1. ABDOMINAL APOPLEXY
Spontaneous hemorrhage into the peritoneal cavity:
Causes:
- Tumors
- Hepatoma
- Spleen
- Other organs
- Arteriosclerotic lesion in older individuals
- Superior mesenteric artery — Mesenteric apoplexy (spontaneous rupture)
- Right colic artery
- Branches of celiac.
- Hemorrhage from congenital aneurysm in young patients — Bleeding from splenic artery aneurysm in pregnancy.
2. ABSCESS, COLD ABSCESS
Abscess: It is a localized collection of pus in a pathological space lined by granulation tissue.
Cold Abscess: Soft fluctuant swelling without signs of inflammation, which is mistaken for a cyst. This is lined by granulation tissue and caseous material. It is due to tuberculous infection and contains tubercle bacilli. It is not hot. Brawny induration, edema and tenderness are absent.
3. ACUTE ABDOMEN
Any sudden spontaneous nontraumatic disorder affecting the abdomen for which urgent operation may be necessary and undue delay in diagnosis may adversely affect the outcome.
4. ADL (ACTIVITIES OF DAILY LIVING)
It is critical to assess the functional status of the prospective older candidate for surgery prior to scheduling an operation.
The activities are—
- Feeding oneself
- Bathing
- Toileting (continence)
- Transferring from bed to chair
- Dressing
- Grooming.
Instrumental ADLs are more complex —
- Food preparation
- Shopping
5. AGENESIS / ATRESIA
Agenesis: Failure of development of an organ or structure.
Atresia: Failure to canalize a viscera.
6. AMYLASE
Amylase: A serum amylase level four times above the normal is indicative of acute pancreatitis.
7. ANKYLOGLOSSIA
Inability to protrude the tongue due to involvement of the muscles of tongue by carcinoma. The tongue deviates to the affected side.
8. APATHETIC HYPERTHYROIDISM
Asymptomatic mild hyperthyroidism occurring in the elderly recognized only by laboratory findings.
9. ARC OF RIOLAN (MEANDERING MESENTERIC ARTERY)
The left colic artery near the splenic flexure bifurcates, one of the branches passes to the right in the transverse mesocolon to anastomose with a similar branch of middle colic artery to form the Arc of Riolan. This has got important role in supplementing the marginal artery (Fig. 10.1).
10. BACTEREMIA, PYEMIA, SEPTICEMIA
Bacteremia: Circulating bacteria in the blood without producing disease.
Pyemia: Circulating infective emboli composed of masses of organisms, vegetations and infected clots in the blood stream.
Septicemia: Circulation of bacteria in blood producing disease.
11. BARRETT'S ESOPHAGUS
It is a metaplasia of the lower esophageal mucosa due to replacement of the squamous epithelium, by columnar epithelium, endoscopically having salmon pink appearance replacing the whitish squamous epithelium pathologically showing intestinal type of epithelium with goblet cells.
12. BILIARY COLIC, CHOLECYSTITIS
The term colic is inaccurate for gallbladder. It produces constant pain in most cases as a result of obstruction to cystic duct. The pain last for 1–5 hours, and rarely shorter than 1 hour duration (Right upper quadrant pain radiating to right upper back, right scapula or between the scapula). Pain lasting beyond 24 hours suggest acute inflammation – Cholecystitis.
13. BOIL, FURUNCLE, FURUNCULOSIS, FOLLICULITIS, CARBUNCLE
Folliculitis: Affection of the root of one hair follicle alone by staphylococcus is called folliculitis.
Boil/Furuncle: Infection of the root of the hair follicle with perifolliculitis caused by Staphylococcus is called Boil/Furuncle.5
Furunculosis: Multiple boils with intervening normal tissue is called furunculosis.
Carbuncle: Infective gangrene of skin and subcutaneous tissue caused by staphylococcus (Multiple boils with involvement of intervening tissue also).
14. BREAST CARCINOMA—DEFINITIONS
Skin tethering and fixity: The skin tethering is due to early involvement of ligaments of Cooper.
Manifested as puckering of the skin. The underling lump can be moved independently of the skin to some extent.
Skin fixity: It is due to invasion of carcinoma along the ligaments of Cooper to the skin.
The lump and the skin cannot be moved seperately.
Retraction (Recent) of nipple: Extension of growth along the lactiferous duct and subsequent fibrosis.
Peau d’ Orange appearance is due to blockage of the lymphatics draining the skin – cutaneous lymphedema. The hair follicles are more firmly fixed to the subcutaneous tissue than the rest of the skin. The hair follicles appear to be retracted and the between areas swell giving the orange peel appearance.
TDLU: (Terminal Duct Lobular Unit): The functional unit of the breast is the terminal duct lobular unit. All cancers of the breast and most benign conditions arise with in TDLU (Fig. 5.4).
Skin Involvement – T4b
Edema (including peau d’ orange) or ulceration of the skin of the breast or satellite skin nodules confined to the breast. Dimpling of the skin and nipple retraction are not considered skin involvement.
Inflammatory carcinoma breast: It is a clinicopathological entity characterized by diffuse erythema and edema (peau d’ orange) of the breast without an underlying palpable mass, involving the majority of the skin of the breast. This is due to tumor emboli within dermal lymphatics. The biopsy should demonstrate cancer within the dermal lymphatic or in breast parenchyma itself. Neglected LABC (locally advanced breast cancer) is not inflammatory Ca.
Extensive in situ component: If more than 25% of the main tumor mass contain in situ disease and there is in situ cancer in the surrounding breast tissue, the cancer is classified as having an extensive in situ component.
Chest wall infiltration: Chest wall includes Ribs, intercostals muscles and serratus anterior muscle but not the pectoral muscle.
Supraclavicular nodes: These are seen in a triangle defined by the omohyoid muscle and tendon, internal jugular vein (medial border) and the clavicle and subclavian vein (lower border). Adjacent nodes outside this triangle are considered to be lower cervical nodes (M1).
Multicentric: Tumor foci in different quadrant is called multicentric.
Microinvasion (Ti mic): Microinvasion of 0.1 cm or less in greatest dimension.
Micrometastasis: Tumor deposits greater than 0.2 mm, but not greater than 2 mm in largest dimension having histologic evidence of malignant activity namely proliferation or stromal reaction.
Isolated tumor cells: Single cell or small clusters of cells not greater than 0.2 mm in largest dimension with no histologic evidence of malignant activity.
15. BRUIT
It is the sound produced by the turbulent blood flow through a stenotic arterial segment which is transmitted distally along the course of the artery. When a bruit is heard over the peripheral vessel, stenosis is present at or proximal to that level.
It is heard loudest during systole and with greater stenosis may extend into diastole. The pitch of the bruit rises as the stenosis becomes more marked. Absence of bruit does not indicated absence of occlusion. When the vessel become completely occluded, the bruit may be disappeared.
16. BURNS, SCALD, FAT BURN
Burns: Injury by dry heat.
Scald: Injury by moist heat.
Fat burn: Injury by boiling oil.
17. BURSAE: BUNION, CLERGYMAN'S KNEE, GOLFER'S ELBOW, STUDENTS ELBOW, HOUSEMAID'S KNEE, TENNIS ELBOW
Bursae: These are fluid-filled cavities lined with flattened endothelium similar to synovium. Usually seen in relation to joints. When they develop over pressure points, they are called adventitious bursae (see examples). They prevent friction during movement. Fluctuation, fluid thrill and transillumination are positive.
Housemaid's knee: It is a subcutaneous bursae between patella and skin.
Clergyman's knee: It is a subcutaneous bursa between skin and ligamentum patella.
Students elbow: It is a subcutaneous bursae between skin and olecranon.
Golfer's elbow: It is medial epicondylitis Tenderness can be elicited at the medial epicondyle at the common flexor origin.
Tennis elbow: It is lateral epicondylitis (Common extensor origin at the lateral epicondyle is affected).
Bunion: Sub cutaneous bursa between skin and head of 1st metatarsal bone.
18. CARBUNCLE
Read boil.
19. CELLULITIS, ERYSIPELAS
Cellulitis: Spreading inflammation of subcutaneous and fascial tissue caused by 7Streptococcus pyogenes. Commences in a trivial infected wound. It has “No edge, No fluctuation, No pus and No limit”.
Morison's aphorism: “Cellulitis occurring in Children is never primary in the cellular tissue, but secondary to an underlying bone infection”.
Cellulitis of the scrotum: Always rule out extravasation of urine.
Erysipelas: It is cuticular lymphangitis.
Milian's ear sign: Facial erysipelas spreads and involves the pinna because it is cuticular lymphangitis. Subcutaneous inflammations stop short for the pinna because of close adherence of the skin to the cartilage.
20. CLAUDICATION, REST PAIN
Claudication: (I limp). Claudication is the cramp like muscle pain which appears following exercise when there is an inadequate arterial blood flow.
It must fulfill three criteria
- It is a cramp like muscle pain (usually the calf)
- Pain develops only when the muscle is exercised.
- The pain disappears when the exercise stops.
Rest pain: It is the continues pain caused by severe ischemia. This pain is present at rest through out the day and the night. The pain is relieved by putting the leg below the level of the heart.
21. CLERGYMAN'S KNEE
Read bursae.
22. COLD ABSCESS
Read abscess.
23. COMPRESSIBILITY, REDUCIBILITY
Compressibility: When the contents of a swelling can be emptied by squeezing but the swelling reappear spontaneously on release of pressure.
Reducibility: When the contents of a swelling can be emptied by squeezing but does not return spontaneously. This requires additional force such as cough or effect of gravity. E.g: Hernia.
24. COMPOUND PALMAR GANGLION
Compound palmar ganglion: It is a tuberculous affection of ulnar bursae, with a swelling in the hollow of the palm, extending to the lower fore arm. Cross fluctuation can be elicited between the palm and lower forearm.
25. CONSTIPATION, OBSTIPATION
Constipation: A bowel frequency of less than one every 3 days. (Fewer than two per week).
Obstipation: (Absolute constipation): Absence of passage of both stool and flatus.
26. COUGH IMPULSE
Cough Impulse: Expansile impulse seen or felt over a swelling when the patient coughs, cries or strains.8
27. CREPITUS
Crepitus: (Grating or crackling sensation imparted to the examining fingers) may be present when the joint contain loose bodies. May communicate with joint. It is also seen in the following conditions.
- Subcutaneous emphysema (surgical emphysema) – gas is present in the subcutaneous tissue.Four types:
- Traumatic – Fracture ribs, injury to nasal fossa, breach of continuity of larynx, tacheostomy, fracture skull involving sinuses.
- Infective – Gas gangrene.
- Extraneous – After fluid administration, closure of surgical wound, etc.
- Complicating rupture of esophagus.
- Fracture of bones
- Extravasation of gas in pneumoperitoneum
- Pseudo gas gangrene (air entrapped in the subcutaneous tissue after laparotomy).
28. CYST
Cyst: It is a pathological fluid-filled sac bound by a wall. It may be true or false. Congenital or acquired.
True cyst: It is one in which the sac is lined with cells of epithelial origin.
False cyst: It is a walled off fluid collection not lined by epithelium. False cyst may be inflammatory or degenerative.
29. DERMOID
Dermoid: Cyst formation due to sequestration of epithelium deep to the skin surface.
30. DIETL'S CRISES
Dietl's crises: This is due to intermittent hydronephrosis. After an attack of acute renal pain, a swelling is found in the loin due to the hydronephrosis. Following the passage of large volume of urine some hours later, the pain is relieved and the swelling will disappear.
31. DIVERTICULUM, DIVERTICULOSIS
Diverticulum: Abnormal external projection from a hollow viscus external to the serosa is called diverticulum. It may be true or false, congenital or acquired. Congenital is true and acquired is false (one meaning of diverticulum is a wayside house of ill-fame).
True diverticulum: Containing all the layers of the bowel wall.
False diverticulum: There is no muscle coat, but all other layers (herniation of mucosa or submucosa through the muscular coat).9
Pulsion diverticulum: The diverticulum is pushed out by intraluminal pressure.
Traction diverticulum: Diverticulum develops as a result of external traction.
Diverticulosis: Presence of multiple false diverticula.
32. DIARRHEA
Diarrhea: If stools contain more than 300ml fluid daily.
33. EDEMA
Edema: It is an imbalance between capillary filtration and lymphatic drainage (this does not mean that all edemas are lymphedemas). This will occur only when the lymphatic system fails to drain the tissue fluid produced by normal capillary filtration.
34. EMPYEMA
Empyema: Collection of pus in a physiological space.
35. ERYSIPELAS (READ CELLULITIS)
Erysipelas: Spreading cuticular lymphangitis caused by Streptococcus pyogenes. It has a sharply defined margin unlike cellulitis. The vesicles contain serum. Milian's ear sign – Erysipelas can spread to the pinna.
36. ERYTHROPLAKIA, LEUKOPLAKIA
Erythroplakia: Any lesion of the oral mucosa that presents as bright red velvety plaques which can not be characterized clinically or pathologically as any other recognizable condition.
Leukoplakia: Any white patch or plaque that can not be characterized clinically or pathologically as any other disease.
37. EXOTOXIN, ENDOTOXIN
Exotoxin: Toxin liberated by living bacteria.
Endotoxin: Toxin liberated after death of bacteria, being a part of the organism itself.
38. EVIDENCE — LEVELS
Levels of evidences: Agency for health care policy and research grading system for evidence and recommendation.
Recommendation of Strength:
A | – Directly based on Category I Evidence. |
B | – Directly based on Category II Evidence or extrapolated recommendation from Category I evidence. |
C | – Directly based on Category III evidence or extrapolated recommendation from Category I or II evidence. |
D | – Directly based on Category IV Evidence or extrapolated recommendation from Category I, II, or III evidence. |
Levels of evidences: Pragmatic grading (Only Three Grades).
39. FISTULA, SINUS
Fistula: It is a communicating tract between two epithelial surfaces lined with granulation tissue. It may be a communication between the skin and hollow viscus or between two hollow viscera (Internal fistula).
Sinus: Sinus is a blind track leading from the surface down to the tissue lined by granulation tissue.
Fistula in ano: The pathology of fistula in ano is ‘cryptoglandular infection’ (Infection of the anal glands in the crypt).
40. FLAIL CHEST
Flail chest: Two point fractures (Two segmental fractures) in each of 3 or more adjacent ribs or costal cartilage.
Bilateral costochondral separation will result in flail sternum.
41. FOLLICULITIS
Read boil.
42. GANGLION
Ganglion: Cystic, myxomatous degeneration of fibrous tissue. They are not pocket of synovium protruding from joints. May be multilocular occasionally.
Content – Viscous gelatinous material.
Fluctuation is present if not tense.
43. GANGRENE, NECROSIS, INFARCTION, SLOUGH
Gangrene: Macroscopic death of tissue with putrefaction.
Necrosis: Microscopic death of tissue.
Infarction: Ischemic necrosis is called infarction.
Slough: A piece of dead tissue separated from living tissue.
44. EARLY GASTRIC CANCER
Early gastric cancer: Cancer of the stomach confined to the mucosa and submucosa irrespective of the nodal status.
45. GASTRINOMA
Gastrinoma: A basal gastric acid output more than 15 m mol/ HR and a fasting gastrin level of more than 200 pg/ ml is strongly supporting the diagnosis.
46. GASTRINOMA TRIANGLE (PSAROS TRIANGLE)
Gastrinoma triangle: The three points forming the triangle are:
- Junction between the head and neck of the pancreas.
- Junction of Cystic duct with CBD.
- Junction between 2nd and 3rd parts of the duodenum.
47. GOITER
Goiter: Any enlargement of thyroid gland is called goiter.
Grading of goiter:
WHO (1990) PEREZZ Classification
Grade 0 | No goiter |
Grade I a | Not visible, but palpable |
Grade I b | Visible with neck extended and palpable |
Grade II | Visible with neck in normal position and palpable |
Grade III | Large gland evident from a distance |
WHO classification (1994)
Grade 0 – No palpable or visible swelling
Grade 1 – A mass in the neck that is consistent with an enlarged thyroid that is palpable, but not visible when neck is in normal position. It moves upwards in the neck as the subject swallows
Grade 2 – A swelling in the neck that is visible when the neck is in a normal position and is consistent with an enlarged thyroid when neck is palpated.
Large goiter:
- Protrusion of goiter beyond chin or jaw.
- Goiter which weighs 80 gm or more after excision.
- Largest neck circumference crossing the goiter being 40 cm or more.
48. GRANULOMA
Granuloma: Tumor-like mass formed in chronic inflammatory tissue.
49. HAMARTOMA, TERATOMA
Hamartoma: A tumor-like formation of tissues indigenous to the site due to developmental aberration.
Teratoma: Tumor-like proliferation of tissues, not indigenous in origin, containing more than one germinal layer.
50. HEMATEMESIS, MELEMESIS, MELENA, HEMATOCHEZIA
Hematemesis: Vomiting of bright red or dark blood.
Melemesis: Vomiting of altered blood is called melemesis. Coffee ground vomitus is due to vomiting of blood that has been in the stomach long enough for gastric acid to convert Hb to methemoglobin.
Melena: Passage of black or tarry sticky, semisolid, stools due to the presence of altered blood. It can be produced by blood entering the bowel at any point from mouth to cecum. The black color is due the Hematin (from Heme). 50 to 100ml of blood in stomach can produce melena. 1 liter of blood in stomach will produce melena for 3–5 days.
Hematochezia: Passage of bright red blood from the rectum (Colon, rectum, and anus) is called hematochezia. Brisk bleeding from upper intestine with rapid transit can also produce it.
51. HERNIA, PROLAPSE
Hernia: Abnormal protrusion of a viscus or part of a viscus lined by a sac through a normal or abnormal opening in the abdominal wall.
Prolapse: Abnormal protrusion of a viscus through a normal or abnormal opening not lined by a sac.
52. HURTHLE CELL TUMOR
Hurthle cell tumor: Presence of more than 75% follicular cells having oncocytic features in thyroid histology is called Hurthle cell tumor.
53. HYDRONEPHROSIS, DIETL'S CRISIS (READ ABOVE)
Hydronephrosis: Aseptic dilatation of pelvi-calyceal system due to partial or intermittent obstruction.
54. HYPERPARATHYROIDISM
Hyperparathyroidism: The combinations of increased PTH levels and hypercalcemia with out hypocalciuria (Hypercalciuria of more than 400 mg/ 24 hour is diagnostic).
55. INCONTINENCE OF URINE
56. INCONTINENCE OF STOOL
Incontinence of stool: Involuntary evacuation of stool.
3. Types
- Incontinence for solid faces
- Incontinence for liquid faces
- Incontinence for gas.
57. INFARCTION
Read gangrene.
58. INGUINAL CANAL
Inguinal canal: It is an intermuscular slit situated between the superficial inguinal ring and deep inguinal ring.
59. INTUSSUSCEPTION
Intussusception: Telescoping of proximal intestine to the distal intestine.
Retrograde intussusception: Telescoping of distal intestine into the proximal intestine (e.g: jejuno-gastric intussusception) after gastro-jeunostomy).
60. JAUNDICE
Jaundice: Yellowish discoloration of skin and mucous membrane due to excessive circulating bile.
61. KARNOFSKY PERFORMANCE STATUS (KPS):
Karnofsky performance status (KPS): The KPS is reliable independent predictor of survival of outcome for patients with solid tumors. It is a required baseline assessment in clinical protocols in head and neck and other cancers.
The AJCC strongly recommends recording of KPS along with standard staging information (TNM). It is a method of measuring co–morbidity. It provides a uniform objective assessment of an individuals functional status. The scale in ten point increments from zero (Dead) to 100 (Normal, no complaints, no evidence of disease) was devised in 1948 by David A Karnofsky.
62. LINE OF DEMARCATION
Line of demarcation: Zone of demarcation between viable and gangrenous tissue indicated by a band of hyperemia and hyperesthesia on the surface and separation is achieved by a layer of granulation tissue.
In dry gangrene the line of demarcation appears in a matter of days without infection and this is called “separation by aseptic ulceration.”
In moist gangrene the line of demarcation is more proximal than dry gangrene and the process is called “separation by septic ulceration”.
63. LIPOMA (UNIVERSAL TUMOR)
Lipoma: It is benign tumor from “adult fat cell’. It is called “universal Tumor” or “ubiquitous tumor” and hence the aphorism: “when in doubt hedge on fat”.
64. LOWER GI BLEED, UPPER GI BLEED
Lower GI bleed: It is a bleeding from distal to the ligament of Treitz.
Upper GI bleed: It is a bleeding from proximal to the ligament of Treitz.
65. MARGINAL ARTERY OF DRUMMOND, ARC OF RIOLAN (READ ABOVE)
Marginal artery of drummond: It is the paracolic vessel of anastomosis between the superior mesenteric and inferior mesenteric arterial system.
66. MASSIVE HEMOTHORAX
Massive hemothorax: When 1500 ml or more of blood is acutely removed from the pleural space, then it is called massive hemothorax.
67. MASSIVE BLOOD TRANSFUSION
Massive blood transfusion: The term massive transfusion implies a single transfusion greater than 2500 ml or 5000 ml transfused over a period of 24 hours.
68. MELENA, MELEMESIS
Read hematemesis.
69. MENARCHE—EARLY
Early menarche: Age of menarche before 12 years.
70. MENOPAUSE —LATE
Late menopause: Menopause after 50 years.
71. MESENTERY OF SMALL INTESTINE — ATTACHMENT
Mesentery of small intestine — attachment: The base of the mesentery attaches to the posterior abdominal wall to the left of the second lumbar vertebra and passes obliquely to the right and inferiorly to the right sacroiliac joint crossing 3rd part of the duodenum, aorta, IVC and right ureter. It is 6 inches (15 cm) in length. Remember the small intestine has got 6 meters length (Fig. 2.1).15
72. MESENTERY OF SIGMOID — ATTACHMENT
Mesentery of sigmoid - attachment: It is shaped like an inverted V. The apex of the V is at the bifurcation of left common iliac artery crossing the brim. The right limb descends to the third piece of the sacrum. The left limb runs along the brim of left side of pelvis. (Fig. 10.2).
73. MESENTERY OF THE TRANSVERSE COLON
Mesentery of the transverse colon: It is attached to the descending part of Duodenum to the head and lower aspect of the body of the pancreas and placed horizontally to the anterior surface of the left Kidney.
74. NECROSIS
Read gangrene.
75. OLD AGE
Old age: Above 65 years is old age and above 85years is very old age.
76. ORAL CAVITY, BUCCAL MUCOSA, RETROMOLAR TRIGONE, TRISMUS, ANKYLOGLOSSIA
Oral cavity: Starts at skin vermilion junction of lip anteriorly to circumvallate papillae of tongue, posterior part of the hard palate, and anterior pillar of tonsil posteriorly. Oral cavity includes the following.
- Lips
- Buccal mucosa
- Upper and lower alveolar ridge
- Retromolar trigone
- Floor of the mouth
- Hard palate
- Oral tongue
Buccal mucosa: Extends from the upper alveolar ridge down to the lower alveolar ridge, and from the commissure anteriorly to the mandibular ramus and retromolar region posteriorly.
Retromolar trigone: It is defined as the anterior surface of the ascending ramus of the mandible. It is triangular in shape with the base being superior behind the third upper molar tooth and the apex inferior behind the 3rd lower molar.
Trismus: (Spasmodic clenching) is inability to open the mouth.
Causes for Trismus⋅
- Oral carcinoma – Involvement of pterygoid, masseter, temporalis and buccinator muscle.
- Inflammatory – Parotitis
- Tooth abscess (Dental)
- Erupting wisdom tooth
- Peritonsillar abscess (Quinsy)
- Tetanus — (Painful smiling — Risus Sardonicus)
Ankyloglossia (Read above).
77. PANCREATITIS, PANCREATIC NECROSIS, PANCREATIC ABSCESS, PANCREATIC ASCITES, PANCREATIC EFFUSION, PSEUDOCYST, PANCREATIC NECROSIS, ACUTE FLUID COLLECTION
Chronic pancreatitis: It is a disease in which there is irreversible progressive destruction of 16pancreatic tissue. Its clinical course is characterized by dynamic progressive fibrosis of the pancreas.
Acute Pancreatitis
Acute fluid collection: It is fluid collection in or near the pancreas with ill defined wall occurring early in acute pancreatitis.
Pancreatitis acute pseudocyst: It is a collection of pancreatic juice enclosed in a wall of fibrous or granulation tissue (Requires 4 weeks).
Pancreatic necrosis: Diffuse or focal area of non viable pancreatic parenchyma. Associated peri pancreatic fat necrosis is present.
Infected pancreatic necrosis: Same as above with infection.
Pancreatic abscess: Circumscribed intra abdominal collection of pus in proximity to pancreas. There is no pancreatic necrosis.
Pancreatic ascites: Chronic generalized peritoneal enzyme rich effusion associated with pancreatic ductal disruption.
Pancreatic effusion: Encapsulated collection of fluid in the pleural cavity.
78. PAPILLOMA (BENIGN PAPILLOMA), POLYP, POLYPOSIS
Benign papillomas: These are hamartomas consisting of an overgrowth of all skin layers and its appendages having a central core and normal sensation. They are well-defined, usually, pedunculated ranging from few millimeters to a few centimeters in size, commonly 5 mm across. The surface may be grooved or deeply fissured. The complications of papilloma are inflammation, bleeding ulceration, pigmentation and keratosis.
Polyp: It is a morphological term and no histologic diagnosis is implied. They are masses of tissue that project into the lumen of viscera. When the base is broader than the head it is called sessile. When the base is narrower than head it is called pedunculated. It may be benign or malignant, Mucosal or sub-mucosal or muscular.
Polyposis: Presence of many polyps.
79. PARALYTIC ILEUS
Paralytic ileus: Defined as a state in which there is failure of transmission of peristaltic waves in the intestine secondary to neuromuscular failure [in the myenteric (Auerbach) and the sub-mucous (Meissner) plexuses.
80. PARAPHIMOSIS, PHIMOSIS
Phimosis: Inability to retract the foreskin to expose the glans.
Paraphimosis: Inability to reduce a previously retracted foreskin.
81. PEAU D’ ORANGE
Read breast
82. PERFUSION, TRANSFUSION
Perfusion: Artificial passage of fluid through blood vessel (usually veins).
Transfusion: Intravenous administration of blood or its components.
83. PROLAPSE – READ HERNIA
Abnormal protrusion of a viscus through a normal or abnormal opening not lined by a sac.
84. PSEUDO THYROTOXICOSIS
Seen in critically ill patients characterized by increased levels of T4 and decreased levels of T3 due to failure of conversion of T4 to T3.
85. PUS
Pus: It is a fluid composed of living and dead bacteria, dead fixed and free cells (the latter representing body's phagocytic response) and foreign material such as sutures, implants and splinters.
Color of the pus may give a clue regarding the organism.
- Creamy yellow – Staphylococci.
- Watery opalescent – Streptococcus
- Blue/Green – Pseudomonas
- Purplish brown – Amoebic liver abscess
- Yellow granules – Actinomycosis.
86. RENAL ANGLE
Renal angle: Angle between the 12th rib and the edge of the erectorspinae muscle. Normally this is empty and resonant. There should not be any tenderness.
Rest pain: It is the continues pain caused by severe ischemia. This pain is present at rest throughout the day and the night. The pain is relieved by putting the leg below the level of the heart.
87. RETENTION OF URINE
Retention of urine: Accumulation of urine in the bladder with inability to void.
Acute retention: Sudden inability to pass urine with a painful bladder.
Size of Urinary Catheter
French or Charriere's scale
Fr or Ch
3 Fr = 1mm outer diameter of catheter
Important causes for retention of urine as per the seven ages are—
1. The infant | – Posterior urethral valve |
2. The school boy | – Enlarged bladder neck (Marion's disease) |
– Obturation by stone | |
3. The “lover age” | – Retention following acute urethritis |
4. The soldier | – Urethral stricture |
5. The justice | – Benign enlargement of the prostate |
6. The sixth age | – Carcinoma of the prostate |
7. The last age | – Carcinoma of the prostate |
– Benign enlargement of the prostate |
Three most important causes for acute retention in female
- Retroverted gravid uterus (Do bimanual palpation of uterus)
- Disseminated sclerosis (CNS examination).
- Hysteria.
“Bashful bladder” – Cannot pass urine when another person is in the vicinity.
88. RETROMOLAR TRIGONE
Read oral cavity
89. RIGIDITY, GUARDING
Rigidity: In Rigidity there is contraction even at rest.
Guarding: In guarding it is secondary to provocation from the examining hand of the physician.
90. RUN IN, DISTAL RUN OFF
Distal run off: Patency of the main vessel beyond an arterial occlusion seen in angiogram.
Run in: Patency of the main vessel proximal to the site of occlusion in angiogram.
91. SCOLIOSIS
Scoliosis: Rotatolateral deformity of the spine.
92. SCREENING, SURVEILLANCE
Screening: It is defined as testing a group of people considered to be at normal risk for a disease, to discover those at increased risk.
Surveillance: It is defined as testing of a group known to be at increased risk for a disease.
93. SINUS
Read fistula
94. STRICTURE, STENOSIS
Stricture: Narrowing of a length of canal or hollow organ.
Stenosis: Narrowing of a segment of canal or orifice.
95. STRANGURY, TENESMUS
Strangury: Painful, frequent, ineffective attempts at micturition.
Tenesmus: Painful, frequent, ineffective attempts at defecation.
96. TENSION PNEUMOTHORAX
Tension pneumothorax: Presence of air in the pleural cavity with signs of mediastinal shift like: Tracheal shift or and Shift of Apex beat.
A tension pneumothorax impairs venous return by caval distortion from mediastinal shift and raised intrathoracic pressure with compression of the contralateral lung.
Radiological signs of tension pneumothorax:
- Tracheal shift
- Spreading of the ribs (Space between ribs increased)
97. THIRD DAY FEVER
Third day fever: If a patient is developing fever on the third postoperative day of surgery, suspect septic foci in the IV cannula.
98. TUBERCLE, CASEOUS MATERIAL, TUBERCULOUS PUS
Tubercle: Microscopically consists of an area of caseation surrounded by:
- Giant cells (having 20 or more peripherally arranged nuclei)
- Zone of epithelioid cells around giant cells
- Zone of inflammatory cells – lymphocytes and plasma cells.
Tubercle is visible to the naked eye towards the end of second week.
Caseous material: It is a dry, granular and cheese like material (Granular structureless material microscopically).
Tuberculous pus: Softening and liquefaction of the caseous material result in a thick creamy fluid called tuberculous pus. Liquefaction is associated with multiplication of bacteria. It is highly infective. It contains fatty debris in serous fluid with a few necrotic cells (It is usually sterile).
99. ULCER
Ulcer: Abnormal breach in the continuity of the skin or mucous membrane due to molecular death of tissue.
100. UPPER G I BLEED
Read Lower GI.
101. VARICOSE VEIN
Varicose vein: (WHO Definition) Abnormally dilated saccular or cylindrical superficial veins which can be circumscribed or segmental.
102. VOLVULUS
Volvulus: Axial rotation of a portion of bowel about its mesentery. Volvulus can occur in the cecum, sigmoidcolon and in the stomach.
In the stomach, there are two types of volvulus.
- Organoaxial – rotation of stomach in horizontal direction (common).
- Mesenteroaxial – rotation of the stomach in the vertical direction.
103. WEIGHT LOSS
Weight loss: Loss of more than 10% body weight over a period of 6 month.