Essential Orthopedic Review Questions and Answers for Senior Medical Students
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Sara Aghamohammadi, M.D
Sara Aghamohammadi, M.D. Philosophy of Care It is a privilege to care for children and their families during the time of their critical illness. I strive to incorporate the science and art of medicine in my everyday practice such that each child and family receives the best medical care in a supportive and respectful environment. Having grown up in the San Joaquin Valley, I am honored to join UC Davis Children's Hospital's team and contribute to the well-being of our community's children. Clinical Interests Dr. Aghamohammadi has always had a passion for education, she enjoys teaching principles of medicine, pediatrics, and critical care to medical students, residents, and nurses alike. Her clinical interests include standardization of practice in the PICU through the use of protocols. Her team has successfully implemented a sedation and analgesia protocol in the PICU, and she helped develop the high-flow nasal cannula protocol for bronchiolitis. Additionally, she has been involved in the development of pediatric pain order sets and is part of a multi-disciplinary team to address acute and chronic pain in pediatric patients. Research/Academic Interests Dr. Aghamohammadi has been passionate about Physician Health and Well-being and heads the Wellness Committee for the Department of Pediatrics. Additionally, she is a part of the Department Wellness Champions for the UC Davis Health System and has given presentations on the importance of Physician Wellness. After completing training in Physician Health and Well-being, she now serves as a mentor for the Train-the-Trainer Physician Health and Well-being Fellowship. -
Hand Surgery
Plastic & reconstructive surgery د.ﻣﺤﻤﺪ ﺟﺎﺳﻢ ﻣﺤﻤﺪ Lec 2 اﺧﺗﺻﺎص اﻟﺟراﺣﺔ اﻟﺗﻘوﯾﻣﯾﺔ 5TH Stage HAND SURGERY Congenital hand abnormalities SWANSON CLASSIFICATION OF CONGENITAL UPPER LIMB ABNORMALITIES I. Failure of Formation of Parts A. Transverse: truncated limb B. Longitudinal: Radial club hand (Preaxial Deficiency) Cleft hand (Central Deficiency) Ulnar club hand(postaxial deficiency) Phocomelia (Intercalary Deficiency) II. Failure of Differentiation or Separation of Parts A. Symphalangism B. Syndactyly C. Contracture: Arthrogryposis Trigger finger Clasped thumb Camptodactyly Clinodactyly III. Duplication: Polydactyly IV. Overgrowth: Macrodactyly V. Undergrowth: Thumb hypoplasia VI. Congenital Constriction Ring Syndrome VII. Generalized Skeletal Abnormalities and Syndromes. Preaxial Deficiency: Radial Club Hand: They are typically sporadic and unilateral, more common in males, and more common on the right side Radial dysplasias are commonly associated with syndromes including Fanconi anemia, thrombocytopenia absent radius (TAR) syndrome, Holt-Oram syndrome (associated with cardiac septal defects), and VATER(vertebral abnormality, anal imperforation, tracheoesophageal fistula, radial, or renal anomalies. The clinical manifestation of radial club hand is a shortened forearm with radial deviation at the wrist. The pathology affects all structures on the preaxial side of the limb: skeleton, musculotendinous units, joints, neurovascular structures, and soft tissue. CLASSIFICATION OF RADIAL DYSPLASIA I-Short radius II- Hypoplastic radius III- Partial absence of radius IV- Total absence of radius Management Type I mild type II dysplasia may only require splinting . Centralization or radialization of wrist with tendon transfer are the treatments of choice in severe type II, and in types III and IV; repair should be performed at 6 to 12 months of age. In pt with absent thumb, pollicization should be done after 6 month from 1st operation. -
University of Washington Orthopaedics & Sports Medicine
Discoveries 2018 University of Washington Orthopaedics & Sports Medicine University of Washington Department of Orthopaedics and Sports Medicine Discoveries 2018 Department of Orthopaedics and Sports Medicine University of Washington Seattle, WA 98195 EDITOR-IN-CHIEF: Howard A. Chansky, MD [email protected] ASSISTANT EDITORS: Christopher H. Allan, MD [email protected] Stephen A. Kennedy, MD, FRCSC [email protected] Adam A. Sassoon, MD, MS [email protected] MANAGING EDITOR: Fred Westerberg [email protected] Front Cover Illustration: Angie Kennedy, MSc, is a Seattle-based mixed media artist. She specializes in custom collage pieces that use mementos and artifacts to celebrate people and special life events. She drew on her experience as a former scientific researcher to create this collage of images from the pages of the current publication. The ‘W’ in the background is a nod to the University of Washington with an overlay of the current imagery arranged in an abstract assemblage. For more information www.americanheavyweight.com A pdf of this publication is available at our website: www.orthop.washington.edu. Permission Requests: All inquiries should be directed to the Managing Editor, University of Washington, Department of Orthopaedics and Sports Medicine, 1959 NE Pacific Street, Box 356500, Seattle, WA 98195-6500, or at the email address above. Contents 1 Foreword 2 From The Assistant Editors: The Modern Art of Musculoskeletal Research, Education, and Clinical Care 3 2018 Distinguished Alumnus, David J. Belfie, MD 4 New Faculty 6 Department of Orthopaedics and Sports Medicine Faculty 12 Visiting Lecturers Validation of a Rabbit Model of Trauma-Induced 14 Brandon J. Ausk, PhD, Philippe Huber, BS, Heterotopic Ossification Ted S. -
349 D.R. Laub Jr. (Ed.), Congenital Anomalies of the Upper
Index A dermatological anomalies , 182 Abductor digiti minimi (ADM) transfer , 102–103 skeletal abnormalities , 182 Abductor pollicis brevis (APB) , 186–187 upper extremity anomalies , 182, 183 ABS. See Amniotic band syndrome (ABS) visceral anomalies , 182 Achondroplasia defi nition of , 179 classifi cation/characterization , 338 description , 32, 33 defi nition of , 337–338 epidemiology of , 181 genetics , 338 genetics and embryology management , 338 molecular etiology , 180 Acrocephalosyndactyly syndrome , 32, 33, 179 prenatal diagnosis , 180–181 Acrosyndactyly repair, ABS , 300–302 molecular basis of , 180 Adactylic group IV symbrachydactyly , 129, 131 postoperative care and complications , 187 Al-Awadi syndrome , 154 treatment Amniotic band syndrome (ABS) APB release , 186–187 acrosyndactyly repair , 300–302 border digits syndactylies , 184 anesthesia concerns of fi rst web space release , 186 induction and maintenance of anesthesia , 43 patient age , 183 postoperative concerns , 43 secondary revisions , 187 preoperative preparation , 42–43 symphalangism , 184 classifi cation , 298 syndactyly ( see Syndactyly) clinical presentation thumb radial clinodactyly , 186–187 acrosyndactyly , 297–298 type II apert hand , 187–188 digital malformation , 297 Apical ectodermal ridge (AER) , 3–5 distal skeletal bones tapering , 297–298 Arthrogryposis , 210 hand deformity , 297 classic arthrogryposis , 305–306, 308 complications , 302 classifi cation , 305, 306 constriction band release defi nition of , 229, 230, 305 Upton’s technique , 299, 301 de-rotation osteotomy, shoulder , 308, 309 z-plasty , 299–300 distal , 230–231 ( see Distal arthrogryposis) diagnosis of , 296 elbow treatment digital hypoplasia reconstruction , 302 muscle transfers , 310–311 etiology of , 295–296 nonoperative management , 308 preoperative considerations , 299 posterior elbow capsular release , 309 treatment , 299 radial head dislocations , 311 Amniotic constriction band syndrome. -
Appendix: FRCS Plast Classification Systems
Appendix: FRCS Plast Classification Systems Contents • Aesthetic • Cancer Staging • Craniofacial • Congenital • General • Hand • Reconstruction/Flaps • Trauma • Incidences • Other Useful Bits for the Exam Aesthetic Baker, Capsule Formation 1975 I – No capsule II – Palpable III – Visible IV – Painful Heimburg, Tuberous breast, BJPS , 1996;49:339–345 Type 1: Hypoplasia of infero-medial quadrant Type 2: Hypoplasia of both inferior quadrants Type 3: Hypoplasia of both lower quadrants and subareolar skin shortage Type 4: Severely constricted base Matarasso Classification of Abdominoplasty Type 1: Excess fat only – liposuction Type 2: Mild skin excess, infra-umbilical divarification – mini- abdominoplasty infra-umbilical plication liposuction S. Hettiaratchy et al. (eds.), Plastic Surgery, 197 DOI 10.1007/978-1-84882-116-3, © Springer-Verlag London Limited 2012 198 Appendix: FRCS Plast Classification Systems Type 3: Moderate skin excess, infra and superior divarifica- tion – As above Type 4: Severe skin excess – Standard abdominoplasty with plication and liposuction Paysk zones around an expander Inner zone: Fibrin layer with macrophages Central zone: Fibroblasts and myofibroblasts Transitional zone: Loose collagen Outer zone: Blood vessels and collagen Regnault classification of ptosis 1st degree: Nipples at or above IMF 2nd degree: Nipples below IMF but above most dependant portion of the breast 3rd degree: Nipples below the most dependant portion of the breast • Pseudo-ptosis – where the majority of the breast mound lies below the IMF but -
Polydactyly of the Hand
A Review Paper Polydactyly of the Hand Katherine C. Faust, MD, Tara Kimbrough, BS, Jean Evans Oakes, MD, J. Ollie Edmunds, MD, and Donald C. Faust, MD cleft lip/palate, and spina bifida. Thumb duplication occurs in Abstract 0.08 to 1.4 per 1000 live births and is more common in Ameri- Polydactyly is considered either the most or second can Indians and Asians than in other races.5,10 It occurs in a most (after syndactyly) common congenital hand ab- male-to-female ratio of 2.5 to 1 and is most often unilateral.5 normality. Polydactyly is not simply a duplication; the Postaxial polydactyly is predominant in black infants; it is most anatomy is abnormal with hypoplastic structures, ab- often inherited in an autosomal dominant fashion, if isolated, 1 normally contoured joints, and anomalous tendon and or in an autosomal recessive pattern, if syndromic. A prospec- ligament insertions. There are many ways to classify tive San Diego study of 11,161 newborns found postaxial type polydactyly, and surgical options range from simple B polydactyly in 1 per 531 live births (1 per 143 black infants, excision to complicated bone, ligament, and tendon 1 per 1339 white infants); 76% of cases were bilateral, and 3 realignments. The prevalence of polydactyly makes it 86% had a positive family history. In patients of non-African descent, it is associated with anomalies in other organs. Central important for orthopedic surgeons to understand the duplication is rare and often autosomal dominant.5,10 basic tenets of the abnormality. Genetics and Development As early as 1896, the heritability of polydactyly was noted.11 As olydactyly is the presence of extra digits. -
Evidence-Based Management of Suspected Appendicitis in The
October 2011 Evidence-Based Management Volume 13, Number 10 Of Suspected Appendicitis In Authors Michael Alan Cole, MD Associate Physician, Department of Emergency Medicine, Brigham The Emergency Department and Women’s Hospital; Clinical Instructor, Harvard Medical School, Boston, MA Nicholas Maldonado, MD Abstract Emergency Physician, Brigham and Women’s Hospital/Massachusetts General Hospital, Harvard Affiliated Emergency Medicine Residency, Boston, MA Appendicitis is the most common cause of acute abdominal pain requiring surgical treatment in persons under 50 years of age, Peer Reviewers with a peak incidence in the second and third decades. Women John Howell, MD, FACEP, FAAEM Clinical Professor of Emergency Medicine, The George Washington have a greater risk of misdiagnosis and a higher negative appen- University, Washington, DC; Director of Academics and Risk Management, dectomy rate. Atypical presentations of appendicitis are com- Best Practices, Inc., Inova Fairfax Hospital, Falls Church, VA monly misdiagnosed, resulting in increased morbidity, mortality, Christopher Strother, MD Assistant Professor of Emergency Medicine and Pediatrics, Director, and potential litigation. The variability of presentation relates to Emergency and Undergraduate Simulation, Mount Sinai School of the varied anatomical location and the visceral innervation of the Medicine, New York, NY appendix. Patients presenting with possible appendicitis should Robert Vissers, MD, FACEP be risk stratified based on history, physical examination, and Chief, Emergency Medicine, Quality Director, Legacy Emanuel Hospital, Adjunct Associate Professor, Oregon Health & Science University School laboratory data. An elevated white blood cell (WBC) count alone of Medicine, Portland, OR (> 10,000 cells/mm3) offers poor diagnostic utility; however, CME Objectives combining WBC count > 10 and C-reactive protein (CRP) level > Upon completion of this article, you should be able to: 8 achieves notable predictive power in the diagnosis of acute ap- 1. -
Clinical and Molecular Genetic Study of Kindreds with Limbs and Neurological Anomalies
Clinical and Molecular Genetic Study of Kindreds with Limbs and Neurological Anomalies PhD Dissertation By Muhammad Afzal Human Genetics 2020 Human Genetics Lab, Department of Zoology Faculty of Biological Sciences Quaid-i-Azam University, Islamabad, Pakistan Acknowledgments I offer my humblest and sincere thanks to Almighty ALLAH, Who bestowed me with potential and ability to make a solid contribution to already existing ocean of knowledge and I also feel pleasure to offer thanks for Holy Prophet Hazrat Muhammad (PBUH), Who showed us the right path and enabled us to recognize our creator. This work would not have been possible without the support and encouragement of my teacher Dr. Sajid Malik, under whose supervision I chose this topic and began the thesis. Actually, when I registered at QAU, I was nothing but today I would able to submit this thesis. He always has been a continuous source of encouragement for me. I am grateful to Dean Faculty of Biological Sciences; Prof. Dr. Muhammad Shahab and chairman department of Animal Sciences; Assoc. Prof. Dr. Sajid Malik for providing pre-requisites for this work and thus facilitating this task. Clerical and technical assistant in scientific research is an undeniable important element. So I am righteous in thanking Syed Mujahid Hussain (Lab. assistant), Naeem Masih and Samiullah for their thorough and in time assistance. I am highly thankful to Rana Mazhar (Principal Punjab group of colleges) because he provided me the financial assistance whenever I need at any time at any occasion during the field work and compilation of thesis and he never disappointed me. -
High Yield Points
Team Motivation FMGE/MCI Coaching Academy Radiology (FMGE Essentia - 3) HIGH YIELD POINTS RESPIRATORY SYSTEM – SIGNS SIGN / SPECIFIC FEATURE SEEN IN Meniscus / Moon/ Air crescent / Double arch sign Hydatid cyst of lung Cumbo sign Water lilly / Camalotte sign Serpent sign / Rising sun sign Empty cyst sign Popcorn calcification Hamartoma Mediastinal nodes of histoplasmosis Westermark sign Pulmonary thrombo-embolism Hapton’s hump Palla sign Fleishner lines Felson’s sign Sail sign Thymic enlargement Mulvay Wave sign Notch sign Comet tail sign Rounded atelectasis Golden S sign RUL collapse secondary to a central mass Luftsichel sign LUL collapse Broncholobar sign LLL collapse Ring around artery sign Pneumo-mediastinum Continuous diaphragm sign Tubular artery sign Double bronchial wall sign V sign of Naclerio Spinnaker sail sign Deep sulcus sign Pneumothorax Visceral pleural line Thumb sign Epiglottitis Steeple sign Croup Air crescent sign Aspergilloma Monod sign Bulging fissure sign Klebsiella pneumonia Batwing sign Pulmonary edema on CXR Collar sign Diaphragmatic rupture Dependant viscera sign Feeding vessel sign Pulmonary septic emboli Finger in glove sign ABPA Halo sign Aspergillosis Head cheese sign Subacute hypersensitivity pneumonitis Juxtaphrenic peak sign RUL atelectasis Reversed halo sign Cryptogenic organized pneumonia Saber sheath trachea COPD Sandstorm lungs Alveolar microlithiasis Signet ring sign Bronchiectasis Superior triangle sign RLL atelectasis Split pleura sign Empyema Tree in bud sign on HRCT Endobronchial spread in TB -
Acute Appendicitis: Hispanics and the Hamburger Sign
Research Article More Information *Address for Correspondence: Romero- Acute Appendicitis: Hispanics and the Vazquez Ana M, MS, Ponce Health and Sciences University, Ponce, Puerto Rico- School of Medicine, Puerto Rico, Tel: (787)363-6739; Hamburger Sign Email: [email protected]; [email protected] 1 1 1 Garcia Gubern C , Colon Rolón L , Ruiz Mercado I , Oliveras Submitted: 12 November 2019 Garcia C1, Caban Acosta D1, Muñoz Pagán J1, Iriarte I3, Bolaños Approved: 19 November 2019 Published: 20 November 2019 Ávila G2, Peguero Rivera J2, Sánchez Gaetan F2, Oneill Castro J2, 1 1 How to cite this article: Garcia Gubern C, Colon Cordero Colón Paola N , Garcia-Colon Carlos A and Romero- Rolón L, Ruiz Mercado I, Oliveras Garcia C, Caban 4 Vazquez Ana M * Acosta D, et al. Acute Appendicitis: Hispanics and the Hamburger Sign. Arch Surg Clin Res. 1 MD, Department of Emergency Medicine Hospital San Lucas, Ponce, Puerto Rico 2019; 3: 078-081. 2Department of Surgery Hospital San Lucas, Ponce, Puerto Rico DOI: dx.doi.org/10.29328/journal.ascr.1001041 3Ponce Health and Sciences University, Ponce, School of Public Health, Puerto Rico ORCiD: orcid.org/0000-0001-7214-0748 4Ponce Health and Sciences University, Ponce, School of Medicine, Puerto Rico Copyright: © 2019 Garcia Gubern C, et al. This is an open access article distributed under the Creative Commons Attribution License, Abstract which permits unrestricted use, distribution, and reproduction in any medium, provided the Objective: To describe the presenting clinical fi ndings of patients with acute appendicitis and original work is properly cited. compare them with those described in the medical literature. -
Thumb Duplication: Concepts and Techniques Michael A
CORE Metadata, citation and similar papers at core.ac.uk Provided by PubMed Central Review Article Clinics in Orthopedic Surgery 2012;4:1-17 • http://dx.doi.org/10.4055/cios.2012.4.1.1 Thumb Duplication: Concepts and Techniques Michael A. Tonkin, MD Department of Hand Surgery and Peripheral Nerve Surgery, University of Sydney, Royal North Shore Hospital, St. Leonards and Department of Hand Surgery, University of Sydney, Children’s Hospital at Westmead, Westmead, Australia Within the Oberg, Manske, Tonkin (OMT) classifi cation, thumb duplications are a failure of formation and/or differentiation affect- ing the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of ad- equate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specifi c challenges which demand alternative techniques. Keywords: Thumb duplication, Classifi cation, Assessment, Reconstruction Thumb duplication is classified within the International anomaly (Table 1).2) It recognises that formation and dif- Federation of Societies for Surgery of the Hand (IFSSH)/ ferentiation occur together, not as separate independent Swanson classifi cation of congenital anomalies of the hand processes, and directs us to the site of insult in the devel- and upper limb as a “duplication” (group 3).1) Included are oping limb bud. -
Acute Appendicitis in Adults
International Surgery Journal Vagholkar K. Int Surg J. 2020 Sep;7(9):3180-3186 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: http://dx.doi.org/10.18203/2349-2902.isj20203822 Review Article Acute appendicitis in adults Ketan Vagholkar* Department of Surgery, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India Received: 16 June 2020 Revised: 28 July 2020 Accepted: 03 August 2020 *Correspondence: Dr. Ketan Vagholkar, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Acute appendicitis is one of the commonest abdominal emergency encountered by a general surgeon. Understanding the surgical pathology is pivotal in identifying the stage of disease at which the patient presents for better correlation of clinical features, laboratory and imaging reports. Various scoring systems enhance and aid this process. Imaging confirms the diagnosis. Early diagnosis is essential to prevent complications. Surgery is the mainstay of treatment. Appendicitis may present in various forms in different clinical settings. A uniform approach to presentations may not always yield good results. Though appendectomy is the mainstay of treatment yet a tailor made surgical plan needs to be developed after holistic evaluation of the patient. The article discusses the differential surgical approach based on the etiopathogenesis, diagnosis and variable clinical presentations. Keywords: Acute appendicitis, Diagnosis, Scoring, Treatment INTRODUCTION decreased bowel transit time and reduces the formation of faecoliths, which lead to obstruction and initiation of the Acute appendicitis is one of the most common abdominal inflammatory cascade.2-4 The disease is more common in emergency managed by a general surgeon.