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Oral Questions and Answers in General Surgery
Index:
Arterial disorders
4. Why is Gangrene more common with aneurysms rather than arterial injury?
6. in immediate ttt of arterial injuries, heparinization is indicated only for patients with isolated
vascular bleeding i.e free from any other source of bleeding!
7. If arterial injury is associated with fracture, correct fracture 1st, usually ischemia is
corrected afterwards. If not open
• Vibrating machine.
Subclavian artery is a side branch from aorta, so its not subjected to trauma. (The main factor in
atherosclerosis and formation of atheroma is TRAUMA, Because trauma produces injury of the intima of
arteries facilitating depostition of lipids in subintimal layer and formation of atheroma. So coronaries are
most affected due to trauma by heart beats)
19. claudication is from the name of the roman empror Claudis, it means to limp
20. pseudocluadication: due to neurospinal compression, exaggerated by lumbar lordosis and relieved by
straightening the back.
21. How come some patients complain 1st of rest pain before claudication? Usually
claudication preceeds rest pain, But sometimes rest pain may be the 1st presentation if the patient has angina
and doesn't move much so he won’t complain from claudication and the 1st presentation is rest pain
22. How come patient complains of pain in one limb only, although the
pathology is in both limbs? As the patient feels pain 1st in the more affected limb, so he stops before
feeling pain in the other limb
23. A patient may have both intermittent claudication and rest pain, as they are
different manifestations of different etiologies (not related)
27. Why do you investigate for blood urea and renal functions in chronic
ischemia? As renal arteries are commonly affected by atherosclerosis.
1-Gangrene
2- Taenia interdigitalis (fungal infection that has to be properly treated as minor trauma or
infection predispose to gangrene)
29. In chronic ischemia, If the doctor asks you, what to do for management of
this patient, you reply according to the patient’s category, so you have to know it well
30. Patient is feasible for surgery = proximal obstruction + patent distal run-off
31. Bypass operation above femoral: use synthetic graft, bypass operation
below femoral: use long saphenous vein (size of long saphenous is compatible with femoral,
popliteal arteries)
Raynaud's phenomenon is secondary to a cause thus we treat it's cause first and no value of
sympathectomy
In case of a patient with suspected raynaud's: exclude phenomenon at first to treat the causes
Venous system
3. Types of venographies:
• Ascending venography (dye injected in dorsum of foot)
• Descending venography (Dye injected in IVC)
• Functional venography: to assess muscle pump, on contraction, it checks movement of blood vessels
9. why VV is more common in Lt side? As pressure is higher in the LT side in all individuals as LT
common iliac vein is crossed by RT common iliac artery
10. what are sites of VV?
a- LL
b- Oesophagus
c- Spermatic cord
e- Caput medusae
f- Bronchial varices
After A-V fistula of renal dialysis ( in renal failure pt we do him regular dialysis so we induce A-V fistula to take the
blood from it to the machine)
12. what question you should ask the pt before injection ttt?
15. Why are the elastic stockings below knee, not above? As no complications occur above
knee
16. Why ulcer bearing area is above medial malleolus?
• This area is drained by direct perforators
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Oral Questions and Answers in General Surgery
17. Can complications of VV occur in lateral malleolus? Yes, some people have lateral
perforators
18. Why is varicose ulcer a chronic ulcer? ●Due to anoxia, liposclerosis,
●chronic irritation by hemosiderin, ●superadded infection and periosteitis
20. Why there is chronic traumatic leg ulcer and there is no chronic
traumatic forearm ulcer?
• Due to dependency in the leg.
• Ulcers in legs are more liable for repeated trauma.
• Ulcers in leg are more liable for repeated infections.
21. Margin is the most important for diagnosis of cause of ulcer; it’s the part that has the
original disease, before sloughing of skin
23. TB ulcer shows thin cyanotic margin as TB bacilli produce vasoconstricting substances.
Lymphatic disorders
1. Famous sites for chronic non-specific lymphadenopathy? Inguinal and cervical LNS
2. What to do in case of chronic non specific lymphadenopathy? Don’t say give antibiotics,
because ttt has to be directed to original focus, nodes are not treated.
3. Giant cell?
- It is multinucleated cells.
4. Famous giant cells in surgery?
- Langerhan’s giant cell. (TB, with horse shoe nucleus)
- Reed Sternberg cell. (in lymphoma)
- Giant cells of osteoclastoma.
- Giant cells of Granulomas.
5. Why is the name cold abscess a wrong name? because it is not hot like pyogenic abscess, but it
is warm not cold, and, its not an abscess as it does not contain pus, it contains caseation
6. Management of cold absess is very important, revise from book.
7. Sites of primary T.B.?
- Lung.
- Intestine
- Tonsils
- Skin.
NERVE INJURIES
2. In diagnosis of nerve injury, sweating test may be done, what s the powder
used? Quinizarine powder. It is blue and turns red on exposure to water, so it is used to map out areas of
anhydrosis.
10. When to seek orthopedic ttt? In a chronic patient, with failure to get the nerve to recover.
11. How? In other words, what to do for a chronic patient (in clinical exam)
(A) orthodesis: fixation of joint (e.g. in radial nerve paralysis which causes wrist drop)
(B) Tendon transplantation: e.g. flexor digitalis is sutured in extensors of wrist
• whats the carrying angle? Normally there is an angle between the long axis of forearm and that of
the arm. It is larger in females
If supracondylar fracture occurred → improper healing → Cubitus valgus (wider carrying angle) →
course of ulnar nerve become elongated and this causes delayed ulnar neuritis → we treat the
condition by anterior transposition of ulnar nerve in front of medial epicondyle .
Application: in clinical ask pt with ulnar nerve injury to stand with extended elbow
The doctor will ask you why?Tell him that you are inspecting for wide carrying angle
Thyroid diseases
1. All thyroid is very important oral
2. Thyroglossal cyst and fistula: important oral
6. DD of any sinus
- chronic osteomylitis
- T.B.
8. in case of hypothyroid goitre, how come thyroid hormone are low while the
gland is enlarged and hyperactive?
- it occurs in cases of severe iodine deficiency in which in spite of hyperactivity of the gland, there is no
iodine to synthesize T3 and T4. therefore T3 and T4 are low and TSH will increase leading to more
and more hypertrophy of the gland
10. what does the patient complain of in case of diffuse hyperplastic goitre
(physiological goitre) ?
- fullness in the lower part of front of neck = venus neck !ﺇﻟﺔﺍﻟﺠﻤﺎﻝ ﻓﻰ ﺍﻷﺳﺎﻃﻴﺮ
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Oral Questions and Answers in General Surgery
12. How S.N.G. cause dyspnea? ﺍﺯﺍﻯ ﺑﻴﺤﺼﻞdyspnea()ﻳﻘﺼﺪ ﺍﺯﺍﻯ ﺑﻴﺪﻭﺱ ﻓﻴﺴﺒﺒﻪ
- By pressure on trachea :
1- anteroposterior pressure especially in retrosternal cases
2- lateral kinking of trachea by unilateral goiter
3- compression from both sides in bilateral huge goiter (scabbard trachea ) ﺧﻨﺠﺮ
4- prolonged compression of trachea results in resorption of cartilaginous rings
tracheomalacia
1- Test for VV
2- position ( head down )
3- valve
4- 2 operation in varicose vein & pulmonary embolism
5- Examination in hip joint
22. whats berry’s sign? It occurs due to biding of malignancy on carotid absent carotid pulse.() ﺑﻴﺤﻀﻨﻪ
as malignancy cant infiltrate carotid (there will be no signs of cerebral ischemia)
23. complications of SNG: v imp
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Oral Questions and Answers in General Surgery
25. what kind of injury can be commonly found? 3% of people have recurrent laryngeal nerve
injury of an unknown cause, only explanation is that it is due to recurrent viral neuritis.
30. What does autoimmune thyroiditis mean? Antibodies acting on thyroid instead of TSH, so
response of thyroid will be longer and stronger.
34. Who is the pt. with hyperthyroidism, & a low gland activity?
- Patient with thyroiditis
38. DON’T diagnose toxic goiter if pulse is less than 80/min ECXEPT
if under ttt.
4- not related
c Dyspnea oxygen
d Tachy cardia indral with monitor & ECG & give steroids
a Cocussion of nerve
b Tracheitis
c Laryngitis
59. Eye signs other than exophthalmos: very important (don’t forget to put your hands to stabilize
patient’s head in all of them )
60. Difference between 1ry thyrotoxicosis and 2ry thyrotoxicosis? Revise table from
book (10 points)
61. Thyroid function tests: oral, specially radioactive iodine studies (v imp)
66. In thyrtoidectomy for ttt of SNG & thyrotoxicosis, how much of the gland
should be left in the body?
According to the surgeon’s experience, but usually in SNG, 8 gm on each side, which is equal to distal phalynx of
thumb. In toxic goiter, ½ or 1/3 this amount is left
No, its not reliable, as it doesn’t differentiate between adenoma and carcinoma. Because the only difference
histologically is the presence of vascular or capsular invasion.
70. You discovered a patient with medullary carcinoma, what would you like
to do concerning his family?
Screening for calcitonin level, if proved to be high in one of them, prophylactic thyrtoidectomy is done.
71. Why? Because before malignancy develops, it passes through a phase of hyperplasia of parafollicular cells,
which secrete calcitonin.
77. Patient with medullary carcinoma and pheochromocytoma, which will you
treat 1st?
Pheochromocytoma 1st, although it is usually benign, but patient with pheochromocytoma can not tolerate the
anesthesia required for thyrtoidectomy.
78. What is the 1st LN to be affected in thyroid carcinoma? Recurrent laryngeal node
79. Then? Then pretracheal and prelaryngeal (Delphic), and to lower deep cervical LNS
80. Which are more commonly affected, upper or lower deep cervical LNS? Lower
83. How do we scan for recurrence of thyroid tumour after TOTAL thyroidectomy?
Thyroglobulin, as it is only produced from thyroid and tumour cells.
84. What would you like to give the patient post-thyroidectomy? L-thyroxine short of toxicity
85. Why? as Replacement and for suppression of metastasis.
93. Reidle’s thyroiditis: probably a collagen disease, thyroid is hard (extensive fibrosis), differentiation from
anaplastic carcinoma may need an open biopsy
94. Which part will you remove for biopsy? a wedge of isthmus is removed
95. Why? So that in addition to biopsy, trachea is relieved from obstruction. (remember, in all thyroid operations
we remove isthmus, check Q 48)
Breast
• fever becomes hectic ( fluctuates about 1 C up and down but doesn't return to base line) not
intermittent (return to base line)
• pitting edema
• throbbing pain
• Localization
• fluctuation: cavity containing pus
• Pointing
3. If a case of duct papilloma and you feel a mass, what are the
possibilities?
This is a retention cyst as the papilloma closes the duct partially and causes swelling of acini forming
retention cyst
11. Which is more risky early or late arm edema after operation?
Acquired Congenital
Age of onset: adulthood on top of pre-
Since birth
existing cyst
Site: high in the neck at the cyst level In lower third of the neck
Treatment: surgical excision Surgical excision + step-ladder incision
A patient with extensive 1ry malignancy but without metastasis. It is used in advanced malignancy to under
stage the case, and do surgery e.g. Breast, wilm’s tumor,…
Salivary gland
Skin
• Classification of lipoma is very important for oral exam (refer to your book)
3. Is irreducibility an emergency?
No, but needs surgery
-Common in child
-Weak abdominal ms
-Urinary bladder
-Ceocum
-Sigmoid colon
If:
-huge
-Long standing
-Incompletely reducible
-Desire of micturition
-Double of micturition
Seminoma teratoma
No hemorrhage and necrosis there is Hemorrhage and necrosis
fibrous septa No fibrous septa
Because the skin of the scrotum drains to medial half of the transverse limb of superficial inguinal
LNs
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Oral Questions and Answers in General Surgery
Why?
If there is:
• Hormone production
• Spermatogenesis: Needs 35'C……..dartos ms is the thermostat for spermatogenesis
Embryologically Lt Testis descends first……..so the Rt undescended testis more common And so the Rt inguinal
hernia is more common
Due to vascular communications between the 2 testis which transmit hotness and toxins of the
congested testis to the other one