Nplex 2010 - Minor Surgery

Front 1

What is #11 scalpel blade used for

Back 1

fine cuts and puncturing things, not good for cutting through thick skin

Front 2

What is #10 scalpel like

Back 2

A large curved blade, #3 is even larger same size

Front 3

What two suture materials commonly cause a tissue rxn

Back 3

silk and polyester

Front 4

What are steri strips used for

Back 4

In small areas needing sutures and must be an area that doesn't have a lot of tension on it. Won't leave any scarring.

Front 5

What type of med is procaine

Back 5

anesthetice - ester prototype
Metabolizes to PABA

Front 6

What type of med is Lidocaine

Back 6

Anesthetics - Amide prototype
Can cause heart block
Bupivacaine is the same as Lidocaine, however it lasts longer and therefore can not be used in IV

Front 7

Which of the following is a CONTRAINDICATION for shave biopsy:
a. Hyperpigmented moles greater than 1 cm
b. Molluscum contagiosum
c. Seborrheic keratoses
d. Benign superficial lesions

Back 7

a. Hyperpigmented moles greater than 1 cm

Front 8

Which of the following is a metabolized in the liver:
A. lidocaine
B. Epinephrine
C. cocaine
D. Procaine

Back 8

A. lidocaine

Front 9

Which of the following agents is primarily metabolized by plasma enzymes:
A. Lidocaine
B. Procaine
C. Epinephrine
D. EMLA

Back 9

B. Procaine

Front 10

10cc of a 1% solution of lidocaine contains?

Back 10

100 mg

Front 11

1cc of of 1% lidocaine solution contains:

Back 11

10 mg

Front 12

INDICATIONS for adding epinephrine to local anesthetics include all the following EXCEPT:
1. Decrease oozing
2. Prolong the duration of anesthetic effect
3. Reduced risk in patients with severe cardiovascular disease
4. Decrease risk of toxic reaction by reducing circulating levels of the local

Back 12

3. Reduced risk in patients with severe cardiovascular disease

Front 13

Where can you not use Epi with local anesthesia

Back 13

Any area that does not have blood coming from two directions - any appendage - fingers, toes, nose, penis, clitoris, ears

Front 14

Which of the following is a sign of local anesthesia CARDIOVASCULAR TOXICITY:
A. Shivering
B. Hypotension
C. Syncope
D. Sweating

Back 14

B. Hypotension

Front 15

Which of the following is the best treatment for a TOXIC reaction:
A. Epinephrine
B. Benedryl
C. Lidocaine
D. Oxygen

Back 15

D. Oxygen

Front 16

What are the smaller sutures

Back 16

Big number/0 - the bigger the number the smaller the suture

Front 17

Which of the following is an indication for NON-ABSORBABLE deep suture:
A. Tendon repair
B. Ophthalmic surgery
C. Deep skin wounds
D. Obstetrics

Back 17

A. Tendon repair

Front 18

Which of the following suture types has the highest likelihood of tissue reaction:
A. Chromic gut
B. Nylon
C. Vicryl
D. Prolene

Back 18

A. Chromic gut

Front 19

What is a felon

Back 19

a deep infection that requires debreivment

Front 20

Which of the following suture is the finest (has the smallest diameter):
a. 5/0
b. 000
c. 4-0
d. 6/0

Back 20

d. 6/0

Front 21

Nylon is what type of suture:
a. Absorbable, natural
b. Absorbable, synthetic
c. Nonabsorbable, natural
d. Nonabsorbable, synthetic

Back 21

d. Nonabsorbable, synthetic

Front 22

How is a drained abcess best cared for

Back 22

pack with iodophor gauze - change ever couple of days allowing it to heal from the bottom up.

Front 23

Four cardinal signs of slight finger flexion, fusiform swelling of the finger, pain on passive or active extension of the finger, and tenderness along the tendon sheath into the palm indicate:
a. Paronychia
b. Purulent tenosynovitis
c. Felon
d. Ganglion cyst

Back 23

b. Purulent tenosynovitis

Front 24

Contraindication to I&D include:
a. Fluctuant abscesses
b. Recurrent abscesses
c. Infected puncture wounds
d. Foreign bodies

Back 24

b. Recurrent abscesses

Front 25

All the following may increase the amount of time that a wound takes to heal EXCEPT:
a. hematoma
b. accurate wound approximation
c. high tension
d. dead space

Back 25

b. accurate wound approximation

Front 26

The destruction of all living microorganisms including bacterial spores:
a. Sterilization
b. Disinfection
c. Pasteurization
d. Homogenization

Back 26

a. Sterilization

Front 27

All the following are true regarding Universal Precautions EXCEPT:
a. The blood and body fluids of all patients should be considered potentially infectious
b. The main components include washing hands and sterilization
c. OSHA enforces Universal Precautions
d. The employer must offer HCV vaccine to all employees who have occupational exposure

Back 27

d. The employer must offer HCV vaccine to all employees who have occupational exposure

Front 28

Which of the following is included in the summary of OSHA standards:
a. Disposable gloves can be decontaminated for re-use.
b. Mouth pipetting of blood is prohibited unless the employer can demonstrate that no alternative is feasible
c. If a garment is penetrated by blood, the garment shall be removed
d. Contaminated needles should never be bent

Back 28

c. If a garment is penetrated by blood, the garment shall be removed

Front 29

This surgical tool is best for larger, thick and tough skin on the back:
Iris scissors
#10 blade
#11 blade
#15 blade

Back 29

#10 blade

Front 30

Which of the following scalpel blades has a straight and pointed cutting edge and is used for stabbing and incising the skin in I&D:
#11
#3
#10
#15

Back 30

#11

Front 31

What is the difference btw vertical mattress and simple interrupted

Back 31

vertical mattress has 4 points of contact instead of 2

Front 32

This type of suture has less resistance as it passes through tissue and is less likely to harbor microorganisms. It ties easily but knots may slip and break easily:
Catgut
Silk
Nylon
Braided Vicryl

Back 32

Nylon

Front 33

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Front 34

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Front 35

What % of recurrence of ganglion if ruptured

Back 35

50% - therefore if they aren't causing problems leave it alone

Front 36

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Back 36

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Front 37

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Front 38

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Front 39

How is an interupted suture infection txed

Back 39

just remove that suture

Front 40

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Back 40

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Front 41

This regional nerve block is injected into the anatomical snuff box to provide anesthesia to the lateral aspect of the proximal thumb:
Radial
Ulnar
Median
Pollus

Back 41

Radial

Front 42

This regional nerve block is useful for providing anesthesia to the tip of the little finger:
Radial
Ulnar
Median
Musculocutaneous

Back 42

Ulnar

Front 43

For the trunk, legs, feet or scalp, use the following type of suture and remove after how many days:
3/0, 2-6 days
3/0, 7-14 days
6/0, 2-6 days
6/0, 7-14 days

Back 43

3/0, 7-14 days

Front 44

How is length of time for sutures decided

Back 44

With suture choice and time in place consider location and stress on the wound. The more stress and thicker the skin (back, arm or thigh) the longer in place, and generally larger the diameter of suture required. The less tension and thickness (face) the smaller the suture and the sooner you remove it.

Front 45

At what point is melanoma no longer within our scope

Back 45

ND can excise and send for biopsy but once dx has been made must refer for tx

Front 46

Cryotherapy is indicated for which of the following:
Melanoma
Squamous Cell Carcinoma
Cervical warts
Basal Cell Carcinoma

Back 46

Cervical warts

Front 47

Which of the following conditions can be treated with cryotherapy and has a low risk of complications:
Ganglion cysts
Felon
Plantar warts
Purulent tenosynovitis

Back 47

Plantar warts

Front 48

Indications for electrocautery include:
Bloody fields
Basal cell carcinoma
Actinic keratoses
Recently changing nevi greater than 1 cm diameter

Back 48

Actinic keratoses

Front 49

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Back 49

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Front 50

Slide 34

Back 50

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Front 51

What should you do if one of the sutures in a wound is infected

Back 51

Remove it and drain the pus

Front 52

What is Sterilization

Back 52

the destruction of all living microorganisms, including bacterial spores.

Front 53

what is Disinfection

Back 53

the reduction of a population of pathogenic microorganisms without achieving sterility (not all bacterial spores are destroyed)

Front 54

What is the difference btw a disinfectant and an antiseptic

Back 54

Disinfectant is applied to an inanimate object to disinfect it and an antiseptic is for cleaning a body part

Front 55

Where would you use larger suture material for a longer time

Back 55

Places with a lot of tension

Front 56

What type of cautery can you use for blood areas

Back 56

Has to be bypolar

Front 57

What conditions require contact isolation

Back 57

Things that have high transmision by direct contact for serious illnesses
C Diff, methicillin resistant Staph, E Coli 0157:H7

Front 58

What conditions require air born isolation

Back 58

Things like TB and measles

Front 59

What solution should be used to clean an area

Back 59

10 % bleach or 1% sodium hypochlorite

Front 60

What is required for washing blood stained linens

Back 60

Temp of at least 160 deg F
50-150 ppm of chlorine bleach in washing cycle

Front 61

What is the correct angle for a venopuncture

Back 61

15 deg

Front 62

What angle is IV or butterfly push inserted at

Back 62

30-15 deg

Front 63

What size syringe should be used to draw up an injectable

Back 63

2 times the volume that is being injected

Front 64

What types of things are injected Sub Q

Back 64

fat soluble vitamines, insulin, epi

Front 65

How is a sub Q injection done

Back 65

pinch skin to inject into, insert needle at 45 deg angle, asperate and then inject, then remove needle and massage with dry cotton ball

Front 66

What is wet to dry dressing

Back 66

it is when wet gauze is placed on a wound and then ripped off after it has been dry for a while - it is used for debridement of the wound

Front 67

What is wet to wet dressing

Back 67

Dressing applied wet and then remoistened when it is to be removed

Front 68

How long is dressing left in place

Back 68

24-48 hours

Front 69

How is acidosis treated

Back 69

IV sodium bicarbinate

Front 70

When are sutures removed

Back 70

before epithelialization - about 5 days post op

Front 71

What order are sutures removed

Back 71

Remove alternately not consecutively

Front 72

How do you clean a surgery area

Back 72

remove hair (if needed)
Scrub area with antimicrobial cleanser 3 times - inside moving out

Front 73

When is it CI to do surgery on a digit

Back 73

reduced circulation - DM, Raynaud's, PSS, polyartertisi

Front 74

What is a field block and what is its advantage

Back 74

block of all n to an area - longer duration and less distortion of anatomical landmarks

Front 75

What is the best way to tx a ganglion cyst

Back 75

Refer to a hand specialist

Front 76

What size suture should be used on the face

Back 76

5-0 or 6-0

Front 77

What type of field do you conduct an incision and drainage on for an infected abcess

Back 77

clean field

Front 78

Between cephalexin and mupirocin which is used to prevent skin infection

Back 78

cephalexin, mupirocin is used for beta hemolytic strep

Front 79

What is a dermatofibroma

Back 79

benign lesion that is small dusky colored nodule usually on the leg

Front 80

What type of bandage should be used following skin biopsy

Back 80

non-occlusive bandage - reduce moisture and allow for air circulation

Front 81

What is the common side effect of procain which is why it is not commonly used

Back 81

anaphylaxis

Front 82

What type of anestesia is typically use for the paronychia removal

Back 82

digit block - insert needle distal to MTP and clos to the bone and inject as you pull the needle out

Front 83

What instrument is used to remove a portion of nail

Back 83

an nail elevator

Front 84

What is the max dose of lidocaine w/o epi
How about with epi

Back 84

W/o epi - 4.5 mg/kg (devide by 10 for 1% solution)
With epi - 7 mg/kg

Front 85

How do you preform a matrixectomy

Back 85

Remove nail then apply 80% phenol to nail bed for 1-3 min then neutralize with alcohol - repeat 3 tims

Front 86

How should a person tx their foot after paronychia removal

Back 86

rest and elevate leg for at least 24 hours
remove bandage daily and clean and rebandage

Front 87

How long does marcaine take to act and how long does it work

Back 87

30 min to act then lasts btw 3-8 hrs

Front 88

what lesion is actinic keratosis associed with increased risk for

Back 88

Sqamous cell carcinoma

Front 89

How long should sutures be left in the face

Back 89

5-7 days

Front 90

How long should sutures be left in places other than the face

Back 90

7-10 days

Front 91

Does Cryosurgery require anesthetic

Back 91

no b/c it is freezing the lesion

Front 92

Why would acrochordons increase in size during pregnancy

Back 92

b/c they respond to inc E

Front 93

can you serrated forceps to remove a punch biopsy

Back 93

It isn't a good idea b/c you want to preserve the sample as best as possible.

Front 94

what is milia

Back 94

keratin filled spots - white

Front 95

Goodsall’s rule (used for anal fistula repair) - what is it?

Back 95

if external opening is posterior to an imaginary horizontal line drawn over the anus connecting the ischial tuberosities, then the fistula tract is probably a curved line on the posterior midline of the anal canal. If the external opening is anterior to this same line, then the internal opening is usually on a straight course in the same quadrant of the anal canal.

Front 96

What are two ways a cyst can be handled

Back 96

excised or drained, if drained re-check in 4 weeks to ensure it has not reformed

Front 97

How is pyogenic granuloma txed

Back 97

cryosurgery, currette/cautery or excision if needing to send to pathology

Front 98

What is a keratoacanthoma

Back 98

rapid growing lesion on light exposed skin. Round w/ rolled edges and central keratin plug

Front 99

How many mg of lidocain are in 10 cc or a 1% solution

Back 99

− 10cc of a 1% solution contains 100 mg.

Front 100

What is the max dose of lidocain

Back 100

− The maximum recommended dose (healthy adults) is 4.5 mg/kg (not to exceed a ceiling of 300 mg or 30 ccs of 1%).
− The maximum dose for children over three is determined by the age and weight (i.e. for a normal, healthy child of 5 weighing 23 kg [50 lbs.] the maximum dose is 3.3-4.5 mg/kg [1.5-2 mg/lb], not to exceed a total of 75-100 mg.).
− These doses are for 90 minute - 2-hour intervals.

Front 101

What are common wound infectionous agents

Back 101

Staph is #1
Streptococci and Staph epidermidis (gram positive), E. coli, Proteus, Nitrobacteria, and Klebsiella pneumoniae (gram negative), and occasionally Candida.