Surgery Exam 5

Front 1

Changes in skin and tissue from excess moisture
Can look like white, wrinkled skin (too long in the tub look), or blanching of the wound bed

Back 1

maceration

Front 2

Hollow viscus entered but controlled, bowel prep, drain used, minor break in aseptic tech

Back 2

clean contaminated 5-8% infection rate

Front 3

is the only layer capable
of regeneration

Back 3

epithelial layer

Front 4

Wound is deliberately left open initially and then the wound edges are approximated 3-6 days later.

Back 4

surgical strategy
delayed primary closure

Front 5

what are two main local factors that can affect healing of a wound?

Back 5

1. infection
2. tension

3. foreign body
4. ischemia
5. poor technique
6. previous irradiation

Front 6

what are systemic factors that can affect healing of a wound?

Back 6

1. anemia
2. nutrition
3. chronic dz
4. drugs

Front 7

what is the golden period for wounds?

Back 7

guidelines for when a wound can be closed
around 8 hours for most
unless face or scalp then 12-15 hrs
really depends on contamination and vascular supply

Front 8

MC necrotizing wound infection bacteria?

Back 8

clostridia perfringens

Front 9

when suturing a lip make sure to do what first?

Back 9

align the vermillion border first!

Front 10

process of releasing the tissue beneath the margins of the wound to allow closure without tension

Back 10

undermining

Front 11

______is the enemy of a good repair

Back 11

tension

Front 12

Undermining is best accomplished with a

Back 12

vertical spreading/snipping technique

Front 13

Grasping and locking (ratchet style) instrument to hold surgical ______

Back 13

needles
needle holders

Front 14

when would you use a taper needle?

Back 14

when repairing SQ, vessels, nerves, fascia and mm

Front 15

when would you do a vertical mattress suture?

Back 15

inelastic tissue requiring eversion

Front 16

When would you do a continuous suture?

Back 16

linear uncomplicated wounds, its rapid, even tension distribution

Front 17

when would you do a subcuticular suture?

Back 17

skin closure where removal of skin suture is undesirable

Front 18

donor and recipient are genetically identical

Back 18

isograft

Front 19

tissue from genetically disparate individuals from the same species

Back 19

allograft

Front 20

graft placed in natural anatomic position

Back 20

orthoptic

Front 21

deviation of graft placement into a different anatomical position (ex. Kidney..native kidneys do not get taken out. New kidney gets placed in iliac fossa, with a shortened ureter.

Back 21

heterotopic

Front 22

tissue form 1 site to another in the same individual

Back 22

autograft

Front 23

what is the age range for donor criteria?

Back 23

6 months to 65 years old

Front 24

what is the cornerstone for wound healing?

Back 24

1. cleaning
2. debridement
3. closure
4. protection

Front 25

what is responsible for sensory funciton to the forehead?

Back 25

superorbital nerve

Front 26

do we want to put peroxide on wounds?

Back 26

no!

Front 27

what is the mild antiseptic that can kill the rabies virus?

Back 27

Zephiran

Front 28

what is the DOC for cleaning skin but you can't put in in areas with creases?

Back 28

Hibiclens (chlorhexidine)

Front 29

what type of suture do we use to repair the lip?

Back 29

chromic

Front 30

what is the best Abx to use for animal bites?

Back 30

Augmentin (keflex is cheaper)

Front 31

what is the best suture material to use on the skin?

Back 31

non-absorbable synthetic

Front 32

AVN Femoral Head

Idiopathic

Family History

Boys 5:1 / More common Caucasians

4-8 years old

Back 32

legg-calve- perthes disease

Front 33

Obese adolescents

11-14 years old

Hip/thigh and knee pain

Complications- AVN/OA/Decreased ROM

Back 33

slipped capital femoral epiphysis

Front 34

what does the kocher criteria help dx? what are they?

Back 34

septic hip arthritis
1. fever
2. WBC >12k
3. Sed rate >40
4. Non-WB

Need to operate ASAP - decrease joint damage

Front 35

what attaches at the pea anserine?

Back 35

semitendinosis, gracilis, sartorius

Front 36

what is the criteria for deceased donors?

Back 36

1. irreversible brain death
2. age 6months to 65 yo
3. no evidence of systemic sepsis
4. no evidence of extracranial malignancy
5. no hx of renal disease
6. normal renal fns

Front 37

what type of rejection? • Onset 2-5 days
• Caused by host pre-sensitization to donor Ag (without detectable anti-donor Ab pre-treatment)

Back 37

accelerated

Front 38

what type of rejection?

• Commonly seen but usually not before day 7
• Treated with corticosteroids, antibodies
• VERY common type of rejection
• Happens very commonly in people who stop taking their meds (anti-rejection meds)

Back 38

acute

Front 39

what are the MC tpes of rejection?

Back 39

acute and chronic

Front 40

what are three adverse events that can occur after transplantation?

Back 40

1. rejection
2. infection
3. malignancy

Front 41

what are the MC indications for liver transplant in adults and children?

Back 41

adults - chirrhosis
children - biliary atresia

Front 42

what is the MC type of heart infection to occur soon after a transplant?

Back 42

mediastinitis 2-4 wks after
toxoplasmosis 3w-6mo

Front 43

what is the single most important pathogen in transplantation? when does it show up after the surgery?

Back 43

CMV, seen >21 days after but peaks at 4-6 weeks