comprehensive Flashcards
Hydrofluoric acid treatment
fluoride ions bind to calcium so treat with topical calcium gel or intradermal/intraarterial calcium gluconate
Phenol burn treatment
polyethylene glycol
Phosphorus burn treatment
stain with 0.5% copper sulfate and surgically remove
Silver sulfadiazine (silvadene)
side effect transient leukopenia
Mafenide acetate (sulfamylon)
carbonic anhydrase inhibitor.
side effect acidosis
penetrates deeply
painful
Silver nitrate
side effect hypokalemia, hyponatremia
Mucormycosis
life threatening necrotizing non-purulent infection in diabetics. Zygomycetes right-angle nonseptate branching hyphae
Candida
septate nonbranching hyphae
Histoplasma capsulatum
opportunistic in immunocompromised pulmonary infections. Tiny yeast with occasional unequal bud formation
Anthracycline agent extravasation (doxorubicin)
IV dexrazoxane within 6 hours or topical dimethyl sulfoxide (DMSO)
Papaverine
phosphodiesterase inhibitor induces increase in cyclic adenosine monophosphate (AMP) which causes smooth muscles to relax in vessels
Imiquimod (Aldara)
immune response enhancer that stimulates host cytokine production and induces apoptosis of tumor cells
5-fluorouracil
topical chemotherapeutic agent that inhibits DNA synthesis by blocking methylation of deoxyuridylic acid
Pilomatricoma (pilomatrixoma or calcifying epithelioma of Malherbe)
benign, calcifying tumor of the hair appendages, young (<20 years)
Sebaceous nevus (Jadassohn nevus)
waxy textured skin patch on scalp, face or neck
often present at birth
10-15% transform to BCC
well-circumscribed, yellowiish plaque, becomes verrucous and nodular at puberty
Trichoepithelioma
neoplasms of follicular differentiation. Usually multiple, yellowish-pink, translucent papules symmetrically on cheeks, eyelids and nasolabial area. Ok to observe.
Eccrine poroma
sole of foot or palm under 40 years. Firm papules less than 2cm. Pedunculated with normal or erythematous color and firm. Excise.
Cylindroma
firm, nodular, pink-colored lesion face or scalp. Cylindromas are benign adnexal tumors showing an eccrine and an apocrine differentiation. They are found most commonly on the scalp and face, and are more common in women. Solitary cylindromas are generally sporadic in nature. Multiple cylindromas can be seen in patients with Brooke-Spiegler syndrome as an autosomal dominant trait with variable penetrance. Cylindromas may undergo malignant transformation, and therefore surgical excision is typically recommended, with close postoperative follow-up given high recurrence rates.
indication for rigid fixation in chest reconstruction
defect greater than 5cm or more than 5 ribs resected.
z-plasty
30 degrees increase length 25%
45 degrees increase length 50%
60 degrees increase length 75%
75 degrees increase 100%
collagen types
type I: most abundant (90%); dominant in skin, tendon and bone
type II: cornea and hyaline cartilage
type III: vessel and bowl walls, uterus, and skin
type IV: basement membrane
phases of wound healing
inflammatory: day 1 - 6
fibroproliferative: day 4 - week 3
maturation/remodeling: week 3 - 1 year
incision tensile strength
1 week – 5% 2 weeks – 10% 3 weeks – 20% 4 weeks – 40% 6 weeks – 80%
hypersensitivity reactions
Type I (allergy): immediate release of IgE mediated release of histamine, and other vasoactive mediators resulting in manifestation within minutes. Examples asthma and anaphylaxis. Type 2 (cytotoxic-antibody dependent): binding IgM or IgG to the host cell resulting in membrane attach complex (MAC) destruction. Examples: thrombocytopenia, Goodpasture, membranous nephropathy Type 3 (immune complex-mediated): IgG binding to circulating antigen resulting in formation of immune complex. Complexes collect in vasculature, joints and kidneys resulting in local destruction. Example rheumatoid arthritis, lupus serum sickness Type 4 (delayed type hypersensitivity) activation of TH1 helper T cells by antigen presenting cell. Establish immune response memory so when activated again TH1 cells activate macrophage-mediated cellular damage. Examples: chronic transplant rejection, contact dermatitis, multiple sclerosis.
Types of rejection
Hyperacute: minutes to hours from preformed antibodies. Must remove graft
Acute humeral: 3-7 days antibody and compliment mediated. Treat with plasmapheresis and antiB cell reagents.
Acute cellular: 3-6 months mediated by T cells activated by donor antigens. Increase immunosuppressive medications or anti lymphocytic antibodies
Chronic rejection: months to years both antibody and cell mediated
Sensory receptors
C sensory fibers: Deep, non-localizable pain. Respond to hypoxia, hypoglycemia, muscle metabolic products, touch. Release neuropeptides such as substance P and calcitonin-gene-related peptide (CGRP) which may cause autonomic disturbance in CPRS.
Ia sensory: proprioceptors in muscle to monitor length
Delta fibers: carry cold, pressure and specific area of pain. High conduction velocity.
prednisone
inhibits NF-kB, thereby inhibiting gene expression and T-cell activation
side effects: hypertension, hyperglycemia, hyperlipidemia, weight gain, osteoporosis
cyclosporine
forms complex with cyclophilin and inhibits calcineurin -> inhibition of gene expression of IL-2, etc and Tcell activation
Side effects: nephrotoxicity (less than tacrolimus), neurotoxicity, hypertension, hyperglycemia, hyperlipidemia, gingival hyperplasia, hirsutism
tacrolimus (prograf)
forms complex with FKBP12 and inhibits calcineurin -> inhibition of gene expression of IL-2, etc and Tcell activation
Side effects: nephrotoxicity, neurotoxicity, hypertension, hyperglycemia, hyperlipidemia, gingival hyperplasia, hirsutism
sirolimus (rapamycin)
forms complex with FKBP12 and inhibits mTOR -> inhibition of response to IL-2 and Tcell proliferation
side effects: lung toxicity, hyperlipidemia
azathioprine (imuran)
metabolized to 6-MP by liver -> inhibits purine synthesis, thereby inhibiting lymphocyte proliferation
side effects: bone marrow suppresion, GI symptoms
mycophenolate mofetil (cellcept)
inhibits purine synthesis, thereby inhibiting lymphocyte proliferation
side effects: bone marrow suppresion (less than azathioprine), GI symptoms
biologic immunosuppressants
- antithymocyte globulin: polyclonal antibodies from horse/rabbit -> block Tcell membrane proteins -> Tcell depletion and altered function
side effects: cytokine release syndrome, serum sickness, leukopenia, thrombocytopenia - muromonab-CD3 (OKT3): monoclonal anti-CD3 -> initial activation of Tcell with cytokine release, followed by decreased function and Tcell depletion
side effects: severe cytokine release syndrome (pulmonary edema, hypotension) - alemtuzumab (campath-1H): monoclonal anti-CD52 -> depletion of Tcell and Bcells, NKCs, and monocytes/macrophages
side effects: mild cytokine release syndrome, bone marrow suppresion, autoimmune anemia/thrombocytopenia - basiliximab: chimeric monoclonal anti-IL-2R (CD25) -> prevents IL2 mediated activation
side effects: hypersensitivity reaction - daclizumab: humanized monoclonal antiIL-2R (CD25) -> prevents IL-2-mediated activation
side effects: hypersensitivity reaction
propofol
anticonvulsant cardiac and respiratory depressant bronchodilator antiemetic antipruritic prompt recovery motor activity (nonepileptic myoclonia)
ketamine
dissociative anesthesia (analgesia and amnesia) maintains respiration bronchodilation increase oral secretions hypertension
etomidate
induction of hemodynamically unstable patients (minimal cardiovascular depression)
myoclonic movements
anticonvulsant
high incidence of nausea and vomiting
inhalation agents
Nitrous oxide: diffuses into nitrogen-filled (air-filled spaces to increase pressure (eg tension pneumothorax)
isoflurane: coronary vasodilation
desflurane: laryngospasm, rapid emergence
sevoflurane: best for face mask induction, potent bronchodilator
immunotherapy for melanoma
ipilimumab: monoclonal antibody receptor CTLA-4, stimulates Tcells, high risk immune related reactions
verurafenib: BRAF kinase inhibitor
imatinib: tumors with cKIT mutation
interleukin-2
beckers nevus
adolescents
shoulders of males
tan to dark brown, irregular margins, hair, large
margins SCC
4mm most
6mm if >2cm or SQ invasion
tumors muscle origin
Leiomyoma: - benign - smooth muscle (involuntary) - erector pill of hair follicles - excise Leiomyosacroma: - smooth muscle (involuntary) - erector pill of hair follicles - death by hematogenous spread 1/3 Rhabdomyosarcoma - skeletal muscle - agressive, hematogenous or lymphatic spread - most common sarcoma children - chemotherapy
