Deck 2

Question 1

Differentiate the three chambers of a pleur-evac

Answer 1

1. Collection chamber
2. Water seal chamber = one-way valve, ensures no backwards flow back into the chest
3. Suction control chamber- ensures a max limit on the negative suction pressure applied to the chest

Question 2

Name and differentiate the 4 classifications of hip fractures

Answer 2

Hip fractures classified by anatomic location and fracture type- split into

Intracapsular: at the femoral neck or femoral head
Extracapsular: intertrochanteric or subtrochanteric

Question 3

Differentiate fusiform vs. saccular aneurysm

Answer 3

Fusiform = symmetric enlargement

Saccular = asymmetric enlargement

-associated w/ infection and trauma

Question 4

Identify

Answer 4

Keloid- scar formation where tissue extends beyond the border of the original wound

Question 5

Name the 4 boundaries of the inguinal canal

Answer 5

Anterior wall = aponeurosis of the external oblique (contains the superficial inguinal ring)

Posterior wall = transversalis fascia (contains the deep inguinal ring)

Roof -=internal oblique and transversus abdominis

Floor = inguinal ligament, medial ligament on end

Question 6

Artery most commonly injured in pelvic fracture

Answer 6

Superior gluteal artery

Question 7

Give brief overview of steps of thyrodectomy

Answer 7

1. Incision 2cm above sternal notch
2. Dissect around strap muscles (sternothyroid), reflect sternothyroid laterally and reflect thyroid lobe medially
3. See carotid artery laterally, locate recurrent laryngeal coursing under inferior thyroid artery. Preserve nerve, ligate vessels (both inferior and superior arteries) then resect lobes
4. Ligate inferior thyroid artery branches distal to where parathyroid supply comes off to preserve (or attempt to preserve) parathyroid arteries)
5. Interupted sutures to reapproximate midline fasia, close skin incision

Question 8

Name the three nerves in the groin region susceptible to injury during hernia repair

Answer 8

1. Genital branch of the genitofemoral nerve = most common nerve damaged in hernia repair
   - goes thru internal ring
2. ilioinguinal nerve
3. iliohypogastric nerve

Question 9

Describe the two grafts used in CABG and where they go

Answer 9

1. Saphenos vein (harvested from leg) used to connect aortic arch to distal RCA (distal to the blockage)
2. Internal mammary/thoracic artery (coming from subclavian artery) is relocated off the chest wall and connects distally to the LAD (distal to the blockage)
   - so leave internal mammary connected to subclavian proximally, then relocate from chest wall and reconnect to distal LAD

Question 10

Swan-Ganz catheter

(a) Function
(b) Location

Answer 10

Swan Ganz catheter- thread thru right heart to terminate (balloon) in the pulmonary artery

(a) measures pulmonary capillary wedge pressure = indirect measure of left atrial pressure

Question 11

Name the 4 layers of the colon

Answer 11

Lumen

Mucosa
Submucosa
Muscularis propria
Serosa

Question 12

Differentiate appearance of small vs. large bowel on abdominal Xray

Answer 12

Large bowel:

haustra: markings don’t extend from wall to wall
peripherally located
Small bowel:

valvulae conniventes extend across the lumen and are spaced closer together
centrally located

Question 13

GIve overview of steps of exploratory laparotomy for operative SBO

Answer 13

1. midline incision
2. start exploration at cecum and work backwards towards Ligament of Trites (want to start distally and move proximally, b/c want to minimize manipulation of dilated loops of bowel)
   - full exploration includes SI from lig of Treitz to the ileocecal jxn
3. lyse (cut/bluntly dissect) all adhesions along the way

Question 14

2 nerves you have to watch out for during mastectomy

Answer 14

long thoracic nerve
thoracodorsal nerve

Question 15

Percent of body surface area by areas of the body

Aka how much body surface area is affected if both legs are burned? the font?
in a child?

Answer 15

Rule of 9’s for adults: 9 for head, each arm. 18 for each leg, front, and back

For kids (head is bigger): 18 for head, 9 for each arm, 18 for each leg, front/back, each leg is 14

Question 16

How to differentiate upper vs. lower GI tract

Answer 16

Split by the ligament of Treitz = suspensatory ligamnet of the duodenum

Question 17

Boundaries of Hasselbach’s triangle

Answer 17

Medially- border of the rectus abdmoinis

Laterally- ilioinguinal ligament

Inferior epigastric blood vessels

Question 18

Statistically most common type of hernia

Answer 18

Indirect inguinal hernia

Question 19

Name the layers of the abdominal wall from superficial to deep

Answer 19

1. Skin
2. Subcuntaeous tissue made of
   (a) Camper’s fascia = superficial fatty layer
   (b) Scarpa’s fascia = deep membranous layer
3. Investing (deep) fascia
4. Muscles w/ their aponeuroses (also can be considered additional layers of investing fasia)
   - external obliques
   - internal obliques
   - transversus abdominis
5. traversalis fascia
6. parietal peritoneum

Question 20

Where is McBurney’s point?

Answer 20

2/3 of the way from the umbilicus to the ASIS

Question 21

What is a Hartmann’s procedure

Answer 21

Hartmann’s = proctosigmoidectomy = segmental colonic resection w/ end colostomy

done in emergency to remove the perf/sepsis, then can come back later and do curative surgery
resection of rectosigmoid colon w/ closure of rectal stump and formation of end colostomy

Question 22

During hernia repair the external oblique aponeurosis is opened, what should be found right beneath the external oblique?

Answer 22

Spermatic cord

Dividing the external oblique will expose the internal oblique layer everywhere except the groin, where it exposes the spermatic cord

Question 23

Maneuver to limit hepatic inflow during trauma laparotomy

Answer 23

Pringle maneuver- basically compress the portal triad (hepatic artery, portal vein, CBD) to prevent inflow/outflow

Question 24

Differentiate the two types of ileostomy

Answer 24

End ileostomy = opening in the end of colon to the outside

Loop ileostomy = opening connects back to more colon

Question 25

Benefit of using mesh in hernia repair

(a) What is the alternative to using mesh

Answer 25

Benefit of using mesh = reduced recurrence rates 2/2 tension-free

(a) Alternative is Shouldice repair = 4 layer repair in which you directly sew tissue together
- higher recurrence rate

Question 26

When do inguinal hernias get repaired?

(a) When do femoral hernias get repaired?

Answer 26

Repair inguinal hernias when they’re symptomatic

(a) ALWAYS repair femoral hernias b/c of the 30% complication risk (strangulation) even if asymptomatic
- higher baseline risk => repair

Question 27

Define carcinoma in situ

Answer 27

Carcinoma in situ means the full thickness of the epithelium is involved, but the basement membrane has not been invaded

Question 28

Calot’s triangle

Answer 28

Calot’s triangle = 3 C’s- anatomic structures important in view during lap choley

cystic duct laterally
cystic artery superiorly
common bile duct medially

Question 29

Which stones would we attempt to medically break up?

Answer 29

Kidney stones, NOT gall stones

if you break up a kidney stone you’re just putting pieces into the bladder/urine
but if you were to break up gallstones you’d just shoot tiny pieces out into more tiny ducts