Minor Surgery Exam 2
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- 1.The remodeling phase of wound healing generally starts how many days after injury?
- A.
14 days
- B.
60 days
- C.
30 days
- D.
21 days
- 2.Which cryogen has the least freezing intensity?
- A.
Liquid nitrogen spray
- B.
Nitrous oxide probe
- C.
Liquid nitrogen applicator
- D.
Carbon dioxide slush
- 3.Which of the following is important to good atraumatic technique in incision repair?
- A.
Making sure the knots are as tight as possible
- B.
Placing the stitches as close together as possible
- C.
Using adson forceps to hold the surrounding tissue
- D.
Clamping serrated forceps around the surrounding tissue
- 4.Which of the following is best for general irrigation?
- A.
Alcohol
- B.
Saline
- C.
Hydrogen peroxide
- D.
Betadine
- 5.A non-fixed mass is palpated in the area of the right parotid gland. Which of the following is the best course of action?
- A.
Tell the patient to watch it for 4 weeks and re-examine as neoplasms occur infrequently here
- B.
Refer because of the salivary glands, in which neoplasms frequently occur
- C.
Immediately send the patient to the emergency room
- D.
Perform a punch biopsy
- 6.After removal of a cyst less than 1 cm long, the dead space is best addressed by which of the following?
- A.
Pressure dressing
- B.
Packing the space with gelfoam
- C.
Packing the space with iodoform gauze
- D.
Suturing of the subcutaneous tissues
- 7.Contraindications for a punch biopsy include all of the following except with one?
- A.
Malignant melanoma
- B.
Autoimmune disease
- C.
Squamous cell carcinoma
- D.
Areas of vascular compromise
- 8.Incisional biopsies are best used for which of the following?
- A.
Lesions that require special histological handling
- B.
Lesions that are located in areas difficult to operate on
- C.
Small, discrete lesions
- D.
Lesions that are too large for complete excision
- 9.Cryosurgery is commonly used on all the following except:
- A.
Molluscum contagiosum
- B.
Actinic (solar) keratoses
- C.
Hemorrhoids
- D.
Hemangiomas
- 10.Which of the following statements about skin cysts is true?
- A.
Pilar cysts are often inherited in autosomal dominant pattern
- B.
Epidermal and pilar cysts are uncommon
- C.
Sebaceous cysts are usually malignant
- D.
Sebaceous cysts are uncommon
- 11.Contraindications to digital block include all of the following EXCEPT which one?
- A.
Scleroderma
- B.
Raynauds disease
- C.
Infections of proximal phalanx area
- D.
Nail-bed lacerations
- 12.After a toe nail removal of the left foot, a patient reports edema in the left great toe. Which of the following would be most likely to prevent this occurrence?
- A.
A mild analgesic
- B.
Moderate elevation of the limb
- C.
Local antibiotic gel
- D.
Hot applications
- 13.After debriding a particularly deep, infected wound, a drain is placed to facilitate healing. When should it most likely be removed?
- A.
12 hours
- B.
72 hours
- C.
48 hours
- D.
24 hours
- 14.In treating a subungual hematoma, what is the typical method of choice?
- A.
Electrocautery
- B.
Incisional removal
- C.
Excisional removal
- D.
Cryosurgery
- 15.Of the following, which has the slowest onset time of anesthesia?
- A.
Bupivacaine (marcaine)
- B.
Lidocaine
- C.
Mepivacaine
- D.
Prilocaine
- 16.Which of the following is a typical symptom of an allergic reaction to lidocaine?
- A.
Urticaria
- B.
Myocardial ischemia
- C.
Palpitations
- D.
Sudden migraine
- 17.A 35-year-old female comes to you after accidentally injecting paint into her finger while trying to clear a blocked high-pressure spray gun. The finger was immediately stiff and she noticed a drop of pain ooze out when she bent her finger. What is the most appropriate next step?
- A.
Hospitilization for intensive therapy and antibiotics
- B.
Referral to hand surgeon as the condition may require wide excision and decompression
- C.
Thorough wound irrigation with sterile saline, followed by antibiotics and immobilization of the finger
- D.
Herbal antimicrobials, ice and elevation for 24 hours, then contrast hydrotherapy frequently
- 18.Which of the following statements is true?
- A.
External hemorrhoids can be painlessly banded and frozen
- B.
When using a one layer closure, the loop of suture should be wider deep in the tissue than at the surface
- C.
If properly treated, ganglion cysts will not recur
- D.
First degree hypspadias is an indication for circumcision
- 19.Which of the following has the least tissue reactivity?
- A.
Chromic catgut
- B.
Maxon (polyglyconate)
- C.
Silk
- D.
Dacron (mersilene)
- 20.Which of the following is a relative contraindication for an in-office incision and drainage of an abscess of the leg?
- A.
Diabetes mellitus
- B.
Patient is on antibiotics
- C.
The patient is elderly and has peripheral neuropathy
- D.
Poor nutrition
- 21.Where does paronychia occur?
- A.
In the mouth
- B.
On the penis
- C.
On the nails
- D.
On the scalp
- 22.For which of the following would a skin biopsy be necessary for diagnosis?
- A.
Lichen planus
- B.
Erysipelas
- C.
Dermatofibroma
- D.
Squamous cell carcinoma
- 23.How long should the packing be left in place following skin abscess removal?
- A.
6 hours
- B.
12 hours
- C.
48 hours
- D.
72 hours
- 24.A 24-year-old woman comes to you with a 2 cm laceration to her right shoulder. The wound is a linear, clean cut less than two hours old. What is the suture technique of choice for her?
- A.
Horizontal mattress
- B.
Vertical mattress
- C.
Continuous
- D.
Interrupted
- 25.An 8-year-old boy presents with a 1 cm dirty, jagged wound less than ten hours old in freely movable tissue. Which of the following is the most appropriate response?
- A.
Irrigate with hydrogen peroxide and allow to heal by secondary closure
- B.
Refer to a plastic surgeon
- C.
Irrigate with hydrogen peroxide and allow to heal by delayed primary closure
- D.
Excise the entire wound
- 26.Adverse reactions to local anesthetics most commonly affect the CNS and what other system?
- A.
Cardiovascular
- B.
Lymphatic
- C.
Digestive
- D.
Endocrine
- 27.Which of the following is true of the location for injection of anesthetic of the palmar branch of the ulnar nerve?
- A.
It is blocked lateral to the radial artery
- B.
It is blocked lateral to the brachioradialis tendon
- C.
It is blocked between the tendons of the palmaris longus and abductor pollicis longus
- D.
It is blocked between the flexor carpi ulnaris and the ulnar artery
- 28.A 16-year-old female presents with a deep puncture wound of the medial thigh. Given the nature of the wound, which of the following would be the best approach?
- A.
Disinfect, irrigate and debride the wound, then advise regarding tetanus prevention
- B.
Disinfect, irrigate, and debride the wound, then give broad spectrum antibiotics
- C.
Disinfect and irrigate the wound, then elevate the leg for 24 hours
- D.
Disinfect, irrigate and then excise the entire wound, following with broad spectrum antibiotics
- 29.A collegue consults with you about the possibility of managing an anal fistula using electrodessication. Based on your knowledge of minor surgery, what would your reply be?
- A.
The procedure would only be safe if you had an assistant to help you
- B.
The procedure is safe but requires extensive experience to perform as an in-office procedure
- C.
The procedure would not be effective under any circumstances
- D.
The procedure would be effective if the electrodessication included both electrocautery and hyfrecation
- 30.A 24-year-old female inquires about a lipoma removal. The lesion is 2 cm in diameter, non-erythematous, and fluctuant. The patient is in apparent good health but feeling somewhat fatigued. What contraindication to lipoma removal would running a CBC unmask?
- A.
Pregnancy
- B.
Bleeding disorder
- C.
Anemia
- D.
Infection
- 31.A 10-year-old boy presents with sudden severe pain in the right testis. On palpation there is intense tenderness. The mother believes it is a hernia and asks if you can take care of it in the office. WHich of the following is the most appropriate response for the most likely diagnosis?
- A.
Refer to the emergency department for probable torsion
- B.
Address his probable strangulated hernia by referring him out
- C.
Address his probable strangulated hernia in the office
- D.
Refer to a urologist for probable epididymitis
- 32.The anesthetic of choice for rectal procedures is:
- A.
Bupivacaine 0.25% with epinephrine
- B.
Prilocaine 1% with epinephrine
- C.
Mepivacaine 1% with epinephrine
- D.
Mepivacaine 1% without epinephrine
- 33.Which of the following is considered a more complicated procedure, requiring more extensive surgical experience?
- A.
Sebaceous cyst removal
- B.
Ganglion cyst removal
- C.
Toe nail removal
- D.
Lipoma removal
- 34.A 23-year-old man presents with a bite wound to the leg made by a crazed medical student at a Silencers concert. The wound is 10 days old and was self-managed by the patient. The affected part is remarkable for increased heat, diffused redness, pain and non-pitting edema. The patient complains of headache and slight feverishness. Regional rodes are palpable. WHich of the following is the most likely diagnosis?
- A.
Lymphangitis
- B.
Erysipelas
- C.
Cellulitis
- D.
Tetanus
- 35.Before a minor surgery procedure, in what circumstance would you need to prepare a sterile field?
- A.
If there is an infection
- B.
If the patient is not on antibiotics
- C.
If the lesion is larger than 5mm in diameter
- D.
If you are cutting through the skin
- 36.It is appropriate to request a diagnostic opinion from a second pathologist when:
- A.
Histopathologic diagnosis does not match clinical history
- B.
Pathologist is sure of diagnosis
- C.
Diagnosis matches clinicians impression
- D.
If an automatic second for clinically suspicious skin cancers exists
- 37.Lipomas in what part of the body have a higher risk of becoming liposarcomas?
- A.
Inner thigh
- B.
Lateral neck
- C.
Axilla
- D.
Buttocks
- 38.Which suture absorbs the most rapidly?
- A.
Dexon
- B.
Plain catgut
- C.
Vicryl
- D.
Chromic catgut
- 39.What would be the location of injection of anesthetic for nerve blockade of the radial nerve in the hand?
- A.
Distal to the radial styloid process
- B.
Lateral to the palmaris longus tendon
- C.
Medial to the flexor carpi radialis tendon
- D.
Proximal to the pisiform bone
- 40.A 19 year old man presents with a 0.4 cm, symmetrical, brown, raised, dome-shaped lesion on her upper back. The color is uniform throughout the lesion, the borders are round and regular, and there is no surrounding skin irritation. For cosmetic reasons, she wants to remove the lesions. What is the most likely diagnosis, and what techniques would be appropriate for removal for biopsy?
- A.
Nevus; shave biopsy
- B.
Actinic keratosis; punch biopsy
- C.
Seborrheic keratosis; hyfrecation
- D.
Basal cell carcinoma; total excision
- 41.Your patient had a benign mole removed from her chest 2 weeks ago, and the area treated has scarred. She asks about laser scar revision. How long would you tell your patient to wait before considering scar revision treatment?
- A.
1 month
- B.
Two years
- C.
One year
- D.
4 months
- 42.For the treatment of verruca vulgaris, which of the following is the most common and appropriate form of treatment?
- A.
Excision
- B.
Cryosurgery
- C.
Sclerosing injection
- D.
Infrared photocoagulation
- 43.In attempting to locate the primary opening of an anal fistula, a good rule of thumb is that if the secondary opening lies anterior to a horizontal line bisecting the anus, the internal opening probably:
- A.
Runs on a curved course to the primary opening which is in the posterior midline
- B.
Runs on a straight curve course to the primary opening which is in the same quadrant
- C.
Runs on a curved course to the primary opening which is in the same quadrant
- D.
Runs on a straight course to the primary opening which is in the anterior midline
- 44.A 47-year-old woman presents with pain of the tip of her fingers. There is generalized swelling and redness in a 0.5 cm area of skin proximal of the fingernail of her right forefinger. She does not recall any recent trauma to the fingertip or nail. She was gardening last week before it started, so she thinks that perhaps she got a small cut in the nail itself. She has no fever, fatigue, rashes, joint pain, headaches, or other systemic symptoms. What is the most likely diagnosis?
- A.
Felon
- B.
Abscess
- C.
Furuncle
- D.
Carbuncle
- 45.15cc of 1% of lidocaine contains how many mg of lidocaine?
- A.
150mg
- B.
200mg
- C.
100mg
- D.
75mg
- 46.Which suture is most indicated for closing the deep (buried) layer of an incision on the back?
- A.
6-0 vicryl
- B.
6-0 prolene
- C.
3-0 vicryl
- D.
5-0 plain gut
- 47.How long should you wait to remove sutures after repair of facial injuries?
- A.
24-48 hours
- B.
48-72 hours
- C.
5-7 days
- D.
7-10 days
- 48.Which of the following is true about hyfrecation?
- A.
The procedure is more painful than cryosurgery
- B.
It leaves no scarring
- C.
Bleeding is often profuse with this treatment
- D.
It obviates the need to biopsy suspicious lesions
- 49.When performing a punch biopsy, how do you traction the skin before masking the incision?
- A.
Perpendicular to the skin lines
- B.
Parallel to the skin lines
- C.
Pinch the skin up with your thumb and forefinger
- D.
Spread the skin between your thumb and forefinger
- 50.Which of the following is true about instrument sterilization?
- A.
Soaking for 30 minutes 2% glutaraldehyde solution is adequate
- B.
Domestic pressure cookers can be used effectively
- C.
Boiling in water for 5 minutes is effective
- D.
Portable autoclaves works well for pre-packaged procedure trays
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