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OMS III > Derm > Flashcards

Derm Flashcards

1
Q

cutaneous malignancies

A

all dermal malignancies occur more frequenstly in those iwth pale skin on more sun-exposed areas. diagnosis is by biopsy and the treatment is with surgical removal. no form of skin cancer has effective chemo

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2
Q

skin cancer

A

more sun=more cancer
biopsy
remove

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3
Q

Malignant Melanoma

overview

A

although melanoma occurs more frequently in sun-exposed areas, it is not exclusive to those areas. since there are many benign skin lesions, the main question is one of diagnosis.

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4
Q

cutaneous malignancies

list

A

malignant melanoma

scc

bcc

kaposi sarcoma

actinic keratoses

seborrheic keratoses

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5
Q

worse prognostic significance

A

growing lesions

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6
Q

Malignant Melanoma is best disgnosed clinically by

A

ABCDE

asymmetry
border irregularity
color irregularitis
diameter greater than 6 mm
evolution
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7
Q

the diagnosis for any suspicious lesion

A

is by biopsy taht includes the entire lesion if possible

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8
Q

Benign lesions

A

round
even borders
color even spread
diamter constant

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9
Q

malignant lesions

A

asymmetric
borders uneve
color uneven
diameter increases

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10
Q

Malignant Melanoma

diagnostic test

A

full thickness biopsy is indispensible in diagnosis.do not do a shave biopsy

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11
Q

Malignant Melanoma

treatment/ prognosis

A

surgical removal must include a significant removal of normal skin surrounding the lesion. interferon injection is helpful in widespread siease. melanoma has a strong tendency to metastasize to the brain

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12
Q

Squamos Cell Cancer

A

besides sunligh, scc is geratly increased by organ tranplant secondar to the long-term use of immunosuppressive drugs. all forms of scc start out by looking like and ulcer htat does notheal or continues to grow

biopsy and remove

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13
Q

Basal Cell Carcinoma

A

BCC is the omst common form of skin cancer. the question will describe a waxy lesion that is shiny like a pearl. unlike melanoma, wide margins are not necesary, shave biopsy is a fine way to make the diagnosis. recurrence rates are less than 5%. bcc is a good use of Mohs micrographic surgery

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14
Q

Mohs Micrographic surgery

A

removal of skin cancer under a dissecting mocroscope with immediate frozen section is one of the most precise methods of treateing skin cancer. mohs allows removal of the skin cancer witht he loss of only the smallest amoutn of normal tissue. under microscopy, very thin slices of ksin are removed and examined by frozen section for cancer. you can stop resecting as soon as the margin is cancer-free. in other owrds, there is no need to remove a wide margin routinely.

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15
Q

most is best for

A

delicate areas like the eyelid or ear

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16
Q

Kaposi Sarcoma

A

in the past, kaposi, sarcoma was seen in older men of mediterranean origin. the omst common cause now is AIDS. it is from human herpes virus 8, which is oncogenic. the lesion is more reddish/purplish because it is more vascular than other forms of skin cancer. KS is also found in the GI tract and in the lung. only aids acquired thorugh secual cantact is associated with KS, aids from injection is rarely assocaited with KS

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17
Q

bcc is very

A

slow to grow and is not hyperpigmented

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18
Q

ks occurs in aids pts with cd4 count

A

<100

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19
Q

KS

treatment

A

unlike other skin cancers, ks is not routinely treated with surgical removal

  1. treate the aids with antiretroviral and hte majority of ks will disappear as the cd4 count improves
  2. intralesional injections of vincristine or interferone are very successful
  3. if these fail, use choemtherapy with liposomal doxorubicin
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20
Q

Actinic Keratoses

A

Premalignant lesions from high-intenstiy sun exposure in fari skinned people. tehy have a very samll risk of scc for each individual lesion. since many can occur in a single person the risk is sumculative and significant.

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21
Q

Actinic Keratoses

treatment

A

they are slow to progress, butmust be removed with curettage, crytherapy, laser,or topical 5-flurouracil before they transform. the loal immunostimulatn imiquimod is also effectivve

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22
Q

what is imiquimod used for

A

Actinic Keratoses

molluscum contagiosum

condyloma acuminatum

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23
Q

Seborrheic Keratoses

A

these lesions are extrmely common in the elderly. they are hpyerpigmented lesions commonly referred to aliver spots. they give a stuck on appearance. although they may look like melanoma to some people , Seborrheic Keratoses have no premalignant potention they do not transfrom into melanoma.

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24
Q

Seborrheic Keratoses

treatment

A

cryotherapy, surgery, or laser for cosmetic reasons

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25
Q

Atopic Dermatitis

A

common skin disorder associated with overactivity of mast cells and the immune system. look for a history of:

asthma

allergic rhinitis

family hx of atopic disorders

onset before age 5, very rare to start after age 30

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26
Q

Atopic Dermatitis

presentation

A

bc of premature and idiosyncratitic release of transmitters such as histamine, pruritus and scratching is the most common presentation. scratching leads to scaly rpugh areas of thisckened skin on the face, neck, and skin folds of the popliteal area behindthe knee

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27
Q

Atopic Dermatitis

itching

A

leads to scratching. scratching leads to more itching, superficial infections from staph are common bc microrganisms are driven under the epiermis by scratching. this, in turn, leads to more itching

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28
Q

skin that has thickened bc of scrathicn and drying is describes as

A

lichenified

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29
Q

do food allergies exacerbated Atopic Dermatitis

A

no

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30
Q

IgE levelsare elevatedin

A

atopic dermatitis

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31
Q

Atopic Dermatitis

treatment: skin care

A

stay moisturized: dry skin is more itchy. use a humidifier, especially in the winter. use skin moisturizers more frequently. less itching=less scratching=less itching

avoid bathing, soap, and washcloths. the skin in Atopic Dermatitis is hyperirritable. brushes, washclothes, hot water, and anythign rhat rubs on the skin, evn if minimal can make it worse

cotton is less irritating to skin than wool.

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32
Q

Atopic Dermatitis

topical corticosteroids

A

used in flares of disease. oral steroids are used only int eh most severe acute flares of disease

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33
Q

Atopic Dermatitis

tacrolimus and pimecrolimus

A

t cell inhibiting agents that provide longer-term control andhelp get the pt off steroids. they are used systemically in organ tranplant recipients to prevent organ rejection and keep ots off steroids. they are used topically or atopic dermatitis bc this disorder is a form of immune system hyperactivity.

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34
Q

Atopic Dermatitis

antihistamines

A

mild disease: nonsedating (cetirizine, fexofenadine, loratadine)

severe disease: hydrozyine, benadryl, doxepine

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35
Q

Atopic Dermatitis

antibiotics

A

cephalexin, mupirocin, retapamulin when impetigo occurs

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36
Q

Atopic Dermatitis

uv light

A

for severe recalcitrant disease

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37
Q

tacromlimus and pimecrolimus are rarely associated with

A

developing lymphoma

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38
Q

two derm disease with complex knowledge bases

A

eczema and psoriasis, everthing else is about 2 sentences long

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39
Q

Psoriasis

A

incredibly common with about 2 million people in the us have it

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40
Q

Psoriasis

presentation

A

characterized by silver, scaly plaques that are not itchy most of the time.less than 10% have arthritis. extensive disease is associated with depression

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41
Q

Psoriasis

treatment of local disease

A
  1. topical high ptoency steroids: fluocinonide, triamcinolone, betamethasone, clobetasol
  2. vit a and d ointment help get the pt off steroids. the vit d agent is calcipotriene. steroids cause skin atrophy
  3. coal tar preaparation
  4. pimcrolums and tacrolimus are used on more delicate areas such as the face and penic. they are an alternative steroids and are less potentially deforming
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42
Q

steroids cause atrophy of skin bc

A

they inhibit collagen formation and growth, they try and convert all amino acids into glucose for gluconeogensis

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43
Q

Psoriasis

treatment of extensive disease

A
  1. uv light
  2. antitumor necrosis factor (TNF) inhibitors (etanercept, adalimumab, infliximab). these agents can be miraculous in efficacy for svere disease
  3. methotrexate: used last bc of adverse effects on the liver and lung, it is a drug of last reosrt except for psoriatic arthritis
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44
Q

tnf inhibitors can activate

A

tb so screen with a ppd prior to useing them

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45
Q

Pityriasis Rosea

A

idiophatic, tansient dermatitis that starts out with a single lesion (herald patch) adn then disseminates. it can look like secondary syphilis but is pares the palms and soles. it is transietn, but if sypmtomatic it is treated with steroids or uv light

diffuse erythematous largely macular lesions

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46
Q

Seborrheic dermatitis (dandruff)

A

seborrheic dermattisi is a hypersensitivity reaction to a derma infection with nonvinasive dematophye organisms. this is why both topical steroids (hydrocortisone, alclometason) and antifungal agents (ketoconazole) are useful.

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47
Q

Seborrheic dermatitis (dandruff)

is increased in

A

aids

parkinson disease

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48
Q

the term seborrheic is synonymous with

A

benign

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49
Q

Blistering Diseases

A

pemphigus vulgaris

bullous pemphigoid

poephyria cutanea tarda

50
Q

Pemphigus Vulgaris

etiology

A

although idiopathic, associate with:

ace inhibitors
penicillamine
phenobarbital
penicillin

51
Q

Pemphigus Vulgaris

patho

A

autoantiboides split the epidermis resulting in:

bullae that easily rupture bc they are thin walled

involvemnt of the mouth

fluid loss and infection if widespread, they act like a burn

52
Q

Pemphigus Vulgaris

most characteristic finding

A

nikolsky sign - the loss of denuding of skin from just mild pressure. it is the removal of the superficial layer of skin in a single sheet while pulling on it with afiners worth of pressure

53
Q

Pemphigus Vulgaris

most accurat diagnostic test

A

biopsy showing antibodies on immunofluorescent studies

54
Q

Pemphigus Vulgaris

treatment

A
  1. systemic steroids (prednisone)
  2. azathioprine or mycophenolate to wean the pt off steroids
  3. rituximab (anti-cd20 antibodies) or IVIG in refractory cases
55
Q

w/o treatment Pemphigus Vulgaris

A

is fatal

56
Q

Bullous Pemphigoid

A

bullae stay intact and there is less loss of fluid and infection

mouth involvement is uncommon

not as severe as pemphigus

57
Q

Bullous Pemphigoid

most accurate test

A

biopty with immunofluirescent stains

58
Q

Bullous Pemphigoid

best initial therapy

A

prednisone. to get pts off streoids, use azathioprine, cyclophosphamide, or mycophenolate

59
Q

Bullous Pemphigoids

mild

A

responds to erythromycin, dapsone, and nictoineamide (not niacin)

60
Q

nikolsky sign is absent in

A

Bullous Pemphigoid

61
Q

Porphyria Cutanea Tarda

A

a lbistering skin disease of skin exposed areas in those with a hx of:

liver disease (hep c or alcoholism)
estrogen use
iron overload (hemochromatosis)
62
Q

most frequently test assocaiton with Porphyria Cutanea Tarda

A

hep c

63
Q

Porphyria Cutanea Tarda

look for involvement of the

A

backs of the hands and the face

64
Q

Porphyria Cutanea Tarda

diagnostic tests

A

most accurate is increased uroporphytins in a 24 hour urine collection

65
Q

Porphyria Cutanea Tarda

treatment

A

it is a deficiecny or uroporphyrin decaroxylase activity, correct the underlying cause (stop alcohol or estrogens) and remove iron with phlebotomy

66
Q

Porphyria Cutanea Tarda is a hypersensitivity

A

of the skin to abnormal oprphyrins when they are exposed to light

67
Q

Skin infections

A

impetigo

erysipelas

cellulitis

folliculitis, furuncles, carbuncles

fungal

68
Q

impetigo

A

the most superficial of the bacterial skin infections. staph and stre invade the epidemris, resulting in weeping, crusting, oozing, and draining of the skin

69
Q

impetigo

treatment: mild disease

A

mupirocin

retapamulin

bacitracin

70
Q

impetigo

treatment: severe disease

A

oral agents

dicloxacillin or cephalexin

71
Q

impetigo

treatment for community-aquired MRSA

A

doxycycline

clindamycin

bactrim

72
Q

Erysipelas

A

more severe than imptetigo bc it occurs at a deper level in the skin. more often from strep than staph. invades the dermal lymphatics and causes bacteremia, leukocytosis, fever, and chills. untreated can be fatal

73
Q

Erysipelas

presentation

A

look for a bright, red, hot, swollen lesion on the face. leukocysotis can occur bc it is more often a systemic disease.

74
Q

Erysipelas

treatment: overall

A

although it is more often from strep you must cover for staphy unless you have a culture

75
Q

Erysipelas

treatment: midl disease

A

use oral meds

dicloxacillin, cephalexin, cefadroxyl

penicllin allergi: erythromycin, clarithromycin, or clindamycin

mrsa: doxy, clinda, bactrim

76
Q

Erysipelas

treatment: severe disease (fever present)

A

use iv meds

oxacillin, nafcillin, cefazolin

penicillin allergic: clindamycin, vanco

mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftarolined

77
Q

skin infections with group a beta hemolytic strep can cause glomerulonephritis but not

A

rhuematic fever

78
Q

cross rxn between penicillins and cephalosporings is

A

less than 5%

79
Q

with Erysipelas they will test

A

route of administration, they will test this wth all things

80
Q

Cellulitis

A

an infection of the soft tissue of the skin. it extends from the dermis into the subutaneous tissue. the skin is warm, red, swollen, and tender. Cellulitis inovles the legs more often thean the arms. it does not have collections of walled off infection; taht is an abscess. cellulitis is not only at the hair follicle; that is folliculitis, furuncles, and carbuncles

81
Q

cellulitis

diagnostic tests

A

no diagnositic testing is needed to establish a diagnosis of celluilitis. the most accurates test is to inject sterile saline into the skin and apsirate it for culture. the yield is only 20%. staph is much more common than strep

82
Q

antistaphylococcal penicllins

A

ox
clox
diclox
nag

83
Q

Cellulitis

treatment

A

same as erysipelas

mild disease:

use oral meds

dicloxacillin, cephalexin, cefadroxyl

penicllin allergi: erythromycin, clarithromycin, or clindamycin

mrsa: doxy, clinda, bactrim

Severe disease

use iv meds

oxacillin, nafcillin, cefazolin

penicillin allergic: clindamycin, vanco

mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftaroline

84
Q

why wont topicals cover MRSA

A

the infection is below the deraml/epidermal junction and topical antibiotics will not reach it

85
Q

Folliculitis, Furuncles, Carbuncles

A

these infections originate around hair follicles. the different terms do not have precise definitions, and there is no cutoff poin in size that distinguishes them from one another

86
Q

skin infectino is cause by

A

staph aureus not s epidermids bc it lives on the skin as part of the normal flora

87
Q

Folliculitis, Furuncles, Carbuncles

size of the infection

A

folliculitis is the earliest and mildest

furuncles is a small abscess or collection of infected material

a carbuncle is a collection of furuncles

88
Q

Folliculitis, Furuncles, Carbuncles

severe disease=

A

fever, chills, bacteremia

89
Q

Folliculitis, Furuncles, Carbuncles

treatment

A

same as erysipelas

mild disease:

use oral meds

dicloxacillin, cephalexin, cefadroxyl

penicllin allergi: erythromycin, clarithromycin, or clindamycin

mrsa: doxy, clinda, bactrim

Severe disease

use iv meds

oxacillin, nafcillin, cefazolin

penicillin allergic: clindamycin, vanco

mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftaroline

90
Q

cellulitis is

A

bright red, warm and tender.ther is no weeping of purulent aterial as occurs in impetigo

91
Q

ceftarolin=

A

only cephalosporin that covers MRSA

92
Q

Penicillin Allergy

if the reation is just a rash

A

use cephalosporing

93
Q

Penicillin Allergy

if the rection is a anaphylaxis

A

mild infetion: macrolides, clindamycin, doxycycline, or Bactim

severe infection: vancomycin, linezolid, daptomycin, tigecycline, or ceftaroline

94
Q

medications that cover staph but are not speifice for skin infections

A

second gen cephalosporins (defoxitin, cefotetan, cefuroxime)

beta lactam/beta lactamase combos

amox/clavulanate
ticarcillin/clavulanate
ampicillin/sulfbactam
piperacilin/tazobactam

these meds are not used for first line agents for skin infections bc they would be considred excessive in terms of specturm. they are cover more than is necesary. however, if the pt is alread on one of these medications, you do not need to add anythign to cover skin infection.

they cover additional gram neg organisms

95
Q

Antistaph meds

A

IV

mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftaroline

oral

mrsa: doxy, clinda, bactrim

96
Q

Fungal infection

definition

A

dermatophyte=superfiical fungal infection=tinea

the protper term for superficial fungal ifnections is finea folowed by the name of the body part in latin

97
Q

tinea corporis

A

body

98
Q

tinea manus

A

hand

99
Q

tinea pedis

A

foot

100
Q

tinea cruris

A

goin

101
Q

Fungal infection

best initial test

A

koh perparation, it dissolves epidermal skin cells and leaves the fungi intact so they can be visualized

102
Q

Fungal infection

most accurate test

A

culture

103
Q

Fungal infection

best initial therapy

A

topical antifungal agent if no hair or nails are involved

104
Q

Fungal infection

best initial therya for hair and nail

A

terbinafine, itraconazole is lcose in efficacy

105
Q

Fungal infection

topicals

A 
clotrimazole
keotconazole
econazole
miconazole
nystatin (effective only in yeast infections)
ciclopirox
106
Q

ketoconazole is

A

antiandrogenic, so orally it will cause gynecomastia

107
Q

griseofulvin

A

has less efficacy compared to terbinafine or itraconazole

108
Q

oral and vaginal candidiasis

A

these two infections arethe same disease

koh is best initial test

fungal culutre is most accurate test

however, with a clear presentation of the disease wht you will do next is treat with a topical antifungal from the perious list

109
Q

the drugs that cause hypersensitivity reacsion of the dkin are the same that caues

A

heomlysis, interstitial nephritis, and often drug-induced thrombocytopenia (exept heparin)

110
Q

Drug reactions

common drugs

A 
penicillins
sulfa (thiazides, furosemide, and sulfonylureas)
allopurinol
phenytoin
lamotrigin
nsaids
111
Q

hypersensitivity rxns vary in severity

A

morbilliform rash

112
Q

Drug reactions

Morbilliform rash

A

mildest reaction skin stays intact without mucous membrane involvment. no specific therapy

113
Q

Drug reactions

erythema multiforme

A

widespread, small, target lesions; most are on the turnk. no mucous membrane involvement. may also be from hepres or mycoplasma. prednisone may benefit some patients

114
Q

Drug reactions

stevens-johnson syndrome

A

very severe. involves the mucous membanres.sloughs off respiratory epithelium and may lead to repsiratoyr failure. streoids not clearly beneficial. use ivig

115
Q

Drug reactions

toxic epidermal necrolysis

A

rash with mucous membrane involvement, adds nikolsky sign. steroids definitely do not help, treat with ivig

116
Q

the skin comes off simulating a burn

A

ten

117
Q

Staphylococcal scalded skin syndromea nd toxic shock syndrome

A

different severities of the same event. Staphylococcal scalded skin syndrome looks similar to TEN including nikoslky sign. TSS has teh sameskin ivlovmenet as well as life-threatening multiorgan involvement like:

hypotension
renal dysfuntion (elevated BUN and creatinine)
liver dysfunction
CNS involvement (delirium)
118
Q

Staphylococcal scalded skin syndromea nd toxic shock syndrome

treatment

A

both are treated with supportive care and antistaph meds from earlier. in the absence of penicillinallergy and with a sensitive organism, oxacillin or nafcillin are the most effective medications. cefazolin is interhvangeabel to treated staph. antibiotics do not reverse the disease, but they kill the staph that is producing the toxin

119
Q

mild acne treatment

A

use topical antibacterials such as benzoyl peroxide. if this is ineffective, add topical antibiotics such as clindamycin or erythromycin

120
Q

moderate acne treatment

A

add topical vitamin a derivatives such as tretinoin, adapelene, or tazarotene to topical antibiotics. if there is no response to topical vit a derivatives and antibiotics, use oral antibiotics such as inocycline or doxycycline

121
Q

severe acne treatment

A

add oral vitamine a, isotretinoin to oral antibiotics. isotretinoin causes hyperlipidemia

122
Q

vitamine a derivatives

A

are extremely teratogenic. do a prengancy test. only treate pts on suitable hormonal and barrier birth control

OMS III (21 decks)

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