Dermatologic System Flashcards
0
Q
Squamous cell carcinoma
A
- Second most common skin cancer (20%)
- Arises from epidermal cells
- Most commonly found on head, neck, and hands
- RFs: sun exposure, pale skin, chronic inflammation, immunosuppression, xeroderma pigmentosum, arsenic
- Precursor is actinic keratosis
- Sx: raised, slightly pigmented, ulceration/exudate, chronic scab, itchy
- Dx: excisional bx if small, incisional bx if large
- Tx: Lesions less than 1cm=excise with .5cm margin. Lesions greater than 1cm= resect with 1-2cm margin.
- Palpable LN may indicate metastasis. These pts will eventually die.
- Prognosis is very good if totally excised and no LN involvement.
1
Q
Basal Cell Carcinoma
A
- Most common skin cancer (75%)
- Arises in the germinating basal cell layer of epithelial cells
- RFs: sun exposure, fair skin, radiation, chronic dermatitis, xeroderma pigmentosum
- Most commonly found on head, neck, and hands
- Sx: slow growing, scaly/scab, may have ulceration w/ or w/o pigmentation, “pearl like” appearance.
- Dx: excisional or incisional bx
- Very low risk of metastasis
2
Q
Melanoma
A
- Malignant transformation of the melanocyte (which is derived from neural crest cells)
- Pts at greatest risk are white, blonde/red hair, fair skin, freckles, hx of blistering sunburns, blue/green eyes, actinic keratosis
- Most commonly found on skin, eyes, and anus.
- Characteristics: pigmented lesion with irregular border, surface, and coloration.
- ABCDs: asymmetry, border irregularity, color variation, diameter >6mm
- 4 major types: superficial spreading, lentigo maligna, acral lentiginous, and nodular.
- Superficial spreading= most common type. Occurs in sun and non sun exposed areas.
- Lentigo maligna=malignant cells are superficial. Least aggressive type.
- Acral lentiginous= palms, soles, subungual, and mucous membranes.
- Nodular= vertical growth, most aggressive type.
- Common sites of mets: nodes, lung, liver, bone, heart, brain, small bowel mucosa.
- Dx: excisional bx or incisional bx if large
- The first LN in the draining chain is the sentinel LN and reflects the metastatic status of the group of LNs.
- In situ= .5cm margin
- less than or equal to 1cm= 1cm margin
- 1-4cm= 2cm margin
- > 4cm= 3cm margin
Workup: PE, LFTs, CXR, bone scan
3
Q
Condyloma Acuminata(genital warts)
A
- Sx: pruritic, heaped up lesion, pink/white
- Dx: PE, HPV DNA test, cytology
- Tx: Burn(podophillin, tri/bichloracetic acid), laser, cryotherapy
4
Q
Burns
A
- Alkali burns are more serious than acid burns.
- Electrical burns= most of the destruction is internal because the route of least electrical resistance follows nerves, blood vessels, and fascia.
- Rule of 9s: arm=9%, leg=18%, ant trunk=18%, post trunk=18%, head=9%, perineum=1%.
- Burn pts should get tetanus prophylaxis in the ER.
- Need to check pt’s urine output(goal is 30-50cc), check for eschar, and compartment syndrome.
- Signs of smoke inhalation: smoke/soot in sputum/mouth/nose, nasal/facial hair burns, carboxyhemoglobin(treat with 100% O2), throat/mouth erythema, hx of loss of consciousness/explosion/fire in small area, dyspnea, low O2sat, confusion, HA, coma. Smoke inhalation can be diagnosed with bronchoscopy.
- Burn shock: loss of fluid from the intravascular space->causes leaky capillaries->requires crystalloid infusion.
- Crystalloid fluids given through 2 large bore peripheral venous catheters.
- Do NOT give glucose containing IVF in the first 24hrs.
- After 24hrs, give colloid fluids (D5W and 5% albumin)
- Measure volume status through urine output, BP, HR, peripheral perfusion, and mental status.
- Burn wound infections= increased WBC with left shift, discoloration of eschar, green pigment, necrotic skin lesion, edema, ecchymosis, hypotension.
Minor burns: gentle cleansing with nonionic detergent, debridement of loose skin, topical antibacterial, cover with sterile dressings.
-Major burns: cleansing and application of topical antibacterial agent.
-Complications: pneumonia, central line infection.
- Need to monitor Na closely after a burn.
- Change central lines every 3-4 days.
5
Q
Cellulitis
A
- Blanching erythema from superficial dermal/epidermal infection.
- Strep>Staph
- Sx: red, hot, swollen, tender skin, fever/chills
- Dx: clinical, wound culture
- Tx: 7-10 days of antibiotic, may need IV abx.
6
Q
Pressure Ulcers
A
- Ischemic necrosis due to continuous pressure
- Grade I= persistent redness
- Grade II= partial thickness skin loss
- Grade III=full thickness skin loss
- Grade IV=tissue necrosis, bone and muscle damage.
-Tx:hydrocolloid dressings, may require surgical debridement.
7
Q
Wounds
A
- Primary wound closure= suture wound closes immediately
- Secondary wound closure= wound is left open, heals over time w/o sutures, heals by granulation, contraction, and epithelialization
- Delayed primary closure= suture wound closes 3-5 days after incision
- Sutured wound epithelializes in 24-48 hours
- After primary closure, dressing should be removed on post op day 2
- Wet to dry dressing= damp gauze placed on granulating wound, allowed to dry, then removed for microdebridement
- Infection, ischemia, DM, malnutrition, anemia, steroids, cancer, radiation, and smoking all inhibit wound healing.
- Vit A can reverse effects of steroids
- Abdominal wound dehiscence= opening of fascial closure-need to return to the OR
8
Q
Post op drug eruptions/urticaria
A
- Usually occur 7-14 days after exposure to a new drug. If before that, likely not due to the drug.
- Generally widespread, symmetrical, and pruritic. Will last 1-2 days after stopping the drug.
- Dx: clinical
- Tx: antihistamines, topical steroids
9
Q
Hidradenitis suppuratia
A
- Occurs in sebaceous glands and hair follicles.
- Found in armpits and groin.
- Sx: blackheads, red bumps, itchy/burning, painful, may drain pus.
- Dx: PE, culture of draining area
- Tx: Abx, NSAIDs, corticosteroids, immunosuppressants, TNFalpha inhibitors, oral retinoids. If severe= incision and drainage, surgical removal.
10
Q
Lipomas
A
- Slow growing, mobile, nontender.
- Dx: PE, bx to r/o liposarcoma, CT/MRI if deep/large
- Tx: steroid injections to shrink the size, surgical removal.
11
Q
Epithelial inclusion cysts
A
- Thin layers of epidermal cells filled with epithelial debris.
- Sx: soft to firm, filled with odorous/cheesy material, elevated, may have dimple at site of attachment.
- Most commonly found on face, scalp, ears, neck, back.
- Tx: surgical excision.
12
Q
First Degree Burn
A
- Epidermis only
- Sx: painful, dry red areas.
- Tx: keep clean, +/- neosporin, pain meds.
13
Q
Second degree burn
A
- Epidermis and varying levels of dermis
- Sx: Painful, hypersensitive, swollen, mottled areas with blisters.
- Tx: remove blisters, antibiotic ointment, dressing, pain meds.
14
Q
Third degree burn
A
- all layers of the skin including the entire dermis
- Sx: painless, insenate, swollen, dry, mottled white, charred areas.
- Tx: early excision of eschar(w/i one week), split thickness skin graft.
- Has highest amount of water evaporation.
