Skin and soft tissue review

Question 1

most common nerve injury with anterior shoulder dislocation

Answer 1

axillary nerve

Question 2

most common way to see an ulnar nerve injury from trauma?

Answer 2

elbow fracture

Question 3

• decreased sensation in 4th and 5th digit of hand
• reduced grip
• inability to flex 4th and 5th digit
  what was injured?

Answer 3

ulnar nerve injury

Question 4

most common way to see median nerve injury in trauma?

Answer 4

supracondylar humerus fracture

Question 5

inability to abduct thumb
inability to flex 2nd and 3rd digits of the hand
- what was injured?

Answer 5

median nerve injury

Question 6

inability to extend the wrist, what was injured?

Answer 6

radial nerve injury

Question 7

initial treatment for brown recluse spider bite?

Answer 7

rest
compression
elevation

Question 8

patient on chronic steroids with a chronic wound, what can you supplement to help with wound healing

Answer 8

vitamin A

Question 9

patient with immune thrombocytopenic purpura is post op from splenectomy, still complaining of nose bleeds…next step?

Answer 9

• peripheral smear to look for howell-jolly bodies

- if absent then look for accessory spleen

Question 10

you see a splenic cyst incidentally on CT scan, what is your next step?

Answer 10

• test for echinococcal species -> if positive patient has hyatid disease

Question 11

how do you treat hydatid disease?

Answer 11

• can sterilize cyst in spleen with injection of hypertonic saline, alcohol, or silver nitrate
• then splenectomy trying to make sure no contents are spilled

Question 12

what is Bowen’s disease

Answer 12

squamous carcinoma in situ of the skin

Question 13

what does actinic keratosis morph into given enough time?

Answer 13

Bowen’s disease AKA squamous carcinoma in situ of the skin

Question 14

What is a Marjolin Ulcer?

Answer 14

Squamous cell carcinoma arising from a burn

Question 15

stage 1 pressure ulcer

Answer 15

intact skin, non-blanching erythema

Question 16

stage 2 pressure ulcer

Answer 16

partial thickness skin loss with exposed dermis

Question 17

stage 3 pressure ulcer

Answer 17

full thickness skin loss with exposed fat and granulation tissue

Question 18

stage 4 pressure ulcer

Answer 18

full thickness skin loss with exposed fascia, muscle, bone, cartilage, or bone

Question 19

first stage of wound healing

Answer 19

hemostasis

• less than 1 day

Question 20

First stage of wound healing

Answer 20

inflammation

1-3 days

Question 21

third stage of wound healing

Answer 21

proliferation

4 days-3 weeks

Question 22

fourth stage of wound healing

Answer 22

remodeling

starts at any time after 5 days and lasts years

Question 23

mediators of inflammatory phase of wound healing

Answer 23

neutrophils (1st to get to wound)

Macrophages

Question 24

predominant cell during the proliferation phase of wound healing?

Answer 24

fibroblast

lay down collagen matrix

Question 25

cells active during proliferation stage of wound healing?

Answer 25

fibroblasts and myofibroblasts

Question 26

when do you get 80% of tensile strength from a healing wound?

Answer 26

6 weeks

Question 27

predominant method by which negative pressure wound therapy heals wounds?

Answer 27

promotes formation of granulation tissue

Question 28

cells needed in a wound to promote proliferation and angiogenesis?

Answer 28

Macrophages

Question 29

what is a composite skin graft?

Answer 29

small graft with skin and underlying cartilage or other tissue

Question 30

major molecules involved in first phase of wound healing

Answer 30

inflammatory phase | TNFa, IL-1, PDGF

Question 31

major molecules involved in second phase of wound healing

Answer 31

proliferation stage | PDGF, fibroblast growth factor (FGF), epidermal growth factor (EGF)

Question 32

flesh colored atrophic plaque, biopsy shows spindle cells and stains positive for CD34 and vimentin

Answer 32

Dermatofibrosarcoma

Question 33

Treatment for dermatofibrosarcoma?

Answer 33

can down stage with imatinib wide local excision with 2-4 cm margin

Question 34

Fothergill's sign

Answer 34

palpable abdominal mass that remains fixed with abdominal muscle contraction - rectus sheet hematoma

Question 35

raised purple subcutaneous lesion, biopsy shows monomorphic large pale cells with whirled appearance

Answer 35

Merkel Cell Carcinoma

Question 36

what does Merkel Cell carcinoma stain for traditionally?

Answer 36

Cytokeratin-20 (CK-20)

Question 37

what does small cell carcinoma stain for?

Answer 37

CK-20 and TTF-1 (thyroid transcription factor 1)

Question 38

first cell to arrive to wound after hemostasis?

Answer 38

neutrophil

Question 39

Imbibition

Answer 39

diffusion of nutrients into a skin graft without a direct blood supply

Question 40

Insoculation

Answer 40

donor and recipient capillaries align

Question 41

When does revascularization happen with a skin graft?

Answer 41

typically after POD 5

Question 42

salmon colored fluid coming from midline incision, sign of what?

Answer 42

fascial dehiscence

Question 43

margin for basal cell carcinoma

Answer 43

0.5 cm

Question 44

patient had resection of a pleomorphic adenoma from their parotid gland, now recurred. how do manage this?

Answer 44

-radiation therapy, too difficult to resect in an already operated field

Question 45

thigh mass with biopsy showing atypical spindle cells

Answer 45

sarcoma

Question 46

mainstay of treatment for a soft tissue sarcoma

Answer 46

- 1-2 cm margin | - at least one uninvolved fascial plane

Question 47

role of radiotherapy in soft tissue sarcomas

Answer 47

- adjuvant radiation treatment mainly | - used to reduce recurrence: tumor > 5cm, <1cm margin, unable to re-resect positive margin, high grade

Question 48

abdominal wall mass with biopsy showing long, sweeping fascicles containing bland cells and atypia

Answer 48

- Desmoid tumor

Question 49

treatment for Desmoid tumor

Answer 49

- typically self resolve, follow with 3-6 month follow up CT - if sx then resect

Question 50

most concerning feature of dermatofirbosarcoma protuberans

Answer 50

fibrosarcomatous changes

Question 51

most common form of melanoma in black patients

Answer 51

Acral lentiginous melanoma

Question 52

contraindication for transverse rectus myocutaneous flap

Answer 52

previous abdominal surgery/compromised superior epigastric artery

Question 53

margin needed for skin squamous cell carcinoma

Answer 53

4-6 mm

Question 54

margin needed for 1 cm basal carcinoma

Answer 54

2 mm

Question 55

margin needed for 1-2 cm basal cell carcinoma

Answer 55

3-5 mm

Question 56

margin needed for > 2 cm basal cell carcinoma

Answer 56

1 cm

Question 57

empiric treatment for soft tissue infection

Answer 57

penicillin or carbapenem AND clindamycin

Question 58

first line treatment for moderate to severe hydradenitis

Answer 58

tetracyclines (eg Doxycycline)