Horse Shoe

Kidney : -

Both
Kidney-fus at lower pole
-

Asymptomatic

Kidney arrested from ascending

-

↓
& L-15 vertebrate
↓
obstruct inf

.
Mesenbrie A .

comp" : BI wileric obstruction

:
stone

infection
2x-1s-USG-abd-> show
jused Kidney
↓
IOC -
CECT abd

if < not available-iv

urogram-C D
33
.

↓
M C U
. .
is a
Nephrogram (kidney visible)
part of I C V. .
.

Heterogram (with" (
(v (
tystogram B"
.

In Horse-shor
Kidney - lowerplaced idney 11

a
R =
asymptomatic -

nothing
i n f re
UTI- & the
Stones -

R the
stoner

Identify the condition shown in the CT scan below. (FMG Dec 2020)

A. Wilm’s tumor
B. Polycystic kidney
C. Horse Shoe kidney~
D. Renal cell cancer
⑳
*
PCKD (Polycystic Kidney de)

DAAD-PCKD -
mic
-
-
adults >30
ye

& AR-PCKD -
children

3yr
righ mortality

Effects :

Kidneys damaged
Is Clinical

finding
- HTN (renal HTN)
↓

C1D
ESRD

site-liveras
But at other
Cyst may
->
[Neve in
lung
->
Berry
Mitralamer
vegam
->
Profe

4f-indidental
PA I HTN
young
Palate
pumpin abd Maybe
Ix-1st- USG KUB-multiple cysts (2) in both
Kidneys
d
IOC -

CECT abd

RFT
Severity deranged
- -

R: in
early PCKD- RHTN ,
Tolbactan

in ESRD -

Renal transplant
Identify the radiological investigation showing
polycystic kidney below. (FMG Jan 2022)

a. PET-Scan MRI ->

b. CT
(black bones)
c. MRI ~
d. USG

Renal stones
RF-dietary factors-food 44 oxalates
: :

Caffine/cocco/ tomato
-

Red meat-44 wie acid

UT I-Klebsiella
Hypercalcemia
Hyper PTH

Types of Stones : -

M/ D Ca Oscolate
mulberry app
-

Envelope / dumbell shaped

-

Radio-opaque

⑳
② tripple phosphate-AKA Struvite stones

Staghorn stone
Coffin lid app
-

&
-

Radio-obaque

③ Urie acid-yellow colored

E
-

Rhomboid shaped
-

Radio-lucent

④ Cystein-Hard yellow ,

↑Y Hecagonal
-
Radio-opaque (broz Sulphur)
of
 C18 :
flank pain / pain
colic

Hematuria-dark ded wine

horn

-Stag
calculi

ist
step en
TURE Demetric
:
wim

8 ->
X-Ray KUB

X-Ray KUB / USG KUB

IOC : Plain CT-KUB

contrant⑦nt in UB
7
-
if

to

R : Eme
colic

-> NSAIDS sa then its

-
IVU
-

Stone in UB

elective :

①Conserrative My- <5mm stone

& ESWL /extra-corporeal shock

lithotripsy) us
wave waver

indication :
Imm to 20mm

(not for cystein break the stone

Soft
stones

as

they are hard stones)

42-Prog i damage
will
jetal here

M/
Comb" -

infection
H
bleeding ston
fragments

③ PCNL (percutaneous nephro-lithotomy)

↳
Nephroscope instrument-Kidney-Pelvis
See stone-Break then remove

-> indication-stores comm

Hard stones

ston in lower
calyes
->
CI-Preg
*
Compr-Hemorrhage
->

to
injury colwe
or are
 & RIRS
<Retrograde intra renal x)

e
A patient came with pain in the abdomen and on further
imaging the following is obtained, What is the best
management option for this patient? (FMG Jan 2023)

a PCNL
b ESWL
C Ureteroscopic removal -> for
~
d. Reassurance
Se
writer stone

mainxrayt
kUB

its an endoscopie removal

write stone (ard/stone)
of ↓

endoscope is passed from

withra-U-Writer
↓

stone removal

G .....
...........
 Hydronephrosis :-dialated pelvic-calyal system ↓
obstruction
↳
distal

...

long term-affected kidney will loose

June
·
its

Hydronephrosis

⑲
UIL BIL
-
wictive stone
-
Bladder stone
PU5 obstruc "G
cong
- -

-
Veteric
st r u c t u re
-
Urethral stric ture

Retro-caval wreter Benign enlargement

-
-

of Prostate

&
Se

I
* 1st USG KUB
S
-
:

&

Il
d >
PUS obstruc

IOC CECT its IVC It side

enargement
=>

<
-

IVU->
Clubbing of
P CS
.
.

of calyces
H

Has
, Clubbing of Pelvi-calyceal
system

Identify the condition that does &

not lead to bilateral -

hydronephrosis. (FMG Jan 2023)

-

a Phimosis.V
b Urethral Stricture -

c. Posterior urethral valve -

d. Ureteric stone X
~
Wilm's tumor :
-

mi in
(2-7yr)
child

AlIPA Nephroblastoma (malignant)

-

WAGR =

2ndm/ (m/c-is Neuroblastoma)

of lumb abd in a child
-

in

of adrenal gland
-

metastasis->LN
Hemat-lung
I
:

1st -

USG
↓
IOC -

CECT-Abd & No need to do Bx

R-Nephrectomy chemo
+

Which of the following is &

not true about nephroblastoma ?
- -

(FMG Jan 2023)

a. May spread by lymphatics. -

b. Early lung metastasis is seen -

c. Treatment is by chemotherapy and surgery. ~

d. It is the most common intra-abdominal malignancy.

E -

↳ its

a 2nd r/
 -also as
Hyper-nephroma/ Gravitytumor
RCC :-

elderly smoker male

-

obesity
-

Types :
-
①Clear all-M/
in von-hipple Lindau
syn
-

②
Papillary-long term
"Pramoma bodies"
-
dialysis

③ Chromophobe-Good
prog
④ Medullary -
children sickle cell trait

%I : -elderly man-Grow hematuria

Blood clots in
wine

palpable lump
metastasis -
IN
-

Hematogenous->lungs (Cannon ball metastasis)

Paranoplastic synd .

↓
· Yed ESR
·

Hypucalcemia-Anemia
liver
~
Stauffer syn derangement
-

↳>
metastasis

Ix : -wine-URE-Hematria

↳ UNE

cytology-to see a Cells

-
iSt :

USG kuB
IOC CECT abd
- :

* RCC - chemo a radio resistance

 Staging R
- AIKIA nephron sparing
T, -a Partial
-
24cm -
nephrectomy nephrectomy
b -

4 7cm
-
-
Partial/Radical
Tz -

> 7cm
T21Ts ->
Radical
Tz-a-tumor limited to Renal vein

Id P
·
&L
ou
......
... " b-tu . is below diaphram Ty-Palliative
S
as
er

C-tu .
is above diapar
a

T-Tu reached Gerota's fascia

• A 65-year male presented with a mass in the left lumbar region which
-

was ballotable. He was having abdominal discomfort and on

-

investigations, he was found to have a mass of 8 X 5 X 3cm which was

- -

d
confined within the kidney and was diagnosed as renal cell carcinoma.
e -

What would be the treatment for this patient? (FMG Dec 2021)

a. Partial nephrectomy
b. Radical nephrectomy
-
Tz
c. Radiotherapy
d. Chemotherapy Z
Ca U B
. .
-

my-transitional all cancer

RIF- Smoker
Obesity
elderly men

an Occupational ca . -Chemical factories

p
rubber

Battery Jactor
H
expon to -Naphthaline /D-toludine

Premalignancy SqCC-stones Bilharziasis

->
,

41 elderly make
-

hematuria (blot Clots)

profuse
metastasis -
local-prostate ,
rectum
uterus ,
cervic

LN mets
remat mets-lumbar vertebrae lungs

Ix-1st-wine + URE

I
Legit
urE

tumor manee

sa ku
↓
IOC :
L
Cystoscopy :
biopsy -TC o
Sq

jamets/local MRI
de et
 R
Staging
p
Ta-mucosa not ,
invading lamina prop Cystoscopic resection
t
intraverical chemo
T1 mucora/
.

lamina
submucosa ,
invading
-

p
- - - -

pTz-muscularis
->
Radical cystectomy
pTz
-
adventia

p Ty-a -
resect
adjacent org .

- Palliation
b-unres . 'I

intraverical chemo : -Put BCG or

mitomycin
inside the UB

↳ only for mucoral/submucosal th

not tu.
for mu
invading
A 65 year old smoker , male presented with painless hematuria. On
further investigation he is diagnosed with bladder cancer extending upto -

the muscle layer. What should be the treatment of choice in this patient ?
-

(FMG Jan 2023)

a) intravesical BCG followed by chemotherapy .
b) Systemic chemotherapy
~c) Radical cystectomy
d) Radiotherapy

A& 2 year child is having problems in urination from last 3 months. Contrast
- -

dye is introduced from urethra to visualize the fault. The radiological image
n e

is shown below. What could be the investigation? (FMG June 2022)

A. Micturating cystourethrogram -> in contract

↓
B. Retrograde urethrogram
- Kidney
C. Antegrade pyelography
↓
writer
D. Retrograde pyelography L
Bladder
↓
Now PA wimates
& X-Ray is taken

k
 -
rCU ->
VUR
PUr

-
Bladder

* in Vesico-waterie done
refluc-MCU is
I
⑧ in prothal
value - MCU to see
↓
backflow of wine
hole wreter
key sign in
 Ca-Prostate-

C C
lobe

Y S
lat
-

--C
& ↳

median
7 lobe
CCC)
St -
-

~
-

-> Port lobe

S
① Benign enlagement of prostate-lat lobe or median lobe

② Ca Prostate-post
.
lobe

↳is
far from
A
urethra- rare
wrinary comp"
-
no hematuria

urgency freq
no
-

H
...
:

incidental
diag
while
screening
Mete -
LN
-
Hemat .
met->lumbar vertebrae) : Ch . back pain ent)

- incidental
%

lower back ache *

Ix - -
5 PSA.
=

~ : <3 5 .

suspicious : 3 5 .
to 10 - do Bx
Sugestive : >10 -> Bx

zc : TRUS :
Biopry-adeiocarcinoma
Mets-local-MRI
-
distant-PET scan
 staging R

Tc-screening -PPS ->

Radical protectomy
Tz-limited to prostate

To-beyond breach the capsule

Seminal Vesicle ->
Chemo/ adrogen ablation
Glant-androgen
R)
Ty-adjacent organ
Goserelin Kewrolide (Lant)
Bicalutamide I

(receptor blocker)

*
age old PA = TICa ,
PSA--> do Swelliance

• A patient was operated on for benign prostatic hyperplasia. On

evaluation, incidentally, cancer of the Prostate was detected and on
further workup was found to have metastasis. Which of the following
drug is used for treatment ? (FMG Dec 2021)

a. Goserelin~
b. Adriamycin
c. Cisplatin
d. BCG
 Undescended testier : -

Retroperitorium
↓
not deep ring
in
scrotum

Higher up but
Pathway guinal
in

in
-

, canal

superficial ring
Li

scrotum
Ectopic testies : -

-
not in scrotum

Outside the
Pathway of descend
-

M/c seen at "Superficial inguinal pouch"

# In premature :
child

I undescended - can come down in 3months

%: -
at birth-U or Bl
empty scrotum

age (tenagu)
late sexual
delayed
-> ↳ character or

delayed puberty
↑ Seminomic

Ro if dig . at
Birth-Orchidopercy at smonths

late explore the testies check viable

if dig is -> -

en
~ X
↓

Orchidopery Orchidectomy
if testies is V .

high up-2 staged orchidopocy

Stephen-howler's procedure
• A 14 year old boy presented to the surgery OPD . On examination , his left
scrotal sac is empty. On clinical examination the left testis was found in the
-
superficial inguinal pouch. What is the most likely diagnosis? (FMG June 2022)
>
↳ ectotic
a. Cryptorchidism
b. Left undescended testis
c. Left ectopic testis
~
d. Retractile testis

icocele"-dialated ,
tortuous ,
pampnifor please
left side At
side

->

e
- - -

↓
my bery
:
-left testicular vin is
straight G -

/
I
... V .

high pressure

left-sigmoid colon-compress
-

48 :
dragging pain in scrotum
Bag of
- 7I

worms

on
lying-vein drains
Ix : venous duple of testicular vin

R : 1st-> Percutaneous testicular vin embolization

large- Testicular vein

light excision
 • A young male presented with slight dragging sensation in the scrotum. On
examination a bag of worm feel was noted in the left side of scrotum.
However testes was normal. Diagnosis? (FMG June 2022)

a. Left hydrocele
b. Inguinal hernia
c. Epididymo-orchitis
d. Left varicocele
W

• A&70 year old patient felt heaviness in his left scrotum, and reported to
casualty. There was - -
no pain or tenderness and transillumination
-
test was
negative, most likely diagnosis in this patient would be? (FMG June 2021)
a. Varicocele
-
④ ht transillumination
b. Hydrocelex -
fluc tuation

c. Testicular Torsion
I
in
children

*
->

d. Epididymo orchitis STI-acute pain

young
->
,

Acute Scrotume-Sudden onet pain in scrotum

m/ I
children

in
teens
-

↳ Tortion
↳
of testies
acute
epididymo-orchitis
↳
strangulated
hernia

Tortion of testies-> testies twist ischemic

by itself of testies
-

↓
AHA D anatomical prob Transverse testies
:

② Gap blw listies I Epididymis

③ High investment
of tunica
Vaginatio-Bell Clapper effect

-Ci Vaginalis
-> Tunica

istis

tiist-> ischemia

"Acute scrotum"
Young boy
-

↓
"Phren's rign"-on lifting the testies-Pain4= Torsion
↳ Paind=
④
Epididymo-orchitis

Exploration within Ghrs

 Exploration within Chrs
L

if doubt : Testicular arterial doppler-obstr .

Untwist testies # other testies

- ↓
Viakle
↓
non-Viable
↓
Orchidopery
-

Orchidopey Orchidectomy

• 21 years old boy presented in agony with sudden onset of severe pain in
-

the groin region, associated with redness and swelling of the scrotum. On
- - -

examination the right testis looks higher than the left. Possible diagnosis in
-

this boy is? (FMG June 2021) d

-
a) Testicular torsion Deming sign- Torsion-higher
b) Hydrocele
c) Strangulated inguinal hernia
d) Acute epididymo-orchitis

• ‘Three Testicle appearance’ is seen in? (FMG June 2021)

a. Vaginal hydrocele
Xb. Spermatocele
c. Epididymo orchitis
d. Torsion Testis

looks like 3rd testies

->
 :
effects
- -

①Skin : -

&
Coagulation-dead
⑯ zone of stairs-at risk-
salvaged
①
Hyperthermia-safe
② Systemic effects I inhalation-

Burns
15 %
profound fluid loss -> Hypovolemia
-
=

Septicemia-organ Jaliure
i n fe c te d
-

inhalational Hot
Jumes
-
Airway burns
-

->
laryngeal eduma
-> carbon-monoxide
↓
poisoning
immediate death

& features
: -

Naral hair - Burn

Soot-far/mouth
Stridor

Cyanois
No trapped in a closed room
 Criteria for admission Burns centre
referal
Total burn
surface
·
area

Any full thicknes burn

·

W
(chemical electrical Inhale")
e

Dangerous mechanism burn

↑

of
·
, ,

high risk patient child

elderly I
comorbidity
:

, ,

·
Dangerous area-face pat ,
sole , Genitalia

⑪ Assessment-
-> adult-Walke rule
of 9%
-

⑰]
. . .
head +rick-s %

dy 1. e =99 +
1 =
100 %

·
↳child-fund & Browder charge
nee

0 10
age
=

front & back

N
I-head 942 542

I 24 4 Yu

I 2Y 3
 In
Patchy burns->Pt's hand=11 .
BSA

② Depth of burns : -

color appear Pain Sear

P 20 30

epris
E
>
-
Es
1 epidermal - red
dry
~ X
dermis-

2 I thickness- u X
↓ Superficial-Pink
moist blister
partial

deep- white "mottled" X , deeptouch Hyper-

may brophie
-

sear

3 I full thickness - Black charred X "Excar"

↓

dangerous

10
↓
d
2"
Superficial
??
Resuscitation :
=> -

lot
of IVF->15% -
Hypovolemia
① Parkland's formula -> IVF= 4mX
Body We X % TBSA

↓
within eshes
4x60ky TBSA
:

IVF
give eg
x 50 %

12000m/24h
*
fluid of Choice=RL L-
Glit Glit

(in 1s 8 (e) (noct 16 hrs)

e
↓

Target U O =0
.
.

5m/kg/hr
 & ATLS => 2 m1 X
Bodynt x Y TBSA

↳ Burn-dont include
is
"
in ATLS

↳
if TBSA>50 % then count as 50 %

inhalational burns
in -
early intubation

ivantibiotics
analgesir
->
,
in
-> IV PPI

Curling When ?
->

=>

Wound care :-

"
-

burn-open
-
↳
burn-open/dressing
-

2D/3 burn-anti-microbial
-
+
dressings
↓
Silver
sulphadiazine- for preudomonas
·

actate-causes M acidosis
Majedine
·
·

(beg it contain actate

H
Healing Split thickness skin
8
graft
(deep)
 Plastic Sy:- reconstrue" of wounds/defect

Reconstructive ladder :

from simple to
highe
Bak

Wast

Saling

#
Graft- a
piece of tiue its own blood
supply

eg
: Skin
graft->DSplit thickness (STS4)
② full thicknew (FTSG)

Nerve/tendon/Vascular graft

ISTSG-> epidermis + partial dermic (Site :

thigh)
- -

L un :
fo large wounds-eg : Burns ↳ it heals
by itself .

AKA
There's 4I :

where
-eg face
:

area consmesis is
reg -

graft area < poor vascularity-eg exposed bone tendon

:

->

↳
↳ Dermatome ↓ Humby Knife
Inew machine then placed
ie now
und) at site
 & FTSG epidermist entire dermis (site Schavicularfore
: -
-

ver-cosmetic
purpose-eg face knife needed
:

no is

just I
scalpel/ecizor
%
-large wound
area <
poor vascularity
Site-port auricular -> Hairless area

supra-clavicular Jora

Split skin graft is composed of? (FMG June 2022)

a. Only epidermis
~
b. Epidermis & partial dermis
c. Epidermis & deep dermis
d. Epidermis, dermis, subcutaneous fat.

flaps :-tissue own blood

supply
Types
-
① local
② distant - pedicled flap
->
free flap

D
J
·
->

Rhomboid Hap
⑧
&
-

tob of the - ->

--

V-Y advancement
flap
jingent
 -> removal of Ca
lip

:
after

ABBE
->
flap

jap from
lower lip

Distant
flaps :
->

①Pedicled-Vascular pedide is intact

② free flap -

-> STSG kept

5)
is
Pedick later
intact

Detto-pectoral Hap
=>

Pectoralis
major myocutaneous flap
->

=PMMC-acromiothoracic
-

↓
have best outcome · as work horse
flap
I
free flap : need Vascular anastomosis
=>
-

Radial
free-forearm flap
-