Greg Larsen - Derm Review Flashcards
1
Q
what is pediculosis
A
lice
2
Q
how are pediculosis transmitted
A
through direct contact or fomites
3
Q
can pediculosis jump/fly
A
no!
4
Q
sx of pediculosis
A
constant itching
+/- eczema or lichen simplex chronicus
5
Q
what do these heads have?
A
pediculosis
can look like eczema
6
Q
first line tx for pediculosis according to CDC
A
permethrin 1% lotion
7
Q
brand name for permethrin
A
Nix
8
Q
what do you think when you see: burrows or s shaped erythematous tracts on the skin in inertriginous zones
A
scabies
9
Q
who is at risk for scabies
A
houseolds/communities w. close intimate contact and overcrowding
10
Q
sx of scabies
A
intense itching
can be worse at night
11
Q
what do these people have
A
scabies
12
Q
what question should you ask a patient w. suspected scabies
A
are any family members or close contacts experiencing sympsoms?
13
Q
tx for scabies
A
permethrin cream and another application 1 week later
14
Q
2 skin and soft tissue infections that are commonly associated w. erythema, edema, pain
A
cellulitis
erysipelas
15
Q
deeper infection involving the dermis and subcutaneous tissue
A
cellulitis
16
Q
superficial skin infxn involving lymphatic streaking
A
erysipelas
17
Q
cellulitis and erysipelas are mc caused by
A
GAS
s. aureus
H.flu
18
Q
erisypelas is commonly seen on the
A
face
19
Q
what does this person have
A
erisypelas
20
Q
what does this person have
A
cellulitis
21
Q
cellulitis is commonly seen on the
A
legs
22
Q
cellulitis and erysipelas are commonly missed; what is the ddx for these conditions
A
stasis dermatitis
eczema
DVT
osteomyelitis
ulcerations
pressure sores
fungal infxns
intertrigo
erythrasma
23
Q
whether or not cellulitis and erysipelas are purulent, you should
A
drain and culture!
always!
24
Q
gold standard op empiric tx for cellulitis and erysipelas
A
cephalexin (keflex)
25
what is the more realistic op tx for cellulitis and erysipelas
doxycycline
*bc it covers MRSA*
26
tx for hospitalized pt w. cellulitis/erysipelas
IV abx → ex Vanco
27
“pathetic version of cellulitis”
impetigo
28
what do you think when you see “tiny fragile yellow to honey colored crusted vesicles”
impetigo
29
mc pathogens associated w. impetigo
s.aureus
streptococcus pyogenes
30
what does this kid have
impetigo
31
impetigo can also present as
small fluid filled vesicles that crust over after the bullae ruptures
32
what do these kids have
impetigo
33
tx for localized/limited impetigo
topical mupirocin
34
does topical mupirocin cover mrsa
yes!
35
tx for widespread/non responding impetigo
doxycycline
***only for kids \>8 yo***
***not for pregnant***
36
what do you think when you see: mild exanthem that is generally self resolving; **slapped cheek rash** followed by rash over cheset, back, buttocks, extremities
erythema infectiosum
37
erythema infectiosum is same-same
parvovirus
5th disease
38
what does this kid have
erythema infectiosum (parvovirus)
39
primary cause of transient aplastic crisis
erythema infectiosum (parvovirus)
40
what do you think when you see: coxsackievirus A 16 and enterovirus 71
hand-foot-and-mouth dz
41
what does this kid have
hand food mouth dz
42
how does hand food mouth dz present
vesicular palmoplantar eruptive rash
43
is this hand food mouth dz
no! it is syphilis
44
always be wary of vesicles on the
palms and soles
45
what does this person have
measles (rubeola)
46
contagious viral exanthem via droplet spread and direct contact; single stranded RNA morbillivirus
measles (rubeola)
47
prodrome of measles (3)
cough
coryza/rhinitis
conjunctivitis
48
2 classic signs of measles
nose and eyes run continuously
koplik spots
49
what are koplik spots
blue to white lesions with a red halo
50
what are these
koplik spots → blue to white lesions with a red halo
51
rare group of blistering AI disorders that tend to involve skin and mucosal membranes
pemphigus
52
what do you think when you see desmoglein antibodies Dsg1 and Dsg3
pemphigus
53
what is desmoglein
adhesion molecule that helps keep structural integrity to the epidermis
54
what does this person have
pemphigus
55
mc/dominant form of pemphigus
pemphigus vulgaris
56
how does pemphigus vulgaris present
painful oral erosions
57
what do you think when you see: exceptionally brittle bullae/blisters; **positive nikolsky sign**
pemphigus vulgaris
58
what is nikolsky sign
sloughing of epidermal tissue w. pressure
59
what does this patient have
pemphigus vulgaris
60
shallow erosions/abrasions w. erythema and scaling
+/- blister formation
pemphigus foliceus
61
what does this patient have
pemphigus foliaceus
62
dx for pemphigus
perilesional punch bx w. skin adjacent to blister
63
what do you think when you see Michel's medium
direct immunofluorescence (DIF) for pemphigus
64
Michel's medium helps to
improve shelf life of processing tissue
65
tx for pemphigus
no official clear tx guidelines
reduce inflammatory response w. immunosuppressants → **prednisone**
66
mc AI blistering skin dz
bullous pemphigoid
67
bullous pemphigoid is considered a dz of
advanced age
60 yo +
68
what does this pt have
bullous pemphigoid
69
how does pemphigoid present
localized erythema or urticarial plaques that worsen over time → hives
70
how do blisters of pemphigoid differ from pemphigus
pemphigoid blisters appear more structurally intact → **negative nikolsky sign**
71
rubbing of skin results in sloughing of epidermal tissue
nikolsky sign
72
nikolsky sign is positive in \_\_
and negative in \_\_
pemphigus
pemphigoid
73
what does this pt have
pemphigoid
74
dx for pemphigoid
perilesional punch bx w. skin adjacent to blister
75
DIF including michel's medium is used for
pemphigus
AND
pemphigoid
76
initial serum tests for pemphigoid
BP 180
BP 230
77
mainstay tx for pemphigoid (and pemphigus)
prednisone
78
common acute and recurrent inflammatory/hypersensitivity dz that often follows viral infxn/bacterial infxn or in pregnant pt
erythema multiforme
79
what do you think when you see: **targetoid lesions** often on extremities, hands, feet
erythema multiforme
80
pathology of erythema multiforme involves
immune complexes
81
erythema multiform often presents w. __ targetoid lesions
uticarial
82
what do these patients have
erythema multiforme
83
tx for erythema multiforme
self limiting
+/- prednisone
84
immune complex mediated desquamative hypersensitivity d.o; extreme form of erythema multiform
stevens-johnson syndrome/toxic epidermal necrolysis (TEN)
85
\_\_ are almost always involved in stevens johnson syndrome
oral mucosa → lips
86
stevens johnson is mc seen in what 2 pt pops
kids
young adults
87
what do these patients have
stevens johnson syndrome
88
primary dx test for Stevens Johnson syndrome
punch bx
89
epidermal necrosis and apoptosis of keratinocytes
punch bx finding for stevens johnson
90
in stevens johnson, nikolsky sign will be
positive
91
tx for stevens johnson
d/c meds!
admit to burn unit
fluid/lytes
wound care
consult all the specialists
92
what pharm is contraindicated in stevens johnson
oral steroids
93
pigmentation d.o frequently associated w. pregnancy and women taking OCP
melasma
94
melasma frequently appears on the
forehead
molar cheeks
upper lip
chin
95
acquired loss of pigmentation
vitiligo
96
who is this?
michael jackson duh!
he has vitiligo
97
flat hypopigmented 2-5 mm macules in sun exposed areas
idopathic guttate hypomelanosis
98
what does this patient have
idiopathic guttate hypomelanosis
99
hair loss on any are of the body where hair would normally be present
alopecia
100
alopecia is divided into
scarring/cicatricial
non-scarring
101
scarring alopecias
central centrifugal cicatricial alopecia
lichen planopilaris
frontal fibrosing alopecia
dissecting cellulitis
acne keloidalis nuchae
102
non scaring alopecias
alopecia areata
traction alopecia
genetic pattern hair loss
telogen effuvium
103
central scarring alopecia that spreads outward
central centrifugal cicatricial alopecia
104
what does this patient have
central centrifugal cicatricial alopecia
105
type of alopecia that presents w. patchy erythema and perifollicular scarring on the front-central scalp and crown
lichen planopilaris
106
what does this patient have
lichen planopilaris
107
lichen planopilaris should make you consider
syphilis
108
is lichen planopilaris painful?
yes → pain, stinging, burning in active areas
109
exam of scalp shows spinous hyperkeratotic follicular papules w. perifollicular erythema
lichen planopilaris
110
what does this pt have
lichen planopilaris
111
variant of lichen planopilaris that involves hair loss in other locations (eyebrows/upper extremities)
frontal fibrosing alopecia
112
what does this pt have
frontal fibrosing alopecia
113
patchy pustular eruptions of the scalp; chronic in nature; leads to inflammation and permanent scalp scarring
folliculitis decalvans
114
what does this pt have
folliculitis decalvans
115
wide spread folliculitis w. atrophic patchy scarring and perifollicular crusts
folliculitis decalvans
116
mechanical form of folliculitis/inflammation which causes scarring alopecia; typically affects darker skinned men w. curly hair
acne keloidalis nuchae
117
what does this pt have
acne keloidalis nuchae
118
asymptomatic loss of complete hair in one or more patches of any hair bearing surface
alopecia areata
119
what does this pt have
alopecia areata
120
3 types of alopecia areata
areata
totalis
universalis
121
alopecia areata
partial hair loss
122
alopecia totalis
100% hair loss of scalp
123
alopecia universalis
100% hair loss of whole body
124
what is this and what does it make you think of
exclamation point hairs
alopecia areata
125
what are exclamation point hairs
broader/wider distal shaft and narrow proximal shaft/base
126
alopecia 2/2 to prolonged mechanical tension like grooming and styling
traction alopecia
127
what does this pt have
traction alopecia
128
androgenetic alopecia in men that is a physiologic response 2/2 to androgens
genetic patterned hair loss
129
what do you think when you see hamilton patterns
classification for genetic patterned hair loss
130
tx for genetic patterned hair loss
minoxidil, finasteride (rogaine)
131
temporary shedding brought on by stimulus → ex stress
telogen effluvium
132
inflammation of nailfold tissue; usually infectious
paronychia
133
what do you think when you see chronic paronychia w. green nail
pseudomonas
134
chronic paronychia is \> __ weeks
6
135
what is this
green nail syndrome/chloronychia
pseudomonas
136
fungal infxn of the nails
onychomycosis
137
4 types of onychomycosis
distal subungual
white superficial
proximal subungual
candida onychomycosis
138
white superficial onychomycosis typically requires __ for dx
oral tx rather than topical → itraconazole, fluconazole, terbinafine
139
mc type of onychomycosis
distal subungual
140
type of onychomycosis seen in immunocompromised pt
proximal subungual onychomycosis
141
candida onychomycosis is caused by
candida albicans
142
candida onychomycosis generally involves
all the fingernails
143
what does this pt have
onychomycosis
144
oral med for onychomycosis that can cause liver dz
terbinafine
