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Surgery > Dermatology > Flashcards

Dermatology Flashcards

1
Q

For a bullous lesion what is the ideal timing to get a biopsy?

A

early in presentation

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2
Q

For any pigmented lesion what skin biopsy technique should be used?

A

excisional biopsy

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3
Q

What does the ABCDE system consist of?

A
  • Asymmetry
  • Border irregular
  • Color (2+)
  • Diameter >6mm
  • Evolution of lesion
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4
Q

What is the ABCDE system used for?

A

identifying high-risk lesions

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5
Q

For excisional biopsy, ____ length of the wound is the maximum width.

A

1/3

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6
Q

When performing an excisional biopsy you want to be _____ to the langer lines.

A

parallel

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7
Q

What are the 5 main etiologies of burns?

A
  • thermal
  • electrical discharge
  • friction
  • chemical
  • radiation
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8
Q

What are the 4 burn classifications?

A
  • first degree: superficial
  • second degree: partial thickness
  • third degree: full thickness
  • fourth degree: deep tissue
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9
Q

Once you hit bone, muscle, or tendon what degree burn is that?

A

fourth degree burn

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10
Q

What is the most painful burn class?

A

superficial partial-thickness

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11
Q

How can you distinguish between a superficial vs. deep partial-thickness burn?

A

deep partial-thickness DOES NOT BLANCH

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12
Q

Over ____ % of body surface area is considered a significant burn

A

10%

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13
Q

What method of estimating total % of BSA that was burned is preferred in pediatrics?

A

Lund-Browder chart

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14
Q

Using the rule of nines for estimating burn extent what do the following represent?

  • genitals
  • head
  • each arm
  • each leg
  • anterior trunk
  • posterior trunk
A
  • genitals = 1%
  • head = 9%
  • each arm = 9%
  • each leg = 18%
  • anterior trunk = 18%
  • posterior trunk = 18%
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15
Q

A patient’s palm is considered what % of BSA?

A

1%

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16
Q

What are the 4 signs of pediatric physical abuse with burns?

A
  • burns in distinct shape of an object
  • small circular burns matching a cigarette
  • burns on the perineal area matching a “dip-in” pattern
  • scald burns that have sharply demarcated edges
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17
Q

What is the parkland formula for initial fluid resuscitation?

A
  • LR 4 ml x TBSA burn (%) x Body weight (kg)
  • give first half over the first 8 hours
  • give second half over the next 16 hours
18
Q

What measure do you want to monitor hourly when administering fluids? What is the goal?

A
  • urine output (UOP)

- maintain UOP of 0.5 ml/kg/hr in adults

19
Q

When approaching a soft tissue infection, if you see purulence what pathogen do you need to cover?

A

MRSA

20
Q

What is the treatment for mild vs. moderate/severe purulent soft tissue infection?

A
  • mild = I/D

- mod/severe = I/D + cover MRSA

21
Q

What are the 4 oral agents that cover MRSA?

A
  • clindamycin 450 mg PO TID
  • Bactrim 2 DS tablets PO BID
  • Doxycycline 100 mg PO BID
  • Linezolid (Zyvox) 600 mg PO BID
22
Q

What are the 2 IV agents that cover MRSA?

A
  • vancomycin 15mg/kg IV every 8-12 hours

- Daptomycin (Cubicin) 4mg/kg IV daily

23
Q

What is the treatment for a MILD nonpurulent soft tissue infection?

A

oral antibiotics

24
Q

What is the treatment for a MODERATE nonpurulent soft tissue infection?

A

intravenous antibiotics

25
Q

What is the treatment for a SEVERE nonpurulent soft tissue infection?

A
  • emergent surgical inspection/debridement

- AND broad spectrum antibiotics

26
Q

With cellulitis you expect symptomatic improvement within how many hours?

A

24-48 hours

*if not, consider resistant pathogen or other diagnosis

27
Q

What is the most common pathogen causing dermal abscess?

A

Staph A

28
Q

What are the 5 things you look for when examining a lesion for infection

A
  • erythema
  • drainage
  • fluctuant
  • warmth
  • induration
29
Q

What are the 4 main points of dermal abscess treatment?

A
  • I/D
  • culture
  • local wound care
  • +/- antibiotics
30
Q

What are the 7 indications for antibiotic therapy in a dermal abscess?

A
  • multiple lesions or single lesion >2 cm
  • extensive surrounding cellulitis
  • comorbidities or immunosuppression
  • signs of systemic infection
  • inadequate clinical response
  • presence of an indwelling medical device
  • high risk of transmission
31
Q

What is the empiric therapy to cover MRSA in a dermal abscess? (2 oral medications)

A
  • Bactrim 2 DS tabs PO BID

- Doxycycline 100 mg PO BID

32
Q

What is the empiric therapy to cover MSSA in a dermal abscess? (2 options)

A
  • Dicloxacillin 500 mg PO q6 hours

- Cephalexin 500 mg PO q6 hours

33
Q

What is the threshold for packing a dermal abscess in terms of size?

A

> 5 cm = pack

34
Q

Following a dermal abscess I/D what is the recommended follow up period?

A

24-48 hours for reexamination of wound

35
Q

What is the most common pathogen associated with Type II (monomicrobial) necrotizing fasciitis?

A
  • Group A strep
36
Q

What pathogen is associated with freshwater exposure?

A
  • Aeromonas species
37
Q

What pathogen is associated with saltwater exposure?

A
  • Vibrio species
38
Q

A patient with a PMHx of diabetes is complaining of severe acute pain over her minor trauma site with associated erythema, edema, and fever. On physical exam you notice bullae over the area. What do you suspect the diagnosis is?

A

necrotizing fasciitis

39
Q

What is the gold standard diagnosis and treatment of necrotizing fasciitis?

A
  • diagnosis = surgical exploration

- treatment = surgical debridement

40
Q

What are the 6 criteria for performing Mohs micrographic surgery?

A
  • Large tumor ( >2cm)
  • Poorly defined borders
  • recurrent tumor
  • incompletely excised
  • aggressive histologic features
  • chronic scar (Marjolin’s ulcer)

Surgery (7 decks)

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