Derm, King 5Q

Question 1

wound evaluation of nerves

Answer 1

check distal to wound
light touch and motor function
two point discrimination

Question 2

wound evaluation tendons

Answer 2

complete laceration causes resting deformity because antagonist mm unopposed
partial laceration with pain or relative weakness on strength testing

Question 3

wound evaluation of vasculature

Answer 3

ischemia shows pallor dec pulses or delayed capillary refill distal to laceration
could include rapidly expanding or pulsatile mass or bruit

Question 4

wound eval bone injury

Answer 4

XR to rule out fracture

Question 5

wound evaluation of foreign bodies

Answer 5

glass! (sharp metals unlikely)
patients complaint of feeling foreign body should NOT be ignored
localized pain or tenderness in high risk wound
pain will worse with active AND passive motion

Question 6

plan XR for what tyep foreign bodies

Answer 6

inorganic materials like glass, stones metal

Question 7

CT US or MRI used for what type foreign bodies

Answer 7

organic materials like wood splinters, plastic

Question 8

main reason not to close a wound primarily

Answer 8

wound infection

Question 9

CI to primary wound closure

Answer 9

acute wound > 6 hours old
foreign debris in wound cannot be completely removed
active oozing of blood
dead space under skin closure
too much tension on wound

Question 10

delayed primary closure

Answer 10

compromise between primary repair and allowing acute wound to heal secondarily
wounds >6 hr old
initially Tx wet-dry dressing changes for 2-3 days then suture within 3-4 days

Question 11

when to seek surgical consultation for laceration repair

Answer 11

deep wounds of hand or foot
full thickness lacerations of eyelid, lip or ear
lacerations involving nerves aa, bones or joints
penetrating wounds of unknown depth
severe crush injuries
severely contaminated wounds requiring placement of drain
wounds leading to strong concern about cosmetic outcome

Question 12

cleansing a wound

Answer 12

saline or tap water

iodine and H2O2 to be avoided

Question 13

anesthesia for wound care

Answer 13

injectable lidocaine or bupivacaine

epi dec blood– avoid in fingers toes penis nose and ear lobes

Question 14

if tissue dirty where to inject anesthesia

Answer 14

into skin aorund wound to prevent foreign material from being pushed into tissues

Question 15

allow how long for anesthesia to be effective

Answer 15

5-10 minutes

Question 16

close wounds according to what

Answer 16

lines of langer

Question 17

non absorbable sutures

Answer 17

silk
nylon
polypropylene
cotton
stainless steel

Question 18

silk

Answer 18

low tensile strength

rarely used for minor wounds

Question 19

nylon

Answer 19

first synthetic suture introduced
high tensile strength
elastic
minimal tissue reactivity
low cost
need increase knots to hold suture in place

Question 20

polypropylene

Answer 20

plastic synthetic with low tissue reactivity and high tensile strength
slippery, needs more knots to hold
can accomodate wound swelling since elastic
helpful in dark skin people because purchased in blue color

Question 21

absorbable sutures

Answer 21

catgut
chromic gut
fast absorbing gut
polyglactin(vicryl)
monocryl
polglycolic acid (dexon)

Question 22

cat gut

Answer 22

sheep or cattle intima

tensile for 5-7 days

Question 23

chromic gut

Answer 23

Tx with chromium salt and delays absorption so 10-14 days

Question 24

main use of chromic gut

Answer 24

close lacerations in oral mucosa
rapidly absorbed in oral cavity
not good for dermal and mm layers because tissue reactivity

Question 25

suture for facial lacerations when tissue adhesives cannot be used or suture removal difficult

Answer 25

fast absorbing gut

reinforce with skin tape

Question 26

polyglactin or Vicryl

Answer 26

lubricated braided material with smotth tie down
tensile strength 3-4 weeks
absorbs in 60-90 days
dec tissue reactivity
ideal for subcutaneous sutures

Question 27

monocryl

Answer 27

monofilament good for tying nots
good for contaminated wounds with deep sutures
lose tensile strength in 21 days

Question 28

dexon

Answer 28

braided and less reactive than gut sutures
holds 50% strength for 25 days
high friction so cause binding and snagging when wet
newer forms have synthetic coating to prevent the snaging

Question 29

interupted suture

Answer 29

removal of some but not all sutures like if infection

better for jagged irregular wounds

Question 30

continuous suture “baseball stitch”

Answer 30

closes wound quickly
better cosmetic result tension is uniform
if suture breaks whole wound open

Question 31

subcuticular laceration, what stitch?

Answer 31

running suture ideal because low tension and cosmetic

Question 32

best for everting wound edges in anatomic locations that invert

Answer 32

vertical mattress technique

Question 33

best for high tension wounds or wounds with fragile skin

Answer 33

horizontal mattress technique

Question 34

tissue adhesives like dermabond not used where

Answer 34

high tension areas like joints

Question 35

tissue adhesive CI in

Answer 35

immunosuppressed patients
DM
not in contaminated complex or jagged lacerations
avoided on mucosal surfaces or moist areas like axillae or groin

Question 36

types of incisional Bx

Answer 36

shave and punch

Question 37

excisional Bx

Answer 37

entire area abnormal area removed

Question 38

when doing exicional Bx L vs W of wound

Answer 38

L should be 3-4X W

Question 39

when doing exicional Bx L vs W of wound

Answer 39

L should be 3-4X W

Question 40

phases of wound healing

Answer 40

inflammation
proliferation
maturation

Question 41

aftercare of wound

Answer 41

can shower after 24 hours

no baths

Question 42

timing of removal sutures of face

Answer 42

3-5 days

Question 43

which sutures can be removed 7-10 days

Answer 43

scalp and arms

Question 44

which sutures can be removed 10-14 days

Answer 44

trunk
legs
hands or feet

Question 45

sutures on palms and soles can be removed after how long

Answer 45

14-21 days