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ABSITE > Burn & Skin > Flashcards

Burn & Skin Flashcards

1
Q

what burns can heal by epithelialization (no graft needed)?

A

1st and superficial second

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2
Q

admission criteria for burn

A

TBSA > 10% <10YO or >50YO
TBSA > 20% 10-50 YO
3rd degree > 5% in any age group
electrical, chemical, inhalational, trauma, comorbid, rehab needs, NAT suspected

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3
Q

difference betweern superifical and deep second degree burn?

A

superficial PAPILLARY - pianful, blisters, hair follicles INTACT

deep RETICULAR - decreased sensation, loss of hair follicles

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4
Q

Parklands formula - when to use?

A

for 20%+ TBSA of 2nd degree or 3rd degree

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5
Q

Parklands formula

A

4 cc/kg x TBSA x kg; 1/2 in first 8 hrs other 1/2 in 16 hours LR.

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6
Q

main risk factor for PNA in burn patient?

A

inhalational injury

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7
Q

how to dx inhalational injury if suspected (facial burn, wheezing, carbonaceous sputum)

A

fiberoptic bronchoscopyt

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8
Q

when to use albumin in resuscitation

A

only after 24 hours (decrease pulmonary complications)

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9
Q

types of necrosis in alkali vs acid?

A

alkaline: liquefaction necrosis
acid: coagulation necrosis

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10
Q

tx chemical spill?

A

water irrigation

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11
Q

hydrofluoric acid burn?

A

CALCIUM-gluconate gel on wound.

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12
Q

powder burn?

A

wipe away powder then irrigate

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13
Q

tar burn?

A

cool then wipe with lipophilic solvent

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14
Q

electrical burn

A

watch for polyneuritis demyelinixzation, quadriplegia, transverse myelitis, cataracts, liver necrosis, bowel perf, GB perf, necrotizing panc, posterior shoulder dislocation, vertebral body fracture… get CARDIAC MONITORING

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15
Q

lightning cause of death

A

arrest 2/2 Vfib

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16
Q

child abuse burn cases

A

15% of burn cases

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17
Q

blood flow from graft to burn?

A

0-3 days: imbibition (osmotic) - inosculation
3+ day: neovascularization

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18
Q

how long do homografts (cadaveric) last?

A

4 wks, then are rejected once vascularized

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19
Q

xenografts last?

A

2 wks but do not vascularize

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20
Q

what has less wound contraction? FTSG vs STSG?

A

FTSG; use for hands

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21
Q

STSG dermatome thickness

A

0.12-0.15 mm

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22
Q

how long to immobilize after FTSG?

A

7 days.

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23
Q

infected burn wound

A

no ppx required but
cover PSEUDOMONAS > Staph, E.coli, enterobacter coverage if infected

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24
Q

MC cause of viral infection

A

HSV

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25
Q

ectopia eye burn

A

release eyelid

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26
Q

corneal abrasion

A

can do fluorescin staining.

tx: topical fluoroquinolone or gentamicin

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27
Q

symblepharon

A

eyelid stuck to conjunctiva

release with glass rod

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28
Q

heterotopic ossification of tendons tx

A

physical therapy … may need OR

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29
Q

silvadene SE?

A

silver sulfadiazine…
NEUTROPENIA, THROMBOCYTOPENIA
sulfa allergy

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30
Q

silvadene penetrate eschar?

A

no…. can inhibit epithelialization

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31
Q

pseudomonas coverage for silvadene?

A

none.

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32
Q

silver nitrate SE

A

electrolytes… hyponatremia, hypochloremia, hypoCa, hypoK
also methemoglobinemia esp with G6PD deficiency

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33
Q

silver MOA

A

ribosomal toxicity, intercalates into DNA, denatures proteins,disrupts bacterial cell membrane

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34
Q

eschar and silver nitrate?

A

no…

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35
Q

pseudomonas coverage by silver nitrate?

A

none

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36
Q

sulfamylon (mafenide sodium) SE

A

painful… METABOLIC acidosis (in renal)

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37
Q

eschar and sulfamylon?

A

great penetrance

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38
Q

pseudomonas coverage by sulfamylon?

A

great!

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39
Q

curling vs marjolin ulcer

A

curling: ulcer after/in the setting of burn
marjolin: highly malignant squamous cell cancer in scar/old burn

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40
Q

tetanus shot in burns and frostbite

A

don’t forget

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41
Q

path in erythema multiform>SJS>TEN and SSSS

A

epidermal-dermal separation

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42
Q

SJS, TEN, multiforme, SSSS

A

no steroids
consider supportive, fluids and IVIF +/-

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43
Q

langerhans cells

A

dendritic cellsof skin
act as APCs (MHC class II)
originate from BONE MARROW
role in type IV hypersensitivity

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44
Q

pacinian corpuscle sensation

A

pressure

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45
Q

ruffinis endings sensation

A

warmth

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46
Q

krauses end bulbs sensation

A

cold

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47
Q

meissners corpuscle sensation

A

tactile sense

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48
Q

cause of flap necrosis

A

venous thrombosis mostly

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49
Q

TRAM flap vessels

A

superior epigastric vessels

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50
Q

viability of TRAM determined by what?

A

periumbilical muscle perforators

51
Q

pressure sore stages I-IV

A

I. erythema and pain (tx: offload)
II. partial skin loss with yellow dermis showing (offload, local tx)
III. full thickness, fat showing (tx: sharp debride possible myocut flap)
IV. bone, muscle, adipose, tendon (tx: myocut/glut flap)

52
Q

biggest risk factor for melanoma

A

large congenital nevi, >50 typical nevi, dysplastic or atypical nevi 10% lifetime risk
xeroderma pigmentosum
fair complexion, etc.

53
Q

familial syndrome with melanomas?

A

BK mole syndrome (100% risk)

54
Q

superficial parotidectomy

A

scalp and face melanomas anterior to tragus and above lower lip… 1+ mm deep including of the ear.

55
Q

melanoma in situ or thin lentigo maligna (Hutchinsons freckle

A

0.4 cm margin is good

56
Q

lentigo maligna melanoma

A

least aggressive… radial growth first and presents as elevated nodule

57
Q

superficial spreading melanoma

A

MC type… originates from nevus/sun exposed

58
Q

acral lentiginous

A

very aggressive… palms/soles black.. includes subungual

59
Q

dacarbazine

A

1st line chemo for metastatic melanoma > IFN , immunotherapy /pembro/ipilimumab?, tumor vaccine

60
Q

melanoma staining

A

S-100 and HMB-45

61
Q

MC site for melanoma

A

men: back
women: legs

62
Q

lido 1% dose

A

max 7 mg/kg;
5 mg/kg with epi

63
Q

3 phases of skin grafting

A
  1. imbibition (diffusion)
  2. inosculation (anastomosis of new capillaries) 48 hrs
  3. reinnervation vs neovascularization (starts day 7 organization by fibroblasts)
64
Q

frostbite grades

A

I. superficial
II. blisters
III. necrosis
IV. gangrene

65
Q

frostbite severity

A

mild >32
mod28-32
sev <28

66
Q

frostbite sx severity

A

mild: shiver, mild AMS
mod: agitation, spasticity, dilated pupils, slow RR
sev: prolonged QRS, Osborn waves, flaccid, coma, —-> VFib

67
Q

tPA in frostbite

A

if no improvement 15-20 min active bath
if absent dopplers
if limited perfusion on 99mTc bone scan
within 24hrs of initial rewarming

68
Q

warm fluids

A

43C = 109F in microwave

69
Q

hemangioma timecourse

A

F after birth > quickly grow > quiescence > involute

70
Q

hemangioma tx

A

observe unless bleeds, ulcerates, visual obstruction, airway, CHF involvement

71
Q

glomus tumor

A

AV malformations in subungual area

sx; Pain, cold intolerance, point tenderness of blue mass

72
Q

Love and hildreth sign

A

Glomus tumor

love: extreme pain with pressure on glomus
hildreth: removal of pain with proximal tourniquet inflation

73
Q

glomus dx and tx

A

MRI or US

excision

74
Q

superficial inguinal LN dissection boundaries

A

femoral triangle = inguinal ligament above, sart laterally, adductus magnus medially, the intersection of both inferiorly

75
Q

how to extend superficial inguinal LN dissection to deep LNs

A

extend to 3-4 cm medial to ASIS

or separate transplant incision

76
Q

ifn a2b indication

A

melanoma IIB-III

77
Q

melanoma TNM staging

A

T: breslow
b = ulceration
N: N1=1, N2=2-3, N3=4+
M1a: other skin, LNs
M1b: lung
M1c: other organs

78
Q

mohs margin

A

5mm

79
Q

melanoma in situ

A

5mm-10mm

80
Q

MSLT-II trial for SLN mets

A

instead of completion LAD, just serial clinical exams and nodal basin US q4 mo x 2yrs > q6mo x 3 yrs > annual

81
Q

ehlers danlos defect

A

collagen v

82
Q

margin excision bcc and scc

LN adenectomy

A

bcc 4mm
scc 1cm

for clinically positive nodes

83
Q

BCC pathology

A

peripheral palisading nuclei and stromal retraction

morpheaform: AGGRESSIVE has collagenase production

84
Q

cloquets node

A

first of deep nodes to receive drainage from superficial inguinal nodes

85
Q

histologic zones of a burn

A

hyperemia: recoverable increased perfusion
stasis: poor perfusion, questionable recovery
coagulation: max damage, permanent

86
Q

target UOP

A

0.5 cc/kg/hr adult
1 cc/kg/hr child
2 cc/kg/hr for infant < 6 mos

87
Q

carbon monoxide poisoning sx

A

sz, AMS, lactic acidosis, arrhythmia, MIA

88
Q

CO poisoning dx and tx

A

COHg trend
tx: 100% O2 possible hyperbaric oxygen

89
Q

cyanide poisoning

A

concurrent with CO… treat with cyanokit = hydroxocobalamin

90
Q

SCIP surgical care improvement project 7 intiiatives

A
  1. avoid hyperglycemia
  2. normothermia
  3. ppx abx iwthin 60 min of incision
  4. select appropriate ppx
  5. stop abx within 24 hour of surgery end time
  6. clipper > razor
  7. remove Foley within 2 postop days
91
Q

MC bugs in NSTI

A

nec fasc: GAS
Nec myositis: GAS
nec cellulitis: C. perf or poly

92
Q

types of NSTI

A

Type I: polymicrobial
2: mono MC GAS
3: GN-marine

93
Q

pilonidal disease risk factors

A

M
BMI > 25
sitting
thick body hair

94
Q

MC sarcoma

A
  1. malignant fibrous histiosarcoma
  2. liposarcoma
95
Q

sarcoma workup

A

CXR (lung mets)
MRI (before bx for vascular/neuro/bone invasion)
CBx …if fails? then excisional (<4 cm) or longitudinal incision > 4cm

96
Q

sarcoma tx

A

1-3 cm margin and negative fascial plane ideally +/- radiation +/- neoadjuvant chemo

97
Q

sarcoma px

A

overall poor….
chemo and XRT have NOT changed survival

98
Q

5 yr survival rate with complete resection of sarcoma

A

40%

99
Q

sarcoma radiation indication

A

high grade tumor
close margins <1-3 cm
or tumors > 5 cm

100
Q

sarcoma chemo indication

A

DOXORUBICIN
tumor > 10 cm to allow for limb sparing procedure

101
Q

MC site of sarcoma met

A

LUNG

102
Q

dermatofibrosarcoma protuberans

A

MC young black pts

plaque/nodule > reddish

Tx: resection… and keep resecting with wide margins if recurs no LN staging required

103
Q

dermatofibrosarcoma protuberans chromosomal dx

A

chromosomal translocation 11&22

104
Q

Dermatofibrosarcoma protuberans histo

A

whorled spindle type cells

105
Q

dermatofibrosarcoma mets

A

LUNG&raquo_space;> fibrosarcomatous changes

106
Q

dermatofirosarcoma tx

A

WLE 2-4 CENTIMETER margin

107
Q

meckel cell carcinoma

A

rapid growing firm red purple nodule

108
Q

meckel cell carcinoma dx

A

histo = neuroendocrine

PET scan prior to resection

109
Q

meckel cell carcinoma tx

A

WLE 1-2 cm with SLNB
aduvant radiation for > 2cm or LN mets

110
Q

subungual melanoma tx

A

mid proximal phalanx amputation if finger
toe amp to metatarsal head if toe
SLNB if >1mm

111
Q

herpetic whitlow tc

A

just obs, avoid contact, no I&D

112
Q

lymphangitis MC bug

A

GAS

113
Q

MC erysipelas bug

A

GAS

114
Q

lip lower ca

A

SQUAMOUS

115
Q

lip upper ca

A

BASAL

116
Q

timing of grafting (location)

A

within first week except for:
FACE (abx first then FTSG)
HANDS FTSG
PALMS FTSG
genitals: can use STSG

and change allografts to autografts after the first week!

117
Q

kaposi sarcoma tx

A

HAART to shrink +/- XRT or intralesional vinblastine for local disease

if disseminated, use IFN-a (like for melanoma)

surgery if intestinal hemorrhage

118
Q

dermoid cyst

A

midline, intraabdominal and sacral lesions
need resection due to malignancy risk

119
Q

wart

A

viral…
tx: salicylic acid, liquid nitrogen

120
Q

actinic keratosis tx

A

excisional bx and diclofenac sodium and liquid nitrogen

121
Q

arsenical keratosis

A

associated with SCC

122
Q

merkel cell biomarkers

A

neuron specific enolase
cytokeratin
neurofilament protein

123
Q

merkel tx

A

SLNBx (all need) vs formal LN dissection
+ resection with 2-3 cm margins

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