MSurgII Midterm

Question 1

With electrofulgeration, how do you hold the electrode?

Answer 1

with the electrode away from the skin, producing a spark and a shallow effect

Question 2

How do you hold the electrode with electrodessication?

Answer 2

you touch the skin with the electrode or insert it into the skin to destroy deeper tissues

Question 3

What effects are produced by the hyfrecation machine by Conmed?

Answer 3

electrofulguration and electrodessication

Question 4

What are the advantages of a thermal pencil cautery (hot wire loop)?

Answer 4

Low cost ($15-$20), individual sterile packaging, disposable, safe around the eyes, safe with pacemakers, helpful in sublingual hematomas

Question 5

What are some of the advantages of electrosurgical devices?

Answer 5

Simple, rapid, controls bleeding, compact, affordable, sterile conditions and sutures not required, use for a variety of lesions

Question 6

What are some disadvantages of electrosurgical devices?

Answer 6

Safety risk, hypertrophic scars, “Channeling” of current down vessels and nerves, smoke may carry particles, delayed hemorrhage, slow healing if large area, obliteration of histology, artifacts at margins

Question 7

What the advantages of cryotherapy?

Answer 7

fast, easy, no need for anesthesia, less scarring than electrosurgery. no risk of transmitting infections through the respiratory tract, less scarring

Question 8

What are the disadvantages of cryotherapy verses electrosurgery?

Answer 8

More likely to cause hypo pigmentation, less effective for pedunculate condylomata, slower results, more postoperative swelling, transient discomfort

Question 9

What are the advantages and disadvantages of scalpel versus electrosurgery?

Answer 9

Advantages: best for shave biopsies and excisions, inexpensive, disposable, “cleaner edge”, better wound healing and cosmetic result

Disadvantages: does not control bleeding, small risk of accidentally cutting yourself

Question 10

What are the advantages of electrosurgery over laser treatment?

Answer 10

less expensive, easier to use, does not require a subspecialist

Question 11

What are the advantages of laser treatment over electrosurgery?

Answer 11

good for “resurfacing”, efficiently cut/coagulate/destroy tissue

Question 12

What are the contraindications/cautions base on the patient for use of electrosurgery?

Answer 12

pacemakers, metal plates/pins/prosthetics, body folds, malignancy, eyes

Question 13

Is electrosurgery an appropriate treatment for melanoma? For a lesion around the eye?

Answer 13

NO

Question 14

T/F: The radiosurgery machine is more efficient for cutting than the Hyfrecator, with less tissue damage (less ‘lateral heat’)

Answer 14

TRUE

Question 15

T/F: There are different power settings on electrosurgical machines, useful for different functions

Answer 15

TRUE

Question 16

What are the cautions to observe to prevent fires and burns with electrosurgery?

Answer 16

Do not prep skin with alcohol
do not use ethyl chloride as a local anesthetic, eep oxygen away from equipment, be careful with igniting bowel gas when preforming peri-rectal procedures. have a fire extinguisher.

Question 17

What are cautions when using cryotherapy?

Answer 17

remove callous from plantar warts before freezing, unacceptable scarring may occur, scar may be painful, nerves/vessels may be damaged if freezing too deeply, depigmentation or hyper pigmentation may occur.

Question 18

What type of lighting helps distinguish a macule from a papule?

Answer 18

Oblique

Question 19

Understand the use of diascopy to distinguish a purport from vascular extravasation.

Answer 19

Pressing a glass life to a red lesion

If redness remains: purpuric lesion

If redness disappears: vascular dilatation

Question 20

Confluence of papule leads to the development of larger, usually flat-topped, circumscribed, plateau-like elevations known as:

Answer 20

plaques

Question 21

Plaque results from repeated rubbing of skin and most frequently developed in persons with:

Answer 21

atopy

Question 22

Nodules result from:

Answer 22

infiltrates, neoplasms and metabolic deposits in the dermis or subcutaneous tissues

Question 23

Vesicles and bull arise from a ___ at various levels of the skin, which may be within the ____ or at the _____

Answer 23

Vesicles and bull arise from a cleavage at various levels of the skin, which may be within the epidermis or at the epidermal-dermal interface.

Question 24

_____s develop when serum, blood or purulent exudate dries on the skin surface.

Answer 24

crusts

Question 25

Which layers of the skin are involved in erosion vs. an ulcer vs. a fissure? Which of these lesions typically heals without a scar?

Answer 25

Ulcer: loss of epidermis and user papillary layer of the dermis Erosion: only involved the epidermis, HEALS WO A SCAR Fissure: involves epidermis and dermis

Question 26

T/F: When irritated or injured, a skin take may appear as a necrotic, crusted papule that may not be clinically distinctive and may raise concerns regarding malignancy.

Answer 26

TRUE

Question 27

The easiest means of removing a skin tag is:

Answer 27

lift and snip, using forceps and scissors

Question 28

The diagnostic test "dimple sign" suggests:

Answer 28

dermatofibroma

Question 29

_____ is usually sufficient for removal of a dermatofibroma along with a biopsy if indicated.

Answer 29

simple excision

Question 30

Characteristically, on compression, a neurofibroma demonstrates a ______ sign.

Answer 30

a "buttonhole" sign

Question 31

Café-Au-Lait spots (light brown macules) are a cutaneous finding often seen in:

Answer 31

Neurofibromatosis type 1

Question 32

Over time moles tend to mature through which types?

Answer 32

A, to B and then C types

Question 33

Most nevi are acquired, appearing at age ____ and before are ____.

Answer 33

Most nevi appear after the first year of life and before age 35

Question 34

Regular brown color, surface and border are characteristic features of a nevus that differentiates it from a:

Answer 34

melanoma

Question 35

A blue nevus is similar in appearance to the more serious diagnosis of:

Answer 35

melanoma

Question 36

Weeks to months after incomplete removal of a nevus, brown macular re-pigmentation may appear in the scar and a biopsy specimen takin from the lesion may confused the pathologist with a:

Answer 36

melanoma

Question 37

A small percentage of small dark spots within melanocytic nevi are due to:

Answer 37

melanoma

Question 38

What are the 4 signs that help distinguish a normal mole from a melanoma?

Answer 38

Asymmetry, Irregular border, color and diameter

Question 39

There is a large risk of ____ sin newborns with nevi covering more than 5% of their body surface.

Answer 39

Melanoma

Question 40

T/F: Worrisome moles are those that have changed in color, shape, size, have been acquired in adulthood, bleed or are itching

Answer 40

TRUE

Question 41

What are the differences between common and atypical moles?

Answer 41

Common: sun exposed areas above the waist, #10-40, absent at birth, appear at age 2-6, 5mm (commonly >10mm), irregular border, variable color

Question 42

What are the 3 physical characteristics common to all seborrheic keratoses?

Answer 42

well-circumscribed border, stuck-on appearance, variable tan-brown-black color

Question 43

T/F: Common cutaneous warts are rarely linked with HPV-associated carcinomas

Answer 43

T

Question 44

T/F: condyloma acuminatum (genital wart) is the most common STI

Answer 44

T

Question 45

Cervical cancer is associated with high risk HPV types:

Answer 45

16 and 18

Question 46

HPV types __ and __ are associated with 90% of genital wart cases

Answer 46

6 and 11

Question 47

What callus over a plantar is pared down with a scalpel, the underlying wart has what two characteristics?

Answer 47

interruption of skin lines | black puncta

Question 48

Describe a mosaic wart:

Answer 48

warts overlap each other- no distinct, mother-daughter pattern

Question 49

What is traumatic black heel?

Answer 49

Dried, dark RBCs deposited in the epidermis after trauma

Question 50

What STI can be confused with genital HPV?

Answer 50

Secondary Syphillis

Question 51

What is the goal of wart treatment?

Answer 51

to destroy the virus-containing epidermis and preserve as much uninvolved tissue as possible

Question 52

Bicholoracetic acid and Trichloroacetic acid are particularly useful treatment of warts on:

Answer 52

Palms and soles

Question 53

Imiquimod (Aldara, Zyclara) 5% cream is useful in the treatment of:

Answer 53

anogenital warts

Question 54

T/F: caution must be used when applying podophyllin to extensive lesions because severe systemic reactions may occur from absorption

Answer 54

True

Question 55

Cimetidine HD (Tagamet) mechanism of action:

Answer 55

blocks H2 receptor present on T-suppressor cells, increasing the cell-mediated immunity and improving the treatment of resistant warts

Question 56

T/F: EDandC is never a first-line therapy on the soles of the feet duet to painful scarring potential

Answer 56

TRUE

Question 57

Paring the surface and identifying the presence of skin lines with a translucent core confirms that the lesion is a:

Answer 57

corn

Question 58

What is the treatment goal for a corn?

Answer 58

to provide immediate relief of painful symptoms and then reduce the friction and pressure that has caused their formation.

Question 59

What are the primary and secondary cause of ingrown toenails?

Answer 59

pressure of too tight shoes or cutting the nail too short

Question 60

Understand the concept of packing cotton under the corner of ingrown nails as describes under Conservative Home Health Care slide.

Answer 60

Allows the nail to grow out without poking into the skin. Progress it and change daily. If no improvement in 5 days, see doctor

Question 61

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

Answer 61

Infection persisting with heaping up of granulation tissue

Question 62

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

Answer 62

3

Question 63

What is the typical causative organism of chronic paronychia?

Answer 63

Candida albicans + bacteria Acute= staph aureus

Question 64

T/F: you may need to remove the nail in difficult cases of chronic paronychia

Answer 64

T

Question 65

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

Answer 65

microvascular compromise, necrosis, access formation, septic arthritis, osteomyelitis, tenosynovitis

Question 66

What is the most common cutaneous cyst?

Answer 66

Epidermal inclusion cyst

Question 67

What are 3 causes of epidermal inclusion cysts?

Answer 67

traumatic implantation of epidermis into the dermis, spontaneously from hair follicles, giant comedones

Question 68

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

Answer 68

malleable

Question 69

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

Answer 69

skin

Question 70

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

Answer 70

to prevent recurrence, must remove all epidermal cells

Question 71

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

Answer 71

fluctuance

Question 72

Wait at lease ___ weeks after inflammation and infection has resolved before attempting excision.

Answer 72

4-6 weeks

Question 73

A lipoma may feel ____ but is usually not _____

Answer 73

A lipoma may feel rubbery but is usually not malleable

Question 74

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

Answer 74

sebaceous cysts

Question 75

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

Answer 75

lipoma

Question 76

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 76

malignant tumor