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Surgery > Gen > Flashcards

Gen Flashcards

1
Q

—- suture should not b used for skin

A

Silk

Suture abscess

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2
Q

Grading of wound scales

A

Southampton

ASEPSIS

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3
Q

Formation of hemation wgich grade in southampton grading

A

5

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4
Q

Antibioma

A

Chronic abscess which is partially sterile

…..

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5
Q

Pain in abscess

A

Bursting type

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6
Q

Cold abscess

A

Sorrounding zone of inflammation abscess?

Do not do dependent drainage

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7
Q

Highest risk antibiotic for pseudomembranous colitis

A

Ciprofloxacin

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8
Q

Dd cellulitis near joints in children

A

Acute osteomyelitis

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9
Q

Erysipelas

A 
Spreading cuticular lymphangitis
Rosy red rash disappearing on pressure
Sharp margin
Vesicles with serum
Millians ear sign
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10
Q

Millians ear sign

A

Feature distinguishing btw erysipelas n cellulitis

Ear inv does not occur in cellulitis as pinna has no sc tissues

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11
Q

Dishwater pus

A

Grayish oozing from wound

Necrotizing fasciitis

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12
Q

Necrotizing fasciitis in perineum

A

Fourniers gangrene

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13
Q

Necrotizing fasciitis in anterior abd wall

A

Maleneys gangrene

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14
Q

Maleneys gangrene cause

A

Symbiotic action of microaerophilic non hemolytic strep & staph aureus

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15
Q

Universal precautions

A

8

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16
Q

Why alcohol is used in dual adents

A

To increase durability of sterilization

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17
Q

Sterilising abdomen

A

Medial to lateral

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18
Q

Sterilisation for abdominal surgery

A

Nipple to midthigh

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19
Q

Spontaneous gas gangrene caused by

A

C septicum

C novyi

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20
Q

Septic abortion gas gangrene caused by

A

C sordeli

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21
Q

Only clostridium species which is not a normal part of gut flora

A

C septicum

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22
Q

Clostridium medium for culture

A

Rcb

Naglers reaction +

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23
Q

Subterminal spore

Terminal

A

Perfringes

Tetani

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24
Q

Foaming liver

A

Gas gangrene

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25
Q

4 aspects of management of gas gangrene

A

Wound debridement or amputation
Antibiotics iv
Organ fn with iv fluid fresh blood
O2

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26
Q

Effects of hyperbaric o2 for gas gangrene

A 
Reduces exotoxin
Ischemia
Edema
Growth factors
Vasoconstriction
Migration of neutrophils
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27
Q

Most important toxin in clostridium

A

Lecithinase

Alpha most common

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28
Q

Why foul smelling gas gangrene

A

H2s
Nitrogen
Co2

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29
Q

Why ca is necessary for clostridium

A

Glycogen to co2 lactic acid n hydrogen
Proteinase splits amino acids to ammonia n hydrogen sulphide
Acid neutralised by ammonia n ca

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30
Q

Cf gas gangrene

A 
Incubation period 1 -2 days
Toxae,ia fever tachycardia pallor
Sickly sweet or decaying apple odor
Khakhi brown color
Crepitus
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31
Q

Frequent sites of gas gangrene

A

Adductor region of lower limb n buttocks

Subscapular region in ul

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32
Q

Clinical types gas gangrene

A 
Fulminant
Massive
Group
Single muscle
Subcutaneous
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33
Q

Complications of gas gangrene

A 
Septicemia
Toxemia
Renal failure
Liver failure
Circulatory failure
Dic 
Sec infection
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34
Q

Investigation gas gangrene

A

X ray
Lft urea creatinine tc po2 pco2
Ct gram stain rcb
Maldi tof

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35
Q

Treatment of gas gangrene

A 
Inj benzyl penicillin 20 lac 6x
Inj metronidazole 500mg 3x
Inj aminoglycosides or third gen ceph or metro
Blood trnsfusion
Polyvalent antiserum 25k units nd repeat aftr 6hrs
Hyperbaric o2
Excision debridement
Rehydration electrolyte
Guillotine amputation
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36
Q

Prevention of gas gangrene

A

Proper debridement
Do not suture
H2o2 nd normal saline for cleaning
Penicillin prophylaxis

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37
Q

Central venous pressure

A

Normal 2 to 10 cm
If less than 2cm more fluid is infused
>10cm restricted

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38
Q

Length of catheter in cvp

A

20cm

If by basilic vein 60 cm

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39
Q

Complications of cvp

A

Pneumothorax
Hemothorax
Injury to brachial plexus or vessels
Bleeding sepsis catheter displacment

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40
Q

Catheter used pcwp

A

Swan ganz triple channel pulm artery balloon catheter

Can be kept only for 72hrs

41
Q

Pcwp uses

A

Diff btw right n left ventricular failure
Pulm embolism
Septic shock
Measure n monitor cardiac output

42
Q

Normal pcwp

A

8-12mmhg

43
Q

Normal pulm artery pressure

A

25mmhg 10mmhg

44
Q

Complications of pcwp

A

Arrythmia
Pulm artery rupture
Balloon rupture pulm infarct pneumothorax hemothorax bleeding sepsis thrombosis

45
Q

Indications for oxygen therapy

A 
Chest injuries severe hmge 
Gas gangrene
Coal gas poisoning over morphinisation
Pulm embolism fat embolism
Spont pneumothorax pulm edema cardiac infarction pneumonia cor pulmonale
Cardiogenic shock acute bronchitis
46
Q

Hyperbaric oxygen

A 
>1or 2 atm in compression chamber
Co poisoning tetanus gas gangrene
Bedsores frostbite necrotizing fasciitis
Paralytic ileus
Radiosensitizer.
47
Q

Complications of hyperbaric ox

A 
Cerebral gas embolism
Rupture of tm
Visual defects
O2 toxicity
Co2 narcosis
Resp depression
48
Q

C/i to hyperbaric ox

A

Asthma emphysema high fever chronic sinusitis viral inf pregnancy

49
Q

Most aggressive cutaneous malig tumour

A

Multiple melanoma

50
Q

Origin of malig mel

A

Ectodermal neural crest

51
Q

Dopa reaction

A

Tyrosine-tyrosinase-dopa-oxidase-melanin

52
Q

Xeroderma pigmentosa

A

Autisomal recessive

9q

53
Q

Risk factors for multiple mel

A

Sunlight albinism xeroderma jn naevus dysplastic naevuslarge congenital naevi family history h/o skin ca immunosuppresive drugs

54
Q

Malignancies which spread from mother to fetus

A

Melanoma

Lymphosarcoma

55
Q

Breslows classification for malig mel

A

<0.75mm
.76-1.5
1.5-4
>4

56
Q

Clarks levels

A 
Mm
5 lvls
Only in epidermis
Extension into papillary dermis
Pilling of pap dermis completely
Ext into reticular dermis
Subcutaneous tissue
57
Q

Pigmented lesions of skin

A 
Seborrheic keratosis
Mm
Bcc scc
Naevus sebaceous epidermal naevus
Kaposi sarcoma mucosis fungoids
Cutaneous hemangioma 
Solar keratosis
Pyogenic granuloma
Cutaneous angiosarcoma
58
Q

Types of melanoma

A 
Cutaneous extracutaneous occult
Clinical types
Ss
Nodular
Lentigo maligna
Acral lentiginous
Amelanotic
Desmoplastic
Subungual
Ocular
59
Q

Most common clinical type of melanoma

A

Ss

Pre existing naevi

60
Q

Lentigo maligna

A

Least common least malignant
Hutchisons melanotic freckle
Face neck hands elderly women
In situ

61
Q

Mm mimicking fungal infection

A

Acral lentiginous

62
Q

Mm with perineural invasion

A

Desmoplastic melanoma

63
Q

Hutchisons sign…

Clarks concept…

A

….

64
Q

No _____ in melanoma

A

Induration

65
Q

______ is unknown before puberty

A

Melanoma

66
Q

Glasgow criteria

A

Mole turing malignant
Major: >6mm shape color
Minor:
Abcde

67
Q

In transit nodules

A

Btw primary n. Regional lymph node area

68
Q

Why melanoma in choroid has better prognosis?

A

No lymphatics

69
Q

Satellite nodules

A

Within 2 cm of primar

70
Q

Occult melanomas common in

A

Anus
Genitalia
Scalp eye eac adrenal nedulla nail bed

71
Q

Inv melanoma

A 
Excision biopsy with 2mm margin with deeper fatty tissue
Fnac lymph node
Us
Cxr
Ct 
Urine
Slnb
Tumour markers
72
Q

Tumour markers for melanoma

A

Melan a
S100
Hmb 45
Ldh

73
Q

Measurement breslow

A

Base to granulosa layer?

74
Q

No h/o sun exposure in which type of melanoma

A

Acral lentiginous

75
Q

Swan ganz catheter length

A

110cm

76
Q

Treatment melanoma primary

A 
Handleys wide locL excision
In situ n <1mmm 0.5 to 1cm
1-2mm 1-2cm
2-4mm 2cm
>4mm 2cm
Then primary closue or ssg or local flap
#2 amputation one joint above
#3 abdominoperitoneal resection
#4 enucleation
77
Q

Treatment for lymph node sec in melanoma

A

If palpable fnac nd regional block dissection
Fixed lymph node only chemo
Lymphatic mapping n sentinel node biopsy

78
Q

Sentinel lymph node biopsy

A

Preop lymphoscintillography using gamma cam .5mci tech 99 S into dermis .5cm from margin
Perop after gen anaesthesia before wle 1-5ml isosulphan blue
Investigation of choice for staging
Used in ca breast penis nd melanoma

79
Q

Treatment for loco regional recurrent melanoma

A

Within 5 cm radius of primary tumour
Isolated limb perfusion or isolated limb infusion
Melphalan actinomycin d
Hyperthermia ocygenation

80
Q

Chemotherapy for melanoma indications

A

Secondaries in lung liver bones

After surgery

81
Q

Chemotherapy drugs melanoma

A 
Dtic
Melphalan
Carboplatin vindesin
Cvd cisplatin vinblastine dacarbazine
Tamoxifen?
Immunotherapy
Endolymphatictherapy
Targeted therapy
82
Q

Which vit def predisposes to salivarytumours

A

Vit a

83
Q

Classification of salivary tumours

A 
Epithelial(2)
Non epithelial(3)
Malignant lymphomas
Sec tumours
Lymphoepithelial tumours(2)
84
Q

Rule of 80 in salivary neoplasms

A

80% benign in parotids
80% pa
80% superficial lobe

85
Q

Commonest salivary gland tumour in adult n origin

A

Pleomorphic adenoma

Mesenchymal myoepithelial duct reserve cell

86
Q

Dumb bell tumour

A

If only deep lobe of parotid is involved
Presents as swelling in the lateral wall of pharynx soft palatend posterior pillar of fauces
May hve no visible swelling in pre auricular region

87
Q

Curtain sign

A

Pleomorphic adenoma

Any swelling superficial to the deep fascia will move above the zygomatic bone but parotid swelling is deep

88
Q

Raisedear lobule

A

Pleomorphic adenoma

Parotid swellings

89
Q

Pain in salivary tumours

A 
Malignant transformation 
Dull boring. Type
Mayb referred to ear through auriculotemporal 
Due to
Capsular distension
Obstruction to free flow of saliva
Nerve inf
Inflammation 
Tumour necrosis
90
Q

Inv pleomorphic adenoma

A

Fnac ct mri

91
Q

Why incision biopsy is contraindicated in pleomorphic adenoma

A

Facial nerve injury
Seedling nd recurrence
Parotid fistula formation

92
Q

Warthins tumour

A 
Adenolymphoma or papillary cystadenoma lymphomatosum
Not malig
Only in parotid usually lower lobe
Due to trapping of jugular lymph sacs
Double layer of columnar epi
Common in male n smokers
Tech99 fnac
93
Q

Tyrosine crystal seen in which salivary neoplasm

A

Oncocytoma or oxyphil adenoma

94
Q

Commonest malignant tumour in parotid

A

Mucoepidermoid tumour
Major n minor
Radiation
biphasic

95
Q

Mucoepidermoid tumour types

A

Low grade-mucous cells
Intermediate-clear cell variety
High grade-epidermoid cells

96
Q

Most common tumour in submandibular nd sublingual

A

Cylindromatous carcinoma or adenoid cysticcarcinoma

97
Q

Features of adenoid cystic carcinoma

A 
Common. In females
Slow growing but highly malignant
Cribriform tubular solid
Peineural spread trigeminal nd facial
Lung sec. dormant so not a c/i
Radical parotidectomy with neck nodal dissection n postoperative rt
98
Q

Most aggressive salivary malignancy

A

Carcinoma ex pleomorphic adenoma

Surgery (6 decks)

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