Chapter 11: Hemostasis, Wound Healing and Wound Closure

Collagen

Which of the following interweaves its fibers during the maturation phase of wound healing and increase its tensile strength?

A. Collagen

B. Enzymes

C. Fibrin

D. Protein

Second

A wound that is not sutured and that gradually fills in by granulation, heals by which intention?

A. First

B. Second

C. Third

D. Fourth

Electrical Nerve Stimulation

All of the following are techniques for eliminating dead space in a wound EXCEPT?

A. Careful approximate of tissues

B. Electrical nerve stimulation

C. Placement of wound drain

D. Pressure dressing

Evisceration

Which postoperative wound complication would require immediate surgical treatment?

A. Fistula

B. Adhesions

C. Infection

D. Evisceration

Inflammatory

Which phase of healing for wounds closed by first intention begins within minutes of the incision or injury?

A. Inflammatory

B. Proliferation

C. Maturation

D. Granulation

Keloid

What is the name of a raised hypertrophic scar due to excessive collagen formation in some darker-skinned individuals?

A. Cicatrix

B. Granuloma

C. Keloid

D. Seroma

Blunt

Which type of suture needle is used in friable tissue such as liver or kidney?

A. Blunt

B. Cutting

C. Taper

D. Trocar

Fascia

Which tissue layer of the abdominal wall provides the greatest strength and support of the wound?

A. Skin

B. Fascia

C. Peritoneum

D. Subcutaneous fat

Halsted

Which historical figure in medicine is credited with creating principles of proper tissue handling and suturing?

A. Debakey

B. Cushing

C. Halsted

D. Kocker

Suture permanently swaged on an eyeless needle

Tissue trauma is minimized by using which type of suture-needle combination?

A. Threaded suture on a closed-eye taper needle

B. Threaded suture on a closed-eye Keith needle

C. Suture loaded on a French-eyes taper needle

D. Suture permanently swaged on an eyeless needle

Stick tie

Another name for a suture ligature is a:

A. Free tie

B. Stick tie

C. Tie-on-a-passer

D. Ligature reel

Cutting

Which type of needle is preferred for suturing of skin?

A. Blunt

B. Cutting

C. Taper

D. Spatula

Debridement

What is the term for removal of foreign material or contaminated debris from a wound?

A. Debridement

B. Dehiscence

C. Denuding

d. Desiccation

Protrusion of viscera through all tissue layers

Evisceration of an abdominal wound is:

A. Filling in of a wound from bottom up

B. Excessive scar formation after surgery

C. Protrusion of viscera through all tissue layers

D. Single or multi-layer separation of wound edges

First intention

Which type of healing occurs in an aseptic wound with good approximation and ideal surgical conditions?

A. First intention

B. Second intention

C. Third intention

D. Fourth intention

Ischemia

If tissue is approximated too tightly, it can result in:

A. Adhesions

B. Granulation

C. Ischemia

D. Keloids

Side to side

Primary union wound healing occurs:

A. Bottom to top

B. Top to bottom

C. End to end

D. Side to side

A normal protective response to tissue injury

Inflammation can BEST be described as:

A. A disease process accompanied by fever

B. An exaggerated immune system process

C. A normal protective response to tissue injury

D. An abnormal physiologic response to tissue injury

Inguinal hernia repair with no breaks in technique

Which of the following wounds would be assigned a Class 1?

A. Compound femoral fracture

B. Gunshot wound to the abdomen

C. Appendectomy with no major intestinal spillage

D. Inguinal hernia repair with no breaks in technique

Chronic

What kind of wound is sacral decubitus ulcer?

A. Chronic

B. Clean

C. Closed

D. Contusion

Class ll

Which wound classification would be assigned to a vaginal hysterectomy with anterior and posterior colporrhaphy?

A. Class l

B. Class ll

C. Class lll

D. Class lV

Immunosuppressed status

A patient undergoing chemotherapy and radiation therapy for cancer might experience prolonged wound healing due to:

A. Class l, primary union wound

B. hyperactive immune response

C. Immunosuppressed status

D. Vascular Proliferation

Swaged

What is the term for type of suture that has the strand of suture material inserted into the hollowed-out needle end?

A. Closed eye

B. Crimped

C. Frech-eye

D. swaged

Surgical Silk

Which of the following is a natural, multifilament suture classified as nonabsorbable but loses much of its tensile strength in a year and is undetectable in tissues after 2 years?

A. Polyester

B. Polypropylene

C. Surgical Silk

D. Stainless steel

Provide smooth passage through tissue

Some multifilament sutures are coated to:

A. Provide smooth passage through tissue

B. Decrease the absorption rate

C. Increase the capillarity

D. Prevent knot slippage

Plain surgical gut

Which of the following sutures has comparatively inconsistent tensile strength and rapid absorption rate in vivo with moderate tissue reaction?

A. Plain surgical gut

B. Poliglecaprone

C. Polyglyconate

D. Polydioxanone

Are impregnated with an antibacterial coating

Ethicon sutures may be available with a designation of "plus" for some sutures which means they:

A. Are longer strands than the original versions

B. Have more then one needle in the package

C. Have a heavier gauge needle for thicker tissues

D. Are impregnated with an antibacterial coating

U.S. Pharmacopeia (USP)

Which organization specifies diameter ranges for sutures?

A. American National Standards institute (ANSI)

B. Brown and Sharpe (B&S)

C. U.S. Pharmacopeia (USP)

D. Food and Drug Administration (FDA)

Polytetrafluoroethylene

What is the chemical name of Gore-Tex suture?

A. Polybutester

B. Polypropylene

C. Polyglactin 910

D. Polytetrafluoroethylene

Stainless steel

Which suture is MOST inert in tissue?

A. Chromic gut

B. Plain gut

C. Stainless steel

D. Surgical silk

To prevent sutures from cutting into the skin

What is the primary reason bolsters are used with retention sutures?

A. To facilitate easy post op suture removal

B. To prevent sutures from cutting into the skin

C. To stabilize heavy dressings

D. To prevent dressings from touching the suture line

Occlude the lumen of a blood vessel

Ligatures are used to:

A. Prevent evisceration

B. Eliminate dead space

C. Approximate tissue layers

D. Occlude the lumen of a blood vessel

Tensile strength

What is the term that describes the measure of how much a suture strand can be stretched before breaking?

A. Gage

B. Capillarity

C. Tensile Strength

D. Drag coefficient

They range from 1/2 circle curvature to 5/8 circle curvature

Which of the following is NOT correct about the structure/design of suture needles?

A. They may be eyed or eyeless

B. They may be straight or curved

C. They are classified according to the eye, point and body

D. They range from 1/2 circle curvature to 5/8 circle curvature

Evert the edges outward

How will the surgeon manipulate skin edges of a wound before the surgical technologist places an approximate skin staple?

A. Evert the edges outward

B. Invert the edges inward

C. Overlap the edges tightly

D. Rotate the edges slightly

Mesentery

Which of the following tissues is NOT part of the abdominal wall closure when retention sutures are placed?

A. Fascia lata

B. Mesentery

C. Peritoneum

D. Subcutaneous fat

Veress

Which non-suture needle is used for insufflation of carbon dioxide into the abdomen for laparoscopy?

A. Arterial

B. Hypodermic

C. Spinal

D. Veress

Reverse

Which needle has the cutting edge on the outside curvature of the needle body?

A. Conventional

B. Keith straight

C. Reverse

D. Spatula

8-0

Which suture gauge would be MOST appropriate for ophthalmic surgery?

A. #5

B. 0

C. 3-0

D. 8-0

Subcuticular suture

A continuous suturing technique that places sutures in the endothelial layer of the skin in short, lateral throws is called a:

A. Mattress suture

B. Purse-string suture

C. Traction suture

D. Subcuticular suture

Keith

Which of the following surgical needles is a solid bore (not hollow) straight type of needle?

A. Dorsey

B. Heparin

C. Keith

D. Tru-cut

Suture ligature

Which type of suture ties has an attached needle?

A. Free tie

B. Ligature reel

C. Suture ligature

D. Tie-on-a-passer

Interrupted

The suturing technique MOST appropriate for wounds likely to become infected or suffer potential stress is:

A. Blanket

B. Interrupted

C. Purse-string

D. Simple continuous

They are packaged wet

Which of the following statements is TRUE regarding natural absorbable sutures?

A. They are packaged dry

B. They are packaged wet

C. They are braided multifilament strands

D. They have less tissue reaction than synthetics

Following

A way in which the surgical technologist can assist the surgeon by keeping the suture strand out of the way during a continuous running closure is by:

A. Following

B. Pulling

C. Tagging

D. Tracking

They may be used in infected wounds

Which statement is CORRECT regarding monofilament sutures?

A. They have high capillarity

B. They cause increased tissue drag

C. They are braided, twisted and coated

D. They may be used in infected wounds

PDS Plus

Which absorbable suture provides for the MOST extended wound support?

A. Vicryl

B. Monocryl

C. PDS Plus

D. Polysorb

Purse-string

Which suturing technique would be used to close the stump of the appendix in an open appendectomy?

A. Horizontal mattress

B. Vertical mattress

C. Purse-string

D. Retention

Polyglactin 910

Which type of synthetic mesh is absorbable?

A. Polyglactin 910

B. Polypropylene

C. Polyester fiber

D. PTFE

Intraluminal stapler

Which internal stapling device fires a circular double row of staples to reanastomose the colon?

A. Intraluminal stapler

B. Linear cutter

C. linear stapler

D. ligating clip applier

Polypropylene

Which of the following is synthetic, monofilament, nonabsorbable, and the most inert synthetic suture used frequently in cardiovascular and ophthalmology procedures?

A. Polybuster

B. Polypropylene

C. Polyterephthalate

D. Polytetrafluoroethylene

Synthetic, non-absorbable, monofilament with double-armed taper needles

Which type of suture is often used to create a vascular anastomosis?

A. Synthetic, absorbable, multifilament on a 3/8 circle cutting needle

B. Synthetic, non-absorbable, multifilament on a 1/2 circle taper needle

C. Synthetic, absorbable, monofilament on a keith straight needle

D. synthetic, non-absorbable, monofilament with double-armed taper needles

Skin closure tapes

What is used to close the epidermal layer when a subcuticular wound closure has been done for good cosmesis?

A. Suture bridge

B. Skin closure tapes

C. Split lead shots

D. Suture anchors

Green colored for bile ducts

Which of the following types of vessel loops are NOT available for use?

A. Blue colored for veins

B. Red colored for arteries

C. Yellow colored for nerves

D. Green colored for bile ducts

Cyanoacrylate

what is the chemical name for Dermabond or Indermil?

A. Cryoprecipitate

B. Cyanoacrylate

C. Fibrin glue

D. Polymethyl methucrylate

Traction

What would be the type of suture placed temporarily in the tongue to hold it out of the way in a maxillofacial procedure?

A. Purse-string

B. Retention

C. Suture ligature

D. Traction

Extracorporeal method

Which suture technique involves making a knot in the suture outside of the body and then pushing it inside through a cannula?

A. extracorporeal method

B. figure-of-eight stick tie

C. Intracorporeal method

D. Secondary suture line

Fascia

Which layer of the abdominal wall must be approximated securely even if the other layers are not?

A. Skin

B. Fascia

C. Peritoneum

D. Subcutaneous fat

More

In general, a monofilament suture would require __________ knot throws for security than a multifilament suture.

A. More

B. Fewer

C. The same number of

D. More, but only if coated

High-tensile strength and small diameter

To achieve the goal of leaving as little foreign material in a wound, the ideal suture selected should have:

A. Large diameter gauge

B. An antibacterial coating over it

C. Tightly braided fibers with capillarity

D. High-tensile strength and small diameter

Friable

What is the term for tissue that is easily torn or shredded?

A. Adhesive

B. Dehisced

C. Eviscerated

D. Friable

Third intention

By which intention would a purulent wound treated by debridement and placement of medicated packing, then sutured after resolution of the infection heal?

A. First intention

B. Second intention

C. Third intention

D. Primary union

Enzymatic digestion

Natural absorbable sutures are broken down in the body by:

A. Capillarity

B. Enzymatic digestion

C. Granulation

D. Metabolic factors

Homologous

What is the term for the blood products donated by another person?

A. Hemolytic

B. Hemostatic

C. Hemostasis

D. Homologous

Blood collected from sponges into a basin of sterile saline during repair of ruptured abdominal aortic aneurysm (AAA)

Which of the following is an example of acceptable and safe intraoperative autoinfusion blood collections?

A. Blood collected during a major abdominal trauma procedure with small bowel perforation

B. Bloody ascites fluid drained from the peritoneal cavity during surgery for ovarian cancer

C. Blood collected from sponges into a basin of sterile saline during repair of ruptured abdominal aortic aneurysm (AAA)

D. Bloody fluid suctioned during liver resection with use of reconstituted topical thrombin spray on oozing bleeders

Apportional

Which of the following is NOT a method of achieving hemostasis?

A. Apportional

B. Chemical

C. Mechanical

D. Thermal

Hemophilia

Which of the following is a genetic clotting deficiency?

A. Anaphylaxis

B. Aplastic anemia

C. Hemophilia

D. Hyperthermia

AB

Which blood type in considered the universal recipient?

A. A

B. B

C. AB

D. O

Aspirin

Elective surgery patients may be asked to discontinue use of which medication to prevent drug-therapy induced platelet dysfunction?

A. Antibiotics

B. Anticonvulsants

C. Antacids

D. Aspirin

Sponges

Kittners, cottonoids, and laps are surgical

A. Clamps

B. Ligatures

C. Sponges

D. Tourniquets