12.Instrumentation/15.energy source/16.Suture Flashcards

1
Q

Which of the following is true regarding scissors?
Scissors with straight tips have greater versatility
Scissors with curved tips have greater mechanical advantage
Serrated edges are ideal on the eyelid
Utility scissors have thick blades making up approximately ⅓ of the length

A

C

greater versatility (curved)
greater mechanical advantage (straight)
eyelid (true because they are a lax tissue)
Mayos have thick blades making up approximately ⅓ of the length
utility are sharp-blunts

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2
Q
Which blade does not fit on a #3 handle
•	10
•	12
•	15
•	20
A

D 20
(+21,22,23 go on #4 handle;
#11 goes on 3)

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3
Q

Which is true?
• The angle of each tooth of the ratchet mechanism should be 45 degrees rather than 39 degrees to enhance the security of the engagement of the interlocking teeth.
• Ideally, the surgeon should use a needle holder with a clamping moment less than that of the yield moment of the needle.
• Forceps with cross-serrations (e.g., Rochester-Carmalt forceps) are designed to be used in a tip-clamping fashion
• Forceps with longitudinal serrations (e.g., Crile forceps) are used in jaw-clamping fashion

A

B

39 rather than 45

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4
Q
Which is not a crushing forcep?
•	right-angle forceps
•	babcock tissue forceps
•	allis tissue forceps
•	partial occlusion forceps
•	ochsner-Kocher forceps
A

D partial occlusion forceps

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5
Q

Name this retractor: single ended retractor with a broad U-shaped end

A

Green retractor

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6
Q
Which of the following is NOT a self-retaining retractor/distractor.
•	Rigby retractor
•	Ring Retractor
•	Meyerding retractor 
•	Hintermann retractor
A

C
• Meyerding retractor
There is also a self retaining retractor versus a hand held retractor. In the tobias chapter it is listed in the handheld retractor section
• Hintermann retractor FYI used in small bone/joint (like calcaneal) surgery

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7
Q

Which of the following is a correct pairing of suction tip to function
• The Frasier tip is used for large volumes in body cavities
• The yankauer tip is used for oral procedures and allows effective suction without damaging surrounding tissue
• The Poole tip is used for pin point focal areas of fluid
• The Cardiac rigid suction is used for clearing the airway in cardiovascular resuscitation.

A

B

(Fluted poole tip maximizes suction and minimizes tissue trauma, see link for other tip options)
http://www.medtronic.com/content/dam/medtronic-com/products/cardiovascular/cannulae/adult-suction-support/documents/CardiacSuction_Brochure_2.pdf

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8
Q

Which of the following is true regarding problems with instruments?

a. pitting corrosion is due to destruction of the passive layer
b. fretting corrosion can be due to chlorides in water or other fluids
c. A single rusty instrument may cause corrosive damage to all within the tray
d. The passive layer is a physically applied product to keep instruments lubricated

A

C.

Pitting = pinprick holes and spots from chlorides
Fretting: needs passive layer
passive layer = chemical reaction of chromium and ambient oxygen

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9
Q

Which statement is FALSE?

a. Electrocautery is not electrosurgery
b. Electrocautery is the use of electrical current to heat an instrument
c. When collagen is heated, intramolecular cross-links are broken and the protein undergoes a transition to a random gel like state
d. Cell death occurs are 55* C?

A

D False – 45* C

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10
Q
Collagen cross links are broken at what temperature?
•	a.    50* C
•	b.    55* C
•	c.     60* C
•	d.    65* C
A

D 65

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11
Q

A continuous, undamped waveform will have what type of tissue effect?

A

Pure cutting. Continuous damped will be cutting and coagulation

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12
Q
) What is the maximum diameter of blood vessel that the LigaSure can ligate? 
		A) 3 mm
		B) 5 mm
		C) 7 mm
		D) 9 mm
A

C 7 mm

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13
Q

What is true about stimulated emission lasers vs spontaneous emissions lasers?
A) Spontaneous lasers work at lower temperatures.
B) Stimulated lasers lead to monochromatic emissions.
C) Spontaneous lasers can be more accurate.
D) Stimulated lasers leads to the emission of an electron.

A

B is correct

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14
Q
What property allows lasers to cut, cauterize, coagulate, and vaporize tissue.
		A) Photochemical effect
		B) Photothermal effect
		C) Photomechanical effect
		D) Photoionizing effect
A

B Photothermal

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15
Q
What laser allows for the deepest penetration?
		A) Argon laser
		B) CO2 laser
		C) Nd:YAG laser 
		D) Excismer laser
A

C Nd:YAG

neodymium:yttrium-aluminum-garnet

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16
Q

Which of the following is incorrect regarding suture needle points?
A Blunt needles are used in friable tissue
B Taper needles are used in delicate tissues such as the GIT and urinary bladder
C Cutting needles are used for fibrous tissue such as skin, periosteum, and fascia
D Tapercut needles have a fine point that spreads tissue during passage and is good for fat and muscle

A

D (this is taper, tapercut have a reverse cutting point and an oval body)

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17
Q

Which of the following is true regarding suture?
A Creep is the amount of deformation that occurs without breaking
B Stress relaxation is the tendency of suture to slowly deform under constant stress
C Plasticity is the ability of suture to reduce stress under constant strain
D Pliability is the ease of handling and ability to change the shape of suture

A

D is correct

A = (Plasticity)
B = creep
C = (stress relaxation)
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18
Q

What does the L denote in 316L stainless steel?
• Long, multifilament form
• Low concentration of carbon, which increase corrosion resistance
• Limited handling required to avoid surface defects which may result in crevice or fretting corrosion
• Low chromium and nickel content

A

B

(false, but is available in a twisted multi or a monofilament form)
(careful handling is required)
(has high chromium and nickel)

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19
Q

Which of the following statements is true?
• Woven mesh is anisotropic
• Knitted mesh has a warp and weft, and has a bias at a 45 degree angle that is more elastic and fluid
• Composite mesh was designed to improve surgical handling and has less permanent foreign material
• Porcine submucosa results in a chronic inflammatory response due to its xenogenic nature

A

C correct

(false, knitted mesh is anisotropic, meaning there are different mechanical properties depending on direction force is applied; woven materials in the warp and weft directions are similar)
woven mesh: warp, weft, bias
(after 1 month the leukocyte inflammatory population wanes dramatically, at 3 months the porcine SI submucosa is not histologically apparent)

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20
Q

Which of the following statements is FALSE?
• There is contradictory evidence on the benefits of skin staples versus sutures.
• Regular staple depth is variable and ranges between 3.4-3.9mm
• Staples come in absorbable, titanium or 316L stainless steel
• The longer the staple the better, because that allows best apposition

A

D (false, too small - may not engage the holding layer or occlude blood supply; but too large- may result in an ineffective closure)

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21
Q

Which is true concerning MIS?
A Bipolar electrocautery should be used with great caution compared to monopolar, as several potentially hazardous problems can occur.
B A defect in the insulation of the bipolar instrument shaft can result in the passage of current to tissues that are not in the visual field, leading to iatrogenic injury.
C Direct coupling injuries can occur when the monopolar instrument through which the electrical current is passed comes into contact with the telescope or other instrument, resulting in iatrogenic damage to tissues that may lie outside the visual field.
D Monopolar electrosurgery is safer because it is usually of lower voltage current than bipolar.

A

C is correct

Monopolar more dangerous
(monopolar)
(Bipolar)

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22
Q

Which is true?
A The ligasure seals vessels up to 7 mm, whereas the SurgRx Enseal seals vessels up to 9 mm.
B The SurgRx Enseal has the advantage of sensing tissue impedance within the jaws of the tip, which then adjusts energy output from the generator accordingly to ensure a safe and effective seal.
C The Harmonic system (Ethicon Endo-Surgery) is a device that uses electric energy to cut and coagulate tissue.
D The Harmonic Ace tip is indicated to seal vessels up to 5 mm in diameter.

A

D is correct

A (Both 7 mm)
B (Ligasure)
C (ultrasonic)

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23
Q

Which is FALSE?
A The most common endoscopic stapling devices are 12 mm in diameter.
B They combine two double rows of staggered staples that are separated by a cutting blade, thus allowing secure sealing of each side, which prevents back-bleeding and spillage of contaminated material into the surgical field.
C EndoGIA cartridges (Covidien) are available in lengths of 30, 45, and 60 mm.
D The staple leg lengths are 2.0, 2.5, 3.5, and 4.8 mm.
E The 4.8 mm leg length staple units must be passed down a 15 mm cannula and are used less frequently in veterinary applications.

A

B (triple rows)

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24
Q

Vascular white stapler has a open height of ___ and a closed height of ___ and a width of ___

A

2.5mm
1
3 mm** think TA V3 and has 3 rows of staples

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25
Q

Green TA has a open height of ___ and a closed height of ___ and a width of ___

A

4.8mm **
2
4mm

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26
Q

Blue TA stapler has a open height of ___ and a closed height of ___ and a width of ___

A

3.5mm**
1.5
4mm

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27
Q

Regular skin staples width___ and depth ____

A

W 4.8-5.7

D 3.4-3.9

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28
Q
Which scissors are used for cardiovascular procedures?
A Martin scissors
B Mayo scissors
C Potts-smith scissors
D Westcott scissors
A

C potts smith

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29
Q

What is the correct feature/purpose of a Ruskin rongeur?
A Used for less dense bone
B Single action
C Utilizes a footplate and a single cutting blade
D Requires less force due to mechanical advantage

A

A Used for less dense bone- LEMPERT with finer more delicate jaws
B DOUBLE action
C Utilizes a footplate and a single cutting blade- KERRISON
D true

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30
Q

Which of the following is true?
A Textured tungsten carbide needle-holder jaw inserts provide intermediate needle-holding security, minimize potential for suture material damage
B Mayo-Hegar needle holders have cutting blades (scissors)
C Allis tissue forceps are Non-crushing
D A chisel is double beveled

A

A true
B OLSEN-Hegar needle holders have cutting blades (scissors)
C Allis tissue forceps are crushing (as well as right-angle forceps, Babcock, and Oschner-Kocher)
D An osteotome is double beveled

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31
Q

What are Cooley forceps

A

Atraumatic vascular forcep primarily for cardiothoracic surgery

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32
Q

describe the serrations of a Rochester-Carmalt forcep

A

longitudinal serrations and cross-hatching at the tips

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33
Q

what is the difference between Kelly and Crile forceps?

A

Kelly doesn’t have transverse serations all the way to the end. Crile does

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34
Q

t/f: Locking needle holders should generally be used with 5-0 or larger suture material

A

False - 6-0 or larger suture

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35
Q

t/f: Blood left on an instrument starts to break down its surface within 15 minutes

A

(False - 10 minutes)

36
Q

t/f: Flaws were identified in 25% of new surgical instruments in one study

A

(False - 15%)

37
Q

What is the passive layer of stainless steel instruments?

A

Protective layer resulting from the chemical reaction of chromium and ambient oxygen

38
Q

Describe pitting versus fretting corrosion?

A
Pitting = pinprick-like holes surrounded by discolored spots : Breakdown of the passivating oxide film
Fretting = brown discoloration on a friction surface caused by micro abrasive discoloration of the passive layer: Contact points and crevices most at risk for corrosion
39
Q

Which of the following is not a documented benefit of implementing briefing and debriefing:

a. Improvement in efficiency and communication
b. Decreasing the incidence of wrong side surgery
c. Decreasing a better work environment
d. Decreasing the incidence of retained foreign bodies
e. Decreasing human errors

A

C IMPROVE the work environment

40
Q
Operating room briefing and debriefing has a favorable effect by decreasing intraoperative surgeons delay by more than \_\_%, improve patient surgical outcomes, decrease intraoperative adverse effects, postoperative morbidity and decrease overall hospital mortality
95%
80%
65%
67%
A

B 80%

41
Q

True or false: traffic and excessive conversation in the OR have been associated with decreased risk of infection?

A

False: INCREASED

42
Q

Find the FALSE
A The hospital is structurally divided into three zones: nonrestricted areas, in which street clothes are allowed; restricted (sterile) areas; and semirestricted (nonsterile) areas.
B According to Sawyer, surgical infection is mostly the result of skin bacterial translocation rather than airborne contamination.
C Floors are considered contaminated, yet their role in disease transmission is unclear.
D A laminar airflow system, provides a unidirectional, negative pressure flow of air leading to a decrease in an environmental bacterial loads.

A

D A laminar airflow system, provides a unidirectional, POSITIVE pressure flow of air leading to a decrease in an environmental bacterial loads.

43
Q

Which of the following is true regarding electromagnetic energy
A The difference in potential between two points is current and is measured in amperes
B Electrocautery passes a current through tissues following the path of least resistance
C During the electrosurgery cut mode a series of interrupted waves is delivered which may reach voltage as high as 9000V
D Electrosurgery coagulation is best achieved with a power setting in the range of 30-50 watts

A
A voltage (Volts) = potential difference
B electrosurgery = current through tissues, least resistance
C  coag = interrupted
D true
44
Q

Which of the following is false regarding the tissue effects of electromagnetic energy?
A The best effects of cutting electrosurgery are achieved in a non-contact form where the current arcs to the tissue via the spark
B During an interrupted coagulation waveform the current is available 6% of the time and the remaining 94% the tissue cools producing the coagulation effect
C Coaptive coagulation involves creating a spark between the electrode and tissue
D Dessication coagulation involved protein denaturation resulting in coagulum formation

A

C (Fulgurative coagulation) involves creating a spark between the electrode and tissue
Coaptive coagulation = a type of desiccation coagulation, occurs when the lumen of a vessel is occluded by a metal instrument

45
Q

T/F: Monopolar electrosurgery provides hemostasis for vessels up to 2mm in diameter

A

true

46
Q

T/F: Canine skin incisions made with monopolar electrosurgery are associated with increased wound inflammation and delayed wound healing

A

true

47
Q

T/F: Electrosurgery instruments cannot be used in a wet environment

A

False - bipolar can be used in a wet environment

48
Q

____ lasers are strongly absorbed by water, where as _____ laser interact only slightly with water and can interact with hemoglobin-like pigments.

A
CO2 = water
dioxide = hemoglobin-like pigments
49
Q

Name tissue factors that can cause injury when using a laser (3)

A

Absorption scatter
Thermal conductivity
Local circulation

50
Q

Name laser factors that can cause injury when using a laser (3)

A

Power density
Duration
Wavelength

51
Q

Which laser is the shallowest? Dermis only

A

Eximer

52
Q

Which layer is full thickness dermis (stratum corneum)?

A

CO2
stratum corneum 10,600 nm (wavelength)
0.1 mm
Heating intracellular water → cell explosion

53
Q

Which laser is the deepest?

A

Nd:YAG = stratum+epi+dermis+deep vessels to subcutaneous fat: 1064nm
1.0-5.0 mm

54
Q

???= stratum corneum, epidermis, dermis to deep blood vessels; 800nm
1.0-3.0 mm
Primary tissue effect is coagulation, superior hemostatic abilities

A

Diode

55
Q

T/F: Reverse cutting needles have a triangular tip with the cutting surface on the convex needle surface.

A

true

56
Q

what are the zones of injury of a laser?

A

Zones of injury: Hyperthermia →coagulation → carbonization and vaporization nearest laser

57
Q

“With___ needles, a triangular defect is created during needle passage, in which the vertex created by the cutting edge is directed toward the incision” name? resulting effect?

A

standard cutting

May result in larger hole→ **increased risk suture pull-through

58
Q

Define suture capillarity?
A.Degree to which absorbed fluid is transferred along a suture
B.The degree to which a suture will absorb fluid following immersion
C.The tendency of a suture to slowly and permanently deform under constant stress
D.The ability of suture to reduce stress under constant strain

A

A true
B. absorb fluid following immersion (fluid absorption)
C. slowly and permanently deform under constant stress (creep)
D. reduce stress under constant strain (stress relaxation)

59
Q

Which of the following is true?
A Catgut is made from small intestinal submucosa of cattle or the intestinal serosa of sheep and is available in plain or chromic form
B Catgut loses 90-100% of its strength within 5 days
C Catgut is completely absorbed within 2-3 weeks
D Catgut is uniform throughout

A

A (SIS of sheep, intestinal serosa of cattle)
B Catgut loses …days (7)
C true
D has random thinner areas d/t being a natural substance)

60
Q

True?
A Polyglycolic acid is a monofilament absorbable suture completely absorbed in 3 months and loses approximately 50% of strength in 2-3 weeks
B Polyglactin 910 loses 50% tensile strength in 2-3 weeks and comes in 2 forms antibacterial triclosan coating and irradiated forms
C Poliglicaprone 25 is rapidly absorbed monofilament that loses 50% tensile strength at 2 weeks
D Caprosyn (Polyglytone 6211) has less tissue drag and knot security than chromic gut, however retains strength for twice as long

A

A Polyglycolic acid (multifilament, absorbed completely in 60-90 days, 50% strength 2-3 weeks)
B true
C poliglecaprone (50% in first week, 70-80% by 2 weeks)
D neither retains any strength at 3 weeks in a rat study

61
Q

True?
A Polydioxanone retains 75% tensile strength at 5-6 weeks with intermediate knot security indicating the need for 6 throws at the start of the suture line
B Polyglyconate is a copolymer of glycolic acid and trimethylene carbonate and retains 50% of its strength after 5-6 weeks
C Glycomer 631 is rapidly absorbed at 50% loss within 2-3 weeks and complete absorption at 90-110 days, though stronger and greater first throw knot hold than polyglactin 910
D PDS is readily available

A

A PDS II retains 50% tensile strength… 4 throws at the start)
B Polyglyconate… (4-5 weeks)
C true
D only PDS Plus and PDS II are available

62
Q

FALSE?
A Silk is a multifilament, braided natural suture
B It is produced by silkworms Bombyx mori and Anaphe pernyia
C It is degraded by slow protelysis, losing 50% strength in the first 12 weeks and being completely deteriorated by 5 years
D It is mostly made up of fibroin and sericin

A

C (degraded by hydrolysis, 56% of original strength at 12 weeks, completely deteriorated by 2 years)

63
Q

The L in 316L steel denotes low concentration of carbon which increases corrosion resistance

A

true

64
Q

True?
A Knitted mesh has a warp and weft
B Woven mesh has a course and whale
C The bias is at 45 degrees to the warp and weft
D Knitted mesh is stronger, stiffer, and more porous than woven mesh

A

A woven = warp and weft
B knit = course and whale
C true
D (woven is stronger, stiffer and less porous than knitted)

65
Q

Which is true of skin staples?
A The closed width of regular staples is 4.4 mm
B Closed width of wide staples is 6.8 mm
C Skin staples invert the wound edge
D Stapled surgical incisions have been reported to have greater resistance to infection.

A

A closed width of regular staples=4.8-5.0
B Closed width of wide staples = (6.4-7.0)
C Skin staples (evert)
D true

66
Q

Which of the following is true concerning vascular clips?
A The diameter of a vessel to be occluded should be no more than ⅔ of the vascular clip
B The diameter of a vessel to be occluded should be no less than ¼ the length of the vascular clip
C The clip is applied 1 mm from the cut edge of a vessel
D Arteries and veins can be clipped en bloc

A

A true
B no less than (⅓)
C The clip is applied (Several mm)
D (Ligate separately)

67
Q

Which is true of circular stapling devices?
A Circular stapling devices are designed to perform end-to-end or end-to-side anastomosis
B A triple staggered row of staples is placed
C Circular staples should not be used if combined tissue thickness is less than 1 mm or greater than 2.5 mm
D The anastomosis created is everted

A

A Circular = end-to-end or end-to-side anastomosis. (AND side-to-side)
B (double-staggered row)
C true
D The anastomosis (inverted)

68
Q

Which is true concerning skin glue?
A Polymerization and tissue bonding occur when glue encounters cations.
B Short-chain cyanoacrylates form very strong but very brittle bonds, resulting in low bursting strength and poor clinical performance.
C To place glue, slightly part skin edges, apply glue, then hold edges in apposition.
D The byproducts of skin glue are cyanoacetate and iodide.

A

A (anions in moisture at skin surface)
B true
C (do not want glue in wounds - creates FB reaction and elution of toxins secondary to byproducts, most notably formaldehyde)
D cyanoacetate and formaldehyde

69
Q

Which of the following is true?
A Haptics is a form of Motor heuristics that studies how the perceptions of the hand provide feedback for motor action
B hand tremor and unwanted body movements are minimized by supporting the hand or instrument close to the target and not using excessive force
C Press cuts are not an acceptable way to use a scalpel
D Cutting tissues with the portion of the blade near the tips results in greater crushing injury (scissors)

A

A Haptics is a form of PERCEPTUAL
B true
C SAWING is not an acceptable way to use a scalpel (for the skin, can be used for transecting a ligated pedicle)
D Cutting tissues with the portion of the blade near the FULCRUM/JAWS

70
Q

Which of the following is true?
A Creating a shearing force with scissors is natural for a left handed surgeon with standard instruments
B Transversely oriented serrations on forceps are best used for clamping tissue in the jaw
C The thenar grip saves time during continuous suture placement, but the needle release is often less precise than with the tripod grip
D Blunt-sharp tips are appropriate for blunt dissection (scissors)

A

A shearing force with scissors is natural for a RIGHT
B LONGITUDINALLY oriented serrations on forceps are best used for clamping tissue in the jaw
C true
D sharp-sharp tips are appropriate for blunt dissection

71
Q

Which of the following is true regarding suture patterns?
A continuous Lembert suture utilizes far-near, near-far partial thickness suture bites
B A vertical mattress pattern uses a far-far, near-near with each needle bite taken to the same depth
C Disruption to skin edge blood flow is minimal for horizontal mattress sutures placed under tension
D Simple interrupted pattern to close the abdominal wall has been shown to be stronger than simple continuous, but there is no difference in complication rate

A

A true
B A vertical mattress pattern far-far bite is taken more deeply)
C (local ischaemia from HM sutures under tension)
D (SC comparable to SI in strength and complication rate)

72
Q

T/F: Mattress patterns increase strength across the wound compared with simple interrupted patterns

A

true

73
Q

For vertical mattress sutures, the near placement should be within 3mm of the wound edge

A

false 2 mm

74
Q

Formation of two opposing mirror-image simple knots = ?

A

square knot

75
Q

Two simple knots that are tied with greater tension on one segment than the other = ?

A

half hitch

76
Q

Made of two identical simple knots= ?

A

granny knot

77
Q

What is the least amount of throws needed for a knot?

What is the gold standard amount?

A

Minimum of 4

5 throws is gold standard

78
Q

What are the basic 5 principles of knot tying?

A

Simplest secure knot for the suture material and situation is goal
Avoid friction between strands
Use appropriate tension when tying knots
Tie each knot by pulling the two stands in opposite directions with uniform rate and tension
Avoid damage to suture material

79
Q

T/F: knot security is relative to the coefficient of friction of the suture and represents the force requires to cause a knot to slip

A

true

80
Q

T/F: Net tensile strength of the suture line or ligation is determined by the initial tensile strength of the suture and the knot security

A

true

81
Q

T/F: Weakest point of the suture line is the suture chosen

A

false: knot

82
Q

what is a tuohey needle?

A

Uninsulated or insulated
Curved at the distal tip, not as sharp
Direct in a direction: epidural or perineural catheters

83
Q

which mode should you use when applying energy to a hemostat to perform coaptive coagulation of a vessel?

A

Desiccation: uses coagulation mode (current produce spikes) to produce coagulum

84
Q

which suture NOT use in infected tissue:

A

polyester

85
Q

Why add chromium to gut suture?

A

Improves relative knot security compared to plain gut

absorption about the same (14-80 days compared to 70 days) and is unpredictable