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Senior - Derm 1 > 4 - Serious Stuff > Flashcards

4 - Serious Stuff Flashcards

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Dermatology Board Prep flashcards
1
Q

What is a “drug eruption”?

A

A derm thing caused by drugs

Rash

Pruritus

Could be basically any patient sensitive to any compound in any drug

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2
Q

Describe the morphology of drug eruption:

A

Maculopapular is the MC presentation

Could also be urticarial

Or just skin flushing with pruritus

Basically, could be anything

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3
Q

What is the MC type of drug eruption?

A

Exanthems (maculopapular)

May be indistinguishable from viral exanthem

Goes away rapidly when you stop taking the drug

Usually spares the face

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4
Q

What is the MC site of a fixed drug eruption?

A

The glans penis

But can occur anywhere

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5
Q

Describe a fixed drug eruption

A

Single or multiple, round, sharply demarcated, dusky red plaques

Appear soon after drug exposure

At the same site every time

Often blister

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6
Q

How do we treat drug eruption?

A

Stop the med (duh)

Give antihistamines

PO or topical class III-IV steroids

Be alert for development of anaphylaxis

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7
Q

How will a patient with urticaria appear?

A

Itchy

Uncomfortable

Possibly short of breath, difficulty swallowing, or itchy mouth/throat (ominous signs)

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8
Q

Morphology of urticaria?

A

Hives (wheal)

Firm, edematous plaque

Faint pink with central pallor

Orange peel appearance (2/2 follicular accentuation)

Transient (about 24hrs) then fade and recur

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9
Q

What is the etiology of urticaria?

A

Release of histamine from mast cells

Immediate hypersensitivity reaction

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10
Q

Causes of physical urticaria?

A

Dermatographism

Pressure (belts, constrictive jewelry)

Solar

Cold/heat

Aquagenic

Cholinergic (exercise, emotion)

Usually only lasts 30-60 mins

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11
Q

Acute vs chronic urticaria - what’s the cutoff?

A

6 weeks

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12
Q

Txt of acute urticaria

A

IM or PO diphenhydramine

PO steroids

If anaphylaxis - epinephrine SQ (1:1000)

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13
Q

Txt for chronic urticaria:

A

Antihistamine, 2nd gen (i.e. cetirizine)

H2 blockers (i.e. ranitidine)

PO steroids (short-term)

Restrictive diet

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14
Q

What is angioedema?

A

Localized, dramatic and rapid swelling of the subcutaneous tissue

Burning and painful swelling

Can happen anywhere - commonly the lips, eyes, tongue, trunk, genitalia, hands

Can involve the GI and respiratory tracts

MAY LEAD TO ANAPHYLAXIS

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15
Q

Txt of angioedema

A

Potentially aggressive management (if severe anaphylaxis develops)(have epi ready, if rapid swelling of resp tract may need to intubate before that shit closes up)

IM or PO diphenhydramine

PO steroids

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16
Q

What is the MC small vessel necrotizing vasculitis?

A

Leukocytoclastic (hypersensitivity) vasculitis

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17
Q

Describe Leukocytoclastic (hypersensitivity) vasculitis

A

Prodrome of fever, malaise, myalgia, arthralgia

Lesions itch and are painful

Appear in crops, last 1-4 weeks

Can spread to multiple organs besides skin

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18
Q

Morphology of Leukocytoclastic (hypersensitivity) vasculitis

A

Inflammation of blood vessel walls cause leakage of RBC’s

Vesicles and points of necrosis

Starts small and continues to increase in size, may coalesce

Palpable purpura

Heals with scars and hyperpigmentation

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19
Q

Distribution of Leukocytoclastic (hypersensitivity) vasculitis

A

Any dependent area (due to increased hydrostatic pressure and extravasation of RBC’s

Lower legs, arms, back and sacrum if bed-bound

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20
Q

Etiology of Leukocytoclastic (hypersensitivity) vasculitis

A

Immune-complex deposition on vessel walls, inflammatory response damages walls

Underlying cause could be: viral hepatitis, strep, UTI, drugs, systemic dz, malignancy…soooo again, anything…starting to see a pattern with derm: anything is anything

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21
Q

How do we manage Leukocytoclastic (hypersensitivity) vasculitis

A

Look for a cause

Also, look for systemic involvement (renal, GI, etc)

Txt the underlying condition

Topical steroids / abx cream

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22
Q

50% of Leukocytoclastic (hypersensitivity) vasculitis patients will have:

A

Hematuria

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23
Q

What is Henoch-Schonlein Purpura?

A

An acute Leukocytoclastic (hypersensitivity) vasculitis that occurs mainly in kids (2-10 yrs)

MC systemic vasculitis in kids

Palpable purpura on the legs and buttocks

Athralgias, abdominal pain

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24
Q

Labs for HSP?

A

Nothing specific - ESR, serum complement, and IgA are all up

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25
Q

Morphology of HSP

A

Palpable purpura on legs and butt

Trunk or normally spared

Starts as hives, then class Leukocytoclastic lesions within 48 hrs

2-10mm in diameter and appear in crops among coalescent ecchymosis and pinpoint petechiae

Fade in several days leaving brown macules

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26
Q

What causes HSP?

A

It’s a hypersensitivity reaction

May be preceded by an URI by 1-3 weeks

Strep with IgA deposits around the vessels

27
Q

How do we manage HSP?

A

It’s a self-limiting dz

Watch for GI bleed and blood loss

NSAIDs and PO steroids

Occasionally dapsone or plasmapheresis

28
Q

Long-term prognosis for HSP directly dependent on:

A

The severity of renal involvement

29
Q

What’s the common patient profile for erythema multiforme?

A

Young adults (age 20-40)

Fever, malaise, burning lesions

Preceding URI or HSV infx (or mycoplasma pneumoniae)

30
Q

Morphology of erythema multiforme?

A

Urticarial papules

Target lesion or vesicles/bullae (red macule with central color change, coalesce to involve large areas, recur in crops for 2-3 weeks)

31
Q

Distribution of EM

A

Back of hands
Palms
Soles
Extensor limbs

May be generalized

Mucous membranes in up to 70% of cases

32
Q

Etiology of EM?

A

Preceding URI or HSV

Immune complex dz - damages vasculature, causes tissue necrosis

33
Q

Management of EM:

A

Symptomatic relief, otherwise no tx if mild

Prednisone with taper or 1-3 weeks

If HSV-induced, oral antivirals

34
Q

What’s the patient profile for SJS?

A

Very sick and in pain

Any age, but more common in young children and young adults

Preceded by URI with high fever and malaise

OR induced by meds for seizure, gout, abx

35
Q

Morphology of SJS:

A

Initial - fever, stinging eyes, pain with swallowing - 1-3 days prior to cutaneous sxs

Flat, atypical targets or pruritic macules, widespread on the trunk first, then neck, face, and proximal upper extremities

Palms/soles early - maybe

Bullous lesions

Ulcerative lesions with hemorrhagic crusts appear on the mucosal surfaces

36
Q

Etiology of SJS:

A

Direct toxic effect from seizure drugs

Viral URI

Mycoplasma pneumonia

37
Q

Management of SJS:

A

Steroids controversial

Control itching and pain

IV fluids (really important)

If severe -> burn unit

Ophthalmology consult

ABX if secondary infx

NG feed if severe throat pain

Foley if severe dysuria

38
Q

Complications of SJS:

A

Sloughing of upper and lower respiratory tract

Blindness 2/2 corneal lesions

39
Q

Toxic epidermal necrolysis - presentation

A

Looks like SJS initially but the big difference is that TEN then progresses to the skin peeling off at the dermoepidermal junction

Any age

Prodrome - fever (MC), HA, sore throat (associated URI)

Sudden onset red, tender skin

High mortality

40
Q

Morphology of TEN:

A

Generalized red macular “sunburn” look

Diffuse, hot erythema

Within hours, skin is painful

Skin peels of (Nikolsky sign)(bad sign)

Desquamation

Vesicles and large bullae appear

Scalp is spared

41
Q

Mucous membrane involvement in TEN:

A

Inflammation, blistering, erosion of mucosal surfaces

Especially the oropharynx

GI tract usually spared

Vaginal tract epithelium blisters and erodes

Eyes - purulent conjunctivitis, ulceration, erosion

42
Q

MCC of TEN:

A

ABX

Followed by anticonvulsants, NSAIDs

43
Q

Management of TEN:

A

Burn unit ASAP

NO STEROIDS

Cyclosporine A
Cyclophosphamide
Plasma exchange
IVIG

44
Q

What is the MCC of death in the setting of TEN?

A

Infection (hence the need for burn unit care - they are Jedi’s with avoiding infection)

45
Q

What is staphylococcus scaled skin syndrome? (SSSS)

A

A blistering disease caused by s. aureus exfoliative toxins

46
Q

Who gets SSSS?

A

Newborns (Ritter’s dz), infants, small children

Staph infection with negative skin culture

Common sites for positive cultures: ears, tonsils, sinuses, conjunctiva

47
Q

Morphology of SSSS:

A

Generalized sunburn-like erythema, sandpaper-like rash

Very tender (unlike scarlet fever)

Clown facies - crusting around mouth

Exfoliation

Total body distribution

48
Q

Etiology of SSSS:

A

2/2 coag (+) s. aureus toxin

Same organism as bullous impetigo

The kid’s immature kidney’s can’t clear toxin effectively

49
Q

Management of SSSS:

A

Low mortality

Anti-staph meds (diclox/ceph)

No corticosteroids (interfere’s with host immunity)

Avoid touching skin

50
Q

How to differentiate TEN from SSSS

A

Do a frozen section

Split is SSSS is more superficial than in TEN

51
Q

Mucocutaneous lymph node syndrome is AKA:

A

Kawasaki’s

52
Q

Patient profile for Kawasaki’s

A

2 or 3 year-old, previously healthy, fever 101-104 (unresponsive to antipyretics)

Cervical adenopathy

Rash

Oral/mucous membrane changes

53
Q

Morphology of Kawasaki’s

A

Acute phase - fever 7-14 days and resolves. Conjunctival injection, strawberry tongue, tender edema of palms/soles (peels after 10 days), diffuse maculopapular rash

Subacute phase - end of fever to 25 days -> desquamation of fingers, toes, arthralgias, thrombocytosis

Convalescent phase - begins when clinical signs disappear through normalization of ESR (about 7 weeks after onset)

54
Q

Distribution of Kawasaki’s:

A

Conjunctival injection

Strawberry tongue

Palms/soles -> red, swollen, tender

Diffuse urticaria and maculopapular eruption (desquamation in 5-7 days)

Diaper dermatitis is common

Cervical lymphadenopathy

55
Q

Etiology of Kawasaki?

A

We don’t know.

56
Q

Management of Kawasaki’s

A

Watch for cardiac abnormalities

High-dose IVIG
ASA

57
Q

Labs in Kawasaki’s?

A

WBC can be over 20K

Elevated ESR/CRP

Thrombocytosis

58
Q

What’s the patient profile for toxic shock syndrome (TSS)?

A 
Post-partum
Post-C-section
Nasal packing and nasal staph carriage
Diaphragm use
Post-op (most cases)
1970’s super awesome mega-absorbent tampons
59
Q

What’s the morphology of TSS?

A

Diffuse, scarlet fever-like rash

Macular, erythematous, looks like a sunburn

Desquamation of palms/soles

Vaginal hyperemia and tenderness

Conjunctival injection

Strawberry tongue

60
Q

Diagnostic criteria for TSS:

A

Fever > 102

Diffuse, erythematous, macular rash

Mucous membrane involvement

HOTN (SBP<90mmHg)

Multi-system involvement

61
Q

What causes TSS:

A

Coag (+) staph toxin

Localized infection with systemic toxin spread

62
Q

How do we manage TSS?

A

Beta-lactamase-resistant abx (oxacillin, nafcillin, cefoxitin, vancomycin/clindamycin)

I and D abscess

Remove tampon

Increased hydration

Maintain BP with pressors if necessary

Mortality 5-10% (higher in dudes)

63
Q

Dont use regular tampons

A

Because now there is new all natural Cherokee hair tampons.

Senior - Derm 1 (7 decks)

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