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breast mass found after trauma not regressing after week might not be a hematoma or fat necrosis trivial trauma sometimes brings to the attention of the patient an area of the body that had not been examined before a breast mass ...
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50. which of the following statement(s) concerning the operative approach to abdominal trauma is/are correct? a. pelvic hematomas associated with pelvic fractures should be explored b. central retroperitoneal hematomas should be ...
AIIMS November 1999 Question Paper with Answers and Explanation - 1
d.Plain X ray abdomen. Ans:(c) Ref:Old Bailey p839. A child presents with history of blunt injury abdomen associated with splenic trauma. On examination the child is stable. Which of the following is the treatment of choice a.Splenorrhaphy b.Observation ... A needle aspiration from the thyroid nodule of a patient with pituitary tumor and pheochromocytoma shows which of the following a.Follicular carcinoma b.Medullary carcinoma c.Anaplastic carcinoma d.Papillary carcinoma ...
Solitary Pulmonary Nodule
80 SOLITARY PULMONARY NODULE
Jamie M. Brown M.D., Marvin Pomerantz M.D.
1. What is a solitary pulmonary nodule?
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A solitary pulmonary nodule or “coin lesion” is < 3 cm and is discrete on chest radiograph. It is usually surrounded by lung parenchyma.
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should an infectious solitary pulmonary nodule be removed,Trauma To The Colon & Rectum. Colon Trauma
28 TRAUMA TO THE COLON AND RECTUM
W. Andrew Lawrence M.D., Jon M. Burch M.D.
COLON TRAUMA
1. How do most colon injuries occur?
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Nearly all (> 95%) colon injuries are caused by penetrating trauma from gunshot, stab, iatrogenic, or sexual injury. Blunt colonic trauma is rare and usually results from seat belts during motor vehicle accidents.
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colonic injury grade, iatrogenic colon injury, trauma dos colons, trauma of the colon,Penetrating Abdominal Trauma. Controversy
CONTROVERSY
14. What is the role of laparoscopy and thoracoscopy after penetrating abdominal trauma?
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Although an intriguing diagnostic modality with additional therapeutic capabilities, laparoscopy thus far appears to have limited application after trauma. With the exception of suspected diaphragmatic injury, an isolated solid organ injury, or evaluation for peritoneal penetration, laparoscopy has yet to demonstrate advantages over the algorithm delineated above. The potential for missed injuries, poor evaluation of the retroperitoneum, and expense are major drawbacks. In patients with wounds to the lower chest with pneumothorax (and, thus, an indication for chest tube placement), thoracoscopy is reasonable to exclude diaphragmatic injury.
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25 HEPATIC AND BILIARY TRAUMA
Reginald J. Franciose M.D., Ernest E. Moore M.D.
1. How often is the liver injured in trauma?
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The liver is both big and central, so it is an easy target.
2. Do the liver and spleen respond similarly to injury?
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No. The liver has a unique ability to establish spontaneous hemostasis even with extensive injuries. For this reason, the majority of liver injuries in hemodynamically stable patients can be managed nonoperatively. In contrast, many splenic fractures continue to bleed; therefore, a greater percentage require operative intervention.
Lower Urinary Tract Injury & Pelvic Trauma
31 LOWER URINARY TRACT INJURY AND PELVIC TRAUMA
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What are the causes of bladder injury?
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Iatrogenic manipulation and penetrating or blunt trauma. Because of the rich detrusor blood supply, bladder injury is usually accompanied by hematuria. Other signs may include suprapubic pain, inability to void, or incomplete recovery of catheter irrigation.
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Splenic Trauma
26 SPLENIC TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What is the physiologic role of the spleen?
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In fetal development, the spleen serves as a major site for hematopoiesis. In early childhood the spleen produces immunoglobulin M (IgM) and tuftsin. The spleen also functions as a filter, allowing resident macrophages to remove abnormal red blood cells (RBCs), cellular debris, and encapsulated and poorly opsonized bacteria.
Blunt Abdominal Trauma
23 BLUNT ABDOMINAL TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What elements of the history are important in evaluating a patient with suspected blunt abdominal trauma (BAT)?
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First, the mechanism of injury (e.g., motor vehicle collision, automobile-pedestrian accident, fall) is important. In motor vehicle accidents, note the position of the victim in the car, velocity of impact (high, moderate, low), type of accident (front, lateral, or rear impact; side swipe; rollover), and type of restraint used (shoulder restraint, air-bag, lap belt). Information about damage to the vehicle, such as a broken windshield or bent steering wheel, may raise suspicion of cervical and chest injuries. In a fall, it is important to note the distance fallen and the site of anatomic impact. Vertical landing on the feet or in a sitting position causes a different pattern of injury than lateral landing on the side. Serial vital signs and mental status are always important.
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Thyroid Nodules & Cancer
59 THYROID NODULES AND CANCER
Robert C. McIntyre Jr., M.D.
1. What is the prevalence of thyroid nodules and cancer?
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Thyroid nodules increase throughout life. Nodules are four times more common in females than in males, and 50% of 50-year-old women have a palpable nodule. After exposure to radiation, nodules develop at approximately 2% annually, reaching a peak at 25 years. Nodules are 10 times more frequent in glands examined by ultrasound, at surgery, or at autopsy. Fewer than 50% of thyroid nodules that appear solitary on physical examination are truly solitary.
Each year in the United States, there are approximately 15,000 new cases and 1000 deaths due to thyroid cancer. Up to 35% of thyroid glands examined at autopsy contain occult papillary cancer (< 1.0 cm).
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20 PENETRATING NECK TRAUMA
Clay Cothren M.D., Ernest E. Moore M.D.
1. Why are penetrating neck wounds unique?
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Although comprising only a small percentage of body surface area, the neck contains a heavy concentration of vital structures.
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Abdominal Aortic Aneurysm
71 ABDOMINAL AORTIC ANEURYSM
Mark Nehler M.D., William C. Krupski M.D.
1. What is an abdominal aortic aneurysm (AAA)?
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A ≥ 50% increase in normal aortic diameter. Normal infrarenal aortic diameter is 2.0 cm for men. A definition of AAA as an aorta ≥ 3.0 cm in diameter is appropriate.
2. What is the incidence of AAA?
Hepatic & Biliary Trauma. Biliary Tract Injury
BILIARY TRACT INJURY
22. Why are complications associated with bile duct leaks?
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Bilomas (i.e., collections of bile) frequently become infected and may result in lethal peritonitis. Biliopleural fistula, a communication between the biliary system and pleural cavity, persists because of the relative negative pressure in the thorax and may result in a bile empyema.
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24 PENETRATING ABDOMINAL TRAUMA
Clay Cothren M.D., Ernest E. Moore M.D.
1. Why is there a different approach to stab and gunshot wounds?
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Whereas one third of stab wounds to the anterior abdomen do not penetrate the peritoneum, 80% of gunshot wounds violate the peritoneum. Furthermore, penetration of the peritoneum by a bullet is associated with visceral or vascular injuries in > 95% of cases, whereas only one third of stab wounds violating the peritoneal cavity produce significant injury. (See Figure 24-1.)
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Trauma To The Colon & Rectum. Rectal Trauma
RECTAL TRAUMA
9. How do rectal injuries occur?
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Similar to colon injuries, most rectal injuries result from penetrating trauma. Blunt pelvic fractures should be assessed with a strong suspicion for rectal (and urethral) injury.
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22 PENETRATING THORACIC TRAUMA
Jeffrey L. Johnson M.D., Ernest E. Moore M.D.
1. How often do patients with penetrating chest wounds need an operation?
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Surprisingly rarely. Most civilian penetrating injuries are from knives and low-energy handguns. Consequently, although injuries to the chest wall and lung are common, the majority of patients can be treated with tube thoracostomy alone. Formal thoracotomy or median sternotomy is required in < 15% of isolated penetrating chest injuries.
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OPERATIVE MANAGEMENT OF LIVER INJURY
11. How are acute liver injuries classified?
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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
