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Z.Fiser > Fiser.18.Plastics > Flashcards

Fiser.18.Plastics Flashcards

1
Q

What is the main component of the epidermis?

A

primarily celular

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2
Q

what is the main cell type in the epidermis?

A

keratinocytes

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3
Q

where do keratinocytes originate from in the skin?

A

from the basal cell layer

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4
Q

what is the function of keratinocytes?

A

provide mechanical barrier

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5
Q

what is the origin of melanocytes?

A

neuroectodermal origin from neural crest cells

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6
Q

where do melanocytes reside in the skin?

A

in the basal cell layers

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7
Q

what causes the racial differences in skin color in terms of melanocytes?

A

the denisty of melanocytes is the same among races with the difference in melanin production

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8
Q

what is the main component of the dermis

A

primarily made up of structural proteins (collagen) for the epidermis

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9
Q

what is the function of Langerhans celles?

A

act as antigen-presenting cells (MHC class II)

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10
Q

where do Langherhans cells come from?

A

originate from bone marrow

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11
Q

what is the role of Langerhands cells?

A

have a role in contact hypersensitivity reactions (type IV)

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12
Q

*what type of sensation is transduced by Pacinian corpuscles?

A

pressure

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13
Q

what type of sensation is transduced by Ruffini’s endings?

A

warmth

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14
Q

what type of sensation is transduced by Krause’s end-bulbs?

A

cold

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15
Q

what type of sensation is transduced by Meissner’s corpuscles?

A

tactile sense

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16
Q

what is the difference in the type of sweat produced by eccrine sweat glands and apocrine sweat glands?

A

eccrine sweat glands produce hypotonic aqueous sweat and apocrine sweat glands produce milky sweat

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17
Q

what is the function of eccrine sweat glands?

A

thermal regulation

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18
Q

where are the highest concentrations of apocrine sweat glands?

A

palms and soles

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19
Q

what is the innervation / trigger for apocrine sweat gland production?

A

stimulated by sympathetic nervous system via acetylcholine

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20
Q

how does lipid solubility of a drug affect skin absorption?

A

lipid soluble drugs have increased skin absorption

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21
Q

what is the predominant type of collagen in skin?

A

Type I collagen

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22
Q

what percent of the dermis is made of Type I collagen and what is its function?

A

70% of dermis is made of Type I collagen, gives it tensile strength

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23
Q

define tension in terms of skin and skin molecules

A

resistance to stretching, provided by collagen

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24
Q

define elasticity in terms of skin and skin molecules

A

ability to regain shape, provided by branching proteins that can stretch to 2x normal length

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25
Q

what is the underlying cause of Cushing’s striae?

A

caused by loss of tensile strength and elasticity

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26
Q

what is the MCC of pedicled or anastomosed free flap necrosis

A

venous thrombosis

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27
Q

name three underlying causes of tissue expansion

A

local recruitment, thinning of dermis and epidermis, mitosis

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28
Q

name 5 complications of TRAM flaps

A

flap necrosis, ventral hernia, bleeding, infection, abdominal wall weakness

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29
Q

what is a TRAM flap?

A

transverse rectus abdominis myocutaneous flap reconstruction

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30
Q

what vessels do TRAM flaps rely on?

A

superior epigastric vesels

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31
Q

what type of vessel is the most important determinant of TRAM flap viability?

A

periumbilical perforators

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32
Q

Describe a Stage I pressure sore

A

erythema and pain, no skin loss

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33
Q

describe a Stage II pressure sore

A

partial skin loss with yellow debris

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34
Q

what is the treatment for a stage II pressure sore?

A

localized treatment, keep pressure off

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35
Q

describe a stage III pressure sore

A

full thickness skin loss, subcutaneous fat exposure

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36
Q

what is the treatment of a stage III pressure sore?

A

sharp debridement, likely need myocutaneous flaps

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37
Q

Describe a stage IV pressure sore

A

involves bony cortex, muscle

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38
Q

what is the treatment for a stage IV pressure sore?

A

myocutaneous flaps

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39
Q

how does UV radiation cause DNA damage

A

damages DNA and repair mechanisms; both a promoter and an initiator

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40
Q

what is the single best factor for protecting skin from UV radiation?

A

melanin

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41
Q

what is the type of UV radiation responsible for chronic sun damage?

A

UV-B

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42
Q

what percent of skin cancers are 2/2 melanoma?

A

5%

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43
Q

what percent of skin cancer deaths are 2/2 melanoma?

A

65%

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44
Q

what is the risk of melanoma seen with familial BK mole syndrome?

A

100% risk of melanoma

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45
Q

what is the lifetime risk of melanoma with dysplastic, atypical, or large congenital nevi

A

10% lifetime risk for melanoma

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46
Q

name six risk factors for melanoma

A

xeroderma pigmentosum, fair complexion, easy sunburn, intermittent sunburns, previous skin CA, previous XRT

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47
Q

what percent of melanomas are familial?

A

10%

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48
Q

what is the MC melanoma site in men?

A

back

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49
Q

what is the MC melanoma site in women?

A

legs

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50
Q

name four poor prognostic signs for melanoma

A

men, ulcerated lesions, ocular, mucosal

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51
Q

describe the “A” of the ABCDE of melanoma

A

A: asymmetry (angulations, indentation, notching, ulceration, bleeding)

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52
Q

describe the “B” of the ABCDE of melanoma

A

B: borders that are irregular

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53
Q

describe the “C” of the ABCDE of melanoma

A

color change (darkening)

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54
Q

describe the “D” of the ABCDE of melanoma

A

diameter increase

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55
Q

describe the “E” of the ABCDE of melanoma

A

evolving over time

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56
Q

where do melanomas originate from? (cell type, layer of skin)

A

originate from neural crest cells (melanocytes) in the basal layer of the epidermis

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57
Q

what is the most ominous color of melanoma?

A

blue

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58
Q

what is the MC location for distant melanoma metastases?

A

lung

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59
Q

what is the MCC of small bowel mets?

A

melanoma

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60
Q

how do you dx and treat a suspected melanoma that is <2cm in diameter?

A

excisional bx with a tru-cut core needle bx unless in a cosmetically sensitive area. Will need resection with margins if pathology comes back as melanoma

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61
Q

how do you dx and treat a suspected melanoma that is >2cm in diameter?

A

incisional biopsy (or punch biopsy); will need to resect with margins if pathology shows melanoma

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62
Q

how do you dx and treat a suspected melanoma that is in a cosmetically sensitive area?

A

incisional biopsy (or punch biopsy); will need to resect with margins if pathology shows melanoma

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63
Q

how deep does the melanoma in situ / thin lentigo maligna extend?

A

extends into the superficial papillary dermis only

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64
Q

what is the proper name for melanoma in situ / thin lentigo maligna?

A

Hutchinson’s freckle

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65
Q

what margins are required for excision of melanoma in situ / thin lentigo maligna?

A

0.5cm margins

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66
Q

what is the least aggressive subtype of melanoma

A

lentigo maligna melanoma - minimimal invasion

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67
Q

what type of growth occurs with lentigo maligna melanoma and how does it present?

A

radial growth first, presents with elevated nodules

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68
Q

what is the MC type of melanoma?

A

superficial spreading melanoma, MC with intermediate malignancy

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69
Q

what is the origin of superficial spreading melanoma?

A

originates from nevus / sun-exposed areas

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70
Q

what is the most aggressive type of melanoma and why?

A

nodular melanoma, vertical growth first, most likely to present with mets at the time of dx

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71
Q

what type of growth occurs with nodular melanoma?

A

vertical growth first

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72
Q

how do nodular melanomas present (appearance, location)?

A

bluish-black with smooth borders, can occur anywhere on the body

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73
Q

how aggressive are acral lentiginous melanomas?

A

very aggressive

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74
Q

where and in what population do acral lentiginous melanomas present?

A

on palms and soles in African Americans

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75
Q

what imaging and labs are required for melanoma staging?

A

CT - C/A/P, LFTs, LDH. Physical exam of all possible draining LNs

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76
Q

what is the size threshold to require staging of a melanoma?

A

> or = 1mm

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77
Q

how do you treat for all stages of melanoma?

A

1) resection of primary tumor with appropriate margins and 2) management of lymph nodes

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78
Q

what is the recommended clinical excision margin for melanoma in situ?

A

0.5-1.0cm

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79
Q

what is the recommended clinical excision margin for melanoma that is < or = 1.0mm thick?

A

1.0cm

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80
Q

what is the recommended clinical excision margin for melanoma that is 1.1-2.0 mm thick?

A

1.0-2.0cm

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81
Q

what is the recommended clinical excision margin for melanoma that is > 2.0mm thick?

A

2.0cm

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82
Q

how do you manage clinically positive lymph nodes in a melanoma patient?

A

always need to resect clinically positive lymph nodes

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83
Q

how do you manage clinically negative lymph nodes in a melanoma patients with tumor that is > or = 1.0mm deep?

A

need to perform SLNB

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84
Q

what clinical findings are seen with involved lymph nodes when performing clinical exam? *4 findings)

A

nontender, round, hard, 1-2cm

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85
Q

what additional procedure needs to be performed for all anterior head/neck melanomas > or = 1.0mm deep?

A

superficial parotidectomy

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86
Q

what is the rate of metastasis to parotid for anterior head/neck melanomas that are > or = 1.0mm deep?

A

20% rate of mets

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87
Q

how do you treat axillary node melanoma with no other primary

A

complete axillary node dissection, remove levels I, II, III, unlike breast CA

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88
Q

what are outcomes after resection of melanoma mets?

A

provides some patients with long disease-free intervals and is the best chance for cure

89
Q

how do you treat isolated mets to the lung or liver?

A

if resectable with a low risk procedure, should probably undergo resection

90
Q

name two treatments for systemic disease with melanoma

A

IL2 and tumor vaccines

91
Q

what is the MC malignancy in the US?

A

basal cell carcinoma

92
Q

how much more prevalent is basal cell carcinoma compared to SCC?

A

BCC is 4x MC than SCC

93
Q

what percentage of BCCs occur on the head and neck?

A

80%

94
Q

where do BCCs originate from? (skin layer and cell type)

A

originates from epidermis with basal epithelial cells and hair follicles

95
Q

what are the physical exam findings of BCC? (3)

A

pearly appearance, rolled borders, slow / indolent growth

96
Q

what is the pathology findings a/w BCC?

A

peripheral palisading of nuclei and stromal retraction

97
Q

what procedure should you perform for clinically positive LNs a/w BCC?

A

regional adenectomy

98
Q

what is the most aggressive form of basal cell carcinoma?

A

morpheaform type

99
Q

what enzyme is produced by the morpheaform subtype of basal cell carcinoma?

A

collagenase

100
Q

what are the margins needed to treat BCC?

A

0.3-0.5cm margins

101
Q

when are XRT and chemotherapy indicated for BCC?

A

limited benefit for inoperable disease, mets, or neuro/lymphatic/vessel invasion

102
Q

what are the physical exam findings a/w SCC?

A

overlying erythema, papulonodular with crust and ulceration, usually red-brown. May have surrounding induration and satellite nodules

103
Q

what is the rate of metastases for SCC, BCC, and melanoma?

A

most frequent for melanoma, then SCC, then BCC

104
Q

name 13 risk factors for SCC

A

post-XRT areas, old burn scars, actinic keratosis, xeroderma pigmentosum, Bowen’s disease, atrophic epidermis, arsenics, hydrocarbons (coal tar), chlorophenols, HPV, immunosuppression, sun exposure, fair skin, previous skin CA

105
Q

name four risk factors for metastasis?

A

poorly differentiated, greater depth, recurrent lesions, immunosuppression

106
Q

what are the margins to treat SCC?

A

0.5-1.0cm margins for low risk

107
Q

how can you treat high risk SCC or SCC in aesthetically sensitive areas?

A

Mohs surgery with margin mapping using conservative slices

108
Q

how do you treat clinically positive LNs a/w SCC?

A

regional adenectomy

109
Q

can you use Moh’s surgery to treat melanoma?

A

nope

110
Q

what is the role of XRT and chemotherapy in treatment of SCC?

A

limited benefit for inoperable disease, metastases or neuro/lymphatic/vascular invasion

111
Q

what are the #1 and #2 MC soft tissue sarcomas?

A

1) malignant fibrious histiosarcoma; 2) liposarcoma

112
Q

what percent of sarcomas arise from extremities?

A

50%

113
Q

what percent of sarcomas arise in children?

A

50%

114
Q

what is the source (cell type) of pediatric sarcomas

A

arise from embryonic mesoderm

115
Q

what are the symptoms a/w sarcomas (4)

A

they are large, fast growing and painless. p/w asymptomatic mass, GI bleeding, bowel obstruction, or neurologic deficit

116
Q

why do you need to obtain a CXR when evaluating a suspected sarcoma?

A

r/o lung mets

117
Q

why do you need to obtain an MRI before sarcoma biopsy?

A

r/o vascular, neuro, or bone invasion

118
Q

when is excisional biopsy indicated when evaluating for soft-tissue sarcoma?

A

when mass is < 4cm

119
Q

when is longitudinal incisional biopsy indicated when evaluating for soft-tissue sarcoma?

A

when mass is > 4cm

120
Q

what is the next step in management if longitudinal incisional biopsy comes back positive for sarcoma?

A

need to resect biopsy skin site if biopsy site positive for sarcoma

121
Q

what is the mechanism of spread of sarcoma and how does this affect physical exam findings?

A

hematogenous spread, rare to find node mets

122
Q

what is the MC site of sarcoma mets?

A

lung

123
Q

what is the basis of sarcoma staging?

A

based on grade not size

124
Q

what are the margins for sarcoma resection?

A

at least 3cm margins and at least 1 uninvolved fascial plane. Also try to perform limb-sparing operation

125
Q

how should you treat extremity sarcomas?

A

try to perform limb sparing operations

126
Q

what should you do intraoperatively to areas of likely sarcoma recurrence and why?

A

place clips to mark site of likely recurrence to XRT later

127
Q

when is postop XRT indicated for sarcoma? (3)

A

high grade tumors, close margins, or tumors > 5 cm

128
Q

when is preop chemo/XRT indicated for sarcoma (2)

A

tumors > 10cm and may allow limb-sparing resection

129
Q

what is the treatment for isolated sarcoma mets without other evidence of systemic disease?

A

resected with best chance for survival, otherwise palliate with XRT

130
Q

what type of incision is preferred for pelvic and RP sarcomas?

A

midline incision

131
Q

what neurovascular precautions should you take intraop with sarcoma resection?

A

try to preserve motor nerves and retain or reconstruct vessels

132
Q

Describe the technique for biopsy of an extremity soft tissue mass suspected of being a sarcoma

A

orient incision along long axis of extremity at the point where the lesion is closest to the surface; do not raise flaps or disturb tissue superficial to the tumor; do not enucleate mass within pseudocapsule - leave as undisturbed as possible; obtain hemostasis before wound closure to prevent hematoma which could disseminate tumor cells along tissue planes

133
Q

what is the 5 year survival rate of soft tissue sarcomas s/p complete resection?

A

40%

134
Q

name three poor prognostic indicators with soft tissue sarcoma

A

delay in diagnosis, difficulty with total resction, difficulty getting XRT to pelvic tumors

135
Q

what is the MCC of pediatric head and neck sarcoma?

A

rhabdomyosarcoma

136
Q

what makes surgery on head and neck sarcoma challenging?

A

difficult to get negative margins b/c of proximity to vital structures

137
Q

when is postop XRT indicated for head and neck sarcomas?

A

positive or close margins since negative margins are hard to obtain

138
Q

what are the two MCC of visceral and RP sarcomas?

A

leiomyosarcomas and liposarcomas

139
Q

what is the most important prognostic factor in visceral and RP sarcomas?

A

ability to completely remove the tumor

140
Q

what CA are you at increased risk for with asbestos exposure?

A

mesothelioma

141
Q

what CA are you at increased risk for with PVC exposure?

A

angiosarcoma

142
Q

what CA are you at increased risk for with arsenic exposure?

A

angiosarcoma

143
Q

what CA are you at increased risk for with chronic lymphedema?

A

lymphangiosarcoma

144
Q

what is the subtype (descriptor) for Kaposi’s sarcoma?

A

a vascular sarcoma

145
Q

what are the two MC sites of Kaposi’s sarcoma?

A

oral and pharyngeal mucosa

146
Q

how do oral/pharyngeal Kaposi’s sarcoma present?

A

bleeding, dysphagia

147
Q

what is the MC malignancy in AIDS?

A

Kaposi’s sarcoma, rarely a cause of death

148
Q

what comorbidity is a/w Kaposi’s sarcoma?

A

immunocompromise

149
Q

what is the primary goal of treatment of Kaposi’s sarcoma?

A

palliation

150
Q

what is the best tx of Kaposi’s sarcoma in AIDS patients?

A

AIDS Tx (HAART) shrinks AIDS-related Kaposi’s Sarcoma

151
Q

what is the best treatment for local Kaposi’s sarcoma (2)

A

XRT or intralesional vinblastine

152
Q

what is the best tx for disseminated Kaposi’s sarcoma

A

interferon alpha

153
Q

what is the indication for surgery with Kaposi’s sarcoma

A

when a/w severe intestinal hemorrhage

154
Q

what is the MC soft tissue sarcoma in kids?

A

childhood rhabdomyosarcoma

155
Q

what are the locations that childhood rhabdomyosarcoma are found and which carries the poorest prognosis?

A

head/neck, GU, extremities, trunk. Trunk with poorest prognosis)

156
Q

what is the MC subtype of childhood rhabdomyosarcoma?

A

embryonal subtype

157
Q

what type of childhood rhabdomyosarcoma carries the worse prognosis?

A

alveolar subtype

158
Q

what is the treatment of childhood rhabdomyosarcoma?

A

surgery, doxorubicin-based chemo

159
Q

what are the findings a/w bone sarcomas?

A

most are metastatic at the time of diagnosis

160
Q

what is the cell of origin of osteosarcoma?

A

metaphyseal cells

161
Q

what is the MC location of osteosarcoma?

A

around the knee

162
Q

which age group is most likely to present with osteosarcoma?

A

peds

163
Q

what three soft tissue tumors are you at increased risk for with Neurofibromatosis?

A

CNS tumors, peripheral sheath tumors, pheochromocytoma

164
Q

what soft tissue tumor are you at increased risk for with Li-Fraumeni syndrome?

A

childhood rhabdomyosarcoma

165
Q

what soft tissue tumors are you at increased risk for with hereditary retinoblastoma

A

along with Rb, all other sarcomes

166
Q

what soft tissue tumor are you at increased risk for with tuberous sclerosis?

A

angiomyolipoma

167
Q

what two soft tissue tumors are you at increased risk for with Gardner’s syndrome?

A

familial adenomatous polyposis and intraadominal desmoid tumors

168
Q

what is a plastic surgery consderation with lip lacerations

A

important to line up vermillon border

169
Q

how do xanthomas present and what cells do they contain?

A

yellow, contain histiocytes

170
Q

what is the treatment for xanthomas?

A

excision

171
Q

name the origin and communicability of warts (verruca vulgaris)

A

viral origin, contagious, autoinoculable, can be painful

172
Q

how do you treat warts?

A

liquid nitrogen initially

173
Q

what are the MC locations of lipomas? (3)

A

back, neck, between shoulders

174
Q

are lipomas often malignant?

A

nope rarely malignant

175
Q

name the four findings a/w von Recklinghausen’s disease (neurofibromatomsis type I

A

cafe au lait spots, axillary freckling, peripheral nerve and CNS tumors (neuromas)

176
Q

where do actinic keratosis present?

A

in sun-damaged areas

177
Q

what is the management of actinic keratosis and why?

A

premalignant, need excisional biopsy if suspicious

178
Q

how do you treat seborrheic keratosis

A

not premalignant, no tx needed

179
Q

how does seborrheic keratosis present? (appearance, age, location)

A

can be dark, on trunk, elderly pts

180
Q

what CA is a/w arsenical keratosis?

A

a/w SCC

181
Q

what subtype of cancer is a Merkel cell carcinoma?

A

its a neuroendocrine tumor

182
Q

what is the malignancy of Merkel cell carcioma?

A

very aggressive malignant tumor with early regional and systemic spread

183
Q

what does Merkel Cell carcioma look like on physical exam?

A

red to purple papulonodule or indurated plaque

184
Q

what does Merkel Cell carcinoma look like on physical exam?

A

red to purple papulonodule or indurated plaque

185
Q

what three proteins are released by merkel cell carcinoma?

A

neuron-specific enolase (NSE), cytokeratin, neurofilament protein

186
Q

what are glomus cell tumors made of?

A

blood vessels and nerves

187
Q

how do glomus cell tumors present?

A

painful, MC in terminal aspect of the digit

188
Q

what is the px and tx of glomus cell tumor?

A

benign, tx with tumor excision

189
Q

what is the prognosis of desmoid tumors?

A

benign but locally very invasive, occur in fascial planes, high risk of local recurrence, no distant spread

190
Q

what is the MC location of desmoid tumors?

A

in the anterior abdominal wall

191
Q

what are three risk factors for anterior abdominal wall desmoid tumors?

A

during/following pregnancy, after trauma, after surgery

192
Q

what are two risk factors for intraabdominal desmoid tumors?

A

Gardner’s syndrome and RP fibrosis

193
Q

what makes intraabodminal desmoid tumors difficult ot resect?

A

often encases bowel making it difficult to perform en bloc resection

194
Q

what is the treatment of desmoid tumors?

A

surgery if possible, chemo with sulindac or tamoxifen if vital structure involved or too much bowel would be resected (high risk of short gut with surgery)

195
Q

what is Bowen’s disease and which virus is it a/w?

A

SCC in situ a/w HPV

196
Q

what percent of Bowen’s disease turn invasive?

A

10% turn into invasive SCC

197
Q

what is the treatment of Bowen disease?

A

imiquimod, cautery ablation, topical 5FU

198
Q

why should you avoid WLE of Bowen disease?

A

high recurrence rate with HPV

199
Q

what long term surveillance is required with Bowen disease?

A

regular biopsies to r/o CA

200
Q

what is the clinical presentation of keratoacanthoma

A

rapid growth, rolle edges, crater filled with keratin, can be confused with SCC

201
Q

is keratoacanthoma benign or malignant?

A

benign

202
Q

what is the management of keratoacanthoma and px?

A

always biopsy to be sure to r/o SCC, involute spontaneously, can excise if small and biopsy and observe if large

203
Q

define hyperhidrosis

A

increased sweating especially noticeable in palms

204
Q

what is the treatment for hyperhidrosis

A

antiperspirants, if refractory then thoracic sympathectomy

205
Q

define hidradenitis

A

infection of the apocrine sweat glands, usually in the axilla and groin

206
Q

what are the 2 MCC of hidradenitis (bax)

A

staph / strep

207
Q

what is the treatment of hidradenitis?

A

antibiotics and improved hygeine are first line. May need surgery to remove skin and associated wesat glands

208
Q

what is the MC benign cyst?

A

epidermal inclusion cyst

209
Q

what are the findings a/w epidermal inclusion cyst?

A

completely mature epidermis with creamy keratin material

210
Q

what are the findings a/w trichilemmal cyst?

A

in scalp, no epidermis

211
Q

is trichilemmal cyst benign or malignant?

A

benign

212
Q

is ganglion cyst benign or malignant?

A

benign

213
Q

is dermoid cyst benign or malignant?

A

benign but there is an associated risk of malignancy

214
Q

is pilonidal cyst benign or malignant?

A

benign

215
Q

what are the findings a/w ganglion cyst?

A

over tendons, usually over wrist, filled with collagen

216
Q

what are the findings a/w dermoid cyst?

A

midline intraabdominal and sacral lesions usual

217
Q

what is the treatment of dermoid cyst?

A

need resection due to malignancy risk

218
Q

what are the findings a/w pilonidal cyst?

A

congenital coccygeal sinus with ingrown hair

219
Q

what is the management of infected pilonidal cyst?

A

needs excision

Z.Fiser (22 decks)

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