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Rotation 1: Pediatrics > Dermatology (15%) > Flashcards

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

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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.

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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

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4
Q

Patients with erythema multiforme frequently have a ______ as well

A

fever

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5
Q

Atopic dermatitis is a _____ -mediated reaction with increased ____ production.

A

T cell mediated immune activation

increased IgE production

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6
Q

Describe the appearance of tinea barbae

A

Papules, pustules, and hair follicles

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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

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8
Q

What is the mode of transmission of pediculosis?

A

person to person

fomites (hats, headsets, clothing, bedding)

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9
Q

What part of the body is usually spared in pityriasis rosea?

A

the face

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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

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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)

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12
Q

Where on the body does atopic dermatitis most commonly present?

A

flexor creases i.e. antecubital and popliteal folds

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13
Q

What types of medications typically cause urticarial rashes in regards to cutaneous drug reactions?

A

abx, NSAIDs, opiates, radiocontrast media

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14
Q

What is the hallmark sx of atopic dermatitis?

A

pruritis

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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.

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16
Q

_______ can occur in infants who have prolonged exposure to urine and or feces

A

Diaper rash (contact dermatitis)

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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

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18
Q

In what population are seborrheic keratoses most commonly seen in? With what history?

A

Fair skinned elderly with prolonged sun exposure

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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.

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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

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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)

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22
Q

How is erythema multiforme managed?

If it is oral?

If it is severe?

A

Symptomatically

Steroids/lidocaine/diphenhydramine mouthwash

Systemic steroids

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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

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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

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25
Q

What are nits?

A

White oval shaped egg capsules at the base of the hair shafts, can be removed with a fine toothed comb

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26
Q

What is the recommended course of tx for milia?

A

None, usually disappears by the 1st month of life, may be seen up to 3 months old

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27
Q

How do you diagnose a pt with scabies?

A

Clinically Can scrape skin of burrows with mineral oil to ID mites or eggs under microscopy

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28
Q

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?

A

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

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29
Q

Describe the appearance of cafe au lait macules.

Color?

What are they caused by?

A

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.

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30
Q

Erythema multiforme is a(n) (acute/chronic) self-limited type (1/2/3/4) hypersensitivity reaction most commonly seen in what age population?

A

Acute

4

young adults 20-40 y/o

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31
Q

How do you dx a pt with ritter dz?

What can you cx?

What can you bx? What are you looking for?

A
  1. Clinical diagnosis. Intact bullae are sterile.
  2. Cultures from urine, blood & nasopharynx.
  3. Skin biopsy: lower stratum granulosum layer splitting.
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32
Q

What is the recommended course of management for a pt with ritter dz?

First line?

What if MRSA is suspected?

A
  1. Antibiotics: Penicillinase-resistant penicillin 1st line:* Nafcillin or Oxacillin ± Clindamycin

Vancomycin if MRSAis suspected of if failed penicillin treatment.

  1. Supportive skin care: maintain clean & moist skin, emollients to improve barrier function.
  2. Fluid and electrolyte replacement
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33
Q

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 __.

A

11-26 y/o

70%

6, 11, 16, 18

31, 33, 45, 52, 58

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34
Q

What is first line management of tinea capitus?

A

PO Griseofulvin = 1st line

PO Terbinafine, Itraconazole of Fluconazole 2nd line tx.

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35
Q

Erythema toxicum is thought to be due to ____ ____ ____ and is seen in up to __% of neonates.

A

immune system activation

70%

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36
Q

What is second line treatment for pediculosis?

Why?

A

Lindane

Neurotoxic (HAs, sz) do not use after showering!

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37
Q

______, ______ pain or _____ pain may accompany a cutaneous drug reaction

A

fever, abd pain, joint pain

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38
Q

Describe the presentation of Miliaria Crystallina.

In what patient population is this most commonly seen in?

A

Tiny, friable clear vesicles (due to sweat in the superficial stratum corneum)

MC in neonates (especially in 1 week old neonates).

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39
Q

How do you manage tinea (pityriasis) versicolor?

A
  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.
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40
Q

What is Sturge-Weber Syndrome?

What is the classic triad?

What may a patient with Sturge-Weber Syndrome develop?

A

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

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41
Q

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?

A

5 alpha reductase inhibitor

testosterone to dihydrotestosterone (DHT)

decreased libido, sexual and ejaculatory dysfunction

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42
Q

Most warts typically resolve spontaneously w/in _____ years

A

2

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43
Q

What is the Rule of Nines?

What type of burn is it not applicable to?

A

No applicable to first degree burns

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44
Q

What is pediculosis commonly referred to as?

A

Lice

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45
Q

Describe erythema multiforme’s cutaneous presentation.

A

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

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46
Q

Describe the appearance of tinea capitus

What is the common name for tinea capitus?

A

Varied presentation: annular, scaling lesions & broken hair shafts. Inflamed plaques with multiple pustules (kerion) with scarring & alopecia

“Ring worm” = common name

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47
Q

What is the most common premalignant skin condition? What malignancy can it develop into?

A

Actinic keratosis Squamous cell carcinoma

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48
Q

Describe the cutaneous presentation of SJS/TEN

A

widespread blisters that begin on the trunk and face erythematous/pruritic macules >=1 membrane involvement with epidermal detachment

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49
Q

How do you diagnose a pt with tinea (pityriasis) versivolor?

A
  1. KOH prep from skin scraping: hyphae & spores“spaghetti & meatball” appearance.
  2. Wood’s lamp: yellow-green fluorescence (enhanced color variation seen with versicolor).
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50
Q

What are the three different types of pediculosis louse?

A

head louse (pediculosis humanus capitus), body louse (pediculus humanus corporis), and pubic louse (phthirus pubis)

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51
Q

What causes sebaceous glands to become clogged in acne vulgaris?

A

increased production of follicular keratinocytes

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52
Q

What possible colors could a seborrheic keratosis be?

A

flesh-colored, brown, grey, and black

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53
Q

Seborrheic dermatitis when presenting on an infant along the scalp is called?

A

Cradle cap

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54
Q

What is tinea (pityriasis) versicolor?

A

Overgrowth of the yeast Malassezia furfur (formerly Pityrosporum) - part of the normal skin flora.

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55
Q

What are the three types of cutaneous HPV verruca (warts)?

A

Common (vulgaris) Plantar (plantaris) Flat (plana)

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56
Q

Is angioedema painless/painful?

A

Painless

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57
Q

What is the first step in management of a cutaneous drug reaction?

A

Discontinue the offending medication.

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58
Q

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)

A

1st degree

Epidermis

Erythematous, dry

Painful

(+) capillary refill intact, blanches with pressure

Heals within 7 days, no scarring

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59
Q

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?

A
  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.

  1. Inflamed conjunctiva may be seen (may become purulent) but mucous membranes are not involved.
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60
Q

What physical finding is pathognomonic for common and plantar warts?

A

Thrombosed capillaries

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61
Q

Inflammatory acne vulgaris has _____ and _____ surrounded by inflammation

A

papules and pustules

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62
Q

What is the recommended course of management for pompholyx?

A

Topical steroids

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63
Q

How do you definitively dx an actinic kertosis?

A

Punch or shave bx

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64
Q

Describe the dermatologic presentation of lichen simplex chronicus/neurodermatitis

A

Scaly, well-demarcated, rough, hyperkeratotic plaques with exaggerated skin lines

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65
Q

The three most common triggers of urticaria are ___, ___, and ____.

A

food, medications, infections Also: insect bites, drugs, envr, stress, heat, cold

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66
Q

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)

A

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

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67
Q

What should be done with bedding and clothing after a pediculosis dx?

A

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

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68
Q

Open comedones are called (black/white) heads, and closed comedones are called (black/white) heads. Which is an incomplete or a complete blockage?

A

Black (incomplete) White (complete)

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69
Q

What are the three different types of miliaria?

A

Miliaria Crystallina

Miliaria Rubra

Miliaria Profunda

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70
Q

_______ is best used if the onset of androgenetic alopecia is recent and is involving a smaller area

A

Minoxidil

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71
Q

What is the clinical manifestation of a patient with pediculosis?

A

Intense itching (esp. occipital area), papular urticaria near the lice bites

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72
Q

What is the difference between steven johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

A

BSA affected: SJS = <10%, TEN = >30%

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73
Q

Is angioedema a shallower/deeper form of urticaria?

A

Deeper

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74
Q

What is recommended for pain management in burn patients?

A

Acetaminophen and NSAIDS can be used alone or in conjunction with opioids

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75
Q

Describe a (+) Nikolsky sign

A

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)

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76
Q

What is Scarlet fever also called?

What is it due to?

A

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)

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77
Q

What are the 5 types of cutaneous drug reactions? Describe each and how they are mediated.

A

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

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78
Q

After the herald patch, when does the general exanthem of pityriasis rosea then occur?

A

1-2 weeks later

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79
Q

What type of burns do not require dressing?

A

Superficial

80
Q

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?

A

Genital warts (could also present in the oropharynx) Soft, fleshy, cauliflower like lesions Painless

81
Q

Children with >/=6 Cafe au lait macules (especially when accompanied with _____ or _____ freckling) should be evaluated for possible ________.

A

axillary or inguinal

Neurofibromatosis type I

82
Q

Where is lichen planus most commonly located on the body?

A

Flexor surfaces of extremities, skin, mouth, scalp, genitals, nails, and mucous membranes

83
Q

Atopic dermatitis is otherwise known as _____.

A

eczema

84
Q

Where on the body does angioedema usually present? What serious complication can occur in tandem with angioedema?

A

lips, tongue, eyelids, hands, feet, and genitals Anaphylaxis

85
Q

What time of year is pityriasis rosea most commonly seen?

A

spring/fall

86
Q

________ is a type 1 HSN (Ig___) or complement-mediated edematous reaction of the dermis and or SQ tissues

A

Urticaria (IgE)

87
Q

Port wine stains (otherwise known as _____ _____ or ____ _____) are due to ______.

A

capillary malformations

nevus flammeus

Vascular malformations of the skin –> due to superficial dilated dermal capillaries

88
Q

How to tx/manage cradle cap?

A

Baby shampoo, ketoconazole, topical corticosteroids

89
Q

What are the 5 P’s of lichen planus?

A

Purple

Polygonal

Planar

Pruritic

Papules, with fine scales and irregular borders

90
Q

What is a Mongolian Spot and what is it due to?

In what populations are they most commonly seen?

A

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
Q

What is the recommended tx for scarlet fever?

First line?

A

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
Q

What type of blisters should be removed/debrided?

A

Ruptured blisters

Management of clean and intact blisters is contorversial

93
Q

What is the Parkland formula and what is it used for?

A

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
Q

What differentiates erythema multiforme minor from major?

A

Mucosal membrane involvement (major = mucosa involved)

95
Q

Actinic keratosis is most commonly seen in people with what type of skin? With what kind of history?

A

Fair skinned elderly with prolonged skin exposure

96
Q

What is the recommended course of management for SJS/TEN?

A

tx like a severe burn, fluid and electrolyte replacement, wound care

97
Q

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.

A

72

98
Q

What are potential complications seen in a patient with ritter dz?

A

Secondary infections: sepsis, pneumonia, cellulitis;

Excessive fluid loss

Electrolyte imbalances

99
Q

What is the recommended management of an actinic keratosis?

A

Observation, cryosurgery, or topical 5 flourouracil or Imiquimod

100
Q

Erythema multiforme usually presents acrally, which means…

A

That it affects the distal portions of limbs

101
Q

What tx is recommended for pityriasis rosea?

A

None needed

If pruritis is significant, use PO antihistamines

102
Q

What are some possible etiologies of diaper dermatitis (diaper rash)?

Risk factors for developing?

A
  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
Q

When does an urticarial cutaneous drug reaction rash typically occur following drug administration?

A

within minutes to hours

104
Q

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?

A

Diffusely red rash on the groin or on the scrotum

“jock itch”

Topical antifungal

PO Griseofulvin is ineffective

105
Q

What is dermatographism?

A

local pressure to the skin may cause wheals in that area

106
Q

Topical abx should be applied to any _____ burn

A

nonsuperficial

107
Q

Describe the appearance of a Mongolian Spot.

Are they permanent?

A

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
Q

What are the three different types of mucosal HPV manifestations?

A

Genital warts (condyloma acuminata) Cervical dysplasia/cancer Anogenital carcinoma (intraepithelial)

109
Q

How long does it usually take for the general exanthem of pityriasis rosea to resolve?

A

6-12 weeks

110
Q

What is the recommended tx for a seborrheic keratosis?

A

None needed (benign) Cryotherapy for cosmesis

111
Q

Erythema toxicum usually presents as?

Is this condition self limited or does it require specific tx?

A

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
Q

What is a nevus simplex otherwise referred to as?

A

Stork Bite

113
Q

How could you describe the vesicles of Pompholyx?

A

Pruritic, tapioca-like tense vesicles on the soles palms and fingers

114
Q

Describe the presentation of the general exanthem of pityriasis rosea

A

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
Q

Condyloma acuminata can be treated with _______, in addition to the treatments for verucca vulgaris and plantaris

A

Podophyllin

116
Q

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?

A

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
Q

What is the most common benign skin tumor?

A

Seborrheic keratosis

118
Q

Describe the presentation of miliaria profunda.

What is it caused by?

A

flesh-colored papules

due to sweating in the papillary dermis

119
Q

Where does impetigo most commonly occur?

A

At sites of superficial skin trauma on exposed part of the face and extremities

120
Q

What other physical finding is pathognomonic for scabies?

A

red itchy papules/nodules on the scrotum, glans, or penile shaft, body folds

121
Q

What types of medications typically cause exanthematous/morbilliform rashes in regards to cutaneous drug reactions?

A

abx, NSAIDs, Allopurinol/ thiazide diuretics

122
Q

When taking into consideration the management and wrapping of burns on the hands/feet/fingers/toes, what should be done to prevent maceration?

A

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
Q

What is the recommended management for contact dermatitis?

For diaper dermatitis?

A

Avoid irritants, wet dressings (Burrows solution i.e. Domeboro), and topical corticosteroids

Topical petroleum or zinc oxide, and frequent diaper changes

124
Q

_______ is localized development of hives when the skin is stroked.

A

Dermatographism

125
Q

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?

A

Pruritic scaly eruption rash between toes

“athlete’s foot”

Topical antifungal

PO Griseofulvin is ineffective

126
Q

In what population is perioral dermatitis most commonly seen? With what history?

A

Young women, hx of topical corticosteroid use

127
Q

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)

A

3rd degree

Extends through entire skin

Waxy, white, leathery, dry

PAINLESS

Absent capillary refill

Months, does not spontaneously heal well

128
Q

What are the 3 types of impetigo? Which is the most common? Which is the least common?

A
  1. Nonbullous (MC) 2. Bullous 3. Ecthyma (LC)
129
Q

What medications are most commonly responsible for an erythema multiforme presentation of a cutaneous drug reaction?

A

Sulfonamides, PCNs, phenobarbital, dilantin

130
Q

What are some examples of irritants that can cause contact dermatitis?

What is the mechanism by which this reaction occurs?

A

chemicals, detergents, cleaners, acids, prolonged water exposure, metals

Delayed hypersensitivity

131
Q

Describe what an actinic keratosis looks like

A

Dry, rough, scaly, sandpaper skin lesion or erythematous hyperkeratotic (hyperpigmented) plaques +/- projection on the skin (horns)

132
Q

________ is an idiopathic, cell mediated immune response which presents in an increased incidence in individuals with Hepatitis C

A

Lichen planus

133
Q

When is an escharotomy recommended in a burn patient?

A

When the burn is circumfrential, used to prevent compartment syndrome

134
Q

In pts with perioral dermatitis, there is usually a confluence of ________ on a(n) _____ base. There may be ____ lesions present. Usually, the ________ is spared.

A

papulopustules

erythematous

satellite

vermillion border

135
Q

What is the tx for lichen simplex chronicus/neurodermatitis?

A

Avoid scratching lesion, topical steroids

136
Q

What is the recommended tx for perioral dermatitis?

What should be avoided?

A

Metronidazole or Erythromycin

Avoid topical corticosteroids

137
Q

Where do verruca plana typically present?

A

Face, hands, and shins

138
Q

Describe nonbullous impetigo

A

vesicles, pustules, with a characteristic “honey colored crust”

139
Q

What other condition is pityriasis rosea oftentimes confused with?

How can you r/o the other condition?

A

Syphilis

Order an RPR, if the patient is sexually active

140
Q

After taking what medications does SJS/TEN most commonly occur?

A

Sulfa and anticonvulsant medications

141
Q

What is the name of the condition described below? “Progressive loss of the terminal hairs on the scalp in a characteristic distribution (pattern)”

A

Androgenetic Alopecia

142
Q

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?

A

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
Q

What skin type does HPV infect?

A

Keratinized

144
Q

What does tinea (pityriasis) versicolor look like?

A

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
Q

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)

A

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
Q

Where is a common location on the body for common and plantar warts to appear?

A

Hands

147
Q

Most cutaneous drug reactions are ______ reactions, and are self-limited

A

hypersensitivity

148
Q

What is recommended for management of a port wine stain?

When?

A

Pulse dye laser treatment

Best if used in infancy for best outcomes

149
Q

Describe the appearance of cradle cap.

A

Erythematous plaques with fine white scales

150
Q

Mild, moderate, or severe acne? “Comedones, +/- small amounts of papules and or pustules” Tx?

A

Mild Topical retinoids, Benzoyl peroxide, topical abx, OCPs

151
Q

________ is the key androgen leading to androgenetic alopecia

A

Dihydrotestosterone (DHT)

152
Q

What is the topical drug of choice in the tx of impetigo?

A

Mupirocin (Bactroban) TID x10 days Wash gently with soap and water as well

153
Q

What is the condition described below: “Skin thickening in patients with eczema, secondary to repetitive rubbing and scratching”

A

Lichen simplex chronicus (neurodermatitis)

154
Q

(Male/Female) mites burrow into the skin to do what? What is the scabies mite fecal matter called?

A

Female lay eggs, feed, and defecate scybala, which causes a hypersensitivity reaction in the skin

155
Q

Other than cutaneous presentation, what else may patients with SJS/TEN present with?

A

Fever and URI sx

156
Q

What are milia?

Where are they commonly located?

A

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
Q

For extensive impetigo, or for systemic sx, what is the treatment of choice?

A

Systemic abx (Cephalexin)

158
Q

What is the most common skin eruption associated with cutaneous drug reactions? 2nd most common type? 3rd?

A
  1. Exanthematous/Morbiliform rash 2. Urticarial 3. erythema multiforme
159
Q

What is the topical drug of choice for tx of pediculosis?

A

Permethrin

160
Q

What are the rashes that can affect the palm and soles? (x8)

A

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
Q

What are some potential risk factors of developing impetigo?

A

warm humid conditions, poor personal hygiene

162
Q

What does the child Rule of Nines breakdown look like compared to the adult?

A
163
Q

Describe urticaria

A

blanchable, edematous pink papules, wheals, or plaques (oval, linear, irregular)

164
Q

What is Koebner’s phenomenon?

What other condition is it seen in, in addition to lichen planus?

A

New lesions at sites of trauma

(also seen in psoriasis)

165
Q

Describe the appearance of a seborrheic keratosis

A

Small papule/plaque velvety warty lesion with a greasy/stuck on appearance

166
Q

Impetigo is or is not a highly contagious vesiculopustular skin infection?

A

IT IS

167
Q

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?

A
  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
Q

What is the cutaneous presentation of scabies? Where are they commonly found? Where will they not be found?

A

Intensely pruritic papules and vesicles and linear burrows Intertriginous zones, including web space between fingers/toes, scalp (usually spares neck and face)

169
Q

What is the atopic triad?

A
  1. Eczema
  2. Allergic rhinitis
  3. Asthma
170
Q

Describe the presentation of miliaria rubra.

Where does it present compared to miliaria crystallina?

A

severely pruritic papules (may develop pustules).

Deeper in the epidermis

171
Q

Mild, moderate, or severe acne? “Nodular (>5mm) or cystic acne” Tx?

A

Severe Isotretinoins (highly teratogenic!)

172
Q

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.

A

Staphylococcus aureus

71 and 55

proteolysis and destruction

173
Q

How do you definitively diagnose mucosal HPV?

A

Whitening of the lesion when in contact with acetic acid

174
Q

_______ acne will often heal with scarring

A

nodular/cystic

175
Q

Bullous impetigo is often associated with sx of _____ and _____ and is most commonly caused by what infective agent? Is this condition rare or common?

A

fever and diarrhea staph aureus RARE

176
Q

What are the 4 main pathophysiologic factors that lead to acne vulgaris?

A
  1. Increased sebum production
  2. Clogged sebaceous glands
  3. Propionibacterium acne (P. acne) overgrowth
  4. Inflammatory response
177
Q

What does the herald patch in pityriasis rosea look like?

Where is it located?

How large is it?

A

Solitary salmon-colored macule

on the trunk

2-6cm in diameter

178
Q

What is a nevus simplex/stork bite due to?

Where are they most commonly seen?

How are they managed?

Do they darken over time?

A

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
Q

What less-expensive medication used in the management of scabies can cause sz? How/why? What should be avoided?

A

Lindane Do not use after bath/shower d/t increased absorption through open pores Teratogenic, avoid pregnancy

180
Q

What is the recommended treatment for chronic atopic dermatitis?

A

daily hydration and emollients (eucerin and aquaphor)

181
Q

Pityriasis rosea is associated with ______ infections and is primarily seen in what population?

A

viral infections (HHV7)

children and young adults

182
Q

What is Darier’s sign? What is another name for this?

A

localized urticaria appearing where the skin is rubbed (urticaria pigmentosa)

183
Q

What is nummular eczema?

Where is it usually located on the body?

A

sharply defined coin shaped/discoid lesions

dorsum of the hands and feet and extensor surfaces (i.e. knees and elbows)

184
Q

What is the drug of choice for the tx of scabies?

A

Permethrin topical

185
Q

Ecthyma is described as a(n) ______ ______ caused by what infective agent? Does this condition heal with scarring? Common or uncommon?

A

ulcerative pyoderma

GABHS

Yes, scars

UNCOMMON

186
Q

Describe an exanthematous/morbilliform rash. When does the rash typically present after medication initiation?

A

Generalized distribution of bright red macules and papules that coalesce to form plaques. 2-14 days

187
Q

______ cells release ______ during an urticarial reaction, causing (vasoconstriction/vasodilation) of the venules, leading to ____ of the dermis and SQ tissues.

A

Mast cells histamines vasodilation edema

188
Q

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?

A

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
Q

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 _____.

A

Trichophyton

keratinized, keratin

190
Q

What is miliaria caused by?

Describe how it comes to be present.

What skin flora become increased in number?

A

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
Q

Erythema multiforme is most commonly associated with what virus?

What agent most commonly affects children?

A

Herpes Simplex virus

Mycoplasma

192
Q

What is the recommended treatment for acute atopic dermatitis?

A

topical corticosteroids and antihistamines

topical calcineurin inhibitors (tacrolimus, pimecrolimus)

Crisaborole (Eucrisa) –> nonsteroidal for 2 y/o +

193
Q

Verruca vulgaris and plantaris can be managed with what types of treatments?

A

salicylic acid, cryotherapy, laser

194
Q

What is Pompholyx otherwise known as?

A

Dyshidrosis (Dyshidrosis eczema)

195
Q

What medication is the treatment of choice for urticaria?

A

Oral antihistamines (H2 blockers)

196
Q

What are examples of triggers of atopic dermatitis?

A

heat, perspiration, allergens, contact irritants (wool, nickel, food)

197
Q

What medications most commonly cause erythema multiforme?

A

Sulfa drugs, beta lactams, phenytoin, phenobarbital

Rotation 1: Pediatrics (13 decks)

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