•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

What is levothyroxine? Its half life?

-It's T4.
-Its half life is 7 days.

Remember 6P

•Papillary cancer
-Popular (most common)
-Psammoma bodies
-Palpable lymph nodes (spreads most commonly by lymphatics, seen in 33% of patients)
-Positive 131I uptake
-Positive prognosis
-Postoperative 131I scan to diagnose treat metastases
-Pulmonary metastases.

•Acute limb ischemia
-Pain
-Pallor
-Pulselessness
-Paralysis
-Paresthesia
-Poikilothermia.

#Surgery

-The histologic finding that defines malignancy in follicular cancer is Capsular or blood vessel invasion,so that FNAC isn't useful.

-The most common site of distant metastasis is Bone.

-Total thyroidectomy is the treatment.

#Surgery

Medullary cancer:

-MENII
-aMyloid Median lymph node dissection
-Modified neck dissection if lateral nodes are positive.

#Surgery

•What are the causes for intermittent jaundice?

1.CBD stones
2.Periampullary carcinoma
3.Repeated hemolytic episode
4.Parasite
5.Hemobilia
6.Duodenal diverticula.

#Surgery

To say it's IO, there should be more than 3 air fluid levels.

#Surgery

•Ambutation indicated in 3 D:
-Dead tissues (gangrene)
-Dysfunction
-Diseases(cancer).

#Surgery