Dermatology

Question 1

What is basal cell carcinoma?

Answer 1

a type of cancer that begins in the basal cells

• basal cells produce new skin cells as old ones die
• limiting sun exposure can help prevent these cells from becoming cancerous
• typically appears as a white waxy lump or a brown scaly patch, raised pearly and rolled borders, telangiectasis, central ulcer on sun-exposed areas, such as the face and neck

Question 2

What is the treatment for basal cell carcinoma?

Answer 2

prescription creams fluorouracil (FU)) and imiquimod, photodynamic therapy (PDT), and surgical excision with clear margins

Question 3

What are the body percentages for burns?

Answer 3

• rule of 9’s: 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%
• palmar method: patient’s palm equated to 1%

Question 4

What is a 1st degree burn?

Answer 4

sunburn

-erythema of involved tissue, skin blanches with pressure, the skin may be tender

Question 5

What is a 2nd degree burn?

Answer 5

partial thickness

-skin is red and blistered, skin is very tender

Question 6

What is a 3rd degree burn?

Answer 6

full thickness

-burned skin is tough and leathery, skin non-tender

Question 7

What is a 4th degree burn?

Answer 7

into the bone and muscle

Question 8

What is the treatment for burns?

Answer 8

monitor ABCs, fluid replacement, sulfadiazine
-children with >10% total body surface area and adults with >15% total body surface ares burns need formal fluid resuscitation

Question 9

What is cellulitis?

Answer 9

an acute bacterial skin and skin structure infection of the dermis and subcutaneous tissue; characterized by pain, erythema, warmth, and swelling
-margins are flat and not well demarcated
-caused by staphylococcus and streptococcus in adults
H. influenzas or strep pneumonia in children

Question 10

What is the tx for cellulitis?

Answer 10

• treat mild cellulitis (MSSA) with cephalexin or dicloxacilin
• treat methicillin-resistant staphylococcus aureus infection (MRSA) with
• trimethoprim-sulfamethoxazole (TMP-SMZ) 1 DS tab PO BID
• clindamycin 300-450 mg PO
• doxycycline 100 mg PO BID
• Intravenous vancomycin or linezoild

Question 11

What are the signs and symptoms of mastitis/breast abscess?

Answer 11

nipple discharge, redness, warm skin

Question 12

What are the signs and symptoms of breast cancer?

Answer 12

nipple discharge, breast discomfort, breast mass

Question 13

What are the signs and symptoms of gynecomastia?

Answer 13

nipple discharge, breast enlargement, overweight

Question 14

What are the signs and symptoms of inflammatory breast cancer?

Answer 14

nipple discharge, breast enlargement, redness

Question 15

What are the signs and symptoms of hypogonadism?

Answer 15

nipple discharge, sexual dysfunction, reduced sex drive

Question 16

What are GU processes that cause discharge?

Answer 16

• infections of the vagina, such as a yeast infection, bacterial vaginosis, trichomoniasis, human papillomavirus (HPV), or herpes
• Infection of the cervix (cervicitis)
• an object in the vagina, such as a forgotten tampon
• sexually transmitted infections (STIs), such as chlamydia or gonorrhea
• various sex practices, such as oral-to-vaginal and anal-to-vaginal contact
• vaginal medicines or douching
• menopause: vaginal discharge, an absence of menstruation, anxiety

Question 17

What are the signs and symptoms of abscess?

Answer 17

pain, redness, with or without discharge

Question 18

What is a drug eruption?

Answer 18

drug-induced exanthema are the most common cutaneous reactions to drugs, responsible for approximately 90 percent of all drug rashes
-the most commonly prescribed medications (eg, antibiotics, sulfonamides) are implicated in most cases

Question 19

What is the dx of drug eruption?

Answer 19

clinical evaluation and skin biopsy - shows necrotic epithelium

• diagnosis is often obvious from the appearance of lesions and rapid progression of symptoms
• histologic examination of sloughed skin shows necrotic epithelium, a distinguishing feature
• differential diagnosis in SJS and early TEN include erythema multiforme, viral exanthema, and other drug rashes

Question 20

What is the tx for drug eruption?

Answer 20

stop all potentially offending medications

• early admission to burn out or pediatric intensive care unit for initial stabilization and management of fluid, electrolytes, and nutrition; airway stability; and eye care
• prompt ophthalmology and dermatology consultation
• Intravenous immunoglobulin (IVIG)
• steroids used to be the treatment of choice are now thought to be an increased risk for sepsis

Question 21

What is melanoma?

Answer 21

usually a pigmented lesions with an irregular border, irregular surface, or irregular coloration
-melanoma occurs when the pigment-producing cells that give color to the skin (melanocytes) become cancerous

Question 22

What are the symptoms of melanoma?

Answer 22

• symptoms might include a new, unusual growth or a change in an existing mole
• melanomas can occur anywhere on the body
• asymmetrical, unevenly pigmented patch/plaque with a nodule and an irregular border

Question 23

What are the ABCDE of melanoma?

Answer 23

Asymmetry 
Border is irregular 
Color variability (blue, red, white) 
Diameter (increase or > 6 mm) 
Elevation (raised) 
-prognosis of melanoma is most strongly associated with the depth of the lesion, based on the Clark Classification System of Microstaging

Question 24

What is the clark classification system of Microstaging?

Answer 24

• level I: confined to the epidermis (in situ)
• level II: invasion into the papillary dermis
• level III: penetration to the papillary-reticular dermis
• level IV: invasion into the reticular dermis
• level V: penetration into the subcutaneous fat

Question 25

What is the tx for melanoma?

Answer 25

may involved Mohs surgery, radiation, medications, or in some cases chemotherapy

Question 26

Where do pressure ulcers most often affect?

Answer 26

serum and hip most often affected, reposition every 2 hours

Question 27

What is a stage I pressure ulcer?

Answer 27

erythema of localized area, usually non-blanching over the bony surface

Question 28

What is a stage 2 pressure ulcer?

Answer 28

partial loss of dermal layer, resulting in pink ulceration

Question 29

What is a stage 3 pressure ulcer?

Answer 29

full dermal loss often exposing subcutaneous tissue and fat

Question 30

What is a stage 4 pressure ulcer?

Answer 30

full thickness ulceration exposing bone, tendon, or muscle | -osteomyelitis may be presetn

Question 31

How is a stage 1 pressure ulcer treated?

Answer 31

aggressive preventive measures, thin film dressings for protection

Question 32

How is a stage 2 pressure ulcer treated?

Answer 32

occlusive dressing to maintain healing, transparent films, hydrocolloids

Question 33

How is a stage 3-4 pressure ulcer treated?

Answer 33

debridement of necrotic tissue - exudative ulcers will benefits from absorptive dressings such as calcium alginates, foams, hydrofibers - dry ulcers require occlusive dressing to maintain moisture, including hydrocolloids, and hydrogels

Question 34

What are the differential diagnosis for a rash?

Answer 34

- Antibiotics side effects: adverse antibiotic reactions may occasionally mimic infection by causing fever, skin rashes, and mental status changes - Zinc deficiency is characterized by a perioral pustular rash - Paget disease is a rare condition characterized by an intraepithelial adenocarcinoma of the perianal skin. The most common presenting complaint is intolerable pruritus and examination typically revels a well-demarcated, erythematous, eczematous rash - Herpes zoster presents with classic vesicular lesions which develop unilaterally in a dermatomal distribution - Herpes simplex presents with clear vesicles on an erythematous base; crusting - Systemic rheumatoid disease (still's disease) usually presents with multiple (more than five) involved joints, fever, lymphadenopathy, hepatosplenomegaly, rash, subcutaneous nodules, and pericarditis - Fat emboli from long bone fractures cause a syndrome characterized by respiratory insufficiency, coagulopathy, encephalopathy, and an upper body petechial rash

Question 35

What is the tx for a rash?

Answer 35

decide whether to observe and treat empirically, perform diagnostic testing, or refer to dermatology for workup

Question 36

What is redness/erythema?

Answer 36

can be caused by infection (cellulitis), massage, electrical treatment, acne medication, allergies, exercise, solar radiation (sunburn), photosensitization, cutaneous radiation syndrome, mercury toxicity, blister agents, niacin administration, or waxing and tweezing of the hairs - any of which can cause the capillaries to dilate, resulting in redness -erythema is a common side effect of radiotherapy treatment due to patient exposure to ionizing radiation

Question 37

What are the differential diagnosis for redness/erythema?

Answer 37

- ulcer - eczema - stasis and contact dermatitis - drug allergy - cellulitis, MRSA - erysipelas - chemical burns - angioedema and urticaria - venous insufficiency - Impetigo - herpes zoster - scarlet fever - tinea infections - psoriasis - acne - polycythemia vera - paronychia - osteomyelitis - abscess - autonomic hyperreflexia - lymphadenitis - carbuncle - neutropenia

Question 38

What is squamous cell carcinoma?

Answer 38

raised, slightly pigmented skin lesion; ulceration/exudate; chronic scab; itching

Question 39

What is urticaria?

Answer 39

(hives) is a skin rash triggered by a reaction to certain foods, medications, stress, or other irritants - symptoms include blanch able, pruritic, raised, red, or skin-colored papules, wheels or plaques on the skin's surface - (+) Darier's sign: localized urticaria appearing where the skin is rubbed (histamine release) - angioedema: painless, deeper form of urticaria affecting the lips, tongue, eyelids hand, and genital

Question 40

What is the tx for urticaria?

Answer 40

hives usually go away without treatment, but antihistamine medications are often helpful in improving symptoms - If anaphylaxis give epinephrine 0.3 -0.5 mg; use 1:1,000 dilution for IM route and 1:10,000 for IV route - peds: epinephrine 0.1 mg/kg SC/IV