Wednesday, August 31, 2016
Dr. Nashwan
Seminar
1
هذا السيمنار يحتوي على المعلومات التي ذكرت فقط يرجئ التوسع:ةظحلام
وأيضا هو جزء من سلسلة أسئلة
فيما يلي روابط
لا
كل
1-GUIDE LINE FOR OSCE
https://www.muhadharaty.com/lecture/
2-Slide examination
https://www.muhadharaty.com/lecture/
part of today seminar)
nd
(the 2
spot diagnosis
-
3
https://www.muhadharaty.com/lecture/
Drains
-
4
https://www.muhadharaty.com/lecture/
5-example of examine slides (part of today seminar)
https://www.muhadharaty.com/lecture/12419
نماذج
اسئلة
ساليدات
6-
8&university=1&college_id=1&department
https://www.muhadharaty.com/lectures?depth=
يرجع
للبوربوينت
(الرابط رقم
5 &3
)
عند قراءة هذا السيمنار
-
واكو نقص
بجزء ما كدرنا نحصله بس األغلبية
من
ساليدات هذا الجزء موجودة بالروابط أعاله
التسجيل للسيمنار
الجزء األول
https://www.muhadharaty.com/lecture/
الجزء الثاني
https://www.muhadharaty.com/lecture/
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
2
S1:left scrotal swelling mostly groin hernia(indirect)
Problem__strangulation
most common content is omentum.
How to differentiate b/t omentum & loop of bowel ?
loop of bowel
omentum
You can see the peristalsis
-ve
1-inspection
If the hernia contains bowel
loops, initial difficulty in
reduction is usually
followed by prompt
reduction associated with
Omentum has a more
doughy
consistency and frequently
2-palpation
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
3
a characteristic gurgling
sound.
does not completely
due to the
.
reduce
adhesion
absent bowel sounds on
auscultation
3-auscultation
I.O manifestation
1-vomiting 2-abdominal destention 3-absolute constipation 4-dehydration 5-abd. Pain
Ex. Of Hernia
1-standing position –
a-invagination test b-occlusion test
-vaslva manuvar is beter than asking the pt to cough in order to see hernia is visible or
palpable
Content of inguinal canal(remix)
Complication of hernia
1-general –
2-specefic
Complication of the Herniorrhaphy:
1- wound infection (5-8%)
2- Hematoma
3- Acute urinary retention
4- Respiratory complication
5- Bleeding to the ing;. Canal or the scrotum (may predispose to infection)
6- Chr. Pain d.t trapping of the ilioinguinal n.
7- Tightening /compression of the testicular a. testicular atrophy &/or pain
8- Recurrence in 5% of the pt.
Operative wound classification :
I clean 3.3-4 %
II clean-contaminated 8-10 %
III contaminated &
IV dirty (infected) 28 %
-hernial op. is classified as clean
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
4
Phemosis
Paraphemosis
paraphimosis on the shaft and phimosis on the anterior
S3 :torsion in urology sessions
-----------------------------
S4 :membranous urthral injuery
-retention of urine----so should be drained by suprapubic catheter
-ask the more senior to put
S5: colles #
Fractures caused by out stretched hand?
Supracondylar #
Clavicle #
Colles #
Scaphoid #
S6 :skin traction
S7 :pop (hip Spica )
S8 :open #
S9 : thyroglosal cyst----MC Type is subhyoid
S10 :rectal prolapse ddx :intussception *Mx: rectopexy
S11 :cleft palate &lip
S12:hypospedius
S13;aneurysm
S14 :DVT with leg swelling
S15:hydropneumothorax
two toes
st
S16:gangrene in 1
S17:stag horn stone
S18:imporforated anus –name of view & types __Lateral invertogram view
S19:Ant. Shoulder Dislocation
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
5
الجزء الثاني
/
بالمستشفى
الرابط
https://www.muhadharaty.com/lecture/12419
S1:
Peau d' orange
Peau d' orange: is due to cutaneous lymphatic oedema, where the infiltrated skin is tethered
by the sweat ducts it cannot swell, leading to orange- like skin appearance. It can be seen
over
Stage 3 breast ca. a chronic abscess
S2:HIPS
S3:neurofibromatosis
-Neurofibromas benign tumor of NF. They can develop along a nerve
-Café au lait spots. Brown macules develop during the first 3 years of life. 5 or more greater
than 0.5 cm in diameter are suggestive of NF
S4:retracted stoma
Rx: refashioning
Retracted stoma
Cause : failure of adequate mobilization of colon.
Best sites of colostomy : segmoid & transverse colon.
Colostomy should done 5 cm away from bony prominence & mid line
S5:cushing
S6:Rt c6 CN inj.
S7:ischorectal abscess
-drainage( bz it is not covered by AB) + under GA
Note/any abscess in the gluteal ,breast ,hand, parotid should be done under GA
Steps
:
Steps
1) adequate analgesia
2) exploration
3) most common site of fluctuations
4) crushiate inscion
5) change multilocular abscess into unilocular .
6) wash with N.S
7 ) then put drain
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
6
*Fistula is commonest complication
S8:pile
S9:double bubble sign
S10:varicose ulcer
S11 :post. Throcotomy –indx :chest op (lung )
S12: false aneurysm ----
بسبب القسطرة
Doppler
S13: Paraphemosis
Circumcision or dorsal slit or haylourase injection
S14:urine retention
-catheterization
How to put cathether (any procedure should be memorized –in remix)
Steps:1-
2-
3-
-how to remove the chest tube
Steps???
Indications of removal :1-the indication is terminated(for any removal) + in remix other
indication
S15:torsion
abdominal incisions
مهمة جدا
advantage &disadvantage
كل وحدة
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
7
- midline rapid entry to the abdomen due to the presence of linea alba
it can be extended to T shaped or do thoracotomy
simple to be closed because its one layer
Disadv./ weak because its single layer
-paramedian more stronger because it's 2 layers
Disadvant/ rectus muscle atrophy medial to the incision
weak because there is no posterior rectus sheath
---------------------------------------------------------------
captus medusa
/contraindicated to operate patient with cirrhosis for
umbilical hernia
sudden severe abdominal distention volvulus
sigmoid in elderly male,,cecum in female
perianal hematoma under local anesthesia we remove the blood clot
duodenal ulcer perforation
اكثر وحدة يصير بيها
illum perforation in typhoid
Rx/closure of perforation + omental patch
------------------
----------------------------------
_clostomy(on the skin,contain stool) vs illustomy( 4 cm above the skin,contain only fluid,no
loop type)
_translocated intrauterine device
chest tube
مسافة عن تقريب متر و
80
سم
underwater seal
واذا ما كان عدنا ال
underwater
ممكن نستخدم
heimlich valve
_thyroid mass causing hyperextension
_postoperatively collapse of the trachea most important complication(tracheomalacia)
احيانا نحتاج
tracheostomy
_ if sudden severe mass so there is bleeding
_pilonidal sinus any area contain hair and sweat like(groin axilla umbilicus between fingers in
barber)
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
8
trophic ulcers
ischemic ulcer
trophic ulcers
Distal sites(toes)
Pressure sites &lateral
aspect of foot in bed-ridden
pt
Site
Any size
Any size
Size
Any
any
Shape
Black
Normal color if sterile
Color
Punched out
Punched out
Edge
If infected /+ve
Discharge
tender
No tenderness
Tenderness
Temperature
-ve
Normal pulse around
Pulse
sebaceous cyst
نفرقها عن الباقي بوجود ال
punctum
_chronic suppurative infection of sweat gland
Horn is complication of this cyst bz the sebum will accumulate and become dry with time it'll
be like horn
Slide 38:
_discharge from umbilicus blood (malignancy, in female endometriosis),
Mucus
Urine-fistula with urinary bladder (
Wednesday, August 31, 2016
Dr. Nashwan
Seminar
9
Stool-fistula with colones
_skin graft and flap
Circumcision
indx
-
-complications
C/I in hypospedius
Hidradenitis supurativa
Done by :active group A