What is the most commonly injured organ in blunt trauma?
What is the most commonly injured organ in penetrating trauma?
What is the most common anatomic reason for upper airway obstruction?
What does diagnostic peritoneal lavage miss?
What areas are checked in a FAST scan?
- 1. Pericardium
- 2. Around liver fossa
- 3. Around spleen
- 4. Around pelvis
What is typically missed in a FAST scan?
Hollow viscous injuries
What do trauma CT scans miss?
Hollow viscous injuries
When does abdominal compartment syndrome occur?
Massive fluid resuscitation
What vessels are damaged in an epidural hematoma?
Middle meningeal artery
In a epidural hematoma, where does the blood accumulate?
Between the dura mater and the skull
In a subdural hematoma, where does the blood accumulate?
Between the dura mater and the arachnoid membrane
What is the source of blood in a subdural hematoma?
Tearing of bridging veins
How often are skull fractures seen in epidural hematomas?
85 to 95% of the time
What types of attenuation values do chronic hematomas have?
Low attenuation values
What the three layers of meninges surrounding the brain and spinal cord?
- Dura mater
- Arachnoid mater
- Pia mater
What is the typical symptoms for patients presenting with acute epidural hematoma?
Initial loss of conscious
How do patients typically present after subdural hematomas?
Often in elderly patients after falls or MVAs
When do skull fractures need to be taken to the OR?
Depressed skull fractures
Compound skull fractures
What is the pathogenesis of diffuse axonal injury?
Widespread disruption of axons from acceleration or deceleration injury
Within the layers of the meninges, where does CSF reside?
Between the arachnoid and pia mater
What is the equation for cerebral perfusion pressure (CPP)?
MAP - ICP
What are the major parts of the inner surface of the skull base?
What is the most common site of facial nerve (VII) injury?
What is another name for C1?
What is another name for C2?
What is distinct about the atlas vertebrae?
The atlas has no body
What joint is involved in flexion/extension of the neck?
Atlas - occipital joint
What joint is involved in the lateral rotation of the neck?
Atlas - axis
What is another name for a C1 fracture?
What is the mechanism of a C1 fracture?
Jefferson fracture - axial compression forces
What is unique about the C2 vertebrae?
Odontoid process (dens) emerging from anterior aspect of body of vertebrae
What is the mechanism for a Hangman's fracture?
Hyperextension of neck leading to a C2 fracture
What structures are disrupted in a Hangman's fracture?
Anterior longitudinal ligament
What are the different types of odontoid fractures?
- Type I - Above base of odontoid
- Type II - At base of odontoid
- Type III - extends to vertebral body
What are the three columns of the thoracolumbar spine?
What is the difference between a burst and a wedge fracture?
Wedge fracture only involves anterior column
What separates anterior and middle columns of the spine?
Anterior includes the anterior 1/2 of the vertebral body
What is the pathognomonic sign for hyperparathyroidism?
Subperiostial bone resorption of radial aspect of middle phalanges
What is the most common cause of primary hyperparathyroidism?
Parathyroid adenoma (80%)
What is the most common cause of secondary hyperparathyroidism?
What is the basic structure of the parathyroid glands?
Superior and inferior glands
What is the embryological origin of the parathyroid glands?
Superior - 4th branchial pouch
Inferior - 3rd branchial pouch
What makes up Hesselbach's triangle?
- Rectus muscle (medial border)
- Inguinal ligament (inferior border)
- Inferior epigastric artery (lateral border)
What does the inguinal ligament come from?
What makes up the floor of the inguinal canal?
What abdominal wall muscle does the cremasteric muscle come from?
Relative to Hesselbach's triangle, where do direct hernias form?
Medial to the inferior epigastric artery
Relative to Hesselbach's triangle, where do indirect hernias form?
Lateral to the inferior epigastric artery
What are the most common types of inguinal hernias?
Where do indirect inguinal hernias come from?
Patent processus vaginalis
Where do sliding inguinal hernias come from in males?
Cecum or sigmoid colon
Where do sliding inguinal hernias come from in females?
What types of hernias are infants/children more likely to get?
Almost always indirect inguinal hernia
What is the most common complication after an inguinal hernia repair?
What is the inguinal canal created by?
External oblique aponeurosis/inguinal ligament curls on itself to form U shaped structure
What is inside the inguinal canal in males and females?
Males - spermatic cord
Females - round ligament
What are the components of the spermatic cord?
Testicular artery/vein (Pampiniform plexus)
Genital branch of genitofemoral nerve
What are the boundaries of the femoral canal?
- Inguinal ligament
- Femoral vein
- Lacunar (Cooper's ligament)
Where do epigastric hernias occur?
Through linea alba
What arteries supply the adrenal glands?
- Superior adrenal
- Middle Adrenal
- Inferior Adrenal
Where does the superior adrenal artery emerge from?
Inferior phrenic artery
Where does the inferior phrenic artery emerge from?
Aorta or celiac axis
Where does the middle adrenal artery emerge from?
Where does the inferior adrenal artery come from?
Where do the left and right adrenal veins drain into?
- Left adrenal vein > left renal vein
- Right adrenal vein > IVC
What is the most common source of extrahepatic collateral blood supply to hepatocellular carcinomas?
Inferior phrenic artery
What layer covers the kidneys and adrenals?
What are the most common types of kidney stones?
Calcium oxalate stones (75%)
What is the second most common type of kidney stone?
Struvite stone (Magnesium ammonium phosphate) (15%)
What type of urinary infection is associated with struvite stones?
What types of stones are seen in patients who had their terminal ileums resected and why?
Calcium oxalate - increased calcium oxalate reabsorption in colon, higher chance of precipation of those stones in kidney
What is the number 1 type of testicular tumor?
What are different types of nonseminomatous testicular cancers?
- Yolk Sac
What markers are elevated in non-seminomatous testicular cancers?
What are three muscular groups that make up the diaphragm?
What types of hernias form at the junction between the pars lumbaris and pars costalis?
What types of hernias form between the pars sternalis and the pars costalis on the right side?
What is the name of the space between the pars sternalis and pars costalis on the left side?
What is eventration?
Area of congenital weakness in diaphragm
What are the stages of bone healing?
- 1. Inflammation
- 2. Soft callus formation
- 3. Mineralization of callus
- 4. Removal of callus
What is the mnemonic for Salter Harris Fractures?
- S - same/straight across
- A - Above (physis)
- L - Lower (below physis)
- T - Through
- R - Rammed (crushed)
What types of Salter Harris fractures require open reduction and internal fixation (ORIF)?
Salter Harris Types III, IV and V
What fractures are associated with avascular necrosis?
What bone connects to the tibia?
What bone connects to the talus?
What bones are directly distal to the navicular?
Cuneiform bones (lateral, intermediate, medial)
What bone is lateral to the lateral cuneiform bone?
What bones are distal to the cuneiform bones?
What types of fractures are most commonly associated with nonunion?
5th metatarsal fracture
What is another term for the 5th metatarsal fracture?
What types of fractures are associated with compartment syndrome?
What are the components of the intervertebral disk?
What is the most common type of shoulder dislocation?
Anterior shoulder dislocation (95%)
What are the most common causal associations with a posterior shoulder dislocation?
What structure is at risk for injury in an anterior shoulder dislocation?
What structure is at risk for injury in a posterior shoulder dislocation?
Which structure contains the ovarian vessels and nerve?
Infundibular ligament -
Contains ovarian artery, vein, nerve
What is the blood supply to the ovaries?
Uterine artery - adnexal branch
What is the most common US finding in ovarian torsion?
Large ovary (> 4 cm)
What are the most common presenting sx of ectopic pregnancy?
What is the major cause of vulvar hematomas?
When can vulvar hematomas be managed conservatively?
- 1) Lack of rapid expansion
- 2) Ability to void clear urine
What is endometriosis?
Presence of ectopic endometrial glands and stroma in aberrant locations
What is the most common site of involvement of endometriosis?
What happens to leiomyomas with uterine artery embolization?
Ischemia which causes necrosis and shrinkage of myomas
What are sx of leiomyomas?
Pressure from an enlarging uterus
Adverse pregnancy outcomes
What type of cancer is vaginal cancer typically?
What drug is associated with clear cell carcinoma of the vagina?
What types of cancers are endometrial cancers typically?
What histologic types of endometrial cancers are associated with a worse prognosis?
What cell type of ovarian cancer is most common?
Ultrasound findings of acute cholecystitis?
- Thickening of gallbladder wall
- Pericholecystic fluid
- Gallbladder distention
- Presence of impacted gallstone
- Sonographic murphy's sign
What intestinal artery do emboli typically go to?
What is the definition of volvulus?
Loop of gut has twisted on itself
What anatomic landmark is associated with the ligament of Treitz?
Junction between duodenum and jejunum
What is the most common site for colonic volvulus?
What is the taeniae coli?
Condensations of the outer muscular layer along the length of the colon
What causes haustra to form in the colon?
Taeniae coli are 1/6 of the length of the entire colon - causes pouches of colon to form
What is the widest part of the colon?
What are the spaces between haustra called?
What are valvulae connivente?
Muscular bands encircling small bowel
What is the definition of ileus vs obstruction?
Non-mechanical stasis of bowel vs mechanical stasis of bowel