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eMRCS questions > Surgical technique > Flashcards

Surgical technique Flashcards

1
Q

Scenarios that result in secondary intention wound healing

A

Extensive loss of epithelium
Extensive contamination
Extensive tissue damage
Extensive oedema
Wound reopening

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2
Q

Third intention wound healing

A

Wound is closed several days after formation
Might be after infection is under control or oedema is reduced

Delayed primary closure

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3
Q

Stages in wound healing and cell types involved

A

Inflammatory
Plts- immediate
Neuts- 0-1
Macro 1-2s

Proliferative - epithelial- proluferate- closure in 48hrs
Fibroblasts- 2-4 synthesise ECM
Endothelial- 3-5d

Maturation
Modify collagen cross linking

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4
Q

When do abdominal incisions regain their strength

A

3-4m

Hence why slowly absorbable PDS is used

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5
Q

Ideal theatre designs

A

Close to surgical wards
ICU
Sterile supplies
A+E
CT

20 degree
Clean filtered air

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6
Q

Suture used in bowel, vascular anastomosis and ligation and abdominal, subcutaneous and closure

A

Bowel- vicryl as heals quickly

Vascular anastomosis- prolene- monofilament good for running stitches
Ligation- PDS

Abdo- PDS

Subcut- absorbable

Closure- non absorbable

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7
Q

Principals of vascular anastomosis

A

Prolene - non absorb mono
Evert edges

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8
Q

Principals of duct anastomosis

A

Invert edges
Mono absorbable - PDS
Performed over a stent- removed later e.g T tube CBD

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9
Q

What size of wound will you require grafting or local flap

A

1cm^3

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10
Q

Split vs full thickness

A

Full- better cosmesis
Face
Primary contracture- elastin in dermis

Split- larger
No primary contracture

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11
Q

When is delayed primary closure used

A

If the wound is dirty

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12
Q

Closure of scalp wound

A

Staples

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13
Q

What is used for third degree burn on abdo

A

Split thickness graft

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14
Q

If patient has nose bitten off by dog what reconstruction

A

Debridement, antibiotics, tetanus and rabies

For upper two-thirds defects, thin skin from the preauricular region or neck works well. For lower third defects, the thick skin of the forehead provides the best match.

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15
Q

What can you do to a split thickenss to make it spread more

A

Make it mesh

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16
Q

Blue line around mesh, how quickly does it spread

A

Re- epitheliarization
1mm/day

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17
Q

What is required for a great to stick

A

If there is granulation tissue forming

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18
Q

Closure after drained of foul/painful smelling sebaceous cyst

A

Delayed primary closure

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19
Q

Best Ix fro osteomyelitis

A

MRI

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20
Q

Closure of diabetic foot ulcer

A

VAC assisted closure- encourage granulation tissue

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21
Q

When is VAC assisted closure CI

A

Malignancy
Osteomyeltiis
Necrotic tissue with eschar

Risk of fistulation

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22
Q

Closure of wound dehiscence on abdo

A

Healthy- suture
Wound manager- some granulation tissue where there is a high
output bowel fistula present in the dehisced wound.

Bogota bag- Temporary measure to be adopted when the wound cannot be closed

VAC- ONLY if the correct layer is interposed between the suction device and the bowel.
* Failure to adhere to this absolute rule will almost invariably result in the development of multiple bowel fistulae and create an extremely difficult management problem.

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23
Q

Zadik procedure anaesthesia

A

1% lignocaine in ring block

For toenail removal

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24
Q

What is used in Piere block and antidote

A

Pierre block- Prilocaine

Less cardiotoxic

Methylene Blue

25
Q

What drugs increase lidocaine toxicity

A

BB

Cipro

26
Q

Local doses

A

Agent Dose plain Dose with adrenaline
Lignocaine 3mg/Kg 7mg/Kg
Bupivicane 2mg/Kg 2mg/Kg
Prilocaine 6mg/Kg 9mg/Kg

27
Q

What is CI with diathermy

A

Alcohol based skin prep
Use cholrhexidine or iodine

28
Q

When to give Abx in surgery

A

If giving prosthetic or implant/valve
Tourniquet - give early
Dirty or clean contaminated

29
Q

Which electrical device should you use in ERCP sphincterotomy

A

Monopolar

30
Q

Modes of electrocautery

A

Cutting - uses a continuous waveform with a low voltage- giving high power
* Precise cutting without thermal damage
Causes vaporisation

Coagulation - pulsed waveform with a high voltage.
Causes thermal damage
Causes evaporation

Blending- alternating of both

Desiccation - Active electrode in direct contact with tissue
* Low current and high voltage system
* Results in loss of cellular water but no protein damage (unlike coagulation)
used for treating nodules under the skin where minimal damage to the skin surface is desired.

Fulguration- Electrode probe is held away from tissue
* Produces spray effect with local, superficial tissue destruction
* Low amplitude and high voltage system
- superficial skin charring - over a wider area than when operating in contact with the probe, and this technique is therefore used for very superficial or protrusive lesions such as skin tags

31
Q

What devices are used in brain tumours

A

Ultrasound based devices

  • These include CUSA and Harmonic scalpel.
  • They generate high frequency oscillations that seal and coagulate tissues.
32
Q

Disinfection vs sterilisation

A

Disinfection- eliminating or reducing harmful microorganisms
Sterilization -killing all microorganisms

33
Q

Methods of sterilisation

A

Autoclave- reusable surgical equipment- like metal - air removed pressurised steam at a temperature of 134 degrees for 3 mins
For TB

Endoscopy/laparoscope- 2% glutaraldehyde solution

Ethylene oxide- used in industry - Cannula/sutures

Gamma rays- thermal stable
Plastic syringes, transfusion, needles

34
Q

Flap vs graft

A

Graft takes fast
Covers larger area
Requires granulation tissue to take

Flap- used for bone, tendon, or joint
Non graftable

35
Q

Reconstruction of skin from where tumour of face removed

A

Unsure on boundaries
<2cm can leave
>2cm- graft

Certain of boundaries- local flap

36
Q

Level of evidence

A

1- systemic review, meta analysis

2- randomised controlled trial

3- pseudo randomised or historical controls

4- case reports

5- panel opinion

37
Q

Chemo has extravasated mx?

A

When an extravasation reaction is suspected, the infusion should be stopped and the infusing device aspirated. The extremity should be elevated.

As a general rule cold compresses have been shown to reduce the incidence of subsequent ulceration with doxorubicin.

Warm compresses have been found to be beneficial in extravasation of vinca alkaloids. - vincristine

38
Q

TPN/contrast extravasated mx

A

Withdraw infusion
Hyaluronidase into infusion site

39
Q

Suture to close abdo

A

Polydiocanaone Mono

40
Q

Suture for skin closure

A

Poliglecaprone mono (monocryl)

41
Q

Pre tibial 3-7cm flavour, necrotic and haematoma, bone fine

A

Debride and split thickness

42
Q

Simple finger laceration closure

A

Interrupted 5/0 Ethilon
Removal after 14d

43
Q

Forehead laceration closure

A

Interrupted Prolene 5/0
Removal after 4-5d

Sterries in children

44
Q

Excision of sebaceous cyst or lipoma closure

A

Interrupted 2/0 Vicryl to fat

3/0 monocryl to skin

45
Q

Inguinal hernia closure

A

Prolene 3/0 mesh

vicryl 2/0 fasciae, fat

Monocryl 3/0 skin

46
Q

Laparoscopic appendectomy/chole closure

A

PDS all ports >5mm

Mono 3/0 or glue to skin

Silk to drains

47
Q

Midline lap closure

A

1 PDS to midline fasciae

2/0 vicryl to fat

3/0 mono to skin

3/0 Vicryl Rapide for new stomas

48
Q

Pfannestiel closure

A

1 PDS to rectus
2/0 vicryl to fat
3/0 monocryl to skin

49
Q

Femoral embolectomy closure

A

5/0 prolene ot arterotomy

2/0 vricyl to fascia and fat
3/0 monocryl to skin

50
Q

Use of prolene

A

Vascular anastomosis

Cardiac surgery

51
Q

Ethilon use

A

Skin incision or traumatic wounds

Removed after 4-14d

52
Q

Steel wire use

A

Close sternum after median stenotomy

53
Q

Ethibond use

A

Prostehtic heart valves
Tendon repair
Ribs

54
Q

PDS sue

A

Closing linea alba
Hernia defects
Intestinal or ureteric anastomosis

55
Q

Monocryl use

A

Skin closure

56
Q

Vicryl use

A

Skin and soft tissue closure
Ligation of vessels

57
Q

Cutting vs reverse cutting vs round bodied needle

A

Cutting- sharp on concave edge
For tough tissue such as skin and fascia
Can weaken tissue

Reverse- sharp on convex edge
Used when risk in cutting suture out and causing damage- thin skin, tendon, ligaments, eye

Round taper point- needle point round
Blunt- liver or spleen
Taperpoint- leaky tissue- bowel, vessel, myocardium

58
Q

What anticoagulant does blood bank store donated blood in

A

Citrate - binds to Ca preventing coag

59
Q

Tourniquet types

A

Single cuff pneumatic- knee arthroscopy
Different pressure

Double cuff- regional block

Non pneumatic- venopuncture

eMRCS questions (45 decks)

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