11. Dermatology Flashcards
Redden + swelling with broken skin (bite, puncture wound, ulcer) + warmth + not demarcated
Name/Cause/Dx/Tx
Name: Cellulitis
Cause: GAS, Staph A
Dx: clinical
Tx: Cephalexin, dicloxacilin
abrupt onset of fever, chills, and malaise + warmth on face + well demarcated margins
Name/Cause/Tx
Name: Erysipeals
Cause: GAS (Streptococcus pyogenes)
Tx: IV Penicillin (Vanco if allergy to penicillin)
Honey colored crust
Name/Cause/Dx/Tx/Complication
Name: impetigo
Cause: Staph A
Dx: Clinical, gram stain/culture
Tx: Mupirocin Tid x 10 day
System Abx (fever involve or wide spread) - Cephalexin PO
Complication: poststreptococcal glomerulonephritis
Drink hot water or ETOH cause redness facial flushing
Name/Trigger/Distinguish/Tx/prevention
Name: Rosacea
Trigger: hot drink, ETOH
Distinguish: absence of comedones
Tx: Metronidazole
Prevention: sunscreen, avoid trigger
Comedones + inflammatory + nodular or cystic acne
Name/4 main path/Dx/Tx
Name: Acne Vulgaris
Patho
- increase sebum
- clogged sebaceous gland
- P acne (normal flora) overgrowth
- inflammatory response
Dx
- Mild: comedone small amount
- Moderate: comedone large amount
- Severe: nodular (>5mm)
Tx
- Mild: retinoid cream/benzoyl peroxide
- Moderate: topical + Oral abx (Doxy, or clinda)
- Severe: Isotretinoins (Retin A) *teratogenic*
- Must obtain at least 2 pregnancy test
- Must commit to use 2 pregnancy protection
Nikosky sign positive + Oral lesion + Flaccid blullae (break easy)
Name/Mortality/Dx/Tx/Related dz
Name: Pemphigus vulgari
*High Mortality*
Dx: Punch biopsy
Tx: High dose corticosteriod (1st), MTX
Related: MG, Thymoma
Nikosky sign Negative + RARELY Oral lesion + Tense Bullae (do not extend)
Name/Dx/Tx
Name: Bullae Pemphigoid
Dx: Clinical (tense bullae)
Tx: corticosteriod
Target lesion + Palms or soles + no mucosal membrane
Name/Minor vs Major/Cause/Tx
Name: Erythema multiforme
EM minor - skin only, EM Major - eye, mouth, anus, vargina
Cause: HSV
Tx: Underlying cause (acyclovir), if mucous membrane involve - System corticosteriod
Fever + Mouth mucous membrane sloughing + hx of taking abx or NSAID
Name/Cause/PE/Tx/Admission/TEN
Name: SJS (steven Johnson syndrome)
Cause: MC iatrogenic abx(sulfa or PCN), NSAID, anticonvulsant
PE: Nikolsky sign (slough off skin) + involve in mucous membrane
Tx
- Treat like burn
- Remove medication
Admission: if eye involvement Must be hospitalize due to possible blindness
TEN (toxic epidermal necrolysis): Surface more than 30%, Less than 10% SJS
hx of asthma and seasonal allergy + excoriated flexor creases + has been there earlier in life
Name/PE/Tx
Name: Atopic dermatitis
PE: Pruritius, hx of allergy and asthma
Tx: Emollient(1st),Topical corticosteriod
Contact with plant or water (irritant) + pruritus
Name/Cause/TX
Name: Contact Dermatitis
Cause: contact irritant such as posion ivy, detergents, chemical, diaper rash
Tx
- remove and avoid irritant + topical corticosteroid (if oral - taper them down)
- If diaper rash - Zinc or petroleum
Tapioca like tense vesicles (pompholyx)
Name/Trigger/Tx/Prevention
Name: Dishidrosis
Trigger: sweating, stress, warm weather
Tx: Topical steriod
Prevention: avoidance of long exposure of the hands to water
Skin thickening due to scratching (eczema) + scaly + well demarcated with skin lines
Name/Tx
Name: Lichen simplex chronicus
Tx: avoid scratching the lesion, topical steroid
rash + spares the vermillion border
Name/Risk/Tx/Avoid
Name: perioral dermatitis
Risk: hx of corticosteriod usage, young women
Tx: Topical metronidazole or erythromycin
*Avoid corticosteriod*
Raised scaly thick silver and white appearance at extensor surface (extremity)
Name/PE/Tx
Name: Psoriasis
PE: Auspitz sign (punctate bleeding with removal of plaque/scale), Nail pitting
Tx: Topical steriod (betamethasone, clobetasol), MTX, UVB
Salmon colored macule + christmas tree pattern
Name/Pathogen/PE/Dx/Tx
Name: Pityriasis rosea
Pathogen: HHV7
PE: herald patch (salmon colored macule) + christmas tree pattern (scaling along cleavage lines)
Dx: scrapping off skin
Tx: self-limited, Triamcinolone or histamine for itching
legion in mouth, skin, scalp + purple, pruritic, papule, polygonal
Name/Related/PE/legion in mouth/Tx
Name: lichen planus
Related: Hep C
PE: 5 p’s (lesions appear at the site of mechanical or thermal trauma)
- purple
- polygonal
- planar
- pruritic
- papule
if legion is in mouth - wickham striae
Tx: triamcinolones, mometasone (corticosteriod)
Raised scaly patch shows up and disappear several times
Name/Cause/Tx
Name: Fixed drug eruption
Cause: abx, anticonvulsant, NSAIDS
Tx: Avoid cause, symptomatic tx
Dry, rough, Sandpaper skin legion + hyperpigmented + hx of prolong exposure
Name/Related/PE/Dx/Tx
Name: Actinic keratosis
Related: precancerous (squmous cell carcinoma)
PE: Auspitz sign
Dx: Punch or shave biopsy
Tx: Cryosurgery, Topical - (5-fluorouracil, imiquimod, diclofenac)
hx of sun exposure + velvety warty + stuck on appearance (Pasted on)
Name/Type of malignant/PE/Dx/Tx
Name: seborrheic keratosis
Type of malignant: benign tumor
PE: velvety, suck on appearance (pasted on)
Dx: Shave biopsy
Tx: no tx need, cryosurgery for cosmetic
hx of thyroid dz + short hairs broken off a few mm from the scalp
Name/Related/Tx
Name: alopecia areata
Related: autoimmune disorder (thyroid)
Tx: intralesional triamcinolone (corticosteriod)
tempolar scalp hair loss + hair thinning
Name/Tx
Name: Anderogenic alopecia
Tx: Minoxidil, finasteride
Fungal infection nail
Name/Tx
swelling side nail margin
Name/Cause/Progress/Tx
Name: Onychomycosis
Tx: topical antifungal, systemic steriod, nail removal
Name: Paronychia
Cause: Staph A
Progress: Felon (fingertip pulp (swelling)) - Paronychia may progress to felon
Tx: I&D w/o abx
- abx is only for severe case
Pruritis + white oval-shaped egg capsules at the base of the air shafts
Name/Other name called?(female)/Caution/Dx/Tx/Prevention
Name: Lice
Called: pediculosis/females lay eggs called as NITS
Caution: Transmitted person to person (Sharing hat, clothese)
Dx: clinical (locatd at the base of hair shaft)
Tx: Permethrin, Lindane (too toxcix -> seizure)
Prevention: retreat in 7 days to kill nits, treat sex partner
Intense pruritis + Burrows + blue dot at web spaces
Name/Patho/PE/immuno-suppressant/Dx/Tx
Name: Scabies
Patho: female release egg under skin -> hatch -> excrete feces -> location reaction (type 4 allegergic reaction)
PE: blue dot finding at webspaces, axillae, wrist flexor
Immunosupression person: norweigan (crusted) scabies - cause hyperkeratotic
Dx: Microscopic, skin scraping
Tx: Permethrin, Ivermectin oral for crusted
Multiple Painless bite upon awakening + blood on mattress
Name/Bugs located/PE/Dx/Tx/Prevention
Name: Bed bug
bugs Located: couches, matress
PE: blood stained bedding, allegeric skin reaction
Dx: H & P
Tx: supportive
Prevention: new mattress
Painful bite + muscle cramping/spasm/rigidity
Name/found/fatality/Tx/Disposition
Name: black widow spider bite
Found: woodpiles, out hourses, hidden spaces
Fatality: Never FATAL
Tx: Wound care + pain control (opioid/benzo), Antivenom reserved
Dispositon
- admission for pain contorl 48-72 hrs
- observe 6 hrs if antivenom given
Painless bite + slow healing progress
Name/location/PE/Dx/Tx
Name: Brown spider (3 pairs of eyes)
Located: southeast/midwest
PE: Painless bite, redness, possible necrotic
Dx: Clinically
Tx: supportive care
bee stung/fire ants + redness
Name/type reaction/fatality/PE/Dx/Tx
Name: Bee stings
Type of reaction: IgE
Fatality: if anaphylaxis can be fatal
PE
- Local: pain, edema, redness
- Systemic: SOB, Angioedema, tachycardia, urtcaria
Dx: Clinically
Tx: Epi 0.3mg 1:1000 IM, if cardiac involve Epi 1mg 1:10000 IV
Pearly & waxy + rolled borders + central ulceration
Name/Characteristic/Dx/Tx
Name: Basal cell carcinoma
Characteristic: MC skin cancer in US/slow growth
Dx: punch/shave biopsy
Tx
- electrodesiccation (nonfacial)
- Moh micrographic surgery for facial
hx of HPV infection + red, elevated thicken nodule + blood margins + bleed easy upon pressure + center ulceration
Name/Characteristic/Dx/Tx
Name: Squamous cell carcinoma
Characteristic: slow growth/preceded by actinic keratosis
Dx: Biopsy
Tx: local surgical excision
irregular borders + variation color + diameter >6mm + asymmetry + rapid change in appearance
Name/characteristic/MC Type/Dx/Tx
Name: malignant melanoma
Characteristic: MC skin death related/MET early
MC type: Superficial spreading melanoma
Type: superficial spreading MC type
PE: ABCDE
- asymmetric
- border
- color
- diameter
- evolution
Dx: full thickness + lymph node biopsy
Tx: wide surgical excision + biopsy lymph node or dissection
Hx of HHV8 + plaque like brown/pink/red
Name/MC common type/related/Tx
Name: kaposi sarcoma
MC type: AIDS related type
Related: HHV8, HIV
Tx: HAART therapy
involve skin fail to tan within sun exposure (hyper/hypopigmentation) + oval macules with find scaling
Name/cause/Dx/Tx
Name: Pityriasis versicolor
Cause: overgrowth of the yeast (malassezia furfur) - normal flora
Dx
- KOH prep (hyphae/spores) spaghetti & meatball
- wood lamp (yellow/green)
Tx: selenium sulfide, topical antifungal (calamin lotion, zinc oxide may help)
cradle cap infants + dandruff + greasy/yellow scaling
Name/Tx
Name: Seborrheic dermatitis
Tx: selenium sulfide, ketoconazole
Wheals or plaques + angioedema
Name/type/Tx
Name: Urticaria (hives) & angioedema
Type: Type 1 (IgE)
Tx: Oral histamine
irregular discrete macules & patches of total depigmentation + hx of endocrine dz (thyroid)
Name/Patho/Cause/Dx/Tx
Name: Vitiligo
Patho: destruction of melanocytes (autoimmune)
Cause: hx of endocrine dz (thyroid)
Dx: Wood Lamp
Tx: topical corticosteriod 1st (Topical tacrolimus 0.1%), Systemic - UVB
- Tinea pedis - appearance/Tx
- Tinea corporis - appearance/Tx
- Tinea capitus - appearance/Tx
- Tinea cruris - appearance/Tx
All Tinea cause pathogen name/Dx
- athlete’s foot/Tx: topical antifungal
- Circular rash with clear central + scales/Tx: topical antifungal
- kerion present (inflamed + pustules) + alopecia/Tx: PO griseofulvin
- Griseofulvin SE: No alchohol (disulfiram like) hepatotoxicity - need to check LFT
- rash groin/scrotum/Tx: topical antifungal
Pathogen: trichophyton
Dx: KOH/wood’s lamp
Painless + soft, fleshy cauliflower like lesion
Name/Dx/Tx/Prevention
Name: HPV infection (Condyloma acuminata)
Dx: acetic acid application - whitening
Tx: Resolve its own in 2 years, Trichloroacetic acid (1st - ok for pregnancy), imiquimod (2nd - not for pregnancy)
Prevention: Gardasil vaccination (6 11 16 18)
Folliculitis vs furuncle vs carbuncle
Clinical presentation/Tx
- Folliculitis - small papules or pustules with surrounding redness
- Tx: topical mupirocin, clinda, erythro
- Furuncle: abscess with central plug
- Tx: I & D
- Carbuncle: abscess with multiple openings
- Tx: I & D
Dome shape + central umbilication
Name/Cause/Contagious/Tx
Name: Molluscum contagiosum
Cause: Poxvirus
Contagious: high
Tx: No tx need
hx of sun exposure + hyperpigmentation
Name/Risk/Dx/Tx
Name: Melasma
Risk: OCP, pregnancy, SUN EXPOSURE
Dx: Wood’s lamp
Tx: sunscreen, hydroquinone (not for pregnancy)
Obese woman with DM + abscess at axilla, groin, under breast
Name/Tx/Prevention
Name: Hidradenitis suppurativa
Tx
- Mild - topical cindamycin
- Painful abscess - I&D
Prevention: Smoking makes worse/Stop smoking
Mobile mass + has been there for long time + cottage cheese like substance
Name/Patho/Tx
Name: Sebaceous cysts
Patho: blockage gland
Tx: No need tx
Burns
Rules/Minor VS Major/Tx/other complication
- Rules of nine -
- Head F+B =9%
- Arm F+B=9% x 2
- Chest F+B=18%
- Abd F+B=18%
- Leg F+B=18% x 2
- Genital area=1%
- Minor = 10%>
- Major = 25%<
- Tx
- IV Lactated ringer - 4ml/kg first 24 hours
- ABC intact
- Debridement - death skin remove
- Blister - ruptured blister remove
- Pain control
- Abx - silver sulfadiazine (CI: if Sulfa allegic)
- Dressing + cleaning
- Other complication: hypothermia
Burn degree explain
- 1st degree - superficial burn (sun burn)
- 2nd degree - blister shows
- Partial thickness burn - Most painful burn, capillary refill postivie
- Deep partial thickness burn - Painless, No capillary refill - sacarring
- 3rd degree - Full thickness burn - Doesn’t heal well
hx of celiac dz + pruritic
Name/Tx
Name: dermatitis herpetiformis
Tx: gluten free diet, Dapsone
hx of crohn, UC + painful necrotic ulcer
Name/Risk/Dx/Tx
Name: Pyoderma gangrenosum
Risk: hx of crohn, UC, RA
Dx: clinical
Tx: topical corticosteriod (high potency)
Soft, symetrical painless easily mobile mass
Name/Tx
Name: Lipoma
Tx: None
AA with grossly exaggeratred scar
Name/Risk/Tx
Name: Keloids
Risk: MC AA
Tx: Corticosteriod injections
Friable red(raspberry like) nodule or papule + pregenancy
Name/Risk/Tx
Name: Pyogenic granuloma
Risk: pregnancy
Tx: Surgical removal (pedunculated - shave, nonpedunculated - excision)
Bright red + circular oval shape
Name/Patho/Tx
Name: Cherry angioma
Patho: benigm small blood vessel
Tx: No Tx
7 year old less + mouth, throat pain + Vesicles w/ erythmatous halo on buccal & tongue + rash on feet and hand
Name/pathogen/transmission/Tx
Name: Hand, Foot, mouth disease
Patho: coxsackies
Transmission: fecal-oral (Contagious)
Tx: Self-limits
Laceration explain
Types/Assessment/Prevention/Surgical consult
Type
- Primary - clean wound (like surgical)
- Secondary - dirty wound (infection)
- Tertiary - delayed close wound (open for 4-5 days)
Assessment
- Check nerve/muscle/vessel
- Machanism or time of injury
- possible foreign body
- Golden time - close wound by 18 hours/face 24 hours
Prevention: Tetanus - 10 years
Surgical consult
- involve with face, nerve, bone, arteries
- contaminated wound
- unknown depth of wound
Hyperpigmentation + edema + hx of chronic insufficiency
Name/related/tx
Name: stasis dematitis
Related: chronic insufficiency
Tx: compression stocking, elevation
Spider web like vessel on face + blanch when pressure on
Name/Related/Tx
Name: Telangiectasia
Related: aging, pregnancy, rosacea
Tx: No Tx need
thickened, velvety, darkly pigmented plaques on the neck or axillae + Obese
Name/Dx
Name: Acanthosis Nigricans
Dx: DM test if not yet to screened
HyperSensitivity 4 type explain
- Type I - IgE - anaphylaxis, urticaria, angioedema
- Type II - IgG, IgM antibody- autoimmune
- Type III - IgG, IgM immune complex - Serum sickness, SLE, RA
- Type IV - T cell - contact dematitis, TB skin test
HIV with finger pain + abscess on finger tip
Name/Pathogen/Dx/Tx
Name: Herpetic whitlow
Pathogen: HSV 1,2
Dx: Clinical, viral culture or Tzank smear (scrapping)
Tx: Acyclovir *DO NOT I&D - may lead to viral dissemination or bacterial superinfection.*
Eating tuna + sudden rash
Name/Related fishes/Tx
Name: histamine fish toxicity
Related fishes: Tuna/Blue fish/Mackerel
Tx: Supportive, antihistamines
