case

No Question ansers

1.06 1. The pa)ent turned to the policlinic with complaints about The surgical neck of the humerus, the injury of the axillary nerve
impossibility of independent abduc)on of the arm )ll the
horizontal level. In the anamnesis – there is a men)on about
fracture of the humerus, which occurred 3 months ago.
Specify the level of the fracture and the possible cause of
par)al loss of func)on of the upper limb.

16.03 1. During opera)on on ovarian cancer the surgeon should ligate To find the ovarian artery it is necessary to find the so-called fossa
the ovarian artery. What internal landmarks are used to find ovarica, located on the parietal peritoneum of the posterolateral wall of
it? What structure should be protected from the accidental the pelvis. The fossa is bordered by linea terminalis and external iliac
liga)on? vessels superiorly, internal iliac vessels posteromedially and the
attachment line of the broad ligament of the uterus anteriorly. This
triangular fossa serves to find the ureter (it is located more closely to
the posterior border) and the ovarian artery (which is located more
anteriorly and medially). The structure which should not be
accidentally ligated is the ureter.
10.06 1. The radical mastectomy by Halsted has been performed to the Radical (Halsted) mastectomy; greater and lesser pectoral muscles,
pa)ent. What anatomical structures (besides the gland) are axillary fatty tissue and all five groups of the axillary lymph nodes are
removed by this opera)on? Give the topographical removed. While removing the fatty tissue one should take care of the
substan)a)on for the ac)ons of the surgeon. vessels of scapular vascular network as much as possible to prevent
lymphostasis in the upper extremity.

5.06 1. The pa)ent with a phlegmon of the posterior region of the thigh The pus spread under the gluteus maximus muscle along the sciatic
was accepted to the surgical department. During the opera)on nerve and into the compartment of the adductor muscles — along a.
it was found, that the pus has spread under the gluteus curcumflexa femoris medialis (r. descendens).
maximus muscle and into the compartment of the adductor
muscles. Give the topographical substan)a)on for this
complica)on

9.06 1. ALer inferior tracheotomy the phlegmon of the superior and After inferior tracheotomy the phlegmon can spread into the superior
anterior medias)num has developed in a pa)ent. What were and anterior mediastinum due to the fact, that the previsceral fat space
the ways of spreading of the infec)on? of the neck communicates with the fatty tissue of the superior and
anterior mediastinum.

16.06 1. The pa)ent with the diagnose "inoperable cancer of rectum It is necessary to make the operation of creation of the artificial anus
complicated with obtura)ve intes)nal obstruc)on" was (sigmostoma).
admiNed to the hospital. What opera)on is indicated to the
pa)ent

16.16 1. What opera)on is indicated in a case of injury of the superior In this case the inferior midline laparotomy and the use of two-rowed
wall of the urinary bladder? Give the topographical suture onto the wall of the urinary bladder (without taking the mucous
substan)a)on to the opera)ve approach and maneuver. layer into the suture) are indicated.

4.16 1. The phlegmon of the anterior compartment of the thigh was Along the femoral vessels distally — into the adductor canal;
diagnosed in a pa)ent. What are the possible ways for proximally — into the iliac fossa or into the lesser pelvis; along the
spreading of the pus in this case? perforating vessels — into the posterior compartment of the thigh;
along the circumflex femoral vessels — into the medial compartment
of the thigh.

7.17 1. The squama of the temporal bone is always injured easier and The diploic layer of the temporal squama is very thin and the internal
more frequently, than the another bones of the cerebral lamina is very fragile here. That is why the bone can be easily broken,
department of the head, which can be dangerous for the life of which may cause the injury of a. meningea media (with formation of
the pa)ent. How can it be explained? Give the topographical epidural or subdural hematoma).
substan)a)on for possible complica)ons.

5.11 1. During the football match the football player has received the There is an injury of n. peroneus communis in the superior
trauma – fracture of the neck of the fibula. The foot is in the musculoperoneal canal. This nerve innervates the peroneal muscles
posi)on of plantar flexion, its external margin is lowered. What and the anterior muscles of the leg.
nerve is injured? Explain the place of the injury and the
symptoms.

14.12 1. Acute appendici)s can be complicated with inflamma)on of Recessus ileocaecalis superior is situated between the internal margin
peritoneum in its recesses. What recesses can be the place of of the ileum and the internal surface of the ascending colon. Recessus
forma)on of the abscesses (localized peritoni)s)? ileocaecalis inferior is situated between the lower surface of the ileum
and the wall of the cecum. Recessus retrocaecalis is situated behind
the cecum .

9.32 1. The surgeon is making the opera)ve approach to the bifurca)on Internal jugular vein, superior rootlet of the cervical ansa, vagus nerve.
of the common caro)d artery, located at the level of the
superior margin of the thyroid car)lage. Name the vessels and
nerves, which cover the bifurca)on and should be preserved.

3.01 1. ALer corn abscess located in the second interdigital space the It is located now under the palmar aponeurosis. It may spread onto the
pus has spread into the commissural opening of the palm. In dorsal side of the proximal phalanx (along the lumbrical muscles) and
what layer is the abscess located now? Indicate the ways of into the subcutaneous fatty tissue of the fingers (along the proper
further spreading of the pus. digital vessels).

8.10 1. Purulent paro))s can be complicated by spreading of the pus to The capsule of the gland has two weak places. The first one is located
the adjacent regions through the weak places of the fascial on the superior surface of the gland and allows spreading of the pus
capsule of the paro)d gland. What are the main anatomical into the external acoustic meatus. The second one is located on the
pathways for spreading of the pus based on the peculiari)es of medial surface of the gland (near its pharyngeal process) and makes
the capsule’s anatomy? spread of the pus into the peripharyngeal fat space possible.

13.08 1. It is necessary to perform anastomosis between the posterior Through the inferior wall of the omental bursa.
wall of the stomach and the loop of the small intes)ne. Through
what wall of the omental bursa is it possible to move this loop?

13.09 1. During resec)on of the stomach the injury of the common bile The retroduodenal part of the common bile duct is located 3-4 cm right
duct is possible. On what stage of the opera)on is this from the pyloric part of the stomach. The injury of the common bile
complica)on possible? What peculiari)es of the topography of duct may appear during mobilization of the duodenum.
the common bile duct should be considered to avoid this
complica)on?

13.11 1. The pa)ent was complaining about heartburn and pains in the This hernia passes through the esophageal opening of the diaphragm;
epigastric region during long )me. On roentgenogram the its contents are a cardiac part of the stomach.
hernia of the esophageal opening of the diaphragm was found.
Give the topographical descrip)on of this hernia.

9.04 1. The pa)ent has a foreign body in the cervical part of esophagus, The larynx, trachea, projection of the tracheoesophageal groove on the
which cannot be removed by esophagoscopy. Describe the left side.
landmarks used to perform the opera)ve approach to the
cervical part of esophagus?

9.27 1. During subcapsular subtotal resec)on of the thyroid gland by The posterior fragments of the lobes are saved to prevent the removal
Nikolayev the posterior parts of the lobes are kept intact. What of the parathyroid glands,
is it caused by? Give the substan)a)on. which are located just behind the lobes in the parathyroid fatty tissue.

7.17 1. The squama of the temporal bone is always injured easier and The diploic layer of the temporal squama is very thin and the internal
more frequently, than the another bones of the cerebral lamina is very fragile here. That is why the bone can be easily broken,
department of the head, which can be dangerous for the life of which may cause the injury of a. meningea media (with formation of
the pa)ent. How can it be explained? Give the topographical epidural or subdural hematoma).
substan)a)on for possible complica)ons?

11.02 1. Foreign body of the airways in a child has fallen into one of Penetration of the foreign body into the right bronchus is more
bronchi. Penetra)on of the foreign body into what bronchus is probable due to the fact, that it is wider, than the left one, and has more
more probable and why? vertical direction (being something like continuation of the trachea).

9.10 1. The surgeon, performing the superior tracheotomy, has made The approach is performed strictly along the midline of the neck,
the incision of the skin and superficial fascia along the midline. between the fascial cases of the sternohyoid and sternothyroid
What layers will he pass through to reach the anterior wall of muscles. In case of a deviation the injuries of the internal jugular vein,
the trachea? Between what muscles will he pass? What are the common carotid artery and recurrent laryngeal nerve are possible.
possible complica)ons under devia)on from the midline of the
neck