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SURGERY Flashcards

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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
Durant's RECOVERY position !!
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
26
Parameters for SIRS.!
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
qSOFA score !!
quick Sequential Organ Failure Assessment. Parameters >2 : poor outcome 1. SBP <100 2. RR >22 3. Altered Mental Status
28
Kaposi Sarcoma
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
D/d Kaposi sarcoma-
1 Lymphoma 2 Cutaneous angiomatoses 3 Mycobacterial infection of skin
30
Classification for Lymphoedema
⬇️ 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
6 P's of Arterial Occlusion..!
C/f :- _Pain _Pallor _Paresthesia _Paresis _Poikilothermoa _Pulslessness ( late sign)
32
CREST syndrome
Calcinosis cutis Reynaud phenomenon Esophageal defects Sclerosactyly Telangiectasia
33
Mickey Mouse sign .!
1. In USG Common femoral Artery Femoral artery Vein Great sephanous vein 2. In MRI Hepatic Artery Portal Vein Common bile duct
34
Myopectineal orifice of Fruchaud
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
Usg guided foam sclerotherapy.
_ fot tx of DVT . _ sodium teradecyl sulfate is used. _ max foam permitted in single session is 10-12 ml
36
Best investigation for Bladder Ruptures
⭐Retrograde Cystograph ⬇️ Confirmatory and locate the site of rupture whether intra- pr extraperitonial.
37
M/c complication of Ilial conduit for urinary diverticula
⭐Structure formation Other complications:- _UTI _Uretroilial leak _Metabolic complication ( HyperCHLOREMIC metabolic acidosis)
38
Stone in Laxative abuse.!!
In these pt. HYPOKALAEMIA ⬇️ Kidney produce large amount of AMMONIUM ⬇️ AMMONIUM URATE CRYSTALS
39
Ureterovesical junction..
_ Narrowest part of ureter ⬇️ ⭐Most common site of Stone Impaction
40
Voiding Lut Syndrome.
1. Hesitancy 2. Poor flow 3. Intermittent stream 4. Dribbling 5. Sensation of poor bladder emptying
41
Storage Lut syndrome.!!
1. Frequency 2. Nocturia 3. Urgency 4. Urge incontinence 5. Nocturnal incontinence ( Enuresis)
42
Indications for Open Proatatectomy..
1. Prostate wt.75gm 2. Bladder Diverticulum 3. Large bladder Calculi 4. Urethral structure 5. Prev. Hypospadias repair 6. Orthopedic deformity
43
Drugs causing Meningocele..
TVP ie. Trimethoprim Valproate Phenobarbital
44
Terson Syndrome.!!
SAH + Vitreous haemorrage
45
Orr test!!
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
Graft survival timeline...
◾️Within 48 hrs - plasma Imbibition ◾️after 48hrs - anastomotic connections ⬇️ Inosculation
47
Confirmatory test for acute pancreatitis........
S. amylase & lipase
48
Hyperthrophic Pyloric Stenosis
_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
Mercedes Benz sign
In radioimaging - Air present in GALL STONE _ if there is Biradiate - Seagull sign
50
Mirizzi Syndrome
Adhesion of GB to CBD ( due inflammation) ⬇️ Stone inside GB presses CBD ⬇️ Fistula formation on Long standing case
51
Bouvett Syndrome
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
Charcot's triad
1. Intermittent Rt hypochondrium pain 2. Intermittent fever 3. Intermittent jaundice ⭐feature of Choledocholithiasis. 🌸Reynolds Pentad ie. Charcot triad + shock + altered mental status
53
Light bulb sign 💡 (MRI)
1. Liver hemangioma 2. Pheochromocytoma
54
VACTERL anomaly
Vertebral defects Anal atresia Cardiac defects Tracheo-esophageal abnormalities Renal anomalies Limb anomalies
55
Chemo regimen for Colorectal CA.....
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
Papillon technique....
_Intracavity Radiotherapy _AKA Contact Radiotherapy _done in colorectal CA
57
Catchpole regime
IV Neostigmine, ⬇️ within Minutes pt. Passes flatus and/ feces In case of ⭐ILIUS IN COLON
58
Management of Congenital Pyloric Hypertrophy
Rx 0.45 NS + D + KCl Sx- Ramstedt pyloromyotomy ⬇️ ⬇️ Uneventful Eventfull ⬇️ ⬇️ Feed in 4-6 hrs Feed after 24-48 hrs
59
Management of Peptic Ulcer
Rx 2 attempts of Endoscopy ⬇️ ⬇️ ⬇️ Success Failed Rebleed ⬇️ ⬇️ ⬇️ H. pylori Sx eradication Duodenotomy, endoscopy Underrunning of attempt vessel ⬇️ Sx
60
Mackler triad
1. Retching 2. Chest pain 3. Sc emphysema ⭐seen in Spontaneous esophageal perforation
61
Light bulb sign seen in......
1. Pheochromocytoma in MRI 2. Post. Dislocation of shoulder in x ray
62
Passaro triangle
AKA Gastrinoma triangle 1. Common bile duct 2. Head & neck of pancreas 3. 2nd & 3rd part of duodenum
63
Ratio of collagen 1 replace 3 during remodeling phase
4:1
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