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Questions and Answers

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?

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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?

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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?

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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?

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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?

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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?

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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...

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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What is the recommended treatment for vasovagal syncope?

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What is the primary reason for performing a digital nerve block?

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Flashcards

Phases of wound healing

The process of wound repair, divided into distinct stages characterized by specific cellular and tissue changes.

Local anesthetic for minor surgery

A substance used to temporarily numb a specific area, allowing for pain-free procedures. The amount that can be safely administered depends on the patient's weight.

Sutures in minor surgery

Materials used to close wounds, categorized by their absorption rate and size, chosen based on the location and type of wound.

Dressings and drains in minor surgery

Materials used to protect and support wounds, applied after surgery to promote healing.

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Allergic reaction to anesthesia

A severe adverse reaction to anesthesia, characterized by symptoms such as hives, swelling, and difficulty breathing.

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Cardiovascular reaction to anesthesia

An adverse reaction to anesthesia, impacting the heart and blood vessels, potentially causing changes in heart rate and blood pressure.

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Central nervous system reaction to anesthesia

A serious reaction to anesthesia, affecting the nervous system and leading to symptoms like drowsiness, confusion, and seizures.

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Lidocaine

A type of local anesthetic that is commonly used for minor surgeries and procedures. It is often combined with epinephrine to prolong its duration of action.

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Dosage (mg/kg)

The amount of medication that can be safely given based on a patient's weight. This is expressed in milligrams of medication per kilogram of body weight.

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Epinephrine

A powerful vasoconstrictor that helps to reduce bleeding and prolong the effect of local anesthetics by slowing down their absorption into the body.

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Local Anesthetic

A chemical that causes temporary numbness or loss of sensation in a specific area of the body.

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Local anesthetic dosage calculation

A calculation to determine the appropriate amount of local anesthetic solution needed for a procedure based on patient weight and desired concentration. The formula uses the desired dose (mg/kg), the desired concentration (% or mg/mL), and the patient's weight (kg).

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Bupivacaine (Marcaine)

A type of local anesthetic that is used for longer duration surgeries, such as dental procedures or spinal anesthesia.

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Ester

A group of local anesthetics that are chemically different from amides and are more likely to cause allergic reactions in patients.

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Tetracaine

A topical anesthetic often used in ophthalmology.

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Benzocaine

A popular topical anesthetic that comes in a spray, cream, or gel form and can be used on the skin and mucous membranes.

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Nerve Block

Injecting anesthetic solution near a nerve to block pain signals.

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Distal to MCP/MTP

Injection site for finger/toe nerve blocks, located near MCP/MTP joints.

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Vasovagal Syncope

Loss of consciousness caused by a decrease in blood flow to the brain, often triggered by stress or pain.

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Allergic Reaction to Anesthetics

A type of allergic reaction to anesthetics, causing skin redness, swelling, and breathing difficulties.

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Epinephrine in Anesthetics

A chemical added to local anesthetics, constricting blood vessels to prolong anesthetic effect.

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Cryosurgery

A surgical technique using extreme cold to destroy tissue, often employed for skin lesions.

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Cryoprobe

A specialized probe used in cryosurgery to deliver cold temperatures to target tissue.

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Frozen Margin

The area surrounding a lesion that is frozen during cryosurgery, typically extending 1-2 mm beyond the visible border.

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Depth of Freeze

The depth of freezing required during cryosurgery, similar to the width of the frozen area.

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Tissue Thawing

The process of allowing tissue to thaw after being frozen during cryosurgery before applying another freeze.

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Cryospray

A technique used to freeze and destroy abnormal tissue by spraying liquid nitrogen.

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Grounding Pad

A metal grounding pad used to direct electrical current away from the body during electrocautery.

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Electrocautery

A technique that uses heat to destroy abnormal tissue.

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Cutting Electrode

A cutting electrode used in electrocautery to make incisions.

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Curette

A tool used in electrocautery to scrape away tissue.

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Accidental Cryosurgery

A potential complication of cryosurgery where healthy tissue is accidentally frozen.

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Minor Peripheral Neuropathy

A temporary numbness or tingling sensation that can occur after cryosurgery.

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Liquid Nitrogen Spill

A potential complication of cryosurgery where liquid nitrogen is spilled onto the skin.

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Tying the knot

A knot tying method used in suturing that prevents sutures from untying, involving multiple loops with the final loop depending on suture type.

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Cyanoacrylate glue for wound closure

A type of wound closure using glue, suitable for superficial wounds and facial lesions, holding the edges together for 7-14 days while the wound heals.

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Adhesive sutures (steri-strips)

A type of wound closure using adhesive strips, suitable for superficial, linear wounds with minimal tension, holding the edges together until healing.

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When is Cyanoacrylate glue NOT appropriate?

A contraindication for cyanoacrylate glue wound closure, indicating that it's not appropriate to use this method in these situations.

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Avoiding glue entering the wound?

A step in the cyanoacrylate glue application process where you carefully avoid allowing the glue to enter the wound, ensuring proper healing and preventing complications.

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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.
  • 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.
  • 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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Minor Surgery Study Tips PDF

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.

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