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Surgery > Dermatology from PANCE Pearls > Flashcards

Dermatology from PANCE Pearls Flashcards

1
Q

What is a Cutaneous Drug Reaction

A

Medication-induced changes in skin and mucous membranes
Most are hypersensitivity reactions
Most are self-limiting if offending drug is discontinued

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2
Q

What are triggers for Cutaneous Drug Reactions

A

Antigen from foods, insect bites, drugs, environmental, exercise, infectious

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3
Q

What is a Type I Hypersensitivity Reaction

A

Ig-E mediated
Urticaria and Angioedema
Immediate

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4
Q

What is a Type II Hypersensitivity Reaction

A

Cytotoxic, Ab-mediated

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5
Q

What is a Type III Hypersensitivity Reaction

A

Immune Antibody-Antigen Complex

Such as drug-mediated vasculitis and serum sickness

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6
Q

What is a Type IV Hypersensitivity Reaction

A

Delayed (Cell Mediated)

Such as Erythema Multiforme

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7
Q

What is an Exanthematous/Mobiliform Rash
When does the rash begin
What types of drugs cause it

A

Generalized, bright red macule and papules that coalesce to form plaques
Rash starts 2-3 days after initiation of meds
Antibiotics, NSAIDS, Allopurinol and Thiazide Diuretics

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8
Q

What is an Urticarial Rash
When does the rash begin
What types of drugs cause it

A

Blanchable, edematous pink papule, wheals or plaques
Occurs within minutes to hours of drug administration
Antibiotics, NSAIDS, Opiates and radio contrast

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9
Q

What is Erythema Multiforme

What types of drugs cause it

A

Target Lesions

Sulfonamides, Penicillins, Phenobarbital, Dilantin

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10
Q

What general sx are seen with drug reactions

A

Fever, abdominal pain, joint pain

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11
Q 
Tx of drug reactions
Exanthematous
Urticaria
Erythema Minor
Anaphylaxis
A 
Discontinue medication is #1
Exanthematous: Histamines
Urticaria: Corticosteroids, Antihistamines
Erythema Minor: Sx
Anaphylaxis: IM Epinephrine
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12
Q

What is Urticaria/Angioedema

A

Hives

A type I HSN IgE

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13
Q

Sx or Urticaria

A

Blanchable, edematous pink papules, wheals or plaques
Darier’s Sign: Localized urticaria appearing where the skin is rubbed (histamine induced)
Angioedema: Painless, deeper form of urticaria affecting lips, tongue, eyelids, hands feet and genitals

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14
Q

Tx of Urticaria

A

Antihistamines
Eliminate triggers
H2 blockers
Corticosteroids

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15
Q

What is Erythema Multiforme

A

Acute self-limited type IV HSN reaction

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16
Q

What are common drugs that result in Erythema Multiforme

A

Sulfa Drugs
Beta-Lactams
Phenytoin
Phenobarbital

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17
Q

Sx of Erythema Multiforme

A

Traget lesions
Dusty-violet red purpuric macule/veicle or bullae in center surrounded by pale edematous rim and peripheral red halo
Fever

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18
Q

Tx of Erythema Multiforme

A

Discontinue drugs
Treat sx
Antihistamines, Analgesics, Skin care, Steroids

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19
Q

What is Steven Johnson Syndrome and TEN

What are drugs that cause it

A

Drug Eruption
SJS 30% surface affcted
Usually with Sulfa and Anticonvulsants
If infectious: Mycoplasma, HIV, HSV

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20
Q

Sx of Steven Johnson Syndrome and TEN

A

Fever, URI sx, widespread blisters that begin on trunk/face, erythematous/pruritic macules with epidermal detachment (positive Nikolsky sign)

21
Q

TX of Steven Johnson Syndrome and TEn

A

Treat like severe burns

Hydrate!

22
Q

What is Basal Cell Carcinoma

A

Most common type of skin cancer in US
Found in fair-skinned people with prolonged sun exposure, xeroderma
Slow growing, locally invasive but low incidence of mets

23
Q

Sx of Basal Cell Carcinoma

A

Flat firm area with small raised, translucent/pearly/waxy papule with central ulceration and raised rolled borders
Usually seen on face/nose/trunk
Friable (bleeds easily)
May have Telengiectasis

24
Q

Dx of Basal Cell Carcinoma

A

Punch or Shave Biopsy, see basophilic cells

25
Q

Tx of Basal Cell Carcinoma

A

Electric Desiccation/curettage

Excision, cryosurgery

26
Q

What is a Squamous Cell Carcinoma

A

Second most common skin cancer
Often preceded by actinic keratosis, HPV infection, sun exposure
Usually found on lips, hands, neck, and head

27
Q

What is Bowen’s Disease

A

Squamous Cell Carcinoma in situ

Slow growing, rarely mets

28
Q

Sx of Squamous Cell Carcinoma

A

Red, Elevated nodule with adherent white scaly or crusted bloody margins

29
Q

Dx of Squamous Cell Carcinoma

A

Biopsy

Epidermal and Dermal cells with large pleumorphic hyperchromatic nuclei

30
Q

Tx of Squamous Cell Carcinoma

A

Excision

31
Q

What is Melanoma

A

Skin Cancer
UV radiation is most common cause
Aggressive, high Mets potential
Light-skinned, light hair, light eye color most at risk

32
Q

Sx of Melanoma

A

ABCDE

Asymmetry, Irregular borders, Dark Color, >6mm Diameter, Evolution

33
Q

What is the most important factor for prognosis of a Melanoma

A

Thickness

34
Q

Dx of Melanoma

A

Full thickness wide excisional biopsy with lymph node biopsy

NO Shave Biopsy

35
Q

Tx of Melanoma

A

Excision with lymph node dissection

36
Q

What is Cellulitis

A

Acute, spreading superficial infection of dermal, subcutaneous tissues caused by S. Aureus, Group A Strep
Usually occurs after a break in the skin (trauma, surgical wounds)

37
Q

Sx of Cellulitis

A 
Macular erythema (margins flat, not sharply demarcated), swelling, warmth, and tenderness
Fevers, Chills, Lymphangitis, Myalgias
38
Q

Tx of Cellulitis

A

Cephalexin, Dicloxacillin
Erythromycin or Clindamycin if PCN allergy
Vancomycin or Linezolid if MRSA
Cat Bite (Pasteurella Multocida): Augmentin, Doxy if PCN allergy
Puncture Wound: Ciprofloxacin

39
Q 
What is a 1st degree burn
Depth
Appearance
Sensatin
Capillary Refill
Prognosis
A 
Superficial
Epidermis
Erythematous and Dry, Painful, tender to touch
Refill Intact, Blanches with pressure
Heals within 7 days, No scarring
40
Q 
What is a 2nd degree burn (Superficial Partial Thickness)
Depth
Appearance
Sensatin
Capillary Refill
Prognosis
A

Epidermis + Superficial portion of dermis
Erythematous, Pink, Moist, Weeping, Blisters
MOST painful of all burns, Very tender to touch
Refill Intact, blanches with pressure
Heals within 14-21 days, No scarring but leaves pigment changes

41
Q 
What is a 2nd degree burn (Deep Partial Thickness)
Depth
Appearance
Sensatin
Capillary Refill
Prognosis
A

Epidermis into deep portion of dermis
Red, yellow, pale white, dry, Blisters
Not usually painful, Possible pain with pressure
No Refill
Heals in 3 weeks - 2 months, Scarring is common

42
Q 
What is a 3rd degree burn
Depth
Appearance
Sensatin
Capillary Refill
Prognosis
A 
Extends through entire skin
Waxy, White, Leathery, Dry
Painless
No Refill
Heals in months, Does not spontaneously heal well
43
Q 
What is a 4th degree burn
Depth
Appearance
Sensatin
Capillary Refill
Prognosis
A 
Entire skin into underlying fat, muscle, bone
Black, Charred, Eschar, Dry
Painless
No Refill
Does not Heal
44
Q

What is a minor burn

A
45
Q

What is a major burn

A 
>25% total body surface area in adults
>20% total boy surface area in young/old
>10% full thickness burns
Involves the face, hands, perineum, feet
Cross major joints
Circumferential
46
Q

Tx of Burns

A 
Clean with mild soap and water
NO ice or ointments
Debridement
Tx pain: Acetaminophen, NSAIDS, Opioids
Abx
Silver Sulfadiazine (none on face)
Aloe Vera
Dressings for partial and full-thickness, fingers and toes individually wrapped
IV Fluid Resuscitation: Parkland Formula (Lactated Ringers 4mL/kg/%total surface area for 24 hours.  Give half in the first 8 hours, the other half in the remaining 18 hours
47
Q

Tx of Chemical Burns

A

Irrigate profusely with running water for 20 minutes

48
Q

What is a Pressure Ulcer

Stage I - IV

A

Stage I: Superficial, nonblanchable redness that does not dissipate after pressure is relieved
Stage II: Epidermal damage into dermis. Looks like a blister or abrasion
Stage III: Full thickness of skin and may extend into subcutaneous layer
Stage IV: Deepest, Extending into muscle, tendon or bone

Surgery (12 decks)

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