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Clin Med I Exam I > Derm II > Flashcards

Derm II Flashcards

1
Q

Molluscum Contagoisum is described as ?

How does it transmit?

A

Common pediatric virus caused by poxvirus, MCV-1 to 4

direct skin to contact (most easily spread in pools), gym equipment, and spread by autoinoculation
-Virus replicates in epithelial cells

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2
Q

Molluscum Contagoisum primarily affects what age demographic?

A

young children and sexually active adults and immunosuppressed

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3
Q

What are the signs and symptoms of Molluscum Contagoisum?

Where does this condition usually appear?

A
  • non pruritic flesh colored dome shaped papules 3-6mm
  • curd like material can be expressed (if you try to pop it )

Distribution: present anywhere, but classically over the face, trunk, and extremities, groin

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4
Q

How do you diagnose Molluscum Contagoisum?

What are the differential diagnosis of Molluscum Contagoisum?

A

Diagnosis:

  • Clinical exam/history
  • Punch biopsy

Differential Dx:

  • Warts
  • Milia
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5
Q

How do you treat Molluscum Contagoisum?

A
  • usually not necessary (resolves after a few months up to a few years)
  • avoid autoinoculation or transmission to close contact, therapy may be beneficial

NOT FDA APPROVED TREATMENTS
→ topical cantharadin
→ cryotherapy
(these treatments promotes low amount of irritation to encourage body to produce antibodies)

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6
Q

Veruca Vulgaris (common wart)

→ Most common in ages?
→ Risk factor?
→ Distribution?
→ Size of lesions?

A

→ ages 5-20
→ risk w/ frequent exposure to water
→ distribution to hands and palm and peringuinal, nail folds
→ Size is pinpoint to > 1cm, papules with a rough grayish surface

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7
Q

Verruca Plana (flat wart)
→ Most common in what population?
→ Size of lesions?
→ Distribution?

A

→ children and young adults
→ 2-4 mm flat topped flesh colored papules
→ grouped together on face, neck, wrists, hands

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8
Q 
Verruca Plantaris (plantar wart)
→ where does it distribute to?
A

appear anywhere on the sole(plantar surface), but classically at pressure points on ball of the foot or heal

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9
Q

How do you diagnose and treat Non Genital Verruca (Warts)

A

Diagnose→ clinical exam, punch biopsy

Treatment→ No treatment at all is an option since 65% of warts regress spontaneously w/n 2 years. However, patients risk warts that may enlarge or spread to other areas. Treatment is recommended for patients with extensive spreading, or symptomatic warts or warts that have been present for more than 2 years

  • cryotherapy
  • salicycle acid/cantharidin
  • occlusive dressing
  • intralesional injection of bleomycin (can cause necrosis so be careful)
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10
Q

Tinea Versicolor:
Signs and symptoms?

Treatment?

A

Signs and symptoms?

  • hypo or hyperpigmented round macules (with scaling) that do not tan; located on trunk and arms or face
  • Pt is asymptomatic and notices during summer

Treatment?
-Daily Selenium sulfide shampoo for 15 min x 7 days
-Topical ketoconazole cream daily x 3 weeks
-Oral Ketoconazole 200 mg qd x 2 weeks (careful of LFT’s)
→ (Will get rid of scales but not light spots)

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11
Q

Tinea Versicolor:
How to Diagnose it?

What are the diff dx ?

A

How to Diagnose it?
→ KOH scraping show hyphae and spores (Spaghetti and meatballs)
→ Wood’s light (black light) (orange mustard color)

What are the diff dx ?
-Vitiligo: complete depigmentation (no scale)

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12
Q

Tinea Pedis is common in what population?

Lesions of Tinea Pedis can be described as ?

A

common in young men

Lesions:

  • scale and maceration in toe web spaces
  • moccasin type distribution on plantar surface (distinct borders)
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13
Q

Si/sx of Tinea pedis?

Diagnosis of TP?

Treatment of TP?

A

Si/sx of Tinea pedis?
→ pruritic feet(may hav inflammation and fissures)

Diagnosis of TP?
→ KOH+ or fungal culture

Treatment of TP?
→ Keep feet dry
→ Zeabsorb-AF (miconazole) powder
→ Topical antifungals:
Naftin, ketoconazole, Lotrimine cream BID
→ If severe, Lostrisone creak x 1 wk (steroid+ anti-fungal)

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14
Q

Vitiligo:
si/sx?

dx?

tx?

A

Vitiligo:
si/sx?
→ can occur to anyone
→ hypo pigmentation macules may occur focally or generalized in pattern

dx?
→ clinical or punch biopsy
→ woods light

tx?
→ sunscreen (avoid sun exposure)
→ cosmetic cover up
→ protonic/elidel (Tacrolimus/Pimcrolimus)
-Eximer laser
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15
Q

Varicella (zoster virus) Chicken pox
Epidemology ?

Incubation period?

A

Epidemology ?
-90% occur in children < 10 yo. However tropical countries it tends to be a disease of teenagers

Incubation period?
-10-21 days
-Individuals are infections for 4 days before and 5 days after appearance of exanthem
→ transmitted via direct contact with lesion or respiratory route

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16
Q

Si/Sx of Varicella (zoster virus) Chicken pox ?

A
  • Rash, malaise, low grade temp,
  • Start as faint macules that develop into vesicular eruptions w/ tear drop vesicles on erythematous base (teardrop on a rose petal)
  • Starts on scalp, face, trunk, then spreads to extremities. May appear on palms and soles
  • vesicles are pruritic and become pustular then crusted (lesion no contagious when crusted)
  • can have 2ndary staph infection
  • *adults pt’s tend to have ↑ risk of pneumonia
17
Q

How to diagnose Varicella (zoster virus) Chicken pox?

How to treat Chicken pox?

A

Diagnosis:

  • Clinical
  • Tzank smear from vesicle show multinucleate giant cells**

Tx:
Healthy children (<13)
-supportive: oatmeal baths, calamine lotion, antihistamines
-avoid aspirin due to Eye syndrome→ hepatitis and acute encephalopathy

Immunocompetent Adults:
-Oral Acylovir w/n 24 hrs of onset (↓ severity/duration) for 5 days

Immunocompromised: IV acyclovir

IMMUNIZATION: single dose for children 1-12 (over 13 yo should relieve two vacinations 4-8 wks apart. )

18
Q

Herpes Zoster (shingles) signs and symptoms?

A 
-Prodrome of pain(burning, electrical, throbbing) followed by rash 
→ 55% thoracic 
→ 20% cranial 
→15 % lumbar
→ 5% sacral
  • Lesions are classically unilateral but may disseminate in immunocompromised pt’s
  • Papules and plaques of erythema develop into vesicles may become hemorrhagic or bullous

→ new lesions for 1-5 days (last 2-3 weeks; 6 weeks in elderly pt’s)
→ rarely have pain but no lesions but is possible (4% of pts have shingles reoccur)

19
Q

What does it mean if you see a “Hutchinson’s sign”

A

“Hutchinson’s sign”→ lesions on the side and tip of nose during infection of zoster virus
-ophthalmic division of 5th CN must be seen by ophthalmologist due to complicating concerns of tetinal necrosis, glaucoma, optic neuritis

20
Q

Diff Dx for shingles?

How do you diagnose condition?

A
  • angina pectoris
  • plant dermatitis
  • impetigo (crusty and scabby)
  • biliary or renal colic
  • appendicitis

Diagnosis: clinical once lesions appear→ Tzanck smear

21
Q

How do you prevent and treat shingles?

A

Tx:

  • Antiviral therapy (w/n 3-4 days there will be a resolution of pain and lesions)
  • Valacyclovir or famiciclovir x 7 days
  • prednisone (for more severe situations)
  • Domboro solution (for weepy- advanced version of burrows solution) to relieve itchy and inflammation
  • Pain management→ acetaminophen, NSAIDS, Narcotics, lidoderm patch

Prevention:
-Zostervax >60yo

22
Q

What are some complications of shingles that can occur?

A

Post herpetic neuralgia

→ if pain continues past one month refer to neurologist for pain management (TCA’s, Neurtontin, Gabapentin)

23
Q

HSV-1 and HSV-2 are the cause of herpes in what areas?

A

1: oro-labial herpes
2: genital herpes

> 30% of adults are seropositive for HSV-1

24
Q

How is HSV-1&2 spread?

How long does the infection last for?

A

Initial exposure is through direct contact with infected secretions:

  • Sexual (oral or genital)
  • Auto inoculation: Herpetic Whitlow (picking at it then spreading it to finger→ tenderness and erythema with deep seated blisters)
  • Vertical: mother to baby
  • Life long infection producing chronic latent infections hide in neurons (HSV1 resides in trigeminal ganglia and HSV2 hides in presacral ganglia )
25
Q

How long is the incubation period of HSV?

What triggers the infection?

Is it contagious even if there are no lesions?

A

How long is the incubation period of HSV?
→ 2-20 days

What triggers the infection?
→ stress, menses, fever, infection, sunlight

Is it contagious even if there are no lesions?
→ Yes virus begins before lesions are visible and until they begin to heal

26
Q

Signs and Symptoms of HSV?

A

Primary infections may be asymptomatic
-Prodrome of fever, myalgia, malaise
→Oralabial: tender grouped vesicles/blisters on an erythematous base, ulcerative, exudative “cold sore” lasting 1-2 weeks. Reoccurrence has tingling itching and preceding
→ Genital: group blisters and erosions on vagina, rectum or penis into new blisters over 1-2 weeks
→ Herpetic Whitlow

27
Q

How do you diagnose HSV?

A
  • Fluorescent antibody tests/western blot (differentiate HSV-1, -2)
  • Tzanck smear (giant nucleated cells)
28
Q

Treatment for HSV

A

Tx does not cure it ↓ viral shedding and allows lesion to heal.

  • Primary:
  • acyclovir 200mg 5 x a day for 10 days
  • valacylovir 1gm bid for 10 days
  • Suppressive: > 9 cases a year
  • Acylcovir 400 mg bid
  • Valtrex 1gr daily
  • Recurrent: < 24hrs of onset
  • Acylcovir 400 mg tid x 5 days
  • Valtrex 2gm Bid x 1 day

BE CAREFUL WITH RENALLY COMPROMISED PATIENTS

29
Q

Etiology of acute Paronychia ?

Si/Sx’s of acute Paronychia?

A

Etiology of acute Paronychia ?
-aggressive manicure, nail biting (usually gram + staph aureus)

Si/Sx’s of acute Paronychia?
-erythema, swelling, pain may extend to proximal nail fold. → progresses to formation of pus that separates the skin from the nail

30
Q

Etiology of chronic Paronychia ?

Si/Sx’s of chronic Paronychia?

A

Etiology of chronic Paronychia ?

  • frequent hand washing, water contact (food handlers, dishwashers)
  • Pseudomonas aeruginosa or Candida albicans

Si/Sx’s of chronic Paronychia?

  • Swollen, erythematous tender W/O fluctuant. Nail may become thickened with transverse ridges (6 or more weeks)
  • infection mainly proximal nail bed
31
Q

How do you diagnose Paronychia ?

What is the diff dx?

A

Diagnosis:

  • Fluctuant paronychia usually bacterial (culture/gram stain)
  • KOH wet mounts may show hyphae (yeast…chronic)
  • clinical hx and exam

Diff dx:- herpetic whitlow (viral infection of pulp of fingertip and perionychium

32
Q

How do you tx acute vs. chronic paronychia?

A

Acute:

  • Warm water soaks 3-4xday
  • PO abs for GR pos s. aureus (augmentin)
  • Topical steroid cream
  • I & D if accessed

Chronic:

  • Avoid inciting factors (moisture, manicuring)
  • Warm soaks
  • Topical steroid cream or antifungal: Spectacle
33
Q

What are Onychomycosis lesions and what type of people are they most common in?

A

Infection of finger or toe nails by yeast or fungi most common in people with other nail problems (nail trauma, immunocompromised, vascular insufficiency, Down’s syndrome)

Hands: T. Mentagrophytes
Feet: C. albicans

34
Q

How do you diagnose Onychomycosis ?

What are the si/sxs?

A

How do you diagnose Onychomycosis ?
-KOH + or fungal/yeast culture

What are the si/sxs?

  • usually asymptomatic
  • but you would see nail thickening and sublingual hyperkeratosis (scale build up), nail dystrophy or onycholysis (nail plate elevation from nail bed)
35
Q

How do you treat Onychomycosis?

A

-Non treatment is acceptable
→ topical agents generally ineffective ( penlac lacquer (ciclopirox) solution
→ Jublia (efinaconazole solution

-Oral cure rate <40% check LFT;s before and after
→ Lamisil 250 qd x 6-12 weeks **can’t drink while on it

Clin Med I Exam I (9 decks)

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