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PANCE > 11. Dermatology > Flashcards

11. Dermatology Flashcards

1
Q

Redden + swelling with broken skin (bite, puncture wound, ulcer) + warmth + not demarcated

Name/Cause/Dx/Tx

A

Name: Cellulitis

Cause: GAS, Staph A

Dx: clinical

Tx: Cephalexin, dicloxacilin

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2
Q

abrupt onset of fever, chills, and malaise + warmth on face + well demarcated margins

Name/Cause/Tx

A

Name: Erysipeals

Cause: GAS (Streptococcus pyogenes)

Tx: IV Penicillin (Vanco if allergy to penicillin)

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3
Q

Honey colored crust

Name/Cause/Dx/Tx/Complication

A

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

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4
Q

Drink hot water or ETOH cause redness facial flushing

Name/Trigger/Distinguish/Tx/prevention

A

Name: Rosacea

Trigger: hot drink, ETOH

Distinguish: absence of comedones

Tx: Metronidazole

Prevention: sunscreen, avoid trigger

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5
Q

Comedones + inflammatory + nodular or cystic acne

Name/4 main path/Dx/Tx

A

Name: Acne Vulgaris

Patho

  1. increase sebum
  2. clogged sebaceous gland
  3. P acne (normal flora) overgrowth
  4. 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
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6
Q

Nikosky sign positive + Oral lesion + Flaccid blullae (break easy)

Name/Mortality/Dx/Tx/Related dz

A

Name: Pemphigus vulgari

*High Mortality*

Dx: Punch biopsy

Tx: High dose corticosteriod (1st), MTX

Related: MG, Thymoma

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7
Q

Nikosky sign Negative + RARELY Oral lesion + Tense Bullae (do not extend)

Name/Dx/Tx

A

Name: Bullae Pemphigoid

Dx: Clinical (tense bullae)

Tx: corticosteriod

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8
Q

Target lesion + Palms or soles + no mucosal membrane

Name/Minor vs Major/Cause/Tx

A

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

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9
Q

Fever + Mouth mucous membrane sloughing + hx of taking abx or NSAID

Name/Cause/PE/Tx/Admission/TEN

A

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

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10
Q

hx of asthma and seasonal allergy + excoriated flexor creases + has been there earlier in life

Name/PE/Tx

A

Name: Atopic dermatitis

PE: Pruritius, hx of allergy and asthma

Tx: Emollient(1st),Topical corticosteriod

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11
Q

Contact with plant or water (irritant) + pruritus

Name/Cause/TX

A

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
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12
Q

Tapioca like tense vesicles (pompholyx)

Name/Trigger/Tx/Prevention

A

Name: Dishidrosis

Trigger: sweating, stress, warm weather

Tx: Topical steriod

Prevention: avoidance of long exposure of the hands to water

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13
Q

Skin thickening due to scratching (eczema) + scaly + well demarcated with skin lines

Name/Tx

A

Name: Lichen simplex chronicus

Tx: avoid scratching the lesion, topical steroid

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14
Q

rash + spares the vermillion border

Name/Risk/Tx/Avoid

A

Name: perioral dermatitis

Risk: hx of corticosteriod usage, young women

Tx: Topical metronidazole or erythromycin

*Avoid corticosteriod*

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15
Q

Raised scaly thick silver and white appearance at extensor surface (extremity)

Name/PE/Tx

A

Name: Psoriasis

PE: Auspitz sign (punctate bleeding with removal of plaque/scale), Nail pitting

Tx: Topical steriod (betamethasone, clobetasol), MTX, UVB

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16
Q

Salmon colored macule + christmas tree pattern

Name/Pathogen/PE/Dx/Tx

A

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

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17
Q

legion in mouth, skin, scalp + purple, pruritic, papule, polygonal

Name/Related/PE/legion in mouth/Tx

A

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)

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18
Q

Raised scaly patch shows up and disappear several times

Name/Cause/Tx

A

Name: Fixed drug eruption

Cause: abx, anticonvulsant, NSAIDS

Tx: Avoid cause, symptomatic tx

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19
Q

Dry, rough, Sandpaper skin legion + hyperpigmented + hx of prolong exposure

Name/Related/PE/Dx/Tx

A

Name: Actinic keratosis

Related: precancerous (squmous cell carcinoma)

PE: Auspitz sign

Dx: Punch or shave biopsy

Tx: Cryosurgery, Topical - (5-fluorouracil, imiquimod, diclofenac)

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20
Q

hx of sun exposure + velvety warty + stuck on appearance (Pasted on)

Name/Type of malignant/PE/Dx/Tx

A

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

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21
Q

hx of thyroid dz + short hairs broken off a few mm from the scalp

Name/Related/Tx

A

Name: alopecia areata

Related: autoimmune disorder (thyroid)

Tx: intralesional triamcinolone (corticosteriod)

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22
Q

tempolar scalp hair loss + hair thinning

Name/Tx

A

Name: Anderogenic alopecia

Tx: Minoxidil, finasteride

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23
Q

Fungal infection nail

Name/Tx

swelling side nail margin

Name/Cause/Progress/Tx

A

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
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24
Q

Pruritis + white oval-shaped egg capsules at the base of the air shafts

Name/Other name called?(female)/Caution/Dx/Tx/Prevention

A

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

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25
Q

Intense pruritis + Burrows + blue dot at web spaces

Name/Patho/PE/immuno-suppressant/Dx/Tx

A

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

26
Q

Multiple Painless bite upon awakening + blood on mattress

Name/Bugs located/PE/Dx/Tx/Prevention

A

Name: Bed bug

bugs Located: couches, matress

PE: blood stained bedding, allegeric skin reaction

Dx: H & P

Tx: supportive

Prevention: new mattress

27
Q

Painful bite + muscle cramping/spasm/rigidity

Name/found/fatality/Tx/Disposition

A

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
28
Q

Painless bite + slow healing progress

Name/location/PE/Dx/Tx

A

Name: Brown spider (3 pairs of eyes)

Located: southeast/midwest

PE: Painless bite, redness, possible necrotic

Dx: Clinically

Tx: supportive care

29
Q

bee stung/fire ants + redness

Name/type reaction/fatality/PE/Dx/Tx

A

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

30
Q

Pearly & waxy + rolled borders + central ulceration

Name/Characteristic/Dx/Tx

A

Name: Basal cell carcinoma

Characteristic: MC skin cancer in US/slow growth

Dx: punch/shave biopsy

Tx

  • electrodesiccation (nonfacial)
  • Moh micrographic surgery for facial
31
Q

hx of HPV infection + red, elevated thicken nodule + blood margins + bleed easy upon pressure + center ulceration

Name/Characteristic/Dx/Tx

A

Name: Squamous cell carcinoma

Characteristic: slow growth/preceded by actinic keratosis

Dx: Biopsy

Tx: local surgical excision

32
Q

irregular borders + variation color + diameter >6mm + asymmetry + rapid change in appearance

Name/characteristic/MC Type/Dx/Tx

A

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

33
Q

Hx of HHV8 + plaque like brown/pink/red

Name/MC common type/related/Tx

A

Name: kaposi sarcoma

MC type: AIDS related type

Related: HHV8, HIV

Tx: HAART therapy

34
Q

involve skin fail to tan within sun exposure (hyper/hypopigmentation) + oval macules with find scaling

Name/cause/Dx/Tx

A

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)

35
Q

cradle cap infants + dandruff + greasy/yellow scaling

Name/Tx

A

Name: Seborrheic dermatitis

Tx: selenium sulfide, ketoconazole

36
Q

Wheals or plaques + angioedema

Name/type/Tx

A

Name: Urticaria (hives) & angioedema

Type: Type 1 (IgE)

Tx: Oral histamine

37
Q

irregular discrete macules & patches of total depigmentation + hx of endocrine dz (thyroid)

Name/Patho/Cause/Dx/Tx

A

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

38
Q
  • Tinea pedis - appearance/Tx
  • Tinea corporis - appearance/Tx
  • Tinea capitus - appearance/Tx
  • Tinea cruris - appearance/Tx

All Tinea cause pathogen name/Dx

A
  • 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

39
Q

Painless + soft, fleshy cauliflower like lesion

Name/Dx/Tx/Prevention

A

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)

40
Q

Folliculitis vs furuncle vs carbuncle

Clinical presentation/Tx

A
  • 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
41
Q

Dome shape + central umbilication

Name/Cause/Contagious/Tx

A

Name: Molluscum contagiosum

Cause: Poxvirus

Contagious: high

Tx: No tx need

42
Q

hx of sun exposure + hyperpigmentation

Name/Risk/Dx/Tx

A

Name: Melasma

Risk: OCP, pregnancy, SUN EXPOSURE

Dx: Wood’s lamp

Tx: sunscreen, hydroquinone (not for pregnancy)

43
Q

Obese woman with DM + abscess at axilla, groin, under breast

Name/Tx/Prevention

A

Name: Hidradenitis suppurativa

Tx

  • Mild - topical cindamycin
  • Painful abscess - I&D

Prevention: Smoking makes worse/Stop smoking

44
Q

Mobile mass + has been there for long time + cottage cheese like substance

Name/Patho/Tx

A

Name: Sebaceous cysts

Patho: blockage gland

Tx: No need tx

45
Q

Burns

Rules/Minor VS Major/Tx/other complication

A
  • 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
46
Q

Burn degree explain

A
  • 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
47
Q

hx of celiac dz + pruritic

Name/Tx

A

Name: dermatitis herpetiformis

Tx: gluten free diet, Dapsone

48
Q

hx of crohn, UC + painful necrotic ulcer

Name/Risk/Dx/Tx

A

Name: Pyoderma gangrenosum

Risk: hx of crohn, UC, RA

Dx: clinical

Tx: topical corticosteriod (high potency)

49
Q

Soft, symetrical painless easily mobile mass

Name/Tx

A

Name: Lipoma

Tx: None

50
Q

AA with grossly exaggeratred scar

Name/Risk/Tx

A

Name: Keloids

Risk: MC AA

Tx: Corticosteriod injections

51
Q

Friable red(raspberry like) nodule or papule + pregenancy

Name/Risk/Tx

A

Name: Pyogenic granuloma

Risk: pregnancy

Tx: Surgical removal (pedunculated - shave, nonpedunculated - excision)

52
Q

Bright red + circular oval shape

Name/Patho/Tx

A

Name: Cherry angioma

Patho: benigm small blood vessel

Tx: No Tx

53
Q

7 year old less + mouth, throat pain + Vesicles w/ erythmatous halo on buccal & tongue + rash on feet and hand

Name/pathogen/transmission/Tx

A

Name: Hand, Foot, mouth disease

Patho: coxsackies

Transmission: fecal-oral (Contagious)

Tx: Self-limits

54
Q

Laceration explain

Types/Assessment/Prevention/Surgical consult

A

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
55
Q

Hyperpigmentation + edema + hx of chronic insufficiency

Name/related/tx

A

Name: stasis dematitis

Related: chronic insufficiency

Tx: compression stocking, elevation

56
Q

Spider web like vessel on face + blanch when pressure on

Name/Related/Tx

A

Name: Telangiectasia

Related: aging, pregnancy, rosacea

Tx: No Tx need

57
Q

thickened, velvety, darkly pigmented plaques on the neck or axillae + Obese

Name/Dx

A

Name: Acanthosis Nigricans

Dx: DM test if not yet to screened

58
Q

HyperSensitivity 4 type explain

A
  1. Type I - IgE - anaphylaxis, urticaria, angioedema
  2. Type II - IgG, IgM antibody- autoimmune
  3. Type III - IgG, IgM immune complex - Serum sickness, SLE, RA
  4. Type IV - T cell - contact dematitis, TB skin test
59
Q

HIV with finger pain + abscess on finger tip

Name/Pathogen/Dx/Tx

A

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.*

60
Q

Eating tuna + sudden rash

Name/Related fishes/Tx

A

Name: histamine fish toxicity

Related fishes: Tuna/Blue fish/Mackerel

Tx: Supportive, antihistamines

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