Queries 4

• solitary pulmonary nodule and lobectomy
• caput+medusae+cirrhosis
• what is a fissurotomy
• Anorectal pilonidal
• ileorectal anastomosis for diverticulosis
• penetrating trauma+gallbladder rupture incidence
• Sengstaken
• conn syndrome diastolic
• Abdominoperineal resection rectal trauma
• SURGICAL ANATOMY OF ANORECTAL CANAL in neonates

Spinal Cord Injuries

19 SPINAL CORD INJURIES
J. Paul Elliott M.D., Sanjay Misra M.D.

1. What is the difference between a spinal injury and a spinal cord injury?

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Spinal injuries include damage to the bone, disc, or ligaments. These injuries sometimes result in spinal instability. They also may be associated with spinal cord injury, which is damage to the neural tissue, often with clinical deficit. It is crucial to determine whether there is (1) a spinal injury, (2) a spinal cord injury, and (3) spinal instability.

2. Describe the evaluation of a patient with a suspected spine injury.

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First, be sure that the patient is adequately immobilized and everyone knows to maintain spinal precautions. Second, inspect and palpate the spine for external trauma and step-off. Finally, do a complete neurologic examination including all four extremities. Assess strength, sensation (light touch/proprioception and pain/temperature), muscle tone, reflexes, and rectal tone. Carefully document your results.

Appendicitis

37 APPENDICITIS
Alden H. Harken M.D.

1. What is the classic presentation of acute appendicitis?

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Periumbilical pain that migrates to the right lower quadrant (RLQ) in a patient who is anorexic.

2. Where is McBurney’s point?

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One third the distance between the anterosuperior iliac spine and the umbilicus.

3. What is McBurney’s point?

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The point of maximal tenderness in acute appendicitis.

Basic Care Of Hand Injuries

34 BASIC CARE OF HAND INJURIES
Michael J.V. Gordon M.D., Lawrence L. Ketch M.D.

1. What are the goals of hand repair?

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Functional considerations override cosmesis in the treatment of hand trauma. There are no minor hand injuries. Initial diagnosis and management determine the final result; expert secondary repair cannot overcome primary errors in diagnosis or decision making.