CLINICAL SKILLS WRITTEN EXAM
QUESTIONS AND ANSWERS
Contraindications for Removal of Cerumen and Foreign Body from Ear - Answer-
Tympanic Membrane (TM) Rupture, Inability to Visualize the TM with a suspected
rupture, Uncooperative patient, The presence of a disk battery, FB close to the TM
Contraindication for Removing Foreign Body from Eye - Answer-•Ruptured globe,
globe laceration, or intraocular foreign body.
•Eyelid laceration
•Caustic Splash Exposure
Indications for Urinary Bladder Catheterization - Answer-Sterile urine sample
Urinary Retention/Obstruction
Patients requiring prolonged immobilization/decubitus ulcer
Monitoring output in critically ill patients
Patients with neurogenic bladders
Contraindications for a Urinary Bladder Catheterization - Answer-Blood in the
urethral meatus, allergies to materials used
Indications for a Shave Biopsy - Answer-* Epidermal and Dermal lesions:
* Seborrheic Keratosis
* Verrucous lesions
* Molluscum contagiosum
* Aktinic Keratoses
* Nonmelanoma cutaneous carcinomas (BCC and SCC)
* RASH that is wide spread: shave or punch, multiple lesions
* Rash that is localized: shave/punch, edge, and center
Indications for a Punch Biopsy - Answer-Epidermal or Dermal:
* Dermatofibroma (dermal) punch or excision
* Subcutaneous: lipoma (large punc or excision)
* RASH that is wide spread: shave or punch, multiple lesions
* Rash that is localized: shave/punch, edge and center
* AVOID biopsying blisters or pus
* PIGMENTED LESIONS with suspicion for melanoma: Punch only
if entire lesion is contained in the punch or do multiple punches (Get
the areas that are pigmented) and notify pathologist or do a full excisional biopsy
Contraindications for a Punch Biopsy in Primary Care - Answer-* Avoid the Face for
disfigurement unless you are working in dermatology or facial plastics
* Ears
* Nose
* Lips/vermillion border
* Eye lid
* Eyebrow
* Any area of the body that requires functionality eg: external nose.
, * Remember that when you biopsy skin, you will trade the lesion for a
permanent scar or incision line.
Indications for Cryotherapy - Answer-* Actinic Keratoses
* SK's
* Skin Tags
* Solar Lentigo
* Warts
Contraindications for Cryotherapy - Answer-Never use cryotherapy for any lesion
suspicious for malignancy. It does not treat deep enough to be used for skin cancer.
Indications for Splinting - Answer-•To treat various types of fractures, dislocations,
and soft tissue injuries.
•Acute musculoskeletal injuries requiring immobilization should be splinted not
casted.
•Splint initially because of potential swelling and Compartment syndrome
Contraindications of Splinting - Answer-Allergy
Indications for Casting - Answer-•Cast, if needed, 7-10 days after initial injury
Contraindications for Casting - Answer-•Casting:
•Acute injury phase (too much swelling)
•Skin or soft tissue infection
•Open wound
•Windowing the cast is an option for accessing an open wound
but should be referred to ortho.
Indications for Subungual Hematoma Drainage - Answer-Pain Relief
Contraindications for Subungual Hematoma Drainage - Answer-Damaged nail, Distal
phalanx fracture, Acrylic nails, Melanoma
Indications for Wound Closure - Answer-Decrease wound healing time
Reduce infection
Decrease scar tissue
Repair the loss of structure/function of tissue
Improve cosmetic appearance
Contraindications for Wound Closure - Answer-Contaminated wounds
Wounds opened for > 8 hours , >24 hours on the face, neck or
scalp
The presence of foreign bodies: GET AN XRAY!!!
Extensive wounds involving the tendons, nerves or arteries
Contraindications for Local Anesthesia - Answer-***Do not use epinephrine on nose,
fingers, toes, or
penis.
True allergy (less than 1 % of entire population)
QUESTIONS AND ANSWERS
Contraindications for Removal of Cerumen and Foreign Body from Ear - Answer-
Tympanic Membrane (TM) Rupture, Inability to Visualize the TM with a suspected
rupture, Uncooperative patient, The presence of a disk battery, FB close to the TM
Contraindication for Removing Foreign Body from Eye - Answer-•Ruptured globe,
globe laceration, or intraocular foreign body.
•Eyelid laceration
•Caustic Splash Exposure
Indications for Urinary Bladder Catheterization - Answer-Sterile urine sample
Urinary Retention/Obstruction
Patients requiring prolonged immobilization/decubitus ulcer
Monitoring output in critically ill patients
Patients with neurogenic bladders
Contraindications for a Urinary Bladder Catheterization - Answer-Blood in the
urethral meatus, allergies to materials used
Indications for a Shave Biopsy - Answer-* Epidermal and Dermal lesions:
* Seborrheic Keratosis
* Verrucous lesions
* Molluscum contagiosum
* Aktinic Keratoses
* Nonmelanoma cutaneous carcinomas (BCC and SCC)
* RASH that is wide spread: shave or punch, multiple lesions
* Rash that is localized: shave/punch, edge, and center
Indications for a Punch Biopsy - Answer-Epidermal or Dermal:
* Dermatofibroma (dermal) punch or excision
* Subcutaneous: lipoma (large punc or excision)
* RASH that is wide spread: shave or punch, multiple lesions
* Rash that is localized: shave/punch, edge and center
* AVOID biopsying blisters or pus
* PIGMENTED LESIONS with suspicion for melanoma: Punch only
if entire lesion is contained in the punch or do multiple punches (Get
the areas that are pigmented) and notify pathologist or do a full excisional biopsy
Contraindications for a Punch Biopsy in Primary Care - Answer-* Avoid the Face for
disfigurement unless you are working in dermatology or facial plastics
* Ears
* Nose
* Lips/vermillion border
* Eye lid
* Eyebrow
* Any area of the body that requires functionality eg: external nose.
, * Remember that when you biopsy skin, you will trade the lesion for a
permanent scar or incision line.
Indications for Cryotherapy - Answer-* Actinic Keratoses
* SK's
* Skin Tags
* Solar Lentigo
* Warts
Contraindications for Cryotherapy - Answer-Never use cryotherapy for any lesion
suspicious for malignancy. It does not treat deep enough to be used for skin cancer.
Indications for Splinting - Answer-•To treat various types of fractures, dislocations,
and soft tissue injuries.
•Acute musculoskeletal injuries requiring immobilization should be splinted not
casted.
•Splint initially because of potential swelling and Compartment syndrome
Contraindications of Splinting - Answer-Allergy
Indications for Casting - Answer-•Cast, if needed, 7-10 days after initial injury
Contraindications for Casting - Answer-•Casting:
•Acute injury phase (too much swelling)
•Skin or soft tissue infection
•Open wound
•Windowing the cast is an option for accessing an open wound
but should be referred to ortho.
Indications for Subungual Hematoma Drainage - Answer-Pain Relief
Contraindications for Subungual Hematoma Drainage - Answer-Damaged nail, Distal
phalanx fracture, Acrylic nails, Melanoma
Indications for Wound Closure - Answer-Decrease wound healing time
Reduce infection
Decrease scar tissue
Repair the loss of structure/function of tissue
Improve cosmetic appearance
Contraindications for Wound Closure - Answer-Contaminated wounds
Wounds opened for > 8 hours , >24 hours on the face, neck or
scalp
The presence of foreign bodies: GET AN XRAY!!!
Extensive wounds involving the tendons, nerves or arteries
Contraindications for Local Anesthesia - Answer-***Do not use epinephrine on nose,
fingers, toes, or
penis.
True allergy (less than 1 % of entire population)
