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PANCE/EOC > Dermatology #2 > Flashcards

Dermatology #2 Flashcards

1
Q

What are the four main pathophysiology units of acne vulgaris?

A

1) follicular hyperkeratiniziation
2) increased sebum production
3) overgrowth of Propionibacterium
4) inflammatory response

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2
Q

Clinical manifestations of acne vulgaris depending on the type

A
  • Comedones: open (blackheads) and closed (whiteheads)
  • Inflammatory: papules or pustules surrounded by inflammation
  • Nodular or Cystic: often heals with scarring
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3
Q

Treatment for mild acne vulgaris

A

-Topical: Azelaic Acid, Salicylic acid, Benzoyl Peroxide, or Tretinoin or topical ABX (Clinda, Erythromycin)

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4
Q

Treatment for moderate acne vulgaris

A

-Tx for mild + Oral ABX (Minocycline or Doxy), Spironolactone

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5
Q

Treatment for severe acne vulgaris

A

-Oral Isotretinoin

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6
Q

Adverse effects of isotretinoin

A
  • Dry skin and lips (MC)
  • Highly teratogenic
  • Increased triglycerides and cholesterol
  • Worsening of DM
  • Photosensitivity
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7
Q

What is a furuncle?

A

Deep abscess infection of the hair follicle

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8
Q

MCC of a furuncle

A

Staph A

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9
Q

Treatment for a furuncle

A

Incision and drainage

-ABX for associated cellulitis only

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10
Q

What is Toxicodendron dermatitis?

A

-Caused by poison ivy (in east), poison oak (west of Rocky Mountains), and poison sumac (southeast)

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11
Q

Management for dermatitis caused by poison ivy, oak, or sumac

A
  • Cool compresses, oatmeal baths
  • Avoid use of protective clothing
  • wash area with detergent soap
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12
Q

What is Lichen Simplex Chronicus (Neurodermatitis)?

A

-Skin thickening in patients with atopic dermatitis secondary to repetitive rubbing and scratching (itch-scratch cycle)

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13
Q

Symptoms of lichen simplex chronicus?

A

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

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14
Q

Treatment for lichen simplex chronicus

A

Avoid scratching the lesions
Topical corticosteroids (high-strength)
Antihistamines
Occlusive dressings

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15
Q

What are urticaria?

A

Hives

  • Type I (IgE) hypersensitivity reaction
  • Circumscribed hives or wheals (blanch able, raised, erythematous areas on the skin or mucous membranes) that may coalesce. Intensely pruritic
  • Transient and disappear within 24 hours and new crops often occur
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16
Q

Initial management of choice for urticaria

A

Antihistamines (H1 blockers)

  • H2 blockers (Ranitidine) often added if no response to H1 blockers
  • Glucocorticoids added if severe, recurrent, or persistent cases
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17
Q

What is the pathophysiology of vitiligo?

A

Autoimmune destruction of melanocytes leading to skin depigmentation

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18
Q

Treatment for vitiligo

A
  • Localized: Topical corticosteroids such as Topical Calcineurin inhibitors (Astragraf)
  • Disseminated: Systemic phototherapy plus corticosteroids
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19
Q

Symptoms of cyanide poisoning

A
  • Rapidly developing coma
  • Apnea
  • Cardiac derangement
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20
Q

Treatment for cyanide poisoning

A
  • Hydroxocobalamin

- Cyanide kit (Amyl nitrate for inhalation, IV sodium nitrate, or thiosulfate)

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21
Q

Name three facts about high voltage electric current injuries

A

1) electricity favors the path of least resistance (nerves, muscles and blood). They suffer the greatest damage
2) AC currents 3-5 times more damaging than direct current
3) Morbidity is often greater with low voltage because high voltage propels patient away when touching it

22
Q

When should you admit a patient with an electric current voltage injury?

A

> 600V, even if asymptomatic

-Alkalinize the urine to protect the kidney

23
Q

What is a keloid?

A

Excess production of Type I and III collagen during wound healing

-MC in darker skinned individuals

24
Q

What is the first line management for a keloid?

A 
Corticosteroid injections (intralesional Triamcinolone)
-Laser therapy or cryotherapy
25
Q

A brown recluse spider (Loxosceles reclusa) has a ____ on the anterior cephalothorax. What are some effects of the venom?

A

-Violin pattern

  • Venom is cytotoxic and hemolytic. Local burning and erythema at site of bite followed by red halo and then hemorrhagic bulla that undergoes eschar formation.
  • Fever, chills, nausea, vomiting
26
Q

Treatment for brown recluse bite

A
  • Local wound care and pain control mainstay of management
  • -Clean affected area with soap
  • -Apply cold packs to the site
  • -Keep affected body part elevated
  • -NSAIDs and Tetanus prophylaxis if needed
  • -ABX only needed if cellulitis develops
27
Q

A black widow (Latrodectus Hesperus) produces a neurotoxin. This spider has a _____ on the underside of its belly. Symptoms of the venom include…

A

-Red hourglass shape

  • Local symptoms (pain at bite site)
  • Onset of systemic and neurologic symptoms within 30 minutes - 2 hours
  • -Muscle pain, spasms, rigidity
  • -Bite site is a target lesion
28
Q

Treatment for black widow bite

A
  • Wound care and pain control
  • -Soap and water to clean off bite wound
  • -Muscle relaxants (Benzos) if moderate to severe
  • -Antivenom if not responsive to above treatment
29
Q

Hand, Foot, and Mouth disease is caused by ______ and is MC in what seasons?

A

Coxsackievirus A

-Summer and early fall

30
Q

Describe the rash of Hand, Foot, and Mouth Disease

A
  • Oral enanthem: erythematous macule that become painful oral vesicles surrounded by thin halo of erythema (especially on buccal mucosa and tongue)
  • Exanthem: grayish-yellow macular lesions on distal extremities (palms and soles)
31
Q

Herpangina, caused by ______, is characterized by

A

-Coxsackievirus Type A

  • Sudden onset high fever, stomatitis (small yellow-white lesions on posterior pharynx) that ulcerate before healing
  • Anorexia due to pain
  • Pharyngitis and odynophagia
32
Q

What is lymphangitis?

A

Inflammation of the lymphatic channels due to infectious or non-infectious causes

33
Q

Clinical manifestations of lymphangitis

A
  • Red, tender streaks extending proximally from site of cellulitis
  • May involve regional lymph nodes or systemic symptoms
34
Q

Management of lymphangitis if associated with cellulitis

A

Oral: Cephalexin, Dicloxacillin (Clindamycin or Erythromycin if PCN allergy)
IV: Cefazolin, Unasyn, Ceftriaxone + Clinda
MRSA: CDB or IV Vanco or Linezolid

35
Q

What is Condyloma Acuminata?

A

Caused by HPV infection

-Tiny painless papules evolve into soft, fleshy cauliflower like lesions occurring in genital regions or oropharynx

36
Q

How to diagnose condyloma acuminata

A

Acetic acid application: whitening of lesion with acetic acid

37
Q

Treatment for condyloma acuminata

A
  • Most resolve spontaneously
  • Cryotherapy, trichloroacetic acid, surgical excision can lead to scarring
  • Topical Podophyllotoxin or Podofilox
38
Q

For prevention of condyloma acuminata, what vaccine is given and what does it cover?

A

Gardasil 9

-HPV 6, 11, 16, 18, 31, 33, 45, 52, 58

39
Q

True or False: The HPV vaccine is safe for pregnancy and lactating moms?

A

False

-Contraindicated in pregnancy and lactating moms

40
Q

Dosing of HPV vaccine if < 15 years old

A

2 doses of HPV vaccine at least 6 months apart

41
Q

Dosing of HPV vaccine if > 15 years old or immunocompromised

A

3 doses over a minimum of 6 months. Given at day 0, 2 months, and 6 months.

42
Q

What is the MC benign epidermal skin tumor?

A

Seborrheic keratosis

43
Q

Describe a seborrheic keratosis

A

Velvety, warty lesion with a greasy “stuck on” appearance

44
Q

What is the MC premalignant skin condition?

A

Actinic Keratosis

45
Q

Management of actinic keratosis

A
  • Avoid sun exposure, use sunscreen
  • Liquid nitrogen cryotherapy (if localized)
  • Topical 5FU and Imiquimod (if multiple)
46
Q

Dermatitis Herpetiformis is associated with what condition?

A

Celiac disease (gluten systemic enteropathy)

47
Q

What is the pathophysiology of dermatitis herpetiformis

A

-IgA immune complex deposition in the dermal papillae

48
Q

What is the definitive diagnostic for dermatitis herpetiformis?

A

Direct immunofluorescence (IgA deposition within the papillary dermis)

49
Q

Treatment for Dermatitis herpetiformis

A
  • Gluten free diet

- Dapsone (first line management)

50
Q

Adverse effects of Dapsone

A
  • Peripheral Neuropathy
  • Hemolysis in patients with G6PD deficiency
  • Cimetidine decreases effects of Dapsone

PANCE/EOC (63 decks)

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