204 X2 Flashcards
Hemostasis, essential to successful wound management, occurs when _________ reacts with fibrinogen to form ____________, the basic structure of a clot.
A. Serotonin, fibrin
B. prothrombin, thromboplasin
C. fibrin , thrombin
D. thrombin, fibrin
D. Thrombin, fibrin
Which does not coagulate blood vessels?
Nd: YAG laser
Argon laser
CUSA
Harmonic scalpel
CUSA
Which chemical hemostatic agent must never be injected?
a. Heparin
b. Papaverine
c. Thrombin
d. Epinephrine
c. Thrombin
Which hemostatic agents are absorbable and need not be removed:
1. oxidized cellulose
2. gelatin sponge
3. microcrystalline collagen
4. thrombin
All of the above
Which is/are true about glues?
All of the following are true
They may be used on areas of active blood loss
They confirm to irregular contours
They use cogulation factors in plasma
All of the following are true
The use of electrocoagulation for hemostasis is contraindicated:
A. In oral surgery with halothane anesthesia
B. After an iodophor skin prep
C. In bladder surgery using saline irrigation
D. In lung surgery using methoxyllurane anesthesia
C. In bladder surgery using saline irrigation
Inherited deficiencies of coagulation in which bleeding occurs spontaneously after minor trauma is called:
Pernicious anemia
Tay-Sachs disease
Erythroblastosis fetalis
Hemophilia
Hemophilia
Prothrombin time measures:
The coagulant activity of the extrinsic system, including fibrinogen, prothrombin, and factors V, VII, and X
The presence of immune globulin on the surface of erythrocytes or in the plasma
Disorders of platelet function
Deficiencies of all plasma coagulation factors except VII and XIII
The coagulant activity of the extrinsic system, including fibrinogen, prothrombin, and factors V, VII, and X
The SFA initially seeks to prevent blood loss by:
Appropriate use of the ESU and argon beam coagulator
Anticipatory control of blood vessels
Learning how to use the square knot
Using digital compression before other methods
Anticipatory control of blood vessels
Which is NOT true about damage control technique?
Surgery is aborted when the patient is losing too much heat or blood
Surgery is aborted if the patient can’t be stabilized
Team focuses on stopping hemorrhage and preventing contamination
Cavities and incisions are temporarily closed
Surgery is aborted if the patient can’t be stabilized
Hemostatic agents used in surgery are administered systemically or ______________________ in the form of powders, sponges, solutions, or films.
Intravenously
Topical
Intramuscularly
Subcutaneously
Topical
Which are considered thermal methods of hemostasis:
1. laser
2. photocoagulation
3. bone wax
4. diathermy
5. hemostatic ligating clip
1, 2, 4
Vascular prosthetic grafts may be coated with ______ to prevent bleeding through porous graft surfaces.
Albumin
Thrombin
Fibrin glue
Oxidized cellulose
Albumin
Thrombocytopenia is lack of:
RBCs
WBCs
Thrombin
Platelets
platelets
_______ is the key to a RBC’s ability to carry oxygen.
Fluorocarbon
Hematocrit
Hemoglobin
Thrombin
Hemoglobin
Which prolong(s) coagulation time and may contribute to postoperative hemorrhage:
1. controlled hypotension
2. epinephrine
3. hypothermia
4. warfarin
5. vitamin K
1, 3
Which Of the following is a hemostatic agent that is available in a powder or an absorbable gelatin sponge form which may be cut to the desired size or shape depending on the application?
Avitene
Surgicel
Gelfoam
Thrombin
Gelfoam
________ causes the break down of the formed fibrin network.
Plasmin
Platelets surgery
Thrombin
von Willebrand Factor
Plasmin
A frazier tip suction held to the back of a Cottonoid® pattie are likely used to clear the operative field in which of the following:
Laparoscopic surgery
Endoscopic surgery
Open abdominal surgery
Microsurgery
Microsurgery
The first blood element to arrive after a break in the endothelial lining is the:
von Willebrand Factor
Platelet
Fibrin
WBC
Platelet
When using a monopolar electrode tip, which of the following would be needed to complete the circuit on the ESU?
A. a bipolar forceps
B. an insulated holster
C. an active electrode
D. a dispersive pad
D. a dispersive pad
Which of the following can be fatal for the surgical patient?
Loss of RBCs
Loss of serum
Loss of WBCs
Loss of platelets
Loss of RBCs
An example of the application of indirect pressure is applying it:
With a sponge on stick
Between two fingers (bidigitally)
To an area proximal to the bleeding vessels
With the tip of an instrument, such as the suction tip
To an area proximal to the bleeding vessels
What clotting factor does fibrinogen react with to form fibrin during the clotting process?
Plasma
Thrombin
Collagen
Serotonin
Thrombin
The topical hemostatic agent thrombin should never be directly injected or allowed to enter into a vessel because:
A. it causes uncontrollable vasospasms.
B. the effects are reversed when directly injected and cause more severe bleeding.
C. it can cause clotting and may ultimately lead to death.
D. the risk of infection increases with direct injection.
C. it can cause clotting and may ultimately lead to death.
Which of the following cauterization devices would be appropriate in tight spaces, with high risk for collateral nerve tissue nearby?
Bipolar cautery forceps
Pencil-tip cautery
Needle-tip cautery
Monopolar “pincher” cautery
Bipolar cautery forceps
When the SFA must deal with multiple clamps as tying is about to proceed, he/she should:
Take two or more in the hand at a time to speed the process
Suggest using the ESU rather than tying
Pick them up for tying in the order that they were placed
Take the most accessible one first and proceed in a logical order
Pick them up for tying in the order that they were placed
A patient who is opposed to the acceptance of blood transfusion of religious principles is undergoing a hysterectomy. During surgery, there was significant blood loss causing the hematocrit to drop to 30% with a resulting drop in oxygen saturation. Under these conditions, which of the following is the appropriate response?
Transfuse whole blood
Increase IV fluid drip to allow hemodilution
Change IV fluid to dextrose 5% with water
Transfuse platelets
Increase IV fluid drip to allow hemodilution
The primary difference between the Cushing and Connell suturing techniques for GI anastomosis include which of the following:
The Connell stitch penetrates the mucosal layer, while the Cushing does not
The Cushing stitch penetrates the mucosal layer, while the Connell does not.
The Connell stitch is interrupted, while the Cushing is running stitch
The Cushing stitch is interrupted, while the Connell is a running stitch
The Connell stitch penetrates the mucosal layer, while the Cushing does not
Which of the following statements concerning the principles of suture placement is correct?
Sutures should be placed as close to the wound edge as possible to prevent tissue necrosis
Sutures should be as far as possible from the wound edge to prevent knot slippage and displacement
Sutures should be placed in deep tissue to prevent hematoma
Suture placement should place as much tension on the tissue as possible to promote healing
Sutures should be placed in deep tissue to prevent hematoma
Which of the following types of stitch patterns provides an excellent cosmetic closure?
Subcuticular stitch
Retention stitch
Purse-string stitch
Simple stitch
Subcuticular stitch
Scar maturation:
Occurs immediately following the inflammatory stage
Occurs on days 5-14 and consists of the initiation of production of collagen fibers
Is not a distinct phase of wound healing
Has a variable duration depending upon the specific type of tissues that are wounded
Has a variable duration depending upon the specific type of tissues that are wounded
The amount of tension or pull expressed in pounds that a suture can withstand before it breaks is:
Pliability
Capillarity
Tensile strength
Knot strength
Tensile strength
“Eversion” of skin edges for staple closure means:
Turn the skin edges under for tighter closure
Turn the skin edges up, that is, line up the dermal margins
Overlap one side over the other for double strength
Leave a large gap between the skin-edges to allow for drainage
Turn the skin edges up, that is, line up the dermal margins
Which of the following would affect normal wound healing?
Latex allergy
Penicillin allergy
Peripheral vascular disease
Clean wound
Peripheral vascular disease
A 6-0 suture is:
Larger diameter than a 4-0
Smaller diameter than a 4-0
Is too small for skin closure
B and C
Smaller diameter than a 4-0
Clean, contaminated wounds would include initially clean wounds which were then contaminated by:
Entrance into the pharyngeal cavity
Entrance into the GU cavity
Entrance into the abdomen
A and B
A and B
Fibroblasts are:
RBCs
WBCs
Cardiac muscle cell
Connective tissue cell
Connective tissue cell
Intra-operative superficial and deep suction drain placement with compression dressings following mastectomy procedures reduce the incidence of which of the following complications:
Paresthesia on the undersurface of the arm
Lymphedema
Post-op seroma
Neoplasm recurrence
Post-op seroma
Collagen is:
A blood-borne substance
Substance present in neurologic tissue
The protein substance of connective tissue
The mineralized matrix of bone
The protein substance of connective tissue
The main consideration in surgical needle selection is:
To minimize microbial growth
Stabilization within the jaws of the needle-holder
To minimize trauma
Corrosion resistance
To minimize trauma
Which of the following sutures should not be used in the placement of heart valves?
Polypropylene
Polyglactin
Polydioxanone
Polyglecaprone
Polydioxanone
In which incision could retention sutures be used?
Vertical midline
McBurney
Transverse
Thoracoabdominal
Vertical midline
An absorbable suture that offers extended wound support:
Vicryl
PDS
Plain
Chromic
PDS
Polyglactin 910 suture is:
Absorbable, natural
Nonabsorbable, natural
Absorbable, synthetic
Nonabsorbable, synthetic
Absorbable, synthetic
Which of the following methods should the SFA consider when cutting suture?
According the surgeon’s preference
According to the SFA’s preference
Leave a one centimeter tail for nonabsorbable suture
Cut on the knot for absorbable suture
According the surgeon’s preference
Continuous lateral stitches placed beneath the epithelial layer of the skin are:
Interrupted
Subcuticular
Purse-string
Subcutaneous
Subcuticular
Which of the following organisms normally found on the skin can cause wound infection?
Bacillus botulinum
Staphylococcus aureus
Diplococcus pneumoniae
Candida albicans
Staphylococcus aureus
Which of the following features represent a disadvantage of monofilament suture material?
Higher reactivity than braided material
Not preferable in infected situations
Not preferable near the skin
Poor relative knot security compared with braided material
Poor relative knot security compared with braided material
The three phases of wound healing include all of the following EXCEPT:
Fibroplastic phase
Chronic phase
Remolding phase
Inflammatory phase
Chronic phase
Wound closure using sutures is termed:
Closure by primary intention
Closure by secondary intention
Granulation
None of the above
Closure by primary intention
Sutures placed in a wound to prevent wound evisceration are called:
Stent
Fixation
Retention
Traction
Retention
The method of wound closure during which the wound is allowed to granulate closed is called:
Healing by primary intention
Healing by secondary intention
Healing by third intention
Healing by no intention
Healing by secondary intention
What is a better bed for a skin graft?
Fascia
Fat
Fascia
All angles of the flap are 60º, which means that every side of both the defect and the flap is equal length:
Dufourmental flap
Webster flap
Rhombic flap
Bilobe flap
Rhombic flap
Reorients and lengthens a scar.
TRAM flap
Z-plasty
Free flap
V-Y advancement flap
Z-plasty
Relaxed skin tension lines are:
Not important during surgery
Important for planning incisions
The lines of minimal intention of the skin
B and C
B and C
During a TRAM procedure, which is used to identify and preserve the superior epigastric arteries?
C-arm
Doppler
Echocardiography
Angiography
Doppler
This flap shares a side with the defect (wound). It is mostly used in reconstructive surgery fro small facial defects.
Regional flap
Local flap
Distant flap
Free flap
Local flap
A dual transposition flap used to close circular defects.
Free flap
TRAM flap
Bilobe flap
Z-plasty
Bilobe flap
What is an STSG?
Includes the epidermis and a variable amount of the dermis
Includes the entire epidermis and dermis
Includes the epidermis and a variable amount of the dermis
This flap is away fro the defect and it is done when local tissue is insufficient to cover an adjacent defect requiring a flap to be transferred from a remote location.
Regional flap
Local flap
Distant flap
Free flap
Distant flap
An alternate breast reconstruction flap from women that are thin and may not have enough abdominal tissue:
Gluteal flap
Transverse Rectus flap
Composite flap
Deep inferior epigastric performator flap
Gluteal flap
What muscle is commonly used for TRAM reconstruction in a mammoplasty?
Latissimus dorsi
Transverse abdominis
Internal oblique
Rectus abdominis
Rectus abdominis
The Z-plasty:
Is useful in shortening wounds
Is useful in reorienting the direction of scars
Provides no improvement in cosmesis
Is a free flap
Is useful in reorienting the direction of scars
Advantages of flaps include(s):
They provide blood supply to the recipient site
They provide tissue bulk at a defect
They have no contracture
All of the above
All of the above
Type of closure which consist of consecutive triangles made on one side of the scar with its mirror image on the other side:
Z-plasty
W-plasty
S-plasty
Four flap Z-plasty
W-plasty
What type of flap is separated from all vascular supply that requires microvascular anastomosis?
Free flap
TRAM flap
Z-plasty
STSG
Free flap
Montgomery straps are used to:
Secure head dressings
Hold a thyroid dressing in place
Conform a dressing in place
Hold in place bulky dressings that require frequent changing
Hold in place bulky dressings that require frequent changing
Which of the following is frequently used over an incision in pediatric surgery?
Collodian
Benzion
Cotton-elastic bandage
Pressure dressing
Collodian
During application of a cast, additional padding is often required to protect bony prominences of patients at greater risk for pressure injury. Which of the following padding materials is MOST commonly used in this situation?
Stockinette
Kerlix roll
Webril
Kling
Webril
Appropriate drain type for a nasogastric decompression:
A. No drain
B. Jackson-Pratt closed drain
C. Underwater seal drain
D. Sump drain
D. Sump drain
Appropriate drain type for a spontaneous pneumothorax
A. No drain
B. Jackson-Pratt closed drain
C. Underwater seal drain
D. Sump drain
C. Underwater seal drain
Appropriate drain type for diffusion of peritonitis from a perforated duodenal ulcer
A. No drain
B. Jackson-Pratt closed drain
C. Underwater seal drain
D. Sump drain
A. No drain
Appropriate drain type for splenectomy for ruptured spleen
A. No drain
B. Jackson-Pratt closed drain
C. Underwater seal drain
D. Sump drain
B. Jackson-Pratt closed drain
What are the potential advantages of negative-pressure wound therapy?
1. Draws wound edges together
2. Removes exudates and infectious materials
3. Reduces edema
4. Promotes perfusion and facilitates granulation tissue
1, 2, and 3
2, 3, and 4
2 and 4
All of the above
All of the above
Which of the following should be applied immediately postoperatively to immobilize the surgical site, limit limb motion, and allow for postoperative swelling in open reduction procedures?
Long arm cast
Splint
Long leg cast
Spica
Splint
Immediately following an arthroscopic assisted cruciate ligament (ACL) reconstruction, a patient’s knee is typically placed in:
Hinged knee brace
Posterior splint
A long-leg cast
An anterior splint
Hinged knee brace
Which of the following dressings are derived from bovine, equine, or porcine sources and are effective in recalcitrant wounds?
Composites
Alginates
Cyanoacrylate
Collagen
Collagen
Which of the following is considered a non-impregnated, nonadherent dressing?
Adaptic
Vaseline gauze
Telfa
Xeroform
Telfa
Which of the following casts should be applied to a non-displaced humeral fracture?
Wedge
Hanging
Sugar tong
Munster
Hanging
Which procedure would NOT require a pressure dressing?
Plastic surgery
Knee surgery
Radical mastectomy
Hysterectomy
Hysterectomy
Why would benzoin be applied to the skin before dressing application?
To facilitate easier removal
To increase adhesiveness
To add a microbial film to the skin
To prevent allergic reaction to tape
To increase adhesiveness
A temporary biological dressing is:
Porcine
Telfa
Collagen
Mesh
Porcine
Which of the following wound dressings absorbs exudate from the wound?
Xeroform
Gauze
Tegaderm
Collodion
Gauze
Which of the following is the casting method used to manage a pelvic fracture?
Flexor block cast
Extensor block cast
Spica cast
Short cast
Spica cast
Which is NOT a reason for a pressure dressing?
Prevents edema
Conforms to body contour
Absorbs extensive drainage
Distributes pressure evenly
Conforms to body contour
