Week 5 Flashcards
VATER (VACTERL) is an acronym that stands for the affected parts of the body including the ________,_______,________,___________,______,_________,_________
vertebrae, anus, cardiac(heart) , trachea, esophagus, kidney and limbs
Fever is associated with ______ and _______
Chills and rigor
Is VATER syndrome a hereditary condition?
No
Rigor is a sudden feeling of _____ with ______ accompanied by a ___ in temperature, often with copious _______, especially at the onset or height of a ________.
cold; shivering
rise; sweating
fever
Full meaning?
P
O
T
T
E
R
Pulmonary hypoplasia
Oligohydraminos
Twisted skin
Twisted face
Extremities defect
Renal agenesis
Hydrocalycosis is defined as ________ of a ________ with a demonstrable connection to the renal ______ and an epithelial lining of the cyst wall.
cystic dilatation
major calyx
pelvis
A urinoma is a mass formed by ________________________ .
encapsulated extravasated urine
urinary ascites typically result from spontaneous _________ with ________ of urine into the _________ compartment
bladder rupture; leakage
intraperitoneal
Boundaries of femoral triangle
The borders of the femoral triangle are the ________ superiorly, the _____________ medially, and the __________ laterally.
inguinal ligament
adductor longus muscle
sartorius muscle
Contents of the femoral triangle???
Nerve
Artery
Vein
Empty space
Lymphatics
mastopexy operation to _____________
orchidopexy ,an operation to ________________ and fix it there
gastropexy, surgical _______________________
lift and fix the breast
move an undescended testicle into the scrotum
attachment of the stomach to the intestinal wall.
Due to Bladder outlet obstruction, the bladder gets ________, then ________ leading to __________ muscles which can lead to __________; while the resulting __________ can become a _________
Dilated
Distended
Disarrayed
Traberculation
Sacculation
Diverticuli
A thyroglossal cyst is a congenital _____ filled sac, commonly presenting in (younger or older?) patients (typically ______yrs) and have _______ incidence between men and women.
fluid; younger
<20
equal
Embryology of Thyroglossal Cysts
During embryonic development, the thyroid gland originates from the ______________ ( ____________ ), migrating down to its final position in the neck and connecting back to the tongue via the _____________.
In normal development, this duct will obliterate, however thyroglossal cysts occur when portions of this duct remain patent, creating cavities that may fill with _______ and being prone to infection.
base of the tongue
foramen caecum; thyroglossal duct
fluid
Thyroglossal cysts present as a (palpable or non-palpable ?) (painful or painless?) midline mass that move up with ________ and __________.
When infected, they can _________ and become _______.
Palpable; painless
swallowing and protrusion of the tongue
increase in size ; painful
Standard treatment of a thyroglossal cyst is _____________, with the modified ____________ being the most widely used.
surgical intervention
Sistrunk procedure
Sistrunk Procedure
The central body of the ___________ is removed to allow complete removal of the entire _________. There is a high chance of recurrence if the _____________________ is not removed.
hyoid bone ; thyroglossal tract
medial portion of the hyoid bone
Hyoid bone
____-shaped bone in the neck which _______________.
U
supports the tongue.
It is essential that patients with thyroglossal cyst have _________ scan of the neck to identify the thyroid gland pre-operatively, as the only functioning thyroid tissue may be attached to the cyst and risks getting excised during the procedure.
an ultrasound
Branchial cysts are congenital masses which arise in the ______ aspect of the ________, typically anterior to the __________
lateral; neck
sternocleidomastoid (SCM
A ranula is a _________ or _________, that forms in the ———- under the ________.
It is filled with _________ that has leaked out of a ____________________
fluid collection, or cyst
mouth; tongue
saliva (spit)
damaged salivary gland.
Von Hippel-Lindau syndrome (VHL) is a hereditary condition associated with _________________. VHL-related tumors include hemangioblastomas, which are blood vessel tumors of the brain, spinal cord, and retina.
tumors arising in multiple organs
Brodie’s abscess is defined as a ____________ of the bone. It is an uncommon condition, usually mistaken for being a ______________ , and has been frequently observed to involve the _________ of bones (especially _____)
subacute osteomyelitis
bone tumor
metaphysis; tibia
Complications of undescended testes??
Fertility(lack of)
Atrophy
Inflammation
Testicular torsion, trauma and tumor
Hernias
Contraindication of hypospadias is??
Circumcision
Hydrocele
A _____-filled sac around a ________, often first noticed as ________________.
fluid
testicle
swelling of the scrotum.
A colostomy is surgery to _______________________ . The opening creates a passage from the ___________ to the ___________.
This is so that ___________ and ________ can leave the body through the ________ instead of passing through the _________.
create an opening called a stoma
large intestine ;outside of your body.
solid stool ; gas
stoma ; rectum.
Bedsores — also called _________ and _________ — are injuries to skin and underlying tissue resulting from ___________________
pressure ulcers ; decubitus ulcers
prolonged pressure on the skin.
Bedsores most often develop on skin that _______________, such as the heels, ankles, hips and tailbone.
covers bony areas of the body
People most at risk of bedsores have medical conditions that _______________________ or cause them to _____________________________
limit their ability to change positions
spend most of their time in a bed or chair.
Bedsores can develop over ______ or _________ .
Most sores heal with treatment, but some never heal completely.
hours or days
Warning signs of bedsores or pressure ulcers are:
Unusual changes in _______ or ______
__________
_______ draining
An area of skin that feels _________________ to the touch than other areas
__________ areas
skin color or texture
Swelling; Pus-like
cooler or warmer
Tender
Clinically, the Systemic Inflammatory Response Syndrome (SIRS) is identified by two or more symptoms including ____________,_________,_______, and _________
fever or hypothermia, tachycardia, tachypnoea and change in blood leucocyte count
SIRS
Temp:
HR:
RR:
WBC:
Less than 36 or greater than 38
Greater than 90bpm
Greater than 20 breaths per min
Less than 4k or greater than 11k
_____________________________ (LODS)
________________________________(SOFA)
Logistic Organ Dysfunction System
Sequential Organ Failure Assessment
Criterias in SOFÀ scoring?
Respiratory PO2
Playtelets
GCS
Mean arterial pressure
Liver bilirubin
Renal creatinine
IV Cannula Sizes
14
16
18
20
22
24
26
Orange
Medium gray
Deep green
Pink
Deep blue
Yellow
Violet
The preferred sites for IV cannulation?
Mention 6
Hand
Wrist
Cubital fossa
Foot
Leg
Scalp
Potential complications of IV cannulation include:
Mention 5
phlebitis
cellulitis
sepsis
tissue necrosis
air embolus (incorrect priming).
ACCESS SITE — Centrally inserted central venous catheters are primarily placed via the __________ vein, _________ vein, or ________ vein.
internal jugular
subclavian
femoral
Angles for injection
IM- ?
Subcutaneous-??
IV-??
Intradermal-??
90 degrees
45 degrees
Less than 30 degrees
10-15 degrees
A thrill or buzz is like a _______ caused by ___________ through the fistula and can be felt by placing your fingers just above your incision line.
A ‘bruit’ is a ______ sound.
vibration
blood flowing
whooshing
Which testes drops first?
Right of left
Left
Hernia is a _______ of a__________ through a defect in the __________________________
protrusion
viscus/part of a viscous
wall of its containing cavity
Desmoid tumors are (cancerous or noncancerous?) growths that occur in the ___________.
Desmoid tumors most often occur in the _______,_______, and ________.
noncancerous
connective tissue
abdomen, arms and legs
Another term for desmoid tumors is ________________.
aggressive fibromatosis
Inguinal hernia repairs are of the following three general types:
Herniotomy: ????
Herniorrhaphy : __________________
Hernioplasty :???
removal of the hernial sac only
herniotomy plus repair of the posterior wall of the inguinal canal
herniotomy plus reinforcement of the posterior wall of the inguinal canal with a synthetic mesh
In hernioplasty, instead of ________________ , as is done in herniorrhaphy , the surgeon covers it with a ____,_________ _______, usually made of flexible plastics, such as __________ or _________
stitching the muscle opening shut
flat, sterile mesh
polypropylene, or animal tissue.
Hernioplasty is better-known as __________ hernia repair.
tension-free
Cholelithiasis
Characteristically, this pain is (mild or severe?) and located in the ________ and/or the ___________ quadrant. The pain may radiate to the ________ or the __________ in 60% of the cases and might be associated with nausea or vomiting, usually occurring in the _______ or _________, in 80% of the cases
severe; epigastrium
right upper; upper back
right scapula
late evening or at night
The classic clinical symptoms associated with ___________________________ are known as Charcot’s triad and consist of ___________,___________, and __________
acute obstructive cholangitis
intermittent abdominal pain, fever, and jaundice
Charcot’s cholangitis triad is the combination of_________; _______ , usually with _______ ; and _______________________.
When the presentation also includes __________ and ________ changes, it is known as Reynolds’ pentad.
jaundice; fever ; rigors
right upper quadrant abdominal pain
low blood pressure; mental status
Murphy’s sign is elicited in patients with _____________ by asking the patient to _______________________ while palpating the _______________
acute cholecystitis
take in and hold a deep breath
right subcostal area
Nail clubbing, also known as digital clubbing or clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the ______ and ________.
When it occurs together with joint _______, joint _______, and abnormal _______ and _________ it is known as _____________________________
heart; lungs
effusions; pains
skin and bone growth
hypertrophic osteoarthropathy
Stages of clubbing?
No visible
Mild
Moderate
Gross
Hypertrophic osteoarthropathy
5Rs of Fracture management
Rescuscitation
Radiology and other investigations
Reduce
Retain reduction
Repair and Rehabilitation
Descent of the Testes
The testes develop from the __________ in the (anterior or posterior?) abdominal wall (medial or lateral?) to the developing kidneys.
As the ________ end grows, the ________ end atrophies, resulting in progressive shifting ___wards of the testes.
By the third month the gubernaculum testis, a __________ __________ structure, appears and extends from the ________ end of the testis through the __________ which forms around it, and protrudes through the external ring to pass into the __________.
At the same time a pouch of peritoneum, the __________ , attached to the ________ end of the gubernaculum
(above or below?) the testis herniates and follows the course of the gubernaculum through the inguinal canal into the scrotum.
genital ridge; posterior ;medial
caudal ; cranial ; down
cylindrical ligamentous ;caudal
inguinal canal ;scrotum
processus vaginalis ; upper ;
below
Descent of the testes
From the third to the seventh month, the testis lies in the _______ near the _______ ring.
In the seventh month, it begins its descent to the scrotum (anterior or posterior?) to and projecting into the ___________.
By the _______ month, it has traversed the inguinal canal and is at the _______ ring, and in the _______ month it descends into the scrotum.
iliac fossa ; internal ring.
posterior ;processus vaginalis
eighth month ; external ring
ninth month
The _______ testis usually descends later than the _______ , so accounting for a higher incidence of abnormalities on the ________.
right
left
right.
The testes grows when they are (inside or outside?) of the _______ ring.
Outside
external
The part of the processus vaginalis in the inguinal canal normally becomes obliterated _______ _______ and the part in the ________ remains patent as the _________.
Obliteration ceases at age ______ .
at or soon after birth
Scrotum; tunica vaginalis
2
Failure of obliteration of the processus vaginalis may lead to any of the following abnormalities
Mention 4
I. Indirect inguinal hernia
2. Encysted hydrocele of the cord
3. Infantile hydrocele.
4. Congenital hydrocele.
Indirect inguinal hernia.
The (proximal or distal?) part is patent.
If the entire processus is patent, then a __________ may occur in infancy.
Proximal
complete hernia
Encysted hydrocele of the cord.
The __________ parts are obliterated but the _________ is patent and filled with ———- .
The corresponding anomaly in the female is ____________
proximal and distal
mid-portion; fluid
cyst of the canal of Nuck
Infantilehydrocele.
The processus is obliterated near the ___________ but is otherwise patent and continuous with the ___________
internal ring
tunica vaginalis
Congenital hydrocele.
The _________ processus is patent, but the neck is ________. It contains fluid
entire ; narrow
The testis
It may, however, pass through the external inguinal ring but be prevented from entering the scrotum by a ______ at the _____________ .
It then assumes an _______ position usually superficial to the _____________ in the groin, but occasionally in the ________,_________, or the ___________
fibrous band
neck of the scrotum
ectopic; external oblique aponeurosis
perineum, femoral triangle or the pubic area.
The inguinal canal is an _________ passage directed _____wards , (medially or laterally?) and forwards in the lower part of the AAW, above the _______ through which pass the _________ with the testicular vessels , _________ nerve and the ____________________________ nerve in the male and the __________ in the female
oblique; down; medially
groin; spermatic cord ; ilioinguinal
genital branch of the genito-femoral
round ligament
Inguinal canal:
______ long in adult
Internal Inguinal ring is _____ shaped and found in the _____________
External ring is ______ shaped and is an opening in the ______________
4cm
U ; transversalis fascia
Triangular ; external oblique aponeurosis
The anterior wail of the inguinal canal is formed by the ________________ and additionally in the lateral part by the muscular fibres of the ______________
The posterior wall is formed by the ___________, reinforced superficially by aponeurotic fibres from the ___________ and buttressed in the medial half by the __________
external oblique aponeurosis
internal obljque
transversalis fascia
transversus abdominus; conjoint tendon
Conjoint tendon is the fused common insertion of the __________ and _________ muscles
transversus abdominis
internal oblique
Intussusception is a medical condition in which ______________________
It typically involves the ________ and less commonly the ___________
a part of the intestine folds into the section immediately ahead of it.
small bowel ; large bowel.
Symptoms of intussusception include ————— which may come and go, __________, abdominal _______, and ___________
abdominal pain; vomiting
bloating
bloody stool
intussusception often results in a small bowel ____________ .
Other complications may include _________ or bowel __________.
obstruction
peritonitis; perforation
Risk factors of intussusception in children include certain infections, diseases like __________, and ____________.
Risk factors in adults include __________,_________, and __________
cystic fibrosis; intestinal polyps
endometriosis, bowel adhesions, and intestinal tumors
Treatment of intussusception in children is typically by an ________ with _______ used if this is not successful.
____________ may decrease the risk of another episode.
enema; surgery
Dexamethasone
Intussusception
Treatment: In adults, ________________________ is more often required.
surgical removal of part of the bowel
Intussusception occurs more commonly in __________ than __________.
children
adults.
Intussusception
In children, ________ are more often affected than ________.
The usual age of occurrence is ________ to ________ old.
males ; females
3months ; 3years old
In the most frequent type of intussusception, the ________ enters the ________. However, other types occur, such as when a part of the ________ or ________ prolapses into itself.
ileum ; cecum.
ileum ; jejunum
intussusception
The part that prolapses into the other is called the ________, and the part that receives it is called the ___________ .
intussusceptum
intussuscipiens
Almost all intussusceptions occur with the intussusceptum having been located (proximally or distally?) to the intussuscipiens. This is because _________ of the intestine pulls the ______ segment into the _______ segment.
proximally
peristaltic action
proximal; distal
Intussusception
The trapped section of bowel may have ___________________ , which causes _________.
The ________ is very sensitive to this, and responds by _____________.
This creates the classically described “___________” stool, which is a mixture of ________,______,________ .
its blood supply cut off
ischemia
Mucosa; sloughing off into the gut
red currant jelly
sloughed mucosa, blood, and mucus
An intussusception is often suspected based on history and physical exam, including observation of ________ sign. A _________ examination is particularly helpful in children, as part of the intussusceptum may be felt by the finger.
A definite diagnosis often requires confirmation by diagnostic imaging modalities. _______ is the imaging modality of choice for diagnosis and exclusion of intussusception, due to its high accuracy and lack of radiation. The appearance of _______ sign (also called “ ________ sign” on a sonograph, usually around 3 cm in diameter, confirms the diagnosis.
Dance’s; digital rectal
Ultrasound; target
doughnut
An intussusception has two main differential diagnoses: ___________ and ___________
acute gastroenteritis
rectal prolapse
intussusception VS acute gastroenteritis
Abdominal pain, vomiting, and stool with mucus and blood are present in acute gastroenteritis, but _________ is the leading symptom.
diarrhea
intussusception VS Rectal prolapse
Rectal prolapse can be differentiated by projecting mucosa that can be felt in _________________, whereas in intussusception the finger may ________________
continuity with the perianal skin
pass indefinitely into the depth of the sulcus.
intussusception
Early symptoms can include periodic __________ , nausea, _______ (sometimes _______ in color from _____), pulling _______ to _________ , and intermittent moderate to severe cramping abdominal pain.
abdominal pain; vomiting
green; bile
legs to the chest area
Intussusception
Pain is intermittent—not because _________________ , but because the intussuscepted bowel segment ____________.
Later signs include ________, often with “ ___________ “ stool , and lethargy.
Physical examination may reveal a “ _________-shaped” mass, felt upon palpating the abdomen
the intussusception temporarily resolves
transiently stops contracting
rectal bleeding; red currant jelly
sausage
Classification of intussusception?
Location
Direction
Etiology
What are the risks of thyroidectomy?
_______ changes, such as _______
______throat
Bleeding and blood clots
__________ or _________ that require another surgery
Injury to the ________ or _______
______________
Voice; hoarseness
Sore; Adhesions or scar tissue
esophagus or trachea
Hypoparathyroidism
