Local Anesthetics and Wound Healing Quiz
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Questions and Answers

What is the maximum dose of lidocaine with epinephrine that can be administered to an adult?

  • 300 mg
  • 500 mg (correct)
  • 400 mg
  • 200 mg
  • Which local anesthetic has the longest duration of action when used alone?

  • Lidocaine
  • Bupivacaine (correct)
  • Procaine
  • Mepivacaine
  • A physician needs to perform a minor surgery with an expected duration of 3 hours. Which local anesthetic with epinephrine would be the MOST appropriate choice?

  • Bupivacaine
  • Lidocaine (correct)
  • Mepivacaine
  • Procaine
  • Which of the following best describes the onset of action of Bupivacaine?

    <p>5 minutes</p> Signup and view all the answers

    Why are ester injectables used less frequently than amide injectables?

    <p>Higher risk of allergic reactions</p> Signup and view all the answers

    What is the primary purpose of wet-to-dry dressings?

    <p>To clean and debride wounds with necrotic debris.</p> Signup and view all the answers

    Which phase of wound healing involves the migration of myofibroblasts into the wound?

    <p>Proliferation phase</p> Signup and view all the answers

    Which of the following local anesthetics is commonly used in a topical form for skin and mucous membranes?

    <p>Benzocaine</p> Signup and view all the answers

    During which phase of wound healing do macrophages remove necrotic tissue?

    <p>Inflammation</p> Signup and view all the answers

    What concentration of lidocaine is typically used for children?

    <p>0.25-0.50%</p> Signup and view all the answers

    How long before removal should dressings for open wounds be timed?

    <p>48 hours</p> Signup and view all the answers

    Which of the following situations would warrant the use of Procaine or Tetracaine?

    <p>Ophthalmological Procedures</p> Signup and view all the answers

    Why should caution be exercised when operating on lower extremities of patients with Diabetes Mellitus?

    <p>Higher risk of post-operative wound infections and poor wound healing.</p> Signup and view all the answers

    In the context of potential interference with wound closure, what condition does jaundice indicate?

    <p>Liver dysfunction</p> Signup and view all the answers

    What is the primary concern when operating in areas with superficial vasculature and nerves?

    <p>High propensity for injury</p> Signup and view all the answers

    Why is it recommended to delay surgery for 7-10 days when a patient is taking aspirin?

    <p>To clear the effects on platelet aggregation.</p> Signup and view all the answers

    What is the primary function of chemical mediators released from injured tissue during the coagulation phase?

    <p>To induce vasoconstriction, fibrin formation, and platelet aggregation for hemostasis.</p> Signup and view all the answers

    What is a contraindication for performing cryosurgery?

    <p>High levels of cryoglobulins.</p> Signup and view all the answers

    During what phase of wound healing does the scar tissue attain up to 90% strength of the original tissue?

    <p>Wound remodeling phase</p> Signup and view all the answers

    What is the primary risk of operating on areas with impaired blood circulation?

    <p>Necrosis of tissues</p> Signup and view all the answers

    Which deficiency has the greatest effect on interfering with wound closure?

    <p>Protein</p> Signup and view all the answers

    Why should flammable agents like alcohol be avoided when using electrocautery or hyfrecation?

    <p>They pose a fire hazard.</p> Signup and view all the answers

    What could be a consequence of excessive suture tension in a surgical wound?

    <p>Ischemia of the skin edges.</p> Signup and view all the answers

    When is toe-nail removal contraindicated?

    <p>Presence of paronychia.</p> Signup and view all the answers

    During a digital nerve block procedure, after redirecting the needle towards the palmar nerve, where should the injection be administered?

    <p>Distal to the MCP/MTP joint</p> Signup and view all the answers

    Which systemic adverse effect is NOT associated with anesthetic overdose or intravenous administration?

    <p>Hypertension</p> Signup and view all the answers

    Why is epinephrine added to local anesthetics?

    <p>To induce vasoconstriction, decrease anesthetic's toxic effects, and increase the duration of anesthesia.</p> Signup and view all the answers

    Which of the following is a contraindication for using epinephrine in conjunction with a local anesthetic?

    <p>Areas with poor circulation, such as fingers and toes</p> Signup and view all the answers

    What concentration of epinephrine should be added to 10 mL of anesthetic?

    <p>0.1 mg of 1:1000 epinephrine</p> Signup and view all the answers

    What is TRUE regarding cryosurgery using liquid nitrogen?

    <p>The frozen margin should extend 1-2 mm beyond the lesion’s visible border.</p> Signup and view all the answers

    During cryosurgery, when using a cotton tip applicator to apply liquid nitrogen, what is the next step after applying the liquid nitrogen onto the lesion?

    <p>Allow the tissue to thaw before repeating applications.</p> Signup and view all the answers

    For which type of lesion are cryoprobes frequently used in cryosurgery?

    <p>Small facial lesions</p> Signup and view all the answers

    What is the primary characteristic of an open drain?

    <p>It is not sealed, allowing potential access for bacteria.</p> Signup and view all the answers

    Generally, when should dressings be removed post-operatively?

    <p>After 48 hours, unless otherwise indicated.</p> Signup and view all the answers

    Which suture size represents the thickest diameter?

    <p>O</p> Signup and view all the answers

    For a patient with delayed healing due to corticosteroid usage, when should sutures typically be removed?

    <p>Between 14-21 days to allow for adequate wound closure.</p> Signup and view all the answers

    What suture size is typically used for superficial non-absorbable sutures on the face?

    <p>6-O</p> Signup and view all the answers

    Post-operatively, a patient exhibits angioedema, urticaria, and hypotension. What immediate treatment should be initiated?

    <p>Place the patient in shock position and administer steroids, antihistamines, fluids, and oxygen.</p> Signup and view all the answers

    What is the primary treatment for 'dog ears' that develop post-operatively?

    <p>Removing the sutures, excising the dog ears, and re-suturing the wound.</p> Signup and view all the answers

    When should sutures be removed from the ear or eyelid?

    <p>14 days</p> Signup and view all the answers

    Which degree of hemorrhoids is appropriately treated with band & ligation?

    <p>1st degree: bleeding on defecation, no prolapse</p> Signup and view all the answers

    A patient presents with a purulent infection at the distal pad of their finger. Which of the following is the most appropriate procedure?

    <p>Incision &amp; drainage</p> Signup and view all the answers

    What is the recommended procedure for a keratoacanthoma?

    <p>Excision biopsy</p> Signup and view all the answers

    What is the etiology of Lichen Planus?

    <p>Autoimmune-related</p> Signup and view all the answers

    Which of the following best describes a lipoma?

    <p>A benign growth of adipose tissue</p> Signup and view all the answers

    A patient has milia on their face. Which of the following is the most appropriate treatment option?

    <p>Fine-needle extraction</p> Signup and view all the answers

    Which of the following is the most appropriate treatment for molluscum contagiosum?

    <p>Cryosurgery</p> Signup and view all the answers

    What is the recommended procedure for a Nevi?

    <p>Excision biopsy if it does not meet an abnormal ABCDE criterion</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Pre-Operative Precautions

    • General considerations

      • Patients taking corticosteroids (immunosuppressants) are at higher risk of post-operative infection
      • Patients taking anticoagulants or antiplatelets (blood thinners) may be at higher risk of hemorrhaging. Aspirin should be discontinued 7-10 days before surgery to reduce effects on platelet aggregation
      • Patients with bleeding disorders or coagulopathies
      • Patients with high levels of cryoglobulins, cold urticaria, or Raynaud's disease should not undergo surgery on areas with impaired circulation
    • Cryosurgery

      • Avoid areas at risk for hair loss
      • Patients with significant risk factors like high levels of cryoglobulins, cold urticaria, or Raynaud's disease should not undergo surgery on those areas
    • Electrocautery & Hyfrecation -Avoid flammable agents for disinfection -Caution when working with patients with metal implants, IUDs, metal dentures, or prosthetics, and patients should remove all jewelry

    • Suturing

      • Avoid suture tension during wound closure, as it may cause skin edge ischemia. -Insert the suturing needle perpendicular (90°) to the skin plane to evert skin edges
      • Do not suture wounds with contamination (ex. puncture or bite wounds, wounds with discharge)

    Wound Care

    • Before wound closure
      • Hemostasis is essential prior to any cleaning or wound closure attempt
    • During wound closure
      • Primary closure: used for wounds with minimal contamination, involves approximating and closing the skin edges (suturing)
      • Secondary closure: used for wounds with higher risk of contamination or infection, the wound is left open, allowing healing by epithelialization and wound contraction
      • Delayed primary closure: heavily contaminated wounds that no longer have residual contamination may be closed directly through primary closure methods.
    • After wound closure
      • Dressings -Sutured wounds require dressings to absorb drainage and provide moisture support for epithelialization -Open wounds require dressings to maintain moisture for healing process
    • Interference with wound closure -Factors influencing wound healing such as malnutrition, diabetes, jaundice, uremia, medications or chemotherapy

    Equipment

    • Biopsy punch
      • Instrument used for taking tissue samples from a lesion to study it
      • Diameter selected to allow sampling of area surrounding lesion
    • Cryogens -Liquid nitrogen (most common, rapid and deep destruction) -Carbon dioxide (dry ice, poor tissue destruction)
    • Curette
      • Scraping tool used for superficial and partial-thickness tissue lesions
    • Electrocautery -Electrical current tool used to destroy tissues and coagulate blood vessels
    • Chemical cautery
      • Chemical agents that destroy tissues (ex. phenol, silver nitrate, salicylic acid, etc)

    Operative Procedures

    • Anesthesia
    • Selection and use of different anesthetic types
    • Monitoring adverse effects such as allergic reaction, cardiovascular reactions, central nervous system reactions, vasovagal reactions
    • Other operative procedures
    • Detailed steps for specific procedures such as those involving different lesions

    Post-Operative Procedures

    • Dressings -Purpose: - Absorption of exudates to prevent fluid loss -Aiding in debridement of necrotic tissues -Providing hemostasis (stopping bleeding) -Pain relief -Wound protection and support
    • Removal -Usually removed after 48 hours or as clinically warranted.

    Post-Operative Complications

    • Detailed descriptions of various complications from surgical procedures, categorized by symptoms.

    Operative Procedures by Lesion

    • Descriptions of procedures to treat different kinds of lesions. Each lesion type has a distinct description and suggested treatment method.

    Injecting an Anesthetic

    • Local techniques (direct infiltration, field block) detailed explanations of methods
    • Regional techniques (nerve blocks)

    Adverse Effects to Monitor

    • Potential adverse effects patients may experience from surgical procedure

    Adding Epinephrine

    • Rationale for use, indications, and/or contraindications

    Step-by-Step Instructions for Various Procedures

    • Explicit guidance for each of the types of procedures mentioned in the text (excision, removal, cryo, electrosurgery, etc).

    Excision and Removal

    • Step by step procedure to remove a lesion.
    • Specifics of how to prepare, such as using a clean field or disinfectant

    Incision and Drainage

    • Step-by-step instruction to perform this procedure, using sterile procedures and appropriate tools

    Suturing

    • Description of various suturing techniques (interrupted, buried, horizontal mattress, vertical mattress, running/continuous)
    • Advantages and disadvantages of each technique
    • Specifics for each suture type (synthetic, natural)
    • Conditions where sutures (or adhesives) are contraindicated.

    Alternatives to Suturing

    • Description of use of adhesives (ex. cyanoacrylate glue) as alternatives to sutures
    • Types and functions of adhesives in surgical repair
    • Advantages and disadvantages of using adhesives over sutures.

    Additional information (Page 19)

    • Information on post-operative complications, various lesions (by type), and further detailed information on operative procedures

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    Minor Surgery Study Tips PDF

    Description

    Test your knowledge on local anesthetics and their applications in minor surgical procedures, including their effects during different phases of wound healing. Explore questions on common anesthetics like lidocaine and bupivacaine, and understand the implications for specific patient populations. This quiz is ideal for medical students and healthcare professionals.

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