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MRCS part B- JMB > Periop Care & Surgical Texhnique > Flashcards

Periop Care & Surgical Texhnique Flashcards

1
Q

Phases of a clinical trial?

A

1- small group- safety and PK and PD
2- 50-300- side effects and effectiveness
3 multi enter Rct
4 post marketing study, benefits and optimal use

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2
Q

Levels of clinical evidence

A

A= systematic review of b

1 rct
2 cohort stud
3 case control study (retrospective, compares disease to controls)
4 case series
5 expert opinion
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3
Q

Methods of thromboprophylaxsis

A

Conservative- hydrate well, leg exercises, vte stockings, early mobilisation, TEDs

Medical- IVT, lmwh, stop COCP 4 weeks prior

Surgical- vena cava filter, avoid GA

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4
Q

Reasons for patient positioning and complications?

A

Surgical access, anaesthetic access, prevent harm

Air embolus
Join dislocations
Skin damage
Neuropathies
Eye compression
Decreased lung capacity
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5
Q

Common neuropathies?

A 
Ulnar
Radial
Common peroneal
Sciatic
Saphenous
Obturator
Brachial plexus
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6
Q

What is laminar flow?

A

Unidirectional flow of air

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7
Q

What is acceptable air flow targets in theatre

A

20-40 air changes per hour
<35/m3 of bacteria carrying particles
<1 colony per m3 of clostridium/staph a

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8
Q

Sterilisation equipment?

A

Steam
Dry heat
Ethylene oxide- scopes
Irradiation

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9
Q

What does laser stand for?

How does it work?

A

Light amplification by stimulated emission of radiation

Excitation of a medium by energy leading to photon production

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10
Q

Types of lasers

A

Co2- haemostasis
Argon- photocoagulation
Ruby- tattoo removal

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11
Q

Indications for tourniquet’s?

A 
Bloodless op
Stop bleeding
Biers block
Isolated limb chemo
Cannulation
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12
Q

Principles of safe tourniquet use?

A

Size of cuff- width >1/2 diameter of limb
Padding
No fluid

Exaguinate
Pressure limits-
Lower limb- SBP + 70-130 (max 350)
Upper limb- SBP + 50-100 (max 250)

Max 2 hours

Check NVI post op

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13
Q

Complications of tourniquets

A 
Skin changes
Lactic acidosis
Post tourniquet syndrome- swollen, stiff, pale limb with weakness but no paralysis usually after 1–6 weeks of tourniquet application
Bleeding/haematoma
Muscles ischaemia
Nerve injury- radial
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14
Q

What is diathermy?

A

Passage of high frequency AC (400-10) through body which creates high temperatures of 1000

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15
Q

Why high frequency for diathermy?

A

Low frequency causes muscle stimulation/vf/cardiac stimulation.

Means a higher amp can be used

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16
Q

Different types of diathermy

A

Mono polar- pad on patient is the other pole. High power, less precise

Bipolar- low power, current between forceps, safer for end arteries / pace makers

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17
Q

Complications of diathermy use?

A 
Burns- patient/surgical team
Explosions
Channeling
Capacitor coupling- think lap ports
Direct coupling- buzz forceps
Pacemakers- reprogramming of pacemakers/myocardial burn
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18
Q

How can you classify sutures?

A

Composition- natural/synthetic
Structure- braided (vicryl) vs monofilament (monocryl)
Absorbable

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19
Q

How are sutures absorbable?

A

Proteolytic enzyme

Hydrolysis

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20
Q

Requirements of a perfect suture?

A 
Sterile
Hypoallergenic
Carcinogen free
Uniformity
High tensile strength
Pliable
Predictable absorption pattern
Cost effective
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21
Q

Types of absorbable sutures

A

Vicryl rapide- 42 days
Vicryl- 60 days
Monocryl- 100 days
PDS- 200 days

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22
Q

Needles shape and geometry

A 
Straight vs curved vs j vs compound
Geometry
Round body- friable tissues
Cutting- tough surfaces- skin/sternum
Reverse cutting- on convex edge- subcuticular suture/tendons

Blunt vs sharp

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23
Q

Types of drains

A

Passive drains- penrose drain

Active drain- vac/redivac

24
Q

Indications for dressings?

Dressing if in doubt?

A

Granulating tissue- aquacel/jelonet
Sloughy- aquacel
Necrotic- aquacel
Cavity- simple packing

AQUACEL

25
Q

Leeches indication

Maggots

A

Leeches- encourage vasodilation, anticoagulant and anaesthesia via secreting substances

Maggots
Digests necrotic and sloughy tissue

26
Q

Indication for negative pressure dressings

A

Promote granulation

Remove excess fluid/blood/pus

27
Q

Needlestick transmission rate of HIV, Hep B and C?

A

HIV 0.3%
Hep B 30%
Hep C 3%

28
Q

Timing of needlestick bloods?

A

At time of event for you and patient

6 weeks and 3 month post event

29
Q

Post renal causes of anuria?

A

Bilateral renal stones

Bladder/Prostate/Urethral blockage

30
Q

Describe steps of chest drain insertion?

A

Intro and wash hands
Consent, allergies/anticoagulation
Prep equipment- 11 blade, 24 Fr chest drain, silk suture
LA
Incision and blunt dissection
Insert chest drain (upwards air, downwards blood)
Suture and connect seal system- bubbles

31
Q

What are the indications for inserting a chest drain?

A

Trauma/tension haemopnuemothorax
Large spontaneous pneumothoax
Symptomatic/large 2o pneumothoax

32
Q

When to refer a pneuomothotax to the cardiothoracic surgerons?

A 
Spontaneous haemothorax
Bilateral pnuemothorax
First ContraL pneumothorax
2nd IpsiL pnuemothorax
Failure of lung to re-expand after 5 days
Pregnant
33
Q

What to do if chest drain stops bubbling?

A

A2E
Disconnected/dislodged
CXR
Prepare to remove

34
Q

Technical considerations for skin lesion excision?

A 
Mark at least 3:1 length to width, 2mm excision width
15 blade for incision
3/0 monocryl for intradermal
4/0 prolene for skin
Histology +- marking stitch
35
Q

What excision margin is needed for SqCC/BCC/Melanoma?

A

4mm for SqCC/BCC at least

1cm at least for melanoma

36
Q

What is the histology of a SqCC?

A

Keratin pearls
Atypical keratinocytes
Dermal invasion

37
Q

Where should a diathermy plate be placed?

A

> 70cm2 covered

Dry, shaved skin, away from bony prominence

38
Q

What is diathermy?

A

Alternating current generates high localising heat temperatures that result in coagulation or cutting

39
Q

LA toxicisty management?

A

A2E, CCRISP
No more infusion
Intralipid 20%

LA is a negative inotrope and vasodilator

40
Q

What makes up a pacemaker pre op check and peri operative management?

A 
Model, indication and date of insertion
Degree of HF
Placed in basic mode
Post op check
Continous ECG monitoring
Pacing available
Limit monopolar- make sure current does not pass through monopolar
41
Q

Pre op warfarin management?

A

As per haem/trust guidelines
Stop 5 days before
High risk will need bridging LMWH/unfractionated heparin
Restart Warfarin post op when eating and drinking (haemostais achieved)
Stop heparin when INR in range

42
Q

What is C diff? and risk factors?

A

Nosocomial GI infection
Gram +ve bacilli
Associated with Cephlasporin, co amox, clindamycin, ciprofloxacin

Treat with vanc/met

43
Q

How to manage a diabetic patient peri operatively?

A

Pre op- optimise, anaesthetic/ DSN appointment, lose weight, echo, ecg, cxr
Peri op- 1st on list, 1 missed meal- reduce insulin/VRIII- trust guidelines
Post op monitor BMs, aim for early feed and restarting of regular insulin

44
Q

Risk of cardiac complications if pre op MI?

A

Within 30 days- 30% risk
Within 1 -3 months- 15%
3-6 month- 5%

45
Q

Long term steroid use and operative risk?

A

Addisonian crisis
Poor wound healing
Infection risk

Pre and post op hydrocortisone

46
Q

Difference between chlorahexdine and betadine (iodine)

A

Chlorhex- NICE recommended, better bacterial coverage, some viral and poor fungal/spore coverage. Works for >4 hours

Betadine- potent against bactera, fungi, viral and TB, <4 hours, skin irritator

47
Q

Important points of scrubbing in?

A

Pre scrub wash
First scrub of the day 5 minutes
Next ones can be 3 minutes

48
Q

Difference between cleaning, disinfection and sterilisation?

A

Cleaning- gross removal of debris and dirt
Disinfection- reduction in microorganisms
Sterilisation- Eradication of microorganisms

49
Q

Types of sterilisation?

A

Heat/dry (autoclaving)
Chemical- ethlene oxide, glutaraldhyde
Irradiation

50
Q

How to rank operative emergency and co-morbities?

A 
NCEPOD
1- immediate/life threatening/limb threatening
2- Urgent
3- Expedited
4- Elective
ASA
1- fit and well
2- mild systemic disease
3- severe systemic disease
4- severe uncontrolled systemic disease of constant risk to life
5- moribund
51
Q

What is the use of a paramedian incision?

A

Splenic access?

52
Q

How to classify wounds?

A

Location
Depth
Contamination
Mechanism- abrasion, incision, laceration, de gloving (morell-lavelle)

53
Q

Rate of suture absorption?

A 
This is for complete suture absorption
Vicryl rapide- 42
Vicryl 70 days
Monocryl 90 days
PDS 180 days
54
Q

Suture type used for deep tissue closure, stoma formation, face laceration, bowel anastomosis?

A

PDS
PDS
Nylon/prolene
PDS

55
Q

Different types of diathermy settings?

A

Coagulation- pulsing low temp current which leads to cell death
Cutting- continous high temp current which leads to cell vaporising
Blended- mixed
Spray- coag over a wide area

56
Q

Principles of wound debridement-talk through procedure?

A 
Intro, consent, mark, anaesthetic
Drape and clean
Gross removal of debris
Wound toilet
Deep exploration
Excision of dead skin/deep tissue/bone
Photos
Pack and dress
Reinspect in 48-72 hours
Abx and tetanus
Confirm no bony injuries/vascular injuries
57
Q

Describe an I&D of an abscess

A

MRCS part B- JMB (10 decks)

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