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Acute Care Seminar 1 > Derm > Flashcards

Derm Flashcards

1
Q

Epidermis

A

Superficial layer-contains & maintains & carotene

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2
Q

Dermis

A

Contains connective tissue, sebaceous glands, sweat glands, hair follicles and provides blood supply & nutrition to epidermis

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3
Q

Adipose tissues

A

fat layer, surrounds

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4
Q

Actinic purpura

A

-purple patches or macules may appear where blood has leaked from capillaries into the dermis

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5
Q

Normal findings of aging

A

-check for signs of sun exposures
-letigines (liver spots)
-actinic keratoses (superficial flattened papules covered by dry scales)

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6
Q

Medications that cause photosensitivity

A

Medications that cause photosensitivity or secondary skin cancers. Cipro, Doxy, Levaquin, Bactrim, Voriconazole,

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7
Q

Macules

A

-flat, colored lesions < 2cm

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8
Q

Patch

A

-large, flat lesion > 2cm (size is only difference from macule)

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9
Q

Papule

A

small, solid lesion <0.5 cm raised above the skin

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10
Q

Nodule

A

Larger, solid lesion 0.5-5.0 cm (differs from papule only in size)

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11
Q

Plaque

A

Large > 1 cm flat topped raised lesion

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12
Q

Vesicle

A

Small fluid filled, transclucent lesion <0.5 cm raised above skin

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13
Q

Pustule

A

a vesicle filled with leukocytes

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14
Q

Bulla

A

fluid filled, raised often translucent lesion >0.5 cm

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15
Q

Wheal

A

raised erythematous, edematous papule or plaque usually representing rapid vasodilation or vasopermeability

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16
Q

Telangiectasia

A

dilated, superficial blood vessel

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17
Q

Contact Dermatitis: skin rash

A

-Hypersensitivity reaction
-T lymphocyte mediated
-Irritant versus Allergy

Treatment:
-Identify the offending agent & remove it
-Severe reactions: Systemic steroids may be needed
—Prednisone 1 mg/kg, usually < 60 mg day
—Taper over 2-3 weeks
—May need allergy testing

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18
Q

High Potency steroid for contact dermatitis: Generally limit high-potency TCS to <2 weeks duration

A

-Betamethasone diproprionate
-Clobestasol proprionate
-Halobetasol propionate
-Desoximetasone
-Fluocinonide

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19
Q

Medium potency steroid for contact dermatitis

A

-Betamethasone valerate
-Triamcinolone acetate
-Flurandrenolide
-Fluticasone propionate
-Fluticasone propionate

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20
Q

Low potency steroid for contact dermatitis

A

-desonide
-hydrocortisone

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21
Q

Eczema

A

-Chronic disease w/ flares
-3 phases from childhood to adulthood (early puberty)
-Commonly on Flexor surfaces (hands/eyelids)
-Pruritic, dry, scaly skin, inflammation
-Develop erosions / excursions & hyperpigmented plaques

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22
Q

Triggering factors of eczema

A

Temperature changes, excessive hand washing, contact with irritants, food, emotional stress

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23
Q

Treatment of Eczema

A

-Topical steroids
-May need antibiotic if associated Staph infection
-Antihistamines
-May need oral steroids in severe cases
-Light Therapy
-If severe-may warrant wet wraps or phototherapy

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24
Q

Psoriasis

A

-Many types
-Most common is plaque psoriasis
-Commonly a trigger such a stressful event, strep throat, medications (lithium, antimalarials, beta blockers), cold/dry weather, cut/scratch or bad sunburn

25
Psoriasis: etiology
-Chronic inflammatory skin condition -T cell mediated disorder -Genetic component -erythmatous, sharply demarcated papules & rounded plaques -silvery scales -extensor surfaces like elbows, knees, gluteal cleft and scalp
26
Psoriasis Treatment
-Keep skin well hydrated -Mid-potency topical glucocorticoids -NO ORAL STEROIDS (risk of developing life-threatening pustular psoriasis) -May use methotrexate in severe cases -Topical Vitamin D analogues -UV light
27
Carbuncle
-Abscess filled with pus / dead tissue ----Pea sized to golf ball sized ---Sometimes so deep they cannot drain itself -Caused by bacterial infection, usually Staph Aureus -Contagious Treatment: Excision and drainage Antibiotics
28
Dermatophytosis
-Fungal infections of the hair, skin or nails -Tinned Capitis – Ringworm on the head -Tinea Corporis – Ringworm on body -Tinea Cruris – Jock itch -Tinea/Pityriasis Versicolor – Short sleeve shirt distribution -Tinea Pedis – Athlete’s foot -TineaUnguium/Onychomycosis – Nails
29
-Tinea/Pityriasis Versicolor – Short sleeve shirt: Treatment
-Daily application (no more than 10 minutes) of lotions or Shampoos that contain sulfur, salicylic acid or selenium sulfide; continue for 1-2 weeks after rash resolves -PO agents are not approved for this (no lasting results)
30
Tinea Pedis-Athlete's Foot
-Most common dermatophylte infection -Often chronic -Variable edema, scaling and puritis -May be widespread or localized usually to web space of 4th and 5th toes
31
Treatment of Tinea Pedia-Athletes Foot
-Often need a combination of topical or oral antifungal agents -Requires longer treatment courses due to frequent relapses
32
Herpes Zoster (Shingles)
-Reactivation of varicella-zoster virus -Usually presents in older adults > 50 Predisposing factors: Aging Impaired immune system Radiation Local trauma Surgical stress Spinal cord tumors Lymphoma Fatigue
33
Herpes Zoster findings
-Prodromal symptoms of pain -Malaise, fever, headaches -Increased sensitivity to mild stimuli -Characterized by unilateral pain; presenting prior to the rash
34
Herpes Zoster Physical Exam
-Grouped vesicles on an erythematous, tender base -Usually unilateral rash along a dermatome -May involve 2 or more dermatomes -May occasionally cross midline with few lesions on opposite side -Papules appear in 24 hours, progress to vesicles and bullae in 48 hours, then to pustules with cloudy fluid in 96 hours -Crusts form in 7-10 days and heal in 2-3 weeks
35
Herpes Zoster Tx
-Antiviral therapy (Acyclovir 800 mg PO five times daily for 7-10 days) Other PO tx: -Famciclovir 500mg TID -Valacyclovir 1000mg TID -Foscarnet (IV option) -Antipiuretic agents -moist dressings QID or bath soaks w/ baking soda -Zoster vaccination -pain control -isolation
36
Antivirals: Acyclovir/Valacyclovir
-Bottom of pyramid -HSV -VZV
37
Antivirals: Glanciclovir/Valganciclovir
-Medium of pyramid -HSV -VZV -CMV -HHV-6
38
Antivirals: Foscarnet
-Second to top of pyramid -HSV -VZV -CMV -HHV-6 -HHV-7
39
Antivirals: Cidofovir
-Top of pryamid -HSV -VZV -CMV -HHV6/7 -BK virus -Adenovirus
40
Cabdidiasis
-Fungal/Yeast infection of mucous membranes or skin -Bacterial overgrowth in GI tract in the setting of broad spectrum antibiotic use
41
Skin cancers
-Basal Cell Carcinoma (BCC) -Squamous Cell Carcinoma (SCC) -Melanoma
42
Actinic Keratosis
-Precancerous lesions caused by UV light damage -Derm to follow
43
BCC
-Most common form of skin cancer -caused by exposure to UV light -DX by skin biopsy -*Usually, the only sign of BCC is a growth on the skin -Usually found on sun exposed skin areas-head, neck, back, hands, arms -Dome-shaped skin growth; visible blood vessels; pink or skin colored. Or brown, back or with flecks.
44
BCC Tx
-Excision or surgical procedure to remove growth ----Mohs procedure (extract border or healthy tissue) -Cryosurgery -Radiation -Photo dynamic therapy -Good prognosis if diagnosed early & removed
45
Squamous Cell Carcinoma
-Due to increased sun exposure -Can occur anywhere on the body -flat, reddish, scaly patch that grows slowly (Bowen’s disease) -bump or lump grows, it may become dome-shaped or crusty and can bleed -Biopsy for Dx
46
Melanoma Staging
-Stage 0 (in situ): confined to epidermis -Stage 1-confined to skin but has grown thicker. Can be as thick as 1.0mm -Stage 2-Grown thicker. Thickness ranges from 1.0->4.0mm. Skin covering melanoma may have broken skin. Cancer hasn't spread -Stage 3-melanoma has spread to nearby lymph node or nearby skin -Stage 4-spread to internal organ
47
MRSA skin infection
-Methicillin-resistant Staphylococcus aureus (MRSA)- potentially dangerous type of staph bacteria, resistant to antibiotics commonly used to treat staph infections -May cause skin and other infections -Community acquired (healthy people) or health-care associated -Spread by skin to skin contact
48
MRSA characteristics
-Present as small red bumps that resemble pimples, boils or spider bites -Can quickly turn into deep, painful abscesses that require surgical draining. -May involve only the skin, but can also burrow deep into the body, causing potentially life-threatening infections
49
Redman Syndrome
-Associated w/ vanco -Hypersensitivity mast cell reaction; can cause anaphylactic reaction -occurs in first 4-10 min or soon after infusion
50
Redman Syndrome Symptoms
-Pruritus, an erythematous rash that involves the face, neck, and upper trunk -Hypotension and angioedema can occur -Diffuse burning, itching and generalized discomfort -Dizziness, agitation, headache, chills fever, and paresthesias around the mouth. -Chest pain and dyspnea in severe cases
51
Redman Syndrome Tx
-Tx w/ antihistamines (diphenhydramine 50 mg IV) -Abx such as cipro, ampho B, rifampin can cause this -May pretreat to first dose to prevent reaction (diphenhydramine & H2 blocker) -Once rash and itching resolve may resume at lower rate
52
Steven Johnson's Syndrome (SJS) Erythema Multiforme
-Hypersensitivity reaction that develops in response to medications, infection or illness -Common medications: Barbiturates, Penicillins, Phenytoin, Sulfonamides Infections include: Herpes simplex, Mycoplasma -Can be minor or severe (SJS) -Exact cause unknown; occurs usually in children or young adults -Symptoms: fever, malaise, arthralgias, pruritis, skin lesions (begins as flu like symptoms)-skin begins to blister and peel
53
SJS Toxic Epidermal Necrolysis
Lesions -Rapid onset -Circular, symmetrical nodule, papule or macule surrounded by pale red rings, also called a "target", "iris", or "bulls-eye” lesion -May look like hives -May have vesicles of various sizes (bullae) -Located on the upper body, legs, arms, palms, hands, or feet -May inv`olve the face or lips
54
SJS Treatment
-Antihistamines to control itching -Moist compresses applied to the skin -Oral antiviral medication if it is caused by herpes simplex -Pain medication -Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking -Antibiotics to control any skin infections -Corticosteroids to control inflammation -ICU or burn care unit for severe cases (SJS) -Intravenous immunoglobulins (IVIG) to stop the disease process
55
Urticaria (Hives)
-Chronic-hives lasting more than 6 weeks. More common in women. Usually related to autoimmune disease -Angioedema-massive swelling in deeper tissues w/out wheals
56
MOA of Hives
1-IgE mediated histamine reaction causes plasma to leak from blood vessels into the tissues causing swelling 2-Complement mediated reaction typically with administration of whole blood, plasma, immunoglobulins, drugs & insect stings 3-Nonimmunologic release of histamines usually with drug reactions such as acetylcholine, opiates, polymyxin B or strawberries
57
Treatment of HIVES
-Antihistamines-H1 antagonists and H2 antagonists -Corticosteroids (Prednisone, Methylprednisolone) -Epinephrine (0.3mL/dose SQ/IM for severe hives/angioedema
58
H1 antagonists for Hives
First Generation (Sedating) -Diphenhydramine (Benadryl), -Hydroxyzine (Atarax) Second Generation (Non-sedating) -Fexofenadine (Allegra), -Loratidine (Claritin) or -Cetirizine (Zyrtec)
59
H2 antagonists for hives
Ranitidine (Zantac), Famotidine (Pepcid)

Acute Care Seminar 1 (31 decks)

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