Surgical instrument

Question 1

Contraindication of NG tube insertion

Answer 1

• Esophageal stricture: due to risk of esophageal perforation
• Basilar skull fracture/ facial fracture: potential for intracranial misplacement

Question 2

How to estimate the length of tube to be inserted

Answer 2

Points to measures:

• bridge of the nose
• tragus of the ear
• point halfway between the xiphisternum and the navel

Question 3

How to check correct placement of NG tube

Answer 3

• Aspirating a sample of gastric content to test with litmus
• Auscultating the epigastrium while injecting air through the tube
• Obtaining an x-ray

Question 4

Indication for short-term urinary catheterization

Answer 4

• Relief of acute retention of urine
• Bladder washout
• Cystourethrogram
• Administration of intra-vesical drugs
• Urine output monitoring

Question 5

Indication for long-term indwelling catheterization

Answer 5

• Refractory bladder outlet obstruction
• Chronic retention of urine
• Incontinence

Question 6

Contraindication of urinary catheterization

Answer 6

• Presence of urethral injury

- Urinary tract infection

Question 7

Complication of urinary catheterization

Answer 7

• Infection
• Stricture formation
• Creation of false passage
• Severe bladder spasm due to irritation of the bladder

Question 8

Contraindication for chest tube insertion

Answer 8

• Infection over insertion site

- Uncontrolled coagulopathy

Question 9

Triangle of safety for chest tube insertion

Answer 9

• Lateral border of pectoralis major
• 5th intercostal space
• Lateral border of latissimus dorsi

Question 10

Complication of chest tube insertion

Answer 10

• Laceration or puncture of the intrathoracic organ
• Damage to the intercostal nerve, artery or vein
• Subcutaneous emphysema

Question 11

Type of surgical drain

Answer 11

• Open vs close
• Active vs passive
• Silastic (inert, minimal tissue reaction) vs rubber (red rubber induce intense tissue reaction, eg: form tract in biliary T-tube)

Question 12

When to remove a drain

Answer 12

• Once the drainage has stopped or

- < 25ml/ day

Question 13

Indication for NG tube

Answer 13

• Gastrointestinal decompression for ileus or bowel obstruction
• Administration of medication for who cannot swallow or neurological impaired
• Enteral nutrition
• Stomach lavage

Question 14

Complication of NG tube placement

Answer 14

• Malposition, coiling or knotting
• Pharyngeal and pyriform sinus misplacement
• Esophagitis/ esophageal stricture: due to impaired lower esophageal sphincter, making the patient more susceptible to reflux of gastric contents
• Perforation of pulmonary structures or GIT

Question 15

Uses of mayo curved scissors

Answer 15

• Used to cut thick tissues such as those found in uterus, muscles, breast and foot
• Used for removing bandages and trimming thermoplastic

Question 16

Indication of urinary catheter

Answer 16

> Diagnostic

• Cystourethrogram
• Urine output monitoring

> Therapeutic

• Relief acute retention of urine
• Bladder washout

> Prophylactic
- Drain the bladder to improve access to the pelvis in urological or pelvic surgery

Question 17

Complication of urinary catheter

Answer 17

• Infection
• Stricture formation
• Creation of a false passage due to wrong technique of insertion
• Irritation of the bladder may cause severe bladder spasm

Question 18

Features of Babcock forceps

Answer 18

• Ring-handled and ratcheted forceps
• Circumferential jaw
• Horizontal serration across the edge of the tip of the jaw