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Derm/minor surgery > Exam Two Study Questions > Flashcards

Exam Two Study Questions Flashcards

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1
Q

Why do basal cell carcinomas have a limited capacity to metastasize?

A

If tumor cells lodge at distant sites, they rarely multiply and grow due to absence of necessary growth factors derived from the stroma of the original tumor site.

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2
Q

What are the problem locations/danger zones for BCCs?

A

Around the eyes, in the nasolabial folds, around the ear canal, in the posterior auricular sulcus

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3
Q

Persons age ____ have a ___x fold incidence of BCC than those _____

A

Persons 55-75 have a 100x risk than patients under 20

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4
Q

About ____% of pts who have had BCC will develop another lesion within 5 years.

A

40

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5
Q

What is the most important environmental RF for developing BCC?

A

Chronic UV exposure

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6
Q

Which proposes a greater risk for BCC - intermittent, intense increments of UV exposure or continuous similar dosage over longer period?

A

Intermittent, intense increments

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7
Q

Describe a “rodent ulcer”

A

Some nodular BCCs are called “rodent ulcers”:
Center ulcerates/bleeds, accumulates crust/scale
Ulcerated areas heal with scarring

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8
Q

What is unique about morpheaform BCC that makes identification and treatment difficult?

A

Borders are in distinct and blend with normal skin making border localization by inspection or biopsy impossible

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9
Q

What are treatments of morpheaform BCCs?

A

Preferably mohs micro graphic surgery

Wide excision

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10
Q

Why must BCCs be treated early on?

A

They are locally invasive, aggressive, and destructive to surrounding tissues

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11
Q

Diagnosis of BCC must be confirmed by _____

A

Biopsy

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12
Q

What is more effective for BCCS - surgical excision or ED&C? Why?

A

Surgical excision is more effective because there is better margin control (still less effective margin control than Mohs)

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13
Q

Why would one choose radiation therapy to treat a BCC?

A

Non-invasive - relatively sparing of critical structures

Relatively painless

Good for patients who are not otherwise candidates for surgery

High cure rate for selected lesions

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14
Q

List three features of BCCs that account for a high likelihood for recurrence after initial treatment

A
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15
Q

Most SSCs that occur in sun-exposed areas of the skin have a very ___ rate of metastasis.

A

Low

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16
Q

In dark-skinned individuals, SCCs tend to arise where and are associated with what?

A

Non sun-exposed area (legs, anus) and frequently are associated with chronic inflammation, chronic wounds, or scarring

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17
Q

Genetic RFs for SCCs

A

Fair skin
Light eyes
Red hair
Northern European origin

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18
Q

What areas are more susceptible to the development of SCC?

A

Sites of chronic inflammation, chronic wounds, or scars

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19
Q

A lesion on the vermillion border is ____ until proven otherwise.

A

SCC

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20
Q

Metastasize rate of BCC and SCC

A

BCC - rare, 0.003%
SCC - 5-10%

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21
Q

Cumulative UVB sun exposure in the past ____ years of a person’s life increases the likelihood of SCC in the presence of other RFs.

A

5-10

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22
Q

Features of SCC lesions that correlate with high risk for recurrence and regional or distant metastasis

A

Non-sun exposed areas
SCCs not derived from AKs

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23
Q

Most common non-melanoma skin cancer

A

BCC

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24
Q

Death may result from untreated BCC due to

A

Hemorrhage of eroded large vessels of meningitis

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25
Q

Types of BCC

A

Nodular
Pigmented
Micronodular
Morpheaform (sclerosing)
Superficial

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26
Q

BCC clinical features

A

Malignant skin tumors arising from epidermis, developing hair follicles; rarely occur on lips/genital mucosa

Locally invasive, aggressive, destructive

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27
Q

Nodular BCC clinical features

A

Most common
Round, oval, flat
Pearly with Telangiectasia
Translucent when stretched
Can ulcerate and bleed > heal > cycle
Irregular growth pattern > mass with multilobular surface

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28
Q

Nodular BCC may appear similar to what benign growths

A

Dermal nevi, small epidermal inclusion cysts, sebaceous hyperplasia

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29
Q

What are some alterative herbs using in dermatology?

A

Trifolium pratense (red clover)*
Arctium lappa (burdock)*
Mahonia spp (Oregon grape)
rumex (yellow dock)
Taraxacum
Smilax (sarsaparilla)
Curcuma longa
Urtica dioica

*specificity of seat in the skin

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30
Q

What are some antioxidants/ inflammation modulating herbs using in dermatology?

A

Berberis vulgaris
Camellia sinensis
Silybum marianum
+ all alteratives

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31
Q

What are some immune modulating herbs using in dermatology?

A

Eleuthercoccus senticosus
Ganoderma lucidum

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32
Q

What do alteratives do?

A

Nourishing, restorative tonics with effects focused on digestion, absorption, and elimination

“blood purifier”

Non-specific, broad

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33
Q

Trifolium pratense - common name, part used, energetics

A

Red clover
Flower
Cooling

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34
Q

Trifolium pratense main constituents

A

Phenolic glycosides
Isoflavones

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35
Q

Red clover actions

A

Alterative
Phytoestroenic
Anti-inflammatory
Lymphagogue
Vulnerary

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36
Q

Red clover derm indications

A

Acne
Ulcers of skin, mucous membranes
Burns with poor healing

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37
Q

Articum lappa - common name, part used, energetics

A

Burdock
Root (sometimes seed and leaf)
Cooling

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38
Q

Burdock actions

A

Root: alterative
Leaves: topical, antimicrobial, anti-inflammatory poultice
Seeds: alterative, vulnerary

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39
Q

Burdock derm indications

A

Root: dry, scaly skin conditions - psoriasis, eczema, dandruff, wounds and ulcers (poultice)

Seeds: skin conditions including exanthems

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40
Q

Mahonia/berberis common name, part used, energetics

A

Oregon grape
Root bark and stem bark
Cooling, drying

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41
Q

Oregon grape actions

A

Alterative, antimicrobial

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42
Q

Mahonia/berberis - common name, part used, energetics

A

Oregon grape
Root bark and stem bark
Cooling, drying

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43
Q

Oregon grape actions

A

Alterative, antimicrobial

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44
Q

Oregon grape derm indications

A

Psoriasis, eczema, herpes, pityriasis, acne, syphillis, skin infections

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45
Q

Camellia sinensis - common name, part used

A

Green tea
Leaf

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46
Q

Green tea actions

A

Modulates inflammation, dec sebum production, antimicrobial

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47
Q

Green tea derm indications

A

Topically used for acne vulgaris and rosacea, condyloma accuminata, atopic dermatitis, hypertrophic scar formation, wound healing
UV protection
Dec age related changes

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48
Q

Green tea CI/Caution

A

Take away from iron supplementation

49
Q

Berberis vulgaris common name, part used

A

Barberry
Berries, rhizome, root

50
Q

Actions of barberry

A

Berries: antioxidant, inflammation modulator

Rhizome and root: inflammation modulator, antimicrobial, affects glucose metabolism

51
Q

Indications of barberry

A

Berries: acne, other inflammatory conditions

Rhizome and root: berberine source

52
Q

Silybum marianum common name, part used

A

Milk thistle
Seed

53
Q

Milk thistle actions

A

Hepatoprotective, bitter, antioxidant, galactogogue

54
Q

Derm indications milk thistle

A

Acne

55
Q

What are some herbs good for internal immune modulation?

A

Eleutherococcus and herpes simplex, ganoderma lucidum

56
Q

Eleutherococcus senticosis common name, part used, energetics

A

Siberian ginseng
Root (most researched), stem bark and leaf
Warm, stimulating (higher doses), dispels wind dampness

57
Q

Actions Siberian ginseng

A

Adaptogen, immunomodulating, mild CNS stimulant

58
Q

Indications Siberian ginseng

A

Build vitality, inc resistance to infection, stress + toxicity, improve physical performance, improve mood

59
Q

CI/caution Siberian ginseng

A

Adulteration common; monitor blood glucose in diabetics and hypoglycemias

60
Q

Ganoderma lucidum common name, part used

A

Reishi, ling zhi
Fruiting body

61
Q

Actions reishi

A

Anti-allergic
Anti-hypertensive
Dec platelet aggregation
Dec LDL
Dec arrhythmia
Dec angina

62
Q

Indications reishi

A

Cancer tx to manage fatigue and increase immune function
HTN
Immune def
Insomnia
Hepatitis

63
Q

What actions of vulnerary herbs are beneficial in dermatology?

A

Inc cell proliferation
Promotes angiogenesis
Inc collagen formation
Inc rate of epithelialization
Speeds contraction of wounds
Controls inflammation
Inc tensile strength

64
Q

Calendula part used, energetics

A

Flower, drying

65
Q

Calendula actions

A

Vulnerary, antiinflammatory, antimicrobial

66
Q

Calendula indications

A

Lacerations, abrasions, excoriations, ulcers, eczema, rashes

67
Q

Echinacea part used and energetics

A

Root and rhizome, whole plant

Cooling, drying, stimulating

68
Q

Echinacea actions

A

Vulnerary
Immunomodulator
Anti-inflammatory
Anti-microbial

69
Q

Echinacea indications

A

Infection, sepsis, pharyngitis, snake bites, ulcers

70
Q

What is the best agreed upon screening protocol for malignant melanoma?

A

Skin survey

71
Q

During the ______ growth phase, a malignant melanoma is almost always unable by excision alone.

A

Horizontal

72
Q

Nodular melanomas have no identifiable ___ growth phase and enter the ____ growth phase almost from their inception.

A

Radial/horizontal
Vertical

73
Q

Over __% of superficial spreading malignant melanomas are diagnosed as thin, highly curable tumors of less than __ thickness.

A

60%
1mm

74
Q

Nodular malignant melanomas are the most difficult to diagnose at an early stage, at least half are greater than ___ in thickness when dx

A

2mm

75
Q

The majority of Lentigo melanomas are diagnosed at ___(size)

A

Under 1 mm of thickness

76
Q

The most common type of malignant melanoma among Asians and African Americans is the _____ melanoma, which most commonly arise on _______ surfaces

A

Acral lentiginous melanoma
Palmar, plantar, subungual surfaces

77
Q

_____ is the single most important determinant of prognosis for a malignant melanoma

A

Tumor thickness

78
Q

Stage T1 <1mm malignant melanomas have a 10 yr survival rate of ____

A

92%

79
Q

The definitive “initial” surgical treatment for primary cutaneous melanoma is a _____

A

Wide local excision, down to the deep fascia

80
Q

any malignant melanoma positive biopsy needs to be referred for ____.

A

Mohs procedure

81
Q

Anesthetic are generally (vasodilators/vasoconstrictors)

A

Vasodilators (other than cocaine)

82
Q

Benefits of adding epinephrine to local anesthetic

A

Dec bleeding
Prolongs anesthesia by slowing absorption
Min amount of anesthesia needed (less sys toxicity)

83
Q

Risks of epinephrine

A

Hypoxic damage if used in area with limited circulation

84
Q

What are some of the major drug interactions/bad effects with local anesthetics?

A

MAO inhibitors > hypertensive crisis

Carbamazepine and cyclobenzaprine > potentiate effects

Tricyclics > hypertensive crisis, dysrhythmia

Phenothiazines > hypotension

85
Q

Define infiltration anesthesia

A

Injection of local anesthetic directly into tissue without considering course of cutaneous nerves

86
Q

benefits of field block

A

In both, not injecting anesthesia directly into lesion avoids distortion of anatomy of lesion and allows pathologist to correctly interpret biopsy

Less drug can be used to provide more anesthesia

87
Q

Routes of administration of local anesthesia

A

Topical
Local infiltration
Field block
Digit block/nerve block
IV regional
Spinal
Epidural

88
Q

Max dosage 1% lidocaine with and without epi

A

1% - 4.5 mg/kg
1% with epi - 7 mg/kg

89
Q

Max dosage 0.25% bupivacaine with and without epi

A

0.25% - 3 mg/kg
0.25% with epi - 3.5 mg/kg

90
Q

What are langers lines? How are they used in minor surgery?

A

Topological lines on the human body corresponding to the natural orientation of collagen fibers in dermis and parallel to underlying muscle fibers

Incisions made parallel to langers lines minimize wound tension, heal faster, and produce less scarring

91
Q

What are the “problem areas” of the body for increased risk of scarring/keloids?

A

Upper chest and back
Shoulders

92
Q

How do kraissls lines compare to langers lines?

A

Langers lines = cadavers
Kraissls lines = living people

93
Q

When does the inflammatory stage of healing occur and what happens during this stage?

A

Immediate > 2-5 days
-bleeding stops (vasoconstriction>clot>scab)
-inflammation (opening of blood supply > cleansing of wound)

94
Q

When does the proliferative stage of healing occur and what happens during this stage?

A

5 days - 3 weeks
-granulation (new collagen, new capillaries)
-contraction (wound edges pull together)
-epithelialization (cells cross over moist surface)

95
Q

When does the maturation stage of healing occur and what happens during this stage?

A

3 weeks - 2 years
-collagen forms > inc tensile strength
-scar tissue only 80% strong as original tissue

96
Q

What is the average tissue strength of a healing wound when the sutures are removed at 10-14 days?

A

5-6%

97
Q

Clean v clean contaminated v contaminated v infected

A

Clean - free from microorganisms

Clean contaminated - non-significant contamination, <6 hr til med care

Contaminated - without local infection, >6 hr til med care

Infected - intense inflammatory reaction and infectious process

98
Q

Is there a golden period for closing lacerations?

A

> 8 hrs body, >12-24 face
Not really used any longer

99
Q

What are the two possibilities that lead to a wound healing by secondary intention?

A

Wound left open on purpose > allowed to heal without closure from inner layer towards surface

wound fails to heal via primary intention

100
Q

Advantages of healing by secondary intention

A

Simplicity
Low risk of infection

101
Q

Disadvantages healing by secondary intention

A

Long healing times
Larger scars

102
Q

Steps of delayed primary closure

A

Debride wound
Pack wound with sterile dressing
Cover with supporting bandage
Repeat daily

103
Q

When should DPC be used?

A

Heavily contaminated wounds (combat wounds/major trauma)

104
Q

Electrofulguration v electrodessication

A

Electrofulguration - electrode held away from the skin, produces spark and shallow effect

Electrodessication - touch skin with electrode to destroy tissue

105
Q

Advantages of cryotherapy over electrosurgery

A

Faster and easier
No anesthesia
Less scarring
No smoke plume; no need for smoke evaluator
No risk of HPV/HIV
Tx of choice for actinic keratosis and simple warts

106
Q

Disadvantages of cryotherapy v electrosurgery

A

Hypopigmentation
Less effective for large pedunculated lesions eg condylomata
Final results not immediately visible
More postop swelling
Transient discomfort

107
Q

What tx is good for port wine stain?

A

Laser tx

108
Q

CI electrosurgery

A

Pacemakers, metal plates, prosthetics
Lesions in folds of skin, face
Don’t let pt touch metal table

109
Q

What areas are steri-strips good for?

A

Face, contoured areas, joints, areas of swelling, edema, hematomas

110
Q

Best uses for surgical glue

A

Small, superficial lacerations
May be used on larger wounds after first applying subcutaneous sutures

111
Q

Cautions surgical glue

A

Wounds must be dry
Only use with low infection risk
Don’t use over joints/high friction areas
Deeper lacerations to torso and extremities need subdermal sutures first

112
Q

What types of wounds are not suitable for steri-strips and glue?

A

Lacerations into the deep dermal layers and sub-q

Wounds missing tissue

Wounds w inc wound tension

113
Q

Advantages of staples over sutures

A

Quick placement
Fewer infections
Lower tissue reaction

114
Q

Suture removal times

A

Face: 3-5
Scalp: 5-7
Extrem low tension: 6-10
Extrem high ten: 10-14
Abdomen, chest, back: 6-12

115
Q

Clinical benefits of radio surgery

A

Hemorrhage control
Reduced postop discomfort
Min scar tissue
Readability of biopsy
Enhanced healing
Good cosmetic results

116
Q

Skin lesions treatable with radiosurgery

A

Hemangiomas
Dermatofibromas
Compound nevi
Sebaceous hyperplasia
Thick Seborrheic keratosis
Spider angioma
Cherryangioma

117
Q

When trimming a wound edge the goal is to produce an opening _________ which helps produce eversion of the edges

A

Wider at the base than the surface

118
Q

Small v large bleeders

A

Small “oozing” venous/capillary bleeders

Large “spurting” arterial bleeders

Derm/minor surgery (9 decks)

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