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General Plastics-MJS Flashcards

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1
Q

key cell in epidermis involved in allograft rejection and Type IV hypersensitivity reactions

A

Langerhan cell

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2
Q

Rate of epidermis desquamation

A

27-50 days

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3
Q

Name normal floura of skin

A

staph epidermidis, staph aureus, proprionibacterium, cornybacterium, actinetobacter

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4
Q

Vancouver Scar Scale is out of what and what are the 4 components

A

Vascularity, Pigmentation, Pliability, Height

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5
Q

What are the instructions you give for pressure garmets used over hypertophic burn scars

A

Directions for use
Immediately after sx/wound; 23hrs/d x 6mos
24-30mmHg

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6
Q

What is the max dose of Triamcinolone (Kenolog)

A

120 mg for adults
80mg for peds 6-10 yo
40mg for peds 1-5 yo

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7
Q

side effects of kenolog

A

skin thinning
hypopigmentataion
telangiectasias
skin necrosis

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8
Q

Name 3 hemostatic agents you can apply intraoperatively

A

Tisseel- fibrin sealant.
Surgicel- oxidized cellulose polymer
Gelfoam/Surgifoam- pork skin gelitin

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9
Q

Median nerve at wrist is between which two tendons when you are trying to do wrist block

A

FCR and palmaris

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10
Q

why is it good to mix bicarb in anesthetic

A

decreases the pain of injection. Increases the pH which makes the onset of anesethesia faster. uhbn

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11
Q

When do you stop warfarin before elective surgery

A

5 days

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12
Q

Name a congenital connective tissue disorder that responds well to cosmetic surgery

A

Cutis laxa (autosomal dominant disorder leading to deficient or absent elastin in dermis). They exhibit normal healing and vasculature so are amenable to repeated facelifts.

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13
Q

Describe aplasia cutis. What body part usually? What are the two critical factors when determining reconstruction

A

congential absence of skin-usually on the scalp.

Size of defect and presence of dura are critical factors. The major risk is a sagital sinus bleed.

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14
Q

Phlegmasia cerulea dolens. What is it and how do you treat it.

A

Condition usually found in patient with underlying cancer or trauma, where DVT causes massive swelling of the extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb. There is a high risk of massive pulmonary embolism, even under anticoagulation. Foot gangrene may also occur. An underlying malignancy is found in 50% of cases. Usually, it occurs in those afflicted by a life-threatening illness.

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15
Q

A diabetic comes in with a foot deformity. What is it likely to be

A

Charcot Diabetic foot deformity. Midfoot collapse leading to a classic rocker bottom foot. Results from joint collapse due to insensitivity to pain. Acute Charcot presents as a hot, swollen, red, painful foot, heralding inflammatory bony
destruction.

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16
Q

What are the most common joints involved in Charcots Diabetic Foot deformity

A

This finding corresponds with the
most commonly affected joints in Charcot—the
tarsometatarsal and metatarsophalangeal joint

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17
Q

Acral Lentiginous Melanoma is very common in which patient population.

A

rarest form of melanoma in Caucasians yet accounts for

30 to 60 percent of melanoma in dark-skinned people

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18
Q

What are the indications for SLNB in melanoma

A

1) Any tumor >1mm depth
2) tumor <0.8mm but with ulcerations (worrisome features)
3) tumor 0.8-1.0 with no ulceration

In other words T1b and above

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19
Q

Name 6 painful nodules palpated in skin/fat

A

neuroma, glomus tumor, eccrine spiradenoma, angiolipoma, angioleimyomas, blue rubber bleb nevus

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20
Q

Soft Tissue Sarcomas are assigned a Grade out of 3. What are the three factors

A

1) Differentiation
2) Mitotic Count
3) Tumor Necrosis

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21
Q

Pigmented lesion on the arm that is associated with a triad of severe pain, point tenderness and cold sensitivity. What is it?

A

Glomus tumor

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22
Q

Wide local excision of undifferentiated pleiomorphic sarcoma. What are your margins?

A

2-3cm

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23
Q

Merkel cell WLE margins

A

1-2cm

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24
Q

SLNB indications in sarcoma

A

Only in histological subtypes with increased chance of spread. These include “SCARE” subtypes

Synovial Sarcoma
Clear Cell Sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid Sarcoma
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25
Name the vascular anomalies associated with overgrowth
``` Proteus Klippel Traunahey Parkes Weber Mafucci CLOVES Sturge Weber ```
26
What is Kasabach Meritt Syndrome and in which two vascular tumors is it found?
only in Kaposiform Hemangioepidothelioma and Tufted Angioma.
27
Name two syndromes associated with infantile hemangiomas
PHACES and Von hippel Lindau
28
Features of PHACES syndrome
``` Posterior Fossa Malformations Hemangiomas (facial) Arterial Anomalies Coarctation of Aorta Eye Anomalies Sternal Defects ```
29
Female baby with large facial hemangioma. What might she have
PHACES syndrome
30
What is the treatment for Kasabach-Merritt
Consumptive coagulopathy from vascular tumors (kaposiform hemangioendothelioma and tufted angiomas) that leads to potentially life threatening bleeding. Presents with petechiae, ecchymoses, thrombocytopenia and internal bleeding.
31
Patient come in with greater than 6 months of excessive craniofacial sweating. What is the first line treatment.
Glycopyrolate PO. Then topical antiperspirant, then botox, then refer for consideration of endoscopic sympathectomy
32
Hyperhydosis is associated with pathology of which sweat gland. Hydradenitis Suppurativa is assoicated with pathology of which sweat gland?
Hyperhydrosis casued by eccrine glands | Hydradinitis Suppurtiva caused by apocrine glands
33
What are the 7 Can Med Roles
``` Medical Expert Communicator Collaborator Health Advocate Professional Scholar ```
34
If myasthenia gravis is suspected, what test should be ordered?
Tensilon test—edrophonium injection leading to short-term improvement of ptosis.
35
Three causitive agents of TENS, Three treatments for TENS
allopurinol, sulfa antibiotics, lamotrigine. | Stop offending agent, admit to a burn unit, nutritional and supportive managment.
36
risks factors for PONV
female hx of PONV use of postop opioids nonsmoker
37
you apply EMLA cream before doing an injection. How long does it take to achieve anestyhesia
1 hr!
38
patient with HIV associated lipodystrophy comes for facial fillers. what is the only FDA soft tissue filler for this condition
Sculptra (poly L lactic acid). Long term filler (over 2 years)
39
Describe the difference in calcification patters seen on breast mammography- malignant vs beningn
Malignant calcifications appear as casting (linear or branching) or pleomorphic (granular) Benign have popcorn like appearance,, large rod like or round eggshell appearances
40
What is a rare side effect of phenol chemical peels
cardiac dysrhythmias. patient will need cardiac monitoring during the procedure.
41
FDA recommendations in 2009 for screening of silicone implant rupture?
MRI at 3 years and then every 2 years thereafter.
42
what structure is cut in a transconjunctival approach to lower eyelid bleph
lower conjunctiva and capsulopalpebral fascia
43
polythelia is associated with what anomaly
renal anomalies
44
Name the drugs that cause gynecomastia
``` Anabolic Steroids Spiranolactone Isoniazid Digitalis Metyldopa Ergotmine Antiandrogens Marijuana ```
45
Most common side effect of peiroral rhytid treatment with CO2 laser
hypopigmentation
46
Branham Sign- what is it
Branham Sign- Branham’s sign is the standard clinical test used to determine the hemodynamic significance of an AVF. This is accomplished by applying a compressive force to an artery proximal to the AVF and then evaluating the patient’s heart rate and blood pressure. A positive result occurs when the patient experiences bradycardia and increased blood pressure in response to arterial occlusion. A negative result occurs when the patient does not experience bradycardia and increased blood pressure in response to arterial occlusion.
47
Wavelengths for Tattoos. Black Pigment Blue/Black/Green Yellow
Black- Q switched Nd:Yag 1064nm Black, blue green- Q switched alexandrite 755nm Orange and Yellow- Q swtiched Nd Yag 532 nm
48
First cell to appear in wound healing inflammatory phase
neutrophils
49
What medication is a contrainidication to CO2 laser
isotretinoin
50
DDX of large breast mass in 15 yo girl
fibroadenoma, virginal hypertrophy,
51
Name the laboratory investigations you would order to work up bilateral large gynecomastia in a male. What are these tests meant to rule out?
CBC diff lytes BUN, Cr, LFTS, TSH Testosterone (total and free), estradiol, FSH, LH, BhcG, prolactin These test are intended to rule out germ cell tumors, primary hypogonadism, hyperthyroidism, androgen resistance, pituitary tumors, secondary hypogonadism and lung cancer.
52
What nerve innervates the NAC
T4
53
max dose of tumescent anesthesia
35mg/kg
54
what is the recommended starting dose of botox A for improvement of glabellar wrinkles
20U
55
which rhinoplasty technique recreates the dorsonasal line
spreader grafts
56
What is the Sentinel Lymph node called in the groin
Cloquet's node is also considered as a potential sentinel lymph node
57
Superficial radial nerve block. How do you mark and where do you inject
8cm proximal to radial styloid, 3 fingerbredths proximally. Inject subcu along the dorsal radial half of the wrist.
58
What medication poteniates the action of BOTOX
Calcium channel blockers
59
Merkel Cells live in which layer of skin
Epidermis
60
What are the only two skin genetic disorders that you can do rejuvinating surgery on
cutis laxa and pseudoxantoma elasticum (elastin problems so no wound healing issues). Ehlers danlos and osteogenesis imperfecta are collagen problems (any collagen problems dont operate on them)
61
Whats the Grenz Zone
- a thin subepidermal band of FINE COLLAGEN exempt from the above changes - EOSINOPHILIC - without ELASTIN represents the region where new COLLAGEN is generated continuously by HYPERPLASTIC FIBROBLASTS this region of the PAPILLARY DERMIS, immediately below the BASAL LAYER of the EPIDERMIS, is largely responsible for the REGENERATIVE CHANGES seen after CHEMICAL PEELING ]
62
What is the difference between nonvascularized bone grafts and vascularized bone graft
nonvascularized bone graft undergo necrosis (all osteocytes die) and osteoclasts clear up the bone and there is creeping substitution. They are osteoinductive and osteoconductive but not osteogenic. Vascularized bone dont undergo necrosis as the osteocytes survive the transplant and become OSTEOGENIC.
63
What growth factor induces fibroblast migration and proliferation
TGF beta
64
Whats MOA of Papaverine
phosophodiesterase inhibitor
65
Name 4 conditions that cafe au lait spots are associated with
 NF1 (nf-2) 90% have café au lait spots  McCune Albright’s syndrome: multiple lesions that do not cross the midline + fibrous dysplasia + endocrinopathy  Tuberous sclerosis: AD neurocutaneous disease (MR, epilepsy, facial angiofibroma)  Fanconi anemia
66
Classic triad of glomus tumor
pain pinpoint tenderness cold sensitivity
67
5 Features of Carpenters Syndrome
Craniosynostosis Deafness Mental Retardaation Syndractyly of fingers and toes
68
McCune Albright
polyostotic fibrous dysplasia cafe au lait spots precouscious puberty acromegaly
69
how long do you splint post flexor tendon repair
6 weeks with early active ROM
70
what are the three features of consent
Voluntary Informed Capacity
71
Name 6 features of xeroderma pigmentosa
AR mutation in genes responsible for DNA repair hypersensitivity to sunlight / photophobia extensive cutaneous damage to sun leading to multiple BCC, SCC, melanoma usually lethal by mid 20s extensive freckles, actinic damage, freckles to sunlight ocular opacification, keratitis, tumors diagnosed by skin biopsy
72
List 3 causes of anterior open bite deformity
subcondylar fratures thumb sucking long face syndrome
73
3 features of warfarin induced skin necrosis
obese woman, onset 1-3 weeks post initiation of warfarin, sudden localized pain assocaited with hemmoragic blister that turns necrotic.
74
Features of Xeroderma Pigmentosa
freckles/diffuse solar damaged skin, telangectasias, hypersensitivity to sunlight, high chance for BCC, SCC, Melanoma, death in early adulthood, deficiency in enzyme which repairs UV mediated DNA damage, corneal opacities with eventual blindness.
75
features of SCC
keratin pearls, hyperkeratosis, parakeratosis, acanthosis.
76
Diseases with cafe au lait spots
Tuberous Sclerosis, Mccune Albright Syndrome, Neurofibromatosis, Fanconi Anemia, Ataxia Telengectasia.
77
What is Steward Treves Syndrome
Lympangiosarcoma in the context of longstanding lymphedema
78
What is the #1 and #2 bugs implicated in suppurative chondirtis of the burned ear
pseudomonas then staph aureus
79
DDX for lack of extension in rheumatoid arthritis
``` vaughn jackson syndrome radial sagital band rupture with ulnar subluxation of extensor tendons into groove metacarpal head dislocation trigger finger PIN synovitis ```
80
Name three antispasmodics and explain their mechanism
Lidocaine 4%- vasodilator papavarine- phosphodiesterase inhibitaor (induces smooth muscle relaxation. Verapamil- calcium channel blocker (induces smooth muscle contraction
81
Premalignant skin lesions for SCC. Name 7
1. Aktinic Keratosis 2. Arsenic Keratosis 3. Keratoacanthoma 4. Cutaneous Horn 5. Erythroplakia 6. Leukoplakia 7. Erthroplasia of Querat 8. Bowens Disease

General Plastics-MJS (1 decks)

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