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AGM 1 > Exam 2: Other > Flashcards

Exam 2: Other Flashcards

1
Q

3 types of pain

A

inflammatory, nociceptive, neuropathic

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2
Q

2 types of nociceptive pain

A

visceral, somatic

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3
Q

2 types of neuropathic pain

A

central, peripheral

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4
Q

2 types of inflammatory pain

A

tissue inflammation, hypersensitivity

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5
Q

2 types of somatic pain

A

deep, superficial

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6
Q

pain type: presence of a potentially damaging stimulus

A

nociceptive

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7
Q

pain type: promotes healing by preventing movement and contact

A

inflammatory

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8
Q

pain type: withdrawal reflex

A

nociceptive

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9
Q

pain type: commonly chronic

A

neuropathic

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10
Q

pain type: transient

A

nociceptive

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11
Q

pain type: associated with tissue damage and inflammation

A

inflammatory

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12
Q

pain type: protective function

A

nociceptive

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13
Q

nociceptive pain definition

A

caused by physiological activation of pain receptors

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14
Q

neuropathic pain definition

A

caused by lesion in central or peripheral nervous system

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15
Q

localization of nociceptive pain

A

local and referred

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16
Q

mechanism of neuropathic pain

A

ectopic impulse generation, central sensitization, etc.

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17
Q

dermatome definition

A

the area of the body affected by each nerve root

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18
Q

tx step 1 of pain ladder

A

non-opioid, with or without adjuvant

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19
Q

step 2 of pain ladder

A

pain increasing or persisting

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20
Q

step 3 of pain ladder

A

pain increasing or persisting

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21
Q

step 4 of pain ladder

A

free of cancer pain

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22
Q

tx step 2 of pain ladder

A

opioid for mild-moderate with or without non-opioid, with or without adjuvant

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23
Q

tx step 3 of pain ladder

A

opioid for moderate to severe pain with or without non-opioid, with or without adjuvant

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24
Q

DMARD

A

disease-modifying anti-rheumatic drug

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25
Q

how long for IV pain meds to start working

A

30-60 seconds

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26
Q

how long for IM pain meds to start working

A

10-20 minutes

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27
Q

how long for SL pain meds to start working

A

3-5 minutes

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28
Q

onset IH pain meds

A

2-3 minutes

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29
Q

onset SQ pain meds

A

15-30 minutes

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30
Q

onset PR pain meds

A

5-30 minutes

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31
Q

onset PO pain meds

A

30-90 minutes

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32
Q

what type of opioids are best for severe pain

A

long-acting

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33
Q

what type of opioids are best for moderate pain

A

short-acting

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34
Q

3 long-acting opioids

A

transdermal fentanyl, oxycodone SR, morphine SR

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35
Q

commonly used opioids for moderate pain

A

hydrocodone, oxycodone, codeine, morphine

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36
Q

non-opioids for mild pain

A

APAP, NSAIDs, Cox-2 inhibitors, tramadol, salicylate

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37
Q

adjuvant pain meds

A

antidepressants, anticonvulsants, corticosteroids, topical agents

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38
Q

how often narcotic contract review

A

q 3 months

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39
Q

what must happen q 6 months for narcotic contract

A

urine drug screen

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40
Q

components of 3 month visit for narcotics

A

check PMP, confirm diagnosis, confirm pain plan, evaluate potential for abuse, update comorbidities, document alternative treatments tried, discuss risks and benefits

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41
Q

narcotic contract for sedative/hypnotics?

A

No, but need UDM

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42
Q

who does not need narcotic contract

A

patients who fill less than 90 pills in 90 days

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43
Q

which type of arthritis has swan neck deformity

A

rheumatoid

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44
Q

which type of arthritis has ulnar deviation

A

rheumatoid

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45
Q

which type of arthritis has bouchard’s nodes

A

osteo

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46
Q

4 stages of healing

A

hemostasis, inflammatory, proliferative, remodeling

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47
Q

remodeling stage timeline

A

weeks to months

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48
Q

inflammatory phase timeline

A

hours to days

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49
Q

hemostasis phase timeline

A

seconds to hours

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50
Q

proliferative phase timeline

A

days to week

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51
Q

healing stage epithelialization

A

remodeling

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52
Q

healing stage vasoconstriction

A

hemostasis

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53
Q

healing stage early neutrophil, late macrophage

A

inflammatory

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54
Q

healing stage leukocyte migration

A

hemostasis

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55
Q

healing stage collagen synthesis

A

proliferation

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56
Q

healing stage increase tensile strength of wound

A

remodeling

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57
Q

healing stage chemoattractant release

A

inflammatory

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58
Q

healing stage phagocytosis

A

inflammatory

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59
Q

healing stage ECM reorganization

A

proliferation

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60
Q

healing stage ECM remodeling

A

remodeling

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61
Q

healing stage angiogenesis

A

proliferation

62
Q

healing stage epithelialization

A

proliferative

63
Q

healing stage platelet aggregation

A

hemostasis

64
Q

healing stage granulation tissue formation

A

proliferative

65
Q

what is wound undermining

A

when the edges of a wound become eroded and a pocket forms underneath, measured by putting a probe under the wound edge but parallel to the skin

66
Q

tunneling occurs in what stage pressure ulcers

A

3 and 4

67
Q

stage of wounds with slough

A

3 and 4

68
Q

what should one assume in the presence of slough

A

that the wound is colonized with bacteria

69
Q

composition of slough

A

serum proteins, collagen; may change color if bacteria also present

70
Q

characteristics of stable eschar

A

hard, black, dry, leathery

71
Q

composition of stable eschar

A

desiccated and necrotic tissue

72
Q

when should stable eschar not be removed

A

when it is on a distal arterial wound

73
Q

characteristics of unstable eschar

A

black, shiny, boggy, accompanied by inflammation

74
Q

significance of unstable eschar

A

bacteria are present on viable tissue underneath, watch for signs of infection

75
Q

characteristics of granulation tissue

A

red or deep pink, shiny, bumpy surface, moist

76
Q

composition of granulation tissue

A

new capillaries, matrix, fibroblasts, collagen

77
Q

rolled wound edge aka

A

epibole

78
Q

characteristics of rolled wound edge

A

raised and rounded wound edges that have rolled under

79
Q

rolled wound edge composition

A

healing skin, sealed edge of mature epithelium

80
Q

characteristics of epithelialization

A

paler skin color, ground glass appearance

81
Q

composition of epithelialization

A

epithelial cells (new skin)

82
Q

thin, opaque wound exudate

A

seropurulent

83
Q

think, opaque wound exudate

A

purulent

84
Q

significance of sanguineous exudate

A

new blood vessel growth or disruption of blood vessels

85
Q

significance of serous wound exudate

A

normal during inflammatory and proliferative phases

86
Q

significance of serosanguineous wound exudate

A

normal during inflammatory and proliferative phases

87
Q

significance of purulent wound exudate

A

signals wound infection, may have odor

88
Q

significance of seropurulent wound exudate

A

may be the first sign of infection

89
Q

Stage III pressure ulcer involves what

A

epidermis, dermis, subcutaneous tissue/superficial fascia

90
Q

Stage 1 pressure ulcer involves what

A

epidermis

91
Q

Stage IV pressure ulcer involves what

A

epidermis, dermis, subcutaneous tissue/superficial fascia, underlying structures

92
Q

Stage II pressure ulcer involves what

A

epidermis, dermis

93
Q

partial thickness corresponds to what stage

A

II

94
Q

full thickness corresponds to what stage

A

III, IV

95
Q

Diabetic ulcers are what grade

A

stage of pressure ulcer minus 1

96
Q

appearance of stage III ulcer

A

deep ulceration with or without undermining of adjacent tissue

97
Q

appearance of stage 1 ulcer

A

non-blanchable erythema of intact skin

98
Q

appearance of stage IV ulcer

A

extensive tissue destruction with exposure of underlying structures, tissue necrosis

99
Q

appearance of stage II ulcer

A

superficial ulceration: abrasion, crater, or blister

100
Q

to avoid pressure ulcers, patients should be turned every

A

2 hours

101
Q

dressings for skin tears

A

non-adherent

102
Q

recheck for skin tears

A

24-48 hours

103
Q

Category 3 skin tear

A

flap is completely absent

104
Q

category 1 a skin tear

A

flap is present and can be replaced without stretching, no signs of flap compromise are present

105
Q

category 2a skin tear

A

edges cannot be realigned to normal anatomical position, no signs of flap compromise

106
Q

category 2b skin tear

A

edges cannot be realigned to normal position, signs of flap compromise

107
Q

category 1b skin tear

A

flap is present and can be replaced with stretching, there are signs of flap compromise.

108
Q

what percentage of ulcers are caused by venous insufficiency

A

70%

109
Q

3 characteristics of wounds caused by venous insufficiency

A

shallow ulcer in lower third of leg, surrounding skin changes, irregular in shape

110
Q

3 options for diagnosing venous insufficiency

A

venous duplex imaging, air plethysmography, venography

111
Q

contraindications for pressure stockings

A

open wound, arterial occlusion

112
Q

what pressure should be used for chronic venous insufficiency with edema

A

low-moderate, 30-40

113
Q

high compression pressure and uses

A

50+, lymphedema/phlebolymphedema

114
Q

what pressure is used for edema prevention during daily activities

A

10-15, light support

115
Q

what pressure is used for refractory venous insufficiency or lymphedema

A

moderate, 40-50

116
Q

what pressure is used for DVT prophylaxis in non-ambulatory patients with edema

A

low, 15-20

117
Q

what pressure is used for venous insufficiency with varicosities and dependent edema

A

low, 20-30

118
Q

when should compression stockings be replaced

A

every 3-4 months

119
Q

what is Marjolin’s ulcer and when is it suspected

A

type of squamous cell carcinoma, non-healing venous ulcer after 3 months

120
Q

treatment for stasis derm, dry pruritic

A

moisturizer or petroleum-based emollient

121
Q

tx for stasis derm, dry pruritic burning

A

impregnated gauze

122
Q

tx for stasis derm, impetiginized

A

topical abx (-cin)

123
Q

tx for stasis derm, vesiculation/oozing

A

topical corticosteroids (-inolone)

124
Q

tx for stasis derm, refractory

A

corticosteroids

125
Q

what percentage of PAD patients are asymptomatic

A

> 50%

126
Q

what percentage of diabetic foot ulcers results in LEA

A

25%

127
Q

albumin signalling protein malnutrition

A

<3.5

128
Q

critically low anemia that may inhibit wound healing

A

HCT<18

129
Q

what is atrophie blanche

A

white scarring due to microthromboses

130
Q

what is lipodermatosclerosis

A

fibrosing subcutaneous tissue with progressive induration and hyperpigmentation

131
Q

what finding is normal on venous duplex

A

triphasic

132
Q

what are clinical signs of Marjolin’s ulcer

A

rolled margins, rapid increase in size, excessive granulation

133
Q

what is Buerger’s disease

A

progressive inflammation and thrombosis of small vessels in extremities

134
Q

type of wound bed seen in PAD

A

pale or necrotic

135
Q

what ABI is abnormal

A

<1.0 or >1.3

136
Q

what is hyperkeratosis

A

callous formation at pressure points

137
Q

when is hyperkeratosis seen

A

diabetic neuropathy

138
Q

what is gastrocnemius soleus equinus

A

limited range of motion with increased pressure on sole of foot due to limited ankle dorsiflexion

139
Q

charcot foot

A

rocker bottom

140
Q

what is pes cavus

A

high arch

141
Q

what is pes planus

A

flat foot

142
Q

what A1C is suggestive of nonhealing ulcer

A

> 12

143
Q

what A1C is considered diabetic

A

> 6.5

144
Q

how much periwound erythema for OM

A

> 2 cm

145
Q

is imaging diagnostic for OM?

A

Not always, bone biopsy is gold standard

146
Q

what bacteria is usually present in gangrene

A

clostridium

147
Q

what is the best imaging modality for limb-threatening foot infection

A

CT

148
Q

what are 3 signs of limb-threatening foot infection

A

crepitus, bullae, pain out of proportion

149
Q

what lab values differentiate LTFE from cellulitis

A

elevated CK, AST

150
Q

excess of what nutrient can cause retardation in healing and fibrosis

A

vitamin E

AGM 1 (5 decks)

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