SURGERY - General Flashcards

Question

Who introduced the boiling of surgical instruments?

Answer 1

Galen (130-200 AD).

Answer 2

Identified that the hands of a surgeon were the cause of puerperal fever and showed that washing hands greatly reduces it.

Answer 3

The person’s own microbial flora.

Answer 4

* Air * Infected drops * Contacts * Implants

Answer 5

[environment, instruments, hands, clothing of personnel]

Answer 6

To prevent infection during surgical procedures.

Answer 7

* Iodine * Spirits * Quaternary ammonium compounds

Answer 8

* Wide spectrum of activity * Destroys microbes within a practical period * Active in the presence of organic matter * Effective contact and wettable * Active in any pH * Stable * Long shelf life * Speedy * High penetrating power * Non-toxic, non-allergenic, non-irritative or non-corrosive

Answer 9

* Based on consistency: Liquid, Gaseous * Based on spectrum of activity: High level, Intermediate level, Low level * Based on mechanism of action: Action on membrane, Denaturation of cellular proteins, Oxidation of essential sulphydryl groups, Alkylation of groups, Damage to nucleic acids.

Answer 10

A process that destroys or eliminates all forms of microbial life, including spores.

Answer 11

* Physical Method * Chemical Method * Gaseous Method

Answer 12

Heat sterilization.

Answer 13

Uses higher temperatures (160-180°C) for sterilization and requires exposure time of up to 2 hours.

Answer 14

121-134°C.

Answer 15

* Ionizing (X-rays, gamma rays) * Non-ionizing (Ultra-violet, infrared rays)

Answer 16

Acts on microbes by alkylation and denaturation of nucleic acids.

Answer 17

Instruments that enter sterile tissue or the vascular system and must be sterile.

Answer 18

Items that contact mucous membranes or non-intact skin.

Answer 19

Changing room for all theatre users.

Answer 20

Air embolism occurs during a change of transfusion set and is characterized by symptoms such as gasping respiration, hypotension, and splashing noises over the heart. ## Footnote Management includes giving oxygen, turning the patient to the left side, raising the foot of the bed, and aspirating air in the heart.

Answer 21

1. Stop transfusion 2. Re-group & cross-match remainder of blood 3. Confirm reaction (methaemoglobinaemia, methaemalbumin in plasma) 4. Give diuretics (furosemide, mannitol) 5. Alkalinize urine by NaHCO3 6. Give FFP, platelets to combat oozing/DIC during surgery

Answer 22

Allergic reactions are due to allergens in donor plasma and are mediated by histamine and leucotrienes. ## Footnote They are common in repeated transfusions.

Answer 23

1. Interrupt transfusion 2. Give anti-histamine 3. Give steroids 4. Give adrenaline

Answer 24

Haemolytic reaction involves the haemolysis of donor cells by antibodies in the recipient and occurs in 0.05% of transfusions with a mortality rate of 10-50%. ## Footnote The most important cause is an ABO antigen-antibody reaction.

Answer 25

1. Sensation of heat & pain along the vein 2. Tingling of the limb 3. Rigor 4. Fever 5. Dyspnoea 6. Chest pain 7. Loin pain 8. Shock 9. Haemoglobinuria

Answer 26

It is a reaction between antigens on donor WBC and antibodies in recipient plasma, often following previous transfusions, pregnancies, or presence of endotoxins or pyrogens.

Answer 27

1. Stop transfusion temporarily 2. Give anti-pyretic 3. Give leucocyte-depleted blood products if severe

Answer 28

Bacterial contamination occurs in 2% of banked blood and usually happens when blood is left out at room temperature.

Answer 29

1. Stop transfusion 2. Culture donor and recipient blood 3. Give intravenous broad-spectrum antibiotics

Answer 30

Massive blood transfusion is defined as giving more than half of the patient's blood volume in 1 hour or more than the total blood volume in less than 24 hours.

Answer 31

1. Technical/clerical error 2. Circulatory overload 3. Cardiac arrhythmias/arrest 4. Respiratory complications 5. Bleeding diathesis 6. Reduced O2 delivery

Answer 32

Autologous transfusion is the collection and re-infusion of the patient's own blood.

Answer 33

1. Pre-operative autologous blood donation 2. Acute iso-volaemic haemodilution (AIVH) 3. Intra-operative blood salvage 4. Post-operative blood salvage

Answer 34

Fresh frozen plasma is indicated for correction of coagulopathy and volume expansion.

Answer 35

Platelet concentrate is indicated for severe thrombocytopenia, DIC, and platelet dysfunction.

Answer 36

Blood products should be stored at 2-6°C and have a shelf life of 35 days.

Answer 37

1. Age between 18 & 65 years 2. Weight > 51 kg 3. No major operations/blood donation in the last 6 months 4. No pregnancy/blood transfusion in the last 1 year 5. Free from hepatitis, HIV, syphilis, etc.

Answer 38

Feeding intravenously, bypassing the entire digestive system (mouth to anus) ## Footnote Parenteral nutrition can be for short or long periods of time.

Answer 39

Water, carbohydrates, protein, vitamins, minerals, and fats ## Footnote Parenteral nutrition has standard variations but can be customized.

Answer 40

* Temporary boost of calories before transitioning to enteral feeding or mouth feeding * Patients with long-term hospital stay with malnutrition

Answer 41

Complete nutrition delivered intravenously, contraindicated in the use of the digestive tract ## Footnote TPN is needed if the digestive tract is not functioning or if there is a GI disease requiring complete rest.

Answer 42

* Intestinal ischemia * Small or large intestinal obstruction * Prolonged ileus * Radiation enteritis * Extremely premature birth * Necrotizing enterocolitis * Inflammatory bowel disease * Short bowel syndrome * Gastrointestinal surgery * Chemotherapy

Answer 43

* Detailed clinical history * Body mass index * Laboratory tests (e.g., FLP, LFT, micronutrients) * Team of doctors, nurses, nutritionist, and pharmacists

Answer 44

Should be taken out a few hours prior to use to thaw ## Footnote Properly refrigerated parenteral nutrition can last up to 7 days.

Answer 45

Gradual and graded transition from clear liquid diet to full liquid diet, then to solid diet

Answer 46

* Gives the GI tract time to heal from severe illness or surgery * Provides an important boost for the body * TPN could be life-saving

Answer 47

* Sepsis from the catheter * Atrophy of GI tract * Blood clots * Glucose imbalances (hyper or hypo) * Transient liver reactions * Parenteral nutrition-associated liver disease (PNALD) * Gall bladder problems * Osteoporosis or osteomalacia

Answer 48

Delivery of nutrition through large veins, such as the superior vena cava via the subclavian vein ## Footnote CPN is used to deliver total parenteral nutrition.

Answer 49

Delivery of partial parenteral nutrition through peripheral veins

Answer 50

To administer parenteral nutrition ## Footnote Types of catheters include external 'tunneled' catheters, fully implanted catheters, and peripherally inserted central catheters.

Answer 51

False ## Footnote Parenteral nutrition can be used for short or long periods depending on the patient's needs.

Answer 52

To ensure patient safety and detect potential complications

Answer 53

Key to good outcomes and reducing complications

Answer 54

mouth feeding

Answer 55

Can occur during catheter insertion

Answer 56

Target the cell wall

Answer 57

* Cell wall * Cytoplasmic membranes * Ribosomes * Nucleic acid replication

Answer 58

* Bacteriostatic: Slow or stop growth of bacteria, effective in immunocompetent * Bactericidal: Kill bacteria, better for immunosuppressed

Answer 59

* Penicillin * Cloxacillin * Fusidic acid * Erythromycin * Clindamycin * Lincomycin * Vancomycin

Answer 60

* Tetracycline * Chloramphenicol * Ampicillin/Amoxicillin * Clavulanic acid/Amoxicillin * Piperacillin * Cephalosporins * Trimethoprim * Ciprofloxacin * Imipenem * Sulphonamides * Nitrofurantoin * Rifampicin

Answer 61

* Treat infections * Prophylaxis

Answer 62

* Beta-lactams

Answer 63

Beta-lactamase inhibitor

Answer 64

Antibacterial activity

Answer 65

Good activity on gram positives, less active on gram negatives

Answer 66

Gram negative infections, infective endocarditis, streptococcal and staph infections

Answer 67

Sulphadiazine

Answer 68

Prophylaxis of surgical sepsis

Answer 69

Rarely necessary for more than 48 hours

Answer 70

Benzyl penicillin

Answer 71

Prevent gram negative bacteremia during instrumentation

Answer 72

Sensitivity results

Answer 73

* When not indicated * Inappropriate choice * Suboptimal doses * Longer duration than necessary for prophylaxis

Answer 74

The kidneys are responsible for maintaining plasma osmolality within a narrow range.

Answer 75

* Intracellular fluid (ICF) * Extracellular fluid (ECF)

Answer 76

TBW decreases with age.

Answer 77

* Plasma water (5% of body weight) * Interstitial water (15% of body weight)

Answer 78

The RAA system, ANF, and ADH.

Answer 79

The minimum intake necessary to maintain fluid balance.

Answer 80

A change in plasma osmolality of as little as 1-2% or ECF depletion by 10%.

Answer 81

Losses of water through evaporation, influenced by surface area, temperature, and activity.

Answer 82

To normalize the ICF and ECF chemical environment for cell and organ function.

Answer 83

* Maintenance * Deficit * Supplementary or ongoing loss

Answer 84

Loss of 3-5% of body weight.

Answer 85

Parenteral therapy is needed.

Answer 86

Sodium (Na).

Answer 87

135-145 mEq/L.

Answer 88

* Nausea * Vomiting * Muscle twitching

Answer 89

Serum sodium >150 mEq/L.

Answer 90

Potassium (K).

Answer 91

3.5 - 5.5 mEq/L.

Answer 92

Serum [K+] <3 mEq/L.

Answer 93

* Diuretics * Renal loss * GIT loss * Inadequate K+ intake

Answer 94

Prevention through a potassium-rich diet.

Answer 95

285-295 mosmo/kg H2O.

Answer 96

Regulates urinary water excretion.

Answer 97

A serum potassium level less than 3.5 mEq/L.

Answer 98

* Laxative abuse * Inadequate K+ intake * Metabolic alkalosis * Certain drugs (e.g., catecholamines, β-agonists, hypothermia)

Answer 99

Prevention through a potassium-rich diet.

Answer 100

Metabolic alkalosis.

Answer 101

It must never be given as a push or bolus infusion.

Answer 102

0.3 mEq/kg over 20 minutes.

Answer 103

Serum [K+] > 6 mEq/L.

Answer 104

* Peaked T waves * Widening of the QRS complex

Answer 105

Hemolysis of the specimen.

Answer 106

When serum [K+] is > 7 mEq/L.

Answer 107

Correct acidosis to increase potassium transfer into the intracellular fluid.

Answer 108

* Oliguria and renal failure * Acidosis * Sick cell syndrome * Excessive K+ administration * Congenital adrenal hyperplasia * Hemolysis of blood sample

Answer 109

Obtain a twelve lead EKG.

Answer 110

200 mg/kg IV over several minutes.

Answer 111

Kayexalate™, a cation exchange resin.

Answer 112

Add 2 units of soluble insulin to 60 mL of D12.5%, starting at 0.1 units/kg/h.

Answer 113

1,000 to 1,500 mg.

Answer 114

* Parathyroid hormone (PTH) * Calcitonin * Calcitriol

Answer 115

Total serum calcium level < 8.9 mg/dL.

Answer 116

* Preterm infants * SGA infants * Term infants with birth asphyxia * Infants of diabetic mothers

Answer 117

* Jitteriness * Irritability * High pitched cry * Hypocalcemic seizures * Stridor * Tetany * Decreased myocardial contractility

Answer 118

Slow infusion of calcium gluconate 10% at 200 mg/kg.

Answer 119

Total serum [Ca] > 12 mg/dL.

Answer 120

* Low serum phosphorus * Congenital hyperparathyroidism * William’s syndrome * Hypervitaminosis D * Adrenal insufficiency * Thiazide diuretic therapy

Answer 121

* Correct underlying cause * Adequate hydration * Furosemide to increase calcium excretion * Glucocorticoids to inhibit absorption

Answer 122

Persistent hypocalcemia.

Answer 123

MgSO4 25-50 mg/kg/dose IV slowly.

Answer 124

Serum magnesium concentration > 3 mg/dL.

Answer 125

* Hypotonia * Hyporeflexia * Hypotension * Apnea

Answer 126

Usually symptomatic until magnesium level falls; may require calcium IV.

Answer 127

* Crystalloids * Colloids

Answer 128

* Normal saline (0.9%) * Ringer’s lactate * Dextrose solutions

Answer 129

To maintain or raise colloid osmotic pressure of blood.

Answer 130

(Desired – Observed) X Wt(Kg) X 0.6

Answer 131

7.36-7.44.

Answer 132

* Buffer systems * Respiratory mechanism * Renal mechanism * Liver

Answer 133

Increased pCO2, decreased HCO3.

Answer 134

Na + K - HCO3 + Cl = 10-16 mmol/L.

Answer 135

Disturbances can often be prevented or minimized by appropriate intervention.

Answer 136

Shock ## Footnote Shock results from a reduction in effective circulating blood volume leading to cellular hypoxia.

Answer 137

* Total blood volume is reduced * Heart fails to pump blood effectively * Pooling of blood in peripheral vessels

Answer 138

* Decompensated * Compensated

Answer 139

When the cardiovascular system lacks adequate power for perfusion of the peripheral tissues.

Answer 140

There is adequate power for perfusion, but at the cost of excessive and inefficient use of oxygen.

Answer 141

* Pulmonary embolism * Air embolism * Tension pneumothorax * Cardiac valvular stenosis

Answer 142

Acute Hemorrhage

Answer 143

* Internal bleeding * External bleeding * Loss of plasma * Loss of extracellular fluid

Answer 144

* Minimal tachycardia * No changes in BP * No changes in pulse pressure or respiratory rate

Answer 145

* Tachycardia (>100 bpm) * Tachypnea * Decrease in pulse pressure * Cool clammy skin

Answer 146

* Marked tachycardia * Decreased systolic BP * Oliguria * Significant changes in mental status

Answer 147

* Marked tachycardia * Decreased systolic BP * Narrowed pulse pressure * Depressed mental status

Answer 148

* Hematologic * Cardiovascular * Renal * Neuroendocrine

Answer 149

Renin converts angiotensinogen to angiotensin I.

Answer 150

Aldosterone

Answer 151

Increases reabsorption of water and sodium.

Answer 152

Stimulates glycogenolysis and lipolysis.

Answer 153

Causes vasodilatation and increases capillary permeability.

Answer 154

Results from anaerobic glycolysis.

Answer 155

It is depressed, increasing susceptibility to infection.

Answer 156

Increased anaerobic glycolysis resulting in depletion of ATP.

Answer 157

Confusion or coma.

Answer 158

heart rate

Answer 159

Rapid and deep respiration (air hunger).

Answer 160

Autolysis and cell death

Answer 161

Immunity is depressed, increasing susceptibility to infection

Answer 162

* Macrophage functions * Lymphocyte response to stimuli

Answer 163

* FBC * Electrolyte levels (Na, K, Cl, HCO3, BUN, creatinine, glucose) * Prothrombin time * Activated partial thromboplastin time * ABGs * Urinalysis

Answer 164

Adequate resuscitation before imaging studies

Answer 165

Ultrasonographic examination

Answer 166

Place a nasogastric tube and perform gastric lavage

Answer 167

An upright chest radiograph

Answer 168

Pregnancy test

Answer 169

Diagnostic peritoneal lavage or CT scanning in stable patients

Answer 170

Rapid transport to the hospital

Answer 171

* Maximize oxygen delivery * Control further blood loss * Fluid resuscitation

Answer 172

The patient’s airway

Answer 173

Isotonic crystalloid, such as lactated Ringer solution or normal saline

Answer 174

Trendelenburg position or lifting the patient’s legs up

Answer 175

Sterile collection, anticoagulation, filtration, and retransfusion of blood

Answer 176

Direct pressure for external bleeding and surgical intervention for internal bleeding

Answer 177

* Gram-negative (e.g., E. coli, Klebsiella) * Gram-positive (e.g., Streptococci, Staphylococci)

Answer 178

* Warm, dry, flushed skin * Moderate hypotension * Rapid but bounding pulse * Fever ranging from 38.3 to 41°C

Answer 179

* FBC * Culture of blood, urine, or exudate * Imaging (Ultrasound, CT Scan)

Answer 180

Volume replacement

Answer 181

They inhibit conversion of membrane phospholipids to arachidonic acid

Answer 182

Low blood pressure with a slow pulse

Answer 183

* Cardiac tamponade * Myocardial infarction * Pulmonary embolism

Answer 184

Failure to recognize it early

Answer 185

Coagulopathies due to dilution of platelets and clotting factors

Answer 186

Vasovagal syndrome

Answer 187

* Cardiac tamponade * Myocardial infarction * Cardiac contusion * Pneumothorax * Pulmonary embolism

Answer 188

* Venous congestion * Facial cyanosis * Distended neck veins * Severe hypotension * Reduced pulse pressure * Weak and rapid pulse * Cold clammy skin * Dyspnoea

Answer 189

Directed to the underlying cause

Answer 190

Aspiration of pericardial blood

Answer 191

Insertion of a chest tube

Answer 192

A hypersensitivity reaction occurring within seconds of injection of animal serum or drugs

Answer 193

* Leukotrienes C4, D4, E4 * Histamine * Bradykinin * Prostaglandins

Answer 194

* Choking sensation * Wheezing * Cough * Urticaria * Oedema * Loss of consciousness * Severe hypotension * Faint pulse * Pruritus

Answer 195

Adrenaline (1ml of 1:1000 I.M.)

Answer 196

Every 5 minutes if necessary

Answer 197

Antihistamine

Answer 198

To relieve bronchospasm

Answer 199

0.25-0.5mg in 10ml of saline

Answer 200

Adequate airway

Answer 201

A state of abnormal tissue and cellular perfusion

Answer 202

Substantially underestimating the frequency of occurrence

Answer 203

Acute blood loss

Answer 204

Prompt operative intervention

Answer 205

End-organ dysfunction and death

Answer 206

A state of tissue hypoperfusion due to inadequate oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these factors. ## Footnote Shock can lead to cellular dysfunction and organ failure.

Answer 207

Inadequate tissue perfusion can lead to cellular dysfunction and organ failure. ## Footnote Shock remains a major cause of morbidity and mortality.

Answer 208

* Hypovolemic Shock * Cardiogenic Shock * Distributive Shock * Obstructive Shock ## Footnote Each type has distinct causes such as hemorrhage, cardiac failure, vasodilation, and mechanical obstruction.

Answer 209

A modern classification of shock due to mitochondrial dysfunction and impaired cellular energy utilization, often seen in sepsis. ## Footnote It reflects the evolving understanding of shock mechanisms.

Answer 210

* Blood pressure * Heart rate * Urine output * Mental status ## Footnote These indicators help assess the severity of shock.

Answer 211

* Dynamic Fluid Responsiveness Tests (e.g., passive leg raise, PPV, SVV) * Advanced Hemodynamic Monitoring (e.g., PiCCO, LiDCO, echocardiography) * Microcirculatory Monitoring (e.g., SDF, sublingual capillary assessment) ## Footnote These methods provide more detailed insights into patient status.

Answer 212

Avoidance of excessive fluid administration to prevent fluid overload and capillary leak syndrome. ## Footnote It emphasizes the use of balanced crystalloids over normal saline.

Answer 213

Norepinephrine. ## Footnote Early vasopressor use aims to achieve a MAP > 65 mmHg.

Answer 214

* Vasopressin * Angiotensin II ## Footnote These agents assist in managing shock when initial therapies are inadequate.

Answer 215

* Vitamin C * Thiamine * Hydrocortisone ## Footnote This approach targets immune response and metabolic needs.

Answer 216

140-180 mg/dL. ## Footnote Maintaining glucose levels within this range is essential for patient outcomes.

Answer 217

* IL-6 inhibitors (e.g., Tocilizumab) * JAK inhibitors * Beta-blockade (e.g., Esmolol) * Hemadsorption and cytokine removal (e.g., Polymyxin B hemoperfusion, CytoSorb) * Gene and stem cell therapy ## Footnote These therapies aim to address underlying mechanisms of shock.

Answer 218

They are being explored for mitochondrial dysfunction and endothelial repair. ## Footnote This represents a cutting-edge approach to treating shock.

Answer 219

It continues to evolve with emphasis on individualized therapy, hemodynamic monitoring, and novel pharmacological interventions. ## Footnote Understanding new concepts is crucial for improving patient outcomes.

Answer 220

An inflammatory reaction involving the folds of the skin surrounding the fingernail, characterized by acute or chronic purulent, tender, and painful swellings of the tissues around the nail. ## Footnote Causative agents include Staphylococcus, Pseudomonas aeruginosa, or Streptococcus.

Answer 221

A type of hand infection involving the pad of the finger, typically requiring surgical intervention. ## Footnote Treatment often involves incision and drainage.

Answer 222

Cutaneous abscesses that begin in skin glands and hair follicles, commonly caused by Staphylococcus aureus. ## Footnote They are the most common surgical infections.

Answer 223

A deep-seated mass of fistulous tracts between infected hair follicles, considered more severe than a furuncle. ## Footnote Carbuncles require excision and antibiotics for treatment.

Answer 224

A serious skin infection of the axillae or groin consisting of multiple abscesses of the apocrine sweat glands, often chronic in nature. ## Footnote The classic therapy involves drainage and hygiene.

Answer 225

Infectious accumulation of purulent material (neutrophils) in a closed cavity, usually post-partum, requiring drainage for treatment. ## Footnote MRSA is uncommon in breast abscesses.

Answer 226

A diffuse infection with severe inflammation of dermal and subcutaneous layers of the skin. ## Footnote Common pathogens include skin flora such as Streptococcus and Staphylococcus.

Answer 227

Avoid antibiotics to prevent the development of resistance. ## Footnote Identification and sensitivities of organisms guide antibiotic selection.

Answer 228

Two main types: * Community-Acquired * Hospital-Acquired ## Footnote Community-acquired infections include cellulitis and necrotizing infections.

Answer 229

Wind, Water, Walking, Wonder Drug, Wound. ## Footnote These represent common causes of fever after surgery.

Answer 230

Fastidious anaerobes that can cause a broad spectrum of disease, often leading to necrotizing infections. ## Footnote They may present as crepitant abscess or cellulitis.

Answer 231

Infection involving systemic and local signs of inflammation with bacterial counts ≥ 10^5 cfu/mL. ## Footnote SSIs can be superficial or deep incisional.

Answer 232

Occurs within 30 days after surgery, involving only skin or subcutaneous tissue of the incision. ## Footnote It is different from deep incisional SSI, which involves deeper tissues.

Answer 233

Patient characteristics include: * Age * Diabetes * Obesity * Nicotine use * Preoperative nares colonization with Staphylococcus aureus ## Footnote Surgical factors also contribute, such as duration of operation and skin antisepsis.

Answer 234

Life-threatening organ dysfunction caused by excessive and disproportionate host response to infection. ## Footnote It is defined by SIRS plus evidence of infection.

Answer 235

To prevent the proliferation of commensal microorganisms and reduce the risk of infection. ## Footnote Selection depends on procedure, expected pathogens, and local resistance patterns.

Answer 236

The WHO’s 5 steps: * Before touching a patient * Before a clean/aseptic procedure * After risk of body-fluid exposure * After touching a patient * After touching a patient’s surroundings ## Footnote Soap and water or alcohol-based disinfectants are acceptable, except for C. difficile.

Answer 237

Local signs: Rubor, Calor, Dolor, Tumor, and functio laesa. Systemic signs include SIRS. ## Footnote SIRS criteria include abnormal temperature, heart rate, respiratory rate, and WBC count.

Answer 238

WBC > 10,000, ↑ serum creatinine, ↑ BUN, ↑ CRP, and lactic acid. ## Footnote Urinalysis and blood cultures are critical for diagnosis.

Answer 239

[drainage]

Answer 240

Type of procedure, Degree of contamination, Duration of operation, Urgency of operation ## Footnote These factors can influence the likelihood of surgical complications.

Answer 241

Fistulas and sinus tract, Suppressed wound healing, Immunosuppression and superinfection, Bacteremia, Organ dysfunction, Sepsis, Systemic inflammatory response syndrome ## Footnote These complications can arise following surgical procedures due to infections.

Answer 242

1-3 days ## Footnote Early postoperative infections should always consider preexisting community-acquired infections.

Answer 243

Group A Streptococcus, Clostridium perfringes, Pneumonia (peak at postop day 2), Urinary tract infection (patients with catheter in place) ## Footnote Early infections often arise from specific pathogens.

Answer 244

Surgical site infection ## Footnote This typically occurs after 3 days post-surgery.

Answer 245

Catheter related infections, Antibiotic-associated infection (C. difficile) ## Footnote These infections are often associated with prolonged hospital stays or antibiotic use.

Answer 246

A severe infection that results in tissue death ## Footnote This type of infection can rapidly progress and requires urgent medical intervention.

Answer 247

Localized collections of pus in tissues ## Footnote Abscesses can form as a result of infection and may require drainage.

Answer 248

Diffuse inflammatory process in soft tissues ## Footnote Phlegmons can lead to significant tissue damage and require treatment.

Answer 249

Through lymphatic vessels that drain infected tissues ## Footnote This pathway can facilitate the spread of infection to regional lymph nodes.

Answer 250

Through bacteremia, leading to systemic infection ## Footnote This can result in sepsis and widespread organ dysfunction.

Answer 251

A type of jaundice caused by mechanical obstruction requiring surgical intervention.

Answer 252

* Severe Jaundice * Pruritus * Abdominal swelling * Passage of dark coloured urine * Passage of pale bulky stool * Weight loss * Nausea and vomiting * Right hypochondriac pain * Charcot’s triad: Fever, RUQ pain, Jaundice * Reynaud’s pentad: Fever, RUQ pain, hypotension, altered sensorium

Answer 253

* Unconjugated hyperbilirubinaemia (e.g., haemoglobinopathy) * Viral hepatitis * Liver cirrhosis * Liver carcinoma * Drug-induced cholestasis

Answer 254

A prodromal pre-icteric illness marked by malaise, anorexia, nausea, and weakness.

Answer 255

* Methandrostenolone * Progesterone derivatives in oral contraceptives * Chlorpromazine * Prochlorperazine * Sulphonamides

Answer 256

The finding of a distended non-tender gall bladder is a valuable sign of cholestasis due to obstruction by a tumor of the head of the pancreas, not due to stones.

Answer 257

* White blood cell count * Haemoglobin estimation * Haemoglobin electrophoresis * Urinalysis * Clotting profile

Answer 258

* Plain X-rays of the abdomen * Ultrasonography * Percutaneous Transhepatic Cholangiogram (PTC) * Endoscopic Retrograde Cholangiopancreatography (ERCP) * Contrast enhanced CT scan

Answer 259

* ERCP stone removal * Choledocholithotomy * Transduodenal sphincteroplasty * Choledochojejunostomy * Choledochojejunostomy

Answer 260

Kasai’s operation or liver transplantation.

Answer 261

* Sepsis * Cholangitis * Biliary cirrhosis * Hepatorenal syndrome * Pancreatitis * Hepatic encephalopathy * Uncontrolled bleeding * Renal failure * Malabsorption

Answer 262

It is elevated in gallbladder cancer.

Answer 263

Colicky abdominal pain in the right hypochondrium, sudden in onset, radiating to the back and right shoulder.

Answer 264

Cirrhosis.

Answer 265

To manage coagulopathy and support hemostasis.

Answer 266

* Pruritus * Jaundice * Dark urine * Pale stools

Answer 267

It binds bile salts in the intestine, inhibiting their absorption.

Answer 268

5-year survival is about 2%, with 90% dying before the end of the year.

Answer 269

Bilirubin helps in intestinal absorption, absorption of fats, absorption of fat-soluble vitamins (A, D, E, K), gives stool its color (stercobilin), and is needed in the excretion of cholesterol.

Answer 270

Obstructive lesions block bilirubin secretions, causing malabsorption, steatorrhea, pale stool, and deficiencies in vitamins A, D, E, and K.

Answer 271

Prothrombin disorder.

Answer 272

Osteoporosis.

Answer 273

Urine becomes dark due to the presence of conjugated bilirubin.

Answer 274

Deranged liver function due to hepatotoxicity of bile acid.

Answer 275

* Biliary atresia * Choledochal cyst.

Answer 276

* Cholelithiasis * Biliary stricture * Parasitic infestation (e.g. Ascariasis).

Answer 277

* Carcinoma of the head or periampullary region of the pancreas * Cholangiocarcinoma * Ca gallbladder.

Answer 278

[biliary tree].

Answer 279

* A * D * E * K.

Answer 280

Natural or Synthetic ## Footnote Sutures can also be classified as absorbable or nonabsorbable.

Answer 281

* Not required to be removed * Different predictable absorption times

Answer 282

* Consideration of wound support time * Poor strength * High tissue reactivity due to proteolytic enzyme degradation

Answer 283

By the force, in pounds, which the suture strand can withstand before it breaks when knotted.

Answer 284

The tensile strength of the tissue to be mended.

Answer 285

The tensile strength of the suture need never exceed the tensile strength of the tissue.

Answer 286

#5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics)

Answer 287

The diameter of the suture material.

Answer 288

Use the smallest diameter suture that will adequately approximate tissues.

Answer 289

The diameter of the strand decreases.

Answer 290

* Knot security * Elasticity * Plasticity * Memory * Capillary action * Non-irritant * Non-allergenic * Non-carcinogenic

Answer 291

Sutures that undergo rapid degradation in tissues, losing their tensile strength within 60 days.

Answer 292

Sutures that are not digested by body enzymes or hydrolyzed in body tissue.

Answer 293

Sutures that consist of several filaments or strands twisted or braided together.

Answer 294

* Encounter less resistance as they pass through * Resist harboring organisms which may cause infection * Tie down easily

Answer 295

* Crushing or crimping can create a weak spot * Can be difficult to handle * May not tie knots well * May need 6 or 7 throws to a knot

Answer 296

* Catgut * Chromic Gut * Collagen * Silk

Answer 297

* Handles well * Inexpensive

Answer 298

* Can incite tissue reaction * Nidus for bacteria resulting in chronic infection and sinus formation

Answer 299

* Polyglactin (Vicryl) * Nylon (Ethilon) * Polydioxanone (PDS) * Prolene

Answer 300

Have minimal tissue reaction.

Answer 301

* Can be difficult to handle * Can have good memory (e.g., nylon) * Poor knot security

Answer 302

Made of a single strand of material.

Answer 303

* Easy to handle * Easy to knot * High uniform tensile strength * High tensile strength retention * Consistent uniform diameter * Sterile * Pliable for ease of handling and knot security * Non-allergenic * Predictable performance * Cheap

Answer 304

Placed by an embalmer on the body of a twenty-first dynasty mummy about 1100 B.C.

Answer 305

The Indian physician Sushutra in 500 BC.

Answer 306

Sutures, tissue adhesives, staples, and skin-closure tapes.

Answer 307

Various suturing techniques.

Answer 308

* Knot tying * Types of needles * Common suturing techniques * Giving your sutures a good outcome * Complications

Answer 309

One of the pillars of modern surgery, reducing morbidity and mortality by minimizing blood loss and anemia. ## Footnote Other pillars include anaesthesia and antibiotics.

Answer 310

Reduces morbidity and mortality, minimizes blood loss, attenuates the metabolic response to trauma, reduces infection, and improves wound healing.

Answer 311

Arrest of the escape of blood by either natural means (vessel spasm or clot formation) or artificial means (compression or ligation).

Answer 312

* Local vasoconstriction * Formation of platelet plug * Formation of blood clot

Answer 313

* Fibrinogen * Prothrombin * Tissue thromboplastin * Calcium * Proaccelerin (Labile factor) * VII Proconvertin (Stable factor) * Antihaemophilic factor A * Antihaemophilic factor B (Christmas factor) * Stuart-Power factor * Antihaemophilic factor C * Hagemen factor * Fibrin stabilizing factor

Answer 314

Contact factors exposed to collagen or basement membrane at the site of injury.

Answer 315

Tissue thromboplastin released from damaged cells.

Answer 316

* Smoothness of the endothelium * Continuous blood flow * Prostacyclin * Heparin * Antithrombin III * Protein C & S

Answer 317

* Hemophilia A (factor VIII deficiency) * Hemophilia B (factor IX deficiency)

Answer 318

* Liver diseases * Vitamin K deficiency * Disseminated intravascular coagulation * Anticoagulants * Massive blood transfusion * Platelet disorders

Answer 319

* Easy bruising * Nose bleeds * Prolonged bleeding after cuts * Prolonged/excessive menstrual cycles * Severe bleeding after tooth extraction/surgery

Answer 320

* Bleeding time * Prothrombin time * Partial thromboplastin test * Platelet count * Bone marrow aspiration * Fibrinogen assay * Fibrin degradation product

Answer 321

* Anaesthetic techniques * Digital pressure * Pressure packing * Limb elevation * Vascular clamps and artery forceps * Arterial ligation * Diathermy

Answer 322

* Surgicel (oxidized cellulose) * Gelfoam (gelatin foam) * Avitene (microfibrillar collagens) * Topical thrombin * Fibrin sealant * Platelet sealant

Answer 323

* Fresh Frozen Plasma * Platelet concentrates * Factor concentrate * Tranexamic acid * Aminocaproic acid * Aprotinin * Recombinant factor VIIa

Answer 324

* Idiopathic Hemorrhagic Telangiectasia * Osler-Weber-Rendu syndrome * Low perivascular pressure in muscular dystrophy, Ehlers-Danlos syndrome

Answer 325

* Bernard Soulier syndrome * Glanzman Thrombastenia * Storage pool disease

Answer 326

* Failure of production due to bone marrow impairment * Decreased survival * Qualitative disorders due to massive transfusion or therapeutic platelet inhibitors

Answer 327

* Vitamin K deficiency * Uremia * Massive blood transfusion * Disseminated intravascular coagulation

Answer 328

To preempt surgically important haemorrhage, employ multiple modalities to prevent it, and arrest it when it does occur.

Answer 329

Involves the whole period before, during, and after the proposed surgery. ## Footnote Perioperative care emphasizes a holistic approach to surgical patients.

Answer 330

The period before the scheduled operation, which may be a few days to several weeks. ## Footnote The last 72 hours prior to surgery are considered critical.

Answer 331

The period when surgery is actively ongoing.

Answer 332

Early post-operative is the first 24 hours or the first seven days; late is more than one week after surgery.

Answer 333

Establish rapport, take history, perform physical examination, order special investigations, assess risk and co-morbidity. ## Footnote Common causes for postponing elective surgery should also be discussed.

Answer 334

Present illness, past medical history, family and social history, medications, food, and allergies.

Answer 335

To check vital signs, perform general examinations, and assess systemic reviews.

Answer 336

* Blood tests (FBC, differential, electrolytes, etc.) * Urine, stool, wound swab * Imaging (CXR, ECG)

Answer 337

To discuss diagnoses, treatment options, fees, insurance clearance, and informed consent.

Answer 338

* Surgical checklist * Maintenance of asepsis * Vital signs monitoring * Appropriate anaesthetic technique

Answer 339

* Continuation of intra-operative care * Monitoring vital signs * Wound dressing and care * Post-operative medications * Early ambulation

Answer 340

* Bleeding * Airway obstruction * Infection control issues * Post-operative pyrexia

Answer 341

[multisystem]

Answer 342

Emphasized physiological stress response and organ dysfunction, advocating for multimodal analgesia and early mobilization.

Answer 343

Less than 10 mmHg ## Footnote ICP is a critical measurement in neurosurgery and critical care.

Answer 344

EVD (External Ventricular Drainage) ## Footnote EVD provides direct measurement and allows for drainage of cerebrospinal fluid.

Answer 345

Creatinine clearance ## Footnote This method typically involves 24-hour urine collection.

Answer 346

Indicates potential respiratory failure ## Footnote This level is critical for assessing oxygenation in patients.

Answer 347

To monitor the concentration of carbon dioxide in exhaled air ## Footnote It helps assess ventilation and can warn of respiratory distress.

Answer 348

APACHE II ## Footnote APACHE II includes acute physiologic variables and chronic health status.

Answer 349

6 to 12 mmHg

Answer 350

Tympanic membrane displacement ## Footnote This method does not measure ICP directly.

Answer 351

Detoxification, protein synthesis, and production of biochemicals for digestion ## Footnote The liver has a high functional reserve.

Answer 352

Acute renal failure ## Footnote This finding is significant in differentiating renal causes of oliguria.

Answer 353

MEWS/NEWS ## Footnote These scoring systems can be used in facilities with limited resources.

Answer 354

To measure voltage fluctuations in the brain ## Footnote EEG is used for diagnosing conditions like epilepsy and coma.

Answer 355

Hypercapnia ## Footnote This condition can occur in patients with respiratory failure.

Answer 356

CO = SV x HR ## Footnote Where SV is stroke volume and HR is heart rate.

Answer 357

Increased risk of respiratory failure ## Footnote Management requires careful monitoring of ventilation.

Answer 358

Factor VII ## Footnote Its half-life is 4-8 hours, making it a useful indicator.

Answer 359

To assess liver function and detect hepatocellular damage ## Footnote Differentiation between hepatocellular and obstructive damage is crucial.

Answer 360

0.5 ml/kg/hr ## Footnote This is approximately 30-40 ml per hour for an average-sized adult.

Answer 361

Bispectral index (BIS)

Answer 362

* Phase I: Gas from apparatus and anatomic dead space * Phase II: Increasing CO2 concentration * Phase III: Alveolar gas

Answer 363

Disseminated intravascular coagulation (DIC) ## Footnote DIC is often triggered by severe infections or trauma.

Answer 364

It is used to calculate cardiac output (CO) from blood temperature information and saline injection details. ## Footnote The equation is expressed as Q_T = [V × (T_B – T_I) × K_1 × K_2] / ∫T_B(t) dt.

Answer 365

Cardiac Output ## Footnote CO is calculated as CO = SV x HR, where SV is stroke volume and HR is heart rate.

Answer 366

Percutaneous placement through either the jugular or subclavian vein. ## Footnote Cannulation is typically performed using the Seldinger technique.

Answer 367

* One for balloon inflation * One connected to a thermistor for temperature measurement * Two for pressure monitoring and thermal indicator injection.

Answer 368

It is required for the calculation of systemic vascular resistance (SVR).

Answer 369

* Thrombosis * Infection * Bleeding * Fistula * Pseudoaneurysm.

Answer 370

It involves keeping track of homeostasis in various body systems. ## Footnote These systems include cardiovascular, respiratory, nervous, renal, hepatic, and hematologic.

Answer 371

* Injury * Acute blood loss * Shock * Hypoxia * Acidosis * Hypothermia.

Answer 372

It derives from the Latin word 'monere', meaning to warn or advise.

Answer 373

To detect pathologic variations in physiological parameters and provide early warning of impending deterioration.

Answer 374

* Volume status of the patient * Vasomotor tone * Cardiac output.

Answer 375

Core temperature is measured at sites like the tympanic membrane, esophagus, bladder, or rectum and reflects the body's overall temperature status.

Answer 376

* Ischemia * Arrhythmias * Electrolyte imbalance * Drug toxicity.

Answer 377

It is defined as the inotropic state of the myocardium.

Answer 378

Preload is the stretch of ventricular myocardial tissue just prior to the next contraction, determined by end-diastolic volume (EDV).

Answer 379

It relates cardiac output (Q_T) to oxygen content in arterial and mixed venous blood.

Answer 380

To measure hemoglobin saturation and estimate arterial saturation.

Answer 381

* Radial artery * Femoral artery * Dorsalis pedis artery * Brachial artery.

Answer 382

They stimulate sympathetic tone and are involved in the stress response.

Answer 383

The force resisting ventricular fiber shortening once systole begins.

Answer 384

Accuracy decreases in hypoxemia when SpO2 is less than 90%.

Answer 385

Starling's

Answer 386

Systemic Vascular Resistance.

Answer 387

To monitor hemodynamics including cardiac output and pulmonary artery pressures.

Answer 388

SVO2 = Sao2 - VO2/(QT × Hgb × 1.36).

Answer 389

End-diastolic volume (EDV) ## Footnote Cardiac preload is a critical parameter in assessing heart function.

Answer 390

End-diastolic pressure (EDP) ## Footnote EDP is often used due to its correlation with EDV.

Answer 391

Right ventricular CVP approximates EDP ## Footnote This relationship helps in clinical assessments of cardiac function.

Answer 392

Left ventricular end-diastolic pressure ## Footnote PAOP is measured by inflating a balloon in the pulmonary artery.

Answer 393

To measure pulmonary artery pressures ## Footnote This catheter helps in assessing heart and lung function.

Answer 394

Smaller diameter, noncompressible vessel with visible pulsation ## Footnote Understanding vessel characteristics is crucial for catheter placement.

Answer 395

Floating the catheter ## Footnote The catheter is advanced while monitoring pressures sequentially.

Answer 396

The 'wedged' position ## Footnote This position is necessary for accurate PAOP measurement.

Answer 397

Right atrium, right ventricle, and pulmonary artery waveforms ## Footnote Each of these waveforms provides valuable information about heart function.

Answer 398

Wilhelm Röntgen in 1895 ## Footnote Röntgen worked in a darkened laboratory in Würzburg, Germany.

Answer 399

* Characteristic radiation * Bremsstrahlung radiation

Answer 400

No ionizing radiation utilized ## Footnote Particularly useful in imaging of children and pregnant women.

Answer 401

Gas-filled and bony structures are poorly visualized

Answer 402

Produces and records the ultrasonic signal

Answer 403

−1000 to +1000

Answer 404

Uses a rotating X-ray beam and multiple detectors connected to a computer

Answer 405

Enhance visibility of internal structures

Answer 406

* Iodine compounds * Barium compounds

Answer 407

Potential energy stored in the body’s hydrogen atoms

Answer 408

No ionizing radiation and higher contrast between soft tissues

Answer 409

Tissue with the least hydrogen atoms, such as bones

Answer 410

An unstable form of an element that emits radiation as it decays

Answer 411

Combinations of radioisotopes attached to a pharmaceutical

Answer 412

Gamma camera

Answer 413

Use of ionizing radiation

Answer 414

Visualize soft tissue structures in real time

Answer 415

Limited range of densities it can demonstrate

Answer 416

3D vision ## Footnote Tele-surgery provides a three-dimensional view that enhances the surgeon's ability to operate remotely.

Answer 417

Several hand motion degrees of freedom ## Footnote This allows surgeons to perform intricate movements comfortably.

Answer 418

Favorable learning curve ## Footnote Tele-surgery may be easier for surgeons to learn compared to traditional methods.

Answer 419

Cost ## Footnote The financial investment required for tele-surgery technology can be substantial.

Answer 420

Absent of tactile feedback ## Footnote Surgeons cannot physically feel the instruments as they would in traditional surgery.

Answer 421

Can be claustrophobic ## Footnote Surgeons may experience discomfort due to the enclosed space during procedures.

Answer 422

Have to keep still for long periods in MRI ## Footnote Maintaining a stable position is critical for successful outcomes.

Answer 423

Loss of hard copy audit trail ## Footnote Digital records may not provide the same traceability as physical records.

Answer 424

In 2001 in Strasbourg, France ## Footnote This marked a significant milestone in the field of tele-surgery.

Answer 425

Cholecystectomy ## Footnote This procedure was carried out successfully using tele-surgery techniques.

Answer 426

2-3 meters ## Footnote Surgeons generally operate within a short distance from the robotic system.

Answer 427

Significant advantages in urologic surgery ## Footnote Robotic techniques have improved outcomes in this specialty.

Answer 428

Directly control instruments ## Footnote This contrasts with robotic surgery where movements are scaled.

Answer 429

Surgeon manipulates tele-surgery in scale ## Footnote This allows for precise control of the robotic instruments.

Answer 430

EMR ## Footnote Electronic Medical Records improve the efficiency of patient data management.

Answer 431

Communication not easily recorded in medical record ## Footnote This can hinder documentation and accountability.

Answer 432

Easy to use for photo and video content sharing ## Footnote Surgeons can showcase their work and engage with the community visually.

Answer 433

Allows user to make phone calls ## Footnote This enhances communication capabilities within medical teams.

Answer 434

Robot machine press $1 million to $2.5 million ## Footnote High initial investment is required for robotic surgical systems.

Answer 435

Surgeons eye is on the monitor ## Footnote This involves the use of digital displays to assist during minimally invasive procedures.

Answer 436

Multiple pieces of information ## Footnote This includes real-time data and imaging necessary for surgical decision-making.

Answer 437

Improve patient safety through direct access to medical case history ## Footnote ICT facilitates better communication and data management in healthcare.

Answer 438

Fewer hospitalizations ## Footnote This can result from better management of chronic conditions and preventive care.

Answer 439

Information Communication Technology ## Footnote It encompasses various digital tools and systems used in communication and data management.

Answer 440

Cloud computing ## Footnote This allows data to be stored and accessed over the internet from multiple locations.

Answer 441

Distance barriers ## Footnote This allows access to surgical care in remote areas.

Answer 442

Share data, surgical training, and consultation ## Footnote This promotes collaboration among healthcare providers globally.

Answer 443

A facility within a hospital where surgical operations are carried out in an aseptic environment. ## Footnote Also known as operating room, operating suite, or operation suite.

Answer 444

A condition in which contamination by living microorganisms is reduced to the barest minimum.

Answer 445

The process or procedure whereby transient pathogenic organisms are destroyed.

Answer 446

A state characterized by loss of feeling and sensation induced to perform surgery and other painful conditions, which may be local or generalized.

Answer 447

Operating theatres, built in a gallery style for public observation.

Answer 448

Operations were advertised in newspapers, and surgeons might receive applause from the paying public after a procedure.

Answer 449

Materials made with easily washable surfaces and round-angled objects.

Answer 450

* Sited in a cul-de-sac portion of the hospital * Not close to an incinerator or refuse dump * Away from heavily trafficked areas * Easy access to ICU/HDU, A&E, and wards.

Answer 451

* Ultra Sterile (e.g., Transplant OT) * Sterile * Septic

Answer 452

* Routine * Emergency

Answer 453

* Traditional * Conventional * Modular

Answer 454

* Operating room * Anesthetic room * Scrub room * Utility room

Answer 455

It prevents contaminated air from infiltrating into the theatre.

Answer 456

* Turbulent Ventilation * Displacement Ventilation

Answer 457

* Unventilated Theatre: 3000 cfu/m3 * Well Ventilated Theatre: 200 cfu/m3 * Ultra Clean Air Ventilation: 10 cfu/m3

Answer 458

A designated area for surgical staff to wash hands and prepare for surgery.

Answer 459

It contains materials and equipment for the induction of anesthesia.

Answer 460

* Temperature: 20-22 degrees Centigrade * Humidity: 50-60%

Answer 461

Power supply should be uninterrupted.

Answer 462

Second to third most common healthcare-associated infections.

Answer 463

Mortality can be as high as 77% if complications occur intraoperatively.

Answer 464

It maximizes benefits for patients and considers future needs during the planning process.

Answer 465

Control guidelines designed to protect workers from exposure to diseases spread by blood and other body fluids.

Answer 466

Designed to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources to a susceptible host.

Answer 467

* Hand washing * Decontamination of equipment and devices * Safe use and disposal of needles and sharps * Wearing protective items * Prompt cleaning of spills * Safe waste collection and disposal

Answer 468

* 1877, 1910: Separation of facilities, antisepsis, and disinfections * 1985: Universal Precautions due to HIV emergence * 1987: Body Substance Isolation * 1996: Standard Precautions * 2007: Isolation Precautions

Answer 469

* Blood * Semen * Vaginal secretions * CSF * Synovial fluids * Amniotic fluid * All other body fluids

Answer 470

Hand washing

Answer 471

Ethyl or Isopropyl alcohol

Answer 472

* Gloves * Aprons * Gowns * Protective eyewear * Face shields * Masks

Answer 473

Deposit in thick-walled puncture-resistant containers

Answer 474

A short course of ARV drugs used to reduce the likelihood of HIV infection following occupational exposure.

Answer 475

* Wash exposed wound or skin with soap and water * Inform supervisor of type of exposure * Ensure confidentiality

Answer 476

Within 2 hours of exposure

Answer 477

Soak in 1:100 bleach solution for 30 minutes.

Answer 478

Precautions used in addition to Standard Precautions for specified patients known or suspected to be infected by important pathogens.

Answer 479

To promote surgical safety as a public health issue and improve standards of surgical safety.

Answer 480

* Operate on the correct patient at the correct site * Prevent harm from anesthetics * Prepare for life-threatening airway loss * Prepare for high blood loss * Avoid adverse drug reactions * Minimize the risk for surgical site infection * Prevent retention of instruments in wounds * Secure and identify all surgical specimens * Communicate critical information * Establish routine surveillance of surgical capacity and results

Answer 481

Helps ensure all right things are done for all patients, all the time.

Answer 482

Reduced the rate of postoperative complications and death by more than one-third.

Answer 483

To reduce morbidity and mortality in surgical patients ## Footnote The checklist was found to reduce postoperative complications and death by more than one-third.

Answer 484

1.5% (baseline) to 0.8% (checklist) ## Footnote The p-value for this change was 0.003.

Answer 485

11.0% (baseline) to 7.0% (checklist) ## Footnote The p-value for this change was <0.001.

Answer 486

6.2% (baseline) to 3.4% (checklist) ## Footnote The p-value for this change was <0.001.

Answer 487

2.4% (baseline) to 1.8% (checklist) ## Footnote The p-value for this change was 0.047.

Answer 488

Death rate changed from 0.9% to 0.6% and complications from 10.3% to 7.1% ## Footnote Both changes were statistically significant (p<0.05).

Answer 489

Death rate changed from 2.1% to 1.0% and complications from 11.7% to 6.8% ## Footnote Both changes were statistically significant (p<0.05).

Answer 490

Ensures correct patient, operation, and operative site ## Footnote There are between 1500 and 2500 wrong site surgery incidents every year in the US.

Answer 491

21% ## Footnote This was based on a survey of 1050 hand surgeons.

Answer 492

Safe Anaesthesia and Resuscitation ## Footnote Pulse oximetry could have detected 82% of incidents involving general anaesthesia.

Answer 493

Giving antibiotics within one hour before incision ## Footnote This can cut the risk of infection by 50%.

Answer 494

Communication is a root cause of nearly 70% of reported events ## Footnote This data is from the Joint Commission from 1995-2005.

Answer 495

Enhanced prophylactic antibiotic choice and timing ## Footnote It also improves maintenance of intraoperative temperature and glycemia.

Answer 496

Elective and emergency surgeries

Answer 497

Universal precaution

Answer 498

Informed consent

Answer 499

* Patients' rights * Equity of resources * Confidentiality of patients * Patient and surgical team safety * Conflict of interest * Informed consent

Answer 500

A human immunodeficiency disease that suppresses the immune system

Answer 501

* Horizontal: Sexual intercourse, transfusion, organ donations, contaminated needles * Vertical: Mother-Child (transplacental and breastfeeding)

Answer 502

* Injection drug users * Blood transfusion recipients * Commercial sex workers * People with multiple sex partners * Healthcare workers * Babies born to infected mothers * Gay men

Answer 503

CD4 cells, macrophages, and dendritic cells

Answer 504

* Asymptomatic (seronegative) * Asymptomatic antibody positive * Persistent Generalised Lymphadenopathy * AIDS Related Complex * AIDS

Answer 505

Generalised lymph node enlargement above 1cm in diameter with constitutional symptoms

Answer 506

* Differential diagnosis * Nutritional status * Healing * Infections * Post-op complications * Life expectancy

Answer 507

Prophylactic antibiotics

Answer 508

Used needles should not be recapped and should be placed directly in a sharp box

Answer 509

* Adopt universal precautions * Limit movement and personnel involved * Use disposable equipment * Reduce bleeding * Decontaminate all surfaces

Answer 510

High-risk surgeries

Answer 511

1:2.4-24 million

Answer 512

* Stop the procedure * Decontaminate immediately * Test surgeon and patient for HIV and HBV

Answer 513

* Zidovudine 250mg twice daily * Lamivudine 150mg twice daily * Indinavir 800mg thrice daily

Answer 514

Their HIV status, with at least annual check-ups

Answer 515

Same universal precautions as for HIV, including protective clothing and avoiding high aerosol-generating surgeries

Answer 516

A team of healthcare professionals from various disciplines working together to deliver comprehensive care.

Answer 517

It addresses the complex needs of patients that no single specialty can meet.

Answer 518

Teamwork involves collaboration, coordination, and integration among professionals.

Answer 519

It refers to the acceptance of varied communication styles and methods among team members.

Answer 520

Takes primary ownership responsibility for the patient and coordinates the treatment plan.

Answer 521

Clear role definitions, effective communication, and awareness of power dynamics.

Answer 522

A commitment to collaborative care where individual contributions are understood and valued.

Answer 523

* Saving resources by avoiding duplication of workload * Stimulating group cohesion * Conflict resolution * Building trust with patients

Answer 524

* Patients may 'slip through the net' * Lack of funding * Lack of continuity * Concerns about professional identity

Answer 525

Multiple specialties participate in the management of a patient.

Answer 526

[Lead Clinician]

Answer 527

It aims to improve patient care quality and ensure ongoing support.

Answer 528

Staff operate autonomously and link only when a need is identified.

Answer 529

Information can become siloed, leading to gaps in patient care.

Answer 530

It results in fragmentation of knowledge, making it difficult for professionals to meet complex patient needs.

Answer 531

Coordinates integrated inputs from other specialties and monitors performance.

Answer 532

* India * China * Egypt * Hellenistic Greece ## Footnote These civilizations contributed significantly to the evolution of surgical practices.

Answer 533

Uneducated barbers ## Footnote Barbers performed surgical procedures either on their own or at the request of physicians.

Answer 534

The United Company of Barber Surgeons of London ## Footnote This guild led to greater regulation and the eventual establishment of the Royal College of Surgeons of England.

Answer 535

The introduction of ether anesthesia ## Footnote This advancement allowed for more complex surgical procedures to be performed.

Answer 536

Surgical infections ## Footnote The increased number of operations led to a rise in infections post-surgery.

Answer 537

Joseph Lister ## Footnote Lister's work significantly reduced mortality rates from wound infections.

Answer 538

* Anesthesia * Antisepsis ## Footnote The combination of these techniques revolutionized surgical practices.

Answer 539

* FBC * Differential * E * U * Cr * Hb Genotype * FBS * LFT ## Footnote These tests help assess the patient's health before surgery.

Answer 540

* CXR * ECG ## Footnote These imaging methods provide crucial information about the patient's condition.

Answer 541

* Hormones * Enzymes * Degradation products ## Footnote These tests are tailored based on the suspected condition.

Answer 542

* CT-SCAN * MRI ## Footnote These imaging modalities are essential for detailed visualization of internal structures.

Answer 543

* FNAC * Core biopsy * Incisional biopsy * Excision biopsy ## Footnote These procedures help in diagnosing diseases through tissue examination.

Answer 544

* Strangulated external and internal herniae * Bands and adhesions * Volvulus * Intussusception * Mesenteric ischaemia or infarction * Tumours, strictures and foreign bodies ## Footnote These conditions present with features of obstruction.

Answer 545

* Ruptured ectopic pregnancy * Traumatic rupture of viscera, especially spleen * Ruptured aortic aneurysm * Ruptured liver cell carcinoma * Ruptured pseudo-aneurysm of splenic artery ## Footnote These conditions present with signs of bleeding.

Answer 546

* Ureteric colic * Biliary colic ## Footnote These conditions often result in severe pain.

Answer 547

* Ruptured Graafian follicle * Twisted ovarian cyst * Degenerating myoma ## Footnote These conditions can lead to abdominal pain and require surgical evaluation.

Answer 548

* Gastro-enteritis * Dysentery * Gastritis * Sickle cell disease * Urinary tract infection * Malaria * Myocardial infarction * Pneumonia * Herpes zoster * Hepatitis * Prediabetic coma * Measles, poliomyelitis, mumps * Spinal root lesion * Porphyria * Acute non-specific mesenteric lymphadenitis * Non-specific abdominal pain ## Footnote These conditions can mimic surgical emergencies.

Answer 549

Acute abdomen is any serious intra-abdominal condition that demands urgent attention and treatment. ## Footnote It is usually treated best by surgical operation.

Answer 550

* Careful and adequate history * Examination * Investigations ## Footnote These steps are crucial for effective diagnosis.

Answer 551

* Pain (site, radiation, onset, frequency, periodicity, aggravating/relieving factors, severity & type) * Nausea + vomiting, appetite * Bowel habit * Gynaecological symptoms * Urinary symptoms * Past surgical/medical history * Drug history ## Footnote A thorough history is vital for diagnosis.

Answer 552

* Tenderness * Guarding * Rigidity * Rebound tenderness ## Footnote These signs help identify acute abdominal conditions.

Answer 553

* Erect CXR * AXR * IVU * U/S * CT ## Footnote These imaging modalities assist in identifying underlying conditions.

Answer 554

* Appendicitis * Cholecystitis * Diverticulitis * Pancreatitis * Perforated peptic ulcer * Ischaemic gut * Renal colic * Intestinal obstruction * GI bleeding * Ruptured AAA * NSAP ## Footnote These conditions require prompt diagnosis and management.

Answer 555

It is used to aid in the diagnosis of appendicitis. ## Footnote This scoring system is utilized in approximately 50% of cases.

Answer 556

* RUQ pain radiating to back/shoulder * Vomiting * Fever * RUQ tenderness +/- Murphy’s sign ## Footnote These symptoms are indicative of cholecystitis.

Answer 557

* Lower abdominal pain * Fever * +/- altered bowel habit * LIF peritonitis ## Footnote Diverticulitis is commonly seen in elderly patients.

Answer 558

* Severe upper abdominal pain radiating to back and flanks * Vomiting * Dehydration * Generalised peritonitis * Grey Turner’s sign ## Footnote These signs are critical for diagnosing pancreatitis.

Answer 559

Colicky loin pain radiation to groin and genitalia. ## Footnote Patients often appear in painful distress with unremarkable abdominal examination.

Answer 560

* Sudden onset severe back/left loin pain * History of hypertension * Shock * Absent femoral pulses * Pulsatile mass ## Footnote This condition is a surgical emergency.

Answer 561

It begins as you first clap eyes on the patient. ## Footnote Initial observations can provide crucial information.

Answer 562

Timely intervention can prevent complications and improve outcomes. ## Footnote Physicians and surgeons must be well-versed in this area.

Answer 563

Reduced movement with respiration, Pointing sign, Localised tenderness in RIF, Muscle guarding, Rebound tenderness, Rovsing's sign, Psoas sign, Obturator sign ## Footnote RIF stands for Right Iliac Fossa.

Answer 564

Inflammation of the peritoneum, usually caused by fungal or bacterial infection ## Footnote It can result from infections like ruptured appendicitis or perforated colon.

Answer 565

* Generalized abdominal pain * Abdominal distention * Diarrhea or constipation * Fever * Nausea and vomiting

Answer 566

* Full blood count * Blood culture * Abdominal fluid m/c/s * CT scan * X-ray

Answer 567

* Treat underlying cause * Use of antibiotics * Provide analgesics * Surgery if necessary

Answer 568

* Hepatic encephalopathy * Hepatorenal syndrome * Sepsis * Septic shock

Answer 569

To help prevent negative appendectomies using MANTRELS criteria ## Footnote MANTRELS includes factors like migratory pain, anorexia, nausea and vomiting, tenderness in RLQ, rebound tenderness, elevated temperature, leucocytosis, and shift to left.

Answer 570

Not likely appendicitis

Answer 571

* Decreased dietary fibre * Increased consumption of refined carbohydrates * Obstruction of appendix lumen * Social status * Infection via blood

Answer 572

Length: about 7.5cm; Diameter: 7-8mm

Answer 573

* Lymphoid hyperplasia * Fecal stasis and fecaliths * Parasites * Foreign bodies * Neoplasms

Answer 574

* Adequate fluid rehydration * General assessment and review * Vital signs charting * Diameter of mass marking * Electrolytes correction * Nil per oral for few days

Answer 575

* Retrocaecal * Pelvic * Paracaecal * Subcaecal * Preileal * Postileal * Right hypochondrium (malrotation) * Left iliac fossa (situs inversus)

Answer 576

* Emergency * Elective * Incidental * Interval * Laparoscopic

Answer 577

* Appendix gangrene * Appendix mass * Appendix abscess * Perforation * Spreading peritonitis * Intra-abdominal abscess * Recurrent appendicitis

Answer 578

* Periumbilical pain that shifts to the right iliac fossa * Anorexia * Low-grade fever * Nausea and vomiting * Diarrhea or constipation * Dysuria

Answer 579

Deep palpation of the left iliac fossa causes pain in the right iliac fossa, indicating appendicitis

Answer 580

* Explorative laparotomy * Peritoneal toileting/lavage with saline * Excise appendix stump if seen * Abdominal drain may be used

Answer 581

To rule out gynecological pathology or other differentials and may detect inflamed appendix or abscess

Answer 582

A rapidly progressing, life-threatening condition that can cause shock and organ failure

Answer 583

Caused by obstruction of the appendiceal lumen leading to inflammation

Answer 584

* Localized tenderness in the right iliac fossa * Rebound tenderness * Muscle guarding

Answer 585

Interruption of the forward flow of intestinal content ## Footnote Causes can be intraluminal, in the wall, or extraluminal.

Answer 586

A sudden and complete blockage of the intestinal lumen.

Answer 587

* Acute * Chronic * Acute on chronic

Answer 588

* Single * Closed loop obstruction

Answer 589

* Simple * Strangulation

Answer 590

* Large gallstones * Masses of parasites * Faecaloma * Tumours projecting into the lumen

Answer 591

* Spasm * Localised paralysis * Organic stricture (congenital, traumatic, inflammatory, neoplastic)

Answer 592

* Fibrosis * Adhesions * Endometriosis * Tumours * Abscesses

Answer 593

* Hernia * Torsion (sigmoid volvulus) * Intussusceptions

Answer 594

* Trauma (accidental or operational) * Infective peritonitis * Chemical peritonitis (blood, bile, urine, pancreatic ferments)

Answer 595

* Severe infections (e.g., pneumonia) * Uraemia * Toxaemia of pregnancy (eclampsia)

Answer 596

* Simple * Closed-loop * Strangulation

Answer 597

The bowel becomes distended, peristalsis is vigorous initially, and then becomes feebler before ceasing.

Answer 598

Bowel obstructed at both proximal and distal points, leading to rapid increase in intra-luminal tension.

Answer 599

* Severe, cramping pain * Vomiting (clear, then bilious, then feculent) * Constipation * Abdominal distension * Fever

Answer 600

* Abdominal X-rays (erect and supine) * Full Blood count * Electrolytes/urea * Cross match 2 pints of blood

Answer 601

* Correction of fluid and electrolyte * Transfusion if pale * Nasogastric fluid decompression * Catheterize and measure urinary output * Intravenous antibiotics

Answer 602

Often managed conservatively; laparotomy if obstruction continues.

Answer 603

Surgery is usually urgent; must not wait on acute obstruction.

Answer 604

Intravenous fluid therapy until bowel sounds are heard or flatus is passed.

Answer 605

Lower GI bleed refers to bleeding arising distal to the ligament of Treitz

Answer 606

Hemorrhoids

Answer 607

Colon cancer

Answer 608

* Colon * Rectum * Anus

Answer 609

* Diverticulosis * Polyps * Hemorrhoids * Angiodysplasias * Malignancy

Answer 610

* Passage of blood per rectum * Passage of dark red to bright red stool * Iron deficiency anemia if bleeding is slow and occult

Answer 611

To correct shock and stabilize the patient for further evaluation and treatment

Answer 612

* Pulse rate * Respiratory rate * Blood pressure * Mental state

Answer 613

Takes priority over determining the diagnosis/cause

Answer 614

Crystalloids

Answer 615

* Tests for occult blood * Hemoccult * HemaPrompt

Answer 616

Diagnostic and therapeutic; helps to detect active bleeding from visible vessels

Answer 617

* Injection (adrenaline) * Alcohol * Thermocoagulation * Clipping * Bands

Answer 618

Stabilizes clots and reduces risk of re-bleeding following endoscopic hemostasis

Answer 619

* Endoscopy * Band ligation * Injection sclerotherapy * Somatostatin/octreotide * Terlipressin

Answer 620

Acute GI bleed is defined as < 3 days duration

Answer 621

* Overt: visible blood (melena, bright red blood, coffee grounds) * Occult: only detected by lab tests

Answer 622

Diagnostic only; determines site and cause of bleeding

Answer 623

* Anastomosis bleeding * Intra-abdominal bleeding * Mechanical small bowel obstruction * Sepsis

Answer 624

* Peptic ulcers * Erosions * Mallory Weiss tear * Oesophageal varices * Tumors

Answer 625

Causes portal hypertension and development of porto-systemic anastomosis

Answer 626

Passage of fresh blood per rectum; usually indicates lower GI bleed

Answer 627

Surgery as last resort; segmental colectomy or subtotal colectomy may be performed

Answer 628

Stop if safe to do so

Answer 629

Does not exclude the diagnosis of GI bleeding

Answer 630

* Pale * Dehydrated * Restlessness

Answer 631

Complications include: * Duodenogastric reflux * Diarrhoea * Weight loss * Osteomalacia * Iron deficiency anaemia * Increased incidence of gall stones * Gastric stump carcinoma * Colonic carcinoma * Increased incidence of infections * Gastrojejunocolic fistula * Afferent loop syndrome

Answer 632

A condition where duodenal contents flow back into the stomach

Answer 633

A type of cancer that can develop as a result of chronic irritation from duodenogastric reflux, occurring about 20 years later

Answer 634

Peptic ulcers occur due to an imbalance between mucosal defense mechanisms and aggressive factors

Answer 635

The development of PPI, H2 blockers, effective antibiotics against H. pylori, and endoscopic treatment

Answer 636

A gram-negative flagellated spirochete that produces urease

Answer 637

By splitting urea into CO2 and ammonia, creating an alkaline environment around itself

Answer 638

It stimulates acid production by parietal cells and is associated with parietal cell hyperplasia

Answer 639

A condition characterized by a hypersecretory state due to gastrin-secreting tumors

Answer 640

Factors include smoking and severe physiological stress

Answer 641

NSAIDs can contribute to the development of peptic ulcers

Answer 642

It leads to metaplastic gastric changes in the duodenal mucosa

Answer 643

Clinical features include pain, nausea, vomiting, and gastrointestinal bleeding

Answer 644

Key components include: * Relevant anatomy * Risk factors * Pathophysiology * Classification * Surgical complications * Clinical features * Investigation * Treatment * Prognosis

Answer 645

[bicarbonate]

Answer 646

Lymphatic drainage plays a role in the spread of infection and cancer

Answer 647

Pediatric (<5 y/o, accidental ingestion) and Adult (suicidal attempts, intentional) ## Footnote The pediatric group primarily involves accidental ingestion of alkaline substances, while adults often ingest corrosives intentionally.

Answer 648

Alkalis and Acids ## Footnote Alkalis are more common in western countries, while acids are more prevalent in countries like India.

Answer 649

pH > 7 ## Footnote Alkalis are typically tasteless and odorless, leading to ingestion of larger amounts.

Answer 650

Liquefactive necrosis ## Footnote This type of necrosis leads to deeper injuries and is associated with significant esophageal damage.

Answer 651

Coagulation necrosis ## Footnote This type of necrosis forms a protective eschar that limits the depth of injury.

Answer 652

First-degree, Second-degree, Third-degree ## Footnote Each degree reflects the severity and type of tissue damage caused by corrosive substances.

Answer 653

Retro-sternal or back pain, localized abdominal tenderness, rebound, rigidity, massive hematemesis ## Footnote These symptoms indicate severe complications and require immediate medical evaluation.

Answer 654

To grade the severity of the injury and manage appropriately ## Footnote Endoscopy is crucial for assessing the extent of damage and planning treatment.

Answer 655

Two months ## Footnote Strictures may occur as early as two weeks or as late as years after ingestion.

Answer 656

1000 to 3000-fold increase ## Footnote The mean latency for developing carcinoma is 41 years.

Answer 657

Avoid emetics, neutralizing agents, and gastric lavage ## Footnote These actions can exacerbate injury or lead to perforation.

Answer 658

No later than 48 hours ## Footnote Endoscopy is usually avoided between 5-15 days post-ingestion due to risk factors.

Answer 659

A liquid diet may be initiated, with advancement to a regular diet in 24-48 hours ## Footnote This approach helps manage nutritional needs while minimizing irritation.

Answer 660

Inconclusive in human studies ## Footnote While some animal studies suggest potential benefits, human trials have not shown significant effectiveness.

Answer 661

Dilate the esophageal lumen to 15 mm ## Footnote This procedure aims to relieve obstruction caused by strictures.

Answer 662

Complete stricture, tracheo-oesophageal fistula, patient intolerant to repeated dilatation ## Footnote Surgery may be necessary when dilatation fails or complications arise.

Answer 663

Short segment - dilate; Long segment - replace/bypass ## Footnote Treatment varies based on the length and severity of the stricture.

Answer 664

False ## Footnote Early clinical presentation may not accurately reflect the extent of damage.

Answer 665

Herniorrhaphy ## Footnote Inguinal herniorrhaphy is a common surgical procedure to correct hernias in the groin area.

Answer 666

* Ferguson * Bassini * Shouldice * McVay * Maloney ## Footnote These techniques differ in approach and method for repairing the hernia.

Answer 667

* Closed anterior * Open anterior * Open posterior * Tension-free repair with mesh * Laparoscopic ## Footnote Each group has its own indications and techniques based on the type of hernia.

Answer 668

* Avoid preoperative factors ## Footnote This includes managing factors that may increase intra-abdominal pressure.

Answer 669

* Recurrent hernias * Giant hernias ## Footnote Synthetic prostheses provide additional support to weakened areas of the abdominal wall.

Answer 670

Lichtenstein ## Footnote The Lichtenstein repair is a widely used method for inguinal hernia repair.

Answer 671

* Seroma * Hematoma * Wound infection/separation * Numbness * Hypertrophic scar * Keloid * Acute urinary retention * Testicular atrophy * Scrotal edema * Recurrence * Chronic pain ## Footnote These complications can arise in both early and late postoperative periods.

Answer 672

Transversalis fascia ## Footnote The deep inguinal ring is an important landmark for inguinal hernia surgery.

Answer 673

True ## Footnote The Bassini technique is effective but has a notable recurrence rate.

Answer 674

A vulnerable area of the groin prone to hernias ## Footnote This region is where structures enter and exit the abdominal cavity.

Answer 675

* Chronic cough * Chronic constipation * Vomiting * Ascites * Benign prostatic hypertrophy * Heavy manual work * Weight lifting ## Footnote These factors can contribute to the development of inguinal hernias.

Answer 676

Promotes scar tissue formation ## Footnote Monofilament sutures are preferred for their lower risk of infection and better tissue integration.

Answer 677

Isolation during repair to prevent nerve damage ## Footnote Proper handling of the ilioinguinal nerve is crucial to minimize postoperative pain.

Answer 678

* Non physically modified by tissue fluids * Inert * Non-inflammatory, non-allergic * Non-carcinogenic * Modifiable * Pliable * Sterilizable * Stimulate fibroblastic activity * Permeable * Resistance to mechanical strain ## Footnote These characteristics ensure the prosthesis integrates well with the body and provides effective support.

Answer 679

A protrusion of a viscus partly or wholly through the wall of its containing cavity ## Footnote Hernias can occur in various locations, with inguinal hernias being the most common.

Answer 680

Local anesthesia ## Footnote Halstead's technique made hernia surgery more accessible and less invasive.

Answer 681

* Formal description of surgical repair * Strangulated hernia management ## Footnote Cooper's work laid the foundation for modern hernia surgery.

Answer 682

The area around where the thigh joins the trunk, specifically the inguinal and femoral region.

Answer 683

An oblique passage above the fold of the groin, extending from deep to superficial ring and measuring 4cm long.

Answer 684

Superolaterally by internal oblique muscle and inferomedially by the inferior epigastric artery.

Answer 685

A triangular opening in the fibres of external oblique aponeurosis.

Answer 686

A triangular area where direct inguinal hernias can form due to weak transversalis fascia.

Answer 687

* Testicular artery * Differential artery * Cremasteric artery * Genital branch of genitofemoral nerve * Sympathetic nerves * Ilioinguinal nerve * Ductus deferens * Pampiniform plexus of veins * Lymphatics.

Answer 688

Bounded superiorly by the inguinal ligament, laterally by the sartorius, and medially by the adductor longus.

Answer 689

* Lymph nodes * Femoral vein * Femoral artery * Femoral nerve.

Answer 690

It leads the testis and spermatic cord through the inguinal canal into the scrotum.

Answer 691

A hernia that enters the inguinal canal through the deep ring, typically congenital and more common in males.

Answer 692

* Encysted hydrocoele * Infantile hydrocoele * Congenital hydrocoele.

Answer 693

Indirect inguinal hernia.

Answer 694

Reducible hernias can be pushed back into the abdominal cavity, while irreducible hernias cannot.

Answer 695

An abnormal dilatation of the pampiniform venous plexus within the spermatic cord.

Answer 696

It helps to determine if a scrotal mass is fluid-filled or solid.

Answer 697

hydrocoele.

Answer 698

* Skin: boils, sebaceous cyst, papillomas, warts * Subcutaneous tissue: lymph scrotum, filariasis * Tunica vaginalis: hydrocoele, pyocoele, chylocoele * Testis: orchitis, neoplasm * Epididymis: cysts, infections * Spermatic cord: varicocoele, lymphatic varix.

Answer 699

Reduction and inversion of the sac, repair of fascia transversalis, and reconstruction of the posterior wall.

Answer 700

A unilocular retention cyst derived from some portion of the sperm conducting mechanism.

Answer 701

It forms part of the floor of the inguinal canal.

Answer 702

* Site * Size * Shape * Symmetry * Skin changes * Scars.

Answer 703

A varicocoele is a condition characterized by enlarged veins within the spermatic cord, presenting as a lump and often described as feeling like a 'bag of worms' or with a 'dragging sensation'. ## Footnote It may disappear when lying flat.

Answer 704

90% ## Footnote This is because the spermatic vein drains directly into the left renal vein.

Answer 705

* Infertility * Testicular atrophy ## Footnote Increased intra-scrotal temperature is a contributing factor.

Answer 706

Semen analysis ## Footnote Referral to a urology specialist is necessary if abnormalities are found.

Answer 707

* Embolisation by an interventional radiologist * Open or laparoscopic ligation of the spermatic veins

Answer 708

Epididymitis is inflammation of the epididymis.

Answer 709

* Unilateral acute onset scrotal pain * Swelling * Erythematous overlying skin * Systemic symptoms such as fever

Answer 710

Prehn’s sign ## Footnote Pain may be relieved on elevation of the testis.

Answer 711

Bacterial infections, often STI-related.

Answer 712

Oral antibiotics and analgesia.

Answer 713

Painless lumps arising from the testis.

Answer 714

A firm irregular mass that does not transilluminate.

Answer 715

Testicular cancer.

Answer 716

Ultrasound scan.

Answer 717

Twisting of the testis on the spermatic cord, leading to ischaemia.

Answer 718

* Sudden-onset severe unilateral scrotal pain * Nausea or vomiting

Answer 719

Bell-clapper deformity ## Footnote This allows for rotation due to high attachment of the tunica vaginalis.

Answer 720

Immediate surgical intervention including scrotal exploration and fixation of both testes.

Answer 721

Conditions such as benign leydig cell tumours, sertoli cell tumours, lipomas, or fibromas.

Answer 722

Inflammation of the testis.

Answer 723

Mumps virus.

Answer 724

Rest and analgesia.

Answer 725

Intra-testicular abscess that may require drainage.

Answer 726

Tertiary syphilis causing painless enlargement of the testis.

Answer 727

A rare condition that may follow trauma to the testis, considered due to reaction of interstitial tissue to extravasated spermatozoa.

Answer 728

Chronic inflammation of the gallbladder wall, usually associated with gallstones ## Footnote It results from repeated bouts of subacute or acute cholecystitis or persistent mechanical irritation by gallstones.

Answer 729

More than one-quarter of patients ## Footnote This indicates a potential infectious component in chronic cholecystitis.

Answer 730

Nausea, vomiting, acute abdominal pain, RUQ tenderness ## Footnote Pain often follows a large, fatty meal and may subside over 12-18 hours.

Answer 731

Episodes of acute abdominal pain associated with gallbladder issues ## Footnote Typically triggered by certain foods, especially those high in fat.

Answer 732

Acute cholecystitis, jaundice, acute cholangitis, acute pancreatitis, gallbladder cancer ## Footnote These complications can arise from the obstruction of bile flow.

Answer 733

Pain on palpation of the right upper quadrant during inhalation ## Footnote Indicates possible acute cholecystitis.

Answer 734

Laparoscopic cholecystectomy ## Footnote This is the treatment of choice for symptomatic gallstones.

Answer 735

Obstructive jaundice, abdominal pain, generalized itching, weight loss, fever ## Footnote Symptoms depend on the tumor's location.

Answer 736

Gallstone formation from biliary sludge, hypersaturation of cholesterol, and imbalance in crystallization-promoting proteins ## Footnote Contributing factors include decreased gallbladder motility and increased sphincteric contraction.

Answer 737

Inflammatory bowel disease, especially ulcerative colitis ## Footnote It is characterized by a progressive inflammatory and sclerosing process affecting bile ducts.

Answer 738

Stones in the common bile duct ## Footnote Occurs in 10-15% of patients with gallstones and can lead to significant complications.

Answer 739

Elevated WBC, total serum bilirubin, alkaline phosphatase, aminotransferase, amylase ## Footnote CA19-9 can help distinguish cholangiocarcinoma from benign biliary stricture.

Answer 740

Best visualization of the distal biliary tract and allows for bile or pancreatic cytology ## Footnote Can perform endoscopic sphincterotomy and stone removal.

Answer 741

A condition where the gallbladder wall is covered with calcium deposits ## Footnote Often occurs after long-term inflammation due to gallstones.

Answer 742

False ## Footnote The vast majority are small, non-neoplastic, and inflammatory.

Answer 743

Elevated levels can help distinguish cholangiocarcinoma from benign biliary stricture ## Footnote It is a tumor marker associated with biliary cancers.

Answer 744

Endoscopic ultrasound ## Footnote It can also be used safely during pregnancy.

Answer 745

Ciprofloxacin, mezlocillin with metronidazole or gentamicin ## Footnote Aminoglycosides should be used cautiously due to nephrotoxicity risks.

Answer 746

Episodes of acute bacterial cholangitis, cholangiocarcinoma ## Footnote Treatment results with corticosteroids and antimicrobials are inconsistent.

Answer 747

Lipid deposits in the submucosa and epithelium, appearing as multiple yellow spots ## Footnote This condition is often described as 'strawberry gallbladder'.

Answer 748

Adenomas ## Footnote Only a proportion of these have a cancerous potential. The only reliable means of defining those at risks is by polyp size.

Answer 749

Adenocarcinoma

Answer 750

* Gallstones * Porcelain gallbladder * Female

Answer 751

Inflammation of the gallbladder with pus

Answer 752

Acute cholecystitis

Answer 753

Obstruction, irritation, gall distension, mucosal damage leading to phospholipase release and conversion of biliary lecithin to lysolecithin

Answer 754

To store and concentrate bile

Answer 755

* Cholesterol stones * Pigment stones

Answer 756

About 2 hours

Answer 757

* Escherichia coli * Klebsiella spp. * Streptococcus spp. * Clostridium spp.

Answer 758

Abnormal accumulation and growth of gall bladder mucous tissue

Answer 759

Excessive deposition of cholesterol in lamina propria leading to inflammatory response

Answer 760

* Continuous pain in RUQ/Epigastrum * Fever * Vomiting * Gall bladder mass

Answer 761

Signals the gallbladder to contract and secrete bile

Answer 762

* Genetic factors * Race * Obesity * Rapid weight loss * Female pregnancy

Answer 763

30 to 50 ml

Answer 764

* Duplications * Agenesis * Phrygian cap * Left-sided gallbladder

Answer 765

Gangrene of the gallbladder wall

Answer 766

The incidence of acute cholecystitis follows that of gallstones due to their close relationship.

Answer 767

Pain does not rhythmically increase or decrease in intensity

Answer 768

Calcium bilirubinate

Answer 769

Gallstones

Answer 770

20 million people

Answer 771

Yes, there is marked geographic variation

Answer 772

More than 85%

Answer 773

Acute cholecystitis

Answer 774

It is generally rare

Answer 775

80% to 95%

Answer 776

Countries with the highest prevalence of gallstones

Answer 777

Local spread through the wall, lymphatic to the deep cervical lymph nodes, hematogenous to lungs, liver, bones, and brain ## Footnote Includes para-oesophageal and tracheo-bronchial lymph nodes.

Answer 778

Squamous Cell Carcinoma and Adenocarcinoma ## Footnote Squamous Cell Carcinoma is common in Africa, while Adenocarcinoma is prevalent in the Middle East, Asia, and Eastern Europe.

Answer 779

Staging oesophageal cancer ## Footnote TNM stands for Tumor, Node, Metastasis.

Answer 780

* Achalasia * Corrosive stricture * Hiatus hernia * Plummer-Vinson syndrome * Goitre * Aortic Aneurysm ## Footnote These conditions can present with similar symptoms.

Answer 781

* Barium Swallow * Chest X-ray * Oesophago-Gastro-Duodenoscopy (OGD) * Bronchoscopy * CT of chest & abdomen * CT PET Scan * Laparoscopy/Video Assisted Thoracoscopy ## Footnote These tests help visualize the oesophagus and detect any abnormalities.

Answer 782

* Surgery * Radiotherapy * Chemotherapy * Palliative care ## Footnote Treatment depends on the stage, location, and presence of complications.

Answer 783

Curative intention, especially for stages 0, I, IIa ## Footnote Surgery is based on the stage and location of the cancer.

Answer 784

* Soil deficiencies (zinc, molybdenum, manganese) * Infectious agents (HPV, fungi, bacteria) * Dietary factors (low intake of fruits and vegetables) ## Footnote These factors can increase the risk of developing cancer.

Answer 785

Cancers of the oesophagus ## Footnote Includes both benign and malignant tumors.

Answer 786

A muscular tube approximately 25cm long and 2.3 to 2.5cm in diameter ## Footnote It extends from the pharynx to the gastroesophageal junction.

Answer 787

* Mucous membrane * Submucous layer * Muscular coat * Adventitial coat ## Footnote These layers contribute to the structure and function of the oesophagus.

Answer 788

* Inferior thyroid branches * Oesophageal branches from ascending artery * Thoracic aorta branches * Bronchial arteries * Intercostal arteries * Left gastric artery ## Footnote The blood supply is crucial for the health of the oesophagus.

Answer 789

* Transhiatal Oesophagectomy * Trans Thoracic Oesophagectomy (Ivor-Lewis) * McKeown (Three Stages) Procedure * Video Assisted Oesophagectomy ## Footnote Each approach has its indications based on the tumor's location.

Answer 790

* Anastomotic leak * Pyopnumothorax * Mediastinitis * Atelectasis * Cardiopulmonary failure ## Footnote These complications can significantly affect recovery.

Answer 791

Generally poor prognosis ## Footnote Adenocarcinoma is the most common type of malignant tumor of the oesophagus.

Answer 792

Adenocarcinoma

Answer 793

Neo-adjuvant and adjuvant chemotherapy ## Footnote Chemotherapy can be combined with other treatments for improved outcomes.

Answer 794

Nitrosamines are carcinogenic compounds formed from nitrites, which can be ingested or produced by bacteria in the stomach. ## Footnote They are particularly formed in a hypochlorhydric stomach.

Answer 795

The three types are: * Ulcerative (50%) * Polypoid (20%) * Infiltrative (30%)

Answer 796

The ulcer has a raised, everted, irregular edge, indurated base, and necrotic floor.

Answer 797

Litinus plastica refers to a condition where the stomach is diffusely infiltrated, reducing its capacity and resembling a leather bottle.

Answer 798

About 65% of tumors occur in the pyloric antrum, 25% in the body, and the rest in the fundus and cardia.

Answer 799

The types are: * Intestinal type (35%) * Diffuse type (50%) * Mixed type

Answer 800

The modes of spread include: * Lymphatic * Local * Blood * Transperitoneal * Extra-abdominal

Answer 801

Common features include: * Dyspepsia * Weight loss * Anaemia * Palpable mass in the abdomen

Answer 802

Complications include: * Gastric outlet obstruction * Perforation (4%) * Acute bleeding (10%) * Chronic bleeding leading to iron deficiency anaemia

Answer 803

Dyspepsia includes pain or vague discomfort in the epigastrium, which may or may not be related to meals.

Answer 804

Investigations include: * Oesophago-gastro-duodenoscopy * Barium meal * Endoscopic ultrasonography * Ultrasound and contrast-enhanced CT scan * Laparoscopy

Answer 805

T1 indicates invasion of the mucosa or sub-mucosa.

Answer 806

N0 indicates no lymph nodes involved.

Answer 807

Prognosis depends on the duration of symptoms; early detection leads to better outcomes.

Answer 808

In Japan, the 5-year survival rate is approximately 55% due to early detection and treatment.

Answer 809

Factors include: * Degree of gastric wall invasion * Nodal involvement * Distance metastases * Duration of symptoms * Degree of cellular differentiation

Answer 810

The male to female ratio varies from 2:1 to 3:2.

Answer 811

Risk factors include: * Older age * Male gender * Helicobacter pylori infection * Overweight and obesity * Dietary factors (e.g., aflatoxins) * Stomach polyps * Pernicious anaemia * Alcohol abuse

Answer 812

Approximately 26,890 new cases are expected in 2024.

Answer 813

Ill-defined nutritional deficiencies and carcinogens in food, such as benzpyrene from smoked fish.

Answer 814

About 10% of patients with chronic atrophic gastritis develop gastric cancer.

Answer 815

stomach cancer

Answer 816

Heamorrhage, Renal failure, Pancreatic fistula, Intrabdominal abscess, Delayed gastric emptying ## Footnote Complications can significantly affect recovery and prognosis.

Answer 817

Adenocarcinoma ## Footnote Adenocarcinoma accounts for the majority of pancreatic cancer cases.

Answer 818

9th most common cancer ## Footnote Reflects the overall prevalence of pancreatic cancer in the population.

Answer 819

<5% ## Footnote Indicates the poor prognosis associated with this disease.

Answer 820

13:1 ## Footnote Suggests a significant gender disparity in incidence.

Answer 821

Anorexia and Weight Loss, Upper Abdominal Pain, Jaundice, Pruritus ## Footnote These are some of the primary clinical presentations to look for.

Answer 822

Mucinous cystic Neoplasm ## Footnote This type of cystic neoplasm may be benign or invasive.

Answer 823

Indicates possible metastatic disease ## Footnote This node is associated with advanced abdominal malignancies.

Answer 824

Contrast Enhanced Multi sliced CT ## Footnote Provides detailed information on tumor relation to vascular structures.

Answer 825

Evaluation of jaundiced patients, biopsy, and stenting ## Footnote Essential for both diagnosis and potential therapeutic interventions.

Answer 826

Insulin, Glucagon, Somatostatin ## Footnote These hormones regulate blood sugar and metabolic processes.

Answer 827

Mucinous cystic Neoplasm

Answer 828

Prevention of Hepatorenal failure ## Footnote Helps to stabilize the patient before surgery.

Answer 829

* Smoking * Obesity * New onset Diabetes * Chronic Pancreatitis * Hereditary risks (e.g., Peutz-Jegher Syndrome) ## Footnote Understanding these factors can aid in early detection and prevention strategies.

Answer 830

False ## Footnote The peak incidence is actually between 65-75 years.

Answer 831

Whipple operation or Pancreatico-duodenectomy ## Footnote This procedure is crucial for managing tumors located in the head of the pancreas.

Answer 832

Dull ache, more severe in supine position ## Footnote Pain often indicates perineural invasion and pancreatic ductal blockage.

SURGERY - General Flashcards

(900 cards)