Deck 1

Question 1

2 arteries supplying the thyroid (and what they supply)

A and B on the diagram

Answer 1

Inferior thyroid artery supplies the 4 parathyroid glands

Superior thyroid artery

Question 2

Nerves of concern during thyroidectomy

Answer 2

Superior laryngeal nerve and recurrrent branch of the laryngeal nerve

-and the vagus if it’s a total thyroidectomy and you’re getting pretty lateral

Question 3

What connects the two lobes of the thyroid?

(a) Location in relation to the tracheal rings

Answer 3

Isthmus connects the two lobes

(a) Isthmus located around the 2nd ring of the trachea

Question 4

Describe the venous drainage of the thyroid artery

Answer 4

Superior, middle, and inferior veins drain the thyroid

Question 5

Arterial supply of the parathyroid glands

Answer 5

All 4 are supplied by the inferior thyroid artery

Question 6

3 muscles involved in a thyroidectomy

Answer 6

Sternohyoid- most anterior, connects sternum up to hyoid

Then thyrohyoid and sternothyroid muscles

Question 7

Name and differentiate the two types of bariatric surgery

Answer 7

Restrictive = sense of satiety w/ less food
-gastric bypass, sleeve gastectomy, lap band

Malabsorptive = shorten amount of SI available for food absorption
-massive multiple foul-smelling BMs a day

Question 8

Tx of umbilical vs. inguinal hernia in the newborn

Answer 8

Fix inguinal hernia in newborn before it leaves the hospital- b/c baby’s cry which increases their intraabdominal pressure

Watch and wait for up to 4-5 years for umbilical hernia to spontaneously resolve (which it normally does)

Question 9

Differentiate tx for

(a) femoral neck fracture
(b) intertrochanteric fracture
(c) femoral shaft fracture

Answer 9

(a) Femoral neck fracture- often replace femoral head w/ prosthesis 2/2 risk of ischemia
- displacement of femoral head gives high risk of compromising blood supply

(b) Intertrochanteric fracture- ORIF and immobilization (therefore post-op anticoag is indicated)
- less likely than femoral neck fracture to lead to avascular necrosis => can ORIF instead of replacing w/ prosthesis

(c) femoral shaft fracture- intramedullary rod

Question 10

What is Volkmann’s contracture?

Answer 10

Permanent claw-like deformity undiagnosed compartment syndrome due to brachial artery obstruction

-fracture of elbow/upper arm (classically supracondylar fracture of the humerus) causing brachial artery obstruction => ischemia

Question 11

Most common cause of malignant hyperthermia

Answer 11

Succinylcholine = neuromuscular blockade agent

Question 12

Glasgow score that indicates intubation

Answer 12

Glasgow coma score of 8 or below indicates lack of consciousness => intubate

Question 13

Acute epidural vs. subdural hematoma

(a) Shape of hematoma on imaging
(b) Tx

Answer 13

Acute epidural hematoma

(a) lens-shaped hematoma b/c confined by sutures
(b) Emergent craniotomy can be curative

Acute subdural hematoma

(a) Crescent shaped hematoma b/c blurs past suture lines
(b) Much more severe, hyperthermia or hyperventilate to reduce O2 demand
- craniotomy not curative here

Question 14

Thyroglossal duct cyst

(a) Etiology
(b) Presentation
(c) Tx

Answer 14

Thyroglossal duct cyst = leftover thyroid tissue from embryologic development

(b) Presents w/ irregular central mass at the level of the hyoid bone
(c) Tx = surgical removal

Question 15

What is strabismus?

(a) Why must it be corrected?

Answer 15

Strabismus = when eyes don’t share a common fixation point (cross eyed), when reflection of light comes from a different area of the cornea in each eye

(a) Must correct stabismus to prevent amblyopia (brain and eye not working well together to process images)

Question 16

Tenderness to palpation over the anatomic snuffbox

Answer 16

Fracture of the scaphoid (small wrist bone)

ex: adult falls on outstretched hand => wrist pain
fracture doesn’t show on Xrays until 3 weeks later

Question 17

What is wound dehiscence?

Answer 17

When the abdominal wall tension (intraabdominal pressure) overcomes the strength of the closure (sutures/staples)

can be partial or complete, both are surgical emergencies
dangerous when pt coughs/strains/gets out of bed (basically when they increase intraabdominal pressure)

Question 18

Most common skin cancers

Answer 18

Basal cell carcinoma 50%
squamous cell carcinoma 25%
melanoma 15%

Question 19

Pt seeing flashes of light and floaters in the eye

Answer 19

Retinal detachment = emergency

Question 20

Hypospadias- what is it?

(a) Tx?

Answer 20

Hypospadias = urethral opening present on the ventral side of the penis

(a) Don’t circumcise, then use foreskin for plastic reconstruction

Question 21

Direct vs. indirect inguinal hernia

(a) Relationship to the inferior epigastric vessels
(b) Ability to extend into the scrotum
(c) Age

Answer 21

Direct inguinal hernia (thru Hasselbach’s triangle) 2/2 weakness in the abdominal wall

(a) medial to inferior epigastric vessels
(b) Can exit via superficial inguinal ring, but can’t extend into the scrotum
(c) Middle-aged/elderly since abdominal wall weakens w/ age

Indirect inguinal hernia

(a) sac protrudes laterally to the inferior epigastric vessels
(b) Can extend down into the scrotum and even be difficult to differentiate from testes
(c) Any age, especially young (since 2/2 congenital patency of inguinal canal)

Question 22

How does breast cancer spread?

Answer 22

Via lymphatics

-primarily to axillary LN, but also to internal mammary chain

Question 23

Cause of pain in an indirect inguinal hernia

Answer 23

Compression of the ilioinguinal nerve (innervates groin and upper inner aspect of the thigh)

-lot less common (but possible) to be affected: genital branch of the genitofemoral nerve (innervates lateral aspect of the scrotum)

Question 24

Most important prognostic factor for breast cancer

Answer 24

Lymph node involvement

Question 25

Which layer of tissue needs to be divided to expose a

(a) femoral hernia
(b) indirect inguinal hernia

Answer 25

(a) Femoral hernia: divide the transversalis fascia to expose the femoral canal
(b) Indirect inguinal hernia: patency of processus vaginalis is the hallmark of an indirect inguinal hernia

Question 26

2 structures you need to identify w/ laryngoscope for intubation

Answer 26

Identify epiglottis and vocal cords w/ laryngoscope, then pass the tube thru the vocal cords and inflate 5-10cc of air and connect tube to vent

Question 27

Indications for bariatric surgery

Answer 27

BMI > or = 40
- BMI > or = 35 w/ comorbidities: OSA, DM, HTN

Question 28

What is Hasselbach’s triangle?

(a) Clinical relevance

Answer 28

Hasselbach’s triangle = part of the transversalis fascia that lines the floor of the inguinal canal

(a) Place where abdominal contents protrude thru forming a direct inguinal hernia

Question 29

Contents of the inguinal canal in M and F

Answer 29

M- spermatic cord

F- round ligament

Question 30

Most common location for aortic aneurysms

Answer 30

95% are infrarenal (below the renal arteries)

Question 31

Is gastric bypass restrictive or malabsorptive?

Answer 31

Both- it’s a combo

restrictive b/c you make the stomach much smaller (15mm pouch)
malabsorptive b/c you cut out a lot of intestines: leave a 75-150 cm Roux limb of intestines