Dermatology Board Review

Front 1

Conchal bowl innervation?

Back 1

CN 7,9 and 10

Front 2

Auriculotemporal innervates?

Back 2

Medial upper ear anterior; posterior superior ear

Front 3

Majority of anteior and posterior helix innervation?

Back 3

Greater auricular nn.

Front 4

Levator palpebrae superioris - 1) Function 2) Innervation

Back 4

1) Opens eye
2) CNIII (oculomotor)

Front 5

Embryonic origin of the muscles of facial expression - 1) Lower
2) Upper

Back 5

1) Embryonic platysma - no bony insertions
2) Sphincter colli profundus - all have bony insertions

Front 6

Which pharyngeal arch gives rise to the muscles of mastication?

Back 6

First (mesodermal)

Front 7

Which pharyngeal arch gives rise to the muscles facial expression?

Back 7

Second (mesenchymal)

Front 8

Motor innervation: Temporal branch
1) Muscles
2) Defect

Back 8

1) Frontalis, orb oculi, corrugator supercilii, procerus -- the BTX muscles
2) Brow ptosis - BTX effects/side effects

Front 9

Motor innervation: Zygomatic branch
1) Muscles
2) Defect

Back 9

1) Lower orb oculi, procerus, nasalis (ala), LAO, ZM
2) Ectropion, no nostril flare, can't tightly close eyes

Front 10

Motor innervation: Buccal branch
1) Muscles
2) Defect

Back 10

1) Buccinator, nasalis (transverse), orb oris, LLS, LAO, ZM/ZMin, Risorus
2) Poor mouth seal (drooling), facial droop, muffled speech

Front 11

Motor innervation: Marginal mandibular
1) Muscles
2) Defect

Back 11

1) Orb oris, DAO, DLI, mentalis, platysma
2) Crooked smile *when smiling*; unable to evert lower lip

Front 12

Motor innervation: Cervical branch
1) Muscles
2) Defect

Back 12

1) Platysma
2) Unable to grimace

Front 13

Taste for anterior 2/3 of tongue?

Back 13

CNVII

Front 14

Taste for posterior 1/3 of tongue?

Back 14

CN IX

Front 15

Sensory for ant 2/3 of tongue

Back 15

CN V3

Front 16

Which is more medial - supratrochlear nn or supraorbital nn?

Back 16

Supratrochlear = towards the midline

Front 17

Nerve blocks of V2 and V3 - location of V2 nn block? v3 location?

Back 17

V2 - b/w 1st and 2nd premolar (intraoral) or 1cm below orbital rim midpupillary line.
V3 - b/w 1st and 2nd lower premolar (intraoral)

Front 18

To completely block the nose which two nn need blocking in addition to the infratrochlear nn?

Back 18

1) anterior ethmoidal n (external branch) - nasal tip
2) nasopalatine n - upper philtrum and columella

Front 19

Injecting just radial to the FCU will block which nerve?

Back 19

Palmar branch of the ulnar nerve

Front 20

How does one block the median nerve @ the wrist?

Back 20

Inject just radial or underneath the PL tendon @ the proximal crease (2-3 mL of lidocaine)

Front 21

Limit digital block volume to no more than X mL per finger?

Back 21

4mL total - 1mL for each dorsal and 1mL for each ventral; in practice 1mL on each side of the finger is fine

Front 22

Innervation of the fifth toe?

Back 22

Sural nerve - also the lateral sole

Front 23

Innervation of the majority of the toe skin?

Back 23

Superfical peroneal nerve

Front 24

Innervation between the first and second toes?

Back 24

Deep peroneal nerve

Front 25

Posterior tibial nerve innervates?

Back 25

Plantar Only (PO) - heel and middle of the sole of the foot

Front 26

How does one locate Erb's pt?

Back 26

Midpoint of mastoid -> angle of jaw line; down 6cm; post border of SCM; CN XI here + cervical plexus

Front 27

What defect would be expected with transection of the temporal branch?

Back 27

Brow ptosis and inability to raise the forehead

Front 28

The marginal mandibular branch is transected as it crosses the jawline. What defects would be expected?

Back 28

Drooling and a crooked smile (normal at rest). Located lateral to the insertion of DAO on the mandible

Front 29

What are the branches of the ophthalmic n? Name the two main branches, and each of their divisions.

Back 29

1) Nasociliary --> infratrochlear and anterior ethmoidal
2) Frontal --> supratrochlear and supraorbital

Front 30

Which nerve innervates the nasal tip? What is it's origin?

Back 30

Anterior ethmoidal; comes from the nasociliary branch of the ophthalmic n

Front 31

T/F - all local anesthetics are vasodilating

Back 31

True; cocaine is the only vasoconstricting one

Front 32

Which local anesthetics are pregnancy B in addition to lidocaine?

Back 32

Etidocaine and Prilocaine - both are amides

Front 33

What P450 metabolizes amide anesthetics?

Back 33

3A4 - A for Amide

Front 34

Bupivicaine and mepivacaine are pregnancy C because of what side effect?

Back 34

Bradycardia, fetal

Front 35

This anesthetic can oxidize hemoglobin to methemoglobin.
1) What is it?
2) What is it metabolized into (this metabolite is what causes the issue)
3) Can be used in children older than what age?

Back 35

1) Prilocaine
2) Orthotoludine
3) 1 year
Tx w/ IV methylene blue

Front 36

This anesthetic can cause cardiac toxicity unresponsive to cardiac resuscitation.

Back 36

Bupivacaine

Front 37

Which anesthetic has:
1) Fastest onset
2) Longest action

Back 37

1) Lidocaine
2) Bupivacaine

Front 38

Epinephrine is relatively or contraindicated in which 3 conditions?

Back 38

1) Pregnancy
2) Pheochromocytoma
3) Uncontrolled HTN

Front 39

Adding sodium bicarb to a local anesthetic has what effect on the following:
1) Pain
2) Stability @ room temp
3) Onset of action
4) Duration of action

Back 39

Pain - Decreased (pH increased)
Stability decreased
Onset quicker - closer to physiologic pH
Duration - increased

Front 40

Which local anesthetics are renally excreted?

Back 40

Ester = Renal and shorter action (R and S in the name clue you in); processing is plasma pseudocholinesterase
Amide = liver processing p450 3A4 and renal excretion

Front 41

Other than circumoral numbness, what are 3 other feature of early lidocaine toxicity?

Back 41

1) Metallic taste
2) Nausea
3) Diplopia, lightheadedness, emesis, talkativeness

Front 42

Treatment of choice for lidocaine induced seizures?

Back 42

BZD - diazepam

Front 43

EMLA should not be applied around the eye due to what potential complication?

Back 43

Alkaline injury to the cornea

Front 44

Is occlusion necessary with LMX?

Back 44

No

Front 45

What anesthetic has the shortest duration of action?

Back 45

PROcaine; "Pro's get in, get out and get the job done."

Front 46

What anesthetic has the longest ONSET of action?

Back 46

MEpivacaine; It takes forever to get ready because it's all about "ME."

Front 47

What anesthetic has the shortest ONSET of action?

Back 47

Lidocaine

Front 48

A Northbent scissors performs what additional function?

Back 48

Suture cutting; it has a cutout in the blade

Front 49

What is iodine's microbial coverage?

Back 49

Broad + spores

Front 50

Which antiseptic has residual action?

Back 50

Chlorhexidine; iodine, alcohol both have no residual

Front 51

This bacteriostatic antiseptic is teratogenic and neurotoxic to infants.

Back 51

Hexachlorophene

Front 52

How does isopropyl alcohol achieve antisepsis?

Back 52

Denaturation of proteins

Front 53

Which sterilization method can dull instruments?

Back 53

Steam autoclave; chemical autoclaves have lower humidity and do not have this side effect.

Front 54

Does dry heat sterilization dull metals?

Back 54

No, but it takes 7+ hours

Front 55

Is gas sterilization fast?

Back 55

No; it takes 1-7 days depending on what is being treated

Front 56

What organisms does cold sterilization fail to kill?

Back 56

Hep B and bacterial spores; not considered effective; instruments can't be stored/wrapped

Front 57

What cutaneous side effect is associated with ortho-pthalaldehyde?

Back 57

It stains the skin grey; a fast (10-15 min) cold sterilizer with broader spectrum of coverage

Front 58

Which absorbable suture has the highest tensile strength?

Back 58

Poliglecaprone 25 (Monocryl)

Front 59

Which absorbable suture has the lowest tissue reactivity?

Back 59

Poliglecaprone 25 (Monocryl)

Front 60

Aside from stainless steel, which nonabsorbable sutures have the lowest tissue reactivity?

Back 60

Polybutester (Novafil) and Polypropylene (Prolene)

Front 61

Which absorbable suture persists longest?

Back 61

PDS (polydioxanone)

Front 62

How are synthetic absorbable sutures are broken by the body?

Back 62

HYDROlysis

Front 63

How are natural absorbable sutures are broken by the body?

Back 63

PROTEOlysis (they are natural proteins)

Front 64

What is the reported cure rate for Mohs in recurrent BCCs?

Back 64

96%

Front 65

Describe the pathogenesis of BCCs?

Back 65

1) Inactivation of PTCH (TSG) --> increased SMO or SHH
2) CDKN2A loci (P16)
3) p53 point mutations

Front 66

Patients with Gorlin syndrome are at risk for what GYN tumor?

Back 66

Calcified multinodular ovarian fibroma

Front 67

Linear unilateral BCC syndrome presents with what?

Back 67

BCCs and comedones @ birth

Front 68

What is the 5 year risk of a 2nd BCC?

Back 68

40%

Front 69

Bazex-Dupre-Christol syndrome has which 3 other findings in addition to BCC?

Back 69

1) HYPOhidrosis
2) HYPOtrichosis
3) follicular atrophoderma

Front 70

What is the most common location of Fibroepithelioma of Pinkus?

Back 70

Lumbosacral back

Front 71

Gorlin syndrome patients have numerous bony abnormalities. Name two facial and two chest/extremity bony issues.

Back 71

Facial: broad nasal root, calcified falx, frontal bossing and odontogenic keratocysts (radiolucent)
Chest: Bifid ribs, pectus deformity, Albright's sign (shortened 4th metacarpal)

Front 72

After lymph nodes, where do cutaneous SCCs met?

Back 72

Lungs

Front 73

Perineural invasion by SCC carries a local recurrence rate of what? Met rate?

Back 73

47% local recurrence; 35% metastasis

Front 74

What factors of cutaneous SCC increase risk of metastasis?

Back 74

1) Lateral size > 2cm

Front 75

56% of BCCs have this mutation

Back 75

P53, a TSG

Front 76

What is the 5 year cure rate for BCCs primarily excised w/ 4mm margins?

Back 76

90%, 83% for recurrent BCC

Front 77

What is the 5 year cure rate for BCCs that have been ED&Cd?

Back 77

92-94%

Front 78

MMS is indicated for BCCs of what size? 1) Trunk 2) Face

Back 78

1) 2cm
2) 1cm
Also indicated for aggressive growth pattern, recurrent and high risk sites (ear, eye, genital, nose and temple)

Front 79

Which HPV types have been found in periungual SCC?

Back 79

Stiefel: HPV 16
ASDS: HPV 73

Front 80

SCC on the genitals assoc w/ what HPV types?

Back 80

6 and 11

Front 81

What is the cure rate of MMS for SCC: 1) >2cm 2) Poorly differentiated

Back 81

1) 75% (vs. 98% for <2cm)
2) 67% (vs. 97% for well diff)

Front 82

Keratoacanthomas arise from what skin structure?

Back 82

Theorized to be hair follicle derived

Front 83

In addition to P53 mutations in SCC, what other mutations can be seen with UV induced SCC?

Back 83

1) P16
2) P14
3) Ras oncogene mutations in PUVA associated SCC

Front 84

How many PUVA sessions are required to increase SCC risk?

Back 84

250; leads to Ras oncogene mutations and P53 TSG mutations

Front 85

Between cardiac and renal transplant patients, who is at higher risk of SCC?

Back 85

Cardiac > renal; in general 65x risk for transplant pts due to immunosuppression

Front 86

Oncogenicity of HPV isolates thought to be due to regulation of what viral oncogenes?

Back 86

E6 and E7

Front 87

Epidermodysplasia verruciformis (Lewandowsky-Lutz dysplasia) is a/w what HPV types?

Back 87

5 and 8

Front 88

What is the gene defect on EDV?

Back 88

EVER1 and EVER2 (chr. 17)

Front 89

Is oral retinoid use a/w decreased SCC?

Back 89

Yes; 30% decrease in 2003 study of 'substantial' oral retinoid use in PUVA patients; no effect on BCC

Front 90

KAs have 3 clinical stages: proliferative, mature and resolving; how long are the 1st and last stages?

Back 90

1) Proliferate over 2-4 weeks.
2) Resolve over 4-6 months

Front 91

Ferguson-Smith:
1) What is the tumor?
2) Mutation originated in what geographic area?
3) Inheritance?

Back 91

1) Sudden appearance of mult. eruptive KAs which slowly resolve and recur (starts in childhood)
2) Scotland, 3M:1F
3) AD

Front 92

Grzybowski type KA:
1) Adult or childhood?
2) Internal, external, both?
4) M:F?

Back 92

1) Adult
2) Both, cutaneous and mucosal
3) M:F
Be able to contrast w/ Ferguson-Smith

Front 93

What is the mechanism of imiquimod?

Back 93

Activates TLR-7 --> TNF-a, INF-a and IL-12 (incr. Th-1 cytokines); native ligand is ssRNA

Front 94

What is a new, rare side effect of imiquimod?

Back 94

Eruptive epidermoid cysts

Front 95

What is the MOA of 5FU?

Back 95

Inhibits thymidylate synthetase --> DNA synthesis

Front 96

What does p16 do?

Back 96

p16 is a TSG; it is required for cell cycle arrest; it works via the Rb pathway

Front 97

What does p14 do?

Back 97

p14 is a TSG; it downregulates mdm2; mdm2 downregulates p53, the 'master' TSG. Low mdm2 = high p53 = good.

Front 98

CDKN2A mutations are a/w what specific TSG issues?

Back 98

1) p14 broken --> incr. mdm2 --> decreased p53
2) p16 broken --> Rb not phosphorylated --> increased proliferation

Front 99

What chromosome contains CDKN2A?

Back 99

9p21

Front 100

What % do each of the following constitute of all MM:
1) SSM
2) ALM
3) NM
4) LMM

Back 100

1) SSM - 70%
2) ALM - 1-5%
3) NM - 15%
4) LMM - 5%

Front 101

What is the risk of developing a second primary melanoma after your first?

Back 101

3.5%-4.5%

Front 102

What is the overall risk of local recurrence of MM?

Back 102

4%

Front 103

What is the material used for lymphoscintigraphy in SLN Bx?

Back 103

99mtechnetium sulfur colloid + blue dye

Front 104

Electrocautery involves what type of current flow into the patient?

Back 104

None! Electrocautery is heat transfer (heat made my electrical charge)

Front 105

Which of the following are monoterminal? Biterminal?
1) Electrodessication
2) Electrocoagulation
3) Electrofulguration
4) Electrosection

Back 105

Monopolar: Electrodessication and electrofulguration
Bipolar: Electrocoagulation and electrosection

Front 106

Which of these has contact with the skin:
1) Electrodessication
2) Electrofulguration

Back 106

Electrodessication involves contact (monopolar); damped sine wave; ElectroFULguration is FAR away.

Front 107

This type of electrosurgery requires: 1) dry field
2) grounding pad

Back 107

ElectroCOAGULATION.; moderately damped sine wave

Front 108

What type of waveform is used in electrosection? How much heat is produced?

Back 108

1) Undamped; pure sine wave
2) Minimal heat

Front 109

Which electrosurgical modality uses high voltage?

Back 109

Electrodessication/fulguration; needs to make a spark across the air gap

Front 110

Which type of electrosurgery has the highest risk of pacemaker complications?

Back 110

Electrosection (undamped, low V, high amplitude, AC)

Front 111

What two common surgical chemicals should be avoided in electrosurgical cases?

Back 111

1) Alcohol preps
2) Aluminum chloride

Front 112

Boiling point of:
1) LN2
2) CO2(s)
3) NO(l)

Back 112

1) -196 C
2) -79 C
3) -90 C

Front 113

For maximum destruction freeze fast or slow?

Back 113

Freeze fast; thaw slow

Front 114

What is the recommended freezing temperature for malignant lesions?

Back 114

-50 C

Front 115

Keratinocytes die at what temp?

Back 115

-20 to -30 C

Front 116

Melanocytes die at what temp?

Back 116

-4 to -7 C

Front 117

Fibroblasts die at what temp?

Back 117

-30 to -35 C

Front 118

A graft is placed; What is the first stage; what happens?

Back 118

Imbibition; fibrin attaches graft to bed

Front 119

A graft is placed; What is the second stage; what happens?

Back 119

Inosculation; anastomoses form between vessels and graft

Front 120

A graft is placed; when does neovascularization take place?

Back 120

7 days

Front 121

A graft is placed; when does reinnervation begin?

Back 121

2 weeks

Front 122

A graft is placed; it blackens; what should you do?

Back 122

Nothing

Front 123

Graft dermabrasion can be performed as early as when?

Back 123

4-6 weeks

Front 124

T/F - tumor can grow through a STSG.

Back 124

True; good for placing on sites of high recurrence rate to allow for observation

Front 125

Composite grafts should be no larger than ? to decrease risk of central necrosis?

Back 125

2 cm; require high recipient bed vascularity; typ donor site is helical rim/crus

Front 126

What are the 4 stages of graft "take?"

Back 126

1) Blanching
2) Pale pink @ 6 hrs.
3) Blue @ 24 hours (venous congestion)
4) Pink @ day 7

Front 127

What is the purpose of a free cartilage graft?

Back 127

Maintain contour of a free margin such as a the alar rim

Front 128

Axial pattern flaps are based on?
1) Paramedian forehead flap blood supply?
2) Abbe flap blood supply?
3) Divided when?

Back 128

Name blood supply
1) SupraTROCHlear
2) Sup or Inf labial art
3) 3 weeks