Science Quiz / Wound management and urinary surgery

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Can you name the Wound management and urinary surgery

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More colloquially known as a scrape, this is a wound caused by friction rubbing away part of the flesh?
 
This type of wound is a cut through the layers of skin and sometimes muscle?
 
What is the classification of a wound made under sterile conditions, away from GI, GU, respiratory or oropharyngeal cavities?
 
This type of wound is classified as such because of minimal contamination. Entry without spillage into GI, GU, respiratory or oro-pharyngeal cavities without spillage for example.
 
If an infection is present, or a septic exudate, or fecal contamination from a ruptured colon, the wound is?
 
If there is foreign material in a wound, or a major spillage from a hollow organ, the wound is?
 
Inflammation and debridement continue to day _ of healing, proliferation begins at day _ and ends around day 12.
 
 
How long does maturation or remodelling take?
 
True or false: the decision between first and third intention healing is based chiefly on the time elapsed?
 
This type of healing is encouraged by good suturing technique and can seal the epithelium within 24 h under ideal conditions.
It is considered delayed ____ ____ healing if a traumatic wound is closed, not immediately, but before granulation tissue has formed (usually within 1-5 days after the wound occured). 
If you interrupt secondary healing (by granulation tissue) to suture when there is less contamination and more tissue to work with this is?
 
True or false: second intention healing involves no medical management or surgical closure whatsoever?
 
Name a reason you'd employ primary closure?
 
True or false: all bite wounds are contaminated?
 
The risk of tissue ______ and ____ ____ formation is higher with bite wounds.
 
 
True or false: it may be necessary to give general anesthesia for initial wound management?
 
What should you place on a wound before you clip everything that's going under the bandage?
 
True or false: you may start with tap water initially for wound lavage?
 
True or false: hydrogen peroxide is an option along with dilute chlorhexidine and iodine for second or third round lavage?
 
A 35 cc and 18 gauge catheter or needle provides the ideal _-_ psi which cleanses the wound but does not push bacteria deeper.
 
This is a process you must perform on open wounds after lavaging, and prior to a second lavage (to remove gross debris and necrotic tissue).
 
True or false: you should debride red or purple tissue?
 
True or false: layered debridement is peformed beginning at the skin edges and working inwards.
 
This manner of debridement removes all contaminated tissues in a chunk and closes primarily, in areas with a lot of skin and tissues?
rarely possible 
Which of the following is not an indication for antibiotic prescription for a wound?
a) burn or bite wounds b)open fracture or joint c)deep wound with necrotic tissue d)open wound with insufficient skin to close e)immunosuppression 
Should yous top antibiotics after granulation tissue covers a wound for second intention healing?
 
True or false: amoxicillin is the best choice for gram positive staphylococci and E coli?
 
The golden period, although not set in stone, is generally considered from _-_ hours after injury.
The period when primary closure is possible. May not occur in wounds with too much contamination or tissue trauma. 
Which criterion is not an indication to treat as an open wound?
a)severe contamination b)older than 4 hours c)infected d)can't be closed e)none of the above 
True or false: second intention healing is less recommended in feline patients generally?
 
Name a characteristic of the ideal environment you should provide for the proliferative phase of wound healing under your bandage?
 
This type of bandage is named according to its' condition on applicaiton and removal.
It may be adherent to allow mechanical debridement. 
True or false: wet-to-dry bandaging should cease as soon as granulation tissue appears?
 
True or false: Pseudomonas bacteria thrive when fed sugar.
 
What property of sugar is lost when it attracts fluids and becomes syrup, necessitating bandage changes 1-2x per day?
 
True or false: honey should always be pasteurized for sterility if used in wound healing?
 
True or false: honey actually produces hydrogen peroxide at low concentrations, in a completely nontoxic manner?
 
Which bacterial species has been found to sometimes be resistant to the bactericidal effect of honey?
a) MRSA b)pseudomonas spp. c)E. coli d)helicobacter spp. e)none of the above 
Which of the following components of Medical grade Manuka honey is best for exudative wounds?
a)methylgyoxal b)calcium alginate c)hydrocolloid d)none of the above 
True or false: you should wait to see strike through before a bandage change?
 
Name an indication for immediate bandage change?
 
The species Lucilia sericata gives us medical ______
 
Which of the following would be least applicable for second intention healing bandages for granulating wounds?
a)honey dressing b)silver dressing c)gauze with petrolatum d)cellulose with polyester film 
This kind of dressing is bactericidal and fungicidal, noncytotoxic and increases epithelialization, but leaves grey, green tisues that smell.
 
True or false: grafting is often necessary after second intention healing?
 
What will form if you leave dead space before wound closure?
 
Which is a downside of penrose drains?
a)ineffective at allowing passive drainage b)expensive c)hard and uncomfortable for the animal d)rarely used, little in the literature e)cutaneous bacteria can enter the wound 
True or false: penrose drains should exit through a separate stab incision.
 
True or false: most penrose drains are removed within 24 hours, but may be in for a slong as a week?
 
True or false: penrose drains shoudl be remove donly when fluid production ceases?
 
The more common name for the Jackson-Pratt suction device?
 
Suture increases infection rate due to _____ ____ reaction, and you should use the ______ size possible.
 
 
Name a method of reducing suture tension?
 
True or false: towel clamps may be used to bring the edges of wounds together and test configurations to plan it out?
 
This technique involves tacking down the dermis to underlying fascia to decrease dead space?
 
The release of elastic skin from non-elastic underlying tissue is known as?
Achieved through combination of blunt and sharp disection. Place closed scissors below panniculus, open blades, pull back, repeat. 
The panniculus contains the subdermal plexus and is just above the ______ _______
 
Making multiple small cuts to allow primary closure of a tight wound is known as making ______ ______
 
True or false: a biological tourniquet may form due to second intention healing on limb wounds?
 
Why would hydroretropulsion (retrograde flush) be attempted to retrieve urethral obstruction?
 
What do you risk with a rigid catheters?
 
True or false: a stable animal may be left catheterized after successful retropulsion, and cystotomy peformed later?
 
In females, cystotomy is performed by a caudal abdominal midline incision. In males, a ______ midline incision.
 
Which of the following is true regarding dorsal incisions for cystotomy?
a)they suck b)they minimize post-op leakage c)they are less calculogenic d)you risk fewer abdominal wall adhesions e)there is a lower risk of ureteral trauma 
You can transect this ligament which attaches the bladder to the linea alba.
Hint: it's not the laterals, they contain nerves and ureters... NO TOUCHEY! 
If you flush during cystotomy what direction is recommended? (especially in males with larger stones)
 
True or false: cystotomy is closed in two layers, simple continuous (full thickness), then Lembert or Cushing in seromuscular layer.
 
For infected urine, what are your best choices of suture material for bladder closure?
 
I should definitely perform C and S on a sample of _____ _____, and probably the urine and calculi when performing cystotomy.
Also important to check that you got all radioopaque stones on post-op radiographs, and to analyze the stone composition to formulate a preventive plan. 
When performing pre-scrotal urethrotomy (after failure of hydroretropulsion), you must identify and retract this muscle after skin incision?
 
What sutures should you use to close pre-scrotal urethrotomy?
 
True or false: you should leave the catheter in after urethrotomy during hte 2 weeks of healing?
 
If you anticipate that it will take a while to stabilize a patient for urethrostomy, what are your options to eliminate urine in the meantime?
You may need to perform the second option quickly with a patient under sedative and local if it's unstable and blocked. 
This procedure creates a permanent sutured urethral opening between the urethra and the skin.
Most commonly necessary in cats and dalmatians with recurrent obstructive calculi, no medical management options or response. 
Which of the following is NOT a normal complicaiton of urethrostomy?
a)incontinence b)UTI c)localized skin irritation (urine scalding) d)all of the above are likely complications 
This procedure involves a purse string in the ventral aspect of the bladder, and an exit of a tube through a paramedian stab incision.
 
True or false: you can simply pull out a temporary cystostomy tube, and it will close on its own in 3-5 days?
 
_____ urethrostomy is a last resort. _____ is the #1 site for cats, ______ for dogs.
 
 
 
Which would you prefer for scrotal urethrostomy, simple continuous or simple interrupted closure?
 
True or false: scrotal urethrostoy usually bleeds spontaneously for 3-5 days?
 
What's the general rule as to the number of episodes of obstruction a cat has before perineal urethrostomy is performed?
 
You should be further along the urethra than these glands when performing perianal urethrostomy in cats?
 
True or false: it's important to not catheterize after urethrostomy operations in general?
 
What is the most common cause of bladder rupture?
 
If you perform an abdominocentesis and find over _:_ creatinine ratio in abdominal fluid:serum, this is gold standard positive for rupture?
 
True or false: uroabdomen is always a medical emergency (in the absence of UTI)?
 
True or false: contrast radiography is helpful after a patient is stabilized, as you should localize the rupture before performing surgery?
 
True or false: one can resect up to 75% of bladder wall while debriding necrotic areas?
 
True or false: omental patching is routine when repairing bladder ruptures?
 
This is the usual diagnostic procedure when urethral rupture is suspected. It requires sedation and allows localization, before catheterization.
 
How long should one catheterize a urethral trauma patient?
This allows healing, and can avoid surgery, typically works except with full transections. Give prophylactic antibiotics to decrease stricture risk. 
There's a neoplastic obstruction in the urinary system. What are the two most likely types?
 
 
This condition is repaired by resection of redundant tissue and suturing around the tip of the penis over a catheter with 4-0 monocryl.
Most common with yorkies, bulldogs, bostons, etc. Associated with UTI, stones or erection. 
This breed is most likely to suffer from transitional cell carcinoma (18x more than average)
Rarely treated with surgery, mostly NSAIDs and chemo. 
True or false: You tend to see an average survival time of a little over a month for TCC, if a stent is required.
 

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