Derm Conditions Flashcards
1
Q
christmas tree sign think / Herald patch
A
Pityriasis Rosea (not ringworm)
2
Q
DDX for generalized rash w/ fever (5)
A
- measles (viral WILL blanch)
- rubella
- rocky mtn spotted fever
- viral exanthem
- scarlet fever
3
Q
DDX for generalized red rash w/ bullae (4)
A
- erythema multiforme (major)
- toxic epidermal necrolysis
- pemphigus vulgaris
- bullous pemphigoid
4
Q
does the rash blanch?
A
diascopy
5
Q
scabies test
A
mineral oil preparation
6
Q
stain for HSV sore
A
Tzanck smear
7
Q
bathing over 15 min will _____ skin–although soak 10-15 min before ______ application will ^ absorption
A
dry,
steroid
8
Q
If its ____ wet it, if its _____ dry it.
A
dry,
wet
9
Q
use of corticosteroids near eye can cause
A
glaucoma
10
Q
greasy lotions–“moisturizers”
A
emollients
11
Q
best combo for itchy rash
A
topical antihistamine and oral steroid
12
Q
most common skin disorder
A
ezcema (atopic dermatitis–itchy rash
13
Q
the “itch that rashes”
A
eczema (itch-scratch cycle)
14
Q
eczema is a
A
IgE Type I hypersensitivity rxn
15
Q
eczema typically on
A
flexeral surfaces
16
Q
flat red blotches as eczema
A
maculo-papular
17
Q
eczema sufferer likely to have (3)
A
- family hx
- allergy
- asthma
18
Q
PRURITUS!
A
eczema (atopic dermatitis)
19
Q
If eczema goes on too long
A
lichenification (highest potency steroid appropriate for location and pt)
20
Q
pathogens associated w/ secondary ifx of eczema
A
- Staph (yellow crusting)
- candida
- molluscum contagiosum
- HSV
21
Q
Tx for atopic dermatitis
A
Triamcinolone ointment + anti-itch meds + tx for secondary infx
22
Q
(2) types of contact dermatitis CD
A
- allergic: poison ivy–Type IV hypersensitivity rxn (nickle)
- irritant: inflammation due to chemicals
23
Q
Tx for contact dermatitis
A
high-potency corticosteroid
24
Q
zit =
A
papule
25
small flat discolored area of skin--usually less than 1 cm
macule
26
"end stage" disease of a variety of PRURITIC and ECZEMATOUS disorders
Lichen Simplex Chronicus esp. atopic dermatitis
27
Tx for lichen simplex chronicus (3)
1. break itch/scratch cycle
2. ^ potency flucocorticoid
3. tight time sedation w/ oral antihistamine
28
adolescents/young-middle aged rash more common in females, "papulopustular"--aggravated by topical glucocorticoids
perioral dermatitis TX w/ METRONIDAZOLE gel (antiinflammatory)
29
candida think
satalite lesions
30
"cradle cap" similar presentation to lupus
seborrheic dermatitis (presents as severe DANDRUFF on head and face/ear canals)
31
yellowish --> white greasy scales over erythematous patches/plaques
seborrheic dermatitis
32
cause of seborrheic dermatitis
Yeast--pityrosporon ovale
33
^ risk groups for seborrheic dermatitis (3)
1. Parkinson's
2. stroke
3. HIV+
34
Tx seborrheic dermatitis
ketoconazole and selenium sulfide shampoo
| -babies: olive oil and shampoo
35
rash secondary to venous incompetence and chronic edema
stasis dermatitis (extremely common)
36
easily mistaken for cellulitis--rash in pt's w/ diabetes or DVT
stasis dermatitis
37
stasis dermatits is a
cutaneous marker of venous insufficiency
38
tx for stasis dermatitis
1. leg elevation
2. compression stockings
3. emolliants for rash
39
dyshidrosis aka
pompholyx
40
Atopy
hyperallerfic disorder IgE (eczema, allergic rhinitis, asthma)
41
Dyshidrosis triggers (2)
1. emotional stress
| 2. hot/humid weather
42
"tapioca-like" rash of small papules and vesicles
pompholyx -- always examine soles of feet if lesions found on hands
43
(2) stages of dyshidrosis
1. vesicular stage
| 2. fissure stage
44
treatment for almost all derm disorders
topical steroid
45
morbilliform
"measles -like"
46
drug eruption characteristics (4)
1. utricarial
2. papulosquamous
3. pustular
4. bollous
47
Tx for drug eruption (IgM thing)
- discontinue offending drug
| - oral antihistamine
48
formation of a solitary erythematous patch or plaque that will recur at same site w/ re-exposure to the drug
fixed drug eruption
49
targe lesions think
erythema multiforme minor
50
erythema multiforme associated w/ (
1. pregnancy
2. radiation therapy
3. internal malignancy
4. mycoplasma pneumonia
5. herpes
51
rash plus MUCOSAL INVOLVEMENT think
erythema multiforme MAJOR (more groin involvement)
52
erythema multiforme
systemic drug rxn--like steven-johnson syndrome
53
Tx for erythema multiforme major
tx as if burn (like SJS)
54
type IV hypersensitivity Sulfa drug rxn
Steven-Johnson syndrome (around mouth, face, eyes)
55
Use drug again?
Morbilliform drug rxn:
Fixed drug rxn:
SJS:
- yes (not allergic rxn)
- no
- no
56
chronic inflammation connected w/ drugs, metals, and Hep C--"gray-white lines"
Lichen Planus (LP)
57
gray-white lines
Whickham straie (pathognumonic) --Lichen Planus
58
lichen planus most commonly on (4)
1. wrists
2. shins
3. lower back
4. genitalia
59
Tx lichen planus
topical or systemic glucocorticoids--occlusion dressing
60
herald patch
pityriasis rosea PR -- looks like ring worm--"heralds" rash by a week
61
christmas tree pattern
pityriasis rosea--along cleavage lines of trunk
62
pityriasis rosea course and tx
self-limiting,
| antipuritics + antihistamine
63
common chronic inflammatory process w/ acute flairs--"scurf"
psoriasis--genetic component T-cells
64
2 peaks for psoriasis first onset
1. 20-30 yo
| 2. 50-60 yo
65
psoriasis typically on
extensor surfaces -- areas of thick skins
66
pick off loose skin:
eczema:
psoriasis:
- no bleeding
| - bleeding
67
psoriasis classifications based on morphology (5) slide 93
1. plaque
2. inverse/flexural
3. guttate
4. erythrodermic
5. pustular
68
well-demarcated plaque overlying SILVERY SCALE
psoriasis
69
life threatening form of psoriasis
pustular psoriasis -- DON'T give ORAL CORTICOSTEROIDS
70
oppposite presentation of normal psoriasis--lack scales
Inverse/flexural -- don't confuse w/ candida
71
"raindrop" type psoriasis--w/ scales --often preceded by strep pharyngitis
Guttate psoriasis
72
bright red entire skin surface--fever, chills, malaise
psoriatic erythroderma
73
psoriasis due to corticosteroid withdrawal, must hospitalize,
pustular psoriasis
74
* don't prescribe _____ ________ for acute psoriasis
oral steroid
75
>50% of _____ ________ sufferers have fingernail involvement and JOINT PAIN
psoriatic arthritis (pitting) -- if so ask about joint pain
76
psoriasis tx
gauge area of rash--topical steroids--UV therapy -- refer to derm
NO ORAL STEROIDS FOR ACUTE FLAIRS
77
autoimmue bullous disorder in elderly pt's
bullous pemphigoid--60-80 yo's
78
*erythema doesn't always correspond w/ bullae/vesicels:
| erythema always corresponds w/ blisters:
- bullous pemphigoid
| - bullous empetigo
79
tx for bullous pemphigoid (2)
1. oral prednisone
| 2. azathioprine
80
(3) types of acne vulgaris
1. comedonal (non-inflammatory)
2. papulo-pustular (inflammatory)
3. nodular (inflammatory)
81
acne vulgaris happens where sebaceous glands are abundant i.e. (4)
1. face (T-zone)
2. neck
3. upper trunk
4. upper arms
82
Comodone type (4)
1. whitehead (closed)
2. blackhead (open)
3. inflammed papule
4. inflammed pustule
83
4 factors leading to acne vulgaris
1. androgens
2. sebaceous gland activity
3. plugging of the hair follicle resulting from abnormal keratinization
4. P. acnes in hair follicles (breaks down oil to free fatty acids --> inflammation)
84
don't chart acne vulgaris w/
"acne" -- describe lesions
85
severe nodular and scarring acne vulgaris
isotretinoin (acutane)
86
moderate papular, pustular, nodular acne vulgaris w/out scarring
oral antibiotic w/ topical retinoid and topical benzoil peroxide
87
acne vulgaris is related to _______ vs. rosacea (not sebaceous gland issue) which is not
androgens
88
Nevi
BENIGN lesion of skin
89
an inflammatory disorder predominately affecting the CENTRAL FACE
Rosacea-- NO COMODONES
90
inflammatory disorder related to flushing tendency (heat, emotions, alcohol, hot drinks, spicy foods)
rosacea (more Papules than Pustules)
91
Rhinophyma
rosacea
92
rosacea tx
topical or systemic antibiotics
93
Nevi:
| Brown moles, flat or raised, halo, may not pass ABCDE-->bx
nevomelanocytic nevus
94
looks black -->
blue nevus (resembles melanoma)
95
under diaper, deeper pigmentation, more ethnic individuals, non-blancheable, will fade in 2-3 yrs, painless
mongolian spot
96
small bright red moles, vascular related, NON-blanching
cherry angioma
97
verrucous
"wart" like appearance
98
"stuck-on" appearance
seborrheic keratosis
99
benign skin tumor appearing after 30 years mostly in males
seborrheic keratosis
100
brown fleshy plaque w/ warty surface--face, trunk, upper extremities
seborrheic keratosis--shave bx
101
pre-cancerous to squamous cell carcinoma--sun damage to keratinocytes
actinic keratosis--solar keratosis >males
102
1:1000 actinic keratosis will turn into:
tx:
- squamous cell carcinoma-
1. cryosurg
2. retinoids
3. laser
103
most common type of skin cancer
basal cell carcinoma BCC--don't metastasize
104
types of basal cell carcinoma (translucent or "PEARLY") (5)
1. nodular (translucent--pearly) Only need to know this one
2. ulcerating ("Rolled borders")
3. sclerosing (whitish sclerotic patch)
4. superficial (slightly scally thin plaque--not sun related)
5. pigmented (dark lesion--confused w/ melanoma)
105
BSS dx and tx
- biopsy
| - Mohs surgery
106
UV / HPV related "non-healing" rough, scally patch resembline actinic keratosis
squamous cell carcinoma SCC
107
SCC dx and tx
- bx
| - cryosurgery, 5-fluorouracil cream, Mohs surg
108
Melanoma mnemonic
```
MMRISK
M: mols atypical (dysplastic or large)
M: moles: common moles >50
R: Red hair and freckling
I: inability to tan Types 1-2
S: Sunburn
K: kindred: family history
```
109
AIDS related, nonpruritic, lesion similar to lichen planus
Kaposi sarcoma--purple, fleshy lesions
110
Kaposi sarcoma distribution
lower extremities, head, and neck
111
Kaposi sarcoma think
HIV--CD4 counts and viral load
112
HAART
highly active antiretroviral therapy
113
lice aka
pediculosis
114
lice love
healthy clean hair
115
nits are _____ if they haven't hatched, _____ if they've hatched
black,
| white
116
"the great masquerader"
scabies
117
tx lice w/ ______and repeat in_________
1% permthrine,
| 7 days for nits
118
ues ______ when resistant to permethrin
malathion
119
severe night-time ITCH--spread skin-skin--thick skin bug and tx
1. scabies
| 2. 5% permethrin--or lindane
120
Itching at night think
scabies (high complaints--low physical findings)
| -scaby burrows and lays eggs-->^itch
121
dx scabies (2)
1. mineral oil on slide dig out burrow
| 2. burrows
122
mild utricaria --> full-thickness skin necrosis
spider bite
123
concerns w/ spider bites
secondary infx--assume worst and treat for bac
124
mild local rxn from arthropod bite feeds only on mammal and bird blood
flees and bed bugs,
| Dx: PAPULAR URTICARIA
125
multiple, soft, coalescing filiform papules,
HPV--Condyloma acuminatum
126
cauliflower on genitals and anus
condyloma acuminatum
127
tx for condyloma acuminatum (3)
1. aldara (guardacil)
2. crysurgery
3. surgical removal
128
viral exanthems blanket term ex's (4)
1. measles
2. rubella
3. chickenpox
4. 5th disease
5. etc.
129
cutaneous eruption, erythematous, diffuse/generalized papules and macules all over body and throat (BLANCHING)
viral exanthems
130
with viral exanthems make sure not
measles (present w/ fever and mellase) or rubella
131
herpangina--back of throat rather than herpes in front
cocksacki
132
Herpes simplex stages (2)
1. primary (asymptomatic or w/ bleeding vesicles)
| 2. recurrent (cold sore)
133
Tzanck smear--Giant cells think
Herpes simplex
134
"central umbilication" -- skin-skin
molluscum contagiosum (pox) -- cottage cheese filled
135
tx molluscum contagiosum (3)
1. aldara cream
2. cryosurg
3. supportive
136
"dewdrops on a rose petal" --> papule --> vescicle --> pustule --> crust (vesicles on a erythematous base)
Varicella-zoster virus
137
Varicella-zoster virus forms (2)
1. primary--chicken pox
| 2. recurrent--shingles
138
once VZV lesions crust over...
they're no longer contagious
139
Viral:
- all at same stage (2)
- different stages (1)
- Molluscum contagiosum, shingles
| - chicken pox
140
verrucae aka
warts
141
common wart type
verruca vulgaris
142
wart on sole --may turn black
Verruca plantaris
143
flat wart
verruca plana
144
tx for warts
salicylic acid (compound W)
145
bac inflammation of hair follicle aka
FURuncle aka boil
146
multiple furuncles
carbuncle
147
verrucae etiology
HPV
148
can feel the edges of the abscess
induration w/ palpation
149
boil tx
I&D, antibiotics, pack and leave open if large--culture drainage
150
cellulitis vs
erysipelas (both warm, tender, swollen)
151
Sharply demarcated, GLISTENING, smooth skin infection-->strep pyogenes
erysipelas
152
common location:
cellulitis:
erysipelas:
- lower leg
| - central face/ cheeks
153
infection of hair follicle:
| ingrown hair:
- folliculitis
| - pseudofolliculitis
154
"hot tub" folliculitis
pseudomonas infx--> folliculitis Tx w/ Cipro
155
Folliculitis causes: (gram stain)
DM pts:
chronic antibiotics:
- Staph
| - Klebsiella and E. coli
156
"Bright erythematous w/ Satellite lesions"
candidiasis
157
moist, dark, warm candidiasis etiology
candida albicans --^DM and obesity
158
"White lacy network on erythematous base"
candidiasis
159
tx for candidiasis
topical: nystatin
oral: nystatin, fluconazole
160
tinea versicolor (not a dermatophyte) aka
pityriasis versicolor
161
tinea versicolor etiology
pityrosporum ovale (yeast) opportunistic infx
162
tinea versicolor/ pityrosporum ovale dx
- KOH: "spaghetti and meatballs"
| - woods lamp
163
tinea aka
dermatophyte
164
most common dermatophyte infx--highly contagious --central clearing w/ scale in middle
tinea corporis aka ringworm
165
athlete's foot aka
tinea pedis
166
tinea pedis types (6)
1. interdigital
2. dry
3. moist (macerated)
4. moccasin
5. vesicular
6. ulcerative
167
confirm tinea unguium w/
culture instead of KOH prep
168
See ______ ________ think diabetes
acanthosis nigricans --"velvety thickening"
169
painful nodules on shins
erythema nodosum
170
suppurative dz w/ open double comedones--Apocrine glands
hidradenitis suppurativa--
171
benign subQ fat cell tumor--moveable
lipoma
172
epithelia inclusion cyst aka
epidermal inclusion cyst --very common
173
cystic enclosure filled w/ keratin and debris
epithelial inclusion cysts
174
"black spot" associated w/ pregnancy and oral contraceptive, aka
melasma aka cholasma or mask of pregnancy
175
pilosebaceous glands w/ keratin --> folliculitis --> edema/occlusion --> pilonidal abscess
pilonidal disease
176
sacrococcygeal region --painful, fluctuant mass
pilonidal disease (stinky)
177
wheels think
utricaria
178
phototoxic eruption rom contact w/ light-sensitizing botancial subastance and UVR (i.e. lime juice)
phytophotodermatitis
179
TRANSIENT EDEMATOUS PAPULES/PLAQUES
Hives aka utricaria
180
melanocytes destroyed leading to depigmentation
vitilago
181
dx vitilago
1. bx
| 2. wood's lamp
