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Questions and Answers
Which of the following patient conditions would be a contraindication for minor surgery?
Which of the following patient conditions would be a contraindication for minor surgery?
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A patient experiences dizziness, pallor, and a sudden drop in blood pressure immediately after injection of a local anesthetic. What is the MOST likely cause?
A patient experiences dizziness, pallor, and a sudden drop in blood pressure immediately after injection of a local anesthetic. What is the MOST likely cause?
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What is the MOST appropriate management approach for a facial lesion exhibiting complex vasculature?
What is the MOST appropriate management approach for a facial lesion exhibiting complex vasculature?
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Why is it generally advised to avoid suturing bite wounds or puncture wounds closed?
Why is it generally advised to avoid suturing bite wounds or puncture wounds closed?
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When managing a post-operative wound with a drain, what is the general recommendation regarding the timing of drain removal?
When managing a post-operative wound with a drain, what is the general recommendation regarding the timing of drain removal?
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You are presented with a suspicious skin lesion. According to what should be done during minor surgery, what is the correct order of steps?
You are presented with a suspicious skin lesion. According to what should be done during minor surgery, what is the correct order of steps?
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What is the most important action to take, when a patient is taking blood thinners, and needs minor surgery done?
What is the most important action to take, when a patient is taking blood thinners, and needs minor surgery done?
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Which of the following local anesthetics is characterized by the longest duration of action when used alone?
Which of the following local anesthetics is characterized by the longest duration of action when used alone?
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Lidocaine with epinephrine is administered to an adult patient. If the patient weighs 70 kg, what is the maximum dose of lidocaine (in mg) that can be safely administered, according to the provided information?
Lidocaine with epinephrine is administered to an adult patient. If the patient weighs 70 kg, what is the maximum dose of lidocaine (in mg) that can be safely administered, according to the provided information?
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A 4 year-old child requires a local anesthetic. Which concentration of Lidocaine is most appropriate, according to the text?
A 4 year-old child requires a local anesthetic. Which concentration of Lidocaine is most appropriate, according to the text?
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Which of the following statements accurately describes a key difference between amide and ester local anesthetics?
Which of the following statements accurately describes a key difference between amide and ester local anesthetics?
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Which local anesthetic is commonly used in ophthalmology for procedures like foreign body removal and intraocular pressure testing?
Which local anesthetic is commonly used in ophthalmology for procedures like foreign body removal and intraocular pressure testing?
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TAC (Tetracaine + Epinephrine + Cocaine) has been largely replaced by LET, because...
TAC (Tetracaine + Epinephrine + Cocaine) has been largely replaced by LET, because...
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According to the passage, what is the primary advantage of using lidocaine with epinephrine compared to lidocaine without epinephrine?
According to the passage, what is the primary advantage of using lidocaine with epinephrine compared to lidocaine without epinephrine?
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For which type of surgical procedure is Bupivacaine (Marcaine) most commonly indicated?
For which type of surgical procedure is Bupivacaine (Marcaine) most commonly indicated?
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Compared to other local anesthetics, what is a notable characteristic of Benzocaine?
Compared to other local anesthetics, what is a notable characteristic of Benzocaine?
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What is a significant advantage of using double loops when tying knots during a surgical procedure?
What is a significant advantage of using double loops when tying knots during a surgical procedure?
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Which of the following statements about cyanoacrylate glue is true?
Which of the following statements about cyanoacrylate glue is true?
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What is an inappropriate use case for adhesive sutures like steri-strips?
What is an inappropriate use case for adhesive sutures like steri-strips?
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What must be done if cyanoacrylate glue accidentally enters a wound?
What must be done if cyanoacrylate glue accidentally enters a wound?
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What is one of the contraindications for using cyanoacrylate glue for wound closure?
What is one of the contraindications for using cyanoacrylate glue for wound closure?
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What is the primary purpose of applying a water soluble gel before using the probe on a lesion?
What is the primary purpose of applying a water soluble gel before using the probe on a lesion?
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What should be done if accidental cryosurgery of healthy tissues occurs?
What should be done if accidental cryosurgery of healthy tissues occurs?
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What is the recommended distance from which to spray liquid nitrogen during cryospray treatment?
What is the recommended distance from which to spray liquid nitrogen during cryospray treatment?
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What indication suggests the need to decrease the current during electrocautery?
What indication suggests the need to decrease the current during electrocautery?
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Which complication is associated with minor peripheral neuropathy?
Which complication is associated with minor peripheral neuropathy?
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What should be the relationship between the depth of freeze and the width of freeze in cryosurgery?
What should be the relationship between the depth of freeze and the width of freeze in cryosurgery?
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Why is it advised not to use an alcohol disinfectant during electrocautery procedures?
Why is it advised not to use an alcohol disinfectant during electrocautery procedures?
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What immediate action should be taken if liquid nitrogen spills onto the skin?
What immediate action should be taken if liquid nitrogen spills onto the skin?
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What is the maximum duration for which a cutting electrode should be applied during electrocautery?
What is the maximum duration for which a cutting electrode should be applied during electrocautery?
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Why is cryospray not recommended for small lesions?
Why is cryospray not recommended for small lesions?
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Which of the following is NOT a contraindication for using epinephrine with local anesthesia?
Which of the following is NOT a contraindication for using epinephrine with local anesthesia?
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What is the primary reason for using epinephrine in local anesthesia?
What is the primary reason for using epinephrine in local anesthesia?
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Which of the following signs and symptoms is associated with vasovagal syncope?
Which of the following signs and symptoms is associated with vasovagal syncope?
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Which of the following is NOT a potential systemic adverse effect of local anesthetic overdose?
Which of the following is NOT a potential systemic adverse effect of local anesthetic overdose?
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Which of the following is TRUE regarding the use of cryosurgery for small facial lesions?
Which of the following is TRUE regarding the use of cryosurgery for small facial lesions?
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Which of the following is a potential complication of digital nerve block?
Which of the following is a potential complication of digital nerve block?
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What is the main advantage of using local anesthetic with epinephrine?
What is the main advantage of using local anesthetic with epinephrine?
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Which of the following is a contraindication for using a digital nerve block?
Which of the following is a contraindication for using a digital nerve block?
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What is the recommended treatment for vasovagal syncope?
What is the recommended treatment for vasovagal syncope?
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What is the primary reason for performing a digital nerve block?
What is the primary reason for performing a digital nerve block?
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Study Notes
Pre-Operative Precautions
- General precautions include considering Diabetes Mellitus and Peripheral Vascular Disease when operating on lower extremities due to increased risk of wound infection and poor healing.
- Areas with superficial vasculature and nerves (e.g., face, supraclavicular areas, axillae, fingers, hands, wrists, groin, popliteal fossa, feet) require caution during surgery.
- Patients on corticosteroids (immunosuppressants) have a higher risk of post-operative infection.
- Anticoagulants or antiplatelets (blood thinners) increase the risk of hemorrhaging. Aspirin use may require delaying surgery 7-10 days to minimize platelet effects.
- Patients with bleeding disorders or coagulopathies should be carefully assessed before surgery.
- Cryosurgery is contraindicated in patients with high levels of cryoglobulins, cold urticaria, Raynaud's disease, or paroxysmal cold hemoglobinuria.
- Do not operate on areas where potential hair loss is a concern, or areas with impaired circulation as it could result in tissue necrosis.
Wound Care
- Before Wound Closure: Hemostasis (stopping bleeding) is essential before cleaning and closing a wound.
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During Wound Closure:
- Primary Closure is for low-risk, minimally contaminated wounds, involving approximating and suturing wound edges.
- Secondary Closure (Tertiary) is used for high-risk or already infected wounds involving leaving the wound open to heal naturally.
- Delayed Primary Closure is used in heavily contaminated wounds that no longer show contamination, allowing for primary closure later on.
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After Wound Closure:
- Dressings assist in wound healing by absorbing drainage and providing moisture, especially for sutured wounds.
- Dressings are typically removed after 48 hours for clean wounds.
Phases of Wound Healing
- Phase 1: Coagulation: Immediate response to injury, involving vasoconstriction, fibrin formation, and platelet aggregation to stop bleeding.
- Phase 2: Inflammation: Vasodilation, fluid and mediator accumulation, inflammation to clean the wound. Macrophages remove cellular debris and micro-organisms.
- Phase 3: Proliferation: Fibroblasts produce collagen. Myofibroblasts migrate to contract the wound.
- Phase 4: Wound Remodeling: Collagen production increases as the wound strengthens. Remodeling may continue for years.
Equipment
- Biopsy Punch: A hollow instrument used to obtain a full-thickness tissue sample of a lesion.
- Cryogens: Freezing agents (e.g., liquid nitrogen, nitrous oxide) for tissue destruction.
- Curette: A cutting ring to scrape or remove lesions.
- Electrocautery/Chemical Cautery: Tools using electrical current or chemical agents to destroy tissue or stop bleeding.
Operative Procedures
- Anesthesia: Selecting an anesthetic (e.g., topical lidocaine, EMLA) and considering potential side effects.
- Specific Procedures: Minor surgery involves numerous procedures, including surgical management of lesions such as abscesses, acrochordon, actinic keratosis, basal cell carcinoma, cysts, etc.
- Instruments: Different instruments are used depending on the procedure and the type of lesion. These may include: forceps, needle holders, scalpels, scissors, sutures, etc.
Post-Operative Procedures
- Dressings/Drains: Removing and replacing dressings/drains, considering when and how to perform these actions.
- Post-Operative Complications: Common Post-Operative complications like dog ears, fever and infection, hematomas/ seromas/hemorrhage, hypertrophic scarring/keloids, and wound dehiscence.
- Operative Procedures by Lesion: Detailed surgical procedures for various specific skin lesions.
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Description
Test your knowledge on pre-operative precautions relevant to surgical procedures. This quiz covers essential considerations such as diabetes, anticoagulant use, and specific patient conditions that affect surgery. Ensure you understand the risks involved in operating on vulnerable areas of the body.
