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AGACNP > Dermatology 2 > Flashcards

Dermatology 2 Flashcards

1
Q

Herpes: Two viruses

A

Herpes simplex virus

Herpes zoster virus

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2
Q

Herpes Simplex: Manifestations

A

Non-genital HSV infection (of the oral mucosa, the lips and of the skin)
Genital HSV infection (of the genitals, and the perianal area)

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3
Q

Herpes Zoster: Manifestations

A

Chickenpox

Shingles

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4
Q

Herpes: Characteristics

A

Either disease (HSV or HZV) can reactivate, and the severity of illness is dependent on the immune system of the host, that is, the weaker the immune system, the more severe the disease and the more extensive the lesions

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5
Q

Herpes Simplex: S/Sx

A

Causes a vesicular rash, (ulcerations on mucus membranes) which is painful

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6
Q

Herpes Simplex: Characteristics

A

Contagious by contact, and nearly all adults show some antibody activity whether or not they have ever had an outbreak
Prevention of transmission is helpful, active lesions are contagious

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7
Q

Herpes Simplex: Tx

A
  • Uncomplicated outbreaks: valacyclovir 1000mg PO tid x 7 days
  • Severe outbreaks: acyclovir 5-10mg/kg IV q8hrs
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8
Q

Chicken pox (Varicella zoster): Characteristics

A
  • Chicken pox is much more common in children and now a vaccine is available, making it less frequently encountered
  • Typically, epidemics have coincided with seasonal influenza, and is spread by airborne aerosol
  • Older the Pt the more severe
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9
Q

Chicken pox (Varicella zoster): Time course

A

Incubates over 14 days, then a prodrome of aches/pains, fevers, headache, then the rash appears 2-3 days after

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10
Q

Chicken pox (Varicella zoster): Lesions

A
  • The rash is characterized by multiple erythematous papules and vesicles on erythematous, edematous bases, so-called “dewdrops on a rose petal” or varying size
  • Lesions also appear on the mucosa of the respiratory, GI and GU tracts causing symptoms as well
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11
Q

Chicken pox (Varicella zoster): Prognosis

A
  • Can occasionally progress to an encephalitis or pneumonia, either one can be quite serious and is occasionally fatal
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12
Q

Chicken pox (Varicella zoster): Dx

A

Can be diagnosed clinically, by Tzanck smear, or by antibody screen

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13
Q

Chicken pox (Varicella zoster): Tx

A

No specific treatment is indicated for uncomplicated cases, but with complicated cases (nearly all adult cases):

  • Valacyclovir 1000mg PO tid x 10 days, or Acyclovir 5-10mg/kg IV q8hrs
  • Zoster immune globulin (ZIG)
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14
Q

Shingles: Characteristics

A
  • Shingles is due to a reactivation of varicella zoster virus (VZV) within a person’s body
  • The reactivation can be caused by a decrease in immune function or is sometimes idiopathic
  • Any patient with a reactivation of VZV in any form, is contagious to those who are not immune to it (i.e. it will produce chicken pox, not shingles)
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15
Q

Shingles: Time course

A

Generally, there is a 2-4 day period of pain the area before the rash appears

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16
Q

Shingles: Lesions

A

The rash is erythematous vesicles that erupt along a dermatome, and then become confluent

17
Q

Shingles:

A
  • Valacyclovir 1000mg PO tid x 10 days
  • If in CN V (Ramsay-Hunt syndrome), steroids are needed (can cause Bell’s Palsy)
  • If affecting the cornea, usually ophthalmological consultation is needed, plus the above
  • In severe immunocompromise, it can become disseminated, which requires:
  • Acyclovir 10mg/kg IV q8hrs and very close monitoring while in the hospital for other opportunistic infection
18
Q

Indication of disseminated zoster

A

Sign of HIV, cancer, or other serious illness

19
Q

Terry’s nails: characteristics

A

Loss of the lunula
Proximal 2/3 of the nailbed is hypo pigmented
Distal 1/3 of the nailbed is hyperpigmented

20
Q

Terry’s nails: Seen in

A

CHF, cirrhosis, hypoalbuminemia

21
Q

Blue nails: Seen in

A

Chronic use of antimalaria drugs, minocycline
Hemachromatosis
Wilson’s Dz

22
Q

Yellow nail syndrome: Seen in

A

Pleural effusions, lymphoedema
Bronchiectasis in 40% of Pts
*It involves all the nails

23
Q

Splinter hemorrhages: characteristics

A

Brown or red streaks along the nailbed

24
Q

Splinter hemorrhages: Seen in

A

Trauma to the nail

microemboli as seen in endocarditis

25
Q

Beau’s lines: characteristics

A

Horridontal depressions across the nail plate

Transient arrest of nail growth

26
Q

Beau’s lines: seen in

A

Pts on chemotherapy

27
Q

Koilonychia: characteristics

A

aka “spoon nails”

Caused by softening and thinning of the nail plate

28
Q

Koilonychia: seen in

A

Iron deficiency anemia (long term anemia)
Raynaud’s Dz
hemachromatosis
inherited autosomal dominance disorder

29
Q

Clubbing: characteristics

A

Angle btw the nail fold and the nail plate exceeds 180 degrees
Tissue btw nial and the underlying bone has a spongy quality

30
Q

Clubbing: seen in

A

chronic hyposia or inherited condition

31
Q

Brown nails: characteristics

A

brown line seen in the nail plate

32
Q

Brown nails: seen in

A 
Addison's Dz
Hemachromatosis
Gold Thx
Chronic arsenic poisoning (exterminator, lab tech)
Melanotic nevus
Malignant melanoma
33
Q

Onychomycosis: characteristics

A

Fungal infection

Tx: topical Tx, PO terbinafine if topical Tx fails

34
Q

Paronychia: characteristics

A

Proximal nail fold infection
Painful, swollen, erythematous and warm just adjacent to the nail
Sometimes 2/2 cuticles cut

AGACNP (21 decks)

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