•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

•If the patient has bilateral inguinal hernias ,how would you proceed? And which side to operat first?

-We will repair one side only and then the other side after 6 months.
-This is to avoid over stretching the abdominal muscles if both sides were repaired in the same time..!

•We usually started by:
a. The bigger hernia.
b. That with narrower neck. 
c. The more painful side.

#Surgery

In thyroid surgery:

-The platysma has to be closed with the SC tissue as a separate layer to avoid adherent ugly scar.

-Morphine & hyoscine,(Instead of atropine in toxic cases as atropine causes tachycardia).

-Artery is ligated before vein to avoid lobe congestion.

#Surgery

Common sites of injury to RLN:

–Near inferior thyroid artery
–Near ligament of berry
–At inferior pole of the gland.

#Surgery

-If FNAC shows follicular adenoma; lobectomy is enough because 80 percent of cases are benign.
-If the biopsy report becomes positive for malignancy based on angio or capular invasion: Completion total thyroidectomy must be done.

#Surgery

Sore throat is the first indication of carbimazole toxicity.

#Surgery