Surgery Pre-Class Top Hat Questions

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

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

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 False

True

Which surgical procedure was used as the example in the video on Halsted's Principles for the importance of obliterating dead space? Umbilical hernia repair Sequestrum removal Wobbler surgery all the above

Wobbler surgery

Drains address which of of these Halsted's Principles? Eliminate dead space. Practice meticulous hemostasis. Ensure a good blood supply. Maintain asepsis.

Eliminate dead space

True or false: operating rooms are designed to be high traffic areas, therefore, it is not important how many people come and go from an OR during a procedure. True False

False

Wound contraction is accomplished by which of the following? collagen hydroxyproline myofibroblasts prostaglandins all of the above none of the above

myofibroblasts

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

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

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

False

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

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

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

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

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

It has been on the shelf for greater than six weeks

Please match the suture material to its most appropriate classification: -Nylon -Chromic Cat Gut -Silk -Polyglyconate -Natural Nonabsorbable -Synthetic Absorbable -Synthetic Nonabsorbable -Natural Absorbable

Nylon--> Synthetic Nonabsorbable Chromic Cat Gut--> Natural Absorbable Silk--> Natural Nonabsorbable Polyglyconate--> Synthetic Absorbable

Which of the following is/are considered important elements for inclusion in informed consent? Options for treatment and reasons why those are options. Guarantee of results. Exact financial quote. All of the above. None of the above.

Options for treatment and reasons why those are options.

Antibiotic therapy that is instituted prior to surgery due to a significant risk of infection or when infection would be catastrophic, despite no signs of infection at the time of administration, is best referred to as which of the following? Prophylactic anti-microbial therapy. Therapeutic anti-microbial therapy. Inappropriate use of anti-microbials. Necessary anti-microbial therapy.

Prophylactic anti-microbial therapy

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

Rat tooth forceps

What would be another of Halsted's Principles that could be addressed with drains? Achieve adequate hemostasis. Maintain asepsis. Remove necrotic material. Keep good medical records.

Remove necrotic material

Bandages contribute to a number of important functions post-operatively. Classically they are discussed in terms of three layers: primary, secondary, and tertiary. Which layer is usually responsible for absorption of fluids and exudates from the wound? Primary. Secondary. Tertiary.

Secondary

The Simon et al study showed that clients who had previous experience with surgery personally were more likely to agree with the statement that using pain medication will speed recovery from surgery and hospital discharge than clients who had not had surgery themselves. True False

True

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

True

What is granulation tissue? the dry crusty tissue that forms as a result of scarring a massive amount of unorganized epithelial tissue capillary buds and loops with a supporting structure all the above none of the above

capillary buds and loops with a supporting structure

absorbable suture material can be degraded by two basic mechanisms. Which of the following is/are correct? suture can be absorbed by the proliferative phase of wound healing 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 suture can be absorbed through a chemical reaction that is relatively unpredictable and dependent on species of animal and tissue type Option 1 & 2 Option 1 & 3 Option 2 & 3 Option 2 & 4 Option 1 & 4 Option 3 & 4

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

Why is meticulous hemostasis so important in surgery? Excessive blood loss could be life threatening for small patients Excessive bleeding can infiltrate your surgical field and impair visibility If you get lots blood on your gloves, you will need to change them before you start your closure Excessive bleeding can lead to hematoma and possible subsequent seroma formation post-operatively All of the above Option 2 & 3 Option 1, 2 & 4 Option 1 & 4

Excessive blood loss could be life threatening for small patients Excessive bleeding can infiltrate your surgical field and impair visibility Excessive bleeding can lead to hematoma and possible subsequent seroma formation post-operatively

Which of the following antiseptics is inactivated by organic material? Iodophors Triclosan Hexaclorphene Chlorhexidine gluconate

Iodophors

Assessing a patient for current medications, previous history of surgery or diseases, along with current health concerns, provides the key determinants for the patient's ASA status. True False

True

According to the Veterinary Surgery manuscript by Simon, et al. the analgesic protocol should be determined by which of the following? the cause of the pain severity of the pain how long the pain has been present client ability to perceive patient pain response all of the above none of the above

all of the above

Which of the following can impact the speed and quality of wound healing? The type of bandage, particularly what is in contact with the surface of the wound. Chemicals that are put on or in the wound Patient movement Significant patient systemic illness all of the above none of the above

all of the above

Which of the following is/are known causes of wound(s)? A surgical incision dog bite hot water bottle used to warm a patient squamous cell carcinoma (a type of skin cancer) all of the above none of the above

all of the above

According to the article by Stevens, et al. excessive stress in surgery is linked to which of the following? impaired judgement compromised decision-making decreased communication all the above

all the above

Which of the following cell types are integral to the inflammatory process? neutrophils monocytes macrophages all the above none of the above

all the above

When planning for a surgical approach, tension lines are important because incisions made along tension lines heal better incisions made across (perpendicular to) tension lines heal better it is virtually impossible to make an incision across tension lines incisions made along tension lines will have greater gaping than those made across tension lines

incisions made along tension lines heal better

Infection of a surgical incision is indicated by which of these signs? Heat Swelling Redness Pain all of the above none of the above

All of the above

The risk of a patient getting an infection is dependent on which factors? Resistance of the host. Virulence of the organism. Degree of contamination. All of the above.

All of the above

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

All of the above

Which of the following indicate potential pain in a veterinary patient? Not using the affected area (for example not walking on the limb that was recently operated). Not eating. Not interacting with caregivers (for example, a horse or dog hiding in back of stall/cage instead of in the front where it had been prior to surgery). Elevated heart rate or respiratory rate over its baseline prior to surgery. All of the above. None of the above.

All of the above

Which of the following is/are appropriate to achieve hemostasis? After transecting a "skin bleeder" (small vessel within the subcutaneous tissue) applying curved mosquito hemostats to occlude the vessel prior to placing a ligation around the vessel using a hand tie. Prior to transecting a vessel, using hemostats to bluntly dissect around the vessel to allow suture passage prior to ligation. Applying pressure on oozing capillaries with a gauze sponge. Use of electrocoagulation. Apply mosquito hemostats to a transected small vessel and twist it until the hemostat breaks/tears off the vessel. Apply a cellulose material like surgicel. All of the above Option 1 & 2 None of the above.

All of the above

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 appropriate to involve in your conversation? Risks that are unlikely, but potentially life threatening How much money managing complications from a procedure might cost. Options other than surgery that could be pursued. The client's personal views and how that relates to the surgery all of the above none of the above

All the above

Which of the following patient factors may contribute to an increased risk for surgical site infection? Obesity. Malnutrition. Chronic inflammation. Skin disease in the area of the incision. Hypovolemic shock (low blood volume). All the above. None of the above.

All the above

While setting up for surgery which will use electrocautery, a more experienced veterinary technician admonishes the technician intern working with her NOT to use alcohol after the scrub. Why? Because we have been taught to avoid using alcohol when scrubbing at WSU in principles of surgery. Because electricity cannot penetrate into vessels when there is wet skin. Because electrocautery can not work when alcohol gets on the equipment. Because alcohol is flammable and the addition of the electricity from the electrocautery unit could cause a fire. . . on the patient!

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

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

Because exposure increases microbial contamination

Why is it appropriate to place a foil-wrapped (commercial) scalpel blade in the instrument pack prior to sterilization via autoclave? It is never appropriate to place a scalpel blade in an instrument pack 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 Option 1 & 3 Option 2 & 3 none of the above

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

Please match the process with the appropriate chemical or technology: Hydrogen peroxide gas plasma Gluteraldehyde Chlorhexidine Detergent Cleaning Disinfection Sterilization Antisepsis

Cleaning --> Detergent Disinfection --> Gluteraldehyde Sterilization--> Hydrogen peroxide gas plasma Antisepsis --> Chlorhexidine

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: Sterilization Disinfection Antisepsis Cleaning

Disinfection

What are most appropriate considerations for adult mammals larger than 10kg after surgery? They should be monitored closely to avoid warming up too quickly. Hypoglycemia is a high risk and they should be fed immediately. 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. Easily stressed animals should be monitored with as little invasiveness as possible.

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? The senior most surgeon The resident or intern on the case The head surgery technician Everyone - surgery is a team effort

Everyone - surgery is a team effort

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

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

Why is it important that each patient undergoing a surgical procedure be assigned an ASA or Rating of Physical Status in Surgical Patients? It is required by law. So you can better choose an anesthetic protocol that would be the safest for that specific patient. Assigning and ASA status is something that only needs to be done at large referral practices. Allows the veterinarian to better predict the likelihood of complications and a successful recovery. Option 1 & 2 Option 2 & 4

So you can better choose an anesthetic protocol that would be the safest for that specific patient. Allows the veterinarian to better predict the likelihood of complications and a successful recovery.

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

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

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. A thorough history with the client and a physical examination on the patient, help clarify which of these factors? The degree of contamination. The virulence of the microbe. The resistance of the host. None of the above.

The resistance of the host.

What ASA/physical status category would be appropriate to assign to a non-responsive patient with signs of multiple organs failing as a result of an untreated pyometra? II III IV V

V

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? Performing surgery out of a purpose-built OR is malpractice and the participants should have extra liability coverage The organization should use tents to allow appropriate air exchange With adequate preparation and management of logistics, a gymnasium could work for some surgical procedures. As finances are a major challenge, aseptic protocols are not needed

With adequate preparation and management of logistics, a gymnasium could work for some surgical procedures.

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. An unwrapped #20 blade A foiled-wrapped #20 blade An unwrapped #15 blade A foil-wrapped #11 blade

A foiled-wrapped #20 blade

In preparing to perform an abdominal exploration on a dog, a new graduate veterinarian reviews the procedures she is expecting to perform in the small animal surgery text book by Fossum. She is preparing to perform a liver biopsy via the "guillotine" method. Which of the following materials and instruments should be available? Several types of tissue forceps to grasp the liver where you intend to biopsy Mayo scissors to cut the liver for biopsy Halstead Mosquito hemostatic forceps to assist in controlling hemorrhage A monofilament absorbable suture on a taper needle to create a suture loop to cut through the liver

A monofilament absorbable suture on a taper needle to create a suture loop to cut through the liver

While helping at a humane society over the holiday break, the veterinarian invites you to help with surgery. After successfully, carefully, and appropriately assisting with asepsis, the surgeon asks you to close the abdomen of the last spay of the day under close supervision. After scrubbing, gowning, and gloving, which of the following closures is safe and appropriate for the patient? A ford-interlocking pattern beginning and ending with a slip knot A simple continuous using 3 square knots to begin and end the suture line A simple interrupted pattern using 2 granny knots on each stitch A simple continuous using a surgeon throw and two additional throws to start and end the pattern

A simple continuous using 3 square knots to begin and end the suture line

According to the manuscript by Simon, et al. studies in the US, Finland, and Canada demonstrated that all clients understand the importance of pain management, therefore veterinarians do not need to include this in a pre-surgical planning conversation. True False

False

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

False

Informed consent is important for the client and the veterinarian. A highly technical document 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. True False

False

It is impossible to bandage this area, therefore the closure should include a passive drain. (Horse with laceration to shoulder) True False

False

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

False

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

False

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

False

You have been invited to scrub into orthopedic surgery. As you walk into the OR, you quickly remind yourself of appropriate behaviors to maintain surgical asepsis. Which of the following is a behavior that is NOT in line with best practices? Face sterile areas, even resting your hands on the instrument table or on the draped in patient Folding your arms with your hands in your axillary region to keep you from touching things Pass non-sterile obstacles with your back oriented toward them Alert the surgery resident that his sterile gloved hand touched non-sterile OR equipment while he was draping.

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

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 Managing dead space Ensuring good blood supply Minimize tension on the tissues

Gentle tissue handling

Which of the following non-patient factors can contribute to an increase in surgical complications? Inadequately prepared surgeon. Short anesthesia time. Quick surgery time. All the above. None of the above.

Inadequately prepared surgeon

A cat presents with a draining wound on the left side 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. What is the most appropriate classification of the surgical procedure to address the issue? Clean. Contaminated. Clean-Contaminated. Infected/Dirty

Infected/Dirty

Please order the phases of healing in the order they first appear during uncomplicated wound healing. Contraction Inflammation Remodeling Proliferation

Inflammation Proliferation Contraction Remodeling

Please match the following instruments to their descriptions: -Mayo stand -Metzenbaums -Backhaus -Olsen-Hegar -Halsted mosquito -Clamps used to secure surgical drapes to patients -Needle holders designed for quick release by squeezing handle closed -Tissue forceps that allow for clamping of large amounts of tissue with vessels in an ovarian pedicle for example -Clamps used on drapes that do not penetrate the material -Tissue scissors designed to cut dense or tough tissues -Needle holders with suture cutting capabilities -Platter-sized surgery table used to hold instruments -Tissue forceps designed to assist in hemorrhage control from small vessels -Tissue scissors intended for delicate tissue work -Container designed to hold the garbage bucket

Mayo stand--> Platter-sized surgery table used to hold instruments Metzenbaums--> Tissue scissors intended for delicate tissue work Backhaus--> Clamps used to secure surgical drapes to patient OIsen-Hegar--> Needle holders woth suture cutting capability Halsted Mosquito--> Tissue forceps designed to assist in hemorrhage control from small vessels

Which of the following scissors in LEAST appropriate to cut suture? (Using this instrument incorrectly is a major source of angst by surgeons.} Mayo Hager Mayo Lister Metzenbaum

Metzenbaum

Which of Halsted's principles is addressed through the appropriate use of mattress patterns? Providing adequate hemostasis Decreasing dead space Maintaining asepsis Minimizing tension on the tissues

Minimizing tension on the tissues

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

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

A 3-year Golden Retriever, referred without close evaluation or stabilization by a local veterinarian after being hit by a car, is seen at the emergency clinic. It has an obvious fracture of the right hind leg and is having trouble breathing. The dog has just arrived, what should be done first? Radiographs to assess the fractured limb and to look for other fractures. Bloodwork (complete blood count and chemistry). Physical exam. Radiograph of the chest to determine the cause of the labored breathing.

Physical exam

The absorbable suture material with the longest retention of tensile strength is Polymerized caprolactam Polyglycolic acid Polydioxanone Polypropelene

Polydioxanone

Regarding post-operative care, which of the following is true? All patients who have surgery should be allowed an extended rest (at least 2 weeks). Post-operative care often does not influence the patient's outcome. Clients involvement in the patient's post-operative care long-term should be minimal. Post-operative care requires careful planning and flexibility to shift the course based on the patient's response.

Post-operative care requires careful planning and flexibility to shift the course based on the patient's response.

Concerning pre-surgical hand antisepsis, which of the following is true? The hands of surgical staff have lower bacterial counts than the hands of people not associated with surgery 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. The World Health Organization recommends the use of alcohol based hand rubs, which veterinary medicine has whole-heartedly embraced Prolonged or repeated washing leads to damaged barrier function of the surface layer of the skin

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

In the informed consent video on the Principles of Surgery website, what procedure is being discussed as the example? Fracture repair. Limb amputation. Standard castration. Enucleation.

Standard castration

To sterilize the fiberoptic cable (grey) and arthroscopic camera (black), which is the most appropriate approach? Take all the pieces apart and pack them for sterilization in the autoclave Leave the unit together and pack it for sterilization in the autoclave Take the pieces apart and prepare them for gas sterilization Leave the unit together and prepare it for gas sterilization

Take the pieces apart and prepare them for gas sterilization

Which is the following describes the goal of removal of necrotic tissue? 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 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 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 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

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

A Labrador is on IV fluids after major abdominal surgery (3 socks and 2 rocks removed from GI tract). To take the dog out for a walk, the veterinary assistant disconnects the fluid line, reconnects the fluid line to a new capped needle, and carefully places an injection port (prn) on the catheter extension while wearing clean examination gloves. Why did the assistant wear gloves and cover the end of the fluid line and extension port? Because she is not well trained. To ensure the cleanliness (asepsis) of the catheter and fluid line. To avoid the patient chewing on the catheter. So the fluids do not empty out of the bag while walking the dog.

To ensure the cleanliness (asepsis) of the catheter and fluid line.