SFA 272 - Advanced Surgical Procedures

1. Demonstrate understanding of the cardiorespiratory system.
   1. Explain where one would expect to find most aspirated foreign bodies and why.
   2. Explain why the arterial element is clamped first during anatomic lung resections.
   3. Following a lung resection, explain why the pleural cavity is usually flooded with saline before closing the chest and whether the temperature of the saline matters.
   4. List the different types of bronchogenic carcinomas.
   5. Discuss metastasis to the lung.
   6. List the risk factors for coronary artery disease (CAD) and define "unstable" angina.
   7. Describe the changes that occur in the histologic and gross appearance of the heart after Ml, and relate these to common complications of Ml.
   8. Differentiate the signs and symptoms of right and left congestive heart failure.
   9. Explain the adult cardiac procedures and the pathologies leading up to them.    
   10. Describe the procedures associated with pediatric cardiac procedures
2. Relate the anatomical structures of the abdomen to common surgical procedures.
   1. Name an incision that may encounter the Pyramidalis muscle.
   2. Explain how the "peritoneal cavity" differs from the "abdominal cavity."
   3. Name the structures that form the median, medial, and lateral umbilical folds and identify the surgical procedure during which they are most apt to be seen.
   4. Discuss the various types of peptic ulcers, including the risk of undergoing malignant changes.
   5. Differentiate Billroth and Billroth II procedures and explain "dumping syndrome."
   6. Describe the major manifestations and usual treatment of pyloric stenosis.
   7. Explain the surgical interest in the duodenal "bulb"/"cap."
   8. Discuss the possible results of traumatic injury to the pancreas.
   9. Define a Whipple procedure.
   10. Discuss common mechanisms of splenic injury and the possible complications of splenic trauma and surgery.
   11. Explain why the liver is easily lacerated or ruptured with blunt trauma and what instrumentation should be available during liver trauma surgery.
   12. Discuss the histologic and gross characteristics and the common clinical manifestations of cirrhosis.
   13. Discuss the most common cause of malignancy in the liver.
   14. Diagram the "triangle of Calo!'' and explain its importance during cholecystectomy.
   15. Discuss the various types of gallbladder disease, including their etiology, symptomatology, and  major diagnostic tests.
   16. Explain how the pattern of blood supply to the jejunum/ileum affects vascular occlusions and surgical resections of the small bowel.
   17. Discuss intussusception, Crohn's disease, ulcerative colitis, Irritable Bowel Syndrome, polyps, and diverticulosis.
   18. Describe how a surgeon usually locates the appendix and explain the clinical significance of the pattern of blood supply to the   appendix.
   19. Differentiate between “external hemorrhoids” and “internal hemorrhoids” and identify which are painful and why.
3. Demonstrate understanding of the anatomical features of the post abdominal wall and kidneys in relation to common surgical procedures.
   1. Differentiate a “true” aneurysm, a “false” aneurysm, and a “dissecting” aneurysm or “dissection.”
   2. Discuss the pre- and post-operative aspects of an abdominal aortic aneurysm.
   3. Explain why how long the Aorta can be cross-clamped depends on the level at which it is clamped and why the aneurysm is not dissected free from the Inferior Vena   Cava.
   4. List the signs and symptoms of an expanding or ruptured AAA and differentiate the operative mortality.
   5. Discuss the indications for inserting an intracaval filtering device.
   6. Define “shock kidney.”
   7. Describe the anatomical structures that must be protected during the usual surgical approach for nephrectomy.
   8. Identify the most common cause of kidney trauma and the most common cause of ureteral injury.
   9. Compare the various methods of “angio-access.”
   10. Define Continuous Ambulatory Peritoneal Dialysis (CAPO) and list its advantages over hemodialysis.
   11. Explain the usual placement of a transplanted kidney.
4. Demonstrate understanding of the anatomical features of the male and female pelvis in relation to surgical procedures.
   1. Differentiate hypospadias and epispadias and define Chordee. State the danger inherent in an ascending URI.
   2. Differentiate the characteristics of testicular and prostatic cancers, and discuss how each is treated.
   3. Define BPH and discuss theories about its etiology.
   4. List the indications for the four surgical methods of prostatectomy and discuss possible treatment alternatives.
   5. Discuss the purposes and locations of the performance of an episiotomy.   Explain the location of referred pain from the ovary and during pregnancy. Identify the most common venereal infections and define PID.
   6. Explain what a Pap smear is looking for, and define CIN grading. Compare cervical and uterine cancers.
   7. Define endometriosis, compare the theories of its etiology, and describe the sequelae.
   8. Explain how the character of a fibroid changes with varying estrogen levels.
   9. Identify what types of ovarian tumors are most common in young women and discuss the usually prognosis for ovarian cystadenocarcinoma.
   10. List the indications for Cesarean section delivery.
   11. Compare and contrast the location, character, and predisposing factors of direct and indirect inguinal hernias.
   12. Compare a laparoscopic hernia repair with an open surgical repair.
   13. Discuss where femoral hernias occur and the possible consequences. Define “Richter’s hernia”, “Spigelian hernia”, and “diastasis recti.”
   14. Discuss indications for surgical interventions of pathology relating to the abdomen.
5. Relate anatomical considerations to orthopedic pathology and surgery of the lower limb.
   1. Describe the common surgical approach for insertion of a hip screw/pin/nail.
   2. Identify the most common indications for a total hip replacement, and describe the surgical approach when a  patient is in lateral position.
   3. Identify the structures that compensate for the inherent instability of the knee joint.
   4. Explain why a meniscal tear usually does not heal.
   5. Describe the mechanism for “locking” the knee in extension and “unlocking” for flexion.
   6. Define Baker’s cyst.
   7. List the indications for a total knee arthroplasty and compare the function of a knee prosthesis with that of a total hip prosthesis.
   8. Compare the techniques of AK and BK amputations.
   9. Discuss the causes, possible complications, and indications for surgical treatment of varicose veins of the leg.
   10. Define Pott’s fracture, “clubfoot”, Morton’s neuroma, and “flat feet.”
   11. Differentiate an ankle arthrodesis from a triple arthrodesis.
   12. Define a bunion and compare the most common types of surgical treatment.
6. Discuss the significance of structural components of the skull and brain in intracranial pathologies.
   1. List and explain different types of congenital cranial deformities.
   2. Relate a craniotomy approach and closure to the layers of the scalp and the special character of skull bone.
   3. Explain the relationship of the ventricular system to diagnostic imaging, hydrocephalus and shunting surgery.
   4. Discuss the location, most common presenting signs and symptoms, mortality rate, and principles of surgical management of cerebral aneurysms & AVM’s.
   5. Explain how the knowledge of brain functions is used to diagnose and locate brain tumors.
   6. List methods of resection for benign and malignant brain tumors.
   7. Define types of skull fractures.
   8. Differentiate the character of the bleeding of an epidural vs. a subdural hematoma, and describe how different types of hemorrhages or hematomas are treated.
   9. Differentiate the causes of “communicating’ vs. ‘non-communicating’ hydrocephalus, and discuss types of shunting procedures and their potential long term complications.
   10. List diagnostic methods for intracranial pathologies
   11. Describe different approaches and methods for cranial entry.
   12. Discuss different neurosurgical procedures and their complications.
7. Discuss anatomical considerations relevant to surgery of the face, eye, ear, nose, neck and throat.
   1. List the functions of each of the cranial nerves around the eye and explain the significance of the ciliary ganglion to eye surgery performed under local anesthesia.
   2. Describe the circulation pathway of aqueous humor and relate it to the treatment options for glaucoma.
   3. Define a cataract, explain how it can occur, and compare surgical treatment   options.
   4. Describe the features of the retina, define retinal detachment, and explain why a retinal detachment that is approaching the macula requires immediate surgery.
   5. Define diabetic retinopathy and describe how it is treated
   6. Discuss the clinical significance of the carotid sinus during Carotid   Endarterectomy.
   7. Describe the surgical approach for open tracheostomy.
   8. Describe surgical options for eye pathology.
8. Relate structures of the chest wall and superficial back to pathology and surgery of the chest wall, breast and axilla.
   1. Define “radical mastectomy”, “modified radical mastectomy”, and “lumpectomy”
   2. Name the major nerves and vessels that must be identified and protected during breast and axillary surgery
   3. Describe the different surgical options for the pathology of the breast.
9. Relate anatomical considerations to orthopedic pathology and surgery of the upper limb.
   1. Describe the usual incisional approach to the shoulder joint.
   2. List intracapsular structures that might be seen during a shoulder arthroscopy.
   3. Define carpal tunnel syndrome, Dupuytren’s contracture, and DeQuervain’s contracture.
   4. Describe what happens to the hand with rheumatoid arthritis.
   5. Explain the order of treatment priorities on an injured hand.
   6. Discuss the different surgical options for pathology of the upper limb.