Module 1, Medical deal and pediatrics

Transcription

1 Module 1, Medical deal and pediatrics Department of operative surgery and topographic anatomy Test questions for self training for passing Module 1, writing part Paractical questions with images The patient has been scheduled surgery that requires opening the skull. In the proposed two schemes of skin incision select one that you think is correct. Justify your answer. The figure shows conditional most frequent types of external hernias of abdominal wall. Give them a name, and sign the anatomical structures that are weak to every type of hernia. Specify the names of the two incisions shown. For what operation they used?where is the McBurney point? 1

2 Show location of pericardiocentesis point. Planned removal (1) of tumor (2). Determine which segments will be deleted. The mammary gland is divided into 4 conditional squares. What caused such a clinical necessity? Describe, in which lymph nodes accept lymph from each square. 2

3 Name the tool shown. What is the purpose of button located on one branch? Name shown tool. What is the advantage of this tool over the flat saw? Draw the location of lower central laparotomy. Which anatomical formations will be dissected along such incision? Advantages and disadvantages of this incision. Draw the transverse and longitudinal sternotomy. Which blood vessels in the transverse sternotomy may be damaged? What are the advantages and disadvantages for each? 3

4 Draw a layout for Lanz point and its location. What the importance for this point? Draw a layout for McBurney's point and its location. What the importance for this point? How many meningeal arteries usually taken to consideration? Draw the branches of middle meningeal artery. Draw on picture the trepanational Shipot triangle. Which structures are adjusted to the borders of triangle? 4

5 Explain the necessity of additional anastomose and its advantages and disadvantages. Sign numbered elements Sign parts of biliary tract. Sign large intestine parts and its location relative to the peritoneum. Sign of the stomach. Which parts of the stomach and why are more inclined to have ulcers? 5

6 Sign labeled triangles. What symptom is checked in the triangle number 5? From which side? Sign showed structures on tomography of paranasal sinuses. Sign segments of liver and pointed vessels. Sign different location types of appendix. 6

7 List the sutures shown in the image. What is the current stage of surgery? What type of anastomosis pictured? Dissection of liver tumor (2) planned, tumor partially blocks the venous outflow. Specify the dissection type (1). Sign depicted liver veins. Removal (2) of tumors (3) planned. Determine which segments are deleted sections (2) and (1) Divide, number and sign in Latin the division of the anterior abdominal wall into nine sections. 7

8 Draw the line for Pfannenstiel incision on abdominal wall. For which surgery this approach may be used? Point with arrow the place of efficient blockage of arterial bleeding from the cheek. Which artery is blocked? What artery it descends from? Tumor (1) blocks the venous outflow. What is the prognosis? What is the possible surgery? Sign the listed vessels. 8

9 What is the incision name that is shown between two cartilage? Sign labeled cartilages. What is the purpose of this intervention? What are volumes of resection show with numbers? The most frequent indications for this surgery. What benchmarks are used for conventional lines 1 and 2? What are the three areas that will occur due to horizontal lines? What are the causes of torticollis (wry neck)? What muscles are damaged? What types of torticollis you know? Highlight main steps of surgical treatment. 9

10 What lip malformation shown? At what age surgical treatment recommended? List the main stages of surgical intervention. What type of hernia pictured? What the idea of operation of cruroraphy? Sign numbers. What is the possible operation is shown in figure? Sign numbered objects. What is the name given suture? According to sterility, is it "dirty" or "clean"? Give an example of surgical intervention where this suture is used. 10

11 What is the name of incisions, as shown in the picture? What are the advantages and disadvantages of each? What is the name of the section shown in the figure? What are the typical surgery can be performed using the following access? What is the name of the section shown in the figure? What are the typical operations can be performed using the following access? Why umbilicus bypassed from the left? Which rule for removing stitches shown in the image? What is the danger of non-compliance with this requirement? 11

12 What complication shown with tracheostomy tube inserted? What other complications associated with the introduction of tracheostomy tube may occur? The name of the tool shown? What groups of surgical tools do you know? Which group this tool belongs to? What suture is shown on picture? point its advantages and disadvantages. What is the manure shown in the picture? What the section direction is possible to apply to improve passage for point-to-point anastomosis? 12

13 What suture shown in the picture? What stitch can be used after shown suture to complete processing of the stump? Outline with pen the stomach parts where ulcers are more common. Justify your answer. Mark on schematic drawing of the stomach the volume to be removed for subtotal resection. What are the indications for removal of this volume of the stomach? What caused the need for surgery in the needles of varying curvature? Which of these types of needles commonly used? 13

14 Divide pharynx into three anatomically correct parts and sign their names. What type of suture is shown on the figure? What is the role of buttons under the strings? Sign numbered formations What operation done here? Where implanted vessels usually taken from? Sign labeled vessels. 14

15 Draw the incision of skin which will be used to open inflamed mastoid cavity. What type of suture pictured? What is the name of this suture? Advantages of specified suture in comparison to usual intermittent suture? The pharynx is divided into nasopharings, oropharings, laryngopharings. Check these parts in the picture. Which anatomical benchmarks are between them? The picture shows one of the extended portocaval anastomoses, better known as caput medusae. What two more other portocaval anastomoses you know and how they manifest clinically? 15

16 Outline Calot triangle on the image and describe its borders. For which surgical interventions this triangle will be a guideline? Sign numbered structures. Name parts of ductus choledochus. Point with arrows sinus highmori and meatus nasi inferior. Where the maxillary sinus opened to nasal cavity and where it should be punctured? The human body is studied in three projection planes. Write their names. 16

17 Name the depicted lines on which placemarks they held through? Name the depicted lines on which placemarks they held through? Name the depicted lines on which placemarks they held through? What is the "pathologic circle" which can appear during gastroenteroanastomoses? What is the type of gastroenteroanastomose pictured here, sign numbered elements Test questions 17

18 1. Weak spots of abdominal wall (along middle line) which can give hernias 1).2). and weak spots of lateral region 3).4). 2. What the surgical access to stomach for gastrostomy 1). 3. What the aim of decomplession skull trepanation 1). 4. What the contents of neuro-vascular bunch of the neck 1).2).3). 5. Name adjuscent vesels to the right bronchus which may be damaged during pulmonectomy while we will beprocessing the its ending. 1).2). 6. Which connective tissue layers of the cerebral vault region are more anatomicaly disposed for large distributed extracranial hematomas and pus collection 1).2). 7. In what direction the connection between two thyroid gland lobes should be moved 1). and which rings of trachea dissected 2). for tracheostomy operation 8. Indicate sources of cranial blood supply 1). 2). 9. Name essential stages of surgical treatment for hernias 1).2).3). What the specifics if hernia is blocked (not sliding) 2). 10. Why Toprover's gastrostomy is named as permanent 1). 11. Name sources of blood supply of thyroid gland 1).2).3). 12. Name important cartilages of neck region which are serving as topographic place marks 1).2). 13. Which structures are usually the gate for direct 1). and indirect 2). inguinal hernia 14. Give relative estimation to intermittent and continuous sutures: We can stitch quickly with 1). suture, more reliable is 2) suture, the opening can be fastened with 3) suture. 15. Where and when one can distinguish the pulsation of hepatic artery and the state of hepatic common duct 1).2). Why under the pathologic conditions of common hepatic duct it is not reasonable to create anastomoses between right hepatic duct and duodenum 3).4). 16. Which veins are responsible for creation of porto-caval anastomoses in the region of anterior abdominal wall 1).2).3).4).5). Which veins are developed in umbilical region 6).7).8). 17. Which placemarks are used to define the projection of the bottom of the gallbludder 1).2). 18

19 18. Which veins can be found in the gates of liver 1).2). 19. Which surgical approached may be suggested to uncover abscesses of retro-pharyngeal space 1).2). 20. Complication one can face with while we make puncture of sub-clavicle vein 1).2).3).4).5). 21. List layers which are covering hernial bag in case of direct inguinal hernia 1).2).3).4). 22. Location of Sphincter of Oddi 1). 23. What is the location of Lütkens sphincter 1). 24. Name the parts of the stomach 1).2).3).4).5). 25. Name organs which can be substituted on plactic surgery by loops small intestine 1).2).3).4).5). 26. Mention all veins you will pass through if you will be inserting catheter in the chambers of the heart throught subclavicular vein 1).2). 27. How to stop bleeding from the liver temporary 1). permanently 2). 28. How one can stop bleeding temporary from liver 1). What suture may be used to stop bleeding permanently 2). 29. How inflammation of frontal, maxillary sinus called 1).2). that has developed due to catarrhal inflammation of upper respiratory organs. 30. Point the location of Virchow's node 1). 31. List requirements to intestinal suture 1).2).3).4).5). 32. Name the types of gastrostomy. 1).2). Name the most widely used author methods of gastrostomy 3).4).5). 33. Provide anatomical explanation of the term сaput medusae, which can be observed in patients with portal hypertension. 1). Where is exact location of the this symptom 2). Name big veins which are creating anastomoses on the anterior abdominal wall 3).4).5). 34. Give anatomical explanation of term сaput medusae 1). When 2). and where 3). one can watch this symptom? 19

20 35. In what direction the isthmus of thyroid gland should be moved 1). Which trachea rings are to be dissected for the lower tracheostomy? 36. Give the definition for tracheostomy term 1). 37. The damage of which layer of the brain will show blood in liquor 1). 38. Why bleeding from sinuses of dura mater does not show tendency for self stopping 1). 39. Name the space between cranial layers where quite a good condition persists for distributed hematomas 1). 40. Which anatomical formations are in charge for production of cerebrospinal liquid? 41. What is the dissection direction used, if dissecting hernial blocked bag (the ring of blockage) for direct 1). and indirect hernias 2). 42. With help of which structuress the infection from the inflamed place may be distributed to the sinuses of meningeal layer 1).2). 43. Name structures which are creating the borders of Calot triangle 1).2).3). 44. Name sphincters of bile ducts 1).2).3). 45. Borders of carotid triangle, anterior 1) posterior.2). upper 3). 46. Name neck triangles where one can find sub-clavicle artery 1).2). 47. What the triangle you should know to make operation called mastoidectomy 1). 48. Which triangle serves the place for exposing of external carotid artery 1) 49. Name lymphoid formations of nasopharynx, which frequently involved in inflammation in patients with nasopharyngitis 1). 50. What complications may happen if dissections of recurrent nerves will happen on the operation of thyroid gland removal 1).2). 51. Which part of abdominal cavity under roentgenological investigation will show gas allocation when perforation of duodenal ulcer 1). and stomach 2). What is the deepest pocket of abdominal cavity for males 3). and females 4). 52. Name the parts of common bile duct 1).2).3).4). 53. Name nerver located at the anterior 1). and posterior part of esofagus. 2) 20

21 54. What is the deepest sinus of pleural cavity 1). 55. Name pathologic condition of anterior abdominal wall which may happen when muscular tonus is weakened 1). 56. What the aim of sub-clavicle vein cauterization 1).2).3).4). 57. The outflow of the blood from liver 1). Dangerous complications for have one can have if veins damaged 2). Name hepatic veins 3).4).5). 58. Point the formation where sigmiod sinus is opened 1). 59. The joining of which layers of intestine will provide hermetic stitching of wound 1). and strength 2). 60. Joining of which intersinal layers will give hermetic feature to the stitch 1). What should carefuly be isolated from possible infectioning while dissection of intestine 2).3). 61. Which pleural cavity sinus usually collects pathologic liquid 1). 62. Which foramen of skull penetrated by vertebral arteries? 63. What is the projection line for general carotid artery 1). 64. Mention all complications we may face with on pleural puncture 1).2).3). 65. According to your opinion, what the aim surgeon puts for himself when choosing ⅔ of stomach volume removal when patient has ulcer disease 1).2).3). 66. Name layers of cellular tissues of temporal region 1).2).3). 67. Name special instruments needed for rib resection 1).2).3).4). 68. What are the blood supply sources of anterior abdominal wall 1).2).3). 69. What the consequences may happen if internal carotid artery will be ligated instead of external 1). 70. Name layers you will meet during making dissection when conducting lower tracheotomy 1).2).3). 71. Weak places of anterior abdominal wall within umbilical region 1).2).3). Usual contents of umbilical hernia 4). 72. What is the danger of hernia blockage 1). Indicate the place where inguinal hernia may be blocked 2).3). 21

22 73. Name ligaments creating smaller omentum 1).2).3).4). 74. Give definition of the term "gastrostomy" 1). Name the parts of digestive system which will fit to this operation due to theirs anatomical structure 2).3).4). The aim of this operation 5). 75. Parts of duodenum are 1).2).3).4). and pancreas are 5).6).7). They are located 8).9).10). 76. Name branches of aorta the occlusion of which will give damage to brain circulation 1).2).3). 77. Which manure one can use to prevent outflow of stomach contents to the abdominal cavity when performing gastroenterostomy operation? 78. Give a name for meningeal artery that can be damaged along with injuries of occipital region 1). 79. Name the main types of tracheostomy. 1).2). The direction of dissection lines of the skin may be 3).4). 80. Name vessel passing jugular foramen 1). 81. Layered building of inguinal region 1).2).3).4).5).6).7).8).9).10). 82. Name differentioation signs of cecum and sigmoid intestine 1).2). 83. Indicate the most inportant mediastinal cellular spaces 1).2).З). 84. What the danger of trachea injuries 1).2).3). 85. Explain the reason of additional anastomose by Braun while performing gastroenterostomy 1). Which type of gastroenterostomy implies its presence 2). 86. Explain what forms the fascial capsule for the thyroid gland 1). 87. Explain why in hair-covered part of the head one can observe formation of scalp wound 1). Which tissue layers are in scalp 2).3).4). 22

23 88. Indicate the sources of arterial blood supply of the organs of the lower floor of abdominal cavity 1).2). 89. Explain, why vessels of subcutaneous cellular space of cerebral region are not collapsing after cuts 1). 90. Why retropharyngeal abscess usually are one sided (from the left or from the right) 1). 91. Determine which cellular neck spaces are combined with anterior mediastinum 1).2). What complications may occur in patient having phlegmon in these cellular spaces 3). 92. Name all branches of internal carotid arteries participating in formation of circle of Willis 1).2). 93. Give names for carotid communis artery branches which participating in the circle of Willis 1). 94. Name essential brain grooves 1).2).3). 95. How dissection of vagus influences of stomach secretion? 1). Which types of vagotomy usually used for treating of ulcers 2).3).4).5). 96. Anatomical structures in th root of the lung are 1).2).3). 97. Amount of segments in left lung is 1). and in right lung is 2). 98. Which vesels may be damaged while pulmonectomy on procession of the left bronchus 1).2).3). 99. Which mainly used surgical approaches to lungs you know 1).2) Explain why the damaged vertebral artery bleeding occurs from both proximal and distal ends of the vessel 1) Explain, why cut neck veins are remaining opened 1). and what complications it may bring 2) Which methods of cranial topography are used in clinics to project onto spherical surface grooves and and meningeal layer arteries 1).2) Which nerve damage implies disorders in face skin innervation? 1) Damage of which nerve will bring disorders in mimic muscles innervation 1) An examination of the patient revealed dysfunction of the circular muscle of the eye, the asymmetry of the face and sagging corner of the mouth. What nerve damage which can produce the following symptoms 1) Explain the reason of profound bleeding during traumas of soft tissues of cranial region 1).2). 23

24 107. Indicate the aim of small intestine resection 1).2). Which surgical approach used for these operations 3) Which anatomical blood supply specifics gives opportunity to use small intestine for plastic and restoration surgery 1) What the cellular space may serve as a source of condudted pus in subtemtoral fossa 1) Which organs are placed in anterior mediastinum 1).2) What the skin incision line shape used for mastectomy 1) What the topographical particularities of anatomy of occipital region which are explaning the posibilities of pus distribution from the placed here carbuncle to the sinuses of meningela layer 1).2) Which essential indications to put stomach to intestine anastomoses 1).2). The aim of operation 3) Which vessels one can damage while making dissection in intercostal space 1).2) Where McBurney's point located 1). and for what purpose this point is used 2) Which main dissection lines are used for opening of purulent mastitis 1).2) Indicate the direction of surgical dissection and its placement on abdominal wall while performing operation of unnatural feces opening 1).2) Name the direction of incision for appendectomy on abdominal wall when performing Volkovich-Dyakonov access 1).2). Location of Lanz' point 3). McBurney point 4) Name superficial ligaments of stomach 1).2).3).4).5). and deep 6).7) Indicate places where the congenital narrowings of aorta may be met 1).2) Mention here all the parts of the common bile duct 1).2).3).4) Name layers of lateral abdominal wall 1).2).3).4).5).6).7).8).9).10) What are the requirements for abdominal wall dissections 1).2).3). Name main types of abdominal surgical dissections 4).5).6). 24

25 124. Describe possible surgical access variations to pancreas when abdominal cavity is opened already 1).2).3) Name the sequestial steps for operation of intestine resection, with later side to side type of anastomose performance when abdominal cavity is opened already 1).2).3).4).5) Indicate, wich disorders one can have after removing of illeocecal angle 1).2) List all differences that are distunguishing for transverse colon from ascendent colon and cecum colon. 1).2) Name the sources of blood supply of large interstine. 1).2).3).4).5). And the ways of venous outflow 6).7).8) Name layers which are sharply dissected by surgeon wich lancet 1).2).3).4).5).6) while surgical approach and layers with blunt dissection 7).8) Mention blood supply sources of the liver 1).2) Name all differences of large interstine from small intersine 1).2).3).4) Mention please all regional lymphatic nodes of the mammary gland 1).2).3).4) What the main ways you can introduce small intestine for the esophageal plastics 1).2).3) Indicate, which layers are covering not complete oblique inguinal hernia 1).2).3).4).5).6). and complete inguinal hernia 7).8).9).10).11).12) Name the muscle disposed in the neck, which is used as an external reference when performing operations 1) Mention basic steps for creation of anastomose, whet the abdominal cavity is opened already 1).2).3). How we should remove (the direction of the cut) the loop of smal intestine. 4) 25

26 137. What anatomical predispositions and blood supply specifics allow using small intestine for plastic restoration operations 1) What the technical maneurs are used in operation of colostoma that will prevent the possibility of infectioning of cellular layers of the abdominal wall 1). and of the abdominal cavity 2) Name venous sinus, the damage of which may happen upon the injury of the temporal region of the head 1) Name veins which entering liver 1).2). Which structures holds hepatoduodenal ligament 3).4).5) Which opening provides anatomical connection between veins of nasal cavity with upper sagital sinus 1) Name structures that bordering with stomack: from the top 1).2). from beind 3).4).5).6). in front of 7). below 3).9) What the shape of surgical neck dissection line for subtotal thyroid gland dissection 1). The cut line should be higher than the mandible of sternum for 2). cm Where is the place to check phrenic symptom 1).2) Name the place of dissection where we need to make preparation of the neck part of esophagus 1) Specify the structural features of the hernial sac in case of sliding inguinal hernia 1). At what sliding inguinal hernia in the formation of the hernia sac the bladder wall can be involved 2) Specify the pathogenetic factors of acute mastoiditis 1). Where the place of uncovering the antrum 2). in case of mastoiditis surgery? 148. Which parts of thyroid gland are not supposed to be removed when performing thyroidectomy 1). Why 2) Wich feature of peritoneum layer implies usage of sero-serous suture 1).2) What the most usual spaces of pus location when purulent mammary gland inflammation suspected 1).2).3) What benchmarks are used for the projection of the gallbladder in the abdominal wall 1).2). Name adjacent structures to gallbladder from front and top 3) Specify what complications can occur in penetrating wounds of the chest cavity 1).2).3).4). 26

27 153. Indicate why patients having tumors in the head of the pancreas having impaired passage of bile through the common bile duct 1) Indicate the place where pancreatic duct opened. 1). Explain, why this duct sometimes visible while bile ducts x-ray imagining performed? 155. Describe the main anatomical landmarks that are used for puncture of lateral-phrenic sinus 1).2).3) What are the main sources of blood supply of the anterior abdominal wall 1).2).3).4). Specify the veins that form cava-caval and porto-caval anastomoses 5).6).7) Which pericardial sinus is the most prone to collect pathologic liquid 1) Describe borders of inguinal region 1).2).3) Name the walls of inguinal channel in normal condition 1).2).3).4). and with hernia 5).6).7).8) 160. Name the sequence of stitching by intestinal sutures when performing entero-entero anastomose with point-to-point way. What the maneur will avoid narrowing of such anastomose? 161. The fracture of which bone one can suspect if patient has profound bleeding from ears 1) Explain surgical latin term endings -tomia 1). -stomia 2). -ectomia 3). -raphia 4) -pexia 5). -centesis 6). which are frequently used in the names of surgical manures and operations. Paractical questions 1. Describe sequence and specifics for middle laparotomy. 2. Find on cadaver and describe arteries and veins giving blood to large intestine 3. Describe dissection peculiarities on face due to purulent inflammation of parotid gland. 4. Technique to stop bleeding from meningeal artery and from venous sinus of the brain. 5. Describe operation of upper tracheostomy 6. Describe, how pneumothorax should be closed? 7. Describe appendectomy operation 8. Describe neck fascial layers which can be dissected while performing surgical approach to neck organs 9. What the differential signs of internal and external carotid artery? 10. What are the borders of Shipot triangle? Explain possible complications for its trepanation. 11. Describe operation details of lower tracheostomy 12. Calculate and describe the layers of the temporal region. 27

28 13. Describe process of sequential abdominal wall dissection along the inguinal ligament. 14. Describe operation - decompression trepanation of skull 15. Describe the operation of maxillary sinus trepanation 16. Describe, how to perform trepanation of frontal sinus. 17. Give arguments for the necessity of definition of the appendix projection on the anterior abdominal wall. 18. Describe surgical access to lower part of esophagus 19. Describe operation of mastoid process dissection 20. Describe operation of rib resection 21. Describe stages of operation of appendix removal. 22. Show on anatomical preparation the lateral triangle. Describe borders of this triangle. 23. Describe dissection of subareolar mastitis. 24. Describe pleural punction. 25. Describe vago-sympathetic neck block by Vishnevskiy-Burdenko. 26. Stitching of liver wound. 27. Transrectal dissection. 28. Make a gastrostomy by Stamm-Senn-Kader. 29. Describe dissection for retro mammal mastitis. 30. Stages of sectoral resection of breast on the body. 31. Describe dissections for intramammal mastitis. 32. List and describe the layers of the fronto-parietal-occipital region. 33. Give a rational anatomical justification of the sections with phlegmon and abscesses of the neck. 34. Describe basic steps of osteoplastic trepanation skull trepanation. Situational questions 1. The patient with penetrative injury of umbilical region was recently hospitalized to the surgical department. Which layers of abdominal wall were possibly damaged? 2. While operating patient with blocked inguinal hernia (after premedication and anesthesia) surgeon made layer-by-layer incision and got hernial bag. After dissection of this bag he didn't find any contents. What big mistake surgeon did? 3. While stitching up prolonged wound of small intestine, surgeon put only one row of sutures. After closing the wound he dried cavity and closed layer by layer abdominal cavity. Any mistakes surgeon did? 4. Patient with fracture of clavicle has shown signs of opened pneumotorax. Which part of parietal pleura has been damaged? 5. The patient was hospitalized to the thorax surgery department with gunshot injury of chest. Examination showed than on the fifth intercostal space along parasternal line bullet entrance opening present. Pulse 117/s, blood pressure 85/80 mm of Hg, breathing - 20/min. Auscultation from the left in IV-VI intercostal space aside parasternal line revealed dull sound. Your diagnosis? 6. For temporal bleeding blockage of dissected liver surgeon pressed with fingers hepatic-duodenal ligament, after he entered with fingers of left hand to omental opening. Recollect please, which structures forming that opening. 7. On the question of "What creates the vagina for neuro-vascular bunch?" student answered "Scapulo-clavicular aponeurosis". Is that right? 28

29 8. A patient was enrolled with a penetrating wound to the chest. An objective examination revealed a stab wound measuring 2.5 1cm in the fourth intercostal space on the left parasternal line. What tissue layers the sharp object has damaged? 9. With the purpose of conducting anesthesia and artificial lung ventilation, we need to make intubation through the larynx and trachea. Which structures are forming the entrance to larynx that we need to pay attention on? 10. After intubation with the aim of connection of anesthesiology equipment with following artificial lung ventilation, patient showed enlarged abdomen with tympanic sound on percussion. What the mistake of the anesthesiologist and how you should prevent it? 11. In disclosing purulent mastitis surgeon received massive bleeding. Recollect the sources of blood supply of the mammary gland, the damage of which could cause bleeding. 12. While making punction of pleural cavity in the seventh intercostal space on the anterior axillary line, surgeon punctured the intercostal space and obtained blood in syringe. Surgeon decided to put the diagnosis of hemothorax. what was the mistake of the surgeon? 13. Purulent inflammation in the neck region caused progression of this inflammation to the mediastimun. Which neck cellular spaces may be the primary reason? 14. During subtotal subfascial resection of thyroid gland patient was showing the symptoms of dysphonia. Which anatomical structures were involved and possibly damaged? 15. While performing the pleural puncture with thick needle without syringe in patient who had empiema, patient showed rising of breath and showed dizziness. How one can explain these complications? 16. The patient was hospitalized to the thorax surgery department with the suspicion of blood in pericardia bag. What the moves of surgeon to diagnose this pathologic condition? 17. Patient unwillingly removed rubber tube leading to the stomach, after his operation of gastrostomy by Witzel. What is the mistake of surgeon during operation had took place, any ideas what steps you should do now? 18. During the operation of hernial bag dissection the testicle was found. The patien is boy, of 12 years. What the hernia type patient has, explain the mechanism how this hernia appeared. What special maneuvers needed in this case? 19. A child swallowed a coin. Rentgenologic investigation the coin is shadowed on the level of VI vertebra, from the left. Explain such localization of foreighn body. 20. The toracal department of local hospital has accepted patient with already diagnosed tumor of thoracic region of esofagus. Point out the most apropriate surgial approach to thoracic part of esophagus. 21. While discussing classification of segmental building of the liver, students argued about its anatomical background and necessity of such classification. Help colleagues to get with each other, explain why liver divided in certain amount of segments. 22. When performing the operation of rib resection with the aim to use it for future plastics, the patient got pneumothorax. What is the mistake the surgeon did? 23. On the next day after the operation of plastics of right inguinal hernia patient complained on pain along the keft spermatic cord. Left side of scrotum is enlarged and has tint of blue color. Possible reason of this complication? 29

30 24. Patient with tracheostomy in postoperative period while eating complaining on particles of food appearing in tracheostomic tube, usually combined with strong cough. What the mistakes were made during operation of tracheostomy? 25. The patient has serious aortic insufficiency. What the location of stethoscope application of anterior thoracic wall? 26. In the department of surgical gastroenterology the patient of 30 y.o. was admitted with the diagnosis of high (duodenal) food blockage. Using your knowledge of anatomy, give explanation, why this blockage might have happened. 27. Patient has bicuspid valve deficiency. Indicate the point we can use to apply stethoscope to listen to this valve. 28. Students were performing entero-enterostomy, on small intestines with point to point type of anastomosis. Along with other work, one student made transverse cut to the axis of the intestine. Was that correct step? What would you do instead? 29. The bleeding appeared in the wound while conducting tracheotomy with transverse cut of trachea. The damage of which artery happened here? 30. Which anatomical formations you will meet with while making extraction of thyroid gland from its fascia bag with the aim of gland removal? 31. Children of early age sometimes showing the signs of nasal breath obstruction. This may be associated with enormously big development of lymphoid tissue of mucous layer of pharynx. Overgrowth of which tonsils may cause these symptoms? 32. The venous arc was damaged while surgeon was conducting vertical dissection on neck along white line. The bleeding didn't happen, thus, he left this area without attention. On forthcoming steps of operation, the patient showed symptoms of respiratory insufficiency. Explain what has happened. 33. While puncture of left sub-clavicle vein, surgeon obtained transparent opaque liquid. What the mistake of the surgeon? 34. The surgeon made two deep radial dissections on the patient with retro mammal abscess. What the mistake of surgeon. What your advice? 35. During the revision of the abdominal cavity of the patient after blunt abdominal trauma surgeon discovered massive bleeding from the liver. How you conduct a temporary stopping of bleeding in this case? 36. In tuberculosis of the apical segment of the right upper lobe surgeon performed a right-sided pneumonectomy. Was the radicalism of this surgery justified? 37. During operation of appendectomy surgeon revealed retro-cecal position of appendix. What next steps and guidelines you will suggest to surgeon in this case? 38. While performing operations on posterior mediastinum, there is always high probability to damage nerves placed from the front and from the back of esophagus. What are these nerves & their functions? 39. The patient of 41 y.o. was diagnosed with gastroptosis. Indicate, which sceletotopical placemarks was used by rhentgenologists to put such diagnosis. 30

31 40. Woman of 49 years was hospitalized due to acute pancreatitis. The complex of conservative measures didn't show significant results. Upon surgical intervention, on revision stage, the oedematic changes of pancreas were revealed. Common hepatic duct was dilated, the gall bladder was tensed, and cannot be emptied. How one can explain this? Revision date: 14 Nov