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Surgery > Skin, Soft tissue, Hernias > Flashcards

Skin, Soft tissue, Hernias Flashcards

(60 cards)

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0
Q

ABCDE of melanoma?

A

Asymmetry, border irregularity, color variation, diameter (> 0.6 cm), dark black color, evolution

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1
Q

key PE findings of malignant melanoma?

A

Ulceration, bleeding, changes in size/pigmentation

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2
Q

LN eval in melanoma?

A

Yes

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3
Q

BCC margins?

A

2-4 mm for large/aggressive lesions

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4
Q

Any other tx for BCC?

A

Can give topical 5-FU or radiation

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5
Q

More likely to met to LN: BCC or SqCC?

A

SqCC

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6
Q

Bowen’s disease

A

SqCC in situ

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7
Q

SqCC margins?

A

1 cm

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8
Q

In situ melanoma margins?

A

0.5-1 cm

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9
Q

What is a dysplastic nevus?

A

transition b/w benign and malignant

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10
Q

Staging of melanoma?

A

Breslow thickness

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11
Q

Breslow thickness categories?

A 
< 0.75 mm = T1
0.75 - 1.5 mm = T2
1.50 - 2.50 = T3
2.50 - 3.50 = T3
> 4.0 = T4
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12
Q

Melanoma work-up?

A

CBC, LFTs, CXR

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13
Q

T0 margins?

A

1 cm

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14
Q

T2 margins?

A

2 cm, LN removal if palpable (or Sentinel LN bx)

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15
Q

T4 margins?

A

2-3 cm and will likely die from mets + CT abdomen + MRI brain + Interferon

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16
Q

How does ulceration affect TNM?

A

Adds +1 to T

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17
Q

5 cm lentigo maligna melanoma: management?

A

tends to be superficial and spreading rather than invasive –> excision w/ narrower margin (if on face)

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18
Q

5 cm lentigo maligna (Hutchinson freckle)

A

precursor lesion; observation

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19
Q

Acral lentiginous melanoma

A

MC in dark-skinned individuals; tend to be thicker and associated w/ poorer prognosis

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20
Q

Subungual melanoma

A

Bx –> reexcision involves amputation of distal interphalangeal joint

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21
Q

Anal melanoma. Prognosis? Common location? Tx?

A

Poor prognosis; near 100% mortality at 5 yrs; dentate line; abdominoperineal resection of anorectum

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22
Q

SBO w/ hx of malignant melanoma?

A

Melanoma has unique propensity to met to peritoneal cavity and commonly causes SBO; poor prognosis

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23
Q

Hx of therapeutic radiation and axillary LAD now w/ firm, PAINLESS mass on anterior thigh

A

Sarcoma; # of mitotic figures and degree of necrosis

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24
Common met sites for sarcoma?
Liver, lung, bone, brain
25
Staging of sarcoma?
AP CT, plain CXR +/- chest CT
26
Post-op management of sarcoma?
Radiation therapy for high-grade sarcomas; adjuvant therapy in low-grade
27
Is there a benefit to excision of sarcoma lung mets?
Yes, significant long-term disease-free intervals
28
Which hernia type goes posterior to the inguinal ligament?
Femoral hernia
29
More medial hernia mass - type?
Direct
30
More lateral hernia mass - type?
Indirect
31
Hernia most likely to strangulate?
Femoral (up to 50%)
32
Difference between direct and indirect hernia?
Indirect usually has intact posterior surface (floor of canal) and originates at internal ring Direct, weakness in floor of canal, originates medially to inferior epigastric vessels
33
Conditions that could cause a direct hernia?
Obesity, COPD, ascites, BPH (bladder outlet obstruction), colon or rectal obstruction (tumors, constipation)
34
Indications for hernia repair?
Strangulation/incarceration, narrow neck, femoral hernia, local pain, enlargement, inability to lift, pt preference
35
Surgical options for hernia repair?
Open and laparoscopic
36
Types of Open repairs?
Bassini, Cooper's, Shouldice, Lichtenstein
37
Bassini repair ... ?
reconstruction of posterior inguinal canal, suturing of superior abdominal wall (internal oblique, transverses abdomens, transversalis fascia) to inferior location on inguinal ligament
38
Where is the weakness in a direct hernia?
Transversalis fascia
39
Advantage of Bassini? Disadvantage?
Low recurrence. Weakness is tension it places on structure and with poor tissue it's likely to fail
40
Cooper's repair (McVay) ... ? Better for which type of hernia?
Similar to Bassini except inferior sutures places on Cooper's ligament (periosteum of pubic rams). Femoral and attenuated inguinal ligaments
41
Most hernia repairs are what?
Attach transversalis fascia to inguinal ligament or periosteum of pubic rams
42
Shouldice repair ... ?
Attaches reinforced transversalis fascia to inguinal ligament in two layers
43
Lichtenstein repair ... ?
prosthetic mesh to superior abdominal wall and inguinal ligament ... creates tension on fascial structures ... very popular
44
Types of laparoscopic repairs?
Transabdominal preperitoneal, Totally extra peritoneal
45
Transabdominal preperitoneal repair ... ? Complications?
mesh attachment to floor of inguinal canal from w/in abdominal cavity ... general anesthesia and adhesions
46
Totally extra peritoneal repair ... ?
balloon inflation + mesh
47
Key complications of hernia repair?
Genitofemoral nerve, ilioinguinal nerve, iliohypogastric nerve, lateral femoral cutaneous nerve injuries --> sensory defects Recurrence depends on type of procedure and surgeon Testicular atrophy, edema, ischemia rare Wound infecition/hematoma < 1%
48
Post-op management of Lichtenstein ?
Avoid lifting for 6 weeks (wound will have regained 75-90% final strength) w/ then gradual progression to full lifting
49
Important landmarks to ID during hernia repair?
Ilioinguinal nerve and spermatic cord Ilioinguinal nerve = anterior to external oblique Iliohypogastric = posterior to external oblique, anterior to internal oblique Genitofemoral = lateral in same plane to iliohypogastric
50
Where does the ilioinguinal nerve run to?
Testis w/ external spermatic nerve
51
Difference between an adult and pediatric inguinal hernia?
Pediatric hernias involve NO DEFECT in floor of inguinal canal --> INDIRECT
52
Cause of most pediatric hernias?
Persistent patent processus vaginalis
53
High incidence of unilaterality or bilaterality in pediatric hernias?
Bilaterality
54
Pediatric hernia repair operation?
High ligation of the hernia sac w/ no abdominal wall repair (no defect present)
55
Boundaries of a femoral hernia?
``` Anterior = iliopubic tract (reflection of inguinal lig.) Posterior = Cooper's lig. (Pubic ramus) Medially = pubic tubercle Laterally = femoral vein ```
56
What structures must you be careful to avoid during an inguinal hernia repair?
Bladder, cecum, sigmoid, ovary, appendix
57
Richter hernia?
Protrusion of a portion of intestine into wall of hernia sac
58
Littre hernia?
Protrusion of a Meckel diverticulum into wall of hernia sac
59
What can make ventral hernia repairs more difficult?
inadequate tissue strength, insufficient tissue, infection, poor nutrition .. mesh carries infection risk

Surgery (7 decks)

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