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Junior Posting > Week 1-2 > Flashcards

Week 1-2 Flashcards

1
Q

A surgical suture, also known as a stitch or stitches, is a _______ used to __________ and ____________ after an injury or surgery.

A

medical device

hold body tissues together

approximate wound edges

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2
Q

There are numerous types of suture which differ by _______ and _______ as well as __________ and characteristics

A

needle shape and size

thread material

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3
Q

_________ , or _______, needles with sutures consist of a pre-packed eyeless needle attached to a specific length of suture thread.

A

Swaged

atraumatic

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4
Q

The _____ and ______ needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.

A

ski and canoe

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5
Q

Monofilament versus polyfilament threads

Monofilament fibers have less _________ but create less _________ and are more appropriate with ______ tissues where ___________ can be more significant such as _________________.

A

tensile strength ; tissue trauma

delicate tissues ; tissue trauma

small blood vessels.

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6
Q

Monofilament versus polyfilament threads

Polyfilament (_________) sutures are composed of multiple fibers and are generally greater in _______ with greater ___________, however, they tend to have greater ____________ and theoretically have more propensity to harbor _________

A

braided; diameter

tensile strength; tissue reaction

bacteria

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7
Q

Other properties to consider between a mono or poly filamentous thread

Tensile strength: the ability of the suture to _____________________.

Elasticity: the ability of the suture material to ______________ such as in cases of ________.

Tissue reactivity: ______________ of the surrounding tissue that can cause materials to break down quicker and lose tensile strength.

Knot security: the ability of the suture to __________________

A

hold tissues in place without breaking

adapt to changing tissues ; edema

inflammatory response

maintain a knot that holds the thread in place

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8
Q

(Absorbable or Non absorbable?) (natural or synthetic?) suture have the (Absorbable or Non absorbable?) (natural or synthetic?) fibers have the highest rates of tissue reactivity.

A

Non absorbable synthetic

absorbable natural

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9
Q

Absorbable sutures are either degraded via ___________ or ___________ and should not be utilized on body tissue that would require greater than ___________ of tensile strength.

A

proteolysis : hydrolysis

two months

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10
Q

Absorbable sutures are generally used (internally or externally?) during surgery or to avoid further procedures for individuals with (low or high?) likelihood of returning for suture removal.

A

Internally ;low

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11
Q

Natural absorbable

Natural absorbable material includes ___________ , ___________ and ___________ which are all produced from the _____ extracted from ____________.

They are all (mono or poly?) filaments which have different degradations times ranging from ___-____days.

A

plain catgut, chromic catgut and fast catgut

collagen; bovine intestines

poly; 3–28

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12
Q

Synthetic absorbable

Synthetic absorbable material includes ________ acid, ________ acid, _________, Polydioxanone and Polytrimethylene carbonate.

Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation

A

Polyglactic

Polyglycolic

Poliglecaprone

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13
Q

Best used on:

Plain catgut-
Chromic catgut
Fast catgut-

A

Mucosal tissues
Mucosal, skin, genitalia
Mainly skin, also mucosal

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14
Q

Non-absorbable

They are appropriate for tissues with a (low or high?) degree of mechanical or shear force (________, certain skin location).

A

High

tendons

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15
Q

Sutures

Natural non-absorbable : ______

Synthetic non-absorbable: ______,______,_________

A

Silk

nylon, polypropylene and surgical steel

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16
Q

Sutures

Natural non-absorbable : Silk - ____filament

Synthetic: includes nylon, polypropylene and surgical steel all of which are _____filaments

A

poly

mono

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17
Q

A Marjolin ulcer is a ___________ that arises in the setting of ____________ skin, _______ scars, and _______ wounds

A

cutaneous malignancy

previously injured

longstanding

chronic

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18
Q

_____________________ (ERAS) is a modern approach to help people _______ following surgery

A

Enhanced Recovery After Surgery

recover quicker

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19
Q

ERAS PROTOCOL

Pre-Operative

•Ensuring the patient is as healthy as possible prior to surgery, through ______ and ________

•Optimising medical management, including _________ and ________

•__________ prior to surgery to enhance bowel recovery and avoid bowel prep if appropriate

•Solids allowed until _______ pre-operatively (unless contra-indicated)

•Intake of clear fluids until ______ prior to surgery, with some centres moving towards being able to drink clear fluids up to the time of leaving the ward

•Loading with 12.5% _________ within 2 hours of surgery

A

exercise and weight loss

smoking and alcohol cessation

Altered diet; 6 hours

2 hours

carbohydrate beverage

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20
Q

ERAS PROTOCOL

Intra-Operative

•Use of multimodal and _______ analgesia, including regional anaesthesia*

•Includes avoidance of ____-acting benzodiazepines in the elderly

•Use of multimodal postoperative __________________ prophylaxis

•Use of _______________ surgery

•Targeting a goal-directed fluid therapy regime, including goal-directed _______ management

A

opioid-sparing

short; nausea and vomiting

minimally invasive

haemostasis

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21
Q

Regional anaesthesia includes _______ and ________ anaesthesia, __________ catheters, and _____________ regional blocks

A

spinal and epidural anaesthesia

rectus sheath catheters

local anaesthetic regional blocks

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22
Q

ERAS PROTOCOL

Post-Operative

Ensure adequate _________ is achieved to allow for early mobilisation

Early ________ and optimising nutrition

Multi-disciplinary post-operative patient follow-up, including in the post-acute care phase

A

pain control

oral intake

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23
Q

There are several parts to the operating theatre:

List them

A

Scrubbing area

Operating room

Anaesthetic room

Storage area

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24
Q

There are several parts to the operating theatre:

_____________ – contains sinks and sterile gowns, gloves, and masks/visors etc

___________ – contains the scrub nurse table

A

Scrubbing area

Operating room

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25
Q

Storage area also are often sterile

T/F

A

T

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26
Q

The time it takes for a tissue to no longer require support from sutures will vary depending on tissue type:

Days: ____,_______, or ______

Weeks to Months: ________ or ______

Months to Never: ______________

A

Muscle, subcutaneous tissue or skin

Fascia or tendon

Vascular prosthesis

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27
Q

The ideal suture is the (smallest or largest ?) possible to produce uniform tensile strength, securely hold the wound for the required time for healing, then _________. It should be predictable, easy to handle, produce minimal reaction, and knot securely.

A

Smallest

be absorbed

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28
Q

_________ sutures are commonly used for deep tissues and tissues that heal rapidly

A

Absorbable

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29
Q

For the more commonly used absorbable sutures, complete absorption times will vary:

Vicryl rapide =___ days
Vicryl = ___ days
Monocryl = ~____ days
PDS = ~_____ days

A

42

60

100

200

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30
Q

Non-Absorbable Sutures

Non-absorbable sutures are used to provide _____-term tissue support, remaining ______ by the body’s ________ (until removed manually if required).

A

long

walled-off

inflammatory processes

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31
Q

Non-absorbable sutures

Uses include for tissues that heal (rapidly or slowly?) , such as ______ or ______ , closure of __________, or _______ anastomoses.

A

slowly

fascia or tendons

abdominal wall

vascular

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32
Q

Monofilament vs Multifilament

Suture materials can also be sub-classified by their structure:

Monofilament suture – a single stranded filament suture (e.g _____,——- *, or prolene).

Multifilament suture – made of several filaments that are twisted together (e.g _______ or _______ ).

A

nylon; PDS

braided silk or vicryl

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33
Q

Monofilament vs Multifilament sutures

Monofilament suture
-(Lower or Higher?) infection risk
-(good or poor?) knot security and ease of handling.

Multifilament suture
-(good or poor?) knot security and ease of handling
-(Lower or Higher?) infection risk

A

Lower; poor

Good; Higher

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34
Q

The larger the size ascribed to the suture, the _______ the diameter is, for example a 7-0 suture is ______ than a 4-0 suture.

A

smaller

smaller

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35
Q

When choosing suture size, the _______ size possible should be chosen, taking into account the _______ of the tissue.

A

smallest

natural strength

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36
Q

Commonly, surgical needles are made from _____________ .

A

stainless steel

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37
Q

Surgical needles are composed of:

The _______ end connects the needle to the suture

The _________ or ____________ is the region grasped by the needle holder.

The _________

A

swaged

needle body or shaft

Needle point

38
Q

Needle bodies can be ______,_______, or _________

A

round, cutting, or reverse cutting:

39
Q

Needle bodies can be round, cutting, or reverse cutting:

Round bodied needles are used in _____ tissue such as ______ and _____

Cutting needles are ______ in shape, and have _____ cutting edges to penetrate _____ tissue such as the ______ and _______, and have a cutting surface on the con______ edge

Reverse cutting needles have a cutting surface on the con_____ edge, and are ideal for ______ tissue such as _______ or ______ sutures, and have reduced risk of cutting through tissue

A

friable; liver and kidney

triangular; 3; tough; skin and sternum;cave

Vex; tough; tendon or subcuticular

40
Q

The needle point acts to pierce the tissue, beginning at the maximal point of the body and running to the end of the needle, and can be either _____ or _______

A

sharp or blunt

41
Q

Needle points

Blunt needles are used for ________, and in _____ tissue, and can potentially reduce the risk of blood borne virus infection from needlestick injuries.

Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where ______ must be prevented.

A

abdominal wall closure; friable

leakage

42
Q

Allis forceps are _______ surgical instruments, used to grasp ____ tissues (such as _____)

Babcock forceps are ______ instruments with a (rough or smooth?) end, allowing for more delicate structures (such as ______) to be held in an _______ manner

Dunhill forceps are (small or large?) forceps with _____________ ends, often used to grasp ———- prior to ligation

Lane tissue forceps have ______ teeth, allowing the grasping of _____ tissues, such as ______

A

toothed ; firm tissues ;fascia

jawed ; smooth ; bowel; atraumatic manner

small ;curved serrated ;vessels

interlocking teeth; tough ; fascia

43
Q

Littlewood forceps have ____ ended teeth, used to grasp ______ tissues, such as ______. They are often used to gain entry via the _________ for _______ surgery.

Sawtell forceps are _______ forceps with a ——— end, often used to grasp ———— prior to ligation

Available as curved or straight, Spencer Wells forceps can be used to ______ medium to large sized vessels prior to ligation

A

blunt ;tough ;fascia. ; umbilicus ; laparoscopic

curved ; serrated ; vessels

clamp

44
Q

Debakey forceps are _______ forceps used in a wide variety of procedures, importantly can be used to grasp tissues (such as ______ ) without damaging them

Lanes forceps are ______ instruments, useful for grasping tissues and are widely used within all surgical specialities (however not to be used to grasp _____)

Gillies forceps are (narrow or wide?) ________ forceps, often used to grasp ______ (not to be used to grasp _______)

A

non-toothed ; bowel

toothed ; bowel

narrow ; toothed ; skin ; bowel

45
Q

Mayo scissors are ______ scissors, with _______ ends, often used to cut _______ or ________, either straight or curved

McIndoe scissors are used often for cutting or dissecting ______, characteristically have a ______ blade

A

heavy; semi-blunt; thick tissues or sutures

tissues; curved

46
Q

Rampleys can be used for handle ______ or _______

A

guaze or sponges

47
Q

Diathermy is the use of ________ frequency alternate polarity radio-wave ________ to _______ or _____ tissue during surgery.

A

high frequency

electrical current

cut or coagulate

48
Q

Diathermy

It allows for ______ to be made with limited ________ and is now used in nearly all surgical disciplines.

A

precise incisions

blood loss

49
Q

Diathermy uses _______ frequencies

A

very high

50
Q

Diathermy

Depending on the temperature reached, different results occur: at 60oc, ________ occurs (______), between 60-99oc, _____ occurs and the tissues ______, and at around 100 oc, the tissues ______ (_______).

A

cell death ; fulgurate

dehydration; coagulate

vaporise; cutting

51
Q

Diathermy

Cutting uses a __________ waveform with a __________ voltage.

Coagulation alternatively uses a __________ waveform with a __________ voltage.

A

continuous ; low

pulsed ; high

52
Q

abscess is a localised collection of ____ surrounded by __________.

A

pus

granulation tissue

53
Q

Pus contains ______ tissue with suspended _____________ and ________. It forms when the primary insult is a _______ bacterium and extensive tissue necrosis occurs.

A

necrotic

dead and viable neutrophils

dead pathogens

pyogenic bacterium

54
Q

Over time, the acute inflammation will cease and, if not ___________, the abscess will be replaced by ______.

A

surgically drained

scar tissue

55
Q

An abscess can be a source for _________________ of a pathogen, with the abscess acting as a _______ for the infection.

It can also cause continually rising pressures within the tissue, resulting in _____ and _________ of local structures.

A

systemic dissemination

harbour

pain; destruction

56
Q

The basic principles for the management of a wound or laceration are:

List all 5

A

Haemostasis
Cleaning the wound
Analgesia
Skin closure
Dressing and follow-up advice

57
Q

In cases of significant injury or laceration of vessels, steps may need to be taken to reduce bleeding and aid haemostasis.

These include ________,_______,________, or _________

A

pressure, elevation, tourniquet, or suturing.

58
Q

Wound cleaning is important for reducing infection and promoting healing. There are five aspects of wound cleaning:

List all

A

Disinfect
Decontaminate
Debride
Irrigate
Antibiotics

59
Q

five aspects of wound cleaning:

Disinfect the __________ with antiseptic and Avoid getting ________

Decontaminate the wound by _________

Debride any _______ where possible

Irrigate the wound with _____

Antibiotics for high-risk wounds or signs of infection

A

skin around the wound ; alcohol or detergents inside the wound

manually removing any foreign bodies

devitalised tissue

saline

60
Q

Remember to not use adrenaline with local anaesthetic if administering ________________

A

in or near appendages (e.g. a finger)

61
Q

Skin Closure

To aid wound healing, the edges of the wound can be manually opposed. There are four main methods of doing so:

List all

A

Skin adhesive strips
Tissue adhesive glue
Sutures
Staples

62
Q

Skin Closure

Skin adhesive strips (e.g. Steri-StripsTM) are suitable if ___________ are present

Tissue adhesive glue :a popular choice in ___________

Staples can be used for some ____ wounds

A

no risk factors for infection

paediatrics

scalp

63
Q

When applying a wound dressing to a non-infected laceration, the first layer should be __________ (such as a __________), followed by an __________ to attract any __________, and finally __________ to secure the dressing in place.

A

non-adherent ; saline-soaked gauze

absorbent material ; wound exudate

soft gauze tape

64
Q

Any sutures or adhesive strips should be removed _______ after initial would closure (or ______ if on the head)

tissue adhesive glue will naturally slough off after ______.

A

10-14 days

3-5 days

1-2 weeks

65
Q

Remove dressings at the same time as the sutures or adhesive strips.

T/F

A

T

66
Q

foreign body (________ giant cell)

mycobacterium tuberculosis (_______ giant cell)

fat necrosis (________ giant cell).

A

foreign-body

Langhans

Touton

67
Q

There are two main types of healing, ________ intention and _______ intention.

In both types, there are four stages which occur; _______,________,_______, and ________

A

primary; secondary

haemostasis, inflammation, proliferation, and remodelling.

68
Q

Any wound made by a scalpel will heal by _________ intention. Surgeons can aid healing by ensuring adequate opposition of the wound edges, through use of surgical glue, sutures, or staples.

A

primary

69
Q

When sutures are used to close a wound, ensuring the correct tension of the sutures is essential:

Too loose and the _________________, limiting the primary intention healing and reducing wound strength

Too tight and the ______________ and lead to tissue necrosis and wound breakdown

A

wound edges will not be properly opposed

blood supply to the region may become compromised

70
Q

Healing by secondary intention occurs when ___________, therefore healing must occur from the (top or bottom?) of the wound (up or down?)wards.

A

the sides of the wound are not opposed

bottom

upwards

71
Q

Local factors affecting wound healing

M
I
L
F
S

A

mechanical factors
Infections
Location of wound
Foreign material
Size and type of the wound
Radiation damage

72
Q

Systemic factors affecting wound healing

???

A

Co-morbidities
Obesity
Nutrition
Increasing Age

73
Q

Classification of wound contamination

?

A

Clean
Clean contaminated
Contaminated
Dirty

74
Q

Classification of wound contamination

Clean
_____ signs of inflammation, ____ opening of any of the tracts

Clean contaminated
___________ case that is otherwise _____.
________ opening of respiratory, GI, biliary, or GU tract with _____ spillage

A

No; no

Urgent or emergency; clean

Elective; minimal

75
Q

Classification of wound contamination

Contaminated
_____ spillage from GI tract or entry into biliary or GU tract (in the presence of __________). Or a ________ trauma <___ hours old or a ________ wound to be grafted or covered

Dirty
________ inflammation (e.g. _____)

Preoperative _______ of respiratory, gastrointestinal, biliary, or genitourinary tract, or a penetrating trauma >___ hours old

A

Gross; infected bile or urine

Penetrating; 4; chronic open

Purulent; abscess; perforation;4

76
Q

Fibroadenoma:_______ lesions, _____-defined and ______ on palpation, (pain or painless?)

Lipoma:________ and _______ benign adipose tumour

Cysts: (rubbery or hard?), (smooth or irregular?) , and (well-defined or indistinct?), (pain or painless?)

Nodullarity: (rubbery or hard?) , (smooth or irregular?) , and (well-defined or indistinct?) , (pain or painless?)

Carcinoma: (rubbery or hard?) , (smooth or irregular?) , and (well-defined or indistinct?) (painful or painless?)

A

highly mobile; well; rubbery, painless

soft; mobile

hard, smooth, and well-defined, either

rubbery, irregular, and indistinct, pain

hard , irregular, and indistinct, often painless, rarely painful

77
Q

Adenoma

A _______ adenoma is a benign _______ tumour, typically occurring in the _______ female population.

Papilloma
_________ papillomas are a benign breast lesion that usually occur in females in their ________yrs, most typically occurring in the _________ region

Phyllodes tumours* are _________ tumours. They are commonly (smaller or larger?), occur in an ______ age group, and are comprised of both epithelial and stromal tissue.

A

ductal; glandular; older

Intraductal; 40-50; subareolar

rare fibroepithelial; larger; older

78
Q

benign breast lesions can present in a variety of ways. However in general, benign breast lumps tend to be more (mobile or fixed?) and have (smoother or rougher?) borders than their malignant counterparts, which often have ______ surfaces, a _____ consistency, and can be ______ to different layers of tissue.

A

Mobile; smoother

craggy; firm; fixed

79
Q

Malignant lesions tend to present as a single mass, whilst it is possible to get multiple benign breast lumps.

T/F

A

T

80
Q

Differential Diagnosis of Benign breast lump

The main differentials to consider include _______,_______, and _______

A

cysts, abscesses, and malignant lesions.

81
Q

The mainstay of distinguishing between breast lumps is __________________[.

A

the Triple Assessment

82
Q

All suspicious breast lesions should undergo the triple assessment, warranting _________,________,_________

A

examination, imaging, and histology.

83
Q

Common benign tumour subtypes include ________,________,________,________ and ___________

A

Fibroadenoma, Adenoma, Papilloma, Lipoma, and Phyllodes Tumours

84
Q

Plain catgut is a natural suture material derived from the _________ of _________ or the _________ of _________.

A

submucosa ; sheep intestine

serosa ; cattle intestine.

85
Q

Chromic catgut is a modification of __________ that is tanned with _________ to improve ________ and delay ________.

A

plain catgut

chromic salts

strength; dissolution

86
Q

Current methods for fighting SSIs involve the use of sutures coated with common antibiotics (________). Unfortunately, these antibiotics have been rendered ineffective due to the _____________________________

A

triclosan

increasing rate of antibiotic resistance.

87
Q

The cruciate anastomosis is an arterial network located on the ______ surface of the ______________.

Some authors refer to it as the ____________________.

The cruciate anastomosis is formed by the: _____________________ artery. And ____________ artery

A

posterior; proximal femur

collateral circulation at the hip joint

First perforating branch of deep femoral

Inferior gluteal

88
Q

An arthrotomy is a _________ of a ________ , which should include inspection of the _______, ___________ structures, _________, and __________.

A

surgical exploration of a joint

cartilage; intra-articular

joint capsule; ligaments

89
Q

Traumatic brain injury is classified as ______,_________, or ________, based on the __________________.

A

mild, moderate, or severe

Glasgow Coma Scale (GCS) score

90
Q

Wagner’s classification of Foot ulcers

Ulcer grading Description
Grade O

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

A

No ulcer but high-risk foot

Superficial ulcer

Deep ulcer, no bony involvement or Abscess with bony involvement (as shown by X-ray) abscess

Localized gangrene e.g. toe, heel etc

Extensive gangrene involving the whole foot

Junior Posting (35 decks)

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