Chapter 10 - Preparation for surgery Flashcards
When were modern principles of surgery established?
A) Mid-1700s B) Mid-1800s C) Early 1900s D) Late 1900s
B) Mid-1800s
Which factor is most critical in preventing surgical morbidities?
A) Use of antibiotics B) Surgical team coordination C) Proper technique and sound judgment of the surgeon D) Advanced surgical tools
Answer: C) Proper technique and sound judgment of the surgeon
What percentage of surgical events are related to decision-making?
A) 50% B) 75% C) 25% D) 90%
B) 75%
Which is considered more critical in surgery, deciding to operate or deciding not to operate?
A) Deciding to operate B) Deciding not to operate C) Both are equally important D) It depends on the situation
B) Deciding not to operate
Which aspect of surgery contributes to optimal outcomes?
A) Surgeon’s technical skills B) Use of the latest equipment C) A multidisciplinary and multimodal approach D) Strict adherence to surgery schedules
C) A multidisciplinary and multimodal approach
Which of the following is NOT part of the operative risk assessment?
A) Patient’s inherent capacity to overcome the surgical injury B) Technical feasibility of the procedure C) Cost of the surgery D) The team’s familiarity with the procedure
C) Cost of the surgery
Which patient-related factor is critical for assessing surgical risk?
A) Time of day of the surgery B) Patient’s ability to overcome surgical injury C) Surgeon’s specialization D) Type of anesthesia used
B) Patient’s ability to overcome surgical injury
In which type of situation is postponing urgent surgical interventions advisable?
A) When equipment is unavailable B) To allow time for planning and patient preparation C) When the surgical team is not available D) To avoid night surgeries
B) To allow time for planning and patient preparation
What increases the chance of complications in surgeries?
A) Shorter procedures B) Emergency surgeries performed at night C) Use of robotic techniques D) Surgeries with minimal invasiveness
B) Emergency surgeries performed at night
Which surgical prediction models are available for human surgeons?
A) POSSUM and MODS B) ASA and SMOOS C) RiskPrediction.org and RiskCalculator.facs.org D) ASA and POSSUM
C) RiskPrediction.org and RiskCalculator.facs.org
Why is clinical judgment important in surgery?
A) It can reduce the cost of surgery B) It enhances the efficiency of the surgical protocol C) It identifies patients with poor prognosis D) It eliminates the need for prediction models
C) It identifies patients with poor prognosis
Which type of primary disease is associated with a higher surgical risk?
A) Slowly progressing diseases B) Diseases involving non-vital body systems C) Diseases affecting multiple body systems rapidly D) Diseases with minimal symptoms
C) Diseases affecting multiple body systems rapidly
Why are neonatal animals at higher risk during anesthesia?
A) They are immunocompetent B) They have compensatory mechanisms C) They lack energy stores and compensatory mechanisms D) Their organs are fully developed
C) They lack energy stores and compensatory mechanisms
Which animals are at higher risk of developing postoperative rhabdomyolysis?
A) Small animals B) Obese animals C) Large and heavy animals D) Neonatal animals
C) Large and heavy animals
Which classification system is used to assess the physical status of patients?
A) POSSUM B) MODS C) ASA D) SMOOS
C) ASA
What is the reported mortality rate for animals classified as ASA-2 to ASA-5?
A) 0.3% B) 1.2% C) 3.0% D) 5.6%
What does the MODS system assess?
A) Anesthesia risks B) Multiple organ dysfunction syndrome C) Preoperative nutrition status D) Recovery time
B) Multiple organ dysfunction syndrome
What is POSSUM used for in human surgery?
A) Predicting anesthesia risks B) Estimating the duration of surgery C) Assessing physiological and operative severity D) Evaluating nutritional status
C) Assessing physiological and operative severity
What percentage of surgical complications are caused by technical provider-related errors?
A) 20-30% B) 47-96% C) 15-50% D) 60-80%
B) 47-96%
What is the definition of physical status I? Prognosis?
Healthy with no organic disease. Excellent
What is the definition of physical status II? Prognosis?
Local disease with no systemic signs. Good
What is the definition of physical status III? Prognosis?
Disease causes moderate systemic signs that limit function. Fair
What is the definition of physical status IV? Prognosis?
Disease causes severe systemic signs and threatens life. Guarded
What is the definition of physical status V? Prognosis?
Moribund, not expected to live for more than 24 hours with or without surgery. Grave
What is the definition of physical status E? Prognosis?
The addition of “E” in any of the above classes denotes Emergency surgery: An emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part. Variable.
What are the recommended Laboratory tests MINOR in physical status I and II?
PCV, TP, urine specific gravity
What are the recommended Laboratory tests MAJOR in physical status I and II?
CBC, U/A, surgical panel
What are the recommended Laboratory tests MINOR in physical status III, IV and V?
CBC, U/A, biochemical panel
what are the physiologic parameters to take into account in the P-POSSUM scoring system in humans? They are 6 name them
Hemoglobin
WBC
Urea
Sodium
Potassium
Glasgow Coma Scale
What percentage of deaths in small intestinal colic cases were due to judgment errors?
A) 64% B) 25% C) 45% D) 10%
A) 64%
Which of the following has been linked to better surgical outcomes?
A) Specialization and training of the surgical team B) Use of robotic surgery C) Shorter surgeries D) Nighttime surgeries
A) Specialization and training of the surgical team
What is the main cause of technical errors in routine surgeries?
A) Lack of equipment B) Patient’s unusual anatomy or complicating factors C) Use of advanced procedures D) Fatigue of the surgical team
B) Patient’s unusual anatomy or complicating factors
Which factor is less likely to cause technical errors in surgery?
A) Advanced procedures requiring special training B) Routine surgeries C) Repeat surgeries D) Equipment problems
A) Advanced procedures requiring special training
What is critical to reduce errors in routine surgeries?
A) Implementing advanced technology B) Improving decision-making and team performance C) Shortening the procedure time D) Increasing the number of team members
B) Improving decision-making and team performance
Which condition in horses is linked to higher mortality rates when classified under ASA?
A) Colic B) Laminitis C) Fractures D) Respiratory issues
A) Colic
What increases the chances of perioperative fatalities in horses?
A) Low ASA classification B) High ASA classification C) Routine surgeries D) Daytime surgeries
B) High ASA classification
How much more likely is mortality in colic patients compared to healthy ASA-I animals?
A) 2 times B) 10 times C) 12 times D) 20 times
C) 12 times
hich is a primary determinant of surgical risk in animals?
A) Nutritional status B) Time of surgery C) Size of the surgical team D) Type of anesthesia
A) Nutritional status
Which type of surgery tends to have more complications due to lack of specialized training?
A) Routine procedures B) Advanced procedures C) Emergency surgeries D) Minimally invasive surgeries
B) Advanced procedures
What factor is a key consideration for reducing routine surgical errors?
A) Strict adherence to protocols B) Continuous surgeon education C) More advanced surgical tools D) Increased postoperative care
B) Continuous surgeon education
How are better surgical outcomes related to the number of surgeries performed?
A) More surgeries lead to worse outcomes B) Higher volume of procedures by specialized surgeons leads to better outcomes C) Less frequent surgeries are safer D) There is no correlation between volume and outcomes
B) Higher volume of procedures by specialized surgeons leads to better outcomes
What was the mortality rate associated with healthy ASA-I class horses?
A) 0.1% B) 0.3% C) 1.0% D) 3.6%
B) 0.3%
What kind of animals are predisposed to post-surgical infection due to malnutrition?
A) Large animals B) Neonatal animals C) Cachectic animals D) Healthy animals
C) Cachectic animals
Which animals are at risk for hyperlipemia after surgery?
A) Donkeys and obese animals B) Large and healthy animals C) Elderly animals D) Small animals only
A) Donkeys and obese animals
What type of error contributes to most deaths in small intestinal colic cases?
A) Equipment failure B) Technical and judgment errors C) Delayed diagnosis D) Lack of anesthesia
B) Technical and judgment errors
Which of the following decreases postoperative recovery smoothness in horses?
A) Good cardiovascular condition B) Hypotension during surgery C) Stable nutritional status D) Fast surgery completion
B) Hypotension during surgery
How is the POSSUM system used in human surgery?
A) It evaluates anesthesia protocols B) It calculates recovery time C) It assesses the severity of physiological and operative conditions D) It monitors postoperative care
C) It assesses the severity of physiological and operative conditions
Which surgical complication is more frequent in larger animals?
A) Postoperative herniation B) Hypoglycemia C) Hemorrhage D) Reduced wound healing
A) Postoperative herniation
What outcome is associated with hospitals that perform a high volume of specialized surgeries?
A) Increased complications B) Better surgical outcomes C) Longer recovery times D) Fewer training opportunities
B) Better surgical outcomes
What is the primary purpose of using a surgical safety checklist, as advocated by the WHO?
A) To reduce surgical duration B) To increase patient anesthesia time C) To decrease errors and enhance teamwork and communication D) To minimize costs in surgeries
C) To decrease errors and enhance teamwork and communication
What percentage reduction in surgical morbidity and mortality has been shown with checklist implementation in human studies?
A) 10%-20% B) 25%-40% C) 43%-62% D) 70%-80%
C) 43%-62%
In which field has the use of surgical checklists recently been introduced?
A) Large animal veterinary surgery B) Small animal veterinary surgery C) Equine surgery D) Livestock management
B) Small animal veterinary surgery
What potential error in equine surgery could a checklist help prevent?
A) Incorrect diagnosis B) Incorrect anesthesia dosage C) Operating on the wrong horse or limb D) Overuse of surgical instruments
C) Operating on the wrong horse or limb
What key benefit does a surgical checklist provide to the team?
A) It reduces the need for surgical equipment B) It encourages communication and shared responsibility C) It decreases the time required for the surgery D) It increases the number of personnel involved
B) It encourages communication and shared responsibility
What is the primary risk factor for increased morbidity and mortality in surgeries?
A) Type of anesthesia used B) Surgical technique C) Duration of the procedure D) Size of the animal
C) Duration of the procedure
How much does SSI risk increase with each minute of prolonged surgical time in small animals?
A) 0.5% B) 1% C) 2% D) 5%
C) 2%
What condition in equine surgery is associated with long surgical duration?
A) Tachycardia B) Bradycardia C) Hypertension D) Hyperthermia
B) Bradycardia
What is an appropriate patient preparation time for equine surgery?
A) 10 minutes B) 30 minutes C) 60 minutes D) 90 minutes
B) 30 minutes
What is a key element in establishing a bond between a veterinarian and a client during surgery discussions?
A) Quick diagnosis B) Informed consent C) Surgical speed D) Prescription of medication
B) Informed consent
Which of the following is NOT a factor that can reduce anesthesia time in equine surgery?
A) Surgeon experience B) Poor equipment preparation C) Efficient team coordination D) Procedure planning
B) Poor equipment preparation
Why is informed consent important for veterinarians in the event of litigation?
A) It protects against malpractice claims B) It protects against complaints about the outcome C) It shows effort toward client understanding D) It is a legal requirement in all cases
C) It shows effort toward client understanding
Which of the following is NOT a principle of informed consent?
A) It should be true and objective B) It should be limited to what the client can understand C) It should exaggerate the procedure's benefits D) It should include financial implications
C) It should exaggerate the procedure’s benefits
What is the veterinarian’s role in the decision to proceed with surgery?
A) Sole decision-maker B) Legal representative of the animal C) Advisory role D) Lead in legal paperwork
C) Advisory role
What aspect of the veterinarian-client relationship is crucial for client satisfaction?
A) Short procedure time B) An aligned message between veterinarians C) Frequent follow-ups D) Complete delegation of responsibility
B) An aligned message between veterinarians
Why is collaboration with other experts, like anesthesia staff, crucial in equine surgery?
A) To reduce costs B) To improve patient safety and outcomes C) To increase recovery time D) To minimize surgical complications
B) To improve patient safety and outcomes
What is the first step in evaluating a surgical patient?
A) Laboratory testing B) History taking C) Physical examination D) Imaging studies
B) History taking
Why is it important to discuss the owner’s expectations for the animal during preoperative evaluation?
A) To assess their ability to pay for the procedure B) To determine the best anesthesia type C) To align the surgery with the intended use of the animal D) To ensure post-surgery satisfaction
C) To align the surgery with the intended use of the animal
Why is it important to obtain a tetanus vaccination history before surgery in horses?
A) To avoid anesthesia complications B) To prevent tetanus infection post-surgery C) To ensure better recovery D) To reduce the risk of SSI
B) To prevent tetanus infection post-surgery
What risk factor increases the likelihood of SSI in horses with pituitary pars intermedia dysfunction (PPID)?
A) Delayed wound healing B) Increased susceptibility to anesthesia C) Poor blood circulation D) Faster recovery times
A) Delayed wound healing
What did Koch, Lister, and Halstead contribute to the field of surgery?
A) New surgical techniques B) Principles of antisepsis and asepsis C) Modern anesthesia methods D) Minimally invasive surgery
B) Principles of antisepsis and asepsis
What is one of the most effective and simple methods to prevent SSI?
A) Use of alcohol-based rubs for hand hygiene B) Preoperative shaving of the surgical site C) Extended antibiotic use D) Prolonged patient sedation
A) Use of alcohol-based rubs for hand hygiene
What is the recommended time for surgeon hand preparation before surgery?
A) 30 seconds B) 1 minute C) 2 minutes D) 5 minutes
C) 2 minutes
What is the relative risk increase for developing SSI when basic aseptic principles are not followed?
A) 1.5 times B) 2.5 times C) 3.54 times D) 4.5 times
C) 3.54 times
What is a common compliance issue among human and veterinary surgeons regarding preoperative hygiene?
A) Inadequate use of antibiotics B) Inconsistent hand hygiene practices C) Excessive use of surgical gloves D) Prolonged patient anesthesia
B) Inconsistent hand hygiene practices
What is a key feature of an equine surgical facility to reduce morbidity and mortality?
A) Spacious recovery rooms B) A designated operating facility with dirty-to-clean workflow C) A temperature-controlled environment D) Limited access to anesthesia equipment
B) A designated operating facility with dirty-to-clean workflow
Which of the following is essential to performing equine surgery?
A) Lightweight surgical instruments B) Expensive diagnostic imaging C) Substantial investment in equipment and trained personnel D) Advanced robotic assistance
C) Substantial investment in equipment and trained personnel
Which of the following increases the risk of SSI development in surgery?
A) Full compliance with guidelines B) Basic non-compliance with aseptic principles C) Prolonged hand hygiene procedures D) Delayed patient discharge
B) Basic non-compliance with aseptic principles
What is the estimated SSI rate in human healthcare with full compliance to guidelines for clean surgeries?
A) 0.5% B) 1.5% C) 2% D) 5%
A) 0.5%
What is the largest contributor to SSI risk in surgical environments?
A) Poor facility design B) Lack of advanced equipment C) Human non-compliance with aseptic techniques D) Long anesthesia times
C) Human non-compliance with aseptic techniques
What is a major contributor to the development of SSIs in horses with cardiovascular shock?
A) Delayed surgery times B) Distant site infections C) Poor blood circulation D) Low anesthesia tolerance
B) Distant site infections
What should be done if a remote infection is present in a horse before elective surgery?
A) Administer antibiotics during surgery B) Perform the surgery immediately C) Postpone the surgery D) Perform minimally invasive surgery
C) Postpone the surgery
What is the risk associated with a 1.5-times increase in creatinine from baseline values post-surgery?
A) Increased risk of SSI B) Risk of post-surgical bleeding C) Risk for acute kidney injury D) Risk of heart failure
C) Risk for acute kidney injury
What infection-prevention measure did Pasteur advocate for in surgery?
A) Use of antibiotics B) Avoiding bacteria introduction into wounds C) Preoperative blood tests D) Delayed surgical interventions
B) Avoiding bacteria introduction into wounds
What is the recommended approach when an animal has anemia before elective surgery?
A) Administer anesthesia immediately B) Proceed with surgery without delay C) Correct the anemia before surgery D) Perform surgery without anesthesia
C) Correct the anemia before surgery
What is the main cause of litigation in veterinary surgeries?
A) Outcomes of the surgery B) Established means and methods C) Use of anesthesia D) Informed consent documents
B) Established means and methods
Why should baseline inflammatory parameters be obtained before surgery?
A) To prevent anesthesia complications B) To assess surgical impact and postoperative evolution C) To ensure rapid recovery D) To increase surgical precision
B) To assess surgical impact and postoperative evolution
Which organization’s guidelines are considered high-evidence measures for preventing SSIs?
A) World Health Organization B) Centers for Disease Control and Prevention C) Food and Drug Administration D) National Institutes of Health
B) Centers for Disease Control and Prevention
What is the biggest challenge in infection control during surgery?
A) Use of advanced technology B) Poor surgical technique C) The difference between belief and actual practices D) Limited time for hand hygiene
C) The difference between belief and actual practices
What percentage of human surgeons did NOT comply with recommended hygiene guidelines in preoperative practices?
A) 25% B) 50% C) 63% D) 80%
C) 63%
What is the ideal minimum number of surgical suites in a surgical facility?
A) One B) Two C) Three D) Four
B) Two
Why are closed sterile castrations performed in the “dirty” theater?
A) To increase patient safety B) To reduce environmental pressure on the clean theater C) To minimize risk of infection D) To maximize efficiency
B) To reduce environmental pressure on the clean theater
What is the minimum recommended size for a surgical suite?
A) 40 m² B) 50 m² C) 60 m² D) 70 m²
B) 50 m²
What size is considered optimal for a surgical theater to allow safe movement of staff and equipment?
A) 8 m x 7 m B) 9 m x 7 m C) 10 m x 8 m D) 12 m x 10 m
B) 9 m x 7 m
What equipment requires a larger surgical room due to its size?
A) MRI scanner B) Cone beam mobile CT C) Ultrasound machine D) Endoscopic equipment
B) Cone beam mobile CT
hat should the height of the hoist be to lift an adult Warmblood onto a surgery table?
A) 2 meters B) 3 meters C) 4 meters D) 5 meters
C) 4 meters
Where should hoists NOT be installed in the surgical facility?
A) Induction room B) Recovery room C) Surgical theater D) Preparation room
C) Surgical theater
Why are hoists not recommended inside the surgical theater?
A) They are expensive B) They obstruct movement C) They allow dust and contaminants to accumulate D) They are difficult to maintain
C) They allow dust and contaminants to accumulate
How high should the surgical suite ceilings be to minimize air volume and dirt accumulation?
A) High B) Low C) Medium D) Very high
B) Low
What alternative to hoists is suggested for positioning limbs in arthroscopy procedures?
A) Electric hoists B) Sailing ropes attached to the ceiling C) Hydraulic systems D) Manual lifting
B) Sailing ropes attached to the ceiling
What type of outlets should be installed in surgery rooms to prevent wetting during cleaning?
A) Ceiling-mounted outlets B) Wall-mounted outlets C) Floor-mounted outlets D) Portable outlets
B) Wall-mounted outlets
Why should recessed cabinets be used in surgical theaters?
A) To increase space B) To allow for easier cleaning C) To improve aesthetics D) To reduce noise
B) To allow for easier cleaning
What should the height of pulleys for fracture reduction devices be?
A) Waist height B) Shoulder height C) Ceiling height D) Knee height
A) Waist height
What potential risk is associated with floor drains in surgical theaters?
A) They are difficult to clean B) They can facilitate the formation of bacteria-containing aerosols C) They are expensive to install D) They can cause flooding
B) They can facilitate the formation of bacteria-containing aerosols
Why is the patient preparation room separated from the operating room?
A) To improve workflow B) To increase cleanliness C) To enhance comfort D) To reduce noise
B) To increase cleanliness
What type of vacuum system is recommended for patient preparation rooms?
A) Portable vacuum systems B) Built-in or central vacuum systems C) Handheld vacuum cleaners D) Filtered vacuum systems
B) Built-in or central vacuum systems
What is the benefit of having the vacuum motor outside the patient preparation room?
A) Reduces power consumption B) Reduces air movement and particle dispersion C) Increases suction power D) Minimizes noise
B) Reduces air movement and particle dispersion (Correct)
How should surgeon preparation be handled in a surgical facility?
A) In the surgery room B) In a separate scrub room C) In the patient preparation area D) In the recovery room
B) In a separate scrub room
What should the scrub room contain to facilitate proper hand hygiene?
A) Hand dryers B) Posters demonstrating proper hand preparation C) Soap dispensers D) Sterile towels
B) Posters demonstrating proper hand preparation
Why are standing surgeries becoming more popular?
A) They are cheaper B) They avoid general anesthesia C) They are faster D) They are less risky
B) They avoid general anesthesia
Where should the standing surgery room ideally be located?
A) In the recovery area B) Near the surgical suite C) In the patient preparation room D) Next to the scrub room
B) Near the surgical suite
