Case Files 13-18 (C) Flashcards Preview

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Flashcards in Case Files 13-18 (C) Deck (75)
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1

A closed pocket containing pus

Abscess

2

A blister greater than 0.5 cm in diameter

Bulla (plural: bullae)

3

A closed, saclike, membranous capsule containing a liquid or semisolid material

Cyst

4

A discoloration on the skin that is neither raised nor depressed

Macule (large: patch)

5

A small mass of rounded or irregular shape that is greater than 1.0 cm

Nodule

6

A small, circumscribed elevated lesion of the skin that is less than 1.0 cm

Papule

7

A plateaulike, raised, solid area on the skin that covers a large surface area in relation to its height above the skin

Plaque

8

A lesion through the skin or mucous membrane resulting from loss of tissue

Ulcer

9

A small blister less than 0.5 cm in diameter

Vesicle

10

The single most important risk factor for the development of skin cancer is...

exposure to UV radiation

11

What are the 4 basic types of melanoma?

  1. Superficial Spreading Melanoma
  2. Lentigo Maligna
  3. Acral Lentiginous Melanoma
  4. Nodular Melanoma

12

The most common type of melanoma is...

Superficial Spreading Melanoma

 

Spreads superficially before penetrating (radial growth phase is slower than the vertical phase)

 

Common clinical features: raised borders and brown lesion with pink, whites, grays, or blues

13

Least common type of melanoma

 

Often found in the elderly (commonly diagnosed in the seventh decade of life)

 

*Most common form of melanoma found in Hawaii

Lentigo Maligna

 

Clinicaly characterized as tan to brown lesions with very irregular borders (found on sun-damaged skin such as the face, ears, arms, and upper trunk)

14

Most common melanoma found in African Americans and Asians

Acral Lentiginous Melanoma (think the one that starts with an "A")

 

Usually found under the nails, on the soles of feet, and on the palms of the hands. Common clinical features include: flat, irregular, dark brown to black lesions

15

Most aggressive form of melanoma

Nodular Melanoma

 

Usually invasive at the time of diagnosis. Clinically characterized as brown to black lesions that arise from nevi or normal skin

16

ABCDE of Melanoma

Asymmetry

Borders

Color

Diameter (>6 mm)

Elevation/Evolving

17

What is the next step for any new pigmented lesion that exhibits any of the ABCDE signs or any preexisting nevus that has changed?

Excision with 2-3 mm margin

 

*If pathology indicates a malignancy, the lesion should then be completely excised with 5 mm margins

18

The single most important piece of information for prognosis in melanoma is...

thickness of the tumor (Breslow measurement)

 

Melanomas less than 1 mm thick have a low rate of metastasis and a high cure rate with excision

19

Nevus in a patient with a history of actinic keratoses and HPV raises the risk of...

Squamous cell carcinomas

 

Have a higher rate of metastasis than BCC, but the risk is still low

20

Most common skin cancer

Basal cell carcinoma

 

Typically appear as pearly papules, often with a central ulceration or with multiple telangiectasias (bleeds and itches)

21

Which studies image the upper urinary tract?

i.e., the kidneys and ureters

 

Intravenous pyelogram (IVP)

or

CT

22

What study images the lower urinary tract?

i.e., the urinary bladder and urethra

Cystoscopy

23

The incidence of cancer presenting as asymptomatic microscopic hematuria is...

low

24

Define microscopic hematuria

The presence of three or more RBCs per HPF on two or more properly collected urinalyses

25

Urine samples showing significant proteinuria, erythrocyte casts, and dysmorphic RBCs

Likely glomerular hematuria

 

*Renal hematuria is also associated with proteinuria, but not with erythrocyte casts or dysmorphic RBCs

*Urologic hematuria is not associated with any of the three mentioned above

26

Routine screening for hematuria is

not recommended

27

The initial finding of hematuria by the dipstick method should be...

confirmed by microscopic evaluation of urinary sediment.

 

*the dipstick has limited specificity because it lacks the ability to distinguish RBCs from myoglobin or hemoglobin

28

How do you distinguish glomerular disease from interstitial nephritis?

RBC casts + dysmorphic RBCs = renal glomerular

 

Eosinophils = interstitial nephritis (often caused by analgesics or other drugs)

29

What medications can be given to reduce the risk of contrast nephropathy during an IVP or CT urography?

N-acetylcysteine or IV sodium bicarbonate

 

*Remember to take a CT scan without contrast first to detect calculi

30

What study can you give a patient with renal insufficiency to evaluate their upper urinary tract?

Retrograde pyelography combined with a renal ultrasound