PMDC National Licensing Examination Surgery and Allied Flashcards

24 sample cards from the Surgery and Allied deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Differentiate the clinical presentation of small bowel vs large bowel obstruction.

   Small bowel obstruction: early/profuse vomiting, central colicky pain, less distension, dehydration prominent; X-ray shows central valvulae conniventes. Large bowel obstruction: marked distension, later vomiting (feculent), constipation early; X-ray shows peripheral haustra not crossing the lumen.

2. What are the four cardinal features of intestinal obstruction?

   Colicky abdominal pain, vomiting, abdominal distension, and absolute constipation (no passage of flatus or feces). Bowel sounds are high-pitched/tinkling early and absent later.

3. List the most common causes of small bowel obstruction vs large bowel obstruction.

   Small bowel: adhesions (most common), hernias, and tumors. Large bowel: colorectal carcinoma (most common), volvulus, and diverticular stricture.

4. Distinguish mechanical obstruction from paralytic ileus on examination.

   Mechanical obstruction: colicky pain, hyperactive/tinkling bowel sounds (early). Paralytic ileus: painless distension with ABSENT bowel sounds and no peristalsis (often post-operative, electrolyte disturbance, or peritonitis).

5. What is the order of the ABCDE primary survey in ATLS?

   A - Airway with cervical spine protection; B - Breathing and ventilation; C - Circulation with hemorrhage control; D - Disability (neurological status, GCS, pupils); E - Exposure/Environment (undress and prevent hypothermia).

6. What is the purpose of the secondary survey in ATLS and when is it performed?

   A head-to-toe examination with full history (AMPLE: Allergies, Medications, Past history, Last meal, Events) to identify all injuries. It is performed only after the primary survey is complete, life-threats are addressed, and resuscitation has begun and the patient is responding.

7. Name the immediately life-threatening chest injuries identified in the primary survey (Breathing).

   ATOM-FC: Airway obstruction, Tension pneumothorax, Open pneumothorax (sucking chest wound), Massive hemothorax, Flail chest, Cardiac tamponade. These must be detected and treated during ABC.

8. Describe tension pneumothorax findings and immediate management.

   Respiratory distress, tracheal deviation away from the affected side, absent breath sounds and hyperresonance on the affected side, distended neck veins, hypotension. Immediate needle decompression (2nd intercostal space midclavicular line or 5th ICS anterior axillary line) followed by chest tube.

9. How is the Glasgow Coma Scale scored and what range defines severe head injury?

   GCS scores Eye opening (1-4), Verbal response (1-5), and Motor response (1-6), total 3-15. Severe head injury = GCS 3-8; moderate = 9-12; mild = 13-15. GCS <=8 generally mandates definitive airway (intubation).

10. Differentiate an extradural (epidural) from a subdural hematoma.

    Extradural: arterial (middle meningeal artery), often after temporal fracture, biconvex/lens-shaped on CT, classic lucid interval then deterioration, doesn't cross suture lines. Subdural: venous (bridging veins), crescent-shaped, crosses suture lines, common in elderly/alcoholics, more gradual onset.

11. What is the FAST scan and which four areas does it assess?

    Focused Assessment with Sonography in Trauma - bedside ultrasound to detect free fluid (blood). Views: pericardial (subxiphoid), right upper quadrant (hepatorenal/Morrison's pouch), left upper quadrant (splenorenal), and pelvis (pouch of Douglas).

12. In blunt abdominal trauma, which two solid organs are most commonly injured?

    The spleen (most common) and the liver. Splenic injury presents with LUQ pain and may cause referred left shoulder pain (Kehr's sign).

13. What is the Rule of Nines for estimating burn surface area in an adult?

    Head & neck 9%, each upper limb 9%, each lower limb 18%, anterior trunk 18%, posterior trunk 18%, perineum/genitalia 1%. (The patient's palm ~1% TBSA for patchy burns.)

14. State the Parkland formula for burn fluid resuscitation.

    4 mL x body weight (kg) x %TBSA burned of Ringer's lactate over 24 hours; give HALF in the first 8 hours (from time of burn) and the remaining half over the next 16 hours. Titrate to urine output (0.5-1 mL/kg/hr).

15. Classify burns by depth and their clinical features.

    Superficial (1st degree): epidermis only, red, painful, no blisters (e.g., sunburn). Partial thickness (2nd): blisters, moist, painful, blanches. Full thickness (3rd): leathery, white/charred, painless, non-blanching. 4th degree extends to muscle/bone.

16. When is escharotomy indicated in burns?

    In circumferential full-thickness burns of a limb (causing compartment syndrome/distal ischemia) or of the chest (restricting ventilation). Escharotomy incises the eschar to relieve the constriction.

17. What features suggest inhalational airway injury in a burn patient, mandating early intubation?

    Facial/neck burns, singed nasal/facial hair, soot in mouth/sputum (carbonaceous sputum), hoarseness/stridor, history of fire in an enclosed space. Early intubation is done before airway edema makes it impossible.

18. State the Salter-Harris classification of pediatric physeal (growth plate) fractures.

    Type I: through physis only. Type II: through physis + Metaphysis (most common). Type III: through physis + epiphysis (into joint). Type IV: through metaphysis, physis, and epiphysis. Type V: crush injury to physis (worst prognosis). Mnemonic SALTR.

19. Describe the components of a complete fracture description.

    Site (which bone/region), pattern (transverse, oblique, spiral, comminuted, segmental), displacement, angulation, rotation, shortening, whether open or closed, intra/extra-articular, and associated neurovascular injury.

20. What are the cardinal principles of fracture management ('the 4 R's')?

    Resuscitation (if needed), Reduction (restore alignment - closed or open), Restriction/Immobilization (cast, splint, or fixation), and Rehabilitation (restore function). Plus 'hold' and 'rehabilitate' in the reduce-hold-rehabilitate framework.

21. What is compartment syndrome and its earliest reliable clinical sign?

    A surgical emergency where increased pressure within a fascial compartment compromises perfusion. Earliest/most reliable sign is PAIN out of proportion to injury, worsened by passive stretch of the muscles. (The other 'P's - pallor, pulselessness, paresthesia, paralysis - are late.) Treat with urgent fasciotomy.

22. What is the difference between a dislocation and a subluxation, and which joint dislocates most commonly?

    Dislocation: complete loss of articular contact between the two bones of a joint. Subluxation: partial loss of contact. The shoulder (glenohumeral joint) is the most commonly dislocated major joint, usually anteriorly.

23. Which nerve is at risk in an anterior shoulder dislocation and how is it tested?

    The axillary nerve - tested by sensation over the 'regimental badge' area (lateral upper arm/deltoid) and deltoid motor function. It should be assessed before and after reduction.

24. Compare osteomyelitis spread and the most common causative organism.

    Acute osteomyelitis is most commonly caused by Staphylococcus aureus, spreading hematogenously (commonly to metaphyses of long bones in children) or by direct/contiguous spread from open fractures/surgery. Sickle cell patients have increased risk of Salmonella osteomyelitis.

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