Surgery Chapter 8 Flashcards
Which of the following is advised to be used in chronic delayed pressure urticarial:
A. Colchicine
B. Sulfasalazine
C. Nifedipine
D. Epinephrine
B. Sulfasalazine
Vorinostat, used for a Sezary syndrome, mechanism of action?
Inhibition of the histone deacytylase
Merkel cell carcinoma has been linked to Which of the following?
A. Herpes virus
B. CMV
C. Flavi virus
D. Polyoma virus
D. Polyoma virus
One of the following inherited disorder with abnormal DNA repair has mismatch DNA repair:
A. XP
B. Cockayne syndrome
C. XP – CS overlap
D. Trichothiodystrophy
E. Muir-Torre syndrome
E. Muir-Torre syndrome
Treatment of choicefor delusion of parasitosis A. Doxepin
B. Naltrexone
C. Pramoxetin
D. Pimozide
E. Fexofenadine
D. Pimozide
Deuteranopia (green color blindness) is an ocular abnormality seen in:
A. Langerhans cell histiocytosis
B. EED
C. Fabry
D. Pseudoxanthoma elasticum
E. X- linked ichtyosis
E. X- linked ichtyosis
Multiple layers of granular cells surrounding sweat ducts in the epidermis is characteristically seen in:
A. KID syndrome
B. Erythrokeratosis variabilis
C. CHILD syndrome
D. Netherton’s syndrome
C. CHILD syndrome
S100, CD1, CD68+, Langerin –ve is the immunologic profile of:
A. Benign cephalic histiocytosis
B. Langerhans cell histiocytosis
C. Generalized eruptive histiocytosis
D. Juvenile xanthogranuloma
E. Indeterminate cell histiocytosis
E. Indeterminate cell histiocytosis
Microbiology of Hand-foot-mouth?
Positive-sense RNA virus
Frey syndrome?
Injured parasympathetic nerves erroneously reattach to sweat glands in area resulting in “sweating while eating”
Exceeding > 8 mL per digit causes?
Risk of tourniquet effect, limit 2-4 mL total per digit
Gummy smile muscle?
Levator labii superioris
Cutaneous danger point, Erb’s point, causes?
Winged scapula, inability to abduct arm, and shoulder pain
Erb’s point = site where cervical plexus emerges; located along posterior border of SCM
Mechanism of local anesthetics?
Inhibition of sodium ion influx → prevents depolarization → blocks nerve conduction
Where are amide anesthetics metabolized?
“two ‘I’s’ = amIde”
Metabolized via CYP 3A4 in liver
How are esters metabolized?
via pseudocholinesterases in plasma, renally excreted
Ester anesthetics cross react with?
Mnemonic “PPPESTAA”: Paraphenylenediamine (PPD)
PABA
Para-aminosalicylic acid
Ethylenediamine
Sulfonamides
Thiazides
Anesthetics (esters)
Azo dyes
Contraindications to esters?
Allergy to PABA or cross-reactors, pseudocholinesterase deficiency
Anesthetic with longest duration of action?
Bupivicaine
Highest risk of cardiac toxicity!
Risk of fetal bradycardia
Disadvantages of epinephrine in lidocaine in pregnancy?
↓uterine bloodflow, pregnancy category C but diluting to 1:300,000 considered safe
Contraindications to epinephrine in lidocaine?
Pheochromocytoma, uncontrolled HTN, digital anesthesia in severe PVD, and uncontrolled hyperthyroidism
1% lidocaine is basically?
10mg/mL
Injection techniques to decrease pain with local anesthesia?
■ Buffer w/ bicarbonate
■ Warm anesthetic to body temperature
■ Pretreat w/ topical anesthetics or ice packs
■ Use small diameter needle (30 gauge)
■ Mildly irritate (pinch, rub, Buzzy, ShotBlocker) surrounding skin at the time of injection → decreases transmission of pain signals to brain (“Gate theory” of pain)
■ Inject slowly, starting deep in SQ → gradually move superficial
■ Reintroduce needle at previously anesthetized areas and fan out
■ Music and mental distraction
Preservatives in amides and esters?
Methylparaben or metabisulfite preservatives in amides
PABA in esters
Gold-colored instrument handles indicate?
Tungsten carbide, harder and more durable than stainless steel
Vertical mattress is for?
Vertical = eVert
Horizontal mattress is for?
Horizontal = Homeostasis
Also, running locked sutures provide homeostasis
Purse string suture is for?
↓ wound size and ↓ healing time
Wounds under high tension, can use?
Buried pulley suture
Disadvantage = tissue strangulation
Dermabond is?
Octyl: 2-octyl cyanoacrylate
Liquiband, wound adhesive, is?
Butyl: n-butyl cyanoacrylate (dries faster than derma bond) but more rigid
Examples of absorbable sutures?
Vicryl, chromic gut, PDS, monocryl, plain gut
High tissue reactivity is observed with which suture?
Plain gut, and second highest is silk
Least inflammation is prolene - best for subcuticular sutures
What antiseptic agent is active against spores?
Iodine and iodophors, must wait until dry to be effective
Which antiseptic agent is teratogenic?
Hexachlorophene, causes neurotoxicity too
Biterminal means?
Probe held at a distance (1–2 mm from tissue) → ionized current between probe and tissue “spark gap” is what type?
Electrofulguration
Monoterminal device (e.g., hyfrecator)
Cell types and their freezing times?
○ Melanocytes: –5°C
○ Keratinocytes: –20°C to –30°C
○ Fibroblasts: –35°C to –40°C
○ Benign: –25°C
○ Malignant: –50°C
Nitrogen boiling point: -196
M-plasty is used to?
To shorten length of excision such that the incision does not extend into an undesired location; common uses: near free margins (perioral and periocular regions)
S-plasty is used to?
↑ total length of scar, but the linear distance between two apices remains same as linear closure; redistributes tension along different vectors → ↓ tension in central portion of scar → ↓ risk of centrally depressed scar, ↓ dehiscence, and ↓ contraction of scar; common uses: convex surfaces (forearm and shin) and excisions that cross over a joint (elbow and knee)
Maximum strength of a scar?
80%*
■ 1week = 5%
■ 2 weeks = <10%
■ 1 month = 40%
Ectodermosis Pluriorificialis is a type of:
A. Erythema multiforme minor
B. Erythema multiforme major
C. Mucosal erythema multiforme
D. Herpes associated erythema multiforme
E. Drug associated erythema multiforme
C. Mucosal erythema multiforme
Type of angiokeratoma associated with Cobb syndrome is:
a. Angiokertoma corporis diffusum
b. Angiokeratoma of Fordyce
c. Solitary papularangiokeratoma
d. Angiokeratoma of Mibelli
e. Angiokeratoma circumscriptum
e. Angiokeratoma circumscriptum
Roseola infant is caused by?
HHV-6
“Rose with 6 petals”
Primary effect of local anesthetics on never cells is to inhibit or enhance the depolarization phase of the excitation process?
INHIBIT the depolarization*
Gene for tuberous sclerosis is localized on which chromosomes?
9 and 16
Final concentration of epinephrine in standard tumescent anesthesia is?
1: 1,000,000
Herbs and supplements that enhance anticoagulation effects of warfarin?
Feverfew, fish oil, garlic, ginger, ginkgo, ginseng, bilberry, chondroitin, vitamin E, licorice, devil’s claw, danshen, dong quai, alcohol
Hydorgels used for?
Painful wounds
Alginates used for?
Highly exudative wounds,
