Clinical Skills Final

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101 Terms

1
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why is it important to drain an auricular hematoma?
may scar up and result in cauliflower ear if untreated
2
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which nerve supplies sensation to the upper portion of the ear? lower portion?
upper: auriculotemporal nerve
lower: great auricular nerve
3
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what procedures should you do after evacuating/draining the auricular hematoma?
place bolsters with through-and-through sutures then abx ointment

- bolster dressing needs to be on for 4-8 days
- 1 week of suture if they aren't participating in the tournament
4
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what factors can make removal of an ear foreign body more difficult?
- location in medial half of canal
- ungraspable or large object
- uncooperative patient
- no space to insert instruments
- blood or edema in the ear
5
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what do you need to approximate when repairing an ear laceration?
skin only
- trim away cartilage if needed and sew the skin loosely for swelling and draining
6
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bleeding from where always bleeds anteriorly and can be resolved with pressure or spontaneously
kiesselbach's plexus

- anterior septum is most common site of epistaxis
7
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in epistaxis, which affected artery can result in patient bleeding anteriorly and/or posteriorly and is not resolved with just pressure?
anterior ethmoid artery
- treated w/ packing and time
8
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bleeding from sphenopalatine artery always bleeds __ first, and it bleeds profusely and always requires tx
posteriorly
9
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what would be your next treatment option of anterior nasal bleeding after pressure, humidity, and nasal saline?
cauterization with silver nitrate stick
10
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can you use nasal clamp during epistaxis?
NO! it can cause pressure necrosis on the external nose
11
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why is it necessary to place patients on prophylactic abx when using nasal packing?
to prevent TSS and sinusitis
12
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Unilateral nasal drainage and a foul smell indicates what
FB
13
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what is the MC complication of septal hematoma if it becomes infected?
perforation

- nose cartilage has no blood supply, which can lead to a perforation
14
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patient presents with severe unilateral sore throat, on exam LNs are inflamed and uvula is pointed away from the side of the swollen tonsil. what do you suspect?
peritonsillar abscess
15
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how do you tx peritonsillar abscess?
I&D and place on 5-10 days of PO ATBs (GAS coverage)
16
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(T/F) when draining PTA, you can only numb the surface by applying topical xylocaine, you can't numb the whole pocket of fluid
true
17
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laceration repair for hard palate and gums
dont do anything, leave alone
18
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laceration repair for soft palate
needs general anesthetic
19
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is high riding prostate on DRE a contraindication for urinary cath?
yes
20
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what diagnostic test should you do prior to Cath placement?
retrograde urethrogram (RUG) to see potential urethral injury
21
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complications of urinary cath
- urethral strictures/dilatation
- structural trauma
- bladder stones formation on the cath balloon
- hematuria
- knotted catheter
- UTI
22
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what type of catheter is for difficult cath placement and can avoid false passage?
caude catheter
23
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what type of catheter is for bladder irrigation?
three way catheter
24
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what's the average foley size for adults?
16 Fr.
25
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examples of male anatomy that won't allow you to pass catheter
- spasm of external urethral sphincter
- angulated prostatic urethra
- urethral strictures
- false passage
26
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what kind of stricture is seen in bulbous urethra? in penile urethra?
BU: large caliber stricture (16+ Fr.)
PU: pinpoint stricture (6-8 Fr.)
27
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contraindication with suprapubic catheterization
bladder is not palpable or seen distended on ultrasound
28
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cautions with suprapubic catheterization (3)
- anticoagulation
- prior pelvic/abd surgery (adhesions)
- pelvic CA w/ radiation (adhesions)
29
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what is ophthalmic burr used for?
to remove rust ring
30
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relationship bw frequency and penetration of sound beam
inverse relationship
31
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relationship bw frequency and detail resolution
direct relationship
32
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what structure is hyperechoic/echogenic? anechoic/sonolucent?
hyper: bones

anec: fluid
33
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why can't you do shave biopsy for melanoma?
bc it's graded by depth - get punch biopsy instead
34
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indications for shave biopsy
•Seborrheic keratoses
•Verrucous lesions (Warts)
•Molluscum contagiosum
•Superficial Basal cell carcinomas
•Benign nevi (Cosmetic)
35
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contraindications for shave biopsy
•Most pigmented lesions
•Diagnosis of infiltrative dermatoses
•Suspected sclerosing basal cell carcinoma
•Any lesion with a dermal component
36
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what can you use for bleeding after shave biopsy?
- aluminum chloride 20%
- hand-held cautery (curettage)
- ferric subsulfate
- silver nitrate
37
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what antibiotic ointment should you avoid after you did a shave biopsy?
neomycin - can cause contact dermatitis
38
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what shave technique is used for wide pigmented lesions or sites w/ risk of hypertrophic or keloidal scarring?
saucerization
39
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what technique is used to remove acrochordans (skin tags) and pedunculate nevi?
snip excision
40
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what's the f/u care for patients with a diagnosed malignancy?
complete skin exam bi-annually for consecutive 3 yrs
41
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indications for punch biopsy
- pruritic dermatoses
- vesicular lesions (intact vesicle or bulla)
42
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(T/F) when doing punch biopsy suspecting malignancy, obtain from darkest or thickest area of the lesions
true
43
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if the punch site is larger than 1 cm, what should you scrub the area with? how long?
scrub the area for 3 minutes with chlorhexidine or poxidone-iodine
44
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how far should the punch biopsy extend into?
subq fat
45
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return appointment of punch biopsy and excision to face & ears

neck

scalp

trunk & extremities

distal lower extremities
•Face & Ears: 5 to 7 days
•Neck: 7 days
•Scalp: 7 to 10 days
•Trunk and Extremities: 7 to 14 days
•Distal lower extremities: 10 to 21 days
46
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restrictions with punch biopsy and excision
Heavy lifting or exercising, and water submersion (pool/hot tub)
47
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indications for excision
•Suspected melanomas
•Epidermal cysts
•Lipomas
•Larger basal cell and squamous cell carcinomas
•Dermal lesions larger than 1 cm
48
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how long do you need scrub the site for excision?
5 min
49
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(T/F) Punch biopsy does not need to bandaged
true
50
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Laryngeal papillomatosis in healthcare providers are results from treating what?
HPV and HIV - viral particles can be aerosolized
51
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Treat protruding lesions
Electrofulguration
52
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Hair removal
Electrolysis
53
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Remove flat lesions and lesions under the superficial skin
Electrodesiccation
- only for smaller lesions 1-2 mm, if larger than 3-4 mm = cryosurgery
54
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can you use chlorhexidine to clean the area in electrosurgery?
no! clean the area with povidone-iodine and water only
55
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contraindications for cryosurgery
•Lesions requiring pathology
•Body area with compromised circulation
•Dark skin
•Cold intolerance
•Overlying nerves
56
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what suture has greater knot security and greater infection risk?
multifilament (silk, vicryl)
57
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what suture has poor knot security and lower infection risk?
monofilament (nylon, PDS, praline, monocryl)
58
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the larger the suture size, the smaller...
the diameter is
59
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suture size is not based on thickness, it's based on _____ so different materials are different sizes
breaking strength
60
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review the blade type on slide 12
61
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what suture to use for pts prone to keloid formation?
subcuticular or deep dermal suture
62
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relative contraindication of deep dermal suture
inadequate or thin dermal layer
63
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absorption time for these materials:
vicryl
monocryl
PDS
Vicryl = 60d
Monocryl = ~100d
PDS = ~200d
64
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what two blade types are use for eye (both primary application and reconstructive)?
prime reverse cutting
centerpoint spatula

spatula for cornea, sclera
65
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what can be identified in the CSF of MS patients
Oligoclonal Immunoglobulin Bands
66
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The 3 W's of normal pressure hydrocephalus
Wobbly (gait disturbance), Wet (urinary incontinence), Wacky (dementia)
67
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A xanthochromic CSF specimen is indicative of
SAH
68
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High protein
low glucose
>1000 WBC (diagnostic)
LP bacterial meningitis

(opposite in viral)
69
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absolute contraindications of LP
- local infections
- bleeding tendencies
- increase ICP d/t mass or spinal cord compression
70
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(T/F) latex or betadine allergies is a relative contraindication of LP
true
71
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treatment for post-LP HA
bed rest
fluids
OTC analgesics
Oral or IV caffeine
72
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what is a procedure in which a small vol of blood is injected into a patient's epidural space to stop a leak of CSF leak HA?
epidural blood patch
73
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what position is the best for LP in infants? morbid obese? average adults?
infants - sitting
morbidly obese - upright
avg adults - Lateral decubitus position
74
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LP site
L4-5
75
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CSF collection:
first tube -
second tube -
third tube -
fourth tube -
1: cell count
2: glucose and protein
3: gram stain and culture and sensitivity (C&S)
4: cell count & diff
76
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Max dose and max daily dose of acetaminophen in adults
Max dose - 1000mg every 4 hours
Max daily - 4000mg
77
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Max dose and max daily dose of acetaminophen in peds
Max dose - 15mg/kg every 4 hours (max 1000mg)
Max daily - 75mg/kg/d
78
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how many mg/tsp in peds for APAP
160mg/tsp
79
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Max dose and max daily dose of ibuprofen in adults
Max dose - 800mg every 6 hours (sometimes 600mg)
Max daily - 3200mg
80
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Max dose and max daily dose of ibuprofen in peds
Max dose - 10mg/kg every 6 hours (max 600mg)
Max daily - 40mg/kg/d
81
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how many mg/tsp in peds for ibuprofen
100mg/tsp
82
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How many mL in a teaspoon?
5 mL
83
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1st line tx of MRSA after I&D of abscess
Bactrim and doxy
84
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1st line tx of MRSA for parental inpatient after I&D of abscess
vancomycin
85
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abx for known MSSA after I&D of abscess
keflex
- problem is QID dosing :(
86
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contraindications of subungal trephination
- Crushed or fractured nails
- Fracture of the tuft (distal phalanx)
- Suspected melanoma
- Artificial acrylic nails
87
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what gauge needle is used for a subungal trephination
18g
88
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if there's no significant relief of pain when the drainage of subungal trephination begins, what should you suspect?
underlying injury/fx

- if fx while draining, apply aluminum splint and f/u
89
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what type and size of suture is used for repair of nail bed injuries?
6-0 absorbable suture (vicryl)
90
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Onychocryptosis-
Onychogryphosis-
ingrown nail
curved nail
91
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what type of chemical can be used to ablate an ingrown nail? who is it contraindicated in?
- phenol solution (reduce risk of recurrent problems)
- contraindicated in pregnancy
92
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during the ablation of ingrown nail, what is used to reduce bleeding?
silver nitrate
93
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risk factors of Paronychia
- poor manicure technique
- Nail biting
- Thumbsucking
- DM
- Occupational- hands soaking in water
- Antiretroviral therapy in HIV Tx
94
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Paronychia Treatment for oral exposure (Eikenella)
DOC: Augmentin

or

doxy/bactrim PLUS metronidazole (flagyl)/clindamycin
95
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Paronychia Treatment for non-oral exposure
bactrim for MRSA
keflex (cephalexin) for MSSA
96
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which fingers are MC affected in felon?
thumb and index
97
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Flexor Tenosynovitis is a true hand emergency, how is it typically caused? MC organism?
- penetrating injury
- staph
98
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four cardinal signs of flexor tenosynovitis on PE (Kanaval signs)
1. Fusiform swelling of the entire digit (sausage digit)
2. Partially flexed posture of the finger
3. Tenderness limited to the course of the flexor tendon/sheath
4. Disproportionate pain with passive extension of the finger
99
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flexor tenosynovitis tx
- Immediate hand consult
- Emperic IV ABX with Vanc PLUS 3rd gen cephalosporin OR debridement and sheath irrigation
100
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where can flexor tenosynovitis extend the infections?
palmar hand
- thenar space
- midpalmar space
- hypothenar space