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obce minor surgery > obce minor surgery > Flashcards

obce minor surgery Flashcards

1
Q

lidocaine (xylocaine) use

A

local anesthetic–most popular, w/without epinephrine

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2
Q

mepivacaine (carbocaine) use

A

local anesthetic–no epinephrine

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3
Q

procaine (novocaine) use

A

local anesthetic w/without epinephrine

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4
Q

bupivacaine (marcaine) use

A

local anesthetic-slow onset, long duration

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5
Q

TAC application and use

A

local anesthetic, pediatric patient local anesthetic, sponge with epinephrine, tetracaine, and cocaine.

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6
Q

ophthaine (proparcaine hydorchloride)

A

local anesthetic, for topical eye application

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7
Q

cetacaine (rostra spray)

A

topical local anesthetic, mucous membranes, 1-5 minute duration

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8
Q

ethyl chloride

A

topical local anesthetic- highly flammable, short duration (15-30sec)

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9
Q

4 main reactions to local anesthetic:

A
  1. cardiovascular rxn 2. excitatory CNS effects 3. allergic responses 4. vasovagal syncope secondary to apin and anxiety
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10
Q

epidermis

A

outermost layer of skin: contains no organs, nerve endings or vessels.

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11
Q

epidermis function

A

provides protection

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12
Q

epidermis layers

A

stratum germinativum (basal layer)-parent layer for new cells. Stratum corneum (most superficial) -keritinized or horny layer

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13
Q

dermis

A

lies immediately below the epidermis and is thicker, composed of connective tissue.

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14
Q

cells of the dermis

A

fibroblasts, macrophages, mast cells and lymphocytes

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15
Q

layers of dermis

A
  1. papillary dermis (richly vascular, more superficial) 2. reticular dermis (bulk of adnexal structures: hair follicles, sebaceous glands, sweat glands, nerve fibers, vascular plexi)
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16
Q

significance of dermis in minor surgery

A

key layer for achieving proper wound healing: anchoring site for superficial and deep sutures, must cleanse and debride properly and approximate edges.

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17
Q

superficial fascia

A

deep to dermis, layer of loose CT with fat

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18
Q

superficial fascia primary function

A

insulates against heat loss

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19
Q

superficial fascial layer injury

A

potential for creating dead space–hematoma, devitalized fat can lead to bacterial growth

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20
Q

deep fascia

A

dense, thin, discrete fibrous tissue layer, which encloses muscle groups. Functions to support and protect ST structures

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21
Q

Wound healing phases (1)

A

0-10 min: Immediate response to injury (vessels constrict, platelets aggregate, clotting is activated.

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22
Q

would healing phases (2)

A

inflammatory phase (chemotactic factors are released and attract granulocytes to wound area). Peak # of cells 12-24 hours

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23
Q

wound healing (3)

A

24 hours: epithelialization (epithelial cells of the stratum germinativum or basal layer undergo morphologic and functional changes

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24
Q

wound healing (4)

A

neovascularization: day 3-21. new vessels form

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25
Q

wound healing (5)

A

collagen synthesis. new collagen laid down (collagen fibrils formed by 2nd day)

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26
Q

wound healing (6)

A

wound contraction: scar that forms contracts centripetally

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27
Q

primary union

A

healing by first intention. Clean wounds with min tissue loss. Wounds can be closed by suture or tape within 6 hours without complications

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28
Q

secondary union

A

significant tissue loss: avulsions, infarctions, ulcerations, abscesses. Prone to significant wound contraction.

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29
Q

tertiary union (delayed closure)

A

wound that can be closed after 3-4 days of observations

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30
Q

what technical factors affect wound healing?

A

inadequate wound tension, excessive suture tension, reactive suture material, local anesthetics

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31
Q

what anatomical factors affect wound healing?

A

static skin tension, dynamic skin tension, pigmented skin, oily skin, body region

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32
Q

which conditions and diseased affect wound healing?

A

advanced age, severe alcoholism, acute uremia, diabetes, ehlers danlos, hypoxia, severe anemia, peripheral vascular disease, malnutrition

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33
Q

which drugs affect wound healing?

A

corticosteroids, NSAIDS, penicillamine, colchicine, anticoagulants, antineoplastic agents, positive effects of vit A, C, and zinc sulfate

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34
Q

superficial wounds

A

skin, subcutaneous tissue, fat, and or muscle

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35
Q

deep wounds

A

involve structures excluded in superficial wounds. Not in DC scope of practice

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36
Q

simple wounds

A

interrupted tissue with no sign loss or implantation of debris

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37
Q

complex wounds

A

loss or damage to tissue or contain foreign matter

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38
Q

clean wounds

A

little or no bacterial contamination

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39
Q

dirty wound

A

wounds older than 5 hours or with other reason to suspect contamination, also those contaminated by instrument of injury, and when there is impairment of local circulation.

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40
Q

signs of infection

A

redness, warmth, and swelling extending beyond the immediate confines of the wound. palpable induration of greater than .5 cm. Purulent discharge, regional lymphangitis and wound dehiscence (splitting).

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41
Q

of organisms present in infection

A

100,000 organisms per gram of tissue

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42
Q

MC organisms in infection

A

staph aureus

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43
Q

factors that increase wound infection

A

old wounds (>5 hrs), crushing mechanism, soil or foreign material, lower extremity wounds.

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44
Q

technical factors that increase wound infection

A

detergent scrub solutions, anesthetics with epinephrine, poor suturing technique, excessive suture tension, reactive suture material tincture of benzoin

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45
Q

patient conditions that increase wound infection

A

advanced age, diabetes, uremia, liver disease, malnutrition, corticosteroid therapy

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46
Q

loss of 20% body weight increases risk of infection how much?

A

3x

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47
Q

when are prophylactics necessary to decrease risk of infection?

A

wounds greater than 6 hours, lower extremity wounds, crushing mechanism wounds, human and cat bites, severely contaminated wounds and complicated hand wounds.

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48
Q

age group most susceptible to tetanus

A

over 50

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49
Q

very tetanus prone wounds

A

high level of bacterial contamination, over 24 hours old, containing devitalized tissue which cannot be debrided.

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50
Q

moderately tetanus prone wounds

A

moderate bacterial exposure, over 6 hours old, stallate or crush wounds deeper than 1cm, wounds extending into muscle.

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51
Q

not tetanus prone wounds

A

clean wounds, less than 24 hours old, no devitalized tissue.

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52
Q

fully immunized against tetanus

A

adults: min 3 doses of tetanus toxoid, first and second given 3 months apart, third in 6 months.
children: between ages 6-7, four doses.
boosters every 10 years

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53
Q

tetanus shots for those never immunized

A

first dose with wound repair, second in 4-8 weeks, third 6 months after 2nd.

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54
Q

bite

A

amount of tissue taken when placing suture needle

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55
Q

throw

A

each not of suture consists of a series of throws

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56
Q

superficial suture

A

sutures placed on surface of skin for final closure-made of non-absorbable material

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57
Q

deep suture

A

usually absorbable material-placed in superficial fascia (subcutaneous tissue) or dermis.

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58
Q

continuous sutures

A

wound closure involving many bites along length of wound w/out individual knots.

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59
Q

debridement

A

cleaning away of devitalized tissue or contaminants

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60
Q

devitalized tissue appearance

A

shredded blue, or blackish

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61
Q

hemostasis

A

must be obtained before wound closure to avoid hematoma.

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62
Q

how to achieve hemostasis

A

4x4 gauze pad with pressure, or direct clamping (last resort)

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63
Q

deep layer closure

A

all layers of skin must be brought into and held in proximity.

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64
Q

accurate skin apposition

A

created with an everted suture-achieved with right angle tissue bites.

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65
Q

wide suture bites require fewer or greater number of sutures

A

fewer

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66
Q

what is undermining

A

method to reduce tension, involves releasing dermis and superficial fascia from deeper attachments.

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67
Q

where is undermining used

A

scalp, forehead, and lower leg (particularly over the tibia)

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68
Q

tools for undermining

A

metzenbaum scissors, or iris scissors

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69
Q

simple interrupted suture

A

most common for clean wounds: sutures tied with individual knots

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70
Q

vertical mattress suture for which wounds

A

edges cannot approximate with simple interrupted suture: thin skin, flexural creases, high stress areas.

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71
Q

horizontal sutures

A

suture slightly more everted than vertical mattress

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72
Q

apical suture

A

used to close v-shaped wounds by drawing tip into place

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73
Q

intradermal subcuticular “pull-out” sutures

A

used to avoid prominent suture marks

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74
Q

thread for intradermal subcuticular sutures

A

nylon or fine monofilament

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75
Q

polyglycolic acid absorbable or non? braided or non? synthetic or non.

A

absorbable, braided, synthetic polymer

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76
Q

polyglycolic acid knot security

A

excellent ++++

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77
Q

polyglycolic acid reactivity

A

less reactive

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78
Q

polyglycan-910 (PG910/vicryl): absorbable or non, synthetic or non

A

absorbable, synthetic

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79
Q

polyglycan-910 (PG910/vicryl) knot security

A

good +++, not as good as polyglycoic acid

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80
Q

gut: absorbable or non

A

absorbable (ew)

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81
Q

gut: tensile strength

A

less than synthetic absorbables

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82
Q

gut: tissue reaction

A

reactive

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83
Q

monofilament nylon (ethilon, dermalon): absorbable/non?

A

non-absorbable

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84
Q

monofilament nylon (ethilon, dermalon): knot security

A

poor ++

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85
Q

polypropylene (prolene) absorbable or non?

A

non-absorbable

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86
Q

polypropylene (prolene) strength

A

strongest

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87
Q

polypropylene (prolene) knot security

A

poor +

88
Q

polypropylene (prolene) braided/unbraided?

A

unbraided

89
Q

braided non-absorbable sutures (4)

A
  1. silk-knot security ++++
  2. cotton
  3. braided nylon (nurulon)-knot security +++
  4. multifilament dacron (mersilene)-knot security ++++
90
Q

braided non-absorbable sutures knot security

A

excellent

91
Q

least reactive non-absorbable suture material

A

polypropylene (prolene)

92
Q

most reactive non-absorbable suture material

A

silk

93
Q

most reactive absorbable suture material

A

gut

94
Q

least reactive absorbable suture material

A

polyglycolic acid (dexon) or polyglycan-910

95
Q

curved needle basic types (2)

A

tapered and cutting

96
Q

which is a smaller needle and material 6-0 or 1-0?

A

6-0

97
Q

benefits of wound taping

A 
easy to apply
non-invasive
no anesthesia required
no suture scars
better infection resistance
98
Q

disadvantages of wound taping

A

not well suited for tissue with considerable tension, irregular shapes or concave surfaces.
not great for oily or moist skin

99
Q

four types of occlusive wound dressings

A
  1. Films
  2. foams
  3. hydrocolloids
    4 hydrogels
100
Q

duoderm, comfeel, and ulcer dressing

A

hydrocolloids (occlusive wound dressing)

101
Q

Op-site, tegaderm, bioclusive, uniflex, oproflex, ensure-it, thin film wound dressing and blister film

A

films (occlusive wound dressing)

102
Q

synthaderm and epilock

A

foams (occlusive wound dressing)

103
Q

vigilon

A

hydrogel (occlusive wound dressing)

104
Q

which type of occlusive dressing gets smelly and drains fluid

A

hydrocolloids

105
Q

cryosurgery

A

liquid nitrogen for superficial skin lesions

106
Q

electrocautery

A

small hand-held cordless disposable cautery tool for cutting and coagulation of most skin lesions. Local anesthesia is necessary. some degree of scarring.

107
Q

electrocautery disadvantage

A

smell of burning, scarring

108
Q

hyfrecator (fulguration)

A

ideal for all superficial skin lesions-keratoses, angiomas, warts molluscums and papillomas. ideal for vascular lesions, hemostasis and obliteration.
Electrodes are not self sterilizing.

109
Q

hyfrecator (fulguration) disadvantages

A

smell of burning, difficulty obtaining samples for histology

110
Q

radio surgery

A

combined cutting and coagulation. minimal scarring.

111
Q

radio surgery disadvantages

A

pronounced smell of burning

112
Q

laser

A

converts electrical energy to into light energy. Great for a variety of skin conditions–tattoos, blemishes, tumors, birthmarks, facial aging.

113
Q

laser contraindicaitons

A

cost and additional training

114
Q

minor surgery treatments for spider veins

A

cautery, hyfrector, radio-surgery, laser

115
Q

minor surgery treatments for viral warts

A

cyrosurgery, cautery, hyfrecator, radio-surgery, laser (rarely scalpel)

116
Q

minor surgery treatments for ingrown toenails

A

cryosurgery (sometimes), hyfrecator (sometimes), radio-surgery, scalpel, laser

117
Q

minor surgery treatments for keratosis

A

cryosurgery, cautery, hyfrector, radio-surgery, scalpel, laser

118
Q

minor surgery treatments for basal cell carcinoma

A

cryosurgery, cautery, hyfrector, radio-surgery, scalpel, laser

119
Q

furuncles and carbuncles

A

local staph infections–begin as infection of hair follicle

120
Q

furuncle vs carbuncle

A

furuncle (singular) carbuncle (multiple)

121
Q

paronychia

A

staph infection of the nail

122
Q

nail removal anesthesia

A

nerve block-best option for complete avulsion.

field block

123
Q

can epinephrine be used for nail removal

A

no

124
Q

blade used for nail avulsion

A

flat-spatulated

125
Q

matricectum

A

Matricectomy: the process of surgically or chemically destroying all or part of the base nail portion called the nail matrix. Complete destruction of the nail matrix results in permanent loss of that portion of the nail.

126
Q

fish hook removal

A

anesthetize, push hook through, cut off tip and back hook out.

127
Q

what percent of bites are from dogs/ cats/other animals

A

90/5/5

128
Q

what bacteria is common to animal bites?

A

pasturella multocida (gram negative)

129
Q

what should be treated as if rabies were present?

A

all animal bites

130
Q

what type of wounds are animal bites?

A

dirty

131
Q

where do most human bites occur

A

over the metacarpophalangeal joint on dorsum of hand (clenched fist)

132
Q

bacteria most associated with human bites

A

eikenella corrodens

133
Q

contraindications for snake bite treatment

A

cryotherapy, incision and suction, tourniquets/constrictive bands

134
Q

what is frostbite

A

a form of peripheral vascular disease due to exposure to cold

135
Q

frostbite treatment

A

internal and external rewarming
external with dry warmth
internal with warm liquid

136
Q

treatment of vesicles or blebs from frostbite

A

transfer to hopsital or ED

137
Q

burns of what extent are a medical emergency?

A

adults 15%

children 10%

138
Q

first degree burn

A

epidermis only (sunburn)

139
Q

second degree burn

A

most frequent burn, capillary wall destruction and edema and bleb formation

140
Q

third degree burn

A

destructive tissue loss with subsequent scarring. referral to ED

141
Q

rectum anatomy

A

begins at S3 level, descends along sacrum and coccyx and ends at upper pelvic diaphragm, 12-15cm long

142
Q

anal canal anatomy

A

begins at anorectal junction, 3-4cm long, terminates at anal verge.

143
Q

musculature and innervation of anorectal region

A 
inner tube (visceral smooth muscle-autonomic control)
outer tube (skeletal muscle-somatic control)
144
Q

dentate line

A

midpoint of anal canal-undulating demarcation, 2cm from anal verge.

145
Q

columns of morgagni

A

“pleated” longitudinal fold above the dentate line

146
Q

crypts of morgagni

A

at the base of the columns of morgagni (can have obstruction and abscess formation

147
Q

internal sphincter innervation

A

involuntary-sympathetics (motor) and parasympathetics (inhibitory)

148
Q

bright red blood that drips into toilet and is free from stool

A

associated with bleeding internal hemorrhoids

149
Q

blood on tissues

A

associated with anal fissures or abrasion of anal canal

150
Q

melena

A

pathologic processes higher in GI tracts

151
Q

blood and mucous in stool

A

low lying carcinoma or more commonly UC and crohns

152
Q

skin tag

A

area of hypertrophied cutaneous tissue adjacent to anus

153
Q

skin tag location (anus)

A

posterolateral quadrant

154
Q

sin tag etiology

A 
old external hemorrhoids
anal fissure or fistula
crohns disease
condyloma acuminata
anal neoplasia
pruritus ani
previous anorectal surgery
155
Q

symptomatic skin tag treatment

A

ointments, hot sitz baths, removal

156
Q

skin tag removal options

A

cryosurgery, laser or electrosurgery

157
Q

pruritus ani

A

perianal itching

158
Q

hemorrhoids

A

“sliding down” of the thick, vascular cushions within the anal lining.

159
Q

hemorrhoid locations

A

left lateral, right lateral and posterolateral

160
Q

percent of population over 50 affected by hemorrhoids

A

50-70%

161
Q

external hemorrhoids

A

dilated venules of the inferior hemorrhoidal plexus below the dentate line.

162
Q

internal hemorrhoids

A

symptomatic, swollen submucosal vascular tissue above the dentate line.

163
Q

first degree hemorrhoid

A

no protrusion or bulge into lumen of rectal canal

164
Q

second degree hemorrhoid

A

protrude at stool and reduce spontaneously

165
Q

third degree hemorrhoid

A

produce at stool and must be manually reduced

166
Q

fourth degree hemorrhoid

A

protrude at stool and cannot be reduced

167
Q

mixed hemorrhoids

A

elements of internal and external hemorrhoids present

168
Q

strangulated hemorrhoids

A

prolapsed hemorrhoids, due to spasm of sphincter, lose blood supply and will become gangrenous

169
Q

definitive examination of hemorrhoids

A

anoscopy

170
Q

proctosigmoidscopy

A

to visualize rectum and lower colon and exclude carcinoma and IBD

171
Q

first degree hemorrhoid tx

A

diet change, stool softeners, suppositories and sitz baths

172
Q

rubber band ligature

A

for first degree internal hemorrhoids not relieved by diet

173
Q

sclerotherapy

A

injection of solution (5% phenol in vegetable oil) for hemorrhoids not relieved by diet

174
Q

manual dilation of anus

A

to overcome obstruction due to constricting bands

175
Q

cryotherapy for hemorrhoids problems

A

profuse foul smell for 2 weeks after until necrosed tissue sloughs off

176
Q

keesay technique

A

non-surgical galvanic
historic hemorrhoid tx for chiros
uses 12-14 mA negative galvanic current across hemorrhoid and is repeated in 10-20 treatments

177
Q

fissure in ano

A

painful linear ulcer in anal canal from just below dentat line to anal level

178
Q

fissure in ano sx

A

pain after defecation
frank bleeding
constipation
dysuria

179
Q

fissure in ano location

A

mid line posterior in men 99%
mid line posterior in women 90% with 10% anterior
lateral fissure indication of sever systemic disease

180
Q

sentinel pile

A

swelling at lower end of fissure and swelling and fibrosis at proximal end in anal valves

181
Q

when is surgical repair indicated for anal fissures

A

persistent pain or bleeding
exposure of internal sphincter muscle
induration of fissure edges
development of large sentinel pile

182
Q

blue cyanotic hue of perianal skin

A

crohn’s disease

183
Q

irradiation proctitis

A

iatrogenic condition of patients undergoing radiation therapy. most commonly related to cervical cancer.

184
Q

tuberculosis affecting anorectum

A

caseating granuloma and acid fast bacilli in lesion

185
Q

condylomata acuminata

A

most commonly seen disease of the anorectum. papilloma virus.

186
Q

condylomata lata

A

secondary syphilis

187
Q

neoplasms of the anorectal canal

A

squamous cell carcinoma (MC)
basal cell carcinoma
bowen’s disease
perianal paget’s disease

188
Q

squamous cell carcinoma appearance

A

rolled everted edges and central ulceration

189
Q

fistula

A

abnormal communication between any two epithelial surfaces

190
Q

anal fistula

A

abnormal communication between the anal canal and perianal skin

191
Q

anal fistula origin

A

crypts of morgagni (90%)

192
Q

horseshoe fistula

A

upward tracking fistula that goes circumferentially around the anus

193
Q

abscess vs fistula

A

abscess-acute manifestation

fistula-chronic situation

194
Q

ddx for fistula

A 
bartholin gland abscess
sebaceous cyst
TB
osteomyelitis of the bony pelvis
fissure
urethroperineal fistula
195
Q

most common benign condition of the large bowel

A

polyps

196
Q

appearance of polyps

A

can be sessile, pedunculated or villous

197
Q

which polyps are most likely malignant

A

villous

198
Q

treatment for polyps

A

excisional biopsy

199
Q

povidone-iodine surgical scrub

A

wound cleansing agents (wound periphery and hands)

200
Q

povidone-iodine without detergent

A

wound cleansing agents (wound periphery)

201
Q

chlorhexidine

A

hand cleanser

alternative wound cleanser

202
Q

pluronic F-68

A

face cleaner

203
Q

hexachloropene

A

alternative hand cleanser

teratogenic

204
Q

ganglia

A

cystic swelling near joint capsules and tendon sheaths

205
Q

ganglia tx

A

not covered by chiros

206
Q

benign tumors

A

palpable and usually non-tender mobile encapsulations

207
Q

malignant tumors

A

basal cell c
squamous cell c
melanoma

208
Q

basal cell carcinoma

A 
MC
over 40
area exposed to light
slow growing
rarely penetrates the base membrane 
progress to have raised rolled edges and ulceration or necrotic center
209
Q

squamous cell

A

sun exposed skin
appears as peels on skin or non-healing ulcer
vermillion border of upper lip, paranasal folds, ears, cheeks, axillary region
can arise from actinic keratosis

210
Q

squamous cell tx

A

excisional biopsy

211
Q

melanoma

A 
most dangerous 
least frequent
nevus shaped
jet black
occasionally has visible vascularization
may ulcerate or bleed
212
Q

dexon, dexon plus and dexon S

A

synthetic absorbable sutre

213
Q

vicryl, coated vicryl

A

synthetic absorbable sutre

214
Q

dacron, mersilen

A

braided silk or polyester

215
Q

dermalon, ethilon, nurolon

A

nylon sutures

obce minor surgery (1 decks)

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