Making the Cut: Opening Formation
The Field of Play
Threading the Needle
Red Card for Infections
Nerve Wracking Stoppage Time
100
During laparoscopic entry at the umbilicus, the Veress needle is typically inserted at a 45-degree angle toward which anatomic landmark in patients with normal BMI?
Sacral Promontory
100
The obliterated remnant of which fetal structure forms the median umbilical ligament?
The Urachus (allantois)
100
Which needle is larger: A CT-1 or a CT-2?
AND
What does CT stand for?
CT-1
Circle Taper
100
You have chosen Ancef for surgical prophylaxis for your patient who weighs 160 lbs. What dose does she need?
1 gram
100
Following prolonged lithotomy positioning, the patient develops foot drop and sensory loss over the dorsum of the foot. The inability to dorsiflex the ankle would make dribbling down the pitch nearly impossible. Which nerve is affected?
Common peroneal nerve
(silly Allen stirrups)
200
Much to Dr. Schwartzenburg's displeasure, our team booked him yet another TAH (why nothing minimally invasive?)
He along with the team chose to make a Pfannenstiel incision for the laparotomy. During fascial entry, the anterior rectus fascia is incised transversely and dissect off the rectus muscles. What neurovascular structures are at risk during this dissection?
Inferior epigastric vessels
Iliohypogastric nerve
Ilioinguinal nerve
200
What are the branches of the Anterior Division of the Internal Iliac Artery (7)
Pudendal (internal)
Inferior Gluteal
Middle Rectal
Vaginal
Obturator
Uterine
Superior Vesical
200
Name the 3 parts of a needle
Point
Body
Swage
200
A patient with a severe β-lactam allergy receives clindamycin and gentamicin prior to TAH. Which antibiotic, if any, should be redosed and when?
Clindamycin - ≥1500mL EBL or q6 hrs
200
After abdominal hysterectomy with prolonged self-retaining retractor use, the patient is unable to extend her knee and has diminished patellar reflexes.
Similar to a soccer player who can't take a proper penalty kick because they can't "strike" the ball, what nerve was injured?
The femoral nerve
(Often from lateral retractor blade compression on the Psoas)
300
Name this incision
Cherney incision
300
During Veress needle entry, which two conditions are considered absolute contraindications to using Palmer's Point?
Gastric distension
Splenomegaly
(Known upper abdominal adhesions)
300
Order the suture type from weakest to strongest:
Silk, PDS, Prolene, Nylon, Vicryl, Plain gut, Chromic gut
1) Chromic gut
2) Plain gut
3) Vicryl
4) PDS
5) Silk
6) Nylon
7) Prolene
300
You perform an HSG on a patient who is found to have bilateral hydrosalpinx. What, if any antibiotic and regimen recommended upon discharge?
Doxycycline 100mg BID x 5 days
300
After pelvic lymphadenectomy, a patient develops weakness with thigh adduction and numbness of the medial thigh. A midfielder who suddenly can't keep the ball between their legs might have a similar deficit. Which nerve was injured?
The obturator nerve
(Injured during lymph node dissection, commonly can't ride a horse)
400
You are performing ureterolysis during laparoscopic hysterectomy. Which electrocautery setting would minimize lateral thermal spread while maintaining effective tissue division AND which is the correlating wave form?
Pure cut
(c)
400
What structures pass through the inguinal canal in a female patient?
1. Round ligament
2. Ilioinguinal nerve
3. Genital branch of genitofemoral nerve
400
We tell our patients that the suture we use "dissolves" - but it doesn't.
Name the way each of the following sutures absorb:
(1) Chromic gut (2) Polygalactin (Vicryl)
(1) Chromic Gut - Enzymatic degradation (proteolysis)
(2) Polygalactin (Vicryl) - Hydrolysis
Plain gut - Proteolysis
Monocryl + PDS - Hydrolysis
400
What is the mechanism of action of Ancef?
Bactericidal
Inhibits cell wall synthesis by binding to penicillin binding proteins
400
Following pelvic sidewall dissection, the patient reports numbness over the upper anterior thigh without motor deficits. The injured nerve normally courses along the anterior surface of the psoas muscle. Fortunately, a soccer player with this injury would still make the roster because they have no problem with their motor function. What is the nerve injury?
Genitofemoral nerve
500
During a difficult retroperitoneal dissection, surgeons use a combination of techniques to identify and maintain avascular tissue planes while minimizing collateral bleeding or injury. Name 3 of the classic techniques of expert tissue handling used.
Expert Tissue Handling:
1) Grasp and Tent
2) Push and spread (Blunt dissection)
3) Traction / countertraction
4) Hydrodissection
5) Gentle wiping/teasing
500
What avascular pelvic space is bounded anteriorly by the posterior wall of the bladder, posteriorly by the anterior vaginal wall and cervix, laterally by the vesicouterine ligaments, and superiorly by the vesicouterine peritoneal reflection?
Vesicovaginal space
500
At a patient's routine 6-week postoperative visit following TAH, approximately what percentage of their original tensile strength remains in the Vicryl used to close the vaginal cuff and the PDS used to close the fascia?
Vicryl - 0% (the tissue takes over!)
PDS - around 50% (75% at 2 weeks, 50-60% at 4 weeks, 30-50% at 6 weeks)
500
A patient with morbid obesity receives cefazolin prophylaxis before hysterectomy. Despite appropriate preoperative dosing, obesity remains an independent risk factor for surgical site infection. According to ACOG, name two additional interventions recommended to reduce infection risk.
1. Appropriate weight based dosing
2. Vaginal preparation
3. Avoidance of postoperative hyperglycemia
4. Smoking cessation if applicable
5. Appropriate skin antisepsis
6. Maintenance of normothermia
500
A patient underwent a TLH 3 weeks ago and now reports burning pain in the RLQ radiating to the right groin. The pain is severe with light touch from her clothing, worsens with coughing or sneezing, and improves with hip flexion. Unlike a dramatic World Cup player trying to draw a foul, this patient truly has allodynia. Injury to what two nerves could explain these findings?
Ilioinguinal and Iliohypogastric