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Integumentary Disorders > Integumentary Disorders > Flashcards

Integumentary Disorders Flashcards

1
Q

What is a macule?

Give example.

A

<1 cm, circumscribed flat area

Freckle (ephelides)
Petechiae
Flat nevi/moles

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2
Q

What is a patch?

Give example.

A

> 1 cm, flat area (large macule)

Cafe-au-lait
Mongolian spots

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3
Q

What is a papule?

Give example.

A

<1 cm, small, solid, elevated lesion

Ant bite
Elevated nevus/mole
Verruca/wart

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4
Q

What is a plaque?

Give example.

A

> 1cm, elevation of skin (a large papule)

Psoriasis lesion

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5
Q

What a pustule?

Give example.

A

<1 cm, circumscribed elevation of skin, contains purulent fluid/pus

Acne
Impetigo

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6
Q

What is a vesicle?

Give example.

A

<1 cm, circumscribed elevation of skin, contains serous fluid

HSV
Varicella/chickenpox
Herpes zoster/shingles

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7
Q

What is a nodule?

Give example.

A

> 1cm, solid mass of skin, elevated, can be palpated, often extends into the dermis (deeper)

Xanthoma
Fibroma

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8
Q

What is a bulla?

Give example.

A

> 1 cm, blister, circumscribed elevation, containing serous fluid, extends into the epidermis

Burns
Superficial blister
Contact dermatitis

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9
Q

What is a cyst?

Give example.

A

Any closed cavity or sac
Contains fluid or semi-solid material
Normal or abnormal epithelium

Sebaceous cyst

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10
Q

What kind of derm pathology presents in a gyrate pattern?

A

Scabies

Twisted, coiled, spiral, snake-like pattern

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11
Q

What skin condition is topical metronidazole frequently used for?

A

Rosacea

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12
Q

What are the two contraindications of tetracycline?

A

Not used in pregnancy. Not given in children

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13
Q

What are the two most commonly prescribed oral contraceptives for acne?

A

Ortho Tri-Cyclen and Estrostep
Combo pills
May cause melasma, brownish/tan blotches

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14
Q

What is the most common cause of cellulitis in the outpatient setting?

A

Streptococcus pyrogenes (Group A Strep)…
same as in strep throat
Staph aureus - less common
Other strep is rare

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15
Q

Considering Group A Strep as the cause of cellulitis, what would you prescribe?

A

trimethoprim/sulfamethoxazole (Bactrim) + a Beta-lactam (PCN, amoxicillin, 1st generation cephalosporin (Keflex)

OR

doxyclycine/minocycline + a beta-lactam (PCN, amoxicillin, 1st generation cephalosporin (Keflex)

OR

clindamycin

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16
Q

What is you consider CA-MRSA as the cause of cellulitis. What would you prescribe?

A

Strep pyogenes (Group A strep) - same as strep throat

trimethoprim/sulfamethoxazole (Bactrim) + a Beta-lactam (PCN, amoxicillin, 1st generation cephalosporin (Keflex)

OR

doxyclycine/minocycline + a beta-lactam (PCN, amoxicillin, 1st generation cephalosporin (Keflex)

OR

clindamycin

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17
Q

How would you treat tinea versicolor (hypo/hyperpigemented macules on limbs)?

A

Selenium sulfide and/or topical antifungals

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18
Q

How would you treat someone with onychomycosis?

A

With an oral antifungal such as irtaconazole or terbinafine

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19
Q

When would you consider an immediate referral in your patient with shingles?

A

If suspected ocular involvement

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20
Q

What is actinic keratosis?

What is the treatment?

A

Small patches occurring on sun-exposed areas
Premalignant lesions progress to SCC
Asymptomatic, may be tender
Rough, flesh colored, pink or hyperpigmented

Treat with liquid nitrogen

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21
Q

If untreated, what can actinic keratosis progress to?

A

Squamous cell carcinoma

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22
Q

What is squamous cell carcinoma?

What is the treatment?

A 
Arise out of actinic keratoses
Firm, irregular papule or nodule
Develop over a few months
3-7% metastasize
Appear on prolonged sun exposed areas in fair skinned 
Keratotic, scaly, bleed

Treat with biopsy and surgical excision/Mohs

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23
Q

What is the most common skin cancer?

A

basal cell carcinoma

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24
Q

What is basal cell carcinoma?

What is the treatment?

A

The most common skin cancer
Slow growing lesion (1-2 cm after years)
Waxy, pearly appearnace, may be shiny red
Crater/central depression with rolled edge
May have telangiectatic vessels

Treat with shave/punch bx and surgical excision

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25
What is the treatment for basal cell CA?
Punch biopsy and surgical excision
26
What does ABCDEE stand for?
``` Asymmetry Border irregularity Color variation Diameter >6mm (and growing) Elevation Enlargement... refers to melanoma. ``` Treatment: surgical excision and biopsy`
27
What are some features that distinguish Rocky Mountain Spotted Fever from Lyme disease?
1. More severe illness: macuolopapular or petechial rash, joint pain, fever 2. Different organism (Rickettsiae) 3. Diagnostics are by PCR, immunohistochemical staining, and IFA.
28
What are some similar features between Lyme Disease and RMSF?
1. Flu-like symptoms | 2. Both treated with Doxycycline
29
S/S of small pox
**Isolation** Sudden onset of flu-like symptoms Rash appears as flat, red spots/lesions Within 2 days, lesions turn into small glisters filled with serous fluid and later with purulent fluid. First lesions appear on oral mucosa/palate, face and forearms All lesions are in the same stage of development. The scabs turn to deep, pitting scars Pain can be excruciating No cure/treatment
30
How do you treat small pox?
You don't. Supportive therapy. Isolate infected person.
31
What antibiotics are used in the treatment of anthrax?
PCN, Cipro, Doxy | identified via gram stain
32
Describe the cutaneous effect of anthrax.
95% of cases | Pruritic papule--> ulcer surrounded by vesicles--> black necrotic central eschar with edema--> scar remains
33
How do you treat uncomplicated impetigo?
mupirocin (bactroban) ointment. Put on 2-3x/day for 7 days. Has same efficacy as oral cephalexin.
34
What is the mainstay of rosacea therapy?
laser therapy. *Common triggers should be avoided prior to therapy: hot or cold temperatures, wind, hot drinks, caffeine, exercise, spicy food, alcohol, emotions, topical products that irritate the skin and decrease the barrier, or medications that cause flushing.
35
For what two conditions is UVB light exposure used as a treatment form?
Psoriasis and Pityriasis Rosea
36
What is the treatment for erysipelas? Why?
PCN G/VK because it is a bacterial infection caused by streptococci.
37
What is a wheal? | Give example.
Elevated white or pink compressible papule or plaque A red, axon-mediated flare often surrounds it Commonly associated with allergic reactions PPD test Mosquito bites
38
What is an abscess?
>1 cm | Localized collection of purulent fluid in a cavity formed by disintegration r necrosis of tissues
39
What is a tumor?
"Mass" >a few centimeters in diameter Firm or soft Benign or malignant
40
What kind of derm pathology presents in an annular pattern?
Ringworm Circular, begins in center and spreads to periphery
41
Describe a confluent pattern
Lesions run together
42
Describe grouped pattern
Lesions cluster
43
What kind of derm pathology presents in a linear pattern?
Often contact dermatitis, ie poison ivy Scratch, streak, line, stripe
44
Describe polycyclic pattern
Annular lesions merge
45
Describe solitary or discrete pattern
Individual and distinct lesions that remain separate
46
What kind of derm pathology presents in a target pattern?
Lyme Resembles iris of the eye, lesions with concentric rings of color
47
Describe zostiform pattern
Linear arrangement, along nerve root
48
Acne Open comedones Closed comedones Treatment/Management
open - blackheads closed - whiteheads Pustules/papules of face and upper torso **Mild soap several times/day **Avoid oil-based products **Comedolytic agents - Creams less irritating than Gels **Combination agents - comedolytic + antibiotic
49
Comedolytic agents for acne
Creams less irritating than Gels * Benzoyl peroxide - Bacteriocidal * Salicylic acid (Neutrogena 2%) - Keratolytic * Azelaic acid (Azelex) - Bacteriocidal * Tretinoin (Retin-A) - Pregnancy cat. C, risk of sun burn * Adapalenee (Differin) - Less skin irritation, Preg cat C * Tazarotene (Tazorac) - Expensive, pregnancy cat X
50
Combination agents for acne
Comedolytic + Antibiotic *benzoyl peroxide + erythromycin (Benzamycin) -requires refrigeration *benzoyl peroxide gel + clindamycin (BenzaClin) *benzoyl peroxide + drying agents/sulfacetamide (Novacet or Sulfacet)
51
Topical antibiotics for acne
**Clindamycin - Most frequently used topical for acne** Erythromycin - Second most frequelty used Tetracycline - Not commonly used Metronidazole - Used frequently for rosacea
52
Oral antibiotics for acne
*Tetracycline - Most widely prescribed - contraindicated in pregnancy and in children *Erythromycin *Minocycline *Doxycycline *Clindamycin *Isotretinoin (Accutane) - for severe, unresponsive acne, needs informed consent
53
What is folliculitis? | Common cause?
Inflammation of hair follicle | Staphylococci
54
What is a furuncle? | Common cause?
"Boil" Localized infection originating in the hair follicle Staph aureus
55
What is a carbuncle? | Common cause?
Much larger than a furuncle May be necrotizing Staph aureus
56
What is the most common cause of cellulitis in the inpatient setting?
``` Gram negative organisms E. coli Klebsiella Pseudomonas Enterobacter Staph aureus MRSA? or CA-MRSA? Strep ```
57
What is erysipelas? | Common cause?
**Looks like a sunburn **Rapid progression of erythematous, warm, indurated area **Streptococcus
58
What is hidradenitits suppurativa? | Common cause?
Common in groin or axilla, abscess formation is common Staph aureus
59
What is impetigo? | Common cause?
Infection of the skin Primary lesion is a thin walled vesicle that breaks easily Honey-crusted at the edge Commonly satellite lesions appear and spread to remote areas of the skin Staph aureus
60
What is paronychia? | Common cause?
Manicure gone wrong... Infection around the nail fold, no nail involvement Staphylococci
61
S/S of bacterial skin infection | Management
* Regional lyphadenopathy * Swelling, redness, pustules * Pain, warmth, vesicles, purulent discharge * Fever, malaise, chillss, anorexia *I&D as warrented *Systemic treatment guided towards offending organism *Minor infections, consider topical antimicrobials bacitracin, bactroban (Mupirocin)
62
Drilling a hole through the nail is called what?
Trephination
63
What is candida balanitis? | Management?
Inflammation of the superficial tissues of the penile head Candida albicans Antifungals - miconazole, clortrimazole, fluconazole Steroids
64
What is candida intertrigo? | Management?
Irritation of the skin folds, commonly occurring in warm, moist body areas *Drying agents such as talc/cornstartch *Topical antifungals - Nystatin powder *Oral antifungals - fluocnazole (Diflucan) or itraconazole (Sporanox)
65
What is tinea capitus? | Management?
Dermatophyte infection of the scalp * Selenium 2.5% shampoo * Oral terbinafine, itraconazole or fluconazole * Oral griseofulvin
66
What is tinea corporis? | Management?
RIngworm Dermatophyte infection * Topical antifungals * Severe cases, systemic therapy with ketoconazole
67
What is tinea cruris? | Management?
Jock itch Dermatophyte infection of the groin T. rubrum E. floccosum Topical antifungals Oral antifungals for severe cases
68
What is tinea pedis? | Management
Athlete's foot Dermatophyte infection of the foot Miconazoe Clotrimazole
69
What is tinea manuum? | Management?
Hand/palm Dermatophyte infection of hands/palms Aluminum subacetate solution soaks
70
What is tinea unguium? | Management?
Onycomycosis Persistent fungal infection affecting the toenails and fingernails caused by dermatophytes Oral antifungals - itraconazole, terbinafine
71
What is tinea versicolor? | Management?
hypo/hyperpigmentation macules of skin fungal infection of the skin caused by yeast topical selenium sulfide topical antifungals - miconazole, ciclopirox, clotrimazole
72
Treatment for post-herpetic neuralgia.
gabapentin (Neurontin) | pregabalin (Lyrica)
73
What age can Zostavax be given?
Age 50
74
What is eczema? | Treatment?
Atopic Dermatitis Chronic skin condition characterized by intense pruritus Acute flare ups Red, shiny or thickened patches Inflamed/scabbed lesions with erythema/scaling Dry, leathery lichenification Treatment: Topical steroids, rubbed in well Clobetasol cream/lotion
75
What is psoriasis? | Treatment?
Benign hyperproliferative inflammation of the skin that can be acute or chronic May present as 1st sign of HIV infection Itching, red, precisely defined plaques with silvery scales Fine pitting of the nails Auspitz sign - droplets of blood when scales removed Treatment: Topicals for scalp (tar/salicylic acid shampoo) Topical steroids (betamethasone) UVB light exposure
76
What is pityriasis rosea? | Treatment?
Mild, acute inflammatory disorder More common in females Occurs during spring and fall Herald Patch - initial lesion 2-10 cm in size Generalized rash presents within 1-2 weeks Lesions follow a Christmas-tree pattern Eruption lasts 4-8 weeks Test for syphilis if lesions not itchy, present on palms or soles of feet, lesions are few and perfect ``` Treatment - Oral antihistamine Topica antipruritic Cool compresses Topical steroids UVB light Oral erythromycin ```
77
What is xanthelasma? | What is the treatment?
Yellow plaques as a result of fat buildup under the skin, usually in the inner canthus, upper eyelids HPL is the underlying cause More common in women Peak age onset 40-50 yo Uncontrolled DM is common cause of HPL ``` Tx: Surgical excision Laser Chemical cauterization Electrodesiccation Cryotherapy ```
78
What is Lyme disease? Diagnostic labs? Treatment?
``` **Most common vector-born disease in the US** Takes 24-48 hrs for tick to feed and transmit infecting organism Erythema migrans with central clearing Flu-like symptoms in 50% cases ELISA is initial test Western Blot is confirmatory test Treat with : Doxycydline Amoxicillin Refer ```
79
What is Rocky Mountain Spotted Fever? Diagnostic labs? Treatment?
``` Lethal bacterial infection Transmitted by tick bites Takes 24 hrs for Rickettsiae to be transmitted to the host Maculopapular rash Petechial rash in 35-60% Abdominal pain Joint pain Flu-like symptoms ``` Polymerase chain reaction (PCR) Immunohistochemical (IHC) staining Indirect immunofluescense assay (IFA) w/Rickettsiae antigen Treat with Doxycycline and Refer
80
Describe the inhalation effect of anthrax.
5% of cases Prodromal phase: Non-specific Flu-like Fluminant phase: Fever Diaphoresis Septic shock
81
Genital wart treatment
``` 20% podophyllin (Pododerm) podofilox (Condylox) cryosurgery trichloroacetic acid (TCA) bichloracetic acid (BCA) ```
82
Senile pruritus and treatment
Precipitated by any circumstance that dries a person's skin Bath oils, moisturizing lotions, and massage are beneficial Antihistamines & topical steroids may be prescribed for relief
83
Hypothermia and treatment
Tissue damage resulting from exposure to cold Assess for hypothermia Soak in water at 100 F Treat for pain
84
Insect stings/bites and treatment
Cause toxic reactions that range from local and mild to life threatening Remove stinger Topical or intralesional corticosteroids Topical anesthetics

Integumentary Disorders (2 decks)

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