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Online Med Ed > Dermatology > Flashcards

Dermatology Flashcards

1
Q

blistering diseases

A

pemphigus vulgaris
bullous pemphigoid
dermatitis herpetiformis
porphyria cutanea tarda

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2
Q

pemphigus vulgaris path

A

anti-desmoglein antibodies = desmosomes

intra-epithelial lesions

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3
Q

pemphigus vulgaris pt

A

thin, easily torn blisters (+ Nikolsky)
INVOLVES mucosa
age 30-50

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4
Q

pemphigus vulgaris dx

A

biopsy showing tombstoning

immunofluorescence shows intra-epithelial pattern, surround cells

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5
Q

pemphigus vulgaris tx

A

acute, life-threatening = IVIG
acute, not life-threatening = steroids
chronic = mycophenolate or rituximab

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6
Q

bullous pemphigoid path

A

anti-hemidesmosome antibody

sub-epidermal lesion

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7
Q

bullous pemphigoid pt

A

tense, rigid bull (- Nikolsky)
no mucosa
age 70-80

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8
Q

bullous pemphigoid dx

A

biopsy intact epithelium detached from basement membrane

immunofluorescence shows antibodies at dermal-epidermal junction

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9
Q

bullous pemphigoid tx

A

steroids

  • topical for limited
  • systemic for severe
    mild: dapsone + nicotinamide
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10
Q

dermatitis herpetiformis path

A

deposition disease, papillae
IgA anti-transglutaminase
cutaneous manifestation of celiac sprue

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11
Q

dermatitis herpetiformis pt

A

palpable pruritus rash on extensor surfaces and buttocks

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12
Q

dermatitis herpetiformis dx

A

anti-transglutainase, anti-endomysial
EGD = smooth vili
biopsy not needed = neutrophilic abscess

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13
Q

dermatitis herpetiformis tx

A

remove gluten from diet

temporize with dapsone

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14
Q

porphyria cutanea tarda path

A

most common porphyria
uroporphyrin decarboxylase deficiency
accumulation of uroporphyrins

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15
Q

porphyria cutanea tarda pt

A

bull on sun-exposed lesions

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16
Q

porphyria cutanea tarda dx

A

coral red urine under WOod’s lamp

24hr urine collection for uroporphyrins

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17
Q

porphyria cutanea tarda tx

A

avoid the sun

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18
Q

porphyria cutanea tarda f/u

A

look for hemochromatosis, HepC, EtOH, and OCPs

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19
Q

papulosquamous dermatoses

A

seborrheic dermatitis
psoriasis
pityriasis rosea
lichen planus

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20
Q

seborrheic dermatitis path

A

fungal infection

‘dandruff plus’

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21
Q

seborrheic dermatitis pt

A

rash and flakes seen on scalp and eyebrows, hair-bearing regions only

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22
Q

seborrheic dermatitis dx

A

clinical

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23
Q

seborrheic dermatitis tx

A

selenium shampoo

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24
Q

seborrheic dermatitis f/u

A

HIV, cradle cap, Parkinson’s

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25
Q

psoriasis path

A

autoimmune disease, helper T cells

excess stratum corneum

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26
Q

psoriasis pt

A

symmetric, well-demarcated patches with silvery scales that bleed when picked
nail pitting, onycholysis (nail detachment)

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27
Q

psoriasis dx

A

clinical (may biopsy to r/o lymphoma)

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28
Q

psoriasis tx

A

1st: UV light
alternative: topical steroids (use sparingly)
flare: oral steroids
recalcitrant: immune modulators such as tacrolimus

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29
Q

psoriasis f/u

A

joint pain, seronegative spondyloarthropathy

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30
Q

pityriasis rosea path

A

benign, self-limiting, idiopathic

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31
Q

pityriasis rosea pt

A

flat oval-shaped salmon-colored macule (hyperpigmentation in dark skin)
scaling lesion that does not reach the border (trailing scale)

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32
Q

pityriasis rosea dx

A

RPR to r/o syphilis, pityriasis is clinical

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33
Q

pityriasis rosea tx

A

non, self-limiting

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34
Q

pityriasis rosea f/u

A

if on palms and soles, syphilis likely, should normally spare palms and soles

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35
Q

lichen planus path

A

inflammatory, idiopathic

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36
Q

lichen planus pt

A

intensely pruritic pink/purple flat-topped papules with a reticulated network of fine white lines
wrists and ankles common, can be in mouth or vagina

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37
Q

lichen planus dx

A

clinical

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38
Q

lichen planus tx

A 
topical steroids (first line)
UV light (adjunct)
oral steroids (severe)
immune modulators (recalcitrant)
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39
Q

lichen planus f/u

A

drug induced from ACE-i, thiazides, loops

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40
Q

eczematous dermatoses

A

atopic dermatitis
contact dermatitis
stasis dermatitis
hand dermatitis

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41
Q

atopic dermatitis path

A

immune reaction to allergens or foods

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42
Q

atopic dermatitis pt

A

adult: symmetric lichenification wherever the patient can reach to scratch
child: dry, red, itchy rash on cheeks and extensor surfaces, look for asthma and allergies along with atopy

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43
Q

atopic dermatitis dx

A

clinical

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44
Q

atopic dermatitis tx

A

avoidance of triggers (remove foods)

topical steroids for adult (brief use)

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45
Q

contact dermatitis path

A

hypersensitivity type IV reaction

latex, nickel, poison ivy

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46
Q

contact dermatitis pt

A

well-demarcated red rash in the shape of an object or clothing
pruritic, raised, and red

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47
Q

contact dermatitis dx

A

clinical

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48
Q

contact dermatitis tx

A

avoid contact with triggers

topical steroids

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49
Q

stasis dermatitis path

A

skin changes associated with edema

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50
Q

stasis dermatitis pt

A

edema in an extremity, chronic

brownish discoloration, erythema, scaling at site of edema

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51
Q

stasis dermatitis dx

A

clinical

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52
Q

stasis dermatitis tx

A

get the fluid out of the extremity with either diuretics if overloaded or compression stockings/leg elevation

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53
Q

hand dermatitis path

A

dermatitis isolated to the hands in someone who washes their hands a lot or deals with chemicals

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54
Q

hand dermatitis pt

A

food-service worker, healthcare worker

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55
Q

hand dermatitis dx

A

clinical

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56
Q

hand dermatitis tx

A

moisturizers and avoidance of harsh soaps

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57
Q

hypersensitivity reactions

A 
urticaria
drug reaction
erythema multiform
stevens-johnson syndrome
toxic epidermal necrosis
staphylococcal scalded skin syndrome
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58
Q

urticaria path

A

type I hypersensitivity

IgE induced mast cell degranulation -> histamine release = leaky capillaries

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59
Q

urticaria pt

A

annular, blanching red papule following any antigen exposure (bee stings, heat, pressure, medication)

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60
Q

urticaria dx

A

clinical

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61
Q

urticaria tx

A

antihistamine

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62
Q

urticaria f/u

A

send for RAST to identify culprit antigen

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63
Q

urticaria f/u

A

if anaphylaxis, give subQ epi, f/b steroids, H1-blocker and H2-blocker
- epi is crucial and is first

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64
Q

drug reaction path

A

autoimmune

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65
Q

drug reaction pt

A

pink morbilliform rash occurring 7-14d after drug exposure, usually in hospitalized patients
if day 2-3 after drug, that ISN’T the cause
wide-spread, symmetric, and pruritic

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66
Q

drug reaction dx

A

clinical

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67
Q

drug reaction tx

A

remove offending agent
diphenhydramine for mild symptoms
corticosteroids for severe symptoms

68
Q

erythema multiforme path

A

drug-reaction, HSV reaction

69
Q

erythema multiforme pt

A

targetoid lesions that appear on palms and soles

70
Q

erythema multiforme dx

A

clinical

71
Q

erythema multiforme tx

A

Acyclovir if HSV related

self-limited otherwise

72
Q

erythema multiforme f/u

A

if involving the oral mucosa, it is considered erythema multiforme major, and is SJS spectrum

73
Q

erythema multiforme f/u

A

syphilis can also present with targetoid lesions on palms and soles

74
Q

stevens-johnson syndrome/toxic epidermal necrosis path

A

drug reaction

75
Q

stevens-johnson syndrome/toxic epidermal necrosis pt

A

+ nikolsky and oral involvement

BSA: <10% SJS z> 30% TENS

76
Q

stevens-johnson syndrome/toxic epidermal necrosis dx

A

biopsy

  • SJS = basal cell degeneration
  • TENS = total epidermal thickness necrosis
77
Q

stevens-johnson syndrome/toxic epidermal necrosis tx

A

admit to burn unit, supportive care
NO steroids
withdraw all medications

78
Q

staph scalded skin syndrome path

A

intraepidermal lesions from staph toxin targeting desmoblein (desmosomes)

79
Q

staph scalded skin syndrome pt

A

NO mucosal involvement

febrile, sloughing of skin, skin folds first off the axillae and inguinal creases

80
Q

staph scalded skin syndrome dx

A

biopsy

81
Q

staph scalded skin syndrome tx

A

clindamycin (stop toxin production)

82
Q

hyperpigmentation

A 
nevus
seborrheic keratosis
actinic keratosis
squamous cell carcinoma
keratoacanthomas
kaposi's sarcoma
83
Q

nevus path

A

benign hyperplasia of melanocytes

84
Q

nevus pt

A

raised, painless, pigmented lesion that has none of the ABCDE
if hair-bearing, it is benign

85
Q

nevus dsx

A 
ABCDE... any one means malignancy
Asymmetric
Border irregularity
Color mixed
Diamter large (>5mm)
Evolving over time
86
Q

nevus tx

A

wide excisional biopsy if you think melanoma

leave it alone if all ABCDE are negative

87
Q

seborrheic keratosis path

A

looks like cancer, but isn’t

88
Q

seborrheic keratosis pt

A

large, brown, greasy, ‘stuck on’ lesions

89
Q

seborrheic keratosis dx

A

clinical

90
Q

seborrheic keratosis tx

A

leave it alone

91
Q

seborrheic keratosis f/u

A

biopsy if changing, if not changing, leave it alone.

it could be cancer if it is changing

92
Q

actinic keratosis path

A

premalignant lesion

squamous cell carcinoma in the making

93
Q

actinic keratosis pt

A

sun-exposed area (hands, face, back)
sun-exposed person (sailor, farmer)
erythematous with sandpaper-like yellow to brown scale

94
Q

actinic keratosis dx

A

biopsy

95
Q

actinic keratosis tx

A

primary prevention is key
cryosurgery if small lesion
5-FU if diffuse

96
Q

squamous cell carcinoma path

A

actinic keratosis -> carcinoma in situ -> invasive carcinoma (DOES metastasize)

97
Q

squamous cell carcinoma pt

A 
sun-exposed areas
sun-exposed person
lesion on the lower lip
dark lesion on the face, hands, back
ulcers taht fail to heal (Marjolin's ulcer)
98
Q

squamous cell carcinoma dx

A

biopsy

99
Q

squamous cell carcinoma tx

A

surgical resection

100
Q

keratoacanthomas path

A

benign lesions that look like SCC

101
Q

keratoacanthomas pt

A

they have SCC except it grew rapidly and then resolved spontaneously

102
Q

keratoacanthomas dx

A

surgical resection

103
Q

keratoacanthomas tx

A

surgical resection

104
Q

kaposi’s sarcoma path

A

malignancy of vascular endothelial cells

AIDS (CD4 <200) and HHV-8 coinfection

105
Q

kaposi’s sarcoma pt

A

purple lesions that can be literally anywhere, mouth, arms, intestines

106
Q

kaposi’s sarcoma tx

A

HAART, treat AIDS, this gets better

107
Q

kaposi’s sarcoma f/u

A

local or systemic chemo may be needed in refractory cases (do not learn chemo)

108
Q

hypopigmentation

A

tinea versicolor
vitiligo
albinism
ash leaf

109
Q

tinea versicolor path

A

infection with the fungus Malassezia furfur

110
Q

tinea versicolor pt

A

small scaly patches of hyper and hypopigmentation

111
Q

tinea versicolor dx

A

KOH prep = spaghetti and meatballs, actually hyphae and spores

112
Q

tinea versicolor tx

A

selenium sulfide

113
Q

vitiligo path

A

autoimmune disease

114
Q

vitiligo pt

A

sharply demarcated, small patches of depigmented skin, often on face, hands, and genitalia

115
Q

vitiligo dx

A

Wood’s lamp shows NO pigment

biopsy = absence of melanocytes

116
Q

vitiligo tx

A

none
cosmetics
- bleaching to lighten uniformity
- dyes/makeup to darken uniformity

117
Q

albinism path

A

tyrosinase deficiency

118
Q

albinism pt

A

pale skin, pale eyes, pale hair

119
Q

albinism dx

A

clinical

120
Q

albinism tx

A

supportive, avoid UV light

121
Q

albinism f/u

A

PKU has funny smell, intellectual disability, seizures in addition to pale skin and fair hair
screened for at birth

122
Q

ash leaf path

A

hypo pigmented (NOT depigmented)

123
Q

ash leaf pt

A

child, hypopigmented

124
Q

ash leaf dx

A

Wood’s lamp = ash leaf

CT scan head = tubers

125
Q

ash leaf tx

A

nothing can be done about tuberous sclerosis

supportive care

126
Q

skin infections

A

impetigo
erysipelas
acne vulgaris

127
Q

impetigo path

A

infection with Strep pyogenes

infection with Staph aureus (bullous)

128
Q

impetigo pt

A

child

honey-crusted lesions on face

129
Q

impetigo dx

A

clinical

130
Q

impetigo tx

A

local disease = muprocin
lots of disease = amoxicillin (strep)
refractory = clindamycin (staph)

131
Q

impetigo f/u

A

can cause post-strep glomerulonephritis

canNOT cause rheumatic fever

132
Q

erysipelas path

A

infection of strep in lymphatics

133
Q

erysipelas pt

A

dark red, clearly defined lesion in the shape of lymphatics (tracks or lines)

134
Q

erysipelas dx

A

clinical

135
Q

erysipelas tx

A

ß-lactams, amoxicillin (strep)

136
Q

acne vulgaris path

A

propionibacterium acnes

137
Q

acne vulgaris pt

A

zits, acne

138
Q

acne vulgaris dx

A

clinical

139
Q

acne vulgaris tx

A

comedones = topical retinoids
inflamed comedone = topical retinoids and benzoyl peroxide
severe pustular = oral abx (doxy)
resistant disease = isotretinoin

140
Q

acne vulgaris f/u

A

UPT before isotretinoin (teratogen)

141
Q

alopecia

A 
alopecia areata
trichotillomania
tinea capitis
traction alopecia
chemo
male-pattern baldness
142
Q

alopecia areata path

A

autoimmune disease

well-defined circular bald spot

143
Q

alopecia areata pt

A

may include entire body

exclamation point sign

144
Q

alopecia areata dx

A

clinical, r/o tinea capitis if in question

145
Q

alopecia areata tx

A

steroids

146
Q

trichotillomania path

A

compulsive disorder (OCD, PTSD, MDD)

147
Q

trichotillomania pt

A

patchy alopecia
hair in different lengths of growth
women

148
Q

trichotillomania dx

A

clinical, can use a ‘window’

149
Q

trichotillomania tx

A

treat the psychiatric disease

150
Q

tinea capitis path

A

fungal infection, trichophyton tonsurans

151
Q

tinea capitis pt

A

well-defined circular bald spot

all hairs at equal length

152
Q

tinea capitis dx

A

KOH prep

153
Q

tinea capitis tx

A 
oral antifungals (griseofulvin)
hair loss permanent if not treated
154
Q

traction alopecia path

A

scarring from pulling hair tightly

155
Q

traction alopecia pt

A

tight braiding, ponytails

hair loss is preventable, but irreversible

156
Q

traction alopecia dx

A

clinical

157
Q

traction alopecia tx

A

none

158
Q

chemo path

A

chemo targets rapidly dividing cells

159
Q

chemo pt

A

patients can lose their hair during chemo

clinical

160
Q

chemo dx

A

none

161
Q

chemo tx

A

none

162
Q

male pattern baldness path

A

5DHT (androgen) driven loss of hair

163
Q

male pattern baldness pt

A

crown thins, then loses hair

rest of hair on top of head then follows

164
Q

male pattern baldness dx

A

clinical

165
Q

male pattern baldness tx

A

1st minoxidil topical
best minoxidil topical and finasteride oral
woman = OCPs and spironolactone

Online Med Ed (18 decks)

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