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DERMATOLOGY > Surgery > Flashcards

Surgery Flashcards

1
Q

What nerves innervate the conchal bowl?

A

CNVII, IX, X

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2
Q

A ring block around the entire ear will numb the whole thing except:

A

concha AND external auditory canal

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3
Q

Innervation of the majority of the posterior ear

A

Greater auricular nerve

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4
Q

What nerve is damaged in Frey syndrome?

A

Auriculotemporal nerve (a branch of the mandibular nerve)

Frey syndrome is also called auriculotemporal nerve syndrome which is facial flushing, sweating in response to gustatory stimuli - usually and injury of the parotid nerve

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5
Q

What chemical does Botox prevent the release of?

A

Acetylcholine from the presynaptic terminal

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6
Q

Which part of the Botox protein binds to SNAP25? Heavy chain or light chain?

A

Light chain

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7
Q

What does the heavy chain of Botox do?

A

Binds to the axon terminal

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8
Q

SNAP25 is what type of protein?

A

A SNARE Protein

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9
Q

Which serotypes is SNAP/SNARE cleaved by? (A-E)

A

A & E

VS VAMP which is cleaved by B,D,F,G

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10
Q

Which type of neurotransmitter does Botox block - sympathetic or nonsympathetic?

A

Acetylcholine so it is sympathetic

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11
Q

Property of lasers in which the light waves travel in PHASE together

A

Coherence

Vs collimation which means the light waves travel in parallel. Together these two properties give a laser its ability to be precise

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12
Q

Property of lasers in which light waves travel in parallel to each other

A

Collimation

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13
Q

The emission of ONE well-defined wavelength, rather than a band or variety of wavelength

A

Monochromicity

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14
Q

What is the Fresnel reflectance property?

A

The property of skin that causes 4-7% of light to be reflected because of the difference in the refractive index of the stratum corneum and the Aires

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15
Q

What is the absorption coefficient in the skin? And what does it depend on

A

The absorption coefficient is the probability of a photon being ABSORBED (rather than reflected or scattered) by its target chromophore. And it depends on the CONCENTRATION OF CHROMOPHORES present

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16
Q

Name the three primary skin chromophores

A

Water, melanin, hemoglobin

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17
Q

Name the spectrum of light that melanin absorbs photons in?

A

Broadly across the visible and UV spectrum

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18
Q

Name the spectrum of light that hemoglobins absorb photons in?

A

UV, and specifically green, blue, and yellow regions

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19
Q

Name the spectrum of light that Water absorbs photons in?

A

Infrared spectrum

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20
Q

Name the spectrum of light that the chromophores absorb photons in:
Melanin
Hemoglobin
Water

A

Melanin - Broad UV, Visible light
Hemoglobin - UV, Green, Blue, Yellow
Water - Infrared

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21
Q

Name the wavelengths of the most deeply penetrating lasers

A

650-1200nm

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22
Q

What is the cut-off wavelength when a laser switches from being deep penetrating to superficial

A

1200nm

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23
Q

The least penetrating wavelengths are within which spectrum?

A

Far Infrared and far UV spectrums

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24
Q

Two most superficially penetrating lasers

A

Erbium Yag

CO2 laser

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25
Q

Which type of collagen gets melted during laser therapy?

A

Type I collagen

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26
Q

Definition of thermal relaxation time

A

The time it takes a heated tissue to cool to HALF of its original temperature

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27
Q

What is the relationship between the size of a tissue and it’s thermal relaxation time

A

Thermal relaxation time is equal to the square of the target dimension (in millimeters)

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28
Q

The optical pulse duration in photothermolyis is equal to what:

A

The Thermal relaxation time (TRT)

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29
Q

Name the two most common continuous wave lasers (vs pulsed)

A

Argon and NG:YAG

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30
Q

Peak absorption of oxyhemoglobin

A

577nm (within yellow spectrum)

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31
Q

Wavelength of PDL laser

A

560-600nm

*b/c PDLs are used to treat vascular lesions, and oxyhemoglobin’s peak absorption spectrum is 577nm

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32
Q

Deepest penetrating laser and its absorption wavelength

A

Nd:YAG 1064nm

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33
Q

Wavelength of PDL laser

A

560-600nm

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34
Q

Wavelength of Nd:YAG laser

A

1064nm (deepest penetrating laser, good for dermal vessels)*

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35
Q

Wavelength of Alexandrite laser

A

755nm

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36
Q

Best kind of lasers for treating pigmented lesions and tattoos

A

Q switched lasers (like Q-switched Ruby and Alexandrite)

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37
Q

Q-switched ruby & Alexandrite lasers are useful for removing what kind of lesions?

A

Pigmented nevi & black/green tattoo pigment

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38
Q

Deep black tattoos and dermal melanocytic nevi (like Nevus of Ota) are best treated with which laser?

A

Q switched Nd:YAG

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39
Q

Q switched Nd:YAG laser is used to treat what

A

Deep black tattoos (Dermal involvement)
&
Dermal melanocytosis (like Nevus of Ota)
*b/c Nd:YAG laser is 1064nm, the deepest penetrating, down to dermis

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40
Q

Which laser creates thousands of micro thermal treatment zones in the epidermis and dermis

A

Fraxel (fractional photothermolysis)

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41
Q

How does Fraxel work?

A

Creates thousands of microthermal treatment zones

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42
Q

Highest risk of blindness with which kind of lasers

A

Near-Infrared Q-switched lasers

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43
Q

What kind of media is a PDL laser?

A

Liquid media (rhodamine dye)

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44
Q

Name two lasers with Gas media?

A 
CO2 laser 
Xenon chloride (excimer laser)
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45
Q

To achieve selective photothermolyis, do you want your pulse duration to be less than or greater than your thermal relaxation time (TRTs)?

A

You want you pulse duration to be LESS THAN your TRT

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46
Q

Continuous laser is low or high power?

A

Continuous laser is low power, pulsed laser is high power

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47
Q

Name some examples of continuous wave lasers

A

CO2, argon

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48
Q

Which types of lasers have the shortest TRTs (thermal relaxation times)

A

Q-switched lasers

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49
Q

What percentage of light is reflected off the skin? (As opposed to absorbed or scattered)

A

4-7%

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50
Q

How do you decrease the amount of scatter and therefor increase the amount of absorption in your laser treatment?

A

Increase the spot size

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51
Q

How is epidermal damage minimized during laser treatment?

A

Skin cooling

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52
Q

Parallel cooling is only effective in lasers with a pulse duration greater than what time?

A

> 5ms

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53
Q

Lasers in the UV range (ex: excimer) cause damage to what part of the eye?

A

Lens, causes cataracts

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54
Q

What is essentially the only laser in the UV range?

A

Excimer laser 308nm

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55
Q

Lasers that target melanin or hemoglobin (visible light and/near infrared) damage what part of the eye?

A

Retina (highly pigmented), uvea and iris

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56
Q

What is the difference between monochromicity and coherence?

A

Monochromicity is light that is all ONE wavelength

Coherence is the property of all the wavelengths traveling in PHASE together

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57
Q

Any laser that targets water can cause damage to what part of the eye

A

Cornea/sclera

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58
Q

Greatest fire hazard for which lasers

A

CO2 & Erbium:Yag

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59
Q

Pulse width is the same thing as

A

Pulse duration

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60
Q

How can you increase the depth of penetration

A

Increase the spot size (this will decrease the scatter somehow)

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61
Q

Least penetrating wavelengths

A

Far UV and far IR

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62
Q

What happens if the pulse duration is greater that the TRT?

A

Undesired damage of surrounding tissues

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63
Q

What is the primary mechanism of vessel rupture with PDL

A

CAVATATION

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64
Q

Which have the smallest thermal relaxation times and therefore need the shortest Pulse duration times/pulse width:
Tattoo ink/melanosome
Vessels
Hair follicles

A

Tattoo ink and melanosome for pigmented nevi

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65
Q

What part of the eye does PDL damage?

A

The retina (bc it targets oxyhemoglobin and melanin, and the retina has a high melanin concentration)

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66
Q

Laser treatment of choice of Poikiloderma of Civatte

A

IPL

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67
Q

What is the treatment of choice for leg veins?

A

Long pulsed Nd:YAG laser (because it penetrates deeper)

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68
Q

Treatment of choice for erythrotelangiectatic rosacea

A

IPL or long pulse Nd:YAG

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69
Q

What is the target for laser hair removal

A

Melanin in the hair shaft (bulb and bulbar stem cells)

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70
Q

Most efficacious laser to use for laser hair removal

A

Diode (but comes with a greater risk of post inflammatory hyperpigmentenation in aa persons)

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71
Q

Best laser to use for hair removal in darker skin types

A

Nd:Yag 1064nm (but this is not the most efficacious, Diode laser is)

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72
Q

Resurfacing lasers target what chromophore

73
Q

Site of eye damage in resurfacing lasers

A

Cornea/sclera (because the target chromophore is water)

74
Q

What is the desired immediate endpoint of tattoo removal and what is it due to?

A

Immediate tattoo whitening, and this is accomplished by CAVITATION (the same concept as ablative blood vessels)

75
Q

What kind of laser do you want to use for tattoo removal? (Long wavelength, continuous, pulse-dyed, Q-switched)

A

Q-switched - because you need the short pulsed powerful one

76
Q

Which two lasers are the only ones that can treat green tattoos

A

Ruby and alexandrite

77
Q

Which three lasers treat the three B’s of tattoos?

A

Ruby, Alexandrite, and Nd:YAG treat the three B’s (black, brown, blue)

78
Q

Which type of laser can treat Yellow, white, red or violet

79
Q

Nd:YAG cannot treat what color of tattoo?

80
Q

Name some examples of ablative lasers & non ablative lasers

A

Ablative- Er:YAG, CO2

Nonablative- PDL, Nd:YAG, Diode, IPL

81
Q

Psoriasis can be treated with what kind of laser?

A

Excimer laser (308 nm) makes sense bc nbUVB is 311-312

82
Q

Depth of Excimer laser

83
Q

Depth of Argon laser

A

500nm (488-514nm)

84
Q

KTP laser

85
Q

PDL wavelength

86
Q

Ruby laser wavelength

87
Q

Alexandrite wavelength

88
Q

Diode laser wavelength

89
Q

Nd:YAG wavelength

90
Q

Erbium:Gas wavelength

91
Q

Erbium:YAG wavelength

92
Q

CO2 laser wavelength

93
Q

Brand Name for Poly-L-lactic acid filler

94
Q

What type of material is Sculptra

A

Poly-L-Lactic acid filler

95
Q

Zyderm is what kind of filler material

A

Bovine collagen

96
Q

Polymethyl-methacrylate beads and bovine collagen combine to make what kind of filler?

A

Artefill (permanent filler)

97
Q

Permanent filler is made of what kind of material?

A

Poly-methyl-mecacrylate (ArteFill)

98
Q

Zyplast is what kind of filler?

A

Bovine collagen

99
Q

Radiesse is what kind of filler?

A

Calcium hydroxyapatite

100
Q

What area of the face runs the highest risk of injection necrosis

A

Glabellar region

101
Q

Highest risk for anaphylaxis with which filler?

A

Bovine collagen (Zyplast, Zyderm)

102
Q

Which filler can you see on X-ray films?

A

Radiesse (Calcium hydroxyapetite) it is radio-opaque*

103
Q

Used in HIV lipoatrophy

A

Sculptra (Poly-L-lactic acid)

104
Q

What property of HA fillers increases the durability of the structure?

A

of crosslinks

105
Q

Name the brand name for each filler substance:
Poly-L-lactic acid
Calcium-hydroxyapetite
Bovine collagen
Polymethyl-methacrylate and bovine collagen
Hyaluronic Acid

A 
Poly-L-lactic acid: Sculptra
Calcium hydroxyapetite: Radiesse
Bovine collagen: Zyderm/Zyplast
PMMA/Collagen: Aretfill
Hyaluronic Acid: Juvederm, Restylene
106
Q 
Name the substance found in each filler:
Sculptra
Radiesse
Zyderm/Zyplast 
Artefill
Juvederm/Restylene
A 
Sculptra: Poly-L-lactic acid 
Radiesse: Calcium-hydroxyapetite
Zyderm/Zyplast: Bovine Collagen
Artefill: Polymethylmethacrylate/collagen
Juvederm/Restylene: Hyaluronic acid
107
Q

Superficial vein causing varicose veins

A

Small and great saphenous vein

*vs femoral and politeal veins which are deep veins

108
Q

What is the temperature required to destroy keratinocytes (with LN2)
How about melanocytes?

A
  • 40 to -50C to kill keratinocytes

- 5C to kill melanocytes

109
Q

Laser of choice for facial telangiectasias

A

KTP OR PDL

*KTP more for spider telangiectasias?

110
Q

Eye damage with IPL

A

Retina, iris, uvea

111
Q

What are the components of Jessners

A

JESSER IS A LESR

Lactic acid
Ethanol
Salycilic acid
Resorcital

112
Q

What angle do they place the follicular units during hair transplant?

A

30-45 degree angles

113
Q

How many hairs is in one follicular unit

114
Q

What treatment do you give pregnant women for treatment of:
RMSF
Lyme disease

A

RMSF: Chloramphenicol

Lyme disease: Amoxicillin

115
Q

Which branch of the trigeminal nerve (V) has both sensory and motor functions?

A

V3 (Mandibular branch) does motor to muscles of mastication and sensory to the lower face

116
Q

Boiling point for liquid nitrogen

A

-196 degrees Celsius

117
Q

What artery supplies the paramedian forehead flap?

A

Supratrochlear

118
Q

What artery anastomoses the internal and external carotid arteries?

A

Infraorbital artery (branch of the external to the maxillary

*Also the dorsal nasal artery (internal carotid) eventually anastomoses wtih the facial (angular) artery

119
Q

What artery does the angular artery come from?

A

The facial artery! (External carotid)which also supplies the labial arteries

120
Q

What material are suture coated with now to provide antibiotic properties

121
Q

Natural sutures are absorbed by : proteolysis or hydrolysis?

Vs synthetic sutures?

A

Natural sutures absorbed by PROTEOLYSIS

Synthetic sutures absorbed by HYDROLYSIS

122
Q

Longest lasting absorbable suture

123
Q

Highest initial tensile strength suture

124
Q

Which carotid artery supplies most of the face, the external or the internal?

A

The external! Supplies the mid and lower face

125
Q

Which branch of the internal carotid is responsible for most of th facial arteries on the mid and upper face?

A

Ophthalmic artery

126
Q

The dorsal nasal artery (internal carotid) anastomoses with what external carotid artery?

A

The angular artery of the facial artery

127
Q

Most high risk area for filler, and why?

A

Glabellar area, because can inject the supratrochlear artery or its branches and cause BLINDNESS

128
Q

The forehead, lateral temporal, frontal and periocular areas drain lymph into which specific set of nodes?

A

Upper jugular nodes

129
Q

Motor nerves of the face run superior or inferior to the SMAS?

A

Inferior to the SMAS! Why you need to stay above the SMAS when dissecting on the face

130
Q

Sensory nerves of the face are supplied almost entirely by which nerve?

A

Cranial nerve V - Trigeminal nerve

*motor innervation by Cranial nerve VII- Facial nerve

131
Q

If you accidentally inject lidocaine into a supratrochlear, supraorbital foramen, your whole face will be numb with the exception of what areas?

A

The angles of the mouth and parts of the nose

132
Q

What nerve does Hutchinson’s sign affect?

A

Nasociliary branch of the Opthalmic (V1) cranial nerve

133
Q

Frey syndrome occurs when what nerve is damaged?

A

Auriculotemporal branch of V3 (Mandibular)

*this is bc provides parasympathetic innervation to the parotid gland

134
Q

Name the nerves:

  1. Frey Syndrome
  2. Hutchinson’s sign
A
  1. Freys syndrome - auriculotemporal nerve (V3)

2. Hutchinson’s sign - Nasociliary nerve (V1)

135
Q

Ring block around the ear anesthetize everything EXCEPT:

A

Conchal bowl and the external auditory meats

136
Q

What nerves innervate the conchal bowl and the external auditory meatus?

A

CN VII, IX, X

137
Q

What nerve innervates the posterior notch of the ear?

A

Lesser occipital nerve CN2

138
Q

Most common scalpel handle (name)

A

Bard Parker

139
Q

Which type of scissors used in surgery has a 1:1 handle/blade ratio and is good for coarse dissection?

A

Mayo scissors

140
Q

Scissors with long handle and blunt tip that are good for dissecting areas that are hard to reach

A

Metzenbaum scissors

141
Q

What color handles are super cut scissors noted to have?

A

Black handlese

142
Q

Which type of cutting needle is more likely to tear though wound edge?

A

Conventional (because the sharp edge is facing the wound edge)

Reverse cutting has a decreased risk of sutures tearing through the wound edge

143
Q

Innervation to great toe web space

A

Deep peroneal nerve

144
Q

Innervation to the heel

A

Calcaneal nerve (posterior tibial nerve branch)

145
Q

Innervation to the 4/5th toes

A

Lateral plants (branch of posterior tibial)

146
Q

Innervation of dorsum of foot

A

Superficial peroneal

147
Q

Innervation of lateral mallelous

A

Sural nerve

148
Q

Innervation of medial malleolus

A

Saphenous nerve

149
Q

Innervation of posterior superior ear

A

Lesser occipital nerve (C2)

150
Q

Innervation of the anterior tympanic membrane

A

Auriculotemporal nerve (V3)

151
Q

Nerve that provides tase sensation to anterior 2/3 tongue

A

Facial nerve

152
Q

Innervation to the muscles of mastication

A

V3 Mandibular branch of trigeminal

153
Q

Taste and sensation to the posterior 1/3 of tongue

A

CN IX Glossopharyngeal nerve

154
Q

What deficiency occurs if you cut Spinal accessory nerve?

A

Shoulder drooping, winged scapula

155
Q

Where is Erbs point and what exits there?

A

Erbs point is the midpoint of the posterior border of SCM and the spinal accessory nerve exits here

156
Q

How many mm do wounds contract per day?

A

As much as 0.75mm per day

157
Q

At what time period is wound contraction at its maximum?

158
Q

What are the first cells to arrive after a wound, and what are the most important cells to arrive to heal a wound?

A

First - Neutrophils

Most important - Macrophage

159
Q

What type of Collagen is the first to start to reform in a wound?

A

TYPE III!!!

160
Q

What substance do macrophages release which attracts fibroblasts to heal a new wound bed?

A

Fibronectin

161
Q

Loxosceles

A

Brown recluse

  • spingomyelinase D
162
Q

Lactrodectus mactans

A

Black widow spider

Venom - alpha latrotoxin

163
Q

Tegenaria agrestis

A

Hobo spider. - herringbone striped pattern

164
Q

Cheiracanthium spp.

A

Sac spider - toxin lipase

165
Q

Phidippus spp

A

Jumping spider - toxin is histamine

166
Q

Toxin in black widow spider

A

Alpha lactrotoxin

167
Q

Toxin in brown recluse spider

A

Spingomyelinase D

168
Q

Toxin in wolf spider

169
Q

Toxin in Sac spider

170
Q

Toxin in jumping spider

A

Hyaluronidase

171
Q

Which spider’s toxin is histamine?

A

Wolf spider (Hogna)

172
Q

Which spiders toxin is lipase?

A

Sac spider

173
Q

Which spiders toxin is spingomyelinase D

A

Brown recluse

174
Q

Which spiders bite can occur in ophthalmia nodosa?

175
Q

Which spider has the herringbone pattern?

A

Hobo spider

176
Q

What type of electrosurgery has the highest risk of interfering with an ICD or pacemaker?

A

Electrosection! High amperage, Low voltage, undampened waveform. Good for cutting

177
Q

Boiling point of LN2

178
Q

What bacteria commonly implicated in ear infections?

A

Pseudomonas

DERMATOLOGY (16 decks)

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