Minor Surgery Exam 1

After performing a biopsy, it is necessary to send the sample to the cytologist for further examination. The correct answer is 10% formalin. Formalin is a commonly used fixative in histology laboratories to preserve tissue samples. It helps to prevent degradation and maintain the structural integrity of the cells. By using 10% formalin, the sample can be adequately preserved and prepared for cytological analysis. Sodium tetradecyl sulfate, lidocaine, and marcaine are not appropriate choices for sending the biopsy sample to the cytologist.

The presence of a small, firm, round nodule on the dorsal aspect of the wrist without erythema, pain, epithelial disruption, or discharge suggests a benign tumor rather than an infection. Among the given options, a ganglion cyst is the most likely diagnosis. Ganglion cysts are common soft tissue swellings that often occur on the dorsal aspect of the wrist. They are typically painless and can vary in size. However, it is important to consider lipoma and sebaceous cyst as well in the differential diagnosis, as they can also present as similar nodules on the wrist.

During pregnancy, there is an increase in estrogen levels in the body. Estrogen is known to stimulate the growth of certain types of tissues, including skin tissues. In this case, the pedunculated lesions located below the right axilla are responding to the increased estrogen levels by growing more. This is the most likely rationale behind the worsening of the lesions during pregnancy.

Cryosurgery is a procedure that uses extreme cold to destroy abnormal tissues, such as warts or precancerous lesions. Unlike the other options listed, cryosurgery does not require the use of anesthetic because the extreme cold numbs the area being treated. This makes cryosurgery a relatively painless procedure, eliminating the need for anesthetic.

The most appropriate treatment for this condition is incisional and drainage. The patient's symptoms, including the tender and swollen pustule with erythema, suggest an abscess or localized infection. Incision and drainage is the standard treatment for abscesses, as it allows for the removal of pus and provides relief from pain and inflammation. Biopsy procedures, such as incisional or excisional biopsy, are not indicated in this case as there is no suspicion of malignancy or need for tissue sampling. Dilation and curettage is a procedure used for the removal of tissue from the uterus and is not relevant to this patient's presentation.

Based on the description provided, the lesion is described as a small dark purple lump on the woman's leg. It is firm, intradermal, and measures 6 mm in diameter. The absence of pain, surrounding erythema, epithelial disruption, or discharge suggests that it is not an aggressive or malignant lesion. Therefore, the prognosis of this lesion is benign, meaning it is not likely to metastasize or be fatal.

After a minor surgical procedure on the arm, the original sutures should be left in place for 7-10 days. This duration allows for proper wound healing and reduces the risk of infection. Leaving the sutures in place for a shorter period may result in the wound reopening or not healing fully, while leaving them for a longer period may increase the risk of scarring. Therefore, the recommended time frame for removing the sutures is 7-10 days.

The most likely diagnosis for this case is actinic keratosis. The patient's history of fair skin, red hair, and sensitivity to the sun, along with the presence of a pale pink, scaling plaque with poorly defined borders on the sun-exposed area of the ear, are all consistent with actinic keratosis. Actinic keratosis is a precancerous skin condition caused by long-term sun exposure and is characterized by rough, scaly patches on the skin.

The appropriate procedure for removal of the pedunculated skin lesions is to anesthetize the area, lift the papule with forceps, and remove it at the base of the lesion with a scalpel. This method ensures that the lesion is completely removed from the skin, reducing the risk of recurrence. The use of forceps and a scalpel allows for precise and controlled removal of the lesion. Anesthetizing the area ensures that the procedure is painless for the patient.

The given answer suggests that the small, firm, round nodule on the dorsal aspect of the patient's wrist is most likely attached to underlying tendons and nerves. This is supported by the absence of erythema, pain, epithelial disruption, or discharge, which are typically associated with infection or abscess formation. Additionally, the lack of trauma or clear etiology suggests that the nodule is not malignant. Therefore, the most plausible explanation is that the nodule is attached to underlying tendons and nerves.

The patient's presentation is consistent with a skin infection, most likely cellulitis or an abscess. The tender and swollen pustule with erythema suggests an inflammatory response to bacterial infection. Cephalexin is a first-generation cephalosporin antibiotic that covers many common skin pathogens, including Staphylococcus aureus and Streptococcus pyogenes, which are the most likely causative organisms in this case. Terbinafine is an antifungal medication and would not be effective against a bacterial infection. Mupirocin is a topical antibiotic used for localized skin infections, but in this case, a systemic antibiotic is needed. Piperazine is an anthelmintic medication used to treat intestinal parasites and is not appropriate for this patient's presentation.

The appropriate suture size for suturing an incision on the face is 6-0. This size is smaller and more delicate, making it suitable for the fine and delicate skin of the face. Using a smaller suture size helps to minimize scarring and achieve better cosmetic results.

Procaine is often avoided as an anesthetic because it can cause anaphylaxis, which is a severe allergic reaction. Anaphylaxis can occur suddenly and can be life-threatening, causing symptoms such as difficulty breathing, swelling, and a drop in blood pressure. Due to the risk of anaphylaxis, procaine is generally not used as frequently as other anesthetics.

The most likely diagnosis in this case is dermatofibroma. Dermatofibromas are benign skin lesions that typically present as firm, intradermal nodules. They often have a reddish or purple color and can range in size. They are usually painless and do not have surrounding erythema, epithelial disruption, or discharge. Basal cell carcinoma and malignant melanoma are both types of skin cancer and would typically have different characteristics such as irregular borders, rapid growth, or changes in color. Lipomas are benign tumors composed of fat cells and would not typically have the same appearance as described in the case.

Epinephrine is a vasoconstrictor that can decrease blood flow to the area, which may impair wound healing. Given the patient's history of sunburns and fair skin, it is important to minimize any potential complications during the removal of the lesion. Lidocaine without epinephrine would be the appropriate choice as it provides local anesthesia without the vasoconstrictive effects of epinephrine.

Marcaine is a local anesthetic medication that is commonly used for pain relief during surgical procedures or to numb specific areas of the body. The duration of action of Marcaine is known to be relatively long-lasting compared to other local anesthetics. It typically provides pain relief for a period of 3-8 hours, making it suitable for procedures or conditions that require extended pain management. This duration allows for prolonged pain relief, reducing the need for additional doses or interventions during this time frame.

The correct answer is to rest and elevate the leg for 24 hours. This is because paronychia removal is a minor surgical procedure that may cause some pain and swelling. Resting and elevating the leg can help reduce these symptoms and promote healing. Removing the bandage and washing the toe with soapy water is not mentioned as a post-operative instruction. Similarly, there is no mention of exposing the toe to open air or cutting the toenails to prevent recurrence. Therefore, these options can be ruled out as the correct answer.

The description of the lesion, including its characteristics and location, along with the patient's fair skin, red hair, and history of sunburns, suggests that the lesion is likely an actinic keratosis. Actinic keratosis is a precancerous skin condition that has a risk of developing into squamous cell carcinoma, a type of skin cancer. Therefore, the prognosis of this condition is that it has an associated risk of squamous cell carcinoma development.

The correct answer is #11. The description of the patient's presentation suggests that she may have developed a Bartholin's abscess, which is an infection of the Bartholin's gland located in the medial aspect of the anterior crease between the pelvis and thigh. The presentation of a tender and swollen pustule with erythema, along with the progression from a small pink papule over 2 weeks, is consistent with this diagnosis. Incision and drainage is the treatment for Bartholin's abscess, and for this procedure, a #11 scalpel blade is commonly used.

The most appropriate treatment for this lesion is to refer the patient to a hand surgeon. This is because the patient presents with a small, firm, round nodule on the dorsal aspect of his wrist without any signs of infection or trauma. Given the lack of clear etiology and the need for specialized expertise in hand surgery, it is best to refer the patient to a hand surgeon for further evaluation and management of the lesion.

A punch biopsy sample becoming struck in the core means that it is stuck or lodged in the tissue. In such a situation, using a thin needle would be the best method for removal. A thin needle can be inserted into the tissue around the stuck sample, allowing for careful extraction without causing further damage or complications. The needle's small size and precision make it suitable for this task.

The appropriate max dose of 1% lidocaine without epinephrine for this patient would be 35 ml. Lidocaine is a local anesthetic used to numb the area before a procedure. The dose is calculated based on the patient's weight, and the maximum recommended dose is 4.5 mg/kg. In this case, the patient weighs 77.3 kg, so the maximum dose would be 77.3 kg x 4.5 mg/kg = 348.35 mg. Since the concentration of the lidocaine is 1%, we can convert mg to ml by dividing the dose by the concentration (348.35 mg / 1% = 3483.5 ml). However, since the maximum dose is 35 ml, that would be the appropriate amount to administer.

Based on the given information, the procedure would be performed in a clean field. The patient's presentation of a tender and swollen pustule with erythema suggests an infection. A clean field is appropriate for procedures involving clean wounds or areas of the body that are not normally sterile, such as the skin. In contrast, a sterile field is used for procedures involving sterile body cavities or tissues. The terms "open field" and "closed field" are not relevant to the context of the question.

The appropriate method for performing a matrixectomy to prevent recurrence in this patient is to apply 80% phenol to the nail matrix for 1-3 minutes, followed by neutralization with alcohol. This process should be repeated three times. This method is effective in destroying the nail matrix, which is responsible for nail growth. By using 80% phenol, the matrix is adequately treated to prevent regrowth of the nail. Neutralization with alcohol ensures that the phenol is deactivated and prevents any further damage to the surrounding tissues.

The correct answer is "digital block just distal to the metatarsalphalangeal joint." This is the proper location for the injection of anesthesia prior to the surgical procedure for this condition because the patient presents with pain and swelling at the lateral aspect of his right toe, specifically at the lateral margin of the toenail. By performing a digital block just distal to the metatarsalphalangeal joint, the anesthesia will target the affected area and provide pain relief during the surgical procedure.

The appropriate treatment for this lesion is to not remove it because the scar that may result from removal could be worse than the lesion itself. This is supported by the fact that the patient denies pain, and there are no signs of surrounding erythema, epithelial disruption, or discharge. Additionally, the description of the lesion as a small, intradermal, firm, reddish purple nodule suggests that it may be a benign vascular lesion, such as a hemangioma, which typically do not require treatment unless they cause symptoms or cosmetic concerns.

An elevator is the most appropriate instrument to use in order to loosen the nail for removal. An elevator is a tool commonly used in podiatry to separate the nail from the nail bed. In this case, the patient has a painful and swollen lateral aspect of the toe with a yellow and thickened toenail at the lateral margin. These symptoms are consistent with an ingrown toenail, which occurs when the edge of the nail grows into the surrounding skin. Using an elevator to lift the ingrown nail away from the nail bed would help in its removal and provide relief to the patient.

The most likely diagnosis is abscess, which is supported by the tender and swollen pustule with surrounding erythema. The progression from a small pink papule to a larger, painful, and inflamed lesion is consistent with an abscess. Carbuncle and furuncle should also be considered as differential diagnoses, as they are both types of skin infections that can present with similar symptoms.

An occlusive bandage is a type of dressing that seals the wound completely, preventing air from reaching it. This type of bandage is typically used for wounds that require a moist environment to promote healing or to prevent infection. However, in the case of a skin biopsy, it is important to allow air to reach the wound to promote healing and prevent the accumulation of moisture, which can increase the risk of infection. Therefore, a non-occlusive bandage is the appropriate choice for dressing the wound after a skin biopsy.

Tractioning the skin perpendicular to the skin tension lines before performing the punch biopsy is the appropriate method. This helps to minimize distortion of the tissue and ensures an accurate biopsy sample.