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Professional Practices FINAL EXAM

Terms in this set (200)

Surgical Loupes-
Magnifying glasses worn on glasses during surgery
Nasogastric Tube-
Placed in the stomach to empty gastric contents
Adson-Beckman Retractor-
4x4 ratchet lock; resembles a weitlaner
Bakes Dilator-
Used to dilate the common bile dict
Chromotubation
Used to test tubal patency of fallopian tube; uses methylene blue
Tonsil Schnidt-
Clamp commonly used for tonsils; used for passing suture around or under tissue ("tie on a pass")
Rosen Knife-
Ear knife with rounded plate tip with sharp edges used in a tympanoplasty
Corpus Luteum-
Yellow hormone secreting-body, grows within ruptured ovarian follicle
Lahey Clamp-
Ring handled grasper, 3x3 sharp teeth
Doyen rib raspatory/elevator
Smooth or scrape away rib during certain thoractomy or nephrectomies
R.A.C.E.-
rescue, alert, contain, extinguish
What is it called when a surgical sponge is left in the patient?
Res ipsa Loquitor, " The thing that speaks for itself"
Hurd-Pillar dissector-
Double ended, smooth retracting lip, sharp dissecting end (ENT)
What is a Balfour? How many pieces?
Self retaining, interchangeable, holds abdominal wall, 5,8, or 10
What is Colles fracture?
fracture of the distal end of the radius
What is the study of Mycology?
study of fungi
Definition of Etiology?
study of cause or origin
What is cocaine used for in surgery?
Topically on mucousa of nose, vasoconstrictor
Classes of fire extinguishers-
Class A- Cloth, wood, rubber, paper, plastics
Class B- Gasoline, grease, oil
Class C- Electrical
Class D- Combustible metals (sodium, magnesium, titanium)
Class K- Kitchen
How is the weight of tissue excised during a mammoplasty measured?
grams
Examples of drugs used for hemostasis-
Gelfoam
Avitene
Surgi-cel
Epi
Silver Nitrate
Thrombin
What things are put in the steris? How does it work?
EGDs, Colonoscopies; uses liquid chemical sterilant peracetic acid
What things are put in the Sterrad? How does it work?
Cameras, light cords, batteries; uses hydrogen peroxide gas plasma
What is a Mayo-Hegar?
needle holder; larger, heavier needles; OBGYN
What is a Castroviejo needle holder used for?
Delicate; eye and vascular surgery
T-tube-
closed wound passive drain; drain common bile duct
Fogarty Catheter-
remove emboli and thrombi from vessels
Ellik evacuator-
double glass receptacle; evacuate urinary bladder
Fenestrated drape-
Drape with hole in middle (Laparotomy drape)
Nonfenestrated drape-
Drape with no hole (3 quarter sheet)
O'Sullivan O'Connor retractor-
Self retaining, interchangeable blades, OBGYN
Creutzfeldt-Jakob Disease-
Fatal disease of nervous system
Use disposable wipes
Clean w/sodium NaCIO for 60 min
Cicatrix-
Scar of healed wound
Supine Position-
lying on back, facing upward
Trendelenburg Position-
lying on back with body tilted so that the head is lower than the feet
Reverse Trendelenburg Position-
lying on back with the head higher than the feet
Fowler's position-
a semi-sitting position; the head of the bed is raised between 30 and 90 degrees
Semi-Fowler's position-
beach chair; sitting up at 30 degrees
Lithotomy position-
lying on back with legs raised and feet in stirrups
Prone position-
lying on abdomen, facing downward
Kraske (Jack Knife) position-
prone with hips over break in table, feet below level of head
Lateral position-
side lying position
Sims position-
left lateral position
Allen stirrups should be positioned how?
at the level of upper thigh
Amylase-
enzyme breaks down starch
VATS procedure-
Video Assisted Thoracic Surgery
What retractor would be used on a hip pinning?
Bennett
What do you use to grasp tissue during a thyroidectomy?
Lahey clamp
A patient is scheduled for an I&D of a breast abscess, what should you have available?
Culture tube
On a standard setup for a cholecystectomy, what is needed to clip the cystic artery?
Ligating clips
What retractor is needed for an open thoracic set-up?
Weinburg or Finochietto
The difference between monopolar and bipolar?
Monopolar- current released through single tip, out through grounding pad
Bipolar- current contained in tips, no grounding pad needed
Whose job is it to check the operating bed before surgery?
Circulator
What is the function of platelets?
prevent bleeding, cause clotting, produced in bone marrow
What is the largest peritoneal fold?
greater omentum
What is PMMA and MMA toxicity?
PMMA- made from MMA
MMA- Higher toxicity
BCIS- Bone Cement implantation Surgery
What is a major indication for a vena cava filter or a Greenfield filter?
prevent a pulmonary elmbolism
What is each part of the small intestine?
Duodenum, Jejunum, Ileum
What is the correct sequence of the large intestine? What is its main purpose?
1. Cecum
2. Ascending colon
3. Transverse colon
4. Descending colon
5. Sigmoid colon
6. Rectum
7. Anus
Absorbs water, eliminates waste material
What are the stages of wound healing?
Inflammatory/ Lag phase
Proliferative Phase/ Granulation
Maturation Phase/ Remodeling
What part of the surgical mask should you avoid touching?
Filter
What are the four main steps of an ORIF?
Drill, measure, tap, screw
What is a Nissen Fundoplication?
Treats GERD and hiatal hernias. Fundus wrapped around esophagus; laparoscopically
Where do you prep for a radical vulvectomy?
Vaginal area and abdomen to umbilicus
A patient goes to the ER with clinical deterioration. Who is called? What is clinical deterioration?
Rapid response team; changes in vitals and mental status
What valve divides the left atrium and left ventricle?
mitral valve
What valve is located between the right atrium and right ventricle?
tricuspid valve
What are the layers of the intestinal tract inside to outside?
1. Mucosa
2. Submucosa
3. Muscularis
4. Serosa
How do you know a patient is bleeding internally/hemorrhaging?
BP drops, HR increases, difficulty breathing, cyanosis
Tsunamis are caused by?
underwater volcanoes
What causes ascites?
accumulation of serous fluid in peritoneal cavity
CUSA machine-
Emulsifies abnormal tissue, preserves normal tissue; Cavitron Ultrasonic Surgical Aspiration
Harmonic scalpel-
ultrasonic motion cuts and coagulates tissue
Satinsky clamp-
partially occluding vascular clamp
Examples of laser safety precautions-
Laser eye protection
warning signs
sterile water
wet towels
laser retardant drapes
fire extinguisher
laser masks
non-reflective instruments
Where is the deltoid muscle located?
shoulder
During a cadaver procurement, what organ is harvested last?
kidneys; filter other organs
In what procedures might the sternocleidomastoid muscle and omohyoid muscle be divided?
anterior cervical or radical neck dissection
During a laminectomy, what self-retaining retractor might be used?
meyerding retractor
When an appendix ruptures, what is the greatest concern?
peritonitis, abscess, blockage of intestines, death
Weinburg retractor?
pediatric retractor; blade on thompson retractor
Weinburg procdure?
over-sewing of bleeding vessel; ligation of gastroduodenal artery
What is the most serious post op complication of a radical neck dissection?
edema, hematomas, hemorrhage, infection
Payr clamp-
crushing clamp; occludes lumen of intestine
Once the ear speculum is placed for a myringotomy, what instrument is needed next?
buck ear curette
How should the room be cleaned after a hepatitis patient?
as per hospital policy
What is a keratoplasty?
corneal transplant surgery
Billroth 1 procedure-
A gastroduodenostomy, or surgical anastomosis, of the stomach and the duodenum.
Billroth 2 procedure-
A gastrojejunostomy, or surgical anastomosis, of the stomach and the jejunum.
Allen clamp-
traumatic intestinal clamp; serrations are longitudinal
What should be done when performing an autograft on a burn patient?
donor site is prepped first
Hank dilators-
used in D&C for dilation of cervix; stop ring prevents over insertion
What is a D&C? What is the correct order for the instrument set-up on the back table?
Dilation and curettage of the uterus and cervix
1. auvard weighted speculum
2. single tooth tenaculum
3. sims uterine sound
4. dilators (Hank, Hegar, or Pratt)
5. sims uterine curettes
6. polyp forceps
7. forester sponge stick
8. spoon and telfa
What tendon is harvested and used in an anterior cruciate ligament (ACL) repair?
Semitendinosus, patellar, iliotibial, or gracillis
When should dressing sponges be open during surgery?
After the incision is closed at the end of the case
What procedure would you use the fracture table?
Hip pinning, TFN
What forceps would you use to close a carpal tunnel?
Adson with teeth
What drug is added to saline in most vascular cases to prevent clotting? What drug is used to counteract it?
Heparin; Protamine sulfate
What drug is used to treat malignant hyperthermia?
Dantrolene (Dantrium)
Where should the ST place the soiled sponges?
Kick bucket
What is a passive drain? How does it differ from an active drain?
Passiive drain- relies on gravity (t-tube, penrose)
Active- device itself pulls the fluid (Jackson pratt)
What is the difference between ORIF, OREF, CRIF, CREF?
ORIF- Open reduction internal fixation
OREF- Open reduction external fixation
CRIF- Closed reduction internal fixation
CREF- Closed reduction external fixation
What is a cryophake?
Handheld device; freeze a lens with a cataract
What is a parker retractor?
Double ended; two "C" shaped curves on each end
What happens to tissue if you place it in sterile water?
hypotonic solution; cells in the tissue would swell and rupture
How are kidney stones sent to pathology?
dry
A patient is scheduled for a keratoplasty OD. Is the procedure on the left or right eye?
OD- right eye OS- left eye
What type of instruments are needed for a vagotomy?
Nerve hooks, rubber shods, laparotomy tray
What happens when there is a premature fusion of one or more cranial sutures?
craniosynstosis
What is the blue coating on instruments for?
non-conductive, non-reflective, used during laser surgery
What is an omphalocele?
congenital defect; organs remain outside of abdomen in a sac because of a defect in the muscle of the abdominal wall
What position should a patient be placed in post-op tonsillectomy?
lateral
What type of stapler would you use on a left colon resection?
EEA (end-to-end anastomosis)
What forceps are preferred for closure on a carotid artery?
Debakey forceps
The environment under surgical gloves promotes the growth of what type of microorganism?
bacteria
What is the best time to remove a specimen from the field?
when the surgeon gives you permission
Patient misidentification would be considered what?
unitentional tort-malpractice
Which procedure has the highest risk of a fire developing and why?
any surgery that uses alcohol to prep
Ablation of condylomas uses what device?
CO2 laser most commonly
Classification of lasers?
Class 1 is safest
Class 4 is most dangerous
What retractor is used in a total knee replacement to protect the medial collateral ligament?
Hohmann
When a bloody lap tape drops on the floor, what should the circulator do?
Put on gloves and place it in a hanging count bag. Any countable item or instrument off the sterile field is the circulator's responsibility
What is the purpose of a colored under glove?
to detect a hole in the top glove
What graft would be used in a posterior lumbar fusion?
iliac crest (autograft)
What type of spores are most resistant to gamma radiation?
Bacillus A
What type of surgeries would you use stirrups on?
Cystoscopy and GYN procedures (D&C)
What type of instrument is a Duvall? What is it used on?
Lung Clamp
What type of instrument is an Allison? What is it used on?
Lung retractor ("whisk")
What is the circulators role in the operating room?
(put into own words)
What is a Mcburney's incision commonly used for?
Open appendectomy (oblique incision)
What type of retractors are commonly used for a open appendectomy?
Weitlaners, army-navy
What is the Pfannenstiel incision commonly used for?
C-sections, open hysterectomy
What is the correct sequence of layers incised during a Pfannenstiel incision?
Skin, superficial fascia, deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, exrtaperitoneal fat, and peritoneum
What is a subcostal/kocher incision commonly used for?
open cholecystectomy or liver procedure
If a donor kidney is being transplanted, what incision is used on a first-time donor?
flank
What incision is used for a gastroplasty?
upper midline incision
What is the Pringle maneuver?
clamps hepatic pedicle; allows evaluation of traumatic liver injury
What is glutaraldehyde?
toxic chemical used as a cold sterilant to disinfect and clean heat-sensitive , medical, surgical and dental equipment
What type of dilators can be used during a D&C?
Hank, Hegar, Pratt
What is the proper order of removing the soiled gown and gloves at the end of the procedure?
(put into own words)
What is the correct sequence of blood flow through the heart?
Right atrium
tricuspid
right ventricle
right semilunar valve
pulmonary trunk and artery
lungs
pulmonary vein
left atrium
through the bicuspid
left ventricle
aortic semilunar valve
aorta
to the body
back to the heart
List 6 types of urethral catheters-
A- Simple
B- whistle up
C- caude
D- malecot
E- pezzar
F- standard
What is another name for a Caude catheter?
Tiemann
What type of catheter is used after a TURP?
3-way foley
Yasargil clips-
aneurysm clips
What is the purpose of an arterial line?
measures BP and blood gases, allows repeated arterial blood gas samples to be drawn without injury
What instrument is commonly used to tag suture?
hemostat
Capillary action drain-
fluid flows through small tubes into a closed cross section, which contains fluid and allows it to be suctioned through the tube
What parameters must be met for flash sterilization on an unwrapped instrument with no lumens?
3 min at 270F
The wilson frame would be used for what type of procedure?
Laminectomy
Iridectomy-
Removal of a portion of the iris, uses microscope
FESS-
functional endoscopic sinus surgery; treats chronic inflammatory and infectious sinus diseases
Ptosis-
drooping or falling of the upper eyelid
HoverMatt-
patient floats on cushion of air
ERCP-
endoscopic retrograde cholangiopancreatography; combines upper GI endoscopy and x-rays to treat problems of the bile and pancreatic ducts
How can you predipose a patient to venous thromboembolus?
safety strap too tight, immobilization
How do you preserve bone wax before it is used?
breaks off small pieces and roll into balls
Examples of retractors used during a femoral-femoral bypass?
Volkmann rake, weitlaner, army-navy
What is a scleral bucket procedure?
fixes detached retina
How do you verify the orientation of a breast biopsy?
stitch, clip, ink, can be used to mark the laterality
What can be used to manipulate neonatal bowel?
singley-tuttle ring forceps
What happens when a chest tube is not maintained?
infection
What are some complications of a D&C?
perforated uterus, laceration of the cervix, excess bleeding
What are common causes and symptoms of hypovolemic shock in infants?
vomiting, diarrhea, severe burns, surgery
What are bovie grounding pad placement options?
close to the operative site
What tissue layer is removed during an endarterectomy?
intima (innermost) along with plaque buildup
What is impregnated into the scrub brush?
antiseptic solution; povidone iodine
What are the 4 paranasal sinuses?
maxillary, frontal, ethmoid, sphenoid
Cholangiogram-
detects gallstones in the common bile duct
Mannitol-
osmitrol; osmotic diuretic; reduces intracranial pressure
What is replaced during a shoulder arthroplasty?
humeral head
Wieder tongue blade-
depresses tongue to visualize back of throat
How is the lamina removed during a laminectomy?
with a kerrison rongeur
What are diabetic patients at risk for during surgery and postop?
vascular compromise
When do you do the first closing count during a C-section?
Once the surgeon starts closing the uterus
When do you do the first closing count during a Splenectomy?
Once the surgeon starts closing the abdominal cavity
What part of the brain controls personality?
frontal lobe
What is a ruptured nucleus pulposus?
ruptured intervertebral disc
What medication would you need to have available on your back table in an emergency open heart procedure?
EPI; increases cardiac output
What procedure is performed on women with incontinence?
MMK; bladder sling surgery
What suture is commonly used to keep drains in place?
2-0 or 3-0 silk, sometimes tape
After handing the surgeon a TA stapler, what should you have ready to pass next?
scalpel
A Baron suction is commonly used for what procedures?
ear cases
If the surgeon asks for a stick tie, what does he want?
suture, most often silk, on a swaged needle that "pops off" when pulled on; used often to ligate bleeders
Facial drooping, such as in Bell's Palsy, is caused by damage to what cranial nerve?
Facial nerve
What is a fasciectomy?
Fascia cut to relieve tension
What is a sub-total palmar fasciectomy?
treats contracture in palm of hand; removes affected fascia, leaves healthy fascia
How are suture scissors angled when cutting suture?
parallel to surface; 45 degree angle; cutting close to tips of the scissors
What is Roux-en-Y anastomosis used for?
colon resection
What number cranial nerve is oculomotor?
3 (III)
What number cranial nerve is the Trochlear?
4 (IV)
What gas is used as insufflation for laparoscopic procedures?
Carbon dioxide; 12-15 mm/Hg
What incision is used for an indirect hernia?
Oblique
What is the purpose of a vagotomy procedure?
Decreases gastric secretions
What type of hernia is present within a Hesselbach's triangle?
direct
What hormone can be injected directly into the uterus during a C-section to aid the uterus to contract and shrink to prevent hemorrhage?
pitocin (oxytocin)
During a rhytidectomy, the surgeon uses a #15 blade to make a coronal incision. What will the TS-C hand the surgeon next?
Smooth forceps (such as Debakey or adson without teeth)
What do you do if the fire alarms go off with a fire occurring in the OR while you're in the middle of an abdominal procedure?
Ask for packing so you can be ready to move the patient out of the OR quickly
When should you damp wipe in the OR?
first thing in the morning, before the first case of the day
When would Meckel's Diverticulum likely be found?
During an appendectomy; found in the ileum of the small bowel
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