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Foundations of Clinical Practice II > Derm II (Babcock) > Flashcards

Derm II (Babcock) Flashcards

1
Q

Most common pre-cancerous skin lesion resulting from chronic, cumulative sun exposure in susceptible individuals?

A

Actinic Keratosis

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2
Q

What cancer typically comes from actinic keratosis

A

squamous cell carcinoma

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3
Q

Actinin keratosis: treatment

A

cryotherapy**

other:
Topical fluorouracil
Topical imiquimod

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4
Q

Actinic keratosis: prevention

A

sunscreen with UVA/UVB

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5
Q

Describe Actinic keratosis

A

erythematous or brown rough, scaly papules and plaques found on sun exposed skin. Coarse, sandpaper-like**

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6
Q

Seborrheic Keratosis

A
  • benign
  • common
  • oval, slighty raised, tan/light brown to black well-demarcated papules or plaques <3cm in size
  • appear to be “stuck-on” waxy greasy verrucous appearance
  • Trunk, scalp, face, neck, extremitities
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7
Q

What is the most common malignancy of the skin?

A

basal cell carcinoma

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8
Q

Basal cell carcinoma: risk factors

A
  • heavy, cumulative sun exposure

- Fair-skinned males 20-40s

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9
Q

Basal cell carcinoma: clinical findings

A
  • translucent
  • telangiectatic pearly papule/nodule
  • rolled border and ulcerated center**
  • 85% on head and neck
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10
Q

Basal cell carcinoma: treatment

A

biopsy for diagnosis…

-excision, curettage, MOHS surgery

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11
Q

What is the second most common skin cancer?

A

squamous cell carcinoma

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12
Q

What do squamous cell carcinoma typically arise from?

A

actinic keratosis

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13
Q

Which antibiotic is associated with side effect of blue discoloration of the gums?

A

minocycline

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14
Q

Squamous cell carcinoma: clinical findings

A

-solitary, slowly evolving keratotic or eroded erythematous, yellowish, or skin-colored papule or plaque found on sun exposed areas

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15
Q

Squamous cell carcinoma: risk factors

A
  • long-term sun exposure
  • Exposure to industrial carcinogens
  • HPV
  • immunosuppression
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16
Q

Any isolated keratotic or eroded papule or plaque present >1 month should be considered _____until proved otherwise by biopsy

A

squamous cell cancer

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17
Q

Most malignant skin cancer

A

melanoma

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18
Q

Most common cancer among women 25-29

A

maligant melanoma

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19
Q

Malignant melanoma: risk factors

A
  • age
  • fair skin
  • blue eyes
  • red or blonde hair
  • freckles
  • multiple nevi
  • atypical nevi
  • blistering sunburns before puberty
  • Tanning bed
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20
Q

Which malignant melanoma is most common?

A

superficial spreading

men: back
women: back and legs

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21
Q

Which malignant melanoma grows fast, vertically and is most aggressive?/

A

Nodular (Breslow’s depth)

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22
Q

The demodex mite is associated with which skin condition?

A

Rosacea

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23
Q

What are the ABCDE of malignant melanoma?

A 
Asymmetry
Border - irregular, jagged
Color-multi
Diameter - >6mm (pencil eraser)
Evolving - changing
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24
Q

What is the single most important prognostic factor for malignant melanoma?

A

Thickness of lesion

Increased breslow’s depth = decreased survival

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25
Q

How often should you perform skin exams for melanoma to look for recurrence?

A

every 6 months for 2 years

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26
Q

Kaposi Sarcoma: general

A

vascular* neoplastic condition linked to Human Herpes Virus-8

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27
Q

Kaposi Sarcoma: clinical findings

A

red, brown, or purple macules, plaques and nodules on trunk, extremities, face

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28
Q

What lab is important to perform for Kaposi Sarcoma?

A

Test for HIV. Need to know because AIDS is associated with a more aggressive form

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29
Q

Kaposi Sarcoma: treatment (non-AIDs)

A
  • cryotherapy
  • radiation
  • chemotherapy
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30
Q

Name the epidermal dermatophytosis (affect stratum corneum)

A
  1. Tinea pedis
  2. Tinea corporis
  3. Tinea cruris

-red, scaly, maceration, warm moist environment

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31
Q

Dermatophytosis of hair and hair follicles

A

Trichomycosis (ex. Tinea capitis)

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32
Q

Dermatophyte of the nail apparatus

A

onychomycosis

-nail thickening, subungual debris

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33
Q

How is Tinea pedis, tinea, corporis, tinea cruris treated?

A

KOH (to see hyphae)

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34
Q

Tinea pedis, tinea corporis, tinea cruris: treatment

A

Clotrimazole, miconazole, terbinafine cream for 4-6 weeks

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35
Q

Tinea capitis: diagnosis

A

fungal culture

36
Q

Tinea capitis: treatment

A

Griseofulvin (or terbinafine) for 8 weeks

37
Q

Onychomycosis: diagnosis

A

Fungal culture, KOH of subungual debris

38
Q

Onychomycosis: treatment

A

Oral terbenafine x12 weeks

39
Q

Tinea Versicolor: infective agent

A

Malessezia furfur (superficial yeast infection)

40
Q

Tinea versicolor: clinical findings

A

hypo or hyperpigmented coalescing scaly macules of varying color on trunk, upper extremities (tan, salmon)

41
Q

Tinea versicolor: Diagnosis

A

KOH: spaghetti and meatballs**

Wood’s lamp: blue-green fluorescence

42
Q

Tinea versicolor: treatment

A

Shampoos: selenium sulfide, ketoconazole, zinc pyrithione

Creams: ketoconazole, clotrimazole

Oral: fluconazole, itrazonazole

43
Q

Intertrigo

A

inflammation of skin folds

44
Q

Candidiasis (Candida albicans): general and risk factors

A

-intertrigo (inflammation of skin folds)

Risk factors: moisture, warmth, breaks in skin barrier, antibiotics, glucocorticoids

45
Q

Candidiasis: clinical findings

A

papules and pustules on erythematous base ->confluence and erosion ->beefy red patches with satellite lesions**;
burning > pruritis

46
Q

Candidiasis (candida albicans): diagnosis

A

KOH: pseudohyphae, spores, fungal culture (most sensitive)

47
Q

Candidiasis: treatment

A

-Keep area dry and cool
-loose clothing
topical antifungal - miconazole, clotrimazole, nystatin
-Topical steroid to help burning (low potency 1% hydrocortisone ointment)

48
Q

What should be done for a lesion with suspicion for melanoma?

A

refer to dermatology for excisional biopsy

49
Q

Condyloma acuminate: treatment

A
  • surgery
  • electrocautery
  • laser
  • Imiquimod
50
Q

Verruca vulgaris: appearance and distribution

A

hyperkeratotic, exophytic papules on fingers, hands, knees

-punctate black dots are thrombosed capillaries

51
Q

What reaction is associated with verruca vulgaris?

A

Koebner reaction - spreads with skin trauma

52
Q

Verruca plana

A

flat warts

53
Q

Verruca plana: appearance

A

skin colored or pink smooth slightly elevated flat-topped papules on dorsal hands, arms and face

54
Q

Describe palmoplantar warts

A

thick, endophytic papules on palms or soles of feet

  • can cause callus
  • pain with walking
55
Q

Palmoplantar warts: treatment

A
  1. can go away on its own
  2. Irritate or destroy: Acids, cryotherapy, retinoid crem, surgical removal, duct tape, laser
  3. Imiquimod, candida antigen - immune stimulating
56
Q

Herpes Zoster (Shingles)

A

reactivation of varicella-zoster virus latent in the nerve ganglia

57
Q

Herpes Zoster: describe prodrome

A

stinging pain

58
Q

Herpes Zoster: treatment

A

valacyclovir or famciclovir PO within 48-72 hours

59
Q

What is Hutchinson’s sign?

A

herpes zoster with ocular involvement

-nasociliary branch of trigeminal nerve

60
Q

Molluscum contagiosum: description

A

small (2-6mm) smooth, firm, shiny, dome-shaped flesh-colored papules with central umbilication*

61
Q

Molluscum contagiosum: causitive agent

A

DNA poxvirus

62
Q

Molluscum contagiosum: treatment

A
  • Cryotherapy
  • curettage
  • acids
  • cantharidin
  • Retinoids (topical)
63
Q

Impetigo: cause

A
  • staphylococcus aureus

- streptococcus pyogenes

64
Q

Impetigo: clinical findings

A

small vesicles or pustules rupture ->erosions with yellow honey colored crusts**

65
Q

Impetigo: treatment

A

mupirocin or retapamulin

66
Q

Erysipelas: cause

A

Group A strep

67
Q

Erysipelas: describe

A

upper dermis infection (more superficial than cellulitis)

  • well demarcated
  • gets worse fast!
68
Q

Erysipelas: treatment

A

oral PCN or amoxicillin

IV antibiotics if systemic

69
Q

Cellulitis: describe

A

infection in deep dermis and subcutaneous fat

70
Q

Cellulits: most common pathogens

A

strep pyogenes

71
Q

Cellulitis: treatment

A

Alcohol ingestions: recognize s/sx and lab findings IV or cephalexin oral

(beta-hemolytic strep and MRSA coverage)

72
Q

Scabies: infective agent

A

Sarcoptes scabiei

-Intense itching especially worse at night**

73
Q

Scabies: treatment

A

Permethrin 5% topical lotion/cream

others: lindane, oral ivermectin

74
Q

Pediculosis (lice): treatment

A

permethrin 1% OTC or 5% overnight (if resistance)

or

5% benzyl alcohol (Ulesfia)

75
Q

Spider bite: most common presentation from non-poisonous spider bites

A

papular urticaria

76
Q

Brown recluse spider bite: treatment

A
  • Ice/elevation
  • Antibiotics (erythromycin, cephalosporins)
  • tetanus toxoid
77
Q

Describe the difference in Brown recluse spider bite and black widow spider?

A

Brown recluse - necrotizing

Black widow - neurotoxic

78
Q

Alopecia aerata

A
  • focalized hair loss
  • Autoimmune attack on hair follicles
  • Exclamation point hairs**
79
Q

Alopecia aerata: treatment

A

reassurance - spontaneous resolution in 6 months

-regrowth is fine, thin, white color

  • Topical steroid (potent)
  • Topical minoxidil
80
Q

Paronychia: description

A

Bacterial infection of the proximal or lateral nail bed

-Throbbing pain, swelling, tenderness

81
Q

Paronychia treatment

A 
warm compresses (mild)
cut it open + antibiotics (severe)
82
Q

Vitiligo

A
  • Autoimmune melanocyte destruction

- “chalky” white macules on hands, face, elbows, knees, skin folds, genitals

83
Q

Vitiligo: treatment

A

sunscreen

repigmentation - topical glucocorticoids and tacrolimus, PUVA, grafting

84
Q

Melasma

A

“mask of pregnancy”

melanocytes produce large amount of pigment when stimulated by UV light or increase in hormone levels

85
Q

Acanthosis nigricans

A

hyperpigmented, symmetrical velvety plaques in the neck, skinfolds

  • obesity is a risk factor
  • associated with polycystic ovarian syndrome, diabetes
86
Q

Acanthosis nigricans: treatment

A
  • check fasting glucose

- lactic acid cream, urea cream, retinoids, salicylic acid

87
Q

Pressure ulcers (Decubitus ulcers)

A

“punched out” ulcer -> necrosis with grayish pseudomembrane

Foundations of Clinical Practice II (25 decks)

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