Minor Surgery Flashcards
(195 cards)
1
Q
What are universal precautions?
A
OSHA - things to keep YOU (as provider) protected
2
Q
MC transmitted infx
A
Hep B
3
Q
2% Glutaraldehyde: _____ to disinfect, _____ to sterilize
A
10 min to disinfect
10 hr to sterilize
4
Q
How long do you need to boil to sterilize?
A
> 30 min
5
Q
Dry heat sterilization
A
160’C/320’F for 1 hr
6
Q
Autoclave sterilization
A
15 PSI at 121’C for 15 min
*most efficient and reliable form of sterilization
7
Q
You ______ tools, you ______ people
A
Sterilize tools
Disinfect people
8
Q
How do you disinfect intact skin?
A
10% betadine X3
0.4% chlorhexidine gluconate
9
Q
How do you disinfect an open wound?
A
irrigate with normal (0.9%) saline
*do NOT use H2O2
10
Q
Puncture with nerve, tendon, joint involvement or in chest/abdomen
A
Stabilize (secure large objects) and refer
11
Q
Something to consider with puncture wounds
A
Pt last tetanus shot
12
Q
Do not suture wounds older than
A
8-12 hr on body or 24 hr on face
13
Q
Hypertrophic vs. keloid scar
A
hypertrophic is normal healing
keloid extends beyond the original area of wound
14
Q
Healing stages
A
1) Hemostasis (coagulation): fibrin clot
2) Inflammation: immediately (days 1-4), cytokines and complement
3) Proliferation (granulation): 3-21 days, angiogenesis
4) Remodeling: 3wk to 6-18 mp. Contraction (normal) and contracture (abnl)
15
Q
During inflammation stage of healing: _________ in 5-6 hrs, last 3-4 days to destroy bacterial
A
Neutrophils
16
Q
During inflammation stage of healing: _________ transition from inflammation to repair and phagocytize
A
Macrophages
17
Q
During inflammation stage of healing: __________ migrate w/in 24-48 hr to repair wound (re-epithelialization)
A
Basal cells
18
Q
During inflammation stage of healing: _________ proliferate 1-2 days after injury
A
New keratinocytes
19
Q
During remodeling: ____% strength by 3-4 wks, ____% at 1 year
A
30-40% at 3-4 wk
80-90% at 1 hr
20
Q
__________ is normal due to myofibroblasts and orientation of collagen
A
Contraction
21
Q
________ is abnormal formation of tight scar due to excessive contraction
A
contracture
22
Q
Name this healing intention:
cut with kitchen knife - clean, fresh; we can clean and close it up; 8-12 hr
A
Primary intention
23
Q
Name this healing intention:
Full thickness (into SubQ), older, leave open and allow to heal by granulation; usu. w/ significant tissue lost or contamination/infection; < 12 hr
A
Secondary intention
24
Q
Name this healing intention:
Grossly contaminated wounds without significant tissue loss can be cleaned, packed, covered and left open for 3-5 days - can be sutured after this if not infx; e.g. dog bite
A
Tertiary (delayed primary) intention
25
may cause railroad tract scarring, eversion may be difficult
Simple interrupted
26
easy to evert edges under tension, better for cosmesis
Vertical mattress
27
suture for high tension wounds and fragile tissue; palms or soles
Horizontal mattress
28
larger, deeper wounds; requires _____ sutures
absorbable
| Deep/buried suture
29
dermal layer, not visible, eliminates tracts; linear wounds with little tension; can use absorbable or non-absorbable sutures
SubQ/intradermal running
30
rapid, non-cosmetic, less secure; HIGH risk of infx
Continuous running
31
triangular flaps without strangulation
3 point/half-buried
32
Natural sutures are digested by
body enzymes
33
Plain catgut (suture)
natural, absorbable, some reactivity
| T1/2 = 7-10 days
34
Chromic catgut (suture)
natural, absorbable, less reactivity than plain catgut
chromic salt delays absorption
T1/2 = 2-3 wk
35
least reactivity of sutures, hydrolyzed, easy to tie
synthetic (vicryl, dexon, PDS)
36
Polyglactic/vicryl (suture)
synthetic, absorbable, braided and monofilament
T1/2 = 2-3 wk
*braided = stronger BUT incr. chance of infx
37
Polyglycolic/Dexon (suture)
synthetic, absorbable, monofilament
| T1/2 = 2-3 wk
38
Polydioxanone/PDS (suture)
synthetic, absorbable, monofilament
| T1/2 = 4-6 wk
39
Silk (suture)
natural, non-absorbable, braided, easy to tie
| HIGH tissue reactivity
40
Stainless steel (suture)
natural, non-absorbable, permanent
| minimal tissue reactivity
41
Polyester/Polybutester (suture)
natural, non-absorbable
| HIGH tissue reactivity
42
Nylon/ethilon (suture)
synthetic, non-absorbable, monofilament, slips easily
| low tissue reactivity, low risk infx
43
Polypropylene/prolene (suture)
synthetic, non-absorbable, monofilament, similar to nylon
44
if using steri-strips, do NOT
encircle digits = tourniquet
45
______ helos steri-strips stick better
benzoin
46
wound closure that is fast, low risk of infx, uncomfortable
staples
47
Face/neck: suture gauge ____, remove after _____
5-0, 6-0
| 3-5 days
48
Arm/hands: suture gauge ____, remove after _____
4-0, 5-0
| 7-10 days
49
Trunk/legs/feet/scalp: suture gauge ____, remove after _____
3-0, 4-0
| 7-14 days
50
needle used for cosmetic procedures
conventional cutting
51
MC needle use for most minor surgery procedures
reverse cutting**
52
needle that pierces and spreads without cutting, used in bowel, muscle, and fascia
tapered
53
needle used to dissect friable tissue instead of cutting; liver, kidney, spleen, cervix
blunt
54
Post-op: keep wound/dressing dry for ___ hours and limit movement; redress every ___ days.
24-48 hr
| 2-3 days
55
Post op: remove sutures with _______ with knots pulled across
iris scissor or #11 scalpel
56
if dehiscence occurs, re-suture within
48-72 hrs
| as long as it's not infected!
57
local anesthetics block ____ reuptake to prevent _______ of pain stimuli
Na
depolarization
(called non-depolarization block)
58
10cc of 1% = ___ mg
100
| just add a zero
59
Amides are metabolized in
liver by microsomal enzymes
60
True allergies are rare with amides/esters
amides
61
topical amides
lidocaine and EMLA cream/patch
62
injectable amides
lidocaine
bupivacaine
mepivacaine
63
Lidocaine: _____ onset and ____ duration
onset: 1-10 min
duration: 30-60 min
64
Bupivacaine: _____ onset and ____ duration
onset: 8-12 min
duration: 3-4 hr
65
Max dose of lidocaine in child
3.3-4.5 mg/kg of 1%, not to exceed 75-110 mg total
66
Max dose of lidocaine in adult
4.5 mg/kg of 1%, not to exceed 300 mg (30cc) total
67
Max dose of bupivacaine in adult
4 mg/kg of 0.25%, not to exceed 200 mg
68
Which anesthetic is used for digit blocks
bupivacaine
69
bupivacaine SE
heart block
BLOCKS - used for digit block and MAJOR SE of ht block
70
Mepivacaine: _____ onset and ____ duration
onset: 8-12 min
duration: 2-2.5 hr
*less drowsiness than lidocaine
71
Max dose of mepivacaine in adult
5 mg/kg of 1%, not to exceed 400 mg
72
Esters are metabolized in
peripheral plasma by pseudocholinesterase
73
topical esters
benzocaine
proparacaine
cocaine
TAC (tetracaine + adrenaline/Epi + cocaine)
74
injectable esters
procaine
75
topical ester that is poorly absorbed, need at least 10%
benzocaine
76
topical ester used in ophthalmology, < 1 min onset, 15 min duration
proparacaine
77
topical ester used in ENT procedures, < 1 min onset, 1 hr duration
cocaine
78
topical ester that is CHEAP and FAST
TAC (tetracaine + adrenaline/Epi + cocaine)
79
slower onset and same duration as lidocaine; allergic rxn common
Procaine (an ester)
80
toxic rxn to anesthetics leading to hypotension, bradycardia, cardiac arrest. tx with ____
high dose O2 (helps body metabolize anesthetic)
81
allergic/hypersensitivity to anesthetics; tx mild with _______ and severe with ______
mild: diphenhydramine
severe: Epi and O2; or if in wild follow Epi w/ diphenhydramine and steroids
82
Uses of Epi
1) decreases oozing/bleeding
2) prolongs duration/decreases absorption of anesthetic
3) decreases risk of toxic rxn (b/c decrease absorption)
83
injectable Epi dose for minor surgery procedures
1:200,000 with MAX of 0.2 mg
84
antidote to Epi toxicity/OD
administer IV push of Mg++ and B6 to increase COMT metabolism
85
Never use Epi in
end-arteries (fingers, toes, penis, nose, clitoris, ears)
86
EPI C/I
MOA-I, TCAs, Thyrotoxicosis, severe CVD
| caution in pt with PVD, HTN
87
ND's can perform _________, cannot _________
can: uncomplicated procedures that involve superficial structures
cannot: go into fascia or muscle
88
List of things ND's canNOT do
1) eyes, nose, axilla, groin, neck
2) large size/blood supply
3) depth
4) young children
5) pt. on anti-coag or w/ bleeding d/o
6) pulsating lesion
7) keloid formers
8) immunocompromised
89
Never use ________ if you're suspicious of malignancy
tissue destruction methods (cryo, electro)
90
Liquid nitrogen is stored in
Dewar bottle - can last weeks or months
91
liquid nitrogen procedure
freeze, thaw, refreeze with 2-3mm freezing zone (white area) around lesion for 10-30 sec
92
what should you PARQ pt after using liquid nitrogen
blister forms w/in hours, scab w/in a week, healing in 2-3 wks
93
is it okay to use liquid nitrogen straight from Dewar bottle?
NO
| you can transfer HPV into container
94
Liquid nitrogen C/I
malignancy, Raynaud's, sensitive skin
95
Electrosurgery C/I
flammable EtOH, metal implants, jewelry
**do NOT clean skin w/ EtOH - will light pt on fire!
96
sterile electrode with + current destroys tissue and coagulates b.v.
electrosurgery
97
indirect electrical current, very precise, no blood loss
electrocautery
98
direct, high-frequency current flows through tissue to generate heat; quick and effective with minimal blood loss
hyfrecation
99
complete removal of superficial lesion, both diagnostic and curative
excisional biopsy
100
for excisional biopsy, use ___________ and cut __________
3:1 elliptical with 30' angle corners and #15 blade
parallel to Langer's lines
101
narrow elliptic taken within a lesion to diagnose a larger lesion (biopsy)
incisional biopsy
102
diagnostic and therapeutic and healing is rapid with minimal scarring (biopsy)
shave biopsy
103
with punch biopsy, traction skin ____ to Langer's lines, must go ____ beyond borders
perpendicular
| 1-2 mm
104
scalpels: puncture abscess, incisions, stabbing
#11
105
scalpels: blunt dissection, excision, trimming
#15
106
scalpels: for thick skin (back)
#10
107
scalpels: disposable, sterile and attached to reusable handle
#3
108
forceps that do NOT crush skin, what we use for suturing
toothed adson
109
forceps that do crush skin, we use for foreign body removal
toothless adson
110
scissors for fine dissection
iris
111
scissors for blunt dissection
metzenbaum
112
circumscribed, flat discoloration that may be brown, blue, red, or hypopigmented
macule
113
an elevated solid lesion up to 0.5 in diameter; color varies; may become confluent and form plaques
papule
114
circumscribed, elevated, solid lesion more than 0.5 cm in diameter
nodule
*a large nodule is referred to as a tumor
115
circumscribed collection of leukocytes and free fluid that varies in size
pustule
116
circumscribed collection of free fluid up to 0.5 cm in diameter
vesicle
117
circumscribed collection of free fluid more than 0.5 cm (5 mm) in diameter
bulla
118
loss of intercellular connections (desmosomes) between keratinocytes; occurs in pemphigus vulgaris and related d/o; cell shape changes from polygonal to round
Acantholysis
119
thickening of epidermis (squamous) layer; rete ridges usually extend deeper into dermis
Acanthosis
120
flat discoloration > 5 mm
patch
121
thickened cornified layer, often with prominent granular layer; keratin may be abnl
hyperkeratosis
| either orthokeratotic or parakeratotic
122
exaggeration of normal pattern of keratinization with no nuclei in cornified layer
orthokeratotic
| type of hyperkeratosis
123
type of hyperkeratosis with retained nuclei in cornified layer
parakeratotic
124
hyperplasia of spinosum layer; assoc. w/ hyperlipidemia, Cushing's, DM
acanthosis nigricans
125
verrucas, flat, papules; "stuck on"
seborrheic keratosis
126
chronic scratching cz skin growth
lichenification
127
2' to trauma, increase fibroblasts, brown-firm
dermatofibroma
128
moveable capsule filled with keratin, sebum
epidermal inclusion cysts (sebaceous)
129
sebaceous cyst on head
pilar cyst (wen)
130
subQ moveable nodule; often recur
lipoma
131
is it ok to perform minor surgery on hemangioma?
NO
esp. not cavernous hemangioma
132
dandruff, cradle cap
seborrheic dermatitis
133
for acne vulgaris, avoid ____ and use ______
avoid: B12, iodine
use: zinc, tea tree
134
rough scaling skin, SCC risk
solar (actinic) keratosis
biopsy! (to r/o neoplasm)
135
round/oval papules or plaques, pink/red/purplish on legs
Kaposi's sarcoma
biopsy! (to r/o neoplasm)
136
elevated falt topped area, usu > 0.5 cm
plaques
137
"liver spots", usually benign from excess sun exposure
solar lentigo
biopsy! (to r/o neoplasm)
138
lesion of subQ fat, usually anterior shins; cz by sarcoid, TB, leprosy, histoplasmosis, coccidiomycosis, Crohn's
Erythema nodosum
biopsy! (to r/o neoplasm)
139
MC neoplasm, slow growing, rare Mets
BCC
140
fast growing neoplasm, Mets common, exposure to arsenic
SCC
141
pearly, rolled boarders
BCC
142
indurated, ulcerated/crusty, may bleed easily
SCC
143
MC in females, tumor marker S-100, METS!!
Melanoma
144
MC melanoma
superficial spreading
145
most aggressive melanoma
nodular
146
melanoma in elderly, slow growing
lentigo
147
MC melanoma in dark skin - palms, soles, nails; aggressive!
acral
148
GABHS of dermis
Cellulitis
149
Cellulitis can lead to
necrotizing fasciitis or erysipelas (lymph involvement, orange peel)
150
red streaking along LN
lymphangitis
151
strep infx of superficial lymphatics; usu 2' to immunocompromised, trauma, ulcer
erysipelas
152
chronic venous insufficiency d/t diabetes or bed ridden
stasis dermatitis
153
HPV - genital warts
6, 11
154
HPV - dysplastic
16, 18, 31, 33
155
6th dz, HHV 6/7, maculo-papular rash with high fever
Roseola infantum
156
cranial-caudal macular-papular rash with mild fever
Rubella (German Measles)
157
cough, coryza, and conjunctivitis, koplick spots and cranial-caudal macular-papular rash
Measles (Rubeola)
158
Measles complication
subacute sclerosing panencephalitis
159
staph or strepB, honey colored crust
Impetigo
160
Impetigo tx
mupirocin
161
MRSA tx
mupirocin
162
Herpes zoster tx
Levodopa, UV light
163
Herpes zoster vaccine
Zostavax
164
viral infx; waxy, pink with small central pit; B9
molluscum contagiosum
165
gold with woods lamps
Tinea versicolor (pityriasis versicolor)
166
Vitiligo tx
copper, Vit D, phenylalanine
167
10-20 y/o, herald patch
Pityriasis rosea
168
tx for atopic derm
Psorinum (homeo), Sulphur (homeo), Vit C
169
symmetrical lesions with concentric rings (target lesion)
erythema multiforme
170
timeline of drug eruptions
1-3 weeks after (7 days MC)
*stop taking the drug!
171
infx of nail bed, painful swelling by staph, strep or candida
paronychia
172
deep infection working under nail bed
felon
173
Tinea unguium (nail fungus) tx
Melaleuca alternifolia
174
+Nikolsky sign, blister spreads, AI, DEADLY
pemphigus vulgaris
175
bx: intra-epidermal bullae with anti-epithelial cell Abs against desomsomes (AKA anti-desmoglein-3 antibodies)
pemphigus vulgaris
176
bullae intact in subepidermal space, flexors/trunk
Bullous pemphigoid
| less serious than pemph. vul.
177
bx: epidermal blisters and anti-basement membrane auto IgGs
Bullous pemphigoid
178
dermatographism is seen in what immunologic condition
urticaria
179
cz of erythema multiforme
HSV and Mycoplasma pneumonia
| DDx SJS
180
flu-like sx followed by painful red or purplish rash that spreads and blisters; top layer of affected skin dies and sheds
Stevens-Johnson Syndrome
| usu. a rxn to a medication or infx
181
Bull-s eye, B. Burgdorferi, ixodes ticks
erythema migrans
182
measles-like maculopapular rash
morbiliform drug eruption
183
discoid or malar rash, < sun exposure, IgG/IgM
Lupus erythematous
184
small flesh papules, increase in size on hands and feet
granuloma annulare
185
IgA deposits cz pruritic papules/vesicles; assoc. with celiac dz
Dermatitis herpetiformis
186
Kobner's phenomena
psoriasis
187
Auspitz phenomena
psoriasis
188
bx: mounds of parakeratosis with neutrophils, diminished or absent stratum granulosum, epidermal thickening
psoriasis
189
malar rash with pustules/papules on an erythematous base with telangiectasia; < stress, hot/cold, food triggers
Rosacea
190
red, scaling with prominent skin lines - itching constantly
Lichen simplex
191
Wickham striae, 5 P's on palms and wrist; assoc. w/ Hep C
Lichen planus
192
white, painless patches on tongue that canNOT be scraped off; cz by EBV, usu. in HIV pt.
Hairy leukoplakia
| may need to bx
193
Neurotoxic, painless spider bite
Black widow
194
Necrotoxic, painful spider bite
Brown recluse
195
serpiginous lesions, < night, doesn't go above neck
Scabies
