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Duke PA Surgery from the study guide for Test #1

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
__%, of hospitalized patients suffer from some degree of malnutrition   15-50  
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__ is a common finding with deficiencies in niacin, thiamine, Vitamin B6,Vitamin B12   peripheral neuropathy  
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Represents the critical cellular mass necessary for cellular structure/function   lean body mass  
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Represents 40% of total body weight   lean body mass  
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Depletion is severe insult and defines patient morbidity and mortality   leand body mass  
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60% skeletal muscle, 20% RBC’s and connective tissue, 20% cell mass   lean body cell mass  
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__% of the total body protein is contained in skeletal muscle, and this is major site of protein catabolism during starvation and/or illness   60  
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most widely used biochemical marker of muscle mass   24 hour urine creatinine  
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energy storage compound in skeletal muscle   creatine  
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N intake - N loss   nitrogen balance  
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if nitrogen balance is +2 to +4 net state is __   anabolism  
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if the nitrogen balance is negative net state is __   catabolism  
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normal nitrogen loss is __ g/day   5-8  
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1g N/__g protein   6.25  
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nitrogen intake is measured by   grams protein/24 hours  
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used to determine if protein intake is sufficient to maintain lean body mass   protein balance  
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Estimates severity of lean body mass catabolism and quantifies severity of metabolic stress.   catabolic index (CI)  
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catabolic index of <0 indicates   no significant stress  
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catabolic index of 0-5 indicates   moderate stress  
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catabolic index >5 indicates   severe distress  
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__ is the protrusion of extraperitoneal fat, peritoneum, omentum, bowel, or other viscera through a defect in the transversalis fascia   abdominal hernia  
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__ may convert an area of weakness into a hernia   intra-abdominal pressure  
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__ is especially useful for obese patients when the differential diagnosis includes simple weakness of the abdominal wall in addition to an incisional or epigastric hernia   Computed tomography (CT) scan  
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__ has not been shown more cost-effective or less morbid than open repair   laparascopic hernia repair  
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Cooper's pectineal ligament repair used for __   femoral hernias  
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recurrence rate for repair of primary hernias is <__%   5  
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from superior mesenteric ganglion   Sympathetic Nerve Supply to Colon  
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increases sphincter tone   Sympathetic Nerve Supply to Colon  
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inhibits motility and secretions   Sympathetic Nerve Supply to Colon  
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arises from the vagus   Parasympathetic Nerve Supply to Colon  
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increases intestinal motility   Parasympathetic Nerve Supply to Colon  
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relaxes sphincter tone   Parasympathetic Nerve Supply to Colon  
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most common bacterial flora   bacteroides fragilis  
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99% of colonic flora are __   anerobic bacteria  
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symptoms of acute diverticulitis   LLQ pain + fever  
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initial management of massive lower GI bleed   ABC/vitals, 2 large bore IV lines  
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sign of Crohn's disease   transmural (full thickness) inflammation  
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superficial inflammatory process involving mucosa of colon   ulcerative colitis  
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Screening recommendations for colorectal cancer: Annual digital rectal exam and fecal occult blood test starting at AGE __   50  
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Screening recommendations for colorectal cancer, flexible sigmoidoscopy every __years starting at AGE 50.   3-5  
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If family hx or inherited Colon Cancer Syndrome, annual screening with colonoscopy beginning at __ years of age younger than the earliest detected familial cancer.   10  
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adenomatous colon polyp   premalignant lesion  
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dysfunction of this muscle is associated with fecal incontinence   puborectalis  
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Regarding Hemorrhoids, Patients > 40 yrs of age should be evaluated by colonscopy to rule out __   proximal disease  
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most common reason for fever on first day of post-op   atelectasis  
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a collapse of lung tissue affecting part or all of one lung   atelectasis  
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first sign of hypovolemia in post-op   tachycardia  
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most effective method to prevent DVT   early ambulation of patient  
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never use epinephrine on   tissue with poor collateral circulation  
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never use epinephrine on   the tips of things such as fingers, ears, nose, toes  
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__ is used with Lidocaine will cause vessels to constrict and allow less lidocaine to spread to surrounding tissues   epinephrine  
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you need to be __ whenever you are closing wounds   sterile  
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sutures in the face should be removed after __ days   3-5  
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sutures in the body should be removed after __ days   7-10  
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sutures in the upper extremities should be removed after __ days   10-12  
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suturse in the lower extremities should be removed after __ days   12-16  
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keep sutures in longer with   steroids, immunosuppression, poor nutrition  
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why do we use square nots with sutures   it retains 80-90% of its tensile strength  
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why do we use silk sutures   it is easy to manipulate  
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most widely used non-absorbable suture   silk  
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tensile strenght is lost over time   silk sutures  
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when do you use a cutting needle   on skin  
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when do you use a taper point needle   subcutaneous suture  
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when do you use a taper point needle   fascia  
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when do you use a taper point needle   GI tract mucosa and serosa  
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when do you use a taper point needle   uterus and uterine tube  
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when do you use a taper point needle   vascular surgery  
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when can you use either a taper point needle or a cutting needle   ortho tendon suture  
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__ act as the first line of cellular defense   macrophages  
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dog bites   streptococcus viridans  
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cat bites   pasteurella  
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preoperative anibiotics are given __ before skin incision   1 hour  
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most common post-operative infection   UTI  
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4 W's of post-operative fever   Wind, water, wound, wonder drugs  
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diarrhea post op consider   Clostridium difficile  
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causes pseudomembranous colitis   Clostridium difficile  
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Treatment for Clostridium difficile   PO flagyl  
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advantage to dry dressing   air circulation to wound  
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most commonly used dry dressing   gauze  
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daily dressing replacements   may increase the risk of infection  
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post-op dressings placed under sterile conditions should stay on for __ days depending on the size of the wound   2-5  
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__ are used when repeated dressing changes are required   Montgomery Straps  
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steri-strips are applied __ to wound edges   perpendicular  
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to remove steri-strips pull __ the wound   toward  
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__ is good for small lacerations (scalp)   collodion spray  
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reversed spiral bandaging is used for   tubular structures changing in diameter (calf, forearm)  
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wet compresses should not be used >__hours   24  
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what may occur if wet compresses are used too long   maceration  
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most versitile splint material   plaster of paris  
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__ for sprains is quick and effective for initial immobilization of acute injuries   posterior splinting  
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__ are used to decrease fluids from large abscesses, they are attached to suction   sump drains  
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blood products should not be administered with any catheter smaller than a __ga   20  
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at Duke it is recommended that blood products be given through an IV no smaller than __ga   18  
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Duke Hospital routinely gives non blood product fluids through __ ga IV needles   20  
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patients need to practice as many __ as possible while at the hospital   ADL's  
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the __ vein should be used only in emergency situations since it decreased mobility, requires and armboard and has a greater risk for thrombosis   anticubital  
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the __ aspect of the wrist is not an acceptable site for starting an IV   volar  
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__ should be used for immobilization if an IV is near a joint   armboards  
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tourniquets should not be left on longer than __ minutes when starting an IV   3  
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most common complication associated with IV therapy is __   infiltration  
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swelling, leaking at site, coolness of tissue at site, and blanching are all signs of __ when administering fluids IV   infiltration  
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: Either 2 blades held apart by ratchet or by frames to which various blades may be attached, where one side acts as an anchor and pressure is exerted on the other side.   self-retaining retractors  
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ratchet style self retaining retractor, for superficial use   Weitlaner (thyroid)  
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abdominal retractor to which a bladder blade may be added   Balfour  
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most commonly used suction   Yankauer (chest, tonsil)  
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severed ends of bleeding vessels with minimal tissue damage   hemostats  
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short, fine curved clamp for superficial vessels   Crile (Mosquito)  
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short, straight tipped clamp slightly longer and heavier than a Crile also used for superficial vessels and may also be used to “tag” suture (hold suture in place prior to tying it and cutting it).   Halstead  
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Heavier curved clamp which varies in length and used as a general all-purpose clamp   Kelly  
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fine curved tip clamp medium in length, most commonly used clamp for hemostasis   Tonsil  
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clamp with a right angled tip and medium in length generally used to pass suture around an uncut vessel   Mixter  
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holds tissue for retraction. Vary in length and thickness and are available with and without teeth   Grasping clamps  
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multiple short teeth that do not damage tissue in its grasp. For use on delicate tissue   Allis  
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curved; fenestrated blades without teeth used to grip or enclose delicate structure such as intestines, ureters, and fallopian tubes.   Babcock  
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has a single heavy toothed tip for grasping tough tissue (i.e. fascia, bone, muscle   Kocher  
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ring shaped jaws used to hold sponges (generally prep sponges or stick sponges) and delicate tissue (i.e. lung).   sponge Stick  
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sharp, needle-like curved tips used to secure drapes or to hold tissue (i.e. bone).   towel clips  
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Non-toothed Forceps   Bayonet  
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A major concern with Hexachlorophene is __   Neurotoxicity  
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prolonged skin contact with __ increases risk of toxicity   chloroxylenol  
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__ casts are more rediolucent   fiberglass  
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casting saw doesn't cut skin when used properly b/c it __   rocks/vibrates rather than spin  
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when sending a biopsy specimen place lable on   bottle not lid  
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never send a biopsy specimen with a __   counted sponge  
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gowns are considered sterile in from from __ to table level   shoulder (2" below the neck)  
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sleeves are sterile from __ inches above the elbow to the cuff   2  
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sterile fields are sterile to within __ of the edge only   1 inch  
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Pt lies on back. The footboard is padded and raised. The entire table is tilted so head is higher than feet. The strap is below the knees   Reverse Trendelenburg  
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patient is lies on back, head is lower than feet, the knees are over the lower break in the table. The knee strap is above the knees, and shoulder braces are in place   Trendelenburg  
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When is it OK not to use sterile techniquewhen performing suture placement?   never  
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What size suture should you use for a Saphenous vein – femoral artery anastomosis?   6-0  
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Should a taper needle be used on the skin?   No-use a cutting needle  
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UUN + 4g =   nitrogen loss (from urine, GI, skin)  
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UUN - 0.5 + 3g =   Catabolic Index (CI)  
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example of a clean wound   appendectomy, breast biopsy  
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infection rate in a clean wound <__%   5  
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no violoation of GI, GU or respiratory tracts   clean wound  
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lowest incidence of infection   clean wound  
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elective colon resection   clean-contaminated wound  
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stab wound with colonic perforation   contaminated wound  
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perforated diverticulitis with abscess   dirty wound  
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Choice of perioperative antibiotics   depends on type of operation  
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defect in the transversalis fascia   hernia  
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atelectasis can cause fever within __ hours post-op   48  
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four types of colon polyps   submucosal, hyperplastic, hamartomatous, adenomatous (pre-malignant)  
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puborectalis is located on __   the pubic floor  
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high hematocrit can be from   polycythemia, smoking, anything that increases erythrocyte production  
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low hematocrit can be from   bleeding of any kind  
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low heatocrit <__   30  
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low platelets <__   150  
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most cardiac reinfarctions occur in the first __ days post-op   3  
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with patients on steroids __ may cause hypotension and tachycardia which is unresponsive to pressors   adrenal insufficiency  
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__ hernias go through Hesselbach's triangle   direct  
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rectus abdominis muscle (medially), inguinal ligament (inferiorly), inferior epigastric vessels (superior and laterally),   Hesselbach's triangle  
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__ hernias go through the internal ring within a patent processus vaginalis   indirect  
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inability to recduce hernia contents   incarceration  
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compromise of intestinal vascular supply secondary to incarceration   strangulation  
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"tension free" repair   Lictenstein (mesh) repair  
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standard of care with hernias   put mesh in that is not under tension  
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__% of lean body cell mass is skeletal muscle   60  
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__% of lean body cell mass is RBC's and connective tissue   20  
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most reactive suture   surgical gut (chromic)  
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high tensile strength, low tissue reactivity   nylon suture  
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favored for construction of interrupted percutaneous closure   nylon suture  
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least reactive suture   stainless steel  
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surgical needles are used to pass suture material through desired tissue with __   minimal trauma  
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peripheral IV's should be   changed routinely  
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Peripheral IV size used for trauma __ga   16-18  
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can you reuse a disposable needle   no, what do you think?  
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a hemorrhoid   what is Tyler Hansbrough?  
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if contamination with anaerobes is possible give __ perioperatively   second generation cephalosporins  
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if contamination with aerobes but not anaerobes is possible give __ perioperatively   first generation cephalosporins  
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have a high index of suspicion for __ when discoloration, necrosis, crepitus, drainage of thin, watery, grayish, foul-smelling fluid present   necrotizing fasciitis  
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if infection is seen in <48 hours worry about __ due to clostridium perfringens, or Strep. B   necrotizing fasciitis  
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Scissors   straight mayo, curved mayo, Metzenbaum, chest, wire  
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Hemostats   crile (mosquito), Halstead, Kelly, Tonsil, Mixter (right angle)  
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Grasping clamps   Allis, Babcock, Kocher, Sponge, Towel  
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Forceps (pickups)   Adson, 3/4's, Debakey, Ring, Bayonet  
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Hand-held retractors   vein, skin rake, Army Navy, Appendiceal, Richardson, Deaver, Malleable (Ribbon)  
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Self-Retaining retractors   Weitlaner, Balfour  
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Suction tips   Yankauer, Baby Chest, Frazier, Poole  
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Yankauer   suction  
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baby chest   suction  
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Frazier (abdominal)   suction  
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Poole (neuro)   suction  
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Weitlaner   self retaining retractor  
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Balfour   self retaining retractor  
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malleable (ribbon)   hand held retractor  
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Deaver   hand held retractor  
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Richardson   hand held retractor  
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appendiceal   hand held retractor  
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army navy   hand held retractor  
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skin rake   hand held retractor  
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vein   hand held retractor  
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bayonet   forceps  
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ring   forceps  
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Debakey   forceps  
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3/4's   forceps  
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Adson   forceps  
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towel clips   grasping clamp  
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sponge stick   grasping clamp  
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Kocher   grasping clamp  
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Babcock   grasping clamp  
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Allis   grasping clamp  
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Mixter   hemostat  
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Tonsil   hemostat  
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Kelly   hemostat  
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Halstead   hemostat  
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Crile   hemostat  
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