
angioplasty. You're just trying to dilate
the blood vessel. But if it is completely
blocked, either by an acute embolus, or a
thrombus, then the only thing you can do is a
by-pass. So if the options here are fem
by-pass, or a fem distal by-pass.
You still do embolectomy? Yes, yes,
embolectomy is classically done
for the acute embolus, which is in one area.
You're diagnosing it or seen it by either
angiogram or CT or one of the investigations,
and you just take the embolus out.
In an acute ischemic condition with no peripheral
Acute ischemic limb, no peripheral pulses
palpable, then embolectomy. Embolectomy.
Definitely. And if there's femoral’s palpable.
And they've decresead flow on the
Doppler? Yeah. No, no,
no, no, they'll give Doppler.
The other contraindication for angioplasty
is diffuse disease. So patient has got disease
there, disease here, disease here, then there's
no point doing angioplasty, by-pass is the
best option. But, if it’s three
You can't. Well, triple vessel disease, you're
really -- the only way -- No, in this situation,
the only thing you can do is you can do that's
when you go for distal bypass. Bypass from
above the popliteal and go and anastomose
to the posterior tibial or the dorsalis pedis
or the anterior tibial. But triple vessel
disease, diabetics who pretty much, it will
end up in amputation, isn't it? Very unlikely.
Axillary femoral by-pass,
that's when you have iliac diseases. When
you have high disease, aorto-iliac
disease, so this is your aorta, iliac, femoral.
Now this is diseased. What's the option?
You can't go above the diaphragm, because you're
opening the thorax. You won't do that, so
the only other option is going from the axilla.
So you're going to do an axillo-femoral bypass.
So axillo-femoral bypass is done for diffuse
From crossover bypass graft is, that you
do quite higher up, just above the symphysis
pubis. So this is here, the femoral artery.
It depends on the disease. You can't, you can't
go back. Embolectomy is for acute. And a fem
distal bypass is usually for a triple vessel