FIRST AID FOR THE® Surgery Clerkship Second Edition SERIES EDITORS: MATTHEW S. KAUFMAN, MD S. MATTHEW STEAD, MD, PhD Attending Physician and Co-investigator Epilepsy Research Fellow Chronic Lymphocytic Leukemia Research and Treatment Program Department of Neurology Department of Hematology-Oncology Mayo Clinic and Mayo School of Graduate Medical North Shore–Long Island Jewish Health System Education Manhasset and New Hyde Park, New York Rochester, Minnesota LATHA G. STEAD, MD, FACEP Professor and Chair, Department of Emergency Medicine University of Rochester Rochester, New York VOLUME EDITOR: NITIN MISHRA, MBBS, MS, MRCS (UK) Resident in General Surgery North Shore–Long Island Jewish Health System Manhasset and New Hyde Park, New York New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-164308-5 MHID: 0-07-164308-7 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-144871-0, MHID: 0-07-144871-3. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained here- in is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, dis- assemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly pro- hibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. DEDICATION My work in the book is dedicated to my grandmother, Frances Jacobson. —Matthew S. Kaufman, MD My work in this book is dedicated to my parents, Mr. Rajeshwar Mishra and Mrs. Indu Mishra. —Nitin Mishra, MBBS, MS, MRCS (UK) This page intentionally left blank CONTENTS Contributors vii Introduction ix How to Contribute xi SECTION I: HOW TO SUCCEED IN THE SURGERY CLERKSHIP 1 SECTION II: HIGH-YIELD FACTS FOR THE SURGERY CLERKSHIP 15 The Surgical Patient 17 Wounds 25 Acute Abdomen 35 Trauma 43 Critical Care 63 Fluids, Electrolytes, and Nutrition 75 The Esophagus 97 The Stomach 113 Small Bowel 133 Colon, Rectum, and Anal Canal 155 The Appendix 181 Hernia and Abdominal Wall Problems 189 The Hepatobiliary System 201 The Pancreas 229 The Endocrine System 243 v The Spleen 273 The Breast 279 Burns 297 SECTION III: HIGH-YIELD FACTS FOR SURGICAL ELECTIVES 307 Anesthesia 309 Vascular Surgery 315 Pediatric Surgery 335 Ear, Nose, and Throat Surgery 353 Neurosurgery 395 Cardiothoracic Surgery 419 Transplant 439 The Genitourinary System 453 Orthopedics 469 The Hand 487 SECTION IV: CLASSIFIED: AWARDS AND OPPORTUNITIES 503 Index 519 About the Authors 546 vi CONTRIBUTORS MUHAMMAD AFTAB, MB, BS, MD ARIELLE GLUECK, MD Resident in General Surgery Resident in Pediatrics North Shore–Long Island Jewish Health System Children’s Hospital at Montefi ore Manhasset and New Hyde Park, New York Albert Einstein College of Medicine Cardiothoracic Surgery Bronx, New York Acute Abdomen MALATHY APPASAMY, MD Resident in General Surgery EDWIN GULKO North Shore–Long Island Jewish Health System Medical Student Manhasset and New Hyde Park, New York Class of 2009 Orthopedics Albert Einstein College of Medicine Bronx, New York MICHAEL P. AST, MD Neurosurgery Resident in Orthopedic Surgery North Shore–Long Island Jewish Health System ANUNAYA R. JAIN, MBBS, MCEM (UK) Manhasset and New Hyde Park, New York Research Fellow The Hand Instructor of Emergency Medicine Department of Emergency Medicine LUKAS R. AUSTIN-PAGE Mayo Clinic College of Medicine Rochester, Minnesota Medical Student Section IV: Classifi ed Class of 2010 Albert Einstein College of Medicine Bronx, New York VIJAY KAMATH, MBBS The Pancreas Resident in General Surgery North Shore–Long Island Jewish Health System NETANEL BERKO, MD Manhasset and New Hyde Park, New York Intern The Breast Department of Medicine New York Medical College JONATHAN D. KAYE, MD Sound Shore Medical Center of Westchester Fellow in Pediatric Urologic Surgery New Rochelle, New York Emory University School of Medicine The Surgical Patient Children’s Healthcare of Atlanta Atlanta, Georgia RONEN ELEFANT, MS, MD The Genitourinary System Resident in General Surgery Montefi ore Medical Center ASHLEY KEILER-GREEN, MD Albert Einstein College of Medicine Program Bronx, New York Resident in Emergency Medicine Fluids, Electrolytes, and Nutrition University of New Mexico Albuquerque, New Mexico The Hepatobiliary System TOVA C. FISCHER Medical Student SILVIA KURTOVIC, MD Class of 2009 Albert Einstein College of Medicine Resident in General Surgery Bronx, New York Cedars-Sinai Medical Center The Esophagus; Ear, Nose, and Throat Surgery Los Angeles, California Critical Care REBECCA PARVER GAMSS CHARLES F. LANZILLO III, MD Medical Student Class of 2009 Resident in Ophthalmology Albert Einstein College of Medicine University of Colorado Bronx, New York Denver, Colorado The Spleen Wounds vii JONATHAN MAZUREK, MD CASEY SEIDEMAN Resident in Internal Medicine Medical Student Beth Israel Medical Center Class of 2009 New York, New York Albert Einstein College of Medicine Small Bowel Bronx, New York The Genitourinary System; Colon, Rectum, and Anal Canal NITIN MISHRA, MBBS, MS, MRCS (UK) ANAND SHAH, MD, MPH Resident in General Surgery North Shore–Long Island Jewish Health System Resident in Radiology Manhasset and New Hyde Park, New York Hospital of the University of Pennsylvania Trauma; Transplant Philadelphia, Pennsylvania Vascular Surgery SNEHA MISHRA, MBBS EDAN SHAPIRO Resident in Internal Medicine Wyckoff Heights Medical Center Medical Student Brooklyn, New York Class of 2009 Burns; Anesthesia Albert Einstein College of Medicine Bronx, New York SAMUEL T. OSTROWER, MD The Endocrine System Fellow in Pediatric Otolaryngology GRACE L. YU, MD Children’s Hospital Boston Boston, Massachusetts Resident in Plastic and Reconstructive Surgery Ear, Nose, and Throat Surgery University of Southern California Los Angeles, California TAMAR RUBINSTEIN The Stomach Medical Student LISA ZUCKERWISE Class of 2009 Albert Einstein College of Medicine Medical Student Bronx, New York Class of 2009 Pediatric Surgery Albert Einstein College of Medicine Bronx, New York DAVUT SAVASER, MD The Appendix Resident in Emergency Medicine University of California–San Diego San Diego, California Hernia and Abdominal Wall Problems viii INTRODUCTION This book is designed in the tradition of the First Aid series of books. It is for- matted in the same way as the other books in the series. You will fi nd that, apart from preparing you for success on the clerkship exam, this resource will also help guide you in the clinical diagnosis and treatment of common surgi- cal conditions. The content of the book is based on the objectives for medical students as de- termined by the Association for Surgical Education (ASE). Each chapter con- tains the major topics central to the practice of general surgery and has been specifi cally designed for the medical student. The book is divided into general surgery, which contains topics that comprise the core of the surgery rotation, and subspecialty surgery, which may be of interest but is generally considered less high yield for the clerkship. Knowledge of a subspecialty topic may be useful if observing a related surgery or if requesting a letter from a surgeon in that fi eld. The content of the text is organized in the format similar to other texts in the First Aid series. Topics are listed with bold headings, and the “body” of the topic provides essential information. The outside margins contain mnemon- ics, diagrams, summary or warning statements, and tips. Tips are categorized into Exam Tip , Ward Tip , and OR tip . ix