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Flashcards in Minor Surgery Deck (195)
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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
Q

may cause railroad tract scarring, eversion may be difficult

A

Simple interrupted

26
Q

easy to evert edges under tension, better for cosmesis

A

Vertical mattress

27
Q

suture for high tension wounds and fragile tissue; palms or soles

A

Horizontal mattress

28
Q

larger, deeper wounds; requires _____ sutures

A

absorbable

Deep/buried suture

29
Q

dermal layer, not visible, eliminates tracts; linear wounds with little tension; can use absorbable or non-absorbable sutures

A

SubQ/intradermal running

30
Q

rapid, non-cosmetic, less secure; HIGH risk of infx

A

Continuous running

31
Q

triangular flaps without strangulation

A

3 point/half-buried

32
Q

Natural sutures are digested by

A

body enzymes

33
Q

Plain catgut (suture)

A

natural, absorbable, some reactivity

T1/2 = 7-10 days

34
Q

Chromic catgut (suture)

A

natural, absorbable, less reactivity than plain catgut
chromic salt delays absorption
T1/2 = 2-3 wk

35
Q

least reactivity of sutures, hydrolyzed, easy to tie

A

synthetic (vicryl, dexon, PDS)

36
Q

Polyglactic/vicryl (suture)

A

synthetic, absorbable, braided and monofilament
T1/2 = 2-3 wk

*braided = stronger BUT incr. chance of infx

37
Q

Polyglycolic/Dexon (suture)

A

synthetic, absorbable, monofilament

T1/2 = 2-3 wk

38
Q

Polydioxanone/PDS (suture)

A

synthetic, absorbable, monofilament

T1/2 = 4-6 wk

39
Q

Silk (suture)

A

natural, non-absorbable, braided, easy to tie

HIGH tissue reactivity

40
Q

Stainless steel (suture)

A

natural, non-absorbable, permanent

minimal tissue reactivity

41
Q

Polyester/Polybutester (suture)

A

natural, non-absorbable

HIGH tissue reactivity

42
Q

Nylon/ethilon (suture)

A

synthetic, non-absorbable, monofilament, slips easily

low tissue reactivity, low risk infx

43
Q

Polypropylene/prolene (suture)

A

synthetic, non-absorbable, monofilament, similar to nylon

44
Q

if using steri-strips, do NOT

A

encircle digits = tourniquet

45
Q

______ helos steri-strips stick better

A

benzoin

46
Q

wound closure that is fast, low risk of infx, uncomfortable

A

staples

47
Q

Face/neck: suture gauge ____, remove after _____

A

5-0, 6-0

3-5 days

48
Q

Arm/hands: suture gauge ____, remove after _____

A

4-0, 5-0

7-10 days

49
Q

Trunk/legs/feet/scalp: suture gauge ____, remove after _____

A

3-0, 4-0

7-14 days

50
Q

needle used for cosmetic procedures

A

conventional cutting

51
Q

MC needle use for most minor surgery procedures

A

reverse cutting**

52
Q

needle that pierces and spreads without cutting, used in bowel, muscle, and fascia

A

tapered

53
Q

needle used to dissect friable tissue instead of cutting; liver, kidney, spleen, cervix

A

blunt

54
Q

Post-op: keep wound/dressing dry for ___ hours and limit movement; redress every ___ days.

A

24-48 hr

2-3 days

55
Q

Post op: remove sutures with _______ with knots pulled across

A

iris scissor or #11 scalpel

56
Q

if dehiscence occurs, re-suture within

A

48-72 hrs

as long as it’s not infected!

57
Q

local anesthetics block ____ reuptake to prevent _______ of pain stimuli

A

Na
depolarization

(called non-depolarization block)

58
Q

10cc of 1% = ___ mg

A

100

just add a zero

59
Q

Amides are metabolized in

A

liver by microsomal enzymes

60
Q

True allergies are rare with amides/esters

A

amides

61
Q

topical amides

A

lidocaine and EMLA cream/patch

62
Q

injectable amides

A

lidocaine
bupivacaine
mepivacaine

63
Q

Lidocaine: _____ onset and ____ duration

A

onset: 1-10 min
duration: 30-60 min

64
Q

Bupivacaine: _____ onset and ____ duration

A

onset: 8-12 min
duration: 3-4 hr

65
Q

Max dose of lidocaine in child

A

3.3-4.5 mg/kg of 1%, not to exceed 75-110 mg total

66
Q

Max dose of lidocaine in adult

A

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

67
Q

Max dose of bupivacaine in adult

A

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

68
Q

Which anesthetic is used for digit blocks

A

bupivacaine

69
Q

bupivacaine SE

A

heart block

BLOCKS - used for digit block and MAJOR SE of ht block

70
Q

Mepivacaine: _____ onset and ____ duration

A

onset: 8-12 min
duration: 2-2.5 hr

*less drowsiness than lidocaine

71
Q

Max dose of mepivacaine in adult

A

5 mg/kg of 1%, not to exceed 400 mg

72
Q

Esters are metabolized in

A

peripheral plasma by pseudocholinesterase

73
Q

topical esters

A

benzocaine
proparacaine
cocaine
TAC (tetracaine + adrenaline/Epi + cocaine)

74
Q

injectable esters

A

procaine

75
Q

topical ester that is poorly absorbed, need at least 10%

A

benzocaine

76
Q

topical ester used in ophthalmology, < 1 min onset, 15 min duration

A

proparacaine

77
Q

topical ester used in ENT procedures, < 1 min onset, 1 hr duration

A

cocaine

78
Q

topical ester that is CHEAP and FAST

A

TAC (tetracaine + adrenaline/Epi + cocaine)

79
Q

slower onset and same duration as lidocaine; allergic rxn common

A

Procaine (an ester)

80
Q

toxic rxn to anesthetics leading to hypotension, bradycardia, cardiac arrest. tx with ____

A

high dose O2 (helps body metabolize anesthetic)

81
Q

allergic/hypersensitivity to anesthetics; tx mild with _______ and severe with ______

A

mild: diphenhydramine
severe: Epi and O2; or if in wild follow Epi w/ diphenhydramine and steroids

82
Q

Uses of Epi

A

1) decreases oozing/bleeding
2) prolongs duration/decreases absorption of anesthetic
3) decreases risk of toxic rxn (b/c decrease absorption)

83
Q

injectable Epi dose for minor surgery procedures

A

1:200,000 with MAX of 0.2 mg

84
Q

antidote to Epi toxicity/OD

A

administer IV push of Mg++ and B6 to increase COMT metabolism

85
Q

Never use Epi in

A

end-arteries (fingers, toes, penis, nose, clitoris, ears)

86
Q

EPI C/I

A

MOA-I, TCAs, Thyrotoxicosis, severe CVD

caution in pt with PVD, HTN

87
Q

ND’s can perform _________, cannot _________

A

can: uncomplicated procedures that involve superficial structures
cannot: go into fascia or muscle

88
Q

List of things ND’s canNOT do

A

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
Q

Never use ________ if you’re suspicious of malignancy

A

tissue destruction methods (cryo, electro)

90
Q

Liquid nitrogen is stored in

A

Dewar bottle - can last weeks or months

91
Q

liquid nitrogen procedure

A

freeze, thaw, refreeze with 2-3mm freezing zone (white area) around lesion for 10-30 sec

92
Q

what should you PARQ pt after using liquid nitrogen

A

blister forms w/in hours, scab w/in a week, healing in 2-3 wks

93
Q

is it okay to use liquid nitrogen straight from Dewar bottle?

A

NO

you can transfer HPV into container

94
Q

Liquid nitrogen C/I

A

malignancy, Raynaud’s, sensitive skin

95
Q

Electrosurgery C/I

A

flammable EtOH, metal implants, jewelry

**do NOT clean skin w/ EtOH - will light pt on fire!

96
Q

sterile electrode with + current destroys tissue and coagulates b.v.

A

electrosurgery

97
Q

indirect electrical current, very precise, no blood loss

A

electrocautery

98
Q

direct, high-frequency current flows through tissue to generate heat; quick and effective with minimal blood loss

A

hyfrecation

99
Q

complete removal of superficial lesion, both diagnostic and curative

A

excisional biopsy

100
Q

for excisional biopsy, use ___________ and cut __________

A

3:1 elliptical with 30’ angle corners and #15 blade

parallel to Langer’s lines

101
Q

narrow elliptic taken within a lesion to diagnose a larger lesion (biopsy)

A

incisional biopsy

102
Q

diagnostic and therapeutic and healing is rapid with minimal scarring (biopsy)

A

shave biopsy

103
Q

with punch biopsy, traction skin ____ to Langer’s lines, must go ____ beyond borders

A

perpendicular

1-2 mm

104
Q

scalpels: puncture abscess, incisions, stabbing

A

11

105
Q

scalpels: blunt dissection, excision, trimming

A

15

106
Q

scalpels: for thick skin (back)

A

10

107
Q

scalpels: disposable, sterile and attached to reusable handle

A

3

108
Q

forceps that do NOT crush skin, what we use for suturing

A

toothed adson

109
Q

forceps that do crush skin, we use for foreign body removal

A

toothless adson

110
Q

scissors for fine dissection

A

iris

111
Q

scissors for blunt dissection

A

metzenbaum

112
Q

circumscribed, flat discoloration that may be brown, blue, red, or hypopigmented

A

macule

113
Q

an elevated solid lesion up to 0.5 in diameter; color varies; may become confluent and form plaques

A

papule

114
Q

circumscribed, elevated, solid lesion more than 0.5 cm in diameter

A

nodule

*a large nodule is referred to as a tumor

115
Q

circumscribed collection of leukocytes and free fluid that varies in size

A

pustule

116
Q

circumscribed collection of free fluid up to 0.5 cm in diameter

A

vesicle

117
Q

circumscribed collection of free fluid more than 0.5 cm (5 mm) in diameter

A

bulla

118
Q

loss of intercellular connections (desmosomes) between keratinocytes; occurs in pemphigus vulgaris and related d/o; cell shape changes from polygonal to round

A

Acantholysis

119
Q

thickening of epidermis (squamous) layer; rete ridges usually extend deeper into dermis

A

Acanthosis

120
Q

flat discoloration > 5 mm

A

patch

121
Q

thickened cornified layer, often with prominent granular layer; keratin may be abnl

A

hyperkeratosis

either orthokeratotic or parakeratotic

122
Q

exaggeration of normal pattern of keratinization with no nuclei in cornified layer

A

orthokeratotic

type of hyperkeratosis

123
Q

type of hyperkeratosis with retained nuclei in cornified layer

A

parakeratotic

124
Q

hyperplasia of spinosum layer; assoc. w/ hyperlipidemia, Cushing’s, DM

A

acanthosis nigricans

125
Q

verrucas, flat, papules; “stuck on”

A

seborrheic keratosis

126
Q

chronic scratching cz skin growth

A

lichenification

127
Q

2’ to trauma, increase fibroblasts, brown-firm

A

dermatofibroma

128
Q

moveable capsule filled with keratin, sebum

A

epidermal inclusion cysts (sebaceous)

129
Q

sebaceous cyst on head

A

pilar cyst (wen)

130
Q

subQ moveable nodule; often recur

A

lipoma

131
Q

is it ok to perform minor surgery on hemangioma?

A

NO

esp. not cavernous hemangioma

132
Q

dandruff, cradle cap

A

seborrheic dermatitis

133
Q

for acne vulgaris, avoid ____ and use ______

A

avoid: B12, iodine
use: zinc, tea tree

134
Q

rough scaling skin, SCC risk

A

solar (actinic) keratosis

biopsy! (to r/o neoplasm)

135
Q

round/oval papules or plaques, pink/red/purplish on legs

A

Kaposi’s sarcoma

biopsy! (to r/o neoplasm)

136
Q

elevated falt topped area, usu > 0.5 cm

A

plaques

137
Q

“liver spots”, usually benign from excess sun exposure

A

solar lentigo

biopsy! (to r/o neoplasm)

138
Q

lesion of subQ fat, usually anterior shins; cz by sarcoid, TB, leprosy, histoplasmosis, coccidiomycosis, Crohn’s

A

Erythema nodosum

biopsy! (to r/o neoplasm)

139
Q

MC neoplasm, slow growing, rare Mets

A

BCC

140
Q

fast growing neoplasm, Mets common, exposure to arsenic

A

SCC

141
Q

pearly, rolled boarders

A

BCC

142
Q

indurated, ulcerated/crusty, may bleed easily

A

SCC

143
Q

MC in females, tumor marker S-100, METS!!

A

Melanoma

144
Q

MC melanoma

A

superficial spreading

145
Q

most aggressive melanoma

A

nodular

146
Q

melanoma in elderly, slow growing

A

lentigo

147
Q

MC melanoma in dark skin - palms, soles, nails; aggressive!

A

acral

148
Q

GABHS of dermis

A

Cellulitis

149
Q

Cellulitis can lead to

A

necrotizing fasciitis or erysipelas (lymph involvement, orange peel)

150
Q

red streaking along LN

A

lymphangitis

151
Q

strep infx of superficial lymphatics; usu 2’ to immunocompromised, trauma, ulcer

A

erysipelas

152
Q

chronic venous insufficiency d/t diabetes or bed ridden

A

stasis dermatitis

153
Q

HPV - genital warts

A

6, 11

154
Q

HPV - dysplastic

A

16, 18, 31, 33

155
Q

6th dz, HHV 6/7, maculo-papular rash with high fever

A

Roseola infantum

156
Q

cranial-caudal macular-papular rash with mild fever

A

Rubella (German Measles)

157
Q

cough, coryza, and conjunctivitis, koplick spots and cranial-caudal macular-papular rash

A

Measles (Rubeola)

158
Q

Measles complication

A

subacute sclerosing panencephalitis

159
Q

staph or strepB, honey colored crust

A

Impetigo

160
Q

Impetigo tx

A

mupirocin

161
Q

MRSA tx

A

mupirocin

162
Q

Herpes zoster tx

A

Levodopa, UV light

163
Q

Herpes zoster vaccine

A

Zostavax

164
Q

viral infx; waxy, pink with small central pit; B9

A

molluscum contagiosum

165
Q

gold with woods lamps

A

Tinea versicolor (pityriasis versicolor)

166
Q

Vitiligo tx

A

copper, Vit D, phenylalanine

167
Q

10-20 y/o, herald patch

A

Pityriasis rosea

168
Q

tx for atopic derm

A

Psorinum (homeo), Sulphur (homeo), Vit C

169
Q

symmetrical lesions with concentric rings (target lesion)

A

erythema multiforme

170
Q

timeline of drug eruptions

A

1-3 weeks after (7 days MC)

*stop taking the drug!

171
Q

infx of nail bed, painful swelling by staph, strep or candida

A

paronychia

172
Q

deep infection working under nail bed

A

felon

173
Q

Tinea unguium (nail fungus) tx

A

Melaleuca alternifolia

174
Q

+Nikolsky sign, blister spreads, AI, DEADLY

A

pemphigus vulgaris

175
Q

bx: intra-epidermal bullae with anti-epithelial cell Abs against desomsomes (AKA anti-desmoglein-3 antibodies)

A

pemphigus vulgaris

176
Q

bullae intact in subepidermal space, flexors/trunk

A

Bullous pemphigoid

less serious than pemph. vul.

177
Q

bx: epidermal blisters and anti-basement membrane auto IgGs

A

Bullous pemphigoid

178
Q

dermatographism is seen in what immunologic condition

A

urticaria

179
Q

cz of erythema multiforme

A

HSV and Mycoplasma pneumonia

DDx SJS

180
Q

flu-like sx followed by painful red or purplish rash that spreads and blisters; top layer of affected skin dies and sheds

A

Stevens-Johnson Syndrome

usu. a rxn to a medication or infx

181
Q

Bull-s eye, B. Burgdorferi, ixodes ticks

A

erythema migrans

182
Q

measles-like maculopapular rash

A

morbiliform drug eruption

183
Q

discoid or malar rash, < sun exposure, IgG/IgM

A

Lupus erythematous

184
Q

small flesh papules, increase in size on hands and feet

A

granuloma annulare

185
Q

IgA deposits cz pruritic papules/vesicles; assoc. with celiac dz

A

Dermatitis herpetiformis

186
Q

Kobner’s phenomena

A

psoriasis

187
Q

Auspitz phenomena

A

psoriasis

188
Q

bx: mounds of parakeratosis with neutrophils, diminished or absent stratum granulosum, epidermal thickening

A

psoriasis

189
Q

malar rash with pustules/papules on an erythematous base with telangiectasia; < stress, hot/cold, food triggers

A

Rosacea

190
Q

red, scaling with prominent skin lines - itching constantly

A

Lichen simplex

191
Q

Wickham striae, 5 P’s on palms and wrist; assoc. w/ Hep C

A

Lichen planus

192
Q

white, painless patches on tongue that canNOT be scraped off; cz by EBV, usu. in HIV pt.

A

Hairy leukoplakia

may need to bx

193
Q

Neurotoxic, painless spider bite

A

Black widow

194
Q

Necrotoxic, painful spider bite

A

Brown recluse

195
Q

serpiginous lesions, < night, doesn’t go above neck

A

Scabies