Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Derm > Surg > Flashcards

Surg Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

Mustarde rotation flap

A

Cheek rotation flap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute side effects of ray

A

Radiodermatitis: erythema dry desquamarion and moist desquamatoon
Mucositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic side effects from ray

A 
Atrophy 
Loss of appendages: alopecia and anhidrosis 
Hyper or hypo pigmentation 
Telangiectasia 
Ulceration

Secondary malignancy 1/1000-2000 risk, average 24 years later: BCC SCC AFX MFH fibrosarcoma angiosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List all possible treatment of cutaneous tumors

A 
Mohs 
Excision 
Cryotherapy
Radiation therapy
C&C
Intralesional interferon, 5-fu, methotrexate
PDT
Ablative laser
Topical 5FU and ingenol and imiquimod 
Vidmodegib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal bread loafing of histo examines what % of tumour margins

A

Less than 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

5 year cure rate mohs vs excision

A

Mohs 99%

Conventional 93%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5 year cure rate for recurrent cancers Mohs vs excision

A

Mohs 95%

Excision 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cancers on ear make up what % of cutaneous cancers

A

6% but high recurrences likely due to embryonic fusion planes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Post auricular tumors spread where

A

The ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pre auricular tumors spread where

A

Towards the tragus and medial and superior aspects of the helix. Once at tragus can spread down the external part of tragus between tragar cartilage and parotid gland to deeper like facial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which site most common recurrence for BCC

A

Nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications for Mohs

A 
Recurrent
Positive margin
High risk for recurrence or mets 
Sites that require tissue conservation 
Embryonic fusion planes: peri orbital (medial canthi), nasal, lips, ears, retroauricular sulcus, melolabial folds
Poorly defined clinical margins
PNI
>2 cM
Immunosuppressed 
Previous ray treatment
Demonstrated biological aggressiveness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sites where tissue conservation is important

A 
Eyelids
Ears
Nose
Lips
Digits
Hails
Genitalia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Best site for cure rate for Mohs on penis

A

Glans or prepuce, <1 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Supplements that make you bleed

A

Vitamin E
Gingko biloba
Garlic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ways to identify where the tumour is on the skin

A 
Magnification 
Dermoscopt
Woods light
Curette lightly
Ask patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What angle do you have blade in Mohs

A

30-45 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What kind of specimen is best in Mohs

A

Saucer shaped with 30 degree beveled edges so it can be flattened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What size specimen can fit on a microscope slide

A

0.5-1.5 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you number the edges of tissue specimens in Mohs

A

Clockwise, starting at one o clock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is a Mohs specimen cut

A

Horizontal sections from the deep surface first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you freeze Mohs specimens with

A

Tetrafluorethylchloride

Liquid nitrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What intervals of sections are sliced in Mohs

A

4-8 um

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What stains do you use in Mohs

A

After sliced, stain with H&E, sometimes toludine blue
After gone through slide drainer than rinse and use a clear mounting medium: Cytosdal-60 or similar

Other stains to help with diagnosis
MART1
Cytokerstin
CD34 for DFSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What % of tissue shrinkage from frozen section processing

A

10-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If tumour involved eyelid margin how should you protect the eye

A

Lubricated plastic eye shield after topical Anaesthetia of tetracain Ophthal drops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which instruments are good for perinocular excisions

A

Castro Viejo needle driver

Westcott scissors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patients with high risk of IE who need prophylactic abx

A

Prosthetic cardiac valve
Previous IE
Unrepaired CHD or repaired with prosthetic within 6 m of procedure
Repaired CHD with residual defects
Cardiac transplant recipients with valvulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patients at high risk of joint infection

A 
Joint replacement within last 2 years
Previous prosthetic joint infection 
Immunocompromised
T1 DM
HIV
Malignancy
Malnourishment
Haemophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Sites of high risk of surgical infection

A 
Wedge on lip or ear
Genitalia
Below knee
Skin flap on nose
Skin grafts
Extensive inflammatory disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Aldabra response rates for BCC

A

Superficial 87%

More invasive 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

BCC most important predictor of sub clinical spread a part from agresiva histo

A

> 2.5 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

BCC margins excision versus Mohs

A

<2 cm 4 mm margin clears 95% in excision

Mohs <1 cm 99.9%, 1-2 cm 99.3%, 2-3 98 and >3 84.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Recurrent BCC excision versus Mohs

A

Excision 12.1% recurrent at 5 years

Mohs 2.4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Facial BCC excision versus Mohs

A

Mohs 2.5

Excision 4.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Basosquamous recurrent Mohs versus excision

A

Mohs 4.1

Excision 12-45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What % of BCC become metastatic

A

<0.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Biologically aggressive SCCs

A

Cystic
Clear cell carcinoma
Adenoid SCC
Spindle cell SCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Risk of PNI in SCC

A

<2.5 cm 11 %

>2.5 cm 64%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Margins for SCC excision

A

4-6 mm depending on risk

41
Q

Recurrent SCC Mohs clearance rates

A

94%

42
Q

Verrucous carcinoma rates Mohs versus excision

A

Excision 80

Mohs 98

43
Q

Merkel CC recurrence, nodes and Mets rates

A

Recurrence 30%
Regional LN 50%
Mets 40%

44
Q

Merkel cell carcinoma clinical margins

A

1-2 cm

45
Q

Treatment of choice for DFSP

A

Mohs - no recurrence

Imatinib - tyrosine kinase inhibitor for Mets

46
Q

AFX margins

A

1 cm

47
Q

MAC recurrent rates

A

Excision 50%

Mohs 10%

48
Q

Eccrine porocarcinona - appropriate for Mohs?

A

Well it has skip areas

Also it’s radio resistant

49
Q

Is sebaceous carcinoma appropriate for Mohs

A

CAn have skip lesions and recognizing pagetoid spread may be tricky

50
Q

DFSP margins

A

<2 cm 1.5 cm

Larger 2.5 cm

51
Q

When is adjuvant radiation usually performed

A

Witihin 4-8 weeks post operatively

52
Q

What is the usual total dose of radiation over how many fractions

A

50-55 gy over 20 daily fractions

53
Q

What is the preferred treatment of choice for rad onc treating keratinocyte cancers

A

Electron beam radiotherapy

54
Q

What is the radiation threshold dose that predisposes eyes to cataracts

A

5-10 gray

55
Q

Acute reactions from radiation

A 
Erythema
Dry and then moist desquamation
Dyspigmentation
Ulceration, haemorrhage
Pruritos
Temporary alopecia
Temporary loss of fingernails or toenails
Temporary hypohidrosis
Mucositis

Suspect infection if not healing

56
Q

Late reactions from radiation

A 
Telangiectasias 
Fibrosis 
Necrosis of soft tissue, cartilage, bone 
Dyspigmentation
Permanent alopecia
Hypohidrosis, sweat gland atrophy
Xerostomia 
Delayed wound healing
NMSC ~20 yrs later
57
Q

Success % with radiation usually

A

~90%

58
Q

Ideal tumour size for TEBR

A

< 5 cm diameter, <0.5 cm depth

59
Q

Ideal tumour size for Brachytherapy (both surface and interstitial) radionuclide

A

<2 cm diameter and <0.5 cm depth

60
Q

Ideal tumour size for superficial ray

A

<5 cm diameter and <0.5 cm depth

61
Q

Contraindications for radiation

A

Absolute: genoderm Gorlins, XP

Relative:
AICTD - lupus, scleroderma (Bolognia says this is absolute)
Poorly vasculairsed 
Chronic ulceration 
Trauma 
Thermal burns 
Prior radiation
Deeply invading into the cartilage
Extremities: foot, anterior lower leg, dorsum of hand
<50-60
62
Q

When to do adjuvant radiation for BCC

A

Substantial perineural involvement: >0.1 mm in caliber or >3 nerves, or positive margins

63
Q

When to do adjuvant radiation for SCC if clear margins

What margins

A

if substantial peri neural involvement, larger than 0.1 mm or invasion of nerve below the dermis

Also for nodal mets to the head and neck, unless the patient has 1 small node with no extracapsular extension
Most treated with 1-1.5 cm margin

64
Q

What is the first and second line treatment for DFSP now

A

WLE first
Imatinib second
Radiation is third now and you do a wide field 3-5 cm

65
Q

Can you use radiation treatment for MCC

A

Yes - its recommended as adjuvant regardless of positive or negative margins
Recommend doing within 4 weeks after surgery
The excision site, in transit tissue and draining nodal basins are irradiated to account for subclinical disease UNLESS the primary tumour is <1 cm, negative post operative margins are obtained, no lymphovascular invasion, and SLNB is negative

66
Q

What sort of radiation field for MCC

A

5 cm

67
Q

Common cx post radiation for Kaposi

A

Lymphoedema

68
Q

When to do radiation for melanoma

A

Definitive: large facial lentigo maligna not amenable to surgery - 1-1.5 cm margin

Adjuvant:
Post operatively desmoplastic
LN mets

Stereotactic: CNS mets

Palliative for cutaneous mets, in transit disease etc

69
Q

When to do radiation for UPS

A

Always - post operaatively whether negative or positive margins

70
Q

What is the concern of radiation with systemic therapies for melanoma

A

BRAF and MEK inhibitors may lead to increased toxicity when used with RT - so hold at least 3 days before and after fractionated RT

71
Q

Risk of BCCs and SCCs from radiation (according to bolognia)

A

2% and 1.5% respectively

72
Q

How to deal with a haematoma post op

A

<48 hours large bore needle 16-18 gauge aspiration
>48 hours irrigation

If liquefied (7-10 days) then can needle aspirate

73
Q

When does a haematoma liquefy

A

7-10 days post op

74
Q

Most common timeframe for surgical site infections

A

4–10 days

75
Q

Risk of transformation of individual AK to invasive SCC is what at 5 years

A

2.88%

76
Q

Action spectrum of 8 mop

A

330-335

77
Q

Maximum EMLA dosage

A

0-3 m: 10 cm2 for 1 hour
3-12 m: 20 for 4 hrs
1-6 yes: 100 for 4 hrs
7-12: 200 for 4 hrs

78
Q

Nasal tip side to side closure can do for defects less than what

A

8 mm

79
Q

Max size for dorsal nasal rotation

A

2-2.5 cm

80
Q

with myocutaneous flap incise down to where

A

lateral to subcut fat

medial to periosteum

81
Q

where should you put the peng flap

A

supra tip best site

82
Q

width of paramedian flap

A

1.2-1.5 cm

83
Q

blood supply for nasolabial interpolation

A

random

84
Q

size for composite graft

A

<1 cm

85
Q

principles of the transposed island pedicle

A

draw and ellipse lateral to the defect
undermine distal 3/4 in fat, then swing deeper into muscle to create fat/mm island pedicle
undermine widely
swing around 45-90 degrees

good for deep defects

86
Q

shark island pedicle sutures

A

1st: back of shark to nasofacial sulcus - this should make head and snout drape down into defect
second: snout down to inf border of defect

87
Q

with second intention healing how much contraction occurs/decrease in size

A

30%

88
Q

second intention how long will have open wound

A

4-6 weeks

89
Q

three best closures for nasal dorsum defect

A

peri alar unilateral single sided advancement flap
SCIP
back cut rotation (dorsal nasal rotation essentially)

90
Q

Nasolabial advancement flap - design and where to put sutures

A

Design: inferomedial aspect of defect around alar crease and down nasolabial fold

Sutures:

  1. Pex middle of flap at NF sulcus, pull superomedially
  2. 1/2 cm behind advancing corner of flap to periosteum under superior edge of defect
91
Q

Nasolabial advancement flap negatives

A

Can lower eyelid
Blunting of nasofacial sulcus
Elevation of alar rim
Webbing of medial canthus

92
Q

Rules for back cut rotation flap

A

Surface area of flap needs to be twice the size of the defect
Angle of inverse V should be 30-45 degrees
Undermine above procerus and corrugator supercilli
Close glabella defect first, then close the primary defect

93
Q

If do side to side on lateral forehead, what is the size of the defect

A

<1 cm to ensure no lateral eyebrow elevation

94
Q

Rotation flap general principle regarding area of flap within the arc compared to defect

A

2-3 times the size of defect

95
Q

how long does it take for eyebrow hairs to re grow

A

4 months

96
Q

when in the eyebrow, what considerations for surgery

A

undermine beneath the hair bulb
medial eyebrow hairs grow vertically
lateral eyebrows grow horizontally
make sure to incise parallel to the hair shafts

97
Q

Best closure for the eyebrow

A

O to U or O to H or SCIP
Do O to U if medial or lateral
O to H if in centre of eyebrow

98
Q

DCP initial

A

2%
4X4 cm area
Photoprotect

99
Q

What is the trigeminocardiac reflex

A

Operating in trigeminal nerve - ophthalmic and maxillary branch, trigeminal nerve connects with trigeminal nucleus - links with motor nuclehys of vagus nerve
Results in bradycardia, hypotension, asystole, apnoea, death

Derm (57 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions