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Myclass > SURGERY > Flashcards

SURGERY Flashcards

1
Q

VAC (Vacuum Assisted Closure) required pressure…

A

-125mmHg

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2
Q

PELD criteria incorporate?

A

Paediatric End stage Liver Disease criteria:-

  1. Albumin
  2. T. Bilirubin
  3. INR
  4. Growth failure
  5. Age (<1 )
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3
Q

Risk factors for Berry Aneurysm..?

A
  1. Adult onset Polycystic Kidney Disease (ADPKD) 🌟
  2. Ehler Danlos syndrome
  3. HTN
  4. Smoking
  5. Marfan syndrome
  6. Fibromuscular Dysplasia
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4
Q

What is TRALI ?

A
  • Transfusion Related Acute Lung Injury
  • Develop within 6 hr of transfusion
  • Due to Anti- HLA antibodies
    -C/F - ARDS picture
    Tx - Accordingly
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5
Q

Lethal triad of SHOCK?

A
  1. Hypothermia( due shunting of blood to vital organs )
  2. Acidosis ( due decreased perfusion)
  3. Coagulopathy ( consumptive type)
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6
Q

Components of RTS (Revised Trauma Score)

A
  1. SBP <90
  2. RR >22
  3. GCS <8

⭐Also in q SOFA score

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7
Q

Monro kelly doctorine.

A

Brain has tremendous capacity to compensate ( for an increasing mass or bleed),
But once the point of decompansation is met, there can be sudden decompression and herniation of brain.

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8
Q

Most common site of distant mets in Breast cancer.

A

BONES( Osteolytic type)
⬇️
Vertebral column (mc)
⬇️
LUMBAR>Thoracic(mc )

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9
Q

Breast chemotherapy drugs?

A

CAF / CMF(6 Cycles)

C - Cyclophosphamide ( Haemirrhagic CYSTITIS)
A - Adriamycin ( Dialated CARDIOMYOPATHY)
F - 5 Fluorouracil ( BM Suppression)
M - Methotraxate

LATEST - 4 CYCLES of AC
⬇️
4 cycles of Paclitaxel / Docetaxel

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10
Q

What is POLAND SYNDROME?

A

AMASTIA

  • ABSENCE of breast tissue +U/L Pectoralis major
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11
Q

Drugs causing GYNACOMASTIA..

A

DISCO

D- Digoxin
I- INH
S- Spironolacton
C- Cimetidine
K- Ketoconazole
O- Oestrogen

Other causes_
1. Idiopathic
2. Lapromatous/ Mumps
3. Cirrhosis
4. Klinefelter
5. Paraneoplastic ( RCC, HCC, Testicular CA)

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12
Q

Drugs causing GYNACOMASTIA..

A

DISCO

D- Digoxin
I- INH
S- Spironolacton
C- Cimetidine
K- Ketoconazole
O- Oestrogen

Other causes_
1. Idiopathic
2. Lapromatous/ Mumps
3. Cirrhosis
4. Klinefelter
5. Paraneoplastic ( RCC, HCC, Testicular CA)

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13
Q

What is ATTRACT Trial for?

A

-For DVT patients.
-THROMBOLYSIS useful in patients with 1.PROXIMAL DVT ie. Iliac / Femoral veins involvement
&
2. DVT with moderate to severe symptoms.

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14
Q

Sclerosing agents used in FOAM SCLEROTHERAPY for varicose vein……

A
  1. 3% sodium tetradecyl sulphate (mc)
  2. 3%polidocanol
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15
Q

Gold standard investigation for LYMPHOEDEMA

A

Water Plethysmography ( quantify limb water volume)

-mild _ <20%
-moderate _ 20-40%
-severe _ 40%

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16
Q

Definitive treatment for SECONDARY hyperparathyroidism…

A

RENAL TRANSPORTATION

( not parathyroidectomy)

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17
Q

Mc cause of 2° HYPERparathytoidism..

A

CKD
⬇️
Hence AKA Renal hyperparathyroidism
⬇️
Tx - Renal transplant
Medical - calcium binders, receptors binders

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18
Q

Treatment for TERTIARY HYPERparathyroidism…

A

SUBTOTAL / TOTAL parathyroidectomy with autottansllantation

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19
Q

Bloody nipples discharge…

A

Intraductal papilloma of breast

  • U/L
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20
Q

Inferior epigastric vessel run in between…

A

Transverse abdominis AND peritonium

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21
Q

What is Richter hernia ?

A

-When only BOWEL WALL enters the hernia.

  • clinically can’t be diagnosed BUT still bowel wall get necrosed and perforated with life threatening complications.
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22
Q

Mc nerve injured during LAP hernia repairs?

A

Ans - LATERAL CUTANEOUS NERVE OF THIGH.

  • Nerve damage during open hernia repair
    ⬇️
    ILIOINGUINAL NERVE >genital branch of genitofemoral nerve
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23
Q

Howship romberg sign..

A

Abduction and medial rotation of hip
⬇️
Shooting pain along the obturator nerve

  • occur in Obturator hernia
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24
Q

Tillaux triad of Mesentric cyst…

A
  1. Periumblical swelling
  2. Moves at right angle to attachment of mesentery but not along the line of attachment of mesentery.
  3. Transverse band of resonance over swelling
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25
Q

Durant’s RECOVERY position !!

A

for RECOVERY from Air embolism.

_ min 20cc air requires to cause air embolism.

_it’s left lat. position
⬇️
air can be aspired through Central line /
ot directly aspired from Heart

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26
Q

Parameters for SIRS.!

A

SIRS - Systemic Inflammatory Response Syndrome

Any 2 parameters should be satisfied:-

_Temp.<36° or >38° C
_WBC <4000 or >12000 or >10%band forms in PS
_RR >20
_PR >90
_pCO2 <32mmHg

27
Q

qSOFA score !!

A

quick Sequential Organ Failure Assessment.

Parameters >2 : poor outcome

  1. SBP <100
  2. RR >22
  3. Altered Mental Status
28
Q

Kaposi Sarcoma

A

MALIGNANT TUMOR of vascular smooth muscle.

◾️Types:-
- European ( lower limbs)
- African ( skin & lymph nodes)
- Transplant associated ( skin)
⬇️
Regresses on stopping Immunosuppresants
_ AIDS associated ( very aggressive

◾️c/f:-
_ multiple bluish red nodules
_ LN enlargement
_ Koebner phenomenon

◾️Tx :-
_ Irradiation
_ Chemo
Adriamycin
Bleomyvin
Vinblastin

29
Q

D/d Kaposi sarcoma-

A

1 Lymphoma
2 Cutaneous angiomatoses
3 Mycobacterial infection of skin

30
Q

Classification for Lymphoedema

A

⬇️
Brunner’s classification

  1. Subclinical (Latent)- Not clinically apparent
  2. Pitting edema - disappear on limb elevation
  3. Non pitting- not significantly reduce on elevation
  4. Irreversible Skin changes- fibrosis, papillae
31
Q

6 P’s of Arterial Occlusion..!

A

C/f :-
_Pain
_Pallor
_Paresthesia
_Paresis
_Poikilothermoa
_Pulslessness ( late sign)

32
Q

CREST syndrome

A

Calcinosis cutis
Reynaud phenomenon
Esophageal defects
Sclerosactyly
Telangiectasia

33
Q

Mickey Mouse sign .!

A
  1. In USG
    Common femoral Artery
    Femoral artery Vein
    Great sephanous vein
  2. In MRI
    Hepatic Artery
    Portal Vein
    Common bile duct
34
Q

Myopectineal orifice of Fruchaud

A

Covers 3 defects
1. Inguinal hernia
2. Femoral hernia
3. Obturator hernia

⭐Boundaries
Medially - Rectus ms
Laterally - tendon of iliopsoas
Superiorly - arching fibers of internal oblique
Inferiorly - lig. of coope

35
Q

Usg guided foam sclerotherapy.

A

_ fot tx of DVT .
_ sodium teradecyl sulfate is used.
_ max foam permitted in single session is 10-12 ml

36
Q

Best investigation for Bladder Ruptures

A

⭐Retrograde Cystograph
⬇️
Confirmatory and locate the site of rupture whether intra- pr extraperitonial.

37
Q

M/c complication of Ilial conduit for urinary diverticula

A

⭐Structure formation

Other complications:-
_UTI
_Uretroilial leak
_Metabolic complication ( HyperCHLOREMIC metabolic acidosis)

38
Q

Stone in Laxative abuse.!!

A

In these pt. HYPOKALAEMIA
⬇️
Kidney produce large amount of
AMMONIUM
⬇️
AMMONIUM URATE CRYSTALS

39
Q

Ureterovesical junction..

A

_ Narrowest part of ureter
⬇️
⭐Most common site of Stone Impaction

40
Q

Voiding Lut Syndrome.

A
  1. Hesitancy
  2. Poor flow
  3. Intermittent stream
  4. Dribbling
  5. Sensation of poor bladder emptying
41
Q

Storage Lut syndrome.!!

A
  1. Frequency
  2. Nocturia
  3. Urgency
  4. Urge incontinence
  5. Nocturnal incontinence ( Enuresis)
42
Q

Indications for Open Proatatectomy..

A
  1. Prostate wt.75gm
  2. Bladder Diverticulum
  3. Large bladder Calculi
  4. Urethral structure
  5. Prev. Hypospadias repair
  6. Orthopedic deformity
43
Q

Drugs causing Meningocele..

A

TVP ie.
Trimethoprim
Valproate
Phenobarbital

44
Q

Terson Syndrome.!!

A

SAH + Vitreous haemorrage

45
Q

Orr test!!

A

The child is made to sit on chair both UL &LL fully flexed close to the chest.
⬇️
This puts pressure on Inguinal canal Downward
⬇️
The testes come down in the Scrotum
( test+ )

⭐done to confirm RETRACTILE TESTES

Mn - Reassurance

46
Q

Graft survival timeline…

A

◾️Within 48 hrs - plasma Imbibition

◾️after 48hrs - anastomotic connections
⬇️
Inosculation

47
Q

Confirmatory test for acute pancreatitis……..

A

S. amylase & lipase

48
Q

Hyperthrophic Pyloric Stenosis

A

_1st MALE child .
_olive green shape epigastric lump
Visible peristalsis lt to rt
Non bilious vomiting
_X ray
Mushroom sign
Double/ triple track sign
Teat sign
Shoulder sign
Caterpillar sign
Diamond sign
_Hypochloremic Hypokalemic Metabolic acidosis
_Paradoxical ACIDURIA

_ Fluid= .45 NS+ Dextrose+ KCl

⭐Ramstad pyloromyotomy

49
Q

Mercedes Benz sign

A

In radioimaging - Air present in GALL STONE

_ if there is Biradiate - Seagull sign

50
Q

Mirizzi Syndrome

A

Adhesion of GB to CBD ( due inflammation)
⬇️
Stone inside GB presses CBD
⬇️
Fistula formation on Long standing case

51
Q

Bouvett Syndrome

A

Gastric Outlet Obstruction ( GOO)
coz of GB stone

_ on X ray abdo:-
Riegler’s triad 1. Pneumobilia
2. Small intestine
obstruction features
3. Radiopac shadow in Rt
iliac fossa ( Ca+ coating)

52
Q

Charcot’s triad

A
  1. Intermittent Rt hypochondrium pain
  2. Intermittent fever
  3. Intermittent jaundice

⭐feature of Choledocholithiasis.

🌸Reynolds Pentad
ie. Charcot triad + shock + altered mental status

53
Q

Light bulb sign 💡 (MRI)

A
  1. Liver hemangioma
  2. Pheochromocytoma
54
Q

VACTERL anomaly

A

Vertebral defects
Anal atresia
Cardiac defects
Tracheo-esophageal abnormalities
Renal anomalies
Limb anomalies

55
Q

Chemo regimen for Colorectal CA…..

A

FOLFOX - Folinic acid, 5 FU, Oxaliplatin

FOLFIRI - Folinic acid, 5 FU, Irinotecan

CAPEOX - Capecitabine, Oxaliplatin

⭐Indication :-
1. LN positivity
2. T3, T4 stage
3. Mets

56
Q

Papillon technique….

A

_Intracavity Radiotherapy
_AKA Contact Radiotherapy
_done in colorectal CA

57
Q

Catchpole regime

A

IV Neostigmine,
⬇️
within Minutes
pt. Passes flatus and/ feces
In case of ⭐ILIUS IN COLON

58
Q

Management of Congenital Pyloric Hypertrophy

A

Rx

0.45 NS + D + KCl
Sx- Ramstedt pyloromyotomy
⬇️ ⬇️
Uneventful Eventfull
⬇️ ⬇️
Feed in 4-6 hrs Feed after 24-48 hrs

59
Q

Management of Peptic Ulcer

A

Rx

2 attempts of Endoscopy
⬇️ ⬇️ ⬇️
Success Failed Rebleed
⬇️ ⬇️ ⬇️
H. pylori Sx
eradication Duodenotomy, endoscopy
Underrunning of attempt
vessel ⬇️
Sx

60
Q

Mackler triad

A
  1. Retching
  2. Chest pain
  3. Sc emphysema

⭐seen in Spontaneous esophageal perforation

61
Q

Light bulb sign seen in……

A
  1. Pheochromocytoma in MRI
  2. Post. Dislocation of shoulder in x ray
62
Q

Passaro triangle

A

AKA Gastrinoma triangle

  1. Common bile duct
  2. Head & neck of pancreas
  3. 2nd & 3rd part of duodenum
63
Q

Ratio of collagen 1 replace 3 during remodeling phase

A

4:1

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