Principles of Surgery VM 568 | Questions and Answers (Complete Solutions)

Principles of Surgery VM 568 | Questions and Answers (Complete Solutions) When using the electronic books through the WSU library link everyone in class can use the electronic version of Small animal surgery secrets at the same time One of your classmates missed class and would like to know where to locate a recording from the lecture. Which of the following is correct On the principles of surgery confluence page In the orientation to Principles of Surgery video, the narrators explained what to expect in the course. Among those items are which of the following? The focus will be a holistic overview of surgery from preoperative preparation through post-operative care and everything in between To understand the impact of a technique or process, it can be helpful to understand outcomes before that intervention was added. Without antisepsis, the mortality (death) rate of patients undergoing abdominal procedures, fracture repairs, and limb amputations was 50% or higher Two vital transformations to surgery that were explored in the Gawande article were the development/discovery of anesthesia and asepsis. Which of the following reflects how the profession responded to those ideas initially? While the initial report of anesthesia was hailed as a great achievement, the response to Joseph Lister's articles on antisepsis were met with significant skepticism. To be a good surgeon, you need a healthy dose of self-confidence. As an example, in 1929 an intern was unable to convince his supervisors to allow him to try a procedure on patients or animals as they deemed it too risky. He opted to perform it on himself, pioneering work that has extended millions of lives. True Surgery is not benign. In the Gawande article what was the highest surgical mortality reported associated with one case in early surgical descriptions? 300% Veterinarian surgery has followed surgery on humans in its evolution. Therefore, it is important to understand the history of surgery to understand the history of surgery to understand how we may progress and respond to that progress. According to the article by Atul Gwande on the history of surgery, early surgeons were most limited in their efforts by The patients pain and likelihood of systemic infection When putting instruments in the ultrasonic cleaner of autoclave, which of the following are correct? The box locks should be open in the cleaner and autoclave Regarding the care of surgical instruments, which are important considerations? Tap water can cause stains on instruments if precautions are not taken A crushing instrument used to clamp blood vessels is called Hemostat True or false? The location of the needle holder grip along the arc of the needle determines some of the mechanical characteristics True Which of the following statements is true regarding curved surgical scissors? The provide greater maneuverability When using a scalpel, it should be held with which of the following grips? Depending on the context, any of the above could be appropriate Each type of surgical instrument is designed for a particular use and should be used only for that purpose. Using instruments for procedures for which they were not designed may damage the instrument True Which forceps will induce the most trauma to delicate tissue, despite being used correctly? Rat tooth forceps Which of the following is appropriate to use with a #4 Bard Parker handle? #20 blade Please match the following instruments to their descriptions Mayo stand - a platter - sized surgery table used to hold instruments Metzenbaum - tissue scissors intended for delicate tissue work Backhaus - clamps used to secure surgical drapes to patients Olsen - Hegar - needle holders with suture cutting capability Halsted Mosquito - tissue forceps designed to assist in hemorrhage control from small vessels Which of the following is most appropriate to prepare stainless steel surgical instruments for sterilization Place in an ultrasonic cleaner Which of the following is true regarding the pack in this picture? Use information available in the image to make your decision It is not well packed, resulting in non-sterile instruments Regarding the use of towel clamps, which of the following is best-practice Lorna-Edna towel clamps may be repositioned while Backhaus towel clamp may not The surgeon is working on removing some fibrous (tough) tissue from an old wound before she reconstructs it. Which of the following scissors is most appropriate for this task? Mayo A number 3 Bard Parker handle fits with which scalpel blade or blades? 10, 11, 12, 15 Please match the process with the appropriate chemical or technology Cleaning - detergent Disinfection - gluteraldehyde Sterilization - hydrogen peroxide gas plasma Antisepsis – chlorhexidine Regarding the surgical environment, which of the following is true? Minor surgeries on healthy patients may be performed "in the field" Which of the following is an optimal protocol for achieving aseptic preparation of a puppy's skin prior to an ovariohysterectomy? 4% (full strength) Chlorhexidine scrub rinsing with sterile water Regarding surgical attire, which of the following aligns with best practice to ensure patient safety? If you are performing surgery and have a beard, you should wear a special surgical cap that covers your facial hair Concerning pre-surgical hand antisepsis, which of the following is true? Prolonged or repeated washing leads to damaged barrier function of the surface layer of the skin You are scrubbed into orthopedic surgery. Which of the following is a behavior that is NOT in line with best practice to ensure patient safety? Folding your arms with your hands in your axillary region to keep you from touching things Which of the following will NOT achieve sterilization? Scrubbing skin for 5 minutes with Chlorhexidine scrub followed by alcohol rinse The process used to prepare inanimate surfaces like the surgery table and floor in operating room for surgical procedures is best referred to as: Disinfection A group of volunteer veterinarians and vet nurses are traveling to a developing nation to perform routine health care, including surgery. Which of the following is accurate With adequate preparation and management of logistics, a gymnasium could work for some surgical procedures Which of the following techniques is the most appropriate to perform a surgical scrub on a patient (ex. for routine spay) In a circular motion, starting from the center and working your way towards the outer edges Regarding surgical draping, which of the following is true A towel too close to the incision site can be moved away from the incision site When moving around in a surgical setting, which of the following is appropriate If you become dizzy or think you are going to pass out, it is important to let the surgeon and technician know so they can help you Which of the following is true regarding appropriate sterile glove use If a surgery glove is punctured, it must be replaced with a new glove A scrubbed - in surgical assistant is accidentally sprayed in the head, face, and chest with sterile fluid from the arthroscopy pump during a procedure. What is the most appropriate course of action? Step away from the patient quickly and completely re-gown and re-glove Wound contraction is accomplished by which of the following? Myofibroblasts Which of the following can impact the speed and quality of wound healing all of the above the type of bandage, particularly what is in contact with the surface of the wound chemicals that are put on it or in the wound patient movement significant patient systemic illness What is granulation tissue? capillary buds and loops with a supporting structure Which of the following cell types are integral to the inflammatory process? all of the above neutrophils monocytes macrophages When planning for a surgical approach, tension lines are important because incisions made along tension lines heal better Order the phases of healing in the order they first appear during uncomplicated wound healing inflammation proliferation contraction remodeling Which of the following is/are known causes of wound(s) all of the above a surgical incision dog bite hot water bottle used to warm a patient squamous cell carcinoma (a type of skin cancer) Why is it appropriate to place a foil-wrapped (commercial) scalpel blade in the instrument pack prior to sterilization via autoclave? B&C Because the inside of the foil pack is already sterile and the autoclave sterilizes the outside Having the foil wrapper makes the blade less dangerous than being unwrapped within the pack Which of the following is true regarding operating rooms (OR) in veterinary medicine The optimal OR is designed to have positive air flow (i.e., more pressure in the OR than outside) Based on the stages of wound healing, how long should a patients be administered a non-steroidal anti-inflammatory (NSAID) medications following an uncomplicated benign (non-cancerous) mass removal? 3 days When preparing to remove a 3cm by 3cm round dermal mass located over the left scapula of a German Shepherd dog, what is the best way to determine the direction of least skin tension surrounding this mass in order to plan the surgical incision Physically pinch around the mass and see which direction creates the least tension A 10 - year - old Airedale terrier sustained a 10 cm, longitudinal (parallel to the long axis of the dog) laceration to his back/dorsum. Treatment included anesthetizing the dog, cleaning the minimally - contaminated laceration, and closing the laceration despite the skin being tight in some areas. Which of the following factors will NOT negatively affect wound healing in this patient? the length of the wound A client with two highly curious grade-school aged kids is visiting a practice you are shadowing. When the kids find out you are in veterinary school, they start asking questions. From the look on the veterinarian face, it is clear she expects you to take the questions seriously and answer to the best of your ability. How would you respond to the following question? "I just cut myself with paper from my art project. How come it took several seconds for me to start bleeding after I cut myself? Point out that they are quite observant and explain "your body has a reflex that makes the vessels squeeze closed for a second after you cut yourself" When it comes to wound healing, which of the following is true for the outcome? Most tissues do not heal with the same strength as the original tissue Which of the following is likely to be true with second intention healing? Myofibroblasts will be an important element of successful healing To sterilize the fiberoptic cable (grey) and arthroscopic camera (black), which is the most appropriate approach? Take the pieces apart and prepare them for gas sterilization Is this instrument (tissue forceps) being held correctly? No. pencil grip must be used Where is a surgeon's throw indicated for use? Tissues with high tension Tissues that heal slowly should be sutured with rapidly absorbing suture so that the suture material does not interfere with healing false, should be using non-absorbable or slow absorbing suture so the wound has time to heal A good rule of thumb for picking out suture material is: if it is internal, should be absorbable, if it is external, it should be non-absorbable A patient at the local humane society has been spayed. Which of the following is appropriate for the closure of the linea alba or rectus abdominus muscle layer? simple continuous The absorbable suture material with the longest retention of tensile strength is Polydiaxanone Absorbable suture material can be degraded by two basic mechanisms. Which of the following is/are correct B and C suture can be absorbed by white blood cells during the inflammatory phase of wound healing suture can be absorbed through a predictable and repeatable chemical reaction The definition of an absorbable suture material is one that undergoes degradation and rapid loss of tensile strength within 60 days Please order the following phases of wound healing in the order they first appear to last inflammation, proliferation, contraction, remodeling Which suture material is the largest? 3-Vicryl Why would using a Connell suture pattern with an uncoated multifilament material be contraindicated for closure of an enterotomy incision? Bacteria could potentially move from inside the bowel lumen to the peritoneal cavity via the suture Which of the following suture types will have the most tissue drag (resistance when traveling through tissue?) 2-0 synthetic multifilament no-absorbable (Vetafil or Barunamid) Which of the following suture types is/are characteristic (s) of a suture that impact knot security? plastic deformation Which of the following suture materials would be best to close deep layers (muscle) of an infected wound Polygalactin 910 – Vicryl Trauma causes compromise to tissue and healing. Which of the following is true regarding suturing potentially comprised tissues, including skin? A non-absorbable or an absorbable suture that is degraded via hydrolysis is ideal because the wound inflammation would not affect suture degradation Which of the following suture materials will have the most secure knots (i.e., best knot security) Stainless steel Which of the following is most true regarding the use of non-absorbable sutures in deep tissues or inside the body Should never be done One-step alcohol based antiseptic solutions like ChloraPrep are more effective than Betadine, Chlorhexidine, or alcohol alone True The classic use of scrubbing alternately with providone iodone and alcohol three times for a total of 5 minutes is not recommended in the most current edition (5th of Fossum) True chlorhexidine binds to keratin which prolongs its aseptic properties True Which of the following is the best protocol to clean clipper blades used on a patient with a suspected multi-drug resistant bacterial infection Wear examination gloves during the process of cleaning, disinfecting, and lubricating A 6 year old lab mix had a traumatic dog bite wound closed 4 days prior is presented for a recheck examination. What clinical sign(s) would be an indication that the wound is dehiscing all of the above swelling around the bite area skin discoloration at the end of the sutured area serosanguinous discharge from the wound Based on your knowledge of wound healing, what stage is this wound in? The wound is the same temperature as the surrounding tissue, raised, and the pink tissue in the center bleeds readily when bumped Proliferative Which of the following wound closures would result in the quickest healing, assuming no complications, for a simple cutaneous mass removal from the flank of a horse Primary You are observing surgery and notice the veterinarian opens the jaws of the Mayo-Hager needle holders to tug on the monofilament suture material placed in a cystotomy (bladder) incision in order to tighten the pattern to achieve a water-tight seal. What is the consequence of this action? the action weakened the suture material by compromising its integrity While scrubbing into surgery the surgery resident dons a paper absorbent headband. Why? to catch