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Proc Derm 2020 > Electrosurgery, electrocoagulation, electrofulguration, electrodessication, electrosection, electrocautery > Flashcards

Electrosurgery, electrocoagulation, electrofulguration, electrodessication, electrosection, electrocautery Flashcards

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Dermatology Board Prep flashcards
1
Q

Electrosurgery refers to hermal tissue damage resulting from tissue resistance to the passage of high-frequency, alternating electric current.

A

T

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2
Q

Electrocautery is a form of electrosurgery.

A

F No current flows through the patient.

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3
Q

Electrocoagulation, electrofulguration, electrodesiccation and electrosection are not forms of electrosurgery.

A

F

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4
Q

The precise tissue effect of electric current depends on current density, voltage and electromagnetic waveform.

A

T

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5
Q

The risk of pacemaker and implantable cardioverter-debfibrillator malfunction with electrosurgery is high.

A

F Extremely low.

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6
Q

Electrolysis uses direct current to induce tissue damage via a chemical reaction at the electrode tip.

A

T

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7
Q

Coblation uses high-frequency alternating current to ionize an electrically conductive medium (usually isotonic saline solution) and transmits heat to cause superficial epidermal and dermal damage with minimal collateral tissue destruction.

A

T It’s used for facial rejuvenation.

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8
Q

Electrocautery uses tissue resistance to the passage of high-frequency alternating current to convert electric energy to heat, resulting in thermal tissue damage.

A

F This is true for high-frequency electosurgery, ie. electrodessication, electrogfulguration, electrocoagulation, electrosection.

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9
Q

Electrosection uses direct or high-frequency alternating current to heat an element that causes thermal injury by direct heat transference to tissue.

A

F This is true for electrocautery.

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10
Q

The element in electrocautery is hot, unlike the cold electrode of electrosurgery.

A

T

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11
Q

Electric current refers to the net flow of electrons through a conductor per second, and is measured in amperes.

A

T

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12
Q

The thinner the electrosurgical tip, the lower the current density at the point of electrode contact.

A

F Thinner tip = greater current density.

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13
Q

High current density results in greater tissue injury, and is the basis of surgical diathermy.

A

T

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14
Q

Therapeutic uses of direct current include electrolysis, iontophoresis, and sometimes electrocautery.

A

T

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15
Q

Resistance refers to the ability of a conductor to impede the passage of an electric current, and is measured in ohms.

A

T

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16
Q

Fat has a low resistivity to electric current, whereas muscle has a high resistivity.

A

F Fat = high resistivity, muscle = low

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17
Q

The resistivity of wet skin is higher than the resistivity of dry skin.

A

F Wet = low, dry = high

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18
Q

Electric current always flows from a region of high electron concentration to one of low electron concentration.

A

T

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19
Q

Heat production in tissue depends on such factors as resistance, current density and the duration of current application.

A

T

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20
Q

For a given current density, heat production is greater in fat than muscle.

A

T Because of its higher resistivity.

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21
Q

Minimal heat is generated in substances with high resistance.

A

F Little resistance. Eg blood

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22
Q

An electrosurgical unit is composed of three components: a transformer that modifies voltage; an oscillating circuit that increases the frequency; and the patient circuit.

A

T

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23
Q

Undamped waveforms are used in electrosection.

A

T

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24
Q

Moderately damped waveforms are used in electrofulgaration.

A

F Electrocoagulation.

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25
Q

Markedly damped waveforms are used in electrocoagulation and electrodessication.

A

F Electrofulguration and electrodessication.

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26
Q

Cardiac pacemakers, deep-brain stimulators or implantable cardiodefibrillators may malfunction in the presence of electromagnetic radiation.

A

T

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27
Q

A non-alcohol solution such as chlorhexidine or povidone-iodine should be used when performing electrosurgery.

A

T Alcohol may spark or heat.

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28
Q

When performing electrosurgery in the perianal region, moist packing should be placed over the anus to prevent ignition of methane.

A

T!

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29
Q

The prefixes ‘mono-‘ and ‘bi-‘ refer to the number of treatment electrodes used in electrosurgery. .

A

T Mono = 1 electrode delivers current to pt. Bi = 2 electrodes

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30
Q

Electrodessication and electrofulguration involve deep tissue destruction.

A

F Superficial. Electrocoagulation is deep.

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31
Q

Electrofulgration and electrodessication are monoterminal.

A

T

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32
Q

Electrocoagulation and electrosection are biterminal.

A

T

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33
Q

Electrocautery is monoterminal.

A

F No terminal – hot wire.

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34
Q

Electrofulguration involves tissue contact with an active electrode.

A

F

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35
Q

Electrodesiccation, electrocoagulation and electrosection do not involve tissue contact with an active electrode.

A

F

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36
Q

Voltage used for electrocagulation, electrosection and electrocautery is high.

A

F Low. Amperage is high.

37
Q

Voltage used for electrofulguration and electrodessication is low.

A

F High. Amperage is low.

38
Q

At low power settings electrofulguration and electrodessication are the preferred method for superficial lesion destruction

A

T

39
Q

Treatment of highly vascular lesions with electrofulguration and electrodessication may result in a wet operative field, which quickly dissipates the heat

A

T

40
Q

Because of their low amperage, electrodesiccation and electrofulguration are best suited for destruction of superficial and relatively avascular lesion, such as verrucae and seb K

A

T

41
Q

Most tissue damage performed with electrofulguration and electrodessication is epidermal and there is minimal risk of scarring with lower power settings. .

A

T Higher power settings may be assoc with increased dermal coagulation, superficial scarring and hypopigmentation

42
Q

Electrodessication represents a variation of electrofulguration in which the electrode is held 1-2mm fro the skin surface, and causes superficial tissue dehydration by sparks.

A

F Other way around. Electrofulgration is the variant of electrodessication.

43
Q

Electrodessication and electrofulguration are best suited for superficial and relatively avascular lesions, such as verrucae and seborrhoeic keratoses.

A

T

44
Q

Electrocoagulation uses low-voltage, moderately damped or partially rectified, high-amperage current in a biterminal fashion to cause deeper tissue destruction and haemostasis with minimal carbonisation.

A

T

45
Q

The heat generated with electrocoagulation can be used to seal vessels by fusion of their collagen and elastin fibres.

A

T Operative field must be dry for maximal efficacy.

46
Q

Electrocoagulation with biterminal forceps offers the advantage of localised electrocoagulation with minimal current flow beyond the treatment area.

A

T

47
Q

Electrosection with undamped current yields cutting with some coagulation, whereas slightly damped current yields cutting without coagulation.

A

F Undamped = without coagulation,

Slightly damped = some coagulation

48
Q

Electrosection using pure sine waves provides benefit over conventional scalpel surgery.

A

F Pure sine waves cut without coagulating.

49
Q

Electrosection currents are commonly ‘blend’ damped and undamped wavetrains to cause simultaneous cutting and coagulation.

A

T

50
Q

When performed correctly, electrosection requires moderate manual pressure from the operator as the electrode glides through tissue.

A

F No manual pressure as electrode guides through tissue with minimal resistance.

51
Q

If sparking occurs during electrosection, the power setting is likely too high.

A

T

52
Q

If the electrode drags during electrosection, the power setting is likely too low.

A

T

53
Q

Advantages of electrosection are its speed and its ability to simultaneously cut and seal bleeding vessels.

A

T

54
Q

Electrocautery uses low –voltage, high-amperage, direct or alternating current to heat a surgical tip to cause tissue dessication, coagulation or necrosis by direct heat transference to the tissue.

A

T

55
Q

Carbonised tissue on the treatment electrode decreases current density and insulates against current flow, thereby reducing cutting and coagulation effect.

A

T

56
Q

C+C actually refers to the sequence of curettage followed by electrodessication applied in 2-3 repetitions to the lesion.

A

T

57
Q

If one reaches subcutaneous fat during C+C the procedure should be abandoned for excision.

A

T

58
Q

C+C should be used with caution in lesions with the potential for follicular extension as recurrence risk is higher.

A

T

59
Q

C+C should only be used to treat superficial BCC.

A

F Also nodular.

60
Q

The highest cure rates for BCC treated by C+C destroy a substantial peripheral margin around the initial curettage.

A

T 2-8mm.

61
Q

Cure rates for BCC treatment with C+C vary from 60-70%

A

F

88-99%

62
Q

Patient age, sex, and lesion duration before treatment of a BCC with C+C are significant determinants of 5-year recurrence.

A

F

63
Q

Increasing lesion diameter is not a significant determinant of 5-year recurrence post treatment of a BCC with C+C

A

F

64
Q

Anatomical location is an independent determinant of 5-year recurrence post BCC treatment with C+C

A

T High risk sites = nose, paranasal, NLF, ear, chin, mandible, periocular, perioral

65
Q

Low-risk sites for BCC recurrence post C+C include the scalp, forehead, pre- and post-auricular and malar areas.

A

F These are middle-risk sites. Low-risk = neck, trunk, extremities.

66
Q

BCC 5-year recurrence rates post C+C are 3% for low-risk sites, 5% for middle-risk sites for lesions 10mm) and 5% for high-risk sites for lesions 5 mm).

A

T

67
Q

Haemostasis can be performed on vessels up to 4mm.

A

F 1mm. Bigger should be ligated.

68
Q

Incisions can be safely made with electrocoagulation.

A

F Associated with higher postop infections.

69
Q

Electrosection results in more collateral tissue damage compared to scalpel surgery with some histological distortion of surgical margins.

A

T

70
Q

For specimens requiring H&E analysis, use of a filtered, fully rectified current (cutting without coagulation) should be used to prevent significant electrosurgical artefact.

A

T

71
Q

Electrochemotherapy refers to the local application of short, high-voltage, electric pulses to tumour tissue to increase tumour uptake of local or systemic chemotherapy.

A

T

72
Q

Wounds created by electrosection develop tensile strength more rapidly than scalpel wounds.

A

F They are weaker for 21 days postoperatively, and thereafter have equal strength.

73
Q

The indifferent electrode should have broad contact with skin, and not be placed over a bony prominence, scar tissue, or implanted metal.

A

T

74
Q

With pacemakers/defibrillators, they may be changed to a fixed-mode rate or magnetically deactivated during electrosurgery to prevent malfunction.

A

T

75
Q

Intraoperative techniques to minimise pacemaker/debfibrillator malfunction include using electrocautery, Shaw scalpel (no current flow through patient), or biterminal forceps (minimises current leakage in patient).

A

T

76
Q

When performing electrosurgery on a patient with a cardiac PPM or defibrillator, you should choose a site far from the heart and device for grounding.

A

T

77
Q

When performing electrosurgery on a patient with a cardiac PPM or defibrillator, you should ensure that the heart does not lie directly in the path between the treatment and indifferent electrode.

A

T

78
Q

When performing electrosurgery on a patient with a cardiac PPM or defibrillator, the duration of electrosurgical current does not need to be restrained.

A

F Use current bursts

79
Q

Current ‘channelling’ refers to the phenomenon of current concentration as it flows through a small area.

A

T

80
Q

Current ‘channelling’ particularly occurs on vascular areas.

A

F Areas with narrow stalk or base.

81
Q

Current ‘channelling’ has been reported on the scrotum with subsequent necrosis.

A

T!

82
Q

The active electrode of an electrosurgical device may be left on the patient while not in use.

A

F Should never do this due to risk of burn from inadvertent activation.

83
Q

An indifferent electrode can be cut to size or bent in order to conform to the patient’s anatomy and allow for better contact.

A

F Never do this – decreases the dispersion area, current may concentrate at points.

84
Q

The risk of current channelling may be minimised by using ‘bipolar’ forceps, an indifferent electrode, or by increasing the cross-sectional area of current flow.

A

T Wrap saline-soaked sponge (electrolyte conductor) around narrow base of mass being treated.

85
Q

The heat induced by electrosurgery sterilises the electrode tip.

A

F This is true for electrocautery.

86
Q

HPV may become aerosolized in blood microdroplets and in electrosurgical smoke.

A

T

87
Q

Demand-type pacemakers are not affected by electrosurgical interference, whereas fixed-rate pacemakers can be.

A

F Other way round.

88
Q

Electrosection poses the greatest risk for PPM-related complications.

A

T

89
Q

Most modern PPMs are designed with metallic covers and filters that minimize the risk of PPM malfunction by effectively rejecting extraneous electrical interference.

A

T

Proc Derm 2020 (50 decks)

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