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Thrombophilia 41 h. Bleeding, Thrombocytopenia 42 6. Infectious Disease a. Antibiotics 44 b. HIV 44 c. TB 45 d. Sepsis 45 e. Brain Inflammation 46 f. Lung Infection 47 g. UTI 47 h. Genital Ulcers 48 i. Skin Infections 49 j. Endocarditis 50 k. Antibiotics 50 l. Surgery 50 7. Endocrinology a. Anterior Pituitary 52 b. Posterior Pituitary 53 c. Thyroid Nodules 54 d. Men Syndromes 54 e. Thyroid Disorders 55 f.

Adrenals 56 g. Diabetes 58 h. Diabetic Emergencies 59 8. Neurology a. Stroke 60 b. Dizziness 60 c. Seizure 61 d. Tremor 62 e. Headache 63 f. Back Pain 64 g. Dementia 65 h. Coma 66 i. Weakness 67 9. Rheumatology a. Approach To Joint Pain 68 b. Lupus 69 c. Rheumatoid Arthritis 70 d. Other Connective Tissue Dz 71 e. Monoarticular Athropathies 72 f. Seronegative Arthropathies 73 Dermatology a. Blistering Disease 74 b. Papulosquamous Dermatoses 75 c.

Eczematous Dermatoses 76 d. Hypersensitivity Reactions 77 e. Hyperpigmentation 78 f. Hypopigmentation 79 g. Skin Infections 80 h. Pediatrics a. Newborn Management 82 b. Neonatal ICU 82 c. FTPM and Constipation 83 d. Neonatal Jaundice 84 e. Baby Emesis 85 f. Congenital Defects 86 g. Well Child Visit 87 h.

Vaccinations 88 i. Preventable Trauma 89 j. Abuse 90 k. Infectious Rashes 91 m. Acute Allergic Reactions 92 n. Chronic Allergic Reactions 92 o. ENT 93 p. Upper Airway 94 q. Lower Airway 95 r. GI Bleed 96 s. CT Surgery 97 t. Orthopedics 98 u. Peds Psych 99 v.

Sickle Cell 99 w. Ophthalmology x. Urology y. Seizures z. Immunodeficiencies Psychiatry a. Anxiety Disorders b. Impulse Control Disorders c. OCD and Related Disorders d. Mood Disorders f. Mood II Life and Death g. Psychotic Disorders h.

Eating Disorders i. Personality Disorders j. If you feel that we have violated your copyrights, then please contact us immediately. You may send an email to arshadullahbangash gmail.

Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Could you please reupload the pdf notes for basic sciences? Thank you! Could you please upload the link again? Every patient should be on tele in recovery and high risk patients should stay EKG for 1 night for monitoring. DO NOT give clot busters. Confirm the diagnosis with a CT scan.

Prevention is key. If aspiration combative patient, emergency surgery is suspected treat with abx that cover gram neg and anaerobes. Hypoxia can do it and is a simple fix give O2 and Altered intubate as needed. PEEP Benzos Renal Complications Beyond infection there are only a few diseases to consider; they are all based upon how much urine is being made.

Leave a Foley in place if two in-and-out caths Yep are required. Vs Nope Foley 2 Zero Output means a mechanical obstruction or post-renal failure. Anuria is rare unless BOTH ureters are cut. Unkink Renal Failure the catheter and urine will flow.

See nephrology for details. But first, just do a cc Fluid cc bolus challenge. If dehydrated, Urine Output will Obstruction Challenge increase slightly with the bolus. Mucking around in the gut can cause some problems. Given the situation, it should be possible to determine which of these is going on: 1 Paralytic Ileus is expected post-op.

Ileus is common on the first day but should subside with ambulation and diet. An upright and flat KUB should show diffuse enlargement of small and large bowel.

Watch for hypokalemia - a common cause of ileus. A contrast swallow CT could also be done to see if tracer material passes the obstruction to confirm. Ultimately, this patient goes back to the OR. Their colon only will be very dilated, shown on a flat and upright KUB. Do a colonoscopy to rule out cancer and to decompress the abdomen two for one deal.

Leave a rectal tube in place. Ogilvie Syndrome 1 Dehiscence. The skin is intact but the fascia has failed. If dressings are unusually soaked or have a salmon-color blood and peritoneal fluid look sort of pink think dehiscence.

Evisceration must be prevented. Bind the abdomen and limit movement and straining. This is how patients get ventral hernias. Elective surgical repair is the treatment. The wound pops open and the bowel pops out. This is an emergency. Cover the bowel with warm saline dressings and get back to the OR.

Absolutely never push it back in. Absolutely never use dry dressings. Fistulas Fistulas are defined as a connection between two epithelialized surfaces. When they exist consider what has kept them open. Radiating to the Back Complications and sequella, however, are a surgical topic. The CT scan CAN be used to make the diagnosis of complications, but it should be reserved until after the complications are seen.

Surgery can be done later, a necrosectomy after the Pancreatitis BUT fluid collection has solidified. The first is that necrotizing pancreatitis who is ill and stays ill. This is why serial Necrotizing CT scans become part of the treatment.

But for the person with Pancreatitis typical pancreatitis, an abscess will show on day 5 ish with persistent fever and leukocytosis. When found, they need to be Drain Abscess drained. The best is percutaneous; if severe, drain them Poor Prognosis surgically. A late sequelae is a pseudocyst - so named because it does not have an endothelial lining. In someone with mass symptoms dyspnea, ascites, and Pseudocyst early satiety , after acute pancreatitis suspect a pseudocyst. Get a CT scan. They need to be drained: to the skin percutaneous , the GI tract cystogastrostomy , or surgically open.

Chronic Pancreatitis Patients present with chronic pain that mimics acute pancreatitis. Give the patient Oxygen, Dantrolene, Cooling Blankets, and watch for myoglobinuria i.

Do a CXR and listen to the lungs. If O2 positive, give spirometry to improve ventilation. Do prophylactic incentive spirometry always.

First, do a CXR to see Heparin consolidation. If they can pee on their own, surgery! A Exam 2 cm greater on one leg compared to the other is highly suggestive. Anticoagulate with Low Molecular Weight Heparin bridge to warfarin.

Prophylax with early mobilization and heparins. A good closure and good wound care could prevent this. Treat with antibiotics. If erythematous, warm AND boggy, drain the abscess.

If not sure, an Ultrasound can be done to clarify. Deep Abscess Wound Someone messed up. Emergent Surgeries are Glucose. However, subacute and elective procedures may be more harmful than the condition they intend to treat. Both add up to one thing: pump failure.

Rates of perioperative complication, especially the Aortic Stenosis 3 presence of JVD, are the worst prognostic factor on the index. If not, optimize the patient medically.

Low EF is bad. Low EF and wet is worse. Any patient with an existing pulmonary disease smoker, Smoking Smoke COPD, fibrotic lung, asthmatic should be evaluated.

You can give oxygen during surgery, so CO2 retention is worse than low oxygen. Child-Pugh Smoking Cessation should be started 8 weeks before surgery 1 2 3 because congestion initially worsens and bronchodilators Encephalopathy None A little A lot should be given to optimize FEV1 at the time of surgery. Its intent is for tracking the liver; surgeons use the Childs-Pugh to put into determination of who should get a liver transplant, though it can a category for a one-time assessment for surgery.

The goal of therapy is vigorous nutritional support: PO is better than IV and 10 days is better than 5 days. If someone is ever peritoneal rebound tenderness, involuntary guarding they go to surgery.

Late, Obstruction the distal intestines decompress while the proximal bowel Incomplete Surgery Surgery Emergently swells. If they have an incomplete obstruction do serial exams and attempt conservative measures fluids, potassium and NG tube decompression.

Hernias Hernias are just a wall defect that intestines can move through. Question is: When do Hernias go to OR? Direct hernias are groin hernias of adults that pass directly 1. Femoral hernias are groin hernias pass under the inguinal Question is: What type is it? Reducible is considered elective, incarcerated urgent. If the incarcerated hernia turns strangulated, with obvious peritoneal signs and an affected hernia, it becomes a surgical emergency Reducible Elective Elective requiring emergent Ex-Lap.

Go straight to treatment surgery. If unsure, get a CT scan while preparing the OR. For the test, if the diagnosis is Periumbilical Pain obvious go straight to surgery. Carcinoid produces serotonin. Intestinal serotonin is degraded by the liver. With mets to the and peritoneal signs liver, serotonin goes to the R heart causing fibrosis, flushing, Negative? The lungs degrade serotonin sparing Vague symptoms Physical the L heart, releasing 5-HIAA to be excreted into the urine; it is worrisome for Exam Inflammation used as a screening tool for the cancer.

It must be staged and resected. A particular variant, consider an embolic or even thrombotic occlusion of the acute narrow angle glaucoma, is caused by fluid being trapped retinal artery. If you see cherry-red spots on the fovea, the in the anterior chamber. After a patient has spent a prolonged diagnosis is made. If available and within a limited period in low light situations i. This though difficult. To buy them time, or to get the clot further produces eye pain headache and an intensely rigid eyeball.

The problem is that the hyperventilate rebreathed CO2 as in a paper bag to pupil dilated so pressure built up. While preparing an OR or getting the ophthalmologist, give smaller area of vision. Drill a hole with a laser to Cataracts are caused by Age and diabetes. This will present let out fluid. The person will products. It cellulitis and treat like a regular cellulitis with antibiotics.

To tell the difference Corneal Abrasions between wet and dry, simply to a retinal exam. Pain in the eye from toxic or traumatic exposure requires vigorous irrigation.

Surgery may need to be done to repair lacerations. Wet can be treated with laser Dry is treated with supportive care Retinal Detachment This can occur spontaneously Marfan, HTN or following major trauma. The patient will either complain of floaters indicating minor disease or of a veil or cloud on top of their visual picture indicating severe disease.

Vision is compromised from there on, but without treatment they will lose all vision. Often, these are found incidentally by getting images of the abdomen for something else. That is, they are asymptomatic in most cases. Screen by using an ultrasound in men who are over the age of 65 and have at least smoked at some point in their lifetime. Current smokers are at higher risk. EVAR endovascular repair is the same as open surgery. Dissecting Hematoma Classic Elements of Dissection A dissection is caused by very elevated blood pressures, often Tearing chest pain radiating to the back seen in a career hypertensive someone who has had high blood Asymmetric blood pressures arm to arm pressure for a long time.

There are three elements that define Widened Mediastinum Dissection. If there are 2, the diagnosis is essentially confirmed. The X-ray will show the widened no false mediastinum. The diagnostic test of choice is a CT angiogram that will demonstrate the false lumen. Other tests need to be considered, as the CTA is contraindicated in renal disease.

Ascending dissections also called Type A can involve the great vessels and cause aortic regurgitation. These are fatal. They must undergo emergency surgery.

An organic no anticoagulation needed echocardiogram shows the lesion. Surgical replacement is the sort of, definitely no bridge needed right answer. Balloon valvotomy is absolutely wrong. Just like regurg, replace it when desired or treat with LV dilation. Aortic Insufficiency Aortic regurgitation is caused by infection, infarction, or in the case of aortic dissection.

Other signs of chronic AI are widened pulse pressure, water-hammer pulses, pistol-shot pulses, and head bobbing. This will require emergent replacement.

Mitral Stenosis Caused almost exclusively by rheumatic heart disease. This murmur can lead to CHF and Afib dilation of the left atrium.

Options are a commissurotomy balloon dilation or simply replacement of the valve. However, in a euthyroid patient nodules can be cancer. FNA is the mainstem of management. If for cancer proceed to Thyroidectomy. Follicular cancer can be treated with radioactive iodine. Use the Sestamibi scan to find which one is enlarged. Take caution after resection for hypocalcemia perioral tingling, Chvostek Sign, Trousseau sign ; as the atrophied glands kick in they may not produce enough initially.

Cut it out. A CT scan locates the adenoma so it can be resected. Do a CT to find it, then try to resect it often, this fails. Now, they will have pain, can be anywhere from meningeal signs to coma, and may have a focal neurologic deficit. The diagnosis is made with a CT scan without contrast. It will show blood but outside the parenchyma and between the gyri separating it from other bleeds. The best radiographic test is to obtain a MR angiogram or CT angiogram.

The arteriogram with the wire is reserved for intervention. Clipping is a neurosurgical procedure. To prevent vasospasm acute infarct after SAH the patient needs to be on calcium channel blockers. This and seizures are the late complications. This occurs most often at the caudate and putamen. There are some herniation syndromes you could learn, but the yield is silly low. The CT head will show blood in the parenchyma.

Consider this the same as SAH — seizure prophylaxis, hydrocephalus, etc. Follow up with CT scans track how rapidly the hematoma is expanding. If they survive, rehabilitation is key. Patients may have complaints of headaches that are Glioblastoma worse in the morning.

Diagnose a lesion using an MRI. Definitive diagnosis is made by biopsy. Resection is rarely curative. Posterior Fossa Tumor Pituitary Tumors Tumors in children are usually in the posterior fossa and in the Craniopharyngioma Medulloblastoma anterior fossa in adults.

Resect and the patient will improve. I 7 Medulloblastoma also arises in the 4th ventricle. Resection chemo AND radiation are required. Mets usually make it through the medium caliber vessels and get stuck as a single or multiple lesions at the grey-white border.

Because the axillary nerve may be injured there may also be deltoid paresthesia. Relocate and sling. If there was a - Seizures and Lightning Strikes seizure or electrical injury, treat those as well. It looks like a dinner fork two prongs sticking up - Dorsally displaced radius Diagnose with an X-ray and cast it. The ulna breaks while the radius - Upward block and a downward blow dislocates.

An x-ray diagnoses it. In this wound the Galeazzi Fracture radius breaks gets hit first while the ulna dislocates. An x-ray - Downward block and a downward blow diagnoses it. Do casting or ORIF for the fracture. Initially, the x-ray will be normal. Do an x-ray and cast it. Ensure there is intact vascular and neural - Shortened Leg and Externally Rotated function distal to break. An intertrochanteric fx gets plates. MRI is used for the knee. The posterior draw sign indicates PCL tear.

A valgus stress is from the lateral side and is more common because the Collateral Ligament Tear lateral side is exposed , rupturing the medial collateral ligament. But, a healthy active athlete Meniscus Tear complaining of pain and a click on full extension is likely to have - Pain in the knee, click on full extension a torn meniscus.

Pushing a frail bone too Stress Fracture far can cause a fracture. This is seen in out-of-shape weekend - Weekend warrior or forced march warriors or in people on forced march. The patient will - Pinpoint tibia pain complain of pinpoint tibia pain. Like the scaphoid fracture, the - X-ray normal X-ray is normal for 2 weeks. Use a cast if severe and crutches - Cast anyway and watch the fracture unfold on repeat X-ray.

This requires direct trauma pedestrian - Adult pedestrian struck struck, adult. The deformity is usually obvious, confirmed by - X-ray x-ray, repaired by casting if closed, nailing if open with ORIF. They will all be swollen, tender, and - Running, Popping, Limping painful.

Compartment Syndrome Compartment Syndrome After reperfusion to a previously ischemic extremity clot, - Reperfusion or Crush crush , the leg will swell. Confined by the fascial planes, the - Vascular compromise extremity becomes tense with an excruciating pain on passive - Excruciating pain on passive flexion flexion. Measure pressures. Release the tension with fasciotomy. The extension of the thumb mother cradling baby, guy lifting heavy median nerve innervates the plantar surface sensation and motor weights in the overhead position, anything where you have to of the first three digits.

This is seen in people who do repetitive push. The major presenting complaint is thumb inside a closed fist and performing an ulnar deviation.

Pain gives way to paresthesias and weakness, ultimately Radial deviation, no pain. Ulnar deviation pain. With increased with thenar atrophy. This syndrome can be reproduced using the pain, the diagnosis is clear.

Surgical reattachment is median nerve. The diagnosis is clinical, so we start with possible but will not be the answer on the test. Should that fail, intraarticular steroids can be attempted. But we see it often in to the OR, obtain an electromyography to confirm the diagnosis.

The hand will be Carpal tunnel syndrome may be the presenting symptom of unable to extend because the fascia is contracted and balled up rheumatoid arthritis. The fascia actually pulls the hand closed. Treat by typically following a penetrating injury.

If that fails, use intraarticular injections. There will also be a fever. See this as mini-compartment test. Surgical reattachment is possible but will not be the answer on the test. Trigger Finger Inflammatory There is no sports injury but instead is a stenosing tenosynovitis. The patient is unable to extend finger caution confusing this for Mallet Finger.

For pediatrics every disease has its own case you are studying surgery only unique presentation. Developmental Dysplasia of the hip nontraumatic The hip is insufficiently deep so the femur head constantly Septic Any Joint pain Aspirate Drain and Abx pops out. Confirm the diagnosis with an ultrasound at Transient Any Joint pain after History Supportive weeks as there can be physiologic laxity initially around Synovitis viral illness time of birth which may resolve.

Once diagnosed put the child in a harness to keep the femur approximated to the join as the joint grows out. Legg-Calve-Perthe Disease When a child is around six years old they can suffer from avascular necrosis of the hip. Diagnose by x-ray and then cast.

Dx Patient Sxs Dx Tx iii. Slipped Capital Femoral Epiphysis Osgood- Teenage Knee pain with Clinical Support An orthopedic emergency, it can occur in adolescents who Schlatter athlete swelling are either obese or in a growth spurt. Get a frog-leg position usually girl Rods x-ray to confirm. Surgery is required. It shows up in any age though Onion-skin usually a toddler during a febrile illness with complaints Fractures If a plate involved do open reduction and internal fixation of joint pain.

Do an x-ray first then a joint aspiration with Gram stain and culture. It needs to be drained and antibiotics should be started. Transient Synovitis On the differential for septic hip.

Treat supportively. The athlete has two options: stop exercising curative or play through it. If they work through, it there may be a palpable nodule. Otherwise, it causes no permanent sequelae but it does hurt. Their thorax will tip to the side causing a cosmetic deformity. More severe disease can cause respiratory issues. Treat by bracing with the goal of slowing progression not curing. Surgery with rod placement is reserved for severe cases. Have two in mind: osteogenic sarcoma presents with a sunburst onion skin pattern typically at the distal femur.

Resection is treatment in both cases. If the fracture involves the growth plate an ORIF is needed to ensure the plate is realigned.

Otherwise the kid will grow up with one leg shorter than the other. That means murmurs. Each murmur has a characteristic sound, appearance, and association. They can represent any number of high flow states typical in kids. This Right Ventricular Hypertrophy causes increased vascular markings on chest X-ray. Atrial Septal Defect Because the atria are low pressure, the consequences are small so this can be found at any age.

Closure if needed is typically achieved via catheter-directed device closure. Ventricular Septal Defect This is the most common congenital heart disease. Depending on the type, some may close spontaneously and do not require intervention. Children that have evidence of right-sided hypertrophy, increased right-sided pressures, failure to thrive, or heart failure need immediate repair.

Patent Ductus Arteriosus A connection between the aorta and the pulmonary artery. The murmur may not be apparent on day one but may be noticed on the exit exam. In term infants, these usually are no big deal and most self-resolve within 7 days if they are going to. In preterm infants, these often need closed indomethacin or surgery as they can cause hemodynamic instability. Use prostaglandins if the PDA is needed for a critical heart lesion.

This results in cyanosis blue baby and decreased Blue Baby Syndrome vascular markings on chest X-ray. They present either with acute cyanosis or chronic effects such as clubbing. While there are others, these two are most commonly seen, discussed, and tested. During the Deoxygenated first 8 weeks of embryogenesis the heart forms and twists. Without a PDA this is fatal so give prostaglandins. It presents Pulm Artery on day 1 as a blue baby. If severe, we get a blue baby and it requires immediate intervention.

The tricky way of presenting is in a toddler with tet Spells cyanosis relieved by squatting. Squatting causes an increase in systemic vascular resistance, pushing more right ventricular blood into the lungs.

Look for a boot-shaped heart on chest X-ray. This is associated with Down and DiGeorge syndromes. Surgery is definitive therapy. The others are rare. Review Step 1 notes for clarity or to impress your attending. First, get blood pressures on arms and legs; there will be a large disparity.

Do an echocardiogram to definitely diagnose. Surgically correct. The A nal imperforate most common type is type C. This is where the proximal esophagus is C ardiac Echo blind and the distal esophagus has an aberrant connection running from T racheal the trachea to the stomach. These kids will vomit everything including E sophageal secretions from birth. Place a NG tube and obtain an x-ray. NG tube R enal ultrasound should coil up in the esophagus.