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Dermatology Flashcards

1
Q

Describe what transient neonatal pustular melanosis looks like.

A

surrounding erythema everywhere but hands/feet, vesicles rupture leaving collarete scale –> hyperpigmentation –> lasts for months

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2
Q

Which neonatal lesion is seen at birth, which is later (when)?

A 
TNPM - at birth
ET - day 1; goes away 2/3 wks
SubQ fat necrosis - 1-6 weeks
Neonatal acne/neonatal cephalic pustulosis  -2wks to 3mo
Seborrheic derm - 2wks to 1yr
Infantile acne 3mo --> 3/4 yrs
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3
Q

Which neonatal rash has eosinophils? which has neutrophils?

A

Eos erythema toxicum

Neuts TNPM

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4
Q

What is causing agent for neonatal cephalic pustulosis?

A

malassezia furfur

P. ovale

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5
Q

What causes neonatal acne?

A

excessive maternal androgen

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6
Q

Cause of seborrheic dermatitis

A

P. ovale

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7
Q

Pattern: pustules at day 1

A

erythema toxicum

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8
Q

Pattern: Papules and pustules on cheek and skin with comedones

A

neonatal acne

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9
Q

Pattern: Pattern papules and pustules on face and neck without comedones at 3weeks age

A

neonatal cephalic pustulosis

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10
Q

Pattern: If infantile acne is so severe what do you think of?

A

abnormal Androgen source such as congenital adrenal

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11
Q

Pattern: bad peeling, mouth, butt, extensor of extremities and fingers/toes, irritable, FTT, diarrhea, alopecia

A

acrodermatitis enteropathica

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12
Q

Pattern: at 1-6 weeks, firm, indurated, non-tender plaque with cellulitic erythema

A

Sub Q fat necrosis

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13
Q

What is a cause of subQ fat necrosis?

A

hypercalcemia, irritability, constipation, FTT, seizures

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14
Q

Pattern: at 3 weeks, greasy, yellow scale on scalp, midface, groin, trunk

A

seborrheic dermatitis

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15
Q

How do you treat neonatal acne?

A

benzo peroxide, antibiotics

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16
Q

How do you treat neonatal cephalic pustulosis?

A

topical antifungals

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17
Q

How do you treat acrodermatitis enteropathica

A

give zn

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18
Q

How do you treat seborrheic dermatitis

A

zinc or selenium to kill p. ovale and hydrocortisone

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19
Q

How do you treat subQ fat necrosis

A

diuretics to decrease Ca2+ , decr Ca2+ in diet, corticosteroids

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20
Q

What is time course of regular hemangioma

A

present in 1st few months of life, grows rapidly first 6 months, starts involuting after 1st yr by 10%/yr

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21
Q

Periorbital hemangioma can cause what?

A

amblyopia

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22
Q

Beard hemangioma can cause what?

A

recurrent croup, upper airway problem

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23
Q

Lumbosacral hemangioma can be a sign of what?

A

tethered cord, spinal fusion

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24
Q

Sacral/perineal hemangioma can be a sign of what?

A

renal and GU abnormalities

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25
Q

Liver hemangioma can cause what?

A

CHF, anemia, thrombocytopenia (trapping)

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26
Q

Large segmental or liver hemangioma can be associated with what?

A

hypothyroidism

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27
Q

What is first line treatment for hemangiomas?

A

beta blockers

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28
Q

What are SE of beta blockers?

A

Hypoglycemia, hypotension, bradycardia, bronchospasm

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29
Q

Besides the generic barrier cream, steroids/propanolol, analgesics, and abx for ulcerated hemangioma, what is the distinct treatment that can be given for this?

A

Platelet derived growth factors

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30
Q

Patter: tufted angioma at 3 weeks of life, thrombocytopenia, coagulopathy, microangiopathic hemolytic anemia

A

Kasaback-Meritt

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31
Q

What must you do if you see multiple hemagiomas of skin?

A

Get MRI and liver US

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32
Q

Pattern: posterior fossa syndrome, aortic arch, micro-ophthalmia, sternal clefting, arterial anomalies such as internal carotid problems leading to stroke, hemangiomas (V1)

A

PHACES

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33
Q

Suspicious for PHACES, what must you do?

A

MRI/MRA, ECHO, optho, neuro consult

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34
Q

Pattern: Unilateral large purple stain at birth that darkens and thickens causing plaque

A

port-wine stain

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35
Q

What is a Rx for port-wine stain

A

pulse dye laser

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36
Q

What eye problem do you worry about with Sturge Weber?

A

glaucoma, need MRI w/ contrast and ophtho consult

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37
Q

What are some calcineurin inhibitor?

A

tacrolimus, pimocrolimus

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38
Q

What is severe SE of calcineurin inhibitor?

A

can cause cancer if used for long time

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39
Q

If patient presents with lots of and prolonged seborrheic dermatitis and eczema, what should you also think about?

A

Langerhan, immunodeficiencies, biotin deficiency and organic acidemia, psoriasis, tinea capitas, atopic dermatitis and eczema

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40
Q

Steroid dose for lesions on face, groin, axillae, trunk, extremities

A

low potency 1%

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41
Q

Steroid dose for lesion that are severe on palms and soles

A

high potency

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42
Q

What is the risk factor for atopic dermatitis?

A

Hx, FHx of atopy (asthma or allergic rhinitis)

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43
Q

Pattern: pruritic, chornic or relapsing skin skin in infant everywhere but groin and axillae.

A

Atopic dermatitis

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44
Q

What does atopic dermatitis predispose you too?

A

Staph, HSV, warts, molluscum

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45
Q

What should you consider if atopic dermatitis is severe and early onset?

A

Food allergy, associated atopy

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46
Q

Pattern: school aged children, hypopigmented plaques with indistinct borders on cheeks and chin

A

Pityriasis alba

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47
Q

Pattern: firm, skin-colored or erythematous papules on lateral upper arms, anterior upper thighs, cheeks

A

Mechanical removal, salicyclic/lactic acid topical, RA

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48
Q

Pattern: coined shape lesions on leg that itches, can get excoriated.

A

Nummular eczema

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49
Q

Rx for nummular eczema

A

antifungal

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50
Q

What happens if you put steroids on nummular eczema?

A

fungus will proliferate

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51
Q

Difference between irritant and allergic contact dermatitis

A

Irritant - lip licker, diaper

Allergic Type IV poison oak/ivy

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52
Q

Pattern: edema, papules, vesicles, oozing, crusting, scaling, thickened skin, chronic lichenification, fissuring

A

Allergic contact dermatitis

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53
Q

Rx for allergic contact dermatitis

A

avoidance, topical CS, topical calcineurin inhibitor for 1-4 weeks, oral CS if severe

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54
Q

What test can be done for allergic contact dermatitis?

A

patch testing

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55
Q

Pattern: redness, cracking, peeling of weight-bearing surface

A

juvenile plantar dermatosis

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56
Q

What is cause of juvenile plantar dermatosis?

A

secondary to repeated maceration and dry

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57
Q

Rx for juvenile plantar dermatosis.

A

emollient, topical steroids

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58
Q

Name 4 types of tinea capitis

A

1) scale with alopecia + auricular lymph nodes
2) black-dot tinea - spores in hair shaft (hair falls off)
3) Seborrheic w/out hair loss
4) Kerion - inflammatory, hair loss, fever, increased WBC, flu-like, with fever, adenopathy

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59
Q

Pattern: abscess with hair loss

A

Tinea capitis kerion

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60
Q

Rx for tinea capitis kerios

A

Systemic antifungal +/- oral CS

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61
Q

Cause of tinea capitis

A

90% trich tonsurans, 10% microsporum canis

Fomites or contact person

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62
Q

What is woods lamp useful in detecting with tinea?

A

Microsporum canis, not useful for T. tonsurans

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63
Q

Main Rx for tinea capitis

A

1) Griseofulvin which is fungistatic
2) Topical selenium or ketoconazole
3) Terbinafine, itraconazole, fluconazole (all reservoir meds), last two can cause drug interactions

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64
Q

What does griseofulvin have to be given with?

A

fatty meal

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65
Q

SE of griseofulvin

A

hepatitis, fatty liver, decrease OCP

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66
Q

Pattern: foot dermatitis on weight bearing surface

A

Juvenile plantar dermatosis

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67
Q

Pattern: foot dermatitis in interdigital, arch

A

tinea pedis

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68
Q

Pattern: foot dermatitis on dorsum of foot

A

contact derm

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69
Q

Pattern: scaly, raised erythematous margin +/- central clearing on body

A

Tinea corporis

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70
Q

Dx for tinea corporis

A

KOH will how hyphae with spores

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71
Q

Rx for tinea corporis

A

antifungals for 2-4 weeks, topical steroids may mask dx

72
Q

Rx for tinea pedis

A

topical antifungals, oral antifungals if widespread or resistant, keratolytics for moccasin type infections

73
Q

Pattern: Adolescents, has white patches almost liquified on superficial nail and the some nails lift off

A

onychomycosis - tinea unguium

74
Q

Rx for onychomycosis

A

oral terbinafine and itraconzaole

75
Q

Pattern: adolescent, warm humid weather, confluent macules with sharp borders and varying levels of hypopigmented patches with mild scale

A

Pityriasis versicolor

76
Q

Pattern: sphagettic and meatballs under KOH, fluoresce yellow-orange with Wood’s lamp

A

Pityriasis versicolor

77
Q

Infectious agent for pityriasis versicolor

A

skin yeast (malasezzia, pityrosporum)

78
Q

Rx for pityriasis versicolor

A

Topical selenium, ketoconazole shampoos; topical antifugnals, systemic keto, itra, fluco
Griseo NOT EFFECTIVE

79
Q

Incubation period for scabies

80
Q

Pattern: papules, vesicles, burrows with other lesions around that look eczematous, impetigo, nodules can be intertriginous

81
Q

Dx for scabies

A

scrapings under minearl oil

82
Q

Rx for scabies

A

Permethrin, topical ivermectin is 2nd line, in resistant cases, can be used oral

83
Q

Why lindane is bad

A

CNS and lung toxicity

84
Q

What are “black” lice and what are the white ones?

A

Nits and white are hatched eggs

85
Q

Rx for head lice

A

permethrin or pyrethrin, malathion, 5% benzoyl alcohol; no need to treat fomites

86
Q

Pattern: 2-7 year old in summer and sprint with small wheal with central punctum, develops firm nodules

A

papular urticaria

87
Q

Rx for papular urticaria

A

Antipruritics

88
Q

Pattern: papules coalesce into plaque, SPARES TRUNK, low grade fever, itching, lasts 3-8 weeks

A

Papular acrodermatitis of childhood

89
Q

What is Gianotti Crosti?

A

id rxn to preceding infection, can be secondary to EBV and enterovirus

90
Q

Cause of warts

A

human papillomavirus

91
Q

Rx for warts

A

topical RA, light freezing, imiquimod; flat warts that are numerous are hard to treat so wait for spontaneous resolution 2/3 over 2 years

92
Q

Cause of molluscum contagiosum

93
Q

Pattern: 3 or 4 yro with superficial fragile blisters, perioral fissuring or peeling, blister extends when pushed, red skin peels

A

staph scalded skin

94
Q

Cause of staph scalded skin?

A

epi staph toxins A/B

95
Q

Rx for staph scalded skin

A

antibiotics, emollients

96
Q

Pattern: persistent redness in perianal region, can blister or ulcerate + papules

A

Perianal infectious dermatitis

97
Q

Cause of perianal infectious dermatitis

A

group A strep and staph

98
Q

Rx for perianal infectious dermatitis

A

antibiotics

99
Q

What are drugs associated with acne?

A

INH, phenytoin, corticosteroids, lithium, sunscreens, cosmetics, OCP

100
Q

Rx for comedomal acne

A

Topical tretinon or benzoyl peroxide

101
Q

Rx for mild acne

A

benzoyl peroxide

102
Q

Rx for moderate acne

A

benzoyl peroxide, topical tretinoin, topical or oral antibiotics

103
Q

Rx for severe acne

A

isotretinoin, OCPs for females

104
Q

Pattern: hair loss, scalp looks good, very rapid loss, exclamation hair, fhx of autoimmune (TH, IBD, DM)

A

alopecia areata

105
Q

Rx for alopecia areata

A

mid-high potency topical or injected corticosteroids, topical minoxidil, anthralin, calneurin inhibitors

106
Q

Pattern: Diffuse thinning of hair 6wk to 4mo after a stressful event

A

Telogen effluvium

107
Q

What workup should be considered for telogen effluvium

A

CBC, Fe, TSH, T4 (could also be zinc, FA/biotin deficiency

108
Q

Decreased production of hair by chemotherapy

A

Anagen effluvium

109
Q

Pattern: oval or linear lesions of incomplete hair loss and perifollicular inflammation

A

Traction alopecia

110
Q

What is cause of vitiligo?

A

auto-immune against melanocytes

111
Q

Rx and workup of vitiligo

A

Biopsy shows absence of melanocytes, w/u other immune disorders

112
Q

Pattern: erythema, streaky like juice stain 24hrs after exposure to UA, limes, lemons, celery/grass

A

phytophotodermatitis

113
Q

Pattern: small papule that coalesce into silver-grey scale, pinpoint bloody when scale removed

114
Q

Pattern: small droplets of red papules with silver-grey scale on top.

A

Guttate psoriasis

115
Q

Causes of guttate psoriasis and associated symptoms that precede it.

A

Group A strep; perianal cellulitis, URI, arthritis, uveitis

116
Q

Pattern: large patch then 10 days later, smaller macules/papules along the skin creases, scale lifts from center, lasts 4 to 8 weeks

A

Pityriasis rosea

117
Q

Rx for guttate psoriasis

A

Avoid skin/sun exposure/injury. topical steroid 1st line, calciprotriene or tacrolimus, narrow UVB, cyclosporine, anti-TNF

118
Q

Pattern: papules on extremities, target lesion for 10 days, disappear in 2 wks. Central area of epidermal damage (blister, ulcer, crusting)

A

erythema multiforme

119
Q

What are causes of erythema multiforme?

A

HSV, mycoplasma, drugs

120
Q

Urticaria or EM:

Truncal, prox extremity; central clearing, new lesions over 7-10d, lesions transient, swelling hands/feet

121
Q

Urticaria or EM:
Acral distribution, central blister, ucler, or crust; all lesions come up at same time, fixed lesions for 7 to 10d, no edema

122
Q

Can acyclovir be used for EM?

123
Q

Pattern: small droplets of red papules with silver-grey scale on top.

A

Guttate psoriasis

124
Q

Causes of guttate psoriasis and associated symptoms that precede it.

A

Group A strep; perianal cellulitis, URI, arthritis, uveitis

125
Q

Pattern: large patch then 10 days later, smaller macules/papules along the skin creases, scale lifts from center, lasts 4 to 8 weeks

A

Pityriasis rosea

126
Q

What is the typical cause of SJS?

A

Mycoplasma/drugs (50/50)

127
Q

Pattern: papules on extremities, target lesion for 10 days, disappear in 2 wks. Central area of epidermal damage (blister, ulcer, crusting)

A

erythema multiforme

128
Q

What are causes of erythema multiforme?

A

HSV, mycoplasma, drugs

129
Q

Urticaria or EM:

Truncal, prox extremity; central clearing, new lesions over 7-10d, lesions transient, swelling hands/feet

130
Q

Urticaria or EM:
Acral distribution, central blister, ucler, or crust; all lesions come up at same time, fixed lesions for 7 to 10d, no edema

131
Q

Can acyclovir be used for EM?

132
Q

Pattern: pruritic, edematous lesion that clears centrally (may be blue or brown in the middle) associated with swelling hands/feet, pinpoint or 10-12 ring, each lesion last 24hrs.

133
Q

Causes of urticaria

A

IgE mediated or secondary mast cell degranulation, respiratory virus, GAS, coccidiomycosis, histoplasmosis, EBV

134
Q

Rx for urticaria

A

antihistamine, steroids, doxepin

135
Q

What is the typical cause of TEN?

A

90% Drugs 1-12 weeks after initiation

136
Q

What drugs can cause TEN?

A

Abx, AED, allopurinol, NSAIDs

137
Q

SJS or TEN

Prodrome of fever, HA, sore throat, cough, arthralgias, vomiting or diarrhea

138
Q

SJS or TEN

High fever/tender skin or erythroderma

139
Q

SJS or TEN

Severe mucous membrane involvement, stomatitis, conjunctiva, GU/GI tracts

140
Q

What determines terminology used SJS vs TEN

A

Extent of blistering

141
Q

Mortality rate for SJS and TEN

A

10 and 30%

142
Q

SJS/TEN

Multi-organ dysfuntion

A

GI tract and lungs

143
Q

Should relatives of pts with SJS/TEN from drug avoid that drug?

144
Q

Pattern rash starts with mucous membrane involvement

145
Q

Pattern: red macules start centrally, develop into papular or mrobilliform eruption

146
Q

Can congential melanocytic nevi and neurocutaneous melanosis and acquired melanocytic nevi lead to melanoma

A

All can, larger lesion or if axial lesion, more likely to have higher change of melanoma

147
Q

What should you worry about when you see large congenital melanocytic nevi on head, neck, and back

A

increased ICP, Sz, spinal cord compression

148
Q

UVA or B: absorbed by dermis

149
Q

UVA or B: absorbed by epidermis

150
Q

UVA or B: causes aging

151
Q

UVA or B: causes cancer, sunburn

152
Q

UVA or B: SPF measures protection again this

153
Q

Pattern: at birth, yellow/orange/tan hairless lesion on scalp, face or neck, orange peel texture

A

nevus sebaceous

154
Q

Is there risk for malignancy with nevus sebaceous?

155
Q

Pattern: subQ non-tender nodule found over later brow or midline nasal region

A

dermoids - should MRI to delineate extent of lesion

156
Q

Pattern: slow growing, irregular, rock hard mass in head and neck that is bluish

A

pilonatricoma

157
Q

What is pilonatricoma

A

benign tumors of hair shaft that calcifies

158
Q

Pattern: yellow/orangish lesion that when you scratch can blister, looks like orange peel

A

mastocytosis

159
Q

What two skin lesion looks like orange peel texture?

A

nevus sebaceous and mastocytosis

160
Q

What is the difference in two lesions that has orange peel texture?

A

Nevus sebaceous - hairless lesion

Mastocytosis - urticaria when you scratch it

161
Q

Pattern: brownish lesion that can lead to eruptionand affect other organs to cause abdominal pain, diarrhea, vomiting

A

urticaria pigmentosa

162
Q

Pattern: ring-shpaed, not scaly, skin colored or violaceous occurs in skin creases

A

Granuloma annulare; self-resolves

163
Q

Rx for mastocytosis

A

oral cromolyn, topical or systemic CS, epi injection, avoid triggers: exercise, heat, cold, stress

164
Q

What is cause of mastocytosis

A

mass cell accumulation in skin or other organs

165
Q

Coal tar preparations are useful in treatment of what?

A

psoriasis and chronic dermatoses

166
Q

Topical selenium sulfide shampoo is helpful to what?

A

tinea versicolor and seborrheic dermatitis

167
Q

What factors can worsen eczema?

A

drying, chemical irritants, heat, and physical trauma

168
Q

Children with atopic dermatitis are prone to skin infections from what?

A

Staphylococcus aureus and HSV

169
Q

Pattern: umbilicated vesicles, forming ulcers that have a “punched-out” appearnace

A

HSV - eczema herpeticum

170
Q

Pattern: erythematous or violaceous nodules

A

sporotrichosis

171
Q

Pattern: Individual vesicles that rupture leaving shallow erosions

172
Q

Two most common bacterial agents for cellulitis

A

streptococcus pyogenes and staphylococcus aureus

173
Q

Difference in way cellulitis by S pyogenes and S aureus present

A

S pyogenes red, tightness in skin

S aureus localized and purulent

174
Q

What is agent? Cellulitis in pt who had a cut on the leg from a stick in a creek +/- immunocompromised or has DM

A

pseudomonas aeruginosa

175
Q

What is agent? necrotizing fasciitis from fish or objects in salt water in an immunocompromised patient.

A

vibrio vulnificans

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