MOD 2

Drilling through the femoral shaft correctly is evidenced by what kind of feedback?

A distinct tactile feeling that the drill bit is contacting hard lateral cortex, soft medullary canal, hard medial cortex, and finally the soft tissue of the medial thigh

What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp?

subgaleal space

There are approximately 1 million reported cases of skin cancer per year with the majority being the highly curable basal or squamous cell cancers. Not as common is the most serious skin cancer, malignant melanoma. Select the individual who is at the highest risk for skin cancer.

A fair-complexioned person testing positive for exposure to human papillomavirus

Age-related changes cause decreased blood flow to the kidneys with a resultant decrease in nephron function. Which condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase?

. Adverse drug reaction

Match the steps to a Nissen fundoplication.A, Heavy mattress sutures (0 braided nonabsorbable) are placed in the crura of the diaphragm to narrow the aperture of the hiatus but not so tight as to constrict the esophagus, thus the purpose of stenting the esophagus with the Maloney dilator.B, After the esophagus is mobilized, a Maloney or Bougie esophageal dilator (40F to 48F) is passed orally into the stomach.C, Penrose drain around the esophagus retracts the esophagus laterally to expose the esophageal hiatus.D, The fundus of the stomach is pulled through the posterior esophageal window and wrapped around the distal esophagus.E, The 360-degree wrap is secured with nonabsorbable sutures to complete the procedure.

. B, C, A, D, E

Minimally invasive surgeries continue to increase in popularity. It seems logical that older patients would benefit from smaller incisions that produce less postoperative pain, atelectasis, and ileus. However, regardless of age, every surgical procedure possesses a certain amount of risk. Which minimally invasive surgical component can present hemodynamic and pulmonary consequences in patients with severe cardiac or pulmonary disease?

. CO 2 pneumoperitoneum

Brain tumors are either malignant or benign, depending on the cell type. Both primary and metastatic tumors of the brain and its membranes are included in the term intracranial tumors. Which two tumor types are the most frequently seen central nervous system (CNS) tumors in adults?

. Glioblastoma, metastatic tumors

Personal comfort or security items should be permitted to accompany children to the OR who are in which developmental age?

. Infancy through adolescence

All body jewelry that pierces the skin should be removed before the skin prep. Select the statement that reflects a true special consideration for skin preparation before facial surgery.

. Leave the eyebrows and eyelashes intact to preserve facial appearance and expression.

Select the statement about the prostate that best reflects its location.

. The prostate is interposed between the bladder neck and the urethra.

The principle of ALARA, as low as reasonably achievable, is a protective measure designed to protect both patients and staff. What are the three principles of ALARA?

. Time, distance, and shielding

The Whipple procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the ____________ as a surgical treatment for____________.

. lower half of the common bile duct; pancreatic cancer

Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone, which leads to a reduced absorption of calcium and phosphorus. This malabsorptive condition is due to a deficiency of ______________ that can be treated by __________________.

. vitamin D; dietary supplements and exposure to sunlight

Microsurgery, a fundamental tool in reconstructive plastic surgery, allows an almost unlimited choice of reconstructive methods, replacement of lost tissue with similar components, and optimal selection of donor sites with minimal morbidity. Reconstructive microsurgical procedures include replantation of amputated body parts, repair of facial nerves, repair of lacerated nerves and blood vessels, treatment of extensive trauma to extremities and hands, reconstruction following removal of extensive cancers, and female to male transsexual reassignment. Today's surgeons skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than:

1 mm

The Glasgow Coma Scale (GCS) is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening, verbal communication, and motor response to verbal and noxious stimuli. Within the scoring range for the GCS, the best possible score is _____, and the worst possible score is ______.

15;3

Anesthesiologists recommend that patients stop taking any herbal supplements before surgery to prevent adverse herb-drug interactions. How long before surgery should the patient stop taking herbal supplements?

2 weeks

Which action best reflects the movement of urine from the renal pelvis to the bladder?

Slight distention of the renal pelvis initiates a wave of peristaltic contractions.

Select the true statement about antimetabolite drugs and their indications for use.

5-fluorouracil and mitomycin can both be administered topically to dissolve scars and pterygia.

Prostate cancer is the most frequently diagnosed cancer in men and is the second leading cause of cancer death in men. Select the triad that best reflects the individual with the highest risk for prostate cancer.

65+ years old, African descent, father had prostate cancer

The occurrence of perioperative mortality in geriatric surgical patients is influenced by several evidence-based factors . Select the patient most at risk for perioperative mortality.

A 70-year-old woman, scheduled for an emergency bowel resection with an American Society of Anesthesiologists (ASA) class IV

A cataract is defined as any opacification of the lens. Cataracts may be congenital, post-traumatic, or induced by medications but are most commonly the result of age-related changes. Which of the following statements about cataracts best describes its presentation or etiology (cause)?

A cataract can be compared to a window that is foggy or yellowed

Select the statement that correctly describes the mechanism of action of contrast media.

A contrast agent works by having either a higher or lower density than the body tissue being investigated.

Among the treatment options for tricuspid valve disease are suture annuloplasty, ring annuloplasty, and valve replacement with either a biologic or a mechanical prosthesis. Like the mitral valve, the tricuspid annulus is saddle-shaped, and techniques to repair the valve should consider this anatomic configuration for optimal repair. Patients with significant tricuspid stenosis, regurgitation, or failed tricuspid (suture or ring) annuloplasty may require insertion of a prosthetic biologic or mechanical valve. Because there are no specific tricuspid prosthetic valves available, what type of prosthetic graft would be created or implanted?

A mitral prosthesis

Complete heart block and bradydysrhythmias are the most common indications for pacemaker implantation. A permanent pacemaker (pulse generator and electrodes) initiates atrial or ventricular contraction, or both. What therapy might be used for acute forms of heart block and dysrhythmias that occasionally occur during and after cardiac surgery?

A temporary pacemaker

Each potential kidney transplant recipient is judged individually as a candidate. Which condition would most likely eliminate a patient as a candidate for kidney transplant?

Active cancer

Select the appropriate triad of corrective actions for the management of TURP syndrome in the intraoperative patient.

Administer hypertonic IV saline, administer IV diuretics, terminate surgery if reaction is severe

The liver, pancreas, and spleen share many similarities. Select the statement about these organs that is true.

All three are solid organs and very vascular.

Bone grafting using allografts or autografts may be used to fill cavities after removal of large amounts of bone that might result in instability, or to fill bony defects and to promote the union of fractures at the time of open reduction. Banked bone is available in many shapes of cortical and cancellous tissue. The American Association of Tissue Banks (AATB) accredits and periodically inspects bone-banking programs to ensure that specific standards are followed in the retrieval, processing, storage, and distribution of bone grafts. Bone graft that is sealed in a sterile labeled envelope from a tissue transplant company and stored in a vacuum-sealed freezer, monitored with an alarm, would be considered a(n):

Allograft

A kidney transplant entails transplantation of a living-related or cadaveric donor kidney into the recipient's iliac fossa. It is performed in an effort to restore renal function and maintain life in a patient who has end-stage renal disease. Select the statement that best reflects the ideal living-related donor candidate.

An identical twin, sibling, or parent; ABO and human leukocyte antigen (HLA) compatibility; good health

Children are more prone to foreign-body ingestion than adults. What is the most significant risk?

Aspiration with airway obstruction

Blunt force to the larynx can result in a fracture and impose immediate airway obstruction. These patients are at risk for a lost airway and may require immediate tracheotomy followed by repair of the fracture when the fracture is unstable or displaced. It is also important to consider that a trauma patient is assumed to have a full stomach; thus these patients are at high risk for aspiration and resultant pneumonia. What is an appropriate action in the event of a lost airway after anesthesia induction and before intubation?

Assist the anesthesia provider with securing the airway while applying cricoid pressure

A broad range of implant materials are used in plastic and reconstructive surgery. Select the implant that represents a biologic composition of a surgical implant.

Autologous human tissue

Polymethyl methacrylate (PMMA, or bone cement) is an acrylic, cement-like substance composed of a liquid methyl methacrylate monomer and a powder methyl methacrylate-styrene copolymer. What element is added to the powder component by the manufacturer to make the finished product radiopaque?

Barium

Select the diagnosis/procedure option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the esophagus.

Barrett's dysplasia of the distal esophagus/endoscopic mucosal resection (EMR)

Of the open hernia procedures listed below, which classic hernia procedure is considered, by some surgeons, to not be anatomically correct because the superior transversalis fascia is sutured to the inguinal ligament instead of to the inferior portion of the transversalis fascia or the Cooper ligament?

Bassini repair

Mediculous hemostasis is extremely important in neurosurgery. Numerous interventions and types of materials are used to limit blood loss. Which of the following describes a best practice toward the goal of achieving hemostasis during neurosurgery?

Because gelatin sponge is absorbable, it can be left in the body.

Select the true statement that best differentiates biofields from electromagnetic fields.

Biofields originate from within the body, while electromagnetic fields are from outside of the body.

The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss. Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained.

Blood pressure within acceptable range

Achieving hemostasis in delicate areas can be a challenge for the neurosurgeon. In addition to using meticulous technique to prevent bleeding, topical agents are routinely used as an adjunct to hemostasis. Some hemostatic products form a composite clot that seals a bleeding site by using a thrombin component that converts fibrinogen in the patient's blood to fibrin. Select the two hemostatic products that provide hemostasis by topical application, essentially acting as a patch rather than a clotting factor.

Bone wax and oxidized cellulose (Surgicel)

Laparoscopic inguinal hernia repair is another method of tension-free mesh repair, with several repair options. The most popular techniques include a totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach. Which of the two techniques provides access to the preperitoneal space without entering the peritoneum?

Both the TEP technique and the TAPP technique if the hernias are recurrent

A 55-year-old woman with uterine cancer is undergoing an open panhysterectomy. She is positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. The surgical team gently abducted the patient's arms into position on padded armboards at less than 90 degrees with palms facing up. Extra padding was placed under her elbows, and an armboard strap was secured over her forearm. The armboards were locked into place to prevent inadvertent abduction. This important maneuver is designed as a risk reduction strategy to prevent:

Brachial plexus injury

A 28-year-old firefighter sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. Which of the following best describes the surgical treatments he will most likely need before he is discharged from the burn center to home?

Debridement, allograft placement during initial healing, and later split-thickness (ST) and full-thickness (FT) skin grafting

The extent of injury after blunt trauma may be difficult to determine. What noninvasive diagnostic test is critical to diagnosis in potential traumatic brain injury?

CT scan of the head

The Caldwell-Luc procedure is a radical antrostomy used to establish a large opening into the wall of the inferior meatus leading to the sinuses. Where is this large incisional approach made?

Canine fossa of the upper jaw

A 12-year-old girl with a history of weight loss and stomach upset and pain after eating is also small for her age. Her pediatrician suspects celiac disease. The patient has arrived at the pediatric endoscopy unit for a procedure that is less invasive and will also have the benefit of spending the next few hours in the mall across from the hospital with her mom until the procedure is over. What is her scheduled procedure?

Capsule endoscopy

The salivary glands produce saliva, which serves to moisten the mouth and initiate:

Carb digestion

Select the structure of the trachea that is a landmark during bronchoscopy.

Carina

Endoscopic examination of the urinary tract, with a sterile cystoscope, is typically designated as which wound classification category?

Class II

A patient consulted a noted colorectal surgeon after experiencing episodes of rectal bleeding over the last 2 weeks. The patient had a screening colonoscopy 5 years ago with several adenomatous polyps and mild diverticular disease. She presents to the endoscopy suite after a successful bowel prep and NPO since midnight. The GI endoscopist is confident that he will find tumor growth in the rectum and decides to employ further diagnostic applications to determine potential for metastasis. Which of the following endoscopic procedures best describes the patient's procedure?

Colonoscopy with endoscopic ultrasound (EUS)

A 57-year-old patient's assessment and examination has revealed a family history of endometrial cancer. She has never been pregnant and has been taking hormone replacement therapy for 4 years. Her physician has scheduled her for a surgical procedure to obtain visual and pathologic information and provide treatment as indicated. The patient was sure that she would have to have a dilatation and curettage (D&C). Her surgery, on the operative schedule, would most probably be written as:

D&C with endometrial and cervical biopsies.

Thoracic aortic aneurysmectomy is excision of an aneurysmal portion of the ascending aorta, aortic arch, or descending thoracic aorta and replacement with a prosthetic graft, valve-graft conduit, or intra-aortic prosthesis. Aneurysms may be caused by atherosclerosis, trauma, infection, or cystic medial degeneration. Which presenting conditions will indicate that surgical intervention is necessary?

Compromised circulation or danger of rupture

During a laminectomy what is the preferred form of hemostasis?

Cottonoid strips or patties

Select the true statement about dacryocystorhinostomy (DCR).

DCR establishes a new passageway for tear drainage into the nasal cavity.

Two patients are scheduled to have a gastrojejunostomy for obstruction. How will perioperative planning differ for a patient weighing 280 lb as compared to that for a 120 lb patient?

Deaver retractors will replace Richardson retractors with the heavier patient.

The mesh-plug open hernia repair technique is indicated for which type(s) of hernias?

Direct and indirect inguinal hernias

While direct and indirect hernias both protrude into the inguinal canal and represent tears in the transversalis fascia, which one of the two occurs within the Hesselbach triangle?

Direct inguinal hernia

Open reduction and internal fixation is a method of providing exposure of the fracture site and using pins, wire, screws, a plate and screw combination, rods, or nails to correct the fracture. Surgeons use open reduction and internal fixation when they are unable to reduce a fracture by closed methods, and skeletal traction is not indicated. What would be an advantage for an open rather than a closed fracture reduction technique?

Direct observation and verification of fracture alignment

The head of the pancreas is fixed to the:

Doudenum

A child's comprehension of, and responses to, the environment are based on his or her developmental age. Many theorists have provided excellent guidelines for assessing the pediatric patient's developmental level in order to use appropriate interventions. The infant develops the belief that the world can be counted on to meet basic needs through the trust versus mistrust concept based on the stages of psychosocial and emotional needs. This theoretical framework of stages was described by ______________, while the stages based on changes in cognition and ability to think were described by _____________.

Dr. Erik Erikson; Dr. Jean Piaget

Select the diagnostic test that represents an invasive cardiac study.

Electrophysiology studies

Select the appropriate procedure performed for a patient with Fuchs' dystrophy, edema after cataract surgery, or keratoconus (abnormal steepening) of the cornea.

Endothelial keratoplasty

The National Center for Complementary and Alternative Medicine (NCCAM) has categorized the many integrative health practice modalities into five major domains. Biofield therapies are therapies that focus on fields believed to originate within the body. To which domain category does biofield therapy belong?

Energy therapies

Review the list below and select the answer that reflects the correct match between the procedure and the disease.

Esophagogastroduodenoscopy (EGD) for gastric ulcer disease

A patient whose neck has been slashed and has a severed lower trachea may also have injury to the

Esophagus

Which of the following organs is supported by a layer of adventitia rather than serosa?

Esophagus

Exposure of intra-abdominal anatomy is crucial to safe surgery and employs varied instruments, applications of highly technical energy sources, patient manipulations, light, and imaging. Review the list below and select the technique that is initiated to promote exposure.

Establishing pneumoperitoneum

Review the list below, and select the option that describes an action that occurs during vitrectomy.

Excision of fibrotic membranes

From the list below, select the statement that is true about fallopian tube cancer.

Fallopian tube cancer is very rare, with an incidence of less than 1%.

The temporary substitution of a pump oxygenator for the heart and lungs allows the surgeon to stop the heart and perform cardiac procedures under direct vision in a relatively dry, motionless field. It also allows the surgeon to manipulate the heart without the risk of producing ventricular fibrillation and reduced cardiac output that jeopardizes perfusion to the myocardial, peripheral, and cerebral tissues. In traditional cardiopulmonary bypass (CPB), systemic venous return to the heart flows by gravity drainage through cannulae placed in the superior and inferior venae cavae or through a single two-stage cannula in the RA into tubing connected to the bypass machine. Blood is oxygenated, filtered, warmed or cooled, and pumped back into the systemic circulation through a cannula placed in the:

Femoral artery

Anesthesia providers are concerned about the potential increased risk of instability intraoperatively resulting from inhibition of coagulation. Which herbal supplement, from the list below, would be implicated in a coagulation interaction?

Feverfew

Bone healing follows a logical sequence beginning with the formation of a hematoma. Select the action that typically occurs after formation of a hematoma.

Fibrin network formation

In TURP, the surgeon passes a resectoscope into the bladder through the urethra and resects successive pieces of tissue from around the bladder neck and the lobes of the prostate gland, leaving the capsule intact. TURP is traditionally indicated for patients with benign obstructive disease of the prostate. A TURP would be indicated for a patient with malignant prostatic disease under which of the following conditions?

For symptom relief of obstruction before initiating other treatments

The extraocular muscles work in yoked pairs, with ocular movements generated by an increase in the tone of one set of muscles and a decrease in the tone of the antagonistic muscles. Of the two muscle types, how many are represented in each eye?

Four recti muscles and two oblique muscles

Identify the correct path of the cardiac conduction system.

From the area where the SVC meets the right atrium to the AV junction close to the tricuspid valve to the right side of the interventricular system into a network of fibers by way of the right and left bundle branches, and from the SA node to the AV node to the bundle of His to the Purkinje system

The recipient liver OR is arranged for a major laparotomy and vascular procedure with customized instruments, supplies, and sutures according to the transplant surgeon's preference. In addition to the general patient care accessories, equipment, and supplies needed for any large surgery, also included are intraoperative laboratory testing and an autotransfusion system. Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant.

From the neck to midthigh; bedline to bedline

With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing ICP. What is an appropriate diuretic medication to give, and what actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF)?

Furosemide (Lasix); monitor for hypotension and note extent of diuresis

Trigeminal neuralgia is an extremely painful and debilitating condition characterized by unilateral intense pain in the ear, eye, lips, nose, scalp, forehead, teeth, or jaw. A variety of treatments, including microvascular surgical decompression, are available. Select a minimally invasive targeted therapy that has demonstrated significant success in ablation of the entry of the trigeminal nerve.

Gamma Knife radiosurgery

The liver is essential in the metabolism of carbohydrates, proteins, and fats, generating nutrient stores of which substance that supplies energy sources to the brain and body?

Glycogen

Most IR procedures are initiated with the Seldinger technique. The first step of the technique is placement of the needle in the vessel. Select the step below that is performed after the needle is placed in the lumen of the vessel.

Guidewire is inserted.

An aneurysm of the LV can develop after a severe myocardial infarction. The affected area of the myocardium is replaced by thin scar tissue that can rupture. The LV undergoes remodeling when the scar stretches as a result of the left ventricular pressure and forms an aneurysm. Left ventricular aneurysmectomy (LVA) is the excision of an aneurysmal portion of the LV. LVA is a form of left ventricular reconstruction undertaken to optimize cardiac function. Select the appropriateaction in preparation for LVA surgery.

Have synthetic patch material and Teflon felt pledgets available

Pure NOTES procedures are transluminal procedures performed using flexible endoscopes and instruments passed through the scopes' working channels. Many surgeons use a hybrid NOTES technique. What is the difference between the pure NOTES and hybrid technique?

Hybrid NOTES is laparoscopic assisted.

TURP syndrome is a state of severe hyponatremia, caused by systemic absorption of irrigating fluid during the procedure. Select the sign/symptom that the anesthesia provider would report in a patient experiencing TURP syndrome.

Hypertension

Bupivacaine and ropivacaine are look-alike/sound-alike drugs. Adverse drug reactions (ADRs) can occur if a clinician confuses these two drugs. Both drugs promote nerve conduction blockage analgesia when given locally, but bupivacaine is cardiotoxic. When selecting a local anesthetic to fill an elastomeric pain pump, what is one contraindication that should be considered?

If the patient is hypersensitive to amide local anesthetics

Select the most common hernia that occurs in both men and women.

Indirect inguinal hernia

Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias.

Inguinal canal, femoral rings, umbilicus

Select the triad of the boundaries of the Hesselbach triangle.

Inguinal ligament, rectus abdominis muscle, deep epigastric vessels

A 42-year-old woman has been diagnosed with severe gastroesophageal reflux disease (GERD) without the dysplastic changes of Barrett's esophagus. Her GERD is unresponsive to proton pump inhibitors and histamine blockers. She also has a history of endometriosis with multiple surgeries for ablation of endometrial implants on her small bowel and adhesiolysis. Her surgeon is hesitant to pursue an open or a laparoscopic Nissen fundoplication surgical approach. Which procedure might her surgeon consider in lieu of a Nissen?

Intraluminal plication of the lower esophageal segment

Which statement about the McBurney incision is most correct?

It is an oblique inguinal incision in the right lower quadrant.

What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy?

It provides a 360-degree range of motion, extending surgeon skill.

What is the purpose of using an intravenous (IV) injection of a radiopaque contrast dye during select imaging diagnostic studies?

It provides visual enhancement of anatomic structures.

Triangular orientation is a term used to describe the method used to provide instrument access to the anatomy during abdominal surgery. It is uniquely associated with which surgical incision?

Laparoscopic port incisions

The most frequently occurring tumors of the spine are metastatic, and the spine is the most common site for skeletal metastasis. From which organs or disease processes do most secondary spinal tumors originate?

Lung, breast, lymphoma, and myeloma

Facial fractures are classified according to a system developed by Rene Le Fort in the early 1900s. A fracture that starts at the nasal bones; crosses the frontal process of the maxilla and lacrimal bones; and extends through the orbital floor, infraorbital rim, and lateral maxillary sinus wall is known as a:

Le Fort II

Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers. Select the statement about Mohs' surgery that best reflects the process, procedure, and outcome goal.

Lesions are mapped, excised, and examined by frozen section until clear margins are found

Select the true statement about specific medications that can affect surgery or cause complications in cardiac surgery.

Lipid-lowering drugs (statins) may promote new onset diabetes mellitus.

Progressive relaxation techniques, biofeedback, meditation, and cognitive-behavioral approaches have a well-documented theoretical basis with supporting scientific evidence. What is the theoretical clinical justification for this relationship categorized as mind-body medicine?

Many mind-body theories have been supported by high-level research.

What is the rationale for using indigo carmine, gentian violet, or brilliant green instead of methylene blue as a skin marker?

Methylene blue produces an inflammatory reaction in CNS tissue.

Lasers assist in vaporization of scar tissue, granulomas, and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures. Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a:

Micromanipulator

The brainstem is located in the posterior fossa and forms the floor of the fourth ventricle. It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord. The brainstem consists of which three structures?

Midbrain, pons, and medulla oblongata

What incision is used for lumbar laminectomy?

Midline directly over the appropriate lumbar spines

A 50-year-old woman with degenerative rheumatoid arthritis is having a two-joint metacarpophalangeal implant of her left hand. The pneumatic tourniquet is applied to the patient's upper left arm and has been inflated to 280 mm Hg for 38 minutes. The surgery is advancing as planned, and the surgeon is preparing to insert the second implant. The circulator has set the time threshold for 60 minutes. During her preoperative assessment, the surgeon noted no contraindications to pneumatic tourniquet use. While the surgery is going well, and the second implant will be inserted and the wound closed before the tourniquet alarms, which risk reduction strategy should be employed?

Monitor duration and remind team before 1 hour is reached

The nasal septum is lined with blood vessels and mucus-secreting cells. The proper name of this lining is the:

Mucoperichondrium

One of the most popular lasers used in plastic and reconstructive surgery is attracted to the water in the skin cells and ablates the cells at a predetermined depth. Collagen material beneath the skin surface is also heated, resulting in smoother and slightly tighter skin. Several lasers are attracted to areas of darker pigmentation. This treatment has virtually replaced dermabrasion, because of its consistency in terms of depth of penetration and also because this technique is less dependent on user technique or skill. Select the laser modality that would be the best option for ablation or removal of a pigmented red tattoo.

Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser

Infants and children with severe gastroesophageal (GE) reflux can have life-threatening complications, including obstructive apnea, aspiration pneumonia, esophagitis, and failure to thrive. What is the name of the procedure, performed open or laparoscopically, that is designed to create a competent antireflux barrier?

Nissen fundoplication

An 84-year-old retired musician was seen by his family practice physician for urinary problems. His physician performed a DRE, which was abnormal, ordered a PSA, and referred him to a urologist. The patient's PSA was 12 ng/mL. His transrectal prostatic biopsy was positive. The biopsy specimen determined a Gleason score of 10, and his AUA score was D2. Based on this clinical diagnostic information, what is the best treatment plan for the patient?

No surgery, because he is probably not a candidate for surgery

Physiologic changes in the elderly may affect the absorption, distribution, metabolism, and excretion of medications. Which statement about medication metabolism is true?

Older adults have slower excretion times attributable to a reduced glomerular filtration rate.

The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs?

Opioids and hypnotics

A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. A prosthesis is placed to restore ossicular continuity and alleviate conductive hearing loss. The patient scheduled for a stapedotomy will probably have a surgical diagnosis of:

Otosclerosis

A power drill and assorted rotating burrs are essential for middle ear surgery and some sinus procedures. A selection of burrs including assorted sizes of round cutting burrs and diamond polishing burrs should be available. During drill and power saw use, the scrub person keeps irrigation solution on the sterile field to:

Prevent clogging

What classification of drugs are gynecologic/obstetric-related medications that require monitoring of blood pressure, assessment for continued bleeding, and monitoring of fundal response to the drug?

Oxytocics

Of the three salivary glands, which one is the largest?

Parotid

When coverage for a defect cannot be achieved through skin grafting, plastic surgeons rely on other techniques to replace tissue. After mastectomy, reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap is one of several options for nonsynthetic prosthetic reconstruction. Another descriptive term for the TRAM flap is the:

Pedicle based flap

Identify the layer of connective tissue that covers all bone.

Periosteum

Ova travel through the fallopian tubes toward the uterus by which type of action?

Peristalisis

What is the anatomical component of the lining of the herniated abdominal weakness and the hernia sac?

Peritoneum

When compared with open and laparoscopic techniques, the potential benefits of NOTES include no visible scars, possibly less pain, and potentially shorter hospital stays. Select a complication that is the most typical risk associated with NOTES.

Peritonitis

A burn patient is transferred to the operating room (OR) from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What is the most important preparation before the patient arrives in the OR?

Prewarm the OR to above the normal ambient temperature and humidity

If an injury to a patient is a result of a violent crime, the team must give special attention to preservation of evidence during the course of patient care. When clothing is removed from the patient, why must it be placed and secured in a paper bag rather than a plastic bag?

Plastic bags may trap moisture and allow mold growth, destroying evidence.

The PSA test is a serum lab test for prostate-specific antigen. If the test value is elevated, the patient is at risk for carcinoma of the prostate; a PSA value greater than 10 ng/mL is highly suggestive of prostatic carcinoma. Tissue from a transrectal prostate biopsy provides the cellular information to confirm the diagnosis. The American Urological Association (AUA) prostate cancer staging tool essentially provides which important information about the tissue specimen?

Prostate cancer stages of severity

Baby Boy Doe is a newborn found outside of the emergency department (ED). He is hypothermic and has several deep lacerations across his back, abdomen, and legs that will require surgical repair. He is transferred to the surgical bay of the ED and prepared for anesthesia induction. Which risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

Provide a radiant heat lamp during placement of monitoring lines and induction.

Colles' (wrist) fracture is a dorsally angulated fracture of the distal end of the radius. Most of these fractures can be managed successfully with closed reduction and immobilization, but external fixation is especially useful in the case of a comminuted intra-articular fracture. Internal fixation with Kirschner wires (K wires) is indicated when the distal end of the radius is severely comminuted and displaced. Select the surgical considerations for a patient with a Colles' fracture fixation.

Provide soft tissue instruments in the OR and external fixation frame

Select the noninvasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function.

Radionuclide imaging

Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament?

The McVay and the Cooper ligament repair

Review the list below and select the correct definition for exenteration.

Removal of the entire orbital contents, including the periosteum

During a robotic-assisted laparoscopic prostatectomy, the patient, positioned in steep Trendelenburg, exhibited signs of deteriorating oxygenation and loss of secured airway requiring immediate intervention. What is the next priority in order to respond to the emergency?

Remove the instruments from the patient

A variety of implantable devices are used in aesthetic and reconstructive plastic surgery procedures. Tracking of these devices is critical to patient safety. Institutions must report any incident of death or serious injury relating to the use of a medical device. What regulatory agency, commission, or act mandates this process when medical devices fail or cause injury?

Safe medical device act

Identify the marginal boundaries of the breasts.

Second to sixth rib horizontally, lateral edge of sternum to anterior axillary line

A 72-year-old patient with multicentric CIS of the vulva, without evidence of leukoplakia and pruritus is scheduled for surgery. She has a history of prior papillomavirus infection. Select the most appropriate surgical option.

Simple vulvectomy

A 38-year-old female has been admitted through the emergency department (ED) for severe abdominal pain, distended abdomen, and fever. The surgery service has been consulted and has scheduled her for exploratory surgery. The patient has undergone two open abdominal surgeries in the past for "female problems" and states that she has a tendency to form keloids. Review the list below and select the most likely preoperative diagnosis for the patient based on her surgical history and symptoms.

Small bowel obstruction with torsion

An adult man was the victim of a low-velocity, low-caliber gunshot wound to the anterior left quadrant of the lower abdomen. The gun was shot at far range. What is the trajectory of the gunshot?

Small entrance wound with no exit wound; energy is dissipated to the tissues

During an emergent total open splenectomy on a patient with blunt force trauma to the abdomen, the circulator and anesthesia provider noticed rust-colored urine in the urinary collection container. They had just hung the third unit of whole blood. What action is the first priority?

Stop the blood transfusion.

The catheter component of an infusion port system is inserted into which structure(s)?

Subclavian or jugular vein

Which breast surgery procedure is also called the nipple-sparing technique (NSM)?

Subcutaneous Mastectomy

The rotator cuff consists of which group of muscles?

Supraspinatus, infraspinatus, teres minor, and subscapularis

Oral malignancies can be linked to specific carcinogens, the most important one being tobacco. Benign or malignant lesions of the tongue, floor of the mouth, alveolar ridge, buccal mucosa, or tonsillar area are excised depending on the extensiveness of disease, involvement of surrounding vessels and nerves, and candidacy for surgery. Benign or small malignant tumors of the oral cavity may be excised without a neck dissection. Which indicator would prompt the surgeon to perform a neck dissection for benign or small malignant tumors?

Suspicious metastatic disease

Review the list below and select the statement that accurately describes toxic anterior segment syndrome (TASS).

TASS is characterized by the introduction of nontoxic materials into the anterior chamber during surgery.

Thrombus formation often depends on the size of a catheter's outer diameter, with respect to the vessel's inner diameter and indwelling time. Select the best practice to prevent thrombus formation.

Use heparinized normal saline in pressure bags and a flush line

How does the lacrimal gland differ from the lacrimal sac?

The lacrimal gland secretes tears that are drained by the lacrimal sac and duct system.

The Surgical Assistant or Scrub prepares a separate treatment set-up for the surgeon to use before the DCR operative procedure is started. Select the statement that describes the justification for this separate treatment set-up.

The nasal cavity is anesthetized with cocaine, and a local anesthetic is administered

A 29-year-old woman is in the emergency department (ED) with a ruptured appendix. Before the operating room team was informed that the patient is 27 weeks' pregnant. What special considerations must the operating room team address with this new information?

The patient may need rapid induction of general anesthesia or spinal anesthesia.

Patients having genitourinary surgery are at risk for impaired urinary elimination. Select the statement that best reflects a desired outcome for an adult patient.

The patient will regain his or her normal pattern of urinary elimination.

At each vertebral level is a pair of spinal nerves, each consisting of an anterior and a posterior root. Select the statement that represents true information about motor or sensory distribution.

The posterior root is the sensory root.

Select the true statement about application and operation of the pneumatic tourniquet.

The tourniquet cuff should not overlap less than 3 inches or more than 6 inches.

The internal mammary arteries (IMAs) are frequently used as grafts during coronary bypass surgery. Where are they located?

They diverge from the subclavian arteries behind the sternum.

Twelve pairs of cranial nerves arise within the cranial cavity. Although they are part of the peripheral nervous system, from a surgical standpoint they are considered part of the anatomy of the head. Which three pairs of nerves, conveniently considered together because of their motor influence on the eye, are subject to toxic, inflammatory, vascular, and neoplastic lesions?

Third, fourth, and sixth cranial nerves

The blood is oxygenated in the lungs and returns to the LA through the pulmonary veins. Where does the blood flow after leaving the LA?

Through the AV (mitral) valve into the left ventricle (LV)

In the pulmonary circulatory system, blood is pumped from the right ventricle (RV) through the pulmonary valve into the main pulmonary artery (PA). The PA divides into the right and left pulmonary arteries, which further subdivide into the arterioles and capillaries of the lungs. Where does the blood from the lungs flow next?

Through the pulmonary veins to the LA

Benign or small malignant tumors of the oral cavity may be excised without a neck dissection, though in the presence of diagnosed or highly suspicious metastatic disease, a selective neck dissection may be performed in an effort to control a cancerous growth in the upper jugular lymphatic chain of the neck. Typically, endotracheal anesthesia is used, and a pharyngeal pack of moist gauze may be inserted in the mouth. When head and neck surgery is performed, the Surgical Assistant must be prepared for possible additional procedures. Of these possibilities, what is the highest-priority consideration for the Surgical Assistant?

Tracheostomy

Acoustic neuromas arise from the Schwann cells of the vestibular portion of the eighth cranial nerve and are benign tumors. What is the postauricular incisional approach that offers the best chance of saving the integrity of the facial nerve?

Translabyrinthine

Contrast media-induced nephrotoxicity (CIN) can occur as a result of a physiologic change. After the administration of contrast media, a transient increase in blood flow is then followed by a longer period of decreased blood flow to the kidneys. Which statement best describes a true risk factor for CIN?

Underlying renal insufficiency is believed to be a predictor of CIN.

A wide variety of drains, stents, and other catheters are designed and used for specific urologic procedures. A commonly used catheter is described by its tip. What catheter type is described as open-ended tip, whistle tip, cone tip, and olive tip?

Ureteral Cath

A 69-year-old pipe smoker with a history of cardiac disease and atrial rhythm disturbance is scheduled for a supratentorial craniotomy and is securely positioned in a semi-sitting position. Intermittent pneumatic compression devices have been placed on both legs. Pulmonary lines have been placed and the area is prepared for preparation of transesophageal electrocardiography (TEE), if needed. During the procedure, the patient reacted with a decrease in arterial pressure and end-tidal CO 2. Precordial "washing machine" sounds emanated from the Doppler. What could be the cause of his deteriorating physiologic status?

Venous air embolism (VAE).

Distance is key to providing protection during fluoroscopy, because radiation exposure follows the inverse square law. (For example, the exposure at 2 meters from the source will be only one-fourth as much as the exposure at 1 meter's distance.) When positioning the patient relative to the fluoroscopy image intensifier/C-arm, the patient should be placed as far away from the _______________ and as close to the __________as possible for optimal image quality and minimum radiation dose to the patient's body.

X-ray tube; image intensifier

A 46-year-old woman had a scar revision of her knee. The knee scar, before revision, was an 8-cm linear, thin scar that extended obliquely across the anterior portion of her knee. The tension of the scar tissue met resistance when she would bend her knee. The surgeon opted to remove the scar with a procedure to break up the linear scar and rearrange the tissue direction to form a natural line. The proper name of this tissue transfer scar revision is the:

Z plasty

A 29-year-old man with paraplegia caused by a spinal cord injury from a diving accident 4 years ago is scheduled for an open cholecystectomy. The patient tells the team that he is latex-sensitive, because he was told that as a spinal cord injured person he should always be considered latex-allergic. An appropriate risk reduction strategy for the patient's latex sensitivity/allergy would be to:

alert the OR and postoperative recovery areas of his latex allergy, check the setup for latex-containing items, and replace those items with nonlatex alternatives.

A circumcision on a 17-year-old patient under general anesthesia was about to be performed. The Surgical Assistant noticed an empty vial of lidocaine 1% with epinephrine 1:100,000 by the computer. The medication cup on the sterile field was labeled "lidocaine 1%." The scrub person had drawn up 10 mL in a syringe to hand to the surgeon for a penile block. The Surgical Assistant's immediate response should be to:

alert the team that lidocaine with epinephrine was accidentally placed on the back table.

Replantation is an attempt to reattach a completely amputated digit or other body part. Revascularization is the procedure performed on incomplete amputations, when the part remains attached to the body by skin, artery, vein, or nerve. Good candidates for replantation are those with which of the following amputations?

almost any body part of a child

The IR procedure that is used to correct a blocked or narrowed blood vessel and restore flow is called:

angioplasty

The three most common skin cancers are basal cell, squamous cell, and melanoma.Treated early, skin cancers such as squamous cell and basal cell carcinomas may be cured by simple excision and closure (with pathologic diagnosis to ensure disease-free margins).Melanoma is treated much more aggressively because of its high mortality. The A-B-C-Ds of the warning signs for skin cancer stand for:

asymmetry, border, color, diameter.

Anesthetic management impacts the success of ophthalmic surgery. Safe ambulatory surgery, especially in certain populations, depends on patient selection, preoperative evaluation, preparation, monitoring, and local anesthesia techniques. Select the patients below that would be appropriate candidates for general anesthesia, instead of local anesthesia alone. (Select all that apply.)

b. A 35-year-old patient who is uncomfortable being in enclosed spaces c. A 22-year-old healthy female for a tear duct probing d. A 48-year-old healthy male with mild head tremors

Cardiac surgery patients are at risk for decreased cardiac output related to emotional (fear), sensory (pain), or physiologic (electrical, mechanical, or structural) factors. Which outcome indicators will provide evidence that the patient's cardiac output will be consistent or improved? (Select all that apply.)

b. Skin is warm and dry. c. Cardiac output is improved from preoperative levels.

Which of the diagnostic modalities listed below does not employ the use of ionizing radiation?

both audiogram and MRI

During cesarean delivery, which is the priority instrument or device needed as soon as the fetal head is delivered?

bulb syringe or aspirator tip

Identify the type of fracture that has more than two fragments.

comminuted

The external ear, which includes the auricle (or pinna) and external auditory canal, is composed of cartilage covered with skin. The primary function of the auricle is to:

concentrate and conduct incoming sound waves into the external auditory canal.

Ryan has an indirect hernia that is characterized by a small neck, thin walls, and close attachment to the cord structures. Marc has a hernia with a short, wide neck, and a thick-walled sac. Based on this description, Ryan has a(n) ____________ hernia and Marc has a(n) __________ hernia.

congenital; acquired

A 55-year-old woman with uterine cancer is scheduled for an open panhysterectomy. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. The patient is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes:

decreased pulmonary compliance and functional residual capacity.

Why would bupivacaine with epinephrine not be given for a skin contracture release of the ear on a 5-year-old boy?

epinephrine is contraindicated in areas with limited vascularity, such as the ears.

A 32-year-old woman, recently an unemployed and uninsured college professor, is diagnosed with an early ectopic pregnancy. Her obstetrician has given her the option of surgical or medical therapy. The patient is well-informed about the details of each medical and surgical option, but her primary concern about her condition is that her decision will be based upon her strong cultural belief system that will not sanction the destruction of the fetus. The patient's treatment decision will most likely be:

emergency laparotomy for a ruptured ectopic pregnancy.

The adrenal glands lie retroperitoneally beneath the diaphragm, capping the medial aspects of the superior pole of each kidney. The adrenal medulla secretes ______________, while the adrenal cortex secretes ____________ and ____________.

epinephrine; steroids and hormones

A long bone fracture in a child can have devastating consequences in terms of the child's skeletal maturity and potential for limb shortening and malformation when the fracture line involves the:

epiphyseal plate.

The nasal cavity is associated with the ear by way of the ____________, and communicates with the conjunctiva through the __________________. Select the options that are appropriate to complete the sentence.

eustachian tube; nasolacrimal duct

A 51-year-old male with hepatobiliary disease is scheduled for surgery. The patient should be assessed for signs and symptoms of jaundice, petechiae, and lethargy and:

eviews his chart for bleeding and coagulation times and the platelet count.

The anterolateral abdominal wall consists of an arrangement of muscles, fascial layers, and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin. The key landmark of the _____________ designates the roof of the inguinal canal, and the key landmark of the __________ designates the floor of the inguinal canal.

external oblique aponeurosis; transversalis aponeurosis and fascia

Where does the majority of chemical digestion in the stomach occur?

fundus and body

An example of a potential risk associated with pneumoperitoneum would be:

gas embolus into an exposed blood vessel during the procedure.

Microsurgical techniques have been applied to cranial, spinal, and peripheral nerve operations. Each time the surgeon must look away and then back to the surgical field, open wound time and anesthesia time are increased while the surgeon becomes reoriented to the field. A Surgical Assistant, directed toward assisting the surgeon in efficiency and expediting the microsurgical procedure would be to:

hand instruments proficiently, in direction of use, without delay.

Myringotomy is often accompanied by the aspiration of fluid under pressure in the tympanum, and the subsequent placement of small, hollow pressure equalization tubes. It is indicated for acute otitis media (AOM) in the presence of an exudate that has not responded to antibiotic therapy. If left untreated, what is the main concern for a child with chronic otitis media?

hearing loss

The functional units of the liver are the lobules. The functional cells of the liver are the ______________, and they manufacture _______________.

hepatocytes; bile

An example of a common postoperative complication related to inguinal hernia surgery is:

hernia recurrence

The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the:

hilum

An important area of the brain that is critical for learning and memory is the ___________, while emotion and social behavior are regulated by the ____________.

hippocampus; amygdala

While the pancreas' function is carbohydrate metabolism with the production of insulin and digestive enzymes, the spleen's function is primarily ___________ with the production of _______________.

immunologic; leukocytes

Hernia-entrapped viscera, typically loops of small intestine, will result in intestinal obstruction with resulting pain, vomiting, and distention. What is the appropriate descriptive diagnosis of this condition?

incarcerated hernia

What condition can be a postoperative complication of compression plating?

localized osteoporosis

A 6-year-old girl's clothes caught fire during a camping trip when she fell into the campfire. She is admitted with full-thickness burns involving both lower legs, circumferentially, excluding her feet, over less than 2% of her body surface area (BSA) and partial-thickness burns over less than 15% of her BSA. Based on the American Burn Association and the "Rule of Nines" classifications, the patient's burns would be classified as ______________ with a burn surface area percentage of approximately ______________.

minor; 9%

When catheterizing the female patient the urethra must be located. The correct order of the external organs of the vulva listed anterior to posterior is:

mons pubis, labia majora, labia minora, clitoris, vestibular glands, vaginal opening.

A nasal polypectomy is the removal of polyps from the nasal cavity. Nasal polyps are benign, grapelike clusters of mucous membrane and connective tissue. When the polyps become large, they obstruct the free passage of air, make breathing difficult, and cause a change in speech quality. Nasal polypectomies are typically performed endoscopically with the use of microdebriders, which remove the polyps by their mechanism of _______________.

morcellation

Which of these organs is not considered an accessory digestive structure?

mouth

The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time?

one fifth

A 9-year-old boy is admitted to the emergency department (ED) after a sledding accident in which he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The computed tomography (CT) scan suggests rupture of the spleen with internal bleeding. The scheduled surgery will most probably be a(n):

open total splenectomy

While assisting in a surgery to repair the middle portion of a torn semitendinosus muscle, the surgeon points to an artery supplying that portion of the muscle and asks you to name it. You reply:

perforating artery

Tympanoplasty is the surgical repair of the tympanic membrane and the tympanum and the reconstruction of the ossicular chain. Conductive hearing loss is caused by an obstruction in the external canal or middle ear, which impedes the passage of sound waves to the inner ear. A common cause of conductive hearing loss would be:

perforation of the tympanic membrane.

A 19-year-old male has suffered from subsacral pain and swelling for 2 weeks and finally was referred to a colorectal surgeon for care. He is currently in the ambulatory surgical center operating room (OR) bed positioned in the jackknife position. The circulator has gently but firmly taped his buttocks laterally to the rails of the OR bed to promote exposure to the surgical site. Which procedure is the patient prepared to undergo based on his symptoms and the surgical preparation?

pilonidal cystectomy

A 67-year-old former competitive track athlete with debilitating osteoarthritis is scheduled for a laparoscopic-assisted vaginal hysterectomy (LAVH). During the preoperative assessment, the patient states that her hip and leg joints are tender, and her movement is limited. The doctor explains that during the procedure she will be "up in stirrups" but will be handled gently and protected from further discomfort. An appropriate action, after the patient is transferred to the OR bed and before anesthesia induction, is to:

place her in the preferred lithotomy position and adjust to her position of comfort.

To accommodate near and distant focus, the lens changes shape and focus by relaxation and tightening of the zonular fibers. What physiologic change of the normal aging process is typically corrected with bifocals?

presbyopia

An example of an indication for liver transplantation would be

primary hepatic cancer.

During gastric emptying, chyme is released into the duodenum through the ________.

pyloric sphincter

Paget's disease is a disorder affecting older adults. The bones are weak and poorly constructed. This degenerative process results in:

rapid, disorganized bone remodeling.

A 46-year-old woman with an early-stage second primary cancer in her left breast has elected to have a bilateral mastectomy with saline implants. She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears. While the patient's breast tumor could be treated with an excisional biopsy, she has decided to have a mastectomy of both breasts, which is considered an appropriate preemptive (preventative) surgery for a woman of her age with two primary cancers of the breast. The saline implant insertion surgery is considered a _______________ procedure, the scar revision is considered a ___________ procedure, and the ear piercing is considered a _______________ procedure.

reconstructive; cosmetic; cosmetic

During the planning phase of a procedure for liposuction, all supplies and devices should be organized, because the procedure may require:

repositioning one or more times during surgery may be necessary.

An ethical consideration with older surgical patients centers on the dilemma of do not resuscitate (DNR) orders. When considering the decision to maintain or suspend DNR orders prior to surgery, the guiding principle should be to:

respect the patient's autonomy.

The refractive apparatus of the eye directs (refracts) the light rays to strike the:

retina

An orthotopic neobladder is surgically created as a bladder substitute after a cystectomy, prostatectomy, or hysterectomy is performed for bladder cancer. Bladder substitution relies on meticulous dissection with preservation of the urinary sphincter and neurovascular bundles, as well as a watertight urethral anastomosis. Also termed the Le Bag continent diversion, which segments of the bowel and/or small intestine are used in this technique to create the neobladder?

right colon and ileum

The internal thoracic lymph nodes, which drain the inner half of the breast, can also be a channel for the:

spread of metastasis

Dermatomes are used for harvesting split-thickness skin grafts (STSGs) from donor sites. What will need to be available for a procedure where STSGs will be taken to cover several large burn areas?

sterile mineral oil, tongue blades, and a mesher dermatome.

The biliary system (also called the biliary tree) drains bile from the gallbladder to the ampulla of Vater. The primary function of the gallbladder is to:

store and concentrate bile

A 42-year-old woman from India is visiting her daughter and new grandson. She is a devout follower of Hindu religious practices and has been diagnosed with splenomegaly, possibly from idiopathic thrombocytopenia. The patient is scheduled for a total splenectomy. During the preoperative assessment, the OR team is concerned about the possibility of significant bleeding because of the patient's coagulopathy and the need for hemostatic agents that are typically used to stop bleeding. Many of these products are manufactured from bovine source products, and it would be in conflict with the patient's religion to use products from a cow. An appropriate risk-reduction strategy for selection of hemostatic agents that would not be in conflict with the patient's belief system would be:

substitute absorbable gelatin and oxidized collagen products; use regular ESU settings.

Which mouth structure is considered the boundary between the buccal cavity and the lingual cavity?

teeth

The science of plastic and reconstructive surgery, which means to mold or create form and shape, improves appearance and body image through an understanding of:

the anatomy and biology of tissue.

Osteoporosis is one of the most common and serious bone diseases and is responsible for more than 2 million fractures a year. Osteoporosis-related fractures most commonly occur in the hip, spine, and wrist, but any bone can be affected. The excessive reduction of total bone mass in osteoporosis is due to:

the loss of calcified matrix and collagenous fibers

A major difference between gastroscopy and colonoscopy is:

the patient's position for the procedure.

Skin grafting provides an effective way to cover a wound if vascularity is adequate, infection is absent, and hemostasis is achieved. Skin from the donor site is detached from its blood supply and placed in the recipient site. The best description of a successful skin graft outcome is:

the recipient site develops a new blood supply from the base of the wound.

Postoperative infection in total hip arthroplasty is _____.

usually Catastrophic

A 49-year-old post-bariatric surgery patient is scheduled for a VASER ®-assisted LipoSelection with tumescent infiltration. The tumescent is a solution of lactated Ringer's, lidocaine, and epinephrine. The SA is aware that using more than 70 mL/kg of wetting solution for infiltration can lead to fluid overload. Select the most appropriate action related to minimizing the risk of tumescent solution overload or disproportion to lipoaspirate.

verify with the surgeon and/or anesthesia provider the total lipoaspirate and volume of wetting solution used.

Which of the following membranes covers the stomach?

visceral peritoneum

The nasal turbinates increase the turbulence of the airflow through the nose to humidify the air. The turbinates also serve another function to the accessory sinuses by:

warming and humidifying inspired air.

Sutures used in ophthalmic surgery are very fine and range in size from 4-0 to 10-0. Handling and arming these sutures can be a challenge for the scrub person with uncorrected presbyopia. Eye sutures should be handled as little as possible to avoid:

weakening and fraying

The surgeon may treat distal limb fractures with a closed reduction, rather than open or external fixation, manipulating the fragments into position without incising the skin. When possible, this is the treatment of choice because it decreases the opportunity for infection, improves results (including bone union of the fracture), and minimizes the recovery period. Closed reduction with local or light anesthesia may permit ambulatory surgery. Select a situation where closed reduction would be performed in addition to open reduction and fixation surgery to a distal limb.

when soft tissue entrapment is suspected

Depending on their location, hernias are classified as direct inguinal, indirect inguinal, femoral, umbilical, incisional, or epigastric. Hernias in any of these groups are either reducible or nonreducible. The characteristic "reducible" hernia can best be described as a hernia:

with visceral contents that can be returned to the abdomen.