General Surgery Miscellaneous Question And Answers

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

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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.