Derm Exam #2 Flashcards

Question

AA Totalis

Answer 1

Total loss of terminal scalp hair

Answer 2

Total loss of all terminal body and scalp hair

Answer 3

Bandlike pattern of hair loss over periphery of scalp

Answer 4

Fine pitting "hammered brass" of dorsal nail plate

Answer 5

Usually clinical to r/o: Biopsy RPR - Syphillis KOH - FUngal ANA - Autoimmune Thyroid

Answer 6

Majority have spontaneous remission Poor prognosis for early onset

Answer 7

Psych, Wigs, Hair pieces, No cure

Answer 8

Class 1 or 2 CS with minoxidil - 5% Anthralin - see heair growth in 2-3 months NOT USED on face

Answer 9

Short term Pred 20-40mg daily, taper over a few weeks

Answer 10

Hyperkaritinazation of the skin and keratotic follicular plugging 50-80% of all adolescents

Answer 11

Plucked chicken skin Becomes worse in winter - patients may pick/scratch - not always itchy 1-2mm raise papules

Answer 12

Clinical dx Biopsy for atypical presentation

Answer 13

Hydration - gentle soap and moisturizers (Cetaphil, Lubriderm, Rx - Lac-Hydrin)2-3xd Steroid creamor salicylic acid BID to reduce inflammation if needed

Answer 14

Nail bed dital to cuticle

Answer 15

Nail grows into the side of the paronychium(nail bed) MC in males in their 20s

Answer 16

Warm soaks Mupirocin BID until healed Proper trimming Training - cotton Surgery

Answer 17

Keep clean with soap and water Mupirocin Resume activity in 48-72 hours

Answer 18

AKA Tinea unguium Fungus invades the nail

Answer 19

Asymptomatic MC complaint - discoloration Thickening and lifting from nail bed

Answer 20

Age Fam hx Poor health Trauma - very active Communal bathing/no shower shoes

Answer 21

r/o melanoma if pigmented dark bands esp in caucasian Nail clipping or scraping - biopsy clipping, KOH scraping

Answer 22

Topical or oral antifungal - Ciclopirox or Efinconazole Daily for 48 weeks 50/50 apple cider vinegar and water 10 minutes per day

Answer 23

6 weeks for fingers 12 weeks for toes Monitor liver May take up to a year for nail to grow back

Answer 24

Detachment of nail from nail bed Trauma, Psoriasis, HSV

Answer 25

Gray to black = Air Green = Bacteria No inflammation and smooth nails

Answer 26

Treat underlying cause

Answer 27

Inflammation of the proximal or lateral nail fold Cellulitis to abcess MCC trauma 2nd MCC bacteria

Answer 28

MCC - Staph Green = Pseudomonas

Answer 29

Painful, Swollen, Tender, Erythematous, Pus

Answer 30

Gram, C&S, KOH, etc.

Answer 31

Warm soaks 3-4x daily until resolution I&D if fluctuant Consult hand surgeon

Answer 32

When: Cellulitis, DM, Peripheral vasc disease, Immune comp Augmentin 10 days ALT: Clinda or Keflex

Answer 33

From repeated exposure Inflammation waxes and wanes Pain Swelling 6+ weeks

Answer 34

Avoid triggers Keep dry Avoid manipulation Warm antiseptic soaks Topical antifungals (oral if severe

Answer 35

Distal involved herpes HSV-1 or gingivostomatitis in children from sucking thumb/finger HSV-2 Adults - healthcare workers

Answer 36

Burning and pruritis followed by vescicular eruption Clinical dx - can use a Tzank smear

Answer 37

NO I&D Self limiting - 3 weeks Contagious OTC pain meds Acyclovir/Valacyclovir

Answer 38

Soft tissue infection of the pulp space of the distal phalanx Hx of penetrating injury, splint, paronychia

Answer 39

Pain, Swelling, Erythema, Tenderness, Abcess usually in thumb or index finger

Answer 40

Osteitis, Osteomyelitis, Septic joint, Tenosynovitis

Answer 41

Gram stain with C&S Tzank to r/o herpetic whitlow XR

Answer 42

Augmentin for 10 days Surgical decompression

Answer 43

Due to persistent hypoxic state

Answer 44

Melanoma of the nailbed, P-J or L-H syndromes

Answer 45

Psoriasis or eczema

Answer 46

Endocarditis, Vasculitis, Lichen planus

Answer 47

2/3 of nailbed appears whit with pink apex Liver disease or HIV

Answer 48

Zinc or iron deficiency

Answer 49

Precancerous epithelial lesions on sun exposed areas of the body - light skin types

Answer 50

Rough - sand paper keratotic lesions Barely elevated Felt more than seen Sun exposed areas May be tender/pigmented

Answer 51

Risk of developing into non-melanoma skin cancer

Answer 52

Clinical - refer to derm if unsure - biopsy Dermoscopy - erythema with pseudo-network around hair follicles Classic gritty feel

Answer 53

Liquid nitrogen to freeze

Answer 54

Lesions that keep coming back Painful or tender

Answer 55

Counsel on sunscreen and sun avoidance Moisturizer with sunscreen 30+ SPF Mineral based is best

Answer 56

Cryosurgery Curettage Shave excision

Answer 57

5-Fluorouracil - MC 2-4 weeks Imiquimod - 16 weeks Picato - 2 days $$$ Diclofenac - 90 days

Answer 58

Blocks DNA synthesis = aptoptosis and selective cell death

Answer 59

BID for 2-4 weeks Localized skin reaction - gonna happen!!

Answer 60

Immune modulator Stimulates local cytokine induction

Answer 61

Non hypertrophic AK on face or scalp

Answer 62

Localized skin reaction -increased clearance rates Wash hands!!!

Answer 63

Disrupts cell membrane followed by neutrophil cytotoxicity - 2 step AK ONLY Risk of SCC

Answer 64

COX-2 inhibitor - inhibits prostaglandin synthesis Localized skin reaction is less severe than other agents

Answer 65

Less cost effective - needs a specialist Cryopeeling, dermabrasion, chemical peels, Laser resurfacing, photodynamic

Answer 66

1st visit - lesion targeted tx 2nd visit - f/u in 2-3 months, biopsy if recurrent, target if new, field therapy if numerous

Answer 67

6-12 months if lesion targeted 3-6 months if field therapy

Answer 68

Malignancy of cutaneous epithelial cells on sun exposed areas of the skin May be proceded by actinic keratoses, HPV

Answer 69

Oral mucosa or lip

Answer 70

Thicker and more keratotic than AK Hard, painful, come in many shapes and sizes Bleed easily Sun exposed or HPV areas

Answer 71

Chronic sun exposure Low fitzpatrick Skin grafts Age HPV

Answer 72

May occur in scars - still happens!!

Answer 73

SCC confined to the epidermis AKA Bowens disease More common in transplant/AIDS patients

Answer 74

Dermoscopy - Red vessels as dots, Scale/Crust, Shiny white structures Coiled vessels Keratin pearl - orange ovoid Gray brown dots in pigmented Biopsy if concerning

Answer 75

Examination of refional lymph nodes

Answer 76

Pleomorphic SC with variable nuclear size Overlying parakeratosis Kertinocyte mitoses Dyskeratosis

Answer 77

Excision with narrow margins (3-5mm) is choice Mohs or 6mm borders in high risk lesions

Answer 78

Electrodessication with curretage - leaves large circular scars Radiation for very large

Answer 79

Imiquimod 5FU

Answer 80

Watch for suspicious lesions - scars w/o trauma SPF 30+ sunscreen No tanning beds

Answer 81

Fast growing solitary SCC variant Craterioform - volcano shape Treat quickly -Mohs excision

Answer 82

MC Skin Cancer Neoplasm of basal keratinocytes Sun exposed areas Mostly a cosmetic issue - not frequently metastatic

Answer 83

Nodular Ulcerating Infiltrating Pigmented Superficial

Answer 84

Pearly papule Well defined borders Smooth and firm with telangiectasias May have erosions

Answer 85

Translucent pearly smooth, firm, telangiectectic +/- elevated borders - rat eaten

Answer 86

Scar like plaque with pink/white with ill defined borders

Answer 87

Thin patch or plaque Pink/Red +/- scaling

Answer 88

Firm papule/Nodule with or without umbilication Smooth pearly surface Pigmented or stippled

Answer 89

Really good - 3/5 will develop another one - follow Non-healing or bleeding needs workup

Answer 90

Sun exposed areas More than one under 30 may mean nevoid BCC syndrome or ionizing radiation exposure Larger than they appear

Answer 91

Nests and cords with peripheral pallisading and central hahazard arrangement Hyperchromic nuclei and scant cytoplasm Marked solar elastosis Apoptotic neoplastic cells

Answer 92

Sun protection Follow with provider Watch for suspicious lesions

Answer 93

Cryosurgery, Moh's - high risk area or large lesion (over 2cm)

Answer 94

end in ~degib Hedgehog pathway inhibitors (Vismodegib, Sonidegib)

Answer 95

Benign overgrowth of skin cells Congenital or Acquired - often regress by 60

Answer 96

Asymptomatic Symmetric Sharp borders Uniform color

Answer 97

Dermoscopy

Answer 98

Scalp, anogenital, or mucosal Rapid change Irregular borders Erosions Persistent itching

Answer 99

Precursor to superficial spreading melanoma Asymptomatic Irregular shape Sharp and ill defined borders Variegated color Maculopapular

Answer 100

Usually clinical - biopsy if needed

Answer 101

Observation Surgical excision with biopsy if changing or can't be observed

Answer 102

3 month if fam hx of melanoma 6-12 months if sporadic

Answer 103

Monthly self exams Skin exams for family members

Answer 104

Aggressive malignancy of color producing cells

Answer 105

Superficial spreading - MC Nodular melanoma Lentigo maligna melanoma Acral lentiginous melanoma - LC

Answer 106

Over 25 nevi Blistering sunburn before puberty Tanning beds Immune suppression

Answer 107

De novo (more common) or precursor from existing lesion Radial growth then vertical growth leading to metastasis

Answer 108

Assymetric macule with variagated pigment trunk in men or LE in women MC

Answer 109

Dark brown bluish-black nodule that grows rapidly May bleed/ulcerate Trunk, head, or neck

Answer 110

Assymetric brown to black macule or patch with color variegation and irregular borders SLOW GROWING Begins more weel defined

Answer 111

Assymetric brown to black macule - palms, soles, nail apparatus

Answer 112

A - Asymmetry B - Borders C - Color D - Diameter E - Evolving

Answer 113

Look for the Nevi that is not like the others on a patient with many lesions

Answer 114

If you can punch the whole thing punch, if it is large - shave

Answer 115

Clark - Levels I-V (Epidermis, Dermisx3, Fat) TNM Staging Breslow

Answer 116

Breslow stage over 0.76

Answer 117

0.5 cm for in situ 1 cm for under 1mm 1-2 cm for 1-2mm 2cm for over 2 mm May depend on area - use slow Mohs for difficult area

Answer 118

BCC or SCC - Every 6 months Hx of Melanoma - every 3 months

Answer 119

Excisional procedure that allows for real time evaluation of tumor margins Indicated for SCC and BCC Spares healthy tissue

Answer 120

Mask of face, genitalia, tops of hands and feet

Answer 121

Rest of head, shins

Answer 122

Cure rates not as good as mohs Indications - Well defined BCC and low risk SCC

Answer 123

Punch and remove - creates oval Apply in circular twisting motion Suture or cauterize CI in aftive infection

Answer 124

UVA - Passes through window glass UVB - Most burns does not pass through window glass UVC - Absorbed by the ozone All age the skin!!

Answer 125

Ratio of burn with sunscreen v. without (ie. SPF 15 takes 15 times longer to burn)

Answer 126

Acute exanthemous eruption -single herald plaque Becomes generalized later Herpes 6 and 7

Answer 127

Herald patch to general - oval or slightly raised Salmon red General exanthem with marginal collarette Christmas tree pattern Rarely involves face

Answer 128

NOT ON FACE usually

Answer 129

Spontaneous remission in 6-12 weeks Oral antihistamines Topical anti-pruritic (Sarna) Triamcinolone Oral prednisone

Answer 130

Acute or chronic Idiopathic - Believed to be CD8/CD45Ro cells Exposure to metals?

Answer 131

4P's Polygonal or oval papules - annular, purple, pruritic Violaceous white lines - Whickham striae - grouped or disseminated Ciggarette paper skin

Answer 132

Wrist, Lumbar, Shin, Scalp, Glans penis, Mouth

Answer 133

Large thick plaques

Answer 134

White, bluish well demarcated papules and plaques with central atrophy

Answer 135

Follicular papules and plaques that lead to cicitricial alopecia

Answer 136

Bullous pemphigoid w/ LP

Answer 137

Hyperpigmented dark brown macules in sun-exposed area and flexural folds

Answer 138

Papules in sun exposed areas

Answer 139

Therapy resistant spots = ulcers

Answer 140

40-60% have mouth involvement

Answer 141

Lacy white hyperkeratosis on buccal mucosa, lips, tongue, gingiva

Answer 142

Months to years Biopsy extremely helpful for dx

Answer 143

Topical steroids w/ triamcinolone 1st line Under occlusion for cutaneous lesions

Answer 144

Cyclosporine or prednisone Retinoids as adjunct

Answer 145

Chronic condition of the dermis Self limited MC in females

Answer 146

Skin colored or red-brown Shiny beeded papules Hands, feet, elbows, knees Looks like tinea

Answer 147

Clinical but biopsy is diagnostic

Answer 148

Foci of chronic inflammatory and hastocytic infiltrations in superficial and mid dermis Necrobiosis of connective tissue surrounded by pallisading histocytes and multinucleated giant cells

Answer 149

Not always necessary - 70% go away in two years Topical triamcinolone ILK Cryo may resolve but leaves scarring (worse with dark skin

Answer 150

Common acute inflammatory/immunologic reaction pattern of the SQ fat Infection, Drugs, Inflammation, Sarcoidosis

Answer 151

20-30 years old Females more common

Answer 152

Painful, tender, fever, malaise, arthralgia (esp. ankles)

Answer 153

Indurated, red nodules 3-20cm Diffuse margins Deep seated in fat Bilateral but NOT symmetrical

Answer 154

Elevated ESR and CRP, leukocytosis Spontaneous resolution in 6 weeks 2 punch biopsies to get dermis, then adipose fat - must get the fat!!!

Answer 155

Bed rest Compressive bandages Wet dressings

Answer 156

NSAIDs and Prednisone

Answer 157

T cell mediated Poorly understood

Answer 158

20-30 50-60

Answer 159

Psoriatic without active lesion Slight capillary dilation and curvature Slight increase in dermal mononuclear cells and mast cells Increase in epidermal thickness

Answer 160

A developing lesion Progressive capillary dilation and toruosity Increase in mast cells, t cells, and degranulation of mast cells Increasing epidermal thickness

Answer 161

10 fold increase in blood flow and epidermis Increase in T cells Neutrophils in stratum corneum

Answer 162

Trauma d/t friction causes tetanerization Immune and genetic

Answer 163

Guttate or nummular psoriasis Multiple small lesions with spontaneous remission Follows strep pharyngitis

Answer 164

Pustules instead of patches, papules and plaques Corticosteroid withdrawal Stinging, burning, pruritis

Answer 165

MC presentation Classic lesions for months to years with little change Dull red plaques, well demarcated

Answer 166

Papule/Patch/Plaque Silvery white scales that leave small blood droplets when scratched - Auspitz sign (easy removal) Pruritis

Answer 167

Salmon/Pink papules 2-10 mm Concentrated on trunk with scalp and extremity lesions Resolves spontaneously or becomes chronic

Answer 168

Elbows Knees Scalp Gluteal cleft - MC Palms/Soles

Answer 169

Thick, adherent silvery white or yellow scaling Painful cracking and fissures

Answer 170

Sharply marginated Intense pruritis NO hair loss

Answer 171

Usually more macerated and moist

Answer 172

Pitting, onycholysis Yellow/Brown oil spots

Answer 173

2-5mm pustules Erupt into dusky red erosions/crusts Persists for years

Answer 174

Pustules coalesce into lakes Nikolsky sign LIFE THREATENING May evolve to plaque psoriasis

Answer 175

Joint stiffness and pain with swelling, redness and tenderness

Answer 176

Usually clinical -biopsy, strep test for acute inflammatory, KOH for fungal suspicion Culture for pustular

Answer 177

Generalized - refer to derm Psoriatic arthritis - to rheumatology

Answer 178

Apply high potency topical steroids after soaking lesions Calcipotriol Vitamin D analog Occlusive dressing

Answer 179

Tazarotene with GC and UV therapy Coal tar with salicylic acid Emollients

Answer 180

Dovonex, Calcitrene (brand names) Binds to Vitamin D receptor and regulates cell growth

Answer 181

Psoriasis Apply thin layer BID May cause burning, itching, photosensitivity

Answer 182

Also for psoriasis Binds to vitamin D receptor and regulates growth

Answer 183

Tar shampoo followed by medium-high potency lotion

Answer 184

High potency topical steroid ointment with occlusive dressing PUVA soaks Oral retinoids

Answer 185

Short term steroids (2-4 weeks) followed by: Vitamin D analog OR Topical retinoid (tazarotine) OR topical calcineurin inhibitor (tachrolimus/pimecrolimus)

Answer 186

Long time to heal PUVA Oral retinoids Biologics for complicated

Answer 187

Tazarotine - retinoid

Answer 188

Stinks - odor

Answer 189

Refer to derm UVB or Oral PUVA photochemotherapu

Answer 190

Hospitalization with IV fluids In hospital derm consult IV abx

Answer 191

PUVA UVB Oral retinoid Biologics

Answer 192

Within an hour of first dose

Answer 193

After an hour, usually within 6 hours but can be weeks to months

Answer 194

Maculopapular rash PCN administration in EBV and CMV 2-3 days immediate Delayed 7-10 days

Answer 195

PCN, Carbamazepine, Allopurinol, Gold salts

Answer 196

Sulfonamides, NSAIDs, Isoniazid, erythromycin, streptomycin

Answer 197

Barbituates, BZDs, Phenothiazines, tetracyclines

Answer 198

D/c drug usually - if we want to keep the drug treat with oral or topical steroids

Answer 199

Patch or plaque at the same site upon exposure Onset 30 min-8 hours

Answer 200

Shaply marginated, dusky red later, erythematous early Glans penis is common site

Answer 201

Remove offending agent Topical steroid for non-eroded lesion Abx for eroded lesion Antihistamine for pruritis

Answer 202

Sulfonamides Dapsone Sulfasalazine Phenytoin Carbamazepine Phenobarbital

Answer 203

2-6 weeks after drug initiation or after increase in dose Fever, facial edema Lymphadenopathy and Hepatosplenomegaly

Answer 204

Maculopapular eruption starting on face Oropharyngeal lesions

Answer 205

Need three of: Cutaneous drug eruption Hematologic abnormalities Systemic involvement (Lymphadenopathy >2cm; elevated LFT, Elevated BUN/Cr)

Answer 206

Stop all suspected medications Topical steroid with mild/mod Oral steroids if mod/severe

Answer 207

Acute febrile eruption Sterile pustules with erythematous base Resolve over 2 weeks Desquamate over 2 weeks

Answer 208

Common benign neoplasms appearing on the chest and back Stuck on appearing with well defined borders Unknown etiology

Answer 209

Stuck on, greasy, itchy Yellow to black/brown Well demarcated Waxy scale

Answer 210

Inlfamed seborrheic keratosis - pink siny plaque Can be a sign of internal cancer

Answer 211

Ridges, fissures forming a cerebreform (brain like) pattern Looped or hairpin vessels Scaloped border

Answer 212

Made clinically Dermoscopy to differentiate between melanoma Biopsy if concerned for cancer

Answer 213

Sharply demarcated proliferation of monotonous epidermal keratinocytes Small keratin cysts "horn cysts"

Answer 214

Removed for cosmetic purposes Reassure on chronic nature Dermoscopy if suspicious

Answer 215

Cryosurgery Shave excision for large

Answer 216

Dark pigmentation usually on the face/maxilla May be seen in pregnancy Woods lamp can dx but not necessary

Answer 217

Triluma which is Flucinolone, Hydroquinone, and Tretinoin

Answer 218

Localized proliferation of melanocytes in caucasian patients Brown oval with ill defined borders Sun exposed areas

Answer 219

Cryotherapy of Laser tx

Answer 220

Skin tags May become tender, orhemorrhagic May be seen in metabolic syndrome

Answer 221

Often a plugged pilosebaceous gland Symptomatic until infected

Answer 222

Cryotherapy Snipping Electrodessication

Answer 223

Flesh colored firm nodules Malodorous contents Face, Trunk, Neck Scrotum

Answer 224

Don't pick at or squeeze

Answer 225

Clinical, make refer to bx or FNA

Answer 226

No tx if asymptomatic I&D if inflamed I&D and abx if infected Excision - best performed when not inflamed

Answer 227

May wax and wane - watch for non-healing but not common

Answer 228

MC soft tissue tumor Collection of fat cells in a fibrous capsule MC on trunk

Answer 229

Soft, painless, slow growing nodule 1-10cm in size Rubbery

Answer 230

Clinical Bx IF: Pain, movement restriction, rapid growth May surgically excise if problematic

Answer 231

Dark blue violaceous papule due to a dilated venule MC on face, lips, ears MC over 50 Lined with endothelial cells

Answer 232

Compresses with pressure Lightened with diascopy Vascular on dermoscopy

Answer 233

Resect for cosmetic reasons - laser excision

Answer 234

Pruritic, raised well-circumscribed areas of erythema and edema WBCs cause extravasation of fluid to dermis

Answer 235

Raised erythematous-pink-skin colored wheals with central pallor Size and shape change rapidly Resolves in 24 hours May be able to draw on skin

Answer 236

Can progress to angioedema or anaphylactic shock H1+H2+Steroid is recommended

Answer 237

Loratadine, Fexofenadine, Cetirizine 1st gen but second line: Benadryl and Vistaryl

Answer 238

Cimetidine, Famotidine, Rantidine

Answer 239

Antihistamines PRN

Answer 240

Rapidly growing vascular lesions following a trauma Red and friable, smooth, may have crusts and erosions

Answer 241

Surgical excision Electrodissection and Currettage

Answer 242

Cherry, Capillary, Or Strawberry Vascular tumors in babies starting at 2-4 weeks of age MC tumor in babies

Answer 243

Red, Soft, compressible papules or nodules 1-10cm

Answer 244

Resolve by 5-10 years old

Answer 245

aka Cavernous Lower dermis or SQ fat Purple/Bluish with telagiectasias

Answer 246

Under 2mm papules over the entire body

Answer 247

Present at birth

Answer 248

Check Doppler US for blood flow - may obstruct airway, etc. Propranolol 1 st line - can be topical Prednisone 2-3mg/kg daily Laser an option

Answer 249

Depigmentation disorder causing absence of melanocytes Often genetic

Answer 250

Chalk or white macules with sharp margins Sun exposed areas New macules in areas of recent trauma

Answer 251

Symmetrical and widespread Skin around mouth, fingers, toes, nipples genitalia

Answer 252

Only on one part or side of the body in aband Seen at a young age progresses over 1-2 years

Answer 253

Only 1-3 macules in a single site

Answer 254

Over almost the entire body d/t confluence of macules

Answer 255

Clinical May do a bx or woods lamp exam

Answer 256

No cure - oral JAK inhibitors may helpSunburn precautions May use glucocorticoids or phototherapy - UV

Answer 257

D/c if no response in two months

Answer 258

Minigrafting Depigmentation using hydroquinone

Answer 259

Structures that adhere cells to one another

Answer 260

Proteins inside of the desmosomes

Answer 261

Hemidesmosomes bind epidermal basement membrane to basal membrane

Answer 262

Loss of cell to cell adhesion d/t autoimmune disorder IgG antibodies bind to desmogleins

Answer 263

Flacid blisters on skin and erosions on mucous membranes Starts in oral mucosa Jewish/Mediterranean descent

Answer 264

Scaly and crusty lesions at 40-60 years MC in Brazil

Answer 265

Depend on when presenting - Vesicles/Bullae, Flacid and leaking May bleed, may be scattered May see erosions

Answer 266

Dislodging of normal appearing epidermis by lateral finger pressure inlesion vicinity is positive

Answer 267

Scalp Face Chest Axilla Groin

Answer 268

Biopsy at edge of blister Direct immunofluorescence on normal appearing lesion-adjacent skin Serology for ab to desmoglein

Answer 269

Leads to death if not treated Prednisone 2-3 mg/kg until cessation, then taper May use immune suppressors Azathioprine or mycophenolate Wound care

Answer 270

Fluid/Electrolyte imbalance Secondary infection Osteoporosis from steroid tx

Answer 271

Rare autoimmune disease usually in the elderly 60-80 MC bullous autoimmune disease

Answer 272

Development of auto-antibodies against basement membrane antigens BPAG1&2 Ab's activate complement system Weakening of adhesions between dermis and epidermis Formation of bullae

Answer 273

Starts as pruritis/Urticaria Large tense firm topped bullae NEGATIVE Nikolsky sign Less severe/painful oral lesions

Answer 274

Biopsy is Gold Standard - linear IgG deposits along basement membrane Serology also possible

Answer 275

Derm referral Prednisone 50-100mg/day divided may couple with azathioprine

Answer 276

Acute hypersensitivity reaction affecting the skin and mucous membranes May have eye involvement Infection or Drug related

Answer 277

Erythematous papular or urticarial type lesions Can have mucosal ulcerations and uveitis Bilateral and symmetric - Usually

Answer 278

Little or no mucosal involvement Vesicles but nobullae No systemic symptoms Confined to face and extremities

Answer 279

Mucosal involvement Confluence of lesions + Nikolsky sign Constitutional symptoms Chelitis/Stomatitis Eye involvement

Answer 280

Drug reaction

Answer 281

Antihistamine for pruritis Low dose topical steroid Antiviral for underlying HSV High dose steroid gel or lido/benadryl topical oral solution

Answer 282

IV fluids Hospital admit Systemic steroids for severe disease Compresses of large lesions

Answer 283

Cytotoxic event caused by immune response resulting in keratinocyte destruction MC d/t rx drugs

Answer 284

Fever chills, Skin tenderness Abrupt mucocutaneous lesions: Macule, Papule, Vesicle/Bulla, Erosion Rapid confluence + Nikolsky sign Red oozing dermis Dermis off in sheets

Answer 285

Face and extremities

Answer 286

Conjunctivitis, Keratitis, etc.

Answer 287

Fever HR over 120 Sloughing of epidermis

Answer 288

Clinical, biopsy may aid - extent determines SJS vs. TEN

Answer 289

Under 10% of body surface

Answer 290

Over 30% of body surface

Answer 291

10-30% of body surface affected

Answer 292

Stop insult IV fluids Parenteral nutrition IV pain meds Would care

Answer 293

Darkening of neck, elbows, etc. - body folds May have skin tags

Answer 294

Obesity Cancer - worry if thin pt. Drug - Niacin Syndromic - Acromegaly or Autoimmune Acral - From leaning on knees, elbows Unilateral - Nevoid Beinign - Auto dom Mixed

Answer 295

Make sure it isn't just dirt - use alcohol pad Usually symmetric Velvety thickening

Answer 296

Patient is dirty

Answer 297

Usually clinical, esp. if hx of diabetes, obestity, PCOS Biopsy if concern for malignancy etc.

Answer 298

Evaluate with other providers for underlying causes - endo, etc.

Answer 299

Retinoid and Vitamin D can be used

Answer 300

Ischial tuberosity, trochanter, sacrum, maleolar, heel

Answer 301

May be deeper than appears - wider at base May need pain meds for full exam

Answer 302

Skin intact with non-blanchable erythema

Answer 303

Partial loss of dermis Shallow, open ulcer

Answer 304

Full thickness skin loss with fat exposed

Answer 305

Exposed bone, muscle or tendon

Answer 306

Covered with slough or eschar Suspected deep injury if purple

Answer 307

May indicate an anaerobic infection

Answer 308

Eliminate risk factors - redistribute pressure Cover with transparent film for protection

Answer 309

Transparent or hydrocolloid dressing - CI in active infection

Answer 310

Debridement

Answer 311

Measure size in cm Exudate Tissue type Score 0-17 (lower is better)

Answer 312

I-II in 1-2 weeks III-IV in 6-12 weeks

Answer 313

Chronic supperative disease of the apocrine gland bearing skin areas (axillae, crural, etc.) Females more common Larger BMI or smokers, occlusive dress

Answer 314

Infiltration, dialtion, and rupture of follicles - become connected leading to tx difficulty

Answer 315

Recurrent painful supurrative lesions that leave scars Open comedomes Abcess, scarring, and sinus tracts

Answer 316

Goal to reduce length, symptoms, scarring, and tunnelling Combo of steroids, abx, retinoin, biologics, surgery used to be more popular

Answer 317

I&D or "de-roof lesions

Answer 318

PCN, Cephalosporins, Augmentin, Clinda

Answer 319

Abx with retinoid (ie. Clinda and Isotretinoin) Excision may be needed Humira

Answer 320

Hygeine Weight loss Warm compress Smoking cessation Tea bags applied to lesions Looser undergarments Laser hair removal/Shaving change

Answer 321

Abnormal response to light - sunburn, rash or urticaria

Answer 322

Pruritis, pain, or tenderness May have toxic or flu like illness if severe Bright red

Answer 323

Develops after 6 hours, peaks at 24

Answer 324

Cool wet dressings Aloe vera NSAIDs for systemic Fluids and rest are improtant for severe cases

Answer 325

10AM to 2PM

Answer 326

At least 30spf applied every 80 minutes

Answer 327

Due to a chemical or allergen causing a photo-reaction - may be due to retinoids, amiodarone, etc. Allergy is more eczematous

Answer 328

Non-delayed Treat like sunburn

Answer 329

Delayed reaction Remove offending agent and steroid, antihistamine tx

Answer 330

Dry skin Ashiness, fine scale and fissuring Pruritic and patchy, less shine

Answer 331

Age - common over 60 Longer bathing Moisturizing use

Answer 332

Use moisturizer - low fragrences - Dove, cetaphil, cerave Bathing in tepid water - not too often Mist skin before applying moisturizers Humidifier

Answer 333

Lactic acid, ammonium lactate, alpha hydroxy acids

Answer 334

Autosomal dominant tough scale - like fish Associated with atpoic derm Extreme dryness

Answer 335

3-12 months of age

Answer 336

Rare - may indicate malignancy

Answer 337

Dry, fine scaling skin, most obsvious in extensor extremities Symptoms better in summer

Answer 338

Clinical - may do a biopsy but not necessary

Answer 339

Emollients are mainstay Humidifier Moisturizing soaps after bathing Keratolytics

Answer 340

Always for on the face Depends on size elsewhere