Week 5 Flashcards by Iseoluwa Ojo

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

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Fever is associated with ______ and _______

Chills and rigor

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Is VATER syndrome a hereditary condition?

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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

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Full meaning?
P
O
T
T
E
R

Pulmonary hypoplasia
Oligohydraminos
Twisted skin
Twisted face
Extremities defect
Renal agenesis

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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

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A urinoma is a mass formed by ________________________ .

encapsulated extravasated urine

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urinary ascites typically result from spontaneous _________ with ________ of urine into the _________ compartment

bladder rupture; leakage

intraperitoneal

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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

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Contents of the femoral triangle???

Nerve
Artery
Vein
Empty space
Lymphatics

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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.

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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

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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

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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

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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

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Standard treatment of a thyroglossal cyst is _____________, with the modified ____________ being the most widely used.

surgical intervention

Sistrunk procedure

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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

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Hyoid bone

____-shaped bone in the neck which _______________.

supports the tongue.

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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

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Branchial cysts are congenital masses which arise in the ______ aspect of the ________, typically anterior to the __________

lateral; neck

sternocleidomastoid (SCM

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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.

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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

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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

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Complications of undescended testes??

Fertility(lack of)
Atrophy
Inflammation
Testicular torsion, trauma and tumor
Hernias

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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