Principles of Surgery- All Tophat Questions

You are scrubbing into surgery and notice that the resident puts an paper absorbent headband. Why would that be important? *A* So the technician can remove his surgical cap and pour water on his head to cool him down when he gets hot. *B* So that the resident looks cool in surgery. *C* To catch sweat from running down his face and onto his gown, gloves, or into the surgical site. *D* To catch sweat from running down his neck and onto his scrubs.

C (To catch sweat from running down his face and onto his gown, gloves, or into the surgical site.)

The absorbable suture material with the longest retention of tensile strength is: *A* Polymerized caprolactam *B* Polyglycolic acid *C* Polydioxanone *D* Polypropelene

C (polydioxanone)

You are scrubbed into a surgery and assisting with a bladder stone removal. The bladder is appropriately isolated from the rest of the abdomen and the stone is removed without complication. The bladder is closed in a routine fashion (inverting pattern) and no other issues are observed during the surgery. How would you characterize this surgery?

Clean-Contaminated

*Process:* cleaning, disinfection, sterilization, antisepsis *Chemical:* detergent, gluteraldehyde, hydrogen peroxide gas plasma, chlorhexidine

Cleaning-detergent, Disinfection-gluteraldehyde, Sterilization- hydrogen peroxide gas plasma, Antisepsis- Chlorhexidine

Why is meticulous hemostasis so important in surgery? One or more. *A* Excessive blood loss could be life threatening for small patients *B* Excessive bleeding can infiltrate your surgical field and impair visibility *C* If you get lots blood on your gloves, you will need to change them before you start your closure *D* Excessive bleeding can lead to hematoma and possible subsequent seroma formation post-operatively

A, B, D

Why is it appropriate to place a foil-wrapped (commercial) scalpel blade in the instrument pack prior to sterilization via autoclave? May be more than one. *A* It is never appropriate to place a scalpel blade in an instrument pack *B* Because the inside of the foil pack is already sterile and the autoclave sterilizes the outside *C* Having the foil wrapper makes the blade less dangerous than being unwrapped within the pack

B and C

Why is it important that each patient undergoing a surgical procedure be assigned an ASA status? One or more *A* It is required by law. *B* So you can better choose an anesthetic protocol that would be the safest for that specific patient. *C* Assigning and ASA status is something that only needs to be done at large referral practices. *D* Allows the veterinarian to better predict the likelihood of complications and a successful recovery.

B and D

Which of the following is an optimal protocol for achieving aseptic preparation of a puppy's skin prior to an ovariohysterectomy? *A* Full-strength Gluteraldehyde rinsing with alcohol *B* 2% hypochlorite (bleach) rinsing with alcohol *C* 4% (full strength) Chlorhexidine scrub rinsing with sterile water *D* 7% (full strength) betadine scrub rinsing with tap water

C (4% full strength Chlorhexidine scrub rinsing with sterile water)

You have been invited to join a volunteer group of veterinarians and vet nurses traveling to a developing nation to perform routine health care, including surgery. Given the circumstances, how should you respond? *A* Remind the organization that performing surgery out of a purpose-built OR is malpractice, no matter the context. *B* Suggest that the organization have tents made that would allow the appropriate air exchange for surgery to be performed. *C* Ask more questions about the resources they have available and how they ensure quality care for the patient. *D* Immediately say yes. When are you ever going to get a chance like this?

C (Ask more questions about the resources they have available and how they ensure quality care for the patient.)

Why should scrubs intended to be worn in the operating room NOT be worn in day-to-day life? *A* Because they get worn out faster *B* Because scrubs don't look cute on anyone *C* Because exposure increases microbial contamination *D* Because once you get pet hair and lint on scrubs it does not come off

C (Because exposure increases microbial contamination)

You are suturing the liver after performing a biopsy. Which is the most appropriate for this task? *A* A braided absorbable suture material on a cutting needle. *B* A braided non-absorbable suture material on a taper needle. *C* A monofilament non-absorbable suture on a cutting needle. *D* A monofilament absorbable suture on a taper needle.

D (A monofilament absorbable suture on a taper needle)

Which of the following could be a complication of not closing in layers? *A* Excessive scar formation *B* Delayed healing *C* Decreased function of the tissues when healed *D* All of the above

D (All of the above)

The process we use to prepare inanimate surfaces like the surgery table and floor in the operating room for surgical procedures is best referred to as:

Disinfection

Drains help us address which of Halsted's Principles?

Eliminate dead space AND remove nectoric tissue

Getting dirt and bacteria in a wound, surgical or traumatic, means that it is infected. True or False

False

True or False: Dead space is only created by making large and/or very deep incisions

False

True or False: Having a standardized form that goes over all the details associated with treatment of a specific disease is an adequate way to provide the client with knowledge and understanding when there is not time for a proper client consent conversation.

False

True or False: Informed consent is best obtained by a receptionist or technician. It is rarely important for the veterinarian to be involved in these conversations.

False

True or False: Informed consent is important for the client and the veterinarian. A well-written and highly technical form covering every potential complication is the best way to ensure the client understands the risks and benefits of the surgery and that the veterinarian is protected from any liability.

False

True or False: Regarding vessel ligation, you should always use a surgeon's throw to ensure you securely ligate the vessel.

False

True or False: Tissues that heal slowly should be sutured with rapidly absorbing suture so that the suture material does not interfere with healing.

False

True or False: To decrease the chances of scarring, it is important to incorporate a drain in the surgical site (incision) closure.

False

True or false: Because it is impossible to bandage this area, it will be important to include a passive drain.

False

True or false: operating rooms are designed to be high traffic areas. It is therefore, a good idea to move around an OR and go in and out of the doors frequently.

False

Which of Halsted's principles is being violated when you make multiple swipes with your scalpel blade vs one smooth cut when making a skin incision?

Gentle tissue handling

True of false: Polyglactin 910 (Vicryl) ultimately becomes carbon dioxide and water as part of its degradation process.

True

True or False. When we assess the patient's health status, including any medications it might be on and previous history of surgery or diseases, along with how healthy it is currently, we are able to describe the patient's ASA status.

True

True or False: The combination of surgery classification, ASA status, and surgeon preparation can predict the likelihood of complications and successful recovery.

True

True or False: in situations where a drain must be used in an area where infection could be catastrophic, it is important to use an active drain rather than a passive drain.

True

True or false: Because chlorhexidine binds to keratin, contact time is less critical than the providone iodine.

True

True or false: One-step alcohol-based solutions like ChloraPrep are more effective than Betadine, Chlorhexidine, or alcohol alone.

True

True or false: Polyglactin 910 (Vicryl) undergoes degradation via hydrolysis.

True

True or false: The classic use of scrubbing alternately with providone iodine and alcohol three times for a total of five minutes is not recommended in the most current edition of Fossum.

True

Now that you have answered the kid's question she starts thinking about more stuff she wants to understand. She shows you her little brother's knee that is healing from an altercation with the pavement (ie, he scraped his knee). The little girl points out that there is an area around the wound that it whiter and sort of wrinkly. She asks you "why does it look like it has bumps and lines by the scab?" You respond *A* "Because as the wound heals there are tiny little muscle fibers that start to pull the edges together and it makes it look wrinkled." *B* "Because the wound is absorbing the material that makes it stronger so parts of it have more strength than others and that makes the skin look like of bunched up." *C* "Don't worry. It is not a big deal. It just looks wrinkled like that because it is really dry. If we put a little Vitamin E ointment on it we will make those ridges go away." *D* "Well, because there was dirt on the pavement and the wound got the dirt in it, it is wrinkling like that in response to the particles of dirt."

A ("Because as the wound heals there are tiny little muscle fibers that start to pull the edges together and it makes it look wrinkled.")

Which of the following suture types would have the best knot security? *A* 3-0 Polypropylene. *B* 3-0 Polygalactin 910. *C* number 2 Polypropylene. *D* number 2 Polygalactin 910.

A (3-0 Polypropylene)

Regarding inverting patterns, which error is considered "fatal or major"? *A* Grabbing the needle from the model with fingers. *B* Failing to use the needle optimally. *C* Suture material outside the sterile window. *D* Too many throws.

A (Grabbing the needle from the model with fingers.)

Which of the following is true regarding sterile glove use? *A* If a surgery glove is punctured you can either place a new glove over the punctured glove or replace the punctured glove with a new glove. *B* Gloves only protect the patient from bacterial on the surgeon's skin. *C* Glove punctures are extremely rare in surgery. *D* Punctured gloves are not a problem and can be ignored in surgery.

A (If a surgery glove is punctured you can either place a new glove over the punctured glove or replace the punctured glove with a new glove.)

A good rule of thumb for picking suture material is: *A* If it is internal, it should be absorbable. If it is external, it should be non-absorbable. *B* It it is internal, it should be non-absorbable. If it is external, it should be absorbable. *C* If it is internal, it should be natural. If it is external, it should be synthetic. *D* If it is internal, it should be synthetic. If it is external, it should be natural.

A (If it is internal, it should be absorbable. If it is external, it should be non-absorbable.)

Sometimes the classic research remains relevant, regardless of how much time has passed. In the 1966 article by Irwin regarding tension lines on the skin of the dog, what was meant by tension lines? *A* Incisions made along these lines gape minimally and heal better than incision made across them. *B* Incisions made across these lines gape minimally and heal better than incisions made with them. *C* There appears to be no consistency in tension lines in canids. *D* Tension lines occur independent of physical forces.

A (Incisions made along these lines gape minimally and heal better than incision made across them.)

Which of the following antiseptics is inactivated by organic material? *A* Iodophors *B* Triclosan *C* Hexaclorphene *D* Chlorhexidine gluconate

A (Iodophors)

Regarding the surgical environment, which of the following is true? *A* Minor surgeries on healthy patients may be performed "in the field" *B* Any surgery should only be performed in an purpose-built OR *C* Orthopedic or neurologic procedures where implants are being placed could be performed outside in the open air *D* Purpose built operating rooms limit airflow through the space

A (Minor surgeries on healthy patients may be performed "in the field")

You are assisting a surgeon who is fixing a simple femur fracture in a cat by implanting an IM pin. The surgeon accidentally drops the IM pin on the floor, which is the last pin of the correct size in the pack. What is the best option for how to proceed? *A* Place the instrument on a perforated metal tray and "flash" sterilize for 5 minute at 270°F. *B* Pick up the instrument and put it in chlorhexidine solution for 15 minutes before putting on a sterile glove to hand it to the surgeon. *C* There are no good options, the surgeon is going to have to use another pin size or choose a different method for fracture fixation. *D* Place the pin in a fresh peel pack and add 15 ml of Ethylene Oxide, let it sit for 20 minutes.

A (Place the instrument on a perforated metal tray and "flash" sterilize for 5 minute at 270°F.)

You have a mass to remove on the side of a horse. Which of the following wound closures would result in the quickest healing, assuming no complications? *A* Primary *B* Delayed primary *C* Second intention *D* They will take the same amount of time.

A (Primary)

When it comes to full and appropriate disclosure when providing veterinary medical care, it is useful to understand the context in which you are working. Which of the following are facts that DO NOT need to be discussed with a client. *A* Risks already known to the client. *B* How much money managing complications from a procedure might cost. *C* Anything that has not been fully evaluated by the scientific method. *D* All facts should always be disclosed to a client.

A (Risks already known to the client)

Which of the following will NOT achieve sterilization? *A* Scrubbing skin for 10 minutes with Chlorhexidine scrub followed by alcohol rinse *B* Ethylene oxide at 120F to 140F and humidity levels from 20-40% for approximately 5 hours *C* Soaking instruments in2 % Gluteraldehyde solution for 10 hours *D* Gravity displacement sterilizer set to 270F for 20 minutes

A (Scrubbing skin for 10 minutes with Chlorhexidine scrub followed by alcohol rinse)

Which of the following determines the strength of a healed wound? *A* amount and type of collagen *B* lines of tension *C* number of capillaries *D* number of myofibroblasts

A (amount and type of collagen)

You have been invited to scrub into an orthopedic surgery. As you walk into the OR, you quickly remind yourself of appropriate behaviors to maintain aseptic technique. Which of the following behaviors should you NOT do? One or more. *A* Stand in the corner so you are out of the way. *B* Face sterile areas and rest your hands on the instrument table. *C* Pass non-sterile areas with your back to them. *D* Keep your hands held high in the air to prevent contamination. *E* Tell the surgery resident that his hand touched a non-sterile piece of equipment while draping.

A and D

Match the procedure to the most appropriate wound classification: *A* Repairing a closed (no skin penetration) long bone fracture in a chicken *B* Exploring a wound in a horse with a chunk of wood imbedded in the muscle *C* Removing a bladder stone from an otherwise healthy goat *D* Removing a gastric foreign body from a labrador puppy with some spillage of gastric contents into the abdominal cavity

A- clean, B- dirty, C- clean contaminated, D- contaminated

You are helping at a humane society over the holiday break. You are asked to help aseptically prepare all the patients, which you do so successfully. Because you do such a great job with those aspects, the head veterinarian asks you to help close the last spay of the day. After scrubbing, gowning, and gloving, you close the abdominal wall. Which of the following closures would you choose? *A* A ford-interlocking pattern beginning and ending with a slip knot *B* A simple continuous using square knots to begin and end the suture line *C* A simple interrupted pattern using granny knots on each stitch *D* A simple continuous using three surgeon throws in a row to end the pattern

B (A simple continuous using square knots to begin and end the suture line)

Which of the following would be most effective to use in situations where organic material is present in the area to be prepared. *A* Iodophores. *B* Chlorhexdine. *C* Hexachlorphene. *D* Triclosan.

B (Chlorhexidine)

You have been invited to scrub into orthopedic surgery. As you walk into the OR, you quickly remind yourself of appropriate behaviors to maintain appropriate aseptic technique. Which of the following is a behavior you should NOT do? *A* Face sterile areas, even resting your hands on the instrument table or on the draped in patient *B* Folding your arms with your hands in your axillary region to keep you from touching things *C* Pass non-sterile obstacles with your back oriented toward them *D* Telling the surgery resident his hand touched non-sterile OR equipment while he was draping.

B (Folding your arms with your hands in your axillary region to keep you from touching things)

Which of the following is true regarding surgical attire? *A* It is NOT important that scrubs be clean before surgery, as they will be covered with a surgical gown. *B* If you are preforming surgery and have a beard, you should wear a special surgical cap that covers your facial hair *C* Masks prevent your respiratory germs from getting into the OR environment *D* If you need to sneeze in the OR, you should turn your face away from the sterile zone before you sneeze.

B (If you are preforming surgery and have a beard, you should wear a special surgical cap that covers your facial hair)

What does infection do to the phases of wound healing? *A* Infection will double each phase of wound healing. *B* Infection will lead to elongation of phases, but exact length is variable. *C* Infection will increase the inflammatory phase only. *D* If an infection is treated quickly it will have no effect on the phases of wound healing.

B (Infection will lead to elongation of phases, but exact length is variable.)

When you ligate a bleeding subcutaneous tissue vessel, which side of the mosquito hemostatic forceps should you pass the suture to allow best visualization prior to ligating? *A* On the concave surface. *B* On the convex surface. *C* Use a straight hemostat so you don't have to worry about which side.

B (On the convex surface)

Which of the following instruments would be LEAST ideal to use to grasp a piece of tissue in order to retract it out of the way if your goal is to avoid tissue trauma? *A* Allis Tissue forceps. *B* Rochester-Oschner forceps. *C* Babcock forceps. *D* Penetrating towel clamp.

B (Rochester-Oschner Forceps)

Which is the following describes the goal of removal of necrotic tissue? *A* The goal is ensure that ALL necrotic tissue has been removed regardless of how much healthy tissue is removed in the process because the wound will not heal if any necrotic tissue is left behind *B* The goal is to reduce the amount of necrotic tissue to a level that the body's normal defenses/healing mechanisms can take care of *C* The goal is to just "open up" the area of necrotic tissue so that the antibiotics can penetrate, you don't really have to remove that much tissue *D* In areas where vital structures are located, for example neurovascular bundles, it is best not attempt any debridement of the necrotic tissue due to the risk of damaging the nearby vital structures

B (The goal is to reduce the amount of necrotic tissue to a level that the body's normal defenses/healing mechanisms can take care of)

Which of the following is true regarding operating rooms (OR) in veterinary medicine: *A* All surgical procedures must be performed in a purpose-built OR *B* The optimal OR is designed to have positive air flow (ie, more pressure in the OR than outside) *C* It is critical to both disinfect and sterilize the OR on a regular basis *D* Any surgical procedure can be performed in the field or in an OR, depending on what is available at the time.

B (The optimal OR is designed to have positive air flow ie, more pressure in the OR than outside)

You are helping clean up after surgery. The patient had been confirmed to have a bacterial infection with a microbe that appears to be resistant to multiple common antibiotics. What should you do when cleaning these clipper blades? *A* Throw them out. *B* Wear examination gloves during the process of cleaning, disinfecting, and lubricating. *C* Culture them and wait for results to decide how to proceed. *D* Leave them for someone else more experienced to clean.

B (Wear examination gloves during the process of cleaning, disinfecting, and lubricating.)

You are suturing a cystotomy incision and notice that your suture line is not as tight as you would like it to be. You use the jaws of your Mayo-Hager needle holders to pull up on the suture loops as it is going through the tissues to tighten. What is the consequence of this action? *A* You cannot get the suture line tight enough so it still leaks. *B* You have weakened the suture material by compromising its integrity. *C* You have damaged the jaws of the needle holder. *D* There is no adverse consequence.

B (You have weakened the suture material by compromising its integrity.)

Which of the following would is appropriate and safe to place in an instrument pack prior to sterilization? You have a #4 Bard Parker handle in the pack. *A* An unwrapped #20 blade *B* A foiled-wrapped #20 blade *C* An unwrapped #15 blade *D* A foil-wrapped #11 blade

B (a foiled-wrapped #20 blade)

What characteristics of a suture material will cause the most tissue drag (ie resistance to suture sliding through tissue)? *A* A coated braided material. *B* A non-coated braided material. *C* A coated monofilament material. *D* A non-coated monofilament material.

B (a non-coated braided material)

Absorbable suture material can be degraded by two basic mechanisms. Which one of more of the following is correct. *A* suture can be absorbed by the proliferative phase of wound healing *B* suture can be absorbed by white blood cells during the inflammatory phase of wound healing *C* suture can be absorbed through a predictable and repeatable chemical reaction *D* suture can be absorbed through a chemical reaction that is relatively unpredictable and dependent on species of animal and tissue type

B and C

Which time frame is the most appropriate for the administration of antimicrobials (antibiotics) as a preventative measure when performing a clean-contaminated surgery? *A* Give the first dose 20 minutes prior to surgery and continue according to the recommended interval until 10 days after surgery. *B* Initiate therapy four hours prior to surgery and treat for an additional 48 hours. *C* Begin 30 minutes prior to surgery and continue for 24 hours after surgery. *D* Start the first dose 4 hours after the surgery is complete and give for an additional five days.

C (Begin 30 minutes prior to surgery and continue for 24 hours after surgery)

Which of the following is NOT a reason to consider a previously sterilized pack to be contaminated? *A* The sterilization indicator tape is ripped and has been replaced with masking tape *B* The paper on the back of the pouch of the peel pack is torn *C* It has been on the shelf for greater than six weeks *D* The pack was dropped in a puddle of water on the OR floor

C (It has been on the shelf for greater than six weeks)

This horse had a small mass removed from the cranio-lateral aspect of the right stifle (see image). The removal went well, this is an image immediately post-op. What is the most likely purpose of the single suture located proximal to the incision? *A* It is a tacking suture to help reduce dead space. *B* It doesn't have a purpose, the student on the case was practicing suture placement. *C* It is holding the drain in place in the wound. *D* It is a ligature around a blood vessel.

C (It is holding the drain in place in the sound)

Regarding the surgical environment, which of the following is true? *A* Any surgery should be performed in a purpose-built operating room. *B* High-end purpose-built operating rooms have negative air pressure in the room to prevent outside air from entering the room. *C* Minor surgeries can be performed in the field without a significant risk of infection with appropriate preparation. *D* Orthopedic procedures where implants are being placed can be done outside if the area is covered.

C (Minor surgeries can be performed in the field without a significant risk of infection with appropriate preparation.)

The definition of an absorbable suture material is *A* One that disappears completely within 30 days *B* One that disappears completely within 90 days *C* One that undergoes degradation and rapid loss of tensile strength within 60 days *D* One that undergoes degradation and rapid loss of tensile strength within 90 days

C (One that undergoes degradation and rapid loss of tensile strength within 60 days)

You are working as an ER veterinarian for a large referral hospital. You have a 3 year Golden Retriever that was referred by a local veterinarian after being hit by a car. The referring vet told you over the phone the patient has a clearly broken right hind leg and was having trouble breathing. Because of the condition of the dog the DVM referred it right away without providing any treatment. The dog has just arrived, what should be done first? *A* Radiographs to assess the fractured limb and to look for other fractures. *B* Bloodwork (complete blood count and chemistry). *C* Physical exam. *D* Radiograph of the chest to determine the cause of the labored breathing.

C (Physical exam)

You are working with a veterinarian on a farm call. The client has two grade-school aged kids with an insatiable curiosity. When they find out you are in veterinary school, they start to ask you all kinds of questions. From the look on the veterinarian and client's faces, it is clear that you need to take these questions seriously and answer them to the best of your ability. "I just cut myself with paper from my art project. How come I don't bleed right away after I cut myself?" How to you respond? *A* Look away and hope the kid will lose interest *B* Answer by saying "it takes a while for the blood to get out of the vessels and into the areas you cut" *C* 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" *D* Think carefully for a minute and then answer "the cells that help your body bleed don't get activated until they are exposed to air for a couple of

C (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")

Which forceps will induce the most trauma to delicate tissue, despite being used correctly? *A* DeBakey tissue forceps *B* Brown-Adson tissue forceps *C* Rat tooth forceps *D* Adson tissue forceps

C (Rat tooth forceps)

You are debriding a wound on the dorsal aspect of a right front distal limb of a horse (see image). You have sharply removed the majority of the necrotic granulation tissue covering the wound. You are concerned that further debridement might cause trauma to nearby important structures (like the pastern joint and fetlock joint). How should you proceed? *A* Continue with debridement very carefully, as it is crucial to remove all necrotic tissue to get the wound to heal. *B* Stop debriding, the wound is already open so no further debridement will be needed for the wound to heal. *C* Stop debridement for now and continue to debride over the next several days with bandaging techniques and/or continued sharp dissection. *D* None of the above, this wound is full of healthy granulation tissue and did not need to be debrided.

C (Stop debridement for now and continue to debride over the next several days with bandaging techniques and/or continued sharp dissection.)

You have been asked to help prepare surgical equipment for sterilization. The OR nurse hands you this piece of equipment. You know the grey cable and black camera are fiberoptic. How should you proceed with those pieces? answerable question reference *A* Take all the pieces apart and pack them for sterilization in the autoclave *B* Leave the unit together and pack it for sterilization in the autoclave *C* Take the pieces apart and prepare them for gas sterilization *D* Leave the unit together and prepare it for gas sterilization

C (Take the pieces apart and prepare them for gas sterilization)

The risk of a patient getting an infection is dependent on the degree of contamination, the virulence of the microbe, and the resistance of the host. When we conduct a thorough history with the client and a physical examination on the patient, which of those factors are we learning most about? *A* The degree of contamination. *B* The virulence of the microbe. *C* The resistance of the host. *D* None of the above.

C (The resistance of the host)

You are working in a practice with new technician who only recently graduated from school. You have been asked to help her set up for the next surgery. The veterinarian had mentioned to you that they surgery would require electrocautery. When the technician starts to scrub you tell her not to use alcohol with the scrub on this patient. Why is that a good decision? *A* Because we have been taught to avoid using alcohol when scrubbing at WSU in principles of surgery. *B* Because electricity cannot penetrate into vessels when there is wet skin. *C* Because electrocautery can not work when alcohol gets on the equipment. *D* Because alcohol is flammable and the addition of the electricity from the electrocautery unit could cause a fire. . . on your patient!

D (Because alcohol is flammable and the addition of the electricity from the electrocautery unit could cause a fire. . . on your patient!)

Of the following list, which is the best protocol for a pre-surgical scrub for a fracture repair that you anticipate will take several hours? *A* Chlorhexidine scrub wiped off with alcohol. *B* Betadine wiped off with sterile water. *C* Chlorhexidine scrub, followed by betadine scrub wiped off with sterile water. *D* Chlorhexidine wiped off with sterile water.

D (Chlorhexidine wiped off with sterile water)

You have just completed a surgery on an adult mammal. Immediately after surgery, what are some important considerations regarding your patient? *A* Its temperature should be monitored closely. We want to make sure these patients do not warm up too quickly. *B* It should be fed as soon as possible. Hypoglycemia is a huge risk in our patients. *C* They should be monitored for 24 hours prior to deciding whether to give pain medications. It is important that veterinary patients have some pain to stay quiet. *D* Easily stressed animals should be monitored with as little invasiveness as possible.

D (Easily stressed animals should be monitored with as little invasiveness as possible.)

Whose job is it to monitor asepsis during surgery and notify others of a break in aseptic technique? *A* The senior most surgeon *B* The resident or intern on the case *C* The head surgery technician *D* Everyone - surgery is a team effort

D (Everyone- surgery is a team effort)

Which of the following suture materials is most appropriate to use in the face of an infected surgical site. The suture will be used to close a deep layer of tissue. *A* Stainless steel *B* Chromic cat gut *C* Plain cat gut *D* Poliglecaprone 25 (Monocryl)

D (Monocryl)

It is important that we keep our knowledge current, as best practices in veterinary surgery are continually evolving. In the recent study by Biermann, et al. in Veterinary Surgery (December 2017), what were some of the important findings? *A* Glove puncture occurred in less than half the surgeries they evaluated. *B* The risk of glove puncture did not change regardless of time in surgery. *C* Students were at a greater risk of puncture than the primary surgeon. *D* One quarter of glove perforations were detected intraoperatively by the wearer.

D (One quarter of glove perforations were detected intraoperatively by the wearer.)

Regarding post-operative care, which of the following is true? *A* All patients who have surgery should be allowed an extended rest (at least 2 weeks). *B* Post-operative care often does not influence the patient's outcome. *C* As veterinarians, we need to be careful not to let clients be very involved in the patient's post-operative care long-term. *D* Post-operative care requires careful planning and flexibility to shift the course based on the patiet's response.

D (Post-operative care requires careful planning and flexibility to shift the course based on the patiet's response.)

Concerning pre-surgical hand antisepsis, which of the following is true? *A* The hands of surgical staff have lower bacterial counts than the hands of people not associated with surgery *B* Longer is better when it comes to surgical scrub. Five minutes is the minimum amount of time you should scrub your hands before surgery, but 10 minutes is even better. *C* The World Health Organization recommends the use of alcohol based hand rubs, which veterinary medicine has whole-heartedly embraced *D* Prolonged or repeated washing leads to damaged barrier function of the surface layer of the skin

D (Prolonged or repeated washing leads to damaged barrier function of the surface layer of the skin)

Concerning pre-surgical hand antisepsis, which of the following is true? *A* Surgeon hands have low bacterial counts because their hands are routinely cleaned for surgery. *B* 5 minutes is the reported time for adequate scrubbing, if your hands are really dirty you should scrub them longer just to be safe. *C* The World Health Organization recommends the use of alcohol based hand rubs, which veterinary medicine has whole-heartedly embraced. *D* Prolonged or repeated washing leads to damaged barrier function of the surface layer of the skin.

D (Prolonged or repeated washing leads to damaged barrier function of the surface layer of the skin.)

You have a six-year old Lab mix who is back for a recheck on a wound you closed 4 days previous. The dog had been bitten by another dog at the dog park and sustained a 6cm laceration to the ventral neck region, which you cleaned and repaired within one hour of the injury. You are concerned about wound dehiscence. What clinical sign(s) would be an indication that the wound is dehiscing? *A* swelling around the bite area *B* skin discoloration at the end of the sutured area *C* serosanguinous discharge from the wound *D* all of the above

D (all of the above)

Which of the following is an appropriate method to achieve hemostasis? *A* After transecting a "skin bleeder" (small vessel within the subcutaneous tissue) using your mosquito hemostats to occlude the vessel and use your handties to apply a ligation around the vessel. *B* Prior to transecting a vessel, using your hemostats to bluntly dissect around the vessel to allow suture passage and then tie your ligation. *C* Put pressure on the oozing capillaries with a gauze sponge. *D* Use electrocoagulation. *E* Apply mosquito hemostats to a transected small vessel and twist it until the hemostat breaks/tears off the vessel. *F* Apply a cellulose material like surgicel. *G* A and B only. *H* All of the above. *I* None of the above.

H (All of the above)

Wound classification helps us determine the likelihood of infection or other surgical complications, both local and systemic. You are presented with a cat who has a draining tract ventral to its left ear. The areas is hot to the touch, swollen, and painful and the cat has a fever of 104F. How do you classify your surgical plan to address this issue?

Infected

You are presented with a cat who has a draining wound on the left aspect of the neck. The areas is hot to the touch, swollen, and painful. The owner reports the swelling has been there for at least a couple days. How do you classify this wound?

Infected

Order phases of healing for the first time they appear during uncomplicated wound healing

Inflammation, proliferation, contraction, remodeling

Which of Halsted's principles is addressed through the appropriate use of mattress patterns?

Minimize tension on the tissue

Question 13 and granulation tissue in POS quiz 2

Pictures

When we talk about bandages, we classically think about them in terms of three layers: primary, secondary, and tertiary. Which layer is usually responsible for absorption?

Secondary