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NP > Adult - Derm > Flashcards

Adult - Derm Flashcards

1
Q

What is the most common of all skin disorders?

A

acne

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2
Q

Which acne symptoms are red flags that indicate the need for referral?

A
  • scarring
  • cyst formation
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3
Q

First line (non-pharmocologic) treatment for acne

A

wash several times daily with mild soap

use oil-free products

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4
Q

What is the order of pharmacologic treatment in acne?

A
  1. comedolytics
  2. topical combination agents: comedolytic + ABT
  3. topical antibiotics
  4. oral antibiotics
  5. oral contraceptives
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5
Q

First line pharmacologic treatment for acne

A

comedolytics:

benzoyl peroxide - bacteriocidal

trentoin (Retin-A)

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6
Q

What is a potential side effect of retin-a (tretinoin)?

A

Increased sensitivity to sunlight

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7
Q

What is the second pharmacologic step in acne treatment?

A

combination agents:

benzoyl peroxide + erythromycin = Benzamycin

benzoyl peroxide + clindamycin = Benzaclin

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8
Q

What is the third pharmacologic step of acne management?

A

topical antibiotics:

clindamycin

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9
Q

What is the** fourth** pharmacologic step of acne management?

A

Oral antibiotics:

tetracycline

why is tetracycline contraindicated in pregnancy and children under 9 years?

due to staining of teeth

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10
Q

What is the** fifth** pharmacologic step of acne management?

A

oral contraceptives:

combination products are most effective

ortho tri-cyclen or estrostep

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11
Q

What is a derm-related side effect of oral contraceptive therapy?

A

melasma - brown splotches on the skin

as opposed to the “mask of pregnancy” which is known as:

chloasma

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12
Q

What are two additional therapies that could be used for acne treatment, though not in primary care?

A

dermabrasion

intralesional injections of the steroid triamcinolone

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13
Q

Which two pathogens are the “major players” in skin infections in the community?

A

staph aureus

strep (usually Group A)

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14
Q

Inflammation of the hair follicle -

term and pathogen

A

folliculitis

staph

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15
Q

Localized infection originating from the hair follicle but now more involved -

term and pathogen

A

furuncle

“boil”

staph

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16
Q

What does a CA-MRSA furuncle look like?

A

A spider bite

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17
Q

A red, swollen, and painful cluster of boils that are connected to each other under the skin -

term and pathogen

A

carbuncle

staph

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18
Q

What are the common causes of cellulitis in the community?

A
  1. Strep pyogenes (Group A) - usual cause
  2. Staph aureus - less common
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19
Q

What are the common causes of cellulits in the inpatient population?

A

Gram NEGATIVE organisms -

E. coli

Klebsiella

Psuedomonas

Enterobacter

less frequently - Gram POSITIVE organisms

MRSA? CA-MRSA?

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20
Q

In the outpatient, what 3 drugs can be used to treat CA-MRSA cellulitis?

A
  • Bactrim (TMP/SMZ)
  • Doxyclycline / minocyline
  • Clindamycin

Which of these also covers Group A strep?

Clindamycin

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21
Q

What additional drug class must be aded to Bactrim or Doxycyline / Minocycline in order to provide Group A strep coverage?

A

a beta lactam

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22
Q

What are some examples of the beta lactams?

A

penicillin

amoxicillin

1st generation cephalosporin (Keflex)

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23
Q

What cellulitis-treating antibiotic provides coverage for both staph and strep?

A

Clindamycin

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24
Q

An acute infection of the upper dermis and superficial lymphatics; more superficial than cellulitis, typically more raised and demarcated

“look’s like big sunburn”

  • condition and pathogen
A

Erysipelas

Strep

Known for insidious or rapid progression?

rapid

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25
Q

Infection and abcess formation,

typically in the axilla or groin -

condition and pathogen

A

Hidradenitis suppurativa

staph

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26
Q

Characterized by honey colored crusts on an erythematous base -

condition and pathogen

A

Impetigo

staph

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27
Q

Infection of the skin around the finger or toe nail -

term and pathogen

A

paronychia

staph

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28
Q

Collection of blood between the fingernail and nail bed -

term and management

A

subungual hematoma

trephination - drilling a hole through the nail

to relieve the pressure

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29
Q

candida **balanitis - **

location?

A

candida of the penile head

30
Q

candida intertrigo -

location?

A

candida in warm, moist folds of skin

31
Q

For most candida, what is management?

A

topical antifungals first

oral antifungals only if topicals unsuccessful

32
Q

Four examples of antifungals?

A

miconazole

clotrimazole

fluconazole

griseofulvin

33
Q

What are two fungal infections which are treated with selenium shampoo?

A

tinea capitus

tinea versicolor

34
Q

Another name for herpes zoster is:

A

shingles

35
Q

Pharm options for herpes zoster have what suffix?

A

-cyclovir

36
Q

What is a red flag in herpes zoster?

A

eye or face involvement -

** refer right away**

37
Q

What medications can be used for post-herpetic neuralgia?

A

gabapentin (Neurontin)

pregabalin (Lyrica)

38
Q

What are two significant side effects of gabapentin and pregabalin?

A

excessive sleep

significant weight gain

39
Q

What vaccine can be used to prevent or mitigate herpes zoster?

approved starting at what age?

A

zostavax

age 50

40
Q

What are pre-malignant, small, rough patches on sun-exposed parts of the body?

A

actinic keratosis

41
Q

What type of skin cancer arises from actinic keratosis?

A

squamous cell carcinoma

42
Q

How is actinic keratoses treated?

A

liquid nitrogen

43
Q

What lesions are the precursors to squamous cell carcinoma?

A

actinic keratosis

44
Q

How long does it take for squamous cell carcinoma to develop from an AK?

A

over a few months

45
Q

Description of squamous cell carcinoma

A

firm, irregular papule or nodule

with keratictic, scaly bleeding

(yum)

46
Q

Treatment for squamous cell carcinoma

A

refer for:

biopsy

Mohs excision

47
Q

Benign, beige to black plaque, with a “stuck-on” appearance.

A

seborrheic keratosis

48
Q

Treatment in seborrheic keratoses

A

liquid nitrogen

or

none

49
Q

What is the most common type of skin cancer?

A

basal cell carcinoma

50
Q

Waxy, pearly, shiny lesion with central depression or rolled edge, and possibly with telangiectatic vessels.

A

basal cell carcinoma

51
Q

What is the treatment for basal cell carcinoma?

A

shave or punch biopsy and surgical excision

52
Q

Which skin cancer has the highest mortality rate?

A

melanoma

53
Q

What are the ABCs to remember with melanoma?

A

A - asymmetry

B - border irrecularity

C - color variation

D - diameter > 6 mm

E - elevation

E - enlargement

54
Q

What is an important detail to teach patients about applying steriods to their atopic dermatitis?

A

it is most effective when rubbed in very well

55
Q

What might be the underlying cause of an explosive onset derm disorder that an adult has never previously had?

A

HIV infection

56
Q

What is the only derm disorder for which tar shampoo is recommended?

A

psoriasis

57
Q

Yellow plaques as a result of fat build up under skin; often near inner canthus.

A

Xanthelasma

what is underlying cause?

hyperlipidemia

58
Q

What is the hallmark rash of Lyme disease?

A

erythema migrans

59
Q

What is the initial test for Lyme disease?

confirmatory?

A

ELISA

Western blot

(same as HIV)

60
Q

What antibiotics are used for Lyme disease?

A

Doxycyline

Amoxicillin

61
Q

What is the typical rash in Rocky Mountain Spotted fever?

A

maculo-papular

petechial

62
Q

What is the testing for Rocky Mountain Spotted fever?

A

PCR (like infant HIV test)

63
Q

What is the treatment for Rocky Mountain Spotted Fever?

A

Doxycycline

64
Q

Hallmark distribution of smallpox lesions -

A

first lesions on face, palate, oral mucosa

spread from there

on any one part of the body, all lesions are at the same stage

65
Q

What is the causative agent of anthrax?

A

bacteria, though often referred to as “spores”

66
Q

Is there a vaccine for anthrax?

A

yes

67
Q

What are the two types of anthrax infections?

A

cutaneous

inhalation

68
Q

What is the progression of the cutaneous form of anthrax?

A

pruritic papule

ulcer surrounded by vesicles

black necrotic eschar with edema

eschar falls off leaving scar

69
Q

What is used to treat anthrax?

A

PCN

ciprofloxacin (Cipro)

doxycyline

70
Q

Treatment options for genital warts:

A
  • podophyllin resin
  • podofilox (Condylox)
  • cryosurgery
  • TCA - trichloroacetic acid
  • BCA - bichloracetic acid

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