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Dermatology Flashcards

1
Q

Parvovirus causes…

A

Fifths disease aka erythema infectiosum

CP: Fever, HA, maculopapular rash (lacy reticular pattern) on back & abd (recurs with heat/sunlight) & “slapped red cheeks”
Tx = symptomatic
Prog = self limiting with excellent prognosis

Parvo-virus - 5 letters & = fifth disease

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2
Q

Coxsackie virus causes…

A

Hand foot & mouth disease

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3
Q

Poxvirus causes…

A

Molluscum contagiosum & other diseases - 9 different pix viruses

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4
Q

SARS is caused by…

A

Coronavirus

All ages
CP: Atypical one

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5
Q

Koebner’s phenomenon - what is it? What diseases does it happen in?

A

New lesions at site of trauma

Seen in psoriasis and lichen planus

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6
Q

Wickham straie

A

Fine white lines on the skin lesions or on the oral mucosa of people w/ lichen planus

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7
Q

Salmon-colored papule with white colarette scaling along cleavage lines

A

Pityriasis Rosea

Confined to trunk & proximal ext, face spared

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8
Q

Pityriasis rosea - thought to be idiopathic but has some relation to which infection?

A

viral infections, especially human herpes virus 7 (HHV7)

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9
Q

Pustular psoriasis - MC location, description

Location
Description
A/w?

A

Deep, yellow, non-infected pustules that evolve into red macules on palms/soles

Most severe variant (von Zumbusch type) – can be deadly. Acute onset widespread erythema, scaling, sheets of superficial pustules (WHOLE BODY). Assoc w/ systemic symptoms: malaise, fever, diarrhea, leukocytosis, hypocalcemia. Caused by: pregnancy, infection & withdrawal of glucocorticoids.

FAM HX of psoriasis (genetic component) - 2/2 keratin hyperplasia cells in the stratum basale due to T-cell activation & cytokine release

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10
Q

Guttate psoriasis

Location
Description
A/w?

A

Small, erythematous papules with fine scales, discrete leisons & confluent papules

Trunk & extremities most affected. Child/young adult w/ no hx psoriasis. Strong assoc w/ recent strep infection.

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11
Q

Plaque psoriasis

Location
Description
A/w?

A

Most common variant (>50%), symmetrically distributed cutaneous plaques on scalp, extensor elbows, knees & gluteal cleft – may be asymptomatic, pruritis common

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12
Q

Inverse psoriasis

Location
Description
A/w?

A

Inverse p = intriginous areas affected (inguinal, perineal, genital, intergluteal, axillary, inframammary), D/dx = fungal/yeast/bac inf under breast folds – given anti-fungal, not better, come back = inverse psoriasis

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13
Q

Erythrodermic psoriasis

A

Uncommon, acute or chronic, generalized erythema/scaling head to toe (whole body), complications = loss of adequate skin barrier (first line innate immune defense → abscess, cellulitis) & electrolyte abnl). NOvesicles/pustules.

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14
Q

Psoriasis is called a multi-systemic disease - Which other systems are involved frequently?

A

Nail beds - nail pitting

Joints - psoriatic arthritis - rheum issue

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15
Q

Mild to moderate psoriasis treatment

A

Mild to Moderate:
Emolients (like eucerin) to keep skin moist

Topical corticosteroids - HIGH DOSE
Hydrocortisone, Triamcinolone, fluocinonide, betamethasone dipropionate, clobetasol

Alternatives:
Vitamin D analogs → calcitriene, calcitrol, tacalcitol)
Tar-T/Gel, Topical retinoids, anthralin shampoo, tacrolimus or pimecrolimus for face

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16
Q

Moderate to severe psoriasis treatment

A

Moderate to Severe Disease:
Phototherapy (good for widespread disease), UVB (alone or w/ topical tar), Narrow band UVB @ sub-erythrmogenic doses, home phototherapy UVB machines

Systemic for severe → 
Methotrexate, Cyclosporine, Apremilast
Biologics (TNF-alpha inhib)
Entarecept, Infliximab, Adalimumab, 
Ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab
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17
Q

Pityriasis (tinea) versicolor etio

KOH?
Woods lamp?
Tx?

A

Malassezi furfur (part of normal skin flora)

KOH - spagetti & meatball from hyphae & spores

Woods lamp - yellow-orange fluorescence

Tx - topical anti-fungal (selenium sulfinde, sodium sulfacetamide, “azoles”

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18
Q

Tx options seborrheic dermatitis, textbook description

A

“Erythematous plaques with fine white scales” over areas of high sebaceous gland secretion (nasolabial fold, forehead, beard muscache, eyelids, chest, scalp (dandruff)

Tx: Topical selenium sulfide, sodium sulfacetamide, ketoconazole, or ciclopirox, steroids

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19
Q

Type I hypersensitivity reaction

A

IgE mediated reaction - Immediate

Ex: urticaria, angioedema, bronchospasm, hypotension, anaphylaxis

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20
Q

Type II hypersensitivity rxn

A

Cytotoxic, antibody-mediated (drugs in combination with cytotoxic antibodies cause cell lysis)

A type II hypersensitivity is said to occur when damage to the host tissues is caused by cellular lysis induced by the direct binding of antibody to cell surface antigens. While the antibodies involved in type I HS are of the IgE isotype, those involved in type II HS reactions are mainly of the IgM or IgG isotype.

Ex - Autoimmune hemolytic anemia, Immune thrombocytopenia, neutropenia

Ab = CELL destruction - why examples are low CELL counts

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21
Q

Type III hypersensitivity reaction

A

Type III hypersensitivity occurs when there is accumulation of immune complexes (antigen-antibody complexes) that have not been adequately cleared by innate immune cells, giving rise to an inflammatory response and attraction of leukocytes. Such reactions may progress to immune complex diseases.

Examples - 
Drug-mediated vasculitis
Serum sickness
Arthus reaction
Reactive arthritis 
IgA Berger, HSP 
PSGN
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22
Q

Type IV hypersensitivity reaction

A

Type IV hypersensitivity is often called delayed or cell-mediated hypersensitivity

This is because antigen exposure activates T cells, which then mediate tissue injury. Depending upon the type of T cell activation and the other effector cells recruited, different subtypes can be differentiated (ie, types IVa to IVd).

Ex: Erythema multiforme

Allergic contact dermatitis, some morbiliform reactions (erythema multiforme), severe exfoliative dermatoses (SJS/TEN), DRESS, AGEP, interstitial nephritis, drug-induced hepatitis etc

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23
Q

Types of hypersensitivity reactions

A

● Type I – Immediate in onset and caused by immunoglobulin (Ig)E-mediated activation of mast cells and basophils

● Type II – Delayed in onset and caused by antibody (usually IgG-mediated) cell destruction

● Type III – Delayed in onset and caused by immune complex (IgG:drug) deposition and complement activation

● Type IV – Delayed in onset and T cell-mediated

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24
Q

Erythema multiforme

Causes
Type of rxn
A/w? 
CP 
Tx
A

Acute, self-limited type IV Hypersensitivity rxn
Lesions evolve over 3-5 days, last 2 weeks
MC in young adults 20-40 YO

A/w HSV (MC), mycoplasma, S. pneumo, DRUGS (sulfa, BL, phenytoin)

CP:
TARGET (iris) lesions that are dull, “dusty-violet” red purpuric macules/vesicles or bullae in the CENTER surrounded by pale edematous rim & a peripheral red halo

EM minor - NO mucosal membrane lesions . Lesions distributed acrally (peripherally).

EM major - involves > 1 mm (oral, genial ocular) - cover more central BSA, NO epidermal detachment

Tx:
Symptomatic, d/c offending drug, antihistamines, analgesics, topical steroids, oral STEROIDs if severe

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25
SJS/TEN occurs most commonly after ?
Sulfa and anticonvulsant meds, nsaids, allopurinol
26
SJS - what percent body surface area sloughs off vs TEN?
SJS < 10% TEN > 30% +/- skin necrosis
27
Clinical manifestations SJS/TEN
Fever URI sx Widespread blisters begin on trunk/face Erythematous/pruritic macules > 1 mucous membrane involvement with epidermal detachment (+Nikolsky's sign) Tx: like severe burns - burn unit admission, pain control, stop offending med, fluid & electrolyte replacemet, wound care
28
Thrombosed capillaries are pathognomonic for what skin lesion?
``` Verruca vulgaris (common wart) Verruca plantis (plantar wart) ```
29
55 YO male comes in concerned about 10 mm velvety warty plaque on his back - what is most likely dx?
Seborrheic keratosis = "Seb ker" Also described as a "greasy, stuck-on" appearance sometimes I think they look warty but book also describes them as "velvety" as the front of this card. MC in fair-skinned elderly w/ prolonged sun exposure.
30
Non-bullous Impetigo etio, tx
STAPH Tx: Mupirocin topical TID x 10 days or if extensive - dicloxacillin
31
Bullous impetigo
Staph Ecthyma = only one where GABHS more prominent --> others (bullous, non-bullous are STAPH predominant) Same tx as non-bullous - topical mupirocin but if extensive disease, dicloxacillin
32
Ecthyma - etio, description
strEp (GABHS), rare Causes ulcerative lesions that extend thru epidermis to deep dermis = PUNCHED out ulcers w/ yellow crusts Treated with ORAL abx if extensive - dicloxacillin
33
MCC follitulitis, tx
STAPH Tx: Topical mupirocin, or topical clinda
34
Furuncle
Deeper infection of the hair follicle (like a bad folliculitis - which is superficial) Tender nodule with fluctuant abscess with central plut - may have surrounding cellulitis Management: I&D, heat compresses, oral abx if a/w cellulitis
35
Carbuncle
Even larger, more painful, interlocking furuncles / abscesses with multiple openings _ cellulitis Management: I&D, heat compresses, oral abx if a/w cellulitis
36
Cellulitis - depth in skin, etio, occurs when?, description/CP,
Infection of the DEEP dermis / SQ fat DX - clinical exam No well-defined borders, indolent onset, with or without purulence, rubor, warmth +/- lymphangitic spread (lymphangitis) = sign of impending bacteremia vs. Erysipela - Acute onset of sx, distinct clear borders (well-demarcated), VERY RED, sys sx common (fever, chills)
37
Erysipelas - etio, description,
Starts w/ E, dute to strep - GABHS MCC WELL - DEMARCATED margins, SUPER red, MC on face Tx: IV Penicillin Vs cellulitis - No well-defined borders, indolent onset, with or without purulence, rubor, warmth Tx: Usually oral Keflex x 1 week. Clinda if PCN allergic. + MRSA, covered w/ bactrim, clinda orally but IV vanc if really sick
38
Cat bite - etio, tx
Pasturella - Augmentin!
39
Dog bite - etio, tx
Capnocytophaga canimorsus Augmentin
40
Human bite - etio, tx
Anaerobes, mouth flora Augmentin
41
Paronychia - etio
Staph
42
Felon
Closed space infection of hte finger pulp - must do I&D w/ abx
43
Scabies - CP, tx
Burrows in web spaces - intense pruritis, increased at night - spares the neck & face - likes warm areas OR - red itchy pruritic papules on scrotum, glans or penile shaft, body folds = pathognomonic for scabies Tx = Permethrin - apply cream to entire body, then repeat 1 week later Think - ppl who do meth think they have scabies & itch all over - tx = perMETHerin (same with lice)
44
Pediculosis (lice)- CP, tx
Intense itching in HEAD/occipital area CP: Nits in hair - white oval shaped egg capsules at hte base of hair shafts - removed w/ a comb Tx = permethrin - for head = shampoo, if in pubic hair then permethrin lotion Bedding & clothing laundered in HOT water w/ detergent & drier in hot drier for 20 + minutes Toys that can't be washed - place in air-tight plastic bag x 14 days
45
Molluscum description, tx
Description: single or multiple dome-shaped, flesh-colored to pearly-white, waxy papules w/ CENTRALUMBILICATION No tx needed in most cases (resolve on own in 3-6 mo) or can use cryotherapy, curettage etc
46
Tinea capitus - description, tx
Varied presentation - annular, scaling lesions, broken hair shafts. Inflamed plaques with multiple pustules with scarring & alopecia - "ring worm" = the common name Tx: PO GRISEOFULVIN **Note: all other dermatophyte infections (tinea barbae, tenia pedis, tineacruris, tinea corporis) first line is TOPICAL antifungal creams but the scalp is too thick & so you need an ORAL antifungals as first line
47
How do you tell apart erythema multiforme from tinea corporis?
Tinea corporis has SCALE Erythema multiforme does not
48
Etiology of tinea infections, dx
AKA dermatophyte infections Casused MC by trichophyton, microsporum Dx: KOH, woods lamp Notes: If caused by microsporum then it glows green under woods lamp Tinea versicolor = yellow- orange under woods lamp. Normal skin = BLUE
49
Pemphigus Vulgaris - patho, description, dx, tx
Gus is 30 YO M anti-drone - does't believe in them & pemphiGUS is AI dz w/ anti-desmosome ab MC in pt in 30's - young CP: Oral mm erosions & ulcerations FIRST, then painful FLACCID skin bullae (rupture EASILY)- leaves painful denuded skin eriosions that bleed easily. + NIKOLSKY SIGN. (b/c desmosomes normally bind keratinocytes together to form the epidermis so your epidermis can't stay all attached & fluid leaks out = bullae) Dx: Skin biopsy (intraepithelial splitting with acantholysis), IgG t/o the epidermis. Elisa = anti-desmoglein ab Tx: HIGH-dose STEROIDS = first line. Methotrexate. Local wound care (like burns)
50
Bullous pemphigoid
What it is: Chronic, widespread AI blisterin skin disease of the ELDERLY (65-75 YO) (AGE = one way to tell apart from pemphigus vulgaris) Patho: Type II HSN - IgG attacks the epithelial basement membrane causing SUB-epidermal blistering (esp in groin, axilla, abdomen) +/- drug-induced CP: TENSE bullae - dont rupture easily (unlike pemphigus = FLACCID bullae = rupture easily) NEGATIVE nikolsky sign Old ppl have lots of growths on them - walking around with tense bullae = new blob growth - wont rupture easily Tx: Systemic corticosteroids, antihistamines, immunosuppressants = azathioprine
51
Melasma - what is it, RF, CP, dx, tx?
What: hypermelanosis of sun-exposed areas RF: Ince estrogen exposure, sun exposure, women w/ darker complexions Dx: wood's lamp - appearance unchanged Tx: Sunscreen, topical bleachers (Hydroquinone)
52
Brown recluse spider bite - look of spider, location in US, bite reaction, treatment
Brown recluse = Loxosceles RECLUSA. MC in southwest/midwest, has a violin shaped- marking on back CP: Bite site necrosis. Venom = vasoconstriction = white halo surrounded by erythema --> vascoconstriction = ischemia = necrosis = hemorrhagic bullae that undergoes eschar formation (Think of whacking violin over your hand super hard = FUCKED up your hand) Tx: Pain control, Tetanus PPX, local wound care +/- debridement if necrosis. Abx if 2ry infection.
53
Black widow
Black widow = latrodectus hersperus CP: Local sx - asx or small amt pain at bite site with SYSTEMIC sx - muscle pain, spasms, rigidity (Widower will poison you without leaving a trace - systemic sx (muscle pain, spasms, rigidity) but local bite mark = fine) Tx: MIld - wound care & pain control. Moderate = severe - opioids +/- muscle relaxants (benzos). Antivenom reserved for pt not responsive to above meds. Given after consult w/ toxicologist.
54
Burns - rule of 9's
**For second and third degree burns only ``` Palm ~1% Face/neck 4.5% Chest 9% ABD 9% Genitalia 1% Front of one arm 4.5% Front of one leg 9% ```
55
What is considered a MINOR burn?
< 10% TBSA in adults < 5% TBSA in kids < 2% full thickness * * Must be isolated injury * *Must not involve face, hands, perineum, feet * *Must not cross major joints, no circumferential burns
56
What is considered a MAJOR burn?
> 25% TBSA in adults >20% TBSA burn in very young or very old > 10% full thickness burn * *Any burn involving face, hands, perineum, feet * *Burn crossing major joints, circumferential burns
57
What tx is recommended for circumferential burns? why?
Escharotomy Prevents compartment syndrome
58
Tx burns
Topical abx to any nonsuperficial burn. Silver sulfadiazine commonly used.
59
IV fluid resuscitation in burns
PARKLAND formula Lactated ringers : 4ml/kg/%TSA 1/2 run in first 8 hours, other 1/2 run over remaining 16 hours
60
Depth of 1st degree burn, CP, cap refill
Depth: Epidermis PE: Erythematous, dry CP: Painful, tender to touch Cap refill: intact, blanches w/ pressure Prognosis: Heals w/in 7 days without scarring
61
Depth of 2nd degree superficial partial thickness burn, PE, CP, prognosis
Depth: Epidermis + superficial portion of dermis (papillary) PE: Erythematous, pink, moist, weeping, + BLISTERING CP: MOST PAINFUL OF ALL BURNS, VERY tender to touch Cap refill: intact, blanches w/ pressure Prognosis: Heals w/in 14-21 days without scarring but +/- pigment changes
62
Depth of second degree burn - deep partial thickness - PE, CP, prognosis
Depth: Epidermis + deep portion of dermis PE: Red, yellow, pale white - DRY, + BLISTERING CP: Not usually painful, +/- pain with pressure, decreased 2-point discrimination Cap refill: Absent capillary refill Prognosis: 3 weeks - 2 months - scarring common, may need skin graft to prevent contractures
63
Depth of 3rd degree burn- PE, CP, prognosis
Depth: FULL thickness PE: Waxy, white, leathery, dry CP: PAINLESS Cap refill: ABSENT Prognosis: Takes MONTHS to heal - does not heal well spontaneously
64
4th degree burn
Depth: Entire skin into underlying fat, muscle, bone PE: Black, charred, eschar, dry CP: PAINLESS Cap refill: Absent Prognosis: Does not heal well. Usually needs debridement of tissues & tissue reconstruction
65
Cyanide poisoning
Cyanide poisoning = Coma & apnea (w/ severe metabolic acidosis) Dx: H&P, cyanide levels Tx: "Cyanide kit" = Amyl nitrate for inhalation, IV sodium nitrite
66
Which kind electrical injury has highest risk for Vfib?
Low voltage AC current GET EKG!!!
67
Stage I pressure ulcer
Superficial, NON-blanchable rednesss that does not dissipate after pressure is relieved
68
Stage II pressure ulcer
Stage II = epidermal damage extending into the dermis - resembles blister or abrasion
69
Stage III
FULL THICKNESS (just like stage III burn) - may extend to SQ layer
70
Stage IV
Deepest = extends beyond fascia into muscle, bone, or tendon
71
Tx pressure ulcer
Stage I-II - wet to dry dressings, local wound care Stage III-IV - may need surgical debridement
72
Pyogenic granuloma
MC in kids Occurs after local trauma CP: Soft, glistening, friable, red nodule (easily bleeds, ulcerates) PE: Shave excision w/ cautery of base if pedunculated, non-pedunculated = surgical excision
73
Pyoderma gangrenosum - what is it? A/w? CP, dx, Tx?
What it is: Ulcerative skin lesion 2ry to immune dysregulation - NAME IS A MISNOMER - neither gangrenous nor infectious - can see why they originally named it that way tho b/c looks like one huge red infected SEVERE ulcer - actually not pus tho it's white granular tissue covering the ulcer) - it is nasty like name sounds but not infected - like a huge ulcerated version of a pyogenic granuloma - granuloma sounds like it's in grandmas but actually in adults A/w: IBD, RA, spondyloarthropathies CP: Inflammatory erythematous blue-red papules or pustules - PAINFUL necrotic ULCER with irregular purple/violet undermined borders & a purulent base Dx: Clinical. If need bx, shows neutrophilic infiltration (usu not needed/done) Tx: Topical corticosteroids or tacrolimus, local wound care

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