Final Exam Flashcards

Question

List the 4 supporting ligaments of the uterus:

Answer 1

Round, broad, cardinal, uterosacral ligaments

Answer 2

Internal os; external os; endocervical canal Fundus, cornua, body (corpus), cervix Endometrium, myometrium, perimetrium

Answer 3

``` accessory structures: Tubes and Ovaries Pertaining to to the menses or menstruation Difficult or painful sexual intercourse Pelvic inflammatory disease Carcinoma in situ Condition; ill, bad, or poor; growth Pertaining to; within; epithelium Condition; new; growth Severe itching A fertilized egg attached outside the uterus ```

Answer 4

Vulva–Facilitate sexual intercourse Vagina –Intercourse; menstrual discharge, and delivery of infant Cervix–Holds developing fetus inside uterus Uterus–Support developing embryo/fetus Tubes–Fertilization, peristalsis of zygote (fertilized ovum) to uterus Ovaries–Store, mature, and release ovum “egg”

Answer 5

Excision of uterus through the vagina, with MIS techniques for dissection from pelvic cavity

Answer 6

Vagina Cervix Internal os; External os; Endocervical canal Uterus Ligaments: round, broad, cardinal, uterosacral Uterine tubes Ovaries Bladder Ureters Physiology: Reproduction; conception/growth of infant Absence of genital prolapse (ligaments too tight to pull uterus into vagina easily) Presence of intra-abdominal scarring Such as post c-section (bladder adhesions) or PID scars Large fibroids or adnexal massesCancer; endometrial or cervical

Answer 7

Insert a vaginal manipulator into the cervix and a vaginal balloon occluder into the vagina Establish laparoscopic access laparoscopic access Dock the robots and position the instruments in the robotic arms and through the ports Manipulate the uterus as the surgeon directed Transect the round ligament using bipolar cautery Identify the ureters Hydrodissect broad ligament; free bladder from uterus Transect the uterosacral and cardinal ligaments and blood vessels Open vaginal vault (FYI: colpotomy; will lose pneumoperitoneum) Move to vaginal approach, transect remaining attachments (including vessels), remove uterus; close vault Restore pneumoperitoneum to Irrigate surgical site with normal saline Achieve hemostasis Close incision and apply dressings (Dermabond, Steri-strips, Obi/peri pad)

Answer 8

Delivery of a fetus (or fetuses) through abdominal and uterine incisions

Answer 9

Uterus Tubes & ovaries Bladder Cervix Uterine vessels (huge) Placenta; umbilical cord Physiology: reproduction Elective Malpresentation (malposition) Fetus is not in correct position for delivery Cephalopelvic disproportion (CPD) fetus’ head is too big to pass through mother’s pelvic outlet multiple fetuses (quadruplets; quintuplets; etc.) Placenta previa A portion of the placenta is seated over the cervix Toxemia pre-eclampsia – hypertension, edema, proteinuria Eclampsia – all signs listed above plus seizures Active Herpes or presence of genital warts Some patients with diabetes Some previous C-sections Urgent Dystocia; AKA failure to progress Cervical dystocia: fails to soften to dilate and efface Uterine dysfunction: won’t contract effectually even with oxytocin Emergent Fetal distress Diagnosed by fetal heart rate/tone and blood chemistry (pH) Abruptio placenta (AKA: placental abruption) Placenta detaches before delivery; varying degrees from minor detachment to major detachment Prolapsed cord Umbilical cord drops out ahead of baby

Answer 10

Using a #10 blade on a #3 knife handle a Pfannenstiel incision is made Achieve hemostasis PRN using ESU The incision is carried deeper with ESU and tissue forceps Fascia is identified and incised Goalet or Army-Navy retractors is used to retract the abdominal wall Superior edge of fascia is grasped (Kochers x 2), fascia is bluntly dissected from underlying rectus muscle ESU used on perforating vessels, transect septum, repeat on inferior edge of fascia Rectus abdominis muscles are separated at midline by blunt dissection Peritoneum is identified, grasped (hemostat x 2), and lifted Incise peritoneum and extend with Metzenbaum scissors Place self-retaining retractor for abdominal wall After open peritoneum: Separate bladder flap and retract it inferiorly Palpate the uterus to determine the fetal placement and position Incise uterus with knife, extend with bandage scissors The obstetrician places their hand into the uterus and manipulates the fetus Remove retractors, deliver baby’s head Clamp and cut cord the umbilical cord using Metzenbaum scissors or Lister bandage scissors, pass baby off to neonatal team Clamp uterine walls (Ring forceps or Penningtons) Deliver placenta, inspected it, and removed from the back table Close uterus in layers using absorbable sutures FYI: First closing count Suture to reattach bladder flap Irrigate the surgical site Achieve hemostasis Close the abdominal wall, followed by the skin Stiches or skin staplers may be used to lose the skin Dressings (ABD pad, 4x4 gauze or long tegaderm) and perineal pad is applied.

Answer 11

Excision of bladder with diversion of urine into an isolated segment of bowel

Answer 12

Bladder, ureters, urethra Ileum and mesentery Physiology: evacuation of urine Bladder cancer

Answer 13

I/H/D/R per Pfannenstiel incision; EUA Isolate bladder from attachments and excise bladder Identify, mobilize and transect ureters; (create mesenteric tunnel) Resect segment of ileum keeping mesenteric blood supply intact Re-anastomose original ileum; close mesentery Sew ureters into the isolated segment of ileum Bring ileal pouch to abdominal wall and create small ostomy Place ureteral catheters as stents; I/H/drain/C/D

Answer 14

Excision of kidney

Answer 15

``` Kidney; Gerota’s capsule/fascia Renal pelvis; ureter Renal artery and vein (renal pedicle) Vena cava and aorta Physiology of kidney: formation and excretion of urine Renal Cancer ```

Answer 16

Mark the incision site with a skin marker Using #15 blade on a #3 knife handle a flank incision is made Achieve hemostasis using ESU The incision is carried deeper through the fat, latissimus dorsi, external oblique, and internal oblique muscles Retract the skin, subcutaneous layers, and rib Incise the transverses abdomens fascia Expose the Gerota’s capsule by dissecting paranephric fat Isolate, clamp, cut, ligate ureter Isolate, clamp, triply ligate, cut renal artery then renal vein heavy silk ties - #1 or #2 Remove the kidney Close the incision by layer Gerota’s capsule External oblique muscle Skin Place a drain Apply dressings (4x4 gauze, Long tegaderm, ABD pad, and Surgical tape)

Answer 17

Removal of the prostate gland through MIS approach with robotic assistance

Answer 18

``` Prostate gland and capsule Seminal vesicles, rectum Penis, urethra, bladder neck, bladder Physiology: Secretion of seminal fluid Prostate cancer ```

Answer 19

A 24 Fr Foley catheter is inserted into the patient Establish laparoscopic access • Dock the robots and position the instruments in the robotic arms and through the ports Replace the 30 degree camera with a 0 degree Grasp and pull the bowel superiorly Identify the rectum Incise the peritoneum Identify and divide the vas deferens and seminal vesicles and dissect gland Preserve the neurovascular bundle Replace the 0 degree camera with a 30 degree Incise the transverse peritoneum Divide the umbilical ligament Incise bladder neck, transect urethra distal to prostate A surgical entrapment bad is inserted through the sheath and the prostate is placed inside The specimen is remove Perform urethrovesical anastomosis and test it The sheaths are removed and each incision site is checked for hemostasis Desufflate A new Foley is inserted Each port site is closed and dressing is applied (derma bond, steri-trips).

Answer 20

Extracorporeal shock wave lithotripsy To crush stone using shockwaves outside the body Total abdominal hysterectomy with bilateral salpingooophorectomy Right salpingooophorectomy Left salpingooophorectomy Laparoscopic-assisted vaginal hysterectomy Vaginal birth after cesarean

Answer 21

Incision made with 10 blade on #3 handle, hemostasis, deepen with ESU and tissue forceps Fascia is identified, incised, and incision extended Small retractor placed in lateral corners to view Superior edge of fascia is grasped (Kochers x 2), fascia is bluntly dissected from underlying rectus muscle ESU used on perforating vessels, transect septum, repeat on inferior edge of fascia Rectus abdominis muscles are separated at midline by blunt dissection Peritoneum is identified, grasped (hemostat x 2), and lifted Incise peritoneum and extend with Metzenbaum scissors (FYI: caution don’t damage bladder inferiorly) Place self-retaining retractor for abdominal wall

Answer 22

Kidneys: filter waste from the body by excretion of urine Adrenal glands: part of the endocrine system Ureters: Peristalsis to carry urine to bladder Urinary bladder: Reservoir for urine bladder trigone: Ureteral orifices (openings) and the urethral orifice Urethra: Exit of urine from body

Answer 23

Perirenal fat – serves to protect kidneys Fascia renalis (Gerota’s capsule)– keeps kidneys in position Hilum – concave area where vessels enter/exit Renal artery and vein – blood supply to kidneys Together with nerves + lymph vessels are called the pedicle Renal pelvis and calyces – funnel for urine

Answer 24

- ureteropelvic junction - ureterovesical junction Urinalysis urinary tract infection prostate specific antigen blood urea nitrogen x-ray of kidneys, ureters, bladder intravenous urogram retrograde urogram

Answer 25

Prostate gland: Production of alkaline fluid for sperm viability Testes: Produce sperm and secrete hormones (reproductive & endocrine) Epididymis (head, body, tail): Seminal fluid secretion Vas deferens: Sperm transport to seminal vesicle Penis: Urination and reproduction

Answer 26

``` corpora cavernosum (2) Spongiosum ```

Answer 27

``` Cystoscopy and RU Sterile water is hypotonic Basic ureteroscopy Saline is isotonic, but is electrolytic 3% Sorbitol or 1.5% Glycine ```

Answer 28

to create an opening renal pelvis Cutting into

Answer 29

``` Inflammation Cellular proliferation Callus formation Ossification Remodeling ```

Answer 30

Prevent SSI or to treat existing infections Reduce bone bleeding Reduce post-op inflammation, swelling

Answer 31

Support, movement Mineral storage Formation of blood cells (hematopoiesis)

Answer 32

Act of bending or being bent, decreasing the angle at a joint Moving parts of a limb into a straight position, increasing the angle at a joint rotate a limb medially rotate a limb laterally

Answer 33

Visual exam of the knee joint

Answer 34

``` Bones and bone features: Femur Femoral condyles Tibia Tibial plateau Patella Ligaments Anterior cruciate ligament (ACL) Posterior cruciate ligament (PCL) Medial (tibial) collateral ligament (MCL) Lateral (fibular) collateral ligament (LCL) Soft tissues Joint capsule Synovium Suprapatellar pouch Patellar tendon Articular cartilage Menisci; medial (1) and lateral (2) Support and movement Torn meniscus Loose bodies Worn patella Torn ACL ```

Answer 35

A tiny incision is made for inflow cannula is made using #11 blade; distend joint with fluid Another incision is made for sheath; sharp trocar using #11 blade; change to blunt trocar then place arthroscope and camera Determine the incision site by inserting a spinal needle Make another incision using #11 blade and insert probe for EUA Treat PRN (provide an example) Shave away meniscus, cartilage, or patella Repair meniscus or remove loose body Remove instruments, arthroscope and trocars Irrigate, close, dress (FYI: inject for post-op pain control)

Answer 36

Visual exam of shoulder joint

Answer 37

``` Bones and bone features: Clavicle Acromion process Scapula Coracoid process Glenoid fossa (cavity) Glenoid labrum (ligament ring surrounding articular cartilage) Humerus (Humeral head) Joints Glenohumeral and acromioclavicular Muscles (rotator cuff) Supraspinatus and Infraspinatus Teres minor and Subscapularis Movement Torn glenoid labrum Torn rotator cuff Impingement syndrome ```

Answer 38

Distend joint with fluid via syringe and spinal needle Inject local The spinal needle is removed and an incision is made over the joint capsule using #11 blade Insert the sheath and sharp trocar into the incision Change into a blunt obturator and insert scope/camera/with inflow cannula Additional Incisions is made for the other port sites; insert instruments PRN; The bicep tendon is identified and examined The bicep tendon is used as a landmark throughout the procedure. Treat PRN* Bankart (Done for recurrent anterior dislocations; repair torn labrum) Reattach labrum to glenoid with bone anchors Rotator cuff repair Insert anchors; and secure sutures to repair tear Acromioplasty (done to correct impingement syndrome; often done in conjunction with other repairs) Use burr to trim portion of acromion Change ports w/switching stick PRN I and remove any loose bodies/Additional local may be inject for post-op pain control/C/D

Answer 39

Open Reduction and Internal Fixation of the radius

Answer 40

I/H/D until the fracture is exposed/R; EXPOSE FRACTURE Reduce fracture with self-retaining bone reduction forceps Malleable plates are placed against the bone and contoured to the radius using a plate benders The plate is placed on the bone and held in place with a self-retaining bone holding forceps The first hole is made using a drill and drill guide. Depth gauge is used to determine the size of the screw The screw is selected and placed on the bone Fixate fracture by applying plat and screw The wound is thoroughly irrigated The tourniquet is released Hemostasis is achieved PRN using ESU The incision is closed and dressings are applied

Answer 41

I/H/D until the fracture is exposed/R: expose fracture Place guide pin into femoral head with guide angle Determine the reaming and tapping depth and screw length Assemble the appropriate triple reamer and place it on the power drill The reamer is placed over the guide pin and drilled into the femoral head Assemble the lag screw insertion together and place it over the guide pin to insert the lag screw The wrench, guide shaft, and guide pin are removed The plate is seated using an impactor and mallet Fixate the plate against the femur using screws The wound is thoroughly irrigated Hemostasis is achieved PRN using ESU The incision is closed and dressings are applied (xeroform, 4x4 gauze, and ABD pad)

Answer 42

Femur Intercondylar notch Condyles Intramedullary canal Tibia Tibial plateau Osteoarthritis (degenerative joint disease) Wear and tear over time; previous injury to joint; usually just one. Rheumatoid arthritis Auto-immune disease; body attacks its own synovial membranes; all synovial joints affected

Answer 43

I/H/D/R; expose joint; reflect patella Align the femur Place a remear into the femoral canal ream Position and secure a femoral valgus angle guide Trim the distal femur Place a, A-P femoral sizer against the resected femur; size by trial Align the tibia Position and secure the tibial resection guide to the tibia Resect and size tibia; place trial Measure, trim, and size patella Place trip and confirm its placement with an alignment rod Test the trials ROM Once the surgeon is satisfied with the ROM remove the trials Place implants and perform ROM I/H/Drains PRN/C/D

Answer 44

Layer of connective tissue covering bone Bands of dense connective tissue that hold bone to bone Strands of fibrous tissue that form ends of muscles and connect muscle to bone

Answer 45

Avascular, aneural connective tissue found at ends of bones Hard, dense, bone that forms the outer shell of the bone marrow cavity Soft spongy bone found inside cortical shell

Answer 46

The bones of limbs that have a shaft and 2 ends; examples: femur, tibia, fibula, humerus, radius, ulna, phalanges Bones of the wrist and ankle that occur in clusters; examples: carpals, tarsals Bones having a partially flat surface; examples: scapula, sternum, pelvic girdle

Answer 47

Bones having varied shapes; examples: Skull bones, facial bones, vertebrae Bones found within tendons; examples: patella (large), head of 1st metatarsal (2) Shaft of a long bone

Answer 48

Flared ends of long bone where growth takes place (epiphyseal plate) a place where 2 bones come together An immovable, fibrous joint; example: suture lines of cranial bones

Answer 49

A slightly movable, cartilaginous joint; examples: symphysis pubis; intervertebral; manubriosternal A freely movable; synovial joint; examples: Knee, hip; shoulder; wrist; C1 and C2 The central portion of the skeleton made up of the skull; vertebral column; ribs The portion of the skeleton made up of the shoulder; arms; hip; legs

Final Exam Flashcards

(73 cards)