Cough Impulse:
-Expansile impulse seen or felt over a swelling when the patient coughs, cries or strains.

#Surgery

Crepitus:
-Grating or crackling sensation imparted to the examining fingers.
-May be present when the joint contain loose bodies.

#Surgery

Flail chest:
-Three or more ribs fractured in 2 or more places.
-Bilateral costochondral separation will result in flail sternum.

Goiter:
- Any enlargement of thyroid gland is called goiter.

Grading of goiter: WHO (1990) Perez Classification
Grade 0 No goiter
Grade Ia Not visible, but palpable
Grade Ib Visible with neck extended and palpable
Grade II Visible with neck in normal position and palpable
Grade III Large gland evident from a distance.

#Surgery

Hydronephrosis:
-Aseptic dilatation of pelvicalyceal system due to partial or intermittent obstruction.

Renal angle:

-Angle between the 12th rib and the edge of the erectorspinae muscle.
-Normally this is empty and resonant.
-There should not be any tenderness.

#Surgery

Phimosis:
-Inability to retract the foreskin to expose the glans.
Paraphimosis:
-Inability to reduce a previously retracted foreskin.

#Surgery

Massive hemothorax:-
When 1500 mL or more of blood is acutely removed from the pleural space, then it is called massive hemothorax.

#Surgery

Lower GI bleed:
-It is a bleeding from distal to the ligament of Treitz.

Upper GI bleed:
-It is a bleeding from proximal to the ligament of Treitz.

#Surgery

Tension pneumothorax:

-Presence of air in the pleural cavity with signs of mediastinal shift like:
Tracheal shift or and Shift of Apex beat.

#Surgery

A tension pneumothorax impairs venous return by caval distortion from mediastinal shift and raised intrathoracic pressure with compression of the contralateral lung.


Radiological signs of tension pneumothorax:
1-Tracheal shift
2-Spreading of the ribs (Space between ribs increased)
3-Lowering of hemidiaphragm.

#Surgery

Third day fever:

-If a patient is developing fever on the third postoperative day of surgery, suspect septic foci in the IV cannula.

#Surgery

Weight loss:
-Loss of more than 10% body weight over a period of 6 months.

#Medicine

Varicose vein: (WHO Definition)

-Abnormally dilated saccular or cylindrical superficial veins which can be circumscribed or segmental.

#Surgery

Seddon’s Classification - Types of nerve injury:

•Neurapraxia
Axons are intact. Spontaneous recovery is complete.

•Axonotmesis:
Axons divided.Connective tissue intact. Wallerian degeneration occurs. Axons then regenerate slowly.

•Neurotmesis :
Whole nerve severed. Recovery may occur if cut ends are apposed.

#Surgery

In the normal adult erect film, usually upto 3 fluid levels are normal. They are:

1.One at the fundus of the stomach
2.One at the duodenal cap
3.One in the terminal ileum.

Porcelain gallbladder:

-Calcification of the gallbladder in plain X-ray is called porcelain gallbladder.
-The importance of this appearance is an association of carcinoma in up to 25% of patients.

#Surgery

Clinical features of tension pneumothorax:

•Acute dyspnea
•Distended neck veins
•Weak pulse
•Low blood pressure
•Tracheal shift
•Shifting of the apex beat •Hyperresonance on the affected hemithorax
•Absent breath sounds on the same side.

How to confirm tension pneumothorax?
-It is a clinical diagnosis and treatment must be instituted urgently without wasting time for radiology!

#Surgery

Surgical emphysema:

•It is the presence of air in the tissues •It requires a breach of air containing viscus which is in communication with soft tissues and the generation of positive pressure to push the air along tissue planes.

What is the physical sign of surgical emphysema?
-Crepitus, due to presence of gas in the subcutaneous tissue.

#Surgery

Why appendicectomy is contraindicated in appendicular mass?

1.Immediate appendicectomy is technically more difficult
2.Fear of disturbing the natural barrier present in the mass.
3.The mass will resolve without surgery (90% will resolve with conservative treatment).
4.Operation can always be resorted to, should the initial conservative trial fail.

#Surgery

-Commonest organ failure in severe Acute pancreatitis is respiratory.

-Biliary tract disease is the commonest cause of acute pancreatitis.

-Magnitude of amylase elevation is not related to severity of the pancreatitis. It increases once symptoms appear for 12–24 hours then decreases in 6 days.

-Persistent elevation suggests complications like pseudocyst, ascites and abscess formation.

#Surgery