Derm and Dental

Question 1

Age related changes to skin

Answer 1

Lost elasticity
Inc fragility
Reduced wound healing
Inc permeability to chemicals
Reduced melanocytes
Decreased cutaneous perfusion
Less exocrine sweat glands
Reduced sebum from sweat glands

Question 2

What is xerosis?

Answer 2

Dry skin
Itchy, excoriation, inflammation
Causes: aging, frequent bathing, high temps
Tx: reduce hot water, avoid harsh cleansers, humidifier, emollients, moisturizers, steroids if severe

Question 3

What is seborrheic dermatitis?

Answer 3

Well demarcated erythematous plaques with greasy yellow scales
Scalp, ear, face, chest
Tx: topical steroids, antifungals

Question 4

What is bullous pemphigoid?

Answer 4

Autoimmune blistering disease
Tense bullae, erythematous base
Tx: topical steroids (clobetasol), systemic steroids

Question 5

What is stasis dermatitis?

Answer 5

Erythematous scaling patches on chronically swollen legs, leads to lipodermatoclerosis (induration, hyper pigmented, erythema)
Caused by venous insufficiency
Tx: compression, topical steroids acutely

Question 6

What is scabies?

Answer 6

Severe pruritic with erythematous papule in specific distribution - sides and webs of fingers, wrists, armpits, elbows, genitals, bum, bottom of feet
Diagnose with skin scrapings
Caused by mites that burrow into skin
Tx: topical permethrin or ivermectin, if crusted then need both, second line benzyl benzoate, antihistamine for itching, topical CS after eradication
Non pharm - machine wash clothing and bedding, sequester other items for 3 days, treat close contacts

Question 7

What is seborrheic keratosis?

Answer 7

Well demarcated lesion with verrucous surface and typical stuck on appearance
Due to proliferation of keratinocytes
Cosmetic treatment only

Question 8

What is a basal cell carcinoma?

Answer 8

Sun exposed surface
Translucent papule
From UV radiation
Tx: surgical excision

Question 9

What is a squamous cell carcinoma?

Answer 9

Well demarcated scaly patch/plaque
From sun exposure
Tx: surgical or radiotherapy

Question 10

What is tinea?

Answer 10

Annular, erythematous
Fungal infection
Tx: topical azole, oral

Question 11

What are risk factors for shingles?

Answer 11

Age
Immunocompromised
Transplant patient
Autoimmune disease
HIV

Question 12

How is shingles transmitted?

Answer 12

Contact with active zoster lesions or airborne
Reactivation of previous VZV infection
Lesions not infected after crusting

Question 13

How does shingles present?

Answer 13

Vesicular rash in 1 or several contiguous dermatomes

Question 14

What are complications of VZV?

Answer 14

Postherpetic neuralgia
Encephalitis (rare)
Disseminated zoster (more than 20 lesions outside dermatome)
Herpes zoster opthalmicus
Ramsay Hunt Syndrome

Question 15

What is the treatment for VZV?

Answer 15

Antiviral therapy
Acyclovir, valacyclovir, famciclovir or brivudine within 72 hours of onset of rash
Strongly recommend if: 50+, mod-severe pain or rash, nontruncal involvement
If complicated give IV acyclovir
Pregabalin for pain
Tylenol for fever

Question 16

What is a recommendation regarding infection control for direct patient care with scabies?

Answer 16

Hand hygiene - washing thoroughly after providing direct care
Use gloves, avoid skin to skin contact
Launder on high heat
Tx those who have had prolonged skin to skin contact

Question 17

How is Zostavax administered? How many doses? What percent does it decrease incidence of shingles and post herpetic neuralgia?

Answer 17

Subcutaneous injection live attenuated vaccine
1 dose
61.1% decrease incidence of shingles
51.4% decreased incidence of post herpetic neuralgia

Question 18

How is Shingrix administered? How many doses? Efficacy?

Answer 18

Two doses, 2 months apart
Recombinant vaccine
Shingles 97% effective
Post herpetic neuralgia 89%

Question 19

What are risk factors for periodontitis?

Answer 19

Age
Smoking
Poor oral hygiene

Question 20

What are five contributors to dental disease in older adults?

Answer 20

Poor oral hygiene
Frequent ingestion of sticky foods with lots of sugar
Lack of dental insurance
Lack of transportation to dentist
Xerostomia
Limited fluoride exposure

Question 21

List 7 adverse outcomes of oral lesions or pool oral health in elderly

Answer 21

1. Altered eating habits/anorexia
2. Halitosis
3. Chronic oral infection
4. Oral pain
5. Speech problems
6. Worse social interactions
7. Diminishes pleasure of eating

Question 22

What are 6 consequences of xerostomia?

Answer 22

1. Oral candidiasis
2. Dental caries
3. Gingival recession
4. Salivary duct calculi
5. Dysphagia
6. Weight loss and malnutrition

Question 23

What medications contribute to xerostomia?

Answer 23

Opioids
Lithium
Anticonvulsants
Antidepressants (TCAs)
Antimuscarinics
Antihistamines
AntiHTN
Antiarrhythmics

Question 24

How to treat xerostomia?

Answer 24

1. Medication review/changes
2. Avoid acidic beverages
3. Avoid smoking
4. Sip on water regularly
5. Chewing gum
6. Artificial saliva
7. Pilocarpine drops