SURGERY 🩸

بسمِ ربُ العرش العظيم..♥️ [اني جَزيتهُم اليوم بما صَبروا..] اعرف كُلش زين رِحلة الجِراحة شلون كانت مُتعبة ومُملة ، بس استشعِروا هاي الآية كُلش زين اسمعوها مرة ومرتين، الله بصير ع كُل مرة قاومتوا التعب والمرض والملل وكملتوا  ، ع كُل مرة كُلشي يدفعكُم توكفون  بس مَوكفتوا ، ع كُل مرة شفتوا المادة صعبة وماتنلم بس مااستسلمتوا.. هذني كُلهن مُمكن انتوا تنسوهن ،لكن حاشا لله ينساهن ،كُلهن برعاية الرحمن و وراهن جَبر كُلش عظيم..♥️

كُل الخوف والقلق والتوتر هذا ،رب العالمين قادر يمحي بلحظة ، بس ثِق بي وامشي..✨

2024/6/5..♥️⏳

بفضل الله تعالى , تقريبا نزلت كلشي مهم يخص الجراحة كلها من الثالث صعودا , اسال الله تعالى ان تكونوا استفاديتوا , بعد بقية اليوم مراح انزل شي حتى منشوش عليكم , اقروا الذهبيات لان تمثل مراجعة للجراحة باكملها , واي شي تحتاجون المعرف مالتنه فوك , والله ولي التوفيق. 😇😇

مجموعة اسئلة وذهبيات منوعة لمواضيع الثالث و اشياء اخرى مهمة تفيدكم يا رب ☝🏻😇

🗯 An 18-year-old school student of East African origin presents with a 2-week history of lethargy, myalgia, rigours with hot flushes and intermittent pyrexia. Neither she nor any close contacts have been travelling recently. Examination reveals ❗️enlarged anterior and posterior chain lymph nodes in the neck. A blood film reveals the presence of ❗️Downey bodies, ❗️thrombocytosis and an increase in the lymphocyte count to 50% of total leucocytes. Dx ➡️ Infectious mononucleosis. 🗯 A 16-year-old girl presents with a ❗️smooth, round and painless lump in the midline of the neck, of which she feels very self-conscious. On examination, it is firm, transilluminates and is painless to touch. In addition, it ❗️moves up when the patient is asked to take a sip of water. DX ➡️ Thyroglossal cyst. 🗯 A 45-year-old female business executive presents with a swelling in the midline of the neck and features of ❗️hyperthyroidism ❗️secondary to Graves’ disease. Following a course of antithyroid medication, a subtotal thyroidectomy is performed. Raised titres of which immunoglobulin ➡️ Anti TSH receptor antibody. 🗯 You are asked to assess a 25-year-old patient who returned from theatre ❗️2 hours ago following a ❗️thyroidectomy for a large, hyperplastic goitre and is now complaining of ❗️difficulty swallowing sips of water. On examination you note that she is ❗️very short of breath with a ❗️respiratory rate of 30 breaths/min, ❗️using her accessory muscles of respiration and only able to answer your questions in two or three words. In addition, there appears to be a ❗️fluctuant mass in the midline of the neck underlying the surgical clips. Immediate management ➡️ Removal of surgical clips at the bedside. (hematoma has been formed) 🗯 A 59-year-old fisherman presents with longstanding weight loss, anorexia and lethargy. Physical examination reveals a ❗️palpable swelling in the ❗️left supraclavicular fossa. A disseminated ❗️adenocarcinoma of the stomach is diagnosed following a gastroscopy and computed tomography scan of the thorax and abdomen. DX ➡️ Troisier’s sign. #general #goldens

🗯 best form of analgesia in 1st post op. period is ➡️ epidural (if no response ➡️ Patient-controlled opiate analgesia). 🗯 A 46-year-old woman re-presents to the emergency department ❗️48 hours following an ‘uncomplicated’ laparoscopic cholecystectomy and on-table cholangiogram. She describes a ❗️history of progressive, constant, right upper quadrant pain radiating to the shoulder tip since the surgery. The pain is ❗️worse on coughing and moving.On direct questioning, she describes a 24-hour history of ❗️nausea and vomiting. The ❗️abdomen is rigid. Her liver function tests are abnormal as follows: bilirubin 60 μmol/L, ALP550 IU/L and AST 220 IU L. Her is <1.5. BEST Dx ➡️ ERCP. 🗯 You are called urgently to see a 67-year-old man who is ❗️24 hours following uncomplicated laparoscopic cholecystectomy. The patient is HIV-positive and has a past history of ❗️thrombocytopenia was 60 × 109/L. He is complaining of ❗️chest pain and SOB and his ❗️abdomen is noticeably more distended than in the initial postoperative period with significant ❗️peri-umbilical tenderness. His postoperative ECG shows lateral ischaemia and his current haemoglobin level is 7.5 g/dL. He is tachycardic and his blood pressure is 115/75 mmHg. NEXT step ➡️ Start blood transfusion (port site hematoma). 🗯 Free air under the hemi-diaphragms is normally presents for 3 days post op. 🗯 You are called to the ward to review a 72-year-old man who is ❗️pyrexial at 38.0°C, ❗️8 hours following an anterior resection for rectal adenocarcinoma with out defunctioning stoma. He is ❗️asymptomatic and ❗️pain-free with an epidural. A ❗️urinary catheter inserted in theatre is draining concentrated urine. He has a ❗️history of chronic airways disease controlled with inhalers. He has ❗️no respiratory distress, ❗️but both lung bases sound quiet. cause for fever ➡️ Systemic response to surgical trauma. 🗯 You are called to see the same patient ❗️7 days postoperatively as he has become unwell and ❗️pyrexial with a temperature of 39.0°C. The patient has ❗️generalized abdominal discomfort. The abdomen is tender with generalized guarding and rebound. The ❗️chest is clear to auscultation. The patient's catheter and epidural were removed 2 days ago. explanation for the patient's pyrexia ➡️ Anastomotic leakage. 🗯 You are called urgently to see an 80-year-old man who is ❗️6 days following open anterior resection for rectal carcinoma with defunctioning stoma. The patient reported seeing a ❗️gush of pink fluid from the central laparotomy wound. You notice that the ❗️small bowel is eviscerating from the wound. Following initial resuscitation, the next best step ➡️ Cover the small bowel with a sterile saline-soaked gauze. 🗯 A 72-year-old woman is about to undergo an elective ❗️total hip replacement for osteoarthritis. She has a history of ❗️hypertension and ❗️type 2 diabetes mellitus but no ischaemic heart disease or peripheral vascular disease. most appropriate thromboembolic prophylaxis ➡️ Subcutaneous low-molecular-weight heparin. 🗯 A 22-year-old man (O blood group) sustained a splenic injury in a road traffic accident. He is undergoing a ❗️transfusion of 4 units prior to surgery. You are asked to review the patient 10 minutes into the transfusion as he has become ❗️unwell and ❗️agitated. He has ❗️pyrexia (39.5°C) with associated ❗️tachycardia (120 beats/min) and ❗️hypotension (80/50 mmHg). Dx ➡️ Haemolytic transfusion reaction (ABO incompatibility). 🗯 A 49-year-old woman weighing 65kg is 5 days ❗️following gastrectomy for gastric carcinoma. Her observations are as follows: ❗️Temperature = 39.0°C ❗️Pulse = 110 beats/min , Blood pressure = 90/50 mmHg , Urine output = 10mL/h ❗️Respiratory rate = 30 breaths/min. Dx ➡️ SIRS. #general #goldens

جدا مهممممممممممم ☝🏻😇

اي طالب عنده اسئلة او شي يفيدنه بيه , خلي يراسل ع هذا المعرف @WiseDr23

مجموعة ملاحظات مهمة تخص التخدير من احد الطلبة جزاه الله خير ☝🏻😇

🗯 Spinal Anesthesia : ❗️Complications 1. Hypotension & bradycardia 2. Nausea & vomiting 3.Postdural puncture headache ❗️Contraindications 1. Hypovolaemia 2. A low fixed cardiac output 3. Local skin sepsis 4. Coagulopathy 5. Raised intracranial pressure 6. Known allergy to local anaesthetic drugs 7. A patient totally uncooperative 8. Previous spinal surgery ❗️what are the risks of having anaesthesia? A: Minor: 🤫Failed IV access. 🤫Lip injury and teeth damage. 🤫Sore throat. 🤫Headache. 🤫Post-operative nausea and vomiting. 🤫Urine retention. B: Major: life-threatening 😥Aspiration of gastric contents. 😥Hypoxic brain injury and cerebrovascular accident. 😥Nerve injury. 😥Chest infection. 😥MI. #anesthesia #goldens

🗯Maximum dose : ❗️Lidocaine-3ml/Kg ❗️Bupivacaine-2mg/kg ❗️Lidocaine+adrenaline-5mg/kg ❗️Prilocaine-6mg/kg. 🗯complication of mechanical ventilation : ✨parenchymal lung damage ✨hospital acquired (nosocomial) pneumonia ✨volutrauma (damage to the lungs caused by overdistention secondary to high mechanical tidal volumes) ✨barotrauma(physical damage to the Jung/mediastinal tissues caused by differences in pressure during ventilation, which can cause pneumothorax pneumomediastinum, pneumopericardium, surgical emphysema and acute lung injury) ✨decreases cardiac output. 🗯 associated systemic effect of epidural analgesia : ❗️decreased surgical stress response ❗️reduced cardiac output ❗️hypotension ❗️ reduction in functional residual capacity ❗️Reduction in postoperative deep venous thrombosis #anesthesia #goldens

هذي كل ملاعيب اليورو , اعتبروها مراجعة تفيدكم ان شاء الله ☝🏻😇

🫘 definitive investigation in bladder cancer ➡️ Cystoscopy and biopsy. 🫘 A 60-year-old man presents with painless haematuria. A cystoscopy confirms the presence of a ❗️tumour in his bladder, which is ❗️malignant on biopsy. He undergoes a staging CT scan which confirms ❗️involvement of the superficial muscle and no evidence of distant metastases. Rx ➡️ Radical cystectomy. 🫘 A 72-year-old man presents with urinary frequency and nocturia. You suspect a diagnosis of ❗️BPH. According to the International Prostate Symptom Score, his symptoms are classified as ❗️mild. best next step ➡️ Watchful waiting. 🫘 post-TURP syndrome. This is caused by systemic absorption of the irrigation fluids used during TURP and these lead to dilution of the plasma, hyponatraemia and hypothermia. 🫘 A 35-year-old man presents with a ❗️lump in his scrotum. On examination the lump is ❗️translucent and nontender. You find it difficult to identify the testes and epididymis separately. DX ➡️ Hydrocele. 🫘 A 56-year-old male presents to his GP with a ❗️fever and backache. He also complains of a ❗️poor stream when urinating. A rectal (PR) examination reveals a ❗️tender and ❗️boggy prostate which is of a ❗️regular size. DX , RX ➡️ prostatitis , Ciprofloxacin. 🫘 A ❗️60-year old male patient presents with ❗️painless haematuria after being referred by the GP. ❗️Urinary cytology was positive. Dx ➡️ Transitional cell cancer (TCC) of the bladder. 🫘 A 76-year-old man was seen in accident and emergency with ❗️abdominal discomfort. On examination he has a ❗️nontender, ❗️dome-shaped cystic mass ❗️dull to percussion ❗️reaching to the umbilicus. Investigation reveal Hb is 96g/L, serum urea is 15mmol/L, serum creatinine is 160mmol/L. DX , best Rx ➡️ Acute urinary retention , Urinary catheterization. 🫘 A 16-year-old boy presents with sudden onset ❗️severe pain in his left scrotum and ❗️vomiting. On examination you note evidence of ❗️scrotal erythema and ❗️tenderness on palpation; ❗️upon elevation of the scrotum, there is ❗️no relief of pain. A ❗️urine dipstick proves negative. DX ➡️ Testicular torsion. #urology #goldens

🫘 A 47-year-old married male comes to your clinic complaining of ❗️right testicular pain that developed quickly over the last 24 hours. He has a recent history of having a ❗️catheter put in post-appendectomy. He reports no fever, dysuria, or urethral discharge. His abdominal examination is normal but he has an ❗️enlarged, exquisitely tender right hemi-scrotum. A urinalysis is normal and his ❗️white blood cell count is 13 × 109/L. Testicular ❗️ultrasonography shows increased blood flow in the affected testicle and epididymis. Dx , 1st line Rx ➡️ epididymo-orchitis , Ofloxacin. 🫘 A 62-year-old man presents with sudden onset ❗️loin pain, ❗️urinary frequency and ❗️dysuria. On examination he is ❗️pyrexic, with a temperature of 38.2°C. He appears notably confused. Dx , IX ➡️ pyelonephritis , GUE. 🫘 A 23-year-old woman presents with ❗️urinary frequency and ❗️dysuria. Routine observations confirm a ❗️temperature of 38.7°C. Blood cultures are taken which demonstrate the ❗️growth of gram-negative organisms. Rx ➡️ Intravenous antibiotics. 🫘 A previously fit and well 22-year-old student presents to his (GP) with an incidental finding of a ❗️painless testicular lump. He has a ❗️past medical history of an undescended testis at birth. Clinical examination shows a ❗️hard, ❗️nontender mass on his left testis which does ❗️not transilluminate. Dx ➡️ testicular cancer. 🫘 A previous fit and well 45-year-old man presents to the emergency department with a 1-day history of severe ❗️left sided loin pain ❗️radiating to his groin. Plain abdominal radiograph reveals a ❗️left ureteral calculus. Urinalysis shows a ❗️trace of blood but nil else. most likely composition of his calculus ➡️ Calcium oxalate. 🫘 A 41-year-old man presents with ❗️urinary frequency, ❗️dysuria and ❗️urgency. Urine cultures are taken which reveal ❗️no bacterial organisms. Dx ➡️ Interstitial cystitis. 🫘 A 62-year-old man presents with ❗️urinary frequency and ❗️dysuria. On examination you note ❗️tenderness in the lower abdomen. On rectal examination you note ❗️tenderness on palpation of his prostate. Dx ➡️ Prostatitis. 🫘 most common metabolic abnormality associated with urinary stones ➡️ Hypercalciuria (hyperparathyroidism). 🫘 A 25-year-old sexually active man presents with ❗️testicular pain and ❗️vomiting. On examination you note his ❗️testicles are swollen and tender. A urine dipstick reveals ❗️3+ leucocytes, 2+nitrites but no blood. Dx ➡️ Epididymo-orchitis. 🫘 A ❗️70-year-old man sees his GP with a 1-month history of ❗️painless haematuria, urinary frequency and mild pelvic and lower back discomfort. He recalls a transient episode of haematuria in his childhood when he lived in ❗️West Africa (❗️schistosomiasis). Clinical examination is unremarkable. DX ➡️ Squamous cell carcinoma of urinary bladder. 🫘 CT scan is the most useful here in diagnosing a possible renal tumour. 🫘 A 50-year-old man presents to his GP with a 1-month history of ❗️dull ache within the right side of his scrotum, which he describes as a ❗️‘dragging sensation’. Clinical examination reveals a ❗️nontender, ❗️twisted mass along the right spermatic cord that feels like a ❗️bag of worms, which does not change in size in the supine position. The rest of the scrotal examination is unremarkable. Dx , Best Ix ➡️ secondary varicocele , CT abdomen. 🫘 A middle-aged man is recently diagnosed with ❗️renal cell carcinoma of his left kidney without evidence of distant metastasis. best Rx ➡️ Radical nephrectomy. 🫘 A 26-year-old man presents with severe colicky pain in his right loin which radiates to his right groin. A urine dipstick is positive for blood. An IVU is requested which demonstrates a ❗️ureteric stone approximately ❗️3mm in size. Following appropriate analgesia. Rx ➡️ Allow for the stone to pass spontaneously. 🫘 A 68-year-old man presents to the urology outpatients clinic with urinary urgency and frequency which is worse when he exercises. This has gradually worsened over a period of weeks. Dx ➡️ bladder stone. #urology #goldens