Minor surgery 2 midterm Flashcards
(102 cards)
1
Q
How do you hold the electrode with electrofulgeration?
A
With electrofulgeration you hold the electrode away from the skin, producing a spark and a shallow effect.
2
Q
How do your use electrodessication?
A
With electrodessication you touch the skin with the electrode (or insert into the skin) to destroy tissue.
3
Q
Which two types of effect are produced by the hyfrecation machine by Conmed?
A
Both electrofulgeration & electrodessication
4
Q
What are the advantages of a thermal pencil cautery (“hot wire loop”)?
A
- Low cost
- Individual sterile packaging
- Disposible
- Safe around eyes
- Safe with patients with pacemakers
- Great to drain subungal hematomas
5
Q
What are some of the advantages of electrosurgical devices?
A
- Simple to use
- Rapid technique
- Control bleeding while cutting tissue
- Compact
- Affordable
- Sterile condition and sutures are not needed
- Infection rarely develops in wounds left open
- Used for wide variety of skin lesions
6
Q
What are some of the disadvantages of electrosurgical devices?
A
- Safety risk-electric shock, burns or fires
- Hypertrophic scar formation
- Channeling of current down vessels and nerves
- Smoke may carry particles into respiratory tract (not great for wart removal)
- Delayed hemorrhage
- Unsightly wound
- Slow healing
- Obliteration of histology (therefore not good for obtaining bx specimen)
- Electrosurgical artifact at margins if used for bx
7
Q
What are the advantages of cryotherapy over electrosurgery?
A
- Faster and easier to perform
- No anesthetics needed
- No risk of developing HPV, HIV or other viral infections through respiratory tract
8
Q
What are the disadvantages of cryotherapy versus electrosurgery?
A
- More likely to cause hypopigmentation
- Less effective than electrosurgery for pedunculated condyloma
- Final result cannot be seen immediately as with electrosurgery
- More guesswork in treating the lesion for inexperienced physician
- May need to be repeated several times
- Causes more postoperative swelling
- Causes discomfort
9
Q
What are the advantages of the scalpel versus electrosurgery? The disadvantages?
A
Advantages:
- Inexpensive
- Disposable
- Cleaner edge on both wound and bx specimen
- No heat induced tissue damage to obscure bx
- Generally better wound healing and cosmetic results
Disadvantages:
- Does not control bleeding
- Small risk of accidental cutting yourself
10
Q
What are the advantages of electrosurgery over laser treatment?
A
- Less expensive
- Easier to use
- Laser requires a subspecialist to determine and perform the best treatment modality for the patient
11
Q
What are the advantages of laser treatment over electrosurgery?
A
- Can efficiently cut, coagulate and destroy tissue
* Good for resurfacing-removing wrinkles
12
Q
What are the contraindications/cautions based on the patient for use of electrosurgery?
A
- Caution with pacemakers
- Caution with metal plated, metal pins or metal prosthetics
- Patients should not touch metal part of treatment cart to avoid current shock
- Malignant lesion is contraindicated
- Body folds are contraindicated
13
Q
Is electrosurgery an appropriate treatment modality for melanoma? For a lesion around the eye?
A
- Melanoma-No way!
- BCC- No way!
- Lesion around eye-No way!
14
Q
True or False?
The radio surgery machine is more efficient for cutting than the Hyfrecator with less tissue damage?
A
FACT: the radiosurgery machine is more efficient for cutting than the Hyfrecator with less tissue damage (less “lateral heat”).
15
Q
True or False?
There are different power settings on electrosurgical machines useful for different functions?
A
FACT: there are different power settings on electrosurgical machines useful for different functions.
16
Q
What are the cautions to observe to prevent fires and burns with electrosurgery?
A
- Do not prep skin with EtOH
- Do not use ethyl chloride as local anesthetic (Flammable)
- Have fire extinguisher near by
- Bowel gas can ignite if performing perirectal procedures
- Electric shock from breaking contact with patient while electrode is activated-keep hand on patient for grounding
- Don’t touch metal
17
Q
What are the cautions when using cryotherapy?
A
- Cosmetically unacceptable scarring may occur
- Remove all callous from plantar warts before freezing
- Nerves and vessels may be damaged with freezing too deeply
- Depigmentation or hyper pigmentation may occur
18
Q
What type of lighting helps distinguish a macule from a papule?
A
- Tangential lighting-oblique lighting
- Macule- circumscribed area of change in normal skin color without elevation or depression, not palpable
- Macular exanthema-rash consisting of macules
- Papule-superficial, solid lesion less than 0.5cm in diameter, palpable
- Papules with distinct borders are seen when lesions increased in # of epidermal cells
19
Q
Understand the use of diascopy to distinguish a purpura from vascular extravasation.
A
*Pressing a glass slide to red lesion is simple way to detect blanching, if redness remains, under pressure, it is purpuric. If redness disappears it is erythematous and due to vascular dilation
20
Q
Confluence of papule leads to what?
A
Leads to the development of larger, usually flat-topped, circumscribed, plateau-like elevations known as plaques.
21
Q
Plaque results from what?
A
Plaque results from repeated rubbing of the skin and most frequently develops in persons with Lichenification.
22
Q
Nodules result from what?
A
Nodules result from Infiltrates, Neoplasm, or Metabolic Deposits in the dermis or subcutaneous tissue.
23
Q
Vesicles and bull arise from what?
A
Vesicles and bullae arise from a Cleavage at various levels of the skin, which may be within the epidermis or at the Epidermal-Dermal Interface.
24
Q
Crusts develop when?
A
Crusts develop when serum, blood, or purulent exudate dries on the skin surface.
25
Which layers of skin are involved in an erosion vs. an ulcer vs. a fissure? Which of these lesions typically heals without a scar?
* Ulcer=> epidermis & papillary layer of dermis
* Fissure=> Abrupt walls of epidermis, but can extend into dermic
* Erosions=> only in the epidermis
26
True or False?
When irritated or injured, a skin tag may appear as a necrotic, crusted papule that may not be clinically distinctive and may raise concern regarding a Malignancy.
FACT: When irritated or injured, a skin tag may appear as a necrotic, crusted papule that may not be clinically distinctive and may raise concern regarding a Malignancy.
27
The easiest means of removal of a skin tag is by?
The easiest means of removal of a skin tag is by lift and snip using Scissors and Forceps.
28
The diagnostic test, “dimple sign”, if positive suggests what?
a Dermatofibroma.
29
Simple incision is usually sufficient for removal of a what?
a dermatofibroma along with a biopsy if indicated.
30
Characteristically, on compression, a Neurofibroma demonstrates a what?
“buttonhole” sign.
31
Café-Au-Alit spots (light brown macule) are a cutaneous finding often seen in what?
Neurofibroma or von Richenhausen.
32
Over time moles tend to mature from Epitheliod too what?
From Epitheliod to Lymphocytoid and then Neuroid types.
33
Most nevi are acquired, appearing sometime after age of what and between what ages?
After the 35th year of life and before age 60 years.
34
Regular brown color, surface, and border are characteristic features of a nevus that differentiate it from?
Melanoma.
35
Their importance in diagnosis of a blue nevus is their similar appearance to what?
nodular Melanoma.
36
Weeks to months after incomplete removal of a nevus, brown macular re-pigmentation may appear in the scar and a biopsy specimen taken from that lesion may confuse the pathologist with?
Rapidly Growing Cells.
37
A small percentage of small dark dots within melanocytic nevi are due to?
Melanoma.
38
What are the 4 signs that help distinguish a normal mole from a melanoma?
1. Asymmetry
2. Border irregularity
3. Color
4. Diameter greater than ¼ inch
39
True or false:
| There is a large risk of Melanoma in newborns with nevi covering more than 5% of the body surface.
True
40
True or false:
Worrisome moles are those that have changed in color, shape, or size, have been acquired in adulthood, bleed, or are itching.
FACT: Worrisome moles are those that have changed in color, shape, or size, have been acquired in adulthood, bleed, or are itching.
41
Know the differences between common and atypical moles.
Junctional:
```
Initial pinpoint
Expands to 4-6cm
Flat or slightly elevated
Smooth
Sharply circumscribed
```
42
Know the differences between common and atypical moles
Compound:
Slightly elevated, dome shape papule
Flesh, brown or halo nevus
43
Know the differences between common and atypical moles
Dermal:
Dome shaped
Verrucoid
Pedunculated
Sessile with broad base
44
Know the differences between common and atypical moles
Common Nevi:
* Usually sun exposed area, mostly above waist
* 10-40 nevi
* Absent at birth, appear from 2-6 years old and grow vertically in uniform manner throughout life, may see more at puberty
* Round, symmetrical, uniform macular or popular smooth boarders
* Nevus cells at the dermoepidermal junction and/or in the dermis
45
Know the differences between common and atypical moles
Atypical:
* Back is most common area, upper and lower limbs, sun protected area, female breast, scalp, butt and groin
* Less than 10 to greater than 100 in numbers
* Appears as normal nevi at age 2-6 and increased in number and size at puberty, new nevi appear throughout life
* Usually greater than 5mm and commonly greater than 10mm
* Irregular borders, flap areas, margin fades into surrounding skin and always has a macular component
* Variable within a single lesion, brown, black, red or pink
* Persistent lentiginous melanocytic hyperplasia with nuclear atypia, concentric eosinophilic fibroplasia, sparse, patchy lymphocytic infiltration
46
What are the 3 physical characteristics common to all seborrheic keratosis
1. Well circumscribes borders
2. “Stuck on” appearance
3. Variable tan-brown-black color
47
True or false?
| Common cutaneous warts are rarely linked with HPV-associated carcinomas.
True
48
```
True or false?
Condyloma acuminatum (genital wart) is the most common STI.
```
True
49
Cervical cancer is associated with high risk HPV types
16 & 18
50
HPV types 6 and 11 are associated with 90% of what cond.?
genital wart cases.
51
When callus over a plantar is pared down with a scalpel, the underlying wart is visualized with interruption of?
Skin lines and black puncta.
52
Describe a “mosaic” wart.
Multiple warts coalesce with Mother wart and daughter warts
53
What is traumatic black heel?
Often mistakes as black puncta, but is dried blood under the epithelium after a trauma to the area.
54
CAUTION: secondary syphilis may be confused with what?
genital HPV!
55
What is the goal of wart treatment?
To destroy the virus containing epidermis and to preserve as much uninvolved tissue as possible.
56
Bichloroacetic acid and trichloroacetic acid are particularly useful for treatment of warts where?
palms and Soles.
57
Imiquimod (Aldara, Zyclara) – 5% cream is useful in the treatment of?
Anogenital and neogenital warts.
58
True or false?
Caution must be used when applying podophyllin to extensive lesions because severe systemic reactions may occur from absorption.
FACT: Caution must be used when applying podophyllin to extensive lesions because severe systemic reactions may occur from absorption.
59
What is thought to block the H2 receptors present on T-suppressor cells, increase the cell-mediated immunity and improve the treatment of resistant warts.
Tagament
60
True or false?
ED&C (Electrodesiccation and Curettage) is never a first-line therapy on the soles of the feet due to painful scarring potential!
FACT: ED&C is never a first-line therapy on the soles of the feet due to painful scarring potential!
61
Paring the surface and identifying the presence of skin lines with a translucent core confirms that the lesion is a?
CORN
62
True or false?
The treatment goal for a corn is to provide immediate relief of painful symptoms and then reduce the friction and pressure that has caused their formation.
FACT: The treatment goal for a corn is to provide immediate relief of painful symptoms and then reduce the friction and pressure that has caused their formation.
63
What is the primary and secondary cause of ingrown toenails?
Primary: Wearing shoes that are too tight
Secondary: Cutting the nail too short
64
Understand the concept of packing cotton under corner of ingrown nail as described under Conservative Home Health Care slide.
It helps prevent further ingrown by lifting the toenail up.
65
When would you use Operative Treatment for an acute ingrown toenail case?
With a definite persisting infection with granulation tissue
66
How many 30-second applications of 88% liquefied Phenol would you use for attempting to permanently kill a portion of the nail bed?
3
67
What is the typical causative organism in chronic paronychia?
Candida albicans
68
True or false?
| You may need to remove the nail in difficult cases of chronic paronychia.
True
69
In a Felon, the unyielding skin of the fingertip, contains the infection and creates tension resulting in?
Microvascular compromise, Necrosis and Abscess formation.
70
The most common cutaneous cyst is?
Sebaceous cyst
71
The three possible causes of epidermal inclusion cysts are?
Traumatic implantation of epidermis into dermis, spontaneously arising from hair follicle, and giant comedones (usually on back).
72
An epidermal inclusion cyst is a nodule that often feels slightly
Malleable
73
An epidermal inclusion cyst is the most common type of cyst located on the?
Scalp
74
Why is it important to remove the complete wall of an epidermal inclusion cyst?
To prevent recurrence
75
What exam finding indicates that an epidermal inclusion cyst is ripe and ready to drain?
A cyst is ripe and ready when it feels fluctuant (fluid like) to palpation.
76
Wait at least ____ weeks after inflammation and infection has resolved before attempting excision
4-6 wks
77
A lipoma may feel _____, but is usually not malleable.
Rubbery
78
Epidermal inclusion cysts and tricholemmal (pilar) cysts are very common, and usually called ______ in error.
Sebaceous cysts
79
If the skin moves over top of the lesion, the lesion is sub-dermal in origin and probably a ______.
Lipoma
80
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.
malignant tumor
81
Diagnostic feature of warts are?
The black puncta dots
82
Nevi of concern are?
Atypical
83
Must palpate skin to differentiate lipoma from?
Cyst
84
With cryotherapy, what does it do to the skin?
Hypopigmentation, if you freeze too long you could have nerve damage
85
What are the different types of cysts, what do they contain within them?
1. Epidermoid cysts-keratin
2. Sebaceous cysts-sebum
3. Pilar cysts-keratin of different nature than epidermoid keratin
4. Lipoma-mature fat cells enclosed by fibrous capsules
86
What are the characteristics of skin tags?
Benign soft tan-flesh colored lesion
| Pedunculated with stalk, fleshy papules
87
What pathology has a buttonhole sign?
Neurofibroma
88
What has a dimple sign?
Dermatofibroma
89
With elliptical incision, there’s a better closure, but it still has a scar with?
fibroma removal
90
Know that lipoma stretched skin, so an ____ incision should be done to remove.
elliptical
91
Know that seborrheic keratosis is a cosmetic problem, but you would biopsy if the lesion is?
rough
92
Know a shave removal is best for seborrheic keratosis, but freezing can be done if?
You confirm with negative biopsy
93
Know the difference between corns and warts
Corns: localized epidermal thickness with hyperkeratosis secondary to chronic pressure or friction. They keep the skin lines whereas warts separate skin lines
94
People tend to get corns removed because they are _____.
painful
95
Know that a lipoma is a ____ lesion
subcutaneous
96
Know how to differentiate an epidermal cyst from an abscess
Sebaceous cysts have central pores
97
Know the most common locations for skin tags
Axilla 48%
Neck 35%
eyelids
98
What are the future risks for excessive sun exposure?
Melanoma
BCC
SCC
99
What is the treatment for actinic keratosis?
First a dermablade or excision is best to biopsy lesion
| If negative biopsy, them cryotherapy is easiest
100
What is the procedure for ingrown toenails
* Place cotton under toenail to prevent continued inward growth
* Performs digital block at base of toe
* Draw a line on the part of nail that needs to be removed
* Place tourniquet on toe
* With knife or scissors remove 2-3mm pice of toenail being sure to cut through the end of the growth plate-avoid cutting the eponychium by pushing it back with blunt instrument
* Separate portion of nail from nailbed with spatula and remove
* Excise hypertrophic granulation tissue that overhangs
* Cauterize if needed
* Remove tourniquet and control bleeding with silver nitriate or hyfercator
* Apply tincture and wrap up with gauze
101
Know that with an elliptical incision, when you see the fat layer, you_____....
have reached the end point, you don’t want to cut deeper.
102
Know that subcuticular suture have the least scarring
running subcuticular
