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primary 3 chronic conditions final exam > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Psoriasis

A

Chronic inflammatory pruritic skin disorder characterized by rapid proliferation of epidermal cells
* Patients may have frequent exacerbations or remissions
May have significant impact on social behavior and self-esteem

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2
Q

Psoriasis Signs and symptoms

A

Hallmark signs:
 *Plaque-type lesions, with silvery white scales on erythematous base
 *May distribute on scalp, elbows, palms, soles, fingernails, nail pitting
 *Auspitz Sign: pinpoint bleeding under the skin’s surface
 *Gluteal pinking: where the gluteal folds are pink and smooth

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3
Q

Psoriasis treatment

A

Treatment
 Topical steroids with plastic occlusion
* *Start with lowest dose possible
o *Especially on face and sensitive skin areas
* May cause thinning of the skin
* May get rebound after steroids are withdrawn

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4
Q

Psoriasis Education:

A

Education:
o striae can develop with overuse
o only use low doses on the face
* F/U in 2 weeks
 UV light

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5
Q
  • Cellulitis signs, symptoms,
A

S/S: swelling, warmth, tenderness of site; fever/chills/malaise

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6
Q
  • Acne Vulgaris
A

Inflammation and infection of the pilosebaceous units
* Causes: genetic, hormonal changes, bacterial infections, PCOS
* Most common during puberty
* Girls > boys, however, boys are worse when it does occur
* Locations: commonly seen on the face, shoulders, chest and back

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7
Q

Mild Acne Vulgaris treatment plan

A

-generally treated with topical only
 1st line: Topical retinoid and antimicrobial (mycins) combo
* Ex-adapalene, alitretinoin, tazarotene, tretinoin
* Pharm: retinoids accelerate the turnover of keratin plugs and decrease comedome formation
* Start at the lowest dose
* *Side effects: redness, drying, scaling of the skin, photosensitivity especially in the first 2-4 weeks (acne may seem to worsen at first) after about 6 weeks the acne will improve
o F/u in 8 weeks after initiation of treatment
o If no improvement, consider adding:
 Benzyl peroxide and antimicrobial(mycins)

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8
Q
  • Moderate Acne treatment
A

Presence of papules and pustules (infected comedomes)
 Treatment
* Continue with prescription topicals (retinol/benzyl/antimicrobial-mycins)
* *Now add oral abx (TCN) ”-clines” for up to 6 months
o *Do NOT given < age 13 y/o (d/t teeth discoloration)
o *Do NOT give to anyone pregnant or breastfeeding
o Can get photosensitivity
o Take with a full glass of water d/t esophageal ulceration/irritation
o IF allergies to TCN, give macrolide for 3 months
 -“mycins”

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9
Q
  • Severe nodulocystic acne
A

Painful indurated nodules (cysts, abscess, nodules)
 *Consider referral to derm
 Treatment:
* Accutane (Category X)
o *Can only be prescribed by providers with special cert (iPledge program)
o PT must be on 2 forms of contraception
o *Pregnancy test must be performed before and after treatment
o *Can only be prescribed 1 month at a time
o *Requires monthly pregnancy tests (PhD must see results)
o Side effects: abd pain(pancreatitis/hepatitis), depression
o *Good documentation is a MUST

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10
Q

Lyme Disease

A

A multisystemic disease transmitted by a specific tick

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11
Q

lyme disease signs, symptoms,

A

S/S: flu-like, weakness, joint pain, unique rash (erythema migrans/’bullseye”)*
* Rash/lesion may come within 7-14 days, but may last 3-30 days after bite
* Lesion will usually spontaneously resolve
* Common areas: belt line, axilla, behind knees, groin
* Common in the NE of the US
*

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12
Q

lyme disease diagnosis

A

Diagnostics
* 1st: Elisa test (blood or CSF)
 If Elisa is negative, no other tests needed
 If Elisa is positive, or indeterminate, move onto Western Blot
* 2nd: Western Blot
 Looking for IgG or IgM antibodies

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13
Q

lyme disease treatment plan

A
  • Treatment
  • For prophylaxis -initiate within 72 hours of tick removal
     Single dose: Doxy 200mg
  • For positive tests or noted bullseye lesion
     Doxy-14-21 days
     Do NOT give during pregnancy or breastfeeding
  • If pregnant, will need IV abx
  • Also educate that OCP are less effective while on Doxy
     DO NOT use in children < 7 years old
  • Use amoxicillin instead
  • F/U depends on stage and severity
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14
Q

Seborrheic Dermatitis

A
  • Chronic superficial disorder that affects the hairy areas of the body where sebaceous glands are present (caused by genetics and/or environment)

    *
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15
Q

Seborrheic Dermatitis signs, symptoms,

A

Scalp, face, eyebrows
* Ex: Cradle cap (in babies)
 Fine, white, yellow greasy scales on erythematous base
 Usually resolves by 8-12 months
* In Adults : yellow greasy scale on face, nasolabial folds, scalp, ear canals
 Usually symmetrical and itchy

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16
Q

Seborrheic Dermatitis treatment plan

A

Treatment
 Sunlight
 Shampoo frequently
 Warm olive oil in the evening and letting it sit overnight
 RX shampoos
 Hydrocortisone (be cautious)
* Education:
o striae can develop with overuse
o only use low doses on the face

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17
Q

Atopic Dermatitis

A

Eczema
Chronic inherited skin disorder marked by extremely pruritic rashes
* Found on hands, Flex folds, neck
* Exacerbated by stress and environmental (seasons/winter), allergies/asthma/allergic rhinitis
* Itching can cause scaling and lichenification (thick, leathery skin)

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18
Q

Atopic Dermatitis signs, symptoms,

A

Presentation
* Can reappear in adulthood after occurrence during childhood
* pruritis, erythema, dry skin, erythema on infraorbital folds, antecubital fossa, posterior patella, scalp
* on infants lesions are erythematous and papular, vesicles may ooze
can be on cheeks
lichenification

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19
Q

Atopic Dermatitis treatment plan

A

Treatment
* Topical steroids (hydrocortisone) and emollients
 Eucerin, baby Oil, antihistamine for itching
 RX-Vistaril/hydroxyzine for itching
 Contraindicated in patients with infected lesions or rosacea
* Avoid using harsh soaps or chemicals
* Use cold water when bathing
* Use education when using topical cortisones
* Education:
 striae can develop with overuse
 only use low doses on the face

20
Q

Melanoma

A

Malignancies arising from melanocytes (pigment-producing cells)
* Usually diagnosed in the early 40’s
* Risk factors: UV exposure
*

21
Q

Melanoma signs, symptoms,

A

*Major: Change in size, change in color, change in shape
* *Minor: presence of inflammation, bleeding, sensation, diameter > 6mm
* Prevention: avoid sun exposure; use sunscreen
* Remember ABCDE

22
Q

ABCDE

A

common characteristics of melanoma: think alphabetically – the ABCDEs of melanoma.
asymmetry,
border,
color,
diameter
evolving

23
Q

Shingles treatment

A
  • Virus from Herpes Zoster
  • Treatment
  • Early treatment can limit the post-herpetic neuralgia
     Begin treatment 48-72 hours after onset of pain/breakout
  • Antiviral
     Acyclovir (5x day), valcyclovir (2 x day, but $$$$)
  • TCA (for post-herpetic neur.)
     Amytriptaline
  • Anticonvulsants (for post-herpetic neur.)
     Gabapentin
  • Lidocaine patch
  • *Immediate referral for lesions near the eye
24
Q
  • Shingles signs, symptoms,
A

Papules or vesicles on a red base that rupture and become crusted
* *Along a dermatome/unilateral (Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine. In this way, dermatomes are much like a map.)
* More common in elderly, especially immunocompromised
* *Prodromal pain, or pain with lesions
* Can last 2-4 weeks or longer
* Post-herpetic neuralgia can last for months or longer

25
Q

Shingles treatment plan

A
  • Treatment
  • Early treatment can limit the post-herpetic neuralgia
     Begin treatment 48-72 hours after onset of pain/breakout
  • Antiviral
     Acyclovir (5x day), valcyclovir (2 x day, but $$$$)
  • TCA (for post-herpetic neur.)
     Amytriptaline
  • Anticonvulsants (for post-herpetic neur.)
     Gabapentin
    Lidocaine patch
  • *Immediate referral for lesions near the eye
    *
26
Q

Dermatomes

A

Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine. In this way, dermatomes are much like a map. The nature of that connection means that dermatomes can help a healthcare provider detect and diagnose conditions or problems affecting your spine, spinal cord or spinal nerves.

27
Q

shingles vaccine

A

Vaccine for > age 50 y/o
* Even if they have had shingles
* *Efficacy wanes after 5 years
* *Repeat if the vaccine was received before age 60, or if it has been > 10 years

28
Q

Rosacea

A

Chronic and relapsing inflammatory skin disorder
* More common in people who are lighter color (Irish, Scottish, English…)
* Also more common in blond or red hair people
* 4 subtypes

29
Q

Rosacea signs, symptoms,

A

Hallmark signs:
* light skinned adult c/o red cheeks
* small papules around mouth, nose, chin
* telangiectasia on cheeks
* pt blushes easily
* c/o dry eyes or chronic blepharitis (ocular rosacea)

30
Q

Rosacea treatment plan

A

Treatment
* Aimed at symptom control and avoidance of triggers that cause exacerbations
 Spicy foods, alcohol, sunlight
 Avoid irritating skin products
 Apply moisture frequently
* Topical gels
 Metronidazole
* Oral TCN over several weeks
* Patient education if using topical steroids
 striae can develop with overuse
 only use low doses on the face

31
Q
  • Mongolian Spots signs, symptoms, treatment plan
    *
A

The most common type of pigmented skin lesion in newborns
* Blue to black colored patches
* Usually located in the lumbosacral area, but can be anywhere
* More common in darker-skinned babies
* Usually, fade by 2-3 years
* No need to be concerned

32
Q

Hemangiomas signs, symptoms

A

“strawberry”
* Raised vascular lesion
* Can be between <0.5cm-4 cm
* Red color, soft to palpation
* Usually on head and neck
* Grow in the first 12 months of life
*

33
Q

Hemangiomas treatment plan

A

Treatment
* Watchful waiting
* Can be referred to derm
 PDL therapy (pulse, dye, laser)
* Reassurance

34
Q
  • Café Au Lait Spots signs, symptoms, treatment plan
    *
A

Flat light or dark brown spots that are > 5mm
* Risk factors are unknown (may be genetic)
* *If 6 or more spots are > 5mm, r/o neuro causes
* May see sz or learning disorders
* Neurofibromatosis

35
Q
  • Herpes Simplex Virus Type 1
A

“cold sores”
* Blisters mostly on the face, lips, eyes
* Usually have prodromal pain, burning, tingling before lesion erupts
* Treatment
 Antivirals: Acyclovir, valacyclovir during the prodromal phase

36
Q
  • Herpes simplex virus type 2
A
  • “genital warts” or oral
  • Painful lesions that are recurrent
  • Viral shedding is greatest on the initial outbreak, then lessens with each additional outbreak
  • Prevention
     Condoms may help
  • Best to treat during prodromal phase
  • Treatment
     Antiviral: acyclovir, valacyclovir
37
Q

HPV

A

May exist without signs
* Can be asymptomatic for many years
* Increases incidence of cervical cancer,
* And Laryngeal or esophageal cancers
* Risk factors: multiple sexual partners, prior STD, circumcised, men with men

38
Q

HPV Warts treatment plan

A

Treatment destroys wart tissue (~45-90% will clear but can return)
* Aldera (Imiquimod) cream
* Podophyllin cream
* May also try laser treatment for external warts
* For cervical warts, refer for biopsy before treatment
* During pregnancy/lactation, warts will grow rapidly, then will regress
* Cryotherapy can be used or TCA; other creams are contraindicated
* F/u in 1-2 weeks
* Screen for other STDs
* Gardisil vaccine is important prior to age of sexual activity

39
Q

most important for exzema

A

Implement a daily bathing and moisturizing routine; skin hydration is imperative
emollients after bathing

40
Q

Emollients

A

Emollients are ingredients in skin creams, lotions, moisturizers or ointments that form a film on your skin. These ingredients can relieve dryness, itching and scaling. Emollients can help your skin feel more comfortable if you have eczema, psoriasis, dry or sensitive skin.

41
Q

when is shingles not infectious?

A

after lesions have crusted over

42
Q

Retinoids

A

Retinoids are a class of medications that are chemically derived from vitamin A

43
Q

demarcated

A

set the boundaries or limits of.

44
Q

Basal Cell Carcinoma

A

Tumors that arise from the basal cell layer of the skin
* Most common in 40-60 y/o
* *Sites: head and neck (80%)
* Men>women

45
Q

Basal Cell Carcinoma Presentation

A
  • Presentation
    Pearly dome nodule with telegenetic vessels
46
Q

Squamous Cell Carcinoma

A

Tumors arising from the epidermis
* Sites: face, nose, lower lip (smokers)
* Indistinct borders, firm surface, scaly, irregular, bleed easily
 Red, tan, brown, grey
* Metastasis in 10%

47
Q

difference between squamous cell and basal cell

A

Basal cell carcinoma most commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels. Squamous cell carcinoma most commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration.

primary 3 chronic conditions final exam (16 decks)

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