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PA Clinical Skills > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What needs to be worn in the OR at all times?

A

Scrubs
Shoe covers
Hats
Masks

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2
Q

What parts of gowns are sterile?

A

From chest level to level of sterile field

From above elbows to cuffs

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3
Q

Why should clippers be used rather than shaving for removal of hair prior to surgery?

A

Shaving is more likely to cause a bunch of small cuts

Opportunities for infection

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4
Q

What are some rules to draping?

A 
Handle drapes as little as possible
Never reach across bed
Hold drape high
Protect gloved hands by cuffing
Any holes must be covered
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5
Q

What is an operative note?

A

Very brief summary of procedure
Written immediately after procedure
Can be written by a PA

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6
Q

What are indications for an NG tube?

A

Sampling gastric contents
Nutritional support
Removing air, blood, ingested substances and gastric contents
Diverticulitis, GI bleeding, Gastric outlet obstruction, intestinal obstruction, near drowning, vomiting

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7
Q

What are contraindications to NG tube?

A 
Obstruction
Damage to structures NG tube would touch
Choanal atresia
Facial trauma
Basilar skull FX
Esophageal stricture
Esophageal burn
Recent surgery on stomach or esophagus
History of gastrectomy
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8
Q

What are complications of NG tube?

A 
Insertion into trachea and lung
Bleeding
Aspiration pneumonia
Gastric erosion
Trauma
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9
Q

How do you confirm that the NG tube is in the stomach?

A

Radiograph
Aspirate
Inject 10 mL air and listen over LUQ
Place end of tube in water, bubbles = lungs

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10
Q

What sizes are used for NG tubes?

A

Neonates, infants, or patients with esophageal problems get 3 - 8 French
Healthy adults get 10 - 18 French

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11
Q

What are contraindications for the drainage of an abscess?

A

Located within triangle made by the bridge of the nose and corners of the mouth
Abscess near anus or genitals

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12
Q

What patients need close observation following I&D

A

DM
Immunocompromised
Debilitating disease

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13
Q

What are complications to I&D?

A 
Cellulitis
Bacteremia
Septicemia
Chronic anal fistula
Deep infection
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14
Q

What is a dry abscess?

A

One that resolves without rupture

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15
Q

What is a sterile abscess?

A

One from which bacteria can not be cultured

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16
Q

What is a chronic/cold abscess?

A

Lacks redness, heat, pain, or swelling

Associated with liquefactive necrosis of TB lesions

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17
Q

What is a hot lesion?

A 
Hot
Redness
Pain
Swelling
Fluctuant on palpation
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18
Q

What are the different types of abscesses?

A

Furuncle/boil - sweat gland/hair follicle
Carbuncle - furuncle that extends into SC tissue
Paronychia - abscess involving nail
Perifollicular abscess - on extremities, buttocks, breasts, or hair follicles

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19
Q

What should be used to clean the skin for an I&D?

A

Povidone - iodine

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20
Q

What way should anesthesia be given for an I&D?

A

Field block

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21
Q

Why should sutures not be given for an I&D?

A

It is infected tissue

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22
Q

In what situations should antibiotics be given for I&Ds.

A

Surrounding cellulitis
Lymphangitis
Strange bacteria

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23
Q

What types of bandages should be applied to I&Ds post op?

A

Nonadherent dressings
Adaptic
Telfa

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24
Q

What are indications for a chest tube to be inserted?

A

Pneumothorax
Hemothorax
Pleural effusion
Empyema

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25
Q

What are contraindications to insertion of a chest tube?

A

Bleeding diathesis
Coagulopathies
Skin infection

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26
Q

What are some complications of a chest tube?

A 
Re-expansion pulmonary edema
SubQ emphysema
Intercostal neuralgia
Organ perforation
Bleeding
Infection
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27
Q

Where should a chest tube be inserted?

A

In the 4th intercostal space

On top of the rib

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28
Q

What is the triangle of safety for a chest tube insertion?

A

Lateral pec major (anterior)
Mid axillary line (posterior)
Nipple line (inferior)
Axilla (apex)

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29
Q

What type of anesthesia should you use for a chest tube?

A

1% lidocaine

Local anesthesia

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30
Q

What equipment should be used for a chest tube?

A 
Size 11 blade scalpel
Kelly curved clamps
Non-absorbable suture
25 and 21 gauge needles
Chest tube (24 to 36 French)
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31
Q

What is a shave biopsy?

A

Removes epidermis and portion of upper dermis

Performed along horizontal plane

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32
Q

What are indications for a shave biopsy?

A 
Seborrheic keratosis
Verrucous lesions (wart)
Molluscum contagiosum
Superficial basal cell carcinoma
Benign nevus
Things will have a "stuck on" appearance
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33
Q

What is the benefit of a shave biopsy?

A

Doesn’t scar because it doesn’t go very deep

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34
Q

When should a curettage not be used?

A

If you need to determine tumor margins

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35
Q

What are contraindications to a shave biopsy?

A

Pigmented lesions
Diagnosis of infiltrative dermatoses
Sclerosing basal cell carcinoma
Any lesion with dermal component

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36
Q

What can be used to reduce the bleeding with a shave biopsy?

A

20% aluminum chloride
Hand held cautery
Monsel’s solution (caution)
Silver nitrate (caution)

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37
Q

What instruments can be used to perform a shave biopsy?

A

Size 15 scalpel

Demablade

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38
Q

How long should a lesion be kept clean and dry following removal?

A

24 hours

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39
Q

What are the two types of punch biopsys?

A

Incisional - removes portion

Excisional - removes entire

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40
Q

What are contraindications to a punch biopsy?

A

Lesions with suspected malignant potential

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41
Q

When should topical anesthetic be applied for a lesion removal?

A

20 - 60 minutes before the procedure

42
Q

What are the disposable sizes for punch biopsy?

A

2, 3, 4, 6, and 8 mm

43
Q

What does histological exam of a punch biopsy require?

A

Two samples or one 6 mm biopsy with directions to split it into two lesions

44
Q

When should sutures be removed following lesion excision?

A 
Face: 5 - 7 days
Neck: 7 days
Scalp: 7 - 10 days
Trunk and extremities: 7 - 14 days
Distal LE: 10 - 21 days
45
Q

When should an excisional biopsy be performed?

A

Any lesion greater than 1 cm

Improved cosmetic result over punch biopsy

46
Q

What is a Mohs procedure?

A

Micrographic surgical procedure

47
Q

When should a Mohs procedure be done?

A

Sclerosing or morpheaform basal cell carcinomas
Recurrent tumors
Any malignant tumor around the eye, nose, lips, or ears

48
Q

What are indications for intubating a patient?

A

Lost ability to maintain airway
Patient at risk for losing ventilation ability
Bypassing obstructions
Suction lower airway secretions and foreign materials

49
Q

What are contraindications for intubation?

A

Laryngeal disruption

50
Q

What is the most common complication of intubation?

A

Broken teeth

51
Q

What are other complications that can occur with intubation?

A 
Cervical spine injuries
Ocular injuries
PTSD
Hypertension
Speech problems
52
Q

What is the narrowest portion of the adult larynx?

Pediatric larynx?

A

Adult: vocal cords
Pediatric: Cricoid cartilage

53
Q

What does the mallampati score represent?

A

How visible the palate is

Higher number means more difficult intubation

54
Q

What are the main sedation options for patients undergoing intubation?

A

Anxiolytics
Analgesics
Paralytics

55
Q

How should a patient be positioned when they are about to be intubated?

A

Patient head at practitioner’s xiphoid process

Patient in sniffing position

56
Q

How do you measure oropharyngeal airway length?

Nasopharyngeal airway?

A

OPA: Corner of mouth to angle of jaw
NPA: tip of nose to tragus of ear

57
Q

What is the difference between a Macintosh and Miller laryngoscope?

A

Macintosh is curved

Miller is straight

58
Q

What size or tracheal tube is typically used during intubation?

A

Men: 7.5 - 8.5
Women: 7 - 8
Max is 10 mm
Pediatrics: 4 + age / 4

59
Q

What is the function of a stylet during intubation?

A

It is a malleable metal that helps guide the intubation tube

60
Q

What are initial conservative treatments for ingrown toenails?

A 
Elevation of nail
Oral antibiotics
Frequent soaking
Loose fitting shoes
Selective trimming of nail
61
Q

What is oncyhocryptosis?

A

Ingrown toenail

62
Q

What is oncyhomycosis?

A

Fungal infection of nail

63
Q

What is paronychia?

A

Inflammation of the nail fold

64
Q

What is oncyhogryposis?

A

Deformed curved nail

65
Q

What are contraindications for nail removal?

A

Bleeding disorder

Allergy to local anesthesia

66
Q

What needs to be applied to the nail matrix during a permanent removal?

A

Phenol solution

67
Q

How do you anesthetize a toe prior to nail removal?

A

1% lidocaine
5 mL

Scrub with povidone-iodine prior to removal

68
Q

What are follow up instructions for patients after they have had a nail removed?

A

Keep foot elevated for 24 - 36 hours

Soak toe in warm water twice a day for several days

69
Q

What are contraindications for draining of a subungal hematoma?

A 
Crushed/fractured nails
Fracture of distal phalanx
Suspected subungal melanoma
Artificial acrylic nails
Hematomas involving more than 50% of the nail
70
Q

What are follow up instructions for patients following a subungal hematoma drainage?

A

Soak digit in warm, soapy water 2-3 times daily

71
Q

What is the difference between a cast and a splint?

A

Cast - completely encases circumference

Splint - encases only part of extremity

72
Q

Why is a splint done over a cast?

A

Allows for swelling

Done in the swelling phase

73
Q

What is important about plaster material when used for casts?

A 
Easier to mold
Heavier
Not as durable
Messy
Generates more heat
74
Q

What is important to know about fiberglass for casts?

A 
Strong
Light weight
Less malleable
Water resistant
Less heat generated
More expensive
75
Q

What are contraindications to casting and splinting?

A

Avoid casting in acute phase (3-4 days)
Don’t cover known skin infection
Don’t cover open wounds that could become infected

76
Q

What are complications of casting and splinting?

A

Compartment syndrome
Cast dermatitis
Pressure sores
Nerve injuries

77
Q

What is used to remove a cast?

A

Oscillating cast saw

78
Q

What are indications for joint aspiration?

A 
Trauma
Monoarticular inflammation
Suspicious systemic rheumatologic disorder
Articular inflammation
Synovial fluid analysis
79
Q

What does normal synovial fluid look like?

A

Straw colored
Clear
Viscous

80
Q

What does the mucin clot test show in RA?

A

Lack of tight ropy clot formation when acetic acid is added to joint fluid

81
Q

What are the cell counts for normal, inflammatory, and infectious synovial fluid?

A

Normal - <200 WBC, <2,000 RBC
Inflammatory - 2,000 - 100,000 WBC
Infectious - 50,000 - 200,000 WBC, >75% PMNs

82
Q

What is the indication for bursal aspiration?

A

Bursal swelling that continues in spite of conservative measures

83
Q

What are contraindications to bursa aspiration?

A

Risks of introducing bacteria outweigh benefits
Burns
Infected skin
Infected subQ tissue

84
Q

What are contraindications for joint aspiration?

A

Risks of introducing bacteria outweigh benefits
After total joint procedures
Bleeding not controlled in hemophiliac patient

85
Q

What are potential complications to joint aspiration?

A 
Intra-articular injury
Reaccumulation of fluid
Injury to vascular or neural structures
Allergic reaction
Infection
Pain
Bleeding
86
Q

What are potential complications to bursa aspiration?

A 
Baker's cyst
Popliteal bursae
Communication between olecranon bursa and elbow joint in RA
Chronic recurrence
Chronic drainage
Pain
Infection
87
Q

Why does synovial fluid have to be aspirated before three or after 7 days of swelling?

A

Clotting process occurs 3-7 days after injury

88
Q

What is the prep for joint aspiration?

A 
Scrub area with povidone-iodine
Use 1% lidocaine
Enter anteromedially or anterolaterally
Use an 18 gauge needle
Joint at 90 degrees
89
Q

What are the diagnostic indication for a lumbar puncture?

A

Infectious: meningitis and encephalitis
Inflammatory: MS and guillan barre
Oncologic: leukemia
Subarachnoid hemorrhage

90
Q

What will you see on a lumbar puncture with subarachnoid hemorrhage?

A

CSF with xanthochromic color

91
Q

What are the therapeutic indications for a lumbar puncture?

A

Spinal and epidural anesthesia
Chemotherapeutic agents
Antibiotics
Lowering CSF pressure

92
Q

What are contraindications for a lumbar puncture?

A 
Increased intracranial pressure: focal neurologic signs
Localized skin infection
Cardiorespirartory compromise
Bleeding diathesis
Previous lumbar surgery
93
Q

What are complications of lumbar punctures?

A 
Cerebellar herniation
Headache
Subarachnoid epidermal cyst
CSF leakage
Pain
Bleeding
Infection
94
Q

What add additional challenges to a lumbar puncture?

A 
Obestity
Osteoarthritis
Degenerative disk disease
Kyphoscoliosis
Prior surgery
95
Q

How should the needle be angled during a lumbar puncture?

A

Towards the umbilicus

96
Q

What type of needle is used for a lumbar puncture?

A

Spinal needle

20-22 gauge

97
Q

Anatomically where should a lumbar puncture be done?

A

Between L3 and L5

98
Q

What are indications for topical hemostats?

A

Capillary oozing
Hard to reach areas
Oozing from suture lines
CSF leaks

99
Q

When irrigating a laceration how much fluid should you use?

A

Minimally 250 to 500 mL of sterile saline

100
Q

What is wound strength at two weeks?
One month?
10 weeks?

A

Two weeks - 10%
One month - 40%
Ten Weeks - 80%

PA Clinical Skills (2 decks)

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