International surgical boards

2022-04-18 20:54:08 Pericardiocentesis

A procedure whereby the pericardial sac is entered via a needle under ultrasonic guidance, the needle is passed medial to cardiac apex, or below the xiphoid process, guided upwards and towards the left shoulder (the above video demonstrate the procedure).

It is used as a diagnostic tool, whereby few millimeters of pericardial fluid is aspirated for analysis e.g diagnosis of pericarditis.

It can also be used therapeutically in case of cardiac temponade.

Complications include (1) Induction of arrhythmia, (2) Injury of a coronary vessel, (3) Puncture of the right ventricle leading to hemorrhage and worsening of the temponade, (4)Introduction of infection.

N.B if temponade was due to free cardiac rupture or aortic dissection, emergency surgery is indicated, pericardiocentesis is not attempted as in most cases it lead to worsening of temponade. Open / Comment

2022-04-17 04:49:03 Colonic angiodysplasia

These are dilated, thin walled, tortous submucosal veins related to ageing, mostly in those over 60 years.

Histologically the vein has very thin muscle coat, it is weak and liable to bleed, in most cases this is chronic bleeding causing anemia, occasionally massive bleeding culminating in hypovolemic shock is seen.

This condition is strongly associated with aortic stenosis, this is called Heyde syndrome, it is also associated with vascular malformations in skin and oral mucosa in Hereditary hemorrhagic telangiectasia.

It can be diagnosed by colonoscopy (see above fig) and dealt with by colonoscopic diathermy or argon laser, if massive bleeding is present surgery is needed with on table colonoscopy to detect the site of bleeding, if this is not possible colectomy may be done.

Barium enema is avoided, it is unhelpful and can mask the lesions on subsequent colonoscopy, selective mesenteric angiography can at times detect these lesions. Open / Comment

2022-04-17 04:49:02 For revision Open / Comment

2022-04-03 02:09:19 Great book for those who wants to have an indepth study of vascular surgery and endovascular therapy Open / Comment

2022-03-27 04:49:44 Radiological features helpful in diagnosis of development hip dysplasia

Shenton's line, a curved line along the inferior edge of the superior pubic ramus in continuity with the femur (see above), in DDH this line is interrupted.

Hilgenreiner line, a horizontal line taken through both triradiate cartilages (see above).

Perkin's line, this is a vertical line perpendicular on the Hilgenreiner line drawn from the lateral edge of the triradiate cartilage, this intersection will form 4 quadrants, normally the femoral head should lie in the lower inner quadrant, whereas in DDH the femoral head lies in the upper outer quadrant. Open / Comment

2022-03-25 03:57:22 Exam day Open / Comment

2022-03-23 19:15:53 Open / Comment

2022-03-22 09:23:08 Question

Regarding anesthesia, identify the above instrument and list the possible complications from this type of anesthesia for which this needle is used? Open / Comment

2022-03-22 06:11:21 Open / Comment