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NPLEX2 Topics > Minor Surgery > Flashcards

Minor Surgery Flashcards

1
Q

_______ fluids of ALL patients should be considered infectious.

A

blood and bodily

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2
Q

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

A

Hepatitis B

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3
Q

Anesthetics are dividided into 2 groups:

A

esters and amides

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4
Q

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

A

Low

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5
Q

Name 2 required universal precautions (OSHA):

A 
Use barriers (gloves, ppe)
Sharps management
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6
Q

Use sterilization for _____, disinfecting for ______.

A

S - tools

D - living tissue

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7
Q

2% Glutaraldehyde takes how long to work?

A

10 mins to disinfect

10 hours to sterilize

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8
Q

Boiling can effectively sterilize at:

A

> 30 mins

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9
Q

Dry heat can effectively sterilize at:

A

160C / 320F x1 hour

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10
Q

Autoclave rules:

A

15 psi at 121c for 15 mins

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11
Q

Intact skin can be disinfected with:

A

10% betadine x3

0.4% chlorhexidine gluconate

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12
Q

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

A

ineffective at disinfecting
slows wound healing
promotes tissue necrosis

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13
Q

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

A

Secure and refer

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14
Q

Let puncture wounds heal by ___ intention.

A

second or third - in case something is still inside

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15
Q

Dont suture wounds older than:

A

8-12 hours, up to 24 if very clean

24 hours on the face/neck (good blood supply)

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16
Q

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

A

nerve
tendon
vasculature
bone

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17
Q

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

A

hypertrophic

keloid

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18
Q

Healing stages:

A

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

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19
Q

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

A

coagulation
platelet aggregation
fibrin clot

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20
Q

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.

A

1-4 (immediately)
platelets
neutrophils

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21
Q

Healing stages - Inflammation:

__________ remove dead neutrophils, necrotic tissue, and microbial pathogens on days _______.

A

macrophages

1-4

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22
Q

Healing stages - Inflammation:

re-epithelialization

A

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

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23
Q

New keratinocytes proliferate ____ days after injury.

A

1-2

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24
Q

Neovascularization is:

And occurs during what healing phase?

A

angiogenesis, brings oxygen and nutrients

proliferative

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25
Q

Remodeling strength at 3-4 weeks:

A

30-40%

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26
Q

Remodeling strength at 1 year:

A

80%

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27
Q

Bromelain can help increase _______ formation.

A

collagen

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28
Q

Healing intention - primary:

A

suture a clean wound

bandage and let heal

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29
Q

Healing intention - secondary: full thickness, into subQ

A

left open, healed by granulation

used with significant tissue loss or contamination

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30
Q

Healing intention - tertiary:

A

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

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31
Q

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

A

Simple interrupted
Vertical mattress
SubQ

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32
Q

Simple interrupted stitching may cause _______ scarring

A

railroad

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33
Q

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

A

easy

better for cosmesis

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34
Q

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

A

high

fragile (thin skin)

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35
Q

Deep or buried stitches - use ______ suture.

A

absorbable (vicryl or dexon)

for large or deep wounds

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36
Q

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

A

dermal layer
not visible
eliminates tracts
linear wounds with little tension

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37
Q

Running stitches are:

A

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

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38
Q

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

A

triangular flaps without strangulation

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39
Q

Two main classes of suture materials:

A

absorbable (natural, synthetic)

non-absorbable

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40
Q

Natural absorbable sutures are digested by:

Examples?

A

body enzymes

Catgut, chromic catgut

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41
Q

Are natural or synthetic absorbable sutures less reactive?

A

Synthetic (vicryl, dexon)

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42
Q

_______ sutures are hydrolyzed and easy to tie.

A

synthetic

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43
Q

Characteristics of silk sutures:

A

high tissue reactivity

easy to tie

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44
Q

Characteristics of stainless steel:

A

minimal tissue reactivity

permanent

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45
Q

Characteristics of polyester/polybutester:

A

high tissue reactivity

46
Q

Characteristics of nylon/ethilon:

A

low tissue reactivity, low risk of infx
slips easily
monofilament

47
Q

Staples:

A

minimal tissue reactivity, low risk of infx
fast
uncomfortable

48
Q

Use ____ knots per gauge:

A

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

49
Q

Suturing face/neck - gauge, remove:

A

5-0, 6-0

3-5 days

50
Q

Suturing arm/hand - gauge, remove:

A

4-0, 5-0

7-10 days

51
Q

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

A

3-0, 4-0

7-14 days

52
Q

Reverse cutting is (most/least) common

A

most common for procedures

53
Q

Dress wounds for:

A

absorption of drainage
support
moisture for epithelialization
limits movement

54
Q

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

A

24-48

55
Q

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

A

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

staph aureus

56
Q

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

A

hematoma
24-72 hours
dehiscence

57
Q

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

A

dehiscence
48-72 hours
let it heal by secondary intention

58
Q

Local antisthetics block ___ reuptake, to prevent:

A

sodium

depolarization and propagation of pain stimuli

59
Q

10cc of 1% lidocaine = __ mg

A

100mg lidocaine

60
Q

IM injection angle:

A

90 degrees

61
Q

SubQ injection angle:

A

30-45 degrees

62
Q

Intradermal injection angle:

A

5-10 degrees

63
Q

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

A

liver

rare

64
Q

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

A

1-10 mins to onset

30-60 min duration

65
Q

Max dose of lidocaine in a child:

A

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

66
Q

Max dose of lidocaine in an adult:

A

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

67
Q

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

A

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

68
Q

Max dose of bupivacaine/marcaine:

A

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

69
Q

Esters are metabolized in ________ by pseudocholinesterase

A

peripheral plasma

more reactions

70
Q

3 ingredients in TAC:

A

Tetracaine (ester)
Epinephrine
Cocaine

71
Q

3 ingredients in TAC:

A

Tetracaine (ester)
Epinephrine
Cocaine

72
Q

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

A

Inadvertant intravascular injection

excessive dose

73
Q

Too much anesthetic, give:

A

oxygen

CNS depressant may cause hypotension, then bradycardia or arrest

74
Q

Treat mild allergic reactions with _____.

Treat severe allergic reactions with ______.

A

diphenhydramine (15 mins)

epinephrine and oxygen

75
Q

Allergy is mc with what type of anesthetic?

A

esters

76
Q

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

A

HR up / BP down

[vs. autonomic response - both go up]

77
Q

Uses of epinephrine: (vasoconstriction)

A
  • decrease oozing
  • prolong duration by limiting absorption into tissues
  • decreasing risk of toxic reactions by reducing circulating anesthetic
78
Q

Side effects of epinephrine:

A 
anxiety
restlessness
tremor
palpitations
tachycardia
79
Q

Epinephrine dose for anesthetic use:

A

1:200,000

< 0.2 mg

80
Q

Epinephrine dose for anaphylaxis:

A

1:1000

81
Q

Contraindications of epinephrine use:

A

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

82
Q

3 parts of the sterile field:

A
  • physician - gloves, washing, mask
  • patient - sterile drape, incision area
  • tray - tools, materials
83
Q

Contraindications to ND PCP doing minor surgery

A
  • 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
Q

Tissue destruction methods:

Never use if:

A

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

85
Q

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

A

“cryogen”

  • HistoFreeze - aerosol
  • Dry ice
  • Nitrous oxide
  • liquid nitrogen - MC
86
Q

If you are going to freeze warts, start by:

A

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

87
Q

Cryotherapy is indicated for:

A
  • warts
  • skin tags (acrochordon)
  • seb keratosis
  • actinic keratosis
88
Q

Dry ice isn’t used much anymore, because:

A

it’s simple, cheap, but not very effective

89
Q

Transport liquid nitrogen in a:

Never use straight from bottle, risk of:

A

Dewar bottle

HPV transmission

90
Q

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

A

2-3 mm

depigmentation

91
Q

Types of electrosurgery:

A
  • Electrocautery - indirect, precise

* Hyfrecation - direct

92
Q

Describe proper excisional biopsy technique:

A

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

93
Q

Punch biopsy technique:

A

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

94
Q

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

A

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

95
Q

When do you use non/toothed forceps?

A

Toothed adson - does not crush skin

Toothless - crushes skin, foreign body removal

96
Q

When do you use iris vs metzenbaum scissors?

A

Iris - fine dissection, not for sutures

Metzenbaum - blunt dissection

97
Q

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

A

5-20
Fibroblasts
Type III collagen

98
Q

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

A

21

Type III collagen

99
Q

Healing stages - Wound Remodeling

Type III collagen is replaced by _______, and collagen fibers are ______.

A

Type I collagen

Cross-linked

100
Q

Healing stages - Proliferation

Fibroblasts differentiate into _______, and cause contracture.

A

Myofibroblasts

101
Q

Which injectable anesthetics are amides?

A

Lidocaine
Mepivacaine
Bupivacaine

102
Q

Which anesthetics are esters?

A

Procaine
Tetracaine
Benzocaine

103
Q

Indications for electrocautery:

A

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

104
Q

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

A

PABA

105
Q

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

A

Methylparaben

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

106
Q

1cc of of 1% lidocaine solution = __ mg

A

10mg

107
Q

Empirical antibiotic tx of an infected wound?

A

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

108
Q

3 reaction types to local anesthetics:

A

Toxic
Allergic or hypersensitive
Autonomic

109
Q

Signs of toxic rxn to local anesthetics?

Tx?

A

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

Tx: oxygen

110
Q

Signs of allergy rxn to local anesthetics?

Tx?

A

Rash, erythema, urticaria, angioedema
Hypotension, bronchospasm

Tx: diphenhydramine, if severe epinephrine and oxygen

111
Q

Signs of autonomic rxn to local anesthetics?

Tx?

A

Tachycardia, sweating, dizziness, faintness, syncope

Tx: pt should lie down

NPLEX2 Topics (4 decks)

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