107. Dermatology Flashcards
1
Q
Epidermis: what is this layer and what is in it?
A
stratified squamous
keratinocytes rpgoressing basal to superficial layer
2
Q
5 layers of epidermis
A
stratum basele
spinosum
granulosum
lucidum
corneum (superf)
3
Q
Epidermis also includes L___ cells and m___
A
langerhans
melanocytes
4
Q
Does epidermis have direct blood supply?
A
no
gets nutrients by diffusion through dermal epidermal junction
5
Q
What important features does the dermis consistent of?
A
ct
blood vessels
lymphatic vessels
n endings
immune cells
6
Q
Subcutaneous layer components
A
ct
adipose tissue
7
Q
Physiologic functions of skin
A
- barrier
- homeostasis of temp
- absorption of UV rays and production of vitamin D
- sendation
- immunologic
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
9
Q
What are 5 main categories of rash
A
- Malignancy
- Immune
- Vaculitic
- Allergic
- Infectious
10
Q
Nicholsky sign +
A
gentle rub of skin = slough of epidermis
11
Q
Primary vs secondary lesions
A
primary - disease itself
secondary - factors like scratching, treatment, healing, complicating infection
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
13
Q
For pt with severe systemic illness, blood tests to do?
A
severe systemic illness
cbc
blood cultures
14
Q
Macule
A
flat circumscribed pigmented area <0.5cm in diameter
15
Q
Patch
A
flat circumscribed pigmented >0.5cm in diameter
16
Q
Papule
A
elevated solid palpable lesion, variable color <.5cm in diameter
17
Q
Plaque
A
elevated solid palpable lesion, variable color >0.5cm in diameter
18
Q
Nodule
A
solid, palpable, subcutaneous lesion <0.5cm in diameter
19
Q
Abscess
A
erythematous, fluctant, tneder fluid filled nodule of any size
20
Q
tumor
A
solid palpable subcutaneous lesion >0.5cm in size (basically big nodule)
21
Q
Vesicle
A
elevated thin walled, circumscribed clear fluid filled lesion <0.5cm in diameter
22
Q
Bulla
A
elevated thin walled, circumscibed lesion >0.5cm in diameter
23
Q
Pustule
A
elevated circumscribed, puruplent fluid filled lesion of any size
24
Q
Petechiae
A
flat erythematous or violaceous nonblanching lesions <0.5cm in daimeter
25
Purpura
flat erythematous or violaceous nonblanching lesions, may be palpable <0.5cm in diameter
26
Scale
thickened area of keratinized epithelium
27
Crust
dried area of plasma pro resulting from inflamm
28
fissures
deep crackes in skin surface extending into dermis
29
Erosions
disruption of surface epithelium, usually linear, traumatic
30
Ulcer
deep erosion extending into dermis
31
Scar
dense collection of collagen a result of healing after trauma or procedures
32
Excoriation
linear erosions typically secondary to scratching or rubbing
33
infections
bacterial viral fungal or protozoal causing breaks in dermal-epidermal junction often erythematous
34
Hyperpigmentation
incr in melanin containing epidermal cells
35
lichenification
abnormally dense layer of keratinized epidermal cells
36
Atopic dermatitis infantile and atopic eczema adult areas affected?
face scalp flexor surface of extremities
37
Dermatomyositis area affected?
dorsal mcp joint
periorbital area
38
disseminated gonorrhea area effeced
distal extremities, near joints
39
erythema nodosum: where present?
anterior shins, ulnar surfaces
40
Herpes zoster where present?
dermatomal distribution, particularly trunk
41
Lichen planus: where present?
wrists
ankles
flexor surfaces
42
Nummular eczema where present?
distal extremities
43
Neurotic excoriations
extremities
face
upper back
neck
44
Pityriasis rosea where present?
trunk
extremities
in xmas tree pattern
45
Prophyria cutanea tarda where present?
sun exposed areas, hands, forearms, feet
46
Psoriasis where present?
extensor surfaces of extremities
sacral area
47
Sarcoidosis where present?
face
extremities
back
48
sebhorrheic dermatitis where present?
chest
nasolabial folds
49
secondary syphilis where present?
torso
palms
soles
50
SLE where present?
nose and cheeks
head and neck
photosens
alopecia
51
tinea versiciolor where present?
upper back and chest
52
Impetigo: 2 pain bugs
staph aureus
GAS
53
Impetigo: typical lesion description
single pustule and later to multiple lesions, often with golden yellow crust
54
Impetigo: itchy or painful?
itchy
55
What is a complication of strep impetigo?
postpyodermal acute GN
56
Staph vs strep Impetigo: differences?
staph is more superficial with less surrounding erythema
57
Impetigo: ddx
hsv
inflammatory fungal infections
58
Bullous Impetigo: caused by toxin of what bug?
staph
59
Bullous impetigo: initial skin lesion/presentation of lesions?
thin walled
1-2cm bullae
rupture leaving thin serous crust and collarette like remnant
face/neck/extremities often affected
60
Bullous impetigo: ddx
contact dermatitis
HSV infection
superficial fungal infections
pemphigus vulgaris
61
Impetigo: abx tx if mild?
bacitracin or mupirocin
62
Impetigo: abx tx if more severe (not MRSA)?
oral abx
docloxacillin or cephalexin
63
Impetigo: abx tx if more severe (MRSA)?
doxy
clinadmycin
septra
64
Tx of bullous impetigo:
dicloxacillin or erythromycin or azithromycin
65
Even without tx, impetigo usually resolves within...
3-6 weeks
66
Folliculitis defn
inflamm of hair follicle
67
Folliculitis appearance
pustules with central hair in sites such as buttocks, thigh, beard or scalp
68
Folliculitis: itchy or painful
mild pain
69
Folliculitis ddx
acne
keratosis pilaris
fungal infection
70
What kind of folliculitis can occur after hot tub use or swimming pools, or in inds on antibiotics for acne?
gram negative pseudomonas
71
Folliculitis treatment local
antiseptic cleanser to area like povidone-iodine/chlorhexadine
72
Folliculitis treatment - extensive
antiseptic cleanser to area like povidone-iodine/chlorhexadine
and
doxy or dicloxacillin
73
Cellulitis: defn
localized erythema, swelling and pain of ST
74
Erysipelas: defn
strep infection of skin and subcut tissue, typically erythematous appearance with well demarcated border
often fever malaise and myalgias
75
___ may be a useful tool to differentiate a cellulitis from a abscess
ultrasound
76
Mild case of cellulitis: tx
cephalosporin or dicloxacillin or clinda
77
IV abx for treatment of cellulitis?
penicillin
ceftr
cefazolin
clindamycin
severe = piptazo
78
Abscess defn
accumulation of pus within body tissues
79
What is a furuncle?
skin abscess caused by staph infection involving hair follicles and surrounding tissue
80
Abscess: findings?
localized soft tissue swelling erythema and fluctuance
81
What will you see that is consistent with abscess on ultrasound?
fluid filled cavity from cellulitis: cobblestoning with fine reticular (net like) areas of hypoechoic stranding
82
Carbuncles: defn
large abscess that develop in the thick, inelastic skin on back of neck, back or thights involving multiple hair follices
can cause sepsis!!
83
Abscess treatment - mild?
I+D + septra or clinda
84
Mod and severe abscesses - treatment?
I+D
culture and sn
IV abx - vanco, dapto, linezolid
85
Hidradentitis suppurativa - defn?
sweat gland current abscess formation in axilla, groin resembling a furuncle
86
Hidradentitis suppurativa - when to tx?
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
87
Oral agents effective against MRSA
septra
doxy
clindamycin
minocycline
88
IV agents effective against MRSA
meropenem/ertapenem
clinda
linezolid
dapto
vanco
89
Ertyhema migans: cause?
Borelia burgdorferi from lyme disease
90
Erythema migrans: clinical stages - how many?
3
91
Lyme disease: stage I
early
malaise, headache, fever, LN incr, arthalgias
60-80% erythema migrans
92
Lyme disease: stage 1 resolves within?
4 weeks
93
Erythema migrans: what does this look like?
erythematous annular nonscaling lesion with a central clearing
94
Lyme disease: stage II
secondary annular lesion
fever
LN incr
neuro maingestations
cardiac conduction abn
last weeks to months
95
Lyme disease: stage III
chronic arthritis
dermatitis
CNS disease
96
Lyme disease: diagnostic tests
elevated ESR
serologic tests - two tiered system of ELISA and reflexive immuno blotting
97
Lyme disease: management
doxy or amox for 10-21d
98
Lyme disease: abx options
doxy
amox
clarithromycin
cefuroxime
erythromycin
azithromycin
99
Necrotizing fasciitis: what is this?
polymicrobial or monomicrobial (GAS, CA-MRSA) severe toxicity infection
100
Necrotizing fasciitis: radiographic test findings?
air
101
Necrotizing fasciitis: abx?
pip tazo or carbapenem
with vanco or linezolid
with clinda to kill active toxin first!!
102
Cutaneous findings with meningococcal infection?
macules
papules
vesicles
petechiae and purpura
103
10% of pt may present with Waterhouse-Friderichsen syndrome: what is this?
meningits AND shock with intracutaneous hemorrhage
104
Scarlet fever: bug cause?
GAS
105
Scarlet fever: distinct rash?
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
106
in 10% of scarlet fever cases what kind of annular, erythematous lesions may you see that transient and reappear over days, weeks or months?
erythema marginatum
107
Treatment of scarlet fever and sandpaper rash?
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
108
Scalet fever pt allergic to penicillin, treatment ?
erythromycin
macrolide
cephalosporin
109
Syphilis primary lesion
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
110
Secondary syphilis lesions
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
111
Primary and secondary syphilis, early latent treatment
benzathine pen B 2.4 milion units IM
vs doxy and azithro if ++ allergic
112
Late latent and tertiary tx of syphilis?
benzathine pen B 3 x 2.4 million units IM at weekly intervals for a total of 7.2 million units
113
Jarisch Herxheimer reaction
symtpoms of fever, headache and malaise after tx of syphilis
114
Disseminated gonococcal infection: lesions
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
115
Disseminated gonococcal infection: tx
culture from wound
ceftr 1g IVq24h
116
Staphylococcal scalded skin syndrome (SSSS): typically occurs in children of what age?
117
Staphylococcal scalded skin syndrome (SSSS): what is it caused by?
exotoxin producing staphylococci
118
Staphylococcal scalded skin syndrome (SSSS): illness begins with what findings?
progression of findings?
erythema and crusting around mouth
then spreads down body, followed by bulla formation and desquamation
desquamation
lesions dry up and clinically resolve 3-7d
119
Staphylococcal scalded skin syndrome (SSSS): what is typically spared?
mucous membranes
120
Staphylococcal scalded skin syndrome (SSSS): treatment
vancomycin
nafcillin
oxacillin
vs allergy: clarithromycin or cefuroxime
121
Toxic shock syndrome: what is this?
acute febrile illness characterized by diffuse desquamating erythroderma
fever, hypotension, constitutional symptoms and multiorgan involvement
121
Toxic shock syndrome (TSS): bug?
exotoxin producing staph aureus
or GAS
122
Toxic shock syndrome (TSS): causes
mentruation/tampon use
burns/post op
postpartum
OM
arthritis
empyema
fasciitis
septic abortion
pharyngitis
peritonsillar abscess
sinusitis
subcutaneous abscess
123
Toxic shock syndrome (TSS): diagnosis requires which 4 criteria?
1. temp of at least 38.9
2. hypotension (SBP 90 or less)
3. rash
4. involvement of at least 3 organ systems
124
Toxic shock syndrome (TSS): typical rash?
diffuse
blanching
macular erythroderma
nonexudative mucous membrane involvement is common
125
Toxic shock syndrome (TSS): when does rash fade?
within 3d
126
Toxic shock syndrome (TSS): once rash fades, where does desquamation occur?
hands and feet
127
Toxic shock syndrome (TSS): initial treatment
IV fluid
ventilatory support
pressors PRN
abx - clinda, vanco, linezolid, imipenem, mero, pip tazo are all options
128
Rocky Mountain spotted fever: bug?
ricketsia rickettsii
by tick saliva
129
Rocky Mountain spotted fever: onset of illness abrupt with what sx?
headache
n/v
myalgias
chills
fever
130
Rocky Mountain spotted fever: may last 3 weeks: what are the predominant organ systems involved?
cns
cardiac
pulmonary
GI
renal
DIC
shock
131
Rocky Mountain spotted fever: when does a rash develop (ie what day?)
2-6th day
132
Rocky Mountain spotted fever: rash appearance?
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
133
Rocky Mountain spotted fever: dx typically?
clinical
134
Rocky Mountain spotted fever: tx?
doxy
children <9 - chloramphenicol
135
Rocky Mountain spotted fever: what abx makes this worse?
sulfa drugs
136
Rocky Mountain spotted fever: what disease looks similar to this but is also treated with doxycylcine?
ehrlichiosis
137
HSV characteristics of lesions
painful grouped vesicles on an erythematous base
clustered, nondermatomal region
138
MC HSV1 area?
mouth
139
HSV: what is this called when on hand?
herpetic whitlow - distal phalanx typically
140
HSV: 1 typically heals within how many days (unless bacterial infection)
7-14d
141
HSV: 2 - presentation in men
either single or multiple vesicles or erosions on penile sahft/glans
+ regional adenopathy, fever, malaise
142
HSV: 2 in women presentation?
herpetic cercivitis or vaginitis - pelvic pain, dysuria, vaginal discharge
143
HSV treatment
acyclovir, famciclovir or valacyclovir
*reduce duration of viral shedding, accel healing and shorten sx duration but have no effect on recurrence
144
HSV: when to give IV treatment?
immunocompromised
mucocutaenous infection in this patients is deadly
145
Varicella zoster: incubation period?
14-21d
146
Varicella zoster: skin lesions?
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
Hallmark of Varicella zoster:
lesions of all three types in one area: macules to papules to vesicles to crusting sometimes within several hours
148
Varicella zoster: complications of disease?
encephalitis
meningitis
pneumonia
secondary staph or strep cellulitis
thrombocytopenia
arrhtirits
hepatitis
GN
149
Varicella zoster: treatment generally?
symptomatic
oral acyclovir is effective if start within 24 hours of development of rash for pt with chronic resp or skin disease
150
Varciella: oral acyclovir is effective if start within __ hours of development of rash for pt with chronic resp or skin disease
24
151
When is varicella contagious until?
all lesions are no longer vesicular - dry and crusted
152
Varicella: who is a candidate for IG?
high risk ind within 10d (ideally 4d of exposure)
-immunocomp
-pregnant
153
When to vaccinate for varicella?
age 1-13y
older children 2 dose sep by 4-8 weeks
154
Herpes zoster: how does this occur?
reactivation of varicella in the dorsal root ganglion
155
Risk factors for Herpes zoster:
female
white
family hx
comorbidities: autoimm disease, asthma, DM, COPD
156
Herpes zoster: what may preceed the rash?
dermatomal pain 1-10d prior
157
Herpes zoster: typical rash?
grouped vesicles on an erythematous base involving one or several adjavent dermatome thorax > trigeminal
158
Herpes zoster: peak incidence age
50-70y
159
Herpes zoster: complications
cns involvement
ocular infection *typically trigeminal area
stroke
meningoencephalitis
myelitis
peripheral neuropathy
MI
160
Herpes zoster: eye involvement issues
conjunctivits to panopthalmitis - treatens vision
fluoroscein exam shows corneal dendritic lesions
can produce anterior uveitis, secondary glaucoma, optic neuritis, corneal scarring
161
Herpes zoster: what is Hutchinson sign?
close correlation between vesicles on tip of nose and eye involvement
so be wary for this
162
Herpes zoster: when are antiretrovirals reasonable
disease started within 48h
163
Herpes zoster: IV for ..
disseminated
164
Herpes zoster: ocular manifestation treatment?
acyclovir
opthalmology for mydriasis and topical CS
165
Herpes zoster: posterherpetic neuralgia treatment
opioids
capcaisin topical
topical or oral gabapentin
TCA
if >60y: vaccine
166
Viral exanthems - over 30 can cause this - some common names?
coxsackie
echovirus
adenovirus
167
Viral exanthems - rash appearance
most maculopapular
can also be scarlet
erytematous
vesicular
petechial
168
Viral exanthems - 5 classic names?
1. measles/rubeola
2. rubella (german measles)
3. HSV6 - roseola
4. parvo B19 (5th disease/erythema infectiosum)
5. enteroviruses (echo, coxsackie)
169
Roseola: which herpes viruses cause this?
6 and 7
170
Roseola: common in which age group?
6mo to 3y
171
Roseola: clinical features?
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
Roseola: rash specifics
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
Roseola: rare but important complication?
encephalitits
174
Roseola: tx?
none - kiddo actually looks quite well, px is excellent
175
Measles/rubeola: when are people considered contagious (ie spread by infectious droplets, how many days pre and post infectious?)
5d pre sx
until 5-6 days onset of derm involvement
176
Measles/rubeola: 3C's
cough
coryza
conjunctivitis
177
Measles/rubeola: second day of illness can see Koplik spots - what are these?
pathognomonic of disease
buccal mucosa as small irregular bright red spots with bluish white centers, can extend to oropharynx
178
Measles/rubeola: cutaneous eruption presents on day 3-5: what do these look like and where?
maculopapular lesions on forehead and upper neck to face, trunk, arms and then legs and feet
179
Measles/rubeola: complications of disease
otitis media (MC)
encephalitis
penumonia
180
Measles/rubeola: tx?
supportive: antipyretics, hydration and tx of pruritis
Vitamin A to hosp pt at dx and repeat second day
181
Measles/rubeola: postexposure prophylaxis tx?
masles virus vaccine or Human IG
182
Rubella/German Measles: common sx?
fever
skin eruption
generalized lymphadeopathy
183
Rubella/German Measles: common in what season?
winter spring
183
Rubella/German Measles: incubation period?
14-21
max communicability is few days before and 5-7 days after onset of rash
184
Rubella/German Measles: rash
red maculopapules on face then to neck, trunk, extremities
trunk - may coalesce but on extremitites do not
usually no desquamation
185
Rubella/German Measles: major complications
encephalitis
arthritis
thrombocytopenia
186
Rubella/German Measles: if pregnant, effects on fetus?
yes
187
Rubella/German Measles: tx?
generally none
antipyretics to. tx headache, athralgias and painful lymphadenopathy
188
Erythema infectiosum/Parvo B19/Fifth disease: sx?
mild - fever, rash
adults get athralgias and arthritis maybe too
189
Erythema infectiosum/Parvo B19/Fifth disease: specific rash?
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
Erythema infectiosum/Parvo B19/Fifth disease: incubation period
4-14d
191
Erythema infectiosum/Parvo B19/Fifth disease: management?
supportive
192
Fungal infections: 1439
193
Tinea corporis: common name?
Ringworm
194
Tinea corporis rash presentation?
Sharply marginated, annular lesion with raised vascular margins and a central clearing. Can be multiple or single.
195
Tinea corporis differential diagnosis
Erythema migraines (associated with Lyme disease), granuloma, annular, psoriasis, cellulitis, erythrasma
196
Tinea corporis treatment of body, groin, extremities
Clotrimazole, miconazole, turbine, BID or TID for one to three weeks
197
Tinea capitis: presentation?
Maybe seen with alopecia typically with thick and scaly, scalp, broken hair, resembling black dots near the scalp may be seen.
198
Tinea capitis: complications?
Kerion formation, lymphadenitis, bacterial, cellulitis, or abscess, scarring alopecia
199
Tinea capitis: differential diagnosis?
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
Tinea capitis: treatment
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
Kerion: what is this?
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
Kerion - treatment?
Same as Tinea capitis with systemic antifungal agent for 6 to 8 weeks
203
Tinea pedis: findings?
Scaling, maceration, vesiculation, Fishering between the toes and on the plantar surface of the foot
204
Differential diagnosis of Tinea pedis:
Contact dermatitis, dyshidrotic eczema
Use KOH prep to differentiate
205
Tinea pedis: treatment
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
Tinea vesicular: what is this and what fungal caused?
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
Tinea vesicular: treatment
Topical antifungal agent 2.5% selenium sulphide shampoo applied for one week
If this fails then can do systemic treatment, such as fluconazole
208
Tinea unguium/onychomycosis: what might be predisposing factors?
Paronychia
Untreated tubes pedis
209
Tinea unguium/onychomycosis: presentation?
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
Tinea unguium/onychomycosis: when can you consider using topical antifungal agents for treatment?
One less than 25% of the nailbed is involved, fingernails respond better than toenails.
Involvement of one or two nails
211
Tinea unguium/onychomycosis: more extensive therapy options for which risk factors?
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
Risk factors for candidiasis
Diabetes
HIV
Pregnancy
Obesity
Smoking
Malnutrition
Malignancy.
Treatment with corticosteroids, antibiotics or immune suppressive agents
213
Where does candidiasis most commonly affect?
Mouth – thrush
214
Candida presentation
White or gray friable material covering an erythematous space on the buccal mucosa, gingiva, tongue, pallet or tonsils
215
differential diagnosis of oral candidiasis
Like in plain, which is typically not easily scraped off
Harry leucoplakia which is white patches on the lateral tongue
216
Oral mucus membrane infection with candida? Is an aids, defining illness.
Albicans
217
Treatment of oral candidiasis
Topical antifungal like clotrimazole five times daily or oral nystatin suspension four times daily times 5 to 7 days
218
Treatment of oesophageal candidiasis
Systemic antifungal therapy: oral fluconazole or IV, iv amphotericin B
219
Where does cutaneous candidiasis typically affect?
Androgenous areas: interdigital, web spaces, groin, axilla, and intergluteal or inter-mammary folds
220
cutaneous candidiasis lesion appearance
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
cutaneous candidiasis differential diagnosis
Contact dermatitis.
Tinea Curtis
Trio
HSV
Flick Yallitis
222
cutaneous candidiasis intertrogenous lesions versus widespread infection treatment
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
Vulvovaginal candidiasis: predisposing risk factors
Diabetes.
Pregnancy
Immunosuppression.
Hormone replacement therapy.
224
Vulvovaginal candidiasis common complaints
Itching.
Dysparuenia
Area.
Vaginal burning
225
Vulvovaginal candidiasis treatment
Over-the-counter intravaginal clotrimazole or single 150 mg dose of oral fluconazole
226
Sporotrichosis: what is this?
Fungal infection that may be transmitted by contact with soil, zoonotic transmission from animals, such as snakes, birds, cats
227
Sporotrichosis: physical exam presentation
Lymphocutaneous findings like pills, nodules, ulcerations
228
Sporotrichosis: diagnosis and treatment
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
Scabies: Paige 1441
230
Scabies - what is this?
Fomite infection intertrigenous areas causing intense pruritis, typically seen in winter months. Between fingers common
231
Scabies - what is this?
Fomite infection intertrigenous areas, papules and pustules causing intense pruritis, typically seen in winter months. Between fingers common
232
Scabies: is crusted lesions contagious?
Very!
233
Scabies: is crusted lesions contagious?
Very!
234
Scabies ddx
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
Scabies ddx
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
Scabies treatment
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
Scabies treatment
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
Pediculosis commonplace name
Lice
239
Pediculosis commonplace name
Lice
240
How long can lice live on fomites?
Up to 4d
241
How long can lice live on fomites?
Up to 4d
242
Ddx pediculosis
The differential diagnosis includes conditions such as tinea capitis, seborrheic dermatitis, atopic
243
Pediculosis dx
Findings of lice on hair shaft
244
Treatment lice
Permethrin 1% shampoo day one and nine or oral ivermectin with high treatment rate
Nit removal from hair
Clean everything by boiling/heat
245
Bed bugs: what kind of bug can they carry that is MRSA R?
E faecium
246
Clinical presentation of a bed bug?
erythematous welt, macule papule urticaria purpura vesicle or bullae with intese pruritis
usally arms legs shoulders
resolve 1-2 weeks
247
Symptomatic tx of bed bugs?
antihistamine
topical CS
248
Contact dermatitis: what is this?
inflammatory reaction of skin to chem, physical or biologic agent that acts as irritant to skin
249
Allergic contact dermatitis: ? hypersensitivity reaction?
delayed
250
Common causes of irritant dermatitis
caustics
industrial solvent
detergents
251
common cause of allergic contact dermatitis
clothing
jewelery
soaps
cosmetics
latex
plants
meds
252
MC allergens include ? compounds (5)
rubber
poison ivy/oak - toxicodendron species
nickel
paraphnylenediamine (stabilizer in topical meds)
253
Primary lesions of contact dermatitis
papules
vesicles
bullae on an erythematous base
streaky linear intensely pruritic lesions are characteristic
254
Tx contact dermatitis
avoid irritant/allergen
tx of resulting inflamm with low potenciy topical steroid around orifices
medium potency creams can be used elsewhere
255
What 4 mediators play a role in urticaria?
histamine
bradykinin
kallikrein
ach
256
Causes of urticaria
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
What systemic diseases can cause urticaria?
SLE
lymphoma
carcinoma
hyperthyroidism
rheumatic fever
juvenile RA
258
Cold urticaria - familial or acquired - underlying illness that can cause this?
cryoglobulinemia
cryofibrinogenemia
syphilis
CTD
259
Cholinergic urticaria - common findings?
wheals 1-3mm in daimeter surrounding by extensive erythematous flares and occassional satellite lesions
tx with cetirizine
260
Urticaria lesion defn
erythematous plaque with pale centers and red borders
last <24h
261
DDX urticaria
drug eruption
exanthems
erythema multiforme
erythema marginatum
JRA
262
Poison ivy - what is common pattern?
vesicular or bullous eruption with oozing/crusting/scaling and fissuing
localized vs asymmetric vs linear, vs unilateral vs disseminated
mucous membranes spared
263
Poison ivy - other sensitizations to ?
cashew
mango
laquer
gingko tree
264
poison ivy - Tx like which diease
Contact dermatitis:
+ CS (systmeic)
wash all clothes
265
MC type of hypersensitivity reaction with drug reactions? (2)
immediate - type 1
delayed - type IV
266
MC drug reaction (rash appearance)?
morbilliform rash
urticaria
fixed drug eruption
267
List 10 severe skin reactions from drug reaction?
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
Toxic epidermal necrolysis: what is this?
>30% BSA vs SJS <10
separation of large sheets of epidermis from underlying dermis
269
Causes of TEN disease?
meds
infection
malignancy
idiopathic
270
Common drugs causing TEN?
sulfa drugs
nsaid
penicillin
aspirin
barbituates
phenytoin
carbamezapine
allopurinol
271
Risk factors for poor px of TEN?
>40yoa
underlying malignancy
HR >120
initial percent epidermal attachemnt >10%
bun >10
BG >252mg/dl
bicarb <20mmol/L
272
TEN rash
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
TEN common other organs effected rather than just skin?
renal
GI
resp
274
Tx of SJS/TEN
stop drug
supportive care: hydration, prevent secondary infection
pain control
wound management, typically best at burn centre
275
Meds that may be involved in SJS/TEN?
systemic steroid
ivig
cylclosporin A
plasmapheresis with specialist
276
Drug Reaction with eosinophilia and systemic symptom (DRESS) syndrome: what is this?
morbilliform skin eruption
fever
LN incr
hematolic abn - eosinophili, atypical lymphocytosis and internal organ involvement
277
Common inciting events for DRESS
anticonvulsants
abx
allopurinol
278
DRESS onset after meds?
2-8 weeks post
279
DRESS tx
stop med
tx systemic steroids
280
Atopic dermatitis: what is this?
eczema/chronic dermatitis
281
Atopic dermatitis: mechanism?
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
Atopic dermatitis: dx criteria?
itchy skin + 3 or more: generalize dry skin in past year, hx of asthma or hay fever, onset rash before 2y, flexural dermatitis
283
Atopic dermatitis: hallmark of disease?
intense pruritis
284
Atopic dermatitis: tx
emollient to tx dryness
betamethasone on body (flourinated CS), mild steroid 0.025% triamcinolone ointment face or intertrigous area
285
Atopic dermatitis: susceptible to which infections?
molluscum contagiosum
HSV
recurrent staph
286
Pityriasis Rosea: what does this look like?
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
Pityriasis Rosea: itchy?
not usually
288
Pityriasis Rosea: ddx
tinea coroporis
guttate psoriasis
lichen planus
drug eruption
lyme
secondary syphilis
289
Pityriasis Rosea: tx?
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
Kawasaki disease: what type of disease is this?
vasculitis
291
Kawasaki disease: phase I: findings
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
Kawasaki disease: subacute ph II
desquamation
thrombocytosis
arhtritis
arthralgias
carditis
may last 30d
high risk sudden death in this phase
293
Kawasaki disease: phase III convalescent
8-10weeks post onset
coroanry anuesym [possible this phase
294
Defn of kawasaki: specific:
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
Lab tests supporting dx of Kawasaki:
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
Management of Kawasaki disease
admission: tx IVIG and aspirin
**need IVIG within first 10d
297
Erythema multiforme: __ reaction
hypersen
298
Erythema multiforme: potential etiologies
hsv
viral
fungal - coccidio, histo, dermatophytosis
bacterial infection - strep, TB
Collagen vascular disease:RA, SLE, dermatomyositis, periarteritis nodosa
Pregnancy
Malignant neoplasm
Idiopathic
299
DDX Erythema multiforme:
urticaria
SSS
pemphigus
pmehogoid
viral exanthems
300
Erythema multiforme: lesions?
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
Erythema multiforme: tx
underlying cause tx
302
Erythema multiforme: who to refer to derm urgently?
immunocomp
multiple lesions - steroids 14-21d with taperv and urgent derm referral
303
Erythema nodosum: what is this?
inflammatory reaction of dermis and adipose tissue - painful palpable ertyhematous or violacious subcutaneous nodules
304
Erythema nodosum: where?
anterior tibia
arms or body
305
Erythema nodosum: what precedes rash?
fever and arthralgia
306
Erythema nodosum: as evolves may resemble?
bruises
307
Erythema nodosum: causes?
drug reaction
sarcoid
coccidiodomycosis
histo
TB
UC
regional enteriits
pregnancy
malignancy
infection
50% idiopathyic
308
Erythema nodosum: management
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
Lichen planus: what is this?
autoimmune condition results in inflammation
310
Lichen planus: 5 P's:
purple
planar
polygonal
pruritic
papules
311
Lichen planus: where found?
wrists and ankles
or area of trauma
312
Lichen planus: tx?
medium - high potency topical steroids
pruritis with anthis
systemic tx if >15% bsa - calcineurin inhib, methotrexate, topical/ssytemic retinoids, phototherapy
313
Bullous pemphigoid: what is this?
autoimmune blistering disorder effecting geri patients
314
Bullous pemphigoid: clinical manifestations
blister - nikolsky neg
itchy
315
Bullous pemphigoid: associated conditions?
malignancy
db
stroke
parkinson disease
CVD
316
Bullous pemphigoid: tx
topical steroids - clobetasol cream BID 1-3 weeks
systemic steroud/doxy if widespread lesion
topical failure = doxy or predn
317
Pemphigus vulgaris: what does this look like?
small flaccid bullae that break esasily forming superficial erosions and crusted ulcerations
nikolsy +
318
Pemphigus vulgaris: mortality before steroids was ?
95%
319
Pemphigus vulgaris: oral lesions common?
yes
320
Pemphigus vulgaris: tx
oral GC
talk to rheum/derm about rituximab, IG, immunoadsorption, immunosuppressive agent
321
MC cutaneous malignancies?
BCC
SCC
melanoma
322
Basal cell carcinoma: what dose this look like?
sun areas of nodular appearance with pearly papule, well defined borders and telangiectasias
323
SCC: appearance?
irregular growth with erythema, induation, inflamm, crusting or oozing
324
Melanoma appearance?
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
Kaposi sarcoma lesion appearance?
painless
raised
brown blakc or purple papule and nodules that don't blanch
face, ches,t genitals, oral cavity
326
Cutaneous signs of systemic disease: urticaria
diseases?
drug reaction
sle
infection
327
Cutaneous signs of systemic disease: pruritis
diseases?
anemia
renal disease
cholestasis
polycythemia
lymphoma
malignancy
thyroid disease
328
Cutaneous signs of systemic disease: head and neck
spider nevi?
diseases?
liver disease
hyperthyroid
329
Cutaneous signs of systemic disease: head and neck
xantheleasma?
disease?
hyperlipidemia
330
Cutaneous signs of systemic disease: head and neck
malar erythema or photosn rash?
disease?
SLE
photo sn = porphyria
331
Cutaneous signs of systemic disease: head and neck
alopecia?
diseases?
thyroid disease
drugs
anemia
malnu
sle
fungal infection
332
Cutaneous signs of systemic disease: head and neck
heliotrop discoloration and eyelid edema?
disease?
dermatomyositis
333
Cutaneous signs of systemic disease: Hands
gottron papules?
diseases?
dermatomyositis
internal malignancy
334
Cutaneous signs of systemic disease: Hands
raynaud phenomenon?
disease?
N
CTD
335
Cutaneous signs of systemic disease: Hands
clubbing?
diseases?
N
internal malignancy
cyanotic cardiac disease
IBD
lung disease
336
Cutaneous signs of systemic disease: Hands
erythema multiforme?
diseases?
drugs
infections
337
Cutaneous signs of systemic disease: Hands
palmar erythema?
diseases?
N
liver disease
pregnancy
RA
sle
338
Cutaneous signs of systemic disease: Legs
erythema nodosum?
diseases?
strep infection
drugs
pregnancy
tb
sarcoid
IBD
339
Cutaneous signs of systemic disease: Legs
pyoderma gangrenosum?
diseases?
IBD
hepatitis
RA
malignancy
340
Cutaneous signs of systemic disease: Legs
pretibial myxedema?
diseases?
hypo or hyperthyroid
341
Cutaneous signs of systemic disease: Legs
necrobiosis lipoidica?
disease?
DM
342
What neoplasms are most commonly producing cutaneous extension?
lymphomas
leukemias
carcinoma of breast, GI, rheum disorder, maligiancy, neurodegenerative disease
343
What malignancies are associated with pruritis?
Hodgkin disease
leukemia
adenocarcinoma
SCC
carcinoid syndrome
MM
polycthemia vera
344
Purpura may be a manifestation of ? diseases
acute granulocytic and monocytic leukemia
myeloma
lymphoma
PV
vascular abnorm
thrombocytopenia
other coag defects
345
Petechiae - systemic diseases?
intradermal hemorrhage
thrombocytopenia
allergic reaction
endocarditis
RMS fever
viral hepatitis
infections
trauma
malignancy
346
Generalized erythroderma - ddx of systemic diseases?
drug reaction
SSSS
erythema multiforme
TEN
malignancy
exacerbation of underlying skin condition
collagen vascular disorder
347
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.
A
348
2. 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
c
349
3. 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
a
350
4. 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
b
351
5. 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
a
352
6. 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.
c
353
7. 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.
B
RMS fever
