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PANCE Practice > Surgery > Flashcards

Surgery Flashcards

1
Q

what does the humeral node drain

A

lateral aspect of hand and FA,
medial arm,
deep tissue of arm and FA,
supratrochlear nod

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2
Q

what does the pecteral node drain

A

anterior thoracic wall and breast

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3
Q

what does the subscapular node drain

A

posterior thoracic wall
posterior shoulder
scapular region

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4
Q

what does the central node drain

A

humeral node
pecteral node
subscapular node

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5
Q

what does the apical node drain

A

central and lymphatic vessels following cephalic vein

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6
Q

what does the infraclavicular node drain

A

lateral aspect of arm and shoulder

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7
Q

what does the supratrochlear node drain

A

medial aspect of arm and FA

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8
Q

what does the supraclavicular node drain

A

head and neck

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9
Q

what does the right subclavian trunk and rt. jugular trunk drain into?

A

right lymphatic duct

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10
Q

what drains into the thoracic duct

A

left jugular trunk and left subclavian trunk

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11
Q

what are the layers of the abdominal wall?

A 
Skin
Camper's Fascia
Scarpas Fascia
External abd. oblique and aponeurosa
Internal abd. oblique and aponeurosa
Transversus abdominis and aponeurosa
Transversalis fascia
Extraperitoneal adipose
Parietal peritoneum
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12
Q

abdominal scarpa’s fasica is the same as what for layer of male anatomy

A

superficial fascia of the scrotum

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13
Q

abdominal external abd. oblique and apo is the same as what layer of male anatomy

A

external spermatic fascia

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14
Q

abdominal internal abd. oblique and apo is the same as what for layer of male anatomy

A

cremasteric fasica

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15
Q

abdominal transversalis fascia is the same as what for layer of male anatomy

A

internal spermatic fascia

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16
Q

Beck’s triad

A

seen in patients with cardiac tamponade

  1. JVD
  2. decreased or muffled heart sounds
  3. decreased BP
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17
Q

where/what is McBurney’s point

A

1/3 of the distance from the anterior iliac spine to the umbilicus on a line connecting the 2

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18
Q

what is McBurney’s sign

A

tenderness at mcburney’s point in pts w/ appendicitis

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19
Q

Murphys sign

A

cessation of inspiration while palpating under the right costal margin; the pt cannot continue to inspire deeply bc it brings an inflamed gallbladder under pressure (seen in acute cholecystitis)

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20
Q

obturator sign

A

pain upon internal rotation of the leg w/ the hip and knee flexed; seen in pts w/ appendicitis or pelvic abscess

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21
Q

virchows triad

A

risk factors for thrombosis:

  1. stasis
  2. abnormal endothelium
  3. hypercoagulability
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22
Q

virchows node

A

metastatic tumor to left supraclavicular node (classicaly due to gastric cancer)

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23
Q

what is SVC syndrome

A

obstruction of the SVC (superior vena cava) by tumor or thrombosis

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24
Q

what is the most common indication for surgery w/ crohns disease

A

small bowel obstruction (SBO)

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25
Q

what is the most common type of melanoma

A

superficial spreading

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26
Q

what is the most common type of breast CA

A

infiltrating ductal

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27
Q

what is the most common site of breast CA

A

upper outer quadrant

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28
Q

what is the most common vessel involved in a bleeding duodenal ulcer

A

gastroduondenal artery

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29
Q

what is the most common cause of common bile duct obstruction

A

choledocholithiasis

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30
Q

what is the most common cause of pancreatitis

A

EtOH

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31
Q

what is the most common cause of SBO in adults in the US

A

postop peritoneal adhensions

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32
Q

what is the most common cause of SBO in children

A

hernias

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33
Q

what is the most common cause of emergency abdnominal surgery in the US

A

acute appendicitis

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34
Q

what is the most common site of GI carcinoids

A

appendix

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35
Q

what is the most common cause of transfusion hemolysis

A

clerical error

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36
Q

what is the most common cause of blood transfusion resulting in death

A

clerical error (wrong blood type)

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37
Q

what is the most common cause of large bowel obstruction

A

colon CA

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38
Q

what is the most common cause of fevere less than 48 hrs post op hrs

A

atelectasis

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39
Q

what is the most common cause of bacterial infection (UTI)

A

E. coli

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40
Q

what is the most common abdominal organ injured in blunt abdominal trauma

A

liver (not the spleen!)

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41
Q

what is the most common abdominal organ injured in penetrating abdominal injury

A

small bowel

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42
Q

what is the most common benign tumor of the liver

A

hemangioma

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43
Q

what is the most common cause of lower GI bleeding

A

upper GI bleeding

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44
Q

what is the most common hernia

A

inguinal hernia (right more than left)

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45
Q

what is the most common CA in females

A

lung

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46
Q

what is the most common CA in males

A

prostate

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47
Q

what is the most common CA causing death in males and females

A

lung

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48
Q

what is the most common cause of free peritoneal air

A

perforated PUD

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49
Q

in what percentage of cases does lower GI bleed stop spontaneously

A

90%

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50
Q

in what percentage of cases does upper GI bleed stop spontaneously

A

80%

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51
Q

what percentage of pt undergoing laparotomy develop a postop SBO at some time later

A

5%

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52
Q

what percentage of pt w/ acute appendicitis will have a radiopaque fecalith on abominal xray (AXR)

A

5%

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53
Q

what percentage of kidney stones are radiopaque on AXR

A

90%

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54
Q

at 6 weeks, wounds have achieved what percentage of their total tensile strenght

A

90%

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55
Q

what is the risk of appendiceal rupture 24 hrs after onset of symptoms

A

25%

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56
Q

one unit of packed RBCs increase the hematocrit by how much

A

3%

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57
Q

additional 1 L by nasal cannula increases FIO2 by how much

A

3%

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58
Q

who was the first to use antiseptic (carbolic acid)

A

Lister

british surgeon

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59
Q

when was the first appendectomy

A

1848 by Hancock

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60
Q

what does GIA stapler stand for

A

gastrointestinal anastomosis

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61
Q

what does TA stapler stand for

A

thoracoabdominal

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62
Q

what does EEA stapler stand for

A

end-to-end anastomosis

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63
Q

how are sutures sized

A

by diameter, states as a number of O’s

  • the higher number of O’s , the smaller the diameter
  • ex. 2-O suture has a larger diameter than 5-O
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64
Q

what are the 3 types of wound healing

A
  1. primary closure (intention)
  2. secondary intention
  3. tertiary intention (delayed Primary closure= DPC)
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65
Q

what is primary intention

A

when the edges of a clean wound are closed in some manner immediately (ex. sutures, steri-strips, staples)

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66
Q

what is secondary intention

A

when a wound is allowed to remain open and healed by granulation, epithelization, and contraction
-used for dirty wounds, otherwise an abscess can form

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67
Q

what is tertiary intention or DPC

A

when a wound is allowed to remain open for a time and then closed, allowing for debridement and other wound care to reduce bacterial counts prior to closure

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68
Q

when should skin sutures be removed

A

as soon as the wound has healed enough to withstand expected mechanical injury
-any stitch left in for more than ~10 days will leave a scar

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69
Q 
what are the guidelines for skin suture removal for 
Face
Extremities
Joints
Back
Abdomen
A

face: 3-5 days
extremities: 10 days
joints: 10-14 days
Back: 14 day
abdomen: 7 days

*leave sutures in longer for patients on steroids

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70
Q

how do you draw blood from the femoral vein

A

NAVEL: in the lateral to medial direction- nerve, artery, vein, empty space, lymphatics

*thus place needle medial to the femoral pulse

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71
Q

what position should a patient be in for a laparoscopic cholecystectomy

A

reverse trandelenburg- pt supine w/ head elevated to make the intestines fall away from the operative field)

72
Q

-ectomy

A

to surgicaly remove part of or an entire structure/organ

73
Q

-orraphy

A

surgical repair

74
Q

-otomy

A

surgical incision into an organ

75
Q

-ostomy

A

surgically creating opening btwn 2 organs, or organ and skin

76
Q

-plasty

A

surgical shaping or formation

77
Q

when can a patient ear prior to major surgery

A

NPO after midnight the night before or at least 8 hrs before surgery

78
Q

what lab test must all women of childbearing age have before entering the OR

A

B-HCG and CBC for possible pregnancy and anemia

79
Q

what preop medication can decrease postop cardiac events and death

A

beta blockers

80
Q

what must you always order preoperatively for your pt undergoing major operation

A
  1. NPO/IVF
  2. preop antibiotics
  3. type and cross blood (PRBCs)
81
Q

who gets preop ECG

A

pts older than 40 y/o

82
Q

what is Billroth I and Billroth II

A

I- antrectomy w/ gastroduodenostomy

II- antrectomy w/ gastrojejunostomy (2 limbs)

83
Q

what is Bassini herniorrhaphy

A

repair of inguinal hernia by approximating transversus abdominis aponeurosis and conjoint tendon to the reflection of Poupart’s (inguinal) ligament

84
Q

what is Nisssen

A

360 degree wrap of the stomach by the fundus of the stomach around the distal esophagus to prevent reflux

85
Q

what is the difference btwn a simple and radical mastectomy

A

radical mastectomy removes the axillary lymph nodes too

86
Q

what inhibits wound healing

A

infection, ischemia, DM, malnutrition, anemia, steroids, CA, radiation, smoking

87
Q

what reverses the deleterious effects of steriods on wound healing

88
Q

is a chest tube placed under or over the rib?

A

OVER to avoid the vessels and nerves

89
Q

what is the most common cause of excessive NGT drainage

A

tip of NGT is inadvertently placed in duodenum and drains the pancreatic fluid and bile

90
Q

what is a foley catheter

A

catheter into the bladder, allowing accurate urine output determination

91
Q

what is a central line

A

catheter placed into the major veins (central veins) via subclavian, internal jugular, or femoral vein approaches

92
Q

how are needles sized?

A

14-gauge needle is 1/4th of an inch (thus a 14-gauge needle is larger than a 21-gauge needle)

93
Q

what is the drainage of the left testicular vein

A

left renal vein

94
Q

what is the drainage of the right testicular vein

95
Q

what is Gerota’s fascia

A

fascia surrounding the kidney

96
Q

what are the prominent collateral circulations seen in portal HTN

A
  • esophageal varices
  • hemorrhoids (inferior hemorrhoidal vein to internal iliac vein)
  • patent umbilical vein (caput medusa)
  • retroperitoneal vein via lumbar tributaries
97
Q

what parts of the GI tract are retroperitoneal

A
  • most of duodenum
  • ascending colon
  • descending colon
  • pancreas
98
Q

what lymph nodes are between the pectoralis minor and major

A

Rotter’s lymph nodes

99
Q

is the left vagus nerve anterior or posterior

A

anterior– remember that the esophagus rotates during development

100
Q

give the location of the following structures:

foregut, midgut, and hindgut

A

Foregut: mout to ampulla of vater

midgut: ampulla of vater to distal 1/3rd of transverse colon
hindgut: distal 1/3rd of transverse colon to anus

101
Q

where are the blood vessels on the ribs?

A

VAN

vein, artery, nerve are underneath the rib

102
Q

what is Hesselbachs triangle

A

area bordered by:

  1. inguinal ligament
  2. epigastric vessels
  3. lateral border of the rectus sheath
103
Q

what nerve is located on top of the spermatic cord

A

ilioinguinal nerve

104
Q

how can you find the appendix after you find the cecum

A

trace the taeniae back as they converge on the origin of the appendix

105
Q

what is the strongest layer of the small bowel

A

submucosa (NOT serosa)

106
Q

which parts of the GI tract do not have a serosa

A

esophagus

middle and distal rectum

107
Q

what does the thoracic duct empty into

A

left subclavian vein

AT left internal jugular vein junction

108
Q

what is the coronary vein

A

left gastric vein

109
Q

which is longer, the left or right renal vein

110
Q

what are the major structural differences between the jejunum and ileum

A

Jejunum- long vasa rectae, large plicae circulares, thicker wall

ileum- shorter vasa rectae, inferior plicae circulares, Inferior wall (thinner)

111
Q

what are the major anatomic differences between the colon and small bowel

A

colon- has taeniae coli, haustra, and appendices epiplociae (fat appendages)

SI- smooth

112
Q

how far up does the diaphragm extend?

A

around the nipples in men– 4th intercostal space, thus abdomen extends to the level of the nipples

113
Q

what dermatome is at the umbilicus

114
Q

what are the major layers of an artery

A

Outter:
adventitia
media
intima

115
Q

what percentage of body weight is in fluid

A

60%

TIE-
total body fluid-60% of weight
ICF-40% of weight
ECF-20%

116
Q

how many liters of blood are in a 70kg man

117
Q

what is the major electrolyte in colonic feculent fluid

118
Q

what is the physiologic response to hypovolemia

A
  • Na/H20 retention via renin
  • aldosterone–> water retention via ADH
  • Vasoconstriction via angioII
  • low urine output (tachy)
119
Q

what is the classic acid-base finding w/ significant vomiting or NGT suctioning?

A

hypokalmeic hypochloremic metabolic alkalosis

why?– loss of gastric fluid- loss of HCl causes alkalosis, driving K into cells

120
Q

how many mL are in 1 oz

121
Q

what is the major extracellular cation

122
Q

what is the major intracellular cation

123
Q

signs/symptoms of hyperkalemia

A
  • decreased DTR
  • weakness
  • paralysis
  • respiratory failure
  • peaked T waves on ECG (flattening T waves in hypokalemia)
124
Q

acronym for treatment of acute symptomatic hyperkalemia

A 
CB DIAL K
calcium
bicarbonate
Dialysis
insulin/dextrose
albuterol
lasix
kayexalate
125
Q

what electrolyte must you replace before replacing K+ in hypokalemia?

A

magnesium

-hypomagnesemia inhibits K reabsorption from the renal tubules

126
Q

what is the most common cause of mild postop hyponatremia

A

fluid overload

127
Q

if hyperkalemia is left untreated, what can occur

A

VT or VF–> death

128
Q

what are the major cardiac electrolytes?

A

potassium (dysrhythmias)
magnesium (dysrhythmias)
calcium (dystrhythmias/inotrope)

129
Q

what coagulation pathway is measured in PT and PTT

A

PT- extrinisic

PTT- intrinsic

130
Q

what is PRBC (packed red blood cells)

A

no platelets or clotting factors

131
Q

FFP (fresh frozen plasma) does what

A

replaces clotting factors (no RBCs, WBCs, platelets)

132
Q

cryo (cyroprecipitates) replaces what

A

fibrinogen, von Willebrand factor, some clotting factors

133
Q

what are the general guidelines for blood transfusion

A
  • acute blood loss
  • Hgb less than 10
  • hx of CAD/COPD or healthy symptomatic pt w/ Hgb less than 7
134
Q

what blood type is universal donor for PRBCs

135
Q

what blood type is universal donor for FFP

136
Q

what is a type and screen

A

Patient’s blood type is determined and the blood is screened for antibodies; a
type and cross from that sample can then be ordered if needed later

137
Q

what is a type and cross

A

Patient’s blood is sent to the blood bank and cross-matched for specific donor units for possible blood transfusion

138
Q

what does plavix do?

A

inhibits platelets

*blocks fibrin crosslinking of platelets

139
Q

what is microcytic anemia “until proven otherwise” in a man or postmenopausal woman

140
Q

what component of blood transfusion can cause a fever

141
Q

when should aspirin administration be discontinued preoperatively?

A

1 week bc platelets live 7-10 days

142
Q

how long do normal RBC live

143
Q

what is the most immediate method to obtain hemostasis

A

pressure (w/ finger)

144
Q

describe warfarins actions

A

inhibits vit. K dependent clotting factors II, VII, IX, X

145
Q

what antihypertensives are contraindicated in pt w/ renal artery stenosis

A

ACE inhibitors

146
Q

what is atelectasis

A

collapse of the alveoli

147
Q

what does ADH do

A

ADH increases NaCl and H2O resorption in the kidney, increasing intravascular volume

148
Q

where is iron absorbed

149
Q

where is vit B12 absorbed

A

terminal ileum

150
Q

where are fat soluble vitamins absorbed

A

terminal ileum

151
Q

what vitamines are fat soluble

A

K, A, D, E

KADE

152
Q

what must bind B12 for absorption

A

intrinisic factor from the gastric parietal cells

153
Q

what are the 5 different types of shock

A
  1. hypovolemic
  2. septic
  3. cardiogenic
  4. neurogenic
  5. anaphylactic
154
Q

what is cardiogenic shock

A

cardiac insufficiency, LV failure, inadequate tissue perfusion

155
Q

what is the acronym for treatment options for anaphylactic shock

A

BASE

Benadryl
Aminophylline
Steroids
Epinephrine

156
Q

what is cellulitis

A

blanching erythema from superficial dermal/epidermal infection
(usually strep more so than staph)

157
Q

what do chief cells produce

A

pepsinogen

158
Q

what do parietal cells produce

A

HCl

intrinsic factor

159
Q

where is calcium absorbed

A

duodenum actively

jujunum passively

160
Q

LLQ pain ddx

A

diverticulitis

UTI

161
Q

LUQ pain ddx

A

PUD, gastritis

162
Q

what type of hernia is most common

A

indirect inguinal 50%
direct inguinal 25%
femoral 5%

163
Q

what is a sliding hernia

A

hernia sac partially formed by the wall of a viscus (ie. bladder/cecum)

164
Q

what is an obturator hernia

A

hernia through obturator canal (females more so than males)

165
Q

what hernia is associated w/ ascites, pregnancy and obesity

A

umbilical hernia

166
Q

inguinal hernia lateral to hesselbach’s triangle

A

indirect inguinal hernia

*through internal ring of inguinal canal towards external ring (indirectly through abdominal wall)

167
Q

inguinal hernia within hesselbach’s triangle

A

direct inguinal hernia

*directly through abdominal wall- does not transverse the internal ring

168
Q

what is a hiatal hernia

A

hernia through esophageal hiatus

169
Q

what is an indirect inguinal hernia caused by

A

patent processus vaginalis (congenital)

170
Q

what is the risk of herniation strangulation

A

highest in fermoral

higher in indirect than direct

171
Q

from what abdominal muscle layer is the cremaster muscle derived

A

internal oblique muscle

172
Q

to what does the inguinal ligament attach

A

anterior superior iliac spine to the pubic tubercle

173
Q

what is the most common organ in an inguinal hernia sac in men

A

small intestine

174
Q

what is the most common organ in an inguinal hernia sac in women

A

ovary/fallopian tube

175
Q

what is the most common hernia in women

A

indirect inguinal hernia

176
Q

what vessel provides blood supply to appendix

A

appendiceal artery- branch of ileocolic artery

177
Q

what is the most common appendiceal tumor

A

carcinoid tumor

PANCE Practice (26 decks)

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