Instrumentation

Question 1

What must sharps be placed in on the completion of surgery

Answer 1

Gallipot

Question 2

What must swabs be placed in on the completion of surgery?

Answer 2

Kick bucket

Question 3

What is a Mayo pin used for?

Answer 3

Hand towel clamps and crushing forceps to facilitate storage and easy lifting from the basket

Question 4

What instrument is the gold-standard for cutting and causes the least trauma?

Answer 4

Stainless steel scalpel

Question 5

What is the most common scalpel handle type?

Answer 5

Number 3

Question 6

What is the most common number blade?

Answer 6

number 10

Question 7

What type of incision gives the best control of length, depth and direction?

Answer 7

Slide cutting

Question 8

Which grip is used for long incisions?

Answer 8

Fingertip grip

Question 9

Which grip increases precision and depth control and is used for shorter/more delicate incisions

Answer 9

pencil grip

Question 10

What type of incision is used to enter body cavities or fluid-filled organs such as the linea alba or the bladder?

Answer 10

Press cutting

Question 11

What material gives better stability and protects suture damage on the tips of needle holders?

Answer 11

Tungsten Carbide

Question 12

What is the difference between Mayo-hegar and Olsen-Hegar needle holders?

Answer 12

Olsen-Hegar have a cutting blade built into the jaws

Question 13

Name the four grip types for instrument handling

Answer 13

• Tripod (most used)
• Thenar
• Palmed
• Pencil

Question 14

Are blunt tipped or sharp tipped scissors preferred?

Answer 14

Blunt tipped

Question 15

What are the advantages of curved vs straight scissors?

Answer 15

Curved scissors improve visibility during dissection
Straight scissors offer a mechanical advantage

Question 16

Which instruments are useful to have long versions of for work in deeper cavities?

Answer 16

• Needle holders
• thumb forceps
• metzenbaums
• right-angled forceps

Question 17

How do you differentiate metzenbaum scissors from Mayos

Answer 17

Metzenbaums: thin, delicate tips used for most dissections
Mays: longer, thicker blades used for cutting dense tissues. Separate pair used for cutting suture

Question 18

Which grip gives best control over forces when using scissors?

Answer 18

Tripod grip

Question 19

Name and describe the three types of force exerted with scissors

Answer 19

Closing: cause blades to come together
Shearing: push the blades flat against each other during closing
Torque: roll the leading edges of the blades inward to touch each other

Question 20

Name the three scissors cutting techniques:

Answer 20

Sharp dissection
Push cutting
Blunt dissection

Question 21

Describe sharp dissection

Answer 21

Standard double-blade cutting action. only the tips are used to prevent crushing tissues

Question 22

What may push cutting be used for?

Answer 22

rapidly cut through less dense, areolar tissue

Question 23

What is blunt dissection used for?

Answer 23

To undermine skin edges or to break down loose connective tissue. Only the tips are used to prevent tissue trauma. Do not use excessively as it increases tissue trauma and dead space.

Question 24

Describe blunt dissection

Answer 24

The tips are introduced under the skin, the blades opened then withdrawn and then closed before re-introduction.

Question 25

Name two types of crushing forceps

Answer 25

Allis forceps Babcock forceps

Question 26

Which forceps have serrated tips and are used to grasp and manipulate dense tissue and fascia. They cause tissue damage due to crushing and should only be used on tissue that is going to be excised

Answer 26

Allis forceps

Question 27

Which forceps have smooth, inverted tips. They are used to hold delicate visceral tissue and tubular organs such as the bowel. Their wider, rounded, grasping surface is less traumatic and the orifices in the tips accommodate some of the tissue, reducing the intraluminal pressure and tissue damage

Answer 27

Babcock forceps

Question 28

Name two types of non-crushing forcep

Answer 28

Doyen intestinal forceps Satinsky clamps

Question 29

Which forceps are used to occlude the bowel lumen during GI procedures. The jaws may be straight or curved, they are concave and have fine longitudinal grooves. When closed, only the tips meet and the bowel is enclosed in the centre of the concavity.

Answer 29

Doyen intestinal forceps

Question 30

Which forceps are used to partially or completely occlude blood vessels. They have a ring handle and a ratchet mechanism to lock the jaws. The U-shaped jaws have fine striations that allow them to firmly grasp and occlude a vessel without crushing it.

Answer 30

Satinsky clamps

Question 31

What are haemostatic forceps used for?

Answer 31

To grasp vessels or vascular pedicles, providing temporary or definitive haemostasis.

Question 32

Describe the two ways to use Halstead mosquito forceps

Answer 32

- Apply with the tip down for tip clamping of small vessels - Apply with the tip up for jaw clamping of vascular pedicles

Question 33

Which instrument may be used to clamp vessels or pedicles which are difficult to access with straighter forceps. They can also be used to dissect around vessels to isolate them prior to ligation

Answer 33

Right-angled forceps

Question 34

What are thumb forceps used for?

Answer 34

Stabilise tissue during dissection and suturing.

Question 35

Name four types of thumb forcep

Answer 35

- Adson - Brown-adson - Debakey - Dressing

Question 36

Which thumb forceps have only two fine teeth so may cause less crushing injury than others

Answer 36

Adson

Question 37

Which thumb forceps have two parallel rows of fine teeth

Answer 37

Brown-Adson

Question 38

Which thumb forceps are used for handling delicate tissue, particularly blood vessels and visceral organs. The jaws contain two rows of microscopic teeth that fit together resulting in an even distribution of tension and atraumatic tissue handling.

Answer 38

Debakey

Question 39

Which thumb forceps have tips with smooth serrations. They are used for handling swabs and should never be used to handle tissues

Answer 39

Dressing forceps

Question 40

Which instruments have pointed tips and are designed to hold drapes to the patient's skin.

Answer 40

Towel clamps

Question 41

What is the most popular type of towel clamp? They have ringed handles and a ratchet lock.

Answer 41

Backhaus

Question 42

Name 4 types of hand-held retractors

Answer 42

- Senn - Lagenbeck - Malleable - Hohman

Question 43

Which retractors are small and double-ended, with one end having three prongs and the other a right-angled blade. Useful for retraction of superficial tissues

Answer 43

Senn retractors

Question 44

Which retractors have flat, right-angled blades and are used for retracting deeper tissues and muscle bellies

Answer 44

Lagenbeck

Question 45

Which retractors are flat and flexible, used to retract organs such as liver lobes or lung lobes within body cavities?

Answer 45

Malleable retractors

Question 45

Which retractors have a flat blade and a beak. The beak is inserted under a bone or fracture fragments while the blade depresses and protects the adjacent soft tissues.

Answer 45

Hohman retractors.

Question 46

Name four types of self-retaining retractors

Answer 46

- Gelpi - Travers - Balfour - Finochietto

Question 47

Which retractors have two arms, ring handles and a ratchet hook. They are ideal for retracting skin edges, subcutaneous tissues and muscles. Exposure is optimised when two are placed at right angles to each other.

Answer 47

- Gelpi (may be standard or paediatric)

Question 48

Which self-retaining retractors have multiple prongs to allow better tissue purchasing and force distribution?

Answer 48

Travers

Question 49

Which retractors have two moveable arms mounted on parallel slide bars. They are used for retraction of the abdominal wall during coeliotomy procedures. The central blade may or may not be used

Answer 49

Balfour

Question 50

Which retractors have two, broad, outward-curved blades mounted on a ratcheted bar. Used for spreading ribs or sternum during thoracotomies

Answer 50

Finochietto

Question 51

Name three types of suction tip

Answer 51

- Adson - Yankour - Poole

Question 52

Which suction tip is best used for precise suctioning of small volumes of fluid

Answer 52

Adson (or Frazier's)

Question 53

Which suction tip efficiently removed larger volumes of fluid

Answer 53

Yankour

Question 54

Which suction tip is used for suctioning fluid from body cavities. The outer fenestrated tube contains an inner pin-point suction tube and prevents occlusion by body tissues

Answer 54

Poole

Question 55

What may a thumb-controlled flexible suction tip be used for?

Answer 55

Remove fluid from the upper airways and trachea. Useful in brachycephalic patients

Question 56

What are monopolar units used for?

Answer 56

Dissection and haemostasis

Question 57

With monopolar cautery, what results in a cutting action

Answer 57

A continuous, undampened waveform

Question 58

How is coagulation achieved with monopolar cautery?

Answer 58

Blending functions and effectively burning tissues

Question 59

What is a potential complication of monopolar cautery if the ground plate is in contact with a small area?

Answer 59

Risk of thermal burns

Question 60

Vessel-sealing devices can seal vessels up to what diameter?

Answer 60

7mm

Question 61

How do harmonic devices work?

Answer 61

Ultrasonic vibrations at 55.5KHz generate heat and coagulate tissues via coaptive coagulation

Question 62

Name and describe two types of photon emission

Answer 62

Spontaneous: electrons are excited then return to rest, emitting photons. not in phase Stimulated emission: the emitted photon is hit by a second and subsequent photons. 'in-phase'

Question 63

What are photochemical effects

Answer 63

Chemical reactions induced directly by light. They can lead to direct tissue destruction

Question 64

What are photothermal effects?

Answer 64

heat-related interactions such as ablation and coagulation. Most medical lasers have a photothermal effect.

Question 65

What is photoablation?

Answer 65

associated with direct breakage of molecular bonds

Question 66

How does photodynamic therapy work?

Answer 66

used in the treatment of some cancers. A chromophone is introduced into diseased tissues. This absorbs laser light and converts it to heat or toxic oxygen radicals, thus destroying tissue