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Foundations- ID/Derm > Derm 2 > Flashcards

Derm 2 Flashcards

1
Q

What are the verrucous lesions?

A

Actinic keratosis

Seborrheic keratosis

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2
Q

What is actinic keratosis?

A

Most common pre-cancerous skin lesion resulting from chronic, cumulative sun exposure in susceptible individuals

Squamous cell carcinoma can arise from pre-existing AK

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3
Q

Presentation of actinic keratosis? dx?

A

single or multiple, discreet, 3mm-1cm erythematous or brown rough, scaly papules and plaques found on sun exposed skin; scale is coarse, sandpaper-like

Diagnosis: clinical, biopsy

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4
Q

Tx for actinic keratosis?

A 
Cryotherapy – most common treatment
Topical fluorouracil (Efudex)
Topical imiquimod (Aldara)

prevention: good sun protection

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5
Q

What is seborrheic keratosis?

A

Common benign growths

onset 40-50 y/o

Oval, slightly raised, tan/light brown to black well-demarcated papules or plaques <3cm in size, “stuck-on” waxy greasy verrucous appearance on trunk, scalp, face, neck, extremities; usually multiples

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6
Q

Tx for seborrheic keratosis?

A

none necessary

Cryotherapy or curettage if irritating or bleeding
Biopsy to r/o malignant lesion if suspicious

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7
Q

What is the MC skin malignancy?

A

basal cell carcinoma

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8
Q

Epidemiology of basal cell carcinoma?

A

Occurs mostly in fair-skinned ind. 20-40 y/o

Heavy, cumulative sun exposure is a predisposing factor

Limited potential for metastasis

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9
Q

Clinical findings of basal cell carcinoma?

A

translucent, telangiectatic pearly papule/nodule with rolled border and sometimes ulcerated center; 85% on head and neck

“sock donut” with necrotic center

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10
Q

Tx for basal cell carcinoma?

A

bx for dx

Surgical – excision, curettage, MOHS surgery

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11
Q

Epidemiology of squamous cell carcinoma?

A

2nd MC skin CA

usually in pts >55

usually arises from AKs

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12
Q

Risk factors for squamous cell carcinoma?

A

Long-term sun exposure is major risk factor; exposure to industrial carcinogens, HPV, immunosuppression are predisposing factors

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13
Q

Clinical findings in squamous cell carcinoma?

A

solitary, slowly evolving keratotic or eroded erythematous, yellowish, or skin-colored papule or plaque found on sun exposed areas

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14
Q

Tx for squamous cell carcinoma?

A

biopsy for dx –>

excision, MOHS surgery

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15
Q

Any isolated keratotic or eroded papule or plaque present >1 month should be considered a…… until proven otherwise by biopsy

A

SCC

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16
Q

Epidemiology of malignant melanoma? Etiology?

A

MC CA among women aged 25-29

cumulative UV exposure

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17
Q

Risk factors for malignant melanoma?

A

age, fair skin, blue eyes, red or blonde hair, freckles, multiple nevi, atypical nevi, FHx, blistering sunburns before puberty, tanning bed use

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18
Q

What are the 5 types of malignant melanoma?

A

Superficial spreading- MC (men-back, women-back and legs)

Nodular – grows fast, more aggressive, grows vertically
-Breslow’s depth

Lentigo maligna

Acral lentiginous – MC in darker skin

Subungual

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19
Q

Presentation for malignant melanoma?

A

usually no symptoms, typically a pigmented papule, plaque, or nodule

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20
Q

What to look for with malignant melanoma?

A 
Asymmetry 
Border- irregular/jagged 
Color-multi-colored 
Diameter >6mm (pencil eraser) 
Evolving
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21
Q

What type of melanoma can be seen freq. on the hands and feet and is more common in darker skin individuals?

A

Acral lentiginous

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22
Q

Dx for malignant melanoma?

A

need to do an excisional biopsy!!

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23
Q

Management for malignant melanoma?

A

high cure rate if dx early

thickness of lesion most important px factor

lymph node involvement has worse px

skin exam Q6 months x 2yrs

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24
Q

What is kaposi sarcoma? Presentation?

A

Vascular neoplastic condition linked to HHV-8

red, brown, or purple macules, plaques and nodules on trunk, extremities, face

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25
Q

Dx of kaposi sarcoma?

A

biopsy

Test for HIV if status unknown

AIDS associated type is more aggressive

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26
Q

Tx for kaposi sarcoma?

A

AIDS associated – treat with HAART, refer to oncologist/HIV specialist

Non-AIDS associated – cryotherapy, radiation, chemotherapy

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27
Q

What are dematophytoses?

A

Group of fungal infections affecting keratinized cutaneous structures; transmitted by humans, animals, soil

  • Epidermal i.e. tinea pedia, (tinea corporis)
  • Trichomycosis-dermatophytosis of hair and hair and hair follicles (tinea capitus)
  • Onychomycosis-nail apparatus
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28
Q

Dx and tx for tinea pedis, tinea corporis, or tinea cruris?

A

KOH-hyphae

Clotrimazole, miconazole, terbinafine cream 4-6 wks

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29
Q

Dx and tx for tinea capitis?

A

Fungal culture-hair w/ whole follicle

Griseofulvin x 8 weeks or terbinafine 4-8 weeks (oral therapy!)

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30
Q

Dx and tx for onychomycosis?

A

Fungal culture, KOH of subungual debris

Oral terbenafine x 12 weeks, cure in 50%

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31
Q

What is tinea versicolor?

A

actually a yeast, not a dermatophyte

SF yeast infection caused by Malessezia furfur

colonization in humid environment, recurs in summer

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32
Q

Clinical findings in tinea versicolor?

A

hypo- or hyperpigmented coalescing scaly macules of varying color on trunk, upper extremities (tan, salmon)

Post-inflammatory hypomelanosis- after resolution, pigmentation doesn’t go away

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33
Q

How do we dx tinea versicolor?

A

scrap scales, KOH- spaghetti and meatballs

wood’s lamp exam: blue/green fluorescence

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34
Q

Tx for tinea versicolor?

A

Shampoo- selenium sulfide, ketoconazole- let it sit on skin x 10 min

Creams: ketoconazole, clotrimazole

Oral: Fluconazole, Itraconazole

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35
Q

ADEs of antifungals?

A

Hepatotoxicity, GI side effects, drug interactions, monitor LFTs

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36
Q

What is candidiasis? Predisposing factors?

A

(Candidia albicans)

Inflammation of skin folds = intertrigo

Predisposing factors: moisture, warmth, breaks in skin barrier, antibiotics, glucocorticoids

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37
Q

Clinical findings in candidiasis?

A

papules and pustules on erythematous base -> confluence and erosion ->beefy red patches with satellite lesions; burning>pruritis

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38
Q

How do we dx candidiasis?

A

KOH – pseudohyphae, spores; fungal culture may be more sensitive

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39
Q

How do we tx candidiasis?

A

Keep area dry, clean, cool

Loose clothing

Topical antifungals – miconazole, clotrimazole; nystatin

Topical steroids – helps burning; use low potency (1% hydrocortisone ointment)

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40
Q

What is condyloma acuminata?

A

A viral disease

genital warts

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41
Q

Etiology of condyloma acuminata? assoc. with?

A

caused by HPV 6, 11, 16, 18, 31 ++

Associated with neoplasia (16 & 18 cause most cervical CA)

42
Q

Clinical findings in condyloma acuminata?

A

fleshy, broad-based papules

43
Q

Tx for condyloma acuminata?

A

surg removal

electrocautery

laser

Imiquimod (cream also used for AK)

Prevention: HPV vaccine

44
Q

What is verruca vulgaris?

A

viral: common wart

caused by HPV (types 2, 4)

45
Q

clinical findings in verruca vulgaris?

A

Hyperkeratotic, exophytic papules on fingers, hands, knees (can occur anywhere)
Punctate black dots – thrombosed capillaries

Koebner rxn -spreads with skin trauma

46
Q

Epidemiology of verruca vulgaris?

A

common in all age groups, skin to skin contact, contaminated objects

47
Q

What are verruca plana?

A

viral: flat warts

caused by HPV (type 3, 10)

48
Q

Clinical findings of verruca plana?

A

Skin colored or pink smooth slightly elevated flat-topped papules on dorsal hands, arms, face

49
Q

What are palmoplantar warts?

A

viral: caused by HPV

Thick, endophytic papules on palms or soles of feet
Can form a callus
Pain with walking

50
Q

What is a variated of palmoplantar warts?

A

mosaic warts (smaller warts coalesce into a large wart plaque)

51
Q

Tx for palmoplantar warts?

A

Can spontaneously resolve

Acids, cryotherapy, retinoid cream, surgical removal, duct tape, laser – all irritating or destructive

Imiquimod, Candida antigen - Immune-stimulating

52
Q

What is herpes zoster?

A

Reactivation of varicella-zoster virus latent in the nerve ganglia (same virus that causes chicken pox)

75% occur in patients >50 y old

53
Q

Clinical findings of herpes zoster?

A

Prodrome of stinging/pain

Clinical findings: grouped vesicles on erythematous base, unilateral, in dermatomal distribution

54
Q

Tx for herpes virus?

A

to prevent post-herpetic neuralgia

Valacyclovir or famciclovir PO within 48-72 hrs of eruption

Pain control

55
Q

What will you see if you have ocular involvement in herpes zoster? What should you include in tx plan?

A

Hutchinson’s sign: vesicles on the side and tip of nose- nasociliary branch of trigeminal nerve affected

ophthalmology consult ASAP

56
Q

What is molluscum contagiosum?

A

viral disease

Well demarcated small 2-6mm smooth, firm, shiny dome-shaped flesh-colored papules with central

UMBILICATION caused by DNA poxvirus

57
Q

What two skin abnormalities can you seen umbilical lesions in?

A

molluscan contagiosum

basal cell carcinoma

58
Q

How is molluscum contagiosum transmitted?

A

spread by skin to skin contact

genitalia in adults - considered STI

59
Q

Tx for molluscum contagiosum?

A

spontaneous resolution

cryotherapy, curettage, acids, cantharidin

topical therapy- retinoids

60
Q

What is impetigo?

A

Superficial infection of the epidermis by S. aureus and GAS (S. pyogenes) arising from superficial breaks in the skin or as a secondary infection of pre-existing dermatoses.

61
Q

Clinical findings of impetigo?

A

small vesicles or pustules rupture ->erosions with yellow honey colored crusts usually peri-nasal or intertriginous sites (bullous form)

62
Q

How can we dx impetigo?

A

gram stain or culture

but usually clinical dx

63
Q

Tx for impetigo?

A

topical mupirocin (Bactroban) or retapamulin

64
Q

How can we prevent impetigo?

A

proper hygiene, very contagious

daily bath with antibacterial soap, frequent hand washing;

check for other family or household members

65
Q

What is erysipelas?

A

Upper dermis infection, more superficial than cellulitis

Group A strep

66
Q

Clinical findings of erysipelas?

A

Raised, well demarcated

Enlarges rapidly
Face, arms, fingers, legs, toes

67
Q

Tx for erysipelas?

A

IV antibiotics if systemic symptoms, otherwise oral PCN or amoxicillin

68
Q

What is cellulitis?

A

Erythema, edema, warmth of skin

Infection in deep dermis and subcutaneous fat

Disruption of skin barrier predisposes to this

GAS and Strep pyogenes most common pathogens

69
Q

Tx for cellulitis?

A

abx covering beta hemolytic strep and MRSA

-Cefazolin IV or cephalexin oral

70
Q

What is scabies?

A

Infestation of the mite Sarcoptes scabiei spread by skin-skin contact; intensely pruritic especially worse at night

71
Q

Clinical findings of scabies?

A

papules with excoriations and gray or skin-colored burrows in s-shape diagnostic especially in finger webs, wrists, ankles, feet, genitalia

72
Q

Tx for scabies?

A

permethrin 5% topical lotion/cream

or Lindane or oral ivermectin

tx all household contacts

antipruritics (can be itchy for 6 wks after tx)

73
Q

What is pediculosis?

A

lice

Capitis (head lice) and pubis (pubic lice) are most common

Pruritus in the affected area, nits (oval grayish-white egg capsules) may be visible

74
Q

Tx for pediculosis?

A

permethrin 1% OTC or 5% overnight for resistance

  • Malathion (ovide)
  • 5% benzyl alcohol (Ulesfia)
  • Treat all contacts
  • Heat sensitive
75
Q

What is the MC presentation from non-poisonous spider bites?

A

papular urticaria

76
Q

Presentation for brown recluse spider?

A

venom is necrotizing

Mild urticaria to full-thickness necrosis

Spider has yellow-brown body with violin-shaped dark brown mark on abdomen

77
Q

Tx for brown recluse spider bit?

A

ice/elevated?

abx: erythromycin, cephalosporins

update tetanus

78
Q

Presentation for black widow spider?

A

venom is neurotoxic

Bite is non-painful; within minutes or hours, severe muscle cramping leg, back, generalized abdominal pain

Spider has red hourglass abdominal markings

79
Q

Tx for black widow spider bit?

A

antivenom

muscle relaxants

supportive care

80
Q

What is alopecia aerta?

A

Focalized hair loss

Autoimmune attack on hair follicles on head, beard, any hair-bearing body location

Can have associated autoimmune disorders

81
Q

Clinical findings in alopecia aerata?

A

discrete, smooth round or oval areas of hair loss without visible inflammation of scalp, face, body

May have nail pits
Exclamation point hairs

82
Q

Tx for alopecia aerata?

A

reassurance-spontaneous resolution in 6 months

Topical steroid – potent

Topical minoxidil

Intralesional steroids

Refer to dermatology - especially if larger areas of hair loss

83
Q

What is paronychia?

A

Acute infection of lateral or proximal nail fold usually caused by S. aureus occuring from a break in the epidermal skin

Pt will c/o throbbing pain

84
Q

Clinical findings in paronychia?

A

tenderness, erythema, swelling, +/- abscess formation and purulent drainage

85
Q

Tx for paronychia?

A

warm compresses- sufficient in mild cases

I&D-Bacterial culture

Oral antibiotics based on organism sensitivity (cephalexin, dicloxacillin)

86
Q

What is vitiligo?

A

Autoimmune process of melanocyte destruction leading to depigmentation; cause unknown

87
Q

What are the predisposing factors to vitiligo?

A

genetic factors, stress, illness, trauma, severe sunburn

88
Q

clinical findings in vitiligo?

A

bilateral, symmetric sharply defined depigmented “chalky”-white macules on hands, face, elbows, knees, skin folds, genitals

89
Q

Tx for vitiligo?

A

sunscreens, cosmetic cover-up

Repigmentation – topical glucocorticoids and tacrolimus, PUVA, grafting

90
Q

What does vitiligo look like on wood’s lamp?

A

chalky white- full depigmentation

91
Q

What is melasma?

A

Common disorder; melanocytes produce a large amount of pigment when stimulated by UV light or increase in hormone levels (pregnancy, OCP’s), “mask of pregnancy”

unknown pathogenesis

92
Q

Epidemiology of melasma?

A

darker skinned ind/ susceptible, women > men

93
Q

Clinical findings of melasma?

A

sharply demarcated brown patches on the forehead and malar prominences

94
Q

Tx for melasma?

A

sunscreen

Hydroquinone, tretinoin

Chemical peels, laser treatments

95
Q

What is acanthosis nigricans?

A

Localized skin disorder manifested by hyperpigmented, symmetrical velvety plaques that are grayish, black, or brown commonly found on the neck, skinfolds

Can occur in obese persons with or without endocrine disorders

96
Q

What are some conditions assoc. with acanthosis nigricans?

A

obesity, diabetes, PCOS

atypical presentations and acute onset - malignancy

97
Q

acanthosis nigricans MCly affects…

A

Native American, African American, and Hispanic populations

98
Q

Tx for acanthosis nigricans?

A

treat underlying condition

Fasting plasma insulin and glucose, weight loss counseling

Topical therapy for cosmetic purposes: lactic acid 12% cream, urea cream, retinoids, salicylic acid 6%

99
Q

What are pressure ulcers? (Decubitus ulcers)

A

Bedsores; produced anywhere on the body by prolonged pressure especially bony sites- below the waist (95%)

100
Q

Clinical findings of pressure ulcers?

A

“punched-out” ulcer -> necrosis with grayish pseudomembrane

101
Q

Tx for pressure ulcers?

A

prevention – minimize pressure, change positions q 2 hours, foam products

Ulcer care- debridement, cleansing, wet-dry dressings, occlusive dressings

Bacterial culture if secondary infection is suspected

Foundations- ID/Derm (5 decks)

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