Dermatology (15%) Flashcards
1
Q
What is the primary cause of increased sebum production in acne vulgaris? When does this most commonly occur?
A
Increased androgens After puberty
2
Q
How do you diagnose dermatophytosis (tinea)?
What would be seen upon inspection under a woods lamp?
A
DX: KOH smear
Wood’s lamp: green fluorescence if due to Microsporum.
3
Q
Scabies are caused by the mites ______ ______, and are spread via ____ or ____. They cannot survive off of the human body for ____ days.
A
Sarcoptes scabiei skin to skin contact or fomites >4 days
4
Q
Patients with erythema multiforme frequently have a ______ as well
A
fever
5
Q
Atopic dermatitis is a _____ -mediated reaction with increased ____ production.
A
T cell mediated immune activation
increased IgE production
6
Q
Describe the appearance of tinea barbae
A
Papules, pustules, and hair follicles
7
Q
Androgenetic alopecia is characterized by hair (thinning/loss) that is (nonscarring/scarring) and most commonly affects what 3 parts of the scalp?
A
Hair loss
Nonscarring
Temporal, midfront, and vertex area of the scalp
8
Q
What is the mode of transmission of pediculosis?
A
person to person
fomites (hats, headsets, clothing, bedding)
9
Q
What part of the body is usually spared in pityriasis rosea?
A
the face
10
Q
What are Pastia’s Lines?
A
linear petechial lesions seen at pressure points, axillary, antecubital, abdominal or inguinal areas.
Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash
11
Q
Is a deep partial thickness burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a deep partial thickness burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
A
2nd degree
Epidermis into deep portion of dermis (reticular)
Red, yellow, pale white, dry, (+) blistering
Not usually painful, (+/-) pain with pressure, may have decreased 2 point discrimination
Absent capillary refill
3 weeks-2 months to heal, scarring common (may need skin graft or excision to prevent contractures)
12
Q
Where on the body does atopic dermatitis most commonly present?
A
flexor creases i.e. antecubital and popliteal folds
13
Q
What types of medications typically cause urticarial rashes in regards to cutaneous drug reactions?
A
abx, NSAIDs, opiates, radiocontrast media
14
Q
What is the hallmark sx of atopic dermatitis?
A
pruritis
15
Q
What is the recommended management of diaper dermatitis?
A
Frequent diaper changes every 2 hours or when soiled.
Open air exposure.
Topical Zinc oxide or petroleum jelly.
1% Hydrocortisone (use for <2 weeks).
May need topical antibiotics.
16
Q
_______ can occur in infants who have prolonged exposure to urine and or feces
A
Diaper rash (contact dermatitis)
17
Q
What is staphylococcal scalded skin syndrome otherwise known as?
In what age group is it most commonly seen in?
A
Ritter disease
Infants or children <5 y/o
18
Q
In what population are seborrheic keratoses most commonly seen in? With what history?
A
Fair skinned elderly with prolonged sun exposure
19
Q
Describe bullous impetigo. What is the difference in the crusts of nonbullous and bullous impetigo?
A
Vesicles form large bullae (rapidly) that then rupture and form thin “varnish like crusts” as opposed to honey colored in nonbullous impetigo.
20
Q
Nonbullous impetigo is associated with _____ lymphadenopathy and is most commonly caused by an infxn by _______, and second most commonly caused by ______.
A
regional Staph aureus GABHS
21
Q
Mild, moderate, or severe acne? “Comedones, larger amounts of papules and or pustules” Tx?
A
Moderate Topical retinoids, Benzoyl peroxide, topical abx, OCPs + oral abx, +/- antiandrogen agents (i.e. spironolactone)
22
Q
How is erythema multiforme managed?
If it is oral?
If it is severe?
A
Symptomatically
Steroids/lidocaine/diphenhydramine mouthwash
Systemic steroids
23
Q
What are some potential risk factors for developing dermatophytosis (tinea)?
A
increased skin moisture (ex. occlusive gear), Immunodeficiency (HIV, OM), peripheral vascular disease
24
Q
Describe the appearance of tinea corporis.
What distinguishes this rash from erythema migrans?
What is the recommended management for this condition?
What may be ineffective in tx?
A
erythematous plaques (circular rash with clear center & defined borders), scaling, cracking & vesicles.
The presence of scales in tinea corporis distinguishes it from erythema migrans.
Topical antifungals
PO Griseofulvin is ineffective
25
What are nits?
White oval shaped egg capsules at the base of the hair shafts, can be removed with a fine toothed comb
26
What is the recommended course of tx for milia?
None, usually disappears by the 1st month of life, may be seen up to 3 months old
27
How do you diagnose a pt with scabies?
Clinically Can scrape skin of burrows with mineral oil to ID mites or eggs under microscopy
28
Describe the presentation of port wine stains.
What happens to them over time?
Where do they occur most commonly?
Are they usually unilateral or bilateral in presentation?
Where are they most commonly seen?
What other abnormalities may they be associated with?
Pink-red sharply demarcated, _blanchable_ macules or papules in infancy
***Over time, they grow and darken to a purple (_port-wine_) color and may develop a thickened surface***
They occur most commonly on the **head** and **neck**
Usually *_unilateral_* or segmental
MC seen on the **face**, but may occur anywhere
*_Glaucoma, spinal abnormalities_*
29
Describe the appearance of cafe au lait macules.
Color?
What are they caused by?
Uniformly **hyperpigmented** macules or patches with *_sharp demarcation_*. Either present at birth (or developing early in childhood).
Varying colors from **light brown to chocolate brown**.
Due to increased number of _melanocytes and melanin_ in the epidermis.
30
Erythema multiforme is a(n) (acute/chronic) self-limited type (1/2/3/4) hypersensitivity reaction most commonly seen in what age population?
Acute
4
young adults 20-40 y/o
31
How do you dx a pt with ritter dz?
What can you cx?
What can you bx? What are you looking for?
1. ***_Clinical_*** diagnosis. Intact bullae are sterile.
2. **Cultures** from urine, blood & nasopharynx.
3. **Skin biopsy**: lower stratum granulosum layer splitting.
32
What is the recommended course of management for a pt with ritter dz?
First line?
What if MRSA is suspected?
1. Antibiotics: ***_Penicillinase-resistant penicillin 1st line_***:\* Nafcillin or Oxacillin ± Clindamycin
Vancomycin if MRSAis suspected of if failed penicillin treatment.
2. _Supportive skin care_: maintain clean & moist skin, emollients to improve barrier function.
3. _Fluid and electrolyte replacement_
33
The Gardasil vaccine is administered to young women \_\_\_-\_\_\_ y/o, and protects against \_\_\_% of HPV strains, including HPV \_\_, \_\_, \_\_, and \_\_.
Gardasil 9 targets the same strains of Gardasil, in addition to HPV types \_\_, \_\_, \_\_, \_\_, and \_\_.
11-26 y/o
70%
6, 11, 16, 18
31, 33, 45, 52, 58
34
What is first line management of tinea capitus?
**PO** **Griseofulvin =** 1st line
PO Terbinafine, Itraconazole of Fluconazole 2nd line tx.
35
Erythema toxicum is thought to be due to ____ \_\_\_\_ ____ and is seen in up to \_\_% of neonates.
immune system activation
70%
36
What is second line treatment for pediculosis?
Why?
Lindane
Neurotoxic (HAs, sz) do not use after showering!
37
\_\_\_\_\_\_, ______ pain or _____ pain may accompany a cutaneous drug reaction
fever, abd pain, joint pain
38
Describe the presentation of Miliaria Crystallina.
In what patient population is this most commonly seen in?
Tiny, friable clear vesicles (due to *sweat* in the superficial stratum corneum)
MC in **_neonates_** (especially in 1 week old neonates).
39
How do you manage tinea (pityriasis) versicolor?
1. _Topical antifungals_: ***_Selenium sulfide_***, ***Sodium sulfacetamide, Zinc pyrithione, "azoles"***.
2. Systemic therapy: Itraconazole or Fluconazole in adults if widespread or if failed topical tx. Must not shower for 8-12 hours afterwards because azoles are delivered to the skin via sweat.
40
What is Sturge-Weber Syndrome?
What is the classic triad?
What may a patient with Sturge-Weber Syndrome develop?
congenital disorder associated with classic triad:
1. **Facial port wine stain** (especially along trigeminal distribution area and around the eyelids)
2. **Leptomeningeal angiomatosis**
3. **Ocular involvement** (*ex. glaucoma*)
May develop _hemiparesis_ **contralateral** to the facial lesion, _seizures_ or _intracranial calcification_ & _learning disabilities_
41
Oral Finasteride is a _____________ medication that inhibits the conversion of ____ to \_\_\_\_\_. It can be used to treat androgenetic alopecia and has side effects that include what 3 things?
5 alpha reductase inhibitor
testosterone to dihydrotestosterone (DHT)
decreased libido, sexual and ejaculatory dysfunction
42
Most warts typically resolve spontaneously w/in _____ years
2
43
What is the Rule of Nines?
What type of burn is it not applicable to?
*No applicable to **first degree** burns*
44
What is pediculosis commonly referred to as?
Lice
45
Describe erythema multiforme's cutaneous presentation.
Target (iris) lesions, dull dusty violet red, purpuric macules/vesicles or bullae in the center surrounded by a pale edematous rim and a peripheral halo
46
Describe the appearance of tinea capitus
What is the common name for tinea capitus?
Varied presentation: _annular_, _scaling_ lesions & _broken_ _hair_ _shafts_. Inflamed plaques with multiple pustules (kerion) with scarring & **alopecia**
"Ring worm" = common name
47
What is the most common premalignant skin condition? What malignancy can it develop into?
Actinic keratosis Squamous cell carcinoma
48
Describe the cutaneous presentation of SJS/TEN
widespread blisters that begin on the trunk and face erythematous/pruritic macules \>=1 membrane involvement with epidermal detachment
49
How do you diagnose a pt with tinea (pityriasis) versivolor?
1. _KOH prep from skin scraping_: ***hyphae & spores***"***_spaghetti & meatball_***" appearance.
2. _Wood's lamp_: ***yellow-green fluorescence*** (enhanced color variation seen with versicolor).
50
What are the three different types of pediculosis louse?
head louse (pediculosis humanus capitus), body louse (pediculus humanus corporis), and pubic louse (phthirus pubis)
51
What causes sebaceous glands to become clogged in acne vulgaris?
increased production of follicular keratinocytes
52
What possible colors could a seborrheic keratosis be?
flesh-colored, brown, grey, and black
53
Seborrheic dermatitis when presenting on an infant along the scalp is called?
Cradle cap
54
What is tinea (pityriasis) versicolor?
Overgrowth of the yeast ***Malassezia furfur*** (formerly *Pityrosporum*) - part of the _normal_ skin flora.
55
What are the three types of cutaneous HPV verruca (warts)?
Common (vulgaris) Plantar (plantaris) Flat (plana)
56
Is angioedema painless/painful?
Painless
57
What is the first step in management of a cutaneous drug reaction?
Discontinue the offending medication.
58
Is a superficial burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a superficial burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
1st degree
Epidermis
Erythematous, dry
**Painful**
***_(+) capillary refill intact_***, blanches with pressure
Heals within 7 days, no scarring
59
How does a patient with Ritter dz typically present?
Where is the erythema worst?
What will be positive?
What may also be observed in the eyes of a patient with ritter dz?
What body parts will not be affected in a patient with ritter dz?
1. Malaise, fever, irritability, extreme skin tenderness --\> ***_cutaneous, blanching erythema_*** - bright skin erythema often starting centrally & around the mouth before spreading diffusely.
**Erythema** is **worse** in the _flexor areas_ and around _orifices_ - especially the ***_mouth_***.
After 1-2 days develop sterile, flaccid ***blisters*** especially in areas of mechanical stress (hands, feet, flexural areas & buttocks)
POSITIVE NIKOLSKY SIGN
Desquamative phase - skin that easily ruptures, leaving moist, denuded skin before healing.
2. ***Inflamed conjunctiva*** may be seen (may become _purulent_) but ***_mucous membranes are not involved_***.
60
What physical finding is pathognomonic for common and plantar warts?
Thrombosed capillaries
61
Inflammatory acne vulgaris has _____ and _____ surrounded by inflammation
papules and pustules
62
What is the recommended course of management for pompholyx?
Topical steroids
63
How do you definitively dx an actinic kertosis?
Punch or shave bx
64
Describe the dermatologic presentation of lichen simplex chronicus/neurodermatitis
Scaly, well-demarcated, rough, hyperkeratotic plaques with exaggerated skin lines
65
The three most common triggers of urticaria are \_\_\_, \_\_\_, and \_\_\_\_.
food, medications, infections Also: insect bites, drugs, envr, stress, heat, cold
66
To what depth does a 4th degree burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
Entire skin into underlying fat, muscle, bone
Black, charred, eschar, dry
***_PAINLESS_***
***Absent capillary refill***
Does not heal well, usually needs debridement of tissues and tissue reconstruction
67
What should be done with bedding and clothing after a pediculosis dx?
laundered in hot water, detergent, hot drier for 20 minutes, toys should be placed in an air tight plastic bags x14 days if cannot be washed
68
Open comedones are called (black/white) heads, and closed comedones are called (black/white) heads. Which is an incomplete or a complete blockage?
Black (incomplete) White (complete)
69
What are the three different types of miliaria?
Miliaria Crystallina
Miliaria Rubra
Miliaria Profunda
70
\_\_\_\_\_\_\_ is best used if the onset of androgenetic alopecia is recent and is involving a smaller area
Minoxidil
71
What is the clinical manifestation of a patient with pediculosis?
Intense itching (esp. occipital area), papular urticaria near the lice bites
72
What is the difference between steven johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?
BSA affected: SJS = \<10%, TEN = \>30%
73
Is angioedema a shallower/deeper form of urticaria?
Deeper
74
What is recommended for pain management in burn patients?
Acetaminophen and NSAIDS can be used alone or in conjunction with opioids
75
Describe a (+) Nikolsky sign
May use a pencil eraser to test for Nikolsky sign--\> The eraser is placed on the skin and gently twirled back and forth. If the test result is (+), a blister will form in the area, usually w/in minutes. A (+) result is usually a sign of a blistering skin condition (i.e. SJS/TEN)
76
What is Scarlet fever also called?
What is it due to?
Scarlatina
Diffuse skin eruption that occurs in the setting of **_GABHS_** (Streptococcus pyogenes) infection
Due to *_Type IV (delayed) hypersensitivity reaction_* to a pyrogenic (erythrogenic toxin A, B or C)
77
What are the 5 types of cutaneous drug reactions? Describe each and how they are mediated.
Type 1: IgE mediated (urticaria and angioedema) Immediate. Type 2: cytotoxic, Ab-mediated Type 3: immune antibody-antigen complex Type 4: delayed (cell-mediated), morbiliform reaction (i.e. erythema multiforme) Nonimmunologic: cutaneous due to genetic incapability to detoxify certain medications
78
After the herald patch, when does the general exanthem of pityriasis rosea then occur?
1-2 weeks later
79
What type of burns do not require dressing?
Superficial
80
If a pt were to present to the office complaining of condyloma acuminata, what are they complaining of? What would they look like? Would they be painful/painless?
Genital warts (could also present in the oropharynx) Soft, fleshy, cauliflower like lesions Painless
81
Children with \>/=6 Cafe au lait macules (especially when accompanied with _____ or _____ freckling) should be evaluated for possible \_\_\_\_\_\_\_\_.
axillary or inguinal
Neurofibromatosis type I
82
Where is lichen planus most commonly located on the body?
Flexor surfaces of extremities, skin, mouth, scalp, genitals, nails, and mucous membranes
83
Atopic dermatitis is otherwise known as \_\_\_\_\_.
eczema
84
Where on the body does angioedema usually present? What serious complication can occur in tandem with angioedema?
lips, tongue, eyelids, hands, feet, and genitals Anaphylaxis
85
What time of year is pityriasis rosea most commonly seen?
spring/fall
86
\_\_\_\_\_\_\_\_ is a type 1 HSN (Ig\_\_\_) or complement-mediated edematous reaction of the dermis and or SQ tissues
Urticaria (IgE)
87
Port wine stains (otherwise known as _____ \_\_\_\_\_ or ____ \_\_\_\_\_) are due to \_\_\_\_\_\_.
capillary malformations
nevus flammeus
Vascular malformations of the skin --\> due to superficial dilated dermal capillaries
88
How to tx/manage cradle cap?
Baby shampoo, ketoconazole, topical corticosteroids
89
What are the 5 P's of lichen planus?
Purple
Polygonal
Planar
Pruritic
Papules, with fine scales and irregular borders
90
What is a Mongolian Spot and what is it due to?
In what populations are they most commonly seen?
Congenital dermal melanocytosis due to mid-dermal melanocytes (melanin producing cells) that fail to migrate to the epidermis from the neural crest
May be seen in \>80% of Asians & East Indian infants. Increased in African-Americans.
91
What is the recommended tx for scarlet fever?
First line?
***Same as strep pharyngitis.***
* May return to school 24 hours after antibiotic initiation*
1. **_Penicillin G or VK_ 1st line**: Amoxicillin, Amoxicillin/clavulanic acid (Augmentin)
2. *Macrolides if PCN allergic*
Other alternatives include Clindamycin, Cephalosporins
92
What type of blisters should be removed/debrided?
Ruptured blisters
## Footnote
*Management of clean and intact blisters is contorversial*
93
What is the Parkland formula and what is it used for?
Calculates **_fluid requirements_** for burn patients in a _24-hour_ period.
Use in **adult** patients with burns. *Children have larger TBSA relative to weight and may require larger fluid volumes.*
Lactated Ringers 4ml/kg/%TSA. IV xfirst 24 hours
**1/2 in 1st 8 hours, the other 1/2 over the remaining 16 hours.**
94
What differentiates erythema multiforme minor from major?
Mucosal membrane involvement (major = mucosa involved)
95
Actinic keratosis is most commonly seen in people with what type of skin? With what kind of history?
Fair skinned elderly with prolonged skin exposure
96
What is the recommended course of management for SJS/TEN?
tx like a severe burn, fluid and electrolyte replacement, wound care
97
After a scabies dx, all clothing/bedding/etc should be placed in a plastic bag for at least ___ hours, then washed and dried using heat.
72
98
What are potential complications seen in a patient with ritter dz?
**Secondary infections**: sepsis, pneumonia, cellulitis;
_Excessive fluid loss_
_Electrolyte imbalances_
99
What is the recommended management of an actinic keratosis?
Observation, cryosurgery, or topical 5 flourouracil or Imiquimod
100
Erythema multiforme usually presents acrally, which means...
That it affects the distal portions of limbs
101
What tx is recommended for pityriasis rosea?
None needed
If pruritis is significant, use PO antihistamines
102
What are some possible etiologies of diaper dermatitis (diaper rash)?
Risk factors for developing?
1. **_Wearing diapers_**: contact dermatitis, miliaria, *candida*.
2. Rash in the diaper area as well as other areas: atopic dermatitis, seborrheic dermatitis.
3. Affects diaper area irrespective of diaper use: scabies, bullous impetigo.
Risk factors: Friction and moisture from urine & feces
103
When does an urticarial cutaneous drug reaction rash typically occur following drug administration?
within minutes to hours
104
Describe the appearance of tinea cruris.
What is it commonly known as?
What is the recommended management for this condition?
What may be ineffective in tx?
Diffusely red rash on the groin or on the scrotum
"jock itch"
_Topical antifungal_
*PO Griseofulvin is ineffective*
105
What is dermatographism?
local pressure to the skin may cause wheals in that area
106
Topical abx should be applied to any _____ burn
nonsuperficial
107
Describe the appearance of a Mongolian Spot.
Are they permanent?
**Blue** or **slate gray** pigmented macular lesions most commonly seen in presacral / sacral-gluteal area (may be seen on the shoulders, legs, back and posterior thighs as well) with indefinite borders. May be solitary or multiple.
Spots usually fade over the first few years of life (before 10 y/o)
108
What are the three different types of mucosal HPV manifestations?
Genital warts (condyloma acuminata) Cervical dysplasia/cancer Anogenital carcinoma (intraepithelial)
109
How long does it usually take for the general exanthem of pityriasis rosea to resolve?
6-12 weeks
110
What is the recommended tx for a seborrheic keratosis?
None needed (benign) Cryotherapy for cosmesis
111
Erythema toxicum usually presents as?
Is this condition self limited or does it require specific tx?
Small erythematous macules or papules --\> pustules on erythematous bases 3-5 days after birth
Does NOT involve the palms or soles
Individual lesions may spontaneously disappear
**Self-limited** --\> usually resolves spontaneously in 1-2 weeks
112
What is a nevus simplex otherwise referred to as?
Stork Bite
113
How could you describe the vesicles of Pompholyx?
Pruritic, tapioca-like tense vesicles on the soles palms and fingers
114
Describe the presentation of the general exanthem of pityriasis rosea
smaller, very pruritic, 1 cm round/oval **salmon colored** papules with white circular (***colarette***) scaling along cleavage lines in a ***_Christmas tree pattern_***, confined to the *trunk* and *proximal extremities*
115
Condyloma acuminata can be treated with \_\_\_\_\_\_\_, in addition to the treatments for verucca vulgaris and plantaris
Podophyllin
116
What is commonly used topically on 2nd-3rd degree burns?
Who is it contraindicated in?
Where on the body should it not be used? Why?
***_Silver sulfadiazene_*** (SSD)
CI in pts w/ sulfa allergies, pregnant women, and children \<2 y/o
Should **NOT** be used on the ***face*** due to possible side effect of *discoloration*
117
What is the most common benign skin tumor?
Seborrheic keratosis
118
Describe the presentation of miliaria profunda.
What is it caused by?
flesh-colored papules
due to sweating in the papillary dermis
119
Where does impetigo most commonly occur?
At sites of superficial skin trauma on exposed part of the face and extremities
120
What other physical finding is pathognomonic for scabies?
red itchy papules/nodules on the scrotum, glans, or penile shaft, body folds
121
What types of medications typically cause exanthematous/morbilliform rashes in regards to cutaneous drug reactions?
abx, NSAIDs, Allopurinol/ thiazide diuretics
122
When taking into consideration the management and wrapping of burns on the hands/feet/fingers/toes, what should be done to prevent maceration?
Fingers and toes should be **individually wrapped** with gauze placed in between them
_Maceration_: *the softening and breaking down of skin resulting from prolonged exposure to moisture.*
123
What is the recommended management for contact dermatitis?
For diaper dermatitis?
Avoid irritants, wet dressings (Burrows solution i.e. Domeboro), and topical corticosteroids
Topical petroleum or zinc oxide, and frequent diaper changes
124
\_\_\_\_\_\_\_ is localized development of hives when the skin is stroked.
Dermatographism
125
Describe the appearance of tinea pedis.
What is is commonly referred to as?
What is the recommended management for this condition?
What may be ineffective in tx?
Pruritic scaly eruption rash between toes
"athlete's foot"
_Topical antifungal_
*PO Griseofulvin is ineffective*
126
In what population is perioral dermatitis most commonly seen? With what history?
Young women, hx of topical corticosteroid use
127
Is a full thickness burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a full thickness burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
3rd degree
Extends through entire skin
Waxy, white, leathery, dry
***_PAINLESS_***
***Absent capillary refill***
Months, does not spontaneously heal well
128
What are the 3 types of impetigo? Which is the most common? Which is the least common?
1. Nonbullous (MC) 2. Bullous 3. Ecthyma (LC)
129
What medications are most commonly responsible for an erythema multiforme presentation of a cutaneous drug reaction?
Sulfonamides, PCNs, phenobarbital, dilantin
130
What are some examples of irritants that can cause contact dermatitis?
What is the mechanism by which this reaction occurs?
chemicals, detergents, cleaners, acids, prolonged water exposure, metals
Delayed hypersensitivity
131
Describe what an actinic keratosis looks like
Dry, rough, scaly, sandpaper skin lesion or erythematous hyperkeratotic (hyperpigmented) plaques +/- projection on the skin (horns)
132
\_\_\_\_\_\_\_\_ is an idiopathic, cell mediated immune response which presents in an increased incidence in individuals with Hepatitis C
Lichen planus
133
When is an escharotomy recommended in a burn patient?
When the burn is circumfrential, used to prevent compartment syndrome
134
In pts with perioral dermatitis, there is usually a confluence of ________ on a(n) _____ base. There may be ____ lesions present. Usually, the ________ is spared.
papulopustules
erythematous
satellite
vermillion border
135
What is the tx for lichen simplex chronicus/neurodermatitis?
Avoid scratching lesion, topical steroids
136
What is the recommended tx for perioral dermatitis?
What should be avoided?
Metronidazole or Erythromycin
Avoid topical corticosteroids
137
Where do verruca plana typically present?
Face, hands, and shins
138
Describe nonbullous impetigo
vesicles, pustules, with a characteristic "honey colored crust"
139
What other condition is pityriasis rosea oftentimes confused with?
How can you r/o the other condition?
Syphilis
Order an RPR, if the patient is sexually active
140
After taking what medications does SJS/TEN most commonly occur?
Sulfa and anticonvulsant medications
141
What is the name of the condition described below? "Progressive loss of the terminal hairs on the scalp in a characteristic distribution (pattern)"
Androgenetic Alopecia
142
What is onychomycosis? Describe it.
Where is it most commonly found on the body?
What is the recommended tx?
What serious side effect are systemic antifungals associated with?
Nail infection by various fungi (ex. tinea, candida). Opaque, thickened, discolored & cracked nails with subungual hyperkeratinization.
Occurs MC on _great toe_.
Management: **Itraconazole & Terbinafine**.
Systemic antifungals: Griseofulvin, ltraconazole & Terbinafine & Griseofulvin associated with **_hepatotoxicity_** & drug interactions.
Topical Ciclopirox.
143
What skin type does HPV infect?
Keratinized
144
What does tinea (pityriasis) versicolor look like?
***Hyper/hypopigmented***, well-demarcated round/oval macules with fine scaling. Often coalesce into patches on the trunk, face, extremities.
The involved skin _fails to tan_ with sun exposure.
145
Is a superficial partial thickness burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a superficial partial thickness burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
2nd degree
Epidermis + Superficial portion of dermis (papillary)
Erythematous, pink, moist, weeping, ***_(+) blistering_***
Most ***PAINFUL*** of all burns, very TTP
**_(+) capillary refill intact_**, blanches with pressure
Heals within 14-21 days, no scarring but +/- pigment changes
146
Where is a common location on the body for common and plantar warts to appear?
Hands
147
Most cutaneous drug reactions are ______ reactions, and are self-limited
hypersensitivity
148
What is recommended for management of a port wine stain?
When?
**Pulse dye laser treatment**
Best if used in *_infancy_* for best outcomes
149
Describe the appearance of cradle cap.
Erythematous plaques with fine white scales
150
Mild, moderate, or severe acne? "Comedones, +/- small amounts of papules and or pustules" Tx?
Mild Topical retinoids, Benzoyl peroxide, topical abx, OCPs
151
\_\_\_\_\_\_\_\_ is the key androgen leading to androgenetic alopecia
Dihydrotestosterone (DHT)
152
What is the topical drug of choice in the tx of impetigo?
Mupirocin (Bactroban) TID x10 days Wash gently with soap and water as well
153
What is the condition described below: "Skin thickening in patients with eczema, secondary to repetitive rubbing and scratching"
Lichen simplex chronicus (neurodermatitis)
154
(Male/Female) mites burrow into the skin to do what? What is the scabies mite fecal matter called?
Female lay eggs, feed, and defecate scybala, which causes a hypersensitivity reaction in the skin
155
Other than cutaneous presentation, what else may patients with SJS/TEN present with?
Fever and URI sx
156
What are milia?
Where are they commonly located?
1-2 mm pearly white-yellow papules (due to keratin retention within the dermis of immature skin)
Seen MC on the **cheeks**, **forehead**, **chin**, and **nose**
157
For extensive impetigo, or for systemic sx, what is the treatment of choice?
Systemic abx (Cephalexin)
158
What is the most common skin eruption associated with cutaneous drug reactions? 2nd most common type? 3rd?
1. Exanthematous/Morbiliform rash 2. Urticarial 3. erythema multiforme
159
What is the topical drug of choice for tx of pediculosis?
Permethrin
160
What are the _rashes_ that can affect the **palm** and **soles**? (x8)
_Coxsackie_ (Hand Foot & Mouth)
_RMSF_ (especially if wrist/ankles involved)
Syphilis (secondary)
_Janeway lesions_ (*cutaneous finding of **endocarditis**, along with osler nodes*)
_Kawasaki_
_Measles_
_Toxic Shock Syndrome_
_Reactive Arthritis_ (Keratoderma Blenorrhagica)
_Meningococcemia_
161
What are some potential risk factors of developing impetigo?
warm humid conditions, poor personal hygiene
162
What does the child Rule of Nines breakdown look like compared to the adult?
163
Describe urticaria
blanchable, edematous pink papules, wheals, or plaques (oval, linear, irregular)
164
What is Koebner's phenomenon?
What other condition is it seen in, in addition to lichen planus?
New lesions at sites of trauma
| (also seen in psoriasis)
165
Describe the appearance of a seborrheic keratosis
Small papule/plaque velvety warty lesion with a greasy/stuck on appearance
166
Impetigo is or is not a highly contagious vesiculopustular skin infection?
IT IS
167
How would a pt with scarlet fever present?
Where does the rash most commonly start and then spread to?
What will the rash typically do over time?
What is the rash commonly associated with in the mouth?
1. Fever, chills, ***pharyngitis*** (strep throat)
2. **_Rash_**: diffuse erythema that blanches with pressure plus many small (1 - 2 mm) papular elevations that feels like "***_SANDPAPER_***" when palpated "***sunburn with goosebumps***".
MC starts in the **groin** and **axillae** then rapidly spreads to the trunk and then the extremities.
The rash often ***_desquamates_*** over time (usually spares the palms & soles)
Often associated with a flushed face with **CIRCUMORAL PALLOR & STRAWBERRY TONGUE**
168
What is the cutaneous presentation of scabies? Where are they commonly found? Where will they not be found?
Intensely pruritic papules and vesicles and linear burrows Intertriginous zones, including web space between fingers/toes, scalp (usually spares neck and face)
169
What is the atopic triad?
1. Eczema
2. Allergic rhinitis
3. Asthma
170
Describe the presentation of miliaria rubra.
Where does it present compared to miliaria crystallina?
severely pruritic papules (may develop pustules).
Deeper in the epidermis
171
Mild, moderate, or severe acne? "Nodular (\>5mm) or cystic acne" Tx?
Severe Isotretinoins (highly teratogenic!)
172
Ritter disease is caused by the disseminated exfoliative exotoxins produced by the bacterium ____ \_\_\_\_\_ (esp. strains __ and \_\_). These toxins may cause ____ and _____ of the intra epidermal desmosomes of the skin.
Staphylococcus aureus
71 and 55
proteolysis and destruction
173
How do you definitively diagnose mucosal HPV?
Whitening of the lesion when in contact with acetic acid
174
\_\_\_\_\_\_\_ acne will often heal with scarring
nodular/cystic
175
Bullous impetigo is often associated with sx of _____ and _____ and is most commonly caused by what infective agent? Is this condition rare or common?
fever and diarrhea staph aureus RARE
176
What are the 4 main pathophysiologic factors that lead to acne vulgaris?
1. Increased sebum production
2. Clogged sebaceous glands
3. *Propionibacterium acne* (*P. acne*) overgrowth
4. Inflammatory response
177
What does the herald patch in pityriasis rosea look like?
Where is it located?
How large is it?
Solitary salmon-colored macule
on the trunk
2-6cm in diameter
178
What is a nevus simplex/stork bite due to?
Where are they most commonly seen?
How are they managed?
Do they darken over time?
Areas of surface capillary dilation
MC seen on the nape of the neck, eyelids, and forehead
1. Observation: most will resolve spontaneously by 2 y/o and do not usually darken over time.
2. Laser therapy will reduce the appearance of the lesions.
179
What less-expensive medication used in the management of scabies can cause sz? How/why? What should be avoided?
Lindane Do not use after bath/shower d/t increased absorption through open pores Teratogenic, avoid pregnancy
180
What is the recommended treatment for chronic atopic dermatitis?
daily hydration and emollients (eucerin and aquaphor)
181
Pityriasis rosea is associated with ______ infections and is primarily seen in what population?
viral infections (HHV7)
children and young adults
182
What is Darier's sign? What is another name for this?
localized urticaria appearing where the skin is rubbed (urticaria pigmentosa)
183
What is nummular eczema?
Where is it usually located on the body?
sharply defined coin shaped/discoid lesions
dorsum of the hands and feet and extensor surfaces (i.e. knees and elbows)
184
What is the drug of choice for the tx of scabies?
Permethrin topical
185
Ecthyma is described as a(n) ______ \_\_\_\_\_\_ caused by what infective agent? Does this condition heal with scarring? Common or uncommon?
ulcerative pyoderma
GABHS
Yes, scars
UNCOMMON
186
Describe an exanthematous/morbilliform rash. When does the rash typically present after medication initiation?
Generalized distribution of bright red macules and papules that coalesce to form plaques. 2-14 days
187
\_\_\_\_\_\_ cells release ______ during an urticarial reaction, causing (vasoconstriction/vasodilation) of the venules, leading to ____ of the dermis and SQ tissues.
Mast cells histamines vasodilation edema
188
When cleansing a burn, what should you use?
What should you not use?
How long should you irrigate a chemical burn with running water for?
Wash the wound using only ***_mild soap and water_*** --\> (skin disinfectants may actually inhibit healing)
Do **NOT** apply ice directly to a burn! (cool compresses can be used to stop thermal burning)
_Chemical Burns_: irrigate profusely with running water for ***at least 20 minutes***.
189
Fungal skin infections are most commonly caused by \_\_\_\_\_\_\_, and also Microsporum, Epidermophyton.
Infects _____ tissues in the stratum corneum of the skin, hair & nails by ingesting \_\_\_\_\_.
Trichophyton
keratinized, keratin
190
What is miliaria caused by?
Describe how it comes to be present.
What skin flora become increased in number?
Blockage of eccrine sweat glands (especially in hot & humid conditions)
This leads to sweat into the epidermis & dermis
Increased counts of skin flora (*S. epidermis, S. aureus*)
191
Erythema multiforme is most commonly associated with what virus?
What agent most commonly affects children?
Herpes Simplex virus
Mycoplasma
192
What is the recommended treatment for acute atopic dermatitis?
topical corticosteroids and antihistamines
topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Crisaborole (Eucrisa) --\> nonsteroidal for 2 y/o +
193
Verruca vulgaris and plantaris can be managed with what types of treatments?
salicylic acid, cryotherapy, laser
194
What is Pompholyx otherwise known as?
Dyshidrosis (Dyshidrosis eczema)
195
What medication is the treatment of choice for urticaria?
Oral antihistamines (H2 blockers)
196
What are examples of triggers of atopic dermatitis?
heat, perspiration, allergens, contact irritants (wool, nickel, food)
197
What medications most commonly cause erythema multiforme?
Sulfa drugs, beta lactams, phenytoin, phenobarbital
