Surgery

Front 1

which are tetanus prone wounds?

Back 1

punture wound
crush injuries
2/3 degree burns
Chronic ulcers
Wounds contaminated with soil, feces, saliva
Avascular/gangrenous wounds
Frostbite
Penetrating eye injuries
Avulsions

Front 2

action of tetanolysin?

Back 2

local cell death by anaerobic lysis

Front 3

action of tetanospasmin?

Back 3

Tetanospasmin interferes with the transmission of inhibitory impulses in the central nervous system.
tetanospasmin affects all nerves, this presents as spasticity .in between spasticity flaccid paralysis is also seen due to involvement of ach. Autonomic disinhibition occurs late in the disease.

Front 4

clinical features of tetanus?

Back 4

muscle rigidity and spasms
trismus
neck stiffness, and dysphagia. Muscle spasm progresses diffusely to involve the facial muscles, causing the classic facial grimace risus sardonicus.

Front 5

antibiotic of choice in tetanus injury?

Back 5

metronidazole.

Front 6

clean minor wounds , no prior H/O vaccination then

Back 6

give tetanus toxoid

Front 7

all other tetanus prone wounds with no prior H/O VACCINATION THEN

Back 7

give tetanus toxoid and tetanus immunoglobulin

Front 8

all other wonds with h/o vaccination present but more than 5-10yrs ago then

Back 8

give tetanus toxoid.

Front 9

what is the immediate treatment for aortic dissection?

Back 9

I/V labetolol therapy to reduce hypertension.started to reduce the pulse and blood pressure of the patient in an attempt to limit the severity of the dissection.

Front 10

what is the treatment for proximal dissection of aorta?

Back 10

emergent surgery

distal aortic dissection can be treated medically.

Front 11

DD of hypotension and aortic dissection?

Back 11

hypotension occurs in patients with proximal aortic dissection.
cardiac tamponade
acute severe AR
intraperitoneal rupture
intrapleural rupture

Front 12

reduced or absent pulses in pts with acute chest pain , think of

Back 12

aortic dissection

Front 13

cause of MI in aortic dissection/

Back 13

a proximal dissection flap may involve the ostium of a coronary artery and cause acute myocardial infarction.

Front 14

conditions which cause type 1 respiratory failure ( hypoxia with normal pco2.

Back 14

pulmonary edema
sepsis

Front 15

conditions which cause type 2 resp failure are (hypoxia plus hypercapnia)

Back 15

ARDS
NARCOTIC USE
increased co2 production
altered resp dynamics

Front 16

results of spirometry in assessing pulmonary function?

Back 16

FEV1 >2L is no serious pulmonary problems
FEV1 <50%-predicted then exertional dysnea present

Front 17

differentiate aspiration pneumonitis from aspiration pneumonia?

Back 17

the main difference lies in the contents aspirated.
Aspiration pneumonitis (Mendelson's syndrome) describes acute lung injury that results from the inhalation of regurgitated gastric contents, whereas aspiration pneumonia results from the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria

Hint 17

Patient with aspiration pneumonitis presents with associated vomiting, altered level of consciousness , cough, wheezing ,laboured respiration. on the other hand patient with aspiration pneumonia is diagnosed when chest X ray shows infiltrate in the posterior segments of the upper lobes and the apical segments of the lower lobes in a susceptible patient.

Front 18

the definitive diagnostic test in chronic mesenteric ischemia is?

Back 18

arteriography/mesenteric angiogram. CT is not done.

Front 19

preffered diagnostic test for mesenteric vein thrombosis?

Back 19

Abdominal/pelvic contrast-enhanced CT,

Front 20

abdominal pain (mostly left lower quadrant), often with urgency, diarrhea, and passage of bright red blood per rectum.diagnosis is ?

Back 20

colonic ischemia.

Front 21

first line of therapy for pts with claudication?
'

Back 21

12 week exercise program and medication.

Front 22

Critical limb ischaemia:

Back 22

• Compromise of blood flow to extremity, causing limb pain at rest. Patients often have ulcers or gangrene.

Front 23

The commonest site of occlusion leading to claudication is

Back 23

superficial femoral artery.

Front 24

most common risk factor for peripheral areterial disease is ?

Back 24

smoking

Front 25

When do irreversible changes occur in a limb and what’s the best time for revascularization?

Back 25

Irreversible changes begin to occur within 4-6hrs of symptom onset. Revascularization is less effective after 8-12 hrs of ischemia.

Front 26

cilostazol is given in?

Back 26

in peripheral vascular disease.
causes vasodilation and has antiplatelet effect.

Front 27

contraindication of cilostazol?

Back 27

congestive heart failure patients.and ejection fraction less than 40%

Front 28

strong risk factors for atherosclerois causing peripheral arterial disease.

Back 28

smoking
HTN
diabetes
hypercholesterimia.

Front 29

presentation for chronic occlusive disease of lower extremities?

Back 29

critical ischemia with pain at rest.
forefoot pain.
he patient with rest pain is often awakened by severe discomfort in the forefoot and hangs the affected extremity off the bed for temporary relief of symptoms.

Front 30

one of the complications of prolonged limb ischemia is ?

Back 30

compartment syndrome. this occurs due to reperfusion injury , which results in both intracellular and interstitial edema.

Front 31

proliferation of fibroblasts is stimulated by ?

Back 31

TGF beta ,transforming growth factor.

Front 32

second and third phases of wound healing are ?

Back 32

proliferative and remodelling(maturation) phase. these phases are constant in any type of wound healing.

Front 33

collagen is produced by

Back 33

fibroblasts.

Front 34

cofactors in the synthesis of collagen (hydroxylation)

Back 34

ferrous iron
ascorbic acid
alpha-ketoglutarate

Front 35

wound maturation/remodelling takes?

Back 35

9-12 months.

Front 36

tertiary healing is /?

Back 36

the wound is closed by active means after a delay of days to weeks. it is performed only in wounds that have a quantitative bacterial count of less than 10*5 organisms /g of tissue.

Front 37

umbilical ring is normal and abdominal wall defect is always right side .

Back 37

gastrochisis

Front 38

abdominal defect is through the umbilical ring and sac present in

Back 38

omphalocele.

Front 39

normal post void residual urine volume is

Back 39

less than 50 ml

Front 40

overflow incontinence, residual volume is

Back 40

> 200ml

Front 41

sideeffect of bupivacaine/

Back 41

cardiotoxic

Front 42

methemoglobinema is a side effect of which anesthetic

Back 42

prilocaine