Dermatology Flashcards
1
Q
- 30-40 yoa
- AI disease of unclear etiology
- Abs produced against Ags in intercellular spaces of epidermal cells
- possible causes are idiopathic, ACEI, penicillamine
- bullae are relatively thin and fragile
- POSITIVE Nikolsky’s sign
- PAINFUL
- not pruritic
- fluid loss and risk of infection d/t loss of skin integrity
- life-threatening
- mouth involvement
A
pemphigus vulgaris
2
Q
MOST ACCURATE test for pemphigus vulgaris
A
skin biopsy
3
Q
treatment for pemphigus vulgaris
A
steroids
4
Q
treatment for pemphigus vulgaris if steroids are ineffective
A
- azathioprine
- mycophenolate
- cyclophosphamide
5
Q
- 70-80 yoa
- can be sulfa drug-induced
- deep blisters
- thicker bullae much less likely to rupture
- oral lesions are RARE
A
bullous pemphigoid
6
Q
test for bullous pemphigoid
A
skin biopsy w/ immunofluorescent Abs
7
Q
treatment for bullous pemphigoid
A
steroids
8
Q
alternative treatment to steroids for bullous pemphigoid
A
- tetracycline
- erythromycin w/ nicotinamide
9
Q
- associated w/ other AI diseases
- can be drug-induced by ACEIs or NSAIDs
- very superficial
- NO oral lesions
A
pemphigus foliaceus
10
Q
diagnosis for pemphigus foliaceus
A
skin biopsy
11
Q
treatment for pemphigus foliaceus
A
steroids
12
Q
- d/o of porphyrin metabolism
- photosensitivity reaction to abnormally high accumulation of porphyrins
- NONHEALING blisters on sun-exposed parts of body
- hyperpigmentation of skin
- hypertrichosis of face
A
porphyria cutanea tarda
13
Q
are associated w/ porphyria cutanea tarda
A
- alcoholism
- liver disease
- chronic hepatitis C
- OCPs
- hemochromatosis
- DM
14
Q
test for porphyria cutanea tarda
A
urinary uroporphyrins
15
Q
treatment for porphyria cutanea tarda
A
- stop drinking alcohol
- stop all estrogen use
- barrier sun protection
- phlebotomy/deferoxamine
- chloroquine (increases porphyrin excretion)
16
Q
- hypersensitivity reaction, most often mediated by IgE and mast cell activation
- evanescent wheals and hives (onset w/i 30 minutes, and lasts
A
urticaria
17
Q
MCC of urticaria
A
- medications
- insect bites
- foods
- emotions
- latex
18
Q
chronic urticaria is associated w/
A
- pressure on skin
- cold
- vibration
19
Q
treatment for severe, acute urticaria
A
- H1 antihistamines
- steroids if life-threatening
20
Q
treatment for chronic urticaria
A
H2 antihistamines
21
Q
treatment for urticaria when trigger cannot be avoided
A
desensitization
22
Q
- milder version of hypersensitivity reaction than urticaria
- “typical” drug reaction
- rash resembles MEASLES (hence the name)
- can appear days after exposure, and even after medication has been stopped
- lymphocyte mediated
A
morbilliform rash
23
Q
treatment for morbilliform rash
A
antihistamines
24
Q
erythema multiforme causes
A
- penicillins
- phenytoin
- NSAIDs
- sulfa drugs
- HSV, or mycoplasma infection
25
- target-like lesions especially on PALMS and SOLES
| - can be described as "iris-like"
erythema multiforme
26
treatment for erythema multiforme
antihistamines and treat underlying infection
27
- hypersensitivity response to medications (penicillins, sulfa drugs, NSAIDs, phenytoin, phenobarbital)
- involves
Stevens-Johnson syndrome (SJS)
28
treatment for Stevens-Johnson syndrome (SJS)
- should be managed in burn unit
| - IVIG, cyclophosphamide, cyclosporine, or thalidomide
29
- most serious version of cutaneous hypersensitivity reaction
- 30-100% BSA involvement
- positive Nikolsky's sign
- drug-induced
toxic epidermal necrolysis
30
MCC of death in toxic epidermal necrolysis
sepsis
31
are prophylactic systemic antibiotics indicated in toxic epidermal necrolysis?
NO
32
causes of death in Stevens-Johnson syndrome (SJS)
infection, dehydration, and malnutrition
33
diagnosis of toxic epidermal necrolysis
skin biopsy
34
what effect do steroids have in toxic epidermal necrolysis?
decrease chances of survival
35
- LOCALIZED allergic drug reaction w/ repeated drug exposure
| - round, sharply demarcated lesions that leave a hyperpigmented spot at the site after they resolve
fixed drug reaction
36
treatment for fixed drug reaction
topical steroids
37
- painful, red, raised nodules on anterior surface of LE's
- nodules are TTP
- do not ulcerate
- ast about 6 weeks
- 2/2 recent infections or inflammatory conditions
erythema nodosum
38
inflammatory conditions associated w/ erythema nodosum
- pregnancy
- recent Streptococcal infection
- coccidioidomycosis
- histoplasmosis
- sarcoidosis
- IBD
- syphilis
- hepatitis
- enteric infections
39
treatment for erythema nodosum
- analgesics and NSAIDs
| - treat underlying cause
40
best INITIAL test for:
- tinea pedis
- tinea cruris
- tinea corporis
- tinea versicolor
- tinea capitis
- onychomycosis
KOH test of skin
41
MOST ACCURATE test for:
- tinea pedis
- tinea cruris
- tinea corporis
- tinea versicolor
- tinea capitis
- onychomycosis
fungal culture
42
- superficial bacterial infection
- described as "weeping," "oozing," "honey-colored," or "draining"
- occurs in warm, humid conditions
- more often caused by Staphylococcus, but sometimes Streptococcus pyogenes
impetigo
43
complication of impetigo
glomerulonephritis
44
treatment for impetigo
- topical mupirocin
| - PO antistaphylococcal abx if topical isn't enough (dicloxacillin, cephalexin, or cefadroxil (PO))
45
- involves both dermis and epidermis
- MCC by group A Streptococcus (pyogenes)
- fever, chills, bacteremia
- bright red, angry, swollen appearance to face
erysipelas
46
treatment for erysipelas
- dicloxacillin, cephalexin, or cefadroxil (PO)
| - oxacillin, nafcillin, cefazolin (IV)
47
if a pt is allergic to PCN w/ reaction being a RASH ONLY, can cephalosporins be used?
YES
48
if a pt is allergic to PCN w/ reaction being ANAPHYLAXIS, can cephalosporins be used?
NO
49
treatment for erysipelas if culture confirms Streptococcus
PCN G, or ampicillin (IV)
50
- involves dermis, and subcutaneous tissue
- caused by Staphylococcus, or Streptococcus
- +/- fever, hypotension, signs of sepsis
cellulitis
51
empiric treatment for cellulitis
oxacillin, nafcillin, cefazolin (IV)
52
treatment for mild cellulitis w/ MRSA
TMP/SMX, doxycycline, or clindamycin
53
- extremely severe, life-threatening skin infection
- starts as cellulitis that dissects into fascial planes
- Streptococcus and Clostridium are MC organisms
- increased risk with DM pts
necrotizing fasciitis
54
necrotizing fasciitis presentation:
- very high fever
- portal of entry into skin
- pain out of proportion to superficial appearance
- bullae
- palpable crepitus
55
diagnostic tests for necrotizing fasciitis
- CPK
| - XR, CT, or MRI to show air in tissue, or necrosis
56
best way to confirm diagnosis and mainstay treatment for necrotizing fasciitis
surgical debridement
57
antibiotic treatment for necrotizing fasciitis
- ampicillin/sulbactam
- ticarcillin/clavulanate
- piperacillin/tazobactam
58
treatment for necrotizing fasciitis if there is definite diagnosis of group A Streptococcus (pyogenes)
clindamycin and PCN
59
mortality rate of necrotizing fasciitis w/o adequate treatment
80%
60
infection loculated under skin surrounding a nail
paronychia
61
treatment for paronychia
- small incision to drain
- antistaphylococcal abx
(dicloxacillin, cephalexin, or cefadroxil (PO))
62
multiple, painful vesicles of genitals
herpes simplex
63
best INITIAL test for genital herpes simplex
Tzanck smear
64
MOST ACCURATE test for genital herpes simplex
viral culture
65
treatment for genital herpes simplex
PO acyclovir, famciclovir, or valacyclovir
66
when should you treat a child for chickenpox?
if immunocompromised
| same meds: PO acyclovir, famciclovir, or valacyclovir
67
complications of varicella
- PNA
- hepatitis
- dissemination
68
treatment for severe pain in elderly pts w/ dermatomal herpes zoster
steroids
69
best efficacy for decreasing risk of postherpetic neuralgia in dermatomal herpes zoster
acyclovir
70
nonimmune adults exposed to chickenpox should receive what?
varicella zoster immune globulin w/i 96 hours of exposure
71
- warts (condylomata acuminata) [heaped up, translucent, white or flesh-colored lesions on mucous surfaces]
human papillomavirus (HPV)
72
treatment for human papillomavirus (HPV)
- mechanical removal
| - imiquimod
73
- ulceration w/ heaped-up indurated edges
| - painLESS
primary syphilis
74
best INITIAL test for primary syphilis
darkfield microscopy
75
treatment for primary syphilis
IM PCN single dose
76
treatment for primary syphilis if PCN allergic
PO doxycycline x 2 weeks
77
- generalized copper-colored, maculopapular rash especially on PALMS and SOLES
- mucous patch
- alopecia areata
- condylomata lata
secondary syphilis
78
diagnostic tests for secondary syphilis
VDRL, or RPR (nearly 100% sensitive)
79
treatment for secondary syphilis
IM PCN single dose
80
treatment for secondary syphilis if PCN allergic
PO doxycycline x 2 weeks
81
- skin infection involving web spaces of hands and feet
- can also cause pruritic lesions around penis and breast
- burrows and excoriations around small pruritic vesicles
- often spares the head
scabies
82
scabies is confirmed by
scraping out organism after mineral oil is applied to burrow
83
best INITIAL treatment for scabies
permethrin
84
treatment for Norwegian scabies (severe crusting)
PO ivermectin
85
- includes the head
- easily transmitted
- extremely high rate of transmission
- sometimes rust colored from ingestion of blood
pediculosis (lice and crabs)
86
diagnosis of pediculosis (lice and crabs)
can be seen attached to hair-bearing areas
87
treatment for pediculosis (lice and crabs)
permethrin
88
- target lesion (> 85%) = rash must be erythematous w/ central clearing and be at least 5cm in diameter
- usually occurs 7-10 days after tick bite
lyme disease
89
treatment for lyme disease
doxycycline, amoxicillin, or cefuroxime (PO)
90
- caused by Staphylococcus attached to a foreign body (nasal packing, retained sutures, surgical material retained in the body)
- fever > 102
- SBP
toxic shock syndrome (TSS)
91
treatment for toxic shock syndrome (TSS)
- vigorous fluid resuscitation
- vasopressors
- antistaphylococcal abx
(oxacillin, nafcillin, cefazolin (IV))
92
treatment for toxic shock syndrome (TSS) if MRSA
vancomycin, or linezolid
93
- mediated by toxin from Staphylococcus
- loss of superficial layers of epidermis
- Nikolsky's sign
- presents w/ NORMAL BP
- NO involvement of liver, kidney, BM, or CNS
Staphylococcal scalded skin syndrome (SSSS)
94
treatment for Staphylococcal scalded skin syndrome (SSSS)
IV oxacillin, or nafcillin
95
- cutaneous infection acquired from contact w/ infected livestock
- occupational hazard of wool sorters
- can be used for bioterrorism
- papule w/ central necrosis (eschar)
- 20% fatality if untreated
anthrax
| Bacillus anthracis
96
how is the diagnosis of anthrax confirmed?
gram stain and culutre
97
treatment for anthrax
ciprofloxacin, or doxycycline
98
MOST ACCURATE test for melanoma
full thickness biopsy of lesion
99
most important prognostic factor for melanoma
tumor thickness
100
treatment for melanoma
excision
101
reduces recurrence rates of melanoma
interferon
102
- BENIGN
| - hyperpigmented lesions in elderly pts ("stuck on" appearance)
seborrheic keratosis
103
- PRECANCEROUS (increases risk of SCC)
- occur on sun-exposed areas in older pts
- can be TTP
actinic keratosis
104
treatment for actinic keratosis
- cryotherapy
- topical 5-FU
- imiquimod
- topical retinoic acid
- curettage
105
- sun-exposed areas in elderly pts
- commonly on the lip
- ULCERATION is common
- metastasis is rare
squamous cell carcinoma
106
diagnosis of squamous cell carcinoma
biopsy
107
treatment for squamous cell carcinoma
surgical removal
108
- shiny, or "pearly" appearance
| - accounts for 65-80% of skin cancer
basal cell carcinoma
109
how is diagnosis of basal cell carcinoma confirmed?
shave or punch biopsy
110
treatment for basal cell carcinoma
surgical removal (Mohs microsurgery)
111
- purplish lesions
| - HIV-positive w/ CD4 count
kaposi's sarcoma
112
treatment for kaposi's sarcoma
- ART to raise CD4 count
| - liposomal doxorubicin and vinblastine if HIV-negative
113
- silvery scales on EXTENSOR surfaces
- nail pitting
- Koebner phenomenon (lesions that develop at site of epidermal injury)
psoriasis
114
treatment for psoriasis
- emollients (moisturizer)
| - salicylic acid
115
treatment for xerosis/asteatotic dermatitis
humidifiers and emollients
116
- high IgE levels
| - red, itchy plaques on FLEXOR surfaces
atopic dermatitis
117
preventive treatment for atopic dermatitis
emollients
118
treatment for active disease of atopic dermatitis
- AVOID SCRATCHING
- topical steroids
- antihistamines
119
- oversecretion of sebaceous material
- hypersensitivity reaction to superficial fungal organism (Pityrosporum ovale)
- scaly, greasy, flaky skin found on red base of scalp, eyebrows, and nasolabial fold
seborrheic dermatitis
120
treatment for seborrheic dermatitis
- topical steroids
- topical antifungal
- zinc pyrithione
121
- hyperpigmentation built up from hemosiderin
| - occurs over long period from VENOUS incompetence of LE's
stasis dermatitis
122
prevention of stasis dermatitis
elevation of LE's
123
- hypersensitivity reaction to soaps, detergents, latex, sunscreen, or neomycin
- jewelry is a common cause
- can present as linear streaked vesicles (especially when caused by poison ivy)
contact dermatitis
124
definitive testing for contact dermatitis
patch testing
125
treatment for contact dermatitis
- identifying causative agent
| - antihistamines and topical steroids
126
- pruritic eruption that begins w/ "herald patch"
- erythematous and salmon colored
- mild and self-limited, resolves in 8 weeks
pityriasis rosea
127
- pustules and cysts occur and rupture
- caused by Propionibacterium acnes
- discharge is odorless
acne
128
treatment for acne: mild disease
- topical antibiotics: clindamycin, erythromycin, or sulfacetamide
- topical retinoids
129
treatment for acne: moderate disease
benzoyl peroxide and retinoids
130
treatment for acne: severe cystic acne
- PO antibiotics
| - PO retinoic acid derivatives
131
definition of stage 1 pressure ulcer
nonblanchable erythema of INTACT skin
132
definition of stage 2 pressure ulcer
superficial ulcers causing PARTIAL thickness loss of epidermis, dermis, or both
133
definition of stage 3 pressure ulcer
deeper ulcers causing FULL thickness loss w/ damage to subcutaneous tissue that may extend to, but NOT through, any underlying fascia
134
definition of stage 4 pressure ulcer
VERY deep ulcers causing FULL thickness loss w/ EXTENSIVE tissue destruction that may damage adjacent muscle, bone, or supporting structures
