LE5 Surgery Feeds Flashcards

Question

24. Harrington Retractor is also called a sweetheart retractor. * A. True B. False

Answer 1

A. True. The Harrington retractor, known for its distinctive heart-shaped end, is often referred to as a "sweetheart" retractor. It is commonly used in abdominal surgeries to retract and hold back organs, such as the liver, to provide better visibility and access to the surgical site.

Answer 2

A. Eutectic Mixture of Local Anesthetics. Composition: Contains two amide-type local anesthetics: 25mg/g Lidocaine = 2.5% 25mg/g Prilocaine = 2.5% Availability: 30g tubes = 750mg 5g tubes = 125mg EMLA cream contains a combination of lidocaine and prilocaine, each at a concentration of 25mg per gram of cream. This concentration translates to 2.5% of each anesthetic. For a 30g tube of EMLA: - Each gram contains 25mg of lidocaine and 25mg of prilocaine. - Therefore, the entire tube contains 30g * 25mg/g = 750mg of lidocaine and 750mg of prilocaine. For a 5g tube of EMLA: - Each gram contains 25mg of lidocaine and 25mg of prilocaine. - Therefore, the entire tube contains 5g * 25mg/g = 125mg of lidocaine and 125mg of prilocaine. The percentage of the anesthetic components remains the same in both tube sizes, which is 2.5% for lidocaine and 2.5% for prilocaine.

Answer 3

A. Malleable (ribbon)

Answer 4

D. Hypospadias

Answer 5

B. Adson, Toothed **ADSON FORCEPS** - Also known as "Adson pickups." - **Variants**: - **Smooth/Without Teeth**: Designed for handling delicate tissues gently to avoid causing damage. - **With Teeth**: Typically used for securely grasping skin. - **Features**: - Notable for having a wider "belly" or grip handle, which can provide a more comfortable and secure grasp for the user. - **Identification**: - When identifying Adson forceps, it's important to specify whether they are with or without teeth, as this determines their specific use in medical procedures.

Answer 6

B. Purse-string suture. **CONTINUOUS SUTURE** - **Overview**: Involves a single strand of suture material running continuously along the wound edge. - **Technique**: The needle alternates from one side of the tissue edge to the other. - **Advantages**: Quick to place and uses less suture material. - **Disadvantages**: Less strength than interrupted sutures; if one section breaks, the entire suture may unravel. **SUBCUTICULAR SUTURE** - **Type**: A running suture placed within the dermis. - **Use**: Ideal for cosmetic closure, including pediatric patients. - **Outcome**: Results in close approximation of skin edges without external suture visibility, producing a minimal scar. **PURSE-STRING SUTURE** - **Application**: Special technique for closing the end of a tubular structure, like the appendix. - **Procedure**: Sutures are placed circularly around the lumen's opening, then drawn tight and knotted to close. **LOCKING SUTURE** - **Purpose**: Adds strength to a running suture line and enhances hemostasis. - **Technique**: After each pass through the wound edges, the needle goes under the previous loop, effectively 'locking' each segment. - **Innovation**: "Self-locking" or barbed sutures, which contain projections that prevent the suture from loosening, offer a modern alternative to traditional locking sutures.

Answer 7

A. subcuticular suture

Answer 8

A. continuous (running) suture

Answer 9

C. Instrument tying 1. **One-Handed Square Knot**: A technique where the surgeon ties a square knot using one hand, which is useful in situations with limited space or when the other hand is occupied. 2. **Two-Handed Square Knot**: A basic and commonly used knot in surgery where both hands are used to tie a square knot, which ensures the knot is secure and lies flat against the tissue. 3. **Surgeon’s Knot**: Similar to the square knot but with an additional throw or loop which adds security to the knot, making it less likely to slip before the knot is tightened, particularly in situations where the tissue is slippery. 4. **Instrument Tie**: A knot-tying technique that uses a surgical instrument, like a needle holder, to assist in the formation of the knot, offering precision and control, particularly in deep or narrow surgical fields.

Answer 10

A. True. In the context of infection control and surgical procedures, a surface is considered contaminated if it has come into contact with any non-sterile item or substance, potentially introducing pathogens that could lead to infection.

Answer 11

A. True. The insertion of an indwelling Foley catheter is a sterile procedure to prevent urinary tract infections. Using sterile gloves, along with other sterile techniques, minimizes the risk of introducing bacteria into the urinary tract.

Answer 12

B. Metzenbaum Straight (Suture) Mayo curveD (Dissecting) Mayo meTzenbaum (delicate Tissue) Iris (fIne tissure/sutures) - **Straight Mayo Scissors**: - Commonly referred to as "Suture Scissors." - Primarily used for cutting sutures. - Not recommended for cutting tissue as they can dull quickly from cutting suture material. - **Curved Mayo Scissors**: - Known as "Dissecting Scissors." - Used for cutting through heavy tissue or muscle and for dissecting heavy tissue. - **Metzenbaum Scissors**: - Often abbreviated as "Metz." - Should not be used for cutting sutures to maintain their delicate edges. - The most commonly used scissors in general surgery for cutting or dissecting delicate tissue. - They have round-tipped, thin, and more delicate blades suitable for precision work but not for cutting sutures, drains, or heavy tissue. - **Iris Scissors**: - Ideal for cutting and dissecting fine tissue and fine sutures. - Frequently used for extremely fine dissection, particularly in plastic surgery. - Characterized by their small size and sharp, pointed tips, with both straight and curved blade options available. Each type of scissor is designed for specific tasks to ensure precision and to avoid damage to the instrument and the tissue. It's important for surgical personnel to use the appropriate scissors for their intended purpose to maintain surgical efficacy and tool longevity.

Answer 13

A. Incisional biopsy A. Incisional Biopsy: This is a type of biopsy in which only a sample of tissue is removed for examination, rather than the entire lesion or tumor. B. Aspiration Biopsy: Also known as fine-needle aspiration (FNA), this involves using a thin needle to withdraw fluid or small tissue fragments from a mass or lump to be examined. C. Excisional Biopsy: In this procedure, the entire lump or suspicious area is removed for diagnostic examination, often used when a lump is smaller and can be completely removed. D. Core Needle Biopsy: This biopsy uses a larger needle than that used in FNA to remove a core of tissue from a lump or mass for examination under a microscope.

Answer 14

D. Mosquito Hemostatic Forceps **MAYO-HEGAR NEEDLE FORCEPS** - **Primary Use**: Designed for holding needles during suturing procedures. - **Secondary Function**: Capable of being used to load blades into blade holders. - **Design Features**: - Possesses a shorter, blunt beak, distinguishing it from hemostats, which have a longer beak. - Resembles a mosquito forceps but is characterized by a thicker and heavier box lock and jaw, making it more robust.

Answer 15

B. False. The Poole suction tip is actually designed for the rapid removal of large volumes of fluid from the abdominal cavity during surgery. It has a removable outer sheath with multiple holes to prevent blockage by tissue, making it unsuitable for delicate areas like the neck, face, and ear.

Answer 16

B. Towel clamp

Answer 17

A. Jackson-pratt drain **Jackson-Pratt Drain Overview**: - A drainage device used to pull excess fluid from the body through constant suction. - Features a flexible plastic bulb that connects to a plastic drainage tube placed within the body. - **Mechanism of Action**: - Operates on the principle of negative pressure vacuum. - Removing the plug and squeezing the bulb evacuates air, creating a vacuum that draws fluid into the bulb from the drainage tube. - **Indications**: - The design prevents intraabdominal contents such as the omentum or intestines from being aspirated into the tube. - **Usage Instructions**: - To drain fluid, the plug is removed, and the bulb is compressed to expel the air. - When the bulb is released and the plug is reinserted while the bulb is still compressed, negative pressure is maintained. - This negative pressure is necessary for the drain to function correctly. - **Usage Analogy**: - The process of creating negative pressure in the JP drain is likened to squeezing, emphasizing the need to maintain negative pressure for effective drainage.

Answer 18

B. False. Shanks: Also referred to as the "legs" of the instrument. The area that extends between the box lock and the finger rings.

Answer 19

C. Indwelling foley catheter

Answer 20

A. Surgical scrub. A surgical scrub is a specific procedure performed by healthcare professionals to clean their hands and arms before a surgery, using antiseptic agents to significantly reduce the number of microorganisms.

Answer 21

D. Penrose drain **PENROSE DRAIN** - **Composition**: Made of a soft rubber tube. - **Function**: Used to facilitate drainage in a wound area, helping to prevent fluid accumulation. - **Indications**: Typically used for superficial wounds. - **Technique**: Employs a double exit strategy to prevent subcutaneous (SC) emphysema, particularly in areas of high motion, where a single exit point might allow air to be drawn into the wound.

Answer 22

A. True. Disinfectants are chemical substances used to eliminate or reduce harmful microorganisms on inanimate objects and surfaces, but they are not necessarily effective against all types of microorganisms, such as bacterial spores.

Answer 23

A. True. While there are several methods to check the placement of a nasogastric tube (NGT), an X-ray is considered the most reliable and definitive method to ensure that the tube is correctly positioned in the stomach or the desired location.

Answer 24

C. swage. The swage is the part of an atraumatic suture where the suture material is bonded to the needle, creating a smooth transition that minimizes tissue trauma during suturing. **Different Needle Eyes:** - **Closed Eye**: - Resembles a traditional sewing needle. - Rarely used in modern medical procedures. - Potential use includes anchoring tubes to the skin. - **French Eye**: - Designed specifically for soft tissue procedures. - The needle's shape is made to separate tissue gently rather than cutting through it. - **Atraumatic (Swaged)**: - Features a nearly seamless connection between the needle and suture, reducing tissue trauma. - The design helps ensure smooth passage through tissue with minimal drag.

Answer 25

A. subcuticular suture. **SUBCUTICULAR SUTURE** - **Type**: A running suture placed within the dermis. - **Use**: Ideal for cosmetic closure, including pediatric patients. - **Outcome**: Results in close approximation of skin edges without external suture visibility, producing a minimal scar. **PURSE-STRING SUTURE** - **Application**: Special technique for closing the end of a tubular structure, like the appendix. - **Procedure**: Sutures are placed circularly around the lumen's opening, then drawn tight and knotted to close. **LOCKING SUTURE** - **Purpose**: Adds strength to a running suture line and enhances hemostasis. - **Technique**: After each pass through the wound edges, the needle goes under the previous loop, effectively 'locking' each segment. - **Innovation**: "Self-locking" or barbed sutures, which contain projections that prevent the suture from loosening, offer a modern alternative to traditional locking sutures.

Answer 26

C. Epispadias

Answer 27

B. False. Directly Proportional: Inc. # = Inc. Diameter **FRENCH SCALE** - **Function**: Measures the size of tubes or catheters used in interventional radiology or surgery. - **Scale Conversion**: - 1 French (Fr) unit equals 0.33 millimeters (mm). - A 16 Fr catheter is approximately 5 mm in diameter. - **Size Relationship**: - The French size is directly proportional to the diameter or lumen of the catheter. Smaller French sizes indicate smaller diameters. - **Patient-Specific Considerations**: - Standard tube sizes often vary by race and gender, but individual patient assessments are crucial. - Adjustments may be needed for non-standard sizes, such as for obese patients or those with larger anatomies. - **Gender Differences in Sizing**: - Males typically require a larger French size due to having a longer urethra. - Stiffer catheters may be used to ensure they reach the bladder effectively.

Answer 28

C. Weitlaner Retractor Self- retaining * Weitlaner retractor * Gelpi retractor * Balfour with blade retractor

Answer 29

C. Phimosis

Answer 30

C. Both. Circumcision, while generally safe, carries potential risks such as bleeding and injury to the penis. These complications are rare but important to consider.

Answer 31

B. Nylon. Non-absorbable suture materials described: **SILK** - **Source**: Derived from silk-worm fibers. - **Characteristics**: Soft, pliable, and has excellent tensile strength. - **Forms**: Available in braided or twisted strands, often coated to prevent wicking. - **Handling**: Exceptional handling and secure, flat knots. - **Usage**: Preferred in deep tissues like intestinal, vascular, ophthalmic, and neurosurgical procedures. Specific types like dermal silk and virgin silk are used for closing skin under strain and in ophthalmological procedures, respectively. - **Degradation**: Begins to break down after about 1 year, usually absent from tissue after 2 years. **NYLON** - **History**: The first synthetic suture material, introduced in 1940. - **Characteristics**: Causes little or no tissue reaction, has high tensile strength but can be stiff in larger sizes. - **Forms**: Available in braided or monofilament strands, coated or uncoated. - **Usage**: Suitable for tissues where long-term strength is not critical. - **Colors**: Comes in black, blue, green, and clear. **POLYESTER** - **Characteristics**: Extremely strong, easy to handle, and relatively inert in tissue. - **Forms**: Braided, available coated or uncoated. - **Usage**: Commonly used in cardiovascular surgery, especially with grafts, due to its strength-to-size ratio. - **Colors**: Green, blue, or white. **POLYPROPYLENE** - **Characteristics**: An inert monofilament suture with high tensile strength and a smooth surface. - **Handling**: Difficult in larger sizes, but knots are flat and secure. - **Usage**: Ideal for plastic, ophthalmic, and vascular surgery, as well as retention sutures in abdominal wall closure. - **Colors**: Clear or blue. **STAINLESS STEEL** - **Characteristics**: The strongest suture material, non-inflammatory. - **Forms**: Available in monofilament and twisted forms. - **Handling**: Requires careful handling due to its tendency to kink and sharp ends. - **Usage**: Used in bone and other connective tissue approximations. - **Precautions**: Must be handled with care to avoid injuries and is cut only with wire scissors.

Answer 32

B. False. Contraindications for NG Tube Insertion: * Esophageal strictures (narrowing of the esophagus). * Recent alkali ingestion, caustic ingestions, or esophageal burns. * Use in comatose patients due to the risk of aspiration. * Trauma patients with cervical or intracranial bleeding, or those with increased intracranial pressure. * Patients who have recently undergone surgery in the oropharyngeal, nasal, or gastric areas.

Answer 33

C. Incision. An incision biopsy involves cutting into and removing a sample of tissue from a lesion, but only a portion of it, for examination under a microscope.

Answer 34

C. Dorsal slit method - **Popularity**: Recognized as the most widely used circumcision method globally. - **Procedure Dynamics**: - Beneficial to have an assistant during the operation for efficiency and safety, though it can be performed solo if necessary. - **Usage**: - Commonly employed in "Operation Tuli," a Filipino community practice of mass circumcision. - **Skill Level**: - Demands a higher degree of surgical skill compared to other circumcision methods. - **Standardization**: - Endorsed by the World Health Organization (WHO) as a preferred technique, often referred to as the Coronal, German, or clean cut method.

Answer 35

D. Scalpel handle **SURGICAL BLADE/SCALPEL** - **Terminology**: - Referred to as a "knife" or "scalpel" when the blade is attached to the handle. - Without the blade, it's called a blade handle or holder. - **Usage**: - Employed for tasks requiring razor-sharp precision in tissue dissection. - **Handling**: - The blade is detachable from the knife handle. - Direct contact with bare hands should be avoided when placing or removing the blade from the holder to prevent injury. - A needle holder or similar instrument should be used for attaching or detaching the blade safely.

Answer 36

D. Interrupted sutures. Interrupted sutures are individual stitches placed across the wound edge, allowing each suture to be tied separately. This technique provides strength and precision in wound closure. Non absorbable suture: Suture material that resists breakdown in the body. Running suture: A method of suturing that uses one continuous suture strand for tissue approximation. Primary intention: he wound-healing process ater a clean surgical repair.

Answer 37

D. None of the above. Aseptic technique rules include maintaining a sterile environment to prevent infection. Talking is minimized to reduce airborne contaminants, and non-scrubbed personnel are not allowed to reach over sterile surfaces to prevent contamination.

Answer 38

B. Needle holder

Answer 39

A. True. Perioperative personnel are required to wear freshly laundered scrub suits to maintain a sterile environment and reduce the risk of infection. This is a standard practice in operating rooms and other sterile environments.

Answer 40

C. Blade holder **SURGICAL BLADE/SCALPEL** - **Terminology**: - Referred to as a "knife" or "scalpel" when the blade is attached to the handle. - Without the blade, it's called a blade handle or holder. - **Usage**: - Employed for tasks requiring razor-sharp precision in tissue dissection. - **Handling**: - The blade is detachable from the knife handle. - Direct contact with bare hands should be avoided when placing or removing the blade from the holder to prevent injury. - A needle holder or similar instrument should be used for attaching or detaching the blade safely.

Answer 41

**SUBCUTICULAR SUTURE** - **Type**: Usually a running stitch. - **Cosmetic Result**: Provides an optimal cosmetic result, especially for incisions such as a bikini cut in cesarean sections. - **Technique**: Suture is passed horizontally through the dermis layer. - **Applications**: Used in surgeries like cesarean sections, appendectomies, cholecystectomies, and for closing contaminated wounds. - **Advantages**: No additional external scars as the suturing is done under the skin.

Answer 42

B. Simple interrupted suturing

Answer 43

A. True. The practice of using double gloves during surgery has become more common as it offers an additional layer of protection against sharps injuries and potential exposure to bloodborne pathogens. This practice is recommended regardless of the type of surgery to enhance safety for healthcare workers.

Answer 44

B. Epispadias

Answer 45

B. False. Sanitation refers to the process of cleaning to reduce the number of microorganisms to safe levels, not necessarily destroying all organisms and spores. Sterilization, not sanitation, is the process that destroys or eliminates all forms of microbial life, including spores.

Answer 46

B. 4.5 ml Based on the formula provided in the table: For a 15 kg boy using 1% lidocaine (10 mg per ml), the maximum safe volume is calculated as: Patient weight x safe dosage (3 mg/kg) ÷ concentration of lidocaine (mg/ml) 15 kg x 3 mg/kg ÷ 10 mg/ml = 4.5 ml So, the maximum safe volume of 1% lidocaine for a 15 kg boy is 4.5 ml.

Answer 47

D. Babcock BABCOCK FORCEPS ● Grasping delicate tissue (e.g., fallopian tube, bowel, vas deferens) ● Additional notes: atraumatic, fenestrated tips

Answer 48

B. False. The Frazier suction tip is indeed more delicate and is designed for precise suction in small areas, such as during neurosurgery or delicate procedures in the ear, nose, and throat (ENT), rather than the larger areas like the chest cavity. Its design allows for targeted suction in confined spaces. **FRAZIER SUCTION TIP** - **Purpose**: Primarily used for removing fluid or debris from confined surgical spaces. - **Suction Amount**: Designed for use with a small amount of suction. - **Design Features**: - A thin instrument that allows for precise control. - Equipped with a single hole at the tip to provide effective suctioning capability.

Answer 49

A. Paraphimosis

Answer 50

A. Nasogastric tube

Answer 51

D. Straight catheter

Answer 52

A. Lidocaine/prilocaine. EMLA cream is a topical anesthetic that contains a mixture of two active ingredients: lidocaine and prilocaine, each at a concentration of 2.5%, making up a total concentration of 5%. Availability: 30g tubes = 750mg 5g tubes = 125mg EMLA cream contains a combination of lidocaine and prilocaine, each at a concentration of 25mg per gram of cream. This concentration translates to 2.5% of each anesthetic. For a 30g tube of EMLA: - Each gram contains 25mg of lidocaine and 25mg of prilocaine. - Therefore, the entire tube contains 30g * 25mg/g = 750mg of lidocaine and 750mg of prilocaine. For a 5g tube of EMLA: - Each gram contains 25mg of lidocaine and 25mg of prilocaine. - Therefore, the entire tube contains 5g * 25mg/g = 125mg of lidocaine and 125mg of prilocaine. The percentage of the anesthetic components remains the same in both tube sizes, which is 2.5% for lidocaine and 2.5% for prilocaine.

Answer 53

A. True. Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens, to prevent infection. This technique is crucial in both critical (e.g., surgical procedures) and semi-critical areas (e.g., certain medical examinations and minor procedures).

Answer 54

A. True. Surgical drains are often removed when the volume of drainage decreases to a certain level, commonly ≤ 125 mL per day, indicating that the body is no longer producing a significant amount of fluid at the surgical site, and the risk of accumulation has decreased.

Answer 55

B. False. A T-Tube is typically used for bile duct drainage after gallbladder surgery, not for preventing subcutaneous emphysema. The purpose of a T-Tube is to ensure bile flow when the duct needs to heal or when there's a need to keep the duct open. It does not relate to the prevention of subcutaneous emphysema, which involves air trapped under the skin.

Answer 56

A. True. **Surgical Drains: Indications** - **Dead Space Elimination**: Surgical drains are placed to eliminate dead space where fluid could accumulate. - **Evacuation of Fluid or Gas**: They are used to remove existing accumulations such as: - Pus - Blood - Serous exudates - Chyle - Bile - **Prevention of Accumulation**: Drains are placed preemptively to prevent the potential buildup of fluid or gas post-surgery. - **Controlled Fistula Formation**: Sometimes used to create a controlled fistula, especially following procedures like common bile duct explorations.

Answer 57

A. Vertical mattress suturing

Answer 58

B. Trocar Chest tube **CHEST TUBE** - **Purpose**: Utilized to drain air and fluid, restoring negative pressure in the pleural cavity. - **Design**: A sterile tube equipped with multiple drainage holes for insertion into the pleural space. - **Use Case**: Essential when pleural cavity pressure balance is disrupted, which can lead to respiratory distress. - **Applications**: Insertion is indicated for conditions including: - Pleural effusion: accumulation of fluid in the pleural space. - Pneumothorax: presence of air in the pleural space causing lung collapse. - Hemothorax: accumulation of blood in the pleural space. - Spontaneous pneumothorax: pneumothorax occurring without an apparent cause. - Tension pneumothorax: a life-threatening condition where air accumulates under pressure in the pleural space. - Traumatic pneumothorax: resulting from blunt or penetrating chest injury. - Cardiac tamponade: pressure on the heart caused by fluid in the pericardium. - Penetrating trauma: injuries where foreign objects have entered the chest. - Chylothorax: accumulation of lymphatic fluid in the pleural space. - **Contraindications**: - Generally, there are no absolute contraindications for chest tube placement, particularly when respiratory distress is present and immediate intervention is required.

Answer 59

A. Malecot catheter

Answer 60

C. tensile strength **PROPERTIES OF SUTURES** - **Physical Characteristics**: - Refers to the structure and size of the suture, affecting how it is used in surgical procedures. - **Tensile Strength**: - The maximum tension the suture can withstand before breaking, determining its durability under stress. - **Fluid Absorption**: - The capacity of a suture to absorb fluid, impacting its behavior and longevity in wet environments. - **Knot Strength**: - The force a knot can endure before slipping or breaking, influenced by the suture’s friction and plasticity. - **Memory (Recoil)**: - The tendency of a suture to return to its original shape, associated with its diameter, plasticity, and elasticity. - **Plasticity**: - The ability of a suture to be bent or crimped without breaking and to retain a new shape, particularly important in knot security. - **Pliability**: - How easily the suture can be handled and tied, relating to its softness and the ease of forming flat knots. - **Absorption Quality**: - How the suture interacts with tissue, including its breakdown and absorption by the body, influenced by tissue enzymes. - **Bioactivity**: - The impact of the suture material on surrounding tissue, which can affect healing and tissue response. - **Composition**: - The chemical, molecular, or elemental components of the suture, defining its properties, biocompatibility, and performance in surgical applications.

Answer 61

C. Richardson appendectomy

Answer 62

B. False. A box lock instrument typically has two main parts: the box lock itself, which is the hinge mechanism allowing the instrument's jaws to open and close, and the handles or rings. The box lock is where the two halves of the instrument pivot. Some might consider the jaws and the shank as separate parts, leading to a different interpretation, but the box lock specifically refers to the pivot point.

Answer 63

B. Closed gloving. The closed gloving technique is used when donning sterile gloves after putting on a sterile surgical gown, to maintain sterility of the gown's sleeves and the gloves. This method prevents the hands from touching the outside of the gloves.

Answer 64

B. Horizontal mattress suturing

Answer 65

B. at the 11 o'clock and 1 o'clock position. The dorsal penile nerves, which are branches of the pudendal nerve, supply sensation to the penis and are anatomically located at the 11 o'clock and 1 o'clock positions relative to the penile shaft. **DORSAL SLIT METHOD WHO TUTORIAL:** - **Preparation**: - Prepare the skin, drape the area, and administer anesthesia to numb the site and maintain sterility. - **Foreskin Management**: - Retract the foreskin and remove any adhesions to expose the area fully. - Mark the intended line of the incision on the foreskin. - Optionally, make a shallow preliminary incision along this line with a scalpel for accuracy. - **Incision Process**: - Grasp the foreskin with artery forceps at the 3 o’clock and 9 o’clock positions to stabilize it. - Place additional artery forceps at the 11 o’clock and 1 o’clock positions on the foreskin. - **Performing the Cut**: - Make a cut between the two sets of artery forceps at the 12 o’clock position, up to but not beyond the marked incision line, using dissection scissors. - Continue to cut along the pre-marked line to completely free the foreskin. - **Final Adjustments**: - Trim any skin tags on the inner edge of the foreskin to leave about 5 mm of skin proximal to the corona for a neat finish. - **Postoperative Care**: - Address and stop any bleeding, then suture the wound to promote healing. - Check for any residual bleeding, and once confirmed it's controlled, apply a dressing to protect the site.

Answer 66

A. Few cells with malignant or many cells with borderline changes

Answer 67

B. False. **MAXIMAL DOSE OF LOCAL ANESTHETICS** - **1% Plain Lidocaine**: - Commonly used local anesthetic due to its rapid onset of action. - Maximum safe dosage: 3 mg/kg body weight. - **Alternative Option**: - A mixture of 5 ml of 1% lidocaine and 5 ml of 0.25% plain bupivacaine. - Though more costly, this combination provides longer-lasting anesthesia, effective for about 4–5 hours post-operation. - **Safety Considerations**: - Lidocaine with epinephrine is not recommended for use in penile procedures. - Risk: Epinephrine can cause constriction of blood vessels, leading to potential gangrene and loss of the penis.

Answer 68

A. True. Thumb forceps, used for grasping, holding, and manipulating tissues during surgery, are commonly referred to as "pick-ups" in the surgical and medical fields.

Answer 69

A. throw. In suturing, a "throw" refers to a single loop or turn of the suture material around the needle holder, which is then tightened to form a knot.

Answer 70

A. True. Circumcision in the Philippines, known locally as "Tuli," is more of a rite of passage and a cultural tradition rather than a religious practice. It is commonly performed as a coming-of-age ritual for boys.

Answer 71

A. True. The Weitlaner retractor is indeed a self-retaining, adjustable retractor used in surgical procedures to hold open the edges of a wound or incision, allowing surgeons better visibility and access to the operative area. Self- retaining * Weitlaner retractor * Gelpi retractor * Balfour with blade retractor

Answer 72

B. False. Biofilms, which are dense colonies of bacteria that adhere to surfaces and are encased in a protective matrix, are notoriously difficult to eliminate and are not easily sterilized by iodophor antiseptics or most other disinfectants. They require more rigorous methods for removal and sterilization.

Answer 73

A. Handwashing with regular soap and water in between patients. Handwashing with soap and water is widely recognized as a fundamental and highly effective practice for reducing the spread of infections in healthcare settings.

Answer 74

B. False Child = 18 fr. **FRENCH SCALE** - **Function**: Measures the size of tubes or catheters used in interventional radiology or surgery. - **Scale Conversion**: - 1 French (Fr) unit equals 0.33 millimeters (mm). - A 16 Fr catheter is approximately 5 mm in diameter. - **Size Relationship**: - The French size is directly proportional to the diameter or lumen of the catheter. Smaller French sizes indicate smaller diameters. - **Patient-Specific Considerations**: - Standard tube sizes often vary by race and gender, but individual patient assessments are crucial. - Adjustments may be needed for non-standard sizes, such as for obese patients or those with larger anatomies. - **Gender Differences in Sizing**: - Males typically require a larger French size due to having a longer urethra. - Stiffer catheters may be used to ensure they reach the bladder effectively.

Answer 75

B. One handed surgical knot tying **A. ONE-HANDED KNOT** - Primarily, the square knot is tied with the two-handed technique, but situations may necessitate the use of one hand. - Illustrations typically demonstrate the left-hand technique for tying single suture strands. - Ensure the direction of hand movements is alternated with each throw to avoid half hitches and ensure a flat, square knot. - The suture's end is pulled through to complete the knot formation. **B. TWO-HANDED KNOT** - The two-handed square knot is the standard method for most sutures due to its reliability and simplicity. - Applicable for various materials including surgical gut, silk, cotton, and stainless steel. - Additional throws may be added as required by the surgical context. - The suture's end is pushed through to create the knot. **C. SURGEON’S KNOT** - Involves an extra turn compared to the square knot, effectively taking a "round turn" on the other line. - It's crucial to finish the knot properly to securely lock the two lines together. - Known for ease and reliability, used for tying a wide range of suture materials. **D. INSTRUMENT TIE** - Frequently employed in laceration repair, especially when suture ends are short. - Exercise care when using a needle holder with certain sutures like PANACRYL* to prevent breaking from repeated bending.

Answer 76

D. 12 ml 40 kg * 3 mg/kg = 120mg 120mg/10mg/mL = 12mL

Answer 77

D. Aseptic technique. Aseptic technique encompasses the methods and practices in healthcare settings that prevent the transmission of infection and cross-contamination, including during surgery. This involves practices such as proper handwashing, sterilization of instruments, and the use of sterile gloves and gowns.

Answer 78

A) Ungiectomy

Answer 79

B) Condyloma acuminata

Answer 80

C) Ring block

Answer 81

B) Penile nerve block

Answer 82

A. Fine needle biopsy

Answer 83

A. Core needle biopsy