Surgery notes for competitive examinations

surgeryDr Sreeja S     

Intervals, Durations etc.


  • Interval appendicectomy – two months after acute attack
  • Appendicular mass resolves within three days or else it forms appendicular abscess by 5 to 10 days.
  • Appendicular mass is to be operated immediately after it resolves.
  • Cholecystectomy for acute cholecystits is preferably done after 8 to 10 weeks.
  • Colostomy matures after two months and it can be closed thereafter.
  • In carcinoma pancreas, death usually occurs in six months after obstructive jaundice.
  • Chronic intestinal ischaemia—Pain in abdomen occurs in 30 minutes after food intake.
  • Return of intestinal motility after operation occurs after 16 hours.
  • Duodenal blow out occurs on 4th postoperative day of gastrectomy.
  • Stoma should be open after polyagastrectomy by 3rd day.
  • Stoma should be open after Billroth 1 operation in five days.
  • Postoperative obstruction by fibrinous adhesions occurs in three to six postoperative days, m) Postoperative obstruction by fibrous adhesions—anytime,
  • Splenectomy in hereditary spherocytosis done best at 7 years (if asymptomatic),
  • Schistosomiasis (Egyptian splenomegaly)—Survival after ascites only 6 to 12 months,
  • Obstructive appendicitis—Gangrene occurs in 12-18 hours.
  • Choledochal cysts are seldom seen before six months of age.
  • Acute pancreatitis—Pseudopancreatic cyst may form at the end of 2nd week. Abscess after 3rd week.


  • Wound tensile strength approaches that of normal tissue by six months but 100% normal after 2 year only.
  • Primary suture of wound—within six hours.
  • Crushed and devitalised wounds. Delayed primary suture in 4 to 6 days after injury.
  • Embolectomy is to be done within 10 hours.
  • Graft rejection – Inflammation appears by 4th day (first set response). Sloughs appear by 10th day. If again grafted from same donor (second set response) sloughs by 6th day.
  • After starting treatment with stilbesterol, for prostatic carcinoma histological changes in 48 hr. Symptoms improve in 2 weeks and prostate smaller in size by 3 to 4 weeks. ;
  • In thyrotoxicosis
    • Treatment with carbimazole, symptoms relieved after 7 to 14 days.
    • Treatment with I131 in 8 to 12 weeks, patient becomes asymptomatic.
    • Repeat the dose after 12 weeks if necessary. -1 Antithyroid drugs can be given 48 hr after I’31.
  • Postoperative thyroid insufficiency manifests in 2 to 3 days after thyroidectomy.
  • Response to iodine in thyrotoxicosis is seen in 24 hours (quickest acting).
  • Parathyroid tetany manifests on 2nd or 3rd postoperative day after thyroidectomy.
  • Pregnancy is contraindicated for 3 years after operation for breast carcinoma.
  • In haemorrhage, physiologically fluid loss is replaced immediately.
  • Stored blood for transfusion, platelets live for 3 days.
  • RBC are suitable for transfusion for 3 weeks after collection.
  • RBC become functional in the body 3 days after transfusion.
  • Phenindione and dicumarol start acting after 36—48 hr.
  • Prothrombin estimation not valid within 6 hr after heparin.

Paediatric Surgery

  • Cleft lip operated at 3 months of age.
  • Cleft palate operated at 1V2 to 2 years.
  • Exomphalos major operated within few hours.
  • Surgery for sacrococcygeal teratoma—soon after birth
  • Orchipexy for undescended testes—2 years (essentially before puberty)
  • Operation for Hirschprung’s disease—after the child gains 8 kg weight and is well thriving
  • Hirschsprung’s disease, symptoms appear in 3 days after birth
  • Congenital hypertrophic pyloric stenosis—symptoms appear at 3 to 6 weeks of age
  • Ectopia vesicae—Diversion of urine best done at 4 to 6 weeks.
  • Operation for patent vitellointestinal duct at 6 months of age
  • Neonatal tetanus occurs within 5-15 days. Usually around 8th day. So called 8th dayisease.
  • Operation for ASD—first decade
  • Operation for PDA—before the child goes to school
  • Fallot’s tetralogy in infancy—palliative correction
  • Posterior fontanelle closes at the age of 4 months.
  • Anterior fontanelle closes at the age of 9-18 months,
  • Newborn passes urine usually within 24 hours,
  • Newborn passes meconium usually within 12 hours,
  • Witch’s milk appears on 3rd day; disappears in 3 weeks,
  • Alpha-fetoprotein disappears in a few weeks after birth.


  • Reaction of degeneration occurs in 3 weeks after nerve injury.
  • Irreversible changes at motor end plates after denervation seen after 18 months.
  • Meningitis after head injury develops in 3-5 days.
  • Extradural haemorrhage usally presents before 18 hours after injury.
  • In head injury, prophylactic anticonvulsants are given forj6 weeks.
  • In post-traumatic epilepsy, or after major head injury, antiepilepties are given for 3 years.
  • Idiopathic epilepsy is rare before 6 years and after 30 years, h)   Spinal concussion—Recovery occurs in 24-48 hours.
  • Spinal injury—Mass reflex appears at 3-6 weeks.


  • Menisci injury heals in 6 weeks.
  • X-ray signs in osteomyelitis seen in 2-3 weeks.
  • Angular deformities of limbs (genu valgum or varus) and in-toeing spontaneously correct by 6 weeks. If necessary, correction done after 6 weeks
  • In-toeing in girls for cosmetic purpose—operation at about 11 years of age.
  • Earliest X-ray sign in myositis ossificans is a cloud of new bone by 4-6 weeks after injury


  • Pulmonary infarction signs detectable in X-ray in 12 hours.
  • X-ray positive for pneumonia 12-18 hours after symptoms appear.
  • Vitamin C stores last for 21/2 to 3 months.
  • B12 stores last for 3 years.
  • Thiamine stores last for few weeks.
  • Drug induced hepatitis occurs within 2 weeks after drug intake.
  • Recovery of vision in multiple sclerosis occurs usually 4-6 weeks after attack.
  • Post streptococcal glomerulonephritis—1 to 3 weeks after streptococcal infection. Post
  • streptococcal rheumatic fever 2-3 weeks after sore throat,
  • After myocardial infarction, leukocytosis peaks on 1st day, fever peaks on 3rd or 4th day
  • Dressier’s syndrome – few weeks or months after myocardial infarction; recovers in a fewdays.
  • Myocardial infarction surgical repair lesions after 6 weeks.
  • Time to reach normal counts in CML with busulphan: 12-18 weeks,
  • Idiopathic thrombocytopenic purpura remits in young in 2-3 weeks,
  • Rose-Waaler test in rheumatoid arthritis positive after 18 months,
  • Reiter’s disease—1-3 weeks after sexual intercourse or dysentery.

Gynaecology and Obstetrics

  • Myomectomy—6 months after caesarian.
  • Time for Huhner’s test or Sim’s test—2 hours after and within 16 hours of intercourse.
  • Fistulas develop 10 days after ureteral ligation or interfering with its blood supply.
  • In prolonged labour, the urinary fistulae develop usually on 5th day.
  • Forceps etc., instrumentation—the urinary fistulas develop immediately. 

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