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Dermatology > Skin Surgery > Flashcards

Skin Surgery Flashcards

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Dermatology Board Prep flashcards
1
Q

How will a skin biopsy be useful in a patient presenting with a rash?

A

Aids diagnosis

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2
Q

Why is a skin biopsy useful in a patient with a tumour?

A

assist in diagnosis
remove malignancy
remove unwanted skin growth

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3
Q

Would you excise a Basal cell carcinoma or a Dermatofibroma?

A

Basal Cell carcinoma

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4
Q

Do you normally excise basal cell papillomas or common melanocytic naevi?

A

No

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5
Q

Why may the biopsy of a rash not provide a diagnosis?

A

different skin conditions may have same histology
eg. different types of eczema look similar on histology

one cause of a skin condition can have several histology patterns
eg. drug eruption

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6
Q

Give examples of the various reactions which can occur as a drug reaction to amoxicillin

A 
morbilliform (measles like) eruption
urticaria
angiodema 
fixed drug eruption
generalised pustulosis
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7
Q

What treatments other than surgery can be used for skin cancers?

A 
Photodynamic therapy
cryotherapy
Chemo/Radiotherapy
5-fluorouracil
solaraze
Imiquimod
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8
Q

What factors must be considered before carrying out skin surgery?

A 
nature of procedure
medical Hx
drug Hx
bleeding disorder
allergies
other- pacemaker, valve defect, epilepsy, diabetes
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9
Q

Give examples of what parts of a patients drug history would alert you before starting a surgical procedure

A

STEROIDS - increased rate of infection post-op
- poor wound healing

ASPIRIN - increased bleeding rate from wound

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10
Q

What parts of the underlying anatomy should you be aware of when making a surgical excision on the face

A 
tiger country
eyelids 
hairline
vermillion
scalp
skin tension lines
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11
Q

What parts of the face are considered to be “tiger country?”

A

Temple - due to superficial temple artery

Front of ear - facial nerve through parotid gland

Side of neck - “Erb’s” point - nerves to ear and joining spinal accessory nerve to shoulder

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12
Q

What are the 5 layers of the scalp?

A 
S - skin
C - connective tissue
A - aponeurosis
L - Loose connective tissue
P - parietal bone
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13
Q

A patient presents with a 2 day history of pain over right side of forehead and nose followed by development of crusty vesicles in the same area. What is the suspected diagnosis?

A

Shingles in the ophthalmic division of the trigeminal nerve

CN V1

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14
Q

What cranial nerve is damaged if the patient complains of numbness over the middle of their cheek?

A

CN V2 (maxillary division)

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15
Q

What nerve is thought to be damaged if a patient presents having been previously well with no history of injury but then experiences sudden loss of movement on right side of his face?

A

Facial Nerve

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16
Q

What trauma of the jaw could interrupt the sensory nerve supply to the chin, and what nerve would be damaged?

A

Fracturing the mandible may interrupt the CN V3 nerve(mandibular division)

17
Q

How could you clinically test the motor function of the facial nerve? (CN VII)

A

ask the patient to:
frown
close eyes tightly

18
Q

What methods of local anaesthesia are available?

A

topical
local infiltration
nerve block
field block

19
Q

Give an example of a common drug used for local anaesthesia

A

lignocaine (lidocaine)

20
Q

In what situations would excretion of lignocaine (lidocaine) be reduced?

A

excretion reduced in liver, renal, cardiac failure, young and elderly

21
Q

What is the maximum safe dose of lignocaine (lidocaine)?

A

max safe dose: 50 ml 1% lignocaine with adrenaline

22
Q

Why is adrenaline added to local anaesthesia?

A

prolongs anaesthesia

reduces bleeding

23
Q

When should the use of adrenaline in local anaesthesia be avoided?

A

avoid in fingers and toes

avoid in patients with cardiac disease, and those on psychotropic drugs

24
Q

How do you make local anaesthetic injections less painful?

A 
relax patient
fine needle
omit adrenaline
neutralise acidity
massage skin
slow injection
subcutaneous injection
follicle opening
nerve blocks
25
Q

Why is it important for local anaesthetic to be a subcutaneous injection rather than into the dermis of the skin?

A

Dermis contains nerve endings

=> would be more painful

26
Q

What are the common complications of taking a skin biopsy?

A 
bleeding
wound dehiscence
infection
scarring
motor or sensory nerve damage
loss of function
27
Q

What alternative types of surgery are available

A 
laser
photodynamic therapy
dermabrasion
plastic surgery
Mohs micrographic surgery
28
Q

What is electro-surgery commonly used for?

A

haemostasis - stops bleeding

Tx of minor skin lesions eg. skin tags

29
Q

Describe the process of curettage and cautery

A

Local anaesthesia
curette to scrape off lesion
wound cauterised to stop bleeding
wound left to granulate and heal

30
Q

What are the advantages and disadvantages of curettage and cautery?

A

ADV:minimally invasive procedure

DISADV: pathology specimen does not accurately record the margins of the tumour

31
Q

What other locally invasive procedures are often used for skin lesions?

A

Shave excision

punch biopsy

32
Q

What are the advantages and disadvantages of a punch biopsy?

A

ADV:
quick
produces good wound edges
Only one suture required

DISADV:
difficult to judge depth
round holes do not always heal well
pathology sample may be too small

33
Q

Skin grafts are more cosmetically appealing than skin flaps TRUE/FALSE?

A

FALSE

skin grafts often display different tone and texture therefore don’t match

34
Q

Where do malignant melanomas commonly metastasise to?

A

Lung
Liver
Brain

35
Q

Why is it important to consider the anatomy of the eyelids when carrying out a surgical excision?

A

If the eyelids become damaged, eye can become damaged quickly by patient

36
Q

Why is the hairline an important anatomical part to consider when carrying out a biopsy?

A

important for cosmetic appearance

37
Q

Why is the scalp an important anatomical region to consider when taking a skin biopsy?

A

Extremely vascular therefore bleeds very easily

38
Q

Why is an excision performed in an elliptical shape and not a circle?

A

Round wound would pucker up

elliptical excision heals in a cosmetically acceptable fashion

ellipsis scars can be hidden in folds of skin much more easily

Dermatology (18 decks)

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