Anatomy and Surgery 2 Flashcards
Extension of the breast
From ribs 2-6
Level of the nipple
4th ICS
Retraction of the nipple is caused by:
Pulling on the lactiferous ducts
Skin dimpling in Breast Ca is caused by:
Shortening of Cooper’s ligament
Interference with lymphatic drainage of the breast
Peau d’ orange sign - thickened, leather like appearance of the skin
Innervation: muscles of facial expression
Cervical branch of CN VII
Level of hyoid bone
C3 or C4
Infrahyoid muscle that depresses the larynx
Sternothyroid
Hyoid muscles innervated by C1 nerve
Geniohyoid, Thyrohyoid
Weakness of Trapezius muscle - cannot shrug and abduct the arm
Accessory nerve lesion - crosses the occipital triangle
Triangle crossed by external jugular vein and subclavian artery
Subclavian/Suboccipital Triangle
Level of Thyroid Gland
C5 to T1 vertebra
Narrow tube that connects the thyroid gland to the tongue
Thyroglossal Duct - normally atrophies and disappears
Condition associated with esophageal atresia resulting to Polyhydramnios
Tracheoesophageal Fistula
Abducts the vocal cords
Posterior cricoarytenoid
Adducts the vocal cords
Lateral cricoarytenoid
Relaxes the vocal cords
Thyroarytenoid
Tenses the vocal cords
Cricothyroid - external branch of SLN
RLN more commonly injured
Left - hooks around arch of the aorta
Nerve supply to the diaphragm
Phrenic - motor (from C3, C4 and C5)
Blood supply of nose
Hasselbach’s plexus (anterior), Woodruff’s plexus (posterior)
Odontogenic tumor that may erode the bone cortex. Radioluscent soap bubble appearance on xray
Ameloblastoma - Tx is resection
Innervates the muscles of mastication
3rd division CN V
Sentinel node of laryngeal SCC
Delffian node - prelaryngeal node
Facial nerve exits what foramen
Stylomastoid foramen
Most common salivary gland malignant tumor
Mucoepidermoid Ca
Nerves protected during Mandibulectomy
Hypoglossal nerve inferiorly, Lingual nerve superiorly
Location of thyroid isthmus
C2-C4
Anatomic landmark where RLNs are prone to injury
Ligament of Berry
RAI imaging for lingual thyroid or to search for residual thyroid after thyroidectomy
Iodine 123
RAI used to screen and treat differentiated thyroid Ca
Iodine 131
Screening method for undifferentiated or anaplastic thyroid Ca
PET scan
Most common thyroid Ca and has the greatest tendency to invade LN
Papillary Ca
Medullary thyroid Ca: worst prognosis
Familial type - MEN 2B
FNAB of Anaplastic Thyroid Ca
Giant multinucleated cells
Tx for Thyroid Lymphoma
CHOP regimen - Cyclophosphamide, Doxorubicin, Oncovin/Vincristine, and Prednisone
Most common malignancy that metastasize to the thyroid
Renal Cell Ca
Sharp indentation that approximates the junction of the body and pyloric part of the stomach
Angular incisure/notch
Portal vein is made of:
Superior mesenteric vein + splenic vein
Rule out what Ca in gastric ulcer
Gastric adenocarcinoma
Most common type of Gastric Ulcer
Type I - found in antral lesser curvature, blood type A
Caused by destruction of the pyloric sphincter resulting to abrupt delivery of hyperosmolar load to the small intestines
Dumping Syndrome
Most common pancreatic tumor in patients with MEN I
Gastrinoma
Diagnosis of ZES
Serum gastrin more than 200pg/mL after a secretin challenge
Gastrinoma Triangle or Passaro’s Triangle
Pancreatic neck, Porta hepatis, 3rd portion of duodenum
Clinical Triad of ZES
Hypersecretion of HCl, severe PUD, Gastrinoma
Large, tortuous submucosal artery in the proximal stomach. Pulsations cause ulceration of the overlying mucosa causing intraluminal bleeding
Dieulafoy’s Lesion
Most common form of Gastric Ca
Gastric Adenocarcinoma - dysplasia as universal precursor
Tx for gastric adenocarcinoma <2 cm
Endoscopic Mucosal Resection - tumors limited to mucosa or submucosa
Diffuse neoplasm involving the entire stomach giving it a “leather bottle” appearance
Linitis plastica
Periumbilical node in Gastric Adenocarcinoma
Sister Mary Joseph’s Node
Peritoneal nodes in Gastric AdenoCa, palpable on rectal examination
Blumer’s Shelf
Tx goal of Gastric AdenoCa
Resection of all tumor with 5cms grossly negative margins
Standard operation in Gasttic AdenoCa
Radical Subtotal Gastrectomy - remove distal 75%
Gastric Lymphoma arises from MALT. Majority are what type?
Non Hodgkin’s B Cell Type
Presents like gastric adenocarcinoma with B symptoms (fever, weight loss, night sweats)
High grade MALT lymphoma
Tx for low grade MALT lymphoma
H. Pylori eradication
GIST arise from the?
Interstitial cells of Cajal - pacemaker in GI tract
Tumor markers of GIST
c-KIT (CD 117) and CD 34
Most common type of GIST
Epithelial cell stroma
Tx for GIST
Wedge resection, Imatinib (Gleevec) for unresectable or metastatic GIST
Gastric carcinoids arise from?
Gastric ECL cells
Most common type of Gastric Carcinoid
Type I - women with hypergastrinemia, small but multiple, low malignant potential
Type of Gastric Carcinoid that occurs in MEN I and ZES
Type II - higher malignant potential
Type of Gastric Carcinoid that presents with Carcinoid Syndrome
Type III - solitary, among men
Biopsy: diffuse hyperplasia of surface mucus secreting cells and decrease parietal cells
Hypertrophic Gastropathy (Menetrier’s Disease) - protein losing enteropathy and hypochlorhydia
Presentation is dilated mucosal blood vessels in the distal stomach
Watermelon Stomach (Gastric Antral Vascular Ectasia)
Most common position of the appendix
Retrocecal
Nerve that can be possibly injured during appendectomy
Iliohypogastric nerve - weakening of anterior abdominal wall
Used as a landmark during OR to identify the location of the appendix
Anterior taenia
Where is McBurney’s Point?
Lateral 1/3 from ASIS to umbilicus
Appendicitis: pain on extension of right thigh
Psoas sign - tip of appendix is retrocecal
Appendicitis: pain on passive internal rotation of the flexed right thigh with the patient in the supine position
Obturator Sign - tip of the appendix is on the pelvis
CT scan findings in Appendicitis
Enlarged enhancing appendix (>6mm), periappendiceal fat stranding, wall thickening
Complication of appendicitis. A mass of inflamed, matted intestine and omentum with little or no discrete collection of pus
Phlegmon - complication of gangrenous acute AP
Most important pathogen in AP related infection
Bacteroides fragilis
When is an incidental appendectomy routinely performed?
Ladd’s procedure - correction of intestinal malrotation with volvolus in children
Most common malignancy of the appendix
Carcinoid - usually at the tip
Tx for adenocarcinoma of the appendix
Right hemicolectomy