PLAB 2 NOTES ASPIRE: THE QUEST FOR EXCEL Str \dhamDisclaimer This book is published and distributed solely by Aspire Education and prepared by various authors working for Aspire Education. However, the publisher and the authors are providing this book and its contents on an “as is” basis and make no representations or warranties of any kind with respect to this book or its contents. The publisher and the authors disclaim all such representations and warranties, including but not limited to warranties of healthcare for a particular purpose and PLAB 2 exam preparatory course material. In addition, the publisher and the author assume no responsibility for errors, inaccuracies, omissions, similarities or any other inconsistencies herein, The contents of this book are for informational purposes only to ‘provide guidance for preparation of PLAB 2 exam in the UK. The content is also not intended to diagnose, treat, cure, or prevent any condition or disease. The publisher and the authorimake no,guarantees concerning the level of success you may experience by folléwing the adviee and strategies contained in this book, and you accept the risk that results will differ for each individual. The similarities of any content / scenario (s) will be totally coincidentalaAspiré Education or any otganisation working in collaboration with Aspire will not b@ held responsible for the content of this book. The use of this book implies your acceptance of this disclaimer, Published by dr-notes.comCOURSES IN THE UK Our upcoming BATCHES: Batch Theta: 14th March 2020 to 25th March 2020 Batch lota: 2nd April 2020 to 13th April 2020 Batch Kappa: 23rd April 2020 to 4th May 2020 Batch Lambda: 14th May 2020 to 25th May 2020 Batch Mu: 4th June 2020 to 15th June 2020 Batch Nu: 26th June 2020 to 7th July 2020 Batch Xi: 16th July 2020 to 27th July 2020 Batch Omicron: 7th August 2020 to 17th’August 2020 Batch Pi: 27th August 2020 to 7th September 2020 Batch Rho: 17th September 2020 to 28th September 2020 Batch Sigma: 8th October 2020 to 19th October 2020COURSES INTERNATIONALLY We conduct overseas courses in: India — 5 Courses Conducted UAE — 3 Courses Conducted Egypt — 3 Courses Conducted Burma — 3 Courses Conducted Bangladesh — 2 Courses Conducted Turkey — 1 Course Conducted Nigeria — 1 Course Conducted Online Courses: Coming soon — 12 Day Live Online Course Published by dr-notes.comOverview of PLAB 2Passing Criteria’s: a. 11/18 b. Minimum Average Score Each Station Division: History Data Gathering - 4 Management —4 Interpersonal Skills~ 4 Total = 12 Overall Total Marks: 216 Total number of stations: 20 Real Stations: 18 Rest Stations: 2 Each Station: Inside cubicle = 8 mins Outside cubicle = 1.5 mins Bells = 3 1*bell -> Enter the Cubicle 2° bell > 6 Min Bell 3 bell > Go to Next Station Total number of timesexam = 3 hours 10 mins The examiner awards a grate between A and E for each marking domain. Each domain is worth the sammin Marking system: After the exam; the grades awarded by the examiner in a station are converted to marks Aza Example of Feedback B Published by dr-notes.comYour score | Your score | Your score |Your total Pass score {maximum 4) | (maximum 4)| {maximum 4)| score | needed |P**/FaH lb 1S (BIS lem IS 1B IS |e IB ER ERE Ele Pass pase Pass. Pass. 4Feedback Statements Consultation Disorganised / Unstructured Consultation. Includes illogical and disordered approach to ‘questioning, You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking, You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation. Issues Does not recognise the issues or priorities in the consultation (for exarfple, the Patient's key problem or the immediate management of an acutely il patient). Youdid nétcecognise the key element of importance in the station. For example, giving health andllifestyle advice to an acutely ill patient. Time Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas, Findings Does not identify abnormal findingBor rest or fails to recognise their implications. You did not identify or recognisé significantfindings in the history, examination or data interpretation. Examination Does not Undertake phYsical examination competently or use instruments proficiently Diagnosis Does not make the correct working diagnosis or identify an appropriate range of differential possibilities. ‘Management Does not develop a management plan reflecting current best practice, including follow up and safety netting. 15 Published by dr-notes.comRapport Does not appear to develop rapport or show sensitivity for the patient's feelings and concerns, including use of stock phrases. You did not demonstrate sufficiently the ability to conduct a patient centered consultation. Perhaps you did not show appropriate empathy or sympathy or understanding of the patient’s concerns. You may have used stock phrases that, show that you were not sensitive to the patient as an individual or failed to seek agreement to your management plan. Listening Does not make adequate use of verbal & non-verbal cues. Poor active Tistening Skills You did not demonstrate sufficiently that you were paying fullattention.to the)patient’s agenda, beliefs and preferences. For example, you may have asked a sefles of questions but not listened to the answers and acted on them. Language Does not use language and/or explanations that are relevaht and|understandable to the, patient, including not checking understandings The examiner may have felt, for example, that you used medical jargon, or spoken too quickly for the patient to tak@lin whatyou were saying ‘Common Challenges in PLAB 2 You are allowed to not know things. . Expect some things that you don’t know. . You are not the onlyae feeling nervous. |. You Have faced similar situations many times before. - Be honest . Free information If patient mentioned something in between then do not ignore the patient. E.g. patient mention about his work but you are taking HPC then tell the patient you mentioned work | will come back to that, . Remember to manage the situation not only the condition. . We are FY2, ask for assistance if not sure. Tell that you work as a part of team. | will go and double check with my senior and wil let you know. Drug is this but | will double check with my book. 10. Reflect ALL emotions by verbalising then and there: You seem to be a bit upset. | apologise. You seem to be a bit anary. You seem frustrated 16~ Introduction and explain why you are there - Build a rapport before launching into the explanation, - _Askf the patient knows why they are here. Ask them to talk about what has happened up to this point. ~ Assess their prior knowledge — itis imperative to ask what they know about the condition/ treatment already - Describe what you are going to talk about (i.e. your structure) and if that would be helpful and ask if they want to add anything or discuss anything else middle = Consider diagram = Chunk and check! This is the most important thing —explain émall bits at @ time and check that they understand the information and ask if they have any aUestions, = Pause after each section. ~ Speak slowly and clearly and be sympathetic and listéfifor/to patient concerns End - Summarise what you have talked about and make a pla = Check they've understood everything ~ Always offer something e.g. a leaflet; Website, specialist nurse contact, follow up appointment ‘Sample Question Where you ar You are an F2 in Paedatrics Dept. Who the patient is: Jenny Julie, aged 2, has been brought to the hospital by her mother because she had a fit. Other information you have about the patient: She has been managed in the A&E department and has been referred to you. Her temperature is 38.9 C. (On examination, there is redness over her left eardrum. What you must do: Please talk to her mother, Mrs. Diana Julie, take history, discuss your plan of management with the mother and address her concerns, v Published by dr-notes.comHistory Taking: Presenting Complain (PC): Elaborate (SOCRATES > Pain) = Site—Where is the pain? Onset - When did the pain start? Gradually? Sudden? Character ~ Could you describe the pain for me? Radiation ~ Does the pain go anywhere? Associated Symptoms ~ Any other symptoms? Time Since when have you been having this pain? Exacerbating & Relieving Factors ~ Anything makesit better/Wworse? = Severity/Scoring ~ Could you score the pain for me? Elaborate (ODIPARA > Other Symptoms) Past Medical History (PMH): Medical Conditions? Medications? Allergies? Hospital Stay/Surgeries Family History Lifestyle: Personal: ‘Smoking Alcohol Do you dfifikjalcohol/Have you ever had alcohol? Whatio you dfink? How muth.do you drink? How often do.you drink? How long for? Wear understand itis difficult to achieve a balanced diet with modern-day challenges Physical Exercise Sexual History ‘Are you sexually active? ‘Are you ina stable relationship? Do you have any other partner? How many partners do you have? Do you use condoms? Do you practice safe sex? When was the last time you had unprotected sex? Which route of sex do you prefer? Oral, Vaginal or Anal? Is your sexual partner male or female? (If needed). 18~ Recreational Drugs Social: - Travel + Occupation = living Condition Sign Posting: lt might sound silly, sometimes alcohol and smoking can make thi know do you drink or smoke? Let me ask you some questions about your lifestyle as sometimes alcohol and smoking can make this condition worse. If you don’t mind telling do you drink or smoke, | Want to ask you some questions might sound weird, but it willlhelp usin assessments. Life Style Modification: For lifestyle modification it is very important to take felevanthistory first and then advise accordingly, itis very important in patients suffering from DM, BIN, High cholesterol and heart diseases. Diet: | understand that you have ajbusy life, but it svafy important to have a sensible diet Having a healthy diet will help in eOntrollingyyour weight and reduces the risk of further complications. Eating out isothealthy,as they use a lot of salt, sugar and fat to make it tastier. | understand it maybe difficult6 cook every day, but you can cook once or twice per week and use it for the whole week. Sdjyou don’t have to eat outside every day. Please tryto havélplenty of fruits and vegetables in your diet. Fruit and vegetables are 2 vital sourcé.of vitamins and minerals end should make up just over a third of the food we eat each day, Please eat 5 portions per day and decrease the size of the portion, Please cut down the amount of red meat and processed meat such as sausages and bacon and try to have white meat such as chicken and fish instead. itis also better to have grilled, steamed or bolled food rather than fried food. We can also refer you to a dietician who can help you better. Patients with Osteoporosis should be advised to have enough dairy products, oily fish and nuts as they are a good source of Vitamin D, Calcium and Omega-3. Patients with Chronic Kidney Disease should be advised to take less water and protein, 19 Published by dr-notes.com‘Smoking: ‘Smoking can damage the inside of wall of blood vessel and narrows them. | know itis not easy to stop smoking, but we are here to help you. We can refer you to the smoking cessation clinic, they will do their best to help you to stop smoking by using different ‘methods. There are nicotine replacement products - including patches, gum, lozenges and ‘mouth and nasal sprays. We can also provide with some tablets (varenicline and, (bupropion). Alcohol: ‘The recommended daily amount of alcohol is 2 units per day. ‘One large glass (250m)) of wine approximately contains 3 units of alco! ‘wine {750ml} contains approximately 9 units of alechol, One pint (585m) of beer or lager contains approximately 2 Itis always advisable to cut down the amount down, but we are here to help you. We can r 20Stress: Stress could worsen your condition. So, itis important to relieve your stress. You may try doing some physical activities such as walking, jogging or swimming. In this way you can relive your stress and relax yourself. You may also try taking yoga classes. Physical Activity: itis advisable to have at least thirty minutes of physical activity every day five times a week. You don’t necessarily have to go to the gym. It shouldn't be in one session; it could be split, into two sessions of fifteen minutes or three sessions of ten minutes. For example, if you use public transport, you can get off one to two stops before reaching home and you can walk instead. If you drive, please walk when you going to buy something from your local shop. If you lve ina flat, you can climb the stairs instead of using the lift. Counselling Disease Counselling: Examination. Initial investigations 3. Disclose Diagnosis Explain Diagnosis Explain about investigations Treatment: It includes medical, non-medical Patient concern . Follow up 9. Warning Signs, Safety netting 10. While discharging a patient especially elderly patient, patients living condition including the home environment and presence of ahy help and support (family or carer) should be elaborated. OT, PT review. Ihave few things to tatk about here Can | do something to make you more comfortable? 1am glad you didn’tdevelop any complications. Note: How does that sound? Are you with me? Are we stil together? Are you getting me? Are you keeping up me? Important: No robotic approach. No learned phrases. Show that we are Safe Doctor: ‘To assess dehydration in patient presenting with diarrhoea or vorniting: Do you feel thirsty? 21 Published by dr-notes.comDo you have any dry mouth? Have you noticed a decrease in urine output? Do you feel lethargic? Do you feel drowsy? Rule Out Anaemia: 1, Do you feel any heart racing? 2. Do you feel any lightheaded-ness or dizziness? 3. Do you have any SOB? 4, Do you feel tired or lethargic? Rule Out Cancer: 1. Weight Loss. 2. Loss of appetite. 3. Anaemia symptoms How to Counsel: Make a two-way conversation. Involve the patient in the conversation, Let the patient ask you question Use short statements and use simple language, Keep checking patients understanding. Go slow. Never rush. Don’t answer if you are not sure. (I will confirm it with my seniors) Do you have any other concern? Medication Counselling: Ask these questions first a. Any medical illnesses? b. Any other medication? Any allergy to any‘riedication? Explain the medication: 1. Function of miedicine. 2. Dose of the’medicine, 3. Route of the medication 4, How oftenwhen and for how long to take medication. 5, Side effects of the medication. General Advice: 1. Take your medication regularly as we prescribe 2. Do not miss any dose 3. Ask your GP before using any other drug, including OTC herbal or supplements. 4, See your GP if you have a persistent side effect. 8. Follow Up. 22Counselling of a Procedur Pre-op Assessmet Pre-op assessment is done few weeks before the operation by a doctor or a qualified nurse. It is done by taking history, doing physical examination and running different tests. Advice about certain medications like diabetic medication, Consent: Itis very important to take consent from patient. The mode of anaesthesia: a, Local Anaesthesia: We will inject some medication to numb the area. We may also give you some mild sleep medication if needed. b, General Anaesthesia: We need to put you to sleep. For GAlavoid éating and drinking 6-8 hours before the surgery. Advantages of Local Anaesthesia compared to General Anaésthesi a. Less complications, less hospital stays and fast recovefy, b. Less fitness is required. Types of Operatior 2. Open Operation: It can be done in local or general anaesthdsi Hysterectomy, Hip Replacement E.g-Hemicolectomy, Open Nephrectomy, b. Keyhole Operation (Laparoscopic): It is done under general anaesthesiatin this operation, we will put you to sleep. The surgeon will make asmall cut, One cut is usually near your belly button. Gas is injected through the cut to inflate the tummy wall to make it easier to see internal organs. A laparoscope whichisi@'thin telescope with a source of light, is pushed through the tummy throughlanother cut. This camera is connected to a TV and through the other cut instruments ar€lpushed in the tummy cavity so the surgeon can see the instruments on the monitor and perform the surgery. E.g.- Ectopic Pregnancy, Female Sterilization etc, Advantages of Keyhole Surgery: a. Less pain, less complications, less hospital stays and fast recovery. b. Small scar. Duration of the Surgery: It may differ from person to person and his overall health. Minor surgery — up to 1 hour Major surgery ~ 2-3 hours Complications: There are some general complications and treatment, 23 Published by dr-notes.coma. Pain painkillers, b. Infection ~ Antibiotics. c. Bleeding and Damage to surrounding structures ~ we will manage accordingly. Hospital Stay: It may differ from person to person and his overall health. Patient mainly the old people should be assessed by OT, PT. Patient should be medically and socially fit before the discharge. For minor surgery — Day care or up to 2-3 day For major surgery — Up to 4-7 days Recovery Period: It may differ from person to person and his overall health. 1 Week ~ Household chores 2 Weeks — Drive and sex 4 Weeks — Office job. 6 Weeks ~ Labour job. Follow up: A few days after surgery, the patient can be réviewed\by GP ofthe surgeon. Ethical Empathy/Sympathy: “can see how this is difficult for Vou” ‘Avoid ~ | can understand What yal aré Boing through/how you feel “How does that sogind?” “Am | making sense'to¥you?” “Let me kfow if I'm going too fast” Breaking Bad News! a. Break the Néws in Layers b. No False Assurance c. Sympathy and empathy ICE e. Ask if they want anyone with them £. Talk about symptoms and investigation g, Disclose the news h. Respond to the reactions of the patient (Denial, Cry etc) i, Bea good listener (Respond by nodding your head) J. Do not interrupt k. Pause is very important 24Medical Error: Patient Safety Apology, Sympathy and Empathy. . Documentation- Document the Incident in the patient record. }. Being Open- inform the patient and their family and carers and apologise. - Reporting — Report the incident by your local reporting system. Learning How will my report inform local and national learning, /. Complaint- What if patient wants to make a complain > PALS. Ice: Ideas “Was there anything you thought it might be?” Concerns "What about it is werrying you in particular?" Expectations "Is there anything in particular you were hoping we would to today?" Paediatrics & Gynaecology/Obstetrics Paediatrics Gynaecology/Obstetrics Birth History [ Period Immunisation (Jabs) Development (Red Book) _rewwney | Diet ( Breast Fed, Bottle Fed) Pill Wee & Poo Non-Accidental Injury [pepsin | 25 Published by dr-notes.comPain Ladder Opioid for Moderate to Severe Pain 1+ +: Non-Opioid Pain Persisting or s+ Adjuvant Increasing Opioid for Mild to Moderate Pain Increasing sNor-Opiaig ‘++ Non-Opioid| + Adjuvant > Adjuvant Simple Painkiller (Aspirin, Paracetamol, NSAIDS)#/2Adjuvants) Weak Opioids (Codeine, Tramadol) +/- Adjuvants Stronger Opioids (Morphine, Diamorphine, Oxycodone, Pethadifie, Fentanyl) +/- Adjuvants Adjuvants for Bone Mets pain ~ Radiotherépy, Bisphosphonates. Adjuvants for Osteoarthritis ~ Steroids (injection)/intra-articular, Bisphosphonates. ‘Adjuvants for Neuropathic Pain - Gabapentin Amitriptyline, Carbamazepine Check Compliance: Do you take the medicine regularly? Do you take the medicinélas preseribed? Any missing dose? = Patients on painkiller and patient has good compliance, but pain is not well controlled. You can ifitrease thé'Gose of medication up to the maximum dose. = You can move upithe pain ladder to a stronger group. When we prescribe weak opioid or strong opioid, we should always have a weak painkiller like Paracetamol or NSAID along with the Opioid painkiller. Did you take any painkillers? What did you take? How much did you take? When did you take it? Side Effects: IF patient has some side effects. We try to tackle the side effects and continue with the same painkiller 26IF side effects cannot be tackled, we change the medication to another drug from the same group or change the route of administration. Oral Morphine can be changed to Oxycodone or Subcutaneous Diamorphine. Fentanyl Patch: It is a very strong painkiller. Indications: Patient is on maximum dose of morphine but still in pain. Patient isin severe pain but wants to be mobile (when you cannot use Sytingé driver). Poor compliance to PO medication. If there is renal impairment (GFR < 30). Usually Fentanyl Patch lasts for 3 days. When you start Fentanyl, it takes 12-24 hours to start working, so You mained to prescribe some other painkiller to your patient when you statfentanybpatch. It takes about 12-24 hours to be clear from the body, solif you stop this medication, you should not give the patient painkiller within 24hours unless patient feels pain. Syringe Driver: The medication thet is used commonly is Dia MOrphine ahd the route is Sub Cutaneous {Sub/Cut). Its one of the options in pain management of terminally il patients. It is a small pump that gives you continuous dose of medication under the skin as an injection. Syringe driver will usually be given to terminally il patients who have been on long term oral morphine and have developed side effects, especially nausea, vomiting Patient Controlled Analgesia (PCA) The medication thet is commonly Used is IV Morphine. This isa small device by which you can control the paifi by pressing.a button. By doing this, medication goes into your blood vessel. This is a programmed device/so you cannot take more than a certain amount of painkillafimone day, so.don’t worry about overdose. Choose the Right Painkiller: Usually in terminally ill patients, we need to start from weak painkillers and then step up to strong painkillers if needed. Usually for post-op pain management, we start from strong painkiller and then step down to weak painkiller Patient may need PCA in the hospital after the operation. PO Morphine along with a simple painkiller after a while. Since the pain will subside after operation, we can shift it to a weak opioid along with a simple painkiller such as Co-codamol. And then we can shift the patient to simple painkiller such as Paracetamol. For Minor Surgery we can start with Weak opioids or simple painkillers. District Nurses can visit people in their own homes or in the residential care home for pain management and support their family members. 7 Published by dr-notes.comMacmillan Palliative Nurses provide help and support to the patient with pain and with palliative care needs to end of life care. They support the person with cancer, their family and the nurses and doctors who are looking after them. Side Effects of Morphine: Constipation: Try to eat food rich in fibres, such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or other non-alcoholic liquid each day. if you can, it may also help to do some gentle exercise. Speak to your doctor about medicine to help prevent or treat constipation caused by morphine if your symptoms do not go away. Feeling sick or vomiting: You should take morphine with or just after a meal or snack fo ease feelings sickness. This side effect should normally wear off after a few days. Talk to your doctor abit taking anti- sickness medicine if it carries on for longer. Feeling sleepy, tired or dizzy: These side effects should wear off within a week or two as your body gets used to morphine. Talk to your'doctor if theyicarry on for longer. There are some serious side effects of the morphine like Seizure, Bréathing Difficulty or Short Shallow Breathing and Muscle Stiffnessjifthat happens pléase contact your GP or go to the ARE. Imaging Tests Chest X-Ray ‘An imaging technique that uses high-energy radiation to highlight abnormalities in body tissue. (TSean series of ays at slightly different angles are taken and a computer is used to put the images together Before having’the scan, you may be given a special dye called a contrast to help improve the quality of the images. This may be swallowed in the form of a drink, passed into your bottom (enema), or injected into a blood vessel MRI Scan Magnetic resonance imaging (MI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. 28usG It uses high-frequency sound waves to create an image of the inside of your body. Bronchoscopy A bronchoscopy is a procedure that allows a doctor or nurse to remove a small sample of cells from inside your lungs. During a bronchoscopy, a thin tube called a bronchoscope is used to examine your lungs and take a sample of cells (biopsy). The bronchoscope is passed through your mouthor nose, down your throat and into the airways of your lungs. ‘The procedure may be uncomfortable, but you'll be given a mild sedativ@ beforehand to help you relax and a local anaesthetic to make your throat numb. The procedure is very quick and only takes a few minutes. Endoscopy ‘An endoscopy is a procedure where the inside of your body examined using an instrument called an endoscope. An endoscope is a long, thin, fleyible tube that has a light source and camera at one end. Images of the inside of your body arefelayed to a television screen. Gastroscopy A gastroscopy is a procedure where a thin, flexible tube called an end oscope is used to look inside the oesophagus (gullet), stomach ani first part of the small intestine (duodenum). Flexible Sigmoidoscopy, A flexible sigmoiddscopy is an @xamination of your back passage (rectum) and some of your large bowel using a device talled a'sigmoidoscope A sigmoidescope fsajlong, thin, flexible tube attached to a very small camera and light. I's inserted into your réctum and up into your bowel. The camera rélays images to a monitor and can also be used to take biopsies, where a small tissue sample is removed for further analysis. A sigmoidoscopy can feel uncomfortable, but it only takes a few minutes and most people go home straight after the examination Colonoscopy A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer. 29 Published by dr-notes.comYour bowel needs to be empty when a colonoscopy is performed, so you'll be advised to eat a special diet for a few days beforehand and take @ medication to help empty your bowel (laxative) on the morning of the examination, You'll be given a sedative to help you relax during the test. The doctor will then insert the colonoscope into your rectum and move it along the length of your large bowel. This isn't usually painful but can feel uncomfortable. The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. A biopsy may also be performed during the test. A colonoscopy usually takes about an hour to complete, and most people.can gohome once they've recovered from the effects of the sedative. IVP or VU {A dye that shows up on X-ray is injected into a yein.in yd arm; the X-ray image highlights any blockages as the kidneys filter the dye out of your bloodland jhto your urine. PET CT Scan APET-CT scan (which stands for positron entission tomography-computerised tomography) may be carried out if the results of the! CT scafishow you have cancer at an early stage. ‘The PET-CT scan can show where there arélactive cancer cells. This can help with diagnosis and treatment. Before having a PET-CT scat) you'll be injected with a slightly radioactive material. You'll be asked to lie down gn a table, which slides into the PET scanner. The scan is painless and takes around 30-60 minutes. CTPA Biopsy/ FNAC A biopsy is a medical procedure that involves taking a small sample of body tissue so it can be examined under a microscope. * Aneedle biopsy —a special hollow needle, guided by X-ray, ultrasound, CT scan or MRI scan, is used to obtain tissue from an organ or from tissue underneath the skin + An excision biopsy — surgery is used to remove a larger section of tissue. 30Anaesthesia Types Local anaesthesia involves numbing an area of the body using a type of medication called a local anaesthetic. ‘These medications can be used to treat painful conditions, prevent pain during a procedure or operation, or relieve pain after surgery. Unlike general anaesthetics, local anaesthetics don't cause you to lase consciousness. This, means they're generally safer, don't normally require any special preparation before they can be used, and you can recover from them more quickiy. General anaesthesia is a state of controlled unconsciousness. During '@@neral anaesthetic, medications are used to send you to sleep, so you're unawar@iof surgery/and don't move or feel pain while it's carried out. General anaesthesia is essential for some surgical procedyfes Where fbimiay be safer or more comfortable for you to be unconscious. It'susuilly Used for long operations or those that would otherwise be very painful It’s not clear exactly how it works, but it's known that all anaesthetics interrupt the passage of signals along the nerves. This means that any’timulatfon to the body doesn't get processed or recognised by the brain. 31 Published by dr-notes.com4_5886592737498631 138.pdf