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
2
Q
what does the pecteral node drain
A
anterior thoracic wall and breast
3
Q
what does the subscapular node drain
A
posterior thoracic wall
posterior shoulder
scapular region
4
Q
what does the central node drain
A
humeral node
pecteral node
subscapular node
5
Q
what does the apical node drain
A
central and lymphatic vessels following cephalic vein
6
Q
what does the infraclavicular node drain
A
lateral aspect of arm and shoulder
7
Q
what does the supratrochlear node drain
A
medial aspect of arm and FA
8
Q
what does the supraclavicular node drain
A
head and neck
9
Q
what does the right subclavian trunk and rt. jugular trunk drain into?
A
right lymphatic duct
10
Q
what drains into the thoracic duct
A
left jugular trunk and left subclavian trunk
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
12
Q
abdominal scarpa’s fasica is the same as what for layer of male anatomy
A
superficial fascia of the scrotum
13
Q
abdominal external abd. oblique and apo is the same as what layer of male anatomy
A
external spermatic fascia
14
Q
abdominal internal abd. oblique and apo is the same as what for layer of male anatomy
A
cremasteric fasica
15
Q
abdominal transversalis fascia is the same as what for layer of male anatomy
A
internal spermatic fascia
16
Q
Beck’s triad
A
seen in patients with cardiac tamponade
- JVD
- decreased or muffled heart sounds
- decreased BP
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
18
Q
what is McBurney’s sign
A
tenderness at mcburney’s point in pts w/ appendicitis
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)
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
21
Q
virchows triad
A
risk factors for thrombosis:
- stasis
- abnormal endothelium
- hypercoagulability
22
Q
virchows node
A
metastatic tumor to left supraclavicular node (classicaly due to gastric cancer)
23
Q
what is SVC syndrome
A
obstruction of the SVC (superior vena cava) by tumor or thrombosis
24
Q
what is the most common indication for surgery w/ crohns disease
A
small bowel obstruction (SBO)
25
what is the most common type of melanoma
superficial spreading
26
what is the most common type of breast CA
infiltrating ductal
27
what is the most common site of breast CA
upper outer quadrant
28
what is the most common vessel involved in a bleeding duodenal ulcer
gastroduondenal artery
29
what is the most common cause of common bile duct obstruction
choledocholithiasis
30
what is the most common cause of pancreatitis
EtOH
31
what is the most common cause of SBO in adults in the US
postop peritoneal adhensions
32
what is the most common cause of SBO in children
hernias
33
what is the most common cause of emergency abdnominal surgery in the US
acute appendicitis
34
what is the most common site of GI carcinoids
appendix
35
what is the most common cause of transfusion hemolysis
clerical error
36
what is the most common cause of blood transfusion resulting in death
clerical error (wrong blood type)
37
what is the most common cause of large bowel obstruction
colon CA
38
what is the most common cause of fevere less than 48 hrs post op hrs
atelectasis
39
what is the most common cause of bacterial infection (UTI)
E. coli
40
what is the most common abdominal organ injured in blunt abdominal trauma
liver (not the spleen!)
41
what is the most common abdominal organ injured in penetrating abdominal injury
small bowel
42
what is the most common benign tumor of the liver
hemangioma
43
what is the most common cause of lower GI bleeding
upper GI bleeding
44
what is the most common hernia
inguinal hernia (right more than left)
45
what is the most common CA in females
lung
46
what is the most common CA in males
prostate
47
what is the most common CA causing death in males and females
lung
48
what is the most common cause of free peritoneal air
perforated PUD
49
in what percentage of cases does lower GI bleed stop spontaneously
90%
50
in what percentage of cases does upper GI bleed stop spontaneously
80%
51
what percentage of pt undergoing laparotomy develop a postop SBO at some time later
5%
52
what percentage of pt w/ acute appendicitis will have a radiopaque fecalith on abominal xray (AXR)
5%
53
what percentage of kidney stones are radiopaque on AXR
90%
54
at 6 weeks, wounds have achieved what percentage of their total tensile strenght
90%
55
what is the risk of appendiceal rupture 24 hrs after onset of symptoms
25%
56
one unit of packed RBCs increase the hematocrit by how much
3%
57
additional 1 L by nasal cannula increases FIO2 by how much
3%
58
who was the first to use antiseptic (carbolic acid)
Lister
| british surgeon
59
when was the first appendectomy
1848 by Hancock
60
what does GIA stapler stand for
gastrointestinal anastomosis
61
what does TA stapler stand for
thoracoabdominal
62
what does EEA stapler stand for
end-to-end anastomosis
63
how are sutures sized
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
64
what are the 3 types of wound healing
1. primary closure (intention)
2. secondary intention
3. tertiary intention (delayed Primary closure= DPC)
65
what is primary intention
when the edges of a clean wound are closed in some manner immediately (ex. sutures, steri-strips, staples)
66
what is secondary intention
when a wound is allowed to remain open and healed by granulation, epithelization, and contraction
-used for dirty wounds, otherwise an abscess can form
67
what is tertiary intention or DPC
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
68
when should skin sutures be removed
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
69
```
what are the guidelines for skin suture removal for
Face
Extremities
Joints
Back
Abdomen
```
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
70
how do you draw blood from the femoral vein
NAVEL: in the lateral to medial direction- nerve, artery, vein, empty space, lymphatics
*thus place needle medial to the femoral pulse
71
what position should a patient be in for a laparoscopic cholecystectomy
reverse trandelenburg- pt supine w/ head elevated to make the intestines fall away from the operative field)
72
-ectomy
to surgicaly remove part of or an entire structure/organ
73
-orraphy
surgical repair
74
-otomy
surgical incision into an organ
75
-ostomy
surgically creating opening btwn 2 organs, or organ and skin
76
-plasty
surgical shaping or formation
77
when can a patient ear prior to major surgery
NPO after midnight the night before or at least 8 hrs before surgery
78
what lab test must all women of childbearing age have before entering the OR
B-HCG and CBC for possible pregnancy and anemia
79
what preop medication can decrease postop cardiac events and death
beta blockers
80
what must you always order preoperatively for your pt undergoing major operation
1. NPO/IVF
2. preop antibiotics
3. type and cross blood (PRBCs)
81
who gets preop ECG
pts older than 40 y/o
82
what is Billroth I and Billroth II
I- antrectomy w/ gastroduodenostomy
II- antrectomy w/ gastrojejunostomy (2 limbs)
83
what is Bassini herniorrhaphy
repair of inguinal hernia by approximating transversus abdominis aponeurosis and conjoint tendon to the reflection of Poupart's (inguinal) ligament
84
what is Nisssen
360 degree wrap of the stomach by the fundus of the stomach around the distal esophagus to prevent reflux
85
what is the difference btwn a simple and radical mastectomy
radical mastectomy removes the axillary lymph nodes too
86
what inhibits wound healing
infection, ischemia, DM, malnutrition, anemia, steroids, CA, radiation, smoking
87
what reverses the deleterious effects of steriods on wound healing
vit. A
88
is a chest tube placed under or over the rib?
OVER to avoid the vessels and nerves
89
what is the most common cause of excessive NGT drainage
tip of NGT is inadvertently placed in duodenum and drains the pancreatic fluid and bile
90
what is a foley catheter
catheter into the bladder, allowing accurate urine output determination
91
what is a central line
catheter placed into the major veins (central veins) via subclavian, internal jugular, or femoral vein approaches
92
how are needles sized?
14-gauge needle is 1/4th of an inch (thus a 14-gauge needle is larger than a 21-gauge needle)
93
what is the drainage of the left testicular vein
left renal vein
94
what is the drainage of the right testicular vein
IVC
95
what is Gerota's fascia
fascia surrounding the kidney
96
what are the prominent collateral circulations seen in portal HTN
- esophageal varices
- hemorrhoids (inferior hemorrhoidal vein to internal iliac vein)
- patent umbilical vein (caput medusa)
- retroperitoneal vein via lumbar tributaries
97
what parts of the GI tract are retroperitoneal
- most of duodenum
- ascending colon
- descending colon
- pancreas
98
what lymph nodes are between the pectoralis minor and major
Rotter's lymph nodes
99
is the left vagus nerve anterior or posterior
anterior-- remember that the esophagus rotates during development
100
give the location of the following structures:
| foregut, midgut, and hindgut
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
where are the blood vessels on the ribs?
VAN
| vein, artery, nerve are underneath the rib
102
what is Hesselbachs triangle
area bordered by:
1. inguinal ligament
2. epigastric vessels
3. lateral border of the rectus sheath
103
what nerve is located on top of the spermatic cord
ilioinguinal nerve
104
how can you find the appendix after you find the cecum
trace the taeniae back as they converge on the origin of the appendix
105
what is the strongest layer of the small bowel
submucosa (NOT serosa)
106
which parts of the GI tract do not have a serosa
esophagus
| middle and distal rectum
107
what does the thoracic duct empty into
left subclavian vein
| AT left internal jugular vein junction
108
what is the coronary vein
left gastric vein
109
which is longer, the left or right renal vein
left
110
what are the major structural differences between the jejunum and ileum
Jejunum- long vasa rectae, large plicae circulares, thicker wall
ileum- shorter vasa rectae, inferior plicae circulares, Inferior wall (thinner)
111
what are the major anatomic differences between the colon and small bowel
colon- has taeniae coli, haustra, and appendices epiplociae (fat appendages)
SI- smooth
112
how far up does the diaphragm extend?
around the nipples in men-- 4th intercostal space, thus abdomen extends to the level of the nipples
113
what dermatome is at the umbilicus
T10
114
what are the major layers of an artery
Outter:
adventitia
media
intima
115
what percentage of body weight is in fluid
60%
TIE-
total body fluid-60% of weight
ICF-40% of weight
ECF-20%
116
how many liters of blood are in a 70kg man
5 L
117
what is the major electrolyte in colonic feculent fluid
potassium
118
what is the physiologic response to hypovolemia
- Na/H20 retention via renin
- aldosterone--> water retention via ADH
- Vasoconstriction via angioII
- low urine output (tachy)
119
what is the classic acid-base finding w/ significant vomiting or NGT suctioning?
hypokalmeic hypochloremic metabolic alkalosis
why?-- loss of gastric fluid- loss of HCl causes alkalosis, driving K into cells
120
how many mL are in 1 oz
30mL
121
what is the major extracellular cation
Na+
122
what is the major intracellular cation
K+
123
signs/symptoms of hyperkalemia
- decreased DTR
- weakness
- paralysis
- respiratory failure
- peaked T waves on ECG (flattening T waves in hypokalemia)
124
acronym for treatment of acute symptomatic hyperkalemia
```
CB DIAL K
calcium
bicarbonate
Dialysis
insulin/dextrose
albuterol
lasix
kayexalate
```
125
what electrolyte must you replace before replacing K+ in hypokalemia?
magnesium
-hypomagnesemia inhibits K reabsorption from the renal tubules
126
what is the most common cause of mild postop hyponatremia
fluid overload
127
if hyperkalemia is left untreated, what can occur
VT or VF--> death
128
what are the major cardiac electrolytes?
potassium (dysrhythmias)
magnesium (dysrhythmias)
calcium (dystrhythmias/inotrope)
129
what coagulation pathway is measured in PT and PTT
PT- extrinisic
| PTT- intrinsic
130
what is PRBC (packed red blood cells)
no platelets or clotting factors
131
FFP (fresh frozen plasma) does what
replaces clotting factors (no RBCs, WBCs, platelets)
132
cryo (cyroprecipitates) replaces what
fibrinogen, von Willebrand factor, some clotting factors
133
what are the general guidelines for blood transfusion
- acute blood loss
- Hgb less than 10
- hx of CAD/COPD or healthy symptomatic pt w/ Hgb less than 7
134
what blood type is universal donor for PRBCs
O neg
135
what blood type is universal donor for FFP
AB
136
what is a type and screen
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
what is a type and cross
Patient’s blood is sent to the blood bank and cross-matched for specific donor units for possible blood transfusion
138
what does plavix do?
inhibits platelets
*blocks fibrin crosslinking of platelets
139
what is microcytic anemia "until proven otherwise" in a man or postmenopausal woman
colon CA
140
what component of blood transfusion can cause a fever
WBCs
141
when should aspirin administration be discontinued preoperatively?
1 week bc platelets live 7-10 days
142
how long do normal RBC live
120 days
143
what is the most immediate method to obtain hemostasis
pressure (w/ finger)
144
describe warfarins actions
inhibits vit. K dependent clotting factors II, VII, IX, X
145
what antihypertensives are contraindicated in pt w/ renal artery stenosis
ACE inhibitors
146
what is atelectasis
collapse of the alveoli
147
what does ADH do
ADH increases NaCl and H2O resorption in the kidney, increasing intravascular volume
148
where is iron absorbed
duodenum
149
where is vit B12 absorbed
terminal ileum
150
where are fat soluble vitamins absorbed
terminal ileum
151
what vitamines are fat soluble
K, A, D, E
| KADE
152
what must bind B12 for absorption
intrinisic factor from the gastric parietal cells
153
what are the 5 different types of shock
1. hypovolemic
2. septic
3. cardiogenic
4. neurogenic
5. anaphylactic
154
what is cardiogenic shock
cardiac insufficiency, LV failure, inadequate tissue perfusion
155
what is the acronym for treatment options for anaphylactic shock
BASE
Benadryl
Aminophylline
Steroids
Epinephrine
156
what is cellulitis
blanching erythema from superficial dermal/epidermal infection
(usually strep more so than staph)
157
what do chief cells produce
pepsinogen
158
what do parietal cells produce
HCl
| intrinsic factor
159
where is calcium absorbed
duodenum actively
| jujunum passively
160
LLQ pain ddx
diverticulitis
| UTI
161
LUQ pain ddx
PUD, gastritis
162
what type of hernia is most common
indirect inguinal 50%
direct inguinal 25%
femoral 5%
163
what is a sliding hernia
hernia sac partially formed by the wall of a viscus (ie. bladder/cecum)
164
what is an obturator hernia
hernia through obturator canal (females more so than males)
165
what hernia is associated w/ ascites, pregnancy and obesity
umbilical hernia
166
inguinal hernia lateral to hesselbach's triangle
indirect inguinal hernia
*through internal ring of inguinal canal towards external ring (indirectly through abdominal wall)
167
inguinal hernia within hesselbach's triangle
direct inguinal hernia
*directly through abdominal wall- does not transverse the internal ring
168
what is a hiatal hernia
hernia through esophageal hiatus
169
what is an indirect inguinal hernia caused by
patent processus vaginalis (congenital)
170
what is the risk of herniation strangulation
highest in fermoral
| higher in indirect than direct
171
from what abdominal muscle layer is the cremaster muscle derived
internal oblique muscle
172
to what does the inguinal ligament attach
anterior superior iliac spine to the pubic tubercle
173
what is the most common organ in an inguinal hernia sac in men
small intestine
174
what is the most common organ in an inguinal hernia sac in women
ovary/fallopian tube
175
what is the most common hernia in women
indirect inguinal hernia
176
what vessel provides blood supply to appendix
appendiceal artery- branch of ileocolic artery
177
what is the most common appendiceal tumor
carcinoid tumor
