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1 Surgical Procedures > MT2 > Flashcards

MT2 Flashcards

1
Q

Induration

A

Thickening/hardening of the skin. associated with inflammation, edema, inflammation, disease

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2
Q

Ulceration

A

Opening in skin associated with poor circulation- skin can’t heal well

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3
Q

Acanthosis (nigricans)

A

Thickening of the epidermis/prickle layer with deepening of the rete pegs. Associated with insulin GF.
Results in discoloration of the skin at folds.

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4
Q

Acantholysis

A

Loss of desmosomes –> blister like presentation. Seen in vesicles in HZO. Can only be seen on histology level

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5
Q

Parakeratosis

A

Stratum Corneum cells retain nuclei –> less prominent granular layer. Occurs when epidermis is rapidly proliferating (tumors)

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6
Q

Hyperkeratosis

A

Thickened/excess stratum corneum. Glossly, greasy, or scaly presentation

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7
Q

Spongiosis

A

Intra epidermal edema causing splaying of keratinocytes with vesicle formation from breaking of desmosomes. Stratum spinousum looks like sponge + vesicle formation

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8
Q

Myxoid Change

A

Excessive extracellular matrix- gives mucoid or gel consistency to lesion

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9
Q

Desmoplastic Change

A

Excessive growth of fibrous or CT in a lesion

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10
Q

Basaloid dermis

A

Basal cells invading into the dermis

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11
Q

5 types of aniseptics

A
  1. Chlorhexidine
  2. Providone iodine
  3. Isopropyl alcohol
  4. BAK
  5. H2O2
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12
Q

4 classes of wounds

A
  1. Clean. Not infected and no inflammation.
  2. Clean-contaminated. Have entered alimentary, respiratory, genital trace in controlled condition.
  3. Contaminated. Fresh open wounds. Breakdown in sterile techniques. Contamination from GI.
  4. Dirty/infected.
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13
Q

Surgical site infections arise why

A

Because of challenges to aseptic technique.

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14
Q

Wound irrigation

A

Continuous fluid flow with saline over wound. Not soaking. Good pressure.

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15
Q

How to manage extent of injurious wound

A 
Probe the canaliculi 
Evaluate nerves 
Evert lid 
Evaluate globe by DFE 
Consider imaging 
Look for damage of the levator or canthal tendons
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16
Q

Blades/Scalpels

How to know handles and blades

A

Charles Russel Brand and Warren Parker (BP) system.
Numbers 1-9 are handles
10-20+ are blades

  • Edge cutting surface can be open (with teeth, wears slowly) or closed (without teeth, smooth, wears fast)
  • Spine is the non-cutting edge of the blade
  • Slot is how the blade is attached to the handle (perm or removable)
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17
Q

Blade 10

A

Curved edge for long cuts, especially soft tissue

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18
Q

Blade 11

A

Pointed tip for stab incision. Short, precise, shallow cuts.

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19
Q

Blade 15

A

Combo. Short, curved edge. For short precise incisions.

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20
Q

What forceps to choose?

A

Tooth/Castrovijo- forward angled teeth. Good for manipulating conj or eyelid skin.

Tissue or adson forceps have grooved edges. Good for grasping skin.

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21
Q

3 types of surgical scissors

A

Westcott-spring- Spring handle. Easily open/close
Vannas- fine blade, can be sharp or curved
Iris- Larger pointed tip

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22
Q

Jaeger plate

A

Protects the globe. Put between eyelid and the globe

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23
Q

2 locking mechanisms for the needle driver

A

Castroviejo, Halsey

24
Q

Where to make the incision

A
  • Along natural tension lines or wrinkles. Tension lines run perpendicular to contraction.
  • At boundaries of anatomic fields.
  • Incise vertical to skin or at a right angle. Don’t angle!! Won’t heal well. Edges won’t come together nicely. (unless at eyebrow, then do parallel to hair shaft)
  • Length should be 4:1 ratio. Widest point should be centered well. Diamond, ellipse/fusiform shape
  • Avoid lid margin (may cause ectropion)
25
Q

Shave biopsy/exision

A

removal of lesion at level of skin surface. For lesions not expected to be progressing into the dermis.
Papillomas, skin tags, keratoses.

26
Q

Punch biopsy/excision

A

Small, circular excision of tissue. Small tubular/cylindrical device used to excise the tissue. Good for full thickness removal or sampling.

27
Q

Incisional vs excisional

A

Incisional- a portion of the lesion is removed.

Excisional- entire lesion is removed. More common in optometry.

28
Q

Tissue transport medium

A

Formalin 10% is common

Honey, saline, liquid nitrogen.

29
Q

Lab samples

A

Label- name, date, location of specimen, only 1 lesion, ICD10 code, description of sample.

30
Q

RF uses energy between

A

3-300gHz. Applies energy current causing dipole water molecules to rapidly vibrate

31
Q

Electrocautery vs electrosurgery

A

Electrocautery- Applying a heating element to heat tissue. Coagulates and constricts the tissues.

Electrosurgery is a higher frequency. Makes the tissue the heating element. Cells burst and steam emitted causes coagulation. Lots of energy at the tip, disperses quickly bc tip-receiver relationship. Not impacted by diffraction/absorption/melanin like lasers.

32
Q

Lateral heat equation

A

lateral heat = (Time x Intensity x Electrode side x Waveform) / Freq
*We cannot impact F
Increased lateral heat with Increased time, intensity, coagulation intensity, and larger electrode

33
Q

When would you use a mono vs bipolar tip for RF?

A

Mono has single tip and single receiver

Bino has 2 tips. Energy passes in small area between them. Very fine accuracy

34
Q

Studies about RF (hot) Vs Scalpel (cold)

A

More scarring in first month with scalpel, then same for the long term.

35
Q

Contra indications for RF

A

Implantable devices
Collagen vascular disease
Autoimmune disease
Recurrent herpetic disease

36
Q

Common RF units

A

Ellman, Bovie, Valley Lab.

All use different frequencies.

37
Q

co2 laser

A

Emits IR beam at 10,600 nm. Targets intra and extracellular water. As energy is absorbed, vaporization of the tissue occurs.

38
Q

When could you use laser tx

A

Trichiasis to destroy lash follicle- Argon or YAG

Skin resurfacing- YAG of Co2

39
Q

Intense pulsed light

A

Emits light at wavelength of 500-1200 nm at periocular or cheek locations. Pulses of 2-25 milliseconds. Absorbed by hemoglobin–> heat. Causes ablation of blood vessels. Reduces telangiectasia and limits pro-inflammatory mediators. Also heats MG and causes better gland expression.

40
Q

How to clean/sterilize instruments

A
  1. Autoclave
  2. Peroxide
  3. Chemical sterilization (H202, bleach)
    C tub?
41
Q

Dispose sharps box when its how full ?

A

3/4

42
Q

Biohazard vs medical waste

A

Biohazard: Waste contaminated with possible infectious agents. Human blood, bodily fluids, pathology waste, sharps. Contaminated items that would release blood or liquid if squeezed. OSHA.

Medical waste: Lab material that are not infectious but could be mistaken for hazardous waste. Globes, paper products for sterilization.

43
Q

Bioharzard waste bin must be

A

Closable, prevent leakage, red color. Coordinate with OSHA for disposal. Assigned a compliance officer.

44
Q

Elements to informed consent

A
  1. Explain procedure. Dx and reason. Describe who will be involved.
  2. Risks/benefits
  3. Reasonable alternatives
  4. Risks and benefits of alternatives
  5. assessment of pt’s understanding of 1-4
45
Q

Exception to informed consent

A

Incapacitated
Life threatening emergency
waived IC

46
Q

Goals in suturing

A

Approximate tissues without excess tension. Minimize ischemia

If deeper than dermis, do double suturing of internal and external.

47
Q

Suture size (US pharmacopeia, USP, zero system)

A

Zero is in the middle.
1, 2, 3 are larger
2oh, 3oh, 4oh, are smaller

Smallest size that will achieve goal is best! Oculoplastics usually use 4oh to 7oh.

48
Q

Filament in the suture

A

Can be single (mono) or multi stranded. More filament = greater strength= greater trauma= greater infection risk.

49
Q

Absorbable suture materials (gut- natural and vicryl-synthetic)

A

Mammalian collagen or polymers that can be hydrolyzed. Tensile strength decreases over time. Still needs to be removed tho.

  1. Plain gut- Collagen from sheep or cow intestine. strength maintained for 7-10 days, dissolves in 70 days.
  2. Chromic gut- bathed in tanning solution. Strength lasts 10-14 days, dissolves in 90 days.
  3. Vicryl. Coated lactide polymers. Common in oculoplastics. Less tissue reaction than gut. Can be coated with antibiotics. Dissolves in 70 days.
    * Remove in 5-7 days or else suture itself will cause a scar.
50
Q

Non absorbable suture materials

A

Natural or synthetic materials that are not broken down by natural enzymes.

  • Silk
  • Nylon
51
Q

Components of a needle

A

Point, body, swage (The end/how its clamped onto suture material)

Characterized by alloy, shape, and coating

52
Q

Surgical yield

A

The amount of strain the needle can withstand before permanent deformation of the needle occurs. Don’t try to reshape it.

53
Q

3 needle point styles

A
  1. Tapered point. 2 opposing cutting edges come to a point.
  2. Conventional cutting. Makes triangle with point upwards.
  3. reverse cutting. Makes triangle with point downwards. (Ideal for skin)
54
Q

Needle curvatures. Why would you want a curved needle

A

More curved allows manipulation in confined space. Ex oral cavity

55
Q

Skin strips

A

Advantage- will not cause injury to skin induced by the suture. Less scarring.
For simple wound closure.
Best in linear lesions, little tension, flat surface, little movement at site, dry areas, low tension.

1 Surgical Procedures (5 decks)

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