FINAL derm Flashcards

Question

What kind of exudate is most common in bacterial infection?

Answer 1

Purulent exudate (has large number of leukocytes)

Answer 2

Gram staining helps determine thickness of the wall to ID/ categorize bacteria. Crystal violet is the dye used. Peptidoglycans in the cell wall retain dye; a thick cell wall retains violet color; a thin does not. Gram positive- stains purple or blue Gram negative- stains pink or red

Answer 3

Staphylococcal, streptococcal pneumonia, cholera (mucous membranes), ?TB

Answer 4

True. In acne vulgaris, there are 4 causative factors: 1) hyperkeratinization of the follicular epithelium 2) excessive sebum production (caused by androgens and testosterone) 3) follicular proliferation of anerobic p. acnes 4) Inflammation and rupture of follicle from accumulated debris and bacteria

Answer 5

Inflammation of hair follicle anywhere on body.

Answer 6

Often staph aureus (most common) or pseudomonas (hot tub folliculitis). Can be fungal.

Answer 7

Bacterial infection spread by trauma/ itching/ shaving. Acneiform eruption becomes pustular, superficial. Leads to dome shaped pustules with small erythematous falos arising in a follicle. Can be tender.

Answer 8

most respond to abx. minimize triggers like heat, friction, occlusion.

Answer 9

Infected pocket/ abscess commonly caused by staph (localized redness) or strep (streaking). Furuncles are walled off masses and carbuncles are deep interconnected aggregates.

Answer 10

Staph (MRSA)

Answer 11

-deep dermal or subcutaneous red, swollen, painful mass -later points toward surface and drains through multiple openings -afebrile -gram stain, C&S indicated

Answer 12

-deep, tender, firm subcutaneous erythematous papules enlarge to deep seated nodules that can be stable or fluctuant within days -often back of neck, upper back, lateral thighs -malaise, fever, chills may precede or occur with height of inflammation -gram stain, C&S indicated

Answer 13

-infection can spread to other sites -recurrent furunculosis may be difficult to eradicate -warm moist dressings -incision and drainage are primary management for pointing, fluctuant lesions (refer to derm if on hands or face) -systemic antibiotics if multiple lesions or signs of systemic illness (fever, malaise, spreading redness, increasing pain) -Dicloaxacillin, cephalexin, clindamycin -good handwashing will reduce # of & on skin. Use separate towels from others. -follow up in 5-7 days to see if improving (2 days if using packing)

Answer 14

Superficial skin infection produced by streptococcus pyogenes, staph aureus, or both

Answer 15

Common (highly infectious), children have higher rates of infection (close physical contact), warm/moist/ humid climates and poor hygiene predispose

Answer 16

Self limited, but if untreated, may spread and last for weeks to months.

Answer 17

May occur after minor skin injury or within lesions of another dermatitis, however, often develops on normal skin. Local or widespread; common on face. Systemic symptoms infrequent. Bullous- thin roofed bullae turn from clear to cloudy, collapse quickly leaving an inner tube shaped rim with central thin, fat, honey color stuck on crust. Lesions enlarge and coalesce. Minimal surrounding erythema. May have adenopathy Non Bullous- vesicles or pustules rupture. Scaling border. Firm adherent crust is honey yellow to white brown; it accumulates.

Answer 18

Antibiotic cream, or oral antibiotics for widespread lesions/ bullous impetigo.

Answer 19

An infection of dermis and subcutaneous tissues characterized by fever, erythema, inflammation, and pain

Answer 20

Staph aureus, MRSA, group B strep

Answer 21

Diabetes, cirrhosis, poor lymphatic circulation, renal failure, poor nutrition, HIV, ETOH, cancer, chemotherapy, pre-existing skin issues and substance abuse are predisposing factors. -Trauma and surgery are risk factors

Answer 22

Redness, warmth, pain, vesicles, blisters. Skin is slightly raised and border is indistinct. Pain on palpation. Very common on lower extremities or ear.

Answer 23

Cellulitis is bacterial infection of dermis/ subcutaneous tissues Erysipelas is infection of superficial dermal layer (margins more clearly demarcated, may involve lymphatics and has streaking. Group A strep.

Answer 24

They are all nail related disorders

Answer 25

Transverse depressions or ridges of all the nails that appear at lunula base

Answer 26

Appear after a stressful event temporarily interrupts nail formation. Causes: high fever, scarlet fever, hand-foot-and-mouth disease, chemo

Answer 27

We don’t. Lines progress distally with normal nail growth, eventually disappear at free edge

Answer 28

Separation of nail from nail bed starting at distal end and slowly progressing proximally nonadherent part of nail is white, yellow or green-tinged

Answer 29

nail trauma, repeated wet work, vigorous repeated manicuring (digging under nails), false nails allergy and psoriasis

Answer 30

Screen patients with unexplained onycholysis for hyperthyroidism, asymptomatic thyroid disease and iron deficiency

Answer 31

cut separated portion of the nail. Promotes dryness and discourages infection. Yeast can grow in space between the nail and nail bed. Treat with topical agents (fungoid tincture that contains miconazole). Consider oral fluconazole for resistant cases

Answer 32

Acute or chronic infection of the cuticle. One or more fingers or toes may be involved

Answer 33

hands frequently exposed to moisture

Answer 34

Staphylococci and streptococci

Answer 35

Abscess may develop, requiring incision and drainage. Pus can develop and expressed from the proximal nail fold. Nail plate is not typically affected, but can become discolored with ridges Treatment: Topical application of thymol. Oral antifungals NOT effective because they do not penetrate affected tissues. Prevention is key by keeping hands dry

Answer 36

Results from increased lateral pressure either by poorly fitting shoes, excessive trimming of lateral nail plate or trauma Usually large toe

Answer 37

Dermis is penetrated by the nail/lateral nail fold, and broken skin becomes purulent and edematous as granulation tissue grows with the penetrating nail pain and swelling

Answer 38

Treatment: removal of the penetrating nail with scissors/curetting granulation tissue and using silver nitrate sticks to treat small areas of granulation Could lead to cellulitis which may require PO antibiotics

Answer 39

Focal collections of mucin (macromolecules in mucus) that don't have a cystic lining Dome-shaped, pink-white, typically occur on the dorsal surface of the distal phalanx in middle-aged and elderly people

Answer 40

Typically benign, no intervention if pain free and does not compromise any function If treatment is needed: cryosurgery of the base: Remove cyst roof w/ scissors, expel gelatinous exudate Freeze the base Treated site will be edematous and exudative, and a bulla will usually develop Healing takes 4-6 weeks, and retreatment is frequently needed

Answer 41

Condylomata acuminata

Answer 42

HPV (human papilloma virus)

Answer 43

Estimated 75% of sexually active people in Canada will have HPV at some point >100 types of HPV

Answer 44

Multiple sexual partners & high risk partners Unprotected sex Immunocompromised Smoking Not vaccinated (The HPV9 vaccine [Gardasil] protects against types 6 and 11)

Answer 45

90% caused by HPV type 6 or 11 (low risk for cancer), although often co-infection with other types of HPV common

Answer 46

True, Infection can remain latent Usually 3 week – 8 month incubation period as well

Answer 47

True, it the most common STI in the world apparently!

Answer 48

Acquired through sexual activity (even just skin to skin contact)

Answer 49

Warts may recur due to subclinical infection, re-infection, or immunosuppression May resolve on own within a few months, but may also maintain or progress if not treated

Answer 50

I'm hoping he would say "cauliflower-like" on an exam? Variable sizes, papules or plaques Many shapes: flat, dome, cauliflower-like, filiform, fungating, pedunculated, cerebriform, plaque-like, smooth, verrucous, or lobulated Colour varies: skin-coloured, white, hyperpigmented, brown, pink or red 1mm – several cm’s

Answer 51

Located on genitalia, groin, perineum, anal skin, perianal skin, and/or suprapubic skin Urethral, cervical, or anal involvement possible If extensive, may interfere with defection or urination, or urethral bleeding

Answer 52

Diagnosis usually based solely on clinical presentation and physical assessment Limited to anogenital region and surrounding areas Biopsy possible for definitive diagnosis, and to rule out malignancy Assess for signs of other STIs: ulcerations, vesicles, or discharge & test accordingly

Answer 53

Very common Timing of infection cannot be confirmed as can take months to have symptoms (if fear or infidelity) May be at risk of other STI Should inform sexual partners as can transmit HPV (still chance if no warts)

Answer 54

An acute, immune-mediated condition affecting skin + mucous membranes (including genital) - Produced by a cytotoxic immune response directed against keratinocytes expressing foreign viral or drug antigens - Infections are the cause for ~90% of cases. Commonly in herpes simplex type 1 & 2. Other common cases are Mycoplasma pneumoniae, and upper respiratory tract infections.

Answer 55

- Usually self-limiting and resolves in 1 month without scarring

Answer 56

"target-shaped" Characterized by numerous target-shaped skin lesions with many types of lesion morphologies (hence name multiforme): target lesions, erythematous macules and papules, urticarial-like lesions, vesicles, and bullae. - Target lesions begin as dusky-red, round macules and papules that may burn and itch. - Early lesions appear suddenly in a symmetric or CROP PATTERN on the palms, soles, backs of the hands and feet & forearms and legs. Bullae and erosions may be present in the oral cavity (NOT to be confused with SJS) - This central area is surrounded by a pale area of edematous skin, which is in turn surrounded by a sharp discrete ring of erythema.

Answer 57

Herpes simplex

Answer 58

Primary Infection: HSV enters nerve endings in the skin directly or travels down peripheral nerves to dorsal root ganglia (DRG) where it stays inactive Recurrent Infection: Occurs after symptomatic or asymptomatic primary infection Local skin trauma, systemic changes reactivate virus Virus then travels via peripheral nerves down to initial infection site

Answer 59

HSV spreads via resp. droplets, direct contact with an active lesion or Salva or cervical secretions containing virus

Answer 60

Primary Infection: Mostly asymptomatic Early signs = Tenderness, pain, mild paresthesia Later: lesions, grouped vesicles (more numerous and spaced out than secondary infection) Localized pain, tender lymphadenopathy, headache, fever, generalized aches Lesions on mucous membrane accumulate exudate, lesions on skin form crust Gingivostomatitis + pharyngitis most frequent (Type1) Vulvovaginitis/painful vaginal + cervical erosions in women w genital infection May have proctitis, anorectal pain, discharge, constipation or tenesmus in men or women

Answer 61

Early signs (same as primary) (tenderness, pain, paresthesia) lesion formation with rapid formation of papules and then vesicles dome-shaped, tense vesicles rapidly umbilicate systemic symptoms rare

Answer 62

Primary Infection: Early sins occur before onset of lesions 3-7 days after contact Lesions last 2-6 weeks and heal without scaring Recurrent Infection: Early signs last 2-24 hrs Lesions appear within 12 hrs after 2 ~ 4 days vesicles rupture and form erosions or crust crust sheds in ~8 days recurrent disease

Answer 63

Chickenpox & shingles

Answer 64

- Have prodromal neuropathic pain before appearance of vesicular rash - neuropathic pain (burning, gnawing) - Vesicular rash/blisters (restricted to single dermatome) - Pain, paralysis, itching and sensitivity after resolution of infection (post-herpetic neuralgia) - Corneal scarring with enduring visual acuity deficits (if herpes zoster opthamicus)

Answer 65

- tracts along neurons to dorsal root ganglia (or trigeminal ganglion) to establish latent infection.

Answer 66

Most common in children under 10 and older adults

Answer 67

Sexual activity Contact sports immunocompromised (previously late marker in HIV) Warm moist environments like steam rooms, saunas, and pools

Answer 68

Belongs to poxvirus family MCV1 and MCV2 as the most common genotypes of virus

Answer 69

Spread by direct skin-to-skin contact, fomites (such as towels) and sexual contact Can also spread on a person’s body via autoinoculation

Answer 70

Remains contagious until the bumps are gone

Answer 71

Umbilicated! Presents as small 2-5mm flesh-coloured dome-shaped papules that often have dimple in center (“umbilicated”) Lesions may be alone or grouped Firm lesions May have larger, more extensive lesions if immunocompromised (such as HIV) May have inflammation, erythema and scaling around lesions Can occur anywhere on the skin but most often trunk, axillae, face, genital regions Does not occur on palms or soles Considered STI when spread to genitals of adult

Answer 72

Diagnosis usually based solely on clinical presentation and physical assessment Distinguishing feature is umbilication (central indent) in papules Can be mistaken for many other skin conditions – skin biopsy can help differentiate

Answer 73

Current sexual partners should seek treatment if symptomatic Not protective (can get reinfected) Preventing spread: try not to scratch, cover lesions with bandage, don’t share facecloths or towels, don’t shave if lesions on face, do not squeeze lesions, avoid contact sports unless can cover all lesions, and avoid sexual contact until lesions are treated and partners are assessed and treated If going to be sexually active, ensure all lesions covered Referral

Answer 74

Pityriasis Rosea (not viral per se but is inflammatory rash that often is preceded by virus such as HSV)

FINAL derm Flashcards

(103 cards)