Fungal

Question 2

risk factors for candida

Answer 2

Skin macerations

Long term use of PO abx

Oral contraceptives

DM

Immunosuppression

Question 3

pathophysiology of candida

Answer 3

candida is part of the normal microbiota in GI and GU tract

it has the ability to invade and cause disease when an imbalance occurs

Question 4

risk factors for oral candidiasis

Answer 4

Most common opportunistic infection in HIV patients

infants

older adults wearing dentures

long term ABX therapy

inhaled steroids

immunodeficiency

chemo/radiation

Question 5

causes of vulvovaginal candidiasis

Answer 5

recent antibiotic therapy

DM

sexual intercourse with infected partner

hormones (HRT, tamoxifen, pregnancy, oral contraceptives)

tight fitting/synthetic clothing

immunosuppression

Question 6

cause of balanitis

Answer 6

uncircumcised

poor hygiene

sexual intercourse with infected partner

Question 7

microscopy of candida

Answer 7

KOH prep reveals budding hyphae and pseudo yeast cells

Question 8

Pathophysiology of tinea versicolor / pityriasis versicolor

Answer 8

Malassezia is a lipid dependent yeast that is part of the normal skin flora

external factors convert malassezia into a pathogenic form

Question 9

risk factors for tinea versicolor

Answer 9

increased humidity and temperatures

hyperhidrosis

topical skin oils

oral contraceptives

malnutrition

corticosteroid use

immunosuppression

Question 10

woods lamp of tinea versicolor

Answer 10

yellow-green color

Question 11

Fungi that cause dermatophyte infections

Answer 11

Trichophyton

Microsporum

Epidermophyton

Question 12

difference between candida and dermatophytes

Answer 12

dermatophytes can only survive in the stratum corneum of hair, skin, and nails and will not survive in the oral mucosa

Question 13

Majority of dermatophyte infections are caused by ___ .

Answer 13

trichophyton rubrum

Question 14

People at higher risk for dermatophyte infections

Answer 14

regular use of topical / systemic corticosteroids

immunosuppressed

crowded living conditions

poor hygiene

high humidity

contact sports

Question 15

clinical presentation of moccasin tinea pedis

Answer 15

well demarcated hyperkeratosis, fine white scale, erythema

one or both heels, soles, lateral borders of foot

chronic and recalcitrant to therapy

Question 16

clinical presentation of interdigital tinea pedis

Answer 16

erythema and scaling to web spaces (between 3rd and 4th most commonly)

maceration and fissures can be present

often occurring in men wearing steel-toed shoes

Question 17

clinical presentation of inflammatory/vesicular tinea pedis

Answer 17

vesicular or bullous eruption to the medial aspects of the foot

Question 18

clinical presentation of ulcerative tinea pedis

Answer 18

erosions or ulcers in the web spaces

frequently associated with bacterial infections and more prevalent in DM or immunocompromised patients

Question 19

Most common dermatophytes causing tinea capitis

Answer 19

Trichophyton tonsurans (most common in US)
-causes “black dot” tinea

microsporum canis (most common world wide)

Question 20

Woods lamp for tinea capitis

Answer 20

blue-green fluorescence

lack of fluorescence does not exclude dermatophyte infection

Question 21

treatment for interdigital tinea pedis

Answer 21

econazole (broad spectrum)

Question 22

treatment for tinea pedis

Answer 22

topical antifungals for 2-4 weeks

lactic acid, ammonium lactate, salicylic acid can help with hyperkeratosis

aluminum chloride hexahydrate 20% can help with interdigital maceration

Question 23

treatment for tinea cruris

Answer 23

topical allylamine antifingal creams for 2-4 weeks
(terbinafine, naftifine, butenafine)

Question 24

treatment for tinea corporis (smaller body surface areas)

Answer 24

topical allylamines
(terbinafine, naftifine, butenafine)

Question 25

treatment for tinea corporis in cases of
-immunocompromised
-large BSA
-unresponsive to topical
-majocchi’s granuloma

Answer 25

Oral:
-terbinafine
-itraconazole
-griseofulvin

Question 26

treatment of tinea manuum

Answer 26

topical allylamines
(terbinafine, naftifine, butenafine)

Question 27

treatment of tinea capitis

Answer 27

topicals are NOT effective

Griseofulvin 20-25mg/kg or 10-15mg/kg every 24 hours
-Gold standard therapy
-most effective tx against microsporum species
-treatment typically 6 weeks
-if symptoms not resolved after 6 weeks, continue 2 weeks

Terbinafine