CLINICAL SURGERY SUMMARY NOTES
CONTENTS
CHAPTER PAGE
1. GENERAL SCHEME OF CASE-TAKING
2. A FEW SPECIAL SYMPTOMS AND SIGNS 11
3. EXAMINATION OF A LUMP OR A SWELLING 21
4. EXAMINATION OF AN ULCER 61
5. EXAMINATION OF A SINUS OR A FISTULA 76
6. EXAMINATION OF PERIPHERAL VASCULAR DISEASES AND GANGRENE ... 80
7. EXAMINATION OF VARICOSE VEINS 100
8. EXAMINATION OF THE LYMPHATIC SYSTEM 109
9. EXAMINATION OF PERIPHERAL NERVE LESIONS 122
10. DISEASES OF MUSCLES, TENDONS AND FASCIAE 142
11 . EXAMINATION OF DISEASES OF BONE 146
12. EXAMINATION OF BONE AND JOINT INJURIES 167
13. EXAMINATION OF INJURIES ABOUT INDIVIDUAL JOINTS 177
14. EXAMINATION OF PATHOLOGICAL JOINTS 213
15. EXAMINATION OF INDIVIDUAL JOINT PATHOLOGIES 223
16. EXAMINATION OF HEAD INJURIES 258
17. INVESTIGATION OF INTRACRANIAL SPACE-OCCUPYING LESIONS 271
18. EXAMINATION OF SPINAL INJURIES 282
19. EXAMINATION OF SPINAL ABNORMALITIES 288
20. EXAMINATION OF THE HAND 310
21 . EXAMINATION OF THE FOOT 320
22. EXAMINATION OF THE HEAD AND FACE 327
23. EXAMINATION OF THE JAWS AND TEMPOROMANDIBULAR JOINT 333
24. EXAMINATION OF THE PALATE, CHEEK, TONGUE AND
, FLOOR OF THE MOUTH 341
25. EXAMINATION OF THE SALIVARY GLANDS 354
26. EXAMINATION OF THE NECK 364
27. EXAMINATION OF THE THYROID GLAND 374
28. EXAMINATION OF INJURIES OF THE CHEST 396
29. EXAMINATION OF DISEASES OF THE CHEST 402
30. EXAMINATION OF THE BREAST 410
31 . EXAMINATION OF A CASE OF DYSPHAGIA 434
32. EXAMINATION OF ABDOMINAL INJURIES 442
33. EXAMINATION OF AN ACUTE ABDOMEN 450
34. EXAMINATION OF CHRONIC ABDOMINAL CONDITIONS 482
35. EXAMINATION OF AN ABDOMINAL LUMP 518
36. EXAMINATION OF A RECTAL CASE 539
37. EXAMINATION OF A URINARY CASE 555
38. EXAMINATION OF A CASE OF HERNIA 594
39. EXAMINATION OF A SWELLING IN THE INGUINOSCROTAL REGION
OR GROIN (EXCEPT INGUINAL AND FEMORAL HERNIAS) 611
40. EXAMINATION OF MALE EXTERNAL GENITALIA 61 7
, GENERAL SCHEME
OF CASE-TAKING
In this chapter it will be narrated in brief, how to follow a patient from his arrival at the
hospital or clinic upto his normal condition, i.e. after he has come round. lt is a general scheme
and applied to all patients whoever come to the surgeon. The student should learn this scheme
and make it a reflex, so that he can apply this scheme to all his patien ts. Ultimately, this w ill
become a habit in his professional career.
This general scheme includes - (1) History taking; (2) Physical examination; (3) Special
investigation; (4) Clinical Diagnosis;(5) Treatment - both medical and surgical; (6) Progress
during postoperative period; (7) Follow-Up; (8) Termination.
In the clinic, it is a good practice to start examining the patient when he walks into the
room rather than to meet him undressed on a coach in a cubicle. It is helpful if the person,
who accompanied the patient, remains by the side of the patient in the early part of the history-
taking. He can provide valuable information about the type of injury the patient might have
sustained, some details of the complaints or about changes in health or behaviour of the patient
in the recent past.
HISTORY-TAKING
1. Particulars of the patient.- Before interrogating about the complaints of the patient,
it is a good practice to know the patient firs t. That means the following headings should be
noted in the history-sheet :
NAME.- It is very important to know the patient by name. The patients like to be asked
by name, as for example, 'Mr. Sirkar, how long are you having this problem?' This will not
only help to elicit the history properly, but also it w ill be of psychological benefit to the patient
just before the operation and in postoperative period. The patient is assured tha t you know
him by name.
AGE. - Congenital anomalies mostly present since birth, e.g. cystic hygroma, cleft lip, cleft
palate, sacro--coccygeal teratoma, phimosis etc. But a few congenital anomalies present later in
, life, such as persistent urachus, branchial cyst, branchial fistula etc. Certain diseases are peculiar
to a particular age. Acute arthritis, acute osteomyelitis, Wilms' tumour of the kidney are found
mostly in infants. Sarcomas affect teenagers. Appendicitis is commonly seen in girls between
14 to 25 years of age. Though carcinomas affect mostly those who have passed 40 years of age,
yet it must be remembered that they should not be excluded by age alone. Osteoarthritis and
benign hypertrophy of the prostate are diseases of old age.
SEX.- lt goes with.o ut saying that the diseases, which affect the sexual organs, will be
peculiar to the sex concerned. Besides these, certain other diseases are predominantly seen in a
particular sex, s uch as diseases of the thyroid, viscerop tosis, movable kidney, cystitis are
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CONTENTS
CHAPTER PAGE
1. GENERAL SCHEME OF CASE-TAKING
2. A FEW SPECIAL SYMPTOMS AND SIGNS 11
3. EXAMINATION OF A LUMP OR A SWELLING 21
4. EXAMINATION OF AN ULCER 61
5. EXAMINATION OF A SINUS OR A FISTULA 76
6. EXAMINATION OF PERIPHERAL VASCULAR DISEASES AND GANGRENE ... 80
7. EXAMINATION OF VARICOSE VEINS 100
8. EXAMINATION OF THE LYMPHATIC SYSTEM 109
9. EXAMINATION OF PERIPHERAL NERVE LESIONS 122
10. DISEASES OF MUSCLES, TENDONS AND FASCIAE 142
11 . EXAMINATION OF DISEASES OF BONE 146
12. EXAMINATION OF BONE AND JOINT INJURIES 167
13. EXAMINATION OF INJURIES ABOUT INDIVIDUAL JOINTS 177
14. EXAMINATION OF PATHOLOGICAL JOINTS 213
15. EXAMINATION OF INDIVIDUAL JOINT PATHOLOGIES 223
16. EXAMINATION OF HEAD INJURIES 258
17. INVESTIGATION OF INTRACRANIAL SPACE-OCCUPYING LESIONS 271
18. EXAMINATION OF SPINAL INJURIES 282
19. EXAMINATION OF SPINAL ABNORMALITIES 288
20. EXAMINATION OF THE HAND 310
21 . EXAMINATION OF THE FOOT 320
22. EXAMINATION OF THE HEAD AND FACE 327
23. EXAMINATION OF THE JAWS AND TEMPOROMANDIBULAR JOINT 333
24. EXAMINATION OF THE PALATE, CHEEK, TONGUE AND
, FLOOR OF THE MOUTH 341
25. EXAMINATION OF THE SALIVARY GLANDS 354
26. EXAMINATION OF THE NECK 364
27. EXAMINATION OF THE THYROID GLAND 374
28. EXAMINATION OF INJURIES OF THE CHEST 396
29. EXAMINATION OF DISEASES OF THE CHEST 402
30. EXAMINATION OF THE BREAST 410
31 . EXAMINATION OF A CASE OF DYSPHAGIA 434
32. EXAMINATION OF ABDOMINAL INJURIES 442
33. EXAMINATION OF AN ACUTE ABDOMEN 450
34. EXAMINATION OF CHRONIC ABDOMINAL CONDITIONS 482
35. EXAMINATION OF AN ABDOMINAL LUMP 518
36. EXAMINATION OF A RECTAL CASE 539
37. EXAMINATION OF A URINARY CASE 555
38. EXAMINATION OF A CASE OF HERNIA 594
39. EXAMINATION OF A SWELLING IN THE INGUINOSCROTAL REGION
OR GROIN (EXCEPT INGUINAL AND FEMORAL HERNIAS) 611
40. EXAMINATION OF MALE EXTERNAL GENITALIA 61 7
, GENERAL SCHEME
OF CASE-TAKING
In this chapter it will be narrated in brief, how to follow a patient from his arrival at the
hospital or clinic upto his normal condition, i.e. after he has come round. lt is a general scheme
and applied to all patients whoever come to the surgeon. The student should learn this scheme
and make it a reflex, so that he can apply this scheme to all his patien ts. Ultimately, this w ill
become a habit in his professional career.
This general scheme includes - (1) History taking; (2) Physical examination; (3) Special
investigation; (4) Clinical Diagnosis;(5) Treatment - both medical and surgical; (6) Progress
during postoperative period; (7) Follow-Up; (8) Termination.
In the clinic, it is a good practice to start examining the patient when he walks into the
room rather than to meet him undressed on a coach in a cubicle. It is helpful if the person,
who accompanied the patient, remains by the side of the patient in the early part of the history-
taking. He can provide valuable information about the type of injury the patient might have
sustained, some details of the complaints or about changes in health or behaviour of the patient
in the recent past.
HISTORY-TAKING
1. Particulars of the patient.- Before interrogating about the complaints of the patient,
it is a good practice to know the patient firs t. That means the following headings should be
noted in the history-sheet :
NAME.- It is very important to know the patient by name. The patients like to be asked
by name, as for example, 'Mr. Sirkar, how long are you having this problem?' This will not
only help to elicit the history properly, but also it w ill be of psychological benefit to the patient
just before the operation and in postoperative period. The patient is assured tha t you know
him by name.
AGE. - Congenital anomalies mostly present since birth, e.g. cystic hygroma, cleft lip, cleft
palate, sacro--coccygeal teratoma, phimosis etc. But a few congenital anomalies present later in
, life, such as persistent urachus, branchial cyst, branchial fistula etc. Certain diseases are peculiar
to a particular age. Acute arthritis, acute osteomyelitis, Wilms' tumour of the kidney are found
mostly in infants. Sarcomas affect teenagers. Appendicitis is commonly seen in girls between
14 to 25 years of age. Though carcinomas affect mostly those who have passed 40 years of age,
yet it must be remembered that they should not be excluded by age alone. Osteoarthritis and
benign hypertrophy of the prostate are diseases of old age.
SEX.- lt goes with.o ut saying that the diseases, which affect the sexual organs, will be
peculiar to the sex concerned. Besides these, certain other diseases are predominantly seen in a
particular sex, s uch as diseases of the thyroid, viscerop tosis, movable kidney, cystitis are
l
