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Derm Surg > ResQ Cards (ASDS) > Flashcards

ResQ Cards (ASDS) Flashcards

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Dermatology Board Prep flashcards
1
Q

Though rare, metastases from BCC occur most often in which 2 locations?

A
  1. lymph nodes

2. lungs

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2
Q

Which form of electrosurgery is completely undamped?

A

electrosection

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3
Q

The 15 blade is most commonly used in which body areas?

A

Confined areas/tight spaces with thin skin such as the conchal bowl

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4
Q

Which three proteins make up the SNARE complex?

A
  1. SNAP-25
  2. Synaptobrevin
  3. Syntaxin
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5
Q

Which specific branch of cranial nerve 7 supplies the nerve fibers responsible for taste in the anterior 2/3 of the tongue?

A

The chorda tympani branch.
This should not be confused with the sensory fibers to the anterior 2/3 of the tongue, which are supplied by the lingual branch of V3.

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6
Q

Which sclerosant is more likely to produce intense muscle cramping?

A

Hypertonic saline

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7
Q

Allis hemostats are particularly useful in what scenario?

A

Grasping the wall of a cyst without puncturing it

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8
Q

Which part of the nail plate is formed by the distal nail matrix?

A

The inferior nail plate

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9
Q

What causes the frosting seen with TCA peeling?

A

Keratocoagulation and precipitation of denatured proteins.

This is in contrast to the frosting with salicylic acid peels, which is due to precipitation of salicylic acid crystals

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10
Q

What nerve innervates the medial plantar surface of the foot?

A

The plantar branch of the saphenous nerve

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11
Q

Digital ischemia is usually the result of what two scenarios?

A
  1. Excessive anesthetic volume

2. Excessive (or extended) tourniquet pressure

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12
Q

Botulinum toxin is a naturally occurring neurotoxin produced by what bacterium?

A

C. botulinum

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13
Q

Which antiseptic agent is flammable in the setting of electrosurgery?

A

Isopropyl alcohol

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14
Q

a ring block around the ear will numb the entire ear except for which portions?

A
  1. the concha

2. the external auditory canal

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15
Q

which sclerosant has the lowest risk of hyperpigmentation secondary to blood extravasation at injection site?

A

chromated glycerin

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16
Q

Which antiseptic agent has been shown to cause hypothyroidism in neonates with chronic maternal use?

A

povidone-iodine

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17
Q

which instrument has a head designed to hold several blades?

A

hair transplant scalpel handle

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18
Q

what is the maximum amount of fat that can be removed during a single liposuction session?

A

5 liters

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19
Q

T/F: the nail matrix lacks a granular layer

A

true

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20
Q

What is the most commonly used medication and dosing regimen for HSV prophylaxis when performing medium and deep chemical peels?

A

Valacyclovir 500mg PO BID (or 1g daily).

Start one day prior to the procedure, and continue for 10 to 14 days.

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21
Q

What is the overall one-year risk of actinic keratosis progression to primary SCC?

A

0.08

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22
Q

What is the optimal ratio of solution to air when creating a foam sclerosant?

A

1:4 solution to air

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23
Q

Which forms of electrosurgery are examples of direct current?

A
  1. electrosurgery

2. electrolysis

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24
Q

How was the potency of one unit of botulinum toxin originally determined?

A

1 unit = LD50 dose for intraperitoneal injection into mice

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25
Q

What is the maximum depth of the ice ball that can be formed with liquid nitrogen cryotherapy?

A

1cm

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26
Q

What percentage of BCCs develop metastases?

A

0.003% to 0.1%

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27
Q

Which forms of electrosurgery are biterminal?

A
  1. electrocoagulation

2. electrosection

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28
Q

Which specific type of needle driver incorporates a scissor proximal to the needle grasping tip?

A

Olsen needle drivers

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29
Q

A 10 blade is sharpest at what portion of the blade?

A

belly

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30
Q

What is the boiling point of liquid nitrogen?

A

-196 degrees Celsius

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31
Q

The anastomosis between the ECA and ICA on the face lies between which two arteries?

A

The angular artery (from ECA) and the dorsal nasal branch of the ophthalmic artery (from ICA)

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32
Q

Which portion of the chemical structure of anesthetic molecules determines the potency of the anesthetic?

A

the aromatic portion

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33
Q

Which nerve branch is responsible for the clinical finding known as Hutchinson’s sign?

A

The external nasal branch of the anterior ethmoidal nerve

vesicles on nasal tip in herpes zoster ophthalmicus

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34
Q

Organ transplant patients are at how many times the increased risk for development of SCC than a nontransplanted patient?

A

65x higher risk of SCC

Also: 10x increased risk of BCC and 3.4x increased risk of melanoma

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35
Q

Which superficial peeling agent is known for its lipophilic qualities and is therefore particularly effective in treatment of acne?

A

Salicylic acid

–also has keratolytic and comedolytic properties which are helpful with acne

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36
Q

Which new closure modality uses a photochemical reaction after exposure to a green light to form covalent linkages between collagen molecules?

A

Photoactivated tissue bonding

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37
Q

Which nerve innervates the distal, dorsal aspect of the second, third, and fourth fingers?

A

Dorsal median nerve

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38
Q

What is the maximum recommended dosage of bupivacaine?

A

175mg–not weight-based

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39
Q

What are potential donor sites for a full thickness skin graft for the nose?

A
  1. periauricular skin
  2. conchal bowl (for nasal tip)
  3. supraclavicular region
  4. nasolabial fold
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40
Q

Uveal melanomas and blue nevi have been associated with mutations in which gene?

A

GNAQ

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41
Q

Which hemostats have curved tips?

A

Allis

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42
Q

Which anesthetics are pregnancy category C? What is the most feared complication in the fetus when these anesthetics are used?

A
  1. bupivacaine and mepivacaine

2. fetal bradycardia

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43
Q

What is the final concentration of lidocaine and epinephrine in a 0.05% solution for tumescent anesthesia?

A

0.05% lido + 1:1,000,000 epi

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44
Q

which needle holder is spring-loaded?

A

Castroviejo

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45
Q

What is the mechanism of action of Ingenol mebutate?

A

Exact mechanism unknown. Leads to immediate cell necrosis (not apoptosis) and increases inflammatory cell response at the site of application

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46
Q

How is the hyaluronic acid in Restylane and Juvederm made?

A

Derived from bacterial fermentation process of Streptococcus equi

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47
Q

Botox was first FDA approved for what indication?

A

blepharospasm

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48
Q

SCC is the most common type of cutaneous malignancy in which two ethnic groups?

A
  1. Asian-Indians

2. African Americans

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49
Q

What is the term for the ability of suture to resist breakage or deformation?

A

tensile strength

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50
Q

Injury to the spinal accessory nerve, cranial nerve 11, at Erb’s Point causes what classical clinical finding?

A

Winged scapula.
CN XI provides motor innervation to the trapezius and the sternocleidomastoid. Damage creates inability to elevate the shoulder and initiate abduction. May also cause chronic shoulder pain.

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51
Q

T/F: the muscles of facial expression of the lower face have bony insertions

A

false

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52
Q

Topical retinoids have been shown to accelerate healing after chemical peels, but must be stopped how long prior to the peeling procedure to ensure an intact epidermal surface?

A

48 to 72 hours.
Retinoids can be restarted after the peel once erythema has subsided–usually 2-3 days for superficial peels, and up to 4-6 weeks for medium depth peels

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53
Q

Which nerve innervates the dorsolateral aspect of the foot and fifth toe?

A

dorsal sural nerve

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54
Q

Which forceps have a long, thin neck between the handle and tip?

A

Bishop-Harmon – often used in ophthalmologic procedures

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55
Q

10 blade is used most commonly for surgery in which areas?

A

Areas of thick skin and dermis such as trunk.

Can also be useful in larger excisions.

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56
Q

What is the appropriate plane of undermining on the temple?

A

Superficial subcutaneous plane above the SMAS.
The temporal branch of CN VII lies within or immediately deep to the SMAS and the superficial fascia in the temple, making it particularly susceptible to injury here.
As this branch arches over the lateral brow, it dives deep to the frontalis muscle, which protects it from injury.

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57
Q

The protease action of botulinum toxin is dependent upon what element?

A

zinc

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58
Q

What is the ideal undermining level near the eyebrow?

A

Subcutis, deep to the hair follicles

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59
Q

When does toenail development begin?

A

Embryologic week 14

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60
Q

Which scissors have long handles and fine curved tips?

A

LaGrange scissors – used for suture removal, skin tags, fine hair removal, etc

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61
Q

The trigeminal nerve provides motor innervation to which group of muscles?

A

The muscles of mastication: masseter, temporalis, medial pterygoid, lateral pterygoid

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62
Q

Needle drivers with a scissor just proximal to the needle grasping tip are particularly useful in what scenario?

A

Operating alone.

Olson drivers combine a needle driver and scissor, which can improve efficiency

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63
Q

Injury to which motor branches of CN VII can be temporary?

A

Zygomatic and buccal – both have extensive rami and cross innervation

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64
Q

What kind of crystals are used in microdermabrasion?

A

Aluminum oxide

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65
Q

local anesthetics preferentially affect which types of nerve fibers?

A
  1. C-fibers

2. A-delta fibers

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66
Q

What are the most commonly used solutions for cold sterilization/chemical immersion?

A

Glutaraldehyde or aqueous formaldehyde

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67
Q

When the sonic hedgehog molecule is in the unbound state, the Patched receptor inhibits what intracellular signal?

A

smoothened

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68
Q

what is the temperature range for destruction of melanocytes?

A

-4 to -7 degrees Celsius

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69
Q

Which of the components of the commonly used triple antibiotic ointment–neomycin, bacitracin, polymyxin B–is responsible for coverage of Pseudomonas?

A

polymixin B

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70
Q

What temperature is required for destruction of a benign lesion with liquid nitrogen?

A

-25 degrees Celsius

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71
Q

What gene is the most commonly mutated in BCC?

A

PTCH1 mutations are present in 2/3 of BCC.

p53 mutations are second most common, seen in about 50%.

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72
Q

Which keratoacanthoma variant is characterized by sudden appearance of KAs in sun-exposed areas during childhood or adolescence, which subsequently resolve and reappear later in life?

A

Ferguson-Smith variant

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73
Q

ulnar nerve block at the dorsal wrist involves injection just lateral to which tendon?

A

flexor carpi ulnaris

–pull back on the plunger before injection as the nerve lies close to the ulnar artery

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74
Q

Mupirocin’s mechanism of action is tied to reversible binding to what bacterial protein?

A

isoleucyl tRNA synthetase

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75
Q

which form of electrosurgery is least damaging to the affected tissue?

A

electrofulguration

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76
Q

Which nerve innervates the plantar surface of the palm and first through third and a half fingers?

A

palmar median nerve

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77
Q

What is the most commonly used sterilization method in the office setting?

A

Steam autoclave

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78
Q

Which branch of CN VII classically innervates the procerus muscle?

A

zygomatic branch

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79
Q

anesthetics prevent action potentials by controlling axonal permeability to what element

A

sodium

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80
Q

It better to freeze a lesion slowly or quickly?

A

Freeze quickly, thaw slowly.

Fast freezing velocity causes intracellular ice formation and cell destruction better than slow velocity.

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81
Q

Which (non-isotretinoin) oral acne medication can lead to increased sun sensitivity and increase the risk of pigment abnormalities post peeling?

A

minocycline
(also OCPs and hormone supplements)
–not sure why this isn’t doxy

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82
Q

After a medium depth peel, despite adequate prophylaxis with valacyclovir 500 mg BID, HSV reactivation is suspected. The antiviral regimen should be changed to what?

A

valacyclovir 1g TID

note: for resistant strains, would need to use foscarnet

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83
Q

T/F: a graft with necrosis should be removed

A

false

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84
Q

T/F: facial nerves lack valves

A

true

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85
Q

What is the mechanism of action of cryo-surgery?

A

Ice crystals form in the extracellular space. As a result, water leaves the cell through osmosis and dehydrates the cell, while water left inside the cell eventually freezes. The crystallization expands and breaks the cell membrane.

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86
Q

Which nerve from the cervical plexus provides sensory innervation to the anterior portion of the neck?

A

transverse cervical nerve

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87
Q

What is the best imaging modality to assess venous disease?

A

Duplex ultrasound

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88
Q

What mineral can be used to bind or chelate arsenic in exposed patients?

A

selenium

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89
Q

What is the minimum amount of compression recommended after sclerotherapy?

A

20mmHg for at least 3 days

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90
Q

Frey’s syndrome is classically associated with what 3 symptoms?

A

auroculotemporal nerve injury, classically d/t parotid surgery. results in pain, vasodilation, and diaphoresis of lateral cheek during or immediately prior to eating

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91
Q

What are some medical comorbidities that are contraindications to using epi in local anesthetics?

A
  1. pheochromocytoma
  2. uncontrolled hyperthyroidism
  3. acute angle closure glaucoma
  4. severe HTN
  5. PVD
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92
Q

Which two subtypes of HPV are most commonly associated with development of subcutaneous SCC?

A

16 and 18

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93
Q

which antiseptic is a halogen?

A

iodine (or povidone-iodine)

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94
Q

What are the recommended lengths for a contraception in both males and females after treatment with vismodegib?

A

females: 7 months
males: 2 months

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95
Q

which FDA approved botulinum toxin has lactulose as an added ingredient?

A

Dysport – but still safe to use in lactose intolerance

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96
Q

Which nerve from the cervical plexus supplies sensory innervation to the anterior and posterior lobule of the ear, as well as the skin overlying the mastoid process?

A

The greater auricular nerve

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97
Q

What is the most common anatomic location for arsenical melanosis?

A

upper back or chest (not acral!)

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98
Q

trigeminal trophic syndrome is often the result of damage to CN V at which site?

A 
the Gasserian (trigeminal) ganglion. leads to erosion of nasal ala.
may be d/t encephalitis, leprosy, or other nervous injury.
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99
Q

What occurs in a graft in the first 24 hours?

A

Imbibition–fibrin attaches graft to recipient bed

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100
Q

Which portion of the chemical structure of anesthetic molecules determines the onset of activity?

A

the aromatic portion

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101
Q

What is the tissue half-life of natural hyaluronic acid?

A

1-2 days

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102
Q

Which nerve innervates the medial palm and the palmar surface of the 4th and 5th fingers?

A

palmar ulnar nerve

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103
Q

What is the recommended maximum dosage of lidocaine in children 1. with epi? 2. without epi?

A
  1. 3 to 4 mg/kg with epi

2. 1.5 to 2 mg/kg without epi

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104
Q

What is the boiling point of solid carbon dioxide/dry ice?

A

-78.5 degrees Celsius

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105
Q

What depth of invasion has been shown to be associated with an increased risk of metastases in cutaneous SCC?

A

> =4mm

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106
Q

Which subclass of sutures has more memory: monofilament or braided?

A

monofilament

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107
Q

Which class of medication may diminish the effect of neurotoxins?

A

Cholinesterase inhibitors

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108
Q

Which type of filler can be frozen and used several months later?

A

autologous fat

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109
Q

diets low in what have been reported to be useful in decreasing the incidence of AKs?

A

fat

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110
Q

Which form(s) of electrosurgery are both low voltage and low amperage?

A

electrolysis

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111
Q

What are the most commonly used settings for the steam autoclave cycle?

A

20-30 minutes, 2 atm pressure, 121 degrees Celsius

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112
Q

Which antiseptic agent has been reported to cause corneal ulcers?

A

chlorhexidine gluconate

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113
Q

What is the first unit component of the nail unit to be recognized during the embryologic period?

A

hyponychium

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114
Q

CN VII emerges from the skull base at which specific location?

A

stylomastoid foramen

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115
Q

What is the mechanism of action of topical 5FU in the treatment of cutaneous neoplasms?

A

Pyrimidine antagonist: inhibits of thymidylate synthetase –> blocks conversion of dUMP to dTMP in DNA and RNA synthesis

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116
Q

What are the most common anatomic locations for basosquamous carcinoma?

A

central face, esp perinasal

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117
Q

Which topical antibacterial agent has the same mechanism of action as gentamicin (binds 30s ribosomal subunit) but ALSO inhibits bacterial DNA polymerase?

A

neomycin

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118
Q

Which anesthetics have the longest duration of action?

A

Overall: Bupivacaine, Etidocaine, Ropivacaine, and Tetracaine.
without epi: ropivacaine
with epi: bupivacaine

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119
Q

Which filler is considered a stimulatory filler?

A

poly-L-lactic acid

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120
Q

What component of triple antibiotic ointment is most likely to cause allergic contact dermatitis?

A

neomycin (cross-reacts with bacitracin)

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121
Q

What are the ingredients of Jessner solution, and what are their amounts?

A
  1. salicylic acid, 14g
  2. resorcinol, 14g
  3. compounded in 95% ethanol
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122
Q

Why is no skin testing required for hyaluronic acids?

A

It has a chemical structure that is uniform throughout species, therefore it is considered immunologically inert

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123
Q

What is the term for the propensity of suture to return to or to maintain its natural configuration?

A

memory

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124
Q

The light chain of the botulinum toxin molecule is responsible for what portion of the neurotoxin’s mechanism of action?

A

protease action (such as cleavage of SNAP-25 for BTX-A)

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125
Q

Which areas of the lower extremities are highest risk for cutaneous necrosis after sclerotherapy?

A

dorsal foot/ankle

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126
Q

Which preservative added to saline, when used as solvent for reconstitution, can decrease the pain associated with botulinum toxin injections?

A

benzyl alcohol

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127
Q

which scalpel blade handle is rounded?

A

Siegel

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128
Q

Which portion of the chemical structure of anesthetic molecules allows for diffusion into axonal membranes?

A

the aromatic portion

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129
Q

which antiseptic agent has been reported to cause ototoxicity in rodents?

A

Chlorhexidine gluconate

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130
Q

Which anesthetic carries a risk of methemoglobinemia?

A

prilocaine

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131
Q

what is the brand name for cyanoacrylate?

A

dermabond

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132
Q

What anatomical facial structures contain a free margin?

A
  1. eyebrows
  2. eyelids
  3. lips
  4. nostril rim
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133
Q

medium depth chemical peels traditionally cause injury to what level of the skin?

A

Papillary to upper reticular dermis–about 0.45mm deep

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134
Q

What is the growth rate of the nail plate?

A

0.1mm daily

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135
Q

Topical imiquimod modifies local immune response through which toll like receptors?

A

TLR-7 with some activity of TLR-8

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136
Q

Which antiseptic agent is a known teratogen and is neurotoxic in infants?

A

Hexachlorophene

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137
Q

Which antiseptic agent should not be used around the ears and eyes?

A

Chlorhexidine gluconate

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138
Q

Which antiseptic agent is a biguanide?

A

Chlorhexidine gluconate

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139
Q

What is the temperature range for destruction of dermal fibroblasts?

A

-30 to -35 degrees celsius

140
Q

What is the one-year risk of actinic keratosis progression to primary SCC?

A

0.075% to 0.24%

141
Q

Which anesthetic is most associated with cardiotoxicity?

A

bupivacaine, followed by ropivacaine

142
Q

What are potential donor sites for a full thickness skin graft for the lower eyelid?

A
  1. upper eyelid

2. posterior sulcus

143
Q

What is the purpose of povidone when added to iodine in antiseptic solutions?

A

solubilizing agent

144
Q

What is the mechanism of action of chemical sclerosants?

A

Direct irritant to endothelial cells to produce endosclerosis

145
Q

What is the mechanism of action of topical gentamicin?

A

Bind the 30s ribosomal subunit, causing misreading of mRNA and inhibiting bacterial protein synthesis

146
Q

Why is prior radiation to the head and neck an important piece of medical history to obtain prior to chemical peeling?

A

Radiation to the head and neck decreases the number of pilosebaceous units in treated areas, much like isotretinoin. This delays wound healing after peeling and increases the risk for abnormal scarring.

147
Q

Which nerve innervates the lateral plantar surface of the foot?

A

plantar sural nerve

148
Q

Compartment syndrome can occur in what location after liposuction?

A

arms

149
Q

What nerve innervates the medial plantar surface of the foot and first through third toes?

A

medial plantar nerve / terminal branch of posterior tibial nerve

150
Q

Mutations in which gene are commonly seen in Spitz nevi but not in malignant melanomas?

A

HRAS

151
Q

synaptobrevin is also called…?

A

vesicle-associated membrane protein (VAMP)

152
Q

which 2 genes are most commonly mutated in malignant melanoma?

A

BRAF (60%) and NRAS (30%)

153
Q

at 24h postop, you notice the graft you placed has turned dusky blue. does this mean it’s necrosing?

A

no. this is normal venous congestion at 24h.

154
Q

frey’s syndrome occurs in approx what percentage of pts undergoing parotid surgery?

A

0.004%

155
Q

name 2 preservatives in amide anesthetics that can cause local allergic reactions?

A
  1. sodium metabisulfite

2. methylparaben

156
Q

use of which topical antimicrobial agent can lead to SJS/TEN in sulfa-allergic patients?

A

silver sulfadiazene

157
Q

somatic mutation of which gene is noted in 40-85% of SKs?

A

FGFR3

-don’t confuse w/FGFR2 mutations, which are seen in Apert, Beare-Stevens, & Crouzon, syndromes and in nevus comedonicus

158
Q

which nerve is susceptible to injury in cutaneous surgeries involving the lateral upper leg?

A

common peroneal nerve as it wraps around head of fibula

159
Q

Which absorbable suture maintains tensile strength the longest?

A

polydioxanone

160
Q

How/why does isotretinoin alter the wound healing response in patients with chemical peels?

A

isotretinoin produces atrophy of the pilosebaceous units, leading to delayed healing after peels and possibly abnormal scarring

161
Q

Use of which topical antibacterial agent has been reported to cause neural deafness in neonates?

A

neomycin

162
Q

what vascular finding is commonly found on dermoscopy of SCCIS?

A

glomerular vessels

163
Q

what common component of sunscreen is a metabolite of ester anesthetics?

A

PABA

164
Q

what nerve innervates the medial palmar surface of the thumb?

A

radial nerve

165
Q

split nails that are visible usually occur as a result of biopsy of what portion of the nail?

A

proximal matrix

166
Q

which scissors have long handles and small angled blades?

A

O’Brien – good for tight areas and leveling beveled edges

167
Q

which scissors have a small concave depression in one tip?

A

suture scissors

168
Q

topical imiquimod has been reported rarely to cause what pigment abnormality?

A

vitiligo-like eruption

169
Q

which 3 nerves exit at Erb’s point along the posterior sternocleidomastoid?

A
  1. greater auricular
  2. lesser occipital
  3. CN XI spinal accessory
170
Q

which form of electrosurgery works in a wet field?

A

electrocautery

171
Q

through what mechanism of action do HA fillers work to produce volumization?

A

hydration

172
Q

which pharyngeal arch gives rise to the muscle of mastication?

A

mesoderm of 1st pharyngeal arch

173
Q

what are the names and amounts of ingredients in a Baker-Gordon phenol peel?

A
  1. Phenol 88% (3mL)
  2. Septisol liquid soap (8 drops)
  3. Croton oil (3 drops)
174
Q

Which portion of the chemical structure of anesthetic molecules determines the class (amide vs ester)?

A

intermediate chain

175
Q

What are the two most commonly used agents for neutralizing a glycolic acid peel?

A
  1. saline

2. 5-10% sodium bicarbonate solution

176
Q

what is the action of detergent sclerosant?

A

Interference with cell surface lipids causes endothelial damage. The endothelial cells desquamate in plaques.

177
Q

Superficial chemical peels traditionally cause injury to what level of the skin?

A

epidermis to papillary dermis (0.06mm)

178
Q

Which muscle supplied by CN VII is the only one known to classically be supplied on the superficial side of the muscle, as opposed to the deep side?

A

The Buccinator

179
Q

Which nerve is thought to be responsible for the majority of the sensory fibers supplying the conchal bowl?

A

Vagus nerve (CN X)

180
Q

What is the most common predisposing factor for the development of SCC in patients with skin of color?

A

Scarring conditions such as cutaneous lupus or burn scars

181
Q

what type of blade handle is rounded all the way through?

A

Beaver round / knurled

182
Q

what nerve innervates the plantar surface of the heel?

A

Calcaneal nerve, branch of the posterior tibial nerve

183
Q

Which division of the ophthalmic branch of the trigeminal nerve is responsible for sensory innervation to the conjunctiva?

A

lacrimal nerve

184
Q

Which forms of electrosurgery are high voltage and low amperage?

A
  1. electrofulguration

2. electrodessication

185
Q

which type of blade handle is flat with grooves for grip near the tip?

A

Bard-Parker #3

186
Q

What is the name given to the convergence of muscles of facial expression that occurs just lateral to the oral commissure?

A

the modiolus

187
Q

What substance can be added to mass produced botulinum toxin to prevent adhesion of the neurotoxin to the glass of the vial?

A

human serum albumin

188
Q

A toenail grows from the matrix to the distal free edge over what period of time?

A

12-18 months

189
Q

When does fingernail development begin?

A

embryologic week 10

190
Q

what are 4 chemicals required in the chemical autoclave?

A
  1. formaldehyde
  2. methyl ethyl ketone
  3. acetone
  4. alcohols
191
Q

What are the two most commonly reported side effects when botulinum toxin is injected for cosmetic indications?

A
  1. headache

2. ptosis (correctable if lid; non-correctable if brow)

192
Q

Use of silver sulfadiazine in neonates has been associated with which two side effects?

A
  1. kernicterus

2. argyria

193
Q

The folliculocentric frosting that can be seen with salicylic acid peels is due to what?

A

Precipitation of salicylic acid crystals
This is in contrast to frosting noted with TCA peels, which is due to keratocoagulation and the precipitation of denatured proteins

194
Q

T/F: filler injections around the glabella or eyes can potentially cause blindness?

A

true

195
Q

What chemical is typically used for a chemical matrixectomy?

A

88% phenol

196
Q

What is the only serotype of botulinum toxin that cleaves syntaxin?

A

BTX-C

197
Q

what causes the Tyndall effect?

A

In aesthetics, the Tyndall effect describes the bluish hue that is visible within the skin as a result of too superficial placement of hyaluronic acid filler

198
Q

Nephrotoxicity with use of mupirocin to large areas of body surface is due to absorption of what?

A

Polyethylene glycol

199
Q

Compared to botulinum toxin serotype A, serotype B has a faster or slower onset of action?

A

faster–but also wears off faster

200
Q

Which non-absorbable suture has the highest tissue reactivity?

A

silk

201
Q

Which antiseptic agent must air dry in order to be bactericidal?

A

Povidone-iodine

202
Q

Spot dermabrasion causes type II collagen fibers to be replaced by what?

A

type I collagen fibers

203
Q

How can you reduce bruising in tumescent liposuction?

A
  1. small cannula size
  2. leave incision sites open to drainage
  3. use of tumescent anesthesia
  4. use of compression
204
Q

A finger nail grows from the matrix to the distal free edge over what period of time?

A

4-6 months

205
Q

What is the name for the property that quantifies how easily suture passes through tissue?

A

Coefficient of friction

206
Q

Where is fibrous fat most often encountered?

A

abdomen and back

207
Q

onabotulinumtoxin A is more commonly known by what name?

A

Botox

208
Q

T/F: the appearance of cellulite with always improve with liposuction

A

false

209
Q

Myobloc is FDA approved for what indication?

A

cervical dystonia

210
Q

Which method of sterilization has the highest risk for corrosivity or dulling of sharp instruments?

A

steam autoclave

211
Q

What can cause a pterygium after a nail matrix biopsy?

A

The proximal nail fold and the open matrix adhere to each other and form a scar

212
Q

Which non-absorbable suture is known for its elasticity?

A

polybutester (Novafil)

213
Q

What is distal angioplasia?

A

Telangiectatic matting that occurs after sclerotherapy. Risk factors include obesity, use of estrogen containing hormones, pregnancy, and family history of telangiectatic veins

214
Q

What types of medication can affect lidocaine metabolism?

A

CYP450 3A4 inhibitors

215
Q

If arterial injection occurs with a sclerosant, what should you do?

A

Immediately apply ice, attempt to flush, and consider hospital admission and vascular surgery consult for administration of IV anticoagulation

216
Q

Which topical antibacterial agent can cause cell degranulation, and is therefore a contraindicated in patients with mastocytosis?

A

polymixin B

217
Q

The efficacy of photodynamic therapy is dependent upon intracellular accumulation of what porphyrin prior to UV exposure?

A

protoporphyrin IX

218
Q

what 2 subunits comprise the concha?

A
  1. superior cymba

2. inferior cavum

219
Q

Which nerve from the cervical plexus supplies innervation to the upper posterior auricle and the scalp posterior to the upper ear?

A

lesser occipital nerve

220
Q

What is the estimated percentage of patients with SCCIS that progress to develop invasive SCC?

A

3 to 5%

221
Q

Nerve block of the entire plantar surface of the foot includes blockade of which three nerves at which three locations?

A
  1. Posterior tibial nerve, immediately behind medial malleolus
  2. Sural nerve, immediately behind lateral malleolus
  3. Saphenous nerve, just above the medial malleolus
222
Q

The degree of clinical improvement with any chemical peel is directly proportional to what quality of the peel?

A

The depth of injury produced

223
Q

what nerve innervates the interdigital space between toes 1 & 2?

A

superficial peroneal (fibular), dorsal

224
Q

what is the typical donor site for a composite graft?

A

ear

225
Q

what oral medications have proven effective in chemoprevention of cutaneous malignancies?

A

Vitamin A / retinoids

226
Q

which muscles of the eye are NOT innervated by CN III?

A

Lateral rectus (CN VI) and superior oblique (CN 3)

227
Q

which forceps have thin, tapered, smooth tips?

A

jeweler’s forceps

228
Q

natural fiber absorbable suture are broken down in tissue by what process?

A

proteolysis

229
Q

how much time must elapse after injection for maximal vasoconstriction from epi to occur?

A

10-15min

230
Q

which 4 genes have been important in susceptibility to BCC?

A
  1. TP53
  2. PTCH1
  3. PTCH2
  4. SUFU
231
Q

which preservative in anesthetics cannot be used in infants with hyperbilirubinemia?

A

methylparaben (displaces bilirubin from albumin)

232
Q

which of the antiseptic agents is rapidly neutralized by blood, serum proteins, and sputum?

A

povidone-iodine

233
Q

which classes of medications can theoretically enhance the effect of neurotoxins?

A
  1. aminoglycosides
  2. cyclosporine
  3. CCBs
234
Q

which topical anesthetic carries the highest risk of ACD?

A

benzocaine

235
Q

a chalazion clamp is particularly useful for hemostasis and immobilization in which areas?

A

lip, earlobe, eyelid

236
Q

which nerve is particularly susceptible to injury with retroauricular surgery in prepubescent patients?

A

facial nerve (CN VII) - exits stylomastoid foramen. in adults, this is protected by mastoid and air spaces, but these are not fully developed until puberty

237
Q

silver sulfadiazene, when used over large areas of body surface, can lead to leukopenia. concomitant use of what medication increases the risk for this complication?

A

cimetidine

238
Q

for what cosmetic indication was botox first approved?

A

glabellar furrows

239
Q

photoactivated tissue bonding uses which dye prior to photoactivation?

A

rose bengal

240
Q

which is the only branch of the trigeminal nerve that carries motor fibers?

A

V3 - mm of mastication

241
Q

CO2 slush is a superficial peeling agent that is formed by dipping the tip of a cone of dry ice into what solution prior to applying to the skin?

A

3:1 mixture of alcohol:acetone

242
Q

if Baker-Gordon phenol peel solution were to enter the eye, what solution should it be flushed with?

A

mineral oil (not water)

243
Q

cutaneous SCC in which anatomic locations have been associated with an increased risk of metastasis?

A

lips, ears

244
Q

which division of the ophthalmic branch (V1) of the trigeminal nerve is responsible for sensory innervation of the tip of the nose?

A

external nasal branch (of the anterior ethmoidal nn)

245
Q

which antiseptic agent has the fastest onset of action?

A

isopropyl alcohol

246
Q

what is the name of the duct that exits the parotid, and where does it enter the oral cavity?

A

Stenson’s duct exits the parotid and enters the oral cavity in the buccal mucosa adjacent the 2nd upper molar

247
Q

where in the body is hyaluronic acid found?

A

ECM of connective tissue and synovial fluid. Also serves as the ground substance of the dermis and fascia.

248
Q

rimabotulinumtoxin B is more commonly known by what name?

A

myobloc

249
Q

which superficial peeling agent is safe for use in pregnancy and breastfeeding?

A

glycolic acid.

SA peels are not recommended d/t risk of salicylism

250
Q

which division of the mandibular branch (V3) of the trigeminal nerve supplies sensory innervation to the tragus?

A

auriculotemporal nerve

251
Q

a patient with Raynaud’s requires a nail biopsy. what should be avoided when anesthetizing?

A

epi

252
Q

what is the recommended max dosage of lidocaine when used in tumescent anesthesia for liposuction?

A

55mg/kg

253
Q

what can be done to decrease the risk of renal toxicity during a phenol peel?

A

make sure pt is well hydrated: 500ml lactated ringer’s prior to peel and 1000ml IVF during immediate postop phase

254
Q

what is the name and value of the range within which protoporphyrin IX maximally absorbs UV light?

A

Soret band: 400-420nm

255
Q

abobotulinumtoxin A is more commonly known by what name?

A

dysport

256
Q

which type of electrosurgery carries the greatest risk for complications related to pacemakers?

A

electrosection

257
Q

which nerve that provides sensory innervation to the sole of the foot is the only one derived from the femoral nerve more proximally in the lower extremity?

A

saphenous nerve. all other sensory nerves to the sole are derived from sciatic nerve.

258
Q

vismodegib’s mechanism of action is due to inhibition of what molecule?

A

smoothened

259
Q

which anesthetic has the shortest duration of action?

A

prilocaine

260
Q

other than methemoglobinemia, what other complication has been seen in kids (especially neonates) with EMLA use?

A

purpura

261
Q

which antiseptic agent has the longest sustained antimicrobial action?

A

chlorhexidine gluconate

262
Q

in which form of electrosurgery does the electrode not contact the treated tissue?

A

electrofulguration

263
Q

what is the temperature range for destruction of keratinocytes?

A

-20 to -30 degrees Celsius

264
Q

what is the name of the small fibrous attachments between periostium and bone?

A

sharpey’s fibers

265
Q

botulinum toxin prevents release of which molecule from presynaptic motor neurons?

A

acetylcholine

266
Q

what lasers can be used to treat post-sclerotherapy hyperpigmentation?

A

QS ruby, alexandrite, or 1064nm lasers

267
Q

which oral medication must be stopped for at least 6, but preferably 12, months prior to medium or deep peels?

A

isotretinoin

268
Q

which commonly-used superficial peeling agent is unique in that it requires neutralization?

A

glycolic acid

269
Q

what medications should patients avoid 2 weeks prior to liposuction?

A

aspirin, NSAIDs, Vitamin E, alcohol, and herbal remedies

270
Q

which of the electrodes is always the “working electrode” in electrolysis?

A

cathode

271
Q

what is the name of the perforating vessels that connect the great saphenous vein to the deep (femoral) veins of the leg at the level of the knee?

A

Boyd perforators

272
Q

how many units of each complexing protein are in each vial of botox?

A

5 nanograms

273
Q

keratoacanthomas in which two anatomic locations are unlikely to regress spontaneously?

A

mucosal and subungual

274
Q

which sterilization method carries the lowest risk of corroding or dulling sharp instruments?

A

dry heat (oven)

275
Q

regular use of which OTC medication has been shown in the literature to decrease the risk of AKs?

A

NSAIDs

276
Q

all botulinum toxins are effectively proteases that cleave what collection of proteins in the presynaptic neuron?

A

SNARE complex

277
Q

which sterilization method is known not to always be effective against bacterial spores and Hep B, and therefore is considered inadequate for sterilizing surgical instruments?

A

cold sterilization / chemical immersion

278
Q

what is the metabolite of prilocaine that can lead to methemoglobinemia?

A

orthotoluidine: can metabolize Hb to metHb

279
Q

what is the maximum recommended volume of anesthetic for a digital nerve block?

A

8mL

280
Q

T/F: reflex sympathetic dystrophy can occur after nail surgery?

A

true: suspect this is pain arises 10 days or longer postop

281
Q

which muscle that assists in mastication is supplied by CN VII?

A

buccinator: the 4 classic mm of mastication are innervated by CN V, but this one assists by keeping food pushed toward the occlusal surface of posterior teeth during chewing

282
Q

which nerve innervates the medial malleolus and proximal medial dorsal foot?

A

saphenous nerve

283
Q

the heavy chain of the botulinum toxin molecule is responsible for what portion of the neurotoxin’s mechanism of action?

A

binding to presynaptic nerve terminal and receptor-mediated endocytosis into presynaptic neuron

284
Q

all available botulinum toxins are what pregnancy category?

A

Cat C

285
Q

what is the thickness range for a split thickness skin graft?

A

0.13mm to 0.78mm

286
Q

which class of anesthetic is metabolized in the liver?

A

amides (by P450 enzyme)

287
Q

what is the mechanism of action of osmotic sclerosants?

A

dehydration of endothelial cells through osmosis, resulting in endothelial destruction, fibrin deposition, and thrombus formation

288
Q

what commonly prescribed medications can increase plasma lidocaine levels?

A

beta-blockers

289
Q

patients with basal cell nevus syndrome are at increased risk of developing what 2 intracranial tumors?

A

medulloblastoma and meningioma

290
Q

which peeling agent is expected to have a slightly yellow discoloration as post-peel response?

A

tretinoin 1%

291
Q

which topical antibacterial agent interacts with phospholipids in bacterial cell membranes, thereby increasing cellular permeability?

A

polymixin B

292
Q

bacitracin impedes bacterial cell wall synthesis by forming a complex with what component of the bacterial cell wall?

A

C55 phenol pyrophosphate

293
Q

which type of electrosurgery causes superficial epidermal carbonization?

A

electrofulguration

294
Q

what is the term for the ability of suture to regain its original form and length after deformation?

A

elasticity

295
Q

which topical antibacterial causes read-through of nonsense mutations and may therefore be well suited for superficial bacterial infections in patients with Hailey Hailey?

A

Gentamycin

296
Q

which class of anesthetics is metabolized by plasma pseudocholinesterase and excreted by the kidneys?

A

esters

297
Q

botulinum toxins are contraindicated in patients with what 3 neurologic diseases?

A

1) myasthenia gravis
2) lambert-eaton syndrome
3) ALS

298
Q

sensory nerve restoration occurs how many weeks post-op?

A

2 weeks

299
Q

which muscles are innervated by the temporal branch of CN VII?

A

frontalis, orbicularis oculi, corrugator, and occasionally procerus (tho this is traditionally zygomatic)

300
Q

what are the most commonly used settings for the dry heat/oven sterilizer?

A

60min at 171 deg C, or 6hr at 121 deg C

301
Q

which 4 histologic characteristics have been established as high risk by the AJCC and may upstage an SCC from Stage I to Stage II?

A

1) poor differentiation
2) perineural invasion
3) Clarks level IV
5) depth of invasion >2mm

302
Q

synthetic absorbable sutures are broken down in tissue by what process?

A

hydrolysis

303
Q

why is it important to consider viscosity when selecting a filler?

A

viscosity measures the ability to resist shearing forces–for filler, this means less ability to spread

304
Q

T/F: hypopigmentation after cryotherapy can be permanent

A

True

305
Q

what instrument is used to harvest a large split-thickness skin graft?

A

dermatome or Weck blade

306
Q

what are the 3 main categories of sclerosing solutions?

A

1) detergent
2) osmotic
3) chemical

307
Q

use of which topical antibacterial over large BSA, especially in burn patients, can cause nephrotoxicity?

A

mupirocin

308
Q

according to the most recent AJCC guidelines, what is the clinical size threshold that upstages an SCC from Stage I to Stage II?

A

2cm

309
Q

which anesthetic has the fastest onset of action?

A

lidocaine (30-45 sec)

310
Q

describe the clinical signs associated with each level of frosting that can be seen with TCA peels

A

Level I: erythema with streaky white areas of frosting
Level II: nearly uniform white enamel coloring with visible erythematous background
Level III: solid white enamel frosting with no visible erythema (signifying penetration to reticular dermis)

311
Q

humans are susceptible to all except which 2 serotypes of botulinum toxin?

A

C and D

312
Q

mutations in which gene have been associated with aggressive metastatic ocular melanomas?

A

BAP-1

313
Q

what nerve injury can occur during liposuction of the neck in an elderly person?

A

damage to marginal mandibular branch of facial nerve 2/2 perforation of platysma

314
Q

what percentage of alcohol has the broadest spectrum and is the optimal strength for antiseptic action?

A

0.7%

315
Q

which sterilization method is most appropriate for heat-sensitive and moisture-sensitive instruments?

A

gas sterilization

316
Q

lid ptosis a/w botulinum toxin injection can be corrected with use of what?

A

apraclonidine eye drops – alpha2 adrenergic agent stimulates contraction of muller’s muscle

317
Q

which non-absorbable suture has the highest risk of infection?

A

silk

318
Q

the CROSS (in TCA CROSS) stands for what?

A

chemical reconstruction of skin scars

319
Q

what causes buttock ptosis?

A

overzealous suctioning

320
Q

what is a high viscosity and high G’ filler?

A

calcium hydroxylapatite

321
Q

which division of the mandibular branch (V3) of the trigeminal nerve usually runs alongside the superficial temporal artery?

A

auriculotemporal nerve

322
Q

which cryosurgery technique tends to produce the lowest final temperature?

A

chamber technique

323
Q

which type of forceps have a broad handle and narrow tip?

A

Adsons

324
Q

which type of needle tip is least likely to cut through tissue?

A

taper

325
Q

what are the 3 most common types of needle tips?

A

1) taper
2) conventional cutting
3) reverse cutting

326
Q

which portion of the chemical structure of anesthetic molecules determines the duration of action?

A

amine

327
Q

which antiseptic agent has been reported to cause keratitis?

A

chlorhexidine gluconate

328
Q

what does it mean if a dusky blue color or blanching of an area occurs immediately after injection?

A

possible vascular injection and potential for impending necrosis

329
Q

what skin d/o is characterized by pustules, erosions, and crusting in areas of alopecia which tend to be atrophic or actinically damaged, often after trauma or field treatment of AKs?

A

Erosive pustular dermatosis

330
Q

what is the term for the capacity of suture to absorb and transfer fluid?

A

capillarity

331
Q

which sclerosant can cause a disulfiram-like reaction?

A

Polidocanol

332
Q

PTCH is a membrane receptor for what molecule?

A

Sonic hedgehog

333
Q

which scissor has a blade to handle ratio of about 1:1?

A

mayo scissor

334
Q

which forms of electrosurgery are monoterminal?

A

electrofulguration and electrodessication

335
Q

which topical antibacterial inhibits bacterial synthesis by interacting with protein L3 on the 50s subunit of the bacterial ribosome?

A

retapamulin (altabax)

336
Q

which component of jessner’s solution has been shown to rarely cause exogenous ochronosis?

A

resorcinol

337
Q

which subtype of keratoacanthoma can reach a size of up to 20cm, demonstrating enlargement/extension of the border w/simultaneous central clearing?

A

KA marginatum centrifugum

338
Q

T/F: a graft is devoid of adnexal structures

A

True

339
Q

T/F: when an eschar forms over a graft, it is likely to undergo necrosis

A

false - healing can occur in the dermal portion of the graft

340
Q

which of the neurotoxins are free from complexing protein?

A

incobotulinumtoxin A

341
Q

which subclass of suture, monofilament or braided, has more capillarity?

A

braided

342
Q

what are the recommended pre-procedure tests prior to liposuction?

A

CBC, PT/PTT, BMP or CMP, hepatitis panel, HIV, UPT

343
Q

which forceps have a wide handle and thin tips with teeth?

A

Brown-Adson

344
Q

name the 4 stages of graft “take”

A

graft blanches then turns pale pink by 6h, dusky blue by 24h, and pink by day 7 (indicating survival)

345
Q

T/F: epi is contraindicated in digital blocks

A

false

346
Q

which systemic treatments are most widely used for syndromic variants of KA?

A

retinoids are most common but MTX, 5FU, and cyclophosphamide are also used

347
Q

where are composite grafts typically used?

A

full-thickness alar rim defects

Derm Surg (1 decks)

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