surgical short cases

Question 1

what are the symptoms of an inguinal hernia

Answer 1

1. communicating hydrocele trasilluminates and is fluctuant hydrocoele of the cord:in females might be irreducible ; in male may be brought down into the scrotum and then get it above undescented testis and scrotum on the side is emptyis often associated with a hernia

Question 2

What are the anatomical different types of hernia?

Answer 2

1. inguinal 2. femoral 3. umbelical 4. incisional 5. rare types

Question 3

What are the symptoms you are looking for in a femoral hernia?

Answer 3

1. enlarged lymphnodes - lymphadenopathy 2. saphnea varix appears thin and blue - compressible and feel a thrill 3. ectopic testis occupying an abnormal position

Question 4

What are symptoms of an umbilical hernia?

Answer 4

they are often irreducible and have narrow necks

Question 5

where do femoral hernias appear

Answer 5

below groin crease below and lateral to the pubic crease

Question 6

which ethnic group are umbilical hernias most common in

Answer 6

african descent children

Question 7

What type of umbilical hernias are common in adults

Answer 7

paraumbilical

Question 8

who are paraumbilical hernias frequent in ?

Answer 8

middle aged multiparous obese women

Question 9

What is an incisional hernia?

Answer 9

an incomplete healed surgical wound

Question 10

What are rare types of hernias

Answer 10

obturator, lumbar, spigelian

Question 11

How do you distinguish between an inguinal and a femoralhernia?

Answer 11

reduce and cover the pubic tubercle have patient cough if inguinal -above the pubic tubercle and medial if femoral- under the and lateral

Question 12

How do you distinguish between an inguinal and a femoral hernia?

Answer 12

reduce and cover the pubic tubercle have patient cough if inguinal -above the pubic tubercle and medial if femoral- under the and lateral

Question 13

how do you differentiate a direct and indirect hernia

Answer 13

deep ringoclusion test mid way between pubic tubercle and asis- put finger there and reduce hernia- if cintained and does not come out when cough- indirect

Question 14

What do you look for during a history of the breast examination?

Answer 14

Pain : any pain? cyclical (fibroadenosis) non cyclical constant localized pain (breast cancer)?

Lump: How fast do they grow? change with period (cyst if disappear)

nipple discharge: Any? colour? (discharge common in benign but colour a good indicator (bloody, green, serous occur in fibroadenosis))

previous breast disease: breast disease in the past? Management?

Menstrual history: age of menarch and menopause? oral contraception and hormone replacement therapy?

obstetric history: breast feeding? compication due to breastfeeding?

family history: breast or bowel cancer in the family

Question 15

What do you look for in the inspection phase of a breast examination?

Answer 15

Size and shape of the breast: asymetry?

appearance nipples: inversion (malignancy)? eczema (padget’s)

Lumps?

symmetry: hands pressed on hips, contracted pectoral muscles

skin changes: erythema, oedema (peau d’orange)

skin dimpling or puckering

prominent veins

Question 16

What do you do in the phase of palpation?

Answer 16

1. palpate all 4 quadrants, areola, nipple axillary tail of breast with flat fingers
2. attempt to express discharge by firm palpation
3. bimanually asking the patient to lean forward

Question 17

What are symptoms of varicose veins

Answer 17

1. pain after standing for long time especialy when hot

itching around ankles

pigmentation

swelling

ulceration

thrombophlebitis

Question 18

What do you ook out for when palpating varicose veins

Answer 18

localised tenderness

thickening and induration which implies thrombophebitis

ulcers

oedema around the ankles

defect in the deep fascia due to perfortor incompetence

Question 19

what are the tests for varicose veins?

Answer 19

trendelenburg test: put the finger on the femoral artery- collapse the vein

tournique test

duplex ultrasound

Question 20

how do you distinguish between the short and long saphenous vein

Answer 20

long is medial anterior

posterior and lateral

Question 21

What symptoms are you looking out for in a thyroid examination?