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EOR - Surgery > Dermatology > Flashcards

Dermatology Flashcards

1
Q

6 causes of generalized rash that Smarty PANCE wants us to consider

A

abx s.e
zinc deficiency
paget dz
HSV/zoster
systemic rheumatoid dz (still’s dz)
fat emboli from long bone fx

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2
Q

characteristic rash of zinc deficiency

A

perioral pustular rash

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3
Q

characteristic rash of paget dz

A

well demarcated
erythematous
eczematous

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4
Q

sx of still’s dz (systemic rheumatoid dz)

A

> 5 joints involved
fever
LAD
hepatosplenomegaly
subcutaneous nodules
pericarditis
rash

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5
Q

characteristic rash of fat emboli from long bone fx

A

upper body petechial rash

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6
Q

characteristics of basal cell carcinoma (5)

A

raised pearly papule w. rolled border
telangiectasis
central ulcer/scab/erosion
erythematous patch > 6 mm
non healing ulcer in sun exposed area
+/- bleeding

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7
Q

3 mc locations for bcc

A

head
neck
hands

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8
Q

what pt pop makes you think bcc

A

fair skinned
hx of sun exposure

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9
Q

what is this

A

bcc

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10
Q

dx for bcc

A

shave/punch bx

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11
Q

tx for bcc (6)

A

topical fluorouracil vs imiquimod
photodynamic therapy
tissue scraping
electrosurgery
mohs surgery
wide local excision

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12
Q

5 rf for bcc

A

sun
fair skin
radiation
chronic dermatitis
xeroderma pigmentosum

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13
Q

rule of 9’s for burns

A
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14
Q

degrees of burns

A

first (superficial): sunburn
second (partial thickness): blisters, painful
third (full thickness): tough/leathery, non-tender
fourth: into bone/muscle

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15
Q

what degree of burn is no longer painful

A

3rd (full thickness)
4th

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16
Q

minor vs major burns based on TBSA

A

minor:
adults: < 10%
kids: < 5%
<2% full thickness

major:
adults: > 25%
kids: > 20%
>10% full thickness
burns involving: face, hands, perineum, cross major joints

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17
Q

tx for burns

A

ABCs
fluids
bacitracin
cleanse

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18
Q

tx for chemical burns

A

irrigate w. running water x 20 mins

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19
Q

indication for fluids w. burns

A

kids: > 10% TBSA
adults: > 15% TBSA

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20
Q

fluid protocol for burns

A

LR x 24 hr:
1/2 in the first 8 hr
1/2 in remaining 16 hr

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21
Q

burns cause what type of shock

A

hypovolemic

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22
Q

is UVA or UVB dominant in sunburns

A

UVB

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23
Q

what type of UV ray is associated w. tanning and photoaging

A

UVA

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24
Q

what type of bacteria is mc associated w. infected burns

A

pseudomonas

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25
Q

what coagulopathy is associated w. burns

A

DIC

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26
Q

what tx is not indicated in the management of burns

A

prophylactic systemic abx

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27
Q

indication for referral to a burn center

A

-partial thickness burn > 20% TBSA at any age
-partial thickness > 10% TBSA in kids < 10 yo OR adults > 50 yo
-3rd degree burns covering > 5% TBSA
-2nd or 3rd degree burns involving critical areas
-associated w. inhalation injury
-electrical/lightning burns
-severe w. coexisting trauma
-preexisting dz complicating burns
-chemical w. threat of cosmetic/functional compromise
-curcumferential burns on extremities/chest

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28
Q

what are the 6 critical areas for burns

A

hands
feet
face
perineum
genitalia
major joints

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29
Q

4 causes of nipple discharge

A

mastitis/abscess
cancer
gynecomastia
hypogonadism

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30
Q

3 sx of gynecomastia

A

nipple discharge
breast enlargement
overweight

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31
Q

3 sx of hypogonadism

A

nipple discharge
sexual dysfxn
reduced libido

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32
Q

describe cellulitis margins

A

flat
not well demarcated

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33
Q

2 mc pathogens associated w. cellulitis: kids vs adults

A

kids: h.flu strep pneumo
adults: s. aureus, GAS

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34
Q

indication for wound culture

A

all purulent wounds
f/u in 48 hr

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35
Q

tx for MSSA cellulitis (2)

A

cephalexin
dicloxacillin

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36
Q

tx for MRSA cellulitis (5)

A

doxy
sulfa
clindamycin
vanco
linezolid

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37
Q

what pathogen is associated w. animal bites

A

pasteurella multocida

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38
Q

abx for animal bites

A

augmentin
pcn allergy: doxy

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39
Q

abx for puncture wound
what pathogen are you worried about

A

cipro
pseudomonas

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40
Q

mc site of cellulitis

A

leg

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41
Q

describe margins w. erysipelas

A

raised
sharply demarcated

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42
Q

what pathogen is mc responsible for skin infxn w. underlying drainage, penetrating trauma, eschar, or abscess

A

s. aureus (MRSA)

43
Q

4 indications for workup w. cellulitis

A

infxn site > 10 mm
severe pain
sx of systemic illness
immuncompromised/rf for serious illness

44
Q

what pathogen is mc involved in wounds w. no drainage or abscess

A

streptococci

45
Q

what abx should be used outpt for cellulitis where you do NOT suspect MRSA

A

cephalexin
alt: dicloxacillin, amoxicillin
pcn allergy: clinda vs macrolide

46
Q

mc cutaneous rxn to drugs

A

drug induced exanthems

47
Q

what drugs are the mcc of drug induced exanthems

A

abx

48
Q

skin bx findings of drug induced exanthems

A

necrotic epithelium

49
Q

name 3 drug induced exanthems

A

SJS
TEN
erythema multiforme

50
Q

tx for drug induced exanthems (3)

A

burn unit
opthmalmology/derm referrals
IVIG

51
Q

what pharm may increase risk for sepsis w. drug induced exanthems

A

steroids

52
Q

3 drugs commonly associated w. drug induced exanthems

A

sulfas
pcn’s
valproic acid

53
Q

2 common post op derm conditions

A

pruritis
uticaria

54
Q

5 causes of post op pruritis/uticaria

A

anesthesia
opioids
latex
abx
LMWH

55
Q

skin rxn to cold that appears w.in mins after cold exposure (ex cold compresses)

A

cold uticaria

56
Q

tx for post op pruritis/uticaria

A

antihistamines
steroids

57
Q

what is ABCDE in relation to melanoma

A

assymetry
border - irregular
color - varied
diameter - increasing/> 6 mm
elevation - raised

58
Q

mc site for melanoma: men vs women

A

men: back
women: legs

59
Q

tumor mc responsible for metastasis to the heart

A

melanoma

60
Q

5 most important independent rf for increased likelihood of melanoma

A

harmm:
hx of prior melanoma
age > 50 yo
(no) regular dermatologist
mole that is changing
male

61
Q

if a mole is suspiciousm bx should include

A

full depth of the dermis slightly beyond edges of the lesion

62
Q

what type of bx is preferred if you suspect melanoma

A

excisional bx

63
Q

excisional bx should be performed on all moles suspicious for melanoma except

A

cosmetically important areas -> do shave bx instead

64
Q

what 2 measuring systems are used for melanoma

A

breslow: thickness
clark: penetration into skin layers

65
Q

clark classification system of microstaging

A

level I: confined to epidermis (in situ)
level II: invasion into papillary dermis
level III: invasion to papillary-reticular interface
level IV: invasion into reticular dermis
level V: invasion into subq fat

66
Q

prognosis for melanoma is associated w. the _ of the lesion

A

depth

67
Q

tx for melanoma

A

stages I-III: surgical excision
stage IV: chemo

68
Q

7 rf for melanoma

A

blone/red hair
fair skin
freckles
hx blistering sunburn
blue/green eyes
actinic keratosis
male

69
Q

3 mc locations for melanoma

A

skin
eyes
anus

70
Q

mc site for melanoma in AA

A

soles of feet -> acral lentiginous melanoma

71
Q

4 types of melanoma

A

superficial spreading
lentigo maligna
acral lentiginous
nodular

72
Q

mc type of melanoma

A

superficial spreading

73
Q

mc sites of metastasis for melanoma: local vs distant

A

local: nodes
distant: lung, liver, bone, heart, brain, small bowel mucosa

74
Q

metastatic routes of melanoma

A

lymphatic
hematogenous

75
Q

melanoma tumormarker

A

S-100

76
Q

tx for digital melanoma

A

amputation

77
Q

what malignancy is most likely to metastasize to the bowel

A

melanoma

78
Q

2 mc locations for pressure ulcers

A

sacrum
hip

79
Q

how often should a pt be repositioned to prevent pressure ulcers

A

q 2 hr

80
Q

staging of pressure ulcers

A

stage I: localized, non blanching erythema
stage II: loss of dermal layer -> pink ulceration
stage III: full dermal loss -> exposed subq tissue/fat
stage IV: exposed bone/tendon/muscle

81
Q

major complication of stage IV pressure ulcers

A

osteomyelitis

82
Q

how can you rule out a stage I pressure ulcer in an area of erythema

A

if it blanches, it is NOT a pressure ulcer

83
Q

injury commonly associated w. pressure ulcer

A

hip fx

84
Q

5 rf for pressure ulcer

A

> 65 yo
impaired circulation
immobilization
malnutrition
incontinence

85
Q

tx for pressure ulcer based on stage

A

stage I: thin film dressing
stage II: thin film dressing, occlusive dressing, hydrocolloids
stage III-IV: debridement, absorptive dressing/foams/hydrofibers, occlusive dressings, hydrocolloids, hydrogels

86
Q

3 types of wound debridement

A

incisional
mechanical
enzymatic

87
Q

incisional debridement is done with

A

scalpel

88
Q

mechanical debridement is done with

A

wet-dry dressings

89
Q

indications for incisional debridement

A

extensive, dry wounds

90
Q

what stage pressure ulcer

A

I

91
Q

what stage pressure ulcer

A

II

92
Q

what stage pressure ulcer

A

III

93
Q

what stage pressure ulcer

A

IV

94
Q

what is this

A

squamous cell carcinoma

95
Q

characteristics of scc

A

enlarging hyperkeratoic macule
scaly/crusted lumps
indurated/ulcerated papules
often tender/painful

96
Q

6 common locations for scc

A

face
lips
ears
hands
forearms
lower legs

97
Q

skin cancer involving telangiectasia

A

bcc

98
Q

skin cancer involving scaly papules

A

scc

99
Q

tx for scc

A

surgical excision
+/- mohs
radiotherapy
cryotherapy
electrodessication/curretage

100
Q

5 indications for mohs

A

nonmelanoma > 2 cm
indistinct margins
recurrent lesions
close to important structures (eyes, nose, mouth)
invasive histology

101
Q

what is this showing

A

scc

102
Q

6 rf for scc

A

sun
pale skin
chronic inflammation
immunosuppression
xeroderma pigmentosum
arsenic

103
Q

what is this

A

AK

104
Q

what is marjolin’s ulcer

A

scc in area of chronic inflammation:
burn
chronic fistula
wound
osteomyelitis

EOR - Surgery (13 decks)

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