dermatology Flashcards
Pt is a 4-week old baby boy brought in by mother with c/o of a red rash on the sides of his face. She states that the rash has been present for a week now. It does not appear to itch at this time. On PE, you note comedones, papules on the lateral aspect of his face.
What does this pt have?
acne vulgaris
If comedone has a black head is it complete or incompletely blocked?
incompletely blocked
A white head on a comodone would indicate what?
thats its completely blocked
If the Pt has greater than 25 lesions is there acne claasified as
A. Comedonal
B. Papular
C. Pustular
D. Nodulocystic
C. Pustular
D-is severe scarring
B- is moderate number of lesions so less than 25 i guess
A. is mild acne
For most acne what is the treatment?
topical retinoids
For cystic acne what is the treatment?
Tetracyclines then oral retinoids like isotretinoin
What test do you need to perform twice before starting isotretinoin
need to perform two pregnancy test
How can you diagnose androgenetic alopecia ?
microscopic examination of cut or plucked hair fibers and scalp biopsies may provide additional information
What will biopsy of the hair fibers show?
telogen and atrophic follicles
what does trichogramma mean?
increased telogen hairs
What hormones could you evaluate to see why hair loss is occurring?
testosterone, DHEA, prolactin
What treatable conditions could attribute to hair loss?
Thyroid, anemia, autoimmune
When treating hair loss with minoxidil/rogaine will you end up loosing more hair before new ones grow back?
yes
Finasteride inhibits what two things to help decrease hair loss?
inhibits T and DHT
spironolactone inhibits/blocks what one thing for preventing hair loss?
DHT
a 5-year-old girl brought in by her mother for an itchy rash on her antecubital fossa, wrist, hands, ankles, and feet. Her mother describes the rash as severely itchy & “thick looking.” Her father had asthma as a child. On PE, you noted a pruritic, xerotic, and lichenified rash on the antecubital fossa, wrist, hands, ankle & feet.
What is the most likely diagnoses?
Atopic dermatitis
What does the term xerosis mean?
dry skin
What type of hypersensitivity is atopic dermatitis and where is it most likely found on the body?
IgE type 1
Most commonly found on the extensor surface (i.e. antecubital and popliteal folds)
If the pt is an infant other than extensor surfaces, where can atopic dermatitis be found?
Scalp and face
a mother wants you to do a skin prick test to figure out the cause of her child’s atopic dermatitis. Do you do it ?
No, you tell the mother skin prick tests are not used for atopic dermatitis
For atopic dermatitis could you do patch testing and an allergy referral to diagnose it?
Yes both those options are viable
What topical creams can you use to treat atopic dermatitis?
tacrolimus and pimecrolimus
For pts with moderate to sever atopic dermatitis that is not well controlled with optimal therapy may require what?
PUVA Phototherapy
What degree of a burn, 1st, 2nd, 3rd, 4th? will blanch when pressure is applied?
1st degree basically sunburn
describe a 2nd degree burn?
skin is red and blistered, skin is very tender
describe a 3rd degree burn?
burned skin is tough and leathery, no sensation as nerves have been destroyed
What is the rule of 9s for children?
Head-18% Each arm- 9% chest-18% back-18% each leg- 14%
For the palmer method of burns, the patients palm equates to what percent?
1%, used for small burns
What is the treatment for mild burns?
- clean w/soap and water
- drain and debride bullae
- Cover with 1% silver sulfadiazine
What is the treatment for moderate/sever burns?
cover with a dry dressing, admit to hospital
What labs should you/could you draw for burns?
- ABG
- CBC
- CK
- CMP
- UA
- Carboxygemoglobin
What percent of burns would require fluid replacement for children and adults?
children >10%
adults >15%
What is the fluid replacement calculation for adults? children?
Adults- LR 4ml x wt (Kg) x %BSA
Children- LR 3ml x wt (kg) x %BSA
Half of fluid goes in over the first 8hrs then 16hours
a 10-year-old boy with a bright pink and itchy rash with a linear pattern on his forearm and the dorsum of his left hand. He states that 4 days ago he went to a wooded park with his family. Several hours later, he noticed that his forearm and the back of his hand are red and itchy. He reports that last summer he had a similar incident when he went to the same park. On PE, a pink patchy rash with a linear pattern is noted on his forearm and the dorsum of his hand. Clear vesicles are also noted within the patches.
What is the most likely diagnoses?
contact dermatitis
Acute contact dermatitis will present as what?
erythema, vesicles, bullae burning, itching
Chronic contact dermatitis will present as?
scaling, lichenification, fissure *well-demarcated border
What type of test can you perform to verify the contact dermatitis?
patch testing
list some of the ways you can treat contact dermatitis?
- antihistamine
- Zinc oxide
- triamcinolone cream 0.1%) or oral steroids, Burow’s solution (aluminum acetate)
- Puva phototherapy
a 10-year-old boy with a bright pink and itchy rash with a linear pattern on his forearm and the dorsum of his left hand. He states that 4 days ago he went to a wooded park with his family. Several hours later, he noticed that his forearm and the back of his hand are red and itchy. He reports that last summer he had a similar incident when he went to the same park. On PE, a pink patchy rash with a linear pattern is noted on his forearm and the dorsum of his hand. Clear vesicles are also noted within the patches.
What is the most likely diagnoses?
diaper rash aka diaper dermatitis or just plane dermatitis
What are some causes of diaper rash?
wet, dark, friction, urine feces, microorganisms
If satellite lesions are present with diaper dermatitis what secondary infection should you think of?
candidiasis
impetigo is associated with what bacteria?
s. aureus
Are laboratory tests necessary to diagnose? if you wanted to do some which ones could you do?
No they are not.
- could do KOH prep and fungal culture of skin scrapings for candida
- Viral culture, mineral oil slide for scabies
- skin culture for s. aureus or group A streptococcus
what are the treatments for diaper rash?
- KEEPP AREA DRY
2. barrier creams like zinc oxide/petroleum jelly
For diaper rash w/candidiasis what are your treatment options?
- nystatin
- clotrimazole
- econazole x2wk
Describe the appearance of perioral dermatitis?
usually occurs in young women, they present with papulopustular, plaques, and scales around the mouth
With perioral dermatitis is the vermillion border spared?
yes this is the lip margin
Should you give steroids for perioral dermatitis?
nope avoid these
what is the first line Tx for perioral dermatitis?
Metronidazole 0.75% gel q12h
For moderate perioral dermatitis would you add an antibiotic?
yes an oral abx and topical
a 3-year-old male who presents today with his mother with c/o rash that started 2 days ago. His mother states that he had an ear infection and was treated with amoxicillin 6 days prior. On physical exam, you note a non-pruritic rash covering his chest and extremities
What is this pt presenting with?
drug eruption
What are some drugs common to causing drug eruptions?
Big ones include Penicillins like amoxicillin, bactrim, NSAIDs, and anticonvulsants
What two labs should be ordered after a drug eruption?
CBC and CMP to evaluate liver and kidney function
What is the first line treatment for drug eruption?
removal of the drug of course
epi dosing for infants weighing less than 7.5kg (16lbs)?
should be given an exat weight based dose, but if this delays tx significantly then 0.15mg dose from autoinjector can be given
Infants and children weighing from 7.5 kg to 25 kg (16 - 55 lbs) can be given what dose of epi?
can be given 0.15 mg by autoinjector (Epi-Pen Jr.) or by drawing up 0.15 mL of the 1 mg/mL solution.
at what weight can someone be given an epi dose of 0.3mg by autoinjector
patients weighing 25-50kg (55-110lbs)
If you weigh more than 50kg can you be given an even higher dose of epi?
yep can get 0.5 mg (0.5 mL of the 1 mg/mL solution).
Drug induced hypersensitivity syndrome can be treated with what?
systemic corticosteroids (1-1.5mg/kg/day) with a slow taper over at least 6 weeks
Acute & chronic urticarial can be treated with?
2nd generation antihistamines like allegra, claritin, zyrtec
a 12-year-old boy who presents with some non-itchy maculopapular rash that looks like targets. He stated that a week ago, he was treated for an HSV infection. On PE, you note a symmetrical red rash with 3 areas of concentricity which are red, white & purplish in color respectively.
What are you thinking it is?
erythema multiforme
what is erythema multiform?
it is a self limiting sometimes recurring skin condition that is considered a type IV hyersensitivity reaction affecting the skin and mucous membranes
What parts of the body are affected by erythema multiforme?
hands, feet, mucous membranes
MCC of erythema multiforme?
HSV is number 1, infection, mycoplasma pna, URI
What two characteristic aspects of erythema multiforme help diagnose it?
blanching and lack of itchiness
the rash also has target (iris) lesions, that are dull “violet red”
major erythema muiltiforme is described as?
widespread skin lesions and affect 2+ mucosal sites
Minor erythema multiforme is described as?
limited region of the skin and 1 type of mucosa (usually oral)
Will there be a positive nikolsky sign with erythema multiforme? with what conditions would you see a positive nikolsky sign?
no with erythema multiforme there is a negative nikolsky sign
You would see a positive nikolsky sign with SJS and TEN
“Slapped cheek” rash on the face, lacy reticular rash on extremities, spares palms and soles describes what?
This describes erythema infectiosum caused by parvovirus B19
How do you Tx erythema infectiosum caused by parvovirus B19 ?
supportive or anti-inflammatories
usually resolves in 2-3 weeks
Pt is an 8yom who presents with rash on hands, feet, mouth and buttocks. Oral exam shows sores in the mouth. What virus caused this? and what is it?
coxsackievirus type A virus.
This is hand-foot-mouth disease
How do you treat hand-foot-mouth disease?
supportive, anti-inflammatories
usually clears up on its own within 10 days
The 4c’s for measles (Rubeola) are?
ough, coryza, conjunctivitis, and cephalocaudal spread
Describe the progression of the measles (Rubeola) rash?
brick red rash on the face beginning at hairline then progressing to palms and soles. it lasts for 7 days
What kind of spots will you see with measles (Rubeola)?
Koplik spots
describe koplik spots?
small red spots in buccal mucosa with blue-white pale center
usually precedes rash by 24-48hrs
What vaccine could prevent someone from getting measles (Rubeola)?
the MMR vaccine (12-15mo, 4-6yr)
how long should someone be isolated for if they get measles (Rubeola)?
for one week
a parent meets you on the streets and asks about a rash their child had. They state is lasted 3 days was pink light red spotted maculopapular rash. It first began on the face, spread caudally to the trunk and extremities.
What rash is the parent wanting to know about?
Rubella (german measles)
What does cephalocaudal spread mean?
beginning at the head and moving to the feet
what lymph nodes will be swollen with rubella?
posterior cervical and posterior auricular
Which rash spreads faster rubeola or rubella? which one darkens and coalesces?
rubella spreads faster
rubeola will darken and coalesce
is rubella teratogenic in the first trimester? what birth defects can occur from it?
- deafness
- cataracts
- TTP
- mental retardation
What is the only childhood exanthem that starts on the trunk and spreads to the face?
roseola (sixth disease)
Roseola is from what form of herpesvirus?
6 and 7
What is the common presentation of roseola
High fever 3-5 days then rose pink maculopapular blanchable rash on trunk/back and face
a 5-year-old girl with crusting facial lesions present for 3 days. The mother reports that prior to the development of the facial lesions her daughter was scratching at insect bites. Examination reveals a red facial rash with a golden “honey-colored crust” and pruritus.
What is the most likely diagnoses?
impetigo
mcc sites for impetigo?
face and extremities
MC organism for impetigo?
S. aureus
How can you diagnose impetigo?
gram stain and culture
will Nikolsky be positive or negative?
negative
What is the treatment for impetigo?
warm water soaks 15-20mins then
1st line med is mupirocin x 5days
If impetigo becomes a wide spread infection what antibiotics do you use?
cephalexin or erythromycin x 1wk
What is a complication of impetigo?
poststreptococcal glomerulonephritis
a 10-year old girl brought in by her mother after she was picked up from school for excessive scratching of her hair. She reports that the itchiness has been ongoing for 1 week. On PE, you note several ovoid, grayish-white eggs less than 1cm from the base of the hair shaft at the back of the head and behind the ears.
What is most likely diagnoses?
Lice
Tx for lice?
Permethrin topical is the drug of choice: Capitis: permethrin shampoo x 10 minutes; Pubis: permethrin lotion x 8 hours
What is being described? purplish, itchy, flat-topped bumps. on mucous membranes, such as in the mouth. it forms lacy white patches, sometimes painful sores.
Lichen planus
what are the 5 p’s that characterize lichen planus?
purple papule polygonal pruritus planar
what is wickham striae?
whitish lines visible in the papules of lichen planus
Tx for lichen planus?
topical steroids
a 15-year-old female with a 3-week history of oval eruption that aligns along the skin folds. She states that a week ago she noticed a 3 cm oval patch with central clearing on her upper thigh. A week later, smaller variants of the initial patch started to erupt. On PE, a wide-scale symmetrical papular eruption is noted over her trunk. Lesions align along the Langer lines in a characteristic Christmas tree pattern.
what is the most likely diagnoses?
Pityriasis rosea
Tx for Pityriasis rosea
the disease is usually self limiting.
can use topical or systemic steroids and antihistamines to relieve itching
a 12-year-old boy who presents with c/o excessive itching in the interdigital spaces of the hands and feet, axillae, and groin. The head and neck are spared. He reports that his brother came home last week from school with itchiness and was later diagnosed with scabies. On PE, you note, linear burrows, excoriations in his web spaces of hands and feet, axillae & groin. Lesions do not appear to be infected.
Most likely diagnoses is what?
scabies
how do you treat scabies?
topical permethrin 5% - apply to the entire body and wash after 8-14 hours ⇒ repeat in one week (> 2 months old)
if pt is less than 2 months old what ointment can you use?
Sulfur 5%-10%
If the pt is immunocomprimised what medication should you give?
oral ivermectin
can you use oral ivermectin in pregnant or breastfeeding individuals?
nope
how long can the pruritus from scabies last after Tx
2-4 weeks
a 60-year-old woman with a severe drug-induced reaction on both lower limbs with few lesions elsewhere in addition to mucosal involvement of the mouth of two days duration. The insulting drug was sulfonamide and the onset of the rash was within 48 hours of taking the drug. The rash comprised of bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosions and peeling.
what is most liekly diagnoses?
SJS
what percent of body is SJS?
3-10%
what drugs commonly cause SJS?
anticonvulsants and sulfa drugs
what are all the different kinds of Tinea?
- Tinea barbae
- Tinea pedis
- Tinea unguium
- Tinea cruris
- Tinea capitis
- Tinea corporis
- Tinea versicolor
Match the following
- Tinea barbae
- Tinea pedis
- Tinea unguium
- Tinea cruris
- Tinea capitis
- Tinea corporis
- Tinea versicolor
A. Athlete’s Foot: pruritic scaly eruptions between toes. Trichophyton rubrum is the most common dermatophyte causing athlete’s foot
B. Infection of the nail
C. papules pustules, around hair follicles
D. “Jock Itch” diffusely red rash in the groin or on the scrotum
E. usually seen in younger children or in young adolescents with close physical contact with others (i.e. wrestlers)
F. is caused by Malassezia furfur, a yeast found on the skin of humans. Lesions consist of hypo or hyperpigmented macules that do not tan
G. The most common fungal infection in the pediatric population. This occurs mainly in prepubescent children (between ages 3 and 7 years). Asymptomatic carriers are common and contribute to spread
1 with C 2 with A 3 with B 4 with D 5 with G 6 with E 7 with F
Which of the tineas can be treated with Topical azole antifungals (1% clotrimazole, 2% ketoconazole)?
Tinea corporis
Tinea cruris
Tinea Pedis
What is the drug of choice to treat Tinea capitis with?
oral griseofulvin
how do you treat tinea versicolor?
selenium sulfide 2.5% applied to the affected skin for 10 minutes
Tx for tinea unguium?
Terbinafine
can you nystatin for any of the Tinea infections?
nope
a 60-year-old woman with a severe drug-induced reaction with extensive skin involvement covering > 30% of her body surface area. The insulting drug was anticonvulsant medication and the onset of the rash was within 10 days of taking the drug. The rash comprised of bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosion and peeling. On examination, her skin peels away in sheets when pressure applied and rubbed.
Most likely diagnoses?
TEN
how do you Dx TEN?
biopsy will show necrotic epithelium
admit to burn unit w/supportive care
a well-appearing 9-month-old male with a rash that comes and goes. According to the mother, citrus was recently added to the patient’s diet. On physical exam, you observe a widespread rash composed of blanchable, edematous, pink, papules, and wheels on the face, trunk, and lower extremities. The patient is started on PRN oral antihistamines for pruritis and the mother is encouraged to eliminate citrus from his diet. The rash resolves within 72 hours.
What is the most likely diagnoses?
Urticaria
Loacalized urticaria appearing where the skin is rubbed is known as what sign?
Darriers sign
what is the commons signs and symptoms of urticaria
blanchable, pruritic, raised, red, or skin-colored papules, wheels, or plaques on the skin’s surface; usually, disappear within 24 hours
What is the first line treatment for urticaria?
Second generation antihistamine blockers (H1) are first-line treatment (Allegra, Claritin, Clarinex, Zyrtec)
a 9-year-old girl with multiple lesions on her hands and feet. She reports that these are not painful or itchy, but they are very embarrassing. Her best friend will no longer hold her hand and refuses to come to her house for a sleepover. Her past medical history includes atopic dermatitis. On physical exam, she has multiple 4-5 mm flesh-colored, sharply demarcated, rough, round, and firm nodules on her hands and feet.
What is the most likely diagnoses?
Verrucae (warts)
All warts are caused by what?
HPV
Match these up
A. Verrucae vulgaris B. Verrucae plana C. Verrucae plantaris D. Condyloma acuminatum E. Epidermodysplasia verruciformia
- (flat warts): Hands, face, arms, legs
- (common warts): skin-colored papillomatous papules
3 (plantar warts): bottom of the foot. Rough surface. Dark spot (thrombosed capillaries)
4 a rare, lifelong hereditary disorder characterized by chronic infection with HPV
5 (venereal warts): flesh-colored, cauliflower appearance genital warts caused by HPV types 6 and 11
A with 2 B with 1 C with 3 D with 5 E with 4
What is the Tx for warts?
most will resolve w/out treatment over 2 years
can use cyrotherapy with liquid nitrogen
can also self administer topical therapy such as salicylic acid
