Dermatology Flashcards by M P

What are three causes of Pemphigus Vulgaris?

Idiopathic
ACEi
Penicillamine

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What type of Bullae are associated with Pemphigus Vulgaris?

Painful

Fragile/Thin/Flaccid –> Nikolsky +

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What conditions have a positive Nikolsky’s Sign? (3)

1) Pemphigus Vulgaris
2) Toxic Epidermal
Necrolysis
3) Staph Scalded Skin
Syndrome

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What is the most accurate test for Pemphigus Vulgaris?

Bx of lesion

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What is the treatment for Pemphigus Vulgaris?

First line: Fluids/Steroids

Second line: Azathioprine, Mycophelolate, Cyclophosphamide

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What conditions are associated with Porphyria Cutanea Tarda?

Alcoholism

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What features distinguish Acute Intermittent Porphyria from Porphyria Cutanea Tarda?

AIP: Abdominal Pain and Psychosis

these are not seen in PCT

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How is Porphyria Cutanea Tarda treated?

Stop inducing agent
Sunscreen/long sleeved clothing
Phlebotomy (to remove iron; use Defuroxamine if cannot do phlebotomy)
Chloroquine (promote excretion of porphyria)

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What is the best initial test for Porphyria Cutanea Tarda?

Urine Uroporphyrins

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What features distinguish Pemphigoid from Pemphigus Vulgaris?

Pemphigoid: Involves dermal-epidermal junction 
Anti-desmoglein Ab's
Intact bullae
Less mortality
Elderly pts 
No oral lesions

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What is the best dx’ic test for Bullous Pemphigoid?

Bx with immunofluorescent Ab

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What is the treatment for Pemphigoid?

Steroids

Alternative: Tetracylcine, Erythromycin w/ Nicotinamide

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What are the common drugs associated with hemolysis, acute hypersensitivity skin rxn, and allergic interstitial nephritis?

Penicillins
Allopurinol
Rifampin
Sulfa Drugs
Quinidine

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What is the treatment for urticaria?

Chronic: Non-sedating Antihistamines

Mild/Moderate: Antihistamines

Severe: Antihistamines, add Steroids

Unknown Trigger: Patch Testing

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What are the factors associated with Chronic Urticaria?

Dermographism (pressure)
Cold
Vibration

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What is the treatment for Morbilliform Rash?

Antihistamines

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What infections are associated with Erythema Multiforme?

Mycoplasma and Herpes related infections

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How is Erythema Multiforme distinguished from Lyme disease?

EM: Small lesions (esp on palms and soles)

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What is the treatment for Erythema Multiforme?

Stop offending Agent Antihistamines

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What is the difference between Erythema Multiforme and Stevens-Johnson Syndrome (SJS)?

EM: No mucosal lesions

SJS: Mucosal surfaces affected

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How are SJS and Toxic Epidermal Necrolysis distinguished?

SJS: 20% total body surface area affected

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What is the best initial test to establish a dx of dermatological fungal infections?

KOH prep of scraping/swab

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What is the best initial therapy for superficial fungal infection involving hair or nail?

Terbinafine or
Itraconazole

(for 6wks-fingers, 12wks-toes)

Can use any topical antifungal for all other fungal infections (ketoconazole, miconazole, clotrimazole, econazole)

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What is the most common adverse effect of terbinafine use?

Hepatotoxicity (Check LFT’s)

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What are the common ORAL empiric drugs used to treat superficial bacterial skin infections?

Dicloxacillin, Cefadroxil, or Cephalexin

What is the treatment for Impetigo?

Mupirocin or Bacitracin (topical Ab)

What sequela can occur 1-2 weeks following bacterial skin infection?

Glomerularnephritis

What is the most common organism associated with Erysipelas?

Group A Strep (Pyogenes)

What is the typical presentation of a pt. with Erysipelas?

Fever, chills, bacteremia and | Bright Red Swollen Rash (esp on face)

What is the treatment for pt with Strep confirmed Erysipelas?

Penicillin or Ampicillin | PO or IV meds

What skin layers are involved in Cellulitis?

Epidermis, Dermis, and Subcutaneous layers

What are the typical organisms associated with Necrotizing Facsiitis?

Clostridia | Strep (anaerobic)

What is the typical presentation/physical exam findings in a pt with Necrotizing Fasciitis?

``` High Fever Point of entry Palpable crepitus Pain (out of proportion to skin wound) Bullae ```

What is the next step in management for a pt presenting with pain, high fever, palpable crepitus, portal of entry on skin?

Surgery for debridement | surgery is diagnostic and therapeutic

What is the standard treatment for Necrotizing Fasciitis?

``` Debridement IV Antibiotics (b-lactam/b-actamase) ``` [If confirmed strep-use penicillin and clindamycin]

What is the treatment for paronychia?

Incision and antistaph systemic antibiotics

What is the next step in management for a pt presenting with crops of vesicular lesions either on lip, genetalia, or in a dermatologic distribution?

Acyclovir administration

What are 3 complications of Varicella infection?

Pneumonia Hepatitis Dissemination of infection

What is the next step in management for a pt with multiple recurrent Herpes outbreaks being treated with Acyclovir?

Switch to Foscarnet | Might also do HIV test

What is the best initial test for a pt presenting with an ulcerative lesion on their lip?

Tzanck Smear

What is the most effective treatment for post herpetic neuralgia?

Gabapentin

What is the maximum amount of time a non-immune adult has to receive Varicella IVIG following exposure to chickenpox?

96 hrs (4 days)

What is the advantage in using Imiquomod to treat (remove) warts?

No damage to normal tissue No pain

What is the best initial test for Primary Syphilis?

Darkfield Microscopy

What is the best initial test for Secondary Syphilis or a pt presenting without an ulcer?

VDRL/RPR and confirm with FTA!!

What is the treatment for neurosyphilis?

IV penicillin

What disease is associated with Chondylomata lata?

Secondary Syphilis

What infection is associated with Chondylomata acuminata?

HPV infection (warts)

What is the next step in treating a pregnant patient dx with syphilis or a pt with neurosyphilis??

Desensitization and Penicillin

What is the treatment for a pt with primary or secondary syphilis?

IM Penicillin (single shot) | If allergic to penicllin-use Doxycycline for 2 wks

What are the possible manifestations of Secondary Syphilis?

Skin: Chondylomata lata, mucous patch, alopecia, maculopapular copper-colored rash involving palms and soles

What is the best way to test for Scabies?

Mineral oil application to area then Scrape

What is the first line treatment for Scabies and Pediculosis?

Permethrin

What is the best treatment for Norwegian Scabies?

Ivermectin (PO)

What is an alternative treatment for Pediculosis?

OTC Pyrethrins

What is the treatment for CNS or cardiac Lyme disease?

IV Ceftriaxone

What can be used to distinguish between Toxic Shock Syndrome and Staph Scalded Skin Syndrome?

TSS: Hypotension - Shock SSSS: Normal BP

How can Toxic Epidermal Necrolysis be distinguished from Staph Scalded Skin Syndrome?

TEN: Drug induced SSSS: Bacterial toxin induced

What tests are used to dx Anthrax infection?

Gram stain and Culture of lesion

What is the treatment for Anthrax?

Ciprofloxacin or Doxycycline

What type of bx is used to dx possible melanoma?

Full thickness | thickness of lesion is best prognostic indicator

What type of bx is used to dx Basal Cell Carcinoma?

Shave/Punch Bx

What is the treatment for Melanoma?

Excision of Lesion and Interferon (to resude recurrence)

What is the treatment for Basal Cell Carcinoma?

Mohs microsurgery (get immediate frozen sections to determine if all cancer is removed)

What is the causal agent for Kaposi Sarcoma?

HHV-8

What is the first line treatment for a pt with Kaposi Sarcoma?

optimize HAART

What is an alternative treatment for pt with Kaposi Sarcoma not responding to standard therapy?

Liposomal Adriamycin and vinblastine

What is the mechanism of action of topical retinoid cream?

Regulate Follicular Keratinization (one cause of pimples)