Instrumentation

Question 1

Why is slide cutting used?

Answer 1

gives the best control of length, depth and direction

Question 2

How is the slide cutting technique performed?

Answer 2

Skin incisions should be made full thickness with the blade perpendicular to the skin. The skin is stabilised by the non-dominant hand, being stretched perpendicular to the direction of the blade.

Question 3

When is the “fingertip” scalpel grip used?

Answer 3

Long incisions

Question 4

How do you perform the fingertip grip

Answer 4

Place blade length against the skin

Question 5

When is the “pencil tip” scalpel grip used?

Answer 5

increases precision and depth control and is used for shorter, delicate incisions.

Question 6

When is the “press cutting” scalpel technique used?

Answer 6

Press cutting and inverse press cutting are used to enter body cavities or fluid-filled organs such as the linea alba or bladder.

Question 7

When are curved scissors beneficial?

Answer 7

improve visibility during dissection

Question 8

What is the benefit of straight scissors?

Answer 8

Mechanical advantage

Question 9

When are long length scissors used? (3)

Answer 9

thoracic and abdominal work, where it is necessary to perform dissection in deep cavities. They are also useful for soft palate surgery.

Question 10

Which scissors have thin, delicate tips and are used for most surgical dissections?

Answer 10

Metzenbaum scissor

Question 11

Which scissors have longer, thicker blades and are used for cutting dense tissues?

Answer 11

Mayo

Question 12

Which scissors should be kept in each kit to be used exclusively for cutting sutures and drapes?

Answer 12

Mayo

Question 13

Which grip gives the surgeon best control of the forces created when using scissors?

Answer 13

Tripod

Question 14

Which forces cause the blades to come together?

Answer 14

Closing

Question 15

How do shearing forces act with scissors?

Answer 15

push the blades flat against each other during closing

Question 16

Define torque forces

Answer 16

roll the leading edges of the blades inwards to touch each other.

Question 17

When is push cutting used?

Answer 17

rapidly cut through less dense, areolar tissue.

Question 18

When is blunt dissection used?

Answer 18

used to undermine skin edges or to break down loose connective tissue.

Question 19

Why do we want to avoid excessive blunt dissection?

Answer 19

as it increases tissue trauma and dead space.

Question 20

What are the benefits of tungsten carbide in needle holders? (2)

Answer 20

provide stability while protecting against suture damage.

Question 21

What is the difference between mayo-hegar and olsen-hegar needle holders?

Answer 21

The Mayo-Hegar is the standard needle holder. The Olsen-Hegar has a cutting blade built into the jaws.

Question 22

Benefits of tripod grip with needle holders (2)

Answer 22

Easy grasping and release of the needle
Precise needle placement.

Question 23

What are crushing forceps used for?

Answer 23

Grasping tissue

Question 24

What are the tips of allis forceps like?

Answer 24

Serrated tips

Question 25

When are allis tissue forceps used?

Answer 25

used to grasp and manipulate dense tissue and fascia.

Question 26

What are the tips of babcock forceps like?

Answer 26

Smooth inverted tips

Question 27

When are babcock forceps used?

Answer 27

They are used to hold delicate visceral tissue and tubular organs such as bowel, their wider, rounded grasping surface being less traumatic.

Question 28

Which forceps are used to occlude the bowel lumen during gastrointestinal procedures, preventing leakage of bowel contents and providing haemostasis

Answer 28

Doyen intestinal forceps

Question 29

When are Satinsky clamps used?

Answer 29

To partially or completely occlude blood vessels

Question 30

When are mosquito forceps applied tips down?

Answer 30

tip clamping of small vessels

Question 31

When are mosquito forceps applied tips up?

Answer 31

jaw clamping of small vascular pedicles prior to ligature application

Question 32

Which grip is employed when applying the mosquito forceps?

Answer 32

Tripod

Question 33

Which grip is employed when removing the mosquito forceps? (2)

Answer 33

Tripod or palmer

Question 34

What is the palmer grip?

Answer 34

One ring is grasped with the thumb and index finger while pressure is applied to the other ring with the middle and ring fingers.

Question 35

Which forceps are used for handling delicate tissue, particularly blood vessels and visceral organs. They have long, slightly curved handles, resulting in a shallow A-shape with spring tension that allows the surgeon to control the pressure on the tissue between the tips. The jaws contain two rows of microscopic teeth that fit together on closure resulting in an even distribution of tension and atraumatic tissue handling.

Answer 35

DeBakey

Question 36

What is the layout of Brown -Adson forceps?

Answer 36

forceps have two parallel rows of very fine teeth.

Question 37

What is the layout of dressing forceps? When are they used?

Answer 37

forceps have tips with smooth serrations. They are used for handling swabs.

Question 38

What is the layout of adson forceps?

Answer 38

forceps have tips with only two fine teeth; these may cause less crushing injury than Brown-Adson forceps.

Question 39

Which forceps cause less crushing injury 0 Adson or brown-adson

Answer 39

Adson

Question 40

Choose six items that might be used to assemble a kit of long instruments.

Answer 40

Needle holders Metzenbaum scissors Adson forceps DeBakey forceps Dressing forceps Right angled forceps

Question 41

Name crushing forceps (3)

Answer 41

Halstead Allis Babcock

Question 42

Name non crushing forceps (2)

Answer 42

Doyen Satinksy

Question 43

Name thumb forceps (2)

Answer 43

DeBakey Adson

Question 44

What do senn retractors look like?

Answer 44

small, double-ended retractors, one end having three prongs and the other a right-angled blade.

Question 45

When are senn retractors used?

Answer 45

Retract superficial tissue

Question 46

What do langenbeck retractors look like?

Answer 46

flat, right-angled blades

Question 47

When are langenbeck retractors used? (2)

Answer 47

deeper tissues and muscle bellies.

Question 48

What do malleable retractors look like?

Answer 48

flat and flexible

Question 49

What are malleable retractors used for?

Answer 49

retract organs such as liver lobes or lung lobes within body cavities.

Question 50

What do hohmann retractors look like?

Answer 50

flat blade and a beak.

Question 51

How are hohmann retractors used?

Answer 51

The beak is inserted under bone or fracture fragments while the blade depresses and protects the adjacent soft tissues.

Question 52

Name 4 hand held retractors?

Answer 52

Senn Langenbeck Malleable Hohmann

Question 53

What do gelpi retractors look like?

Answer 53

two arms, ring handles and a ratchet lock.

Question 54

When are gelpi retractors used? How to optimise use?

Answer 54

These are ideal for retracting skin edges, subcutaneous tissues and muscles. Exposure is optimised when two Gelpi retractors are placed at right angles to each other.

Question 55

What is the benefit of travers over gelpi retractors?

Answer 55

Travers retractors have the same function as Gelpi retractors. However, their multiple prongs allow better tissue purchasing and force distribution.

Question 56

What do balfour retractors look like?

Answer 56

two moveable arms mounted on parallel slide bars

Question 57

When are balfour retractors used?

Answer 57

retraction of the abdominal wall during celiotomy procedures.

Question 58

Which retractors: have two broad, outward-curved blades mounted on a ratcheted bar?

Answer 58

Finochietto retractors

Question 59

When are Finochietto retractors used?

Answer 59

Spreading the ribs or sternum during thoracotomy procedures.

Question 60

When are self retaining retractors used? Name 4

Answer 60

1. Long term exposure 2. Gelpi Travers Baflour Finochietto

Question 61

Which suction tips (2) allow precise suctioning of small volumes of fluid?

Answer 61

Adson Frazier

Question 62

Which suction tip allows suctioning of large volumes of fluid?

Answer 62

Yankqauer

Question 63

When are poole suction tips used? How does the structure benefit this use?

Answer 63

Suction fluid from body cavities The outer fenestrated tube contains an inner pin point suction tube and prevents occlusion by ody tissue

Question 64

When are thumb controlled flexible suction tip used?

Answer 64

Fluid from upper airway + trachea (e.g. brachy)

Question 65

How do radiofrequency devices work?

Answer 65

Radiofrequency devices deliver a high frequency alternating electrical current to tissues to generate heat energy. This heat results in collagen denaturation and tissue shrinkage;

Question 66

How does monopolar radiofrequency work?

Answer 66

the current is applied to the patient via a handpiece (the active electrode). This travels back to the generator via an inactive electrode attached to the patient. This return electrode (sometimes referred to as a grounding pad or dispersive pad) ensures that low-density current passes back to the radiofrequency generator (electrosurgical unit), preventing patient burns

Question 67

What are monopolar units used for? (2)

Answer 67

dissection and haemostasis.

Question 68

What are the risks of monopolar?

Answer 68

thermal damage to tissues and delayed wound healing (If the ground plate is in contact with only a small area)

Question 69

When is bipolar advantageous over monopolar?

Answer 69

can be used in a wet surgical field. This is advantageous if there is active haemorrhage.

Question 70

What wavelength do harmonic devices deliver at? How do they work?

Answer 70

Harmonic devices deliver ultrasound waves at 55.5 KHz. These ultrasonic vibrations generate heat and coagulate tissues.

Question 71

Why are harmonic devices more beneficial than radiofrequency?

Answer 71

In contrast to the obliterative coagulation of radiofrequency units which occurs at much higher temperatures resulting in the burning of tissues, coaptive coagulation minimises collateral tissue damage and prevents charring of tissue.

Question 72

What physical effect do medical lasers have? What are the functions? (5)

Answer 72

photothermal effect, that is they cut, cauterise, coagulate, vaporise or weld tissue