Derm

Question 1

the itch that rashes

Answer 1

atopic dermatitis

Question 2

presentation of atopic dermaitis

Answer 2

xerosis (dry skin)
papular or papulovesicular pruritic lesions

excoriations

Question 3

common locations for atopic dermatitis

Answer 3

kids: face and extensor surfaces
adults: flexor surfaces

nasal and diaper areas usually spared

Question 4

triggers for atopic dermatitis

Answer 4

frequent bathing
hot weather

sweating
contact irritant

food
environmental allergens

Question 5

management of atopic dermatitis

Answer 5

id and limit triggers
moisturize w/in min of bathing or swimming

topical corticosteroids

• mild: 1% hydrocortisone ointment
• mod: 0.1% triamcinolone ointment
• severe: clobetasol ointment

oral anthistamines for pruritus

oral abx for 2nd infections

Question 6

irritant contact dermatitis presentation

Answer 6

skin lesions occur rapidly (min to 24hrs)

sharply demarcated erythema with superficial edema
lesions do not spread beyond site of exposure

Question 7

management of irritant contact dermatitis

Answer 7

Id and avoid irritants

antihistamine creams for pruritus relief

Question 8

allergic contact dermatitis pathophys

Answer 8

delayed cell mediated

type IV hypersensitivity rxn

Question 9

presentation of allergic contact dermaitits

Answer 9

12-72hrs after exposures
well demarcated erythema

edema with vesicles and/or papules

lesions initially confined but later spread

Question 10

poison ivy /poison oak present with

Answer 10

linear lesions that then involve into papules

Question 11

management of allergic dermatitis

Answer 11

id and avoid irritants
cool compresses

antihistamine creams (calamine lotion or hydrocortisone)

corticosteroids for severe cases (21 day course)

Question 12

psoriasis background

Answer 12

T cell driven dz

keratinocyte cell kinetic alteration that leads to overproduction of epidermal cells

Question 13

triggers for psoriasis

Answer 13

stress
alcohol

steroid withdrawal
physical trauma
infection (strepto)

Question 14

presentation of psoriasis

Answer 14

salmon colored, well demarcated erythematous plaques w/ scales

koebner phenomenon (physical trauma causes new lesions to form)

symptoms worse in winter

strepto precipitates onset of disseminated patches

polyarthritis

Question 15

ausptiz sign

Answer 15

removal of scale causes bleeding

seen in psoriasis

Question 16

management of psoriasis

Answer 16

petroleum jelly
topical steroids
- long term use can cause skin atrophy
- dont use systemic steroids for risk of pustular psoriasis

Question 17

seborrheic dermatitis

Answer 17

scaling in regions where sebaceous glands are active

associated with malassezia furfur

greasy scaling macules and papules
MC - face and scalp

may be severe in HIV pts

Question 18

management of seborrheic dermatitis

Answer 18

antidandruff shampoo (contains zinc pyrithione, selenium sulfide 2.5%, salicylic acid or tar

ketoconazole shampoo for scalp

hydrocortisone 2.5% or desonide 0.05% for face

Question 19

decubitus ulcer stages

Answer 19

1) affects superficial layer of skin, skin is intact and nonblanchable erythema is present
2) partial thickness skin loss involving epidermis and/or dermis, serum filled blister
3) full thickness skin loss w/ tissue necrosis, malodorous crateriform ulceration
4) full thickness tissue loss w. exposed tendon, muscle, bone, visible bones and eschar w/in ulcer

Question 20

management of decubitis ulcers

Answer 20

stage I and II

• clean and dry
• topical abx

stage III and IV

• oral abx
• sx intervention

Question 21

prevention of decubitus ulcers

Answer 21

• change positions Q2hrs
• use pillows or foam pads to relieve pressure
• clean and dry

Question 22

complications of decubitus ulcers

Answer 22

cellulitis
osteomyelitis
sepsis
nec fas

endocarditis
meningitis
septic arthritis

Question 23

venous stasis presentations

Answer 23

bilateral “cellulitis”

dependent edema
orange brown hyperpigmentation
erythema

weeping eruptions (chronic) 
honey colored crustings (suggest 2nd bacterial infection) 

MC - medial or lateral malleolus and medial aspect of calf

Question 24

management of venous stasis

Answer 24

obtain pulses
leg elevation
compression stockings

oral antihistamines for pruritus relief

Question 25

diabetic foot ulcers presentation

Answer 25

peripheral neuropathy
deformity + trauma

MC - plantar surface of foot underlying 1st and 5th metatarsal
- great toe, heel

ulcer is punched out surrounded by rim of callous

Question 26

management of diabetic foot ulcer

Answer 26

redistributing pressure off wound
therapeutic footwear

daily dressings for moisture
abx for 2nd inf (vanc, pip/tazo, or cefepime)

consult vasc/pod

Question 27

complications of diabetic foot ulcer

Answer 27

cellulitis
osteomyelitis
sepsis
nec fas

Question 28

systemic abx for an abscess

Answer 28

bactrim
clindamycin
doxycycline

Question 29

cellulitis background

Answer 29

lymphedema is MC risk factor
severe in diabetics and immunocompromised pts

usually bacterial inculation through break in skin

Question 30

presentation of cellulitis

Answer 30

typically unilateral

erythematous, hot
tender area of skin

skin is NOT raised
systemic symptoms

Question 31

dx of cellulitis

Answer 31

PE
wound culture
^WBC and ESR

cobblestoning on US

Question 32

management of cellulitis

Answer 32

oral or IV abx
(cephalexin +/- bactrim if MRSA suspected)

elevation
pain control

Question 33

erysipelas

Answer 33

superifical cutaneous cellulitis with dermal lymphatic vessel involvement

MC etiology = Group A streptococcus
MRSA prevalence increasing

Question 34

presentation of erysipelas

Answer 34

Face and legs MC

erythematous, hot
tender, edematous

sharp demarcation of borders
skin raised

systemic symptoms

Question 35

management of erysipelas

Answer 35

oral or IV abx

cephalexin +/- bactrim if MRSA suspected

Question 36

impetigo

Answer 36

mcc B hemolytic strepto also caused by staph aureus

skin to skin contact transmission (highly contagious)

commonly at the site of cutaneous trauma

Question 37

presentation of impetigo

Answer 37

erythematous macules that develop thin walled vesicles

honey colored cruts appear when vesicles rupture

mc site is between philtrum

Question 38

management of impetigo

Answer 38

mupirocin 2% ointment

Question 39

nec fasc background

Answer 39

caused by gas producing organisms

I: polymicrobial predilection for perineum (gram (-) e coli, gram (+), anaerobes, clos, bact fragi)

II: group A strep
III: vibrio vulnificus
IV: fungals (immunocompromised)

Question 40

risk factors for nec fas

Answer 40

advanced age 
diabetes 
IVDA / alcoholism 
PVD
HIV
immunocompromised

Question 41

presentation of nec fas

Answer 41

cutaneous erythema
edema, crepitus

hemorrhagic blisters
black eschar

malodorous serosanguineous discharge

tenderness beyond erythema (on passive ROM)

systemic sxs