Notes

Acute Limb Ischemia

Acute Limb Ischemia Pulseless Palor Poikilothermia Pain Paresthesia Paralysis 6 hours to fix U/S or arteriogram

Read more

Aortic Dissection

Aortic Dissection Tear in aortic intima → False lumen Risk Factors Hypertension Age >40 Marfan syndrome Presentation Chest pain Sudden onset Tearing Radiate to back Asymmetric BP in arms Diagnosis CTA TEE → Unstable patient (fastest) MRA → Stable patient All have equal sensitivity Treatment Ascending dissection Emergent surgery BP control Descending...

Read more

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm (AAA) >50% ↑ in abdominal aorta diameter True aneurysm Risk Factors Smoking Smoker >65y → Screen for AAA with abdominal U/S Age Presentation Painful pulsatile mass in abdomen Rupture → Hypovolemia Hypotension Tachycardia Diagnosis Best initial → Ultrasound (MUST be done!) Size of AAA Monitor patient >95% sensitivity/specificity...

Read more

Prostate Disorders

BPH Etiology 80% by 80y Does NOT cause prostate cancer Presentation Hesitancy, frequency, weak stream… Opening hematuria Diagnosis DRE Uniform enlargement Rubbery texture U/A, UC Initial PSA recommended but correlate clinically Post-void residual → >50 ml Treatment α blocker Tamsulosin Terazosin Prazosin Doxazosin 5α reductase inhibitor Finasteride Dutasteride Antimuscarinic → ↓ Overactive...

Read more

Erectile Dysfunction

Erectile Dysfunction Classification Failure to initiate Psychological → Nocturnal erection is ok Endocrine Neurologic Failure to fill Arterial Failure to store Veno-occlusive Etiology DM Atherosclerosis Drugs Beta blockers SSRI TCA Diuretic Hypertension Heart disease Prostate cancer surgery/radiation Spine injury Treatment Psychotherapy PDE5 inhibitors Sildenafil Vardenafil Tadalafil Side effect +...

Read more

Scrotal Swelling

Scrotal Swelling Painless Hydrocele Transilluminates Types Non-communicating No change in size Communicating ↑ in size with valsalva Patent processus vaginalis Resolves spontaneously ↑ Risk of indirect inguinal hernia Varicocele Bag of worms above testis Left > Right Does NOT transilluminate ↑ in size with valsalva No need to treat...

Read more

Abdominal Abnormalities

Diaphragmatic Hernia Presentation Respiratory distress Bowel sounds heard in chest Air fluid level on CXR Types Morgagni → retrosternal/parasternal defect Bochdalek → posterolateral defect (most common) More common on the Left side Omphalocele Failure of GI tract retraction at 10-12w Highly associated with Edwards syndrome (trisomy 18) Diagnosis Intestines and organs...

Read more

Compartment Syndrome

Compartment Syndrome Etiology ↑ Pressure → Compression of nerve, vessel, muscle inside a closed space Can happen within a cast Presentation Early Pain → First symptom Pallor Paresthesia → Pins and needles Late Poikilothermia → Cold to touch Paralysis Pulselessness → Worst finding Diagnosis Clinical Complications Necrosis Treatment Medical emergency → Immediate fasciotomy

Read more

Intervertebral Disk Herniation

Herniated Disk Disease Etiology Elderly Lifting injury Nerve root compression Most common site L4-L5 L5-S1 Presentation Electric pain following a dermatome distribution Diagnosis Best initial → Straight leg raising Most accurate → MRI Treatment Best next step → NSAID Activity modification Surgery?

Read more

Spinal Stenosis

Spinal Stenosis Etiology Arthritic changes → Spinal canal narrowing → Nerve root compression L1 C2 Presentation Neck/Back pain Bilateral leg/buttock pain Bilateral leg/buttock numbness Pseudoclaudication Symptoms worsen with walking Symptoms improve with spinal flexion Differentiates from vascular claudication Diagnosis MRI Treatment NSAID Surgery

Read more

Fat Embolism

Fat Embolism Etiology Long bone fracture Most common → Femur Presentation Within 5d of fracture Dyspnea Confusion Petechial rash → Arm, trunk Diagnosis ABG → PO2 <60% CXR → First normal → Then infiltrates U/A → Fat droplets Treatment Oxygen → Keep PO2 >95% Severe hypoxia → Intubation and mechanical ventilation

Read more

Lower Limb Injuries

Knee Injuries ACL is most common injury Mechanism of injury is important Unhappy triad of knee in sports trauma ACL (anterior cruciate ligament) MCL (medial collateral ligament) Meniscus (medial/lateral) Injury Etiology Presentation Diagnosis Treatment MCL Lateral trauma Pain MRI Surgical repair LCL Medial trauma Pain MRI Surgical repair ACL...

Read more