Dermatology Flashcards
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
characteristic rash of zinc deficiency
perioral pustular rash
characteristic rash of paget dz
well demarcated
erythematous
eczematous
sx of still’s dz (systemic rheumatoid dz)
> 5 joints involved
fever
LAD
hepatosplenomegaly
subcutaneous nodules
pericarditis
rash
characteristic rash of fat emboli from long bone fx
upper body petechial rash
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
3 mc locations for bcc
head
neck
hands
what pt pop makes you think bcc
fair skinned
hx of sun exposure
what is this
bcc
dx for bcc
shave/punch bx
tx for bcc (6)
topical fluorouracil vs imiquimod
photodynamic therapy
tissue scraping
electrosurgery
mohs surgery
wide local excision
5 rf for bcc
sun
fair skin
radiation
chronic dermatitis
xeroderma pigmentosum
rule of 9’s for burns
degrees of burns
first (superficial): sunburn
second (partial thickness): blisters, painful
third (full thickness): tough/leathery, non-tender
fourth: into bone/muscle
what degree of burn is no longer painful
3rd (full thickness)
4th
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
tx for burns
ABCs
fluids
bacitracin
cleanse
tx for chemical burns
irrigate w. running water x 20 mins
indication for fluids w. burns
kids: > 10% TBSA
adults: > 15% TBSA
fluid protocol for burns
LR x 24 hr:
1/2 in the first 8 hr
1/2 in remaining 16 hr
burns cause what type of shock
hypovolemic
is UVA or UVB dominant in sunburns
UVB
what type of UV ray is associated w. tanning and photoaging
UVA
what type of bacteria is mc associated w. infected burns
pseudomonas
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:
hx of prior melanoma
age > 50 yo
(no) regular dermatologist
mole that is changing
male
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
I
what stage pressure ulcer
II
what stage pressure ulcer
III
what stage pressure ulcer
IV
what is this
squamous cell carcinoma
characteristics of scc
enlarging hyperkeratoic macule
scaly/crusted lumps
indurated/ulcerated papules
often tender/painful
6 common locations for scc
face
lips
ears
hands
forearms
lower legs
skin cancer involving telangiectasia
bcc
skin cancer involving scaly papules
scc
tx for scc
surgical excision
+/- mohs
radiotherapy
cryotherapy
electrodessication/curretage
5 indications for mohs
nonmelanoma > 2 cm
indistinct margins
recurrent lesions
close to important structures (eyes, nose, mouth)
invasive histology
what is this showing
scc
6 rf for scc
sun
pale skin
chronic inflammation
immunosuppression
xeroderma pigmentosum
arsenic
what is this
AK
what is marjolin’s ulcer
scc in area of chronic inflammation:
burn
chronic fistula
wound
osteomyelitis
