Minor Surgery Flashcards Preview

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Flashcards in Minor Surgery Deck (195):
1

What are universal precautions?

OSHA - things to keep YOU (as provider) protected

2

MC transmitted infx

Hep B

3

2% Glutaraldehyde: _____ to disinfect, _____ to sterilize

10 min to disinfect
10 hr to sterilize

4

How long do you need to boil to sterilize?

> 30 min

5

Dry heat sterilization

160'C/320'F for 1 hr

6

Autoclave sterilization

15 PSI at 121'C for 15 min

*most efficient and reliable form of sterilization

7

You ______ tools, you ______ people

Sterilize tools
Disinfect people

8

How do you disinfect intact skin?

10% betadine X3
0.4% chlorhexidine gluconate

9

How do you disinfect an open wound?

irrigate with normal (0.9%) saline

*do NOT use H2O2

10

Puncture with nerve, tendon, joint involvement or in chest/abdomen

Stabilize (secure large objects) and refer

11

Something to consider with puncture wounds

Pt last tetanus shot

12

Do not suture wounds older than

8-12 hr on body or 24 hr on face

13

Hypertrophic vs. keloid scar

hypertrophic is normal healing

keloid extends beyond the original area of wound

14

Healing stages

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

During inflammation stage of healing: _________ in 5-6 hrs, last 3-4 days to destroy bacterial

Neutrophils

16

During inflammation stage of healing: _________ transition from inflammation to repair and phagocytize

Macrophages

17

During inflammation stage of healing: __________ migrate w/in 24-48 hr to repair wound (re-epithelialization)

Basal cells

18

During inflammation stage of healing: _________ proliferate 1-2 days after injury

New keratinocytes

19

During remodeling: ____% strength by 3-4 wks, ____% at 1 year

30-40% at 3-4 wk
80-90% at 1 hr

20

__________ is normal due to myofibroblasts and orientation of collagen

Contraction

21

________ is abnormal formation of tight scar due to excessive contraction

contracture

22

Name this healing intention:

cut with kitchen knife - clean, fresh; we can clean and close it up; 8-12 hr

Primary intention

23

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

Secondary intention

24

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

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