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Systemic Lab > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Why Biopsy

A

To obtain a sample for histopathology, electron microscopy, or immunofluroescene testing. To obtain a deep culture and to avoid superficial contamination of wounds, to perform an excision for curative or cosmetic purposes.

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2
Q

What if you think it could be melanoma

A

Full thickness biopsy (punch, incision, or excision) is indicated

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3
Q

CI to Biopsy

A

Infection, inflammation, traumatized, coagulopathy.

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4
Q

What to use if suture is indicated

A

Chlorhexidine/Betadine

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5
Q

What do hemostatic agents do?

A

Control bleeding. Use if not stapling or glueing.

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6
Q

When to use non disposable curettages?

A

When cancer is suspected. Allows you to feel good and bad tissue.

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7
Q

Disposable curettages

A

Very sharp. Not when cancer is suspected.

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8
Q

What does a radio frequency unit do?

A

Cauterizes

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9
Q

If you have a choice of lesion

A

Avoid cosmetically important areas, avoid old lesions, avoid ulcers, avoid areas with poor circulation, Do not include normal tissue unless a vesicular-bulbous lesion.

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10
Q

Preparing for Punch Biopsy

A

Obtain a full thickness cylindrical specimen. Select size of punch. Prepare site with alcohol. Re-prep with butadiene or chlorohexidine if sutures will be placed.

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11
Q

Performing a Punch Biopsy

A

Place a ring of anesthesia around the lesion or deep to the lesion.

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12
Q

How to stretch the biopsy site for a punch biopsy

A

Perpendicular to the line of tension.

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13
Q

Punch Biopsy Dressings

A

AB ointment, gauze, band-aid, pressure.

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14
Q

Curettage Biopsy are what kind of biopsy

A

Partial thickness biopsies

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15
Q

When to use Curettage Biopsy

A

Basal cell carcinoma Hyperkeratotic epidermal lesions

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16
Q

Curettage Technique

A

Prepare site with alcohol, use an anesthetic wheel, use the curette to scrape away or scoop out a lesion, Send curetted tissue to pathology if desired, Continue until only normal tissue remains.

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17
Q

When using curettage on carcinomas

A

They scrap out easily. Repeat the sequence 3 times.

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18
Q

Shave Biopsy

A

Partial thickness biopsy used to remove a portion of raised skin. Install local anesthetic under lesion.

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19
Q

How to stop bleeding with shave biopsy

A

Monsel’s can be used if bleeding dried first.

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20
Q

Excisional Biopsy

A

Full thickness.

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21
Q

Excision

A

Removes entire lesion

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22
Q

Incision

A

Removes partial lesion

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23
Q

Excisional Biopsy Technique

A

use sterile technique. Establish field block anesthesia. Outline planned margins. Butadine prep. Drape.

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24
Q

Undermining

A

Cloning in at 15 degrees toward the lesion.

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25
Q

When to use primary closure

A

Wounds less than 24 hours old.

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26
Q

Delayed closure

A

If wound greater than 24 hours old. Cleanse, insert small piece of petroleum gaze, rx for cephalexin X5 days. Day 3 patient returns, wound reirrigated, closure with non-absorbable sutures.

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27
Q

How to close very contaminated or infected wounds

A

Leave them to heal on their own. Scarring may occur.

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28
Q

Choice of closure

A

Sutures, tapes & strips, tissue adhesives

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29
Q

Simple interrupted

A

Easy to perform. Some can be removed early for better comes, some can be left on later.

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30
Q

Vertical Mattress

A

Good for elderly people with thin skin where the tendency of wound edges would be to invert and sutures may pull through

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31
Q

Subcutical running

A

Good for linear wound not under much tension. Avoid pressure on wound as tear easy

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32
Q

Horizontal Matress

A

Good for gaping wounds especially on fragile skin.

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33
Q

Days to remove stitches on face

A

3-5 days

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34
Q

Cutting Needle

A

Ideal for suturing skin. Usually referred now to a “reversed cutting” design.

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35
Q

Swagger eye needle

A

Needle is molded around the thread. No threading is required.

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36
Q

Needle used on face

A

P3

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37
Q

With Simple Interrupted stitch needle enters at

A

90 degrees

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38
Q

Describe simple interrupted stitch.

A

As wide as it is deep. Equidistance from edges and equal depth on each side. Distance between stitches half the distance of the entire suture: min=2 mm. Knots line up on one side. Edges evert.

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39
Q

Vertical Mattress stitch

A

wide wide, narrow narrow. Suture ends finish on the same side.

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40
Q

Subcuticular running stitch

A

Ends can be knotted, taped, or tied.

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41
Q

Suture Tying

A

First throw should just approximate the edges, subsequent throws are for knot security, apply equal tension on both strands, tension is applied parallel to the loop being closed and along the axis of the knot being tightened. Number of throws beyond the initial square: 4 if monofilament (more slippage) and 3 if braided (more friction) Leave 3-4 mm tails at completion

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42
Q

Suture dressing

A

AB ointment with low adherent. Gentle wound washing after 12-24 hours or tegaderm over dressing (allows showering)

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43
Q

Tapes and Strips

A

Used with benzoin or mastisol. Most often used as reinformatment to sutures or staples and sometimes glue. Does not provide skin edge eversion. May also use after suture removal.

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44
Q

Tissue Adhesives

A

Cyanoacrylates with formaldehyde. Nonmucosal lacerations or incisions. Facial, snap. Wound less than 8 cm (gap less than .5 cm). Do not use in noncompliant patients. Patient may shower after 24 hours. Strips will fall off naturally.

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45
Q

Pros of tissue adhesives

A

Fast, less painful, no suture removal, low cost

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46
Q

Cons of tissue adhesives

A

Takes 7 days to reach maximum strength, inadvertent spillage, single use, early dehiscence.

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47
Q

Emergency anaphylaxis

A

If immediate put a tourniquet over the site. Administer .3 ml of epi. and 25-50 mg of oral benadryl. (chew). Oxygen if prn. Initiate CPR if prn.

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48
Q

Junior epipen

A

Green. .15 ml

49
Q

What to check on epipen

A

Date and contents

50
Q

What does epic cause

A

Vasoconstriction and decreased blood flow

51
Q

Describe how to do the epipen

A

Hold with black/orange tip down, remove activation cap just prior to use. Hold near outer thigh and 90 degree angle. Hold the device for several seconds (10 s). Remove the device and massage. About 90% of the solution will still be in the pen but cannot reuse.

52
Q

After give an epipen

A

Monitor BP, pulse, respiration.

53
Q

When might you need a second dose of epipen

A

15 minutes

54
Q

Who to release patient to after epipen

A

Only medical personal.

55
Q

SE of Epinephrine

A

Tachycardia, arrhythmia, angina, increase BP, sweating, tremor, dizziness, HA, nervous, nausea and vomiting, weakness, apprehension, respiratory difficulty. (THAN AIN STD WAR)

56
Q

How to confirm the right patient

A

2 methods.

57
Q

What should you know about your patient prior to injections

A

Medical and allergy history

58
Q

What to do with medications before injections

A

check it. Make sure it is correct meds, injectable, not exited, and it is as it should.

59
Q

Anesthetizes of the site

A

Be smart about it. Can deaden a root and only do one injection.

60
Q

PARQ

A

Purpose and nature of procedure, Alternate procedure, Risk and consequences, Questions and answers.

61
Q

What to do with multi-use meds

A

discard 28 days later.

62
Q

Do you recap the needle before putting it in the sharps?

A

NO

63
Q

What to document after an injection

A

Date and time, drug name, concentration, manufacturer, lot number, amount given. Delivery method when administered. (What, Where, When)

64
Q

What is normally injected IM

A

AB, epinephrine, Diphenhydramine, promethazine, prochlorperazine, vaccines. (DAVE PP)

65
Q

What is normally injected IV

A

NAFL and ICG for angiography, hyperosmatics, verteporfine, edrophonimum) (HVE NI)

66
Q

What to do IM injections

A

poor compliance, need quick absorption, doesn’t come in oral, can’t take orally, not effective oral.

67
Q

IM injection sites

A

Deltoid (do top of shoulder and 1 hand down), thigh, or hip (don’t use)

68
Q

Risks and concent of IM

A

Bruising, tenderness 24-48 hours, tingling due to n. damage, infection

69
Q

Risk and consent of IM meds

A

Inflammation and soreness, allergic reaction, anaphylaxis, medication specific.

70
Q

Needle specifics for IM

A

1-3 ml syringe, 23-25 gauge needle for injection, 1-1.5 inches long.

71
Q

Administering IM

A

Stabilize by pinching with non dominant hand, insert the needle at 90 degrees, release pressure and use non dominant hand to pull back on plunger. Insert medications at a slow pace.

72
Q

After IM

A

Massage with cotton ball.

73
Q

SubQ

A

Pinch skin and insert at 45. Do not massage. Common sites: Arm, Stomach, thigh

74
Q

Needle for SubQ

A

1-3 ml syring, 23-35 gauge, 5/8 inch standard length.

75
Q

Most common sites for FA injection

A

Hand and ancubital fossa.

76
Q

What direction can you do with IV injection

A

Can go from ancubital to hand but not vice versa.

77
Q

IV meds SE

A

Allergic reaction, anaphylaxis, extravasation, N&V

78
Q

What to use for FA

A

3 ml of 25% NaFL.

79
Q

Needle for IV

A

Bevel up. 90 degree between finger and needle.

80
Q

Insertion for IV

A

Begin at 30-45 degrees. If deeper use 45. Flatten once you loose resistance.

81
Q

Procedure for IV

A

Put needle in, flatten, Pull black and remove tourniquets, insert blood and look for extravasation, Put cotton ball over injection site and pull out, Pressure once it is out.

82
Q

When to do ocular Subcutaneous injections

A

Anesthetic for lid lesion removal. Corticosteroids for chalazion

83
Q

When to do subconj. injections

A

Corticosteroid or AB

84
Q

Anesthetic for subcutaneous

A

Inject in the lid. Prefer lid but can do palpebral too.

85
Q

Risk with subcutaneous lid injection

A

tenderness 24-48 hours, lid perforation, pain on injection, hemorrhage/bruisng

86
Q

Equipment for subcutaneous injection

A

3 cc syringe, 5/8 to 1 inch needle.

87
Q

Anesthetic for subcutaneous inj.

A

Lidocaine 2% w/w/0 epinephrine 1/100,000 or 1/20000. and/or bupivacaine .5%.

88
Q

Subcutaneous specifics for injection

A

Bevel up. 15 degrees. Apply firm pressure with cotton ball once needle is out.

89
Q

Intralesional injection needle specifics

A

1-3 cc syringe, 25-27 gauge for steroid.

90
Q

Why subconj injection

A

Allows medications to slowly be absorbed into the eye and systemic by scleral and episclera vessels

91
Q

When are subconj injections commonly used

A

recalcitrant uveitis and corneal ulcers

92
Q

Risks from subconj injection

A

Subconj. heme, ocular tenderness and photosensitivity 24-48 hours, blurred vision and corneal staining, mitosis from briminodine, pain on rotation, dryness and FB sensation, globe performation

93
Q

Equipment for subconj.

A

1-3 cc syringe, 27g X 1 inch needle.

94
Q

Subconj. procedure

A

Put 1 drop .15% briminodine in eye 30 minutes prior, place 1 drop proparicane OU, Place 1 drop proparicane in eye just about to be treated. Go in with bevel up and tangential to globe.

95
Q

Normal steroid injection

A

5-10 mm form limbus. Go in at 2, 4, 8, 10.

96
Q

If doing a procedure and possible what should you have patient discontinue

A

Aspirin for 7 days.

97
Q

Common topical anesthetics used in OD

A

lidocaine with epinephrine. Good for 30 minutes.

98
Q

Why use epinephrine with lidocaine?

A

Decreases bleeding, takes longer to work than lidocaine, prolongs anesthetic affect. Do not use with terminal circulation.

99
Q

SE of lidocaine and epinephrine

A

Pain on injection due to low pH. Allergic run, anaphylaxis, Depress all neurologic tissue (CNS toxicity: restlessness, lightheadedness, tinnitus, dizziness, tremors, seizures Peripheral toxicity: tingle in toes). Cardiovascular depression and hypotension. (RTLTDS)

100
Q

Best time to treat chalazian with steroids

A

Recent onset. Within 8 weeks.

101
Q

Common steroid in OD

A

Methylprednisolone acetate 40mg/ml. Inject .15 ml on average.

102
Q

Side effects of methylprednisolone acetate

A

Tenderness, infection, glaucoma, subconj, heme, cataract formation, ONA, tissue necrosis, EOM fibrosis, CRAO.

103
Q

After chalazian procedure

A

Topical AB or AB steroid used and cool compress. Recheck in 7-14 days. Repeat if still there

104
Q

When to not do subconj injection of steroid

A

Scleritis. Scleral thinning and perforation are consequences.

105
Q

Steroid subconj injection repeatable?

A

May need repeat in 2-3 weeks.

106
Q

SE of subconj steroid

A

Increased IOP, cataract formation, optic nerve atrophy, tissue necrosis, EOM fibrosis, CRAO, corneal staining.

107
Q

Meds for subconj. steroid

A

Methylprednisolone acetate 40 mg/ml. Inject 1-2 ml in 2 or 4 sites

108
Q

Sodium flouroscene vs Indocyanine green

A

Sodium fluorescente (retinal vasculature), IG (choroidal vasculature). Both metabolized by liver. NaFL excreted by kidneys and IG by bile. Both are category C and avoided with pregnancy.

109
Q

Amount of NaFL

A

3 cc of 25% NaFL as a bolus in the vein

110
Q

Amount of ICG

A

40 mg in 2 ml of aqueous solvent as a bolus followed by 5 ml of normal saline.

111
Q

SE of NaFL or ICG to warn pt. about.

A

Yellow tint to skin, sclera, urine (always with NaFl), soreness at site, bleeding at site, discomfort at sit, itching, urticaria (hives)

112
Q

Mild SE of NaFl or ICG

A

Nausea 20-30 s after injection and resolves in 2-3 minutes. Vomiting (in young and thin). Flushing, dizziness, HA, itching, strong taste.

113
Q

Moderate SE of NaFL or ICG

A

Extravasation (tissue damage due to high pH of NaFL), urticaria, syncope, thrombophlebitis at injection site.

114
Q

Severe SE of NaFL or ICG

A

Anaphylactoid rxn: urticaria, hives, itching, swelling of lips, tongue throat, bronchospasm, loss of consciousness, cardiac arrest, tonic clonic seizures, death.

115
Q

High risk for NaFL SE

A

Previous responders. patients with allergies/asthma. Renal insufficiency.

116
Q

High risk for ICG SE

A

Its with allergy to iodine or shellfish. Contains 5% sodium iodine. Renal insufficiency.

117
Q

Use of IV with large IOP in ACG

A

Most will start with topical or oral meds. If not working use acetazolamide, mannitol, urea (hyperosmotics). Others will just use IV acetazolamide first.

118
Q

Tetanus shot

A

Can use in anyone above 7 years. Shake well as it is a suspension.

119
Q

SE of Tetansus shot

A

Inflammation and soreness, syncope, allergic reaction, anaphylaxis, Guillain-Barre Syndrome (inflamed roots of n).

Systemic Lab (3 decks)

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