Surgery EOR Dermatology (Smarty PANCE)

Burns

What are the three main classifications of burns?

Superficial (1st degree), partial-thickness (2nd degree), full-thickness (3rd degree)

What is the hallmark of a superficial burn?

Redness, pain, no blisters (e.g., sunburn)

How do partial-thickness burns present?

Red, painful, and blistered

What is the appearance of full-thickness burns?

White, charred, painless due to nerve damage

What is the Rule of Nines?

A method to estimate total body surface area (TBSA) affected by burns

What is the most critical initial treatment for severe burns?

Fluid resuscitation, typically using the Parkland formula (4 mL/kg per %TBSA)

What is the Parkland formula for burns?

4 mL/kg per %TBSA, half given in the first 8 hours, remainder in the next 16 hours

What topical antibiotic is commonly used in burn management?

Silver sulfadiazine and topical Bacitracin

What is the greatest risk for burn victims?

Infection

When should you consider transferring a burn patient to a burn center?

When TBSA >10%, involvement of face, hands, feet, genitals, or full-thickness burns

What lab abnormalities are common in burn patients?

Hypovolemia, hyperkalemia, metabolic acidosis

How are inhalation injuries associated with burns treated?

Airway management with oxygen or intubation as necessary

What is the indication for escharotomy in burn patients?

To relieve pressure from circumferential burns and restore circulation

Cellulitis

What is the most common pathogen causing cellulitis?

Group A Streptococcus (Strep pyogenes)

What are the typical signs of cellulitis?

Redness, swelling, warmth, and tenderness of the skin

What is the first-line treatment for uncomplicated cellulitis?

Oral antibiotics like cephalexin or dicloxacillin

What distinguishes cellulitis from erysipelas?

Erysipelas involves more superficial layers with sharply demarcated edges

What is the key risk factor for developing cellulitis?

Skin break or injury such as a cut or insect bite

What imaging is used if an abscess or deep infection is suspected with cellulitis?

Ultrasound or CT scan

How do you manage purulent cellulitis?

Empiric antibiotic therapy targeting MRSA (e.g., clindamycin, doxycycline)

What condition must be ruled out in rapidly progressing cellulitis?

Necrotizing fasciitis

What population is at high risk for recurrent cellulitis?

Patients with chronic lymphedema or venous insufficiency

What is the role of IV antibiotics in cellulitis?

For severe cases or failure of oral antibiotics

How can you prevent recurrent cellulitis in at-risk patients?

Skin hygiene, weight loss, compression therapy for edema

What complication can arise from untreated cellulitis?

Sepsis or deep tissue abscess

What is the duration of antibiotic therapy for cellulitis?

Typically 5-10 days, but longer for complicated cases

Dermatologic Neoplasms

What is the most common type of skin cancer?

Basal cell carcinoma

What is the most common risk factor for skin cancer?

UV light exposure

How does basal cell carcinoma typically present?

Pearly, raised lesion with telangiectasia, often on sun-exposed areas

What is the main distinguishing feature of squamous cell carcinoma?

Firm, scaly, red papules or plaques, often with ulceration

What is the ABCDE rule for melanoma?

Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving

What is the preferred treatment for basal cell carcinoma?

Surgical excision or Mohs micrographic surgery

What is the best initial diagnostic step for suspected melanoma?

Excisional biopsy with narrow margins

What is the treatment for localized melanoma?

Wide excision with sentinel lymph node biopsy

What type of biopsy should be avoided in melanoma?

Shave biopsy due to inadequate depth

What is the role of immunotherapy in advanced melanoma?

Checkpoint inhibitors (e.g., nivolumab) improve survival in metastatic disease

What is the most common site of metastasis for melanoma?

Lymph nodes and distant skin sites

What is the primary treatment for squamous cell carcinoma?

Excision with clear margins

How is actinic keratosis related to squamous cell carcinoma?

Actinic keratosis is a precancerous lesion that can progress to squamous cell carcinoma

Epidermal Inclusion Cyst

What is an epidermal inclusion cyst?

A benign cyst containing keratinous material

How does an epidermal inclusion cyst present?

Mobile, firm, subcutaneous nodule often with a central punctum

What is the treatment for asymptomatic epidermal inclusion cysts?

Observation unless inflamed or symptomatic

What is the definitive treatment for an inflamed or infected cyst?

Incision and drainage followed by excision after inflammation resolves

What complication can arise from an untreated infected epidermal inclusion cyst?

Abscess formation

How do you differentiate an epidermal inclusion cyst from a lipoma?

Cysts have a central punctum and are usually firmer, while lipomas are soft and lobulated

What is the recurrence rate after excision of an epidermal inclusion cyst?

Low if completely excised, including the cyst wall

What causes an epidermal inclusion cyst?

Blockage of a hair follicle or skin trauma

What is the most common location for epidermal inclusion cysts?

Face, neck, and trunk

What is the histological finding in an epidermal inclusion cyst?

A cyst lined by squamous epithelium containing lamellated keratin

What is the appearance of a ruptured epidermal inclusion cyst?

Painful, erythematous nodule with cheesy white discharge

What is the best treatment for a ruptured cyst with secondary infection?

Incision, drainage, and oral antibiotics

How can epidermal inclusion cysts be prevented?

There is no reliable prevention method, but avoiding trauma may help reduce risk

Hidradenitis Suppurativa

What is hidradenitis suppurativa?

A chronic inflammatory condition of the apocrine glands leading to abscesses, scarring, and sinus tracts

What are common sites of hidradenitis suppurativa?

Axillae, groin, perineal, and inframammary areas

What is the initial treatment for mild hidradenitis suppurativa?

Topical clindamycin or oral antibiotics like tetracyclines

What is the primary risk factor for hidradenitis suppurativa?

Obesity, smoking, and family history

What is the Hurley staging system for?

It classifies the severity of hidradenitis suppurativa into three stages

What is the treatment for moderate to severe hidradenitis suppurativa?

Oral antibiotics, anti-TNF agents (e.g., infliximab), or surgical excision

What is the role of lifestyle changes in managing hidradenitis suppurativa?

Weight loss and smoking cessation can help reduce flares

What complication can arise from untreated hidradenitis suppurativa?

Formation of sinus tracts and severe scarring

What is the role of surgery in hidradenitis suppurativa?

Wide excision of involved skin in advanced cases

How do you differentiate hidradenitis suppurativa from other skin infections?

Chronicity, location, and the presence of sinus tracts and multiple abscesses

What is the most common presentation of hidradenitis suppurativa?

Painful nodules, abscesses, and draining sinus tracts in apocrine gland-bearing areas

What systemic treatments are considered for hidradenitis suppurativa?

Biologic agents like adalimumab in severe cases

What is the recurrence rate of hidradenitis suppurativa after surgery?

High, particularly in patients who continue smoking or do not lose weight

Lipoma

What is a lipoma?

A benign tumor of adipose tissue

How does a lipoma typically present?

Soft, mobile, and painless subcutaneous mass

What is the treatment for symptomatic lipoma?

Surgical excision

What imaging is used to confirm a lipoma?

Ultrasound or MRI if deep or atypical

How can you differentiate a lipoma from a sarcoma?

Lipomas are typically soft and painless, while sarcomas may be firmer and painful

What is the recurrence rate of a lipoma after excision?

Low if completely excised

What is the histological appearance of a lipoma?

Well-circumscribed mass of mature adipocytes

What is the most common location for lipomas?

Trunk, shoulders, and neck

What complication can arise from a rapidly growing lipoma?

Rarely, a liposarcoma, though most lipomas are benign

What is the usual size range of lipomas?

Typically less than 5 cm, but they can grow larger

What is the most common treatment for multiple lipomas?

Observation unless symptomatic or concerning features present

What are the concerning features of a lipoma that warrant further investigation?

Rapid growth, pain, or firmness

What is the genetic condition associated with multiple lipomas?

Familial multiple lipomatosis

Pressure Ulcer

What are the stages of pressure ulcers?

Stage 1: Non-blanchable erythema, Stage 2: Partial-thickness skin loss, Stage 3: Full-thickness skin loss, Stage 4: Full-thickness tissue loss with exposed bone, tendon, or muscle

What is the most common site for pressure ulcers?

Bony prominences such as the sacrum, heels, and hips

What is the primary cause of pressure ulcers?

Prolonged pressure leading to ischemia of soft tissues

What is the best initial management for a stage 1 pressure ulcer?

Pressure relief and skin protection with barrier creams

What is the gold standard for diagnosing the extent of a pressure ulcer?

Clinical examination, but MRI can be used to assess deeper tissue involvement

How are stage 3 and 4 pressure ulcers treated?

Debridement, wound care, and possibly surgical intervention

What are the risk factors for developing pressure ulcers?

Immobility, poor nutrition, and incontinence

What role do nutritional supplements play in pressure ulcer prevention?

Protein and vitamin C supplementation can aid in healing

What complication can result from an untreated stage 4 pressure ulcer?

Osteomyelitis or sepsis

What is the key prevention strategy for pressure ulcers in bedridden patients?

Regular repositioning and use of pressure-relieving mattresses

What is the role of negative pressure wound therapy in pressure ulcers?

It can help promote healing in deeper ulcers

How is infection in a pressure ulcer diagnosed?

Wound culture and biopsy if osteomyelitis is suspected

What is the primary complication of pressure ulcers in elderly patients?

High risk of infection leading to morbidity and mortality

Dermatologic Procedures

What is the purpose of aspiration of a seroma or hematoma?

To drain accumulated fluid and prevent infection or dehiscence