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Rosens > 107. Dermatology > Flashcards

107. Dermatology Flashcards

1
Q

Epidermis: what is this layer and what is in it?

A

stratified squamous

keratinocytes rpgoressing basal to superficial layer

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2
Q

5 layers of epidermis

A

stratum basele
spinosum
granulosum
lucidum
corneum (superf)

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3
Q

Epidermis also includes L___ cells and m___

A

langerhans
melanocytes

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4
Q

Does epidermis have direct blood supply?

A

no
gets nutrients by diffusion through dermal epidermal junction

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5
Q

What important features does the dermis consistent of?

A

ct
blood vessels
lymphatic vessels
n endings
immune cells

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6
Q

Subcutaneous layer components

A

ct
adipose tissue

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7
Q

Physiologic functions of skin

A
  1. barrier
  2. homeostasis of temp
  3. absorption of UV rays and production of vitamin D
  4. sendation
  5. immunologic
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8
Q

Key hx factors in derm questions

A

onset
duration
exposure to allergens
changes
progression/regression
pain/itch/fever/sex hx/occupation/hobbies
pmhx

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9
Q

What are 5 main categories of rash

A
  1. Malignancy
  2. Immune
  3. Vaculitic
  4. Allergic
  5. Infectious
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10
Q

Nicholsky sign +

A

gentle rub of skin = slough of epidermis

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11
Q

Primary vs secondary lesions

A

primary - disease itself
secondary - factors like scratching, treatment, healing, complicating infection

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12
Q

When might tests be a good idea for rash? (general nonsevere illness)

A
  • secondary syphilis
  • mono (monospot)
  • Throat swab (rapid) and Culture for GAS
    -KOH prep
    -gram stain
  • ESR
    -bx
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13
Q

For pt with severe systemic illness, blood tests to do?

A

severe systemic illness
cbc
blood cultures

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14
Q

Macule

A

flat circumscribed pigmented area <0.5cm in diameter

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15
Q

Patch

A

flat circumscribed pigmented >0.5cm in diameter

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16
Q

Papule

A

elevated solid palpable lesion, variable color <.5cm in diameter

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17
Q

Plaque

A

elevated solid palpable lesion, variable color >0.5cm in diameter

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18
Q

Nodule

A

solid, palpable, subcutaneous lesion <0.5cm in diameter

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19
Q

Abscess

A

erythematous, fluctant, tneder fluid filled nodule of any size

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20
Q

tumor

A

solid palpable subcutaneous lesion >0.5cm in size (basically big nodule)

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21
Q

Vesicle

A

elevated thin walled, circumscribed clear fluid filled lesion <0.5cm in diameter

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22
Q

Bulla

A

elevated thin walled, circumscibed lesion >0.5cm in diameter

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23
Q

Pustule

A

elevated circumscribed, puruplent fluid filled lesion of any size

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24
Q

Petechiae

A

flat erythematous or violaceous nonblanching lesions <0.5cm in daimeter

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25
Q

Purpura

A

flat erythematous or violaceous nonblanching lesions, may be palpable <0.5cm in diameter

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26
Q

Scale

A

thickened area of keratinized epithelium

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27
Q

Crust

A

dried area of plasma pro resulting from inflamm

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28
Q

fissures

A

deep crackes in skin surface extending into dermis

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29
Q

Erosions

A

disruption of surface epithelium, usually linear, traumatic

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30
Q

Ulcer

A

deep erosion extending into dermis

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31
Q

Scar

A

dense collection of collagen a result of healing after trauma or procedures

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32
Q

Excoriation

A

linear erosions typically secondary to scratching or rubbing

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33
Q

infections

A

bacterial viral fungal or protozoal causing breaks in dermal-epidermal junction often erythematous

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34
Q

Hyperpigmentation

A

incr in melanin containing epidermal cells

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35
Q

lichenification

A

abnormally dense layer of keratinized epidermal cells

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36
Q

Atopic dermatitis infantile and atopic eczema adult areas affected?

A

face scalp flexor surface of extremities

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37
Q

Dermatomyositis area affected?

A

dorsal mcp joint
periorbital area

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38
Q

disseminated gonorrhea area effeced

A

distal extremities, near joints

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39
Q

erythema nodosum: where present?

A

anterior shins, ulnar surfaces

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40
Q

Herpes zoster where present?

A

dermatomal distribution, particularly trunk

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41
Q

Lichen planus: where present?

A

wrists
ankles
flexor surfaces

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42
Q

Nummular eczema where present?

A

distal extremities

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43
Q

Neurotic excoriations

A

extremities
face
upper back
neck

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44
Q

Pityriasis rosea where present?

A

trunk
extremities
in xmas tree pattern

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45
Q

Prophyria cutanea tarda where present?

A

sun exposed areas, hands, forearms, feet

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46
Q

Psoriasis where present?

A

extensor surfaces of extremities
sacral area

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47
Q

Sarcoidosis where present?

A

face
extremities
back

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48
Q

sebhorrheic dermatitis where present?

A

chest
nasolabial folds

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49
Q

secondary syphilis where present?

A

torso
palms
soles

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50
Q

SLE where present?

A

nose and cheeks
head and neck
photosens
alopecia

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51
Q

tinea versiciolor where present?

A

upper back and chest

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52
Q

Impetigo: 2 pain bugs

A

staph aureus
GAS

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53
Q

Impetigo: typical lesion description

A

single pustule and later to multiple lesions, often with golden yellow crust

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54
Q

Impetigo: itchy or painful?

A

itchy

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55
Q

What is a complication of strep impetigo?

A

postpyodermal acute GN

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56
Q

Staph vs strep Impetigo: differences?

A

staph is more superficial with less surrounding erythema

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57
Q

Impetigo: ddx

A

hsv
inflammatory fungal infections

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58
Q

Bullous Impetigo: caused by toxin of what bug?

A

staph

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59
Q

Bullous impetigo: initial skin lesion/presentation of lesions?

A

thin walled
1-2cm bullae
rupture leaving thin serous crust and collarette like remnant

face/neck/extremities often affected

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60
Q

Bullous impetigo: ddx

A

contact dermatitis
HSV infection
superficial fungal infections
pemphigus vulgaris

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61
Q

Impetigo: abx tx if mild?

A

bacitracin or mupirocin

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62
Q

Impetigo: abx tx if more severe (not MRSA)?

A

oral abx
docloxacillin or cephalexin

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63
Q

Impetigo: abx tx if more severe (MRSA)?

A

doxy
clinadmycin
septra

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64
Q

Tx of bullous impetigo:

A

dicloxacillin or erythromycin or azithromycin

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65
Q

Even without tx, impetigo usually resolves within…

A

3-6 weeks

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66
Q

Folliculitis defn

A

inflamm of hair follicle

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67
Q

Folliculitis appearance

A

pustules with central hair in sites such as buttocks, thigh, beard or scalp

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68
Q

Folliculitis: itchy or painful

A

mild pain

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69
Q

Folliculitis ddx

A

acne
keratosis pilaris
fungal infection

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70
Q

What kind of folliculitis can occur after hot tub use or swimming pools, or in inds on antibiotics for acne?

A

gram negative pseudomonas

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71
Q

Folliculitis treatment local

A

antiseptic cleanser to area like povidone-iodine/chlorhexadine

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72
Q

Folliculitis treatment - extensive

A

antiseptic cleanser to area like povidone-iodine/chlorhexadine

and

doxy or dicloxacillin

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73
Q

Cellulitis: defn

A

localized erythema, swelling and pain of ST

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74
Q

Erysipelas: defn

A

strep infection of skin and subcut tissue, typically erythematous appearance with well demarcated border

often fever malaise and myalgias

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75
Q

___ may be a useful tool to differentiate a cellulitis from a abscess

A

ultrasound

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76
Q

Mild case of cellulitis: tx

A

cephalosporin or dicloxacillin or clinda

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77
Q

IV abx for treatment of cellulitis?

A

penicillin
ceftr
cefazolin
clindamycin

severe = piptazo

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78
Q

Abscess defn

A

accumulation of pus within body tissues

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79
Q

What is a furuncle?

A

skin abscess caused by staph infection involving hair follicles and surrounding tissue

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80
Q

Abscess: findings?

A

localized soft tissue swelling erythema and fluctuance

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81
Q

What will you see that is consistent with abscess on ultrasound?

A

fluid filled cavity from cellulitis: cobblestoning with fine reticular (net like) areas of hypoechoic stranding

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82
Q

Carbuncles: defn

A

large abscess that develop in the thick, inelastic skin on back of neck, back or thights involving multiple hair follices

can cause sepsis!!

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83
Q

Abscess treatment - mild?

A

I+D + septra or clinda

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84
Q

Mod and severe abscesses - treatment?

A

I+D
culture and sn
IV abx - vanco, dapto, linezolid

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85
Q

Hidradentitis suppurativa - defn?

A

sweat gland current abscess formation in axilla, groin resembling a furuncle

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86
Q

Hidradentitis suppurativa - when to tx?

A

fluctuant, painful and large for drainage

topical clinda for 3mo or if severe: oral cinda with rifampin 3-6mo +/- antiandrogen therapy if cont

recurrent - surgical management

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87
Q

Oral agents effective against MRSA

A

septra
doxy
clindamycin
minocycline

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88
Q

IV agents effective against MRSA

A

meropenem/ertapenem
clinda
linezolid
dapto
vanco

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89
Q

Ertyhema migans: cause?

A

Borelia burgdorferi from lyme disease

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90
Q

Erythema migrans: clinical stages - how many?

A

3

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91
Q

Lyme disease: stage I

A

early

malaise, headache, fever, LN incr, arthalgias

60-80% erythema migrans

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92
Q

Lyme disease: stage 1 resolves within?

A

4 weeks

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93
Q

Erythema migrans: what does this look like?

A

erythematous annular nonscaling lesion with a central clearing

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94
Q

Lyme disease: stage II

A

secondary annular lesion
fever
LN incr
neuro maingestations
cardiac conduction abn

last weeks to months

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95
Q

Lyme disease: stage III

A

chronic arthritis
dermatitis
CNS disease

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96
Q

Lyme disease: diagnostic tests

A

elevated ESR
serologic tests - two tiered system of ELISA and reflexive immuno blotting

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97
Q

Lyme disease: management

A

doxy or amox for 10-21d

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98
Q

Lyme disease: abx options

A

doxy
amox

clarithromycin
cefuroxime
erythromycin
azithromycin

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99
Q

Necrotizing fasciitis: what is this?

A

polymicrobial or monomicrobial (GAS, CA-MRSA) severe toxicity infection

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100
Q

Necrotizing fasciitis: radiographic test findings?

A

air

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101
Q

Necrotizing fasciitis: abx?

A

pip tazo or carbapenem
with vanco or linezolid
with clinda to kill active toxin first!!

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102
Q

Cutaneous findings with meningococcal infection?

A

macules
papules
vesicles
petechiae and purpura

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103
Q

10% of pt may present with Waterhouse-Friderichsen syndrome: what is this?

A

meningits AND shock with intracutaneous hemorrhage

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104
Q

Scarlet fever: bug cause?

A

GAS

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105
Q

Scarlet fever: distinct rash?

A

begins on chest - rough sandpaper like texure due to multitude of tiny papules
spreads rapidly within 24 hours

circumoral pallor

+ may have erythamtous lesions on palate of pharynx

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106
Q

in 10% of scarlet fever cases what kind of annular, erythematous lesions may you see that transient and reappear over days, weeks or months?

A

erythema marginatum

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107
Q

Treatment of scarlet fever and sandpaper rash?

A

oral pen VK 250mg PO BID or TID x 10d
adol-adults QID dosing orb 500mg BID x10d

or IM benzathine penivillin 600 000 units if <27kg vs >/= 1.2 millon units 1x dose

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108
Q

Scalet fever pt allergic to penicillin, treatment ?

A

erythromycin
macrolide
cephalosporin

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109
Q

Syphilis primary lesion

A

chancre singel or multiple at site of inoculation

papule –:> ulcer approx 1c diameter with central base and raised borders

PAINLESS unless secondary infection
has PAINLESS lymphadenopathy

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110
Q

Secondary syphilis lesions

A

erythematous or pink maucles or papules in a symmetric distribution

pigmented macules/papules on palms and soles

moist/flat/verrucous condyloma lata in genital area

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111
Q

Primary and secondary syphilis, early latent treatment

A

benzathine pen B 2.4 milion units IM

vs doxy and azithro if ++ allergic

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112
Q

Late latent and tertiary tx of syphilis?

A

benzathine pen B 3 x 2.4 million units IM at weekly intervals for a total of 7.2 million units

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113
Q

Jarisch Herxheimer reaction

A

symtpoms of fever, headache and malaise after tx of syphilis

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114
Q

Disseminated gonococcal infection: lesions

A

periarticular regions of distal extremities starting as erythematous or hemorrhagic papules, into pustules and vesicles with erythematous halo

tender

gray necrotic or hemorrhagic centre

crusty after 4-5 days

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115
Q

Disseminated gonococcal infection: tx

A

culture from wound

ceftr 1g IVq24h

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116
Q

Staphylococcal scalded skin syndrome (SSSS): typically occurs in children of what age?

A

</=6

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117
Q

Staphylococcal scalded skin syndrome (SSSS): what is it caused by?

A

exotoxin producing staphylococci

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118
Q

Staphylococcal scalded skin syndrome (SSSS): illness begins with what findings?
progression of findings?

A

erythema and crusting around mouth

then spreads down body, followed by bulla formation and desquamation
desquamation
lesions dry up and clinically resolve 3-7d

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119
Q

Staphylococcal scalded skin syndrome (SSSS): what is typically spared?

A

mucous membranes

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120
Q

Staphylococcal scalded skin syndrome (SSSS): treatment

A

vancomycin
nafcillin
oxacillin

vs allergy: clarithromycin or cefuroxime

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121
Q

Toxic shock syndrome: what is this?

A

acute febrile illness characterized by diffuse desquamating erythroderma

fever, hypotension, constitutional symptoms and multiorgan involvement

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121
Q

Toxic shock syndrome (TSS): bug?

A

exotoxin producing staph aureus

or GAS

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122
Q

Toxic shock syndrome (TSS): causes

A

mentruation/tampon use
burns/post op
postpartum
OM
arthritis
empyema
fasciitis
septic abortion
pharyngitis
peritonsillar abscess
sinusitis
subcutaneous abscess

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123
Q

Toxic shock syndrome (TSS): diagnosis requires which 4 criteria?

A
  1. temp of at least 38.9
  2. hypotension (SBP 90 or less)
  3. rash
  4. involvement of at least 3 organ systems
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124
Q

Toxic shock syndrome (TSS): typical rash?

A

diffuse
blanching
macular erythroderma
nonexudative mucous membrane involvement is common

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125
Q

Toxic shock syndrome (TSS): when does rash fade?

A

within 3d

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126
Q

Toxic shock syndrome (TSS): once rash fades, where does desquamation occur?

A

hands and feet

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127
Q

Toxic shock syndrome (TSS): initial treatment

A

IV fluid
ventilatory support
pressors PRN
abx - clinda, vanco, linezolid, imipenem, mero, pip tazo are all options

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128
Q

Rocky Mountain spotted fever: bug?

A

ricketsia rickettsii
by tick saliva

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129
Q

Rocky Mountain spotted fever: onset of illness abrupt with what sx?

A

headache
n/v
myalgias
chills
fever

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130
Q

Rocky Mountain spotted fever: may last 3 weeks: what are the predominant organ systems involved?

A

cns
cardiac
pulmonary
GI
renal
DIC
shock

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131
Q

Rocky Mountain spotted fever: when does a rash develop (ie what day?)

A

2-6th day

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132
Q

Rocky Mountain spotted fever: rash appearance?

A

erythematous macules that blanch on pressure
first seen on wrist and ankles
then up extremities to trunk and face which becomes petechial or hemorrhagic
*have lesions on palms and soles

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133
Q

Rocky Mountain spotted fever: dx typically?

A

clinical

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134
Q

Rocky Mountain spotted fever: tx?

A

doxy
children <9 - chloramphenicol

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135
Q

Rocky Mountain spotted fever: what abx makes this worse?

A

sulfa drugs

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136
Q

Rocky Mountain spotted fever: what disease looks similar to this but is also treated with doxycylcine?

A

ehrlichiosis

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137
Q

HSV characteristics of lesions

A

painful grouped vesicles on an erythematous base
clustered, nondermatomal region

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138
Q

MC HSV1 area?

A

mouth

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139
Q

HSV: what is this called when on hand?

A

herpetic whitlow - distal phalanx typically

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140
Q

HSV: 1 typically heals within how many days (unless bacterial infection)

A

7-14d

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141
Q

HSV: 2 - presentation in men

A

either single or multiple vesicles or erosions on penile sahft/glans

+ regional adenopathy, fever, malaise

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142
Q

HSV: 2 in women presentation?

A

herpetic cercivitis or vaginitis - pelvic pain, dysuria, vaginal discharge

143
Q

HSV treatment

A

acyclovir, famciclovir or valacyclovir
*reduce duration of viral shedding, accel healing and shorten sx duration but have no effect on recurrence

144
Q

HSV: when to give IV treatment?

A

immunocompromised
mucocutaenous infection in this patients is deadly

145
Q

Varicella zoster: incubation period?

146
Q

Varicella zoster: skin lesions?

A

macules ot papules to vesicles to crusting sometimes within several hours

vesicle = 2-3mm in diameter, surrounded by erythematous border - drying = umbilication

on the trunk, scalp, face or extremities

147
Q

Hallmark of Varicella zoster:

A

lesions of all three types in one area: macules to papules to vesicles to crusting sometimes within several hours

148
Q

Varicella zoster: complications of disease?

A

encephalitis
meningitis
pneumonia
secondary staph or strep cellulitis
thrombocytopenia
arrhtirits
hepatitis
GN

149
Q

Varicella zoster: treatment generally?

A

symptomatic

oral acyclovir is effective if start within 24 hours of development of rash for pt with chronic resp or skin disease

150
Q

Varciella: oral acyclovir is effective if start within __ hours of development of rash for pt with chronic resp or skin disease

151
Q

When is varicella contagious until?

A

all lesions are no longer vesicular - dry and crusted

152
Q

Varicella: who is a candidate for IG?

A

high risk ind within 10d (ideally 4d of exposure)
-immunocomp
-pregnant

153
Q

When to vaccinate for varicella?

A

age 1-13y
older children 2 dose sep by 4-8 weeks

154
Q

Herpes zoster: how does this occur?

A

reactivation of varicella in the dorsal root ganglion

155
Q

Risk factors for Herpes zoster:

A

female
white
family hx
comorbidities: autoimm disease, asthma, DM, COPD

156
Q

Herpes zoster: what may preceed the rash?

A

dermatomal pain 1-10d prior

157
Q

Herpes zoster: typical rash?

A

grouped vesicles on an erythematous base involving one or several adjavent dermatome thorax > trigeminal

158
Q

Herpes zoster: peak incidence age

159
Q

Herpes zoster: complications

A

cns involvement
ocular infection *typically trigeminal area
stroke
meningoencephalitis
myelitis
peripheral neuropathy
MI

160
Q

Herpes zoster: eye involvement issues

A

conjunctivits to panopthalmitis - treatens vision
fluoroscein exam shows corneal dendritic lesions

can produce anterior uveitis, secondary glaucoma, optic neuritis, corneal scarring

161
Q

Herpes zoster: what is Hutchinson sign?

A

close correlation between vesicles on tip of nose and eye involvement

so be wary for this

162
Q

Herpes zoster: when are antiretrovirals reasonable

A

disease started within 48h

163
Q

Herpes zoster: IV for ..

A

disseminated

164
Q

Herpes zoster: ocular manifestation treatment?

A

acyclovir
opthalmology for mydriasis and topical CS

165
Q

Herpes zoster: posterherpetic neuralgia treatment

A

opioids
capcaisin topical
topical or oral gabapentin
TCA

if >60y: vaccine

166
Q

Viral exanthems - over 30 can cause this - some common names?

A

coxsackie
echovirus
adenovirus

167
Q

Viral exanthems - rash appearance

A

most maculopapular
can also be scarlet
erytematous
vesicular
petechial

168
Q

Viral exanthems - 5 classic names?

A
  1. measles/rubeola
  2. rubella (german measles)
  3. HSV6 - roseola
  4. parvo B19 (5th disease/erythema infectiosum)
  5. enteroviruses (echo, coxsackie)
169
Q

Roseola: which herpes viruses cause this?

170
Q

Roseola: common in which age group?

171
Q

Roseola: clinical features?

A

abrupt onset temp 39 to 41 for. 3-4 days
then when fever stops, rash starts on trunk, spread to neck and extremities: discrete pink, rose colored macules or maculopapules, blanch on pressure with rare coalescence

172
Q

Roseola: rash specifics

A

then when fever stops, rash starts on trunk, spread to neck and extremities: discrete pink, rose colored macules or maculopapules, blanch on pressure with rare coalescence

173
Q

Roseola: rare but important complication?

A

encephalitits

174
Q

Roseola: tx?

A

none - kiddo actually looks quite well, px is excellent

175
Q

Measles/rubeola: when are people considered contagious (ie spread by infectious droplets, how many days pre and post infectious?)

A

5d pre sx
until 5-6 days onset of derm involvement

176
Q

Measles/rubeola: 3C’s

A

cough
coryza
conjunctivitis

177
Q

Measles/rubeola: second day of illness can see Koplik spots - what are these?

A

pathognomonic of disease
buccal mucosa as small irregular bright red spots with bluish white centers, can extend to oropharynx

178
Q

Measles/rubeola: cutaneous eruption presents on day 3-5: what do these look like and where?

A

maculopapular lesions on forehead and upper neck to face, trunk, arms and then legs and feet

179
Q

Measles/rubeola: complications of disease

A

otitis media (MC)
encephalitis
penumonia

180
Q

Measles/rubeola: tx?

A

supportive: antipyretics, hydration and tx of pruritis

Vitamin A to hosp pt at dx and repeat second day

181
Q

Measles/rubeola: postexposure prophylaxis tx?

A

masles virus vaccine or Human IG

182
Q

Rubella/German Measles: common sx?

A

fever
skin eruption
generalized lymphadeopathy

183
Q

Rubella/German Measles: common in what season?

A

winter spring

183
Q

Rubella/German Measles: incubation period?

A

14-21
max communicability is few days before and 5-7 days after onset of rash

184
Q

Rubella/German Measles: rash

A

red maculopapules on face then to neck, trunk, extremities

trunk - may coalesce but on extremitites do not

usually no desquamation

185
Q

Rubella/German Measles: major complications

A

encephalitis
arthritis
thrombocytopenia

186
Q

Rubella/German Measles: if pregnant, effects on fetus?

187
Q

Rubella/German Measles: tx?

A

generally none

antipyretics to. tx headache, athralgias and painful lymphadenopathy

188
Q

Erythema infectiosum/Parvo B19/Fifth disease: sx?

A

mild - fever, rash
adults get athralgias and arthritis maybe too

189
Q

Erythema infectiosum/Parvo B19/Fifth disease: specific rash?

A

intesnely red on cheks with slapped cheek appearance, cirfcumoral pallor

reticular maculopapuler eruption which may be noted on arms to trunk, buttocks and thighs

can recur with temp change or exposure to sunlight

190
Q

Erythema infectiosum/Parvo B19/Fifth disease: incubation period

191
Q

Erythema infectiosum/Parvo B19/Fifth disease: management?

A

supportive

192
Q

Fungal infections: 1439

193
Q

Tinea corporis: common name?

194
Q

Tinea corporis rash presentation?

A

Sharply marginated, annular lesion with raised vascular margins and a central clearing. Can be multiple or single.

195
Q

Tinea corporis differential diagnosis

A

Erythema migraines (associated with Lyme disease), granuloma, annular, psoriasis, cellulitis, erythrasma

196
Q

Tinea corporis treatment of body, groin, extremities

A

Clotrimazole, miconazole, turbine, BID or TID for one to three weeks

197
Q

Tinea capitis: presentation?

A

Maybe seen with alopecia typically with thick and scaly, scalp, broken hair, resembling black dots near the scalp may be seen.

198
Q

Tinea capitis: complications?

A

Kerion formation, lymphadenitis, bacterial, cellulitis, or abscess, scarring alopecia

199
Q

Tinea capitis: differential diagnosis?

A

Alopecia Arietta (alopecia without scalp changes)
A topic dermatitis (patches of thicken skin with scale)
Nummular, eczema (eczema in small circle patterns)
Bacterial infection, leg, cellulitis, or abscess.
Psoriasis open erythema patches with silvery scale)
Seborrheic Dermatitis yellow, or white patches)
Trichotillomania

200
Q

Tinea capitis: treatment

A

Systemic antifungal leg turbine (less than 25 kg: 125 mg per day PO for six weeks, 25 to 35 kg: 187.5 mg per day PO for six weeks, greater than 35 kg: 250 mg PO for six weeks.)
Alternative medication: itraconazole, fluconazole, griseofulvin

Topical treatments include selenium sulfide, ketoconazole shampoo

Follow up with dermatology or primary care in four weeks

201
Q

Kerion: what is this?

A

Fungal infection, affecting hair follicles that is characterized by intense inflammation, and a boggy ear thymus mass, typically affecting the scalp. Can have pus.

Usually affects the scalp.

202
Q

Kerion - treatment?

A

Same as Tinea capitis with systemic antifungal agent for 6 to 8 weeks

203
Q

Tinea pedis: findings?

A

Scaling, maceration, vesiculation, Fishering between the toes and on the plantar surface of the foot

204
Q

Differential diagnosis of Tinea pedis:

A

Contact dermatitis, dyshidrotic eczema

Use KOH prep to differentiate

205
Q

Tinea pedis: treatment

A

Topical antifungal agent such as terbafine, one percent cream, BID for one to two weeks

Other options:Miconaze cream, clotrimazlkd cream

Severe disease: systemic therapy terbafine, fluconazole, griseofulvin

206
Q

Tinea vesicular: what is this and what fungal caused?

A

Malassezia superficial fungal infection superficial hypo, pigmentation, or hyper pigmentation patches on the chest and trunk primarily

Can be pink, tan, or white

Itchy

207
Q

Tinea vesicular: treatment

A

Topical antifungal agent 2.5% selenium sulphide shampoo applied for one week

If this fails then can do systemic treatment, such as fluconazole

208
Q

Tinea unguium/onychomycosis: what might be predisposing factors?

A

Paronychia
Untreated tubes pedis

209
Q

Tinea unguium/onychomycosis: presentation?

A

Toenails or fingernails that are thickened, opaque, cracked or destroyed.
Nail may contain yellowish longitude, no streaks.
Nail of the great toes, most commonly involved

210
Q

Tinea unguium/onychomycosis: when can you consider using topical antifungal agents for treatment?

A

One less than 25% of the nailbed is involved, fingernails respond better than toenails.
Involvement of one or two nails

211
Q

Tinea unguium/onychomycosis: more extensive therapy options for which risk factors?

A

Advanced age,
Diabetes
Immunity suppression
Widespread infection

Treated with terbafine 250 mg PO daily for six weeks or 12 weeks if it’s a toenail,itraconazole 200 mg POB for one week then repeated for four weeks for two months of a fingernail or 12 weeks if it’s a toenail

212
Q

Risk factors for candidiasis

A

Diabetes
HIV
Pregnancy
Obesity
Smoking
Malnutrition
Malignancy.
Treatment with corticosteroids, antibiotics or immune suppressive agents

213
Q

Where does candidiasis most commonly affect?

A

Mouth – thrush

214
Q

Candida presentation

A

White or gray friable material covering an erythematous space on the buccal mucosa, gingiva, tongue, pallet or tonsils

215
Q

differential diagnosis of oral candidiasis

A

Like in plain, which is typically not easily scraped off
Harry leucoplakia which is white patches on the lateral tongue

216
Q

Oral mucus membrane infection with candida? Is an aids, defining illness.

217
Q

Treatment of oral candidiasis

A

Topical antifungal like clotrimazole five times daily or oral nystatin suspension four times daily times 5 to 7 days

218
Q

Treatment of oesophageal candidiasis

A

Systemic antifungal therapy: oral fluconazole or IV, iv amphotericin B

219
Q

Where does cutaneous candidiasis typically affect?

A

Androgenous areas: interdigital, web spaces, groin, axilla, and intergluteal or inter-mammary folds

220
Q

cutaneous candidiasis lesion appearance

A

Moist, bright, red macules rimmed with a collarette of scale with small satellite, pules or pustules, just peripheral to the main body of the rash

221
Q

cutaneous candidiasis differential diagnosis

A

Contact dermatitis.
Tinea Curtis
Trio
HSV
Flick Yallitis

222
Q

cutaneous candidiasis intertrogenous lesions versus widespread infection treatment

A

Topical imidazole cream like clotrimazole
Ketoconazooe

Wide spread - fluconazole 100 mg PO daily for two weeks or itraconazole 100 mg PO daily for two weeks

Keep the area dry

223
Q

Vulvovaginal candidiasis: predisposing risk factors

A

Diabetes.
Pregnancy
Immunosuppression.
Hormone replacement therapy.

224
Q

Vulvovaginal candidiasis common complaints

A

Itching.
Dysparuenia
Area.
Vaginal burning

225
Q

Vulvovaginal candidiasis treatment

A

Over-the-counter intravaginal clotrimazole or single 150 mg dose of oral fluconazole

226
Q

Sporotrichosis: what is this?

A

Fungal infection that may be transmitted by contact with soil, zoonotic transmission from animals, such as snakes, birds, cats

227
Q

Sporotrichosis: physical exam presentation

A

Lymphocutaneous findings like pills, nodules, ulcerations

228
Q

Sporotrichosis: diagnosis and treatment

A

Serologic testing.
Itraconazole 200 mg PO daily two weeks after lesions have resolved usually 3 to 6 months

Alternatives include oral agents Terbafine, iv amphoteraxin B

229
Q

Scabies: Paige 1441

230
Q

Scabies - what is this?

A

Fomite infection intertrigenous areas causing intense pruritis, typically seen in winter months. Between fingers common

231
Q

Scabies - what is this?

A

Fomite infection intertrigenous areas, papules and pustules causing intense pruritis, typically seen in winter months. Between fingers common

232
Q

Scabies: is crusted lesions contagious?

233
Q

Scabies: is crusted lesions contagious?

234
Q

Scabies ddx

A

pityriasis rosea (sym-metric maculopapular rash), papular urticaria, secondary syphilis (symmetric maculopapular rash), folliculitis, contact dermatitis, atopic dermatitis, seborrhea, dermatitis herpetiformis (autoimmune blistering disorder associated with celiac disease), lichen planus (pruritic violaceous polygonal lesions on the extremities), and psoriasis

235
Q

Scabies ddx

A

pityriasis rosea (sym-metric maculopapular rash), papular urticaria, secondary syphilis (symmetric maculopapular rash), folliculitis, contact dermatitis, atopic dermatitis, seborrhea, dermatitis herpetiformis (autoimmune blistering disorder associated with celiac disease), lichen planus (pruritic violaceous polygonal lesions on the extremities), and psoriasis

236
Q

Scabies treatment

A

Topical permethrin 5% cream to affected areas at nighttime, then again 1-2 weeks later

If still, then oral ivermectin

Treat close contacts

Wash everything

237
Q

Scabies treatment

A

Topical permethrin 5% cream to affected areas at nighttime, then again 1-2 weeks later

If still, then oral ivermectin

Treat close contacts

Wash everything

238
Q

Pediculosis commonplace name

239
Q

Pediculosis commonplace name

240
Q

How long can lice live on fomites?

241
Q

How long can lice live on fomites?

242
Q

Ddx pediculosis

A

The differential diagnosis includes conditions such as tinea capitis, seborrheic dermatitis, atopic

243
Q

Pediculosis dx

A

Findings of lice on hair shaft

244
Q

Treatment lice

A

Permethrin 1% shampoo day one and nine or oral ivermectin with high treatment rate

Nit removal from hair

Clean everything by boiling/heat

245
Q

Bed bugs: what kind of bug can they carry that is MRSA R?

246
Q

Clinical presentation of a bed bug?

A

erythematous welt, macule papule urticaria purpura vesicle or bullae with intese pruritis
usally arms legs shoulders
resolve 1-2 weeks

247
Q

Symptomatic tx of bed bugs?

A

antihistamine
topical CS

248
Q

Contact dermatitis: what is this?

A

inflammatory reaction of skin to chem, physical or biologic agent that acts as irritant to skin

249
Q

Allergic contact dermatitis: ? hypersensitivity reaction?

250
Q

Common causes of irritant dermatitis

A

caustics
industrial solvent
detergents

251
Q

common cause of allergic contact dermatitis

A

clothing
jewelery
soaps
cosmetics
latex
plants
meds

252
Q

MC allergens include ? compounds (5)

A

rubber
poison ivy/oak - toxicodendron species
nickel
paraphnylenediamine (stabilizer in topical meds)

253
Q

Primary lesions of contact dermatitis

A

papules
vesicles
bullae on an erythematous base
streaky linear intensely pruritic lesions are characteristic

254
Q

Tx contact dermatitis

A

avoid irritant/allergen
tx of resulting inflamm with low potenciy topical steroid around orifices

medium potency creams can be used elsewhere

255
Q

What 4 mediators play a role in urticaria?

A

histamine
bradykinin
kallikrein
ach

256
Q

Causes of urticaria

A

meds - penicillin and aspirin common
food
textiles
animal danger and saliva
plants
topical meds
chemicals
cosmetics
viruses
inhaled pollen/mold/dander
stings/insect bites
systemic autoimmune disease/malignancy

257
Q

What systemic diseases can cause urticaria?

A

SLE
lymphoma
carcinoma
hyperthyroidism
rheumatic fever
juvenile RA

258
Q

Cold urticaria - familial or acquired - underlying illness that can cause this?

A

cryoglobulinemia
cryofibrinogenemia
syphilis
CTD

259
Q

Cholinergic urticaria - common findings?

A

wheals 1-3mm in daimeter surrounding by extensive erythematous flares and occassional satellite lesions

tx with cetirizine

260
Q

Urticaria lesion defn

A

erythematous plaque with pale centers and red borders
last <24h

261
Q

DDX urticaria

A

drug eruption
exanthems
erythema multiforme
erythema marginatum
JRA

262
Q

Poison ivy - what is common pattern?

A

vesicular or bullous eruption with oozing/crusting/scaling and fissuing

localized vs asymmetric vs linear, vs unilateral vs disseminated

mucous membranes spared

263
Q

Poison ivy - other sensitizations to ?

A

cashew
mango
laquer
gingko tree

264
Q

poison ivy - Tx like which diease

A

Contact dermatitis:

+ CS (systmeic)

wash all clothes

265
Q

MC type of hypersensitivity reaction with drug reactions? (2)

A

immediate - type 1
delayed - type IV

266
Q

MC drug reaction (rash appearance)?

A

morbilliform rash
urticaria
fixed drug eruption

267
Q

List 10 severe skin reactions from drug reaction?

A

vasculitis
erythema nodosum
angioedema
anaphylaxis
SJS
Toxic epidermal necrolysis
blistering dermatoses
drug induced lupus
lichenoid drug eruptions
psoriasiform drug erruptions
drug induced neutrophili dermatoses (Sweet syndrome, pyoderma gangrenosum)
cutaneous lymphoma like drug reaction

268
Q

Toxic epidermal necrolysis: what is this?

A

> 30% BSA vs SJS <10

separation of large sheets of epidermis from underlying dermis

269
Q

Causes of TEN disease?

A

meds
infection
malignancy
idiopathic

270
Q

Common drugs causing TEN?

A

sulfa drugs
nsaid
penicillin
aspirin
barbituates
phenytoin
carbamezapine
allopurinol

271
Q

Risk factors for poor px of TEN?

A

> 40yoa
underlying malignancy
HR >120
initial percent epidermal attachemnt >10%
bun >10
BG >252mg/dl
bicarb <20mmol/L

272
Q

TEN rash

A

macular fash may appear as target lesions, typically extremities
exanthem than confluent and nikolssky sign +
painful to touch skin
MM + - erythema, blister, sloughing or necorsis

273
Q

TEN common other organs effected rather than just skin?

A

renal
GI
resp

274
Q

Tx of SJS/TEN

A

stop drug
supportive care: hydration, prevent secondary infection
pain control
wound management, typically best at burn centre

275
Q

Meds that may be involved in SJS/TEN?

A

systemic steroid
ivig
cylclosporin A
plasmapheresis with specialist

276
Q

Drug Reaction with eosinophilia and systemic symptom (DRESS) syndrome: what is this?

A

morbilliform skin eruption
fever
LN incr
hematolic abn - eosinophili, atypical lymphocytosis and internal organ involvement

277
Q

Common inciting events for DRESS

A

anticonvulsants
abx
allopurinol

278
Q

DRESS onset after meds?

A

2-8 weeks post

279
Q

DRESS tx

A

stop med
tx systemic steroids

280
Q

Atopic dermatitis: what is this?

A

eczema/chronic dermatitis

281
Q

Atopic dermatitis: mechanism?

A

abnormalties of H and T cell immunity *humeral, cell mediated): eosinophil/mast cell/lymphocyte activation triggered by inc production of IL4 by specific T helper cells

282
Q

Atopic dermatitis: dx criteria?

A

itchy skin + 3 or more: generalize dry skin in past year, hx of asthma or hay fever, onset rash before 2y, flexural dermatitis

283
Q

Atopic dermatitis: hallmark of disease?

A

intense pruritis

284
Q

Atopic dermatitis: tx

A

emollient to tx dryness
betamethasone on body (flourinated CS), mild steroid 0.025% triamcinolone ointment face or intertrigous area

285
Q

Atopic dermatitis: susceptible to which infections?

A

molluscum contagiosum
HSV
recurrent staph

286
Q

Pityriasis Rosea: what does this look like?

A

multiple pink or pigmented oval papules or plaques 1-2cm in diameter on trunk and proximal extremities

hx larger/herald patch pre excuption
mild scaling

lesions parallel to rubs (xmas tree like distrubtion on trunk and extremities)

287
Q

Pityriasis Rosea: itchy?

A

not usually

288
Q

Pityriasis Rosea: ddx

A

tinea coroporis
guttate psoriasis
lichen planus
drug eruption
lyme
secondary syphilis

289
Q

Pityriasis Rosea: tx?

A

self limiting, resolves 8-12 weeks
recurrence rare
supportive caare - zinc oxide or calamine location for itching

severe - may steroids but talk to derm

290
Q

Kawasaki disease: what type of disease is this?

A

vasculitis

291
Q

Kawasaki disease: phase I: findings

A

acut fever lasting ~12d
cutaneous findings- erythematous lesions palms and soles, into blotchy erythematous macular lesions on extremities and trunk
non exudative conjuntivae 1-3 weeks
sttrawberry tongue and pharyngeal erythema
diarrhea, arhtritis, photophobia

292
Q

Kawasaki disease: subacute ph II

A

desquamation
thrombocytosis
arhtritis
arthralgias
carditis

may last 30d

high risk sudden death in this phase

293
Q

Kawasaki disease: phase III convalescent

A

8-10weeks post onset
coroanry anuesym [possible this phase

294
Q

Defn of kawasaki: specific:

A

pt with ever >/=5d duration and presence of at least 4/5:
1`. rash
2. cervical LN (at least 1.5cm)
3. bil conjunctival injection
4. oral mucosal change
5. peripheral extremity change

295
Q

Lab tests supporting dx of Kawasaki:

A

wbc incr
thrombocytosis
elevated CRP
pyuria on urinalysis
ECG: PR and QT prolongation or acute ST/T wave change

ESR elevated in ph II and N ph III

296
Q

Management of Kawasaki disease

A

admission: tx IVIG and aspirin

**need IVIG within first 10d

297
Q

Erythema multiforme: __ reaction

298
Q

Erythema multiforme: potential etiologies

A

hsv
viral
fungal - coccidio, histo, dermatophytosis
bacterial infection - strep, TB
Collagen vascular disease:RA, SLE, dermatomyositis, periarteritis nodosa
Pregnancy
Malignant neoplasm
Idiopathic

299
Q

DDX Erythema multiforme:

A

urticaria
SSS
pemphigus
pmehogoid
viral exanthems

300
Q

Erythema multiforme: lesions?

A

erythematous or violacious macules, papules, vesicles or bullae
*target lesion with 3 zones of color**
symmetric
include hands and feet, extensor surface of extremity

301
Q

Erythema multiforme: tx

A

underlying cause tx

302
Q

Erythema multiforme: who to refer to derm urgently?

A

immunocomp
multiple lesions - steroids 14-21d with taperv and urgent derm referral

303
Q

Erythema nodosum: what is this?

A

inflammatory reaction of dermis and adipose tissue - painful palpable ertyhematous or violacious subcutaneous nodules

304
Q

Erythema nodosum: where?

A

anterior tibia
arms or body

305
Q

Erythema nodosum: what precedes rash?

A

fever and arthralgia

306
Q

Erythema nodosum: as evolves may resemble?

307
Q

Erythema nodosum: causes?

A

drug reaction
sarcoid
coccidiodomycosis
histo
TB
UC
regional enteriits
pregnancy
malignancy
infection
50% idiopathyic

308
Q

Erythema nodosum: management

A

tx underlying etiology
+/- cxr for imaging
best rest, elevation of legs, elastic sotckings
aspirin/other nsaid

usually lasts 3-8 weeks and self resolves
severe pain: K-Iodid 3-4 weeks

309
Q

Lichen planus: what is this?

A

autoimmune condition results in inflammation

310
Q

Lichen planus: 5 P’s:

A

purple
planar
polygonal
pruritic
papules

311
Q

Lichen planus: where found?

A

wrists and ankles
or area of trauma

312
Q

Lichen planus: tx?

A

medium - high potency topical steroids
pruritis with anthis
systemic tx if >15% bsa - calcineurin inhib, methotrexate, topical/ssytemic retinoids, phototherapy

313
Q

Bullous pemphigoid: what is this?

A

autoimmune blistering disorder effecting geri patients

314
Q

Bullous pemphigoid: clinical manifestations

A

blister - nikolsky neg
itchy

315
Q

Bullous pemphigoid: associated conditions?

A

malignancy
db
stroke
parkinson disease
CVD

316
Q

Bullous pemphigoid: tx

A

topical steroids - clobetasol cream BID 1-3 weeks
systemic steroud/doxy if widespread lesion

topical failure = doxy or predn

317
Q

Pemphigus vulgaris: what does this look like?

A

small flaccid bullae that break esasily forming superficial erosions and crusted ulcerations

nikolsy +

318
Q

Pemphigus vulgaris: mortality before steroids was ?

319
Q

Pemphigus vulgaris: oral lesions common?

320
Q

Pemphigus vulgaris: tx

A

oral GC
talk to rheum/derm about rituximab, IG, immunoadsorption, immunosuppressive agent

321
Q

MC cutaneous malignancies?

A

BCC
SCC
melanoma

322
Q

Basal cell carcinoma: what dose this look like?

A

sun areas of nodular appearance with pearly papule, well defined borders and telangiectasias

323
Q

SCC: appearance?

A

irregular growth with erythema, induation, inflamm, crusting or oozing

324
Q

Melanoma appearance?

A

asymmetric lesion with irregular pigmenta- tion, border, and texture, and diameter greater than 6 mm or increas- ing in size. Suspicious lesions should be referred to a dermatologist for biopsy.

325
Q

Kaposi sarcoma lesion appearance?

A

painless
raised
brown blakc or purple papule and nodules that don’t blanch

face, ches,t genitals, oral cavity

326
Q

Cutaneous signs of systemic disease: urticaria

diseases?

A

drug reaction
sle
infection

327
Q

Cutaneous signs of systemic disease: pruritis

diseases?

A

anemia
renal disease
cholestasis
polycythemia
lymphoma
malignancy
thyroid disease

328
Q

Cutaneous signs of systemic disease: head and neck
spider nevi?
diseases?

A

liver disease
hyperthyroid

329
Q

Cutaneous signs of systemic disease: head and neck
xantheleasma?
disease?

A

hyperlipidemia

330
Q

Cutaneous signs of systemic disease: head and neck
malar erythema or photosn rash?
disease?

A

SLE

photo sn = porphyria

331
Q

Cutaneous signs of systemic disease: head and neck
alopecia?
diseases?

A

thyroid disease
drugs
anemia
malnu
sle
fungal infection

332
Q

Cutaneous signs of systemic disease: head and neck
heliotrop discoloration and eyelid edema?
disease?

A

dermatomyositis

333
Q

Cutaneous signs of systemic disease: Hands
gottron papules?
diseases?

A

dermatomyositis
internal malignancy

334
Q

Cutaneous signs of systemic disease: Hands
raynaud phenomenon?
disease?

335
Q

Cutaneous signs of systemic disease: Hands
clubbing?
diseases?

A

N
internal malignancy
cyanotic cardiac disease
IBD
lung disease

336
Q

Cutaneous signs of systemic disease: Hands
erythema multiforme?
diseases?

A

drugs
infections

337
Q

Cutaneous signs of systemic disease: Hands
palmar erythema?
diseases?

A

N
liver disease
pregnancy
RA
sle

338
Q

Cutaneous signs of systemic disease: Legs
erythema nodosum?
diseases?

A

strep infection
drugs
pregnancy
tb
sarcoid
IBD

339
Q

Cutaneous signs of systemic disease: Legs
pyoderma gangrenosum?
diseases?

A

IBD
hepatitis
RA
malignancy

340
Q

Cutaneous signs of systemic disease: Legs
pretibial myxedema?
diseases?

A

hypo or hyperthyroid

341
Q

Cutaneous signs of systemic disease: Legs
necrobiosis lipoidica?
disease?

342
Q

What neoplasms are most commonly producing cutaneous extension?

A

lymphomas
leukemias
carcinoma of breast, GI, rheum disorder, maligiancy, neurodegenerative disease

343
Q

What malignancies are associated with pruritis?

A

Hodgkin disease
leukemia
adenocarcinoma
SCC
carcinoid syndrome
MM
polycthemia vera

344
Q

Purpura may be a manifestation of ? diseases

A

acute granulocytic and monocytic leukemia
myeloma
lymphoma
PV

vascular abnorm
thrombocytopenia
other coag defects

345
Q

Petechiae - systemic diseases?

A

intradermal hemorrhage
thrombocytopenia
allergic reaction
endocarditis
RMS fever
viral hepatitis
infections
trauma
malignancy

346
Q

Generalized erythroderma - ddx of systemic diseases?

A

drug reaction
SSSS
erythema multiforme
TEN
malignancy
exacerbation of underlying skin condition
collagen vascular disorder

347
Q
  1. Which of the following statements regarding tinea capitis is TRUE? a. It is contagious.
    b. It is not transmitted by household pets.
    c. Tinea capitis presents with alopecia with normal underlying
    scalp.
    d. Topical treatment is effective.
    e. Treatment should be instituted for 1 to 2 weeks.
348
Q
  1. A 16-year-old boy presents with cellulitis of his left forearm. What
    is the appropriate initial antibiotic? a. Azithromycin
    b. Ceftriaxone
    c. Clindamycin
    d/ linezolid
    e. pen VK
349
Q
  1. What is the causative organism of erythema migrans? a. Borrelia burgdorferi
    b. Group A Streptococcus
    c. Methicillin-resistant Staphylococcus aureus
    d. Neisseria meningitides
    e. ParvovirusB-19
350
Q
  1. A 26-year-old man presents with an erythematous maculopapular eruption of his torso, palms, and soles. He had a painless lesion on his penis 1 month earlier. What is the treatment of choice?
    a. Azithromycin
    b. Benzathine penicillin G
    c. Ceftriaxone
    d. Doxycycline
    e. Trimethoprim-sulfamethoxazole
351
Q
  1. A 25-year-old female presents with fever, migratory polyarthral-
    gias, and hemorrhagic papules on her fingers and wrists. What is the best treatment?
    a. Ceftriaxone
    b. Ciprofloxacin
    c. Doxycycline d. Ofloxacin
    e. Vancomycin
352
Q
  1. Which of the following statements regarding gonococcal dermatitis
    is TRUE?
    a. Gonococci can usually be seen on gram stain from the lesions. b. It affects primarily men.
    c. It occurs in 1% or 2% of patients with gonorrhea.
    d. The lesions have a predilection for the knees and elbows.
    e. The skin lesions are not tender.
353
Q
  1. A 30-year-old man presents with headache, nausea and vomiting,
    myalgias, fever, and a petechial rash on his extremities and trunk. Lesions are clustered on the palms and soles. What is the best treat- ment?
    a. Cephalexin.
    b. Doxycycline.
    c. Erythromycin.
    d. Penicillin VK.
    e. Trimethoprim-sulfamethoxazole.
A

B

RMS fever

Rosens (67 decks)

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