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RDA Andrews > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

What 5 syndromes are secondary to disease-producing mutations in 12 genes?

A
  • altered pain & temp sensation
  • trophic changes
  • sweating abnormalities
  • ulcers of hands and feet
  • self mutilating behavior
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2
Q

what is another name for mal perforans pedis and definition

A

neuropathic ulceration or perforating ulcer of the foot.

chronic ulcer on sole at site of constant trauma resulting in loss of pain sensation

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3
Q

The primary cause lies in the posterolateral tracts of the cord/ lateral tracts/ or peripheral nerve in which disorders?

A

posterolateral = arteriosclerosis and tabes dorsalis
lateral = syringomyelia
peripheral n. = diabetes or Hansen’s dz

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4
Q

complication of mal perforans pedis

A

osteomyelitis of the metatarsal or tarsel bones

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5
Q

treatment for mal perforans pedis

A

relief of pressure through total-contact cast + debridement of surrounding callus

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6
Q

morphology of mal perforans pedis

A

soft, moist, maloderous lesion w or w/o pruulent discharge –> necrotic ulcer

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7
Q

Most common cause for sciatic nerve injury & Most common finding

A

improper needle placement

paralytic foot drop

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8
Q

thin, shiny, edematous skin that has no sensation will often have what other finding

A

absence of sweating (sciatic nerve injury)

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9
Q

treatment for sciatic nerve injury

A

surgical exploration and repair

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10
Q

Syringomyelia disease process

A

begins insidiously and gradually causes muscular weakness, hyperhidrosis, and sensory disturbances

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11
Q

MC area affected with syringomyelia

A

thumb, index, middle fingers

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12
Q

difference between syringomyelia and Hansen’s dz

A

syringomyelia does NOT interfere with sweating or block the flare around a histamine wheal

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13
Q

Burns are the most freq lesions but what else can be found in syringomyelia

A

contractures, gangrene, bullae, warts

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14
Q

treatment for syringomyelia

A

early surgical tx to prevent progression and improve sx

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15
Q

what is the first responder to pruritogenic stimuli and how is it transmitted to the brain?

A

keratinocytes

via the lateral spinothalamic tract

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16
Q

Name the 4 categories of itch:

A
  1. Pruritoceptive itch (skin d/o)
  2. Neurogenic itch (CNS caused by systemic d/o)
  3. Neuropathic itch (anatomic lesions of the CNS or PNS)
  4. Psychogenic itch (observed in parasitophobia)
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17
Q

General guidelines for itchy patient

A
  • keep cool
  • avoid hot baths/showers, wool
  • use soap only in axilla and inguinal area
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18
Q

How does benzecaine work for relieving pruritis?

A

contact sensitization

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19
Q

What does EMLA stand for and caution for EMLA

A

eutectic mixture of lidocaine and prilocaine ointment;

Caution - EMLA may be TOXIC if used in large areas

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20
Q

Most important internal cause of itching?

A

liver disease, renal failure, diabetes, hypo/hyperthyroidism

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21
Q

What is the first symptom of hodgkins dz and how would you describe it?

A

pruritis - continuous and sometimes accompanied w severe burning (side note: leukemia pruritis is less severe)

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22
Q

Recommended workup for patients with chronic, generalized pruritis

A

history/ physical/ labs
- CBC w diff; thyroid, liver, renal panels; hepatitis C serology; HIV antibody; UA; stool for occult blood; serum electrophoresis; CXR

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23
Q

Presence of eosinophilia on CBC likely means what?

A

parasitic disease; if pt is on systemic steroids then check stool for ova & parasites

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24
Q

Most common systemic c/o pruritis

A

Chronic kidney dz

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25
Q

treatment options for CKD pruritis

A
  • emollients, soaking & smearing
  • gabapentin 100mg 3x/wk after hemodialysis
  • NB UVB or broad band
  • Naltrexone, tacrolimis, ondansetron
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26
Q

How can a patient with CKD eliminate pruritis?

A

renal transplant

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27
Q

Treatment options for chronic liver disease pruritis

A
  • cholestyramine 4-16 g/d
  • *rifampin 150-300 mg/d *Caution: may cause hepatitis
  • naltrexone (not used bc of SE)
  • Sertraline, UVB
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28
Q

What is Ursodeoxycholic acid used for?

A

pruritis in intrahepatic cholestasis of pregnancy

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29
Q

Definitive treatment of end stage liver disease and relief from severe pruritis is seen with what therapy?

A

liver translant

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30
Q

What population is affected by primary biliary cirrhosis?

A

women over 30

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31
Q

Jaundice + dark hyperpigmentation of entire skin with a spared area of hypopigmentation on upper back =

A

primary biliary cirrhosis

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32
Q

Eruptive xanthelasma, planar xanthomas of palms, xanthelasma, tuberous xanthomas of joints

A

primary biliary cirrhosis

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33
Q

what test is positive in primary biliary cirrhosis

A

antimitochondrial antibody test

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34
Q

what labs would you expect to be elevated in primary biliary cirrhosis

A

bilirubin, alk phos, ceruloplasmin, hyaluronate, cholesterol

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35
Q

What % of pts with polycythemia vera have itching and when does it occur?

A

1/3 , induced by temp changes or after bathing

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36
Q

Treatments for PCV itching

A

Aspirin, PUVA/ NB UVB, Paroxetine, IFN alpha-2, Jak

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37
Q

Describe Soak and smear for winter itch

A

soak at comfortable temp for 20 mins before bedtime + apply TAC ointment to wet skin + old pair of PJs {use plain petrolotum ointment if no inflammation present}

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38
Q

Medicaments, fragrant toilet tissue, or preservatives can cause what

A

pruritis ani d/t ALLERGIC contact dermatitis

39
Q

GI causes such as hot spices or failure to cleanse the area, or leaking d/t physical changes may lead to

A

pruritis ani d/t IRRITANT contact dermatitis

40
Q

mycotic pruritis ani will show what on KOH

A

candida albicans, epidermophyton floccosum, trichophton rubrum

41
Q

treatment for pruritis ani

A
  • Tucks, Balneol
  • non infectious –> steroid or tacrolimus or pramoxine
  • sitz baths then petrolatum over wet skin (provides barrier)
42
Q

MC type of pruritis scroti

A

psychogenic pruritis

43
Q

fungal infections

A

spare the scrotum, except for candidiasis

44
Q

scrotum candidasis symptoms

A

burning (not itching), eroded, weepy, crusted

45
Q

pruritis scroti tx

A

mainstay = corticosteroids

or tacrolimus, pramoxine, dozepin and simple petrolatum (after sitz bath)

46
Q

5 MC causes of pruritis vulvae

A

unspecified dermatitis, LSC, chronic vulvovaginal candidasis, dysethetic vulvodynia, psoriasis

47
Q

T vaginalis shape

A

piriform

48
Q

lichen planus vulva tx

A

high potency steroids

49
Q

lichen sclerosis vulva tx

A

pulsed dosing high potency steroid or tacrolimus or pimecrolimus

50
Q

Itchy points is another name for what condition?

A

puncta pruritica; it is followed by SKS at the same site as itchy points

51
Q

what is aquagenic pruritus and who gets is

A

= itching, prickling discomfort when exposed to water that goes away when not exposed.
1/3 = older men w PCV
2/3 = younger women no underlying dz

52
Q

Tx for aquagenic pruritis

A

soak & smear, antihistamines, sodium bicarb in bath water, propranolol, SSRIs, ASA, pregabalin, montelukast,, NB UVB, possibly tight clothes

53
Q

What is aquadynia and what tx is useful

A

15-45 min PAIN after water exposure,

clonidine and propranolol provide relief

54
Q

how to distinguish between scalp pruritus vs inflammatory causes

A

scalp pruritus lacks excoriations, scaling, or erythema

55
Q

Tx for scalp pruritus

A

tar shampoos, sal acid shampoos, steroid gels, mousse , ILK, minocycline, oral antihistamines, doxepin

56
Q

African americans treated for malaria will sometimes get

A

drug induced pruritus d/t antimalarial

57
Q

Hydroxyethyl startch (HES) and opioid use

A

cause drug induced pruritus

58
Q

prurigo simplex morphology

A

itchy red bump, dome shaped + vesicle

59
Q

prurigo simplex initial tx

A

topical steroids, oral antihistamines

60
Q

prurigo simplex recalcitrant tx

A

UVB, PUVA

61
Q

25 year old Japanese women in the winter and spring with hx of weight loss, diet, aorexia, diabeties, ketouria

A

think prurigo pigmentosa (mucous membranes spared)

62
Q

DOC for prurigo pigmentosa

A

minocycline 100-200mg/d

Dapsone + diet change (STEROIDS NOT EFFECTIVE)

63
Q

Japanese male over 55 with flat topped red, brown itchy papules that spare skinfolds is called what?

A

Papuloerythroderma of Ofuji

64
Q

blood eosinophelia and deck-chair sign is found in

A

Papuloerythroderma of Ofuji

65
Q

DOC for PEO

A

systemic steroids

66
Q

another name for LSC

A

circumscribed neurodermatitis

67
Q

main symptom + findings of LSC

A

paroxysmal pruritus + crisscross pattern striae and flat-topped shiny, smooth quadrilateral facets

68
Q

Goal for treating LSC and how to achieve it

A 
goal = avoid scratching
how = use high potency steroid cm/oint, occlusion of medium potency, ILK, botox, unna boot
69
Q

describe prurigo nodularis

A

multiple itchy nodules on extremities in linear fashion; worse w stress

70
Q

treatment for prurigo nodularis

A

ILK or topical steroid (soak & smear), cordran, UVB, Vit D3 ointment/ calcipotriene/ tacrolimus, ISOTRETINOIN (random)

71
Q

Thalidomide risks

A

dose-dependent neuropathy at cummulative doses of 40-50g *can be used for prurigo

72
Q

Lenalidomide

A

less neuropathy SE than thalidomine, but may cause myelosuppression, venous thrombosis, and SJS

73
Q

Psychosis defined

A

presence of delusional ideation (fixed misbelief not shared by subculture)

74
Q

ohychophagia

A

biting nails

75
Q

dermatophagia

A

habit or compulsion

76
Q

Russell’s sign

A

crusted papules on dersum of hand from cuts by teeth - bulimia

77
Q

initial step for delusions of parasitosis and other name for this condition

A

exclude a true infestation; Morgellons dz

78
Q

Pimozide SE

A

stiffness, restlessness, prolonged QT interval, extrapyramidal signs
treats tourettes and delusions of parasitosis

79
Q

delusions of parasitosis first line agents

A

risperidone or olanzapine (atypical antipsychotic)

80
Q

treatment neurotic excorations

A

doxepin (anti depression/ antipruritic)

81
Q

MC psychopathologies assoc w psychogenic excoriations

A

depression, anxiety, OCD

82
Q

Linear excavations superficial or deep, more on left side for right handed person and vice versa

A

psychogenic/ neurotic excoriations

83
Q

difference between malingering and dermatitis artefacta

A

malingering pt goal = material gain

DA goal = unconscious goal to gain attention and assume sick patient role

84
Q

distinctive, geometric, bizarre lesions found in unemployed middle aged women

A

factitious dermatitis / dermatitis artefacta

85
Q

Munchausen syndrome or munchausen by proxy

A

subset of the factitious dermatitis / dermatitis artefacta patients

86
Q

ways to prove diagnosis that has been faked

A

biopsy, occlusive dressings to protect lesions from pt

87
Q

Tx for factitious dermatitis / dermatitis artefacta

A

Psychotherapy (pt will reject and doc shop for more tx), best to provide symptomatic tx and nonjudgemental support + SSRI or low dose antipsychotics

88
Q

trichotillomania defined

A

urge to pull out hair, “friar tuck” vertex and crown alopecia

89
Q

What is it called when a trichobezoar extends from stomach to the intestine

A

rapunzel syndrome

90
Q

onychophagy in a stressed out girl with broken hairs that look twisted on microscope likely suffers from ___. What else would you look for

A

trichotillomania, comorbid psycholopathology like most common OCD, depression or anxiety

91
Q

trichomalacia defined

A

deformed hair shafts

92
Q

Alternative technique to biopsy childs scalp

A

shave a part of involved area and observe for regrowth of normal hairs

93
Q

treatment for trichomania

A
  • child: psychiatrist for CBT (habit reversal training)
  • adult: clomipramine, N-acetycysteine
  • bezoars: surgical removal

RDA Andrews (1 decks)

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