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ABSITE > soft tissue > Flashcards

soft tissue Flashcards

1
Q

hurley stages of HS

A

I. localized abscesses
II. sinus tracts
III. interconnected tracts

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2
Q

tx HS

A

I: topical clinda, benzoyl wash
II: PO doxy + rifampin + antiandrogenic, adalimumab refractory
+ III: wide excision with healing by secondary intention (no graft)

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3
Q

acute abscess HS

A

deroof (not “I&D”)

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4
Q

LRINEC

A

for NSTI; Na<135, Cr >1.6, glucose, Hgb<13.5, WBC>15000, CRP>150
6+ = NSTI sus
8 = dx

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5
Q

how long to observe for rabies?

A

10 days

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6
Q

erysipelas vs cellulitis

A

differentiated from cellulitis by its raised lesions with sharply demarcated borders between infected and normal skin
also GAS

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7
Q

merkel cell carcinoma

A

skin neuroendocrine cells > purplish nodule/plaque
test positive for neuron specific enolase, cytokeratin, neurofilmanet protein

resection with 1- to 2-cm margins and ***sentinel lymph node biopsy in clinically localized cases

metastatic workup before surgery for high-risk tumors should be considered. Positron emission tomography/computed tomography and magnetic resonance imaging would be appropriate choices for an initial staging approach.

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8
Q

melanoma dx

A

<2 cm: excisional Bx Tru Cut CNBx unless cosmetically sensitive (just then curative excision with margins)

> 2cm or cosmetically: incisioanl Bx w

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9
Q

stains for melanoma

A

S100 and HMB-45

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10
Q

melanoma scary depth?

A

6mm

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11
Q

melanoma clinically node positive

A

need FNA of node.
if positive, can do therapeutic dissection or neoadjuvant therapy

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12
Q

melanoma mgmt margins

A

5-mm margins for melanoma in situ
1-cm margins for invasive melanoma <1mm depth
1- to 2-cm margins for invasive melanoma 1 to 2 mm depth
2-cm margins for invasive melanoma depth > or equal to 2 mm.

Sentinel lymph node biopsy should be done for patients with melanoma of Breslow depth greater than or equal to 0.8 mm or less than 0.8 mm but with high-risk features such as ulceration or increased mitotic 2+, <42YO, lymphovascular invasion, head or neck region

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13
Q

Head and neck melanomas anterior to ear and above lip needs this in addition to SLNBx

A

superifical parotidectomy

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14
Q

postop melanoma surveillance MSLT2 trial

A

The Multicenter Selective Lymphadenectomy Trial 2 (MSLT-2),positive SLNBx followed by nodal ultrasounds every 4 months for the first 2 years, every 6 months for years 3 through 5, and then annually

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15
Q

ax node positive in melanoma?

A

need level I, II, and III nodes*****

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16
Q

worst prognosis for melanoma?

A

nodular type; bluish black

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17
Q

desmoplastic melanoma subtype; postop radiation?

A

Desmoplastic melanoma is the one subtype where radiation to the primary site has been shown to increase local control rates.

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18
Q

melanoma in situ or “thin lentigo maligna” mgmt

A

0.5 cm margins is OK

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19
Q

melanoma metastatic disease mgmt

A

First line: dacarbazine (first line)
also
Pembrolizumab PD-1 with ipilimumab (chemotherapy)

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20
Q

MC type of melanoma

A

superficial spreading (sun exposed)

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21
Q

where does acral lentiginous melanoma present?

A

African Americans; soles/palms/below fingernails

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22
Q

dermatofibrosarcoma protuberans (reddish firm nodule) factor that increases metastatic risk?

A

fibrosarcomatous change
(look for mets to LUNG if seen) – get CT chest

just resect and resect and resect if recurs locally (wide local excision)

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23
Q

pilonidal disease dx?

A

clinical alone.

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24
Q

sarcoma mgmt

A

NEOADJ or ADV RADIATION
+
RESECTION to microscopically negative margins and preservation of extremity function

preoperative radiation should be considered for larger tumors (more than 5 cm) and high-grade tumors to increase the chances of complete tumor resection, preservation of critical neurovascular structures, and limb salvage, and to improve margin negativity rates

no SNLBx (heme spread only)

sarcomas are chemosensitive typically. Chemotherapy (DOXORUBICIN) is typically reserved for certain and select cases of unresectable tumors, metastasis, or particularly chemosensitive subtypes

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25
Q

mgmt of sarcoma isolated mets

A

resect if palliative not indicatd

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26
Q

MC sarcoma

A

malignant fibrous histiosarcoma > liposarcoma

27
Q

chronic paronychia mgmt

A

topical steroids > nail plate removal.

28
Q

melanoma prognosis based on? recurrence base on?

A

prognosis based on Breslow
recurrence based on nodal disease (off SNLBx)

29
Q

I&D recurrence in pilonidal disease?

A

I&D 40% recurrence

30
Q

sarcoma initial diagnostic step?

A

IMAGING VIA MRI (because heterogenous and need to aim biopsy at most high grade spot; also r/o vascular/neuro/bone invasion)

then, Core Needle Bx > FNA (only use for recurrence)
excisional Bx if < 4 cm

31
Q

sarcoma staging based off of? AKA most important prognostic factor

A

GRADE.

32
Q

where does sarcoma met to? HEME

A

lungs

33
Q

NSTI type I
and type II

A

Type I: polymicrobial

Type II: mono microbial (S. pyogenes, C. perfrigens > Vibrio (eating touching oysters)

34
Q

Clostridium septicums association

A

colon cancer

35
Q

postop seroma prevention; vacuum closed drains; when to DC drain?

A

<30cc/day.

36
Q

pilonidal disease surgical management

A

only after I&Ds have failed
excision with primary repair
if still fails, needs flap: rhomboid (Limberg flap), Karydakis flap, and cleft-lift technique.

37
Q

mgmt of herpetic whitlow

A

observation and avoid contact; don’t incise the bed of the ulcer (systemic spread)

38
Q

decubitus staging

A

Stage 1: intact skin characterized by non-blanching erythema
Stage 2: partial thickness injury with loss of dermis. This may present as a shallow ulcer with (1) red or pink wound bed or (2) intact blister or bullae.
Stage 3: full-thickness skin loss with exposure of subcutaneous fat or tissue but no exposed muscle, tendon, or bone.
Stage 4: full-thickness skin loss with exposed muscle, tendon, or bone
Unstageable: lesions with overlying eschar or slough with indeterminable depth

39
Q

desmoid tumor (aggressive fibromatosis from fibroblasts)

A

get MRI first to characterize and need to STAGE it and biopsy.

small, asymptomatic: surveillance
if bigger, sx: surgical resection is indicated (high rate of recurrence)
If cannot resect: NSAIDs, tyrosine kinase inhibitors, hormonal therapy, or chemotherapy

40
Q

suspected basal cell carcinoma?

A

excisional biopsy

41
Q

Dysplastic nevus syndrome = familial atypical multiple mole melanoma FAMM:

A

AD disease >50 dysplastic nevi and family hx

42
Q

MC malignancy in US

A

BCC (4x SCC)

43
Q

pathology of basal cell carcinoma

A

peripheral palisading of nucleia nd stromal retraction

44
Q

basal cell carcinoma tx

A

resect with 0.3 to 0.5 cm margins or MOHS if high risk

45
Q

morpheaform type of basal cell carcinoma

A

most aggressive; produces COLLAGENASE

46
Q

squamous cell ca tx

A

5-10mm resection

47
Q

bowens disease

A

SCC in situ ass’d HPV

mgmt: imiquimod, cautery, topic 5-FU, avoid wide local excision
CTM with frequent bx to r/o cancer

48
Q

exceptions to margins for SCC

A

penile, vulvar, and Marjolin’s (burn) need 2 cm margins

49
Q

liposarcoma surveillance

A

stage I disease: physical exam every 3 to 6 months for 2 to 3 years and then annually. A CT chest>chest x-ray should be considered every 6 to 12 months.

stage II or stage III disease: seen every 3 to 6 months for clinical assessment for 2 to 3 years, then every 6 months for the next 2 years, and then annually. Imaging of the tumor site and chest is routinely performed.

50
Q

pilonidal disease abx indication

A

if cellulitis or immunocompromised (because otherwise just drain acutely)

51
Q

leiomyosarcoma mgmt

A

chemotherapy for metastatic
no radiation
surgical resection for R0

52
Q

what happens when scintigraphy identifies 2 nodal basins?

A

dissect both.

53
Q

superificial inguinal lymphadenectomy

A

= femoral triangle plut 5-7 cm above inguinal ligament
the adductor longus muscle medially
sartorius muscle laterally.
superior boundary is the inguinal ligament (need to clear above this)

54
Q

melanoma staging

A
55
Q

burn energy needs equation?

A

indirect calorimetry; determining resting energy requirements in complex patients

56
Q

kaposi sarcoma mgmt

A

HAART shrinks it
radiation or intralesional vinblastine for local
IFN-a for dissmeinated
surgery if intraabdominal bleeding

57
Q

rhabdomyosarcoma (vagina= botryoides tumor) is MC sarcoma in kids

A

embryonal more common; alveolar type worst prognosis]
think: Li Fraumeni syndrome

58
Q

rhabdomyosarcoma has whwat in path?

A

desmin

59
Q

rhabodmyoarcoma mgmt

A

surgery or doxorubicin chemotherapy

60
Q

neuromas association

A

think NF or von REcklinghausen dz (cafe au lait, axillary freckling, peripheral and CNS tumors)

61
Q

mgmt actinic keratosis

A

get an excisional bx to confirm then use diclofenac sodium and liquid nitrogen

62
Q

suppurative thrombophlebitis

A

IV abx x 4-6 wks

63
Q
A
64
Q
A

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