derm Flashcards
most common cause of abscess
staph aureus
erysepelas
most common strep progenes
induration differentiates from cellulitis (more superficial)
usually on lower legs (most common) or face
impetigo
usually staph
honey colored crusts
warm cloth to remove crusts and then mupricon (bactroban)
avoid scratch
bullous pemphigoid vs pemphigoid vulgaris
bullous pemph- low mortality, elderly, NEGATIVE nikolsky, tense bullae, no oral lesions, usually due to drug rxn
pemph vulgaris- NIKOLSKY (acantholysis), high mortality, younger, flacid bullae (due to acantholysis), ORAL LESIONS, systemic immune problem, IV steroids
what has positive nikolsky sign
Staph scalded skin syndrome
Toxic epidermal necrolysis (TEN)
pemph vulgaris
desquamation
erythema multiform (EM minor)- target lesions, palms and soles, herpes (90%), mycoplasma pneumonia steven johnson syndrome- MUCOUS MEMBRANE involvement, pcn, sulfa, 30%BSA, burns icu
atopic dermatitis
associated with IgE
usually have asthma and allergies as well (atopy triad)
contact dermatitis
plants- toxicodendron (family of poison ivy)
id rxn- rxn to something that touches one part of your body and now another part of your body gets a rxn
tx- systemic steroid taper (if small topical steroid)
dishydrosis
pomphylx
itchy vessicles
due to excessive sweating
topical steroids
lichen simplex chronicus
due to itchy areas
tx- topical steroids
psoriasis
extensor surfaces plaques with silvery scales can get pitting of nails auspitz sign koeber phenomina tx- topical steroids (strong like betamethasone and clobetasol), uv light, retinoids (isoretnoin)
most common psoriasis
plaque psoriasis
psoriatic arthritis
hla b27 positive iritis sacroilitis IBD sausage fingers pencil cup deformity tx- systemic steroids immune modulators (methotrexate)
pityriasis rosea
herpes 7 herald patch viral prodrome christmas tree distribution tx- self limited
lichen Planus
wrist, ankle, mouth
5 p’s
pruritic, planar, purple, polygonal, papules
tx- topical steroids
actinic keratosis
due to sun damage
pre cancerous for SQUAMOUS CELL
seborrheic keratosis
beige to brown or black with a velvety warty surface
benign
waxy plaque
appears “stuck on”
paronychia
infection of nail fold
I&D
Lice
pediculosis usually pruritic excoriations tx- permethrin (elimite/nix), malthion retreat in 7 days
scabies
burrows (tunnels) intense pruritic blue dot intertriginous areas (wrist, web spaces, flexor, axilla) tx permethrin cream, antipruritic meds
crusted/norwegian scabies
hyperkeratotic immunosuppressed HIV pts dermatologist ivermectin tx
bed bugs
can be pruritus (not usually)
blood stained bedding
groups of 3’s for bites
tx supportive (unless secondary infection)
black widdow
woodpiles, outhouses
painful bite (skin prick)
bulls eye (central blanching w/ erythema
sxs- muscle cramps, diaphoresis, abdominal pain, spasm
can present like acute abdomen w/ negative ct
tx- pain control, benzos, antivenom
brown recluse
fiddle back spider (violin on head) 3 pairs of eyes (not 4) necrotic arachnidism (cell ulcer that progresses to necrosis) painless bite rare comp- shock, dic, hemolysis tx- supportive
hymenoptera
bee, wasp, ants
can cause anaphylaxis -IgE type 1 mediated rxn
tx of lyme disease
doxy
if breast feeding or child amoxicillin
tx of rocky mountain spotted fever
doxy (for both kids and adults)
UVB
what burns you, cataracts (b for burn, blindness)
UVA
tans you, ages you (A for age, a for tan)
basal cell carcinoma
most common in sun exposed areas pearly waxy papule easy bleeding central crater w/ rolled border non healing dx- biopsy, punch tx- surgical (mohs), cryotherapy, topical (imiquimod)
squamous cell carcinoma
actinic (solar) keratosis scaling, crusting, telangestias raised nodule, shallow ulcer head, neck, oral dx- punch bipsy
melanoma
bad one causes most skin cancer deaths can cause subungal ABCDE (asymetry, irregular border, variation in color, diameter >6mm, evolution of lesions) dx- wide margin excision biopsy
kaposi sarcoma
HIV or immunosuppressed
herpes virus 8
most common in men on men
painless purple red blue papules
formula for IV fluids for burns
4cc/kg x %BSA in the first 24 hours
Give 1/2 of fluid in 8 hours
based on time of injury
parkland formula
what burns are worse
alkali
signs of inhalation burns
singed nose hairs
facial burns
carbonaceous sputum
rosacea
chronic skin disorder with intermittent facial flushing, telangectasias, and often large bulbous red nose
molloscum contagiosum
discrete, flesh colored, waxy dome shaped umbilicated papules
pox virus
warts
verrucae
caused by HPV
topical therapies imiquod, surgery (cryosurgery-freeze)
dermatophyte lesions
fungal infections (ring worm) erythematous, annular patch w/ distinct red raised border with central clearing tinea... foot (pedis) groin (cruris) trunk/arm/leg (corporis)
griseofulvin
antifungal
need to be careful in pts w/ alcohol (antabuse)
tinea versicolor
yeast infection of skin
tx- selenium sulfide shampoo (selson blue)
seborrheic dermatitis
itchy, flaking (usually found on scalp, behind ears, eyebrows, or nasolabial folds)
erythematous, greasy, yellow scaling papules and patches with indistinct border
migrans vs marginatum vs multiform
Erythema migrans is called so because the rash appears to migrate outward with a central clearing. Hence if you observed the rash for some days you would be able to differentiate migrans from multiforme and marginatum. It would also be a single lesion at the site of the tick bite (although in disseminated infections they can be multiple). Erythema multiforme has multiple lesions, which are raised (and pruritic). Erythema marginatum is found mostly on extensor surfaces, ring like but not raised (and not pruritic). So yes, clinical context is always useful (and often necessary).
what to do next if pap smear shows atypical squamous cells of undetermined significance
do HPV viral testing
If HPV comes back positive then do colposcopy
most common type of thyroid cancer
papillary
most common cause of encephalitis
HSV
most common cause of SVC syndrome
lung cancer (especially adenocarcinoma)
most common cause of acute bronchitis
rhinovirus
1st line tx in pcos
ocp
chornic silicosis
diffuse rhonchi and low pitched rales
wilson disease
ceruplasmin decreased
copper accumulation
liver biopsy is gold standard
