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EOR - Emergency Medicine > Dermatology > Flashcards

Dermatology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what is this showing

A

bullous pemphigoid

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2
Q

_ is an acquired autoimmune blistering skin d.o caused by linear deposition of abs to _ at the _ junction

A

bullous pemphigoid
hemidesmosomes
epidermal-dermal

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3
Q

more severe form of bullous pempigoid the involves the mucous membranes

A

pemphigus vulgaris

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4
Q

what is this showing

A

top layers of skin slip away from lower layers when rubbed -> nikolsky sign

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5
Q

positive nikolsky sign is associated w. which blistering skin d.o

A

pemphigus vulgaris

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6
Q

where are bullae located w. bullous pemphigoid (4)

A

axillae
thighs
groin
abdomen

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7
Q

dx for bullous pemphigoid
hallmark findings

A

dx: skin bx w. immunofluourescence
findings: deposition of IgG and C3 basement membrane

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8
Q

pruritit scalp, body, or groin
small white specs on hair shaft

A

lice

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9
Q

ovoid grayish-white eggs

A

nits

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10
Q

management of lice

A

-launder fomites in H2O > 131 degrees
-topical permethrin w. wet combing, repeat in 9 days
-permethrin to body, leave on 8-12 hr
-STI screen if pubic
-eyelashes: ophthalmic petroleum jelly
-severe: oral ivermectin
-treat whole fam

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11
Q

rule of 9’s for burns
vs
palmar method

A
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12
Q

degrees of burns

A

1st: sunburn - blanches w. pressure, +- tender skin
2nd: partial thickness - red/blistered, very tender skin
3rd: full thikness - tough/leathery, non tender skin
4th: into bone and muscle

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13
Q

minor vs major burn criteria

A

minor:
adults: <10% TBSA
kids/old: < 5% TBSA
< 2% full thickness

major:
adults: > 25% TBSA
kids/old: > 20% TBSA
> 10% full thickness

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14
Q

indications for IVF for burns
IVF of choice

A

children: > 10%
adults: > 15%

LR IV x 24 hr

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15
Q

what is this showing

A

pilonidal cyst: abnl hairgrowth at tailbone containing hair/skin

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16
Q

pilonodial cysts result from

A

abscess -> sinus tract at upper part of natal cleft

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17
Q

teenager w. intermittent pain, discomfort, and swelling above the anus or near tailbone

A

pilonidal cyst

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18
Q

tx for pilonidal cyst

A

I&D/remove
find sinus tract
cefazolin + metro/augmentin if cellulitis

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19
Q

acute bacterial skin/skin structure infxn involving dermis and subcutaneous tissue

A

cellulitis

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20
Q

classic sx of cellulitis

A

pain
erythema
warmth
swelling

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21
Q

describe skin findings of cellulitis

A

flat margins, not well demarcated

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22
Q

mc cause of cellulitis in kid vs adults

A

kids: h.flu, strep pneumo
adults: staph, strep

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23
Q

dx for cellulitis

A

culture all purulent wounds

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24
Q

tx for cellulitis:
MSSA:
MRSA:
animal bite:
puncture wound:

A

MSSA: cephalexin vs dicloxacillin
animal bite: augmentin
puncture wound: cipro (think pseudo)
MRSA: bactrim vs clinda vs doxy vs vanco/linezolid

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25
Q

2 areas mc affected by pressure sores

A

sarum
hip

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26
Q

stages of pressure ulcers

A

stage 1: localized erythema, no blanching, bony surface
stage 2: partial loss of dermal layer, pink ulceration
stage 3: full dermal loss, subcutaneous fat often exposed
stage 4: full thickness ulceration exposing bone/tendon/muscle

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27
Q

common complication of pressure sore

A

osteomyelitis

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28
Q

tx for pressure ulcers

A

stage I: aggressive preventive, thin film dressings
stageII: occlusive dressing, transparent films, hydrocolloids
stage III-IV: debridement, calcium alginate dressing, hydrocolloids, occlusive dressings, +/- debridement

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29
Q

5 rf for pressure ulcers

A

> 65 yo
impaired circulation
immobilizatoin
malnutrition
incontinence

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30
Q

what stage pressure ulcer is this

A

I

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31
Q

what stage ulcer is this

A

III

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32
Q

what stage ulcer is this

A

II

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33
Q

what stage ulcer is this

A

IV

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34
Q

4 types of dermatitis to know

A

contact
atopic
seborrheic
perioral

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35
Q

2 types of contact dermatitis

A

allergic
irritant

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36
Q

what is this showing

A

well demarcated erythema, erosions, vesicles -> contact dermatitis

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37
Q

2 common causes of allergic dermatitis

what type of hypersensitivity is it

A

nickel
poison ivy

type IV

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38
Q

5 causes of irritant dermatitis

A

diaper rash
cleaners
solvents
detergents
urine
feces

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39
Q

tx for contact dermatitis

A

burow’s solution (aluminum acetate)
topical steroids
zinc oxide

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40
Q

zinc oxide makes you think of

A

tx for diaper rash

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41
Q

what is this showing

A

pruritic, eczematous lesions, xerosis, lichenification -> **atopic dermatitis **

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42
Q

mc location of atopic dermatitis: adolescents vs infants

A

adolescents: flexor creases -> ex antecubital and popliteal folds

infants: face, scalp

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43
Q

atopic dermatitis is a type _ hypersensitivity

A

1

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44
Q

rapidly evolving red rash, may be blistered or swollen

A

eczema

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45
Q

what is this showing

A

nummular eczema

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46
Q

first line tx for eczema

A

topical steroids

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47
Q

erythematous yellowish greasy scales - crusted lesions

A

seborrheic dermatitis (cradle cap)

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48
Q

mc location for seborrheic dermatitis: infants vs adults/adolescents

A

infants: scalp
adults/adolescents: body folds

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49
Q

tx for seborrheic dermatitis

A

ketoconazole shampoo/topical

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50
Q

what is this showing

A

papulopustular plaques/scales around the mouth -> perioral dermatitis

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51
Q

what pt pop does perioral dermatitis mc affect

what is the tx

A

young women

topical metronidazole

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52
Q

tx to avoid for perioral dermatitis

A

steroids

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53
Q

classification of rashes

A

infectious vs noninfectious

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54
Q

noninfectious rashes to know

A

eczema
contact dermatitis
psoriasis
seborrheic dermatitis
drug eruptions
rosacea
hives (utircaria)
allergic dermatitis
xerosis (dry skin)

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55
Q

erythematous, morbilliform, maculopapular rash starting on head and spreading downward

A

measles

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56
Q

5 causes of breast discharge

A

mastitis/breast abscess
breast cancer
gynecomastia
inflammatory breast cancer
hypogonadism

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57
Q

nipple discharge, breast enlargement, overweight

A

gynecomastia

58
Q

nipple discharge, sexual dysfxn, reduced sex drive

A

hypogonadism

59
Q

what mite causes scabies

A

sarcoptes scabiei

60
Q

what rash is associated w. scabies

A

pruritic papules
s shaped/linear burrows on the skin
worse at night
severely itchy

61
Q

where is scabies commonly located

A

web spaces of hands, wrists, waist

62
Q

definitive dx for scabies

A

microscopic eval of skin scrape

63
Q

tx for scabies

A

topical permethrin 5% to entire body -> wash off after 8-14 hr
repeat in one week
wash all fomites in high heat, no contact w. body x 72 hr

alt/severe: oral ivermectin

64
Q

mc adverse drug rxn

A

skin

65
Q

derm sx of impending CVD

A

-anaphylaxis
-DRESS (drug rash w. eosinophilia/systemic sx)
-SJS/TEN
-extensive bullous rxn
-generalized erythroderma

66
Q

tx for anaphylaxis or widespread urticaria

A

epinephrine
prednisone
antihistamines

67
Q

what is this showing

A

drug rxn

68
Q

2 spider bites to know

A

brown recluse
black widow

69
Q

what spider is this

A

brown violin on the abdomen -> brown recluse

ps this is my least favorite flashcard of all time

70
Q

what spider is this

A

red hourglass on abdomen -> black widow

ps this is tied for my least favorite flashcard of all time

71
Q

brown recluse bites are assocaited w. _ symptoms

black widow bites are associated w. _ symptoms

A

brown recluse: skin necrosis
black widow: neurologic

72
Q

skin sx of brown recluse bite

A

first 3-4 hr: local burning, central necrosis, erythematous margin around ischemic center halo

24-72 hr: hemorrhagic bullae w. eschar formation -> necrosis

73
Q

tx for brown recluse bite

A

wound care
local symptomatic measures
delayed excision

74
Q

neuro manifestations of black widow bite

A

n/v
Ha
fever
syncope
convulsions

+/- rxn at bite site

75
Q

tx for black widow bite

A

wound care
local symptomatic measures
+/- opioids/benzos
anti-venom in kids/elderly

76
Q

what is this showing

A

large, confluent, erythematous plaques
bullae near jaw

erysipelas

77
Q

well-demarcated, raised, superficial skin infxn w. lymphatic involvement

A

erysipelas

78
Q

erysipelas is always caused by

A

GAS (pyogenes)

79
Q

systemic sx of erysipelas

A

f/c

80
Q

dx and tx for erysipelas

A

dx: C&S

tx:
-mild: pen g
-moderate: bactrim + pcn/cephalexin
-severe: carbapenems + linezolid OR vanco

81
Q

severe hypersensitivity complex affecting skin and mucus membranes

A

SJS

82
Q

progression of SJS

A
  1. flu like prodrome
  2. painful red/purplish rash that spreads and blisters
  3. layers of skin peel away in sheets -> Nikolsly sign
83
Q

more severe form of SJS

A

toxic epidermal necrolysis (TEN)

84
Q

SJS affects _% of the body
TEN affects _% of the body

A

SJS: 3-10%
TEN: >30%

85
Q

dx for SJS/TEN

A

skin bx showing necrotic epithelium

86
Q

tx for SJS/TEN

A

early admit to burn unit
lytes/fluids/nutrition
ABC
eye care
IVIG

87
Q

_ may increase risk of sepsis in SJS/TEN

A

steroids

88
Q

what is this showing

A

SJS

89
Q

what is this showing

A

TEN

90
Q

zoster presentation: primary vs later

A

primary: vesicles on an erythematous base
later: dewdrops on a rose petal

91
Q

herpes zoster starts on the _ and spreads down

A

face

92
Q

how is zoster transmitted

A

respiratory droplets

93
Q

after manifesting as chicken pox, zoster remains latent in the

A

dorsal root ganglion

94
Q

what is this showing

A

shingles

95
Q

definitive dx for zoster

A

tzanck smear -> multinucleated giant cells

96
Q

shingles involving CN V

A

zoster opthalmics

97
Q

what is this showing

A

dendritic lesions on slit lamp exam -> zoster opthalmicus

98
Q

zoster involving CN VII -> otalgia, lesions on the ear, auditory canal, and TM - facial palsy auditory sx

A

zoster oticus -> ramsay hunt syndrome

99
Q

tx for shingles

A

acyclovir vs valacyclovir vs famciclovir
w.in 72 hr to prevent post herpetic neuralgia

100
Q

what is post herpetic neuralgia

A

pain > 3 mo
paresthesias
decreased sensation

101
Q

tx for postherpetic neuraltia (3)

A

gabapentin vs TCA
topical lidocaine
capsaicin

102
Q

when is the zoster vaccination recommended

A

50 and older

2 doses 2-6 months apart

103
Q

crusting facial lesions
red rash w. golden “honey-colored crust”

A

impetigo

104
Q

2 pathogens associated w. impetigo

A

s. aureus - mc
GABHS

105
Q

progression of impetigo

A
  1. papules -> vesicles w. surrounding erythema
  2. vesicles rupture -> form thick adherent, golden crust
106
Q

_ is a common finding w. impetigo rash

A

LAD

107
Q

mc age for impetigo

A

2-5

108
Q

where do impetigo sores mc start

A

nose/mouth

109
Q

4 hallmarks of impetigo

A

nonpainful
pruritic
honey colored
weeping

110
Q

4 rf for impetigo

A

warm humid climate
poverty
crowding
poor hygiene

111
Q

what is secondary impetigo

A

forms at site of abrasion/scratches

112
Q

dx for impetigo

A

gram stain w. culture

113
Q

tx for impetigo

A

mild: topical mupirocin
severe: dicloxacillin vs cephalexin
MRSA: doxy, clinda, bactrim

114
Q

when can kids return to school after starting abx for impetigo

A

24 hr

115
Q

complication of impetigo

A

post strep GN

116
Q

skin rash triggered by rxn to foods, meds, stress, or irritants

A

urticaria

117
Q

describe urticaria

A

blanchable, pruritic, raised, red or skin colored papules, wheels, plaques

disappear w.in 24 hr

118
Q

localized urticaria appearing where the skin is rubbed (histamine release_

A

darier’s sign

119
Q

painless, deeper form of urticaria affecting lips, tongue, eyelids, hands, genitals

A

angioedema

120
Q

what are the different types of antihistamines

A
  1. H1 blockers:
    -first gen: hydroxyzine, diphenhydramine
    -second gen: allegra, claritin, clarinex, zyrtec
  2. H2 blockers: cimetidine, ranitidine
121
Q

first gen antihistamines (hydroxyzine, diphenydramine) are mc used to treat

A

insomnia
anxiety

122
Q

second gen antihistamines (allegra, claritin, clarinex, zyrtec) are mc used to treat

A

skin conditions

123
Q

what is this showing

A

uticaria/hives

124
Q

4 systemic d.o that cause itching

A

allergies
liver dz/jaundice
CKD
psychogenic

125
Q

5 viral exanthems to know

A

erythema infectiosum (fifth dz/parvo)
hand-foot-mouth dz
measles
rubella
roseola (sixth dz)

126
Q

what is this showing

A

“slapped cheek rash”
erythema infectiousum/parvo/5th dz

127
Q

what is this showing

A

lacy, reticular rash -> erythema infectiosum/parvo/5th dz

128
Q

what pathogen causes hand-foot-mouth dz

A

coxsackievirus type A

129
Q

what is this showing

A

hand-foot-mouth dz

130
Q

cough
coryza
conjunctivitis
cephalocaudal spread

A

4 c’s of measles

131
Q

describe the rash associated w. measles

A

morbilliform, maculopapular brick red rash beginning on face, progressing to palms/soles

132
Q

what is this

A

measles

133
Q

what is this showing

A

koplik spots -> precedes measles

134
Q

describe koplik spots

A

small red spots in buccal mucosa w. blue-white pale center

135
Q

tx for measles

A

supportive
antiinflammatories
isolation x 1 week after rash onset

136
Q

rubella rash first appears on the _ face
and has _ spread

A

face
cephalocaudal spread

137
Q

major risk w. rubella

A

teratogenic in 1st trimester -> deafness, cataracts, TTP, mental retardation

138
Q

roseola (6th dz) is caused by

A

HSV 6 or 7

139
Q

only childhood exanthem that begins on the trunk and spreads to the face

A

roseola

140
Q

progression of roseola (6th dz)

A
  1. high fever prodrome x 3-5 days
  2. rose pink maculopapular blanchable rash on trunk/back and face

EOR - Emergency Medicine (13 decks)

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