- •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
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Chapter 74 / Orthopaedic Surgery 715 |
What is the usual |
Pain and swelling; pathologic fractures |
|
presentation? |
are rare |
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What is the treatment? |
Curettage and bone grafting |
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ARTHRITIS |
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Which arthritides are |
Osteoarthritis |
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classified as degenerative? |
Post-traumatic arthritis |
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What signs characterize |
Heberden’s nodes/Bouchard’s nodes |
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osteoarthritis? |
Symmetric destruction, usually of the |
|
|
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hip, knee, or spine |
What are Bouchard’s nodes? |
Enlarged PIP joints of the hand from |
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cartilage/bone growth |
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What are Heberden’s nodes? |
Enlarged DIP joints of the hand from |
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cartilage/bone growth |
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What is post-traumatic |
Usually involves one joint of past trauma |
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arthritis? |
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What are the treatment |
1. NSAIDS for acute flare-ups, not for |
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options for degenerative |
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long-term management |
arthritis (3)? |
2. |
Local corticosteroid injections |
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3. Surgery |
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What are the characteristics |
Autoimmune reaction in which invasive |
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of rheumatoid arthritis? |
pannus attacks hyaline articular cartilage; |
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rheumatoid factor (anti-IgG/IgM) in 80% |
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of patients; 3 more common in |
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women; skin nodules (e.g., rheumatoid |
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nodule) |
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What is pannus? |
Inflammatory exudate overlying synovial |
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cells inside the joint |
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What are the classic hand |
Wrist: radial deviation |
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findings with rheumatoid |
Fingers: ulnar deviation |
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arthritis? |
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What are the surgical |
1. |
Arthroplasty |
management options for |
2. |
Arthrodesis (fusion) |
joint/bone diseases (3)? |
3. Osteotomy |
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716 Section III / Subspecialty Surgery
What is the major difference between gout and pseudogout?
Gout: caused by urate deposition, negative birefringent, needle crystal
Pseudogout: caused by calcium pyrophosphate positive birefringent square crystals (Think: Positive Square crystals PSeudogout)
What is a Charcot’s joint? |
Arthritic joint from peripheral |
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neuropathy |
PEDIATRIC ORTHOPAEDICS |
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What are the major differences between pediatric and adult bones?
Children: increased bone flexibility and bone healing (thus, many fractures are treated closed, whereas an adult would require O.R.I.F.), physis (weak point)
What types of fractures are |
Greenstick fracture |
unique to children? |
Torus fracture |
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Fracture through physis |
SALTER-HARRIS CLASSIFICATION |
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What does it describe? |
Fractures in children involving physis |
What does it indicate high |
Potential growth arrest |
risk of? |
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Define the following terms: |
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Salter I |
Through physeal plate only |
Salter II |
Involves metaphysis and physis |
Salter III |
Involves physis and epiphysis |
Salter IV |
Extends from metaphysis through physis, |
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into epiphysis |
Salter V |
Axial force crushes physeal plate |
Chapter 74 / Orthopaedic Surgery 717
Define the following fractures by Salter-Harris grade:
Salter III
Salter IV
Salter I
Salter V
718 Section III / Subspecialty Surgery
What acronym can help you remember the Salter classifications?
What is the simple numerical method for remembering the SalterHarris classification?
Salter II
“SALTR”:
Separated type I Above type II Lower type III Through type IV Ruined type V
(N normal)
Why is the growth plate of concern in childhood fractures?
Growth plate represents the “weak link” in the child’s musculoskeletal system; fractures involving the growth plate of long bones may compromise normal growth, so special attention should be given to them
Chapter 74 / Orthopaedic Surgery 719
What is a chief concern when oblique/spiral fractures of long bones are seen in children?
What is usually done during reduction of a femoral fracture?
What is unique about ligamentous injury in children?
What two fractures have a high incidence of associated compartment syndrome?
Child abuse is a possibility; other signs of abuse should be investigated
Small amount of overlap is allowed because increased vascularity from injury may make the affected limb longer if overlap is not present; treatment after reduction is a spica cast
Most “ligamentous” injuries are actually fractures involving the growth plate!
1.Tibial fractures
2.Supracondylar fractures of humerus (Volkmann’s contracture)
CONGENITAL HIP DISLOCATION
What is the epidemiology? |
Female male, firstborn children, |
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breech |
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Presentation, 1 in 1000 births |
What percentage are bilateral?
How is the diagnosis made?
What is Barlow’s maneuver?
10%
Barlow’s maneuver, Ortolani’s sign Radiographic confirmation is required
Detects unstable hip: patient is placed in the supine position and attempt is made to push femurs posteriorly with knees at 90 /hip flexed and hip will dislocate (Think: push Back Barlow)
What is Ortolani’s sign? “Clunk” produced by relocation of a dislocated femoral head when the examiner abducts the flexed hip and lifts the greater trochanter anteriorly; detects a dislocated hip (Think: Out Ortolani’s)
What is the treatment? Pavlik harness—maintains hip reduction with hips flexed at 100 to 110
720 Section III / Subspecialty Surgery
SCOLIOSIS
What is the definition? |
Lateral curvature of a portion of the spine |
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Nonstructural: corrects with positional |
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change |
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Structural: does not correct |
What are three treatment |
1. |
Observation |
options? |
2. |
Braces (Milwaukee brace) |
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3. |
Surgery |
What are the indications for |
Respiratory compromise |
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surgery for scoliosis? |
Rapid progression |
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Curves 40 |
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Failure of brace |
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MISCELLANEOUS
Define the following terms: Legg-Calvé-Perthes disease
Slipped capital femoral epiphysis
Idiopathic avascular necrosis of femoral head in children
Migration of proximal femoral epiphysis on the metaphysis in children; the proximal femoral epiphysis externally rotates and displaces anteriorly from the capital femoral epiphysis, which stays reduced in the acetabulum
(Note: Hip pain in children often presents as knee pain)
Blount’s disease |
Idiopathic varus bowing of tibia |
Nursemaid’s elbow |
Dislocation of radial head (from pulling |
|
toddler’s arm) |
Little League elbow |
Medial epicondylitis |
Osgood-Schlatter’s |
Apophysitis of the tibial tubercle resulting |
disease |
from repeated powerful contractions of |
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the quadriceps; seen in adolescents with |
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an open physis |
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Treatment of mild cases: activity |
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restriction |
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Treatment of severe cases: cast |
What is the most common |
Osteochondroma (Remember, 80% of |
pediatric bone tumor? |
bone tumors are benign in children) |