General Surgery

Discuss the etiology, pathology, diagnosis, clinical features, and management of tetanus.

Answer:

Tetanus:

• It is a condition of toxemia due to the absorption of soluble toxin from the wound contaminated with Clostridium tetani.

Tetanus Etiology:

• Clostridium tetani is the causative organism.
• It is a gram-positive anaerobic rod with terminal round spore.
• Exotoxins produced by it are tetanospasmin and tetanolysin.

Tetanus Pathology:

Tetanus occurs due to absorption of soluble exotoxin from the site of infection.
↓
Implantation of tetani pores into wound
↓
Germination of spores.
↓
Toxins reaches the central nervous system via.

Motor nerves or
Bloodstream or
Lymphatics
↓
Toxins reaches the cord and fixed to the motor cells of the anterior horn.
↓
Causes extreme hyperexcitability of motor neurons.

Tetanus Clinical Features:

• Trismus combined with pain and stiffness of the neck, back, and abdomen.
• Dysphagia.
• Risussardonicus in which eyebrows and the comers of the mouth are drawn up.
• Muscles of the neck and trunk gradually becomes rigid.
• Muscles rigidity spreads in descending pattern from the jaw and facial muscles to the extensor muscles of the limb.
• Constitutional symptoms are:
  • Temperature becomes elevated.
  • Pulse becomes rapid.
  • Cyanosis.

Tetanus Types:

1. Acute tetanus – incubation period is less than 10 days.
2. Chronic tetanus – incubation period is about 1 month.
3. Delayed tetanus or latent tetanus.
   • Organism remans latent in the wound for months or years in it.
4. Local tetanus.
   • In it there are local contractures of muscles.
5. Cephalic tetanus.
   • In it there is irritation or paralysis of the cranial nerves.
6. Bulbar tetanus.
   1. In it there is extensive spasm of muscles of deglutition and respiration.
7. Late tetanus – Has a prolonged incubation period.
8. Tetanus neonatorum.
9. Recurrent tetanus.

Tetanus Treatment:

1. Treatment of established cases.
   • Passive immunization with 4000 units of humotetalong with tetanus toxoid injection
   • Antibiotics.
     • High dose of injection penicillin 10 lac units every 4 hours.
     • Metronidazole 500 mg 4 8th hourly for 10 days.
   • Wound care.
     • Thorough cleansing and debridement of wound.
     • Removal of all necrotic tissues and foreign bodies.
     • Blood clots, foreign bodies, and pus are cleared off.
     • Patient is shifted to a quiet, dark, well-ventilated room.
2. Mild cases.
   • Sedatives are used such as promazin 200 mg
   • I.M and a barbiturate or injection diazepam 5 – 40 mg 4.
   • Repeated 4 times in a day.
3. Moderate cases.
   • Use of nasogastric tube for feeding.
   • Self-retaining catheter to drain urine.
   • Administration of 4 fluids.
4. Severe cases.
   • Use of muscles relaxant, tubocurarine 40 mg 4 initially followed by IM.
   • A tracheostomy is carried out.
   • A sedative like pentothal sodium is used.
   • Nasogastric feeding.
   • Administration of 4 fluids and electrolytes.

Tetanus Diagnosis:

1. Laboratory diagnosis.
   • Gram staining of the specimen is done to demonstrate Cl. Tetani bacilli.
2. Spatula test.
   • Involves touching the oropharynx with a spatula or tongue blade.
   • In normal individual, it develop a reflex spasm of the masseter and the patients bite the spatula.
3. Demonstration of toxin.
   • 0.2 ml of 2 – 4 days old cooked meat culture is injected.

Wound Sinus And Fistula Important Notes

Definitions

Wound: It is discontinuity or break in the surface epithelium

Healing: Replacement of destroyed tissue by living tissue

Regeneration: Replacement of lost tissue by tissue similar in type

Repair: Replacement of lost tissue by granulation tissue followed by fibrosis and scar tissue formation

Asepsis: Precautions taken before surgical procedure against development of infection

Nosocomial infection: Infection acquired from hospital

Sinus: It is a blind tract leading from the surface down into the tissues

Fistula: It is an abnormal communication between 2 epithelial surfaces commonly between a hollow viscus and skin or between 2 hollow viscera

1. Causes of wound
   • Trauma
   • Physical, chemical, and microbial agent
   • Ischaemia
2. Types of wounds
   • Open wounds
     • Incised wound
     • Lacerated
     • Penetrating wound
     • Crushed wound
   • Closed wounds
     • Contusion
     • Abrasion
     • Haematoma
3. Types of wound healing
   • Healing by the first Intention
     • When a wound is sutured primarily, the wound healing occurs with minimum scaring
   • This is known as healing by the first intention
   • Healing by Second Intention
     • When there is irreparable skin loss or the wound becomes infected, primary suturing is not possible
     • In such cases wound heals with more scar tissue and takes longer time to heal
     • This is known as healing by secondary intention
4. Process of wound healing
   • Inflammation
   • Epithelisation
   • Granulation tissue formation
   • Scar remodeling
5. Complications of wound healing
   • Implantation cyst
   • Painful scar
   • Cicatrization
   • Keloid formation
   • Neoplasia
6. Factors Affecting Wound Healing
7. Types of sinus
   • Congenital
     • Preauricular
     • Umbilical
   • Acquired
     • Pilonidal
     • Osteomyelitis
     • Actinomycosis
     • Tuberculosis

Wound Sinus And Fistula Long Essays

Question 1. What is wound healing? What are the types? How do you manage compound fracture of the mandible?
Answer:

Wound healing: Wound healing means replacement of lost tissues by living tissues

Wound Healing Types:

1. Healing by the first Intention
   • When a wound is sutured primarily, the wound healing occurs with minimum scarring
   • This is known as healing by the first intention
2. Healing by secondary intention
   • When there is irreparable skin loss or the wound becomes infected, primary suturing is not possible
   • In such cases, the wound heals with more scar tissue and takes longer time to heal
   • This is known as healing by secondary intention

Management of Compound Fracture

• Immediate splinting and first aid are done
• Assessment of associated problems is done like
  • Shock
  • Associated injuries
  • Vessels and nerve involvement
  • Type of fracture
• Resuscitation is carried out by
  • Blood transfusion
  • Antibiotics
  • 4 fluids
  • Analgesics
  • Wound debridement
• X-ray of the fracture part is taken
  • Reduction of the part is done
  • It means restoration of anatomical alignment
  • It is done under general anesthesia with muscle relaxation
  • Compound fracture requires open reduction
  • It is carried out by screws, plates, and wires
• Immobilization
  • Once reduced, it should be maintained by proper immobilization
  • United fractured site is stiff due to immobilization
• Physiotherapy and rehabilitation
  • Stiffness is corrected by it
• A final x-ray is taken to confirm the proper union of fracture segments.

Question 2. Describe types of wounds and their management.
Answer:

Wound:

• It is discontinuity or break in the surface epithelium.
• It may be caused by.
  • Trauma.
  • Physical-chemical and microbial agents.
  • Ischaemia.

Read And Learn More: General Surgery Question and Answers

Types of Wounds:

According to the morphology.

1. Open wounds.
   • Incised wounds
     • These are usually caused by a sharp knife or razor.
     • They are relatively clean wounds.
     • The wound can bleed a lot and quickly.

• • Open Wounds Management:
    • Application of pressure to stop bleeding.
    • Cleaning with septic solution.
    • Closure by primary suturing.
    • Repair of all damaged tendons, nerves, and major blood vessels within 6 hours of injury.

• • Lacerated Wounds
    • Commonly occur following road traffic accidents.
    • Edges of wounds are jagged with certain lacerated and devitalized structures inside the wound.
    • Bleeding may be severe.
    • Injury may involve skin and subcutaneous tissue.
  • Lacerated Wounds Management:
    • Thorough debridement of wound.
    • Trimming of edges.
    • Repair of tendons and nerves is delayed till complete healing of the wound occurs due to the risk of contamination.

• • Penetrating Wound
    • Occurs due to stab injury.
    • Involves more depth than an incised wound.
    • Example: stab injuries of the abdomen.
  • Penetrating Wound Management:
    • Observe the patient for at least 24 hours.
    • Layer-by-layer exploration followed by primary suturing is done.

• • Crushed Wounds
    • Occurs due to industrial, road traffic and wear injuries.
    • They cause severe hemorrhage, death of the tissues, and crushing of blood vessels.
  • Crushed Wounds Management:
    • Good debridement.
    • Removal of all necrotic and dead tissues.
    • Later delayed primary suturing should be performed.

1. Closed Wounds
   • Closed Wounds Contusion
     • Minor soft tissue injury without break in the skin.
     • It produces discoloration of the skin due to the collection of blood underneath.

• • Closed Wounds Management:
    • Rest the injured site.
    • Apply ice for 10-15 min for every 2 hours to close blood vessels.
    • Compress and wrap firmly with a bondage.
  • Abrasion
    • In it, the epidermis of the skin is scraped off.
    • Caused by sliding fall onto a rough surface.
  • Abrasion Management:
    • Heal on their own within 1-2 weeks.
    • Just needs cleaning of the area with a septic solution.
  • Hematoma
    • It refers to the collection of blood.
    • Common in patients who have bleeding tendencies.
  • Hematoma Management:
    • Pressure is applied in the form of bondage to reduce hemorrhage and welling.

According to the thickness of the wound:

1. Superficial – involves epidermis and dermis upto dermal papillae.
2. Partial thickness – involves upto lower dermis.
3. Full thickness – involves the skin and subcutaneous tissues.
4. Deep wounds – wounds penetrate an organ or tissue.

According to the involvement of other structures:

1. Simple wounds – comprise only one organ/tissue.
2. Combined wounds – mixed tissue trauma.

According to time elapsed:

1. Fresh wounds – upto 8 hours from trauma.
2. Old wounds – after 8 hours from trauma.

According to bacterial contamination of wound:

1. Clean wounds – made by the doctor during an operation or under sterile conditions.
2. Clean-contaminated wounds.
3. Contaminated wounds.
4. Dirty wounds.

Question 3. Discuss the pathology and healing of wounds.
Answer:

Pathology of wounds: Pathology of wound healing consists of the following events:

1. Inflammation: It begins immediately at the time of injury and causes:

Aggregation of platelets.
↓
Initiation of coagulation cascade
↓
Formation of platelet plugs to stop bleeding.
↓
Transient vasoconstriction.
↓
Vasodilation.
↓
Release of histamine which produces local vasodilation and increases vascular permeability.
↓
Release of kinins, kalikerin enzyme, and prostaglandin.
↓
Chemotaxis.
↓
Initially, migration of polymorphonuclear leucocytes occurs followed by monocytes at the site.
↓
Phagocytosis occurs to ingest cell debris.

2. Wound contraction:

• Wound contraction occurs after 3-4 days after injury.
• The period when there is no wound contraction occurs is called an initial lag period.
• After this period, there is a period of rapid contraction which is completed by the 14th day.
• The wound is reduced to approximately 80% of its original size.
• The amount of contraction depends on the amount of skin available surrounding the wound to be stretched over the wound.
• It occurs due to
  • Removal of fluid by drying.
  • Contraction of collagen.
  • Contraction of granulation tissue.

3. Epithelisation:

• The epidermis immediately adjacent to the wound edge thickens on the first day.
• Marginal basal cells lose their attachment from the underlying dermis and migrate into the wound.
• Basal cells proliferate and the daughter cells formed migrate to the site.
• Within 48 hours, the entire, wound surface is re-epithelialized.

4. Granulation tissue formation:

• Hematoma within the wound is replaced by granulation tissue consisting of new capillaries and fibroblasts.

5. Scar remodeling:

• It is the last stage of wound healing.
• On about the 7th day, wounds show a delicate fine reticulum of young collagen fibers to form a scar.
• Scar strength increases gradually.
• Maturation takes many months.
• As time proceeds, the following changes occur.
  • Change in bulk and form of scar.
  • Anatomical arrangement.
  • Fibers become thicker.
  • Non-oriented fibers disappear.
  • Fibers form 3-dimensional networks.

Healing of wound:

1. Healing by the first intention.
   • When a wound is sutured primarily, wound healing occurs with minimum scarring.
   • This is known as healing by first intention.
   • It occurs in wounds in which the anatomical location and the size allow the skin continuity to be restored.
2. Healing by the second intention.
   • When there is irreparable skin loss or the wound becomes infected, primary suturing is not possible.
   • In such cases, the wound heals with more scar tissue and takes a longer time to heal.
   • This is known as healing by secondary intention.
   • Example: healing of abrasions, ulcers, etc.

Question 4. Discuss the stages of wound healing for closed and open wounds. What are the factors affecting wound heating?
Answer:

Stages of wound healing: Whether it is closed or open wounds, stages of healing remain the same.

Factors affecting wound healing:

1. General factors:
   • Age: In young age, healing is faster while in old age it is delayed due to the presence of deliberating diseases.
   • Nutrition:
     • Protein deficiency: It causes impairment of granulation tissue and collagen formation.
     • Vitamin C deficiency: Causes failure of collagen formation.
     • Vitamin A deficiency: Vitamin A is required for proper epithelialization.
     • Zinc, copper, calcium, and manganese deficiency.
       • Causes failure of granulation tissue formation.
   • Hormones:
     • Corticosteroids may delay wound healing because of their anti-inflammatory activity.
     • Cortisone decreases the rate of protein synthesis and inhibits normal inflammatory reactions.
     • Anabolic steroids like testosterone increase the speed of wound healing.
   • Cytotoxic drugs: Prevent or delay wound healing.
   • Jaundice and uraemic: Delay wound healing due to poor fibroblastic repair.
   • Diabetes: Causes delay in healing.
   • Generalized infection: The presence of pus delays healing
   • Malignancy, anemia: Delays healing
2. Local factors:
   • Position of skin wound:
     • When skin wounds are parallel to the lines of langer, they heal faster.
     • If wounds are present at the right angle to these lines, healing is delayed.
   • Blood supply: Wounds with poor blood supply heal slowly.
   • Tension: Tension at the wound while suturing delays healing.
   • Infection: The presence of infection delays healing.
   • Haemotoma: Precipitates infection and delays healing.
   • Oxygen: It enhances the killing of pathogens by macrophage, increases the production of fibroblasts, and enhances healing
   • Movement: Movement of the injured site delays healing.
   • Radiation exposure:
     • Radiation affects vascularity.
     • Causes delay in the formation of granulation tissue.
     • Inhibits wound contraction.
     • Wound healing is delayed.
   • Ultraviolet light: Increases the rate of healing.
   • Other factors which delay healing are:
     • Faulty technique of wound closure.
     • Presence of foreign bodies.
     • Adhesion to bony surface.
     • Necrosis.
     • Impairment of lymphatic drainage.

Question 5. Classify wound infections. Write briefly about hospital-acquired infections and their prevention.
Answer:

Hospital-acquired/nosocomial infections:

• It is defined as an infection that results from treatment in a hospital or any health service unit.
• Infection can be from the patient’s organism or external sources.

Causative organisms: They are classified as:

1. Conventional pathogens could cause disease in healthy persons in the absence of any immunity.
2. Conditional pathogens could cause disease only in persons with lower resistance.
3. Opportunistic pathogens that could cause generalized infections.
   • Example: staphylococci, gram-negative organisms.

Wound Infections Types:

• Surgical wounds and other soft tissue are infectious through discharging wounds.
• Urinary tract infections – infected urine, feces.
• Respiratory tract infection – infected sputum.
• Gastroenteritis.
• Meningitis.

Wound Infections Prevention:

• Isolation.
• Proper ventilation of the ward.
• Cleaning of the hospital environment.
• Preventing transmission from the environment.
• Surface sanitation.
• Proper scrubbing and gloving before any procedure.
• Autoclaving, sterilisation of instrument.
• Safe injection practice.
• Proper disposal of wastes.
• Uses of disinfectant.
• Avoid unnecessary use of antibiotics to prevent the development of resistance.

Question 6. Discuss bleeding wounds on the face.
Answer:

Bleeding wounds on the face

 

Wound Sinus And Fistula Short Essays

Question 1. Discuss factors affecting wound healing.
Answer:

Factors Affecting Wound Healing

Question 2. Healing by primary Intention.
Answer:

Primary Intention Definition:

• When a wound is sutured primarily, wound healing occurs with minimum scarring.
• This is known as healing by primary or first intention.

Primary Intention Stages:

1. Initial bleeding.

• The space between the surfaces of the incised wound is filled with blood.
• Disruption of blood vessels occurs.
• Results in formation of fibrin-rich haemal- toma.

2. Acute inflammation.

• Following changes occur.

Vasoconstriction
↓
Increased capillary permeability
↓
Release of vasoactive substances
↓
Migration of polymorphs to the site
↓
Phagocytosis.

3. Organization: Minimum granulation tissue formation occurs

4. Proliferation: Basal cells present at the wound margin proliferate and migrate towards the space.

5. Remodeling: New matrix synthesis occurs.

Primary Intention Contraindications:

• An acute wound of more than 6 hours old.
• Presence of foreign bodies.
• Active oozing of blood from the wound.
• Dead space under the skin closure.
• Too much tension is present while suturing.

Question 3. Healing by secondary intention.
Answer:

Secondary Intention Definition:

• When there is irreparable skin loss, primary suturing is not possible.
• So the wound heals with more scar tissue and takes a longer time to heal.
• This is known as healing by secondary intention.

Secondary Intention Stages:

1. Initial inflammation.
   • Inflammation is prolonged due to the presence of more necrotic tissues and bacteria.
   • It affects surrounding tissues.
   • The wound is filled with coagulum.
2. Wound contraction.
   • Occurs due to stretching of the surrounding skin to close the defect.
   • After 2-3 days, dermal edges move towards each other.
   • After 5-10 days, it moves rapidly while after 2 weeks it slows down.
3. Granulation tissue formation.
   • Granulation tissue completely covers the exposed wound gradually.
   • It forms a temporary protective layer till epi-realization begins.
4. Epithelialisation.
   • Epithelium gradually grows over granulation tissue.
   • Epithelial cells slide into the wound forming a thin tongue of cells between granulation tissue and clot.
5. Remodeling.
   • It is prolonged.
   • Remodeling of granulation tissue and scar occurs.
   • As a result, the wound area forms a flat scar.

Question 4. What is sinus and fistula? What are its causes?
Answer:

Sinus and fistula

• A sinus is a blind track leading from the surface down to the tissues.
• There may be a cavity in the tissues that is connected to the surface through the sinus.
• The sinus is lined by granulation tissue.

Fistula:

• A fistula is a communicating track between two epithelial surfaces, commonly between a hollow viscus and the skin.
• It is lined by granulation tissue.
• It may be abnormal communication between vessels.

Fistula Types:

1. Blind – with only one open end.
2. Complete – with both external and internal openings.
3. Incomplete, with external skin opening which does not connect to any internal organ.

Fistula Causes:

1. Congenital – preduricular sinus, branchial fistula, trachea-oesophageal fistula, arteriovenous fistula.
2. Acquired.
   • Bursting of sinus-example: fistula-in-ano.
   • Trauma or medical treatment.
   • Due to tooth abscess – median mental sinus.
   • The pilonidal sinus and thyroglossal fistula are examples of the acquired type.

Question 5. Difference between sinus and fistula.
Answer:

Difference between sinus and fistula

 

Wound Sinus And Fistula Short Answers

Question 1. Types of wounds.
Answer:

According to the morphology:

1. Open wounds.
   • Incised wounds
   • Lacerated wounds
   • Penetrating wounds
   • Crushed wounds
2. Closed wounds
   • Contusion
   • Abrasion
   • Hematoma.

According to the thickness of the wound:

• Superficial
• Partial thickness
• Full-thickness.
• Deep wounds.

According to the involvement of other structures.

• Simple wound
• Combined wounds

According to the time elapsed:

• Fresh wounds
• Old wounds.

According to the bacterial contamination:

• Clean wounds
• Clean contaminated wounds
• Contaminated wounds
• Dirty wounds.

Question 2. Healing by primary intention.
Answer:

Healing Primary Intention Stages:

• Initial bleeding
• Acute inflammation
• Organization
• Proliferation
• Remodeling

Question 3. Healing by secondary intention.
Answer:

Secondary Intention Stages:

• Initial inflammation
• Wound contraction
• Granulation tissue formation
• Epithelisation
• Remodeling.

Question 4. Enumerate three factors influencing wound healing.
Answer:

Factors influencing wound healing

Question 5. Causes of persistence of sinus and fistula.
Answer:

Causes of persistence of sinus and fistula

• Causes of persistence of sinus and Fistula:
• Presence of foreign body or necrotic tissue
• Absence of rest.
• Non-dependant or inadequate drainage of the abscess.
• Presence of chronic infections like tuberculosis, actinomycosis, etc.
• Epithelialization of the track.
• Distal obstruction of the track.
• Malignancy.
• Irradiation.
• Dense fibrosis around the wall of the track.

Question 6. Hypertrophic scar.
Answer:

Hypertrophic scar

• A hypertrophic scar is characterized by hypertrophy or proliferation of mature fibroblasts or fibrous tissues without any proliferation of blood vessels.
• It remains localized and gradually regresses.

Hypertrophic Scar Features:

• It never gets worse.
• It is non-tender.
• Doesn’t spread to surrounding normal tissue.
• Once treated it does not recur.
• It regresses after 6 months.
• Common in.
  • Young individual
  • The scar crossing normal skin creases
  • Over sternum.

Hypertrophic Scar Treatment:

• Regress on its own.
• If necessary excision can be done.

Question 7. Keloid scar.
Answer:

Keloid scar

Keloid scar is characterized by the proliferation of immature fibroblasts and immature blood vessels.

Keloid Scar Features: Commonly in:

• Black race
• Tuberculosis patients
• Over sternum.
• In women.

Keloid Scar Etiology

• Tuberculosis.
• Hereditary.
• Dislocation of hair follicles.
• Incision crossing lines of Langer.

Keloid Scar Presentation

• Has claw-like processes.
• It always itch.
• Looks smooth, and pink, and raised patch.
• Gets worse even after 1 year.
• Recurs after excision.
• The margin is tender, and vascular.
• Spreads and affects normal surrounding tissue

Keloid Scar  Treatment:

1. Conservative treatment:
   • Intrakeloidal injection of steroids.
   • Intrakeloidal hyaluronidase injection.
   • Intrakeloidal injection of Vitamin A.
   • Intrakeloidal injection of methotrexate.
   • Deep. X-ray therapy.
   • Ultrasonic therapy.
2. Surgical treatment.
   • Excision and resuturing
   • Shaving away the excess scar tissues and then resurfacing the area with a skin graft.

Question 8. Lacerated wound
Answer:

Lacerated Wound Causes:

• Injury by blunt objects
• Fall on a stone
• Road traffic accidents

Lacerated Wound Features

• Involves skin and subcutaneous tissue
• Crushing of tissues
• Edges are jagged
• Results in
  • Necrosis of tissues
  • Bruising
  • Hematoma

Lacerated Wound Treatment

• Wound excision and primary suturing

Question 9. Pre auricular sinus
Answer:

Pre auricular sinus

• May be unilateral or bilateral
• Usually asymptomatic
• If infected it causes pain

Pre auricular Treatment

• Uninfected sinus can be left untreated
• Infected pro-auricular sinus is treated as
  • Antibiotics
  • Drainage
  • Excision

Question 10. Types of healing
Answer:

Types of healing

1. Healing by primary intention
   • When a wound is sutured primarily, the wound healing occurs with minimum scarring
   • This is known as healing by primary intention
2. Healing by secondary intention
   • When there is irreparable skin loss or the wound becomes infected primary suturing is not possible
   • In such cases wound heals with more scar tissue and takes longer time to heal
   • This is known as healing by secondary intention

Question 11. Abscess
Answer:

Abscess Definition: It is a collection of pus in the body

Abscess Classification

• Pyogenic
• Pyaemic
• Cold abscess

Abscess Clinical features

• Rubor – redness over the area
• Dolor – throbbing pain
• Color – the inflamed area is hot
• Tumor – swelling of the involved area
• Functlolacsa – Impairment of function

Abscess Treatment

• Incision and drainage of pus

Question 12. Orocutaneous fistula
Answer:

Orocutaneous fistula

• It is pathological communication between the cutaneous surface of the face and the oral cavity
• It leads to esthetic and functional problems due to continuous leakage of saliva

Orocutaneous fistula Causes

• • Malignancy
  • Osteoradionecrosis
  • Residual lesions of cysts and tumors of the oral cavity
  • Inflammation
  • Trauma

Wound Sinus And Fistula Viva Voce

1. The pilonidal sinus is usually found in the natal cleft
2. Granulation tissue formation occurs by 2 processes – stage of vascularization and stage of vascular- citation
3. Type 1 collagen is found in tendons, ligaments, skin, and bone
4. Type 2 collagen is in cartilage
5. Type 3 collagen is found in the fetal dermis
6. The period when no wound contraction is seen is called the initial lag period
7. Within 48 hours of the wound, the entire wound gets re-epithelioid
8. Wound contraction occurs from the 4th day to the 14thday
9. In the first 48 hours, polymorphonuclear leukocytes are dominant
10. Monocytes become the dominant cell type by the 5th day.

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Bacterial Infections Important Notes

1. Different infections
2. Pyaemia
   • A condition characterised by formation of secondary foci of suppuration in various parts of the body
3. Bacteraemia
   • Indicates bacteria circulating in the bloodstream
4. Septicaemia
   • Indicates presence of bacteria in bloodstream as well as liberation of toxins
5. Toxaemia
   • Condition in which toxins circulates in the bloodstream
6. Classification of granuloma
   • Caseous
   • Gummatous
   • Suppurative
   • Fibrinoid
7. Lymph nodes in different infections
   • Rubbery in syphilis
   • Matted in tuberculosis
8. Abscess
   • It is a cavity filled with pus and lined by a pyogenic membrane
   • Types
     • Pyaemic abscess
     • Pyogenic abscess
     • Cold abscess
   • Principle of treatment
     • Drainage of pus
     • Culture and sensitivity test
     • Use of proper antibiotics
9. Tuberculosis
   • Causative organism – mycobacterium tuberculosis
   • Routes of inhalation of tubercle bacilli
     • Direct spread to the lungs
     • Through tonsils
     • Enter the bloodstream
   • Stages of tubercular lymphadenitis
     • Stage of lymphadenitis
     • Stage of periadenitis
     • Stage of cold abscess
     • Stage of collar stud abscess
10. Syphilis
    • Causative agent – Treponema pallidum
    • Types:
11. Tetanus
    • Causative agent – Clostridium tetani
    • Toxins produced – tetanolysin, tetanospasmin
    • The interval between the first symptom and first reflex spasm is known as period of onset
    • If it is less than 48 hours, the condition is almost fatal
    • Incubation period is followed by period of onset
    • Types
      • Tetanus neonatal/ eighth day disease
        • Occurs usually around 6-8 day of birth due to contamination of the umbilical cord
      • Post-abortal/ puerperal tetanus
        • Due to unsterile manipulation during abortion or during labor
      • Postoperative tetanus
        • Following elective surgery
      • Latent tetanus
        • Develops after few months to years following wound
      • Bulbar tetanus
        • Involves muscles of deglutition and respiration
      • Cephalic tetanus
        • Occurs after wound of face and neck
12. DPT vaccine
    • Involves Diphtheria, Pertussis and Tetanus toxoid
    • 3 doses are given at 6,10 and 14 weeks of age
    • Booster dose is given at 18 months and 5 years of age
13. Gas gangrene
    • Etiological agent – cl. Perfringes
    • Toxins produced by it are
      • Alpha toxin
      • Beta toxin
      • Theta toxin
      • Hyaluronidase
      • Collagenase
      • Leucocidin

Read And Learn More: General Surgery Question and Answers

Bacterial Infections Long Essays

Question 1. Describe the etiology, pathology, clinical features and management of Bacterial Infections.

Answer:

Actinomycosis:

• It is a chronic, suppurative granulomatous diseases.

Bacterial Infections Etiology:

• Actinomyces israelii, an anaerobic gram-positive filamentous organisms causes it.

Bacterial Infections Pathology:

Bacterial Infections Clinical Features:

Three clinical forms of actinomycosis are identified.

1. Facio-cervical actinomycosis.
   • Frequently involves lower jaw.
   • Present as a painless firm mass called lumpy jaw.
   • Underlying .connective tissue, muscle, and bone are destroyed and replaced by granulation tissue.
   • Gradually softening occurs at some places forming abscess.
   • It later burst to form sinuses.
   • Overlying skin becomes indurated and bluish in colour.
   • Pus contains sulphur granules.
   • Lymph nodes are not involved.
2. Abdominal form.
   • Mainly affects the caecum or appendix.
   • Submucosa contains flat grey nodules which later enlarges.
   • Suppuration within it leads to abscess formation.
   • Later abdominal wall is involved with multiple discharging sinuses.
   • Liver is involved through portal vein.
   • Lesion is a honeycomb mass.
3. Lungs.
   • It is common in children.
   • Involves direct spread from neck or from the abdomen.
   • Lungs becomes jumbled with multiple abscesses cavity surrounded by abundant fibrous tissue.

Bacterial Infections Management:

• As it is a chronic disease, it is difficult to treat.
• In crystalline penicillin – 10 lakh units once a day for 6 -12 months is given.
• Later it is reduced to 4 lakh units.
• Tetracycline and lincomycin are other alternatives.
• Actinomycosis of the abdomen needs. Hemocolectomy.
• Surgical treatment includes incisions and drainage of abscesses, excision of the sinus tract, and relieving obstruction.

Question 3. Discuss pathogenesis, clinical features, and treatment of gas gangrene.

Answer:

Gas Gangrene:

• It is a rapid spreading infective gangrene of the muscle characterized by collection of gass in the muscles and subcutaneous tissue.

Gas Gangrene Pathogenesis:

Gas gangrene is caused by an anaerobic, gram-positive, spore-forming facillus, Clostridium per-fringes.

Develops in wounds where there is heavy contamination.

This causes low oxygen tension.
↓
Multiplication of Clperfringes.
↓
Release of exotoxins by them.
↓
Causes lysis of erythrocytes, leucocytes, platelets, fibroblasts, and muscle cells.
↓
Further tissue damage occurs.

Gas Gangrene Clinical Features:

1. General:

• Anaemia anxiety.
• Low-grade fever.
• Rapid pulse.
• Hypotension – due to toxin production.
• Nausea, vomiting.

2. Local:

• Sudden onset of pain in affected part.
• Pain worsens as time passes.
• Gradual swelling and gross oedema of the part.
• Profuse discharge of brownish and foul swelling fluid.
• Discoloration of skin – khaki to greenish due to hemolysis.
• Crepitus follows gas production.
• Muscle becomes green to black in color.

Gas Gangrene Treatment:

1. Surgery.
   • Multiple longitudinal incisions for decompression and drainage.
   • Aggressive surgical debridement in the form of excision of all devitalized tissues.
   • In severe type of gas gangrene, amputation is carried out.
2. Supportive treatment.
   • Penicillin 10 lac units every 4 hours.
   • Supplemented by tetracycline 2 g daily or chloramphenicol 2g or streptomycin 1 – 2g.
   • Blood transfusion.
   • Administration of anti-gas-gangrene serum.
   • Hyperbaric oxygen.

Question 4. Define carbuncle. Mention its etiology, clinical features, and treatment of carbuncle.

Answer:

Carbuncle Definition: Carbuncle is infective gangrene of the subcutaneous tissue.

Carbuncle Etiology:

• Staphylococcus aureus.
• Gram-negative bacilli.
• Streptococci.

Carbuncle Clinical Features:

• Sites involved are.
  • Commonly back, nape of the neck.
  • Rarely – cheek, shoulders, dorsum of the hand.
• Age and sex: generally affects males above 40 years of age.
• Presentation.
  • Painful, stiff swelling.
  • Spreads very rapidly.
  • Overlying skin becomes red, dusky, and oe- dematous
  • Central part softens and multiple vesicles appear on skin.
  • Vesicles transform into pustule.
  • Pustule burst and allow the discharge to come out over skin through various openings.
  • This results in a cribiform appearance.
  • Openings enlarges, coalesce, and forms ulcer containing ashy-grey slough.
  • Patient in diabetic.

Carbuncle Treatment:

• Improvement of general health of patient.
• Diabetic control through insulin injections.
• Antibiotic are administered, like cloxacillin, flucloxacillin, erythromycin, and some cephalosporin.
• Surgery required if.
  • Toxaemia and pain persist even after the antibiotic course.
  • When the carbuncle is more than 2xh inch in diameter.
  • Cruciate incision is preferred which extends opto margin of the inflammatory zone.

Question 5. Describe signs, symptoms, and treatment of alveolar abscess.

Answer:

Alveolar abscess

Abscess is a collection of pus. Alveolar abscess is an abscess in the alveolar ridge of the jaw, usually caused by the spread of infection from a non-vital tooth.

Alveolar abscess Clinical features:

• Produced severe pain in the affected tooth.
• Localized swelling.
• Reddening of the overlying mucosa.
• Pain aggrevates on application of pressure.
• Application of heat intensifies pain while application of cold may relieve pain.
• Elevated body temperature.
• Affected tooth is non-vital and can be mobile.
• Pus discharging sinus are formed.

Alveolar abscess Treatment:

• Incision and drainage of pus
• Pulpectomy.
• Analgescis – for relieving pain.
• Antibiotic – to treat infection.
• Extraction of offending tooth,

Question 6. Describe etiology, clinical features, diagnosis and treatment of chronic osteomyelitis of jaw.

Answer:

Osteomyelitis:

• It is defined as an inflammation of bone and bone marrow along with the surrounding periosteum.

Osteomyelitis Types:

1. Acute
2. Sub-acute
3. Chronic

Chronic osteomyelitis of Jaw:

• The disease persisting for more than a mouth is called chronic osteomyelitis.

Osteomyelitis Etiology:

• Fracture of mandible.
• Alveolar abscess.
• Radiation
• Chemical necrosis.
• Rarely tuberculosis, syphilis, and actinomycosis.

Osteomyelitis Clinical Features:

• Local osteitis:
• Formation of a cavity due to osteolytic lesion with surrounding sclerosis.
• It is called Brodie’s abscess.
• Sequestrum may or may not be present.
• Bone necrosis occurs.
• Mandible is more often affected than maxilla.
• Pain is mild and dull in nature.
• Jaw swelling with sinus tract formation occur.

Osteomyelitis Diagnosis:

1. Radiology:

• Shows periosteal reaction.
• Brodie’s abscess is seen on X-rays.
• Sequestrum is present can be detected.
• Involucrum is identified.

Osteomyelitis Treatment:

1. Medical therapy.
   • Systemic antibiotics – given for 2 – 4 months.
     • Penicillin.
     • Metronidazole.
     • Clindamycin.
   • Topical antibiotics.
     • Used as systemic cannot reach the site.
2. Surgical management.
   • Sequestromy is done.

Suitable incision is made at dependent part.
↓
Involucrum is chiselled out
↓
Cavity is made open
↓
Sequestrum is removed.
↓
Cavity is packed with petroleum jelly gauze
↓
Antibiotics are administered.

Question 7. Define gangrene. Write types, causes, and management of gangrene.

Answer:

Gangrene It is death of a portion of the body with putrefaction

Gangrene Types:

• Dry gangrene – due to slow occlusion of arteries
• Wet gangrene – due to sudden occlusion of arteries

Gangrene Causes

1. Arterial occlusion – atherosclerosis, embolism, Raynaud’s disease, Buerger’s disease, cervical rib
2. Venous obstruction – deep vein thrombosis
3. Nervous disease – peripheral neuritis, hemiplegia, paraplegia
4. Traumatic gangrene – direct injury to main artery, indirect injury
5. Infective gangrene – carbuncle, cancrumoris, gas gangrene
6. Physical gangrene
   • Heat – bums and scalds
   • Cold – frostbite
   • Escharotics – acids and alkalis
   • Electricity
   • X-ray

Gangrene Treatment

• General treatment
  • Nutritious diet
  • Control of diabetes
  • Relief of pain
• Local treatment
  • Conservative
    • Affected part is
      • Kept dry
      • Kept elevated
      • Not heated
      • Protected from local pressure
      • Carefully observed and toileted
  • Surgical
    • Sympathectomy
    • Amputation
    • Direct arterial surgery
      • In chronic occlusion of artery

 

Bacterial Infections Short Essays

Question 1. Ludwig’s angina.

Answer:

Ludwig’s angina:

It refers to rapidly spreading cellulitis involving simultaneously all three spaces – submandibular, sublingual, and submental spaces.

Ludwig’s angina Etiology:

• Odontogenic infection.
• Traumatic injuries.

Ludwig’s angina Clinical Features:

• Brawny hard swelling of neck involving all three spaces.
• Reddening of the overlying skin.
• Local rise in temperature.
• Oedema of the floor of the mouth which pushes tongue upwards and results in difficulty in swallowing.
• Dehydration.
• High-grade fever.
• Hoarseness of voice.
• Putrid halitosis.
• Increased salivation.

Ludwig’s angina Treatment:

• Airway maintenance.
• Administration of antibiotics.
  • Pencillin G- 24 million units number 4, 4 – 6 hourly.
  • Gentamycin – 80 mg IM BD.
  • Metronidazole – 400 mg 8 hourly.
• 4 fluids – to correct dehydration.
• Removal of causative agent.
• Surgical management.

General anaesthesia.
↓
Curved incision over most prominent part of the sub-mandibular gland.
↓
Mylohyoid muscle is divided
↓
Pus is drained.
↓
Irrigate the cavity.
↓
Place drainage tube.
↓
Close the woimd with loose sutures.

Question 2. Trismus or Lockjaw.

Answer:

Trismus or Lockjaw:

Trismus: It is defined as inability to open mouth.

Trismus or Lockjaw Etiology:

• Pericoronitis.
• Inflammation of masseter muscle.
• Peritonsillar abscess.
• TMJ disorders.
• Submucous fibrosis.
• Treatment:
• Treat the cause
• Analgesic – to relieve pain.
• Muscle relaxant – for masseter muscle.
• Hot fomentation.
• Physiotherapy.

Question 3. Boil.

Answer:

Boil:

Boil Definition: It is an acute staphylococcal infection of a hair follicle with perifolliculitis.

Boil Clinical Features:

• Common on the back and neck.
• Boil of the external auditory meatus is very painful.
• Starts with a painful and indurated swelling.
• Later softening occurs at the centre which leads to pustule formation.
• It burst to discharge a greenish small amount of slough.
• Next a deep cavity develops lined by granulation tissue.

Boil Complication:

• Cellulits:
• Infection of neighboring hair follicles.
• Secondarily infect lymph nodes.

Boil Treatment:

• Improvement of general health of patient.
• Drainage of pus.
• Clean the area with suitable disinfectant.
• Antibiotic cloxacillin is given if necessary.

Question 4. Erysipelas.

Answer:

Erysipelas:

Erysipelas Definition: It is an acute inflammation of the lymphatics of the skin and mucous membrane.

Erysipelas Etiology: Streptococcus haemolyticus group A is the causative organism.

Erysipelas Clinical Features:

• Poor general health.
• Starts as a rose-pink rash which spreads to adjacent normal skin.
• Vesicles appears which burst to discharge serous secretion.
• Fever
• Toxaemia.
• Oedema of eyelids or scrotum.
• When it involves pinna, it is described as Millian’s ear sign positive.

Erysipelas Complication:

• Gangrene of skin and subcutaneous tissue.
• Septicaemia.
• Rarely lymphoedema.

Erysipelas Treatment:

• Inj. Crystalline penicillin 10 Ink units 6 hourly IM/IV for 5 -10 days.

Question 5. HIV or AIDS.

Answer:

HIV or AIDS:

Human Immunodeficiency virus (HIV) is the causative agent for AIDS (Acquired immune deficiency syndrome).

• HIV has the capability of destroying T-cells and thus harms the entire immune system.

HIV or AIDS Spread of Infection:

• Through sexual contact.
• Through blood transfusion.
• From infected mother to foetus.

HIV or AIDS Clinical features:

• Patients remains asymptomatic for 1 – 2 months.
• Later it may have following symptoms.

Question 6. Syphilis.

Answer:

Syphilis:

• Syphilis is a venereal disease caused by treponem pallidum.

Syphilis Clinical Features:

Disease is divided into four stages.

1. Primary syphilis.
   • Hard chancre gradually develops at the site of entry of organisms.
   • Initially it appears as a papule which gradually becomes eroded and forms ulcer.
   • Edges of ulcer are raised.
   • Surrounding skin is oedematous.
   • Occurs over the glans of the penis and coronal sulcus in males and inner side of labia minora and cervix in females.
   • Extra genital chancres occurs in the anal or perianal region, lip, tongue, nipple, etc.
   • Regional lymph nodes are involved.
   • They are enlarged with rubbery consistency.
2. Secondary syphilis.
   • Appears in 2 – 3 months after primary syphilis.
   • Produces generalized rash – dull red in color.
   • Snail track ulcers appears.
   • There are wart-like growths called condylo- malta.
   • Generalised painless lymphadenopathy occurs.
   • Others symptoms include:
     • Sore throat.
     • Alopecia.
     • Bone and joint pain.
     • Hepatitis.
     • Malaise
     • Headache, backache.
     • Pyrexia.
3. Tertiary suphilis.
   • Affects the blood vessels.
   • There is perivascular collection of lymphocytes and plasma cells.
   • Gumma is another characteristic feature.
   • It is an accumulation of granulation tissue with central necrosis.
4. Latent syphilis.
   • It is asymptomatic.
   • Serum tests are positive.

Syphilis Treatment:

1. Early syphilis.
   • Procaine penicillin G 6 lacs units daily for 15 days,
2. Late syphilis.
   • Procaine penicillin G 6 lacs units daily for 3 weeks.
3. Patient allergic to penicillin.
   • Doxycycline 100 mg thrice daily for 15 days.

Question 7. Precautions for surgeons in HIV-infected patients.

Answer:

In OPD:

• Any patient with open wounds, examine after wearing gloves.
• Use disposable instrument.
• Reusable instrument clean with soap and water and immerse in glutaraldehyde.

In the operating room:

• Dental chair is covered with single sheet of polythene.
• Minimize the number of personnel in room.
• Any staff member with abrasions or lacerations is not allowed.
• All staff members should wore shoes, gloves, gowns, and protective glasses.
• Use sterilization techniques.
• AZT should be given to health workers following exposure.

Question 8. Active immunity.

Answer:

Active immunity:

Active immunity is the resistance developed by an individual as a result of antigenic stimulus.

Active immunity Mechanism: it stimulates humoral and cell-mediated immunity.

Active immunity Types:

1. Natural active immunity.
   • Acquired by natural subclinical or clinical infectious.
2. Artificial active immunity.
   • It is produced by vaccination.
   • Vaccines are prepared from live, attenuated, or killed micro-organisms or their antigens or toxoids.
   • Vaccines stimulate a primary response against the antigen without causing symptoms of the disease.

Question 9. Passive immunity.

Answer:

Active immunity:

• It is received passively by the host.
• It is induced by preformed antibodies against infective agent or toxin.
• Protection starts immediately after the transfer of immune serum.
• It is short lasting.

Types:

1. Natural.
   • Transferred from mother to foetus or infants.
   • To foetus – transplacentally and to infant through milk.
2. Artificial.
   • Transferred through parenteral administration of antibodies.

Uses:

• To provide immediate short-term protection in a nonimmune host.
• For suppression of active immunity.
• For treatment of serious infection.

Question 10. Diagnostic tests for HIV.

Answer:

1. Specific tests:
   • Screening tests.
     • ELISA test.
       • Enzyme-linked immunosorbent assay is most widely used test.
       • It requires only microlitre quantities of specimen to detect.
       • In it an enzyme acts on substrate to produce a color in a positive test.
       • Most laboratory uses a commercial ELISA -kit.
     • Rapid tests.
       • Requires less than 30 minutes.
       • Includes.
       • Dot-blot assay.
       • Praticle agglutination.
       • HIV spot
       • Comb tests.
   • Supplemental tests.
     • Western blot test:
       • HIV proteins are separated by electrophoresis.
       • These are then blotted on strips of nitrocellulose paper.
       • These stips are reacted with test sera.
       • Position of the colour band on the strip indicates fragment of antigen with which antibodies have reacted.
       • Indirect immunofluorescence test.
       • HTV-infected cells are fixed on glass slide.
       • Reacted with serum and then with fluoresain conjugated antihuman gammaglobulin.
       • Positive test produces apple-green fluorescence.
2. Non-specific test:
   • Total leucocyte count.
     • Lymphocyte count is less than 400 per mm3 in AIDS patients.
   • T-lymphocyte subset assays.
     • In normal individual CD4 : CDS is 2:1
     • In AIDS patients -CD4 : CD8 is 0.5:1

Question 11. Tubercle bacilli/Koch’s bacilli.

Answer:

Tubercle bacilli:

• Tubercle bacilli is slender, straight or slightly curved bacillus with rounded ends.
• Arrangement – occurs singly, in pairs, or in small clumps.
• Size -1 – 4 pm x 0.2 – 0.8 pm
• They are acid-fast, non-sproing, non-capsulated & non-motile bacilli.
• With Zienl – Neelsen staining, tubercle bacilli are seen bright red in color.
• It is called Koch’s bacilli on the name of its dis- corver.

Tubercle bacilli Types:

• Human type – M tuberculosis.
• Bovine type – M bovis.
• Vole type – M microti.
• African type – M africanum.

Question 12. Tetanus bacilli.

Answer:

Tetanus bacilli:

Clostridium tetani causes tetanus.

• It is gram-positive, slender bacilli.
• Size- 4 – 8 pm x 0.5 pm
• It has spherical, terminal spores.
• Spore is about 3-4 times wider than the bacillary
• body, giving rise to drumstick appearance.
• It is non-capsulated and motile with peritrichate flagella.
• It is mainly found in manure and soil.
• It is normal inhabitant of the intestines of human beings and animals.

Question 13. Endotoxins.

Answer:

Endotoxins:

Endotoxin are lipopolysaccharide in nature.

• They form an integral part of cell wall of bacteria.
• Produced by gram negative bacteria.
• They are released from the bacterial surface by natural lysis of the bacteria or by the disintegration of the cell wall.
• They are heat stable.
• Is toxicity depends on the lipid component
• They cannot be toxoided.
• Poor antigenic.
• Has no enzymatic action.
• They are non-specific in their action.
• Usually produces fever.
• Thus, this area is called dangerous area of the face.

Question 14. Septicaemia.

Answer:

Septicaemia:

Septicaemia is a condition in which bacteria circulate and actively multiply in the bloodstream and liberates toxins produced by them.

Septicaemia Clinical Features:

• Pyrexia.
• Rigors
• Hypotension.
• Intravascular coagulation defects.
• Petechial hemorrhages.
• Jaundice due to liver damage.
• Septic shock.
• Peripheral circulatory failure.
• Decrease/Absence 6f Urine output.

Septicaemia Routes of Spread:

• Streptococcus, are main causative organism.
• It spread to other organs by.
  • Direct extension into open vessels.
  • Release of infected emboli.
  • Discharge of infected lymph.

Septicaemia Treatment:

• 4 administration of antibiotics – aminoglycosides and metronidazole.
• Blood transfusion.
• Plasma expanders.
• Inj. Hydrocortisone is given.

Question 15. Dangerous area of face.

Answer:

Dangerous area of face:

• The area from the corners of the mouth to the bridge of the nose including the nose and maxilla forms the dangerous area of the face.
• The facial vein communicates with the cavernous sinus through communication between the supraorbital and pterygoid plexus via deep facial vein.
• Cavernous sinus is present in the cranial cavity between the layers of meninges.
• Infections from the face specially from the upper lip and lower part of face can spread in a retrograde di rection and causes thrombosis of the cavernous sinus.
• Thus this area is called dangerous are of the face.

Question 16. Boundaries of the back of neck.

Answer:

back of neck Boundaries:

• Anteriorly – posterior border of sternocleidomastoid.
• Posteriorly – anterior border of trapezius.
• Inferiorly/base-middle third of clavicle.
• Apex lies on the superior nuchal line where trapezius and sternocleidomastoid meet.
• Roof – investing layer of deep cervical fascia.
• Floor.
  • Splenius capitus.
  • Levator scapulae.
  • Scalenusmedius.
• back of neck Contents.
  • Occipital triangle.
    • Nerves.
      • Spinal accessory.
      • Four cutaneous branches of cervical plexus.
      • Muscular branches.
      • C5, C6 roots of branchial plexus.
      • Third and fourth cervical nerves.
      • Dorsal scapular nerve.
    • Vessels.
      • Transverse cervical artery and vein.
      • Occipital artery.
    • Lymph nodes.
      • Supraclavicular nodes.
  • Subclavian triangle.
    • Nerves.
      • Three trunks of branchial plexus.
      • Nerve to serratus anterior.
      • Nerve to subclavius.
      • Suprascapular nerve.
    • Vessels.
      • Third part of subclavian artery and vein.
      • Suprascapular artery and vein.
      • Commencement of transverse cervical artery and termination of the corresponding vein.
      • Lower part of the external jugular vein.
    • Lymph nodes.
      • Few members of the supraclavicular chain.
      • Posteroinferior group of the deep cervical lymph node.

Question 17. TB cervical lymphadenitis.

Answer:

TB cervical lymphadenitis:

TB cervical lymphadenitis Etiopathogenesis:

1. In anterior triangle of neck.

Mycobacteria pass through tonsillar crypts.
↓
Affects tonsillar node or jugulodigastric node.

2. In posterior triangle.

• Lymph nodes are affected due to the involvement of adenoids.

3. Spread from apex of lung.

• Organism penetrate Sibson’s fascia and cause enlargement of supraclavicular nodes.

Question 18. dry gangrene

Answer:

Dry gangrene:

• It is a form of gangrene occurring due to ischaemia

Dry gangrene Causes:

• Ischaemia
• Atherosclerosis
• Buerger’s disease
• Raynaud’s disease
• Trauma
• Ergot poisoning

Dry gangrene Features:

• Begins in the distal part of the limb
• Occurs in one of the toes which is far from blood supply where bacteria fails to grow
• Spreads slowly upwards
• Line of demarcation is seen between the gangrenous part and viable part as a bright red line
• Color changes from greenish to black due to hemolysis of RBCs

Dry gangrene Treatment:

• General
  • Nutritious diet
  • Relief of pain
• Conservative
  • Affected part is
    • Kept dry
    • Kept elevated
    • Not heated
    • Protected from local pressure
    • Carefully observed and toileted
• Surgical
  • Limited amputation

 

Bacterial Infections Short Answers

Question 1. Cellulitis.

Answer:

Cellulitis:

Definition: It is a nonsuppurative inflammation spreading along the subcutaneous tissues and connective tissue planes and across interstitial spaces.

Cellulitis Etiology:

• Causative organisms are
  • Streptococcus pyogenes.
  • Variety of aerobic and anaerobic bacteria.

Cellulitis Clinical features:

• Fever
• Toxaemia.
• Diabetic patient are commonly affected.
• Affected part is warm, swollen and tender.
• Pitting edema with brawny induration is present.
• Enlargement and tenderness of regional lymph nodes.
• Common sites are
  • Lower limb
  • Face
  • Scrotum.

Cellulitis Treatment:

• Diabetic control by insulin.
• Rest and elevation of part.
• Glycerine MgSO₄ dressing to reduce edema.
• Antibiotics.
  • Crystalline penicillin 10 lac units IM/IV 6 hourly for 5-7 days or.
  • Ciprofloxacin 500 mg twice daily.
• If antibiotics fail, incision and drainage of pus is carried out.

Question 2. Complications of cellulitis.

Answer:

Complications of cellulitis:

• Abscess
• Necrotizing fasciitis
• Toxaemia.
• Septicaemia.
• Precipitates ketoacidosis.

Question 3. Alveolar abscess.

Answer:

Alveolar abscess:

• Alveolar abscess is an abscess in the alveolar ridge of the jaw, usually caused by the spread of infection from non-vital tooth.

Alveolar abscess Clinical Features:

• Dull and constant pain.
• Seen in childhood and early adult life.
• Swelling of the cheek.
• Redness and oedema of overlying mucosa.
• Inflamed and tender regional lymph nodes.
• Complications:
• Osteomyelitis.
• Ludwig’s angina.

Question 4. Apical abscess/Root abscess.

Answer:

Apical abscess:

Apical abscess Definition: It can be defined as a localized, acute or chronic suppurative infection in the periapical region of the tooth.

Apical abscess Synonyms:

• Dentoalveolar abscess.
• Periapical abscess.

Apical abscess Clinical features:

• Severe pain in affected tooth.
• Tooth is non-vital and mobile.
• Swelling and redness of overlying mucosa.
• Extrusion of tooth.
• Fever.
• Localized lymphadenitis.
• Pus discharging sinus may develop.

Question 5. Cold abscess.

Answer:

Cold abscess:

Cold abscess is non-reacting in nature.

• It is a sequele of tubercular infection.
• It occurs due to caseation necrosis of lymph nodes resulting in fluctuant swelling in the neck.

Cold abscess Clinical features:

• Sites involved.
  • Neck and axilla.
  • Loin from caries spine.
  • Chest wall-side and back.
• Caseation of lymph nodes.
• Nodes are soft and matted.
• Cystic and fluctuant swelling.
• Transillumination is negative.

Cold abscess Treatment:

• Antitubercular regimen.
• Oblique aspiration,
• Excised as a whole

Question 6. Osteomyelitis

Answer:

Osteomyelitis:

Osteomyelitis Classification:

1. According to duration and severity,
   • Acute
   • Chronic,
2. Clinical types,
   • Acute suppurative
   • Primary chronic,
   • Secondary chronic,
   • Non-suppurative,
3. Presence of pm.
   • Suppurative,
   • Non-suppurative.

Osteomyelitis Treatment:

• Administration of antibiotics,
• Sequestromy,
• Hyperbaric oxygen therapy.

Question 7. Sequestrum.

Answer:

Sequestrum:

Sequestrum is a fragment of dead tissue usually bone that has separated from healthy tissue as a result of injury/disease,

• It is avascular.

Sequestrum Types:

1. Primary sequestrum.
   • Completely separated from bone,
2. Secondary sequestrum.
   • Partially separated from bone.

Sequestrum Management:

• Removed by sequestromy.

Question 8. Pyaemia.

Answer:

Pyaemia:

Pyaemia is a condition clmmUtfamni by formation of secondary foci of suppuration in various parts of the body by pyogenic bacteria,

• These foci are caused by the lodgement of septic emboli formed as a result of breaking up of an infected thrombus.
• It is occasionally associated with,
  • Acute osteomyelitis,
  • Acute Inflammation of intracranial sinus,
  • Acute bacterial endocarditis.

Question 9. Hilton’s method of drainage.

Answer:

Hilton’s method of drainage:

indication: When there are plenty of important structures Jike nerves and vessels around the abscess cavity.

Technique:

Incision of skin and subcutaneous tissue on the most prominent and most dependent part,
↓
Sinus forceps is forced through the deep fasica into the abscess cavity,
↓
Blades are gradually opened.
↓
Pus drains out.
↓
Forcep is taken out with jaws open,
↓
Abscess cavity is explored by finger.

Question 10. Tetanus prophylaxis.

Answer:

Tetanus prophylaxis:

1. Active immunization.

• Tetanus toxoid either as plain toxoid or adsorbed on aluminum phosphate APT is used.
• 0.5 ml is given intramuscularly.
• It is given as DPT vaccine i.e., along with toxoid of diphtheria and pertusis vaccine.

2. Passive immunization.

• Antitetanus toxoid prepared from horse serum is used (ATS).
• 1500 TU is given intramuscularly immediately after wounding.
• To avoid the risk of hypersensitivity, human anti-tetanus immune globulins (HTIG) is used.
• Dose – 250 units.

3. Combined prophylaxis.

• First dose of tetanus toxoid in one site with administration of ATS or HTIG in another arm.

4. Proper debridement of the wound.

5. Penicillin 10 lacs IM twice daily.

Question 11. Gangrene.

Answer:

Gangrene:

Gangrene Definition: Gangrene is death of a portion of the body with putrefaction.

Gangrene Types:

1. Dry gangrene.
2. Wet gangrene.

Gangrene Causes:

• Arterial occlusion.
• Venous obstruction.
• Nervous diseases.
• Traumatic gangrene.
• Infective gangrene.
• Diabetic gangrene.
• Physical gangrene -Heat, cold.

Question 12. Dry Gangrene.

Answer:

Dry Gangrene:

Dry gangrene is a form of gangrene occurring due to ischaemia.

Dry Gangrene Causes:

• Ischaemia.
• Atherosclerosis.
• Buerger’s disease
• Raynaud’s disease.
• Trauma.
• Ergot poisoning.

Dry Gangrene Features:

• Begins in the distal part of a limb.
• Occurs in one of the toe which is far form blood supply where bacteria fails to grow.
• Spreads slowly upwards.
• Line of demarcation is seen between the gangrenous part and the viable part.

Question 13. Actinomycosis.

Answer:

Actinomycosis:

It is a chronic, suppurative granulomatous disease caused by actinomyces Isrealli.

Actinomycosis Clinical Forms:

• Cervicofacial.
• Abdominal form.
• Lungs.

Actinomycosis Treatment:

• In crystalline penicillin initially 10 lakh units once a day for 6-12 months, later 4 lakh units daily.
• Hemicolectomy for abdominal forms.
• Incision and drainage of abscess.
• Excision of sinus.
• Releiving obstruction.

Question 15. Syphilis.

Answer:

Syphilis:

Syphilis is a venereal disease caused by treponema-pallidum.

Syphilis Route of Transmission:

• Sexual contact.
• From mother to foetus.
• Through blood transfusion.
• Through infected needles.

Syphilis Stages:

• Primary syphilis.
• Secondary syphilis.
• Tertiary syphilis.
• Latent syphilis.

Question 16. Congenital syphilis.

Answer:

Congenital syphilis:

Congenital syphilis occurs in children born of an infected mother.

Congenital syphilis Features:

• Hutchison’s triad which consists of.
  • Hypoplasia of incisor and molar teeth.
  • Eight nerve deafness and
  • Interstitial keratitis in the eye.
• Mulberry molars with constricted and atrophic cusps.
  • Screwdriver-shaped incisor.
  • Fissuring and scarring of comer of mouth.
  • Frontal bossing.
  • Saddle nose.
  • Short maxilla with high palatal arch.
  • Mandibular prognathism.
  • Delayed eruption of teeth.

Question 17. Hutchison’s teeth.

Answer:

Hutchison’s teeth:

It is characteristic feature of congenital syphilis.

• In it the affected permanent incisors exhibit tapering of mesial and distal surfaces towards the incisal edge rather than towards cervical margin.
• This gives a typical screwdriver appearance.
• Such teeth also have a central notch at their incisal edge.
• Hence called Hutchison’s incisors.
• These changes are more pronounced in maxillary central incisors.

Question 18. HIV.

Answer:

HIV:

Human immune deficiency virus belongs to the family retroviridae.

• It causes AIDS.

HIV Morphology:

• HIV is a spherical enveloped virus.
• Size – 90 – 120 nm in diameter.
• The envelope contains projecting spikes.
• HIV contains two identical copies of the single-stranded RNA genome.
• Core is surrounded by a nucleocapsid composed of proteins.

HIV Modes of Transmission:

• Sexual contact.
• From mother to foetus or infant.
• Parenteral transmission.
  • Blood transfusion.
  • Contaminated needles and syringes.
  • Intravenous drug abusers.

Question 19. Orbital cellulitis.

Answer:

Orbital cellulitis:

When cellulitis affects the eyes, it is called ocular cellulitis.

Orbital cellulitis Forms:

1. Periorbital.
2. Orbital.

Orbital cellulitis:

• It is an infection of the soft tissue in the eye socket.
• Disease starts in the ethamoid sinus arid the infection spreads into the subperiosteal lining of the orbit.
• It can cause permanent damage to eye.
• It is more common in children above 5 year.
• In severe cases, the infection can spread to the optic nerve, causing impaired vision.

Orbital cellulitis Causes:

• Bacterial or fungal infections of the sinuses.

Question 20. Active immunity.

Answer:

Active immunity:

Active immunity is the resistance developed by an individual as a result of antigenic stimuli.

Types:

1. Natural.
   • Acquired by natural subclinical or clinical infections.
2. Artificial
   • Acquired by vaccination.

Question 21. Pressure sores/bedsores/Decubitus ulcer.

Answer:

Pressure sores:

Pressure sores appears on the points of pressure when a patient is long bedridden. It occurs on the skin covering bony areas.

Pressure sores Sites involved:

• Hips
• Back
• Ankles
• But locks.

Pressure sores Causes:

• Undue pressure on the part.
• Lying on certain area for long periods.
• Thinner skin is present next to bone or cartilage.

Pressure sores Predisposing factors:

• Old age.
• Sensory loss of the part.
• Malnutrition.
• Moisture.
• Anaemia.
• Improper nursing.

Pressure sores Features:

• Discoloration of the skin.
• Pain in the affected area.
• Infection.
• Open skin.
• Skin may be softer or firmer than the surrounding skin.

Question 22. Cross infection.

Answer:

Cross infection:

Cross-infection refers to the transmission of a pathogenic organism from one person to another. When it occurs in hospitals, it is called nosocomial infection.

Cross infection Causes:

• Streptococcal infection.
• Viral hepatitis.
• Fecal-oral infections
• Fungal infections.

Cross infection Prevention:

• Maintain good personal hygiene
• Better sanitation.
• Better Nursing.

Question 23. Epltaxls.

Answer:

Epltaxls:

• Epltaxls is nasal bleeding.

Epltaxls Causes:

• Trauma.
• Exposure to warm, dry air for long time.
• Nasal and sinus infections.
• Allergic rhinitis.
• Nasal foreign body.
• Vigorous nose blowing.
• Deviated nasal septum.
• Cocaine use.
• Use of anti-coagulant.
• Hypertension.
• Bleeding disorders.

Question 24. Antibioma.

Answer:

Antibioma:

• Antibioma is antibiotic-induced swelling.
• Due to continuous administration of antibiotics given after abscess formation, the following changes occurs.
  • Wall becomes fibrosed.
  • Pus becomes sterile.
  • Whole mass becomes firm.
• This condition is known as antibioma.

Sites involved:

• Breast
• Thigh
• Ischiorectal fossa.

 

Diseases Of The Oral Cavity Important Notes

1. Stomatitis
   • It describes inflammation of the lining of the mouth
   • Stomatitis Types
2. Cancrumoris
   • Progression of lesion
     • Area of edema and induration on the lip
     • The area becomes ischaemic and necrotic
     • Spreads over larger areas of lips, cheeks, and jaws and destroys them
3. Ulcers of tongue
4. Carcinoma of tongue
   • Sites
     • Anierior or 2/ 3rd – 50 %
     • Posterior 1 /3rd – 20 %
     • Dorsum -10 %
     • Tip – 10%
     • Undersurface- 10%
   • Predisposing factor
     • Pipe smoking
     • Syphilis
     • Chronic superficial glossitis
     • Alcohol
     • Chronic irritation
   • Carcinoma Of Tongue Types
     • An ulcer
     • A warty growth
     • An indurated plaque or mass
     • A fissure
   • Carcinoma Of Tongue Feature
     • Presents as painless irregular ulcer
       • Edges – raised and everted
       • Floor – covered by yellowish-grey slough
       • Base – indurated
     • Repealed spitting
     • Excessive salivation
     • Fetor oris
     • Ankyloglossia
     • Hoarseness of voice and dysphagia
     • Regional lymphadenopathy
     • Later blood stained saliva occurs
     • Pain occurs due to the involvement of the lingual nerve
   • Carcinoma Of Tongue Treatment
     • Surgery
     • Radiotherapy
     • Block dissection in case of cervical Jymphadenopathy
5. Carcinoma of lip
   • In 90% of cases, it involves the lower lip
   • Related to exposure to sunlight
   • Males are commonly affected
   • Present as a flat nodule or indurated crack at skin-vermillion junction
6. Etiology of carcinoma of the cheek
   • Sepsis
   • Smoking
   • Spirit
   • Sharp tooth
   • Syphilis
   • Spices
7. Causes of macroglossia
   • Lymphangioma
   • Haemangioma
   • Neurofibroma
   • Muscular macroglossia
   • Primary mesodermal amyloidosis
   • Infiltrating carcinoma

Read And Learn More: General Surgery Question and Answers

Diseases Of The Oral Cavity Long Essays

Question 1. Enumerate and write tumors of the cheek and floor of the mouth
Answer:

Tumors of the cheek and floor of the mouth

Question 2. Discuss the etiology, clinical features, diagnosis, and management of carcinoma of the tongue.
Answer:

Carcinoma Of Tongue: Carcinoma of the tongue is a common lesion

Carcinoma Of Tongue Etiology:

• Premalignant conditions like
  • Leukoplakia
  • Erythroplakia
• Six
  • Smoking
  • Syphilis
  • Spices
  • Spirit
  • Sepsis.
  • Sharp tooth

Carcinoma of Tongue Clinical Features

• Age- 50 years of age
• Sex- males are commonly affected
• Site- common in anterior 2/3rd of tongue and edges
• Excessive salivation
• A painless lump or ulcer develops on the surface of the tongue
• Foetor oris
• Ankyloglossia
• Pain due to involvement of nerves
• Hoarseness of voice and dysphagia- if carcinoma involves posterior 1/3rd of tongue
• Enlarged cervical lymph nodes

Carcinoma of Tongue Diagnosis:

• Edge biopsy- done under general anesthesia
• FNAC- of lymph nodes
• Indirect and direct laryngoscopy- to examine posterior third growth
• CT scan to detect extension of carcinoma
• Chest radiograph- to detect bronchopneumonia

Carcinoma of Tongue Management

• Surgery
  • Wide incision
    • Indicated if the growth is less than 1 cm in diameter
    • A wide incision with a 1 cm margin and depth of 1 cm is used
  • Partial glossectomy
    • Indicated when the lesion is less than 2 cm and confined to the lateral border of the tongue
    • About one-third of the tongue is removed
  • Hemiglossectomy
    • Indicated when radiotherapy fails
    • Removal of half of the anterior 2/3rd of the tongue is done
  • Total glossectomy
    • Indicated in pervasive growth involving the entire tongue
    • Combined with radiotherapy
  • Commando operation
    • Indicated when carcinoma of the tongue is fixed to the mandible
    • It comprises of
      • Hemiglossectomy
      • Hemimandibulectomy
      • Removal of the floor of the mouth
      • Radical neck dissection
• Radiotherapy
  • Interstitial radiotherapy
    • Indicated as preliminary treatment when the growth is more than 1 cm in diameter in the anterior 2/3rd of the tongue
  • Teletherapy
    • Useful in carcinoma of posterior l/3rd of the tongue when the lesion is larger than 2 cm in diameter
    • Cobalt 60 unit is used
  • When there is a large tumor, both the primary site and neck are irradiated to 4500 rads
• Chemotherapy
  • Amethoprin- 50 mg/ day for 5 days can be used to reduce the size of the tumor
• Treatment of lymph node
  • When lymph nodes are not enlarged- prophylactic block dissection of the neck is done
  • When lymph nodes are enlarged- Commando’s operation is carried out
  • When enlarged lymph nodes are fixed- deep radiotherapy is done

Question 3. Describe the etiology, clinical features, diagnosis, and treatment of carcinoma of the cheek.
(or)
Describe the etiology, and pathology of carcinoma of the cheek and how you will manage it if it involves the mandible
Answer:

Carcinoma Of Cheek: Squamous cell carcinoma is a common carcinoma of the cheek

Carcinoma Of Cheek Etiology:

• Six Ss
  • Smoking
  • Spirit
  • Spices
  • Sharp tooth
  • Sepsis
  • Syphilis
• Premalignant conditions
  • Leukoplakia
  • Erythroplakia
  • Hyperplastic candidiasis
  • Submucosal fibrosis
• Betel nut chewing

Carcinoma of Cheek Clinical Features:

• Development of exophytic growth- cauliflower-like growth
• Nonhealing ulcer develops
• Edges are everted
• Ulcer bleeds on touch
• Pain occurs when it is infected
• Fixity to underlying structures
• Trismus
• Dysphagia
• Halitosis
• Enlargement of submandibular and upper deep cervical lymph nodes

Carcinoma of Cheek Diagnosis:

• Wedge biopsy
• OPG- to rule out an extension
• FNAC- from lymph nodes
• CT scan- to detect extension

Carcinoma of Cheek Treatment

• Surgery
  • Wide excision followed by split skin graft for small superficial ulcer
  • Wide excision followed by flap reconstruction for infiltrative ulcer
• Radiotherapy
  • External radiotherapy
    • Large total doses of 6000-8000 cGy units are given
  • Interstitial radiotherapy
    • Indicated in infiltrative small lesions
• Advanced carcinoma of the cheek
  • T3 and T4 lesions require surgery followed by postoperative radiotherapy
  • Repaired by myocutaneous flap
  • Reconstruction after surgery can be done by
    • Split skin graft
    • Deltopectoral cutaneous flap
    • Forehead flap
    • Pectoralis major myocutaneous flap
    • Cortical bone graft
    • Free flaps
• Chemotherapy
  • Drugs used are
    • Methotrexate
    • Vincristine
    • Bleomycin
    • Adriamycin

Question 4. Discuss the etiology, pathology, and clinical features of oral carcinoma and the management of gingival carcinoma

Answer:

Oral Carcinoma It is the common malignant neoplasm in the head and neck region

Oral Carcinoma Etiology:

• Tobacco smoking
• Use of smokeless tobacco
• Alcohol consumption
• Malnutrition
• 3 fitted dentures
• Radiations
• Viral Infections
• Immunosuppression
• Chronic infections
• Occupational hazards
• Genetic factors
• Pre-existing oral diseases

Oral Carcinoma Pathology:

It is characterized by malignant cells

• These cells show variable degrees of differentiation
• Cells Invade through the basement membrane into the dermis

Oral Carcinoma Arrangement:

• Cellfi arc arranged in concentric layers called epithelial pearls
• They contain keratin material in the center of the coll masses
• Cells are separated by lymphocytes

Oral Carcinoma Clinical Features:

• Associated with oral leukoplakia and erythroplakia
• Initial symptoms are
  • Asymptomatic
  • White or rod, variegated patch
  • Nodule or fissure over oral mucosa
  • Painless
• Later symptoms
  • Past enlarging
  • Exophytic or invasive ulcer
• Persistent induration around the periphery
• Presence of superadded candidal infections
• Painful lesions due to secondary infections
• Fixation to the underlying tissues
• Trismus
• Invasion of the alveolar bone
• Enlarged regional lymph nodes
• Pathological fractures of the jaw bone

Gingival Carcinoma: Occurs due to tobacco and betel nut chewing

Gingival Carcinoma Management:

• Surgical excision
• Radiotherapy
• Chemotherapy

Question 5. Discuss differential diagnosis, clinical features, and management of gum swelling.
Answer:

Gum Swelling Differential Diagnosis:

• Chronic gingivitis
• Gingival abscess
• Periodontitis

Gum Swelling Clinical Features:

• Mandibular gingiva is more affected than maxilla
• The attached gingiva Is more affected than the free gingiva
• The initial lesion appears as verrucous leukoplakia or as a small ulceration with an indurated margin
• bony invasion occurs
• Mobility and premature loss of teeth
• Nonhealing extraction socket
• Extends to the neighboring structures

Gum Swelling Management:

• Surgical excision
• Radiotherapy
• Chemotherapy

Question 6. Discuss the etiology of oral cancer and how to detect nearly oral cancer and describe the steps to prevent it.
Answer:

Oral Cancer It is the common malignant neoplasm in the head and neck region

Oral Cancer Etiology:

• Tobacco smoking
  • Cigarettes
  • Bidis
  • Pipes
  • Cigars
• Use of smokeless tobacco
  • Snuff dipping
  • Gutkha
  • Tobacco chewing
• Alcohol consumption
• Malnutrition
  • Vitamin deficiency
• 3 fitted dentures
  • Broken prosthesis
  • Chronic irritation
• Radiations
  • Actinic radiation
  • X-ray radiation
• Viral infections
  • Herpes simplex virus
  • Human papilloma virus
  • Human immunodeficiency virus
  • Epstein burr virus
• Immunosuppression
  • AIDS
  • Organ transplants
• Chronic infections
  • Candidiasis
  • Syphilis
• Occupational hazards
• Genetic factors
• Pre-existing oral diseases

Oral Cancer  Investigation

• Histopathological examination
  • Exhibit excessive proliferation of malignant cells
  • Cellular pleomorphism
  • Xuclear hyperchromatic
  • Breakdown of basement membrane
  • Intense inflammatory cell infiltration
• Radiographic examination
  • Exhibits bone destruction
  • Shows ill-defined radiolucent areas
  • Expansion and destruction of cortical plates
  • Pathological fractures of bone
• Exfoliative cytology
  • Used to detect the neoplastic cells as these cells tend to exfoliate or shed to the surface
• Toluidine blue test
  • Detects dysplastic changes
• Acridine binding method
  • Detects dysplastic cells
• DNA probe
  • Help to determine the DNA content of tumor cells
• Tumor markers
  • Carcinoembryonic antigen and alpha-fetoprotein are tumor markers that detect tumor

Oral Cancer  Prevention:

• Primary prevention
  • Avoid exposure to tobacco and other deleterious habits
  • Primary prevention Methods
    • Reducing tobacco habits by making tax hikes for tobacco-related products
    • Making changes in the manufacturing process of tobacco items
• Secondary prevention
  • It includes
    • Early detection and treatment of already-developed cancer
    • Prompt management of potentially risky precancerous lesions and conditions
    • Treatment of early cancer

Question 7. Define oral ulcer. Classify ulcers. Discuss the differential diagnosis of ulcers of the oral cavity and management of ulcers of the palate.
Answer:

Oral Ulcer Ulcer is a break in the continuity of the covering epithelium

Oral Ulcer Classification:

• Clinically
  • Spreading ulcer
  • Healing ulcer
  • Callous ulcer
• Pathological
  • Nonspecific ulcer
    • Traumatic ulcer
    • Arterial ulcer
    • Venous ulcer
    • Neurogenic user
    • Infective ulcer
  • Specific ulcer
    • Syphilitic ulcer
    • Tubercle ulcer
  • Malignant ulcer
    • Epithelioma
    • Rodent ulcer

Oral Ulcer Differential Diagnosis:

• Aphthous ulcer
  • It is a small painful ulcer seen on the tip, undersurface, and sides of the tongue in its anterior part
  • It is small and superficial
  • Surrounded by a hyperaemic zone
  • It is quite painful
  • Has yellowish border
  • It is a painful ulcer
• Dental ulcer
  • Caused by mechanical irritation
  • Occurs at the periphery or undersurface of the tongue
  • It is elongated
  • Presents a slough at the base and is surrounded by a zone of erythema and induration
  • It is painful
• Syphilitic ulcer
  • Called snail track ulcer
  • Occurs rarely on the tongue
• Tuberculous ulcer
  • Young adults are affected
  • Ulcers are shallow, multiple, and greyish-yellow in color
  • Seen at the tip, margin, and dorsum of the tongue
• Post pertussis ulcer
  • Occurs in children with whopping cough
  • Seen at the upper part of frenum linguae and undersurface of the tip
• Chronic nonspecific ulcer
  • Occurs in the anterior 2/3rd of the tongue
  • It is moderately indurated
  • Painless
• Carcinomatous ulcer
  • Occurs in elder persons
  • The site involves- the anterior 2/3rd of the tongue
  • It may be a single or multiple
• Herpetic ulcer
  • Common in children and young adults
  • Associated with acute neuralgic pain
  • Vesicles appears
• Ulcers due to glossitis
  • Ulcers are superficial and multiple with hyperemia
  • Pain occurs during meals

Management of Ulcer of Palate:

• Removal of the causative agent
• The membrane is swabbed away with pledgets of cotton soaked with hydrogen peroxide
• Mouth should be kept clean by repeated use of mouthwash
• Antibiotics used if required

Question 8. Surgical anatomy of the maxillary sinus, clinical features and management of maxillary sinusitis
Answer:

Maxillary Sinus: It is pyramidal with a base forming the lateral nasal wall and an apex at the root of the zygoma.

• Capacity: 10-15 ml
• Size: Height 3.5 cm; Width 2.5 cm; Anteroposterior depth 3.2 cm
• Roof: Formed by the floor of the orbit
• Floor: Alveolar process of maxilla
• Anterior Wall: Facial surface of maxilla
• Posterior Wall: Sphenomaxillary wall

Medial Wall: Lateral wall of nasal cavity

Vascular and Nerve Supply:

• Blood Supply: Facial artery
  • Infraorbital artery
  • Greater palatine artery
• Nerve Supply:
  • Infraorbital nerve
  • Anterior, middle, and posterior superior alveolar nerves
• Lymphatic Drainage: Submandibular lymph nodes

Maxillary Sinusitis Clinical Features:

• • Pain on lowering your head
  • Tenderness in canine fossa
  • Redness of the area
  • Nasal discharge
  • Nose block
  • Change in voice
  • Dry cough
  • Fever
  • Malaise
  • Headache

Maxillary Sinusitis  Management:

• Antibiotics:
• Decongestants:
• Analgesics
• Antihistamines
• Steam inhalation
• Local heat application
• Antral lavage
• Irrigation of sinus through lukewarm water

Question 9. What are the causes of oral malignancy? How do you manage carcinoma of the cheek?
Answer:

Causes of Oral Malignancy

• Tobacco smoking
  • Cigarettes
  • Bidis
  • Pipes
  • Cigars
• Use of smokeless tobacco
  • Snuff dipping
  • Guikha
  • Tobacco chewing
• Alcohol consumption
• Malnutrition
  • Vitamin deficiency
• 3 fitted dentures
  • Broken prosthesis
  • Chronic irritation
• Radiations
  • Actinic radiation
  • X-ray radiation
• Viral infections
  • Herpes simplex virus
  • Human papilloma virus
  • HIV
  • Epstein Burr virus
• Immunosuppression
  • AIDS
  • Organ transplants
• Chronic infection
  • Candidiasis
  • Syphilis
• Occupational hazards
• Genetic factors
• Pre-existing oral diseases

Diseases Of The Oral Cavity Short Essays

Question 1. Stomatitis

Answer:

Stomatitis

• Stomatitis used to describe any kind of inflammation of the lining of the mouth
• It may affect the surface of the tongue

Stomatitis Causes:

• Trauma
• Mechanical
• Chemical agents
• Thermal injury
• Radiotherapy
• Idiopathic
• Malnutrition

Stomatitis Types:

• Traumatic stomatitis
  • It is covered by a thin grey glistening coagulum
  • It heals on its own
• Aphthous stomatitis
  • May be solitary or multiple
  • Small vesicles with hyperaemic base appear
  • These are painful and tender
  • These vesicles break and form painful ulcers
• Monilial stomatitis
  • Occurs due to Candida albicans
    • Starts as a spot on the buccal mucosa
    • Excessive salivation occurs
    • Swallowing is painful
• Recurrent aphthous ulceration
  • Seen in adults
  • Seen on the inner sides of the lips and cheek and the undersurface of the tongue
  • These recur in different parts of the mouth
  • Ulcers are very painful
  • There is excessive salivation
  • They heal on their own

Question 2. Erythroplakia
Answer:

Erythroplakia

• It is a red patch or plaque which cannot be characterized clinically or pathologically as any other condition and which has no apparent cause
• It has clearly defined margins

Erythroplakia Types:

• Homogenous erythroplakia
  • The lesion appears bright red, velvety soft areas on the oral mucosa
  • Has irregular but well-defined margins
• Erythroplakia interspersed with patches of leukoplakia
  • There is the presence of multiple, irregular erythematous areas
  • Few white leukoplakic patches occur
• Speckled erythroplakia
  • There is the presence of soft, irregular, raised, erythematous areas in the epithelium with a granular surface
  • There are some tiny, focal white plaques distributed all over red surfaces

Erythroplakia Differential Diagnosis

• Erosive lichen planus
• Early squamous cell carcinoma
• Atrophic candidiasis
• Kaposi’s sarcoma
• Contact allergy

Erythroplakia Treatment:

• Deep and wide surgical excision of the lesion
• Regular follow up

Question 3. Carcinoma of lip
Answer:

Carcinoma of lip Clinical Features:

• Age/sex: elderly males
• Non-healing ulcer
• Edge is everted
• Induration present
• The floor is covered with slough
• Bleeding spots present
• Fix to underlying subcutaneous tissue
• Cervical Lymphadenopathy

Carcinoma of lip Differential Diagnosis:

• Keratoacanthoma
• Ectopic salivary gland tumour
• Pyogenic granuloma
• Leukoplakia

Carcinoma of lip Treatment:

• Surgery:
  • Abbe flap
  • Estlander flap
• Radiotherapy
  • Dose: 4000-6000 cGv units

Question 4. Etiology, clinical features, and management of malignant sinusitis
Answer:

Malignant Sinusitis Etiology

• Genetic mutation
• Smoking
• Long-term exposure to chemicals and irritants
• Infections like human papillomavirus

Malignant Sinusitis Clinical features

• Difficulty breathing through the nose
• Loss of sense of smell
• Nose bleed
• Discharge from nose
• Facial pain and swelling
• Watery eyes
• A sore or lesion on the roof of the mouth
• Vision problems
• Lump in neck
• Difficulty in the opening of the mouth

Question 5. Write about Leukoplakia
Answer:

Leukoplakia

It is a whitish patch or plaque that cannot be characterized, clinically or pathologically, as any other disease and which is not associated with any other physical or chemical causative agent except the use of tobacco.

Leukoplakia Etiology:

• Smoking
• Spices
• Spirits
• Sharp tooth
• Sunlight
• Syphilis

Leukoplakia Stages

1. Keratosis
2. Acanthosis
3. Dyskeratosis
4. Speckled leukoplakia
5. Carcinoma in situ

Leukoplakia Treatment

• Stoppage of all habits
• Surgical excision
• Cryosurgery
• Administration of vitamin A

Diseases Of The Oral Cavity Short Answers

Question 1. Angular stomatitis
Answer:

Angular stomatitis

It is a superficial ulceration at the corner of the mouth

Angular stomatitis Causes:

• Licking the corners of the mouth
• Over closure
• Dribbling of saliva
• Atrophic oral mucosa

Angular stomatitis Clinical Features:

• Inflamed red-brown fissures at the comer of the mouth
• Results in scar formation

Angular stomatitis Treatment:

• Improve general health
• Application of mercurochrome or Gentian violet B Vitamin supplement
• Iron supplements

Question 2. Tongue tie
(or)
Ankyloglossia
Answer:

Tongue tie

It is a congenital developmental condition characterized by fixation of the tongue to the floor of the mouth

Tongue tie Clinical Features:

• Males are commonly affected
• Defective speech
• Dental deformities
• Difficulty in sucking
• Difficulty in swallowing
• Tension in anterior lingual gingiva

Tongue tie Treatment:

1. Frenulectomy- in severe cases of ankyloglossia

Question 3. Cancrum Oris
Answer:

Cancrum Oris

It is an extensive ulcerative disease of cheek mucosa occurring in malnourished children

Cancrum Oris Precipitating Factors:

• Malnutrition
• Major diseases like diphtheria
• Vincent’s organism

Cancrum Oris Treatment:

• Ryle’s tube-feeding
• Improve the nutrition
• Antibiotics: metronidazole-400 mg TID for 7-10 days
• Reconstructive surgery

Cancrum Oris Complications:

• Fibrosis
• Septicaemia
• Restricted jaw movement
• Death

Question 4. Lingual thyroid
Answer:

Lingual thyroid

• It is a round red swelling seen at the back of the tongue at the foramen caecum
• It contains thyroid tissue at the foramen caecum

Lingual thyroid Complications:

• Hemorrhage
• Respiratory obstruction
• Dysphagia
• Speech impairment

Lingual thyroid Treatment: L-thyroxin replacement therapy- to reduce the size of the swelling

Question 5. Ulcers of tongue
Answer:

Ulcers of tongue

• Aphthous ulcer
  • It is a small painful ulcer seen on the tip, undersurface, and sides of the tongue in its anterior part
  • It is small and superficial
  • Surrounded by a hyperaemic zone
• Dental ulcer
  • Caused by mechanical irritation
  • Occurs at the periphery or undersurface of the tongue
• Syphilitic ulcer
  • Called snail track ulcer
  • Occurs rarely on the tongue
• Tuberculous ulcer
  • Ulcers are shallow, multiple, and greyish-yellow in color
  • Seen at the tip, margin, and dorsum of the tongue
• Post pertussis ulcer
  • Occurs in children with whopping cough
  • Seen at the upper part of frenum linguae and undersurface of the tip
• Chronic nonspecific ulcer
  • Occurs in the anterior 2/3rd of the tongue
  • It is moderately indurated
• Carcinomatous ulcer
  • Occurs in elder persons
  • The site involves- the anterior 2/3rd of the tongue
  • It may be a single or multiple
• Herpetic ulcer
  • Common in children and young adults
  • Associated with acute neuralgic pain
  • Vesicles appear
• Ulcers due to glossitis
• Ulcers are superficial and multiple with hyperemia
• Pain occurs during meals

Question 6. Haemangioma of tongue
Answer:

Haemangioma of tongue

• Cavernous haemangioma occurs on tongue
• Arises from veins
• It consists of multiple dilated venous channels
• It is a spongy swelling

Haemangioma of tongue Management:

• Conservative treatment
  • Injection of sclerosing agent
  • Cautery
• Surgery
  • Ligation of feeding vessels
  • Excision of the lesion
  • Diathermy to control hemorrhage

Question 7. Predisposing factors- carcinoma of the tongue
Answer:

Predisposing factors- carcinoma of the tongue

• Predisposing factors of carcinoma of the tongue are
  • Pipe smoking
  • Syphilis
  • Chronic superficial glossitis
  • Alcohol
  • Chronic irritation
  • Betel nut

Question 8. Glossitis
Answer:

Glossitis

Involvement of the tongue due to any cause with or without inflammation is called glossitis

Glossitis Causes:

• Local causes
  • Mechanical trauma
  • Mechanical irritation
  • Allergic reaction
  • Dry mouth
• Systemic causes
  • Herpes simplex virus
  • Iron deficiency anemia
  • Aphthous ulcer
  • Oral lichen planus
  • Pemphigus Vulgaris

Glossitis Clinical Features:

• Pain and tenderness in the tongue
• Swelling in the tongue
• Color changes to beefy dark red or pale
• Halitosis
• Difficulty in speech, eating, and swallowing
• Loss of papillae on the tongue

Question 9. Sinusitis
Answer:

Sinusitis Etiology:

• Nasal infections
• Dental infections
• Trauma

Sinusitis Causative Organisms:

• Streptococcus
• Pneumococci
• Staphylococci
• Clinical Features:
• Pain on lowering your head
• Tenderness in canine fossa
• Redness of the area
• Nasal discharge
• Nose block
• Change in voice
• Dry cough
• Fever
• Malaise
• Headache

Question 10. Anaplasia
Answer:

Anaplasia Definition:

• Anaplasia is a lack of differentiation and is a characteristic feature of most malignant tumors.
• Depending upon the degree of differentiation, the extent of anaplasia is also variable i.e., poorly differentiated malignant tumors have a high degree of anaplasia.

Result of Anaplasia:

1. Loss of polarity
2. Pleomorphism
3. N: C ratio changes from 1:5 to 1:1
4. Anisonucleosis.
5. Hyperchromatism.
6. Prominent nucleolus
7. Tumorgaint cells
8. Chromosomal abnormalities.

Question 11. Metaplasia
Answer:

Metaplasia Definition: Metaplasia is defined as a reversible change of one type of epithelial or mesenchymal adult cells to another type of adult epithelial or mesenchymal cells, usually in response to abnormal stimuli.

Metaplasia Types: Metaplasia is divided into the following two types.

1. Epithelial Metaplasia
   1. Squamous metaplasia
   2. Columnar metaplasia
2. Mesenchyme metaplasia
   1. Osseous metaplasia
   2. Cartilaginous metaplasia

Question 12. Oral thrush
Answer:

Oral thrush Features:

• The lesions appear soft, white, and slightly elevated plaques
• The sites involved are:

1. Buccal mucosa
2. Tongue
3. Gingiva
4. Palate
5. The floor of the mouth
6. Entire oral cavity’ is involved in severe cases

Oral thrush Person affected arc

1. HIV patients
2. Cancer patients undergoing chemotherapy or radiotherapy
3. Neonates and infants
4. Debilitated and chronically ill patients

Question 13. Impacted teeth
Answer:

Impacted teeth Definition: It is the cessation of the eruption of a tooth caused by a physical barrier or ectopic positioning of a tooth

Impacted teeth Causes:

Question 14. Micrognathia
Answer:

Micrognathia

It is an orofacial anomaly characterized by the development of jaws smaller than normal

Micrognathia Causes:

• Pierre- Robin syndrome
• Hallerman- Steriff syndrome
• Trisomy 13
• Trisomy 18
• Turner syndrome
• Marfan syndrome
• Progeria

Micrognathia Types:

• Pseudo micrognathia
• True micrognathia

Micrognathia Clinical Features:

• Defective alignment of teeth
• Crowding
• Malocclusion
• Retruded chin
• Difficulty in feeding
• Difficulty in speech

Question 15. Macroglossia
Answer:

Macroglossia

Macroglossia is characterized by an abnormally large tongue in the oral cavity

Macroglossia Types:

• Congenital
• Acquired

Macroglossia Clinical Features:

• Causes displacement of teeth
• Develops tongue-thrusting habits
• Results in obstructive sleep apnea
• Spacing in teeth
• Distortion of the mandibular arch
• The lateral margin of the tongue exhibits scalloping indentation
• Defective speech
• Unesthetic appearance

Macroglossia Treatment:

• Removal of the causative agent
• Surgical reduction or trimming

Question 16. Giant cell epulis
Answer:

Giant cell epulis

• Peripheral giant cell granuloma is also called giant cell epulis
• It appears in the mouth as an overgrowth of tissue due to irritation or trauma
• They frequently appear on gingiva Color ranges from red to bluish-purple
• It can be pedunculated or sessile
• Common in females
• More often found over the mandible rather than the maxilla
• The underlying alveolar bone can be destroyed resulting in cauterization
• Treatment involves surgical removal of bone

Question 17. Causes of Macroglossia
Answer:

Causes of Macroglossia

It is an abnormally large tongue

Question 18. Subacute osteomyelitis
Answer:

Subacute osteomyelitis

• It is a chronic low-grade infection of bone characterized by lack of systemic manifestation
• The causative organism is Staphylococcus
• The onset is insidious
• Pain is a common symptom
• Swelling and tenderness over the involved area are seen
• Treatment
  • Surgical debridement
  • Antibiotics

Diseases Of The Oral Cavity Viva voce

1. Cancrum Oris is associated with leukemia

2. Carcinoma of the lip commonly occurs over the lower lip

Diseases Of The Nervous System Important Notes

1. Nerve injuries
   • Neuropraxia
     • It is temporary physiological paralysis of nerve conduction
     • Recovery is complete
     • There is no reaction of degeneration
   • Axonotmesis
     • It is the division of nerve fibers or axons with intact nerve sheath
     • There is the reaction of degeneration distal with near-complete recovery
     • Features – sensory loss. Paralysis of muscles or causalgia
   • Neurotmesis
     • Complete division of nerve fibers with sheath occurs
     • Degeneration occurs proximal upto first node of Ranvier
     • Recovery is incomplete
2. Tinel’s sign
   • Used to assess the level of regeneration
   • Done by tapping over the course of the nerve from distal to the proximal end to elicit a sensation
   • Result
3. Commonly used tendon grafts are
   • Palmaris tendon in the forearm
   • Plantaris tendon in leg
4. Trigeminal Neuralgia
   • It is a sudden, severe, brief, stabbing, recurrent pain along the distribution of the trigeminal nerve
   • Trigeminal Neuralgia Etiology:
     • Pathological
     • Dental pathosis
     • Traction on division of trigeminal nerve
     • Ischaemia
     • Aneurysm of internal carotid artery
   • Trigeminal Neuralgia Environmental
     • Allergic
     • Irritation to the ganglion
     • Secondary lesions

Read And Learn More: General Surgery Question and Answers

• • Trigeminal Neuralgia Trigger zones
    • Vermillion border of lip
    • Around eyes
    • Ala of nose
  • Trigeminal Neuralgia Management
    • Medical
      • Carbamazepine – 100 mg twice daily
      • Dilantin – 300-400 mg
      • Gabapentin – 11200 -3600 mg/day
      • Baclofen – 10 mg T1D
    • Surgical
      • Injection of alcohol in gasserian ganglion
      • Nerve avulsion
      • Electrocoagulation of gasserian ganglion

Diseases Of The Nervous System Short Essays

Question 1. Bell’s Palsy
Answer:

Bell’s Palsy

Idiopathic paralysis of the facial nerve of sudden onset

Bell’s Palsy Etiology:

• 5 Hypothesis:
• Rheumatic
• Cold
• Ischaemia
• Immunological
• Viral

Bell’s Palsy Clinical Features:

• Pain in post auricular region
• Sudden onset
• Unilateral loss of function
• Loss of facial expression
• Absence of wrinkling
• Inability to close the eve
• Watering of eve
• Inability to blow the cheek
• Obliteration of nasolabial fold
• Loss of taste sensation
• Hyperacusis
• Slurring of speech

Bell’s Palsy Management:

• Physiotherapy:
  • Facial exercises
  • Massaging
  • Electrical stimulation
• Protection to eye
  • Covering of eye with bandage
• Medical management
  • Prednisolone – 60-80 mg per day
    • 3 tablets for 1st 4 days
    • 2 tablets for 2nd 4 days
    • 1 tablet for 3rd 4 days
  • Surgical treatment
    • Nerve decompression
    • Nerve grafting

Question 2. Trigeminal Neuralgia
Answer:

Trigeminal Neuralgia Definition: It is a sudden, severe, brief, stabbing, recurrent pain along the distribution of the trigeminal nerve

Trigeminal Neuralgia Etiology

Trigeminal Neuralgia Clinical Features:

• Age: Around 35 years
• Sex: Common in female
• Site: Right lower portion of the face, usually unilateral
• Duration: a few seconds to a few minutes
  • As time passes duration between the cycles decreases
• Nature: stabbing or lancinating
• Aggravating factors: activation of Trigger Zones
  • These are the vermillion border of the lip, around the eyes, and the nose
• Interference with other activities:
  • The patient avoids shaving, washing face, chewing, and brushing, as these may aggravate pain
  • These lead to a poor lifestyle
• Extreme cases: leads to “Frozen Or Mask Like Face”

Trigeminal Neuralgia Management:

1. Medical:
   • Carbamazepine: initial dose: 100mg twice daily until relief is achieved
   • Dilantin: 300-400mg in single or divided doses
   • Gabapentin: 11200-3600 mg/day TID/QID
   • Baclofen: 10 mg TID
   • Amitryptaline: 25-75 mg/ day QID
   • Combination therapy: dilantin + carbamazepine
2. Surgical
   • Injection of alcohol in gasserian ganglion
   • Nerve avulsion: performed on lingual, buccal, or mental
     • nerve
     • Part of the nerve is sectioned
   • Electrocoagulation of gasserian ganglion: diathermy is done

Question 3. Electrocoagulation of Trigeminal ganglion
Answer:

Electrocoagulation of Trigeminal ganglion

• Electrocoagulation of the Trigeminal ganglion refers to percutaneous heat ablation of the Gasserian ganglion at the base of the skull
• It is performed by placing a needle into the ganglion through which an electrical current passes, heating the probe and producing a thermal lesion in the ganglion

Electrocoagulation of Trigeminal ganglion Side Effects:

• Facial numbness- mild to severe
• It may be temporary

Electrocoagulation of Trigeminal ganglion Complications:

• Unintended nerve damage
• Failure to access the Trigeminal nerve or Gasserian ganglion
• Bleeding from the puncture site
• Apnoea

Question 4. Nerve grafting

Answer:

Nerve grafting

Nerve grafting is defined as the replacement of a damaged nerve with a section of a healthy nerve that has been removed from another part of the body

Nerve grafting Indication: When nerve suturing is impossible or undesirable

Nerve grafting Ideal Requirements:

• Should be immunologically acceptable
• Should undergo Wallerian degeneration
• Should contain active nerve cells
• Should become vascularised after being placed in a favorable nourished bed

Nerve grafting Donor Sites:

• The saphenous nerve of the thigh
• The sural nerve of the leg
• The medial cutaneous nerve of the forearm

Question 5. Neuropraxia
Answer:

Neuropraxia

Neuropraxia is the mildest type of peripheral nerve injury

Neuropraxia Features

• No organic damage
• Endoneurium, perineurium, and epineurium are intact a Temporary physiological paralysis of conduction through the intact nerve fibers
• No Wallerian degeneration
• There may be sensory loss or weakness of muscle groups
• Recovery is complete and requires hours to a few weeks
• EMG shows a lack of fibrillation

Question 6. Neurotmesis
Answer:

Neurotmesis

• In Neurotmesis there is partial or complete division of the nerve fibers as well as their sheaths
• Partial lesion produces lateral neuroma while complete division produces terminal neuroma.

Neurotmesis Clinical Features:

• In the proximal segment of the divided nerve:
  • Retrograde degeneration up to the first node of Ranvier
  • Distal ends of the axons move downwards
  • The gap between the divided nerve ends gets replaced by organic clots and fibrous tissue
• In the distal segment of the divided nerve:
  • Wallerian degeneration of axons occurs
  • Schwan cells proliferate to form small bulb-like projection

Neurotmesis Treatment:

• Primary nerve repair
• Done in clean incised wounds when presented within 6 hours of injury
• It is immediate suturing of the nerve
• Secondary nerve repair
• Done in untidy contaminated wounds presented after 6 hours of injury
• In it, suturing is delayed for 3-4 hours

Question 7. Axonotmesis
Answer:

Axonotmesis

In axonotmesis, there is a rupture of nerve fibers or axons within intact sheaths

Axonotmesis Features:

• Wallerian degeneration occurs in the distal portion of the broken axons
• Loss of sensation, tone, and power of the muscles
• There is no nerve conduction distal to the site of injury
• EMG shows fibrillation potential and positive sharp waves
• Area of anesthesia and paralysis of muscles will be restricted to those structures which are supplied by the damaged nerve
• Secondary effects
  • Impaired circulation due to disuse
  • The affected portion is cold and blue
  • Trophic changes occur
  • Affected muscles no longer respond to stimulation

Axonotmesis Treatment:

• Maintain good nutrition
• Exercise of the paralyzed muscles
• Encouragement of the patients
• Axonal regeneration occurs without any surgical treatment.

Question 8. Types of nerve injuries
Answer:

Seddon’s Classification:

1. Neuropraxia:
   • Results from mild insult to nerve
   • No axon degeneration occurs
   • Mild paraesthesia present
2. Axonotmesis
   • Severe injury
   • Degeneration of afferent fibers
   • Severe paraesthesia present
3. Neurotmesis
   • Most severe injury of nerve
   • Complete destruction of nerve structure

Sunderland’s Classification:

1. First-degree injury
   • Type 1
     • Mild compression of the nerve trunk
     • Results in ischemia and conduction block
     • No axonal degeneration
     • Recovery within a day
   • Type 2
     • Moderate compression
     • Results in edema and conduction block
     • Recovery within 1-2 days
   • Type 3
     • Severe compression
     • Disruption of myelin sheath
     • Sensory loss
     • Recovery in 1-2 months
2. Second-degree nerve injury
   • Synonymous to Seddon’saxonotmesis
   • Axonal damage occurs
   • Epineurium, perineurium and endoneu- rium is intact
   • Paraesthesia and anaesthesia present
   • Spontaneous recovery
3. Third-degree nerve injury
   • Synonymous to Seddon’s axonotmesis
   • Axonal damage
   • Damage to epineurium
   • Paraesthesia and anaesthesia present
   • Regeneration of axon is blocked
   • Incomplete sensory recovery
   • Surgical repair needed
4. Fourth-degree nerve injury
   • Synonymous to Seddon’saxonotmesis
   • Damage to epineurium, endoneurium and axons
   • Intact epineurium
   • Sensory impairment
   • Poor recovery
   • Surgical intervention needed
5. Fifth-degree nerve injury
   • No conduction of impulses
   • Even epineurium is destroyed
   • Poor prognosis

Question 9. Facial nerve palsy
Answer:

Facial Nerve Palsy Etiology:

• Congenital
• Traumatic
• Infections
• Inflammation
• Neoplastic
• Idiopathic

Facial Nerve Palsy Clinical Features:

• Unable to raise eyebrows
• Unable to blow cheeks
• Expressionless face
• Absence of wrinkling and Absence of function of the mandibular nerve
• Lack of movement of the upper lip
• Unable to close one eye
• Absence of nasolabial fold
• Absence of taste sensation
• Drooling of the lower lip on the affected side

Question 10. Frey’s syndrome

Answer:

Frey’s syndrome

This is auriculotemporal nerve syndrom

Frey’s syndrome Causes: Iatrogenic causes- followed by parotidectomy

Frey’s syndrome Features:

• Pain in auriculotemporal nerve distribution
• Gustatory sweating
• Flushing on affected side

Frey’s syndrome Diagnosis: Positive starch iodine test

Frey’s syndrome Treatment:

• Topical application of anticholinergic
• Radiation therapy
• Surgical procedures
  • Skin excision
  • Nerve section
  • Tympanic neurectomy

Question 11. Horner’s syndrome

Answer:

Horner’s syndrome

Homer’s syndrome is a clinical syndrome caused by damage to the sympathetic nervous system

Horner’s syndrome Clinical Features:

• The affected part of the face shows:
• Ptosis
• Anhydrosis
• Dilation lag
• Enophthalmos
• Loss of ciliospinal reflex
• Bloodshot conjunctiva

Horner’s syndrome Diagnosis:

1. Cocaine drop test
   • Cocaine eyedrops block tire reuptake of noradrenaline resulting in the dilation of a normal pupil
   • In Horner’s syndrome, the pupil fail to dilate
2. Paredrine test
   • Helps to localize the cause of miosis
3. Dilation lag test

Question 12. Branches of facial nerve

Answer:

Branches of facial nerve

1. Within the facial canal
   • Greater petrosal nerve
   • Nerve to stapedius
   • Chorda tympani nerve
2. At its exit from stylomastoid foramen
   • Posterior auricular
   • Digastric
   • Stylohyoid
3. Terminal branches
   • Temporal
   • Zygomatic
   • Buccal
   • Marginal mandibular
   • Cervical
4. Communicating branches with adjacent cranial and spinal nerve

Diseases Of The Nervous System Viva Voce

1. Tinel’s sign is used to assess level of regeneration
2. Cut the end of nerve forms neuroma proximally and glioma distally
3. Causalgia is burning sensation in the distribution of a peripheral nerve
4. Carpel tunnel syndrome is the compression neuropathy of the median nerve in the carpus
5. Tendon is the continuity of muscle

Diseases Of Salivary Glands Important Notes

1. Sialolith
   • Mostly occurs in submandibular glands due to
     • Highly viscous secretion
     • Presence of gland independent position
     • Alkaline secretion with a high concentration of calcium and phosphate ions
     • Gland duct is torturous
   • Sialolith Complications
     • Ductal stricture
     • Acute sialadenitis
     • Ductal dilation
   • Sialolith Treatment
     • Small stones are removed by manipulation
     • Larger stones are removed by transoral sialolithotomy
2. Nerves that are at risk during submandibular gland excision are
   • Marginal mandibular branch of facial nerve
   • Lingual nerve
   • Hypoglossal nerve
3. Classification of salivary gland tumours
   • Based on spread of tumours
   • Histological classification
     • Adenoma
       • Pleomorphic
       • Myoepithelioma
       • Basal cell adenoma
       • Warthin’s tumours
       • Canalicular adenoma
       • Cystadenoma
   • Carcinoma
     • Acinic cell carcinoma
     • Mucoepidermoid carcinoma
     • Adenoid cystic carcinoma
     • Adenocarcinoma
     • Squamous cell carcinoma
   • Nonepithelial tumour
   • Malignant lymphomas
   • Secondary tumours
   • Unclassified
   • Tumour like lesions
     • Sialoadenesis
     • Oncocytosis
     • Necrotizing sialometaplasia
     • Salivary gland cyst
4. Malignant transformation of pleomorphic adenoma occurs when tumour
   • Becomes painful
   • Starts growing rapidly
   • Feels stony hard
   • Gets fixed
   • Cervical lymph nodes gets enlarged
   • Causes restriction of movements of the jaws
5. Mucous retention cyst and ranula
6. Types of ranula
   • Simple – ranula situated in the floor of the mouth without cervical prolongation
   • Deep/plunging ranula – intra buccal ranula with cervical prolongation
7. Complications of ranula
   • Infection
   • Bursting
   • Repeated trauma
   • Difficult in speech arid eating
8. Causes of xerostomia
   • Chronic anxiety and depression
   • Dehydration
   • Antimuscarinic and sympathomimetic drugs
   • Salivary gland diseases like Sjogren’s syndrome
   • Nutritional deficiencies
9. Causes of sialorrhoea
   • Painful oral ulcers
   • Dentures
   • Parkinson’s disease
   • Atropine

Diseases Of Salivary Glands Long Essays

Question 1. Describe clinical features, diagnosis, and management of carcinoma of parotid gland and classify salivary gland tumours
Answer:

Carcinoma of Parotid Gland: It consists of 70% of the salivary tumours

Carcinoma of Parotid Gland Clinical Features:

• It starts growing rapidly
• Skin infiltration occurs
• Facial nerve paralysis
• Exhibits fixation to the masseter muscle
• Red, dilated veins over the surface
• Presence of regional lymphadenopathy
• Tumours becomes stony hard

Read And Learn More: General Surgery Question and Answers

Carcinoma of Parotid Gland Investigations:

• Fine needle aspiration cytology
  • It is done to confirm the diagnosis and rule out malignancy
• Diagnostic imaging techniques
  • Radiograph of the bones- shows bone resorption
  • Computrer tomography
    • It allows direct, bilateral visualization of the salivary gland tumour and detects overall dimension and tissue invasion
    • Demonstrate bony invasion
    • Define extra glandular spread and cervical lymph node
  • Magnetic resonance imaging
    • Provides superior soft tissue delineation such as perineural invasion

Carcinoma of Parotid Gland Treatment:

• Radical parotidectomy
  • Includes removal of both the lobes of the parotid gland, facial nerve, parotid duct, fibres of masseter, buccinator, pterygoids, and radical block dissection of the neck
• Postoperative radiotherapy
  • Indications
    • If the deep lobe is involved
    • If the lymph nodes are involved
    • High-grade tumours
    • If margins are positive

Carcinoma of Parotid Gland Classification:

1. Epithelial tumours:
   • Adenomas
   • Pleomorphic adenoma
   • Cystadenoma
   • Basal cell adenoma
   • Warthin’s tumour
2. Carcinoma
   • Adenocarcinoma
   • Epidermoid carcinoma
3. Nonepithelial tumours:
   • Fibroma
   • Lipoma
   • Lymphoma
4. Malignant lymphoma
5. Secondary tumours
6. Unclassified tumors
7. Tumour like lesions
   • Sialadenitis
   • Oncocytosis
   • Necrotizing sialometaplasia

Question 2. What is mixed parotid tumour? Give clinical features and its management
Answer:

Mixed Parotid Tumour: Pleomorphic adenoma is called mixed parotid tumour

Mixed Parotid Tumour: Clinical Features:

• Age: 5th and 6th decade
  • Sex: common in females
  • Site: common in parotid gland

Mixed Parotid Tumour: Features:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• Smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of the mandible
• Deeper lesions:
• Over the lateral wall of oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• Palatal lesion causes surface ulceration
• In buccal mucosa it is present as small, painless nodular lesion

Mixed Parotid Tumour: Investigation

1. Duration of the lesion:
   • Longer duration- malignancy
2. Nature of onset
   • Gradual and painless- malignant
   • Sudden and painful- inflammatory
3. Rapidity of growth
   • Slow-benign
   • Rapid- malignant
4. Associated symptoms
   • Discharge of pus
   • Dryness of mouth
   • Constitutional symptoms
5. FNAC- to rule out malignancy
6. CT Scan- for deeper lesions
7. FNAC- for lymph nodes involvement
8. X-ray of bone- for resorption

Mixed Parotid Tumour: Treatment:

• Surgical excision-parotidectomy
  • It is a surgical treatment for salivary glands tumours

Mixed Parotid Tumour: Types:

1. Superficial parotidectomy
   • Anaesthesize
   • Incision over the preauricular crease, curved downward upto tip of mastoid
   • Elevation of skin and superficial fascia
   • Preserve the facial nerve
   • Dissect the gland away from each branch of gland
   • Hemostasis
   • Placement of drains
   • Suturing
2. Total parotidectomy
   • Involves removal of entire parotid gland
   • Superficial parotidectomy done
   • Then remove tumour deep to the facial nerve

Question 3. What are the causes of acute parotitis? Describe its clinical features and management.
Answer:

Acute Parotitis: It is an acute inflammation of the salivary gland

Acute Parotitis Etiology:

• It is caused by Staphylococcus aureus
• Factors causing it are:
  • When the salivary flow is reduced
  • Partial obstruction of the duct with retention of secretions

Acute Parotitis Clinical Features:

• Pain and swelling of the side involved D There is brawny oedematous swelling over the parotid region
• The temperature is high n Cellulitis occurs of the overlying skin
• Pus may come out through the internal opening of the parotid gland

Acute Parotitis  Management:

• Improve general health of the patient n Maintain oral hygiene
• Soft diet should be prescribed n Antibiotics are started
• Gentle parotid massage is done at regular intervals
• Drainage of pus

Question 4. Describe the pathology, clinical features, and management of submandibular salivary calculus.
Answer:

Submandibular Salivary Calculus Clinical Features:

• Age: middle-aged adults
• Sex: common in males

Submandibular Salivary Calculus Pathology:

• Site: common in the submandibular gland due to the following:
  • Due to viscous secretion
  • Higher concentration of calcium and phosphate
  • Tortuous anatomy of the ducts
  • Dependent position of the gland

Submandibular Salivary Calculus Features:

• Recurrent swelling of the gland region
• Recurrent episodes of sialadentitis
• Tense and tender gland
• Aggregates at the meal time
• Type of pain: pulling or drawing sensation
  • Severe, stabbing type
• Enlarged gland
• Location: unilateral
• In chronic cases: formation of fistulas, sinus tracts and ulcerations in the area
• Necrosis of the gland acini
• Lobular fibrosis
• Complete loss of secretion of the gland
• So there is increased risk of infections

Submandibular Salivary Calculus Diagnosis:

• Manual palpation
• Occlusal radiograph in case of the submandibular gland
• Sialography

Submandibular Salivary Calculus Treatment:

• Locate the sialolith radiographically
• Suture behind and below the duct to prevent the spillage of stone
• If sialolith is present posteriorly, incision is given medially
• If sialolith is present anteriorly, incision is placed medial to plicasublingualis
• Locate the duct
• Locate the stone
• Incise over the stone
• Remove it through the forceps

Question 5. Discuss in detail about salivary gland tumors of clinical features, investigations, pathology, management, and complications of pleomorphic adenoma of parotid gland

Answer:

Pleomorphic Adenoma:

• Clinical Features:
  • Age: 5th hand 6th decade
  • Sex: common in females
  • Site: common in parotid gland

Pleomorphic Adenoma of Parotid Gland Features:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• Smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of mandible
• Deeper lesions:
• Over the lateral wall of the oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• Palatal lesion causes surface ulceration
• In buccal mucosa it is present as small, painless nodular lesion

Pleomorphic Adenoma of Parotid Gland  Pathology:

• Pleomorphic adenoma is a benign parotid tumour
• It is derived from a mixture of epithelial and myoepithelial cells
• The tumour has three components
  • Epithelial cell component
  • Myoepithelial cell component
  • Stromal component
• Investigation:
  • Duration of the lesion:
    • Longer duration- malignancy
  • Nature of onset
    • Gradual and painless- malignant
    • Sudden and painful- inflammatory
  • Rapidity of growth
    • Slow- benign
    • Rapid- malignant
  • Associated symptoms
    • Discharge of pus
    • Dryness of mouth
    • Constitutional symptoms
  • FNAC- to rule out malignancy
  • CT Scan- for deeper lesions
  • FNAC- for lymph nodes involvement
  • X-ray of bone- for resorption

Pleomorphic Adenoma of Parotid Gland  Treatment:

• Surgical excision-parotidectomy
• It is a surgical treatment for salivary glands tumours

Pleomorphic Adenoma of Parotid Gland  Types:

1. Superficial parotidectomy
   • Anaesthesize
   • Incision over the pre auricular crease, curved downward upto tip of mastoid
   • Elevation of skin and superficial fascia
   • Preserve the facial nerve
   • Dissect the gland away from each branch of gland
   • Hemostasis
   • Placement of drains
   • Suturing
2. Total parotidectomy
   • Involves removal of entire parotid gland
   • Superficial parotidectomy done
   • Then remove tumour deep to the facial nerve

Pleomorphic Adenoma of Parotid Gland  Complication:

• Facial palsy
• Frey’s syndrome

Question 6. Classify salivary glands tumours. Discuss the etiology, clinical features, and management of War- thin’s tumour.

Answer:

Warthin’s tumour Classification:

1. Based on spread of tumours

2. Histological classification

• Adenoma
  • Pleomorphic
  • Myoepithelioma
  • Basal cell adenoma
  • Warthin’stumours
  • Canalicular adenoma
  • Cystadenoma
• Carcinoma
  • Acinic cell carcinoma
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Adenocarcinoma
  • Squamous cell carcinoma
• Nonepithelial tumour
• Malignant lymphomas
• Secondary tumours
• Unclassified
• Tumour like lesions
  • Sialoadenesis
  • Oncocytosis
  • Necrotizing sialometaplasia
  • Salivary gland cyst

Warthin’s tumour Clinical features

• Age: 50-70 years
• Sex: common in males
• Site: common in parotid gland especially in lower part overlying angle of the mandible
• Characterised by slow enlarging, well-circumscribed soft, painless swelling of gland
• Well-capsulated and movable
• Present over angle of mandible
• Size – 2-4 cm in diameter
• Shape- spherical in shape
• Occurs bilaterally
• Produces compressible and doughy feeling on palpation
• Little movable in all directions

Etiology:

• It is derived from salivary tissue inclusions present in lymph node

Warthin’s tumour  Management:

Anaesthesize the area
/
Incision is given over the pre-auricular area
/
Elevate skin and superficial fascia
/
Isolation of facial nerve
/
Dissection of superficial portion of parotid gland from underlying tissues
/
Removal of gland along with tumour inside
/
Hemostasis
/
Placement of drains
/
Suturing

Diseases Of Salivary Glands Short Essays

Question 1. Salivary fistula/ parotid fistula

Answer:

Salivary fistula

• A parotid fistula may arise from the parotid gland or parotid duct
• Openings
  • Internally inside the mouth
  • Externally to the exterior

Salivary fistula Causes:

• Penetrating injuries
• Rupture of parotid abscess
• Inadverent incision and drainage
• Complication of superficial parotidectomy

Salivary fistula Clinical Features:

• Opening in the cheek with discharge
• Discharge comes out during meals

Salivary fistula Investigations:

• Sialogram with watery solution of lipiodol is performed

Salivary fistula Treatment:

• When fistula is connected with the main duct- reconstruction of the duct by Newman or Seabrock’s operation is performed
• If reconstruction fails, resection of the auriculotemporal nerve is done
• If above measures fails, a complete parotidectomy is done

Question 2. Salivary gland or submandibular gland calculi

Answer:

Salivary gland

It is a pathological condition characterized by the presence of one or more calcified stones within salivary gland itself or within its duct

Etiology:

• Stagnation of saliva
• Ductal epithelial inflammation and injury
• Biological factors

Pathogenesis:

• Formation of soft nidus of mucin, protein, bacteria and desquamated cells.
• Allows concentric, lamellar crystallization
• Gradually sialolith increases in size

submandibular gland calculi Composition of Sialolith:

• Calcium phosphate
• Calcium carbonate
• Salts of Mg, Zn, etc
• Glycoproteins
• Mucopolysaccharides
• Cellular debris

submandibular gland calculi Clinical Features:

• Age: middle-aged adults
• Sex: common in males
• Site: common in the submandibular gland due to the following:
  • Due to viscous secretion
  • Higher concentration of calcium and phosphate
  • Tortuous anatomy of the ducts
  • Dependent position of the gland

submandibular gland calculi Features:

• Recurrent swelling of the gland region
• Recurrent episodes of sialadentitis
• Tense and tender gland
• Aggregates at the meal time
• Type of pain: pulling or drawing sensation
  • Severe, stabbing type
• Enlarged gland
• Location: unilateral
• In chronic cases: formation of fistulas, sinus tracts & ulcerations in the area
• Necrosis of the gland acini
• Lobular fibrosis
• Complete loss of secretion of the gland
• So there is increased risk of infections

submandibular gland calculi Diagnosis:

• Manual palpation
• Occlusal radiograph in case of submandibular gland
• Sialography

submandibular gland calculi Treatment:

• For submandibular gland:
• Locate the sialolith radiographically
• Suture behind and below the duct to prevent the spillage of stone
• If sialolith is present posteriorly, incision is given medially
• If sialolith is present anteriorly, incision is placed medial to plicasublingualis
• Locate the duct
• Locate the stone
• Incise over the stone
• Remove it through the forceps

For parotid gland:

• Locate the sialolith
• Semilunar incision given anterior to the opening of the duct
• Reflection of gland n Locate the stone
• Incise over the stone ” Remove it

Question 3. Surgical anatomy of parotid gland

Answer:

Surgical anatomy of parotid gland

• Parotid gland is present on the lateral aspect of the face
• It is divided by the facial nerve into
  • Superficial lobe- overlies masseter and mandible
  • Deep lobe- present between mastoid process and the styloid process, ramus of the mandible, and the medial pterygoid muscle
• Parotid duct
  • It arises from the superficial lobe
  • It is called Stenson’s duct
  • It is 2-3 mm in diameter
  • It receives tributaries from the superficial, deep, and accessory lobes
  • It passes through the buccinator muscle and opens in the mucosa of the cheek oppposite the upper 2nd molar tooth
• Parotid gland is covered by a
  • True capsule which is a condensation of fibrous stroma of the gland,
  • False capsule
  • Parotid fascia
• Parotid swellings are very painful
• They can be infected by the mumps virus
• Spread of infection from the oral cavity can result in parotid abscess

Question 4. Mucous cyst or mucocele

Answer:

Mucous cyst or mucocele

• It is a swelling caused by the accumulation of saliva at the site of a traumatized or obstructed minor salivary gland duct

Mucous cyst Types:

• Extravasation:
  • It is formed as a result of trauma to a minor salivary gland excretory duct
  • It is more common
  • It does not have an epithelial cyst wall
• Retention:
  • Caused by obstruction by calculus of duct

Mucous cyst Clinical Presentation:

• Site:
  • Extravasation: lower lip more common
  • Other sites involve buccal mucosa, tongue, floor of the mouth, and retromolar area
  • Retention: palate or floor of the mouth
• Appearance:
  • Discrete, painless, smooth-surface swelling
• Size:
  • Ranges from few millimeters to few centimeters
• Colour:
  • Superficial lesions have blue hue
  • Deeper lesions can be more diffuse, covered by normal appearing mucosa without blue colour
• Treatment:
• Surgical excision to prevent recurrence
• Aspiration of fluid does not provide long-term benefit
• Surgical management may cause trauma to adjacent structures and can lead to development of new lesions
• Intralesional injections of corticosteroids

Question 5. Ranula

Answer:

Ranula

• Special type of mucocele
• Resembles the belly of a frog

Site:

• Floor of the mouth
• Superficial or deep to the mylohyoid muscle

Ranula Cause:

• Trauma to duct

Ranula Features:

• Slow-growing unilateral lesion
• Soft and freely movable
• Superficial lesions:
  • Thin-walled bluish lesion
• Deeper lesions:
  • Well circumscribed
  • Covered by normal mucosa

Ranula Types:

• Simple type
• Plunging ranula

Ranula Treatment:

• Marsupialization

Question 6. Adenolymphoma of parotid gland
(or)
Warthin’s tumour

Answer:

Adenolymphoma of parotid gland

• It is located in the inferior pole of the gland, posterior to the angle of mandible

Parotid Gland Presentation:

• SEX: common in males
• AGE: 5th and 8th decade of life
• Presents as a well-defined, slow-growing mass in the tail of parotid
• Painless but can become superinfected n It is smooth with well defined capsule

Parotid Gland  Treatment:

• Easily removed with margin of normal tissue
• Large tumour treated by superficial parotidectomy

Question 7. Xerostomia

Answer:

Xerostomia

• It refers to a subjective sensation of a dry mouth, but not always, associated with salivary hypofunction

etiology:

• Development
  • salivary gland aplasia
• Water or metabolic loss
  • Impaired fluid intake
  • Hemorrhage
  • Vomiting or diarrhea
• Iatrogenic
• Medications
  • Antihistamines
  • Decongestants
  • Antidepressants
  • Antipsychotic
• Radiation therapy
• Systemic diseases
  • Diabetes mellitus
  • Sjogren’s syndrome
  • HIV infections
• Local Factors
  • Decreased mastication
  • Smoking
  • Mouth breathing

Xerostomia Clinical Features:

• Reduction in salivary secretions
• Residual saliva is either foamy or thick
• Mucosa appears dry
• Tongue is fissure
• Difficulty in mastication and swallowing
• Food adheres to the oral membranes
• Increased prevalence of candidiasis
• More prone to dental caries

Xerostomia Treatment:

• Elimination of causative agents
• Avoid medications causing xerostomia
• Use of noncarbonatea sugarless fluids, xylitol-containing gums
• Use of pilocarpine to treat xerostomia

Question 8. Submandibular sialadenitis

Answer:

Submandibular sialadenitis Causes

• Occurs due to
  • Sequele to acute inflammation
  • Intermittent obstruction by calculus
  • Autoimmune disease
  • Bilateral Sjogren’s syndrome

Submandibular sialadenitis Features

• Recurrent attacks of pain and swelling
• Discharge of small amount of pus
• Dilatation of ductules, atrophic acini
• Replacement of gland by chronically inflamed scar tissue
• Unilateral pain and swelling
• Reduced salivary flow

Submandibular sialadenitis Treatment

• Antibiotics to control infection
• Removal of calculus
• Dilatation of constricted ducts
• Duct irrigation
• Radiotherapy
• Total conservative parotidectomy

Question 9. Adenoid cystic carcinoma

Answer:

Adenoid cystic carcinoma

• It is highly malignant tumour of salivary gland

Adenoid cystic carcinoma Clinical features

• Slow growing
• Spreads along perineural tissue
• May invade periosteum or medullary bone
• Bony tenderness occurs
• It is hard and fixed
• Produce anaesthesia of skin overlying the tumour
• Spreads through local infiltration, lymphatics, and blood

Pathology

• Contains cords of dark staining cells with cystic spaces containing mucin
• Contains myoepithelial cells and duct epithelium

Adenoid cystic carcinoma Treatment

• Radical parotidectomy with block dissection of neck
• Palliative radiotherapy to reduce pain and to arrest the progress of the disease

Diseases Of Salivary Glands Short Answers

Question 1. Ranula

Answer:

Ranula

• Special type of mucocele
• Resembles the belly of a frog

Ranula Site:

• Floor of the mouth
• Superficial or deep to mylohyoid muscle

Ranula Cause:

• Trauma to duct

Ranula Features:

• Slow-growing unilateral lesion
• Soft and freely movable
• Superficial lesions:
• Thin walled bluish lesion

Ranula Deeper lesions:

• Well circumscribed
• Covered by normal mucosa

Question 2. Sialogram
(or)
Sialography

Answer:

Sialogram

Used for investigation of sialolith

Sialogram Procedure:

1. Identification of duct
2. Exploring of the duct
3. Introduction of cannula
4. Introduce contrasting media
   • Lipid soluble or
   • Water soluble agents
5. Amount of the agent
   • Submandibular gland: 0.5-0.75 ml
   • Parotid gland- 0.76-1 ml
6. Radiograph is taken
   • Occlusal view
   • AP view

 SialogramInterpretation:

1. Parotid Gland- tree in winter appearance
2. Submandibular gland- Bush in winter appearance
3. Sjogren’s syndrome- Cherry blossom appearance
4. Malignant tumour- Ball holding in hand appearance

Question 3. Acute parotitis
(or)
Parotid abscess

Answer:

Acute parotitis

• It is an acute inflammation of the salivary gland

Etiology:

• It is caused by Staphylococcus aureus
• Factors causing it are:
  • When the salivary flow is reduced
  • Partial obstruction of the duct with retention of secretions

Acute parotitis Clinical Features:

• Pain and swelling of the side involved
• There is brawny oedematous swelling over the parotid region
• The temperature is high
• Cellulitis occurs of the overlying skin
• Pus may come out through the internal opening of the parotid gland

Question 4. Salivary calculus

Answer:

Salivary calculus

• It is a pathological condition characterized by the presence of one or more calcified stones within salivary gland itself or within its duct

Etiology:

• Stagnation of saliva
• Ductal epithelial inflammation and injury
• Biological factors

Pathogenesis:

• Formation of soft nidus of mucin, protein, bacteria, and desquamated cells.
• Allows concentric, lamellar crystallization
• Gradually sialolith increases in size

Composition of Sialolith:

• Calcium phosphate
• Calcium carbonate
• Salts of Mg, Zn, etc
• Glycoproteins
• Mucopolysaccharides
• Cellular debris

Question 5. Mikulicz’s disease

Answer:

Mikulicz’s disease

• It is a benign lesion
• Characterize by symmetric lacrimal, parotid, and submandibular gland swelling with associated lymphocytic infiltration
• It is associated with prominent infiltration of IgG4- positive plasmocytes into the involved gland, so called IgG4-related plasmacytic endocrinopathy

Etiology:

• It is unknown
• Been speculated that autoimmune, viral, or genetic factors are involved

Mikulicz’s disease Presentation:

• Affects middle-aged persons
• Unilateral or bilateral salivary gland swelling
• Reduced salivary flow

Mikulicz’s disease Treatment:

• Methylprednisolone pulse therapy and prednisolone

Question 6. Mixed parotid tumour
(or)
Pleomorphic adenoma

Answer:

Mixed parotid tumour Clinical Features:

• Age: 5th and 6th decade
• Sex: common in females
• Site: common in parotid gland

Mixed parotid tumour Features:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• Smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of mandible
• Deeper lesions:
• Over the lateral wall of the oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• Palatal lesion causes surface ulceration
• In buccal mucosa it is present as small, painless nodular lesion

Question 7. Xerostomia

Answer:

Xerostomia

• It refers to a subjective sensation of a dry mouth, but not always, associated with salivary hypofunction

Xerostomia Clinical Features:

• Reduction in salivary secretions
• Residual saliva is either foamy or thick
• Mucosa appears dry
• Tongue is fissure
• Difficulty in mastication and swallowing
• Food adheres to the oral membranes
• Increased prevalence of candidiasis
• More prone to dental caries

Xerostomia Treatment:

• Elimination of causative agents
• Avoid medications causing xerostomia
• Use of noncarbonated sugarless fluids, xylitol containing gums
• Use of pilocarpine to treat xerostomia

Question 8. Sjogren’s syndrome

Answer:

Sjogren’s syndrome

• It is a chronic autoimmune disease
• Characterize by oral and ocular dryness, exocrine dysfunction, and lymphocytic infiltration

Etiology:

• It is unknown

Sjogren’s syndrome Presentation:

• Decreased salivary function
• Dry mouth
• Difficulty in chewing, swallowing, and speech
• Dry, cracked lips
• Angular chelitis
• Mucosa is painful and sensitive to species
• Mucosa is pale and dry
• Friable or furrowed
• Minimal salivary pooling
• Tongue is smooth and painful
• Increased dental caries and erosion of enamel
• Susceptible to infection
• Increased risk of developing malignant lymphoma
• Hypergammaglobulinemia
• Autoantibodies
• Elevated sedimentation rate
• Decreased WBC
• Monoclonal gammopalhies
• Hypocomplementemia

Question 9. Plunging ranula

Answer:

Plunging ranula

• When the intrabuccal ranula has a cervical prolongation it is called plunging or deep ranula.
• It is derived from the cervical sinus
• It passes beyond the floor of the mouth along the posterior border of the mylohyoid muscle and appears in the submandibular region

Plunging ranula Complications:

• It bursts due to repeated trauma
• Rarely infected
• Causes difficulty in rating and speech

Plunging ranula Differential Diagnosis:

• Sublingual dermoid
• Lipoma
• Submandibular lymph node swelling
• Submandibular salivary gland swelling

Plunging ranula Treatment:

• Complete excision of the ranula

Question 10. Sialadenitis

Answer:

Sialadenitis Causes

• Occurs due to
  • Sequele to acute inflammation
  • Intermittent obstruction by calculus
  • Autoimmune disease
  • Bilateral Sjogren’s syndrome

Sialadenitis Features

• Recurrent attacks of pain anti-swelling
• Discharge of small amount of pus
• Dilatation of ductules, atrophic acini
• Replacement of gland by chronically inflamed scar tissue
• Unilateral pain and swelling
• Reduced salivary flow

Diseases Of Salivary Glands Viva Voce

1. Commonest location of the pleomorphic adenoma in the parotid gland is tail of the gland
2. Superficial parotidectomy is the treatment ot choice for pleomorphic adenoma
3. Adenoid cystic carcinoma is the only tumour that shows a tendency for perineural invasion
4. Tumors of the minor salivary glands are encountered most frequently in the palate
5. Ranula usually arises from glands of Blandin and Nuhn situated on the floor of the mouth

Cleft Lip And Cleft Palate Important Notes

1. Rule of 10 for cleft repair
   • Weight should be 10 lbs
   • Age – 10 weeks
   • Haemoglobin – 10 gm%
2. Surgeries used for cleft lip repair are
   • Millard’s rotation advancement flap surgery
   • Tennison-Randall triangular flap method
3. Surgeries for cleft palate repair
   • Ward Wills operation
   • Y-V push-back palatoplasty

Cleft Lip And Cleft Palate Long Essays

Question 1. Classification of cleft lip and cleft palate and writing about their effects on eating and teeth
Answer:

Cleft Lip and Cleft Palate Classification:

• Venn’s classification
  • Grade 1- cleft of soft palate only
  • Grade 2- cleft of the hard and soft palate to the incisive foramen
  • Grade 3- complete unilateral cleft of the soft and hard palate and the lips and alveolus
  • Grade 4- complete bilateral cleft of the soft and hard palate and the lips and alveolus
• Davis and Ritchie’s classification
  • Grade 1 – alveolar cleft
  • Grade 2- post alveolar cleft
  • Grade 3- alveolar cleft
• Kernahan and Stark’s classification
  • Cleft of primary palate only
  • Cleft of primary and secondary palate
  • Cleft of secondary palate only

Cleft Lip and Cleft Palate Effects on Eating:

• Difficulty in feeding
• Difficulty in suckling on the nipple to get enough milk due to
  • Intake of too much air while feeding
  • Milk coming out through the nose
• For this feeding the baby in different positions and angles is recommended

Cleft Lip and Cleft Palate Effects on Teeth:

• The first teeth may be missing
• If present it may come out
• Overcrowding of teeth
• Overgrowth of the maxilla occurs compared to the mandible
• Needs orthodontic treatment
• Removal of some teeth is done

Read And Learn More: General Surgery Question and Answers

Question 2. Describe the congenital anomalies of the faciomaxillary region and describe the management of cleft palate
Answer:

Congenital Anomalies:

• Classification
• Congenital
• Harelip- causes
  • Nonfusion of maxillary processes and medial nasal process
  • Defective development of the frontonasal process
  • Non fusion of two mandibular process
• Oblique facial cleft
  • Arise due to confusion of the maxillary and lateral nasal process
• Macrostomia
  • Due to inadequate fusion of maxillary and Mandibular process
• Microstomia
  • Due to too much fusion
• Bifid nose
  • Due to bifurcation of frontonasal process
• Mandibulofacial dysostosis
• Retrognathia or agnathia
• Hypertelorism- widely separated eyes

Management of Cleft Palate:

• Langenbeck’s operation
  • Margins of the cleft are pared, the nasal septum is defined and separated off the upper surface of the cleft palate
  • Mucoperiosteal flaps are lifted from the hard palate
  • Two release incisions are made on each side just medial to the alveolar margins
  • Mucoperiosteal flaps are mobilized
  • The cleft is then repaired

Question 3. Describe the etiology, pathogenesis, clinical features, and management of cleft lip.
Answer:

Cleft Lip

A cleft lip is a congenital anomaly caused due to abnormal facial development during gestation

Cleft Lip Etiology:

• Hereditary
• Increased parental age
• Associated with other syndromes like Pierre Robin’s syndrome, ectodermal dysplasia
• Environmental factors
  • Nutritional deficiency
  • Radiation exposure
  • Steroids injections
  • Hypoxia
  • Aspirin and other teratogenic drugs

Cleft Lip Pathogenesis:

• Various theories are put forward, they are
  • Asynchronous development of various processes leading to fusion between them
  • Failure of mesodermal development to form connective tissue bands across lines of fusion
  • Interruption in the migration of the neural crest cells from the neural plate

Cleft Lip Clinical Features:

• Upper lip cleft is occasionally associated with the presence of two small blind tubes in the lower lip
• Lower lip cleft is rare
• Patient looks ugly
• Difficulty in suckling
• Teeth may come out through the gap
• Defective speech
• Deformed nostrils

Cleft Lip Management:

• Mirault- Blair operation- it is carried out in three stages
• Stage 1
  • Adequate mobilization of the lip lateral to the cleft, the ala of the affected nostril, and a considerable part of the cheek is performed the lip is everted
  • The incision is made in a groove between the lip and the maxilla
  • Bleeding is checked by firm pressure
• Stage 2
  • An ink mark is made on the lip
  • The margins are made of raw
• Stage 3
  • Skin flaps are sutured
  • A rubber tube is introduced through the nostril
  • The mucous membrane and the muscles are sutured separately with chromic catgut
  • Finally, the skin is sutured

Question 4. Describe the etiology, pathogenesis, clinical features, and management of cleft palate.
Answer:

Cleft Palate

• It is a congenital disorder
• It involves a breach in the continuity of the palate formed during the development of the face
• Corrected entirely surgically

Cleft Palate Etiology:

• Hereditary
• Sex
• Maternal age
• Syndrome associated
• Environmental factors

Cleft Palate Pathogenesis:

• Various theories are put forward, they are
  • Asynchronous development of various processes leading to fusion between them
  • Failure of mesodermal development to form connective tissue bands across lines of fusion
  • Interruption in the migration of the neural crest cells from the neural plate

Cleft Palate Clinical Features:

• Facial deformity
• Inability to feed
• Defective speech
• Nasal regurgitation of fluids
• Difficulty in hearing
• Defect in smelling
• Repeated respiratory tract infection
• There may be chances of aspiration pneumonia
• Dental problems
  • Malformed teeth
  • Malocclusion
  • Congenital anomalies

Timing of Repair: 12-24 Months

Management Protocol of Cleft Patients:

1. Immediately after birth
   • Pediatric consultation
2. First few weeks
   • Hearing testing
3. t10-12 weeks
   • Surgical repair of lip
4. Before 1 year or I8 months
   • Surgical repair of palate
5. 3 months after palate repair
   • Speech and language repair
6. 3-6 years
   • Soft palate lengthening
7. 5-6 years
   • Pharyngeal surgery
8. At 7 years
   • Orthodontic treatment phase 1
9. 9-11 years
   • Pre-alveolar bone grafting
10. 12 years or later
    • Full orthodontic treatment phase 2
11. 15-18 years
    • Placement of implant
12. 18-21 years
    • Surgical advancement
13. Final nose and lip revision
    • Rhinoplasty

Cleft Lip And Cleft Palate Short Essays

Question 1. Cleft Lip
Answer:

Cleft Lip

A cleft lip is a congenital anomaly caused due to abnormal facial development during gestation

Cleft Lip Etiology:

• Hereditary
• Increased parental age
• Associated with other syndromes like Pierre Robin’s syndrome, ectodermal dysplasia
• Environmental factors
  • Nutritional deficiency
  • Radiation exposure
  • Steroids injections
  • Hypoxia
  • Aspirin and other teratogenic drugs

Cleft lip Clinical Features:

• Upper lip cleft is occasionally associated with the presence of two small blind tubes in the lower lip
• Lower lip cleft is rare
• Patient looks ugly
• Difficulty in suckling
• Teeth may come out through the gap
• Defective speech
• Deformed nostrils

Cleft Lip Management:

• Mirault- Blair operation- it is carried out in three stages
• Stage 1
  • Adequate mobilization of the lip lateral to the cleft, the ala of the affected nostril, and a considerable part of the cheek is performed the lip is everted
  • The incision is made in a groove between the lip and the maxilla
  • Bleeding is checked by firm pressure
• Stage 2
  • An ink mark is made on the lip
  • The margins are made of raw
• Stage 3
  • Skin flaps are sutured
  • A rubber tube is introduced through the nostril
  • The mucous membrane and the muscles are sutured separately with chromic catgut
  • Finally, the skin is sutured

Question 2. Cleft Palate
Answer:

Cleft Palate

• It is a congenital disorder
• It involves a breach in the continuity of the palate formed during the development of the face
• Corrected entirely surgically

Cleft Palate Etiology:

• Hereditary
• Sex
• Maternal age
• Syndrome associated
• Environmental factors

Cleft palate Clinical Features:

• Facial deformity
• Inability to feed
• Defective speech
• Nasal regurgitation of fluids
• Otological problems
• Dental problems
  • Malformed teeth
  • Malocclusion
  • Congenital anomalies

Question 3. Development of face

Answer:

Development of face

• Around 4th week of intrauterine life, a prominent bulge develops on the ventral aspect of the embryo.
• Below it, there is a depression called stomadeum.
• The mesoderm covering the developing forebrain proliferates and forms a downward projection called the frontonasal process.
• The pharyngeal arches are laid down.
• The first branchial arch helps in the development of nasomaxillary complex.
• It forms the lateral border of the stomodeum.
• It gives off a bud from its dorsal end called nasal placodes.
• These placodes soon shrink to form nasal pits.
  • At this stage, stomodeum is surrounded
  • Above- frontonasal process
  • Sides- maxillary process
• Below- Mandibular process
• The resultant nasal pit divides into the medial nasal process and lateral nasal process
• The maxillary process lust with the lateral nasal process and forms a nasolacrimal duet
• Lower lip
  • The Mandibular processes of the two sides grow towards each other and fuse in the midline to form lower lip ami lower jaw
• Upper lip
  • Formed by the two media nasal prominence and the two maxillary prominences
• Nose
  • The maxillary process fuses with the medial nasal process, as a result, nasal pits are cut off from the stadium
  • The frontonasal process becomes narrower to form nasal septum
• Cheeks
  • Formed by the fusion of maxillary and Mandibular process

Question 4. Hare lip
Answer:

Hare lip

It is used to describe defects of the lip

Hare lip Causes:

• Nonfusion of maxillary processes with the medial nasal process- leads to a defect in the upper lip
• Defective development of frontonasal process- leads to midline defect of the upper lip
• Nonfusion of two mandibular processes- leads to midline defect of the lower lip

Cleft Lip And Cleft Palate Viva Voce

1. A cleft lip is formed due to disturbance during 6 weeks of IU life
2. A cleft palate is formed due to disturbances during 8 weeks of IU life
3. A cleft lip is formed due to a defect in the fusion of the medial nasal process with the maxillary process
4. A cleft palate is formed due to defective fusion of the premaxilla and two palatine processes
5. Cleft lip repair begins at 3-6 months of age
6. Cleft palate repair begins at 6-8 months of age

Burns Skin Grafting And Flaps Important Notes

1. Depth Of Burns
   • Depth Of Burns First degree
     • Burns are confined to the epidermis
     • They are painful, erythematous, and blanch to touch with an intact epidermal barrier
   • Depth Of Burns Second Degree
     • Divided into two types- superficial and deep
     • Have some degree of dermal damage
   • Depth Of Burns Third-degree
     • Involves the epidermis and dermis
     • Characterized by a hard, leathery eschar
     • It is painless due to nerve damage
     • Black, white, or cherry red
     • Wounds heal by re-epithelization from the wound edges
     • Deep dermal and full-thickness burns require excision with skin grafting
   • Fourth degree
     • Burns involve other organs beneath the skin such as muscle, bone, and brain
2. Burns Skin Grafting And Flaps Classification
3. Rule of nine
   • Given by Wallace
   • Used to calculate the severity of burns
     • Head and neck – 9%
     • Upper limb ( right and left) – 18%
     • Thorax (front and hack) – 18%
     • A Women (front and back) – 18%
     • Lower limb ( front and back ) – 18%
     • Lower limb ( right and left) – 18%
     • Lxtemal genitalia – 1%
4. Electrical burns
   • In it, the visible areas of tissue necrosis represent only a small portion of destroyed tissue
   • Electrical current enters a part of the body through fingers or hand
   • Proceeds through tissues with lower resistance to current such as nerves, blood vessels, and muscles
   • The current then leaves the body at a grounded area typically the foot
   • The muscle is the major tissue through which the current flows and thus it sustains the most damage
   • Electrical Burns Features and Effects
     • Patients may develop cardiac dysrhythmias
     • Muscle damage results in the release of hemochromogens which are filtered in glomeruli
     • May result in obstructive nephropathy
     • Port wine-colored urine may be present
     • A large amount of blood pigment may be deposited in the collecting tubules of the kidney as a result of hemolysis
     • Hemoglobinuria will be gradually followed by oliguria ia and anuria, and the patient may die of uremia
5. Management of burns
   • Fluid replacement
     • In 10% of burns in children
     • In more than 15% of burns in adults
     • The formula to calculate fluid replacement is
       • % of burns * body weight / 2
   • Use of nasogastric tube in >35% burns
   • Blood replacement therapy in 25-50% burns
6. Effects of burns
   • Local effects
     • Cell necrosis
     • Collagen denaturation
     • Infection
     • Inflammation
   • Systemic effects
     • Hypovolaemia
     • Gastric or duodenal ulcer
     • Multiple organ transfer
     • Hypoxia
7. Types of grafts

Burns Skin Grafting And Flaps Long Essays

Question 1. Classification of burns
Answer:

Classification of buBurnauburnernurn is a wound in which there is coagulative necrosis of the tissues.

Burns Classification:

1. According to the mechanism of injury
   • Ordinary burns
     • Caused by dry heat like fire, open flame, airplane injury
   • Scalds
     • Caused by moist heat
     • Example: hot liquid or hot steam
   • Electric bums
     • Caused by low voltage electrical sources
     • Tissue damage occurs
     • The skin gradually undergoes coagulation necrosis
     • It causes minimal destruction of skin
     • The skin is involved at two points- at the point of contact and the point of exit
     • Electrical injury to the muscles is associated with the release of haemo chromogens into the bloodstream
   • Chemical burn
     • Caused by strong acid or base
     • The severity of damage is related to the concentration of the chemical and duration of contact
   • Radiation injury
     • Usually caused by x-rays or radium
     • Radiodermatitis occurs which are of two types
       • Acute radiodermatitis- exposure dose is highly excessive
       • Chronic radiodermatitis- occurs due to small doses of irradiation
   • Cold burns
     • Caused by exposure to cold like freezing injury, frostbite, trench foot
     • Causes coagulative necrosis of tissue
2. According to burn depth
   • First degree burn
     • Involves epidermis only
     • Manifests as erythema, painful, dry texture
     • Heals in a week or less
   • Second degree burn
     • The entire thickness of the epidermis is destroyed
     • Blebs or vesicles are formed between the separating epidermis and dermis
   • Third degree burns
     • Involves full thickness of the dermis
     • Appears a stiff and white or brown scar
     • Absence of pain
   • Fourth degree burn
     • Extends through skin, subcutaneous tissue, and into underlying muscle and bone
     • Result in amputation and severe functional impairment
3. According to burn severity
   • Major burns
     • Full thickness burns
     • Associated with inhalational injury, electrical burns
     • Require referral to a specialized burn treatment center
   • Moderate burns
     • Full-thickness burns involving 2-10% of total body surface area
     • Require hospitalization for burn care
   • Minor burns
     • Full-thickness burns involving less than 2% of total body surface area
     • Do not require hospitalization.

Question 2. Pathology and treatment of burns and management of 50% burns in a person aged 40 years.
Answer:

Burns Pathology:

• Local Changes
  • Severity of burn
    • First degree burn
      • Hyperemia of the skin with slight edema of the epidermis
    • Second degree burns
      • The entire thickness of the epidermis is destroyed
      • Formation of blebs and vesicles
    • Third degree burns
      • Destruction of the epidermis and dermis

Read And Learn More: General Surgery Question and Answers

• • Extent of burn
    • It is expressed as a percentage of the total surface area
    • Estimated by the rule of nines
  • Vascular changes
    • Dilatation of small vessels
    • Local liberation of histamine
    • Increased blood flow to the injured part
    • Increased capillary permeability
    • Blister formation
  • Infection
    • Due to the destruction of the epidermis, there is a loss of barrier against infection
    • This causes severe infection
  • Systemic Changes
    • Shock
    • Biochemical changes
    • Electrolyte imbalance
    • Hypoproteinaemia
    • Hyperglycaemia
    • Rise in blood urea and creatinine levels
  • Changes in blood
    • Haemoconcentration
    • Rise in hemoglobin level
    • Increase in the number of RBCs
    • Sludging of blood
    • Fall in eosinophil count
    • Aggregation of RBC, WBC, and platelets
    • Anaemia
    • Alteration in coagulation
  • Systemic lesions

Treatment of Burns:

• Treatment of shock
  • Sedation
    • As burn is very painful sedatives and analgesics are prescribed
    • Administered during first 4-5 days
    • Usually, injection of morphine is preferred
  • Fluid resuscitation
    • Started as soon as possible
    • A blood transfusion is required
    • Ringer’s lactate solution is used
  • Maintenance of airway
    • Administration of 100% oxygen with ventilation support
• General treatment
  • Tetanus prophylaxis
    • Intramuscular administration of tetanus toxoid in the dose of 0.5 ml usually provides adequate prophylaxis
  • Antibiotics
    • Microorganisms contaminate the wound
    • Thus systemic antibiotics are given on 1st or 2nd day of injury
  • Nutritional support
    • Feeding is supported by a nasogastric tube through which nutrients are delivered. 24 hours a day
  • Gastric decompression
    • Requires introduction of nasogastric suction as intestinal motility is gradually lost
    • Gastric aspirates should be regularly monitored
• Local treatment
  • First-aid measures
    • The patient is immediately removed from the source
    • Apply cool clean water to the area
  • Burn wound care
    • The wound is cleansed with a surgical detergent and all loose nonviable skin is removed
    • Blister is punctured
    • Regular dressing is carried out
  • Skin grafting
    • Excise the wound
    • The patient’s donor skin can lie meshed to increase the size of the graft
    • It is then covered with cadaveric skin

Skin Grafting And Flaps  Management: Fluid Resuscitation

• The goal is to maintain the vital organ function as soon as possible
• Several formulas are proposed
• Evans’ formula
  • 1st 24 hours
    • Normal saline- 1/2 ml/kg/% burn
    • 2000 ml of 5% dextrose
    • Colloid-containing fluid- 1 ml/kg/% burn
  • 2nd 24 hours
    • Normal saline- 1/2 of l st 24 hours
    • 2000 ml of 5% dextrose
    • Colloid containing fluid- 1/2 of 1st 24 hours
• Brooke’s formula
  • 1st 24 hours
    • Ringer’s lactate solution 1.5 ml/kg/% burn
    • Colloid containing fluid 0.5 ml/kg/% burn
    • Dextrose solution- 2000 ml
  • 2nd 24 hours
    • Ringer’s lactate solution 1/2 – 3/4 th of 1 st 24 hours
    • Colloid containing, solution 1/2 to 3/4 of 1st 24 hours
    • Dextrose solution 2000 ml

Question 3. Define burns and scalds. Discuss management of 20% burns.
Answer:

Burns and Scalds Definition:

• Burns Burn is a wound in which there is coagulative necrosis of the tissue
• Scalds It is a thermal injury or burn caused by moist heal

Burns and Scalds Management:

• First-aid measures
  • Remove the patient from the source
  • Wrap the patient in a fire blanket
  • Apply running cold water
  • Remove clothing
  • Maintain patent airway
• Airway maintenance
  • Breathing and ventilation
  • Circulation is maintained
  • Fluid resuscitation
• Wound care
  • Analgesic are preferred
  • A blood transfusion is required
  • Use of antibiotics to prevent infection
  • Nutritional support
  • Debridement of wound
  • Regular dressing
  • Excision of the devitalized tissues
  • Skin grafting

Burns Skin Grafting And Flaps Short Essays

Question 1. Burn shock
Answer:

Burn shock

• Shock is the most important effect of burns
• Burn Shock Types

Burn shock Treatment:

• Sedation
  • As the bum is very painful sedatives and analgesics are prescribed
  • Administered during first 4-5 days
  • Usually, injection of morphine is preferred
• Fluid resuscitation
  • Started as soon as possible
  • A blood transfusion is required
  • Ringer’s lactate solution is used
• Maintenance of airway
  • Administration of 100% oxygen with ventilation support

Question 2. Superficial burns
Answer:

Superficial burns

• First-degree burns are called superficial burns
  • Involves epidermis only
  • Manifests as erythema, painful, dry texture
  • Heals in a week or less

Superficial burns Management:

• First-aid measures
  • Remove the patient from the source
  • Wrap the patient in a fire blanket
  • Apply running cold water
• Wound care
  • Analgesic are preferred
  • Debridement of wound

Question 3. Rule of nine in burns
Answer:

Rule of nine in burns

• The length and width of the burn wound are expressed as a percentage of the total surface area displaying 2nd or 3rd-degree burn
• The extent is estimated by the rule of nines which is as follows:
• It applies only to adults

Question 4. Burns
Answer:

Burns

Burns: A burn is a wound in which there is coagulative necrosis of the tissues.

Burns Classification:

1. According to the mechanism of injury
   • Ordinary burns
   • Scalds
   • Electric burns
   • Chemical bums
   • Radiation burns
   • Cold burns
2. According to bum depth
   • First-degree bum
   • Second-degree bum
   • Third-degree bum
   • Fourth-degree bum
3. According to severity
   • Major bums
   • Moderate bums
   • Mild bums

Burns Management

• Treatment of shock
  • Sedation
    • As the bum is very painful sedatives and analgesics are prescribed
    • Administered during first 4-5 days
    • Usually, injection of morphine is preferred
  • Fluid resuscitation
    • Started as soon as possible
    • A blood transfusion is required
    • Ringer’s lactate solution is used
  • Maintenance of airway
    • Administration of 100% oxygen with ventilation support
• General treatment
  • Tetanus prophylaxis
    • Intramuscular administration of tetanus toxoid in the dose of 0.5 ml usually provides adequate prophylaxis
  • Antibiotics
    • Microorganisms contaminate the wound
    • Thus systemic antibiotics are given on 1st or 2nd day of injury
  • Nutritional support
    • Feeding is supported by a nasogastric tube through which nutrients are delivered 24 hours a day
  • Gastric decompression
    • Requires introduction of nasogastric suction as intestinal motility is gradually lost
    • Gastric aspirates should be regularly monitored
• Local treatment
  • First-aid measures
    • The patient is immediately removed from the source
    • Apply cold clean water to the area
• Bum wound care
  • The wound is cleansed with a surgical detergent and all loose nonviable skin is removed
  • Blister is punctured
  • Regular dressing is carried out
• Skin grafting
  • Excise the wound
  • The patient’s donor skin can be meshed to increase the size of the graft
  • It is then covered with cadaveric skin

Question 5. Skin grafting
Answer:

Skin grafting

Skin grafting is a surgical procedure involving the transplantation of skin or a skin substitute over a bum or nonhealing wound

Skin grafting Indications:

• Extensive raw wound
• Large wound due to trauma or burn
• Contracted scar
• Skin loss from surgically removed malignant growth
• In reconstructive surgeries

Skin grafting Types:

• Split thickness
  • Includes epidermis and a variable amount of dermis
  • Healing occurs by re-epithelization from the dermis and surrounding skin
• Full thickness
  • Includes epidermis and all the dermis
  • The donor site is sutured
• Composite graft
  • These are small grafts containing skin and underlying cartilage or other tissue

Question 6. PMMC flap
Answer:

PMMC flap Procedure:

• Skin below and medial to nipple over the muscle is used
• The incision is made over the skin
• Below the line or 3rd rib to retain the deltopectoral hap area
• The lower border of the muscle is raised
• Care is taken to avoid injury to thoracoacromial vessels
• The flap is raised over the medial and lateral margins of the pectoral and is the major muscle
• Skin with muscle is dissected from the deeper structures
• The flap is raised upwards upto the coracoid
• Lateral pectoral vessels are retained
• Pectoral nerves should be retained
• The defect below is usually closed primarily with sutures
• The flap is tunneled in the subcutaneous plane towards the neck or oral cavity
• Postoperatively flap is observed for color changes, seroma, and infection
• The neck is flexed towards the flap side
• A suction drain is placed
• Neck flap covers the carotids
• In the case of the oral cavity, skin can be split in half to cover both the inner and outer aspects of the oral cavity

PMMC flap uses:

• To cover the defect over the cheek/neck/pharynx/ intraoral lesions after wide excision
• Used along with deltopectoral flap.

Burns Skin Grafting And Flaps Short Answers

Question 1. Split skin grafting
Answer:

Split skin grafting

• Split skin grafting includes epidermis and variable amount of dermis
• Donor sites
  • Thigh
  • Buttock
• Healing occurs by re-epithelization from the dermis and surrounding skin

Split Skin Grafting Indications:

• Resurfacing large wound
• Lining cavities
• Resurfacing mucosal deficits
• Closure of flap donor sites
• Resurfacing muscle flaps

Split Skin Grafting Types:

• Thin- 0.005-0.012 inch
• Intermediate-0.012-0.018 inch
• Thick- 0.018-0.030 inch

Split Skin Grafting Disadvantages:

• More fragile
• Cannot withstand radiotherapy
• Contract during healing
• Gets hypo or hyperpigmented
• Less esthetic
• Lack of smooth texture

Question 2. Composite skin graft
Answer:

Composite skin graft

• Composite skin graft contains more than one tissue like skin, bone, tendons, cartilage, and muscle
• For example, it is used in the treatment of basal cell carcinoma

Composite skin graft Procedure:

• A graft is excised from the donor site
• A desired shape is obtained from it
• It is picked using a special instrument
• Placed over the injured part
• Secured in place with the help of sutures

Question 4. Plasma expanders
Answer:

Plasma expanders

Plasma expanders are high molecular weight substances which when infused IV exert osmotic pressure and remain in the body for a long time to increase the volume of circulating fluid

Plasma Expanders Ideal Properties:

• Should exert oncotic pressure comparable to plasma
• Should be long lasting
• Should be nonantigenic
• Should be pharmacologically inert

Plasma expanders Plasma Expanders Used Are:

• Dextrans
• Gelatin polymer
• Hydroxyethyl starches
• Polyvinyl pyrrolidone
• Human albumin obtained from pooled human plasma

Question 5. Burns of face
Answer:

Burns of face

• Facial burns vary from superficial to deep burns.
• Over 50% of burns involve the head and neck region.

Burns of face Causes:

• Flame
• Electric current
• Steam
• Hot substances
• Chemicals

Burns of face Treatment:

• Objectives
  • Restoration of function
    • Airway patency
    • Protection of cornea
    • Neck mobility
• Comfort
• Appearance

Question 6. Skin grafting indications
Answer:

Skin grafting indications

• Extensive raw wound
• Large wound due to trauma or bum
• Contracted scar
• Skin loss from surgically removed malignant growth
• In reconstructive surgeries

Question 7. Scalds
Answer:

Scalds

• Scald is a thermal injury or bum caused by moist heat such as boiling water, hot oil, or tar
• Injury is severe and sometimes life-threatening H Skin grafting is required
• Most thickness burn grafting results in scarring
• They result in a higher percentage of body surface area burned and longer stay in the hospital

Question 8. Third degree burns
Answer:

Third degree burns

It involves of entire depth of the epidermis and dermis

Third-degree burns Features

• It is painless due to the destruction of nerves Skin appears tough, dry, and eschar
• Thrombosed subcutaneous veins are seen
• In 3-5 weeks, eschar gets separated

Question 9. Types of skin grafting
Answer:

Types of skin grafting

1. Split thickness
   • Includes epidermis and a variable amount of dermis
   • Healing occurs by re-epithelization from the dermis and surrounding skin
2. Full thickness
   • Includes epidermis and all the dermis
   • The donor site is sutured
3. Composite graft
   • These are small grafts containing skin and underlying cartilage or other tissue

Question 10. Electric burns
Answer:

Electric burns

• Caused by low voltage electrical sources
• Tissue damage occurs
• The skin gradually undergoes coagulation necrosis
• It causes minimal destruction of skin
• The skin is involved at two points – at the point of contact and the point of exit
• Electrical injury to the muscles is associated with the release of hemochromogens into the bloodstream

Burns Skin Grafting And Flaps Viva Voce

1. Head and trunk in severely burnedpatientstaccounts for 45% of total body surface
2. Split-thickness grafts are used when the burns are extensive
3. Full-thickness grafts used to cover small areas
4. Lactated Ringer’s solution without dextrose is the fluid of choice except in children younger than 2 years
5. 5% dextrose Ringer’s lactate is used in children

General Surgery Miscellaneous Important Notes

Composition of Local Anaesthesia

General Surgery Miscellaneous Short Essays

Question 1. Local anaesthesia
Answer:

Local Anaesthesia Definition: It is loss of sensation in a circumscribed area of the body characterized by depression or excitation of nerve endings and inhibition of the conduction process of peripheral nerve

Local Anaesthesia Composition:

1. Local anesthetic- ester or amide
2. Vasoconstrictor- Epinephrine
3. Antioxidant- Sodium metabisulphite
4. Preservative- Methyl paraben
5. Fungicide-Thymol
6. Salt- sodium chloride
7. Vehicle- Distilled water or Ringers lactate solution

Local Anaesthesia Ideal Properties:

1. Nonirritant
2. No permanent damage to nerve
3. Low systemic toxicity
4. Effective
5. Short onset of action
6. Long-lasting effect
7. Potent
8. Free of allergens
9. Stable and biocompatible
10. Able to sterilize it

Question 2. Complications of local anaesthesia
Answer:

Local Anaesthesia Complications:

1. Needle breakage:

• Due to sudden movement of patient
  • Narrow gauge needle
  • Broken needle
  • Bonded needle
• Local Anaesthesia  Management:
  • Radiograph to locate it
  • Expose the site and remove it

2. Facial nerve paralysis:

• Facial Nerve Paralysis Causes: Insertion of needle into parotid capsule
• Facial Nerve Paralysis Management:
  • Self-curing
  • Eye can be protected with the help of eye pad
• Paraesthesia:

• • Paraesthesia Cause: Injury to the nerve
  • Paraesthesia Management: Self-recovery by regeneration of nerve

Read And Learn More: General Surgery Question and Answers

3. Trismus:

• Trismus Cause: Trauma to medial pterygoid muscle, Contaminated needle
• Trismus Management:
  • Analgesic
  • Muscle relaxants
  • Mot fomentation
  • Physiotherapy

4. Pain on injection:

• Pain on injection Cause: Blunt needle, Broader gauge needle
• Pain on injection Management: Use of short, narrow-gauge needle

5. Burning on injection:

• Burning on injection Cause:
  • Acidic solution of LA
  • Contaminated needle
• Burning on injection Management:
  • Isotonic solution by addition of bicarbonate
  • Use of disposable needle

6. Soft tissue injury:

• Soft Tissue Injury Cause: Due to unaware of numbness of lips patient tries to do lip biting
• Management:
  • Explain the patient about the numbness
  • Use of lipguards in children
• Soft Tissue Injury Hematoma:

• • Hematoma Cause: Injury to blood vessels
  • Hematoma Management:
    • Assure of proper anatomy of landmarks and nerve
    • Massage the area
    • Antibiotics
    • Hot fomentation

7. Infection:

• Local Anaesthesia Infection Causes: Contaminated needle
• Local Anaesthesia Infection Management:
  • Use of disposable needle
  • Antibiotics
  • Drainage of space involved
  • Physiotherapy

8. Necrosis of tissues Causes :

• Seen in palatal injection
• This region is tightly bound to the underlying bone
• Thus excessive pressure is required for insertion of needle
• Leads to blanching of the area
• Vasoconstriction and localized necrosis

9. Edema Causes:

• Injury to nerve
• Contaminated needle

10. Edema  Management:

• Subsides on its own
• Avoid application of hot fomentation
• Application of cold fomentation
• As it acts as a vasoconstrictor and analgesic

11. Post-anesthetic lesions

• Ulcers
• Allergic reactions

Post-anesthetic lesions Causes:

• Trauma
• Allergy to LA agent

Systemic Complications Local Anaesthesia :

Overdose:

1. Overdose Causes:
   • Excessive dose of LA
   • Systemic disorders of metabolism
2. Overdose Features
   • Nausea
   • Vomiting
   • Diplopia
   • Tremors
   • Acidosis
   • Respiratory distress
   • Chest pain
   • Bradycardia
   • Hypotension
   • Dizziness
3. Overdose Management:
   • Reassure the patient
   • Maintain patient’s airway
   • Intubate if necessary
   • Cardiac life support giyen
   • 4 fluids and vasopressors given for hypotension
4. Hypersensitivity:
   1. Hypersensitivity Causes:
      • Allergy to LA
      • Allergy to the preservative used
   2. Hypersensitivity Features:
      • Pruritis
      • Utricaria
      • Dyspnoea
      • Wheezing
      • Nausea, vomiting
      • Erythema
   3. Hypersensitivity Management:
      • Stop the procedure
      • Mild allergy-corticosteroids
      • Severe allergy- epinephrine 1:1000 of 0.3-0. ml SC
      • If symptoms continues 5 ml of 1:10000 epi nephrite given 4

Question 3. FNAC
Answer:

FNAC Method:

• 23-26 gauge needle is inserted into the tissues
• Aspirate the needle
• Cystic fluid is collected in it
• Examine the fluid

FNAC Indication:

• Cystic cavity
• OKC

Question 4. Anaphylaxis
Answer:

Anaphylaxis Features:

• Severe dyspnoea
• Hoarseness of voice
• Hypotension
• Nausea
• Cyanosis
• Abdominal cramps
• Tachycardia
• Bronchospasm
• Chest tightness

Anaphylaxis Management:

• Upright position of patient
• Elevate the legs
• Basic life support
• Administer adrenaline 1:1000 0.3 mg IM
• Administer oxygen
• Recovery of patient
• Give antihistamine IM
• Continue basic life support
• Transfer the patient to hospital

Question 5. Oral submucous fibrosis
Answer:

Oral submucous fibrosis

• It is a pre-cancerous condition
• It is characterized by juxta epithelial inflammatory reaction in the oral mucosa followed by a fibro elastic transformation of the lamina propria loading to mucosal atrophy, rigidity, and trismus

Oral Submucous Fibrosis Etiology:

• Consumption of red chilies
• Consumption of areca nuts
• Nutritional deficiencies
• Immunological factors
• Genetic factors

Oral Submucous Fibrosis Features:

• Burning sensation
• Difficulty in mastication
• Referred pain in ear
• Depapillation of longue
• Restricted movement of floor of mouth
• Shrunken uvula
• Fibrous bands
• Restricted mouth opening
• Stiffness of buccal mucosa

Oral Submucous Fibrosis Management:

• Quit the habit
• Antioxidant- Oxyacc-1 capsule/ day
• Multivitamin therapy
• Steroid- Betnovate 0.12%
• Tumeric application
• Intralesional injection of Hyaluronidase-1500 U
• Physiotherapy
• Splitting of fibrous bands
• Laser

Question 6. Mechanism of action of LA
Answer:

Mechanism of action of LA

• Displacement of calcium ions from sodium channel receptor site which permits
• Binding of LA molecule to this site which produces
• Blockade of the sodium channel and a
• Decrease in sodium conductance, which leads to
• Depression of rate of electrical depolarization
• Failure to achieve the threshold potential level along with a
• Lack of development of propagated action potential which is called
• Conduction blockade

Question 7. Mandibular nerve block
Answer:

Mandibular nerve block

• Nerves anaesthesized: inferior alveolar nerve and its branches
  • Areas to be anesthetized: mandibular teeth and its supporting tissues

Mandibular Nerve Block Landmarks:

• Mucobuccal fold
• Anterior border of coronoid process
• Coronoid notch
• Pterygomandibular raphe
• Retromolar pad
• Retromolar triangle
• External oblique ridge

Mandibular Nerve Block  Technique:

• Position the patient in semi-reclined position
• Move your index finger over the mesiobuccal fold up to external oblique ridge
• Move it up and down to obtain depression
• This is a coronoid notch
• Retract the cheek
• Support the mandible
• Insert 1 5/8 inch 25 gauge needle from lingual side
• Aspirate and Slowly deposit the solution

Positive Aspiration: 10-15%

Question 8. Paget’s disease of bone
Answer:

Paget’s disease of bone

It is bone disorder characterised by an excessive uncoordinated phase of bone resorption and subsequent deposition of bone in same area

Paget’s Disease Of Bone Clinical Features

• Age-old people are usually affected
• Sex – common in males
• Site – weight-bearing areas
  • Skull
  • Pelvis
  • Sternum
  • In jaws, common in maxilla than in mandible
• Presentation
  • Pain is always present
  • Bilateral swelling
  • Waddling gait
  • Involvement of facial bone causes leontiasis ossea
  • Headache
  • Enlargement of skull

Paget’s Disease Of Bone  Radiological features

• Haphazardly arranged radiolucent and radiopaque areas representing new bone deposition and resorption in the involved area
• This gives cotton wool appearance
• In jaw, it shows
  • Prognathic mandible
  • Hypercementosis
  • Obliteration of periodontal ligament space
  • Root resorption
  • Loss of lamina dura

Paget’s Disease Of Bone  Complication: Osteosarcoma

Question 9. Causes and complications of chronic otitis media
Answer:

Chronic Otitis Media Causes:

• Inflammation of middle ear
• Resistant bacterial infection
• Risk factors
  • Traumatic perforation of tympanic membrane
  • Insertion of grommets
  • Craniofacial abnormalities

Chronic Otitis Media  Complications

• Meningitis
• Intracranial abscess
• Facial paralysis
• Conductive hearing loss
• Scarring of tympanic membrane
• White calcified plaques in tympanic membrane

Question 10. Causes of inflammation
Answer:

Causes of inflammation

• Infection
• Injury
• Autoimmune disorders
• Long-term exposure to irritants
• Contributing factors are
  • Smoking
  • Alcohol
  • Stress
  • Obesity

General Surgery Miscellaneous Short Answers

Question 1. Pain
Answer:

Pain

• Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage
• It is considered as part of the body’s defense system

Pain Management

• Acute pain- by analgesics and antibiotics
• Chronic pain
  • Analgesics
  • Sedatives
  • Physiotherapy

Question 2. Adenoid
Answer:

Adenoid

• It is mass of soft tissue present behind the nasal cavity.
• It is part of immune system
• It is formed by lymphoid tissue.
• It is present at birth and disappears in adolescence.

Adenoid Causes:

• Bacterial infections
• Viral infections
• Pollutants

Adenoid Disorders:

• Adenoiditis
• Obstructive sleep apnoea
• Middle ear infections

Adenoid Treatment:

• Adenoidectomy
• Antibiotics to treat infection

Question 3. Otitis media
Answer:

Otitis media

• In middle ear infections, middle ear gets inflamed and is filled with fluid
• This is called Otitis media

Otitis Media Clinical Features:

• In infants
  • Irritability
  • Pulling and stretching of ear
  • vomiting
  • Drainage from ear
  • Fever
• In adults
  • Earache
  • Hearing problems
  • Fever
  • Pressure sensation in ear
  • Dizziness
  • Nausea
  • Vomiting

Question 4. Chemotherapy
Answer:

Chemotherapy

Chemotherapy refers to the use of chemical in infectious diseases to destroy microorganisms without damaging the host tissues

Chemotherapy Drugs:

• Alkylating agents
• Antimetabolites
• Anthracyclines
• Plant alkaloids
• Topoisomerase inhibitors
• Anti-tumor agents

Chemotherapy Adverse Effects:

• Immunosuppression
• Myelosuppression
• Fatigue
• Gastrointestinal distress
• Nausea
• Vomiting
• Diarrheoa
• Apolecia
• Damage to specific organs
• Cardiotoxicity
• Hepatotoxicity
• Nephrotoxicity
• Ototoxicity

Question 5. Insulin
Answer:

Insulin

Insulin is stored in granules in the beta islet cells of the pancreas

Insulin Actions

• Stimulates uptake and metabolism of glucose in the peripheral tissues
• Inhibits lipolysis
• Facilitates amino acid uptake

Insulin Side Effects

• Hypoglycaemia
• Allergy
• Lipodystrophy
• Edema

Insulin Classification

• Conventional insulins
  • Short and long-lasting
  • Intermediate-acting
  • Long-acting
• Highly purified insulin
• Human insulin
• Insulin analogs
• Insulin mixtures

Question 6. Penicillin
Answer:

Penicillin

β Lactum antibiotic Mechanism:

• Inhibit cell wall synthesis
• Inhibit transpeptidase thus inhibit synthesis of peptidoglycan

Penicillin Classification:

• Natural- Penicillin G
• Semisynthetic
  • Acid resistant – Penicillin V
  • Penicillin resistant- Methicillin
  • Aminopenicillin- Ampicillin
  • Antipseudomonal penicillin- Carbenicillin

Penicillin Uses:

• Orodental infections
• Syphilis
• Gonorrhea
• Streptococcal infections
• Tetanus
• Prophylactic
• Gangrene

Penicillin Adverse Reaction:

• Hypersensitivity
• Anaphylaxis
• Local pain at the site of injection
• Suprainfection
• Farish Herxheimer reaction

Question 7. Antioxidant
Answer:

Antioxidant

Antioxidant is a molecule capable of inhibiting the oxidation of other molecules

Antioxidant Uses:

• Inhibit oxidation reactions
• Used as ingredients in dietary supplements
• Prevents cancer, coronary heart disease
• Industrial use as preservatives in food and cosmetics
• Prevents degradation of rubber and gasoline

Antioxidant Agents:

• Thiols
• Ascorbic acid
• Polyphenols
• Glutathione
• Superoxide dismutase

Question 8. Spinal anesthesia
Answer:

Spinal anesthesia

• Local anaesthetic solution is injected into the subarachnoid space between L2-3 or L3-4 below end of the spinal cord
• Lower abdomen and lower limbs are anaesthetized and paralyzed

Spinal Anesthesia Advantages

• Safe
• Affords good analgesic
• Muscle relaxant
• No loss of consciousness

Spinal Anesthesia Uses:

• Surgical procedures on the
  • lower limb
  • Pelvis
  • Lower abdomen
  • Obstetric procedures
  • Cesarean section

Spinal Anesthesia Complications:

• Hypotension
• Bradycardia
• Respiratory paralysis
• Headache
• Cauda equine syndrome
• Sepsis
• Nausea
• Vomiting

Question 9. Topical anaesthesia
(or)
Surface acting anaesthesia
Answer:

Topical anaesthesia

Anaesthesia of mucous membrane of the eye, nose, mouth, tracheobranchial tree, oesophagus, and genitourinary tract can be produced by direct application of the anaesthetic solution

Topical Anaesthesia Actions:

• Produces vasoconstriction
• Prolongs duration of action
• Anaesthesia is superficial

Topical Anaesthesia Agents Used:

• Tetracaine
• Lignocaine
• Phenylephrine

Question 10. Prophylactic antibiotics
Answer:

Prophylactic antibiotics

Question 11. Drugs used in general anaesthesia
Answer:

Drugs used in general anaesthesia

1. Volatile anaesthetics
   • Ether
   • Trichloroethylene
   • Halothane
   • Enflurane
   • Isoflurane
   • Sevoflurane
2. Gaseous anaesthetics
   • Nitrous oxide
   • Cyclopropane
3. Intravenous anaesthetics
   • Thiopentone
   • Methohexitone sodium
   • Propanidid
   • Ketamine
   • Propofol
   • Fentanyl
4. Oxygen

Question 12. Signs of inflammation
Answer:

Signs of inflammation

1. Rubor – redness
   • Cause – vasodilatation in the area of inflammation
2. Tumour – swelling
   • Cause
     • Increased local hydrostatic pressure
     • Transudation of fluid into extracellular space
3. Calor – heat
   • Cause – vasodilatation
4. Dolor – pain
5. Function laesa – loss of function

Question 13. Paronychia
Answer:

Paronychia

• It is common hand infection
• Types

1s. Acute paronychia

• Occurs in subcuticular area under eponychia
• Cause – mild injury to finger
• Causative organism – staphylococcus aureus and streptococcus pyogenes

Paronychia Features

• Suppuration occurs
• It spreads around skin margin and under the nail causing hang nail or floating nail
• Severe throbbing pain and tenderness with pus under nail root
• Nail is tender to touch

Paronychia Treatment

• Antibiotics
• Analgesics
• Drainage of pus
• Removal of floating nail

Chronic paronychia: Occurs due to fungal infection

Chronic paronychia Features: 

• Itching in thi-nailbed
• Recurrent pain
• Discharge

Chronic paronychia Treatment

• Long-term antifungal therapy
• Antibiotics
• Removal of nails in severe infection

General Surgery Miscellaneous Viva Voce

1. The primary site of action of the local anesthesia is nerve membrane
2. Maxillary first molar is the most difficult tooth to Anaesthesize by infiltration alone
3. Cocaine increases the vasoconstrictive action of adrenaline
4. Succinylcholine prevents laryngospasm due to GA
5. Most common cause of death occurring during GA administration is due to airway obstruction with improper ventilation.