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PNCE > Derm > Flashcards

Derm Flashcards

1
Q

tx acne vulgaris

A

mild: benzoyl peroxide topical/wash first line, benzoyl peroxide + abx (topical clinda/erythro) 2nd line
moderate: systemic abx (PO doxy/mino) 1st line, topical retinoids (adapalene, trentinoin) 2nd line
severe: systemic retinoids (PO isotrentinoin/accutane)
hormonal: OCP or spironolactone

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2
Q

Isotrentinoin monitor

A

need pregnancy test done

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3
Q

acne rosacea tx

A

topical metronidazole
brimonidine: for itchy dry eyes
resistant/ocular: PO tetracycline, retinoids

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4
Q

folliculitis MCC

A

S. aureus

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5
Q

Folliculitis from hot tub MCC

A

pseudomonas

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6
Q

tx folliculitis

A

topical mupirocin 1st line
benzoyl peroxide
2nd line: PO clindamycin, bactrim, keflex

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7
Q

erythema multiforme hypersensitivity reaction

A

type IV

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8
Q

erythema multiforme MCC

A

herpes simplex virus (HSV1)

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9
Q

erythema multiforme rx causes

A

beta lactams, sulfonamides, phenytoin, phenobarbital

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10
Q

erythema multiforme tx

A

minor: supportive
PO acyclovir for HSV
major: PO prednisone, mucous membranes involved

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11
Q

SJS/TEN med causes

A

allopurinol
abx (sulfa, bactrim), tetracyclines, penicillin
anticonvulsants (carbamazepine, lamotrigine, phenytoin)
NSAIDS
sulfasalazine

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12
Q

SJS vs TEN

A

SJS <10%
SJS/TEN: 10-30%
TEN: >30%

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13
Q

SJS/TEN tx

A

dermatologic emergency
initial: D/C Rx. admit to ICU/burn unit
supportive care

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14
Q

alopecia sx

A

localized, round, no inflammation or scarring

exclamation mark hairs

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15
Q

alopecia tx

A

resolves in 6mo
refer to derm if large area
potent topical CS

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16
Q

androgenic alopecia tx

A

minoxidil (smaller area and recent onset)

oral finasteride

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17
Q

finasteride AE

A

decreased libido

sexual or ejaculatory dysfunction

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18
Q

onychomycosis MC type

A

distal sublingual (DSO) due to T. rubrum

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19
Q

onychomycosis tx

A

terbinafine

2nd line: itraconazole

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20
Q

terbinafine AE

A

hepatotoxic, monitor LFT

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21
Q

itraconazole monitor

A

check LFT

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22
Q

paronychia tx

A

w/ abscess: culture and I&D, PO bactrim or clindamycin
w/o abscess: topical abx
severe: empiric PO abs
nail biter: augmentin, tx for eikenella

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23
Q

brown recluse bite sx

A

red, white, and blue sign

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24
Q

brown recluse bite tx

A

rest, ice, elevation
tetanus
supportive

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25
Q

black widow bite sx

A

local papule w/ halo

neuro/msk sx (diaphoresis, abd pain, muscle fasciculations)

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26
Q

black widow bite tx

A

initial: wound care, tetanus
opioids and benzos
antivenin in severe cases

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27
Q

scorpion sting can cause

A

pancreatitis

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28
Q

scorpion sting sx

A

increased oral secretions
blurred vision, tongue fasciculations
nystagmus, chorea, hyperthermia

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29
Q

scorpion sting tx

A

antivenom needed
analgesics, IV benzos, tetanus
intubate if respiratory compromise

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30
Q

snake bite sx

A

bleeding (coagulopathy)
local edema, neuromuscular blockage
cardiac failure due to hypotension and acidosis

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31
Q

rattlesnake identification

A

triangular head with elliptical pupils and nostril pits

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32
Q

coral stake identification

A

ren on yellow stripes w/ black in between

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33
Q

rattlesnake bite sx

A

local pain, swelling, paresthesia

oozing blood, coagulopathy

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34
Q

coral snake bite sx

A

muscle paralysis

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35
Q

rattlesnake bite tx

A

antivenom
observe for 8hrs
dopamine for shock

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36
Q

coral snake bite tx

A

antivenin needed
observe 8h
dopamine for shock

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37
Q

erythema infectiosum etiology

A

5th disease

Parvovirus B19

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38
Q

erythema infectiosum sx

A

children 4-10yo
low fever, coryza
slapped cheek
lace like reticular eruption on trunk and extremities

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39
Q

erythema infectiosum test

A

clinical

specific IgM ab to confirm

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40
Q

erythema infectiosum tx

A

supportive

resolves 5-10d

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41
Q

erythema infectiosum complications

A

aplastic crisis (sickle cell)

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42
Q

hand foot and mouth dz etiology

A

coxsackie virus type A

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43
Q

hand foot and mouth dz sx

A

children
mild F, sore throat, joint pain
painful oral lesions, palms and soles, grey yellow vesicles palms and soles
vesicular lesions w/ erythematous halos

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44
Q

herpangina sx

A

sudden fever

stomatitisL small vesicles on soft palate, uvula, and tonsils

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45
Q

hand foot and mouth tx

A

supportive

resolves in 10d

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46
Q

hand foot and mouth complications

A

myocarditis

CNS dz

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47
Q

rubeola sx

A

measles, unvaccinated children
F, conjunctivitis, cough, coryza
begin on face, spread down
koplik spots (grains of salt on wet background)

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48
Q

rubeola test

A

clinical, confirm w/ serology and report to local/state departments
anti measles IgM and IgG

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49
Q

rubeola tx

A

self limited
supportive
vitamin A

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50
Q

necrotizing fasciitis etiology

A

GABHS

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51
Q

fournier’s gangrene

A

necrotizing fasciitis of the penis/scrotum

pts w/ DM, impaired immunity, or trauma

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52
Q

fournier’s gangrene sx

A

pain out of proportion, erythema

blue, hemorrhagic bullae –> gangrene –> septic shock

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53
Q

fournier’s gangrene tx

A

surgical debridement

broad spectrum abx (zosyn, imipenim)

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54
Q

cellulitis etiology

A

GABHS (s. pyogenes)

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55
Q

cellulitis tx

A 
non purulent outpt: PO cephalexin 
MRSA (IVDU): PO clindamycin 
purulent/systemic infx: IV clindamycin, culture
fluctuant: I&D, tx both MRSA and GAS 
Bites: augmentin
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56
Q

erysipelas etiology

A

GAS (S. pyogenes)

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57
Q

erysipelas vs cellulitis

A

Cellulitis: not sharply demarcated
erysipelas: well defined margins

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58
Q

erysipelas tx

A

limb elevation
mild: PCN/amoxicillin or cephalosporin
IV: cefazolin or ceftriaxone

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59
Q

erysipeloid

A

puncture wound from raw fish, shellfish, raw meat, poultry
edema, purplish erythema w/ sharp irregular margins extending peripherally but clearing centrally
tx w/ pen G or V, cephalosporin, or clindamycin

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60
Q

impetigo etiology

A

S. aureus or GAS

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61
Q

impetigo tx

A

topical mupirocin

PO cephalexin/dicloxacillin

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62
Q

another name for staphylococcal scalded syndrome

A

Ritter disease

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63
Q

staphlococcal scalded skin syndrome

A 
S. aureus 
neonate/children
flaccid blisters in areas of mechanical stress
MSSA: IV nafcillin
MRSA: IV vanco
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64
Q

candida intertrigo sx

A

candida diaper dermatitis in children
beefy red plaques
peripheral scaling
satellite lesions

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65
Q

candida intertrigo test

A

clinical
KOH prep initial
fungal culture definitive

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66
Q

candidal intertrigo tx

A

nystatin, clotrimazole, or ketoconazole 1st line
severe: PO fluconazole, itraconazole
diaper dermatitis: zinc oxide, nystatin cream

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67
Q

tinea capitis sx

A

school kids, pruritic scalp w/ patchy hair loss

kerion: inflammatory plaque w/ drainage and crusting. raised boggy lesion w/ purulent nodules

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68
Q

tinea capitis test

A

clinical
KOH/ woods lamp
culture definitive

69
Q

tinia capitis tx

A

conservative, ketoconazole or selenium sulfide shampoo

PO antifungals 1st line= griseofulvin PO (child), terbinafine

70
Q

tinea corporis MCC

A

trichophyton rubrum

71
Q

tinea corporis sx

A

scaly patch in oval/annual shape w/ central clearing

72
Q

tinea corporis test

A

KOH

microscopy and culture definitive

73
Q

tinea corporis tx

A

topical antifungals 1st line: clotrimazole or miconazole
allylamines 2nd line: terbinafine
failure of topicals: PO itraconazole or PO terbinafine

74
Q

tinea pedis tx

A

topical clotrimazole and miconazole 1st line
topical terbinafine if <12yo
PO terbinafine or itraconazole 2nd line

75
Q

tinea versiolor association

A

seborrheic dermatitis

76
Q

tinia versicolor etiology

A

malassezia

77
Q

tinta versicolor sx

A

hypo/hyperpigmented macules/patches of trunk, neck, and face

lesions w/ fine scaling

78
Q

tinea versicolor test

A

KOH: spaghetti and meatballs

woods lamp: yellow/green scales

79
Q

tinea versicolor tx

A

1st line: shampoo (selenium sulfide, ketoconazole)

2nd line: PO antifungals (fluconazole, itraconazole)

80
Q

amphotericin B AE

A 
nephrotoxic
cardiotoxic (QT prolongation, arrhythmia, electrolyte imbalance)
81
Q

ketoconazole AE

A

avoid in pregnancy and breastfeeding
CI in arrhythmias
D/C PPI (for absorption)

82
Q

ciclopirox AE

A

facial edema
V tach in shampoo form
skin irritation/pruritus

83
Q

terbinafine AE

A

hepatotoxic
CI in SLE, children <4yo, and breastfeeding
check and monitor LFT

84
Q

griseofulvin AE

A

hepatotoxic
CI in pregnancy and breastfeeding
SJS

85
Q

lice caused by

A

pediculosis capitis

86
Q

lice tx

A

was everything in hot water
topical pediculicide: permethrin cream
PO ivermectin if topical fails

87
Q

scabies cause

A

sarcoptes sabiei (mite)

88
Q

scabies sx

A

burrows, linear markings on wrist, elbow, and webs of fingers

89
Q

scabies tx

A

topical permethrin

ivermectin if immunocomp

90
Q

lindane AE

A

neurotoxic
seizures
teratogenic

91
Q

condyloma acuminatum caused by

A

HPV 6 and 11

92
Q

condyloma acuminatum transmission

A

sexual contact (adults)
if in children, investigate abuse
immunocomp

93
Q

condyloma acuminatum tx

A

1st: TCA, todophyllin, imiquimod

operative

94
Q

HSV sx

A

vesicles on erythematous base

bright red rim

95
Q

HSV test

A

tzank smear

confirm w/ PCR

96
Q

HSV tx

A

acyclovir

1st time/conservative: cool compress, lubricants, topical/PO analgesics

97
Q

herpes zoster tx

A

famciclovir

postherpetic neuralgia: gabapentin

98
Q

shingle vaccine

A

one time dose >50yo regardless of chickenpox hx

99
Q

molluscum contagiosa etiology

A

poxvirus

100
Q

molluscum contagiosa sx

A

flesh colored pearly white dome shaped papules w/ central umbilication
BOTE: tenderness, crusting, erythema, inflammatory halo

101
Q

molluscum contagiosum tx

A

self limited, resolve in 6-9mo

102
Q

chickenpox caused by

A

HHV3

103
Q

chickenpox sx

A

teardrop vesicles

104
Q

chickenpox tx

A

supportive

immunocomp: acyclovir

105
Q

chickenpox complications

A

secondary infx
reyes syndrome (ASA=CI)
encephalitis

106
Q

verrucae etiology

A

HPV 1, 3, 10

107
Q

verrucae tx

A

salicylic acid or cryotherapy 1st line

108
Q

actinic keratosis has potential of turning into

A

SCC

109
Q

actinic keratosis sx

A

sun exposure
rough gritty scale
sandpaper
easier to feel than see

110
Q

actinic keratosis tests

A

clinical

skin bx: doesn’t bleed w/ excoriation

111
Q

actinic keratosis tx

A

annual f/u w/ derm
liquid nitrogen/cryo if single lesion
topical 5FU, imiquimod if multiple

112
Q

seborrheic keratosis sx

A

wart like, velvet or verrucous
waxy greasy
stuck on appearance

113
Q

seborrheic keratosis tx

A

N/A

curettage or cryotherapy for cosmetic

114
Q

BCC of skin sx

A

translucent pearly white or shiny pink papule/nodule
telangiectasia
raised/rolled boarder

115
Q

BCC of skin dx

A

dermoscopy initial

definitive: skin bx

116
Q

BCC skin tx

A

nonfacial, small, superficial: electrodesiccation and curettage
danger sites: mohs
nonsurgical: imiquimod, 5FU cream
f/u Q 6-12mo for 2yrs

117
Q

kaposki sarcoma etiology

A

HHV8
HIV/AIDS
CD4 <100

118
Q

kaposki sarcoma sx

A

red/purple painless lesion
oral lesions start on feet, leg, hands
slowly spread centripetally

119
Q

kaposki sarcoma tx

A

antiviral

HAART therapy

120
Q

melanoma criteria

A 
Asymmetric
Border irregularity
Color change
Diameter >6mm
Evolution over time
121
Q

most important prognosis factor for mets of melanoma

A

thickness

122
Q

SCC skin sx

A

sun exposed, HPV, actinic keratosis hx

friable, raised elevated thickened nodule

123
Q

SCC skin tests

A

1st line and definitive: skin bx

124
Q

SCC skin tx

A

surgical excision TOC

mohs

125
Q

perioral dermatitis tx

A

topical metronidazole or erythromycin
oral tetracyclines
avoid topical CS

126
Q

contact dermatitis tx

A

topical steroids

127
Q

poison ivy tx

A

PO prednisone

128
Q

drug eruption causes

A

bactrim, tetracyclines, PCN, NSAIDS, allopurinol

129
Q

drug eruption tx

A

D/c med
diphenhydramine
topical steroids
reassurance

130
Q

DRESS (drug reaction w/ eosinophilia and systemic systems) causes

A

anticonvulsants: phenytoin, carbamazepine
allopurinol
sulfonamides (sulfasalazine)
abx: minocycline, vancomycin

131
Q

DRESS sx

A

systemic sx and internal organ involvement w/ drug eruption
2-8wks after drug exposure
morbilliform rash, F, LAD, eosinophilia >700
liver, kidney, lung

132
Q

atopic triad

A

eczema
allergic rhinitis
asthma

133
Q

nummular eczema sx

A

coin shaped

dorsum of hands, feet, and extensor surfaces

134
Q

lichen Planus sx

A

6Ps: papule, purple, polygonal, planar, pruritic, plateau

whickham striae

135
Q

lichen Planus tx

A

first line: high dose topical steroids w/ occlusion (betamethasone)
2nd line: PO prednisone, phototherapy, PO retinoids

136
Q

lichen simplex chronicus

A

neurodermatitis

skin thickening in patients w/ eczema secondary to scratching

137
Q

pityriasis rosea etiology

A

HHV7

138
Q

pityriasis rosea sx

A

stage 1: URI sx
stage 2: herald patch, salmon colored
eruption: Christmas tree distribution, longer lines
stage 3: resolution 4-12w w/o scarring

139
Q

pityriasis rosea test

A

clinical

skin bx w/ KOH -

140
Q

pityriasis rosea tx

A

self limited

mild: topical emollients and PO antihistamines
severe: topical steroid creams, UVB phototherapy

141
Q

koebners sign

A

lesions appear at site of mechanical or thermal trauma

142
Q

auspitz sign

A

small pinpoint bleeding when scraped off

psoriasis

143
Q

psoriasis tx

A

moisturizers + topical steroids, first line (triamcinolone or clabetasol)

moderate: topical RX and systemic (MTX)
severe: topical + systemic TX, phototherapy, biologics

144
Q

seborrheic dermatitis tx

A

initial: emollients/shampoos/topical steroids
anti dandruff shampoo: topical keoconazole, selenium sulfide
flares: topical CS (desonide)
severe: PO ketoconazole or steroids

145
Q

melasma tx

A

daily sunscreen
triple topical therapy: hydroquinone, trentinoin, CS
laser, chemical peels

146
Q

vitiligo associated w/

A

vitamin D deficiency
thyroid
alopecia

147
Q

vitiligo tx

A

potent topical CS

topical tacrolimus/pimecrolimus ointment

148
Q

cyanide poisoning tx

A

amyl nitrate

IV sodium nitrate or thiosulfate

149
Q

MC complication pressure ulcers

A

osteomyelitis

150
Q

stasis dermatitis sx

A

itchy pruritic red scaly plaques, yellow brown pigmentation
venous ulcers (medial malleolus)
inverted champagne bottle legs

151
Q

stasis dermatitis test

A

doppler US

152
Q

stasis dermatitis tx

A

elevation, compression stockings
high potency topical CS
avoid topical Abx

153
Q

bullous pemphigoid tx

A

prednisone

mild/stable/local: topical CS or tacrolimus

154
Q

pemphigus vulgaris tx

A

PO steroids 1st line

155
Q

pemphigus vulgaris associated with

A

Rx: PCN, captopril, cephalosporin
thymoma
myasthenia gravis
lupus

156
Q

acanthosis nigricans malignancy

A

MC gastric CA

lung/GU/lymphoma

157
Q

acanthosis nigricans malignant sx

A

palms, oral mucosa, periocular, vermillion border
mamillary
stripe hands

158
Q

hidradenitis suppurativa tx

A

mild: topical abs (clindamycin) + intralesional tramcinolone
mod/maintenance: PO abx (minocycline, doxy, augmentin, clindamycin)
severe: immunosuppressants (adalimumab, cyclosporine)
surgery

159
Q

photosensitivity reaction caused by

A

abx: tetracyclines (doxy), sulfonamides, FQ
antipsychotics: chlorpromazine
diuretics: furosemide, HCTZ
amiodarone, promethazine

160
Q

pyogenic granuloma

A

aka lobular capillary hemangioma
children/young adult after trauma
solitary glistening friable red (raspberry like) nodule or papule
excision, topical imiquimod, injectable sclerosis agents

161
Q

pyoderma gangrenosum

A

associated w/ IBD
ulcerative skin lesion 2ndry to immune dysregulation
painful necrosis ulcer w/ irregular purple undermined borders and purulent base
tx w/ topical CS high potency or tacrolimus

162
Q

miliaria

A

blocked eccrine sweat glands

163
Q

milia tx

A

N/A

resolves 1st month of life

164
Q

child with >6 cafe au lait macules

A

possible neurofibromatosis type I

165
Q

port wine stains

A

pink red sharply demarcated macules or papules
darken to purple and may develop thickened surface
pulse dye laser treatment

166
Q

surge weber syndrome

A

triad: facial port wine stain, leptomeningeal angiomatosis, ocular involvement (glaucoma)
can develop hemiparesis contralateral to facial lesion
seizures
intracranial calcification and learning disabilities

167
Q

Mongolian spots

A

blue or slate gray pigmented macular lesions
common in presacral/sacral-gluteal area, indefinite borders
usually fade over first few years (before 10yo)

168
Q

nevus simplex

A

stork bite
surface capillary dilation on nape of neck , eyelid, forehead
observation: resolve by 2yo and dont darken over time
laser therapy to reduce appearance

PNCE (33 decks)

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