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SKIN SOFT TISSUE Flashcards

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1
Q

VAC pressure recs

A

A negative pressure of -50 to -125 mm Hg is applied either intermittently or continuously.

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2
Q

A high-output fistula produces

A

200 to 500 mL/day.

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3
Q

A patient presents with a 3- x 4-cm skin lesion on his leg that has been present for 10 days. Treatment with a beta-lactam antibiotic has produced no improvement. The patient is ambulatory and has a normal WBC count. A culture returns community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).

Which of the following antibiotics would be an appropriate recommendation?

A

Compared with HA-MRSA, CA-MRSA strains tend to be more susceptible to antimicrobial agents outside of the beta-lactam class. CA-MRSA isolates are

HA-MRSA is susceptible to vancomycin, daptomycin, linezolid, and tigecycline. Doxycycline yielded a 90% cure rate when used to treat CA-MRSA skin infections. Although drugs used for HA-MRSA could be used for a CA-MRSA skin infection, they are not necessary and increase the cost of care.

Patients with a CA-MRSA skin infection must be investigated for the presence of an abscess that needs drainage. Drainage alone may suffice in some cases. When cellulitis is present with or without an abscess, antibiotics are indicated. Current recommendations suggest using oral agents appropriate for CA-MRSA as initial treatment. Drugs used to treat HA-MRSA are used if initial treatment fails.

Aztreonam and amoxicillin/cavulanate are beta-lactam antibiotics and would not be appropriate choices, especially because previous beta-lactam coverage has not been successful.

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4
Q

Compared with HA-MRSA, CA-MRSA strains tend to be more susceptible What class of antibiotics

A

to antimicrobial agents outside of the beta-lactam class.

far more likely to demonstrate susceptibility to ciprofloxacin, clindamycin, doxycycline, rifampin, trimethoprim-sulfamethoxazole, and erythromycin, compared with nosocomial or HA strains.

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5
Q

HA-MRSA is susceptible to

A

vancomycin, daptomycin, linezolid, and tigecycline.

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6
Q

and immunologic origin of melanocyte

A

Neuro crest

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7
Q

60 mmHg and produce pressure necrosis of the skin and underlying soft tissue and what time.

A

One hour

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8
Q

What is the pressure that is generated to the sacrum and laying in a standard Hospital mattress

A

150 mmHg

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9
Q

primary wavelength responsible for skin cancer from the sun

A

UVB

315-290 nm

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10
Q

best initial treatment for burn with hydrofluoric acid

A

Copious water irrigation (or saline)
30 minutes
Do not neutralize

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11
Q

Wet complications are seen with HCl burn

A

calcium deficit (this neutralized acid)

Decreased calcium may cause cardiac arrhythmia

After water flush:
Ammonium compound
Calcium carbonate gel-detoxifies fluoride

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12
Q

Risk factors for actinomycotic infection and diagnostic finding and treatment

A

tooth extraction
Facial trauma

Sulfur granules

Penicillin and sulfa my

Deep infection-abscess/chronic scarring may require surgical treatment

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13
Q

Pyoderma gangrenosum

A

associated with systemic disease 50%

Inflammatory bowel disease
Rheumatoid arthritis
Hematologic malignancy
Monoclonal immunoglobulin a gammopathy

Treatment:
Many of acute chemotherapy plus aggressive wound care and skin grafting

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14
Q

Staphylococcal scalded skin syndrome:
Pathology
Associations
Treatment

A

Excellent toxin
skin biopsy-cleavage granular of epidermis
Infection of nasopharynx/middle ear

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15
Q

Toxic epidermal necrolysis

A 
immune response to drugs:
Sulfonamides
Phenytoin
Barbiturates
TETRACYCLINE

Diagnoses skin biopsy
Structural defect of dermal epidermal junction-similar to second-degree burn

Treatment:
Fluid resuscitation electrolytes
Treated skin As a burn

More than 30% true diagnosis of TEN

Less than 10%total body surface area is called Steven Johnson syndrome

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16
Q

Stevens Johnson syndrome

A

Less than 10%total body surface area is called Steven Johnson syndrome

if greater than 30% this is classified as TEN

respiratory and epithelial sloughing including GI tract

May require temporary coverage with catheter or porcine graft to allow epidermis to spontaneously regenerate

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17
Q

most common type of cutaneous cyst

A

epidermal cyst
Substance inside assistant keratome (NOT sebum)

Single, firm nodule anywhere and body

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18
Q

Dermoid cyst

A

Congenital lesion

Epithelium his truck during fetal development

Eyebrow most frequent site

A form anywhere from tip of nose to forehead

liking ovary views may demonstrate bone tissues nerve tissue

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19
Q

Trichilemmal cyst

A

pillar cyst

outer layer resembles root sheath of hair follicle

Second most common cutaneous cyst

Most often Scalp females

did not contain granular layer

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20
Q

Capillary hemangioma

A

port wine stain

At present and midface may signify:
Churg-Strauss syndrome:
CT scan brain to rule out intracranial berry aneurysm

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21
Q

Most common type of basal cell carcinoma

A

Nodular

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22
Q

Most common type of skin cancer

A

Basal cell carcinoma

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23
Q

Types of basal cell carcinoma and treatment

A 
Nodular-most common
Superficial spreading
Micronodular
Infiltrative
Pigmented
Morpheaform

Waxy, rolled, pearly borders surrounding septal scar

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24
Q

Relatively aggressive form of basal cell carcinoma

A

Morpheaform

Appear this flap, plaque-like lesion

Other aggressive form:
Basal squamous type-may metastasize similar to squamous cell carcinoma

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25
Marjolin's ulcers
Burn scars Squamous cell carcinoma Osteomyelitis, previous injury, scar This type of squamous cell carcinoma tends to be more aggressive and metastasize to earlier
26
Angiosarcoma associated with Stewart-Treves for syndrome
associated with lymphedema-classic delayed presentation status post axillary dissection breast cancer May rise on scalp, face, neck Appears as bruise Increased risk with prior radiation in the setting of chronic lymphedema Anaplastic endothelial cells surrounding vascular channels Treatment: Total excision of early lesion may occasionally tear Clearly it chemoradiation
27
List order frequency of types of melanoma
Superficial spreading Nodular Lentigo Acral
28
most common type of melanoma
Superficial spreading
29
Superficial spreading melanoma
Most common Anywhere in the skin except the hands and feet Typically flat measure 1-2 cm diameter Prolonged radial growth before vertical extension improved prognosis to 2 delayed vertical growth
30
nodular melanoma
increased vertical early growth Dark color off and raised More aggressive and superficial spreading though similar prognosis when equal depth
31
Then T. go melanoma
Most frequently: Neck, face, hands, elderly 10 to be quite large diagnosis Best prognosis because invasive growth occurs late
32
Acral lentigo melanoma
These common Relatively rare in dark skinned people though much more common in dark skinned people than Caucasian home Consults Subungual Most common great toe or thumb subungual posterior nail fold
33
Treatment of melanoma less than 1 mm depth
1 cm excision margin
34
Treatment of melanoma greater than 1.01 mm depth
2 cm excision margin
35
With our margins needed for Merkel cell carcinoma 2 millimeters in diameter
3 cm?
36
Merkel cell carcinoma
wide excision down to the fascia left brain paracranium): Martin: 1.5-2 cm (or Mohs) Nodes: Sentinel or regional dissection Adjuvant radiation to primary no sites and poor prognosis group Cisplatin: May be used for regional or distant metastases Neuroepithelial differentiation not true squamous cell carcinoma Associated with up to 25% metachronous or synchronous lesion! Highly aggressive Prophylactic regional lymph node dissection with adjuvant radiation recommended
37
Dermatofibrosarcoma protuberans Chemotherapy
second most common sarcoma Presents to young patient's 30-40-year-old Wide excision: 3 cm margin; frozen section margins Or Mohs Radiation for: Close margin specimen 1 cm were involved margins thick cannot be reexcised Chemotherapy sensitive: Imitinab selective inhibitor of platelet derived growth factor (PD GF)
38
nevus sebaceous of Jadassohn most commonly associated with
Basal cell carcinoma Developed during childhood
39
Cell origin of sarcomas
mesoderm | May originate from peripheral nervous system or ectodermal
40
most common soft tissue sarcoma in adults
malignant fibrous histiocytoma | Excluding Kaposi's sarcoma
41
List most common types of soft tissue sarcoma in adults
``` malignant fibrous histiocytoma Liposarcoma Leiomyosarcoma I classified sarcoma Synovial sarcoma Malignant peripheral nerve sheath tumor Rhabdomyosarcoma Fibrosarcoma Ewing's sarcoma Angiosarcoma Osteosarcoma Epithelioid sarcoma Chondrosarcoma Clear cell sarcoma Alveolar soft part sarcoma Malignant hemangiopericytoma ```
42
Most common soft tissue sarcoma in children
rhabdomyosarcoma most common in children 15 Skeletal muscle
43
Rhabdomyosarcoma presentation, pathology, treatment
The most common children 15 The great he had a he very well a dressing present he
44
most likely site for metastasis for malignant fibrous histiocytoma
lymph node - this is an exception usually hematogenous spread Other exceptions:
45
exceptions when sarcomas metastasize other than hematogenous pattern
``` malignant fibrous histiocytoma Epithelioid sarcoma Rhabdomyosarcoma Clear cell sarcoma Synovial sarcoma Angiosarcoma ```
46
risk factors for developing sarcoma
chronic lymphedema risk increases with concomitant radiation Capillary all infections Stuart Treves Syndrome Other cancer associations: Cervix Ovary Lymphatic
47
syndrome associated with developing sarcoma
Familial adenomatous polyposis careful, hamartoma most common ``` also: Retinal blastoma Li-Fraumaeni syndrome neurofibromatosis type I Atrial ```
48
type of sarcoma most likely to be associated with abdominal metastases
myxoid liposarcoma
49
The most appropriate initial method the biopsy suspected 4 cm sarcoma of the lower leg
Core needle biopsy
50
Wayne is incisional biopsy obtained for sarcoma of the leg
The less than 3 cm
51
when is excisional biopsy be entertained for suspected sarcoma
extremity and trunk lesions smaller than 3 cm The
52
Sarcoma with low risk of metastasis
Dermatosarcoma protuberans Desmoid Well-differentiated liposarcoma Hemangiopericytoma
53
Sarcomas with high risk of metastasis
``` Angiosarcoma Clear cell sarcoma Pleomorphic liposarcoma Poorly differentiated liposarcoma Leiomyosarcoma Rhabdomyosarcoma Synovial sarcoma ```
54
Most important prognosticator for sarcoma
histologic grade ``` Other factors: Differentiation Pleomorphism Necrosis Mitoses Secondary ```
55
when is sentinel lymph node biopsy recommended for melanoma
in melanoma patient's with clinically and radiographically negative regional lymph nodes: 1. primary lesion larger than 1 mm or 2. Ulceration/mitotic rate less than 1 mm²
56
when is regional lymphadenectomy recommended for melanoma
``` #1 positive sentinel lymph node #2 clinically palpable nodal disease AND a pathologically proven involved lymph node #3 Author opinion: microscopic positive node ```
57
axillary dissection for melanoma
includes all 3 levels unlike like breast Skeletonized axillary vein If pectoralis minor must be sacrificed-divided close to the coracoid process Preserve long thoracic nerve Thoracodorsal nerve if they're not involved with tumor
58
Neck lymphadenectomy for melanoma
``` modified radical neck lymphadenectomy: Spare: Spinal accessory nerve cranial nerve 11 Sternocleidomastoid Internal jugular vein ``` clear all ipsilateral cervical nodes
59
lymph node dissection for melanoma of anterior face, scalp, upper neck, clinically apparent cervical disease
superficial parotidectomy considered in conjunction with lymphadenectomy
60
Groin dissection for melanoma Overview
2 nodal basins: Inguinal femoral Iliac obturator RARELY performed both : “radical groin dissection” (Possible if positive node of Cloquet, more than 4 positive nodes and superficial inguinal femoral dissection, palpable extracapsular extension the femoral nodes) the
61
Inguinal femoral node dissection for melanoma
Superficial Lower external oblique Inguinal ligament Within femoral triangle
62
iliac obturator dissection for lymph nodes for melanoma
deep inguinal dissection ``` Only performed if #1radiographic evidence of deep nodes preoperatively #2 positive Cloquet node #3 more than 4 positive nodes on inguinal femoral dissection and palpable or extracapsular extension of femoral nodes ``` Removed nodes from colon Iliac vessels Obturator nerve Node of Cloquet (iliofemoral junction)
63
Left lateral neck levels
1 2 3 4 6 5
64
radiation therapy for extremity soft tissue sarcoma
“ vast majority of extremity soft tissue sarcoma can be treated with limb sparing surgery with low local recurrence rates and adjuvant radiation therapy is used” Small (less than 5 cm), superficial, well-circumscribed tumors with margin greater than 1 cm normal tissue) may not require adjuvant radiation
65
Sarcoma most responsive to chemotherapy
Synovial sarcoma Also fibrosarcoma Intermediate sensitivity: Liposarcoma Next a fibrosarcoma
66
Most common presenting symptom of retroperitoneal sarcoma
Large abdominal mass Relatively asymptomatic
67
most appropriate surgical treatment of a 2 cm leiomyosarcoma greater curvature of the stomach is
local resection a 3 cm (2-4 cm) margin of normal tissue | Not subtotal gastrectomy
68
most common location for soft tissue sarcoma
Extremity 59% Trunk 19% Retroperitoneum 13% Head and neck 9%
69
Most common histology type of soft tissue sarcoma
``` Malignant fibrous histiocytoma 28% Leiomyosarcoma 12% Liposarcoma 15% Synovial sarcoma 10% Malignant peripheral nerve sheath tumor at 6% ```
70
best tumor marker to monitor her recurrence of colon cancer
Carcinoembryonic antigen CEA NOT specific to colon cancer
71
Alpha-fetoprotein
Associated with hepatocellular carcinoma
72
marker for thyroid cancer
Calcitonin medullary
73
Marker for breast cancer
CA 15-3
74
Marker for carcinoid tumor
5 hydroxyindoleacetic acid
75
emergency radiation therapy is used for
Spinal cord compression from metastatic prostatic cancer Superior vena cava obstruction from carcinoma of the lung Vertebral bone pain from metastatic breast cancer
76
requirements for therapeutic agent to be used in diffuse peritoneal metastasis the
Lipid viability low rate of peritoneal absorption rapid plasma clearance
77
increased risk of cancer after nuclear bomb
thyroid Breast Lung Chronic myeloid leukemia
78
cancer associated with Epstein-Barr virus
B-cell lymphoma Burkitt's lymphoma Nasopharyngeal cancer Hodgkin's disease
79
infection associated with sulfa granules
actinomycosis Granulomatous Craniofacial; mandible Tooth extraction previous believed to be fungus - name
80
Treatment of actinomycosis
penicillin | Also sensitive to sulfa
81
Organism involved with lymphogranuloma venereum
Chlamydia Intracellular Two-week incubation Painful lymph nodes
82
Treatment of chlamydia
Doxycycline Or Azithromycin and one dose
83
Margin for basal cell carcinoma
2-4 mm
84
Most common type of melanoma
superficial spreading Nodular lentigo Acral
85
Clark levels
Epidermis Papillary dermis Reticular dermis-deep net Subcutaneous
86
should a lymph node dissection be done with a 5 mm depth melanoma
no | Over 4 mm chance of metastasis is so high that it is not worth doing node dissection
87
Cancers seen with Merkel cell carcinoma
up to 25% chance of synchronous or metachronous squamous cell carcinoma
88
Treatment of Merkel cell cancer
3 mm margin No dissection Radiation
89
Treatment of Kaposi's sarcoma
radiation Combination chemotherapy Surgery preserved for bowel obstruction airway compromise
90
hidradenitis suppurativa Gland involved Presentation Treatment
aprocrin glands the wide local excision Split-thickness skin graft-wounds did not granulate well
91
Toxic epidermal neck lysis Pathophysiology Treatment Risks-causes
``` Dermal epidermal junction Similar to second degree burn cause: Sulfa Barbiturates ``` Treat of burn wound discontinue offending agent
92
scalded skin syndrome
staphylococcal exo toxin can be proceeded by staff ear infection
93
best treatment for large capillary hemangioma
“port wine stain “ | Laser destruction
94
most common type of skin cancer to affect the lip
squamous cell carcinoma
95
treatment of squamous cell carcinoma of the lip
surgery and radiotherapy of been shown to be equally effective Surgery small lesions Radiotherapy for medium lesions ( radiation therapy increase in sensitivity to future sun exposure) Combination therapy for large lesions

SKIN SOFT TISSUE (1 decks)

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