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Surgery II > Ops Details Part I > Flashcards

Ops Details Part I Flashcards

1
Q

What are the types of suture materials?

A
  • Natural
  • Synthetic
  • Absorbable
  • Non-absorbable
  • Monofilament
  • Multifilament

Each type has specific characteristics and uses in surgical procedures.

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2
Q

What is the ideal suture material characterized by?

A
  • Safe (sterile, non-allergenic)
  • Easy to handle
  • Induces minimal tissue reaction
  • Not predisposed to bacterial growth
  • High tensile strength
  • Secure knotting
  • Resistant to shrinking in tissues
  • Absorbed completely

These qualities are essential for effective wound closure and healing.

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3
Q

Fill in the blank: Absorbable sutures are used to hold wound edges in approximation temporarily, until they can withstand _______.

A

normal stress

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4
Q

What are the characteristics of plain gut sutures?

A
  • Loses tensile strength quickly (half-life 5-7 days)
  • Produces marked tissue reactivity

Plain gut sutures are natural absorbable sutures.

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5
Q

What is the half-life of chromic gut sutures?

A

10-14 days

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6
Q

What are the types of non-absorbable sutures used for?

A
  • Exterior skin closure
  • Permanent encapsulation within the body cavity
  • Prosthesis attachment
  • Patients with a history of reaction to absorbable sutures

Non-absorbable sutures remain in place for an extended period.

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7
Q

True or False: Monofilament sutures have more pliability than multifilament sutures.

A

False

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8
Q

What is a purse string suture used for?

A

To close circular wounds such as hernia or appendiceal stump

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9
Q

What are the recommended suture removal times for different body areas?

A
  • Face: 3-4 days
  • Scalp: 5 days
  • Trunk: 7 days
  • Arm or leg: 7-10 days
  • Foot: 10-14 days

Timely removal is important to prevent complications.

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10
Q

What are surgical drains classified by?

A
  • Communication with atmosphere (closed or open)
  • Structure of drain (flat sheet, corrugated sheet, tube, sump)
  • Material (rubber, latex, plastics, siliconized)
  • Pliability (soft, rigid)
  • Flow (passive or active)
  • Site drained (pelvic, subhepatic, subcutaneous)

Each classification helps determine the appropriate drain for specific surgical needs.

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11
Q

What is the rule for abscess drainage incisions?

A
  • Incision must be at the most dependent site
  • Adequate incision length
  • Parallel to major vessels and nerves
  • Along skin crease if possible

Proper incision technique is essential for effective drainage.

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12
Q

What is delayed primary closure?

A

Approximation of wound margin delayed for several days to prevent infection

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13
Q

What is the purpose of wound closure tapes?

A

Useful for flat, dry, nonmobile surfaces where wounds fit together with no tension

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14
Q

What type of wounds are tissue adhesives not useful for?

A
  • Wounds near the eye
  • Mucous membranes or mucosal surfaces
  • Wet wounds or exposed to body fluids
  • Areas with dense hair
  • Wounds under significant tension

These conditions can complicate healing and adhesion.

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15
Q

What key factors are considered in the classification of surgical incisions?

A
  • Vertical (midline, paramedian)
  • Transverse (Kocher’s subcostal, McBurney’s)
  • Oblique (muscle cutting)
  • Abdominothoracic

The type of incision can affect recovery and surgical outcomes.

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16
Q

What are the steps involved in the technique of abscess drainage?

A
  • Incision at the most dependent site
  • Open cavity and expose loculi
  • Pack cavity with gauze
  • Leave drain in place for 48-72 hours

Proper technique is crucial for effective drainage and preventing recurrence.

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17
Q

What are the indications for Hilton’s Method?

A

Used where important structures like vessels or nerves are liable to be injured

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18
Q

What is the function of a Penrose drain?

A

Flat drain dependent on gravity and capillary action

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19
Q

What is healing by secondary intention?

A

Open wound margins spontaneously approximate by biologic contraction

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20
Q

What is the incision type used in the breast?

A

Radial incision, circumareolar, or at sub-mammary fold

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21
Q

How should incisions be made in the axilla?

A

Vertical to gap when the arm is abducted

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22
Q

What is the incision direction in the cubital fossa?

A

Transverse in the cubital crease

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23
Q

What is the incision direction in the gluteal region?

A

Downwards, lateral & forwards along fibres of gluteus maximus

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24
Q

What is the incision direction in the popliteal fossa?

A

Transverse in the popliteal crease

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25
What is the incision method for draining a pulpe space abscess?
A lateral straight incision under local ring anaesthesia
26
What position should a patient be in for breast abscess drainage?
Supine with the arm abducted on an arm board
27
What is the procedure for incising a breast abscess?
Incise the abscess, take a swab of pus for culture and sensitivity
28
What should be done after breaking down loculi in a breast abscess?
Send part of the cyst wall to histology
29
What is the purpose of packing the cavity after abscess drainage?
To promote healing and prevent re-accumulation of fluid
30
When should a tube drain be considered in breast abscess treatment?
In large abscesses that are not in the dependent part of the breast
31
What should be done if there is surrounding cellulitis or skin damage after an abscess drainage?
Leave the wound open with a small pack in situ
32
What is the position for drainage of a perianal abscess?
Lithotomy
33
What type of incision is made over a perianal abscess?
Cruciate incision
34
What should be used for postoperative care of a perianal abscess?
Loose packing and dressing or warm sitz baths
35
What are the postoperative complications of perianal abscess drainage?
Development of fistula-in-ano, bleeding/haematoma
36
What position is recommended for drainage of a parotid abscess?
Supine with head up and neck extended
37
What is the incision type for a parotid abscess?
Vertical incision of skin and superficial fascia
38
What is Hilton's Method used for?
To open the cavity of the abscess while avoiding injury to facial nerve branches
39
What is Ludwig’s angina?
Infection involving sublingual, submental, and submandibular spaces, often of dental origin
40
What are the signs of Ludwig's angina?
Pain, drooling, dysphagia, submandibular swelling, trismus
41
What is the management for Ludwig's angina?
Airway management, early aggressive antibiotics, surgical intervention
42
What is the procedure for ingrowing toenail surgery?
Wedge excision of nail and tissue around, complete removal of germinal matrix
43
What postoperative advice should be given after ingrown toenail surgery?
Elevate the leg for 1 day, remove dressing and sutures after 12 days
44
What is the indication for excision biopsy of a breast lump?
When fine needle aspiration or Truecut biopsy has failed to exclude malignancy
45
What should be confirmed before a breast lump procedure?
The side and site of the breast lump
46
What incision types can be used for breast lump surgery?
Circumareolar or radial incision
47
What should be ensured during the incision for breast surgery?
Complete haemostasis with diathermy
48
What is emphasized during the dissection of benign breast lesions?
Stay close to the lesion itself, avoiding unnecessary excision of healthy tissue
49
What is the preferred method for closing the wound after excision?
Use Vicryl for subcutaneous tissues and subcuticular Monocryl or Prolene for skin
50
What should be done with specimens during excision?
Send for histopathology
51
What should be used to hold and stabilize very mobile breast lumps during dissection?
Allis forceps ## Footnote Allis forceps are specialized surgical instruments used to grasp and hold tissues securely.
52
What instruments can be used to dissect breast tissue?
Scalpel, scissors, diathermy ## Footnote Diathermy is a surgical technique that uses high-frequency electrical currents to cut tissue and coagulate blood vessels.
53
What is the aim during the haemostasis phase in breast surgery?
Complete haemostasis ## Footnote Haemostasis refers to the process of stopping bleeding, essential for surgical procedures.
54
What should be inspected in all quadrants of the biopsy before closure begins?
All quadrants for haemostasis ## Footnote Ensuring haemostasis in all quadrants minimizes the risk of postoperative bleeding.
55
What should be done if there is a large cavity or dead space during closure?
Bring out a small suction drain ## Footnote A suction drain helps to remove fluids that may accumulate in the cavity post-surgery.
56
What type of suture should be used to close breast tissue and subcutaneous tissues?
Vicryl on a cutting needle ## Footnote Vicryl is a type of absorbable suture material commonly used in soft tissue closure.
57
What suture material is recommended for skin closure?
Subcuticular Monocryl or Prolene ## Footnote Monocryl is an absorbable suture, while Prolene is a non-absorbable suture material.
58
What should be infiltrated into the wounds at the end of closure?
Local anaesthetic ## Footnote Local anaesthetic helps to minimize pain in the postoperative period.
59
How should the wounds be dressed after closure?
With an adhesive waterproof dressing ## Footnote This type of dressing allows for bathing in the early postoperative period without wetting the wound.
60
What is the primary purpose of preoperative evaluation?
To evaluate the patient's current medical status and provide a clinical risk profile for treatment decisions that may influence outcomes. ## Footnote This includes making recommendations concerning cardiac problems over the perioperative period.
61
List the goals of preoperative evaluation.
* Documentation for which surgery is needed * Assessment of patient overall condition/health status * Uncovering issues that could cause problems during and after surgery * Perioperative risk determination * Optimize medical condition to reduce morbidity and mortality * Develop perioperative plan of care * Education of patient and family * Reduce anxiety * Facilitate recovery * Reduce cost * Decrease length of hospital stay * Reduce cancellations day of surgery * Increase patient/family satisfaction
62
What aspects should be included in a patient's medical history during preoperative evaluation?
* Past and current medical history * Review of systems * Medication history * Alcohol, tobacco, and non-prescribed drugs * Vital signs * Surgical history * Allergies * Family history of adverse reactions to anesthesia * Neonatal history for children
63
What is Goldman’s index of cardiac risk used for?
To predict cardiac risks associated with surgery based on factors like age, CHF, MI history, and more. ## Footnote A specific EF (ejection fraction) threshold is considered (EF < 35%).
64
What are some pulmonary risk factors in preoperative evaluation?
* Smoking * CO2 retention * Low FEV1 * COPD
65
What are the components of the Child-Pugh classification used for hepatic risk assessment?
* Ascites * Bilirubin levels * Clotting factors * Diet * Encephalopathy
66
What laboratory tests are typically required for surgical patients?
* CBC * Coagulation testing * Pregnancy testing * LFT * Renal function testing ## Footnote Tests should be consistent with medical histories and proposed procedures.
67
What must be included in informed consent information?
* Description of procedure * Alternative therapies * Underlying disease process * Name and qualifications of person performing procedure * Explanation of risks * Right to refuse treatment
68
What is the minimum fasting period before surgery for clear liquids?
2 hours.
69
Define 'Clean Operations' in surgical classification.
Operations in which no inflammation is encountered and the respiratory, alimentary, or genitourinary tracts are not entered.
70
What are the four main types of anesthesia?
* General anesthesia * Regional anesthesia * Monitored anesthesia care (MAC) * Local anesthesia
71
Describe the ASA Classification and its significance.
A classification system that helps predict anesthetic/surgical risks based on the patient's health status, with higher classes indicating higher risks. ## Footnote Class 1 is healthy, while Class 5 is moribund.
72
What are common postoperative complications?
* Pain * Hypovolemic shock * Thrombophlebitis * DVT * Pulmonary embolus * Fluid overload * Atelectasis * Pneumonia * Airway obstruction * Surgical site infection (SSI)
73
What criteria are used in the Post Anesthetic Discharge Scoring (PADS) system?
* Vital signs * Ambulation and mental status * Pain * Surgical bleeding * Fluid intake/output
74
True or False: Patients must be 18 years old to sign their own consent.
True.
75
What is the role of the nurse in the informed consent process?
To act as an advocate, witness, and ensure the appropriate person signs the consent.
76
What is the classification for 'Dirty Operations'?
Operations performed in the presence of pus or where there is a previously perforated hollow viscus.
77
Fill in the blank: The patient's _______ must be reviewed to ensure no adverse responses related to anesthesia.
history

Surgery II (8 decks)

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