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Derm Flashcards

1
Q

Basic things to consider for skin

A

Appearance: texture, hydration, sun exposure
Temperature: cold vs hot, sweating, clammy, doughy
Rash/lesions: redness, excoriations, borders, changes
Color: natural pigment- can influence tx choice

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2
Q

Hx of eczema

A

Hx of allergies
Recurring rash, worse in winter mos, exacerbation by heat
“The itch that rashes”
Usually flexor/extensor surfaces, faces, hands
-Dry, erythematous, scaly patches or plaques

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3
Q

Lab and work up for eczema

A

Could do KOH prep to r/o tinea

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4
Q

DDx of eczema

A

Tinea
Contact dermatitis
Lichen simplex chronicus
Seborrheic dermatitis

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5
Q

Health maintenance of eczema

A

Avoid hot water bathing
Use detergent/soap without fragrances/dyes
Keep skin lubricated

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6
Q

Tx/medications of eczema

A

Antihistamines for itching
Topical steroids
-Not curable, only treatable
-Choose appropriate steroid class for location
-Do not use for longer than 2 wks at a time- can cause striae
–Peds: one wk
-Occlusive dressings if needed

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7
Q

F/u in eczema

A

As needed
Refer to derm if no relief
-Can cause significant skin disfigurement that can be embarrassing, esp in peds

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8
Q

Clinical pearls of eczema

A

Extra virgin olive oil is a great moisturizer and can be used to maintain between flare ups; apply to damp skin after bathing; add to bath water

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9
Q

Typical sites of eczema

A 
Face
Neck
Elbows
Wrist
Groin
Knees
Ankles
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10
Q

Hx taking/PE findings of drug reactions

A 
Recent medication changes
-Think beyond new medication (pharmacy change, etc)
Symmetric cutaneous reaction
-Purpura, erythema, blisters
R/o other causes
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11
Q

Lab and workup for drug reactions

A 
Usually based on HPI/PE
Bx if needed
-Cannot tell you if it is a drug reaction only
Based on severity of reaction
-CBC, CMP, cultures
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12
Q

DDx of drug reactions

A 
Contact dermatitis
Erythema multiforme
Lichen planus
Pityriasis
Urticaria
Vasculitis
SJS
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13
Q

Health maintenance of drug reactions

A

Avoid causative agent

Label medical record

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14
Q

Tx/medications of drug reactions

A

Antihistamine
Topical steroid
Systemic steroids
IVIG

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15
Q

Hx/PE of pityriasis rosea

A

Usually acute onset, spreading over last several weeks
+/- itching
Herald patch, Christmas tree distribution
-Salmon colored, usually on trunk

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16
Q

Lab and work up for pityriasis rosea

A

KOH prep to r/o tinea

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17
Q

DDx of pityriasis rosea

A

Contact dermatitis
Tinea
Drug reaction

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18
Q

Health maintenance of pityriasis rosea

A

No known cause

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19
Q

Tx/meds for pityriasis rosea

A

Usually resolves spontaneously in 6-8 wks

Sometimes topical/PO steroids

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20
Q

F/u for pityriasis rosea

A

As needed

Bx if not resolving

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21
Q

Hx/PE of psoriasis

A

Usually hx of similar
Worse with stress
+/- joint pain
Silver “fish scale” plaques usually on knees and elbows
Variant-punctate psoriasis, gutate psoriasis

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22
Q

Lab and work up of psoriasis

A

Bx to confirm

ANA usually positive

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23
Q

DDx of psoriasis

A

Eczema

Lichen sclerosis chronicus

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24
Q

Health maintenance of psoriasis

A

None

Avoid triggers

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25
Tx/meds of psoriasis
Topical steroids Kenalog intralesional injections UV light therapy Biologic agents- Humira, Remicade, Embrel
26
Hx/PE of herpes simplex
Recurrent skin lesions, usually oral or genital Prodrome pain, itching, burning before lesion arises Erythematous viesicles that spread Herpetic whitlow: nail bed Ocular: refer to ophthalmology
27
Lab and work up of herpes simplex
Culture HSV 1 and 2 | Tzanck smear
28
DDx of herpes simplex
Herpes zoster Hand/foot/mouth Chancroid (genital)
29
Health maintenance of herpes simplex
DO NOT SHARE razors | Avoid contact during outbreak
30
Tx/meds for herpes simplex
Zovirax cream/ointment Acyclovir, Famvir, valacyclovir Vaccine?
31
F/u for herpes simplex
As needed for recurrent breakouts | Maintenance therapy
32
Hx/PE of molluscum contagiosum
Flesh colored papules with central umbilication that spread Can be sexually transmitted -R/o sexual abuse in peds
33
Lab and work up of molluscum contagiosum
Bx
34
DDx of molluscum contagiosum
Verruca | Chicken pox
35
Health maintenance of molluscum contagiosum
Hand washing-contagious through contact
36
Tx/meds of molluscum contagiosum
Self-limited Retin-A: apply daily LN2 tx Podophylin: wash off in 1-2 hrs, repeat q2 wks prn
37
Hx/PE of impetigo
Highly contagious Gram + bacteria | Honey crusted lesion
38
Lab and diagnostic workup of impetigo
Culture
39
DDx of impetigo
Erysipelas Herpes Folliculitis/acne
40
Health maintenance of impetigo
Avoid contact during outbreak | Good hygiene
41
Tx/meds for impetigo
Mupirocin Keflex PO Altabax
42
F/u of impetigo
Within 1 wk to ensure clearing
43
Hx/PE of erythema multiforme
Type IV hypersensitivity Minor, major, SJS Hx recent URI Target lesions, mucous involvement, +/- palms/soles
44
Lab and work up of erythema multiforme
CBC, CMP | Bx
45
Etiology of erythema multiforme
EM and SJS are both caused by drugs, but infectious agents are considered to be the major cause of EM Hx of HSV infections 1-3 wks before onset of EM EM minor: triggered by HSV in nearly 100% of cases EM major: herpetic etiology also accounts for 55% of cases, other infections, Mycoplasma SJS and EM major: Drugs are found to be major cause, antibacterial sulfonamides, anticonvulsants, NSAIDs, allopurinol
46
DDx of erythema multiforme
Granuloma annulare Erythema migrans Drug eruption Viral exanthem
47
Health maintenance for erythema multiforme
Symptomatic tx Self-limited Avoid causative agent Risk of recurrence
48
Tx/meds for erythema multiforme
Topical corticosteroids Antivirals Supportive measures
49
F/u for erythema multiforme
Prophylaxis for recurrence
50
Hx/PE of acne
``` Current skin cleansing regimen Can often be due to irritation Recurrent breakouts on face, chest, back Consider other underlying causes- Cushings, thyroid, etc Comedones, pustules, cysts ```
51
Lab and work up of acne
R/o underlying cause
52
DDx of acne
MRSA Hidradentitis supporitiva Cushings
53
Health maintenance of acne
Avoid skin irritants | Sometimes d/t pH imbalance- avoid acidic/alkali foods
54
Tx/meds for acne
``` Depends on severity Topical abx/bacteriocidals PO abx OCP for females Accutane- only qualified providers, +/- teratogenic, monitor lipids ```
55
Acne f/u
Monthly | Maintain tx for several mos (>6 mos)
56
Clinical pearls of acne
Always ask about it, pts don't talk about it but it bothers them If not resolving, think MRSA, culture
57
Hx/PE of actinic keratosis
Non healing scaly erythematous based plaque Sometimes heal but comes back Face, scalp, arms
58
Lab and work up of actinic keratosis
Bx to r/o SCC
59
DDx of actinic keratosis
SCC/BCC Dyshidrosis Dermatitis
60
Health maintenance of actinic keratosis
Sunscreen at young ages | Avoid smoking
61
Tx/meds for actinic keratosis
Topical fluorouracil -Apply sparingly, basically burns top layer of skin so causes redness; use in winter mos Liquid nitro TCA peel
62
F/u of actinic keratosis
2 wks after start tx | Monthly/q3-6 mos
63
Hx/PE of seborrheic keratosis
"Stuck on" hyperpigmented macules Spreading, growing Face, back, abdomen
64
Lab and work up of seborrheic keratosis
Bx to r/o DN versus AK
65
DDx of seborrheic keratosis
DN/melanoma Actinic keratosis Neurofibroma
66
Health maintenance for seborrheic keratosis
Usually genetic
67
Tx/meds for seborrheic keratosis
Lachydrinf or mild lesions | Liquid nitrogen
68
F/u of seborrheic keratosis
As needed
69
Hx/PE of cellulitis
Localized erythema and edema +/- tenderness Usually underlying infection Can be non-necrotizing which only requires local tx vs. necrotizing which requires systemic tx and close monitoring bc life-threatening
70
Lab and workup of cellulitis
CBC, CMP | Culture
71
DDx of cellulitis
Erysipelas (GAS)- superficial, shiny, defined borders Necrotizing fasciitis -Can be streptococcal or non streptococcal, determines tx -Must suspect if rapidly progressing (24 hrs) eschar/necrosis and/or signs of sepsis (increased HR, oliguria, mental status changes) -Life threatening MRSA DVT
72
Health maintenance of cellulitis
Hygiene | Prevention
73
Tx/meds for cellulitis
IV vs PO abx - In mild cases of cellulitis treated on an outpt basis: Dicloxacillin, amoxicillin, or cephalexin - In pts who are allergic to pcn: clindamycin or a macrolide (clarithromycin or azithromycin) - An initial dose of parenteral antibiotic with a long half-life (e.g., ceftriaxone) followed by an oral agent

DSE (14 decks)

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