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Clin Med I > Derm I > Flashcards

Derm I Flashcards

1
Q

Pt presents w/ purulent lesion on one leg that developed over the past several days, no systemic sxs

A

Cellulitis

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2
Q

Pt presents w/ a well demarcated erythematous butterfly lesion that developed acutely + fever & chills

A

Erysipelas

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3
Q

Pasteurella multocida

A

cat bite

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4
Q

Capnocytiphaga canimorsus

A

dog bite

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5
Q

Erysipelothrix rhusipathiae

A

petting zoo –> goat, camel, llama bite

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6
Q

Vibro vulnificus

A

ocean related

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7
Q

Pseudomonas aeruginosa cellulitis common in

A

diabetics, IC pts, hospitalizations

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8
Q

Sporothrix schenckii

A

rose gardener

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9
Q

Where do skin abscess’ collect

A

within the dermis or SC space

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10
Q

Pt presents with painful, fluctuant, erythematous nodule & regional adenopathy

A

Skin abscess

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11
Q

For Skin & Soft Tissue infections, which dz has systemic sxs and which do not

A

systemic - Erysipelas

non-systemic - cellulitis & skin abscess

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12
Q

MC pathogens for Erysipelas

A
  • beta hemolytic strep

- staph aureus

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13
Q

MC pathogens for Cellulitis

A
  • beta hemolytic strep

- staph aureus (including MRSA)

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14
Q

MC pathogens for Skin abscess

A

-staph aureus (including MRSA)

mostly bacterial but can be viral

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15
Q

furuncle vs carbuncle

A

-skin abscess of a single hair follicle vs multiple hair follicles

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16
Q

Dx of erysipelas vs cellulitis vs skin abscess

A
  • manifestation & hx

- ultrasound for diff. between cellulitis (cobble stone appearance) vs. skin abscess (fluid filled)

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17
Q

LRINEC Score (use/when/meaningful value)

A
  • used to distinguish Necrotizing Fasciitis from other soft tissue infections
  • use when: concerning hx/exam, pain out of proportion to exam, rapidly progressing cellulitis

> 6 rules in NF

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18
Q

Complications of Cellulitis

A
  • NF –> OR debridement
  • Bacteremia & Sepsis –> draw blood cultures
  • Osteomyelitis –> get X-Rays
  • Septic joints –> aspirate, can culture
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19
Q

Differential dx for cellulitis/erysipelas

A

Gout, DVT, Venous stasis dermatitis

20
Q

If cellulitis/erysipelas not responding to abx w/in 24-48 h –> consideration?

A

underlying abscess

21
Q

most common bacterial infection in children

A

impetigo

22
Q

3 y/o pt presents with thick golden crust around mouth –> 1st line management?

A

non-bullous impetigo

Topical Therapy: Muprocin (Bactroban) TID, Retapamulin (Altabax) BID

23
Q

Progression of non-bullous impetigo

A

papules –> vesicles surrounded by erythema –> rapid enlargement & breakdown –> form thick adherent golden crusts

24
Q

5 y/o presents w/ dark brown crusted lesion on his trunk –> what pathogen is most likely & how does it cause this lesion?

A

bullous impetigo

S. aureus –> produces a toxin to cleave the superficial layer

25
Q

Progression of bullous impetigo

A

vesicles enlarge –> form flaccid bullae w/ clear fluid –> darken and rupture –> thin brown crust

26
Q

pt presents with punched out lesions covered w/ yellow crusts –> what pathogen is most likely?

A

Ecthyma

Group A beta-hemolytic Strep pyogenes

27
Q

Non-bullous impetigo most often caused by:

A

Staph aureus

less commonly –> beta-hemolytic strep group A

28
Q

DX of Impetigo

A
  • manifestation + hx

- gram stain + culture

29
Q

Pt with extensive Impetigo or punched out ulcers –> management?

A

Oral Therapy

  • Dicloxacillin 250 mg QID
  • Cephalexin 250 mg QID
30
Q

Pt presents w/ intensely pruritic, erythematous plaques with central pallor & a swollen upper lip, pt reports increased discomfort @ night for the past 8 weeks –> management?

A

Chronic urticaria (> 6 weeks)

H1 +/- H2 antihistamine

D/T angioedema and severe sxs –> Prednisone 30 - 60 mg QD (taper over 5 - 7 days)

31
Q

what % of the population experiences urticaria? age/gender predilection?

A

20% –> often no trigger

affects all ages/genders

32
Q

pt develops multiple raised, circumscribed, erythematous plaques that are intensely itchy, and transiently disappear –> what mediated this reaction?

A

Cutaneous mast cells in the superficial dermis

-release Histamine (pruritus) & vasodilators (Swelling)

33
Q

If allergen is suspected cause of urticaria, what testing is ordered

A

serum test for allergen specific IgE aBs

34
Q

Management of urticaria focused on

A

-short-term relief of pruritus & angioedema (H1 +/- H2 antihistamine)

35
Q

H1 antihistamines

A

diphenhydramine, chlopheniramine, hydroxyzine, certirizine, loratidine, fexodfenadine

36
Q

H2 antihistamines

A

rantidine, nizatidine, famotidine, cimetidine

37
Q

When do we consider glucocorticoids for the management of urticaria?

A
  • sxs > 2 - 3 days
  • severe sxs
  • angioedema
38
Q

Most common benign soft-tissue neoplasm

A

lipoma

39
Q

pt presents w/ a solitary soft, painless, subQ nodule; round on torso –> what is a possible genetic association?

A

gene rearrangement of chromosome 12 –> solitary lipoma

40
Q

> 50% lipomas develop where?

% of the population to develop a lipoma?

A

in the subQ tissue

majority are on upper extremities or trunk

1% of population

41
Q

Dx of lipoma

A
  • Hx & PE

- can ultrasound to determine if nodule is solid vs. liquid

42
Q

Management of Lipoma

A
  • asymptomatic –> no treatment

- cosmetic issues, pain, or uncertain dx –> surgical excision

43
Q

Most common cutaneous cyst

A

Epidermal inclusion cyst

44
Q

pt presents w/ a firm, skin-colored dermal nodule w/ a visible central punctum –> what is the pathophysiology

A

-implantation & proliferation of epithelial (junk) elements into the dermis d/t trauma –> lesion can stay stable or grow –> spontaneous rupture –> cheesy material

45
Q

Who is most likely to develop an epidermal inclusion cyst

A

men (2x more likely)

certain hereditary conditions –> Gardener syndrome

46
Q

Dx & management of epidermal inclusion cyst

A
  • Hx & PE
  • asymptomatic –> no treatment
  • can excise cyst or incision & drainage
  • intralesional injections w/ Triamcinolone

Clin Med I (4 decks)

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