Icm Fall Surgery

Front 1

What is the code of Hammurabi?
Whats the oldest surgery book?
Who was the father of surgery?

Back 1

Scaled punishments from way back

Edwin smith papyrus, 3000BC – oldest surgical treatise

Susrutha

Front 2

What agent was used for sterilization of materials including sutures in 1867?

Back 2

Carbolic acid

Front 3

Whats a catgut?

Back 3

Suture, 1599

Front 4

What are the 3 phases of wound healing?

Back 4

1. Inflammation (fibrin clot, in 24 hrs we get PMN, monocytes from 48-72 hours)
2. Proliforative (72 hrs, fibroblasts- collagen I/III)
3. Remodeling (apoptosis of collagen, inflammatory cells, capillaries. Collagenase remodels the wound, collagen is crosslinked and made strong)

Front 5

In what phase of wound healing do we have lots of fibroblasts, what are they doing?

Back 5

Priliforative, they are proliferating and laying down collage. This collagen will then be remodeled in the next stage by collagenase. This is scar formation

Front 6

In what phase of wound healing do we have increased PMN and monocytes?

Back 6

Inflammation, this is the first one- PDGF, VEGF, lots of GF to get things going here! Fibrin clot make of platelets

Front 7

In what phase of wound healing is there collagenase?

Back 7

3rd phase, remodeling phase. This makes the collagen more organized and strong

Front 8

what phase of wound healing in a scar formed

Back 8

phase 2, proliferation- collagen

Front 9

What are things that affect wound healing?

Back 9

Age, blood flow, malnutrition/catabolism, edema, radiation, steroids/chemotherapy- decrease inflammation (we need some of this). Chronic wounds, leg ulcers.

Front 10

What is wound strength after surgery. 1 week
3 weeks
6 weeks

Back 10

1: 3%
3 10%
6 35-50%

Front 11

What are the layers of the abdominal wall?

Back 11

Skin

sub subcu fat
campers
Scarpas 
ext oblique
internal oblique
transversalis abdominous
transversalis fascia
preperitoneal fat
peritoneum

Front 12

What layer of the abdomen MUST be sutured back together?

Back 12

External oblique

Front 13

What is wound dihescence?>

Back 13

when the external oblique ISNT stitched back tight and organs can eviscerate out. Pink lemonaid sign!

Front 14

Whats the pink lemonade sign?

Back 14

Pink discharge from a wound- can indicate wound dishesance and possible evisceration

Front 15

Whats the catchy phrase for proper surgical closure?

Back 15

Approximate but don’t strangulate the tissue (poor approximation if we have serous fluid, old blood, pus, fistula in the dead space of a wound)

Front 16

What are the 2 needle types on sutures?

Back 16

Taper, cutting (not for liver/kidney)

Front 17

In a post op note what is ADC VAAN DIML

Back 17

Admit Diagnose Condition (stable) Vitals Allergies Activities Nursing Diet IV fluids Meds Labs

Front 18

In a post op Note what is? PP ABCDEFFG

Back 18

Preop DDX Postop DDx Anesthesia Blade (surgeon) Complications Drains Estimated blood loss (EBL) Fluids I/O Fiindings Go to assessment/plan

Front 19

Where does an indirect hernia go?

Back 19

Down the spermatic cord

Front 20

What kind of hernia goes through the spermatic cord?

Back 20

Indirect

Front 21

If a wound is separated can you go home? What about dishesience? What about evisceration?

Back 21

Seperation- can go home. Dishesience- needs to be fixed. Evisceration- FIX ASAP!!

Front 22

do you want to test neck ROM for intubation

Back 22

ya

Chin to chest 45*
Chin to shoulder 40*
Head back 55*

Front 23

what are mallampati signs?

Back 23

determines ease of intubation

1. big hole, can see tonsils, and uvula
2. a little smaller- can see some tonsil and uvula
3. can only see a bit of uvula
4. can only see palate

1 is easy, 4 is hard

Front 24

what is the correct force for intubate

Back 24

lift upwards, dont push on teeth

Front 25

fill in the blanks- layers of the abdominal wall

1. Skin
2.
3.
4.
5
6
7
8
9
10. peritoneum

Back 25

1. skin
2. subcu fat
3. campers fascia
4. scarpas fascia
5. external oblique
6. internal oblique
7. transversus abdominus
8. transversalis fascia
9. peritoneal fat
10. peritoneum

Front 26

what types of hernia is more common in men? what about women

Back 26

MEN
inguinal (direct and indirect)


Women
Femoral

Front 27

what type of hernia is below the inguinal ligament? abive

Back 27

Below: femoral

Above: inguinal

Front 28

whats the dif btwn the direct and indirect inguinal hernia

Back 28

Direct: comes out through the abdominal wall, does not pass through inguinal ring, found in hesselbachs triangle

Indirect: comes through internal inguinal ring and travels through inguinal canal with spermatic cord

**recall both are superior to the inguinal ligament, the femoral is infereior to the inguinal ligament

Front 29

whats more common, direct or indirect inguinal hernia

Back 29

Indirect:

more common in men
comes through inguinal ring and travels with spermatic cord in inguinal canal

Front 30

what are the characteristics of these hernias:

1. Indirect Inguinal
2. Direct Inguinal
3. Femoral
4. Pantaloon

Back 30

Indirect Inguinal: most common, more common in men. Passes through inguinal ring through the canal and travels with spermatic cord

Direct: travels directly into the inguinal canal through a weakened abdomen, palpated in hesselbachs triangle. almost always in men

Femoral: more common in women, through femoral canal, inferior to the inguinal ligament

Pantaloon: combo of direct and indirect and looks like pantaloon

Front 31

what happens with BL laryngeal N damage

Back 31

airway obstruction!!!

Front 32

what cANCER IS THE second leading cause of death due to malignancy

Back 32

colorectal cancer