12.Instrumentation/15.energy source/16.Suture Flashcards
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
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
Which blade does not fit on a #3 handle • 10 • 12 • 15 • 20
D 20
(+21,22,23 go on #4 handle;
#11 goes on 3)
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
B
39 rather than 45
Which is not a crushing forcep? • right-angle forceps • babcock tissue forceps • allis tissue forceps • partial occlusion forceps • ochsner-Kocher forceps
D partial occlusion forceps
Name this retractor: single ended retractor with a broad U-shaped end
Green retractor
Which of the following is NOT a self-retaining retractor/distractor. • Rigby retractor • Ring Retractor • Meyerding retractor • Hintermann retractor
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
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.
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
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
C.
Pitting = pinprick holes and spots from chlorides
Fretting: needs passive layer
passive layer = chemical reaction of chromium and ambient oxygen
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?
D False – 45* C
Collagen cross links are broken at what temperature? • a. 50* C • b. 55* C • c. 60* C • d. 65* C
D 65
A continuous, undamped waveform will have what type of tissue effect?
Pure cutting. Continuous damped will be cutting and coagulation
) 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
C 7 mm
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.
B is correct
What property allows lasers to cut, cauterize, coagulate, and vaporize tissue. A) Photochemical effect B) Photothermal effect C) Photomechanical effect D) Photoionizing effect
B Photothermal
What laser allows for the deepest penetration? A) Argon laser B) CO2 laser C) Nd:YAG laser D) Excismer laser
C Nd:YAG
neodymium:yttrium-aluminum-garnet
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
D (this is taper, tapercut have a reverse cutting point and an oval body)
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
D is correct
A = (Plasticity) B = creep C = (stress relaxation)
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
B
(false, but is available in a twisted multi or a monofilament form)
(careful handling is required)
(has high chromium and nickel)
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
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)
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
D (false, too small - may not engage the holding layer or occlude blood supply; but too large- may result in an ineffective closure)
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.
C is correct
Monopolar more dangerous
(monopolar)
(Bipolar)
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.
D is correct
A (Both 7 mm)
B (Ligasure)
C (ultrasonic)
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.
B (triple rows)
Vascular white stapler has a open height of ___ and a closed height of ___ and a width of ___
2.5mm
1
3 mm** think TA V3 and has 3 rows of staples
Green TA has a open height of ___ and a closed height of ___ and a width of ___
4.8mm **
2
4mm
Blue TA stapler has a open height of ___ and a closed height of ___ and a width of ___
3.5mm**
1.5
4mm
Regular skin staples width___ and depth ____
W 4.8-5.7
D 3.4-3.9
Which scissors are used for cardiovascular procedures? A Martin scissors B Mayo scissors C Potts-smith scissors D Westcott scissors
C potts smith
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 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
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 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
What are Cooley forceps
Atraumatic vascular forcep primarily for cardiothoracic surgery
describe the serrations of a Rochester-Carmalt forcep
longitudinal serrations and cross-hatching at the tips
what is the difference between Kelly and Crile forceps?
Kelly doesn’t have transverse serations all the way to the end. Crile does
t/f: Locking needle holders should generally be used with 5-0 or larger suture material
False - 6-0 or larger suture
