MSurgII Midterm Flashcards
With electrofulgeration, how do you hold the electrode?
with the electrode away from the skin, producing a spark and a shallow effect
How do you hold the electrode with electrodessication?
you touch the skin with the electrode or insert it into the skin to destroy deeper tissues
What effects are produced by the hyfrecation machine by Conmed?
electrofulguration and electrodessication
What are the advantages of a thermal pencil cautery (hot wire loop)?
Low cost ($15-$20), individual sterile packaging, disposable, safe around the eyes, safe with pacemakers, helpful in sublingual hematomas
What are some of the advantages of electrosurgical devices?
Simple, rapid, controls bleeding, compact, affordable, sterile conditions and sutures not required, use for a variety of lesions
What are some disadvantages of electrosurgical devices?
Safety risk, hypertrophic scars, “Channeling” of current down vessels and nerves, smoke may carry particles, delayed hemorrhage, slow healing if large area, obliteration of histology, artifacts at margins
What the advantages of cryotherapy?
fast, easy, no need for anesthesia, less scarring than electrosurgery. no risk of transmitting infections through the respiratory tract, less scarring
What are the disadvantages of cryotherapy verses electrosurgery?
More likely to cause hypo pigmentation, less effective for pedunculate condylomata, slower results, more postoperative swelling, transient discomfort
What are the advantages and disadvantages of scalpel versus electrosurgery?
Advantages: best for shave biopsies and excisions, inexpensive, disposable, “cleaner edge”, better wound healing and cosmetic result
Disadvantages: does not control bleeding, small risk of accidentally cutting yourself
What are the advantages of electrosurgery over laser treatment?
less expensive, easier to use, does not require a subspecialist
What are the advantages of laser treatment over electrosurgery?
good for “resurfacing”, efficiently cut/coagulate/destroy tissue
What are the contraindications/cautions base on the patient for use of electrosurgery?
pacemakers, metal plates/pins/prosthetics, body folds, malignancy, eyes
Is electrosurgery an appropriate treatment for melanoma? For a lesion around the eye?
NO
T/F: The radiosurgery machine is more efficient for cutting than the Hyfrecator, with less tissue damage (less ‘lateral heat’)
TRUE
T/F: There are different power settings on electrosurgical machines, useful for different functions
TRUE
What are the cautions to observe to prevent fires and burns with electrosurgery?
Do not prep skin with alcohol
do not use ethyl chloride as a local anesthetic, eep oxygen away from equipment, be careful with igniting bowel gas when preforming peri-rectal procedures. have a fire extinguisher.
What are cautions when using cryotherapy?
remove callous from plantar warts before freezing, unacceptable scarring may occur, scar may be painful, nerves/vessels may be damaged if freezing too deeply, depigmentation or hyper pigmentation may occur.
What type of lighting helps distinguish a macule from a papule?
Oblique
Understand the use of diascopy to distinguish a purport from vascular extravasation.
Pressing a glass life to a red lesion
If redness remains: purpuric lesion
If redness disappears: vascular dilatation
Confluence of papule leads to the development of larger, usually flat-topped, circumscribed, plateau-like elevations known as:
plaques
Plaque results from repeated rubbing of skin and most frequently developed in persons with:
atopy
Nodules result from:
infiltrates, neoplasms and metabolic deposits in the dermis or subcutaneous tissues
Vesicles and bull arise from a ___ at various levels of the skin, which may be within the ____ or at the _____
Vesicles and bull arise from a cleavage at various levels of the skin, which may be within the epidermis or at the epidermal-dermal interface.
_____s develop when serum, blood or purulent exudate dries on the skin surface.
crusts
Which layers of the skin are involved in erosion vs. an ulcer vs. a fissure? Which of these lesions typically heals without a scar?
Ulcer: loss of epidermis and user papillary layer of the dermis
Erosion: only involved the epidermis, HEALS WO A SCAR
Fissure: involves epidermis and dermis
T/F: When irritated or injured, a skin take may appear as a necrotic, crusted papule that may not be clinically distinctive and may raise concerns regarding malignancy.
TRUE
The easiest means of removing a skin tag is:
lift and snip, using forceps and scissors
The diagnostic test “dimple sign” suggests:
dermatofibroma
_____ is usually sufficient for removal of a dermatofibroma along with a biopsy if indicated.
simple excision
Characteristically, on compression, a neurofibroma demonstrates a ______ sign.
a “buttonhole” sign
Café-Au-Lait spots (light brown macules) are a cutaneous finding often seen in:
Neurofibromatosis type 1
Over time moles tend to mature through which types?
A, to B and then C types
Most nevi are acquired, appearing at age ____ and before are ____.
Most nevi appear after the first year of life and before age 35
Regular brown color, surface and border are characteristic features of a nevus that differentiates it from a:
melanoma
A blue nevus is similar in appearance to the more serious diagnosis of:
melanoma
Weeks to months after incomplete removal of a nevus, brown macular re-pigmentation may appear in the scar and a biopsy specimen takin from the lesion may confused the pathologist with a:
melanoma
A small percentage of small dark spots within melanocytic nevi are due to:
melanoma
What are the 4 signs that help distinguish a normal mole from a melanoma?
Asymmetry, Irregular border, color and diameter
There is a large risk of ____ sin newborns with nevi covering more than 5% of their body surface.
Melanoma
T/F: Worrisome moles are those that have changed in color, shape, size, have been acquired in adulthood, bleed or are itching
TRUE
What are the differences between common and atypical moles?
Common: sun exposed areas above the waist, #10-40, absent at birth, appear at age 2-6, 5mm (commonly >10mm), irregular border, variable color
What are the 3 physical characteristics common to all seborrheic keratoses?
well-circumscribed border, stuck-on appearance, variable tan-brown-black color
T/F: Common cutaneous warts are rarely linked with HPV-associated carcinomas
T
T/F: condyloma acuminatum (genital wart) is the most common STI
T
Cervical cancer is associated with high risk HPV types:
16 and 18
HPV types __ and __ are associated with 90% of genital wart cases
6 and 11
What callus over a plantar is pared down with a scalpel, the underlying wart has what two characteristics?
interruption of skin lines
black puncta
Describe a mosaic wart:
warts overlap each other- no distinct, mother-daughter pattern
What is traumatic black heel?
Dried, dark RBCs deposited in the epidermis after trauma
What STI can be confused with genital HPV?
Secondary Syphillis
What is the goal of wart treatment?
to destroy the virus-containing epidermis and preserve as much uninvolved tissue as possible
Bicholoracetic acid and Trichloroacetic acid are particularly useful treatment of warts on:
Palms and soles
Imiquimod (Aldara, Zyclara) 5% cream is useful in the treatment of:
anogenital warts
T/F: caution must be used when applying podophyllin to extensive lesions because severe systemic reactions may occur from absorption
True
Cimetidine HD (Tagamet) mechanism of action:
blocks H2 receptor present on T-suppressor cells, increasing the cell-mediated immunity and improving the treatment of resistant warts
T/F: EDandC is never a first-line therapy on the soles of the feet duet to painful scarring potential
TRUE
Paring the surface and identifying the presence of skin lines with a translucent core confirms that the lesion is a:
corn
What is the treatment goal for a corn?
to provide immediate relief of painful symptoms and then reduce the friction and pressure that has caused their formation.
What are the primary and secondary cause of ingrown toenails?
pressure of too tight shoes or cutting the nail too short
Understand the concept of packing cotton under the corner of ingrown nails as describes under Conservative Home Health Care slide.
Allows the nail to grow out without poking into the skin. Progress it and change daily. If no improvement in 5 days, see doctor
When would you use Operative Treatment for an acute ingrown toenail case?
Infection persisting with heaping up of granulation tissue
How many 30 second applications of 88% liquefied Phenol would you use for attempting to permanently kill a portion of the nail bed?
3
What is the typical causative organism of chronic paronychia?
Candida albicans + bacteria
Acute= staph aureus
T/F: you may need to remove the nail in difficult cases of chronic paronychia
T
In a felon, the unyielding skin of the fingertip, contains the infection and creates tension, resulting in:
microvascular compromise, necrosis, access formation, septic arthritis, osteomyelitis, tenosynovitis
What is the most common cutaneous cyst?
Epidermal inclusion cyst
What are 3 causes of epidermal inclusion cysts?
traumatic implantation of epidermis into the dermis, spontaneously from hair follicles, giant comedones
An epidermal inclusion cyst is a nodule that often feels slightly:
malleable
An epidermal inclusion cyst is the most common type of cyst located on the:
skin
Why is it important to remove the complete wall of an epidermal inclusion cyst?
to prevent recurrence, must remove all epidermal cells
What exam finding indicates that an epidermal inclusion cyst is ripe and ready to drain?
fluctuance
Wait at lease ___ weeks after inflammation and infection has resolved before attempting excision.
4-6 weeks
A lipoma may feel ____ but is usually not _____
A lipoma may feel rubbery but is usually not malleable
Epidermal inclusion cysts and tricholemmal (pilar) cysts are very common and usually called ______ in error
sebaceous cysts
If the skin moves over the top of a lesion, the lesion is sub-dermal in origin and probably a:
lipoma
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.
malignant tumor
