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.