TS-C Certification Exam Study Guide: Anatomy & Physiology, Surgical Procedures, and Instrumentation

A&P: Specific Anatomy & Functions

Major Arteries

The major arteries supply blood to critical regions of the body, each with specific anatomical and clinical significance.

• Internal carotid artery: Supplies blood to the brain (if blocked, can cause stroke).

• External carotid artery: Supplies blood to superficial facial structures.

• Superior mesenteric artery: Supplies blood to the small bowel.

• Inferior mesenteric artery: Supplies blood to the distal large bowel.

• Popliteal artery: Supplies blood to the lower extremity.

Gastrointestinal Tract & Accessory Organs

The gastrointestinal (GI) tract is responsible for digestion and absorption of nutrients, with accessory organs aiding in these processes.

• Alimentary tract: mouth → pharynx → esophagus → stomach → small intestine → large intestine → rectum → anus

Stomach

• Sections: cardia, fundus, pylorus

• Layers: mucosa, submucosa, muscularis, serosa

• Function: Churns food, mixes with gastric juices, initiates protein digestion

• Pyloric sphincter: Controls passage of chyme into the duodenum

Small Intestine

• Sections: duodenum, jejunum, ileum

• Duodenum function: Continues breakdown of food

• Jejunum & ileum function: Absorb nutrients from food

Large Intestine

• Begins at the ileocecal valve (where ileum joins cecum)

• Sections: cecum → ascending colon → hepatic flexure → transverse colon → splenic flexure → descending colon → sigmoid colon → rectum → anus

• Appendix: Located at the ileocecal valve

Liver

• Produces bile, stored in the gallbladder

• Bile flows from cystic duct → common bile duct → Ampulla of Vater (where bile and pancreatic duct merge)

• Bile function: Breaks down fats for easier digestion

• Sphincter of Oddi: Controls bile flow into duodenum

Pancreas

• Location: Behind the stomach

• Function: Produces enzymes to break down starches, fats, and sugars; releases hormones for metabolism

Specific Surgical Procedures, Conditions & Diseases

Thoracic (Lungs)

• Pneumonectomy: Removal of an entire lung

• Lobectomy: Removal of part of a lobe of a lung

• Video-Assisted Thoracic Surgery (VATS): Minimally invasive surgery for chest conditions

• Tracheostomy: Incision in the neck to allow a tube into the trachea

Abdomen/Peritoneal Cavity

• Indirect hernia: Protrudes through abdominal cavity via inguinal ring

• Direct hernia: Protrudes medial to inferior epigastric vessels

• Segmentectomy: Removal of one or more major lobes of the liver

• Trisegmentectomy: Removal of right lobe and part of left lobe of liver

• Wedge resection: Section removed for diagnosis or treatment

Other Organs & Procedures

• Liver biopsy: Removal of a small piece of liver for diagnosis

• Whipple procedure: Pancreaticoduodenectomy for pancreatic cancer

• Splenectomy: Removal of spleen

• Gastrectomy: Removal of part or all of the stomach

• Billroth I & II procedures: Treatment of stomach cancers

Colorectal/GI Tract

• Anal fistula: Abnormal tunnel from anus to skin

• Pilonidal cyst: Congenital defect, epithelial tissue trapped below skin

• Diverticulosis: Outpouchings in colon wall

• Partial/complete colectomy: Removal of part/all of colon

Ophthalmology (Eyes)

• Scleral buckling procedure: Repair of detached retina

• Keratoplasty: Removal of diseased cornea

• Vitrectomy: Removal of vitreous humor

• Enucleation: Removal of entire eye

Orthopedic

• Baker's cyst: Develops in popliteal fossa

• ACL repair/replacement: Surgical repair of anterior cruciate ligament

• Colle's fracture: Fracture of distal radius

• Open Reduction Internal Fixation (ORIF): Fixation of broken bone

Order of Fixation
Drill → Measure → Tap → Screw

Genitourinary (GU)

• Hydrocelectomy: Removal of fluid-filled sac over testicle

• Cystoscopy: Endoscopic examination of bladder

• Transurethral resection of prostate (TURP): Removal of prostate tissue via urethra

• Varicocelectomy: Removal of varicose veins from scrotum

Gynecologic

• Ileal conduit: Tube from small intestine for urinary diversion

• Marshall-Marchetti-Krantz: Corrects stress incontinence

• Shirodkar/McDonald procedures: Cervical cerclage for incompetent cervix

• Pelvic exenteration: Removal of uterus, tubes, ovaries, bladder, rectum

• Laparoscopic-Assisted Vaginal Hysterectomy (LAVH): Minimally invasive hysterectomy

• Myomectomy: Removal of uterine fibroids

Otorhinolaryngology (ENT)

• Uvulopalatopharyngoplasty (UPPP): Reconstruction of soft palate/pharynx

• Functional Endoscopic Sinus Surgery: Treats chronic sinusitis

• Myringotomy: Incision in tympanic membrane to drain fluid

Plastic & Peripheral Vascular

• Rhytidectomy: Face lift

• MOHS procedure: Removal of basal cell carcinoma

• AV fistula: Connection of radial artery to cephalic vein for dialysis

• Thrombus: Stationary blood clot

• Embolus: Mobile blood clot

• Stenosis: Plaque in vessel/artery

• Angioplasty: Performed due to stenosis

Anesthesia & Pharmacology

General Anesthesia

General anesthesia induces unconsciousness and loss of sensation for surgical procedures.

• Induction: Initiation of anesthesia

• Maintenance: Monitoring under anesthesia

• Emergence: Withdrawal and regaining consciousness

• Recovery: Post-anesthesia care

Regional & Local Anesthesia

• Lidocaine: Short-acting anesthetic

• Marcaine/Bupivacaine: Long-acting anesthetic

• Epinephrine: Vasoconstrictor, prolongs anesthesia

Commonly Used IV Solutions

Solution	Purpose
NaCl (0.9%)	Basic saline solution
Dextrose	Source of calories
Lactated Ringer's Solution	Replenishes electrolytes

Surgical Pharmacology

Medication Handling

• 5 Rights of Medication Handling:

  1. Right Patient

  2. Right Drug

  3. Right Dose

  4. Right Route

  5. Right Time

Hemostatic Medications & Agents

Agent	Function
Heparin	Anticoagulant (prevents blood clotting)
Protamine	Coagulant (reverses heparin)
Epinephrine	Vasoconstrictor (raises BP)
Thrombin	Topical agent for surface bleeders
Silver nitrate	Caustic agent for light bleeding

Antibiotics

• Bacitracin: Used for skin infections

• Kefzol, Ancef, Keflin: Used for respiratory tract infections

• Kanamycin: Used for E. coli and resistant organisms

Contrast Solutions

• Radiopaque: Used to view body structures under x-ray

• Omnipaque: Used for reproductive system, spinal cord, kidneys, etc.

• Carotigraf: Used to view heart and major blood vessels

Tissue Dyes & Stains

Dyes

• Definition: Colored substance used to differentiate tissue specimens

• Common types: Gentian violet, Methylene blue, Indigo carmine

Stains

• Definition: Used to differentiate normal cells from abnormal ones

• Lugol's solution: Used for Schiller test (cervical dysplasia)

• Monsel solution: Used to identify abnormal tissue cells

• Acetic acid: Used to enhance detection of cervical neoplasia

Administrative & Personnel

Preference Cards

• Documents listing surgeon's preferences for specific procedures

• Always follow surgeon's request for supplies and instruments

Sentinel Events & Incident Reports

Sentinel Events

• Unexpected incidents causing injury or harm

• Examples: Fire in the O.R., equipment malfunction

• Report must be completed and submitted to risk management

Incident Reports

• Completed as soon as possible after an event

• Include: Who, what, when, where, supervisor contacted

The Surgical Environment

• O.R. Temperature: 68°F – 73°F

• O.R. Humidity: 30% – 60%

• Positive air flow: Maintains sterile environment

• Negative pressure: Used in decontamination rooms

• Air exchanges: 10–20 per hour

Equipment, Maintenance & Sterilization

Decontamination, Disinfection & Sterilization Processing

• Cycle: Decontaminate → Assemble → Disinfect/Sterilize → Sterile storage

• Decontamination: Removes bioburden (gross soil)

• Disinfection: Destroys all pathogenic organisms except bacterial spores

• Sterilization: Destroys all forms of microbial life

Methods of Sterilization

Method	Description
Hi-temp steam	Cheapest, fastest method
Low-temp sterilization	Used for heat/moisture-sensitive devices
Flash/Immediate Use Steam	Emergency sterilization
Glutaraldehyde	High-level disinfectant for endoscopes

Instrumentation: Basic & Complex

Power Equipment

• Activated by nitrogen gas, electricity, or battery

• Common attachments: Saws, drills, screws, reamers

Basic Instrumentation

• Retractors: Hand-held and self-retaining (e.g., Hibbs, Taylor, Hohmann, Alms, Hookwalter, O'Connor-O'Sullivan, Balfour, Omnitract)

• Rongeurs: Used to remove bone (e.g., Leksell, Kerrison)

• Scissors: Stevens Tenotomy (blunt, tapered ends)

• Staplers: GIA, LDS, EEA, TA, purse-string

• Clamps: O'Gyn clamp, Heaney clamp

• Dilators & Sounds: Hegar dilators, uterine sound

• Neuro & Spine: Mayfield retractor, lamina spreader, Cloward cervical retractor

• ENT: MacIvor retractor, Weider tongue depressor, nasal speculum, ear speculum, Jansen-Middleton forceps

Endoscopes, Camera & Light Cord

• Flexible endoscope: Colonoscope, esophageal scope

• Rigid endoscope: Arthroscope, cystoscope, laryngoscope

• Camera: Lens fits into circular part of camera

• Light source: Provides illumination

Common Supplies & Equipment

• Sequential compression devices (SCDs): Prevent deep vein thrombosis

• Veress needle/Hasson trocar: Create pneumoperitoneum for laparoscopy

• Trocar: Access body cavity laparoscopically

Additional info: Some sections (e.g., administrative, incident reporting, and equipment maintenance) are expanded for context and completeness, as they relate to the safe and effective practice of anatomy and physiology in surgical settings.