1. Systematic approach Simon Ali 13 th September 2007

2. Overview What is a systematic approach What is a systematic approach Why should you use it Why should you use it What systems are used What systems are used Examples Examples Summary Summary

3. What is a systematic approach? A method of classification A method of classification Based primarily on body systems & ‘sieves’ Based primarily on body systems & ‘sieves’ Pathological Pathological Anatomical Anatomical Aetiological Aetiological Surgical Surgical Think logically Think logically Common things first, rare things last Common things first, rare things last

4. Why should you use it? Provides a framework for differential diagnosis Provides a framework for differential diagnosis Provides a rationale for investigations Provides a rationale for investigations Stops you ‘pulling answers out of mid air’ Stops you ‘pulling answers out of mid air’ Traditionally used by surgeons Traditionally used by surgeons Can be used for anything Can be used for anything Gets you out of a hole in finals, esp LOCAS… Gets you out of a hole in finals, esp LOCAS…

5. Body Systems Cardiovascular & Blood Cardiovascular & Blood Gastro-intestinal Gastro-intestinal Neurological Neurological Respiratory Respiratory Genitourinary & Reproductive Endocrine Musculoskeletal & Skin Up to you to create your own list Up to you to create your own list For example: For example:

6. The Pathological Sieve Definition Definition Histology Histology Clinical Features Clinical Features Differential Diagnosis Differential Diagnosis Ix / Rx / Mgmnt Ix / Rx / Mgmnt Prognosis Prognosis Aetiology Epidemiology Risk Factors Clinical Staging Complications Other In essence, this is the disease framework In essence, this is the disease framework

7. The Anatomical Sieve Requires a bit of thought and some anatomy… Requires a bit of thought and some anatomy… For example, causes of obstruction For example, causes of obstruction Luminal Luminal e.g. FB, impacted faeces e.g. FB, impacted faeces Intramural Intramural e.g tumours, inflammation e.g tumours, inflammation Extramural Extramural e.g. volvulus, adhesions e.g. volvulus, adhesions

8. The Aetiological Sieve Differentiate based on disease processes Differentiate based on disease processes 1st Point: is it Congenital or Acquired? 1st Point: is it Congenital or Acquired? If congenital, you have your answer If congenital, you have your answer If acquired, consider making up a rhyme along the basis of the following If acquired, consider making up a rhyme along the basis of the following TIN CAN MED DIP TIN CAN MED DIP This is the ‘textbook’ version… This is the ‘textbook’ version…

9. The Aetiological Sieve Trauma Trauma Inflammatory Inflammatory Neoplastic Neoplastic Circulatory Circulatory Auto-immune Auto-immune Nutritional Nutritional Metabolic Endocrine Degenerative Drugs Iatrogenic Psychosomatic

10. Surgical Sieves Type of complication Type of complication Are they general or specific Are they general or specific General General Risks of anaesthesia, risks of surgery Risks of anaesthesia, risks of surgery Specific Specific What can go wrong with specific tissues / procedures What can go wrong with specific tissues / procedures Timescale of complication Timescale of complication Immediate, early or late Immediate, early or late

11. Example 1 What are the causes of aortic stenosis? What are the causes of aortic stenosis?

12. Example 2 What are the immediate injuries that may result from a fall from height? What are the immediate injuries that may result from a fall from height?

13. Example 3 What are the possible complications of TURP? What are the possible complications of TURP?

14. Limitations of this approach Not a substitute for learning your stuff Not a substitute for learning your stuff It is only an aid memoiré It is only an aid memoiré Common problems should be known inside out Common problems should be known inside out Emergencies should be known inside out Emergencies should be known inside out This does not appeal to everyone This does not appeal to everyone

15. Summary Sieves can provide useful frameworks Sieves can provide useful frameworks Based on anatomy and disease processes Based on anatomy and disease processes To be used in conjunction with knowledge To be used in conjunction with knowledge Turn up to everything Turn up to everything Read up on everything you don’t know Read up on everything you don’t know Avoid revising ‘comfortable’ areas Avoid revising ‘comfortable’ areas You should pass! You should pass!