Surgery

Upper Limb Injuries

Upper Limb Injuries Anterior Shoulder Dislocation Etiology Strain of glenohumeral ligaments >95% of shoulder dislocations Presentation Arm held to side Forearm externally rotated Severe pain Diagnosis Best initial → X-ray Most accurate → MRI Complications Axillary artery injury Axillary nerve injury Treatment Shoulder relocation Immobilization Weak pulse/sensation → Surgery Posterior...

Fractures

Fractures Presentation Pain Swelling Deformity Diagnosis → X-ray Treatment rules Closed reduction Mild fracture No displacement Open reduction + internal fixation Severe fracture Displacement or misalignment Surgery and debridement Open fracture Types Comminuted fracture Bone broken into multiple pieces Cause → Crush injuries Stress fracture Cause → Repetitive insult to bone Most...

Transplant Medicine

Transplant types Autologous → From the patient himself Allogenic → From genetically different donor Syngeneic → From identical twin Drugs Immunosuppressant Prednisone MMF Tacrolimus (FK506) Antilymphocyte Ab (OKT3) Antibiotic TMP/SMX Ganciclovir Ketoconazole Rejection reactions Hyperacute Within minutes ABO incompatibility → Preformed Ab Vascular thrombi ⇒ Tissue ischemia Cytotoxic agents...

Bone Cancer

Ewing Sarcoma Classic presentation 10-20y Multilayered onion-skinning on X-ray of Femur diaphysis 11, 22 translocation Mid shaft Systemic symptoms → Fever, Anorexia, Fatigue Onion skin on X-ray Eat Wings and Onion Rings Osteosarcoma Rb gene (Retinoblastoma) Metaphysis Distal femur Proximal tibia Proximal humerus Metastasis to lungs ↑ Alk. P...

Brain Tumors

Urology

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...

Urologic Cancers

Simple renal cyst → Incidental finding, No treatment needed, Reassurance only Renal Cell Carcinoma Adenocarcinoma Etiology Male Smoking Obesity Cysts due to ESRD von-Hippel-Lindau Angiomatosis Visceral cysts RCC CNS tumors Presentation Triad Hematuria Flank pain Flank mass LEFT-SIDED varicocele Fever Malaise ↓ Weight Anemia 5-10% → Polycytemia Diagnosis Best initial →...

Cardiothoracic Surgery

Cardiothoracic Abnormalities

Surgical Hypertension

Endocrine Surgery

Genitourinary Abnormalities

Hydrocele Fluid filled sac in scrotum Painless Along spermatic cord Transilluminates Remnant of tunica vaginalis Resolves in 6 months Differentiate from inguinal hernia Varicocele Swelling in scrotum Dull ache and heaviness in scrotum Varicose vein in scrotal veins Enlarged pampiniform plexus Increased with pressure Diagnosis Best initial → Physical exam...