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Surgery Rotation EORE > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the MC cause of Cellulitis?

A

S. aureus & Group A beta hemolytic strep (GABHS/S. pyogenes)

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2
Q

what’s the s/s of cellulitis?

A

Local: macular erythema (flat margins, not sharply demarcated), swelling, warmth, and tenderness

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3
Q

what is erysipelas caused by?

A

group A strep (GABHS)

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4
Q

what’s the s/s of erysipelas vs cellulitis?

A

well demarcated margins and erythematous

MC involves the face

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5
Q

what’s the tx of erysipelas?

A

IV PCN, Vanco (if PCN allergy or MRSA suspected)

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6
Q

what is lymphangitis? what are complications of it?

A

spread of the infection via the lymphatic vessels. Seen as streaking from the infected area following the lymph vessels

complications = bacteremia

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7
Q

where does erysipelas MC occur on the body?

A

the face

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8
Q

what’s the tx of cellulitis NOT caused by MRSA?

A

Cephalexin; Dicloxacillin

Clinda or Erythromycin if PCN allergic

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9
Q

what are tx of cellulitis caused by MRSA?

A

IV Vanco PLUS Zosyn

PO options are: Bactrim (2nd best PO med for MRSA, but doesn’t cover strep well), Clindamycin, Doxy

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10
Q

what bacteria is from a cat bite and what’s the tx?

A

Cat bite = Pasteurella multocida

Tx: Augmentin (Amox/clavulanate)
-doxy if PCN allergic

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11
Q

what bacteria is from a dog bite and what’s the tx?

A

Capnocytophaga = bacteria from dog bite

Tx: Augmentin
-2nd line is Clinda + Cipro or Bactrim

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12
Q

what’s the tx for a human bite?

A

Augmentin

-2nd line is Clinda + Moxi or Bactrim

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13
Q

what’s the tx for a puncture wound?

A

Cipro (covers pseudomonas)

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14
Q

what is a furuncle (boil)?

A

deep infection of hair follicle (vs folliculitis is superficial)

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15
Q

what’s the s/s of furuncle

A

fluctuant abscess w/ central plug (may have surrounding cellulitis)

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16
Q

what’s the tx for furuncle?

A

I&D, heat compress, PO abx if a/w cellulitis

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17
Q

what’s folliculitis?

A

superficial hair follicle infection MC from staph aureus

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18
Q

what’s the s/s of folliculitis?

A

singular or clusters of small papule or pustules w/ surrounding erythema

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19
Q

what’s the tx for folliculitis?

A

topical mupirocin, clindamycin, erythromycin

PO abx for refractory/severe cases -> Cephalexin, dicloxacllin

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20
Q

what’s a carbuncle?

A

interlocking furuncles/abscess with multiple openings*** + cellulitis

larger, more painful than furuncle

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21
Q

what’s the tx for carbuncle?

A

same as furuncle - I&D, heat compress, PO abx if a/w cellulitis

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22
Q

what’s the MC type of skin cancer in the US?

A

Basal Cell Carcinoma

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23
Q

what are causes of Basal Cell Carcinoma?

A

sun exposure = main RF

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24
Q

what’s patho of Basal Cell Carcinoma?

A

slow growing: locally invasive but VERY LOW INCIDENCE OF METS

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25
what are the 3 types of BCC?
Nodular (MC), Superficial, Morpheaform
26
what's the MC type of BCC?
Nodular
27
what's the s/s of Nodular BCC?
***waxy/pearly, dome shaped, smooth, raised, rolled borders, ***telangiectatic, ***central ulceration ***slowly enlarging, doesn't heal, bleeds easily MC on face/nose/trunk
28
how do you dx BCC?
punch or shave bx
29
what's the GOLD STANDARD tx for BCC?
Mohs
30
what's the MC type of melanoma and 2nd MC type?
superficial spreading = MC type Nodular = 2nd MC type (most malignant subtype d/t dominant vertical growth phase)
31
what's the most malignant subtype of melanoma?
nodular d/t vertical growth
32
what's the s/s of superficial spreading melanoma?
lesions may be tan, brown, blue, or black
33
what's the s/s of nodular melanoma?
Blueish-black, less variable in color/shape than other subtypes
34
what's the Mc type of melanoma found in dark-skinned pts?
Acral lentiginous
35
what's the s/s of Acral lentiginous melanoma?
Occur on palmar surfaces of hands, plantar surfaces of feet, and underneath nails
36
what's the MOST IMPT prognostic factor for METS from melanoma?
thickness
37
what's the tx for melanoma if <1mm in thickness?
wide excision w/ a 1cm wide margin
38
what's the tx for melanoma if >1mm in thickness?
wide excision w/ a 2cm wide margin
39
when do you do LN bx for melanoma?
if LN palpable on exam
40
what's precursor of SCC of skin?
actinic keratosis
41
what's the s/s of SCC of skin?
red, elevated papule, plaques or nodules with adherent white scaly or crusted, bloody margins hyperkeratosis, ulceration or hyper pigmentation non-healing that may bleed w/out trauma
42
how do you dx SCC of skin? tx?
Bx = dx Tx = wide local surgical excision
43
what skin does 1st degree burn involve?
only the epidermis
44
what's the s/s of 1st degree burn?
red, dry, mod painful, blanches with direct pressure (refill intact)
45
what's the tx of 1st degree burn?
heals w/in 7 days, so no tx no scarring
46
what skin does 2nd degree superficial partial thickness burn involve?
epidermis to superficial portion of dermis (papillary)
47
what's the s/s of 2nd degree superficial partial thickness burn?
red, moist, weeping ***BLISTERING MOST PAINFUL OF ALL BURNS, VERY TENDER TO TOUCH blanches on direct press (refill intact)
48
what's the MOST PAINFUL of all burns?
2nd degree superficial partial thickness burn
49
what skin does 2nd degree deep partial thickness burn involve?
epidermis into deep portion of dermis (reticular)
50
what's the s/s of 2nd degree deep partial thickness burn?
red, yellow, pale, ***white waxy color, ***dry ***BLISTERING, but NOT PAINFUL (b/c of destruction of nerves) ***ABSENT CAPILLARY REFILL
51
what's the difference b/w the s/s of 2nd degree burns?
2nd degree superficial partial thickness burn -BLISTERING AND EXTREMELY PAINFUL AND HAS CAPILLARY REFILL (blanches on direct pressure 2nd degree deep partial thickness burn - BLISTERING, BUT NOT PAINFUL - ABSENT CAPILLARY REFILL
52
what's the tx for 2nd degree deep partial thickness burn?
heals in 3 weeks-2 months SCARRING COMMON
53
what's the tx for 2nd degree superficial partial thickness burn?
heals in 14-21 days NO SCARRING
54
what's a full thickness burn?
third degree -> destroys all layers of the skin
55
what's the initial tx for severely burned pts after removal of source of burn and ABCs?
fluid resuscitation with LR's
56
what's the rule of 9's for burns in adults?
total head = 9% total of each arm = 9% total of each leg = 18% total of chest (front & back) = 18% total of abdomen/lower back (front & back) = 18% ***whole trunk is 36%
57
what burns do NOT require dressing for tx?
superficial burns
58
what's the empiric tx of cellulitis?
ABX THAT ARE EFFECTIVE AGAINST MRSA Clinda, Bactrim, Tetracyclines (Doxy or Mino)
59
what is serous discharge?
Clean, watery (may have slightly brownish hue) Result of protein and other fluids Normal too much = bad bacteria
60
what is purulent discharge?
Thick, yellow, green, tan or brown Not normal Contains pus, WBCs, dead bacteria and various inflammatory cells (signs of infection)
61
what's serosanguinous discharge?
Pale, red, watery Mixture of serous and sanguineous -Features added plasma
62
what's sanguineous discharge?
Bright red, indicative of active bleeding Most common in deep partial thickness and full thickness wounds During inflammation stage of wound, a little indicates proper circulation
63
what is Type 1 cutaneous drug reaction?
IgE mediated: urticarial and angioedema (immediate) Urticarial = 2nd MC type
64
what's the tx of Type 1 cutaneous drug rxn (urticaria/angioedema)?
systemic corticosteroids, antihistamines?
65
what's Type 2 cutaneous drug rxn?
Cytotoxic, Ab-mediated
66
what's Type 3 cutaneous drug rxn?
Immune antibody-antigen complex | -Drug mediated vasculitis and serum sickness
67
what's Type 4 cutaneous drug rxn?
Delayed (cell mediated) -Morbiliform reaction (i.e. Erythema multiforme)
68
what is erythema multiforme?
acute self-limited type 4 hypersensitivity rxn rash evolves over 3-5 days and persists about 2 weeks
69
what is erythema multiforme a/w?
herpes simplex virus (MC)*** ***Meds: sulfa drugs, beta-lactam, phenytoin, phenobarbital
70
what are the s/s of erythema multiforme?
***TARGET lesions -> dull "dusty-violet" red, purpuric macules/vesicles or bullae in the center
71
what's the tx of erythema multiforme?
d/c offending drug, PO antihistamines, STEROIDS (systemic if severe)
72
what's a exanthematous/morbiliform rash?
MC skin eruption "bright-red" macule & papule that coalesce to form plaques PERSISTENT LESIONS (vs urticaria are NOT) caused by abx, NSAIDs, allopurinol, thiazides rash begins 2-14 days after medication initiation
73
what drugs cause SJS and TEN?
sulfa and anticonvulsants MC
74
what is the difference b/w SJS and TEN?
SJS = sloughing <10% body surface area TEN = sloughing >30% (may develop skin necrosis)
75
what's the s/s of SJS and TEN?
fever & URI sx's -> WIDESPREAD BLISTERS on trunk/face, erythematous/pruritic macule >/= 1 mucous membrane and involves EPIDERMAL DETACHMENT (NIKOLSKY SIGN)
76
what's the tx of SJS and TEN?
Treat like severe burns -burn unit admission, pain control, stop offending agent, fluid replacement, wound care
77
what's Dress Syndrome? s/s?
Drug induced hypersensitivity syndrome S/S = fever, severe exanthematous rash (exfoliative), generalized LAD, hematologic abnormalities Organ damage = carditis, hepatitis, nephritis NO mucosal lesions (therefore different from SJS and TENs)
78
what is urticaria & angioedema? Common med cause?
Type 1 hypersensitivity rxn (IgE mediated) Commonly caused by CPNs (e.g. Cefotetan and PCNs)
79
what are the s/s of urticaria?
pruritic, circumscribed, raised erythematous ***wheals*** or plaques, with central pallor transient, blanching occurs w/in min-hrs after drug administration
80
what's the treatment of choice for urticaria and angioedema?
PO antihistamines

Surgery Rotation EORE (10 decks)

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