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Peds EOR > Derm > Flashcards

Derm Flashcards

1
Q

open comodones

A

blackheads

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2
Q

closed comodones

A

whitehead

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3
Q

Impetigo etiology

A

S. aureus or strep

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4
Q

Impetigo tx

A

Topical mupirocin for small number of non-bullous lesions

Oral therapy for anything else: dicloxacillin, cephalexin, or clindamycin

Suspect MRSA→ clindamycin or linezolid

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5
Q

Lice tx

A

Permethrin 1% ​(shampoo & lotion), Ivermectin (Lindane restricted d/t neurotoxicity)

2nd tx in 7-10 days to kill any surviving nits

Can return to school after 1st tx

Mechanical wet combing is an alternative therapy for kids too young for medical therapy ( < 2 months)

Examine household & close contacts

Wash bedding & clothing in hot water w/ detergent, dry in hot drier x20min

Toys that can’t be washed should be placed in air-tight plastic bag x14days

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6
Q

Lichen Planus presentation

A

Develop on flexor surfaces of extremities, mucous
membranes of skin, mouth, scalp, genitals, nails

Purple popular pruritic polygonal planar

Oral white lacy patches = ​Wickam striae

Koebner phenomenon, fine scales

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7
Q

Lichen Planus tx

A

Typically resolves in 8-12mo

1st line = antihistamines, steroid ointment

2nd line = systemic steroids, UVB therapy

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8
Q

Scarlet Fever presentation

A

Pharyngitis

Strawberry tongue

Sandpapery rash that is worse in the groin and axilla with desquamation of palms and soles

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9
Q

Scarlet Fever tx

A

Penicillin VK or amoxicillin administered to prevent sequelae of rheumatic fever

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10
Q

Scarlet Fever etiology

A

GAS

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11
Q

Androgenetic alopecia

A

Male pattern baldness

Variable and unpredictable

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12
Q

Androgenetic alopecia tx

A

Minoxidil solutions = most effective in recent onset and smaller areas of hair loss

Finasteride may also be effective

SE = loss of libido and ED

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13
Q

Atopic derm presentation

A

Papules and plaques, with or without scales, are noted and may be associated with edema, erosion, and
crusts

MC on the flexural surfaces, neck, eyelids, forehead, face, and dorsum of the
hands and feet

pruritus and dry, scaly skin. Scratching leads to lichenification, fissures, and
worsening rash

Secondary infections caused by Staph aureus

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14
Q

Atopic derm etiology

A

Type I IgE mediated hypersensitivity rxn

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15
Q

Atopic derm tx

A

Antihistamines → ↓ itching

Topical corticosteroids = mainstay of the treatment; systemic corticosteroids should be
avoided

Tacrolimus and pimecrolimus are topical calcineurin inhibitors (immunomodulators) approved for moderate to severe atopic dermatitis
(less atrophy w/ prolonged use when compared to topical corticosteroids but may carry a potential to cause malignancy)

Hydration and topical emollients are key to management

Soaps, vigorous rubbing, frequent bathing, and irritant clothing such as wool should be avoided

UVB phototherapy is effective

Severe systemic cases may necessitate cyclosporine

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16
Q

Contact derm etiology

A

Type IV T-cell mediated rxn

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17
Q

Posion ivy tx

A

Tecnu, calamine lotion, oatmeal baths, astringents (witch hazel)

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18
Q

Allergic vs contact derm etiology

A

Type IV T-cell mediated rxn

Allrgic → metallic salts, plants (poison ivy), fragrances, nickel, preservatives, formaldehyde, propylene glycol, oxybenzone, bacitracin, neomycin, bleached rubber, chrome, sorbic acid

Irritant → water, soaps, detergents, wet work, solvents, greases, acids, alkalis, fiberglass, dusts, humidity, chrome, lip licking or other trauma

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19
Q

Allergic vs contact derm presentation

A

Eczematous (irritant), vesicular (allergic)

Allergic → Acute with macules, papules, vesicles, and bullae, chronic with lichenification, scaling, fissures, uncommon on scalp, palms, soles, or other thick-skinned areas that allergens can’t get through

Contact → Acute with bullae, erythema, and sharp borders, chronic with poorly-demarcated erythema, scales, and pruritus, fissured, thickened, dry skin, usually palmar

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20
Q

Diaper Dermatitis etiology

A

Candida

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21
Q

Diaper Dermatitis presentation

A

Red, well defined margins, pustules, vesicles, papules or scales

Satellite lesions

Common in dark, moist areas (axillae, under breast)

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22
Q

Diaper Dermatitis treatment

A

Topical antifungals such as nystatin

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23
Q

Perioral Dermatitis presentation

A

Papulopustules form on erythematous bases and may become confluent with plaques and scales

Vermilion border is spared, and satellite lesions are common

24
Q

Perioral Dermatitis treatment

A

Avoid topical steroids bc will aggravate the lesions

Topical metronidazole or erythromycin or oral minocycline, doxycycline, or tetracycline

Untreated lesions will fluctuate over time, similar to rosacea

25
Q

Type I drug rxn

A

IgE mediated​, immediate

urticaria, angioedema

26
Q

Type II drug rxn

A

Ab-mediated​, cytotoxic (drugs in combo with cytotoxic antibodies)

27
Q

Type III drug rxn

A

immune​ ab-antigen complex​

drug mediated vasculitis and serum sickness

28
Q

Type IV drug rxn

A

delayed ​cell-mediated​

erythema multiforme

29
Q

Exanthematous Drug Eruption presentation

A

> 2 d after drug

Limited to skin

Lesions initially appear on trunk and spread to extremities in symmetric fashion

Erythematous macules and infiltrated papules, pruritus and mild fever may be present

30
Q

Exanthematous Drug Eruption tx

A

Resolves a few days - week after med stopped

Can continue med if not too severe and med cannot be subsuituted

Topical steroids, oral antihistamines and reassurance

Cold to help with itch

31
Q

1st deg burn

A

epidermis only, ✚ pain and ✚ erythema

32
Q

2nd deg burn

A

epi + dermis, ✚ pain, ✚ blisters ✚ erythema

33
Q

3rd deg burn

A

through dermis, white and painless w/ surrounding 2nd deg burns

34
Q

Parkland formula

A

LR @ 4ml x kg x BSA burn (half over 1st 8hrs, rest over next 16hrs)

35
Q

Adult burn %

A 
head →9 
trunk→ 18
back→ 18
each arm→9
each leg→18
genitalia→ 1
36
Q

Ped burn %

A 
head→18
trunk→18
back→ 18
each arm→ 9
each leg→ 14
genitalia→1
37
Q

Pityriasis Rosea presentation

A

Herald patch= initial salmon-colored macule on trunk → general examthem

Salmon colored oval/round papules with white circular scaling along clevage lines

Very pruritic, christmas tree pattern, confined to trunk and proximal extremities

May follow URI

38
Q

Pityriasis Rosea tx

A

Self-limited→ resolves in 6-12 wk

For itch → topical steroids, PO anihistamines, moisturizeds, oatmeal baths

+/- UVB light if severe

39
Q

Scabies presentation

A

Distribution is most common on the hands, wrists, genitalia, and axillary areas

Lesions often are seen in the web spaces btwn fingers and toes, around the belt line, or at the edges of socks.

Pruritic burrows, vesicles, or nodules with excoriations and crusting

40
Q

Scabies tx

A

1% lindane or 5% permethrin in a lotion or cream

apply to the skin from the chin to the bottom of the feet and leave overnight (8 hr) then wash off in the AM

Repeat tx in 7 days
Antihistamines or topical steroids may help relieve the itching

Lindane is more toxic and should be avoided in children younger than 2 yo, people with extensive
dermatitis, and those who are pregnant or lactating.

All bedclothes and clothing of infected pts and household contacts should be washed

All close physical contacts should receive scabicide tx as well

41
Q

Tinea Versicolor presentation

A

Hypo or hyperpigmented macular lesions

Esp on trunk

Fine rim of scale

42
Q

Tinea Versicolor etiology

A

Malasezzia furfur (no really a tinea)

43
Q

Tinea Versicolor w/u

A

KOH prep for spaghetti and meatballs

44
Q

Tinea Versicolor tx

A

Topical selenium sulfide, pyrithione zinc, propylene glycol, ciclopirox, azole, or terbinafine

± UV light therapy

Systemic ketoconazole if recurrent or refractory

45
Q

Tinea capitis tx

A

po griseofulvin, terbinafine, or itraconazole

46
Q

Tinea Barbae, manuum, corporis, cruis, faciale, pedis tx

A

po griseofulvin, terbinafine, or itraconazole, air exposure

Topical terbinafine, naftifine, butenafine

± Soaks with aluminum acetate

2nd line: topical azole

47
Q

Tinea Unguium (onocomycosis) tx

A

1st line is oral terbinafine

2nd line is oral azole or ciclopirox topical lacquer

3rd line is repeat therapy or nail removal

48
Q

SJS vs TEN

A

SJS <10% TBSA and TEN >30%

49
Q

SJS & TEN presentation

A

Mucocutaneous blistering rxns most often caused by drug rxn

Fever, photophobia, sore throat, mucosal inflammation, and sore mouth

Lesions tend to be concentrated more on the trunk at first

May be painful/sting

Progression occurs over 4 days → diffuse erythema, necrotic epidermis, wrinkled surfaces, sheetlike loss of epidermis, and raised, flaccid blisters (Nikolsky sign)

50
Q

SJS and TEN w/u

A

✚ Nikolsky sign

Anemia, lymphopenia

Bx is diagnositc

51
Q

SJS and TEN tx

A

Prompt withdrawal of offending agent

Transferto burn unit, gluid and electrolyte corrections

Regrowth of skin takes 3 weeks (more in pressure-point area)

52
Q

Urticaria tx

A

Eliminate known cause

Acute → PO H1 antihistamine, such as diphenhydramine, hydroxyzine, fexofenadine, or
cetirizine

Chronic → H2 antihistamine, such as famotidine or ranitidine, may be added to the H1 regimen

EpiPen if concern for anaphylaxis

53
Q

Verrucae presentation

A

Skin warts→ flat or superficial

Plantar warts→ deep

Rough surface, cauliflower like

54
Q

Verrucae etiology

A

Caused by HPV

Replicates in cutaneous and mucosal epithelium

Common warts can occur on any surface of the skin while genital warts (condylomata) are spread through sexual contact

HPV 16 and 18 are RF for dysplasia

55
Q

Verrucae tx

A

Spontaneous regression is typical over time

Salicylic Acid for common warts

Cryosurgery or E D&C (scar risk)

Imiquimod (Aldara)

Intralesional interferon if other tx fail

Anogenital→ trichloroacetic Acid or topical podophyllin

Surgical excision is successful but recurrence is common

Vaccination for 16, 18, 6 and 11

Peds EOR (14 decks)

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