OPERATIONS

OF
SURGERY

- Final Exam -
Anal canal

Question :
- What's embryological
significant
Embryological significant :

1. Above dentate line

- Derive from endoderm
- Insensitive
2. Below dentate line
- Derive from ectoderm
- Sensitive
Mesh repair

Question :
1. Type of mesh
2. Complications
3. Type of repair of hernia
Absorbable mesh :
-Vicryl
Non-absorbable mesh :
-skin graft
-prolene
-nylon
Mixed :
-vipro

Complications :
-recurrence of hernia
-FB  tissue body reaction
-seroma
-immunological complication
-rejection
-adhesion

Type of hernia repair :

-herniotomy
-hernioraphy (bassini, shouldice, copper ligaments, keel repair, rodney mangel,
cattle’s repair)
-hernioplasty
 Question :
1. Drainage LN group
2. Number of LN involved during
radical mastectomy
Breast
3. What structure need to preserve
4. Type of breast surgery
Drainage LN :
-axillary LN (anterior, posterior, lateral, central, apical)
-internal mammary LN
-superficial lymph plexus
-deep lymph plexus
-lymphatic to rectus sheath (lower medial quadrant)

Number of LN involved in radical mastectomy :

-30 to 40

Structure need to be preserved :

-Long thoracic nerve
-Nerve to serratus anterior
-Nerve to latismus dorsi
-Medial & lateral pectoral nerve
-Axillary artery & vein

Types of breast surgery :

-lumpectomy
-segmentectomy
-quadrantectomy
-tylectomy (mass in between 2 quadrants)
-radical mastectomy
-modified radical mastectomy
Laparoscopy cholecystectomy
Question :
- Complications
Complications :
-haemorrhage
-biliary leakage
-subphrenic collection of bile, blood / abscess
-jaundice
-post cholecystectomy syndrome (pain & dyspepsia
following surgery)
-misidentification of CBD
-colonic / visceral injury
Goodsall's rule of fistula
It is imaginary line drawn between ischial tuberosity dissecting
the anus

If external opening anterior to Goodsall’s, internal opening on

the same radius / short direct fistulous tract

External opening behind Goodsall’s, internal opening in midline

posteriorly
 Question :
Incisional hernia - type of repair in hernia
Types of hernia repair : (hernioraphy)
-Bassini
-Shouldice
-McVay
-Halsted’s
-Blood good
-Lytel repair
-Marcy’s repair
 Question :
- Type of urinary bladder
stones
Urinary bladder stones
Types of urinary bladder stone :
1. Primary
-cystine
-uric acid
-xanthine

2. Secondary
-triple phosphate
-oxalate
-calcium oxalate
PCNL
Def :
-Endoscopic technique of fragment & removal of renal stone

Indications :
-Large > 2cm
-Cystine stone
-Urinary obstructive lesion
-Failure ESWL

CI :
-Bleeding diathesis
-Renal congenital anomalies
-Pregnancy

Advantage :
-Small endoscopic incission
-Minimal side effect
-Short hosp stay
 Question :
1. Type of zone
Adrenal gland 2. Type oh hormones
release
Types of zones + hormones released :
-zona glomerulosa -> mineralocorticoids (aldosterone)
-zona fasciculata -> glucocorticoids (cortisol)
-zona reticularis -> sex hormones (androgen, estrogen)
 Question :
- what's proper treatm
Congenital hernia
Proper treatment for congenital hernia :
-herniotomy
-circumsized the baby
 Question :
1. Complications of
Bone fractures
fracture
2. Type of fracture
Complications of fractures :
-malunion
-delayed union
-non union
-avascular necrosis
-haemorhage
-deformity (Volksman ischemic contracture)

Types of fractures :
-linear
-green stick
-spiral
-oblique
-transverse
 Question :
1. Different level of
amputation
2. Complications of
Lower limb amputation
Different level of amputation :
-big toe
-trans metatarsal
-ankle disarticulation
-below knee
-above knee

Complications of amputation :
-neuroma
-skin infection
-psychic trauma
-bleeding
 Question :
1. Complications of thyroid scan
2. Complications of thyroid surgery
Isotope thyroid scan
3. Type of nerve injury around
thyroid
Complications of thyroid scan :
-Allergic reaction
-teratogenic in pregnancy & breastfeeding
-carcinogenic

Complications of thyroid surgery :

1. Operative
-general comp of anaesthesia
-haemorrhage
-shock
-injury to surrounding structures (external laryngeal nerve,
recurrent laryngeal nerve, trachea, oesophagus)
2. Post operative
-haemorrhage
-infection
-hypothyrodism
-hypo parathyroidism
-recurrent thyrotoxicosis
-thyroid storm
Nerve injury around thyroid :
-ELN -> loss of highed pitch sound
-RLN ->
Complete unilateral > hoarseness
Complete bilateral > aphonia
Partial unilateral > dyspnea on exertion
Partial bilateral > stridor
 Question
1. Where to apply
2. Why
3. Types of breast abscess
4. Rules of pack gauze of
breast abscess

Helton's method of treatment of abscess

Where to apply :
-Circum areolar
-Radial
-In retro (gillard thomas)
-In precious organ (breast, parotid, perianal, submucous abscess)

Why :
-for important places of important structures

Types of breast abscess :

-Subcutaneous
-Submammary
-Intramammary
-Superficial / deep

Rules of pack gauze :

-hemostasis
-to reduce pain
-avoid soiling of surrounding
-avoid rapid closure of cavity
 Question :
1. Complications of
surgery
2. Types of tumor
3. Terminal branch of
Parotid gland swelling facial nerve in parotid
Complications of superficial parotidectomy :
-neurapraxia
-anasthesia of ear lobule
-frey’s syndrome
-salivary fistula
-haemorrhage
-recurrence

Types of tumor :
Benign
-pleomorphic adenoma
-adeno lymphoma
Malignant
-mucoepidermoid
-adenoid cystic

Terminal branches of facial nerve :

-temporal
-zygomatic
-buccal
-mandibular
-cervical
Breast abscess
 Question :
Skin closure
1. Type of skin closure
Types of skin closure :
1. Midline incission
- Peritoneal closure
- Fascial closure
- Subcutaneous closure
- Skin closure

Incisional hernia on top of midline incission :

1. Keel’s operation
2. Cattell’s operation

Skin closure by :
-skin graft
-flap
-tissue expander
Mammography of breast
Finding :
-spiky lesion suspect malignancy

Types of breast cancer :

-adenocarcinoma
-invasive adenocarcinoma
-advance carcinoma
-in situ

Investigations :
-ultrasound
-stereotactic biopsy
-mri
-PET scan
Thyroid gland Question :
1. Type of Surgery
2. Causes of recurrence of
tumor
Types of surgery :
-partial thyroidectomy
-subtotal thyroidectomy
-total thyroidectomy
-lobectomy
-isthmectomy

Causes of recurrence tumor :

-subtotal thyroidectoomy
-incomplete removal
Orchidopexy (in undescended testes)
What is orchidopexy :
Fixation of testes to lateral half of scrotum

Technique :
-Bevan
-Benson
 Paraumbilical hernia

What can be found in the sac ?

-colon
-small intestine
-all abdominal structure except pancreas

Repair of paraumbilical hernia :

-Mayo’s repair
-Tension free repair
Modified radical mastectomy
-Skin, SC tissue, nipple & areola are removed
-Preservation of pectoral muscle

Complications of modified radical mastectomy :

-wound infection
-seroma
-bleeding
-lymph edema
 Question :
Gall bladder stones 1. Type of stone
2. Complications
Types of stone :
-pigmented stone (black / brown)
-cholesterol stone
-facette
-mamillated

Complications of stone :
-obstructive jaundice
-acute pancreatitis
-gall stone ileus
-long standing  mlignancy

Complications of laparoscopic cholecystectomy :

-
 Question :
Sebaceous cyst of scalp
1. Complications
Complications of sebaceous cyst :
-infection
-sebaceous horn
-ulceration
-localized alopecia
-calcification
-cocks peculiar tumor
Conservative parotidectomy