Surgical Tech ( Appleton and Lange) Part 11

The saphenous vein and internal mammary artery are harvested for a coronary artery bypass. The saphenous vein is commonly used as a graft to bypass blocked coronary arteries, while the internal mammary artery, located in the chest, is also often used as a graft due to its proximity to the heart and its ability to provide a good blood flow. These vessels are harvested from the patient's own body and are used to reroute blood flow around blocked or narrowed coronary arteries, improving blood supply to the heart muscle.

Perfusion is the correct answer because it accurately describes the function accomplished by the cardiopulmonary bypass machine. Perfusion refers to the process of providing oxygenated blood to the body's tissues and organs while bypassing the heart and lungs. The cardiopulmonary bypass machine takes over the function of the heart and lungs during certain medical procedures, such as open-heart surgery, by circulating and oxygenating the blood. Therefore, perfusion is the term used to denote this function accomplished by the machine.

ESWL uses shock waves to break down kidney stones. These shock waves are generated outside the body and then transmitted into the body through a medium. Water is the most commonly used medium for ESWL as it efficiently transmits the shock waves and allows for precise targeting of the stones. Water also helps to minimize any discomfort or pain during the procedure. Therefore, water is the correct answer for the medium used in ESWL.

The ideal requirements for cadaver donors include being free of infection or malignancy, normotensive up until death, and being under hospital observation before death. However, "any age" is not an ideal requirement for cadaver donors. This suggests that there may be age restrictions or preferences when it comes to cadaver donors.

The Braasch bulb is not used for dilating urethral strictures. Philips filiform and followers, Van Buren sounds, and McCarthy dilators are all commonly used instruments for this purpose. The Braasch bulb may be used for other procedures, but not specifically for dilating urethral strictures.

Kanamycin and Bacitracin are antibiotics that are commonly used to prevent infection during surgical procedures. In the case of penile implant insertion, it is important to minimize the risk of infection at the insertion site and around the implant. Therefore, irrigating the insertion site and the implant with Kanamycin and Bacitracin helps to reduce the chances of bacterial contamination and subsequent infection. Normal saline, Betadine, and sterile water do not possess the same antimicrobial properties as Kanamycin and Bacitracin, making them less effective in preventing infection in this context.

A tunneler is a surgical instrument used to create a tunnel under the skin or through tissues. In a femoral-popliteal bypass surgery, a graft is used to bypass a blocked or narrowed femoral artery, restoring blood flow to the lower leg and foot. During this procedure, a tunneler may be used to create a tunnel through which the graft can be threaded, allowing it to be placed in the correct position. Therefore, a tunneler would be used in a femoral-popliteal bypass surgery.

A carotid endarterectomy is a surgical procedure performed to remove plaque from the carotid artery. Plaque is a buildup of fatty substances, cholesterol, calcium, and other substances in the artery walls. This buildup can narrow or block the artery, leading to reduced blood flow to the brain and increasing the risk of stroke. Removing the plaque helps restore normal blood flow and reduces the risk of stroke. Therefore, the goal of a carotid endarterectomy is to remove plaque.

A percutaneous nephrolithotomy is a minimally invasive procedure used to remove kidney stones. It involves creating a small incision in the back and using specialized instruments to access and remove the stones. The procedure typically utilizes an ultrasound wand to locate the stones, a flexible nephroscope to visualize and remove the stones, and a lithotriptor to break up larger stones. However, a lithotriptor tub is not used in this procedure. A lithotriptor tub is a device used in extracorporeal shock wave lithotripsy (ESWL), a different procedure that uses shock waves to break up kidney stones from outside the body.

Mediastinal shift refers to the movement of the mediastinum, which is the space in the middle of the chest between the lungs. A reduction of negative pressure on one side of the thoracic cavity, such as in the case of a pneumothorax (collapsed lung), can cause the mediastinum to shift towards the affected side. This occurs because the negative pressure on the normal side of the thoracic cavity pulls in an effort to equalize pressure. Therefore, mediastinal shift is the correct answer in this context.

In the case of a patient experiencing a ventricular fibrillation, the correct action to be followed is to defibrillate. Ventricular fibrillation is a life-threatening condition characterized by abnormal and chaotic electrical activity in the heart, causing the ventricles to quiver instead of pumping blood effectively. Defibrillation involves delivering an electrical shock to the heart to restore its normal rhythm. This procedure aims to stop the chaotic electrical activity and allows the heart to resume its normal pumping function.

When a knitted graph is preclotted, it minimizes bleeding. Preclotting refers to the process of allowing the graft to form a clot or thrombus before implantation. This clot helps to seal any potential bleeding points and reduces the risk of excessive bleeding during and after the graft placement. By minimizing bleeding, preclotting ensures better hemostasis and improves the overall success and outcome of the graft procedure.

Chordee is the correct answer because it refers to a condition where the male penis is curved ventrally, meaning it bends downward. This curvature causes the meatus (the opening of the urethra) and the glans (the head of the penis) to be in close proximity to each other. Paraphimosis refers to the retraction of the foreskin behind the glans and inability to pull it back to its original position. Phimosis refers to the tightness of the foreskin that prevents it from being pulled back. Epispadias is a condition where the urethra opens on the upper side of the penis.

To complete a single-lung transplant, three anastomoses must be performed. An anastomosis is a surgical connection between two blood vessels or organs. In the case of a lung transplant, the first anastomosis is performed between the pulmonary artery of the donor lung and the recipient's pulmonary artery. The second anastomosis connects the donor lung's pulmonary vein to the recipient's pulmonary vein. Lastly, the bronchus of the donor lung is connected to the recipient's bronchus, which is the third anastomosis. These three anastomoses are crucial in establishing the necessary blood flow and airway connections for a successful lung transplant.

The cooling and flushing of pancreas, liver, and kidneys of cadaver donors is achieved by cannulation of the organ and infusion of large amounts of Ringer's lactate solution. Ringer's lactate solution is commonly used in medical procedures as it contains electrolytes that help maintain the body's fluid balance. It also provides a source of energy for cells and helps prevent acidosis. Therefore, using Ringer's lactate solution for cooling and flushing the organs ensures that they are properly preserved and prepared for transplantation.

Arterial blood gases are used as an intraoperative diagnostic test to measure tissue perfusion. This test provides information about the oxygen and carbon dioxide levels in the blood, as well as the pH and bicarbonate levels. By analyzing these parameters, healthcare professionals can assess the adequacy of tissue oxygenation and ventilation, which are crucial for optimal tissue perfusion. Therefore, arterial blood gases are a valuable tool in monitoring and managing patients during surgery to ensure sufficient tissue perfusion and overall patient well-being.

Disposable chest drainage units are used to provide drainage collection from the intrapleural space, maintain a seal to prevent air from entering the pleural cavity, and provide suction control determined by water level. However, they do not aid in re-establishing positive pressure in the intrapleural space. Positive pressure in the intrapleural space can be achieved through other methods such as positive pressure ventilation or positive end-expiratory pressure (PEEP).

Bailey is the correct answer because it is a surgical instrument commonly used to reapproximate the ribs following an open thoracotomy. The Bailey rib contractor is specifically designed for this purpose, allowing the surgeon to hold and manipulate the ribs during the procedure. It helps in achieving proper alignment and stability of the ribs, facilitating the healing process and reducing the risk of complications.

Decortication of the lung refers to the surgical removal of fibrous deposits on the visceral and parietal pleura. This procedure is performed to treat conditions such as pleural effusion, empyema, or fibrosis, where the fibrous tissue restricts lung expansion and causes breathing difficulties. By removing the fibrous deposits, the lung is able to expand more freely, improving lung function and relieving symptoms.

The Garceau tapered tip is used to dilate the ureter. This catheter has a tapered tip that allows for easy insertion and dilation of the ureter. It is commonly used in medical procedures to widen or open up a narrowed or blocked ureter.

Collin's solution is used to preserve a donor lung before transplant into a recipient.

A resectoscope is a surgical instrument used for transurethral resection of the prostate (TURP) or other procedures in the urinary tract. It is designed to remove tissue or perform other surgical interventions. To ensure safety during the procedure, a nonconducting, isomotic glycine irrigating solution must be used. This solution helps to maintain the correct balance of fluid and electrolytes in the body and prevents electrical conduction, reducing the risk of complications. Therefore, a resectoscope requires the use of this specific irrigating solution.

A retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an abdominal incision made in the anterior prostatic capsule. This approach allows the surgeon to access the prostate gland from the front, or anterior, side of the body. The term "retropubic" refers to the location of the incision, which is made below the pubic bone. This procedure is commonly used for the treatment of prostate cancer and other conditions affecting the prostate gland.

In cardiac surgery, hypothermia is employed to reduce oxygen consumption. Lowering the body temperature during surgery decreases the metabolic rate of the patient, which in turn reduces the amount of oxygen the body needs to function. This is beneficial during cardiac surgery as it allows the heart to work at a slower rate, making it easier for the surgeon to perform the necessary procedures. By reducing oxygen consumption, hypothermia helps protect the heart and other organs from potential damage during the surgery.

The given correct answer for this question is "Candela." Laser lithotripsy is a medical procedure that uses lasers to break down kidney stones. Candela is a well-known brand that manufactures medical lasers, including lasers used in lithotripsy procedures. Therefore, it is likely that the correct answer in this context refers to the specific laser device manufactured by Candela that is used in laser lithotripsy.

Amputated extremities are wrapped and refrigerated in the morgue because this method helps to preserve the specimens and prevent decomposition. Wrapping the extremities helps to protect them from any external contamination, while refrigeration slows down the growth of bacteria and other microorganisms that can cause decay. This ensures that the specimens remain in a suitable condition for further examination and analysis in the pathology lab. Placing the extremities in a dry container would not provide the necessary preservation and could lead to deterioration.

A suprapubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision made in the lower abdomen, just above the pubic bone. This procedure is done by accessing the prostate gland through the bladder, hence the term "suprapubic". It is different from a transurethral prostatectomy, which is a minimally invasive procedure done through the urethra, and a suprapubic cystostomy, which is the creation of a surgical opening in the bladder for drainage purposes.

In balloon angioplasty, a procedure used to open narrowed or blocked blood vessels, a dilating balloon is used to widen the vessel. The balloon is inflated with a diluted solution of contrast media. Contrast media is a substance that helps visualize blood vessels on X-ray images, allowing the surgeon to see the area being treated more clearly. By diluting the contrast media, it ensures that the balloon is properly inflated and can effectively widen the blood vessel without causing any damage or complications.

Urethroplasty is the alternative approach to surgical TURP that has resulted from advances in radiologic techniques and balloon catheter technology. Urethroplasty is a surgical procedure used to repair or reconstruct the urethra, the tube that carries urine from the bladder to the outside of the body. It is a viable alternative to surgical TURP because it utilizes the advancements in radiologic techniques and balloon catheter technology to effectively treat urethral conditions without the need for traditional surgical methods.

The question is asking for the option that is NOT a procedure for continent urinary diversion postcystectomy. A continent urinary diversion is a surgical procedure that creates a new way for urine to be stored and eliminated from the body after the removal of the bladder. The Kock pouch, Indiana pouch, and "Le bag" are all options for continent urinary diversion. However, the ileal conduit is not a continent urinary diversion procedure. Instead, it involves creating a stoma on the abdomen and diverting urine through a small piece of the small intestine (ileum) to a urostomy bag outside the body.

Pyelostomy is the correct answer because it refers to the temporary diversion of urinary drainage by using an external catheter to drain the renal pelvis. Vesicostomy is the creation of an artificial opening in the bladder for urinary diversion, while nephrostomy involves the insertion of a catheter directly into the kidney to drain urine.

A soft stent is left in place to ensure free drainage of the kidney postoperatively following an anastomosis of a ureter during a ureteral reimplantation procedure. The stent helps to keep the ureter open and allows urine to flow freely from the kidney to the bladder. This helps to prevent any obstruction or leakage of urine and promotes proper healing and recovery after the surgery.

A nephrostomy is a temporary urinary diversion procedure where a tube is inserted directly into the kidney to drain urine. It is used in cases of urinary obstruction or when the bladder cannot be accessed. Unlike the other options listed, which are all permanent urinary diversions, a nephrostomy is not considered a permanent solution as it is typically used as a temporary measure until the underlying issue can be resolved or a more permanent diversion can be performed.

After making an incision into the scrotum during a vasectomy, the forceps used to grasp the vas and bring it to the surface for surgery is the Allis forceps. The Allis forceps have a toothed surface that provides a secure grip on the tissue, allowing the surgeon to manipulate and hold the vas deferens during the procedure. This helps in ensuring accurate and controlled surgical maneuvers during the vasectomy.

Thoracic outlet syndrome refers to the compression of the subclavian vessels and the brachial plexus, typically caused by the first rib. It is a condition that can result in pain, numbness, and weakness in the upper extremities. Surgical intervention may be necessary to relieve the compression and alleviate the symptoms. Cervical sympathectomy and thoracic sympathectomy are unrelated procedures that involve the removal of sympathetic nerves in the neck and thoracic regions, respectively. Decortication is a surgical procedure that involves the removal of the outer layer of a structure, typically the lungs.

A reverse sterilization procedure in the male is called a vasovasostomy or an epididymovasostomy. Both options B and C are correct because they refer to different types of reverse sterilization procedures in males. A vasovasostomy involves reconnecting the vas deferens, while an epididymovasostomy involves connecting the vas deferens directly to the epididymis. Both procedures aim to restore fertility in men who have previously undergone sterilization.

Talc is introduced through a thoracoscope to deal with recurrent pleural effusion attributable to advanced cancer. Talc is commonly used as a sclerosing agent in pleurodesis, a procedure to create adhesions between the pleural layers, preventing the accumulation of fluid in the pleural space. This helps to manage pleural effusion and relieve symptoms in patients with advanced cancer. Talc is preferred due to its ability to effectively induce pleurodesis and its low cost compared to other substances like chemotherapeutics, tetracycline, or hemostatic agents.

The correct answer is radial artery and cephalic vein. These vessels are commonly used for access procedures in hemodialysis. The radial artery is accessed for arterial blood flow, while the cephalic vein is accessed for venous blood flow. This combination allows for the exchange of blood between the patient and the dialysis machine, facilitating the removal of waste products and excess fluid from the body. Using the radial artery and cephalic vein for access helps to ensure effective and efficient hemodialysis treatment.

Transcystoscopic urethroplasty is a surgical approach that utilizes a cystoscopic setup as its base. This procedure involves repairing or reconstructing the urethra using a cystoscope, a thin tube with a camera that is inserted through the urethra. It is a minimally invasive technique that allows for precise visualization and manipulation of the urethra, reducing the risk of complications and promoting faster recovery compared to traditional open surgery. This alternative approach is effective in treating various urethral conditions such as strictures or obstructions.

Ti-Cron would be the suture of choice for a graft-to-tissue anastomosis in vascular surgery because it is a non-absorbable, braided polyester suture that provides excellent tensile strength and resistance to tissue slippage. It is also easy to handle and tie securely, making it ideal for vascular surgery where the sutures need to withstand high tension and maintain long-term durability.

A cystostomy is a method of bladder drainage that diverts urine away from the urethral vaginal area. It involves creating a surgical opening in the bladder wall and inserting a catheter to allow urine to drain out. This procedure is commonly used in cases where the normal flow of urine is obstructed or when there is a need for long-term bladder drainage. The other options listed, Foley catheterization, ileal conduit, and Stamey procedure, are not specifically designed to divert urine away from the urethral vaginal area.

Pyeloplasty is the correct answer. Pyeloplasty is a surgical procedure that involves the correction of a redundant renal pelvis and the resection of a stenotic portion of the ureteropelvic junctions. It is performed to relieve the obstruction and improve the drainage of urine from the kidney to the bladder. The Foley Y-V procedure, ureteroplasty, and ureteropyeloscopy are not specifically related to the correction of a redundant renal pelvis and resection of a stenotic portion of the ureteropelvic junctions.

Placement of a vascular graft proximal to and inclusive of the common iliac vessels indicates that the graft needs to be inserted in a way that it branches out into two separate limbs. This is necessary to accommodate the blood flow in the two iliac vessels. Therefore, the correct answer is a bifurcated graft, which is designed specifically for this purpose. An autogenous graft is a graft taken from the patient's own body, and it may not be suitable for this particular placement. A straight Teflon graft and a polytetraflurethylene graft are not designed to bifurcate and would not be appropriate in this scenario.

Mannitol is the drug of choice for adequate diuresis of a living donor before, during, and post-removal of the kidney. Mannitol is a diuretic that works by increasing the osmolarity of the filtrate in the renal tubules, leading to increased water excretion. This helps to promote diuresis and maintain urine output during the procedure. Additionally, mannitol also has a protective effect on the kidneys by reducing the risk of ischemic injury during surgery. Therefore, mannitol is the most appropriate choice for achieving adequate diuresis in this context.

Cardiac catheterization refers to the process of inserting a sterile catheter into the heart through either the brachial or femoral artery. This procedure is done to perform image intensification, allowing for a clearer view of the heart. Angiography involves imaging blood vessels using contrast dye, while arteriography focuses specifically on imaging arteries. Cardioscopy refers to the use of a tiny camera to visualize the heart. Therefore, the correct answer is cardiac catheterization.

The correct answer is Nd:YAG because it is a type of laser commonly used in medical procedures, including the destruction of small recurrent bladder tumors. Nd:YAG lasers have a longer wavelength, which allows them to penetrate deeper into tissue, making them effective for treating tumors located in the bladder. CO2 and argon lasers are also used in medical procedures, but they are not specifically mentioned in the context of destroying bladder tumors. Therefore, the correct answer is Nd:YAG.

IAPP stands for intra-aortic balloon pump, which is a cardiopulmonary technique that employs the principle of counterpulsation. Counterpulsation is a method used to increase cardiac output by assisting the heart during the cardiac cycle. The intra-aortic balloon pump works by inflating during diastole, which increases coronary blood flow and reduces the workload on the heart. It then deflates during systole, which decreases the afterload and improves cardiac output. Therefore, IAPP is the correct answer as it is a technique that utilizes counterpulsation to enhance cardiac output.

Decompression of the portal circulation can be achieved through various surgical procedures, such as splenorenal shunt, portocaval anastomosis, and mesocaval shunt. These procedures create alternative pathways for blood flow, diverting it away from the portal vein and reducing portal hypertension. However, an arteriovenous shunt does not decompress the portal circulation. Instead, it creates a direct connection between an artery and a vein, bypassing the liver altogether. This can lead to complications such as high-output cardiac failure and should be avoided in the management of portal hypertension.

Hydrocelectomy is the correct answer because it involves the surgical removal of the tunica vaginalis, which is the sac surrounding the testicles. This procedure is performed to treat a hydrocele, which is a buildup of fluid in the scrotum. By excising the tunica vaginalis, the surgeon can remove the excess fluid and alleviate the symptoms associated with a hydrocele. Vagotomy is the surgical cutting of the vagus nerve to reduce stomach acid production, vasectomy is the surgical sterilization of the vas deferens to prevent sperm from reaching the semen, and varicocelectomy is the surgical removal of varicose veins in the scrotum.

Fluoroscopy is a technique that uses X-ray imaging to visualize real-time moving images of the internal structures of the body. It is commonly used in various vascular procedures to guide the placement of devices or to assess the flow of blood. However, myocardial pacing electrode placement does not typically require fluoroscopy as it is a procedure that involves the insertion of a pacing lead directly into the heart muscle. This procedure is usually performed under direct visualization using other imaging techniques such as echocardiography or electrocardiography. Therefore, fluoroscopy is not required for myocardial pacing electrode placement.