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Step2CK > Derm Stepup > Flashcards

Derm Stepup Flashcards

1
Q

what causes cellulitis

A

staph aureus
GAS
MRSA

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2
Q

risk facotrs cellulitis

A

IV drug use and DM
immunicompromised
srugery
venous or lymphatic dysfunction

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3
Q

H and P for cellulitis

A

erythema, swollen and painful skin, myalgias, chillas, warmth
fever, lymphadenopathy

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4
Q

labs in cellulitis

A

inc WBC ESR and cRP

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5
Q

Tx cellulitis

A

oral cephalosporings, penicillinase-R beta lactams
IB antibioics for severe cases
linezolid or vanco for MRSA

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6
Q

complications cellulitis

A

necrotizing fasciitis

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7
Q

abscesses in lower back and perineal area are caused by what bacteria

A

anaerobes

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8
Q

hidradenitis suppurativa

A

chronic follicular occlusion and apocrine gland inflammation

causes recurrent abscesses in axilla groin and perineum

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9
Q

Tx for hidradenitis suppurativa

A

incision and drainage

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10
Q

complications of hidradenitis suppurativa

A

large eroding facial abscess can cause cavernous sinu thormbosis

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11
Q

what causes necrotizing fasciitis

A

GAS or multipathogen

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12
Q

signs necrotozing fasciitsi

A 
erythema, warm swollen skin
loss of sensation
fever
crepitus from gas
purple discoloration
bullae
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13
Q

labs in necrotizing fasciitis

A

inc WBC ESR and CRP

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14
Q

imaging for necrotizing fasciits

A

XR or CT

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15
Q

Tx for necrotizing fasciitis

A

surgical debridement, drainage, IB antibitics

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16
Q

what causes gangrene

A

poor vascular supply or severe infection (perfringens)

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17
Q

rotten smelling skin

A

gangrene

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18
Q

dry gangrene

A

gradual necrosis of skin from vascular insufficiency

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19
Q

wet gangrene

A

necrosis from acute vascular obstruction or infection

have blistering

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20
Q

imaging of gangrene

A

subcutaneous air on XR or CT for wet gangrene

angiography or MRA for vascular insufficnecy

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21
Q

what causes impetigo

A

GAS or staph

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22
Q

Tx impetigo

A

washing
erythromycin
cephalosporins
topical antibiotics

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23
Q

what causes acne vulgaris

A

propionibacterium acnes

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24
Q

Tx for acne vulgaris

A

topical retinoids

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25
Q

causes of acne outbreaks in adults

A

corticosteroids and androgens

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26
Q

complications acne vulgaris

A

permanent scarring

oral vitamin A analogues cause birth defects and hepatotoxicity

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27
Q

before prescribing oral isotretinoin

A

2 negative pregnancy tests

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28
Q

tzanck smear of HSV

A

multinucleated giant cells

viral culture confirms

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29
Q

varicella

A

varicella zoster virus

chicken pox then shingles

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30
Q

pregnant woman with chicken pox, next step

A

give varicella Ig

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31
Q

immunocompromised patients are at risk from what complications of varicella virus

A

encephalopathy and retinitis

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32
Q

what strains HPV assoc with genital warts

A

6 and 11

aslos assoc with cervical CA

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33
Q

molluscum contagiousm

A

usually in patients with HIV

painless shiny papules with central umbilication

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34
Q

labs for molluscum contagiousm

A

giemsa and wright stain will show large inclusion bodies

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35
Q

Tx for molluscum contagiousm

A

chemical, laser, cryotherapy

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36
Q

severe pruritis worse after hot baths in webs of fingers

A

scabies

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37
Q

Tx scabies

A

permethrin cream r oral ivermectin

benadryl to help with pruritis

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38
Q

complicaitons scabies

A

infection of close contacts

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39
Q

type I HS reaction skin

A

mast cell degranulation
diffuse urticarial rash
only lasts hours

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40
Q

type IV Hs reaction

A

lymphcyte activity
morbilliform rash
several days after second exposure
(allergic contact dermatitis)

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41
Q

most common causes allergic contact dermatitis

A

poison ivy poison oak
nickel
soaps
latex

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42
Q

Tx for allergic contact dermitiis

A

topical corticosteroids and antihistamines

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43
Q

erythema multiforme

A

serious cuteaneous HS reaction

drugs infection or vaccines cause it

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44
Q

signs of erythema multiforme

A

malaise, myalgias, pruritis, macules, plaques, vesicles

target lesions

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45
Q

labs in erythema multiforme

A

increased eosinophiles

skin Bx will show increased lymphocytes and necrotic keratinocytes

46
Q

Tx for erythema multiforme

A

stop offending agent, corticosteroids, analgesics

47
Q

what drugs commonly cause erythema multiforme

A

penicillins, sulfonamides, NSAIDs, oral contraceptives and anticonvulsants

48
Q

stevens johnson syndrome

A

severe form erythema multiforme
mucous membranes and skin sloughing
high risk dehydration

49
Q

Common infectious causes erythema multiforme

A

HSV and mycoplasma pneumonia

50
Q

Topic epidermal necrolysis

A

HS reaction of skin sloughing and full thickness epidermal necrosis

51
Q

labs in toxic epidermal necrolysis

A

dec WBC
dec Hb and Hct
inc ALT AST

52
Q

Tx for topic epidermal necrolysis

A

stop offening agent, Tx in burn center with IV hydraiton, corticosteroids and IV Ig

53
Q

Seborrheic dermatitis

A

chronic hyperporliferation

plaques with yellow greasy scales

54
Q

Tx for seborrheic dermatitis

A

shampoo with selenium, tar or ketoconazole for scalp

topical corticosteroids and antigundals

55
Q

atopic dermatitis

A

chronic skin rahs, dry skin patches with papules

56
Q

risk factors atopic dermatiits

A

asthma, allergic rhinitis, FMH

57
Q

Tx for atopic dermatitis

A

moisturizing cream, topical corticosteroids or tacrolimus

58
Q

rash in atopic dermatitis

A

pruritis

erythematous patches of dry skin, maybe vesicles on flexor surfaces and dorsum hands and feet, chest, back or face

59
Q

cradle cap

A

seborrheic dermatitis in infants

60
Q

psoriasis

A

epidermal hyperproliferation
red plaques with silvery scales on extensor surfaces
auspitz sign- bleed easily when scales removed

61
Q

labs of psoriasis

A
  • RF
    skin Bx will show thickened epidermis
    absend granular cell layer
    nucleated cells in stratum corneum and increased uric acid and ESR
62
Q

tx psoriasis

A

topical corticosteroids, tar, retinoids, tacrolimus, antifungals, phototherapy, MTX, cyclosporine, anti-TNFa

63
Q

pityriasis rosea

A

viral association
papular lesion on trunk and extremities in tree pattern
herald patch is the singe round lesion that appears before the eruption

64
Q

Tx of pityriasis rosea

A

topical steroids, phototherapy, erythromycin

65
Q

erythema nodosum

A

inflammation subcut fat septa causeing painful erythematous nodules on anterior tibias or trunk

66
Q

cause of erythema nodosum

A

delayed immunologic reaction, collagen vascular diseases, IBD, drugs

67
Q

labs in erythema nodosum

A

possible + ASO titer
increased ESR
skin Bx shows fatty infiltration

68
Q

Tx erythema nodosum

A

NSAIDs, K iodide, corticosteroids

69
Q

pemphigus pemphigoid

A

autoimmune with auto Ab to epidermal BM

70
Q

signs pemphigus pemphigoid

A

painful fragile blisters in oropharynx, on chest, face and perineal region
rupture easily

71
Q

skin Bx pemphigus pemphigoid

A

separating epidermal cells (acantholysis) with intact BM

antiepidermal Ab on immunofluorescence

72
Q

Tx pemphigus pemphigoid

A

corticosteroids, azathioprine or cyclophosphamide

73
Q

complications pemphigus pmephigoid

A

sepsis, osteoporosis

high mortality if not treated

74
Q

bullous pemphigoid

A

autoimmune with autoAb against BM

75
Q

signs of bullous pemphigoid

A

above 60 years old
widespread blistering especiialy flexor surfaces and perineal area
erosions
pruritis

76
Q

Tx bullous pemphigoid

A

oral or topical corticosteroids or azathioprine

77
Q

porphyria cutanea tarda

A

deficiency of hepatic uroporphyrinogen decarboxylase

used for heme metabolism

78
Q

risk factors for porphyria cutanea tarda

A 
alcoholisms
hep C
iron overload
estrogen use
smoking
79
Q

signs Sx porphyria cutanea tarda

A

chronic blistering lesions on sun exposed areas like dorsum of hands
hyperpigmented skin, facial hypertrichosis
ruptured blisters heal poorly

80
Q

labs in porphyria cutanea tarda

A

elevated LFTs
increased total plasma porphyrin
increased urine porphyrins
decreased uroporphyrinogen decarboxylase

81
Q

Tx of porphyria cutanea tarda

A

periodic phlebotomy, low dose chloroquine, hydroxychloroquine
sunscreen use, avoidance triggers

82
Q

actinic keratosis

A

precancerous skin lesion

83
Q

what can actinic keratosis change into

A

squamous cell CA

84
Q

risk factors actinic keratosis

A

sun exposure

85
Q

rash in actinic keratosis

A

erythematous papule with rough yellow-brown scales that are

86
Q

Bx of actinic keratosis

A

dysplasia epithelium

87
Q

Tx actinic keratosis

A

topical 5 -fluorouracil or imiquimod or cryotherapy

88
Q

complications

A

only 0.1% progress to squamous cell CA

89
Q

what skin lesion is hyeprpigements, warty and looks “stuck on”

A

seborrheic keratosis

90
Q

when suspect actinic keratosis next step

A

Bx to rule out squamous cell

91
Q

what sunlight radiation causes cancer

92
Q

what does squamous cell carcinoma of skin look like

A

painless, erythematous papule with scaling or keratinized growths
can bleed or uclerate

93
Q

Mohs excision

A

serial shallow exicions with histo analysis to minimzed cosmetic damage

94
Q

complications squamous cell carcinoma

A

5-10% mets

95
Q

basal cell carcinoma comes from

A

basal epidermal cells

96
Q

pearly papule iwht telangiectasias

A

basal cell

97
Q

Bx of basal cell

A

basophilic staining epidermal cells in palisades

98
Q

Tx basal cell carcinoma

A

surgical excision, mohs, radiaiton or crytotherapy

99
Q

most common skin cancer

A

basal cell

100
Q

complications basal cell

A

mets in less than 0.1%

101
Q

risk factors melanoma

A

sun exposure, fair complexion, FMH, numerous nevi

102
Q

types of melanoma

A

superficial spreading
nodular
acral lentiginous
lentigo maligna

103
Q

what do you not do for suspected melanoma

104
Q

most common type melanoma

A

superficial spreading

laterally before vertically

105
Q

describe nodular melanoma

A

grows only vertically and invasive rapidly

difficult to detect

106
Q

where is acral lentiginous melanoma

A

palms, soles and nail beds

107
Q

slow melanoma

108
Q

Tx malnoma

A

surgical excision with 0.5 cm margin in situ
1 cm margin if 2mm thick
possible lymph node dissection
chemo and radiation if mets

109
Q

complications melanoma

A

aggressive,

mets to lung, brain and GI tract

110
Q

most important prognostic factor for melanoma

A

thickness of lesion

Step2CK (26 decks)

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