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Clin Med Exam 1 (Lauren) > Cellulitus, Pemphigus And Others > Flashcards

Cellulitus, Pemphigus And Others Flashcards

1
Q

What is the mask of pregnancy

A

Melasma/chloasma

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2
Q

Warm, tender, well demarcated erythema on cheeks

A

Erysipelas

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3
Q

Best initial treatment for abscess

A

I and D

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4
Q

What does bullous impetigo look like?

A

Flaccid bulla

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5
Q

What stage of pressure injury is this: Full thickness skin loss, adipose is visible. Eschar may be visible. Fascia, muscle, bone not exposed.

A

Stage 3

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6
Q

What is the second most common cause of folliculitis?

A

Gram-negative bacteria. Pseudomonas.

Causes Hot tub folliculitis

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7
Q

Prodrome of eczemtatous and urticaria eruptions that lead to tense bullae +/- mucosal involvement

A

Pemphigoid

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8
Q

What does acanthosis nigricans look like

A

Hyperpigmented, velvety plaques

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9
Q

What is Drug Induced Cutaneous Lupus?

A

NOT lupus
It’s a reaction that comes from taking certain drugs like diltiazem or HCTZ

It will go away after stopping the med

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10
Q

What are the two forms of non-purulent cellulitis?

A

Cellulitis

Erysipelas

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11
Q

What is the treatment for pemphigoid?

A

STEROIDS topical or oral
Derm referral
General skin care

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12
Q

What is the treatment for Erythemaa Migrans?

A

Doxycycline or Amoxicillin

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13
Q

How does pemphigus start?

A

FLACCID BULLAE IN MOUTH

Then may spread to other skin

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14
Q

WHat is often the actual diagnosis when pt says they have a spider bite

A

MRSA

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15
Q

What antibiotics would you use for more severe cases of staphylococcal folliculitis? (Topical, oral, and if MRSA was suspected)

A

Topical: mupirocin
Oral: cephalexin
MRSA: sulfa, clindamycin, doxycycline

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16
Q

What disease is associated with Nikolsky sign?

A

Pemphigus

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17
Q

PemphiguS= Superficial Separation=> intraepidermal acantholysis=>FLACCID bullae that rupture easily=> infection=> death possible

A

That was the story of pemphigus

Fragile bulla, fragile patients

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18
Q

How do you prevent Lyme disease if you got bit by a tick

A

Remove tick before 36 hours
Single 200mg doxycycline dose if attached longer

Overall risk of developing Lyme is low
Antibiotic prophylaxis should not replace preventative measures like wearing long pants and wearing bug spray

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19
Q

What are the two forms of purulent cellulitis

A

Purulent cellulitis

Abscess

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20
Q

Applied pressure leading to slough, blistering

A

Nikolsky’s sign (in pemphigus)

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21
Q

Do most patients with Rocky Mountain spotted fever know that they got bit by a tick

A

No 1/3 are unaware (most? Whatever)

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22
Q

What is the most common cause of death for pts with pemphigus?

A

Secondary infections

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23
Q

How does Cushing syndrome affect skin?

A

Affects pilosebaceous unit and causes increased sebum, acne, androgen is alopecia, hirsutusm, atrophy, and stretch marks

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24
Q

What is the gold standard for diagnosing dermatitis herpetiformis

A

Direct immunofluorescence

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25
Q

What does malar/butterfly rash look like

A

Erythema on cheeks and bridge of nose, sparing the nasolabial folds

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26
Q

“Honey colored crusting”

A

Impetigo (non bullous)

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27
Q

How do you treat Rocky Mountain Spotted Fever

A

Doxycycline to reduce death

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28
Q

What does erythema multi forme look like

A

Target lesions

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29
Q

What are the symptoms of Porphyria cutanea tarda

A

Painless subepidermal blistering of skin on sun exposed areas
Photosensitivity

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30
Q

What pathogen usually causes nonbullous and bullous impetigo?

A

Staph

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31
Q

What does pemphigoid look like

A

TENSE bullae on trunk/extremities
Mucosa may or may not be involved

Lengthy prodrome before

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32
Q

What pathogen usually causes ecthyma?

A

Strep

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33
Q

How do you diagnose Porphyria cutanea tard? It looks like pemphigoid!

A

Check labs for elevated porphyrins, abnormal liver labs, increased iron

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34
Q

What are the 2 types of cellulitis?

A

Nonpurulent (cellulitis or erysipelas)

Purulent (abscess v purulent cellulitis)

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35
Q

What skin condition is associated with gluten sensitivity?

A

dermatitis herpetiformis

NOT HERPES

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36
Q

Tx for dermatitis herpetiformis?

A

Stop eating gluten

Dapsone

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37
Q

How do you treat stage 3 and 4 pressure injuries

A

Debridement of necrotic tissue
Dressing
+/- Antibiotics

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38
Q

What can cause Melasma/chloasma

A

Pregnancy

Oral contraceptive use

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39
Q

What is the difference between erythema multiforme major and minor?

A

EM major affects mucosa

Minor does not

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40
Q

How do you treat Porphyria cutanea tarda?

A

Discontinue whatever caused it (drug, alcohol, smoking etc)

Bloodletting (iron depletion prevents formation of UROD inhibitor)

Low dose hydroxychloroquine

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41
Q

What is the treatment for the cutaneous manifestations of SLE?

A

Sun protection
Smoking cessation
Topical or intralesional steroids
Hydroxychloroquine

-consider possibility of drug induced cutaneous lupus

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42
Q

What are the two tick borne illnesses discussed?

A

Erythema migrans

Rocky Mountain spotted fever

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43
Q

Hyperpigmented gums, buccal mucosa, elbows, palms

A

Adrenal insufficiency, for example, Addison’s

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44
Q

What IV antibiotic might be necessary for MRSA

A

Vancomycin

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45
Q

What causes pemphigus?

A

Autoimmune disease where antibodies cause the epidermal cells to separate from each other

(May be Genetic, idiopathic, sometimes drug induced)

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46
Q

Erythematous, scaly plaques on face and scalp on a patient with lupus

A

Discoid lupus

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47
Q

What does ecthyma (impetigo) look like?

A

“Punched out” ulcers with crust

Like cigarette burns

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48
Q

Itchy papules and vesicles associated with gluten sensitivity

A

Dermatitis herpetiformis

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49
Q

Erythema on cheeks and bridge of nose sparing nasolabial folds

A

Malar/butterfly rash which is present in 50% of SLE patients

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50
Q

What oral antibiotics are given for MRSA

we don’t do topical ever for MRSA

A

Trimethoprim-sulfamethoxazole (Bactrim)

Doxycycline

Clindamycin

51
Q

What are the symptoms of cellulitis or erysipelas

A

Redness, swelling, warmth +/- fever

52
Q

If a lesion has pus, which bacteria is it most likely

A

Staph

53
Q

What does erysipelas look like

A

Sharply demarcated border/WELL DEFINED

Red, warm,raised, painful
On cheeks and legs
Fever common- these are SICK patients

54
Q

When would you give antibiotics after draining an abscess?

A 
>2cm
Multiple lesions
Toxicity
Extensive cellulitis
Indwelling medical device
Immunosuppression
High risk for transmission (athlete, military)
55
Q

Oral antibiotics for MRSA

A

Bactrim (sulfa), doxycycline, clindamycin

56
Q

What is the treatment for Erysipelas

A

Cefazolin or ceftriaxone

Empirical IV treatment for strep (IV because these pts are SICK)

57
Q

What is acantholysis

A

Skin peeling off

58
Q

What are the symptoms of abscess

A

Painful, fluctuant red nodule

59
Q

How do you diagnose pemphigoid?

A

Biopsy the lesion and area around lesion and then DIF it

Serology- IIF it and ELISA it

60
Q

Hyperpigmented, velvety plaques on neck and axilla

A

Acanthosis nigricans

61
Q

What is lymphangitis?

A

Tender red streaks extending proximally (inflammation of lymphatic channels)

62
Q

What does discoid lupus look like

A

Annular, red, scaly plaques

on sun exposed areas

63
Q

How does folliculitis progress, if it does?

A

Folliculitis —> furuncle—>carbuncle/abscess

64
Q

Blistering on dorsum of hands caused by deficiency of UROD

A

Porphyria Cutanea Tarda

65
Q

What is the best treatment for pressure injury (ulcer)

A

Prevention

66
Q

What is the treatment for abscess?

A

Incision and drainage with culture +/- antibiotics

67
Q

What bacteria causes erysipelas

A

B-hemolytic strep

68
Q

Characteristic location of rash in RMSF

A

Ankles, wrists, then trunk. Look at palms and soles

69
Q

What antibiotics are given to pts with purulent cellulitis and abscess?

A

Trimethoprim-sulfamethoxazole
Doxycycline
Clindamycin

(Bigger antibiotics due to possibility of MRSA)

70
Q

What is Cushing syndrome?

A

Too much cortisone

71
Q

How does Rocky Mountain Spotted Fever start?

A

NONSPECIFIC symptoms: fever, headache, malaise, nausea, etc

2-14 days after tick bite

72
Q

What is the most common cause of erythema multiforme

A

Herpes simplex

73
Q

What should you do to the borders of cellulitis?

A

Mark them

74
Q

What is Addison’s disease

A

Not enough cortisone

75
Q

What stage of pressure injury:
Partial thickness skin loss with exposed dermis. Adipose not visible, no eschar (dead tissue that falls off healthy skin)

A

Stage 2

76
Q

What is the bacteria that causes erythema migrans (Lyme disease)

A

Borrelia Burgdorferi

77
Q

What oral antibiotic would you give for more severe cases of “hot tub folliculitis” caused by pseudomonas

A

Ciprofloxacin

78
Q

What is the treatment for dermatitis herpetiformis?

A

Gluten elimination

+Dapsone (a misc antibiotic that helps while diet change kicks in)

79
Q

How do you treat stage 2 pressure injury

A

Dressing to maintain moist wound environment

80
Q

Most common cause of erysipelas

A

B-hemolytic strep

81
Q

What does erythema migrans look like

A

Bullseye appearance

Raised, red, and warm

82
Q

What is the treatment for pemphigus?

A

Systemic steroids and immunosuppressive agents are mainstay
+ vicious lidocaine and triamcinolone dental paste for oral lesions
+antibiotics for 2* infections
IN ANY CASE YOU REFER THEM URGENTLY

83
Q

What other symptoms can erythema migrans/Lyme disease cause?

A

Fatigue, headache, myalgia, arthralgia, fever

Late stage: cardiac, arthritis, neurologic, may mimic Bells Palsy

84
Q

What does Nonbullous impetigo look like?

A

Papules, vesicles and pustules that become HONEY COLORED CRUSTING

85
Q

How do you treat mild bullous and bullous impetigo?

A

Topical mupirocin

86
Q

How long after tick bite does the bullseye rash appear

A

7-14 days

87
Q

PemphigoiD= Deep epidermal junction => TENSE bullae that don’t rupture easily=> heal without scarring

A

That was the story of pemphigoid

88
Q

Tick bite leading to target lesion rash

A

Lyme disease/erythema migrans

89
Q

What is acanthosis nigricans associated with

A

Insulin resistance

90
Q

What are the three types of impetigo?

A
  1. Nonbullous
  2. Bullous
  3. Ecthyma
91
Q

How do you diagnose Rocky Mountain spotted fever?

A

Usually clinical because labs are unreliable

92
Q

How do you treat stage 1 pressure injury?

A

Transparent film for protection

93
Q

What is the most common form of pemphigus?

A

Pemphigus vulgaris

94
Q

What is immunofluorescence?

A

technique used to visualize a specific protein or antigen in cells

DIF-tissue
IIF- serum

95
Q

What is the most common bacteria for cellulitis?

A

Strep (B-hemolytic)

96
Q

What are the 2 cutaneous manifestations of Systemic lupus erythematosus?

A

Discoid lupus

Malar/butterfly rash

97
Q

Who is more likely to get impetigo

A

Kids (nose pickers)

98
Q

Most common cause of bacterial folliculitis?

A

Staph

99
Q

What is Nikolsky sign?

A

Pressing on skin in UNinvolved area and sliding causes it to slough off (acantholysis)

100
Q

What stage of pressure injury is this: Full thickness skin and tissue loss with exposed muscle, tendon, bone or other fascia. Eschar and rolled edges common. Fistulas may be present.

A

Stage 4

101
Q

What stage of pressure injury: intact skin with localized erythema?

A

Stage 1

102
Q

True or false: many pts with MRSA have no risk factors?

A

TRUE

103
Q

Hyperpigmentation of face during pregnancy

A

Melasma

104
Q

Do all patients with Rocky Mountain spotted fever get a rash?

A

No, 10% of them don’t ever get a rash

105
Q

Most common treatment required for folliculitis

A

None- self limited

But if severe: mupirocin or dicloxacillin, cephalexin

106
Q

how does hypothyroidism affect the skin/

A

Dry cool skin

107
Q

Where does the rash of Rocky Mountain Spotted fever start?

A

Ankles and wrists, then the trunk

Always look at palms and soles!!!

108
Q

What bacteria usually causes abscess

A

Staph

109
Q

Can you do topical antibiotics for erysipelas?

A

No, they need IV medications for strep (Cefazolin, ceftriaxone)

110
Q

Does folliculitis usually go away on its own?

A

Yes

111
Q

What bacteria causes Rocky Mountain Spotted Fever?

A

Rickettsia rickettsia

112
Q

What should you do after you remove a tick?

A

Observe area for 30 days for erythema migrans

Removal within 2-3 days usually prevents Lyme

113
Q

What is the treatment for nonpurulent cellulitis (not erysipelas)

A

Cephalexin (PO) or Cefazolin (IV)

Empirically covers strep and staph

114
Q

What is porphyria cutanea tarda

A

deficiency of the UROD enzyme in the liver.

Causes excess porphyrins to build up

115
Q

How does Addison’s disease affect the skin?

A

Hyperpigmentation of skin and gums

116
Q

How do you treat moderate to severe non bullous and bullous impetigo?

A

Oral: dicloxicillin, cephalexin

117
Q

What other disease do most people with dermatitis herpetiformis have

A

Celiac disease

118
Q

What are the two types of pemphigoid?

A

Bullous pemphigoid

Mucous membrane pemphigoid (MMP)

119
Q

What is the treatment for erythema multiforme?

A

+/-topical steroids
Antihistamines
Anesthetic mouthwash
Oral steroids if severe

NEVER antiviral meds for EM even though its herpes

120
Q

Typical bacteria that causes hot tub folliculitis

A

Pseudomonas

121
Q

How would hyperthyroidism affect the skin?

A

Warm moist skin

Pretibial myxedema-nonpitting, scaly thickened skin with orange peel appearance

122
Q

What are the symptoms of folliculitis?

A

ITCHING

Some pain

123
Q

How do you diagnose pemphigus?>

A

Nikolsky sign

Biopsy the lesion as well as the area around the lesion and DIF it

Serology to confirm dx

124
Q

What is hirsutism

A

Bearded ladies

Clin Med Exam 1 (Lauren) (5 decks)

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