- •Dedication
- •Editors and Contributors
- •Foreword
- •Preface
- •Contents
- •PREPARING FOR THE SURGERY CLERKSHIP
- •SURGICAL NOTES
- •COMMON ABBREVIATIONS YOU SHOULD KNOW
- •RETRACTORS (YOU WILL GET TO KNOW THEM WELL!)
- •SUTURE MATERIALS
- •WOUND CLOSURE
- •KNOTS AND EARS
- •INSTRUMENT TIE
- •TWO-HAND TIE
- •COMMON PROCEDURES
- •NASOGASTRIC TUBE (NGT) PROCEDURES
- •CHEST TUBES
- •NASOGASTRIC TUBES (NGT)
- •FOLEY CATHETER
- •CENTRAL LINES
- •MISCELLANEOUS
- •THIRD SPACING
- •COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
- •CALCULATION OF MAINTENANCE FLUIDS
- •ELECTROLYTE IMBALANCES
- •ANTIBIOTICS
- •STEROIDS
- •HEPARIN
- •WARFARIN (COUMADIN®)
- •MISCELLANEOUS AGENTS
- •NARCOTICS
- •MISCELLANEOUS
- •ATELECTASIS
- •POSTOPERATIVE RESPIRATORY FAILURE
- •PULMONARY EMBOLISM
- •ASPIRATION PNEUMONIA
- •GASTROINTESTINAL COMPLICATIONS
- •ENDOCRINE COMPLICATIONS
- •CARDIOVASCULAR COMPLICATIONS
- •MISCELLANEOUS
- •HYPOVOLEMIC SHOCK
- •SEPTIC SHOCK
- •CARDIOGENIC SHOCK
- •NEUROGENIC SHOCK
- •MISCELLANEOUS
- •URINARY TRACT INFECTION (UTI)
- •CENTRAL LINE INFECTIONS
- •WOUND INFECTION (SURGICAL SITE INFECTION)
- •NECROTIZING FASCIITIS
- •CLOSTRIDIAL MYOSITIS
- •SUPPURATIVE HIDRADENITIS
- •PSEUDOMEMBRANOUS COLITIS
- •PROPHYLACTIC ANTIBIOTICS
- •PAROTITIS
- •MISCELLANEOUS
- •CHEST
- •ABDOMEN
- •MALIGNANT HYPERTHERMIA
- •MISCELLANEOUS
- •OVERVIEW
- •CHOLECYSTOKININ (CCK)
- •SECRETIN
- •GASTRIN
- •SOMATOSTATIN
- •MISCELLANEOUS
- •GROIN HERNIAS
- •HERNIA REVIEW QUESTIONS
- •ESOPHAGEAL HIATAL HERNIAS
- •PRIMARY SURVEY
- •SECONDARY SURVEY
- •TRAUMA STUDIES
- •PENETRATING NECK INJURIES
- •MISCELLANEOUS TRAUMA FACTS
- •PEPTIC ULCER DISEASE (PUD)
- •DUODENAL ULCERS
- •GASTRIC ULCERS
- •PERFORATED PEPTIC ULCER
- •TYPES OF SURGERIES
- •STRESS GASTRITIS
- •MALLORY-WEISS SYNDROME
- •ESOPHAGEAL VARICEAL BLEEDING
- •BOERHAAVE’S SYNDROME
- •ANATOMY
- •GASTRIC PHYSIOLOGY
- •GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- •GASTRIC CANCER
- •GIST
- •MALTOMA
- •GASTRIC VOLVULUS
- •SMALL BOWEL
- •APPENDICITIS
- •CLASSIC INTRAOPERATIVE QUESTIONS
- •APPENDICEAL TUMORS
- •SPECIFIC TYPES OF FISTULAS
- •ANATOMY
- •COLORECTAL CARCINOMA
- •COLONIC AND RECTAL POLYPS
- •POLYPOSIS SYNDROMES
- •DIVERTICULAR DISEASE OF THE COLON
- •ANATOMY
- •ANAL CANCER
- •ANATOMY
- •TUMORS OF THE LIVER
- •ABSCESSES OF THE LIVER
- •HEMOBILIA
- •ANATOMY
- •PHYSIOLOGY
- •PATHOPHYSIOLOGY
- •DIAGNOSTIC STUDIES
- •BILIARY SURGERY
- •OBSTRUCTIVE JAUNDICE
- •CHOLELITHIASIS
- •ACUTE CHOLECYSTITIS
- •ACUTE ACALCULOUS CHOLECYSTITIS
- •CHOLANGITIS
- •SCLEROSING CHOLANGITIS
- •GALLSTONE ILEUS
- •CARCINOMA OF THE GALLBLADDER
- •CHOLANGIOCARCINOMA
- •MISCELLANEOUS CONDITIONS
- •PANCREATITIS
- •PANCREATIC ABSCESS
- •PANCREATIC NECROSIS
- •PANCREATIC PSEUDOCYST
- •PANCREATIC CARCINOMA
- •MISCELLANEOUS
- •ANATOMY OF THE BREAST AND AXILLA
- •BREAST CANCER
- •DCIS
- •LCIS
- •MISCELLANEOUS
- •MALE BREAST CANCER
- •BENIGN BREAST DISEASE
- •CYSTOSARCOMA PHYLLODES
- •FIBROADENOMA
- •FIBROCYSTIC DISEASE
- •MASTITIS
- •BREAST ABSCESS
- •MALE GYNECOMASTIA
- •ADRENAL GLAND
- •ADDISON’S DISEASE
- •INSULINOMA
- •GLUCAGONOMA
- •SOMATOSTATINOMA
- •ZOLLINGER-ELLISON SYNDROME (ZES)
- •MULTIPLE ENDOCRINE NEOPLASIA
- •THYROID DISEASE
- •ANATOMY
- •PHYSIOLOGY
- •HYPERPARATHYROIDISM (HPTH)
- •PARATHYROID CARCINOMA
- •SOFT TISSUE SARCOMAS
- •LYMPHOMA
- •SQUAMOUS CELL CARCINOMA
- •BASAL CELL CARCINOMA
- •MISCELLANEOUS SKIN LESIONS
- •STAGING
- •INTENSIVE CARE UNIT (ICU) BASICS
- •INTENSIVE CARE UNIT FORMULAS AND TERMS YOU SHOULD KNOW
- •SICU DRUGS
- •INTENSIVE CARE PHYSIOLOGY
- •HEMODYNAMIC MONITORING
- •MECHANICAL VENTILATION
- •PERIPHERAL VASCULAR DISEASE
- •LOWER EXTREMITY AMPUTATIONS
- •ACUTE ARTERIAL OCCLUSION
- •ABDOMINAL AORTIC ANEURYSMS
- •MESENTERIC ISCHEMIA
- •MEDIAN ARCUATE LIGAMENT SYNDROME
- •CAROTID VASCULAR DISEASE
- •CLASSIC CEA INTRAOP QUESTIONS
- •SUBCLAVIAN STEAL SYNDROME
- •RENAL ARTERY STENOSIS
- •SPLENIC ARTERY ANEURYSM
- •POPLITEAL ARTERY ANEURYSM
- •MISCELLANEOUS
- •PEDIATRIC IV FLUIDS AND NUTRITION
- •PEDIATRIC BLOOD VOLUMES
- •FETAL CIRCULATION
- •ECMO
- •NECK
- •ASPIRATED FOREIGN BODY (FB)
- •CHEST
- •PULMONARY SEQUESTRATION
- •ABDOMEN
- •INGUINAL HERNIA
- •UMBILICAL HERNIA
- •GERD
- •CONGENITAL PYLORIC STENOSIS
- •DUODENAL ATRESIA
- •MECONIUM ILEUS
- •MECONIUM PERITONITIS
- •MECONIUM PLUG SYNDROME
- •ANORECTAL MALFORMATIONS
- •HIRSCHSPRUNG’S DISEASE
- •MALROTATION AND MIDGUT VOLVULUS
- •OMPHALOCELE
- •GASTROSCHISIS
- •POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
- •APPENDICITIS
- •INTUSSUSCEPTION
- •MECKEL’S DIVERTICULUM
- •NECROTIZING ENTEROCOLITIS
- •BILIARY TRACT
- •TUMORS
- •PEDIATRIC TRAUMA
- •OTHER PEDIATRIC SURGERY QUESTIONS
- •POWER REVIEW
- •WOUND HEALING
- •SKIN GRAFTS
- •FLAPS
- •SENSORY SUPPLY TO THE HAND
- •CARPAL TUNNEL SYNDROME
- •ANATOMY
- •MISCELLANEOUS
- •NOSE AND PARANASAL SINUSES
- •ORAL CAVITY AND PHARYNX
- •FACIAL FRACTURES
- •ENT WARD QUESTIONS
- •RAPID-FIRE REVIEW OF MOST COMMON CAUSES OF ENT INFECTIONS
- •THORACIC OUTLET SYNDROME (TOS)
- •CHEST WALL TUMORS
- •DISEASES OF THE PLEURA
- •DISEASES OF THE LUNGS
- •DISEASES OF THE MEDIASTINUM
- •DISEASES OF THE ESOPHAGUS
- •ACQUIRED HEART DISEASE
- •CONGENITAL HEART DISEASE
- •CARDIAC TUMORS
- •DISEASES OF THE GREAT VESSELS
- •MISCELLANEOUS
- •BASIC IMMUNOLOGY
- •CELLS
- •IMMUNOSUPPRESSION
- •OVERVIEW OF IMMUNOSUPPRESSION MECHANISMS
- •MATCHING OF DONOR AND RECIPIENT
- •REJECTION
- •ORGAN PRESERVATION
- •KIDNEY TRANSPLANT
- •LIVER TRANSPLANT
- •PANCREAS TRANSPLANT
- •HEART TRANSPLANT
- •INTESTINAL TRANSPLANTATION
- •LUNG TRANSPLANT
- •TRANSPLANT COMPLICATIONS
- •ORTHOPAEDIC TERMS
- •TRAUMA GENERAL PRINCIPLES
- •FRACTURES
- •ORTHOPAEDIC TRAUMA
- •DISLOCATIONS
- •THE KNEE
- •ACHILLES TENDON RUPTURE
- •ROTATOR CUFF
- •MISCELLANEOUS
- •ORTHOPAEDIC INFECTIONS
- •ORTHOPAEDIC TUMORS
- •ARTHRITIS
- •PEDIATRIC ORTHOPAEDICS
- •HEAD TRAUMA
- •SPINAL CORD TRAUMA
- •TUMORS
- •VASCULAR NEUROSURGERY
- •SPINE
- •PEDIATRIC NEUROSURGERY
- •SCROTAL ANATOMY
- •UROLOGIC DIFFERENTIAL DIAGNOSIS
- •RENAL CELL CARCINOMA (RCC)
- •BLADDER CANCER
- •PROSTATE CANCER
- •BENIGN PROSTATIC HYPERPLASIA
- •TESTICULAR CANCER
- •TESTICULAR TORSION
- •EPIDIDYMITIS
- •PRIAPISM
- •ERECTILE DYSFUNCTION
- •CALCULUS DISEASE
- •INCONTINENCE
- •URINARY TRACT INFECTION (UTI)
- •MISCELLANEOUS UROLOGY QUESTIONS
- •Rapid Fire Power Review
- •TOP 100 CLINICAL SURGICAL MICROVIGNETTES
- •Figure Credits
- •Index
Chapter 74 / Orthopaedic Surgery 705
Name the nerves of the brachial plexus.
What are the two indications for operative exploration with a peripheral nerve injury?
DISLOCATIONS
Think: “morning rum” or “A.M. RUM” Axillary, Median, then Radial, Ulnar, and Musculocutaneous nerves
1.Loss of nerve function after reduction of fracture
2.No EMG signs of nerve regeneration after 8 weeks (nerve graft)
SHOULDER
What is the most common |
95% are anterior (posterior are associated |
|
type? |
with seizures or electrical shock) |
|
Which two structures are at |
1. |
Axillary nerve |
risk? |
2. |
Axillary artery |
How is it diagnosed? |
Indentation of soft tissue beneath |
|
|
acromion |
|
What are the three |
1. |
Reduction via gradual traction |
treatment steps? |
2. |
Immobilization for 3 weeks in internal |
|
|
rotation |
|
3. |
ROM exercises |
ELBOW |
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|
|
|
What is the most common |
Posterior |
|
type? |
|
|
Which three structures are |
1. |
Brachial artery |
at risk? |
2. |
Ulnar nerve |
|
3. |
Median nerve |
What is the treatment? |
Reduce and splint for 7 to 10 days |
|
HIP |
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|
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|
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When should hip |
Immediately, to decrease risk of avascular |
|
dislocations be reduced? |
necrosis; “reduce on the x-ray table!” |
|
What is the most common |
High velocity trauma (e.g., MVC) |
|
cause of a hip dislocation? |
|
|
706 Section III / Subspecialty Surgery |
|
|
What is the most common |
Posterior—“dashboard dislocation”— |
|
type? |
often involves fracture of posterior lip of |
|
|
acetabulum |
|
Which structures are at risk? |
Sciatic nerve; blood supply to femoral |
|
|
head—avascular necrosis (AVN) |
|
What is the treatment? |
Closed or open reduction |
|
KNEE |
|
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What are the common types? |
Anterior or posterior |
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Which structures are at risk? |
Popliteal artery and vein, peroneal |
|
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nerve—especially with posterior |
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dislocation, ACL, PCL (Note: need |
|
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arteriogram) |
|
What is the treatment? |
Immediate attempt at relocation |
|
|
(do not wait to x-ray), arterial repair, |
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and then ligamentous repair (delayed |
|
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or primary) |
|
THE KNEE |
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What are the five ligaments |
1. |
Anterior Cruciate Ligament (ACL), |
of the knee? |
2. |
Posterior Cruciate Ligament (PCL), |
|
3. |
Medial Collateral Ligament (MCL), |
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4. |
Lateral Collateral Ligament (LCL), |
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5. |
Patellar Ligament |
Anterior cruciate ligament
Lateral 
collateral 
ligament 
4 0 '
Patellar ligament
Posterior cruciate ligament
Medial collateral ligament
F R H
Chapter 74 / Orthopaedic Surgery 707
What is the Lachman test for a torn ACL?
Thigh is secured with one hand while the other hand pulls the tibia anteriorly
20to 30-degree knee flexion
What is the meniscus of the knee?
What is McMurray’s sign?
What is the “unhappy triad”?
What is a “locked knee”?
What is a “bucket-handle tear”?
In collateral ligament and menisci injuries, which are more common, the medial or the lateral?
Cartilage surface of the tibia plateau (lateral and medial meniscus); tears are repaired usually by arthroscopy with removal of torn cartilage fragments
Seen with a medial meniscus tear: medial tenderness of knee with flexion and internal rotation of the knee
Lateral knee injury resulting in:
1.ACL tear
2.MCL tear
3.Medial meniscus injury
Meniscal tear that displaces and interferes with the knee joint and prevents complete extension
Meniscal tear longitudinally along contour of normal “C” shape of the meniscus
Medial
ACHILLES TENDON RUPTURE
What are the signs of an Achilles tendon rupture?
Severe calf pain, also bruised swollen calf, two ends of ruptured tendon may be felt, patient will have weak plantar flexion from great toe flexors that should be intact; patient often hears a “pop”
708 Section III / Subspecialty Surgery |
|
Name the test for an |
Thompson’s test: a squeeze of the |
INTACT Achilles tendon. |
gastrocnemius muscle results in plantar |
|
flexion of the foot |
Plantar flexion
Achilles 
tendon tear 
What is the treatment for an |
Young surgical repair |
|
Achilles tendon rupture? |
Elderly many can be treated with |
|
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progressive splints |
|
ROTATOR CUFF |
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What four muscles form the |
Think: “SITS”: |
|
rotator cuff? |
1. |
Supraspinatus, etc. |
|
2. |
Infraspinatus |
|
3. |
Teres minor |
|
4. |
Subscapularis |
When do tears usually occur?
What is the usual history?
Fifth decade
Intermittent shoulder pain especially with overhead activity, followed by an episode of acute pain corresponding to a tendon tear; weak abduction
What is the treatment? |
Most tears: symptomatic pain relief |
|
Later: if poor muscular function persists, |
|
surgical repair is indicated |
What is Volkmann’s |
Contracture of forearm flexors secondary |
contracture? |
to forearm compartment syndrome |