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NPLEX2 review of modalities > minor surgery > Flashcards

minor surgery Flashcards

1
Q

what bodily fluids are potentially infectious

A

blood, semen, vaginal secretions, CSF, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, unfixed tissue or organs,

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2
Q

potential forms of transmission of blood born pathogens

A

contaminated bodily fluid that contacts eyes, mouth, nose, broken skin, or stick with a needle

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3
Q

what does universal precautions mean?

A

blood and bodily fluids from all patients should be considered potentially infectious

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4
Q

what is the most frequently occuring work related disease BBP

A

HBV

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5
Q

accidental needle sticks are most likely to transmit what infection

A

HIV

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6
Q

only safe ways to recap needles

A

one handed or hemostat change

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7
Q

when should sharps be placed in a sharps container

A

asap

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8
Q

Needle holder types, and purpose

A

blunt nosed, ratcheted
hold needle and suture- toothed better grip more damage to needle

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9
Q

Scissor types and uses

A

iris scissors: TISSUE ONLY
Suture scissors- suture cutting

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10
Q

Forceps types and uses

A

adsons with teeth- for tissue holding- cause less trauma to samples
Adsons without teeth- hold suture, foreign bodies, pick up from sterile field - NOT TISSUE THEY CRUSH IT
splinter forceps- removal of foreign body

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11
Q

Hemostats other names and use

A

other names: clamps, forceps, kelly’s , mosquitoes
remove scalpel blades, hold tourniquets, clamp vessels, hold skin tags/tissue that is to be removed

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12
Q

scalpel blade #11 use

A

stabbing, incising skin such as I/D

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13
Q

scalpel #15 use

A

standard blade for excision, trimming, dissecting tissue

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14
Q

scalpel #10 use

A

for tough skin, back and scalp- work hoarse

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15
Q

how to clean medical instruments

A

clean with plastic brush under cool water after use
dry
lubricate with instrument milk
sterilize instrument

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16
Q

definition of sterilization

A

destruction of all living organisms including spores

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17
Q

definition of disinfecting

A

reduction of microorganism population without achieving sterility - spores end up left on surface

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18
Q

Definition of a disinfectant

A

germicidal substance used on inanimate objects to kill pathogenic microorganisms but not all

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19
Q

definition of antiseptic

A

chemical agent applied to BODY to kill or stop growth of pathogenic microorganisms

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20
Q

methods for sterilization of instruments

A

Chemical , boiling, hot air oven, auto clave, gas, radiation , disposable instruments

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21
Q

how to sterilize with chemicals

A

Alcohol 70% and chlorhexidine 5% - emergency use only- 2 minutes- DOES NOT STERILIZE

2% GLUTARALDEHYDE soak for 10minutes to disinfect, 10hrs to sterilize

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22
Q

Boiling to sterilize

A

100 degrees C or 212 F for 5min disinfects
Boil 30minutes at sea level to sterilize

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23
Q

Hot air oven to sterilize

A

160 degrees C , 320 F for 1 hr

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24
Q

Autoclave

A

sterilize wrapped instrument packs- uses steam under pressure for 15minutes

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25
Q

More zeros on a suture label mean what

A

finer thread and better cosmetic results

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26
Q

Where should finer sutures be used

A

face , beck , back of hands , where concern for scaring

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27
Q

Where is larger suture used

A

scalp, back, trunk, palms, soles , areas of greater tension

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28
Q

monofilament versus multifilament

A

Monofilament- single strand, less resistance with use, less likely to harbor microbes. Tie easily, knots tend to slip and break

Multifilament - several strands braided together, stronger and pliable, slip less easily. Tend to harbor microbes,

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29
Q

Absorbable suture versus non absorbable

A

Absorbable- for locations where it will not be removed such as deep wounds to close sub q space

non absorbable - dont break down and must be removed or used for permanent grafts

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30
Q

categories of absorbable sutures

A

Natural and synthetic
Natural - made from mammalian collagen and body enzymes break them down

Synthetic- polymers which are hydrolyzed over time to break down - less reaction from the body

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31
Q

Name the natural absorbable sutures

A

plain cat gut- breaks down over 7-10 days , may have tissue reaction

chromic cat gut- delayed break down over 2-3 weeks less reaction in tissue

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32
Q

Name synthetic absorbable sutures

A

polyglactic or vicryl - both braided and not. smooth, easy to tie, holds for 4-7 weeks good for SUBQ

Polyglycolic or dexon - monofilament, no reaction, several weeks - SUBQ

polydioxanone PDS - monofilament- 6 weeks

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33
Q

Name synthetic absorbable sutures

A

polyglactic or vicryl - both braided and not. smooth, easy to tie, holds for 4-7 weeks good for SUBQ

Polyglycolic or dexon - monofilament, no reaction, several weeks - SUBQ

polydioxanone PDS - monofilament- 6 weeks

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34
Q

name non absorbable sutures

A

silk- braided, easy to tie, increased infection risk, 1 year- vessel ligation

nylon - monofilament, low reactivity, high tensile strength, need extra knots tied- good for skin and SubQ

Polypropolyene- flexible, strong, slick. more expensive

stainless steel- permanent- abdoment, sternal wound, tendon repair

polyester

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35
Q

when can you use a steri strip

A

for superficial lacerations, wound is clean, little tension

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36
Q

locations that should never have a steri strip used

A

knees, elbows, hands, feet, inside mouth, groin
never wrap around digits= torniquet

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37
Q

Dermabond use

A

apply 3 thin layers, set for 3 minutes, as strong as sutures, slough off as wound heals usually 10 days

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38
Q

types of needles

A

reverse cutting needle- most common and for suturing

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39
Q

types of ties and uses

A

two handed- most secure
one handed- fast, good for deep space
instrument- conserving sutures- most common type

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40
Q

to what length should ends be cut

A

1/8th in

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41
Q

where should knots be positioned at the end of the procedure

A

all to the superior or medial side to prevent being absorbed into skin

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42
Q

at what angle should the needle enter and leave skin

A

90 degrees / right angles

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43
Q

what should your stich due to skin edges for best healing

A

evert them

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44
Q

what are 3 ways to lesson tension on a wound when suturing

A

use deep buried sutures
undermine the wound borders
use more sutures

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45
Q

what is the rule of halves

A

first stich in middle of wound, each following stich halves the remaining space

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46
Q

what stitch causes railroad tracking scars, is time consuming, is the most common stich

A

simple interrupted

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47
Q

what stitch is used for eliminating dead space in deep wounds and connects the sub q space

A

deep buried

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48
Q

what type of suture should be used for deep buried

A

vicryl or dexon absorbable

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49
Q

what stitch is good for high tension wounds like palms or soles, and can also close dead space. but may also result in railroad track scars

A

vertical mattress

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50
Q

what is the technique for a vertical mattress stich

A

far, far, near , near OR far, near, near , far

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51
Q

stich that is made up of 2 interconnected simple interrupted stitches, forms square

A

horizontal matress

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52
Q

stitch with best cosmetic outcome but least strength

A

running stitch- subq or intradermal

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53
Q

what type of wounds can safely be closed with a running stitch

A

clean, linear, with little tension

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54
Q

what is the fastest stitch but least cosmetically supportive

A

continuous running

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55
Q

what stitch is used for triangular wounds

A

three point or half burried

56
Q

how to do a three point stich

A

secure point with single subcutaneous stitch then secure sides with simple interupted stitches

57
Q

what does epinephrine help with

A

decreases bleeding, prolongs duration of anesthetic, decrease risk of toxic reaction to LA

58
Q

what to local anasthetics due to stop pain signals

A

block sodium uptake into cell in nerves impacting pain nerves first because they are the smallest

59
Q

what are the three types of adverse reactions to local anesthetics

A

toxic- overdose due to injecting into a vessel- avoid this by pulling back before injecting

autonomic - vasovagal

allergic

60
Q

signs of local anesthetic toxicity

A

tinnitus, numbness of lips, lighheadedness, N/V, shivering, tremors, seizure, CNS depression, low blood pressures.

61
Q

how to treat toxicity

A

oxygen

62
Q

Lidocaine

A

amide local anesthetic
rapid onset in 10min
last up to 1hr
common dosing: 2-6cc of 1% solution for minor office procedures
MAX dose300mg or 30cc should still be less than 4.5mg/kg

63
Q

bupivacaine

A

amide local anesthetic
slower onset 12min
longer duration at 3-4hrs
Max dose 4mg/kg of .25% solution

64
Q

procaine

A

ester anesthetic
alternative to lidocaine
slower onset , lasts about 1 hour
allergic reactions are more common

65
Q

max dose for epinephrine when mixing it with your anesthetic

A

less than 0.2mg

66
Q

areas in which epinephrine is contraindicated

A

ears, nose, toes, fingers, genitals,

67
Q

what size needle should you use for injecting anesthetic

A

smallest possible

68
Q

what are the 3 rules of giving anesthetic

A

use smallest amount while still being effective
never exceed max dose
ensure it has taken effect before starting the procedure - poke or pressure test

69
Q

can you do a minor office procedure on a lesion know or suspected to be malignant

A

NO - refer to derm

70
Q

potentially cancerous lesions described as what

A

assymetric
irregular borders
variable color especially 3+
larger than 6mm in diameter
change in appearance over time
bleed or itch

71
Q

areas not allowed to have minor surgery done by us

A

eyes, nose, axilla, groin , posterior triangle of neck

72
Q

reasons to refer out

A

cancer or suspect cancer
off limits area
pt has coagulation disorder
know keloid former
serious systemic illness

73
Q

How to remove nevi

A

eliptical excision, shave biopsy, punch biopsy, hyfrectation.

suspicious at all= punch or elliptical with biopsy

74
Q

sun exposed are, slow growing, papule, becomes ulcerated with rolled edges . May be pearly with fine telangiectasias

A

basal cell carcinoma

75
Q

most deadly skin lesion

A

melanoma

76
Q

sun exposed area, firm and irregular with scaly , keratotic, bleeding and friable surface

A

squamous cell carcinoma

77
Q

what is the precursor for squamous cell carcinoma

A

actinic keratosis

78
Q

red scaly, sandpaper patches on light exposed area

tx with cryo, flourouracil cream, hyfrectation, shave excision

A

actinic keratosis

79
Q

common on head, neck , dorsum of hands, foreams, and trunk in elderly.
flat topped with stuck on appearance, deeply pigmented with granular surface

tx with cryo, curettage, shave, elliptical

A

seborrheic keratosis

80
Q

fleshy , pedunculated lesion found on neck, armpit

remove wth lift and snip then cauterize or firm pressure

A

papillomata

81
Q

benign, inflammtory mass of blood vessels and friboblasts. Forms quickly after trauma or infection . Looks like a polyp with collar around base, bright red, bleeds easily

A

pyogenic granuloma
due cryo, cureette, excision

82
Q

how to ID a spider vein

A

disappears with pressure

83
Q

benign dermal lump, usually on legs, feel like lentils in skin and are mobile

A

dermatofibroma

elliptical excision

84
Q

on light exposed skin, grows fast, round with rolled edges and central keratin plug, often inflamed

A

keratocanthoma

usually spontaneously resolve in 6 months, curette, or excision with biopsy

85
Q

small, pearly, hard papules with umbilicated center

A

molluscum contagious
usually self resolve
consider homeopathics or topical melissa or glycyrrhiza

86
Q

caused by HPV, usually on plantar surface of feet or hands, or genitals

A

verrucae or warts

start with topical treatments- duct tape, salicyclic acid, podophyllin, thuja, tea tree oil

cryotherpay - shave down wart with #10 blade, until it bleeds or pt feels discomfort , apply liquid nitrogen with cotton tipped applicator until zone 2-3mm beyond wart border. let thaw and repeat twice more

87
Q

conditions that can be treated with elliptical excision

A

benign nevi, dermatofibroma, warts, seborrheic keratosis

88
Q

how to do elliptical excision

A

Measure length: width ratio of 3:1, with 30degree angles , include 2 mm health tissue border in measurements
orient the excision parallel to skin tension lines , draw it
field block
prep with betadine x3
set up sterile field
make first cut with 15 blade through the skin and subq
cut perpendicular to skin while applying tension
undermine with iris scissors
mark one edge of specimen - place in 10% formalin
control bleeding with gauze , pressure, electrocautery
undermine lateral edges
close deadspace if needed with deep b
place sterile dressing

89
Q

how to do shave biopsy

A

raise lesion with intradermal anesthetic at its base
stabilize and stretch skin on either side
use 15 blade or razor blade
slice through a very thin portion of skin using one directional strokes, keeping blade parallel until fully removed.

90
Q

how to perform punch biopsy

A

small obviously benign lesion
stretch skin perpendicular to skin tension lines at time of punch to form oval
twist trephine down through dermis
lift specimen with toothed forceps, cut base with iris scissors
cautery or pressure as needed to hemostasis
place suture if needed apply small dry dressing

91
Q

how to help an abscess become fluctuant

A

warm compressions, poultices, homepathic hepar sulph, antibiotics

92
Q

how to do I/D procedure

A

obtain informed consent
follow sterile technique, is not a sterile procedure
anesthesia- ensure its adequate
cut parallel to resting skin tension lines
cut with 11 blade across full incision site
culture drainage
used gloved finger to break up adhesions and loculations
irrigate well with normal saline
loosely pack with 1/4-1/2 in lodoform or gauze, leave a tail out to wick
apply thick clean dry dressing

93
Q

post I/D care

A

24hr after procedure start warm soaks leaving packing in do this 3-4 times daily
redress with clean dry dressing
follow up within 2 days
after reassessment continues soaks for 7 days or until healed

94
Q

how to treat cysts

A

same as abcess but do not rupture capsule as the whole thing needs to be removed to prevent recurrence
close with deep sutures
send specimen to pathology

95
Q

how to treat lipoma

A

prep with sterile field
linear incision over lipoma follow skin tensionlines
blunt dissection to remove lipoma
ligate tethering vessels with absorbable suture
probe to ensure no lobes left
close dead space , remove extra skin if needed to approximate

96
Q

when to refer a laceration

A

cut tendon, cut nerve, on face, foreign body deeper than fascia or near critical structure , very large with significant bleeding

97
Q

how to treat puncture

A

flush with NS in 30cc syringe and blunt 18g needle , debride if needed. leave open and dress with sterile dressing

98
Q

types of wound closure

A

primary , delayed, open or 1 degree, 3rd degree, 2ndary

99
Q

immediate suturing of wound, it is less than 12 hours old, very clean

A

primary closure

100
Q

visibly contaminated wounds, or seen after 12hrs. must be cleaned well, packed with moist dressing and monitored for 4 days. closed if no signs of infection.

A

delayed or 3 degree

101
Q

very contaminated or already infected wounds, and will cause more scarring as a result. wound left open to heal

A

second degree or open treatment

102
Q

four phases of wound healing

A

hemostasis, inflammation, granulation, remodeling

103
Q

when does granulation begin and how long does it last

A

days 3-4 after injury and lasts for 3 weeks

104
Q

when does remodeling occur

A

after 3 weeks from injury over the next year

105
Q

contraction versus contracture

A

contraction is good- normal process

contracture- too tight of skin causes scaring limiting motion

106
Q

nutrients to promote wound healing

A

vitamin C, zinc, copper, vitamin E, flavonoids

107
Q

what does vitamin C help with

A

collagen formation and reducing inflammation
1000mg multiple times per day

108
Q

what does zinc help with

A

supports DNA, RNA, and collagen formation and promotes cell growth

30mg picolinate per day

109
Q

what does vitamin A help with

A

regeneration of epithelial cells and recovery from burns
25,000 IU daily

110
Q

what do B vitamin do

A

help with collagen cross linking

111
Q

what does copper do

A

supports collagen cross linking at 2mg per day

112
Q

what does vitamin E do

A

reduces scar formation and adhesions topically
reduce scarring at 400IU internal daily

113
Q

flavonoids

A

reduce scars 1:2 ratio with vitamin C

114
Q

bromelain

A

reduces inflammation, minimizes scarring

115
Q

when to remove face and neck stitches

A

6 days or less

116
Q

when to remove stitches in arms or hands

A

7-10days

117
Q

when to remove stitches in trunk, legs, feet, scalp

A

7-14 days

118
Q

size suture to use for skin on face or neck

A

5-6 nylon or prolene

119
Q

size suture to use on skin of arms or hands

A

4-5 nylon or prolene

120
Q

suture to use on skin of trunk, legs, feet, scalp

A

3-4 nylon or prolene

121
Q

size of suture to use on buried stitches

A

3-4 vicryl or dexon

122
Q

how to remove sutures

A

grasp suture ends with smooth forceps
pull knot and suture across axis of closed wound to prevent reopening
cut suture as close to skin as possibel with scissors

123
Q

how to prevent wound infection risk

A

achieve hemostasis, eliminate dead space, thoroughly clean wounds, follow sterile technique

124
Q

when does redness and itching become a potential sign of infection

A

after 4 days since the procedure

125
Q

common homeopathics for wound infections

A

apis and ledum

126
Q

swollen slowly enlarging erythematous mass along or beside the suture line that presents 24-72 hr post procedure

A

hematoma
if large- reopen, carterize and leave open

127
Q

causes of wound reopening or dehiscence

A

infection, hematoma, inadequate undermining, poor suture technique, excessive activity, removing suture too soon

128
Q

paronychia is what and caused by what

A

infection of folds around nail
caused by staph, HSV, fungus. secondary to hangnail, sliver or injury

129
Q

signs of purulent tenosynovitis

A

slight flexion of the finger at rest
fusiform swelling of finger
pain on passive or active extension
tenderness along tendon sheath into palm

130
Q

subungual hematoma

A

release pressure with electrocautery through the nail or hot paper clip or bore with needle tip

131
Q

ganglion cyst

A

slow growing, usually on dorsal wrist. most resolve spontaneously.
due surgery if there is pain, limited funcion, cosmesis

132
Q

distribution of ulnar nerve

A

pinky and ring finger dorsum and palmar

133
Q

radial nerve distribution

A

back of thumb and base of first three digits , up dorsum of arm

134
Q

median nerve distribution

A

thumb to lateral edge of ring finger on palmar surface and middle three fingers on dorsal surface

135
Q

from how high up can sterile instruments be dropped onto a sterile field

A

4 inches

136
Q

what to document

A

hx of any wound
pt age, prior tx , allergies, tetanus status, meds,
general beginning condition, vitals
describe wound- location, size, length, superficial or deep, clean or contaminated, and type
function of nerves and tendons
that informed consent was attained written and oral
wound pep, anesthesia, suture material and size, type and number of stitches, dressings, post op instructions provided, follow up care provided

NPLEX2 review of modalities (7 decks)

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