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surgery > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Three events recorded for pt safety

A

Adverse event
Near miss event
No harm event

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2
Q

Which event gives the most reliable data regarding patient safety mechanism

A

Near miss event data

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3
Q

Usage of checklist before surgery reduced mortality rate by

A

From 1.9% to 2%

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4
Q

The written consent should contain complications wrt procedure.
Should we include all known complications in the consent?

A

Any complications with incidence more than 1% should be included

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5
Q

Color coded IV lines

A 
Orange 14G
Grey   16 G
Green  18G
Pink    20G
Blue     22 G
Yellow  24G
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6
Q

Pt with dehydration and hypotension requires quick IV fluid which IV Canula should be preffered

A

Wide bore with fast flow rate

Orange is widest bore

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7
Q

Narrowest bore with least flow rate

A

Yellow 24 G

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8
Q

Pt after rta brought to er with severe blood loss
Which of following IV lines will be used
16G
18G
20G
22G

A

Minimum two 18G iv inserted
If available a wider can be used
Here 16G is given in option

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9
Q

Most common complication and mgt of iv lines

A

Superficial thrombophlebitis

TT change of canula

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10
Q

Total parenteral nutrition is given to pt which iv line should be used

A

As tpn rich in sugar

Wide bore needle for fast flow rate with short length

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11
Q

I/V canula for burn pt

A

Dehydration - urgent requirement wide bore needle

Edema with burn long length preferred

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12
Q

Phases of surgical safety checklist

A

Sign in ward to OT
Time out BEFORE INDUCTION

SIGn out BEFORE SKIN CLOSURE

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13
Q

Site marking is included in which checklist phase

A

Sign in phase

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14
Q

In which phase surgeon is asked for anticipated blood loss

A

Time out

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15
Q

Responsibility of scrub nurse is

A

Sterility Maintainence

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16
Q

Duty of nurse during sign out phase

A

Nurse does guaze count and equipment count

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17
Q

Actual blood loss during sign out phase is told by

A

Anaesthetist

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18
Q

Each phase of checklist is signed by

A

Nurse
Anaesthetist
Surgeon

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19
Q

How is blood loss calculated during surgery

A

Mops soaked +blood in suction - irrigating fluid

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20
Q

Volume of blood in a completely soaked big mop

A

100cc blood

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21
Q

Advantage of lines in mop/guaze

A

These lines are Radiopaque and used in locating missing mop using C arm

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22
Q

A fist full of clot is how much blood

A

500 cc blood

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23
Q

Zones in an OT

A

Protective zone
Clean zone
Aseptic zone
Disposal zone

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24
Q

Zone connecting protective to aseptic zone

A

Clean zone
It has equipment storeroom
Maintenance workshop

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25
Q

Most common position used for abdominal breast surgery

A

Supine

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26
Q

Neutral OT position is

A

The head end and foot end of table are at same level

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27
Q

Position used in pelvic surgery

A

Trendelenburg

The foot end of table is raised

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28
Q

Reverse trendelenburg position is

And used in

A

Head end is raised and foot end is lowered

Laparoscopy cholecystectomy

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29
Q

Use of prone position

A

Spinal surgery

Pilonidal sinus surgery

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30
Q

Lithotomy position uses stirrups to abduct lower limb

Most common complication due to it

A

Improper padding or over abduction leads to common peroneal nerve injury

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31
Q

Kidney position is used for

Over abduction of arm can lead to

A

Thoracotomy
Nephrolithotomy
Nephrectomy

Injury to brachial plexus

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32
Q

Position for cranial surgery especially posterior cranial fossa

A

Fowler’s position

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33
Q

Advantage and disadvantage of fowlers position

A

Adv relatively bloodless surgery
Disad increase risk of air embolism
Prevention by ligation of vein before cutting

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34
Q

Rose position is achieved by

A

30 degree head elevation
Towel roll placed below shoulder blades
Increase risk of air embolism

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35
Q

Position used in thyroid surgery

A

Rose position

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36
Q

Mgt of air embolism during surgery

A

Durants recovery position
It is left lateral decibitus
And air aspirated through central line

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37
Q

Most common complication of laparoscopy cholecystectomy

A

Right shoulder tip pain

Because co2 used in surgery enters beneath right dome of diaphragm and irritates diaphragm

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38
Q

Why is jack knife position no longer used

A

It causes positional asphyxia

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39
Q

Lloyd David position is and used for

A

Trendelenburg+ lithotomy position

Used in Abd perineal resection and low anterior resection

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40
Q

Instrument used to hold surgical blade

A

Bard parker handle

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41
Q

No 12 blade is used for

A

Suture removal

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42
Q

Stab blade is used for

A

No 11 blade for I &D

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43
Q

Blade used to make incision

A

No 10,15,20,21,22,23

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44
Q

Imp things to make sure while handling blades

A

Belly is the sharpest portion
Blade should be always passed in kidney tray with pointes end towards one self
Blade should always be perpendicular to skin

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45
Q

Cautery pad is used in which type of cautery

A

Monopolar cautery

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46
Q

Why bipolar doesn’t require cautery pad

A

Because current travels from one paddle toother paddle and completes the circuit

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47
Q

Cautery tip in monopolar is aka

Use of 2 buttons

A

Bovie tip
Yellow for cutting
Blue for coagulation

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48
Q

Advantage of bipolar over monopolar cautery

A

Bipolar is safe when used near vital nerves,

49
Q

Monopolar cautery should be avoided in

A 
Pt with pacemaker 
Thyroid surgery
Parotid surgery
Penile surgery
Surgery involving end arteries
50
Q

Waves produxed in cutting mode

A

Low Voltage
Continuous current
Less thermal spread

51
Q

Waves produced coagulation mode

A

AC
High voltage
More thermal spread

52
Q

Disadvantage of monopolar cautery

A

Interference with cardiac conduction

Lateral spread causes thermal damage to nearby nerves

53
Q

Preferred site for cautery pad

When cautery doesn’t work

A

A well vascular wide hairless area of contact
When cautery pad is not attached
Small cautery pad leads to burns

54
Q

Ligasure energy source

It is used for

A

Heat and pressure

Sealing vessel upto 7mm diameter in 2-4 sec

55
Q

Ligasure energy source

It is used for

A

Heat and pressure

Sealing vessel upto 7mm diameter in 2-4 sec

56
Q

Harmonic scalpel works on the principle of

Advantage?

A 
Ultrasonic waves
Heat is not produced 
Used close to vital structure 
Precise 
Can cut through scar tissue
57
Q

Instrument used in area with low collagen tissue like non cirrhotic liver

A

Cusa

Cavitron ultrasonic surgical aspirator

58
Q

T/F

Dist between two sutures should be 2 times depth of wound

A

True

59
Q

Mattress suture should be used if simple sutures are unable to cause eversion of skin edge
T/F

A

True

60
Q

Round body needles should be preferred for skin suturing

T/F

A

False

It cannot cross skin

61
Q

Monocryl is one of the best suture msterial for subcuticular suturing
T/ F

A

True

62
Q

CBD repair suture material used?

A

Polydiaxone
Round body needle
5-0

63
Q

Vascular anastomosis suture material and needle

A

Prolene

Round body needle

64
Q

Rectus sheath suture material used

A

Prolene

Cutting needle

65
Q

Nerve repair suture material used

A

Nylon

Round body needle

66
Q

Best suture material for sub cuticular suturing

Knot used

A

Monocryl 3-0
Cutting needle
Tied by aberdeen knot

67
Q

10-1 sutures are finer than no1 sutures

T/F

A

True

68
Q

Number 1 suture is easier to handle as compared to 10-0

T/F

A

True

Because itis thicker

69
Q

No 1 suture are likely to fracture more commonly as compared to 10-0 ?

A

False

They are thicker

70
Q

Drains used after Modified radical mastectomy

Indicated when?

A

Romovac suction drain

Usedwhen output is more than 40 cc for 2 consecutive days

71
Q

Use of minivac suction drain

A

Used after sentinel LN biopsy

72
Q

Chest tube drainage system is aka

A

Underwater seal system

73
Q

T/F

Lscs is clean contaminted type of wound?

A

True

74
Q

Ilieal perforation is dirty wound?

A

True

75
Q

Right hemicolectomy is pt with prepared bowel?

Clean /clean contaminated/dirty?

A

Clean contaminated

76
Q

Lap chole in acute cholecystitis? Type of wound

A

contaminated

77
Q

Knee replacement is clean surgery?

T/F?

A

True

78
Q

Early case of duodenal perforation is a ____ type of wound

A

Clean contaminated

79
Q 
All of the following are risk factor for increase risk of wound infection except
OBESITY
HYPERTENSION
JAUNDICE
CANCER
A

Htn

80
Q

34 yr old pt underwent laprotomy for ileal perforation and was in recovery when multiple episodes of loose stools which composes of mainly mucus with spikes of fever. Most probable cause of her condition

A

Pelvis diarrhea due to pus in pelvis

81
Q

Most common surgical site infection on post op say 1

A

Atelectasis

82
Q

Most common cause of post op fever in a surgical pt

A

Surgical site infection

83
Q

Most common cause of post of fever overall

A

UTI

84
Q

SSI is any wound infection within 15 days of surgery?

A

False, 30 days of surgery

85
Q

Burst abdomen following abdominal surgery usually develops around day 6

A

True

86
Q

Most common site of intra abdominal collection in pt of bowel surgery

A

Puch of douglas

87
Q

Hypothermia during surgery reduces risk of infection?

A

No it increases

88
Q

For a female pt undergoing abdominal surgery with part should be cleaned

A

From inframammary fold to mid thigh

89
Q

In a prolonged surgery prophylactic antibiotics should be repeated after

A

4 hrs

90
Q

A dual ring abd wound protector is superior to single ring protector
T/F?

A

True

91
Q

Washing the wound cavity with antibiotics after surgery reduces wound infection rate?

A

False

92
Q

In transparenteral nutrition, sudden glucose intolerance is an early sign of sepsis
T/F

A

True

93
Q

Central line for TPN should be changed every 2 weeks to prevent infection
T/F

A

No central line is not changed unless infection is suspected

94
Q

In TPN, electrolytes should be checked every 2-3 days?

A

True

95
Q

TPN is best delivered through?

A

Central line

96
Q

Subclavian central lines have higher rate of pneumothorax as compared to IJV central line
T/F?

A

True

97
Q

Subclavian central lines are easier to insert as compared to IJV central line
T/F

A

False

98
Q

Best nutrition regimen in a pt with esrd

A

Low volume high calories

99
Q

Following TPN, one expect wt gain after how much time?

A

5-7 days

100
Q

Femoral lines have the highest infection rate

T/F

A

True

101
Q

Nasogastric tube cam be used for feeding upto 2-3 wks

T/F

A

True

102
Q

Nasojejunal tube should be used if there is?

A

Bad gastric emptying

103
Q

Most common complication of enteral nutrition

A

Tube related - migration of tube, blockade

104
Q

Most common complication related to feeding regimen

A

Osmotic diarrhea

105
Q

Tube feed should be withheld is aspiration is–

A

More than 200 cc in 2 hr period

106
Q

Method for feeding gastrostomy

A

Stam method
Witzel method
Percutaneous endoscopic gastrostomy

107
Q

Why is surgeon knot secure knot

A

Because it has 2 throws followed by one throw

108
Q

Purse string suture used for

A

Bury tha base of appendix

Stapler haemorrhoidopexy

109
Q

Edges preferred for skin suture

What to do when simple suture fails to cause it

A

Everted edges

Mattress suturing

110
Q

Far near near far suture is used for

A

Better obliteration of cavity

111
Q

Shoe string method is used for

A

It is used for delayed closure of wound

Healing by tertiary intention is achieved

112
Q

Where to hold needle

A

At junc of 2/3 from pointed end and 1/3 from swaged end

113
Q

Use of round body and cutting needle

A

Round body -splits tissue, atraumatic, delicate structure like blood vessel, cbd

Cutting needle - cuts through tissue, traumatic, used for tough structure skin fascia

114
Q

Jenkins rule of mass closure

A

Minimum length of prolene used to close rectus sheath wound is 4times length of rectus sheath wound

115
Q

Catgut is derived from

Its tensile strength

A

Submucosa of sheep gut

Undergoes degradation by 7-10 days

116
Q

Strongest layer of bowel

Suture edges for bowel Suturing

A

Submucosa

Inverted edges

117
Q

Technique for bowel anastomoses

A

Single layer - stitch at extramucosal single layer applied

Two layer outer and inner layer

118
Q

Two layer repair technique in bowel Anastomosis

A

First layer - albert layer closed by Round body vicryl
Second layer lembert layer is a seromucosal layer
RB silk

119
Q

Salmon fluid sign is seen in

A

Burst abdomen

Large quantities of reddish fluid escapes from main wound

surgery (5 decks)

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