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PA Clinical Skills > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

What needs to be worn in the OR at all times?

A

Scrubs
Shoe covers
Hats
Masks

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2
Q

What parts of gowns are sterile?

A

From chest level to level of sterile field

From above elbows to cuffs

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3
Q

Why should clippers be used rather than shaving for removal of hair prior to surgery?

A

Shaving is more likely to cause a bunch of small cuts

Opportunities for infection

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4
Q

What are some rules to draping?

A 
Handle drapes as little as possible
Never reach across bed
Hold drape high
Protect gloved hands by cuffing
Any holes must be covered
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5
Q

What is an operative note?

A

Very brief summary of procedure
Written immediately after procedure
Can be written by a PA

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6
Q

What are indications for an NG tube?

A

Sampling gastric contents
Nutritional support
Removing air, blood, ingested substances and gastric contents
Diverticulitis, GI bleeding, Gastric outlet obstruction, intestinal obstruction, near drowning, vomiting

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7
Q

What are contraindications to NG tube?

A 
Obstruction
Damage to structures NG tube would touch
Choanal atresia
Facial trauma
Basilar skull FX
Esophageal stricture
Esophageal burn
Recent surgery on stomach or esophagus
History of gastrectomy
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8
Q

What are complications of NG tube?

A 
Insertion into trachea and lung
Bleeding
Aspiration pneumonia
Gastric erosion
Trauma
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9
Q

How do you confirm that the NG tube is in the stomach?

A

Radiograph
Aspirate
Inject 10 mL air and listen over LUQ
Place end of tube in water, bubbles = lungs

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10
Q

What sizes are used for NG tubes?

A

Neonates, infants, or patients with esophageal problems get 3 - 8 French
Healthy adults get 10 - 18 French

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11
Q

What are contraindications for the drainage of an abscess?

A

Located within triangle made by the bridge of the nose and corners of the mouth
Abscess near anus or genitals

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12
Q

What patients need close observation following I&D

A

DM
Immunocompromised
Debilitating disease

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13
Q

What are complications to I&D?

A 
Cellulitis
Bacteremia
Septicemia
Chronic anal fistula
Deep infection
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14
Q

What is a dry abscess?

A

One that resolves without rupture

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15
Q

What is a sterile abscess?

A

One from which bacteria can not be cultured

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16
Q

What is a chronic/cold abscess?

A

Lacks redness, heat, pain, or swelling

Associated with liquefactive necrosis of TB lesions

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17
Q

What is a hot lesion?

A 
Hot
Redness
Pain
Swelling
Fluctuant on palpation
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18
Q

What are the different types of abscesses?

A

Furuncle/boil - sweat gland/hair follicle
Carbuncle - furuncle that extends into SC tissue
Paronychia - abscess involving nail
Perifollicular abscess - on extremities, buttocks, breasts, or hair follicles

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19
Q

What should be used to clean the skin for an I&D?

A

Povidone - iodine

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20
Q

What way should anesthesia be given for an I&D?

A

Field block

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21
Q

Why should sutures not be given for an I&D?

A

It is infected tissue

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22
Q

In what situations should antibiotics be given for I&Ds.

A

Surrounding cellulitis
Lymphangitis
Strange bacteria

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23
Q

What types of bandages should be applied to I&Ds post op?

A

Nonadherent dressings
Adaptic
Telfa

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24
Q

What are indications for a chest tube to be inserted?

A

Pneumothorax
Hemothorax
Pleural effusion
Empyema

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25
What are contraindications to insertion of a chest tube?
Bleeding diathesis Coagulopathies Skin infection
26
What are some complications of a chest tube?
``` Re-expansion pulmonary edema SubQ emphysema Intercostal neuralgia Organ perforation Bleeding Infection ```
27
Where should a chest tube be inserted?
In the 4th intercostal space | On top of the rib
28
What is the triangle of safety for a chest tube insertion?
Lateral pec major (anterior) Mid axillary line (posterior) Nipple line (inferior) Axilla (apex)
29
What type of anesthesia should you use for a chest tube?
1% lidocaine | Local anesthesia
30
What equipment should be used for a chest tube?
``` Size 11 blade scalpel Kelly curved clamps Non-absorbable suture 25 and 21 gauge needles Chest tube (24 to 36 French) ```
31
What is a shave biopsy?
Removes epidermis and portion of upper dermis | Performed along horizontal plane
32
What are indications for a shave biopsy?
``` Seborrheic keratosis Verrucous lesions (wart) Molluscum contagiosum Superficial basal cell carcinoma Benign nevus Things will have a "stuck on" appearance ```
33
What is the benefit of a shave biopsy?
Doesn't scar because it doesn't go very deep
34
When should a curettage not be used?
If you need to determine tumor margins
35
What are contraindications to a shave biopsy?
Pigmented lesions Diagnosis of infiltrative dermatoses Sclerosing basal cell carcinoma Any lesion with dermal component
36
What can be used to reduce the bleeding with a shave biopsy?
20% aluminum chloride Hand held cautery Monsel's solution (caution) Silver nitrate (caution)
37
What instruments can be used to perform a shave biopsy?
Size 15 scalpel | Demablade
38
How long should a lesion be kept clean and dry following removal?
24 hours
39
What are the two types of punch biopsys?
Incisional - removes portion | Excisional - removes entire
40
What are contraindications to a punch biopsy?
Lesions with suspected malignant potential
41
When should topical anesthetic be applied for a lesion removal?
20 - 60 minutes before the procedure
42
What are the disposable sizes for punch biopsy?
2, 3, 4, 6, and 8 mm
43
What does histological exam of a punch biopsy require?
Two samples or one 6 mm biopsy with directions to split it into two lesions
44
When should sutures be removed following lesion excision?
``` Face: 5 - 7 days Neck: 7 days Scalp: 7 - 10 days Trunk and extremities: 7 - 14 days Distal LE: 10 - 21 days ```
45
When should an excisional biopsy be performed?
Any lesion greater than 1 cm | Improved cosmetic result over punch biopsy
46
What is a Mohs procedure?
Micrographic surgical procedure
47
When should a Mohs procedure be done?
Sclerosing or morpheaform basal cell carcinomas Recurrent tumors Any malignant tumor around the eye, nose, lips, or ears
48
What are indications for intubating a patient?
Lost ability to maintain airway Patient at risk for losing ventilation ability Bypassing obstructions Suction lower airway secretions and foreign materials
49
What are contraindications for intubation?
Laryngeal disruption
50
What is the most common complication of intubation?
Broken teeth
51
What are other complications that can occur with intubation?
``` Cervical spine injuries Ocular injuries PTSD Hypertension Speech problems ```
52
What is the narrowest portion of the adult larynx? | Pediatric larynx?
Adult: vocal cords Pediatric: Cricoid cartilage
53
What does the mallampati score represent?
How visible the palate is | Higher number means more difficult intubation
54
What are the main sedation options for patients undergoing intubation?
Anxiolytics Analgesics Paralytics
55
How should a patient be positioned when they are about to be intubated?
Patient head at practitioner's xiphoid process | Patient in sniffing position
56
How do you measure oropharyngeal airway length? | Nasopharyngeal airway?
OPA: Corner of mouth to angle of jaw NPA: tip of nose to tragus of ear
57
What is the difference between a Macintosh and Miller laryngoscope?
Macintosh is curved | Miller is straight
58
What size or tracheal tube is typically used during intubation?
Men: 7.5 - 8.5 Women: 7 - 8 Max is 10 mm Pediatrics: 4 + age / 4
59
What is the function of a stylet during intubation?
It is a malleable metal that helps guide the intubation tube
60
What are initial conservative treatments for ingrown toenails?
``` Elevation of nail Oral antibiotics Frequent soaking Loose fitting shoes Selective trimming of nail ```
61
What is oncyhocryptosis?
Ingrown toenail
62
What is oncyhomycosis?
Fungal infection of nail
63
What is paronychia?
Inflammation of the nail fold
64
What is oncyhogryposis?
Deformed curved nail
65
What are contraindications for nail removal?
Bleeding disorder | Allergy to local anesthesia
66
What needs to be applied to the nail matrix during a permanent removal?
Phenol solution
67
How do you anesthetize a toe prior to nail removal?
1% lidocaine 5 mL Scrub with povidone-iodine prior to removal
68
What are follow up instructions for patients after they have had a nail removed?
Keep foot elevated for 24 - 36 hours | Soak toe in warm water twice a day for several days
69
What are contraindications for draining of a subungal hematoma?
``` Crushed/fractured nails Fracture of distal phalanx Suspected subungal melanoma Artificial acrylic nails Hematomas involving more than 50% of the nail ```
70
What are follow up instructions for patients following a subungal hematoma drainage?
Soak digit in warm, soapy water 2-3 times daily
71
What is the difference between a cast and a splint?
Cast - completely encases circumference | Splint - encases only part of extremity
72
Why is a splint done over a cast?
Allows for swelling | Done in the swelling phase
73
What is important about plaster material when used for casts?
``` Easier to mold Heavier Not as durable Messy Generates more heat ```
74
What is important to know about fiberglass for casts?
``` Strong Light weight Less malleable Water resistant Less heat generated More expensive ```
75
What are contraindications to casting and splinting?
Avoid casting in acute phase (3-4 days) Don't cover known skin infection Don't cover open wounds that could become infected
76
What are complications of casting and splinting?
Compartment syndrome Cast dermatitis Pressure sores Nerve injuries
77
What is used to remove a cast?
Oscillating cast saw
78
What are indications for joint aspiration?
``` Trauma Monoarticular inflammation Suspicious systemic rheumatologic disorder Articular inflammation Synovial fluid analysis ```
79
What does normal synovial fluid look like?
Straw colored Clear Viscous
80
What does the mucin clot test show in RA?
Lack of tight ropy clot formation when acetic acid is added to joint fluid
81
What are the cell counts for normal, inflammatory, and infectious synovial fluid?
Normal - <200 WBC, <2,000 RBC Inflammatory - 2,000 - 100,000 WBC Infectious - 50,000 - 200,000 WBC, >75% PMNs
82
What is the indication for bursal aspiration?
Bursal swelling that continues in spite of conservative measures
83
What are contraindications to bursa aspiration?
Risks of introducing bacteria outweigh benefits Burns Infected skin Infected subQ tissue
84
What are contraindications for joint aspiration?
Risks of introducing bacteria outweigh benefits After total joint procedures Bleeding not controlled in hemophiliac patient
85
What are potential complications to joint aspiration?
``` Intra-articular injury Reaccumulation of fluid Injury to vascular or neural structures Allergic reaction Infection Pain Bleeding ```
86
What are potential complications to bursa aspiration?
``` Baker's cyst Popliteal bursae Communication between olecranon bursa and elbow joint in RA Chronic recurrence Chronic drainage Pain Infection ```
87
Why does synovial fluid have to be aspirated before three or after 7 days of swelling?
Clotting process occurs 3-7 days after injury
88
What is the prep for joint aspiration?
``` Scrub area with povidone-iodine Use 1% lidocaine Enter anteromedially or anterolaterally Use an 18 gauge needle Joint at 90 degrees ```
89
What are the diagnostic indication for a lumbar puncture?
Infectious: meningitis and encephalitis Inflammatory: MS and guillan barre Oncologic: leukemia Subarachnoid hemorrhage
90
What will you see on a lumbar puncture with subarachnoid hemorrhage?
CSF with xanthochromic color
91
What are the therapeutic indications for a lumbar puncture?
Spinal and epidural anesthesia Chemotherapeutic agents Antibiotics Lowering CSF pressure
92
What are contraindications for a lumbar puncture?
``` Increased intracranial pressure: focal neurologic signs Localized skin infection Cardiorespirartory compromise Bleeding diathesis Previous lumbar surgery ```
93
What are complications of lumbar punctures?
``` Cerebellar herniation Headache Subarachnoid epidermal cyst CSF leakage Pain Bleeding Infection ```
94
What add additional challenges to a lumbar puncture?
``` Obestity Osteoarthritis Degenerative disk disease Kyphoscoliosis Prior surgery ```
95
How should the needle be angled during a lumbar puncture?
Towards the umbilicus
96
What type of needle is used for a lumbar puncture?
Spinal needle | 20-22 gauge
97
Anatomically where should a lumbar puncture be done?
Between L3 and L5
98
What are indications for topical hemostats?
Capillary oozing Hard to reach areas Oozing from suture lines CSF leaks
99
When irrigating a laceration how much fluid should you use?
Minimally 250 to 500 mL of sterile saline
100
What is wound strength at two weeks? One month? 10 weeks?
Two weeks - 10% One month - 40% Ten Weeks - 80%

PA Clinical Skills (2 decks)

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