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Surgery rotation
part 1
67
Anatomy
Graduate
11/10/2010

Additional Anatomy Flashcards

 


 

Cards

Term
What type of ABX do you use before surgery?
Definition

Ancef-Cefazolin

 

1st generation cephalosporin

Term

What type of carcinoma is this?

 

common over 50

Non-healing ulcer/warty nodule

Cutaneous horn

Definition
Squamous cell carcinoma
Term
Tx for Squamous cell carcinoma?
Definition

Surgical resection/excision

Mohs microscopic surgery

Sentinal node biopsy

Term
What's Mohs microscopic surgery?
Definition

Used only when tumor is in critical anatomical site

 

Eyelid

Nose

Lip

 

resection margin is often reduced to 3-6 mm

Term

What type of carcinoma is this?

 

Grows slowly

Ulcerated pink shiny nodule

central scab/umbilication

Telegiectasis

Definition
Basal Cell Carcinoma
Term

Most common form of cancer in fair skinned who do not tan well

 

1.2 million cases

 

ultraviolet light exposure cause

Definition
Basal Cell Carcinoma
Term
Tx for Basal Cell Carcinoma?
Definition

Excision

Radiotherapy

Term
What does Squamous Cell Carcinoma arise from?
Definition
Actinic Keratosis
Term

Type of benign lesion?

 

Flattened papule

Covered by dry scale

TAN/ PINK/ GRAYISH

Round/Irregular

Definition

Actinic Keratosis

 

Remember this goes into SCC

Term

Type of benign lesion?

 

Yellowish-Brown raised Lesion

"Stuck On"  apperance

 

Feels:  Greasy, Velvety/Warty

 

Definition
Seborrheic Keratosis
Term

Type of benign lesion?

 

Congenital

Black/Brown growth OR Mark on skin

<6mm diameter

Usually appears in 1st decade of life

Follow: ABCDE guidelines

Definition

Nevi

 

"Freckle"

Term
What are 3 types of benign lesions?
Definition

Actinic Keratosis (can lead to SCC)

Seborrheic Keratosis

Nevi

Term
What are the ABCDE of Melanoma?
Definition

A-Asymmetry

B-Borders irregular

C-Color variation (mixture of black, blue, red)

D-Diameter >6mm

E-Elevation (may be flat)

Term

??

 

Benign tumor consisting of fat

Most common human neoplasm

Little potential for malignancy

Definition
Lipoma
Term
Where are lipomas usually found on the body?
Definition

Between skin & muscle

 

Neck

Shoulders

Back

Abdomen

Arms

Thigh

Term
How do lipomas feel?
Definition

Doughy like

move readily

 

NON-TENDER

Term

??

 

collection of liquefied tissue "pus" somewhere in the body

 

Results from body's defense reaction to foreign material

Definition
Abscess
Term
How do you dx an abscess?
Definition

Ultrasound/Flouroscopy

CT

Term
Most common pathogen for abscess?
Definition

Staphlococcus Aureus

 

remember in some areas/cities:  MRSA is presenting

Term
Presentation of an abscess??
Definition

Painful

Warm to touch

Swollen

Erythemic

Term
Common sites of Abscess?
Definition

Tooth

Armpits

Base of spine

Groin

Vagina

Anus

Term

??

 

Folliculitis

Furnuncle

Carbuncle

Definition

Folliculitis:  Inflammation of hair follicle

 

Furnuncle:  Inflammation around hair follicle w/ central plugging  "Boil"

 

Carbuncle:  Collection of furnuncles

Term
Tx of Abscess??
Definition

I & D  (incision & drainage)

 

1. Numb area w/ Lidocaine

2. Create opening w/ 11inch blade

3. Express pus w/ lite pressure

4. Sterile dressing

5. ABX if immunocompromised

Term

??

 

Small pit or sinus located in the midline superficial to coccyx or lower sacrum

Definition
Pilonidal cyst
Term

??

Cystic cavity containing keratin & hair in the subcutaneous tissue of natal cleft?

Definition
Pilonidal Cyst
Term

Presentation of Pilonidal Cyst??

 

Acute

Chronic

Definition

Acute:  Abscess, Red, Warm, Swelling, may have fluctuance

 

Chronic:  Sinus felt in natal cleft

Occasional discomfor/drainage

 

Fever, Pus, Inc WBCs

Term

Management of Pilonidal Cyst??

 

Medical

 

Surgical

Definition

Medical:  Sitz bath, ABX, Analgesics, Hydrocodone, Codeine, NSAIDS

 

Surgical:  Abscess I&D

Term
Risk factors for Pilonidal Cyst??
Definition

Dark thick hair

Obesity

Sedentary

Prolonged w/ sitting

Local hirtusism

Poor hygiene

Inc Sweating

Term
Cystic collection of synovial fluid over a joint or a tendon sheath??
Definition
Ganglion Cyst
Term
Common site for Ganglion Cyst?
Definition

Hand & Wrist

Usually dorsal-back of hand located over scapholunate ligament

Can be volar

 

More common in FEMALES

Term

??

 

Soft/firm, Mobile, Non-tender round mass

 

Inside:  Thick, sticky, clear, colorless jelly like material

Definition
Ganglion cyst
Term

Dx Ganglion Cyst??

 

Definition

Large bore needle aspiration

US

PE

MRI

Term
Management of Ganglion Cyst??
Definition

Most:  Resolve spontaneously

Non-operative

 

IF: Painful, Limits activity, Cosmetically unacceptable

Surgical excision

Term

??

Tear of skin caused by a blunt force, not a sharp instrument

Definition

Laceration

 

Usually d/t crushing force

Term
Presentation of laceration??
Definition

Pain at site of injury

Bleeding

Deformity at injury

 

Bridging intact blood vessels

Term
Tx of lacerations??
Definition

Clean area w/ soap & water

Bacitracin-antibiotic ointment

Steri strips/ band aids/ left open for secondary healing

 

Operative: Sutures

Silver sulfadizene applied to clean area

Term
What is a wound?
Definition

Trauma to skin causing a disruption in the DERMAL layers

 

Surgical OR Traumatic

Term

??

 

Phases of wound healing

Definition

1. Inflammatory

 

2. Proliferative

 

3. Maturation/Remodeling

Term
What is the 1st phase of wound healing?
Definition

Inflammatory Phase:

 

1. Vasoconstriction

2. Hemeostasus

3. Vasodilation/Epithelization

4. Migration of Fibroblasts

Term
?? 2nd phase of wound healing
Definition

Proliferation Phase:

1. Fibroblasts arrive & secrete collagen

2. Angiogenesis

3. Contraction

 

Wound is filling up with granulation tissue, margins contract, decrease wound surface area

Term
?? 3rd phase of healing
Definition

Maturation/Remodeling Phase:

1. Collagen deposits reduced

2. Collagen is becoming more organized & cross-linked

-increased strengthtile

3. Wounds contract

Term

What are the 4 classifications of wounds??

 

Definition

1. Clean

2. Clean-contaminated

3. Contaminated

4. Infected

Term
What is a clean wound?
Definition

Incision made during a surigical procedure w/ aseptic techniques.

 

No GI, Respiratory, Gu tract involved

Term
What is a Clean-Contaminated wound?
Definition

Similar to clean

Surgical procedure with aseptic technique

 

GI, Respiratory, GU INVOLVED

Term
What is Contaminated wound?
Definition

Similar to clean & clean-contaminated

 

EXCEPT Gross spillage (bile, stool)

 

Traumatic wound

Term
What is an infected wound?
Definition

Established infection before wound is made

(incision of an abscess)

OR

 heavily contaminated  wound

Term
What are the infection rates for the 4 types of wounds?
Definition

Clean:  2%

 

Clean-Contaminated:  10%

 

Contaminated: 20%

 

Infected:  50%

Term
What are the wound closure classifications?
Definition

Primary intention

 

Secondary intention

 

Third intention

Term
?? Primary intention wound closure
Definition

ALL layers closed

 

Best chance for minimal scarring

Usually for Clean & Clean contaminated wounds

 

Wound edges brought together by:

Sutures, Tape, Staples

Term
Secondary intention wound closure??
Definition

Deep layers CLOSED

Superficial layers are left OPEN to granulate from the inside to out

 

Often leaves wide scar & frequent wound care

Prolonged process

 

Reason to use:  Excessive tissue loss & INFX

Term

??

Deep layers CLOSED

Superficial layers are left OPEN to granulate from the inside to out

 

Often leaves wide scar & frequent wound care

Prolonged process

 

Reason to use:  Excessive tissue loss & INFX

Definition
Secondary Intention Wound Closure
Term

??

ALL layers closed

 

Best chance for minimal scarring

Usually for Clean & Clean contaminated wounds

 

Wound edges brought together by:

Sutures, Tape, Staples

Definition
Primary Intention Wound Closure
Term
What are the contraindications for wound closure??
Definition

WOUND is:

1. > 6 hrs

2. > 24hrs on face

3. Infected

4. Highly contaminated

5. Excessive tensile (joint)

6. Retained foreign body

Term
Third Intention/ Delayed Primary Intention wounds closure??
Definition

Deep layers closed

 

Superficial layer left OPEN until 4th/5th day inspected for

Is it clean & begun to granulate:

IRRIGATE & CLOSE

 

If it looks infected:

LEAVE OPEN & HEAL BY SECONDARY INTENTION

 

These wounds are usually from contaminted wounds

Term

??

Deep layers closed

 

Superficial layer left OPEN until 4th/5th day inspected for

Is it clean & begun to granulate:

IRRIGATE & CLOSE

 

If it looks infected:

LEAVE OPEN & HEAL BY SECONDARY INTENTION

 

These wounds are usually from contaminted wounds

Definition
Third Intention/Delayed Primary Intention
Term
?? Dehiscence
Definition

Separation of surgical incision/Rupture of closed wound

 

Premature bursting open/splitting along natural surgical suture lines

 

COMPLICATION of surgery d/t poor wound healing

Term

??

Separation of surgical incision/Rupture of closed wound

 

Premature bursting open/splitting along natural surgical suture lines

 

COMPLICATION of surgery d/t poor wound healing

Definition
Dehiscence
Term

Dehiscence:

 

Most common site

Usually occure when

Early signs

Definition

Most common site:  Abdominal/Pelvic Regions

 

Usually occure when:  7-10 days post closure

 

Early signs: Pink Serous discharge from wound

Term

INFECTIONS:

 

? most vulnerable

systemic signs

dx studies

Definition

? most vulnerable:  Immunocompromised

 

systemic signs:  Fever, Chills, Loss of appetite, N, V

 

dx studies: CT scan, FNA, Open wound

Term

Management of infections of wounds?

 

 

Definition

Mild erythema may resolve after suture/staple removal

 

If infx persists beyond 48 hrs w/ ABX tx:

Wound is OPENED & DRAINED

Suspect ABSCESS

Term
ABX for Class 1 wound??
Definition

Usually infected by Staph

 

1st generation cephalsporin

Term
ABX for Class 2,3,4  wound??
Definition

Enteric Pathogens-  Gentamycin

 

Aerobic Gram NEG.-  3rd gener. Cephalasporin

 

Anaerobic-Metronidazole

Term

??

Decubiti Ulcer

Definition

Chronic ulcer that appears in PRESSURE areas in debilitated pts that are confined to their beds/immobile

 

D/T:  Excessive prolonged pressure causing ISCHEMIA & eventually NECROSIS of skin & sub Q tissue or from FRICTION

Term
Decubitus Ulcer Presentation??
Definition

Early: RED/PURPLE

Late:  DARK BLUE/BLACK necrosis

Term
Decubitus Ulcer Complications??
Definition

Cellulitis

Fascitis

Osteomyelitis

Sepsis

Rare-Bleeding

Term
Decubitus Ulcer Stages??
Definition

STAGE:

I-reddness of skin, NO SKIN BROKEN

 

II-Blister, PARTIAL thickness skin loss

 

III-FULL thickness skin loss w/ damage to sub Q tissue

 

IV-FULL thickness w/destruction to Muscle, Bone, & supporting structures

Term
Decubitus Ulcer Management??
Definition

1. Medical: Correct underlining disorders & improve nutrition

 

2. Local wound care:  avoid pressure, water mattress, cushions, pads;  dressings

 

3. Surgery:  Drain & Debridement

Cover w/ healthy tissue-skin grafts

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