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Surgery Rotation EORE > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the MC cause of Cellulitis?

A

S. aureus & Group A beta hemolytic strep (GABHS/S. pyogenes)

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2
Q

what’s the s/s of cellulitis?

A

Local: macular erythema (flat margins, not sharply demarcated), swelling, warmth, and tenderness

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3
Q

what is erysipelas caused by?

A

group A strep (GABHS)

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4
Q

what’s the s/s of erysipelas vs cellulitis?

A

well demarcated margins and erythematous

MC involves the face

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5
Q

what’s the tx of erysipelas?

A

IV PCN, Vanco (if PCN allergy or MRSA suspected)

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6
Q

what is lymphangitis? what are complications of it?

A

spread of the infection via the lymphatic vessels. Seen as streaking from the infected area following the lymph vessels

complications = bacteremia

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7
Q

where does erysipelas MC occur on the body?

A

the face

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8
Q

what’s the tx of cellulitis NOT caused by MRSA?

A

Cephalexin; Dicloxacillin

Clinda or Erythromycin if PCN allergic

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9
Q

what are tx of cellulitis caused by MRSA?

A

IV Vanco PLUS Zosyn

PO options are: Bactrim (2nd best PO med for MRSA, but doesn’t cover strep well), Clindamycin, Doxy

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10
Q

what bacteria is from a cat bite and what’s the tx?

A

Cat bite = Pasteurella multocida

Tx: Augmentin (Amox/clavulanate)
-doxy if PCN allergic

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11
Q

what bacteria is from a dog bite and what’s the tx?

A

Capnocytophaga = bacteria from dog bite

Tx: Augmentin
-2nd line is Clinda + Cipro or Bactrim

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12
Q

what’s the tx for a human bite?

A

Augmentin

-2nd line is Clinda + Moxi or Bactrim

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13
Q

what’s the tx for a puncture wound?

A

Cipro (covers pseudomonas)

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14
Q

what is a furuncle (boil)?

A

deep infection of hair follicle (vs folliculitis is superficial)

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15
Q

what’s the s/s of furuncle

A

fluctuant abscess w/ central plug (may have surrounding cellulitis)

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16
Q

what’s the tx for furuncle?

A

I&D, heat compress, PO abx if a/w cellulitis

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17
Q

what’s folliculitis?

A

superficial hair follicle infection MC from staph aureus

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18
Q

what’s the s/s of folliculitis?

A

singular or clusters of small papule or pustules w/ surrounding erythema

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19
Q

what’s the tx for folliculitis?

A

topical mupirocin, clindamycin, erythromycin

PO abx for refractory/severe cases -> Cephalexin, dicloxacllin

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20
Q

what’s a carbuncle?

A

interlocking furuncles/abscess with multiple openings*** + cellulitis

larger, more painful than furuncle

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21
Q

what’s the tx for carbuncle?

A

same as furuncle - I&D, heat compress, PO abx if a/w cellulitis

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22
Q

what’s the MC type of skin cancer in the US?

A

Basal Cell Carcinoma

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23
Q

what are causes of Basal Cell Carcinoma?

A

sun exposure = main RF

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24
Q

what’s patho of Basal Cell Carcinoma?

A

slow growing: locally invasive but VERY LOW INCIDENCE OF METS

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25
Q

what are the 3 types of BCC?

A

Nodular (MC), Superficial, Morpheaform

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26
Q

what’s the MC type of BCC?

A

Nodular

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27
Q

what’s the s/s of Nodular BCC?

A

**waxy/pearly, dome shaped, smooth, raised, rolled borders, **telangiectatic, ***central ulceration

***slowly enlarging, doesn’t heal, bleeds easily

MC on face/nose/trunk

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28
Q

how do you dx BCC?

A

punch or shave bx

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29
Q

what’s the GOLD STANDARD tx for BCC?

A

Mohs

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30
Q

what’s the MC type of melanoma and 2nd MC type?

A

superficial spreading = MC type

Nodular = 2nd MC type (most malignant subtype d/t dominant vertical growth phase)

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31
Q

what’s the most malignant subtype of melanoma?

A

nodular d/t vertical growth

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32
Q

what’s the s/s of superficial spreading melanoma?

A

lesions may be tan, brown, blue, or black

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33
Q

what’s the s/s of nodular melanoma?

A

Blueish-black, less variable in color/shape than other subtypes

34
Q

what’s the Mc type of melanoma found in dark-skinned pts?

A

Acral lentiginous

35
Q

what’s the s/s of Acral lentiginous melanoma?

A

Occur on palmar surfaces of hands, plantar surfaces of feet, and underneath nails

36
Q

what’s the MOST IMPT prognostic factor for METS from melanoma?

A

thickness

37
Q

what’s the tx for melanoma if <1mm in thickness?

A

wide excision w/ a 1cm wide margin

38
Q

what’s the tx for melanoma if >1mm in thickness?

A

wide excision w/ a 2cm wide margin

39
Q

when do you do LN bx for melanoma?

A

if LN palpable on exam

40
Q

what’s precursor of SCC of skin?

A

actinic keratosis

41
Q

what’s the s/s of SCC of skin?

A

red, elevated papule, plaques or nodules with adherent white scaly or crusted, bloody margins

hyperkeratosis, ulceration or hyper pigmentation

non-healing that may bleed w/out trauma

42
Q

how do you dx SCC of skin? tx?

A

Bx = dx

Tx = wide local surgical excision

43
Q

what skin does 1st degree burn involve?

A

only the epidermis

44
Q

what’s the s/s of 1st degree burn?

A

red, dry, mod painful, blanches with direct pressure (refill intact)

45
Q

what’s the tx of 1st degree burn?

A

heals w/in 7 days, so no tx

no scarring

46
Q

what skin does 2nd degree superficial partial thickness burn involve?

A

epidermis to superficial portion of dermis (papillary)

47
Q

what’s the s/s of 2nd degree superficial partial thickness burn?

A

red, moist, weeping

***BLISTERING

MOST PAINFUL OF ALL BURNS, VERY TENDER TO TOUCH

blanches on direct press (refill intact)

48
Q

what’s the MOST PAINFUL of all burns?

A

2nd degree superficial partial thickness burn

49
Q

what skin does 2nd degree deep partial thickness burn involve?

A

epidermis into deep portion of dermis (reticular)

50
Q

what’s the s/s of 2nd degree deep partial thickness burn?

A

red, yellow, pale, **white waxy color, **dry

***BLISTERING, but NOT PAINFUL (b/c of destruction of nerves)

***ABSENT CAPILLARY REFILL

51
Q

what’s the difference b/w the s/s of 2nd degree burns?

A

2nd degree superficial partial thickness burn
-BLISTERING AND EXTREMELY PAINFUL AND HAS CAPILLARY REFILL (blanches on direct pressure

2nd degree deep partial thickness burn

  • BLISTERING, BUT NOT PAINFUL
  • ABSENT CAPILLARY REFILL
52
Q

what’s the tx for 2nd degree deep partial thickness burn?

A

heals in 3 weeks-2 months

SCARRING COMMON

53
Q

what’s the tx for 2nd degree superficial partial thickness burn?

A

heals in 14-21 days

NO SCARRING

54
Q

what’s a full thickness burn?

A

third degree -> destroys all layers of the skin

55
Q

what’s the initial tx for severely burned pts after removal of source of burn and ABCs?

A

fluid resuscitation with LR’s

56
Q

what’s the rule of 9’s for burns in adults?

A

total head = 9%

total of each arm = 9%

total of each leg = 18%

total of chest (front & back) = 18%

total of abdomen/lower back (front & back) = 18%

***whole trunk is 36%

57
Q

what burns do NOT require dressing for tx?

A

superficial burns

58
Q

what’s the empiric tx of cellulitis?

A

ABX THAT ARE EFFECTIVE AGAINST MRSA

Clinda, Bactrim, Tetracyclines (Doxy or Mino)

59
Q

what is serous discharge?

A

Clean, watery (may have slightly brownish hue)

Result of protein and other fluids

Normal

too much = bad bacteria

60
Q

what is purulent discharge?

A

Thick, yellow, green, tan or brown

Not normal

Contains pus, WBCs, dead bacteria and various inflammatory cells (signs of infection)

61
Q

what’s serosanguinous discharge?

A

Pale, red, watery

Mixture of serous and sanguineous
-Features added plasma

62
Q

what’s sanguineous discharge?

A

Bright red, indicative of active bleeding

Most common in deep partial thickness and full thickness wounds

During inflammation stage of wound, a little indicates proper circulation

63
Q

what is Type 1 cutaneous drug reaction?

A

IgE mediated: urticarial and angioedema (immediate)

Urticarial = 2nd MC type

64
Q

what’s the tx of Type 1 cutaneous drug rxn (urticaria/angioedema)?

A

systemic corticosteroids, antihistamines?

65
Q

what’s Type 2 cutaneous drug rxn?

A

Cytotoxic, Ab-mediated

66
Q

what’s Type 3 cutaneous drug rxn?

A

Immune antibody-antigen complex

-Drug mediated vasculitis and serum sickness

67
Q

what’s Type 4 cutaneous drug rxn?

A

Delayed (cell mediated)

-Morbiliform reaction (i.e. Erythema multiforme)

68
Q

what is erythema multiforme?

A

acute self-limited type 4 hypersensitivity rxn

rash evolves over 3-5 days and persists about 2 weeks

69
Q

what is erythema multiforme a/w?

A

herpes simplex virus (MC)***

***Meds: sulfa drugs, beta-lactam, phenytoin, phenobarbital

70
Q

what are the s/s of erythema multiforme?

A

***TARGET lesions -> dull “dusty-violet” red, purpuric macules/vesicles or bullae in the center

71
Q

what’s the tx of erythema multiforme?

A

d/c offending drug, PO antihistamines, STEROIDS (systemic if severe)

72
Q

what’s a exanthematous/morbiliform rash?

A

MC skin eruption

“bright-red” macule & papule that coalesce to form plaques

PERSISTENT LESIONS (vs urticaria are NOT)

caused by abx, NSAIDs, allopurinol, thiazides

rash begins 2-14 days after medication initiation

73
Q

what drugs cause SJS and TEN?

A

sulfa and anticonvulsants MC

74
Q

what is the difference b/w SJS and TEN?

A

SJS = sloughing <10% body surface area

TEN = sloughing >30% (may develop skin necrosis)

75
Q

what’s the s/s of SJS and TEN?

A

fever & URI sx’s -> WIDESPREAD BLISTERS on trunk/face, erythematous/pruritic macule >/= 1 mucous membrane and involves EPIDERMAL DETACHMENT (NIKOLSKY SIGN)

76
Q

what’s the tx of SJS and TEN?

A

Treat like severe burns

-burn unit admission, pain control, stop offending agent, fluid replacement, wound care

77
Q

what’s Dress Syndrome? s/s?

A

Drug induced hypersensitivity syndrome

S/S = fever, severe exanthematous rash (exfoliative), generalized LAD, hematologic abnormalities

Organ damage = carditis, hepatitis, nephritis

NO mucosal lesions (therefore different from SJS and TENs)

78
Q

what is urticaria & angioedema? Common med cause?

A

Type 1 hypersensitivity rxn (IgE mediated)

Commonly caused by CPNs (e.g. Cefotetan and PCNs)

79
Q

what are the s/s of urticaria?

A

pruritic, circumscribed, raised erythematous wheals or plaques, with central pallor

transient, blanching

occurs w/in min-hrs after drug administration

80
Q

what’s the treatment of choice for urticaria and angioedema?

A

PO antihistamines

Surgery Rotation EORE (10 decks)

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