Final Reverse Flashcards
(87 cards)
1
Q
Plaster is:1. Easier to mold but more thermogenic - skin burns2. More absorbent - exudates3. Longer to harden - 10 min & fully by 8hFiberglass1. Hardens fully w/in 1-2h2. More expensive3. Require protective gowns due to resin
A
Plaster vs. fiberglass splints
2
Q
- Tx of simple nondisplaced Fx2. Immobilize closed reduction of joints & Fx3. Tx severe sprains & strains4. Tx congenital deformities5. Manage chronic foot & ankle conditions
A
Indications of casts
3
Q
- Before 3-4 days of injury (compartment syndrome)2. Concealing infection
A
Contraindications to casts
4
Q
- Cast dermatitis2. Pressure sores - ulcers3. DVT4. Nerve injury5. Transient muscle atrophy & joint stiffness6. Compartment syndrome
A
Complications of casts
5
Q
Tx achilles tendonitisEvery other time - keep at 90 degrees
A
When would you splint the ankle in equines position?
6
Q
- Scaphoid Fx2. DeQuervian’s
A
Thumb spica splint
7
Q
Fx of 4th/5th metacarpals/digits
A
Ulnar gutter splint
8
Q
- Metacarpal Fx2. Soft tissue injury3. Carpal tunnel
A
Volar wrist spint
9
Q
- Distal radial (Colles)2. Ulnar Fx
A
UE sugar-tong splint
10
Q
- Tibia injury2. Fibula injury3. Jones Fx
A
Short leg posterior splint
11
Q
Posterior ankle injuries
A
Lower leg sugar tong “stirrup” splint
12
Q
- Removal of post traumatic/non-traumatic knee effusion - relief of pain2. R/o suspicious Dx3. Need for fluid analysis (GS, culture, cell counts, crystal analysis, PCR)
A
Indications for arthrocentesis
13
Q
- Burns, infected tissue2. Prosthetic joints - needs referral3. Hemarthrosis when underlying coagulopathy has not been corrected
A
Contraindications for arthrocentesis
14
Q
- Bleeding, infection, cartilage damage, fluid reaccumulation 2. Injury to neurovascular structures3. Allergic rxns to meds For bursal aspiration also:1. Development of a chronic sinus tract - especially when bursa connects to the joint2. Spreading RA to the bursa
A
Complications for arthrocentesis
15
Q
Max extension - lateral approach Space medially btwn the femoral condyles & behind the patella
A
Where is the best site to aspirate a knee?
16
Q
- Arthropathies2. Bursitis3. Tendonitis4. Plantar fasciitis5. RA6. Ganglion cysts7. Trigger points8. Carpal tunnel9. Neuromas
A
Indications for joint ejections
17
Q
- Prosthetics2. Tumors3. Infections4. Neuro conditions5. Bleeding issues
A
Contraindications to joint injections
18
Q
Olecranon
A
What is the most accessible bursa?
19
Q
Posteriolateral humeral head Fx
A
What is a Hills-Sachs lesion?
20
Q
Fx or tear of the glenoid ligament or bone
A
What is a Bankhart lesion?
21
Q
Axillary nerve damage
A
Pt presents w/ paresthesias associated with a shoulder dislocation..what should you suspect?
22
Q
- Stimson technique/Milch maneuver2. Kocher maneuver3. Hippocratic maneuverConscious sedation w/ Fentanyl & Midazolam Velpeau sling Old people move at 3wks, young 6 wksVigorous motion old people 6 wks, young 3 mo
A
How do you reduce a shoulder dislocation?
23
Q
Shoulder reductionPt prone, arm hanging with 5-15lb wt, traction w/ rotationDoesn’t work w/ adhesive capsulitis
A
Stimson technique
24
Q
Shoulder reduction Slow external rotation w/ a downward traction
A
Kocher maneuver
25
Shoulder reductionLongitudinal traction w/ contralateral pulling to reduce humeral head
Hippocratic maneuver
26
MCP dorsal dislocations
Which type of finger dislocations might need open reductions?
27
Digital lidocaine blockAxial traction & flexionFull extension splint for 6 wksDIP? Same but splint in flexion for 2-4wks
How to reduce PIP dislocations?
28
Thumb
MC MCP joint dislocation?
29
1. 4 or more2. Facial furuncles from nose bridge to corners of the mouth3. Perianal abscesses w/ rectal extension
Contraindications to abscess drainage
30
Hidradenitis Suppurativa Multiple recurrences - Need surgery
What should you suspect if Pt has abscesses in axilla & groin?
31
Warm compresses, continue breast feeding abx - Dicloxacillin, Bactrim Not responding? US to r/o abscess
Tx mastitis
32
MSSA & MRSA Tx - I&D + Keflex +/- Bactrim Allergic? Clindamycin or DoxyRefractory? Tigecycline
MC organisms causing abscesses
33
1. Peritonsillar/retropharyngeal2. Ant. triangle of neck3. Supraclavicular fossa4. Deep axillary5. AC space 6. Groin7. Popliteal space
Concerning anatomic locations for draining abscesses
34
1. >5mmPLUS2. Cellulitis3. Comorbidities4. FB penetrating wounds/bites
When to give abx after draining abscess?
35
Nail matrix ablation w/ 88% phenol soln.
How to prevent ingrown toenail from regrowing?
36
DressingBreaks down tissue...good for necrosis
What is DuoDerm & what is it used for?
37
Xeroform
What type of dressing keeps a moist wound bed?
38
TelfaAvoid removing new tissue
What type of dressing is non-adherent?
39
Occlusive
What types of dressings should you avoid with PVD?
40
Insides come out
What is evisceration?
41
Separation
What is dehiscence?
42
ex. AlgiDERM & AlgisiteFrom brown seaweed - absorb 20x their weightBest for infected wounds w/ heavy exudate
What are alginates & when are they used?
43
Ex. E-Z DermGel/film for partial thickness wounds like burns/abrasionsBarrier protection, moist environment, minimizing protein loss & pain
What are Biosynthetic dressings & when are they used?
44
Ex. BCG MatrixUsed in non-infected areas, partial & full thickness wounds except 3rd degree burnsPromotes debridement & granulation via extra collagenRequires another primary dressing to absorb exudate
What are collagen dressings & when are they used?
45
Ex. MepilexAbsorbent & protective for skin tears & granulating woundsCan be primary/secondary dressings
What are foam dressings & when are they used?
46
Ex. DuoDERMFor necrotic woundsNot for heavy exudates/infected wounds
What are hydrocolloids & when are they used?
47
Ex. Aquacel Can be used as fillerGood for moderate exudate to maintain moist bed for granulation Allows for autolytic debridemnet Conforms to wound
What are Hydrogel dressings & when are they used?
48
Ex. TegadermSecondary dressingWaterproof & microbial resistant - allows excess moisture to evaporate
What are transparent film dressings & when are they used?
49
Negative pressure wound therapyExposed vital structures, florid infection, CA, ischemic wounds, fragile wounds. allergies Mechanism: Inc. blood flow, dec. inflammation/bacterial burden/devitalized tissue
When should you avoid wound vacs?
50
1. Intact skin - blanchable erythema2. Partial thickness tissue loss involving epidermis +/- dermis 3. Full thickness - NOT into underlying fascia4. Full thickness w/ extension into underlying structures
Decubitus ulcers
51
Aggressive SCC in area of chonic inflammation
What is a Majolin ulcer?
52
Removes part of epidermis & upper dermis Snip, saucerization (deep shave), curettageContraindicationsL1. Melanoma/dysplastic nevi2. Hair/dermal components3. Suspected sclerosing BCC
Shave Bx
53
Incisional - removes part of lesionExcisional - removes whole lesion2-8mm Heal by secondary intention
Punch Bx
54
1. Chest2. Upper back 3. Arms
Which areas are high risk for keloids?
55
Drysol / cautery
How do you stop bleeding after shave Bx?
56
NO
Is curettage sent to pathology?
57
>8 mm Use ellipse pattern w/ 4:1 length:width ratioAbx?Groin, lower extremities, high risk, prosthetic materials, oral lesions
What size lesions should you excise?
58
Pts w/ implantable electronic devisesFacial PPE required - respirator or high filtration face mask
When should you avoid electrosurgery?
59
Shave
What type of Bx should you use for facial lesions?
60
1. Median cubital - MC for phlebotomy2. Cephalic3. Basilic
What veins are in the antecubital fossa?
61
No more than 2 mins
How long can the tourniquet be left on?
62
1. Blood cultures2. Red 3. Gold4. Light blue5. Green/Lavender6. Gray
CLSI recommended order of blood draw
63
q72h
How often should an IV catheter be changed?
64
1. Ammonia2. CO23. Lactate
When is arterial sampling preferred over venous?
65
1. No arterial pulse2. Abnormal allen test3. Arterial disease4. Coagulopathy5. AV shunt6. Cellulitis7. Uncooperative Pt
Contraindications to arterial puncture?
66
1. Blood - 15-302. IV - 15-303. Arterial - 40-604. Arterial line 30-455. Intradermal - 15 6. SQ - 457. IM - 90
Angles for blood punctures
67
1. BP monitoring2. Frequent blood gas sampling
Indications for arterial line
68
Influenza & yellow fever
Allergic to eggs, which vaccines should you avoid?
69
Hep B
Allergic to Baker's yeast, which vaccines to avoid?
70
Varicella
Allergic to gelatin, which vaccines to avoid?
71
1. MMR2. Varicella3. Live attenuated flu4. Yellow fever
Which vaccines should pregnant & IC avoid?
72
Slow absorption - good for delayed rxnsVolar forearm best - distal to AC space15 degrees - DONT massage
Intradermal injections
73
Optimal abs. in fatty regionsBetter w/ lipophilic & lower volume drugs Good locations: lower abd, thigh, lower lat back
SQ injections
74
Best absorptionHighly vascular Best sites - deltoid, vastus lateralusVentrogluteal - risk of sciatic nerve injury3 deltoid
IM injections
75
IM - more risk of sciatic nerve injuryV technique
Technique for ventrogluteal injection
76
No - IM vaccines don't need to aspirate
IM injection of flu vaccine, do you need to aspirate first?
77
1. >60 min surgery2. ICU postop3. Procedure involving urinary tract, prostate, colon/rectum or major GYN 4. Limited mobility postop
Indications for urinary cath in surgical Pts
78
1. Injury - blood clot at meatus Relative - urethral stricture, recent urinary tract surgery
Contraindications to urinary cath
79
F - 3.5-5 cmM - 15-17 cm 3 cuvres - penile, membranous, prostatic
Length of urethra
80
Age/2 + 8 Infants <6mo. - feeding tube 5F
What size urinary cath to use in kiddos?
81
18-20 F
Urinary cath size w/ BPH?
82
1. Rectal bleeding2. Anorectal pain3. Pruritis4. Anal discharge5. Mass found on DRE
Indications for performing anoscopy
83
1. Severe rectal pain 2. Perirectal abscess, acutely thrombosed hemorrhoid, anal fissure3. Imperforate anus/severe anal stricture 4. Recent anorectal surgery
Contraindications for anoscopy
84
Pregnancy
Contraindication for endometrial Bx?
85
1. Abnl bleeding2. Postmenopausal bleeding3. Amenorrhea for 1 yr4. Endometrial dating of menstrual cycle5. Infertility6. Response to hormonal therapy7. Atypical glandular cells on Pap8. Prior Dx of endometrial hyperplasia9. FH
Indications for endometrial Bx
86
Test for presence of posteriorly dislocated hip Abduct hips until touching table - feel clunk as femur pops back into acetabulum
Ortolani test
87
Test for ability to sublux or dislocate an intact but unstable hip Dislocates hipBring leg down - pull leg forward & adduct w/ posterior force
Barlow test
