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STEP Pathology > deck_5403461 > Flashcards

deck_5403461 Flashcards

1
Q

What is Tinea capitis?

A

ringworm of the scalp that is very common in 3-7 yos

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2
Q

What are the main causes of Tinea Capitis?

A

-90% by Trichophyton tonsurans-Microsporum canis

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3
Q

How is tinear capitis contracted?

A

Via humans, animals, fomites (shared brushes, combs, hats)or sometimes oil that results typically in a asymptomatic carrigae phase initially

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4
Q

What are the primary risk factors for tinea capitis?

A

-large family size-crowded living conditions-low socioeconomic status

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5
Q

Tinea capitis presentations (seb derm more like in AA kids)

A

This occurs because the bugs can get into the hair shafts and cause them to break off

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6
Q

Tinea capitis presentations (you cannot diagnose this with a woodflam lamp anymore!)

A
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7
Q

Keroid is caused by marked inflammation that can causepermanent scarring and hair loss in these situations. For these you can consider sysemic steroids for decreased pain and inflammation

A
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8
Q

T or F. LAD is common with tinea capitis

A

T. Especially in the posterior cervical and sub-occipital regions (correlates well with + fungal cultures in setting of scaling and alopecia)

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9
Q

How can tinea capitis be confirmed?

A

gold standard is FUNGAL CULTURE (very important to confirm)-use a moistened cotton tip to rub vigorously over the affected area and then use a standard bacterial culture

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10
Q

What is this?

A

Seborrheic Dermatits (in the DDx with tinea captitis)- this is usually more chronic and unusual after infancy and before puberty (infants with cradle cap (waxy yellow scale) or teen or adults with dandruff)

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11
Q

What dis stuff?

A

Psoriasis (on the DDx for tinea)- usually will see more erythema plaques with silvery scales and favors postauricular and posterior hairline

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12
Q

What is this?

A

Alopecia areata- on the DDx for tinea capitis except no broken hairs, LAD, erythema

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13
Q

How is tinea capitis treated?

A

Requires SYSTEMIC antifungal to penetrate hair follicle and griseofulvin is the gold standard (microsize or ultramicrosize)Microsize used most often:20mg/kg/d for at least 8 weeksNOTE: M. canis infections may require higher doses and longer course for clearance

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14
Q

Advice on Tx for tinea capitis

A

Give with fatty food for absorption and may divide bid if large volume needed for bigger kids

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15
Q

AEs of Griseofulvin?

A

mostly well-tolerated but may see HA, GI pain, photosensitivity or drug rxns

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16
Q

Adjuvant Tx for tinea?

A

Add an antifungal shampoo 2-3 times a week (Ketoconazole 2% or selenium sulfide) to aid in removal or scales and eradicate spores (consider all members of house use)Fomite education (dont share combs, etc.)-Terbinafine can be used if 4+ yo

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17
Q

T or F. M. canis does not respond well to Terbinafine

A

T. Need to know what you’re treating

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18
Q

AEs of Terbinafine?

A

hepatotoxicity and rare heme effects (get a baseline ALT/AST and CBC monitoring if immunodeficient)

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19
Q

What is tinea corporis?

A

Superficial fungal infection of skin due to contact with infected person or animal

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20
Q

What are the main causes oftinea corporis in young children?

A

M. canis > M. audouinii, T > mentagrophytes

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21
Q

What are the main causes oftinea corporis in older childrena/adults?

A

T. rubrum, T. verrucosum, T. menatgrophytes (young child with T. rubrum likely has a parent with tinea pedis and/or onychomycosis)

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22
Q

What is a Majocchi’s granuloma?

A

Chronic tinea corporis infection may cause penetration into the hair follicles resulting in erythematous plaques or patches with nodules

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23
Q

What is this?

A

Nummular (solid redness; annular- red border) Atopic Dermatitis- this is on the DDx for tinea corporis but nummular and very pruriticneeds steroids to treat

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24
Q

What dis?

A

Psoriasis- on the DDx for tinea corporis BUT more of a dull pink colour, nummular and distribution is different

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25
Q

What is this?

A

Granuloma annulare- very similar to tinea corporis- never scaly, with a raised ‘rubbery’ rim and tend to show up on the dorsal ahnds, wrists, feet, and ankles

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26
Q

How is tinea corporis used?

A

Topical for superificial/localzied for at least 2-4 weeks and treat affected area and and extra rim of normal skin. If no improvement, and culture positive, proceed to oral therapy. Consider systemic therpay for disseminated/Majocchi’s and tinea faciei

27
Q

What is Tinea Manuum?

A

tinea of the hands that is most common in men (rare in children)

28
Q

What are the major causes of Tinea Manuum?

A

T. rubrum, T. mentagrophytes, and E. floccosum

29
Q

Diagnosis?

A

KOH (branched septated hyphae) and follow up with a fungal culture

30
Q

What is tinea cruris?

A

“jock itch” common in men and rare in children with risk factors including obesity, heat, and humidity and having the same causal organisms as Tinea Manuum

31
Q

Actual penis and scrotum are not usually affected. Same diagnosis

A
32
Q

Risk factors for tinea pedis?

A

occlusive shoes and communal pools/showers

33
Q

What is ‘moccasin’ pattern Tinea pedis caused by?

A

T. rubrum (fine dry scale over soles)

34
Q

What is ‘vesiculobullous’ pattern Tinea pedis caused by?

A

Vesicles/bullouson soles (esp. insteps) due to T. mentographytes commonly

35
Q

What is this?

A

•Contact Dermatitis (on the DDx for tinea pedis)–Dorsal feet more commonlyaffected

36
Q

What is this?

A

Dyshidrotic eczema (on the DDx for tinea pedis)- more likely on the soles or between toes characterized by“tapioca vesicles” that areVERY itchy

37
Q

DescribeTinea Unguium(Onychomycosis)

A

Nail infection common in ELDERLYmales

38
Q

What are the most common causes of TInea Unguium?

A

T. rubrum, T. mentagrophytes, E. Floccosum but can be caused by Non-dermatophyte molds and yeasts

39
Q

What are the risk factors for contracting tinea unguium?

A

Immunosuppression, diabetes, HIV, poor circulation, trauma, dystrophy

40
Q

What are the patterns of Tinea Unguium?

A

–Distal subungual–Proximal subungual–White superficial–Candida

41
Q

What is this?

A

–Distal subungual pattern = most common•Invasion of distal nail plate, onycholysis with thickening and discoloration

42
Q

What pattern of tinea unguium is this?

A

Proximal subungal–Uncommon and pathognomonic forHIV positive patient

43
Q

What pattern of tinea unguium is this?

A

•White superficial–White plaques on dorsal nail plate

44
Q

What is this?

A

Candida- notice how red the nail is around the nailbed

45
Q

What is this?

A

Chronic Paronychia•Nail dystrophy caused byCandida albicans–Confirm with stain and culture

46
Q

How isChronic Paronychia treated?

A

•Topical ketoconazole if mild•Oral fluconazole if severe (»3 mos for fingernails)–Baseline CBC, LFT’s

47
Q

What is this?

A

Trchyonychia (aka20 nail dystrophy)•Ridging, grooves, pitting, discoloration, fragility

48
Q

What are the causes of trachyonychia?

A

Can beIdiopathic, lichen planus, psoriasis, etc.

49
Q

What is this? When is it common?

A

Beau’s Lines-Transverse grooves or furrows that results when stress causes temporary arrest of nail matrix (very common after Hand, Foot, and Mouth disease)•Nail may shed completely (onychomadesis)

50
Q

What is this?

A

Habit Tic Deformity-Habitual picking at the cuticle

51
Q

How are nail infections treated?

A

Topical agents are not very effective because they dont penetrate the nail plate well or reach the nail matrix so Penlac (8% Ciclopirox lacquer) may work if superifical infection not involving lunula (has to be given for months) and urea helps soften the nail plate

52
Q

Tx for nail infections?

A

Systemic therapy typically needed and terbinafine is the DOC (Griseofulvin not that effective and has a high recurrence rate) usually 6 weeks for fingernails and 12 weeks for toenails

53
Q

Is any monitoring needed during nail infection therapy?

A

Yes, get a baseline CBC and LFT and repeat in 2-4 weeks typically (not 100% necessary)

54
Q

How long does it take fingernails to grow out? Toenail?

A

Fingernail- 4 to 6 monthsToenail- 12-18 months

55
Q

What is Tineaversicolor?

A

aka pityriasis veriscolor (a common superficial fungal disorder of skin), caused by the dimorphic fungus Malssezia furfur (aka Pitrosporum), a normal skin flora.Usually presents in adolescence and likely oily spots of skin

56
Q

How does this present?

A

Multiple scaling, oval macules, patches and thin plaques over upper trunk, proximal arms, andsometimes face and neck regions. It can be hyper- or hypopigmented due to azelaic acid production.

57
Q

When is Tinea versicolor common?

A

Summer

58
Q

What is Pityriasis alba?

A

On the DDx for tinea versicolor that is most common on the face but the discoloration is patchy and usually due to dry skin

59
Q

What is this?

A

KOH prep is usually sufficient (spaghetti and meatball appearance)

60
Q

How is tinear versicolor treated?

A

Education is a big part because the course of this tends to be chronic and recurrences are common.Drugs; Topical selenium sulfide lotion/shampoo effective

61
Q

How can recurrent or severe tinea versicolor be treated?

A

Can go to systemic therapy- ketoconazole (work up a sweat, wait 10-12 hr to shower) or fluconazole (doesnt require a sweat) once a weekand still use topical for maintenance

62
Q

Places for candidisis? Types?

A

•Intertriginous•Paronychia•Angular Cheilitis at oral commissures due to increased moisture (e.g. elderly, lip lickers, dentures) (below)

63
Q

How can candidiasis be treated?

A

•Topical anti-yeast cream•Decrease moisture

STEP Pathology (80 decks)

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