minor surgery Flashcards
1
Q
define surgery
A
branch of medicine that treats disease, injury, and deformities by manual or operative methods
2
Q
superficial
A
near surface
3
Q
define abrasion
A
wearing away of structure thru unusual or mechanical means
4
Q
benign
A
non-malignant
5
Q
lesion
A
any pathological or traumatic discontinuity of tissue or loss of function of a part
6
Q
foreign body
A
any material lodged in human tissue that is foreign
7
Q
excise
A
to cut off
8
Q
incise
A
to cut into
9
Q
ligate
A
to tie off
10
Q
sound
A
to probe deep with a blunt instrument
11
Q
debride
A
to clean away damaged or necrotic tissue
12
Q
-tome
A
to cut
13
Q
-ectomy
A
to remove or cut out completely
14
Q
antiseptic
A
substance that will inhibit growth and development of microorganisms w/o destroying them
15
Q
local anesthetic
A
agent whose primary effect is to bring about temp loss of local sensory nerve function
16
Q
stages of anesthetic (loss of what sensations)
A
first lose pain, then pressure and touch
17
Q
3 complications of minor surgery
A
1=anxiety
pre/post op bleeding
reaction to anesthetic
18
Q
best age range for minor surgery
A
15-65
19
Q
3 body types
A
ectomorph, mesomorph, endomorph
20
Q
which body type has the worst prognosis/ greatest risk
A
endomorph
21
Q
what 3 special tests should be ordered prior to surgery
A
UA, clotting time/prothrombin, and CBC
22
Q
4 methods of instrument sterilization are
A
steam autoclaving, gas autoclaving, dry + cold sterilization
23
Q
which instrument sterilization technique is most effective?
A
gas autoclaving
24
Q
what gas chemical is used with gas autoclaving?
A
ethylene oxide
25
instrument sterilization technique that is effective (kills bacteria and spores) but dulls instruments
steam autoclaving
26
what is the downside (2) of gas autoclaving
expensive and deadly to humans
27
downside to dry sterilization
does not kill spores
28
iodine bath is the MC method for which sterilization
cold sterilization
29
when would you use cold sterilization
for instruments that can't be autoclaved: scissors, non-disposable scalpels
30
T/F shaving is recommended
false- should cut instead
31
how many times should you clean skin with antiseptic before surgery
at least five
32
strength/effectiveness of antiseptics determined by
phenol coefficient
33
5 coal tar group antiseptics
phenol, cresol, resorcinol, thymol, trinitrophenol
34
antiseptic that is also known as carbolic acid
phenol
35
phenol can be used as an ingredient in a chest rub called ____
camphorated phenol (30% phenol)
36
phenol can be used for itching/burning d/t poison oak/ivy that is called...
phenolated lotion of calamine
37
antiseptic that has a phenol coefficient of 3X, brown liquid, and tarry odor
cresol
38
antiseptic that is color and odorless with coefficient of -1X
resorcinol
39
50% conc of this antiseptic is used for linseed oil soap (to disinfect rooms and equipment
cresol
40
antiseptic used on telephone poles and railroad ties
cresol
41
.25-.5% conc of this antiseptic can be used as vaginal douche
cresol
42
this antiseptic with 5-10% conc can be used to treat psoriasis, ezcema, and erysipelas
resorcinol
43
antiseptic that is colorless, but aromatic and very dis-solvable in alcohol
thymol
44
this antiseptic can be used in mouth washes
thymol
45
this antiseptic is used to treat fungus and hookworm
thymol
46
antiseptic also known as picric acid
trinitrophenol
47
antiseptic with phenol coefficient of 7X, no smell, bitter, yellow, and will stain
trinitrophenol
48
antiseptic that can be used on burns and superficial wounds, but only 9% of body otherwise too caustic
trinitrophenol
49
a group of antiseptic that contains mercury is called..
dye group
50
4 antiseptics in the dye group are:
proflavin dihydrochloride
methylrosaniline
methylthionine chloride
merthiolate
51
antiseptic that is used to saturate gauze; treatment of conjunctival gonorrhea + otitis media, furunculosis and carbunculosis
proflavin dihydrochloride
52
antiseptic also known as gentian violet
methylrosaniline
53
antiseptic Used for tx of chronic cystitis, fungus, burns, and ringworm
methylrosaniline
54
antiseptic that is effective against gram + bacteria (ie staph)
methylrosaniline
55
antiseptic also known as thymerol and thymersol
methiolate
56
this antiseptic contains 50% mercury
methiolate
57
this antiseptic is effective against spore bearing bacteria and fungicide; used as final scrub in pre-op skin prep
merthiolate
58
antiseptic also known as methylene blue
methylthionine chloride
59
antiseptic that is a dark green powder, used mainly as urinary antiseptic and to dx vag fistulas
methylthionine chloride
60
halogen containing group of antiseptic contains either (3)
chlorine, iodine, or bromine
61
an antiseptic that is a yellowish gas that is deadly when inhaled
chlorine
62
antiseptic that is used to make Dankins solution
chlorine
63
antiseptic that Dissolves bacteria, pus, and necrosed tissue w/o disturbing clots. Best for open wounds, but irritates intact skin
chlorine
64
antiseptic with metallic luster and odor that is more soluble with potassium iodide
iodine
65
an antiseptic that is a popular choice for surgical scrubs and skin prep
iodine
66
is a patient is allergic to iodine can use ___
benzalkonium chloride aka zephiran
67
benzalkonium chloride aka
zephiran
68
___ MC used in skin prep and cold sterilization (contains iodine)
beta dyne
69
5% iodine conc =
lugol's solution
70
what is lugols solution
5% conc of iodine that can be applied to external mucosal lining
71
an antiseptic that is effective for warts, excess tissue, ulcers, canker sores, and cauterization of bleeders.
silver nitrate
72
antiseptic used in crede treatement
silver nitrate
73
___ also contains silver and used to treat chronic/acute sinusitis
argyrol
74
poor antiseptic that: When over 80% concentration it will harden protein coat of bacteria, making it harder to penetrate. Less than 50% and it will draw water out of the cell and dehydrate them
alcohol (MC form ethanol)
75
antiseptic that oxidates protein of bacteria; very powerful- never apply to patient... used for biopsies
formaldehyde
76
another name for formaldehyde
formalin
77
an antiseptic that bubbles debris to surface
hydrogen peroxide
78
antiseptic that.... MC 3% concentration for washing/lavaging wounds and ulcers
Cannot use on closed cavity
Diluted to 1:5 parts water= effective mouth rinse for gingivitis
hydrogen peroxide
79
3 antiseptics used as astringents
boric acid; potassium aluminum sulfate, and zinc
80
antiseptic that reduces swelling of mucous membrane
boric acid
81
antiseptic: 10% concentration for skin irritation, 2% for conjunctivitis, 2-4% for open wounds, burns, abscesses, and vaginal packs for vaginitis.
boric acid
82
antiseptic: used for skin irritation, .5-1% to stop bleeding of small cuts (septic pencil for shaving nicks)
Potassium aluminum sulfate aka alum
83
antiseptic used for burns and skin diseases (usually in oxide form)
zinc
84
___good as fungicidal and antiseptic. Used for irrigating ears, athletes foot, insect bites, animal scratches, etc
Hydroxyquinoline sulfate:
85
tea tree oil good for which infection
staph
86
aka neomycin polymycin (used for dressing to aid in anti-infection)
bacitracin
87
MC topical post op ointment
neosporin
88
wound cleaning solution: Effective against gram - and + bacteria, fungi, and viruses. Brand names: betadine, operand, acudyne, and clonidine
providone-iodine
89
effective against gram + bacteria. Mostly used for hand scrubbing- also toxic to open wounds. Marked under names Hibiclens and STERIS tat.
chlorhexidine
90
new, potentially useful wound cleanser w/nonionic detergent. Most suited for wound cleansing of face- no antibacterial activity though. Under name Shur-Clens
pluronic-F-68
91
good against gram + bacteria; recent studies show potential toxicity, but Remains alternative for hand scrubbing b/c of cumulative and protective buildup in the skin. Under name PHisoHex
hexachlorophene
92
percentage of antiseptic to be used
1-2% only
93
T/F: toxicity with local anesthetic and epinephrine is caused by the anesthetic and not epinephrine
true
94
disadvantages of epinephrine
vasoconstriction, increase potential for infection
95
gauge needle used for anesthetic
25-27
96
topical skin refriderant that can be used as a pre-injectable for those with anxiety
ethyl chloride
97
what do you need to do after inserting needle into skin before injecting anesthetic
pull back on plunger to make sure didn't hit vein/artery
98
anesthetic should be introduced....(method)
on the move
99
method of introducing local anesthetic where portal of entry has been created by trauma (ie laceration)- needle is introduced to exposed edge of skin
direct filtration
100
MC method of introducing local anesthetic- preferred if wound is dirty- decrease risk of infection better than direct infiltration
field block
101
another name for field block
parallel margin infiltration
102
MC type of nerve block
digital
103
when would one use nerve block?
when nail removal or complete anesthesia of digit required or with eye/mouth
104
another name for procaine
novocaine
105
anesthetic that can be with or w/o epinephrine and used for all types of conduction anesthesia. Ester base solution- less desirable d/t higher risk of toxic reaction. Only 1% conc needed
procaine/novocaine
106
another name for tetracaine
pontocaine
107
anesthetic that is very potent and toxic (10x more potent than procaine). Only used for spinal block… not for chiro minor surgery use
tetracaine/pontocaine
108
another name for lidocaine
xylocaine
109
anesthetic that is MC - can be with or w/o epinephrine. Amide based solution= lower toxicity, rapid diffusibility, topical activity and chemically stable. Immediate results
lidocaine/xylocaine
110
another name for mepivacaine
carbocaine
111
anesthetic that is amide based and common. Better for procedures where longer time frames are needed. Slightly vasoconstrictive (caution with distal end organs) no epinephrine
Mepivacaine (carbocaine)
112
another name for bupivacaine
marcaine
113
anesthetic that is newer amide solution. Slow onset of action, but longer lasting
Bupivacaine (marcaine)
114
anesthetic that is best used for pediatric patients *but vasoconstrictive
TAC
115
what is in TAC
equal parts mix tetracaine .5%, (adrenalin chloride) epinephrine 1:2000, and cocaine 11.8%
116
another name for ophthaine
proparacaine hydrochloride
117
anesthetic that is .5% glycerine solution for topical eye application. Applied via eyedrops and best for foreign body removal or ocular pressure testing. Onset: 13 secongs and lasts 15-20 minutes.
Ophthaine (proparacaine hydrochloride)
118
anesthetic that is contraindicated for hypersensitivity reactions, allergies, cardiac disease, and hyperthyroidism- prolonged use could lead to loss of vision
Ophthaine (proparacaine hydrochloride)
119
another name for cetacaine
rostra spray
120
anesthetic that is topical for mucous membranes only- not conjunctiva though. Good for overriding gag reflex or as pre-injectable. Only lasts 1-5 minutes and contains small amt of tetracaine and benzocaine
rostra spray (cetacaine)
121
topical skin refrigerant that is highly flammable- used as pre-injectable. Can also be used for lancing furuncles and carbuncles where inoculation has risks of introducing infection into deeper adjacent tissues. Anesthetic effect short lived: 15-30seconds **DC not allowed to use in practice**
ethyl chloride
122
T/F: local effects of anesthetic will self resolve
true
123
systemic effects of anesthetic include: (5)
hypotension, bradycardia, seizures, and vasovagal syncope, and allergic response
124
MC effect of local anestehtic aside from pain/anxiety
fainting (vasovagal syncope)
125
what usually causes inadvertent reactions to local anesthetic
injection of solution into vessel directly (vein)
126
1st phase of wound healing (1/6)
immediate response to injury
127
2nd phase of wound healing (2/6)
inflammatory phase
128
3rd phase of wound healing (3/6)
epithelialization (scab formation)
129
4th phase of wound healing (4/6)
neovascularization
130
5th phase of wound healing (5/6)
collagen synthesis
131
6th phase of wound healing (6/6)
wound contraction- forming of scar
132
how long can it take to get back to full strength of tissue after injury
6-12months
133
T/F: primary wounds usually can be closed with sutures or skin tape
true
134
what usually causes a primary union
knife wound
135
what is the "golden period" to perform surgery w/o complications
6hours
136
which wounds are best for secondary union
Significant tissue loss or devitalization (avulsion, infractions, ulcerations, abscesses). Best to let heal by secondary union or intention.
137
T/F you can close a secondary union with sutures
FALSE
138
T/F tertiary union/delayed closures can be closed with suture after 3-4 days of observation
true
139
T/F tertiary union need antibiotics
true
140
what are 3 conditions/habits that will cause alterations in wound healing?
diabetes, smoking, strong anesthetics
141
which type of wound can involve muscle but not nerve
superficial
142
type of wound that involves tendons and vasculature
deep
143
type of wound where there is no significant loss or implantation of debris
simple
144
puncture wounds are a type of which wound
simple
145
type of wound that has loss/damage of tissue, contain foreign matter
complex
146
2nd degree burns are considered what type of wound
complex
147
type of wound likely to become infected, has debris
dirty
148
Studies show that presence of _______ organisms per gram of tissue represents critical mass necessary to cause infection
100,000
149
signs of infection for lacerations that have been sutured include: erythema extending ___cm beyond wound margin
1cm
150
signs of infection for lacerations that have been sutured include: palpable induration greater than __cm and redness, purulent discharge, and wound splitting
.5cm
151
MC infection caused by which bacteria
staphylococcus aureus (44-80%)
152
other type of bacteria that cause infection include: E. coli, proteus, enterobacter, klebsiella, and ____
strep
153
__X increase in infection rate with 20% wt loss in chronically ill patient
3x
154
how long after wound does infection risk increase
5hrs
155
what is the name of the vaccine for tetanus
anti-tetanus prophylaxis
156
full immunization of tetanus includes how many doses with boosters every ___ yrs
3 doses; 10yrs
157
wound closure term: amount of tissue taken when placing a suture needle in skin/fascia
bite
158
wound closure term: number of times the suture material is looped around in order to secure a knot.
throw
159
wound closure term: each knot of a suture consists of a series of ____
throws
160
wound closure term: ___ sutures placed on surface of skin for final closure and made of nonabsorbable material (aka skin closures)
superficial sutures
161
___ sutures made with absorbable material, placed in the superficial fascia or dermis with knot buried in wound
deep
162
single sutures tied separately whether deep or superficial
interrupted
163
wound closure effected by taking several bites the full length of the wound without tying individual knots. *knots are only ties at the beginning and end of the closure to secure the suture material
continuous/running
164
debridement is done with a #___ scalpel
15
165
T/F: hemostatis doesn't need to be obtained before wound closure can be carried out
false- must obtain- use gauze with direct pressure to stop bleeding if needed
166
T/F everted sutures leave nasty scars
false- inverted sutures leave scars- want to use everted sutures
167
which suture technique is the MC for clean wound w/o complications such as deep involvement or multiple openings
simple interrupted
168
___ suture used for areas of high stress
vertical mattress
169
___ suture done by taking a shallow 1st loop and a deep second loop then tie off.
vertical mattress
170
__ suture are simple interrupted sutures cannot be used towards the triangulated end of a flap- this suture draws the tip into place by taking a bit through the deeper layer.
apical
171
apex of cut of apical suture must point towards (head/heart)
heart
172
___ suture also called pull out suture is when an injury is closed under some tension (decreases scarring)
intradermal subcuticular
173
can add a ___ to a suture: small section of surgical rubber or small square of a surgical glove can be rolled into shape of tube and inserted into the inferior most aspect of a wound during closure
penrose drain
174
3 types of absorbable suture material
polyglycolic acid
polyglycan-910
gut
175
absorbable suture material that is suture of choice aka PGA and dexon
polyglycolic acid
176
absorbable suture material that is: Braided synthetic polymer which is less reactive and better able to resist infection from invading bacteria. Great for knot security and holds half its tensile strength for 25 days.
Hard to work with when wet
polyglycolic acid
177
absorbable suture material that is: synthetic polymer for deep closure. Great workability but not as good of knot security. Holds tensile strength better. AKA PG910, Vircryl
polyglycan-910
178
what type of animal gut is used?
sheep
179
sheep gut treated with ___ to retard absorption
chromic salt
180
2 downsides to using gut as suture material
Less strength and wound security than synthetics and has more tissue reaction
181
monofilament nylon has poor knot security due to memory of monofilament- must make at least ___ throws otherwise will unravel
6
182
3 types of nonabsorbable suture material that can be used
monofilament nylon, polypropylene, and braided
183
nonabsorbable suture material that is MC for minor wounds and lacerations. Able to resist infections, minor tissue reaction, good tensile strength and wound security
monofilament nylon
184
non-absorbable suture material aka ethilon or dermalon
monofilament nylon
185
___ is another monofilament polymer -strongest and best wound security. Less likely to cause skin irritation and just as good at infection resistance as nylon. However, poor knot security, and more difficult to work with.
polypropylene (prolene)
186
___ nonabsorbable sutures are less commonly used today
braided
187
Braided nonabsorbable sutures less commonly used today (silk, cotton, braided nylon). Have excellent workability and knot security but prone to ____
tissue reactivity and infection- best to remove ASAP
188
(cut/ tapered) needles have a nice sharp edge while (cut/tapered) is closer to a sewing needle- puncture vs cut
cut- nice edge; tapered=puncture
189
3 advantages to wound taping
easy to apply, noninvasive, no anesthesia needed
190
2 conditions where wound taping isn't recommended
wounds with tension/irregular/concave
| and with moisture/oily skin
191
moist wound healing also known as
occlusive wound dressing
192
advantage of occlusive wound dressing
prevents crust formation
193
4 types of occlusive wound dressing
films; foams; hydrocolloids; hydrogels
194
occlusive wound dressing that is: thin, transparent, adherent polyurethane’s. Transmit water vapor, oxygen, and carbon dioxide. Non-absorbent. However, likely to remove new skin when epithelium layer forms
film
195
occlusive wound dressing that has: minimal absorption; nonadherent material taped in place over wound
foams
196
occlusive wound dressing that is: water impermeable, opaque, gas impermeable, absorbent. Will gradually separate from wound- only time new one should be applied.
Hydrocolloids
197
occlusive wound dressing that is: semitransparent, nonadhesive, absorbent (aka doctor spenko’s second skin)
hydrogels
198
T/F: fractures are often overlooked in open wounds or bleeding injuries
true
199
____dressing: MC for burns and skin grafts. Have bacteriostatic action and can be readily removed after soaking in water
petrolatum coated
200
controlled cell proliferation to a limited sense. Cells adapt to stress. Simplest non-involved type of tumor (ie: calluses or hyperkeritization)
hyperplasia
201
type cell proliferation: an adaptive substitute of one type of fully differentiated adult cell from another type of adult cell. Common with excretory ducts of any gland of the body where there is chronic irritation and inflammation
metaplasia
202
most severe and potentially dangerous type of cell proliferation. Loss of regularity of individual cells as well as loss of architectural orientation. Exhibit pleomorphism- vary in size, shape, and possess large irregular nuclei.
dysplasia
203
3 types of malignant skin tumors
basal cell carcinoma
squamous cell carcinoma
melanoma
204
MC type of skin cancer and easiest to treat
basal cell carcinoma
205
MC cause of basal cell carcinoma and squamous cell carcinoma is...
UV light
206
this type of malignant skin tumor is slow growing (1-2yrs for lesion to reach 1cm), rarely penetrates the base membrane and less than 1% metastasize
basal cell carcinoma
207
basal cell carcinoma lesions that are left untreated have ____ borders and a _____
raised rolled borders and ulcerated/necrotic center
208
this type of malignant skin tumor has the Appearance of non-healing ulcer and MC: upper lip, paranasal folds, ears, cheeks, and axillary regions
squamous cell carcinoma
209
T/F: growth rate of squamous cell carcinoma is rapid
true- and easily metastasizes
210
this type of malignant skin tumor is the most dangerous but least frequent- lethal if metastasizes and must be referred out immediately
melanoma
211
this type of malignant skin tumor is Jet black ( color variation), asymmetry, border irregularity, diameter increase, elevation/evolution. sometimes has visible vascularization
melanoma
212
T/F: melanoma in late stages will have nevi that will ulcerate or bleed with microtrauma
true
213
T/F: melanoma has rapid onset and lesion will change shape and color.
true- if it does this refer immediately for excersion and biopsy
214
___% of head and neck cancers begin in the oral cavitiy
75%!! always check
215
___ are benign skin tumors that are Bulging structures resulting from excessive formation of collagen in the healing stages of a wound
keloids
216
____ are benign tumors consisting of encapsulated fat tissue arising from the subcutaneous fascia (painless)
lipomas
217
___ are Tumor like structures that are caused by blockage of the duct of a sebaceous gland located next to hair follicle. Sebaceous material will continue to be produced by the gland but has no portal of exit making it enlarged (grape-gold ball size)
sebaceous cyst
218
how can you differentiate a lipoma from a sebaceous cyst
there will be a small central well in the middle of the raised lump of a sebaceous cyst
219
___ is associated with a trichilemmal/pilar cyst filled with keratin found on the scalp that may be indistinguishable from a sebaceous cyst
WEN
220
verrucae vulgaris is also known as
warts
221
___ are Benign epithelial growth formed by hypertrophy of the papillae. May occur at any location on the cutaneous or mucous membrane surfaces.
warts
222
T/F warts are caused by a virus and can transfer from one person to another
true: papovavirus
223
___ is an excellent method of treatment for warts but ___ is the most common
surgical excision; electrodesiccation
224
___ are Small growths of skin in many areas. It is a layer of skin covering a central stalk of fibrous tissue that contains a nutrient artery and vein
papillomas
225
what is another name for papilllomas
skin tags
226
___ is a bengin, hard, hornlike projections extending above the level of the skin.
cutaneous horn
227
___percent of cutaneous horns can become malignant
12%
228
___ are benign, hard, round, moveable, slow growing, non-inflammatory lesions. Composed of bundles of connective tissue that are cartilaginous in their hardness
fibromas
229
___ is a benign, cystic swelling surrounded by a fibrous tissue wall and occurring in the vicinity of joint capsules and tendon sheaths.
ganglia
230
liquid nitrogen can be used to treat superficial skin lesions (ie warts) and obtain biopsies with minimal scarring and rarely need anesthetic. this method is called?
cryosurgery
231
T/F only one treatment of cryosurgery is needed
false- often need more than 1 treatment
232
___ is a type of treatment that uses a small, hand held cordless. requires local anesthesia for most lesions, some scarring but self sterilization
electrocautery
233
___ is a type of treatment that is ideal for all superficial skin lesions. Requires local anesthetic, does scar, and not self sterilizing but lowccost and portable
hyfrecator
234
with hyfrecator you should warn the patient of what
burning smell
235
T/F you can not obtain biospy easily with hyfrecator
true
236
___ is a type of treatment that combines cutting and coagulation with minimal scarring. requires local anesthetic but can obtain specimen and self sterilizing
radio-surgery
237
like hyfrecator, ___ also causes burning smell- probably moreso
radiosurgery
238
__ is a type of treatment of light amplification by stimulated emission of radiation. does cost a lot and require special training but lots of other uses
laser
239
____ are local staphylococcal infections of the skin and the subcutaneous tissue.
All start as infection of hair follicle or sebaceous glad and progress to small area of induration with central necrosis
furuncles and carbuncles
240
what is the difference between a furuncle and carbuncle
furuncles is a singular formation, if extends to another area and reaches considerable size then it is a carbuncle
241
another name for a furuncle (single formation)
boil
242
furuncles take ___ days to become fully "ripe" with central core of necrosis and are painful
4-6
243
if furuncle/carbuncle is left untreated and increase in temp what happens?
"toxemia"- results in absorption form the area of infection and outcome can be serious- life threatening
244
___ is the simplest type infection that involves the distal phalanx. Appears along the nail near the base. Result of staphylococcus aureus invasion following trauma or biting off hangnail (painful and swollen)
paronychia
245
T/F: can not use epinephrine additive to control bleeding of distal organs
true
246
human bites commonly contain which organism and require referral
eikenella coorodens
247
what is the best treatment for snake bite
immobilization splint at heart level
248
T/F: ice, sucking out poison, and tourniquets are acceptable treatments for snake bites
false! they all complicate the problem
249
what is a commonly used antivemon for widow spider
lyovac
250
brown spiders have ___ poison that causes: anorexia, apathy, dehydration during first 8 hours.
loxoscles
251
loss of heat due to wet clothing/contact with metal is known as
conduction
252
loss of heat due to high wind velocity/ wind chill is known as
convection
253
loss of heat due to difference in temp gradients between body and surrounding environment
radiation
254
with freezing temps you will get these 3 symptoms in this order
stinging, burning, then numbness
255
when reach numbness stage of cold, skin will become ___ in color
wax-white
256
when heating a cold area, you may experience which symtpoms
itching/tingling and redness
257
with cold exposure, you could get chilblains which are...
nodular swellings surrounded by reddened area of hyperemia or cyanotic flat swellings in exposed area
258
T/F chilblains can cause symptoms (tingling, pain, aggravation to warmth) long after exposure to cold
true
259
with exposure to cold, be cautious of how rewarm body: external warming should be done by ____ while internal ___
external: dry warmth and internal warm liquids
260
when should you go to the hospital/ER after cold exposure
if vesicles or blebs appear
261
serious burn is considered if extends __% in kids and __% in adults
10% kid; 15% adult
262
which degree of burn involves epidermis only and manifests as an erythematous reaction (ie: sunburn). No blisters or systemic effects except maybe nausea, headache, or malaise.
first
263
which degree burn is most common and has more marked local tissue disturbance with capillary wall destruction- edema and bleb formation.
second
264
which degree of burn has destruction and tissue loss with scarring and requires pt to go to ER
third
265
furuncles and carbuncles have a central necrosis known as
a pustule
266
which antiseptic is teratogenic? (think would cleaning solutions..)
hexachlorophene
267
what is the best treatment for conjunctivitis
2% boric acid
268
2-4% boric acid is used to treat what?
conjunctiva, irrigation of open wounds, burns, abscesses, and vag pack
269
most common and serious complication to wound laceration repair is..
infection
270
what should be applied to an abscess if less than 5cm
clindamycin
271
condylomata lata=
syphilis
272
condylomata acuminata=
HPV
273
undermining procedures are..
used to reduce wound tension
274
what tool is used for undermining
scissors
275
epinephrine causes what
vasoconstriction
276
T/F: tetraunion can be closed after 3-4 days observation
true
277
T/F: you can close secondary union with suture after 3-4 days observation
NO! best left to heal w/o sutures
278
a patient takes a lot of aspirin...this may cause?
increased bleeding
279
you should worry about patients taking coumadin or heparin (heart meds) because..
cause increase bleeding
280
what about diuretics? (dyazide and lasix) what should you worry about
decreased BP
281
why is there an increased risk with patients with resp complaints (asthma, COPD, emphysema)
decreased oxygen intake leads to acidosis
282
an example of resident human flora is...
staph epidermis
283
an example of transient human flora is..
staph aures (MC cause infection)
284
when is a surgical site considered infected?
if produces pus or suppurates within 30 days
285
what is an exception to the "surgical site infection" rule
abcesses
286
the max dose for anesthetics is ___ cc
30cc
287
epinephrine with 1% lidocaine max dose is ___cc
50cc
288
what are disadvantages of using epinephrine
potentiates wound infection, potential necrosis of distal end organs, risk of small bleeder going unnoticed (leads to post op hemorrhaging)
289
a ___ cc syringe is used for wound irrigation and lavage
50cc
290
povidone, betadine, and methiolate are used for...
iodine based scrubs used as pre-op skin prep
291
direct filtration is good because you don't need to pierce the skin again, but what are some cons
causes trauma- changes shape of area and secondary inflammation possible increased infection risk
292
which conditions would you use field block for
sebaceous cystectomy, lipmectomy, excision, foreign body removal
293
aside from injecting anesthetic directly into a vessel, what else can cause a toxic reaction
rapid absorption from highly vascular area or excessive volume or conc of anesthetic
294
the epidermis (outer layer of skin) has 2 layers- what are they (stratum....)
stratum germinativum and stratum corneum
295
the stratum germinativum (basal layer) does what that is important to wound healing
provide cells for new epidermis formation during wound repair
296
the stratum corneum (basal layer) does what that is important to wound healing
its the most superficial layer, kerantinized and gives final cosmetic appearance
297
the dermis (deep to the epidermis) contains ____ that elaborate collagen
fibroblasts
298
hair follicles and sebaceous glands found in the ____ layer
reticular
299
____ is the key layer for achieving proper wound repair
dermis
300
an injury in the ____ layer could create dead space leading to hematoma
supericial fascia
301
injury to the superficial fascia layer could have increased risk of infection because...
contains fat that could lead to increased bacterial growth
302
anesthetic should be injected between which two layers
dermis and superficial fascia
303
antitetanus prophylaxis is what
vaccine for tetanus
304
with ___ bites of skin edges, fewer sutures required
wider
305
careful with wide bites because
could lead to marginal ischemia and necrosis of skin edges
306
you can alleviate excessive tension by (_____ sutures)
placing a few deep sutures
307
with needle size, the larger the number the ___ the diameter
smaller
308
another name for benadryl
diphenhydramine HCL
309
what can you give to a patient having an allergic reaction to lidocaine
benadryl
310
T/F antiseptics should not be used in wounds
true- just to decontaminate skin
311
____ is a good absorbable suture material for diabetics
polyglyconate monofilament
312
why is polyglyconate monofilament a good suture material for diabetics?
has long lasting tensile strength (these wounds heal slowly)
313
for non-absorbable materials, ______ is best because has more tensile strength and decreased infection risk compared to silk and braided polyester
nylon braided polybutilate coated polyester
314
T/F: treatment of ganglia within scope of practice
false
315
why are interrupted sutures a good option
can be removed or replaced individualy
316
CAM support includes
bromelain, comfrey, aloe vera, honey, vitamin C, propolis, tumeric, catendula
317
why is vitamin C good for minor surgery CAM support
collagen synthesis
318
____ is a good treatment for verrucae
nitric acid and bichloracetic acid (more recent)
319
what is matricectomy
surgically or chemically destroying all or part of base of nail portion
320
MC tumor of head/neck
squamous- basal MC body
321
what is hirschprung dz
congenital megacolon
322
MC bacteria from dog bite
pasteurella multocida
323
steam autoclaving temperature and pressure
120 C 750mmHG/14PSI
324
sebaceous cysts have a central ___
well
325
T/F warts have a central well
no! no "central"
326
T/F ganglionic cyst on wrist is solid
no- a cyst is a swelling surrounded by fibrous tissue
327
what size suture material is best for fine suturing of face
5-0 or 6-0
328
neomycin polymycin is found in...
bacitracin AND neosporin
329
Chlorhexidine vs hexachlorophene names
chlor=hebiclen STARIS
hexa=phisohex
both effective for gram + bacteria
330
T/F chlorhexidine is teratogenic
false- hexachlorophene is
331
sebaceous cyst exercised with ____ - an excision designed so that scar runs parallel with existing skin crease
elliptical
332
define elliptical excision
an excision designed so that scar runs parallel with existing skin crease
333
wound cleaning solution that can be used in wound around eye and doesn't sting
poloxamer 188 LF
334
rolled border/edge with central ulceration is a sign of what 2 conditions
basal cell or squamous cell in anus
335
silver nitrate vs boric acid
silver nitrate: tx warts, ulcers, cauterize bleeders. "crede treatment" (for conjuctiva gonorrhea). .25-1% tx infection of mucous membrane, sinuses, throat.
boric acid: astringent gp; decrease mucousal membrane swelling; 10%conc tx skin irritation, 2% conjuctivITIS; 2-4% burns/abcess/vag pack
336
proflavin dihydrochloride vs boric acid
pro. dihydro: dye gp (cont mercury) used to saturate gauze; treat furuncles/carbuncles; was #1 tx for conj gonorrhea and otitis media before antibiotics
boric acid: astringent gp; decrease mucousal membrane swelling; 10%conc tx skin irritation, 2% conjuctivITIS; 2-4% burns/abcess/vag pack
337
proflavin dihydrochloride vs silver nitrate
pro. dihydro: dye gp (cont mercury) used to saturate gauze; treat furuncles/carbuncles; was #1 tx for conj gonorrhea and otitis media before antibiotics
silver nitrate: tx warts, ulcers, cauterize bleeders. "crede treatment" (for conjuctiva gonorrhea). .25-1% tx infection of mucous membrane, sinuses, throat.
338
5% conc of ______ is called lugol's solution
iodine
339
iodine used in ____ and ____ as skin prep/cold sterilization
beta dyne and providyne
340
what should you apply to an abcess?
penecillin!
341
gas used for gas autoclaving
ethylene oxide
342
best suture material for diabetics
polyglyconate monofilament (Maxon) and polydioxanone monofilament (PDS) -- both absorbable
343
pyrexia definition
fever
344
pyrexia and pain with sitting and deification and coughing are S/S of ___ or ____
abcess/ ano fistula
345
delayed closure also known as..
tertiary union
346
5-0 and 6-0 braided silk is for
fine suturing about the face and fingers
347
5-0 and 6-0 nylon (ethilon/dermalon) is for
fine suturing about the face and hands
348
_____ is for heavy work about the scalp and limbs- especially areas of high stress such as across a joint
3-0 and 4-0 braided silk
349
3-0 and 4-0 nylon (ethilon/dermalon) is for
minor wounds and lacerations about the scalp, trunk, and extremities
350
5-0 plain catgut vs 3-0 and 4-0 plain catgut
5-0: fine vessel ties and fine interrupted subcut. sutures of face
3-0 4-0: for larger vessel ties... trunk and limbs
351
____ is for repair of deeper structures where a longer period of time for security is desirable
4-0 chromic catgut
352
what suture material is used for pull out/ subcuticular sutures
4-0, 5-0, 6-0 polypropylene (prolene)
353
4-0 polyglycolic acid (dexon) used for..
deep closures of the scalp, trunk, and extremities
354
5-0 polyglycolic acid (dexon)
deep closures of the hand and face
