Derm Flashcards
Red, scaly, patchy rash with licenification. Very itchy seen on scalp, face, extensor and flexor surfaces. Sharply defined coin shaped plaques.
Eczema.
Two things in history to suspect atopic eczema?
Hx of allergies or asthma.
Treatment for eczema?
Motsturize with emmoliants, topical corticosteroids, antipruretics. Antihistamines.
This causes tense pruritic vesicles on palms and soles. Difficult to manage. Looks like tapioca. Dx? Tx?
Dyshidrotic eczema. Super potent corticosteroids, tar soaks, erythromycin, refer to derm.
Irregularly grouped, red papulopustules on a red base, peri oral but spare the vermillion border. Dx? Tx?
Peri oral dermatitis. Abx, flagyl, erythromycin
Eczema like eruption on lower legs with varicose ties, swelling and edema. Dx? Cause? Tx?
Stasis dermatitis. Secondary to PVD. Support stockings, elevation, exercise, weight loss, topical steroids.
Dry to inflammatory scaly and greasy plaques. Dx? Tx?
Seborrheic dermatitis. Tx with shampoos, ketoconazole cream, may resemble malignant melanoma.
Solitary patch of itchy skin with licenification. Greater than 1 cm. dx? Tx?
Lichen simplex chronicus. Avoid itching and steroids.
5 P’s: purple, planar, polygonal, pruritic, papules….. Dx? Tx?
Lichen planus. Dx with punch bx. Treat with corticosteroids.
Round or oval salmon colored lesions follow a Christmas tree pattern after a herald patch on the trunk. Variable latching lasts weeks to months. Dx? Tx?
Pityriasis rosea. Can mimic secondary syphilis so do RPR. Tx with corticosteroids and UVB light.
This is a T cell mediated disease of unknown etiology. Rut hematomas silver scaly plaques. Mostly on extensor surfaces. Dx? Tx?
Psoriasis. Tx is topical steroids, retinoids, tars, shampoos. Uv light. Avoid systemic steroids and refer!
This causes plaques, blisters in a target like shape on the extensor surfaces. Caused by an immunologic reaction in skin to an antigen. Dusky red target lesions. Dx? Tx?
Erythema multiforme.
Meds that can cause erythema multiforme?
NSAIDs, sulfa, quinolone, allopurinol, colchicine.
Erythema multiforme can progress to what and then what?
Stevens Johnson syndrome then to toxic epidermal necrolysis.
This often starts with a targetoid lesion then becomes painful and tender oral and skin lesions.
Stevens Johnson syndrome.
Percent of epidermal detachment in Stevens Johnson syndrome?
Less than 10%
Treatment for SJS?
Systemic steroids, supportive care, stop the drug causing it!!!
This is a severe form of SJS. Usually has high fever.
TENS.
What is the percent of epidermal detachment in TENS?
Greater than 30%.
This is an autoimmune disease causing very painful mouth erosions and bullae. The slightest pressure can cause the skin to pull off in sheets. Dx? Tx?
Pemphigus vulgaris. Dx by bx. Treatment is systemic steroids.
This is an autoimmune attack on the basement membrane causing sub epidermal blistering. Common in the elderly. Dx? Tx?
Bullous pemphigoid. Dx with punch bx. Treat with corticosteroids or methotrexate.
Treatment for acne comedones?
Benzoyl peroxide, retinoids
Treatment for acne papules and pustules?
Benzoyl p, retinoids, abx.
Treatment for acne nodules or cysts?
Accutane. It is teratogenic. And elevates lipids.
Describe rosacea?
Adult acne with no comedones, pos blushing and telangectasias. Treat with trigger avoidance, m
Flagyl, clindamycin.
Treatment for warts?
Podofilox, liquid nitrogen, imiquimod
Pearly umbilicated papules 1-5mm, on face, neck, trunk, thighs. Dx. Tx?
Molluscum contagiosum. Spread by skin to skin contact. May resolve on own or cryosurgery and curettage.
This is a superficial bacterial infection of the epidermis. Honey colored crusting lesions . Dx? Tx?
Impetigo. Treat with mupirocin.,
Bacteria that causes impetigo?
S. Aureus.
This is a deep dermis and subcutaneous tissue infection. Can cause fever, chills, malaise, pain with erythema and edema.
Cellulitis.
Risk factors for cellulitis?
DM, cirrhosis, malnutrition, cancer.
Common bacteria causing cellulitis?
Staph or group a strep.
Treatment for cellulitis?
Augmentin, keflex
This is an infection of the epidermis and dermis, sometimes bright red. Patient has fever, malaise, calls, nausea and adenopathy. Elevated sharply demarcated borders of rash. Dx? Tx?
Erysipelas. Common strep pyogenes. Tx with pen, azithromycin, Keflex.
Tx for hot tub folliculitis and bug common?
Pseudomonas and tx with cipro.
Tx for Tinea capitis?
Oral griseofulvin.
Fungus that causes Tinea versicolor?
Malassezia furfur.
Chronic paronychia organism?
Candida
Beefy red rash with satellite pustules? Dx? Tx?
Candida. Area clean and dry, nystatin or azoles.
Noted on chronic sun exposed skin. Rough Sandpapery patch, crusted. Dx? Tx?
Actinic keratosis. Shave bx to rule out SSC. Treat with liquid nitrogen, 5FU, sun protection and regular follow up.
Benign epidermal neoplasm with a stuck on appearance. Dx? Tx?
Seborrheic keratosis. Can resemble MM so bx if needed. Treat with liquid nitro, curettage, shave.
Most common skin cancer?
Basal cell carcinoma.
This is a pearly white lesion with a translucent rolled border. Can ulcerated and bleed. Dx?
Basal cell carcinoma.
Treatment for basil cell carcinoma?
Punch biopsy. Surgery, 5FU.,follow up with frequent skin exams and avoid sun.
Eczema that doesn’t itch?
Squamous cell carcinoma.
Second most common skin cancer?
Squamous cell carcinoma.
Where are SCC found on skin?
Lips, hands, neck head. Red scaly papule or plaque.
Cutaneous horns associated with?
SCC.
Warts on hands that don’t improve on own or with treatment what next?
Bx to rule out SCC.
Treatment for SCC?
Wide local excision. Radiation. Follow up often, avoid sun.
Most common cancer in women ages 25-30?
Melanoma
What must you get when biopsying a lesion suspected to be melanoma?
Subcutaneous tissue to heck for breslows depth. For staging.
Clinical presentation of melanoma.?
Itching tenderness, bleeding ulceration or change in ABC’s.
Treatment for melanoma?
Excision. Interferon reduces recurrence.
A tumor caused by human herpes virus 8.
Kaposi sarcoma. Aids defining illness.
Biopsy of kaposi sarcoma shows?
Spindle cells
Tx of kaposi sarcoma?
Lesions shrink. With antiretroviral therapy. No cure.
Scabes treatment for pregnant or babies?
6-10% sulfur in petroleum.
Spider bite that causes immediate sharp pain and can lead to abdominal, leg and back pain. Dizziness, headache, sweating, nausea, vomiting. Dx? Tx?
Black widow bite. Tx with antivenin, calcium gluconate and analgesic.
Spider bite during moving logs or wood. Mild at first then severe pain with necrotic fatty areas. May have blue grey vesicles. Dx? Tx?
Brown recluse. Ice, elevate, avoid strenuous activity, abx, ASA.
Loss of hair without scarring in a well circumcised area, exclamation point hairs. Likely autoimmune. Dx? Tx?
Alopecia areata. Tx with corticosteroids and minoxidil.
Hair loss due to stress?
Telogen effluvium.
Nail plat is yellow or white. Dx? Tx?
Onychomycosis. Test with KOH. Tx with lamisil 6 wks. Fingers and 12 wks toes.
This is a rapid onset of bright red, pus, painful swelling of the lateral nail bed. Dx? Tx? Common pathogen?
Acute paronychia. I&D, s. Aureus. Keflex
Describe first degree burn.
Minor epithelial damage, sunburn. No blisters!
Describe second degree burn.
Superficial partial thickness: epidermis and superficial dermis, pink soft moist skin with thin walled blisters.
Deep partial thickness: epidermis into lower dermis, red, white skin with thick walled blisters.
Describe throw degree burns.
Full thickness burns. Skin is white and leathery and numb. From immersion burns, flames, high voltage electricity.
Describe 4th degree burns.
Full thickness of skin and other tissues.
Rule of nines for adults?
9% head, each upper extremity.
18% anterior trunk, posterior trunk and each leg.
1% genitals.
Rule of 9’s for kids?
18% head and neck. 9% each arm. 18% anterior trunk, posterior trunk. 13% each leg 1% genitals.
How do you treat suspected inhalation injury pre hospital?
Humidified O2 no rebreather 10-12 LPM
What is the Parkland formula for burns?
4mL/kg/%burned in first 24 hrs. (Half given in first 8hrd, rest over next 16 hrs). Use lactated ringers!
Pain med of choice for burns?
Morphine.
This is an inflammatory disorder of the apocrine glands causing double open comedones. Dx? Tx?
Hydradenitis suppurative. Treat with weight loss, decrease friction, cleansers, abx and surgery.
If you see acanthosis nigricans screen patient for what?
Internal malignancy or DM.
Thick velvety plaques in neck, axilla, thighs. Dx? Tx?
Acanthosis nigricans. Treat with 12% lactic acid lotion. Screen for lymphoma or adenocarcinoma!
Autoimmune attack on melanocytes. Woods lamp accentuates. Dx? Tx?
Vitiligo. Treat with topical corticosteroids or phototherapy.
What is urticaria caused from?
Hypersensitivity reaction mediated by IgE and mast cells.
If individual urticaria lesions last greater than 24 hrs…..
Biopsy. Rule out vasculitis, connective tissue dz, drug eruption.
Treatment of urticaria?
H1 blockers, H2 blockers, tricyclic antidepressant like doxepin
Palpable purpura?
Vasculitis. Must biopsy.
