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DOOS3 > DERM2-Table 1 > Flashcards

DERM2-Table 1 Flashcards

1
Q

What is psoriasis?

A

chronic disorder w/polygenic predisposition & trigger factors (strep pharyngitis, HIV, interferon, beta blockers, lithium, steroid tapering), characterized by flares & remission

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2
Q

What is the clinical skin finding of psoriasis?

A

Plaque: most common, well demarcated brick red plaques w/adherent silvery scales; scalp, trunk, limbs (extensor surfaces); B/L symmetrical – elbows & knees*,

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3
Q

What are the clinical variants of psoriasis other than the classic plaque finding?

A

1‭)‬Guttate: usually presents

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4
Q

What are PE findings with psoriasis?

A

Well-defined red papules coalesce into plaques, sharply demarcated silver scales that adhere to plaque and inflammatory autoimmune associations (RA, spondylitis)

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5
Q

What are the nail PE findings in psoriasis?

A

Pitting, salmon patch (oil spot), onycholysis w/red rim, splinter hemorrhages, subungual debris

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6
Q

What are 2 signs specific to psoriasis?

A

1‭) ‬Auspitz sign: pinpoint bleeding following scraping or pulling scale

2‭)‬Koebner phenomenon = response to trauma

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7
Q

How is psoriasis diagnosed?

A

Order RF & HLA-B27 w/arthropathy
Consider CBC, CMP, hepatitis panel, HIV, etc
Annual CVD assessment

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8
Q

What is first line tx for psoriasis?

A
  • Emollients- maintenance
  • Topical steroids: moderate to high potency- 1st line
  • Vitamin D analogues: calcipotriene, topical retinoids: tazarotene
  • Ultraviolet phototherapy or laser: significant body surface area involvement or non-response to topical
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9
Q

What is 2nd line tx for psoriasis?

A

methotrexate, targeted immunomodulators, biologics, cyclosporine/immunosuppressants

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10
Q

What are the mild psoriasis topical agents that can be used?

A

corticosteroids, Vit D analogue (calcipotriene), moisturizers
Reserve topical calcineurin inhibitors (TCI)

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11
Q

What are the tx combos for mod-severe psoriasis?

A

: combo phototherapy & systemic (MTX, cyclosporine/calcineurin inhibitor, acitretin/retinoid), biologics d/t TNF-α inhibition (etanercept, adalimumab, infliximab, ustekinumab) or d/t PDE4 inhibition (apremilast)

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12
Q

When should you refer psoriasis?

A

moderate-severe psoriasis, recalcitrant psoriasis

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13
Q

What is pityriasis rosea?

A

self-limiting skin eruption w/multiple papulosquamous lesions; ↑ spring & autumn incidence

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14
Q

What is the suspected etiology of pit rosea?

A

HHV 6&7

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15
Q

What might be a common hx a pt presents with when suspected pit rosea?

A

›5% w/ HA, arthralgia, low grade fever, malaise prior to Herald patch, + pruritus
›Over few weeks lesions increase in # & distribution then spontaneously resolve

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16
Q

What is the most common initial sign for pit rosea?

A

salmon-colored oval lesion aka “herald patch” ( trunk & enlarges over days to 3-10 cm) w/widespread rash following after 7–14 days

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17
Q

What is the average duration of pit rosea?

A

6-8 weeks

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18
Q

What is the PE findng for the rash following the herald patch?

A

›Pink to salmon color round/oval plaques w/fine scales centrally & collarets of loose scales; follows Langer’s lines
with a secondary eruption in the “Christmas tree” pattern

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19
Q

How is pit rosea dx?

A

›Clinical features
›KOH prep to r/o tinea; r/o syphilis, WBC – normal
›Punch biopsy

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20
Q

What is the tx for pit rosea?

A 
›Self-limiting – give reassurance
›Pruritus: topical steroids (class 3 or 4 – triamcinolone cream)
›Severe case: UVB phototherapy or natural sunlight
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21
Q

What is lichen planus?

A

idiopathic, cutaneous, inflammatory disorder of skin, hair, nails & mucous membranes
cell mediated immune response

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22
Q

What is lichen planus associated with?

A

Hep C

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23
Q

What will be pt hx with lichen planus?

A

Pruritus, white(lacy) area on oral mucosa

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24
Q

When does lichen planus typically resolve?

A

In 2 years

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25
Q

What are PE findings for lichen planus?

A

1-10 mm flat-topped (planar), red to violaceous, shiny papules occur in crops
Violaceous w/fine, white lacy pattern (Wickham striae) on surface of papules & plaques

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26
Q

What is pathogomonic for lichen planus?

A

Wickham striae

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27
Q

What is a phenomenon associated with lichen planus?

A

Koebner phenomenon: new lesions may be noted at sites of minor injuries such as scratches or burns

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28
Q

How is lichen planus dx?

A

Biopsy if indicated

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29
Q

What is tx for lichen planus?

A

›Topical or intralesional steroids; TCI, phototherapy

›Systemic steroids if no response

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30
Q

What is atopic dermatitis?

A

Common inflammatory condition - pruritic, chronic, relapsing

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31
Q

What is atopic dermatitis associated with?

A

Asthma and allergies

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32
Q

What is the age dependent sequence of atopic dermatitis?

A

atopic march (epidermal defect atopy asthma allergic rhinitis

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33
Q

What is the hallmark saying of atopic dermatitis?

A

An itch that rashes

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34
Q

Where is the rash presentation in kids? Adults?

A

›Infant/child/adolescent: Face & neck, extensor surfaces

›Adult: flexor surfaces

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35
Q

What are PE findings for atopic dermatitis?

A

Lesions: erythematous, macular or papular, + crusts &/or oozing; can develop lichenification w/chronic scratching

Associated: xerosis, excoriations, keratosis pilaris (red bumps on back of arm), periorbital darkening (allergic shiners), Dennie-Morgan folds (lower lid pleats), post-inflammatory hypopigmentation/lesion sites

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36
Q

How is atopic dermatitis dx?

A

no single test, IgE can be elevated, + eosinophilia

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37
Q

What is the tx for atopic dermatitis?

A

›Low level maintenance/all pt
Everyone at all times
‭ ‬›Daily emollient cream or ointment & trigger avoidance- could be cream during day ointment at night, avoid temp changes, pollens, etc whatever triggers pts specific

›High level maintenance/ pt w/“hot spot”
‭ ‬›Intermittent topical CS (2 days/week)
‭ ‬›Want to prevent steroid atrophy

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38
Q

What do you do in an active flare of atopic derm for tx?

A

Daily use of topical steroids until all lesions clear, then low level maintenance

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39
Q

Why might you give a pt with atopic derm abx?

A

if there are lots of opening from itching

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40
Q

What kind of steroids do you want to use to tx atopic derm in kiddos? Adults?

A

›Infants/kiddos: low potency (hydrocortisone) BID to TID

›Adults: higher potency (triamcinolone or betamethasone) BID to TID

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41
Q

What is dyshidrotic eczema?

A

chronic, relapsing, pruritic eruption w/ vesicles; associated w/hyperhidrosis & atopic dermatitis

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42
Q

What will be a pt hx that may lead you to think dyshidrotic eczema?

A

›Episodic dysesthesia (burns, stings) & pruritus w/symptom-free intervals
›PMH: atopy

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43
Q

What should you evaluate your pt for if you suspect dyshidrotic eczema?

A

Evaluate for stress

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44
Q

What are PE findings for dyshydrotic eczema?

A

›Sites: palms > soles, interdigital areas; typically B/L & symmetric
›Early: clear vesicles, non-erythematous
later: vesicles become unroofed & inflamed w/desquamation & peeling

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45
Q

How is dyshydrotic eczema dx?

A

›biopsy if uncertain

›Exclude allergic or irritant contact dermatitis

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46
Q

How is dyshydrotic eczema tx?

A

›Mild: low potency topical steroids; moderate to severe: high potency steroids w/occlusive dressing
›Emollients, lukewarm (aka tepid) bathing
›Antihistamines

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47
Q

What is nummular eczema?

A

common pruritic, chronic, relapsing inflammatory condition

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48
Q

What is the pt hx for nummular eczema?

A

no prior atopic dz

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49
Q

What is the PE for nummular eczema?

A

well-demarcated lesions (coin shaped, 2-3 cm diameter - legs/men & arms/women)

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50
Q

How is nummular eczema dx?

A

No specific way

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51
Q

How is nummular eczema tx?

A

topical steroids, TCI, phototherapy

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52
Q

What is lichen simplex chronicus?

A

chronic dermatitis d/t habitual rubbing or scratching; often superimposed over atopic dermatitis

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53
Q

What is the typical hx of lichen simplex chronicus?

A

gradual onset pruritus out of proportion to appearance of lesion

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54
Q

What do you need to evaluate your pt for if dx with lichen simplex chronicus?

A

psychosocial issues (stress, depression, anxiety)

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55
Q

What are PE findings of lichen Simplex Chroniucs?

A

Lichenification & excoriated areas: flesh tone to pink or hyperpigmented plaques w/exaggerated skin lines; non-erythematous, non-vesicular in easily reached areas

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56
Q

How is lichen dx?

A

biopsy if no response to treatment

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57
Q

What is the tx for lichen?

A

›Topical anti-pruritic agents (doxepin, menthol preps) or oral antihistamines; topical anesthetic

›High potency topical steroids w/transition to lower potency topical steroids as resolution allows, + occlusive dressing

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58
Q

What is seborrheic dermatitis?

A

chronic, relapsing disorder of burning, scaling & itching w/symptom-free intervals

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59
Q

what are PE findings of seborrheic dermatitis?

A

symmetric distribution; pink-yellow to red-brown greasy, scaly lesions scalp, ears, medial eyebrows, upper lids, nasolabial folds, central chest, body folds

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60
Q

How is seborrheic derm dx?

A

biopsy w/treatment failure or if think its CA

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61
Q

How is seborrheic derm tx?

A

›Topical steroids (short course)
‭ ‬›Mild strength – face & body folds
‭ ‬›Moderate strength – scalp, ears
›Daily shampoo: alternate gentle shampoo w/selenium sulfide or zinc shampoo – every other week

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62
Q

What is stasis dermatitis?

A

chronic, pruritic, eczematous, erythematous, scale-crust dermatitis; non-inflammatory edema of LE

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63
Q

What is stasis derm often seen?

A

Chronic venous insufficiency: typically = cycle of scratching, excoriations, weeping & crusting d/t inflammation; starts UL goes BL

64
Q

What is the typical pt hx with stasis derm?

A

›Usually > 50 y/o; usually insidious onset w/erythema & edema initially with PMH of vascular dx DVT, cellulitis

65
Q

What should you evaluate your pt for if suspected stasis derm?

A

hypercoag status also get ABI

66
Q

What are PE findings of stasis derm?

A

Scaly, eczematous patches w/violaceous or brown lesions, medial malleolus
Varicosities, petechiae superimposed on discoloration
Secondary ulcers occur as a result of weakened skin around the ankles

67
Q

What is 1st line tx for stasis derm?

A

›Antibiotics w/indication 2ndary infection
›Burrow’s (wet dressing, soak) or cooling paste if ulcerated
‭ ‬›Apply x 15-30 min & reapply PRN or soak area x 15-30 min q8hr
›Topical steroid, leg elevation, debride PRN

68
Q

What are PE findings of diaper dermatitis?

A

›Mild: shiny erythema + scaling; Moderate: papules, vesicles, erosions
›Prominent lesions on buttocks, thighs, mons pubis or scrotum

69
Q

What pathogen should you suspect if your pt has satellite lesions from diaper derm?

A

CANDIDA

70
Q

How is diaper derm tx?

A

Purely contact dermatitis: low potency topical steroid
Candida suspected: antifungal
Barrier ointment
NAKED BABIES YAY SO CUTE

71
Q

What is the hx for contact derm?

A

›Pruritus 2ndary to direct toxic effect (topical or systemic exposure)
exposures and allergies… meds can also cause this

72
Q

What are the types of contact derm?

A

irritant contact dermatitis vs. allergic contact dermatitis

73
Q

What is irritant contact derm?

A

localized, non-immunologically mediated cutaneous inflammatory rxn

74
Q

What is allergic contact derm?

A

delayed-type hypersensitivity rxn d/t prior exposure & sensitization

75
Q

What does contact derm look like?

A

erythema, edema, vesiculation w/subsequent erosions & scaling

76
Q

Where is the contact derm rash located?

A

›Sites/irritant: usually hands, feet, lips
›Sites/allergic: well demarcated & localized to contact area or diffuse, patchy distribution (body shampoo); extension beyond site w/autosensitization

77
Q

How is contact derm dx?

A

patch test

78
Q

What is the tx for contact derm?

A

›Avoid irritant or allergen

›Antipruritic

79
Q

What are some short term tx options for contact derm?

A

topical steroids: higher potency (fluocinonide TID) w/transition to low or medium potency (triamcinolone)or systemic (severity dependent)

80
Q

What does poison ivy look like?

A

streaky erythema & papules @ site of contact w/vesicular development hours later
-w/in 48 hours

81
Q

How is poison ivy tx?

A

›Ultrapotent topical steroids or oral w/severe/widespread
›Antipruritic
›Education: “leaves of 3, leave them be”

82
Q

What are the comedones in acne vulgaris?

A

›Closed comedones = “whitehead; open comedones (dilated follicular opening w/keratin plug (oxidized lipids & melanin)= “blackhead”

83
Q

What are the subtypes of acne vulgaris and who is affected by them?

A

›Acne excoriee (habitual picking) – girls & young women

Acne fulminans - boys 13-16 y/o w/inflamed nodular lesions face, trunk & UE – systemic symptoms too!

84
Q

What are the degrees of involvement for acne?

A

Mild: few papules/pustules; no nodules
Moderate: some papules/pustules; few nodules Severe: numerous papules/pustules; many nodules

85
Q

What should you r/o with acne vulgaris?

A

r/o androgen excess

86
Q

How is acne vulgaris tx?

A

1st line: topical retinoids & benzyl peroxide or retinoids & topical antibiotic

87
Q

When should you refer acne?

A

nodulocystic acne, moderate-severe acne, recalcitrant acne

88
Q

What is rosacea?

A

chronic condition characterized by recurrent flushing/blushing & telangiectasia (erythematotelangiectatic)

or pink to red papules & pustules (papulopustular )

or hypertrophy & irregular thickening of the nose/forehead/cheeks/chin (phymatous)

89
Q

What is the typical presentation?

A

episodic erythema, “flushing & blushing”

90
Q

What are the subtypes of rosacea?

A

›Subtype: transient papulopustular of central face

›Subtype: phymatous = persistent deep erythema, irregular surface nodules, thickened skin

91
Q

How is rosacea tx?

A

›Oral/low-dose tetracyclines

›Topical: metronidazole(really good 1st line), antibiotics, sulfur-containing compounds

92
Q

Should you use steroid in rosacea?

A

NO DO NOT- one of the only non steroids

93
Q

What is perioral dermatitis?

A

chronic papulopustular facial dermatitis

94
Q

What often precedes perioral derm?

A

long-term use topical steroids on face

95
Q

What are aggravating factors for perioral derm?

A

anti-aging creams, skin care w/petrolatum or paraffin base, whitening toothpaste

96
Q

What are PE findings for perioral derm?

A

pinpoint erythematous papulovesicles & papulopustules w/ scaling around eyes, chin, lips & nasolabial folds

97
Q

what is the tx for perioal derm?

A

›Pt education, reassurance, discontinue anti-aging (retinol) creams, whitening toothpaste & all steroids
›Oral tetracycline antibiotic 4-8 week course; topical metronidazole gel….
Typical first-line therapy: Doxycycline 100mg BID x 3-4 weeks

98
Q

What is lice?

A

contagious, parasitic infestation spread by direct contact w/fomites, bedding/linens or infected individuals

99
Q

What is first line tx for capitis?

A

wet combing & permethrin; can repeat in 7-9 days if live nits observed

100
Q

What is 1st line tx for corporis?

A

linen & clothes hygiene (149F), treat pruritus & 2ndary infection

101
Q

What is 1st line tx for pubic?

A

wet combing & permethrin 1% cream; can repeat in 7-9 days if live nits observed

102
Q

What is scabies?

A

contagious, parasitic infestation spread by direct contact w/fomites, bedding/linens or infected individuals

103
Q

How long might it take for symptoms of scabies to appear?

A

3-6 weeks

104
Q

What are common PE findings for scabies?

A

›Erythematous papules w/scale-crust, excoriations

›Most common: finger webs, flexor surfaces of wrists, elbows, axillae, buttocks, genitalia, ankles & feet

105
Q

What is pathognomonic of scabies?

A

Burrows (threadlike, gray-white, wavy lines)

106
Q

How is scabies tx?

A

1st line: permethrin 5% cream leave on 8-14 H then wash off, can repeat in 1 wk if needed

107
Q

Who else should be tx if your pt has scabies?

A

ALL CLOSE CONTACTS

108
Q

what are local symptoms of black widow spider bite?

A

sharp or burning pain within minutes of bite but typically resolves within minutes to hours

109
Q

What are systemic symptoms of black widow bite?

A

›onset within 20 – 30 minutes
›Hyperesthesia, perspiration, N/V, tachycardia, restlessness, agitation or sense of impending death
›Painful cramps or spasms: arm bite may lead to chest tightness or dyspnea; leg bite may lead to abdominal pain or leg spasms

110
Q

What should you look for on the skin with black widow spider bite?

A

often nothing seen or palpated but look for be two pinpricks size openings, tender target lesion, urticaria, piloerection, edema, localized perspiration

111
Q

What are findings of neuro for black widow bites?

A

tetanic contractions of limbs, spasms, rigidity

112
Q

What is tx for a black widow spider bite?

A

Supportive care, tetanus immunization prn & ED for severe rxn

113
Q

What are local symptoms of brown recluse bite?

A

often asymptomatic or stinging/burning pain w/onset 1 – 24 hours s/p bite

114
Q

What are systemic signs of brown recluse bites?

A

F/C/N/V, malaise

115
Q

What are skin findings for brown recluse?

A

usually no visible injury the first 1 – 3 days, possible pinprick lesions

116
Q

What should you get in brown recluse spider bites?

A

UA to check for systemic hemolysis

117
Q

What is tx for brown recluse?

A

Supportive care, tetanus immunization prn & ED for severe rxn, hemolysis or shock

118
Q

What is the incubation period for RMSF?

A

2-14 days post bite

119
Q

What days does the fever happen?

A

3-5 days PRE-rash myalgias and HA

120
Q

What does the rash look like in RMSF?

A

Pink to erythematous macular-popular rash on wrists/ankles, widespread central petechiae

121
Q

What is the 1st line tx for RMSF?

A

empiric doxycycline or TCN

122
Q

When do symptoms appear in lyme dz?

A

3-30 days post-bite

123
Q

What are s/s of lyme?

A

›F/C, HA, fatigue, myalgia, arthralgia, LAD

›Erythema migrans rash (average about 7 days)

124
Q

What are s/s that can present days- months post bite in lyme?

A

Severe HA, neck stiffness, arthritis (knees & large joints), Bell’s palsy, palpitations or an irregular heart beat (aka Lyme carditis), episodic dizziness or SOB, shooting pain, numbness or tingling/hands or feet, problems w/short-term memory

125
Q

How is lyme dx?

A

2 step process for antibodies
›EIA followed by Western blot
›Both need to be positive

126
Q

How is lyme dx tx?

A

›oral doxycycline, amoxicillin, or cefuroxime axetil

›CNS or cardiac forms of illness – IV ceftriaxone or penicillin

127
Q

What is myiasis?

A

Cutaneous furuncular myiasis, caused by the human botfly

128
Q

What is the clinical presentation for myiasis?

A

locally painful, firm furuncular lesion w/centrally located pore

129
Q

What are common pathogens in cat/dog bites?

A

Strep, staph, Pasteurella multocida, anerobes

130
Q

How should cat/dog bites be tx?

A

›Clean wound
›Broad-spectrum antibiotics
›Tetanus booster
›+ rabies vaccine/immunoglobulin

131
Q

What is marine envenomation?

A

Dermatitis d/t contact w/sea anemone, coral, sponges

132
Q

What is the acute rxn caused by marine envenomation?

A

›urticarial, erythematous or hemorrhagic = seabather’s eruption
›Localized bathing suit area & intertriginous sites – edematous pink papules
(Jellyfish or sea anemone )

133
Q

How is marine envenomation tx?

A

Denature venom, remove foreign body, or topical steroids

134
Q

What is seborrheic ketatosis?

A

common condition > 40 y/o;
greasy appearance, warty texture; appears “stuck on; sites: face, neck, scalp, back, upper chest & less frequently on arms, legs & lower trunk

135
Q

How is seborrheic ketatosis dx?

A

dermoscopy

136
Q

How is seborrheic ketatosis tx?

A

liquid nitrogen, surgical excision

137
Q

What is actinic keratosis?

A

typically multiple pre-malignant lesions on sun-exposed areas d/t cumulative solar damage

138
Q

What are PE findings typical of actinic keratosis?

A

small (

139
Q

What should you do if you have a pt present with actinic keratosis?

A

biopsy - r/o SCC & BCC

140
Q

How is actinic keratosis tx?

A

liquid nitrogen cryo or topical 5-fluorouracil, imiquimod or diclofenac

141
Q

What is a classic pt hx when present with high suspicion of BCC?

A

present w/pimple that won’t heal or recurrent scab

142
Q

What are risk factors for BCC?

A

Sun exposure, pale. Light eye/hair, male, tendency to sunburn, hx of skin CA, FITZ skin types I/II

143
Q

Where are the majority of BCC found?

A

Face, then neck

144
Q

What is the most common presentation of BCC?

A

Nodular: most common, pink, pearly papule, or nodule often w/central telangiectasia or umbilication, ulceration & rolled periphery

145
Q

What are 2 other presentations? What can they be mistaken for?

A

›Pigmented: papule w/glassy transparency, can be speckled
‭ ‬›Can be mistaken for melanoma
›Superficial: erythematous patch/plaque w/atrophic center ringed by translucent micropapules, usually on trunk or extremities
›Morpheaform: firm, flesh-colored or yellowish & waxy w/pink tinge, scar like papule or plaque w/ill-defined borders

146
Q

How is BCC dx?

A

Dermoscopy/ biopsy

147
Q

How is BCC tx?

A

›Topical imiquimod

Surgical excision

148
Q

What is SCC?

A

malignant epithelial tumor arising from keratinocytes of epidermis; 2nd most common skin cancer

149
Q

What is the typical presentation of SCC?

A

Ca in ‭ ‬sun-exposed sites of elderly & fair-skinned individuals

150
Q

What does SCC typically grow from?

A

arise from actinic keratoses but some arise de novo, old scar, sites previously exposed to radiation or HPV

151
Q

Where is the most common site of mets and where does SCC most commonly met to?

A

Ears or vermilion border and mets to the LUNGS

152
Q

What are PE findings in SCC?

A

Erythematous, keratotic papule or nodule on sun damaged skin; varying degrees of ulceration, erosion, crust or scale & color red to brown, tan or pearly;

153
Q

How is SCC dx?

A

biopsy, CT

154
Q

How is SCC tx?

A

total excision: electrocautery or Mohs

155
Q

What is tx for melanoma?

A

›surgical w/staging & sentinel LN biopsy

›Mohs microsurgery

156
Q

What sunblock ingredients cover which wavelengths?

A

›UVA coverage: benzophenones, oxybenzone, methyl anthranilate, avobenzone
›UVB coverage: PABA, cinnamates
›All wavelength: titanium dioxide, zinc oxide

DOOS3 (12 decks)

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