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Dermatology Flashcards

1
Q

alopecia areata

A
  • non-scarring immune-mediated, targets anagen follicles
  • ASSOC W/ OTHER AUTOIMMUNE
  • sx: smooth, discrete circular patches of complete hair loss
  • EXCLAMATION POINT HAIRS
  • nail pitting, fissuring, trachyonychia (roughening)
  • ALOPECIA TOTALIS (complete scalp hair loss)
  • ALOPECIA UNIVERSALIS (complete body/scalp hair loss)

-tx: INTRALESIONAL CORTICO, TOPICAL CORTICO

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2
Q

androgenetic alopecia

A
  • progressive loss of terminal hairs on scalp
  • DHT (dihydrotestosterone) leads to this

-sx: hair thinning and nonscarring hair loss mc on the temporal scalp, mid-front scalp or vertex area

  • tx: MINOXIDIL
  • ORAL FINASTERIDE (5-alpha reductase inhibitor)
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3
Q

atopic dermatitis (eczema)

A
  • atopic disease association (triad)
  • altered immune rx –> T cell-mediated immune activation and inc IgE production
  • triggers: heat, perspiration, allergen, contact irritants
  • sx: PRURITIUS HALLMARK
  • acute lesions: red, ill-defined blisters/papules/plaques
  • later: dries, crusts over, scales
  • MC IN FLEXOR CREASES
  • DERMATOGRAPHISM
  • NUMMULAR: COIN-SHAPED, sharply defined, esp on dorsum of hands, feet and extensor surfaces
  • tx:
  • ACUTE: TOPICAL CORTICO + ANTIHISTAMINES
  • topical calcineurin inhibitors (tacrolimus, pimecromlimus) are alternatives to steroids)
  • CHRONIC: daily hydration and emollients, oral antihistamines used for itching
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4
Q

contact dermatitis

A
  • tx: avoid irritants, topical cortico

- diaper rash: topical petroleum or zinc oxide to area

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5
Q

dyshidrosis (dyshidrotic eczema)

A
  • triggers: sweat, stress, warm weather, metals
  • sx: pruritic “tapioca-like” tense vesicles on soles, palms and fingers (lateral digits)
  • tx: TOPICAL STEROIDS, OINTMENTS PREFERRED, cold compress, burrow’s solution, tar soaks
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6
Q

lichen simplex chronicus (neurodermatitis)

A
  • SKIN THICKENING in pt W/ ECZEMA - 2ry to rubbing/scratching (itch/scratch cycle)
  • sx: scaly, well-demarcated, rough hyperkeratotic plaques w/ EXAGGERATED SKIN LINES
  • tx: AVOID SCRATCHING LESIONS, TOPICAL STEROIDS, antihistamines, occlusive dressing
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7
Q

perioral dermatitis

A

-mc in young women, may have hx of topical cortico use

  • sx: papulopustules on erythematous base, which may become confluent into plaques w/ scales
  • may have satellite lesions
  • SPARES VERMILLION BORDER
  • tx: TOPICAL METRONIDAZOLE OR ERYTHROMYCIN
  • oral: tetracyclines
  • AVOID TOPICAL CORTICO
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8
Q

lichen planus

A
  • idiopathic cell-mediated immune response
  • inc incidence w/ HEP C

-sx: 5 P’S: PURPLE, POLYGONAL, PLANAR, PRURITIC PAPULES w/ fine scales and irregular borders
-mc on flexor surfaces of extremities, skin, mouth, scalp, genitals, nails
+/- KOEBNER’S PHENOMENON (new lesions at sites of trauma)
-WICKHAM STRIAE: fine white lines on skin lesions or oral mucosa, nail dystrophy

  • tx: TOPICAL CORTICO 1ST LINE
  • antihistamines for itch, occlusive dressing
  • 2nd line: PO steroids, UVB therapy, retinoids
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9
Q

pityriasis rosea

A
  • uncertain etiology (+/- associated w/ viral infections HHV7)
  • primarily children or older adults
  • inc in spring/fall, can mimic syphilis
  • sx: HERALD PATCH (solitary salmon macule) on trunk –> general exanthem 1-2 wk later (smaller, itchy 1 cm round/oval) SALMON-COLORED PAPULES W/ WHITE CIRCULAR COLLARETTE SCALING ALONG CLEAVAGE LINES IN CHRISTMAS TREE PATTERN
  • trunk and proximal extremities (face spared)
  • resolves in 6-12 weeks

-tx: NONE NEEDED
-po antihistamines, topical cortico, oatmeal baths
+/- UVB phototherapy if severe and early in course

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10
Q

psoriasis

A

-keratin hyperplasia (proliferating cells in stratum basale and stratum spinosum due to T cell activation and cytokine release –> greater epidermal thickness and increased epidermis turnover)

  • sx: PLAQUE MC TYPE
  • MC ON EXTENSOR SURFACES of elbows, knees, scalp, nape of neck
  • NAIL PITTING
  • AUSPITZ SIGN
  • KOEBNER’S PHENOMENON (new lesions at trauma sites)
  • Pustular: deep, yellow non-infected pustules that evolve into red macules on palms/soles
  • Guttate: small, red papules w/ fine scales, discrete lesions
  • Inverse: erythematous (lacks scale) mc seen in body folds (groin, gluteal fold, axilla)
  • Erythrodermic: generalized erythematous rash involving most of the skin (worst type)
  • Arthritis: inflamatory arthritis, joint stiffness >30 min relieved w/ activity; sausage digits, “pencil in cup” deformit on xray
  • tx: MILD-MOD –> TOPICAL STEROIDS (HIGH) +/- vitamin d analogs (calcipotriene), topical retinoids/vitamin a
  • MOD-SEV –> PHOTOTHERAPY UVB, METHOTREXATE, cyclosporine, retinoids, biologic agents
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11
Q

pityriasis (tinea) versicolor

A
  • overgrowth of MALASSEZIA FURFUR
  • sx: hyper/hypopigmented
  • dx: KOH PREP –> HYPHAE AND SPORES
  • WOOD’S LAMP: YELLOW-GREEN FLUORESCENCE
  • tx: TOPICAL ANTIFUNGALS (SELENIUM SULFIDE, SODIUM SULFACETAMIDE, ZINC PYRITHIONE, “AZOLES”)
  • systemic: itraconazole or fluconazole if widespread or failed topical tx; must not shower 8-12 hours after bc azoles delivered to skin via sweat
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12
Q

seborrheic dermatitis

A
  • etiology unknown, maybe hypersensitive to MALASSEZIA FURFUR
  • occurs in areas of high sebaceous gland oversecretion (scalp, face, eyebrows, body folds)
  • worse during winter or w/ stress

-sx: CRADLE CAP INFANTS, DANDRUFF

  • tx: topical selenium sulfide, sodium slufacetamide, ketoconazole
  • systemic: oral antifungals (itra, fluc, keto, terbinafine)
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13
Q

cutaneous drug reactions

A
  • most cutaneous drug reactions are self-limited if DC’d
  • triggers: foods, insect bites, drugs, enviro, exercise, infx

TYPE I: IgE MEDIATED (URTICARIA + ANGIOEDEMA)

TYPE II: CYTOTOXIC, AB-MEDIATED (drugs in combo w/ cytotoxic antibodies cause cell lysis)

TYPE III: IMMUNE ANTIBODY-ANTIGEN COMPLEX (drug-mediated vasculitis and serum sickness)

TYPE IV: DELAYED (CELL-MEDIATED) - morbilliform reaction (erythema multiforme)

  • sx:
  • EXANTHEMATOUS/MORBILIFORM RASH: MC SKIN ERUPTION - “bright-red” macules and papules that coalesce to form plaques; typically begins 2-14 days after med initiation (abx, nsaids, allopurinol, thiazides)
  • URTICARIAL: 2nd mc type; occurs w/in minutes to hours after drug admin (abx, nsaids, opiates, radiocontrast)
  • ERYTHEMA MULTIFORME: 3rd mc; target lesions may not always be present (sulfonamides, penicillins, phenobarbital, dilantin)
  • FEVER, ABDOMINAL OR JOINT PAIN MAY ACCOMPANY THE CUTANEOUS RX
  • less common: acneiform, eczematous, exfoliative, photosensitivity, vasculitis
  • tx:
  • discontinue offending med
  • Exanthematous/Morbiliform –> oral antihistamines
  • Drug-induced Urticaria/Angioedema –> SYSTEMIC CORTICO, ANTIHISTAMINES
  • Erythema Minor –> symptomatic tx
  • Anaphylaxis –> epi
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14
Q

urticaria (hives) + angioedema

A
  • TYPE I HSN (IgE) edematous reaction
  • triggers: food, meds, infx, insect bites, drugs, enviro, stress, heat/cold
  • MAST CELLS RELEASE HISTAMINE (causing vasodilation of venules –> edema of dermis + sq tissue)

-sx:
URTICARIA (BLANCHABLE, PINK PAPULES, WHEALS OR PLAQUES), often disappear w/in 24 hrs and new appear
-Dermatographism (pressure cause wheals in area)
-Darier’s sign - local urticaria appearing where skin rubbed
ANGIOEDEMA: painless, deeper form of urticaria affecting lips, tongue, eyelids, hands, feet and genitals

-tx: ORAL ANTIHISTAMINES, eliminate precipitant factors, corticosteroids, H2 blockers

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15
Q

erythema multiforme

A
  • TYPE IV HSN - acute self-limited
  • skin lesions usually evolve over 3-5 days and last 2 wks
  • mc in young adults 20-40y

-Associations: HSV MC, mycoplasma (esp kids), S. pneumo, SULFA DRUGS, BETA-LACTAMS, PHYNYTOIN, PHENOBARBITAL, autoimmune, malignancy

  • sx:
  • TARGET LESIONS, DULL “DUSTY-VIOLET”, PURPURIC MACULES/VESICLES OR BULLAE in center w/ pale rim and red halo; OFTEN FEBRILE
  • EM Minor: target lesions distributed acrally; no mucosal membrane lesions
  • EM Major: target lesions w/ INVOLVE MUCOUS MEMBRANE (oral, genital or ocular), more central lesions, NO EPIDERMAL DETACHMENT
  • tx:
  • symptomatic: dc drug, antihistamines, analgesics, skin care
  • oral: STEROID, lidocaine, diphenhydramine mouthwash
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16
Q

SJS + TENS

A
  • MC AFTER DRUG ERUPTIONS, ESP SULFA AND ANTICONVULSANTS
  • nsaids, allopurinol, abx
  • infx less common - mycoplasma, HIV, HSV, malignancy, idio
  • SJS = sloughing <10% of body surface
  • TEN = sloughing >30%; may devo skin necrosis
  • sx: FEVER + URI SX –> WIDESPREAD BLISTERS begin on trunk/face, red/itchy macules + mucous membrane involved W/ EPIDERMAL DETACHEMENT (+ NIKOLSKY SIGN)
  • tx: like severe burns, pain control, prompt dc of offending med, fluid/electro replacement, wound care
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17
Q

acne vulgaris

A
  • INCREASED SEBUM PRODUCTION: inc androgens (inc sebaceous gland activity)
  • CLOGGED SEBACEOUS GLANDS: d/t inc proliferation of follicular keratinocytes
  • PROPIONIBACTERIUM ACNE OVERGROWTH (P. ACNE): part of normal flora that overgows in blocked pores –> lipase production by P. acne converts sebum into inflam fatty acids that damage healthy cells –> inflam response
  • sx:
  • comedomes
  • inflammatory: papules/pustules surrounded by inflam
  • nodular or cystic acne: often heals w/ scars

-dx + tx:
MILD: comedomes +/- small papules or pustules
-TOPICAL RETINOIDS, BPO, TOPICAL ABX, OCPs

MODERATE: comedomes, larger amounts of papules or pustules

  • like mild + ORAL ABX (TETRACYCLINES - DOXY OR MINOCYLINE)
  • SPIRONOLACTONE (K sparing diuretic)

SEVERE: nodular (> 5mm) or cystic acne
-ISOTRETINOIN –> HIGHLY TERATOGENIC (need 2 types BC)

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18
Q

rosacea

A
  • persistent vasomotor instability w/ lesion formation (inc capillary permeability)
  • mc males >30 yo
  • triggers: ETOH, INC TEMP (HOT DRINKS, HOT/COLD WEATHER, HOT BATHS, SPICY FOODS, MEDS)
  • sx: ACNE-LIKE RASH + ERYTHEMA, FACIAL FLUSHING, TELANGIECTASIA, SKIN COARSENING, PAPULOPUSTULES W/ BURNING/STINGING, red eyes
  • absence of comedones separates it from acne
  • tx:
  • topical: METRONIDAZOLE 1ST LINE, azelaic acid, ivermectin cream
  • mod/sev: oral abx, laser
  • LIFESTYLE MOD: SUNSCREEN, avoid tones, astringents, menthols, camphor, triggers
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19
Q

actinic keratosis

A

-premalignant to SQUAMOUS CELL CARCINOMA (MC PREMALIGNANT SKIN CONDITION)

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20
Q

seborrheic keratosis

A
  • MC BENIGN SKIN TUMOR

- CRYOTHERAPY (cosmetic)

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21
Q

HPV infections

A

-HPV infects keratinized skin, causing excessive proliferation and retention of the stratum corneum –> papule formation

-sx:
COMMON + PLANTAR WARTS (VULGARIS + PLANTARIS)
-firm, hyperkeratotic papules w/ red-brown punctations (thrombosed capillaries are pathognomonic), mc hands

FLAT WARTS (VERRUCA PLANA): numerous, small, discrete, flesh-colored papules 1-5 mm in diameter; typical on face, hands, shins

GENITAL WARTS (CONDYLOMA ACUMINATA): tiny, painless papules evolve into soft, fleshy, cauliflower-like lesions ranging from skin-colored to pink or red, occurring in clusters int he genital regions and oropharynx - may persist for months and may spontaneous resolve

  • dx: MUCOSAL HPV (WHITENING OF LESION W/ ACETIC ACID APPLICATION)
  • histology: koilocytic squamous cells w/ hyperplastic hyperkeratosis
  • tx: MOST WARTS SPONTANEOUSLY RESOLVE IN 2 YRS
  • verruca vulgaris and plantaris: topical otc salicylic acid, cryotherapy, electrocautery, laser
  • condyloma acuminata: chemical, salicylic acid, cryo, laser
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22
Q

vitiligo

A
  • AUTOIMMUNE DESTRUCTION OF MELANOCYTES –> SKIN DEPIGMENTATION
  • sx: irregular discrete macules and patches of depigmentation (commonly includes dorsum of hands, axilla, face, fingers, body folds, genitals)
  • tx:
  • local: topical corticosteroids; calcineurin inghib for facial involvement
  • disseminated: systemic phototherapy may aid in repigmentation
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23
Q

basal cell carcinoma

A
  • MC TYPE OF SKIN CANCER IN US
  • mc in fair-skinned w/ prolonged sun exposure, XERODERMA PIGMENTOSUM (genetic disorder w/ inability to repair damaged caused by UV light exposure)
  • sx:
  • SLOW GROWING, LOCALLY INVASIVE BUT LOW INCIDENCE METASTASIS
  • flat, firm area w/ SMALL, RAISED, PEARLY/WAXY PAPULE AND CENTRAL ULCERATION + RAISED, ROLLED BORDER
  • MC ON FACE, NOSE, TRUNK
  • friable (bleeds easily)
  • may have TELAGIECTATIC VESSELS

-dx: PUNCH OR SHAVE BX

  • tx: ELECTRODESICCATION/CURETTAGE mc in nonfacial
  • MOHS FOR FACIAL INVOLVEMENT
  • small/superficial: imiquimod + 5FU for superficial nonfacial
24
Q

malignant melanoma

A
  • UV RADIATION ASSOC W/ 80% CASES
  • AGGRESSIVE, HIGH METS POTENTIAL
  • inc in Caucasians, light hair/eyes; xeroderma pigmentosum

4 Major Subtypes:

  1. SUPERFICIAL SPREADING mc type 70% - may arise de novo or from pre-existing nevus
  2. Nodular - 2nd mc
  3. lentigo maligna
  4. Acral lentiginous - mc type on dark-skinned
  5. DESMOPLASTIC - MOST AGGRESSIVE
  • sx: ABCDE
  • usually >6 mm
  • THICKNESS MOST IMPORTANT PROGNOSTIC FACTOR FOR METS

-dx: FULL-THICKNESS WIDE EXCISIONAL BX W/ LYMPH NODE BX

-tx: COMPLETE WIDE SURGICAL EXCISION
+/- adjuvant therapy in some high risk: a-interferon, immune therapy or radiotherapy

25
Q

squamous cell carcinoma of skin

A
  • 2nd mc type skin cancer
  • OFTEN PRECEEDED BY AK, HPV INFX, sun, enviro exposure, xeroderma pigmentosum, chronic wounds
  • HYPERKERATOSIS and ulceration
  • BOWEN’S DISEASE = SCC IN SITU (SLOW GROWING)
  • sx: RED, ELEVATED, THICK NODULE with adherent WHITE SCALY OR CRUSTED, BLOODY MARGINS
  • dx: BIOPSY = atypical keratinocytes and malignant cells
  • tx: WIDE LOCAL EXCISION, electrodesiccation and curettage, Mohs, radiation
26
Q

kaposi sarcoma

A
  • connective tissue cancer caused by HHV-8
  • MC IMMUNOSUPPRESSED PT OR HIV (CD4 <100)
  • sx: MACULAR, PAPULAR, NODULES, PLAQUE-LIKE BROWN/PINK/RED OR VIOLACEOUS LESIONS
  • tx: HAART THERAPY
27
Q

erythema nodosum

A

-PAINFUL, ERYTHEMATOUS INFLAMMATORY NODULES SEEN ON ANTERIOR SHINS, usually bilateral

  • etiologies:
  • ESTROGEN EXPOSURE, ocps, pregnancy
  • Inflammatory disorders: SARCOIDOSIS, IBD, leukemia
  • Infections: strep, TB, sarcoid, fungal (cocci)
  • tx: generally self-limited
  • nsaids, corticosteroids if persistent (and not infx)
28
Q

impetigo

A
  • occurs at sites of superficial skin trauma, FACE and extremities
  • RF: warm, humid, poor personal hygiene

NONBULLOUS: VESICLES, PUSTULES –> “HONEY COLORED CRUST” MC TYPE
-regional lymphadenopathy, STAPH AUREUS MC, GABHS

BULLOUS: vesicles form large bullae –> rupture –> thing “varnish-like crusts”, fever, diarrhea
-STAPH AUREUS MC, rare - usually seen in newborn/young

ECTHYMA: ulcerative pyoderma caused by GABHS; heals w/ scarring

  • tx: MUPIROCIN (BACTROBAN) TOPICALLY DOC, tid 10d
  • extensive/more areas systemic sx: cehpalexin
29
Q

folliculitis

A
  • superficial hair follicle infx w/ singluar or clusters of small papules or pustules, STAPH MC
  • tx: TOPICAL MUPIROCIN, CLINDA, ERYTHROMYCIN
30
Q

furuncle

A
  • BOIL: deeper infx of hair follicle, tender
  • FLUCTUANT ABSCESS W/ CENTRAL PLUG

-tx: I+D, HOT COMPRESS, oral abx

31
Q

carbuncle

A
  • larger, more painful, INTERLOCKING FURUNLCES / ABSCESSES W/ MULTIPLE OPENINGS + CELLULITIS
  • tx: I+D, HOT COMPRESS, oral abx
32
Q

cellulitis

A

-MC CAUSED BY STAPH AUREUS + GABHS/S.PYOGENES

  • sx: MACULAR ERYTHEMA, NOT SHARPLY DEMARCATED, swelling, warmth, tenderness
  • systemic sx (not common): fever, chills, lymphadenopathy, lymph tracking (LYMPHANGITIS), myalgias, vesicles, hemorrhage, necrosis may devo
  • tx: abx X 7-10 days
  • CEPHALEXIN, DICLOXACILLIN, clinda, erythromycin
  • MRSA = iv vanc or linezolid, bactrim (po)
33
Q

scabies

A

SARCOPTES SCABIEI - females burrow into skin to lay eggs, feed and defecate

  • sx: INTENSELY PRURITIC LESIONS, LINEAR BURROWS common in INTERTRIGINOUS ZONES AND WEBS OF FINGERS/TOES, SCALP, usually spares neck and face
  • INCREASED ITCHING AT NIGHT
  • RED, ITCHY PAPULES OR NODULES ON SCROTUM, GLANS OR PENILE SHAFT PATHOGENOMIC FOR SCABIES
  • dx: clinical, skin scraping of burrows w/ mineral oil to see mites/eggs under micro
  • tx: PERMETHRIN TOPICAL (NIX) DOC
  • LINDANE - DON’T USE AFTER BATH/SHOWER - CAUSES SEIZURES (inc absorption in open pores)
  • all clothing, bedding placed in plastic bag at least 72 hours then washed and dried hot
34
Q

pediculosis

A
  • head, body, pubic lice
  • sx: INTENSE ITCHING, PAPULAR URTICARIA NEAR LICE BITES
  • tx: PERMETHRIN DOC
  • 2nd line: Lindane - seizure risk if used after bath/shower)

-bedding/clothing washed in hot water and dried in hot drier; anything can’t be washed placed in air-tight plastic bag for 14 days

35
Q

molluscum contagiosum

A
  • viral infection (poxviridae family) HIGHLY CONTAGIOUS
  • mc children, sexually active adults, HIV

-sx: SINGLE OR MULTIPLE DOME-SHAPED, FLESH-COLORED TO PEARLY-WHITE, WAXY PAPULES W/ CENTRAL UMBILICATION - curd-like material may be expressed from center

  • tx: NONE NEEDED (resolves 3-6 mo)
  • curettage, cryotherapy, topical retinoids in severe
36
Q

dermatophytosis

A
  • fungal skin infx: TRICHOPHYTON, micosporium, epidermophyton
  • infects keratinized tissues in stratum corneum of skin, hair and nails by ingesting keratin
  • RF: increased skin moisture, immunodeficiency, peripheral vascuar dz

TINEA CAPITUS - ring worm –> annular, scaling lesions w/ broken hair, inflamed plaques w/ multiple pustules (KERION) w/ scarring and ALOPECIA –> PO GRISEOFULVIN

TINEA BARBAE - papules, pustlues and hair follicles

TINEA PEDIS - athletes foot –> TOPICAL ANTIFUNGAL

TINEA CRURIS - jock itch –> TOPICAL ANTIFUNGAL

TINEA CORPOSIS - plaques w/ circular rash, definied border, scaling –> TOPICAL ANTIFUNGAL

ONYCHOMYCOSIS - mc great toe –> ITRACONAZOLE AND TERBINAFINE; systemic griseofulvin, itra and terbi

37
Q

pemphigus vulgaris

A
  • autoimmune 2ry to desmosome disruption (link keratinocytes)
  • ANTI-DESMOSOME / ANTI-EPITHELIAL AB
  • mc young 30-40s

-sx: ORAL MUCOSAL MEMBRANE EROSIONS AND ULCERATIONS –> PAINFUL FLACCID SKIN BULLAE, leaving painful skin erosions that bleed easily
+NIKOLSKY SIGN (detachment of skin under pressure/trauma)

-dx: BX, IgG throughout epidermis

-tx: HIGH-DOSE CORTICO 1ST LINE
METHOTREXATE, local wound care

38
Q

bullous pemphigoid

A
  • chronic widespread autoimmune blistering skin disease
  • ELDERLY 60+
  • Type II HSN (IgG) autoimmune attack on the epithelial basement membrane
  • sx: SUBEPIDERMAL BLISTERING (esp groin, axilla, abdomen, flexural areas)
  • URTICARIA PLAQUES –> TENSE BULLAE (DON’T RUPTURE EASILY), ITCHY
  • negative nikolsky sign

-tx: SYSTEMIC CORTICO, antihistamines, immunosuppressants

39
Q

melasma

A
  • RF: INC ESTROGEN EXPOSURE (OCP, PREGNANCY), SUN EXPOSURE, women w/ darker complexion
  • sx: hypermelanotic symmetrical macules esp face/neck
  • dx: WOOD’S LAMP: appearance unchanged
  • tx: SUNSCREEN, HYDROQUINONE, retinoids, peels
40
Q

brown recluse

A
  • mc southwest and midwest
  • sx: local burning and erythema for 3-4 hours –> blanched area (vasoconstriction) –> red margin around ischemic center “RED HALO” –> 24-72h after HEMORRHAGIC BULLAE THAT UNDERGOES ESCHAR FORMATION
  • tx: LOCAL WOUND CARE, elevate, most heal spontaneous
  • nsaids, tetanus prophylaxis if needed
  • dermal necrosis - debridement, abx if 2ry infx
41
Q

black widow

A
  • sx:
  • LACTRODECTISM local - asymptomatic or pain at bite site w/ onset of general sx 30m - 2h –> SYSTEMIC SX: MUSCLE PAIN, SPASMS, RIGIDITY (mc back, extremities, abdomen)
  • usually limted and resolves 1-3 days

-Exam: BLANCHED CIRCULAR PATCH W/ SURROUNDING RED PERIMETER AND CENTRAL PUNCTUM

  • tx:
  • Mild: wound care, pain control
  • Mod-Sev: opioids +/- musclue relaxers; antivenom reserved for pt not responsive to other tx
42
Q

hidradenitis suppurativa

A
  • chronic abscess of apocrine sweat glands or sebaceous cysts w/ tract formation
  • mc obese women - axilla, groin, under breasts or anogential area
  • tx:
  • mild: topical clinda, interlesional injections of triamcinolone
  • DEEP, RECURRENT: punch debridement if small, unroofing if larger w/ washout, I+D
  • sx excision of apocrine glands might prevent recur
43
Q

sebaceous cysts

A
  • epidermoid or pilar cysts; both secrete keratin (not sebum) and don’t originate from sebaceous glands
  • sx: mobile masses of fibrous tissue and keratinous substance
  • tx: cosmetic removal, I+D if infected
44
Q

burn size

A

rule of nines - not used for 1st degree
-palm = 1% of TBSA

Minor burns:
<10% TBSA in adults
<5% TBSA in young/old
<2% full-thickness burn
-must be isolated injury
-must not involve face, hands, perineum, feet
-must not cross major joints; must not be circumferential

Major burns:
>25% TBSA in adults
>20% TBSA in young/old
>10% full-thickness burn
-involve face, hands, perineum, feet
-crossing major joints, circumferential burns
Rule of Nines
head/neck = 9% total back and front
upper limbs = 9% each
trunk = 36% total back and front
genitals = 1%
lower limbs = 18% each
45
Q

burn management

A

Cleansing:

  • wash mild soap and water
  • DON’T APPLY ICE DIRECTLY
  • CHEMICAL - IRRIGATE PROFUSELY 20 MIN

Debridement:

  • sloughed/necrotic skin may be debrided
  • escharotomy recommended for circumferential burns to prevent compartment syndrome

Blisters:
-ruptured should be removed

Pain:
-acetaminophen, nsaids, opioids

Antibiotics:

  • topical should be applied to any non-superficial burn
  • SILVER SULFADIAZINE commonly used 2nd/3rd (C/I IF SULFA ALLERGIES, PREGNANT, CHILDREN <2 MO, OR ON FACE - discoloration)
  • aloe vera or topical abx (bacitracin) for superficial burns

Dressings:

  • superficial burns don’t require dressings
  • partial/full thickness - dressing to prevent infx (non-adherent gauze and elastic gauze)
  • fingers and toes individually wrapped to prevent maceration

IV Fluid Resuscitation: PARKLAND FORMULA
-LACTATED RINGERS 4ml/kg/%TSA - IV first 24h
(1/2 in 1st 8 hours and other 1/2 over next 16 hrs)

46
Q

burn degrees

A

First: superficial

  • epidermis
  • dry, red, tender to touch
  • cap refill intact
  • heals w/in 7 days, no scarring

Second: superficial partial-thickness

  • epidermis and superficial dermis
  • red/pink, moist, weeping, blistering
  • most painful of all types
  • cap refill intact
  • heals 14-21 days, no scarring but pigment change

Second: deep partial-thickness

  • epidermis into deep dermis
  • red, yellow, pale white, dry, blistering
  • not usually painful, decreased 2 point discrimination
  • absent cap refill
  • heals 3w - 2mo, scarring common (may need graft)

Third: full-thickness

  • extends through entire skin
  • waxy, white, leathery, dry
  • painless
  • absent cap refill
  • heals in months, doesn’t spontaneously heal well

Fourth

  • entire skin into fat, muscle, bone
  • black, charred, eschar, dry
  • painless
  • absent cap refill
  • doesn’t heal well, usually needs debridement of tissues and reconstruction
47
Q

smoke inhalation injury

A

-must r/o upper airway obstruction and CO toxicity

UPPER AIRWAY OBSTRUCTION

  • smoke inhalation usually limited to upper airways (steam can travel to lower airways)
  • sx of possible upper airway thermal injury: SURFACE BURNS OF THE NECK + FACE, HOARSENESS, SINGED NASAL HAIR, SOOT IN MOUTH/NOSE, BLACK SPUTUM
  • respiratory stress may be apparent hours later

CARBON MONOXIDE TOXICITY

  • neuro: headache, nausea, malaise, ams, seizures, brain hypoxia, coma
  • cardiac: dysrhythmias, dyspnea, angina
  • dx: MEASURE SaO2, INC CARBOXYHEMOGLOBIN, METHEMOGLOBIN
  • tx: O2 100% NONREBREATHER 10-12L/min UNTIL CARBOXYHEMOGLOBIN <10%, may need hyperbaric O2 in severe
48
Q

cyanide poisoning

A
  • sx: rapidly devo coma, apnea (w/ severe lactic acidemia), cardiac derangements
  • dx: H+P, cyanide levels
  • tx: “cyanide kit” - amyl nitrite for inhalation, IV sodium nitrite or thiosulfate
49
Q

high voltage electric injuries

A

-sx:
CARDIAC ARREST (low voltage ac may produce ventricullar fib; high-voltage ac/dc may produce asystole)
RHABDOMYOLYSIS
neurological

  • tx:
  • tx thermal burns, telemetry
  • admit if >600V even if asymptomatic; keep urine output at 100ml/hr and alkalinize the urine to protect kidney
50
Q

pressure ulcers

A

Stage 1: superficial, NONBLANCHABLE REDNESS that doesn’t go away after pressure relieved

Stage 2: epidermal damage into DERMIS, resembles a BLISTER OR ABRASION

Stage 3: full thickness of skin and may extend into SQ

Stage 4: deepest, extends beyond fascia, extends into MUSCLE, TENDON OR BONE

  • TX:
  • wet to dry dressings, hydrogels
  • 1+2 - local wound care, pain manage
  • 3+3 - may need sx debridement
51
Q

dermatitis herpetiformis

A
  • pruritic autoimmune skin disorder STRONGLY ASSOCIATED W/ CELIAC DISEASE –> IgA IMMUNE COMPLEX DEPOSITION IN DERMAL PAPILLAE
  • sx: pruritic, papulovesicular rash on extensor surfaces and scalp
  • tx: gluten-free diet, DAPSONE
52
Q

keloid

A

-excess production of type 1 and 3 collagen during wound healing; MC IN AA

  • tx: CORTICOSTEROID INJECTION 1ST LINE
  • 2nd: intralesional 5-FU, silicone gel sheets, pressure tx, cryotherapy
53
Q

pyogenic granuloma

A
  • aka lobular capillary hemangioma
  • mc in children / young adults esp after trauma (inc incidence in pregnancy - gingival involvement)

-sx: SOLITARY GLISTENING, FRIABLE RED NODULE OR PAPULE, evolves over period of weeks, mc arms hands, fingers, legs

  • tx:
  • pedunculated - shave excision or curettage and cautery of base
  • nonpedunculated - surgical excision
  • topical imiquimod or alitretinoin gel, injectable sclerosing agents
54
Q

pyoderma gangrenosum

A

-ulcerative skin lesion 2ry to immune dysregulation
+/- preceded by trauma
-ASSOC W/ INFLAMMATORY DZ (CROHNS, UC, IBD), RA

-sx: PAINFUL, NECROTIC ULCER W/ IRREGULAR PURPLE/VIOLET UNDERMINED BORDERS AND PURULENT BASE

  • tx:
  • HIGH-DOSE TOPICAL CORTICO or tacrolimus
  • 2nd line: systemic cortico or cyclosporine if refractory to topical therapy
  • 3rd: IVIG, cyclophosphamide
55
Q

erysipelas

A

Patient will be complaining of malaise, fever, chills, or nausea

PE will show intense and deeply erythematous, sharply demarcated elevated shiny patch

Most commonly caused by Streptococcus pyogenes infection (group A beta strep)

Treatment is:
Infections with systemic symptoms parenteral cefazolin, ceftriaxone or flucloxacillin
Mild to moderate infections (without systemic symptoms) oral amoxicillin or cephalexin

Concepts / Lists (16 decks)

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