SKIN SOFT TISSUE Flashcards
VAC pressure recs
A negative pressure of -50 to -125 mm Hg is applied either intermittently or continuously.
A high-output fistula produces
200 to 500 mL/day.
A patient presents with a 3- x 4-cm skin lesion on his leg that has been present for 10 days. Treatment with a beta-lactam antibiotic has produced no improvement. The patient is ambulatory and has a normal WBC count. A culture returns community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
Which of the following antibiotics would be an appropriate recommendation?
Compared with HA-MRSA, CA-MRSA strains tend to be more susceptible to antimicrobial agents outside of the beta-lactam class. CA-MRSA isolates are
HA-MRSA is susceptible to vancomycin, daptomycin, linezolid, and tigecycline. Doxycycline yielded a 90% cure rate when used to treat CA-MRSA skin infections. Although drugs used for HA-MRSA could be used for a CA-MRSA skin infection, they are not necessary and increase the cost of care.
Patients with a CA-MRSA skin infection must be investigated for the presence of an abscess that needs drainage. Drainage alone may suffice in some cases. When cellulitis is present with or without an abscess, antibiotics are indicated. Current recommendations suggest using oral agents appropriate for CA-MRSA as initial treatment. Drugs used to treat HA-MRSA are used if initial treatment fails.
Aztreonam and amoxicillin/cavulanate are beta-lactam antibiotics and would not be appropriate choices, especially because previous beta-lactam coverage has not been successful.
Compared with HA-MRSA, CA-MRSA strains tend to be more susceptible What class of antibiotics
to antimicrobial agents outside of the beta-lactam class.
far more likely to demonstrate susceptibility to ciprofloxacin, clindamycin, doxycycline, rifampin, trimethoprim-sulfamethoxazole, and erythromycin, compared with nosocomial or HA strains.
HA-MRSA is susceptible to
vancomycin, daptomycin, linezolid, and tigecycline.
and immunologic origin of melanocyte
Neuro crest
60 mmHg and produce pressure necrosis of the skin and underlying soft tissue and what time.
One hour
What is the pressure that is generated to the sacrum and laying in a standard Hospital mattress
150 mmHg
primary wavelength responsible for skin cancer from the sun
UVB
315-290 nm
best initial treatment for burn with hydrofluoric acid
Copious water irrigation (or saline)
30 minutes
Do not neutralize
Wet complications are seen with HCl burn
calcium deficit (this neutralized acid)
Decreased calcium may cause cardiac arrhythmia
After water flush:
Ammonium compound
Calcium carbonate gel-detoxifies fluoride
Risk factors for actinomycotic infection and diagnostic finding and treatment
tooth extraction
Facial trauma
Sulfur granules
Penicillin and sulfa my
Deep infection-abscess/chronic scarring may require surgical treatment
Pyoderma gangrenosum
associated with systemic disease 50%
Inflammatory bowel disease
Rheumatoid arthritis
Hematologic malignancy
Monoclonal immunoglobulin a gammopathy
Treatment:
Many of acute chemotherapy plus aggressive wound care and skin grafting
Staphylococcal scalded skin syndrome:
Pathology
Associations
Treatment
Excellent toxin
skin biopsy-cleavage granular of epidermis
Infection of nasopharynx/middle ear
Toxic epidermal necrolysis
immune response to drugs: Sulfonamides Phenytoin Barbiturates TETRACYCLINE
Diagnoses skin biopsy
Structural defect of dermal epidermal junction-similar to second-degree burn
Treatment:
Fluid resuscitation electrolytes
Treated skin As a burn
More than 30% true diagnosis of TEN
Less than 10%total body surface area is called Steven Johnson syndrome
Stevens Johnson syndrome
Less than 10%total body surface area is called Steven Johnson syndrome
if greater than 30% this is classified as TEN
respiratory and epithelial sloughing including GI tract
May require temporary coverage with catheter or porcine graft to allow epidermis to spontaneously regenerate
most common type of cutaneous cyst
epidermal cyst
Substance inside assistant keratome (NOT sebum)
Single, firm nodule anywhere and body
Dermoid cyst
Congenital lesion
Epithelium his truck during fetal development
Eyebrow most frequent site
A form anywhere from tip of nose to forehead
liking ovary views may demonstrate bone tissues nerve tissue
Trichilemmal cyst
pillar cyst
outer layer resembles root sheath of hair follicle
Second most common cutaneous cyst
Most often Scalp females
did not contain granular layer
Capillary hemangioma
port wine stain
At present and midface may signify:
Churg-Strauss syndrome:
CT scan brain to rule out intracranial berry aneurysm
Most common type of basal cell carcinoma
Nodular
Most common type of skin cancer
Basal cell carcinoma
Types of basal cell carcinoma and treatment
Nodular-most common Superficial spreading Micronodular Infiltrative Pigmented Morpheaform
Waxy, rolled, pearly borders surrounding septal scar
Relatively aggressive form of basal cell carcinoma
Morpheaform
Appear this flap, plaque-like lesion
Other aggressive form:
Basal squamous type-may metastasize similar to squamous cell carcinoma
Marjolin’s ulcers
Burn scars
Squamous cell carcinoma
Osteomyelitis, previous injury, scar
This type of squamous cell carcinoma tends to be more aggressive and metastasize to earlier
Angiosarcoma associated with Stewart-Treves for syndrome
associated with lymphedema-classic delayed presentation status post axillary dissection breast cancer
May rise on scalp, face, neck
Appears as bruise
Increased risk with prior radiation in the setting of chronic lymphedema
Anaplastic endothelial cells surrounding vascular channels
Treatment:
Total excision of early lesion may occasionally tear
Clearly it chemoradiation
List order frequency of types of melanoma
Superficial spreading
Nodular
Lentigo
Acral
most common type of melanoma
Superficial spreading
Superficial spreading melanoma
Most common
Anywhere in the skin except the hands and feet
Typically flat measure 1-2 cm diameter
Prolonged radial growth before vertical extension
improved prognosis to 2 delayed vertical growth
nodular melanoma
increased vertical early growth
Dark color off and raised
More aggressive and superficial spreading though similar prognosis when equal depth
Then T. go melanoma
Most frequently:
Neck, face, hands, elderly
10 to be quite large diagnosis
Best prognosis because invasive growth occurs late
Acral lentigo melanoma
These common
Relatively rare in dark skinned people though much more common in dark skinned people than Caucasian
home
Consults
Subungual
Most common great toe or thumb subungual posterior nail fold
Treatment of melanoma less than 1 mm depth
1 cm excision margin
Treatment of melanoma greater than 1.01 mm depth
2 cm excision margin
With our margins needed for Merkel cell carcinoma 2 millimeters in diameter
3 cm?
Merkel cell carcinoma
wide excision down to the fascia left brain paracranium):
Martin: 1.5-2 cm (or Mohs)
Nodes: Sentinel or regional dissection
Adjuvant radiation to primary no sites and poor prognosis group
Cisplatin: May be used for regional or distant metastases
Neuroepithelial differentiation not true squamous cell carcinoma
Associated with up to 25% metachronous or synchronous lesion!
Highly aggressive
Prophylactic regional lymph node dissection with adjuvant radiation recommended
Dermatofibrosarcoma protuberans
Chemotherapy
second most common sarcoma
Presents to young patient’s 30-40-year-old
Wide excision: 3 cm margin; frozen section margins
Or
Mohs
Radiation for:
Close margin specimen 1 cm were involved margins thick cannot be reexcised
Chemotherapy sensitive:
Imitinab
selective inhibitor of platelet derived growth factor (PD GF)
nevus sebaceous of Jadassohn most commonly associated with
Basal cell carcinoma
Developed during childhood
