MRCS Part A_ Essential Revision Notes_ Book 1

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3.1 Local anaesthesia3.2 Regional anaesthesia3.3 Sedation3.4 General anaesthesia3.5 Complications of general anaesthesiaCare of the patient in theatre4.1 Pre-induction checks4.2 Prevention of injury to the anaesthetised patient4.3 Preserving patient dignity
SECTION 1Assessment of fitness for surgeryIn a nutshell ...Before considering surgical intervention it is necessary to prepare the patient as fully as possible.The extent of pre-op preparation depends on:Classification of surgery:• Elective• Scheduled• Urgent• EmergencyNature of the surgery (minor, major, major-plus)Location of the surgery (A&E, endoscopy, minor theatre, main theatre) • Facilities availableThe rationale for pre-op preparation is to:Determine a patient’s ‘fitness for surgery’Anticipate difficultiesMake advanced preparation and organise facilities, equipment and expertise • Enhance patient safetyand minimise chance of errorsAlleviate any relevant fear/anxiety perceived by the patientReduce morbidity and mortalityCommon factors resulting in cancellation of surgery include:nadequate investigation and management of existing medical conditions • New acute medical conditionsClassification of surgery according to the National Confidential Enquiry into Patient Outcome and Death(NCEPOD):lective: mutually convenient timing • Scheduled: (or semi-elective) early surgery under time limits (eg 3weeks for malignancy) • Urgent: as soon as possible after adequate resuscitation and within 24 hoursPatients may be:mergency: admitted from A&E; admitted from cliniclective: scheduled admission from home, usually following pre assessment
Page 4 and 5: © 2012 PASTEST LTDEgerton CourtPar
Page 6 and 7: Tristan E McMillanChapter 2 Surgica
Page 8 and 9: Claire Ritchie ChalmersChapter 5 Pr
Page 10 and 11: George Hondag Tse
Page 12 and 13: Nigel W GummersonChapter 7 Evidence
Page 14 and 15: Nigel W GummersonChapter 10 Paediat
Page 16 and 17: AcknowledgementsI would like to tha
Page 18 and 19: Picture PermissionsThe following fi
Page 20 and 21: copyright material. However, if any
Page 22 and 23: General Infirmary, Leeds Orthopaedi
Page 24 and 25: Consultant Clinical Oncologist, Ken
Page 26 and 27: A Tension pneumothoraxB Aortic rupt
Page 28 and 29: Emergency medicine 9Oncology 8Surgi
Page 30 and 31: The MRCS exam and syllabus is being
Page 34 and 35: In 2011 NCEPOD published Knowing th
Page 36 and 37: history of problems under anaesthet
Page 38 and 39: cardiovascular system • All patie
Page 40 and 41: orthopaedics, spinal cord compressi
Page 42 and 43: General concerns of the surgical pa
Page 44 and 45: Documentation often starts with cle
Page 46 and 47: SECTION 2Preoperative management of
Page 48 and 49: Indications for perioperative corti
Page 50 and 51: Heparinucopolysaccharide purified f
Page 52 and 53: FBCorrection of anaemia is essentia
Page 54 and 55: Assessing myocardial ischaemiaECG:
Page 56 and 57: HypertensionCauses of hypertensionE
Page 58 and 59: Patients should have the pacemaker
Page 60 and 61: arbon monoxide reduces oxygen deliv
Page 62 and 63: advance - can predispose to lactic
Page 64 and 65: Preoperative management of epilepsy
Page 66 and 67: Preoperative management of cholesta
Page 68 and 69: C-spine: 15% of RA patients have at
Page 70 and 71: 20-27Malnourished
Page 72 and 73: 30-35Overweight
Page 74 and 75: Morbidly obese50-60 Super-obese }60
Page 76 and 77: Catabolic states40-45 1.5-2.5
Page 78 and 79: Increasingly catabolic stateDue to
Page 80 and 81: Aspirationncreased gastric volume a
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Technical problemsurgery takes long
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Metabolic complicationsyperglycaemi
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Upper GI surgeryOesophageal and gas
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Dosage of local anaesthetic agents:
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3.2 Regional anaesthesiaField block
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The sciatic nerve block can be perf
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nguinal ligament T12High block may
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cause seizures) • All patients ha
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Inhalational anaesthetics may also
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Contraindications of depolarising m
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No IV access required
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Dose titratableUpper oesophageal to
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DisadvantagesRespiration maintained
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Loss of airway controlIrritantMay c
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Apnoea commonPatient monitoring dur
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cardiovascular collapse • Managem
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Treatment of malignant hyperpyrexia
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Risk factors for aspiration• Rais
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Muscle injuriesPressure-area injury
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CHAPTER 2Surgical Technique and Tec
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SECTION 1Surgical wounds1.1 Skin an
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Depth of woundSuperficial woundsSup
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1.4 Pathophysiology of wound healin
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Neutrophils1-2 days
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Fibroblasts2-4 days
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Endothelial cellsFigure 2.3 Wound h
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and growth factors that activate fi
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LiverThe liver has remarkable regen
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Nutritional factorsroteins are esse
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perpendicular to the skin, avoids a
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SECTION 2Surgical technique2.1 Prin
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Scalpel blades should be changed us
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Abdominal incisionsFigure 2.6 Commo
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reat vessels (especially ascending
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Thoracic closure is covered in the
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Bipolarower power unit (50 W)urrent
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Choose your suture with regard to:S
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Polyglycolic acidynthetic homopolym
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Staples for skin closureThe teeth o
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infectionExamples of surgical drain
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packingxamples: Kaltostat, SorbsanF
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Uses of biopsyBiopsy is used specif
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Advantages of core biopsyimple, eas
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Advantages of endoscopic biopsyvoid
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Advantages and usesssessment of ope
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Figure 2.10 Incisions for benign le
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upuytren’s contracture surgeryngr
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Hollow organs: GI and genitourinary
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General factorsoor tissue perfusion
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each consultant’s preference, and
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• Fundoplication• Gastric bypas
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photographic images or video. A sec
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Physiological changes include:or ch
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variety of operations using multich
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Disadvantagesecurity of access site
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3.8 Managing the surgical listThere
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SECTION 4Diagnostic and interventio
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Occasionally patients can have true
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levels on the screen as different l
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ExpenseClaustrophobiaContraindicate
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CHAPTER 3Postoperative Management a
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• Endoplasmic reticulum• Golgi
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Transport across membranesGeneratio
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Energy from lipidsThe basic compone
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channels open and sodium ions flood
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muscle therefore travel in both dir
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Figure 3.6 The structure of the myo
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Thrombocytes (platelets)The haemato
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ncrease in allergic states (eg hayf
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• Ileal resection• Crohn’s di
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aemoglobinopathyInappropriate incre
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Inflammationurnsrauma (eg postopera
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LymphocytosisLymphocytosis is used
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latelet count of >1000 × 10 9 /lli
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kidney, liver and penis (priapism)I
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Nitric oxideTissueplasminogenactiva
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It is often expressed as the intern
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Acquired bleeding disordersThromboc
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giving advice about minimising othe
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Clots usually start in the deep vei
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No risk factors other than age with
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Scores ≥3Moderate probability of
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Complications of pulmonary embolism
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INR of 0.8-1.2 Normal coagulationIN
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Blood compatibility testingDonor an
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significant haemorrhage) • Prophy
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Early complications:Immunological c
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administration of donated blood (wh
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Chronic Group characterised by an u
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Lymphoma is a cancer of the reticul
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Multiple myeloma is a neoplastic pr
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1.3 Fluid balance and fluid replace
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ATPase pump which was discussed ear
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Figure 3.14 The movement of fluids
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In general, fluid maintenance needs
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• Small risk of anaphylaxis• Li
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In a nutshell ...The products of me
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Respiratory acidosisRespiratory aci
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normal (ie if there was no respirat
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Metabolism = anabolism + catabolism
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Energy supplied by different food t
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This is achieved by:utaneous vasoco
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SECTION 2Critical care2.1 The struc
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Admission to ITUor elective, emerge
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Medical staffTU director: should ha
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Improvement in survivalThis is poss
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Systemic vascular resistanceSystemi
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Regulation of stroke volumeStroke v
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Arterial BP sensorsMean arterial pr
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ChemoreceptorsChemoreceptors found
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Natriuretic peptidesBlood volume ch
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wide QRS (>0.12) occurs when depola
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Catheterisation and hourly urine me
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Fluid challenge using CVP monitorin
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Figure 3.22 Pressure waves as cathe
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SternumThis consists of three parts
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Costal cartilages-7 articulate dire
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Innermost intercostalsross more tha
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Lung rootsulmonary artery lies supe
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The mechanics of breathingThe funct
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The work of breathingThe work of br
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Respiratory rateThe amount of air b
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ChemoreceptorsChemoreceptors detect
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Binds four molecules of O 2 per mol
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Increased carboxyhaemoglobinIncreas
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CvO 2 is measured by substituting m
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urrent management depends on what i
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Chest traumaHypovolaemia
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Burns
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Fat embolism
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DIC
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haemoglobin, and combined this beco
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Early (see ‘Hazards’ above): da
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Mini-tracheostomyA small tracheosto
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Continuous positive airway pressure
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ExtubationThe patient must:e able t
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fibres terminate in lamina 2 and la
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Spinal mechanismsOpioids act direct
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Referred painThis is when pain is p
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Methods of assessing acute painSubj
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reventing the development of pain i
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Aetiology of chronic painNeural sys
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Assessment of chronic painistory of
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Pain in malignancyPain from maligna
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OralSublingual
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IntravenousInhalational
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Transdermal SpinalParacetamolildly
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Management of analgesiaRemember to
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Disadvantages of PCAechnical error
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Routes for sedationolus dosing: pre
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Indications for peripheral venous a
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Complications of peripheral venous
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introduced into the vein:eedle intr
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Ultrasonography for identification
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Infuse and pumpIn a nutshell ...The
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Blood pressureim for MAP >60 mmHg o
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SECTION 3Postoperative complication
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Postoperative pyrexiaPyrexia is a c
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Prophylaxis for wound infectionsden
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eriprosthetic fracturealunionon-uni
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In a nutshell ...Respiratory proble
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cascade).Factors influencing renal
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There are two types of nephrons wit
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Measurement of GFRThere are a numbe
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Oliguria is defined as a urine outp
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Measurement Prerenal RenalUrinary s
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Indications for renal replacement t
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SIRS is a disseminated inflammatory
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3.5 Sepsis and septic shockDefiniti
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Management of sepsis-induced shock,
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Neurological failureCS <6 in the ab
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CHAPTER 4Infection and Inflammation
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SECTION 1Inflammatory processesIn a
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Due to three different responseshe
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Mediators of the inflammatory respo
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Kinin systemLysosomal enzymes
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Fibrinolytic system
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Complement systemThe complement sys
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Coagulation and fibrinolysisThe clo
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Lysosomal enzymesLeucocytes degranu
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pyrogen (see Section 2, The immune
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Infiltration of tissue with mononuc
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OrganismMycobacterium tuberculosis
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Treatment of TBultiple drug therapy
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Symptoms of syphilisThese are divid
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Treatment of syphilisntravenous (IV
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Demographics of leprosyHO data show
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Classification of leprosyaucibacill
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Asbestosissbestosis results from pr
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Immune reactions and granulomasGran
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FibrinogenComponent of the clotting
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(eg rofecoxib, celecoxib, valdecoxi
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Commensal organismsNormal commensal
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roliferation of T lymphocytesntibod
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Figure 4.5 Activation of CD8 + T ly
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proliferations: uncontrolled produc
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Monozygotic twins of patients are a
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Group of autosomal or X-linked rece
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are some reports that the risk of i
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Endotoxinsipopolysaccharide molecul
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Gram-negative bacteriaStain pink/re
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eath of the host cell by lysis to r
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Figure 4.12 The virionaccine includ
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Human immunodeficiency viruses (HIV
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ring-enhancing lesions on CT/MRI
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immunodeficiency. Progressive deple
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(systemic; often fatal in immunosup
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lagellate parasitesesponsible for A
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Examination for sepsisPossible foci
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Acute phase proteinsCRP is commonly
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Clotting screenThere may also be a
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MicrobiologySee section 4.6, Specim
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Organism related to wound typelean
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4.3 Abscess managementIn a nutshell
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ontaminated needlePathology of necr
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If considering endocarditis, three
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Growth in both bottlestaphylococci:
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SECTION 5Prevention and control of
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wound sepsis • Therefore shave im
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SterilisationSterilisation methods
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Dry heat sterilisationot-air ovenso
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Irradiation sterilisationse of gamm
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Hydrogen peroxidenly weak bacterici
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Patient preparationSkin disinfectio
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Dirty woundsross pus, perforated vi
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tudents (medical and nursing)aborat
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SECTION 6Antibiotic control of infe
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Bacteriostatic antibioticsnclude te
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ttachment of mRNA to ribosome (eg b
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Alteration of cell membrane functio
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Aminoglycosidesxamples: gentamicin,
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Sulfonamidesxamples: co-trimoxazole
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Quinolonesxamples: ciprofloxacin, n
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CellulitisMost likely organisms are
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Complicated UTIUTI involving urosep
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Diarrhoea after food poisoningMay n
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infection and antibiotic resistance
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Systemic MRSA infectionsMay require
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5.2 Radiotherapy5.3 Chemotherapy5.4
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Information from death certificates
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reast cancer: much less common in t
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Environmental exposuresbestos: the
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Screeningnitial increase in inciden
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differentiation:Labile cells: const
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tem cell: a cell from an embryo, fe
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HypertrophyIncrease in cell size bu
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Chemical carcinogensChemical carcin
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are damaged or missing).Examples of
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Familial cancers - congenital mutat
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• Surgical prophylaxis (eg mastec
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Homeostasis: eg loss of the uterine
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Inhibitors of angiogenesisNaturally
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in the filtering lymph nodes draini
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components and the abnormal cells a
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e simple and cheap/cost-effective
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SECTION 4Clinical and pathological
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in guiding treatment.4.3 Tumour mar
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SECTION 5Principles of cancer treat
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Sentinel nodes can then be identifi
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Administration of radiotherapyocall
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Alkylating agentsAntimetabolitesAnt
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ChlorambucilCLLNon-Hodgkin’s lymp
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Bladder cancerOvary cancerWilms’
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Acute complicationsausea and vomiti
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ncreasing use in primary treatment
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Dry mouthAppetite loss, nausea, vom
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Colic
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Muscle spasmNerve pain-compression
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Nerve irritationLiver pain (capsula
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Dyspnoea
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CoughGIAntacid, metoclopramide, chl
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AnorexiaLactulose, co-danthrusate
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Nausea and vomitingSkin/mucous memb
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Dry mouthNeurological
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HypoxiaConfusion/sedationConfusion/
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Key features of using the LCPNon-es
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Management of spinal cord compressi
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leep disturbance and loss of diurna
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Planning and follow-upPlanning for
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CHAPTER 6TraumaPart 1: Head, Abdome
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SECTION 1Overview of trauma1.1 Hist
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servicesrimary care: general practi
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LaryngoscopeRapid communication lin
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Fully stocked anaesthetictrolleyDes
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OxygenBlood sampling equipment1.4 T
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SECTION 2Injury and shock2.1 The bi
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HypothermiaHypothermia may be accid
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Hypovolaemic shockPathophysiology o
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sign of ongoing blood loss.Fluid re
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Expect the following values for uri
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Contraindicationsulmonary oedemausp
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SECTION 3Resuscitation: the primary
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Recognition of a compromised airway
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Chest wall movementAdminister suppl
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Surgical cricothyroidotomyThis tech
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Spontaneous breathing may resume wh
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Establish IV accessEstablish IV acc
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HistoryIt is important to take a me
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ThoraxAbdomenPelvisExtremitiesSpine
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DocumentationDocument ABCDE status,
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Moderate Coma lasting >24 hours No
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Obstruction of CSF flow (rarely an
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Burr holesA burr hole is a small ho
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Best eye-opening response 4 Open sp
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blood supply and nerve supply of th
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This consists of:asal bones (right
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The inferior alveolar nerve provide
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Figure 6.17 Le Fort injuryZygomatic
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Types of traumalunt chest trauma as
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Figure 6.18 Tension pneumothoraxrai
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If there are any signs of penetrati
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Procedure box: PericardiocentesisIn
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Confirmation of oesophageal trauma
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Contraindications to DPLbsolute - d
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Management includes simultaneous as
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4Grade5A completely shattered kidne
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bladder. If this is unsuccessful, p
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If there is blood at the urethral m
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RadiotherapyStructure of peripheral
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In a nutshell ...The major trauma p
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Figure 6.21 The peripheral and cent
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system can manifest as priapism and
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These usually result in wedge fract
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aematomaseudo-aneurysm occurs when
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SECTION 5Special cases in trauma5.1
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Pathophysiology of burnsBurn injuri
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Primary surveyAirway + C-spineEnsur
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DeathCO poisoning must be excluded
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Fluid resuscitationFluid resuscitat
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Assessment of the burn woundIn addi
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Management of special areasFaceSign
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Figure 6.24 Causes of death (A) and
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BreathingNote these differences whe
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n children aged <6 years: intraosse
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ExposureRemember that the relativel
Page 752 and 753:
Abdominal trauma in childrenecompre
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lunt/penetrating uterine traumalace
Page 756 and 757:
The diagnosis of brainstem deathDef
Page 758 and 759:
neither revascularization nor amput
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Nigel W GummersonPathophysiology of
Page 762 and 763:
SECTION 1Pathophysiology of fractur
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Reparative phaseFibroblasts, recrui
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Factors that delay bone healingSyst
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A fall on the outstretched hand the
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SECTION 3Principles of management o
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Complications of internal fixationn
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1-3 Limb ischaemia (double score if
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Complications of fracturesComplicat
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Fractures and fat embolism syndrome
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Radial nerveRadial nerve (most comm
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Distal radial fractureLumbar-sacral
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Sciatic nervePopliteal artery and c
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Open tibial fracturePriorities in m
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Features of cellulitishere is infec
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Risk factors for cellulitisymphoede
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Features of gas gangrenehock and se
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Risk factors for gas gangrenefter a
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Features of tetanusSymptoms begin 3
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Risk factors for tetanusounds that
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Treatment of tetanususcle relaxants
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increase the risk of AVN. Early and
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Features of AVNainhondrolysis and c
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Fractures and myositis ossificansMy
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Treatment of myositis ossificansiff
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Treatment of CRPS type IUsually thi
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Mechanics of anterior shoulder disl
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Radiographs of anterior shoulder di
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Proximal humerus fracturesThese fra
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GroupIISurgical neck fracture with
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GroupIV
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Group Fracture dislocationsVIGroups
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Fractures around the elbowAdult sup
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Complications of fractures around t
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Complications of forearm shaft frac
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Scaphoid fractureThe most commonly
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Intracapsular fracture of the proxi
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Management of intracapsular fractur
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Postoperative complications of intr
Page 838 and 839:
Complications of proximal femur fra
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Complications associated with tibia
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The pelvic ring comprises the sacru
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Investigating pelvic fracturesA pla
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Acetabular fracturesAcetabular frac
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Classification of spinal injuriesSp
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Treatment of cervical spine injurie
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Type Iistraction injury of growth p
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Complete, greenstick and torus frac
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SECTION 7Soft-tissue injuries and d
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pathology at presentation or pathol
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of patella (patella tendon rupture)
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Forced dorsiflexionWhen the foot is
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SECTION 8Compartment syndromeIn a n
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Management of compartment syndromeI
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Nerys ForesterSurgical research and
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There are advantages and disadvanta
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ControlsA control group is a group
Page 874 and 875:
Asking an answerable questionClinic
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All studies suffer from loss to fol
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Applying evidence to clinical pract
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se and storage of human tissue (if
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Paper contentThe paper should inclu
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ReferencesCross-reference statement
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Experimental studies are the RCTs.S
Page 888 and 889:
Observational studyAccurate and pre
Page 890 and 891:
CrosssectionalExample is Framingham
Page 892 and 893:
RandomisedcontrolledtrialInterventi
Page 894 and 895:
Measures of spreadMeasure of spread
Page 896 and 897:
The normal distributionIf you study
Page 898 and 899:
Types of biasbserver bias: may occu
Page 900 and 901:
Survival analysisSurvival analysis
Page 902 and 903:
5.2 Who can obtain consent?5.3 Who
Page 904 and 905:
interests of their patients.Non-mal
Page 906 and 907:
SECTION 2Clinical governance and ri
Page 908 and 909:
improvements in safety.A patient sa
Page 910 and 911:
This has replaced the Health Care C
Page 912 and 913:
rediction scores (eg ASA)emographic
Page 914 and 915:
Personal knowledgeThis may be subdi
Page 916 and 917:
Referral involves transferring some
Page 918 and 919:
even where there has probably been
Page 920 and 921:
egible handwritingclearly defined p
Page 922 and 923:
complication after surgery, and the
Page 924 and 925:
Permanent incapacityThis is a compl
Page 926 and 927:
atients whose conditions may be rel
Page 928 and 929:
ny financial interest must be openl
Page 930 and 931:
CHAPTER 9Orthopaedic SurgeryNigel W
Page 932 and 933:
Disorders of the hand10.1 Clinical
Page 934 and 935:
SECTION 1Bone, muscle and joint str
Page 936 and 937:
Parathyroid hormoneine regulator of
Page 938 and 939:
Oestrogens and androgensAnabolic ho
Page 940 and 941:
Bone cellsThe osteoblasts and osteo
Page 942 and 943:
load transfer from the articular su
Page 944 and 945:
Synovial jointsSynovial joints are
Page 946 and 947:
muscle occurs. This is called the s
Page 948 and 949:
Type II fibresew mitochondriaich in
Page 950 and 951:
SECTION 2Joint pathologyDifferentia
Page 952 and 953:
Pain in OA is due to:nflamed and th
Page 954 and 955:
flares, 5% per cent show relentless
Page 956 and 957:
chronic renal failurePathological f
Page 958 and 959:
SECTION 3Bone pathology3.1 Osteopor
Page 960 and 961:
skeletal loading.
Page 962 and 963:
supplements should be given first t
Page 964 and 965:
capital epiphysisMain radiological
Page 966 and 967:
aged >90. Most commonly seen in Bri
Page 968 and 969:
SECTION 4The hip and thigh4.1 Anato
Page 970 and 971:
Nerve supply and movement of the hi
Page 972 and 973:
ExtensionGluteus maximus and hamstr
Page 974 and 975:
AbductionPiriformis, obturators, qu
Page 976 and 977:
Medial rotation4.2 Anatomy of the g
Page 978 and 979:
nferior glutealedial femoral circum
Page 980 and 981:
Move:Thomas’ test for fixed flexi
Page 982 and 983:
Signs of osteoarthritis of the hipT
Page 984 and 985:
Rheumatoid arthritis of the hipRheu
Page 986 and 987:
Compartments of the thighFemoral tr
Page 988 and 989:
SECTION 5The knee5.1 Anatomy of the
Page 990 and 991:
Posterior cruciateligamentPosterior
Page 992 and 993:
• Femur• Posterior ligament of
Page 994 and 995:
Clinical examinationStanding, trous
Page 996 and 997:
Joint injectionsSecond-line treatme
Page 998 and 999:
SECTION 6Disorders of the foot and
Page 1000 and 1001:
Classic peroneal nerve injuryoss of
Page 1002 and 1003:
Classic tibial nerve injuryoss of a
Page 1004 and 1005:
The arches of the footMedial longit
Page 1006 and 1007:
Toenails: onchogryphosis, subungal
Page 1008 and 1009:
Pes cavus (claw foot)This is charac
Page 1010 and 1011:
Surgical optionsild to moderate def
Page 1012 and 1013:
SECTION 7The shoulder and humerus7.
Page 1014 and 1015:
the glenoid cavity to the anatomica
Page 1016 and 1017:
Infraspinatuseinforces the posterio
Page 1018 and 1019:
Anterior (deltopectoral) approachAp
Page 1020 and 1021:
translation: fixing humeral head in
Page 1022:
7.5 Anatomy of the upper armIn a nu
Page 1025 and 1026:
ensory braches: posterior cutaneous
Page 1027 and 1028:
ronation is performed by pronator t
Page 1029 and 1030:
8.3 Clinical assessment of the elbo
Page 1031 and 1032:
8.4 Elbow disordersTennis elbowTenn
Page 1033 and 1034:
SECTION 9The forearm and wrist9.1 A
Page 1036 and 1037:
9.2 Bones of the forearmAnatomy of
Page 1038:
Compartment 6 (ulnar)Extensor carpi
Page 1041 and 1042:
Zone5Area of carpal tunnelContains
Page 1043 and 1044:
Approachevelop plane between brachi
Page 1045 and 1046:
Approachevelop plane between extens
Page 1047 and 1048:
SECTION 10Disorders of the hand10.1
Page 1049 and 1050:
Remember to assess any sensory defi
Page 1051 and 1052:
ParonychiaApical infectionsPulp inf
Page 1053 and 1054:
Conservative management of the rheu
Page 1055 and 1056:
•Little
Page 1057 and 1058:
Index• Thumb (least commonly)Cond
Page 1059 and 1060:
skin (unlike sebaceous cysts) nor t
Page 1061 and 1062:
supracondylar fracturesExamination
Page 1063 and 1064:
Palpationalpate the nerve where it
Page 1065 and 1066:
Powerbductor pollicis brevis: this
Page 1067 and 1068:
Treatment of carpal tunnel syndrome
Page 1069 and 1070:
InspectionAsk patient to roll up th
Page 1071 and 1072:
Sensationlnar side of the palm over
Page 1073 and 1074:
InspectionAsk the patient to roll u
Page 1075 and 1076:
Sensationesions distal to the elbow
Page 1077 and 1078:
canals, causing thrombosis of blood
Page 1079 and 1080:
Spread of infectionOsteomyelitis ma
Page 1081 and 1082:
Common organisms. aureus is most co
Page 1083 and 1084:
Clinical features of septic arthrit
Page 1085 and 1086:
pollution is dilution’ashout may
Page 1087 and 1088:
In adultsecondary OAoint stiffnessi
Page 1089 and 1090:
Aetiology of acute osteomyelitisCau
Page 1091 and 1092:
Other causesalmonella spp. in patie
Page 1093 and 1094:
Investigating acute osteomyelitisad
Page 1095 and 1096:
Classification of chronic osteomyel
Page 1097 and 1098:
Management of chronic osteomyelitis
Page 1099 and 1100:
Microbiology of skeletal TBCausativ
Page 1101 and 1102:
Spinal TBSpinal TB typically involv
Page 1103 and 1104:
Management of skeletal TBAnti-TB ch
Page 1105 and 1106:
Microbiology of spinal infectionsCo
Page 1107 and 1108:
Management of spinal infectionsTrea
Page 1109 and 1110:
Pathogenesis of prosthetic joint in
Page 1111 and 1112:
Management of prosthetic joint infe
Page 1113 and 1114:
Swellingleeding into tumours may pr
Page 1115 and 1116:
pen incisional biopsypen excisional
Page 1117 and 1118:
• Second smaller peak in incidenc
Page 1119 and 1120:
definitive investigationresentation
Page 1121 and 1122:
maging: lytic lesion in epiphysis.
Page 1123 and 1124:
Fibrous dysplasiapidemiology: major
Page 1125 and 1126:
Imaging of skeletal metastasesPlain
Page 1127 and 1128:
SECTION 13Spine13.1 Development of
Page 1129 and 1130:
Figure 9.18 Formation of the neural
Page 1131 and 1132:
Role of the spineStructuralaintenan
Page 1133 and 1134:
attachment points for the muscles a
Page 1135 and 1136:
Cervical vertebraell have a hole in
Page 1137 and 1138:
Sacrumransmits the weight of the bo
Page 1139 and 1140:
Intervertebral discsThese are the j
Page 1141 and 1142:
Figure 9.24 Some of the extrinsic m
Page 1143:
Posterior longitudinal ligamentimil
Page 1146 and 1147:
Suboccipital triangleThis is a tria
Page 1148 and 1149:
Forces on the spineWhen comparing r
Page 1150 and 1151:
Spinal cord coveringsThe spinal cor
Page 1152 and 1153:
Composition of the spinal cordThe s
Page 1154 and 1155:
Spinal nerve roots and spinal nerve
Page 1156 and 1157:
Spinal nerve leaves the foramen↓D
Page 1158 and 1159:
Figure 9.28 The interrelationships
Page 1160 and 1161:
Sympathetic nervous systemIf you ca
Page 1162 and 1163:
Spinal nerve↓
Page 1164 and 1165:
Postganglionic fibres↓Grey ramus
Page 1166 and 1167:
Radicular arteriesThe radicular art
Page 1168 and 1169:
HistoryWhen taking a history for so
Page 1170 and 1171:
Summary of neurological examination
Page 1172 and 1173:
Elderly; on steroidsSpinal fracture
Page 1174 and 1175:
Night sweatsTumour, infection
Page 1176 and 1177:
Previous cancer historyMetastatic t
Page 1178 and 1179:
Recent bacterial infectionInfection
Page 1180 and 1181:
Saddle anaesthesiaCauda equina synd
Page 1182 and 1183:
Generalised ill health
Page 1184 and 1185:
Examination Bruising/haematomaTumou
Page 1186 and 1187:
Neurological loss with level
Page 1188 and 1189:
Severe pain on palpation
Page 1190 and 1191:
Lax anal sphincterPerianal/perineal
Page 1192 and 1193:
LymphadenopathyTumour
Page 1194 and 1195:
Abnormal chest examinationTumourInv
Page 1196 and 1197:
Disc prolapseProlapse of the interv
Page 1198 and 1199:
spastic paraparesis, and hyper-refl
Page 1200 and 1201:
Inflammation of ligamentous inserti
Page 1202 and 1203:
Replacement by fibrous tissue↓
Page 1204 and 1205:
Wall testIf a healthy person stands
Page 1206 and 1207:
Extraskeletal manifestationsritis (
Page 1208 and 1209:
Spinal infectionsSee also Section 1
Page 1210 and 1211:
Causes of back painAge 0-10Scoliosi
Page 1212 and 1213:
Management of nerve root painOnce s
Page 1214 and 1215:
Cauda equina syndromeIf the narrowi
Page 1216 and 1217:
Microdiscectomyim: to remove hernia
Page 1218 and 1219:
Intradiscal extracanalicular approa
Page 1220 and 1221:
Posterolateral or intertransverse f
Page 1222 and 1223:
Transforaminal lumbar interbody fus
Page 1224 and 1225:
Pathology of neck painAcute cervica
Page 1226 and 1227:
Management of cervical spondylosisO
Page 1228 and 1229:
ortality (5% for transoral odontoid
Page 1230 and 1231:
urgical treatment reserved for larg
Page 1232 and 1233:
Figure 9.33 Cobb’s method for mea
Page 1234 and 1235:
SpondylolisthesisSpondylolisthesis
Page 1236 and 1237:
The most common site is the lumbar
Page 1238 and 1239:
Spinal column reconstructionThe aim
Page 1240 and 1241:
DecompressionDecompression is a gen
Page 1242 and 1243:
spinal surgery). Upper limb procedu
Page 1244 and 1245:
InfectionImplanting prosthetic mate
Page 1246 and 1247:
Skeletal dysplasiaOsteogenesis impe
Page 1248 and 1249:
septic arthritis in cases where sus
Page 1250 and 1251:
Flex the knees.Place hands so that
Page 1252 and 1253:
Perthes’ diseasePerthes’ diseas
Page 1254 and 1255:
Acute-on-chronic presentation is co
Page 1256 and 1257:
15.2 Problems with the foot in chil
Page 1258 and 1259:
varus/valgus malalignment.Pathologi
Page 1260 and 1261:
Discoid lateral meniscusIncidence i
Page 1262 and 1263:
dominant form is often associated w
Page 1264 and 1265:
CHAPTER 10Paediatric surgeryStuart
Page 1266 and 1267:
SECTION 1Children as surgical patie
Page 1268 and 1269:
Abdominal organs in childrenThere a
Page 1270 and 1271:
Maintenance fluid and electrolyte r
Page 1272 and 1273:
Recognising shock in children is mo
Page 1274 and 1275:
9 months Crawls, babbles, eg ‘mam
Page 1276 and 1277:
Give initial bolus of 20 ml/kg flui
Page 1278 and 1279:
Embryology of the GI tractBy the th
Page 1280 and 1281:
The pharyngeal gutThis extends from
Page 1282 and 1283:
The spleen is a foregut derivative
Page 1284 and 1285:
reatment consists of closure of the
Page 1286 and 1287:
Low and intermediate anorectal anom
Page 1288 and 1289:
bowel lumen and its detergent effec
Page 1290 and 1291:
Embryology of the diaphragmFigure 1
Page 1292 and 1293:
week 6.Figure 10.10 Development of
Page 1294 and 1295:
Formation of the definitive kidneyT
Page 1296 and 1297:
Testesf the germ cells carry an XY
Page 1298 and 1299:
Descent of the testesThe testis is
Page 1300 and 1301:
Genital ducts in the malen the pres
Page 1302 and 1303:
External genitalia in the malehe ge
Page 1304 and 1305:
ay be solitary, multiple or bilater
Page 1306 and 1307:
Associationsystic change in other o
Page 1308 and 1309:
Medullary sponge kidneyystic dilata
Page 1310 and 1311:
Management of PUJ obstructionThe in
Page 1312 and 1313:
Surgery is performed between the ag
Page 1314 and 1315:
Figure 10.15 Ectopic positions for
Page 1316 and 1317:
ilms tumourntersex disorders (gonad
Page 1318 and 1319:
3.7 Urinary tract infections in chi
Page 1320 and 1321:
Idiopathic scrotal oedemaHenoch-Sch
Page 1322 and 1323:
SECTION 4Paediatric oncologyIn a nu
Page 1324 and 1325:
are patent and if blood flow is nor
Page 1326 and 1327:
of tumour volume • Given in fract
Page 1328 and 1329:
Rhabdomyosarcoma
Page 1330 and 1331:
Germ cell tumoursLiver tumours (hep
Page 1332 and 1333:
Treatment of liver tumoursurther ch
Page 1334 and 1335:
Investigating rhabdomyosarcomanitia
Page 1336 and 1337:
Investigating neuroblastomat presen
Page 1338 and 1339:
Treatment of Wilms tumourhemotherap
Page 1340 and 1341:
Staging of germ cell tumoursarious
Page 1342 and 1343:
SECTION 5Paediatric general surgery
Page 1344 and 1345:
can be identified by the prepyloric
Page 1346 and 1347:
ust preserve the umbilicus to avoid
Page 1348 and 1349:
engorged (with rectal bleeding) and
Page 1350 and 1351:
Investigating intussusceptionbdomin
Page 1352 and 1353:
Outcome of treatmentRecurrence rate
Page 1354 and 1355:
CHAPTER 11Plastic SurgeryStuart W W
Page 1356 and 1357:
giving ‘granular’ appearance 4.
Page 1358 and 1359:
complete surgical excision of the c
Page 1360 and 1361:
lesion, particularly on the limbs o
Page 1362 and 1363:
SCC commonly presents in older, fai
Page 1364 and 1365:
Aetiology of melanomaMalignant mela
Page 1366 and 1367:
1.01-2.0 1-22.01-4.0 2-3>4 3Managin
Page 1368 and 1369:
IIb T3bN0M0 T4aN0M0 63-67IIc T4bN0M
Page 1370 and 1371:
Avulsion involves tearing or forcib
Page 1372 and 1373:
Wound debridementDebridement is the
Page 1374 and 1375:
Tissue expansionTissue expansion is
Page 1376 and 1377:
FlapsA flap is a vascularised unit
Page 1378 and 1379:
Scapular and parascapular flapsFlap
Page 1380 and 1381:
Gracilis flapGracilis is a long thi
Page 1382 and 1383:
List of Abbreviations5-HIAA 5-hydro
Page 1384 and 1385:
CT computed tomographyCTEV congenit
Page 1386 and 1387:
ITUIVIVUJGAJIAJVPKUBLALDHLFTsLIFLMW
Page 1388 and 1389:
RARBCRIFRTARUQSBPSIMVSIRSSLESMASPEC
Page 1390 and 1391:
BibliographyBooks:nderson ID (1999)
Page 1392 and 1393:
lter RB, Harris WR (1963) ‘Injuri
Page 1394 and 1395:
management ref 1, ref 2specimen col
Page 1396 and 1397:
liver trauma ref 1pre-hospital resu
Page 1398 and 1399:
aplastic ref 1blood transfusion ref
Page 1400 and 1401:
terior white commissure ref 1terola
Page 1402 and 1403:
electrical injuries ref 1hypothermi
Page 1404 and 1405:
cille Calmette-Guérin (BCG) vaccin
Page 1406 and 1407:
opsy ref 1bone infections ref 1, re
Page 1408 and 1409:
infections ref 1island ref 1, ref 2
Page 1410 and 1411:
segmental ref 1traumatic injuries r
Page 1412 and 1413:
hydrostatic pressure ref 1membrane,
Page 1414 and 1415:
rriage, microbial ref 1rtilageartic
Page 1416 and 1417:
fibres ref 1ancre ref 1emical burns
Page 1418 and 1419:
indamycin ref 1inical decision-maki
Page 1420 and 1421:
postoperative see postoperative com
Page 1422 and 1423:
of surgery ref 1st-utility analysis
Page 1424 and 1425:
osteoclast development ref 1SIRS re
Page 1426 and 1427:
ad spacealveolar ref 1anatomical re
Page 1428 and 1429:
hiscenceanastomosis ref 1wound ref
Page 1430 and 1431:
aphragmcongenital herniation ref 1e
Page 1432 and 1433:
sabilityburns ref 1paediatric traum
Page 1434 and 1435:
odenumatresia ref 1development ref
Page 1436 and 1437:
ectrolytescytoplasmic ref 1daily re
Page 1438 and 1439:
dothelial cellsinflammatory respons
Page 1440 and 1441:
ergymetabolism, paediatric patients
Page 1442 and 1443:
aporation, heat loss via ref 1
Page 1444 and 1445:
posureburns ref 1paediatric trauma
Page 1446 and 1447:
ctor VIIIconcentrate ref 1deficienc
Page 1448 and 1449:
sciotomycompartment syndrome in cal
Page 1450 and 1451:
distaladults ref 1children ref 1fat
Page 1452 and 1453:
gersDupuytren’s contracture ref 1
Page 1454 and 1455:
latedeficiency ref 1red cell ref 1l
Page 1456 and 1457:
fracturesadults ref 1children ref 1
Page 1458 and 1459:
ngal infections ref 1ITUs ref 1, re
Page 1460 and 1461:
Duties of a Doctor ref 1Good Medica
Page 1462 and 1463:
nital tractdevelopmental abnormalit
Page 1464 and 1465:
ucoseenergy production from ref 1,
Page 1466 and 1467:
nadsdescent ref 1development ref 1o
Page 1468 and 1469:
emarthrosishaemophilia-related ref
Page 1470 and 1471:
emophiliaA ref 1B (Christmas diseas
Page 1472 and 1473:
alingfracture ref 1wound see wound
Page 1474 and 1475:
artconducting system ref 1trauma se
Page 1476 and 1477:
rpes simplex virus1 (HSV-1) ref 12
Page 1478 and 1479:
merusanatomy ref 1, ref 2fractures
Page 1480 and 1481:
perkalaemiamassive transfusion ref
Page 1482 and 1483:
povolaemiaburn injuries ref 1physio
Page 1484 and 1485:
capacitypermanent ref 1temporary re
Page 1486 and 1487:
formationconfidentiality see confid
Page 1488 and 1489:
sulin therapydiabetes mellitus ref
Page 1490 and 1491:
tracranial haemorrhageburr holes re
Page 1492 and 1493:
nsdistribution in body ref 1see als
Page 1494 and 1495:
aspirationdiagnostic ref 1, ref 2,
Page 1496 and 1497:
dneyaberrant vasculature ref 1bilat
Page 1498 and 1499:
parotomyabdominal trauma ref 1, ref
Page 1500 and 1501:
erdevelopment ref 1immaturity in ne
Page 1502 and 1503:
wer leganatomy ref 1see also ankle;
Page 1504 and 1505:
mbar spinebiomechanics ref 1disc re
Page 1506 and 1507:
acrophagesacute inflammation ref 1,
Page 1508 and 1509:
edian ref 1
Page 1510 and 1511:
embranecell ref 1transport ref 1emb
Page 1512 and 1513:
etastatic diseaseskeletal ref 1surg
Page 1514 and 1515:
otor endplate ref 1, ref 2
Page 1516 and 1517:
ucous membranesbarrier to infection
Page 1518 and 1519:
ckabscesses ref 1burns, management
Page 1520 and 1521:
urological assessmentback/spinal pr
Page 1522 and 1523:
servational studies ref 1server bia
Page 1524 and 1525:
sophagusatresia ref 1cancer ref 1tr
Page 1526 and 1527:
erating theatre staffminimising ris
Page 1528 and 1529:
tcomesresearch study ref 1, ref 2su
Page 1530 and 1531:
ygen contentarterial blood (CaO 2 )
Page 1532 and 1533:
3 protein ref 1, ref 2cemakers ref
Page 1534 and 1535:
in assessmentchronic pain ref 1paed
Page 1536 and 1537:
ncreasdevelopment ref 1secretions r
Page 1538 and 1539:
telladislocation ref 1fractures ref
Page 1540 and 1541:
lvispaediatric patients ref 1second
Page 1542 and 1543:
ysiologycellular ref 1general ref 1
Page 1544 and 1545:
gmented skin lesionsassessment of s
Page 1546 and 1547:
eumothoraxopen ref 1tension ref 1ly
Page 1548 and 1549:
anion gap ref 1daily requirements r
Page 1550 and 1551:
evalence ref 1, ref 2evalence bias
Page 1552 and 1553:
ostate cancerepidemiology ref 1, re
Page 1554 and 1555:
oteinscatabolism after surgery ref
Page 1556 and 1557:
eudoaneurysmsinjecting drug users r
Page 1558 and 1559:
blicationsurgical outcomes ref 1wri
Page 1560 and 1561:
estionsclinical ref 1patient ref 1,
Page 1562 and 1563:
dial neckfractures ref 1posterolate
Page 1564 and 1565:
diationheat loss via ref 1injuries
Page 1566 and 1567:
flexestendon ref 1testing ref 1flex
Page 1568 and 1569:
placement arthroplastyhip ref 1infe
Page 1570 and 1571:
spiratory distresspaediatric patien
Page 1572 and 1573:
suscitationacute renal failure ref
Page 1574 and 1575:
turday night palsy ref 1alds ref 1a
Page 1576 and 1577:
reeningcancer ref 1, ref 2programme
Page 1578 and 1579:
nsory functionperipheral nerve inju
Page 1580 and 1581:
dislocationsanterior ref 1posterior
Page 1582 and 1583:
dium/potassium pump (Na + /K + ATPa
Page 1584 and 1585:
curvatureabnormal ref 1measurement
Page 1586 and 1587:
ffcritical care ref 1theatre see op
Page 1588 and 1589:
pination, forearm ref 1, ref 2, ref
Page 1590 and 1591:
rgical teampreparation ref 1see als
Page 1592 and 1593:
amsconflict within ref 1working in
Page 1594 and 1595:
ighanatomy ref 1compartments ref 1i
Page 1596 and 1597:
oracotomyanterolateral ref 1, ref 2
Page 1598 and 1599:
umbmallet ref 1movement ref 1simian
Page 1600 and 1601:
esclaw ref 1hammer ref 1mallet ref
Page 1602 and 1603:
initial hospital care ref 1limping
Page 1604 and 1605:
atmentoptions, alternative ref 1ref
Page 1606 and 1607:
nar nerveanatomy ref 1, ref 2, ref
Page 1608 and 1609:
per limbarterial injuries ref 1comp
Page 1610 and 1611:
ethracongenital abnormalities ref 1
Page 1612 and 1613:
inary tractcongenital abnormalities
Page 1614 and 1615:
ine outputburns ref 1hypovolaemic s
Page 1616 and 1617:
scular accesschildren ref 1, ref 2c
Page 1618 and 1619:
insanastomoses ref 1injuries ref 1,
Page 1620 and 1621:
ntilatory supportcritical care ref
Page 1622 and 1623:
n Hippel-Lindau syndrome ref 1, ref
Page 1624 and 1625:
ound closureprimary ref 1principles
Page 1627 and 1628:
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