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Minor Surgery > Minor surgery 2 midterm > Flashcards

Minor surgery 2 midterm Flashcards

1
Q

How do you hold the electrode with electrofulgeration?

A

With electrofulgeration you hold the electrode away from the skin, producing a spark and a shallow effect.

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2
Q

How do your use electrodessication?

A

With electrodessication you touch the skin with the electrode (or insert into the skin) to destroy tissue.

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3
Q

Which two types of effect are produced by the hyfrecation machine by Conmed?

A

Both electrofulgeration & electrodessication

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4
Q

What are the advantages of a thermal pencil cautery (“hot wire loop”)?

A
  • Low cost
  • Individual sterile packaging
  • Disposible
  • Safe around eyes
  • Safe with patients with pacemakers
  • Great to drain subungal hematomas
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5
Q

What are some of the advantages of electrosurgical devices?

A
  • Simple to use
  • Rapid technique
  • Control bleeding while cutting tissue
  • Compact
  • Affordable
  • Sterile condition and sutures are not needed
  • Infection rarely develops in wounds left open
  • Used for wide variety of skin lesions
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6
Q

What are some of the disadvantages of electrosurgical devices?

A
  • Safety risk-electric shock, burns or fires
  • Hypertrophic scar formation
  • Channeling of current down vessels and nerves
  • Smoke may carry particles into respiratory tract (not great for wart removal)
  • Delayed hemorrhage
  • Unsightly wound
  • Slow healing
  • Obliteration of histology (therefore not good for obtaining bx specimen)
  • Electrosurgical artifact at margins if used for bx
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7
Q

What are the advantages of cryotherapy over electrosurgery?

A
  • Faster and easier to perform
  • No anesthetics needed
  • No risk of developing HPV, HIV or other viral infections through respiratory tract
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8
Q

What are the disadvantages of cryotherapy versus electrosurgery?

A
  • More likely to cause hypopigmentation
  • Less effective than electrosurgery for pedunculated condyloma
  • Final result cannot be seen immediately as with electrosurgery
  • More guesswork in treating the lesion for inexperienced physician
  • May need to be repeated several times
  • Causes more postoperative swelling
  • Causes discomfort
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9
Q

What are the advantages of the scalpel versus electrosurgery? The disadvantages?

A

Advantages:

  • Inexpensive
  • Disposable
  • Cleaner edge on both wound and bx specimen
  • No heat induced tissue damage to obscure bx
  • Generally better wound healing and cosmetic results

Disadvantages:

  • Does not control bleeding
  • Small risk of accidental cutting yourself
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10
Q

What are the advantages of electrosurgery over laser treatment?

A
  • Less expensive
  • Easier to use
  • Laser requires a subspecialist to determine and perform the best treatment modality for the patient
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11
Q

What are the advantages of laser treatment over electrosurgery?

A
  • Can efficiently cut, coagulate and destroy tissue

* Good for resurfacing-removing wrinkles

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12
Q

What are the contraindications/cautions based on the patient for use of electrosurgery?

A
  • Caution with pacemakers
  • Caution with metal plated, metal pins or metal prosthetics
  • Patients should not touch metal part of treatment cart to avoid current shock
  • Malignant lesion is contraindicated
  • Body folds are contraindicated
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13
Q

Is electrosurgery an appropriate treatment modality for melanoma? For a lesion around the eye?

A
  • Melanoma-No way!
  • BCC- No way!
  • Lesion around eye-No way!
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14
Q

True or False?

The radio surgery machine is more efficient for cutting than the Hyfrecator with less tissue damage?

A

FACT: the radiosurgery machine is more efficient for cutting than the Hyfrecator with less tissue damage (less “lateral heat”).

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15
Q

True or False?

There are different power settings on electrosurgical machines useful for different functions?

A

FACT: there are different power settings on electrosurgical machines useful for different functions.

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16
Q

What are the cautions to observe to prevent fires and burns with electrosurgery?

A
  • Do not prep skin with EtOH
  • Do not use ethyl chloride as local anesthetic (Flammable)
  • Have fire extinguisher near by
  • Bowel gas can ignite if performing perirectal procedures
  • Electric shock from breaking contact with patient while electrode is activated-keep hand on patient for grounding
  • Don’t touch metal
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17
Q

What are the cautions when using cryotherapy?

A
  • Cosmetically unacceptable scarring may occur
  • Remove all callous from plantar warts before freezing
  • Nerves and vessels may be damaged with freezing too deeply
  • Depigmentation or hyper pigmentation may occur
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18
Q

What type of lighting helps distinguish a macule from a papule?

A
  • Tangential lighting-oblique lighting
  • Macule- circumscribed area of change in normal skin color without elevation or depression, not palpable
  • Macular exanthema-rash consisting of macules
  • Papule-superficial, solid lesion less than 0.5cm in diameter, palpable
  • Papules with distinct borders are seen when lesions increased in # of epidermal cells
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19
Q

Understand the use of diascopy to distinguish a purpura from vascular extravasation.

A

*Pressing a glass slide to red lesion is simple way to detect blanching, if redness remains, under pressure, it is purpuric. If redness disappears it is erythematous and due to vascular dilation

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20
Q

Confluence of papule leads to what?

A

Leads to the development of larger, usually flat-topped, circumscribed, plateau-like elevations known as plaques.

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21
Q

Plaque results from what?

A

Plaque results from repeated rubbing of the skin and most frequently develops in persons with Lichenification.

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22
Q

Nodules result from what?

A

Nodules result from Infiltrates, Neoplasm, or Metabolic Deposits in the dermis or subcutaneous tissue.

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23
Q

Vesicles and bull arise from what?

A

Vesicles and bullae arise from a Cleavage at various levels of the skin, which may be within the epidermis or at the Epidermal-Dermal Interface.

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24
Q

Crusts develop when?

A

Crusts develop when serum, blood, or purulent exudate dries on the skin surface.

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25
Q

Which layers of skin are involved in an erosion vs. an ulcer vs. a fissure? Which of these lesions typically heals without a scar?

A
  • Ulcer=> epidermis & papillary layer of dermis
  • Fissure=> Abrupt walls of epidermis, but can extend into dermic
  • Erosions=> only in the epidermis
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26
Q

True or False?
When irritated or injured, a skin tag may appear as a necrotic, crusted papule that may not be clinically distinctive and may raise concern regarding a Malignancy.

A

FACT: When irritated or injured, a skin tag may appear as a necrotic, crusted papule that may not be clinically distinctive and may raise concern regarding a Malignancy.

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27
Q

The easiest means of removal of a skin tag is by?

A

The easiest means of removal of a skin tag is by lift and snip using Scissors and Forceps.

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28
Q

The diagnostic test, “dimple sign”, if positive suggests what?

A

a Dermatofibroma.

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29
Q

Simple incision is usually sufficient for removal of a what?

A

a dermatofibroma along with a biopsy if indicated.

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30
Q

Characteristically, on compression, a Neurofibroma demonstrates a what?

A

“buttonhole” sign.

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31
Q

Café-Au-Alit spots (light brown macule) are a cutaneous finding often seen in what?

A

Neurofibroma or von Richenhausen.

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32
Q

Over time moles tend to mature from Epitheliod too what?

A

From Epitheliod to Lymphocytoid and then Neuroid types.

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33
Q

Most nevi are acquired, appearing sometime after age of what and between what ages?

A

After the 35th year of life and before age 60 years.

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34
Q

Regular brown color, surface, and border are characteristic features of a nevus that differentiate it from?

A

Melanoma.

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35
Q

Their importance in diagnosis of a blue nevus is their similar appearance to what?

A

nodular Melanoma.

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36
Q

Weeks to months after incomplete removal of a nevus, brown macular re-pigmentation may appear in the scar and a biopsy specimen taken from that lesion may confuse the pathologist with?

A

Rapidly Growing Cells.

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37
Q

A small percentage of small dark dots within melanocytic nevi are due to?

A

Melanoma.

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38
Q

What are the 4 signs that help distinguish a normal mole from a melanoma?

A
  1. Asymmetry
  2. Border irregularity
  3. Color
  4. Diameter greater than ¼ inch
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39
Q

True or false:

There is a large risk of Melanoma in newborns with nevi covering more than 5% of the body surface.

A

True

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40
Q

True or false:
Worrisome moles are those that have changed in color, shape, or size, have been acquired in adulthood, bleed, or are itching.

A

FACT: Worrisome moles are those that have changed in color, shape, or size, have been acquired in adulthood, bleed, or are itching.

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41
Q

Know the differences between common and atypical moles.

Junctional:

A 
Initial pinpoint
Expands to 4-6cm
Flat or slightly elevated
Smooth
Sharply circumscribed
42
Q

Know the differences between common and atypical moles

Compound:

A

Slightly elevated, dome shape papule

Flesh, brown or halo nevus

43
Q

Know the differences between common and atypical moles

Dermal:

A

Dome shaped
Verrucoid
Pedunculated
Sessile with broad base

44
Q

Know the differences between common and atypical moles

Common Nevi:

A
  • Usually sun exposed area, mostly above waist
  • 10-40 nevi
  • Absent at birth, appear from 2-6 years old and grow vertically in uniform manner throughout life, may see more at puberty
  • Round, symmetrical, uniform macular or popular smooth boarders
  • Nevus cells at the dermoepidermal junction and/or in the dermis
45
Q

Know the differences between common and atypical moles

Atypical:

A
  • Back is most common area, upper and lower limbs, sun protected area, female breast, scalp, butt and groin
  • Less than 10 to greater than 100 in numbers
  • Appears as normal nevi at age 2-6 and increased in number and size at puberty, new nevi appear throughout life
  • Usually greater than 5mm and commonly greater than 10mm
  • Irregular borders, flap areas, margin fades into surrounding skin and always has a macular component
  • Variable within a single lesion, brown, black, red or pink
  • Persistent lentiginous melanocytic hyperplasia with nuclear atypia, concentric eosinophilic fibroplasia, sparse, patchy lymphocytic infiltration
46
Q

What are the 3 physical characteristics common to all seborrheic keratosis

A
  1. Well circumscribes borders
  2. “Stuck on” appearance
  3. Variable tan-brown-black color
47
Q

True or false?

Common cutaneous warts are rarely linked with HPV-associated carcinomas.

A

True

48
Q 
True or false?
Condyloma acuminatum (genital wart) is the most common STI.
A

True

49
Q

Cervical cancer is associated with high risk HPV types

A

16 & 18

50
Q

HPV types 6 and 11 are associated with 90% of what cond.?

A

genital wart cases.

51
Q

When callus over a plantar is pared down with a scalpel, the underlying wart is visualized with interruption of?

A

Skin lines and black puncta.

52
Q

Describe a “mosaic” wart.

A

Multiple warts coalesce with Mother wart and daughter warts

53
Q

What is traumatic black heel?

A

Often mistakes as black puncta, but is dried blood under the epithelium after a trauma to the area.

54
Q

CAUTION: secondary syphilis may be confused with what?

A

genital HPV!

55
Q

What is the goal of wart treatment?

A

To destroy the virus containing epidermis and to preserve as much uninvolved tissue as possible.

56
Q

Bichloroacetic acid and trichloroacetic acid are particularly useful for treatment of warts where?

A

palms and Soles.

57
Q

Imiquimod (Aldara, Zyclara) – 5% cream is useful in the treatment of?

A

Anogenital and neogenital warts.

58
Q

True or false?
Caution must be used when applying podophyllin to extensive lesions because severe systemic reactions may occur from absorption.

A

FACT: Caution must be used when applying podophyllin to extensive lesions because severe systemic reactions may occur from absorption.

59
Q

What is thought to block the H2 receptors present on T-suppressor cells, increase the cell-mediated immunity and improve the treatment of resistant warts.

A

Tagament

60
Q

True or false?
ED&C (Electrodesiccation and Curettage) is never a first-line therapy on the soles of the feet due to painful scarring potential!

A

FACT: ED&C is never a first-line therapy on the soles of the feet due to painful scarring potential!

61
Q

Paring the surface and identifying the presence of skin lines with a translucent core confirms that the lesion is a?

A

CORN

62
Q

True or false?
The treatment goal for a corn is to provide immediate relief of painful symptoms and then reduce the friction and pressure that has caused their formation.

A

FACT: The treatment goal for a corn is to provide immediate relief of painful symptoms and then reduce the friction and pressure that has caused their formation.

63
Q

What is the primary and secondary cause of ingrown toenails?

A

Primary: Wearing shoes that are too tight
Secondary: Cutting the nail too short

64
Q

Understand the concept of packing cotton under corner of ingrown nail as described under Conservative Home Health Care slide.

A

It helps prevent further ingrown by lifting the toenail up.

65
Q

When would you use Operative Treatment for an acute ingrown toenail case?

A

With a definite persisting infection with granulation tissue

66
Q

How many 30-second applications of 88% liquefied Phenol would you use for attempting to permanently kill a portion of the nail bed?

A

3

67
Q

What is the typical causative organism in chronic paronychia?

A

Candida albicans

68
Q

True or false?

You may need to remove the nail in difficult cases of chronic paronychia.

A

True

69
Q

In a Felon, the unyielding skin of the fingertip, contains the infection and creates tension resulting in?

A

Microvascular compromise, Necrosis and Abscess formation.

70
Q

The most common cutaneous cyst is?

A

Sebaceous cyst

71
Q

The three possible causes of epidermal inclusion cysts are?

A

Traumatic implantation of epidermis into dermis, spontaneously arising from hair follicle, and giant comedones (usually on back).

72
Q

An epidermal inclusion cyst is a nodule that often feels slightly

A

Malleable

73
Q

An epidermal inclusion cyst is the most common type of cyst located on the?

A

Scalp

74
Q

Why is it important to remove the complete wall of an epidermal inclusion cyst?

A

To prevent recurrence

75
Q

What exam finding indicates that an epidermal inclusion cyst is ripe and ready to drain?

A

A cyst is ripe and ready when it feels fluctuant (fluid like) to palpation.

76
Q

Wait at least ____ weeks after inflammation and infection has resolved before attempting excision

A

4-6 wks

77
Q

A lipoma may feel _____, but is usually not malleable.

A

Rubbery

78
Q

Epidermal inclusion cysts and tricholemmal (pilar) cysts are very common, and usually called ______ in error.

A

Sebaceous cysts

79
Q

If the skin moves over top of the lesion, the lesion is sub-dermal in origin and probably a ______.

A

Lipoma

80
Q

If you believe a lesion is a lipoma but are uncertain of the diagnosis, particularly if the lesion feels quite firm, a _______ must be considered.

A

malignant tumor

81
Q

Diagnostic feature of warts are?

A

The black puncta dots

82
Q

Nevi of concern are?

A

Atypical

83
Q

Must palpate skin to differentiate lipoma from?

A

Cyst

84
Q

With cryotherapy, what does it do to the skin?

A

Hypopigmentation, if you freeze too long you could have nerve damage

85
Q

What are the different types of cysts, what do they contain within them?

A
  1. Epidermoid cysts-keratin
  2. Sebaceous cysts-sebum
  3. Pilar cysts-keratin of different nature than epidermoid keratin
  4. Lipoma-mature fat cells enclosed by fibrous capsules
86
Q

What are the characteristics of skin tags?

A

Benign soft tan-flesh colored lesion

Pedunculated with stalk, fleshy papules

87
Q

What pathology has a buttonhole sign?

A

Neurofibroma

88
Q

What has a dimple sign?

A

Dermatofibroma

89
Q

With elliptical incision, there’s a better closure, but it still has a scar with?

A

fibroma removal

90
Q

Know that lipoma stretched skin, so an ____ incision should be done to remove.

A

elliptical

91
Q

Know that seborrheic keratosis is a cosmetic problem, but you would biopsy if the lesion is?

A

rough

92
Q

Know a shave removal is best for seborrheic keratosis, but freezing can be done if?

A

You confirm with negative biopsy

93
Q

Know the difference between corns and warts

A

Corns: localized epidermal thickness with hyperkeratosis secondary to chronic pressure or friction. They keep the skin lines whereas warts separate skin lines

94
Q

People tend to get corns removed because they are _____.

A

painful

95
Q

Know that a lipoma is a ____ lesion

A

subcutaneous

96
Q

Know how to differentiate an epidermal cyst from an abscess

A

Sebaceous cysts have central pores

97
Q

Know the most common locations for skin tags

A

Axilla 48%
Neck 35%
eyelids

98
Q

What are the future risks for excessive sun exposure?

A

Melanoma
BCC
SCC

99
Q

What is the treatment for actinic keratosis?

A

First a dermablade or excision is best to biopsy lesion

If negative biopsy, them cryotherapy is easiest

100
Q

What is the procedure for ingrown toenails

A
  • Place cotton under toenail to prevent continued inward growth
  • Performs digital block at base of toe
  • Draw a line on the part of nail that needs to be removed
  • Place tourniquet on toe
  • With knife or scissors remove 2-3mm pice of toenail being sure to cut through the end of the growth plate-avoid cutting the eponychium by pushing it back with blunt instrument
  • Separate portion of nail from nailbed with spatula and remove
  • Excise hypertrophic granulation tissue that overhangs
  • Cauterize if needed
  • Remove tourniquet and control bleeding with silver nitriate or hyfercator
  • Apply tincture and wrap up with gauze
101
Q

Know that with an elliptical incision, when you see the fat layer, you_____….

A

have reached the end point, you don’t want to cut deeper.

102
Q

Know that subcuticular suture have the least scarring

A

running subcuticular

Minor Surgery (7 decks)

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