Week Five - Ingrown Toenails, Paronychia, Felons, Epidermal Inclusion Cysts, Sebaceous Cysts, and Lipomas

Question 1

What are the primary and secondary causes of ingrown toenails?

Answer 1

• Pressure of tight shoes (made worse by rapid growth of feet)
• Cutting the nail too short

Question 2

Why do you pack cotton under the corner of an ingrown toenail?

Answer 2

• Allows the nail to grow out without poking into the tissue

- Afterwards, can trim the nail appropriately

Question 3

When would you use Operative Treatment for an acute ingrown toenail case?

Answer 3

• When there is a definite persisting infection with a heaping up of granulation tissue

Question 4

How many 30-second applications of 88% liquefied Phenol would you use for attempting to permanently kill a portion of the nail bed?

Answer 4

• Three

Question 5

What is the typical causative organism of paronychia?

Answer 5

Acute
- Staphylococcus aureus

Chronic
- Candida albicans + bacteria

Question 6

When might you need to remove the nail?

Answer 6

• Difficult cases of chronic paronychia

Question 7

In a felon, the unyielding skin of the fingertip contains the infection and creates tension resulting in _____, ______ ______, ______, and ______ ______

Answer 7

• ??
• Microvascular compromise
• Necrosis
• Abscess formation

Question 8

The most common cutaneous cyst is a ________ cyst

Answer 8

• Epidermoid (epidermal inclusion)

Question 9

The three possible causes of epidermal inclusion cysts are ________ and _________ and _______

Answer 9

• Traumatic implantation of epidermis into dermis
• Spontaneously, often from the upper portion of a hair follicle
• May originate from giant comedones

Question 10

An epidermal inclusion cyst is a nodule that often feels slightly ______

Answer 10

• Malleable

Question 11

An epidermal inclusion cyst is the most common type of cyst located on the _______

Answer 11

• Back (?)

Question 12

Why is it important to remove the complete wall of an epidermal inclusion cyst?

Answer 12

• To prevent recurrence

Question 13

What exam finding indicates that an epidermal inclusion cyst is ripe and ready to drain?

Answer 13

• When the lesion is not inflamed (?)

Question 14

Wait at least ______ weeks after inflammation and infection has resolved before attempting excision of an epidermal inclusion cyst

Answer 14

• 4-6 weeks

Question 15

A lipoma may feel _____ but is usually not malleable

Answer 15

• Rubbery

Question 16

Epidermal inclusion cysts and tricholemmal (pilar) cysts are very common, and usually called ______ _____ cysts in error

Answer 16

• Sebaceous cysts

Question 17

If the skin moves over top of the lesion, the lesion is sub-dermal in origin and probably a ______

Answer 17

• Lipoma

Question 18

If you believe a lesion is a lipoma, but are uncertain of the diagnosis, particularly if the lesion feels quite firm, a _______ ______ must be considered

Answer 18

• Malignant tumor