07.1. Fever and Hypotension in the Intensive Care Unit
10.What Is the Differential Diagnosis for a Postoperative Patient with Fever? (◘ Table 1.1)
11.What Is the Classic Timing for the Different Causes of Postoperative Fever (the Five Ws)? (◘ Table 1.2)
12.What Is the Most Likely Diagnosis in This Patient?
13.What Other Diagnoses Should Be Considered in a Postoperative Patient with Fever and Hypotension?
15.What Clues Are Expected on History and Physical for a Patient in Sepsis?
16.How Is Sepsis Defined and Evaluated?
17.What Physical Exam Findings Suggest That a Patient Is Unable to Protect Their Airway?
18.Compare and Contrast Aspiration Pneumonia and Pneumonitis
20.What Are the Different Types of Shock? (◘ Table 1.3)
21.What Is the Pathophysiology of Septic Shock?
22.What Is Acute Respiratory Distress Syndrome (ARDS)?
23.If the Patient Were to Become Pulseless, What Are the Hs and Ts to Consider? (◘ Table 1.4)
25.What Are the Initial Laboratory Studies to Order for a Patient in Septic Shock?
26.What Is the Significance of Increased Serum Creatinine and Oliguria?
27.What Is the Difference Between the Two Types of Renal Replacement Therapy: Hemodialysis (HD) and Continuous Renal Replacement Therapy (CRRT)?
28.What Are the Initial Imaging Studies to Order for a Postoperative Patient Believed to Be in Septic Shock?
30.What Are the Initial Management Goals for a Patient in Septic Shock?
31.What Is Rapid Sequence Intubation (RSI)?
32.What Drugs Are Ideal to Use for Sedation in a Critically Ill and Intubated Patient?
33.What Drugs Are Ideal to Use for Analgesia in a Critically Ill and Intubated Patient?
34.How Should the Patient’s Oliguria Be Managed?
35.What Is the Significance of a Low pH?
36.How Are Glucose Levels Managed in the Septic Patient?
37.If the Patient Develops ARDS, What Are the Principles of Management?
38.If the Patient Became Pulseless, How Should ACLS Be Executed?
39.What Is the Difference Between Synchronized and Desynchronized Shock?
41.Should Crystalloids or Colloids Be Used for Resuscitation in Septic Patients?
42.What Is the Role of Procalcitonin in Septic Patients?
48.2. Nausea, Vomiting, and Left Groin Mass
51.What Is the Differential Diagnosis for a Groin Mass (Use MINT Mnemonic)? (◘ Table 2.1)
52.What Is the Diagnosis for This Patient?
54.How Can Physical Exam Help Differentiate Between a Hernia and Other Causes of a Groin Mass?
55.What Are the Three Most Common Risk Factors for Developing a Hernia?
58.What Is the Difference Between a Reducible and an Incarcerated Hernia?
59.What Is the Difference Between an Incarcerated and a Strangulated Hernia?
60.What Is the Pathophysiology of an Indirect Inguinal Hernia?
61.What Is the Pathophysiology of a Direct Inguinal Hernia?
62.What Are the Borders of Hesselbach’s Triangle?
63.What Are the Other Types of Hernias?
64.Why Are Femoral Hernias More Prone to Incarceration?
65.What Is the Significance of a Suspected Hernia Being Below as Opposed to Above the Inguinal Ligament?
66.What Is a Richter’s Hernia?
67.What Is a Sliding Hernia?
69.How Do You Diagnose a Hernia in an Adult?
70.How Do You Diagnose a Hernia in an Infant?
71.How Do You Distinguish Between a Direct and an Indirect Inguinal Hernia Intraoperatively?
72.What Is the Role of Imaging Studies in the Diagnosis of Hernia?
74.What Is the Principle Component of the Operative Management of an Indirect Inguinal Hernia in an Adult? How About a Direct Inguinal Hernia?
75.What Are the Principles of the Management of an Incarcerated Hernia?
76.What Is the Recommended Management for a Recurrent Inguinal Hernia?
77.What Is the Recommended Management for an Umbilical Hernia in an Infant?
78.What Is a Cord Lipoma, and What Is the Recommended Management?
80.What Nerves Can Be Injured During Hernia Repair? What Is the Mechanism of Injury? What Are the Consequences? (◘ Table 2.3)
81.Areas Where You Can Get in Trouble
82.Attempting to Reduce a Strangulated Hernia
83.Open Hernia Repair in Women
84.Reduced Hernia with Persistent Post-reduction Pain and SBO
86.Do You Repair or Observe Asymptomatic Inguinal Hernias?
87.What Is the Recommended Management for an Inguinal Hernia in a Premature Infant?
88.Do You Repair Asymptomatic Ventral/Incisional Hernias? Is Mesh Needed for Repair?
89.Do You Repair Inguinal Hernias Laparoscopically or Open in Men?
90.What Is the Role of Robotic-Assisted Surgery in the Repair of Inguinal Hernias?
91.Inguinal Hernia (◘ Fig. 2.5)
94.Differential Diagnosis
95.Pathology/Pathophysiology
98.3. Abdominal Pain, Nausea, and Vomiting
101.What Is the Differential Diagnosis? (◘ Table 3.1)
102.What Is the Most Likely Diagnosis?
103.History and Physical Exam
104.What Is the Significance of SBO in a Patient Without a History of Abdominal Surgery?
105.What Is the Howship-Romberg Sign?
106.What Is the Significance of Severe Abdominal Pain and Localized Tenderness in Association with an SBO?
107.What Other Causes of Abdominal Pain Should Be Considered in a Young Woman?
109.What Is the Pathophysiology of SBO?
110.Are Bowel Sounds Helping in Diagnosing SBO?
111.What Are the Most Common Causes of an SBO? (◘ Table 3.2)
112.What Is a Closed-Loop Obstruction?
113.What Is the Risk of Developing SBO After Different Operations?
114.Does Laparoscopic Surgery Have a Lower Risk for SBO Compared to Open Surgery?
115.What Are the Mechanisms of Fluid Loss in SBO?
116.What Is the Mechanism of Metabolic Alkalosis and Aciduria in Patients with Ongoing Emesis?
118.What Laboratory Tests Should Be Obtained in the Initial Workup for SBO?
119.What Imaging Is Recommended for an SBO?
120.What Findings on CT Scan Suggest That the Bowel Is Compromised (Ischemic/Gangrenous)?
121.How Do You Differentiate Large and Small Bowel on Radiographs?
122.What Are the Different Radiologic Findings Associated with SBO? (◘ Table 3.3)
123.How Is a Complete SBO Different from a Partial SBO?
124.How Do You Distinguish SBO from Large Bowel Obstruction (LBO)?
125.How Do You Distinguish Between Postoperative Ileus and Early SBO After Abdominal Surgery?
127.What Are the Initial Steps in the Management of an SBO?
128.What Is the Next Step?
129.When Should You Operate on a Patient with SBO?
130.What Should You Do If You Suspect Nonviable Bowel During Laparotomy for SBO?
131.Areas Where You Can Get in Trouble
132.Nausea and Vomiting Months to Years After Gastric Bypass
133.Abdominal Complaints in Opioid Drug Users
135.Operating in Adults with Intussusception or SBO with No History of Abdominal Surgery
136.Clamp Trials with NG Tubes in SBO Patients
137.Closed-Loop Obstruction (◘ Fig. 3.2)
138.Summary of Essentials
139.History and Physical Exam
143.4. Right Leg Pain, Swelling, and Erythema for Two Days
146.What Is the Differential Diagnosis? (◘ Table 4.1)
147.What Is the Most Likely Diagnosis?
149.What Is the Implication of Crepitus?
150.What Are the Risk Factors for NSTI?
151.What Is the Implication of Bullae? Violaceous Skin?
152.What Are the “Hard Signs” of NSTI? What Percent of Patients with NSTI Have Such Hard Signs?
153.Why Is It Important to Distinguish Between Cellulitis and NSTI? How do Laboratory Values Help?
155.What Is the Spectrum of NSTI?
156.What Are the Typical Organisms Seen in NSTI?
157.What Is the Implication of Culturing Clostridium Septicum from the Wound?
158.What Is the Term for NSTI That Involves the Scrotum and/or Perineum?
160.What Are the Initial Steps in the Management of NSTI?
161.How Do You Determine How Much Tissue to Debride?
162.What If Extensive Muscle Necrosis Is Found?
163.What Are the Intraoperative Findings That Confirm NSTI?
164.What Do You Do If Your Suspicion for NSTI Is High But You Are Not Certain of the Diagnosis?
165.Is Imaging Beneficial in the Diagnosis of NSTI?
166.What Is the Anticipated Mortality Risk Associated with NSTI?
167.Area Where You Can Get in Trouble
168.Postsurgical Wound with Dishwater Purulent Fluid
169.Assuming First Debridement Is Adequate
171.What Is the Role of Hyperbaric Oxygen?
172.Summary of Essentials
173.History and Physical Examination
176.Question Set: Acute Care Surgery
180.5. Abnormal Screening Mammogram
183.What Is the Differential Diagnosis for an Abnormal Mammogram in the Absence of a Palpable Breast Mass? (◘ Table 5.1)
184.What Is the Most Likely Diagnosis?
186.Should Women Perform Self Breast Examinations?
187.What Are the Risks of Mammography?
188.Why Is Mammography Not Useful in Young Women (<30 Years Old)?
190.What Is the Gail Risk Model?
192.What Is One Characteristic of Mammographic Calcifications that Helps Differentiate Between Benign and Malignant Conditions?
193.What Are the Primary Features of Ductal Carcinoma In Situ (DCIS)?
194.What Are the Primary Features of Lobular Carcinoma In Situ (LCIS)?
195.How Does Breast Cancer Metastasize to the Spine?
197.How Are Mammograms Used in Staging Breast Lesions?
198.What Is the Next Step in Management for the Above Patient?
199.What Is a Stereotactic Core Needle Biopsy?
200.How Does One Interpret the Results of a Stereotactic Core Needle Biopsy?
201.What Is the Next Step If the Repeated Stereotactic Biopsy Is Still Discordant?
202.What Other Findings on Core Needle Biopsy Require Surgical Excisional Biopsy?
203.What Constitutes Positive Margins on a Malignant Specimen?
205.What Is the Next Step If the Stereotactic Needle Biopsy Demonstrates DCIS?
206.What Is the Next Step If the Stereotactic Biopsy Demonstrates LCIS?
207.What Is the Difference Between an Excisional Biopsy and a Lumpectomy?
208.What Are the Treatment Options for LCIS?
209.What If the Stereotactic Biopsy Demonstrates Invasive Ductal Carcinoma?
210.Can You Get Lymph Node Metastasis with DCIS?
211.What Should You Consider for a Patient with Mastitis that Does Not Resolve with Antibiotics?
213.Prophylactic Bilateral Mastectomy
214.Controversy in Breast Cancer Screening Guidelines
215.Summary of Essentials
219.Etiology/Pathophysiology
222.6. New Palpable Mass in the Right Breast
225.What Benign Conditions Are in the Differential Diagnosis of a Palpable Breast Mass? (◘ Table 6.1)
226.What Malignant Lesions Are in the Differential Diagnosis of a Palpable Breast Mass? (◘ Table 6.2)
227.What Is the Most Likely Diagnosis for This Patient?
229.What Features on Physical Examination Are Suggestive of Breast Cancer?
230.What Are the Risk Factors for Breast Cancer?
231.What Are the Different Types of Nipple Discharge and What Is the Differential Diagnosis for Each?
232.What Should You Suspect If a Patient Has a Diagnosis of Breast Infection That Does Not Respond to Antibiotics?
233.Pathology/Pathophysiology
234.What Histologic Features of Fibrocystic Changes Are Associated with Increased Risk for Cancer?
235.What Is the Pathophysiology of “Peau d’ Orange”?
236.What Is the Pathophysiology of Nipple Retraction?
238.How Does the Age of the Patient Affect the Workup of a New, Palpable Breast Mass?
239.What Imaging Is Recommended for Working up a New Breast Mass in Women over 30?
240.What Metastatic Workup Is Recommended Following a Diagnosis of Breast Cancer?
241.How Is Breast Cancer Staged Clinically?
242.Are Tumor Markers for Breast Cancer Utilized?
243.What Is a Triple-Negative Breast Cancer?
244.What Breast Cancer Subtype Do Patients with BRCA Develop?
245.What Are the Unique Features of Invasive Lobular Carcinoma?
246.How Is a Diagnosis of Inflammatory Breast Carcinoma Confirmed?
247.How Should Fat Necrosis Be Worked Up?
249.What Surgical Options Are Available for Patients with Early Breast Cancers Without Metastatic Spread?
250.What Is the Premise Behind SLNB?
251.Why Does SLNB Need to Be Performed at the Same Time as a Mastectomy and Not Later?
252.Can There Be More Than One Sentinel Node?
253.What Do You Do If During SLNB No Sentinel Lymph Node Is Identified?
254.What Are Contraindications to BCT?
255.Can the Nipple and Breast Skin Be Spared During a Simple Mastectomy?
256.What Are the Management Options for Clinically Advanced Breast Cancers?
257.When Do You Perform ALND?
258.What Are the Boundaries in the Axilla for Breast Dissection?
259.To What Structure Are Axillary Lymph Node Levels Referenced?
260.What Is the Purpose of Axillary Lymph Node Dissection? Does It Affect Survival?
261.What Is the Treatment for Inflammatory Breast Carcinoma?
262.What Are the Options for Hormonal Therapy, and What Is the Premise Behind It?
263.What Study Must Be Done Prior to Starting Trastuzumab?
264.Why Is an Aromatase Inhibitor (AI) Only Effective in Postmenopausal Women?
265.Does Everyone with Breast Cancer Require Chemotherapy?
266.What Are the Most Common Chemotherapy Regimens?
267.What Are the Options for Breast Reconstruction? What Is the Timing?
269.What Nerves Are at Risk for Damage During ALND? (◘ Table 6.6)
270.What Is the Most Morbid Complication of Lymph Node Dissection?
271.What Does Long-Standing Lymphedema Increase Risk For?
272.Areas You Can Get in Trouble
273.Ignoring a Breast Mass During Pregnancy
274.Ignoring a Breast Mass in an Elderly Male
276.How Aggressive Should Therapy Be for Early-Stage Breast Cancer?
277.Summary of Essentials
279.Etiology/Pathophysiology
284.7. Recently Changed Skin Lesion
287.What Is the Differential Diagnosis? (◘ Table 7.1)
288.What Is the Most Likely Diagnosis?
290.What Risk Factors for Skin Cancer Are Common to SCC, BCC, and Melanoma?
291.What Factors During Childhood/Teen Years Are Associated with an Increased Risk of Skin Cancer?
292.What Genetic Conditions Are Associated with an Increased Risk of Skin Cancer?
293.What Are Findings on Physical Examination That Differentiate a Benign Nevus from Melanoma?
294.What Is the Ugly Duckling Sign?
295.Why Is It Important to Inquire About and Examine Areas of Chronic Skin Inflammation?
296.On What Areas of the Skin Are Melanomas Most Likely to Occur in Non-White Patients?
297.What Is the Most Common Site of Melanoma in Men Versus Women?
298.What Is the Most Common Site of Digital Melanoma?
299.Does the Regular Use of SPF Protection Reduce the Risk of Skin Cancer?
300.What Is Suggested by a Bright, Red, Raised Plaque in an Infant?
302.What Is a Nevus? What Are Dysplastic Nevi? Are Nevi at Risk for Malignant Transformation?
303.What Is Dysplastic Nevus Syndrome?
304.From Where Does Melanoma Arise?
305.What Is the Most Common Skin Cancer? Second Most Common? Which Skin Cancer Is Associated with the Greatest Number of Deaths?
306.What Is the Most Common Precancerous Skin Lesion?
307.What Is Bowen’s Disease?
308.What Is the Metastatic Risk of BCC, SCC, and Melanoma?
309.What Are the Four Subtypes of Melanoma? (◘ Table 7.3)
310.What Is the Breslow Depth?
312.What Are the Different Types of Skin Biopsy?
313.Once the Diagnosis of Melanoma Is Established, What Additional Studies Should Be Obtained?
314.What Are Poor Prognostic Indicators with Melanoma?
316.What Treatment Options Exist for Skin Cancers? (◘ Table 7.5)
317.What Is the Primary Therapy for BCC/SCC Skin Cancers?
318.What Type of Surgical Margins Do You Need for BCC Versus SCC?
319.How Is Melanoma Surgically Managed?
320.What Is the Purpose of the SLNB, and How Is It Performed?
321.How Is Melanoma of the Fingernail Managed?
322.What Is the Prognosis for Melanoma?
323.What Is the Follow-Up Protocol for Melanoma?
324.What Is Mohs Surgery? What Are the Main Indications for Its Use? Is It Appropriate for the Treatment of Melanoma?
325.Areas Where You Can Get in Trouble
326.Assuming That a Discolored Nail Bed Is a Benign Condition
327.Pink Nodule Progressing to a Blue Color in an Immunocompromised Patient
329.Melanoma Recurring Many Years After Initial Presentation
331.Is There Any Benefit for Surgical Resection for Stage IV (Distant Metastasis) Melanoma?
332.Role for Completion Lymph Node Dissection (CLND)
333.Summary of Essentials
335.Differential Diagnosis
336.Pathology/Pathophysiology
340.Question Set: Breast and Skin
344.8. Chest Pain, Diaphoresis, and Nausea
347.What Is the Differential Diagnosis? (◘ Table 8.1)
348.What Is the Most Likely Diagnosis?
350.What Are the Risk Factors for MI?
351.What Elements of the History and Physical Exam Make MI Less Likely in a Patient Presenting with Chest Pain?
352.What Is Suggested by Episodic Chest Pain Unrelated to Exertion in a Young Person?
353.What Are the Classic History and Physical Exam Findings Seen in MI?
354.What Group of Women Is at Highest Risk for MI? Why?
355.What Are the Differentiating Features of Various Cardiac Murmurs? (◘ Table 8.2)
356.Changes Seen in Systolic Murmurs with Various Maneuvers (◘ Table 8.3)
357.What Are the Three Classic Symptoms of Aortic Stenosis?
358.What Is the Dreaded Consequence of Aortic Stenosis?
360.What Is Meant by ACS?
361.What Are the Series of Events That Take Place During an Acute MI?
362.What Coronary Vessel Is Most Often Affected?
363.Are There Different Mechanisms of MI?
365.What Are the Initial Diagnostic Steps for Suspected MI?
366.What Is the Role of Measurement of Cardiac Enzyme Levels in the Blood?
367.What Is the Best Cardiac Enzyme to Diagnose a Second MI on Top of a Recent MI?
368.What Is the Role of ECG?
369.What Is the Role of Imaging?
371.What Is the Initial Management of STEMI?
372.What If PCI Is Unsuccessful?
373.Should Oxygen Always Be Administered for a Patient with ACS?
374.What Is the Initial Management of NSTEMI?
375.What Is the Most Important Determinant of Long-Term Outcome After STEMI? Is There a Role of Emergency CABG After a STEMI?
376.What Are the Indications for CABG in the Elective Setting?
377.What Does the Traditional CABG Entail?
378.What Is the Best Conduit for CABG?
379.Should More Than One Coronary Artery Be Bypassed During CABG?
380.How Does CABG Compare to Coronary Artery Stenting in Patients with Multivessel Coronary Artery Disease?
381.What Are the Predictors of Mortality Following CABG?
383.What Are the Complications of MI? (◘ Table 8.7)
384.How Does Cardiac Tamponade Lead to Obstructive Shock?
385.What Is Suggested by Fever, Chills, and Leukocytes in a Patient with Pericardial Effusion?
386.How Does Papillary Muscle Rupture Lead to Acute Mitral Regurgitation?
387.Areas You Can Get in Trouble
388.Valvular Heart Disease
389.Summary of Essentials
394.9. Chest and Back Pain
397.What Is the Differential Diagnosis? (◘ Table 9.1)
398.What Is the Most Likely Diagnosis?
400.What Are the Risk Factors for Aortic Dissection?
401.What Is the Significance of Unequal Pulses in the Upper and Lower Extremities in Patients with Aortic Dissection?
402.What Is the Significance of an Increased Pulse Pressure?
403.What Is the Significance of New Diastolic Murmur?
404.What Is the Significance of a History of Intravenous Drug Use Disorder?
406.What Is the Initial Event Leading to an Aortic Dissection?
407.Why Are Patients with Marfan’s Syndrome at Increased Risk for Aortic Dissection?
408.Why Are Patients with Vascular Ehlers-Danlos Syndrome (EDS) at Increased Risk for Aortic Dissection?
409.Are Dissections and Aneurysms the Same Disease?
410.How Are Aortic Dissections Classified?
411.How Do Aortic Dissections Cause Complications?
412.What Life-Threatening Complications Are Specific to Dissections That Involve the Ascending Aorta/Aortic Arch (Stanford Type A)?
413.What Major Complications Are Specific to Dissections That Involve the Descending and Infrarenal Aorta (Stanford Type B)?
415.What Tests Should Be Ordered Immediately?
416.What Is the First Imaging Modality Recommended in a Patient Who Presents with Acute Chest Pain?
417.What Imaging Is Recommended If the Patient Is Hemodynamically Unstable and an Aortic Dissection Is Highly Suspected?
419.What Is the First Step in the Management of an Aortic Dissection?
420.What Is the Next Step (After Starting Antihypertensives) Once the Diagnosis of Type A Dissection Is Established?
421.What Is the Next Step (After Starting Antihypertensives) Once a Diagnosis of Type B Dissection Is Established?
422.When Should Patients with Type B Dissection Undergo Surgical Repair?
423.What Are the Surgical Options for a Type B Dissection?
424.What Are the Differences in Prognosis and Definitive Management Between Type A and Type B Aortic Dissections?
425.What Are Some of the Post-Operative Complications After Sternotomy?
426.Areas Where You Can Get in Trouble
427.Giving Beta-Blockers to a Patient with Aortic Dissection Complicated by Cardiac Tamponade or Severe Aortic Regurgitation
428.Confusing Type-A Aortic Dissection with Acute MI
430.Endovascular Repair of a Stable Asymptomatic Type B Aortic Dissection
431.Aortic Dissection (◘ Fig. 9.5)
432.Summary of Essentials
433.History and Physical Exam
438.10. Hemoptysis, Cough, and Weight Loss
441.What Is the Differential Diagnosis? (◘ Table 10.1)
442.What Is the Most Likely Diagnosis?
444.What Are the Risk Factors for Lung Cancer?
445.What Is the Importance of Occupational Exposure?
446.What Is the Significance of a Pleural Effusion?
447.What Is the Significance of an Enlarged Cardiac Silhouette?
449.Does This Patient Have a Solitary Pulmonary Nodule (SPN)?
450.How Is Lung Cancer Classified? Why Is It Important?
451.What Is the Epidemiology of Lung Cancer?
452.What Syndromes Are Often Associated with Lung Cancers? (◘ Table 10.5)
453.What Are Common Sites of Metastasis for Primary Lung Cancer?
454.Is Universal Screening for Lung Cancer Appropriate?
455.Is Screening of Benefit to Any Group?
457.What Are the Initial Diagnostic Steps for Suspected Lung Cancer?
458.Should a Biopsy Be Performed?
460.How Are SPNs Managed?
461.How Does the Lung Cancer Type Influence Management?
462.What Is the Importance of Preoperative Evaluation?
463.Areas You Can Get in Trouble
464.What If the Patient Has a History of Lung Transplant?
465.What Are Potential Infectious Complications in Patients with Suspected or Confirmed Lung Cancer?
466.Summary of Essentials
467.History and Physical Exam
472.Question Set: Cardiothoracic
476.11. Incidentally Discovered Adrenal Mass on CT Scan
479.What Is the Differential Diagnosis?
480.What Is the Most Likely Diagnosis?
482.What Are the Findings on History and Physical Examination in a Patient That Hypersecretes Cortisol?
483.What Is the Difference Between Cushing’s Syndrome and Cushing’s Disease?
484.What Is the Clinical Presentation of an Adrenal Nodule That Hypersecretes Aldosterone?
485.What Is the Clinical Presentation of a Pheochromocytoma?
486.What Signs and Symptoms Should Raise Suspicion for an Adrenocortical Carcinoma?
488.What Is the Most Common Adrenal Mass?
489.What Are the Zones of the Adrenal Gland and What Hormones Do They Produce?
490.What Are the Physiologic Effects of Normal and Excessive Cortisol Secretion?
491.What Is the Cause of Hypertension and Hypokalemia in Hyperaldosteronism?
493.What Is the Next Step in Workup When an Adrenal Adenoma Is Suspected or Seen on Imaging?
494.What Is the Purpose of the Low-Dose Dexamethasone Suppression Test?
495.How Do ACTH Levels and the High-Dose Dexamethasone Test Help Identify the Source of Hypercortisolism?
496.What Laboratory Testing Can Identify Hyperaldosteronism?
497.What Is Adrenal Vein Sampling? What Is Its Role in Evaluating Hyperaldosteronism?
498.What Laboratory Testing Can Identify a Pheochromocytoma?
499.What Is the Best Imaging Modality to Evaluate an Adrenal Nodule? What Is Another Option?
500.What Imaging Characteristics Help to Differentiate a Benign from Malignant Lesion?
502.What Is the Treatment for a Nonfunctional Adrenal Mass? How Does the Size Impact Management?
503.What Is the Surveillance Protocol for an Adrenal Nodule That Will Not Be Resected?
504.What Is the Treatment for a Functional Adrenal Mass?
505.What Are Important Perioperative Management Principles?
506.What Are the Key Surgical Principles During an Adrenalectomy?
508.What Is the Prognosis of an Adrenal Adenoma?
509.Key Areas Where You Can Get in Trouble
510.What Is the Role of Percutaneous Needle Biopsy in the Workup of an Adrenal Mass?
511.Medical or Surgical Therapy for Hyperaldosteronism?
512.Summary of Essentials
514.Etiology/Pathophysiology
518.12. Fatigue, Constipation, and Depressed Mood
521.What Is the Differential Diagnosis of Hypercalcemia?
522.What Is This Patient’s Diagnosis?
523.What Condition Can Mimic Primary HPT?
525.What Is the Typical Presentation for Patients with Hypercalcemia?
526.What Are the Renal Manifestations of Hypercalcemia?
527.What Are the Gastrointestinal Manifestations of Hypercalcemia?
528.What Are the Neurological Manifestations of Hypercalcemia?
529.What Is Chvostek’s Sign?
530.What Is Trousseau’s Sign?
531.What Is a Hypercalcemic Crisis?
532.What Are the Risk Factors for Primary HPT?
533.Why Is Family History Important?
534.What Are the Physical Exam Findings of HPT? What Is the Significance of an Anterior Neck Mass Palpated in a Patient with HPT?
537.Describe the Location of the Parathyroid Glands. What Is Their Embryological Development?
538.Pathology/Pathophysiology
539.What Pathology Causes Primary HPT?
540.What Is the Typical Pathology in Primary HPT Associated with the MEN Disorders?
541.What Is the Pathophysiology of Secondary HPT?
542.What Causes Tertiary HPT?
543.What Are the End Organs Affected by PTH?
544.What Is the Basic Physiology of Calcium Metabolism?
545.What Is the Most Common Cause of PTH Deficiency? How Does It Manifest?
547.What Laboratory Tests Are Used for the Diagnosis of Primary HPT?
548.What Is the Difference Between Total Serum Calcium Level and Ionized Calcium Level?
549.If the Serum Calcium Is High, But the PTH Level Is Normal, Does That Rule Out Primary HPT?
550.How Can the Serum Chloride to Phosphate Ratio Suggest Primary HPT?
551.What Other Tests Should Be Ordered in a New Diagnosis of HPT?
552.What Radiologic Findings Are Suggestive of Bony Involvement in HPT?
553.What Tests Help Localize the Involved Gland in HPT?
554.What If All Localizing Scans Fail to Localize the Abnormal Parathyroid Gland(s)?
556.What Are the Indications for Parathyroidectomy in Primary HPT?
557.What Are the Indications for Parathyroidectomy in Secondary HPT?
558.What Is the Nonoperative Management of Patients with HPT?
559.What Is the Role of Intraoperative PTH Monitoring?
560.What Are the Surgical Options for HPT?
561.Why Is It Not Advised to Remove All Four Parathyroid Glands?
562.What Is the Postoperative Management Following Parathyroidectomy?
563.What Is the Treatment for a Neck Hematoma with Stridor?
564.What Are the Benefits of Parathyroidectomy?
565.What Syndrome Causing Postoperative Hypocalcemia Can Occur Following Parathyroidectomy?
566.Areas Where You Can Get in Trouble
567.Assuming Normal Calcium Rules Out HPT
568.Hypocalcemia That Does Not Respond to Calcium Replacement
570.How Do You Treat Hypercalcemic Crisis?
571.Algorithm for the Work-Up and Management of HPT (◘ Figs. 12.3 and 12.4)
572.Summary of Essentials
577.13. Intermittent Episodes of Sweating, Palpitations, and Hypertension
580.What Is the Differential Diagnosis of Secondary Hypertension? (◘ Table 13.1)
581.What Is the Most Likely Diagnosis?
583.What Is the Classic Triad of Symptoms in Pheochromocytoma?
584.What Are the Other Symptoms of Pheochromocytoma?
585.Why Do Some Patients Have Orthostatic Hypotension?
586.Can Patients with Pheochromocytoma Be Asymptomatic?
587.What Is the Average Age of Diagnosis? Is There a Gender Predisposition?
588.What Is the “Rule of Tens,” and Is It Still True?
590.What Is a Pheochromocytoma?
591.What Are the Effects of Normal and Excessive Catecholamine Secretion? (◘ Table 13.3)
592.What Are the Predominant Catecholamines in Adrenal and Extra-Adrenal Tumors?
593.Where Do Pheochromocytomas Develop?
594.What Can Trigger a Hypertensive Crisis in Pheochromocytoma?
595.Why Do Patients with Pheochromocytoma Have Elevated Hematocrit Levels?
596.Why Do Patients with Pheochromocytoma Have Hyperglycemia?
597.What Defines a Malignant Pheochromocytoma?
599.What Laboratory Tests Can Help Establish the Diagnosis of Pheochromocytoma?
600.What Medications Can Interfere with Urine or Plasma Testing?
601.What Imaging Studies Are Helpful in Making the Diagnosis?
602.What Should Be Done If Imaging Demonstrates Bilateral Adrenal Gland Masses?
604.What Is the Treatment for Pheochromocytoma?
605.What Are the Important Surgical Principles?
606.How Do You Prepare a Patient for Surgery?
607.What Can Happen If a Beta-Blocker Is Given Prior to Adequate Alpha-Blockade?
608.When Is Genetic Testing Indicated?
609.What Are the Main Complications Specifically Associated with Adrenalectomy for Pheochromocytoma? (◘ Table 13.4)
610.How Often Should Plasma and Urinary Catecholamines Be Measured Postoperatively?
612.What Is the Overall Prognosis for Pheochromocytoma?
613.What Is the Treatment for Malignant Pheochromocytoma?
614.Key Areas Where You Can Get in Trouble
615.Do Not Biopsy a Pheochromocytoma
616.Pheochromocytoma Along with MEN 2A
617.Hypertensive Crisis During Surgery Due to Undiagnosed Pheochromocytoma
618.Summary of Essentials
620.Etiology/Pathophysiology
624.14. Neck Mass That Moves with Swallowing
627.What Is the Differential Diagnosis for a Thyroid Mass? (◘ Table 14.1)
628.What Is This Patient’s Diagnosis?
630.What Are the Common Symptoms of a Patient with a Thyroid Nodule?
631.How Common Are Thyroid Nodules, and How Often Are They Cancerous?
632.Describe the Different Types of Thyroid Cancer? (◘ Table 14.2)
633.What Are the Risk Factors for Thyroid Cancer?
634.What Are the Symptoms of Hyperthyroidism?
635.What Are the Symptoms of Hypothyroidism?
636.How Should the Thyroid Be Examined?
637.What Is the Significance of the Mass Moving Up and Down with Swallowing?
638.What Is the Appearance of a Patient with Severe or Long-Standing Hyperthyroidism?
639.What Is the Appearance of a Patient with Severe or Long-Standing Hypothyroidism?
641.What Is the Function of the Thyroid Gland?
642.What Is Thyroglobulin?
643.What Are the Actions of Thyroid Hormones?
644.What Is the Embryologic Origin of the Thyroid?
645.Why Is Fine-Needle Aspiration (FNA) Unable to Diagnose Follicular Thyroid Carcinoma?
646.What Is Considered a Well-Differentiated Thyroid Cancer?
647.What Are Psammoma Bodies?
649.What Laboratory Tests Are Recommended for a Thyroid Mass?
650.What Are the Appropriate Imaging Studies for a Thyroid Nodule?
651.Is Routine Use of Nuclear Imaging Useful for an Isolated Thyroid Nodule?
652.What Nodules Should Undergo FNA?
653.What Is the Bethesda Reporting System for FNAs of Thyroid Nodules? (◘ Table 14.3)
655.What Is the Next Step in a Patient with an Inadequate/Nondiagnostic FNA?
656.What Is the Next Step for a Benign FNA Result?
657.What Is the Next Step for an FNA Which Reports AUS or FLUS?
658.What Is the Next Step for an FNA Result of Suspected Follicular Neoplasm?
659.What Is the Next Step If the Thyroid Lobectomy Reveals Follicular Cancer?
660.What Are the Advantages of Total Thyroidectomy in Thyroid Cancer Versus Lobectomy?
661.What Thyroid Malignancy Is Amenable to Thyroid Lobectomy Alone? When Is Total Thyroidectomy Appropriate?
662.Is It Ever Appropriate to Proceed Directly to Total Thyroidectomy without Performing a Lobectomy First?
663.What Is the Management of Anaplastic Thyroid Cancer?
664.When Should Central Lymph Node Dissection Be Done? Lateral Neck Dissection?
665.What Is the Role of Intraoperative Frozen Section Pathology?
666.Which Thyroid Cancers Concentrate Radioactive Iodine?
667.What Are the Important Elements of Postoperative Management of Thyroid Cancer?
668.Radioactive Iodine Ablation
669.Suppressive Thyroxine Therapy
671.If You Suspect Recurrence, What Study Do You Perform?
672.Does External Beam Radiation Play a Role in Thyroid Cancer?
673.What Nonoperative Management Is Available for Thyroid Nodules?
675.What Are the Major Structures That Can Be Injured During Thyroidectomy?
676.What Should Always Be Assessed Preoperatively in Patients Undergoing Thyroid Surgery that Have Had Previous Neck Surgery?
677.What Is the Next Step If a Postoperative Patient Develops Stridor in the Recovery Room and the Neck Wound Appears to Be Tense?
678.Key Areas Where You Can Get in Trouble
679.Incomplete Family History in Patient with Thyroid Mass
680.Obtaining CT with Iodinated IV Contrast in Patients with Thyroid Cancer
681.Missing Postoperative Hypocalcemia
683.Role of Prophylactic Central Neck Dissection (CND) for Papillary Thyroid Cancer
684.Summary of Essentials
690.Question Set: Endocrine
694.15. Progressively Hoarse Voice
697.What Is the Differential Diagnosis for Hoarseness? (◘ Table 15.1)
698.What Is the Most Likely Diagnosis in This Patient?
699.History and Physical Examination
700.What Information Can the Nature of Hoarseness Provide?
701.At What Point Should Hoarseness Warrant Consultation with an Otolaryngologist?
702.What Are the Risk Factors for Laryngeal Carcinoma?
703.What Is the Significance of Bloody Sputum?
704.What Is the Most Common Type of Laryngeal Cancer?
706.What Is the Innervation of the Larynx? (◘ Table 15.2)
707.What Are the Potential Consequences of Unrecognized Squamous Cell Carcinoma of the Upper Aerodigestive Tract?
708.Do Laryngeal Papillomas Cause Cancer?
710.What Examination Should Be Performed to Evaluate the Vocal Cords?
711.If Laryngeal Cancer Is Suspected, What Additional Tests Are Warranted?
713.What Treatments Are Available?
714.What Variables Affect Prognosis for Laryngeal Cancer?
715.Areas Where You Can Get in Trouble
717.Summary of Essentials
718.History and Physical Examination
719.Etiology/Pathophysiology
723.16. Lump on the Neck Increasing in Size
726.What Is the Differential Diagnosis? (Apply the “KITTENS” Mnemonic) (◘ Table 16.1)
727.What Is the Most Likely Diagnosis for This Patient?
728.What Risk Factors Are Associated with Head and Neck Cancer in General?
729.What Risk Factors Are Associated with Specific Head and Neck Cancers? (◘ Table 16.2)
730.How Have the Demographics of Head and Neck Cancer Changed in the Last 10 Years?
731.What Premalignant Lesions Should Be Looked for on Physical Examination?
732.What Are Torus Palatinus and Mandibular Tori?
733.What Symptoms Can Be Associated with Head and Neck Cancer, and What Are the Likely Sources? (◘ Table 16.3)
734.What Are the Key Aspects of the Head and Neck Exam in the Evaluation of a Solitary Neck Mass?
735.What Is the Typical Presentation of Sialadenitis and What Is Its Most Common Cause?
737.What Are Nonneoplastic Causes of Salivary Gland Enlargement?
738.What Is the Differential Diagnosis for Salivary Glands Tumors? What Is Their Malignant Potential?
739.What Is Virchow’s Node? Why Is It Concerning?
740.What Are the Most Common Sites of Head and Neck Cancer?
741.What Is Meant by the Term “Primary Tumor”? What Is Meant by “Unknown Primary”?
742.What “Primary Tumors” Arise in the Neck?
743.What Does a Newly Discovered Malignant Neck Mass Most Likely Represent?
744.What Types of Abscess Are in the Differential of a Neck Mass? (◘ Table 16.5)
745.Etiology/Pathophysiology
746.What Is the Pathophysiology of Head and Neck Cancer?
748.Is Observation an Acceptable Strategy for a Newly Discovered, Isolated, and Enlarged Cervical Lymph Node?
749.In Addition to the Physical Exam Mentioned in the Vignette, What Procedure Is Performed in the Office by the Head and Neck Surgeon When a Metastatic Neck Lymph Node Is Suspected?
750.What Laboratory Tests Should Be Obtained?
751.What Initial Imaging Modality Is the Diagnostic Test of Choice to Search for the Primary Tumor?
752.What Is the Best Way to Obtain a Tissue Sample to Determine If the Neck Mass Is a Metastatic Lymph Node?
753.Once FNA Confirms that the Neck Mass Is a Metastasis, What Is the Next Step in Determining the Location of the Primary Tumor?
754.What Is the Role of an Open Neck Biopsy in the Evaluation of Solitary Neck Mass?
755.What Laboratory Studies Can Be Utilized to Assess for Infectious and Inflammatory Causes of Neck Masses?
757.Areas Where You Can Get into Trouble
758.Missing a Cancer Diagnosis
759.Not Recognizing Potentially Life-Threatening Signs in Advanced Stages of Cancer
762.The Role of Open Biopsy
763.Summary of Essentials
765.Etiology/Pathophysiology
768.17. Aural Fullness, Hearing Loss, and Tinnitus
771.What Is the Differential Diagnosis for Hearing Loss in a Child? (◘ Table 17.1)
772.What Other Diagnoses Need to Be Considered in an Adult with Hearing Loss? (◘ Table 17.2)
773.What Is the Most Likely Diagnosis?
775.What Is the Peak Age for OME?
776.What Are the Risk Factors for OME?
777.What Is the Implication of Regression in Language?
778.What Is the Implication of the Presence or Absence of Otalgia?
779.How Does One Distinguish Between Otitis Externa and Otitis Media on History and Physical Exam?
780.What Is the Main Symptom Seen with OME?
781.Etiology/Pathophysiology
782.What Is the Most Likely Etiology for Sudden Deafness?
783.What Are the Two Main Causes of OME?
784.What Other Diagnoses Need to Be Considered in an Adult with OME?
785.Which Pathogens Are Most Commonly Found in OME?
786.What Is the Most Significant Complication That May Result from OME?
787.How Can Trauma Lead to Hearing Loss?
788.What Are Potential Consequences of Blunt Trauma to the External Ear?
789.Is There a Genetic Predisposition for Hearing Loss?
791.What Two Tests Will Help Differentiate a Conductive Hearing Loss from a Sensorineural Hearing Loss? How Are They Performed?
793.In Children, What Is the Management for the Majority of Cases of OME?
794.What Is Autoinflation? Is There a Role for It in OME?
795.Are Antihistamines and/or Decongestants Recommended for OME in Children? How About Steroids or Antibiotics?
796.Should Antibiotics Be Used Routinely for Patients with OME?
797.What Are the Indications for Tympanostomy Tube Insertion?
798.How Does the Management of OME Differ in Adults?
799.What Are the Long-Term Complications from Untreated Otitis Media?
800.Summary of Essentials
807.Question Set: Head and Neck
810.VI: Hepatopancreaticobiliary
811.18. Postprandial Right Upper Quadrant Pain
814.What Is the Differential Diagnosis? (◘ Table 18.1)
815.What Is the Most Likely Diagnosis?
817.Why Is the Term Biliary Colic a Misnomer? What Is a Better Term?
818.Why Is It Important to Distinguish Between Symptomatic Cholelithiasis and Acute Cholecystitis?
820.What Is the Significance of the Patient’s Inspiration Stopping with RUQ Palpation?
821.What Is the Significance of Abdominal Pain After Eating Fatty Foods?
822.What Is the Significance of RUQ Pain Combined with Scapular Pain?
823.What Is the Difference Between Visceral and Somatic Pain?
824.How Does One Clinically Distinguish Between Symptomatic Cholelithiasis and Acute Cholecystitis? (◘ Table 18.2)
825.What Is the Clinical Significance of the Patient’s Low-Grade Fever, Tachycardia, and Leukocytosis?
826.What Is Chronic Cholecystitis?
827.What Exactly Causes Acute Cholecystitis?
828.What Is Hydrops of the Gallbladder?
829.What Are the Typical Pathogens in Bile?
830.What Are the Components of Bile?
831.What Are the Two Main Types of Gallstones?
832.What Are the Main Risk Factors for Developing Cholesterol Gallstones?
833.How Do Cholesterol Gallstones Form?
834.How Do Pigmented Gallstones Form?
835.What Are the Different Manifestations of Gallstone Disease? (◘ Table 18.3)
837.What Is the Next Step in the Work-Up? What Are the Specific Findings That Would Confirm the Diagnosis?
838.What Is a Sonographic Murphy’s Sign?
839.What Is the Normal CBD Diameter, and What Is the Implication of a Dilated CBD?
840.How Accurate Is Ultrasonography in Detecting Gallstones Within the Gallbladder? Within the CBD?
841.What If the Ultrasound Demonstrates Gas Bubbles in the Gallbladder Wall?
842.Why Should Liver Tests, Amylase, and Lipase Always Be Sent in the Presence of RUQ and Epigastric Pain? What Is the Significance of Abnormalities?
843.Is Amylase or Lipase Better to Rule Out Pancreatitis?
844.What If Acute Cholecystitis Is Suspected but the Ultrasound Does Not Demonstrate Gallstones?
845.Can You Develop Acute Cholecystitis Without Gallstones?
847.What Is the Next Step in the Management of a Patient with an Ultrasound Demonstrating Gallstones, Pericholecystic Fluid, Gallbladder Wall Thickening of 5 mm, and a Positive Sonographic Murphy’s Sign?
848.What Is the Ideal Choice of Antibiotics?
849.What If Gallstones Are Discovered Incidentally? Do They Require a Cholecystectomy?
850.How Should Symptomatic Cholelithiasis Be Managed?
852.What Is a Major Complication of Laparoscopic Cholecystectomy That Is More Common in the Setting of Acute Cholecystitis?
853.What Is the Differential Diagnosis and Work-Up for Abdominal Pain That Develops Soon After Cholecystectomy?
854.What Is a Biloma? How Is It Diagnosed? Treated?
855.What Is the Differential Diagnosis If the Patient Develops RUQ Pain Several Weeks or Months After Cholecystectomy?
856.What Is Sphincter of Oddi Dysfunction (SOD)?
858.When Should Acute Cholecystitis Be Managed Nonoperatively?
859.What Is the Role of Robot-Assisted Laparoscopic Cholecystectomy?
860.Gallstones (◘ Figs. 18.8 and 18.9)
861.Summary of Essentials
864.Pathology/Pathophysiology
868.Additional Important Facts
869.19. Right Upper Quadrant Pain, Fever, Nausea, and Vomiting
872.What Is the Differential Diagnosis? (◘ Table 19.1)
873.What Is the Diagnosis for This Patient?
874.What Are the Diagnostic Criteria for Cholangitis?
876.What Are the Causes of Obstructive Jaundice that Lead to Cholangitis?
877.Why Does the Patient Have Dark Urine but Not Pale Stools?
878.At What Level of Bilirubin Will Jaundice First Be Visible?
879.What Is Charcot’s Triad?
880.What Is Reynolds’ Pentad? What Percent of Patients with Cholangitis Have All Components?
882.Why Are Gallstones the Most Common Cause of Obstructive Jaundice with Cholangitis?
883.What Are Potential Consequences of Unrecognized Acute Cholangitis?
884.Is Clinical Jaundice Always a Sign of Biliary Disease?
885.How Does Entamoeba Histolytica Infection Lead to RUQ Pain?
886.Are there Any Congenital Conditions that Can Lead to Obstructive Jaundice and/or Cholangitis?
888.How Can LFTs Help Distinguish Between Hepatic and Posthepatic Causes of Jaundice?
889.What Imaging Is the Diagnostic Test of Choice? Does the Test Provide Direct or Indirect Evidence for the Diagnosis?
891.What Are the Most Important Immediate Management Steps Once a Patient Develops Fever and Leukocytosis?
892.What Is the Antibiotic Treatment for Acute Cholangitis?
893.Once the Patient Is Resuscitated, Antibiotics Started, and the Diagnosis Is Established, What Intervention Is Recommended? What Is the Goal of that Intervention?
894.Following Successful ERCP, What Is the Next Step in Management?
895.Areas Where You Can Get in Trouble
896.A History of Bloody Diarrhea in a Patient Who Presents with Cholangitis
897.A Middle-Aged Woman with Pruritus, Fatigue, and Normal RUQ US
898.Biliary Decompression in a Patient with a Gastric Bypass
900.Timing of ERCP with Severe Cholangitis: Emergently (in the Middle of the Night) or Urgently (the Next Morning)?
901.Endoscopic Retrograde Cholangiopancreatography (◘ Fig. 19.2)
902.Summary of Essentials
904.Etiology/Pathophysiology
908.20. Severe Epigastric Pain with Nausea and Vomiting
911.What Is the Differential Diagnosis for Epigastric Abdominal Pain? (◘ Table 20.1)
912.What Is the Diagnosis for this Patient?
913.How Do You Diagnose Acute Pancreatitis?
915.What Nonsurgical Conditions Can Mimic an Acute Abdomen?
916.What Is the Significance of Bruising Around the Umbilicus, Flank, and Inguinal Ligament?
917.What Are the Signs, Symptoms, and Findings of Acute Pancreatitis?
918.What Structures Are in the Retroperitoneum?
920.What Is the Pathophysiology of Pancreatitis?
921.What Are the Etiologies for Pancreatitis?
922.What Medications Can Cause Pancreatitis? (◘ Table 20.2)
923.How Do Gallstones Cause Acute Pancreatitis?
924.In Patients with Gallstone Pancreatitis, How Often Does the Gallstone Remain Impacted in the Distal Common Duct?
925.What Are the Differences Between Acute and Chronic Pancreatitis? (◘ Table 20.3)
926.How Is the Severity of Pancreatitis Classified?
927.How Is Organ Failure Defined?
928.What Is the Mechanism of Hypotension in Pancreatitis?
929.What Are the Main Pulmonary Complications of Acute Pancreatitis?
930.What Are the Different Histopathologic Types of Acute Pancreatitis? What Are the Important Differences?
932.How Is the Severity of Pancreatitis Determined?
933.Why Does One Get Hypocalcemia with Severe Pancreatitis?
934.What Is the Natural Disease Course of Acute Pancreatitis?
935.What Is the Most Common Cause of Mortality in the First Week of Severe Acute Pancreatitis? Beyond the First Week?
937.What Are the Most Important Laboratory Tests to Order When Suspecting Acute Pancreatitis?
938.Which Laboratory Test Is Most Specific for Acute Pancreatitis?
939.What Is the Diagnostic Imaging of Choice on Admission for Acute Pancreatitis?
940.What Are the Classic Abdominal X-Ray Findings in Acute Pancreatitis?
941.What Is the Classic Chest X-Ray Finding in Acute Pancreatitis? How Does This Finding Influence Prognosis?
942.What Is the Role of Abdominal CT Scan on Admission?
943.What Is the Role of Abdominal CT Scan during Subsequent Hospitalization?
944.What Is the Role of Urgent ERCP in Gallstone Pancreatitis?
946.What Is the Initial Treatment for Acute Pancreatitis?
947.What Is the Subsequent Management Plan? And How Does This Differ Between Gallstone and Alcoholic Pancreatitis?
948.How Does the Severity of Acute Pancreatitis Affect Management?
949.What Is the Management Algorithm for Acute Pancreatitis? It Is Shown in ◘ Fig. 20.5
951.What Should You Suspect If a Patient with Severe Acute Pancreatitis Develops a Fever and Leukocytosis 4 Weeks into the Hospitalization?
952.What Should You Suspect If a Patient with a Recent Hospitalization for Pancreatitis Comes in 6 Weeks Later with Vague Abdominal Pain, a Palpable Epigastric Mass, and Persistently Elevated Serum Amylase?
953.What Are the Complications of Chronic Pancreatitis?
954.Acute Pancreatitis After a Vascular Procedure
955.What Is the Most Common Indication for Surgical Management in Chronic Pancreatitis?
956.What Are Less Common Vascular Complications of Pancreatitis?
958.Is Urgent ERCP Beneficial for Severe Pancreatitis?
959.Should Prophylactic Antibiotics Be Administered for Severe Acute Pancreatitis?
960.Areas Where You Can Get in Trouble
961.Missing Hypercalcemia as the Cause of Pancreatitis
962.Pseudohyponatremia in Pancreatitis
964.Whipple (Pancreaticoduodenectomy)
965.Summary of Essentials
972.21. New Onset of Painless Jaundice
975.What Is the Differential Diagnosis of Jaundice? (◘ Table 21.1)
976.What Is the Most Likely Diagnosis?
978.What Is Courvoisier’s Sign?
979.What Is the Implication of Painful Versus Painless Jaundice?
980.What Is Migratory Thrombophlebitis?
981.What Are the Risk Factors for Pancreatic Cancer? Cholangiocarcinoma? Gallbladder Carcinoma?
982.What Is a Sister Mary Joseph Nodule? And What Is the Implication?
984.What Causes Jaundice?
985.Why Is some Jaundice Painless and some Painful?
986.What Is the Metabolism of Bilirubin?
987.What Is the Mechanism behind “Clay-Colored” Stools?
989.In a Patient with Obstructive Jaundice, What Would the Typical Laboratory Findings be?
990.How Do you Distinguish Between Jaundice from Biliary Obstruction (Posthepatic) and Hepatocellular Damage?
991.What Initial Imaging Is Recommended?
992.What Is the Next Recommended Imaging Choice for Painless Jaundice?
993.What Three Categories Are Used with Respect to the Resectability of Pancreatic Cancer?
994.Is a Biopsy of a Suspected Pancreatic Cancer Necessary in all Cases?
995.What Is the Role of Magnetic Resonance Cholangiopancreatography (MRCP) and/or Endoscopic Retrograde Cholangiopancreatography (ERCP)?
996.What Is the Role of Tumor Markers CA 19-9 and Carcinoembryonic Antigen (CEA)?
998.What Is the Role of Preoperative Stenting in the Presence of a Pancreatic Mass with Obstructive Jaundice?
999.What Is the Role of Neoadjuvant Therapy for Pancreatic Adenocarcinoma?
1000.What Is the Surgical Management of Pancreatic Head (or Periampullary) Cancer?
1001.Why Must the Duodenum Be Removed When Surgically Resecting a Pancreatic Head Tumor?
1002.In Addition to Pancreatic Cancer, for What Other Conditions Is a Whipple Performed?
1003.What Are the Options for Palliation in Patients Who Are Not Candidates for Pancreatic Resection? (◘ Table 21.2)
1004.What Is the Most Common Complication that Is Specific to a Whipple/Pancreatectomy? What Are Some Other Pancreas Surgery Specific Complications?
1005.Is There a High Risk of Diabetes After a Whipple Procedure?
1006.How Do You Suspect/Diagnose a Postoperative Pancreatic or Biliary Leak?
1007.Areas Where You Can Get in Trouble
1008.Increased INR (PT) with Pancreatic Cancer
1009.Incidental Liver Findings on CT Scan
1010.Summary of Essentials
1011.History and Physical
1012.Etiology/Pathophysiology
1016.Question Set: Hepatopancreaticobiliary
1019.VII: Lower Gastrointestinal
1020.22. Bright Red Blood per Rectum
1023.What Is the Differential Diagnosis of a Lower GI Bleed (LGIB)? (◘ Table 22.1)
1024.What Is the Most Likely Diagnosis?
1025.Why Is Age an Important Factor in a Patient with a LGIB?
1026.Why Are the Onset and Duration of Bleeding Important?
1027.What Do the Color and Amount of Blood Tell Us About the Source of Bleeding? (◘ Table 22.2)
1028.What Is an Occult Bleed?
1029.What Associated Symptoms Are Important to Look for, and How Do They Help in the Differential Diagnosis?
1030.Why Is a History of Pelvic Radiation or Prior Aortic Surgery Important?
1031.Why Should One Inquire About Alcohol History and Look for Stigmata of Liver Cirrhosis?
1032.What Is the Implication of Abdominal Tenderness on Physical Examination?
1033.Can Upper and LGIB Be Distinguished Based on History and Physical Examination?
1034.What Is the Significance of Finding Iron-Deficiency Anemia in Association with a LGIB?
1035.How Does Ischemic Colitis Classically Present?
1036.What Are the Risk Factors for Diverticulosis?
1037.Etiology/Pathophysiology
1038.What Is a Diverticulum?
1039.What Causes a Diverticulum?
1040.What Is the Difference Between Diverticulum, Diverticulosis, and Diverticulitis? (◘ Table 22.3)
1041.What Is the Most Common Site of Diverticula? Why?
1042.How Common Is a Diverticular Bleed?
1043.What Is the Natural History of a Diverticular Bleed?
1044.What Is Angiodysplasia? What Are the Risk Factors?
1045.What Causes Ischemic Colitis?
1046.What Are the Primary Watershed Areas of the GI Tract?
1047.What Is the Natural History of Ischemic Colitis?
1048.What Are the Differences Between Ischemic Colitis and Acute Mesenteric Ischemia? (◘ Table 22.4)
1050.What Are the Initial Steps in the Management of a LGIB?
1051.What Is the Next Step?
1052.How Does the Hemodynamic Stability of the Patient Affect the Subsequent Management and Diagnostic Workup?
1053.What Is the First Diagnostic Test of Choice? How Effective Is This Test in Visualizing the Source of LGIB in the Acute Setting?
1054.What If This Diagnostic Test Is Not Able to Visualize the Bleeding? What Are Other Options for Localizing the Source of Bleed? What Are the Advantages/Disadvantages of Each Modality?
1055.What Is the Next Step If These Modalities Fail to Identify the Exact Source of Bleeding?
1056.What If Arteriography Localizes the Source of Bleeding but Is Unable to Stop the Bleeding with Embolization?
1057.What Is the Pathophysiology and Management of Hemorrhoids?
1059.Areas Where You Can Get in Trouble
1060.Bleeding After Colonoscopic Biopsy or Polypectomy
1061.Pneumoperitoneum After Colonoscopy
1062.Failure to Perform Anoscopy/Proctoscopy
1063.Large Intestine Pathologies (◘ Fig. 22.1)
1064.Summary of Essentials
1065.History and Physical
1068.23. Right Lower Quadrant Abdominal Pain
1071.What Is the Differential Diagnosis for Right Lower Quadrant Pain in an Adult? (◘ Table 23.1)
1072.What Other Conditions Should You Consider in the Differential Diagnosis for Right Lower Quadrant Pain in Women? (◘ Table 23.2)
1073.What Other Conditions Should You Consider in the Differential Diagnosis for Right Lower Quadrant Pain in a Child? (◘ Table 23.3)
1074.What Is the Most Likely Diagnosis?
1075.History and Physical
1076.What Is Usually the First Symptom of Appendicitis, and What Is the Classic Sequence of Symptoms?
1077.What Is the Hamburger Sign?
1078.What Are Rovsing’s, Psoas, and Obturator Signs and McBurney’s Point Tenderness?
1080.What Explains the Transition from Periumbilical Pain to Right Lower Quadrant Pain in Appendicitis?
1081.What Is a Closed-Loop Obstruction?
1082.How Does a Closed-Loop Obstruction Pertain to Acute Appendicitis?
1083.What Are Some Other Examples of a Closed-Loop Obstruction?
1084.What Are Other Causes of Appendiceal Obstruction?
1086.What Are the Critical Laboratory Values Utilized in the Workup of Acute Appendicitis?
1087.What Is the Significance of WBCs in the Urine Without Bacteria? How Might This Mislead the Clinician?
1088.What Imaging Is Used in Diagnosing Appendicitis?
1089.If Symptoms and Signs of Appendicitis Are Classic, Is Imaging Necessary?
1091.What Is the Surgical Treatment for Appendicitis?
1092.Is Appendicitis a True Surgical Emergency?
1093.What Is the Role of Pre- and Postoperative Antibiotics for Acute Non-perforated Appendicitis?
1094.How Is Perforated or Gangrenous Appendicitis Generally Treated?
1095.What if the CT Shows an Abscess or a Phlegmon?
1096.How Should You Proceed if You Are Performing a Laparoscopic Appendectomy and You Discover That the Appendix Appears to Be Normal? Do You Remove the Appendix Anyway? Are There Circumstances Where an Appendectomy Is Contraindicated?
1097.Are There Long-Term Consequences to Removing the Appendix?
1098.Areas Where You Can Get in Trouble
1100.Missing Ovarian Torsion: A Surgical Emergency
1101.Misdiagnosing Acute Appendicitis During Pregnancy
1102.Under Age 5: Harder to Get History and Examine and More Prone to Early Rupture
1103.Elderly: More Prone to Rupture
1104.Immunosuppressed Patient
1105.Areas of Controversy
1106.Should Acute Non-perforated Appendicitis be Managed Nonoperatively?
1107.After Nonoperative Management of an Appendiceal Abscess or Phlegmon, Is Interval Appendectomy Necessary?
1108.Acute Appendicitis (◘ Fig. 23.5)
1109.Summary of Essentials
1118.24. Pencil-Thin Stools and Intermittent Constipation
1121.What Is the Differential Diagnosis for a Change in Bowel Habits? (◘ Table 24.1)
1122.What Is the Most Likely Diagnosis?
1124.What Screening Is Recommended for Colorectal Cancer?
1125.What Are the Recommended Colorectal Cancer Screening Guidelines for Individuals Who Have a First-Degree Relative Diagnosed with Colorectal Cancer or Those with Inflammatory Bowel Disease (IBD)?
1126.What Are the Differences Between the Various Screening Modalities?
1127.History and Physical
1128.What Is the Significance of the Patient’s Unintended Weight Loss?
1129.What Are the Risk Factors for Colon Cancer?
1130.Where Does Colon Cancer Rank in Terms of the Most Common Cancers in the United States? In Terms of the Highest Overall Mortality? (◘ Table 24.3)
1131.Are Right- or Left-Sided Colon Cancers More Common, and How Do the Presentations Differ?
1132.Why Is the Rectal Examination Important in Suspected Colorectal Cancer?
1134.What Is a Polyp, and How Are They Generally Classified?
1135.What Is the Difference between Different Colonic Polyps? (◘ Table 24.4)
1136.What Is Juvenile Polyposis Syndrome?
1137.How Is Juvenile Polyposis Syndrome Distinguished from Other Syndromes with Hamartomatous Polyps?
1138.How Do You Distinguish the Adenomatous Polyposis Syndromes?
1139.What Is the Relationship of Colon Cancer with Lynch Syndrome?
1140.What Are the Modified Amsterdam Criteria for Lynch Syndrome?
1141.What Is the Relationship of Colon Cancer with FAP?
1142.What Are the Two Variants of FAP?
1143.How Do Colon Cancers Develop?
1144.What Features of an Adenoma Are Associated with an Increased Malignant Risk?
1145.Why Screen Every 10 Years When Using Colonoscopy?
1146.Why Is Colonoscopy Superior to Flexible Sigmoidoscopy for Screening?
1147.Where Are the Most Common Metastatic Sites for Colorectal Cancer?
1148.What Is the Difference Between Synchronous and Metachronous Tumors?
1150.For the Patient Described Above, What Would Be the Next Steps in the Workup?
1151.Is There Any Role for Testing His Stool for Blood?
1152.Once a Diagnosis of Colon Cancer Is Established, What Laboratory Tests Are Recommended?
1153.Is CEA Useful for Screening? How Is it Used?
1154.What Other Conditions Can Elevate the CEA Level?
1155.What Is Additional Imaging, if Any, Is Recommended Once a Diagnosis of Colon Cancer Is Established?
1156.How Is the Workup of Colon and Rectal Cancers Different?
1157.How Do You Stage Colon Cancer?
1159.How Are Polyps That Are Found During Colonoscopy Managed?
1160.What Is a “Bowel Prep,” and Why Is it Done?
1161.What Are the Recommended Operations in Colon Cancer?
1162.What Operations Are Typically Offered to Patients with Rectal Cancer?
1163.How Many Lymph Nodes Should Be Resected?
1164.Why Is Neoadjuvant Therapy Used for Rectal Cancer and Not Colon Cancer?
1165.Why Is Radiation Therapy Used for Rectal Cancer and Not Colon Cancer?
1166.What Are the Major Complications Specific to Colon Surgery?
1167.How Is Surveillance Performed After Resection of Colon Cancer?
1168.Areas of Controversy
1169.Treatment of Stage-IV (Metastatic) Colon Cancer
1170.Is it Useful to Follow CEA Levels After Surgery?
1171.Summary of Essentials
1172.History and Physical
1179.25. Chronic Constipation Presenting with Severe Abdominal Pain
1182.What Is the Differential Diagnosis? (◘ Table 25.1)
1183.What Is the Most Likely Diagnosis?
1184.History and Physical
1185.What Is the Difference Between Obstipation and Constipation?
1186.What Are the Classic Physical Exam Findings in Bowel Obstruction?
1187.What Findings from History and Physical Examination Can Help Distinguish Between Small and Large Bowel Obstruction?
1188.Why Is a History of Neurologic or Psychiatric Disorders Important?
1189.What Is the Classic Presentation for Ogilvie’s Syndrome?
1190.Etiology/Pathophysiology
1191.What Are the Most Common Causes of LBO?
1192.Where in the Colon Is a Cancer Most Likely to Cause an LBO?
1193.What Is the Difference Between Malrotation and Volvulus?
1194.How Does the Etiology Differ Between Sigmoid and Cecal Volvulus?
1195.What Are the Risk Factors for Sigmoid Volvulus?
1196.What Is Meant By the Term Complicated Volvulus?
1198.What Are the First Steps in the Workup of a Suspected Large Bowel Obstruction?
1199.What Is the First Imaging Recommended for a Suspected Large Bowel Obstruction?
1200.How Is Cecal Volvulus Differentiated from Sigmoid Volvulus on X-Ray?
1201.What Additional Imaging Is Recommended?
1203.What Are the Initial Steps in the Management of a Large Bowel Obstruction?
1204.What Is the Subsequent Treatment for a Sigmoid Volvulus?
1205.Following Successful Detorsion of Uncomplicated Sigmoid Volvulus, What Is the Next Step in the Management?
1206.How Is Complicated Sigmoid Volvulus Managed?
1207.What Is the Treatment for a Cecal Volvulus?
1208.Area Where You Can Get in Trouble
1210.Summary of Essentials
1211.History and Physical
1212.Etiology/Risk Factors
1215.26. Left Lower Quadrant Pain and Fever
1218.What Is the Differential Diagnosis? (◘ Table 26.1)
1219.What Is the Most Likely Diagnosis?
1220.History and Physical
1221.What Are the Risk Factors for Diverticulosis?
1223.Where in the Colon Do Diverticula Occur Most Frequently? Which Diverticula Are More Prone to Infection? Bleeding?
1224.Do Diverticula Occur in the Rectum? Why or Why Not?
1225.What Are True and False Diverticula? Which Type Are Sigmoid Diverticula?
1226.What Are the Main Complications of Diverticulitis? How Would They Present? (◘ Table 26.2)
1227.What Are the Main Etiologies for a Colovesical Fistula? Colovaginal Fistula?
1228.How Does a Colovesical Fistula Present?
1229.What Is Meant by Complicated Versus Uncomplicated Diverticulitis? What Is the Implication?
1230.What Is the Hinchey Staging System?
1232.What Imaging Is Recommended?
1233.What Two Diagnostic Studies Are Contraindicated in the Acute Setting of Suspected Diverticulitis, and Why?
1235.What Is the First Step in the Management of Suspected Acute Diverticulitis?
1236.What Is the Subsequent Management for Uncomplicated Diverticulitis?
1237.What Operation Is Performed in the Elective Setting for Sigmoid Diverticulitis? How Is This Operation Different Than Surgery in the Urgent or Emergent Setting?
1238.Complicated Diverticulitis
1239.What Is the Management of Complicated Diverticulitis?
1240.What Are the Indications for Urgent Surgery? What Operation Is Recommended in the Urgent Setting?
1241.How Does One Determine the Proximal and Distal Extent of Colon Resection? What if There Are Diverticula Throughout the Colon?
1242.What Is the Recommended Treatment for Diverticulitis Complicated by a Localized Abscess?
1243.What Is the Recommended Treatment for Diverticulitis with a Colovesical Fistula?
1244.Is Free Air on CT an Absolute Indication for Emergency Surgery?
1245.Following an Episode of Acute Diverticulitis, What Study Is Recommended 6–8 Weeks Later?
1246.Areas Where You Can Get in Trouble
1247.Elderly Patient with Chronic Constipation and NSAID Use, with Sudden Abdominal Pain
1248.Areas of Controversy
1249.How Many Episodes of Uncomplicated Diverticulitis Are Acceptable Before Elective Surgery Is Recommended?
1250.Is There a Role for Aspirin in the Prevention or Management of Diverticulitis?
1251.One Stage Colon Resection and Immediate Reanastomosis for Perforated Diverticulitis
1252.Should Patients with Prior Episodes of Diverticulitis Avoid Eating Nuts, Popcorn, or Corn?
1253.Complications of Diverticulitis (◘ Fig. 26.3)
1254.Summary of Essentials
1255.History and Physical
1259.27. Fatigue and Bloody Diarrhea
1262.What Is the Differential Diagnosis of Chronic Diarrhea with Mucus and/or Blood? (◘ Table 27.1)
1263.What Are the Key Differences Between Ulcerative Colitis and Crohn’s? (◘ Table 27.2)
1264.What Is the Diagnosis for This Patient?
1265.History and Physical
1266.What Is the Age Distribution of IBD?
1267.What Are the Risk Factors for IBD?
1268.Is Smoking a Risk Factor for Both Crohn’s and UC?
1269.How Do Patients with IBD Typically Present Clinically?
1270.What Are the Extraintestinal Manifestations of IBD?
1271.What Is the Significance of Short Stature and Delayed Onset of Puberty?
1274.What Is the Final Common Pathway for the Pathogenesis of IBD?
1275.Are Patients with IBD at Increased Risk for Cancer?
1276.What Is the Screening Recommendation for Colon Cancer in IBD?
1277.What Portion of the GI Tract Is Most Commonly Affected in Crohn’s?
1278.What Complications Affect IBD Patients?
1279.How Does Crohn’s Lead to Gallstones or Kidney Stones?
1280.What Types of Anemia Are Seen with IBD?
1281.What Nutritional Deficiencies May IBD Patients Have?
1282.What Conditions Will Prevent Fistulas from Resolving Spontaneously?
1284.What Laboratory Studies Are Recommended? What Serology Is Recommended?
1285.What Is the Primary Modality for Diagnosing IBD?
1286.What Are the Classic Findings on a CT Scan?
1288.What Are the Medical Therapies Available?
1289.Will Most IBD Patients Eventually Require Surgery?
1290.What Are the Surgical Indications for Crohn’s? Ulcerative Colitis?
1291.Why Is it Recommended to Avoid Small Bowel Resection with Crohn’s Disease if Possible?
1292.In a UC Patient, What Would Be the Concern if They Presented with Sepsis, Diffuse Abdominal Pain, and a Markedly Distended Colon?
1293.Areas Where You Can Get in Trouble
1294.Bloating and Watery Diarrhea After Terminal Ileum Resection in Crohn’s
1295.Cecal or Terminal Ileum Inflammation in Association with Suspected Appendicitis
1296.Inflammatory Bowel Disease (◘ Fig. 27.1)
1297.Summary of Essentials
1298.History and Physical
1302.Question Set: Lower Gastrointestinal
1306.28. Neck Pain and Extremity Weakness Following Trauma
1309.What Spinal Cord Syndromes Are Associated with Cervical Spine Injury? (◘ Table 28.1)
1310.Clinically, What Is the Difference Between a Complete and Incomplete Spinal Cord Injury?
1311.What Is the Most Likely Diagnosis?
1312.History and Physical
1313.What Are the Most Common Cervical Spinal Levels Involved After Trauma?
1314.What Dermatome Level Supplies the Shoulders? What Must You Remember About the Dermatome Map When Testing Sensation on the Chest?
1315.Why Is it Important to Check Deep Tendon Reflexes?
1316.How Are Deep Tendon Reflexes Graded?
1317.What Are the Devastating Clinical Examination Findings in Patients with Complete Spinal Cord Injury in the High Cervical Cord (at or Above C3)?
1318.What Is the Term for Sensory or Motor Dysfunction Caused by Pathology of a Nerve Root? What Are the Clinical Signs and Symptoms Associated with This Disorder?
1319.What Is the Term for Sensory or Motor Dysfunction Caused by Pathology of the Spinal Cord? What Are the Clinical Signs and Symptoms Associated with This Disorder?
1320.What Does the Presence of Lower Motor Neuron Signs in the Upper Extremities and Upper Motor Neuron Signs in the Lower Extremities Suggest?
1322.What Is the Difference Between Spinal Shock and Neurogenic Shock?
1323.What Is Sacral Sparing? What Is Its Significance in the Setting of Spinal Shock?
1324.What Are the Common Mechanisms for Neck Injuries?
1325.What Is Atlanto-Occipital Dislocation?
1326.What Is the Pathophysiology of the Three Most Common Incomplete Spinal Cord Injuries? (◘ Table 28.5)
1327.Why Are the Distal Lower Extremities Typically Spared in Central Cord Syndrome?
1328.Which Incomplete Cord Syndrome Carries the Best Prognosis for Recovery of Neurological Function, Bowel and Bladder Function, and Ambulatory Capacity?
1329.Which Incomplete Cord Syndrome Carries the Worst Prognosis for Functional Recovery?
1330.What Spinal Cord Injury Can Occur After Surgery on the Thoracic Aorta?
1332.How Do You Diagnose Spinal Cord Injuries and Cervical Vertebral Fractures?
1333.What Are the NEXUS Criteria?
1334.What Type of Imaging Should Be Obtained?
1335.What Is the Indication for Ordering an MRI Scan of the Cervical Spine?
1336.Can a Spinal Epidural Abscess Occur After Trauma?
1337.What Is SCIWORA and SCIWOCTET?
1339.What Are the General Treatment Principles for Patients with Cervical Spine Injury?
1340.How Is Neurogenic Shock Treated?
1341.What Are the Goals of Management for Patients with Complete Spinal Cord Injuries or High Cervical Cord Injuries?
1342.Why Is There a Lower Threshold for Surgical Intervention in Patients with Incomplete Spinal Cord Injury Versus Patients with Complete Spinal Cord Injury?
1343.What Are the General Indications for Emergent Surgery with Spinal Cord Injury?
1344.Areas Where You Can Get in Trouble
1345.Complications with the Exposure of the Anterior Cervical Spine
1346.Impaired Upper Extremity Strength After Whiplash
1348.Steroid Therapy for Acute Spinal Cord Injury
1349.Timing of Decompressive Surgery with Acute Spinal Cord Injury
1350.MRI for Obtunded Patients
1351.Spinal Cord Injury (◘ Fig. 28.2)
1352.Summary of Essentials
1353.History and Physical
1357.29. Loss of Consciousness Following Head Trauma
1360.What Is the Differential Diagnosis for a Severe (GCS ≤8) Traumatic Brain Injury? (◘ Table 29.1)
1361.What Is the Most Likely Diagnosis?
1362.History and Physical
1363.What Is the Definition of a TBI?
1364.How Do You Calculate the GCS?
1365.What Non-head Trauma Factors Affect GCS?
1366.What Are Raccoon Eyes? What Is Battle’s Sign?
1367.How Does the Physical Exam Help to Localize the Site of Intracranial Bleeding?
1368.What Is the Implication of Abnormal Arm Flexion/Leg Extension with Pain Stimulation? Arm/Leg Extension?
1369.How Does the Presentation of Chronic SDH Differ from Acute SDH?
1370.What Is the Implication of Clear Fluid Leaking from the Ear?
1371.How Would a Cerebellar Hemorrhage Present?
1373.What Is a Concussion?
1374.What Is Uncal Herniation?
1375.What Is Subfalcine Herniation?
1376.What Is the Pathophysiology of an Epidural Hematoma?
1377.What Is the Implication of a “Lucid” Interval Seen in Patients with an EDH?
1378.What Is the Pathophysiology of an Acute Subdural Hematoma?
1379.What Is Cerebral Perfusion Pressure (CPP)?
1380.What Is the Most Powerful Intracranial Vasodilator?
1381.What Is the Pathophysiology of Cushing’s Triad?
1382.What Is a Coup vs. Contrecoup Injury?
1383.What Is Paroxysmal Sympathetic Hyperactivity?
1385.What Initial Management Is Recommended for the Above Patient?
1386.What Are the Indications for Head CT with TBI?
1387.Describe the Findings on CT Head for Various Intracranial TBIs (◘ Table 29.3)
1388.What Medical Treatment Options Are There for Intracranial Hypertension?
1389.What Is the Role of Hyperventilation in TBI?
1390.How Does Mannitol Work?
1391.Is There a Role for Corticosteroids in the Treatment of TBI? What Is the Difference Between Vasogenic and Cytotoxic Edema?
1392.What Are the Criteria for Brain Death? What Conditions Must Be Ruled Out?
1393.Area You Can Get in Trouble
1394.Guidelines for Head CT in Children
1395.Patient with No Obvious Trauma Presenting with “Worst Headache of My Life”
1396.Persistent Headaches and Papilledema in a Chronic SDH Patient
1397.Summary of Essentials
1398.History and Physical
1401.Question Set: Neurosurgery
1405.30. Multiple Extremity Injuries After Motor Vehicle Collision
1408.What Is the Most Likely Diagnosis?
1409.History and Physical
1410.What Should Be Assessed During Extremity Evaluation of a Trauma Patient?
1411.What Is an Open Fracture?
1412.What Is the Likely Etiology of the Neurologic Deficit in His Right Arm?
1413.What Is the Significance of Hearing a Bruit on Auscultation of the Right Clavicle?
1414.How Does Fat Embolism Syndrome Present?
1415.What Is a Dangerous Sequela for a Tibia Fracture (or Forearm Fracture)?
1416.What Concomitant Fracture Is Important to Consider in All Femur Fractures?
1417.How Do Distal Forearm Fractures Typically Present in Children, and What Is Their Management?
1419.What Are Seddon’s Three Basic Categories of Nerve Injury? (◘ Table 30.1)
1420.How Fast Does an Injured Axon Regenerate?
1421.Does Wallerian Degeneration Occur with Neurapraxia?
1422.What Are the Three Layers of the Nerve Sheath?
1423.What Are the Classic Nerve Injuries Associated with Fractures? (◘ Table 30.2)
1424.What Is the Presumed Pathophysiology of Fat Embolism Syndrome?
1425.What Artery Is Most at Risk with a Supracondylar Humerus Fracture?
1427.What Is the Extent of Imaging Recommended with All Long Bone Fractures?
1428.What Is a Floating Knee?
1430.How Are Open Fractures Graded?
1431.What Is the Most Important Determinant of Severity for Fractures?
1432.What Antibiotics Are Indicated for Open Fractures in Farm Accidents or Soil-Contaminated Wounds?
1433.What Else Should Be Considered for Wounds Contaminated with Dirt and Soil?
1434.What Are the Principles of Surgical Management of an Open Fracture? What Is the Optimal Timing?
1435.How Are Skin Wounds Closed?
1436.Why Is It Important to Have Early Stabilization of Open Fractures?
1437.Which Should Be Repaired First in a Patient with Concurrent Bone Fracture and Associated Vascular Injury with a Hard Sign (e.g., No Distal Pulse)?
1438.What Is the Difference Between Open and Closed Reduction?
1439.What Is the Difference Between Internal and External Fixation? What Are the Advantages/Disadvantages?
1440.What Are the Main Management Concerns for a Femur Fracture?
1441.What Single Type of Orthopedic Fracture Is at the Greatest Risk for Hemorrhagic Shock?
1442.What Is the Optimal Timing of Femur Fracture Repair? What Is the Main Risk if Repair Is Delayed? What Are the Main Options in Repair?
1443.Do All Femur Fractures Require Fixation? Do All Radius Fractures Require Fixation?
1444.What Should Be Considered in a Child Who Is Not Yet Walking and Presents with a Femur Fracture?
1445.What Is the Management for Fat Embolism Syndrome?
1446.What Is the Most Important Factor to Prevent Fat Embolism Syndrome Before It Occurs in a Polytrauma Patient?
1447.What Is the Management for a Clavicle Fracture?
1448.What Are the Complications Associated with Colles Fracture?
1449.Why Is CT Angiography Recommended After Posterior Knee Dislocation?
1451.What Are the Important Risks Associated with Fracture Treatment?
1453.Limb Salvage or Amputation
1454.Areas Where You Can Get in Trouble
1455.Missing Other Fractures
1456.Failure to Recognize a Neurologic Deficit
1457.Summary of Essentials
1458.History and Physical
1463.Closed Femur Fracture
1465.31. Immediate Swelling After Trauma to the Knee
1468.What Is the Differential Diagnosis for Acute Knee Pain? (◘ Table 31.1)
1469.What Is the Most Likely Diagnosis?
1470.History and Physical Exam
1471.What Is the Classic History for the Various Ligamentous Injuries in the Knee? (◘ Table 31.2)
1472.What Are the Classical Physical Exam Signs for Knee Injuries and How Are They Performed?
1473.What Does a History of Locking or Catching Signify?
1474.Why Is It Important to Perform a Careful Vascular Exam?
1475.Why Is It Important to Perform a Careful Neurologic Exam?
1476.What Is the Significance of Having Soft Muscular Compartments in the Lower Leg?
1477.What Is the Importance of Asking About Previous Knee Surgery?
1478.What Should Be Considered in Patients with Recurrent Fractures?
1479.What Is the Significance of Being Able to Bear Weight?
1480.Why Is It Important to Look for Lacerations or Wounds?
1482.What Two Basic Mechanisms Lead to ACL Injury?
1483.Is ACL Injury More Common in Males or Females?
1484.What Is the Terrible (Aka “Unhappy”) Triad of the Knee?
1485.What Is the Distribution of Blood Supply to the Meniscus and Why Is It Important?
1486.What Is the Significance of a “Popping” Noise on Traumatic Injury?
1487.What Injury Would You Expect from a Dashboard Knee Injury?
1488.What Is the Normal Range of Motion of the Knee?
1489.What Is the Significance of Being Unable to Actively or Fully Extend the Knee While the Examiner Can Do So Passively?
1490.What About Pain Inferior to the Patella with an Intact Extensor Mechanism of the Knee?
1492.What Is the Next Step in the Workup of This Patient?
1493.What Is the Meaning of Patella Alta and Baja on an X-Ray?
1494.What Are the Characteristic Radiographic Features of Osteoarthritis of the Knee, and Why Is It Important to Consider After ACL Injury?
1495.How Should Suspected Septic Arthritis or Crystalline Arthropathy Be Worked Up?
1496.What Imaging Would You Use to Confirm a Suspected ACL Injury?
1498.Is There a Role for Nonoperative Management of ACL Tears?
1499.What Is the Management for the Patient in This Case?
1500.What Is the Management of a Meniscal Tear?
1501.Areas Where You Can Get in Trouble
1502.Failure to Recognize a Knee Dislocation or Vascular Injury
1503.Failure to Recognize a Septic (Infected) Knee Joint
1504.Summary of Essentials
1506.History and Physical Exam
1507.Etiology/Pathophysiology
1510.32. Adolescent Male with Right Groin Pain and Limp
1513.What Is the Differential Diagnosis for Groin Pain with a Limp or Refusal to Bear Weight? (◘ Table 32.1)
1514.What Is the Most Likely Diagnosis?
1515.History and Physical
1516.What Important Demographic Factor Limits the Differential Diagnosis for This Patient?
1517.What Is an Antalgic Gait?
1518.What Risk Factors Are Shared by Patients That Develop SCFE?
1519.What Is the Most Common Presentation of SCFE and Physical Exam Findings?
1520.What Is the Significance of External Rotation of His Leg and Resisting Internal Rotation?
1521.What If the Patient Holds the Thigh in Slight Hip Flexion and Internal Rotation?
1522.Why Is It Important to Examine the Hip in the Setting of Knee Pain?
1523.Why Is It Important to Consider Delayed Growth, Puberty, or Endocrinological Signs or Symptoms If SCFE Is Suspected?
1524.Why Is It Important to Clarify the Meaning of Hip Pain in History?
1525.What Would Be the Significance of a History of a Recent Upper Respiratory Tract or Other Viral Infections?
1526.Why Is It Important to Ask About Travel or Exposure to Wildlife?
1527.Why Is a Family History of Joint Disease Important?
1528.Why Would a History of Corticosteroid Use Be Important?
1529.What Are Other Important Risk Factors for Secondary Osteonecrosis of the Hip?
1530.What Is the Significance of a Leg Length Discrepancy with This Clinical Presentation?
1531.What Is the Importance of the Ability to Bear Weight or Range the Hip?
1532.What Are the Component Steps in the Orthopedic Examination of a Painful Hip?
1533.What Are Some Common Physical Exam Tests Utilized in the Examination of the Hip? (◘ Table 32.2)
1535.What Is the Pathophysiology for the Orthopedic Mechanical Diagnoses? (◘ Table 32.3)
1536.Are “Shin Splints” the Same as Tibial Stress Fractures?
1538.What Laboratory Tests Would Be Useful and Why?
1539.What Analysis Should Be Done if Joint Aspiration (Arthrocentesis) Is Done for Suspected Infection?
1540.What Is the First Imaging That Would Be Recommended?
1541.What Are the Classic X-ray Findings of Pediatric Orthopedic Mechanical Hip Disease? (◘ Table 32.5)
1542.What Other Imaging Is Useful if the Diagnosis Is Unclear?
1544.What Is the Management for the Following Diagnoses on the Differential? (◘ Table 32.6)
1546.What Are the Important Potential Complications of Surgery for SCFE?
1548.Do Both Hips Require In Situ Screw Fixation in Patients with SCFE?
1549.Area Where You Can Get in Trouble
1550.Never Miss Septic Arthritis
1551.Summary of Essentials
1552.History and Physical
1557.33. Chronic Right-Hand Pain
1560.What Is the Differential Diagnosis? (◘ Table 33.1)
1561.What Clues on History and Physical Examination Might Direct You Toward Specific Diagnoses? (◘ Table 33.2)
1562.What Is the Most Likely Diagnosis?
1563.History and Physical
1564.What Is the Most Common Nerve Entrapment Syndrome in the Upper Extremity?
1565.What Are the Major Risk Factors for CTS?
1566.What Are the Best-Known Classic Signs of CTS?
1567.Are There Any Other Overlapping Median Nerve Diagnoses to Consider?
1569.What Physical Exam Finding Helps Distinguish Proximal Median Nerve Compression at the Elbow (Pronator Teres Syndrome) from Compression at the Carpal Tunnel?
1570.What Findings Help Distinguish CTS from Cervical Spine Root Pathology?
1571.What Is Thoracic Outlet Syndrome and What Physical Exam Tests Distinguish It from Spinal Root Pathology?
1572.What About Myelopathy?
1573.What Are Ganglion Cysts?
1575.What Nerve Is Compressed in CTS?
1576.What Is the Motor Distribution of the Median Nerve in the Hand?
1577.What Is the Sensory Distribution of the Median Nerve in the Hand?
1578.What Is the Origin of the Median Nerve from the Cervical Spine Roots?
1579.Where Is the Median Nerve Located in the Wrist?
1580.What Are the Boundaries of the Carpal Tunnel?
1581.How Many Structures Course Through the Carpal Tunnel? What Are the Contents of the Carpal Tunnel?
1582.What Is the Pathophysiology of CTS and Potential Causes?
1583.What Is the Significance of Thenar Wasting?
1584.What Systemic Conditions Are Often Associated with CTS?
1586.How Is Carpal Tunnel Diagnosed?
1587.Do Any Medical Neuropathies Need to Be Ruled Out?
1588.How Is Suspected Cervical Spine Disease Worked Up?
1590.What Is the Initial Treatment for CTS?
1591.What Is the Second Line of Treatment?
1592.What Are Indications for Surgical Intervention for CTS?
1593.What Is the Gold Standard Treatment for CTS?
1594.How Is CTS Associated with Hypothyroidism Managed?
1595.Areas Where You Can Get in Trouble
1596.What Is the “Million-Dollar Nerve”?
1597.Summary of Essentials
1603.Additional Important Facts
1604.Question Set: Orthopedic Surgery
1608.34. Full-Term Male Infant with Respiratory Distress
1611.What Is the Differential Diagnosis of Surgical Causes of Neonatal Respiratory Distress? (◘ Table 34.1)
1612.What Is the Most Likely Diagnosis?
1613.What Cardiac Lesion Can Mimic Respiratory Distress in a Neonate?
1614.What Are the Most Common Causes of Neonatal Respiratory Distress?
1615.History and Physical
1616.What Is the Significance of the Supracostal Retractions and Grunting?
1617.What Information Does the Pulmonary Examination Provide?
1618.Why Is the Heartbeat Displaced?
1619.Why Is the Absence of Prenatal Care Important?
1620.What Is a Common Benign Cause of Stridor in Newborns?
1622.What Is Thought to Be the Etiology of CDH?
1623.Are There Different Type of CDHs?
1624.How Is Fetal Blood Shunted Away from Pulmonary Circulation in Utero?
1625.What Are the Changes That Occur During Childbirth That Allow the Neonate to Transition to Breathing Air?
1626.How Is This Transition Affected By CDH?
1627.Are There Associated Anomalies?
1629.What Is the Best Initial Diagnostic Test?
1631.What Is the Most Important Step in Clinical Management?
1632.What Type of Ventilation Is Recommended? What if the Patient Cannot Be Adequately Oxygenated and/or Ventilated?
1633.What Is the Timing of Surgical Repair?
1634.Area Where You Can Get in Trouble
1637.Type of Repair: Open Versus Minimally Invasive Surgery (MIS)
1639.What Is the Prognosis for CDH? What Are the Factors Affecting Prognosis?
1640.Summary of Essentials
1641.History, Physical Examination, and Diagnosis
1642.Etiology/Pathophysiology
1644.35. Infant with Bilious Emesis
1647.What Is the Differential Diagnosis for Bilious Emesis in an Infant? (◘ Table 35.1)
1648.How Does Age Affect the Differential Diagnosis of Bilious Emesis? (◘ Table 35.2)
1649.What Is the Diagnosis?
1650.History and Physical
1651.Why Is It Important to Distinguish Between Bilious and Nonbilious Vomiting in an Infant?
1653.What Is the First Imaging Study to Obtain?
1654.What Is the Next Step in Diagnosis?
1656.What Defines the Midgut?
1657.What Is the Normal Developmental Sequence of Events of the Human Midgut?
1658.What Is the Etiology of Malrotation?
1659.Does Malrotation Always Result in Midgut Volvulus? Is It Always Acute?
1661.Are Plain Radiographs Always Necessary?
1662.How Do You Distinguish Midgut Volvulus from Duodenal Atresia?
1663.How Do You Distinguish Midgut Volvulus from Jejunoileal Atresia?
1664.How Do You Distinguish Midgut Volvulus from Necrotizing Enterocolitis (NEC)?
1666.What Is the Most Important Immediate Management Issue?
1667.What Operation Is Required?
1668.Area Where You Can Get in Trouble
1670.Diagnosis in Older Children
1671.Malrotation (◘ Fig. 35.3)
1672.Summary of Essentials
1673.History, Physical Examination, and Diagnosis
1674.Etiology/Pathophysiology
1677.36. Infant with Nonbilious Emesis
1680.What Is the Differential Diagnosis? (◘ Table 36.1)
1681.What Is the Most Likely Diagnosis?
1682.History and Physical
1683.Why Is It Important to Distinguish Between Bilious and Nonbilious Vomiting in an Infant?
1684.What Is the Classic History for HPS?
1685.What Are the Classic Physical Examination Findings?
1687.What Is the Pathophysiology of This Condition?
1689.What Is the First Imaging Study to Obtain?
1690.What Electrolyte Abnormalities Would You Expect?
1692.What Is the Most Important Immediate Management Issue?
1693.What Is the Treatment?
1694.What Is the Timing of Surgery?
1695.When Can the Patient Resume Eating?
1696.Areas Where You Can Get in Trouble
1697.Inadequate Resuscitation Prior to Surgery
1699.Nonsurgical Management
1700.Summary of Essentials
1701.History, Physical Examination, and Diagnosis
1704.37. Infant Born with Abdominal Wall Defect
1707.What Is the Differential Diagnosis for a Newborn with an Abdominal Wall Defect? What Are the Common and Distinguishing Features? (◘ Table 37.1)
1708.What Is the Most Likely Diagnosis in This Case?
1709.History and Physical Examination
1710.Which of the Above Diagnoses Are the Most Common?
1711.What Are the Specific Differences Between Gastroschisis and Omphalocele? (◘ Table 37.2)
1713.What Is the Etiology of Gastroschisis?
1714.What Is the Etiology of Omphalocele?
1715.Which Condition Is More Urgent? Which Is Associated with Greater Long-Term Problems?
1716.Management and Work Up
1717.What Is the Next Step in the Management of Gastroschisis?
1718.After the Initial Management, What Is the Next Step?
1719.How Does the Initial Management of Omphalocele Differ?
1720.What Is the Timing of the Closure of the Abdominal Wall Defect?
1721.What Is the Management of Pediatric Umbilical Hernias?
1722.Areas Where You Can Get in Trouble
1723.Not Properly Protecting the Bowel
1724.Not Addressing Nutritional Needs
1725.Not Recognizing Abdominal Compartment Syndrome After Repair
1726.Summary of Essentials
1728.Omphalocele-Associated Conditions
1732.38. Excessive Drooling in a Newborn
1735.What Is the Differential Diagnosis of Excessive Drooling/Feeding Intolerance in a Newborn? (◘ Table 38.1)
1736.What Is the Most Likely Diagnosis?
1737.History and Physical
1738.What Are Other Possible Presentations of TEF?
1740.What Is the Significance of Oxygen Desaturation that Only Occurs While Feeding?
1741.What Is Thought to Be the Etiology of EA?
1742.How Are the Different Types Classified?
1743.What Are the Associated Anomalies?
1745.What Is the Best Initial Diagnostic Test?
1746.Are Other Studies Necessary for Diagnosis?
1747.Can the Diagnosis of TEF Be Made Prenatally?
1749.What Is the First Step in Clinical Management?
1750.What Is the Timing of Surgical Repair?
1751.Are Any Other Studies Needed Prior to Surgery?
1752.What Are the Complications After Surgical Repair?
1753.What Is the Prognosis?
1754.Area Where You Can Get in Trouble
1756.Summary of Essentials
1758.History and Physical Examination
1761.Question Set: Pediatric Surgery
1764.XI: Surgical Complications
1765.39. Postoperative Bleeding
1768.What Is the Differential Diagnosis of Bleeding in the Postoperative Setting? (◘ Table 39.1)
1769.What Is the Most Likely Cause of the Bleeding in the Patient Described Above?
1770.What Is the Differential Diagnosis for Prolonged PTT and the Common Features? (◘ Table 39.2)
1771.What Is the Most Likely Diagnosis?
1772.History and Physical Examination
1773.Why Is It Important to Ask About a History of Bleeding After Minor Trauma/Procedures?
1774.Why Is It Important to Ask About a Family History of Bleeding?
1775.What Medical Conditions Are Risk Factors for Bleeding?
1776.Physiology/Pathophysiology
1777.What Is the Difference Between Primary and Secondary Hemostasis Disorders?
1778.What Is Coagulopathy?
1779.What Is Meant by a Medical Versus a Surgical Postoperative Bleed?
1780.What Is the Pathophysiology of vWD? What Are the Subtypes?
1781.How Does Renal Failure Cause Coagulopathy?
1782.How Does Liver Disease Cause Coagulopathy?
1783.What Are the Vitamin K-Dependent Clotting Factors?
1784.How Is Thrombocytopenia Defined? How Do Various Platelet Count Thresholds Affect Bleeding?
1785.What Are the Causes of Thrombocytopenia? (◘ Table 39.5)
1786.What Are the Two Types of HIT? What Is the Typical Timeline for HIT? (◘ Table 39.6)
1787.What Is the Mechanism of DIC?
1788.What Is Hyperfibrinolysis? How Is It Classified?
1789.What Coagulation Factors Do INR and PTT Measure, and What Drug Therapies Can They Monitor? (◘ Table 39.8)
1790.Describe the Mechanism of the Commonly Used Antiplatelet and Anticoagulant Medications (◘ Table 39.9)
1792.Prior to an Elective Operation, What Is the Best Method to Identify a Patient at Risk for Bleeding During Surgery? Is Routine Laboratory Screening for Bleeding Disorders Necessary?
1794.What Is the First Step in the Management of a Patient with Suspected Postoperative Bleeding?
1795.At What Point Should Re-exploration Be Considered for a Patient Who Is Bleeding Postoperatively?
1796.How Is Bleeding Secondary to Uremia Corrected?
1797.How Is Bleeding Secondary to Liver Disease Corrected?
1798.At What Threshold Should Platelets Be Administered?
1800.What Are the Different Types of Transfusion Reactions, Their Causes, and Management? (◘ Table 39.10)
1801.What Is the Leading Cause of Transfusion-Related Fatalities?
1802.What Are the Phases of Wound Healing?
1803.Areas You Can Get in Trouble
1804.Failing to Stop Antiplatelets/Anticoagulants in a Timely Fashion Prior to Surgery
1805.Summary of Essentials
1806.History and Physical Examination
1810.40. Postoperative Decreased Urine Output
1813.What Is the Differential Diagnosis for a Rise in Creatinine in the Postoperative Setting? (◘ Table 40.1)
1814.What Is the Most Likely Cause for the Patient’s Decreased Urine Output?
1815.History and Physical Exam
1816.Why Is It Important to Review the Operative Record and the Anesthetic Record?
1817.What Is the Most Common Presentation of AKI?
1818.What Is the Difference Between Oliguria and Anuria?
1819.What Are the Most Common Nephrotoxic Medications?
1820.Physiology/Pathophysiology
1821.Which Patients Are at Greatest Risk for Intravenous Contrast-Induced AKI?
1822.What Is the Major Force Driving Filtration in the Kidney?
1823.Does Unilateral Ureteral Obstruction Lead to Renal Failure?
1824.Is It Common to Have Oliguria Following Major Surgery? If So, Why?
1825.Can Prerenal AKI Lead to Intrarenal AKI and Eventually Renal Failure?
1826.How Does General Anesthesia Affect Cardiac and Renal Function?
1828.What Is the Best Initial Test When Suspecting AKI?
1829.What Other Tests Can Help Distinguish Between the Three Major Categories of AKI?
1830.What Are the Causes of Hyponatremia and how Does Urine/Serum Osmolality Help?
1831.How Do Specific Gravity and the Presence of Cells/Casts in a Urinalysis Help? (◘ Table 40.3)
1832.What Are the RIFLE Criteria?
1833.What Imaging Is Useful in the Workup of Oliguria?
1835.When Encountering Low Urine Output in a Patient with an Indwelling Foley Catheter, What Needs to Be Ruled Out First as an Easily Correctable Cause?
1836.What Should Be Done Next?
1837.What Is a Fluid Challenge?
1838.What if the Patient Does Not Respond to Repeat Fluid Challenges? How Do You Assess Fluid Responsiveness?
1839.What Should Be Done if the Patient Is Suspected of Having a Postrenal Obstruction?
1840.What Are the Indications for Urgent/Emergent Dialysis?
1841.What Is the Role of Diuretics in the Treatment of Oliguria?
1842.Area You Can Get in Trouble
1843.MRI in Patient with Renal Failure
1844.Areas of Controversy
1845.Does Contrast-Induced Nephrotoxicity Actually Exist?
1846.Summary of Essentials
1847.History and Physical Exam
1848.Physiology/Pathophysiology
1851.41. Shortness of Breath 5 Days After Surgery
1854.What Is the Differential Diagnosis for Postoperative Shortness of Breath? (◘ Table 41.1)
1855.What Is the Most Likely Diagnosis?
1856.History and Physical Exam
1857.What Is Virchow’s Triad? Which Part of the Triad Can Be Invoked in the Patient?
1858.What Is the Wells Score for PE?
1859.What Are the Main Clinical Findings Associated with a DVT?
1860.What Are the Five Classic Causes (Ws) of Postoperative Fever and When in the Postoperative Setting Would Each Be Expected to Occur? (◘ Table 41.4)
1862.What Causes Atelectasis and How Does It Cause Alkalosis?
1863.Does Atelectasis Cause Postoperative Fever?
1864.What Are the Most Commonly Inherited Causes of Hypercoagulability (Thrombophilia)?
1865.What Are the Most Common Acquired Causes of Hypercoagulability?
1866.What if a Patient Has No Obvious Component of Virchow’s Triad and Presents with VTE?
1867.What Is the Difference Between a Cardiac and Noncardiac Cause of Postoperative Pulmonary Edema?
1868.How Do You Distinguish Between Cardiogenic and Noncardiogenic Pulmonary Edema Based on History and Physical Exam?
1869.Why Is It Important to Distinguish Between Cardiogenic and Noncardiogenic Pulmonary Edema?
1870.What Are the Three Routes by Which a Patient Develops Postoperative Pneumonia?
1871.What Is an A-a Gradient? What Is the Differential of a Wide A-a Gradient?
1873.What Is the Full Diagnostic Algorithm for a Possible Pulmonary Embolism? (◘ Fig. 41.1)
1874.When There Is a High Suspicion of VTE, What Is the First Step in the Workup/Management?
1875.When Suspicion of VTE Is Low, What Is the First Step in the Workup?
1876.In a Patient with PE, What Are the Most Common Findings on ABG, ECG, and CXR? (◘ Table 41.5)
1877.What Are the Classic, Though Uncommon, Findings on CXR and ECG That Are Associated with PE?
1878.Since CXR and ECG Are Often Normal with a PE, How Do They Help?
1879.What Are the Typical Findings on CT Angiography for PE? What Is the Sensitivity and Specificity?
1880.How Does a V/Q (Ventilation/Perfusion) Scan Work? Why Has It Fallen Out of Favor for the Diagnosis of PE?
1881.If the Patient Is Critically Ill and Unable to Be Transported for CT Imaging, What Bedside Options Are There for the Indirect Diagnosis of PE?
1882.How Is the Severity of PE Classified?
1884.What Is the Initial Anticoagulant Management of PE?
1885.What If the Patient Has a History of or Suspected Heparin-Induced Thrombocytopenia (HIT)?
1886.What Are the Four Options for the Subsequent Treatment of PE?
1887.When Should tPA Be Considered?
1888.When Should Pulmonary Embolectomy Be Considered?
1889.What If the Patient Has a Contraindication to Anticoagulation?
1890.What Is the Recommendation for Long-Term Anticoagulation After First-Time VTE?
1891.Areas Where You Can Get in Trouble
1892.Anticoagulation During Pregnancy
1893.Summary of Essentials
1894.History and Physical Exam
1896.Differential Diagnosis
1900.Question Set: Surgical Complications
1904.42. Abdominal Pain Following Motor Vehicle Collision
1907.Is This Patient in Shock? What Are the Different Types of Shock?
1908.History and Physical Exam
1909.What Are the Clinical Manifestations of Hypovolemic Shock?
1910.What Is the Significance of Blood at the Urethral Meatus?
1911.What Is the Significance of Gross Hematuria?
1913.How Much Blood Loss Is Necessary to Cause Hypotension (As in the Patient Above) in the Supine Position?
1914.What Are the Five Main Sources of Major Blood Loss in Blunt Trauma?
1915.What Are the Most Likely Injuries in Each of These Locations That Would Lead to Major Blood Loss?
1916.What Cavity Should Not Be Considered to Be the Source of Hemorrhagic Shock and Why?
1918.What Are the ABCDE of Trauma Patient Management?
1919.What Type of Airway Is Recommended in the Trauma Setting?
1920.What Are the Two Types of Surgical Airways? Which One Is More Appropriate in the Emergent Trauma Setting?
1921.Why Is Nasotracheal Intubation Not Recommended in the Trauma Setting?
1922.How Does One Confirm Proper Intubation?
1923.What Is the First Step in the Management of the Patient Presented?
1924.Where Should the Peripheral IV Lines Be Placed?
1925.Is a Central Line Preferred over a Peripheral IV for Trauma Patients?
1926.What Is the Ideal Fluid Resuscitation in Trauma?
1927.Why Are Excessive Crystalloid Infusions Avoided in Trauma Patients?
1928.What Is Colloid? What Is the Theoretical Benefit? Is There Any Actual Benefit in Trauma Resuscitation?
1929.Why Are Large Doses of K+ Not Given in the Initial Resuscitation?
1930.What Is the Role of Tranexamic Acid (TXA)?
1931.After Appropriate Fluid Resuscitation Is Started, What Must Be Done Next?
1932.What Is Included in the Secondary Survey of Trauma Patients?
1933.What Imaging Adjuncts Are Used as Part of the Secondary Survey in Blunt Trauma?
1934.Is FAST Scan Useful in Hemodynamically Stable Blunt Trauma Patients, and in Penetrating Trauma?
1935.What Are the Next Steps After a FAST, and What Injuries Can Be Missed?
1936.Subsequent Management
1937.What Is the Management of Intra-Abdominal Bleeding Due to Splenic Injury?
1938.What Is the Management of Intra-Abdominal Bleeding Due to Liver Injury?
1939.What Are the First Steps in the Management of Patients with a Pelvic Fracture? What Is the Subsequent Management?
1940.Areas You Can Get in Trouble
1941.Failing to Recognize the Significance of Free Fluid in the Peritoneal Cavity When There Is No Solid Organ Injury
1942.Treating Hypovolemic Shock Initially with Vasopressors
1943.Infection After Splenectomy
1944.Jaundice and Hematemesis After Liver Injury
1945.Management of a Pelvic Fracture in a Hemodynamically Unstable Patient
1946.Blood Loss in Trauma (◘ Fig. 42.3)
1947.Summary of Essentials
1949.History and Physical Exam
1952.Subsequent Management
1954.43. Penetrating Abdominal Trauma
1957.What Is the Most Likely Diagnosis?
1958.History and Physical
1959.What Three Physical Exam Findings Independently Mandate Immediate Operative Intervention in Patients with Penetrating Abdominal Trauma?
1960.What Is a Tangential GSW?
1961.Do Patients with Findings of a Tangential GSW Require Any Further Workup?
1963.What Are the Borders of the Anterior Abdomen, Flank, Back, and Thoracoabdomen? (◘ Table 43.1)
1964.What Is the Significance of Injuries to the Thoracoabdominal Region?
1965.What Three Distinct Regions Comprise the Internal Abdomen?
1966.Why Is It Difficult to Diagnose Injuries to Retroperitoneal Organs in Trauma Patients?
1967.What Is the Zone Classification for Retroperitoneal Hematomas and How Does the Location Affect Management?
1968.What Are the Two Most Common Organs Injured Following a Penetrating Abdominal Injury?
1969.What Injuries Must Be Ruled Out with GSWs That Travel Across the Pelvis?
1971.What Initial Workup Is Recommended for the Above Patient?
1972.In the Absence of Shock, Peritonitis, or Evisceration, What Imaging Is Recommended for a Patient with Penetrating Abdominal Trauma?
1973.Is a FAST Exam Helpful for Patients with Penetrating Abdominal Trauma?
1974.Is There a Role for Local Wound Exploration for Penetrating Abdominal Injury?
1976.What Are the First Steps in the Management of This Patient?
1977.What Is a Massive Transfusion Protocol (MTP)?
1978.When Should MTP Be Initiated?
1979.What Is Permissive Hypotension?
1980.Should Empiric Antibiotics Be Routinely Administered to All Patients with Penetrating Trauma?
1981.Should Tetanus Vaccines or Tetanus Immunoglobulin Be Routinely Administered to Patients with Penetrating Trauma?
1982.How Do You Manage a Patient Who Presents with Impalement?
1983.Subsequent Management
1984.What Are the Management Options in Patients with Penetrating Abdominal Trauma?
1985.When Is It Appropriate to Consider Nonoperative Management of Patients with Penetrating Abdominal Trauma?
1986.Why Are Trauma Patients Prepped and Draped from Chin to Knees in the Operating Room?
1987.What Is the Traditional Mainstay of Surgical Management for Patients with Penetrating Abdominal Trauma?
1988.What Is the “Lethal Triad of Death” in Trauma? What Is the Lethal Diamond?
1989.What Is Damage Control Surgery?
1990.How Long Should Antibiotics Be Continued for Following a Trauma Laparotomy?
1991.Do Patients with Small Bowel or Colon Injuries Require a Stoma?
1993.What Is Abdominal Compartment Syndrome? Who Is at Risk?
1994.Special Situations/Circumstances
1995.Thoracoabdominal Penetrating Wounds
1996.Summary of Essentials
1997.History and Physical Exam
2000.Subsequent Management
2001.Subsequent Management
2003.44. Pedestrian Struck by Motor Vehicle
2006.What Is the Most Likely Diagnosis?
2007.History and Physical Exam
2008.What Are “Hard” and “Soft” Signs of Vascular Injury?
2009.Do All Patients with Hard Signs Need to Go Emergently to the OR?
2010.What Are the Ps of Acute Limb Ischemia?
2011.What Is the Implication of an Audible Bruit/Palpable Thrill Near an Artery in Association with Trauma?
2012.What Are the Principles of the Physical Examination of an Injured Extremity?
2014.What Is the Mechanism of Popliteal Artery Injury?
2015.What Are the Classic Orthopedic Fractures/Dislocations That Are Associated with Arterial Injury? (◘ Table 44.2)
2016.Why Is It Important to Promptly Reduce a Dislocation?
2017.What Is a Minimal Vascular Injury?
2018.What Is Suggested by Numbness of the Skin Overlying the Lateral Shoulder After Shoulder Dislocation?
2020.Should the Knee Be Tested for Ligamentous Injury?
2021.What Noninvasive Bedside Test Provides Objective Evidence of a Vascular Injury? How Is It Performed?
2022.If the ABI Is Abnormal, What Additional Vascular Imaging Study Is Recommended?
2023.What Additional Radiologic Imaging Study Is Recommended for a Posterior Knee Dislocation?
2024.In Penetrating Trauma, Should an Angiogram Be Performed If the Bullet/Stab Wound Is Close to an Artery, Even If There Are No Signs of Injury and the ABI is Normal?
2025.What Is the Mangled Extremity Severity Score and How Is It Used?
2027.What Are the First Steps in the Management of This Patient?
2028.Is There a Role for Tourniquets in Patients with Life-Threatening Hemorrhage of an Extremity?
2029.What Is the Next Step in the Management of a Knee Dislocation?
2030.What Is the Next Step Following Reduction?
2031.What Are the Principles of Operative Management of a Popliteal Artery Injury in This Setting?
2032.If a Conduit Is Needed to Replace the Injured Artery, Where Is It Taken From?
2033.What If the Popliteal Vein Is Also Injured?
2034.What If There Is a Combined Orthopedic and Vascular Injury? Which Is Repaired First?
2035.Does Heparin Administration Help?
2036.What Is the Risk of Limb Loss with a Posterior Knee Dislocation and Popliteal Injury?
2037.Area Where You Can Get in Trouble
2038.Assuming There Is No Arterial Injury Because You Think You Feel Palpable Pulses
2040.The Role of Endovascular Repair
2041.Summary of Essentials
2042.History and Physical Exam
2046.45. Gunshot Wound to the Left Neck
2048.History and Physical Examination
2049.What Are the Most Important Parts of the History and Physical Examination for a Patient with a Neck Injury?
2050.What Are Hard Signs of Vascular Injury?
2051.What Are Other Nonvascular Hard Signs That May Warrant a Surgical Exploration?
2052.What Is the Significance of the Following Signs/Symptoms? (◘ Table 45.1)
2053.What Is the Diagnosis in This Patient?
2055.What Key Anatomic Structures Are at Risk of Injury Within the Neck? (◘ Table 45.2)
2057.What Is the Significance of Whether or Not the Injury Has Penetrated the Platysma (Superficial Neck Muscle)?
2058.What Types of Arterial Injuries Do Bullet Wounds Cause?
2059.What Is a Pseudoaneurysm? How Does It Differ from a Hematoma?
2060.What Is an Arterial Intimal Injury? How Is It Managed? What Is a Dissection?
2061.What Nerve Would Be Injured If This Patient Presented with Vocal Cord Paralysis?
2063.What Study Is Recommended for Patients with Penetrating Neck Trauma?
2065.What Are the First Steps in the Management of a Penetrating Neck Wound?
2066.What Is the Next Step Following the Initial Management?
2067.What If There Are No Hard Signs of Injury?
2068.What Are the Principles of Repair of a Carotid Injury?
2069.How Do You Manage an Injury to the Internal Jugular Vein?
2070.How Does the Type of Arterial Injury Seen on CTA Affect Management? (◘ Table 45.3)
2071.Areas Where You Can Get in Trouble
2072.Not Addressing Airway First (Even with No Obvious Airway Compromise)
2073.Missing a Blunt Carotid Injury
2074.Child with Sharp or Blunt Object in Mouth
2075.Retropharyngeal Abscess Following Neck Injury
2076.Summary of Essentials
2077.History and Physical Examination
2081.46. Stab Wound to the Chest
2084.What Are Considered the “Lethal Six” Injuries of Thoracic Trauma? (◘ Table 46.1)
2085.What Are Considered the “Hidden Six” Injuries of Thoracic Trauma? (◘ Table 46.2)
2086.How Is the Diagnosis of Tension Pneumothorax Established?
2087.How Is the Diagnosis of Cardiac Tamponade Established?
2088.What Is the Most Likely Diagnosis in This Patient?
2089.History and Physical
2090.What Is the Differential Diagnosis for a Combative Trauma Patient?
2091.What Is the Differential Diagnosis of the Absent Breath Sounds on the Left?
2092.What Is the Implication of a Penetrating Injury to the Chest That Is Above Versus Below the Nipple?
2093.Why Is It Important to Know the Type of Weapon Used in a Penetrating Injury?
2094.What Is the Concern Given That the Systolic and Diastolic Pressures in the Patient Presented Are So Close to Each Other?
2095.Why Is It Important to Roll the Patient Over?
2096.What Is the Significance of Air Bubbling from a Penetrating Chest Wound?
2097.What Is Subcutaneous Emphysema?
2099.Why Is a Tension Pneumothorax Dangerous?
2100.What Is the Implication of Distended Jugular Veins?
2101.What Causes Hypotension in Cardiac Tamponade?
2102.What Are the Hemodynamic Findings in Cardiac Tamponade?
2103.What Is the Most Important Factor in the Development of Cardiac Tamponade?
2104.Does a Normal Abdominal Examination Rule Out an Intra-Abdominal Injury? Why or Why Not?
2105.Why Are Penetrating Chest Trauma Patients at Increased Risk of Air Embolism? How Would It Present?
2106.Why Would a Trauma Patient Lose Pulses (Cardiac Arrest) After Induction or Intubation During General Anesthesia?
2108.What Is the First Step in Management?
2109.What Is the Next Step?
2110.What Is a Needle Thoracostomy? What Is the Indication for Placement? Where Is It Placed? Why Is That Location Chosen? What Needs to Follow After It Is Placed?
2111.What Is a Tube Thoracostomy? What Is the Indication for Placement? Where Is It Placed?
2112.When Does a Hemothorax Mandate Going to Surgery (Thoracotomy)?
2113.Should Prophylactic Antibiotics Be Given for Chest Tube Placement?
2114.Does a Larger Chest Tube Allow for Better Evacuation of Air or Blood?
2115.What Are the Goals and Guidelines for Resuscitative or Emergency Department Thoracotomy (EDT)?
2116.What Is the Next Step?
2117.Following the Primary Survey, What Is the Next Step in the Management?
2118.Once Cardiac Tamponade Is Highly Suspected, What Is the Next Step?
2119.What Is the Role of a Subxiphoid Window?
2120.Are Vasopressors Recommended in the Management of Traumatic Cardiac Tamponade?
2121.Subsequent Management
2122.What Should Be Immediately Ordered in All Patients That Present with Combative Behavior?
2123.How Much Pleural Fluid Can the Diaphragm “Hide” in an Upright Chest Radiograph?
2124.What Is the Classic Description for Cardiac Tamponade on Chest Radiograph?
2125.How Does a Chest Tube Drainage System Work, and How Do You Look for a Leak?
2126.Does Inspiring 100% O2 Help to Resolve a Pneumothorax?
2127.How Is a Sucking Chest Wound Managed?
2128.How Is Flail Chest Managed?
2129.What Is the Most Important Management in Patients with Rib Fractures?
2130.When Should Patients Undergo Rib Fixation?
2131.How Would You Manage a Traumatic Air Embolus?
2132.What Can Increase the Risk of Developing an Air Embolism in a Patient Arriving with Penetrating Chest Trauma?
2133.What Are the Classic Mechanisms and Imaging Findings for Aortic Injury?
2135.What Is the Most Dangerous Complication Following Pericardiocentesis?
2136.What Nerve Is at Risk When Opening the Pericardium During EDT?
2137.How Is a Recurrent or Persistent Hemothorax Managed if Chest Tube Drainage Fails?
2138.What Should You Consider in Patients with a Pneumothorax That Continue to Have a Large Air Leak Following Chest Tube Placement?
2139.Areas Where You Can Get in Trouble
2140.Long-Term Consequence of Missing a Diaphragm Injury
2141.Do All Patients with Pneumothorax Require a Chest Tube?
2142.Missed Esophageal Injury
2143.Areas of Controversy
2144.How Accurate Is Focused Assessment with Sonography for Trauma (FAST) in the Setting of Penetrating Trauma?
2145.Special Situations/Circumstances
2146.Following Chest Tube Placement for a Traumatic Pneumothorax/Hemothorax, When Is It Appropriate to Remove It? What Is the Main Risk During Removal?
2147.Initially Stable Patient with Multiple Rib Fractures Has Increasing Oxygen Requirements and Respiratory Distress
2148.Lethal Six Injuries of Thoracic Trauma (◘ Fig. 46.1)
2149.Summary of Essentials
2150.History and Physical
2151.Differential Diagnosis
2152.Pathology/Pathophysiology
2154.47. Burns to the Face, Trunk, and Extremities
2157.What Is the Diagnosis and What Are the Associated Complications in This Patient?
2158.History and Physical
2159.What Are the Risk Factors for Burn Injuries?
2160.How Does One Determine the Severity of a Burn Injury?
2161.What Is the Significance of Carbonaceous Sputum?
2162.What Is the Significance of Cherry-Red Skin in a Patient Rescued from a House Fire?
2163.What Is the Significance of a Circumferential Burn in the Extremity? How About If on the Chest?
2165.What Are the Different Mechanisms of Burn Injury? (◘ Table 47.2)
2166.What Are the Physiologic Manifestations of a Burn?
2167.Why Are Burn Patients at Increased Risk for Severe Volume Depletion?
2168.Why Are Burn Patients at Higher Risk for Gastrointestinal Ulcers?
2169.What Organisms Are Classically Involved in Burn Wound Infections?
2171.What Is the First Step in the Evaluation of This Patient?
2172.How Is Inhalational Injury Definitively Diagnosed?
2173.What Is the Best Way to Evaluate for Carbon Monoxide Poisoning? How Does CO Lead to Death?
2174.How Do You Diagnose a Burn Wound Infection?
2176.When Should You Consider Immediately Intubating a Burn Patient?
2177.What Type of Fluid Should Be Used Acutely in a Burn Patient?
2178.How Do You Calculate the Appropriate Volume of Fluid Resuscitation for a Burn Victim in the First 24 Hours?
2179.What Is the Management for CO Poisoning?
2180.What Electrolyte Abnormality Must Be Closely Monitored in Burn Patients?
2181.What Should Be Considered as a Potential Cause of Deteriorating Respiratory Status in a Patient with a Circumferential Third-Degree Chest Burn? How Do You Treat It?
2182.Can Circumferential Extremity Burns Cause Compartment Syndrome?
2183.What Things Can Be Done to Reduce the Hypermetabolic Response Seen in Severe Burn Injuries?
2184.How Do You Manage Burn Wounds?
2185.Should Burn Patients Be Started on Prophylactic IV Antibiotics?
2186.What Topical Burn Agents Are Commonly Utilized in Burn Patients? (◘ Table 47.3)
2187.What Medication Should All Burn Patients Be Started on to Prevent Curling’s Ulcers?
2188.Can Patients with Severe Burn Injuries Be Fed Orally? Why or Why Not?
2189.What Are the Principles of Management for Chemical Burns?
2190.What Is the Key Management Principle for Patients with Electrical Burns?
2191.Areas You Can Get in Trouble
2194.Chronic Non-Healing Wound
2196.Summary of Essentials
2197.History and Physical
2201.48. Severe Right Leg Pain After Tibia Fracture
2204.What Is the Differential Diagnosis? (◘ Table 48.1)
2205.What Is the Most Likely Diagnosis?
2206.History and Physical
2207.What Are the Ps of Compartment Syndrome?
2208.What Is the Implication of Pulselessness in the Setting of Compartment Syndrome?
2209.What Are Considered Early Symptoms/Signs of Compartment Syndrome?
2210.What Is Meant by Pain Out of Proportion to the Physical Exam Findings?
2211.How Do the Ps Differ from Acute Limb Ischemia?
2212.Can Patients with Acute Limb Ischemia Also Develop Compartment Syndrome?
2214.How Many Compartments Are There in the Upper Leg (Thigh)? Lower Leg? Upper Arm? Forearm? (◘ Table 48.2)
2216.How Are the Etiologies of Compartment Syndrome Classified?
2217.What Is the Pathophysiology of Compartment Syndrome?
2218.What Is the Significance of First Web Space Numbness?
2219.What Is Volkmann’s Ischemic Contracture?
2220.What Is Abdominal Compartment Syndrome? What Are the Risk Factors?
2222.How Is the Diagnosis of Extremity Compartment Syndrome Established?
2223.What Is the Role of Measuring Compartment Pressures with Suspected Extremity Compartment Syndrome?
2224.How Is Abdominal Compartment Syndrome Diagnosed?
2226.What Is the Treatment of Extremity Compartment Syndrome?
2227.If Compartment Syndrome Is Suspected in Only One Compartment of the Lower Leg, Why Is Fasciotomy Performed for All Four Compartments?
2228.What Compartment in the Lower Leg Is Most Often Missed During Fasciotomy?
2229.What Is the Treatment of Abdominal Compartment Syndrome?
2231.What Are the Consequences of Delayed Recognition of Compartment Syndrome?
2232.What Complications Can Occur from Lower Leg Fasciotomy? (◘ Table 48.3)
2233.Areas of Controversy
2234.Should Patients at High Risk for Getting Compartment Syndrome Undergo Prophylactic Fasciotomies?
2235.Compartments of the Lower Leg (◘ Fig. 48.1)
2236.Summary of Essentials
2237.History and Physical
2242.Question Set: Trauma
2245.XIII: Upper Gastrointestinal Bleeding
2249.What Is the Differential Diagnosis for an Upper GI Bleed (UGIB)? (◘ Table 49.1)
2250.What Are the Most Likely Diagnoses in This Patient?
2251.History and Physical
2252.What Information Can the Color and Texture of Stool or Emesis Provide?
2253.If a Patient Presents with Bright Red Blood per Rectum, Is It Always a Lower GI Bleed?
2255.What Are Esophageal Varices?
2256.What Is Acute Gastritis?
2257.What Is Chronic Gastritis?
2258.What Is Dieulafoy’s Lesion?
2259.What Are the Important Anatomic Correlations for Peptic Ulcer Disease?
2261.Why Might the Hemoglobin/Hematocrit Be Normal in Spite of a Major GI Bleed?
2262.What Happens to the BUN/Creatinine Ratio During an UGIB?
2263.What Part of the GI Tract Is Considered an UGIB?
2264.What Is the Difference Between Occult and Obscure GI Bleeding?
2265.What Is a Common Cause of GI Bleeding and/or Anemia Unique to Patients with a Hiatal Hernia?
2267.What Are the First Steps in the Management of This Patient?
2268.What Is the Role of Placing an NG Tube?
2269.What Is the Difference Between a “Type and Screen” and a “Type and Cross”? Which One Is More Appropriate in This Setting?
2270.What If the Patient Needs Blood Immediately?
2271.How Should the Bed Be Positioned in a Patient Who Is Vomiting Blood?
2272.Following Resuscitation, What Is the Next Step in the Management?
2273.In What Setting Should the Patient with an UGIB Be Managed?
2274.Following Stabilization, What Is the Next Step in the Management? What Is the Optimal Timing?
2275.What if Upper Endoscopy Fails to Show the Source of a GI Bleed? What Other Imaging Might Be Useful?
2276.In the Absence of Varices, What Are the Therapeutic Endoscopic Options for Treating an UGIB?
2277.What Are the Indications for Surgery in a Patient with an UGIB?
2278.What Are the Surgical Options for a Bleeding Ulcer that Fails Medical Management?
2279.Special Management Circumstances
2280.If an Ulcer or Gastritis Is Found on Endoscopy, What Additional Studies/Therapies Are Recommended?
2281.How Do You Test for H. pylori Eradication?
2282.How Does the Management of UGIB Differ for Esophageal Varices?
2283.What Is the Best Way to Prevent Recurrent UGI Bleed from Esophageal Varices?
2284.How Does the Management of UGI Bleeding Differ for a Mallory-Weiss Tear?
2285.Following Gastrectomy, Why Would Patients Develop Nausea, Dizziness, and Flushing?
2286.Areas Where You Can Get in Trouble
2287.Assuming That UGIB in a Patient with Alcohol Use Disorder Is Due to Esophageal Varices
2288.Sequelae of Ingesting Harmful Liquids
2289.Summary of Essentials
2290.History and Physical Exam
2291.Pathology/Pathophysiology
2292.Differential Diagnosis
2295.Special Management Situations
2297.50. Severe Epigastric Abdominal Pain
2300.What Is the Differential Diagnosis? (◘ Table 50.1)
2301.What Is the Most Likely Diagnosis?
2302.History and Physical
2303.What Are the Most Common Symptoms in a Patient with Peptic Ulcer Disease (PUD)? How Might One Distinguish Gastric from Duodenal Ulcers?
2304.What Is the Typical Presentation for a Perforated Peptic Ulcer?
2306.How Common Are Peptic Ulcer Perforations and How Often Do They Result in Death?
2307.What Is the Most Common Cause of Peptic Ulcers?
2308.How Do NSAIDs Lead to Peptic Ulcers?
2309.What Are Some Other Factors That May Lead to the Presence of Peptic Ulcers?
2310.What Are the Five Types of Gastric Ulcers and How Are They Categorized? (◘ Table 50.3)
2311.How Does Vomiting Change a Patient’s Acid/Base Balance?
2313.How Is the Diagnosis of Perforated PUD Established?
2314.What Laboratory Studies Should Be Sent?
2315.What Additional Diagnostic Studies Are Recommended for a Patient with a Suspected Perforated PUD?
2316.What Is the Role of a CT Scan?
2317.What Is the Role of an Upper GI Study (UGIS)?
2319.What Is the Basic Principle of Surgical Treatment for Perforated Peptic Ulcer?
2320.How Should a Perforated Peptic Ulcer Be Repaired?
2321.Is Conservative (Nonoperative) Management in Perforated PUD Ever Appropriate?
2322.What Are the Principles of Nonoperative Management?
2323.Can Perforated Peptic Ulcers Be Treated Laparoscopically?
2324.Summary of Essentials
2325.History and Physical
2329.51. Weight Loss and Early Satiety
2332.What Is the Differential Diagnosis for a Patient with Vague Abdominal Pain? (◘ Table 51.1)
2333.What Is the Most Likely Diagnosis?
2334.History and Physical
2335.What Is the Prevalence of Gastric Cancer and What Causes It?
2336.What Are the Risk Factors for the Development of Gastric Cancer?
2337.Why Is the Mortality Rate So High for Gastric Cancer?
2338.What Are the Most Common Symptoms/Signs for a Patient with Gastric Cancer? What Are “ALARM” Symptoms/Signs?
2340.Are There Specific Findings on Physical Exam for Gastric Cancer?
2342.What Is the Vascular Supply to the Stomach?
2343.What Is an Intestinal-Type Gastric Adenocarcinoma?
2344.What Is a Diffuse-Type Gastric Adenocarcinoma?
2345.What Is Linitis Plastica?
2346.What Is a Gastrointestinal Stromal Tumor (GIST)?
2347.Does Lymphoma Occur in the Stomach?
2349.What Is the Best Way to Work Up a Patient with Suspected Gastric Cancer?
2350.Is Screening for Gastric Cancer Recommended in Asymptomatic Patients?
2351.Once the Diagnosis of Gastric Cancer Is Established, What Further Staging Is Recommended?
2353.How Is Gastric Cancer Treated?
2354.What Is the Role of HER2 Gene Amplification and Chemotherapy?
2355.How Is GIST Treated?
2357.What Are the Common Complications That Can Occur After a Gastric Resection?
2358.How Are Anastomotic Leaks Identified and Treated?
2359.Summary of Essentials
2360.History and Physical
2365.52. Chest Pain After Vomiting
2368.What Is the Differential Diagnosis? (◘ Table 52.1)
2369.What Is the Most Likely Diagnosis?
2370.History and Physical
2371.What Are the Risk Factors for Boerhaave’s Syndrome?
2372.Why Is Boerhaave’s Syndrome So Often Unrecognized?
2373.What Is Mackler’s Triad?
2374.What Is the Most Specific Sign of an Esophageal Rupture?
2375.What Are the Similarities and Differences Between Boerhaave’s Syndrome and Mallory-Weiss Tear? (◘ Table 52.2)
2377.What Are the Most Common Causes of Esophageal Perforation?
2378.Why Do Patients with Boerhaave’s Syndrome Become So Septic?
2380.What Is the First Step in Workup for a Patient Suspected of Having Boerhaave’s Syndrome?
2381.What Is the Role of Oral Contrast Studies in Diagnosing Boerhaave’s Syndrome? How About CT?
2382.What Type of Contrast Should Be Used?
2383.Is There a Role for Endoscopy During Diagnosis?
2385.What Are the Initial Steps in the Management of a Patient with Boerhaave’s Syndrome?
2386.Does the Time Interval Between Perforation and Intervention Matter?
2387.What Are The Three Main Treatment Options, and How Do You Decide Which One To Choose?
2388.Which Patients Are Appropriate for Conservative Management, and What Does It Constitute?
2389.When Is Stenting the Best Option?
2390.What Are the Surgical Options for a Patient with Boerhaave’s Syndrome?
2391.What Is the Prognosis of a Patient with Boerhaave’s Syndrome?
2393.How Effective Are Endoscopic Options for a Patient with Boerhaave’s Syndrome?
2394.Summary of Essentials
2395.History and Physical
2399.Question Set: Upper Gastrointestinal Bleeding
2406.What Is the Differential Diagnosis? (◘ Table 53.1)
2407.What Is the Most Likely Diagnosis for This Patient?
2408.History and Physical
2409.What Is the Cremasteric Reflex?
2410.What Would Cause an Absent Cremasteric Reflex?
2411.What Is the TWIST Score for Testicular Torsion?
2412.What Is Prehn’s Sign? Is It Reliable?
2413.What Is the Blue-Dot Sign?
2414.What Are the Four Cardinal Symptoms and Signs of Testicular Torsion?
2415.Does a History of Trauma or Presence of Fever Rule Out Testicular Torsion?
2416.Pathology/Pathophysiology
2417.What Congenital Defect Predisposes Children to Developing Testicular Torsion?
2418.How Does Testicular Torsion Cause Ischemia?
2419.How Does One Distinguish Testicular Torsion from Acute Epididymitis?
2421.How Does the TWIST Score Help in Determining What Additional Workup Should Occur?
2422.If Suspicion of Testicular Torsion Is Intermediate, What Additional Workup Should Occur?
2423.In the Trauma Setting, What Are the Most Important Things to Look for on Doppler Ultrasound?
2425.In the Setting of Suspected Testicular Torsion, What Is the Optimal Timing from Initial Evaluation to Definitive Management?
2426.Is There a Role for Manual Detorsion in the Emergency Department?
2427.What Is the Surgical Treatment for Testicular Torsion?
2428.What If the Testicle Is Necrotic at the Time of Surgical Exploration?
2429.What Is the Recommended Management for Minor Trauma to the Testes?
2430.What Are the Operative Indications for Testicular Trauma?
2431.What Is the Management of Acute Epididymitis?
2432.Does Loss of a Testicle from Torsion Affect Fertility?
2433.Areas Where You Can Get in Trouble
2434.Penile Pain After Sexual Intercourse
2436.Summary of Essentials
2438.History and Physical
2445.Why Is the Location of a Scrotal Mass Important to Identify?
2446.Describe the Cause(s) of Scrotal Masses Found Involving the Skin (◘ Table 54.1)
2447.What Is the Differential Diagnosis of Scrotal Masses Involving the Spermatic Cord? (◘ Table 54.2)
2448.What Is the Differential Diagnosis of Scrotal Masses Involving the Epididymis? (◘ Table 54.3)
2449.What Is the Differential Diagnosis of Scrotal Masses Found Involving the Testes? (◘ Table 54.4)
2450.What Is the Most Likely Diagnosis for This Patient?
2451.History and Physical
2452.What Features on History and Physical Examination Favor the Diagnosis of Testicular Cancer?
2453.What Is the Implication of Constitutional Symptoms in Association with a Painless Testicular Mass?
2454.What Risk Factors for Testicular Cancer Should Be Obtained on History?
2455.What Features on Physical Examination Favor a Nonmalignant Etiology?
2456.What Are the Main Diagnoses to Consider in the Presence of a Very Painful Scrotal Mass?
2457.What Benign Processes Are Typically Painless?
2458.What Physical Exam Maneuver Can Help Identify a Varicocele?
2459.Pathology/Pathophysiology
2460.Does Cryptorchidism Increase the Risk of Developing Testicular Cancer in the Undescended Testicle, the Contralateral Descended Testicle, or Both?
2461.What Is the Most Common Subtype of Testicular Tumor? Is It Malignant?
2462.What Are the Major Pathologic Subtypes of Testicular Cancers? (◘ Table 54.5)
2463.What Causes Gynecomastia in Patients with Testicular Cancers?
2464.What Are the Differences Between Epididymitis and a Spermatocele?
2465.Why Does a Varicocele Form? Why Is It More Often on the Left? Why Does It Affect Fertility?
2466.What Is the Pathophysiology of a Hydrocele?
2468.What Is the Key Imaging Modality for a Patient with a Painless Testicular Mass?
2469.Once a Solid Testicular Mass Is Identified, What Additional Imaging Is Recommended?
2470.What Relevant Blood Tests Should Be Obtained in a Patient with Testicular Cancer?
2471.Is Percutaneous Biopsy for a Testicular Tumor Recommended?
2472.What Are the Key Differences Between a Seminoma and Nonseminoma? (◘ Table 54.7)
2474.How Is Pathologic Confirmation of Testicular Cancer Determined?
2475.Why Is an Inguinal Incision Preferred Over a Scrotal One?
2476.What Other Treatment Modalities Are Utilized After Initial Surgery for Testicular Cancer?
2477.What Should Be Recommended for Patients About to Undergo Orchiectomy and/or Chemotherapy?
2478.Does Unilateral Orchiectomy Lead to Impotence?
2479.Areas Where You Can Get in Trouble
2480.Rapidly Expanding Scrotal Mass Following Blunt Trauma
2481.Summary of Essentials
2482.History and Physical
2483.Pathology/Pathophysiology
2489.What Is the Differential Diagnosis for Gross Hematuria? (◘ Table 55.1)
2490.What Are the Most Likely Diagnoses for This Patient?
2491.History and Physical
2492.What Are the Differences Between Gross and Microscopic Hematuria?
2493.Why Is the Color and Consistency of the Urine Important? (◘ Table 55.2)
2494.Other than Blood, What Can Make Urine Appear Red?
2495.Does It Matter if Hematuria Is at the Beginning of the Urine Stream or at the End?
2496.What Is the Importance of Pain in Association with Hematuria?
2497.What Is the Classic Presentation for Nephrolithiasis?
2498.What Are the Risk Factors for Nephrolithiasis?
2499.How Does Autosomal Dominant Polycystic Kidney Disease Present?
2500.What Are the Most Common Symptoms/Presentation for Renal Cancer?
2501.What Are the Main Risk Factors for Renal Cancer?
2502.What Is the Most Common Presentation for Bladder Cancer? What Are the Risk Factors?
2503.What Is the Most Common Presentation for Prostate Cancer? What Are the Risk Factors?
2504.What Comprises the Urinary Tract and Where Along the Tract Can Bleeding Arise?
2505.Pathology/Pathophysiology
2506.Where Do Renal Stones Develop and in What Circumstances Do They Lead to Symptoms?
2507.Why Do High Protein Diets Increase the Risk of Developing Renal Stones?
2508.What Is the Most Common Type of Renal Stone and What Is the Leading Cause of This Type of Stone?
2509.What Is the Most Common Type of Renal Cancer?
2510.Where Is the Most Common Location for RCC Metastasis?
2511.What Genetic Syndromes Are Associated with RCC?
2512.What Paraneoplastic Syndromes Are Associated with RCC? (◘ Table 55.4)
2513.What Is the Most Common Type of Bladder Cancer?
2514.What Is the Most Common Type of Prostate Cancer?
2516.What Is the Next Step in the Workup after a Positive Urine Dipstick for Blood?
2517.What Additional Laboratory Tests Should Be Ordered During the Hematuria Workup? (◘ Table 55.5)
2518.What Is the Best Diagnostic Test for Nephrolithiasis?
2519.What Further Workup Is Recommended in the Presence of Gross Hematuria?
2520.Does Negative Urine Cytology Rule Out a Malignancy?
2523.What Is the Best Management for Nephrolithiasis? How Does the Size of the Stone Change Management?
2524.What Are the Emergent Surgical Indications for Renal Stones?
2526.What Are the Treatment Options for Renal Masses Concerning for RCC?
2527.What Is a Radical Nephrectomy?
2529.How Is Urothelial Cell Carcinoma of the Bladder Treated?
2531.What Is a Radical Prostatectomy? Which Patients Are Appropriate Candidates for This Procedure?
2532.What Are Nonsurgical Treatments for Prostate Cancer?
2533.Special Circumstances
2534.What Are the Next Steps in Management if Significant Hematuria Persists Despite Foley Catheter Placement and Manual Irrigation?
2535.Areas You Can Get into Trouble
2536.Not Placing a Foley Catheter in the Setting of Significant Gross Hematuria
2537.Placing a Foley Catheter in the Setting of Trauma and Blood at the Urethral Meatus
2538.Bladder Rupture After Blunt Trauma
2539.Can Gross Hematuria Be Associated with an Abdominal Aortic Aneurysm (AAA)?
2540.Fever, Flank Pain, and Gross Hematuria Following a Blood Transfusion
2541.Summary of Essentials
2542.History and Physical
2543.Pathology/Pathophysiology
2546.Question Set: Urology
2550.56. Transient Loss of Vision in the Right Eye
2553.What Is the Differential Diagnosis for Transient Monocular Vision Loss? (◘ Table 56.1)
2554.What Is the Most Likely Diagnosis for This Patient?
2555.History and Physical Examination
2556.What Is the Term for the Eye Symptom the Patient Describes?
2557.In a Patient with This Eye Symptom, What Finding on Fundoscopic Ophthalmologic Examination Would Support a Carotid Artery Source of the Symptom?
2558.What If the Patient Instead Described Transient Motor and Sensory Loss of the Left Arm and Leg, What Term Would Be Used for Such a Symptom?
2559.How Does One Distinguish a TIA from a Stroke?
2560.What Does a Carotid Bruit Signify?
2561.What Else Can Cause a Bruit in the Neck?
2562.What Is Subclavian Steal Syndrome?
2563.Are Dizziness, Syncope, and Headaches Considered Symptoms of Carotid Stenosis?
2564.What Are the Risk Factors for Carotid Stenosis?
2566.What Are the Branches of the ECA?
2567.What Is the First Branch of the ICA?
2568.What Is the Classic Anterior Circulation Ischemic Stroke in Terms of Arterial Distribution and Symptoms?
2569.Why Is It Important to Distinguish Between Anterior and Posterior Circulation Symptoms?
2571.What Are the Two Main Causes of Stroke?
2572.What Are the Main Sources of Cerebral Emboli?
2573.What Is a Lacunar Stroke?
2574.How Is an Atherosclerotic Plaque Formed?
2575.Why Does Atherosclerotic Plaque Localize at the Bifurcation of the Carotid Artery?
2576.How Does a Carotid Stenosis Typically Cause Symptoms?
2577.Is the Degree of ICA Stenosis Related to the Risk of Symptoms Developing?
2578.If a Patient Had Multiple TIAs with the Same Symptom Each Time, What Is the Most Likely Source of the TIA?
2579.What Happens When the ICA Occludes?
2580.What Is a Symptomatic Carotid Artery Stenosis?
2581.What Additional Symptom Can Help Differentiate Left from Right Carotid Artery Stenosis?
2583.How Useful Is the Presence of a Bruit for Detecting Carotid Artery Stenosis?
2584.What Is the Diagnostic Test of Choice for the Workup of Possible Carotid Stenosis?
2585.Are Additional Diagnostic Studies Warranted?
2587.What Are the Three Management Options for Symptomatic Carotid Stenosis?
2588.At What Percent of ICA Stenosis Should CEA Be Considered in Symptomatic Patients?
2589.Following a Stroke or TIA, What Is the Optimal Timing of CEA?
2590.Why Is CEA Not Recommended for a Symptomatic Patient with an Occluded (100% Stenosis) ICA?
2591.What Is the Role of CEA in a Patient with Symptomatic ICA Stenosis that Resulted in Complete Paralysis of the Arm and Leg As Well As Aphasia?
2592.What Is the Anticipated Stroke Risk Reduction for CEA for a Symptomatic 70–99% ICA Stenosis?
2593.What Is the Management of Carotid Stenosis in an Asymptomatic Patient? (◘ Table 56.4)
2594.At What Percent of ICA Stenosis Should CEA Be Considered in Asymptomatic Patients?
2595.What Is the Anticipated Stroke Risk Reduction for CEA for an Asymptomatic 60–99% ICA Stenosis?
2596.Why Is There Less Benefit from CEA in Women?
2597.What Medications Have Been Shown to Reduce the Risk of Perioperative Stroke After CEA?
2598.Why Is Blood Pressure Control Important Prior to CEA?
2599.What Complication Likely Occurred in a Patient Complaining of a Severe Headache Days After CEA?
2600.What Cranial Nerves Are at Risk of Injury During CEA? (◘ Table 56.5)
2601.What Is an Acceptable Risk of Stroke/Death Following CEA?
2602.What Is the Role of Mechanical Thrombectomy in the Management of Ischemic Stroke?
2603.What Imaging Is Required Before Performing Mechanical Thrombectomy?
2604.Area Where You Can Get in Trouble
2605.New Neurologic Deficit in the Postoperative Recovery Room After CEA
2607.Carotid Stenting Versus CEA for Symptomatic High-Grade (>70%) ICA Stenosis
2608.Carotid Artery Disease (◘ Fig. 56.2)
2609.Summary of Essentials
2610.Differential Diagnosis
2613.Pathology/Pathophysiology
2616.57. Right Calf Pain with Walking
2619.What Is the Differential Diagnosis? (◘ Table 57.1)
2620.What Is the Most Likely Diagnosis?
2621.History and Physical
2622.What Is Claudication, and What Is the Three-Part Definition that Should Be Obtained by History?
2623.Claudication Is a Symptom of What Underlying Disease?
2624.What Are the Main Risk Factors for PAD?
2625.What Is the Spectrum of Severity in PAD?
2626.What Is Critical Limb-Threatening Ischemia (CLTI)?
2627.What Is Ischemic Rest Pain, and How Does It Present?
2628.What Is Buerger’s Sign?
2629.How Is the ABI Measured?
2630.How Many Pulses Should Be Examined?
2631.In Addition to a Pulse Deficit, What Other Findings on Leg Examination Would Support PAD?
2633.What Muscle Groups Are Affected by Claudication?
2634.Where Is the Hunter/Adductor Canal Located?
2636.What Is Dependent Rubor?
2637.Why Is the Onset of Claudication Consistently at the Same Walking Distance?
2638.What Other Disease Processes Can Cause Claudication?
2639.What Condition Is Classically Associated with Claudication in the Upper Extremities?
2640.What Is Buerger’s Disease?
2641.What Is Leriche’s Syndrome (Aortoiliac Occlusive Disease)?
2643.What Is the Next Step in the Diagnostic Workup?
2644.How Is PAD Defined? (◘ Table 57.3)
2645.What Is the Typical ABI of a Patient with Claudication? Rest Pain?
2646.Once the Diagnosis of PAD Is Established with ABI and Duplex, Are Further Studies Needed? If So, What Study?
2647.What is a Formal Angiogram?
2649.What Is the Risk of Limb Loss for Patients with Claudication?
2650.What Is the Risk of Limb Loss for Patients with Ischemic Rest Pain in the Foot?
2651.What Symptoms/Signs Are Considered an Indication for More Aggressive Management?
2653.What Is the Initial Management of Claudication?
2654.Are There Any Drugs Specifically Approved by the Food and Drug Administration (FDA) for Claudication?
2655.What About a Statin? Does It Improve Claudication?
2656.What About Aspirin? Does It Improve Claudication?
2657.What About Clopidogrel?
2658.What About Anticoagulants Such as Heparin or Warfarin?
2659.What Are the Invasive Therapeutic Options?
2660.If Medical Management Fails, Which Patients with Claudication Are Candidates for an Invasive Therapeutic Approach?
2661.Which Patients with PAD Should Go Directly to an Invasive Therapeutic Approach Rather Than an Initial Attempt at Medical Management?
2662.What Is the 5-Year Mortality for Patients with PAD?
2663.Key Areas Where You Can Get in Trouble
2664.Confusing the Dependent Rubor of Rest Pain with Cellulitis (or Confusing Dependent Rubor with a Well-Perfused Foot)
2665.Assuming an ABI of >1.0 Is a Sign of Normal Circulation in a Diabetic Patient
2666.Areas of Controversy
2667.Should a Patient with Claudication Who Is Still Smoking Undergo an Invasive Procedure?
2668.Should a Patient with Claudication Ever Undergo an Invasive Procedure?
2669.In a Patient with CLTI (Rutherford Class 4, 5, or 6), Is It Better to Attempt an Endovascular Approach (Angioplasty/Stenting) or to Perform an Open Surgical Bypass (Using Reverse Saphenous Vein)?
2670.Summary of Essentials
2673.Pathology/Pathophysiology
2674.Differential Diagnosis
2680.58. Sudden Onset of Severe Left-Sided Abdominal Pain
2683.What Is the Differential Diagnosis? (◘ Table 58.1)
2684.What Is the Most Likely Diagnosis?
2685.History and Physical Examination
2686.What Is the Typical Presentation for an Unruptured AAA?
2687.What Are the Risk Factors for AAA?
2688.Is Diabetes a Risk Factor for AAA?
2689.Is There a Role for Physical Examination in the Detection of AAA? What Are the Limitations?
2690.Is There a Role for AAA Screening? If So, Who Should Be Screened and How Often?
2691.Shouldn’t Women Who Have Smoked Also Be Screened for AAA?
2692.In a Patient with an AAA, What Other Arteries Might Have Aneurysms? How Would You Screen for Them? What Is the Main Risk Associated with Those Aneurysms?
2694.What Is the Normal Diameter of the Infrarenal Aorta in Men? Women?
2695.What Is the Primary Defect in AAA?
2696.At What Diameter Is the Infrarenal Aorta Considered to Be Aneurysmal?
2697.What Is the Average Annual Growth Rate of AAA?
2698.What Factors Influence Growth Rate?
2699.What Are Matrix Metalloproteinases (MMPs), and What Is Their Role in AAA Formation?
2700.Is There a Genetic Component to AAA Formation?
2701.If an AAA Ruptures, Where Does It Typically Do So?
2702.What Is the Relationship Between AAA Rupture and Size?
2703.Other Than AAA Size, What Are Other Risk Factors for AAA Rupture?
2704.What Are the Primary Differences Between an Aortic Dissection and an AAA? (◘ Table 58.2)
2706.What Is the First Step in the Evaluation of a Patient with a Suspected Ruptured AAA?
2707.In a Patient with Suspected Ruptured AAA, What Is the Goal of Fluid Resuscitation?
2708.What Imaging Is Recommended for Suspected Ruptured AAA in a Hemodynamically Stable Patient?
2709.How Does the Imaging of Choice Differ in a Hemodynamically Unstable Patient?
2711.How Does AAA Size and Growth Rate Influence Management for an Asymptomatic AAA in Males? (◘ Table 58.3)
2712.Non-ruptured Asymptomatic AAA
2713.Why Wait for the AAA to Reach this Size? Why Not Repair a Smaller AAA Since the Patient Is Theoretically Healthier and Is Younger?
2714.What Surgical Options Are Available for Asymptomatic AAA?
2715.How Do the Two Surgical Approaches Compare in Terms of Perioperative Morbidity and Mortality? What About Long-Term Mortality?
2717.What Are the Surgical Options for a Patient with a Ruptured AAA?
2718.What Anatomical Factors Make an AAA Unsuitable for EVAR?
2719.What Is the Mortality Risk if an AAA Ruptures?
2720.What Is the Main Achilles Heel of Endovascular Repair?
2721.How Should Patients Be Monitored After an Endovascular AAA Repair?
2722.Are There Any Consequences To Annual CT Scans?
2723.Areas Where You Can Get in Trouble
2724.Assuming That an AAA Is Not Ruptured Because No Contrast Extravasation Is Seen on CT
2725.Early-Onset Diarrhea After AAA Repair
2726.GI Bleed After AAA Repair
2728.Since EVAR Has a Lower Risk of Perioperative Mortality Than Open Repair, Should We Lower Our Threshold for AAA Repair (i.e., <5.5 cm) If the Patient Is an EVAR Candidate?
2729.Which Is the Best Option for Elective AAA Repair, Open or EVAR?
2730.Abdominal Aortic Aneurysm (AAA) (◘ Fig. 58.3)
2731.Summary of Essentials
2732.History and Physical Examination
2737.59. Cold, Painful Right Lower Extremity
2740.What Is the Differential Diagnosis? (◘ Table 59.1)
2741.What Is the Most Likely Diagnosis?
2742.History and Physical
2743.What Is the Difference in Timing Between Acute and Chronic Limb-Threatening Ischemia (CLTI)?
2744.What Are the “Ps” of Acute Limb Ischemia?
2745.Why Is the Cardiac History Important in Determining the Etiology of ALI?
2746.What Are the Key Findings That Point Toward an Embolic Etiology Rather Than a Thrombotic Event?
2747.Why Is It Important to Examine the Contralateral, Nonischemic Limb?
2748.How Would You Best Assess This Patient’s Atherosclerotic Disease History?
2749.Why Is It Important to Ask About Past Interventions for PAD?
2750.How Do Peripheral Artery Aneurysms Typically Present, and What Are Their Common Associations?
2752.Where in the Arterial Tree Do Cardiac Emboli Tend to Lodge?
2753.Why Do Aneurysms Cause Thrombus Formation?
2754.How Does Peripheral Arterial Disease Lead to Acute Limb Ischemia?
2755.How Long Can Muscle Tissue Withstand Ischemia Before Irreversible Damage Occurs?
2757.What Is the First Step After Suspecting ALI?
2758.What Does a Doppler Probe Detect and What Are the Three Signals?
2759.Is the Ankle–Brachial Index Useful for ALI?
2760.How Is the Severity of ALI Determined?
2761.What Imaging Is Recommended?
2762.What Additional Imaging Should Be Done If an Embolus Is Suspected as the Cause for ALI? If a Paradoxical Embolus Is Suspected?
2764.What Are the Three Most Important Initial Management Steps?
2765.What Are the Main Therapeutic Options for ALI?
2766.What Are the Absolute Contraindications to Thrombolytic Therapy? Relative Contraindications?
2767.How Does One Choose Between Open Surgery and Endovascular Therapy?
2768.Who Is the Best Candidate for Surgical Balloon Embolectomy?
2769.What Is the Treatment for Irreversible Limb Ischemia?
2770.What Are the Potential Dangerous Sequelae of Reperfusion Following ALI?
2771.Areas Where You Can Get into Trouble
2772.Failing to Monitor for Elevated CPK and Myoglobinuria
2773.Following Revascularization, the Patient Develops Peaked T Waves on the EKG
2774.Following Revascularization, the Patient Develops a Swollen Leg
2775.Platelet Count Drop 5 Days After Successful Reperfusion
2776.Acute Limb Ischemia (◘ Fig. 59.1)
2777.Summary of Essentials
2778.History and Physical
2783.Areas Where You Can Get into Trouble
2784.Question Set: Vascular
3296.Fig. 2.1: Femoral hernia. (From: Ates M, et al. First laparoscopic totally extraperitoneal repair of Laugier’s hernia: a case report. Hernia. 2013;17(1):121–3. Reprinted with permission from Springer Nature)
3297.Fig. 2.2: Umbilical hernia. (From Miller R, et al. Umbilical hernia in babies and children. In: LeBlanc K, Kingsnorth A, Sanders D, editors. Management of abdominal hernias. Cham: Springer; 2018. Reprinted with permission from Springer Nature)
3298.Fig. 2.3: Normal pelvic CT without hernia. White arrows: normal inguinal canals
3299.Fig. 2.4: Axial (a) and coronal (b) CT scans showing a right-sided femoral hernia. Note that it is medial to the femoral vein and inferior to the inguinal ligament. White arrows: hernia sac. Black arrows: femoral vein. Black dotted line: location of inguinal ligament
3300.Fig. 2.5: Laparoscopic View of the Myopectineal Orifice. This view shows the landmarks for various hernias. An indirect hernia occurs lateral to the inferior epigastric vessels, a direct hernia occurs medial to the vessels, and a femoral hernia occurs inferior to the inguinal ligament. Also shown are the triangle of doom, which contains the external iliac vessels, and the triangle of pain, which contains sensory nerves
3301.Fig. 3.1: Upright abdominal X-ray with air-fluid levels
3302.Fig. 3.2: Small Bowel Obstruction. A closed-loop obstruction of the small bowel is shown, caused by an adhesive band. This condition requires urgent surgery due to a high risk of strangulation and bowel ischemia
3303.Fig. 5.1: Normal screening mammogram, craniocaudal (CC) view
3304.Fig. 5.2: Abnormal screening mammogram (CC view) showing 1 cm foci of microcalcifications in the upper outer quadrant BI-RADS (category 0)
3305.Fig. 6.1: Diagnostic mammogram with craniocaudal (CC) view (left) and mediolateral oblique (MLO) view (right). White arrows: mass suspicious for malignancy. Black arrow: enlarged axillary lymph node suspicious for malignant involvement
3306.Fig. 9.1: Chest radiograph on admission showing widening of the upper mediastinum
3307.Fig. 9.2: Aortic dissection classification scheme diagram. (Illustration by Anne-Sophie Sillesen; From: Pandey and Hamady (2012). Reprinted with permission)
3308.Fig. 9.3: Axial CT showing a Stanford type A aortic dissection involving the ascending and descending aorta. White arrows: intimal flap. Black arrow: true lumen
3309.Fig. 9.4: Axial CT showing a Stanford type B aortic dissection involving the descending aorta. White arrow: intimal flap. Black arrow: normal ascending aorta
3310.Fig. 9.5: Complications of Aortic Dissection. An aortic dissection can occlude major arteries, leading to severe complications. These include superior mesenteric artery occlusion causing bowel ischemia, renal artery occlusion causing impaired renal perfusion, and iliac artery occlusion causing acute limb ischemia
3311.Fig. 11.1: Axial CT showing a small incidentaloma—an asymptomatic adrenal nodule discovered incidentally
3312.Fig. 11.2: Cushing’s syndrome
3313.Fig. 11.3: Axial CT of the normal left adrenal gland
3314.Fig. 11.4: Axial CT showing a large adrenal mass consistent with malignant adrenal cortical carcinoma
3315.Fig. 11.5: Algorithm for workup and management of incidental adrenal mass
3316.Fig. 12.1: Parathyroid glands
3317.Fig. 12.2: Sestamibi scan showing a hyperactive parathyroid adenoma
3318.Fig. 12.3: Diagnostic algorithm for primary hyperparathyroidism
3319.Fig. 12.4: Management algorithm for primary hyperparathyroidism
3320.Fig. 13.1: Coronal CT with an enhancing adrenal nodule consistent with pheochromocytoma
3321.Fig. 13.2: Algorithm for diagnosis and treatment of pheochromocytoma (Paroxysmal symptoms, intermittent or sustained hypertension, family history, or adrenal mass seen on imaging)
3322.Fig. 14.1: Diagnostic algorithm for nonfunctioning solitary thyroid nodule found on examination or imaging
3323.Fig. 15.1: Algorithm for diagnosis and management of hoarseness
3324.Fig. 16.1: Work-up of neck mass suspicious for malignancy: If at any point in the work-up the primary tumor is identified, treatment should be tailored to the specific site and type of the tumor. If at the end of the diagnostic work-up no primary tumor has been identified, all sites in the head and neck should be treated
3325.Fig. 18.1: Thickened gallbladder wall on ultrasound. (From Kimura Y et al. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:12. ©Japanese Society of Hepato-Biliary-Pancreatic Surgery. Reprinted with permission.)
3326.Fig. 18.2: RUQ abdominal ultrasound of a normal thin-walled gallbladder
3327.Fig. 18.3: RUQ ultrasound showing thickened, edematous gallbladder wall consistent with acute cholecystitis
3328.Fig. 18.4: Gallstone ileus. (From Liau et al. A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis. Clin J Gastroenterol. 2009;2:239. Reprinted with permission)
3329.Fig. 18.5: Axial CT of a normal thin-walled gallbladder
3330.Fig. 18.6: Axial CT showing air in the gallbladder wall, known as emphysematous cholecystitis
3331.Fig. 18.7: Work-up for delayed recognition of CBD injuries
3332.Fig. 18.8: Gallstones: Clinical scenarios (a) in which gallstones can cause significant problems within the biliary and gastrointestinal systems, including: Symptomatic cholelithiasis: Transient obstruction of the cystic duct causing intermittent biliary colic. Acute cholecystitis: Persistent obstruction of the cystic duct, leading to inflammation and infection of the gallbladder. Choledocholithiasis: Obstruction of the common bile duct, potentially causing jaundice and cholangitis. Gallstone pancreatitis: Obstruction of the pancreatic duct, resulting in inflammation of the pancreas. Gallstone fistula to duodenum: Formation of a fistula (b) between the gallbladder and duodenum, leading to the passage of gallstones into the gastrointestinal tract
3333.Fig. 18.9: Critical view of safety: A key step in laparoscopic cholecystectomy to prevent bile duct injury. It is achieved when the hepatocystic triangle is cleared of tissue, the lower third of the gallbladder is dissected off the cystic plate, and only two structures (the cystic duct and artery) are seen entering the gallbladder
3334.Fig. 18.10: Porcelain gallbladder on coronal CT. (From Amorosa JK, et al. GastroIntestinal radiology. In: Pitchumoni C, Dharmarajan T, editors. Geriatric gastroenterology. New York: Springer; 2012. Reprinted with permission)
3335.Fig. 19.1: Overall treatment algorithm
3336.Fig. 19.2: ERCP Procedure: During an ERCP, an endoscope is advanced into the duodenum to cannulate the ampulla of Vater. The procedure can be used for stone extraction (a), performing a sphincterotomy (b), and placing a biliary stent (c) to prevent further obstruction
3337.Fig. 20.1: Chest X-ray showing diffuse bilateral pulmonary infiltrates characteristic of ARDS
3338.Fig. 20.2: Axial CT with a normal-appearing pancreas (black arrows: normal pancreas)
3339.Fig. 20.3: Axial CT scan with peripancreatic fluid collections exhibiting thick irregular walls and marked fat stranding, consistent with abscesses
3340.Fig. 20.4: Axial CT scan showing a thin-walled peripancreatic fluid collection consistent with pancreatic pseudocyst
3341.Fig. 20.5: Management algorithm for acute pancreatitis (based on the practice guidelines from the American College of Gastroenterology)
3342.Fig. 20.6: Whipple procedure: This procedure involves the division of four structures: the stomach/duodenum, CBD, pancreatic neck, and jejunum (a). The surgical specimen contains the duodenum, gallbladder, CBD, and the head of the pancreas (b). Reconstruction involves three new connections: a pancreaticojejunostomy, a gastrojejunostomy, and a hepaticojejunostomy (c)
3343.Fig. 21.1: Algorithm for presentation of jaundice
3344.Fig. 22.1: Diverticular disease: The illustration depicts two forms of diverticular disease: a bleeding diverticulum in the right colon and diverticulitis in the left colon, which is characterized by inflammation that can lead to abscess or perforation.
3345.Fig. 23.1: McBurney’s point. a McBurney’s point marked for mini incision. b Incision appearance on postoperative day 4. The procedure began by making a small incision, 1.5–1.8 cm in length, according to the thickness of the abdominal wall, at McBurney’s point. (From Chen D, et al. Gasless single-incision laparoscopic appendectomy. Surgical Endoscopy. 2011;25:1473. Reprinted with permission from Springer Nature)
3346.Fig. 23.2: Algorithm for acute appendicitis
3347.Fig. 23.3: Coronal CT showing the normal appendix (white arrow) as a thin tubular structure arising from the base of the cecum
3348.Fig. 23.4: Coronal CT showing a dilated, thick-walled, fluid-filled appendix containing appendicoliths, indicating acute appendicitis. White arrows, dilated appendix; black arrows, appendicoliths
3349.Fig. 23.5: Progression of Appendicitis: This figure shows the progression of appendicitis, which begins with luminal obstruction. This leads to increased pressure and venous congestion, followed by ischemia and full-thickness perforation of the appendix wall
3350.Fig. 24.1: Adenoma-carcinoma sequence (From Chu DZJ, et al. The Surgeon’s Role in Cancer Prevention. The Model in Colorectal Carcinoma. Annals of Surgical Oncology 2007;14(11):3058. Reprinted with permission from Springer Nature)
3351.Fig. 24.2: Axial CT of hypoenhancing liver masses consistent with metastases
3352.Fig. 25.1: Abdominal x-ray showing the “coffee bean” or “bent inner tube” sign of sigmoid volvulus
3353.Fig. 26.1: Axial CT of the pelvis showing a normal sigmoid colon with thin walls and filled with stool. There are no diverticula
3354.Fig. 26.2: Axial CT of the pelvis demonstrating sigmoid diverticula with significant wall thickening of the sigmoid colon, consistent with acute sigmoid diverticulitis. White arrows: diverticula
3355.Fig. 26.3: Diverticulitis complications: Local inflammation from diverticulitis can lead to numerous complications, including the formation of an abscess, perforation, stricture causing obstruction, or a colovesicular fistula
3356.Fig. 27.1: a and b, Differences between Crohn’s disease (left) and ulcerative colitis (right), specifically related to depth of mucosal involvement, gross lesion distribution, mucosal appearance on colonoscopy, and complications
3357.Fig. 28.1: a Lateral radiograph and b computed tomographic scan. (Reprinted from Vollmer et al. (2011). Copyright 2011, with permission from Elsevier)
3358.Fig. 28.2: These illustrations demonstrate three common patterns of spinal cord injury
3359.Fig. 29.1: Non-contrast head CT demonstrating an acute epidural hematoma. (From Hanley DF, et al. Coma and intensive care neurology. In: Rosenberg RN, editor. Atlas of clinical neurology. London: Current Medicine Group; 2003. Reprinted with permission from Springer Nature)
3360.Fig. 29.2: Non-contrast head CT demonstrating an acute subdural hematoma. (From Erdogan B, et al. Hemispheric cerebrovascular venous thrombosis due to closed head injury. Childs Nerv Syst. 2004;20:239. ► https://doi.org/10.1007/s00381-003-0845-7. Reprinted with permission from Springer Nature)
3361.Fig. 30.1: Right mid-shaft humerus fracture. (From Jordanov MI. The “rising bubble” sign: a new aid in the diagnosis of unicameral bone cysts. Skeletal Radiol. 2009;38:597. ► https://doi.org/10.1007/s00256-009-0685-y. Reprinted with permission from Springer Nature)
3362.Fig. 30.2: Intramedullary nail for femoral fracture (From Li X, et al. Pseudoaneurysm of the profunda femoris artery following a long anterograde intramedullary nail for an unstable intertrochanteric hip fracture: a case report and review of the literature. Eur J Orthop Surg Traumatol. 2011;21:293. ► https://doi.org/10.1007/s00590-010-0700-y. Reprinted with permission from Springer Nature)
3363.Fig. 31.1: (a) Normal radiograph of the knee. (From Abdul-Jabar HB, et al. Primary meningococcal oligoarthritis of the knee—case report and review of the literature. Eur Orthop Traumatol. 2011;2:149. ► https://doi.org/10.1007/s12570-011-0078-2. Reprinted with permission Springer Nature). (b) Arthritic knee. (From Leonard M, Murphy PG. End-stage osteoarthritis of the knee presenting with foot drop. Eur J Orthop Surg Traumatol. 2007;17:399. ► https://doi.org/10.1007/s00590-007-0200-x. Reprinted with permission from Springer Nature)
3364.Fig. 32.1: Developmental dysplasia of the hip radiograph showing normal right and subluxated left hip
3365.Fig. 32.2: SCFE schematic
3366.Fig. 32.3: SCFE radiograph (frog lateral) showing SCFE on the left and normal on the right
3367.Fig. 34.1: Chest radiograph of an infant with CDH
3368.Fig. 34.2: Diagnostic algorithm for surgical causes of neonatal respiratory distress
3369.Fig. 35.1: Photograph of malrotation with midgut volvulus
3370.Fig. 35.2: UGI contrast study with small bowel follow-through
3371.Fig. 35.3: Abnormal positioning of the bowel (a) due to malrotation and Ladd’s bands, which can progress to midgut volvulus (b)
3372.Fig. 36.1: Ultrasound image of pyloric stenosis (pyloric length is 24 mm)
3373.Fig. 37.1: Gastroschisis (a) and omphalocele (b)
3374.Fig. 37.2: Initial silo placement for gastroschisis (a) and complete reduction (b)
3375.Fig. 38.1: (a, b) Anteroposterior and lateral chest radiographs after orogastric tube placement (arrows). The stomach (S) is shown in the anteroposterior radiograph
3376.Fig. 38.2: (a–f) Gross classification of esophageal atresia and tracheoesophageal fistula. (From Harmon CM, Coran AG. Congenital anomalies of the esophagus. In: Coran AG, et al. Pediatric Surgery, 7th edition. Copyright Elsevier (2012). Reprinted with permission)
3377.Fig. 39.1: Coagulation cascade. HMWK high molecular weight kininogen, PK prekallikrein, TF tissue factor. (From: Kottke-Marchant K. The role of coagulation in arterial and venous thrombosis. In: Contemporary Cardiology: Antithrombotic Drug Therapy in Cardiovascular Disease. Kottke-Marchant K, editor. © Humana Press, a part of Springer Science+Business Media, LLC 2010, reprinted with permission)
3378.Fig. 41.1: Low likelihood is based on Wells score ≤4. D-dimer assay is considered normal if the D-dimer level is <500 ng/dL
3379.Fig. 41.2: Axial CT angiogram showing a filling defect in the left pulmonary artery consistent with pulmonary embolism
3380.Fig. 42.1: Axial CT showing a ruptured spleen with free fluid around the liver from blunt abdominal trauma
3381.Fig. 42.2: Axial CT showing severe blunt liver trauma as evidenced by regions of hypoenhancement suggesting laceration and/or vascular compromise
3382.Fig. 42.3: Sources of bleeding in trauma: Potential sources of major blood loss after blunt trauma include the chest, abdomen, retroperitoneum, long bones, and external wounds (“the street”)
3383.Fig. 43.1: Lethal triad of death in the trauma patient. (Source: From Grabo and Beekley (2017). © Springer Nature 2017, Reprinted with permission)
3384.Fig. 44.1: Algorithm for extremity injury management
3385.Fig. 46.1: These illustrations demonstrate the lethal six injuries of thoracic trauma. 1. Airway obstruction a—more likely to be due to blood in context of trauma 2. Tension pneumothorax b—increased pressure from pneumothorax leads to mediastinal shift and results in decreased preload in the heart and cardiovascular collapse 3. Open pneumothorax c—air is drawn into the pleural space during inhalation, leading to respiratory collapse 4. Massive hemothorax d—resulting from a bleeding vessel from thoracic trauma (ex rib fracture) 5. Flail chest e—multiple adjacent rib fractures resulting in a free segment of chest wall that moves paradoxically and impairs adequate ventilation 6. Cardiac tamponade f—blood accumulation in the pericardial sac, which in turn impairs the heart’s ability to fill and pump, resulting in hypotension and shock
3386.Fig. 47.1: Rule of 9s in adults
3387.Fig. 48.1: Four compartments of the lower leg include a (1) Anterior compartment—contains the deep peroneal nerve. (2) Lateral compartment—contains the superficial peroneal nerve. (3) Superficial posterior compartment. (4) Deep posterior compartment—contains the tibial nerve and posterior tibial artery. To perform a four-compartment fasciotomy, two incisions are made on the lower leg—one 2 cm medial to the tibia, and one 1 cm medial to the fibula b.
3388.Fig. 49.1: Management algorithm of UGIB
3389.Fig. 51.1: Axial CT of gastric adenocarcinoma showing a thickened stomach wall and a metastatic gastrosplenic mass. Black arrows: thickened stomach. White arrows: gastrosplenic mass
3390.Fig. 51.2: Algorithm for gastric cancer
3391.Fig. 52.1: Algorithm for the treatment of a patient with Boerhaave’s syndrome
3392.Fig. 53.1: Blue-dot sign. (From Kaplan GW, McAleer IM. Office urology. In: Poppas DP, Retik AB, editors. Pediatric urology. Atlas of clinical urology. London: Current Medicine Group; 2003. Reprinted with permission)
3393.Fig. 53.2: Scrotal Doppler ultrasound showing absent flow in the left testis consistent with testicular torsion. Note: normal color flow in the right testicle (left side of image)
3394.Fig. 54.1: Scrotal ultrasound showing an enlarged testicle with heterogeneous echotexture suggestive of infiltrative cancer. Compare with normal testis on the left of the image. White arrow: abnormal testicle
3395.Fig. 55.1: Abdominal X-ray showing branching radiopaque stones outlining the renal collecting system, consistent with staghorn calculi
3396.Fig. 56.1: Lateral CT angiogram showing high-grade stenosis at the origin of the internal carotid artery (white arrow)
3397.Fig 56.2: Carotid artery embolism: An atherosclerotic plaque within the common carotid artery can serve as a source of emboli, which can travel to arteries like the ophthalmic artery
3398.Fig. 57.1: Coronal CT angiogram showing a normal aorta and common iliac arteries
3399.Fig. 57.2: Coronal CT angiogram showing occlusion of the abdominal aorta just below the renal arteries
3400.Fig. 58.1: Axial CT showing a normal aorta
3401.Fig. 58.2: Axial CT showing a ruptured abdominal aortic aneurysm with thrombus and large left-sided fluid collection consistent with rupture. Black arrow: thrombus. White arrows: fluid collection
3402.Fig. 58.3: A normal aorta. a can progress to a saccular b abdominal aortic aneurysm or a fusiform abdominal aortic aneurysm c. Endovascular aortic repair (EVAR) is a procedure that endovascularly inserts a stent graft to reinforce the aortic wall and reduce risk of aneurysm rupture d
3403.Fig. 59.1: This compares two major causes of acute limb ischemia: embolism versus atherosclerotic plaque. An embolus typically originates from the heart (a) or large arteries and can travel through the bloodstream, causing sudden blockage of blood flow and leading to acute onset of limb ischemia (b). In contrast, atherosclerotic plaque results in gradual narrowing of an arterial lumen over time leading to plaque formation and stasis, which can lead to in-situ thrombosis (c)
3404.Table 1.1: Differential diagnosis for postoperative fever
3405.Table 1.2: Classic timing of postoperative fever (The Five Ws)
3406.Table 1.3: Hemodynamic profiles of the different types of shock
3407.Table 1.4: Reversible causes of cardiac arrest (Hs and Ts)
3408.Table 2.1: Differential diagnosis of groin mass
3409.Table 2.2: Types of groin hernias
3410.Table 2.3: Nerve injuries during hernia repair
3411.Table 3.1: Differential diagnosis of clinical presentation
3412.Table 3.2: Common causes of small bowel obstruction
3413.Table 3.3: Radiologic findings associated with small bowel obstruction
3414.Table 4.1: Differential diagnosis of clinical presentation
3415.Table 4.2: LRINEC score
3416.Table 5.1: Differential diagnosis of clinical presentation
3417.Table 5.2: Ductal carcinoma in situ (DCIS) versus lobular carcinoma in situ (LCIS)
3419.Table 6.1: Differential diagnosis of a palpable breast mass
3420.Table 6.2: Malignant lesions of the breast
3421.Table 6.3: Relative risk (RR) for breast cancer
3422.Table 6.4: Hormonal therapy in breast cancer
3423.Table 6.5: Chemotherapeutic regimens for breast cancer
3424.Table 6.6: Nerves at risk during axillary lymph node dissection
3425.Table 7.1: Differential diagnosis of clinical presentation
3426.Table 7.2: “ABCDEs” of melanoma
3427.Table 7.3: Four subtypes of melanoma
3428.Table 7.4: Breslow thickness 5-year survival
3429.Table 7.5: Treatment options for skin cancer
3430.Table 7.6: Melanoma excision
3431.Table 8.1: Differential diagnosis of clinical presentation
3432.Table 8.2: Differentiating features of cardiac murmurs
3433.Table 8.3: Effects of maneuvers on systolic murmurs
3434.Table 8.4: Acute coronary syndrome
3435.Table 8.5: Coronary anatomy and ECG changes
3436.Table 8.6: Management of STEMI
3437.Table 8.7: Complications of MI
3438.Table 9.1: Differential diagnosis of clinical presentation
3439.Table 9.2: Physical findings for endocarditis
3440.Table 9.3: Characteristics of Stanford type A versus type B aortic dissection
3441.Table 10.1: Differential diagnosis of clinical presentation
3442.Table 10.2: Occupational exposure
3443.Table 10.3: Light’s Criteria for Pleural Effusion Classification
3444.Table 10.4: Lung cancer subtypes
3445.Table 10.5: Syndromes associated with lung cancer
3446.Table 11.1: Common adrenal incidentalomas
3447.Table 12.1: Differential diagnosis of hypercalcemia
3448.Table 12.2: Different types of hyperparathyroidism
3449.Table 12.3: Calcium metabolism
3450.Table 13.1: Differential diagnosis of secondary hypertension
3451.Table 13.2: Hereditary syndromes associated with pheochromocytoma
3452.Table 13.3: Physiological effects of catecholamine receptors
3453.Table 13.4: Postoperative complications after adrenalectomy
3454.Table 14.1: Differential diagnosis for a thyroid mass
3455.Table 14.2: Types and characteristics of thyroid cancer
3456.Table 14.3: Bethesda reporting system for thyroid FNAs
3457.Table 15.1: Differential diagnosis of hoarseness
3458.Table 15.2: Innervation of the laryngeal muscles
3459.Table 16.1: Differential diagnosis of clinical presentation
3460.Table 16.2: Risk factors for head and neck cancers
3461.Table 16.3: Symptoms of head and neck cancer
3462.Table 16.4: Differential diagnosis for salivary glands tumors
3463.Table 16.5: Types of neck abscesses
3464.Table 17.1: Differential diagnosis of hearing loss in a child
3465.Table 17.2: Differential diagnosis of hearing loss in an adult
3466.Table 18.1 Differential diagnosis of clinical presentation
3467.Table 18.2 Differentiation between symptomatic cholelithiasis and acute cholecystitis
3468.Table 18.3 Manifestations of gallstone disease
3469.Table 18.4: Postcholecystectomy Syndrome (PCS)
3470.Table 19.1 Differential diagnosis of clinical presentation
3471.Table 20.1 Differential diagnosis of epigastric abdominal pain
3472.Table 20.2 Common etiologies of acute pancreatitis
3473.Table 20.3 Acute vs. chronic pancreatitis
3474.Table 20.4: Hyperamylasemia
3475.Table 21.1 Differential diagnosis of painless jaundice
3476.Table 21.2 Palliative options
3477.Table 22.1 Differential diagnosis of LGIB
3478.Table 22.2 Localization of bleeding based on stool characteristics
3479.Table 22.3 Terminology related to diverticular disease
3480.Table 22.4 Comparison of ischemic colitis and acute mesenteric ischemia
3481.Table 23.1 Differential diagnosis for RLQ pain in an adult
3482.Table 23.2 Differential diagnosis for RLQ pain in women
3483.Table 23.3 Differential diagnosis for RLQ pain in a child
3484.Table 23.4: Signs of appendicitis
3485.Table 24.1: The differential diagnosis for a change in bowel habits
3486.Table 24.2: Screening for colorectal cancer
3487.Table 24.3: The most frequently diagnosed cancers and its overall cancer-related mortality
3488.Table 24.4: Adenomatous polyps/Adenomas
3489.Table 24.5: Location of colon cancer and procedure
3490.Table 25.1 Differential diagnosis of clinical presentation
3491.Table 26.1 Differential diagnosis of clinical presentation
3492.Table 26.2 Complications of diverticulitis
3493.Table 26.3: Management of complicated diverticulitis
3494.Table 27.1 Differential diagnosis of chronic diarrhea
3495.Table 27.2 Distinguishing features of Crohn’s and ulcerative colitis
3496.Table 27.3: Nutritional deficiencies in IBD
3497.Table 28.1 Spinal cord syndromes associated with cervical spine injury
3498.Table 28.2: Common dermatomal levels
3499.Table 28.3: Deep tendon reflexes
3500.Table 28.4: Upper motor neuron (UMN) and lower motor neuron (LMN) signs
3501.Table 28.5 Pathophysiology of incomplete spinal cord injuries
3502.Table 29.1 Differential diagnosis for severe TBI
3503.Table 29.2: Glasgow Coma Scale (GCS)
3504.Table 29.3 CT findings for TBI
3505.Table 30.1 Seddon’s classification of nerve injury
3506.Table 30.2 Common nerve injuries associated with fractures
3507.Table 30.3: Gustilo-Anderson grading system
3508.Table 30.4: Clostridium tetani infection
3509.Table 31.1: Differential diagnosis of acute knee pain
3510.Table 31.2: Classic history for ligamentous injuries
3511.Table 31.3: Knee maneuvers
3512.Table 31.4: Arthrocentesis findings
3513.Table 32.1: Differential diagnosis for groin pain
3514.Table 32.2: Physical exam tests for the hip
3515.Table 32.3: Pathophysiology for orthopedic mechanical diagnoses
3516.Table 32.4: Kocher criteria to diagnose septic arthritis in pediatric population
3517.Table 32.5: X-ray findings of pediatric orthopedic mechanical hip diseases
3518.Table 32.6: Management of diagnoses for the differential
3519.Table 33.1: Differential diagnosis of clinical presentation
3520.Table 33.2: History and physical exam findings
3521.Table 34.1: Differential diagnosis of surgical causes of neonatal respiratory distress
3522.Table 34.2: Most common anomalies associated with CDH
3523.Table 35.1: Differential diagnosis for bilious emesis in an infant
3524.Table 35.2: Differential diagnosis of bilious emesis by age
3525.Table 36.1: Differential diagnosis of nonbilious emesis in neonate
3526.Table 37.1: Differential diagnosis and distinguishing features for a newborn with an abdominal wall defects
3527.Table 37.2: Differences between gastroschisis and omphalocele
3528.Table 38.1: Differential diagnosis of excessive drooling/feeding intolerance in a newborn
3529.Table 38.2: Anomalies found in VACTERL
3530.Table 39.1: Differential diagnosis of postoperative bleeding
3531.Table 39.2: Differential diagnosis for prolonged PTT and common features
3532.Table 39.3: Subtypes of vWD
3533.Table 39.4: Thrombocytopenia presentation based on platelet count
3534.Table 39.5: Causes of thrombocytopenia
3535.Table 39.6: Types of heparin-induced thrombocytopenia (HIT)
3536.Table 39.7: Disseminated intravascular coagulation (DIC)
3537.Table 39.8: INR and PTT
3538.Table 39.9: Commonly used antiplatelet and anticoagulant medications
3539.Table 39.10: Types of transfusion reactions, causes, and management
3540.Table 40.1: Differential diagnosis for a rise postoperative creatinine
3541.Table 40.2: FENa, UOSM, UCr/PCr, and UNa
3542.Table 40.3: Implications of urinalysis findings
3543.Table 40.4: RIFLE criteria
3544.Table 41.1: Differential diagnosis for postoperative shortness of breath
3545.Table 41.2: Mechanisms of VTE and risk factors
3546.Table 41.3: Wells score
3547.Table 41.4: Causes of postoperative fever
3548.Table 41.5: Findings on ABG, ECG, and CXR in PE
3549.Table 42.1: Types of shock in the trauma setting
3550.Table 42.2: Shock classes I–IV
3551.Table 43.1: Borders of the anterior abdomen, flank, back, and thoracoabdomen
3552.Table 43.2: Retroperitoneal zones
3553.Table 43.3: Tetanus prophylaxis recommendations
3554.Table 43.4: Criteria for nonoperative management of penetrating abdominal trauma
3555.Table 44.1: Signs of vascular injury
3556.Table 44.2: Classic orthopedic fractures/ dislocations associated with arterial injury
3557.Table 45.1: Significance of various signs/symptoms following penetrating neck trauma
3558.Table 45.2: Neck zones and structures at risk with penetrating injury
3559.Table 45.3: Types of arterial injury and their typical management
3560.Table 46.1: The lethal six injuries of thoracic trauma
3561.Table 46.2: The “Hidden six” injuries of thoracic trauma
3562.Table 46.3: Types of pneumothorax
3563.Table 46.4: Indications and contraindications for EDT
3564.Table 46.5: Chambers of chest tube drainage system
3565.Table 47.1: Severity of burn injuries
3566.Table 47.2: Mechanisms of burn injury
3567.Table 47.3: Topical burn agents
3568.Table 48.1: Differential diagnosis for clinical presentation
3569.Table 48.2: Compartments of the leg and arm
3570.Table 48.3: Complications of lower leg fasciotomy
3571.Table 49.1: Differential diagnosis for case presentation
3572.Table 49.2: Color and texture of stool and emesis
3573.Table 49.3: Acute versus chronic gastritis
3574.Table 49.4: Bleeding vessels in peptic ulcer disease
3575.Table 50.1: Differential diagnosis of case presentation
3576.Table 50.2: Comparison of duodenal and gastric ulcers
3577.Table 50.3: Types of gastric ulcer
3578.Table 51.1: Differential diagnosis for a patient with vague abdominal pain
3579.Table 51.2: Types of gastric adenocarcinoma
3580.Table 52.1: Differential diagnosis for case presentation
3581.Table 52.2: Comparing boerhaave’s syndrome and mallory-weiss tear
3582.Table 53.1: Differential diagnosis for scrotal pain/mass
3583.Table 54.1: Scrotal masses involving the skin
3584.Table 54.2: Differential diagnosis of scrotal masses involving the spermatic cord
3585.Table 54.3: Differential diagnosis of scrotal masses involving the epididymis
3586.Table 54.4: Differential diagnosis of scrotal masses involving the testes
3587.Table 54.5: Major subtypes of testicular cancer
3588.Table 54.6: Organisms causing epididymitis
3589.Table 54.7: Comparison of seminoma and nonseminoma
3590.Table 55.1: Differential diagnosis for gross hematuria
3591.Table 55.2: Implications of abnormal color/consistency of urine
3592.Table 55.3: Renal stones
3593.Table 55.4: Paraneoplastic syndromes associated with renal cell carcinoma
3594.Table 55.5: Recommended studies for hematuria work-up
3595.Table 56.1: Differential diagnosis for transident monocular vision loss
3596.Table 56.2: Anterior circulation
3597.Table 56.3: Management of carotid stenosis in a symptomatic patient
3598.Table 56.4: Management of carotid stenosis in asymptomatic patient
3599.Table 56.5: Cranial nerves at risk during CEA
3600.Table 57.1: Differential diagnosis for case presentation
3601.Table 57.2: The Rutherford classification system of chronic limb ischemia
3602.Table 57.3: Relationship of ABI to presence/severity of PAD
3603.Table 58.1: Differential diagnosis for the case presentation
3604.Table 58.2: Comparison of aortic dissection and abdominal aortic aneurysm
3605.Table 58.3: Recommendations for management of AAA based on size
3606.Table 58.4: Five types of endoleaks
3607.Table 59.1: Differential diagnosis for case presentation
3608.Table 59.2: Common causes of acute limb ischemia
3609.Table 59.3: Common locations of lower extremity embolic occlusion and their presentations
