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SB82 Plastics & Skin
SB82 Plastics, Skin and Soft Tissue - Loosely taken from Fiser's ABSITE review
| Question | Answer |
|---|---|
| The main cell type in the epidermis ___________ | Keratinocyte |
| Origin of melanocytes ______________ | Neuroectoderm |
| Location of melanocytes ____________ | Basal layer of the epidermis |
| Melanocytes have dendritic processes that transfer melanin to neighboring keratinocytes via ______________ | Melanosomes |
| Density of melanocytes is the same among races; the difference is in _____________ | Production of melanin |
| Langerhans cells are part of the MHC class __________ | Two |
| Langerhans cells originate from this location ____________ | Bone marrow |
| These dermal structures provide pressure sensation ________________ | Pacinian corpuscles |
| These dermal structures provide the sensation of warmth ________________ | Ruffini |
| These dermal structures provide the sensation of cold ________________ | Krause |
| These dermal structures provide tactile sensation ________________ | Meissner’s corpuscles |
| These sweat glands produce aqueous sweat ___________ | Eccrine |
| These sweat glands produce milky sweat _____________ | Apocrine |
| Most apocrine sweat is produces due to stimulation of the __________________ | Sympathetic nervous system |
| Type I collagen comprises ___________ % of dermis weight | Seventy |
| What molecule gives tensile strength to the dermis? ___________ | Type I collagen |
| Elastins are branching proteins that allow the dermis to stretch to _________ times normal length | Two |
| These skin deformities are caused by loss of tensile strength and elasticity in some disease processes ______________ | Cushing’s striae |
| This process brings nutrients to and waste away from skin grafts in post-graftin days 0-3 _____________ | Imbibition |
| In split-thickness skin grafts, skin is regenerated from these structures | Hair follicles and skin edges |
| What is the benefit of full-thickness skin grafts? | Less wound contraction |
| Blood supply to skin grafts after day 3 occurs through _____________ | Neovascularization |
| What is the most common cause of necrosis of pedicled or anastomosed free-flaps? __________ | Venous thrombosis |
| TRAM flaps rely on what vessels for blood supply? ________ | Superior epigastric vessels |
| The most important determinant of TRAM flap viability __________ | Periumbilical perforators |
| The best natural factor in protecting the skin from UV radiation ___________ | Melanin |
| Melanoma only comprises 3-5% of all skin cancer, but causes __________ % of skin-cancer deaths | 65 |
| You have a patient with familial BK mole syndrome. What is the lifetime risk of melanoma for this patient? | ~100% |
| What percentage of melanomas are familial? | 10% |
| Most common site of melanoma in men and women, respectively _________ | Back and legs |
| Melanoma originates from ______________ cells in the basal layer of the epidermis | Neural crest |
| The most common location for metastases from melanoma __________ | Lung |
| You have a patient who has and SBO. CT scan reveals a metastatic-appearing lesion on the small bowel. What is the likely cause? _____________ | Melanoma |
| A patient has a skin lesion suspicious for melanoma, which measures > 2 cm in width. What is the appropriate initial management? | Incisional biopsy for lesions > 2 cm diameter, or in a cosmetically-sensitive area |
| The least aggressive form of melanoma _________ | Lentigo maligna |
| Most common form of melanoma ____________ | Superficial spreading |
| Type of melanoma most likely to have metastasized at diagnosis _________ | Nodular |
| Melanoma type found on palms and soles ___________ | Acral lentiginous |
| Margins for melanoma | Clear margins if < 0.5 mm in depth; 1 cm margins if 0.5-1.0 mm in depth; 2 cm margins if > 1.0 mm in depth |
| Your patient with biopsy-proven 1.1 mm-deep melanoma is scheduled for excision. There are no clinically-positive lymph nodes. What is the appropriate management? | Sentinel lymph node biopsy |
| The pathology report on your patient with a 1.1 mm-deep melanoma and clinically-negative lymph nodes shows margins > 2 cm and positive sentinel lymph node. What is the appropriate management? | Formal lymph node dissection |
| A patient comes to clinic with a palpable, non-tender axillary lymph node. Biopsy reveals melanoma. On examination, no primary lesion is detectable. What is the appropriate management? | Complete axillary node dissection |
| The most common malignancy in the United States ____________ | Basal cell carcinoma |
| Pathology of basal cell carcinoma | Peripheral palisading of nuclei, and stromal retraction |
| What is the most aggressive form ofr basal cell carcinoma? ____________ | Morpheaform |
| What enzyme is produced by morpheaform basal cell carcinomas? _____________ | Collagenase |
| Margins for BCC ____________ | 0.5 cm |
| Name for squamous cell carcinoma that develops on the rim of a burn wound or non-healing wound/scar _____________ | Marjolin’s ulcer |
| A patient with SCC has clinically positive nodes. What is the appropriate management? | Regional lymphadenectomy |
| Margins for SCC | 0.5-1cm |
| Most common soft tissue sarcoma _____________ | Malignant fibrous histiocytoma |
| Second most common sot tissue sarcoma ___________ | Liposarcoma |
| What percentage of sarcomas arise from extremities? ___________ | 50% |
| Most common presentation of a soft-tissue sarcoma _____________ | Painless mass |
| Sarcomas spread through this route ___________ | Hematogenous |
| Your patient has a suspected soft-tissue sarcoma of his leg measuring 4.1 cm. What is the appropriate management? | Longitudinal incisional biopsy for sarcomas > 4.0 cm; otherwise may perform excisional biopsy |
| Most common site for sarcoma metastasis ____________ | Lung |
| Staging of sarcomas is based on ___________ | Grade (not stage or nodes) |
| Type of chemotherapy for sarcoma _____________ | Doxorubicin |
| Margins for sarcoma excision _________ | At least 3 cm and no involved fascial planes |
| Post-operative radiation therapy is indicated for sarcomas with these characteristics | High-grade, close margins, greater than 5 cm |
| Why is hemostasis important after sarcoma excision? | Hemostasis helps avoid hematomas, which can disseminate tumor cells through normal tissue planes. |
| 5-year survival rate after complete sarcoma resection | 40% |
| Cause of death in patients with retroperitoneal sarcomas | Local recurrence (rarely due to metastasis) |
| Sarcoma related to asbestos exposure _____________ | Mesothelioma |
| Sarcoma related to PVC or arsenic exposure _________ | Angiosarcoma |
| Sarcoma related to chronic lymphedema __________ | Lymphangiosarcoma |
| Treatment for local Kaposi sarcoma | XRT or intralesional vinblastine |
| Most common soft tissue sarcoma in children ________ | Rhabdomyosarcoma |
| Most common rhabdomyosarcoma subtype ______________ | Embryonal |
| Subtype of rhabdomyosarcoma with the worst prognosis ___________ | Alveolar |
| Treatment for childhood rhabdomyosarcoma | Surgical excision and doxorubicin-based chemotherapy (as with most sarcomas) |
| Osteosarcoma originates from the _______________ cells, usually at the knee _____________ | Metaphyseal |
| Treatment for osteosarcoma | Resect joint, followed by reconstruction vs. amputation |
| Xanthomas are yellow in color, contain this cell type ___________, and require excision | Histiocytes |
| Initial treatment for verruca vulgaris ___________ | Liquid nitrogen |
| Your patient presents with a reddish-purple papulonodular plaque with surrounding induration. What is the likely diagnosis? _________ | Merkel cell carcinoma |
| You biopsy a reddish-purple papulonodular plaque. If it is a Merkel cell carcinoma, what substances do you expect it to stain for? | Neuro-specific enolase, cytokeratin, neurofilament protein |
| Your patient presents with a painful swelling at the tip of her finger. Biopsy shows intertwined blood vessels and nerves within the specimen. What is the diagnosis? _________ | Glomus cell tumor |
| Intra-abdominal desmoid tumors are associated with what conditions? | Gardner’s syndrome and retroperitoneal fibrosis |
| Treatment for refractory hyperhidrosis ________ | Sympathectomy |
| Most common organisms in hidradenitis suppurativa | Staph and strep |
| Type of sweat gland infected in hidradenitis suppurativa ____________ | Apocrine |
| Definition of keloid vs. hypertrophic scar | In keloids, the collagen goes beyond the original scar; in hypertrophic scars, the collagen stays within the confines of the scar tissue |
| You may use steroids, silicone, and pressure garments but NOT radiation therapy for this type of scar malformation ___________ | Hypertrophic scar |
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