surgical complications

Question 1

what drugs might give you a morbilliform rash and arthralgias 3 days later if Mono was treated with it.

Answer 1

ampicillin, amoxicillin azithromycin (3As)

Question 2

how long can perichondritis and chondritis last after a wedge excision of the ear.

Answer 2

2 months

Question 3

For a cartilage post op ear infection what two Fluoroquinolones could be chosen for treatment?

Answer 3

Cipro ciprofloxacin
levofloxacin

Question 4

What is this condition called

Answer 4

Erosive pustular dermatosis of the scalp

Question 5

How is erosive pustular dematosis of the scalp treated.

Answer 5

High potency topical steroids.

Dapsone and calcineurin inhibitors as well as a second line treatment

Question 6

what is the main cardiac complication of Bupivacaine

Answer 6

Bradycardia

Question 7

If someone is having an arrythmic reaction to Bupivacaine what can be given to correct it.

Answer 7

lipid emulsion

Bupivacaine is highly lipid soluble

Question 8

increasing Lipid solubility of an anesthetic does what

Answer 8

Increases the potency

(penetrates the nerve better)

Question 9

what are the four branches of the facial artery

Answer 9

angular

lateral nasal

superior labial

inferior labial

Question 10

Should tension vectors be horozontial or perpendicular to a free margin

Answer 10

Perpendicular

Question 11

What is this condition

Answer 11

levamisole cut cocaine toxicity

It is an anti helminthic for pets

Question 12

If prophylactic antibiotic is needed what is most commonly used

Answer 12

2 grams Cephalexin 30-60mins prior to keratinized skin surgery.

Question 13

what is the antibiotic prophylaxis for mucosal surfaces that meet criteria

Answer 13

2 grams amoxicillin 30-60min prior to the procedure

Question 14

What are the four stages of hematoma formation

Answer 14

First stage- early development - if not removed later phases occur <48 hours

Second Stage- Gelatinous day2-3

Third stage - Organization hard and rubbery- difficult to get out day 3-5

4th stage- Liquifaction 7-10 days

Question 15

What is Frey’s Syndrome

Answer 15

Gustatory sweating due to auriculotemporal nerve damage.

Question 16

What four classes of drugs can potentiate side effects of epinephrine?

Answer 16

Beta Blockers

MAO inhibitors

Tricyclic antidepressants

Phenothiazines

Question 17

circumoral numbness is associated with what complication during surgery?

Answer 17

lidocaine toxcity

Question 18

What is the dtug of choice if you can’t give cephalexin 2gms 30-60mins prior to surgery due to a PCN and possible cross rxn

Answer 18

Clindamycin 600mg one hr prior to surgery.

Question 19

which has a higher rate of infections secondary intention healing or first intention healing

Answer 19

Secondary intention healing

Question 20

What is the risk for infection primary intention vs secondary intention

Answer 20

3.2 % vs 6.8%

Question 21

what is the rate of infection face vs leg

Answer 21

2.5% vs 10.5%

Question 22

What are three things to know about intralesional injection of clindamycin to prevent post op infections

Answer 22

Lower systemic absorption than oral

No increase in antibiotic resistance

decreased GI effects

Question 23

what areas of the body have a higher rate of surgical infections

Answer 23

nose lips ears

lower leg and feet

groin

Question 24

what is the most common cultured bacteria in surgical wound infections

Answer 24

Staphlococcus aureus

Question 25

Name three anticoagulants that have more post op bleeding than coumadin aspirin and plavix

Answer 25

Apixaban - Eliquis bid Rivaroxaban - Xarelto qd factor Xa inhibitor Dabigabtran - Pradaxa bid thombin inhibitor

Question 26

what is the treatment for overdose of apixaban and Rivaroxaban

Answer 26

Eliquis & Xerelto Factor Xa Andexxa

Question 27

what is the treatment for overdose of dabigatran

Answer 27

Pradaxa Idarucizumab (Praxbind)

Question 28

what vascular problem causes the quickest flap necrosis

Answer 28

venous congestion can occur in less than 4 hours order edema-capillary slowing- thrombosus arteries and veins- ischemia- necrosis

Question 29

how to tell veinous congestion from arterial insufficiency

Answer 29

11 blade prick will not bleed in arterial insuffieceny and will ooze dark purple blood in venous congestion Venous congestion will be cyanotic or purple flap Arterial insufficeny will be pale

Question 30

what is trigeminal trophic syndrome and how is it treated.

Answer 30

anesthetic ucler on upper lip or more commonly ala with nasal tip sparing Multiple treatments exist anti depressants bolsters Steroids flap anticonvulants gabapentin and pregbalin

Question 31

what foods do laxtex cross react allergically

Answer 31

Bananas Avocado chestnut Kiwi and Passion Fruit

Question 32

What is a serious risk for surgery on the nasal sidewall

Answer 32

the opthalmologic veins drain into the cavernous sinus. Septic thrombosis can occur with meingitis and brain abcesses

Question 33

What is the maxium dose of Lidocaine with epi for tumescent anesthesia?

Answer 33

55mg/Kg

Question 34

LAST (Local and Systemic Toxcisity) can occur in over 60 minutes in what % of patient that get it.

Answer 34

25% 40% at 10 minutes

Question 35

What are early symptoms of LAST from lidocaine.

Answer 35

perioral numbness paraesthesias tinnitus tremor all signs of CNS stimulation followed by CNS inhibition then cardiac stimulation followed by inhibition

Question 36

antibiotic prohylaxis is reccomended for high risk surgical site infection in all cases what are the high risks 6

Answer 36

lower extremity Groin Wedge excisions lip or ear Flaps on the nose Grafting Extensive inflamatory disease.