Signs of Primary Thyrotoxicosis:

1. Eye signs
2. Tachycardia
3. Tremors
4. Moist skin
5. Thyroid bruit
6. Peritibial myxedema.
Here eye signs are more common.

-Signs of Secondary Thyrotoxicosis:

1-Signs of cardiac failure:
-Edema of ankles
-Orthopnea
2-Eye signs: Only lid lag and lid retraction can be seen
• No tremor • No exophthalmos, only seen in Primary type "Grave's disease".

Here CVS signs are more common than eye signs.

Signs of Myxedema"Hypothyroidism":

-Obese
-Dry inelastic skin
-Macroglossia
-Mask like facies
-Loss of hair in lateral eye brow
-Hoarseness of voice
-Pseudo myotonic reflex (delayed ankle jerk); also called ‘hung up’ reflex.

Signs of Retrosternal extension:

-As above examination, you can obtain them.
-Look at face, neck, upper chest for dilated veins, congestion, edema, puffiness, palpate tracheal rigns in SS notch, also below the lump, percuss over manibrium sterni for dullness, ask the patient to elevate both limbs for Pemberton's sign.

نفس ما شرح د. رمزي.
من الڤيديو الهندي، الشلوف، Long case.

Ochsner-sherren regimen

#Surgery

Timing of sutural removing.

#Surgery

The Differences between the thyriod surgeries.

#Surgery

Dr. Ramzi.

#Surgery

Manchester staging of Breast cancer:

Stage I:
-Mobile tumour in the breast; no deeper fixation; skin if involved lesser the size of the tumour; lymph node spread is absent.

Stage II:
-Same as stage 1 with mobile discrete axillary nodes.

Stage III:
-Fixed to pectoralis major or skin involvement more the tumour size or fixed/adherent node.

Stage IV:
-Tumour fixed to chest wall, involvement same or opposite supraclavicular nodes, opposite axillary nodes, opposite breast, cancer en cuirasse, distant blood spread.

Note:
-Manchester staging and Columbia classification are obsolete (not used now).

#Surgery

Apparent leg length discrepancy:

-Measuring distance from the umbilicus or xiphisternal junction to the medial malleoli.

-Unequal distance signifies apparent leg length discrepancy, especially if there is not a true leg length discrepancy.

-It may be caused by pelvic obliquity or adduction or flexion deformity in the hip joint.

-Note:
It's performed after doing true leg length discrepancy.

#Surgery

What are indications of cholecystectomy in asymptomatic GB stone?

1-Patient is diabetic or immunosuppressed.Why?
It causes Emphysematous severe fulminant cholecystitis, that leads to gangrene, perforation and peritonitis.
2–High chances or risk of developing gallbladder carcinoma
3–Stone more than 2.5 cm/multiple stones
4–If gallbladder wall is thickened
5–Porcelain Gallbladder- Absolute indication for cholecystectomy! 10٪ will develop adenocarcinoma.

#Surgery

Liver can persist or live without hepatic artery i.e (presence of portal vein only) but if the liver is healthy.
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Qaudate lobe is the only lobe which does not drain its venous blood to hepatic vein
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We don't put tube in case of TB abscess or amoebic abscess because this procedure lead to formation of fistula .
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The commonest site for rupture of amebic abscess is the peritoneal cavity.


د ناجي حومش.

#Surgery

Three questions to ask patient in a short case history:

-What happened? "CC"
-When happened? "Duration"
-What is the current situation? "Complications, investigations, or ttt and surgery".

#Surgery

Summary of Hx:

-Age, gender,name, Important findings in personal history, Chief complaint, Analysis of chief complaint, Important findings in review of systems, with important negative findings!Important drugs,family and socioeconomic history, and your most probable diagnosis.

#Surgery

Kocher’s test:

-Slight push on lateral lobes will produce stridor in case of obstructed trachea. Because trachea is already compressed"Slit like"!
-It may be positive in large mass bilaterally.

#Surgery