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E-med exam 3 > Skin & Soft tissue > Flashcards

Skin & Soft tissue Flashcards

1
Q

Wounds prone to Tetanus

A

Longer than 6 hrs old
Deep >1 cm
Grossly contaminated
Avulsion/puncture/crush

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2
Q

DTaP vaccination schedule (5 different times)

A

2, 4, 6, 15 mo

4 yr

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3
Q

Tdap vaccination

A

11-12 YO
then once for adults

Td every 10 years

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4
Q

Risk factors for Improper Wound Healing

A 
Infection
Smoking
Malnutrition
Immobile
Diabetes
Vascular dz
Immunosup meds
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5
Q

Most common animal bite pathogen

A

Pasteurella

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6
Q

Where do dog bites usually occur

A

Head and neck of children <10 yo

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7
Q

Cat bite puncture below the periosteum

A

may lead to Osteomyelitis or Septic arthritis

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8
Q

Bite- maxillary intercanine distance is >2.5 cm

A

think Adult bite

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9
Q

Most common human bite pathogens

A

Eikenella Corrodens
Group A strep
Staph

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10
Q

Adult bite

A

> 2.5 cm

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11
Q

Clean surface of bite

A

Povodine Iodine

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12
Q

What type of closure for dog bites

A

Primary closure

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13
Q

When to consult surgery on BITES

A

Deep penetrating
Complex facial
Assoc w Neurovascular compromise
Wound with complex infection

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14
Q

Prophylactic Abx for what type of bites

A 
Deep puncture
Mod-Sev w crush injury
Underying venous or lymphatic compromise
Hand, face, genitalie, close to bone/joint
Requiring closure
Compromised host
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15
Q

Plantar puncture

A

X Ray
Closure: secondary intent (heal from inside out)
Tetanus
Watch for Signs of infection

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16
Q

CONTRA to closing lacerations

A

Contaminated
Greater than 12 hrs old
Presence of FB
Involving tendon, nerve, artery

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17
Q

Wound classification

A

Clean
Clean-contaminated
Contaminated
infected

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18
Q

Clean

A

Surgical incision

No involvement of GI, GU, respiratory

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19
Q

Clean-contaminated

A

Involvement of GI, GU, respiratory

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20
Q

Contaminated

A

Gross spillage into wound (bile, stool)

Traumatic

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21
Q

Wound Closure Classification

A

Primary intent
Secondary intent
Delayed primary intent

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22
Q

Primary intent

A

all layers closed
minimal scarring
For Clean or Clean-contaminated wound

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23
Q

Secondary intent

A

Deep layers closed, superficial layers left to granulate

Can leave wide scar

Needs frequent wound care

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24
Q

Delayed primary intent

A

Deep layers closed, THEN 4-5 days after superficial layers are closed if no concern for infection

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25
Q

Absorbable sutures

A

Vicryl
Polydioxanone PDS
Chromic gut

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26
Q

Non absorbable sutures

A

Prolene

Nylon

27
Q

Sutures with excellent handling, pref for Cardiovascular procedure

A

Nylon

28
Q

Prolene and Nylon are

A

NON absorbable

29
Q

Simple interrupted

A

most uncomplicated skin lacs

30
Q

Subcuticular

A

lacs on face

want a really clean line

31
Q

Langer’s lines

A

orientation of collagen fibers

Lacs that run at right angles to these lines tend to gape

32
Q

Post suture care

A

keep dry for 48 hours

33
Q

days to removal for scalp

A

7-14

34
Q

days to removal for FACE

A

5

35
Q

Who needs Abx?

A 
Wound >12 hrs old, esp on hands
Bites
Crush wounds
Contaminated
Avascular (like ear)
Joint space
Hx of valv heart dz
Immunocomp pts
36
Q

Most imp means to decrease infection

A

Irrigation!!!

37
Q

All sutured wounds need re-check in

A

24-48 hours

highly contaminated wounds need another recheck in 48-72 hours

38
Q

Consider absorbable sutures for YOUNG KIDS or ELDERLY in whom suture removal might be a BIOTCH

A

Chromic gut

Vicryl

39
Q

Cellulitis does NOT involve the

A

Fascia or

Muscles

40
Q

Cellulitis is WITHOUT

A

formation of abscess

41
Q

Most common Cellulitis pathogen in an immunoCOMPETENT (good immune system) pt

A

Strep A

Staph Aureus

42
Q

Most common Cellulitis pathogen in an immunoCOMPROMISED pt

A

may be nontraditional org:

Pseudomonas
Proteus
Serratia
Enterobacter
Citrboacter
43
Q

Cellulitis

A

Red, hot, swollen tender
Regional lymphadenopathy
Fever, malaise, chillls
+4 cardinal signs

44
Q

Signs of WORSENING or SEVERE Infection

A 
Violaceous bulla
Cutaneous hemorrhage
Skin sloughing
Skin anesthesia
Rapid progression
Gas in tissue

Require EMERGENT SURGICAL eval

45
Q

Outpatient care of Cellulitis

A

Limb elevation
Empiric abx
F/u in 48-72 hours

46
Q

Times to admit pt with Cellulitis

A

Face or dental
Immunocompromised pt
Orbital cellulitis
Pt with Comorbidity (cardiac, hepatic, renal)
Cellulitis affecting more tan 1/4 of extremity

47
Q

Abx tx for Cellulitis

“mainstay”

A

Beta-lactam

  • Amoxicillin
  • Amox-clavulanate
48
Q

Tx Cellulitis when Strep or MRSA are suspected

A

Cephalaxin

49
Q

Ceftriaxone is used for Cellulitis when?

A

Gram (-)

50
Q

If pt has PCN allergy, what Abx do we use to treat Cellulitis?

A

Macrolides

  • Azithro
  • Erythro
  • Clarithro
51
Q

Broad spectrum that treats both gram (+) and (-) pathogens

A

FluoroQ

  • Levofloxacin
  • Ciprofloxacin

“the big guns”

52
Q

Cephalexin covers

A

MRSA

53
Q

Most likely pathogen in wounds without drainage or abscess

A

Strep

54
Q

Prophylactic tx regimen for recurrent cellulitis

3-4 episodes per year

A

Penicillin or Erythromycin BID for 4-52 weeks

55
Q

Increased risk for abscess

A

Staph aureus carrier
Break in skin
Immunocomp

56
Q

Abscesses requiring surgical referral

A 
Peri-rectal
Anterior and lateral neck
Hand 
Next to vital Nerve or Blood vessel (facial, carotid artery, femoral artery)
Breast abscess near areola and nipple
57
Q

How often to change packing in abscess

A

Every 24 hours

58
Q

Recurrent abscesses should bathe with ______ daily

A

Chlorhexidine

59
Q

if MRSA causing recurrent abscess is suspected, consider 5 day decolonization regimen

A

BID nasal Mupirocin
Daily Chlorhexidone wash
Daily wash sheets/towel

60
Q

Burn wound infection

A

Staph Aureus

61
Q

Tx of Burn wound infection

A

Avoid hypothermia
Culture
Systemic abx with sepsis or shock

62
Q

Tx Cellulitis associated with Burn wound infection and suspect MRSA

A

Add VANCO

63
Q

Necrotizing fasciits

A

DESTROYS muscle fascia and overlying subQ

spares the muscle

64
Q

Fournier’s gangrene

A

Blisters, crepitus, subQ gas
fever, tachy, hypotension

Tx: aggressive debridement and broad spectrum Abx

E-med exam 3 (5 decks)

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