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Surgery > Skin, Soft tissue, Hernias > Flashcards

Skin, Soft tissue, Hernias Flashcards

0
Q

ABCDE of melanoma?

A

Asymmetry, border irregularity, color variation, diameter (> 0.6 cm), dark black color, evolution

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1
Q

key PE findings of malignant melanoma?

A

Ulceration, bleeding, changes in size/pigmentation

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2
Q

LN eval in melanoma?

A

Yes

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3
Q

BCC margins?

A

2-4 mm for large/aggressive lesions

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4
Q

Any other tx for BCC?

A

Can give topical 5-FU or radiation

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5
Q

More likely to met to LN: BCC or SqCC?

A

SqCC

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6
Q

Bowen’s disease

A

SqCC in situ

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7
Q

SqCC margins?

A

1 cm

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8
Q

In situ melanoma margins?

A

0.5-1 cm

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9
Q

What is a dysplastic nevus?

A

transition b/w benign and malignant

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10
Q

Staging of melanoma?

A

Breslow thickness

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11
Q

Breslow thickness categories?

A 
< 0.75 mm = T1
0.75 - 1.5 mm = T2
1.50 - 2.50 = T3
2.50 - 3.50 = T3
> 4.0 = T4
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12
Q

Melanoma work-up?

A

CBC, LFTs, CXR

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13
Q

T0 margins?

A

1 cm

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14
Q

T2 margins?

A

2 cm, LN removal if palpable (or Sentinel LN bx)

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15
Q

T4 margins?

A

2-3 cm and will likely die from mets + CT abdomen + MRI brain + Interferon

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16
Q

How does ulceration affect TNM?

A

Adds +1 to T

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17
Q

5 cm lentigo maligna melanoma: management?

A

tends to be superficial and spreading rather than invasive –> excision w/ narrower margin (if on face)

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18
Q

5 cm lentigo maligna (Hutchinson freckle)

A

precursor lesion; observation

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19
Q

Acral lentiginous melanoma

A

MC in dark-skinned individuals; tend to be thicker and associated w/ poorer prognosis

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20
Q

Subungual melanoma

A

Bx –> reexcision involves amputation of distal interphalangeal joint

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21
Q

Anal melanoma. Prognosis? Common location? Tx?

A

Poor prognosis; near 100% mortality at 5 yrs; dentate line; abdominoperineal resection of anorectum

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22
Q

SBO w/ hx of malignant melanoma?

A

Melanoma has unique propensity to met to peritoneal cavity and commonly causes SBO; poor prognosis

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23
Q

Hx of therapeutic radiation and axillary LAD now w/ firm, PAINLESS mass on anterior thigh

A

Sarcoma; # of mitotic figures and degree of necrosis

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24
Q

Common met sites for sarcoma?

A

Liver, lung, bone, brain

25
Q

Staging of sarcoma?

A

AP CT, plain CXR +/- chest CT

26
Q

Post-op management of sarcoma?

A

Radiation therapy for high-grade sarcomas; adjuvant therapy in low-grade

27
Q

Is there a benefit to excision of sarcoma lung mets?

A

Yes, significant long-term disease-free intervals

28
Q

Which hernia type goes posterior to the inguinal ligament?

A

Femoral hernia

29
Q

More medial hernia mass - type?

A

Direct

30
Q

More lateral hernia mass - type?

A

Indirect

31
Q

Hernia most likely to strangulate?

A

Femoral (up to 50%)

32
Q

Difference between direct and indirect hernia?

A

Indirect usually has intact posterior surface (floor of canal) and originates at internal ring

Direct, weakness in floor of canal, originates medially to inferior epigastric vessels

33
Q

Conditions that could cause a direct hernia?

A

Obesity, COPD, ascites, BPH (bladder outlet obstruction), colon or rectal obstruction (tumors, constipation)

34
Q

Indications for hernia repair?

A

Strangulation/incarceration, narrow neck, femoral hernia, local pain, enlargement, inability to lift, pt preference

35
Q

Surgical options for hernia repair?

A

Open and laparoscopic

36
Q

Types of Open repairs?

A

Bassini, Cooper’s, Shouldice, Lichtenstein

37
Q

Bassini repair … ?

A

reconstruction of posterior inguinal canal, suturing of superior abdominal wall (internal oblique, transverses abdomens, transversalis fascia) to inferior location on inguinal ligament

38
Q

Where is the weakness in a direct hernia?

A

Transversalis fascia

39
Q

Advantage of Bassini? Disadvantage?

A

Low recurrence. Weakness is tension it places on structure and with poor tissue it’s likely to fail

40
Q

Cooper’s repair (McVay) … ? Better for which type of hernia?

A

Similar to Bassini except inferior sutures places on Cooper’s ligament (periosteum of pubic rams). Femoral and attenuated inguinal ligaments

41
Q

Most hernia repairs are what?

A

Attach transversalis fascia to inguinal ligament or periosteum of pubic rams

42
Q

Shouldice repair … ?

A

Attaches reinforced transversalis fascia to inguinal ligament in two layers

43
Q

Lichtenstein repair … ?

A

prosthetic mesh to superior abdominal wall and inguinal ligament … creates tension on fascial structures … very popular

44
Q

Types of laparoscopic repairs?

A

Transabdominal preperitoneal, Totally extra peritoneal

45
Q

Transabdominal preperitoneal repair … ? Complications?

A

mesh attachment to floor of inguinal canal from w/in abdominal cavity … general anesthesia and adhesions

46
Q

Totally extra peritoneal repair … ?

A

balloon inflation + mesh

47
Q

Key complications of hernia repair?

A

Genitofemoral nerve, ilioinguinal nerve, iliohypogastric nerve, lateral femoral cutaneous nerve injuries –> sensory defects

Recurrence depends on type of procedure and surgeon

Testicular atrophy, edema, ischemia rare

Wound infecition/hematoma < 1%

48
Q

Post-op management of Lichtenstein ?

A

Avoid lifting for 6 weeks (wound will have regained 75-90% final strength) w/ then gradual progression to full lifting

49
Q

Important landmarks to ID during hernia repair?

A

Ilioinguinal nerve and spermatic cord

Ilioinguinal nerve = anterior to external oblique
Iliohypogastric = posterior to external oblique, anterior to internal oblique
Genitofemoral = lateral in same plane to iliohypogastric

50
Q

Where does the ilioinguinal nerve run to?

A

Testis w/ external spermatic nerve

51
Q

Difference between an adult and pediatric inguinal hernia?

A

Pediatric hernias involve NO DEFECT in floor of inguinal canal –> INDIRECT

52
Q

Cause of most pediatric hernias?

A

Persistent patent processus vaginalis

53
Q

High incidence of unilaterality or bilaterality in pediatric hernias?

A

Bilaterality

54
Q

Pediatric hernia repair operation?

A

High ligation of the hernia sac w/ no abdominal wall repair (no defect present)

55
Q

Boundaries of a femoral hernia?

A 
Anterior = iliopubic tract (reflection of inguinal lig.)
Posterior = Cooper's lig. (Pubic ramus)
Medially = pubic tubercle
Laterally = femoral vein
56
Q

What structures must you be careful to avoid during an inguinal hernia repair?

A

Bladder, cecum, sigmoid, ovary, appendix

57
Q

Richter hernia?

A

Protrusion of a portion of intestine into wall of hernia sac

58
Q

Littre hernia?

A

Protrusion of a Meckel diverticulum into wall of hernia sac

59
Q

What can make ventral hernia repairs more difficult?

A

inadequate tissue strength, insufficient tissue, infection, poor nutrition .. mesh carries infection risk

Surgery (7 decks)

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