Moroccan

Question 1

Answer 1

knife handle

knife handles are used to hold various blades to create scalpel. Scalpels are used to make skin incisions or whenever a fine precision cut is necessary.

Question 2

Answer 2

Towel Clamp

a ratcheted instrument with curved, sharp, tinelike jaws.

is used for holding towels in place when draping, when grasping tough tissue, and during reduction of small bone fractures.

Question 3

Answer 3

Curved/ Straight forceps - clamp (Kelly)

a curved or straight clamp w/horizontal serrations that run the complete length of the jaws.

Question 4

Answer 4

Blood Culture Bottles

blue for -aerobic

red for - anaerobic (put in here first)

Important to be sterile and use different needle than the one used to collect sample from the patient. There are filll lines on these bottles which indicate how much blood is needed

Question 5

What are they all for / what do they ahve in them

Question 6

Answer 6

Chest Drain Bottle/Bucket

Is a bucket which has measurement indicators on the side, a tube going into the bucket and all the way to the bottle (allows the formation for a water seal when sterile water is filled to the prime level - indicataed by a line on the bottle). This seal is important when draining a pneumothorax

Suction can be applied to encourage emptying and closure.

Bubbling - insinuates that air is still coming out

Swinging - reflects the rise and wall of the water chamber with respiration–> if this stops the tube could be blocked/ kinked. generaly reduces as the pneumothorax resolves

Uses - pneumothorax, haemothorax, pleural effusion, empyema, post-op

Question 7

Answer 7

Mosquito forceps/clamp (Schmidt looks similar but is longer and is more curved - used for deeper wounds)

a curved or straight clamp w/fine tips and horizontal serrations that run the length of the jaws.

is used to occlude bleeders in small or superficial wounds before cauterization or ligation. Used often for delicate or small confined procedures. Some examples are plastics, pediatrics, thyroid, and hand procedures.

Question 8

Answer 8

Allis / Babcock Intestinal Forceps

Interlocking fine teeth/ flat rounded edges- designed to minimise trauma to tissue as it is handled

Allis (the one with teeth) - is used for lifting, holding, and retracting slippery dense tissue that is being removed (vagina, tonsils bowel..)

Babcock - is used for grasping and encircling delicate structures (ureters, bowel etc..)

Question 9

Answer 9

Foerster Sponge Forcep

can be curved or straight and has two round tips w/horizontal serrations.

is used to create a sponge stick, for grasping tissues such as the lungs, or for removing uterine contents.

Question 10

Answer 10

Mayo NEedle holder

has a broader jaw that is rounded at the tip w/crisscross pattern on the inner jaw.

is used for holding heavy needles when suturing.

Question 11

Answer 11

Debakey Tissue Forceps

an atraumatic tissue forceps w/an elongated, narrowed blunt tip. A set of parallel fine serrations runs the length of one jaw w/a center row of serrations on the oppostie side that interlocks to grip when closed

grasps numerous types of tissue; used in many types of surgery (particular vascular). Doesn’t damage tissue structures

Question 12

Answer 12

Adson Toothed Tissue Forcep

aligns the edges of the wound during stapling of the skin; grasps superficial tissues so that Steri-Strips can be placed.

the fine tips have two small teeth on one side and one small tooth on the other side that fit together when closed. All of the Adson tissue forceps are the same size and shape. They are differentiated by the inner tips.

Question 13

Answer 13

Straight Mayo Scissors

heavy scissors w/straight blades

are used to cut suture - use the tips of the scissors and rotate the scissors slightly to assess the length that is beign cut

Question 14

Answer 14

Curved Mayo Scissors

heavy scissors w/curved blades and blunt or sharp tips.

dissect or undermine heavy fibrous tissues - only used to cut tissue!

Metzenbaum - the longer and thinner scissors shown. can be curved or straight

Used to cut more delicate tissue

Question 15

Answer 15

i) Yankauer and ii) Poole (the fenestrated one) suction tips

These are tips attached to plastic tubes. Can be disposable or reusable (disposable more commonly used)

Yankauer - . Slightly bent at the end. disposable is the most widely used

Poole - allows for lots of suction to occur at once and can also be used to suction inside the femur.

Question 16

Answer 16

Weitlaner (the one with three outward prongs) and gelpi (only one prong) tissue retractors

self-retaining finger-ringed instrument w/a ratchet/release device on the shanks, which holds them open in the wound

Weitlaner - 3 prongs

Gelpi - 1 prong

Hold wound edges open - Weitlaner can be sharp so be careful to avoid damage to tissue

Question 17

Answer 17

Richard -eastman retractor - Looks like it has the platforms at each end

Richardson retractor - has a fancy handle

Army- navy retractor - has an oval hole in the middle and two platforms at each end

Deaver retractor - very curved looking end with a straight handle

Question 18

Answer 18

Balfour with bladder blade and wingnut

Self-retaining retractor device with adjustable wing-nuts and an axis to adjust the size of field retracted. Shallow curved central point.

Use - Used in abdominal surgery near the bladder and allows shallow retraction so as not to interfere with the bladder.

Question 19

What are the different types?

What do the numbers mean?

Which are A_______ and which are non- A______?

Answer 19

Abosrbable - Catgut, Monocryl and Vicryl

Non- Absorbable - Ethilon, Prolene, Silk

Numbers 11-0 –> 0 –> 7 - 11-0 finest you can get

7 - is the broadest you can get.

the broader ones are more braided whereas the finer ones have less filaments (11-0 = monofilament).

Monofilament (single strand) - is good for handling fine tissue, tie down easily and minimise scarring

Multifilament - has greater tensile strength, is stronger, have good tissue handling characteristics and are generally less absorbable/last longer.

Question 20

Answer 20

Disposable rigid sigmoidoscope

A tube with a narrowed end that allows for the attachment of a light source and air insufflation

Must DRE first and the sigmoidoscope must be lubricated

Uses - Insepction of the rectum and distal sigmoid. Biopsies can be taken. Can facilitate the insertion of a decompression tube in voluvlus.

Question 21

Answer 21

Non disposable rigid sigmoidoscope

Question 22

Answer 22

Drainage bag

Can be connected to an NG tube/ or abdominal drains etc. Should be placed below wherever is being drained (drainage acts by gravity)

Question 23

Answer 23

Cuffed ET Tube

Definitive airway. Should be sized appropriately for the patient and then the tube is passed under laryngoscopy guidance through the vocal cords.

Cuff should be inflated and then the position should be checked by looking for chest rise, foggy tube and also listening over the precordium for gurgling sound (insinuates that the tube is in the oesophagus)

indications:

GCS <8 in trauma

Long surgeries

ITU (short term)

Cardiac arrests

Question 24

Answer 24

Feeding NG Tube

Fine bore tube made of sililastic (less prone to blockage). Passed through the nose (lubricated) and should be sited in Stomach, Duodenum, Jejenum.

Has a wire - this wire is kept in situ until x ray confirmation of correct position upon which it is removed.

Has 2 ports - one for food and one for medicine

uses - facilitates long term enteral feeding in –> unsafe swallow, upper GI surgery, malnutrition.

Question 25

Answer 25

**Fracture Plates** Metal device with holes for the attachment of intramedullary and extramedullary screws. Holes are distributed along this device to allow multiple points of fixation to control the bone.

Question 26

**Describe some fluids**

Answer 26

NS - Contains Sodium and Chloride ions. Dextrose - Contains glucose. Should be noted that it has no electrolytes in it at all as the sugar becomes CO2. So essentially **just water** Hartmann's - Contains Soidum, Chloride, Bicarb and Lactate Colloid - can be artificial (gelofusin) or biological (blood). Used to expand the intravascular compartment in shock, haemorrhage. **raise oncotic pressure**

Question 27

Answer 27

**hemiarthroplasty** Used in NOFs for patients \>70 Has a ball (articulates with acetabulam) and stem (fitted into the femur). Can be : **Cemented -** Thompson **uncemented -** Austin Moore ( is serrated and has holes in it allowing for bone to grow into the implant itself) **Cement can be impregnated with antibitics and the medulla of the femur should be 'reemed' or suctioned before placement.**

Question 28

Answer 28

**Total hip replacement** Used in younger patients with NOF/ Osteoarthritis Has an acetabular cap, ball and stem. The stem is usually cemented

Question 29

Answer 29

**Total knee replacement (can be partial, total, or patellar replacements)** Constituents: Femoral implant, Tibial Implant, Plastic spacer (acts as the cartilage) **Implantsa are cemented into place** Patellar can be left as an attachment point for muscles if relatively undiseased **Ligaments:** ACL almost always removed PCL usually removed New ligament sparing appraoces are being innovated **approaches:** Traditional anterior approach - involves partial resection of quadriceps Many other incisions including quadriecps sparing incision (Anteromedial)

Question 30

Answer 30

**Spinal Needle** Long Needle with a beveled end, graduations throughout, a depth stop and a removal stylet. Used for taking CSF samples and for measuring CSF opening pressure Send off for - Biochem (pH, LDH, Glucose, Protein), Cytology, Microbiology, Protein electrophoresis, Viral PCR Opening pressure: 5- 20 cm H20 \>20 = SAH, Meningitis \<5 = Dural leak

Question 31

Answer 31

**Nasal prongs** 1-4 /l min 24-40 % O2

Question 32

Answer 32

**Simple face mask** **4-6 LPM** 40-60%

Question 33

Answer 33

**non - rebreather** 60-90% \>10 LPM The resevoir bag allows delivery of high concentration

Question 34

Answer 34

Venturi Masks DIfferent attachments with different concentrations of FiO2 delivered Instructions on rate of oxygen to be delivered on each venturi attachment

Question 36

Answer 36

verres needle Spring loaded needle with an acess port at the end for the introduction of air into the peritoneum during surgery

Question 37

Answer 37

**PEG Tube** Gastrostomy is just beneath costal margin Jejunostomy is just above a line through umbilucs Both left sided Indications for enteral feeding - Catbolosism (sepsis , burns), Coma, Malnutrition, Dysphagia (stroke, bulbar palsy, oesophageal strictures/srugery) 5

Question 38

Answer 38

**PICC Line (peripherally inserted central cathter** If it was shorter and triple lumened Hickmann Line They're both essentially tunneled lines for hte long term provision of drugs, and feed into a central vein **Indications**: Prolonged obstruction or ileus (\>7d), High output fistula, Short bowel syndrome, Severe Crohn's, Severe malnutrition, Severe pancreatitis, Unable to swallow e.g. oesophageal Ca

Question 39

Answer 39

**Redivac** - example of a closed drainage system that is used to prevent haematoma formation

Question 40

Answer 40

**Wound drainage tube (Jackson pratt drainage device)** Closed system (with additional suction) post operatve drainage device to drain bodily fluids

Question 41

Answer 41

Portacath - non visible type of central venous access. Access port is subcutaneous and is accessed via non-coring huber needles. Is tunnelled

Question 42

Answer 42

**Tube thoracostomy**

Question 43

Answer 43

**central venous catheter** Goes into subclavian/ jugular vein and is used to give drugs centrally Can have up to 5 ports allowing for multiple drugs to be given simultaneously

Question 44

Answer 44

Kelly Proctoscope and Obturator The obturator is removed once the proctoscope is in situ

Question 45

Answer 45

Fibre optic proctoscoep

Question 46

Answer 46

**Simple Robinson Drain**

Question 47

Answer 47

**Urometer** Designed for accurte urine output monitoring

Question 48

Answer 48

**Tracheostomy -** definitive airway device

Question 49

Answer 49

Cricothyrotomy kit

Question 50

Answer 50

**Swan Ganz Cathter** Inserted into the right pulmonary artery Indirect measure of Left atrial pressure