Rule in RTA:

-Any unconscious patient should be considered as having spinal cord injury untill proved otherwise.

#Surgery

Meckel’s diverticulum (Rule of 2’s):

•2% of population
•2 times commoner in males
•2 feet proximal to ileocaecal valve
•2 inches in length
•2 types of common ectopic tissue
(gastric and pancreatic).

#Surgery

Rule in malignant surgery:

-Don not do surgical operation for cancer if metastasis is present.

-Note: may be done if the operation is for palliative procedure in critical sites as trachea .

#Surgery

Remember 6F

•Follicular carcinoma of Thyroid:
-Follicular
-Female
-Forty
-Far away "mets. by blood"
-FNAC" not conclusive "
-Familial.

•Gall stones:
-Forty
-Female
-Fatty
-Fair
-Flatulent
-Fertile.

•Generalized abdominal distention:
-Fluid
-Fetus
-Full bladder
-Faces
-Fat
-Fibroma
-Flatus.

#Surgery

GALLSTONE ILEUS

-It is a type of acute intestinal obstruction, often seen in elderly and is due to blockage by a bolus or mass of gallstones which commonly enter the intestine through cholecystoduodenal fistula (75%) or rarely through cholecystointestinal or gastric fistulas.


#Surgery

Aortoiliac disease (Leriche syndrome)

-Triad of bilateral buttock, hip, or thigh claudication, erectile dysfunction, and absent/diminished femoral pulses.

#Surgery

•Thyroid swelling and toxic features appear simultaneously in primary thyrotoxicosis.

#Surgery

-Dyspnea in thyroid:
• Tracheomalacia in long standing MNG
• Retrosternal extension
• Cardiac failure due to secondary thyrotoxicosis
•Infiltration by anaplastic carcinoma.

-Hoarseness of voice:
•Infiltration of recurrent laryngeal nerve by malignancy
• Edema of vocal cord.

#Surgery

Goiter is usually painless.

Pain is seen in cases of:
–Hemorrhage
–Malignancy infiltrating the nerves
–Thyroiditis
–Anaplastic carcinoma.

#Surgery

•In secondary thyrotoxicosis cardiac manifest is more common than eye manifest. Why?

-Because secondary thyrotoxicosis is already common in old age with aged heart and complications ,so the sympathetic over activity affects the heart more.
-Primary thyrotoxicosis is common in young age.

What is the dose of thyroxine given?

Thyroxine doses: (T4) Eltroxin(Levothyroxine) tablet: 0.1 mg tablet available.

1-Supplement treatment (hypothyroidism): 👉🏼1 tablet (0.1mg).

2-Substitution treatment (after thyroidectomy): 👉🏼2 tablets (0.2mg).

3-Suppression treatment (for papillary carcinoma): 👉🏼3 tablets(0.3mg).

#Surgery

-FNAC cannot differentiate follicular adenoma and carcinoma ,because the differentiation is based on capsular invasion.

#Surgery

X-ray of neck in Thyroid case:

1. Position of trachea
2. Retrosternal extension
3. Cervical spondylosis
4. Calcifications
i. Benign dystrophic
ii. Psammoma bodies
5. Barium swallow X-ray (esophagus compression)
6. Metastasis to skull.

Note:
-Cervical spondylosis if present may lead to limb paralysis if the neck is hyperextended during surgery hence X-ray of neck is important.

#Surgery

USG neck to differentiate in thyroid:

• Cystic or solid swelling
• Multinodular or solitary nodular
• To find nodes.

#Surgery

Causes of postoperative pyrexia and complication, Rule of "W".
#Surgery

•Best diagnostic test in stable patient with blunt trauma abdomen is👉🏼CECT.
BUT
•Investigation of choice for blunt trauma abdomen in unstable patient👉🏼USG.
•Investigation of choice for diagnosing intra abdominal bleeding in an unstable patient👉🏼USG.


•Patient of penetrating injury to the abdomen with shock, next best step is👉🏼Laparotomy

•If Diagnostic peritoneal lavage is positive, do directly 👉🏼 Laparotomy.

•Most commonly injured in the blunt trauma  is 👉🏼Spleen,"In recent study,liver"

•Most commonly injured in penetrating trauma is 👉🏼Small intestine.

#Surgery

Different types of abdominal incision in surgery.

#Surgery

•What is the most dangerous type of appendicitis ? Why ?

-Post-ileal type is considered the most dangerous type, because :

1. No shift of pain which is misdiagnosed as gastroenteritis
2. No omental localization👉🏼peritonitis 
3. Affection of iliocaecal vein 👉🏼 portal pyemia
4. Affection of appendicular artery👉🏼gangrene.

#Surgery

We use the spirometry after post operative or after chest tube  to expand the lung.

#Surgery