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Lymph channels run parallel to which structures?
Veins
Body temp is regulated by the
Hypothalamus
Which two electrolytes are essential for normal cardiac contraction
Potassium and calcium

* important ions that affect cardiac muscle contractility
Water constitutes what average normal percentage of total body weight
50-70%

*approx. 60% of adult body weight
The thyroid gland consists of right and left lobes joined by the
isthmus

* long band of tissue that connects two lobes
Langer lines generally lie perpendicular to the direction of
underlying muscle tension

*natural lines located along skin generated by tension in dermal and epidermal layers of the skin
The arterial supply to the intestinal tract, with exception of the stomach , duodenum, and distal rectum, is derived from the
Superior and inferior mesenteric arteries

*blood supply to the small intestine
Excessive secretion of growth hormone in adults causes
Acromegaly
The inner lining of the mucosa of the gastrointestinal tract is composed of
Epithelium

* simple column of epithelium composes the outer layer of the villus on the lining of the small intestine
The large artery that arises from the left side of the aortic arch and descends into the arm is the
Subclavian

*3rd branch of the aortic arch
An enzyme active in the digestion of starches
Amylase

* Starch splitting enzyme
The normal p.H of blood is
7.3-7.4(5)
Which cells secrete pepsinogen
Chief
Which veins drains the intracranial venous sinuses to veins on the outside of the skull
Emissary

*emissary veins connect the sinuses of the dura mater with the veins located on the exterior surface of the skull
Which arteries supplies blood to the brain
Vertebral and internal carotids
Which artery divides into the anterior and middle cerebral arteries
Internal carotid

*Two internal carotid arteries and the basilar artery unite in a circular structure near the base of the brain near the circle of Willis. This circle is formed by the anterior cerebral arteries which are derived from the internal carotid arteries and the posterior cerebral arteries which are derived from the basilar artery.
Which artery is a direct branch of the internal carotid?
Middle cerebral
The lateral ventricles within the cerebral hemisphere communicate with the third ventricle through the opening called
Foramen of Monro

* The two large ventricles connect to the third ventricle via an interventricular foramen , the foramen of Monro
The third ventricle of the brain empties into the fourth ventricle through the
Aqueduct of sylvius

*Third ventricle connects to the fourth ventricle via cerebral aqueduct the aqueduct of sylvius
Spinal fluid is produced by the
Choroid Plexus

* nearly 800 ml of CSF is produced daily by specialized capillaries called choroid plexus
The fold of dura mater that separates the cerebral hemispheres is
Falx Cerebri

*two brain hemispheres
What separates the frontal and temporal lobes
Fissure of Sylvius

*The cerebrum is divided by sulci and fissures in specific lobes and the lateral boundary of the anterior portion of the cerebrum is the lateral sulcus or the fissure of sylvius
The frontal lobe is bounded posteriorly by the central sulcus also called the ,
Fissure of Rolando

* posterior boundary of the anterior portion of the cerebrum is the central suculus or fissure of rolando
Which areas located in the frontal gyrus of the brain controls the function of speech?
Broca's
The white line of Hilton is situated
Between the external and internal anal sphincters

*anatomical landmark
A chemical reaction that provides energy by the breakdown of food molecules is called
Catabolism

* Chemical process breaks down larger molecules into smaller molecules to provide energy
Adipose tissue lies in which of the following skin layers
Subcutaneous
Collagen is produced by which of the following connective tissue layers
Fibroblasts
Normal cardiac output for an adult
4-8 L/minute
Which veins drains the right side of the vertebral column
Azygos

*Azygos vein originates in the dorsal abdominal and runs to the right side of the vertebral column to join the superior vena cava
Which arteries supplies the cecum, ascending colon, hepatic flexure, and proximal portion of the transverse colon?
Superior mesenteric

*Superior mesenteric receives blood from the small intestine
The celiac artery trifurcates into the
left gastric, splenic, and hepatic arteries
A prolongation of the breast tissue located in the upper , outer part of the breast that passes through an opening in the axillary fascia is called the
Axillary Tail of Spence

* Elongated quadrant of breast tissue that enters the axilla-only breast tissue located under the deep fascia
The mammary gland is fixed to the overlying skin and the underlying pectoral fascia by fibrous bands known as
Suspensory ligaments of Cooper

* extends from the dermis to the fascial layer and helps support the breast tissue
The arterial blood supply to the breast is supplied from the branches of the
internal mammary, axillary, and lateral thoracic

*Thoracic branches of the axillary artery
Which is the loose areolar tissue that separates the breast from the pectoralis major muscle
Retromammary space

*layer of areolar tissue that contains lymphatics and vessels
Which lymph nodes is located between the pectoralis major and minor muscles
Rotter
*aka interpectoral group
Which nerve travels along the anterior-lateral chest wall and innervates the serratus anterior muscle?
Long Thoracic
Which nerve innervates the latissimus dorsi muscle?
Thoracodorsal
The nerve of Grassi is associated is associated with the
Stomach

* aka crimminal nerve of Grassi-posterior branch of the vagus nerve MUST be identified during truncal vagotomy
The veins of sappey drain the
Diaphragm

*Diaphragm veins that drain into the liver
The node of Lund is located in the
Triangle of Calot

*The cystic node is located in the triangle of calot aka calots node
Where is Hartmanns pouch located?
Gallbladder infundibulum

*enlargement of the neck of the gallbladder caused by stone(s)
The small ducts that drain bile directly into the gallbladder are called
Hepatic
What is the name for the small pancreatic duct?
Santorini
Three structures that form the anatomical triangle of Calot
Cystic duct, common hepatic duct, lower edge of the liver

* Triangle of Calot is an imaginary landmark
The point of separation between the posterior rectus sheath superiorly and the absence of the sheath inferiorly is called the
Arcuate line.

*important landmark in lap hernia -superior to the line the aponeurosis of the internal oblique muscle contributes to the anterior and posterior rectus sheath. Inferior to the line internal oblique and transverse abdominus aponeurosis are situated anterior to the rectus muscle.
At what point does the external iliac artery become the femoral artery?
At the location of the inguinal ligament. (next to)

*aka pouparts ligamnet
The avascular are located in the mesentery and to the left of the middle colic artery is
The space of Riolan

*anatomical landmark located in the mesentery and can be found by identifying the middle colic artery
Series of arcades along the mesenteric border throughout the length of the colon is called the
Marginal artery of Drummond

*long collateral vessels connects the superior mesenteric circulation with that of the inferior mesenteric artery and forms continuous arcade
Valves of the gallbladder are called
Heister

*Gallbladder neck and cystic duct contained spiral shaped mucosa/folds
Which nerves are located lateral to the long thoracic nerve and innervates the latissimus dorsi muscle
Thoracodorsal
Which ligament connects the thyroid to the trachea?
Berry

*located superiorly on the thyroid- the ligament of berry is made of connective tissue connects the thyroid to the tracheal rings
The structure that binds the small intestine to the posterior abdominal wall is the
Mesentery
The left gastric, right gastric, right gastroepiploic, left gastroepiploic and short gastric arteries supply the
Stomach
The two muscles that form the pelvic diaphragm are
Levantor ani and coccygeus

*The pelvic diaphragm is one of two muscles that extends across the outlet of the pelvis.
Which statement describes a nonrecurrent laryngeal nerve
Variant laryngeal nerve that branches from the vagus and travels directly to the larynx

*A nonrecurrent laryngeal nerve is a variant nerve that branches off the vagus and travels directly into the larynx at the level of the inferior horn of the thyroid cartilage.
Jacksons membrane would be found near the
Cecum

*aka jacksons veils are peritoneal folds located across the ascending colon from the cecum to the right flexure
The flexure between the transverse colon and the descending colon is called the
Splenic
The anastomosis of arcades between the superior and inferior mesenteric vessels is known as the long anastomosis of
Riolan
Which nerve innervates the diaphragm ?
Phrenic
The rectus sheaths the meet to form a tough fibrous white band that extends from the xiphoid process to the pubic symphysis is the
Linea Alba
Which organ is completely retroperitoneal
Kidney
The liver is divided into two principal lobes by which ligament?
Falciform
The sphincter located at the distal end of the common bile duct that opens into the duodenum is the
Oddi

*Controls the release of pancreatic juice into the duodenum
The cartilage distal to the thyroid cartilage and proximal to the thyroid gland is the
Circoid
Which vein is shared by the pancreas and the liver?
Portal
The head of the pancreas is surrounded by the
duodenum
Which arteries supplies blood to the thyroid gland
external carotid
what structures are located in the anterior mediastinum?
Thymus, ascending aorta, lymph nodes
The anatomical division between the inguinal and femoral regions is the
Poupart's ligament
Hesselbachs triangle is bounded by the rectus abdominis muscle, inferior epigastric vessels, and
Inguinal ligament
the inner lining of the mucosa within the gastrointestinal tract is composed of
simple columnar epithelium
another name for the folds on the inner wall of the stomach is
rugae

*thick folds
The area where the common bile duct joins the pancreatic duct and enters the duodenum is called the
ampulla of vater
The uterine artery is a branch of the anterior trunk of the
internal iliac artery

*main blood supply for the pelvis and perineum
The ovary is suspended from the posterior leaf of the broad ligament by the
Mesovarium
The ovarian artery is a branch of the
abdominal aorta
Which ligament travels in the upper part of the broad ligaments below and in front of the fallopian tubes, passing over the vesicle vessels and nerve?
Round

*Round ligament of the uterus travels in the upper part of the broad ligaments below and in front of the fallopian tubes
The uterine artery is a branch of the anterior trunk of the
internal iliac artery
Which ligament encloses the round ligament and extends from the lateral surface of the uterus to the pelvic wall
Broad
what is the nourishing coat of the eyeball that consists mainly of blood vessels
Choroid

*Choroid provides nourishment to the posterior segment of the retina and holds melanocytes that provide melanin
The ophthalmic artery divides into the
Supraorbital and supratrochlear

*the ophthalmic artery is a branch of the internal carotid and divides into the two branches to supply the globe, the muscles and the eyelids
which rectus muscle moves the eyeball upward and medially?
superior
the recurrent laryngeal nerve that supplies the vocal cords lies very close to the
inferior thyroid artery

*the recurrent laryngeal nerve that supplies the vocal cords crosses the inferior thyroid arteries
The arterial blood supply to the nose is from branches of the internal and external
maxillary
The five branches of the facial nerve from superior to inferior after it enters the parotid gland is
Temporal, zygomatic, buccal, mandibular, cervical
Where do the mental nerves and vessels exit from the mandible
Foramen
In addition to the zygoma, which other bones comprises the zygomatic arch?
temporal
Which is a principle muscle of the pelvic floor?
levator ani

*on the pelvic floor the lavator ani extends as a sheet of muscle across the pelvic outlet and innervates the pudendal nerve
The junction of the superior mesenteric and splenic veins forms the
portal vein
the tibial and common peroneal nerves are terminal branches of which of the following nerves
sciatic
the arterial supply to the bladder is derived mainly from the
internal iliac

*from the superior and vesicle arteries that branch from the internal iliac artery
A rounded protuberance found at a point of articulation with another bone is called a
condyle
what structures of the kidney does urine drain into from the major calyces
renal pelvis

*where the ureter enters the kidney and the pelvis expands into the calyces which collect urine
At which vertebral level is the odontoid process located
C2

*on the superior surface of the second cervical vertebra the odontoid process projects upward
which cavity within the brain is filled with cerebrospinal fluid
ventricles

*interconnected cavities filled with CSF
Which ligament is attached to the posterior lateral condyle of the femur and to the notch of the midline of the tibia between the tibial condyles
Anterior cruciate
The gelatinous substance within an intervertebral disc is called
nucleus pulposus
which vein proximally travels across the neck of the abdominal aorta
renal

*left renal vein crosses the neck of the abdominal aorta proximally
the branches of the aortic arch are
brachiocephalic (1) left common carotid (2) left subclavian (3) branches
The terminal arterial branches of the aorta are the
Right and left common iliacs

*when aorta ends it divides into right and left common iliac arteries
The coronary arteries originate at the base of the ascending aorta also known as the
Sinus of Valsalva

*The largest artery, aorta, ascends from the left ventricle of the heart. At its base are three cups of the aortic valve. Opposite each valve is a swelling of the aortic wall, the aortic sinus.
which are branches of the left coronary artery
circumflex and anterior descending arteries

*left coronary artery divides into the circumflex which supplies the left ventricle and atrium and the anterior descending artery which supplies both ventricles
the thoracic duct begins in the
abdomen at the cisterna chyli
two thirds of the breast tissue rests on the pectoralis major muscle and the other one third rests on the
serratus anterior
the carotid body and carotid sinus are two sensory structures; the carotid body is an
chemoreceptor

*carotid body is located in the wall of the carotid sinus and contains chemoreceptors to aid in regulating circulation and respiration
The valve that prevents the retrograde flow of blood into the atrium from the left ventricle is the
Mitral
Deoxygenated blood is carried from the right ventricle to the lings via which structure?
pulmonary arteries
at the base of each internal carotid artery is an enlargement called the
Sinus

*carotid sinus contains baroreceptors that aid in controlling blood pressure
The three protective tissue layers called the meninges lie in the following order starting with the most superficial
Dura mater, arachnoid, pia mater

* cover the brain and the spinal cord
Fissure of sylvius separates the
frontal and temporal lobe
the great sensory nerve of the face and head is the
trigeminal
which cranial nerve emerges from the medulla, passes through the skull and descends through the neck region into the thorax and abdominal region?
X

*Tenth pair, vagus nerves originate in medulla oblongata and downward into the chest and abdomen
which of the cranial nerves innervates the superior oblique muscle
Trochlear (IV)
which cranial nerves innervates the inferior, medial, superior rectus, inferior oblique and levator palpebrae muscles of the eye?
oculomotor (III)
which cranial nerves innervates the lateral rectus muscle of the eye?
Abducens (VI)
The dura plane that separates the cerebrum from the cerebellum is the
Tentorium cerebelli, transverse
identify the following arterial branches of the celiac trunk
1) celiac trunk
2) splenic trunk
3)left gastric artery
4)common hepatic artery
5)gastroduodenal artery
6)proper hepatic artery
7)left hepatic artery
8) right hepatic artery
identify the following structures
(1) portal vein
(2) right gastric artery
(3) splenic vein
(4) inferior mesenteric vein
(5) superior mesenteric vein
(6) superior hemorroidal vein
Identify the following structures of the biliary tract
1- intrahepatic ducts
2- left hepatic duct
3-right hepatic duct
4-common hepatic duct
5-gallbladder
6- cystic duct
7-common bile duct
8- Ampulla of vater
identify the following nerves in the axillary region
1-thoracodorsal
2-long thoracic
3-medial pectoral
4-lateral pectoral
traffic patterns in the surgery department are designed to
aid in preventing surgical site infections

*and help facilitate the movement of patients and personnel
what is the principal goal of suctioning blood and body fluids from the wound?
improve wound visibility
what characteristics of drape materials is incorrect
flame-retardant
which type of patients is at risk for developing a latex sensitivity
child with spina bifida
principal goal of the surgical assistant during the surgical procedure is to
provide exposure
what should be confirmed before admission of any blood product?
date of expiration

*blood has a specific shelf life
recommended minimum number if air exchanges in the O.R is
15 times an hour with three exchanges of fresh air
if a surgical assistant places the operative patients well being above all other factors, then the surgical assistant is said to have a strong
surgical conscious
seepage of skin preparation solution under a patient may result in
chemical burns
The frozen section examination provides the surgeon with a
quick preliminary diagnosis

*immediate tissue identification and communicated with the surgeon immediately
When assisting the surgeon with the draping, where should the surgical assistant stand in relation to the surgeon?
on the opposite side of the O.R table from the surgeon
studies show that the lowest infection rates have been obtained in surgical cases where patient body hair was
not removed
a hemodynamic complication in the patient could be caused by
myocardial ischemia

*hemodynamics is the study of movement and blood and provides information as related to the function of the heart and major organ systems. a complication of normal hemodynamics is myocardial infarction
infants are at risk of loosing body heat quickly due to their
thin layer of subcutaneous brown fat for insulation

*infants experience high heat loss due to their incomplete thermoregulatory system and only a thin layer of sub-q brown fat for insulation
heat loss from the body occurs by all the following methods except
condensation

*radiation-transfer to cool O.R temp drops
evaporation-sweat evaporates=cooling
conduction-cold O.R table skin-table
the earliest sign of MH is
increase end tidal CO2


*muscle rigidity , higher increase in co2 rapid increase in body temp
intraoperative fluid and electrolyte imbalance are affected by
blood loss, fluid shifts and replacement


*organ dysfunctions , shifts of K+ and drugs
Vitamin D deficiency can lead to
hypocalcemia

*essential for absorption of calcium, can cause bone disorders such as Rickets
Acid base imbalances reflect
Hypoxia, hypothermia, and hypovolemia

*an acid/base imbalance can result from either a respiratory problem in handling CO2 or metabolic inequality between hydrogen and bicarbonate. In both cases the kidneys are creating more bicarbonate tp resolve the increasing amount of acid that results from a decrease in O2, hypothermia and loss of fluids.
platelet concentration s often transfused during the immediate preoperative period for the purpose of
preserving clotting ability

*blood replacement involves the administration of whole blood or components such as plasma, red packed rbc or platelets via IV to increase the number of rbc and blood volume as well as provide blood clotting factors
Hemolytic reactions caused by ABO incompatibility are most often caused by
antibodies to the donor foreign proteins

*if mismatched blood is transfused antibodies are produced to combat the antigens from the incompatible ABO donors blood
the correct arm placement when positioning a patient supine with arms extended on arm boards is
armboards extended <90 degrees with palms facing up
the force of integumentary injuries that results from the skin remaining stationary while the underling tissues shift is known as
Shearing

*when positioning patients hands at side observe hands to avoid a pressure injury such as shearing or crushing
what is a potential physiological response when lowering a patients legs from the lithotomy position
Hypotension

*blood pressure changes
Correct range for the pneumatic tourniquet pressure on an average adult for an upper extremity is
250-300mmHg

*may be higher in lower extremity
Setting of the pneumatic tourniquet pressure in an average adult for a lower extremity should be
Higher than the systolic pressure by one-half of the value

*normally
The most common skin cancer is
basal cell carcinoma

*70% of reported instances
in the event that a child needs an emergency procedure and the parents cannot be located to sign the permission,
Permission is signed by two consulting physicians

*not the surgeon
The principal of personal liability
Holds everyone legally responsible for their own negligent acts
By definition, carcinoma in situ is a malignant neoplasm that has not
extended beyond the basement membrane

*aka pre invasive cancer, carcinoma in situ shows aplastic cells that demonstrate no behavioral evidence of invasion or metastasis
The blood component administered to patients with a clotting problem
platelets

* platelets adhere to rough surfaces and to each other making a plug in a vascular break or interruption. Blood coagulates and the platelets release serotonin which contracts smooth vessels in the blood vessel walls
which of the following refers to a civil wrong committed against a person or property, not including a breach of contract?
Tort
What is the normal value of the BUN for adults?
7-18 mg/dl

*5-20mg/dl
The specific gravity of a normal urine sample is
1.015-1.025


*1.015-1.024 normal fluid intake
during lateral positioning
pillow is placed between the legs
the lithotomy position requires each of the following except
each leg is raised slowly and gently as it is grasped by the toes
in which of the circumstances could the patient sustain an injury to the pudendal nerves
positioned on the fracture table


*perineal post should be well padded. prolonged pressure can cause fecal incontinence and loss of perineal sensation
an imperforation or closure of a normal opening is called
Atresia

*interruption of the continuity in tubular and anatomic structure
A lower oblique incision is called an
inguinal

*transplant, urologic, and vascular procedures
Normal adult male range for RBC is
4.2-6.1 mill/u
Normal adult range of WBC is
5,000-10,000/mm3
Normal adult range for sodium is
136-145 mEq/L
Normal adult range for potassium is
3.5-5.5 mEq/L
Which types of blood components is the most common source of bacterial infection in a transfusion?
Platelets

*Stored at room temp allowing staphylococcus or streptococci from donors skin to be incubated
The doctrine of respondeat superior refers to
Employer liability for employees negligent conduct
The legal doctrine that mandates every professional carry out his or her duties according to national standards of care practiced throughout the country is
doctrine of reasonable man
Liability is a legal rule that
Holds each individual responsible for his or her own actions
What is a result of potassium imbalance
cardiac arrhythmias
a vagal response would be
bradycardia
The normal pH of urine is
4.6-8.0

*diet has the greatest effect on pH
A white count of 14,000 cu/m would most likely indicate
an infection

*normal 5-10,000mm3
When an immediate confirmation of malignancy is needed, the specimen will be sent to pathology for
frozen section
A method to protect tissue from CO2 laser is to cover the area with
wet towels
mechanical, thermal, and chemical are appropriate mechanisms to achieve
hemostasis
significantly decreased volume of circulating blood or plasma in the body may cause the patient to go into
hypovolemic shock
The purpose of hemostasis is to
prevent blood loss
what is considered biological hazards in the operating room
body fluids and laser plume
what is the most common change in vital signs that is associated with early hypovolemic shock
tachycardia
measures to treat atelectasis
pain control and early ambulation

*and incentive spirometry deep breathing exercises
most appropriate devices to prevent skin pressure ulcers and deep tissue injury in the O.R are
gel pads
What nerve can be injured if the legs are improperly flexed at the hip in the lithotomy position?
obturator
drains are typically passed to the exterior through what
adjacent stab wound incision
which dressing is used when moderate to heavy fluid drainage is expected
three-layer
in the lateral chest position, a sandbag or padding is placed under the chest at the axillary level to
prevent pressure on the lower arm
Chvostek's sign can indicate
hypocalcemia

*spasm of the facial muscle when facial nerve is tapped with a finger
The proper placement of the legs for a patient in the lateral position is
lower leg flexed, upper leg straight

*this aids in stability on the bed
ulnar nerve damage could result from
placement of an elbow on unpadded table
what is at the greatest risk for fluid volume deficit?
trauma victim with extensive burns of the body

*skin prevents fluid loss
clostridium perfringens is associated with which clinical condition
gas gangrene

*spore forming anaerobic gram + bacilli
phagocytosis by the white blood cells is an example of the body's
second line of defense

*white blood cell surrounds foreign particle
cell "drinking" is called
pinocytosis

*"drink in" droplet of liquid around them
An organelle that is responsible for the packaging of proteins is the
Golgi complex

*organelle adjacent to the nucleus that is composed of layers of flattened membrane sacs and packages proteins.
An organelle that contains digestive juices is the
lysosome

*digests waste material
The anaerobic bacterium that causes gas gangrene is
clostridium perfringens
which of the following are procaryotic
bacteria

* bacterial and blue green algae are the only two procaryotic microorganisms (DNA is not contained)
Which of the following are eucaryotic?
Fungi

*their DNA is contained in a nucleus
The gram stain differentiates
bacteria
An emergency drug that increases myocardial contractility is
calcium chloride

*myocardial stimulant that increases contractions
What body system evokes a physiologic response that is similar to the response evoked by sympathomimetic cardiovascular drugs
sympathetic nervous system

*increase heart rate constricts blood vessels and increases blood pressure. certain sympathomimetic drugs are used as vasopressors and cardiac stimulants
one kilogram is equal to
1,000 grams
What statement is NOT TRUE concerning hematocrit?
hematocrit value is the volume of red blood cells expressed as the number of cells per cubic millimeter

*Hematocrit is the volume of erythrocytes in a specific volume of blood and is expressed as a % (37-52%)
general and regional anesthesia contribute to body heat loss by causing
vasodilation

*possible causing hypothermia
primary drug utilized to treat MH
dantrolene
the isotonic solution that is closest to human physiology is
0.9 NS

*AKA physiological saline
when a drug loses its effectiveness in a patient, the patient is said to have developed
tachyphylaxis

*tolerance patient has developed to repeat administration of a drug over time
What is the mechanism of action of heparin
breaks down the clot

*heparin is an anticoagulant
The only depolarizing muscle relaxant in clinical use is
Succinylcholine (Anectine)
Lidocaine with epinephrine is contradicted in surgery of the
hand

*due to vasoconstrictive properties of epi
A patient scheduled for surgery has a hematocrit reading of 45% of total blood volume which is
within normal range (37-52%)
When drawing a blood sample , a safe time lapse between blood drawing and analysis is
10 min

*after 10 min analysis cannot be considered accurate
When given as a preoperative medication, atropine produces
drying of secretions

*A anticholergenic drug, blocks receptors on the vagus nerve and inhibits mucous secreations in the respiratory and digestive tracts
A drug combined with heparin that causes a postoperative loss of anticoagulant activity is
protamine sulfate

*reduces anticoagulant actions and reduces effect of heparin
The drug added to a local anesthetic to increase diffusion is
Hyaluronidase

*protein enzyme that when mixed with local increases rate of anesthetic diffusion
Which is a measurement of the pressure of carbon dioxide in the arterial blood
PaCO2
Which is a measurement of the amount of bicarbonate in arterial blood
HCO3
Which is NOT an inhalation anesthetic agent
Propofol

*hypnotic agent chemically unrelated to other anesthetic substances
Cephalothin sodium (Keflin) is a
antibiotic

*cephalothin is the generic name
Drug used to reverse hypotension is
levarterenol (levophed)

*severe hypotension, cardiac arrest and shock
meperidine hydrochloride (Demerol) is a
analgesic
Dextran is used parenterally to
expand blood plasma volume

*in emergencies
a barbiturate that may be used for sleep the night before surgery is
secobarbital

*preoperative sedative
Common pathogens infecting traumatic wounds often require the use of
penicillianse-resistant penicillin
what is the amount of time that heparin is systemically distributed in the adult
3 min

*is considered sufficient
What is an example of an isotonic IV solution
0.9% sodium chloride
the volume of red blood cells in whole blood is determined by which of the following tests
Hematocrit
A common complication during emergence from general anesthesia is
Hypoxia

*managing the patient during emergence depends on eliminating the inhalation agent and intravenous agent and reversal of the neuromuscular blockade-100%O2 should be administered to patients because of the risk for hypoxia (during recovering) from these agents
which antibiotics should not be given as a preoperative prophylaxis to a pediatric patient
Ciprofloxacin

*NOT for pediatrics or pregnant women as it interferes with the growth plate
During administration of general anesthesia there is a loss of the eyelid reflex in stage
II

*patient looses consciousness, the beginning of regular breathing and loss of the eyelid reflex
Aminoglycosides are a category of antibiotics that
can cause severe ototoxicity and nephrotoxicity
Which of these local anesthetics has a longer duration
Marcaine

*four hours or longer
A microscopic blood count that estimates the percentages of each type of leukocyte within a sample is called
Differential
Some patients may show the most severe and life threatening type of reaction to certain drugs known as
Anaphylaxis
A broad spectrum bactericidal antibiotic that interferes with synthesis of the cell wall and has a chemical structure similar to penicillians
Cefazolin

*cephalosporin that interferes with a cell wall synthesis and has cell structure similar to penicillian
Cricoid pressure is applied to prevent
aspiration
Epi should be used in which of the following situations
Anaphylaxis

*treat hypotension resulting from a allergic reaction
Which is a narcotic antagonist
Naloxone hydrochloride (Narcan)

*reverse opioid analgesics when necessary
The reversal agent for heparin-induced anticoagulation is
Protamine sulfate
Which should not be administered to a patient who is exhibiting asystole
Isoproterenol

*catecholamine that produces an increase in myocardial contraction and heart rate
According to the Mallampati classification of preoperatively assessing airway adequacy for intubation purposes , what is class III?
Only the base of the uvula can be visualized

*Mallampati classification is used for assessing airway adequacy of patients, comparing tongue to mouth size.
In cataract surgery , a viscous jelly sometimes used to occupy space is
Healon
A miotic drug is
Pilocarpine

*constricts
Which local anesthetic is used most frequently for preoperative ocular-instillation
Tetracaine
A solution used for eye irrigation
Balanced salt solution

*most frequently used
Which of the following is a dye used in ophthalmic surgery to diagnose corneal abrasions
Fluorescein Sodium
The reactions ototoxicity and nephrotoxicity can be a result of administering
Aminoglycosides
Which drugs paralyzes the sphincter muscle of the iris?
Cycloplegics

*and mydriatics
Which of the following statements describes second-degree AV block?
Some, but not all, atrial beats are conducted to the ventricles

*not all atrial beats are conducted to the ventricles, pacemaker may or may not be indicated
The P-wave displays______, and the PR segment is caused by the delay in the AV node.
Atrial depolarization

*in the cardiac cycle
The T-wave indicates
Ventricular repolarization

*in the cardiac cycle
An emergency drug used for treating ventricular fibrillation or tachycardia is
Inderal (propranolol)

*beta-adrengeric receptor blocking agent used to treat dysrhythmias and ventricular fibrillation
High doses of nitrous oxide block the metabolism of which of the following
Vitamin B12
An emergency drug used in cardiac surgery that increases myocardial contractility is
calcium chloride
Cardiac arrhythmias of ventricular origin can be treated with
Lidocaine
What is the drug of choice when lidocaine fails to achieve response for treating ventricular tachycardia/ventricular fibrillation during sudden cardiac arrest
Bretylium
Which method should the surgical assistant consider when cutting the sutures
According to the surgeons preference
Which would affect normal wound healing
Peripheral vascular disease

*consequence of low blood flow and reduces bodies ability to move O2=ulcers and gangrene.
The most common cause of delayed wound healing in the operative patient is
Wound infection
Three phases of wound healing include all of the following EXCEPT
Chronic phase

*FYI fibroplastic phase-aka proliferative
Which of the sutures should not be used in the placement of heart valves
polydioxanone

*not used in the placement of prosthesis / heart valves/synthetic graft
wounds in which there is significant bacterial contamination, foreign bodies, or extensive tissue trauma are generally closed by which intention?
Granulation
Which of the following types of stitch patterns provides an excellent cosmetic closure?
Subcuticular

*placed completely under the epidermal layer of the skin
The primary factor when selecting the surgical the surgical needle
Reducing as much as possible the trauma to the tissue

*Surgical needles are chosen to move suture through tissue with the least amount of trauma to tissue
Which of the following microorganisms is responsible for causing postoperative wound edge erythema and rebound tenderness
group B streptococci

* can enter through the incision and spread through the lymph vessels and nodes causing inflammation and cellulitis
It is recommended that the square knot is
preformed as a two-handed tie

*can be done as one handed-recommended as two handed
which statement concerning the principles of suture placement is correct
sutures should be placed in deep tissue to prevent hematoma

*serum and or blood clots can form in dead space, especially in deep tissue. sutures should be properly placed to prevent hematomas from forming
Sutures placed in a wound to prevent wound evisceration are called
retention

*placed at some distance from primary suture line and provide a secondary suture line and used to prevent strain and reduced dead space
in which incision could retention sutures be used
vertical midline

*reinforce primary suture line
which type of stitches incorporates the seromuscular layer and submucosa
Lembert

*Suture is placed through seromuscular layer and submucosa. This technique is used as second layer of bowel anastomosis
During hemostasis, prothrombin and thromboplastin, along with calcium ions in the blood, form:
Thrombin
Endoscopic knot tying performed externally, introduced, and secured intra-abdominally is,
extracorporeal

* through a trocar
What is an abnormal activated clotting time
more than 120 seconds

* ACT is frequently used in the O.R to asses heparin anticoagulation. more than 120 seconds is an abnormal ACT lab value
Wound classification is assigned when
procedure is complete
removal of devitalized tissue is
debridement
which phase of healing begins within minutes of injury
inflammatory
which type of needle would be selected for use on skin or tendon
cutting
an absorbable suture that offers extended wound support
PDS
Polyglactin 910 suture is
Absorbable , synthetic
Continuous lateral stitches placed beneath the epithelial layer of the skin are
subcuticular
The amount of tension or pull expressed in pounds that a suture can withstand before it breaks is
tensile strength
If the suture breaks and the remainder of the suture line stays intact which suture technique was utilized
interrupted
Serosanguineous drainage means
blood-tinged

*serum and blood
The term for a wound that completely separates and the internal organs extrude is
evisceration
which is a continuous circular suture placed around the lumen of a structure causing it to close
purse-string
Postoperatively, skin staples are generally removed
5-7 days
a wound that is left open and closed secondarily when there is no longer evidence of infection is an example of
delayed closure
Wound drains may be secured with
nonabsorbable suture on a cutting needle
Which term refers to the transmission of fluid along a strand of suture
capillarity

*multiple strand sutures have characteristics of capillarity which is the ability to harbor bacteria and tissue fluids that can then travel the length of the suture strands this is why multifilament should NOT be used in the presence of infection
Which blood components are essential in clot formation?
platelets
Which is the body's normal response to cell and tissue injury
inflammation

*initial response of the body to tissue injury
What causes localized temperature elevation during the inflammatory response
increased blood flow
between which of the following postoperative days can dehiscence typically occur
fifth and tenth
Delayed wound healing may be related to
age
A common pathogen typically associated with decubitus ulcers is staphylococcus _______
Aureus
Which wound complication would require immediate surgery
evisceration
what is used to reinforce a subcuticular closure
Steri-strips

*applied to the skin over subcuticular closure to reinforce closure
impaired healing of a vertical abdominal incision can result in
herniation
During a whipple procedure which of the following surgical maneuvers is preformed to dissect the lateral peritoneal attachments of the duodenum?
Kocher

*Dissection of the lateral peritoneal attachments allowing visualization of duodenum, pancreas, and other retroperitoneal structures
Which site is used for autotransplanting one or more of the parathyroid glands?
Forearm

*if pathology is present the parathyroid gland(s) are transplanted to the non-dominal forearm. if no pathology is present the gland(s) are transported to the sternocleidomastoid
A major concern in draining gangrenous gallbladder is
contamination

*decreased blood supply that is the result of edema and distention may result in gangrene.
which nerve is at the greatest risk for injury during a thyroidectomy
recurrent laryngeal
what anastomosis is accomplished during a whipple procedure (pancreaticoduodenectomy)
Hepaticojejunostomy

*during reconstruction 3 anastomosis are preformed. pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy.
A hernia through which bowel or omentum extends and cannot be returned to its normal position through manipulations referred to as
incarcerated hernia

*contents of hernia sac are trapped in the extrabdominal sac in an incarcerated hernia-biggest danger is blood supply to trapped contents may become necrose.
Which types of hernias occur in hesselbachs triangle
Direct

*direct inguinal
What is the most common type of hernias that occur in females
femoral hernia
Which is the anastomosis of choice when preforming a total abdominal colectomy for ulcerative colitis
ileoanal

*involves creating ileal pouch that is anastomosed to the anus and rectum
The flexure at the junction of the duodenum and jejunum is the
ligament of treitz

*AKA suspensory ligament. It marks the end of the duodenum and the beginning of the jejunum
intercostal nerves and vessels are located
inferior to the rib

*located in spaces between ribs
The section of the gastrointestinal tract that is least affected by Crohns disease is the
Rectum

*inflammatory bowel disease that can affect any segment of GI tract but usually doesn't affect the rectum
Hernia means
Rupture

*latin term
Which nerve must be identified and protected from injury during a thyroidectomy
Recurrent laryngeal

*injury could result in hoarseness, loss of voice, and inability to cough
What type of incisions are used for a laparoscopy
infraumbilical

*midline laparotomy incision around the umbilicus and carried to the fascia in the early steps of the laparotomy
Both direct and indirect hernias are the result of tears in the
Transversalis fascia

*primary focus of inguinal herniation focus of weakness in the are of coopers ligament leading to inguinal herniation
Which nerves must be identified during an inguinal hernia repair
iliohypogastric and ilioinguinal

*important nerves in the groin
Which hernia involves the peritoneum and the abdominal viscera forms part of the hernia sac?
sliding
during a larposcopic hernia repair stapling is avoided in the triangular area inferior to the internal inguinal ring called
Triangle of Doom

*bordered by vas deferens, and spermatic cord. The iliac vessels and femoral nerve are located in the triangle.
during a laproscopic hernia repair, staples should not be placed below the lateral iliopubic tract in order to avoid injuring the
genitofemoral and lateral femoral cutaneous nerves

*prone to entrapping nerves
Which of the following nerves is dissected from the lesser curvature of the stomach when preforming a highly selective vagotomy (parietal cell vagotomy)
Nerves of Latarjet

*are identified anteriorly and posteriorly and dissection occurs approximately 7 cm from the pylorus
The invagination of the proximal intestine into the lumen of the distal intestine is called
intussusception
failure of the intestines to encapsulate within the peritoneal cavity of a newborn is called
omphalocele

* during the 11th week of fetal development when the viscera do not withdraw from the exocoelomic position to the peritoneal cavity
newborn vomiting, free of bile and projectile in nature is indicative of
pyloric stenosis
Hirschsprung's disease is synonymous with
Congenital aganglionosis
the most common intraabdominal childhood tumor is
nephroblastoma

* aka Wilms tumor
pathologic enlargement of the male breast is called
gynecomastia

*results from a hormonal imbalance
Surgical enlargement of the passage between the prepylorus of the stomach and the duodenum is a
pyloromyotomy

*incising the muscle layer of the pylorus while preserving the mucous underneath
a left subcostal incision indicates surgery of the
spleen

*left rectus paramedian, midline, or subcostal incision are used to enter the peritoneal cavity
Which breast procedure removes the entire breast and axillary contents but preserves pectoral muscles
modified radical mastectomy
a sigmoid colostomy is brought through the
rectus muscle

*since there is a lower incidence of peristomal hernia
which surgical maneuver refers to the dissection of the lateral peritoneal attachments of the duodenum to allow inspection of the duodenum, pancreas and other retroperitoneal structures
Kocher

*see question 299
Which surgical maneuver mobilizes the descending colon to the midline to expose the abdominal aorta
Mattox
what is the most common liver cancer
metastatic disease

*hepatocellular carcinoma is most common primary malignancy of the liver
Removal of all liver tissue to the right of the falciform ligament is called
Trisegmentectomy
Which artery is susceptible to injury during a cholecystectomy
right hepatic
increased WBC, bilirubin, alkaline phosphatase and positive blood culture would be associated with
Cholangitis

* cholangitis is a bacterial infection of the biliary tract due to obstruction.
a tumor that involves the junction of the right and left hepatic ducts
klatskin

*choleangiocarcinoma of the bile duct located at the junction of the right and left hepatic ducts
which paired nerves must be carefully identified during a thyroidectomy?
recurrent laryngeal

*innervates muscle of the larynx
The usual location of meckels diverticulum is
approximately two feet from the iliocecal valve.

*can mimic appendicitis. Two feet is the rule of 2's. 2 feet from the valve, 2% of the population, symptoms before the age of 2, male to female ratio is 2:1, and most meckals is 2 inches long
postoperative complications of an appendectomy include all BUT
stenosis of the ileocecal valve
all of the following complications can result from a total thyroidectomy except
esophageal rupture
anatomical landmarks for a laproscopic inguinal hernia include all but
medial scrotal sac
the incision for the tracheostomy is approximately 1/4" above the
suprasternal notch

*1-2 cm
which nerve innervates the trapezius and sternocleidomastoid, and should be identified and preserved from performing a radical neck dissection
Accessory
When closing the peritoneum or intestine, which type of needle is used
taper
to establish a tracheostomy, a transverse or midline incision is made in the neck between the
cricoid cartilage and suprasternal notch
which two arteries must be preserved during pancreas retrieval
splenic, superior mesenteric

*the celiac axis, superior mesenteric and splenic arteries are dissected free. the splenic and mesenteric (superior) are divided approximately 1/2 cm beyond their origin
in order to preserve the hepatic artery during liver and pancreas procurement , which branch artery must be identified and ligated?
gastroduodenal

*ligated and divided if pancreas and hepatic if just pancreas the artery is not divided
Zenkers diverticulum is an out pouching of the
esophagus
an elderly patient who is one week post-abdominal surgery complains of a "popping" sensation associated with coughing or straining. The most likely cause is
Dehiscence
which structures must be anastomosed during a live transplant
Hepatic artery

*Arterial revascularization involves an end to end anastomosis of the hepatic artery
during common bile duct exploration, which of the following structures is more likely to be accidentally injured?
hepatic artery
which type of hernias is typically the result of postoperative wound dehiscence
incisional

*poor healing of a previous surgical incision may weaken the abdominal fascia and cause an incisional hernia
dumping syndrome is a complication of
Gastric bypass

*dumping syndrome is when food goes through the stomach very rapidly and enters the small intestine largely undigested.
a cholesteatoma is a benign tumor that develops in the
mastoid bone

*caused by a build-up of squamous epithelium and associated products in the middle ear and mastoid
adenocarcinoma of the head of the pancreas can result in jaundice, because of compression of the
Bile duct

*in the liver hepatocytes produce bile which is transported by ducts that eventually become the hepatic duct and common bile duct which is at the head of the pancreas. An excessive amount of bilirubin, a primary bile pigment results in jaundice
what is a intraoperative hazard of laparoscopic surgery
perforation
postoperative hernias are common after which of the following incisions
paramedian
when performing an inguinal hernia repair and incising the external oblique muscle, the sensory nerve that innervates the scrotum and must be preserved is
ilioinguinal
which section of the stomach is wrapped behind the esophagus during a nissen procedure
fundus

*the fundus is grasped and passed behind the esophagus and regrasped from the other side
which retractors is typically used to retract the strap muscles during a thyroidectomy
Green (loop)

*also to retract the sternocleidomastoid muscle
which is the most common physically identifiable pathology of portal hypertension
splenomegaly
a left subcoastal incision is typically used for
splenectomy
which arteries is identified, ligated, and divided during perineal dissection portion of an abdominoperineal resection
inferior rectal artery
The Trendelenburg position would be most appropriate for which of the following procedures
total abdominal hysterectomy
a thoracoabdominal incision would be used for
hiatal hernia repair
a vagotomy is typically performed in conjunction with which other procedure
pyloroplasty

*for gastric drainage
the position used typically in thyroid and gallbladder surgery is
reverse Trendelenburg
To preform cholangiography, which duct is identified and incised for placement of the cholangiocatheter?
Cystic
which two tests are the most cost-efficient in preoperative determination of calculi in the bile tract
percutaneous ultrasound, liver function tests

*used to see if intraoperative cholangiogram will be needed
the condition of imperforate anus includes all EXCEPT
chalasia

anomalies of imperforate anus are stenosis, agenesis, membrane atresia
which position would be the most optimal for a pilonidal cystectomy
Kraske

*anus and pilonidal area accessible
when removing anal warts with a laser, the rectum is packed with a wet sponge to
prevent the escape of methane gas

*or moist towels
A herniation of the cul-de-sac of douglas is a
enterocele

*usually contains loops of intestine
a vesicourethral abdominal suspension is known as
marshall-marchetti

* procedure to bring the bladder and urethra into the pelvis
A stamey endoscopic procedure is preformed to
suspend the vesicle neck

*preformed by suspending the bladder facial attachments to the resected fascia with suture
the curved transverse incision used for pelvic surgery is called
pfannenstiel
when establishing the pneumoperitoneum for laparoscopic procedures. the CO2 gas pressure is kept between
14-16mmHg

* in order to keep the abdomen distended
when positing a patient for gynecological procedure involving candy cane stirrups, the surgical assistant is deliberate in avoiding pressure on the lateral aspect of the patients knee to prevent injury to which nerve
peroneal
the most commonly identified ovarian cyst is the
follicular

*rupture of the cyst can cause severe pain
which is the preferred procedure for recurrent or persistent carcinoma of the cervix after radiation therapy has been completed
pelvic exteneration
extrauterine disease of the female reproductive system may utilize the following lasers via a colposcope or laproscope EXCEPT
Candela

*CO2, YAG, ARGON are commonly used through colposcopes or laparoscopes to treat extrauterine diseases such as a pelvic endometriosis and cervical dysplasia
in which procedure will the patient be placed in the supine position with the right side slightly elevated by a wedge
caesarean section

*keep uterine pressure off the vena cava
which procedure involves abdominal, perineal, and groin dissection
radical vulvectomy
which organ is frequently trapped in the inguinal sac of female patients
ovary

*often accompanied by the fallopian tube
A vulsellum forceps is used in_____surgery
gynecological

*aka tenaculum
which ligament that contains fibrous tissue and non-striated muscle fibers passes in an inferior direction from the cervix on each side of the rectum to the front of the sacrum
uterosacral
is the veress needle is not positioned inside the peritoneal cavity, what happens to the flow of CO2 and pressure
flow decreases and pressure increases
which artery is contained within the cardinal ligament
uterine
during cataract surgery, the irrigation/ aspiration hand piece is used for
removed residual cortex
retraction of eyelid tissues requiring intermittent retraction and release over a period of time is accomplished by utilizing
traction sutures
what laser is used to destroy the lens capsule during cataract surgery
YAG
which ophthalmic medications is injected into the anterior chamber during a cataract procedure to aid in keeping the iris in position prior to inserting the lens prosthesis
Acetylcholine chloride

*constrict the pupil and aid in keeping iris in position
the mechanical strength of a weak eye muscle due to strabismus in a pediatric patient can be corrected by all of the following EXCEPT
Recession

*the mechanical strength of a weak extraocular muscle can be increased by placing a tuck in the muscle to shorten it, freeing the attachment point of the muscle and reattaching closer to the cornea (attachment) and removing part of the muscle
a chalazion is a chronic inflammation of the
meibomian gland

*chronic inflammation of the oil-secreting meibomian glands in the tarsal plate of the eyelid. inflammation is due to blockage of the gland
which procedure is done for chronic dacrocystitis
dacryocystorhinostomy

* to remedy malformation or trauma to nasolacrimal duct. aka-DCR
a procedure to treat retinal detachment
scleral buckling
what involves small, corneal incisions as treatment for myopia?
radical keratotomy

*multiple, small, radial incisions in the cornea
when preforming a tympanoplasty, the graft is secured to the oval window when
the footplate of the stapes cannot move

*the graft can be secured to the oval window when the stapes footplate is fixed
which incision is indicated for an esophagogastrectomy?
thoracoabdominal
what is an alternate procedure to stapedectomy
stapedotomy

*otomy vs ectomy
what structures that travel through the temporal bone must be identified and preserved when performing a mastoidectomy ?
mastoid sinus, facial nerve

*near the mastoid sinus
the term epistaxis means
nasal bleeding
chronic Otis media can lead to the loss of hearing. In the early stages, the patient can be helped by
myringotomy
which nerve must be preserved to prevent muscle weakness during a parotidectomy
facial
which incision allows for optimal exposure of frontal sinus fractures
coronal
which nerve innervates the muscles around the chin must be protected from injury when repairing a fracture of the mandible
marginal mandibular
which branch of the trigeminal nerve must be identified and preserved when performing a submandibular gland removal
lingual
prior to plating a mandibular fracture what should be applied to ensure proper occlusion of the teeth
arch bars
what should be sent postoperatively with the patient who has arch bars applied
wire scissors

*and sent home with the patient
a patient is being evaluated for undergoing a breast reconstruction procedure and indicates she still smokes. Which of the following procedures would the surgical assistant recommend?
Free TRAM flap

*involves the deep inferior epigastric artery which provides increased blood supply to protect against the nicotine induced vasospasm
A common autologous donor site for a free flap graft for replacing the jaw bone is
Fibula

*osseus free flaps is the tibia. up to 25cm of fibula graft may be taken for mandibular reconstruction.
When possible during a plastic surgery procedure, incisions should be placed
perpendicular to the long axis of the underlying muscle

*to minimize tension and scarring
sutures from the ear may be removed after
10-14 days
reasons for skin graft failure include
hematoma

*or seromas typically caused by inadequate hemostasis, along with infection and movement (shear)
cleft lip repair is usually recommended at
3 months

*followed by palatoplasty before 12 months
which of the congenital anomalies limits the skull's volume and increases the intracranial pressure?
craniosynostosis

*premature closure of the cranial sutures
which statement is CORRECT concerning the handling of renal calculi?
kept dry to avoid interference with a chemical analysis

*sent in a dry jar
Which type of fistulas refers to leakage of urine into the vagina?
vesicovaginal
when preforming a radical cystectomy with ileal conduit, which of the following is an alternative patient position that a surgeon may prefer?
low lithotomy

*or supine
a staghorn stone is one that lodges and continues to grow in the
renal calyx

*solid deposit or deposits of mineral and salts in a structure that can be smooth, jagged or staghorn
which of the following solutions is used during a diagnostic cystoscopy
distilled water

*aid in visualization, rinse away blood, resected tissue or stone fragments
which of the following is NOT considered a permanent urinary division
nephrostomy

*temporary urinary diversion after surgery siliastic tubes are placed internally to avoid using an open surgical procedure in order to drain the kidney temporarily
a radical lymphadenectomy is performed to treat cancer of the
testicles

*a unilateral lymphadenectomy is commonly preformed on the same side as the tumor unless metastases has occurred
a transplanted kidney is placed into the
iliac fossa
The bladder is supported by the rectovesical fascia called
denonvilliers

*fascia is located between the rectum and vagina or prostate
which of the following is the surgical treatment of vesicoureteral reflux
ureteral reimplantation

*in order to increase the length of the ureter
what is the fornix in the kidney organ
edge of the minor calyces

*of each minor calyces
which of the following is not a complication of a transurethral prostatectomy
rectal injury
the fascia surrounding the kidney is called
Gerota's
the donor left kidney is preferred in order to procure additional length of the
vein

*left=longer renal vein easier anastomosis in living donors the smaller right kidney is taken to let donor keep larger left
which of the following affect renal vascular resistance?
mannitol
a patient who has undergone a right-side herniorraphy presents 2-5 postoperatively with swollen and tender testis. which of the following complications is most likely occurring?
ischemic orchitis

*thrombis of the venules in the pampinform plexus within the spermatic cord causing venous congestion of the testis. this can be prevented by avoiding undue dissection within the spermatic cord
the kidney lift should be situated directly below which of the following when positioning a patient for a nephrectomy
iliac crest
which vein, in addition to the gonadal and lumbar, should be clamped and ligated when preforming a left kidney procurement
adrenal

*lumbar vein and its tributaries and the gonadal and adrenal veins are clamped, divided and ligated so the full length of the renal vein can be preserved
which of the following nerves can be injured during a lateral lower leg fasciotomy
superficial peroneal

*nerve is situated in the anterior portion of the lateral compartment of the leg
the most reliable tendon graft for primary reconstruction of the anterior cruciate ligament is
patellar
the type of fracture that is caused by impaction of one bone upon another is
compression
which of the following can be a cause of locking of the knee joint
osteochondral defects

*particles such as joint mice become lodged within the joint they cause irritation and locking may occur
which type of fracture is at the greatest risk for infection
open fracture

*bone pierces through the skin
the trauma patient with a cervical spine injury at or near C3 to C5 is at great risk for
respiratory difficulties

*paralysis of the diaphragm
which nerve is affected by carpal tunnel syndrome
median

*repetitive stress injury caused by tenosynovitis that places pressure on the median nerve
an injury to the long thoracic nerve could cause
winged scapula

*long thoracic nerve innervates the serratus anterior muscle-abnormal outward bulging of the scapula=winged scapula
an injury to the ulnar nerve could cause
claw hand

*ulnar nerve innervates the 3rd, 4th, and 5th fingers and muscles of medial forearm
during a triple arthrodesis, the capsule of the talonavicular, calcaneocuboid, and subtalar joints are circumferentially incised to
gain as much ankle joint mobility as possible

*if optimal mobility is attained and the release allows the foot to be placed in normal anatomical position, excision of large bony wedges won't be necessary
which muscle is an important anatomical landmark in fractures of the forearm
pronator teres

*connects the end of the radius to the humerus and ulna innervated by the median nerve
which of the fractures is caused by falling on the back of the hand with the wrist flexed, also called reverse Colles' fracture
Smith's

*involves volar displacement and angulated fracture caused by falling on the dorsum of the hand
which of the following carpal bones is fractured most frequently
Scaphoid
which of the metacarpals is most commonly fractured when associated with a "boxers" fracture
fifth

*occurs due to a combination of axial compression and bending
which disorders is characterized by compression of the abductor pollicis longus and extensor pollicis brevis tendon near the radial stylus process
De Quervain's

*stenosing tenosynovitis caused by inflammation of the tendons located in the first dorsal section of the wrist
the most frequent site of cartilage tears in the knee joint is the
medial meniscus

*requiring arthroscopic surgery
what is correct concerning the Bankart procedure
anterior capsule is reattached to rim of the glenoid

*with heavy sutures
what fracture is most commonly associated with a fat embolism
femur
which nerve is at risk for injury in a humerus shaft fracture
Radial

*swelling of surrounding tissues can compress the internal vessels and nerves
what is a monteggia fracture?
fracture of the proximal third of the ulna with radial dislocation

*resulting in angulation of ulnar fragments
which nerve is compressed in carpal tunnel syndrome
median

*entrapment of the median nerve on the volar surface of the wrist
under which structure is the nerve trapped in carpal tunnel syndrome
transverse carpal ligament

*is incised to release pressure being placed on the median nerve
which movement of the upper extremity would be most painful if tendinitis of the supraspinatus muscle is present
Abduction of the shoulder

*supraspinatus muscle connects the scapula to the humerus and abducts the arm
the border of the acetabular fossa of the hip joint that is deficient forming a C-shaped fossa that creates a gap bridged by the
transverse ligament

*bridges gap formed by C-shaped fossa
what is the fibrocartilage structure of the acetabular fossa that encloses the head of the femur
labrum

*helps keep it securely in place
following an injury to the lower limb, your patients knee is evaluated. His leg can easily be displaced anteriorly on a fixed thigh. This would indicate a torn
anterior cruciate ligament

*the anterior drawer test is formed, increased anterior movement of the tibia on the femur with the knee in 90 degree flexion is a physical finding of an ACL tear
which nerve is at risk for injury when a humeral shaft fracture occurs
Radial nerve.

*radial nerve travels next to the shaft of the humerus and moves posterior near the distal end by the elbow and continues downwards=susceptible injury when a humeral shaft fracture is sustained
what is not a carpal bone
cuboid bone

*this is one of the 7 tarsal bones
what is the best indicator for possible failure of a below the knee amputation to heal?
absence of a popliteal artery pulse when palpated

*= poor vascularization
a laceration or avulsion of the extensor tendon at the proximal phalanx or proximal interphalangeal (PIP) joint is called a
Boutonniere deformity
The distal tibia articulates with which of the following structures?
Talus

*to form part of the ankle joint
the narrow rim of fibrocartilage around the edge of the glenoid cavity is
glenoid labrum

*forming a rim that deepens the cavity
the superior margin of the hip bone is called the
iliac crest
the patellar ligament is attached proximally to the patella and distally to which structure
tibial tuberosity

*tibial tuberosity attaches distally to the patellar ligament and proximally to the patella
which tendon is located under the clavicle and is the site of most rotator cuff repairs
supraspinatus

*tendon
which knee ligament prevents the femur from sliding posteriorly on the tibia and is the usual site for knee ligament reconstruction
ACL
what nerves are most frequently injured die to a shoulder dislocation
Axillary

*the injury is usually neurapraxia which is temporary loss of motor and sensory function due to blockage of nerve conduction
What diagnostic imaging techniques are used to aid in diagnosing a rotator cuff tear
MRI

*and arthrogram
what is a complication of internal K-wire fixation of a Colles' fracture?
nerve damage
What structure may be used for replacement of the ligament during an ACL pair
Patellar tendon
when preforming a cannulated screw fixation for nondisplaced femoral neck fractures, compression of the
anterior screws is completed first

*then compression of posterior screws in order to prevent the collapse of posterior femoral neck
which lymph nodes must be removed and histologically examined when preforming a segmental pulmonary resection for lung cancer
Lobar

*segmental resection involves removal of one or more anatomic subdivisions of the pulmonary lobes
in severe aortic stenosis, all of the following are indications for valve replacement except
palpitations

*plus fatigue and dyspnea
most common cause of mitral stenosis
Rheumatic fever

*mitral stenosis is narrowing of the valve opening
the wound classification of a thoracotomy is
clean-contaminated
plication of the inferior vena cava or insertion of an umbrella type filter is preformed to treat
pulmonary embolus

*or prevent
the most congenital defect of the heart is a
ventricular septal defect

*approx. 2-6 of every 1,000 births
a needle biopsy of the lung may be accomplished with a
Chiba

*it is inserted through the chest wall
what statement about the heart is INCORRECT
blood passes through the bicuspid (mitral) valve when it flows from the right atrium to the right ventricle

*Tricuspid
Cardiopledia induces cardiac
Arrest
When the myocardium weakens and enlarges losing the ability to pump blood into the systemic circulation, the resulting condition is called
Heart failure

*preoperative heart failure is characterized by tachycardia, low cardiac output, pulmonary or peripheral edema. All of which contribute to enlargement and weakening
Insufficient blood flow to the hear muscle may lead to
myocardial infarction

*if the coronary arteries become obstructed, the blood flow to the heart is reduced which may result in myocardial infarction
Which vessels are typically utilized for a coronary artery bypass
Saphenous vein and internal mammary artery
When preforming a high ligation and stripping of the great saphenous vein, which of the arteries are located at the saphenofemoral junction and should be kept from injury
superficial external pudendal

*anatomical landmark located at the junction
in which procedure would a fogarty catheter be utilized
embolectomy.

*balloon tipped fogarty catheter is inserted through an arteriotomy to facilitate the removal of an arterial embolism
What is the purpose for the surgical creation of an arteriovenous fistula
Hemodialysis

*in arm or leg to give access to the patients circulation
When preforming an open AAA, which artery or arteries are cross-clamped prior to cross-clamping the aorta
Iliac

*to reduce the risk of distal embolization
Which of the cranial nerves is at risk for injury during a carotid endarterectomy
Hypoglossal


*innervates the muscle of the tongue and is at risk because it travels anterior to the internal carotid artery
during a vascular procedure, monitoring the activated clotting time intraoperatively provides useful data for judging the need for reversal or addition of
Heparin

*heparin is an anticoagulant used to prevent venous thrombosis, pulmonary embolism, acute coronary occlusions, heart attacks and strokes
Deep vein thrombosis occurs most commonly in the
left iliac vein

*due to aortic bifurcation crossing and compressing the vein
what may be requested during an emergency femoral embolectomy
Arteriograms

*If a dx of an embolism cannot be clearly established, a preop arteriogram is ordered so anatomy can be examined and serve as a guide during surgical revascularization
What is applied topically to arteries for prevention of vasoconstriction
papaverine
During a carotid endarterectomy, which of the following arteries is initially incised
common carotid

*arteriotomy is made in the lateral portion of the distal common carotid and extended into internal carotid artery
What is NOT a layer of an artery
Tunica muscularis

*this is an outer layer of tunica mucosa, the innermost tissue layer of the intestine wall
Meningiomas are benign tumors that originate in the
Dura

*benign and slow growing tumors of the CNS
A potential complication that can occur when the patient is undergoing an occipital craniotomy while in the fowlers position is
Hypotension

*blood flow to upper body is reduced
Incomplete closure of paired vertebral arches that can be treated surgically is known as
Spina Bifida

*Neural tubes fail to close properly=defects in posterior lumbar vertebral, fascia, and dura that causes exposure of the meninges, spinal cord and nerve roots through the skin
What could occur when a posterior fossa craniotomy is performed with the patient in a sitting position
Venous air embolism

*when patient is positioned
Which arteries could be injured if the screws for an anterior cervical discectomy are placed laterally rather than straight or at a medial angle
Vertebral

*vertebral arteries travel upward through the foramina of the transverse processes of the cervical vertebral could be injured
To prevent the plates, screws and rods from breaking when preforming a spinal fusion, bone graft is needed to fuse to
bone

*bone is needed to fuse the bone graft in order to avoid hardware breakage
What hemostatic agents is most frequently used during spinal fusion
Thrombin

*used in spinal fusion to facilitate the conversion of fibrinogen to fibrin and is effective in treating capillary bleeding
The center structure of the intervertebral disc, which may herniate into the spinal nerve, is the
nucleus pulposus

*gelatinous core of intervertebral disc surrounded by fibrocartilage
A ventriculoperitoneal shunt is used to
Treat hydrocephalus

*multi holed shunt is placed into the lateral ventricle and connected to a distal draining tube that is inserted into the right atrium or peritoneal cavity
What is usually caused by an injury to the middle meningeal artery
epidural hematoma