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J's ClinMed Deck > Dermatology > Flashcards

Dermatology Flashcards

1
Q

anicteric

A

without jaundice

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2
Q

actinic

A

changes from the sun

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3
Q

stucco keretosis

A

flat stuck on appearing legion with regular borders

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4
Q

senile angiomas

A

tiny red dots in older people

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5
Q

polycythemia vera

A

bone marrow produces too many RBCs and possibly WBCs and platelets and can cause pruritus and burning pain in hands

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6
Q

hodgkin’s lymphoma

A

cancer of the lymphatic system with many symptoms but include pruritus, fever, chill, swollen lymph nodes

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7
Q

erythema nodosum

A

violet or red subcutaneous nodules usually in pretibial area. Could be present in TB pt, oral contraceptives or Lupus pts

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8
Q

pruritus

A

itching

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9
Q

What primary skin disorders can cause pruritus?

A

xerosis, atopic dermatitis, contact dermatitis, venous stasis, lichen stasis, lichen planus, urticaria, dermatophytosis, psoriasis, scabies, pediculosis

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10
Q

What systemic disorders can cause pruritus?

A

renal, cholestasis, malignancy, MS, thyroid disorders, diabetes, venous stasis, Iron deficiency anemia, HIV, allergies, psychiatric

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11
Q

Emollient

A

usually used to treat pruritis.

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12
Q

Moisturizer

A

ie mineral oil, coconut oil, lactate and urea supply water.

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13
Q

Occlusives

A

reduce water loss e.g. petroleum jelly

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14
Q

Creams

A

absorb well and don’t feel greasy. Because creams contain alcohol they can sting! Also contain preservatives that may cause an allergic contact dermatitis.

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15
Q

Ointments

A

petrolium based so more of an emollient, less cosmetically acceptable. Ointments less likely to sting. Has propylene glycol/?irritant. Good for vulvar dermatosis.ointment more potent than same cream.

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16
Q

Lotions

A

more water than oil so easily absorbed and spread easily over large area. The higher prop of water to oil helps dry skin, go good in weeping dermatosis.

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17
Q

Gels

A

Gels have similar effect to lotions. helps to dry skin due to high proportion of water

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18
Q

Foams

A

dry easily without signif residue. Good for hair line. But $$

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19
Q

Potency of treatments

A 
Super potent (class I)
Potent (class II and III)
Intermediate (class IV to V)
Mild (classes VI to VII)
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20
Q

What is KOH scraping used for?

A

used to diagnose fungal infection

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21
Q

eczematous

A

scaling, crusting or oozing. synonymous with dermatitis

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22
Q

winter Itch

A

eczema brought on by winter or dry contions and aggravated by hot water/ drying soaps

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23
Q

Winter itch treatment

A

emollients and possibly mild to low potency topical corticosteroid to minimize itching

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24
Q

xerosis

A

dry skin

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25
Q

best treatment of xerosis

A

thick creams or ointments due to low water/ high oil content

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26
Q

contact dermatitis

A

any dermititis arising from direct skin exposure to a substance. Either an irritant or an allergen

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27
Q

allergic contact dermatitis

A

delayed-type hypersensitivity, requires initial sensitization, becomes more intense with repeated exposure, intense pruritus,

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28
Q

Acute allergic contact dermatitis presentation

A

erythema, edema, weepy, and vesicles

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29
Q

chronic allergic contact dermatitis presentation

A

lichenification, scaly and hyperpigmentation

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30
Q

atopic dermatitis affects who most often?

A

affects children genetically with environmental interactions also. personal or family hx of allergies, asthma, or allergic rhinitis

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31
Q

Treatment of atopic dermatitis

A

eliminate exacerbating factors disrupting epidermal barrier, emollients best applied immediately after bathing, daily topical corticosteroid, topical macrolide immunomodulators and possibly control pruritus.

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32
Q

factors to consider when prescribing a topical corticosteroid

A

pregnancy, potency, vehicle, amount, refills (avoid)

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33
Q

other atopic dermatitis therapies

A

phototherapy, oral calcineurin inhibitors, immunosuppressants (methotrexate), probiotics, oral essential fatty acids and chinese herbs possibly

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34
Q

widespread herpes simplex virus

A

known as eczema herpeticum. needs to be treated with antivirals immediately or IV

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35
Q

eczema herpeticum

A

numerous small red blisters with clear fluid with bright red halos surrounding. once they break they skin may be sore and pt may feel ill. needs to be treated immediately with oral antivirals or possibly IV

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36
Q

S. Aureus derm presentations

A

honey-colored crusting, folliculitis and pyoderma

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37
Q

localized S. aureus Rx

A

mupirocin (antibiotic)

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38
Q

Extensive S. aureus Rx

A

oral cephalosporin or penicillinase-resistant penicillins (antibiotics)

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39
Q

seborrheic dermatitis

A

inflammatory condition with overproduction of skin cells and sebum (greasy scales) found mostly on the scalp, face, nasolabial folds and mid upper chest, e.g. dandruff

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40
Q

seborrheic dermatitis causes

A

unknown but could be fungal/yeast causing redness flaking but it could also be that the flaking could be allowing an overgrowth of fungus…

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41
Q

cradle cap

A

seborrheic dermatitis found most commonly on infants head but also seen on face, ears, neck and diaper.

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42
Q

cradle cap treatment

A

usually resolves without treatment but white petroleum or mineral oil overnight and toothbrush to loosen scales or shampooing with baby shampoo and using soft toothbrush frequently

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43
Q

seborrheic dermetitis treatment

A
  1. low potency corticosteroid and/or 2% ketoconazole cream
  2. sulfa-based products
  3. shampoos with tar, selenium sulfide, pyrithone or ketoconazole
  4. off label use of tacrolimus or pimecrolimus for recalcitrant disease
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44
Q

causes of diaper associated dermatitis

A

irritant, candidal or allergic

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45
Q

irritant diaper dermatitis

A

usually surfaces in direct contact with diaper (buttock, lower abdomen and genitalia)

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46
Q

non-diaper associated dermatitis

A

scabies, herpes virus, psoriasis, bacterial

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47
Q

Tzanck test

A

use to diagnose blisters as herpetic

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48
Q

management of diaper dermatitis

A
  1. eliminate direct contact with feces and urine
  2. create topical barrier (petrolium, zinc oxide)
  3. powders (controversial)
  4. anti-fungal (make sure it is below barrier of ointment
  5. corticosteroids
  6. antibiotics (sulcrafate Rx labeled for duod ulcers also acts as physical barrier and has antibacterial activity. AVOID neosporin (neomycin) and bacitracin they contain inciting allergens.)
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49
Q

refractory diaper dermatitis

A

consider referral, immunodeficiency, nutritional deficiency, abuse, neglect or type 1 diabetes

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50
Q

prevention of diaper dermatitis

A

frequent diaper changes and barriers

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51
Q

dyshidrotic eczema

A

pruritic chronic recurrent vesicles lateral aspects of the fingers, palms and soles which desquamate and leave cracks

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52
Q

desquamate

A

to shed, peel off or come off in scales

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53
Q

what is dyshidrotic eczema when vesicle is large enough to be bullae called?

A

pompholyx

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54
Q

dyshidrotic eczema Rx

A

medium to potent topical corticosteroid

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55
Q

dyshidrotic eczema differential diagnosis

A

tinea (fungus) and contact dermatitis

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56
Q

venous stasis dermatitis contributing factors

A

1.venous hypertension, 2.chronic inflammation and 3.microangiopathy

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57
Q

venous stasis dermatitis

A

No fever, bilateral involvement (not cellulitis), notable varicosities, and hyperpigmentation.

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58
Q

venous stasis dermatitis treatment

A

mild topical corticosteroid and leg elevation and pressure, topical antibiotics avoided

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59
Q

venous stasis dermatitis prevention

A

unna boots for acute dermatitis and knee-high compression 20-40mmHg for prevention and review medications. can cause edema which will exacerbate

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60
Q

lichen planus

A
  • The p’s = pruritic, shiny, purple, polygonal, and papules
  • symmetrical on wrists, flexural surfaces of arms legs, lower back and genetalia
  • linked to HepC
  • knoeber phenomenon and wickums stria
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61
Q

psoriasis

A

similar to lichen planus except that it is on the extensor surface of knees and elbows as well as intergluteal cleft

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62
Q

knoeber phenomenon

A

present in lichen planus. occurs near site of injury

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63
Q

wickums stria

A

white, lacy pattern and erythematous erosion are present on buccal mucosa

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64
Q

wickums stria treatment

A

high potency topical corticosteroid, fluticasone spray or trimcinolone paste. 1% TID for 3 months and taper over 3 months chlorhexidine rinse or miconazole ointment for antimycotic concommitment

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65
Q

lichenoid drug reaction

A

unlike lichenoid platus, more eczematous,psoriasiform or scaly, frequently photodistributed, usually does not involve mucose and is uncommon to present wickham striae

66
Q

lichen platus biopsy type?

A

deep shave or punch

67
Q

lichen planus treatment

A
  1. topical or systemic corticosteroid
  2. retinoids
  3. immunosuppressants (mycophenolate)(must check for TB)
    phototherapy
68
Q

TB Testing

A

5mm, 10mm, 15mm. 5 mm is considered positive in immunocomprimised pts or if a person is in direct contact with an active TB pt whereas 15 mm or greater is considered positive in healthy pts.

69
Q

lichen simplex chronicus (circumscribed neurodermatitis)

A

lichinified sqaumous hyperplasia pruritic skin, precipitated by emotions,

70
Q

what does recalcitrant mean?

A

not responsive to treatment

71
Q

lichen simplex chronicus treatment

A

soak in warm water, seal in moisture with topical corticosteroid ointment and possibly antihistamine
recalcitrant: intralesional triamcinolone, tacrolimus

72
Q

nummular dermatitis

A

intensly pruritic patches (2-10 cm) on trunk and lower extremities. spontaneous. raised around the edges if fungus

73
Q

nummular dermatitis differential diagnosis

A

tinea

74
Q

nummular dermatitis Rx

A

potent topical steroid, and emollient post bathing

75
Q

dermatitis herpetiformis

A

NOT HERPETIC, chronic recurrent pruritic vesicular eruption often on erythematous base and symmetrical pattern. IgA deposits in dermal papillae. autoimmune blistering associated with gluten sensitive enteropathy. increased risk of GI lymphoma. 90% have circulating antibodies to transglutaminase.

76
Q

dermatitis herpetiformis treatment

A

dapsone (antibiotic) and gluten-free diet; although with good diet, you may not need dapsone

77
Q

psoriasis risk factors

A

1-3% of worlds population. 1/3 have family history. men and women and all races equal. onset is bimodal 20 and 60 y/o. concordant among monozygotes more than dizygotes. associated with human leukocyte antigens (HLA) b13, 17 and 27

78
Q

three types of arthritis

A

osteoarthritis, rheumatoid arthritis and psoriatic arthritis (can destroy the bone)

79
Q

psoriasis exacerbating factors

A

stress, infection and medication (lithium and beta blockers)

80
Q

psoriasis clinical manifestations

A

sharply marginated, scaly plaque on elbows, knees, presacral and scalp. Auspitz sign either plaque (80%), guttate, inverse, nail or pustular

81
Q

plaque psoriasis

A

common in young adults, symmetricaly distributed erythematous, sharply defined and raised plaque (1-10cm) with thick silvery scale involving the scalp, elbows, knees and back. look for nail pitting, umbilicus and intergluteal cleft.

82
Q

what drugs can exacerbate psoriasis?

A

BB lithium, antimalarial and less commonly ACE, NSAIDS, and terbinafine

83
Q

considerations for treatment of psoriasis

A

based on severity (topical vs systemic), comorbidities (psychosocial), pt preference, evaluation of response. if they are put on immunocompromising medication or long term steroid, need to check for TB

84
Q

mild-moderate psoriasis treatments

A

Can combine intermittently corticosteroid with topical retinoids or UVB intermittent steroid combo

  1. topical corticosteroids and emollients
  2. topical tar or topical retinoids (tazarotene)
  3. tacrolimus or pimecrolimus for facial or intertriginous areas
  4. methotrexate
  5. phototherapy
  6. biologics
85
Q

retinoids

A

regulate epithelial cell growth

86
Q

severe psoriasis treatments

A

Know when to refer

  1. phototherapy
  2. retinoids
  3. methotrexate, cyclosporin
  4. biologics or immunomudulatory
87
Q

guttate psoriasis

A

small (less than 1 cm) droplike scaly plaques that appear abruptly and occur most often in children and adolescents. frequently triggered by prior staph infection

88
Q

inverse psoriasis

A

reverse typical presentation on extensor surfaces. easily misdiagnosed as fungal or bacterial due to lack of scaling

89
Q

what does intertriginous mean?

A

used to describe areas where skin rubs together

90
Q

What is Auspitz sign?

A

bleeding where scales are ripped off in psoriasis

91
Q

nail psoriasis

A

causes pitting (psoriatic involvement of the nail matrix), localized color change “oil drop”, severe confused with onchomycosis

92
Q

generalized pustular psoriasis

A

severe, life-threatening complications. widespread erythema and sheets of superficial pustules. von Zumbusch varient. seen with withdrawal of systemic corticosteroid, pregnancy and infection

93
Q

von Zumbusch varient

A

fever, diarrhea, leukocytosis, and hypocalcemia

94
Q

psoriasis comorbidities

A

metabolic syndrome, cardiovascular disease, inflammatory bowel disease. moderate to severe psoriasis should be informed of increased risk for MI (check lipid panels)

95
Q

How can we diagnose psoriasis?

A

H&P exam, rarely skin biopsy to rule out other conditions

96
Q

psoriasis differential diagnosis?

A

seborrheic dermatitis, topic dermatitis and lichen simplex chronicus

97
Q

psoriatic arthritis

A

coincidental skin involvement, arthritis can precede skin involvement, nail involvement is severe, distal interphalangeal joints spondyloarthropathies. severe destructive arthritis and deformaties = arthritis mutalins

98
Q

what is arthritis mutalins?

A

form of psoriatic arthritis that is severe destructive arthritis and deformities

99
Q

what drugs can exacerbate psoriasis?

A

BB lithium, antimalarial and less commonly ACE, NSAIDS, and terbinafine

100
Q

considerations for treatment of psoriasis

A

based on severity (topical vs systemic), comorbidities (psychosocial), pt preference, evaluation of response. if they are put on immunocompromising medication or long term steroid, need to check for TB

101
Q

mild-moderate psoriasis treatments

A

Can combine intermittently corticosteroid with topical retinoids or UVB intermittent steroid combo

  1. topical corticosteroids and emollients
  2. topical tar or topical retinoids (tazarotene)
  3. tacrolimus or pimecrolimus for facial or intertriginous areas
  4. methotrexate
  5. phototherapy
  6. biologics
102
Q

retinoids

A

regulate epithelial cell growth

103
Q

sever psoriasis treatments

A

Know to refer! phototherapy, systemic retinoids, methotrexate, cyclosporin, biologics and immunomodulary drugs (this one is important since you need to check for TB

104
Q

intertriginous treatments of psoriasis

A

class 6 or 7, tacrolimus or pimecrolimus

105
Q

treatment of nail psoriasis

A

physical maneuvers like shaving or nail removal

106
Q

erythema multiforme major categories

A

Drug reaction

  1. SJS steven-johnson syndrome
  2. TEN toxic epidermal necrolysis
  3. SJS/TEN overlap
107
Q

erythema multiforme minor

A

target or iris lesions generally found on extensor surfaces, palms, soles or mucosal membranes, possibly the result of herpetic flare or mycoplasma

108
Q

erythema multiforme major

A

Favors the trunk. acute inflammatory symmetric macular, papular, urticarial, bullous or purpuric with history of recurrence. prodromal malaise and fever. necrosis and sloughing of epidermis can be seen.

109
Q

Stevens-Johnson syndrome (SJS)

A

erythema multiforme major less than 10% body surface area

110
Q

Toxic epidermal necrolysis (TEN)

A

erythema multiforme major more than 30% body surface area. about 50% begin with diffuse erythema, almost invariably drug induced.

111
Q

SJS/TEN overlap

A

erythema multiforme major between 10-30% body surface area

112
Q

Lesions on palms causes?

A

meningococcal, secondary syphilis or benign iris lesions.

113
Q

Possible erythema multiforme causes

A

drugs like NSAIDs, allopurinol and anti -convulsants. even topicals. infections like mycoplasma. pneumonia may trigger SJS (may only be iris lesions)

114
Q

erythema multiforme minor treatment

A

usually self limited. intervention is usually targeted at pain (burning) or pruritis in mild disease. If severe mucosal involvement, use systemic glucocorticoid. anti-virals are not very helpful due to late timing. If caused by drug, discontinue use.

115
Q

erythema multiforme major treatment

A

discontinue med immediately, supportive multi-specialty team/burn unit, systemic glucocorticosteroids (not fully substantiated). no universal effective therapy

116
Q

SJS and TEN history

A

drug exposure preceding symptoms (avg. 14 day), re-exposure to drug symptoms within 48 hours

117
Q

SJS and TEN signs

A

erythroderma, facial edema, pain, palpable purpura, skin necrosis, blistering, mucosal erosion, swelling of tongue. prodrome

118
Q

SJS and TEN lab abnormalities

A

lymphopenia, careful of demargination with glucocorticoids, mild ins in transaminases, overt hep in 10% TEN, Diagnosis is made by histology with full thickness epidermal detachement.

119
Q

additional drug reaction pattern

A

Basically, there are many different types of drug reactions and we treat them accordingly. morbilliform, urticaria/angioedema (give steroid), anaphylaxis, hypersensitive vasculitis, exfoliative dermatitis/ erythroderma, hypersensitive syndrome, fixed drug eruption, photosensitive

120
Q

acronym FLAP

A

used to diagnose strep, F = fever, L = lack of cough, A = adenopathy (anterior cervical nodes), P = pharyngeal exudates (white stuff on tonsils)

121
Q

morbilliform

A

macular lesions 2-10mm
possible etiology = penicillin, other b lactams, carbamazepine, allopurinol
Rx: drug cessation, antihistamines for pruritis, and topical corticosteroids
pts with epstein barr or CMV will develop morbilliform if given ampicillin or amoxicillin

122
Q

what are urticaria and how do they present?

A

Hives
acute or chronic
pruritic, erythematous, edematous plaque
can be accompanied by angioedema and/or systemic anaphalaxis

123
Q

how do you treat urticaria if angioedema is developing near the mouth

A

systemic steroid

124
Q

uriticaria cause

A

drugs, food, infection, systemic dz or idiopathic

125
Q

How to treat severe reactions of urticaria?

A

drug cessation, antihistamines, epinephrine and corticosteroids.

126
Q

increase eosinophils on CBC can possibly be a sign of what?

A

parasites

127
Q

what should you think if someone has chronic urticaria?

A

malignancy or if eosinophils are high too then could be parasite

128
Q

fixed drug eruption

A

Causes a lesion that will likely occur in the exact same spot if same Rx is given. commonly mistaken for spider bites

129
Q

fixed drug eruption treatment

A

cessation of drug and given potent topical corticosteroid

130
Q

Drugs that can cause photosensitivity?

A

thiazides (first line anti-HTN) and tetracyclines (common acne med). These are the drugs she emphasized out of everything: amiodarone, thiazide, tetracycline, furosemide, phenothiazines, sulfonamides, and psoralens

131
Q

What particular concern do we have about warfarin (coumadin)?

A

anti-coagulant-induced skin necrosis

132
Q

What particular concern do we have about lithium?

A

psoriasis, acne, hair loss

133
Q

What particular concern do we have about iodides in amiodarone and radiocontrast material?

A

allergies to the iodide

134
Q

what is cutaneous necrosis from warfarin caused by?

A

a reduction in protein c levels, which induces hypercoaguable state

135
Q

drug eruptions are more likely in who?

A

pts with genetic predisposition, immunosuppressed and are also linked to accompanying viral infection (herpes virus 6)

136
Q

percoset is a combination of what drugs?

A

oxycodone and acetominophen

137
Q

what are the different combinations of percoset?

A

2.5mg/325 mg, 5/325, 7.5/500, 10/325 and 10/650

138
Q

what is pityriasis rosa?

A

papulosquamous eruption that is self limited that occurs more commonly in the spring or fall,
Herald path on 50-90 % of cases with christmas tree distribution usually on torso

139
Q

what is the likely cause of pityriasis rosa?

A

likely viral, possibly herpes virus 6 or 7

140
Q

what is a herald patch?

A

One patch that is bigger than the rest. it is slighly raised and has a very thing scale (like cigarette paper)

141
Q

what are some differential disgnoses for pityriasis rosea?

A

secondary syphilis, guttate psoriasis, tinea corporis, plus

142
Q

treatment for pityriasis rosea?

A

usually none
if there is pruritis, medium potency topical corticosteroid
if sever itch, oral acyclovir promptly
Can last 2-3 months

143
Q

Acne epidemiology

A
  • preventant in adolescents
  • activated by androgens therefore more common and severe in males
  • tends to resolve in 3rd decade
  • post-adolescent predominately affects women
144
Q

If women have particularly bad acne, what else should you ask them?

A

if they have deepening of voice, decreased breast size, clitoromegaly, alopecia, oligomenorrhea and hirsutism since it could be caused by an adrenal or ovarian tumor

145
Q

development of acne lesions

A
  • a disease of pilosebaceous follicles
  • follicular hyperkeratinization
  • sebum production
  • propionbacterium acnes (P. acnes) growth
  • inflammation
146
Q

Acne vulgaris is a disorder of the?

A

pilosebaceous follicles

147
Q

What is involved in the pathogenesis of acne vulgaris?

A
  • follicular hyperkeratinization
  • sebum production
  • propionbacterium acnes (P. acnes) growth
  • inflammation
148
Q

The accumulation of what material contributes to formation of comedones?

A

sebum and keratinous material

149
Q

What contributes to the inflammation response in acne vulgaris?

A

Bacterial proliferation by propionbacterium acnes (P.acnes) and follicular rupture which releases proinflammatory lipids and keratin into dermis.

150
Q

What interaction do kids in adrenarche and P.acnes have? (not sure if we need to know this?)

A

Sebaceous glands enlarge with adrenarche (the prepubertal period in which levels of DHEA-S rise) and sebum production increases. Sebum provides a growth medium for P. acnes, an anaerobic diphtheroid that is a normal component of skin flora. Microcomedones provide an anaerobic lipid-rich environment that allows these bacteria to thrive; they utilize triglycerides in sebum as a nutrient source by hydrolyzing them into free fatty acids and glycerol.
Inflammation results from the proliferation of P. acnes. Sequencing of the P. acnes genome has led to the identification of the following bacterial properties that may contribute to the inflammatory response [7,8]:

151
Q

What three types of acne are there?

A
  1. solely comedonal
  2. papular or pustular inflammatory
  3. cyst or nodules (can cause scarring)
152
Q

what acne would you use oral isotretinoin (accutane) with?

A

in cystic or nudular acne

153
Q

what are closed comedones?

A

tiny, flesh non-inflamed bumps

154
Q

what are open comedones?

A

slightly larger, black material aka black head

155
Q

what are some diagnostic evaluations for acne?

A

endocrine function (if acne and abnormal growth of their hair), medication history, and/or examine skin for type and location

156
Q

hirsutism

A

excessive hair growth on female where there normally is very little or none

157
Q

acne external factors, things that seem to make acne better or worse.

A
  • water cosmetics better
  • scrubbing promotes inflammation
  • soaps astringents remove sebum but do not decrease production.
  • diet is controversial
  • stress (corticotropin releasing hormone CRH)
158
Q

Will topical steroids help erythema and inflammation associated with acne?

A

yes but the fluorinated will cause acne to form eruption

159
Q

what is a good treatment of open comedones and pustular acne?

A

benzoyl peroxide

160
Q

What history and physical questions are good to answer before prescribing for acne?

A

clinical type (comedonal, inflammatory, nodular), skin type (oily vs dry), scarring or hyperpigmentation (may warrant more aggressive), menstrual history, prior positive or negative therapy, medication history

161
Q

what are some negative aspects of isotretinoin (accutane?

A

(accutane) very terratogenic, check liver and watch for mood swings, don’t prescribe to depressed, can possibly promote crohn’s disease, have them use chap stick

J's ClinMed Deck (12 decks)

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