Derm Flashcards
First appears high fever (103-105), headache, red eyes, and N/V, then on 3rd day a rash erupts on hands and feet and spreads to trunk.
Rocky mountain spotted fever
dry, round, and red-colored lesions with a rough texture and don’t heal; common in sun-exposed areas
actinic keratosis
Precursor for squamous cell carinoma
actinic keratosis
s/s of meningitis
sore throat, cough, fever, headache, stiff neck, photophobia, changes in LOC
rash in meningitis
petechial rash to axilla, flanks, wrist, and ankles
trx for close contacts of those with meningitis
rifampin
This rash appears within 7-14 days after a deer tick bite
bulls-eye rash in Lyme disease
If a vesicular rash appears on nose, then
assume it is shingles until proven otherwise
s/s of melanoma
Asymmetry, border irregularity, color is dark, diameter is greater than 6 mm, enlargement or change in size
basal cell carcinoma
pearly or waxy skin lesion that can bleed easily
most common type of melanoma in blacks and asians
acral lentiginous melanoma
acral lentiginous melanoma
black lesions on nailbeds, palmar and plantar surfaces
A hematoma that involves _____ of the nail has a high risk of ischemic damage to the nail matrix
more than 25%
treatment for subungual hematoma
burn a 18 gauge needle and push 3-4 mm into nail and drain
classic lesions appear bulls-eye like but can range from hives, blisters, petechia/purpura, and hemorrhagic lesions that are painful
Steven Johnson syndrome
drug classes associated with SJS
PCN, sulfa, barbiturates, dilantin
HIV infected patients have a very high risk of SJS due to
TMP/SMZ
Bulla is seen in
SJS, impetigo, second degree burns
soft and round wart-like fleshy growths mostly on the trunk or back
seborrheic keratoses
raised and yellow-colored soft plaques that are located under the brow or upper and lower lids of the eyes
xanthelasma
may be a sign of hyperlipidemia if seen in those less than 40
xanthelasma
brown to tan colored stains located on the upper cheeks and forehead in women who are pregnant or on OCP
melasma
another name for moles
nevi
inherited skin disorder that results in extremely dry skin
xerosis
velvet thickening of the skin behind the neck
acanthosis nigracans
avoid steroids in these cases because it will worsen the infeciton
fungal infection
What in use in infants, children, and adults with thin facial skin
0.5-1% hydrocortisone
an inherited skin disorder in which squamous epithelial cells undergo rapid mitotic division and abnormal maturation
psoriasis
pinpoint areas of bleeding remain in the skin when a plaque is removed
auspitz sign
black box warning with topical tacrolimus for psoriasis
malignancy (skin and lymphoma)
treatment for actinic keratosis
cryotherapy; fluorouracil cream 5%
superficial skin infection caused by yeasts Pityrosporum orbiculare or Pityrosporum ovale
tinea versicolor
diagnostic for tinea versicolor
KOH slide shows hyphae and spores
trx for tinea versicolor
topical selenium sulfide or ketoconazole cream bid x 2 weeks
s/s of atopic dermatitis (eczema)
extremely pruritic rashes on hands, flexural surfaces and neck
classic rash of atopic dermatitis (eczema)
multiple small vesicles that rupture and weep; then they become lichenified d/t constant itching
trx for atopic dermatitis (eczema)
hydrocortisone 1 to 2.5%; triamcinolone
treatment for contact dermatitis
calamine lotion; oatmeal baths; Aveeno;
Severe: oral prednisone tape 12-14 days
treatment of candidiasis intertrigo
Nystatin powder bid
treatment of HIV esophageal Candida infections
fluconazole
treatment for clenched fist injury
refer to ER d/t high risk of infection to bone
several boils that coalesce to form a large boil or abscess
carbuncle
trx for non-MRSA nonpurulent cellulitis
dicloxacillin QID x 10 days; macrolides for PCN allergy
trx for cellulitis
Bactrim DS, doxycycline, or clindamycin x 10 days
large and hot indurated red skin lesion located on shins or cheeks; caused by Staph aureus
erypsipelas
treatment for human or animal bites
augmentin x 10 days; clindamycin + fluoroquinolone for PCN allergy
wounds that stay open
puncture wounds, cat bites, wounds > 12 hours old (24 hours for face)
infection caused by Staph aureus to sebaceous glands of axilla that becomes chronic
hidradenitis suppurativa
trx for hidradenitis suppurativa
Augmentin or dicloxacillin x 10 days
acute superficial infection by strep pyogenes or S. aureus that is very contagious and pruritic; common in warm and humid weather
impetigo
trx for impetigo
cephalexin or dicloxacillin x 10 days; mupiricon ointment
Caused by Borrelia burgdorferi
Lyme disease
trx for lyme disease
doxycycline bid or tetracycline x 14 days
caused by Rickettsia rickettsii
rocky mountain spotted fever
trx for rocky mountain spotted fever
doxycycline bid x 21 days; refer stat
how long is chickenpox contagious
1-2 days before onset of rash until the lesions have crusted over
how long is shingles contagious
from the onset of rash until the lesions have crusted over
duration of shingles
2-4 weeks
labs for shingles
viral culture, PCR for ZDV
meds for shingles
acyclovir 5x/day or valacyclovir bid x 10 days for initial breakout and 7 days for flare ups
most serious complication of shingles
post hereptic neuralgia
trx for post hereptic neuralgia
tricyclic antidepressants, anticonvulsants, or gabapentin
for those with varicella vaccine
they can still get shingles but it will be a more mild disease than those who have been unvaccinated
shingles vaccine
for those 60 and older
extremely painful red bumps/blisters on sides of finger or cuticle area
herpetic whitlow
cause of herpetic whitlow
direct contact with cold sore or genital herpes lesion
bacterial infection of the nail folds
paronychia
causes of paronychia
S. aureus, streptococci, or pseudomonas
trx for paronychia
soak finger in warm water for 20 min 3x/day; apply mupiricin ointment after soaking; drain if abscess present
salmon-colored oval scaly lesions on cleavage line or a “christmas tree” pattern
pityriasis rosea
course of pityrisasis rosea
lasts 2-4 weeks, self-limiting
s/s of scabies
itching in webs of hands, axilla, breasts, waist, genital; itching worse at bedtime
trx for scabies
permethrin 5% cream; apply head to toe and wash off in 8-14 hours; wash all clothes/linen used in the past 3 days
itching duration with scabies
may persist for up to 2-4 weeks
trx for tinea infections
terconazole cream bid
s/s of tinea capitis
children with scaly patches and alopecia
trx for tinea capitis
griseofulvin bid x 6-12 weeks (check baseline LFTs and repeat in 2 weeks)
“sandpaper” rash with sore throat
scarlet fever
hypopigmented round to oval macular rashes on upper shoulders/back that is not itchy
tinea versicolor
smooth papules 5 mm in size that are dome-shaped with a central “plug”
molluscum contagiosum
tinea cruris
jock itch
topical trx for mild acne
RetinA 0.25% cream every other day at bedtime for 2-3 weeks, then daily;
benzyl peroxide and erythromycin (Benzamycin) cream
tetracyclines can be given for acne starting at age
13
complication of tetracycline for acne
permanent discoloration of tooth enamel; decrease effectiveness of OCP
guidelines for isotretinoin (Accutane)
category X; patient must sign consent, enroll in pregnancy prevention program, use 2 forms of contraception, only monthly supplies, must do pregnancy test monthly.
light skinned individual c/o acne-like pustules around nose, mouth, and chin; may blush easily; red-eyes/blepharitis
rosacea
trx for rosacea
No cure. metronidazole topical gel; azelaic acid gel; low dose tetracycline or minocycline
trx for first degree burns
cold packs for 24-48 hours
burn that is red colored skin with superficial blisters (bullae)
second degree burn
trx for second degree (partial thickness) burns
cleanse with mild soap and water. DO NOT rupture blisters. Trx with silvadene and apply dressing.
refer for these kinds of burns
third degree burns, facial burns, electrical burns, burns on ears or nose, burns greater than 10% BSA.
rule of nines for adult burns
each arm and head is 9%;
each leg, anterior trunk, and posterior trunk is 18%
caused by Bacillus anthracis
Anthrax
three types of anthrax
cutaneous, GI, and pulmonary (bioterrorism)
postexposure prophylaxis for anthrax
ciprofloxacin 500 mg bid x 60 days
inhalation or ingestion of this can cause respiratory distress and organ failure in 6-8 hours; no known antidote
ricin toxin (from castor beans)
difference between erypsipelas and cellulitis
erypsipelas only affects superficial layer of skin; cellulitis affects the deeper layers of the skin
treatment for lice
permethrin 1% apply to dry hair x 10 min, may repeat in 2 weeks
multiple papules and pustules on lower back and buttocks that do not itch or cause pain.
folliculitis
This atbx has poor staph coverage
PCN
transmission of shingles
you cannot transmit shingles to another person, but you can transmit chickenpox
anti-inflammatory effect of NSAIDs
need to use 600-800 mg to reach anti-inflammatory effect; less than 600 is for analgesic effect.
trx for post-herpetic neuralgia
TCA, gabapentin, Lyrica
Shingles vaccine is for
those age 60 and older
organisms involved in cat, dog, and human bites
pasturella, staph, streptococcus
how long to give atbx for bites
for prophylactic: 3-5 days;
for treating infection: 7-10 days
application tips for antifungal creams
apply 1-2 inches beyond the rash,
treat for 1-2 weeks,
treat 1-2 weeks after resolution to prevent recurrence
fungal infections are usually always
superficial infections; which is why topical agents are effective
most effective trx for onychomycosis
oral terbinafine for 6-12 weeks
s/s of lupus
fatigue, joint aches, butterfly rash
diagnostic for lupus
high ANA
common sites for basal cell carcinoma
head and neck
disease associated with seborrheic dermatitis
parkinson’s
least potent to most potent topicals
lotion, cream, gel, ointment
best delivery of a topical steroid in an elderly person with thin skin
lotion (least potent)
herpangina is caused by
coxsackie A virus
rash with measles (rubeola)
brick red rash that starts on head and spreads down to extremities
rash with roseola (exanthem subitum)
high fever for 2-4 days, then fever stops and rash appears
s/s of herpangina
painful vesicles on soft palate and mouth
important education with Fifth’s disease
avoid contact with pregnant women, can cause fetal death
usual age at which roseola is diagnosed
7-13 months
s/s of measles (rubeola)
“three C’s”: conjunctivitis, coryza (runny nose), cough; Koplik spots
grain of sand appearance in oral mucosa
Koplik spots in measles
