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Anatomy Surgery 1 Flashcards

1
Q

Lining of epidermis

A

Stratified squamous epithelium

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2
Q

Immune cells in the epidermis

A

Langerhan’s cells

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3
Q

Nerve cells in dermis

A

Meissner’s (light touch), Pacinian (pressure)

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4
Q

Major chemoattractant for fibroblasts during the proliferation phase of wound healing

A

PDGF

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5
Q

Threshold of pressure injury

A

At least 1 hour of 60mmHg pressure

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6
Q

Apocrine gland blockage, infection and abscess formation

A

Hidradenitis suppurativa

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7
Q

Present as nodules and spread to form draining tracts. (+) sulfur granules on histology

A

Actinomycosis - follows tooth extraction, osontogenic infection, facial trauma

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8
Q

Rapidly enlarging, necrotic ulcer with violet border and surrounding erythematous halo

A

Pyoderma gangrenosum - linked to ulcerative colitis, IBD

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9
Q

Immune mediated, separation of skin at dermo-epidermal junction and >30% TBSA involvement

A

Toxic Epidermal Necrolysis

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10
Q

Most common site of dermoid cyst

A

Eyebrow

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11
Q

Skin lesions that yellow, non-tender, pruritic with a velvety greasy texture. Found in chest, back and abdomen,

A

Seborrheic keratoses - unrelated to sun exposure

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12
Q

Sudden multiple eruptions of seborrheic keratoses associated with ovarian or gastric Ca

A

Lesser Trelat Sign

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13
Q

Tender, warty, brown or black lesions on sun exposed areas

A

Solar (actinic) keratoses - premalignant (SCC)

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14
Q

Treatment for congenital nevi

A

Excision, since it is premalignant

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15
Q

Most common benign head and neck tumor in adults

A

Hemangioma - initial rapid proliferation followed by slow involution

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16
Q

Consumptive coagulopathy due to a hemangioma

A

Kasabach Merritt Syndrome

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17
Q

Benign neoplasm usually affecting hands

A

Glomus tumor - blue, subungual discolortion associated with tenderness and cold sensitivity

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18
Q

Most common soft tissue tumor

A

Lipoma

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19
Q

Neural tumor that invades striated skeletal muscles

A

Granular Cell Tumor

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20
Q

Histology: Neurilemoma

A

Schwann cells packed in palisading rows

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21
Q

Most common type of skin cancer?

A

Basal Cell Carcinoma - waxy, cream colored with rolled, pearly borders surrounding a central ulcer

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22
Q

Histopath: Squamous cell carcinoma

A

Keratin pearls

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23
Q

SCC in situ

A

Bowen’s Disease

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24
Q

SCC in penis

A

Erythroplasia of Queyrat

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25
Q

SCC arising from burn areas

A

Marjolin’s Ulcer - has an earlier metastasis

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26
Q

Most common spread of malignant melanoma

A

Superficial spread (70%) - anywhere except hands and feet

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27
Q

Malignant melanoma with the best prognosis

A

Lentigo maligna - face, neck, hands of elderly

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28
Q

Least common malignant melanoma, most common on great toe or thumb

A

Acral lentiginous - (+) Hutchinson’s sign or pigment in paronychial area

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29
Q

Provides structural support to the breast

A

Cooper’s suspensory ligaments - anchors the dermis to the pectoralis fascia

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30
Q

Provides a route for Breast Ca metastases to bone

A

Batson’s Vertebral Plexus

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31
Q

Measurement of gynecomastia

A

At least 2cm in diameter

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32
Q

Thrombophlebitis that involves the superficial veins of the anterior chest wall and breast

A

Mondor’s Disease - acute pain on lateral side, tender and firm cord following vein distribution

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33
Q

Veins involved in Mondor’s Disease

A

Lateral thoracic vein, thoracoepigastric vein, superficial epigastric vein

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34
Q

Epidemic puerperal mastitis is due to?

A

MRSA

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35
Q

Tx for non epidemic (sporadic) mastitis

A

Empty breast using suction pumps, I&D cannot be done

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36
Q

Mimics Breast Ca on PE, mammogram and gross pathologic examination

A

Radial Scars and Complex Sclerosing Lesions - need to do biopsy

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37
Q

Large, pale, vacuolated cells in the rete pegs of epithelium of the breast

A

Paget Cells - chronic eczematous eruption of the nipple

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38
Q

Differentiate Paget’s Disease from Melanoma

A

(+) CEA - Paget’s Disease, (+) S 100 - Melanoma

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39
Q

Most common invasive Breast Ca

A

Invasive ductal Ca - (+) axillary LN, central stellate configuration with chalky white or yellow streaks

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40
Q

Invasive Breast Ca associated with BRCA 1 cancers

A

Medullary Ca - soft, hemorrhagic and bulky

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41
Q

Invasive Breast Ca with the best prognosis

A

Tubular Ca

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42
Q

Histopathology: Indian file configuration of cells, Signet ring cell Ca

A

Invasive Lobular Carcinoma

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43
Q

Biopsy method for breast lesions

A

Core needle biopsy

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44
Q

Gold standard in Breast Ca management

A

MRM - removal of all breast tissue and pectoralis fascia, ALND (I and II)

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45
Q

Moveable, midline neck mass

A

Thyroglossal Duct Cyst - Tx is Sistrunk Operation

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46
Q

Most common Branchial Cleft Anomaly

A

2nd - lateral neck at SCM and tonsillar fossa openings

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47
Q

Mucous retention cyst involving the sublingual gland

A

Ranula - found in the floor of the mouth, treat with Marsupialization

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48
Q

Granulomatous lesion in the oral cavity that is an exaggerated inflammatory response

A

Epulis - Tx is excision if symptomatic, same appearance as a malignant lesion in the gingiva

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49
Q

Expansive endosteal lesion of the mandible, of bony origin

A

Central Giant Cell Reparative Granuloma - Tx is curettage

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50
Q

Rare benign tumor of tongue (mid 1/3), derived from Schwann cells

A

Granular Cell Myoblastoma or Abrikossof tumor - Tx is wedge excision to r/o SCC of tongue

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51
Q

Benign lesion but highly expansile and destructive fibrovascular neoplasms of the nose among adolescent males

A

Juvenile Nasopharyngeal Angiofibroma - massive epistaxis

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52
Q

Tx for Juvenile Nasopharyngeal Angiofibroma

A

Angioembolization or open surgery (Weber Ferguson approach)

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53
Q

Removes cervical LN I-V, spinal accessory nerve, IJV, SCM

A

Radical neck dissection: Crile Procedure

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54
Q

Removes cervical LN I-V

A

Modified RN/Functional Neck Dissection: Bocca Procedure

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55
Q

Selective neck dissection for oral malignancies

A

Supraomohyoid (I,II, III)

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56
Q

Selective neck dissection for laryngeal malignancies

A

Lateral (II, III, IV)

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57
Q

Selective neck dissection for thyroid malignancies

A

Posterolateral (II, III, IV and V)

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58
Q

Cervical LN with the highest yield for biopsy

A

Level IV

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59
Q

Majority of lip Ca occurs in the lower lip except?

A

BCC in the upper lip

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60
Q

Paresthesia in Ca of lip indicates?

A

Mental nerve involvement

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61
Q

Most common location of tongue Ca

A

Lateral and ventral surface

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62
Q

Blind biopsies in unknown primary head and neck Ca

A

Base of tongue, pyriform sinus, tonsillar fossa, nasopharynx

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63
Q

Tx for subglottic laryngeal Ca

A

Total laryngectomy with bilateral neck dissection (MRND)

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64
Q

True or false: the smaller the salivary gland, the higher the risk of malignancy

A

TRUE

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65
Q

Most common benign epithelial salivary gland tumor

A

Pleomorphic adenoma

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66
Q

Most important branch of the facial nerve to preserve

A

Temporal branch - closes the eyes

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67
Q

Young patients with long standing nodule and symptoms of hyperthyroidism

A

Toxic Adenoma (Plummer’s Disease) - unilateral lobectomy + isthmusectomy

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68
Q

Given 7-10 days pre-op to decrease vascularity of the thyroid and lessen risk of thyroid storm

A

Lugol’s iodine solution

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69
Q

Condition to suspect when a patient has recurrent Acute Suppurative Thyroiditis

A

Persistent pyriform sinus fistula - 3rd branchial cleft anomaly

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70
Q

Autoimmune disorder involving HLA-B8 and HLA-DR3

A

Grave’s Disease

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71
Q

Autoimmune disorder involving CD 8 T-helper cells, HLA-B8 HLA-DR3 and HLA-DR 5

A

Chronic thyroiditis or Hashimoto’s Lymphocytic Thyroiditis

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72
Q

Most common inflammatory disorder of the thyroid gland and leading cause of hypothyroidism

A

Hashimoto’s Thyroiditis - diffuse infiltration by small lymphocytes and plasma cells

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73
Q

Presentation is a painless, hard anterior neck mass with compressive symptoms in weeks

A

Reidel’s thyroiditis - invasive fibrous thrombosis, diagnose through open biopsy and treat with wedge excision

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74
Q

FNAB: orphan annie nuclei, psammoma bodies

A

Papillary Thyroid Ca

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75
Q

Most important prognostic factor in Papillary thyroid Ca

A

Age

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76
Q

Thyroid Ca that cannot be diagnosed by FNAB

A

Follicular and Hurthle Cell Ca

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77
Q

Thyroid Ca common in iodine deficient areas

A

Follicular Ca - minimum Tx is lobectomy+isthmusectomy

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78
Q

Dx of Follicular Ca and Hurthle Cell Ca

A

Capsular and vascular invasion

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79
Q

Tx for unresectable, locally invasive or recurrent disease and for bony metastases

A

External beam RT - involves carotids and prevertebral fascia

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80
Q

When are thyroglobulin levels measured post-op?

A

6 months initially then annually - increased levels is suggestive of metastatic or persistent normal thyroid tissue

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81
Q

Ca that arises from the parafollicular or C cells locate at the superolateral lobes of the thyroid gland

A

Medullary Thyroid Ca

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82
Q

Medullary Thyroid Ca premalignant lesion for familial cases

A

C Cell hyperplasia

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83
Q

Familial MTC is secondary to?

A

Germ line mutation at the ret proto oncogene

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84
Q

Earliest symptom of hypocalcemia

A

Perioral numbness

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85
Q

Blood supply of parathyroids

A

Inferior thyroid artery - from thyrocervical trunk

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86
Q

Most common location of ectopic parathyroids

A

Paraesophageal

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87
Q

Most common cause of primary hyperparathyroidism

A

Parathyroid adenoma - only 1 gland involved

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88
Q

Pentad of Primary Hyperparathyroidism

A

Kidney stones, painful bones, abdominal groans, psychic moans, and fatigue overtones

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89
Q

Preoperative localization test for primary hyperparathyroidism

A

Sestamibi scan

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90
Q

Mainstay Tx for hypercalcemic crisis

A

IV 0.9% saline hydration to dilute the calcium

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91
Q

Secondary hyperparathyroidism happens among?

A

Patients with chronic renal failure

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92
Q

Level of esophagus

A

From C6 to T1

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93
Q

Relation of Vagus nerve to the esophagus

A

Left vagus - anterior surface, Right vagus - posterior surface

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94
Q

Hernia of the abdominal part of the esophagus and part of stomach

A

Hiatal hernia

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95
Q

Hernia of the fundus or body of the stomach

A

Paraesophageal hernia

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96
Q

Histology of the esophagus

A

Stratified squamous non-keratinized epithelium

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97
Q

Definitive Tx for GERD

A

Nissen Fundoplication - 360 degree wrap

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98
Q

Esophageal lengthening procedure

A

Collis gastroplasty

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99
Q

Procedure that anchors the esophagus to its new position in the crura

A

Hill posterior gastropexy

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100
Q

Borchardt’s Triad: indicative of incarcerated intra thoracic stomach

A

Chest pain, retching with inability to vomit, inability to pass NGT

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101
Q

Most common esophageal diverticula

A

Zenker’s Diverticula - found in Killian’s Triangle

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102
Q

Killian’s Triangle

A

Area of potential weakness situated behind the esophagus at the level of the cricopharyngeus muscle

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103
Q

Most common esophageal motility disorder

A

Achalasia - due to neurogenic degradation

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104
Q

Triad of Achalasia

A

Hypertensive LES, aperistalsis of esophageal body, failure of LES to relax

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105
Q

Gold standard in diagnosing Achalasia

A

Manometry

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106
Q

Tx for Achalasia

A

Heller’s Myotomy + Partial fundoplication

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107
Q

Esophogeal motility disorder with continuous high amplitude peristalsis

A

Nutcracker esophagus - increased mean duration of contraction

108
Q

Spontaneous rupture of the esophagus into the left pleural cavity or just above the gastroesophageal junction

A

Boerhaave’s syndrome

109
Q

Diagnosis of esophageal rupture

A

Water soluble contrast esophagogram (Gastrografin) shows extravasation in the lateral decubitus position

110
Q

Grading in caustic injuries with pseudomembrane formation

A

2nd degree

111
Q

Most common type of esophageal Ca

A

Esophageal SCC - located in middle 3rd of the thoracic esophagus

112
Q

Plummer Vinson Syndrome: predisposing condition to esophageal Ca

A

Triad - dysphagia, IDA, esophageal webs

113
Q

Precursor lesion of Esophageal Adenocarcinoma

A

Barret’s metaplasia - squamous mucosa of the esophagus turns to columnar

114
Q

Surgical Tx for Esophageal Ca

A

Ivor Lewis Procedure: trans thoracic esophagectomy, trans hiatal esophagectomy

115
Q

Thin submucosal ring in the lower esophagus

A

Schatzki’s Ring

116
Q

Longitudinal tears at the gastroesophageal junction

A

Mallory Weiss Tear

117
Q

Remnant of umbilical vein

A

Ligamentum teres or round ligament - between L lobe and quadrate lobe

118
Q

Remnant of ductus venosus

A

Ligamentum venosum - between L lobe and caudate lobe

119
Q

Connects the liver to the anterior abdominal wall

A

Falciform ligament

120
Q

Portal Triad

A

Portal vein, Hepatic Artery, Bile Duct

121
Q

Porta Hepatis

A

CBD, Portal Vein, Hepatic Artery, Lymphatics

122
Q

Blood supply of liver

A

Portal vein (superior mesenteric and splenic vein), Hepatic artery (celiac artery)

123
Q

Where is biopsy of the liver done?

A

R 10th ICS, mid axillary line

124
Q

Phagocytic cells of the liver

A

Kupffer Cells

125
Q

Fat storing cells of the liver

A

Eto cells

126
Q

Interlobar fissure that divides the liver into R and L lobes

A

Cantlie’s Line

127
Q

Liver venous drainage: segments 5-8

A

R hepatic vein

128
Q

Liver venous drainage: segments 4, 5, 8

A

Middle hepatic vein

129
Q

Liver venous drainage: segments 2, 3

A

Left hepatic vein

130
Q

Liver venous drainage: caudate lobe

A

IVC - hardest to resect, not removed in a L hepatectomy

131
Q

All clotting factors are synthesized in the liver except:

A

Factor 8

132
Q

Removes phosphate from phosphoryl choline, maintains solubility of cholesterol in the bile

A

Alkaline phosphatase

133
Q

Serum bilirubin levels in jaundice

A

> 2.5 to 3mg/dL

134
Q

Monomicrobial cause of spontaneous bacterial peritonitis

A

E. coli

135
Q

Predicts the surgical risks of intra-abdominal operations performed on patients with cirrhosis

A

Child Turcotte Pugh Score - nutritional status, ascites, encephalopathy, serum bilirubin, serum albumin, prothrombin time

136
Q

Criteria for Portal Hypertension

A

Direct portal venous pressure > 5mmHg of IVC pressure, Splenic pressure > 15mmHg

137
Q

Most accurate method of determining portal HTN

A

Hepatic venography

138
Q

Most significant manifestation of portal HTN

A

Esophageal varices - can do prophylactic Endoscopic Variceal Ligation

139
Q

Preferred medical management for acute variceal bleeding

A

Octreotide

140
Q

Non selective shunt for acute variceal bleeding

A

Totally diverts blood away from the liver to the systemic circulation. For Child’s A. Decrease in portal pressure. Encephalopathy as possible complication

141
Q

Congestive hepatopathy characterized by obstruction to hepatic venous outflow

A

Budd Chiari Syndrome - caused by polycythemia vera, pregnancy, OCP use

142
Q

Tx of Budd Chiari Syndrome

A

Systemic anticoagulants - most patients are Child C

143
Q

Most common cause is impaired biliary drainage. Organism most implicated is E coli

A

Pyogenic liver abscess - elevated WBC, ESR, alkaline phosphatase

144
Q

Pyogenic liver abscess UTZ

A

Hypoechoic lesions with well defined borders and variable internal echoes

145
Q

Pyogenic liver abscess CT:

A

Hypodense lesions with peripheral enhancement

146
Q

Organism in amebic liver abscess

A

Entamoeba histolytica - located at superior anterior aspect of R lobe

147
Q

Amebic liver abscess

A

Necrotic central portion containing reddish brown pus like material (anchovy paste)

148
Q

Tx for Amebic liver abscess

A

Metronidazole 750mg TID for 7-10 days, aspiration for abscess >10cm

149
Q

Liver disease caused by Echinococcus granulosus

A

Hydatid Disease - cyst in the anteroinferior or posteroinferior portions of the R lobe

150
Q

Result of cyst rupture in Hydatid Disease

A

Allergic or anaphylactic reaction

151
Q

Most common benign solid masses in the liver

A

Hemangioma - common among women, pain is the most common symptom and an indication for resection

152
Q

Hemangioma MRI:

A

Hypointense on T1 and Hyperintense on T2

153
Q

Clearest risk factor for hepatic adenoma

A

Use of OCP - Tx is resection since it may undergo malignant degeneration

154
Q

Tx for Liver Focal Nodular Hyperplasia

A

Observe, resect if with abdominal pain - no malignant degeneration

155
Q

Diagnosis of Hepatocellular Ca

A

AFP >500ng/dL

156
Q

Proximal or hilar cholangiocarcinoma

A

Klatskin Tumor - Tx through resection

157
Q

Gallbladder contracts to expel bile upon release of this hormone

A

Cholecystokinin

158
Q

Infundibulum of the GB, junction between neck and cystic duct

A

Hartmann’s Pouch

159
Q

Triangle of Calot

A

Liver (superior), cystic duct (inferior) common hepatic duct (medial)

160
Q

Blood supply of GB

A

Cystic artery from R hepatic artery (SMA)

161
Q

Common site of an impacted gallstone

A

Hepatopancreatic ampulla

162
Q

Referred pain in gallstones

A

Dull, aching, poorly localized pain over the T5 through L1 dermatomes

163
Q

Form from the invagination of the epithelium through the fibromusculat layer in the GB

A

Rokitansky Aschoff Sinus - result of inflammation and an increase in intraluminal pressure

164
Q

Whipple Procedure

A

Head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed

165
Q

Normal GB wall thickness

A

<4mm

166
Q

True or false: GB lacks muscularis mucosa and submucosa

A

TRUE

167
Q

Location of Hepatic Artery

A

Anterior to the portal vein and medial to CBD

168
Q

Common source of postcholecystectomy biliary leaks

A

Ducts of Luschka

169
Q

Action of Cholecystokinin

A

GB contraction and sphincter of Oddi relaxation

170
Q

Hormones that cause GB contraction

A

CCK and Vagus

171
Q

Hormones that inhibit GB contraction

A

VIP, Somatostatin

172
Q

Bile duct opens into this structure, 10cm distal to pylorus, that is surrounded by the sphincter of Oddi

A

Ampulla of Vater

173
Q

Regulates the flow of bile and pancreatic juice into the duodenum

A

Sphincter of Oddi - prevents regurgitation of duodenal contents into the biliary tree

174
Q

GB stones UTZ:

A

Acoustically dense, (+) posterior shadow, moves with changes in position

175
Q

Acute Cholecystitis UTZ:

A

GB thickening, pericholecystic fluid, sonographic murphy sign

176
Q

Multiple, multifaceted mulberry shaped stone

A

Mixed type (>70% cholesterol)

177
Q

Soft and mushy pigment stones secondary to bacterial infection of bile stasis

A

Brown Pigment Stones

178
Q

Small, brittle, spiculated stones due to hemolytic disorders and cirrhosis

A

Black Pigment Stones - precipitation of unconjugated bilirubin

179
Q

Disease due to partial obstruction of the cystic duct

A

Chronic cholecystitis (Biliary Colic) - episodic, subsides spontaneously

180
Q

Stone in CBD

A

Choledocholithiasis

181
Q

Primary choledocholithiasis

A

Brown pigment stone formed in CBD - biliary stasis and infection

182
Q

Secondary choledocholithiasis

A

Cholesterol stone formed in the GB and migrate to CBD

183
Q

Gold standard test for Choledocholithiasis

A

ERCP - diagnostic and therapeutic

184
Q

Ascending bacterial infection associated with partial or complete blockage of bile duct

A

Cholangitis - gallstones most common cause

185
Q

Charcot’s Triad

A

Cholangitis - fever, pain and jaundice

186
Q

Reynold’s Pentad

A

Cholangitis - Charcot’s Triad plus septic shock and disorientation

187
Q

Tx for Cholangitis with distal obstruction

A

ERCP or stent

188
Q

Tx Cholangitis with proximal obstruction

A

Percutaneous transhepatic cholangiogram

189
Q

Congenital cystic dilatations of the biliary tree

A

Choledochal cysts - pancreatic secretions refluxes into the bile duct. (Abdominal pain, jaundice, mass)

190
Q

Most common type of choledochal cyst

A

Type 1 Fusiform - Tx with excision + roux en Y hepaticojejunostomy

191
Q

Choledochal cyst: Choledochocoele

A

Type 3 - Tx sphincterotomy

192
Q

Tx for Type 4 choledochal cyst

A

Segmental liver resection

193
Q

Type 5 choledochal cyst: Caroli’s Disease

A

Tx liver transplantation

194
Q

Inflammatory strictures involving both extra and intrahepatic biliary tree

A

Sclerosing Cholangitis - may degenerate into cholangiocarcinoma

195
Q

Dx and Tx for sclerosing cholangitis

A

Dx ERCP/PTC, Tx is liver transplantation

196
Q

Most common Gallbladder carcinoma

A

Adenocarcinoma - gallstones most important risk factor

197
Q

Gallbladder Ca limited to muscular layer

A

T1 - Tx cholecystectomy

198
Q

Gallbladder Ca reaching perimuscular connective tissue

A

T2 - Tx extended cholecystectomy, liver segments IVB and V

199
Q

Gallbladder Ca with spread to other organs

A

T3 or T4 - Tx extended R hepatectomy, liver segments IV to VIII

200
Q

Tumor that most commonly involves the hepatic duct bifurcation

A

Bile Duct Carcinoma - adenocarcinoma, nodular type most common

201
Q

Tumor markers for Bile Duct Ca

A

CA 125, CEA, CA 19-9

202
Q

Dx method for Bile Duct Ca that can determine its resectability

A

Percutaneous Transhepatic Cholangiogram

203
Q

Retroperitoneal exocrine and endocrine gland

A

Pancreas

204
Q

Pancreas: embraced by the C shaped curve of the duodenum

A

Head - Ca obstructs the bile duct causing obstructive jaundice

205
Q

Projection from the inferior part of the head

A

Uncinate process - Ca here compresses the SMA

206
Q

Begins in the tail of the pancreas and runs through the parenchyma to the head where it merges with the bile duct and opens to the 2nd part of the duodenum

A

Main Pancreatic Duct of Wirsung

207
Q

Blood supply of the pancreatic head and neck

A

Superior pancreaticoduodenal artery (gastroduodenal) and Inferior pancreaticoduodenal artery (SMA)

208
Q

Blood supply of the body and tail of the pancreas

A

Pancreatic arteries (splenic)

209
Q

Venous drainage of pancreas

A

Pancreatic veins, empty into splenic veins

210
Q

Cancer of neck and body of the pancreas

A

Portal or IVC obstruction

211
Q

Dorsal and ventral fusion of the pancreas

A

Annular pancreas - ring of pancreatic tissue around duodenum

212
Q

X ray: duodenal obstruction

A

Double bubble sign - dilation of stomach and distal duodenum

213
Q

Pancreatic duct that drains the upper half of the head and opens in the duodenum on the minor duodenal papilla

A

Accessory Duct of Santorini - often absent

214
Q

Most common congenital anomaly of the pancreas

A

Pancreas divisum - risk factor for acute and chronic pancreatitis

215
Q

Tx of Annular Pancreas

A

Bypass, duodeno-duodenostomy (connect D1 and D3)

216
Q

Flank ecchymosis: acute pancreatitis

A

Grey Turner’s Sign

217
Q

Periumbilical ecchymosis: Acute Pancreatitis

A

Cullen’s Sign - blood dissects up the falciform ligament

218
Q

Ecchymosis in the inguinal area: Hemorrhagic Pancreatitis

A

Fox’s Sign

219
Q

Gold standard in Dx Pancreatitis: Abdominal CT Scan

A

Peripancreatic fat stranding, fluid collections, non enhancing pancreatic parenchyma with gas (necrosis)

220
Q

Colonic spasm adjacent to an inflamed pancreas

A

Cut-Off sign

221
Q

Focal duodenal and jejunal ileus in the area of the head of the pancreas

A

Reversed 3 or Inverted 3 Sign

222
Q

DOC for severe pancreatitis

A

Imipinem

223
Q

Primary pathologic process of Chronic Pancreatitis

A

Chronic alcoholic pancreatitis - DM and steatorrhea are common

224
Q

Calcifications in the pancreas establishes the diagnosis of?

A

Chronic Pancreatitis

225
Q

Tx for chronic pancreatitis with a normal duct

A

Whipple - pancreaticoduodenectomy

226
Q

Tx for chronic pancreatitis with dilated duct

A

Puestow - longitudinal pancreaticojejunostomy

227
Q

Umbilicus is normally at the level of?

A

L3

228
Q

External oblique vs Internal oblique

A

EO - downward and medially, IO - upward and medially

229
Q

Innermost, flat abdominal muscle

A

Transversus abdominis

230
Q

What makes up the conjoint tendon?

A

Internal oblique + Transversus abdominis

231
Q

Cremaster muscle is derived from what layer of the abdominal wall?

A

Internal oblique

232
Q

Congenital type of hernia

A

Indirect

233
Q

Acquired type of hernia

A

Direct

234
Q

Neck of hernial sac is narrow, lateral to inferior epigastric vessels, enters the scrotum

A

Indirect

235
Q

Neck of hernial sac is wide, medial to inferior epigastric vessels, never enters the scrotum

A

Direct

236
Q

Hernia that protrudes through the anterior abdominal wall and covered by peritoneum and layers of spermatic cord

A

Indirect

237
Q

Hernia that passes directly through Hesselbach’s Triangle

A

Direct

238
Q

Hesselbach’s Triangle

A

Medial - rectus abdominis. Superior and Lateral - inferior epigastric artery. Inferior and lateral - Poupart’s or inguinal ligament.

239
Q

Scrotal derivative of abdominal superficial fascia

A

Dartos muscle - gives the wrinkled appearance of the scrotum

240
Q

Sensory and motor fibers of cremasteric reflex

A

Sensory - ilioinguinal nerve. Motor - genital branch of genitofemoral nerve.

241
Q

Peritoneum: sensitive to pressure, heat and cold. Pain is localized

A

Parietal peritoneum

242
Q

Peritoneum: stimulated by stretching, poorly localized pain

A

Visceral peritoneum

243
Q

Opening or connection between the lesser peritoneal sac and greater peritoneal sac

A

Epiploic Foramen of Winslow

244
Q

Connects the stomach with other viscera

A

Omentum

245
Q

Abdominal policeman. From the greater curvature of the stomach to transverse colon

A

Greater omentum

246
Q

From the lesser curvature of the stomach and proximal duodenum to the liver

A

Lesser omentum

247
Q

Hepatoduodenal ligament conducts the Portal Triad

A

Portal vein lying posterior, CBD anterior and to the R, Hepatic artery anterior and to the L

248
Q

Medial, fan shaped part of inguinal ligament

A

Lacunar (Gimbernat’s) Ligament

249
Q

Preperitoneal space behind pubic symphysis. Site of laparoscopic hernia repairs

A

Space of Retzius

250
Q

Arching fibers that press down during increase in intra-abdominal pressure

A

Shutter mechanism - prevents hernia even if there is a weak spot or patent procesus

251
Q

Triangle of Doom contains:

A

Iliac artery, Iliac vein

252
Q

Lower expanded part of procesus vaginalis that is normally closed off just before birth

A

Tunica vaginalis

253
Q

Inguinal hernia relation to pubic tubercle

A

Neck is above and medial to the pubic tubercle

254
Q

Femoral hernia relation to pubic tubercle

A

Neck below and lateral to pubic tubercle

255
Q

Hernia that is more common among elderly females

A

Femoral hernia

256
Q

Repair for femoral hernia

A

McVay Repair - repair attached to pectineal or Cooper’s ligament

257
Q

Tension less repair of ernia

A

Lichtenstein Hernioplasty

258
Q

Laparoscopic repair for recurrent, bilateral and femoral hernias

A

Transabdominal preperitoneal

259
Q

Lumbar Hernia

A

Grynfeltt’s hernia - superior lumbar triangle. Petit’s hernia - inferior lumbar triangle.

260
Q

Hernia at the posterior diaphragm

A

Bochdaleck’s hernia

261
Q

Hernia lateral to the rectus muscle

A

Spigelian hernia

262
Q

Hernia that contains a Meckel’s diverticulum

A

Littre’s Hernia

263
Q

Hernia with 2 loops in the same ring (W shaped)

A

Maydl’s hernia

264
Q

Hernia in the anterior diaphragm

A

Morgagni’s hernia

265
Q

Most common early postoperative complication of hernia repair

A

Urinary retention

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