Surgery Tips 2

Question 1

Osteomyelitis

Answer 1

Infection of the bone
Causes - staph aureus except in sickle cell pts (salmonella species)
RFs - diabetes mellitus, sickle cell anaemia, IVDU, immunosuppression, alcohol excess
Ix - MRI
Mx - flucloxacillin (clindamycin) for 6 weeks

Question 2

Hip fracture

Answer 2

Pain + shortened and externally rotated leg
Intracapsular (subcapital) - from the edge of the femoral head to the insertion of the capsule of the hip joint
Undisplaced - internal fixation or hemiarthroplasty if unfit
Displaced:
- Young and fit - reduction and internal fixation
- Older and reduced mobility - hemiarthroplasty or total hip replacement
Extracapsular - these can either be trochanteric or substrochanteric (the lesser trochanter is the dividing line) - dynamic hip screw (if reverse oblique, transverse or subtrochanteric - intramedullary device)
Aim is to allow immediate post operative weight bearing

Question 3

Anterior shoulder dislocation

Answer 3

External rotation and abduction

Associated with greater tuberosity fracture, Bankart lesion, Hill-Sachs defect

Question 4

Inferior shoulder dislocation

Answer 4

Luxatio erecta - extremity held over head in fixed position with elbow flexed

Question 5

Posterior shoulder dislocation

Answer 5

Rim’s sign, light bulb sign, Trough sign

Question 6

Superior shoulder dislocation

Answer 6

Rare and usually follow major trauma

Question 7

Lateral epicondylitis

Answer 7

AKA tennis elbow
Pain and tenderness localised to the lateral epicondyle
Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
Lasts between 6 months and 2 years
Aute pain for 6-12 weeks

Question 8

Medial epicondylitis

Answer 8

AKA golfer’s elbow
Pain and tenderness localised to the medial epicondyle
Pain is aggravated by wrist flexion and pronation
Also get numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement

Question 9

Radial tunnel syndrome

Answer 9

Due to compression of the posterior interosseous branch of the radial nerve
Symptoms are similar to lateral epicondylitis
Pain is 4-5 cm distal to the lateral epicondyle
Worsened by extending the elbow and pronating the forearm

Question 10

Cubital tunnel syndrome

Answer 10

Due to the compression of the ulnar nerve
Intermittent tingling in the 4th and 5th finger -> numbness in the 4th and 5th finger with associated weakness
Worse when the elbow is resting on a firm surface or flexed for extended periods

Question 11

Olecranon bursitis

Answer 11

Swelling over the posterior aspect of the elbow
Associated pain, warmth and erythema
Affects middle-aged male patients

Question 12

Fat embolism

Answer 12

Respiratory - persistent tachycardia; tachypnoea, dyspnoea, hypoxia usually 72 hours after; pyrexia
Dermatological - red/ brown impalpable petechial rash; subconjunctival and oral haemorrhage/petechiae
CNS - confusion, agitation, retinal haemorrhages and intra-arterial fat globules on fundoscopy

Question 13

Renal stone burden of less than 2cm in aggregate

Answer 13

Lithotripsy

Question 14

Renal stone burden of less than 2cm in pregnant females

Answer 14

Ureteroscopy

Question 15

Complex renal calculi/staghorn calculi

Answer 15

Percutaneous nephrolithotomy

Question 16

Ureteric calculi less than 5mm

Answer 16

Manage expectantly

Question 17

Staghorn calculi

Answer 17

Struvite stone
Proteus infection -> no lithotripsy
Mx - percutaneous nephrolithotomy

Question 18

Renal colic analgaesia

Answer 18

Diclofenac 75mg (severe - IM; less severe - PR)

Question 19

Torsion of the spermatic cord

Answer 19

Sudden onset pain in scrotum (usually left side), vomiting, tender testes
Cremasteric reflex absent
Mx - surgical exploration (both testis should be fixed as bell clapper testis is often bilateral)

Question 20

Torsion of the testicular appendage

Answer 20

Sudden onset pain in scrotum (usually left side), vomiting, tender testes
Cremasteric reflex present
Mx - surgical exploration (both testis should be fixed as bell clapper testis is often bilateral)