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PAS 531 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Stasis dermatitis

A

Usually bilateral lower extremities with CHRONIC VENOUS INSUFFICIENCY.
Hyperpigmentation
Varicose veins
Edema
Telangiectasia

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2
Q

Stasis dermatitis pathophys

A

Dysfunction of venous valves obstruct flow causing venous hypertension.
Changes dermis

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3
Q

Stasis dermatitis risk factors

A

Age
Family
Tobacco
Standing
Obesity
Hx of DVT, heart failure, HTN

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4
Q

Stasis dermatitis clinical manifestation

A

Erythematous scaling
Exzematous patches/plaques on legs with ema.
Medial ankle mostly
Dull pain worsened with standing

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5
Q

Where is stasis dermatitis mostly seen

A

Medial ankle

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6
Q

Acute forms of stasis dermatitis

A

Inflammation
Weeping plaques
Vesiculatoin
Crusting
Ulcerations on medial ankle

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7
Q

Chronic forms of stasis dermatitis

A

Pruritic
Hyperpigmentation
Scaling
Edema
Varicosities
Telangiectasias

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8
Q

Chronic stasis dermatitis management

A

Petrolatum jelly
Topical corticosteroids

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9
Q

Acute stasis dermatitis management

A

Topical steroids 1-2 weeks BID
Wet dressings
Compression bandages (Unna Boot)

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10
Q

Acute stasis dermatitis management for secondary infection

A

Culture
Mupirocin for staph or strep.
Assess for cellulitis

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11
Q

Cellulitis

A

Unilateral
Acute
Shiny
Erythema and edema
Warm
Tender

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12
Q

Telangiectasia

A

Harmless but can be sign of other condition
Small red blood vessels
Serpentine
Spider veins
Present in Rosacea

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13
Q

Telangiectasia management

A

Cosmetic
Laser treatment
Sclerotherapy

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14
Q

Hemangioma

A

Cherry angiomas
Benign vascular skin lesion from proliferating endothelial cells and dilation of capillary beds

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15
Q

Hemangioma clinical manifestation

A

Asymptomatic
Firm
Papular
Red, blue purple
Blanchable

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16
Q

Hemangioma management

A

Biopsy if suspicious (black)
Cosmetic

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17
Q

Petechiae

A

Smaller
Nonblanching red, purple macules.
Caused by hemorrhaging.

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18
Q

Purpura

A

Larger
Discoloration of skin or mucous membranes due to hemorrhage from small blood vessels.
Associated with platelet and coagulation disorders

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19
Q

Purpura treatment

A

Diagnose underlying coagulation issue.

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20
Q

Anagen

A

Hair active growing phase
90-95% of hairs

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21
Q

Catagen

A

Transitional phase
Lower portion of hair production ceases

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22
Q

Telogen

A

Resting/shedding phase

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23
Q

Scarring (cicatricial) alopecia

A

Hair follicle is irreversibly destroyed and replaced by fibrous scar tissue.
Occurs following trauma or inflammation.

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24
Q

Scarring (cicitricial) alopecia treatment

A

Topical steroid (clobetasol)
Tetracycline if topicalsteroid doesn’t work
Steroidal injection

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25
Q

Nonscarring (noncicitricial) alopecia

A

Hair follicles are preserved with potential for hair regrowth

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26
Q

Non scarring alopecia examples

A

Tinea capitis
Hypothyroidism
Anagen effluvium
Trichotillomania
Secondary syphilis
SLE
Telogen effluvium
Deficiency of zinc, iron, or vitamin D

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27
Q

Scarring Alopecia examples

A

Scleroderma
Tinea capitits
Folliculitis
DLE
Lupus vulgaris
Lichen planopilaris

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28
Q

Male progressive androgenetic alopecia

A

Reduction of hairs on scalp.
Genetic
80% of white men by age 80
Thinning starts 20-40

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29
Q

Male androgenetic alopecia treatment

A

Minoxidil - topical FIRST
Finasteride - oral
Photobiomodulation (lazer therapy)
Platelet rich plasma (PRP)
Hair transplant
Scalp reduction flaps

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30
Q

Female androgenetic alopecia

A

Gradual thinning over crown
Affected women have DHEA-S

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31
Q

Female androgenetic alopecia treatment

A

Minoxidil - topical
Finasteride - oral

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32
Q

Alopecia Areata

A

Immune-mediated
Family Hx important
25% have other autoimmune disorders
Random clearly defined oval patches
Rapid loss of hair
Tiny EXCLAMATION POINT hairs may be present

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33
Q

Alopecia Areata treatment

A

Can control but not prevent spread.
High potency topical or intralesional corticosteroids (triamcinolone acetonide).
Squaric acid dibutyl ester
Anthralin
Minoxidil

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34
Q

Alopecia totalis

A

Total hair loss of scalp

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35
Q

Alopecia universalis

A

Total hair loss on ENTIRE body

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36
Q

Telogen effluvium

A

Hair falls out all over scalp due to interruption of hair production

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37
Q

Anagen effluvium

A

Rapid hair loss from medical treatment

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38
Q

Loose anagen syndrome

A

Common in young children when hair not firml rooted in follicle

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39
Q

Advanced alopecia areata

A

Autoimmune disease in which body’s immune system attacks healthy tissues including hair follicles

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40
Q

Trichotillomania

A

Pulling out hair.
Random patches
Often unilateral (dominant hand)

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41
Q

Trichotillomania treatment

A

Habit reversal therapy
N-acetylcysteine

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42
Q

How fast does fingernail grow

A

1mm/month

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43
Q

Beau Lines

A

Transverse groves
Temporary arrest of roximal nail matrix proliferation.

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44
Q

Stippling/pitting of nails

A

Seen in psoriasis, alopecia areata, hand eczema.
Shallow or deep depressions in nails

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45
Q

Acral lentiginous melanoma

A

Dark streak in nail.

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46
Q

Yellow nail syndrome

A

Nails turn yellow, thicken, and stop growing
Could be lung disease, rheumatoid arthritis, nail infection

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47
Q

Clubbing of nails

A

Curved
Harmless or lung, heart, liver, or stomach/intestine probs

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48
Q

Splinter hemorrhages

A

narrow red to almost black longitudinal lines on nail bed.
Blood enclosed in subungual keratin
Develop either from thrombosed or ruptured capillaries in nail bed

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49
Q

Onychomycosis (Tinea unguium)

A

Fungal skin infection.
Caused by trichophyton rubrum or candida albicans.
Nail discoloration
50-60% of abnormal nails

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50
Q

Onychomycosis treatment

A

Terbinafine FIRST
Itraconazole
Fluconazole

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51
Q

Acute Paronychia

A

Inflammation involving lateral and proximal folds of nail.
Caused by Staph Aureus
Less than 6 weeks

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52
Q

Acute Paronychia treatment

A

Warm compress.
Topical mupirocin
Topical antibiotics
Oral abx that covers S. aureus for severe

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53
Q

Chronic Paronychia

A

6 weeks or longer
Proximal nail fold inflammation can cause loss of cuticle.
Can be secondary to candida infection

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54
Q

Chronic paronychia treatment

A

Topical steroids FIRST
ketoconazole or fluconazole
Surgery last resort

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55
Q

Felon

A

Subcutaneous abscess of distal phalanx MC caused by staph aureus
Pus collects

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56
Q

Felon treatment

A

Oral antibiotics that cover G+.
1st gen cephalosporin (Cephalexin)
or Bactrim (T-S) for MRSA

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57
Q

Onycholysis

A

Distal separation of nail plate from nail bed.
Nail looks white/yellow
Caused by exposure to water/soaps

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58
Q

Onycholysis treatment

A

Keep nails short.
Treat underlying cause

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59
Q

Subungual hemotoma

A

Collection of blood under nail

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60
Q

Subungual hematoma treatment

A

Drain with needle

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61
Q

Acne Vulgaris

A

Mostly in adolescents.
Less in asians and africans

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62
Q

Acne vulgaris pathogenesis

A

Androgen-mediated stimulation of sebaceous gland.
Imbalance in microbiome of pilosebaceous follicle.
Immune responses may be genetic.

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63
Q

Acne vulgaris lesion development

A

Follicular hyperkeratiniation and plugging blocks sebum drainage.
Androgns stimulate sebaceous glands to make more sebum.
Propionibacterium acnes lipase turn lipids to fatty acids and make proinflammatory mediators

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64
Q

C. acne

A

Most prominent bacteria within pilosebacious follicles.
Activates immune response causing inflammation

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65
Q

Acne vulgaris clinical manifestation

A

Open comedone (blackhead)
Closed comedone (whitehead)
Papaules
Papulopustules.
Seborrhea (looking greasy)
Nodules

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66
Q

Characteristics of mild acne vulgaris

A

Scattered, small, inflamed papules or pustules without scaring.
NO nodules

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67
Q

Characteristics of moderate to severe acne vulgaris

A

Visually prominent acne with many comedonal or inflamed papules or pustules.
Nodules
Scarring

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68
Q

Infantile Acne vulgaris

A

elevated androgens from immature adrenal glands.

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69
Q

Acne fulminans

A

Special form of Acne vulgaris.
Rare.
Adolescent boys.
Severe cystic acne with suppuration, hemorrhagic crusts, ulcerations on trunk/chest.
Malaise, fatigue, fever
Leukocytosis, increased ESR
Can be triggered by isotretinoin

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70
Q

Hyperandrogenism

A

Polycystic ovarian syndrome (PCOS)
Adrenal tumors
Ovarian tumors

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71
Q

Topical retinoids

A

First line acne vulgaris management (Tretinoin QD
Adapalene QD
Tazarotene QD)
Improvement in four weeks.
Can cause flaking, irritation, dryness, erythema, sun sensitivity.
Don’t use in pregnancy

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72
Q

Benzoyl peroxide

A

First line acne vulgaris management.
Antibacterial
Can cause stinging, irritation erythema

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73
Q

First line acne vulgaris management

A

Topical retinoids and benzoyl peroxide

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74
Q

Second line acne vulgaris management

A

Azelaic BID or Salicylic QD TIC

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75
Q

Topical antibiotics for acne vulgaris

A

Clindamycin FIRST
erythromycin, minocycline
USe with benzoyl peroxide to prevent resistance

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76
Q

Dapsone

A

Acne vulgaris topical antibiotic
Alternative topical therapy
Perscription only.
Do NOT use with benzoyl peroxide due to skin discoloration

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77
Q

Moderate to severe acne vulgaris management

A

Stepwise
Oral isotretinoin
Oral antibiotics
Oral contraceptive pills
Spironolactone

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78
Q

Isotretinoin (acutane)

A

Retinoid inhibits gland function and keratinization.
Given for months.
Tetratogenic
Don’t take with tetracycline

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79
Q

Oral antibiotics to use for Acne vulgaris

A

Tetracyclines

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80
Q

Acne vulgaris and oral contraceptive

A

Can be used to help females that have had their periods.
CCOCP with antiandrogenic progestin

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81
Q

Spironolactone with acne vulgaris

A

Blocks androgen receptors inhibiting androgen synthesis as K sparing effect.
Can be used with COCPs
Can’t use in preg

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82
Q

Folliculitis

A

Usually Staph aureus or Pseudomonas aeruginosa (hot tub)

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83
Q

Folliculitis clinical manifestation

A

Pinpoint pustule around hair follicle

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84
Q

Folliculitis management

A

Benzoyl peroxide.
TOpical mupirocin
Pseudomonal coverage (Ciprofloxacin)

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85
Q

Folliculitis barbae

A

Folliculitis of beard hair follicles.
Often from shaving.
Give oral antibiotics
Doxycycline

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86
Q

Rosacea clinical manifestations

A

Erythema
Telangiectasia
Papulopustules
Disfigurement of nose (rhinophyma), eyelids (metophyma) from sebaceous hyperplasia and lymphedema.
Rubbery

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87
Q

Rosacea eye involvement

A

Foreign body sensation
Blepharitis
Lid margin relangiectasia
Meibomian gland inflammation
Frequent chalazion
Conjunctivitis
Corneal ulcers

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88
Q

Rosacea course

A

Recurrences common.
After few years, may disappear spontaniously but usually lasts lifetime.

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89
Q

Rosacea management

A

Sun protection.
Avoid skin irritants like essential oils.
Metronidazole gel
Brimonidine gel
Azelaic acid
Ivermectin gel
Monocycline, doxycycline, or metronidazol for severe
Lazer therapy
Bea blockers

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90
Q

Perioral (peifacial) dermatitis

A

Variant of rosacea.
Multiple small inflammatory erythematous papules, papulovesicles, or papulopustules around mouth, nose, or eyes.
Itching, burning, tightness

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91
Q

Perioral (perifacial) dermatitis management

A

Topical metronidazol, erythromycin, calcineurin inhibitors.
Systemic oral tetracyclines for severe
NO topical steroids (makes condition worse)

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92
Q

Melasma

A

Usually in potentially child bearing pts.
Hyperfunctional melanocytes that deposit excessive melanin in dermis and epidermis.
Effected by sunlight, pregnancy, oral contraceptives, idiopathic

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93
Q

Melasma clinical manifestations

A

light or dark brown pigmentation on face.
Macular
Uniform but may be blotchy

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94
Q

Melasma management

A

Photoprotection.
Hydroquinone
Azelaic
Combo of fluocinolone , hydroquinone, and azelaic acid or tretiinoin
Chemical peel o wound skin to regenerate healthy skin.
Laser and light therapy

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95
Q

Vitilligo

A

Likely autoimmune and genetic.
Sometimes linked to injury, sunburn, or stress
Melanocyte self destruction

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96
Q

Vitiligo comorbities

A

Hashimoto’s
Type I diabetes
Alopecia aeata
PErnicious anemia
Rheumatoid arthritis
Psoriasis

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97
Q

Vitiligo diagnosis

A

Use Woods lamp
Lab studies used to rule out endocrine or autoimmune disease

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98
Q

Vitilligo treatment

A

FIRST Mid to high potency topical corticosteroids.
Second topical calcineurin inhibtors.
Oral glucocorticoids prednisone.
Phototherapy

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99
Q

Kaposi Sarcoma

A

Human Herpes Virus 8
Endothelial cells reproduce at uncontrollable rate
GI effects
Older males of mediterranean or central/eastern european ancestry

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100
Q

Kaposi sarcoma clinical findings

A

Multiple red or purple plaques or nodules.
Mucosal and cutaneous lesions

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101
Q

How to diagnose kaposi sarcoma

A

biopsy

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102
Q

Kaposi sarcoma management

A

Palliative local therapy
Radiation/chemo
Antiretroviral against AIDS

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103
Q

Transplant-associated kaposi sarcoma

A

Agressive
High mortality rate

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104
Q

Basal cell carcinoma

A

From UV exposure
Most common skin cancer
Not very deadly
Not ususally metastatic
Immunosuppressed have increased risk

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105
Q

Basal cell carcinoma

A

Pearly/translucent erythematous papule with central ulceration.
Telangiectasia
Slow growing
Could be nonhealing ulcer

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106
Q

How to diagnose basal cell carcinoma

A

Dermiscopy
Biopsy
Punch or shave

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3
4
5
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107
Q

Basal cell carcinoma management

A

Electrodesiccatoin and curretage
Topical imiquimod
Topical 5-fluor
Mohs micrographic surgery
Radiation

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108
Q

Actinic keratosis

A

UV exposure
Premalignancy
Prevalence increases with age and sun exposure

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109
Q

Actinic keratosis clinical findings

A

Sun exposed areas.
Hyperpigmented, pink, or flesh-colored
Feels like sandpaper
Tender to palpation

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110
Q

Actinic keratosis diagnosis

A

Clinical
Lesions should be biopsied

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111
Q

Actinic keratosis management

A

Liquid nitrogen
Fluorouracil cream
Imiquimod

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112
Q

Squamous cell carcinoma

A

2nd most common skin cancer
Malignant neoplasm of keratinizing epidermal cells.
Actinic keratosis is a precursor
Common in immunosuppressed and organ transplant

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113
Q

Squamous cell carcinoma clinical findings

A

Red, pink, brown, hard keratotic nodules taht ulcerate.
Sun exposed areas

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114
Q

Bowen’s disease

A

Squamous cell carcinoma in situ
Intraepidermal

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115
Q

Squamous cell carcinoma diagnosis

A

Dermoscopy
Biopsy with histology
Punch or shave

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116
Q

Squamous cell carcinoma management

A

Electrodessicatoin and curettage
Topical imiquimod
TOpical 5-fluorouracil
Wide surgical incision
Cemiplimab
Radiation

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117
Q

Malignant melanom

A

The big bad boy
Leading cause of death due to skin disease
7.5% death rate
60% men

118
Q

What increases risk of malignant melanoma

A

UV
History of any skin cancer
Abnormal melanocytes
multiple nevi
Immunosuppression

119
Q

Malignant melanoma clinical findings

A

Asymmetric
Borders irregular
Color variation
Diameter>6mm
Evolution
Ugly duckling

120
Q

Where is superficial melanoma usually found on men

A

Back

121
Q

Where is superficial spreading melanoma usually found on women

A

Lower extremities

122
Q

Superficial spreading melanoma

A

70% of all melanomas
Color variation
Plaque with irregular borders
Tumor thickness <1mm

123
Q

Nodular melanoma

A

15-30% fo all melanomas
Hard to find early
Dark
Pedunculated
Polyploid
Tumor thickness >2mm

124
Q

Lentigo maligna melanoma

A

10-15% of melanomas
Sun damage
Tan or brown macule with asymmetry and evolves with color changes and raised border

125
Q

Acral lentiginous melanoma

A

<5% of all melanomas
Most melanoma on dark skin people
On palms, plantar, and sublingula surface

126
Q

Ocular melanoma

A

Eye melanoma

127
Q

Malignant melanoma diagnosis

A

Dermoscopy
Biopsy with histology

128
Q

Localized Malignant melanoma management

A

WIde surgical excision
Mohs procedure
Topical imiquimodMeta

129
Q

Metastatic malignant melanoma

A

Lymph node resection
Nivolumab

130
Q

Malignant melanoma stages

A

0 - in situ
1 - localized
2 - localized
3 - spread to lymph nodes
4 - spread to lymph nodes

131
Q

Seborrheic keratosis Clinical findings

A

Noncancerous
Stuck on appearance
Brown/black
Waxy/velvety
Size variation

132
Q

Seborrheic keratosis diagnosis

A

clinical dermoscopy

133
Q

Seborrheic keratosis management

A

Liquid nitrogen
Elextrodessication
Shave excission

134
Q

Lipoma

A

Localized overgrowth of adipose cells
Under the skin

135
Q

Lipoma clinical findings

A

Subcutaneous mass
Soft, mobile, flesch colored nodule well circumscribe

136
Q

Lipoma diagnosis

A

Clinical
Excisional biopsy

137
Q

Lipoma management

A

surgical excision if bothering pt

138
Q

Epidermal inclusion cyst

A

Benign growth of upper portion of hair follicle.
Common in gardner syndrome

139
Q

Epidermal inclusion cyst clinical findings

A

Flesh colored nodule or papule with overlying central punctum.
Foul smelling cheese inside

140
Q

Epidermal inclusion cyst diagnosis

A

Clinical
Cultures are sterile (not infection)

141
Q

Epidermal inclusion cyst Treatment

A

Punch incision with cyst removal of small lesions.
Surgical excision for large lesions
Triamcinolone acetomide intralesional administration for inflamed

142
Q

Dermatofibroma

A

Benign fibrohistiocytic tumor of middermis.
Fibrous rxn triggered by trauma

143
Q

Dermatofibroma clinical findings

A

Scarlike
Red, brown, or flesh-colored nosuel with hyperpigmented halo.
Most often on legs and arms.
Dimples downwaed

144
Q

Dermatofibrosis diagnosis

A

Punch biopsy

145
Q

Dermatofibroma management

A

Punch biopsy
Low recurrence rate

146
Q

Pilonidal disease

A

DIsruption of skin overlying coccyx pit (butt crack) from butt hairs.
Peak incidence in males 16-20
Rare after age 40

147
Q

Pilonidal disease clinical findings

A

Pain, redness, swelling in acute.
Midline with drainage and inflammation and hair extruding from pits in chronic.
Recurretn is from chronic nonhealing wounds inn midline of gluteal cleft after surgical brocedure

148
Q

Pilonidal disease management

A

Usually regress over time
Incision and drainage.
Hair removal.
Just pull the hair out might fix it

149
Q

When to do shave biopsy

A

Suspicion of malignancy is low

150
Q

When to do punch biopsy

A

Suspicion of malignancy is low

151
Q

Incisional biopsy

A

Only take out part of lesion

152
Q

When to do excisional biopsy

A

Suspicion of malignancy high

153
Q

Mohs Micrographic surgery

A

Take out lesion and test it to find where lesion goes under the skin.
Keep taking out layers but in more specific areas from what you find in layer above.

154
Q

Acanthrosis Nigricans clinical manifestations

A

Velvety hypigmented plaques in skin folds.
Associated with insulin resistance

155
Q

Acanthrosis nigricans management

A

Treatment of obesity and insulin resistance

156
Q

Ichthyosis clinical manifestation

A

Fine, white-gray scaling of skin
Palms and soles show skin marking (hyperlinearity)

157
Q

Ichthyosis Vulgaris Cause

A

Loss of function mutations in filaggrin gene.
Inherited through autosomal semi-dominant pattern

158
Q

Recessive x-linked ichthyoses

A

Affects males
Mutation of STS gene

159
Q

Ichthyosis management

A

Emollients
Petrolatum
Salicylic acid
Glycolic acid
Lactic acid
Urea

160
Q

Cutaneous horns clinical manifestations

A

Projection of hard, yellow, brown stuff from skin.
Horn is taller than base width

161
Q

Suspicious cutaneous horns

A

Painful
Large and red at base
Wide base

162
Q

Keloids clinical manifestations

A

Purplish-red
Firm
Smooth
Raised scarring after injury

163
Q

Keloids pathogenesis

A

Maybe excessive production of collogen, elastin, proteoglycans, fibroblasts, mast cells

164
Q

Keloid management

A

Resistant to treatment
Excision could make it worse
Intralesional corticosteroid (triamcinolone) injection

165
Q

Keloid prevention

A

Kenalog injection after surgury before closing up

166
Q

Acrochordons

A

AKA Skin tags
Harmless
Loose collagen fibers and blood vessels

167
Q

Acrochordons management

A

Cryotherapy
Excision
Electrosurgery
Ligation with suture (use lidocane)

168
Q

Erythema nodosum

A

Inflammatory disorder of subcutaneous fat.
Hypersensitivity rxn of unknown cause
Most common in women 25-40

169
Q

Erythema nodosum clinical manifestations

A

Erythematous, tender, nonulcerated, immobile nodules on bilateral shins.
Fatigue, fever, malaise

170
Q

Erythema Nodosum risk factors

A

Strep infection
COCP
Pregnancy
Malignancy

171
Q

Erythema Nodosum diagnositics

A

Clinical
CBC
Strep test
CXR
TB skin test
Preg test

172
Q

Erythema Nodosum management

A

Leg elevation
Rest
Compression stockings
NSAIDs then glucocorticoids (prednisone)

173
Q

Miliaria rubra

A

AKA heat rash
Caused by blockage, inflammation of sweat glands

174
Q

Miliaria rubra clinical manifestations

A

2-4mm non follicular papules, papulorvesicles.
Pruritic

175
Q

Miliaria rubra management

A

Hydrocortisone

176
Q

Hidradenitis suppurativa

A

Chronic inflammatory involving sweat glands.
Common in perianal, perineal areas

177
Q

Hidradenitis suppurativa pathophysiology

A

Follicular occlusiono from keratinocyte proliferation causing follicular hyperkeratosis and plugging

178
Q

Hidradenitis suppurativa clinical manifestations

A

Infflammatory nodules
Painful
Open comedones
In skin folds
Scarring

179
Q

Hurley staging

A

Hidradenitis suppurativa stging system.
1-abscess formation
2- recurrent abscess with skin tunnels and scarring
3- Diffuse involvement or multiple interconnected skin tunnels across entire area.

180
Q

Hidradenitis suppurativa risk factors

A

Black
Women
Obesity
Smoking
Genetics
Androgenic contraception

181
Q

Hidradenitis suppurativa management

A
  1. Topical clindamycin
  2. Oral doxycycline
182
Q

Hidradenitis suppuratva complications

A

Abscess
Strictures
Fistula
Depression
Suicide

183
Q

Polymorphus light eruption

A

AKA sun poisoning
More often in females
Pruritic erythematous papules or plaques hours-days after sun exposed area
recurrent

184
Q

Chronic actinic dermatitis

A

Rare
Photo induced eczema
Older males
Eczematous patches on face, neck, hands, scalp , chest
Lichenification plaques

185
Q

Actinic pruigo

A

Hereditary
PMLE variant
Childhood onset
Papulonodular hemorrhagic crust on sun exposed.
Actinic cheilitis
Conjunctivitis

186
Q

Poryphyria cutanea tarda

A

Hypersensitivity to abnormal porphyrins causing skin blistering
Caused by low activity of liver enzyme uroporphyrinogen decarboxylase

187
Q

Porphyria cutanea tarda risk factors

A

Estrogen use
Smoking
Liver disease

188
Q

Porphyria cutaneatarda clinical manifestations

A

Chronic blistering on sun exposed areas.
Hyperpigmentation
Scarring

189
Q

What test is used to diagnose fungal infection

A

KOH prep under microscope

190
Q

Tinea corporis

A

Ring worm
Fungal infection
Ring shaped lesions with scaly border
Itchy

191
Q

What people usually get ring worm

A

People that have been around infected pet

192
Q

Tinea corporis prevention

A

Treat infected houshold pets
Use foot powder
Keep feet dry

193
Q

Tinea corporis management

A

Terbinafine
Itraconazole

194
Q

Tinea Cruris

A

Jock itch
Sharp margins
Clear center
Follicular pustules sometimes
Hyperpigmentation

195
Q

Tinea cruris diagnosis

A

Candidiasis
Seborrheic dermatitis
Psoriasis of body folds

196
Q

Tinea cruris treatment

A

Drying powder (miconazole nitrate)
Terbinafine cream
Itraconazole PO

197
Q

Tinea Manuum

A

Fungal infection of palms of hand.

198
Q

Tinea pedis

A

Athlete’s foot
Common in diabetics

199
Q

Tinea Mauum/Pedis clinical manifestations

A

Itching, burning, stinging
Pain
Flaking

200
Q

Tinea Munuum/Pedis treatment for macerated stage

A

Aluminum subacetate soaks.
Broad spectrum antifungal creams
Topical allylamine if imidazoles fail

201
Q

Tinea Munuum/Pedis treatment for dy and scaly stage

A

Any antifungal

202
Q

Systemic treatment for Tinea Munuum/Pedis

A

Itraconazole/terbinafine

203
Q

Tinea Versicolor

A

Velvety/tan/pink/white macules that do not tan.
Central upper trunk
Malassezia infection

204
Q

Spaghetti and meatballs on KOH prep

A

Tinea versicolor

205
Q

Tinea versicolor treatment

A

Selenium sulfide lotion
Ketoconazole shampoo
Two doses of oral fluconazole

206
Q

Mucocutaneous candidiasis clinical findings

A

Itching
Burning of vulva and anus
Superficial denuded, beefy-red areas
White stuff on oral and vaginal mucous membranes.
Groin glute cleft, under breast, webbing of fingers

207
Q

Mucocutaneous candidiasis lab findings

A

Budding yeast and pseudohyphae

208
Q

Mucocutaneous candidiasis treatment`

A

Clotrimazole for nails
Nystatin or cotrimazole for skin
Topical fluconazole for anus

209
Q

Intertrigo

A

Caused by heat, moisture, and friction.
Folds of skin
Candidiasis can complicate

210
Q

Inertrigo treatment

A

hydrocortzolne and imidazole or clotrimazole creams

211
Q

Herpes (HSV) symptoms

A

Recurrent small group vesicles
Regional tender lymphadenopathy
Neuralgia
Nodular lesions at sights of involvement

212
Q

Herpes treatment

A

Acyclovir (5x a day)
valacyclovir
Famciclovir
Pritelivir for suppression

213
Q

Molluscum contagiosum

A

Pox virus.
Dome-shaped WAXY PAPULES
Face
trunk
extremeties

214
Q

Molluscum contagiosum treatment

A

Curettage
Liquid nitrogen
Light electrosurgery
topical KOH solution
Cantharadin

215
Q

Warts

A

Verrucous papules anywhere on the skin or mucous membrane
HSV lesion
Usually bo symptoms
Itch anogenital warts
Plantar warts resemble warts or calluses

216
Q

Nongenital Wart treatment

A

Liquid nitrogen
Keratolytic agents and occlusion (salicylic acid products)
Disection
CO2 laser therapy
Squaric acid dibutylester
Bleomycin
Fluorouracil
Soaking in warm water

217
Q

Genital wart treatment

A

Liquid nitrogen
Podophyllum resin
Imiquimod
Sinecatechins
Operative removalLaser therapy

218
Q

Impetigo

A

Honey crust
Macules, pustules
Usually around mouth
Caused by staph or strep (G+)

219
Q

Impetigo treatment

A

Soaks and scrubbing
Mupirocin (top)
Ozenoxacin (top)
Retapamulin (top)
Doxy or cephalexin for systemic
Bactrim for MRSA in community associated

220
Q

Furunculosis (boils) and carbuncles

A

Painful inflammatory abscess on hair follicle
Staph

221
Q

Carbuncle

A

Made of furuncles in adjoining hair follicles

222
Q

Furunculosis and carbuncles clinical findings

A

Pain
Tenderness
Gradually enlarges
Softens
Inflammations subsides before necrosis

223
Q

Furunculosis and carbuncle managemebt

A

Doxy
Bactrim
Clindamycin
Linezolid
45 chlorhexidine whole body wash
Hot compress

224
Q

What to give for recurring Furunculosis (boils) and carbuncle

A

Cephalexin/doxy and rifampin or clindamycin

225
Q

Cellulitis symptoms

A

Edema
Erthemia
Pain, chills, fever
Lower leg
Staph or strep

226
Q

Cellulitis treatment

A

Naficillin

227
Q

What to give for MRSA

A

Vancomycin
Linezolid
Clindamycin
Daptomycin
Doxycycline
Bactrim

228
Q

Erysipelas symptoms

A

Edema
Circumscribes
Hot
Red
Pain
Vesicle or bullae on surface
Lesions heal without scar

229
Q

Erysipelas cause

A

Superficial form of cellulitis
Caused by beta hemolytic strep

230
Q

Necrotizing myositis cause

A

Caused by clostridia (gas gangrene

231
Q

Necrotizing fasciitis cause

A

Strep pyogenes (group a hemolytic)
Sometimes Staph

232
Q

Necrotizing fasciitis treatment

A

Emergency surgery.
IV IG to reduce mortality

233
Q

Varicella

A

Chicken pox
Fever and malaise mild in children and worse in adult.
Maculopapules change to vesicles.
Lesions are in different stages at different times.
Will later on reactivate as shingles (HZV)

234
Q

Herpes zoster (shingles) virus

A

Comes from dormant varicella.
Rash follow dermatome
Very painful

235
Q

Hutchinson Sign

A

Lesion at tip of nose, corner of eye, and root and side of nose.
Indicates involvement of trigeminal nerval shingles.

236
Q

Ramsey Hunt Syndrome

A

Shingles.
Facial palsy and lesions on external ear.
Possible tinnitus or deafness showing ganglion involvement

237
Q

Varicella treatment

A

Antihistamine
Acetaminophen
Acylclovir

238
Q

Herpes zoster (shingles) treatment

A

Valacylclovir or famciclovir
Gabapenin or lidocaine for neuropathic pain
Antidepresents

239
Q

Varicella/shingles vaccines

A

Shingrix (subunit. Preferred)
Zostavax (live)

240
Q

Varicella rash

A

Dew drops on a rose petal
Pustular and crusting
Pruritic
Centrifugal

241
Q

Abscess

A

Deep infection mostly on back, trunk extremities after skin barrier broken.
Pus

242
Q

Abscess treatment

A

Bactrim
Doxy
Minoxycline
Clindamycin
(MRSA)

243
Q

Superficial burn

A

Epidermis only
No blistering

244
Q

Superficial partial thickness burn

A

Epidermis and shallow dermis
Blisters
Blanches

245
Q

Deep partial thickness burn

A

Epidermis and deeper dermis.
Blisters
Does not blanch

246
Q

Full thickness burn

A

Epidermis, entire dermis, and subcutaneous tissue.
No blanching
No blisters
Painless

247
Q

Deeper burn

A

Soft tissue, muscle, bone
Painless

248
Q

Minor burn management

A

Cool with water for up to 5 mins or wet gauze for 30 min
NSAIDs or tylenol
NO abx
antihistamines
tetanus shot

249
Q

Primary survey after burn

A

Check airway and inhalation effort
Need airway if black sud

250
Q

Severe burn management

A

Narcotics, analgesics, sedatives IV.
Cover partial thickness wounds with sheets to lower pain.
NO cold compress bc of hypothermia

251
Q

Compartment syndrome

A

Massive fluid accumulation can cause increase in compartment pressure

252
Q

Parkland formula

A

4mL x kg x TBSA% = total crystalloid fluids in first 24 hours
Half total volume given in eight hours
Half of total volume given in next 16 hours.
Only for partial and full thickness (no superficial)

253
Q

Pernio (chilblains)

A

Inflammatory change from exposure to wet cold above freezing point.
Edematous, reddish, purple, painful

254
Q

Trench foot

A

Caused by prolonged exposue to cold water or mud
injury to vascular to feet
Red feet or hands, endematous, numb, extremely painful
Hemorrhagic bullae

255
Q

Frostbite

A

Tissue freezing and forming ice crystal in tissue.
Palor
Numbness
Prickling
Severe is white, yellow, immobile with edema hemorrhagic blistors, necrosis, and gangrene

256
Q

Cold injury management

A

Pain management
Rewarm with water slightly above body temp
Avoid dry heat
Don’t pop blisters

257
Q

Cold injury pharmacologic management

A

Tissue plasminogen activator
Low MW heparin
Tetanus prophylaxes

258
Q

Erethema multiforme

A

HSV
Mycoplasma pneumoniae
Target lesions
Erosions
Bullae
Negative nikolsky sign

259
Q

Positive nikolsky sign

A

Ability to extend area of superficial sloughing by applying gentle pressure to skin

260
Q

Erythema multiforme managemtn

A

High potency topical corticosteroid gel
Mouthwash with lidocaine
Acyclovir if HSV

261
Q

Stebens Johnson Syndrome Toxic Epidermal Necrolysis

A

Same disease on spectrum.
Mucocutaneous severe rxn with extensive necrosis and epidermal detachment.
SJS<10% of body surface
TEN>30% of body surface

262
Q

Risk factor for Sevens Johnson Syndrome and Toxic Epidermal Necrolysis

A

Meds are leading trigger (bactrim).
Mycoplasma pneumonia

263
Q

SJS/TEN clinical manifestations

A

Flu-like
Erythematous macule with purpuric center and spreads to diffuse erythema then bullae then erosion.
Tender
Face/trunk
Mucosal lesions

264
Q

SJS/TEN complications

A

Fluid loss
Hypovolemic shock
Fluid embalance
Renal failure
GI necrosis

265
Q

Pemphigus

A

Autoimmune blistering disorders from acantholysis.
Blisters in mucous membranes and skin.

266
Q

Pemphigus Vulgaris

A

Most common pemphigus
Jews
Type II hypersensitivity rxn

267
Q

Pemphigus vulgaris presentation

A

Mucosal and cutaneous bullae
Bullae becomes crusts and erosions
Positive nikolsky sign

268
Q

Pemmphigus vulgaris compications

A

Secondary infection
FLuid and electrolyte imbalances
Septicemia from staph

269
Q

Pemphigus vulgaris diagnostics

A

Punch biopsy
Immunofluorescence for igG.
ELISA

270
Q

Bullous pemphigoid

A

Non-emergent
Mostly elderly
Mostly male

271
Q

Bullous pemphigoid presentation

A

Pruritic urticarial or edematois lesions folllowed by tesne blisters.
Negative nikolsky

272
Q

Bullous pemphgoid diagnostics

A

Punch biopsy with immunofluorescence.
C3 and IgG

273
Q

Staph scalded skin syndrome (SSSS)

A

AKA Ritter’s disease
Children <6 yo

274
Q

Staph Scalded Skin Syndrome pathophysiology

A

Hematogenous dissemination of exotoxins that leave desmoglein1 and desmosomal linking protein.
Detachment of superficial epidermsi
Staph infection

275
Q

Staph Scalded Skin Syndrome clinical manifestations

A

flaccid bullae
Positive Nikolskyy sign.
Fissuring around mouth
NO mucosal involvement

276
Q

Staph Scalded Skin Syndrome management

A

Oxacillin

277
Q

Pressure ulcers

A

AKA decubitus ulcer, bed sore, pressure wound.

278
Q

Pressure ulcer management

A

Redistribution of pressure
Wound care

279
Q

Exanthematous drug eruption

A

Maculopapular eruption.
Commonly caused by abx

280
Q

Exanthematous drug eruption clinical manifestations

A

Disseminated
Generalized
Symmetric erethematous macules/papules

281
Q

Uticaria

A

AKA hives, welts, wheals
Caused by drugs, food insect sting, infection
Autoimmune

282
Q

Uticaria presentation

A

Present in minutes and disappear within a day.
Pruritic
Erythematous, round/oval, raised circumscribed plaques often with central pallor

283
Q

Urticaria management

A

Short term release of pruritis and angiodema.
H1 antihistamines (second gen is first line)

284
Q

Angiodema Presentation

A

Anaphylaxis
Swollen lups, face, mouth, throat, genitals, extremities

285
Q

Angiodema management

A

H1 antihistamines
H2 blockers

286
Q

Hereditary angiodema

A

Angiodema episodes without urticaria or pruritis.
C1 inhibitor produces excessive bradykinin

287
Q

Hereditary angiodema managament

A

Emergent infusion of C1 inhibitor

288
Q

Bradykinin mediated angiodema

A

Stop ace inhobitors.
Start bradykinin blocker (ecallantide) or Bradykinin receptor antagonist (Icatibant)

289
Q

Exfolliatie dermatitis

A

red skinUticarial erythematous patches that get larger and turn into bright erthema
Rare
Severe
Usually caused by ace inhibitor, allopurinol, sulfa.
Elevated epidermal turnover

290
Q

Primary intention of wound care

A

Wound is clean
Suture the wound

291
Q

Secondary intentino of wound care

A

Wound heal s from inside out.
Don’t suture.
Example is abscess, animal bites, contaminated wound.

PAS 531 (4 decks)

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