Bryan - Surgery - Test 1 Part 2 - Spring 2Nd Year

Front 1

What does tennis have to do with blood loss?

Back 1

It describes the classes of blood loss
class 1 - 15%
class 2 - 15-30%
class 3 - 30-40%
class 4 - loss of >40% (game over)

Front 2

T or F:
Septic shock can be initiated by gram positive, gram negative bacteria or fungal organisms.

Back 2

True!

Front 3

What does SIRS stand for? Infection with which type of organism initiates this?

Back 3

Systemic Inflammatory ResponSe;
Gram negative bacteria (endotoxin; LPS) initiates SIRS

Front 4

Which of the following is associated with SIRS?
a) infection with a gram positive bacteria
b) infection with a gram negative bacteria
c) local and severe infection
d) multiple organs involved
e) infection enters systemic circulation

Back 4

b) infection with a gram negative bacteria
c) local and severe infection
d) multiple organs involved
e) infection enters systemic circulation

Front 5

What commonly binds to the lipid A portion of LPS in systemic circulation? What cell-surface molecule potentiates the expression of this antigen?

Back 5

HDL or Lipopolysaccharide Binding Proteins (LBPs);
CD14 expresses the antigen

Front 6

What are clinical signs of endotoxemia?

Back 6

tachycardia, tachypnea, prolonged CRT, hyperemic mm, muscle fasciculations, fever, decreased GI sounds/colic, changes in mentation

Front 7

What is usually seen in the CBC in a patient with endotoxemia?

Back 7

leukopenia, neutropenia, left shift, metabolic acidosis, increased blood lactate

Front 8

What are some examples of crystalloid fluids?

Back 8

LRS
Plasmalyte A
Normasol-R
0.9% NaCl

Front 9

What are the 4 methods of calculating a fluid dose for shock?

Back 9

1) Estimate % blood loss and administer 4x this volume
2) 90ml/kg for dogs; 55 ml/kg for cats
3) administer 1 circulating blood volume
4) Give 1 ECF volume (daily fluid maintenance) in one hour

Front 10

What is the "golden period" in wound healing?

Back 10

4-6 hrs

Front 11

Choose clean, clean-contaminated, contaminated, or dirty wound...
...splenectomy.

Back 11

Clean

Front 12

Choose clean, clean-contaminated, contaminated, or dirty wound...
...lung lobectomy.

Back 12

Clean-contaminated

Front 13

Choose clean, clean-contaminated, contaminated, or dirty wound...
...intussecption reduction with spillage of GI contents.

Back 13

contaminated

Front 14

Choose clean, clean-contaminated, contaminated, or dirty wound...
...3 day old bite wound

Back 14

dirty

Front 15

What are the approximate times before suturing for the following:
Primary closure
Delayed primary closure
Secondary closure
Second intention

Back 15

Primary closure (immediate)
Delayed primary closure (1-5d)
Secondary closure (>5d)
Second intention (never sutured)

Front 16

What are the 4 phases of wound healing?

Back 16

coagulation
inflammation
proliferation
maturation

Front 17

When does granulation tissue usually appear in wound healing?

Back 17

by day 3 to 5

Front 18

Put these cells in the order of inflammatory appearance:
Granulocytes
Lymphocytes
Macrophages

Back 18

Granulocytes
Macrophages
Lymphocytes

Front 19

What type of collagen is laid-down first in wound healing?

Back 19

Collagen III

Front 20

What are the steps to wound proliferation?

Back 20

Fibroplasia
Angiogenesis
Epithelization
Contraction

Front 21

When is the wound the most reliant on sutures for stability?

Back 21

Days 3-5

Front 22

What are the two physiologic factors affecting wound healing?

Back 22

Oxygen
Temperature
(higher levels of both positively influence wound healing)

Front 23

How does diabetes affect healing response?

Back 23

decreases chemotaxis and adhesion of neutrophils

Front 24

T or F:
Corticosteroids are contraindicated in wound healing.

Back 24

False, one dose at time of wounding has been shown to have no effect on healing rate

Front 25

What are the three layers used in bandaging?

Back 25

Contact (Primary) layer
Intermediate (secondary) layer
Outer (tertiary) layer

Front 26

Choose adherent-absorption, occlusive, or semi-occlusive bandage...
...used for debridement of road rash.

Back 26

adherent-absorptive

Front 27

Choose adherent-absorption, occlusive, or semi-occlusive bandage...
...used when granulation tissue is present.

Back 27

semiocclusive

Front 28

Choose adherent-absorption, occlusive, or semi-occlusive bandage...
...dry-dry is an example.

Back 28

adherent-absorptive

Front 29

Choose adherent-absorption, occlusive, or semi-occlusive bandage...
...stimulates granulation tissue.

Back 29

adherent-absorptive

Front 30

Choose adherent-absorption, occlusive, or semi-occlusive bandage...
...increases epithelialization.

Back 30

occlusive

Front 31

What is the most common type of bandage?

Back 31

Robert-Jones (stabilizing or modified)

Front 32

Which bandage types are non weight-bearing? What is a possible complication with all of these?

Back 32

i) Velpeau
ii) Carpal flexion
iii) Ehmir
iv) 90/90

All can cause nerve damage

Front 33

How can limb viability be assessed when a bandage has been put on too tight?

Back 33

Pinch toes (clamp bone if necessary);
cut toenail and look for bleeding

Front 34

What is the golden rule for joint stabilization?

Back 34

Stabilize the joint above and below the affected joint

Front 35

What should be unbandaged in order to monitor swelling?

Back 35

Two toes!

Front 36

How often should bandages be changed?

Back 36

Every 3 to 7 days

Front 37

What are emergency situations that a client should look for when monitoring a bandage?

Back 37

Swelling
Hot/cold extremities
Pain
Soilage, wet
Strike-through
Sudden lameness

Front 38

How should a bandage be wrapped?
a) distal to proximal
b) proximal to distal

Back 38

a) distal to proximal

Front 39

The introduction of organisms into a wound describes
a) infection
b) contamination
c) sepsis
d) dirty wound

Back 39

b) contamination

Front 40

The establishment of organisms in a wound and subsequent host reaction describes...

Back 40

...infection

Front 41

The presence of bacteria in blood describes
a) sepsis
b) infection
c) bacteremia
d) endotoxemia

Back 41

c) bacteremia

Front 42

The presence of sufficient bacteria in the blood causing illness describes
a) sepsis
b) infection
c) bacteremia
d) endotoxemia

Back 42

a) sepsis

Front 43

What are the classifications of surgical site infection?

Back 43

Superficial incisional SSI
Deep incisional SSI
Organ or space SSI

Front 44

What host factors increase risk of post-op infections?

Back 44

Immunocompromization
Prior irradiation to surgical site
Older age of the animal (SA) (>8 years)
Distant sites of active infection
Fat or thin animal

Front 45

What are some pre-surgery factors contributing to increased post-op infection risk?

Back 45

Clipping b4 anesthetic induction
Inadequate skin prep
Anesthesia duration >1hr
Use of propofol

Front 46

What is the approximate critical level of contamination before infection occurs?

Back 46

10^5 organisms/gm tissue

Front 47

What are some factors DURING surgery that will increase post-op infection risk?

Back 47

>10^5 organisms/gm tissue
Surgery duration of >90min
Multifilament suture used
Foreign material (implants)
Avascular tissues

Front 48

T or F:
Antimicrobial prophylaxis is recommended for clean-contaminated, contaminated, and dirty surgeries.

Back 48

False!
If using antibiotics in dirty surgeries, this is treatment not prophylaxis

Front 49

When should antibiotic prophylaxis be used in clean surgeries?

Back 49

When an infection would be catastrophic (eg: hip replacement)

Front 50

When should prophylactic antibiotics be administered?

Back 50

Between 30 and 60 minutes before surgery.