Procedures In Derm (Nicely)

Question 1

What does a KOH prep allow you to see?

Answer 1

fungal or parasitic infections

Question 2

how does a KOH prep allows you to see certain infections?

Answer 2

dissolves the tissue/keratin to reveal fungi/yeast or parasites

Question 3

indications/ types of lesions for shave biopsy

Answer 3

seborreheic keratosis, verruca (warts), molluscum contagiosum, skin tags, nevi, superficial BCC

Question 4

When would you use shave biopsy ? Where would the lesion be?

Answer 4

epidermis or upper portion of dermis

Question 5

What do you do in addition to a shave biopsy to ensure the base of the lesion is destroyed?

Answer 5

currettage

Question 6

contraindications for a shave biopsy

Answer 6

not sure it’s benign, pigmented lesions, lesion with dermal component, infiltrative (extends beyond superficial dermal layer)

Question 7

When would you do a snip excision

Answer 7

pendunculated nevi, skin tags

Question 8

What is a punch biopsy used to diagnose?

Answer 8

large lesion or multiple lesions and NEVER to remove anything that looks like cancer

Question 9

contraindications to punch biopsy

Answer 9

if it looks like cancer and too big for punch, excise it

Question 10

indications for an excisional biopsy

Answer 10

lesion larger than 1cm, suspected melanoma, lipoma, bcc/scc

Question 11

excisional biopsy procedure - take into consideration

Answer 11

determine lines of tension, mark margins with pen if lesion may blanch, elliptical incision for better suturing

Question 12

What is cryotherapy

Answer 12

destruction of tissue by freezing

Question 13

how is cryotherapy controlled?

Answer 13

diameter of freeze=depth of freeze

Question 14

most common indications for cryosurgery

Answer 14

actinic keratoses, skin tags, verrucae, small hemangioma

Question 15

special indications for cryotherapy

Answer 15

BCC -full thickness destruction freeze & curette cycle

papular nevi - full thickness freeze, freeze & curette cycle

Question 16

contraindications for cryotherapy

Answer 16

melanoma, bad circulation, previous poor rxn

Question 17

cryotherapy procedure

Answer 17

freeze until ice ball extends 2-3mm beyond edge; freeze, thaw, refreeze

Question 18

cryotherapy procedure for full thickness destruction

Answer 18

ice ball 5-8mm beyond lesion, thaw 5 mins, refreeze

Question 19

What can laser therapy treat

Answer 19

actinic keratoses, seborrheic keratosis, acne, skin tags, vascular lesions

Question 20

indications for subungal hematoma evacuation

Answer 20

painful hematoma

Question 21

contraindications for subungal hematoma evacuation

Answer 21

nail fracture, fracture of involved finger (finger fractured and goes through nail), hematoma involve 50% nail

Question 22

procedure for subungal hematoma evacuation

Answer 22

• xray to rule out fracture

- puncture nail with needle

Question 23

ingrown toe nail indications for removal

Answer 23

lack of improvement or recurrent episodes

-fungal infections, chronic

Question 24

complications of toenail removal

Answer 24

infection, bleeding, regrowth/return of sx

Question 25

procedure for toe nail removal

Answer 25

supine position, digital block, cut nail, loosen & lift

Question 26

indications for I&D

Answer 26

persistent, localized collection of infection; pain, fever, redness, swelling

Question 27

contraindications for I&D

Answer 27

facial furuncles in triangle of doom, abscess near rectum or genitalia

Question 28

complications with I&D

Answer 28

• cellulitis
• re-infection
• failure to reduce size/redness/swelling/pus

Question 29

what does a wood’s light reveal?

Answer 29

fluoresces fungal infection, bacterial infection, head lice, etc

Question 30

what color does a wood’s lamp fluoresce

Answer 30

coral red

Question 31

Where do you take the cells for a tzanck smear?

Answer 31

scrape base of ulcer

Question 32

what are you looking for with a tzanck smear?

Answer 32

giant, multinucleate cells indicative of herpes