Derm2Exam Flashcards
The borders of cellulitis are ________?
not well defined
The borders of erysipelas are ________?
sharply defined
clinical presentation of cellulitis
erythema, edema and warmth in deeper dermis and subcutaneous fat
clinical presentation of cellulitis
erythema, edema and warmth in upper dermis and superficial lymphatics
most common cause of cellulitis?
gram positive
most common cause of erysipelas?
mostly beta hemolytic strep
treatment of cellulitis/ersyipelas?
Elevation, treat underlying condition, antibiotics PO/parenteral
what is impetigo?
superficial bacterial infection that looks like honey-crusted lesions
risk factors of impetigo
poverty, crowding, poor hygiene, underlying scabies
impetigo sequelae (following)?
poststreptococcal glomerulonephritis and rheumatic fever
impetigo treatment?
antibiotics (something that will treat S. aureus and beta-hemolytic strep
erythema marginatum presentation?
pink barely raised, non-pruritic rings on trunk and inner surfaces of arms and legs
erythema marginatum possibly related to?
rhuematic fever or carditis
tinea corporis presentation?
expanding ring like lesions with scaly erythematous advancing raised edge and clear center found on the body aka ring worm
what is the striatum corneum
highest level of epidermis (horned layer)
where is the tinea pedis found?
on feet
How do you treat tinea corporis/tinea pedis?
topical antifungal
how do you treat nail or hair fungal infections?
PO antifungal
what is tinea versicolor?
chronic hyperpigmented (or less likely, hypopigmented) scaling dermatosis
How do you treat versicolor?
one large dose of antifungal.
where is tinea barbae found?
in the hair
where is tinea capitis found?
on the head
what does tinea capitis look like?
hair breaks off at the follicle and leaves a black dot.
what can form if you get tinea capitis?
kerion
what is a kerion formed from?
a reaction to the fungus tinea capitis
what is a kerion?
a boggy elevated tneder nodule (gray patch) with possible cervical lymphadenopathy
what color would the kerion turn if you had a woods light?
blue green
what is onychomycosis mainly caused by in the toenails?
mostly dermophytes
what is onychomycosis mainly caused by in the fingernails?
mainly yeast
what are the three types of onychomycosis?
distal subungal. proximal subungal and white superficial
what do you suspect if you see a proximal subungal toe
HIV
when would you have to treat for nail fungus?
if its a fingernail,symoptomatic, peripheral neuropathy or diabetes
what is paronychia?
inflammation of lateral and posterior nail folds
how do you treat paronychia?
ora antibiotics and topical anti-staph. also if abcess I&D and oral antibiotics
what are the different stages of hair growth?
anagen, catagen and telegen
what is anagen?
where your hair starts to grow and is growing
what is catagen?
the in between phase of anagen and telegen
what is telegen?
hair is a the end of its life and closer to the skin so it falls out easier
what are some non-scarring types of alopecia?
alopecia areata, pattern alopecia, telegen effuvium and trichotillomania
alopecia areata
autoimmune inflammatory with very smooth patches with short fractures hair at edges
types of alopecia areata
totalis and universalis
what is totalis
alopecia areata on the entire head
what is universalis?
alopecia areata on the whole body
treatment of alopecia areata?
refer to derm for intralesional corticosteroid and immunomodulator
what is pattern alopecia?
androgenic alopecia that results in hair thinning on crown or recession at the temples
pattern alopecia in women?
frontal hair is preserved but there is a wider part anteriorly
Treatment of pattern alopecia?
shorten the telogen phase (minoxidil), in women use oral anti-androgens
If a woman presents with pattern alopecia and has other abnormal excessive hair growth what should you test her for?
hirsuitism
what is telegen effuvium
non-inflammatory diffuse hair loss usually following an illness or injury
what is trichotillomania?
people pulling their hair out. you can usually see hair growing back in
what are some of the scarring alopecias?
chemical, physical trauma, bacterial or fungal infection, sever herpes zoster in opthalmic branch, chronic discoid lupus
Herpes simplex clinical presentation
cluster of pink papules that become vesicular
herpes simplex symptoms
painful ulcers with prodromal stage
how is herpes simplex transferred?
via oral secretions or herpetic lesions
what are the primary infection symptoms of herpes simplex?
10-14 days fever, lymphadenopathy and pain
what are some of the herpes simplex triggers?
UV light, fatigue, trauma, laser or immunosuppression
what are some tests to determine if it’s herpes simplex?
PCR (pricey btu definitive) or tzanck preparation (look for multinucleated giant cells)
what are you looking for in a tzanck preparation?
multinucleated giant cells
how can you tell the difference between herpes simplex ulcer and syphilis?
syphilis ulcer is not painful
herpes zoster transmission?
aerolized or direct contact
herpes zoster clinical presentation
prodrome (fever, malaise, pharyngitis, loss of appetite)
complications of herpes zoster
neurological –> encephaliits and reye syndrome** don’t give kids aspirin, pneumonia and infections
what is reye syndrome associated with?
Its a complication of herpes zoster and aspirin in children
what are the important things to remember about the herpes zoster vaccine?
it’s live so don’t give to pregnant women, cancer or HIV pts
what are the clinical features of herpes zoster?
chicken pox** generalized vesicular rash from macules to papules to vesicles to crusted papules
reactivation of VZV clinical presentation
painful unilateral dermatomal distribution with vesicular rash aka SHINGLES
complications of reactivation of VZV
zoster ophthalmicus (ophthalmic branch of trigeminal nerve), postherpetic neuralgia, motor neuropathy and meningitis
how can you test that it is shingles (reactivation of VZV)
tzanck or PCR
what are the clinical symptoms of molluscum contagiosum?
flesh color dome shaped papules with central core caused by pox virus
what are some of the treatments of molluscum contagiosum?
I’m pretty sure you don’t do anything. they willl just go away eventually
what are some of the treatments of common warts?
observe, liquid nitro, salicylic acid, duck tape, snip or shave
what is a persistent infection of anogenital warts possibly?
SCC
how to treat anogenital warts?
keep genitals dry, clean and use condoms or chemical,physcial destruction, immunologic or surgical
what is acanthosis nigricans?
benign hypertrophic dark plaques in flexural and intertriginous areas) skin disease underlying medical condition (typically obesity and insulin resistance)
how to treat acanthosis nigricans?
treat underlying condition first and skin will fix naturally
what is melasma?
skin hyperpigmentation, malar, central face and mandibular
how do you treat melasma?
bleach, topical retinoids, chemical peels or discontinue OC or give birth and it will go away
what is melasma caused by>
typically OC or pregnancy
what is vitiligo?
autoimmune depigmentation of the skin, slowly enlarging macules
how to treat vitiligo?
repigmentation, make up or staining
what is vitiligo associated with?
hashimoto, grves, diabetes pernicious anemia, rheumatoid arthritis
what is it if a woods lamp turns something blue green
fungal
what is it if a woods lamp turns something coral red?
bacterial
what are the 3 main features of hidradenitis suppurtiva?
blind boil, bilateral involvement, relapses and chonicity
what is hidradenitis suppurtiva?
inflammatory noduels, abcesses and sinusus with scarring mostly in intertriginous areas
what is the treatment of hidradenitis suppurtiva?
nroe cure, just control
what are the Hurley stages?
o 1. Abcess without sinus tract or scarring
o 2. Recurrent tract formations and scarring
o 3. Diffuse and interconnected tracts
what is a precursor of SCC?
actinic keratosis, scar, chronic ulcer
what are the ABCDE
asymmetry, border irregularities, color variation, diameter greater than 6mm, evolution of color change
what is leser trelat sign?
explosive onset of multiple seborrheic keratoses significant of GI malignancy
what is the treatment of actinic karatosis
depends on size and location. liquid nitro, surgical or prevention
wht are the clinical symptoms of scabies?
intensly pruritic, vesicles or nodules with excoriation and crusting
treatment of scabies?
permethrin cream
what are the clinical symptoms of brown recluse?
infarction of the skin, sinking macule, extension into muscle
black widow clinical symptoms?
neurologic overstimulation
treatment of black widow and brown recluse?
diazepam
how are pediculosis transferred?
lice go from fomite to fomite, no jumping
how is pediculosis treated?
lice are treated with permethrin cream
what are the clinical sings of bedbugs?
three bites in a row
what are the clinical signs of chiggers?
intense itching around sock and pant line
what is lipoma?
benign adipose tumor
what is liverdo reticularis?
mottled builish discoloration of skin
secondary liverdo reticularis is indicitive of?
serious disease. vasuclar obstructoin viscositiy changes, drugs
idiopathic liverdo reticularis
netlike patterm that discoor after warming
purpura clinical presentation
bleeding under skin or mucousal membrane does not blanch. petichiae or ecchymosis
what are xanthomas?
macuels, papules plaques, nodules or infiltrations in tendons. check cholesterol.
where is tuberous xanthoma found?
elbow and knees
where is tendinous xanthoma found?
achilles
what is xanthelasma?
polygonal papules and plaques in upper and lower eye lids
where is phemphigus follaceous?
confined to the skin
where is Pemphigus vulgaris and paraneoplastic pemphigus
involves skin and mucosal surfaces. associated with malignancy, non-hodgkins lymphoma
what is pemphigus?
autoimmune blistering disease of skin and mucosal membranes
what is erythema nodosum?
actue inflammatory immune reaction of subcutaneous fat (panniculitis)
what could erythema nodosum be caused from?
TB, OC, Lupus, behcets
cutaneous lupus erythromatosis is what?
multisystem autoimmune disease involving connective tissue and blood vessels
what are the signs of cutaneous lupus erythromatosis?
malar rash (butterfly), palmar erythema on fingertips. nailfold telangiectasia, palpable purpura
what is dermatofibromyosis?
autoimmune idopathic inflammatoy myopathy targetting skin or skeletal muscles
signs of dermatofibromyosis?
heliotrope, flat topped violacous papules over knuckles, progressive proximal muscle weakness
what is heliotrope?
changes oer eyelids and periorbital +/- edema
how to treat dermatofibromyosis?
immunosuppressant
what are signs of hep c?
jaundice, spider angiomas, palmar erythema, terry’s nails, prurutis, purpura
what is hep c associated with?
lichen planus
why are elderly considered special populations?
loss of elasticity, and subcutaneous tissue, less hydrated, vit D deficient, decreased immunity
what infections are typical in immunocomprimised pts?
opportunistic infections (seborrheic dermatitis, fungal infections and cutaneous manifestions),
