Surgery Cheatsheet MBBS Finals

Cheatsheet Content

### Septic Shock - **Definition:** Life-threatening organ dysfunction from dysregulated host response to infection, leading to circulatory/metabolic abnormalities. - **Clinical Features:** - **Hypotension:** MAP < 65 mmHg despite fluids. - **Lactate:** > 2 mmol/L. - **Organ Dysfunction:** Altered mental status, AKI, ARDS, coagulopathy. - **Management (Golden Hour):** 1. **Resuscitation:** Measure lactate, blood cultures, broad-spectrum IV antibiotics (within 1 hr), 30 mL/kg crystalloid for hypotension/lactate. 2. **Vasopressors:** Norepinephrine to maintain MAP ≥ 65 mmHg if hypotension persists. 3. **Source Control:** Identify and remove infection source (e.g., drain abscess). 4. **Supportive Care:** Ventilatory, renal, glucose control, stress ulcer/DVT prophylaxis. ### Metabolic Response to Trauma: Ebb and Flow Phases - **Ebb Phase (Initial Shock, 24-48 hrs):** - **Purpose:** Conserve energy, maintain circulatory volume. Hypometabolism. - **Features:** Hypovolemia, decreased CO, decreased metabolic rate/temp, increased catecholamines, insulin resistance, lactic acidosis. - **Flow Phase (Recovery/Hypermetabolic, days-weeks):** - **Purpose:** Repair injury, restore homeostasis. Hypermetabolism, catabolism. - **Features:** Hyperdynamic circulation, increased metabolic rate/temp, catabolism (protein/fat breakdown), increased stress hormones (cortisol, cytokines), insulin resistance, negative nitrogen balance. ### Blood Components and Uses | Component | Uses | | :-------- | :--- | | **PRBCs** | Symptomatic anemia, acute blood loss. | | **FFP** | Coagulopathy (warfarin reversal, DIC, liver disease). | | **Platelets** | Thrombocytopenia with active bleeding, severe prophylactic. | | **Cryoprecipitate** | Hypofibrinogenemia, Factor XIII deficiency. | | **Albumin** | Volume expansion (hypovolemic shock), severe hypoalbuminemia. | ### Enteral Feeding: Indications & Complications (NG in Sick Patient) - **Indications:** Inadequate oral intake (>5-7 days), impaired swallowing (stroke), hypermetabolic states (burns, sepsis), protection of gut mucosa. - **NG Complications:** 1. **Mechanical:** Tube misplacement (aspiration, pneumothorax), obstruction, nasal/pharyngeal irritation. 2. **GI:** **Aspiration pneumonia** (most serious), diarrhea, nausea/vomiting, high gastric residual volume. 3. **Metabolic:** **Refeeding syndrome**, hyperglycemia, fluid/electrolyte imbalances. ### Premalignant Conditions of Oral Cancer - **Leukoplakia:** White patch, non-scrapable. - **Erythroplakia:** Red patch (higher malignant potential). - **Oral Submucous Fibrosis (OSMF):** Chronic fibrosis from betel quid chewing. ### Triage - **Definition:** Prioritizing patients based on severity, prognosis, resources. - **Categories:** - **Red (Immediate):** Life-threatening, requires immediate intervention. - **Yellow (Delayed):** Serious, but not immediately life-threatening. - **Green (Minor):** Walking wounded, minor injuries. - **Black (Expectant/Deceased):** Unlikely survival or deceased. ### Claudication Distance - **Definition:** Distance a PAD patient can walk before ischemic pain stops them. - **Significance:** Indicator of PAD severity, monitors progression/treatment response. ### Exudate vs. Transudate | Feature | Exudate | Transudate | | :------ | :------ | :--------- | | **Mechanism** | Inflammation, increased permeability. | Altered hydrostatic/oncotic pressure. | | **Protein** | High (>3 g/dL) | Low (<2.5-3 g/dL) | | **LDH** | High | Low | | **Causes** | Infection, malignancy, pancreatitis. | CHF, cirrhosis, nephrotic syndrome. | ### Intravenous Pyelogram (IVP) - **Definition:** X-ray of urinary tract using IV contrast. - **Indications (largely replaced by CT):** Hematuria, urinary obstruction, congenital anomalies. ### Central Venous Pressure (CVP) - **Definition:** Pressure in vena cava, reflects right ventricular preload/intravascular volume. - **Normal:** 2-6 mmHg. - **Significance:** High CVP (hypervolemia, RV failure); Low CVP (hypovolemia). ### Common Absorbable Surgical Sutures | Suture Type | Material | Uses | | :---------- | :------- | :--- | | **Catgut** | Collagen | Rapidly healing tissues, ligating small vessels. | | **Vicryl** | Polyglactin 910 | General soft tissue, skin (subcuticular), GI. | | **PDS** | Polydioxanone | Slow-healing tissues, fascia closure, prolonged support. | | **Monocryl** | Poliglecaprone 25 | Rapidly healing tissues, skin (subcuticular). | ### Positive Doctor-Patient Relationship - **Definition:** Therapeutic alliance built on trust, respect, empathy, communication. - **Key Elements:** Trust, empathy, respect, open communication, shared decision-making, confidentiality. - **Benefits:** Improved outcomes, patient satisfaction, reduced errors. ### MCQs - **Ulcers healing:** c. Healing by First intention occurs on clean cut edges without gaps or tissue loss. - **Secondary haemorrhage:** c. Infection. - **Anaphylactic shock treatment:** d. Intracardiac adrenaline (in context of options, but IM is first-line clinically). - **GIT complication of burn:** b. Curling's ulcer. - **Ulcer in burn tissue:** b. Curling's. - **Port wine stain:** c. Type of hemangioma (vascular malformation). ### Lump in Epigastrium: Causes & Investigation - **Causes:** - **Gastric:** Carcinoma, GIST, pyloric stenosis. - **Pancreatic:** Carcinoma, pseudocyst. - **Liver/Gallbladder:** Hepatomegaly, HCC, hydrops. - **Omental/Peritoneal:** Omental cake, desmoid. - **Vascular:** AAA. - **Wall:** Epigastric hernia, rectus sheath hematoma. - **Investigation:** 1. **History & Exam:** Onset, associated symptoms, palpation (site, size, consistency, mobility, pulsatility). 2. **Blood Tests:** CBC, LFTs, amylase/lipase, tumor markers (CA 19-9). 3. **Imaging:** - **USG Abdomen:** First-line, differentiate solid/cystic. - **CT Abdomen:** Gold standard for detailed anatomy, extent, mets. - **EUS/OGD:** Gastric/pancreatic lesions, biopsy. 4. **Biopsy:** USG/CT guided FNA/core biopsy. ### Hypothyroid Patient: Symptoms & Management - **Symptoms:** Fatigue, cold intolerance, weight gain, dry skin, bradycardia, constipation, depression. - **Management:** 1. **Levothyroxine (L-thyroxine):** Synthetic T4, drug of choice. - **Dosing:** Start low, titrate based on TSH (target 0.4-4.0 mIU/L). Take on empty stomach. 2. **Monitoring:** Regular TSH, clinical assessment. 3. **Special Considerations:** Lower doses for elderly/cardiac patients. Increased dose in pregnancy. ### Intussusception: Types & Management - **Definition:** Telescoping of bowel segment into distal segment. - **Types:** - **Ileocolic (most common):** Ileum into colon. - **Idiopathic:** Infants (lymphoid hyperplasia as lead point). - **Secondary (with Lead Point):** Older children/adults (Meckel's, polyps, tumors). - **Management:** 1. **Resuscitation:** IV fluids, NG tube, antibiotics. 2. **Non-Operative Reduction:** - **Method:** Air enema (pneumatic reduction) under fluoroscopy. - **Indications:** Stable patient, no peritonitis/perforation. 3. **Surgical Management:** - **Indications:** Failed non-op reduction, peritonitis, perforation, bowel ischemia, lead point. - **Procedure:** Manual reduction or resection + anastomosis. ### Ileostomy: Advantages & Disadvantages - **Definition:** Surgical opening of ileum onto abdominal wall. - **Advantages:** Disease management (IBD, cancer), symptom relief, allows distal bowel healing, improved QoL for severe cases. - **Disadvantages:** - **Fluid/Electrolyte Imbalance:** High volume liquid output, dehydration. - **Stoma Complications:** Skin irritation, retraction, prolapse, high output. - **Nutritional Deficiencies.** - **Psychological Impact.** - **Need for appliance.** ### Bleeding Per Rectum: Causes & Diagnosis - **Causes:** - **Anorectal:** Hemorrhoids (painless, bright red), anal fissure (painful, bright red). - **Colonic:** Diverticular disease (painless, massive), angiodysplasia, colorectal cancer/polyps, IBD, ischemic colitis. - **Small Intestinal:** Meckel's (painless, maroon), angiodysplasia. - **Diagnosis:** 1. **History:** Color/amount of blood, associated symptoms (pain, weight loss, change in bowel habits). 2. **Physical Exam:** Vital signs, abdominal exam, DRE, proctoscopy. 3. **Investigations:** - **Blood Tests:** CBC, coagulation profile. - **Endoscopy:** **Colonoscopy** (gold standard), flexible sigmoidoscopy, OGD (if UGI suspected). - **Imaging:** CT angiography, radionuclide scan (for active/intermittent bleeding). ### Triple Assessment of Breast Lump - **Definition:** Combines three methods for high diagnostic accuracy. - **Components:** 1. **Clinical Examination:** History (lump, risk factors), physical exam (palpation of lump, axillae). 2. **Imaging:** - **Mammography:** For women >35-40 (calcifications, masses). - **USG Breast/Axilla:** First-line <35, differentiates solid/cystic, axillary nodes. 3. **Pathological Assessment (Biopsy):** - **FNAC:** Cytology for quick diagnosis (cysts, malignancy). - **Core Needle Biopsy (CNB):** Histology, definitive diagnosis, receptor status. Image-guided. ### Ideal Site of Chest Tube Drainage - **Fifth Intercostal Space (ICS) in the Mid-Axillary Line.** - **"Safe Triangle":** Bounded by pectoralis major (anterior), latissimus dorsi (posterior), 5th ICS (inferior). - **Rationale:** Avoids neurovascular structures, breast, abdominal organs; optimal for air/fluid drainage.