Derm Flashcards
This rash is described as “sandpaper” initially on face, neck, chest and axilla moving to abdomen, extremities and palmar surface and soles in 48 hours. It is accompanied by sore throat and systemic symptoms of fever, malaise?
Scarlet fever (Strep B)
This abrupt small red petechial rash initially erupting on wrist, forearms and ankles accompanied febrile illness occurs most often south central states of North Caroline, Oklahoma, Alaska, Tennessee and Missouri?
Rocky Mountain Spotted Fever (tic-borne)
This non pruritic hypopigmented macular rash is most commonly found on the upper shoulders and back? What is the treatment?
Tinea versicolor
Topical selenium sulfide or ketoconazole bid x 2 weeks
Pityriasis rosacea presents in what classic way and what is the treatment?
A oval plagues with salmon-colored areas with herald lesion is noted first, then Christmas tree pattern on back.
Self limiting- antihistamines for itching
This rash has smooth dome shaped paplues that 2-5mm centrally umbillicated with a white plug?
Molluscum contagiosum
Erythema migrants (bull’s eye rash) is a sign for what significant disorder?
Lyme disease
A 14 year old patient who presents with petechia/purpural rash on the axilla, wrists, flanks, and ankles accompanied by high fever, headache and alerted level of consciousness is suspicious for?
Meningococemia (meningitis)
A 65 year old male presents with sudden onset rash on one side of forehead, eye pain, photophobia, and blurred vision is suspected to have what emergent condition?
Shingles infection of the trigeminal nerve (CN5 V)
During an annual exam, patient complains of a new mole that is painless and has grown recently. Upon examination, you note a 6 mm firm Nevi with asymmetrical with irregular borders, brown and purplish in color. What do you suspect and what is the next intervention?
Melanoma- prompt referral to dermatology for biopsy/excision.
T/F aural lentiginous melanoma is cancer under the nail bed?
True
A skin lesion that has distinct borders, is waxy appearing with light fleshy pink to brown color containing an atrophic or ulcerated center that fails to heal and bleeds easily is suspicious for?
Basal cell carcinoma
An opaque papule found on sun-exposed skin that is without distinct borders with karototic scaling and bleeds easily is suspicious for what disorder?
Squamous cell carcinoma
Multiple dry, round, rough red lesions that do not heal found on elderly persons are most likely and what is the risk associated?
Actinic keratosis- can be precancerous squamous cell lesions
Acral means?
Hands or feet (distal portions of limb)
Annular is what shaped rash?
Ring-like (ringworm, tinea corporis)
Flexural means?
Body folds (flexor surfaces)
An area where two skin surfaces touch or rub each other are?
Intertriginous
A coin-shaped round rash is described as?
Nummular
How does a Maculopapular rash look?
Small raised colored lesions
Wartlike is described as?
Verrucous
Dry skin is described as?
Xerosis
What is the difference between a vesicle and a pustule?
Both are small raised lesions, but vesicle contains serious fluid, pustule is purulent.
T/F a wheal that is >1cm is called a bulla?
True
Observable thickening of the epidermis caused by chronic rubbing or itching is?
Litchenified
What are some of the causes of urticaria?
Medication reaction, viral/bacterial infections, insect bites and other allergies.
Painless waxy warlike fleshy growths on the trunks of middle to older aged adults are?
Suborrheic keratoses
This painless loss of epidermal melanocytes is often associated with autoimmune disorders. It creates irregular shaped areas of hypopigmentations that spreads and coalesces over time?
Vitiligo
Acrochordon is also known as?
Skin tags
Triamcinolone 1% is considered what strength of topical steroid?
Class III Medium-high
Fluocinolone 0.01% is considered what class strength?
Class VI (low)
T/F it is generally safe to use high potency topical steroids on the face and intertriginous areas?
False, lower potency are appropriate
T/F most high potency topical steroids are safe for children?
False, only lowest potency (VI or VII)
During exam, you notice multiple hypopigmented macula’s on chest, shoulders and back that worsen after patient was in the sun. What is the diagnosis and treatment?
Tinea versicolor- selenium sulfate and topical ketoconizole and lamisil bid x 2 weeks.
This rash is an inherited skin disorder presently with extremely pruritic small vesicles and lesions that become litchenfield, found commonly on cheeks, flexural folds, hands, trunk, knees and elbows affecting adults and children as well.
Eczema
What is the treatment for eczema?
Prevention, topical steroids (low to moderate potency) and moisture.
Rhus dermatitis is what?
Contact with irritant plant oil (poison ivy/oak)
Contact dermatitis rash usually appears as?
Pruritic and bright red, evolving into bullous or vesicular lesions. Distribution can follow shape of area affected or be irregular.
Because this pathogen is likely with puncture wounds, antibiotic should be prescribed?
Pseudomonas and Fluoroquinolones
This bacterial infection is common in hairy places and responds well to mupirocin ointment?
Folliculitis
What is the DOC for animal or human bites?
Augmentin 875mg bid x 10 days
-OR- PCN allergy
Doxycycline 100mg bid, Bactrim DS BID
This chronic and recurrent inflammatory disorder of the apocrine glands produces painful nodules, abscesses and pustules in axilla, mammary areas, perinatal and groin.
Hidradenitis suppurativa
This skin infection is caused by Strep and Staph affecting children producing pink to red lesions which evolve into versiculopustules often erupting into honey colored crusts and is treated how?
Impetigo
- mupirocin 2% for more mild cases
- Keflex or azithromycin if more severe
What is the treatment for Lyme disease?
Doxycycline bid x 10 days (all ages)
Amoxicillin 500mg tid as well
What is the treatment for Rocky Mountain spotted fever?
Doxycycline 100mg Po bid x7 days for adults and pets >8years old
A child presents with fever, sore throat and malaise with follow by an pruritic vesicular rash eruption is likely to have what disorder?
Varicella (chicken pox)
Vesicular rash that is present on one side of the body and follows a dermatome pattern is what condition?
Shingles
What is the treatment for shingles?
Acyclovir 5 times a day or valacyclovir bid x 10 days
Vesicular rash and pain localized to the external ear, can extend into the canal with facial pain is what disorder?
Ramsay Hunt Syndrome (herpes zoster oticus)
Herpetic whitlow affects what part of the body and presents with what symptoms?
The sides of fingers, cuticals, and terminal phalanx with painful vesicular lesions
T/F incision and drainage of paronychia is often indicated?
True
What is the typical time frame between herald patch and lesions erupt in pityriasis rosacea?
1-2 weeks
What is the treatment for pityriasis rosacea and what is the typical course?
Symptomatic itching relief, common course is 6-8 weeks
T/F Kwell lotion is the drug of choice for scabies?
False- there is a black box warning due to potential neurotoxicity
After infestation with scabies, how long does it take for symptoms to manifest?
May be up to 4-8 weeks after contact
Where are scabies lesions usually found and how do they appear?
Serpiginous (snakelike) or linear burrows with papular, vesicular, or crusted lesions. Most commonly in the interdigital webs of hand, feet, axillae, breast, buttock folds, waste, and male generals.
What is the classic presentation for scabies?
Severely pruritic rash that worsens nocturnal
What is the treatment for scabies?
Permethrin 5% after showing- leaving on for 10-14 hours every 7 days. Removal and washing of all clothing and linens
Most tinea infections generally respond well to what topical treatment?
Clotrimazole (lotrimin)
Ketoconazole
Miconazole (monostat)
What is the biggest risk with topical and oral antifungals?
Hepatic failure
What is the first line treatment for comodonal acne?
topical retinoids (Trentinoin)
This rash produces dome-shaped papules, 2-5mm with central implications (white plug) and is caused by direct contact with poxvirus?
Molluscum Contagiosum
A burn that is red with bullae and intact dermal layer is what stage?
Partial thickness (Second degree)
A burn that is moderately red and does not produce a bullae is what stage?
Superficial-thickness (first-degree)
Full-thickness burn (Third degree) presents as?
Involving the epidermal and dermal layers. Skin, subcutaneous and soft tissue fascia are damaged
T/F partial thickness burns of 10% or greater should be referred to burn center?
True
In rule of 9s for adults, what does each arm, leg, anterior and posterior trunk count for?
Head- 9
Arm- 9 each
Leg, A/P truck-18 each
Groin-1
T/F contact dermatitis is usually distributed and appears equally bilaterally?
False- it tends to be unilateral location and shape
T/F seborrheic keratoses are physiological and benign?
True, actinic keratoses are not physiologic and are a precursor to squamous cell carcinoma (SCC)- they also do not have the waxy (sebum) appearance of seborrheic keratoses.
T/F anthrax prophylaxis is doxycycline 100mg bid (or Fluoroquinolones)
True
New psoriatic plaques that form of traumatized areas of the skin in those who suffer from psoriasis is known as?
Koebner phenomenon
For patients with acne who are failing two prescription topicals, what is the next step?
Minocycline, tetracycline or doxycycline.
What anti metabolic disease-modifying anti rheumatic drug is first line oral therapy for psoriasis that failed topicals?
Methotrexate
What drug can be given as a prophylactic agent to prevent post-herpetic neuralgia (PHN)?
TCAs: amitriptyline
T/F oral ketoconazole is highly recommended for skin and ungual fungal infections?
False- due to efficacy of topicals and high risk of hepatic failure
T/F those who are on anti-TNF biological are not at a higher risk of developing squamous cell carcinoma and melanoma?
False- they have a higher risk
T/F primary skin healing/closure relates to allowing the body to naturally heal?
False- primary closure occurs when a wound is mechanically closed by sutures, staples or skin-glue within 24 hours.
This is an example of secondary intention
T/F tertiary intention is also known as intentional delayed closure
True- often done with crush or heavily contaminated wounds such as dog bites
T/F patient presents with a laceration that occurred over 24 hours ago. Due to the length of time, this should be deeply irritated and allowed to close by secondary intention?
True
T/F closed fist injuries has high risk of hidden complications such as foreign bodies and fractures warranting X-ray?
True
Sutures should be left facial wounds for how many days (on average)?
5-7 days
How long should sutures be left in upper extremities?
7-10 days
How long should sutures be left in upper extremities?
7-14 days
T/F a growth that is >2cm is called a nodule?
False, a nodule is 0.5-2cm, tumor is >2cm
Reticular describe a rash appearing like?
Netlike
T/F clobetasol is a Class 1 (strongest) topical steroid?
True
This maculopapular rash presents in a lace-like pattern?
Fifth disease
A rash that is on the feet or hands is called?
Acral
Skin tags are also known as?
Acrochordon
What are the recommended immediate interventions for brown recluse spider bite?
Ice and immobilization
Lesions that appear like a bulls-eye with central clearing that erupt suddenly with hives, blisters, petechia, purpura including a prodrome of systemic flu-like symptoms is suspicious for what disorder? What patients are at high risk?
Steven-Johnson Syndrome (Erythema Multiforme)
Drug reaction to NSAIS, sulfa drugs, anti-epileptics drugs, and others
OR
Herpes, mycoplasma infections and malignancy
Fine silvery scale papules and plaques commonly found over extensor surfaces with nail pitting is and what is the treatment?
Psoriasis
Medium-potency topical steroids first line
Second line- topical retinoids and oral agents
T/F onychomycosis usually responds well to topical antifungals?
False
