Kanchana Sundaramurthy DNB (Surg) MRCS
Consultant Surgeon Apollo Hospitals Chennai, Tamil Nadu India
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357
Registered Office
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021
+91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
e-mail: jaypee@jaypeebrothers.com, Visit our website: www.jaypeebrothers.com
Branches
- 2/B, Akruti Society, Jodhpur Gam Road SatelliteAhmedabad 380 015, Phones: +91-79-26926233, Rel: +91-79-32988717Fax: +91-79-26927094, e-mail: ahmedabad@jaypeebrothers.com
- 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park EastBengaluru 560 001, Phones: +91-80-22285971, +91-80-22382956, 91-80-22372664Rel: +91-80-32714073, Fax: +91-80-22281761 e-mail: bangalore@jaypeebrothers.com
- 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon RoadChennai 600 008, Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089Fax: +91-44-28193231 e-mail: chennai@jaypeebrothers.com
- 4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road,Hyderabad 500 095, Phones: +91-40-66610020, +91-40-24758498Rel:+91-40-32940929, Fax:+91-40-24758499 e-mail: hyderabad@jaypeebrothers.com
- No. 41/3098, B & B1, Kuruvi Building, St. Vincent RoadKochi 682 018, Kerala, Phones: +91-484-4036109, +91-484-2395739+91-484-2395740 e-mail: kochi@jaypeebrothers.com
- 1-A Indian Mirror Street, Wellington SquareKolkata 700 013, Phones: +91-33-22651926, +91-33-22276404+91-33-22276415, Rel: +91-33-32901926, Fax: +91-33-22656075e-mail: kolkata@jaypeebrothers.com
- Lekhraj Market III, B-2, Sector-4, Faizabad Road, Indira NagarLucknow 226 016 Phones: +91-522-3040553, +91-522-3040554e-mail: lucknow@jaypeebrothers.com
- 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, ParelMumbai 400 012, Phones: +91-22-24124863, +91-22-24104532,Rel: +91-22-32926896, Fax: +91-22-24160828e-mail: mumbai@jaypeebrothers.com
- “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred RoadNagpur 440 009 (MS), Phone: Rel: +91-712-3245220, Fax: +91-712-2704275e-mail: nagpur@jaypeebrothers.com
USA Office
1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA, Ph: 001-636-6279734
Clinical Surgical Case Manual
© 2009, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition
9788184485721
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
7Preface
This book is brought out as a comprehensive study of surgical clinical cases, their presentation and management options. This is not a textbook of surgery. It is meant to be used by the students in preparation for postgraduate clinical examination, by the surgical teachers before clinical teaching sessions, by the examiners of various postgraduate surgical exams as well as by the practitioners of surgery as an aide.
In studying this book, if the postgraduate student and the surgical practitioner get a clear picture of the surgical condition facing him and ways to manage it, the purpose of writing this book is more than satisfied.
At the end of some of the chapters, a section on frequently asked questions is added, to help the exam going candidate face his examiner confidently. This book also contains tips on good performance in theory, clinical and viva-voce examinations, so that the candidate who follows these tips has that crucial edge over the others. It is my sincere hope that the exam going candidates find this book a priceless possession for their clinical preparation and surgical practitioners for their day-to-day management of cases.
This book consists of skin, vascular surgery, head and neck surgery, breast, gastroenterology, hepatobiliary surgery and urology.
Your comments and suggestions for improvement are welcome. Kindly address them to kan_sundar@yahoo.co.in
9Tips on Writing Theory Answers
- Do not write what is not asked for example, when etiopathology is asked, writing about management is unnecessary.
- When you are asked to write about clinical features, always start with history and clinical examination.
- When you are asked to write about management, write investigations and treatment.
- In investigations, include history and clinical examination, as this is the first investigation done by the clinician.
- In treatment, in addition to treatment of the condition, enumerate the complications and mention the treatment of complications.
- When you are asked to write about epidemiology, include incidence and prevention as well as spread in case of malignancy.
- Incidence
- Geographical area
- Age
- Sex
- Pattern of disease
- Areas affected
- Etiology
- Congenital
- Traumatic
- Inflammatory
- Infective
- Bacterial
- Viral
- Fungal
- Autoimmune
- Degenerative
- Pathology
- Macroscopic appearance
- Microscopic appearance
- Spread
- Direct Along bowel wall
- Horizontal
- Vertical
- Adjacent organs
- Intraluminal
- Intracavitary
- Lymphatic
- Bloodstream
- Distant metastasis
- Miliary spread
- By invasion or embolic spread
- History
- Name, age, sex, geographical area
- Complaints — duration of each
- Sequence of events
- Past history — medical/surgical
- Family history
- Personal history — smoking, alcohol, diet, occupation
- Menstrual history in female
- Clinical Examination
- General examination
- Build
- Nourishment
- Icterus
- Cyanosis
- Clubbing
- Lymphadenopathy
- Pedal edema
- Anasarca
- Cachexia
- Hydration
- Gait
- Local site
- Inspection
- Palpation
- Percussion
- Auscultation
- Measurement
- Movement
- Investigations
- Blood
- Hematology
- Coagulation
- Biochemistry
- Smears
- Microbiology — cultures
- Radiology
- X-ray
- Contrast X-ray
- Nuclear scan
- Pathology
- FNAC/Trucut
- Histopathology
- Treatment
- Change of lifestyle— counseling
- Medical treatment
- Preoperative
- Postoperative
- Surgical treatment
- Complications
- Course of the disease (if untreated)
- Postoperative complications
- Treatment of complications
- Medical
- Surgical
- Prognosis
- Percentage survival
- Prognostic factors
- Patient factors
- Disease factors
- Prognostic index
- Before facing any exam, be it theory, clinical or viva, it is desirable to plan for the answers you are going to give. Your answers should attract the examiner in a unique way and that will make him sit up and notice you.
- A theory answer should have a plan in the first page which tells the examiner what he is going to read in the next few pages. The plan should consist of the broad side headings and classification.
- Confine the short note to two pages. Diagrams and flow charts tell the examiner what you want to convey much more effectively than volumes of written pages.
- During clinical exam, see that you are the speaker and the examiner is the listener. Do not allow it to be the other way round.
- Lead the examiner to the points you want to tell him rather than the points which he wants to ask you.
- Act as the consultant discussing the case with a colleague rather than the student facing a barrage of questions.
- During viva voce, radiology interpretation is given weightage. Always start with the most obvious abnormality in the radiology film and then proceed to describe the rest of the film.