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(PA school) CAM I > Dermatology II > Flashcards

Dermatology II Flashcards

1
Q

1) What is the most common benign epithelial tumor?
2) Demographic of this tumor?
3) What does it look like?

A

1) Seborrheic keratosis
2) Hereditary, rare before 30 y/o, M>F
3) Skin-colored, tan, brown, black
Small papules to larger plaques with warty surface (“stuck-on” appearance)

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2
Q

1) What does seborrheic keratosis look like?
2) What should you exclude?
3) What is the Tx?

A

1) Stippling on surface; face, trunk, upper extremities
2) Exclude SCC & melanoma
3) No treatment necessary, can use cryo if bothersome

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3
Q

What may be described as having a “stuck-on” appearance?

A

Seborrheic keratosis

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4
Q

Acanthosis nigricans:
1) What does it look like? Where?
2) What’s it related to?

A

1) Velvet, thickened, hyperpigmentation on neck, axilla, groin, other body folds
2) Obesity, endocrine disorders, diabetes, drugs (insulin, OCP and other hormone therapies, corticosteroids,) and malignancy

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5
Q

What is the Fitzpatrick skin type scale? Describe each type

A

1) Type 1: always burns, never tans
2) Type 2: usually burns, tans w. difficulty
3) Type 3: burns mildly, tans gradually
4) Type 4: rarely burns, tans w. ease
5) Type 5: never burns, tans very easily

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6
Q

Acanthosis nigricans:
1) When is it common?
2) Tx?

A

1) Can be common at the onset of puberty (endocrine issue)
2) Treatment: retinoids, address underlying disorders, difficult to completely eradicate

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7
Q

Cherry angioma (aka hemangioma):
1) What is it typically?
2) What color can it be?
3) What are the Sx?

A

1) Very common erythematous papule. Typically <3mm.
2) Can be violaceous or black
3) Asymptomatic, usually occur on trunk, benign

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8
Q

Cherry angioma (aka hemangioma):
1) Demographic?
2) What causes them?
3) Tx?

A

1) Age 30+
2) Dilated capillaries
3) Laser or electrocoagulation. Cryo not effective

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9
Q

List 2 examples of benign lesions

A

1) Seborrheic keratosis
2) Cherry angiomas

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10
Q

True or false: Actinic keratosis is precancerous [to SCC]

A

True

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11
Q

Actinic keratosis:
1) Is it painful?
2) Is it benign? Explain.
3) Tx?

A

1) Possibly tender, painful if excoriated
2) Precancerous (m/c precursor lesion of Squamous cell carcinoma)
3) Cryo- and laser surgery, 5- fluorouracil cream, imiquimod cream

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12
Q

Actinic keratosis:
1) What does it look like?
2) What skin does it occur in?
3) Demographics?
4) What size and texture?

A

1) Single or multiple discrete, pinkish, dry, rough, or adherent scaly lesions, not well demarcated
2) Habitually sun-exposed skin of adults (outdoor workers)
3) Middle age, M>F, Skin Type I-III
4) Usually < 1cm, round or oval-ish; rough, like coarse sandpaper

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13
Q

True or false: cryosurgery/ cryotherapy is used on focused, small spots that could turn into SCCs (like actinic keratosis, not melanomas)

A

True

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14
Q

List 2 derm parasites

A

Lice & scabies

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15
Q

What are the 3 members or pediculosis (lice) infestations?

A

1) Head lice: Pediculus Humanus Capitis
2) Pubic lice/ crabs: Phthirus pubis
3) Nits (eggs) on hair shafts (even eyelashes)

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16
Q

Pediculosis (lice):
1) How is it transmitted?
2) Sx? What can cause secondary infection?

A

1) Transmission: hats, caps, brushes, combs, pillows, theater seats (crowding, poverty, low personal hygiene,) SELFIES
2) Pruritis of scalp and back of neck (excoriations on scalp (r/o secondary infection)); possible posterior occipital lymphadenopathy; visible lice and nits

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17
Q

Pediculosis (lice):
1) DDx?
2) How is it diagnosed?

A

1) Seborrheic dermatitis, scabies, bed bugs, hair spray or gel, impetigo, LSC, delusions of parasitosis
2) Clinical detection of lice (louse comb), nits within 4 mm of scalp

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18
Q

Visible lice and nits and pruritis are Sx of what?

A

Lice

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19
Q

Treatment (capitus & pubis) for pediculosis: what is the OTC/ first line option?

A

Permethrin cream rinse (5% Elimite, 1% Nix) (resistance common

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20
Q

1) What are some prescription Txs for pediculosis?
2) What Rx is not used anymore?

A

1) Topical ivermectin lotion (most effective,) benzyl alcohol
Malathion (Ovide): > 6 y/o (volatile, flammable)
2) Lindane (Kwell): not 1st line (neurotoxicity, seizures), do not use in children. Not used in US

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21
Q

Pediculosis:
1) How are nits removed?
2) What else should be done (besides Rx)?

A

1) Remove nits using a special comb (wet combing)
2) Sanitize clothing and bedding (hot water)
Examine/treat close contacts at same time, especially children

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22
Q

Scabies (Sarcoptes scabiei):
1) What are its Sx?
2) Where does it typically occur?

A

1) Intense, generalized, intractable pruritis “Itching so bad I can’t sleep”
-Burrows, vesicles, nodules, excoriations
-Skin-colored, linear or serpiginous ridges
2) Interdigital web spaces, axilla, wrists, flexor areas waist, groin, waistband, genitals (usually spares head & neck in adults)

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23
Q

1) What are 3 DDx for scabies?
2) How is scabies diagnosed?

A

1) Can look like urticaria, drug reactions, eczema
2) Clinical, skin scraping for mites, eggs, & feces

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24
Q

Scabies: What are the 2 Rx options?

A

1) Elimite (5% Permethrin 60 gm): apply from neck down after bath (< 2 yo treat head also) leave on 8-10 hrs then rinse.
-Repeat in 1 wk. Do not use in children < 2 months old
2) Ivermectin 0.2 mg/kg/dose PO q2wk x 2 doses give w food if crusted or severe give more often

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25
Q

1) How long can scabies pruritis last? How is this extra itching treated?
2) What else is important to consider for scabies (besides Rx)

A

1) Pruritis can continue up to 2-3 weeks (Post Scabietic Dermatitis)
Topical steroids, Antihistamines (Atarax, Benadryl)
2) Clothes, sheets, etc. wash normally the next morning; bedspread, stuffed animals, pillows, coats put in plastic bag for 7 days
-Treat all family members on the same nights as patient

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26
Q

Latrodectism: Latrodectus (widow spiders):
1) When do black widow bites usually occur?
2) Where do most bites occur?
3) Are there Sx? Explain

A

1) Outdoor activities
2) ~75% on extremities
3) Initially asymptomatic or mild pain; systemic symptoms 30-120 min

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27
Q

Latrodectism: Latrodectus (widow spiders):
1) What are the primary Sx?
2) Is it a self-limiting condition?
3) What are some other Sx?

A

1) Muscle pain (extremities, abdomen, back), rigidity
2) Pain self-limited, resolves in 24-72 hours
3) Possibly tremor, diaphoresis, weakness, shaking, local paresthesia, nausea, vomiting, HA

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28
Q

Latrodectism: Latrodectus (widow spiders):
1) What does Tx depend on?
2) Explain Tx

A

1) Depends on severity
2) Wound care, PO analgesics
IV analgesics & benzos, consider Antivenom
Monitor vitals and breathing closely

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29
Q

Loxoscelism: Loxosceles (recluse spiders):
1) Where do these bites usually occur? What do they possibly look like?
2) Are there Sx?
3) Is it self-limiting?

A

1) Upper arm, thorax, inner thigh, LE
Red plaque or papule, vesicles possible
2) Usually asymptomatic, may have pain or burning
3) Most self-resolve in 1 week

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30
Q

Loxoscelism: Loxosceles (recluse spiders):
1) What may happen if a pt reacts to them? (not everyone reacts to them)
2) What are the rare systemic issues?

A

1) Develop dark, depressed center (24-48 hrs), then dry eschar & ulcer (~10% necrosis) red, white, blue lesions
2) Malaise, n/v, fever, myalgias, dark urine, pallor, jaundice, icterus

31
Q

List and define the 2 primary types of alopecia

A

1) Scarring: inflammatory, permanent loss
2) Non-scarring: mild/non-inflammatory, non-permanent loss

32
Q

What are some causes of non-scarring alopecia?

A

SLE, secondary syphilis, hyper/ hypothyroidism, Fe defic anemia, Vit D deficiency, pituitary insufficiency

33
Q

1) The most common form (genetic) of alopecia is what?
2) What is the Tx?

A

1) Androgenic alopecia
2) Minoxidil 5% (OTC), finasteride (Propecia)

34
Q

1) What is the etiology of alopecia areata?
2) Give some potential associations
3) What does it look like?

A

1) Unknown, possibly autoimmune
2) Hashimoto thyroiditis, pernicious anemia, Addison disease, vitiligo
3) Localized round oval patches, non-scarring

35
Q

Alopecia areata:
1) What hair is involved?
2) What is its classic Sx?
3) What are the two different kinds?

A

1) May also involve beard, brows, or lashes
2) “Exclamation point hairs” (2-3 mm long)
3) Entire scalp (alopecia totalis), entire body (alopecia universalis)

36
Q

Alopecia areata:
1) Is it ever self-limiting?
2) Tx?

A

1) 80% complete re-growth (focal)
2) PO steroids (severe), IL steroids

37
Q

Telogen Effluvium
1) What is it?
2) Who is it most common in?
3) Tx?

A

1) Non-scarring, temporary hair loss after recent stress (up to 3 months prior)
2) Most common in middle-aged females
3) Supportive care, reassurance, self-care. Hair grows back over months when stress resolves

38
Q

Telogen Effluvium
1) What is the first step of diagnosis?
2) What is a test for this condition?
3) What 2 labs should be done to rule out DDx?

A

1) Hx: major life event, illness, major weight loss
2) Hair pull test: Gently pull on small tuft of hair from different places on scalp. If > 4-6 hairs fall out with white bulbs at the root, then TE likely
3) Thyroid panel, vitamin deficiencies

39
Q

List 2 disorders of the nails

A

1) Onychomycosis: toenail fungus
2) Paronychia

40
Q

1) What is Onychomycosis (Tinea Unguium)?
2) What does it look like?
3) How do you confirm Dx?

A

1) Trichophyton (T. rubrum) infection of fingernails or toenails
2) Brittle, hypertrophic, yellowing & friable nails withsubungual debris
3) KOH prep (hyphae), fungal culture

41
Q

Onychomycosis (Tinea Unguium)?
1) Is it difficult to treat?
2) What are some indications for Tx?

A

1) Yes; long therapy & frequent recurrence
2) Discomfort, inability to exercise, DM, immunocompromised

42
Q

1) What are the 4 potential locations of tinea?
2) What does it look like under a microscope?

A

1) Capitis, corporis, unguium, pedis
2) Pears/ovals and septated sticks (hyphae)

43
Q

1) What is the Tx of tinea unguium (onychomycosis) on the fingernails?
2) What abt the toenails?

A

1) Topical antifungals (limited); PO griseofulvin 500mg 1 PO BID w/high fat meal x 4mo, terbinafine 250 mg PO QD x 6 wk must monitor ANC and d/c if ANC< 1000 or itraconazole 200mg cap PO BID w food x 1 wk
2) PO terbinafine 250 mg PO QD x 12 wk must monitor ANC and d/c if ANC< 1000 (if no response to griseofulvin)

44
Q

1) What must you do prior to treating tinea unguium (onychomycosis)?
2) What is not recommended & why?
3) What is a new Tx?

A

1) Must confirm dx prior to tx **Hepatic function test & CBC q4-6 weeks for PO antifungals
2) Ketoconazole not recommended for either form due to higher risk for hepatotoxicity
3) Lasers now available

45
Q

Paronychia:
1) What is it?
2) What are the 2 types?
3) Risk factors?
4) Tx?

A

1) Infection of lateral & proximal nail folds, painful
2) Acute or chronic
3) Hangnail, thumb sucking, nail biting, DM, manicures, dishwashing
4) Skin care (warm water soaks,) PO antibiotics, triple antibiotic cream, *I&D abscess (acute/ flocculent)

46
Q

Dermatophytosis: list all the types of tinea

A

1) Tinea pedis: foot
2) Tinea manum: hand
3) Tinea cruris: crural fold, groin “jock itch”
4) Tinea corporis, aka “ringworm”: body, extremities
5) Tinea facialis: facial
6) Tinea capitis: scalp hair
7) Tinea barbae: beard hair

47
Q

List 6 viral skin conditions

A

1) Dermatophytes/tinea
2) Condyloma acuminatum
3) Molluscum contagiosum
4) Herpes simplex
5) Varicella-zoster virus infections
6) Verrucae

48
Q

1) What does tinea/ dermatophytosis need to continue?
2) What is the Tx?

A

1) Moist environment
2) PO terbinafine, itraconazole, fluconazole
Topical clotrimazole, miconazole, ketoconazole
** remember to monitor LFTs and CBC/ANC

49
Q

Tinea corporis (ringworm):
1) What is it?
2) How is it diagnosed?
3) Tx?

A

1) Circular lesion on the body with erythematous border and scales (ring-like), may have excoriation or vesicles. Pruritic.
2) Skin scraping, KOH prep
3) Topical antifungal (clotrimazole cream OTC = Lotrimin.) -PO antifungal if widespread or resistant to topical treatment.

50
Q

What does tinea versicolor look like?

A

Random blotches of light or dark skin

51
Q

Tinea versicolor:
1) Sx and timeline?
2) What causes it?

A

1) Hypo/hyper-pigmented, scaly, sharp margins, scattered, usually on trunk; waxes and wanes x years, hypopigmented areas can remain after effectively treated
2) Overgrowth of cutaneous flora – Malassezia

52
Q

Tinea versicolor:
1) What will you see on a skin scraping?
2) How do you distinguish from vitiligo?

A

1) Round yeast and elongated hyphae = “spaghetti and meatballs” on microscopic exam prepared with KOH
2) Scale may fluoresce blue/green with woods lamp. Vitiligo remains white without scale

53
Q

1) What are the tinea versicolor Microscopic spores and hyphae called?
2) Tx?

A

1) Malassezia; look like spaghetti and meatballs
2) Topical Selenium sulfide 2.5% shampoo, azole creams, terbinafine 1%soln

54
Q

Condyloma acuminata:
1) What is it also called?
2) What causes it?
3) Sx and location?

A

1) Anogenital warts
2) HPV 6 and/or 11 most common
3) Soft flesh -colored papules “cauliflower -like”: external genitalia, perianal skin, perineum, or groin

55
Q

Condyloma acuminata:
1) Tx?
2) Risk factors?
3) Tx?
4) Prevention?

A

1) Direct contact with skin or mucosa (STI)
2) Sex, immunosuppression; screen for other STIs
3) Cryotherapy, Imiquimod 5% cream, surgery
4) HPV vax, condoms

56
Q

Molluscum contagiosum:
1) What causes it? Is it self-limiting? Explain
2) What does it look like?
3) Where on the body?
4) What is the common way of transmission?

A

1) Poxvirus; self limiting but remission is ~13 months.
2) Single or multiple dome-shaped, waxy papules 2-5 mm diam, umbilicated
3) M/c on face, lower abdomen, genitals
4) Autoinoculable (wet skin-skin contact,) shared towels

57
Q

Molluscum contagiosum:
1) Can it be a STI?
2) Who is it common in?
3) Best Tx?
4) Other Tx?

A

1) STI: penis, pubis, inner thighs
2) Common in AIDS
3) Curettage or liquid nitrogen (cryotherapy)
4) Imiquimod cream, retinoid cream

58
Q

Differentiate between HSV-1 and HSV-2

A

1) HSV-1 (oral): primary infection, then possible recurrent attacks due to sun exposure, orofacial surgery/lasers, fever, viral infections, stress
2) HSV-2 (genital): sexual contact, asymptomatic shedding
-Genital herpes may also be due to HSV-1

59
Q

Herpes simplex:
1) Classic presentation?
2) Location?
3) What is another possible Sx?

A

1) Burning, stinging, grouped vesicles on erythematous base (“dew drops on a rose petal”)
2) Any location, most common on vermillion border, penile shaft, labia, perianal skin, or buttocks
3) Possible tender regional lymphadenopathy

60
Q

Herpes simplex:
1) DDx
2) How is it diagnosed?

A

1) Chancroid, syphilis, trauma, other vesicular skin eruptions
2) Clinical (viral culture or PCR, Western blot, ELISA can also be done)

61
Q

How do you treat herpes simplex during:
1) First episode
2) Mild recurrences
3) Frequent or severe recurrences

A

1) Acyclovir 400 mg PO TID x 7-10 d (or BID for suppression,) valacyclovir, or famciclovir
2) No therapy for most, may use 3-5 days of antivirals (above)
3) Suppressive antiviral therapy reduces outbreaks & viral shedding (labialis – valacyclovir 500 mg PO QD, genital 1000mg PO QD)

62
Q

Varicella zoster virus (VZV) infections:
1) What is it?
2) When does it usually present? Is it contagious?
3) How are Sx different in peds vs adults?
4) Describe the rash

A

1) VZV/HHV-3 chickenpox (varicella)
2) Mostly during childhood, highly contagious.
3) Fever & malaise mild in children, marked in adults.
4) Pruritic rash: face, scalp, trunk & later extremities

63
Q

Varicella zoster virus (VZV) infections:
1) Describe the rash over time
2) When is it more severe?
3) Tx?

A

1) Maculopapular > vesicles > crusts/excoriated
2) In older & immunocompromised
3) Uncomplicated in children require no antivirals; consider 5-7 days of acyclovir for patients > 12 y/o

64
Q

Vaccination for what is > 98% effective (single or quad MMRV)?

A

Varicella zoster virus (VZV)

65
Q

Varicella zoster virus (VZV):
1) What can it occur as in adults?
2) How?
3) Risk factors?
4) What is the pattern of lesions?

A

1) Shingles
2) VZV dormant in cranial nerve sensory ganglia & spinal dorsal root ganglia after primary infection
3) Immunosuppressed, biologic agents, older age, stress
4) Lesions resemble chickenpox but follow unilateral dermatomal pattern (thoracic & lumbar roots most common)

66
Q

Varicella zoster virus (VZV):
1) Describe the pain
2) What are 2 potential complications?
3) What is a complication of one of those complications?

A

1) Pain often severe & usually precedes rash
2) HZ opthalmicus & Ramsay Hunt syndrome (VII)
3) Postherpetic neuralgia (60-70% pts with HZ & > 60 y/o)

67
Q

Varicella zoster virus (VZV):
1) Tx?
2) Is the a vaccine?

A

1) Valacyclovir or famciclovir within 72 hrs (uncomplicated), tapering course steroids; IV acyclovir for extradermatomal complications
2) Yes, for pts > 50 y/o (2 doses, 2 months apart)

68
Q

What are the 3 types of candidiasis?

A

1) Oral
2) Cutaneous
3) Genital

69
Q

Oral candidiasis :
1) Sx?
2) Tx?

A

1) Can cause pain or changes in taste
2) Nystatin susp: swish and spit QID x 1w

70
Q

Cutaneous candidiasis:
1) What causes it/ etiology?
2) Where does it occur?
3) Sx?

A

1) Fungal infection: Candida species (albicans)
2) Warm, humid environments
3) Very Pruritic, sometimes painful papules and patches, can become macerated (often mirror images in intrigenous areas) with satellite lesions

71
Q

Cutaneous candidiasis:
1) Risk factors?
2) Where on the body?
3) Tx?

A

1) Obesity, DM, steroids
2) Oral, Interdigital, groin, perineal, intergluteal cleft, inframammary, axillae, intertrigo (satellite lesions)
3) Keep area dry, nystatin cream, PO antifungals if severe

72
Q

Genital candidiasis:
1) Who is it very common in?
2) Risk factors?
3) How is it diagnosed? What is one Sx?
4) Tx?

A

1) Very common in females
2) HIV, DM, Pregnancy, uncircumcised, recent antibiotic use
3) Clinical diagnosis; Can have cottage cheese like discharge
4) PO Diflucan, can use topicals, but not as effective here
4) Can have cottage cheese like discharge

73
Q

1) Verrucae are also called what?
2) What are the 3 types?
3) What are the Sx?
4) How can it be prevented?
5) Can it be self-limiting?

A

1) Warts (HPV)
2) Common, plantar, genital
3) Usually asymptomatic; tenderness (plantar), itching (anogenital)
4) Vaccination for anogenital HPV types (prevent infection & reduce cancer)
5) Yes, can have spontaneous resolution

74
Q

1) How would you Tx ocular verrucae (aka HPV aka warts)?
2) What about for non-genital type?
3) What abt for in the genital area?
4) What abt the plantar region?

A

1) Oculoplastic surgery
2) Salicylic/lactic acid, imiquimod cream, cryotherapy (liquid nitrogen), laser, surgery
3) Cryotherapy, imiquimod, surgery
4) Paplex ultra (salicylic and lactic acid)

(PA school) CAM I (29 decks)

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