General Surgery Flashcards
(119 cards)
1
Q
Three events recorded for pt safety
A
Adverse event
Near miss event
No harm event
2
Q
Which event gives the most reliable data regarding patient safety mechanism
A
Near miss event data
3
Q
Usage of checklist before surgery reduced mortality rate by
A
From 1.9% to 2%
4
Q
The written consent should contain complications wrt procedure.
Should we include all known complications in the consent?
A
Any complications with incidence more than 1% should be included
5
Q
Color coded IV lines
A
Orange 14G Grey 16 G Green 18G Pink 20G Blue 22 G Yellow 24G
6
Q
Pt with dehydration and hypotension requires quick IV fluid which IV Canula should be preffered
A
Wide bore with fast flow rate
Orange is widest bore
7
Q
Narrowest bore with least flow rate
A
Yellow 24 G
8
Q
Pt after rta brought to er with severe blood loss
Which of following IV lines will be used
16G
18G
20G
22G
A
Minimum two 18G iv inserted
If available a wider can be used
Here 16G is given in option
9
Q
Most common complication and mgt of iv lines
A
Superficial thrombophlebitis
TT change of canula
10
Q
Total parenteral nutrition is given to pt which iv line should be used
A
As tpn rich in sugar
Wide bore needle for fast flow rate with short length
11
Q
I/V canula for burn pt
A
Dehydration - urgent requirement wide bore needle
Edema with burn long length preferred
12
Q
Phases of surgical safety checklist
A
Sign in ward to OT
Time out BEFORE INDUCTION
SIGn out BEFORE SKIN CLOSURE
13
Q
Site marking is included in which checklist phase
A
Sign in phase
14
Q
In which phase surgeon is asked for anticipated blood loss
A
Time out
15
Q
Responsibility of scrub nurse is
A
Sterility Maintainence
16
Q
Duty of nurse during sign out phase
A
Nurse does guaze count and equipment count
17
Q
Actual blood loss during sign out phase is told by
A
Anaesthetist
18
Q
Each phase of checklist is signed by
A
Nurse
Anaesthetist
Surgeon
19
Q
How is blood loss calculated during surgery
A
Mops soaked +blood in suction - irrigating fluid
20
Q
Volume of blood in a completely soaked big mop
A
100cc blood
21
Q
Advantage of lines in mop/guaze
A
These lines are Radiopaque and used in locating missing mop using C arm
22
Q
A fist full of clot is how much blood
A
500 cc blood
23
Q
Zones in an OT
A
Protective zone
Clean zone
Aseptic zone
Disposal zone
24
Q
Zone connecting protective to aseptic zone
A
Clean zone
It has equipment storeroom
Maintenance workshop
25
Most common position used for abdominal breast surgery
Supine
26
Neutral OT position is
The head end and foot end of table are at same level
27
Position used in pelvic surgery
Trendelenburg
| The foot end of table is raised
28
Reverse trendelenburg position is
| And used in
Head end is raised and foot end is lowered
| Laparoscopy cholecystectomy
29
Use of prone position
Spinal surgery
| Pilonidal sinus surgery
30
Lithotomy position uses stirrups to abduct lower limb
| Most common complication due to it
Improper padding or over abduction leads to common peroneal nerve injury
31
Kidney position is used for
| Over abduction of arm can lead to
Thoracotomy
Nephrolithotomy
Nephrectomy
Injury to brachial plexus
32
Position for cranial surgery especially posterior cranial fossa
Fowler's position
33
Advantage and disadvantage of fowlers position
Adv relatively bloodless surgery
Disad increase risk of air embolism
Prevention by ligation of vein before cutting
34
Rose position is achieved by
30 degree head elevation
Towel roll placed below shoulder blades
Increase risk of air embolism
35
Position used in thyroid surgery
Rose position
36
Mgt of air embolism during surgery
Durants recovery position
It is left lateral decibitus
And air aspirated through central line
37
Most common complication of laparoscopy cholecystectomy
Right shoulder tip pain
| Because co2 used in surgery enters beneath right dome of diaphragm and irritates diaphragm
38
Why is jack knife position no longer used
It causes positional asphyxia
39
Lloyd David position is and used for
Trendelenburg+ lithotomy position
| Used in Abd perineal resection and low anterior resection
40
Instrument used to hold surgical blade
Bard parker handle
41
No 12 blade is used for
Suture removal
42
Stab blade is used for
No 11 blade for I &D
43
Blade used to make incision
No 10,15,20,21,22,23
44
Imp things to make sure while handling blades
Belly is the sharpest portion
Blade should be always passed in kidney tray with pointes end towards one self
Blade should always be perpendicular to skin
45
Cautery pad is used in which type of cautery
Monopolar cautery
46
Why bipolar doesn't require cautery pad
Because current travels from one paddle toother paddle and completes the circuit
47
Cautery tip in monopolar is aka
| Use of 2 buttons
Bovie tip
Yellow for cutting
Blue for coagulation
48
Advantage of bipolar over monopolar cautery
Bipolar is safe when used near vital nerves,
49
Monopolar cautery should be avoided in
```
Pt with pacemaker
Thyroid surgery
Parotid surgery
Penile surgery
Surgery involving end arteries
```
50
Waves produxed in cutting mode
Low Voltage
Continuous current
Less thermal spread
51
Waves produced coagulation mode
AC
High voltage
More thermal spread
52
Disadvantage of monopolar cautery
Interference with cardiac conduction
| Lateral spread causes thermal damage to nearby nerves
53
Preferred site for cautery pad
| When cautery doesn't work
A well vascular wide hairless area of contact
When cautery pad is not attached
Small cautery pad leads to burns
54
Ligasure energy source
| It is used for
Heat and pressure
| Sealing vessel upto 7mm diameter in 2-4 sec
55
Ligasure energy source
| It is used for
Heat and pressure
| Sealing vessel upto 7mm diameter in 2-4 sec
56
Harmonic scalpel works on the principle of
| Advantage?
```
Ultrasonic waves
Heat is not produced
Used close to vital structure
Precise
Can cut through scar tissue
```
57
Instrument used in area with low collagen tissue like non cirrhotic liver
Cusa
| Cavitron ultrasonic surgical aspirator
58
T/F
| Dist between two sutures should be 2 times depth of wound
True
59
Mattress suture should be used if simple sutures are unable to cause eversion of skin edge
T/F
True
60
Round body needles should be preferred for skin suturing
| T/F
False
| It cannot cross skin
61
Monocryl is one of the best suture msterial for subcuticular suturing
T/ F
True
62
CBD repair suture material used?
Polydiaxone
Round body needle
5-0
63
Vascular anastomosis suture material and needle
Prolene
| Round body needle
64
Rectus sheath suture material used
Prolene
| Cutting needle
65
Nerve repair suture material used
Nylon
| Round body needle
66
Best suture material for sub cuticular suturing
| Knot used
Monocryl 3-0
Cutting needle
Tied by aberdeen knot
67
10-1 sutures are finer than no1 sutures
| T/F
True
68
Number 1 suture is easier to handle as compared to 10-0
| T/F
True
| Because itis thicker
69
No 1 suture are likely to fracture more commonly as compared to 10-0 ?
False
| They are thicker
70
Drains used after Modified radical mastectomy
| Indicated when?
Romovac suction drain
| Usedwhen output is more than 40 cc for 2 consecutive days
71
Use of minivac suction drain
Used after sentinel LN biopsy
72
Chest tube drainage system is aka
Underwater seal system
73
T/F
| Lscs is clean contaminted type of wound?
True
74
Ilieal perforation is dirty wound?
True
75
Right hemicolectomy is pt with prepared bowel?
| Clean /clean contaminated/dirty?
Clean contaminated
76
Lap chole in acute cholecystitis? Type of wound
contaminated
77
Knee replacement is clean surgery?
| T/F?
True
78
Early case of duodenal perforation is a ____ type of wound
Clean contaminated
79
```
All of the following are risk factor for increase risk of wound infection except
OBESITY
HYPERTENSION
JAUNDICE
CANCER
```
Htn
80
34 yr old pt underwent laprotomy for ileal perforation and was in recovery when multiple episodes of loose stools which composes of mainly mucus with spikes of fever. Most probable cause of her condition
Pelvis diarrhea due to pus in pelvis
81
Most common surgical site infection on post op say 1
Atelectasis
82
Most common cause of post op fever in a surgical pt
Surgical site infection
83
Most common cause of post of fever overall
UTI
84
SSI is any wound infection within 15 days of surgery?
False, 30 days of surgery
85
Burst abdomen following abdominal surgery usually develops around day 6
True
86
Most common site of intra abdominal collection in pt of bowel surgery
Puch of douglas
87
Hypothermia during surgery reduces risk of infection?
No it increases
88
For a female pt undergoing abdominal surgery with part should be cleaned
From inframammary fold to mid thigh
89
In a prolonged surgery prophylactic antibiotics should be repeated after
4 hrs
90
A dual ring abd wound protector is superior to single ring protector
T/F?
True
91
Washing the wound cavity with antibiotics after surgery reduces wound infection rate?
False
92
In transparenteral nutrition, sudden glucose intolerance is an early sign of sepsis
T/F
True
93
Central line for TPN should be changed every 2 weeks to prevent infection
T/F
No central line is not changed unless infection is suspected
94
In TPN, electrolytes should be checked every 2-3 days?
True
95
TPN is best delivered through?
Central line
96
Subclavian central lines have higher rate of pneumothorax as compared to IJV central line
T/F?
True
97
Subclavian central lines are easier to insert as compared to IJV central line
T/F
False
98
Best nutrition regimen in a pt with esrd
Low volume high calories
99
Following TPN, one expect wt gain after how much time?
5-7 days
100
Femoral lines have the highest infection rate
T/F
True
101
Nasogastric tube cam be used for feeding upto 2-3 wks
| T/F
True
102
Nasojejunal tube should be used if there is?
Bad gastric emptying
103
Most common complication of enteral nutrition
Tube related - migration of tube, blockade
104
Most common complication related to feeding regimen
Osmotic diarrhea
105
Tube feed should be withheld is aspiration is--
More than 200 cc in 2 hr period
106
Method for feeding gastrostomy
Stam method
Witzel method
Percutaneous endoscopic gastrostomy
107
Why is surgeon knot secure knot
Because it has 2 throws followed by one throw
108
Purse string suture used for
Bury tha base of appendix
| Stapler haemorrhoidopexy
109
Edges preferred for skin suture
| What to do when simple suture fails to cause it
Everted edges
Mattress suturing
110
Far near near far suture is used for
Better obliteration of cavity
111
Shoe string method is used for
It is used for delayed closure of wound
| Healing by tertiary intention is achieved
112
Where to hold needle
At junc of 2/3 from pointed end and 1/3 from swaged end
113
Use of round body and cutting needle
Round body -splits tissue, atraumatic, delicate structure like blood vessel, cbd
Cutting needle - cuts through tissue, traumatic, used for tough structure skin fascia
114
Jenkins rule of mass closure
Minimum length of prolene used to close rectus sheath wound is 4times length of rectus sheath wound
115
Catgut is derived from
| Its tensile strength
Submucosa of sheep gut
Undergoes degradation by 7-10 days
116
Strongest layer of bowel
| Suture edges for bowel Suturing
Submucosa
| Inverted edges
117
Technique for bowel anastomoses
Single layer - stitch at extramucosal single layer applied
| Two layer outer and inner layer
118
Two layer repair technique in bowel Anastomosis
First layer - albert layer closed by Round body vicryl
Second layer lembert layer is a seromucosal layer
RB silk
119
Salmon fluid sign is seen in
Burst abdomen
| Large quantities of reddish fluid escapes from main wound
