Surgery Flashcards
Battle’s sign
Ecchymosis behind the ear
Fracture the base of the skull
Herniation syndrome
1- subfalcine herniation under the falx cerebri : compression the anterior cerebral artery
2- downward transtentorial : rupture of paramedian basilar artery ( duret hemorrhage
3- transtentorial uncal : the inner part of temporal lobe herniate through the gap
Ipsilateral mass lesions
- posterior cerebral artery
- ipsilateral CNIII : downward and out position and dilated pupil and ptosis
- ipsilateral hemiparesis
-brain stem hemorrhage (duret)
4 - cerebellar tonsillar into the foramen magnum: cardio respiration arrest
Lowering the cranial blood pressure
1- hyperventilation reduces co2 levels which produce vasoconstriction in the brain
2- reduces metabolic demand by sedation
3 - increasing venous flow ( elevation of the head )
4- therapeutic lumber puncture
Epileptic seizure and electrical burn
Massive uncoordinated muscle contraction
Posterior shoulder dislocation
Closed reduction
Outstretched arm and axillary fullness and flattened deltoid
Anterior shoulder dislocation
Examines the axillary nerve ( weakness of abduction)
Shoulder pain
1- rotator cuff impingement
2- rotator cuff tears
3- adhesive capsulitis
Tendinopathy
Repetitive activity above shoulder height
The space between humeral head and acromion is reduced
Neer test shoulder internally rotated and forearm pronated
Rotator cuff tears
Supra and infra spinatus
Weakness of abduction
Drop arm test
Unable to lower the arm
It will drop rapidly around mid adduction
Trt surgery
Adhesive capsulitis
Frozen shoulder syndrome
Inflammation, fibrosis,
Shoulder stiffness
Dx : > 50% reduction in both passive and active ROM
Colles fracture
An outstretched hand
Dinner fork deformity of the wrist
Compression of the median nerve
Montegia fracture
Diaphyseal fracture of the proximal ulna with anterior dislocation of the radial head
Monte giga fracture
Galeazei fracture
Monteggia ulnar fracture
Galeazei radial
Trt open reduction and internal fixation
Buckle (torus) fracture
Forearm
Stable and incomplete fracture
X ray cortical bulge
Trt pain control and splint placement
Greenstick fracture
Strong periosteum which limits the fracture line from extending through the width of the bone
Opposite side without a break in the cortex
Unstable fracture
Immobilisation casting
Bilirubin stone
Pigmented radiopaque
Chlolesterol stone radiolucent
Pigmented :
Black : calcium bilirubin
Brown: infectious diseases
Biliary sludge absence of cholecystokinin there is no contraction of gall bladder leads to biliary stasis
Prolonged fasting and rapid weight loss and prolonged use of total parental nutrition
Post cholecystectomy syndrome
The same pain is persistent
Stone in the common bile duct or sphincter oddi dysfunction
Sphincter of oddi dysfunction
Dilated common bile duct without visible stones
Manometry
Trt sphincterotomy
Porcelain gallbladder chronic disease
Calcification and inflammation
Ct scan : calcified rim in the gall bladder with central bile filled dark area
Adeoncarinoma
Surgery
Hernias
1- indirect hernia
2- direct hernia
3- femoral hernia
4- incisional hernia
Groin hernias
- indirect
Direct
Femoral
1- indirect: male infants - patent processus vaginalis - protruding through deep linguinal ring
Lateral to inferior epigastric vessels
Direct hernia
Older men - weakness of transversalis fascia
Protrude through hesselbach triangle
Travels medial to inferior epigastric vessels
Femoral herniated
Woman- weakness of proximal femoral canal
Protruding through femoral ring
Travels inferior to inguinal ring
Appendix
Psoas sign RLQ pain : retrocecal appendix
Obturator sign : RLQ pain with internal rotation pelvic appendix
Rovsing signs: appendix
Rectal tenderness: pelvic
Postoperative fever
1- blood products given during or prior surgery( within a few hours)
2- acute fever (first week) nosocomial infection
3- subacute fever > 1 week : drug fever or clostridium difficile after long course of ANTIBIOTICS surgical site infection
4- delayed postoperative fever viral from blood products or infective endocarditis
Fever and muscle rigidity soon after surgery under general anesthesia
Malignant hyperthermia ( halothen and succinylcholine )
Mutation in the gene which codes for ryanodine receptors- release high levels of Ca in the cytoplasm which activates ATP consumption- heat and muscle damage
Painful swelling of parotid gland aggravated by chewing after surgery
Dehydrated post operative patients and elderly are prone to develop acute bacterial parotitis
Tenderness that improves with elevation of the testes
Prehn sign epididymitis
Pathogen from the urethral in a retrograde through ejaculatory duct to the ductus deferens
Risk factors: age > 35 and bladder outlet obstruction
Those who are under 35 from sex chlamydia
Acute onset of back pain and profound hypertension
Should be evaluated for a presumptive diagnosis of ruptured abdominal aortic aneurysm
Levofloxacin increases collagen degradation
Should be avoided in patients with a known aortic aneurysm
Leriche syndrome
Arterial occlusion at the bifurcation of the aorta into the common iliac
Trade of : bilateral hip thigh buttock claudication
Absent femoral pulse
Impotence always present with this condition
أساسي للتشخيص يعني
Chronic venous insufficiency
Varicose veins and skin discolouration or skin ulceration
Erythrocytes extravasation causes hemosiderin deposition: stasis dermatitis
Fever and abdominal pain or flank pain radiating to the groin
Psoas sign
Psoas abccess
Acute abdominal pain + lower intestinal bleeding
Ischemic colitis
Repair of aneurysm of aorta
Sudden back pain or flank with sudden hemp dynamic instability
Retro peritoneal hematoma
Cardiac Catheterisation
Lateral epicondylitis: tennis elbow
Medial epicondylitis: golfers elbow
Overuse
NSAIds
Positive trendelebberg sign
Dropping of the contralateral hem pelvis below its normal horizontal level during monopedal stance
Bursitis
1 pre patellar bursitis housemaid’s knee : due to staphylococcus. Aspiration of bursal fluid
2- pes anserinus pain syndrome ( anserine) anterior medial of the tibial plateau valgus test is negative to rule out the medial collateral ligaments
3- trochanteric bursitis : worsened with hip flexion
Abduction aggravate the pain
Hip range of motion is normal
Young parents with thalamic hemorrhage and there is no risk factors
Look for urine toxicology screen
Subcortical hemorrhage for cocaine
Large irregular king stone with UTIs
Struvite mg amonium phosphate
Pulmonic valve stenosis
Ejection click , crescendo - decrescendo murmur, over the second left of intercostal space widened s2
Plural effusion with coronary artery bypass surgery
Small and early onset (1-2 days)
No respiratory symptoms
