General Surgery Miscellaneous Important Question And Answers

Question 1 Write a short note on Sushruta.

Answer. Sushruta, one of the earliest surgeons in recorded history (600 BC) is believed to be the first individual to describe plastic surgery.

• Sushruta who lived nearly 150 years before Hippocrates vividly described the basic principles of plastic surgery in his famous ancient treatise Sushruta Samhita.
• He is dubbed as the “Founding Father of Surgery” and the Sushruta Samhita is identified as one of the most outstanding commentaries on the Medical Sciences of Surgery.
• He is said to have been a physician originally of
  South India is active in Varanasi.

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• His period is usually placed between the period of 1200-600 BC.
• One of the earliest known mentions of the name is from the Bower Manuscript (4th or 5th century), where Sushruta is listed as one of the ten sages residing in the Himalayas.
• Sushruta has described surgery under eight heads
  Chedya (excision), Lekhya (scarification), Vedhya(puncturing), Esya (exploration), Ahrya (extraction), Vsraya (evacuation) and Sivya (Suturing).
• The Sushruta Samhita, in its extent form, in 184 chapters contains descriptions of 1,120 illnesses,700 medicinal plants, 64 preparations from mineral sources, and 57 preparations based on animal sources.
• The text discusses surgical techniques of making incisions, probing, extraction of foreign bodies, alkali and thermal cauterization, tooth extraction, and excisions. etc.
• Sushruta’s Contribution to the field of Plastic
  Surgery can be enumerated as follows:
• • Rhinoplasty (cheek)
  • Classification of mutilated earlobe defects and techniques for the repair of torn earlobes (15 different types of otoplasties)
  • Cheek flap for reconstruction of the absent ear lobe.
  • Repair of accidental lip injuries and congenital cleft lip.
  • Piercing children’s ear lobes with a needle or awl.
  • Use of suture materials of bark, tendon, hair, and silk.
  • Needles of bronze or bone (circular, two fingerbreadths wide and straight, triangular bodied, three finger – breadths wide)
  • Classification of burns into four degrees and explaining the effect of heat stroke, frostbite, and lightning injuries.
  • Fourteen types of bandaging capable of covering almost all the regions of the body and different methods of dressings with various medicaments.
  • Use of wine to dull the pain of surgical incisions.
  • Describe 20 varieties of sharp instruments (sastra) and 101 types of blunt instruments (yantra) and their handling techniques.
  • Systematic dissection of cadavers.
  • Advocated the practice of mock operations on inanimate objects such as watermelons, clay plots, and reeds.
  • Use of leeches to keep wounds free of blood clots.
  • A code of ethics for teachers as well as students.

 

Question 2. Write a short note on Surveyor.

Answer. Surveyor is the one of the members of the trauma team.

Surveyors are of two types, i.e. primary surveyor and secondary surveyor.

Primary Surveyor (Surgical resident)

• Performs the primary survey, relaying all pertinent findings to the team.
• May perform the secondary survey, relaying all pertinent findings to the team.
• Performs or assists in the performance of any life-saving procedures at the direction of the team leader

Secondary Surveyor (Surgical resident or intern)

• Assists with the “exposure” aspect of the primary survey and applies warm blankets.
• May perform the secondary survey, relaying all pertinent findings to the team
• Performs or assists in the performance of any life-saving procedures at the direction of the team leader

Surveying in Maxillofacial injuries

Primary Survey

• Identify the airway compromise from fracture or hemorrhage.
• Bilateral anterior fractures of the mandible have the risk of falling back of the tongue.
• Orotracheal intubation should be needed.
• With the help of mouth props and epistaxis balloons hemorrhage should be controlled.
• Anterior and posterior nasal packing can be needed.

Secondary Survey

• Orbital rim, zygomatic arches, and mandible should be palpated to identify fractures.
• Eyes should be examined: Restricted eye movement is suggestive of an orbital fracture.
• Subconjunctival hemorrhage can be suggestive of a fracture of the skull.
• Proptosis and ophthalmoplegia can be suggestive of retrobulbar hemorrhage.
• Sensation should be assessed in the maxillary branch of the trigeminal nerve.
• Check intracanthal distance which should be 30–35mm. If the distance is more than the mentioned range, it is suggestive of nasoethmoid fracture.
• The intraoral examination is necessary. Assess the occlusion and intraoral hematomas.

 

Question 3. Write briefly on Louis Pasteur.

Answer. Louis Pasteur was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation, and pasteurization.

• He is remembered for his remarkable breakthroughs in the causes and prevention of diseases, and his discoveries have saved countless lives ever since.
• He reduced mortality from puerperal fever and created the first vaccines for rabies and anthrax. His medical discoveries provided direct support for the germ theory of disease and its application in clinical medicine.
• He is best known to the general public for his invention of the technique of treating milk and wine to stop bacterial contamination, a process now called pasteurization.
• He is regarded as one of the three main founders of bacteriology, together with Ferdinand Cohn and Robert Koch, and is popularly known as the “Father of Microbiology”

Question 4. Write briefly on types of skin grafts.

Answer. Skin grafts are of two types, i.e.
1. Partial thickness graft
2. Full-thickness graft.

Skin grafts Partial thickness Graft

• It is also known as Thiersch graft or split-thickness skin graft
• In it, there is the removal of the full epidermis and part of the dermis from the donor area.
• It can be thin, intermediate, and thick.
• It is indicated in a well-granulated ulcer, clean wound, or defect which is not apposed and after the surgery to close and cover the created defect.
• It should not be done over bone, tendon, cartilage and joint.

Skin grafts Full thickness Graft

• It includes both the epidermis and the full dermis.
• It should be done over the face, eyelid, hand, fingers, and the joints.
• It is used only for small areas.
• Its functional and cosmetic results are excellent.

Question 5. Write a short answer on sequelae of inflammation.

Answer. The inflammatory process can culminate in one of the following outcomes;

• Resolution: It means a complete return to normal tissue following acute inflammation.
  This occurs when tissue changes are slight and the cellular changes are reversible e. g. resolution in lobar pneumonia.
• Healing. Healing by fibrosis takes place when the tissue destruction in acute inflammation is extensive so that there is no tissue regeneration. But when tissue loss is superficial, it is restored by regeneration.
• Suppuration: When the pyogenic bacteria causing acute inflammation result in severe tissue necrosis, the process progresses to suppuration. Initially, there is intense neutrophilic infiltration.
  Subsequently, a mixture of neutrophils, bacteria, fragments of necrotic tissue, cell debris, and firin comprise pus which is contained in a cavity to form an abscess.
  The abscess, if not drained, may get organized by dense fibrous tissue, and in time, get calcified.
• Chronic inflammation. Persisting or recurrent acute inflammation may progress to chronic inflammation in which the processes of inflammation and healing proceed side by side.