Surgery

Question 1

Colles fracture
Cause, RF,Association

Answer 1

Cause: Fall onto out-stretched hand
RF: Osteoporosis
Association: Ulnar styloid fracture, scaphoid fracture, wrist sprain, supracondylar humerus fracture

Question 2

Patellar tendon rupture
Cause, Sx, Exam

Answer 2

Cause: strong quad contraction with foot firmly planted and knee partially flexed

Sx: sudden severe pain, anterior knee swelling, difficulty walking

Exam: superior displacement of patella, can’t extend knee (if fully torn)

Tx: complete –> surgical repair within 10 days. Partial –> immobilization in extension x6 weeks –> PT

Question 3

Knee injury
ACL vs PCL causes, Dx

Answer 3

ACL tear: caused by posterior force –> large hemarthrosis
PCL tear: caused by anterior force –> large hemarthrosis
Definitie dx: MRI

Question 4

Transfusion reaction
1. Non-hemolytic: Pathogenesis , reduction
2. IgA reaction: pathogenesis, reduction

Answer 4

1. Non-hemolytic reaction
   - Occur within 1-6hrs
   - When RBCs and plasma are separated, a small amount of plasma/WBC remain –> WBC release cytokines –> fever, chills, malaise during transfusion
   - Reduction: Leukoreduction thru filtering
2. IgA reaction:
   When RBCs and plasma are separated, residual plasma contain IgA. IgA-deficient patients develop Ab –> anaphylactic reaction.
   - Reduce risk by washing RBC

Question 5

Drugs to stop pre-op

Answer 5

ACE - hold night before surgery for patient without HF to prevent possible hypotension

Diuretics -stop day of surgery to prevent possible hypovolemia and hypotension

Raloxifene/Tamoxifen - stopped 4 weeks before to reduce risk of venous thromboembolism.