The document contains extensive medical information regarding the anatomy, pathophysiology, assessment, and treatment of various gastrointestinal conditions, including the esophagus, stomach, small intestine, and appendix. It discusses specific diseases, risk factors, diagnostic techniques, and treatment options, emphasizing clinical scenarios and surgical considerations. Various surgical procedures, radiographic findings, and signs related to gastrointestinal disorders are also detailed.

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SURGERY 3 EVALS COMPILATION
Esophagus 50
Stomach 21
Small intestine 11+19
Liver and Gallbladder 40
Pancreas and spleen 50
Chest wall, lungs, mediastinum, pleura 35
Congenital and acquired heart disease 40
Arterial disease 35
Thoracic aneurysm and aortic dissection 25
Venous and lymphatics 25
Neurosurgery 35
Plastic Surgery 25
Urology 30
Bone infections and tumors 40
Hand & wrist, congenital, spine 20
Fractures of LE and UE 35
Esophagus
1) Upper thorax deviates to left
2) Middle thorax stays at midline
3) Lower thorax deviates to left
4) Cervical 5 cm
5) Thorax 20 cm
6) Abdominal 2 cm
7) Aorta thoracic
8) Azygos vein thoracic
9) Coronary vein abdominal
10) Inferior phrenic vein abdominal
11) Circular lesion Grade I
12) Linear lesion Grade II
13) Granulation tissue Grade II
14) Cobblestone Grade III
15) Stricture Grade IV
16) Relieved by antacids heartburn
17) Worsen by chocolate heartburn
18) Worsen by bending over regurgitation

2. 19) Bronchospasm regurgitation
20) Relieved by passage of bolus dysphagia
21) Abnormal columnar epithelium
22) Normal squamous epithelium
23) Hallmark goblet cells
24) Metaplasia goblet cells
25) Ulceration squamocolumnar junction
26) Belsey partial fundoplication
27) Nissen complete fundoplication
28) Toupet partial fundoplication
29) Laparoscopically both
30) Transthoracically both
31) Smooth, punch out defect leiomyoma
32) Bird’s beak achalasia
33) Subcutaneous emphysema Boerhaave’s
34) Tertiary contraction corkscrew
35) Filling dilation at carinal bifurcation traction diverticulum
36) Arise from mucosa squamous cell carcinoma
37) Arise from submucosal glands adenocarcinoma
38) Mainly in lower 3rd
adenocarcinoma
39) Mainly in middle 3rd
squamous cell carcinoma
40) Zinc deficiency is a risk factor squamous cell carcinoma
41) Smoking and alcohol are risk factors squamous cell carcinoma
42) Leiomyoma is a risk factor neither
43) Barrett’s is a risk factor adenocarcinoma
44) Late diagnosis squamous carcinoma
45) Mistaken for carcinoma in cardia adenocarcinoma
46) Dissolution injury alkali
47) Coagulative injury acid
48) NGT both
49) NaHCO3 none
50) Orange juice alkali
Chapter 24 – ESOPHAGUS
1. transition from pharynx to esophagus – at the lower border of the 6th
cervical vertebra = corresponding
to the cricoid cartilage anteriorly
2. thoracic portion of esophagus = 20cm
3. fried food = causes gastric distention causing GERD
4. gastric distention causes unfolding of the sphincter
5. pxs can be placed on 8-12wks of simple antacids when first seen with symptoms of heartburn w/o
obvious complications
6. lye / other alkali can be neutralized with half-strength vinegar, lemon juice or orange juice.
7. esophageal web – caused by ingestion of ferrous sulfate
8. vomiting – not an obligatory factor in malory-weiss syndrome
9. majority of px w/ Mallory-weiss syndrome = bleeding will stop spontaneously
Stomach (c/o Twinkle)
Anatomy
1. angle of his- fundus
2. parietal (oxyntic cells)- body
3. angularisincisura- antrum
4. nerves of latarjet- body
5. crow’s foot- antro-pyloric region
6. criminal nerve of Grassi- fundus
7. nocturnal acid secretion- more commonly elevated than daytime secretion
8. duodenal ulcer- twice as common in men compared to women
9. gastric ulcer- same incidence in men and women
10. deep bleeding on the posterior duodenal bulb or the lesser gastric curvature are high risk lesions, erode large arteries not
amenable to non-operative treatment, consider early operation

3. 11. Johnson classification- Type 3
12. Pathologic types of gastric cancer (excavated lesions that may extend into the muscularispropria without invasion of this
layer by the actual cancer cells- type 3)
13. Stage 3a of gastric Ca- T4, N0
14. Stage 3B of gastric ca- T3, N2
15. Virchow’s node- cervical, supraclavicular and axillary lymph nodes may be enlarged
16. Sister Joseph’s nodule- palpable umbilical nodule pathognomonic of advanced disease, evidence of malignant ascites
17. Blumer- rectal shelf
18. GIST- c-kit, PDGFRA, CD34
19. GIST- imatinib
20. Easiest to perfrom- Stamm’s gastrostomy
21. Gastrostomy- complication: metabolic bone disease (difference between gastric and duodenal ulcer)
Chapter 25 – STOMACH
1. Interprandial basal acid secretion = 2-5 mEq HCl per hour
2. somatostatin inhibits pepsinogen secretion
3. alarm symptoms / indications for esophagogastroduodenoscopy
- weight loss
- recurrent vomiting
- dysphagia
- bleeding
- anemia
4. tests for H. pylori
- serologic test
- urea breath test
- histologic test
- rapid urease test – simplest method when endoscopy is necessary
- culture
- NOT INCLUDED: gastric fluid analysis
5. Up to 90% of px with duodenal ulcers, and 70-90% of px w/ gastric ulcers have H. pylori infxn
6. proximal duodenum = typical location of peptic ulcers in gastrinoma
7. rectal shelf of blumer – in the pouch of Douglas (drop metastasis in gastric CA)
8. erosion of submucosal artery in dieulafoy’s lesion – bleeding
9. Mallory weiss tear – caused by forceful vomiting and/or retching
10. early dumping = 15-30minutes after a meal –diaphoretic, weak, light-headd and tachycardic;
ameliorated by recumbence or saline infusion → diarrhea
11. late dumping = 2-3hours ff a meal; relieved by admin of sugar; associated w/ hypoglycemia and
hyperinsulinemia
anemia – most common metabolic side effect in px who have had a gastric bypass for morbid obesity
Small Intestine (c/o Twinkle)
Case
1. vomiting- proximal obstruction
2. abdominal series
3. closed loop obstruction- U shaped or C shaped
4. strangulation- thickening of the bowel wall
5. ileocecal disease- majority of small bowel disease
6. FRIEND- foreign body, radiation enteritis, infection/inflammation, epithelialization of the fistulous tract, neoplasm, distal
obstruction
7. Adenocarcinoma- frequency of 35-40%
8. Meckels diverticulum- 100 cm of the ileocecal valve
9. Meckel’s diverticulum- 2 feet to the ileocecal valve in adults
10. Bleeding- main problem in meckels
11. MC presentation- bleeding, internal obstruction and diverticulitis
Appendix
1. broad-spectrum antibiotics
2. anorexia

4. 3. vomiting- d/t neural stimulation and presence of ileus
4. diarrhea- occurs in some patients
5. direct rebound tenderness
6. rovsing’s sign
7. cutaneous hyperesthesia
8. psoas sign
9. obturator sign
10. WBC- 10,000-18,000
11. Plain films,
12. Chest xray to rule out right lower lobe
13. Barium enema
14. Graded compression sonography
15. Arrowhead sign- thickening of cecum
16. Alavarado scoring
17. Computerized sonography, USD
18. Abnormal location of appendix and their unusual sites of pain example pregnancy
19. Treatment of appendix
SMALL INTESTINE
Small bowel obstruction
PE: IAPP (findings?)
Hernias
Occult blood
Tenderness
Electrolyte
Hypokalemia
Hypocalcemia
Hypomagnesemia
Hypermagnesemia
Fluid loss
Decreased oral intake of fluids
Vomiting
Sequestration in bowel lumen/wall
Radiologic findings
Dilated small bowel loops
Air-fluid levels
Paucity of air in colon
Jejunum vs. ileum
More arterial arcades
Larger circumference
Thicker wall
Lesser fatty mesentery
Longer vasa recta
Lesser aggregates of lymphoid follicles
Meckel’s diverticulum
Characteristics (Rule of 2’s)
2% prevalence
2:1 female predominance
2ft. proximal to ileocecal valve
2yrs below (50%)
Drawing of Meckel’s
Location: antimesenteric border, 2 ft proximal to ileocecal valve
Enterocutaneous Fistula
“FRIEND”
Foreign body in fistula tract
Radiation enteritis
Infection/inflammation at fistula origin
Epithelialization of fistula tract
Neoplasm at fistula origin

5. Distal obstruction
APPENDIX
Sequence of events (APV)
Anorexia
Abdominal pain
Vomiting
Location of tip of appendixlocation of pain
Rectocecal: flank or back pain
Recto-ileal: testicular pain
Pelvic: suprapubic pain
“Variations in the anatomic position/location of the appendix accounts for many of the variations in the principal locus of the
somatic phase of the pain
Draw McBurney point (2/3 from the umbilicus in the line drawn from umbilicus to ASIS)
Use of Alvarado scale: to ascertain likelihood of appendicitis
Indicators: signs, symptoms, lab findings
Interpretation:
0-4: unlikely
5-6: compatible w/ appendicitis; do CT
7-8: high likelihood of appendicitis
9-10: almost certain; operated
Lab work-up of appendicitis and for what
WBC count: to know if perforated
Urinalysis: rule out urinary tract as source of infection
Plain radiograph: rule out other pathologies
Ultrasound: establish dx (look for appendicolith)
CT: look for arrowhead sign
Laparoscopy: diagnostic & therapeutic
10 layers of abdominal wall in Rocky-Davis incision
Skin
Camper’s fascia
Scarpa’s fascia
External oblique m.
Internal oblique m.
Internal oblique aponeurosis
Transversus abdominis
Transversalis fascia
Prepertioneal fat
Peritoneum
Draw appendix
Site of obstruction: origin of appendix
Point of rupture: distal to point of osbstruction along antimesenteric border
Chapter 29 – APPENDIX
1. growth of cecum displaces appendix medially toward ileocecal valve
2. amt of lymphoid tissue – steady decrease with age
3. obstruction of lumen – dominant causal factor
4. distention of appendix – stimulates stretch fibers – vague dull diffuse pain
5. engorgement and vascular congestion – capillaries and venules are occluded
6. involvement of parietal peritoneum – shift in pain to the right lower quadrant
7. perforation – antimesenteric border
8. antibiotics – 24-48hours in nonperforated appendicitis
9. abdominal pain – prime symptom
10. dx of appendicitis –questioned if px is not anorectic
11. tenderness – maximal at McBurney’s point
12. Rovsing’s sign – pain in RLQ – when palpatory pressure exerted in LLQ

6. 13. abdominal findings may be absent when appendix hangs into the pelvis
14. if appendix fills on barium enema, appendicitis is excluded; if it does not fill – no determination can
be made
15. graded compression sonography – inconclusive if appendix is not visualized and there is no
pericecal fluid or mass
16. px w/ Alvarado scale scores of 9-10 must go to the operating room
17. rupture – distal to the point of luminal obstruction along antimesenteric border
18. phlegmon – matted loops of bowel adherent to the adjacent inflamed appendix or a periapendiceal
abscess
19. acute mesenteric adenitis – after an upper respiratory infxn
20. underdeveloped greater omentum to contain a rupture– significant morbidity in children
21. ruptured graafian follicle - leukocytosis and fever are minimal or absent; pain occurs at midpoint of
menstrual cycle – mittelschmerz
22. appendicitis – most frequently encountered extrauterine disease requiring surgical tx during
pregnancy
23. open appendectomy - Mc Burney (oblique) or Rocky Davis (transverse) RLQ muscle-splitting incision
24. if (+) perforation or gangrene – skin and subcu left open to heal by 2ndary intent or closed in 4-5days
as delayed primary closure.
25. Fowler-Weir incision= medial extension of incision w/ division of anterior and posterior rectus sheath;
for further eval of lower abdomen
26. tx of appendicitis w/palpable/radiograph. documented mass (abscess/phlegmon) = conservative
therapy w/ interval appendectomy 6-10weeks later.
27. wound infxn in appendectomy = confined to the subcutaneous tissue
28. fecal fistula – due to sloughing of that portion of the cecum inside a constricting purse-string suture
29. carcinoid tumor – firm, yellow, bulbar mass
30. tx for adenoCA – formal right hemicolectomy
Chapter 27 – SMALL INTESTINE
1. jejunum contrasted to ileum = larger diam, thicker wall, more prominent plicae circulares, less
fatty mesentery, longer vasa recta
2. ligament of treitz = demarcates duodenum from jejunum
3. parasympathethic – vagus nerve
4. intra-abdominal adhesions related to prior abdominal surgery = etiologic factor in up to 75% of cases
of small bowel obstruction
5. small bowel obstruction (sbo)– uncommonly caused by neoplasms
6. extrinsic causes of s.b.o. = adhesions, hernias, carcinomatosis
7. abdominal series: radiograph of abdomen-supine, abdomen-upright, chest-upright
8. most specific finding for sbo = triad of dilated small bowel loops (>3cm diam), air-fluid levels on
upright films, & paucity of air in the colon
9. tx of sbo = stomach continuously evacuated of air and fluid us NG tube
10. most intestinal neoplasms are asymptomatic until they become large
11. sbo caused by small bowel neoplasm = can be a result of intussusception w/ the tumor as the lead
point
12. hemorrhage = 2nd
most common mode of presentation of small bowel neoplasm (1st
: partial sbo)
13. carcinoid tumors – diarrhea, flushing, hypotension, tachycardia and fibrosis of endocardium and
valves of right heart
14. symptomatic benign neoplasms of s. i. = surgically resected or removed endoscopically
15. chemotherapy = primary therapy if small intestine is diffusely affected by lymphoma
terminal ileum = most frequently affected segment in radiation enteritis
Liver and gallbladder

7. 1) PTC means percutaneous transhepatic cholangiogram
2) HIDA route IV
3) Most common site of cholangiocarcinoma bifurcation
4) Child Pugh bilirubin
5) Albumin
6) INR
7) Encephalitis
8) Ascites
9) Stone after 6 mos recurrent
10) Tubular, brown stone retained?
11) Portal hypertension in males testicular atrophy
12) Gynecomastia
13) Most common parasite ascaris/clonorchis?
14) Tx for penetrating extrahepatic injury? Cholecystectomy?
15) IOC means intraoperative cholangiogram
16) Perihilar klatskin’s tumor
17) Tumor markers CA 19-9
18) AFP
19) CEA
20) RF for adenoma oral contraceptives
21) RF for HCC alcohol
22) Hepatitis
23) Adenoma leads to rupture
24) Malignancy
25) Chemo for cholangiocarcinoma 5-FU
26) Most common mortality gastroesophageal bleed
27) Organ involved for #26 esophagus
28) Endoscopic modality for #26 sclerotherapy
29) Ligation
30) Sengstaken-blakemore hemostasis? Decompression?
31) Sugiura procedure, removal of spleen
32) Stone least likely brown pigment
33) Any stone etiology supersaturation of bile
34) Most common cause of extrahepatic injury surgery
35) Biliary colic obstruction of
36) Cystic duct
37) Mirizzi syndrome infundibulum
38) Dilated veins esophagus?
39) Stomach?
40) Air in gallbladder emphysematous gallbladder
Chapter 31 – GALLBLADDER
1. average capacity = 30-50mL
2. fundus – contains most of smooth muscles
3. same peritoneal lining that covers the liver covers the fundus and inferior surface of gallbladder
4. cystic artery – usu. Branch of right hepatic artery
5. triangle of Calot boundaries: cystic duct, common hepatic duct, liver margin
6. extrahepatic ducts: R and L hepatic ducts, common hepatic ducts, cystic duct, common bile duct
7. 500 to 1000mL of bile produced by liver per day
8. VIP and somatostatin inhibit contraction
9. black pigment stones – small brittle
10. both cholesterol and pigment stones – almost always form in the gallbladder
11. cholecystectomy – definitive tx for acute cholecystitis
12. reynold’s pentad – fever, jaundice, RUQ pain, septic shock and mental status changes
13. sclerosing cholangitis – results in secondary biliary cirrhosis
14. signs and symptoms of CA of gallbladder – indistinguishable from those assoc. w/ cholecystitis
and cholelithiasis
15. Klatskin tumors – perihilar cholangiocarcinomas
LIVER
Origin of hepatic a.: celiac trunk

8. Confluence of portal v.: superior mesenteric v. & splenic v.
Left lateral lobe: segments II & III
Location of dilated vessels in portal hypertension: periumbilical area, chest
Risk of adenoma, not in FNH: malignancy, rupture
Use of Sengstaken-Blakemore tube
Control of refractory variceal bleeding
Most common mortality in portal hpn
Gastroesophageal variceal bleeding
Organ affected: esophagus
Endoscopes used: EGD, EVL
Most important phospholipid: lecithin
Helpful nitric oxide: endothelial
Substrate of deoxycholic acid: cholesterol
Sigiura procedure: spleen
PE of male w/ portal hpn
Testicular atrophy
Gynecomastia
Child-Pugh classification
Serum bilirubin
Serum albumin
INR
Encephalopathy
Ascites
Risk factor of HCC: hepatitis (viral), alcohol
Exposure to what (in hepatic adenoma): estrogen
Ligaments that attach liver to diaphragm
L & R triangular lig.
Ligament attaching liver retroperitoneum
R coronary lig.
Initial imaging of liver: abdominal USD
Block USD: obesity, bowel gas
What is in contact w/ segment 4A cephalad: diaphragm
Location of bile duct (cystic duct): right & posterior
What type of bilirubin is seen in urine: conjugated
What kind of jaundice is cholangitis: post-hepatic jaundice
How many weeks antibiotics in pyogenic liver abscess: 8wks
More accurate lab tests for hepatic synthesis evaluation: albumin, aPTT
GALLBLADDER & BILIARY TREE
Does not move w/ change in position: polyp
Portion of CBD not visualized: retroduodenal
Retained stone
4 causes of gallbladder cancer
5-fluorouracil
Secondary choledochal stones
What is IOC: intra-operative cholangiogram
Hydrops: mucus
Spherocytosis: black pigment
Toxin: lysolecithin
Herpes zoster
Management of injury: cholecystectomy
Cause of extrahepatic injury: iatrogenic
Mirizzie’s syndrome: infundibulum
Pancreas and spleen
Acute pancreatitis

9. 1) Position lateral decubitus with knees flexed
2) Do CT scan no
3) DDx for hyperamylasemia except mesenteric infarction?
4) Flank ecchymosis
5) Patient observed to be anxious but lying steady
6) Least seen in radiograph colon cut-off
7) 2nd
week, peripancreatic fluid collection leave alone
8) 3rd
week, delay CT pseudocyst
9) Mgt for #8 internal drainage
10) Lactescent fat
11) Courvosier sign except tenderness
12) Blumer’s shelf palpation
13) Organ involved in acute injury lung
14) Mx of #13 absent breath sound
15) Feeding NJT
16) Why in #15 because it bypasses duodenum
17) APACHE-II of 10 severe
18) Give antibiotics for #17 yes for splenectomy
19) True of amylase except if normal, elevate after 15th
hour
20) DIC except decrease fibrin
21) Drug to give except morphine
22) Dehydrated, lab value increased except albumin
23) Retching, ABG of hypochloremic metabolic alkalosis
24) Retching Mallory-Weiss
25) On admission, prognostic sign except BUN
Pancreatic malignancy
26) Most likely found in head and uncinate process
27) Biopsy adenocarcinoma
28) CEA and CA 19-9 except elevated, cholangitis
29) Initial radiograph US, for gallstone
30) Somatostatin pancreatic duct leakage
31) Hereditary except melanoma
32) TNM, T for size
33) Complete resection except SMA/SMV
34) --? Prerenal
35) WOF shock by assessing UO
Spleen
36) Sickle cell valine to glutamic acid
37) SC- splenectomy palliative for splenomegaly?
38) SC erythrocytes
39) SC both parents
40) SC- pain sequestration crises
41) SC- anemia cause for splenectomy
42) SC- hydroxyurea except malignant transformation
43) Accessory spleen falciform ligament
44) Splenic notch inferior pole
45) White pulp increase size
46) Red pulp venous sinus
47) Palpable below subcostal 2x size
48) Ligamentous attachment abdominal wall
49) Originate from mesoderm
50) Common infectious organism S. pneumoniae
Chest wall, Lungs, Mediastinum, Pleura
1. Bronchiectasis CT
2. Contiguous CT
3. Cytology inc. adenocarcinoma
4. dec. mesothelioma
5. Pleurodesis sclerosis
6. Bat droppings Histoplasmosis
7. Lab worker for 5 years Cryptococcus
8. skin Can characteristically be pinched desmoid tumor
9. Bronchiectasis macrolide
10. Example of macrolide azithromycin

10. 11. Caspofungin cell wall synthesis
12. TB adenosine deaminase in pleural effusion
13. Lytic plasmacytoma
14. Inc. ESR Ewing’s sarcoma
15. to avoid TIF w/o reference to sternal notch
16. 2 weeks TIF
17. to prevent undue tension 3/4
18. endotracheal intubation Ischemia
19. initially drain 1L
20. Pancoast adenocarcinoma
21. Massive hemoptysis NEC 1
22. Mimic lobar BAC
23. Teratoma surgical
24. Seminoma chemotherapy
25. Pericardium Masaoka III
26. Neuroblastoma posterior mediastinum
27. Sestamibi scan parathyroids
28. Stippled in radiograph malignant
29. Popcorn appearance hamartoma
30. MDRTB therapy rifampicin, isoniazid
31. squamous cell ca Except peripheral
32. Adenoacarcinoma peripheral lungs
33. Solitary BAC
34. wide excisional biopsy in lesions not more than 2cm
35. stenosis Tube same size as trachea
CHEST WALL, LUNGS, MEDIASTINUM, PLEURA
Bronchiectasis: CT
Contiguous: CT
Cytology: inc. adenocarcinoma; dec. mesothelioma
Pleurodesis: sclerosis
Bat droppings: Histoplasmosis
Lab worker for 5 years: Cryptococcus
Can pinch: desmoid tumor
Bronchiectasis: macrolide
Example of macrolide: azithromycin
Caspofungin: cell wall synthesis
TB: adenosine deaminase in pleural effusion
Lytic: plasmacytoma
Inc. ESR: Ewing’s sarcoma
w/o reference to sternal notch
2 weeks: TIF
3/4
Ischemia
1L
Pancoast: adenocarcinoma
Massive hemoptysis: NEC 1
Mimic lobar: BAC
Teratoma: surgical
Seminoma: chemotherapy
Pericardium: Masauka III
Neuroblastoma: posterior mediastinum
Sestamibi scan: parathyroids
Stippled in radiograph: malignant
Popcorn appearance: hamartoma
MDRTB therapy: rifampicin, isoniazid
Except: peripheral
Adenoacarcinoma: peripheral lungs
Solitary:BAC
2cm: subglottic space (narrowest part of trachea)

11. Tube same size as trachea
Congenital and Acquired Heart Disease
1. Left ventricle fibroma
2. Myxoma left atrium
3. ASD hypertrophy right ventricle
4. Moderate stenosis 1.0-1.5
5. AS cause of edema arrhythmia
6. ASD CXR right ventricle
7. VSD CXR biventricular
8. Increase pulmonary marking except TOF
9. Decrease pulmonary marking TOF
10. Intervention of CoA resection
11. Complication restenosis
12. MV insufficiency (RHD) III
13. MV insufficiency (RHD) tethering of leaflet / annular dilation
14. Cardioplegia max 3 hrs
15. Cardioplegia potassium, cold
16. 1 month VSD 80%
17. Square root sign RV diastolic
18. CHF CXR Kerley B line
19. PDA left posteolateral
20. Impt coronary artery anterior descending
21. TOF seizure abscess
22. PDA pulmonary artery to descending aorta
23. Egg shaped TGA
24. Boot shaped RVH
25. Complication of PDA repair hoarseness
26. Ebstein tricuspid
27. RV
28. Unstable angina rupture of plaque
29. CABG left internal thoracic
30. In-situ graft
31. Cardioplegia diastolic
32. Partial AVSD primum
33. Ebstein RV hypertrophy
34. ASD repair 4 ½ yo
35. Aortic insufficiency except thrust
36. CoA distal to branches
37. Cor triatriatum 2 chamber; horizontal; LA
38. VSD below TV; without muscle inlet
39. TOF dxc exept cardiac catheterization
40. Aortic insufficiency widened aortic annulus
Congenital and Acquired Heart Disease (Chapter 20-21)
• Patient watching TV, experienced pain when he sat up to change the tv channel – NYHA Class III
• Primary conduit for CABG – left IMA
• Other conduits for CABG – right IMA and saphenous vein
• Cause of mitral stenosis – rheumatic heart disease
• Type of valves used for patients at a younger age – mechanical valves
• Most common neoplasm of the heart – metastatic tumor
• “couer de stein” – constrictive pericarditis
• 1 cm3
• Solution content – potassium
• Autograft source of diseased AV – pulmonic graft
• Lifestyle modifications for management of heart diseases – exercise, smoking, alcohol, diet, etc.
• Esophagus, stomach, gallbladder
• Cardiac catheterization/coronary angiography, 2D echo

12. • TOF – boot-shaped
• Rare type of muscular VSD with multiple connections between the right and LVs – “Swiss cheese”
• No. of chambers in cortriatum – 2
• Two parts involved in Ebstein’s anomaly – tricuspid valve and RV
• ASD – foramen ovale
• Severe LVOTO – extreme pallor/poor peripheral perfusion
• Common heart defect with COA – bicuspid aortic valve
• For patients older than 40 – cardiac catheterization
• Prostaglandin source – placenta
• Location of COA – distal to the left subclavian artery
• PDA survival – left ventricle function
• TOF patient position – squat
• Avoid in PDA surgery – recurrent laryngeal nerve
• End result of VSD – LV hypertrophy
Arterial disease
1) R arm SBP: 145; L arm SBP: 135
R PT SBP: 140; L PT SBP: 180
R DP SBP: 145; L DP SBP: 150
ABI? 0.96, right
2) Intermittent claudication except hips, knee, foot, thigh
3) Arachnodactyly Marfans
4) Arterial biopsy giant cell arteritis
5) Acute limb ischemia max time 2 weeks
6) Rupture of aortic aneurysm? Takayasu, Marfan, Giant cell, EDS
7) Arc of Roilan IMA to SMA
8) Complaint in mesenteric ischemia abdominal pain
9) Least complaint in mesenteric ischemia vomiting
10) Chronic mesenteric ischemia CT & angiography
11) Elevated lipid profile in aortoiliac type I
12) Plucked chicken skin except neck
13) Cure of Raynaud none
14) Complaint of AAA no complaint
15) Late filling endoleak type II
16) Renal segment of aorta CA & SMA above renal
17) No need for long term surveillance of AAA open repair
18) Bradycardia carotid bifurcation
19) For bradycardia atropine
20) B-mode echogenecity
21) B-mode black and white
22) Doppler angle 60
23) Maximum size of aorta 3 cm
24) Restrict in pseudoxanthoma calcium
25) Advantage of MRA over CT for elevated crea level
26) Amaurosis fugax vision loss
27) Raynaud’s hand
28) Ulceration in Behcet’s penis
29) Gold standard for renal DSA
30) 2+ traditional scale markedly reduced
31) Screen for AAA ultrasound
32) Med used in testing renal function captopril
33) Diffuse spasm, low filling nonocclusive mesenteric ischemia
34) Beveled needle single wall, retrograde
35) Valves involved in Marfan’s bicuspid & aortic
ARTERIAL DISEASE; ANEURYSMS & AORTIC DISSECTON
Gold standard dx: MRA

13. Iodine contrast: CT scan
Abdominal distention, acidosis: mesenteric ischemia
Chronicity: 14 days or 2 weeks
Meaning of TEE: transesophageal endoscopy
TEE for: ascending aorta
Meaning of ABI: ankle-brachial index
ABI 0.7: claudication
2 goals: stabilize dissection, prevent rupture
2 Tx: beta-blockers, direct vasodilators, Ca-blockers, ACEI
Penetrating aortic ulcer: disrupted atherosclerotic plaque
Most common preventable cause: atherosclerosis
Compression of median arcuate lig: celiac trunk
Pulsus paradoxus: pericardial tamponade
Middle branch of aortic arch: L common carotid a.
Distal branch: L subclavian a.
Shortest branch: brachiocephalic trunk
Thoracic aneurysm and aortic dissection
1. Classical PE finding discrepancies between pulse
2. And blood pressure
3. Chronic dissection minimum of __ weeks 2
4. Ross procedure, use own pulmonary artery
5. Borst procedure for descending thoracic aorta and arch
6. Prerequisite for open repair of aneurysm BP control?
7. Prerequisite for endovascular; prox and distal at least 2 cm
8. Aside from BP, control pain
9. Meds for #8 morphine
10. Fentanyl
11. First branch brachiocephalic artery
12. Second branch left common carotid artery
13. Third branch left subclavian artery
14. Shortest branch brachiocephalic artery
15. Respiratory findings of aortic valve insufficiency dyspnea
16. Rales
17. Intramural hematoma, rupture of vasa vasorum
18. TEE means transesophageal echocardiogram
19. Emergency operation if dissection found in ascending segment of aorta
20. Pulsus paradoxus cardiac tamponade
21. Swift diagnostic modality CT scan
22. Laplace formula tension = pressure x radius
23. Aside from amphetamine, abusive substance causing dissection cocaine
24. Goal for aggressive pharma therapy for dissection stabilize dissection
25. Prevent rupture
Venous and Lymphatic System
1. Goals of treatment of lymphedema minimize swelling
2. Prevent recurrent infection
3. Lymphedema praecox; ares foot
4. Calf
5. Minimum compression for lymphedema 20 mmHg
6. Advance cases of lymphedema, weeping of fluid accompanied by hyperkeratosis
7. Vein if Giacomini small saphenous vein
8. GSV to common femoral vein landmark pubic tubercle
9. Pierce clavipectoral fascia cephalic vein
10. Unna's boot 3 layers
11. Sclerotherapy < 3mm
12. Saphenous venous stripping >2cm

14. 13. Difference between PAD and PCD cyanosis
14. PCD leads to venous gangrene
15. Pigmentation of CVI is from deposits of hemosiderin
16. Compute: 90 kg UFH maintenance drip 1620 units/hr
17. 70 kg hirudin bolus 28 mg
18. 80 kg argatroban 160 ug/min
19. Monitor UFH aPTT
20. 2 symptoms to be controlled for outpatient LMWH pain
21. Edema
22. Warfarin is an example of vitamin K antagonist
23. Warfarin blood product fresh frozen plasma
24. Thrombolytic agent degrades fibrin
25. HIT heparin-induced thrombocytopenia
Venous and Lymphatic Disease (Chapter 24)
• Media
• Sural nerve
• Intradermal
• Pain
• Pitting edema
• Blanching
• 6,400 units
• 1,440 units
• LMWH (SC)
• Secondary DVT
• Elastic compression stocking
• Great saphenous vein
• Heparin-induced thrombocytopenia
• Factor II
• Gelatin, zinc oxide, sorbitol, magnesium aluminum silicate, calamine, glycerin
• Congenital lymphedema
• Lymphedema praecox
• Lymphedema tarda
• Decompression
• Venography
• Cellulitis
• Protamine sulfate
• Hepatobiliary
• Medial aspect
Neurosurgery
Case 1 – trauma, patient with ET tube
1. In securing airway, ___ should also be protected neck?
2. Worsens TBI hypoxia
3. hypotension
4. E is 2, meaning... opens to pain
5. E means eye opening
6. M is 3, meaning... decorticate/flex
7. M means motor response
8. V means verbal response
9. V is 1 T

15. 10. Total score is 6 T?
11. Give fluids normal saline solution/PNSS
12. Seizure prophylaxis phenytoin
13. If 50kg, give ___ as bolus 850 mg
14. Epidural hematoma lentiform
15. Subdural hematoma crescent
16. Affected vessel in epidural hematoma middle meningeal artery
17. Middle phase of epidural hematoma lucid interval
18. Layer of scalp lead to massive bleeding aponeurosis/connective tissue?
19. Peptic ulcer from TBI cushing’s ulcer
20. Management craniotomy
Case 2 – patient has tumor, done CT scan (revealed hydrocephalus)
21. CT showed tumor in tentorium cerebelli; accdg to location, what tumor infratentorial
22. Hydrocephalus in CT; what is compressed fourth ventricle/cerebral aqueduct?
23. PE symptoms consistent with tumor location ataxia
24. Nystagmus/cranial nerve palsy
25. No occurrence of ___; most likely based on location seizure
26. Dexamethasone for vasogenic edema
27. Herniation of ___ through foramen magnum tonsils
28. The above is part of cerebellum
29. Contents of cranial vault blood
30. CSF
31. Brain tissue
32. Normal ICP 4-14 mmHg
33. Management VP shunt?
34. Additional diagnostic procedure MRI
35. If compressed, may lead to death brainstem
Neurosurgery (Chapter 42)
• Infratentorial
• Seizure
• Brain tissue, blood, CSF
• Ataxia, nystagmus, cranial nerve palsies
• Vasogenic edema
• 4-14 mmHg
• Fourth ventricle
• Ventriculostomy
• Whole brain radiation therapy (WBRT)
• pNSS
• phenytoin
• 850 mg
• Eye opening response
• Opens to pain
• Motor response
• Flexor posturing/decorticate
• Hypotension, hypoxia
• Biconcave/lens/lentiform
• Crescent
• Middle meningeal artery
Verbal response
NEUROSURGERY

16. Tumor causing inc. ICP: infratentorial
Sx of infratentorial: Ataxial nystagmus, cranial nerve palsies
Seizure
Vasogenic edema
Tonsil
Cerebellum
Contents of cranial vault: blood, CSF brain tissue
Normal ICP: 4-14mmHg
What layer of scalp leads to massive bleeding
Aponeurosis
Hydrocephalus: VP shunting
Trauma: craniotomy
4th
ventricle
Epidural hematoma: Middle meningeal artery
Decorticate
1
6
Components of Glasgow coma scale: eye opening, motor response, verbal response
Epidural hematoma: lentiform
Subdural hematoma: crescent
Fluid given: NSS w/o glucose
Dose: 850mg
Phenytoin
Brainstem
Hypoxia
Hypotension
MRI
Cushing’s ulcer
Awakens/lucid interval
Plastic Surgery (c/o Twinkle)
1-2: cause of cleft, failure to fuse of:
1. medial nasal process
2. maxillary prominence
3. 4%- if a parent is cleft
4. Simonart band
5. Incisive foramen
6. millard- rotation advancement procedure
7. Furlow-Z plasty, double opposing
8. Pectoralis major flap
9. Rectus abdominis flap
10. Trapezius
11. Latissimusdorsi flap
12. Palatoplasty-fistula
13. Tumescent local anesthesia
14. Rhytidectomy- for hematoma
15. TRAM acronym
16. Earliest time for split –thickness graft
17. Earliest repair for palatoplasty- 6 months
18. TRAM blood supply- sup. Epigastric artery
19. Early diagnosis for cleft
20. Cleft priority-feeding
21. Why?- cannot generate negative pressure when sucking
Factors of skin grafting:
22. Infection

17. 23. Mechanical shear force
24. Hematoma
25. Seroma
PLASTIC/RECONSTRUCTIVE SURGERY
Tissue expansion
Transposition
Rotational
Advancement
35mg/kg
Eyelid reconstruction: blepharoplasty
Rhytidectomy: facelift
Dynamic territory
Potential territory
Conditioning – inc. reliability of flap
Full thickness – epidermis & complete layer of dermis
Thick-split grafts: more primary contraction, less 2ndary contraction
Advantage of full thickness: durability, cosmesis
Nutrition to graft: fibrin layer
Capillary buds: inosculation
NAM (cleft lip vs. palate)
Hypercoagulability
Change in laminar flow
Subcutaneous
Urine output/vital stats
18months? 9months?
5 days
Caffeine, smoking
Rhinoplasty
Plastic and Reconstructive Surgery (Chapter 45)
• Transposition – single pivot point
• Rotational – single pivot point, semicircular
• Advancement – Burrow’s triangle
• Cleft lip first
• 6 months old
• Full-thickness flap – high vascularity (good healing), for cosmesis (good cosmetic appearance)
• High 1°
• Low 2°
• Fibrin and plasma
• Inosculation
• Dynamic territory
• Potential territory
• Advancement procedure
• Conditioning – delay
• Blepharoplasty – eyelids
• Cervical rhytidectomy – facelift
• Lidocaine max dose – 35 mg/kg – 1750mg
• 5 days
• Class 1 maxillary
• Cottle sign – rhinoplasty
• Tissue expansion
• Change in constitution of blood, altered blood laminar flow
• Remove subcutaneous

18. • Smoking, caffeine
Urologic Surgery
1. True of kidney left renal vein longer
2. True of adrenal gerota’s fascia
3. True of ureter inferior = iliac
4. True of prostate denonvillier’s
5. True of penis glans penis
6. True of testis tunica albuginea – non compliant
7. Bladder except adenocarcinoma (industrial solvents)
8. AFP and HCG germ cell and nonseminomatous
9. Priapism except epinephrine
10. Testicular cancer none (inguinal/iliac)
11. Renal vascular metastasis vena cava
12. BCG bladder cancer
13. Grade 4 renal vein laceration
14. Ischemia and necrosis distal 3rd
15. Paraphimosis glans
16. Complication of TURP hyponatremia
17. BPH large, transurethral catheter
18. TURP endoscopic, penile urethra
19. Coude prostatic
20. Reflex cremasteric
21. Posterior urethral injuries prostate and membranous
22. Fournier’s gangrene except buck’s
23. Butterfly sign buck’s fascia
24. Epididymoorchitis hydrocele
25. Unilateral cryptorchidism – bring down to monitor for change
26. BPH except dysuria
27. Testicular trauma dx USD
28. Struvite ammonium and magnesium
29. ?? Non contrast CT
30. ?? indinavir
Bone Infections and Tumors
1. Antecedent of osteitis pubis pelvic surgery
2. Diskitis child-lumbar-unknown
3. Charcot’s joint T. pallidum
4. Fungal infection simulate TB blastomycosis
5. Sickle cell anemia s. typhi
6. Minimum time IV antibiotics 2 weeks
7. Why drain fluctuant mass
8. New growth squamous cell carcinoma
9. Majority of cases s. aureus
10. Spirochete t. pallidum
11. Hallmark of chronic osteo draining sinus
12. Empiric therapy oxacillin
13. Maximum time to wait for response to antibi 48 hours
14. Not reliable in infants fever
15. Intense osteoblastic response periosteal stripping
16. Xray shows bone problems 10-12 days
17. Not true for TB high grade fever
18. Initial infection metaphysis

19. 19. Effective barrier epiphysis
20. True of sequestrum and involucrum except involucrum surrounded by granulation tissue
21. Multiple myeloma marrow
22. Glomus tumor vascular
23. Ewing’s sarcoma marrow
24. Codman’s tumor cartilaginous
25. Adamantinoma location tibia
26. Osteoid osteoma except painless
27. Osteochondroma except surgery is necessary
28. Phalanges enchondroma
29. Solitary bone cyst location metaphysis
30. Osteosarcoma metastasis lung
31. Osteolytic, least origin of metastatic bone tumor prostate
32. Osteoclastoma aside from long bones sacrum
33. Osteosarcoma upper tibia
34. Chemo in rhabdomyosarcoma useless
35. Multiple myeloma calcium
36. Multiple myeloma except irradiation only palliative??
37. Acid phosphatase male-prostate
38. Ewing’s except sunburst??
39. Treatment for ewing’s radiotherapy
40. Codman’s triangle below the periosteum
Bone Infections and Tumors (Handouts)
• Staphylococcal
• Volkmann’s canals
• Pus – sequestrum
• IV antibiotics – 2-4 weeks
• Sequestrectomy – chronic stage
• Cancellous bone source – iliac
• Brodie’s abscess – fibula
• Epiphysis, hip capsule – within
• Squamous cell carcinoma
• Diskitis – lumbar
• Palliation – pain
• Sulfur granules – actinomycosis
• Clutton’s – Treponemapallidum
• Clutton’s – knee joint
• Gumma – Syphilis
• Osteosarcoma – sunburst pattern
• Tuberculous osteomyelitis
• Glomus tumor – vascular tissue
Chapter 42 – ORTHOPAEDICS
1. MRI – most valuable for examination of soft tissues
2. ligaments and meniscus can usually be seen on an MRI
3. evaluation of pelvic injuries: AP radiograph, inlet and outlet views
4. 5 simple acetabular fractures: posterior wall, posterior column anterior wall, anterior column and
transverse fractures
5. anterior hip dislocations – from forced abduction or anterior-posterior force to an abducted thigh; less
common than posterior hip dislocation

20. 6. nonsurgical tx of tibial plateau fractures = short term immobilization with a long leg cast followed by
bracing or immediate cast-bracing with delayed weight bearing
7. middle 3rd
clavicle = most common site of clavicular fractures
8. distal 3rd
of clavicle – 2nd
common site
9. Bankart lesion – tear in the glenoid labrum due to anterior shoulder dislocation
10. Hill-Sachs lesion – compression fracture of the posterolateral aspect of the humeral head by the
glenoid rim due to anterior shoulder dislocation
11. Monteggia fracture – fracture of the ulna with an associated dislocation of the radial head
12. Galeazzi fracture – fracture in the distal third of the radius with an associated dislocation of the distal
radioulnar joint
13. nightstick fracture – isolated fracture of the ulna
14. greenstick fracture – imcomplete fracture sustained by immature bones due to capacity to undergo
plastic deformation without breaking
15. Colles-Pouteau fracture – fracture of the distal radial metaphysis with dorsal displacement of the
distal fragment; most common fracture of the distal radius
16. Barton’s fracture – dorsal articular marginal fracture (distal radius fracture)
17. Letenneur’s fracture – volar Barton’s fracture (distal radius fracture)
18. Hutchinson’s or Chauffeur’s fracture – fracture of the radial styloid
19. Popeye deformity of arm – due to rupture of the long head of the biceps
20. plantar fasciits – plantar heel pain
21. stress fracture– common cause of forefoot pain or fatigue fracture of the metatarsal
22. tarsal tunnel syndrome – compression of the tibial nerve; vague symptoms – numbness and tingling
on plantar aspect of foot
Hands & Wrist, Congenital Disorders, Spine (Modified T/F)
Hands and Wrist
1. Flexor retinaculum ulnar side – pisiform and triquetrium pisiform and hamate
2. Tapping wrist – Phalen’s test Tinel’s test
3. Basis of median nerve – radial artery Palmaris longus tendon
4. Ulnar – (something letter G) canal Guyon’s canal
5. Cubital tunnel – ulnar nerve T
6. Fluctuation of nail fold – felon paronychia
7. Gilula – distal edge of distal row proximal edge of distal row / distal edge of proximal row
8. Jahss maneuver – index finger small finger
Congenital
9. Barlow – adduct and elevate adduct and depress
10. SCFE – knee pain groin pain
11. Pavlik – Legg-Calves-Perthes congenital hip dysplasia
12. Clubfoot contracted – medial tendon T / Achilles tendon ?
13. Maximum time for nonsurgical mgt for clubfoot – 8 mos T
14. Osgood-Schlatter – ankle pain knee pain
Spine
15. Vertebra prominens – C1 C7
16. Slip disc weaken – nucleus polposus annulus polposus
17. To view dens – lateral view AP open mouth view
18. Compression fracture – middle column anterior column
19. Jefferson – lateral segment T ?
20. Scoliosis most common – degenerative idiopathic
Congenital Abnormalities & Surgery of the Hand and Wrist (Handouts)
• Jefferson fracture – AP x-ray image
• Clay shoveler’s – posterior compartment
• Neurogenic – lumbar spine stenosis

21. • Scoliosis (most common) – idiopathic curves
• Braces – useless in 45° scoliosis
• Loss of disc height
• Polio – neuromuscular
• Barlow’s test
• Galeazzi’s sign – shortening
• Perkin’s, Shenton’s
• Pavlik harness
• Kite’s – calcaneous
• Achilles tendon – lengthening
• Bipartite patella – asymptomatic
• Fibula absence
• First to ossify – capitate
• Trapezoid – index finger metacarpal
• Bears most of the load – scaphoid
• FDS
• Guyon’s canal – ulnar artery
• De Quervain’s – thumb
Fractures of UE and LE
1. Primary callus circulatory
2. Wound closure circulatory
3. Union metabolic
4. Reinforcement metabolic
5. Remodeling mechanical
6. 2 years mechanical
7. __ are hallmark of __ stage mesenchymal cells; circulatory
8. Late type I
9. Innermost in cast stocking
10. After cast take x-ray
11. Fiberglass elasticity
12. Breaking strength cortical
13. Intramedullary internal fixation rods and nail
14. Compartment >30 mmHg
15. Compartment syndrome incision fascia? Skin?
16. Falls calcaneus
17. Torsional and dorsiflexion except calcaneus
18. Avulsion injury 5th metatarsal
19. Achilles plantar flexion
20. Patella manual reduction
21. Hip: position posterior
22. Substantial blood loss intertrochanteric
23. Most common hip fracture femoral neck
24. With hip dislocation femoral head
25. Pelvis lateral
26. Medial 3rd of clavicle anterior
27. Middle 3rd of clavicle elevate? Depress, anterior, posterior

22. 28. Scapula glenoid
29. Elbow except condyloid
30. Radial nerve humeral shaft
31. Night stick fracture ulnar diaphysis
32. Monteggia fracture of proximal ulna & radial head dislocation
33. Monteggia radial head dislocation
34. Galeazzi except ulnar nerve compression
35. Colles fracture except widening of joint
COLON, RECTUM & ANUS
2 types of stool & define
Melena: dark red; proximal GIT bleeding
Hematochezia: bright red; distal GIT bleeding
Procedure of DRE & rationale
Position on bed when in left lateral decubitus
Facing wall, ceiling
In contact w/ bed, free edge of bed
Draw clock position of mass
Differentiate internal & external hemorrhoids
Do endoscopy because…
Milligan-Morgan (Open) Hemorrhoidectomy
Allowed to heal by secondary intention
Acute & long term complications of hemorrhoidectomy
Acute: urinary retention, infection, bleeding
Chronic: incontinence, anal stenosis, ectropion
Types & maximum lengths of endoscopes
Anoscopy: 8cm; views anal canal
Proctoscopy: 25cm; views rectum & distal sigmoid
Flexible sigmoidoscopy: 60cm; views sigmoid
Colonoscopy; 100-160cm: views colon, up to terminal ileum
Viscious triad of anal fissure: pain, spasm, ischemia
Draw location of ileostomy & colostomy
Chapter 28 – COLON, RECTUM, ANUS
1. midgut = small intestine, ascending colon, proximal transverse colon
2. hindgut = distal transverse colon → proximal anus
3. covered by serosa = intraperitoneal colon and proximal 1/3 of rectum
4. lack serosa = mid and lower rectum
5. cecum = widest portion of colon; thinnest muscular wall; most vulnerable to perforation
6. epicolic – lymph nodes found on bowel wall
7. paracolic – inner margin of bowel adjacent to arterial arcades
8. intermediate – around mesenteric vessels
9. main – at origin of superior and inferior mesenteric arteries
10. sentinel lymph nodes – first 1-4 nodes to drain a specific segment of colon
11. valves of Houston = 3 distinct submucosal folds
12. waldeyer’s fascia = rectosacral fascia
13. denonvilliers’ fascia = separates rectum from prostate and seminal vesicles in men, and from vagina
in women
14. columns of morgagni = longitudinal muscle folds surrounding the dentate line; into which anal crypts
empty
15. inferior rectal vein = drains into internal iliac vein
16. E. coli – most common aerobe; Bacteroides – most common anaerobe
17. rectoanal inhibitory reflex – distention of rectum causes reflex relaxation of internal anal sphincter
18. anoscopes = 8cm; examines anal canal
19. endorectal ultrasound – evaluates depth of invasion of neoplastic lesion

23. 20. CEA – detect early recurrence of colorectal ca
21. unexplained iron def anemia – indication for colonoscopy
22. internal hemorrhoid – painless bright-red rectal bleeding w/ bowel movements
23. combination of 3 doses of neomycin and erythromycin = bowel preparation; decreases post-op infxn
by decreasing bacterial load of colon
24. complicated diverticulitis:
- w/ abscess
- obstruction
- diffuse peritonitis (free perforation)
- fistulas bet colon and adjacent structures
25. melanin spots on buccal mucosa and lips = peutz-jeghers syndrome
26. HNPCC / Lynch’s syndrome = autosom. dominant; colorectal ca develops at an early age
27. sigmoid volvulus:
- bent inner tube
- coffee bean appearance
- bird’s beak
28. C. difficile – pseudomembranous colitis
29. clindamycin – first antimicrobial agent assoc. w/ pseudomem. Colitis
30. bowel surgery – increases risk of c. difficile colitis
31. internal hemorrhoid = may prolapse or bleed but rarely becomes painful unless thrombosed or
w/necrosis
32. anal fissure = spasm of internal anal sphincter
33. lateral location of anal fissure – evidence of underlying dis (crohn’s, HIV, syph, tb, leukemia)
34. perianal abscess – most common; painful swelling at anal verge
35. ischiorectal abscess – horse-shoe abscess
36. Goodsall’s rule – transverse line dividing perineum? to anterior and posterior to identify internal
opening of fistulas in ano
37. fistulas w/ external opening anteriorly – short radial tract
38. fistulas w/external opening posteriorly – curvilinear fashion to the posterior midline
39. exceptions to goodsall’s rule – greater than 3cm from anal margin
Amputation, Prostheses and Braces (Handouts); Sports Med, Soft Tissue Injuries and Joint Disorders (Chapter 43)
• acute vascular diseases – arteriosclerosis, thromboangiitisobliterans
• fingers and metacarpals amputation, important elements – grasp, pinch, hook
• malignant tumor measures before amputation – resection, irradiation
• proximal to metatarsals – major amputations
• SACH foot – syme amputation
• PTB – patellar tendon
• Replantation – upper limb
• Should be done to stump for prosthesis-making - ?
• Forequarter amputation – removal of scapula and most of clavicle
• Amputation in children, overgrowth – humerus, tibia, fibula
• Hemi-pelvectomy – Canadian-type hip disarticulation
• Orthoses – for relief of stress on weakened tissues
• Thomas brace – neck
• Orthotist – brace-maker
• Varus – LCL
• Reverse Lachman’s – PCL
• Basketball injury – ACL, MCL, medial meniscus
• Locked knee – menisci
• Shoulder impingement – supraspinatus tendon
• Knee – anterior peripatellar approach
• Shoulder displacement/dislocation – anterior

24. • Confirmatory test – MRI/arthroscopy
Chapter 5 – SURGICAL INFECTIONS
1. for bowel surgery – clear liquid diet for 12-24 hours prior to colonic resection, concurrent with using a
cathartic preparation and ingesting large amts of fluid to flush the contents of colon
2. antimicrobial agents – 2ndary importance to effective surgery w/regard to tx of surg. infxn
3. prophylaxis – admin of antimicrob. agent prior to initiation of surg. procedure
4. empiric therapy = limited to short course of drug (3-5 days)
5. Cefazolin – prophylaxis for breast surgery
6. 3-5 days = antibiotic therapy for perforated or gangrenous appendicitis
7. E. coli = most common aerobic bacteria causing hepatic abscess
Intraabdominal Infections (Sabiston Chapter 32)
• Hematogenous route
• Most common pathogen in adults – E. coli
• Most common pathogen in children – pneumococcus
• Common in adults – liver, ascites
• 100,000
• Indwelling catheter – except Bacteriodes fragilis
• Indwelling catheter – after 5 days
• Lesser sac – left lobe of the liver
• Except povidone-iodine
• Morrison’s pouch – stomach
• Most common site of perforation – cecum
• Peritonitis delayed – head injury
• Typhoid ileitis – hematochezia
• Post-op leakage – 5-7 days
• Perforation – 12 hours
• pH – decrease/low
• frank peritonitis – anastomosis
• X-ray – air-fluid level
• Kehr’s sign – left subphrenic
• Temporization
• STD – tubo-ovarian
• Retroperitoneal – ureter
• Highest mortality in perforation – duodenum

25. • Most common in children – kidney