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Final Flashcards

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1
Q

Plaster vs. fiberglass splints

A

Plaster is:

  1. Easier to mold but more thermogenic - skin burns
  2. More absorbent - exudates
  3. Longer to harden - 10 min & fully by 8h

Fiberglass

  1. Hardens fully w/in 1-2h
  2. More expensive
  3. Require protective gowns due to resin
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2
Q

Indications of casts

A
  1. Tx of simple nondisplaced Fx
  2. Immobilize closed reduction of joints & Fx
  3. Tx severe sprains & strains
  4. Tx congenital deformities
  5. Manage chronic foot & ankle conditions
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3
Q

Contraindications to casts

A
  1. Before 3-4 days of injury (compartment syndrome)

2. Concealing infection

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4
Q

Complications of casts

A
  1. Cast dermatitis
  2. Pressure sores - ulcers
  3. DVT
  4. Nerve injury
  5. Transient muscle atrophy & joint stiffness
  6. Compartment syndrome
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5
Q

When would you splint the ankle in equines position?

A

Tx achilles tendonitis

Every other time - keep at 90 degrees

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6
Q

Thumb spica splint

A
  1. Scaphoid Fx

2. DeQuervian’s

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7
Q

Ulnar gutter splint

A

Fx of 4th/5th metacarpals/digits

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8
Q

Volar wrist spint

A
  1. Metacarpal Fx
  2. Soft tissue injury
  3. Carpal tunnel
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9
Q

UE sugar-tong splint

A
  1. Distal radial (Colles)

2. Ulnar Fx

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10
Q

Short leg posterior splint

A
  1. Tibia injury
  2. Fibula injury
  3. Jones Fx
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11
Q

Lower leg sugar tong “stirrup” splint

A

Posterior ankle injuries

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12
Q

Indications for arthrocentesis

A
  1. Removal of post traumatic/non-traumatic knee effusion - relief of pain
  2. R/o suspicious Dx
  3. Need for fluid analysis (GS, culture, cell counts, crystal analysis, PCR)
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13
Q

Contraindications for arthrocentesis

A
  1. Burns, infected tissue
  2. Prosthetic joints - needs referral
  3. Hemarthrosis when underlying coagulopathy has not been corrected
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14
Q

Complications for arthrocentesis

A
  1. Bleeding, infection, cartilage damage, fluid reaccumulation
  2. Injury to neurovascular structures
  3. Allergic rxns to meds

For bursal aspiration also:

  1. Development of a chronic sinus tract - especially when bursa connects to the joint
  2. Spreading RA to the bursa
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15
Q

Where is the best site to aspirate a knee?

A

Max extension - lateral approach

Space medially btwn the femoral condyles & behind the patella

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16
Q

Indications for joint ejections

A
  1. Arthropathies
  2. Bursitis
  3. Tendonitis
  4. Plantar fasciitis
  5. RA
  6. Ganglion cysts
  7. Trigger points
  8. Carpal tunnel
  9. Neuromas
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17
Q

Contraindications to joint injections

A
  1. Prosthetics
  2. Tumors
  3. Infections
  4. Neuro conditions
  5. Bleeding issues
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18
Q

What is the most accessible bursa?

A

Olecranon

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19
Q

What is a Hills-Sachs lesion?

A

Posteriolateral humeral head Fx

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20
Q

What is a Bankhart lesion?

A

Fx or tear of the glenoid ligament or bone

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21
Q

Pt presents w/ paresthesias associated with a shoulder dislocation..what should you suspect?

A

Axillary nerve damage

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22
Q

How do you reduce a shoulder dislocation?

A
  1. Stimson technique/Milch maneuver
  2. Kocher maneuver
  3. Hippocratic maneuver

Conscious sedation w/ Fentanyl & Midazolam
Velpeau sling
Old people move at 3wks, young 6 wks
Vigorous motion old people 6 wks, young 3 mo

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23
Q

Stimson technique

A

Shoulder reduction
Pt prone, arm hanging with 5-15lb wt, traction w/ rotation

Doesn’t work w/ adhesive capsulitis

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24
Q

Kocher maneuver

A

Shoulder reduction

Slow external rotation w/ a downward traction

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25
Hippocratic maneuver
Shoulder reduction | Longitudinal traction w/ contralateral pulling to reduce humeral head
26
Which type of finger dislocations might need open reductions?
MCP dorsal dislocations
27
How to reduce PIP dislocations?
Digital lidocaine block Axial traction & flexion Full extension splint for 6 wks DIP? Same but splint in flexion for 2-4wks
28
MC MCP joint dislocation?
Thumb
29
Contraindications to abscess drainage
1. 4 or more 2. Facial furuncles from nose bridge to corners of the mouth 3. Perianal abscesses w/ rectal extension
30
What should you suspect if Pt has abscesses in axilla & groin?
Hidradenitis Suppurativa | Multiple recurrences - Need surgery
31
Tx mastitis
Warm compresses, continue breast feeding abx - Dicloxacillin, Bactrim Not responding? US to r/o abscess
32
MC organisms causing abscesses
MSSA & MRSA Tx - I&D + Keflex +/- Bactrim Allergic? Clindamycin or Doxy Refractory? Tigecycline
33
Concerning anatomic locations for draining abscesses
1. Peritonsillar/retropharyngeal 2. Ant. triangle of neck 3. Supraclavicular fossa 4. Deep axillary 5. AC space 6. Groin 7. Popliteal space
34
When to give abx after draining abscess?
``` 1. >5mm PLUS 2. Cellulitis 3. Comorbidities 4. FB penetrating wounds/bites ```
35
How to prevent ingrown toenail from regrowing?
Nail matrix ablation w/ 88% phenol soln.
36
What is DuoDerm & what is it used for?
Dressing | Breaks down tissue...good for necrosis
37
What type of dressing keeps a moist wound bed?
Xeroform
38
What type of dressing is non-adherent?
Telfa Avoid removing new tissue
39
What types of dressings should you avoid with PVD?
Occlusive
40
What is evisceration?
Insides come out
41
What is dehiscence?
Separation
42
What are alginates & when are they used?
ex. AlgiDERM & Algisite From brown seaweed - absorb 20x their weight Best for infected wounds w/ heavy exudate
43
What are Biosynthetic dressings & when are they used?
Ex. E-Z Derm Gel/film for partial thickness wounds like burns/abrasions Barrier protection, moist environment, minimizing protein loss & pain
44
What are collagen dressings & when are they used?
Ex. BCG Matrix Used in non-infected areas, partial & full thickness wounds except 3rd degree burns Promotes debridement & granulation via extra collagen Requires another primary dressing to absorb exudate
45
What are foam dressings & when are they used?
Ex. Mepilex Absorbent & protective for skin tears & granulating wounds Can be primary/secondary dressings
46
What are hydrocolloids & when are they used?
Ex. DuoDERM For necrotic wounds Not for heavy exudates/infected wounds
47
What are Hydrogel dressings & when are they used?
``` Ex. Aquacel Can be used as filler Good for moderate exudate to maintain moist bed for granulation Allows for autolytic debridemnet Conforms to wound ```
48
What are transparent film dressings & when are they used?
Ex. Tegaderm Secondary dressing Waterproof & microbial resistant - allows excess moisture to evaporate
49
When should you avoid wound vacs?
Negative pressure wound therapy Exposed vital structures, florid infection, CA, ischemic wounds, fragile wounds. allergies Mechanism: Inc. blood flow, dec. inflammation/bacterial burden/devitalized tissue
50
Decubitus ulcers
1. Intact skin - blanchable erythema 2. Partial thickness tissue loss involving epidermis +/- dermis 3. Full thickness - NOT into underlying fascia 4. Full thickness w/ extension into underlying structures
51
What is a Majolin ulcer?
Aggressive SCC in area of chonic inflammation
52
Shave Bx
Removes part of epidermis & upper dermis Snip, saucerization (deep shave), curettage ContraindicationsL 1. Melanoma/dysplastic nevi 2. Hair/dermal components 3. Suspected sclerosing BCC
53
Punch Bx
Incisional - removes part of lesion Excisional - removes whole lesion 2-8mm Heal by secondary intention
54
Which areas are high risk for keloids?
1. Chest 2. Upper back 3. Arms
55
How do you stop bleeding after shave Bx?
Drysol / cautery
56
Is curettage sent to pathology?
NO
57
What size lesions should you excise?
>8 mm Use ellipse pattern w/ 4:1 length:width ratio Abx? Groin, lower extremities, high risk, prosthetic materials, oral lesions
58
When should you avoid electrosurgery?
Pts w/ implantable electronic devises Facial PPE required - respirator or high filtration face mask
59
What type of Bx should you use for facial lesions?
Shave
60
What veins are in the antecubital fossa?
1. Median cubital - MC for phlebotomy 2. Cephalic 3. Basilic
61
How long can the tourniquet be left on?
No more than 2 mins
62
CLSI recommended order of blood draw
1. Blood cultures 2. Red 3. Gold 4. Light blue 5. Green/Lavender 6. Gray
63
How often should an IV catheter be changed?
q72h
64
When is arterial sampling preferred over venous?
1. Ammonia 2. CO2 3. Lactate
65
Contraindications to arterial puncture?
1. No arterial pulse 2. Abnormal allen test 3. Arterial disease 4. Coagulopathy 5. AV shunt 6. Cellulitis 7. Uncooperative Pt
66
Angles for blood punctures
1. Blood - 15-30 2. IV - 15-30 3. Arterial - 40-60 4. Arterial line 30-45 5. Intradermal - 15 6. SQ - 45 7. IM - 90
67
Indications for arterial line
1. BP monitoring | 2. Frequent blood gas sampling
68
Allergic to eggs, which vaccines should you avoid?
Influenza & yellow fever
69
Allergic to Baker's yeast, which vaccines to avoid?
Hep B
70
Allergic to gelatin, which vaccines to avoid?
Varicella
71
Which vaccines should pregnant & IC avoid?
1. MMR 2. Varicella 3. Live attenuated flu 4. Yellow fever
72
Intradermal injections
Slow absorption - good for delayed rxns Volar forearm best - distal to AC space 15 degrees - DONT massage
73
SQ injections
Optimal abs. in fatty regions Better w/ lipophilic & lower volume drugs Good locations: lower abd, thigh, lower lat back
74
IM injections
Best absorption Highly vascular Best sites - deltoid, vastus lateralus Ventrogluteal - risk of sciatic nerve injury 3 deltoid
75
Technique for ventrogluteal injection
IM - more risk of sciatic nerve injury | V technique
76
IM injection of flu vaccine, do you need to aspirate first?
No - IM vaccines don't need to aspirate
77
Indications for urinary cath in surgical Pts
1. >60 min surgery 2. ICU postop 3. Procedure involving urinary tract, prostate, colon/rectum or major GYN 4. Limited mobility postop
78
Contraindications to urinary cath
1. Injury - blood clot at meatus Relative - urethral stricture, recent urinary tract surgery
79
Length of urethra
F - 3.5-5 cm M - 15-17 cm 3 cuvres - penile, membranous, prostatic
80
What size urinary cath to use in kiddos?
Age/2 + 8 Infants <6mo. - feeding tube 5F
81
Urinary cath size w/ BPH?
18-20 F
82
Indications for performing anoscopy
1. Rectal bleeding 2. Anorectal pain 3. Pruritis 4. Anal discharge 5. Mass found on DRE
83
Contraindications for anoscopy
1. Severe rectal pain 2. Perirectal abscess, acutely thrombosed hemorrhoid, anal fissure 3. Imperforate anus/severe anal stricture 4. Recent anorectal surgery
84
Contraindication for endometrial Bx?
Pregnancy
85
Indications for endometrial Bx
1. Abnl bleeding 2. Postmenopausal bleeding 3. Amenorrhea for 1 yr 4. Endometrial dating of menstrual cycle 5. Infertility 6. Response to hormonal therapy 7. Atypical glandular cells on Pap 8. Prior Dx of endometrial hyperplasia 9. FH
86
Ortolani test
Test for presence of posteriorly dislocated hip Abduct hips until touching table - feel clunk as femur pops back into acetabulum
87
Barlow test
Test for ability to sublux or dislocate an intact but unstable hip Dislocates hip Bring leg down - pull leg forward & adduct w/ posterior force

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