Minor Surgery Exam 2

Adverse reactions to local anesthetics commonly affect the CNS (central nervous system) and the cardiovascular system. This means that in addition to affecting the nerves and brain, these reactions can also impact the heart and blood vessels. This is important to consider when administering local anesthetics, as cardiovascular effects such as changes in heart rate or blood pressure may occur. Monitoring the patient's cardiovascular status is crucial to ensure their safety during the procedure.

Saline is the best option for general irrigation because it is a sterile solution of salt and water, which is similar to the body's natural fluids. It is commonly used for cleaning wounds, as it helps to remove debris and bacteria without causing further damage or irritation. Additionally, saline is safe to use on sensitive areas, such as the eyes or mucous membranes, making it suitable for various irrigation purposes. Alcohol, hydrogen peroxide, and betadine are not recommended for general irrigation as they can be too harsh and may cause tissue damage or delay the healing process.

Paronychia is a condition characterized by an infection that occurs around the nails. It usually affects the skin at the base or sides of the nails, causing redness, swelling, and pain. This infection can be caused by bacteria or fungi entering the skin through small cuts or breaks in the nail area. Therefore, the correct answer is "on the nails."

The question asks for the amount of lidocaine in 15cc of a 1% lidocaine solution. To find the amount, we need to calculate 1% of 15cc. Since 1% is equivalent to 0.01, we multiply 0.01 by 15cc to get 0.15cc. Since 1cc of lidocaine is equal to 10mg, 0.15cc would be equal to 1.5mg. Therefore, 15cc of 1% lidocaine contains 150mg of lidocaine.

The most appropriate response in this scenario is to refer the 10-year-old boy to the emergency department for probable torsion. Testicular torsion is a surgical emergency that occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This condition requires immediate surgical intervention to prevent testicular damage or loss. The sudden severe pain and intense tenderness in the right testis are indicative of testicular torsion, and therefore, prompt referral to the emergency department is necessary for further evaluation and management.

A skin biopsy would be necessary for the diagnosis of squamous cell carcinoma. Squamous cell carcinoma is a type of skin cancer that arises from the squamous cells in the epidermis. A skin biopsy involves removing a small sample of skin tissue for examination under a microscope. This allows a pathologist to analyze the cells and determine if they are cancerous. Lichen planus, erysipelas, and dermatofibroma are all skin conditions that can usually be diagnosed through clinical examination and do not typically require a biopsy for diagnosis.

The most likely diagnosis in this case is a felon. A felon is an infection of the pulp space of the fingertip, usually caused by a puncture wound or a small cut in the nail. It is characterized by pain, swelling, and redness in the affected area. The absence of systemic symptoms such as fever, fatigue, and rashes, as well as the localized nature of the symptoms, support the diagnosis of a felon rather than other options such as abscess, furuncle, or carbuncle.

When performing a minor surgery procedure, it is important to prepare a sterile field if you are cutting through the skin. This is because cutting through the skin creates an entry point for potential pathogens, increasing the risk of infection. By preparing a sterile field, the risk of introducing harmful bacteria or other microorganisms into the surgical site is minimized, promoting a safer and more successful procedure.

Moderate elevation of the limb would be most likely to prevent the occurrence of edema in the left great toe after a toe nail removal. Elevating the limb helps to reduce swelling by allowing fluid to drain away from the affected area. By raising the foot to a moderate height, gravity assists in the movement of fluid out of the toe, reducing the risk of edema. The other options, such as a mild analgesic, local antibiotic gel, or hot applications, may provide pain relief or prevent infection but are less likely to directly address the issue of edema.

Cryosurgery is the most common and appropriate form of treatment for verruca vulgaris. Cryosurgery involves freezing the affected area with liquid nitrogen, which destroys the wart tissue. It is a widely used and effective treatment for verruca vulgaris because it is relatively painless, has minimal scarring, and can be performed in a clinic setting. Excision, sclerosing injection, and infrared photocoagulation are not typically used for the treatment of verruca vulgaris, making cryosurgery the correct answer.

When performing a punch biopsy, it is important to traction the skin perpendicular to the skin lines. Tractioning the skin in this manner helps to stabilize the area and create a taut surface for making the incision. This allows for better control and precision during the procedure. Tractioning parallel to the skin lines may cause the skin to shift or bunch up, making it difficult to make a clean incision. Pinching the skin up or spreading it between the thumb and forefinger may also not provide the necessary stability and tautness required for a successful punch biopsy.

Ganglion cyst removal is considered a more complicated procedure requiring more extensive surgical experience compared to the other options listed. This is because ganglion cysts are often located near critical structures such as nerves and blood vessels, making their removal more challenging. Additionally, ganglion cysts can be deeply rooted and have complex connections, requiring the surgeon to have a high level of skill and experience to ensure complete removal and minimize the risk of complications.

The most likely diagnosis in this case is a nevus, which is a benign mole. The description of a symmetrical, brown, raised, dome-shaped lesion with uniform color, round and regular borders, and no surrounding skin irritation is consistent with a nevus. Shave biopsy would be an appropriate technique for removal for biopsy, as it involves using a blade to shave off the superficial layers of the lesion for examination under a microscope. This technique is commonly used for diagnosing and removing benign skin lesions like nevi.

3-0 vicryl is the most indicated suture for closing the deep (buried) layer of an incision on the back. Vicryl is a synthetic absorbable suture that provides good tensile strength and has a slow absorption rate, making it suitable for deep tissue closure. The larger size of 3-0 is preferred for closing deeper layers of tissue as it provides better support and stability compared to smaller sizes. The other options, 6-0 vicryl, 6-0 prolene, and 5-0 plain gut, are either too small or not absorbable, making them less suitable for closing the deep layer of the incision.

Carbon dioxide slush has the least freezing intensity compared to the other options. This is because carbon dioxide slush is formed when carbon dioxide is cooled to a temperature below its freezing point, resulting in a semi-solid mixture. While it is still extremely cold, liquid nitrogen spray, nitrous oxide probe, and liquid nitrogen applicator have lower freezing points and therefore have a higher freezing intensity.

The best course of action is to refer the patient because neoplasms frequently occur in the salivary glands. This suggests that the palpated non-fixed mass could potentially be a neoplasm, and further evaluation and management by a specialist are necessary.

Cryosurgery is a medical procedure that involves the use of extreme cold to destroy abnormal or diseased tissue. It is commonly used to treat conditions such as molluscum contagiosum, actinic keratoses, and hemangiomas. However, cryosurgery is not typically used to treat hemorrhoids. Hemorrhoids are swollen blood vessels in the rectum or anus, and they are usually treated with other methods such as topical creams, lifestyle changes, or surgical procedures.

The most appropriate next step is to refer the patient to a hand surgeon as the condition may require wide excision and decompression. This is because the patient accidentally injected paint into her finger, resulting in immediate stiffness and pain. These symptoms, along with the oozing of pain when bending the finger, suggest a serious injury that may require surgical intervention. Therefore, a hand surgeon would be best equipped to assess and treat the patient's condition.

When the histopathologic diagnosis does not match the clinical history, it is appropriate to request a diagnostic opinion from a second pathologist. This is because a discrepancy between the two could indicate a potential error or misinterpretation in the initial diagnosis. Seeking a second opinion helps to ensure accuracy and avoid any potential misdiagnosis or inappropriate treatment.

The procedure would not be effective under any circumstances because electrodessication is not a recommended or effective method for managing an anal fistula.

Urticaria is a typical symptom of an allergic reaction to lidocaine. Urticaria, also known as hives, is characterized by raised, itchy, and red welts on the skin. It is a common allergic reaction and can occur as a result of exposure to certain medications, including lidocaine. Other symptoms of an allergic reaction to lidocaine may include swelling, itching, difficulty breathing, and in severe cases, anaphylaxis. Myocardial ischemia, palpitations, and sudden migraine are not typically associated with an allergic reaction to lidocaine.

After the removal of a skin abscess, it is recommended to leave the packing in place for 48 hours. This is because the packing helps to absorb any remaining fluid or pus from the abscess, promoting healing and preventing infection. Leaving it in place for this duration allows for adequate drainage and reduces the risk of complications.

Diabetes mellitus is a relative contraindication for an in-office incision and drainage of an abscess of the leg because individuals with diabetes have a compromised immune system and impaired wound healing, which can increase the risk of infection and complications during the procedure.

Contraindications for a punch biopsy are conditions or factors that make it unsafe or inappropriate to perform the procedure. Autoimmune diseases, such as lupus or rheumatoid arthritis, can increase the risk of complications during or after a biopsy due to the potential for impaired wound healing or increased bleeding. Therefore, autoimmune disease is a contraindication for a punch biopsy. Malignant melanoma, squamous cell carcinoma, and areas of vascular compromise are all valid contraindications as well, but the question asks for the exception.

The correct answer is that the location for injection of anesthetic of the palmar branch of the ulnar nerve is blocked between the flexor carpi ulnaris and the ulnar artery. This means that the anesthetic is injected in the space between these two structures to effectively block the nerve and provide localized anesthesia.

Electrocautery is the typical method of choice in treating a subungual hematoma. This procedure involves using a heated electrical device to burn or cauterize the affected area, which helps to stop bleeding and promote healing. It is a relatively quick and effective method that can be performed in a clinical setting. Incisional removal involves making a small cut to drain the hematoma, while excisional removal involves removing the entire nail to access and treat the hematoma. Cryosurgery uses extreme cold to freeze and destroy the hematoma. However, in the case of a subungual hematoma, electrocautery is the most commonly used method.

Digital block is a local anesthesia technique used to numb a specific finger or toe for various procedures. Contraindications are conditions or factors that make the use of digital block risky or inappropriate. Scleroderma and Raynaud's disease are both conditions that can cause poor blood flow and may make digital block difficult or ineffective. Infections in the proximal phalanx area can spread with the use of digital block and should be avoided. However, nail-bed lacerations do not pose a contraindication to digital block, as they can be effectively treated with this technique.

Bupivacaine (marcaine) has the slowest onset time of anesthesia compared to lidocaine, mepivacaine, and prilocaine. Bupivacaine is a long-acting local anesthetic that takes longer to reach its peak effect. It is often used for procedures that require prolonged anesthesia or post-operative pain control. Lidocaine, mepivacaine, and prilocaine have faster onset times and are commonly used for shorter procedures or when a rapid onset of anesthesia is desired.

Pilar cysts are often inherited in an autosomal dominant pattern. This means that if a person has a pilar cyst, there is a high chance that their offspring will also develop the cyst. Autosomal dominant inheritance means that only one copy of the mutated gene is needed for the condition to be passed on. Pilar cysts are benign growths that occur within the hair follicles, typically on the scalp. They are usually painless and can be surgically removed if desired.

Using adson forceps to hold the surrounding tissue is important to good atraumatic technique in incision repair because it allows for precise and controlled manipulation of the tissue, minimizing trauma to the surrounding area. Adson forceps have fine, delicate tips that can securely grasp the tissue without causing excessive damage or crushing. This helps to ensure that the incision is repaired with minimal trauma, promoting proper healing and reducing the risk of complications.

Sutures are typically removed after a certain period of time to ensure proper wound healing. In the case of facial injuries, it is recommended to wait 5-7 days before removing sutures. This timeframe allows for adequate healing of the facial tissues, reducing the risk of complications such as infection or scarring. Waiting longer than 7 days may result in the sutures becoming embedded in the skin, making removal more difficult. Removing sutures too early, on the other hand, may lead to wound reopening or poor healing.

Bupivacaine 0.25% with epinephrine is the anesthetic of choice for rectal procedures because it provides effective pain relief and vasoconstriction. The addition of epinephrine helps to constrict blood vessels, reducing bleeding during the procedure. Bupivacaine is a long-acting local anesthetic, which means it provides prolonged pain relief after the procedure. This combination of bupivacaine and epinephrine is commonly used for procedures that require anesthesia in the rectal area.

Incisional biopsies are best used for lesions that are too large for complete excision. In cases where a lesion is too large to be completely removed, an incisional biopsy allows for the sampling of a representative portion of the lesion for histological examination. This helps in obtaining a diagnosis and determining the appropriate treatment plan without the need for complete excision of the entire lesion.

The remodeling phase of wound healing typically begins around 21 days after the injury. During this phase, the newly formed collagen fibers in the wound start to reorganize and strengthen, leading to the restoration of tissue strength and function. This phase can last for several months or even years, as the wound gradually remodels and matures.

The suture technique of choice for a 2 cm laceration to the right shoulder is interrupted sutures. Interrupted sutures involve individually tying each suture, which allows for precise alignment and tension control. In this case, the wound is a clean cut and less than two hours old, making interrupted sutures an appropriate choice for optimal wound closure and healing. Horizontal mattress and vertical mattress sutures are typically used for wounds under tension or in areas with poor vascularity. Continuous sutures are used for long, straight incisions that are not under significant tension.

The most likely diagnosis in this case is cellulitis. Cellulitis is a bacterial skin infection that typically occurs when bacteria enter through a break in the skin. The symptoms described, including increased heat, diffused redness, pain, non-pitting edema, headache, slight feverishness, and palpable regional nodes, are consistent with cellulitis. Lymphangitis is inflammation of the lymphatic vessels and would not explain the other symptoms. Erysipelas is a specific type of cellulitis that is characterized by a raised, well-defined border, which is not mentioned in the question. Tetanus is a bacterial infection that affects the nervous system and would not typically present with the described symptoms.

Maxon (polyglyconate) has the least tissue reactivity compared to the other options. This is because polyglyconate is a synthetic absorbable suture material that is known for its low tissue reactivity. It is designed to minimize the inflammatory response and promote better healing, making it a preferred choice in surgical procedures. Chromic catgut, silk, and dacron (mersilene) are all natural or synthetic materials that may cause more tissue irritation and inflammation.

The best approach for a deep puncture wound of the medial thigh would be to disinfect, irrigate, and debride the wound. This is important to prevent infection and remove any foreign material or debris from the wound. Additionally, advising regarding tetanus prevention is crucial as puncture wounds are at high risk for tetanus contamination. Broad-spectrum antibiotics are not necessary unless there are signs of infection. Elevation of the leg alone would not be sufficient for wound management. Excising the entire wound is not necessary unless there are specific indications for surgical intervention.

Plain catgut absorbs the most rapidly among the given options. Catgut is a type of absorbable suture material made from the submucosal layer of sheep or goat intestines. Plain catgut is not treated with any chemicals or coatings to delay absorption, making it more rapidly absorbed by the body. This makes it suitable for use in tissues that heal quickly, such as the oral cavity or superficial skin layers. Dexon, vicryl, and chromic catgut are also absorbable sutures, but they have different characteristics and absorption rates compared to plain catgut.

Hyfrecation is a medical procedure used to remove tissue using high-frequency electrical current. The given answer states that the procedure is more painful than cryosurgery. This implies that hyfrecation may cause more discomfort or pain compared to cryosurgery, which is a procedure that uses extreme cold to destroy abnormal tissue.

After the removal of a cyst less than 1 cm long, the dead space refers to the empty space left behind. Suturing the subcutaneous tissues is the best way to address this dead space. Suturing helps to close the wound and minimize the empty space, promoting proper healing and preventing the accumulation of fluid or air. Pressure dressing, packing the space with gelfoam, and packing the space with iodoform gauze are not as effective in addressing the dead space as suturing the subcutaneous tissues.

The drain should most likely be removed after 48 hours. This is because after debriding a deep, infected wound, a drain is placed to help with healing by allowing any excess fluid or infection to drain out. Leaving the drain in for too long can increase the risk of infection or other complications. Removing the drain after 48 hours allows enough time for the initial drainage to occur, but also minimizes the risk of leaving it in for too long.

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Lipomas in the inner thigh have a higher risk of becoming liposarcomas. Liposarcomas are malignant tumors that develop from fat cells. The inner thigh is an area where liposarcomas are more likely to occur compared to other parts of the body. This could be due to various factors such as the specific type of fat cells present in the inner thigh or the anatomical characteristics of the area. Regardless of the exact reason, it is important to monitor and potentially biopsy lipomas in the inner thigh to rule out the possibility of liposarcoma.

After the removal of a benign mole, it is common for the treated area to scar. Laser scar revision is a treatment option that can help improve the appearance of scars. However, it is important to wait for an adequate amount of time before considering this treatment. Waiting for one year allows the scar to fully mature and stabilize, which is crucial for the success of the laser scar revision. This waiting period ensures that the scar has healed properly and reduces the risk of complications during the treatment.

The correct location for the injection of anesthetic for nerve blockade of the radial nerve in the hand is distal to the radial styloid process. This means that the injection should be administered below the bony prominence on the lateral aspect of the wrist. This location ensures that the anesthetic is delivered close to the radial nerve, which is responsible for providing sensation to the back of the hand and fingers.

Running a complete blood count (CBC) would unmask an infection as a contraindication to lipoma removal. The patient's fatigue and the presence of a fluctuant lesion may indicate an underlying infection. A CBC can help identify an elevated white blood cell count, which is a sign of infection. Removing the lipoma in the presence of an active infection can lead to complications such as worsening of the infection or spread of the infection to other areas. Therefore, it is important to rule out infection before proceeding with the lipoma removal.

If the secondary opening of an anal fistula lies anterior to a horizontal line bisecting the anus, it suggests that the internal opening runs on a straight curve course to the primary opening, which is in the same quadrant. This means that the path of the fistula follows a straight line initially, then curves towards the primary opening, which is located in the same quadrant as the secondary opening.

The most appropriate response in this scenario is to excise the entire wound. This is because the wound is dirty and jagged, which increases the risk of infection. By excising the entire wound, the contaminated tissue is removed, reducing the risk of infection and promoting proper healing. Irrigating with hydrogen peroxide may help clean the wound, but it is not sufficient in this case. Referring to a plastic surgeon may be necessary for complex wounds, but it is not the most appropriate response based on the given information. Allowing the wound to heal by delayed primary closure is not recommended due to the risk of infection.

Domestic pressure cookers can be used effectively for instrument sterilization. This is because pressure cookers create high temperatures and steam, which can effectively kill microorganisms and sterilize instruments. However, it is important to note that proper technique and guidelines should be followed to ensure effective sterilization.