{"id":37069,"date":"2026-06-17T07:14:49","date_gmt":"2026-06-17T01:44:49","guid":{"rendered":"https:\/\/atsixty.com\/?p=37069"},"modified":"2026-06-17T22:49:57","modified_gmt":"2026-06-17T17:19:57","slug":"surgery-summative-revision-notes","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/surgery-summative-revision-notes\/","title":{"rendered":"Surgery: Summative Revision Notes"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&amp;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&amp;display=swap\" rel=\"stylesheet\">\n<style>\n#srev01 *,#srev01 *::before,#srev01 *::after{box-sizing:border-box;margin:0;padding:0}\n#srev01{\n  --surg:#2C5F8A;--surg-dark:#1E4464;--surg-pale:#EBF2F8;--surg-mid:#3A78A8;\n  --acc:#8B3D20;--acc-pale:#FDF0EB;\n  --ink:#1A2A38;--ink-mid:#3A5A6A;--ink-soft:#7A98AD;\n  --line:#D6E5EE;--cream:#F4F8FB;--warm:#FAFCFE;\n  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.rv-quiz-link:hover{background:var(--surg);color:#fff}\n#srev01 .rv-footer{margin-top:32px;text-align:center;font-size:0.80rem;color:var(--ink-soft);font-style:italic;line-height:1.6}\n#srev01 .rv-footer a{color:var(--surg);font-style:normal;font-weight:600;text-decoration:none;border-bottom:1px solid var(--surg)}\n#srev01 .rv-footer a:hover{opacity:0.75}\n@media print{\n  #srev01 .rv-header{background:#2C5F8A !important;-webkit-print-color-adjust:exact}\n  #srev01{padding-bottom:20px}\n  #srev01 .rv-section{break-inside:avoid;box-shadow:none}\n}\n@media(max-width:480px){\n  #srev01 .rv-title{font-size:1.45rem}\n  #srev01 .rv-sec-title{font-size:1rem}\n  #srev01 table{font-size:0.76rem}\n  #srev01 td,#srev01 th{padding:6px 8px}\n}\n<\/style>\n\n<div id=\"srev01\">\n\n  <div class=\"rv-header\">\n    <div class=\"rv-eyebrow\">Morning Rounds \u00b7 Surgery Series<\/div>\n    <div class=\"rv-title\">Surgery<br><em>Summative Revision Notes<\/em><\/div>\n    <div class=\"rv-subtitle\">Seven topics \u00b7 NEET-PG \u00b7 Key facts, tables, classifications and surgical rules<\/div>\n    <div class=\"rv-chips\">\n      <span class=\"rv-chip\">Upper GI<\/span>\n      <span class=\"rv-chip\">Lower GI<\/span>\n      <span class=\"rv-chip\">Hepatobiliary<\/span>\n      <span class=\"rv-chip\">Breast &amp; Endocrine<\/span>\n      <span class=\"rv-chip\">Urology &amp; Hernias<\/span>\n      <span class=\"rv-chip\">Vascular &amp; Trauma<\/span>\n      <span class=\"rv-chip\">Oncology &amp; Periop<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"rv-body\">\n\n    <div class=\"rv-intro\">\n      <p>These notes consolidate the seven Surgery Morning Rounds. They are written for rapid pre-exam revision \u2014 not first-time learning. Each section heading links to its quiz. Summative pill-badges at the end of each section capture the single-line facts most likely to appear as isolated IBQs.<\/p>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 1 \u2014 UPPER GI SURGERY\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/upper-gi-surgery\/\">\n          <div class=\"rv-sec-num\">Topic 01 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Upper GI Surgery <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Achalasia<\/div>\n        <p><strong>Pathology:<\/strong> loss of inhibitory (NO\/VIP) neurons in Auerbach's (myenteric) plexus \u2192 tonically contracted LES + aperistalsis. <strong>Barium:<\/strong> bird-beak \/ rat-tail sign. <strong>Diagnosis:<\/strong> high-resolution manometry (gold standard). <strong>Pseudoachalasia trap:<\/strong> carcinoma of GEJ mimics achalasia \u2014 always endoscope to biopsy, especially if age &gt;55, symptom duration &lt;1 year, or rapid weight loss.<\/p>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Treatment<\/th><th>Notes<\/th><\/tr>\n            <tr><td>Pneumatic dilation<\/td><td>First-line non-surgical; 80\u201390% initial success; ~30% recurrence<\/td><\/tr>\n            <tr><td><strong>Heller's cardiomyotomy + partial fundoplication<\/strong><\/td><td>Surgical gold standard (Dor or Toupet wrap to prevent GORD)<\/td><\/tr>\n            <tr><td>POEM<\/td><td>Per-oral endoscopic myotomy; equivalent efficacy; no anti-reflux component<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Modified Johnson's Classification \u2014 Gastric Ulcer<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Type<\/th><th>Site<\/th><th>Acid<\/th><th>Key point<\/th><\/tr>\n            <tr><td><strong>I<\/strong><\/td><td>Incisura angularis, lesser curvature (MC, ~60%)<\/td><td>Normal\/low<\/td><td>H. pylori; lowest malignancy risk; Billroth I preferred<\/td><\/tr>\n            <tr><td><strong>II<\/strong><\/td><td>Body + concurrent duodenal ulcer<\/td><td>High<\/td><td>Treat as duodenal ulcer (acid-driven)<\/td><\/tr>\n            <tr><td><strong>III<\/strong><\/td><td>Prepyloric (&lt;3 cm from pylorus)<\/td><td>High<\/td><td>Behaves like duodenal ulcer<\/td><\/tr>\n            <tr><td><strong>IV<\/strong><\/td><td>Near GEJ (high lesser curvature)<\/td><td>Normal\/low<\/td><td>Highest malignancy risk; biopsy mandatory<\/td><\/tr>\n            <tr><td><strong>V<\/strong><\/td><td>Anywhere<\/td><td>Normal\/low<\/td><td>NSAID-induced; no H. pylori link<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p>All gastric ulcers: 6\u20138 biopsies from ulcer edge + repeat endoscopy at 8 weeks to confirm healing.<\/p>\n\n        <div class=\"rv-sub\">Dumping Syndrome<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th><\/th><th>Early<\/th><th>Late<\/th><\/tr>\n            <tr><td><strong>Timing<\/strong><\/td><td>15\u201330 min post-meal<\/td><td>1.5\u20133 hrs post-meal<\/td><\/tr>\n            <tr><td><strong>Mechanism<\/strong><\/td><td>Hyperosmolar load \u2192 fluid shift \u2192 VIP\/serotonin<\/td><td>Rapid glucose absorption \u2192 insulin overshoot \u2192 hypoglycaemia<\/td><\/tr>\n            <tr><td><strong>Symptoms<\/strong><\/td><td>Flushing, palpitations, diarrhoea (vasomotor)<\/td><td>Sweating, tremor, confusion (neuroglycopenic)<\/td><\/tr>\n            <tr><td><strong>Blood glucose<\/strong><\/td><td>Normal or slightly elevated<\/td><td>Low (&lt;3.5 mmol\/L)<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p><strong>Management:<\/strong> small, frequent, low-carbohydrate meals; no fluids with meals; lie down post-meals. Octreotide if refractory. Roux-en-Y revision for severe medically refractory cases.<\/p>\n\n        <div class=\"rv-sub\">Upper GI Bleed \u2014 Variceal<\/div>\n        <p>Endoscopic band ligation (EBL) = endoscopic treatment of choice. <strong>Pharmacological agent:<\/strong> start vasoactive drug immediately on suspicion \u2014 <strong>terlipressin<\/strong> (V1-selective; reduces mortality) or octreotide\/somatostatin. Never use PPI as primary treatment for variceal bleed. <strong>Prophylactic antibiotics<\/strong> (ceftriaxone) mandatory in all cirrhotics \u2014 reduces SBP, rebleeding, mortality. Sengstaken-Blakemore tube = bridge only when EBL fails.<\/p>\n        <p><span class=\"rv-pill\">Achalasia: NO\/VIP neuron loss<\/span> <span class=\"rv-pill\">Type I GU: incisura, low acid<\/span> <span class=\"rv-pill\">Type IV GU: highest Ca risk<\/span> <span class=\"rv-pill-blue\">Early dumping: vasomotor, normal glucose<\/span> <span class=\"rv-pill-green\">Varices: terlipressin + EBL + prophylactic antibiotics<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/upper-gi-surgery\/\">\u25b6 Open Quiz 01<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 2 \u2014 LOWER GI SURGERY\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/lower-gi-surgery\/\">\n          <div class=\"rv-sec-num\">Topic 02 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Lower GI Surgery <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Intussusception<\/div>\n        <p>MC cause of intestinal obstruction in infants 3 months\u20133 years (peak 5\u201310 months). Triad: colicky pain + redcurrant jelly stool + sausage-shaped mass. Dance's sign = empty RIF. USS: target\/doughnut sign. <strong>First-line:<\/strong> pneumatic (air) enema \u2014 80\u201390% success. Surgery for failed enema, peritonitis, perforation, or gangrene. Lead points (older children): Meckel's diverticulum, lymphoma, HSP.<\/p>\n\n        <div class=\"rv-sub\">Crohn's vs Ulcerative Colitis \u2014 Surgical Essentials<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Feature<\/th><th>Crohn's<\/th><th>UC<\/th><\/tr>\n            <tr><td>Distribution<\/td><td>Any site, skip lesions, rectal sparing<\/td><td>Rectum \u2192 proximal, continuous, always involves rectum<\/td><\/tr>\n            <tr><td>Wall<\/td><td>Transmural<\/td><td>Mucosal + submucosal only<\/td><\/tr>\n            <tr><td>Histology<\/td><td>Non-caseating granulomas<\/td><td>Crypt abscesses; no granulomas<\/td><\/tr>\n            <tr><td>Surgery<\/td><td><strong>NOT curative<\/strong>; conserve bowel; disease recurs<\/td><td><strong>Curative<\/strong>; proctocolectomy + IPAA<\/td><\/tr>\n            <tr><td>Unique complications<\/td><td>Fistulae, abscesses, strictures, perianal disease<\/td><td>Toxic megacolon, PSC (primary sclerosing cholangitis)<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Peutz-Jeghers Syndrome<\/div>\n        <p><strong>Gene:<\/strong> STK11\/LKB1 (chr 19p). <strong>Features:<\/strong> mucocutaneous melanin pigmentation (lips, buccal mucosa, fingertips) + hamartomatous polyps (jejunum &gt; ileum; arborising smooth muscle core on histology). MC complication: intussusception (polyps = lead points). <strong>Cancer risk:<\/strong> colorectal (39%), gastric (29%), pancreatic (36%), breast (54%), gonadal. Surveillance: 2-yearly capsule endoscopy + colonoscopy from age 8.<\/p>\n\n        <div class=\"rv-sub\">Sigmoid Volvulus<\/div>\n        <p>MC colonic volvulus (80%). Coffee-bean \/ omega sign pointing to <strong>RUQ<\/strong>. <strong>First-line (viable bowel):<\/strong> endoscopic decompression (flexible sigmoidoscopy + flatus tube). Hartmann's procedure for gangrenous bowel \/ failed decompression. <strong>Definitive:<\/strong> elective sigmoid resection (recurrence ~50% without surgery). Caecal volvulus: coffee-bean in RLQ points to LUQ \u2014 endoscopy rarely works \u2192 surgery (right hemicolectomy).<\/p>\n\n        <div class=\"rv-sub\">Acute Appendicitis \u2014 Alvarado Score<\/div>\n        <p>MANTRELS mnemonic (max 10): Migration (1) + Anorexia (1) + Nausea\/vomiting (1) + Tenderness RIF (2) + Rebound (1) + Elevated temp (1) + Leukocytosis (2) + Shift to left (1). Score \u22657 in males \u2192 proceed to theatre without imaging. Score 5\u20136 \u2192 USS or CT. <strong>Ochsner-Sherren regimen:<\/strong> appendicular mass (day 3\u20135, no peritonitis) \u2192 conservative + interval appendicectomy at 6\u20138 weeks.<\/p>\n\n        <p><span class=\"rv-pill\">Intussusception: pneumatic enema first<\/span> <span class=\"rv-pill\">Crohn's: not curative<\/span> <span class=\"rv-pill\">PJS: STK11, arborising polyp<\/span> <span class=\"rv-pill-blue\">Sigmoid volvulus: endoscopy first<\/span> <span class=\"rv-pill-green\">Alvarado \u22657 in males: direct to OT<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/lower-gi-surgery\/\">\u25b6 Open Quiz 02<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 3 \u2014 HEPATOBILIARY & PANCREAS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/hepatobiliary-pancreas\/\">\n          <div class=\"rv-sec-num\">Topic 03 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Hepatobiliary &amp; Pancreas <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Acute Cholangitis<\/div>\n        <p><strong>Charcot's triad:<\/strong> RUQ pain + fever + jaundice. <strong>Reynold's pentad:<\/strong> triad + altered sensorium + hypotension (septic cholangitis, Grade III \u2014 mortality &gt;50%). MC cause: choledocholithiasis (~85%). <strong>Management:<\/strong> IV antibiotics + resuscitation \u2192 ERCP + sphincterotomy + stone extraction within 24\u201348 hrs (Grade II) or within 12 hrs (Grade III). Surgery (CBD exploration) reserved for failed ERCP.<\/p>\n\n        <div class=\"rv-sub\">Acute Pancreatitis \u2014 Severity Assessment<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Ranson's \u2014 Admission (5)<\/th><th>Ranson's \u2014 48 hours (6)<\/th><\/tr>\n            <tr><td>Age &gt;55 \u00b7 WBC &gt;16,000 \u00b7 Glucose &gt;11 mmol\/L \u00b7 LDH &gt;350 \u00b7 AST &gt;250<\/td><td>HCT fall &gt;10% \u00b7 BUN rise &gt;5 \u00b7 Ca\u00b2\u207a &lt;2 mmol\/L \u00b7 PaO\u2082 &lt;60 \u00b7 Base deficit &gt;4 \u00b7 Fluid &gt;6 L<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p>Score &lt;3 = mild; 3\u20134 = moderate-severe; \u22655 = severe (&gt;50% mortality). <strong>Cannot be calculated until 48 hours.<\/strong> Best single marker: CRP &gt;150 mg\/L at 48 hrs. Amylase\/lipase levels do NOT correlate with severity. <strong>Key management rules:<\/strong> aggressive IV Ringer's lactate; early enteral nutrition via NJ tube; no prophylactic antibiotics; surgery (necrosectomy) only for confirmed infected necrosis, never in first 2 weeks.<\/p>\n\n        <div class=\"rv-sub\">Biliary Atresia<\/div>\n        <p>MC cause of conjugated neonatal jaundice. Acholic stools + dark urine + conjugated hyperbilirubinaemia + elevated GGT. USS: absent\/small GB, non-dilated ducts. HIDA scan: no tracer excretion into gut. Diagnosis: intraoperative cholangiogram. <strong>Treatment: Kasai hepatoportoenterostomy \u2014 must be performed before 60 days of age<\/strong> for best outcome. ~70\u201380% eventually require liver transplantation.<\/p>\n\n        <div class=\"rv-sub\">Hydatid Cyst<\/div>\n        <p>Echinococcus granulosus (dog = definitive host; sheep = intermediate; humans = accidental). Gharbi classification: Type I = unilocular; Type II = multivesicular\/daughter cysts; Type III = solid matrix; Type IV = calcified wall (inactive); Type V = fully calcified. <strong>First-line (Gharbi I\/II):<\/strong> PAIR (Puncture, Aspiration, Injection of scolicidal agent, Re-aspiration) under ultrasound + albendazole cover. Surgery for large (&gt;10 cm), infected, biliary communication, or superficial cysts. Never drain without scolicidal agent \u2014 secondary hydatidosis.<\/p>\n\n        <div class=\"rv-sub\">Carcinoma Pancreas<\/div>\n        <p><strong>Courvoisier's law:<\/strong> painless, palpable, non-tender GB + jaundice = malignant obstruction (chronic stone disease fibroses GB wall). <strong>Double-duct sign:<\/strong> simultaneous CBD + pancreatic duct dilatation on MRCP = periampullary\/pancreatic head Ca. <strong>Resectability:<\/strong> no distant mets + SMA\/coeliac axis clear + SMV\/portal vein patent (only ~15\u201320% at presentation). <strong>Whipple's:<\/strong> pancreatic head + duodenum + CBD + GB + distal stomach resected. MC post-op complication: delayed gastric emptying. Dreaded: pancreatic fistula.<\/p>\n\n        <p><span class=\"rv-pill\">Reynold's pentad: Grade III cholangitis<\/span> <span class=\"rv-pill\">Ranson's: not before 48 hrs<\/span> <span class=\"rv-pill\">Kasai: before 60 days<\/span> <span class=\"rv-pill-blue\">PAIR + albendazole for hydatid<\/span> <span class=\"rv-pill-green\">Courvoisier's: malignant obstruction<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/hepatobiliary-pancreas\/\">\u25b6 Open Quiz 03<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 4 \u2014 BREAST, THYROID & ENDOCRINE\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/breast-thyroid-endocrine\/\">\n          <div class=\"rv-sec-num\">Topic 04 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Breast, Thyroid &amp; Endocrine Surgery <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Nipple Discharge<\/div>\n        <p><strong>Intraductal papilloma:<\/strong> MC cause of blood-stained single-duct spontaneous discharge in reproductive-age women. Treatment: microdochectomy (single duct excision; cannulate pre-operatively with lacrimal probe). <strong>Duct ectasia:<\/strong> green\/cheesy, bilateral, multiple ducts, older women, nipple retraction \u2192 Hadfield's operation (total duct excision). <strong>Paget's disease:<\/strong> eczematous nipple-areola change + underlying DCIS\/invasive Ca; Paget cells (clear halo) on biopsy.<\/p>\n\n        <div class=\"rv-sub\">Thyroid Carcinoma \u2014 Summary<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Type<\/th><th>Cell<\/th><th>Spread<\/th><th>Marker<\/th><th>Histology hallmark<\/th><\/tr>\n            <tr><td><strong>Papillary (MC, 80%)<\/strong><\/td><td>Follicular<\/td><td>Lymphatic<\/td><td>Thyroglobulin<\/td><td>Orphan Annie nuclei + Psammoma bodies<\/td><\/tr>\n            <tr><td>Follicular (~10%)<\/td><td>Follicular<\/td><td>Haematogenous<\/td><td>Thyroglobulin<\/td><td>Capsular\/vascular invasion (needs excision \u2014 cannot diagnose on FNAC)<\/td><\/tr>\n            <tr><td>Medullary (~5%)<\/td><td>C-cells (parafollicular)<\/td><td>Lymphatic + haematogenous<\/td><td><strong>Calcitonin<\/strong><\/td><td>Amyloid stroma (Congo red +ve)<\/td><\/tr>\n            <tr><td>Anaplastic (~2%)<\/td><td>Follicular<\/td><td>Direct invasion<\/td><td>None<\/td><td>Pleomorphic giant cells; median survival 3\u20136 months<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p><strong>Follicular Ca trap:<\/strong> FNAC cannot diagnose it \u2014 capsular\/vascular invasion is only seen on excision histology. FNAC reports follicular neoplasm (Bethesda IV) \u2192 hemithyroidectomy for diagnosis.<\/p>\n\n        <div class=\"rv-sub\">Post-Thyroidectomy Hypocalcaemia<\/div>\n        <p>Parathyroid devascularisation \u2192 \u2193 PTH \u2192 \u2193 Ca\u00b2\u207a. Signs: Chvostek (facial twitch, CN VII) + Trousseau (carpal spasm, BP cuff). <strong>Symptomatic \/ Ca\u00b2\u207a &lt;1.9 mmol\/L:<\/strong> IV calcium gluconate (not chloride IV). Mild: oral calcium carbonate + alfacalcidol. <strong>RLN injury:<\/strong> unilateral = hoarse voice; bilateral = airway compromise \u2192 emergency tracheostomy.<\/p>\n\n        <div class=\"rv-sub\">Phaeochromocytoma \u2014 Rule of 10s<\/div>\n        <p>10% bilateral \u00b7 10% extra-adrenal (paraganglioma; MC = organ of Zuckerkandl) \u00b7 10% malignant \u00b7 10% familial (MEN 2A\/2B, VHL, NF1) \u00b7 10% in children. Diagnosis: 24-hr urinary metanephrines (most sensitive). <strong>Pre-op preparation (mandatory): alpha-blockade FIRST (phenoxybenzamine 10\u201314 days) \u2192 then add beta-blockade.<\/strong> Never beta-first: unopposed alpha \u2192 hypertensive crisis. High-salt diet + liberal fluids to expand contracted plasma volume.<\/p>\n\n        <div class=\"rv-sub\">MEN Syndromes<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Type<\/th><th>Gene<\/th><th>Components<\/th><th>Surgery sequence<\/th><\/tr>\n            <tr><td><strong>MEN 1<\/strong> (Wermer)<\/td><td>Menin, chr 11q13<\/td><td>3 Ps: Parathyroid (MC) + Pituitary + Pancreas (gastrinoma)<\/td><td>Parathyroidectomy (3\u00bd glands)<\/td><\/tr>\n            <tr><td><strong>MEN 2A<\/strong> (Sipple)<\/td><td>RET, chr 10q11<\/td><td>Medullary thyroid Ca + Phaeochromocytoma + Hyperparathyroidism<\/td><td><strong>Phaeochromocytoma first, then thyroidectomy<\/strong><\/td><\/tr>\n            <tr><td><strong>MEN 2B<\/strong><\/td><td>RET codon 918<\/td><td>MTC + Phaeochromocytoma + Mucosal neuromas + Marfanoid<\/td><td>Prophylactic thyroidectomy &lt;6 months of age<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p>RET = proto-oncogene (gain of function). Menin = tumour suppressor (loss of function). In MEN 2A\/2B: always screen for phaeochromocytoma before any elective surgery.<\/p>\n\n        <p><span class=\"rv-pill\">Papilloma: microdochectomy<\/span> <span class=\"rv-pill\">Follicular Ca: FNAC cannot diagnose<\/span> <span class=\"rv-pill\">Medullary Ca: calcitonin marker<\/span> <span class=\"rv-pill-blue\">Phaeochromocytoma: alpha before beta<\/span> <span class=\"rv-pill-green\">MEN 2: phaeochromocytoma first<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/breast-thyroid-endocrine\/\">\u25b6 Open Quiz 04<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 5 \u2014 UROLOGY & HERNIAS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/urology-hernias\/\">\n          <div class=\"rv-sec-num\">Topic 05 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Urology &amp; Hernias <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Carcinoma Bladder<\/div>\n        <p>MC urological malignancy; 90% transitional cell carcinoma. Risk factors: smoking (MC), aniline dyes (2-naphthylamine), schistosomiasis (SCC, not TCC), cyclophosphamide. Painless haematuria = bladder Ca until proven otherwise. <strong>NMIBC (Ta\/T1\/Tis):<\/strong> TURBT + intravesical BCG (high-grade) or single-dose mitomycin C (low-grade). <strong>MIBC (T2+):<\/strong> radical cystectomy + urinary diversion (ileal conduit or neobladder) \u00b1 neoadjuvant cisplatin.<\/p>\n\n        <div class=\"rv-sub\">Testicular Torsion<\/div>\n        <p>Surgical emergency. Bell-clapper deformity (bilateral in ~50%). Triad: sudden onset severe scrotal pain + high-riding horizontal testis + absent cremasteric reflex. <strong>6-hour rule:<\/strong> 100% salvage &lt;6 hrs; 50% at 12 hrs; 10% at 24 hrs. Do not wait for Doppler USS if clinical diagnosis is confident. <strong>Operation:<\/strong> scrotal exploration \u2192 if viable: detorsion + bilateral orchidopexy (three-point fixation). If non-viable: orchidectomy + contralateral orchidopexy.<\/p>\n\n        <div class=\"rv-sub\">Inguinal Hernia Anatomy<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Feature<\/th><th>Indirect<\/th><th>Direct<\/th><\/tr>\n            <tr><td>Relation to inferior epigastric artery<\/td><td>Lateral (through deep ring)<\/td><td>Medial (through Hesselbach's triangle)<\/td><\/tr>\n            <tr><td>Coverings<\/td><td>3 layers (inc. internal spermatic fascia)<\/td><td>2 layers<\/td><\/tr>\n            <tr><td>Scrotal descent<\/td><td>Common<\/td><td>Rarely descends<\/td><\/tr>\n            <tr><td>Strangulation risk<\/td><td>Higher<\/td><td>Lower<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p><strong>Hesselbach's triangle (RIP):<\/strong> Rectus abdominis (medial) + Inferior epigastric artery (lateral) + Poupart's ligament (inferior). <strong>Triangle of Doom:<\/strong> vas deferens (medial) + testicular vessels (lateral) \u2014 contains external iliac vessels; no staples\/tacks here in TEP\/TAPP. <strong>Corona Mortis:<\/strong> aberrant obturator artery (~30% of patients) \u2014 fatal bleeding if divided.<\/p>\n\n        <div class=\"rv-sub\">Cryptorchidism<\/div>\n        <p>Orchidopexy timing: <strong>6\u201318 months, ideally before 12 months<\/strong> (germ cell loss begins from 6 months). Malignancy risk 3\u20135\u00d7 higher (MC tumour: seminoma). Orchidopexy does not eliminate cancer risk but brings testis into an examinable position. Hormonal therapy (hCG\/GnRH): &lt;20% success for inguinal UDT \u2014 not recommended. Impalpable testis: diagnostic laparoscopy first.<\/p>\n\n        <div class=\"rv-sub\">TUR Syndrome<\/div>\n        <p>Absorption of hypotonic glycine 1.5% irrigation fluid through open venous sinuses during TURP \u2192 dilutional hyponatraemia (Na\u207a &lt;125 mEq\/L) + hypervolaemia + glycine neurotoxicity (visual disturbance). <strong>Treatment:<\/strong> fluid restriction + IV furosemide + hypertonic saline (1.8\u20133%) if Na\u207a &lt;120 or severe symptoms (correct \u226410 mEq\/L\/24 hrs). Prevention: bipolar TURP or HoLEP (use saline irrigation).<\/p>\n\n        <p><span class=\"rv-pill\">T2 bladder Ca: radical cystectomy<\/span> <span class=\"rv-pill\">Torsion: 6-hour window<\/span> <span class=\"rv-pill\">Direct hernia: medial to inf. epigastric<\/span> <span class=\"rv-pill-blue\">Triangle of Doom: external iliac vessels<\/span> <span class=\"rv-pill-green\">Orchidopexy: 6\u201318 months<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/urology-hernias\/\">\u25b6 Open Quiz 05<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 6 \u2014 VASCULAR, TRAUMA & BURNS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/vascular-trauma-burns\/\">\n          <div class=\"rv-sec-num\">Topic 06 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Vascular, Trauma &amp; Burns <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Blunt Abdominal Trauma<\/div>\n        <p>MC injured organ: spleen &gt; liver &gt; small bowel\/mesentery. <strong>Haemodynamically unstable + positive FAST \u2192 emergency laparotomy<\/strong> (no CT). Stable + positive FAST \u2192 CT abdomen for grading and management planning. <strong>Damage control surgery:<\/strong> abbreviated laparotomy \u2014 pack + clamp + temporary closure; avoid lethal triad (hypothermia + acidosis + coagulopathy). FAST: free fluid in Morrison's pouch, splenorenal pouch, pelvis, pericardium.<\/p>\n\n        <div class=\"rv-sub\">DVT \u2014 Management<\/div>\n        <p><strong>Proximal DVT:<\/strong> LMWH bridge \u2192 DOAC (rivaroxaban or apixaban) for minimum 3 months (provoked). Unprovoked: 3\u20136 months + reassess. Cancer-associated: LMWH or DOAC indefinitely. <strong>IVC filter:<\/strong> only if anticoagulation absolutely contraindicated. <strong>Thrombolysis:<\/strong> only for massive PE with haemodynamic instability or phlegmasia cerulea dolens. Stop OCP; thrombophilia screen after anticoagulation completed.<\/p>\n\n        <div class=\"rv-sub\">Burns \u2014 Key Numbers<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Body region (adult)<\/th><th>TBSA %<\/th><\/tr>\n            <tr><td>Head &amp; neck<\/td><td>9%<\/td><\/tr>\n            <tr><td>Each upper limb<\/td><td>9%<\/td><\/tr>\n            <tr><td>Anterior trunk<\/td><td>18%<\/td><\/tr>\n            <tr><td>Posterior trunk<\/td><td>18%<\/td><\/tr>\n            <tr><td>Each lower limb<\/td><td>18%<\/td><\/tr>\n            <tr><td>Perineum<\/td><td>1%<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p><strong>Parkland formula:<\/strong> 4 mL \u00d7 weight (kg) \u00d7 %TBSA = total Ringer's lactate in 24 hrs. \u00bd in first 8 hrs from <em>time of burn<\/em> (not admission); \u00bd in next 16 hrs. Titrate to UO 0.5\u20131 mL\/kg\/hr. IV fluids for \u226515% TBSA (adult), \u226510% (child). No colloid in first 24 hrs. <strong>Eponyms:<\/strong> Curling's ulcer = stress ulcer in burns (duodenum); Marjolin's ulcer = SCC in chronic burn scar.<\/p>\n\n        <div class=\"rv-sub\">Peripheral Arterial Disease \u2014 Fontaine Classification<\/div>\n        <p>Stage I: asymptomatic \u00b7 IIa: claudication &gt;200 m \u00b7 IIb: claudication &lt;200 m \u00b7 III: rest pain \u00b7 IV: tissue loss. CLTI = Stages III + IV. <strong>ABPI:<\/strong> normal 0.9\u20131.3; mild 0.7\u20130.9; moderate 0.4\u20130.7; severe &lt;0.4; &gt;1.3 = non-compressible (diabetics). <strong>First-line for claudication (Stage II):<\/strong> supervised exercise therapy + smoking cessation + statin + antiplatelet. Revascularisation for disabling claudication or CLTI.<\/p>\n\n        <div class=\"rv-sub\">AAA \u2014 Repair Thresholds<\/div>\n        <p>Elective repair: \u22655.5 cm in men; \u22655.0 cm in women; or any symptomatic\/rapidly expanding (&gt;1 cm\/year) regardless of size. <strong>EVAR vs open:<\/strong> EVAR = lower 30-day mortality but requires lifelong surveillance for endoleaks + higher reintervention rates; long-term survival equivalent. Open = more durable, no mandatory follow-up imaging. <strong>Laplace's law:<\/strong> wall tension \u221d pressure \u00d7 radius. Ruptured AAA triad: tearing back pain + hypotension + pulsatile mass \u2192 direct to theatre.<\/p>\n\n        <p><span class=\"rv-pill\">Unstable FAST+: laparotomy not CT<\/span> <span class=\"rv-pill\">DVT: DOAC 3 months minimum<\/span> <span class=\"rv-pill\">Parkland: time of burn not admission<\/span> <span class=\"rv-pill-blue\">Fontaine IIb: supervised exercise first<\/span> <span class=\"rv-pill-green\">AAA \u22655.5 cm: elective repair<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/vascular-trauma-burns\/\">\u25b6 Open Quiz 06<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 7 \u2014 ONCOLOGY, NEUROSURGERY & PERIOP\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/oncology-neurosurgery-periop\/\">\n          <div class=\"rv-sec-num\">Topic 07 \u00b7 Surgery<\/div>\n          <div class=\"rv-sec-title\">Oncology, Neurosurgery &amp; Perioperative <span class=\"rv-arrow\">\u2197<\/span><\/div>\n        <\/a>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">EDH vs SDH<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Feature<\/th><th>Extradural (EDH)<\/th><th>Subdural (SDH)<\/th><\/tr>\n            <tr><td>Source<\/td><td><strong>Middle meningeal artery<\/strong> (arterial)<\/td><td>Bridging cortical veins (venous)<\/td><\/tr>\n            <tr><td>CT shape<\/td><td><strong>Biconvex (lens-shaped)<\/strong>; does not cross sutures<\/td><td>Crescent-shaped; crosses sutures freely<\/td><\/tr>\n            <tr><td>Classic history<\/td><td><strong>Lucid interval<\/strong> (KO \u2192 recovery \u2192 rapid decline)<\/td><td>Acute: severe injury; Chronic: elderly, minor trauma\/anticoagulants<\/td><\/tr>\n            <tr><td>Location<\/td><td>Temporal\/temporoparietal (pterion fracture)<\/td><td>Frontoparietal; bilateral in chronic<\/td><\/tr>\n            <tr><td>Treatment<\/td><td>Emergency craniotomy + clot evacuation<\/td><td>Acute: craniotomy; Chronic: burr hole drainage<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p><strong>Kernohan's notch:<\/strong> uncal herniation compresses contralateral cerebral peduncle \u2192 ipsilateral hemiplegia \u2014 a false localising sign. <strong>Pterion:<\/strong> thinnest skull bone, overlies MMA groove.<\/p>\n\n        <div class=\"rv-sub\">Soft Tissue Sarcoma<\/div>\n        <p>Features suggesting malignancy: &gt;5 cm + deep to deep fascia + hard + heterogeneous on MRI + rapid growth. Biopsy: core needle (or incisional along long axis \u2014 so tract is excised en bloc). <strong>Never excisional biopsy<\/strong> \u2014 shelling through pseudocapsule seeds tumour. Treatment: <strong>wide local excision (R0) + post-operative radiotherapy<\/strong> \u2014 limb salvage in ~90%. Amputation reserved for tumours involving major neurovascular structures. Metastasis: haematogenous \u2192 lungs (not lymph nodes, except synovial sarcoma).<\/p>\n\n        <div class=\"rv-sub\">Carcinoma of the Lip<\/div>\n        <p>95% SCC; lower lip 90% (sun exposure, pipe smoking). T staging: T1 \u22642 cm; T2 2\u20134 cm; T3 &gt;4 cm. N1 = single ipsilateral node \u22643 cm. <strong>Management:<\/strong> wide excision (V-plasty for &lt;\u2153 width; Abbe\/Karapandzic flap for larger) + ipsilateral supraomohyoid neck dissection (levels I\u2013III) for N+ disease. Occult nodal rate ~30% in cN0 T2 \u2192 elective neck treatment recommended.<\/p>\n\n        <div class=\"rv-sub\">OPSI \u2014 Post-Splenectomy<\/div>\n        <p>Fulminant bacteraemia with encapsulated organisms (SHiN: <em>Streptococcus pneumoniae<\/em> [MC], <em>Haemophilus influenzae<\/em> type b, <em>Neisseria meningitidis<\/em>). Mortality 50\u201370% once established. <strong>Prevention:<\/strong> three vaccines (pneumococcal + meningococcal ACWY + Hib) \u22652 weeks pre-op (elective) or 2 weeks post-op (emergency) + lifelong penicillin V + emergency antibiotic card. Post-splenectomy findings: Howell-Jolly bodies, target cells, thrombocytosis.<\/p>\n\n        <div class=\"rv-sub\">Wound Classification &amp; SSI<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Class<\/th><th>Definition<\/th><th>SSI risk<\/th><th>Antibiotic prophylaxis<\/th><\/tr>\n            <tr><td><strong>I \u2014 Clean<\/strong><\/td><td>GI\/GU\/resp not entered; no inflammation<\/td><td>&lt;2%<\/td><td>Only if implant used<\/td><\/tr>\n            <tr><td><strong>II \u2014 Clean-contaminated<\/strong><\/td><td>Controlled GI\/GU\/resp entry; minor break<\/td><td>5\u201310%<\/td><td>Yes<\/td><\/tr>\n            <tr><td><strong>III \u2014 Contaminated<\/strong><\/td><td>Fresh trauma; major break; acute inflammation<\/td><td>~20%<\/td><td>Yes (therapeutic)<\/td><\/tr>\n            <tr><td><strong>IV \u2014 Dirty\/Infected<\/strong><\/td><td>Old wound; established infection; perforated viscus<\/td><td>&gt;30\u201340%<\/td><td>Yes (therapeutic)<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n        <p>Prophylaxis: given <strong>30\u201360 minutes before skin incision<\/strong> (cefazolin first choice). Superficial incisional SSI: open wound + send swab + saline-moistened dressings + healing by secondary intention. Antibiotics not routinely required if adequately drained.<\/p>\n\n        <p><span class=\"rv-pill\">EDH: lucid interval + biconvex CT<\/span> <span class=\"rv-pill\">STS: never shell through pseudocapsule<\/span> <span class=\"rv-pill\">Lip SCC: supraomohyoid dissection<\/span> <span class=\"rv-pill-blue\">OPSI: SHiN organisms<\/span> <span class=\"rv-pill-green\">Prophylaxis: 30\u201360 min before incision<\/span><\/p>\n\n        <a class=\"rv-quiz-link\" href=\"https:\/\/atsixty.com\/index.php\/surgery\/oncology-neurosurgery-periop\/\">\u25b6 Open Quiz 07<\/a>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         EXAMINER'S FAVOURITES \u2014 CROSS-SERIES RAPID RECALL\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Cross-Series \u00b7 Surgery<\/div>\n        <div class=\"rv-sec-title\">Examiner's Favourites \u2014 Rapid Recall<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Classifications to know cold<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tbody><tr><th>Classification<\/th><th>What it grades<\/th><th>Key anchor<\/th><\/tr>\n            <tr><td>Modified Johnson's (I\u2013V)<\/td><td>Gastric ulcer site + acid<\/td><td>Type I = incisura, low acid (MC); Type IV = GEJ, highest Ca risk<\/td><\/tr>\n            <tr><td>Ranson's (11 criteria)<\/td><td>Pancreatitis severity<\/td><td>Cannot calculate before 48 hrs; \u22655 = severe<\/td><\/tr>\n            <tr><td>Gharbi (I\u2013V)<\/td><td>Hydatid cyst<\/td><td>I\/II = active (PAIR); IV\/V = inactive (no treatment)<\/td><\/tr>\n            <tr><td>Alvarado \/ MANTRELS (10)<\/td><td>Acute appendicitis<\/td><td>\u22657 in males = direct to OT; RIF tenderness + leukocytosis = 2 pts each<\/td><\/tr>\n            <tr><td>Fontaine (I\u2013IV)<\/td><td>PAD severity<\/td><td>III\/IV = CLTI; ABPI &lt;0.4 = critical<\/td><\/tr>\n            <tr><td>Wound class (I\u2013IV)<\/td><td>SSI risk<\/td><td>I &lt;2%; II 5\u201310%; III ~20%; IV &gt;30%<\/td><\/tr>\n          <\/tbody><\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Eponymous signs \u2014 one-liners<\/div>\n        <p>\n          <span class=\"rv-pill\">Charcot's triad: pain + fever + jaundice (cholangitis)<\/span>\n          <span class=\"rv-pill\">Reynold's pentad: + confusion + hypotension<\/span>\n          <span class=\"rv-pill\">Courvoisier's sign: palpable non-tender GB = malignant obstruction<\/span>\n          <span class=\"rv-pill\">Dance's sign: empty RIF in intussusception<\/span>\n          <span class=\"rv-pill\">Cullen's \/ Grey Turner's: retroperitoneal haemorrhage (pancreatitis)<\/span>\n          <span class=\"rv-pill-blue\">Chvostek \/ Trousseau: hypocalcaemia<\/span>\n          <span class=\"rv-pill-blue\">Kernohan's notch: false localising sign (EDH)<\/span>\n          <span class=\"rv-pill-blue\">Curling's ulcer: stress ulcer in burns<\/span>\n          <span class=\"rv-pill-blue\">Marjolin's ulcer: SCC in burn scar<\/span>\n          <span class=\"rv-pill-green\">Bell-clapper deformity: testicular torsion<\/span>\n          <span class=\"rv-pill-green\">Goodsall's rule: fistula-in-ano tract direction<\/span>\n        <\/p>\n\n        <div class=\"rv-sub\">Number anchors<\/div>\n        <p>\n          <span class=\"rv-pill\">Parkland: 4 \u00d7 kg \u00d7 %TBSA; \u00bd in first 8 hrs from burn<\/span>\n          <span class=\"rv-pill\">AAA repair: \u22655.5 cm (men), \u22655.0 cm (women)<\/span>\n          <span class=\"rv-pill\">Torsion: 6-hr window for 100% salvage<\/span>\n          <span class=\"rv-pill\">Orchidopexy: 6\u201318 months (ideal: 12 months)<\/span>\n          <span class=\"rv-pill-blue\">Kasai: before 60 days<\/span>\n          <span class=\"rv-pill-blue\">MEN 2B thyroidectomy: &lt;6 months of age<\/span>\n          <span class=\"rv-pill-blue\">TUR syndrome: Na\u207a &lt;125; correct \u226410 mEq\/L\/24 hrs<\/span>\n          <span class=\"rv-pill-green\">Prophylaxis timing: 30\u201360 min before incision<\/span>\n          <span class=\"rv-pill-green\">OPSI vaccines: \u22652 weeks pre-op or 2 weeks post-op<\/span>\n        <\/p>\n\n        <div class=\"rv-sub\">Sequence rules \u2014 surgery in order<\/div>\n        <p>\n          <span class=\"rv-pill\">MEN 2A: phaeochromocytoma first, thyroid second<\/span>\n          <span class=\"rv-pill\">Phaeochromocytoma: alpha-block before beta-block<\/span>\n          <span class=\"rv-pill-blue\">Corrosive ingestion: never vomit, never neutralise<\/span>\n          <span class=\"rv-pill-blue\">Pancreatitis necrosectomy: never in first 2 weeks<\/span>\n          <span class=\"rv-pill-green\">Burns: Ringer's lactate, no colloid in first 24 hrs<\/span>\n          <span class=\"rv-pill-green\">TURBT before cystectomy: stage the bladder first<\/span>\n        <\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- Footer -->\n    <div class=\"rv-footer\">\n      Surgery Summative Revision \u00b7 atsixty.com \u00b7 Morning Rounds Series<br>\n      <a href=\"https:\/\/atsixty.com\/index.php\/surgery\/surgery-morning-rounds-index\/\">\u2190 Return to Surgery Series Index<\/a>\n    <\/div>\n\n  <\/div>\n<\/div>\n\n\n<ul class=\"wp-block-latest-posts__list wp-block-latest-posts\"><li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/surgery-summative-revision-notes\/\">Surgery: Summative Revision Notes<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/oncology-neurosurgery-periop\/\">Oncology, Neurosurgery &amp; Periop<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/vascular-trauma-burns\/\">Vascular, Trauma &amp; Burns<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/urology-hernias\/\">Urology &amp; Hernias<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/breast-thyroid-endocrine\/\">Breast, Thyroid &amp; Endocrine<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Morning Rounds \u00b7 Surgery Series SurgerySummative Revision Notes Seven topics \u00b7 NEET-PG \u00b7 Key facts, tables, classifications and surgical rules Upper GI Lower GI Hepatobiliary Breast &amp; Endocrine Urology &amp; Hernias Vascular &amp; Trauma Oncology &amp; Periop These notes consolidate the seven Surgery Morning Rounds. They are written for rapid pre-exam revision \u2014 not first-time&hellip;&nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[56],"tags":[],"class_list":["post-37069","post","type-post","status-publish","format-standard","hentry","category-surgery"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Surgery: Summative Revision Notes - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/surgery\/surgery-summative-revision-notes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Surgery: Summative Revision Notes - atsixty\" \/>\n<meta property=\"og:description\" content=\"Morning Rounds \u00b7 Surgery Series SurgerySummative Revision Notes Seven topics \u00b7 NEET-PG \u00b7 Key facts, tables, classifications and surgical rules Upper GI Lower GI Hepatobiliary Breast &amp; Endocrine Urology &amp; Hernias Vascular &amp; Trauma Oncology &amp; Periop These notes consolidate the seven Surgery Morning Rounds. 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