Clin Med Flashcards

Question

Macules/patches on trunk & arms, can coalesce, often have fine scale. Asymptomatic other than mildly pruritic

Answer 1

Tinea Versicolor

Answer 2

``` Permethrin Cream 5% (again 10-14 days later) & Oral Ivermectin (again 14 days later) ```

Answer 3

Permethrin 1% cream

Answer 4

4 main factors: follicular hyperkeratinization, increased sebum production, cutibactreium acnes w/in follicle, inflammation

Answer 5

Acne Vulgaris (be cautious with rapid appearance)

Answer 6

Topical Retinoid (Tretinoin cream)

Answer 7

Topical Retinoid, Benzoyl Peroxide, +/- Topical Abx (Erythromycin, Clindamycin)

Answer 8

Topical Retinoid, Benzoyl Peroxide, and Oral Abx (Tetracycline)

Answer 9

Topical Retinoid, Benzoyl Peroxide, and Oral Abx OR Oral Isotretinoin Monotherapy

Answer 10

Topical Clindamycin, Topical Azelaic acid, Oral Erythromycin (DO NOT use peroxide)

Answer 11

telangiectasis. 1st line tx: behavior mod 2nd line tx: Laser light therapy, Topical Brimonidine

Answer 12

NO COMEDONES

Answer 13

1st and 2nd line: Topical | Mod-severe: Tetracyclines (doxy, mino, tetra) & Macrolides (___mycin)

Answer 14

Tx: Early: Isotretinoin Advanced: Surgical debulking, laser ablation

Answer 15

dry eyes, pain, itchy, blurry vision, sensitive, blepharitis, conjunctivitis, stye

Answer 16

Topical abs & Cyclosporin, Oral Abx REFER OUT

Answer 17

scorpion sting

Answer 18

symptomatic, Tetanus, observation

Answer 19

swelling & erythema for hours-2 days | tx: cold compress

Answer 20

exag erythema & swelling, getting bigger over time. lasts 5-10 days tx: cold compress, Prednisone, Antihistamine, NSAID

Answer 21

worsenign over 3-5 days, fever | tx: abx

Answer 22

IM Epinephrine

Answer 23

blanched circular patch with surrounding red perimer, central punctum

Answer 24

Catecholamine release- intmt radiating pain, abd pain, CP, back pain, muscle spasm, local/regional sweating, hA, N/V tx: sx, Tetanus, Muscle relaxer, Antivenom if severe

Answer 25

Necrotic Bite! in severe cases

Answer 26

painless at first --> increase over 2-8 hrs red plaque or papule w/ central pallow (may see bite marks) vesiculation can occcur

Answer 27

dark depressed center after 1-2 days w/ chills, HA, fever and rarely- renal failure, anemia, hypotension, DIC, Rhabdomyolosis

Answer 28

autoimmune against melanocytes. mild, white macules with homogenous depigmentation. well defined borders

Answer 29

``` Topical & systemic corticosteroids Calcineurin inhibitor UV phototherapy Skin graft Sunscreen, make up, screen for stress ```

Answer 30

chronic inflammatory condition involving the hair follicle common places: Axillary, Inguinal, Anogenital F>M

Answer 31

starts w/ single deep seated inflammatory nodule | Follicular occlusion --> rupture --> immune response

Answer 32

Purulent drainage, sinus tract, comedones, scarring

Answer 33

Local: Clinda & Intralesional Corticosteroid Anti-androgenic agents Systemic: Doxy or Mino Surgery: Punch Deb or Wide Exc Severe: TNH inhibitor & Oral Retinoid

Answer 34

chronic, non contagious, inflammatory skin disease FLG gene mutation, Type I hypersensitivity IgE mediated

Answer 35

ill defined, erythematous, scaling patches --> edematous papules & vesicles

Answer 36

Eczema Herpeticum- viral infection of HSV 1

Answer 37

Topical/Oral steroids Calc Inhibitors (Pimecrolimus Elidel cream & Tacrolimus Protopic ointment) +/- Antihistamine Gold standard: Petroleum vaseline

Answer 38

AKA Neurodermatitis

Answer 39

caused by excessive itching. Leathery appearance, pigmentation, exagg skin marking tx: STOP itching, high potency topical steroid, moist, antidepressant, antihistamine

Answer 40

Tapioca, VERY ITCHY, vesicles coalesce & rupture

Answer 41

worse with stress and hot weather | tx: Reassurance, Burow's dressing (Domebror solution) topical steroids

Answer 42

Topical retinoid (only adults), Urea, Salicylic acid, Alpha-hydroxy acids, cream, exf scrubs

Answer 43

``` Poison Ivy "uroshiol oil" delayed type hypersensitivity main sx: ITCHY Hands, Face, eyelids Red, papular, with NONDISTINCT margins. blisters and edema ```

Answer 44

Topical steroids 1-2x daily for 7-14 days | consider Oral steroids (Prednisone) if involving face or >20% BSA

Answer 45

Most common "Morbilliform" or "Rubelliform" NO mucosal involvement Note: underlying viral condiitons can affect rxn to drug (i.e. Mono)

Answer 46

Penicillin & Sulfa

Answer 47

Urticaria (Hives)/ Angioedema | Hives- circumscribed, raised, red eruptions with central pallor

Answer 48

IgE mediated, can become more sever with repeated exposure | Common culprits: Cephalosporin & Sulfa

Answer 49

Common Culprits: Antiepileptic, Allopurinol, Sulfa, Minocycline, Vancomycin, Dapsone, Sulfa fever, face swelling, morbilliform rash, lymphadenopathy, blood abn, visceral involvement

Answer 50

``` Allopurinol Anticonvulsant (Phenobarbital, Carbamazepine, Lamotrigine) Sulfa NSAIDS Mycoplasma Pnemunae ```

Answer 51

SEPSIS (Staph aureus & P. aeruginosa)

Answer 52

"Age spot" "senile freckle"

Answer 53

Solar Lentigo

Answer 54

Brown, Warty, Waxy, Stuck on appearance

Answer 55

proliferation of immature keratinocytes "Barnacles of aging" can increase to Irritated SK

Answer 56

"Leser Trelat Sign" work up further bc this is assoc with GI and Lung CA

Answer 57

Keratocanthoma considered benign, but biopsy to be safe. some consider a less aggressive form of SCC

Answer 58

Pre Cancer, SandPaper "oooh-kay"

Answer 59

Topical Fluorouracil cream is preferred. can also do: cryotherapy, photodynamic therapy, Imiquimod (aldara) cream

Answer 60

consider SCC in situ

Answer 61

2nd most common skin CA. originates from Keratinocytes

Answer 62

funny looking growth. SCALY EXOPHYTIC, Indurated, and/or FRIABLE papule, plaque, or nodule. pink, red, or skin colored. may be itchy or tender. WARTY looking

Answer 63

Wide Excision! margin based on risk. Mohs for high risk/cosmetic Non surgical: radiation, Imiquimod cream, Flurocil cream 5%, Photodynamic therapy f/u every 3-6 months Rare metastatic potential: 5%

Answer 64

nodular, flesh colored, pearly, with TELANGECTASIA central ulceration with rolled border

Answer 65

Surgery preffered: Curettage & dessication, excision with 4mm margin, Mohs for high risk/cosmetic

Answer 66

non surgical: radiation, imiquimod cream, 5% fluoric cream, photodynamic therapy f/u every 6-12 months

Answer 67

ABCDES. sneaky. superficial spreading is most common type. deep growth is most dangerous

Answer 68

pigmented plaque, nodule, or papule

Answer 69

a type of malignant melanoma in elderly with chronic sun exposure

Answer 70

Gold standard: wide surgical excision w/ 2 cm CLEAR MARGIN f/u every 3 mo

Answer 71

etio: Paramyxovirus

Answer 72

3 Cs: cough, coryza, conjunctivitis

Answer 73

"Koplik spots" tiny white spots inside mouth

Answer 74

a rare complication from Measles. can occur 2-10 years after rash dissapears! death within 1-3 year

Answer 75

sx, Vitamin A, Ribavirin?, Vaccinate!!

Answer 76

``` Fifth Disease Etio: Parvovirus B19 "SLAPPED CHEEK" Lacy Rash! Pain & Inf of Joints ``` Comp: Transient Aplastic Crisis & Pregnant Hydrops No vaccine

Answer 77

``` Congenital Rubella Syndrome -Blueberry Muffin baby! -hearing loss -mental retardation -cardio & eye defects -death 85% chance of having fetal damage if mother gets infected by this ```

Answer 78

"German Measles" 3 Day Measles Pinpoint, pink, maculopapules

Answer 79

DIFFERENT SPREADING PATTERN: start @ Trunk/neck -----> face/extremities

Answer 80

High fever --> gone --> blanching pink/red mac-pap rash

Answer 81

Coxsackie virus

Answer 82

``` Poxvirus Autoinoculation Tx: self limiting but very conagous resolve in 6-12 mo Tx recommended in genital region: Podophyll cream, cryotherapy, curretage, cantharidin ```

Answer 83

Genital warts "cauliflower" Tx: topical Podophyll cream, Immunotherapy, surgery-electrocautery, laser, cryotherapy, excision

Answer 84

Plantar warts common warts Resolve on own in 1-2 yrs but recurrence often Seeds: tiny pigmented thrombosed capillaries

Answer 85

Salicylic acid, Cryotherapy, Electrodessication, snip or shave biopsy

Answer 86

"Chicken pox" different stages: papule, ulcer, blister rare comp: group A strep, encephalitis, Reye synd Acyclovir (antiviral) given in immunocomp

Answer 87

"shingles" elderly & immunocomp grouped vesicles on erythematous base Chronic comp: PHN and HZO

Answer 88

Post Herpetic Neuralgia- lancinating pain that can last mo-yrs after lesions of shingles leave

Answer 89

Herpes Zoster Opthalmicus- eye involvement "Hutchinson Sign" - lesions on nose. vision threatening linked to trigeminal ganglion activatoin

Answer 90

``` Start early!! "FAV" antivirals Famciclover (Famvir) Acyclovir (Zovirax) Valacyclovir (Valtrex) x 7 days ``` Chronic pain: Gabapentin (Neurontin) & Pregabalin (Lyrica)

Answer 91

"FAV" antiviral meds Famciclovir (Famvir) Acyclovir (Zovirax) Valacyclovir (Valtrex)

Answer 92

soft, mobile, fluctuant, central punctum tx: maybe nothing, could resolve on own Uninfected: Kenalog injection, I&D, excision Infected: I&D, abx

Answer 93

yellow, greasy scale "Cradle cap" "Seborrheic Blepharitis" Tx: antifungal & topical steroid blepharitis & cradle cap: olive oil, baby shampoo, warm compress

Answer 94

"Herald Patch" CHRISTMASS TREE rash- raised, fine scaled pink oval papules & plaques, may have "cigarette paper" often confused with tinea- do KOH prep! spring/fall time. teens/young adults

Answer 95

suspected cause: HHV-6/7

Answer 96

will go away on own in 6-8 wks Oral Antihistamine prn Medium strength topical corticosteorid Sun exposure

Answer 97

"The Four P's!" Pruritic, purple, polygonal, papules/plaque

Answer 98

The four Ps! "WHICKAM STRIAE" tiny white lines running through papules WRIST, ANKLES, skin, back, penis, mouth 50% autoimmune (T cells)

Answer 99

"Koebner Phenomenon" develop of lesions in sites of trauma self limited but can last 1-2 years (SO LONG, pts do not want to hear this)

Answer 100

``` Topical corticoteriods Intralesional Tramcinolone High potency on trunk/ext 2nd line: oral steroids, phototherapy, oral Retinoid other: cyclosporine (immunosuppresssant) ```

Answer 101

red plaque covered with SILVERY WHITE SCALE

Answer 102

hyperproliferation of keratinocytes

Answer 103

Koebner phenomenon- new spots at sites of lesions | Auspitz sign- scrap off scale and see tiny blood vessels

Answer 104

Pustular | Erythrodermic

Answer 105

Do not use oral steroids!!

Answer 106

Sunshine, bath, emolliant, occlusive dressing, rest Group I or II corticosteroids topical Vitamin D, coal tar, topical Retinoid, Topical Calc Inhib Limited disease <5% BSA- Super high potency steroids Phototherapy Systemic therapy

Answer 107

greater than or equal to 5% BSA- needs phototherapy or systemic and refer to DERM

Answer 108

often Asymmetric joint line tenderness/effusion Lab: ESR- Elevated Sedimentation Rate & Leukocytosis (revealing inflammation) "Sausage digit" Dactylitis

Answer 109

NSAIDS, DMARDS- disease modifying anti-rheumatic, Methotrexate, TNF inhibitor, Humira

Answer 110

Red streaking extending proximally Inflammation of LYMPHATIC channels d/t inflammation or infection Tender

Answer 111

inflammation of hair, itching, occasional pain Papules/ Pustules Usually infectious- S. Aureus is most common

Answer 112

Gram negatie bacteria diff type of tx: Ciprofloxacin

Answer 113

Tx: Topical: Mupirocin Oral: Cephalexin/Keflex

Answer 114

Oral Sulfa, Clindamycin, Doxycycline

Answer 115

"honey colored crusting" contagious superficial bacterial infection-common in children (auto-inoculation)

Answer 116

3 types: Bullous, Non bullous, Ecthyma

Answer 117

``` vesicles enlarge and become flaccid bulla Etiology: Staph Aureus Tx: Topical: Mupirocin Oral Dicloxicillin, Cephalexin ```

Answer 118

``` most common "honey colored crusting" Etiology: Staph Aureus Tx: Topical: Mupirocin Oral: Dicloxicillin, Cephalexin ```

Answer 119

"punched out" cigarette burn looking Etio: Strep Tx: Always Oral: Dicloxicillin, Cephalexin

Answer 120

usually caused by STREP tx: Empiric Oral: Cephalexin IV: Cefazolin

Answer 121

usually caused by STAP AUREUS

Answer 122

ELDERLY, dangerous Sharply demarcated border with well defined margin Cheeks & lower ext Aggressive tx: IV or IM Cefazolin, Ceftriaxone

Answer 123

Staph Aureus Painful, fluctuant, erythematous nodule "Ripe? Fluid filled? Bounce back effect? ready to be drained

Answer 124

I&D w/ C&S, | +/- Abx: Trimethoprim-Sulfamethoxazole (Bactrim), Doxycycline, Clindamycin

Answer 125

Empiric abx with MRSA coverage | Trimethoprim-Sulfamethoxazole (Bactrim), Doxycycline, Clindamycin

Answer 126

IV Vancomycin

Answer 127

Malar Butterfly Rash 50%- on cheeks, nasolabial folds spared Discoid Lupus 15-30%- annular, red, scaly plaque

Answer 128

avoid sun Topical or intralesional steroid Hydroxychloroquine vs other systemic meds Consider "Drug induced Lupus" *Always check med list

Answer 129

"Target Lesions" Most common etio: Herpes Simplex** Most cases self limited w/in 2 weeks ``` Tx if not resolved: +/- topical steroids oral antihistamine anesthetic mouthwash maybe Antiviral but ONLY for chronic cases (bc acute will resolve on own) Oral steroid for severe case ```

Answer 130

Assoc w/ Gluten Sensitivity & Celiac Disease Very ITCHY Herpetiform pattern- vesicles on erythematous base Dx gold standard: DIF- Direct Immunoflourescence Tx: Dapsone & See a dietician to learn new ways to eat

Answer 131

SUPERFICIAL blistering disorder Secondary infection is leading cause of death Flaccid bullae- rupture easily Oral cavity most common- can spread to skin "NIKOLSKY SIGN" dx: DIF gold standard Tends to be chronic recurring issue Tx: systemic corticosteroids Immunosupp agents Topical Lidocaine & Dental pase w/triamcinolone acetonide 0.1% for mouth Antibiotics

Answer 132

DEEP, sub epithelial not as serious as other Bullous condition Tense blisters, do not rupture as easily Starts w pruritis like eczema, papules or hives, progress to --> urticarial red plaques and blisters on trunk & extremities, +/- mucosal involvement Tx: topical/systemic corticosteroids Derm referral maybe immunosupp agents

Answer 133

"mask of pregnancy" cause: sun, birth control usually goes away on its own tx if desired: skin lightening agents, chemical peels, avoid sun

Answer 134

hyperpigmented, velvety plaques assoc w/insulin resistance

Answer 135

hair growth in females | many causes

Answer 136

Adrenal Excess Cushing is TOO MUCH cortisol Acne, stretch marks-striae, skin thinning

Answer 137

Addison does not have enough low cortisol Dark, bronze skin and GUMS affects melanin

Answer 138

"Orange peel appearance" to skin assoc w/ Grave's disease- non pitting, scaly, thickening skin Pretibial Myxedema warm, wet, sweaty skin

Answer 139

Painless, sub-epidermal blistering of sun exposed areas Heme synth problem Not enough UROD leads to EXCESS PORPHYRINS dx: look for elev porphyrins in urine and serum. look for elev iron Tx: Phlebotomy to reduce iron levels, discontinue & treat potential cause

Answer 140

4 phases: 1. intact skin w/localized redness (transparent film for protection) 2. partial thickness skin loss w/exposed dermis (dressing that maintains moist environ. as long as it's not infected) 3. full thickness skin loss WITH ADIPOSE visible, eschar maybe visible 4. full thickness skin loss WITH exposed MUSCLE< TENDON, BONE, or FASCIA. eschar and rolled edges visible. look for tunneling (Debridement of nectrotic tissue, appropriate dressing, +/- abx)

Answer 141

tick attached for at least 36 hours Etio: Borrelia Burgdorferi Rash: ERYTHEMA MIGRANS- Bullseye rash!! Rash occur w/in 7-14 days Sx progress to cardiac, arthritis, neurologic Bell's dx: consider Lyme disease in ddx After 36 hours, option of single dose of Doxycycline to reduce risk of chronic comp

Answer 142

only takes 6 hours of tick attachment!! Etio: Rickettsia rickettsia Usually rash (90%) within 3-5 days Macular--> PETECHIAL lesions. ANKLES, WRISTS, PALMS, & SOLES, and then trunk Treat if you have any suspicion!! 10% never get rash and this can be potentially lethal Tx with Doxycycline

Answer 143

"Whickam's striae" tin white lines running through purple papules "Koebner Phenomenon" new lesions in areas of trauma

Answer 144

"Koebner Phenomenon" new lesions in areas of trauma | "Auspitz sign" punctate spots of bleeding when plaque removed

Clin Med Flashcards

Exam 1