Exam 2 Office Procedures Flashcards
(23 cards)
What is informed consent?
A discussion led by the physician covering material facts about the procedure, including diagnosis, proposed procedure, alternative treatment options, risks, and benefits.
What material facts must be disclosed by the physician during informed consent?
- Diagnosis
- Proposed procedure
- Alternative treatment options
- Risks and benefits of treatment
- Risks of refusing treatment
Who must be advised of the personnel involved in a procedure?
Patients must be informed about all personnel and their roles, without needing to name them specifically.
Can patients refuse to allow students or residents to participate in their care?
Yes, patients can refuse students or residents, and physicians can refuse to care for patients who do not allow their participation.
What must physicians do if asked about their experience with a procedure?
Physicians must answer truthfully regarding how many times they have performed the procedure and their success rates.
What should be documented during the informed consent process?
Material facts discussed, the individuals present, and the date and signature.
List potential complications that can occur with dermatologic procedures.
- Damage to underlying structures
- Dyspigmentation
- Recurrence or incomplete treatment
- Infection
- Bleeding
- Keloid formation
When is antibiotic prophylaxis indicated prior to a skin procedure?
Only for patients at risk for endocarditis or prosthetic joint infections, or for specific conditions such as infected skin or certain anatomical areas.
What medications should be discontinued prior to skin procedures?
- ASA/NSAIDs for reasons other than antithrombotic: discontinue 5-7 days prior
- Antithrombotic agents do not need to be discontinued.
Under what conditions should tetanus immune globulin be administered for a skin wound?
- Unknown vaccination status
- Incomplete vaccination series
- Vaccinated but >10 years since last dose
- Vaccinated but with a dirty wound >5 years
- Contaminated wound in HIV or severely immunocompromised patients
Which type of injection causes the least pain?
Subcutaneous injections are less painful compared to intradermal injections.
What strategies can decrease pain during local anesthesia administration?
- Add sodium bicarbonate to Lidocaine
- Inject slowly and perpendicular
- Warm the solution
- Apply stroke, vibration, or pressure
- Ice the skin
- Use a small needle
- Prefer subcutaneous over intramuscular injections
What are the alternatives for patients allergic to ester-based local anesthetics?
Amide anesthetics such as lidocaine, mepivacaine, bupivacaine, prilocaine, and dibucaine.
What is the effect of epinephrine on anesthetic duration?
Epinephrine causes vasoconstriction, leading to a longer duration of anesthesia.
What should be done before performing a digital nerve block?
Examine and document that there are no neurovascular deficits prior to the block.
Describe the procedure for loosening and lifting an ingrown nail.
Scrub & drape the toe, perform a digital nerve block, and use a hemostat or elevator to loosen and lift the nail with upward pressure.
What is a subungual hematoma?
A collection of blood under the nail from trauma, which can be treated with nail trephination if <48 hours old.
What are the red flags for subungual melanoma?
- Single digit involvement
- Longitudinal growth >3mm
- Hutchinson’s sign
- Rapid enlargement
What is the preferred biopsy technique for a suspicious pigmented lesion?
Excisional biopsy is the preferred technique for all suspicious pigmented lesions.
What type of suture is best for skin and what size is typically used?
Nylon (ethilon), monofilament, typically size 3-0 to 5-0.
What are the indications for cryotherapy?
- Actinic keratosis
- Condyloma
- Verrucae
- Freckles
- Seborrheic keratoses
- Skin tags
- Molluscum
- Granulation tissue
- Cervical intraepithelial neoplasia
What are absolute contraindications for cryotherapy?
- Melanoma/uncertain diagnosis
- Cryosurgery sensitivity
- End-stage vascular compromise
- Recurrent/high-risk BCC or SCC
- Inability to accept pigment changes
How does the procedure differ for removing a single-barb versus a double-barb fishhook?
Single-barbed: Advance and clip off the tip before backing it out. Double-barbed: Advance, cut off the eye, and pull on the sharp end.
