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FNP2- test 1 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Why use a wet compress?

A

Use to decrease inflammation, mild wound debridement, anti-bacterial benefits
Antibacterial: aluminum acetate, acetic acid, silver nitrate

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2
Q

topical steroid groups

1-7

A

Group 1: strongest

Group 7: weakest

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3
Q

Disorder of the pilosebaceous follicles → increased sebum production, altered keratinization, inflammation, bacterial colonization

A

Acne Vulgaris

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4
Q

What is considered mild acne?
moderate acne?
Severe?

A

Mild → less than ¼ of face without scarring or nodules, moderate → ½ of face, severe → ¾ face

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5
Q

characterized by comedones, erythematous papules, pustules and nodules

A

Acne Vulgaris

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6
Q

Acne differentials

A

Milia
Rosacea
Perioral Dermatitis
Sebaceous Hyperplasia

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7
Q

How long does it take for acne medicine to take effect

A

6-12 weeks

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8
Q

First-line tx for acne

A

Topicals are first line: tretinoin (retin-a), adapalene (differin), tazarotene, azelaic acid, benzoyl peroxide, salicylic acid

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9
Q

Oral Antibiotics for Acne

A

Oral abx: for inflammatory acne and used for severe cases, unresponsive to topicals, scarring prone pts, lesions on trunk and back

Minimum 6 weeks; once improvement is achieved, d/c and stick to retinol

Most used: minocycline (most effective), doxycycline, erythromycin, tetracycline

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10
Q

Hormone Therapy to Tx Acne

A

ombined oral contraceptives, spironolactone, drosperidone

Antiandrogen meds that cause sebaceous gland suppression

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11
Q

What to know about Isotretinoin

A

Severe acne ONLY; monitored by derm, monthly triglyceride and hepatic function monitoring, 2 forms of birth control for women

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12
Q

Best way to differ rosacea from acne

A

rosacea does NOT have comedones

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13
Q

Rosacea that coexists with acne; most often seen between 30-50 y/o women, men are more severely affected if they have it

A

Acne Rosacea

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14
Q

…end up having psoriasis arthritis, autoimmune disorder, T cells have a key role, environmental triggers can bring a flare, immune stimulation of epidermal keratinocytes that builds up the layers and creates the plaques/ lesions

A

Psoriasis

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15
Q

5 types of Psoriasis

Plaque (most common)- \_\_\_\_
Guttate-\_\_\_\_\_\_
Inverse- \_\_\_\_\_\_
Pustular-\_\_\_\_\_\_\_
Erythrodermic - \_\_\_\_\_\_\_
A

5 types:
Plaque (most common)- grey, crusty
Guttate- young adults and children, water droplet scaly
Inverse- mistake it for fungal
Pustular- looks dry and mistake for tines pedis
Erythrodermic - broad and hot

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16
Q

when to use Emollient creams and lotions

A

Dry lesions
Loss of cutaneous moisture, epidermal lipids and proteins
Best if you applied to damp skin
Creams with urea and lactic acid work best
Thicker is better

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17
Q

Warnings for topical steroid level I (psoriasis, hand eczema)
ex. Clobetasol

A

not for face, axillae, groin or under breasts! Limit use to 14 days

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18
Q

Warnings for topical steroid levels II and III (atopic dermatitis adults)
ex. Difloorasone, Desoximetasone

A

not for face, axillae, groin or under breasts!

Limit use to 21 days

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19
Q

Warnings for topical steroid levels IV and V (atopic dermatitis in children)
ex. Triamcinolone
Hydrocortisone valerate

A

Limit use in children to 7-21 days, limit in intertriginous areas

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20
Q

Warnings for topical steroid levels VI & VII
ex. Desonide, Hydrocortisone
(eyelid dermatitis, diaper dermatitis)

A

reevaluate if not responded in 28 days - avoid long term use continuous in any areas

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21
Q

benign Dilated venules, <0.5cm, mostly found on trunk

After the age of 30 y.o
Red and are 3-5mm
Not associated with disease process
Tx = cosmetic- electrodessication, laser

A

cherry angioma

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22
Q

Small skin flaps, attached by a stalk

can occur anywhere on the body, increase with weight gain, increase the frequency with age

A

Skin Tags

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23
Q

Autoimmune disorder; causes chronic inflammatory response at bulbs of hair and breaks easily (cycles of growth and loss) → stress, Addison dx, lupus, thyroid dx causes

A

Alopecia areata

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24
Q

Common tx for Alopecia Areata

A

Topical Minoxidil

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25
Q

Most common type of hair loss : heredity thinning of hair, effects anagen (growth) phase, polygenetic
tx?

Men: receding hairline at temples, thinning frontal and vertex; women: diffuse thinning, frontal-parietal areas most affected

A

Androgenic alopecia

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26
Q

Other name for atopic dermatitis

A

eczema

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27
Q

Patho: We see it on cheeks in children, AC
Risk Factors:
Children
Environmental triggers (soy, fish, dust mites, molds, staph)

A

Atopic Dermatitis / EZCEMA

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28
Q

2 phases of Atopic Dermatitis / EZCEMA

A

Acute phase: weep, red, scales

Chronic: Lichenified skin due to scratching- dry - > Risk for infection

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29
Q

Form of eczema, allergies response
Resolutions takes 3 weeks
Remains sensitive to offending substance

Treatment
Avoid triggers, topical creams, lotions, corticosteroids

A

Contact Dermatitis

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30
Q

Patho:
Benign but if untreated -> squamous cell carcinoma
Risk Factors:
Sun exposure, tanning beds, fair skin, blue/ green eyes

A

Actinic Keratosis

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31
Q

How to manage Actinic Keratosis

A 
Refer for tx 
Liquid nitrogen (freeze-thaw technique)

Topical 5-fluorouracil (Efudex, Carac) or imiquimod (Aldara)

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32
Q

hair prematurely enters telogen (shedding of mature hair) phase → sudden hair loss
Women, men, infants affected; causes: childbirth, high fevers, medications, endocrine abnormalities, anemia, malnutrition

A

Telogen Effluvium

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33
Q

Patches of hair loss on scalp, eyebrows, eyelashes, beard (men)

A

Alopecia areata

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34
Q

How to tx alopecia in women? men?

A

Minoxidil (rogaine) only FDA approved for women, finasteride (Propecia) preg cat X

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35
Q

Important to ask about with alopecia?

A

History!

Ask about sx (scalp itching, pain, flaking) → differentials

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36
Q

Diagnostics for bites?

A

C-reactive protein, sed rate for tx response

Radiographs for fractures, foreign bodies, soft tissue injury, subq gas, osteomyelitis

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37
Q

How to manage a bite?

A

DO NOT CLOSE IT
Irrigate wound with sterile NS, pack if necessary
Bites to face → debride, preemptive abx, primary closure, then ED/plastics referral
Cat and human bites, puncture wounds, infected wounds, wounds >6-12 hours old should be left open r/t infection risk
hand/foot wounds: immobilization 1-3 days
Qday outpatient monitoring

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38
Q

Abx tx for bites?

A

Prophylaxis only for high-risk bites or patients; cat/hand 5-7 days prophylactic abx
amox/clav (augmentin)

5-7 days; clindamycin + doxy for pcn allergy
Older infected bites → IV abx in hospital

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39
Q

What to do if possibly rabies bite?

A

wash immediately with soap and water OR 1% iodine solution
Watchful waiting for most bites
If animal becomes ill, patient should be treated; high risk bites should be treated
If bite is on head/neck, do not do watchful waiting for tx → TX IMMEDIATELY
Tx: immunization of human rabies immune globulin (HRIG) or purified chick embryo vaccine (PCEV); active immunization with human diploid cell vaccine (HDCV) or PCEV days 0,3,7,14

40
Q

Firm, intradermal nodules in skin; mostly found in women on the legs
-Typically asymptomatic, but pruritic/tender if sx occur, Variable color
Fitzpatrick sign
Cosmetic or discomfort purposes → deep excision necessary, inform pt scar may be more unattractive than lesion itself

A

dermatofibroma

41
Q

What is Fitzpatrick sign?

A

(dimple sign)
Squeeze lesion with thumb and forefinger → lesion will dimple
-> dermatofibroma

42
Q

Skin lesion varying size from 2mm-3cm (Present as waxy or verrucous appearing papules or plaques that have a “stuck on” appearance; variable color)

Family members, advancing age, anywhere on body (frequently trunk, no palms or soles)

A

seborrheic keratosis

43
Q

Most common benign non-melanocytic skin lesion on body

A

seborrheic keratosis

44
Q

how to tx seborrheic keratosis?

when to be concerned?

A

Bx or referral to derm for atypical lesion
Cryotherapy, shave biopsy or curettage

Worried if Change in SK, irregular borders, color changes, unusual black or blue

45
Q

First line abx. med mgmt for insect/ spider bites?

A

Amox-clav first line

Allergies: Cephalosporin or Bactrim + clindamycin

Cleansing. IRRIGATION

46
Q

Autoimmune disorder: large, tense, subepidermal blisters occurring on normal or erythematous skin
-> presence of circulating IgG antibodies for hemidesmosomal BP against proteins of dermal-epidermal junction

A

Bullous Pemphigoid

47
Q

What phase of Bullous Pemphigoid?
mild to severe pruritis with erythematous, eczematous papules or urticarial lesions lasting several weeks to months; early sign of dx, delays diagnosis

A

Prodromal phase

48
Q

What phase of Bullous Pemphigoid?
presents suddenly intense pruritus, widespread blister formation
Lower abd, flexor aspects of arms and legs including axillae, groin and thighs, oral lesions common

A

Bullous phase

49
Q

Risk factors/ triggers for Bullous Pemphigoid lesions

A

> 60 y/o

Triggers for lesions: trauma (burn, UVR, radiotherapy), drugs (lasix, enalapril, ibuprofen, abx), herpes virus, EBV

50
Q

(ability to split dermis from epidermis with pressure) negative in BP(Bullous Pemphigoid) pt

A

Nikolsky sign

51
Q

Gold standard diagnostic for Bullous Pemphigoid?

A

direct immunofluorescence (DIF) microscopy of skin bx;

52
Q

goals with tx eczema

A

PREVENT ITCH/ hydrate =goal

moisturizer/ rehydration - after bath

53
Q

3 months of age, SUPER itchy
Acute phase: weep, red, scales
Chronic: Lichenified skin due to scratching- dry
Risk for infection
Turns to this if untreated and continuous scratching

A

Atopic Dermatitis

54
Q

1st line tx for chronic atopic dermatitis/ eczema if infected with staph or strep?

A

first line cephalosporins - cephalexin

55
Q

Rash 24-72 hours from contact - oils, so SHOWER
Vesicles
Does Not follow dermatome
Itchy

A

Plant Dermatitis

… Domeboro- compress wet dressing, dries it up

56
Q

Greasy, white or yellow scales, itchy
Ear or around nose (nasal folds)
Redness
Cradle cap→ baby shampoo to keep it clean
Can be mistaken for yeast if in diaper area
PE: looks and flakes like dandruff

A

Seborrheic (dermatitis)

57
Q

Inflammation or infection of hair follicles, typically result of an infection
Occurs in regions with hair that is thick, long, and dark; area under occlusion → head, neck, axillae, groin, buttocks
- Topical benzoyl peroxide
Abx if needed

Superficial should resolve on own

A

Folliculitis

58
Q

Candida is resistant to ____

A

Nystatin

59
Q

how to manage candida?

A

Treat the mother and the baby BOTH
Clotrimazole 10 mg dissolve in mouth 5x/day for 14 days

Nystatin- 4-6ml swish and spit 3-4x/day 7-14 days CONTINUE AFTER symptoms resolved

Fluconazole 200mg by mouth first day, 100mg for 2-3 weeks

60
Q

Cutaneous dermatophyte infection -> Circular ring and central clearing
CONTAGIOUS- athletes (wrestlers)

A

Cruris Corporis - ringworm

61
Q

How to tx Cruris Corporis - ringworm

A

Oral (more severe/widespread): itraconazole 200 mg 1x/day or terbinafine 250mg 1x/day for 2-3 weeks (watch the liver)
topical anti-fungal: mild to moderate lesions BID 7-10 days after lesions resolve
Use clean towel

62
Q

4 types of Pedis- Athlete’s foot (fungal)

A

Chronic hyperkeratotic- pattern of lesions, scale and thick
Chronic intertriginous- the skin breaks between the toes
Acute ulcerative-
Vesiculobullous -

63
Q

Crusty, red ring with central clearing on foot

A

Pedis- Athlete’s foot

64
Q

how to tx Pedis- Athlete’s foot

A

K+ hydroxide
Drying agents: anti-fungal powders (miconazole), gentian violet
Keep feet dry, dont use corn starch (hold moisture and promotes growth of dermatophytes)
Oral (more severe /widespread): itraconazole 200 mg 1x/day for month or terbinafine 250mg 1x/day for 2-6 weeks

65
Q

Brought on by autoimmune disease… blackheads in small pitted areas of the skin.. Often occur in pairs
Red tender bumps
Painful, pea-sized under skin , Itching and burning, Occurs where skin rubs against skin or hair follicle… can occur anywhere there is hair but often in axilla

Women, obese, smoker, ance, family hx, 20-29 y.o, may resolve after menopause

A

Hidradenitis suppurative & hyperhidrosis (autoimmune)

66
Q

superficial/partial thickness: epidermis only, glossy, red, painful

A

1st degree burn

67
Q

partial-thickness: dermis involved, dull or glossy with pink, red or white pigmentation; may blister → very painful

A

2nd degree burn

68
Q

full thickness to sq fat: matte, white, brown, red or black; insensate is hallmark

A

3rd degree burn

69
Q

what labs to check with serious burns?

A

cbc, glucose, electrolytes (high K+-cell breakdown), BUN, creat- rhabdo, renal fxn, tissue perfusion, , UA-myoglobin=ATN,; chest xray (inhalation), culture of site if delayed healing

70
Q

Periungal tissue induated with infectious matter
Antibiotics appropriate for likely causative organisms
Nail may need to be removed if nail has separated from the bed

A

paronchial Infections

71
Q

Caused by trauma to the nail
May result in loss of nail… usually grows back
If no hx of trauma, consider Proteus or Pseudomonas infection

A

subungal hematomas

72
Q

inflammatory dermatitis, co-exist with acne
Later in life 30-50 y.o
Spicy foods, ETOH
Clinical Manifestations:
On the face, looks like flushing, burns
manage w/ Topical metronidazole 3-4 months

A

Pityriasis Rosacea (rash)

73
Q

T cells have a key role, environmental triggers can bring a flare, immune stimulation of epidermal keratinocytes that builds up the layers and creates the plaques/ lesions

A

Psoriasis (rash) - Autoimmune

74
Q

(most common Psoriasis)- grey, crusty, over bigger areas of skin

A

Plaque

75
Q

type of psoriasis- young adults and children, water droplet scaly

A

Guttate

76
Q

type of psoriasis … broad and hot

A

Erythrodermic

77
Q

How to manage autoimmune psoriasis

A

Severe (>20%- refer to dermatology); if joint swelling/ joint pain refer to rheumatology
High potency topical steroid - hard to be absorbed because of the plaque
UV light therapy
Immunosuppressive drugs- biologics

78
Q

skin cancer warning signs

A

Open sore that does not heal for 3 weeks
A spot or sore that burns, itches, stings, crusts, or bleeds
Any mole or spot that changes in size or texture, develops irregular borders, appears pearly, translucent, or multicolored
Changes that occur over a month or more should be evaluated

79
Q

Most common skin cancer-> sun exposure
Lesions vary from normal, flesh-colored lesions to slightly pigmented
Typically have raised, shiny appearance with pearly borders
>3 weeks- think BCC
They can spread

A

Basal Cell Carcinoma: rise up a little more

80
Q

Lesion is typically roughened, scaling area that does not heal and readily bleeds when scraped
Keratinization can lead to heaped-up, flaky appearance
Don’t spread
… needs total excision

A

Squamous Cell Carcinoma

81
Q

Most fatal skin cancer; heavy sun exposure
UV radiation → DNA damage, gene mutation, immunosuppression, oxidative stress, inflammatory response

Surgical cure- IF CAUGHT EARLY, if spread- deadly
Immunotherapy

A

melanoma

82
Q

ABCDE of melanoma

A

Asymmetry of the border; Border irregularities; Color variability within lesion; Diameter >6mm (¼ in); Elevation

83
Q

common MM sites in African Americans, Asian Americans, and dark-skinned individuals

A

nails, hands and feet

84
Q

primary skin lesion vs secondary?

A

Primary skin lesions are present at the onset of a disease
secondary skin lesions result from changes over time caused by disease progression, manipulation (scratching, picking, rubbing), or treatment.

85
Q

elevation in the skin with smooth surface and sloping borders (usually) light pink ranges from 3mm- 20 cm
ex. mosquito bite

A

Wheal

86
Q

raised lesion up to 1cm in diameter filled with clear fluid

ex: herpes simplex (early stages)

A

Vesicle

87
Q

Raised lesion > 1cm in diameter, filled with clear fluid

ex:

A

bulla

88
Q

raised lesion filled with pus

ex: acne

A

pustule

89
Q

a spot, circumcised, up to 1 cm; not palpable; not elevated above or depressed below surrounding skin surface; hypopigmented, hyperpigmented, or erythematous
ex. freckle

A

Macule

90
Q

a spot, circumcised, greater than 1 cm; not palpable; not elevated above or depressed below surrounding skin surface; hypopigmented, hyperpigmented, or erythematous
ex. Cafe au lait spots, Mongolian spots

A

Patch

91
Q

A bump, palpable and circumcised, elevated and less than 5 mm in diameter, might be pigmented, erythematous, or flesh-toned
ex. elevated nevus

A

Papule

92
Q

similar to papule, diameter of 5mm- 2cm, may have significant palpable dermal component
ex. fibroma, xanthoma, intradermal nevi

A

nodule

93
Q

usually well-circumcised lesion with large surface area and slight elevation
ex. psoriasis, lichen planus

A

plaque

94
Q

painful burning, usually unilateral, lesions last about 7-10 days

A

Herpes Zoster

95
Q

Pustules on the skin, recently in hot tub

A

Folliculitis

96
Q

How to dx and tx herpes zoster?

A

dx with Tzank smear

Tx: with an antiviral (acyclovir, valacyclovir)

97
Q

Folliculitis tx?

A

benzol peroxide

if necessary: penicillins (others work too)

FNP2- test 1 (7 decks)

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