International surgical boards

2021-12-09 02:22:40 Open / Comment

2021-12-09 00:59:11 Open / Comment

2021-12-08 10:18:15 An amazing view of the neuromuscular junction seen by electron microscopy showing the post-synaptic membrane and the terminal motor nerve ending loaded with acetylcholine-containing vesicles and mitochondria (marked with stars). Open / Comment

2021-12-08 07:50:14 Familial atypical multiple mole melanoma syndrome (FAMMM)

This is an inherited skin condition in which there is multiple unusual nevi (see fig above).

It is inherited as autosomal dominant disease with penetrance ranging from 50% to 92%.

The diagnosis is based on finding multiple unusual nevi and a family history of the same manifestation, the signficance of FAMMM syndrome is the development of multiple malignant melanomas, and an increased risk for pancreatic cancer.

Treatment involve resection of malignant skin lesions, as well as screening for pancreatic carcinoma. Open / Comment

2021-12-08 07:15:30 Open / Comment

2021-12-08 04:01:38 Explaining features of chronic pancreatitis

PAIN: it results from increased intraductal pressure due to fibrotic obstruction of the ducts and irritation of peripancreatic nerves by the inflammatory process, pain is chronic slowly progressive and relentless with acute exacerbations (attacks of 'mini' acute pancreatitis) some patients find relieve of pain by drinking alcohol which is the main culprit in chronic pancreatitis.

WEIGHT LOSS: Results from avoidance of food due to postprandial pain (due to release of secretin that stimulate pancreas secretion) anorexia, malabsorption (due to loss of exocrine tissue) and insulin defeciency (due to destruction of islets).

STEATORRHEA: result from fat malabsorption due to loss of pancreatic lipase, this occur when more than 90% of pancreatic tissue is lost.

HOT WATER BOTTLE SYNDROME: some patients find relief by application of heat resulting in erythema ab igne (pigmentations). See above figure. Open / Comment

2021-12-08 01:49:54 Open / Comment

2021-12-07 06:55:02 Causes of subtotal villous atrophy

Subtotal villous atrophy is a histopathological term used to describe blunting of intestinal villi (villi becomes short) with hyperplasia of the crypts.

This results in a reduced surface area for absorption and therefore the patient may present with diarrhea and malabsorption, causes include :

1) Coeliac disease.
2) Tropical sprue.
3) Giardia Lamblia infection.
4) Microscopic colitis.
5) Dermatitis herpetiformis.
6) HIV-related enteropathy.
7) Radiation enteritis.
8) Hypogammaglobulinemia.
9) Small intestinal lymphoma.
10) Zollinger Ellison syndrome.

Above fig shows subtotal villous atrophy in coeliac disease. Open / Comment

2021-12-06 11:46:23 Ewart sign

This sign describes a particular situation that can occur in patients with pericardial effusion.

Ewart sign occur when the pericardial sac is large enough to compress the lower part of the left lung.

When the left lung is compressed percussion below the left scapula becomes dull, and also ausculation here will sound like wind going through a pipe (bronchial breathing).

The coexistence of pericardial effusion plus dull percussion and bronchial breathing below the left scapula is thus referred to as Ewart's sign.

Above figure shows the flask shaped heart shadow in pericardial effusion.

Typically ECG shows small complexes because electric activity has to travel through fluid and become attenuated, and the electric axis (direction of normal electric current flow) keeps on changing as the heart swings side to side in the pericardial fluid, this phenomenon is called electric alternans. Open / Comment

2021-12-06 10:45:04 Open / Comment