ABFAS Clinical Procedures and Protocols 2 — Questions and Answers
Question 1: When performing a digital block for lesser toe surgery, which nerve must be anesthetized to achieve complete anesthesia of the toe?
- Sural nerve only
- Both plantar and dorsal digital nerves (Correct answer)
- Medial plantar nerve only
- Deep peroneal nerve only
Correct answer: Both plantar and dorsal digital nerves
Complete digital block requires anesthetizing both the plantar and dorsal digital nerves on each side of the toe.
Question 2: Which type of suture material is most appropriate for closing the deep fascial layers in foot surgery to minimize risk of infection?
- Chromic gut
- Silk
- Monofilament absorbable suture (Correct answer)
- Polyester braided suture
Correct answer: Monofilament absorbable suture
Monofilament absorbable sutures like PDS or Monocryl are preferred for deep layers due to lower bacterial adherence compared to braided materials.
Question 3: A patient requires excision of a ganglionic cyst on the dorsum of the foot. Which anatomical structure must be carefully identified and preserved during this procedure?
- Flexor hallucis longus tendon
- Extensor digitorum brevis muscle
- Dorsalis pedis artery and deep peroneal nerve (Correct answer)
- Posterior tibial artery
Correct answer: Dorsalis pedis artery and deep peroneal nerve
The dorsalis pedis artery and deep peroneal nerve run on the dorsum of the foot and are at risk during dorsal ganglion excision.
Question 4: During an Austin bunionectomy, what is the standard range of degrees for the capital fragment displacement?
- 1–2 mm laterally
- 3–6 mm laterally (Correct answer)
- 8–10 mm laterally
- Greater than 12 mm laterally
Correct answer: 3–6 mm laterally
The Austin (chevron) osteotomy typically displaces the capital fragment 3–6 mm laterally to correct the intermetatarsal angle.
Question 5: Which local anesthetic agent provides the longest duration of action and is commonly used for postoperative pain control in foot and ankle surgery?
- Lidocaine
- Mepivacaine
- Bupivacaine (Correct answer)
- Chloroprocaine
Correct answer: Bupivacaine
Bupivacaine has a duration of 4–12 hours, making it the preferred agent for prolonged postoperative analgesia.
Question 6: In a patient with suspected compartment syndrome of the foot following calcaneal fracture, which measurement confirms the need for fasciotomy?
- Compartment pressure above 10 mmHg
- Compartment pressure above 20 mmHg
- Compartment pressure within 30 mmHg of diastolic pressure (Correct answer)
- Compartment pressure above 50 mmHg
Correct answer: Compartment pressure within 30 mmHg of diastolic pressure
Fasciotomy is indicated when compartment pressure is within 30 mmHg of diastolic blood pressure (delta-P ≤ 30 mmHg).
Question 7: What is the primary purpose of a pneumatic tourniquet applied at the ankle level during foot surgery?
- To reduce systemic anesthetic absorption
- To provide a bloodless surgical field (Correct answer)
- To prevent deep vein thrombosis
- To stabilize the ankle joint
Correct answer: To provide a bloodless surgical field
An ankle tourniquet creates a bloodless operative field, improving visualization and reducing blood loss during foot surgery.
ABFAS Clinical Procedures and Protocols 2
When performing a digital block for lesser toe surgery, which nerve must be anesthetized to achieve complete anesthesia of the toe?