Gen Flashcards
—- suture should not b used for skin
Silk
Suture abscess
Grading of wound scales
Southampton
ASEPSIS
Formation of hemation wgich grade in southampton grading
5
Antibioma
Chronic abscess which is partially sterile
…..
Pain in abscess
Bursting type
Cold abscess
Sorrounding zone of inflammation abscess?
Do not do dependent drainage
Highest risk antibiotic for pseudomembranous colitis
Ciprofloxacin
Dd cellulitis near joints in children
Acute osteomyelitis
Erysipelas
Spreading cuticular lymphangitis Rosy red rash disappearing on pressure Sharp margin Vesicles with serum Millians ear sign
Millians ear sign
Feature distinguishing btw erysipelas n cellulitis
Ear inv does not occur in cellulitis as pinna has no sc tissues
Dishwater pus
Grayish oozing from wound
Necrotizing fasciitis
Necrotizing fasciitis in perineum
Fourniers gangrene
Necrotizing fasciitis in anterior abd wall
Maleneys gangrene
Maleneys gangrene cause
Symbiotic action of microaerophilic non hemolytic strep & staph aureus
Universal precautions
8
Why alcohol is used in dual adents
To increase durability of sterilization
Sterilising abdomen
Medial to lateral
Sterilisation for abdominal surgery
Nipple to midthigh
Spontaneous gas gangrene caused by
C septicum
C novyi
Septic abortion gas gangrene caused by
C sordeli
Only clostridium species which is not a normal part of gut flora
C septicum
Clostridium medium for culture
Rcb
Naglers reaction +
Subterminal spore
Terminal
Perfringes
Tetani
Foaming liver
Gas gangrene
4 aspects of management of gas gangrene
Wound debridement or amputation
Antibiotics iv
Organ fn with iv fluid fresh blood
O2
Effects of hyperbaric o2 for gas gangrene
Reduces exotoxin Ischemia Edema Growth factors Vasoconstriction Migration of neutrophils
Most important toxin in clostridium
Lecithinase
Alpha most common
Why foul smelling gas gangrene
H2s
Nitrogen
Co2
Why ca is necessary for clostridium
Glycogen to co2 lactic acid n hydrogen
Proteinase splits amino acids to ammonia n hydrogen sulphide
Acid neutralised by ammonia n ca
Cf gas gangrene
Incubation period 1 -2 days Toxae,ia fever tachycardia pallor Sickly sweet or decaying apple odor Khakhi brown color Crepitus
Frequent sites of gas gangrene
Adductor region of lower limb n buttocks
Subscapular region in ul
Clinical types gas gangrene
Fulminant Massive Group Single muscle Subcutaneous
Complications of gas gangrene
Septicemia Toxemia Renal failure Liver failure Circulatory failure Dic Sec infection
Investigation gas gangrene
X ray
Lft urea creatinine tc po2 pco2
Ct gram stain rcb
Maldi tof
Treatment of gas gangrene
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
Prevention of gas gangrene
Proper debridement
Do not suture
H2o2 nd normal saline for cleaning
Penicillin prophylaxis
Central venous pressure
Normal 2 to 10 cm
If less than 2cm more fluid is infused
>10cm restricted
Length of catheter in cvp
20cm
If by basilic vein 60 cm
Complications of cvp
Pneumothorax
Hemothorax
Injury to brachial plexus or vessels
Bleeding sepsis catheter displacment
Catheter used pcwp
Swan ganz triple channel pulm artery balloon catheter
Can be kept only for 72hrs
Pcwp uses
Diff btw right n left ventricular failure
Pulm embolism
Septic shock
Measure n monitor cardiac output
Normal pcwp
8-12mmhg
Normal pulm artery pressure
25mmhg 10mmhg
Complications of pcwp
Arrythmia
Pulm artery rupture
Balloon rupture pulm infarct pneumothorax hemothorax bleeding sepsis thrombosis
Indications for oxygen therapy
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
Hyperbaric oxygen
>1or 2 atm in compression chamber Co poisoning tetanus gas gangrene Bedsores frostbite necrotizing fasciitis Paralytic ileus Radiosensitizer.
Complications of hyperbaric ox
Cerebral gas embolism Rupture of tm Visual defects O2 toxicity Co2 narcosis Resp depression
C/i to hyperbaric ox
Asthma emphysema high fever chronic sinusitis viral inf pregnancy
Most aggressive cutaneous malig tumour
Multiple melanoma
Origin of malig mel
Ectodermal neural crest
Dopa reaction
Tyrosine-tyrosinase-dopa-oxidase-melanin
Xeroderma pigmentosa
Autisomal recessive
9q
Risk factors for multiple mel
Sunlight albinism xeroderma jn naevus dysplastic naevuslarge congenital naevi family history h/o skin ca immunosuppresive drugs
Malignancies which spread from mother to fetus
Melanoma
Lymphosarcoma
Breslows classification for malig mel
<0.75mm
.76-1.5
1.5-4
>4
Clarks levels
Mm 5 lvls Only in epidermis Extension into papillary dermis Pilling of pap dermis completely Ext into reticular dermis Subcutaneous tissue
Pigmented lesions of skin
Seborrheic keratosis Mm Bcc scc Naevus sebaceous epidermal naevus Kaposi sarcoma mucosis fungoids Cutaneous hemangioma Solar keratosis Pyogenic granuloma Cutaneous angiosarcoma
Types of melanoma
Cutaneous extracutaneous occult Clinical types Ss Nodular Lentigo maligna Acral lentiginous Amelanotic Desmoplastic Subungual Ocular
Most common clinical type of melanoma
Ss
Pre existing naevi
Lentigo maligna
Least common least malignant
Hutchisons melanotic freckle
Face neck hands elderly women
In situ
Mm mimicking fungal infection
Acral lentiginous
Mm with perineural invasion
Desmoplastic melanoma
Hutchisons sign…
Clarks concept…
….
No _____ in melanoma
Induration
______ is unknown before puberty
Melanoma
Glasgow criteria
Mole turing malignant
Major: >6mm shape color
Minor:
Abcde
In transit nodules
Btw primary n. Regional lymph node area
Why melanoma in choroid has better prognosis?
No lymphatics
Satellite nodules
Within 2 cm of primar
Occult melanomas common in
Anus
Genitalia
Scalp eye eac adrenal nedulla nail bed
Inv melanoma
Excision biopsy with 2mm margin with deeper fatty tissue Fnac lymph node Us Cxr Ct Urine Slnb Tumour markers
Tumour markers for melanoma
Melan a
S100
Hmb 45
Ldh
Measurement breslow
Base to granulosa layer?
No h/o sun exposure in which type of melanoma
Acral lentiginous
Swan ganz catheter length
110cm
Treatment melanoma primary
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
Treatment for lymph node sec in melanoma
If palpable fnac nd regional block dissection
Fixed lymph node only chemo
Lymphatic mapping n sentinel node biopsy
Sentinel lymph node biopsy
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
Treatment for loco regional recurrent melanoma
Within 5 cm radius of primary tumour
Isolated limb perfusion or isolated limb infusion
Melphalan actinomycin d
Hyperthermia ocygenation
Chemotherapy for melanoma indications
Secondaries in lung liver bones
After surgery
Chemotherapy drugs melanoma
Dtic Melphalan Carboplatin vindesin Cvd cisplatin vinblastine dacarbazine Tamoxifen? Immunotherapy Endolymphatictherapy Targeted therapy
Which vit def predisposes to salivarytumours
Vit a
Classification of salivary tumours
Epithelial(2) Non epithelial(3) Malignant lymphomas Sec tumours Lymphoepithelial tumours(2)
Rule of 80 in salivary neoplasms
80% benign in parotids
80% pa
80% superficial lobe
Commonest salivary gland tumour in adult n origin
Pleomorphic adenoma
Mesenchymal myoepithelial duct reserve cell
Dumb bell tumour
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
Curtain sign
Pleomorphic adenoma
Any swelling superficial to the deep fascia will move above the zygomatic bone but parotid swelling is deep
Raisedear lobule
Pleomorphic adenoma
Parotid swellings
Pain in salivary tumours
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
Inv pleomorphic adenoma
Fnac ct mri
Why incision biopsy is contraindicated in pleomorphic adenoma
Facial nerve injury
Seedling nd recurrence
Parotid fistula formation
Warthins tumour
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
Tyrosine crystal seen in which salivary neoplasm
Oncocytoma or oxyphil adenoma
Commonest malignant tumour in parotid
Mucoepidermoid tumour
Major n minor
Radiation
biphasic
Mucoepidermoid tumour types
Low grade-mucous cells
Intermediate-clear cell variety
High grade-epidermoid cells
Most common tumour in submandibular nd sublingual
Cylindromatous carcinoma or adenoid cysticcarcinoma
Features of adenoid cystic carcinoma
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
Most aggressive salivary malignancy
Carcinoma ex pleomorphic adenoma
