Minor Surgery Flashcards Preview

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Flashcards in Minor Surgery Deck (111):
1

_______ fluids of ALL patients should be considered infectious.

blood and bodily

2

_______ is the most frequently occurring work-related infectious disease.

Hepatitis B

3

Anesthetics are dividided into 2 groups:

esters and amides

4

2% Glutaraldehyde has a (low/high) tissue toxicity.

Low

5

Name 2 required universal precautions (OSHA):

Use barriers (gloves, ppe)
Sharps management

6

Use sterilization for _____, disinfecting for ______.

S - tools
D - living tissue

7

2% Glutaraldehyde takes how long to work?

10 mins to disinfect
10 hours to sterilize

8

Boiling can effectively sterilize at:

>30 mins

9

Dry heat can effectively sterilize at:

160C / 320F x1 hour

10

Autoclave rules:

15 psi at 121c for 15 mins

11

Intact skin can be disinfected with:

10% betadine x3
0.4% chlorhexidine gluconate

12

Why do we irrigate with normal saline instead of H2O2 or other antiseptics?

ineffective at disinfecting
slows wound healing
promotes tissue necrosis

13

If skin is punctured, and large items are still in the skin, you should:

Secure and refer

14

Let puncture wounds heal by ___ intention.

second or third - in case something is still inside

15

Dont suture wounds older than:

8-12 hours, up to 24 if very clean
24 hours on the face/neck (good blood supply)

16

If you can't rule out these kinds of damage, you should always refer:

nerve
tendon
vasculature
bone

17

Normal scar healing is called ______, while extending beyond the original area is called ________.

hypertrophic
keloid

18

Healing stages:

1 - hemostasis/coagulation
2 - inflammation
3 - proliferation (granulation)
4 - remodeling

19

Healing stages - Hemostasis is also called _______, and is characterized by _____ and formation of a _______.

coagulation
platelet aggregation
fibrin clot

20

Healing stages - Inflammation occurs on days ______. Cytokines are secreted by ________, complement cascade is triggered, and _______ arrive in 5-6 hours, staying 3-4 days to destroy bacteria.

1-4 (immediately)
platelets
neutrophils

21

Healing stages - Inflammation:
__________ remove dead neutrophils, necrotic tissue, and microbial pathogens on days _______.

macrophages
1-4

22

Healing stages - Inflammation:
re-epithelialization

fibroblasts and epithelial cells bridge across the wound, finished bridging by days 3-4

23

New keratinocytes proliferate ____ days after injury.

1-2

24

Neovascularization is:
And occurs during what healing phase?

angiogenesis, brings oxygen and nutrients
proliferative

25

Remodeling strength at 3-4 weeks:

30-40%

26

Remodeling strength at 1 year:

80%

27

Bromelain can help increase _______ formation.

collagen

28

Healing intention - primary:

suture a clean wound
bandage and let heal

29

Healing intention - secondary: full thickness, into subQ

left open, healed by granulation
used with significant tissue loss or contamination

30

Healing intention - tertiary:

without significant tissue loss -> clean, pack, cover, leave open 3-5 days, then suture if non-infected
* dog bite
* puncture with contaminated tool
> you may want to reopen if the skin starts healing over too soon

31

3 important stitches to be comfortable with if you want to do minor surgery:

Simple interrupted
Vertical mattress
SubQ

32

Simple interrupted stitching may cause _______ scarring

railroad

33

Vertical mattress is (easy/hard) to evert under tension.

easy
better for cosmesis

34

Horizontal mattress is good for (high/low) tension wounds and (fragile/dense) tissue

high
fragile (thin skin)

35

Deep or buried stitches - use ______ suture.

absorbable (vicryl or dexon)
for large or deep wounds

36

What are some indications for using subcuticular/intradermal running stitches:

dermal layer
not visible
eliminates tracts
linear wounds with little tension

37

Running stitches are:

less secure
high risk of infection
quick to put in
not cosmetic

38

3-point, half-buried stitches are good for:

triangular flaps without strangulation

39

Two main classes of suture materials:

absorbable (natural, synthetic)
non-absorbable

40

Natural absorbable sutures are digested by:
Examples?

body enzymes
Catgut, chromic catgut

41

Are natural or synthetic absorbable sutures less reactive?

Synthetic (vicryl, dexon)

42

_______ sutures are hydrolyzed and easy to tie.

synthetic

43

Characteristics of silk sutures:

high tissue reactivity
easy to tie

44

Characteristics of stainless steel:

minimal tissue reactivity
permanent

45

Characteristics of polyester/polybutester:

high tissue reactivity

46

Characteristics of nylon/ethilon:

low tissue reactivity, low risk of infx
slips easily
monofilament

47

Staples:

minimal tissue reactivity, low risk of infx
fast
uncomfortable

48

Use ____ knots per gauge:

one knot over gauge (5 knots for a 4-0)

49

Suturing face/neck - gauge, remove:

5-0, 6-0
3-5 days

50

Suturing arm/hand - gauge, remove:

4-0, 5-0
7-10 days

51

Suturing trunk/leg/foot/scalp - gauge, remove:

3-0, 4-0
7-14 days

52

Reverse cutting is (most/least) common

most common for procedures

53

Dress wounds for:

absorption of drainage
support
moisture for epithelialization
limits movement

54

Post-op, keep wounds + dressing dry for _____ hours.

24-48

55

Infections occur ____ days post-procedure, and the most common pathogen is ___________

4-10 days (normal inflammation occurs before day 4)
staph aureus

56

Blood collection following surgery is called ______, happens _____ hours after surgery, and may lead to infection or ______.

hematoma
24-72 hours
dehiscence

57

Wound rupture along the incision after suture is closed is called ______. You can re-suture within ____. After that window, you want to:

dehiscence
48-72 hours
let it heal by secondary intention

58

Local antisthetics block ___ reuptake, to prevent:

sodium
depolarization and propagation of pain stimuli

59

10cc of 1% lidocaine = __ mg

100mg lidocaine

60

IM injection angle:

90 degrees

61

SubQ injection angle:

30-45 degrees

62

Intradermal injection angle:

5-10 degrees

63

Amides are metabolized in the _____, and true allergies are (common/rare).

liver
rare

64

Lidocaine/xylocaine has a ___ min onset, ___ min duration.

1-10 mins to onset
30-60 min duration

65

Max dose of lidocaine in a child:

3.3-4.5 mg/kg, not to exceed 75-110mg

66

Max dose of lidocaine in an adult:

4.5 mg/kg, not to exceed 300mg (30cc of 1%)

67

Bupivacaine/marcaine has a ___ min onset, ___ hour duration. Indicated for:

8-12 min onset
3-4 hour duration
digital block

68

Max dose of bupivacaine/marcaine:

4 mg/kg of 0.25%, not to exceed 200mg

69

Esters are metabolized in ________ by pseudocholinesterase

peripheral plasma
more reactions

70

3 ingredients in TAC:

Tetracaine (ester)
Epinephrine
Cocaine

71

3 ingredients in TAC:

Tetracaine (ester)
Epinephrine
Cocaine

72

We pull back on the plunger before injecting to avoid what adverse reaction?

Inadvertant intravascular injection
excessive dose

73

Too much anesthetic, give:

oxygen
CNS depressant may cause hypotension, then bradycardia or arrest

74

Treat mild allergic reactions with _____.
Treat severe allergic reactions with ______.

diphenhydramine (15 mins)
epinephrine and oxygen

75

Allergy is mc with what type of anesthetic?

esters

76

In true anaphylaxis reaction, how do pulse and BP change?

HR up / BP down
[vs. autonomic response - both go up]

77

Uses of epinephrine: (vasoconstriction)

* decrease oozing
* prolong duration by limiting absorption into tissues
* decreasing risk of toxic reactions by reducing circulating anesthetic

78

Side effects of epinephrine:

anxiety
restlessness
tremor
palpitations
tachycardia

79

Epinephrine dose for anesthetic use:

1:200,000
< 0.2 mg

80

Epinephrine dose for anaphylaxis:

1:1000

81

Contraindications of epinephrine use:

End-arteries (fingers, nose, toes, penis, clitoris, ears)
MAOIs, TCAs, thyrotoxicosis, severe CAD
caution with PVD, HTN

82

3 parts of the sterile field:

* physician - gloves, washing, mask
* patient - sterile drape, incision area
* tray - tools, materials

83

Contraindications to ND PCP doing minor surgery

* location - lesion on nose, eye, axilla, groin, post neck
* large size / blood supply
* depth - lipomas can be intertwined in mm/bone
* young children
* pt on anti-coags / with bleeding disorder
* pt on a corticosteroid
* pulsating lesion
* keloid forming pt
* systemic illness with depleted immune system

84

Tissue destruction methods:
Never use if:

cryotherapy
electrosurgery
** if you want to biopsy! **

85

Cryotherapy - freezing with _______, which leads to anoxia and death.

"cryogen"
* HistoFreeze - aerosol
* Dry ice
* Nitrous oxide
* liquid nitrogen - MC

86

If you are going to freeze warts, start by:

using #10 scalpel blade to shave it down to black dots or pin-prick bleeding, THEN cryo

87

Cryotherapy is indicated for:

* warts
* skin tags (acrochordon)
* seb keratosis
* actinic keratosis

88

Dry ice isn't used much anymore, because:

it's simple, cheap, but not very effective

89

Transport liquid nitrogen in a:
Never use straight from bottle, risk of:

Dewar bottle
HPV transmission

90

Liquid nitrogen - freeze, thaw, refreeze, with ___mm zone around lesion.
May cause __________

2-3 mm
depigmentation

91

Types of electrosurgery:

* Electrocautery - indirect, precise
* Hyfrecation - direct

92

Describe proper excisional biopsy technique:

3:1 elliptical excision with 30 deg corners
#15 scalpel
parallel to Langer's Lines

93

Punch biopsy technique:

traction perpendicular to Langer's Lines
1-2mm beyond edge of lesion
full thickness of dermis

94

When do you use #10, 11, and 15 scalpels?

11 - puncture abscess, incision, stabbing
15 - blunt dissection, excision, trimming
10 - like 15, thick skin

95

When do you use non/toothed forceps?

Toothed adson - does not crush skin
Toothless - crushes skin, foreign body removal

96

When do you use iris vs metzenbaum scissors?

Iris - fine dissection, not for sutures
Metzenbaum - blunt dissection

97

Healing stages - Proliferation occurs on days _____. ______ deposit ______, in order to strengthen the wound.

5-20
Fibroblasts
Type III collagen

98

Healing stages - Wound Remodeling occurs from day ______ onwards. ______ formed during proliferation is broken down.

21
Type III collagen

99

Healing stages - Wound Remodeling
Type III collagen is replaced by _______, and collagen fibers are ______.

Type I collagen
Cross-linked

100

Healing stages - Proliferation
Fibroblasts differentiate into _______, and cause contracture.

Myofibroblasts

101

Which injectable anesthetics are amides?

Lidocaine
Mepivacaine
Bupivacaine

102

Which anesthetics are esters?

Procaine
Tetracaine
Benzocaine

103

Indications for electrocautery:

− Obtaining hemostasis
− Removing acrochordons
− Draining subungual hematomas
− Removing actinic + seborrheic keratosis
− Removing other benign lesions often combined with curettage

104

Esters metabolize into ______, which is associated with true allergic reactions.

PABA

105

If a patient is allergic to PABA, they may also be allergic to _______, which is included in amide anesthetics (unless single use).

Methylparaben
Use a preservative-free amide for pts allergic to esters/PABA

106

1cc of of 1% lidocaine solution = __ mg

10mg

107

Empirical antibiotic tx of an infected wound?

Cephalexin 500mg tid-qid
-or-
Clindamycin 300mg tid if pt is allergic to penicillin or if they have a known hx of MRSA

108

3 reaction types to local anesthetics:

Toxic
Allergic or hypersensitive
Autonomic

109

Signs of toxic rxn to local anesthetics?
Tx?

CNS: tinnitus, numbness of the lips, light-headedness, N/V
Cardio: hypotension, bradycardia

Tx: oxygen

110

Signs of allergy rxn to local anesthetics?
Tx?

Rash, erythema, urticaria, angioedema
Hypotension, bronchospasm

Tx: diphenhydramine, if severe epinephrine and oxygen

111

Signs of autonomic rxn to local anesthetics?
Tx?

Tachycardia, sweating, dizziness, faintness, syncope
Tx: pt should lie down