Dermatology Flashcards by Alice Richards

6 causes of generalized rash that Smarty PANCE wants us to consider

abx s.e
zinc deficiency
paget dz
HSV/zoster
systemic rheumatoid dz (still’s dz)
fat emboli from long bone fx

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characteristic rash of zinc deficiency

perioral pustular rash

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characteristic rash of paget dz

well demarcated
erythematous
eczematous

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sx of still’s dz (systemic rheumatoid dz)

> 5 joints involved
fever
LAD
hepatosplenomegaly
subcutaneous nodules
pericarditis
rash

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characteristic rash of fat emboli from long bone fx

upper body petechial rash

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characteristics of basal cell carcinoma (5)

raised pearly papule w. rolled border
telangiectasis
central ulcer/scab/erosion
erythematous patch > 6 mm
non healing ulcer in sun exposed area
+/- bleeding

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3 mc locations for bcc

head
neck
hands

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what pt pop makes you think bcc

fair skinned
hx of sun exposure

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what is this

bcc

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dx for bcc

shave/punch bx

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tx for bcc (6)

topical fluorouracil vs imiquimod
photodynamic therapy
tissue scraping
electrosurgery
mohs surgery
wide local excision

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5 rf for bcc

sun
fair skin
radiation
chronic dermatitis
xeroderma pigmentosum

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rule of 9’s for burns

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degrees of burns

first (superficial): sunburn
second (partial thickness): blisters, painful
third (full thickness): tough/leathery, non-tender
fourth: into bone/muscle

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what degree of burn is no longer painful

3rd (full thickness)
4th

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minor vs major burns based on TBSA

minor:
adults: < 10%
kids: < 5%
<2% full thickness

major:
adults: > 25%
kids: > 20%
>10% full thickness
burns involving: face, hands, perineum, cross major joints

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tx for burns

ABCs
fluids
bacitracin
cleanse

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tx for chemical burns

irrigate w. running water x 20 mins

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indication for fluids w. burns

kids: > 10% TBSA
adults: > 15% TBSA

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fluid protocol for burns

LR x 24 hr:
1/2 in the first 8 hr
1/2 in remaining 16 hr

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burns cause what type of shock

hypovolemic

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is UVA or UVB dominant in sunburns

UVB

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what type of UV ray is associated w. tanning and photoaging

UVA

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what type of bacteria is mc associated w. infected burns

pseudomonas

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what coagulopathy is associated w. burns

DIC

what tx is not indicated in the management of burns

prophylactic systemic abx

indication for referral to a burn center

-partial thickness burn > 20% TBSA at any age -partial thickness > 10% TBSA in kids < 10 yo OR adults > 50 yo -3rd degree burns covering > 5% TBSA -2nd or 3rd degree burns involving critical areas -associated w. inhalation injury -electrical/lightning burns -severe w. coexisting trauma -preexisting dz complicating burns -chemical w. threat of cosmetic/functional compromise -curcumferential burns on extremities/chest

what are the 6 critical areas for burns

hands feet face perineum genitalia major joints

4 causes of nipple discharge

mastitis/abscess cancer gynecomastia hypogonadism

3 sx of gynecomastia

nipple discharge breast enlargement overweight

3 sx of hypogonadism

nipple discharge sexual dysfxn reduced libido

describe cellulitis margins

flat not well demarcated

2 mc pathogens associated w. cellulitis: kids vs adults

kids: h.flu strep pneumo adults: s. aureus, GAS

indication for wound culture

all purulent wounds f/u in 48 hr

tx for MSSA cellulitis (2)

cephalexin dicloxacillin

tx for MRSA cellulitis (5)

doxy sulfa clindamycin vanco linezolid

what pathogen is associated w. animal bites

pasteurella multocida

abx for animal bites

augmentin pcn allergy: doxy

abx for puncture wound what pathogen are you worried about

cipro pseudomonas

mc site of cellulitis

leg

describe margins w. erysipelas

raised sharply demarcated

what pathogen is mc responsible for skin infxn w. underlying drainage, penetrating trauma, eschar, or abscess

s. aureus (MRSA)

4 indications for workup w. cellulitis

infxn site > 10 mm severe pain sx of systemic illness immuncompromised/rf for serious illness

what pathogen is mc involved in wounds w. no drainage or abscess

streptococci

what abx should be used outpt for cellulitis where you do NOT suspect MRSA

**cephalexin** alt: dicloxacillin, amoxicillin pcn allergy: clinda vs macrolide

mc cutaneous rxn to drugs

drug induced exanthems

what drugs are the mcc of drug induced exanthems

abx

skin bx findings of drug induced exanthems

necrotic epithelium

name 3 drug induced exanthems

SJS TEN erythema multiforme

tx for drug induced exanthems (3)

burn unit opthmalmology/derm referrals IVIG

what pharm may increase risk for sepsis w. drug induced exanthems

steroids

3 drugs commonly associated w. drug induced exanthems

sulfas pcn's valproic acid

2 common post op derm conditions

pruritis uticaria

5 causes of post op pruritis/uticaria

anesthesia opioids latex abx LMWH

skin rxn to cold that appears w.in mins after cold exposure (ex cold compresses)

cold uticaria

tx for post op pruritis/uticaria

antihistamines steroids

what is ABCDE in relation to melanoma

assymetry border - irregular color - varied diameter - increasing/> 6 mm elevation - raised

mc site for melanoma: men vs women

men: back women: legs

tumor mc responsible for metastasis to the heart

melanoma

5 most important independent rf for increased likelihood of melanoma

**harmm:** **h**x of prior melanoma **a**ge > 50 yo (no) **r**egular dermatologist **m**ole that is changing **m**ale

if a mole is suspiciousm bx should include

full depth of the dermis slightly beyond edges of the lesion

what type of bx is preferred if you suspect melanoma

excisional bx

excisional bx should be performed on all moles suspicious for melanoma except

cosmetically important areas -> do shave bx instead

what 2 measuring systems are used for melanoma

breslow: thickness clark: penetration into skin layers

clark classification system of microstaging

level I: confined to epidermis (in situ) level II: invasion into papillary dermis level III: invasion to papillary-reticular interface level IV: invasion into reticular dermis level V: invasion into subq fat

prognosis for melanoma is associated w. the _ of the lesion

depth

tx for melanoma

stages I-III: surgical excision stage IV: chemo

7 rf for melanoma

blone/red hair fair skin freckles hx blistering sunburn blue/green eyes actinic keratosis male

3 mc locations for melanoma

skin eyes anus

mc site for melanoma in AA

soles of feet -> **acral lentiginous melanoma**

4 types of melanoma

superficial spreading lentigo maligna acral lentiginous nodular

mc type of melanoma

superficial spreading

mc sites of metastasis for melanoma: local vs distant

local: nodes distant: lung, liver, bone, heart, brain, small bowel mucosa

metastatic routes of melanoma

lymphatic hematogenous

melanoma tumormarker

S-100

tx for digital melanoma

amputation

what malignancy is most likely to metastasize to the bowel

melanoma

2 mc locations for pressure ulcers

sacrum hip

how often should a pt be repositioned to prevent pressure ulcers

q 2 hr

staging of pressure ulcers

stage I: localized, **non blanching** erythema stage II: loss of dermal layer -> **pink ulceration** stage III: full dermal loss -> exposed subq tissue/fat stage IV: exposed bone/tendon/muscle

major complication of stage IV pressure ulcers

osteomyelitis

how can you rule out a stage I pressure ulcer in an area of erythema

if it blanches, it is NOT a pressure ulcer

injury commonly associated w. pressure ulcer

hip fx

5 rf for pressure ulcer

> 65 yo impaired circulation immobilization malnutrition incontinence

tx for pressure ulcer based on stage

stage I: thin film dressing stage II: thin film dressing, occlusive dressing, hydrocolloids stage III-IV: debridement, absorptive dressing/foams/hydrofibers, occlusive dressings, hydrocolloids, hydrogels

3 types of wound debridement

incisional mechanical enzymatic

incisional debridement is done with

scalpel

mechanical debridement is done with

wet-dry dressings

indications for incisional debridement

extensive, dry wounds

what stage pressure ulcer