Cellulitus, Pemphigus And Others Flashcards
(124 cards)
1
Q
What is the mask of pregnancy
A
Melasma/chloasma
2
Q
Warm, tender, well demarcated erythema on cheeks
A
Erysipelas
3
Q
Best initial treatment for abscess
A
I and D
4
Q
What does bullous impetigo look like?
A
Flaccid bulla
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
6
Q
What is the second most common cause of folliculitis?
A
Gram-negative bacteria. Pseudomonas.
Causes Hot tub folliculitis
7
Q
Prodrome of eczemtatous and urticaria eruptions that lead to tense bullae +/- mucosal involvement
A
Pemphigoid
8
Q
What does acanthosis nigricans look like
A
Hyperpigmented, velvety plaques
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
10
Q
What are the two forms of non-purulent cellulitis?
A
Cellulitis
Erysipelas
11
Q
What is the treatment for pemphigoid?
A
STEROIDS topical or oral
Derm referral
General skin care
12
Q
What is the treatment for Erythemaa Migrans?
A
Doxycycline or Amoxicillin
13
Q
How does pemphigus start?
A
FLACCID BULLAE IN MOUTH
Then may spread to other skin
14
Q
WHat is often the actual diagnosis when pt says they have a spider bite
A
MRSA
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
16
Q
What disease is associated with Nikolsky sign?
A
Pemphigus
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
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
19
Q
What are the two forms of purulent cellulitis
A
Purulent cellulitis
Abscess
20
Q
Applied pressure leading to slough, blistering
A
Nikolsky’s sign (in pemphigus)
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)
22
Q
What is the most common cause of death for pts with pemphigus?
A
Secondary infections
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
24
Q
What is the gold standard for diagnosing dermatitis herpetiformis
A
Direct immunofluorescence
25
What does malar/butterfly rash look like
Erythema on cheeks and bridge of nose, sparing the nasolabial folds
26
“Honey colored crusting”
Impetigo (non bullous)
27
How do you treat Rocky Mountain Spotted Fever
Doxycycline to reduce death
28
What does erythema multi forme look like
Target lesions
29
What are the symptoms of Porphyria cutanea tarda
Painless subepidermal blistering of skin on sun exposed areas
Photosensitivity
30
What pathogen usually causes nonbullous and bullous impetigo?
Staph
31
What does pemphigoid look like
TENSE bullae on trunk/extremities
Mucosa may or may not be involved
Lengthy prodrome before
32
What pathogen usually causes ecthyma?
Strep
33
How do you diagnose Porphyria cutanea tard? It looks like pemphigoid!
Check labs for elevated porphyrins, abnormal liver labs, increased iron
34
What are the 2 types of cellulitis?
Nonpurulent (cellulitis or erysipelas)
Purulent (abscess v purulent cellulitis)
35
What skin condition is associated with gluten sensitivity?
dermatitis herpetiformis
NOT HERPES
36
Tx for dermatitis herpetiformis?
Stop eating gluten
| Dapsone
37
How do you treat stage 3 and 4 pressure injuries
Debridement of necrotic tissue
Dressing
+/- Antibiotics
38
What can cause Melasma/chloasma
Pregnancy
| Oral contraceptive use
39
What is the difference between erythema multiforme major and minor?
EM major affects mucosa
Minor does not
40
How do you treat Porphyria cutanea tarda?
Discontinue whatever caused it (drug, alcohol, smoking etc)
Bloodletting (iron depletion prevents formation of UROD inhibitor)
Low dose hydroxychloroquine
41
What is the treatment for the cutaneous manifestations of SLE?
Sun protection
Smoking cessation
Topical or intralesional steroids
Hydroxychloroquine
-consider possibility of drug induced cutaneous lupus
42
What are the two tick borne illnesses discussed?
Erythema migrans
| Rocky Mountain spotted fever
43
Hyperpigmented gums, buccal mucosa, elbows, palms
Adrenal insufficiency, for example, Addison’s
44
What IV antibiotic might be necessary for MRSA
Vancomycin
45
What causes pemphigus?
Autoimmune disease where antibodies cause the epidermal cells to separate from each other
(May be Genetic, idiopathic, sometimes drug induced)
46
Erythematous, scaly plaques on face and scalp on a patient with lupus
Discoid lupus
47
What does ecthyma (impetigo) look like?
“Punched out” ulcers with crust
| Like cigarette burns
48
Itchy papules and vesicles associated with gluten sensitivity
Dermatitis herpetiformis
49
Erythema on cheeks and bridge of nose sparing nasolabial folds
Malar/butterfly rash which is present in 50% of SLE patients
50
What oral antibiotics are given for MRSA
| we don’t do topical ever for MRSA
Trimethoprim-sulfamethoxazole (Bactrim)
Doxycycline
Clindamycin
51
What are the symptoms of cellulitis or erysipelas
Redness, swelling, warmth +/- fever
52
If a lesion has pus, which bacteria is it most likely
Staph
53
What does erysipelas look like
Sharply demarcated border/WELL DEFINED
Red, warm,raised, painful
On cheeks and legs
Fever common- these are SICK patients
54
When would you give antibiotics after draining an abscess?
```
>2cm
Multiple lesions
Toxicity
Extensive cellulitis
Indwelling medical device
Immunosuppression
High risk for transmission (athlete, military)
```
55
Oral antibiotics for MRSA
Bactrim (sulfa), doxycycline, clindamycin
56
What is the treatment for Erysipelas
Cefazolin or ceftriaxone
Empirical IV treatment for strep (IV because these pts are SICK)
57
What is acantholysis
Skin peeling off
58
What are the symptoms of abscess
Painful, fluctuant red nodule
59
How do you diagnose pemphigoid?
Biopsy the lesion and area around lesion and then DIF it
Serology- IIF it and ELISA it
60
Hyperpigmented, velvety plaques on neck and axilla
Acanthosis nigricans
61
What is lymphangitis?
Tender red streaks extending proximally (inflammation of lymphatic channels)
62
What does discoid lupus look like
Annular, red, scaly plaques
| on sun exposed areas
63
How does folliculitis progress, if it does?
Folliculitis —> furuncle—>carbuncle/abscess
64
Blistering on dorsum of hands caused by deficiency of UROD
Porphyria Cutanea Tarda
65
What is the best treatment for pressure injury (ulcer)
Prevention
66
What is the treatment for abscess?
Incision and drainage with culture +/- antibiotics
67
What bacteria causes erysipelas
B-hemolytic strep
68
Characteristic location of rash in RMSF
Ankles, wrists, then trunk. Look at palms and soles
69
What antibiotics are given to pts with purulent cellulitis and abscess?
Trimethoprim-sulfamethoxazole
Doxycycline
Clindamycin
(Bigger antibiotics due to possibility of MRSA)
70
What is Cushing syndrome?
Too much cortisone
71
How does Rocky Mountain Spotted Fever start?
NONSPECIFIC symptoms: fever, headache, malaise, nausea, etc
2-14 days after tick bite
72
What is the most common cause of erythema multiforme
Herpes simplex
73
What should you do to the borders of cellulitis?
Mark them
74
What is Addison’s disease
Not enough cortisone
75
What stage of pressure injury:
Partial thickness skin loss with exposed dermis. Adipose not visible, no eschar (dead tissue that falls off healthy skin)
Stage 2
76
What is the bacteria that causes erythema migrans (Lyme disease)
Borrelia Burgdorferi
77
What oral antibiotic would you give for more severe cases of “hot tub folliculitis” caused by pseudomonas
Ciprofloxacin
78
What is the treatment for dermatitis herpetiformis?
Gluten elimination
+Dapsone (a misc antibiotic that helps while diet change kicks in)
79
How do you treat stage 2 pressure injury
Dressing to maintain moist wound environment
80
Most common cause of erysipelas
B-hemolytic strep
81
What does erythema migrans look like
Bullseye appearance
Raised, red, and warm
82
What is the treatment for pemphigus?
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
What other symptoms can erythema migrans/Lyme disease cause?
Fatigue, headache, myalgia, arthralgia, fever
Late stage: cardiac, arthritis, neurologic, may mimic Bells Palsy
84
What does Nonbullous impetigo look like?
Papules, vesicles and pustules that become HONEY COLORED CRUSTING
85
How do you treat mild bullous and bullous impetigo?
Topical mupirocin
86
How long after tick bite does the bullseye rash appear
7-14 days
87
PemphigoiD= Deep epidermal junction => TENSE bullae that don’t rupture easily=> heal without scarring
That was the story of pemphigoid
88
Tick bite leading to target lesion rash
Lyme disease/erythema migrans
89
What is acanthosis nigricans associated with
Insulin resistance
90
What are the three types of impetigo?
1. Nonbullous
2. Bullous
3. Ecthyma
91
How do you diagnose Rocky Mountain spotted fever?
Usually clinical because labs are unreliable
92
How do you treat stage 1 pressure injury?
Transparent film for protection
93
What is the most common form of pemphigus?
Pemphigus vulgaris
94
What is immunofluorescence?
technique used to visualize a specific protein or antigen in cells
DIF-tissue
IIF- serum
95
What is the most common bacteria for cellulitis?
Strep (B-hemolytic)
96
What are the 2 cutaneous manifestations of Systemic lupus erythematosus?
Discoid lupus
Malar/butterfly rash
97
Who is more likely to get impetigo
Kids (nose pickers)
98
Most common cause of bacterial folliculitis?
Staph
99
What is Nikolsky sign?
Pressing on skin in UNinvolved area and sliding causes it to slough off (acantholysis)
100
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.
Stage 4
101
What stage of pressure injury: intact skin with localized erythema?
Stage 1
102
True or false: many pts with MRSA have no risk factors?
TRUE
103
Hyperpigmentation of face during pregnancy
Melasma
104
Do all patients with Rocky Mountain spotted fever get a rash?
No, 10% of them don’t ever get a rash
105
Most common treatment required for folliculitis
None- self limited
| But if severe: mupirocin or dicloxacillin, cephalexin
106
how does hypothyroidism affect the skin/
Dry cool skin
107
Where does the rash of Rocky Mountain Spotted fever start?
Ankles and wrists, then the trunk
Always look at palms and soles!!!
108
What bacteria usually causes abscess
Staph
109
Can you do topical antibiotics for erysipelas?
No, they need IV medications for strep (Cefazolin, ceftriaxone)
110
Does folliculitis usually go away on its own?
Yes
111
What bacteria causes Rocky Mountain Spotted Fever?
Rickettsia rickettsia
112
What should you do after you remove a tick?
Observe area for 30 days for erythema migrans
Removal within 2-3 days usually prevents Lyme
113
What is the treatment for nonpurulent cellulitis (not erysipelas)
Cephalexin (PO) or Cefazolin (IV)
| Empirically covers strep and staph
114
What is porphyria cutanea tarda
deficiency of the UROD enzyme in the liver.
| Causes excess porphyrins to build up
115
How does Addison’s disease affect the skin?
Hyperpigmentation of skin and gums
116
How do you treat moderate to severe non bullous and bullous impetigo?
Oral: dicloxicillin, cephalexin
117
What other disease do most people with dermatitis herpetiformis have
Celiac disease
118
What are the two types of pemphigoid?
Bullous pemphigoid
| Mucous membrane pemphigoid (MMP)
119
What is the treatment for erythema multiforme?
+/-topical steroids
Antihistamines
Anesthetic mouthwash
Oral steroids if severe
NEVER antiviral meds for EM even though its herpes
120
Typical bacteria that causes hot tub folliculitis
Pseudomonas
121
How would hyperthyroidism affect the skin?
Warm moist skin
Pretibial myxedema-nonpitting, scaly thickened skin with orange peel appearance
122
What are the symptoms of folliculitis?
ITCHING
Some pain
123
How do you diagnose pemphigus?>
Nikolsky sign
Biopsy the lesion as well as the area around the lesion and DIF it
Serology to confirm dx
124
What is hirsutism
Bearded ladies
