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Clinical: General Surgery > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the appearance of basal cell carcinoma

A

white waxy lump or a bown scaly patch, raised patch, raised pearly and rolled borders, telangiectasis, a central ulcer on sun-exposed areas, such as neck and face

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2
Q

what is the diagnostic test of choice for BCC

A

shave or punch biopsy prior to initiating burative treatment

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3
Q

what are treatment options for BCC

A

fluorouracil(FU), Imiquimod
photodynamic therapy (PDT)
surgical excision with clear margins

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4
Q

what type of burn presents with skin blanching with pressure

A

1st degree burn (sunburn)

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5
Q

what burn presents with skin is red and blistered and tender

A

second degree (partial thickness)

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6
Q

what burn is presents wtih tough, leathery skin without pain

A

full thickness (3rd degree burn)

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7
Q

what type of burn involves the muscles and bone

A

4th degree

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8
Q

what is the treatment for burns

A

monitor ABC’s, fluid replacement and sulfadiazine

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9
Q

what is an acute bacterial skin/skin structure infection of the dermis and subQ tissue

A

cellulitis

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10
Q

how is cellulitis characterized

A

pain, erythema, warmth and swelling

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11
Q

what etiologies cause cellulitis

A

staphylococcus and streptococcus in adults
h.influenzae or strep pneumonia in children

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12
Q

what kind of infection does not have sharp, well-defined borders

A

cellulitis

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13
Q

what type of infection has sharp and well defined borders

A

erysipelas infection

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14
Q

how is cellulitis diagnosed

A

culture should be taken of all purulent wounds and followed up in 48hours

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15
Q

what is the treatment of mild cellulitis (MSSA)

A

cephalexin 500mg QID x 5-7d
cefuroxime 500mg BID x 5-7d
if PCN allergy, Clindamycin 450mg TID x 5-7d

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16
Q

what is the treatment for cat bites

A

augmentin or doxycycline if PCN allergic

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17
Q

what medication are puncture wounds treated with

A

Cipro (cover psudomonas)

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18
Q

what is the treatment of MRSA cellulitis

A
  • Trimethoprim-sulfamethoxazole 1ds PO BID x 7d
  • clinda 450 PO TID x 7d
  • doxy 100mg BID x 8 days
  • IV Vanco or Linezolid
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19
Q

what are causes of breast/nipple discharge

A

mastitis/breast abscess
breast cancer
gynecomastia
inflammatory breast cancer
hypogonadism

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20
Q

what are cuases of GU discharge

A

infx of vagina (yeast, BV< trichomoniasis, HPV, herpes)
cervicitis
FB
STI
sex practices
menopause

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21
Q

what is a pigmented lesion with an irregular border, irregular surface or irregular coloration

A

melenoma

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22
Q

What is ABCDE

A

signs of melenoma
Asymmetry
Borders
Color
Diameter
Evolving

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23
Q

how is melanoma treated

A

MOHs surgery
radiation
medications
or sometimes, chemo

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24
Q

what stage pressure ulcer presents with full thickness loss, often exposing subcutaneous tissues and fats

A

Stage 3

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25
Q

what stage pressure ulcer presents with parital loss of dermal layer, resulting in pink ulceration

A

Stage 2

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26
Q

what stage pressure ulcers present as full-thickness ulceration exposing bone, tendon, or muscle and ostomyelitis may be present

A

Stage 4

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27
Q

how mange stages of pressure ulcers are there

A

4

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28
Q

how are stage III-IV pressure ulcers treated

A

debridement of necrotic tissue. exudative ulcers will benefit from absorptive dressings such as calcium alignates, foams and hydrofibers. dry ulcers require occlusive dressing to maintain moisture

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29
Q

what is the treatment of stage 2 pressure ulcers

A

occlusive dressing to maintain healing, transparent fims, hydrocolloids

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30
Q

what are risk factors for pressure ulcers

A

age >65
impaired circulation
immobilization
undernutrition
incontinence

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31
Q

what are causes of surgical rashes

A

incisional rashes
drug-related rashes
infectious rashes
allergic reactions

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32
Q

how are surgical rashes diagnosed

A

patient history and physical
may require skin biopsy, culture trest, blood tests

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33
Q

what is the treatment for incisional rashes

A

gentle cleaning and appropriate wound care
monitoring for signs of infection

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34
Q

what is the treatment for drug-related rashes

A
  • discontinuing the offending drug
  • administration of antihistamines or steroids in case of severe reactions
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35
Q

what is the treatment for infectious rashes

A
  • antibiotics for bacterial infections
  • proper wound care and hygiene
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36
Q

what is the treatment for allergic reactions

A
  • identification and avoidance of the allergen
  • use of antihistamines or corticosteroids to reduce symptoms
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37
Q

what are preventitive measures for surgical rashes

A
  • using hypoallergenic materials for sutures and dressings
  • careful selection and monitoring of drugs used during and after surgery
  • maintaining strict aseptic techniques to prevent infections
38
Q

what is erythma

A

redness of the skin, often a sign of irritation, inflammation or infection.
in post-surgical contect, it can be a normal part of the healing process, but it may also indicate complications such as infxn/allergic rxn

39
Q

what are causes of erythema in surgery

A
  • normal healing response
  • infection
  • allergic reaction
  • inflammation
40
Q

what should be considered with the diagnosis and assessment of erythema with surgery

A
  • duration and spread
  • associated symptoms
  • pt history
41
Q

what is the treatment for normla healing erythema

A
  • monitor area for changes
  • educate the pt on what to watch for in terms of worsening symptoms
42
Q
A
42
Q

what is the treatment for infection erythema

A
  • administer appropriate abx
  • provide wound care and possibly drainage if needed
43
Q

what is the treatment for allergic reaction erythema

A
  • identify and remove all the allergens
  • treat with antihistamine or coticosteroid as needed
44
Q

what is the treatment for inflammation erythma

A
  • use of anti-inflammatory medications
  • ensure proper wound care and rest
  • prevention
45
Q

what are prevention stategies for surgical erythema

A
  • use of hypoallergenic materials
  • adhering to sterile technique to reduce infection risk
  • preoperative assessments for known allergies or sensitivities
46
Q

what presents as raised, slightly pigmented skin lesion; ulceration/exudate; chronic scab; itching

A

Squamous cell carcinoma

47
Q

how does cutaneous SCC present

A

enlarging hyperkeratotic macule, scaly, or crusted lumps

48
Q

how are BCC and SCC differentiated on exam

A

BCC has telangiectasiaas with central ulceration and rolled border vs scaly papules of SCC

49
Q

what are symptoms of urticaria

A

blanchable, pruritic, riased, red or skin-color papules, wheels or plaques on skin surface

50
Q

what is a positive Dariers sign

A

localized urticaria appearing where the skin is rubbed (histamine release)

51
Q

what is a painless, deeper urticaria that affects lips, tongue, eyelids, hands and genitals

A

angioedema

52
Q

A 32-year-old man presents to the emergency department with a widespread, painful rash that started two days after undergoing an appendectomy. He reports that the rash initially appeared on his trunk and then rapidly spread to his face, neck, and extremities. On examination, the rash consists of multiple red, purpuric macules and targetoid lesions. He also has erosions on his oral mucosa and conjunctival injection. His temperature is 38.6°C (101.5°F), and he is in obvious discomfort. Which of the following is the most likely diagnosis?
A Stevens-Johnson Syndrome
B Urticaria
C Erysipelas
D Drug reaction with eosinophilia and systemic symptoms (DRESS
E Psoriasis

A

A. SJS

The patient’s presentation is consistent with Stevens-Johnson Syndrome (SJS), a severe mucocutaneous reaction characterized by widespread purpuric macules, targetoid lesions, and involvement of mucosal surfaces such as the oral mucosa and conjunctiva. SJS is often triggered by medications, and the onset within a few days of surgery suggests a drug reaction, possibly to an antibiotic or anesthetic agent used during the appendectomy. The presence of fever, mucosal involvement, and the rapid progression of the rash are typical features of SJS.

53
Q

A 68-year-old man with a history of extensive sun exposure presents with a pearly, translucent nodule on his nose. The nodule has tiny blood vessels on the surface and has been slowly growing over the past year. Which of the following is the most likely diagnosis?
A Melanoma
B Squamous cell carcinoma
C Basal cell carcinoma
D Actinic keratosis
E Seborrheic keratosis

A

C. Basal cell carcinoma

Basal cell carcinoma is the most common form of skin cancer. The lesions are induced by ultraviolet radiation in susceptible individuals. Risk factors include age older than 40, light complexion, positive family history, and male sex. The lesion has pearly, raised borders with telangiectasia and a central ulcer that may crust. Sun-exposed areas are most commonly affected.

54
Q

A 55-year-old woman presents with a lesion on her cheek that has been slowly enlarging over several months. The lesion is a pearly papule with a rolled border and central ulceration. What is the most appropriate next step to confirm the diagnosis?
A Skin biopsy
B Mohs micrographic surgery
C Clinical diagnosis based on appearance
D Dermoscopy
E MRI of the lesion

A

A. skin biopsy

55
Q

Treatment options for basal cell carcinoma include all of the following except
A Mohs micrographic surgery
B Topical 5-fluorouracil
C Topical Imiquimod
D Bevacizumab
E Radiation therapy

A

D. Bevacizumab

56
Q

A 45-year-old woman presents to the emergency department with a 2-day history of increasing redness, warmth, and swelling in her left lower leg. She denies any trauma or insect bites but reports a low-grade fever and malaise. She has a history of type 2 diabetes mellitus. On examination, the affected area is erythematous, edematous, and tender to touch, extending from the ankle to the mid-calf. There is no purulent discharge, and the borders of the erythema are not sharply demarcated. Which of the following is the most likely diagnosis?
A Cellulitis
B Deep vein thrombosis (DVT)
C Necrotizing fasciitis
D Erysipelas
E Contact dermatitis

A

A. Cellulitis

The patient’s presentation is consistent with cellulitis, a common bacterial skin infection that involves the deeper dermis and subcutaneous fat. It is characterized by erythema, warmth, swelling, and tenderness, often accompanied by systemic symptoms such as fever and malaise. The lack of sharp borders and the presence of diabetes mellitus, a risk factor for cellulitis, further support this diagnosis.

57
Q

A patient is first seen with burns to the entire right arm, the anterior right leg, and genitals. The estimated burn surface area would be calculated as:
A 15%
B 19%
C 23%
D 27%
E 37%

A

B. 19%

The total burn surface area would be calculated as 19%: 9% for the entire right arm; 9% for the anterior right leg (half of 18%); and 1% for the genitalia. The Rules of Nines (first degree not included in calculation) is used to determine the extent of injury: head and neck, 9%; arm (each), 9%; trunk (anterior), 18%; trunk (posterior), 18%; leg (each), 18%; and genitalia, 1%.

58
Q

Which one of the following would not be part of your immediate management plan for a patient with 46% BSA involvement of deep-partial thickness thermal burns?
A Fluid resuscitation and urethral catheterization
B Prophylactic systemic antibiotics
C Analgesic administration
D Topical antibiotics on burn sites

A

B. prophylactic systemic antibiotics

Prophylactic systemic antibiotics administration is not indicated in the management of burns. All other options are correct.

59
Q

Which of the following treatments is a criterion for referral of a patient to a burn center?
A Third-degree burns covering more than 3% of the total body surface area (TBSA)
B Partial-thickness burn larger than 10% of TBSA in a patient of any age
C Partial-thickness burn larger than 5% of TBSA in children younger than 10 years
D Circumferential burns on the extremities or chest

A

D. Circumferential burns on the extremities or chest

59
Q

A burn that extends into the bone and muscle best describes
A 1st degree burn
B 2nd degree burn
C 3rd degree burn
D 4th degree burn

A

D. 4th degree burn

59
Q

Burns are a cause of what type of shock?

A

Hypovolemic shock

59
Q

Wounds in burn victims are more prone to be infection by what bacteria?

A

Pseudomonas aeruginosa

60
Q

burns are associated wtih what consumptive coagulopathy?

A

Disseminated intravascular coagulation (DIC)

61
Q

A 55-year-old male presents to the clinic with a 3-day history of purulent discharge from a surgical wound on his abdomen. He underwent an elective cholecystectomy 10 days ago. The wound is erythematous and slightly swollen, but he denies fever or significant pain. On examination, the discharge is noted to be yellowish and thick. Which of the following is the most likely diagnosis?
A Seroma
B Wound dehiscence
C Surgical site infection
D Hematoma
E Lymphorrhea

A

C. surgical site infection

62
Q

Which one of the following organisms is not commonly implicated in cellulitis?
A Staphylococcus aureus
B Haemophilus influenzae
C Neisseria sp
D Streptococcus sp

A

c. Neisseria sp

63
Q

The drug of choice to treat a serious methicillin-resistant S. aureus (MRSA) skin infection is
A Penicillin
B Dicloxacillin
C Cefuroxime
D Vancomycin
E Metronidazole

A

D. vancomycin

64
Q

Which of the following increases risk for severe infection?
A Diabetes
B Cholecystitis
C Amyloidosis
D Alpha thalassemia

A

A. Diabetes

65
Q

Which of the following is the most common site of cellulitis?
A Face
B Hand
C Leg
D Arm

A

C. Leg

66
Q

Which of the following pathogens is most likely responsible for a skin infection with underlying drainage, penetrating trauma, eschar, or abscess?
A Vibrio vulnificus
B Staphylococcus aureus
C Streptococcus pneumoniae
D Pseudomonas aeruginosa

A

B. Staphylococcus aureus

67
Q

Which of the following is an indication for workup in patients with suspected cellulitis?
A Regional lymphadenopathy
B Infection site on the torso
C Tachypnea
D Infection site >10 mm

A

c. tachypnea

68
Q

Which of the following is the more appropriate choice for outpatient treatment of cellulitis in which CA-MRSA is not suspected?
A Cephalexin
B Linezolid
C Doxycycline
D Terbinafine

A

a. cephalexin

69
Q

Cellulitis may progress to _ _ _ _ due to necrosis of subcutaneous tissue.

A

necrotizing fascitits

70
Q

73yo female with hx of afib on chronic warfarin therapy is diagnosed with mild cellulitis of her forearm. you would like to prescribe her a first-gen cephalosporin as the first-line tx. is this a good choice for the patient?

A

No. cephalosporins can have an antivitamin K effect. given that the pt is on chronic warfain therapy, this may adverstly affect her INR and bleeding rate. your best bet is to choose another abx.

71
Q

an 8yo child received a kitten as a new pet and wat bitten a week later. a tender papule develops at the site. she now presents with headache, fever, malaise, and tender regional lymphadenopathy?

What is the diagnosis?
what is the etiology?
what is the treatment?

A

cat-scratch disease - usu develops 3days to 6 weeks s/p cat bite/scratch
Bartonella henselae
for pts with lymphadenitis - 5 day course of azithro

72
Q

in general, we avoid (what medicine) in children < 8yo b/x of concerns for dental staining?

A

tetracyclines

73
Q

A 48-year-old male presents with widespread erosions and detachment of the epidermis suspected to be Stevens-Johnson syndrome. He recently started several new medications. Which of the following medications is NOT a commonly reported trigger for Stevens-Johnson syndrome?
A Phenytoin
B Allopurinol
C Sulfamethoxazole
D Ibuprofen
E Carbamazepine

A

D. ibuprofen

74
Q

Which of the following is incorrect about Stevens-Johnson syndrome (SJS)?
A It is a milder form of toxic epidermal necrolysis with less than 20% body surface area detachment
B Nevirapine is a trigger
C Loss of vision could be a complication
D Corticosteroid may be used in the treatment of patients with SJS

A

a. it is a milder form of TEN wtih less than 20% BSA detachment

75
Q

A 40-year-old female with Stevens-Johnson syndrome is admitted to the hospital. She has extensive blistering and epidermal detachment covering 5% of her body surface area. Which of the following is the most appropriate initial step in the management of this patient?
A High-dose systemic corticosteroids
B Intravenous immunoglobulin (IVIG)
C Immediate discontinuation of all non-essential medications
D Start of broad-spectrum antibiotics
E Cyclosporine therapy

A

c. immediate discontinuation of all non-essential medications

76
Q

A 45-year-old woman presents with a widespread urticarial rash 2 days after undergoing an elective laparoscopic hysterectomy. She reports intense itching but no other symptoms. She has no known drug allergies and has not taken any new medications except for the antibiotics and analgesics prescribed postoperatively. She denies any respiratory distress, facial swelling, or gastrointestinal symptoms. Which of the following is the most likely cause of her symptoms?
A Anaphylaxis to surgical materials
B Acute urticaria due to a drug reaction
C Postoperative infection
D Delayed hypersensitivity reaction to anesthesia
E Autoimmune response to surgery

A

b. acute urticaria due to drug reaction

77
Q

Prognosis of melanoma is most strongly associated with what dimension?
A depth of the lesion
B location of the lesion
C size of the lesion
D variation in color

A

a. depth of lesion

78
Q

Which is not generally a characteristic of a suspicious skin lesion?
A Asymmetric border
B Bleeding
C Color change
D Variegation of color
E Diameter less than 5 mm

A

e. diameter less than 5mm

79
Q

A 47-year-old man presents with a skin lesion that has been changing in size and shape. On examination, she is found to have a 7-mm, asymmetric, darkly pigmented lesion with some color variegation and irregular borders. Which one of the following skin biopsy techniques is most appropriate for confirming the diagnosis?
A A shave biopsy
B Electrodesiccation and curettage
C Elliptical excision
D Mohs’ surgery

A

c. elliptical escision

80
Q

The most common histologic type of melanoma is
A Lentigo maligna melanoma
B Superficial spreading malignant melanoma
C Acral-lentiginous melanoma
D Nodular melanoma

A

B. superficial spreading malignant melanoma

81
Q

what are the four major histologic types of melanoma?

A
  1. superficial spreading
  2. lentigo maligna
  3. acral lentiginous
  4. nodular
82
Q

what is the most common type of melanoma

A

superficial spreading

83
Q

Which of the following can impede the healing of decubitus ulcers?
A Wet-to-dry dressing changes
B Doughnut cushions
C Frequent position changes
D Air-fluidized mattresses
E Debridement of nonviable tissue

A

b. doughnut cushions

84
Q

Which of the following describes Stage IV pressure ulcer?
A Nonblanchable erythema of intact skin
B Full-thickness wounds with extension into muscle, bone, or supporting structures
C Full-thickness skin loss with damage to the subcutaneous tissue that may extend down to, but not through, the underlying fascia
D Partial-thickness skin loss involving the epidermis and/or dermis

A

b. full-thickness wounds with extension into muscle, bone, or supporting structures

85
Q

A paraplegic patient developed a sacral decubitus ulcer secondary to sitting in a wheelchair for prolonged periods of time. Initial treatment included debridement and saline dressing changes. The wound has significant serous drainage without evidence of infection. Which of the following interventions would be recommended to promote rapid closure of the wound?
A Application of platelet-derived growth factor
B Negative pressure wound vacuum device
C Occlusive dressings
D Topical 1% silver nitrate

A

b. negative pressure wound vacuum device

86
Q

Which of the following is not an indication for referral for Mohs’ micrographic surgery?
A Lesion in close proximity to nose
B Lesion size > 2 cm
C Lesion with indistinct margin
D Recurrent lesions
E Lesion is identified as an actinic keratosis

A

e. lesion is identified as an actinic keratosis

87
Q

Which of the following statements concerning squamous cell carcinoma is not true
A It is the most common form of skin cancer
B Actinic keratosis is a precursor
C Long-term sun exposure is a risk factor
D May appear as firm indurated papule, nodule or plaque with adherent rough scale

A

a. is it the most common form of skin cancer

88
Q

Treatment options for squamous cell carcinoma include all of the following except
A Mohs micrographic surgery
B Electrodessication and curettage
C Radiotherapy
D Topical corticosteroid

A

d. topical corticosteroid

Clinical: General Surgery (10 decks)

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