NPLEX 2 > Minor Surgery > Flashcards

Minor Surgery Flashcards

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1
Q

_______ fluids of ALL patients should be considered infectious.

A

blood and body fluids

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2
Q

_______ is the most commonly transmitted infection.

A

Hepatitis B

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3
Q

Anesthetics are dividided into 2 groups:

A

esters and amides

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4
Q

2% Glutaraldehyde has a (low/high) tissue toxicity.

A

Low

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5
Q

Name 2 required universal precautions (OSHA):

A 
Use barriers (gloves, ppe)
Sharps management
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6
Q

Use sterilization for _____, disinfecting for ______.

A

S - tools

D - living tissue

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7
Q

2% Glutaraldehyde takes how long to work?

A

10 mins to disinfect

10 hours to sterilize

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8
Q

Boiling can effectively sterilize at:

A

> 30 mins

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9
Q

Dry heat can effectively sterilize at:

A

160C / 320F x1 hour

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10
Q

Autoclave rules:

A

15 psi at 121c for 15 mins

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11
Q

Intact skin can be disinfected with:

A

10% betadine x3

0.4% chlorhexidine gluconate

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12
Q

Why do we irrigate with normal saline instead of H2O2?

A

H2O2:
slows wound healing
promotes tissue necrosis

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13
Q

If skin is punctured, and large items are still in the skin, you should:

A

Secure and refer

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14
Q

Let puncture wounds heal by ___ intention.

A

third - in case something is still inside

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15
Q

Dont suture wounds older than:

A

8-12 hours

24 hours on the face

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16
Q

If you can’t rule out these kinds of damage, you should always refer:

A

nerve
tendon
vasculature
bone

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17
Q

Normal scar healing is called ______, while extending beyond the original area is called ________.

A

hypertrophic

keloid

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18
Q

Healing stages:

A

1 - hemostasis
2 - inflammation
3 - proliferation (granulation)
4 - remodeling

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19
Q

Healing stages - Hemostasis is also called _______, and is characterized by formation of a ___________.

A

coagulation

fibrin clot

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20
Q

Healing stages - Inflammation begins _____, days 1-4. Cytokines are secreted by ________, complement cascade is triggered, and _______ arrive in 5-6 hours, staying 3-4 days to destroy bacteria.

A

immediately
platelets
neutrophils

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21
Q

Healing stages - inflammation:

__________ transition from inflammation to repair and phagocytize.

A

macrophages

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22
Q

Healing stages - inflammation:

re-epithelialization

A

basal cells

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23
Q

New karatinocytes proliferate ___ days after injury.

A

1-2

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24
Q

Neovascularization is:

A

angiogenesis, brings oxygen and nutrients

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25
Remodeling strength at 3-4 weeks:
30-40%
26
Remodeling strength at 1 year:
80%
27
Bromelain can help increase _______ formation.
collagen
28
Healing intention - primary:
suture a clean wound | bandage and let heal
29
Healing intention - secondary: full thickness, into subQ
left open, healed by granulation | used with significant tissue loss or contamination
30
Healing intention - tertiary:
without significant tissue loss -> clean, pack, cover, leave open 3-5 days, then suture if non-infected * dog bite * puncture with contaminated tool > you may want to reopen if the skin starts healing over too soon
31
3 important stitches to be comfortable with if you want to do minor surgery:
Simple interrupted Vertical mattress SubQ
32
Simple interrupted stitching may cause _______ scarring
railroad
33
Vertical mattress is (easy/hard) to evert under tension.
easy | better for cosmesis
34
Horizontal mattress is good for (high/low) tension wounds and (fragile/dense) tissue
high | fragile
35
Deep or buried stitches - use ______ suture.
absorbable | for large or deep wounds
36
What are some indications for using subcuticular/intradermal running stitches:
dermal layer not visible eliminates tracts linear wounds with little tension
37
Running stitches are:
less secure high risk of infection quick to put in not cosmetic
38
3-point, half-buried stitches are good for:
triangular flaps without strangulation
39
Two main classes of suture materials:
absorbable (natural, synthetic) | non-absorbable
40
Natural absorbable sutures are digested by:
body enzymes
41
Which natural absorbable suture is less reactive?
chromic catgut - chromic salt delays absorption, has 2-3 week 1/2 life plain catgut > chromic catgut > synthetic sutures
42
_______ sutures are hydrolyzed and easy to tie.
synthetic
43
Characteristics of silk sutures:
high tissue reactivity | easy to tie
44
Characteristics of stainless steel:
minimal tissue reactivity | permanent
45
Characteristics of polyester/polybutester:
high tissue reactivity
46
Characteristics of nylon/ethilon:
low tissue reactivity, low risk of infx slips easily monofilament
47
Staples:
minimal tissue reactivity, low risk of infx fast uncomfortable
48
Use ____ knots per gauge:
one knot over gauge (5 knots for a 4-0)
49
Suturing face/neck - gauge, remove:
5-0, 6-0 | 3-5 days
50
Suturing arm/hand - gauge, remove:
4-0, 5-0 | 7-10 days
51
Suturing trunk/leg/foot/scalp - gauge, remove:
3-0, 4-0 | 7-14 days
52
Reverse cutting is (most/least) common
most common for procedures
53
Dress wounds for:
absorption of drainage support moisture for epithelialization limits movement
54
Post-op, keep wounds dry for _____ hours.
24-48
55
Post-op, keep wounds dry for _____ hours.
24-48
56
Infections are common ____ days post-procedure, and the most common pathogen is ___________
4-10 days | staph aureus
57
Blood collection following surgery is called ______, happens _____ hours after surgery, and may lead to infection or ______.
hematoma 24-72 hours dehiscence
58
Wound rupture along the incision after suture is closed is called ______. You can re-suture within ____. After that window, you want to:
dehiscence 48-72 hours let it heal by secondary intention
59
Local antisthetics block ___ reuptake, to prevent:
sodium depolarization and propagation of pain stimuli
60
10cc of 1% lidocaine = __ mg
100mg lidocaine
61
IM injection angle:
90 degrees
62
SubQ injection angle:
30-45 degrees
63
Intradermal injection angle:
5-10 degrees
64
Amides are metabolized in the _____, and true allergies are (common/rare).
liver | rare
65
Lidocaine/xylocaine has a ___ min onset, ___ min duration.
1-10 mins to onset | 30-60 min duration
66
Max dose of lidocaine in a child:
3.3-4.5 mg/kg, not to exceed 75-110mg
67
Max dose of lidocaine in an adult:
4.5 mg/kg, not to exceed 300mg (30cc of 1%)
68
Bupivacaine/marcaine has a ___ min onset, ___ hour duration. Indicated for:
8-12 min onset 3-4 hour duration digital block
69
Max dose
4 mg/kg of 0.25%, not to exceed 200mg
70
Esters are metabolized in ________ by pseudocholinesterase
peripheral plasma | more reactions
71
3 ingredients in TAC:
Tetracaine (ester) Epinephrine Cocaine
72
3 ingredients in TAC:
Tetracaine (ester) Epinephrine Cocaine
73
We pull back on the plunger before injecting to avoid what adverse reaction?
Inadvertant intravascular injection | excessive dose
74
Too much anesthetic, give:
oxygen | CNS depressant may cause hypotension, then bradycardia or arrest
75
Treat mild allergic reactions with _____. | Treat severe allergic reactions with ______.
Benadryl (15 mins) | epinephrine and oxygen
76
mc with
esters
77
In true anaphylaxis reaction, how do pulse and BP change?
HR up / BP down | [vs. autonomic response - both go up]
78
Uses of epinephrine: (vasoconstriction)
* decrease oozing * prolong duration by limiting absorption into tissues * decreasing risk of toxic reactions by reducing circulating anesthetic
79
Side effects of epinephrine:
``` anxiety restlessness tremor palpitations tachycardia ```
80
Epinephrine dose for anesthetic use:
1:200,000 | < 0.2 mg
81
Epinephrine dose for anaphylaxis:
1:1000
82
Antidote
IV push of magnesium and B6 | COMT
83
Contraindications of epinephrine use:
End-arteries (fingers, nose, toes, penis, clitoris, ears) MAOIs, TCAs, thyrotoxicosis, severe CAD caution with PVD, HTN
84
3 parts of the sterile field:
* physician - gloves, washing, mask * patient - sterile drape, incision area * tray - tools, materials
85
Contraindications to ND PCP doing minor surgery
* location - lesion on nose, eye, axilla, groin, post neck * large size / blood supply * depth - lipomas can be intertwined in mm/bone * young children * pt on anti-coags / with bleeding disorder * pt on a corticosteroid * pulsating lesion * keloid forming pt * systemic illness with depleted immune system
86
Tissue destruction methods: | Never use if:
cryotherapy electrosurgery ** if you want to biopsy! **
87
Cryotherapy - freezing with _______, which leads to anoxia and death.
"cryogen" * HistoFreeze - aerosol * Dry ice * Nitrous oxide * liquid nitrogen - MC
88
If you are going to freeze warts, start by:
using #10 scalpel blade to shave it down to black dots or pin-prick bleeding, THEN cryo
89
Cryotherapy is indicated for:
* warts * skin tags (acrochordon) * seb keratosis * actinic keratosis
90
Dry ice isn't used much anymore, because:
it's simple, cheap, but not very effective
91
Transport liquid nitrogen in a: | Never use straight from bottle, risk of:
Dewar bottle | HPV transmission
92
Liquid nitrogen - freeze, thaw, refreeze, with ___mm zone around lesion. May cause __________
2-3 mm | depigmentation
93
Types of electrosurgery:
* Electrocautery - indirect, precise | * Hyfrecation - direct
94
Describe proper excisional biopsy technique:
3:1 elliptical excision with 30 deg corners #15 scalpel parallel to Langer's Lines
95
Punch biopsy technique:
traction perpendicular to Langer's Lines 1-2mm beyond edge of lesion full thickness of dermis
96
When do you use #10, 11, and 15 scalpels?
11 - puncture abscess, incision, stabbing 15 - blunt dissection, excision, trimming 10 - like 15, thick skin
97
When do you use non/toothed forceps?
Toothed adson - does not crush skin | Toothless - crushes skin, foreign body removal
98
When do you use iris vs metzenbaum scissors?
Iris - fine dissection, not for sutures | Metzenbaum - blunt dissection
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