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Facts > Surgery > Flashcards

Surgery Flashcards

1
Q

Pelvis fracture - ATLS 10th edition

A

Rupture urethra
Scrotal hematoma
Blood at urethral meatus
Limb length discrepancy
Rotational deformity of leg
(High riding prostate in 9th edition removed)

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2
Q

Inguinal canal

A

Posterior wall - fascia tranversalis, conjoined tendon (medially)
Roof - arched fibres of conjoined tendon
Anterior wall - External oblique, internal oblique (laterally)
Floor - inguinal ligament

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3
Q

Triangle of doom

A

Medial - vas deferens
Lateral - gonadal vessels
Inferior - peritoneum

Contents:
External iliac vessels
Deep circumflex iliac vessels
Genital branch of GFN

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4
Q

Triangle of pain

A

Lateral: Iliopubic tract
Medial: Gonadal vessels
Inferior: peritoneum

Contents (L→M)
Lateral cutaneous nerve of thigh (mc injurured in lap)
Anterior cutaneous nerve of thigh
Femoral branch of GFN
Femoral nerve

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5
Q

Nerves injured in hernia surgery

A

Open hernia - ilioinguinal nerve
Lap hernia - lateral cutaneous nerve of thigh
Open appendix - iliohypogastric
Nerve entrapment in mesh - iliohypogastric

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6
Q

Myopectineal orifice of fruchaud

A

Superior: conjoined tendon
Medial: rectus
Lateral: psoas
Inferior: pecten pubis

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7
Q

European hernia society

A

Ventral
1)Medial
M1 - Subxiphoid - 3cm below xiphoid
M2 - Epigastric - 3cm above umbilicus
M3 - Umbilical - At umbilicus
M4 - Infra umbilical - 3cm below umbilicus
M5 - Supra pubic - 3cm above pubic symphisis
Defect size
I - <4cm
II - 4-10cm
III - >10cm

2)Lateral
L1 - subcostal
L2 - flank
L3 - iliac
L4 - lumbar

Inguinal
P/R - Primary/Recurrent
L/M/F - Indirect/Direct/Femoral
Defect size
I - <1.5cm
II - 1.5-3cm
III - >3cm

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8
Q

Liver transplant in case of secondaries

A

Possible only in Colorectal cancer, carcinoids and cholangiocarcinoma

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9
Q

Gall bladder cancer treatment

A

Tis - mucosa, T1a - lamina propria : cholecystectomy

T1b - muscularis, T2 - serosa, T3 - any one organ : extended cholecystectomy (GB, Lesser Omentum, Nodes, Liver - wedge resection/ segments V&IVb)

Margin positive Stump involvement: Removal of bile duct and hepatojejunostomy

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10
Q

GB polyp

A

<10mm - observation, 6 monthly follow up
>10mm - elective lap cholecystectomy

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11
Q

GB adenomyomatosis

A

Rokitansky Aschoff sinus - Excessive epithelial proliferation and infolding within the underlying muscular layer

Bile in RA sinus → intramural dystrophic calcification
Serosa never involved

MRI - pearl necklace sign
USG - comet tail sign

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12
Q

Reynolds pentad

A

Seen in Cholangitis
Pain \
Fever. – charcots triad
Jaundice /
Hypotension
Altered sensorium

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13
Q

Suspicion of cholangitis

A

Gall stone in USG
CBD dilated >8mm (n=6mm)
LFT - ↑conjugated bilirubin, ↑ALP, ↑GGT

Suggestion: MRCP

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14
Q

Central dot sign

A

Seen in Intrahepatic choledochal cyst
Todani type(IVa & V)

Treatment: segmental resection or Liver transplant

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15
Q

Best investigation for site of bile leak

A

ERCP

Treatment
At stump - ERCP stenting
Other site - laparotomy and repair

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16
Q

PAIR in hydatid disease - Contra indications

A

Superficial cysts with risk of impending rupture
Inaccessible location of cyst
Cysts with multiple internal septal divisions (honeycombing pattern)
Dead/inactive/calcified cysts
Cysts communicating with biliary tree
Lung/Brain cyst(no pericyst)
Pregnancy
Bleeding disorder

17
Q

Genes for IBD

A

NOD2(CARD 15)
ATG16L1

18
Q

Colon cancer

A

Hereditary

Protective drugs
Estrogen
NSAIDs - Aspirin/Sulindac
Metformin
Diet - calcium, selenium and fibres

R - Iron deficiency Anemia & lump
L - altered bowel habits, chronic obstruction

Investigation: colonoscopy, CECT, CEA
Metastasize to liver

19
Q

Bochdalek hernia

A

Left posterior congenital diaphragmatic hernia
Most common
Occurs earlier
Scaphoid abdomen
PPV and Bag & mask ventilation contraindicated
ECMO preferred
Cause of death: PAH & Pulmonary hypoplasia

20
Q

Morgagni hernia

A

Less common
Right anterior congenital diaphragmatic hernia
Occurs late

21
Q

De Quervain’s thyroiditis

A

HLA BW35
Subacute thyroiditis
Viral infection
Painful tender goitre
Hyper → Hypo (few months)→Eu

FNAC - multinucleated giant cells

Treatment: supportive

22
Q

Most important prognostic factor in ca breast

A

Stage > Axillary LN status

In metasatic ca - ER/PR status

23
Q

CLABSI

A

Central Line Associated Blood Stream Infection
Cause - Coagulase negative staph epidermidis

24
Q

Vaccine after splenectomy

A

H. Influenza
Pneumococcus
Meningococcus

Elective: 2 weeks before surgery
Emergency: At discharge or 2 weeks after surgery

↑Risk - children, initial 2 yrs and hematological cause

Facts (24 decks)

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