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DERMATOLOGY PANRE Flashcards

1
Q

Acne vulgaris (Level 2) what is it?

A

Obstruction of pilosebaceous units (i.e. hair follicles & sebaceous glands), with/without
inflammation → formation of:
○ Comedones (whiteheads or blackheads) → non-inflammatory acne( blackheads incomplete blockage and complete bloakage-white heads )
○ Papules, pustules, nodules and/or cysts → inflammatory acne

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2
Q

Acne vulgaris (Level 2) presentation?

A

Lesions typically develop on face & upper trunk, most often in adolescents
Comedones can become inflamed from Propionibacterium
○ Comedonal (mild)
○ Papulopustular (moderate)
○ Nodulocystic (severe)

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3
Q

Acne vulgaris (Level 2) Dx?

A

Clinical

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4
Q

Acne vulgaris (Level 2) tx?

A

Comedones: Topical retinoid (e.g. tretinoin)
○ Mild inflammatory acne: Topical retinoid alone, or with topical antibiotics (e.g.
erythromycin, clindamycin), benzoyl peroxide, or both
○ Moderate acne: Oral antibiotics (e.g. tetracycline ) + topical tx as for mild acne
○ Severe acne: Oral isotretinoin (teratogenic)
■ When taking isotretinoin, patients, providers & pharmacists must be
registered with iPledge (pregnancy testing, oral contraceptive pills for
women, etc)
○ Cystic acne: Intralesional triamcinolone
○ Mild/moderate acne usually heals without scarring by mid-20s
○ Patients should avoid triggers (e.g. cosmetics)
○ Severe acne can result in physical & psychological scarring → appropriate
referral is indicated

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5
Q

Actinic keratosis (Level 2) -what is it?

A

Precancerous changes in skin cells due to many years of sun exposure; most often seen in
fair-skinned individuals

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6
Q

Actinic keratosis (Level 2) CM?

A

White, pink or red, poorly marginated, scaly or crusty macules,
papules or plaques of varying thickness

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7
Q

Actinic keratosis (Level 2) Dx?

A

Clinical; biopsy for definitive dx

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8
Q

Actinic keratosis (Level 2) Tx?

A

Minimizing UV light exposure (e.g. protective clothing, sunscreen)
○ Dermatologic consultation/referral (cryotherapy or curettage with
electrocautery, topical 5-fluorouracil [5-FU])

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9
Q

AKA: Hives, wheals → migratory, well-circumscribed, red, itchy or burning plaques on the
skin that occur due to mast cell & basophil release of histamine & other vasoactive
substances; acute lesions have a duration <6 wks

A

What is Acute urticaria

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10
Q

Acute urticaria (Level 2) two types?

A

Immune-mediated: IgE activated mast cell degranulation
○ Allergic reaction: Food (e.g. shellfish, peanuts), drugs (e.g. penicillin)
● Non-immune-mediated: non-allergic activation of mast cells
○ Non-allergic drug effect, emotional or physical stimuli (stress; heat or cold
exposure)

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11
Q

Acute urticaria (Level 2) Dx ? TX?

A

Dx: Clinical
● Tx:
○ Try to identify the offending agent
○ Antihistamines (e.g. cetirizine, diphenhydramine) → First-line tx
○ Epinephrine for angioedema of airway structures

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12
Q

What is Drug eruptions (Level 2)

A

Drug eruptions typically occur in any patient who is taking medication & suddenly
develops a symmetric, cutaneous eruption
● Can mimic a wide range of dermatoses including morbilliform, urticarial, papulosquamous,
pustular & bullous lesions

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13
Q

What typically cause Drug eruptions (Level 2)?

A

Common culprits: Antibiotics, anti-epileptics, NSAIDs

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14
Q

Drug eruptions (Level 2) dx? Treatment?

A

Dx: Clinical; biopsy, immunoserology, skin patch testing

● Tx: Stop offending agent, symptomatic treatment; most are self-limited

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15
Q

Do drug eruptions occur in the sam or different spot?

A

Fixed drug eruptions typically occur in the same location each time

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16
Q

What is Atopic dermatitis (Level 2)? What is it associated with ?

A 
Atopic dermatitis (AKA: eczema) is a chronic inflammatory disorder of the skin
characterized by intense itching &amp; various skin lesions
○ Associated with IgE (i.e. asthma &amp; allergies
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17
Q

At what age does Atopic dermatitis (Level 2) presents?

A

Usually starts early in life & is a chronic, relapsing condition

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18
Q

Common triggers of Atopic dermatitis (Level 2)

A

ollen, dust, sweat, harsh soaps, rough fabrics, fragrances

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19
Q

Atopic dermatitis (Level 2) CM? (Acute and chronic)

A

Acute: Red, edematous, scaly patches or plaques that may be weepy; ± vesicles
○ Chronic: Dry, lichenified lesions due to chronic scratching
○ Usually occurs over flexor creases in older children & adults

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20
Q

Atopic dermatitis (Level 2) dx? Tx?

A

Dx: Clinical
● Tx:
○ Mainstay: Topical corticosteroids
○ Antihistamines for pruritus
○ Supportive skin care: non-soap cleansers, moisturizers
○ Avoidance of precipitating factors, if identified

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21
Q

What is Basal cell carcinoma (Level 1)

A

Superficial, slow-growing carcinoma derived from basal keratinocytes
● Commonly occurring in fair-skinned people with a history of sun exposure

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22
Q

What is the most common skin CA?

A

Basal cell carcinoma

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23
Q

Basal cell carcinoma (Level 1) CM

A

Most common clinical manifestations: Small, shiny, firm, pink nodule with a pearly border; telangiectasias that usually occur on the face; recurrent ulceration; crusting of the
lesion are also common.
Slow growing
● “Classic” description → Central crater with rolled border (“Rodent ulcer”)

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24
Q

Basal cell carcinoma (Level 1) dx ? Treatment

A

Dx: Clinical & biopsy

● Tx: Surgery, topical chemotherapy (e.g. imiquimod, 5-FU)

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25
Q

Burns (Level 2)

A

Injury to skin or other tissues caused by thermal exposure (e.g. heat or cold), electricity,
chemicals, or radiation

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26
Q

First degree burn

A

painful red skin (e.g. sunburn)

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27
Q

First degree burn

A

Epidermis only painful red skin (e.g. sunburn)

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28
Q

3rd degree burn

A

Epidermis & dermis (full thickness burn) →often ↓ or no pain, dry, waxy or
leathery appearance, loss of hair follicles & glands

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29
Q

4th degree

A

Burn extending to deep tissues (fat, muscles, tendons, bone)

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30
Q

Burns dx?

A

Dx: Clinical; appropriate tests for associated conditions (e.g. endoscopy for inhalation
injury)

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31
Q

Burns Tx?

A

ABCs
○ IV fluids (e.g. lactated Ringers) for burns >10% BSA (guided by Parkland formula)
○ Wound cleaning, dressing & serial assessment
○ Surgery for deep partial thickness & full thickness burns
○ Supportive measures, pain control
○ Management at burn center for select patients, PT, OT

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32
Q

Burns Tx?

A

ABCs (airway breathing circulation)
○ IV fluids (e.g. lactated Ringers) for burns >10% BSA (guided by Parkland formula)
○ Wound cleaning, dressing & serial assessment
○ Surgery for deep partial thickness & full thickness burns
○ Supportive measures, pain control
○ Management at burn center for select patients, PT, OT

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33
Q

Electrical burns tx?

A

Skin findings may not correlate with underlying tissue damage;
measure creatine kinase & check for myoglobinuria for evidence of muscle damage (Skin appears normal but underneath skin is a big mess)

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34
Q

What are the complications for burns?

A

Hypovolemia & infection

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35
Q

Most common organisms of Cellulitis (Level 3)?

A

Group A beta, Staphylococcus aureus (methicillin-resistant S. aureus [MRSA] → common

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36
Q

What are organisms are typical of Cellulitis (Level 3)

A

Pasteurella, Pseudomonas aeruginosa, Vibrio vulnificus, Group B streptococci

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37
Q

What organism for Cellulitis (Level 3) is common in neonates?

A

Group B streptococci (e.g. S. agalactiae

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38
Q

Cellulitis (Level 3)-Haemophilus influenzae is found in what type pts ?

A

Children

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39
Q

Cellulitis (Level 3)-Pseudomonas aeruginosa is found in what type pts ?

A

with DM or neutropenia, hot tub/spa users,

hospitalized patients

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40
Q

Cellulitis (Level 3)-Vibrio vulnificus is found in what type pts ?

A

Marine environments

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41
Q

Cellulitis (Level 3)-Pasteurella multocida is found in what type pts ?

A

Cat/dog bites

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42
Q

Cellulitis (Level 3)-Eikenella corrodens

A

Human bites

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43
Q

Cellulitis (Level 3) CM of skin? Other CM?

A

Involved skin is red & hot with indistinct borders, tender, edematous & induratedn (NOT FLUCTUANT): Fever, chills, tachycardia, headache; May have lymphangitis, lymphadenopathy, petechiae, vesicles & bullae

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44
Q

Cellulitis (Level 3) dx? imaging?

A

Clinical; lab tests → Leukocytosis; cobblestoning on ultrasound

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45
Q

Cellulitis (Level 3) Tx?

A

Tx: Antibiotics targeted at suspected organism
○ Strep/staph → dicloxacillin, cephalexin
○ Penicillin allergic pts → clindamycin; azithromycin
○ MRSA → trimethoprim/sulfamethoxazole, clindamycin, doxycycline

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46
Q

Cellulitis (Level 3) Complications?

A

Abscess formation, necrotizing subcutaneous infection, bacteremia with
sepsis

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47
Q

Erysipelas (Level 3)-What is it?

A

Superficial bacterial skin infection that involves dermal lymphatics

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48
Q

Erysipelas (Level 3) Risk factors?

A

Risk factors: Infants, children, elderly, lymphatic obstruction, lymphedema, immune
deficiency states

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49
Q

Erysipelas (Level 3) cm?

A

Clinical manifestations: Fever, chills, malaise; involved skin has red, shiny, raised,
indurated, tender plaques with sharp, demarcated borders; classically on face or legs

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50
Q

Erysipelas (Level 3) dx? MC organism?

A

Clinical; Group A beta-hemolytic streptococci

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51
Q

Erysipelas (Level 3) cm?

A

Clinical manifestations: Fever, chills, malaise; involved skin has red, shiny, raised,
indurated, tender plaques with sharp, demarcated borders; classically on face or legs; Pruritic, edematous, painful, DEMARCATED BORDERS

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52
Q

Contact dermatitis (Level 2)? TYPES?

A

Acute inflammation of the skin caused by irritant or allergens
● Irritants (immune system not activated): Chemicals, soaps, plants
● Allergic response: Type IV cell-mediated hypersensitivity reaction (e.g. poison ivy)
○ Id reaction: Activated T cells migrate to different location & cause dermatitis at site
remote from initial trigger

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53
Q

Contact dermatitis (Level 2)-most common in pts with ?

A

atopic disorders

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54
Q

Contact dermatitis (Level 2) cm?

A

Pain (irritants), pruritus (allergens), involved skin can range from
erythema to blistering & ulceration
○ Rash may take the shape of the object (e.g. watch)

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55
Q

Contact dermatitis (Level 2) -(dx)

A

Clinical; possibly patch testing

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56
Q

Most comedones (acne) become inflamed from?

A

Propionibacterium

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57
Q

Contact dermatitis tx?

A

Mainstay: Topical or oral corticosteroids
○ Avoid offending agents
○ Supportive care (e.g. Burow solution compresses, antihistamines)

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58
Q

Erythema multiforme (Level 1)

A

Inflammatory reaction to an infectious agent or drug
Etiology:
○ Herpes simplex virus → most common
○ Drugs, vaccines

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59
Q

Erythema multiforme (Level 1) CM ?

A

Sudden onset of asymptomatic, symmetric erythematous
macules, papules, wheals, vesicles, bullae, or a combination of lesions
○ Usually starts on distal extremities (including palms & soles), then moves centrally

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60
Q

Erythema multiforme (Level 1) Classic findings?

A

Target lesions, oral lesions (intraoral vesicles, erosions)

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61
Q

What is the most common etiology Erythema multiforme (Level 1) ?

A

Herpes simplex virus → most common

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62
Q

Erythema multiforme (Level 1) dx and tx?

A

Dx: Clinical

● Tx: treat underlying cause; supportive tx

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63
Q

What is Herpes simplex virus (Level 2)?

A

Herpes simplex virus infections commonly cause recurrent infections affecting the skin,
mouth, lips, eyes & genitals

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64
Q

Etiology of Herpes simplex virus (Level 2)?

A 
Etiology:
○ Herpes simplex virus type 1: Usually causes gingivostomatitis, herpes labialis &amp;
herpes keratitis (saliva transmission)
○ Herpes simplex virus type 2: Usually causes genital lesions (sexual contact
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65
Q

How is Herpes simplex virus (Level 2) reactivation stimulated by?

A

Sunlight, fever, physical/emotional stress,

immunosuppression

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66
Q

CM of Herpes simplex virus (Level 2)

A

Mucocutaneous lesions are usually clusters of small, painful

vesicles on an erythematous base

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67
Q

How is Herpes simplex virus (Level 2) dx?

A

Clinical; confirmation testing – Tzanck smear, culture, PCR, direct
immunofluorescence or serology

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68
Q

Treatment care of Herpes simplex virus (Level 2)

A

If treatment is begun early for primary or recurrent lesions, mainstay: antivirals
(e.g. acyclovir)

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69
Q

What is Dermatophyte infections (Level 2)

A

Fungal infections of keratin in the skin, hair and nails
○ Tinea ____ → pedis (foot), cruris (groin), corporis (trunk, limbs), unguium (nails) &
versicolor (AKA: pityriasis versicolor)

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70
Q

Transmission of Dermatophyte infections (Level 2)

A

Usually person-to-person or animal-to-person

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71
Q

Most common organisms of Dermatophyte infections (Level 2)

A

Trichophyton
○ Microsporum
○ Epidermophyton
○ MALASSEZIA FURFUR (tinea versicolor

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72
Q

Clinical of characteristics Dermatophyte infections (Level 2)

A

Varies by location, host susceptibility & hypersensitivity
○ Usually very little inflammation; ASYMPTOMATIC → MILD ITCHING
○ Lesions are usually erythematous, SCALY ANNULAR PATCHES with a distinct border &
CENTRAL CLEARING

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73
Q

How is Dermatophyte infections (Level 2) diagnose?

A

Dx: Clinical, KOH wet mount, culture of plucked hairs

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74
Q

Tx of Dermatophyte infections (Level 2)

A 
Topical antifungals (e.g. terbinafine, clotrimazole)
■ Topical steroids should be avoided because they promote fungal growth
○ Oral antifungals for nail &amp; scalp infections
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75
Q

Hidradenitis suppurativa (Level 2)

A

CHRONIC inflammatory condition of hair follicles & associated structures → rupture of
follicles, development of abscesses, sinus tracts & scarring

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76
Q

Hidradenitis suppurativa (Level 2) CM:

A

Swollen, tender nodules usually develop in axillae or groin
○ 2° bacterial infection can occur
○ Inflamed nodules can coalesce into PALPABLE CORDLIKE FIBROTIC bands

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77
Q

Hidradenitis suppurativa (Level 2) Dx: TX?

A

Dx: Clinical; Topical antibiotics (clindamycin), intralesional corticosteroids & oral antibiotics
(e.g. tetracycline)
○ Surgery

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78
Q

What is What is Impetigo (Level 2)? What are the RF? What are the organisms?

A

Superficial skin infection commonly occurring in infants & children
● Risk factors: Moist environment, poor hygiene
● Organisms: Staph aureus (most common); also Strep pyogenes, or both

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79
Q

Impetigo (Level 2) CM, what are the 2 types of presentations?

A

Nonbullous: Erythematous macule becomes clusters of vesicles or pustules that
rupture & develop a HONEY-COLORED CRUSTY EXUDATE over the lesions
○ Bullous: Similar, but VESICLES ENLARGE RAPIDLY to form bullae which then rupture &
expose a larger base covered by a similar crusty exudate
○ PRURITUS IS COMMON → scratching which can spread the infection to other sites

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80
Q

Impetigo (Level 2) Dx and TX?

A

Dx: Clinical
● Tx:
○ Mainstay: Topical mupirocin; ORAL ANTIBIOTICS for more SEVERE cases
○ Wash crusty areas with mild soap & water

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81
Q

Wha tis Lipomas (Level 2)

A

Common benign tumor made of ADIPOSE TISSUE

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82
Q

Cm of Lipomas

A

SOLITARY, SOFT, MOVABLE SUBCUTANEOUS (right below surface) nodules, commonly
occurring on proximal limbs, trunk, or neck
○ Multiple lipomas = familial, or associated with various syndromes

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83
Q

Lipomas Dx and TX?

A

Dx: Clinical

● Tx: surgical excision only if painful

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84
Q

What are Epidermal inclusion cysts

A

Most common benign cutaneous cyst

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85
Q

What are the MC benign cutaneous cyst?

A

Epidermal inclusion cysts

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86
Q

CM of cutaneous cysts?

A

Firm, globular(globe-shape), movable, NONTENDER mass that contains a WHITE,
CHEESY & MALODOROUS SUBSTANCE; if rupture or infected=painful

Often times, a punctum or pore can be visualized on the overlying skin

87
Q

TX and DX of cutaneous cysts?

A

Surgical excision or I & D if infected → cyst wall must also be removed to prevent
recurrence; Clinical

88
Q

What is Melanoma (Level 1)

A

Malignancy of melanocytes; that occurs most commonly on skin

89
Q

MC cause of skin cancer deaths ?

A

Melanoma

90
Q

Melanoma occurs where else beside the skin?

A

oral cavity, genito-rectal areas, choroid of eye & nail beds

91
Q

RF of Melanoma?

A 
Repeated sun/UV exposure, family or personal hx, fair skin, atypical moles, ↑
# of melanocytic nevi, immunosuppression
92
Q

CM of melanoma? Does melanoma metastasis?

A

Lesions vary in size, shape & color (usually pigmented), and their
propensity to invade & metastasize (metastasis occurs via lymphatics & blood vessels);
local metastasis results in formation of satellite lesions - think ABCDE

93
Q

Key findings in melanoma? ABCDE?

A

Change in size, consistency, shape (e.g. irregular borders), color (e.g. red,
white, blue pigmentation of surrounding skin), or signs of local inflammation; A-asymmetry, B borders, C color, d -diameter, E evolving/elevation

94
Q

Melanoma dx and tx?

A

excisional biopsy; Dermatology consult/referral; possibly oncology depending upon extent of disease

95
Q

What virus causes Molluscum contagiosum (Level 2)

A

poxvirus, chronic skin infection

96
Q

Molluscum contagiosum is MC seen in ?

A

Children

97
Q

Molluscum contagiosum form of transmission?

A

Direct contact, autoinoculation, bath water & fomites (e.g. towels

98
Q

CM of Molluscum contagiosum?

A

Clusters of flesh-colored, dome-shaped, smooth, waxy or pearly
UMBILICATED PAPULES, usually 2-5 mm in diameter; Lesions do not occur on palm & soles
○ Immunosuppressed patients may develop more widespread infection

99
Q

Molluscum contagiosum lesions occurs in what body part in children? Adults?

A

Children: Face, trunk, extremities

○ Adults: Pubis, penis or vulva

100
Q

Molluscum contagiosum dx? Do lesions regress? If you how long? TX

A

Clinical; Most lesions regress in 1-2 yrs; tx is mostly for cosmetic reasons
○ Mechanical → Curettage, cryosurgery, laser tx, electrocautery
○ Topical irritants → Trichloroacetic acid, tretinoin
○ Prevent spread

101
Q

What is Onychomycosis (Level 2)

A

Fungal infection of the nail plate, nail bed, or both (TOENAILS 10X > fingernails)

102
Q

RF of Onychomycosis

A

Tinea pedis, older age, exposure to someone else with this condition,
immunocompromised (ex dm, hiv etc)

103
Q

What are the organisms in Onychomycosis?

A

Dermatophytes (e.g. Trichophyton rubrum ) → Most common; Non-dermatophyte molds (e.g. Aspergillus )

104
Q

Onychomycosis CM?

A

Deformed & white → yellow discolored nail plate

105
Q

How is Onychomycosis Dx?

A

Clinical; potassium hydroxide (KOH) wet prep, culture

106
Q

Onychomycosis is treated ? prevention

A

Asymptomatic-tx not necessary as oral tx =long term +hepatotoxicity & drug
interactions (if on meds); Mainstay: Oral terbinafine or itraconazole
○ Topical tx may help (e.g. efinaconazole, ciclopirox); Keep nails trimmed short, keep feet dry, use absorbent socks &
antifungal foot powder

107
Q

What is Paronychia (Level 2)?

A

Inflammation of PROXIMAL &/OR LATERAL NAIL fold adjacent to nail plate

108
Q

Why does Paronychia occur in the fingers? Toes?

A

Fingers: Usually due to HANGNAIL OR NAIL BITING

● Toes: Usually due to INGROWN TOENAIL

109
Q

Paronychia is mc cause by what organism?

A

Staph aureus

110
Q

Paronychia cm?

A

Pain, warmth, redness, swelling & throbbing

111
Q

Paronychia dx ? TX

A

Clinical; Warm compresses or soaks & anti-staph antibiotics
○ If pus present → I & D

112
Q

What is Pilonidal disease (Level 2? Whom do they most occurred?

A

abscess or chronic draining sinus in the SACROCOCCYGEAL AREA ; occurring
in young, hirsute men or women

113
Q

How does Pilonidal disease presents ?

A

One or several, midline or adjacent to midline, pits or sinuses that
often contain hair in the skin of the sacrococcygeal cleft
○ Lesions are usually asymptomatic until they become infected

114
Q

Pilonidal dx? Tx?

A

DX? Abscess → I & D

○ Surgery follow-up for definitive tx

115
Q

What is Pityriasis rosea (Level 2)? It occurs Most often in ? Possible etiology?

A

Self-limited inflammatory disease of the skin; women between

ages 10-35 yrs; viral (herpes virus) vs drugs?

116
Q

CM of Pityriasis rosea

A

-Single, primary, 2-10 cm HERALD PATCH on the trunk or proximal limbs,
followed by a CENTRIPETAL ERUPTION of smaller ROSE-, SALMON- OR FAWN-COLORED papules &
plaques over the next 7-14 DAYS- Christmas tree distribution [orients along skin lines]);
lesions are usually ITCHY, SCALY & SLIGHTLY RAISED; May present with viral prodome prior (malaise, headache)

117
Q

Pityriasis rosea dx and tx ?

A

Dx: Clinical

● Tx: topical corticosteroids, oral antihistamines as needed for itching

118
Q

Does Pityriasis rosea presents with viral produce?

A

It may but not necessary

119
Q

What are Pressure ulcers (Level 2)?

A

Areas of skin necrosis and ulceration where tissues are compressed between bony
prominences & hard surfaces; other causes also include friction, shearing forces & moisture (areas of dying tissue with ulcers due to tissues are being squished in-between hard surfaces)

120
Q

What are the RF of Pressure ulcers?

A

> 65 yrs, impaired circulation & tissue perfusion, immobilization,
undernutrition, decreased sensation & incontinence

121
Q

What are the Clinical manifestations (commonly used staging system of Stage 1-IV) of pressure ulcers?

A

Stage I: Non- blanching erythema
○ Stage II: Loss of epidermis (superficial) or partial thickness skin loss
○ Stage III: Crater ulcer with full thickness skin loss (∅ bone/muscle exposure)
○ Stage IV:(all the way) Full thickness ulceration with exposure of underlying bone, tendon or
muscle

122
Q

Pressure ulcers dx and tx?

A

Clinical; 1. Pressure reduction 2. avoidance of friction & shearing forces 3. Good nutrition

  1. Wound care (cleaning, debridement, dressings)
  2. Infection & pain control
  3. Surgery referral for skin grafts or other treatments
123
Q

Psoriasis (Level 2)

A

Hyperproliferation of epidermal keratinocytes along with inflammation of the epidermis
& dermis thought to be triggered by environmental factors (e.g. trauma, infection, drugs)
in susceptible individuals (overgrowth of keratins in skin +inflammation of top /middle )

124
Q

What are subtypes of psoriasis?

A

Plaque psoriasis → MOST COMMON (90%); psoriatic arthritis (5-30%)
involves inflammatory arthritis

125
Q

CM of Psoriasis (Level 2)

A

Asymptomatic or pruritic, well-circumscribed, erythematous

papules & plaques covered with SILVERY SCALES

126
Q

What are the common locations of Psoriasis

A

scalp, EXTENSOR

SURFACES of elbows & knees, nails, sacrum, gluteal cleft & genitals;

127
Q

How is Psoriasis dx and treated?

A

Dx: Clinical; Tx: 1. Topical: Corticosteroids, vit D3 analogs (e.g. calcitriol), emollients, coal tar preps

  1. UV light tx
  2. Systemic tx: Methotrexate, immunomodulatory agents (e.g. etanercept)
  3. Appropriate dermatology referral
128
Q

What is Rosacea (Level 2)

A

Chronic inflammatory disorder of the skin that most commonly affects the FACE & SCALP OF
individuals with fair skin(aka adult acne)

129
Q

What ages does Rosacea (Level 2)

A

30-50 yrs

130
Q

Possible triggers of Rosacea (Level 2)

A

Sun exposure, emotional stress, cold/hot weather, Et-OH, spicy foods,
hot baths, hot drink

131
Q

cM Rosacea (Level 2)

A

Facial FLUSHING/STINGING, TELANGIECTASIAS, erythema, papules,
pustules, and in severe cases, RHINOPHYMA (large red, bulbous nose

132
Q

How is Rosacea (Level 2 dx and tx?

A 
Dx: Clinical
● Tx:
1. Avoidance of triggers
2. Topical: Metronidazole, ivermectin
3. Oral: Antibiotics (e.g. doxycycline) 4.  For severe cases (e.g. rhinophyma): Isotretinoin, surgery
133
Q

What is Scabies (Level 2)? How is transmitted?

A

Infestation of skin with the mite SARCOPTES SCABIEI; Typically person-to-person; HIGHLY CONTAGIOUS

134
Q

Rf of scabies ?

A

Crowded conditions (e.g. schools, shelters, barracks), immunosuppression

135
Q

Scabies (Level 2)

A

INTENSELY PRURITIC lesions (classically, worse at night) with
erythematous papules & burrows in FINGER WEB SPACES, FLEXOR surfaces of wrists, elbows &
axillary folds (INTERTRIGINOUS AREAS), waistline, umbilicus & genitals;
○ In adults, the face is not involved

136
Q

Scabies (Level 2)

A

Clinical; microscopic examination of skin scrapings for mites, ova, fecal pellets;
Tx: 1. Mainstay: Topical permethrin or lindane (can be neurotoxic; not for use in
children <2 yo)
2. Pruritus: Topical corticosteroids, oral antihistamines
3. Treat close contacts, launder clothing & bedding

137
Q

What is Lice (Level 2)? 3 main types?

A

Infestation of scalp, body, pubic area or eyelashes by lice (pediculosis); 1. Head lice, 2. body lice 2. Pubic lice.

138
Q

How is head lice transmitted?

A

Person to person

139
Q

Head lice signs/symptoms?

A

Severe pruritus; excoriations & posterior cervical adenopathy

140
Q

head lice dx?

A

Finding of lice (combing thru wet hair) or nits [eggs] (near base of hair
shaft), usually at back of head or behind ears → live nits fluoresce with
Woods lamp

141
Q

Head lice tx?

A

Tx: Mainstay: Topical permethrin (may need retreatment in 7 days); nit
removal with fine-toothed comb; laundering of personal items; oral
antihistamines for pruritus

142
Q

what is Body lice? How is it transmitted?

A

live on bedding or clothing; NOT ON PEOPLE ; transmission: Sharing of clothing/bedding in cramped, crowded settings

143
Q

Body lice s/s?

A

Pruritus; small red puncta on skin caused by bites, linear scratch marks &
urticaria; most commonly seen on SHOULDERS, BUTTOCKS & ABDOMEN

144
Q

Body lice dx and tx?

A

Finding lice & nits in clothing (esp. seams); nits may be present on body hairs;Mainstay: thorough cleaning or replacement of clothing/bedding; oral
antihistamines for pruritus

145
Q

Pubic lice? transmission? where do they live?

A

crabs; Sexually transmitted in adolescents & adults; also fomites; (live on people

146
Q

Pubic lice cm?

A

Pruritus; usually infest pubic & perianal hairs, but may spread to thighs, trunk
& facial hair (beard, mustache, eyelids); ± pale, bluish-gray skin macules (from
anticoagulant activity of louse saliva), excoriations & regional lymphadenopathy

147
Q

Pubic lice dx and tx?

A

Dx: Finding of nits (Woods lamp) &/or lice
Tx: 1. Mainstay: topical permethrin (may need retreatment in 7 days); treat sexual
partners; laundering of personal items; oral antihistamines for pruritus; petrolatum
for eyelash infestations

148
Q

Seborrheic dermatitis (Level 2)

A

Inflammation of skin areas that have a high density of sebaceous glands (e.g. face, scalp,
upper trunk) [cradle cap in infants (inflammation of skin thats has lots of secreting glands)

149
Q

What organism may play in seborrheic dermatitis?

A

Malassezia (fungus) may play a role

150
Q

Seborrheic dermatitis cm?

A

Develops gradually with occasional pruritus & dandruff → GREASY
SCALING OR YELLOW-RED SCALING PAPULES along hairline & face (nose, eyebrows, eyelids, ears

151
Q

Seborrheic dermatitis dx and tx?

A

Dx: Clinical
● Tx:
○ Mainstay: Tar preparations & topical corticosteroids
○ Topical antifungals

152
Q

Spider bites (Level 2) types?

A

Black widow:Brown recluse:

153
Q

where do spider bites typically occur near what places?

A

woodpiles, outhouses, or in hidden spaces

154
Q

How are black widow described?

A

Large, shiny black spider with a red-orange hourglass marking on abdomen
○ Only female envenomates humans

155
Q

Are black widow’s bite fatal?

A

no

156
Q

sx/s of Black widow:

A

PAINFUL ‘pin prick’ bite with sx developing within 30 mins → ‘BULL’S EYE’ WITH
ERYTHEMA & CENTRAL BLANCHING at bite site, diaphoresis, muscle cramping, spasm
or rigidity & abdominal pain (may mimic acute abdomen

157
Q

Black widow dx and tx?

A

Dx: Clinical (hx of seeing spider)
○ Tx: Wound care, opioids for pain relief, benzodiazepines for muscle spasms;
antivenom for severe cases

158
Q

brown recluse are described as ?

A

Small, brown spider with VIOLIN-SHAPED mark on dorsal thorax

159
Q

Are brown recluse bites fatal?

A

yes, they can be

160
Q

Brown recluse dx and tx?

A

Dx: Clinical

● Tx: wound care, supportive care; possibly surgery for necrotic tissue

161
Q

Squamous cell carcinoma (Level 1)

A

Malignant tumor of epidermal keratinocytes

162
Q

2nd most common skin CA?

A

Squamous cell carcinoma; Metastasis can occur & is more common with CA involving lingual or mucosal
surfaces

163
Q

Squamous cell carcinoma (Level 1) risk factors?

A

Precancerous lesions (e.g. actinic keratosis, leukoplakia); sun exposure

164
Q

sx/s Squamous cell carcinoma (Level 1)?

A

red papule or plaque with scaly, crusted or HYPERKERATOTIC SURFACE; any
NON-HEALING LESION found on sun-exposed surface

165
Q

Squamous cell carcinoma (Level 1) dx and tx?

A

Dx: Clinical & biopsy; Tx: Surgery, topical chemotherapy, radiation

166
Q

what is Stevens-Johnson syndrome (SJS) (Level 1)

A

Severe CUTANEOUS hypersensitivity reaction involving <10% BSA

167
Q

Stevens-Johnson syndrome (SJS) (Level 1) etiology?

A

Most commonly due to drug reaction (sulfa drugs, antibiotics, antiepileptics)

168
Q

Stevens-Johnson syndrome (SJS) (Level 1) sx/s?

A

1-3 wks after drug exposure → patients develop malaise, fever, headache, cough &
KERATOCONJUNCTIVITIS; macules then appear, rapidly spread & coalesce → LARGE, FLACCID
BULLAE THAT SLOUGH OVER 1-3 DAYS; skin, mucosal & eye pain are common; lesions may
involve PALMS & SOLES

169
Q

Stevens-Johnson syndrome (SJS) (Level 1) dx and tx?

A

Dx: Clinical, biopsy

● Tx: remove offending agent, treat similar to burns

170
Q

Toxic epidermal necrolysis (Level 1)

A

Severe form of SJS involving >30% BSA

171
Q

sx/s of Toxic epidermal necrolysis (Level 1)

A

Large sheets of epithelium may slough (+ NIKOLSKY SIGN) exposing weepy, painful &
erythematous skin; painful oral lesions, keratoconjunctivitis; may involve GU &
RESPIRATORY EPITHELIUM

172
Q

Toxic epidermal necrolysis (Level 1) dx and tx?

A

Dx: Clinical, biopsy
● Tx: Remove offending agent, burn ICU, supportive care, appropriate consults (e.g.
ophthalmology)

173
Q

Brown recluse sx/s ?

A

Painless bite with pain then developing over 30-60 mins; bite area
becomes erythematous & ecchymotic, ± pruritus; central bleb then forms → fills
with blood, ruptures & leaves a BLACK COLORED ESCHAR OVER AN ULCER; severe
systemic effects can occur

174
Q

What differentiates acne from rosacea? corticosteroid-induced acne

A

rosacea does not have comedones;; which lacks comedones and in which pustules are usually in the same stage of development)

175
Q

Neonatal acne? length? located? tx?

A

newborn to 8 weeks, lesions limited to the face, responds to topical ketoconazole 2% cream

176
Q

what oral birth control has been approve for acne ?

A

Ethinyl estradiol– norgestimate (Ortho Tri-Cyclen) is approved by the FDA for treatment of acne vulgaris in women and adolescent girls.

177
Q

What is Cherry Angioma?

A

Benign growth of small blood vessels; Usually seen in pts >30 yo

178
Q

What is the mc benign vascular tumor?

A

Cherry Angioma;

179
Q

Cherry Angioma CM?

A

bright red, circular or oval in shape, flat or raised

180
Q

Cherry Angioma TX?

A

usually no treatment needed unless bleeding or bothersome; possibly
electrodesiccation, liquid nitrogen, laser; Any change in size, shape or color should have dermatology follow-up

181
Q

What is Folliculitis

A

Infection & inflammation of hair follicle

182
Q

What is the organisms of folliculitis?

A

Organisms: Staphylococcus aureus (most common); also Pseudomonas aeruginosa (‘hot tub
folliculitis

183
Q

Folliculitis presentations?

A

pruritus, follicular pustules with penetrating hair
o Deeper infection → furuncle (abscess of hair follicle)
o Furuncle spread to adjacent follicles → carbuncle

184
Q

Folliculitis dx and tx?

A

Tx: mild superficial dz - topical antibiotics (eg. mupirocin); more extensive dz – oral
antibiotics (eg. cephalexin, clindamycin

185
Q

What is Hand Foot and Mouth? What virus is responsible? how long does it last

A

Oral enanthem & a macular, maculopapular or vesicular exanthem usually on the hands &
feetmost often due to Coxsackievirus A serotypes & usually lasts 7-10 days

186
Q

Hand foot and mouth is transmitted how?

A

is fecal-oral, but can also occur by contact with oral & respiratory secretions
or vesicular fluid

187
Q

Hand foot and mouth presents?

A

usually <7 yo; mouth or throat pain or refusal to eat, vesicles with
erythematous halos on buccal mucosa & tongue followed 1-2 days later with extremity
exanthem (may occurred in adults)

188
Q

Dx and Tx for Hand foot and mouth

A

clinical

● Tx: supportive

189
Q

Lacerations: wound assessment?

A
  1. Mechanism & time of injury
  2. Possible foreign body: get x-ray (metal & glass are radiopaque)
  3. Assess condition & viability of tissues
  4. Functional assessment
    a. Neurologic: motor, sensory (light touch, 2-point discrimination)
    b. Vascular: pulses, capillary refill
    c. Muscles/tendons: flexion, extension, ab-/adduction
  5. Wound exploration
190
Q

Why close wounds?

A

Achieve hemostasis, repair loss of structure &/or function,
↓ healing time, ↓ likelihood of infection, ↓ scar tissue formation & improve
cosmetic appearance

191
Q

When to close wounds

A

Golden period’ is variably defined; in general, clean uninfected wounds on most
areas of the body in healthy pts can be closed primarily up to 18 hrs after injury –
for the face, up to 24 hrs after injury

192
Q

Wound stages ?

A
  1. Hemostasis
    (Clot formation) 2. Inflammation
    (Demolition 3. Proliferation 4. Remodeling
    (Maturation)
193
Q

Hemostasis?

Clot formation

A

(Clot formation) 1. Vascular constriction

2. Thrombus formation

194
Q

Inflammation

A

(Demolition); 1. PMN infiltration

  1. Monocyte infiltration ® macrophage
  2. Lymphocyte infiltration
195
Q

Proliferation

A
  1. Re-epithelialization
  2. Angiogenesis
  3. Collagen synthesis
  4. Extracellular matrix formation
196
Q

Remodeling

A

(Maturation)

  1. Collagen remodeling
  2. Vascular maturation & regression
197
Q

Wound healing categorie

A

Primary closure (intention

198
Q

What is Primary closure of wound healing?

A

closing lacerations or surgical wounds with apposed

edges using sutures, staples, skin adhesive; results in minimal scarring

199
Q

What is 2nd closure of wound healing?

A

process used for wounds with large separated
wound edges (eg. gouges, infected or chronic wounds); needs frequent wound
care, wounds granulate from inside out, typically produces larger scar

200
Q

What is Delayed primary closure (tertiary intention)

A

wounds are left open for 4-5 days,

then re-evaluated – if no signs of infection, wounds are surgically closed

201
Q

Tetanus prophylaxis?

A

Clean/minor wounds: last tetanus shot within 10 yrs

o Contaminated/large wounds: last tetanus shot within 5 yrs

202
Q

Possible indications for surgical consult/referral for lacerations?

A

Deep or penetrating wounds of unknown depth
o Full-thickness lacerations of eyelid, nose, lip or ear
o Lacerations involving nerves, arteries, bones or joints
o Severe crush and/or contaminated wounds
o Wounds with strong concern about cosmetic outcome

203
Q

What are Photosensitivity Reactions?

A

Abnormal skin reactions to UV or visible light (AKA: photodermatoses

204
Q

Polymorphous light eruption? Presentation? tx?

A

(AKA: ‘sun poisoning or sun allergy’)
o Idiopathic photodermatosis
o Presentation: pruritic papules & plaques that appear hrs to days after
sun exposure; can last several days
o Tx: topical steroids, oral antihistamines; prevention (avoiding sun exposure,
protective clothing, sunscreen

205
Q

Drug-induced phototoxicity? Common agents? Presentation? tx?

A

Most common drug-induced photo eruption
o Common agents: tetracyclines, thiazides, sulfonamides, fluoroquinolones, NSAIDs,
phenothiazines
o Presentation: erythema, edema, occasionally with vesicles or bullae, that occurs in
sun exposed areas of the skin within mins to hrs of sun exposure
o Tx: treat similar to sunburn (cool compresses, oral analgesics), stop offending
agent, sun protective measures

206
Q

What is Phytophotodermatitis? Presentation? TX?

A

Topical skin exposure to a plant substance → phototoxic reaction (eg. carrot,
citrus, mulberry, legume family)
o Presentation: erythema, edema, vesicles, bullae on sun exposed skin surface of
plant exposure; Tx: cool wet compresses, topical steroids, NSAIDs, avoiding contact with
offending plant(s)

207
Q

What is Stasis Dermatitis

A

Inflammatory dermatosis of the lower extremity due to chronic venous insufficiency with
venous hypertension

208
Q

Stasis Dermatitis presentation?

A

edema, pruritus, reddish-brown skin discoloration (usually over
medial ankle), eczematous skin changes; late – lichenification, hyperpigmentation,
induration, lipodermatosclerosis

209
Q

Stasis Dermatitis TX?

A

Chronic venous insufficiency: compression stockings, elevation, ambulation,
weight reduction
o Symptomatic: wet dressings, topical steroids, emollients

210
Q

What is Telangiectasia?

A

Small superficial dilated capillaries or veins (AKA: spider veins) located near surface of
skin or mucous membranes
o Usually benign

211
Q

Telangiectasia is associated?

A

Can be associated with pregnancy, aging, rosacea, alcoholism

212
Q

Telangiectasia presentation?

A

discrete pink & red, punctate, linear or lacework-like blood vessels that
blanch with pressure

213
Q

Telangiectasia tx?

A

Tx: usually not required; may be treated for cosmetic purposes (sclerotherapy, laser)

panre (15 decks)

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