AS notes Surgery

Question 1

what is littres hernia?

Answer 1

Hernial sac containing strangulated Meckel’s diverticulum.

Question 2

what is amyands hernia?

Answer 2

inguinal hernia containing strangulated appendix

Question 3

what side are inguinal hernias more common?

Answer 3

right

Question 4

what causes congenital inguinal hernias?

Answer 4

patent processus vaginalis

- can cause hydrocele and indirect hernia

Question 5

state some causes of acquired inguinal hernias?

Answer 5

Chronic cough: COPD, asthma
 Prostatism
 Constipation
 Severe muscular effort: e.g. heavy lifting
 Previous incision/repair
 Ascites / obesity
 Appendicectomy

Question 6

what type of inguinal hernia is more common in younger patients?

Answer 6

indirect hernia

- through the deep ring

Question 7

what type of inguiunal hernia is more common to strangulate?

Answer 7

indirect hernia

Question 8

what investigation should be done for inguinal hernia?

Answer 8

US

Question 9

what is the elective and emergency surgical tretament for femoral hernias?

Answer 9

Elective: Lockwood Approach
 Low incision over hernia c¯ herniotomy and
herniorrhaphy (suture ing. ligt. to pectineal ligt.)

Emergency: McEvedy Approach
 High approach in inguinal region to allow inspection and
resection of non-viable bowel.
 Then herniotomy and herniorrhaphy

Question 10

where is a dermoid cyst from in children?

Answer 10

midline of neck or nose

medial and lateral ends of eyebrow

Question 11

what is a dermoid cyst made up of?

Answer 11

epidermal lined cyst deep to the skin

Question 12

what investigations should be done for neck lumps?

Answer 12

Clinical assessment Imaging: US

Cyto/Histo: aspiration or biopsy

Question 13

give two examples of midline neck lumps in children/young adults?

Answer 13

dermoid cyst

thyroglossal cyst

Question 14

give some causes of anterior triangle neck lumps? (pulsatile and non pulsatile)

Answer 14

Pulsatile
 Carotid artery aneurysm
 Tortuous carotid artery
 Carotid body tumour (chemodectoma)

Non-pulsatile
 Branchial cysts
 Laryngocele
 Goitre
 Parotid tumour (lump in postero-superior area)

Question 15

give some causes of submandibular triangle neck lumps?

Answer 15

 Salivary stone
 Sialadenitis
 Salivary tumour

Question 16

give some causes of posterior triangle neck lumps?

Answer 16

LNs
 Cervical ribs
 Pharyngeal pouch
 Cystic hygromas
 Pancoast’s tumour

Question 17

what is cystic hygromas?

Answer 17

Congenital multiloculated lymphangioma arising from the jugular lymph sac

Question 18

give two examples of midline neck lumps in adults?

Answer 18

thyroid isthmus mass

ectopic thyroid tissue

Question 19

where is the location of cystic hygromas and there clinical findings?

Answer 19

Lower part of post. triangle but may extend to axilla.
 ↑ in size when child coughs/cries
 Transilluminates brilliantly

Question 20

where can thyroglossal cysts be found?

Answer 20

Can be located anywhere between foramen caecum
and the thyroid
 Usually just inferior to the hyoid: subhyoid
 Or, just above the hyoid: suprahyoid

Question 21

what is the treatment of thyroglossal cysts?

Answer 21

 Sistrunk’s Op: excision of cyst and thyroglossal duct

- the mid section of the hyoid bone can be removed as well

Question 22

where does a pharyngeal pouch usually occur?

Answer 22

Killian’s dehiscence
 Between thyro- and crico-pharyngeal muscles that
form the inferior constrictor

Question 23

what can be make the pain of cervical lymphadenopathy worse?

Answer 23

alcohol

Question 24

state some causes of lymphadenopathy? LIST

Answer 24

 Lymphoma and Leukaemia
 Infection
 Sarcoidosis
 Tumour

Question 25

state some causes of salivary gland enlargement ?

Answer 25

 Parotitis
 Sjogren’s / Sicca Syndrome
 Sarcoid
 Amyloid
 ALL
 Chronic liver disease
 Anorexia or bulimia

Question 26

what is the most common salivary gland neoplasm?

Answer 26

Pleiomorphic Adenoma

Question 27

what is Frey’s Syndrome?

Answer 27

 Redness and sweating skin over parotid area
 Occurs in relation to food (inc. thinking)
 Auriculotemporal branch of CN V3 carries
sympathetic fibres to sweat glands over parotid
area and parasympathetic fibres to the parotid
 Reinervation of divided sympathetic nerves by
fibres from the secretomotor branch of
auriculotemporal branch of CN V3

• complication of parotidectomy

Question 28

what genetic conditions can cause bilateral undescended testis?

Answer 28

Noonans

Prader willi

Question 29

what structure attaches to the inferior pole of the testis and pulls them into the scrotum?

Answer 29

gubernaculum

Question 30

what are retractile testis?

Answer 30

Normal development but excessive cremasteric reflex

Question 31

what is the surgery for undescended testis?

Answer 31

Orchidopexy by Dartos Pouch Procedure

Question 32

can hormonal treatment be done for undescended testis?

Answer 32

β-HCG may be tried if testis is in inguinal canal

Question 33

what nerve root supplied the testis?

Answer 33

T10

Question 34

what is found on clinical examination during testicular torsion?

Answer 34

Testis rides high and lies transversely (however lie can be normal if the testis has twisted a full 360 degrees)
inflammed, hot, swollen, extremely generally tender

Question 35

what is Torted Hydatid of Morgagni ?

Answer 35

testicular appendix torsion

Question 36

what is the testicular appendix a remnent of?

Answer 36

Remnant of Mullerian duct

Question 37

what is the presentation of phimosis in children?

Answer 37

Mx: Gentle retraction, steroid creams, circumcision

Question 38

what is the management of phimosis in children?

Answer 38

 Pres: recurrent balanitis and ballooning

Question 39

what is Paraphimosis?

Answer 39

 Tight foreskin is retracted and becomes irreplaceable.

 ↓ venous return → oedema and swelling of the glans