Vascular Surgery

Acute Limb Ischemia

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

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...

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...

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...

Leg Ulcers

Peripheral Vascular Disease

Etiology DM Hyperlipidemia Hypertension Smoking Presentation Leg pain (calves) on exertion → Intermittent claudication Both walking UP and DOWN hill Spinal stenosis is worse walking DOWN hill Smooth shiny skin Loss of Hair follicle Sweat gland Sebaceous gland Diagnosis Best initial → Ankle-brachial index (ABI) → <0.9 Most...

Orthopedics

Hand 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...