Wound Inf. +AntimicrobUse/ Tissue Handling/Sx Hemostasis

Question 1

Which of the following is FALSE regarding surgical site infections?
a.Risk of infection increased by 2x with every hour increase in surgery time
b.With each hour of anesthesia there is a 30% increase in risk for surgical site
infection
c.With surgery, you have a increase in circulating total lymphocytes, CD4+
T-lymphocytes, and CD8+ lymphocytes
d.Propofol use can increase risk of surgical site infections in dogs and cats

Answer 1

c.
With surgery, you have a DECREASE in circulating total lymphocytes, CD4+
T-lymphocytes, and CD8+ lymphocytes

Question 2

Which of the following has not been shown to have an increased risk for surgical site 
infection?  
a.Patients with hyperadrenocorticism  
b.Patients with diabetes mellitus 
c.Patients with hypothyroidism 
d.Intact male dogs and cats

Answer 2

B

b.Patients with diabetes mellitus

Question 3

Which is true?
a.Gram positive activity increases and Gram negative activity decreases as one
progresses from first to third-generation drugs.
b.The antibiotic is administered within a 2 hour period before the surgical incision is
made.
c.The antibiotic should not be administered beyond 24 hours post surgery, unless a major break in sterile technique or an unexpected change in
contamination classification.
d.Time-dependent antibiotic growth inhibition is dependent on the peak
concentration of the drug (Cmax) at the site of infection.

Answer 3

C

a.Gram positive activity DOWN and Gram negative activity UP as one
progresses from first to third-generation drugs.
b.The antibiotic is administered within a 1 hour period
d. concentration dependent (Cmax)

Question 4

Bacterial load throughout GI tract? (Dudley question)

a. Stomach
b. SI
c. Colon

Answer 4

a. Stomach - 10^3
b. SI - 10^6
c. Colon - 10^12

Question 5

Which of the following is false?

a. Heuristics are elements of skill and are especially needed for surgery
b. There are 3 types of heuristics
c. Cognitive heuristics is being able to recognize tissues
d. Motor heuristics is being able to handle tissues
e. Haptics is a form of perceptual heuristics

Answer 5

C

False - perceptual

Question 6

Name the 7 Halsted principles:
•BADHATG
or
Go Down PATH A

Answer 6

Gentle tissue handling
eliminate Dead space
Preserve blood supply to tissues
strict Aseptic technique
minimize Tension 
appropriate Hemostasis
Appose tissues accurately

Question 7

True or false: The blood supply in the wound edge is directly proportional to the wound closure tension.

Answer 7

(False, inversely proportional)

Question 8

Which of the following is not an appositional suture pattern?
•	Simple interrupted 
•	Modified gambee 
•	Half-buried vertical mattress 
•	Horizontal mattress

Answer 8

D Horizontal mattress

Question 9

Which of the following is false regarding continuous Lembert sutures?
• It is used to close large hollow viscera (e.g. stomach, urinary bladder, stomach)
• It has parallel purchase
• It has partial thickness purchase

Answer 9

B (false, this is Cushing and Conell, Lembert is perpendicular)

Question 10

Which is FALSE?
• Two-handed knots offer the advantage of allowing the greatest precision in maintaining constant suture tension during tying
• One-handed ties utilizing the nondominant hand are efficiently placed but provide less suture tension control.
• Hand ties generally use more suture than instrument ties
• Knot security is related to the coefficient of friction of the suture and represents the force required to cause a knot to form.

Answer 10

D (…knot to slip)

Question 11

What are the five tenets of suture tying?

Answer 11

The simplest secure knot for the suture material and the situation is the goal.
• When tying a knot, avoid friction between strands, as suture weakening may result. Avoid vertical tension on suture strands when tying knots, to minimize friction.
• Use appropriate tension when tying knots.
• Tie each knot by pulling the two suture ends in opposite directions with uniform rate and horizontal tension.
• Avoid damage to the suture material when tying knots by never applying needle holders to any portion of the suture that is to remain in the patient

Question 12

Which is FALSE?
• Net tensile strength of the suture line or ligature is determined by the initial tensile strength of the suture and the knot security.
• The weakest point in a suture line or ligature is practically always the knot.
• Relative knot security is defined as knot-holding capacity in percent of the tensile strength of the suture.
• Synthetic absorbable suture materials tend to have a relative knot security approximating 42%.

Answer 12

D (67%)

Question 13

Which of the following is a technique for blood flow reduction as a method of hemostasis?
•	Topical ephedrine
•	Hypotension 
•	Distant vascular clamps or snares
•	Tourniquets
•	All of the above

Answer 13

D all

also hypothermia, reduced perfusion

Question 14

Which vessels can be permanently ligated in dogs, but not in cats?
• Both common iliac veins, hepatic vein
• Both jugular veins, both common carotid arteries
• Femoral arteries, both jugular veins
• Left renal vein, femoral arteries

Answer 14

B (if vertebral artery is present and circle of Willis is functional)

A(both species)
C(femoral arteries in both)
D(dog only for left renal vein)

Question 15

Which of the following is a false statement about tourniquets?
• Consequences of tourniquet use include intramuscular swelling, and degeneration of myelin of compressed nerves
• Application of a tourniquet does not vary between different sized patients.
• The recommended cuff pressure to achieve tourniquet affect is 100 mm Hg above the patient’s systolic pressure
• The maximum time for a tourniquet is 1.5-2 hrs.

Answer 15

B (False P = T/ RW so a tourniquet applied with the same pressure as a larger patient would result in a higher pressure on a smaller patient because of the smaller limb radius) similar to LAPLACE’S LAW - NxT/RxW

rec time (thought to correspond to the point at which muscle ATP stores are depleted)

Question 16

Name risk factors associated with SSI (6)?

Answer 16

Duration of surgery
Duration of anesthesia
Surgical site preparation
Method of wound closure
Antimicrobial prophylaxis
Comorbidities

Question 17

The risk of SSI increases with _____ hour of surgery

Answer 17

each

Question 18

Name some potential problems/complications associated with surgical site preparation (6)

Answer 18

Traumatic clipping, 
poor maintenance of clipper care, 
excessive scrubbing, 
use of harsh biocides,
 recontamination of prepared sites, 
inadequate contact time for biocides

Question 19

True or false: Although stainless steel skin staples provide rapid wound closure with a tighter seal, they may induce an exaggerated inflammatory response and have increased bacterial attachment

Answer 19

True

Question 20

According to Turk et al., 2015- what is the SSI rate of all surgical procedures?

Answer 20

3%

Question 21

Redosing every \_\_\_ half-lives of the drug is indicated for time-dependent antimicrobials
1
1.5
2
2.5

Answer 21

2

Question 22

What is the half-life of cefazolin?

Answer 22

47min

Question 23

A large prospective TPLO study in Canada found (A. Nazarali et al.);
An increase in SSI was observed when the initial dose was administered > __ minutes from first incision.
50
70
90
100

Answer 23

100

Question 24

Name arteries/veins that can be occluded temporarily? (7)

Answer 24

Hepatic artery and portal vein
Femoral A
Renal A
Caudal VC
Carotid A
Aorta
tumor A blood supply

Question 25

Name arteries/veins that can be permanently ligated in both dogs and cats? (11)

Answer 25

Brachiocephalic V
Brachial A
Hepatic V
Femoral A; femoral V
both external iliac A
both common iliac  V
abdominal VC caudal to liver in case of chronic compression and established collateral circulation OR concurrent right nephrectomy

Question 26

Name arteries that can be permanently ligated in DOGS only (2)?

Answer 26

both common carotid A if vertebral A is preserved and circle of willis is fxnl
Left renal vein

Question 27

What vessels can up temporarily ligated up to 30 min?

Answer 27

Hepatic A; Renal A + V; Abdominal aorta

Question 28

What vessels can up temporarily ligated up to 15-20 min?

Answer 28

splenic A+V

Question 29

What vessels can up temporarily ligated 10-15 min?

Answer 29

Portal triad (hepatic A, portal V, common bile duct)

Question 30

What vessels can up temporarily ligated 5-10 min?

Answer 30

descending thoracic aorta

Question 31

Which hemostatic mineral forms a clot independent of the clotting cascade, and can therefore form a clot in the presence of heparin and warfarin?

Answer 31

chitosan

Question 32

Which is true?
A Ethamsylate improves platelet formation in the presence of vascular injury.
B Desmopressin can improve pancreatic blood flow in the presence of acute necrotizing pancreatitis in dogs and may have an antiinflammatory effect
C Zeolite is a crystalline mineral compound with a high surface area. Zeolite absorbs water to concentrate clotting factors and platelets, activates platelets, and releases calcium ions that activate the coagulation cascade
D Chitosan is thought to stimulate the “glass effect,” which is seen when the surface negative charge of glass promotes rapid onset of blood clotting

Answer 32

Ethamsylate: adhesiveness and aggregation of platelets, pancreatic blood flow
C true and has glass effect
D Chitosan has a high surface area, which rapidly forms a stable gel-like clot on contact with blood

Question 33

Which is true?
A Desmopressin (DDAVP) is a synthetic analogue of guanine vasopressin that stimulates the release of von Willebrand factor and factor VIII from endothelial cells
B Desmopressin can be used to prevent and treat bleeding in patients with and without von Willebrand factor (vWF) deficiencies
C The main side effects are related to the antidiuretic effects, causing hypernatremia and water retention.
D There are no publications on the use of DDAVP in cats

Answer 33

A Arginine vasopressin
B Desmopressin Does NOT affect hemostasis in normal patients
C The main side effects are related to the antidiuretic effects, causing__and water retention. HYPOnatremia
D true

Question 34

What are two categories of antifibrinolytics? What are their differences?

Answer 34

1. serine protease inhibitors (aprotinin)
2. Lysine analogues (epsilon-aminocaproic acid, tranexamic acid),
   * both inhibit plasmin- or plasminogen-mediated fibrinolysis
   * Lysine analogues generally are much more potent than serine protease inhibitors

Question 35

What is the most common active hemostatic agent?
Alginates
Thrombin gelatin matrix 
Thrombin 
fibrinogen/collagen fleece

Answer 35

C thrombin

Question 36

Which of the following is not a mechanical hemostatic agent?
A Gelatins
B Chitin 
C Collagens
D Wax

Answer 36

B Chitin (hemostatic polymer/mineral)
Gelatins, Collagens, Wax 
\+ include oxidized cellulose and polysaccharide spheres +/- oxidized cellulose

Question 37

Which of the following is not a group of hemostatic agents? What do each of them do?
A Mechanical 
B Biologic 
C Active
D Hemostatic sealant

Answer 37

A Mechanical - absorb blood to provide a mechanical barrier or tamponade further bleeding, also create matrix for clot formation
B is BS ;)
C Active - stimulate normal hemostasis or improve hemostasis
D Hemostatic sealant - products created for sealing of vascular or dural defects without utilizing endogenous hemostatic mechanisms - like glue

Question 38

Whats the suggested maximum time a Esmarch tourniquet should be applied for?

Answer 38

Most recommendations suggest a maximum time of 1.5 to 2 hours, which is thought to correspond to the point at which muscle adenosine triphosphate (ATP) stores are depleted.

Question 39

When can you define an infection as nosocomial infection?

Answer 39

arises 48hrs after hospitalization

Question 40

what gene accounts for MRSA

Answer 40

mecA gene → methicillin resistance