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Thread: Some questions i was asked in ward exam

  1. #1
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    Default Some questions i was asked in ward exam

    I had surgery ward exam today.

    2 cases and one table viva..in each,i wasn't able to answer 2-3 questions.

    I'm posting them here..If you know answers, then kindly post them.

    Investigations in case of hernia 45yrs old male..
    i missed USG abdoman for enlarged prostate and residual urine volume. actually i've spoken about p/r so i thought i shdn't speak USG.

    Main difference between shouldice and bassini's technique of hernia repair?
    i spoke about 6 layers and 3 layers but sir told to speak first tensonfree in shouldice & lichtenstein and with tenson in bassini.

    Will you use h2o2 in pt. with diabetic for management of ulcer?
    I've said no bcz it'll destroy granulation tissue by coagulation of aminoacids and retard healing. I don't know whether it's right or wrong as examiner's response was neither positive nor negative.

    Formula by which no. of metalic bougie is derived? i don't know it.
    e.g. 10/14 or 11/14.
    Difference between 2 types of metalic bogie.
    I just answered diff. between numerator and denominator is 4 in one and 3 in other but don't know name of 2nd one and other points.

    Appendectomy in chronic appendicitis?What's the name of that appendectomy?
    I answered not emergency but planned. but i didn't know name. It's interval appendectomy.

    What's different between usual foley's and silver impregnated? mechanism.
    i answered that silver coated is longer lasting 3-4wks while foley's to be changed every 2weeks. But mechanism by which silver helps i didn't know.

    If femoral is occluded, then also limb can be viable?
    i answered yes, collaterals---where ?--around popliteals----between which vessels? ---- i don't know this.

    Common sites of atherosclerosis?
    i answered aortofemoral, abd & thorasic aorta. Rest artery names i wasn't able to recall at that time. So i answered smartly organwise then


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    Silver impregnated foley's is used in prevention of nosocomial urinary tract infections...

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    Quote Originally Posted by drgauravkatiyar View Post
    Silver impregnated foley's is used in prevention of nosocomial urinary tract infections...
    What's mechanism? I answered longer acting and examiner asked how it'll act longer? my answer was right but i didn't know mechanism.

    Well, i got results too.
    Got highest marks. 72/100.

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    Talking For the uninitiated(read I/II yrs)..

    Rule of the Innocently Ignorant: Do not expect to know the answers to the surgery viva questions in post#1 (coz u wont) and in sum cases,don’t expect to even understand the ques(coz u wont,again)And most importantly,don’t be disheartened coz these are questions a considerably brilliant final yr guy wasn’t able to answer..
    But if u are of the nerdy kinds who start reading Bailley after their first clinical posting:Pl don’t read further.
    But 4 ppl like me(read college truants) here’s a spin buster for ur heads to (hopefully) stop spinnin:Understanding the questions

    Investigations in case of hernia 45yrs old male..
    • USG abdomen for enlarged prostate-clear.
    • Residual urine volume-Volume of urine left in the bladder at the end of micturition in conditions like bladder atony,BPH,etc.
    • p/r –a digital per-rectal examination that can detect an enlarged prostate.

    Main difference between shouldice and bassini's technique of hernia repair?
    • 3 layers-in Bassini’s,the posterior wall of the inguinal canal is reconstructed by suturing the transversalis fascia,the transversus abdominis muscle and the internal oblique muscle medially to the inguinal ligament laterally.Interrupted suturing is done.
    • 6 layers-in Shouldice technique.This is a variant of Bassini's wer the foll is done:flaps of fascia transversalis are superimposed,six continuous nonabsorbable sutures of steel thread are used(which distributes tension evenly-hence it is “tension-free”- and also prevents defects occuring thru interrupted sutures),proximal stump of cremaster strengthens the deep ring and the flaps of ext oblique aponeurosis are superimposed
    • Lichtenstein:"tension-free prosthetic hernioplasty":reconstruction of the floor of the inguinal canal by means of a synthetic mesh.
    h2o2 for management of diabetic ulcer?-clear

    Bougie: A thin cylinder of rubber, plastic, metal or another material that is inserted into or though a body passageway, such as the esophagus, to diagnose or treat a condition. A bougie may be used to widen a passageway, guide another instrument into a passageway, or dislodge an object.
    Number of a bougie: Bougies are available in a wide range of sizes(numbers) and degrees of flexibility.The number is supposedly calculated using sum formula.

    Appendectomy in chronic appendicitis?Clear

    Foley’s and silver impregnated-Foley catheter is an indwelling urinary catheter while silver impregnated Foley catheter is a modification of the same.

    Femoral occlusion,Collaterals-Clear

    Arteries most prone to atherosclerosis-Clear

    Ha ha..so that’s all there is to the questions..No big deal na..Now let’s jus hope Vitrag doesn’t say I’ve posted bakvaas in his thread..
    oops..sorry..bakvaas=rubbish
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

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    Lightbulb Ahem..ahem..

    1.H2O2 for treating a diabetic ulcer:I think the answer would be yes and no,depending on the grade of ulcer.According to the Marion labs Wound Classification System,(based on the color of the wound)the RED wound is clean,healing and granulating.YELLOW signals possible infection,need 4 cleanin/debridement or the presence of necrotic tissue.The BLACK wound is necrotic and needs cleaning and debridement.
    • Topical H2O2 (or in d form of honey,which has naturally occurring enzymes that release h2o2)is BENEFICIAL in case it’s a (Yellow/)Black wound coz h2o2 oxidises the bacteria and necrotic material by liberating nascent oxygen.
    • But h2o2 is best AVOIDED for red wounds coz it can retard the healing process that has begun in such an wound-->Note:this is the inference I drew after reading a dozen articles on this topic thru google search ..So Error liability:moderate

    emedicine link proving the 2nd point(that h2o2 shld be avoided)
    [HIDE]
    Code:
    http://www.emedicine.com/med/TOPIC551.HTM
    [/HIDE]

    2.Mechanism by which silver helps:
    Antimicrobial efficacy against both Gram +ve n Gram –ve bacteria helps prevent nosocomial UTI.This might also be the reason behind silver impreg lasting longer coz u dont need to change the catheter often to eliminate risk of UTI.Not sure.

    3.Collaterals b/w which vessels:
    a.b/w the descending branch of the lateral circumflex femoral and the descending genicular artery(last br of femoral in hunter’s canal)
    b.b/w the fourth perforating artery and muscular br’s of the popliteal artery.

    4.Arteries most susceptible to atherosclerosis:(in descending order)
    • Abdominal aorta
    • Thoracic aorta
    • Coronary arteries
    • Popliteal arteries
    • Internal carotid artery
    • Vessels of the circle of willis
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

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    @fathima, you answered better in 2nd post radher than first.

    from where you came to know Collaterals b/w which vessels? reference?


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    Arrow

    Quote Originally Posted by vitrag24 View Post
    @fathima, you answered better in 2nd post radher than first.
    The first is meant only for beginners..No wonder u dont like it
    from where you came to know Collaterals b/w which vessels? reference?
    Chaurasia..under clinical anatomy of Hunter's canal,it says-The femoral artery is exposed and ligated in the Hunter's canal for various surgical procedures and collaterals are established b/w..
    And that emedicine link..there's jus one mention of h2o2 on that page..More than half way down the page,immediately above the sub-heading "DRUG CATEGORY:hemorrheologic agents"..Actually ill paste that line here..dont waste ur time searching-
    "Topical agents to avoid: Avoid cytotoxic agents, such as hydrogen peroxide, povidone iodine, acetic acid, and Dakin solution (sodium hypochlorite), except as noted above under infected wounds."
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

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    Smile Enlarged prostate:p/r Vs. USG abdomen

    Quote Originally Posted by vitrag24 View Post
    Investigations in case of hernia 45yrs old male..
    i missed USG abdoman for enlarged prostate and residual urine volume. actually i've spoken about p/r so i thought i shdn't speak USG.
    Hey did you know why USG abdomen is the first investigation (even b4 a p/r) to be done if an enlarged prostate is suspected?
    Suppose I do a p/r to detect prostatic enlargement and then send the pt for a USG.Of course the USG will detect the enlargement even if my fingers didnt.Next I order a biochemical invest. for PSA values.Do you think I might be able to tell apart a benign hypertrophy from a malignancy based on these values?
    No.
    Because the p/r would have elevated PSA values, eliminating the difference b/w an elevation of a benign nature and that of a malignant nature.
    So p/r jeopardises your diagnosis

    Courtesy: My surgery prof
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

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    Congrats man on getting th highest ..


    Very useful questions and answers. Thanks Fathima

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