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Peds Core Exam > Surgery AAD Questions > Flashcards

Surgery AAD Questions Flashcards

1
Q

What agent if used for cleaning to the eye can cause corneal damage, sensorineural deafness, severe allergic reaction

A

Chlorhexidine gluconate

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2
Q

Corneal damage via what: corneal de-epitheliazation, conjunctival chemosis, anterior stromal edema

A

Chlorhexidine

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3
Q

How does chlorhexidine cause damage to the ear

A

damage to the chochlea resulting in sensorineural hearing loss
-typically in setting of prolonged exposure of chlorhexidine to the tympanic membrane rupture

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4
Q

T/F: You can use fractional ablative lasers on the neck and chest with altered settings

A

True (you cannot use fully ablative lasers)

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5
Q

What is seen on histological examination of skin after fractional ablative laser

A

collagen remodeling, neocollagenesis

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6
Q

What can you treat with fractional ablative laser

A

scars, photo damage, rhytides

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7
Q

Mental nerve: sensory or motor

A

sensory

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8
Q

Common complication (4%) of deoxycholic acid injections for submental fat

A

marginal mandibular nerve paresis

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9
Q

What is the safe dose of plain lidocaine?

How much lidocaine is in each cc of 1%?

A

4.5 mg/kg

10 mg

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10
Q

What is the max safe dose of lidocaine with epi?

A

7 mg/kg

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11
Q

What is the max safe dose of tumescent anesthesia lidocaine with epinephrine?

A

55 mg/kg

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12
Q

What do you do if you drop a graft on the floor?

A

Inform the patient, lavage the graft in chlorhexidine or povidone iodine for 60 seconds and proceed with the procedure

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13
Q

What layer are virtually all fillers injected into

A

subcutis or deeper tissue layers

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14
Q

Injections into what plain can lead to violaceous nodules

A

dermis (Tyndall effect)

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15
Q

What is the cause of darkening after Q switched laser for brown, red and pink pigments

A

Reduction of ferric oxide to ferrous oxide (similar rxn in titanium dioxide in white and flesh colored pigments)

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16
Q

If you have paradoxical darkening with red/brown tattoo removal, what laser can nearly or completely treat

A

Nd:YAG laser

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17
Q

What is the treatment for eyelid ptosis from botox

A

apraclonidine

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18
Q

Primary artery for a nasolabial interpolation flap

A

angular artery

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19
Q

How much tumescent anesthesia can you use in a 75 kg person?

A

4125 mg (55 mg/kg)

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20
Q

What organ metabolizes lidocaine

A

Liver (CYP3A4 pathway)

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21
Q

What is the function of an M plasty

A

Decrease the length of a scar

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22
Q

Name the types of advancement flaps (7)

A
  1. Unilateral Burow’s advancement (A to L or O to L)
  2. Unilateral crescentic advancement (cheek to nose crescentic)
  3. Unilateral O to U advancement (helical rim advancement)
  4. Bilateral A to T or O to T
  5. bilateral O to H
  6. Island pedicle, ‘kite’ flap renamed V to Y
  7. Mucosal advancement
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23
Q

What type of flap: redirect a scar and lengthen a scar?

A

Z plasty

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24
Q

What are the WLE margins for DFSP?

A

2-4 cm to the superficial muscular fascia (WLE with 4 cm margins to 95% clearance in tumors <3x3cm)

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25
Q

Name the artery: approximated by the most prominent glabellar frown lines near the medial eyebrow

A

Supratrochlear

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26
Q

Name the syndrome: sebaceous neoplasms +/- keratoacanthomas and visceral malignancies (GU and colorectal cancers)

A

Muir Torre Syndrome (MLH1, MSH2, MSH6)

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27
Q

Next steps if suspect Muir Torre (3)

A
  1. Perform immunohistochemistry to evaluate for mismatch repair proteins
  2. Refer for age appropriate cancer screenings
  3. Take a detailed personal and family hx
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28
Q

What two sources are common for cartilage to support the nasal ala?

A

antihelix and conchal bowl

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29
Q

Name the high risk cardiac people that need abx prior to surgery (4)

A
  1. prosthetic valve
  2. hx of infective endocarditis
  3. unrepaired congenital heart disease
  4. cardiac transplant patients with cardiac valvulopathy
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30
Q

Name the joint people that need abx before surgery

A
  1. within 2 years of replacement
  2. previous joint infx
  3. type 1 DM, immunosuppressed or hemophilia
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31
Q

What areas deemed consideration of abx prior to surgery (5)

A
  1. oral mucosa
  2. groin/leg
  3. wedge excision of lip or ear
  4. nasal flaps
  5. all grafts
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32
Q

What type of skin graft has greater metabolic demand, retains adnexal structures and contracts less

A

Full thickness skin graft (FTSG)

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33
Q

Monomorphous small round nuclei around vascular spaces

A

Glomus tumor

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34
Q

Crateriform lesion lined by a hyperplastic epithelium with atypical keratinocytes with abundant eosinophilic cytoplasm

A

Keratoacanthoma

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35
Q

Cyst lined by keratinizing squamous epithelium

A

Epidermal infundibular cyst

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36
Q

Digitated lesion with a fibrovascular core

A

Wart

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37
Q

Full thickness epidermal atypia

A

SCC

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38
Q

What part of the nail develops melanoma

A

nail matrix

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39
Q

What does the distal matrix give rise to

A

ventral (inferior) nail plate

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40
Q

What does the proximal matrix give rise to

A

superficial (dorsal) nail plate

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41
Q

What part of the matrix should be biopsied to prevent dystrophy of the nail

A

distal matrix via a horizontal or tangential biopsy for sufficient tissue sample without disrupting the proximal matrix

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42
Q

True or False: A biopsy of the nail bed would allow for a dx of subungal melanoma

A

False: A biopsy of the nail bed would not allow for a diagnosis of subungual melanoma

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43
Q

What lasers can result in delayed hypopigmentation

A

Erbium:YAG or CO2

  • fully ablative lasers
  • mechanical dermabrasion
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44
Q

Name the flap: camouflage a scar by breaking it up into smaller components, improve a postprocedure web, release tension surrounding a free margin and reorient a scar

A

Z-plasty: transposition flap based on a 60 degree Z with central limb oriented across the long axis of the scar and two limbs oriented at 60 that are transposed

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45
Q

Tip of nose sensation

A

anterior ethomoidal nerve

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46
Q

What ganglia results in trigeminal trophic syndrome

A

geniculate ganglion or gasserian ganglia (trigeminal ganglia)

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47
Q

What innervates the tip of the nose

A

medial nasal branch of the anterior ethmoidal nerve

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48
Q

What is the correct plane to undermine for eyebrow repair?

A

Subcutaneous below the follicular unit (above the muscles to avoid injury to sensory nerves)

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49
Q

During what trimester should non-urgent procedures be done

A

Second trimester

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50
Q

What is an allergic contact allergen found in hydrocolloid dressings

A

Colophony: hydrogenated resin

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51
Q

Name the allergen: found in the rubber in elastic dressings

A

Carba

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52
Q

What are the high risk factors in SCC (BWH)

A
  1. diameter >2 cm
  2. poorly differentiated histology
  3. perineural invasion of at least 0.1 mm
  4. invasion beyond subq fat
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53
Q

BWH T1-T3 SCC

A

T1: 0 high risk factors
T2a: 1 high risk factor
T2b: 2-3 high risk factors
T3: 4 high risk factors

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54
Q

SCC AJCC8 Staging

A

T1 <2 cm
T2 >2 cm but <4 cm
T3 Tumor >4 cm or minor bone invasion or perinueral invasion or deep invasion
T4a Tumor with gross cortical bone and/or marrow invasion
T4b Tumor with skull bone invasion and/or skull base foramen involvement

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55
Q

Name the term: suture’s ability to transfer fluid along its’ strand by wicking fluid from an immersed end to a dry end

A

Capillarity: as it increases, bacterial load increases

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56
Q

What are initial sx of lidocaine toxicity (5)?

A
  1. tinnitus
  2. lightheadedness
  3. circumoral numbness
  4. metallic taste
  5. double vision
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57
Q

What are late sx of lidocaine toxicity?

A
  1. nystagmus
  2. speech slurring
  3. muscle twitching
  4. fine tremors

Later: respiratory depression, coma

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58
Q

What two mutations can cause basal cell nevus syndrome?

What mutation does NOT result in odontogenic keratocysts

A

PTCH1, SUFU

SUFU does NOT have odontogenic keratocysts, but still has a 20x increased risk of medulloblastoma

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59
Q

Damage to what nerve: inability to raise the eyebrow, and drooping of the ipsilateral eyebrow

A

temporal branch of facial (innervation of frontalis)

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60
Q

Damage to what nerve: result in asymmetry with a crooked smile and drooling on the affected side due to injury of muscles that innervate the lip depressors

A

Marginal mandibular (branch of facial)

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61
Q

Damage to what nerve: shoulder drooping, winged scapula, inability to abduct the arm

A

spinal accessory nerve

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62
Q

Name the species that silk comes from

A

Bombyx mori (family bombycidae)

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63
Q

Name the suture: high tissue reactivity to lots of inflammation, high tissue capillarity (high infx), soft/pliable and good for mucosal surfaces

A

Silk

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64
Q

Polyglactin 910

A

vicryl

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65
Q

Poliglecaprone 25

A

monocryl

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66
Q

Why would you not want to treat verrucous carcinoma with radiation

A

fear of anaplastic transformation

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67
Q

What is the muscle that allows the eyelid to open fully

A

levator palpebrae superioris

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68
Q

What muscle may be affected if botox is injectect less than 1 cm above the eyebrow or lateral to the midpupillary line

A

levator palpebrae superioris

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69
Q

Name the med: alpha-2 adrenergic agonist that causes Muller muscles to contract and provide some compensation for the weakened levator

A

Apraclonidine

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70
Q

What is the most common complication of an interpolation flap

A

Bleeding 9%

infection 1-3%, dehiscence 0.5%, necrosis 3%

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71
Q

Trichilemmomas–name the ds and the associated cancers

A

Cowden: breast, thyroid (some melanoma)

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72
Q

Fibrofolliculomas, acrochordons, trichodiscomas–name the ds and the systemic associations

A

Birt-Hogg-Dube: renal cancer, pulmonary cysts (pneumothorax)

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73
Q

CK20

A

Merkel Cell Carcinoma

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74
Q

What is the most common virus a/w merkel cell carcinoma

A

polyomavirus

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75
Q

What type of virus is polyomavirus

A

nonenveloped, ds DNA virus

76
Q

What type of virus is parvovirus

A

single stranded DNA virus

77
Q

What 2 viruses are enveloped, double stranded DNA viruses

A

Herpes and pox

78
Q

Name (6) nonenveloped, single stranded RNA viruses

A
  1. Norwalk virus
  2. Coxsackievirus
  3. Hepatitis A
  4. Hepatitis E
  5. Poliovirus
  6. Rhinovirus
79
Q

Name (5) enveloped, single stranded RNA viruses

A
  1. Hepatitis C
  2. Yellow fever
  3. Dengue virus
  4. West Nile
  5. Rubella
80
Q

Damage to what part of the eye with PDL can lead to permanent damage

A

Retina

81
Q

What part of the eye is damaged with ablative lasers?

A

Corneal or scleral burns

82
Q

What areas of the eye are damaged by pigmented lesion laser?

A

Retina or choroid

83
Q

What is contraindicated with an allergy to bee stings

A

Hyaluronidase

84
Q

True/False: there is no evidence to justify delaying tx with hair removal, lasers, lights, vascular lasers, nonablative fractional and fractional devices in patients who are receiving isotretinoin or have received it in the last 6 months

A

True

85
Q

T/F: Topical abx may impair wound healing

A

True

86
Q

T/F: there is no difference in infection rates for mohs or reconstruction with sterile or non sterile glove use

A

True

87
Q

Plane to undermine in the scalp

A

sub galea aponeurotica in the loose connective tissue

88
Q

What part of the eye can be damaged by the CO2 laser

A

Cornea

89
Q

What type of laser damages the retina

A

visible near infrared spectrum (180-400 nm)

90
Q

What light spectrum is UVA

A

315-400

91
Q

What type of sclerosing agent induces endothelial cell damage via alterations in surface tension around endothelium

A

Detergents (ethanolamine oleate, polidocanol, sodium tetradecyl sulfate)

92
Q

What type of slcerosing agent causes direct injury via corressive action to endothelial cells

A

Chemical irritants (glycerin, polyiodide iodine)

93
Q

Damage to what nerve: inability to raise the eyebrow, drooping of the ipsilateral eyebrow, inability to close eye completely

A

Temporal branch of facial nerve–innervation of frontalis

94
Q

Damage to what nerve: asymmetry with a crooked smile, drooling on the affected side due to injury of muscles that innervate the lip depressors

A

Marginal Mandibular branch of facial nerve

95
Q

Motor or sensory: greater auricular, lesser occipital, transverse cervical

A

sensory

96
Q

What nerve is damaged and what is it a branch of in Frey’s syndrome?

A

Auriculotemporal branch of cranial nerve V in the parotid region (vasodilation and hyperhidrosis of the ipsilateral cheek when eating)

97
Q

Buccal nerve–sensory or motor

A

senosory (buccal branch of facial is motor)–decreased sensation of the skin over the cheeks

98
Q

Injury to the mental nerve

A

decreased sensation of the front of the chin and lower lip

99
Q

Name the sensory nerves of the zygomatic arch and upper cheek

A

Zygomaticofacial and zygomaticotemporal nerves

100
Q

What is best for margin control in MIS

A

Mohs and staged excision

101
Q

Name high risk features of SCC (5)

A
  1. poorly differentiated, undifferentiated
  2. sclerosing
  3. invasive with a Breslow depth of 2 mm or greater
  4. Clark level IV or greater
  5. perineural or perivascular invasion
102
Q

T/F: Any active viral or bacterial infx is a contraindication to ablative laser treatment

A

True

103
Q

Contraindications to ablative surgery (2)

A
  1. hx of keloid formation (hypertrophic scar ok)

2. personal hx of lupus or scleroderma or active inflammatory ds (family hx is ok)

104
Q

How long to wait for isotretinoin to be complete before pursuing fully ablative laser

A

6 months

105
Q

What is the artery for an Abbe flap

A

inferior labial artery

106
Q

Paranuclear dot positivity with cytokeratin (CK20) antibodies

A

Merkel Cell Carcinoma

107
Q

What is the use of CK20

A

distinguish MCC from metastatic small cell carcinoma of the lung, neuroblastoma, melanoma

108
Q

What is cutaneous lymphocyte associated antigen used for

A

positive in lymphoma cutis and absent in MCC

109
Q

rare, slow-growing sweat gland tumor eccrine (or apocrine?) differentiation

A

primary cutaneous mucinous carcinoma

110
Q

what is the most common location for primary cutaneous mucinous carcinoma

A

eyelid

111
Q

What additional work up is recommended in primary cutaneous mucinous carcinoma

A

Need to differentiate from metastatic ds: total body CT, mammogram, colonoscopy

112
Q

surgical tx of primary cutaneous mucinous carcinoma

A

excision–mohs is ineffective

113
Q

type of flap: recruitment of excess tissues, limite in their ability to redirect tension vectors

A

advancement and rotation flaps

114
Q

Injection into what muscle when trying to inject the depressor anguli oris can lead to asymmetric smile

A

Depressor labii inferioris

-avoid this via injecting laterally to the nasolabial folds to avoid overlapping

115
Q

AE a/w injection into what muscle: upper lip drop, phonation problems

A

orbicularis oris–lip sphincter weakness and incompetence in the ability to adequately purse the lips

116
Q

What muscle to inject to fix a gummy smile

A

levator labii superioris alaeque nasi

117
Q

Best way to remove hair if needed for surgery

A

Remove via clipping with scissors just prior to surgery

118
Q

What is the target of proteolysis in onabotulinumA (botox) and E

A

the light chain of botox catalyzes the proteolysis of one of the three synaptosomal-associated protein receptors 25 kd

119
Q

What is the heavy chain of botox responsible for

A

attachment to the motor nerve axon terminal and translocation across the cell membrane

120
Q

What serotype of botulinum toxin cleaves syntaxin-1

A

C

121
Q

What serotypes of botox cleave vesicle associated membrane protein

A

B, D, F, G

synaptobrevin

122
Q

What is the only absorbable suture from natural materials

A

surgical gut (sheep or cow intestines)

123
Q

What stains are positive in Merkel Cell Carcinoma

A

cytokeratin 20 positive in paranuclear dot pattern, synaptophysin positive, chromogranin positive, CAM 5.2 positive, PanCK positive, neuron enolase positive, thyroid transcription factor-1 negative (to rule out small cell carcinoma)

124
Q

Is SNLB recommended in Merkel?

A

Yes–all cases (1/3 of cases have micrometastatic disease)

125
Q

What chemotherapy is FDA approved for tx of metastatic merkel

A

PD-L1 inhibitor (pempbrolizumab or avelumab)

126
Q

What would you like the apices of surgery angles to be

A

Less than 30 degrees

127
Q

What are the advantages of a split thickness skin graft over a full thickness skin graft (5)

A
  1. decreased metabolic demand
  2. ability to place over a recipient bed with diminished vascular supply (periosteum or perichondrium)
  3. ability to place at a recipient site at high risk of tumor recurrence (can detect this)
  4. ease of application
  5. ability to cover large defects
128
Q

Disadvantages of spit thickness skin graft compared to full thickness skin graft

A
  1. suboptimal cosmetic outcome
  2. loss of adnexal structures
  3. increased graft contraction
  4. presence of a granulating donor site in the post op period
129
Q

What is the cause of transient post-inflammatory hyperpigmentation in laser tx

A

inadequate cooling (skin types III-V)

130
Q

Pre and post tx with what can prevent PIHyper

A

hydroquinone, sunscreen

131
Q

What nerve damage causing flattening of the forehead and drooping on the affected side eyebrow

A

Temporal nerve (care to undermined the superficial subcutaneous plane and to avoid extensive cautery)

132
Q

Preferred level of undermining for nasal bilobed flap

A

subnasalis (submuscular)

133
Q

CD34 and CD31 positive

A

Kaposi’s sarcoma

134
Q

S100+, vimentin+, HLA-DR, FcC3b, CD1a

A

Langerhan’s cell histiocytosis (histiocytosis X)

135
Q

CD30+

A

Lymphomatoid papulosis

136
Q

CK20+, ethidium monazide synaptophysin, neuron-specific enolase and neurofilaments

A

Merkel Cell Carcinoma

137
Q

What two conditions are CD34+

A

DFSP, Kaposi’s sarcoma

138
Q

Stain to use on Mohs for melanoma

A

MART-1

139
Q

How many mg is in 1% lidocaine

A

10 mg/mL

140
Q

What is the thermal relaxation time of a given target equal to

A

square of the diameter of the target, expressed in seconds

141
Q

Name the nerve: frontalis, upper orbicularis oculi, corrugator supercilii muscles

A

Temporal branch of facial

142
Q

What wave length of laser is most likely to cause damage to the retina

A

400-1400 nm

143
Q

Damage to what: Q switched laser to a ‘popping’ sound by the patient

A

due to photoacoustic disruption of the retina

144
Q

What is the medium of an excimer laser

A

xenon and chloride gas

145
Q

Innervation of levator palpebrae superioris

A

oculomotor nerve III–lifts the upper eyelid

146
Q

Path of temporal branch of facial nerve

A

Crosses the zygomatic arch and travels along the deep surface of the temporoparietal fascia and under the superficial musculoaponeurotic system (SMAS)

147
Q

Take another layer or close: Folliculocentric basaloid proliferations (FBP) are irregular strands of basaloid cells emanating from the upper portion of hair follicles

A

Close: reactive phenomenon–normal skin, margins of BCC, various neoplastic and non-neoplastic skin conditions

148
Q

Key stitch in rhombic transposition

A

closes secondary defect (end of the curve)

149
Q

What meds in HIV to lipoatrophy

A

thymidine analogs, nucleoside reverse transcriptase inhibitors in combination with protease inhibitors

150
Q

What are the FDA approved fillers for HIV lipoatrophy

A

poly-l-lactic acid (Sculptra; Galderma) and calcium hydroxylapatite filler (Radiesse)

151
Q

What are hyluronic acid fillers FDA approved for

A

injection into the mid-to-deep dermis for the correction of moderate to severe facial wrinkles and folds

152
Q

Nonabsorbable microspheres that stimulate fibroblasts to encapsulate each microsphere and augment tissue volume by fibroplasia

A

Polymethylmethacrylate filler

153
Q

FDA approved silicone oil

A

Only for intraocular ophthalmic use–not approved for filling face or body contouring

154
Q

Tx of AFX

A

Mohs

155
Q

What strength of salicylic acid is safe to use in skin of color

A

up to 30% without PIPA

156
Q

Glycolic up to what percent is superficial

A

50%

157
Q

TCA peel of what percent is deeper superficial peel

A

10-30% (over 35% medium to deep)

158
Q

Common cause of standing cones (dog ears)–4

A
  1. large apical angles
  2. excision on a convex surface
  3. excess subq tissue at the apical edges
  4. sides of unequal length during surgical planning
159
Q

What abx can coat sutures

A

Triclosan (does not cross react with penicillin)

160
Q

What is the only biterminal device

A

Electrosection

161
Q

What is the key stitch in advancement flaps

A

Closure of the primary defect

162
Q

What makes incobotulinum toxin A unique

A

Prior to opening–no refrigeration and it does not contain complexing proteins

163
Q

Why would onabotulinum toxin A be good in DM patients

A

no sugar moiety

164
Q

What botox contain dried serum albumin

A

inco, abobo, onabotulinum

165
Q

Name the toxin: inhibit the release of acetylcholine at neuromuscular junctions by cleaving SNAP-25

A

A

166
Q

Name the toxin: inhibits the release of acetylcholine through cleavage of synaptorbrevin

A

B

167
Q

Name 2 deep peels

A

Jessner solution TCA>50% and Baker Gordon phenol-croton oil peel

168
Q

Medium depth Jessner-TCA peel

A

35%

169
Q

Name the paramedian forehead flap artery

A

supratrochlear artery

170
Q

Next step to dx as met of BCC

A

biopsy (ie core bx of iliac crest lesion)

171
Q

Mohs to the scalp (name the dx): SOB, confusion, HA, seizures, loss of consciousness, neurologic sx (facial droop, hemiplegia, hemiparesis)

A

Air embolism-exposed bone to negative pressure gradient to pull air into the diploic spaces

172
Q

Name the sclerosing agent: works through formation of amphiphilic micelles that cause death to endothelial cells by extracting and denaturing their cell surface proteins

A

polidocanol–a detergent

173
Q

Name two chemical irritants

A

Glycerin and polyiodinated iodine

174
Q

What is the most important factor affecting full thickness skin graft: diabetes, nutritional deficiency, HTN, atherosclerosis, cigarette smoking

A

Smoking

175
Q

What is contraindicated in surgery with uncontrolled hyperthyroidism and pheochromocytoma

A

Epinephrine–causes dysrhythmias, tachycardia, thyrotoxic crises

176
Q

What type of sclerosant is contraindicated in a patent symptomatic foramen ovale

A

Foam sclerotherapy

177
Q

What is the preferred lenght: width ration for a elliptical excision

A

3:1 and 4:1

178
Q

What muscle can be affected leading to eyebrow ptosis with injections to frontalis

A

Diffusion into the levator palpebrae superioris

179
Q

What is the result of rare injection into the superior rectus muscle

A

Impaired gaze and diplopia

180
Q

How deep should a nail matrix bx extend

A

to the periosteum

181
Q

Where does the artery come from for an Abbe flap

A

Pedicle is created from the contralateral lip and sutured into place (axial flap)

182
Q

What two stitches for wounds under tension

A

Pulley stitch

Subq inverted cross mattress stitch

183
Q

Laser for solar lentigo

A

QSwitched Nd:YAG 532 nm (could also do QSwitched ruby 694 nm, Q Switched alexandrite 755 nm, or IPL)

184
Q

What do you tx with the excimer laser

A

Inflammatory skin conditions–psoriasis and vitiligo

185
Q

What is the safest hair removal laser for darker skin types

A

1064 nm Nd: YAG laser

186
Q

Where is Erb’s Point? What is there?

A

Midpoint of the posterior border of the sternocleidomastoid–superficial branches of the cervical plexus (greater auricular nerve, lesser occipital, transverse cervical, supraclavicular)

Peds Core Exam (2 decks)

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