Dermatology2 Flashcards
What is the prophylaxis for influenza?
Oseltamivir (Tamifulu), Zanamivir (Relenza) and Peramivir (neuromindase inhibitor)
When should antivirals be given for influenza?
within 48hrs
What is the recommendation for vaccine for influenza?
everyone > 6mo
When is the influenza season?
Nov- March
C/I for influenza vaccine?
egg allergy, previous rxn to vaccine, developed Guillain Barre syndrome, have had GBS in past 6ks, <6mo
What are the symptoms of flu?
abrupt fever, chills, malaise, muscle aches, sore throat, headache, coryza
What defines AIDS?
CD4 count of <200 cells
What screening test is used for HIV?
ELISA
What test confirms HIV?
Western blot
What is the txt for HIV?
HAART
When should PEP be started for HIV?
within 72hrs of exposure
How is HIV transmitted?
semen, blood, vaginal secretions breast milk
Erythema migrans is seen in what disease?
Lyme disease
What is the treatment for lyme disease?
Doxycycline
What is the prophylactic for lyme disease?
Doxycycline
What are the 3 stages of lyme disease?
early localized, early disseminated, late disease
Diagnosis lyme disease?
ELISA followed by Western blot to confirm
What is the txt of lyme disease in children and preggo?
Amoxicillin or cefuroxime
What is the classic triad of meningitis?
fever greater than 38
nuchal rigidity
headache
Knee extension causes pain neck?
Kernig’s sign
Leg raise when bend neck?
Brudzinski’s sign
What is seen in babies with suspected meningitis?
bulging fontanelle
What are the two types of meningitis?
aseptic and bacterial
What is the most common cause of aseptic meningitis?
Enterovirus
What is the most common cause of bacterial meningitis?
S. pneumoniae
Evidence of meningitis but negative blood cultures indicates?
Aseptic meningitis
Gram negative diplococci?
N. meningitidis
MC cause of neonate meningitis?
E. coli and S. agalactiae
MC cause of >60 or immunocomprised meningitides?
Listeria or cryptococcus neoformans
Dx of meningitis?
lumbar puncture
CSF finding for bacterial meningitis?
Increase protein
decreased glucose
markedly increased opening pressure
CSF finding for viral meningitis?
normal pressure increased WBC (lymphocytes)
CSF finding for Guillain Barre Syndrome?
increased protein
normal glucose
Household contacts of pts with bacterial meningitis are treated with?
Ciprofloxacin, Rifampin, Levaquin, Zithromax, Rocephin
What is the treatment for bacterial meningitis?
Dexamethasone + empiric IV abx (cephalosporin, vancomycin, pencillins)
What is the treatment for viral meningitis?
symptomatic or IV acyclovir for HSV
What is seen in dx of mono?
atypical lymphocytosis
A Pencillin given in mono can cause what?
maculopapular rash
Classic triad of mono?
fever
lymphadenopathy
pharyngitis
How is mono transmitted?
oropharyngeal secretions and salvia
The kissing disease
Epstein Barr virus
Pts with mono are at risk of what?
splenic rupture
How is Epstein Barr virus diagnosed?
“monospot”
What is a monospot?
mononucleosis rapid slide agglutination test for heterophile antibodies
What antibodies are seen in mono?
heterophile antibodies
Treatment for Mono?
Supportive
Can a patient contract mono again after exposure?
nope!
Rose spots is seen in?
Enteric fever (salmonella typhi)
Pea soup diarrhea is seen in?
Enteric fever (typhoid)
infected egg yolks?
Gastroenteritis (salmonella typhimurium, Enteritidis)
How is salmonella treated?
Cefriaxone, fluoroquinolones, azithromycin
Fever increases with “pea soup” diarrhea followed by pink papules on the trunk, which fades when pressure is applied
Salmonella typhi
The most common form of salmonella infection?
gastroenteritis
What is the treatment for gastroenteritis?
self-limited, symptomatic
What symptoms are seen in gastroenteritis?
mucus+ bloody diarrhea vomiting abdominal pain fever cramping
Diarrhea from poultry products- dairy, meat, eggs, exotic pets (reptiles, turtles)
salmonell
What are symptoms of typhoid?
headache, pea soup stools (brown-green), intractable fever, bradycardia, rose spots
Diarrhea from undercooked ground beef, unpasteurized milk/ apple cider, day care centers, contaminated water
enterohemorrhagic ecoli 0157:H7
Treatment for enterohemorrhagic ecoli?
fluid replacement and supportive
Abx use in enterohemorrhagic e.coli can cause what?
hemolytic uremic syndrome
What are symptoms of enterohemorrhagic e.coli?
water diarrhea -> bloody, crampy abdominal pain, vomiting. Fever low grade
Rice water stools?
Vibrio cholerea
What is the MC cause of traveler’s diarrhea?
Enterotoxigenic e.coli
What are the symptoms of enterotoxigenic e.coli?
abrupt onset of watery diarrhea, abdominal cramping, vomiting
Lower abdominal pain, explosive watery diarrhea, mucus blood
Shigella
MC strain of shigella in US?
S. sonnei
What diarrhea can cause reactive arthritis and febrile seizure in children?
Shigella
Whom does Shigella predominately affect?
children (daycares)
treatment for Shigella?
ciprofloxacin
What is the diagnosis of Shigella?
leukocytes and red blood cell on stool culture
Transmitted by drinking unsanitary water/ice
enterotoxigenic e.coli (traveller diarrhea)
What can cause osteomyelitis in the sickle cell patient?
Salmonella
Salad bar diarrhea?
Shigella
How is cryptococcus neoformans meningitis diagnosed?
india ink stain
A rash present with meningitis indicates?
Neisseria meningitidis
multiple well demarcated red/purple infiltrative firm nodules and plaques in pt with a history of HIV
Kaposi sarcoma
What virus causes Kaposi sarcoma?
Human Herpes Virus 8 (HHV8)
AIDS defining cancer?
Kaposi sarcoma
Dx of Kaposi sarcoma?
biopsy- spindle cells mixed w/ vascular tissue
What is the txt for Kaposi sarcoma?
Chemotherapy or radiation
Prognosis of melanoma is most strongly associated with what dimension?
depth of lesion
The most common histologic type of melanoma?
Superficial spreading malignant melanoma
What type of melanoma is seen on the palms, soles, and nail beds?
acral lentiginous melanomas
Txt for Melanoma?
wide excision I-III, IV- chemo
Asymmetric, elevated, blue-tinged lesion with irregular scalloped borders
melanoma
large pruritic, subepidermal bullae in a 75y/o
Bullous pemphigoid
chronic acquired autoimmune subepidermal blistering skin disorder
Bullous pemphigoid
What is the mechanism of bullous pemphigoid?
IgG produced against the basement membrane
Whom does bullous pemphigoid usually affect?
60-80yr old, increases with age
Dx of bullous pemphigoid?
biopsy w/ immunofluorescence - IgG and C3 basement membrane
Txt for bullous pemphigoid?
Topical Corticosteriods, Prednisone, Azathioprine
Nikolsky sign negative in what disease?
Bullous pemphigoid
What are the 3 main pathogens seen in cellulitis?
H. influenzae, Streptococcus, Staphylococcus
Red hot, swollen, tender, fever, and chills
cellulitis
What is the txt for mild cellulitis (MSSA)?
Cephalexin or Dicloxacilln
What is the txt for MRSA?
TMP-SMZ, clindamycin, doxycyline
What is the treatment for a cat bite?
Augmentin or Doxy
Txt for a puncture wound through the shoe?
Ciprofloxacin (Pseudomonas)
raised cauliflower like lesions in clusters on shaft of penis
condyloma acuminatum
What HSV strains cause genital warts?
6 and 11
what vaccine is approved for HPV?
Gardasil 9
How is condyloma acuminatum dx?
NAAT, colposcopy, anoscopy
What is the txt for condyloma acuminatum?
Imiquimod (Aldara), Podofilow, Cryotherapy, surgery or TCA (trichloroacetic acid)
T/F HPV vaccine treats a existing infection
False
When should the HPV vaccine be given?
before the start of sexual activity (age 11-12)
Breakout from nickel, poison ivy?
Allergic dermatitis
Breakout from diaper, cleaners, solvents, detergents, urine, feces
irritant
pruritic lesions, lichenification mostly on the flexor creases
atopic dermatitis
What type of reaction is atopic dermatitis?
IgE, Type I
Coin shaped disc shaped skin lesion?
nummular eczema
Erythematous, yellowish greasy scales, crusted lesions
seborrheic dermatitis
What is the txt for seborrheic dermatitis?
Antifungal shampoo
topical corticosteriod
olive oil compresses
Young woman. Papulopustular, plaques, and scales around the mouth
Perioral dermatitis
What type of reaction is allergic dermatitis
Type IV
What is the dx for dermatitis?
patch test
Pts with atopic dermatitis usually have?
asthma or allergic rhinitis
The “itch that rashes”
atopic dermatitis
Txt for atopic dermatitis?
topical cortiocosteriods
Txt for perioral dermatitis?
topical metronidazole, erythromycin
What is C/I txt in perioral dermatitis?
topical steroids- cause flare of lesions
What is the most common adverse drug reaction?
Skin reactions
What dosage of epinephrine is used for acute txt of anaphylaxis?
02-0.5 mg
What is the txt for drug eruption?
withdrawal offending drug
epi, prednisone-prevent recurrence
urticaria- 2nd gen anthistamine
acute onset of vesicles without erythema on the lateral aspects of fingers, palm, and feet
dyshidrosis
What is another name for dyshidrosis?
pompholyx
What causes dyshidrosis?
unknown
Resembles tapioca pudding?
dyshidrosis
Txt of dyshidrosis?
1st line- Topical steroids, 2nd- oral steroids
What do pt with dyshidrosis usually have in their pmhx?
atopic background
Painful rash, that is red, hot, shiny, raised, indurated, and tender, well demarcated and hot to the touch
erysipelas
What organism causes erysipelas?
Streptococcus pyogenes (group A strep)
What is erysipelas?
superficial cellulitis w/ dermal lymphatic involvement
What looks like cellulitis but is well demarcated and painful?
erysipelas
What must be ruled out in erysipelas?
MRSA
Dx erysipelas?
culture and senstivity
Txt for mild erysipelas?
Penicillin G (allergy- erythromycin or clindamycin)
What type of reaction is erythema multiforme?
Type IV
What common infection is associated with erythema multiforme?
herpes simplex
What drugs can cause erythema multiforme?
sulfa drugs phenytoin barbiturates penicillin allopurinol
Target or iris lesions, localized to hands, feet or mouth
erythema multiforme
Dx of erythema multiforme?
absent of prodromal symptoms preceding HSV infection
Neg Nikolsky
Txt for erythema multiforme?
Avoid substances
control herpes- acyclovir
topical corticosteriods
Slapped cheek
Erythema infectiosum
What causes Erythema infectiosum?
Parvovirus B19
What symptoms are seen in erythema infectiosum?
slapped cheek rash on face and lacy rash on extremities
What are sickle cell pts at risk with erythema infectiosum?
aplastic crisis
How is fifth disease diagnosed?
clinical, enlarged nuclei
Txt for fifth disease?
NONE, symptomatic
Older adults who get fifth disease what syndrome can occur?
polyarthropathy syndrome (swelling/ pain in joints)
Sores in the mouth, rash on hands, feet, mouth, and buttocks?
Coxsackievirus
T/F Coxsackievirus is contagious in the 1st week of illness?
True
Txt for Hand, Foot, and Mouth disease?
supportive
What virus causes measles?
paramyxovirus
What the three phases of measles?
prodrome
enanthem
exanthem
3 C’s in the prodrome measles phase?
cough
coryza
conjunctivitis
Koplik spots?
Rubeola (Measles)
When does Koplik spot appear?
Enanthem phase
When does the rash appear in measles and how does it spread?
Exanthem
face downward
What serology dx measles?
Igm antibodies
txt of measles?
supportive (during rash must be isolated)
What vaccine protects against measles?
MMR
Describe measles rash?
brick red maculopapular blanching rash on face progressing to palms and soles lasts 7 days
3-day rash that appears on face spreads downward
Rubella (German Measles)
Symptoms of rubella?
rash, fever, lymphadenopathy
Which rash is teratogenic in the 1st trimester?
Rubella
What is seen in congenital rubella syndrome?
hearing loss
developmental delay
growth retardation
cardiac and ophthalmic defects
What is the difference between rubeola and rubella rash?
rubella is less red (pink maculopapular rash)
txt for rubella?
supportive and vaccine
Whom is Roseola usually seen in ?
children 6mo- 2yrs old
How does Roseola usually present?
high fever, followed by a pink maculopapular rash
How does Roseola rash spread?
starting at trunk and neck spreading elsewhere
Just as the child appears to be recovering from fever, a red rash appears?
Roseola
What causes Roseola
HHV 6
Txt for Roseola?
supportive
Besides rash and fever what can Roseola cause?
afebrile seizures
What is associated with Nagayama spots?
Roseola
Papules and pustules in hair follicules
Folliculitis
Hot tub users folliculitis is caused by what organism?
Pseudominas
Folliculitis is MC caused by?
S. aureus
What causes razor bumps?
Pseudofolliculitis barbae
Txt of hot tub folliculitis?
none
1st line txt for folliculitis?
Mupirocin ointment and topical benzoyl peroxide
Mechanism behind Hidradenitis suppurativa?
disorder of apocrine gland
txt of hidradenitis suppurativa?
Topical clindamycin +/- oral abx
Intralesional triamcinolone
Non painful, pruritic lesion in a <6y/o child that has “honey colored crust?
Impetigo
MC cause of impetigo in temperate regions and tropical?
S. aureus and Strep pyoderma
Txt for impetigo?
topical mupirocin
Complications of impetigo?
poststreptococcal glomerulonephritis
strep throat
Most common form of impetigo?
nonbullous impetigo
several ovid, grey white eggs in hair
lice
Pediculosis?
lice
Txt for lice?
Permethrin topical
flat topped, shiny, violaceous papules with fine white lines (wickham striae), pruritic
Lichen planus
What are the 5 P’s of Lichen planus?
pruritic, purplish, polygonal, planar, papules
Txt for lichen planus?
resolves spontaneous
Topical steroid ointments- antihistamines-Hydroxyzine, 2nd line- systemic steriods
What disease is Lichen planus associated with?
Hep C
All pts with Lichen planus should be checked for?
Hep C
Hyperpigmented large plaque that is very itchy that is spreading across the front left ankle
Lichen simplex chronicus
What causes Lichen simplex chronicus?
chronic repeated rubbing or scratching of the skin causing lichenifications
Condition that causes thick leathery brownish skin?
Lichen simplex chronicus
Txt of lichen simplex chronicus?
STOP SCRATCHING
High potency steroids
Non-painful mass on upper back that is slow growing, firm, but highly mobile
Lipoma
Treatment of lipoma?
surigical excision or liposuction
Hyperpigmentation, light to dark brown macules to bilateral cheeks
Melasma
What causes melasma?
increase in estrogen
Chloasma, or the mask of pregnancy
Melasma
What can cause melasma?
OCP
pregancy
HRT
What can be used to dx melasma?
wood’s lamp
Txt for melasma?
Stopping exposure
topical hydroquinone (bleaching)
chemical peels
sunblock
flesh-colored, waxy dome shaped, umbilicated pearly papules over the face, trunk, and extremities
molluscum contagiosum
Molluscum contagiosum is usually seen in whom?
Children, but can affect adults
What causes molluscum contagiosum?
Pox virus
Extensive molluscum contagiosum in adults suggest?
immunosuppresion
What screening is indicated in a adult with molluscum contagiosum?
HIV
Txt of molluscum contagiosum?
NONE! self limited
Yellowish-green nail pigmentation
onychomycosis
Dx of onychomycosis?
KOH prep
Txt for oral antifungal?
terbinafine
What are sde of terbinafine?
liver failure, monitor LFT and liver failure
What should be monitored with terbinafine therapy?
LFT
What causes most toenail and fingernail oncyhomycoses?
Dermatophytes
Fingernail onychomycosis is more often caused by?
Candida
Red, warm pain along nail margin after manicure
paronychia
MC cause of Acute of paronychia?
staph aureus
MC cause of chronic paronychia?
candida albicans
Txt for acute paroncyhia?
I&D, warm compresses, abx cream
Txt for chronic paronychia?
topical antifungal clotrimazole or nystatin
Abscess or sinus tract in the upper part of the gluteal cleft
Pilonidal disease
Txt for pilonidal disease?
I&D, if infection Cefazolin + metronidazole or bactrim
A HEARLD patch following a URI that line up along skin folds and resembles CHRISTMAS Tree distribution
Pityriasis rosea
HEARLD PATCH and CHRISTMAS TREE distribution
Pityriasis rosea
What organism causes pityriasis rosea?
Herpes virus 7
What is the txt for pityriasis rosea?
NO treatment! self limiting
What appears first in pityriasis rosea?
herald patch
Who is at the greatest risk for developing pressure ulcers?
spinal cord injuries
What is the best txt for pressure ulcer?
prevention by frequent positioning
Well demarcated, erythematous, silvery scaly plaques involving the scalp and extensor
Psoriasis
Auspitz sign and Koebner’s phenomenon?
bleeds when scale is picked
minor trauma causes new lesion
MC type of psoriasis?
Psoriasis Vulgaris
Txt of psoriasis?
emollients, Vit D, topical retinoids, tar, anthralin, corticosteroids
Whom is more likely to have rosacea?
women aged 30-50
Facial erythema, telangiectasia, papules, and rhinophyma
Rosacea
What are 3 triggers of rosacea?
heat, alcohol, and spicy foods
Where is rosacea most common?
forehead, cheeks, and nose
Txt for rosacea?
topical metronidazole
Intensely itchy, painful, red streaks between the fingers, that is worse at night
Scabies
Vesicles and burrows in the webbed spaces of the fingers and toes
Scabies
What causes scabies?
Sarcoptes scabiei hominis
Dx for scabies?
skin scrape (microscope)
Txt for scabies?
Topical 5% permethrin cream
Oral ivermectin
Flesh colored, grey brown and black papules/plaques with a velvty warty texture, “Stuck on” apperance, barnacles of old age
seborrheic keratosis
T/F seborrheic keratosis is benign and usually asymptomatic?
True
Txt for seborrheic keratosis?
NO txt (not premalignant)
Necrotic wound with central necrosis around a red halo would be seen in what insect bite?
Brown recluse spider
N/V, HA, fever, syncope and convulsions, muscle spasm would be seen in what insect bite?
Black widow spider
Txt for brown recluse spider bite?
wound care, delayed excision
Txt for black widow spider bite?
wound care, benzo’s, antivenom- elderly and kids
What classifies as Stevens Johnson syndrome (SJS)?
milder form <10% of body surface
What classifies as Toxic Epidermal Necrolysis (TEN)?
severe form >30% of body surface
What two classes of drugs cause SJS?
Anticonvulsants
sulfa drugs
What symptoms are seen in SJS and TENS?
+ Nikolyskys sign
red papules and dusky blisted eroded areas, mucous membrane involvement
Txt for SJS?
Stop all offending meds
Burn unit admin
Intravenous immunoglobulin (IVIG)
Steroids use to be the TOC for SJS, but now it has a increase risk for what?
Sepsis
More severe form on SJS?
TEN
DX for TEN and SJS?
biopsy
Txt for TEN?
burn unit
Cyclosporine
Tinea corporis?
infection of body surfaces other than feet, groin, face, scalp hair or bread
Tinea pedis?
infection of feet
Tinea cruris?
infection of the groin
Tinea capitis?
infection of scalp hair
Tinea unguium?
infection of nail
What medicine is not effective for dermatophyte infections?
Nystatin
What is the most common fungal infection in pediatrics?
Tinea capitis
Drug of choice for Tinea capitis?
Oral griseofulvin
Txt for Tinea barbae?
oral griseofulvin
What is the most common dermatophyte causing athlete’s foot?
Trichophyton rubrum
Txt for Tinea pedis?
Topical antifungals- azoles
Txt for jock itch?
Topical antifungals- azoles
What is the most comon cause of Tinea corporis?
T. rubrum
Txt for tinea corporis?
Topical antifungals- azole or terbinafine
What organism causes Tinea versicolor?
Malassezia furfur
Hypo or hyperpigmented macules that do not tan
Tinea versicolor
Txt for Tinea versicolor?
selenium sulfide shampoo 2.5%
Dx of Tinea infections?
KOH prep
Whom should be monitored closely when using oral antifungals?
Pt with hepatic disorders
When taking griseofulvin pts should avoid ?
alcohol- can cause a disulfiram rxn- flushing, HA, N/V, sweating, weakness, vertigo
Blanchable, edematous pink papules, wheals or plaques often disappears within 24hrs
Urticaria
Another name for Hives?
Urticaria
What is Darier’s sign?
localized urticaria appearing where the skin is rubbed
What mechanism causes urticaria?
release of histamines due to Ig E
Dx of urticaria?
lab testing not indicated
skin or IgE testing
1st line txt for urticaria?
2nd gen antihistamine H1 (Fexofenadine, Loratadine, Desloratadine, Cetirizine)
If 1st line txt for urticaria doesn’t work whats next?
double H1 or add H2 antihistimine (Cimetidine, ranitidine, nizatidine, famotidine)
Corticosteriods
Txt of urticaria that might progress to anaphylaxis?
EpipEN
4-5mm flesh colored, sharply demarcated, rough, round and firm nodules with no skin lines, pinpoint black dots
warts (verrucae)
T/F Freezing and other destructive modalities do not kill the virus but just destroy the cells that harbor HPV?
True
Txt for verrucae?
most resolve in 2yrs
cryotherapy w/ liquid nitrogen
salicylic acid
What is vitiligo?
patterned loss of melanin pigment that occurs when immune cells destroy the melanocytes
Where does Vitiligo normally occur?
around orifices- mouth, eyes, nose, and anus
What 3 autoimmune diseases is Vitiligo associated with?
Addison’s disease
Hyperthyroidism
Pernicious anemia
DM
Dx of vitiligo?
wood’s light
“Milk white” fluorescence under Wood’s light?
Vitiligo
Whom is at a 50% risk of having Vitiligo?
someone w/ a family hx
hypo pigmentation macules
Vitiligo
Txt for Vitiligo?
sunscreen, cosmetic cover up, repigmentation therapy
Which dermatitis is assoicated with celiac disease (gluten-intolerance)?
dermatitis herpetiformis
What is acanthosis nigricans commonly associated with?
hyperinsulinemia, insulin resistance, obesity, endocrine disorders
velvety, Hyperpigmented, papillomatous lesions of the neck and axillae
acanthosis nigricans
Pts with acanthosis nigricans are at risk for what?
metabolic syndrome
Txt for acanthosis nigricans?
weight loss and metformin
What is malignant acanthosis nigricans associated with?
gastric carcinoma
