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Review > Derm > Flashcards

Derm Flashcards

1
Q

Onset of rash with RMSF

A

2-5 days after fever

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2
Q

RMSF rash

A
  • petechiae erupting on both wrists, forearms, and ankles
  • rapidly progress towards trunk and becomes generalized
  • 10% do not develop rash
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3
Q

First line treatment for RMSF

A

Doxycycline

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4
Q

Erythema migrans

A

-bulls eye rash

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5
Q

When does erythema migrans rash occur

A

-7-14 days after deer tick bite

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6
Q

Measles rash description

A

-Koplick spots: small, white, round spots on red base of buccal mucosa

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7
Q

Scabies rash description

A
  • pruritic especially at night

- serpiginous rash on interdigital webs, waist, axilla, penis

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8
Q

Scarlet fever rash description

A

-sandpaper rash with sore throat

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9
Q

Meningococcemia rash

A

purple-colored to dark-red painful skin lesions all over body

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10
Q

Meningococcemia (meningitis) presentation

A
  • sore throat
  • cough
  • fever
  • Headache
  • stiff neck
  • photophobia
  • change in LOC
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11
Q

People at highest risk for meningitis

A
  • first year college students in dorms
  • asplenia
  • defective spleen (sickle cell)
  • HIV
  • complement immune system deficiencies
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12
Q

What level of precaution is needed for meningitis

A

droplet

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13
Q

What CN does herpes zoster ophthalmicus affect

A

-CNV

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14
Q

Most common type of melanoma in AA and Asians

A
  • Acral Lentiginous melanoma

- palms, under nails, soles of feet

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15
Q

Acral lentiginous melanoma presentation

A
  • dark brown to black lesions on nail beds, palmar, and plantar surfaces
  • subungal melanoma: longitudinal brown to black bands on nail bed
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16
Q

BCC presentation

A
  • pearly or waxy skin lesion with atrophic or ulcerated center that does not heal
  • bleeds easily with trauma
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17
Q

Actinic keratosis

A
  • precursor to SCC
  • dry, round, red colored lesions with rough texture
  • does not heal
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18
Q

> ___% hematoma of nail matrix has high risk of permanent ischemic damage to nail bed if not drained.

A

25

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19
Q

SJS and TENs

A
  • multiple lesions ranging from hives to necrosis

- TEN more severe than SJS

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20
Q

HIV patients taking which medication is at higher risk for SJS

A

Bactrim

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21
Q

3 layers of skin

A

epidermis
dermis
subcutaneous

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22
Q

Common skin conditions of AA

A
  • keloids
  • hyperpigmentation
  • traction alopecia
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23
Q

T/F People with darker skin need more sun exposure to synthesize vitamin D

A

true

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24
Q

Vitamin D deficiency in pregnancy

A

infantile rickets

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25
Q

Which cancer is most common

A

BCC

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26
Q

Macule

A

flat

-<1 cm

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27
Q

papule

A

palpable solid

<0.5 cm

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28
Q

Plaque

A

flattened elevated with variable shape

>1 cm

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29
Q

Bullae

A

fluid filled

>1 cm

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30
Q

Vesicle

A

filled with serous fluid

<1 cm

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31
Q

Pustule

A

elevated lesion <1 cm filled with purulent fluid

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32
Q

Lichenification

A

-thickening of epidermis due to chronic itching

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33
Q

Acral

A

-distal portions of the limbs like hands and feet

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34
Q

Annular

A

ring shaped

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35
Q

exanthem

A

cutaneous rash

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36
Q

Flexural

A

skin flexure are body folds

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37
Q

Morbilliform

A

rash that resembles measles

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38
Q

Nummular

A

coin-shaped

round

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39
Q

Serpiginous

A

shaped like a snake

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40
Q

Verrucous

A

wart-like

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41
Q

Xanthelasma

A

raised and yellow-colored soft plaques

-if <40, r/o HLD

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42
Q

Melasma

A
  • mask of pregnancy
  • upper cheeks, malar area, forehead, chin
  • can be permanent, may lighten over time
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43
Q

Vitiligo is more common in patients with

A

autoimmune disease

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44
Q

Vitiligo treatment

A

refer to derm

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45
Q

Cherry angioma treatment

A

none needed

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46
Q

Xerosis

A

-inherited skin disorder that is extremely dry skin

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47
Q

Acanthosis nigricans can indicate what

A

-diabetes
-metabolic syndrome
-obesity
Cancer of GI tract

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48
Q

Acrochordon

A

skin tags

-more common in diabetics and obese

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49
Q

Steroid class range

A

1 (superpotent) to 7 (least potent)

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50
Q

Topical steroids on children and face

A
  • use class 7: 0.5%-1% hydrocortisone

- Class 6: fluocinolone

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51
Q

How long do topical steroids need to be used for HPA axis suppression to occur

A

> 2 weeks

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52
Q

Psoriasis patho

A
  • inherited

- squamous epithelial undergo rapid mitotic division and abnormal maturation

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53
Q

Koebner phenomenon

A

new psoriatic plaques form over areas of skin trauma

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54
Q

Auspitz sign

A

pinpoint areas of bleeding in skin when scales from a psoriatic plaque are removed

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55
Q

Fingernail presentation with psoriasis

A

pitting

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56
Q

Psoriasis medications

A
  • topical steroids
  • topical retinoids
  • tar preparations
  • severe disease: MTX, cyclosporine, biologics
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57
Q

Topical tacrolimus BBW

A
  • rare malignancy

- use sunblock

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58
Q

Goeckerman regimen

A

-UVB light and tar-derived topical may induce remission in severe psoriasis

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59
Q

Guttate sporiasis

A
  • drop-shaped lesions

- severe psoriasis from GABHS

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60
Q

Actinic keratoses treatment

A

-refer to derm for biopsy

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61
Q

Tinea versicolor treatment

A
  • selenium sulfide and topical azole antifungals (ketoconazole, terbinafine)
  • will take several months for pigment to fill in
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62
Q

Mild eczema treatment

A
  • hydrocortisone 2.5%

- low-potency, group 5

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63
Q

Moderate eczema treatment

A
  • Triamcinolone acetonide

- medium potency, group 4

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64
Q

Halcinonide (Halog)

A

high potency topical steroid

group 2

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65
Q

Contact dermatitis treatment

A
  • stop exposure
  • topical steroids once to twice a week 1-2 weeks
  • calamine lotion
  • oatmeal baths
  • consider referral to allergist
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66
Q

superficial candidiasis presentation

A
  • bright red shiny lesions
  • itch or burn
  • intertriginous areas
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67
Q

thrush presentation

A
  • severe sore throat
  • white adherent patches
  • hard to dislodge
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68
Q

Superficial candidiasis treatment

A
  • Nystatin powder and/or cream in skin folds
  • OTC antifungals: miconazole, clotrimazole
  • Prescription: terconazole, ciclopirox
  • keep dry and aerated
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69
Q

Thrush treatment

A
  • Nystatin oral suspension (swish and swallow)

- Magic mouthwash: lidocaine, diphydramine, Maalox for severe sore throat

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70
Q

HIV positive patients with thrush treatment

A

-oral fluconazole

71
Q

Leading cause of shellfish associated death in US

A

V. vulnificus

72
Q

People with liver disease or IC or pregnant should avoid eating raw or undercooked oysters or clams due to

A
  • Vibrio vulnificus infection

- 50% mortality

73
Q

Clenched fist injuries treatment

A

-ED

74
Q

Necrotizing Fasciitis infected area may appear like what

A

-woody induration

75
Q

Folliculitis treatment

A

Muporicin

usually self limiting

76
Q

Furuncle treatment

A
  • warm compress
  • if >2 cm, I&D
  • if over joint, refer to ED for xray to rule out osteomyelitis
77
Q

What is a furuncle

A

infected hair follicle

78
Q

What is a carbuncle

A

-several boils that coalesce to form a large boil or abscess

79
Q

Carbuncle treamtent

A
  • mild cases
  • nonpurulent: dicloxacillin PO, cephalexin, clindamycin
  • PCN allergy: azithromycin
  • suspected MRSA: Bactrim DS or doxycycline
  • severe cases: ED referral
80
Q

Erysipelas is what

A
  • subtype of cellulitis involving upper dermis and superficial lymphatics
  • usually Strep
81
Q

Erysipelas can present where

A
  • lower legs

- cheeks

82
Q

Human and dog bite treatment

A
  • Augmentin 875mg/125mg PO BID x 10 days
  • PCN allergy: Doxycyline BID, Bactrim + metronidazole or clindamycin
  • irrigate
  • no suture
  • if cartilage involvement refer to plastics
  • tetanus booster
  • f/u 24-48 hours
83
Q

Hidradenitis Suppurativa patho

A
  • chronic and recurrent inflammatory disorder of apocrine glands
  • painful nodules, abscess, pustules in axilla, mammary area, perianal, groin
  • risk: smoking and obesity
  • no cure
84
Q

Hidradenitis suppurativa treatment

A
  • mild: CHX (Hibiclens) wipes
  • topical clindamycin
  • warm compress
  • avoid high glycemic foods, dairy
  • smoking cessation, weight loss
  • oral abx: tetracycline, doxycycline, minocycline
  • refer to derm
85
Q

Two types of impetigo

A
  • bullous

- nonbullous; more common

86
Q

Treatment for severe impetigo

A

-Keflex, dicloxacillin x10 days

87
Q

Mild impetigo treatment

A

-Clean lesions and apply muporicin

88
Q

Impetigo and school

A

-no school until 48-72 hours of treatment

89
Q

Prophylaxis for close contacts with meningitis

A

-Rifampin PO every 12 hours x 2 days

90
Q

close contact description

A

-<3 feet of persons infected for >8 hours or directly exposed to patients oral secretions, going back to 7 days before onset of patients symptoms and until 24 hours after initiating abx

91
Q

Lyme disease organism

A

-Borrelia burgdorferi

92
Q

Early lyme labs

A
  • enzyme immunoassay (EIA): if negative, no further
  • if positive, IFA or western blot
  • if both EIA and IFA are (+)= Lymes
  • antibody testing may have false negative in first 4-6 weeks
93
Q

Early Lyme treatment

A

-Doxycycline BID x 10 days

94
Q

RMSF labs

A
  • Antibody titers to R.rickettssi by indirect fluorescent abs
  • biopsy of skin lesion
  • CBC, LFTs, CSF, etc
95
Q

how to remove tick

A
  • tweezers grasp part closest to tick
  • pull upward
  • do not twist or jerk
96
Q

How long is chickenpox contagious

A

-1-2 days before onset of rash and until all lesions have crusted over

97
Q

How long is shingles contagious

A

-onset of rash until lesions have crusted over

98
Q

Gold standard diagnosis for varicella zoster virus

A

-viral culture, PCR

99
Q

When are antivirals most effective for varicella zoster

A

-within 48-72 hours after appearance of rash

100
Q

Postherpetic neuralgia treatment

A
  • tricyclic antidepressants (low-dose amitriptyline)
  • anticonvulsants
  • gabapentin
  • lidocaine 5% patch
101
Q

Ramsay Hunt syndrome

A
  • ipsilateral facial paralysis
  • ear pain
  • vesicles in ear canal and auricle
  • refer to neurologist
102
Q

Herpetic whitlow cause by

A

herpes simplex 1 or 2

103
Q

Herpetic whitlow presentation

A
  • acute onset extremely painful red bumps
  • small blisters on sides of skin
  • ask about oral or genital herpes
104
Q

Herpetic whitlow treatment

A
  • mild: analgesics

- severe: acyclovir

105
Q

Herpetic whitlow patient education

A

-cover with bandage until lesions healed

106
Q

Paronychia treatment

A
  • soak in warm water for 20 minutes three times a day
  • apply triple abx or muporicin after soaking
  • Abscess: I&D, gently separate the cuticle margin from nail bed to drain
107
Q

Herald patch

A
  • first lesion to appear
  • largest
  • appears 2 weeks before full breakout
108
Q

How long does pityriasis rosea last

A

6-8 weeks

self-limiting

109
Q

Scabies presentation

A

-serpiginous or linear burrow rash

110
Q

Scabies labs

A
  • skin scraping wet mount

- observe for mites or eggs

111
Q

Scabies treatment

A
  • Pemethrin 5%
  • apply from neck to feet
  • wash off after 8-14 hours
  • repeat in 7 days
  • treat everyone in household
  • wash all things
  • pruritus improves in 48 hours but can last up to 2-4 weeks
  • treat with Benadryl and topical steroids
112
Q

Tinea capitis treatment

A
  • Baseline LFT and repeat 2 weeks after starting systemic antifungal treatment –> not needed unless treatment extends beyond 8 weeks
  • Gold standard: griseofulvin daily to BID x 6-12 weeks
113
Q

Kerion

A

complication of tinea capitis

  • inflammatory and indurated lesions that permanently damage hair follicles causing patchy alopecia
  • permanent
114
Q

Tinea corporis treatment

A
  • Topical treatment 1-2x per week for 3 weeks (ketoconazole, clotrimazole)
  • oral antifungals (terbinafine, itraconazole, fluconazole)
115
Q

Tinea manuum is usually caused by

A

-scratching foot that is infected with tinea

116
Q

What medication should be avoided with suspected dermatophyte infection

A

topical steroids

117
Q

Treatment of mild onychomycosis

A

Penlac “nail polish” (cyclopirox)

118
Q

Onychomycosis treatment

A
  • oral terbinafine or itraconazole 1 week per month for 3 months (pulse therapy)
  • not all need treatment
119
Q

Mild acne treatment

A
  • Rx: Tretinoin topical (Retin-A)
  • benzoyl peroxide gel with erythromycin (Benzamycin) or with clindamycin (Cleocin)
  • start with lowest dose: Retin-A 0.25%
  • alt: azelaic acid or salicylic acid (OTC)
120
Q

Patient education with retinoids

A
  • skin can become red and irritated
  • may worsen at first, will improve in 4-6 weeks
  • if no improvement in 8-12 weeks, consider increasing dose or adding BP with erythromycin
121
Q

Mild acne criteria

A
  • open and closed comedones

- with or without small papules

122
Q

Moderate acne criteria

A

-papules and pustules with comedones

123
Q

Moderate acne treatment

A
  • Retin-A, Benzamycin, or Cleocin
  • Oral abx: Tetracycline, minocycline, doxycycline, erythromycin, or clindamycin
  • Tetracyclines not for <13 years old!
  • can consider OCP
124
Q

Severe cystic acne criteria

A

-mild and mod acne with painful indurated nodules, cysts, abscesses, and pustules over face, shoulders and chest

125
Q

Severe cystic acne treatment

A
  • Isotretinoin (Accutane) category X
  • prescribed by prescribers in iPLEDGE program
  • 2 forms of contraception
  • monthly pregnancy test shown to pharmacist
126
Q

Rosacea patho

A

-chronic relapse inflammatory skin disorder

127
Q

Rosacea presentation

A
  • Celtic background
  • chronic and small acne-like papules and pustules around nose, mouth, chin
  • telangiectasias present on nasal area and cheeks
  • blushes easily
  • blonde or red-haired with light eyes
  • may have red eyes, dry eyes, or chronic blepharitis
128
Q

Rosacea treatment

A
  • Metronidazole (Metrogel) topical gel

- Azelaic acid (Azelex) topical gel

129
Q

Complications of rosacea

A
  • rhinophyma

- ocular rosacea

130
Q

How long does molluscum take to resolve

A

6-12 months

131
Q

When is molluscum considered an STD

A

-if lesions are located on genitals in sexually active adolescents and adults

132
Q

First degree burn

A
  • superficial
  • erythema only, painful
  • clean with soap and water
  • cold packs for 24-48 hours
  • benzocaine or aloe vera
133
Q

Second degree burn

A
  • partial thickness
  • red colored with superficial blisters
  • painful
  • water and mild soap
  • do not rupture blisters
  • treat with silver sulfadiazine (Silvadene) or triple antibiotic (Polysporin)
  • honey or aloe vera
134
Q

Third degree burn

A
  • full thickness burn
  • rule out airway and breathing compromise
  • smoke inhalation injury –> emergency
  • painless
  • REFER
135
Q

Body surface for child each arm

A

9%

136
Q

Body surface for child each leg

A

14%

137
Q

Body surface child front trunk and back

A

18% each

138
Q

Body surface adult each arm and head

A

9%

139
Q

Body surface adult each leg, anterior trunk, posterior trunk

A

18%

140
Q

Criteria for burn referral

A
  • burns involving face, hands, feet, genitals, major joints
  • electrical burns, lightening burns
  • partial thickness >10% TBSA
  • Third-degree burn in any age group
141
Q

Anthrax is caused by

A

Bacillus anthracis

G-

142
Q

Cutaneous anthrax presentation

A
  • papule that enlarges in 24-48 hours

- eschar and ulceration

143
Q

Pulmonary anthrax presentation

A
  • recent work with animals, wools, hair
  • bioterrorism
  • flu-like
  • cough, hemoptysis, dyspnea, hypoxia, shock
144
Q

Cutaneous anthrax treatment

A

-doxycycline, cipro, levo

145
Q

Smallpox treatment

A
  • symptomatic

- 20-50% mortality rate

146
Q

Smallpox vaccine is given when

A

3-4 days postexposure

147
Q

With suspected MRSA infection, which antibiotic to give if patient has PCN allergy

A
  • doxycycline
  • minocycline
  • clindamycin
148
Q

Treatment duration for suspected bioterrorism with anthrax

A

60 days

149
Q

Trephination

A

straighten one end of a large paper clip or 18 gauge needle and heat it with a flame
gently drill down nail until blood seeps out

150
Q

Primary healing

A
  • primary closure
  • wound closed within 24 hours by suturing, glue, strips
  • least amount of scarring
151
Q

Secondary intention wound healing

A
  • left open with formation of granulation tissue and scarring
  • heals from bottom of wound up
  • wound edges not well approximated
  • more scarring
152
Q

Tertiary intention

A
  • delayed primary closure
  • wounds with heavy contamination left open to heal by secondary intention (granulation) and contarction
  • wound edges approximated in 3-4 days
  • produces most scarring
153
Q

Phases of wound healing

A
  • hemostasis
  • inflammation
  • Proliferation
  • Remodeling

HIPR (HYPER)

154
Q

Hemostasis

A

constriction of blood vessels, platelet aggregation, fibrin formation

155
Q

Inflammation

A
  • macrophages and lymphocytes proliferate

- inflammatory mediators

156
Q

Proliferation

A

basal and epithelial cells proliferate

-angiogenesis

157
Q

Remodeling

A

-remodeling of collagen and scar formation

158
Q

Areas with high risk of ischemia

A

-tip of nose
-ears
fingertips
toes
penis

159
Q

Local anesthesia medication used

A

lidocaine 1%

160
Q

What wounds are not to be sutured

A

-puncture wounds or human or animal bites
-heavily contaminated wounds
lacerations >12 hours old
wounds open for more than 24 hours

161
Q

When are sutures to be removed

A

within 7-10 days

162
Q

Why is ecthyma treated with an oral medication

A

because of dermis involvement

163
Q

Which tinea infections require oral treatment

A
  • captitis
  • unguium (onychomycosis)
  • barbae
164
Q

Lupus presentation

A
  • butterfly rash
  • child-bearing aged female
  • arthritis
  • arthralgias
165
Q

Lupus labs

A
  • presence of ANA antibodies

- refer to rheumatology

166
Q

Weakest vehicle strength for topical steroids

A

lotions

167
Q

Most potent vehicle strength for topical steroids

A

ointments

168
Q

Pinworm diagnosis

A
  • visual inspection of anus, may have mobile worms
  • looks like cotton threads
  • tape on asshole early in the morning
169
Q

Pinworm treatment

A

-Albendazole

PO

170
Q

Alt medication for child presenting with Lyme-like symptoms

A
  • Amoxicillin

- doxycycline should not be used in children <13

171
Q

First line treatment for genital warts

A

cyrotherapy

172
Q

Erythema multiforme description

A

target rash

173
Q

Days to quarantine suspected rabies positive animal

A

10 days

174
Q

Candida intertrigo

A
  • candida in body areas where skin rubs together

- breasts, groin

Review (24 decks)

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