Deck 1 Flashcards
2 arteries supplying the thyroid (and what they supply)
A and B on the diagram
Inferior thyroid artery supplies the 4 parathyroid glands
Superior thyroid artery
Nerves of concern during thyroidectomy
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
What connects the two lobes of the thyroid?
(a) Location in relation to the tracheal rings
Isthmus connects the two lobes
(a) Isthmus located around the 2nd ring of the trachea
Describe the venous drainage of the thyroid artery
Superior, middle, and inferior veins drain the thyroid
Arterial supply of the parathyroid glands
All 4 are supplied by the inferior thyroid artery
3 muscles involved in a thyroidectomy
Sternohyoid- most anterior, connects sternum up to hyoid
Then thyrohyoid and sternothyroid muscles
Name and differentiate the two types of bariatric surgery
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
Tx of umbilical vs. inguinal hernia in the newborn
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)
Differentiate tx for
(a) femoral neck fracture
(b) intertrochanteric fracture
(c) femoral shaft fracture
(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
What is Volkmann’s contracture?
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
Most common cause of malignant hyperthermia
Succinylcholine = neuromuscular blockade agent
Glasgow score that indicates intubation
Glasgow coma score of 8 or below indicates lack of consciousness => intubate
Acute epidural vs. subdural hematoma
(a) Shape of hematoma on imaging
(b) Tx
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
Thyroglossal duct cyst
(a) Etiology
(b) Presentation
(c) Tx
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
What is strabismus?
(a) Why must it be corrected?
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)
Tenderness to palpation over the anatomic snuffbox
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
What is wound dehiscence?
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)
Most common skin cancers
Basal cell carcinoma 50%
squamous cell carcinoma 25%
melanoma 15%
Pt seeing flashes of light and floaters in the eye
Retinal detachment = emergency
Hypospadias- what is it?
(a) Tx?
Hypospadias = urethral opening present on the ventral side of the penis
(a) Don’t circumcise, then use foreskin for plastic reconstruction
Direct vs. indirect inguinal hernia
(a) Relationship to the inferior epigastric vessels
(b) Ability to extend into the scrotum
(c) Age
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)
How does breast cancer spread?
Via lymphatics
-primarily to axillary LN, but also to internal mammary chain
Cause of pain in an indirect inguinal hernia
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)
Most important prognostic factor for breast cancer
Lymph node involvement
Which layer of tissue needs to be divided to expose a
(a) femoral hernia
(b) indirect inguinal hernia
(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
2 structures you need to identify w/ laryngoscope for intubation
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
Indications for bariatric surgery
BMI > or = 40
- BMI > or = 35 w/ comorbidities: OSA, DM, HTN
What is Hasselbach’s triangle?
(a) Clinical relevance
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
Contents of the inguinal canal in M and F
M- spermatic cord
F- round ligament
Most common location for aortic aneurysms
95% are infrarenal (below the renal arteries)
Is gastric bypass restrictive or malabsorptive?
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
