General Flashcards
A patient comes in with a foreign body to the finger. What is your first step?
Evaluate for sensation and circulation
What is the number one cause of FB sensation?
Glass
If it is small, asymptomatic, no need to remove.
Which materials pose the highest risk of infection when it comes to foreign bodies?
Organic splinters
A patient comes in with a horizontal splinter. How do you treat?
Incise/deroof and remove.
Irrigate with NS.
A patient comes in with a vertical splinter. How do you treat?
Elliptical incision, lift cone and undercut.
Irrigate with NS.
A patient comes in with a subungual splinter. How do you treat?
V section, shave, or trephination.
Remove splinter and irrigate with NS.
A patient comes in with sweaty tennis shoe syndrome following a nail puncture to the foot. What criteria must they meet in order to be considered for this dx?
> 4 days of persistent symptoms post puncture.
A patient comes in with a nail puncture. What sequelae are we most concerned about?
Osteomyelitis
What is the causative agent of sweaty tennis shoe syndrome?
Tx?
Pseudomonas aeruginosa
16+: ciprofloxacin
<16: ceftazidime
Define cellulitis
Diffuse skin infection that presents with warmth, edema, and erythema
Define abscess
localized skin infection that contains pus within the dermis or subcutaneous space
Define a furuncle
Boil
Single infection that develops around a hair follicle
Define a carbuncle
a coalescence of several furuncles
Deeper than furuncles and can cause scarring
What are some common areas abscesses tend to grow in?
Back of neck, face, axillae, and buttocks - coarse haired areas
What is the number one infective agent in superficial purulent skin infections?
Stah. aureus
What must you NOT do when working on an abscess that is located on the finger/toe, penis or nose?
DO NOT use epinephrine
A patient presents with an abscess. Are antibiotics needed? How do you treat?
Tx: I&D
PO antibiotics are not needed unless there is surrounding cellulitis. Topical antibiotics are not effective.
A patient presents with an abscess. What criteria must be met for it to be packed?
abscess >5 cm
Pilonidal cyst - on gluteal cleft.
DM patient
Immunocompromised
A patient presents with a pilonidal cyst and cellulitis. Is antibiotic treatment recommended?
Yes - cellulitis and the pilonidal cyst
A patient comes in with a history of recurrent and multiple abscesses. Is antibiotic treatment recommended?
Yes - recurrent and multiple abscesses
A 2 month old patient comes in with an abscess. Is antibiotic treatment recommended?
yes - extremes of age (young infants and elderly)
A patient comes in with purulent cellulitis without signs of systemic infection. What tx is called for?
TMP-Sulfa BID x 7 days
A patient comes in with purulent cellulitis with signs of systemic infection. What tx is called for?
IV vancomycin q 12 hrs - this covers MRSA
A patient comes in for a perirectal abscess. What tx is not recommended?
I&D
When is I&D contraindicated?
- Anterior/lateral neck abscesses that came from congenital cysts - thyroglossal duct cyst, cystic hygroma
- hand abscesses - not paronychias/felons
- abscesses adjacent to vital nerves/blood vessels
- abscesses in the central triangle of the face - tx with warm compresses, broad spectrum antibiotics, referral to otolaryngology
- breast abscesses - especially if near nipple
A patient comes in with a visible, painful subungual hematoma. The nail is fractured as is the distal phalanx. How do you treat?
NOT WITH a nail bed trephination.
Contraindications to a trephination:
- crushed/fractured nails
- finger fx - especially distal phalanx
- subungual melanoma
- acrylic nail
- hematomas >50%+ of nail
What are the indications for a nail avulsion?
Onychomycosis
Onychocryptosis - ingrown toenail
Chronic, recurrent paronychia - infection of skin surrounding the nail
Trauma
You have a patient with a suspected abrasion to the eye. After stabilizing the patient, what must you do?
Emergent referral to ophtho
Under what conditions is a slit lamp contraindicated?
- ruptured globe
- intraocular foreign body
- eyelid laceration unless superficial and horizontal/paraellel to eyelid
- caustic splash exposure - IRRIGATE!!
What is a positive Seidel sign?
It’s done post-FB removal.
Positive sign: aqueous humor oozing at penetration site through the cornea
- “dark waterfall”” under UV light
A patient presents with a painless, chronic granulomatous inflammation of a Meibomian gland that produces a nodule. What is this?
Chalazion
A patient presents with a staph. infection of a superficial accessory gland in the eyelid margins. What is it?
Hordeolum - stye
A patient comes in with a penetrating foreign body to the eye. What do you do?
Leave it in place
Place a fox shield
NO MRI
STAT ophtho referral
What are the indications for a cerumen impaction/FB removal?
- foreign body
- ceruen impaction & associated symptoms
- can visualize the TM
What are the contraindications for a cerumen impaction/FB removal?
- current/past TM perforation
- PSH ear/TM
- sudden onset severe dizziness/hearing loss
- <4 yo/uncooperative
- can’t visualize the FB
- large hard round objects
What are the complications of a cerumen impaction/FB removal?
Minor
- pain, vertigo, N, trauma
Major
- trauma induced Otitis Externa
- TM perforation
- Alkaline necrosis of auditory canal (batteries)
- Hearing loss
Where do most epistaxis occur?
Kiesselbach plexus
