TNM staging of some cancer.

#Surgery

Types of shock in a burned patient:

1-Hypovolemic shock:
Due loss of enormous amounts of fluid and proteins from damaged area, excessive loss of water due to evaporation, this leads to AKI.

2-Septic shock: "worst"
Bacteria will colonize the burnt area, it's very bad because it's very difficult to eradicate bacteria unless skin coverage is achieved.

3-Neurogenic shock:
It's due to severe pain.

4-Distributive shock:
This type occurs when there is a widespread dilation of blood vessels, leading to a decrease in blood pressure. In burned patients, distributive shock can be caused by the release of inflammatory mediators and the loss of fluid from damaged blood vessels.

5-Cardiogenic shock:"less"
-It happens when there is damage to the heart muscle which leads to ↓COP.

6-Obstructive shock?
In case of chest wall burns where constriction of overlying skin causes respiratory distress.

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Remember:

-MC cause of death in burns: Septicemia.

-MC cause of early death in burns: Hypovolemic shock.

-MC cause of late death in burns: Septicemia.

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Types of dressing in Acute burn.

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Hamartoma and types.

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Mucoepidermoid carcinoma.

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Pseudoarthrosis=pseudo-joint bw 2 fragments of bone# with cartilage formation bw them, as a result of farcture nonunion.

Arthrodesis=(artificial syndesis or ankylosis) it is an artificial induction of joint ossification bw 2 bones by surgery used to relieve intractable joint pain which can't be managed by pain medications, splint or other treatments.(causes of such pain are #s with joint disruption, severe sprain, arthritis of spine, hand, foot)

Arthroscopy is an endoscope inserted into the joint through small incision for diagnostic or sometimes therapeutic purposes)

Arthroplasty(prosthetic replacement of the joint) indications:
-OA osteoarthrritis
-RA
-AVN avascular necrosis
-CHD congenital hip dislocation
-traumatized or malaligned joint
-Joint stiffness

Pseudoarthrosis: is a form of non-union due to formation of an adventitious bursa (i.e. bursa in an abnormal site) between the
sclerosed ends of the fragments with formation of a new joint with a new range of mobility .

Most Important Tests of Synovial Fluid:

(3 C's)

-Culture and gram stain
-Cell count and differential
-Crystal examination (protein, LDH, glucose less helpful)

#Medicine

It is Arthrocentesis:

-Aspiration of synovial joints is performed for diagnostic or therapeutic purposes.
-Synovial joints are aspirated for myriad reasons, the most common of which include:
1. To rule out infection
2. To diagnose arthropathies
3. To relieve pain.

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Kocher criteria for Septic arthritis diagnosis.

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Kocher's criteria of septic arthritis

A point is given for each of the four following criteria:

•Non-weight-bearing on affected side
•Erythrocyte sedimentation rate > 40
•Fever > 38.5 °C
•White blood cell count > 12,000

Score👉🏻 Likelihood of septic arthritis
1👉🏻 3%
2👉🏻 40%
3👉🏻 93%
4👉🏻 99%

This is in adults, the difference is only ESR due to age variant.

X-ray findings in Osteoarthritis:

1-Joint space narrowing "1st"
2-Subchondral sclerosis
3-Osteophytes
4-Cysts.

#Surgery

X-ray findings in case of Charcot's joint:

They are similar of osteoarthritis.
1-Bone fragmentation
2-Bone destruction
3-New bone growth
4-Loss of joint space
5-Large osteophytes may be present
6-Parrot's beak"Large curved osteophytes that present in spine".
7-Scattered chunks "pieces" of bone.

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Talus fracture classification:

1-Lateral talar process fracture "Snowboarding injuries"
2-Posterior process fracture
3-Head fracture
4-Body fracture
5-Talar neck fracture
6-Osteochondral Talar dome fracture.

#Surgery

Pattellar dislocation Classification:

-Reduced vs Unreduced
-Congenital vs Acquired
-Acute vs Chronic
-Lateral, medial, Superior, Intra-articular.

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Thombson test:
In Achilles tendon rupture:

-With no rupture, squeezing the calf causes active planter Flexion of the foot.

-With rupture, it's negative.

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Q angle:

-It is the angle formed by a line drawn from the anterior superior iliac spine through the center of the patella and a line drawn from the center of the patella to the center of the tibial tubercle.


Normal:
In males:
10-14°
In females:
15-17°

Significance:
-The degree of genu valgum can clinically be estimated by the Q angle.

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Classification of Primary breast cancer.

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Possible x ray findings in acute pancreatitis

◼️Sentinel loop sign, represents localised ileus of intestinal loops near the inflamed pancreas.

◼️Generalised paralytic ileus, if inflammation is severe and diffuse, dilated bowel loops will be seen as intestinal obstruction.

◼️Colon cut-off sign, describes a situation in which the colon seems to abruptly "end" as shown in the figure above, it may relate to functional retraction of the phrenicocolic ligament.

◼️Renal halo sign, the inflammatory exudate in the retroperitoneal space seem to enhance the perirenal fat appearing as a radiolucent halo surrounding the kidney, this may occur around both kidneys.

◼️Pleural effusion, may occur as a result of posterior disruption of inflamed pancreatic duct with subsequent formation of a pleuropancreatic fistula.

◼️Calcified radio-opaque gallstone, may point toward gallstone pancreatitis, it has to be noted that only 10% of gallstones are radio-opaque.

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