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ITE > Cutaneous > Flashcards

Cutaneous Flashcards

1
Q

What is the Parkland Formula?

A
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2
Q

Dx and Tx of Erythema
Multiforme

A

Hallmark = TARGET lesions, SYMMETRIC on palms & soles (± trunk, face), minimal to no mucosal involvement, -Nikolsky; Rx: remove trigger, supportive

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3
Q

What is the most common cause
of Erythema Multiforme?

A

Infections: HSV (most common viral cause) > Mycoplasma (most
common bacterial cause)

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4
Q

What drugs are most commonly
associated with Erythema
Multiforme?

A

SOAPS: Sulfa, Oral hypoglycemics, Anticonvulsants, Penicillin, NSAIDS

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5
Q

What is the difference between
Stevens Johnson Syndrome and
Toxic Epidermal Necrolysis?

A

BOTH: mucosal involvement, drugs = most common cause, flu-like prodrome, painful target lesions, +Nicholsky’s; SJS: <10% TBSA, most common in children; TEN: >30% TBSA, more common in elderly, fluid /lyte problems common; Rx (both): supportive, remove trigger

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6
Q

What distinguishes Staph
Scalded Skin Syndrome (SSSS)
from SJS/TEN?

A

SSSS: NO mucosal involvement, younger children/infants/newborns, caused by infection (Staph exotoxin) & treated with antibiotics (Nafcillin/Dicloxacillin), NO STEROIDS; BOTH: painful rash, bullae, + Nikolsky

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7
Q

Dx and Tx of Necrotizing
Fasciitis?

A

Type 1: polymicrobial (most common), abdomen/perineum, DM2 = risk factor.
Type 2: monomicrobial (GAS), extremities.
SSx: severe pain out of proportion to exam, rapid progression, erythema (most common finding), crepitus, necrosis, cellulitis turns dusky blue with bullae/vesicles, dirty dishwater discharge, La Belle Indifference (pt unconcerned); XR: SQ emphyesma; Rx: broad sepctrum IV abx (Clinda halts toxin production) AND surgical debridement (definitive tx)

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8
Q

Dx and Tx of Urticaria

A

Transient pruritic edematous plaques, red border with central clearing, NOT symmetric; Rx: remove trigger, benadryl/steroids/epi prn

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9
Q

Dx and Tx of Rocky Mountain
Spotted Fever?

A

Rickettsia rickettsii.
Transmission: wood tick (must be attached for 6 hours to transmit, eastern US (Carolinas, Oklahoma).
SSx: fever (MC sx), centripetal (wrists/ankles → trunk) maculopapular rash (palms + soles), calf tenderness.
Labs: low platelets, hypoNa.
Rx: Doxycycline

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10
Q

College kid with petechiae →
purpura presents in shock

A

Meningococcemia; seen in college kids, military barracks (close
quarters), caused by N. meningitidis (requires airborne precautions);
Rx: ceftriaxone, supportive,
Note: tx high-risk contacts with Rifampin, CTX or Cipro

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11
Q

What is the difference between
Pemphigus Vulgaris and Bullous
Pemphigoid?

A

PemphiguS: Superficial, flaccid bullae → break easily & crust, +mucosal involvement, +Nikolsky; Associations: Myasthenia, thymoma; Rx: steroids;
PemphgoiD: Deeper, elderly, pruritic papules → tense bullae,
NO mucosa, -Nikolsky, Tx: steroids, tetracylcine or dapsone

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12
Q

Shock + Erythroderma and
possible foreign body

A

Toxic Shock Syndrome. Bacteria that produce toxins. Staph (TSS):
more common; erythematous rash w/ desquamation + hypotension + high fever ≥3 organ systems, assoc. w/ foreign body; Strep (STSS): fever, but less rash often with existing wound, not associated with foreign bodies. Rx: remove foreign bodies FIRST, supportive care, and antibiotics (clinda first to reduce protein production, then empiric broadspectrum
for sepsis coverage), IVIG for refractory cases

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13
Q

Gunmetal gray pustules on
palms

A

Disseminated Gonococcemia (arthritis-dermatitis syndrome).
SSx: fever + migratory arthritis + rash (papules → pustules with gray necrotic or hemorrhagic center);
Dx: genital + throat culture;
Rx: ceftriaxone.
Complications: tenosynovitis, septic arthritis

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14
Q

Dx and Tx of Impetigo

A

Most often in kids, facial vesicles rupture and become “honey-crusted”, + contagious, Staph more common cause than strep, Tx topical mupirocin (if small area) vs systemic keflex (more extensive or bullous)

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15
Q

What is the characteristic rash
and cause of Erysipelas?

A

Well demarcated, slightly raised, beefy red plaque. Group A Strep = most common cause

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16
Q

Obese woman with red macular
rash under breasts, noted
satellite lesions

A

Candida; also associated with immunocompromised state; Rx: PO
nystatin for thrush, Topical azoles for rashes, dry skin care

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17
Q

What is the difference between
Candida and Tinea rashes?

A

Candida: seen in babies, immunocompromised, DM, fat adults
(intertriginous), rash: red + macular with characteristic satellite lesions,
Rx PO nystatin for thrush, Topical azoles for rashes, dry skin care;
Tinea: sharply marginated, annular lesion with raised or vesicular
margins with central clearing, Rx: topical azoles for everything except scalp and nails (griseofulvin)

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18
Q

What are the names for Tinea
infections in the following areas:
groin, foot, scalp, nail

A

Groin: Crura (jock itch),
Foot: Pedis,
Scalp: Capitis,
Nail: Unguium

19
Q

Compare the rashes of HSV and
HPV

A

HSV: vesicular clusters with painful erosions (T1- mouth, T2- genitals,Rx: acyclovir);
HPV: cauliflower-like and painless (anogenital warts) = most common STD in US (> Chlamydia)

20
Q

Vesicle or ulcer noted on tip of
nose or ear?

A

Herpes Zoster (shingles), tip of nose (Hutchinson sign) for herpes
ophthalmicus (V1), ear (Ramsay-Hunt) if CN 7/8;
Rx: acyclovir, steroids

21
Q

What is the characteristic rash
Molluscum Contagiosum?

A

Dome-shaped fleshy papule with central umbilication on face/torso/ext; most common in kids in daycare or adults with HIV; caused by MCV (pox virus),
Rx: self-limited, cryotherapy

22
Q

Compare the rashes of Scabies
and Pediculosis

A

Scabies: linear burrows in interdigital web space and intertriginous areas with expreme pruritis;

Pediculosis (lice): erythematous macules/wheals,
extreme pruritis, nits visible; Rx (BOTH): decontamination, Permethrin cream (often repeat 1wk, esp lice)

23
Q

Compare atopic dermatitis and
psoriasis

A

Atopic dermatitis (eczema): usually kids <5, allergy/asthma history, winter months, dry pruritis skin with lichenification
(hyperpigmentation/thickening) in flexural areas,

Psoriasis: welldemarcated erythematous plaques/papules with silvery white scales in extensor areas, +Auspitz sign (small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques),
Rx (BOTH): emollients, topical steroids

24
Q

Dx and Tx of Seborrheic
Dermatitis

A

Cradle cap. Occurs in infants. Yellowish, greasy scales on scalp, ±
diaper area & axillae; Rx: emollients, topical antifungals, steroids

25
Q

What is associated with
seborrheic dermatitis in adults?

A

HIV

26
Q

Dx and Tx of Contact Dermatitis

A

Discrete, well-defined or demarcated rash (papules/vesicles/bullae) 2/2 direct irritant vs allergic reaction; Tx remove trigger, protect skin, steroids

27
Q

What is the duration of steroid
treatment for poison oak/ivy?

A

3wks

28
Q

What are the distinguishing
features of Basal Cell vs
Squamous Cell Carcinoma?

A

BCC: pink, pearly papules with telangectasia in sun-exposed areas, more common;
SCC: UV exposure, ulcerated center with firm-raised border;
Rx: BOTH referred for biopsy

29
Q

What characteristics are
concerning for melanoma?

A

ABCDE: Asymmety, Border (irregular), Color (different shades, not
uniform), Diameter (>6 mm), Evolution;
Rx: excisional biposy; depth = most important prognostic factor

30
Q

Purple papule on gums

A

Kaposi Sarcoma; lesions most commonly oral, also GI and pulm, they are painless and nonpruritis, seen in HIV/AIDS patients,
Rx: treat HIV

31
Q

Blanching strawberry lesion on
infants head

A

Hemangioma; 50% resolve by 5yrs; head > trunk > extremity

32
Q

What distinguishes a Lipoma
from a Sebaceous Cyst?

A

Lipoma: well-circumscribed, mobile and painless, “Slippage sign” with normal overlying skin;
SC: central punctum, cottage cheese discharge, no slippage, may have secondary infection; Rx (both): referral for excision

33
Q

What defines the stages of
decubitus ulcers?

A

I: nonblanching erythema, intact skin;
II: partial thickness, exposed dermis;
III: full thickness skin loss, exposed SQ fat;
IV: full thickness tissue loss, exposed bone/tendon/muscle

34
Q

Painful red nodules on shins

A

Erythema Nodosum; Associated with IBD, malignancy, infection (strep most common), meds (OCPs); Rx: supportive, high dose ASA 650mg q4hrs or NSAIDs. Pts have a prodrome of fever, malaise and arthralgias.

35
Q

Characteristic rash of Pityriasis?

A

Herald patch → “Christmas tree” distribution rash to trunk, ± pruritis, Rx: self-limited, antihistamines; Rule out syphilis as cause

36
Q

What is the difference between
the rashes of Pityriasis and
Secondary Syphilis?

A

Syphilis is asymmetric and involves palms and soles

37
Q

What are the appropriate
precautions for patients with
Shingles?

A

If pt is immunocompromised or possible disseminated infection then airborne + contact precautions are required; if pt is immunocompetent with localized zoster then standard precautions can be followed

38
Q

What rashes are associated with
palmar lesions?

A

Syphilis (secondary), RMSF, Scabies, Erythema Multiforme

39
Q

What rashes are associated with
+ Nikolsky sign?

A

SJS, TEN, SSSS, Pemphigus Vulgaris

40
Q

What rashes are associated with
vesicles/bullae?

A

Bullous pemphigoid, Pemphigus Vulgaris, Necrotizing fasciitis,
Disseminated Gonorrhea

41
Q

What rashes are associated with
Petechiae/Purpura?

A

RMSF, Meningococcemia, DIC, Endocarditis

42
Q

What rashes are associated with
target lesions?

A

Lyme disease, Erythema Multiforme, SJS

43
Q

Dx and Tx of Henoch-Schonlein
Purpura (HSP)

A

Patient will be 4-12-years-old. SSx: recent URI, abdominal pain,
arthralgia, and a rash (buttocks +lower extremities; exam:
maculopapular rash (palpable purpura), non-pruritic; Most commonly caused by IgA mediated vasculitis; Rx: supportive care. Complications: nephropathy, intussusception

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