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Clin med 1 - DERM/RHUM - exam 1 > Derm > Flashcards

Derm Flashcards

1
Q

What are the 3 most common skin and soft tissue infections? what is included in their differential dx?

A

Cellulitis Erysipelas Skin abscesses Gout DVT Venous stasis dermatitis (Bilateral)

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2
Q

Skin layers affected in Cellulitis, Erysipelas and Skin abscesses?

A

cell - deeper dermis and subcutaneous fat

erys - upper dermis and superficial lymphatics

skin ab - upper and deeper dermis

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3
Q

Name skin condition: unilateral presentation raised above level of surrounding skin with clear demarcations b/w involved and uninvolved skin. Non-purulent. acute onset of sx.

A

Erysipelas

b-hemolytic strep can present with butterfly rash on face**

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4
Q

pathogen responsible for: erysipelas cellulitis abscesses

A

ery - B-hemolytic strep

cell - b-hemolytic strep, staph aureus, MRSA

abscesses: sstaph aureus, MRSA

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5
Q

risk factors for Cellulitis, Erysipelas and Skin abscesses?

A

Skin barrier disruption

Preexisting skin conditions (eczema, impetigo, tinea)

Skin inflammation

Edema due to lymphatic drainage or venous insufficiency (venous stasis presents BILATERALLY)

Obesity

Immunosiuppression

Close contact w/ people w/ MRSA

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6
Q

complications of Cellulitis, Erysipelas and Skin abscesses?

A

NF

bacteremia and sepsis - blood cx

osteomyelitis - x-rays

septic joint - aspiration

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7
Q

Pasteurella multocida

A

cat bite

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8
Q

Capnocytophaga canimorsus

A

dog bite

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9
Q

Erysipelothrix rhusiopathiae

A

farm animals

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10
Q

Vibrio vulnificus

A

water borne = step on something at beach

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11
Q

Pseudomonas aeruginosa

A

must cover if pt is a diabetic

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12
Q

Sporothrix schenckii

A

rose gardener

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13
Q

Define impetigo

A

contagious superficial bacterial infection seen most commonly on the face seen in children age 2-5 more common in summer and fall

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14
Q

Primary vs secondary impetigo

A

primary - direct bacterial invasion of normal skin

secondary - infection at sites of skin trauma

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15
Q

what is the most common bacterial infection in children?

A

impetigo 3rd most common skin condition in children

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16
Q

Name the skin condition

A

non-bullous impetigo

Most common form

S auerus

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17
Q

Name skin condition?

A

bullous impetigo

vesicles enlarge to form flaccid bullae with clear fluid

becomes darker -> rupters leaving thin brown crust

fewer lesions - seen primarily in children

trunk more affected

S.aureus strain that produces a toxin that causes cleavage of superficial skin layer

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18
Q

Nsme skin condition?

A

Impetigo + Ecthyma

ulcrative form

lesions extend through epidermis to deep dermis

“punched out” ulcers covered in yellow crusts

Group A beta hemolytic strep pyrogenes

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19
Q

Treatment for Impetigo + ecthyma

A

ORAL

Dicloxacillin 250 mg QID

cephalexin 250 mg QID

erythromycin (penicillin allergy)

clindamycin (MRSA suspected)

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20
Q

Treatment for non-bullous and bullous impetigo?

A

TOPICALS

mupirocin (bactroban) TID

retapamulin (Altabax) BID

ORAL - if extensive

dicloxacillin

cephalexin

erythromycin (for penicillin allergy)

clindamycin (if mRSA suspected)

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21
Q

Complications of impetigo?

A

poststreptococcal glomerulonephritis

edema

HT

fever

hematuria

all seen 1-2 wks post infection

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22
Q

MRSA CA vs MRSA HA

A

CA -

  • Sensitive to non-beta-lactam antibiotics
  • Initially reported in IVDU
  • Most frequent cause of SSTI presenting to US ERs and ambulatory clinics

HA

  • Infection that occurs >48 hours following hospitalization
  • Leading cause of surgical site infection
  • Multidrug resistance
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23
Q

Treatment for MRSA

A

PO

trimethoprim-sulfamethoxazole

clindamycin

doxycycline

minocycline

IV

vancomycin

daptomycin

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24
Q

Define clinical presentation of Urticaria

A

intensley puritic raised erythematous plaques with central pallor

ANY area of body can be affected

waxing and waning (lesions appear and disapper w/in 24 hrs) - more severe at night

sometimes accompanied by angioedema (lips, extremeties, genitals)

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25
Q

Etiology and Pathophysiology of urticaria

A

infections

IgE mediated

direct mast cell activation (narcotics, muscle relaxants, radiocontrast agents, vanocmycin)

physical stimuli

mediated by mast cells in superficial dermis and basophils

release multiple mediators including histamine and vasodilatory mediators

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26
Q

Name medications that result in direct mast cell activation?

A

narcotics/opiods

muscle relaxants

radiocontrast agents

vancomycin

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27
Q

Management of urticaria

A

focus on short term relief of puritis and angioedema (2/3 will spontaneously resolve)

H1 antihistamines

  • Diphenhydramine (Benadryl)
  • Chlopheniramine (chlor-trimenton)
  • Hydroxyzine (Vistaril)
  • Certirizine (Zyrtec)
  • Loratadine (Claritin)
  • Fexofenadine (allegra)

H2 antihistamines

  • Ranitidine (zantac)
  • Nizatidine (Axid)
  • Famotidine (Pepcid)
  • Cimetidine (Tagamet)

glucocorticoids for sx lasting longer then 2-3 days (SEVERE)

prednisone 30-60 mg taper over 5-7 days

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28
Q

Name H1 antihistamines used to tx urticaria

A
  • Diphenhydramine (Benadryl)
  • Chlopheniramine (chlor-trimenton)
  • Hydroxyzine (Vistaril)
  • Certirizine (Zyrtec)
  • Loratadine (Claritin)
  • Fexofenadine (allegra)
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29
Q

Name H2 antihistamines used to tx urticaria

A
  • Ranitidine (zantac)
  • Nizatidine (Axid)
  • Famotidine (Pepcid)
  • Cimetidine (Tagamet)
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30
Q

Define Lipoma

A

most common benign soft tissue neoplasm (!% of population)

soft, painless, round or oval subcutaneous nodule

mature fat cells enclosed by a thin fibrous capsule - rarely inolve fascia or deeper muscles (superficial)

common on upper extremities and trunk

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31
Q

Lipoma and genetics

A

cause of lipomas are unknown - some have genetic predisposition

familial multiple lipomatosis - multiple lipomas in multiple family members

Gardner Syndrome - rare inherited condition characterized by familial adenomatous polyposis (multiple lipomas), common on face, scalp, neck and trunk

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32
Q

Tx for lipomas

A

none

if bothersome - surgical excision of fat cells and fibrous capsule (cosmetic or pain reasons)

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33
Q

What is the most common cutaneous cyst?

A

Epidermal inclusion cysts

firm, skin colored dermal nodules with visable central punctum

asymptomatic, can be red and inflammed

freely moveable

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34
Q

Pathophysiology of epidermal inclusion cysts

A

implantation and proliferation of epithelial elements into dermis (dead skin implants into hair follicle) from trauma or comedome

cyst wall consists of normal stratified squamous epithelium

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35
Q

Tx for epidermal inclusion cysts

A

asymptomatic - no tx, will resolve on own

Not inflammed - punch excision of cyst and drainage = must pull out all of “cheesy inside” along with capsule or cyst will reform

intralesional injections w/ triamcinolone - inject cyst w/ steroid to decrease size and inflammation

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36
Q

•Most common cutaneous disorder affecting adolescents and young adults (mostly males) that resolves in third decade of life

A

acne

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37
Q

Four main factors are involved in acne patho

A
  1. Follicular hyperkeratinization
  2. Increased sebum production - provides growth medium for c. acnes
  3. Cutibacterium ances (FKA Propionibacterium acnes) within the follicle - Microcomedones provides an anaerobic lipid-rich environment for bacteria
  4. Inflammation -Microcomedones provides an anaerobic lipid-rich environment for bacteria
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38
Q

cause of infantile acne?

A

androgens

Contributes to the development of acne through stimulating the growth and secretory function of the sebaceous gland

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39
Q

Labs ordered in pt w/ acne.

A

DHEA-S

total testosterone

free testosterone

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40
Q

4 types of Rosacea?

A
  • Erythematotelangiectatic
  • Papulopustular
  • Phymatous
  • Ocular rosacea
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41
Q

cause of Rosecea

A

Cause is unknown, possible factors include

  • Immune dysfunction
  • Inflammatory reactions to cutaneous microorganisms
  • UV damage
  • Vascular dysfunction
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42
Q

Dx? and Tx?

A

Erythematotelangiectatic or “classic rosecea”

FIRST LINE – avoid triggers, sun protection and decrease alc intake

SECOND LINE – laser and light-based therapy

Pharmacotherapy – alpha adrenergic agonists

  • Topical brimonidine (Mirvaso)
  • Topical oxymetazoline (Rhofade)
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43
Q

type of roseca more common in MEN

A

Phymatous

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44
Q

Pt presents w/ papules and pustules in central face. On examination you see reddness extending beyond the follicle.

Dx and Tx:

A

Papulopustular R

Topical metronidazole 0.75% (most common)

Azelaic acid 20% cream

Ivermectin 1% cream

Oral

  • Tetracycline, doxy, minocycline
  • Isotretinoin 0.3 mg/kg QD
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45
Q

Tx of phymatous Rosecea

A

Oral isotretinoin 0.3-1 mg/kg QD in early disease

Laser ablation and surgery in advanced disease

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46
Q

Side effect seen in more then 50% of pts w/ Rosecea

A

Ocular!!!!!

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47
Q

Lesions are characterized by well-demarcated erythematous plaques with silver scale. Dx??

A

Psoriasis

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48
Q

•When compared to normal epidermis, psoriasis epidermis shows:

A
  • Increased number of epidermal stem cells
  • Increased number of cells undergoing DNA synthesis
  • A shortened cell cycle time of keratinocytes
  • A decreased turnover time of epidermis
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49
Q

Most common type of psoriasis and where do the lesions present?

A

chronic plaque

symmetrically distributed on:

Scalp, extensor elbows, Knees and gluteal cleft most common sites

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50
Q

pt is a 10 y/o boy presnting to clinic w/ a rash on trunk and proximal extremties. you recognize the child as he came into clinic a few weeks ago to be tx for strep pharyngitis.

Dx and Tx????

A

guttate psoriasis

will resolve and not likely lead to chronic psoriasis

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51
Q

Pt presents w/ rash. you see no visable scaling. she was previously prescribed ketoconazole by another provider. after no relief of sx she presents to you.

dx??

A

Inverse psoriasis

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52
Q

most common clinical manifestation in pts w/ psoriatic arthritis?

A

nail psoriasis (nail pitting)

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53
Q

pts presents w/ fever, diarrhea, leukocytosis and hypocalcemia. on examination you see widespread erythema, scaling, and sheets of superficial pustules.

Dx and what could have caused this?

A

pustular psoriasis

pregnancy, infection or withdrawal of oral glucocorticoids

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54
Q

what is erythrodermic psoriasis

A

Generalized erythema and scaling from head to toe

inpatient management

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55
Q

what is auspitz sign

A

pinpoint bleeding after removal of plaque

dx of psoriasis

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56
Q

Tx choices for MILD psoriasis

A

less then 5% BSA

emollients

top corticosteroids - Hydrcortisone 1%, Triamcinolone 0.1%, Flucinonide 0.05%

Tar-T gel (neutrogena)

Vitamin D analogs

topical retinods (tazarotene)

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57
Q

Tx for mod-severe psoriasis ?

A

5-10% BSA

phototherapy (photochemotherapy)

  • w/ either oral or bath psoralen followed by UVA radiation
  • Increased cancer risk of non-melanoma skin cancer and melanoma

excrimer laser

methotrexate

cyclosporine

aprimelast

  • •TNF- alpha inhibitors*
  • •IL-17 inhibitors*
  • •IL-23 and related cytokine inhibitor*
  • •*specialist managed*
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58
Q

define hidradenitis suppurativa and the pathophys of the dz

A

Apocrine sweat gland dysfunction

  • Follicular occlusion, follicular rupture and associated immune response
  • Ductal keratinocyte proliferation -> ductal plugging -> expansion -> rupture and release of contents -> stimulating immune response and leading to sinus tracts in skin
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59
Q

Describe the 3 stages of the Hurley staging system for HS.

A

1: abscess formation
2: recurrent abscess formation w/ sinus tract formation and scarring
3: Diffuse involvement of multiple connected sinus tracts

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60
Q

Dx (stage) and tx

A

Avoidance of skin trauma

Smoking cessation

Weight management

Antiseptics – chlorhexidine 4% once/week

Emollients

Management of comorbidities

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61
Q

Dx (stage) and tx

A

Oral tetracyclines for several months

Clindamycin 300 mg BID and rifampin 600 mg QD

Oral retinoids

Antiadrenergic therapies – OCPS, spironolactone

Punch biopsy of fresh lesion (drain tracts

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62
Q

dx (stage) and Tx

A

TNF- alpha inhibitors

Adalimumab

Infliximumab

Systemic glucocorticoids – prednisone

Cyclosporin

Surgery

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63
Q

along w/ hair loss what is another common sx in pts w/ alopecia?

A

Onychorrhexis – longitudinal fissuring of nail plate

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64
Q

pathophys of alopecia

A
  • Autoimmune disease in which hair follicles in the growth phase (anagen) prematurely transitions to the non-proliferative involution (catagen) and resting (telogen) phase
  • This leads to sudden hair shedding and inhibition of hair regrowth
  • T-cell mediated
  • Inappropriate trigger of immune response against follicular antigens

Commonly presents

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65
Q

diagnostic finding of pts w/ alopecia

there are 2****

A

exclamation point at hair margins

•Skin biopsy -> Peribulbar lymphatic infiltrates surrounding follicles (swarm of bees)

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66
Q

first line tx for limited patchy hairloss

A
  • Topical or intralesional corticosteroids
  • Triamcinolone 2.5-5 mg/ml
  • Betamethasone dipropionate 0.05%

or topical

Monoxidil

anthralin cream

PUVA

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67
Q

first line tx for extensive hair loss

A
  • Topical immunotherapy
  • Diphenylcyclopropenone (DPCP)
  • Squaric acid dinutyl ester (SADBE)

Systemic therapies

Oral glucocorticoids

Sulfasalazine

Methotrexate

Cyclosporin

Biologics

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68
Q

what is eczema (dermatitis) closely related to?

A

asthma

allergic rhinitis

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69
Q

what type of hypersenitivity rxn is atopic derm

A

type I IgE mediated

•Intense itching produced by mast cells and basophils in dermis.

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70
Q

where does atopic dermatitis usually present

A

•Presents on flexor surfaces, neck eyelids, face, dorsum of hands and feet

** face and extensor/flexor in children

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71
Q

you dx your pt w/ atopic dermatitis but she DOES not want steroid creams and wants something she can use longer term?

What do you prescribe?

A
  • Pimecrolimus (Elidel)
  • Nonsteroidal
  • Addition/alternative to topical steroids.
  • Good for long term use.

OR

  • Topical immunemodulators
  • Tacrolimus (Protopic) -> Nonsteroidal (cytokine inhibitor)
  • Used as an addition/alternative to topical steroids.
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72
Q

pt presents w/ coin shaped pruritic patches and plaques in clusters on her legs.

Name another condition this resembles and what you would do to rule it out.

Dx and TX

A

tinea corporis - usually clear in center

r/o w/ KOH swab

dx Nummular Eczema

tx

  • Acute: Intermediate strength topcial steroid (triamcinalone cream 0.1%).
  • Or if severe, high potency (Clobetasol ointment) +/- occlusion.

Long term: treatment with less potent topical steroids

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73
Q

pt presents w/ small vesicles appear on hands and feet complaning of pruritus

dx? and cause?

A

Dyshydrosis

•inflammation and foci of intercellular edema (spongiosis) which becomes loculated in the skin of the palm and soles.

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74
Q

tx dyshydrosis

A
  • Mild cleansers (Cetaphil)
  • Emollient barrier creams, protective gloves, avoidance of irritants.
  • Burow’s solution. (Antibacterial Astringent)
  • Topical corticosteroids are the mainstay.
  • High: Clobetasol Ointment for acute flare
  • Med: (triamcinolone 0.1% or Fluocinonide 0.05%) with or without occlusive dressing.
  • Protopic and Elidel for long term management
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75
Q

Dx and Tx

A

stasis dermatitis - seen mostly in women

  • Elastic compression stockings
  • Burrow’s solution
  • Moderate topical steroid: Desonide, Triamcinalone cream.
  • Treat any secondary infection with po Abx. (Keflex)
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76
Q

woman presents in clinic w/ a rash showing clustered papulopustules on erythematous bases w/ scale around her mouth. she tells you she just finished using hydrocortisone cream.

dx and tx

A
  • Topical antibiotics: Metronidazole or erythromycin.
  • Severe cases may require oral minocylcin / doxycycline.
  • *Avoid topical steroids* - will exacerbate sx
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77
Q

how do we tx Seborrheic Dermatitis on both scalp and face??

A
  • Scalp: zinc shampoo, Ketoconazole shampoo
  • Face, intertiriginous areas: Low potency topical steroids

(Desonide or Valisone Cream)

offending agent: p. ovale

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78
Q

pt presents w/ hardened area over wrist. It is a solitary pruritic eczematous eruption that appears Lichenified.

dx and tx

A

Lichen Simplex Chronicus

Intermediate strength topical steroid.

  • Triamcinalone cream 0.1% prn
  • Occlusion when able
  • Oral antihistamines
  • Protopic
  • Elidel 1%
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79
Q

upon a yearly skin check of your 35 y/o pt. she complaing of a Purple, Polygonal, Pruritic, Papule on her scalp. w/ further examination of the mouth you see white lesions in the buccal mucosa.

Dx? Tx

A

Lichen Planus

Potent topical steroids with occlusion dressing, or intralesional steroid injections.

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80
Q

a 70 y/o pt comes in for a skin check. you see this. it appears to be stuck on and hace a warty appearance.

Dx tX?

A

Seborrheic Keratosis

none

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81
Q

•Vascular neoplasm brought on by genetic factors, hormonal factors, immunodeficiency or infection with Human Herpes Virus 8????

A

Kaposi sarcoma

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82
Q

Pt presents to clinic w/ this lesion on her face. on palpation you feel a sandpaper texture.

Dx and TX

A

actinic keratosis

Precursor for squamous cell carc.

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83
Q

tx of actinic keratosis w/ limited number of lesions

For extensive broad and numerous lesions???

A

•Cryotherapy

Imiquimod (less irritating then 5-Fu)

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84
Q

what is the most common cancer

A

basal cell

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85
Q

pathophys of basal cell

A
  • BCC arise from immature pluripotential cells associated with the hair follicle. Mutations activate pathway that controls cell growth.
  • Mutation also activates oncogenes and inactivates tumor suppressor genes, leading to tumor growth.
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86
Q

what is characteristic ft of all basal cell carc.

A

Bleeding w/out pain

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87
Q

Pt presents to clinic w/ waxy, pearly, semitranslucent nodules or papules with “rolled edge” forming around a central depression that is ulcerated, crusted and bleeding.

Dx ??

A

nodular basal cell

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88
Q

what form of skin cancer is most common in hispanics and asians??

A

Pigmented

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89
Q

on examination appears appears as a dry scaly lesion, superficial flat growths,

Dx?

A

Superficial BCC

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90
Q

pt arrives w/ complaints of a new plaque on side of nose. on physical exam you notice a white sclerotic plaque with telangiectasia.

Dx?

A

Morpheaform (sclerosing) BCC

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91
Q

gold standard tx for BCC

A

Mohs procedure

92
Q

topical tx for BCC

A
  • 5% imiquimod
  • for the treatment of nonfacial superficial BCCs that are less than 2 cm in diameter. Applied 5 days per week, for a duration of 6-12 weeks. Has 80% cure rate.
  • 5-FU
  • approved for the treatment of superficial BCC, administered twice daily for 3-6 weeks.
94
Q

where is SCC most frequently seen

A

areas of AK, sun exposed skin

face, backs of hands.

95
Q

type of skin cancer w/ no preference for sun exposed areas

A

melanoma

over 50% of cases develop from preexisiting nevi

96
Q

Define the ABCD of melanoma

A

A asymmetry

B Border (edges are irregular)

C Color is varied

Diameter >6mm

97
Q

what type of melanoma?

A

superficial spreading

98
Q

what type of melanoma?

most COMMON in sundamaged skin

starts as macular and becomes nodular

SLOW indidious growth

A

Lentigo maliga

99
Q

you see this melanoma in sun exposed areas head, neck and trunk. it is usually Friable or ulcerated and bleeding

100
Q

most common type of melanoma in darker skin types and most commonly seen on nails and feet.

A

acral-lentiginous

101
Q

tx of melanoma

A
  • Surgical excision
  • Radiation
  • Chemotherapy

Adjunct therapy

  • Cytokines (IL-2)
  • Vemurafenib
  • Dabrafenib
  • Trametinib
102
Q

pt came into office last week and a questionable lesion was biopsied. results show the presence of keratin or “keratin pearls.” You read the pracitioners note where they add that there was Lymphadenopathy on palpation in adjacent lymph nodes.

Dx?

103
Q

etiology of melanoma

A
  • Damage to DNA of Melanocyte that promote oncogenes and inhibit tumor suppressor genes.
  • Half have non inherited BRAF oncogene mutation

Familial inherited melanomas often have mutation in tumor suppressor genes like CDKN2A and CDK4

104
Q

describe lesions seen in measles (rubeola)

A

start as macular or morbilliform rash on anterior scalp and behind ears then by day 2 or 3 down the trunk to extremities

Including palms/soles

105
Q

what is pathogonomonic finding in rubeola (measles)

A

Koplick spots (white papules on buccal mucosa)

106
Q

is there a prodrome w/ measles?

107
Q

pathogen responsible for rubella?

A

toga virus

108
Q

what is this called and a sign of what dz?

A

Forscheimer’s sign - rubella

109
Q

is there a prodrome w/ rubella

110
Q

pt presents w/ pale pink morbilliform macules that began on face and spreads inferior, covering entire body in 24h. he also notes pain w/ upward lateral eye movement.

dx?

111
Q

pathogen responsible for fifth dz (erythema infectiosum)

112
Q

what are the 3 phases in fifth dz (erythema infectisum)

A
  • 1st: abrupt asypmtomatic erythema of cheeks (slapped cheek) that is diffuse and macular.
  • 2nd: by day 4 discrete erythematous macules and papules on proximal extremities and later the trunk evolving into lacey reticulate pattern by day 9.
  • 3rd: recurring stage, eruption is reduced or invisible, only to reoccur with exposure to heat (bath) or sunlight.
113
Q

what is a herald patch diagnostic of.

A

Pityriasis Rosea

114
Q

what is the most common form of adverse drug rxn? where do the lesions begin and spread to?

A

morbilliform rash (type IV hypersen)

Erythema with macules and papules initially on trunk then generalizing within 2 days.

115
Q

pt presents to clinic w/ strange mark on penis. he says it reoccurs and it sometimes itchy. The only changes he has made to his routine is taking ibprof after football practice to relieve muscle soreness.

Dx? and what causes this?

A

fixed drug rxn

NSAID, Sulfonamides, Barbiturates.

116
Q

pt presents to clinic w fever and painful lesions. upon examination they have a target appearacne. currently they are localized to hands and feet. SHe is taking phenytoin and penicillin.

Dx? Tx?

A

Erythema Multiforme

if severe - systemic steroids

117
Q

pt presents w/ blistering painful lesions on trunk. Dx?? and what are we concerned for?

A

SJS

progressing to TENS

118
Q

Bullous pemphigoid patho?

A
  • IgG Antibodies bind to basement membrane. à activates complement and inflammatory mediators à attracts inflammatory cells to the basement membrane which release proteases lead to blister formation.
  • Blister formed by cleavage of the basal cells away from the basal lamina.
  • Antibodies cause separation of epidermis from dermis.
119
Q

tx for bollous Pemphigoid

A

potent topical steroids

occlusive dressing

Severe - prednisone

120
Q

pt complains of burrowing lesions located on feet and web spaces b/w hands. lesions are itchy?

Dx? what does this dz spare?

A

scabies (delayed IV hypersen)

face

121
Q

what type of bug manifestation would we only see immunocompromised pts

A

norwegian scabies

122
Q

tx of scabies

A

topical

  • Permethrin 5% cream. (Elimite)
  • Lindane1 % lotion or cream (Kwell)
  • More toxic (not for pregnant or kids

Oral

•Ivermectin (Stromectol)

123
Q

how to differentiate b/w Pediculosis Corporis and scabies

A

Pediculosis Corporis SPARES hands and feet

scabies does NOT

124
Q

pt dx w/ Pediculosis capitus along w/ intense itching of the scalp and lice within the hair follicles what other manifestation would we see?

A

posterior cervical lymphadenopathy,

125
Q

most effective tx for head lice

A

Ovid Lotion – most effective for head lice NOT for children

126
Q

Tx for lice

A

•OTC Nix cream rinse

Permethrin acts as neurotoxin resulting in paralysis of nerves in exoskeletal respiratory muscles of parasite à death

Ovid Lotion

bactrim

vaseline

127
Q

along w/ the many systemic sx what sx is most severe in pts w/ a black widow spider bite

A

Abdominal pain

128
Q

what spider bite leads to necrosis of the tissue

A

brown recluse

129
Q

Dz and Tx?

A

black widow bite

ACLS

Antivenom administered in ER. (risk of allergic reaction).

Analgesics (Morphine)

Anithistamine (Benadryl)

Tetanus

130
Q

pathogen responsible for tinea versicolor

A

Malassezia furfur (yeast).

131
Q

pt arrives to clinic at the end of august complainig of well defined round macules with scaling on trunk and arms, or face. under woods light you see:

Dx/Tx

A

Tinea versicolor

Daily Selenium sulfide shampoo

Topical Ketoconazole cream daily x 3 weeks.

Oral Ketoconazole (careful of LFT’s).

132
Q

diagnostic test when you suspect fungal infection:

133
Q

a KOH smear was performed and results show hyphae and spores (Spaghetti and meatballs).

Dx?

A

tiinea versicolor

134
Q

if you did not have access to a woods light. how do you differentiate b/w Vitilago and tinea versicolor?

A

ttinea vers:

Pt is asymptomatic and notices during the summer.

Well defined round macules with scaling on trunk and arms, or face.

vitilago

hypopigmentation macules may occur focally or generalized in pattern. NO SCALE

Hair in vitiliginous areas usually become white

135
Q

pt arrives to clinic complaining of a lesion on her mouth. Physical exam shows tender grouped vesicles/blisters on an erythematous base.

Dx? and what test could you perform to comfirm your dx?

A

herpes

Tzanck smear (giant nucleated cells)

136
Q

Tx for herpes

A

acyclovir

valcyclovir

137
Q

pt comes to clinic complaining of

Rash, malaise, low grade temp

She says the rash stared as faint macules that develop into vesicular eruptions with “teardrop” vesicles on erythematous base. you notice the rash is only on the scalp and face.

Dx? and where shoudl you warn the pt that the rash will spread to?

A

varicella

trunk, then spreads to extremities. (May appear on palms/soles. )

138
Q

pt comes to clinic complaining of lesions on the side and tip of the nose. she describes them as “burning”, “electrical”, “throbbing”. The lesion is unilateral.

what is this lesion called?

Dx?

How should you advise pt?

A

shingles (herpes zoster)

hutchinsons sign

Ophthalmic division of 5th cranial nerve must be seen by ophthalmologist due to complicating concerns of tetinal necrosis, glaucoma, optic neuritis.

139
Q

which dz shows lesions usually unilaterally and along a dermatome?

A

herpes zoster

140
Q

what is this?

A

hutchinsons sign - herpes zoster

141
Q

what is this indicative of?

142
Q

how do you differentiate herpes simplex from varicella based on Tzanck smear?

A

varicella

Tzank smear from vesicle show multinucleated giant cells

herpes

Tzanck smear -> Giant nucleated cells

143
Q

what is Onychomycosis and how do we tx?

A

Lamisil

check LFTs

144
Q

what dz is associated w/ break in the skin associated with trauma to the eponychium (cuticle) or nail fold and maceration of proximal nail fold. usually seen in people in the food industry/ always have hands in water?

what pathogens are responsible?

A

Chronic Paronychia

•pseudomonas aeruginosa or candida albicans

145
Q

what dz is associated w/ aggressive manicure, nail biting?

pathogen responsible?

A

Acute Paronychia

Usually Gram + (Staphylococcus aureus)

146
Q

tx for chronic paronchyia

A

Avoid inciting factors (moisture, manicuring)

Warms soaks

Topical steroid cream o

Antifungal : Spectazole

147
Q

tx for acute paronchyia

A

Warm water soaks 3-4xday

PO Abx for Gr+ S.aureus (Augmentin 2gr x 5d)

Topical steroid cream

I&D if abscessed.

148
Q

what is the most common wart that is associated w/ frequent exposure to water?

A

Veruca Vulgaris (common wart)

149
Q

10 y/o comes into office and presents w/ 2-4mm flat topped flesh colored papules on face.

Dx?

A

Verruca Plana (flat wart)

150
Q

what wart is found on the soles of feet/ pressure points?

A

Verruca Plantaris (plantar wart)

151
Q

4 Ps of Lichn Planus

A

Purple

  • Polygonal
  • Pruritic
  • Papule
152
Q

tx of warts

A

IF has not resolved on own:

  • Cryotherapy
  • Salicylic acid / Cantharidin
  • Occlusive dressing
  • Intralesional injection of Bleomycin
153
Q

Herpetic Whitlow:

A

occurring on the fingers or periungually, tenderness and erythema with deep seated blisters

154
Q

Tzank smear from vesicle show multinucleated giant cells

155
Q

Tzanck smear à Giant nucleated cells

A

herpes simplex

156
Q

is erysipelas purulent?

157
Q

most common bacterial infection in children

158
Q

Name the types of BCC

A

nodular

superficial

Morpheaform (Sclerosing):

pigmented

159
Q

type of BCC seen in darker complextions

160
Q

type of BCC that may be misdiagnoses as eczema or psoriasis.

A

superficial

161
Q

Name 4 types of melanoma

A

superficial spreading

lentigo maliga

nodular

acral-lentigous

162
Q

most common melanoma in sundamaged skin

A

lentigo maliga

163
Q

type of melanoma that is seen on sun exposed areas and is probable ulcerative or bleeding

164
Q

name most common melanoma in darker skin types

A

acral lentigous

165
Q

where do acral lentigous melanoma commonly present

A

palms

soles

nailbeds

166
Q

type of melanoma that starts macular then becomes nodular w/ a slow insidous growth rate

A

lentigo maliga

167
Q

melanoma that is

Tendency to multicoloration including black, red, brown, blue and white.

Boarders tend to be more sharply defined.

A

superficial spreading melanoma

168
Q

Lesions on sun exposed areas may be superficial papules, plaques or nodules, discrete and hard arising from an indurated, round elevated base.

Over months becomes larger and ulcerated, initially covered by crust.

169
Q

hallmark of SCC on biopsy

A

•Biopsy: The histologic hallmark of SCC is the presence of keratin or “keratin pearls.” These are well-formed desmosome attachments and intracytoplasmic bundles of keratin tonofilaments.

170
Q

what is the Most common epithelial precancerous lesion

A

actinic keratosis

171
Q

•Spindle cells found in nodular lesions. Dx?

A

Kaptosi sarcoma

172
Q

estimated that over 90% of adults over the age of 60 years have one or more

A

Seborrheic Keratosis

173
Q

May be asymptomatic, but often pruritic. 2/3 of people will have lesions for < 1yr. May cause hair loss and damage nails. Variations can be ulcerative.

  • Grouped together, flexor aspect of wrists, lumbar area, eyelids, shins, scalp.
  • May have Reticulate white lesions on buccal mucosa.
  • 4 P’s. Purple, Polygonal, Pruritic, Papule.

dx?

A

Lichens Planus

174
Q

tx lichen plannus

A

Potent topical steroids with occlusion dressing, or intralesional steroid injections.

175
Q

type of impetigo that forms thick adherent golden crusts

A

non-bullous (most common)

S. Aureus

176
Q

enlarges vessicles w/ flaccid bullae w/ clear fluid become darker and ruptures leaving a thin brown crust.

Dx?

A

bullous impetigo

S. Aureus strain - that produce a toxin that cause clevage of superficial skin layer

177
Q

Pathogen responsible for ecthyma

A

Group A beta hemolytic strep pyogenes

178
Q

what skin condition is sometimes accompanies by angioedema

179
Q

pt presents w/ firm skin colored dermal nodules, visible central punctum. they are asymptomatic.

dx?

A

epidermal inclusion cysts

180
Q

differentiate b/w wart and epidermal inclusion cysts

A

epidermal inclusion cysts have a central punctum

181
Q

tx for mild acne

A

BPO + topical retinoid / abx

182
Q

tx of moderate acne

A

BPO + topical retinoid + oral abx

183
Q

tx for severe acne

A

everything

+oral isotretinoin

184
Q

psoriasis seen in children/ young adults w/ no hx of psoriasis

185
Q

name 4 types of rosacea

A

Erythematotelangiectati

Papulopustular

Phymatous

ocular

186
Q

name 6 types of psoriasis

A

chronic plaque

guttate

pustular

Erythrodermic

inverse

nail

187
Q

lower lip SCC

A
  • Starts as actinic cheilitis
  • Local thickening on keratosis then firm nodule that may grow outward as sizable tumor.
  • Usually + hx of smoking
188
Q

Periungual SCC

A
  • Presents with signs of swelling, erythema and localized pain.
  • Commonly in the nailfolds of hands resembling a wart
189
Q

dry scaly lesion w/ threadlike border

A

Superficial BCC

misdx as psoriasis due to appearance of flat scaly lesion

190
Q

melanoma w/ no apparent radial growth phase, Smooth, Dome-shaped and shows ulcerations/bleeding

A

nodular

primarily sun exposed areas of head, neck and trunk

191
Q

melanoma w/ sharply defined borders

A

superficial spreading

appears pigmented- blue, black, white

192
Q

melanoma that is Light brown, uniform pigmentation

A

acral lentigous

seen on darker skin types, nails ans palms of feet

Clin med 1 - DERM/RHUM - exam 1 (2 decks)

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