Skin Flashcards
Scaly, thick, greasy surface with scattered keratin plugs (pigmented)
Seborrhoeic keratosis
if Seborrhoeic keratosis - Multiple superficial + irregular – itchy but not bleeding – sample by
– shave biopsy
DIP Heberdens –
Osteoarthirits
SCC at sites of chronic inflammation, osteomyelitis, burns
Marjolins ulcer
aggressive malignancy in chronic lymphedema
Lymphangiosarcoma
Lymphodaema age ranges
Millroy’s <1, Meige 1-35, Tarda >35
Necrolytic migratory erythema: Abdo + bum blisters, weight loss and diarrhoea – some intact vesicles
pancreatic alpha cell gluconoma ->1kg, CT + resect.
Venous stasis ulcer – exophytic in
Venous stasis ulcer – exophytic in malignant transformation only
Keloid scar goes beyond
Keloid scar goes beyond incision
PT burns – lose hair follicles but not
PT burns – lose hair follicles but not sweat glands
Dercums disease –
Dercums disease – multiple lipomas aka adiposis dolorosa.
All collagen
All collagen – derived from gycline
Dermatofibroma
Dermatofibroma – at site of previous trauma, dermal overgrowth of fibrous tisue
Homan’s procedure
The skin still has a HOME
Radical lymphodema resection with skin flaps still intact.
Charles’ procedure
Radical lymphodema resection with skin grafts overlaid - no longer done
SCC which therapy is safe? Spead by?
SCC – radiotherapy safe, spread by lymphatics
Merkel Cell tumours
Firm, painless, nodule, exposure to Merkel cell polyomavirus (MCV),
Fistula in ano = line by…
Fistula in ano = line by squamous epithelia
Big facial wound – graft using
full thickness skin graft
anaesthetic for for sebaceous cyst on scalp
1% lignocaine with 1 in 200,000 adrenaline for sebaceous cyst on scalp
Lupus vulgaris is not associated with the Koerner phenomenon.
A true Koebner response occurs in:
Psoriasis
Vitiligo
Halo naevus
Lichen planus.
Aggressive fibromatosis –
desmoid tumours
If BCC <2cm, Margin of
If BCC <2cm, Margin of 3-5mm
Keratokenthoma –
rapid growing and keratin core
Cryoprecipitate – Has factor…
Cryoprecipitate – Factor VIII (Factors V and VIII – sensitive to temp degredation)
What blood products or derivatives can cause urticaria and what can cause pyrexia?
FFP – Urticaria, RBCs – Pyrexia!
vWF stabilizes factor VIII - you can give
tranexamic acid, DDAVP/Desmopressin
stimulates vWF release from endothelia via V2 receptor
Low platelet counts + raised FDP – X is most likely..
Low platelet counts + raised FDP – DIC more likely
ITP – transfuse platelets….when relative to splenic ligatiobn
ITP – transfuse platelets after splenic artery ligation
Blood film findings post-splenectomy
Jolly bodies will appear,
Poikilo/ target cells and
Pappenheimer bodies,
erythrocyte siderotic granules
Blood film finding in lead poisoning
Stipple cells in lead poisoning
Hyperacute transplant rejection what Abs
IgG anti HLA Class I antibodies in the recipient
Acute transplant rejection
Acute transplant rejection – Type IV – T Lymphocytes
In chronic rejection after 6 months you find…
Chronic >6 months – vascular changes
Haemolytic anaemia – T2: Auto-Ab’s for
or Cell surface Ags (ACID, EGGT +M-MA-T)
Interpretation blood clotting test results
H v V
H - v V APTT PT BT UNN UNU UUN
Abnormal coagulation
Cause Factors affected
How We Do Life
HWDL (W+L both get 7’s)
H 2,9,10,11 (then get rid of 11)
W - 2,7,9,10 (only one without 11)
D - 1,2,5,8,11 (get rid of 8)
L - 1,2,5,7,9,10,11
Post splenectomy sepsis:
Post splenectomy sepsis: Strep Pneumonae, Haem Influenz, Meningococci
Myofibroblasts at what stage of wound healing
Myofibroblasts – 6 weeks into wound healing
RA can result in..cytosis
RA – Thrombocytosis
Stored blood - less 2,3 DPG - therefore
Stored blood - less 2,3 DPG - a higher affinity for oxygen (left shift)
Anti phospholipid syndrome=
Lupus anticoagulant / Anti-cardiolipin / Anti-beta2-glycoprotein
Heparin – all forms – hyperaemia -by
Heparin – all forms – hyperaemia -by inhibiting aldosterone
Iatrogenic gram +ve infection with room temp platelets
platelets
Acquired Fact 12 deficiency – Prolonged..
Acquired Fact 12 deficiency – Prolonged PTT
Prolonged Abx or Cholestatic jaundice results in
Prolonged Abx or Cholestatic jaundice – Vit K deficiency
Sudden anaemia and LOW reticulocyte count b/g Sickle
Parvovirus infection
TNF – secreted mostly by
TNF – secreted mostly by Macrophages
4 days post-splenectomy – high…
4 days post splenectomy – high platelet count
Warfarin inhibits
2,7,9,10
LA for for biars blocks
Prilocaine best for biars blocks 6/9a, less cardiotoxic
Methylene blue for
Methylene blue for methaemoglobinaemia
Procaine and benzocaine are…
Procaine and benzocaine – amino-esters
Lignocaine – type and mechanism
Lignocaine – amide blocks Na channels
Etomidate – up and downs with use of it..
Etomidate – adrenal suppression – but best cardiac profile!
Difference between Pethidine and Morphine
Pethidine: different structure and less fat soluble to morphine, less biliary spasm
Atracurium – hydrolysed and releases
Atracurium – hydrolysed and releases histamine
Lido dosing
Lido 3/7a
Bupivicaine dosing
Bup 2/2a
Collagen Synthesis, Vitamin C is needed for
Vitamin C is needed for the hydroxylation of proline during collagen synthesis.
Fat embolism – like PE +…
Fat embolism – like PE + confusion + petechial rash
Sino nasal cancer - related..
Sino nasal cancer - 50% SCC - wood dust exposure, no strong smoking link.
Liver Angiosarcoma - associated with
Liver Angiosarcoma - vinyl chloride exposure
z score is determined using the
z score is determined using the normal distribution and is not a descriptive statistic.
Transient nerve function loss for a few weeks…
Transient nerve function loss for a few weeks – neuropraxia (no Wallerian degeneration)
Medullary chemoreceptors –
arterial CO2
ormal pulmonary artery occlusion pressure =
Normal pulmonary artery occlusion pressure = 8-12mmHg
ARR =
ARR = 1/NNT
Abdo CT in trauma even if pregnant?
YES
P value – risk of rejecting true null hypothesis
Type 1 error
How much of you is water and where it is?
Water 60% bodyweight
65% Water intracellular, 35 extracellular. 5% in plasma.
Montgomery ruling –
not just % risk, patient’s hypothetical significance to risk
Which inhibit protein synthesis?
What do the rest do
McFAT inhibits protein synthesis: Macrolides, chloramphenicol, Fusidic acid, Amioglycosides, tetracyclines.
Pen+Cephs cell wall.
Rifampicin RNA.
Rest inhibit DNA
For Desication…
In Active contact: Low current + High voltage – in contact = Dessication
(loss of water but not protein)
Fulgration
Low amplitude and high voltage system - spray effect for superficial tissue destruction - bladder tumours
Cutting
Sinusoidal and non modulated waveform
High average power and current density
Precise cutting without thermal damage
esmarch bandage tourniquet – higher rate of
Esmarch bandage tourniquet – higher rate of neuropraxia
Chordoma –
Chordoma – midline axial tumour inc clivus
Cluster RCTs – more prone to
Cluster RCTs – more prone to unit of analyses errors
Bone callous – visible on xray after
Bone callous – visible on xray after 3 weeks
Amiodarone does not cause lymphadenopathy T/F?
True
Amiodarone does not cause lymphadenopathy
Obesity – not a risk factor for osteoperosis
T/F?
True
Obesity is not a risk factor for osteoperosis
RCTs can be unblinded. T/F?
RCTs can be unblinded. T!
42yo, BMI 15 hernia repair. Give
Give 10 kcal/kg/day initially,
oral thiamine 200-300mg/day,
vitamin B co strong 1 tds and supplements.
Cohort studies assess the
Cohort studies assess the relative risk
Sharpey’s fibres attach
Sharpey’s fibres attach periosteum to bone
Prevalence is equal to
Prevalence is equal to pretest probability
Hyperventilation will lower ionised
Hyperventilation will lower ionised plasma Ca2+ levels
What is the three-sigma rule?
68-95-99.7 rule or three-sigma rule
Almost the entire population will fall within 3 SD’s if normally distributed.
RR =
RR = Ex Rate/Control Rate
RRR=
RRR= (ER-CR)/CR
Halothane is ….
Hepatotoxic
Bolam’s test
Bolam’s test – if your decision is in agreement with professional standard of practice
1L 0.9% NaCl = x mmol
154
Long-standing offensive discharge from the ear…
Cholesteatoma
