Dermatology #4 Flashcards
Three MCC of dermatophyte infections
Trichophyton, Microsporum, Epidermophyton
Explain what these are:
Tinea Capitis: _____
Tinea Barbae: ____
Tinea Pedis: _____
Tinea Cruris: _____
Tinea Corporis: _____
Scalp
Hair Follicles
Foot
Groin
Trunk, legs, arms, neck (body)
Tinea Capitis, AKA ______, is MC in who?
Ringworm
Poor hygiene, preadolescents, African Americans
Diagnostics for Tinea Infection
-KOH prep (initially)
-Woods Lamp
-Culture Definitive
When using a Wood’s Lamp, what will you see and what is the cause if…
No fluorescence: Trichophyton
Fluorescence: Microsporum
Treatment for Tinea Capitis and one thing to be remembered with the treatment
-Oral Griseofulvin
–Can cause hepatitis, so avoid if the patient drinks alcohol
-Others: Oral Terbinafine, Lifestyle changes to prevent recurrence
True or False: Tinea Capitis is the ONLY Tinea that requires an oral medication?
True
Tinea Pedis, also known as _____, is….
Athlete’s Foot
The MC dermatophyte infection
Which type of athlete’s foot is MC
Interdigital
Treatment for athlete’s foot
Topical antifungals: Butenafine, Tolnaftate, Azoles
Tinea Cruris, also known as ______, is due to which fungus?
Jock Itch
Trichophyton Rubrum
Tinea Corporis MCC and who does it occur in most times?
T. Rubrum
Direct contact, so think wrestlers for example
Tinea Versicolor is caused due to a yeast. Name the yeast.
Malessezia Furfur
Symptoms of Tinea Versicolor
-Hyper or hypo pigmented well-demarcated round macules with fine scaling
-Involved skin fails to tan!!!
What diagnostics can be done for Tinea Versicolor and what is seen?
KOH Prep: hyphae and spores (spaghetti and meatballs)
Wood’s Lamp: yellow-green fluorescence
Treatment for tinea versicolor
Topical Selenium Sulfide, Sodium Sulfacetamide Shampoo
Oral Azoles if no relief with those
MC association of acanthosis nigricans
Obesity, disorders with insulin resistance (DM, Cushing’s, etc.)
What is one unique thing about acanthosis nigricans that should be remembered?
It is a paraneoplastic syndrome and usually the 1st skin manifestation of a cancer
Acanthosis Nigricans MC manifests where
Neck, groin, navel, axillae
Treatment for acanthosis nigricans
Blood glucose control (first line)
Topical Tretinoin or Calcipotriene
What is hidradenitis Suppurativa?
Disease of apocrine sweat glands (axillae) that is due to chronic hair follicle obstruction
Symptoms and treatment of hidradenitis suppurativa
Deep-seated nodules, abscesses, tracts
Topical Clindamycin
MC benign soft-tissue neoplasm
Lipoma
Describe a lipoma
-Soft, painless, subcutaneous nodule that are freely mobile
-On Neck MC
-No treatment needed
What is melasma?
AKA Chloasma (mask of pregnancy)
Hyperpigmentation of sun exposed areas
Risk factors for melasma
Sun exposure, increased estrogen (pregnancy, OCP’s)
Treatment for melasma
-Sun protection
-Triple therapy: Fluocinolone acetonide + Hydroquinone + Tretinoin
-Hydroquinone Cream to help bleach skin
What is pilonidial disease and what is the treatment?
-Cyst/abscess in gluteal cleft that forms due to chronic sinus tract development
-Warm compresses, drainage
Risk factors for pressure ulcers
Incontinence, elderly, immobilization
Explain the four stages of pressure ulcers
-1: superficial, nonblanchable redness
2: damage into dermis, blister/abrasion
3: into subcutaneous layer
4: deepest. Into muscle/tendon/bone
Treatment for pressure ulcer
Wound care, pressure redistribution, and debridement of wounds
Urticaria, also known as _____, is a Type ___ immediate hypersensitivity reaction
Hives
Type I
What causes urticaria?
Release of histamine, bradykinin, and prostaglandins
Explain urticaria in words
Circumscribed hives or wheals (blanch able, raised, erythematous areas on skin)
Although urticaria is usually self-limiting, what are some treatments that can be given to patients?
Antihistamines (H1 blockers): Loratidine and Fexofenadine
H2 blockers: Diphenhydramine, Epi-Pen
What is vitiligo?
Autoimmune destruction of melanocytes that leads to skin depigmentation
Vitiligo is associated with
Thyroid disease
Treatment for vitiligo
Topical corticosteroids
Phototherapy if disseminated
Explain the rule of 9’s
4.5 head front
9 torso front
9 chest front
4.5 arm front
4.5 arm front
1 groin
9 front leg
9 front leg
Explain a “minor burn”
< 10% TBSA in adults
<5% in kids/elderly
< 2% full thickness
Does not involve hands, feet, face, perineum
Explain a “major burn”
> 25% in adults
20% in kids or old
10% full thickness
Does involve hands, feet, face, or perineum
What is the palmar method for determining the severity of a burn? What method is used for kids?
Palm is 1/2 of a %
Lund Browder Chart
Explain a first degree burn
Damage to epidermis
Erythema, pain to palpation
Dry without blistering
Capillary refill intact
Explain a second degree partial thickness burn
Damage to epidermis and dermis
Blanches, painful (superficial)
-blister, non painful (deep)
-Blistering
-Pink, moist skin
-No capillary refill if DEEP
Explain a third degree partial burn
Full thickness burn
white, waxy, leathery skin
Dry, does not blanch
Not painful, no capillary refill
Explain a fourth degree burn
Exposed fascia, muscle, bone
Skin black/dry/charred
Painless, no capillary refill
Initial Burn Care
-Cooling: room temp water or colored gauze, soapy water to cleanse
-Tetanus Prophylaxis
-Dressing: Petroleum Gauze
-Follow up in 24 hours if not admitted
-Topical ABX if partial or full thickness (bacitracin, Polymyxin B Sulfate, Chlorhexidine)
For Moderate to Severe burns….
Get CBC, UA and myoglobin to check for rhabdomyolysis, electrolytes
Fluid resuscitation
-Monitor urine output
What method is used for fluid resuscitation in burns?
Parkland Formula
4 mL x weight (kg) x % TBSA
Half over 8 hours, then other half over the next 16 hours (Ringer’s Lactate)
If the patient is suspected of carbon monoxide poisoning, what will be seen on an ABG or VBG?
Increased carboxyhemoglobin
Symptoms of carbon monoxide poisoning
Headache (MC)
Bright red vessels on funduscopy
Cherry red skin
Treatment for carbon monoxide poisoning
100% nonrebreather oxygen
Symptoms of cyanide poisoning
Rapidly developing coma, apnea, cardiac poblems
Treatment for cyanide poisoning
Hydroxocobalamin
With electrical burns, what is the usual voltage in a home? Industrial?
Homes: < 1000V
Industrial: > 1000V
Regarding electrical burns, explain AC vs DC, symptoms and which is more severe
AC: tetany and fibrillation.
DC: asystole and muscle contraction
AC more dangerous because DC usually throws the patient away due to the power
What labs/diagnostics should you consider for an electrical burn?
ECG: arryhthmias
UA: Myoglobinuria, Rhabdomyolysis
Troponin for chest pain
Treatment for electrical burns (when should you admit the patient)?
Admit if > 600 V even if asymptomatic
Maintain urine output
