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Peds EOR > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is acne vulgaris characterized by?

A

areas of

  • open comedones (blackheads) incomplete blockage
  • closed comedones (whiteheads) complete blockage
  • papules
  • pustules
  • nodules or cysts
  • may result in scarring
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2
Q

What is category I of acne vulgaris?

A

comedonal: comedones (+/-small amounts of papules and pustules)

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3
Q

What is category II of acne vulgaris?

A

papular: moderate number of lesions, little scarring

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4
Q

What is category III of acne vulgaris?

A

pustular: lesions >25, moderate scaring

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5
Q

What is category IV of acne vulgaris?

A

nodulocystic: severe scarring

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6
Q

What is the treatment of most acne vulgaris?

A

topical retinoids

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7
Q

What is the treatment of cystic acne?

A

tetracyclines, than oral retinoids - isotretinoin

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8
Q

What are the side effects of isotretinoin?

A

dry lips, liver damage, increased triglycerides/cholesterol, pregnancy category X
-must obtain 2 pregnancy tests prior to starting it and monthly while on it

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9
Q

Androgenetic alopecia

A

gradual conversion of terminal hairs - indeterminate - vellus hair

  • genetic predisposition (androgen)
  • Males 20-40 yo, W MC after 50
  • Men > women
  • MC in white men
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10
Q

What is the dx of androgenetic alopecia?

A
  • microscopic examination of cut or plucked hair fibers and scalp biopsies may provide additional information that is helpful for diagnosis
  • Biopsy: telogen and atrophic follicles
  • Trichogramma: increased telogen hairs
  • Hormones: testosterone, DHEA, prolactin
  • Treatable: thyroid (TSH), anemia (CBC), autoimmune (ANA)
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11
Q

What is the tx of androgenetic alopecia?

A
  • topical: minoxidil/rogaine 2%, 5% (hair loss first before regrowth)
  • finasteride 1 mg - inhibits.T and DHT
  • spironolactone - blocks DHT
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12
Q

What are the characteristics of atopic dermatitis?

A
  • pruritic
  • eczematous lesions
  • xerosis (dry skin)
  • lichenification (thickening of the skin and an increase in skin markings)
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13
Q

Where are the most common spots for atopic dermatitis to be in adolescent?

A

flexor creases (antecubital and popliteal folds)

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14
Q

What kind of hypersensitivity is atopic dermatitis?

A

IgE, type 1 hypersensitivity

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15
Q

Where are on an infant is atopic dermatitis?

A

face and scalp

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16
Q

How do you dx atopic dermatitis?

A

History and physical

  • conduct patch testing to verify
  • allergy referral
  • skin prick tests NOT used for contact derm
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17
Q

What is the treatment for atopic dermatitis?

A
  • review medications: OTX, RX, homeopathic, hot water, humidifier
  • antihistamine (hydroxyzine or Benadryl), animals
  • avoid agent, topical or oral steroids
  • PUVA phototherapy
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18
Q

What are the MCC of burns?

A

scalding, direct thermal, and flame burns

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19
Q

What is a first degree burn?

A

Sunburn

  • erythema of involved tissue
  • skin blanches with pressure
  • the skin may be tender
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20
Q

What is a second degree burn?

A

Partial Thickness

  • skin is red and blistered
  • the skin is very tender
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21
Q

What is a third degree burn?

A

Full Thickness

  • burned skin is tough and leathery
  • skin non-tender
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22
Q

What is a fourth degree burn?

A

into the bone and muscle

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23
Q

What is the rule of 9’s?

A
  • head 9%
  • each arm 9%
  • chest 9%
  • abdomen 9%
  • each anterior leg 9%
  • each posterior leg 9%
  • upper back 9%
  • lower back 9%
  • genitals 1%
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24
Q

What is the palmar method?

A

patient’s palm equate to 1%

-used for small burns

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25
Q

What is the overall treatment for burns?

A

monitor ABCs, fluid replacement, sulfadiazine

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26
Q

What is the treatment for mild burns?

A
  • clean with soap and water
  • drain and debris bullae
  • cover with 1% silver sulfadiazine
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27
Q

What is the treatment for moderate/severe burns?

A

cover with dry dressing and admit to hospital

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28
Q

What labs needs to be done on burn patients?

A

ABG, CBC, CK, CMP, UA, carboxyhemoglobin

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29
Q

What burn patients get fluid replacement?

A

-children with >10% total body surface area and adults with >15% total body surface area burns needs formal fluid resuscitation

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30
Q

What IV fluids are given to that patient?

A

IV Fluids: LR via 2 large bore

  • adults: LR 4 ml x wt (kg) x %BSA
  • children LR 3 ml x wt (kg) x %BSA
  • half given her the first 8 hours, then 16 hours
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31
Q

What is contact dermatitis?

A

a skin rash caused by contact with a certain substance

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32
Q

What are acute contact dermatitis characteristics?

A

erythema, vesicles, bullae burning, itching, erythema

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33
Q

What are chronic contact dermatitis characteristics?

A

scaling, lichenification, fissure, well-demarcated Ford

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34
Q

What is the allergic etiology of contact dermatitis?

A
  • nickel, poison ivy, etc.

- type 4 hypersensitivity

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35
Q

What is irritant etiology of contact dermatitis?

A

a direct toxic effect of an offending agent on the skin (cleaners, solvents, detergents, urine, feces)

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36
Q

How is contact dermatitis dx?

A

History and physical

  • conduct patch testing to verify
  • allergy referral
  • sick prick tests NOT used for contact dermatitis
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37
Q

What is the treatment of contact dermatitis?

A
  • review medications: OTX, RX, homeopathic, hot water, humidifier
  • Antihistamine (hydroxyzine or Benadryl), animals
  • Zinc oxide (diaper rash)
  • avoid agent, topical (triamcinolone cream 0.1%) or oral steroids, Burow’s solution (aluminum acetate)
  • PUVA phototherapy
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38
Q

What is diaper dermatitis?

A

rash on buttocks region, common in infants 3 weeks - 2 years

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39
Q

What causes diaper dermatitis?

A

wet, dark, friction, urine, feces, and microorganisms

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40
Q

What are the symptoms of diaper dermatitis?

A

fussiness, crying with diaper change, diarrhea, shiny erythema with dull margins

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41
Q

What secondary infections can occur with diaper dermatitis?

A
  • satellite lesions - candidiasis
  • impetigo (s. aureus)
  • herpes simplex virus (child sexual abuse)
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42
Q

What is the dx of diaper dermatitis?

A

laboratory tests are not necessary but may help confirm the diagnosis in recalcitrant cases

  • KOH prep and fungal culture of skin scrapings for candida
  • viral culture, mineral oil slide for scabies
  • culture for skin lesions for s. aureus or group A streptococcus
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43
Q

What is the tx of diaper dermatitis?

A

Keep area dry to allow airflow

  • barrier creams zinc oxide/petroleum jelly
  • Candidiasis: nystatin, clotrimazole, econazole x 2 week
  • discuss proper diaper changes, disposable, avoid tight-fitting
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44
Q

What is perioral dermatitis?

A
  • young women, papulopustular, plaques, and scales around the mouth
  • lip margin (vermillion borde) is spared
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45
Q

What is the dx of perioral dermatitis?

A

clinical, a biopsy may help

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46
Q

What is the tx of perioral dermatitis?

A

-topical metronidazole, avoid steroids

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47
Q

What is the tx of mild perioral dermatitis?

A
  • topical alone 1st line
  • topical pimecrolimus 0.1%
  • erythromycin solution q12h
  • metronidazole 0.75% gel q12h
  • clindamycin lotion q12 hours
  • oral abx: doxycycline if necessary - no gels, solutions, or lotions on eye
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48
Q

What is the tx of moderate perioral dermatitis?

A

topical + oral ABX

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49
Q

What is drug eruptions?

A

an adverse cutaneous reaction in response to the administration of a drug; usually within the past 6 weeks

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50
Q

Where does the most common adverse drug reaction occur on the body?

A

skin

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51
Q

What drugs commonly cause drug eruptions?

A
  • penicillin such as amoxicillin, ampicillin
  • bactrim
  • allopurinol
  • NSAIDs
  • calcium channel blockers
  • sulfonamides
  • anticonvulsants
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52
Q

What is the dx of drug eruptions?

A

typically clinical

  • any new medications taken in the past 6 weeks should be appropriately documented
  • complex drug eruption should be worked up
  • CBC, CMP should be ordered to evaluate liver and kidney functions
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53
Q

What is the tx of drug eruptions?

A

remove the offending drug once identified is the first treatment measure

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54
Q

What is erythema multiform?

A

an acute, self-limited and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction affecting the skin and mucous membranes

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55
Q

What is the most common cause of erythema multiform?

A

infection, herpes simplex, mycoplasma pneumonia, upper respiratory infections

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56
Q

What are the less common causes of erythema multiform?

A

drugs (sulfonamides, Beta-lactams, phenytoin), often idiopathic

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57
Q

What are the common clinical findings of erythema multiform?

A
  • target (iris) lesions, dull “violet” red
  • macules, vesicles, central bull with pale red rim and peripheral red halo
  • blanching and lack of itchiness help characterize this rash
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58
Q

What is major erythema multiform?

A

causes widespread skin lesions and affects 2+ mucosal sites

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59
Q

What is minor erythema multiform?

A

affects a limited region of the skin and 1 type of mucosa (usually oral)

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60
Q

What is the dx of erythema multiform?

A
  • presents as raised (papular), target lesions with multiple rings and dusky center (as opposed to annular lesions in urticaria)
  • negative nikolsky sign
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61
Q

What is the tx of erythema multiform?

A

Remove the offending agent

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62
Q

What is the tx of mucocutaneous lesions of erythema multiform?

A
  • IV fluids if needed
  • oral compound solution (throat soothe/magic swizzle)
  • systemic steroids for severe(prednisone 40-60 mg)
63
Q

What is the tx of ocular lesions of erythema multiform?

A

immediate referral/consult

64
Q

What is the tx of recurrent erythema multiform?

A

antiviral QD

65
Q

What is erythema infectious (fifth disease)?

A
  • Parvovirus B19 - “slapped cheek” rash on face - lacy reticular rash on extremities, spares palms and soles
  • resolves in 2-3 weeks
  • treatment is supportive, anti-inflammatories
66
Q

What is hand-foot-and mouth disease?

A
  • children <10 years old caused by coxsackievirus type A virus producing sores in mouth and rash on the hands, feet, mouth, and buttocks
  • usually clears up on its own within 10 days
  • treatment is supportive, anti-inflammatories
67
Q

What are the 4 C’s of measles (rubeola)?

A

cough, coryza, conjunctivitis, and cephalocaudal spread

68
Q

What does the rash of of measles (rubeola) look like?

A
  • morbilliform- maculopapular, brick red rash on face beginning at hairline then progressing to palms and soles last - rash lasts 7 days
  • koplik spots (small read spots in buccal mucosa with blue-white pale center) precedes rash by 24-48 hours
69
Q

What is the treatment of measles (rubeola)?

A

supportive - anti-inflammatories, isolate for 1 week after onset of rash
-MMR vaccine (12-15 months, 4-6 years)

70
Q

What is rubella (German measles)?

A

“3-day rash” pink light-red spotted maculopapular rash first appears on face, spreads caudally to the trunk and extremities and becomes generalized within 24 hours (lasts 3 days)

71
Q

What is the spread of rubella (German measles)?

A

-cephalocaual spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular)

72
Q

What is Roseola (sixth disease)?

A
  • herpesvirus 6 or 7, only childhood exanthema that starts on the trunk and spreads to the face
  • high fever 3-5 days then rose pink maculopapular blanch able rash on trunk/back and face
73
Q

What is the treatment of Roseola (sixth disease)?

A

supportive and is most cases, roseola is a benign and self-limited disease

  • fever can be controlled with antipyretics if it is associates with discomfort
  • the rash resolves without treatment
74
Q

What is impetigo?

A

a highly contagious skin infection

-area of superficial skin trauma

75
Q

What are the most common locations of impetigo?

A

face and extremities

76
Q

What is impetigo most commonly caused by?

A

S. aureus

77
Q

What are the pain symptoms are impetigo?

A
  • red sores that form around the nose and mouth

- the sores rupture, ooze for a few days, then form a yellow-brown crust

78
Q

What is the most common form of impetigo?

A

non-bollous

79
Q

What is the most common cause of non-bollous impetigo?

A

S. aureus, GABHS

80
Q

What are the characteristics of non-bollous impetigo?

A

vesicles, pustules “honey-colored” and weeping

81
Q

What is the most common cause of bullous impetigo?

A

S. aureus

82
Q

What are the characteristics of bullous impetigo?

A

Bullae, varnish-like crust, fever, diarrhea

83
Q

What is the dx of impetigo?

A

gram stain and culture, (-) Nikolsky

84
Q

What is the tx of impetigo?

A

warm water soaks 15-20 min then

-1st line topical bactroban (mupirocin) x 5 days

85
Q

What is the tx of widespread infection from impetigo?

A
  • cephalexin or erythromycin x 1 week
  • MRSA: docyclcline
  • sick + MRSA: vancomycin
  • bullous or severe: PO ABC
86
Q

what are the complications of impetigo?

A

post streptococcal glomerulonephritis

87
Q

What are the characteristics of lice?

A

pruritic scalp, body or groin

  • nits are observed as small white specs on the hair shaft
  • body (corporis)
  • pubic (pubis)
88
Q

What is the tx of lice?

A

launder potential formats such as sheets in hot water

  • permethrin topical is the drug of choice
  • Capitis: permethrin shampoo x10 minutes
  • Pubis: permethrin lotion x 8 hours
89
Q

What is lichen planus?

A

a chronic papulosquamous inflammatory dermatosis of unknown etiology, probably autoimmune in origin

90
Q

What are the characteristics of lichen planus?

A
  • appears as purplish, itchy, flat-topped bumps
  • on mucous membranes, such as in the mouth
  • forms lacy white patches, sometimes with painful sores
91
Q

What are the 5 P’s of lichen planus?

A
  • purple
  • papule
  • polygonal
  • pruritus
  • planar
92
Q

What is Wickham striae?

A

whitish lines visible in the papule of lichen planus and other dermatoses

93
Q

What is the treatment of lichen planus?

A

topical steroids

94
Q

When does pityriasis rosea occur?

A

children and young adults

95
Q

What is pityriasis rosea characterized by?

A

an initial herald patch, followed by the development of a diffuse papulosquamous rash in Christmas tree pattern

96
Q

What is a herald patch?

A

large oval plaque with central clearing and scaly border

-1st sign of pityriasis rosea

97
Q

What is the tx of pityriasis rosea?

A

self limiting: topical or systemic steroids and antihistamines are often used to relieve itching
-asymptomatic lesion do not require treatment

98
Q

What is scabies?

A

pruritic papules: S-shaped or linear burrows on the skin

  • often located in web spaces of hands, wrists, waist with sever itching
  • worse at night
99
Q

How is scabies diagnosed?

A

microscopic observation of mite, egg or feces after skin scrape

100
Q

What is the treatment of scabies?

A
  • topical permethrin 5% - apply to entire body and wash after 8-14 hours - repeat in one week (>2 months old)
  • sulfur 5-10% ointment (<2 months)
  • all clothing bedding, towels washed and dried using heat and have no contact with the body for at least 72 hours
101
Q

What is the treatment of scabies for extensive involvement or immunocompromised individual?

A

oral ivermectin

  • (0.2 mg/kg) - often 3 mg tabs take four now and repeat in 2 weeks
  • do no use in pregnant/breastfeeding women or children <15 kg
102
Q

How long may the pruritus with scabies last?

A

2-4 weeks after treatment

103
Q

What is Stevens-Johnson syndrome?

A

a rare, serious hypersensitivity complex that affects the skin and the mucous membranes
-usually a reaction to a medication or an infection commonly caused by anticonvulsant and sulfa drugs

104
Q

How much of you body does Stevens-Johnson syndrome cover?

A

3-10%

105
Q

What are the characteristics of Stevens-Johnson syndrome?

A
  • begins with prodrome of flu-like symptoms, followed by a painful red or purplish rash the spreads and blisters
  • layers of skin peel away in sheets (+) Nikolsky’s sign (pushing blisters causes further separation from the dermis)
106
Q

What is the difference between Stevens-Johnson syndrome and toxic epidermal necrolysis?

A

less than 10% of body surface area detachement

107
Q

What is the dx of Stevens-johnson syndrome?

A

skin biopsy shows necrotic epithelium

108
Q

What are the ddx of Stevens-Johnson syndrome?

A

erythema multiforme, viral exanthema, drug rash

109
Q

What is the tx of Stevens-Johnson syndrome?

A

stop all offending medications, early admission to burn unit, manage fluid/electrolytes/nutrition, airway stability, eye care

  • IVIG
  • steroids used to be tx of choice but now thought to increase risk of sepsis
110
Q

What is tinea?

A

superficial fungal infections of the skin, hair and nails are characterized by erythema, scaling, changes in color and pruritus

111
Q

What are the risk factors of tinea?

A

increased skin moisture, immunodeficiency (HIV, DM),, peripheral vascular disease

112
Q

How do you dx tinea?

A

KOH

113
Q

What does the KOH of dermatophytes look like?

A

long, branching fungal hyphae with septations

114
Q

What does the KOH of candidiasis look like?

A

budding yeast, pseudohyphae

115
Q

What does the KOH of tinea versicolor look like?

A

short hyphae and clusters of spores (“spaghetti and meatballs”)

116
Q

What is tinea barbae?

A

papules pustules, around hair follicles

117
Q

What is the treatment of tinea barbae?

A

oral anti fungal therapy is necessary - two or four week course of griseofulvin microsize or oral terbinafine, itraconazole and fluconazole are also effective for dermatophyte folliculitis

118
Q

What is tinea pedis?

A

athlete’s foot: pruritic scaly eruptions between toes

119
Q

What is the most common dermatophyte to cause athlete’s foot?

A

trichophyton rubrum

120
Q

What is the treatment for tinea pedis?

A

topical antifungals - azoles (1% clotrimazole, 2% ketoconazole), allylamines, butenafine, ciclopirox, tolnaftate, and amorolfine

121
Q

What is tinea unguium (dermatophyte onychomycosis)?

A

infection of the nail

122
Q

What is the treatment of tine unguium?

A

terbinafine is the first-line oral agent for mild to moderate dermatophyte onychomycosis

123
Q

What is tinea cruris?

A

“jock itch” diffusely red rash in the groin or on the scrotum

124
Q

What is the treatment for tinea cruris?

A

topical antifunals - azoles (1% clotrimazole, 2% ketoconazole), allylaines, butenafine, ciclopirox, and tolnaftate is effective
-nystatin is not effective for dermatophyte infections

125
Q

What is the most common fungal infection in the pediatric population?

A

tinea capitis

126
Q

When does tinea capitis mainly occur?

A 
prepubescent children (between ages 3 and 7 years) 
-asymptomatic carriers are common and contribute to spread
127
Q

What is the treatment of tinea capitis?

A

systemic therapy warranted to penetrate the hair shaft

  • oral griseofulvin (drug of choice)
  • in addition, topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly surpasses viable spores
  • laboratory monitoring is not needed
128
Q

What is tinea corporis?

A

ringworm

-usually seen in younger children or in young adolescents with close physical contact with others (wrestlers)

129
Q

What is the treatment for tinea corporis?

A

topica asole antifungals (1% clotrimazole, 2% ketoconzole) or 1% terbinafine cream applied twice daily for 2-4 weeks

130
Q

What is tinea versicolor caused by?

A

Malassezia furfur

131
Q

What is tinea versicolor?

A
  • a yeast found on the skin of humans

- lesions consist of hypo and hyperpigmented macule that do no tan

132
Q

What is the treatment of tinea versicolor?

A

selenium sulfide 2.5% applied to the affected skin for 10 minutes
-wash off thoroughly, apply daily for 7-10 days, monthly applications may help prevent recurrences

133
Q

What is not an effective treatment for dermatophyte infections?

A

nystatin

134
Q

What is toxic epidermal necrolysis?

A

a rare, life-threatening skin condition that is usually caused by a reaction to drugs

135
Q

How much of your body does toxic epidermal necrolysis cover?

A

30%

136
Q

What is the difference between Steven Johnsons Syndrome and Toxic epidermal necrolysis?

A

older patients and >30% of body surface affected

137
Q

What is the dx of toxic epidermal necrolysis?

A

biopsy (necrotic epithelium)

138
Q

What is the tx of toxic epidermal necrolysis?

A

admit to burn unit with supportive care, consult ophthalmology if eyes affected, cyclosporine and possibly plasma exchange for severe cases

139
Q

What is urticaria?

A

hives a skin rash triggered by a reaction to certain foods, medications, stress or other irritants

140
Q

What are the symptoms of urticaria?

A

blanchable, pruritic, raised, red or skin-colored papules, wheels, or plaques on the skin’s surface, usually disappear within 24 hours

141
Q

What is the Darier’s sign?

A

localized urticaria appearing where the skin is rubbed (histamine release)

142
Q

Does urticaria have a positive or negative daters sign?

A

positive

143
Q

What is angioedema?

A

painless, deeper form of urticaria affection the lips, tongue, eyelids, hand, and genital

144
Q

What is the dx of urticaria?

A

extensive lab testing not indicated, skin or IgE testing limited to the specific history of provoking allergen

145
Q

What is the tx of urticaria?

A

hives usually go away without treatment but antihistamine medications are often helpful in improving symptoms

  • second generation antihistamine blockers (H1) are first-line treatment (Allegra, Claritin, Clarinex, Zyrtec)
  • first generation antihistamine for sleep disturbances: hydroxyzine/diphenhydramine
  • H2 antihistamine as adjuvants: cimetidine, ranitidine
  • steroids for exacerbations avoid chronic use
146
Q

What is used for anaphylaxis?

A

epinephrine

147
Q

What is verrucae (ReelDx)?

A

warts

148
Q

What are all warts caused by?

A

Human papilloma virus - most resolve without treatment over 2 years

149
Q

What are verruca vulgaris?

A
  • common warts

- skin-colored papillomatous papules

150
Q

What is verruca plana?

A
  • flat warts

- hands, face, arms, legs

151
Q

What is verrucae plantaris?

A
  • plantar warts

- bottom of foot, rough surface, dark spot (thromboses capillaries)

152
Q

What is condyloma acuminatum?

A
  • venereal warts

- flesh-colored, cauliflower appearance genital warts caused by HPV types 6 and 11

153
Q

What is epidermodysplasia verruciformis?

A

a rare, lifelong hereditary disorder characterized by chronic infection with HPV

154
Q

What is the tx of warts?

A

most resolve without treatment over 2 years

  • cryotherapy with liquid nitrogen may be applied with a cotton swab or with a cryotherapy gun
  • self-administered topical therapy such as salicylic acid

Peds EOR (12 decks)

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