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NPLEX 2 Flashcards > DONE: Minor Surgery > Flashcards

DONE: Minor Surgery Flashcards

1
Q 
Diagnosis this: a soft fluctuant mass, localized collection of pus, painful and tender, erythematous
what bugs are most common?
is a gram stain and culture recommended?
recommended treatment?
when would we give ABX?
A

abscess
S. aureus
usually yes
incision and drainage (#11 scalpel and hemostat) using a field block > break up the loculations and DO NOT CLOSE - pack with iodoform gauze

if there were symptoms of a systemic inflammatory response

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2
Q 
Diagnosis this: infection of multiple hair follicles, a coalescent inflammatory mass with pus draining from multiple sites
mc bug?
mc place they appear?
population in which they are common?
how different from a furuncle?
how is it treated?
A 
carbuncle
staph aureus
back of the neck
diabetes
larger and deeper than furuncles
incision and drainage
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3
Q

Diagnosis this: infection of the hair follicle, an inflammatory nodule with overlying pustules
mc bug?
treated?
how is it different from folliculitis?

A

furuncle/boil
s aureus
incision and drainage, can also apply moist heat and it could rupture and drain spontaneously
folliculitis is more superficial and the pus is limited to the epidermis, not the dermal or subQ layer

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4
Q

Diagnosis this: soft, painless mass that have a rancid odor, noncompressible. they are usu congenital and occur in lines of cleavage, and around eyes and on base of nose?
DX?

A

dermoid cyst

preop CT is recommended as they can extend intracranially

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5
Q

Diagnosis this: skin-colored nodule with a central punctum that is freely moveable and contains skin flora in a cheesy keratinous material
TX?

A

epidermoid cyst/epidermal inclusion cyst

incision and drainage if inflamed > break up the loculations!

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6
Q

Diagnosis this: soft and mobile, slow growing, firm, fluctuant nodule with a small central well?
what is it filled with?
common location?
treatment?

A

sebaceous cyst

filled with keratin, sebum

behind the ears, scalp, back of neck or shoulders, arm

incision and removal of the entire mass - removal of entire mass helps reduce recurrence (would make an elliptical incision, in a lipoma it would be an incision down the middle)

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7
Q

Diagnosis this: lumps that develops along tendons or joints of wrists or hands, pain with pressure, hard, fixed smooth lesion?
Tx?

A

ganglion cyst

TX: refer to someone: immobilize, aspirate, or excision

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8
Q

Diagnosis this: skin-colored, odorless cyst on the scalp, caused by protein buildup in a hair follicle. painless, firm, and smooth

TX?

A

trichilemmal/pilar cyst or wen

tx: minimal excision technique

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9
Q

Diagnosis this: firm, white papules 1-2 mm lesions

Tx?

A

milia

nick with a #11 blade and express keratinaceous white kernel

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10
Q

Diagnosis this: fibroepithelial polyp that ranges between 1-10 mm

A

acrocordon/skin tag

lift and snip, excision, electrodessication, or cryosurgery

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11
Q

Diagnosis this: rough, scaling skin with a risk of SCC, sandpaper like texture, hyperkeratotic, pearly gray white appearance?
how to DX?
TX?

A

actinic keratosis
biopsy any lesions that are resistant to treatment
tx: liquid nitrogen, 5FU, photodynamic therapy, excision

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12
Q

Diagnosis this: dome-shaped, 0.1-0.4 cm red lesions that blanch with pressure
TX?

A

cherry hemangioma
TX: we DO NOT cut into these lesions - esp if cavernous, but could be treated with: electrocautery and 1% lidocaine, shave excision and electrocautery, laser therapy, or cryo

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13
Q

Diagnosis this: cone-shaped lesion made of keratin

TX?

A

cutaneous horn

excision, liquid nitrogen

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14
Q

Diagnosis this: skin lesion that erupts in sun-damaged skin, a variant of SCC
tx?

A

keratoacanthoma

tx: surgical excision, electrotherapy and curettage, 5fu

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15
Q

Diagnosis this: liver spots, usually benign from excessive sun exposure

A

solar lentigo

tx: liquid nitrogen, excision and biopsy

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16
Q

Diagnosis this: dark spot

A

nevus

tx: cryo, cautery, hyfrecator, radiosurgery, laser (no scalpel)

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17
Q

Diagnosis this: small, red papule that grows rapidly over weeks to months and then stabilizes

A

pyogenic granuloma

tx: surgical excision, laser, cryo, etc

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18
Q

Diagnosis this: yellowish or skin colored soft small papules on the face - usu nose, cheeks, and forehead

tx?

A

sebaceous hyperplasia

tx: electrodessication, laser, cryo, phototherapy

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19
Q

Diagnosis this: initially a flat macule > waxy verrucous papule is usually described as stuck on
diagnosis?
treatment?

A

seborrheic keratosis
if unsure of DX, get a BX
curettage or liquid nitrogen

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20
Q

Diagnosis this: threadlike red lines or patterns

tx?

A

telangiectasia

tx: cautery, hyfrecator, radiosurgery, laser

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21
Q

Diagnosis this: hyperkeratotic flesh colored hard papules located near areas of trauma
diagnosed?
tx?

A

verrucae vulgaris/common warts (HPV
clinical dx
no treatment, liquid nitrogen, or salicylic acid, can also snip a pedunculated one

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22
Q

Diagnosis this: deep infection working under the nail bed

treated?

A

felon

I&D, ABX

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23
Q

how would you treat an ingrown toenail?

A

matricectomy

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24
Q

Diagnosis this: infection of the nail bed with painful swelling caused by?
treated?

A

paronychia
staph*, strep, or candida
warm compress + cephalexin, drain abscess if present

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25
Q

Diagnosis this: red or black or brown area formed under the nail bed

tx?

A

subungual hematoma

nail trephination

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26
Q

Diagnosis this: abnormal communication between the anal canal and perianal skin
tx?

A

anal fistula

tx: lay open and tract excision

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27
Q

Diagnosis this: cauliflower-like mass that is soft and sometimes friable
tx?

A

condyloma acuminata

tx: podophyllin, surgical excision, electro-dessication, cryotherapy

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28
Q

Diagnosis this: cyst that forms in the cleft at the top of the buttocks, It typically occurs after puberty, consists of a small hole or tunnel in the skin that may become infected and fill with fluid or pus.
tx?

A

pilonidal cyst - It’s believed to be caused by a combination of changing hormones, hair growth, and friction from clothes or from spending a long time sitting.
refer for tx

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29
Q 
Diagnosis this: skin colored papule or nodule with a rolled translucent or pearlytelangiectatic border and a depressed center?
caused by?
favors what areas of body?
aggressive? mets?
what kind of BX?
tx?
A

basal cell carcinoma - the most common skin cancer
chronic exposure to UVB
> 80 on face, favors upper lip
locally aggressive, but rarely mets
do a shave if it is shallow, and a punch or excisional when needed
TX: refer to an oncologist > shave excision with electrodessication, cryo, 5FU, radiation

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30
Q

Diagnosis this: brown firm, moveable between the layers, BB pellet under the skin? usu secondary to trauma, increased fibroblasts, often seen on the wrist
tx:

A

dermatofibroma

incision and removal (but delapp said we dont remove these because the scarring is worse)

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31
Q

Diagnosis this: benign soft tissue tumor that is slow growing, lobulated and enclosed by a thin fibrous capsule. it is soft, rubbery, and usu painless, often reoccuring?
diagnosed?
treatment?

A

lipoma
clinical - only BX if atypical features
refer for surgical removal (but i feel like we can also excise

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32
Q 
Diagnosis this: neoplasia that is fast growing, metastasizes, and related to As exposure. indurated, ulcerated or crusty, and might bleed easily?
caused by? precursor?
where does it favor?
how does it frequently present?
aggressive? mets?
tx?
A

squamous cell carcinoma
sun exposure, actinic keratosis
lower lip
“non-healing ulcer”
more rapid growth than BCC and mets easily
referral for surgical excision and biopsy, Mohs

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33
Q

Manage this: bite

most bites are from?

A

amox-clauv as it is effective against aerobic and anaerobic
secondary healing - let it close on its own. primary is not recommended, but you can approximate the wound

dogs

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34
Q

which pharmaceutical is generally safe during first TM? lidocaine, epinephrine, bupivacaine, or mepivacaine

A

lidocaine

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35
Q

what should be considered infectious in all patients?

A

blood and bodily fluids

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36
Q

what is the most commonly transmitted infection through blood and bodily fluids?

A

hepatitis B

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37
Q

difference between sterilization and disinfection?

A

we sterilize things that are dead (instruments), we disinfect skin

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38
Q

how long do we disinfect/sterilize with 2% glutaraldehyde?

A

10 minutes to disinfect

10 hours to sterilize

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39
Q

if we are going to choose to boil something, how long does it need to be boiled for?

A

> 30 minutes

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40
Q

if using dry heat (oven) to sterilize, what degree and for how long?

A

160 C or 320 F for 1 hour

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41
Q

steam autoclave is the most efficient and reliable method of sterilization, at what pressure? temp? minutes?

con?

A

15 psi at 121 C for 15 minutes

it dulls sharp instruments

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42
Q

intact skin should be disinfected with? for how long?

A

10% betadine X3
OR
0.4% chlorhexidine gluconate

for 2 minutes

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43
Q

we should never use ? on open skin, instead we should…

A

hydrogen peroxide - it slows wound healing

0.9% NS

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44
Q

when should we refer puncture wounds?

A

if any nerve, tendon, or joint involvement, or in the chest or abdomen

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45
Q

what do we do if something large is in the skin?

A

SECURE the item and REFER to the ED

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46
Q

what do we do with a puncture wound?

A

clean, debride, and leave open with sterile dressings to prevent infection. always consider their last tetanus shot. dont forget about rose bushes!

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47
Q

how to manage abrasions?

A

clean, debride, and dress

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48
Q

after how long do we not suture lacerations?

A

older than 8-12 hours OR > 24 hours if on the face

this is no longer true, but still tested on

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49
Q

what is the difference between a hypertrophic or keloid scar? tx?

A

hypertrophic = normal healing

keloid = extends beyond original wound more common in black people - can be TX with cryo

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50
Q

name the 4 stages of healing?

A

hemostasis, inflammation, proliferation, remodeling

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51
Q

describe hemostasis

A

the formation of a fibrin clot - coagulation

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52
Q

how long does inflammation stage last?

A

days 1-4

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53
Q

during this phase, platelets secrete cytokines, clot formation triggers the complement cascade

A

inflammation

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54
Q

during the inflammation phase, how long does it take neutrophils to show up and how long do they stay for?

A

5-6 hours
3-4 days
job is to destroy bacteria

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55
Q

during the inflammation phase, what is the job of the macrophages?

A

to transition from inflammation > repair and phagocytize

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56
Q

during the inflammation phase, describe re-epithelialization

A

basal cell migrate within 24-48 hours to repair the wound

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57
Q

during the inflammation phase, how long does it take keratinocytes to proliferate?

A

1-2 days

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58
Q

the proliferation/granulation phase takes place on what days?

A

3-21

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59
Q

what occurs in the proliferation phase?

A

new capillaries are surrounded by fibroblasts and form granulation tissue.

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60
Q

when does angiogenesis occur?

A

proliferation phase

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61
Q

how long does the remodeling phase take?

A

from week 3 - 6-18 months

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62
Q

name the percentage strength of skin and by how many weeks in the remodeling phase

A

3-4 weeks: 30-40%

1 year: 80%

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63
Q

what is the difference between contraction and contracture?

A

contraction = normal. myofibroblasts and orientation of collagen
contracture: abnormal = formation of a tight scar due to excessive contraction

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64
Q

describe the difference between the healing intentions:

A

primary: a sutured clean wound (may want to avoid in infection, DM, bites, immune suppression, chronic disease, malnutrition, obesity, or malignancy)
secondary: full thickness laceration (into the subQ), left open and eventual re-epithelialization - used when there is significant tissue lost or contamination/infection < 12 hours

tertiary (aka delayed primary): grossly contaminated wound without significant tissue loss: can be cleaned, packed, and covered and left open for 3-5 days. can be sutured at this point if not infected (like a gunshot wound)

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65
Q

this kind of suture could cause railroad track scarring and eversion could be difficult. it is the most frequently used

A

simple interrupted

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66
Q

this kind of suture is easier to evert edges under tension and is better for cosmesis, use on thin skin, flexural creases (fingers, palms), and areas of high stress

A

vertical mattress

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67
Q

this kind of suture is good for high tension wounds and fragile tissue, use it on the palms or soles

A

horizontal mattress

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68
Q

this kind of suture is for deep or larger wounds and requires what kind of sutures?

A

deep or buried

absorbable

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69
Q

this kind of suture is in the dermal layer, not visible, and eliminates tracts. use for linear wounds with little tensions. what kind of sutures are best?

A

subarticular/intradermal running

absorbable or nonabsorbable polypropylene

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70
Q

this kind of suture is rapid, not cosmetic, less secure and has a high risk of infection

A

continuous running

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71
Q

this kind of suture has triangular flaps without strangulation

A

3 point or half buried

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72
Q

this kind of suture is digested by enzymes

A

natural absorbable

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73
Q

this kind of suture is hydrolyzed by enzymes

A

synthetic absorbable

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74
Q

name the types of natural absorbable sutures, how much tissue reactivity they have and their half life

A

plain catgut: higher reactivity, 7-10 days

chromic catgut: (the chromic salt will delay absorption), lower reactivity, 2-3 week 1/2 life

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75
Q

name the 3 types of synthetic absorbable sutures and their half life

A

vicryl - braided and monofilament - 2-3 week

dexon - monofilament - 2-3 week

PDS - monofilament - 4-6 week

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76
Q

rank these sutures in order from most to least reactive: plain catgut, chromic catgut, synthetic sutures

A

plain > chromic > synthetic

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77
Q

name the three natural non-absorbable sutures, and tissue reactivity

A

silk: braided, easy to tie, but has high tissue reactivity

stainless steel: permanent, minimal tissue reactivity

polyester: high tissue reactivity

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78
Q

name the 2 synthetic non-absorbable sutures

A

nylon: monofilament, slips easily, low tissue reactivity and low infection risk

polypropylene/prolene: monofilament, similar to nylon, strongest with best wound security, best for a subcuticular pullout

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79
Q

what to remember with steri strips?

what helps steri strips stick better

A

DONT ENCIRCLE DIGITS - can create a tourniquet

benzoin

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80
Q

pros/cons of staples

A

fast and low risk of infection

uncomfortable

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81
Q

how many knots do you tie?

A

one more than the gauge of the suture

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82
Q

how do you remember which suture size is smaller?

A

the more 0s there are, the smaller the suture

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83
Q

when would you use a suture 6-0

A

face or neck

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84
Q

when would you use a suture 5-0

A

face or neck

arm or hands

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85
Q

when would you use a suture 4-0

A

arm or hands

trunk/legs/feet/scalp

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86
Q

when would you use a suture 3-0

A

trunk/legs/feet/scalp

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87
Q

when would you use conventional cutting needles?

A

cosmetic procedures

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88
Q

when would you use reverse cutting needles?

A

laceration, etc procedures

this one is the most common

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89
Q

when would you use tapered needles?

A

bowel, muscle, and fascia = pierces and spreads without cutting

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90
Q

when would you use blunt needles?

A

liver, kidney, cervix = dissect friable tissue instead of cutting

91
Q 
when would you remove sutures on the 
face?
neck?
scalp?
arms?
trunk?
legs?
hands/feet?
palms/soles?
A 
3-5
5-7
7-10
7-10
10-14
10-14
10-14
14-21
92
Q

the point of dressings are to provide absorption of drainage from wound, provide support, moisture for re-epithelialization, and limits movement.

going from skin to external, how do we dress a wound?

A 
non-adherent layer
gauze
elastic
tape
occlusive
93
Q

post op care: how long to keep dry? how often redressed? how to remove sutures?

A

dry for 24 hours and limit movement
redress every 2-3 days
remove sutures with iris scissors or an 11 scalpel with knots pulled across

94
Q

how many days post procedure does infection typically appear? most common pathogen?

A

4-10 days

staph aureus

95
Q

how long after surgery would a hematoma appear? what is it? risks?

A

24-72 hours
blood collection

may lead to infection or dehiscence

96
Q

what is dehiscence and how long after surgery can we re-suture?

A

wound rupture along the incision after the sutured closed. you can re-suture within 48-72 hours

97
Q

local anesthetics blocks the re-uptake of? what does it prevent?

A

Na

depolarization and propagation of pain stimuli

called a non-depolarization block??

98
Q

what is the cc, %, and mg ratio?

does the cc or the concentration(%) make something more risky in terms of toxicity?

A

(10 * cc) * % = mg, for example:

10cc of 1% = 100mg (less risky)
1cc of 1% = 10mg
5cc of 2% = 100mg (more risky)

the concentration makes the solution higher risk of toxicity

99
Q

angles of injection?

A

90 deg IM
30-45deg subQ
5-10deg intradermal

100
Q

where are amide and ester anesthetics metabolized? who has more reactions?

A

metabolized by the liver by microsomal enzymes- true allergies are rare

met by peripheral plasma - more allergic reactions

101
Q

name 2 topical amide anesthetics

A

lidocaine and EMLA

102
Q

name the 3 infiltrative amide anesthetics - what is their onset and duration in minutes?

A

bupivacaine/marcaine: 8-12, 3-4 hours
lidocaine/xylocaine: 1-10, 30-60
mepivacaine/carbocaine: 8-12, 2-2.5 hours

103
Q

max dose of lidocaine for a child and adult?

A

child: not to exceed 75-110mg total (3.3-4.5 mg/kg)
adult: not to exceed 300 mg (30cc of 1%) 4.5mg/kg

104
Q

which infiltrative amide anesthetic do we use for digit blocks? why?

A

bupivacaine/marcaine because it has a longer duration of action

105
Q

10cc of 1% lidocaine contains how many mg?

A

100

106
Q

max dose of bupivacaine in an adult?

A

4mg/kg of 0.25%, not to exceed 200mg

lidocaine is not to exceed 300mg
mepivacaine is not to exceed 400mg

107
Q

max dose of mepivacaine for an adult? when is mepivacaine preferred?

A

5mg/kg of 1%, not to exceed 400 mg

preferred for longer surgeries, but does not come with epinephrine

108
Q

too much bupivacaine can cause?

A

heart block

109
Q

name 4 topical ester anesthetics? 1 infiltrative?

A

benzocaine, proparacaine, cocaine, TAC

procaine/novocain

110
Q

what percent of benzocaine is needed and why

A

at least 10% because is it poorly absorbed

111
Q

main use of proparacaine, onset and duration?

A

ophthalmologists, < 1 min, 15 min

112
Q

main use of cocaine? onset and duration?

A

ENT procedures, <1 min, 1 hour duration

113
Q

what is TAC? what are the pros?

A

tetracaine ester, epinephrine, and cocaine - it is cheap and fast

we do not use this in minor surgery, it is usually used for spinal blocks. however there is a topical form that can be used in lacerations/open wounds

114
Q

compare procaine/novocain to lidocaine

A

procaine = ester, allergic reactions are common, slower onset, same duration of action (30-60min)

lidocaine = amide, allergic reactions not as common, quicker onset (1-10 min), same duration *most common

115
Q

after anesthestic, someone is experiencing hypotension, then bradycardia or cardiac arrest > what is this called and how did it happen? what is it treated with?

A

toxic reaction - usually an inadvertent intravascular injection or excessive dose was given

treat with oxygen

116
Q

t/f: allergic hypersensitivities to anesthetic are rare

A

true

117
Q

if someone is having an allergic reaction to anesthetic after the first dose vs many frequent exposures, what type hypersensitivity are they experiencing?

A

I or IV

118
Q

how are mild and severe allergic reactions to anesthetic treated?

A

benadryl > epinephrine and O2

119
Q

what is the most common allergy to anesthetic

A

ester anesthetics

procaine, cocaine, TAC, benzocaine, proparicaine

120
Q

this type of reaction to anesthetic looks like tachycardia, sweating, dizziness, and syncope. it resolves within minutes and requires minimal intervention

A

autonomic

121
Q

what are 3 uses of epinephrine in minor surgery? how is it doing these things?

A
  1. help decrease oozing
  2. helps prolong duration by limiting absorption
  3. decrease risk of toxic reaction by reducing circulating anesthetic

via vasoconstriction

122
Q

side effects of epinephrine include?

A

anxiety, restless, tremors, palpitations, tachycardia

123
Q

concentration(%) and max dose(mg) of epinephrine for minor surgery procedures?

A

1:200,000 concentration with a MAX of 0.2mg

124
Q

antidote of epinephrine

A

IV push of Mg and B6 to increase COMP metabolism

125
Q

never use epi?

A

fingers, toes, nose, lobes, hoes

people on MAOIs, TCAs, thyrotoxicosis, or severe CVD

caution in pts with PVD or HTN

126
Q

what kind of procedures can NDs perform?

A

uncomplicated procedures that involve superficial structures, cannot go into fascia, or muscle

127
Q

can NDs remove suspicious malignant lesions?

A

they may

128
Q

8 contraindications to minor surgery procedures for ND’s?

A
  1. Location: eyes, nose, axilla, groin, posterior neck
  2. Large Size/Blood Supply
  3. Depth
  4. Young Children
  5. Patients taking anticoagulants or with a bleeding disorder
  6. Pulsating lesion
  7. Keloid formers
  8. Systemic illness with depleted immune system
129
Q

2 methods of destructing tissue?

A

cryotherapy or electrosurgery

130
Q

what is cryotherpy?

A

freezing tissue with cryogen leading to anoxia and death

131
Q

side effect of histofreeze?

A

aerosol can with a 3 year shelf life, if inhaled can cause CNS depression and chronic exposure to it is hepatotoxic

132
Q

why is dry ice not used as much anymore?

A

simple, cheap, but not effective

133
Q

pro/con of nitrous oxide?

A

can be stored indefinitely

expensive. prolonged exposure can cause infertility or abortion

134
Q

most common form of cryotherapy?

A

liquid nitrogen

135
Q

what is liquid nitrogen stored in and how long does it last?

A

dewar bottle

can last weeks or months

136
Q

which form of cryo is most effective with rapid and deep freezing?

A

cryotherapy

137
Q

how to do cryo therapy using liquid nitrogen?

A

freeze, thaw, and refreeze with a 2-3mm freezing zone around the lesions for 10-30 seconds

q tip is left on skin for 3-5 seconds

138
Q

how long does it take a liquid nitrogen burn to heal?

A

blister within a few hours, scabs within a week, heals within 2-3 weeks

139
Q

never use liquid nitrogen straight from bottle why?

A

warts can be put into the bottle

140
Q

side effect of liquid cryo?

A

depigmentation

141
Q

contraindications to liquid nitrogen?

A

malignancy, raynauds, and sensitive skin

142
Q

forms of electrosurgery?

how does it work?

A

electrocautery and hyfrecation

a sterile + electrode destroys tissues and coagulates blood vessels

143
Q

contraindications to electrosurgery?

A

flammable alcohol, metal implants, and jewelry

144
Q

compare electrocautery and hyfrecation?

A

E: indirect current, very precise, no blood loss

H: direct, high frequency generates heat, quick and effective with minimal blood loss and great precision

145
Q

tissue preserving method?

A

biopsy: when the tissue is examined histologically by a pathologist using various dyes

146
Q

name 4 types of biopsy and when they would be used?

which ones are both DX and therapeutic?

A

excisional: complete removal of a superficial lesion, both DX and curative
incisional: narrow ellipse taken within a lesion to DX a large lesion
shave: DX and therapeutic, healing is rapid with minimal scarring
punch: trephine may obtain full thickness of dermis with minimal scarring - make sure to traction skin perpendicular to langers lines, and go 1-2 mm beyond border

147
Q

most common BX type?

what do you need to useknow this

A

excisional

3-1 elliptical with 30 deg angle corners and #15 blade, parallel to langers line

148
Q

most common size punch

A

4mm trephine

149
Q

when would i use a ##11, 15, 10, and 3 blade scalpel?

A

11: puncturing abscess, incisions, stabbing
15: blunt dissection, excision, trimming
10: like 15 but for thicker skin
3: disposable, sterile and attached to a reusable handle

150
Q

when would i use a toothed or toothless adson?

A

toothed does not crush skin, use for suturing

toothless crushes skin, use for a foreign body removal

151
Q

when would i use an iris, metzenbaum, and suture scissors?

A

I: fine dissection, dont cut sutures (you can, but if they give you the option to use suture scissors, choose those)

M: blunt dissection

S: cutting sutures

152
Q

describe a needle holder

A

tungsten carbide, blunt nose, rachets and is smooth

only used for suturing

153
Q

describe a hemostat?

A

holding, clamping, can be used to break up tissue

154
Q

describe this lesion: round coin-shaped lesion

A

nummular lesion, also known as a discoid lesion

discoid or malar rash can be seen in lupus

155
Q

describe this lesion: a linear shaped lesion that often occurs for an external reason such as scratching

A

linear lesion

156
Q

describe this lesion: concentric rings likes a dartboard
what disease is it seen in?
what is it caused by?
treatment?

A

target or iris lesion - seen in erythema multiforme
caused by HSV and mycoplasma pneumonia
self limiting
DDX: SJS

157
Q

describe this lesion: a rash that appears to be whirling in a circle

A

gyrate rash

158
Q

describe this lesion: lesions grouped in a circle

A

annular

granuloma annulare - small flesh papules increase in size on hands and feet

159
Q

describe this lesion: small patch of skin that is altered in color, but not elevated

A

macule

160
Q

describe this lesion: a large area of color change with a smooth surface

A

patch

161
Q

describe this lesion: an elevated, solid, palpable lesion that is smaller than 1 cm

A

papule

162
Q

describe this lesion: an elevated solid palpable lesion > 1 cm

A

nodule

163
Q

describe this lesion: a papule or nodule that contains fluid or semi-fluid material and is fluctuant

A

cyst

164
Q

describe this lesion: a palpable circumscribed lesion > 1 cm that is usu elevated and can be the result of coalesced papules

A

plaque

165
Q

describe this lesion: a small blister < 1 cm with liquid

A

vesicle

166
Q

describe this lesion: a circumscribed lesions with pus

A

pustule

167
Q

describe this lesion: a large blister > 1 cm with liquid

A

bulla

168
Q

describe the difference between hyperkeratosis, pankeratosis, acantholysis, and acanthosis

A

hyperkeratosis: thick stratum corneum
pankeratosis: nucleated keratinocytes in the stratum corneum
acantholysis: loss of intercellular cohesion between keratinocytes
acanthosis: overgrowth of stratum spinosum

169
Q

how to tell if a dermal nevi is benign?

A

ABCDE: asymmetry, border, color, diameter, elevation

170
Q

there is a 10% chance that this lesion turns into SCC?

A

AK

171
Q

diagnose this: poorly defined velvety hyperpigmentation of flexural skin?
mc locations?
associated with?

A

acanthosis nigricans
neck, armpits, skin folds
hyperlipidemia, Cushings, and DM

172
Q

what is this process called: thick, leathery skin usu caused by chronic scratching

it is a common consequence of?

A

lichenification

atopic derm/eczema

173
Q

diagnose this: flakes and itching on scalp

treatment?

A

seborrheic dermatitis, dandruff, cradle cap

selenium sulfide shampoo

174
Q

difference between open and closed comedones?

A 
open = black
closed = white
175
Q

what should we avoid and use in acne vulgaris?

systemic ABX?

A

avoid B12 and iodine
use zinc and tea tree

clindamycin in mild, doxycycline in moderate, isotretinoin in severe

176
Q

difference between vitiligo and melasma

A

V: pigment change, autoimmune destruction. TX: copper, vit D, phenylalanine

177
Q

diagnose this: round or oval papules or plaques that are pink red or purple, usu on legs

A

kaposis sarcoma

178
Q

where is erythema nodosum usually located?

what is it associated with?

A

anterior shins - it is a lesion of subQ fat

sarcoid, TB, leprosy, histoplasmosis (MW and SE), coccidiomycosis (SW), crohns

The presence of erythema nodosum in a case of coccidioidomycosis is a good prognostic indicator. It means that the symptoms are likely to resolve without serious sequelae.

179
Q

more common neoplasia in women, associated with tumor marker S-100, metastasizes, grows and changes rapidly
how is it treated?

A

melanoma

refer for excisional biopsy

180
Q

risks of melanoma?

A

family history, fair skin, AK, outdoor work, sun burns

181
Q

most common form of melanoma?

A

superficial spreading

182
Q

most aggressive form of melanoma?

A

nodular

183
Q

melanoma seen in the elderly, slow growing?

A

lentigo

184
Q

most common melanoma in dark skin, aggressive, seen in palms, soles, and nails

A

acral

185
Q

diagnose this: diffuse, superficial, spreading infection of the dermis and sub Q fat?
bug?
diagnosed?
treated?

A

cellulitis > can lead to necrotizing fasciitis or erysipelas

GABHS (staph in large wounds)

usually clinical, but can get blood cultures

*must know that this is different than purulent collections of pus, where the mainstay treatment is I/D. the treatment for cellulitis is SYSTEMIC ANTIMICROBIAL THERAPY** - cephalexin** penicillin, amoxicillin, amox-clauv,f clindamycin

186
Q

diagnose this: infection of the upper dermis including superficial lymphatics: orange peel appearance. usu due to IC, trauma, ulceration, or skin injury
bug?
diagnosed?
most common location?

A

erysipelas

streptococcus (A, as well as B, C, F, G)

usually clinical, but can get blood cultures

lower legs

187
Q

red streaking along the LNs? usu deeper

A

lymphangitis

188
Q

chronic venous insuff due to DM or bed ridden

A

stasis dermatitis

189
Q

6th disease, HHV6/7, maculopapular rash with high fever

A

roseola infantum

190
Q

cranial caudal macular papular rash with CLAD and fever

A

rubella/german measles

191
Q

cough, coryza, koplik spots, subacute sclerosing panencephalitis

A

measles

192
Q

diagnose this: honey colored crust
what 2 bugs are most common?
how do we usually DX?
tx?

A

impetigo
staph or strep B
gram stain and culture
topical mupirocin

193
Q

diagnose this: prodrome with itch, possibly a fever or facial infection
what do you avoid/tx with?
what is seen on Tzanck?

A

herpes simplex
TX: lysine, acyclovir, valacyclovir AVOID: arg
multinucleated giant epithelial cells

194
Q

dermatomal, neuritic pain, vesicular eruptions

tx?

A

zoster

TX: levodopa, UV light, ZOSTAVAX

195
Q

diagnose this: viral infection, waxy pink rash with small central pit
how is it DX?
what virus is it?
treatment?

A

molluscum contagiousm
can BX to confirm, but none are required
poxvirus
TX: salicylic acid, electrodessiation, cryo, vit B9

196
Q

diagnose this: brown or white scaling macules, dry and scaly, could itch?
diagnosed?
tx?

A

tinea/pityriasis versicolor
looks gold on a woods lamp or + on KOH - hypahe/spores
topical terbinafine or ketoconazole

197
Q

IgE reaction to thinks like Nickel

A

dyshidrotic eczema, pomphylox

198
Q

diagnose this: single, large oval scaly rose colored plaque > papular rash parallel to the ribs? what are these called?
common sites?
virus?
treatment?

A 
pityriasis rosea
Herald's patch
christmas tree distribution
trunk, proximal arms and legs
HHV7
none > self-limiting
199
Q

most common on flexor surfaces

A

AD: psorinum, sulphur, vit C

200
Q

diagnose this: raised, discolored nail that is yellow thick or crumbly
how to DX?
TX?

A

tinea unguium/onychomycosis
can do KOH prep of scrapings > hypahe
terbinafine is most effective, can also do tea tree oil

201
Q

diagnose this: vesicles and bulla, autoimmune blistering disease?
what is it called when sliding or rubbing pressure on the skin causes separation of the epidermis?
what is it called when pressure applied to the bulla causes it to spread laterally?
how do you DX?
what is seen on BX? serum?
treatment?

A

pemphigus vulgaris autoimmune - deadly

Nikolsky sign

Asboe-Hansen sign

Tzank, BX with immunoflorescence: IgG and C3 deposition in intraepidermally

intraepidermal bullae with antiepithelial cells against desmosomes, antidesmoglein 3 Abs

corticosteroids, immunosuppressive agents

202
Q 
diagnose this: pruritic, tense, intact subepidermal bulla, flexors and trunk affected
what type of reaction?
how is it DX?
what is on BX? serum?
TX?
A

bullous pemphgoid
type II hypersensitivity
immunoflorescence: linear deposition of IgG and C3 along the basement membrane
epidermal blisters and antibasement membrane auto IgGs
systemic steroids

203
Q

bulls eye lesions, caused by burgdorgeri, ixodes tick

A

erythema migrans

204
Q

measles like maculopapular rash

A

morbilliform drug eruption

205
Q

emergency rash caused by SSRI?

A

SJS or toxic epidermal necrolysis

206
Q

explain the difference between irritant and allergic contact dermatitis

treatment?

A

irritant: not immune related (laundry, soap, alcohols, oils, etc)
allergic: type IV hypersensitivity reaction (poison ivy, allergens)

avoid irritants, topical or oral steroids

207
Q

associated with CD, IGA deposits causing papules or vesicles

A

dermatitis herpetiformis

208
Q

diagnose this: dry skin with prolonged, severe pruritus, seen on extensor surfaces in infants and flexural in adults: IgE reaction, eosinophilia, asthma, hay fever?

how DX?
tx?

A

atopic dermatitis/eczema
clinical DX
topical corticosteroids

209
Q

diagnose this: well-demarcated, flat, elevated erythematous papules and plaques with silvery scales?
what is pin point bleeding?
what is rash in areas of trauma?
what is seen on BX?

A

psoriasis
Auspitz sign
Koebners phenomenon
absent or diminished stratum granulosum, parakeratosis, epidermal thickening

210
Q

diagnose this: associated with rhinopyema, worse with stress, hot and cold, food trigger, malar rash with pustules or papules on erythematous base w telangiectasia

first line treatment?

A

rosacea

oral tetracycline and topical metronidazole, topical azelaic acid

also trigger avoidance, avoid topical steroids and makeup

211
Q

red scaling with prominent skin lines and constant itch

A

lichen simplex

212
Q

diagnose this: wickhams striae, 6 Ps, palms and wrist, associated with Hep C
what are the 6 P’s?
what is koebner’s phenomenon?
what is there an increased risk of developing due to this?
TX?

A

lichen planus
polygonal, pruritic, planar, purple, papules, and plaques
when lesions develop in places of scratching
SCC
topical corticosteroids, immune suppressants

213
Q

white, painless patches on tongue that can not be scraped off

A

hairy leukoplakia - EBV in HIV pts

214
Q

painless bite that is neurotoxic

tx?

A

black widow

Lyovac = antivenom

215
Q

painful bite that is necrotoxic

A

brown recluse

216
Q

diagnose this: itching worse at night, doesnt go above neck

treatment?

A

scabies

permethrin

217
Q

which HPV are dysplastic vs warts?

A

6, 11 warts

16, 18 dysplastic

218
Q

what is the most common benign tumor in older individuals?

A

seb keratosis

219
Q

patient characteristics: what age makes best candidate for minor surgery?

A

15-65

220
Q

patient characteristics: which body type tends to heal quick? slower?

A

ectomorph - thinner

endomorph - heavier

221
Q

patient characteristics: name two medications that should always be asked about before minor surgery and why?

A

aspirin or anticoagulants - could prolong clotting time

diuretics - could lower blood pressure

222
Q

patient characteristics: name high risk candidates

A

those with diabetes - healing time is increased
blood dyscrasias, hemophilia, leukemia, anemia
those with heart problems or a history of them
asthmatics or those with COPD
serious nervous disorders like schizophrenia, etc

223
Q

T/F? shaving should only be done on areas where the hair will grow back

A

FALSE - we dont shave anymore because it can cause a secondary infection

NPLEX 2 Flashcards (13 decks)

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