Abscesses, Pilonidal Disease and Skin Conditions Flashcards
What is an abscess?
1 - sac filled with fluid lined by epithelial cells
2 - fluid filled sac lined by granulation tissue
3 - pus filled collection lined by only epithelial cells
4 - pus filled collection that can be lined by any cells
4 - pus filled collection that can be lined by any cells
- can occur anywhere in the body
What is pus?
1 - dead tissue
2 - immune cells (normally neutrophils)
3 - bacteria
4 - all of the above
4 - all of the above
Abscess in the UK are commonly caused by bacteria. What is the most common bacteria that causes abscesses?
1 - staphylococcus aureus
2 - streptococcus
3 - enterobacteriaceae
4 - legionella
1 - staphylococcus aureus
What is the incidence of abscesses?
1 - 0.5 / 1000
2 - 5 /1000
3 - 50 / 1000
4 - 500 / 1000
3 - 50 / 1000
Abscesses can form from pre-existing pathology. Which of the following is NOT commonly associated with causing a cyst?
1 - Epidermal cyst
2 - Pilonidal sinus
3 - Erysipelas
4 - Fistula
5 - Foreign body/device
3 - Erysipelas
- skin infection affecting the dermis layer of the skin
Patients who are immunocompromised are at risk of abscess formation as they struggle to fight off infection and form a fibrinogen capsule around the infection, immune cells and dead tissue. In addition to a reduced immune system, which of the following is NOT a risk factor for abscess formation?
1 - breach of skin
2 - gender
3 - smoking
4 - obesity
2 - gender
- skin breaches are due to:
- Iatrogenic (e.g. surgery)
- Intravenous drug users (up to 65% IVDUs will get abscesses)
- Foreign body
- Trauma
There are several mechanisms involved in abscess formation. Arrange the following, in order of what most common mechanisms:
1 - pus if formed (liquefactive necrosis) causing local necrosis
2 - some bacteria killed, others resistant to phagocytosis
3 - pyogenic (pus forming) bacteria introduced to tissue
4 - fibrinogen surrounds pus containing it
5 - cytokines releases attracting neutrophils
3 - pyogenic (pus forming) bacteria introduced to tissue
5 - cytokines releases attracting neutrophils
2 - some bacteria killed, others resistant to phagocytosis
1 - pus if formed (liquefactive necrosis) causing local necrosis
4 - fibrinogen surrounds pus containing it
Even though fibrinogen and other immune cells have contained the bacteria in an abscess, there are still live bacteria which in addition to local necrosis can spread and typically can cause which 2 of the following?
1 - sepsis
2 - erysipelas
3 - cellulitis
4 - cyst
1 - sepsis
3 - cellulitis
- the pus can reach epithelial surface, discharge and spread, resulting in cellulitis and sepsis
When we suspect an abscess we may see the 5 cardinal signs of inflammation. Which one is NOT one of the 5 signs?
1 - Calor (warmth)
2 - Rigor (stretch)
3 - Dolor (pain)
4 - Rubor (redness)
5 - Tumour (swelling)
6 - Functio Laesa (loss of function)
2 - Rigor (stretch)
In addition to the 5 cardinal signs of inflammation we may also see the following in an abscess:
1 - pointing (abscess comes to a point)
2 - cellulitis that spreads
3 - fever and systematically unwell
4 - advanced changes with necrosis
Although most diagnose of abscess are through clinical judgement, which imaging modality can be used to check 1st?
1 - ultrasound
2 - MRI
3 - CT
4 - X-ray
1 - ultrasound
- 1st choice
- BUT CT or MRI may be needed to check for internal abscess formation post-operatively
Which 2 of the following would be a conservative management be for the treatment of an abscess?
1 - percutaneous drainage
2 - surgical drainage
3 - antibiotics
4 - wait and see
3 - antibiotics
4 - wait and see
- some abscess point and just discharge and heal by secondary intention
Which 2 of the following would be a non-conservative management be for the treatment of an abscess?
1 - percutaneous drainage
2 - surgical drainage
3 - antibiotics
4 - wait and see
1 - percutaneous drainage
2 - surgical drainage
- depends on the location
- sample of pus may be helpful if ongoing pathology
If an abscess becomes recurrent or chronic despite treatment, what does this suggest?
1 - poor drainage
2 - antibiotic resistant
3 - ongoing pathology
3 - ongoing pathology
What is pilonidal disease?
1 - piles (haemorrhoids)
2 - chronic abscess
3 - percutaneous inflammation
4 - inflammatory skin infection
4 - inflammatory skin infection
- pilus = hair
- nidus = nest
- skin becomes infected, likely to contain hair and debris
Pilonidal disease can affect multiple places in the body, but which of the following is most common?
1 - axila
2 - scalp
3 - natal cleft
4 - between fingers
3 - natal cleft
- deep groove between the buttocks
What is the incidence of pilonidal disease?
1 - 0.25 / 100,000
1 - 2.5 / 100,000
1 - 25 / 100,000
1 - 250 / 100,000
1 - 25 / 100,000
- most common ages 15-40
Is pilonidal disease more common in men or women?
- men
- 2-4 times more common
Which of the following is NOT a risk factor for pilonidal disease?
1 - black ethnicity
2 - hirsutism (excessive hair growth in females)
3 - obesity
4 - deep natal cleft
1 - black ethnicity
- more common in white ethnicity
Although the exact mechanism of pilonidal disease is unknown, it is suspected that the following occurs:
1 - loose hair is trapped in natal cleft skin
2 - pit forms (start of a fistula)
3 - pit fills with debris and hair
4 - chronic inflammation follows causing sinus formation
5 - subsequent midline or lateral openings form
Which of the following is NOT a common clinical presentation of pilonidal disease?
1 - always symptomatic
2 - acute abscess (50% will develop a chronic sinus)
3 - intermittent swelling or discharge
4 - pain
1 - always symptomatic
- lots of patients can remain asymptomatic
If the pilonidal disease becomes symptomatic it will need to be treated. Treatment includes:
1 - remove pits
2 - remove abnormal skin +/- closure +/- flatten natal cleft
3 - skin flaps may be needed if significant skin loss
What is the recurrence following this procedure?
1 - 0.15 - 0.4%
2 - 1.5 - 4%
3 - 15 - 40%
4 - >65%
3 - 15 - 40%
When assessing a patients skin condition, we need to ask lots of questions. Which of the following is NOT a common questions about the patients presenting problem?
1 - Age
2 - Duration?
3 - Changing or stable?
4 - Increasing size and if so, how fast?
5 - Associated symptoms (pain, itching, bleeding)?
6 - Colour change?
1 - Age
When we examine a patients skin problems, we need to do the following:
1 - assess site (anatomical lesions like pilonidal sinus) or skin exposure
2 - layer of skin involved
- epidermal lesions are visual
- dermis or deeper lesions may have normal epidermis
- skin punctum suggests epidermal appendage
3 - margins are important for:
- regular and discrete lesions are likely cysts
- deep tethering suggests deep origin
-superficial tethering suggests skin appendage lesion
4 - consistency:
- soft = lipoma or cyst
- hard = inflamed or malignant
5 - Pulsatility
- direct (arterial lesion)
- transmitted (lesion overlies an artery)
6 - Emptying
- venous lesions (e.g. saphena varix) empty or blanch on pressure and refill
7 - Transillumination
- fluid of solid filled
8 - Temperature and colour
- redness or warmth may suggest infection or inflammation (or sometimes vascular origin)
- pigmentation can be uniform or irregular may suggest benign or malignant
Which imaging modality is most commonly used when clinical diagnosis is difficult in skin lesions?
1 - CT
2 - MRI
3 - X-ray
4 - ultrasound
4 - ultrasound
- CT and MRI occasionally
What is a needle biopsy?
1 - large sample taken percutaneously
2 - small sample taken percutaneously
3 - surgical biopsy taken
4 - removal of whole abnormal skin lesion
2 - small sample taken percutaneously
- only good for cytology
- cellular information but no structural details
What is a core biopsy?
1 - large sample taken percutaneously
2 - small sample taken percutaneously
3 - surgical biopsy taken
4 - removal of whole abnormal skin lesion
1 - large sample taken percutaneously
- provides tissue and cellular information
What is a incisional biopsy?
1 - large sample taken percutaneously
2 - small sample taken percutaneously
3 - surgical biopsy taken
4 - removal of whole abnormal skin lesion
3 - surgical biopsy taken
What is a excisional biopsy?
1 - large sample taken percutaneously
2 - small sample taken percutaneously
3 - surgical biopsy taken
4 - removal of whole abnormal skin lesion
4 - removal of whole abnormal skin lesion
Why do we need to be very careful when taking biopsies?
1 - pain for patient
2 - if malignant can cause seeding
3 - aesthetics following biopsy
4 - request of patient
2 - if malignant can cause seeding
Epidermal lesions include skin tags, warts and naevia (birth marks/moles). Do these need to be treated?
- generally no unless they become symptomatic
An epidermoid cyst, classed as a cystic lesion of the skin, also called a sebaceous cyst, but not arising in the sebaceous glands are benign growths on the skin. What are they commonly filled with?
1 - blood
2 - immune cells and dead tissue
3 - sebum and keratin
4 - hair
3 - sebum and keratin
- rarely need treating unless they become symptomatic
What is a dermoid cyst?
1 - lesion of the dermis
2 - pus fulled collection within the dermis
3 - necrotic tissue of the dermis
4 - remnants of embryonic tissue
4 - remnants of embryonic tissue
- collect under under the dermis
- can become inflamed and infected, so need removing
What is a lipoma?
1 - benign tumours of fat
2 - infection of a lymph node
3 - malignant tumours of fat
4 - infection of the lymphatics
1 - benign tumours of fat
Lipomas are generally benign tumours of fat. Which of the following is NOT true about lipomas?
1 - occur anywhere on the body
2 - vary in size and shape
3 - soft to palpation
4 - always symptomatic
4 - always symptomatic
- generally they are asymptomatic
- may need removing if growing, symptomatic or unsure of diagnosis
What is a ganglia?
1 - mucin filled cyst connected to joint capsule or tendon
2 - pus fulled collection within the dermis
3 - necrotic tissue of the dermis
4 - remnants of embryonic tissue
1 - mucin filled cyst connected to joint capsule or tendon
- normally form and attached to deeper tissues
- can heal or need drainage or surgical excision
