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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
Q

What is the treatment for basal cell CA?

A

Punch biopsy and surgical excision

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26
Q

What does ABCDEE stand for?

A 
Asymmetry
Border irregularity
Color variation
Diameter >6mm (and growing)
Elevation
Enlargement... refers to melanoma.

Treatment: surgical excision and biopsy`

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27
Q

What are some features that distinguish Rocky Mountain Spotted Fever from Lyme disease?

A
  1. More severe illness: macuolopapular or petechial rash, joint pain, fever
  2. Different organism (Rickettsiae)
  3. Diagnostics are by PCR, immunohistochemical staining, and IFA.
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28
Q

What are some similar features between Lyme Disease and RMSF?

A
  1. Flu-like symptoms

2. Both treated with Doxycycline

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29
Q

S/S of small pox

A

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

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30
Q

How do you treat small pox?

A

You don’t. Supportive therapy. Isolate infected person.

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31
Q

What antibiotics are used in the treatment of anthrax?

A

PCN, Cipro, Doxy

identified via gram stain

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32
Q

Describe the cutaneous effect of anthrax.

A

95% of cases

Pruritic papule–> ulcer surrounded by vesicles–> black necrotic central eschar with edema–> scar remains

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33
Q

How do you treat uncomplicated impetigo?

A

mupirocin (bactroban) ointment. Put on 2-3x/day for 7 days. Has same efficacy as oral cephalexin.

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34
Q

What is the mainstay of rosacea therapy?

A

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
Q

For what two conditions is UVB light exposure used as a treatment form?

A

Psoriasis and Pityriasis Rosea

36
Q

What is the treatment for erysipelas? Why?

A

PCN G/VK because it is a bacterial infection caused by streptococci.

37
Q

What is a wheal?

Give example.

A

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
Q

What is an abscess?

A

> 1 cm

Localized collection of purulent fluid in a cavity formed by disintegration r necrosis of tissues

39
Q

What is a tumor?

A

“Mass”
>a few centimeters in diameter
Firm or soft
Benign or malignant

40
Q

What kind of derm pathology presents in an annular pattern?

A

Ringworm

Circular, begins in center and spreads to periphery

41
Q

Describe a confluent pattern

A

Lesions run together

42
Q

Describe grouped pattern

A

Lesions cluster

43
Q

What kind of derm pathology presents in a linear pattern?

A

Often contact dermatitis, ie poison ivy

Scratch, streak, line, stripe

44
Q

Describe polycyclic pattern

A

Annular lesions merge

45
Q

Describe solitary or discrete pattern

A

Individual and distinct lesions that remain separate

46
Q

What kind of derm pathology presents in a target pattern?

A

Lyme

Resembles iris of the eye, lesions with concentric rings of color

47
Q

Describe zostiform pattern

A

Linear arrangement, along nerve root

48
Q

Acne
Open comedones
Closed comedones
Treatment/Management

A

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
Q

Comedolytic agents for acne

A

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
Q

Combination agents for acne

A

Comedolytic + Antibiotic

*benzoyl peroxide + erythromycin (Benzamycin)
-requires refrigeration
*benzoyl peroxide gel + clindamycin (BenzaClin)
*benzoyl peroxide + drying agents/sulfacetamide
(Novacet or Sulfacet)

51
Q

Topical antibiotics for acne

A

Clindamycin - Most frequently used topical for acne

Erythromycin - Second most frequelty used
Tetracycline - Not commonly used
Metronidazole - Used frequently for rosacea

52
Q

Oral antibiotics for acne

A

*Tetracycline - Most widely prescribed - contraindicated in pregnancy and in children

*Erythromycin
*Minocycline
*Doxycycline
*Clindamycin
*Isotretinoin (Accutane) - for severe, unresponsive acne,
needs informed consent

53
Q

What is folliculitis?

Common cause?

A

Inflammation of hair follicle

Staphylococci

54
Q

What is a furuncle?

Common cause?

A

“Boil”
Localized infection originating in the hair follicle
Staph aureus

55
Q

What is a carbuncle?

Common cause?

A

Much larger than a furuncle
May be necrotizing
Staph aureus

56
Q

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

A 
Gram negative organisms
  E. coli
  Klebsiella
  Pseudomonas
  Enterobacter
Staph aureus
  MRSA? or CA-MRSA?
Strep
57
Q

What is erysipelas?

Common cause?

A

**Looks like a sunburn
**Rapid progression of erythematous, warm, indurated
area
**Streptococcus

58
Q

What is hidradenitits suppurativa?

Common cause?

A

Common in groin or axilla, abscess formation is common

Staph aureus

59
Q

What is impetigo?

Common cause?

A

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
Q

What is paronychia?

Common cause?

A

Manicure gone wrong…
Infection around the nail fold, no nail involvement

Staphylococci

61
Q

S/S of bacterial skin infection

Management

A
  • 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
Q

Drilling a hole through the nail is called what?

A

Trephination

63
Q

What is candida balanitis?

Management?

A

Inflammation of the superficial tissues of the penile head

Candida albicans

Antifungals - miconazole, clortrimazole, fluconazole
Steroids

64
Q

What is candida intertrigo?

Management?

A

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
Q

What is tinea capitus?

Management?

A

Dermatophyte infection of the scalp

  • Selenium 2.5% shampoo
  • Oral terbinafine, itraconazole or fluconazole
  • Oral griseofulvin
66
Q

What is tinea corporis?

Management?

A

RIngworm
Dermatophyte infection

  • Topical antifungals
  • Severe cases, systemic therapy with ketoconazole
67
Q

What is tinea cruris?

Management?

A

Jock itch
Dermatophyte infection of the groin

T. rubrum
E. floccosum

Topical antifungals
Oral antifungals for severe cases

68
Q

What is tinea pedis?

Management

A

Athlete’s foot

Dermatophyte infection of the foot

Miconazoe
Clotrimazole

69
Q

What is tinea manuum?

Management?

A

Hand/palm
Dermatophyte infection of hands/palms

Aluminum subacetate solution soaks

70
Q

What is tinea unguium?

Management?

A

Onycomycosis

Persistent fungal infection affecting the toenails and
fingernails caused by dermatophytes

Oral antifungals - itraconazole, terbinafine

71
Q

What is tinea versicolor?

Management?

A

hypo/hyperpigmentation macules of skin

fungal infection of the skin caused by yeast

topical selenium sulfide
topical antifungals - miconazole, ciclopirox, clotrimazole

72
Q

Treatment for post-herpetic neuralgia.

A

gabapentin (Neurontin)

pregabalin (Lyrica)

73
Q

What age can Zostavax be given?

A

Age 50

74
Q

What is eczema?

Treatment?

A

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
Q

What is psoriasis?

Treatment?

A

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
Q

What is pityriasis rosea?

Treatment?

A

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
Q

What is xanthelasma?

What is the treatment?

A

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
Q

What is Lyme disease?
Diagnostic labs?
Treatment?

A 
**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
Q

What is Rocky Mountain Spotted Fever?
Diagnostic labs?
Treatment?

A 
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
Q

Describe the inhalation effect of anthrax.

A

5% of cases

Prodromal phase:
Non-specific
Flu-like

Fluminant phase:
Fever
Diaphoresis
Septic shock

81
Q

Genital wart treatment

A 
20% podophyllin (Pododerm)
podofilox (Condylox)
cryosurgery
trichloroacetic acid (TCA)
bichloracetic acid (BCA)
82
Q

Senile pruritus and treatment

A

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
Q

Hypothermia and treatment

A

Tissue damage resulting from exposure to cold

Assess for hypothermia
Soak in water at 100 F
Treat for pain

84
Q

Insect stings/bites and treatment

A

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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