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PNP Board Review > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Erythema toxicum neonatorum

A

Transient, benign, polymorphous skin rash of infancy.

Erythematous macules followed by wheals, vesicles, and sometimes pustules.

Palms and soles spared

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2
Q

Incidence, risk factors and typical age for erythema toxicum neonatorum

A

Occurs in 50-60% of newborns
More common in full-term/post-term infants and those with >2500g birth weight
Usually appears 24-48 hours after birth and resolves in 5-7 days

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3
Q

Acne neonatorum: definition and management

A

A new vulgaris appearing in the first 2-6 weeks of life, presumably 2/2 maternal and neonatal androgens

Self-limiting, occurs in 20% of infants

“6-week rash”

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4
Q

Port wine stain

Possible complications and associated conditions

A

Lesions covering entire half of face or bilateral face may be associated with Sturge Weber syndrome (neuro-ocular manifestations)

Hypertrophy Of soft tissue and bone with extremity lesions

Lesions on back, particularly crossing midline, associated with spinal/vertebral malformations

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5
Q

Port wine stain management

A

Refer to dermatologist early. Pulsed dye laser treatment recommended early in infancy, definitely before 1 year

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6
Q

Growth pattern for capillary hemangioma

A

Rapid growth beginning at birth and peaking around 6 months.
Involution begins between 9-12 months
10% resolution per year (10% at 1 year, 50% at 5 years, etc)

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7
Q

Complications of hemangiomas

A

Depth rather than size determines risk
Very deep may cause cardiovascular compromise
Thrombocytopenia may occur from platelet sequestration
Visual disturbance with orbital/eyelid/periorbital
Occult hepatic hemangiomas possible
Head/face lessons carry risk if subglottic lesion with airway compromise (hoarseness and stridor rapidly worsening in first weeks of life)
Ulceration as involution occurs

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8
Q

Lesions concerning for neurofibromatosis or Albright syndrome

A

Cafe au lait spots that are > 1.5cm or 6 or more in number

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9
Q

Risk factors for malignant melanoma development

A

Sunburn and excessive exposure prior to 10yoa

Family history

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10
Q

Albinism management

A

Sun protection counseling
Derm referral for skin changes
Ophtho referral for vision assessment

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11
Q

Vitiligo

Definition

A

Acquired autoimmune destruction of melanocytes resulting in hypopigmented areas on skin, oral mucosa and genitalia

Segmental- unilateral, 2 dermatomes
Generalized- >2 dermatomes, often bilateral

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12
Q

Vitiligo management

A

Sun protection
Topical steroids
Topical tacrolimus (inhibits T-cels)
Derm referral for other therapies

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13
Q

Psoriasis definition

A

Acquired inflammatory disorder with chronic relapsing-remitting pattern of erythematous plaques With silver-grey-white scales

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14
Q

Psoriasis guttate

A

Small patches primarily on trunk, upper arms and thighs

Often follows strep infection

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15
Q

Psoriasis vulgaris

A

Large plaques primarily on elbows and knees

Often associated with constant rubbing and trauma, “Koebner’s response”

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16
Q

Psoriasis management

A

Controlled and limited sunlight exposure
Topical corticosteroids
At least BID moisturizer or mineral oil

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17
Q

Atopic derm

Etiology/incidence

A

Disorder of skin barrier function, chronic forms often associated with filaggrin mutation and deficiency. Some associated with high IgE levels and altered immune function

10-15% incidence
Up to 50% develop other atopic disease
Up to 25% have symptoms that persist into adulthood

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18
Q

Dermatitis management

A

Topical steroids, oral antihistamine for pruritis, topical antibiotic for secondary infection

Diaper/atopic: emollients

Seborrheic: antiseborrheic shampoos, mineral oil, topical steroids, or topical salicylic acid. Some infants benefit from topical ketoconozole (melasezzia species may play too in etiology)

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19
Q

Burn classification

A

Superficial: epidermis only; erythema, edema, and dry tenderness
Partial-thickness: involve epidermis and part of dermis; includes moist areas and blisters
Full-thickness: Epidermis, dermis, and dermal appendage involvement; white, brown, black, swollen, dry areas with loss of sensation

20
Q

Define minor burn

A

Less than 10% BSA for superficial burns

Less than 2% BSA for partial- or full-thickness

21
Q

Define major burn

A

More than 10% BSA for superficial burns
More than 2% BSA for partial- or full-thickness burns
Any burns of hands, feet, face, eyes, ears, and perineum, regardless of BSA involved

22
Q

Burn diagnostics

A

Electrolyte studies, especially if burn is extensive

Culture of secondary infections

23
Q

Burn management - when to admit

A

Inpatient admission for all major burns, suspected abuse, esophageal or airway burns, or concomitant injuries (i.e. fractures)

24
Q

Outpatient burn management

A

Cool compresses
Pain control - acetaminophen or ibuprofen
Prophylactic antibiotics on open blistered areas (mupirocin or silver sulfadiazine [don’t use on face])
Push fluids for hydration
Topical emollients to repair and maintain barrier

25
Q

Recommended SPF for children

A

greater than 30, apply 20 minutes before exposure

26
Q

Cellulitis - common pathogens

A

Strep
H. influenzae
S. aureus
MRSA

27
Q

Cellulitis management

A

Burrow’s solution compresses
Topical antibiotics - mupirocin
Oral abx: Staph- cephalexin or dicloxacillin
Strep - amoxicillin, cehazolin, nafcillin
H. flu - augmentin
MRSA- Bactrim or clindamycin

28
Q

impetigo - pathogens

A 
Staphylococcus aureus (most common)
Streptococci
29
Q

Impetigo management

A

Topical mupirocin for most cases
Oral abx for extensive disease, entire family affected, athletes, daycare: cephalexin or dicloxacillin
Use amoxicillin if strep suspected
Use bactrim or clinda if MRSA suspected

30
Q

Staphylococcal Scalded Skin syndrome

Definition

A

Toxin-mediated systemic bacterial infection with skin manifestations.
Caused by toxin produced by S. aureus

31
Q

Staphylococcal Scalded Skin syndrome

presentation

A

Abrupt onset fever and malaise
Generalized erythema and swelling, particularly perioral, periorbital, elbows, knees, groin, and axilla
Light pressure causes pain and desquamation
Vesicles and bullae

32
Q

Staphylococcal Scalded Skin syndrome

Diagnostics

A

Blood culture or secretion culture to confirm S. aureus

33
Q

Staphylococcal scalded skin syndrome

management

A

Hospitalize all neonates and sever cases for IV abx

Mild cases with stable environment: outpatient cefazolin or dicloxacillin, encourage fluids, fever and pain control

34
Q

Acne vulgaris, mild - treatment

A

First line: Either BP or topical retinoid, or a combination of the two. May add topical antibiotic in fixed-ratio combination therapy
Alternate: topical dapsone

35
Q

Acne vulgaris, moderate - treatment

A

First line: Combo therapy containing BP + retinoid and/or antibiotic -or- PO antibiotic + BP + retinoid +/- topical abx
Alternate: consider adding OCP or isotretenoin

36
Q

Acne vulgaris, severe - treatment

A

Likely requires derm referral
First line: PO abx + combo therapy with BP + retinoid + topical abx -or- PO isotretenoin
Alternate: Consider OCP, spirinolactone in older teens

37
Q

Topical abx in acne vulgaris

A

not recommended as monotherapy due to high resistence

38
Q

PO abx in acne vulgaris

A

Extended release minocyline only FDA approved abx; use in kids >12yoa
Tetracycline and doxycycline also used

39
Q

Viral warts - treatment

A

salicylic acid and occlusive tape

40
Q

pyogenic granuloma

definition and management

A

lobular capillary hemangioma - bleed easily

treatment required, either shave excision and cautery or surgical removal

41
Q

Tinea versicolor

A

Macules/patches that are hypo- or hyperpigmented, or erythematous; caused by Malassezia species
treat with topical ketoconozole or selenium sulfide
Repigmentation may take months

42
Q

Tinea corporis - presentation/management

A

Pruritic, erythematous, annular patch with central clearing and scaly raised border.
Topical terbinafine or azole antifungals

43
Q

Tinea capitis - management

A

Topicals ineffective, requires PO griseofulvin for 10-12 weeks and terbinafine for 6 weeks. Selenium sulfide shampoo may shorten length of fungal shedding and reduce familial infection

44
Q

Telogen effluvium

A

Most common cause of diffuse hair loss
Mature hair follicles switch prematurely to telogen (resting) state then shed within 3 months
Typically occurs after major stress (pregnancy, surgery, major illness, severe weight loss)
Self-limited with regrowth over a few months

45
Q

Transient Neonatal Pustular Melanosis

A

Self-limiting condition most common in full-term infants with darker skin pigment. Pustules erupt to leave an erythematous or hyperpigmented macule with collarette of scale. Macules fade over a few months

46
Q

Pityriasis Alba - description

A 
Acquired condition
Scaly, hypopigmented macules
Indistinct borders
Various shapes/sizes
Primarily on cheeks
47
Q

Pityriasis alba - clinical course

A

May be pruritic or erythematous
Exacerbated by sunlight
Spontaneous resolution in 3-4 months
Moisturize and protect from sunlight

PNP Board Review (5 decks)

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