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Exam 4 > Dermatology/ ID > Flashcards

Dermatology/ ID Flashcards

1
Q

<6mm, macule/papule, well-defined border, homogenous color [brown or pink]

A

benign mole

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2
Q

> 6mm, ill-defined border, irregular color

A

Atypical Nevi

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3
Q

Asians; ‘old & unchanged’ = benign; ‘new or changed’ = EVALUTE IMMEDIATELY

A

Blue nevi

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4
Q

hereditary; ↑sun exposure; fade without sun

A

freckles

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5
Q

sun exposed area; tx w/topic agents/laser/cryotherapy

A

Lentigines [sunspots]

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6
Q

benign; beige/brown. VELVETY or thick/scaly papules/plaques; stuck-on appearance. If unbothersome leave alone, may use cryotherapy otherwise

A

Seborrheic Keratosis

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7
Q

flat/raised; red, white, blue, black; RECENT CHANGE IN APPEARANCE – SUSPECT; tumor thickness = prognostic factor

A

Malignant Melanoma

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8
Q

MOST COMMON FORM OF SKIN Cx, sun-exposed areas – light-skinned pt; papule/nodule + central scab or erosion, slow-growing, waxy pearly appearance + vessels easily visible; BACK / CHEST; dx: punch/shave biopsy; MOHs = HIGHEST CURE RATE; High recurrent follow-up annually

A

Basal Cell Carcinoma

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9
Q

red, conical hard nodule ulcerate + bleed; NO HEAL; Mohs excision; follow-up 2x/yr

A

Squamous Cell Carcinoma

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10
Q

narrow linear crack into the epidermis, exposing dermis (athletes’ foot)

A

fissure

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11
Q

flat, discoloration <1cm, (freckle)

A

macule

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12
Q

flat discoloration >1cm, (vitiligo)

A

patch

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13
Q

skin thickening usually found over pruritic or friction areas atopic dermatitis, areas of recurrent scratching

A

Lichenification

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14
Q

raised, flaking lesion (dandruff, psoriasis)

A

scale

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15
Q

loss of dermis/epidermis (pressure sore)

A

ulcer

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16
Q

a vesicle-like lesion with purulent content (acne, impetigo)

A

pustule

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17
Q

raised lesion >1cm same or different color than surrounding skin (psoriasis)

A

plaque

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18
Q

in streaks (poison ivy)

A

linear

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19
Q

in a ring (erythema migrans)

A

annular

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20
Q

along neurocutaneous dermatome (herpes zoster)

A

dermatomal

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21
Q

circumscribed area of skin edema (hives, urticaria)

A

wheal

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22
Q

fluid fluid <1cm (varicella)

A

vesicle

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23
Q

fluid-filled, >1cm blister (2nd-degree burn0

A

bulla

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24
Q

raised lesion, <1cm, same or diff color than surrounding skin (raised nevus)

A

papule

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25
Q

raised lesion >1cm, usually mobile (epidermal cyst)

A

nodule

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26
Q

dry skin (atopic dermatitis)

A

xerosis

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27
Q

net like cluster

A

reticular

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28
Q

multiple lesions blend together

A

confluent

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29
Q

Small flesh-colored, pink macule/papule, feels rough like sandpaper, TENDER when brushing a finger over, affects sun-exposed area. Consider pre-malignant and may progress to SCC

A

Actinic Keratosis

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30
Q

Treatment for AK

A

cryotherapy

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31
Q

Treatment for BCC

A

Mohs

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32
Q

Treatment for Lentigines

A

topic agents/laser/cryotherapy

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33
Q

Treatment for Seborrheic keratosis

A

cryotherapy if bothersome

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34
Q

Treatment for SCC

A

Mohs

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35
Q

ORANGE-RED or GRAY WHITE with GREASY or white dry scaling macules/papules of varying size. Redness/scaling occurring in regions where sebaceous glands. Are most active – FACE & SCALP

A

Seborrheic dermatitis

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36
Q

Treatment for seborrheic dermatitis

A

topical ketoconazole and selenium sulfide – shampoo [zinc pyrithione or selenium – use daily WASH HEAD TO TOES]; ketoconazole 1-2% 2x/week; Tar shampoo – scalp; low potency steroid cream 1-2.5% flares

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37
Q

Treatment for blepharitis

A

J&J baby shampoo daily

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38
Q

Silvery scales on bright red well-demarcated plaque; knees, elbows, scalp; onycholysis associated joint pain; <10% BSA

A

Psoriasis

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39
Q

injury or irritation of normal skin may cause a flare of psoriasis

A

Koebner phenomenon

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40
Q

the appearance of small bleeding pt after layers of scale are removed [pinpoint bleeding]

A

Auspitz sign

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41
Q

These drugs may cause Flare / Exacerbate existing plaque

A

BB, antimalarial, statins, lithium

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42
Q

A drug that may cause a severe rebound of psoriasis

A

systemic corticosteroids

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43
Q

1st line of treatment for psoriasis

A

high-ultra potent topical steroids 2-3x/wk MAX

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44
Q

Treatment for plaque psoriasis

A

calcipotriene ointment 0.005% or calcitriol ointment 0.003% vit D analogs BID [start with both steroid + vitD 2x/day until plaques improve à continue vitD daily x2 more weeks; Tar shampoo [scalp daily]; 6% salicylic acid gel [Keralyt] @ night with shower cap – wash out in AM

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45
Q

VELVETY TAN or pink macules DON’T TAN; fine scales not visible / seen with scraping lesion; CENTRAL UPPER TRUNK; HIGH RECURRENCE RATE – YEAST. Dx: KOH prep; re-pigmentation may take wk-months

A

tinea versicolor

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46
Q

Treatment for tinea versicolor

A

SELENIUM SULFIDE LOTION: neck-waist daily 5-15m wash off [once x7d, once per week x4wk, monthly]; ketoconazole shampoo [leave on 5m BEFORE rinsing]; ketoconazole PO daily [SWEAT! No shower 8-12hr]

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47
Q

Ring-shaped lesion; scaly border; central clearing; ANYWHERE ON BODY

A

Tinea Corposis (ringworm)

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48
Q

Treatment for tinea corposis

A

topical antifungals [OTC 7-14d after clearing]; NO CORTISONE [lotrisone]; griseofulvin 350-500mg BID 4-6wk

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49
Q

SIGNIFICANT ITCHING intertriginous areas + peripherally spreading sharply demarcated centrally clearing erythematous lesion; CANDIDIASIS bright red + satellite

A

tinea crusis (jock itch)

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50
Q

Treatment for tinea crusis

A

drying powder MICONAZOLE

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51
Q

Asymptomatic scaling; fissures or maceration between toes; moccasin distribution; CELLULITIS COMPLICATION; itching/burning/stinging

A

tinea pedis (Athlete’s foot)

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52
Q

Treatment for tinea pedis

A

PREVENTION! Drying powders

[miconazole]; griseofulvin, itraconazole, terbinafine = SEVERE cases

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53
Q

Localized violaceous red plaques; scaling follicular plugging; atrophy dyspigmentation & telangiectasia; PHOTOSENSITIVITY; malar rash = BUTTERFLY

A

Lupus

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54
Q

Lupus medication triggers

A

hctz, CCB, H2 blockers, PPI, ACE-I, terbinafine;

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55
Q

type of lupus that occurs on face/scalp – thumbtack like

A

DLE

56
Q

lupus that occurs on the trunk

A

SCLE

57
Q

Lupus treatment

A

PROTECT SKIN FROM SUNLIGHT, SPF>50 uva/uva coverage; NO RAD TX; high potency corticosteroid cream EVERY PM with an occlusive dressing

58
Q

Scaling, red plaque on breast [uni or bil]; intraductal mammary carcinoma

A

Paget’s Disease

59
Q

Squamous cell carcinoma in situ – abnormal growth of cells in epidermis [outer layer]; 0.5-3cm slightly raised pink-red plaque, excision; develop into SCC 3-5% RARE

A

Bowen’s Disease

60
Q

Unpigmented white macules 0.5-5cm; MEN/WOMEN

A

Vitiligo

61
Q

Treatment for vitiligo

A

wear protective clothing/sunscreen; topical corticosteroids, phototherapy, >40% BSA = sx graft or perm depigmentation

62
Q

HSV 1 occurs where?

A

Mouth

63
Q

HSV 2 occurs where?

A

Genital

64
Q

Triggers for HSV 1 flare

A

surgery, stress, sun exposure, fever

65
Q

A cluster of vesicles on erythematous base; mouth; STINGING/BURNING before; crust & heal in 1 week

A

Herpes Simplex

66
Q

Bleeding/ulceration are the most ominous sign of:

A

malignant melanoma

67
Q

single most important prognostic factor in malignant melanoma

A

tumor thickness

68
Q

Key clinical feature of atopic dermatitis

A

itching

69
Q

a cardinal sign of secondary infection in atopic dermatitis

A

infra-auricular fissure

70
Q

the most common form of erythema multiforme minor

A

herpes simplex

71
Q

initial treatment for herpes simplex

A

valtrex 1g TID 7-10 days

72
Q

treatment of recurrent HSV

A

initiate @ 1st signs 12-24hr Valtrex 500mg PO BID x3d

73
Q

suppressive treatment therapy for HSV

A

Valtrex 500mg once a day x1yr [up to 5-7yr] WEAR CONDOMS

74
Q

Clusters of lesions [unilateral] on FACE/TRUNK – dermatome w/pain along that nerve [pain occurs 48hr+ BEFORE rash

A

herpes zoster

75
Q

pain/burning that persists after herpetic infection

A

post-herpetic neuralgia

76
Q

vaccine for zoster

A

Shingrix Vaccine: 2 doses [1 now; repeat 2-6mo] born before 1980 should have antibodies – if you test and it’s NEG = need varicella vaccine [1 today, another 4wk later = 2 doses]

77
Q

referral needed to __________ if zoster on face

A

ophthalmology

78
Q

treatment for post-herpetic neuralgia

A

TCAs or gabapentin

79
Q

Pruritic ‘tapioca’ vesicles PALMS/SOLES/SIDES OF FINGERS. May have scaling/fissures after vesicles dry. Associated with ATOPIC DERMATITIS. Increased occurrence with stress or may be driven by nickel allergy. Must check for tinea pedis

A

POMPHOLYX VESICULOBULLOUS – Hand Eczema [Dyshidrosis]

80
Q

Treatment for dyshidrosis

A

TOPICAL CORTICOSTEROIDS; RECURRENT; AVOID IRRITANTS – EMOLLIENT AFTER WASHING

81
Q

Erythema, scaling perineal area; URINE/FECES; beefy red sharply demarcated w/satellite lesions

A

Primary Irritant Contact Dermatitis

82
Q

Treatment for primary CD

A

ZINC OXIDE; if >3d diaper rash = CANDIDA ALBICANS = Nystatin

83
Q

Hx of venous insufficiency/immobility; irregular shaped ulceration on LE above malleolus [edema, hyperpig brawny edema, scaling, erythema à breakdown]; 1st check ABI <0.7 = Vas Sx

A

leg ulcer r/t venous insuff

84
Q

treatment for leg ulcer

A

Compression TED hose + wound care (unna boot if ABI WNL); Pentoxifylline 400mg TID accel healing

85
Q

Asians/NA/AA 90%, blue-black lumbosacral area; fade as skin darkens; NOT ABUSE

A

Mongolian Spot

86
Q

Light brown oval macule; ANYWHERE ON BODY; develops as pt ages

A

CAFÉ AU LAIT

87
Q

If 6 or more Cafe Au Lait > 1.5cm present increased risk for?

A

neurofibromatosis (NF-1)

88
Q

Red rubbery vascular plaque/nodule; regresses by 9yo

A

hemangioma

89
Q

Treatment for hemangiomas

A

PO propanolol

90
Q

caused by HPV

A

warts

91
Q

Treatment for warts

A

vaccine Gardasil 9yr [27 max G, 22 B]; fever, pain, fainting, site rx; monitor 15m post inj; liquid nitro, keratolytic agents 40% salicylic acid

92
Q

Treatment for genital warts

A

podophyllum resin

93
Q

STAPH; itching/burning hair follicle; hot tub 1-4d after [pseudomonas]; TENDER, pruritic pustular lesion + fatigue, low-grade fever, malaise

A

folliculitis

94
Q

Treatment for folliculitis

A

SILVADENE BID or cipro if recurrent

95
Q

Deep-seated abscess entire hair follicle + adj tissue; STAPH AUREUS

A

furuncle/ boil

96
Q

several furuncles

A

Carbuncle

97
Q

Treatment for furuncle/boils

A

I&D + PO abx

98
Q

Firm, benign growth of upper portion of hair follicle; black comedone or punctum; foul-smelling cheesy material on I&D

A

epidermal inclusion cyst

99
Q

SEVERE ITCHING AT NIGHT + burrows interdigits

A

scabies

100
Q

treatment for scabies

A

15-20m close physical contact or bedding; plastic bag x14d or high heat 60C; permethrin 5% 1 app neck down 8-12hr rinse repeat 1wk; triamcinolone cream for persistent itching

101
Q

hands, palms, soles, MM; herpes simplex. TARGETOID LESIONS clear centers concentric; erythematous rings “iris” lesions

A

erythema multi-forme minor

102
Q

trunk; <10% epidermal detachment; caused by medication

A

erythema multi-forme major

103
Q

Medications that may cause erythema multi-forme major

A

sulfa, NSAID, allopurinol, anticonvulsants STOP DRUG; >30% ADMIT

104
Q

itching + nits in hair

A

pediculosis (lice)

105
Q

treatment for pediculosis

A

permethrin 5% cream on scalp

106
Q

Located on Upper trunk body [no palms, soles], erythematous, blanching except in skin folds (Pastia sign) fine macules, sandpaper-like rash. Fever occurs 1-2 days prior. Not pruritic

A

scarlet fever

107
Q

petechiae on the palate, strawberry tongue, Group A beta-hemolytic strep culprit, circumoral pallor, enlarged tonsils

A

scarlet fever

108
Q

Treatment for scarlet fever

A

PCN or erythromycin/ clinda with PCN allergy

109
Q

Starts with FEVER caused by parvovirus spread through respiratory secretions. Affects face and thighs, Erythematous “slapped cheek” pink papules and macules in lacy reticular pattern, low grade fever, pruritic. Contagious 1 week prior to rash

A

erythema infectiosum (5ths Dz)

110
Q

pregnant women may develop this complication with 5ths disease which increases risk for fetal demise

A

Hydrops fetalis

111
Q

Prominent feature is abrupt onset of fever 102-105 degrees for 3-8 days which resolves abruptly then faint maculopapular pink spots that blanch upon pressure that develop on FACE FIRST, then spreads down body. Transmitted through respiratory secretions. Incubation period 9 days. Caused by human herpesvirus 6 or 7

A

Roseola

112
Q

Incubation period 9-14 days. Prodrome of fever, cough, conjunctivitis, and coryza. Koplik spots appear 1-2 days prior to and after onset of rash. Maculopapular rash cephalocaudally [face/hairline down body over 3 days] then becomes confluent. Supportive treatment only

A

Rubeola (Measles)

113
Q

lasts 3 days, incubation period 4-14 days. Prodrome of respiratory symptoms, low-grade fever, conjunctivitis. Characteristic post-auricular and sub-occipital adenopathy. Most infectious 1-5 days after rash appears. Starts on face then spread to extremities and trunk while fading from face.

A

Rubella “3 day German Measles”

114
Q

Unilateral parotid swelling progressing to bilateral and salivary gland swelling. Prodromal features last 3-5 days low-grade fever, headaches, malaise/myalgias, loss of appetite. May have an earache. Transmitted through respiratory droplets. May cause aseptic meningitis, pancreatitis, orchitis, and miscarriage in 1st trimester. Symptomatic treatment: NSAIDs, warm/cold packs, Tylenol, rest/fluids

A

Mumps (rubulavirus)

115
Q

Widely scattered red macules and papules followed rapidly by vesicles, pustules then crusting in 5-7 days. New crops stop after 5-7 days. Contagious usually 1-2 days before rash appears and until lesions crust over. Spread primarily through droplets and direct contact with lesions. Pruritus usually intense.

A

Varicella

116
Q

Prevention and treatment of Varicella

A

Varivax, 12mo & 5yr booster. May give 72hr from exposure.

117
Q

Incubation 1-2 months after exposure. 2-3 day prodrome of malaise leads to febrile illness. Major complaint is pharyngitis and generalized adenopathy, splenomegaly and hepatomegaly common. Heterophile antibodies may not be detectable until 2nd week of illness. Symptomatic treatment. Avoid contact sports for 6-8w. Followup LFTs/ultrasound if indicated.

A

Infectious Mononucleosis

118
Q

Caused by Cocksakie Type A rash found on tongue, oral mucosa, hands, and feet. Associated with fever (1st symptom), malaise, and sore throat.

A

Hand-Foot-Mouth

119
Q

Oval, fawn-colored, scaly eruption that follows the cleavage lines of the trunk “Christmas Tree Pattern” Herald Patch occurs 1-2 weeks prior to lesions. Oval plaques up to 2 cm in diameter- crinkled or cigarette paper appearance- tiny scale on the edges but clear in the center. Appears mostly in Spring/Fall. If plantar, palmar, or mucous membrane lesions are present- screen for secondary syphilis. Consider UV treatment

A

Pityriasis Rosea

120
Q

Macules, vesicles, bullae, pustules, and honey-colored crusts Contagious – staphylococci or streptococci
Face and other ‘exposed’ body parts. Soaks and scrubbing can be helpful- clears the pus.
Topical agents such as bacitracin and mupirocin (Bactroban) are indicated the first line

A

Impetigo

121
Q

Single or multiple dome-shaped, waxy papules, 2-5 mm in diameter with umbilication. Initial appearance are firm, solid, flesh-colored lesions but change to soft, white, pearly gray in color that may have suppuration.
Spread by wet skin-to-skin contact. Estimated time to remission is approximately 13 months. Can be treated with liquid nitrogen, curettage, or light electrocautery.
These lesions should spontaneously resolve without treatment.

A

Molloscum Contagiosum

122
Q

Scaly red plaques (no thickening as with psoriasis) – can be long term with weeping- consider staph infections. Face, neck, upper trunk, wrists, hands, and antecubital and popliteal folds. Family hx of asthma, allergic rhinitis, or atopic dermatitis (Triangle of A).
Dx criteria: Must have pruritus, typical morphology and distribution (flexural lichenification, hand eczema, nipple eczema, eyelid eczema in adults), onset in childhood with chronicity.

A

Atopic Dermatitis (Eczema)

123
Q

Erythematous macules, papules, and vesicles- look for patches, such as where something may have rubbed or brushed against the skin. Results from contact with an allergen or chemical. Soaps, detergents, solvents, metals, antimicrobials such as bacitracin or polysporin, artificial nails, adhesive tape, etc. Consider latex as well. Treatment: prompt and thorough washing of affected area with liquid dishwashing soap to remove the oils must be done within 30 minutes to decrease the effects of the irritant. McPhee suggests Dial Ultra. Barrier creams – applied prior to exposure- include Stokogard, Hollister Moisture Barrier, and Hydropel. treat the itching with caladryl, calamine, Benadryl cream OR Benadryl tablets, Vistaril, etc. New treatment option- Zanfel- may prove beneficial- according to the package instructions- it may be used anytime after exposure. Reports 10 year half life (15 treatments per box)

A

Contact Dermatitis

124
Q

Comedomes are hallmark although papular, pustular, cysts or nodules may be present. Treatment begins with educating the patient- treatment can take 6-8 weeks to make a difference- avoiding topical oils found in cosmetics and hair products is helpful. Comedones respond well to topical retinoids such as Retin A (tretinoin). Benzoyl peroxide 2.5% will do well (and cause less irritation than the 10%)- may be combined with an antibiotic for topical application (Benzaclin, Bezamycin). Papular or Cystic Acne- same initial treatment as comedones- if no response- then consider oral antibiotics such as doxycycline, minocycline, etc. Severe Acne: Accutane: NOT RESPONDING TO TX; supply 1mo at a time; 2 forms of effective of birth control (abstinence can be 1 form) must be utilized INFORMED CONSENT; enroll in a monitoring program (iPledge); MUST HAVE two serum preg tests before starting tx

A

Acne Vulgaris

125
Q

Erythema and telangiectasia with a tendency to flush easily. May have associated flares with acne- papules and pustules. Hyperplasia of the soft tissue of the nose- rhinophyma. May be triggered by heat, hot/spicy food/drink, sunlight, exercise, alcohol, emotions, or hormones (menopause). Burning and stinging may accompany the flushing. avoid triggers- use broad spectrum sunscreen (although this might take some experimenting to find one that is well tolerated). Metronidazole gel, 0.75% can be applied bid or 1% applied qd. Another alternative is clindamycin gel. Oral medications can be used when topical are not effective.

A

Rosacea

126
Q

36-58hr to transmit; borrelia burgdorferi spirochete, gram- bacteria; REFER TO ID; stage 1 erythema migrans 3-30 day incub; viral illness “summer cold” that resolves 3-4wk without tx; stage 2: FATIGUE, cardiac, neuro; stage 3: musc mo-years after infection; ELISA, western blot; all ages + preg. Erythema migrans “bullseye” Treatment: doxy 200mg PO x1 proph; active tx: 14-21 days in early stage doxy >8yr or amox

A

Lyme Disease

127
Q

Treatment for cat bites

A

prophyl PCN + ceph or augmentin

128
Q

Treatment for all bites

A

AUGMENTIN if allergic to PCN— clinda+doxy or Bactrim or a fluoroquinolone 5-7 days

129
Q

Monkey bites add?

A

Valtrex

130
Q

38.3C or 101F needs >3wk of fever to diagnose. Infections account for most cases in children and adults cancer.

A

FEVER OF UNKNOWN ORIGIN

131
Q

fluoroquinolone single dose [>10d watery stool C&S + O&P]

A

TRAVELERS DIARRHEA

132
Q

Highest attack rate in children <6y with a peak from 6m-2y. Stools are watery but may have mucous and blood which may indicate shigellosis. Fever, abdominal pain and diarrhea associated with bacteremia especially in newborns/infants.

A

Salmonella Gastroenteritits

133
Q

shorter incubation 2-4 hours; vomiting is main symptom, no fever

A

Staph food poisoning

134
Q

resembles salmonellosis clinically, must culture to differentiate

A

campylobacter

135
Q

Treatment for salmonella

A

antibiotics in infants <3m, SSD, immunocompromised, severely ill children. 3rd generation cephalosporin and fluoroquinolones for adults. Plus PROBIOTICS

Exam 4 (3 decks)

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