Download B) modified radical mastectomy

Study Guide #3
Chapters 12-20
1) Describe the following types of hernias:
A) indirect- congenital or acquired weakness in the transversalis fascia; occur
lateral to deep epigastric vessels; protrude through the inguinal ring and pass
down the inguinal canal; may descend into the scrotum; appear more
frequently in men.
B) direct- Acquired weakness in the transversalis fascia from heavy lifting,
chronic coughing, or straining to urinate or defecate; occur within
Hesselbach’s triangle; emerge between deep epigastric artery and the rectus
abdomens muscle and protrude into the inguinal canal but not into the
spermatic cord (and rarely into the scrotum); appear more frequently in men
C) femoral- protrudes from the groin, below the inguinal ligament into the thigh
2) Define the following terms:
A) cholecystectomy- Excision of the gallbladder.
B) choledochoscopy- Direct visualization of the common bile duct by means of
a choledochoscope.
C) choledochotomy- Surgical incision of the common bile duct.
3) Describe the following incisions and name one procedure which could be done
using each incision. Draw a diagram if you wish.
A) midline- A longitudinal midline incision can be upper abdominal, lower
abdominal, or a combination of both going around the umbilicus. Depending
on length of the incision, it begins in the epigastrium at level of the xiphoid
process and may extend vertically to the suprapubic region. After incision of
the peritoneum, the falciform ligament of the liver is divided.
B) subcostal- A right or left oblique incision begins in the epigastrium and
extends laterally and obliquely just below the lower costal margin. It
continues through the rectus muscle, which is either retracted or transversly
divided. Although the incision affords limited exposure except for upper
abdominal viscera, cosmetically it provides good results because it follows
skin lines and produces limited nerve damage. Although painful, it is a strong
incision postoperatively. Examples of use include biliary procedures and
splenectomy.
C) paramedian- The parmedian incision is a vertical incision about 4 cm
(approximately 2 inches) lateral to the midline on either side in the upper or
lower abdomen. After skin and subcutaneous tissue are incised, the rectus
sheath is split vertically and muscle retracted laterally. This incision allows
quick entry into the abdominal cavity with excellent exposure. It limits
trauma, avoids nerve injury, is easily extended, and gives a firm closure.
Examples of use include access to biliary tract or pancreas in right upper
quadrant and to left lower quadrant for resection of sigmoid colon.
D) McBurney- The area just below the umbilicus and 4cm (about 2 inches)
medial from the anterior superior iliac spine marks McBurney’s point in the
right lower quadrant. A muscle-splitting incision extending through fibers of
the external oblique muscle is made. The incision is deepened, and internal
oblique and transversalis muscles are split and retracted. The peritoneum is
then entered. This is a fast, easy incision, although exposure is limited. Its
primary use is for appendectomy.
E) Pfannenstiel- Pfannenstiel’s incision is a curved transverse incision across
the lower abdomen within the hairline of the pubis. The rectus fascia is
severed transversely and the muscles are separated. The peritoneum is incised
vertically in the midline. This lower transverse incision provides good
exposure and strong closure for pelvic procedures. Its primary use is for
abdominal hysterectomy.
4) What is the common name for a pancreatoduodenectomy, and what is removed?
Whipple. Radical removal of the head of the pancreas, the entire
duodenum, a portion of the jejunum, the distal third of the stomach, and
the lower half of the common bile duct, with the re-establishment of
continuity of the biliary, pancreatic, and gastrointestinal tract systems for
carcinoma of the head of the pancreas or ampulla of Vater.
5) Explain the suture technique for an intestinal anastamosis. Include sutures and
layers of tissue.
1) Posterior Serosa- 3-0 or 4-0, nonabsorbable (silk or prolene usually),
interrupted
2) Posterior Mucosa- 3-0 or 4-0, absorbable (chromic or vicryl usually),
interrupted or running
3) Anterior Mucosa- same as posterior Mucosa
4) Anterior Serosa- same as posterior Serosa
6) Explain the advantages of using stapling devices.
Stapling instruments are used for ligation and division, resection, anastomosis,
and skin and fascia closure. They are employed in thoracic, gynocological and
abdominal surgery. Because of the mechanical application of these instruments,
tissue manipulation and handling are reduced. The edema and inflammation that
usually accompany anastomosis are also reduced. Mechanical staplers utilize
cartridges of tiny stainless steel or absorbable, nonmetallic staples that are
commercially preloaded, presterilized and prepackaged. The staples are
essentially nonreactive, and there use thereby minimizes the probability of tissue
reaction or infection. Because of the noncrushing B shape of the staples, nutrients
can pass through the staple line to the cut edge of the tissue. This characteristic
reduces the possibility of necrosis and promotes healing. The use of staplers
significantly decreases operating time and may shorten postoperative stays.
7) What is removed in each of the following procedures:
A) simple mastectomy
Removal of the entire breast without lymph node or muscle
dissection. Performed to halt the spread of cancer
B) modified radical mastectomy
Removal of the entire involved breast; all axillary lymph nodes are
resected; the major pectoralis muscle is left in place; the minor
pectoralis muscle may or may not be resected. Performed for
infiltrating ductal and small malignant lesions. Breast reconstruction
may be performed immediately, or in a few days, in patients with
small lesions with no metastases.
C) radical mastectomy
Removal of the entire involved breast along with axillary lymph
nodes, pectoral muscles, and all fat, fascia, and adjacent tissues. The
radical mastectomy has been replaced in almost all cases by the
simple mastectomy and the modified radical mastectomy to allow for
breast reconstruction.
8) In a cholecystectomy, what two structures must be identified, ligated, and
divided?
cystic duct and cystic artery
9) What is a Meckel’s diverticulum?
It is an anomalous sac that protrudes fro the wall of the ileum between 30 and 90
cm from the ileocecal sphincter. It is congenital, resulting from the incomplete
closure of the yolk stalk, and occurs in 1% to 2% of the population. The
diverticulum is usually asymptomatic, but the conditions is suggested by signs of
appendicitis in infancy, by sudden and painless bleeding, usually in childhood, or
by symptoms of intestinal obstruction. Symptomatic diverticula are most
commonly resected. Surgical resection of asymptomatic diverticula is also
recommended to avoid diverticulitis, obstruction, and blood loss, which may
occur. Many Meckel’s diverticula are discovered incidentally during surgery for
other causes and on postmortem examination.
10) Define the following terms:
A) dysmenorrhea- painful menstruation attributed to forceful contractions of
the uterus.
B) amenorrhea- absence or suppression of menstruation.
11) Define the following terms:
A) cystocele- Herniation of the bladder into the vaginal canal.
B) enterocele- Herniation of the cul-de-sac of Douglas which usually contains
loops of small intestine.
C) rectocele- Herniation of the rectum into the vagina.
12) Define the following terms:
A) hydrocelectomy- Surgical excision of a hydrocele (The accumulation of
serous fluid in a sack like cavity, especially in the tunica vaginalis of the
testes).
B) orchiectomy- Surgical excision of a testicle.
C) spermatocelectomy- Surgical excision of a spematocele (A cystic tumor of
the epididymis containing spermatozoa.
D) vasectomy- Removal of all or a segment of the vas deferens. Usually done
bilaterally to produce sterility in the male.
E) cryptorchidism- Undescended testes
D) epispadias- Congenital malformation in which the urethra terminates on the
dorsum of the penis in the male or above the clitoris in the female; more
common in the male.
E)
hypospadias- Developmental anomaly in which, in the male, the urethra
opens on the ventral surface of the penis or on the perineum, or in the female,
the urethra opens into the vagina.
13) What 2 drugs are frequently paced on the pep stand for nasal surgery?
Topical anesthetic (usually cocaine) and a local anesthetic (such as Lidocaine)
14) Define the following terms:
A) antrostomy- Operation to form an opening in an antrum (any closed cavity
or chamber, especially in a bone[ex- the maxillary sinus]).
B) rhinoplasty- Reconstruction of the nose to correct any deformities; designed
to improve the cosmetic appearance of the nose.
C) rhytidectomy- Aesthetic procedure to remove excess skin in the face and
neck area and tighten underlying support structures, such as muscle and
superficial fascia; also called a face-lift.
D) septoplasty- Excision and resection of the septum to correct any deviation as
the result of injury or a congenital deformity; designed to improve the
functioning capabilities of the nose. (a.k.a. nasal septal reconstruction [NSR]
and submucous resection of the septum[SMR])
E) otoplasty - correction of external ear deformities.
Indications
1) Microtia: small ears; prosthesis available
2) Macrotia: large ears are reduced
3) Trauma
4) Malignancy
15) Describe a Caldwell-Luc procedure.
Creation of a new passageway between the maxillary sinuses and the nasal cavity
to establish drainage and to remove any diseased tissue, polyps, or tumors;
incision is made in the oral mucous membrane above the canine teeth called the
canine fossa.
16) Explain the rule of Nines 1) 9% for head and neck, and each upper extremity; 18% for anterior trunk,
posterior trunk, and each lower extremity; and 1% for perineum.
2) Lund and Browder chart: percentage of burn is based on age and anatomical
location; useful in estimating burn damage in children, where percentages of body
surface vary greatly.
17) Define the following terms:
A) dacryocystorhinostomy- Forming a communication between the lacrimal
sac and the middle meatus of the nose through the lacrimal bone to establish a
new tear passageway for drainage directly into the nasal cavity or for chronic
dacryocystitis.
B) microtia- unusually small size of the auricle or external ear.
C) myringotomy- Incision of the tympanic membrane under direct vision to
treat acute otitis media or to release fluid in the middle ear; PE tubes are
frequently inserted through the tympanic membrane in connection with this
procedure.
D) stapedectomy- Removal of the stapes and re-establishment of linkage
between the incus and oval window by interposition of a vein graft,
polyethylene tube, or other prosthesis.
E) tympanoplasty- Any procedure performed to repair defects in the tympanic
membrane and/or middle ear structures.
F) Cheiloplasty - rearrangement of the tissue of the lips of an infant due to a
congenital anomaly.
18) A skin graft that encompasses both the dermis and the epidermis is_Full
thickness.
19) What do the following abbreviations stand for?
a) STSG – split thickness skin graft
b) FTSG – full thickness skin graft
20) What type of fractures are classified as Le Fort?
Facial fractures. Le Fort I- maxilla, II- maxilla & nose, III- maxilla, nose, cheeks and
lower orbits.
21) What are the characteristics of:
a) First-degree burn: involves epidermis; characterized by redness of skin
(erythema) swelling, pain; first-aid treatment is to rinse in cold water.
b) Second-degree burn: involves epidermis and part of dermis; characterized by
redness, swelling, pain, and blisters; open for infection and loss of body fluid.
c) Third-degree burn: involves injury to full thickness of the skin;
characterized by anesthetic surface which is dry, pearly white, and/or charred;
destroyed skin will slough and form eschar; requires skin grafts.
d) Fourth-degree burn: extended beyond skin into subcutaneous tissue, muscle,
or bone; requires full-thickness grafts.
22) Define the following terms:
A) arthrodesis- The surgical immobilization of a joint.
B) arthroplasty- The operative procedure of reshaping or reconstructing a
diseased joint. The procedure may require the use of an artificial joint.
C) meniscectomy- Removal of the meniscus (semilunar) cartilage of the knee.
D) neurolysis- 1: Stretching of a nerve to relieve tension, 2: Loosening of
adhesions surrounding a nerve, 3: Disintegration or destruction of nerve
tissue.
E) patellectomy- Surgical removal of the patella.
F) synovectomy- Excision of synovial membrane (membrane lining the capsule
of a joint).
23) Describe the following fractures. Draw a diagram if you wish.
A) open or compound- An fracture is considered open or compound when either
the proximal or distal end of bone, or both, protrudes from the fracture site
through adjacent tissues and skin. Because of the risk of infection developing
in the exposed bone, and open fracture is a surgical emergency.
B) closed or simple- Sometimes referred to as a simple fracture, broken
fragments do not protrude through tissue to puncture the skin.
C) comminuted- A fracture that causes the bone to splinter and break into more
than two pieces.
D) greenstick- A fracture that involves only part of the thickness of the bone.
The bone is usually either partially bent or partially broken as when a green
stick breaks. It occurs mostly in children.
E) multiple- a fracture in which the bone is broken in several different places.
This is a fracture that extends several fracture lines in one bone.
F) Colles’- This is a transverse fracture of the distal end of the radius (just above
the wrist) with displacement of the hand backward and outward.
24) What is the name for correction of a Hallux Valgus deformity? Bunionectomy
or metatarsal osteotomy
25) Describe a rotator cuff repair.
Occurs in the humerus at the insertion site of four muscles ( infraspinous, supraspinous,
teres minor, and subscapularis). May follow trauma or degenerative joint disease.
Problems with abduction of the arm the shoulder. Treated with splints and braces or
surgery. Procedure: torn edges are sutured with a heavy nonabsorbable suture if tear is
simple; massive tears require insertion of torn edges into the bone by a wedge osteotomy
or by drilling holes.
26) What is the common term for methyl methacrylate, and name one use for it.
Bone Cement; to cement a prosthesis
27) Name at least ten items you need to have for an arthroscopy.
Answers may vary. Some answers may include:
Alligator forceps
Stille probe
#3 handle with #11 blade
needleholder
suture scissors
0, 30,70, and/or 120 scope
outflow cannula
shaver and blades
sheath, obturator, and trocar
suction tubing
TUR tubing
light cord
camera
video cart
assorted forceps
28) What type of bone holding forceps is nicknamed a turkey claw?
Lowman
29) Name two brands of scalp clips.
Raney (most common), Michel (used occasionally), adson
30) Describe a transphenoidal hypophysectomy procedure.
Removal of the pituitary gland or pituitary gland tumor through a
transspenoidal approach. Incision is made in the upper gum margin and
passes through the inferior nasal cavity and sphenoid sinus to the floor of
the sella turcica which is opened to expose the pituitary gland. This
procedure requires the use of an image intensifier and an operating
microscope, and is performed by an ENT surgeon who enters and closes
the cavity, and by a neurosurgeon who performs the hypophysectomy.
31) Describe the following drugs and their common usages:
A) mydriatics- dialate the pupil while allowing the patient to focus
B) miotics- an agent that causes the pupil to contract; pilocarpine, acetylcholine
32) Define the following terms:
A) astigmatism- Form of ametropia (imperfect refractive powers of the eye in
which the principal focus does not lie on the retina, as in hyperopia, myopia, and
astigmatism), in which the refraction of a ray of light is spread over a diffuse area
rather than being sharply focused on the retina. Due to differences in curvature in
various meridians of the eye
B) chalazion- Small, hard tumor analogous to sebaceous cyst developing on the
eyelids, formed by distention of a meibomian gland with secretion.
C) ecchymosis- A form of macula appearing in large irregularly formed
hemorrhagic areas of the skin. The color is blue-black changing to greenish
brown or yellow. A bruise.
D) glaucoma- Disease of the eye characterized by increase in intraoccular
pressure, which results in atrophy of the optic nerve and blindness. There are two
types: primary, which occurs without known cause, and secondary, in which there
is an increase in intraoccular pressure as a result of other eye disease. The acute
type is attended by acute pain. An early sign of glaucoma is subjective complaint
that lights appear to have halos around them.
E) hyperopia- Farsightedness. Defect in vision in which parallel rays come to a
focus behind the retina due to flattening of the globe of the eye or to error in
refraction.
F) myopia- Nearsightedness. Defect in vision in which parallel rays come to a
focus in front of the retina; objects can be seen distinctly only when very close to
the eyes.
G) pterygium- Triangular thickening of bulbar conjunctiva extending from the
inner canthus to the border of the cornea with the apex toward the pupil.
H) strabismus- Disorder of the eye in which optic axes cannot be directed to the
same object. The squinting eye always deviates to the same extent when the eyes
are carried in different directions. Strabismus can result from reduced visual
acuity, unequal ocular muscle tone, or an oculomotor nerve lesion.
33) What is removed in each of the following thoracic procedures:
A) wedge resection- excision of a small part (or wedge) from the periphery of
the lung.
B) segmental resection- Removal of an individual bronchovascular segment of
a pulmonary lobe with ligation of segmental branches of pulmonary vessels
and division of the segmental bronchus.
C) lobectomy- Removal of one or more diseased lobes of the lung.
D) pneumonectomy- Removal of an entire lung, commonly performed to treat
carcinoma of the lung.
E) pulmonary decortication- Excision of fibrinous deposits or restrictive
membranes of pleurae that interfere with respiratory function.
34) Define the following terms:
A) arteriosclerosis- Term applied to a number of pathological conditions in
which there is thickening, hardening, and loss of elasticity of the walls of
arteries.
B) atherosclerosis- A form of arteriosclerosis characterized by a variable
combination of changes of the intima of the arteries, not arterioles, consisting
of the focal accumulation of lipids, complex carbohydrates, blood and blood
products, fibrous tissue and calcium deposits, and associated with changes in
the media of the arteries.
35) What are the characteristics of the following congenital defects:
A) coarctation of the aorta- Localized malformation resulting in narrowing of
the aorta.
B) patent ductus arteriosus- Persistence of a communication between the main
pulmonary artery and the aorta, after birth.
C) tetralogy of Fallot- An anomaly of the heart consisting of pulmonary
stenosis, interventricular septal defect, dextroposed (displaced to the right)
aorta that receives blood from both ventricles, and hypertrophy of the right
ventricle.
36) In what surgical specialty would heparinized saline be used as an irrigant?
Vascular
37) Name 2 types of bulldog vascular clamps.
DeBakey, Cooley, Glover, Johns Hopkins, Dieffenbach, Gregory and
Serrefine
38) For each instrument listed give the type of instrument, what its used for, and
the specialty(s) it would be used in:
A) hegar dilators- dilators; dilates the cervix; GYN
B) heany clamps- clamp; clamps uterine ligaments; GYN
C) O’Sullivan-O’Conner- self-retaining retractor; hold open a pfannenstiel
incision; GYN, GU
D) Bakes dialator- biliary dialator; dilates the biliary tract; GI
E) weitlaner- self retraining retractor; holds open a variety of small wounds;
several specialties, including vascular, general, neuro, and ortho
F) gelpi- self retaining retractor; holds open a variety of wounds; general
mostly, neuro and ortho occasionally.
G) cushing bayonet forceps- forceps; extension of fingers into small areas, or
areas where fine dexterity is needed; ENT, neuro, ortho
H) hurd- dissector and pillar retractor; one end helps to free (or dissect) the
tonsil from its fossa, the other end retracts; ENT, T&A specifically
I) cottle speculum- speculum; holds nose open for visibility in the nose; ENT
J) bailey - rib contractor; holds ribs in position for closing the chest; thoracic
K) sauerbruch- rib ronguer and rib shears; takes bites of bone, cuts rib;
thoracic
L) lebsche- sternal knife; cuts sternum (used with a mallet); Thoracic, vascular
39) Name some common dermatomes, and explain their - used for split-thickness
skin grafts (STSGs). Knife dermatomes. Drum-type manual dermatomes (Reese and
Padgett-Hood): restricted to use on flat or open areas but provide uniform thickness
for STSG. Motor-driven dermatomes (Brown, Padgett): have oscillating blades that
work like hair cutters wit power supplied by electricity or compressed air: for use on
firm areas such as the things, opened up and kept on separate sterile table, foot pedal
is placed at surgeon’s feet when ready for use and removed immediately after use,
blades is inserted into the carrier, generally by the surgeon, and adjusted for desired
thickness, sterile mineral oil is applied to the donor site and the assistant holds tissue
taut with a sterile tongue blade.
40) Describe the action of a skin mesher and its use - enlarges graft two to three
times by making multiple uniform slits in the skin graft. Used for expanding skin to
cover large denuded areas. Skin, removes by a dermatome, is stretched out over
plastic disposable dermacarrier and passed through rollers of the skin graft mesher.
Scrub or assistant grasps edges of the skin with Adson forceps as it is advanced. Skin
is left on the carrier and kept moist with saline until the recipient site is ready.
Immediately after skin is removed, the donor site is covered with moist sponges
soaked in a solution of 20 mg of Neosynephrine to 100 ml of normal saline or sprayed
with topical thrombin for hemostasis. Donor site dressed with nonadherent gauze,
moist dressings, or covered with bio-occlusive dressing. Skin may be sutured or
stapled in place on the recipient site.