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Ch 3 MDT Flashcards

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Dermatology Board Prep flashcards
1
Q

Inflammation of a hair follicle that can occur anywhere on the body where hair is found

A

Folliculitis

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2
Q

Most common infectious etiology of bacterial Folliculitis

A

Staph aureus

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3
Q

Most common etiologies of non-infectious Folliculitis

A

Pseudo-folliculitis barbae (PFB)

Mechanical Folliculitis (Skinny Jean Syndrome)

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4
Q

Folliculitis Risk Factors

A

Hair removal (shaving, plucking, waxing, epilating agents)

Other pruritic skin conditions: eczema, scabies

Occlusive dressing or clothing

Personal carrier or contact with MRSA-infected persons

Diabetes

Immunosuppression

Use of hot tubs or saunas

Chronic antibiotic use

Tattoos

Poor Hygiene

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5
Q

Abrupt onset of follicular erythematous papules or pustules, with pruritus and pain in hairy areas

Rash occurs on hair-bearing skin, especially the face (beard, proximal limbs, scalp, and pubis

A

Folliculitis

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6
Q

Pseudomonal folliculitis appears as a widespread rash, located mainly at:

A

Trunk and limbs

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7
Q

Clinical hallmark of folliculitis

A

Hair emanating from the center of the pustule

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8
Q

General treatment and prevention of Folliculitis

A

Antiseptic and supportive care is usually enough

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9
Q

MRSA drugs

A

Bactrim

Clindamycin

Doxycycline

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10
Q

Complications of Folliculitis

A

Recurrent Folliculitis (PRIMARY)

Progression to furunculosis or abscesses

Cellulitis

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11
Q

Condition caused by ingrowing hairs, mostly in the beard area

Affects people with curly hair or those with hair follicles oriented at an oblique angle to the skin surface

A

Pseudofolliculitis Barbae

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12
Q

PFB

What is often a problem in affected skin, especially in African-American people?

A

Keloid formation

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13
Q

What may result from PFB?

A

Scarring and hyperpigmentation

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14
Q

PFB affects ____% of black people

and ___% of white people

A

50-75%

3-5%

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15
Q

Treatment for mild to moderate PFB

A

Medical treatment with grooming modifications

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16
Q

Treatment for moderate to severe PFB

A

Laser hair reduction with grooming modifications

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17
Q

PFB Laser Treatment

A series of at least ____ treatments is usually needed, with ____ days in between

A

Three

30-45 days

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18
Q

A contagious, superficial, intra-epidermal infection occurring prominently on exposed areas of the face and extremities

A

Impetigo

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19
Q

A deeper, ulcerated impetigo infection often with lymphadenitis

A

Ecthyma

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20
Q

Most common form of impetigo.

Formation of vesiculopustular that rupture, leading to crusting with a characteristic golden appearance

Local lymphadenopathy may occur

A

Nonbullous impetigo

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21
Q

Staphylococcal impetigo that progresses from small to large flaccid bullae

Ruptured bullae leaves brown crust

Less lymphadenopathy

Trunk more affected

A

Bullous impetigo

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22
Q

Impetigo risk factors

A

Warm, humid environment

Tropical or subtropical climate

Summer or fall season

Minor trauma, insect bites, breaches in skin

Poor hygiene, poverty, crowding, epidemics, wartime

Familial spread

Complication of pediculosis, scabies, chickenpox, eczema /atopic dermatitis

Contact Dermatitis

Burns

Contact sports

Children in daycare

Carriage of group A streptococcus and Staph aureus

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23
Q

Cutaneous pyoderma characterized by thickly crusted erosions or ulcerations.

Usually a consequence of neglected impetigo and classically evolves in impetigo occluded by footwear and clothing

A

Ecthyma

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24
Q

What is the key to avoid infection of impetigo?

A

Avoidance of spreading

HAND WASHING

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25
Q

Treatment for impetigo

A

Mupirocin ointment

Remove crusts clean with gentle washing 2-3 times daily; clean with antibacterial soap, chlorhexidine, or betadine

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26
Q

Severe impetigo treatment may require:

A

Nafcillin or Cefazolin IV antibiotics

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27
Q

Complications of Impetigo

A

Ecthyma

Cellulitis

Resistance to treatment

Lymphangitis

Furunculosis

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28
Q

An acute bacterial infection of the dermis and subcutaneous tissue

Typically caused by bacterial penetration through a break in the skin

A

Cellulitis

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29
Q

Most common etiologies of cellulitis

A

Hemolytic streptococci

Staph aureus

Gram-negative aerobic bacilli

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30
Q

Cellulitis is present with what four classic signs of inflammation?

A

Erythema

Edema

Tenderness

Elevated skin temperature

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31
Q

Most common portal of entry for lower leg cellulitis

A

Toe web intertrigo with fissuring

Secondary to interdigital tinea pedis

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32
Q

History

  • Previous trauma, surgery, animal/human bites, dermatitis, and fungal infection are portals of entry for bacterial pathogens
  • Pain, itching, and/or burning
  • Fever, chills, and malaise
A

Cellulitis

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33
Q

Physical Exam

  • Localized pain and tenderness with erythema, induration, swelling, and warmth
  • Regional lymphadenopathy
  • Purulent drainage from abscesses
A

Cellulitis

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34
Q

Labs considered for cellulitis when:

A

Signs of systemic disease (Fever, HR >100, SBP <90 mm Hg)

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35
Q

What needs to be ruled out in a patient with cellulitis?

A

DVT

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36
Q

Cellulitis treatment

A

Mark borders with a permanent marker

Immobilize and elevate limb

Pain relief

Compression for edema

Antibiotics

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37
Q

Antibiotics of choice for Human and Animal bites

A

Amoxicillin & clavulanic acid (Augmentin)

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38
Q

Complications of Cellulitis

A

Local abscess or bacteremia, sepsis

Superinfection with gram-negative organisms

Lymphangitis

Gangrene

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39
Q

Medical Emergency

Rare and rapidly progressing infection involving any layer of soft tissue including skin, subcutaneous fat, fascia, and/or muscle

Extensive tissue destruction, systemic toxicity, limb loss and are potentially fatal

A

Necrotizing Fasciitis

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40
Q

Risk factors for necrotizing fasciitis

A

Major penetrating trauma

Minor laceration or blunt trauma

Skin breach

Recent surgery

Mucosal breach

Immunosuppression

Malignancy

Obesity

Alcoholism

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41
Q

Most frequently occurs in the extremities and may mimic DVT

Pain, erythema, edema, cellulitis and high fever

Pain is out of proportion to the severity of the physical findings

A

Necrotizing Fasciitis

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42
Q

Labs for Necrotizing Fasciitis

A

MRI: Edema along the fascial plane

X-ray, CT or US are useful in demonstrating the air bubble in soft tissues

Cultures: Group A strep and mixed aerobic and anaerobic bacteria

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43
Q

Treatment for Necrotizing Fasciitis

A

Prompt and wide surgical debridement is the cornerstone

Broad-spectrum antibiotics

MEDEVAC

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44
Q

Complications of Necrotizing Fasciitis

A

Toxic shock syndrome

Amputation

Septic Shock

Death

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45
Q

A well-circumscribed, painful, inflammatory nodule at any site that contains a hair follicle. May extend into the dermis and subcutaneous tissues

A

Furuncle

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46
Q

A collection of pus within the dermis and deeper skin tissues. Manifests as painful, tender, fluctuant, and erythematous nodules

Typically do not present with systemic symptoms

A

Abscess

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47
Q

A coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles

Typically presents with systemic symptoms and fever

A

Carbuncle

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48
Q

Risk factors of abscesses (furuncle, abscess, carbuncle)

A

Carriage of pathogenic staphylococcus sp. in nares, skin, axilla, and perineum

Diabetes mellitus, malnutrition, alcoholism, obesity, atopic dermatitis

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49
Q

Deep subcutaneous erythematous papules enlarge to deep-seated nodules that can be stable or become fluctuant within several days

Multiple Hair Follicles. Most commonly occurs on the back of the neck, upper back and lateral thighs

Tender, perifollicular swelling, terminating in discharge of pus and necrotic plug

Malaise, chills, and fever may precede or occur during the height of inflammation

A

Carbuncle

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50
Q

Mainstay treatment for an abscess, furuncle, or carbuncle

A

Incision and Drainage

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51
Q

Carbuncles should be handled by dermatology or general surgery in all situations unless patient is:

A

Unable to be transferred

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52
Q

Most common benign cutaneous cysts

A

Sebaceous Cyst (epidermal)

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53
Q

The cyst wall consists of normal stratified squamous epithelium derived from:

A

Follicular infundibulum

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54
Q

Firm or fluctuant flesh-to-yellow colored solitary nodule (0.5-5 cm) which often connects with the surface by keratin-filled pores

Grow slowly over time and may remain stable for months to years

Commonly located on face, neck, upper back, chest; if due to trauma, on buttocks, palms, or plantar side of feet

A

Stable epidermal cyst

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55
Q

Warm, red and boggy and tender on palpation

Sterile, purulent material and keratin debris often point towards and drain to the surface

These lesions mimic and present very similarly to abscesses

A

Inflamed/Ruptured Epidermal Cyst

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56
Q

Biopsy of a cyst shows:

A

Encapsulated keratinocytes and cellular debris

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57
Q

Indications for removal of cysts

A

Inflamed/ruptured or infected epidermal cyst

Produces functional deficit

Cosmetic

Pain secondary to location and duties

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58
Q

Cysts

What must be removed to prevent further infection?

A

Capsule

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59
Q

The most common benign mesenchymal neoplasm in adults and are composed of mature white adipocytes

A

Lipoma

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60
Q

Lipomas can occur on any part of the body and usually develop superficially in the ______ tissue

A

Subcutaneous

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61
Q

Soft, painless subcutaneous nodule ranging in size from 1->10 cm

Occur most frequently on the trunk and upper extremities and can be round, oval, or multilobulated

Frequently patients have more than one

A

Lipoma

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62
Q

Transition of a preexisting lipoma to an atypical lipomatous tumor represents an exceeding rare phenomenon at ___%

A

<0.1%

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63
Q

Lipomas may be excised by dermatology for what reasons?

A

Cosmetic

Pain

Impedance of duties

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64
Q

Intramuscular lipoma recurrence rate is up to ___%

A

20%

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65
Q

Acute inflammatory process, with or without abscess formation, that involves the proximal and lateral nail folds and that has been present for less than 6 weeks

A

Paronychia

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66
Q

Paronychia is commonly caused by:

A

Manicuring, nail biting, thumb sucking, and picking at a hangnail

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67
Q

Acute paronychia of the toes is associated with:

A

Ingrown toenails

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68
Q

Most common infection of the hand, representing 35% of all hand infections in the U.S.

A

Paronychia

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69
Q

Paronychia treatment

A

Warm compresses or soaks

Drainage using a scalpel blade inserted between the nail and nail fold

Antibiotics if warranted

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70
Q

What is unnecessary in the treatment of paronychia?

A

Skin incision

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71
Q

Complications of paronychia

A

Further extension of infection with deeper involvement

Nail distortion in chronic infections

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72
Q

Abscess of the distal phalanx fat pad

Staph aureus is the most common pathogen

Painful and swollen distal pulp space

A

Felon

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73
Q

The digital pulp, the fleshy mass at the fingertips, is divided into multiple compartments by _____ _____ that provide structural support

A

Fibrous septae

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74
Q

Pyogenic infection of the distal digital pulp space, with pus collecting in the spaces formed by the vertical septa anchoring the pad to the distal phalanx

Nearly always follows minor finger injury (splinter or needle prick)

A

Felon

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75
Q

Felon treatment

A

Incision and drainage by a Dermatologist

Antibiotics

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76
Q

Labs/Studies/Imaging for a Felon

A

Imaging to evaluate for retained foreign body and to rule out involvement of the distal phalanx

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77
Q

Complications of a Felon

A

Osteitis & osteomyelitis

Ulcerative and tissue necrosis

Flexor tenosynovitis

Septic Arthritis

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78
Q

Grows best in warm, moist environments so infection is often confined to mucous membranes and intertriginous areas

Opportunistic pathogen when allowed to overgrow and predisposing conditions permit

A

Candida (fungal)

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79
Q

What layers of the epithelium does yeast infect?

A

Outer Layers only

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80
Q

Fungal infection Risk Factors

A

Hormonal alterations
-Pregnancy, oral contraceptives, diabetes

Elimination of competing microorganisms
-Antibiotics

Physical environment changes
-Skin maceration, increased humidity/temperature

Direct/Indirect Immunosuppression
-Corticosteroid therapy, immunosuppression

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81
Q

Candidiasis occurs most commonly in what type of areas?

A

Intertriginous areas (axillae, groin, digital web spaces, glans penis, beneath breasts, vulvovaginal)

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82
Q

Red, glistening surface with a long, cigarette paper-like, scaling and advancing border

A

Candidiasis

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83
Q

Treatment for Candidiasis

A

Skin kept dry and exposed to air as much as possible

Antifungals

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84
Q

What is not recommended in the treatment for Candidiasis?

A

Topical Steroids

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85
Q

Diagnosis for Candidiasis is based on:

A

Clinical Appearance

Location of Infection

Presence of predisposing factors

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86
Q

Candidiasis

Positive culture alone is usually meaningless because Candida is:

A

Omnipresent

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87
Q

Superficial fungal infections of the skin/scalp; various forms of dermatophytosis

A

Tinea

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88
Q

Infection of the crural fold and gluteal cleft

A

Tinea Cruris

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89
Q

Infection involving the face, trunk, and /or extremities often presents with ring-shaped lesions, hence the misnomer ringworm

A

Tinea corporis

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90
Q

Infection of the scalp and hair; affected areas of the scalp can show characteristic black dots resulting from broken hairs

A

Tinea capitis

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91
Q

Can subsist on protein, namely keratin and can cause disease in keratin-rich structures such as skin, nails, and hair

A

Dermatophytes

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92
Q

Infections acquired from animals

A

Zoophilic

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93
Q

Infections acquired from personal contact

A

Anthropophilic

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94
Q

Scaling, round or oval pruritic plaques characterized by a sharply defined annular pattern with peripheral activity and central clearing

Papules and occasionally pustules/vesicles present at border and, less commonly in center

A

Tinea Corporis

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95
Q

Treatment for Tinea Corporis

A

Antifungal creams for at least 2 weeks

Continue treatment 1 week after resolution of infection

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96
Q

Tinea corporis treatment that requires oral therapy

A

Extensive lesions or those with red papules

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97
Q

Tinea corporis

What medication may be considered for highly inflamed lesions to minimize scarring?

A

Short course of prednisone

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98
Q

Labs/studies/imaging for Tinea Corporis

A

KOH Prep

Woods lamp

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99
Q

Complications of Tinea Corporis

A

Extension of diease down to the hair follicles

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100
Q

Well-marginated, erythematous, halfmoon-shaped plaques in crural folds that spread to medial thighs; advancing border is well defined, often with fine scaling and sometimes vesicular eruptions

Lesions are usually bilateral and do not include scrotum/penis (unlike candida infections)

A

Tinea Cruris

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101
Q

First line treatment for Tinea Cruris

A

Topical antifungal cream

Absorbent powders

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102
Q

Treatment for refractory, inflammatory or widespread tinea cruris infections

A

Oral antifungals

Resume topical antifungals/powders once resolved

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103
Q

Complications of Tinea Cruris

A

Secondary Bacteria infections

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104
Q

Superficial infection in the interdigital web and soles of the feet caused by dermatophytes

Most common Dermatophyte infection

A

Tinea Pedis

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105
Q

Itching, burning, and stinging of interdigital webs and plantar surfaces

Pain may indicate secondary infection

Most present with asymptomatic scaling

Woods lamp exam with not fluoresce

A

Tinea Pedis

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106
Q

Treatment for Tinea Pedis

A

Open-toed shoes

Shower shoes

Dry between toes after showering & frequent sock changing

Cotten socks (absorbent, non-synthetic)

Antifungal powders

Wide shoes

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107
Q

Caused by Pityrosporum orbiculare

Organism is nourished by sebum

Very common in excess heat and humidity
-Prevalence can reach 50% in tropical areas

Not a dermatophyte infection

A

Tinea versicolor

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108
Q

Velvety tan, pink or white macules that do not tan

Fine scales that are not visible but are seen by scraping the lesion

Central upper back, chest, and proximal areas (highest concentration of sebum)

Asymptomatic; Appearance is often the patient’s main concern

A

Tinea Versicolor

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109
Q

Labs/Studies for Tinea Versicolor

A

Woods lamp will show hypo-pigmented areas of infections

-Faint yellow-green fluorescence

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110
Q

Complications of Tinea Versicolor

A

Relapses without any complications

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111
Q

Treatment for Tinea Versicolor

A

Selenium sulfide from neck to waist

Ketoconazole shampoo to chest and back

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112
Q

Oral treatment for Tinea Versicolor is reserved for patients with:

A

Extensive disease who do not response to topical treatment

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113
Q

Acquired through direct contact of the nail with dermatophytes, yeast, or non-dermatophyte molds in the environment or through spread of fungal infection from affected skin

A

Onychomycosis

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114
Q

Predisposing factors for onychomycosis

A

Tinea pedis, psoriasis, hyperhidrosis, obesity, advancing age, contact with infected household members

Trauma, poor nail grooming, sports and fitness activities, occlusive shoes

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115
Q

Most common onychomycosis presentation

A

Distal subungual onychomycosis

-Begins with white/yellow/brown discoloration of distal corner of the nail that gradually spreads moving proximally

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116
Q

Treatment for Onychomycosis

A

Confirm with KOH & fungal culture for potential liver toxicity

LFT

Oral antifungal (Gold Standard)

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117
Q

Required labs for onychomycosis

A

KOH and Fungal Culture to begin treatment

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118
Q

Disposition for onychomycosis

A

Consult to dermatology and/or podiatry

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119
Q

A contagious parasitic infection of the skin caused by the mite Sarcoptes scabiei

A

Scabies

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120
Q

Scabies is transmitted by:

A

Prolonged human to human direct skin contact

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121
Q

Scabies rash appears __ weeks after exposure

A

2-6 weeks

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122
Q

Cardinal feature of Scabies

A

Intense pruritus that worsens at night

123
Q

Secondary lesions of Scabies

A

Impetigo

Eczema

124
Q

Labs/Studies/Imaging for Scabies

A

Ink test

125
Q

Treatment for Scabies

A

Permethrin 5% or Lindane 1% applied to entire skin surface from the neck down to include fingernails/toenails and in the umbilicus

After 12 hours, patient will bathe

Treatment regimen should be repeated in 1 week

126
Q

Scabies

What may be used to control pruritus and inflammation after treatment with a scabicide?

A

Topical steroids

127
Q

Obligate human parasites

Direct contact is source of transmission

Transmission via hats, brushes, or ear phones is common

A

Pediculus humanus capitis

128
Q

Lice feed or suck blood every ___ hours (blood meal)

A

3-6 hours

129
Q

Lice live for about _____

A

1 month

130
Q

Female lice can lay __ eggs per day

A

7-10

131
Q

Lice eggs (nits) are firm casts cemented to the hair shaft; hatch every __ days

A

8-10

132
Q

Pediculosis pubis

A

Pubic louse

133
Q

Pediculosis Corporis

A

Body louse

134
Q

Pediculosis capitis

A

Head louse

135
Q

Head lice are __ mm in length

A

3-4 mm

136
Q

Pediculosis Capitis

Easier to see than lice and are fluorescent

A

Nits

137
Q

Sky-blue macules on the inner thighs or lower abdomen

A

Pubic louse infestation

138
Q

Treatment for Lice

A

Permethrin / Lindane

Remove nits

Clothes and sheets washed and dried on high temperature

139
Q

What can ‘unglue’ nits?

A

50% vinegar and 50% water

Applied and removed in 15 minutes

140
Q

Home remedies that can kill lice

A

Vaseline over scalp overnight (repeat for 3-4 weeks)

Hair Clean 1-2-3 hairspray

141
Q

Common, acute, self-limited papulosquamous skin rash that is most commonly seen in individuals 10-35 years old

Viral etiology

“Pink Scales”

Sometimes preceded by a prodrome

A

Pityriasis Rosea

142
Q

Pityriasis Rosea

Prodromal symptoms are reported in ___% of patients

-Malaise, mild fever, headache, sore throat, cough, or mild URI or GI symptoms

A

69%

143
Q

Classic Pityriasis Rosea begins with a _____ ______ on the trunk or proximal limbs that precedes secondary eruption by 7-14 days

A

Herald Patch

144
Q

2-5 cm round or oval, sharply delimited, pink or salmon-colored lesion on the chest, neck or back

A

Herald Patch (PR)

145
Q

Lesions are distributed with long axes along cleavage

  • Christmas tree pattern on back
  • V-shaped pattern on upper chest

Resolve in 45 days

A

Pityriasis Rosea

146
Q

Medications for Pityriasis Rosea

A

Treat symptomatically

=Steroids/Antihistamines

147
Q

Labs/Studies/Imaging for Pityriasis Rosea

A

KOH if atypical presentation

Serologic Syphilis testing

148
Q

Complications of PR

A

Long term skin pigmentary changes

Abortion during pregnancy

149
Q

Herpes

Primary outbreaks manifest as:

A

Herpetic gingivostomatitis

150
Q

Herpes

Recurrent episodes usually affect the:

A

Vermillion border of lips of mucosa of the hard palate

151
Q

HSV-1 can be transmitted via:

A

Mucous membranes/secretions

Kissing/Sharing utensils or towels

152
Q

HSV-1

__% infected by age 6

A

33%

153
Q

__% of adults reported to have experienced oral herpes

A

60-90%

154
Q

Herpes recurrences may be precipitated by:

A

Stress, sun, illness, fatigue, dental work, local trauma, menstruation, pregnancy, and immunodeficiency

155
Q

Herpes

Recurrent episodes occur in older children and adults, frequently with a prodrome of:

A

Perioral tingling, itching, numbness, pain, or burning

Followed by papulovesicular lesions (cold sore) on the lip or vermilion border

156
Q

Herpes

Antiviral medications may reduce duration by about how many days?

A

1 day

157
Q

Complications of Herpes Simplex

A

Pyoderma

Eczema Herpeticum

Herpetic Whitlow

Ocular Keratitis

158
Q

Diffuse pox-like eruption complicating atopic dermatitis; sudden appearance of lesions in typical atopic areas (upper trunk, neck, head); high fever, localized edema, adenopathy

A

Eczema herpeticum

159
Q

Localized infection of affected finger with intense itching and pain, followed by vesicles that may coalesce with swelling and erythema

Mimics pyogenic paronychia; neuralgia and axillary adenopathy are possible; heals in 2-3 weeks

A

Herpetic whitlow

160
Q

Clinical syndrome associated with reactivation of latent varicella zoster virus

Typically occurs years after primary Varicella Zoster Virus infection

A

Herpes Zoster (Shingles)

161
Q

> __% of adults in United States are seropositive for varicella

A

95%

162
Q

Herpes Zoster is most common at what age?

A

> 60 years old

163
Q

What amount of people will contract herpes zoster in their lifetime?

A

One-third

164
Q

Characteristic prodrome of Herpes Zoster that may precede rash by 1-5 days

A

Acute neuritis

Paresthesias with allodynia or hyperesthesia described by patient as deep burning, throbbing, or stabbing sensation

165
Q

Unilateral dermatomal rash without midline crossing that favors the thoracic, cranial, lumbar, and cervical dermatomes

A

Herpes Zoster

166
Q

Begins with red macules and papules that progress to clear vesicles within 1-2 days with new vesicles forming over 3-5 days

Vesicles evolve into pustules within 7 days; ulcerating and crusting of pustules by day 14

A

Herpes Zoster

167
Q

Herpes Zoster

Lesions usually heal within ___ weeks

A

2-4 weeks

168
Q

Medications for Herpes Zoster

A

Antivirals <72 hours after onset or if new lesions are appearing

Pain control

169
Q

Occurrence of pain for months or years in the same dermatomal distribution as was affected by herpes zoster

A

Postherpetic Neuralgia

170
Q

Acute herpetic neuralgia refers to pain preceding or accompanying the eruption of rash that persists up to __ days from its onset

A

30 days

171
Q

Subacute herpetic neuralgia refers to pain that persists beyond healing of the rash but which resolves with ___ months of onset

A

4 months

172
Q

Refers to pain persisting beyond four months from the initial onset of rash

A

Postherpetic Neuralgia

173
Q

Reduces the incidence of Postherpetic Neuralgia by 50% when given within 72 hours of rash onset

A

Antivirals

174
Q

Involves the Opthalmic division of the trigeminal nerve

Presents with malaise, fever, headache, and periorbital burning/itching

A

Herpes Zoster Opthalmicus

175
Q

___% of patients with HZO experience direct ocular involvement if antiviral therapy is not used

A

50%

176
Q

Vesicles on the tip/side of nose precedes the development of HZO

A

Hutchinson’s Sign

177
Q

Disposition of patients with Herpes Zoster on the face

A

Medical officer for further evaluation

178
Q

Warts is caused by what virus?

A

Human papillomavirus (HPV)

179
Q

HPV

___ types

___ can infect humans

A

200 types

150 can infect humans

180
Q

HPV

Infection occurs by:

A

Direct skin contact

181
Q

HPV

Incubation period is approximately ___ months

A

2-6 months

182
Q

Verruca vulgaris

A

Common warts

183
Q

Verruca plantaris

A

Plantar warts

184
Q

Verruca plana

A

Flat (plane) warts

185
Q

Warts that are typically few in number

Hands, periungual skin, elbows, knees and plantar surface

Block dots are thrombosed capillaries

May occur singly, in groups, or as coalescing warts forming plaques

A

Verrucae Vulgaris

186
Q

Warts, slightly elevated and flat-topped

Vary in size 0.1-0.3 cm

May be few or numerous and often occur grouped or in a line as a result of spread from scratching

Forehead, back of hands, chin, neck and legs

Typically asymptomatic, however, cosmetically distressing

A

Flat (plane) warts

187
Q

Caused by HPV infection on the plantar foot

Occurs at points of maximal pressure, such as over the heads of the metatarsal bones

Cluster many warts is called a “mosaic wart”

A

Plantar Warts

188
Q

How to differentiate between plantar warts and corn/callus

A

Black dots are seen in warts

Corns have a hard painful translucent central core

189
Q

Treatment for warts

A

Salicylic acid

Cryotherapy

Duct tape

190
Q

Complications of warts

A

Scarring and recurrence

Some types of HPV have higher risks for Carcinoma

191
Q

Non-immunologic reaction to substance or action producing direct damage to skin by chemical abrasion or physical irritation

Causes: Chemical agents, alcohol, creams, powders, moisture, friction, and temperature extremes

A

Irritant Contact Dermatitis

192
Q

Due to a delayed immunologic response to a cutaneous or systemic exposure to an allergen to which the patient has been previously sensitized

A

Allergic Contact Dermatitis

193
Q

Most common cause of allergic contact dermatitis

A

Poison ivy

Poison sumac

Poison oak

194
Q

Allergic contact Dermatitis

Latency period of ____ hours

A

12-48 hours

195
Q

Most common cause of metal dermatitis

A

Nickel

196
Q

Hands are most often affected

Erythema, dryness, painful cracking or fissuring and scaling are typically, Vesicles may be present

Tenderness and burning are common and predominate the itching

Open skin may burn on contact with topical products

A

Irritant Dermatitis

197
Q

Irritant Dermatitis prevention

A

Avoidance of exposure

PPE

198
Q

Irritant Dermatitis Treatment

A

Steroid ointments

Frequent application of a bland emollient is essential

199
Q

Vesicles, edema, redness, and extreme pruritus

Strong allergens such as poison ivy produce bullae

Distribution first confined to the area of direct exposure

May spread beyond areas of direct contact

Itch and swelling are key components of the history

A

Allergic Contact Dermatitis

200
Q

Most common sites of Allergic Contact Dermatitis

A

Hands, forearms and face

201
Q

Allergic Contact Dermatitis treatment

A

Avoid allergic substance

Topical steroids

202
Q

Patch testing for allergic contact dermatitis should be delayed until the dermatitis has subsided for at least __ weeks

A

2 weeks

203
Q

Seborrheic Dermatitis

A

Dandruff

204
Q

Chronic, superficial, recurrent inflammatory rash affecting sebum-rich, hair regions of the body, especially the scalp, eyebrows, and face

Prevalence: 3-5%

A

Seborrheic Dermatitis

205
Q

Treatment for Seborrheic Dermatitis

A

Control rather than cure

-Shampoos: Zinc pyrithione, Selenium sulfide, Ketoconazole, Salicylic Acid, Coal tar

206
Q

Chronic, inflammatory disorder most commonly characterized by cutaneous erythematous plaques with silvery scale

Complex immune-mediated disorder associated with flares related to systemic, psychological, infectious, and environmental factors

A

Psoriasis

207
Q

Most common variant of Psoriasis at 80% of cases

A

Plaque (vulgaris) Psoriasis

208
Q

Psoriasis

__% have psoriasis in a first-degree relative

A

40%

209
Q

Well-demarcated salmon pink to red erythematous papules and plaques; silvery scale

Scalp, auricular, postauricular area; extensor surfaces (knees elbows); umbilicus, lower back, intergluteal cleft, and nails

A

Plaque Psoriasis

210
Q

Nail findings of plaque psoriasis

A

Pitting, oil spots, onycholysis

211
Q

Pinpoint bleeding with removal of scale

A

Auspitz sign (plaque psoriasis)

212
Q

New psoriatic lesions arising at sites of skin injury/trauma

A

Koebner phenomenon

213
Q

Plaque psoriasis

Genitals affected in up to ___% of patients

A

40%

214
Q

Treatment for psoriasis

A

Topical corticosteroids/retinoids

Systemic therapy if >20% of the body or very uncomfortable

Phototherapy

215
Q

Disposition for Psoriasis

A

Routine referral to dermatology for further evaluation and definitive treatment

216
Q

Complications of Psoriasis

A

Psoriatic arthritis

Exfoliative dermatitis

217
Q

Disorder of the pilosebaceous units

Notable for open/closed comedones, papules, pustules, nodules

Early to late puberty, may persist in 20-40% of affected individuals into 4th decade

A

Acne vulgaris

218
Q

Ance vulgaris

___% of adolescents affected

A

80-95%

219
Q

Open comedones

A

Blackheads

220
Q

Closed comedones

A

Whiteheads

221
Q

Treatment for comedonal (non-inflammatory) acne

A

Topical retinoid

222
Q

Treatment for mild comedonal + papulopustular acne

A

Topical antimicrobial

Topical retinoid

Antibiotics for those who cannot tolerate retinoids

223
Q

Treatment for moderate papulopustular and mixed acne

A

Topical retinoid

Oral antibiotics

Topical benzoyl peroxide

224
Q

Treatment for severe acne (nodulocystic acne)

A

Oral isotretinoin monotherapy

225
Q

Acne medication

Antibacterial properties and also comedolytic

Visible improvement typically occurs within three weeks, with maximum results evident after 8-12 weeks

A

Benzoyl peroxide

226
Q

Acne Medication

Reduce the number of comedonal acnes in the sebaceous follicles and suppress inflammation. May cause skin irritation

Use with benzoyl peroxide to decrease the occurrence of bacterial resistance

A

Topical Antibiotics (erythromycin & clindamycin)

227
Q

Most common topical antibiotics used for the treatment of acne

A

Erythromycin and clindamycin

228
Q

Most frequently used oral antibiotics for acne therapy

A

Doxycycline and minocycline

229
Q

Treatment for severe recalcitrant nodular acne who is unresponsive to conventional therapy, including systemic antibiotics

20 week course

Teratogenic

Only prescribed by clinicians who participate in iPLEDGE

A

Isotretinoin

230
Q

What can be beneficial in the treatment of acne for women older than 15?

A

Contraceptives

231
Q

Complications of Acne

A

Cyst formation

Pigmentary changes

Severe scarring

Psychological problems

Gram-negative folliculitis

232
Q

An abscess, or sinus tract, in the upper part of the natal (gluteal) cleft

A

Pilonidal abscess

233
Q

Means “nest of hair”

A

Pilonidal

234
Q

Physical exam reveals one or more primary pores (pits) in the midline of the natal cleft and/or a painless sinus opening

No acute inflammation or infection

A

Asymptomatic pilonidal disease

235
Q

Tender, swollen, and fluctuant nodule located along the superior gluteal fold

A

Acute pilonidal abscess

236
Q

Treatment for an acute pilonidal abscess

A

Incision and drainage

Antibiotics in the presence of cellulitis

237
Q

Complications of pilonidal abscess

A

Systemic infection

Recurrence

238
Q

Active hair growth

80-85% of hairs are in this stage at a given time

A

Anagen (growth) Phase

239
Q

Hair growth stops due to papilla detaching (removing blood supply)

1-3% of hairs are in this stage at a given time

A

Catagen (transitional) phase

240
Q

Hair is resting phase for 1-4 months, up to 10-15% of hairs in a normal scalp.

Hair is no longer connected to anything but the follicle

A

Telogen (resting) Phase

241
Q

In late telogen phase, the follicle begins to grow again and hair base breaks free from the root and is shed

2 weeks, new hair shaft begins to emerge

A

Exogen (shedding) Phase

242
Q

Anagen phase for shorter hairs (eyelashes, eyebrows, leg/arm hair)

A

1 month

243
Q

Anagen duration for scalp hair

A

> 6 years

244
Q

= “hair loss”

A

Alopecia

245
Q

Present follicular markings suggest a _______ alopecia

A

non-scarring

246
Q

Absent follicular markings suggest a ______ alopecia

A

Scarring

247
Q

Alopecia

Occur secondary to something else in the body (systemic disease, endocrine disorders, vitamin deficiencies, malnutrition)

A

Non-scarring alopecia

248
Q

Most common form of male hair loss affecting 30-50% of men by age 50

Occurs in highly reproducible pattern, affecting the temples, vertex and mid frontal scalp

A

Androgenetic alopecia

249
Q

Androgenetic alopecia

Familial tendency and racial variation and heredity account for __% of disposition

A

80%

250
Q

Believed to be an immunologic process. Patches that are perfectly smooth and without scarring

Involvement may extend to all of the scalp hair or to all scalp and body hair

A

Alopecia Areata

251
Q

Alopecia of all the scalp hair

A

Alopecia totalis

252
Q

Alopecia of all scalp and body hair

A

Alopecia universalis

253
Q

Temporary hair loss that usually happens after stress, a shock, or a traumatic event. Usually occurs on the top of the scalp

A

Telogen effluvium

254
Q

May occur following any type of trauma or inflammation that may scar hair follicles

Chemical, physical trauma, bacterial or fungal infections, severe herpes zoster, chronic discoid lupus erythematosus, scleroderma, and excessive ionizing radiation

A

Cicatricial Alopecia

255
Q

Treatment of alopecia

A

Most cases hair re-grows and no treatment is needed

Consider treatment on how to deal with emotional stress

Referral to dermatology for more intense treatment

256
Q

Labs/Studies/Imaging for Alopecia

A

TSH

CBC

257
Q

Complications of Alopecia

A

Depression/Anxiety

Mid-life crisis

258
Q

Acute, delayed, and transient inflammatory response of the skin secondary to excessive exposure to ultraviolet radiation (UVR)

Depending on frequency and exposure time, damage to melanocytes and keratinocytes

A

Sunburn

259
Q

Susceptibility to sunburn =

A

Susceptibility to skin cancer; associated with an increased risk of melanoma at all ages

260
Q

Risk factors of Sunburn

A

Near the equator

More likely to occur at noon

Altitude

Reflection from snow (90%), Sand (15-30%), Water (5-20%)

Fair skin, blue eyes, red & blond hair

261
Q

Sunburn

Erythema is first noted at ___ hours

Peaks at ____ hours

Subsides at ____ hours

A

3-5 hours

12-24 hours

72 hours

262
Q

Sunburn

Blisters heal without scarring in ____ days

A

7-10

263
Q

Sunburn

Scaling, desquamation, and tanning are noted ____ days after exposure

A

4-7

264
Q

Occur quickly and appear as a sunburn

A

Drug-induced phototoxic reactions

265
Q

Rare, IgE-mediated, photodermatosis characterized by pruritis, stinging, erythema, and wheal formation after exposure to sunlight

A

Solar urticarial

266
Q

Complications of Sunburn

A

Melanoma

Actinic Keratoses

267
Q

The most important part of treatment for sunburn is:

A

Prevention

  • Protective clothing (SPF 50+)
  • Sunscreen (SPF 30+)
268
Q

Measures the UV radiation required to produce sunburn on protected skin (with sunscreen) relative to UV radiation is required to produce sunburn on unprotected skin (no sunscreen)

A

SPF

269
Q

SPF is related directly to:

A

Amount of Solar Exposure (not time)

270
Q

Treatment for Sunburn

A

Cool compresses or soaks, calamine lotion, aloe vera

NSAIDs

271
Q

Contraindicated in the treatment of Sunburn

A

Topical Corticosteroids

272
Q

Caused by lateral pressure of poorly fitting shoes, by improper or excessive trimming of the lateral nail plate or by trauma

Pain, redness and swelling caused by the nail penetrating the surrounding nail tissue

A

Ingrown Nail

273
Q

Virtually the only toe involved, with either the medial or lateral border of the nail may be affected

A

Great toe

274
Q

Treatment of ingrown nail

A

Removing the penetrating nail with scissors and curetting the granulation tissue

Small areas of granulation tissue can be simply treated with silver nitrate

275
Q

Podiatrists treat chronic recurrent ingrown nails by destroying the lateral nail matrix with:

A

Phenol

276
Q

Most common of all injuries to the upper extremities; typically results from a direct blow to the fingernail or a squeezing type injury to the distal finger

Causes bleeding into the space between the nail bed and nail itself

A

Subungual hematoma

277
Q

Separation of the nail from the nail bed

A

Onycholysis

278
Q

Subungual hematoma

What must be done prior to draining/trephination?

A

Rule out additional/more severe injuries

279
Q

Subungual hematoma

Drainage methods

A

Heated paperclip

Cautery Pen

Drill method

Needle method

280
Q

Most common acquired benign epithelial tumor of the skin

Often mistaken for Melanoma

Typically develop after age 50

Usually Asymptomatic

A

Seborrheic Keratoses

281
Q

Usually multiple lesions, which can arise anywhere except the lips, palms, and soles

Begin as circumscribed tan brown patches or thin plaques

Over time, may become more papular or verrucous with a greasy scale and a stuck-on appearance

A

Seborrheic Keratoses

282
Q

Treatment for Seborrheic Keratoses

A

Cryotherapy

Curettage/shave excision

Electrodessication

283
Q

Result from the proliferation of atypical epidermal keratinocytes

Represent early lesions on a continuum with squamous cell carcinoma

Precancerous lesions

Frequently occur in sun-exposed areas

A

Actinic Keratoses

284
Q

Risk factors of Actinic Keratoses

A

Extensive sun exposure, history of sunburns, sunscreen usage

Fair Skin, Male, >40 years old, geography

285
Q

Commonly described as having a “rough, sandpaper-like” feeling

A

Actinic Keratoses

286
Q

Patients with multiple Actinic Keratoses lesions require:

A

Annual Follow-up

287
Q

Malignant tumor arising from melanocytic cells

Most fatal form of skin cancer

Increasing faster than any other potentially preventable cancer in the United States

A

Melanoma

288
Q

Strongest association of Melanoma

A

Intermittent exposure and sunburn that occurred in adolescence or childhood

289
Q

Nearly 50% of melanoma deaths in the U.S. occur in:

A

White males, age >50

290
Q

Lesion will be the “ugly duckling”, different than the other lesions

  • Asymmetrical
  • Irregular borders
  • Color Changes
  • Diameter >6 mm
A

Melanoma

291
Q

Treatment for Melanoma

A

Dermatology:

-Biopsy, Complete excision of entire lesion into the subcutaneous fat

292
Q

The goals of wound repair for lacerations and incisions are to:

A

Achieve Hemostasis

Prevent Infection

Preserve Function

Restore Appearance

Minimize patient discomfort

293
Q

Wound Healing

Day 0-5: no Gain in wound strength

A

Phase I: Initial Lag Phase

294
Q

Wound Healing

Days 5-14: Rapid increase in wound strength occurs.

A

Phase II: Fibroplasia Phase

295
Q

Wound Healing

Day 14 until healing is complete: Further connective tissue remodeling. Up to 80% of normal skin strength achieved.

A

Phase III: Final Maturation Phase

296
Q

Indications for wound repair

A

Lacerations open for less than 12 hours

Repair of sites where a lesion has been surgically removed

297
Q

Contraindications for wound repair

A

Wounds open more than 12 hours

Animal or human bites

Puncture wounds

298
Q

Four principles that should be incorporated in the process of closing any wound

A
  1. Control all bleeding
  2. Eliminate “dead space”
  3. Accurately approximate tissue layers
  4. Approximate the wound with minimal skin tension
299
Q

Stitch should be wide as it is deep

Equal distance from the wound margin and of equal depth

No closer than 2 mm of other sutures

Ideal for the scalp

A

Simple Interrupted Sutures

300
Q

Quick and distributes tension evenly and provides excellent cosmetic results

Less desirable in traumatic lacerations because of the increased risk of contamination

A

Simple running stitch

301
Q

Promotes eversion of the skin edges. It is useful when the natural tendency of lose skin is to create inversion of the wound margins, which is to be avoided

Appropriate when the skin is very thin and interrupted sutures have a tendency to pull through

A

Vertical Mattress Sutures

302
Q

Suture technique is helpful in wounds under a moderate amount of tension; also promotes wound edge eversion

Useful on palms of hands or soles of feet and in patients who are poor candidates for deep sutures because of susceptibility to wound infections

A

Horizontal Mattress Sutures

303
Q

Provide a rapid and simple alternative to other methods of skin closure and wound repair

Indicated for:

  • Wounds whose edges are easily approximated and not under undue tension
  • Long, Linear wounds of the scalp
  • Proximal extremities or the torso where cosmetic is not a concern
A

Skin Staples

304
Q

Skin staples are contraindicated for:

A

Facial or neck tissue

Areas where there is an inadequate subcutaneous base

Over small mobile joints or wherever staples may interfere with normal function

Wounds that are macerated/infected or over large tissue loss

Derm (3 decks)

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