204 X2 Flashcards by Jessica Moore

Hemostasis, essential to successful wound management, occurs when _________ reacts with fibrinogen to form ____________, the basic structure of a clot.

A. Serotonin, fibrin
B. prothrombin, thromboplasin
C. fibrin , thrombin
D. thrombin, fibrin

D. Thrombin, fibrin

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Which does not coagulate blood vessels?

Nd: YAG laser
Argon laser
CUSA
Harmonic scalpel

CUSA

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Which chemical hemostatic agent must never be injected?

a. Heparin
b. Papaverine
c. Thrombin
d. Epinephrine

c. Thrombin

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Which hemostatic agents are absorbable and need not be removed:
1. oxidized cellulose
2. gelatin sponge
3. microcrystalline collagen
4. thrombin

All of the above

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Which is/are true about glues?

All of the following are true
They may be used on areas of active blood loss
They confirm to irregular contours
They use cogulation factors in plasma

All of the following are true

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The use of electrocoagulation for hemostasis is contraindicated:

A. In oral surgery with halothane anesthesia
B. After an iodophor skin prep
C. In bladder surgery using saline irrigation
D. In lung surgery using methoxyllurane anesthesia

C. In bladder surgery using saline irrigation

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Inherited deficiencies of coagulation in which bleeding occurs spontaneously after minor trauma is called:

Pernicious anemia
Tay-Sachs disease
Erythroblastosis fetalis
Hemophilia

Hemophilia

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Prothrombin time measures:

The coagulant activity of the extrinsic system, including fibrinogen, prothrombin, and factors V, VII, and X
The presence of immune globulin on the surface of erythrocytes or in the plasma
Disorders of platelet function
Deficiencies of all plasma coagulation factors except VII and XIII

The coagulant activity of the extrinsic system, including fibrinogen, prothrombin, and factors V, VII, and X

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The SFA initially seeks to prevent blood loss by:

Appropriate use of the ESU and argon beam coagulator
Anticipatory control of blood vessels
Learning how to use the square knot
Using digital compression before other methods

Anticipatory control of blood vessels

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Which is NOT true about damage control technique?

Surgery is aborted when the patient is losing too much heat or blood
Surgery is aborted if the patient can’t be stabilized
Team focuses on stopping hemorrhage and preventing contamination
Cavities and incisions are temporarily closed

Surgery is aborted if the patient can’t be stabilized

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Hemostatic agents used in surgery are administered systemically or ______________________ in the form of powders, sponges, solutions, or films.

Intravenously
Topical
Intramuscularly
Subcutaneously

Topical

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Which are considered thermal methods of hemostasis:
1. laser
2. photocoagulation
3. bone wax
4. diathermy
5. hemostatic ligating clip

1, 2, 4

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Vascular prosthetic grafts may be coated with ______ to prevent bleeding through porous graft surfaces.

Albumin
Thrombin
Fibrin glue
Oxidized cellulose

Albumin

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Thrombocytopenia is lack of:

RBCs
WBCs
Thrombin
Platelets

platelets

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_______ is the key to a RBC’s ability to carry oxygen.

Fluorocarbon
Hematocrit
Hemoglobin
Thrombin

Hemoglobin

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Which prolong(s) coagulation time and may contribute to postoperative hemorrhage:
1. controlled hypotension
2. epinephrine
3. hypothermia
4. warfarin
5. vitamin K

1, 3

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Which Of the following is a hemostatic agent that is available in a powder or an absorbable gelatin sponge form which may be cut to the desired size or shape depending on the application?

Avitene
Surgicel
Gelfoam
Thrombin

Gelfoam

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________ causes the break down of the formed fibrin network.

Plasmin
Platelets surgery
Thrombin
von Willebrand Factor

Plasmin

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A frazier tip suction held to the back of a Cottonoid® pattie are likely used to clear the operative field in which of the following:

Laparoscopic surgery
Endoscopic surgery
Open abdominal surgery
Microsurgery

Microsurgery

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The first blood element to arrive after a break in the endothelial lining is the:

von Willebrand Factor
Platelet
Fibrin
WBC

Platelet

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When using a monopolar electrode tip, which of the following would be needed to complete the circuit on the ESU?

A. a bipolar forceps
B. an insulated holster
C. an active electrode
D. a dispersive pad

D. a dispersive pad

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Which of the following can be fatal for the surgical patient?

Loss of RBCs
Loss of serum
Loss of WBCs
Loss of platelets

Loss of RBCs

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An example of the application of indirect pressure is applying it:

With a sponge on stick
Between two fingers (bidigitally)
To an area proximal to the bleeding vessels
With the tip of an instrument, such as the suction tip

To an area proximal to the bleeding vessels

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What clotting factor does fibrinogen react with to form fibrin during the clotting process?

Plasma
Thrombin
Collagen
Serotonin

Thrombin

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The topical hemostatic agent thrombin should never be directly injected or allowed to enter into a vessel because: A. it causes uncontrollable vasospasms. B. the effects are reversed when directly injected and cause more severe bleeding. C. it can cause clotting and may ultimately lead to death. D. the risk of infection increases with direct injection.

C. it can cause clotting and may ultimately lead to death.

Which of the following cauterization devices would be appropriate in tight spaces, with high risk for collateral nerve tissue nearby? Bipolar cautery forceps Pencil-tip cautery Needle-tip cautery Monopolar “pincher” cautery

Bipolar cautery forceps

When the SFA must deal with multiple clamps as tying is about to proceed, he/she should: Take two or more in the hand at a time to speed the process Suggest using the ESU rather than tying Pick them up for tying in the order that they were placed Take the most accessible one first and proceed in a logical order

Pick them up for tying in the order that they were placed

A patient who is opposed to the acceptance of blood transfusion of religious principles is undergoing a hysterectomy. During surgery, there was significant blood loss causing the hematocrit to drop to 30% with a resulting drop in oxygen saturation. Under these conditions, which of the following is the appropriate response? Transfuse whole blood Increase IV fluid drip to allow hemodilution Change IV fluid to dextrose 5% with water Transfuse platelets

Increase IV fluid drip to allow hemodilution

The primary difference between the Cushing and Connell suturing techniques for GI anastomosis include which of the following: The Connell stitch penetrates the mucosal layer, while the Cushing does not The Cushing stitch penetrates the mucosal layer, while the Connell does not. The Connell stitch is interrupted, while the Cushing is running stitch The Cushing stitch is interrupted, while the Connell is a running stitch

The Connell stitch penetrates the mucosal layer, while the Cushing does not

Which of the following statements concerning the principles of suture placement is correct? Sutures should be placed as close to the wound edge as possible to prevent tissue necrosis Sutures should be as far as possible from the wound edge to prevent knot slippage and displacement Sutures should be placed in deep tissue to prevent hematoma Suture placement should place as much tension on the tissue as possible to promote healing

Sutures should be placed in deep tissue to prevent hematoma

Which of the following types of stitch patterns provides an excellent cosmetic closure? Subcuticular stitch Retention stitch Purse-string stitch Simple stitch

Subcuticular stitch

Scar maturation: Occurs immediately following the inflammatory stage Occurs on days 5-14 and consists of the initiation of production of collagen fibers Is not a distinct phase of wound healing Has a variable duration depending upon the specific type of tissues that are wounded

Has a variable duration depending upon the specific type of tissues that are wounded

The amount of tension or pull expressed in pounds that a suture can withstand before it breaks is: Pliability Capillarity Tensile strength Knot strength

Tensile strength

“Eversion” of skin edges for staple closure means: Turn the skin edges under for tighter closure Turn the skin edges up, that is, line up the dermal margins Overlap one side over the other for double strength Leave a large gap between the skin-edges to allow for drainage

Turn the skin edges up, that is, line up the dermal margins

Which of the following would affect normal wound healing? Latex allergy Penicillin allergy Peripheral vascular disease Clean wound

Peripheral vascular disease

A 6-0 suture is: Larger diameter than a 4-0 Smaller diameter than a 4-0 Is too small for skin closure B and C

Smaller diameter than a 4-0

Clean, contaminated wounds would include initially clean wounds which were then contaminated by: Entrance into the pharyngeal cavity Entrance into the GU cavity Entrance into the abdomen A and B

A and B

Fibroblasts are: RBCs WBCs Cardiac muscle cell Connective tissue cell

Connective tissue cell

Intra-operative superficial and deep suction drain placement with compression dressings following mastectomy procedures reduce the incidence of which of the following complications: Paresthesia on the undersurface of the arm Lymphedema Post-op seroma Neoplasm recurrence

Post-op seroma

Collagen is: A blood-borne substance Substance present in neurologic tissue The protein substance of connective tissue The mineralized matrix of bone

The protein substance of connective tissue

The main consideration in surgical needle selection is: To minimize microbial growth Stabilization within the jaws of the needle-holder To minimize trauma Corrosion resistance

To minimize trauma

Which of the following sutures should not be used in the placement of heart valves? Polypropylene Polyglactin Polydioxanone Polyglecaprone

Polydioxanone

In which incision could retention sutures be used? Vertical midline McBurney Transverse Thoracoabdominal

Vertical midline

An absorbable suture that offers extended wound support: Vicryl PDS Plain Chromic

PDS

Polyglactin 910 suture is: Absorbable, natural Nonabsorbable, natural Absorbable, synthetic Nonabsorbable, synthetic

Absorbable, synthetic

Which of the following methods should the SFA consider when cutting suture? According the surgeon's preference According to the SFA's preference Leave a one centimeter tail for nonabsorbable suture Cut on the knot for absorbable suture

According the surgeon's preference

Continuous lateral stitches placed beneath the epithelial layer of the skin are: Interrupted Subcuticular Purse-string Subcutaneous

Subcuticular

Which of the following organisms normally found on the skin can cause wound infection? Bacillus botulinum Staphylococcus aureus Diplococcus pneumoniae Candida albicans

Staphylococcus aureus

Which of the following features represent a disadvantage of monofilament suture material? Higher reactivity than braided material Not preferable in infected situations Not preferable near the skin Poor relative knot security compared with braided material

Poor relative knot security compared with braided material

The three phases of wound healing include all of the following EXCEPT: Fibroplastic phase Chronic phase Remolding phase Inflammatory phase

Chronic phase

Wound closure using sutures is termed: Closure by primary intention Closure by secondary intention Granulation None of the above

Closure by primary intention

Sutures placed in a wound to prevent wound evisceration are called: Stent Fixation Retention Traction

Retention

The method of wound closure during which the wound is allowed to granulate closed is called: Healing by primary intention Healing by secondary intention Healing by third intention Healing by no intention

Healing by secondary intention

What is a better bed for a skin graft? Fascia Fat

Fascia

All angles of the flap are 60º, which means that every side of both the defect and the flap is equal length: Dufourmental flap Webster flap Rhombic flap Bilobe flap

Rhombic flap

Reorients and lengthens a scar. TRAM flap Z-plasty Free flap V-Y advancement flap

Z-plasty

Relaxed skin tension lines are: Not important during surgery Important for planning incisions The lines of minimal intention of the skin B and C

B and C

During a TRAM procedure, which is used to identify and preserve the superior epigastric arteries? C-arm Doppler Echocardiography Angiography

Doppler

This flap shares a side with the defect (wound). It is mostly used in reconstructive surgery fro small facial defects. Regional flap Local flap Distant flap Free flap

Local flap

A dual transposition flap used to close circular defects. Free flap TRAM flap Bilobe flap Z-plasty

Bilobe flap

What is an STSG? Includes the epidermis and a variable amount of the dermis Includes the entire epidermis and dermis

Includes the epidermis and a variable amount of the dermis

This flap is away fro the defect and it is done when local tissue is insufficient to cover an adjacent defect requiring a flap to be transferred from a remote location. Regional flap Local flap Distant flap Free flap

Distant flap

An alternate breast reconstruction flap from women that are thin and may not have enough abdominal tissue: Gluteal flap Transverse Rectus flap Composite flap Deep inferior epigastric performator flap

Gluteal flap

What muscle is commonly used for TRAM reconstruction in a mammoplasty? Latissimus dorsi Transverse abdominis Internal oblique Rectus abdominis

Rectus abdominis

The Z-plasty: Is useful in shortening wounds Is useful in reorienting the direction of scars Provides no improvement in cosmesis Is a free flap

Is useful in reorienting the direction of scars

Advantages of flaps include(s): They provide blood supply to the recipient site They provide tissue bulk at a defect They have no contracture All of the above

All of the above

Type of closure which consist of consecutive triangles made on one side of the scar with its mirror image on the other side: Z-plasty W-plasty S-plasty Four flap Z-plasty

W-plasty

What type of flap is separated from all vascular supply that requires microvascular anastomosis? Free flap TRAM flap Z-plasty STSG

Free flap

Montgomery straps are used to: Secure head dressings Hold a thyroid dressing in place Conform a dressing in place Hold in place bulky dressings that require frequent changing

Hold in place bulky dressings that require frequent changing

Which of the following is frequently used over an incision in pediatric surgery? Collodian Benzion Cotton-elastic bandage Pressure dressing

Collodian

During application of a cast, additional padding is often required to protect bony prominences of patients at greater risk for pressure injury. Which of the following padding materials is MOST commonly used in this situation? Stockinette Kerlix roll Webril Kling

Webril

Appropriate drain type for a nasogastric decompression: A. No drain B. Jackson-Pratt closed drain C. Underwater seal drain D. Sump drain

D. Sump drain

Appropriate drain type for a spontaneous pneumothorax A. No drain B. Jackson-Pratt closed drain C. Underwater seal drain D. Sump drain

C. Underwater seal drain

Appropriate drain type for diffusion of peritonitis from a perforated duodenal ulcer A. No drain B. Jackson-Pratt closed drain C. Underwater seal drain D. Sump drain

A. No drain

Appropriate drain type for splenectomy for ruptured spleen A. No drain B. Jackson-Pratt closed drain C. Underwater seal drain D. Sump drain

B. Jackson-Pratt closed drain

What are the potential advantages of negative-pressure wound therapy? 1. Draws wound edges together 2. Removes exudates and infectious materials 3. Reduces edema 4. Promotes perfusion and facilitates granulation tissue 1, 2, and 3 2, 3, and 4 2 and 4 All of the above

All of the above

Which of the following should be applied immediately postoperatively to immobilize the surgical site, limit limb motion, and allow for postoperative swelling in open reduction procedures? Long arm cast Splint Long leg cast Spica

Splint

Immediately following an arthroscopic assisted cruciate ligament (ACL) reconstruction, a patient's knee is typically placed in: Hinged knee brace Posterior splint A long-leg cast An anterior splint

Hinged knee brace

Which of the following dressings are derived from bovine, equine, or porcine sources and are effective in recalcitrant wounds? Composites Alginates Cyanoacrylate Collagen

Collagen

Which of the following is considered a non-impregnated, nonadherent dressing? Adaptic Vaseline gauze Telfa Xeroform

Telfa

Which of the following casts should be applied to a non-displaced humeral fracture? Wedge Hanging Sugar tong Munster

Hanging

Which procedure would NOT require a pressure dressing? Plastic surgery Knee surgery Radical mastectomy Hysterectomy

Hysterectomy

Why would benzoin be applied to the skin before dressing application? To facilitate easier removal To increase adhesiveness To add a microbial film to the skin To prevent allergic reaction to tape

To increase adhesiveness

A temporary biological dressing is: Porcine Telfa Collagen Mesh

Porcine

Which of the following wound dressings absorbs exudate from the wound? Xeroform Gauze Tegaderm Collodion

Gauze

Which of the following is the casting method used to manage a pelvic fracture? Flexor block cast Extensor block cast Spica cast Short cast

Spica cast

Which is NOT a reason for a pressure dressing? Prevents edema Conforms to body contour Absorbs extensive drainage Distributes pressure evenly

Conforms to body contour

204 X2 Flashcards

(87 cards)